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PubMed1995

Correlation of fornix damage with memory impairment in six cases of colloid cyst removal.

We studied six patients in whom colloid cysts had been removed surgically from the third ventricle. The patients were selected simply by availability for the study, not on grounds of clinically diagnosed amnesia or its absence. The outcomes of operation ranged from one patient who had postoperatively resumed a normal life without complaint of memory disorder at any stage, through four who complained of memory disorder since operation, to one who was so severely amnesic as to require constant supervision. Each patient was given psychometric tests of memory, and was also scanned by magnetic-resonance imaging. One of us examined the six scans and assessed the extent of damage to the fornix, and any other brain damage, in ignorance of the outcomes of the psychometric tests. The fornix in the right hemisphere had been destroyed in all six cases, and all showed evidence of moderate or severe impairment in nonverbal memory. The fornix in the left hemisphere was intact in only one patient; this was the patient who had resumed a normal life without complaint of memory disorder. The left fornix was damaged with some sparing in one further patient, and the remaining four patients showed destruction of the fornix in the left as well as in the right hemisphere. The severity of impairment in verbal memory in these six cases was related to the severity of the damage to the left fornix. No other evidence of brain damage appeared to be systematically related to memory ability. These results add to the evidence that bilateral fornix damage produces amnesia, and that sparing of the left fornix alone is sufficient to ensure a more favourable outcome.

Adult↗
PubMed1999

Cluster headaches: association with anxiety disorders and memory deficits.

OBJECTIVE: To estimate the frequency of mood and anxiety disorders and to assess memory and executive functions among a representative group of patients with episodic cluster headache (ECH) during the course of an acute episode. METHODS: We compared 21 patients with ECH with 21 patients with tension headache (TH) matched for age, sex, and educational level. Psychiatric diagnosis was made by a semi-structured interview and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. Quantitative measures of depression and anxiety were obtained using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HARS). In addition, all patients received a neuropsychological evaluation to assess basic memory and executive functions. RESULTS: Of the 21 patients with ECH, 5 (24%) met DSM-IV criteria for an anxiety disorder during the year before the episode. Panic disorder was diagnosed in two patients (10%). The remaining three patients (14%) met criteria for generalized anxiety disorder. Of the 21 patients with TH, 2 (10%) met diagnostic criteria for an adjustment disorder with depressed mood, and 1 (5%) met criteria for an adjustment disorder with mixed anxiety and depressed mood. HARS scores were higher among patients with ECH (Kruskal-Wallis, chi2 = 4.3, df = 1, p = 0.03). ECH patients also showed significantly lower Auditory Verbal Learning Test scores (Kruskal-Wallis, chi2 = 6.5, df = 1, p = 0.01). CONCLUSIONS: When compared with a group of patients with TH, ECH patients showed a higher frequency of anxiety disorders during the year before the onset of headaches and significantly greater HARS scores during the episode. In addition, patients with ECH were selectively impaired in verbal memory.

Adult↗
PubMed1998

Are genetic factors important in the aetiology of leukoaraiosis? Results from a memory clinic population.

OBJECTIVE: To discover whether polymorphism in either the apolipoprotein E (ApoE) or angiotensin-converting enzyme (ACE) genes is associated with leukoaraiosis, white matter lesions visible on neuroimaging of the brain, which is commonly seen in dementia as well as some normal elderly subjects. DESIGN: Prospective study of consecutive patients attending our memory disorders clinic, to examine the relationship between leukoaraiosis and polymorphism of the ApoE and ACE genes. SETTING: Memory disorders clinic in Bristol, UK. PATIENTS: 182 patients attending the memory disorders clinic for investigation of possible dementia of whom 75% were suffering from dementia, 20% from memory impairment but no dementia and in 5% of whom a dementing illness was thought to be unlikely; 38% of all patients had visible white matter lesions and 16% had cerebral infarcts. MEASURES: Patients and/or carers who agreed to participate in the study had their ACE and ApoE genotype determined and their brain CT/MRI scans were assessed by a neuroradiologist, blind to the result of the genotyping, for the presence or absence of white matter low attenuation. RESULTS: There was a significant association between white matter lesions and the DD genotype (p < 0.05), but not the ApoE genotype. However, this relationship with the DD genotype was only significant for patients with a previous infarct. CONCLUSION: Homozygosity of ACE gene deletion polymorphism is a risk factor for white matter lesions when it is associated with cerebral infarction. This suggests that it may be possible to identify subjects who are at greater risk of developing white matter lesions and are at risk of cognitive impairment and possibly dementia.

Aged↗
PubMed1995

Thought disorder, working memory and attention: interrelationships and the effects of neuroleptic medications.

Impairments in attention and vigilance, working memory and organization of speech (thought disorder) have been reliably observed in patients with schizophrenia. The response in these cognitive parameters to neuroleptic medications can be used to sharpen their characterization in neuropsychological terms. In particular, a review of the literature suggests that while working memory is relatively insensitive to neuroleptics, attention and thought disorder may improve with neuroleptic administration. On the basis of the response to typical and atypical neuroleptics, attention as deployed in the Continuous Performance Test may reflect response readiness rather than actual vigilance. Thought disorder, which is often assumed to be the result of impaired discourse planning due to a reduced capacity for working memory, does not covary with working memory, and the two parameters show different responses to neuroleptic medications. Rather, cognitive studies suggest that thought disorder may arise from abnormalities within the semantic system itself.

Antipsychotic Agents↗
PubMed1998

Effects of ketamine on thought disorder, working memory, and semantic memory in healthy volunteers.

BACKGROUND: The N-methyl-D-aspartate receptor antagonist, ketamine, produces a clinical syndrome of thought disorder, perceptual distortion, and cognitive impairment. METHODS: We have administered ketamine to healthy volunteers to characterize the formal thought disorder and specific memory dysfunction associated with ketamine. Ten healthy volunteers underwent a double-blind, placebo-controlled, ketamine infusion (0.12 mg/kg bolus and 0.65 mg/kg/hour). Thought disorder was evaluated with the Scale for the Assessment of Thought, Language and Communication. Cognitive testing involved working and semantic memory tasks. RESULTS: Ketamine produced a formal thought disorder, as well as impairments in working and semantic memory. The degree of ketamine-induced thought disorder significantly correlated with ketamine-induced decreases in working memory and did not correlate with ketamine-induced impairments in semantic memory. CONCLUSIONS: This study characterizes the formal thought disorder associated with ketamine and may suggest that ketamine-induced deficits in working memory are associated with ketamine-induced thought disorder.

Adult↗
PubMed1988

The neuropsychology of paramedian thalamic infarction.

A longitudinal study of three patients with CT-scan documented paramedian thalamic infarctions (bilateral, primarily right, unilateral left) is reported and the neuropsychology of human paramedian thalamic infarction is reviewed. The neuropsychological deficits following these selected lesions, the nature of the clinical memory disorder, and the neuroanatomy of memory are discussed. The significance of cortical/subcortical relationship in explaining observed behavioral changes is emphasized. Brain damage with maximum involvement in the dorsomedial nuclei and mamillothalamic tracts appears to cause primarily a memory disorder and frontal-limbic behavioral changes, the severity and profile of deficits depending on lesion extent and location. Both anterograde and remote memory loss may be present. Asymmetry in memory at the level of the thalamus was observed, following the left-verbal, right-nonverbal dichotomy.

Aged↗
PubMed1984

Disorders of memory, language and beliefs, following closed head injury.

A 26-year-old man developed a syndrome following a head injury, characterized by disturbances of memory, language, and beliefs, and lasting for several years. The clinical picture was suggestive of a number of conditions, but diagnostic of none. The aetiology involved a complex interaction of biological and psychological factors, and these are discussed in relation to similar syndromes described in the literature.

Adult↗
PubMed2002

["The 5 words": a simple and sensitive test for the diagnosis of Alzheimer's disease].

OBJECTIVE: Alzheimer's disease (AD) is under-diagnosed in France. Today only an estimated 50% of patients are identified. Diagnosis of AD is particularly difficult because the amnesic syndrome, characteristic of the disease, is often confused with memory dysfunction that is frequent during the process of aging. The improvement in the diagnostic conditions of AD relies on the availability of a simple and reliable tool for screening memory disorders of organic origin. METHOD: The 5-word test studies the recall of a short list, which the physician ensures the patient has registered. Its construction permits the identification of patients exhibiting objective memory disorders. A validation study has been conducted in 86 patients suffering from AD and 126 persons complaining of functional memory disorders. RESULTS: The study has shown the sensitivity (91%) and specificity (87%) of the 5-word test in identifying patients with AD. CONCLUSION: This is a rapid (2 minutes) and simple test that is easy to use in medical practice for the screening of AD.

Age Factors↗
PubMedDate not supplied

[Clinico-neuropsychological studies of patients with arteriovenous malformations who have had hemorrhages with blood in the cerebral ventricles].

The clinical and neuropsychological signs were studied in 32 patients with arteriovenous malformations of various site who had sustained hemorrhages into the cerebral ventricles. The studies allowed the authors to identify the neuropsychological syndrome which involved the following signs: disorientation, chiefly in time, marked inertia in various scopes of activities, emotional and volitional disorders, and dysmnesia. Memory defects were seen in all spheres of mnestic activity: there were abnormalities in the actualization of consolidated knowledge, modal non-specific memory disorders in the experiment, defects in memory for current events. The degree of defect severity was found to be directly proportional to that of prior hemorrhages. In the absence of hydrocephalus, the disorders were regressive. The authors discuss what topical belonging of the detected syndrome is and how it is related to the phase of consciousness restoration.

Adolescent↗
PubMed2002

Levodopa and bromocriptine in hypoxic brain injury.

BACKGROUND: Postanoxic encephalopathy is frequent in patients presenting with abrupt cardiac arrest or respiratory failure. Little is known about the effectiveness of oral medications on the cognitive and motor consequences. OBJECTIVE: To present data suggesting partial improvement after administration of levodopa/benserazide. METHODS: After observing partial benefit in one case, each patient admitted to rehabilitation following brain anoxia was systematically treated with levodopa/benserazide (200/50 to 400/100 mg/day), then bromocriptine (15 mg/day). RESULTS: In the first patient, brain anoxia was severe, with secondary agitation, quadriparesis, involuntary movements, inattention and communication disorders. Introduction of levodopa/benserazide resulted in reduction of agitation and involuntary movements and improvement of communication, thus facilitating care and rehabilitation efforts. A weaning test resulted in rapid worsening. The four following patients also presented with anoxia of variable severity. Marked improvement was observed in case 2, presenting with agitation, loss of orientation, amnesia, postural disorders, involuntary movements and dysphagia, with a withdrawal test resulting in immediate re-enhancement of symptoms. Modest improvement was observed in patient 3, who had hypokinesia, rigidity, adynamia, impaired attention, and reduced verbal fluency. Patient 4 presented with memory disorders without motor difficulties: mild improvement was observed in daily life and memory tests. In patient 5 who also presented with severe memory disorders, the benefit was absent. In each case, bromocriptine was introduced 3-4 weeks following levodopa, but without additive effect. Both treatments could be interrupted after a few months, without worsening. CONCLUSIONS: Levodopa and benserazide can be of benefit in the few months following brain anoxia, especially on some of the motor disorders and apathy, but the benefit is inconstant and modest on memory disorders. Anoxia could alter dopaminergic mesencephalic systems, which activate the striatal and mediobasal frontal cortex, and these disorders could be partially reversible by medical treatment.

Adult↗
PubMed1996

Influence of apolipoprotein E genotype on the transmission of Alzheimer disease in a community-based sample.

The epsilon 4 allele of the apolipoprotein E locus (APOE) has been found to be an important predictor of Alzheimer disease (AD). However, linkage analysis has not clarified the role of APOE in the transmission of AD. The results of the current study provide evidence that the pattern of transmission of memory disorders differs in nuclear families in which the AD-affected proband did carry an epsilon 4 allele versus those families in which the AD-affected proband did not carry an epsilon allele. Further, risk of AD due to APOE genotype in the probands is modified by family history of memory disorders, suggesting gene-by-gene interactions. Family history remained a significant predictor of AD for affected probands with some, but not all, APOE genotypes in a logistic regression analysis. Though nonadditive in the prediction of AD, APOE genotype and family history acted additively in the prediction of age at AD onset. The results of complex segregation analysis were inconsistent with Mendelian segregation of memory disorders both in families of affected probands who did or did not carry an epsilon 4 allele, yet these two groups had significantly different parameter estimates for their transmission models. These results are consistent with gene-by-gene interactions, but also could result from common elements in the familial environment.

Age of Onset↗
PubMed1970

Memory and disorders.

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Electroconvulsive Therapy↗
PubMed1998

Comparative effects of schizophrenia and temporal lobe epilepsy on memory.

The goal of this study was to further characterize episodic memory functioning in schizophrenia. This study compared verbal and visual learning and memory performance in (1) patients with schizophrenia (N = 35), (2) patients with temporal lobe epilepsy (TLE; N = 30), and (3) normal controls (N = 25). Results indicated significant memory impairments in patients with schizophrenia and TLE. "Savings" score measures of memory decay showed that the loss of information in schizophrenia and TLE was approximately equal, and quantitatively mild compared to that found in most neurologic groups with memory disorders. The severe difficulty shown by the schizophrenia group on a task of incidental recall suggested that the absence of instructional set added to a vulnerability to memory deficit. In contrast, relatively mildly impaired performance on paired associate learning suggested that patients with schizophrenia benefited from retrieval cues, multiple trials, and short (nonsupraspan) informational loads. Because patients with schizophrenia consisted of a relatively nonchronic sample with a mean IQ of 99.7, their memory disorder could not be attributed to schizophrenic dementia, nor was it accounted for by other potential confounds. Patients with schizophrenia, even those relatively early in the course of illness, have a mild episodic memory disorder.

Adolescent↗
PubMed2003

[What is dementia? 6. From physiological aging to dementia].

Many studies have been devoted to the cognitive changes associated with age, and several attempts have been made for their classification in order to distinguish normal from pathologic changes. In the last few years, a consensus has been reached to classify elderly people in three groups: a) cognitively normal subjects whose cognitive functions score in the range of those of healthy subjects paired according to age and educational level, presenting or not memory complaints; b) subjects with dementia; c) an intermediate group of subjects presenting a cognitive impairment not severe enough to meet the criteria for dementia. The term mild cognitive impairment (MCI) has been proposed to describe these subjects who are at high risk to progress to dementia in the years following the diagnosis. For the first time, MCI construct allows the recognition of the prementia phase of degenerative or vascular cerebral diseases progressing to dementia. However, the lack of clear operational diagnostic criteria and ambiguities about the signification of MCI make the interpretation of the results of studies devoted to this concept hazardous. From a practical point of view, the physician, when faced with a patient complaining of his\her memory, should answer two main questions. "How to recognize memory disorders resulting from incipient AD?" and "What is the signification of memory complaints not related to AD?" The semioloy of memory complaints and the qualitative aspects of the memory deficit allow the diagnosis of incipient AD with pretty good accuracy. Due to the location of the first lesions of AD in hippocampal regions, memory disturbances in AD are related to a deficit in memorization of new information in episodic memory. Conversely, memory disorders related to normal aging, depression, and degenerative or vascular brain lesions not involving hippocampus, are related to deficits in the processes of recall of previously memorized informations. Benign memory complaints have been considered to be linked to the decrease of memory performance, and defining a special group of normal elderly subjects. However, no direct relationship has been demonstrated between memory complaints and performance. In our opinion, all memory complaints are essentially related to psychoaffective disturbances, mainly anxiety, changes in identity and decrease of self-esteem associated with aging.

Aged↗
PubMed1992

Memory remembered: 1970-1991.

Substantial changes in our knowledge of the neurologic and cognitive processes underlying memory disorders have occurred between 1970 and 1991. Models of memory stressing consolidation, retrieval, and executive processes have had a positive effect on the way memory disorders are assessed in the clinical setting. The memory tests available today are superior to those used in the 1970s in terms of their sensitivity and selectivity. Similarly, cognitive psychologists have successfully used clinical patients to evaluate the validity of their models derived from normal subjects. It is concluded that cognitive and clinical psychology are not disparate fields; rather, the two have been highly interdependent in a positive manner.

Journal Article↗