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[Neuroradiological manifestations of primary Sjögren's syndrome].

Primary Sjögren's syndrome (PSS) is considered as the most frequent connective tissue disease. Neurological complications may affect the peripheral nervous system and to a lesser extent the central nervous system. Neurological manifestations often precede or reveal SSP. Peripheral neuropathy is the most common and well-known neurological complication of PSS. Its frequency is about 20-30 percent of patients. Distal sensory or sensorimotor axonal neuropathy is the most frequent followed by sensory neuronopathy, the only neurological complication characteristic of SSP. Recently, several cases of motor neuron syndrome have been reported suggesting that it could be a neurological complication of SSP. CNS involvement consists of cerebral or spinal cord involvement and its frequency is debated. Cerebral dysfunction may be focal or multifocal according to the number and location of lesions. Its course may be acute, remittent or progressive. Cognitive dysfunction and psychiatric manifestations seem to be frequent in SSP but this needs to be confirmed by further studies. Spinal cord involvement consists of acute myelitis or progressive myelopathy. In CNS involvement, there is no correlation between clinical findings and results of CSF study or MRI which can be normal or disclose unspecific abnormalities. For all neurological complications, response to corticosteroids or immunosuppressive therapy is unpredictable. As neurological manifestations in SSP are miscellaneous, SSP diagnosis should be considered in any unexplained neurological setting because sicca syndrome is often mild or asymptomatic and immunological abnormalities or other extraglandular manifestations of PSS may be lacking.

Central Nervous System Diseases↗

Contrast study on cognitive function with MRI and positron emission tomography imaging in transient global amnesia.

OBJECTIVE: To study cognitive function and cerebral metabolic changes in patients with transient global amnesia (TGA). METHODS: Three patients with TGA were given mini-mental state examination (MMSE), revised Wechsler memory scale (WMS-R) examination and magnetic resonance imaging (MRI) scans after they had been diagnosed as TGA. Using (18)F labelled deoxyglucose as tracer, patients were given a positron emission tomography (PET) examination at different periods during recovery. RESULTS: No obvious abnormality was found in MMSE and MRI scans in the three patients. However, WMS-R examination and cerebral PET imaging displayed cognitive dysfunction of varying degrees and low metabolism in local areas related to memory in 2 of 3 patients. CONCLUSIONS: In TGA patients, cognitive function and cerebral metabolic levels are closely correlated with duration of symptoms. It is necessary to stop the TGA attack as quickly as possible early time.

Aged↗

[Brain atrophy and cognitive disorder in multiple sclerosis].

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system causing severe disability via the progressive damage of white matter. Beyond physical signs cognitive dysfunction might be present as well. The aim of this study was to investigate the frequency and characteristics of brain atrophy and cognitive alterations. Significant cortical and subcortical atrophy was found on brain MRI of 30 MS patients included in this study comparing to healthy controls. Abnormal findings were detected in more than 60% of patients using a cognitive test battery. Generally, verbal abstraction, visuospatial orientation, attention, short-term memory was impaired and the psychomotor speed was decreased, even in the early stage of the disease. Depression-related complaints were found in 57% of this population. The Kurtzke scale, the atrophy of corpus callosum and widening of 3rd ventricle and Sylvian fissures were related to impaired cognitive performances. The authors would like to call attention to the early cognitive deficit and the need of treatment in MS.

Adult↗

Neurometrics: computer-assisted differential diagnosis of brain dysfunctions.

Normative developmental equations provide reliable descriptors of brain electrical activity in people 6 to 90 years old. Healthy persons display only chance deviations beyond predicted ranges. Patients with neurological impairment, subtle cognitive dysfunctions, or psychiatric disorders (including dementia and primary depression) show a high incidence of abnormal values. The magnitude of the deviations increases with clinical severity. Different disorders are characterized by distinctive profiles of abnormal values of brain electrical features. Computerized differential classification of some of these disorders can be achieved with high accuracy. Such classification, providing objective corroboration of brain dysfunctions, may be a useful adjunct to psychiatric diagnosis, which relies primarily on subjective clinical impressions. These methods may provide independent criteria for diagnostic validity, evaluations of treatment efficacy, and more individualized therapy.

Age Factors↗

Cognitive change in ALS: a prospective study.

OBJECTIVES: To investigate longitudinally the profile of cognitive impairment in nondemented patients with ALS. METHODS: Twenty nondemented patients with ALS and 18 controls were interviewed at two time points separated by a 6-month interval. The extensive battery was designed to accommodate the range of physical disability present in ALS, and included measures of executive, memory, language, and visuospatial functions, everyday behavior, and emotion. RESULTS: On a test of simple word retrieval (Computerised Sentence Completion Test) patients with ALS became slower over time, while controls became faster at completing sentences with appropriate words. This effect remained when the analysis accommodated for progressive speech disability. Patients with ALS also displayed an impairment in both written and spoken verbal fluency indices (time to think of each word) at both time points, but there was no evidence of deterioration over time. On the Short Inventory of Minor Lapses, carers of patients with ALS displayed increased awareness of cognitive dysfunction in everyday behavior while controls' ratings of their partners decreased. In addition, patients displayed more depressive symptomology (although well below clinical levels) on the second interview vs controls. Patients with ALS also displayed emotional lability at both time points, although this did not increase over time. CONCLUSIONS: Cognitive deterioration in nondemented patients with ALS is a relatively slow process. Selective cognitive impairment in the form of verbal fluency deficits, most likely indicating executive dysfunction, appears relatively early on in the course of the disease, although language functions may become vulnerable as the disease progresses.

Adult↗

Neuropsychological differences between schizophrenic patients with heterogeneous Wisconsin Card Sorting Test performance.

This report compares neuropsychological test results of schizophrenic patients with good (5-6 categories achieved) and poor (0-1 categories achieved) performance on the Wisconsin Card Sorting Test (WCST). It was found that the subjects with poor performance also had substantial deficits on the subtests of the Wechsler Adult Intelligence Scale-Revised and the Halstead-Reitan Battery. The subjects with good WCST performance demonstrated a relatively mild degree of impairment on these tests, except for normal performance on the verbal subtests of the WAIS-R. It was concluded that: (1) not all schizophrenic patients have dense perseverative behavior as identified by impaired performance on the WCST; (2) impaired performance on the WCST is accompanied by a variety of other cognitive deficits; and (3) there appear to be measures more sensitive to cognitive dysfunction in schizophrenia than the WCST.

Adult↗

Interictal paroxysmal epileptic discharges during sleep in childhood: phenotypic variability in a family.

We report three children of the same parents who exhibited various types of cognitive disorders, ranging from severe mental deficiency with transient autistic-like regression to specific neuropsychological disabilities, associated with paroxysmal EEG abnormalities with various patterns of severity. This familial association highly suggests a genetic factor responsible for both epileptic discharges on EEG and cognitive dysfunction.

Brain↗

Theoretical models of cognitive aging and implications for translational research in medicine.

PURPOSE: We provide an overview of theoretical models of cognitive aging and present empirical research that uses these models to explain older patients' medical behaviors and to develop interventions for improving the delivery of health information and services to older adults. DESIGN AND METHODS: Theoretical accounts of age and cognition are summarized and are related to key research findings, including age differences in comprehension of medical information, adherence, and use of medical technologies. The implications of cognitive aging theories for designing optimal medical environments and enhancing adherence are discussed. RESULTS: Age declines in basic cognitive abilities such as working memory capacity limit older adults' ability to comprehend and recall several types of novel medical information. In contrast, automatic processes and environmental cues can benefit older adults, as shown by age increases in compliance for practiced or mentally imaged health behaviors, but can also be dangerous, as shown by older adults' greater belief in false but familiar health statements. Last, cognitive aging is shown to be a useful model for investigating cognitive disorders. IMPLICATIONS: Cognitive aging theories are important for understanding older patient behaviors and suggest age-related declines as well as gains in performance in medical domains. In addition, models of cognitive aging are useful in guiding the development of interventions that improve health care in older patients and in furthering our understanding of cognitive dysfunction in populations other than older adults.

Aged↗

Cognitive impairment among the elderly in a Korean rural community.

Cognitive function among the elderly aged 65 or older was studied in a rural community of Korea. The prevalence rates of cognitive impairment were significantly higher in females (64%) than in males (33%). Sex differences of prevalence of both mild impairment (25% in males vs 45% in females) and severe (8% in males vs 19% in females) reached statistically significant levels. The prevalence of severe impairment increased with age, and the age-related increase was steeper after 80 in males and after 75 in females. The prevalence of mild impairment, on the other hand, did not increase so prominently with aging. From this point of view, it could be assumed that severe cognitive impairment may be highly related to real dementia, and that the elderly with mild impairment may consist of heterogenous groups associated with cognitive dysfunction of mild degree.

Aged↗

Central catecholamine metabolism in vivo and the cognitive and motor deficits in Parkinson's disease.

Cerebrospinal fluid levels of homovanillic acid (HVA) in unmedicated patients with Parkinson's disease were 45% of levels in control subjects. Levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) and platelet monoamine oxidase activity (MAO) did not differ. Within the Parkinson's disease group platelet MAO B activity correlated with HVA (an MAO B substrate) but not MHPG (an MAO A substrate). A mild global dementia was found that did not correlate with the more severe motor deficit. There was a negative correlation between the motor deficit and HVA levels but not with MHPG. Cognitive functioning correlated positively with platelet MAO, and the ratio of HVA to MHPG levels and negatively with MHPG alone. It is postulated that dopaminergic and noradrenergic activity or the functional balance between these systems may contribute to the observed cognitive dysfunction.

Blood Platelets↗

Cognitive and behavioral dysfunction in Parkinson's disease: neurochemical and clinicopathological contributions.

The cognitive and behavioral sequelae (i.e., nonmotor profile) of Parkinson's disease (PD), with executive dysfunction and depression being most prominent, have typically been overshadowed due to an emphasis on motor symptomatology. The apparent categorization of PD as a disorder isolated to the dopaminergic system may be a generalization of the disease pathology. Dopamine therapy, used for the treatment of motor symptoms, has not consistently been shown to resolve nonmotor impairments. Research evidence indicates that nondopaminergic neurotransmitter systems (i.e., serotonergic, noradrenergic, & cholinergic) are disrupted in PD and may contribute to cognitive and behavioral dysfunction. Furthermore, Lewy bodies within cortical and subcortical structures can add to the nonmotor profile in PD. Pharmacological interventions for the treatment of cognitive and behavioral impairments associated with PD are few, especially for nondemented patients. The current review of the literature highlights evidence that associates nonmotor dysfunctions with neurochemical and clinicopathological correlates of PD.

Brain↗

Prediction of changes in memory performance by plasma homovanillic acid levels in clozapine-treated patients with schizophrenia.

RATIONALE: Cognitive dysfunction in schizophrenia has been demonstrated to be dependent, in part, on dopaminergic activity. Clozapine has been found to improve some domains of cognition, including verbal memory, in patients with schizophrenia. OBJECTIVES: This study tested the hypothesis that plasma homovanillic acid (pHVA) levels, a peripheral measure of central dopaminergic activity, would predict the change in memory performance in patients with schizophrenia treated with clozapine. METHODS: Twenty-seven male patients with schizophrenia received clozapine treatment for 6 weeks. Verbal list learning (VLL)-Delayed Recall (VLL-DR), a test of secondary verbal memory, was administered before and after clozapine treatment. Blood samples to measure pHVA levels were collected at baseline. RESULTS: Baseline pHVA levels were negatively correlated with change in performance on VLL-DR; the lower baseline pHVA level was associated with greater improvement in performance on VLL-DR during treatment with clozapine. Baseline pHVA levels in subjects who showed improvement in verbal memory during clozapine treatment ( n=13) were significantly lower than those in subjects whose memory performance did not improve ( n=14). CONCLUSIONS: The results of this study indicate that baseline pHVA levels predict the ability of clozapine to improve memory performance in patients with schizophrenia.

Adult↗

Behavioral approaches to the assessment of attention in animals.

Increasing awareness that disorders of attention may underlie cognitive dysfunctions associated with intoxication and neurodegenerative disease has stimulated research into the neural bases of attention. Because attention comprises a constellation of hypothetical cognitive processes, it can only be inferred from behavior, of either human or non-human subjects, under appropriate experimental conditions. Many behavioral procedures have been proposed for modeling attention in animals, but not all of these procedures have been systematically associated with specific attentional processes. This review endeavors to evaluate critically the construct validity of these procedures (i.e., to determine the degree to which a given procedure assesses a particular process) and to suggest experiments to improve the conceptual links between these procedures and the processes they purport to assess. Five categories of processes have been identified from the animal literature: orienting, expectancy, stimulus differentiation (including stimulus salience, discrimination of a critical stimulus from its context, and selection among stimuli), sustained attention, and parallel processing. The review discusses the strengths and weaknesses of specific behavioral procedures for assessing these categories of attentional processes and, given the conceptual uncertainties involved, it attempts to summarize the present state of knowledge of the pharmacology and neurobiology of attention.

Animals↗

Recognition of psychological and cognitive impairments in the emergency department.

Ninety-six patients presenting to a university hospital emergency department were screened before triage for psychological symptoms or cognitive impairment using the General Health Questionnaire (GHQ) and Mini-Mental State examination (MMS). Charts were reviewed for demographic information and emergency physicians' recognition of psychological symptoms or cognitive dysfunction. Of the patients studied, 38% had positive results on the GHQ, and 18% had positive results on the MMS. Psychological symptoms or cognitive impairments were recognized by the emergency physicians in only 8% of those with positive GHQ results and 6% of those with positive MMS results. The usefulness of screening measures for psychological symptoms and cognitive impairment of emergency department patients is discussed.

Cognition Disorders↗

An MRI study of cerebellar vermis morphology in patients with schizophrenia: evidence in support of the cognitive dysmetria concept.

BACKGROUND: Cumulative evidence suggests the cerebellum is involved in cognition and may be important in the pathoetiology of schizophrenia. Functional imaging studies have identified a possible neural circuit that includes the cerebellum and may be abnormal in patients with schizophrenia, manifesting as a fundamental cognitive deficit conceptualized as cognitive dysmetria. To explore the role of the cerebellum in cognitive dysfunction and schizophrenia, this study was designed to evaluate the morphology of the cerebellar vermis, its relationship to other cortical areas, and to cognitive function in patients with schizophrenia. METHODS: Male patients with schizophrenia (n = 65) were matched by age and gender to 65 healthy male controls. Volume measures of the 4 cerebral lobes and total cerebellum were obtained using automated methods. The area of the cerebellar vermis (divided into three lobes) was traced on a midsaggital MRI slice. RESULTS: Patients had smaller frontal and temporal lobes. There were no group differences in total cerebellar volume. Patients had a smaller vermis area, accounted for by a smaller anterior lobe. The anterior vermis area was positively correlated with total cerebellar volume, temporal lobe volume, and FSIQ in patients, but not controls. CONCLUSIONS: These findings support the theory that regions of the cerebellum may be involved in a neural circuit that is structurally and functionally abnormal in patients with schizophrenia, leading to cognitive dysmetria.

Adolescent↗

Neuropsychological correlates of psychotic features in major depressive disorders: a review and meta-analysis.

Neuropsychological functioning has been a focus of study in psychotic disorders for many decades. These studies have focused primarily on schizophrenia, and less so on the affective psychoses, including psychotic major depression PMD. Several studies have provided evidence of cognitive dysfunction in PMD. However, these studies have utilized different assessment methods and instruments. Consequently, a clear picture of the nature and severity of cognitive impairment in PMD has yet to emerge in the literature. The current review seeks to provide a summary of the literature by composing a quantitative and qualitative review of the research to date on the cognitive impairment in psychotic major depression, specifically as it contrasts to those deficits observed in nonpsychotic depression. This review also provides a summary model of the pathophysiology of PMD to provide the necessary context to understanding the biological mechanisms of these impairments.

Affective Disorders, Psychotic↗

Hydergine: a review of 26 clinical studies.

This report reviews 26 clinical drug trials which investigated the effectiveness of Hydergine, a dihydrogenated ergot alkaloid, used frequently in geriatric psychopharmacology. The methodological characteristics and significant results for each study are presented in outline form. In total, 32 symptoms were assessed in six or more studies. Therapeutic benefits following Hydergine treatment occurred in the areas of cognitive dysfunctions, mood depression, and the composite scores as measured by subjective clinical behavioral rating scales. It is suggested that the improvement reported in cognitive functions and mood depression is a reflection of the global change observed by clinicians in patients' overall behavior duirng the interview. This conclusion that Hydergine does produce some global improvement indicates that further research with Hydergine is warranted, provided more objective instruments are employed such as those described in the report.

Aged↗

Late effects of adjuvant chemotherapy on cognitive function: a follow-up study in breast cancer patients.

BACKGROUND: Neuropsychological examinations have shown an elevated risk for cognitive impairment 2 years after therapy in breast cancer patients randomized to receive adjuvant high-dose cyclophosphamide, thiotepa, carboplatin (CTC) chemotherapy compared with a non-treated control group of stage I breast cancer patients. Patients randomized to receive standard-dose fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy showed no elevated risk compared with controls. However, breast cancer patients treated with conventional cyclophosphamide, methotrexate, 5-fluorouracil (CMF) chemotherapy showed a higher risk of cognitive impairment. The present study was designed to obtain a greater insight into these long-term neuropsychological sequelae following chemotherapy and their course in time. PATIENTS AND METHODS: At 4 years post-therapy, 22 of the original 34 CTC patients, 23 of 36 FEC patients, 31 of 39 CMF patients and 27 of 34 control patients were re-examined with neuropsychological tests. RESULTS: Improvement in performance was observed in all chemotherapy groups, whereas in the control group there was a slight deterioration in test results. A differential attrition was observed among the groups, with a relatively high percentage of initially cognitively impaired patients from the CTC group dropping out due to factors related to disease progression. CONCLUSIONS: The results suggest that cognitive dysfunction following adjuvant chemotherapy in breast cancer patients may be transient. Additional studies are needed to investigate the differential attrition of patients with cognitive impairment.

Adult↗