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PubMed2002

[Developmental amnesias].

OBJECTIVE: The literature on clinical and physiophatologic characteristics of the spectrum of memory disorders in childhood is reviewed in this article. DEVELOPMENT: There are only a few detailed reports of permanent specific memory disorders in children. Early anoxo ischaemic bihippocampal injuries can cause a selective permanent impairment of episodic daily life memory with preservation of semantic learning and general intelligence; this dissociation has been related to partial hippocampal damage whilst the entorhinal, parahippocampal and prefrontal cortices, which are critical to systematized memorizing and work memory, keep normal. Biological psychiatry research has shown that early childhood amnesias after psychological maltreatment or abuse could be related to damage in neuronal systems which support memory, caused by glutamatergic cascade. Both severe bilateral hippocampal sclerosis (also mediated by toxic neurotransmitters) in early malignant epilepsies, and massive bilateral damage of mesial temporal lobes due to herpex virus encephalitis or Reye's syndrome, cause severe amnesic deficits, frequently accompanied by absence of any language development and autism with features of Klüver-Bucy syndrome. There are also on record some examples of Korsakoff's syndrome in children with midfossa tumors. CONCLUSIONS: All types of classical amnesias described in adults have been observed in children. Developmental amnesias are probably more frequent than currently presumed. It must be paid special attention to selective autobiographical memory impairments in individuals who underwent a partial bihippocampal damage in perinatal or early postnatal periods; they are to be distinguished from, although it may coexist with, other clinical situations such as attention deficit disorder or semantic pragmatic disorder.

Adult↗
PubMed2002

Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic.

OBJECTIVE: Herbal medicines and conventional drug therapies are often taken in combination. The objective of our study was to identify the range of natural health products and conventional drug therapies used by older adults (aged 65 years and over) attending a memory clinic, and to specifically evaluate the frequency of potential interactions between herbal medicines and conventional drug therapies. DESIGN: We interviewed consecutive patients attending the Memory Disorders Clinic at the Baycrest Centre for Geriatric Care, a University of Toronto teaching hospital, between 4 July and 15 August 2000. Patients were asked to bring to their appointment all natural health products (i.e. herbal medicines, vitamins and minerals) and conventional drug therapies (i.e. prescription and over-the-counter) they were currently using. We collected information on current and previously used natural health products and current conventional drug therapies. Patients were classified as having the potential for an interaction if they were using a current herbal medicine in combination with a conventional drug therapy and the interaction had been reported previously in the medical literature. PARTICIPANTS: We interviewed 195 consecutive patients attending the Memory Disorders Clinic at the Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada. RESULTS: Of the 195 patients in our sample, 33 (17%) were 'current users', 19 (10%) were 'past users', and 143 (73%) were 'never users' of herbal medicines. Among the 52 patients who were 'current or past users', the most frequently used herbal medicines were ginkgo (Ginkgo biloba) [39 users], garlic (n = 10), glucosamine sulphate (n = 9) and echinacea (n = 8). Among the 33 patients who were current users, the most commonly used herbal medicines were Ginkgo biloba (n = 22), glucosamine sulphate (n = 8) and garlic (n = 6). Among the 33 current users, we identified 11 potential herb-drug interactions in nine patients. The 11 herb-drug interactions we identified were between ginkgo and aspirin (acetylsalicylic acid) [n = 8], ginkgo and trazodone (n = 1), ginseng and amlodipine (n = 1) and valerian and lorazepam (n = 1). CONCLUSIONS: Herbal medicines are widely used. Almost one-third of current users of herbal medicines were at risk of a herb-drug interaction. The most common potential herb-drug interaction was between ginkgo and aspirin. This finding has important potential implications because both of these products are regularly used by older people. Physicians and other healthcare providers should be aware of potential herb-drug interactions and should monitor and inform their patients accordingly.

Aged↗
PubMed2002

The Key Behaviors Change Inventory and executive functioning in an elderly clinic sample.

The Key Behaviors Change Inventory (KBCI) was developed to assess executive, behavioral, and emotional functioning following brain insults and to track the course of recovery. The purpose of this study was to investigate, in an elderly memory disorder clinic sample, the convergent and discriminant validity of the KBCI by examining the relationships between various measures of executive functioning and the KBCI scales that theoretically relate to executive functions. The KBCI was administered to the caregivers of 97 consecutive patients who came to a memory disorders clinic seeking services. The KBCI scales of Inattention, Apathy, Unawareness of Problems, and Communication Problems were significantly correlated with cognitive measures of executive functioning but not with measures of memory, visuospatial abilities or global cognitive functioning. In contrast, KBCI scales of Interpersonal Difficulties, Somatic Difficulties, and Emotional Adjustment were not related to any cognitive measures, either executive or nonexecutive. Contrary to predicted findings, the Impulsivity Scale was not associated with cognitive measures of executive functioning. This lack of relationship most likely reflects the failure to include executive measures of orbitofrontal functioning in this study. Results provide convergent and discriminant validity support for the KBCI. The KBCI may be a useful tool for assessing and tracking the executive, behavioral, and emotional sequelae of neurologic disorders.

Adaptation, Psychological↗
PubMed1999

A clinicopathological comparison of community-based and clinic-based cohorts of patients with dementia.

OBJECTIVES: To compare the sensitivity and specificity of the clinical diagnosis of Alzheimer disease, the distribution of pathological causes, and the demographic and clinical characteristics of 2 different groups of patients with dementia. DESIGN: Retrospective clinicopathological study. SETTING: A memory disorder clinic in a university hospital and a multiethnic community. PATIENTS: Sixty-three patients from a memory disorder clinic and 26 patients from a large community-based study who underwent autopsy after clinical evaluation. MAIN OUTCOME MEASURES: Differential distribution of clinical and pathological findings, with clinicopathological correlations. RESULTS: Clinic patients were younger at diagnosis, more educated, and more likely to be white. Of the 63 clinic patients we evaluated, 29 (46%) had a pathological diagnosis of definite AD, 15 (24%) had a diagnosis of mixed AD, and 19 (30%) had a diagnosis of another type of dementia. The pathological diagnoses in the community patients were distributed as follows: 6 (23%) had definite AD, 6 (23%) had mixed AD, 6 (23%) had cerebrovascular disease, and 8 (31%) had another type of dementia. The difference in distribution of pathological diagnoses between these 2 groups was only significant for cerebrovascular diseases. For patients seen at the clinic, the sensitivity of the clinical diagnosis of AD was 98% and the specificity was 84%; for the community group, the sensitivity was 92% and the specificity was 79%. CONCLUSIONS: The difference in sensitivity and specificity of clinical diagnosis was not statistically significant between the groups of clinic patients and community patients. Dementia associated with cerebrovascular disease was more prevalent in the community sample. This difference may be attributable to clinical and demographic differences between the 2 groups.

Age Factors↗
PubMed1995

Is semantic memory consistently impaired early in the course of Alzheimer's disease? Neuroanatomical and diagnostic implications.

To establish whether semantic memory is consistently impaired in patients with very mild dementia of Alzheimer's type (DAT), we assessed episodic and semantic memory in 52 patients with DAT who were divided into three sub-groups according to dementia severity on the Mini-Mental State Examination (minimal > 23, mild 17-23 and moderate < 17) and 24 matched controls. The minimal group showed impairment on the following semantic memory measures: category fluency, naming of line drawings, naming to verbal description, answering semantic feature questions and a non-verbal picture-picture matching task (the Pyramids and Palm Trees Test). The mild and moderate groups showed additional deficits on picture sorting and word-picture matching tests. Within the minimal and mild groups there was, however, considerable heterogeneity. While some patients showed a consistent impairment across all of the semantic memory tests, others were impaired on only on a subset of these tests and a few even performed flawlessly. In contrast, all patients showed a profound deficit in episodic memory: delayed recall of new verbal and non-verbal material appears to be a particularly sensitive marker of early DAT. These data are in keeping with recent neuropathological studies demonstrating that the transentorhinal region is consistently involved at a very early stage. Lesions in this site cause a functional disconnection of the hippocampus, and hence a profound episodic memory disorder. The fact that many, but not all, patients with early disease also show impairment of semantic memory suggests that damage to the transentorhinal region is not sufficient to produce significant disruption of semantic memory. Such disruption reliably occurs, we hypothesize, only when the pathology extends to the temporal neocortex proper.

Aged↗
PubMed1991

Double dissociation of short-term and long-term memory for nonverbal material in Parkinson's disease and global amnesia. A further analysis.

The traditional concept of memory disorder is deficiency of the long-term (LTM) but not short-term (STM) component of memory. STM impairment with LTM sparing is seldom reported. The present study investigated STM and LTM for nonverbal material in three neurological conditions associated with memory impairment: bilateral medial temporal lobe lesions (patient H.M.), Parkinson's disease (PD) and Alzheimer's disease (AD). Subjects received 3 tests of nonverbal memory: forward block span, immediate and delayed recall of the Wechsler Memory Scale drawings, and immediate and delayed recognition of abstract designs. Compared with the normal control group, the patient groups displayed different patterns of sparing and loss of the two components of memory: in PD, only STM was impaired; in medial temporal lobe amnesia, only LTM was impaired; and in AD, STM and LTM were both impaired. The contrasting patterns of sparing and loss of STM and LTM in PD and global amnesia were present for both recognition and recall. These results provide evidence that STM and LTM are dissociable processes and are served by separate neurological systems: STM depends upon intact corticostriatal systems, whereas LTM depends upon intact medial temporal lobe systems.

Aged↗
PubMed1990

[Memory and interference resistance of the speech-acoustic system as the indicators of the functional state of the temporal structures in focal epilepsy].

In 99 patients with focal epilepsy, the memory was studied in comparison of melodies and emotions along with the speech-acoustic++ system noise rejection. The degree of these functions impairment was primarily determined by the severity of the brain organic damage and other intra- and extrafocal factors. The impairment of noise rejection could be manifested by its increase or decrease with reference to the normal levels. Memory disorders manifested themselves in facilitated comparison of emotions and especially of melodies with increased delay. Decreased noise rejection and memory disorders were most pronounced in right temporal pathology. Increased noise rejection pathognomonic of the children with cerebral paralysis and left temporal lobe lesion was related to the activation in the mirrored focus.

Adolescent↗
PubMed1982

[Left paramedian thalamic infarct. Memory and language study].

Unusual findings in a patient with a paramedian infarct of the left thalamus, shown by CT scan were the elective nature and long duration of memory disorders. Mild amnesia has been relatively stable for two years, and is apparent during tests as an anterograde verbal memory deficiency for all modalities (serial, associative, logical), without facilitation during learning or recall by semantic or phonologic cues. On the other hand, anterograde visual, gestual or tactile memory, and particularly retrograde verbal and visual memory are well retained. The worsening effect of verbal interferences on word learning is emphasized, whereas no similar phenomenon has been observed for visual material. The antero-internal thalamic lesion in the dominant hemisphere results in a memory disorder of a particular type which cannot be explained by the cognitive disorder, or by the very transient initial aphasic disturbance. Prolonged verbal amnesia with persistent reduction in fluency most probably results from a deficiency of specific incitation in using and memorizing verbal material, without other negligence phenomena. The role of the thalamocortical and particularly frontocingular connections are discussed, according to the semiology.

Association Learning↗
PubMed1992

[Memory and language disorders in Alzheimer's dementia].

Memory dysfunction is the most notable feature of dementia of the Alzheimer type and is virtually mandatory for this diagnosis. The disruption of language ability is also a prominent clinical feature of this disease. Recent advances in cognitive neuropsychology suggest that Alzheimer type dementia in the early stages of the disease can be characterized by abnormalities but also by sparing of other cognitive mechanisms, particularly in memory and language. Nevertheless, many studies indicate an heterogeneity in cognitive profiles. This existence of subgroups of patients with Alzheimer type dementia would have important implications for therapeutic studies as well as investigations concerned with etiology.

Alzheimer Disease↗
PubMed2003

Targeting the CREB pathway for memory enhancers.

Today, the clinical notion of 'memory disorder' is largely synonymous with 'Alzheimer's disease.' Only 50% of all dementias are of the Alzheimer's type though, and dementias represent only the more severe of all learning/memory disorders that derive from heredity, disease, injury or age. Perhaps as many as 30 million Americans suffer some type of clinically recognized memory disorder. To date, therapeutic drugs of only one class have been approved for the treatment of Alzheimer's disease. Fortunately, basic research during the past 25 years has begun to define a 'chemistry of brain plasticity,' which is suggesting new gene targets for the discovery of memory enhancers.

Alzheimer Disease↗
PubMed2005

Early-onset dementia: frequency and causes compared to late-onset dementia.

BACKGROUND: Research on the epidemiology of dementia has focused on the elderly. Few investigations have studied differences in etiologic frequencies between early-onset dementia (EOD), with onset at an age of less than 65 years old, and the more common late-onset disorder. OBJECTIVES: To determine relative frequencies and characteristics of EOD versus late-onset dementia (LOD; age of onset > or =65 years) diagnosed in a large memory disorders program over a 4-year period. METHODS: We reviewed medical records, including an extensive neurobehavioral and neurological evaluation, of all patients seen at a large Veteran's Affairs Medical Center Memory Disorders clinic between 2001 and 2004 and assessed demographic variables, final diagnoses, presence of dementia, and differential diagnosis of dementing illnesses. RESULTS: Among 1,683 patients presenting for evaluation of an acquired decline in memory or cognition, 948 (56%) met established clinical criteria for a dementing illness. About 30% (n = 278) of these had an age of onset of <65 years, compared to 670 with LOD. Patients were predominantly male (98%). Compared to the late-onset group, the EOD patients were less severely impaired on presentation, but they did not differ in gender distribution or educational background. The EOD group had significantly more dementia attributed to traumatic brain injury, alcohol, human immunodeficiency virus (HIV), and frontotemporal lobar degeneration compared to the LOD patients. In contrast, the LOD group had significantly more Alzheimer's disease compared to the EOD group. CONCLUSIONS: This study, conducted at a Veterans Affairs Hospital, is the largest series to date on EOD, and found a previously unexpectedly large number of patients below the age of 65 with cognitive deficits and impaired functioning consequent to head trauma, alcohol abuse, and HIV. These findings highlight the differential distribution and importance of preventable causes of dementia in the young.

Age of Onset↗
PubMed2001

[Contribution of positron emission tomography to functional neuroimaging in Alzheimer's disease].

When combined with cognitive investigations, functional neuroimaging methods such as positron emission tomography allow to depict the neural substrates that underlie the neuropsychological alterations in Alzheimer's disease. Capitalising on the variance in both cognitive performances and resting cerebral metabolic rate of glucose (CMRGlc) in Alzheimer's disease, it is possible to correlate these two quantitative variables on a pixel-by-pixel basis and to generate maps showing the significant correlations in stereotaxic space. Some examples using this approach in the domain of memory disorders are presented in this brief review. We notably show that the localisation of the significant correlations differs from one memory system to another, as evaluated by clinical memory tasks. This approach also unravels the compensatory mechanisms that take place with evolution of the disease. Over and above its interest in clinical neuropsychology, this method constitutes a new source of inferences complementary to the classic activation paradigm in normal subjects, as the latter identifies the cerebral structures that are involved with, but not necessarily indispensable for, the normal execution of the task. This approach highlights the interest of combining functional neuroimaging and neuropsychology to better understand the neural substrates of cognitive deficits in both patients with memory disorders and elderly normal subjects.

Alzheimer Disease↗
PubMed1975

[The relationship between the side of the lesion and the psychopathology of focal lesions of the frontal lobes].

The author studied 36 patients with benign tumors, located in one of the frontal lobes: in 20 cases in the left and in 16 cases in the right lobe. In tumors of the left lobe there were disorders in the motor and initiative side of speech, general inhibition, a decline in the level of generalizing, a prevalence of memory disorders, rather than attention, inertia of mental processes with a preservation of a sense of being ill. Tumors of the right frontal lobe were characterized by an insufficient insight to the illness, euphoria, an absence of a critical understanding of the environment, a prevalence of attention disorders over memory disturbances, a narrowing of the volume of simultaneously perceived information and a tendency towards a confabulatory addition to fragmentarily perceived images.

Brain Neoplasms↗
PubMed2006

Recall and recognition memory in amnesia: patients with hippocampal, medial temporal, temporal lobe or frontal pathology.

The relationship between recall and recognition memory impairments was examined in memory-disordered patients with either hippocampal, medial temporal, more widespread temporal lobe or frontal pathology. The Hirst [Hirst, W., Johnson, M. K., Phelps, E. A., & Volpe, B. T. (1988). More on recognition and recall in amnesics. Journal of Experimental Psychology: Learning, Memory, & Cognition, 14, 758-762] technique for titrating exposure times was used to match recognition memory performance as closely as possible before comparing recall memory scores. Data were available from two different control groups given differing exposure times. Each of the patient groups showed poorer recall memory performance than recognition scores, proportionate to the difference seen in healthy participants. When patients' scores were converted to Z-scores, there was no significant difference between mean Z-recall and Z-recognition scores. When plotted on a scatterplot, the majority of the data-points indicating disproportionately low recall memory scores came from healthy controls or patients with pathology extending into the lateral temporal lobes, rather than from patients with pathology confined to the medial temporal lobes. Patients with atrophy extending into the parahippocampal gyrus (H+) performed worse than patients with atrophy confined to the hippocampi (H-); but, when H- patients were given a shorter exposure time (5s) and compared with H+ at a longer exposure (10s), their performance was virtually identical and did not indicate any disproportionate recall memory impairment in the H- group. Parahippocampal volumes on MRI correlated significantly with both recall and recognition memory. The possibility that findings were confounded by inter-stimulus artefacts was examined and rejected. These findings argue against the view that hippocampal amnesia or memory disorders in general are typically characterised by a disproportionate impairment in recall memory. Disproportionate recall memory impairment has been observed in a number of published cases, and the reason for the varying pattern obtained across hippocampal patients requires further examination.

Adult↗
PubMed1999

[Attention deficit disorders and memory capacity in children with language delay and in normal children].

In order to investigate the hypothesis that language-impaired children also show deficits in memory, 110 language-impaired and 123 children showing no such impairments (average age 10;0 yrs.) were tested for verbal memory and selecting attention through a matching familiar figures test. As an additional measure, teachers assessed the children, using DSM criteria, for both general attentivenesse and attention deficit disorder. The results revealed significant differences between both groups concerning their ability to memorise word lists and difficulties resisting distractions. They also show a significantly diminished stability regarding the retention of memories. Furthermore, the ability to memorise has proved to be greatly independent of both selective attention and the rated attentiveness in class. It is therefore concluded that language-impaired children have difficulties in acquiring information as well as a limited capacity to memorise. These differences in ability to memorise between language-impaired children and children with no impairments are most likely attributable to the meta-cognitive competence of the child.

Attention↗
PubMed1990

The Gospel Oak Study: prevalence rates of dementia, depression and activity limitation among elderly residents in inner London.

The steps to setting up a population register of elderly residents are described. Based upon this, 87.2% of the elderly residents of an inner-city electoral area were screened for memory disorder, depression and activity limitation using the Short CARE. Contact with medical and social agencies was also recorded; 4.7% were classed as cases by the dementia diagnostic scale, sufferers being older and not living alone. Of the residents 15.9% were classed as depressed, this state being more prevalent in those not currently married. The depressed were, in contrast to the demented residents, likely to be in recent contact with hospital and general practitioner. Thirty-two per cent of the population showed impairment in daily activity, these individuals were usually older, not married and receiving hospital care. Sleep disorder and complaint of many somatic symptoms were associated with a diagnosis of depression. In contrast, most respondents with a subjective complaint of memory disorder, which was common in this population, were neither suffering from depression nor dementia. With this accurate sampling frame and a good response rate, the prevalence rate of clinical depression must be seen as disturbingly high. The prevalence rate of dementia approximated to that of other surveys. This study also indicated that general practitioners' lists may be inaccurate and that non-responders to first approaches for interview, although similar in demographic features to those responding, may contain among them many suffering from dementia.

Activities of Daily Living↗
PubMed1998

Suicidal ideation and the 'wish to die' in dementia patients: the role of depression.

OBJECTIVE: To determine the prevalence of self-reported suicidal ideation and the 'wish to die' in dementia patients, their association with depressive symptoms and the type of dementia. DESIGN: The cohort was formed retrospectively of consecutive referrals between 1985 and 1994 of cognitively impaired patients who met American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, third edition and third edition, revised, criteria for dementia. They were assessed for depression using the 21-item Hamilton Rating Scale for Depression (HRSD) which includes an item on suicide. SETTING: An outpatient multidisciplinary memory disorders clinic in Sydney, Australia. PATIENTS: The sample comprised 221 patients with dementia: 148 with Alzheimer's disease according to NINCDS-ADRDA criteria, 24 with vascular dementia diagnosed by a Hachinski ischaemia scale score of seven or more, plus focal neurological signs, symptoms or computed tomography-visible lesions, and 49 with other dementias. MEASURES: Cognitive impairment was measured by the Mini-Mental State Examination and the Blessed orientation-information-memory-concentration test and dementia scales, depression by the 21-item HRSD, suicidal ideation and the 'wish to die' as defined by the suicide item on the HRSD, functional capacity by the activities of daily living scale and the instrumental activities of daily living scale. Caregiver psychological morbidity was assessed with the General Health Questionnaire. RESULTS: 12 patients (5.4%) felt life was not worth living, seven (3.2%) 'wished to die' or had thoughts of death, two (0.9%) had suicidal ideation or gestures and none had made any suicide attempts. The nine patients who 'wished to die' or had suicidal ideation scored 12 or more on the HRSD. Of these, six were clinically depressed. Suicidal ideation and the 'wish to die' were significantly correlated with the presence of depressive symptoms as measured by the HRSD (suicide item excluded), but only in those with Alzheimer's disease. There were no significant differences in HRSD scores between the dementia groups. Suicidal ideation was unrelated to the presence of insight into loss of memory. CONCLUSIONS: Suicidal ideation and/or the 'wish to die' is self-reported in 4% of dementia patients attending a memory disorders clinic and is associated with comorbid depressive symptoms, particularly in Alzheimer's disease.

Aged↗