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[Bencyclane in memory disorders. Treatment of memory disorders caused by electroshock in a group of depressed patients].

Subjects treated with electroshock and subjected simultaneously to bencyclan at a dose of 00 mg (2 ampoules) i.v. and 100 mg (1 pill) per os pro die did not present dysmnesia either during the intervals between one electroshock treatment and another, nor at the conclusion of treatment (on average 12 sessions in about 40 days), while a control group treated at the same rhythm and with the same number of sessions, but without bencyclan, presented considerable memory lapses which disappeared only after a lengthy period of this latter treatment. Memory disturbances have been evaluated with a memorization test to which all patients were subjected. This test belongs to the group of intellectual efficiency reactive tests used in the psychology laboratory of the Catholic University of Milan; it consists of a group of 12 figures of common objects which, once observed, have to be recalled exactly immediately and some time later by the patient, who has to indicate the name and position of the objects represented in the chart.

Adult

[Memory disorders in schizophrenia].

The current interest in memory disorders in schizophrenia results from the way perceptions of schizophrenia--whose organic origin is becoming increasingly evident--and memory--according to which there exist not one, but several memories--have developed. Memory disorders in the schizophrenic cannot be considered in isolation from knowledge accumulated in other areas of the cognitive and neuro-sciences; a more detailed understanding of these disorders requires a comparison of the different cognitive approaches, both with each other and with the neurobiological and clinical approaches, so that they can be integrated. Despite numerous methodological and conceptual difficulties, it now appears to have been established that the schizophrenic's memory deficit should be seen in the context of a wider cognitive deficit, that the memory tasks are not all disturbed and that the memory deficit cannot be identified with one specific form of memory. Thus, iconic formation, short-term memory in the traditionally accepted sense and implicit memory are hardly, if at all, affected; in contrast, the early processing of information, working memory and explicit memory are disturbed, probably to the extent that they require the implementation of strategies to organise the information to be memorized. Finally, in certain tasks, such as those evaluating latent inhibition or negative priming, schizophrenics perform better than normal subjects, suggesting that schizophrenics' cognitive deficit is localised. This profile of memory disorders is compatible with a dysfunction predominating in the frontal and temporo-hippocampal regions. Neuroleptics and anticholinergics have opposite effects on cognitive and mnesic performance, which is improved by the former and aggravated by the latter. The influence of clinical symptoms, positive or negative, institutionalisation of patients and chronic tardive dyskinesia is unclear. Among the theoretical proposals put forward to account for the observed disorders, those relating to a disturbance of the action planning process and to that of the internal representation of context are compatible with the observed memory disorders. All the clinically derived data and those produced by the cognitive and neurosciences indicate a need to reformulate the links between memory, selective attention and evaluation of the relevance of a stimulus, to develop a general model of the reciprocal interactions between cognition and affectivity and to look for the origin of a pathology as complex as schizophrenia, not in a local lesion in an isolated cerebral structure but in a disturbance of the dynamic interactions within a functional, parallel and distributed network of broadly interconnected regions.

Antipsychotic Agents

[Memory disorders in patients with saccular aneurysms of the internal carotid arteries].

Neuropsychological analysis of disorders of memory in patients with sacculated aneurysms of the internal carotid arteries, 14 of whom were examined in the immediate and 30 in the remote periods after the hemorrhage, showed that the side of the lesion may be judged by the character of these disorders. The disorders of memory were of a modally-specific character and emerged in the link of direct reproduction in aneurysms of the right internal carotid artery and in the link of delayed (under conditions of interference) reproduction in aneurysms of the left internal carotid artery. The general cerebral signs in the acute stage of subarachnoid hemorrhage are also manifested specifically in the structure of the memory defect.

Adult

[Memory disorders in vascular lesions of the brain].

The authors studied clinical and psychological features in disorders of memory due to vascular brain lesions. With the aid of pyktograms the character of activities of the examinees during the process of perception and differences in disorders of moderation in patients with lesions of the frontal and occipital parts of the brain were demonstrated. It is established that in the initial stages of the mnestic process the leading role is played by frontal lobes, while in latent reproductivity the significance of occipital brain areas increases.

Basilar Artery

Longitudinal diagnosis of memory disorders.

Early referral for specialist assessment is becoming more common with memory disorders and dementia: the mean Mini-Mental State Examination (MMSE) score of new patients at our clinic rose from 18.7 to 20.7 between 1986 and 1990. The clinical diagnosis of mild to moderate dementia has been recognized to be difficult, but several studies have reported cross-sectional diagnosis. We examined the number of visits required to establish a clinical diagnosis of dementia in the first 125 patients attending a Memory Disorders Clinic who had at least two visits (six months apart) and the stability of the diagnoses. Just under half of the patients required at least two visits to establish the clinical diagnosis. The MMSE was not a good guide to the number of visits required but the diagnosis at the first visit remained stable in all patients who scored < or = 10/30. Sixteen per cent of patients interchanged between the categories of Alzheimer's, mixed and vascular dementias. Possible age-associated memory impairment progressed to dementia in six of eight cases, and depression to dementia in three cases. The diagnosis of mild to moderate dementia should not be restricted to a cross-sectional approach, but should involve serial clinical, psychological and affective assessments.

Aged

An outline for the analysis of dementia. The memory disorder of Huntingtons disease.

Methods have been developed for assessing the cognitive parameters contributing to a memory disorder. Our findings suggest that individuals with Huntington disease have impairments in the encoding of new information and the consistent retrieval from storage of learned material. Their difficulties lie particularly in the realm of episodic memory.

Adult

[Memory disorders in epileptic children with temporal psychomotor seizures].

The authors demonstrate the results of experimental psychological examination of memory in 57 patients with epilepsy in psychomotor temporal seizures. It was possible to show that in such cases there was a total decline of short-time memory. In bilateral foci and a long-term development of the disease there was a formation of an amnestic syndrome. The most distinct changes were seen in a delayed reproduction. In an electrostimulation of the structures of the temporal lobe by means of implanted electrodes the experiments displayed an intactness of direct reproduction during a stimulation of the neocortex, a moderate decrease in a stimulation of the hypocampus and a grave -- when stimulating the amygdalar complex.

Amygdala

[Memory disorders in parkinsonism patients].

The experience of memory and retention weaknesses in Parkinsonian patients led us to question if these are only due to age-specific deteriorations, and if these weaknesses change during the L-Dopa therapy of the underlying disease. For this reason 30 Parkinsonian patients and 30 normal subjects of a matched control group took part in five different tests of retention and memory: digit span (Wechsler), visual retention test (Benton), Wechsler Memory Scale (subtests 4 and 7), delayed recall (Williams). The results (including some further samples of the test literature) gave some evidence of test-material-specific weaknesses in Parkinsonian patients: especially such memory decay as is dependent on the interval of retention. An organic deterioration of the intermediate term memory is suggested. This result could not be fully explained by known psychological or neurological characteristics of the underlying disease.

Age Factors

Memory complaints, memory disorders and focus localization in patients with partial epilepsy.

Our study aimed at analysing effects of epileptic foci on memory function in patients with partial epilepsy. Twenty-eight patients with spontaneous memory complaints and psychometrically established memory disorders were assessed by 21-channel electroencephalography recorded both during cognitive testing and during 99mTc-HMPAO single photon emission computed tomography (SPECT). Computed tomography (CT) was performed on the same day. None of the epilepsy-related factors (seizure type, seizure frequency, type of epilepsy, age at onset of the seizures, type of antiepileptic treatment) could be related directly to severity or type of memory impairment (classified into the categories 'global', 'verbal' and 'non-verbal'). Remarkably, this study found no significant relationship between EEG focus localization and severity of measured memory impairment. Most areas with hypoperfusion on the SPECT were found in the group with global (severe) amnesia, typically with a right frontal localization. Abnormalities on CT were predominantly found in the same group, however, with a right-sided parietal localization. An unanticipated finding was that the majority of temporal CT and SPECT lesions were found in the group with relatively better memory performance.

Adult

Memory disorder in Korsakoff's psychosis: a neuropathological and neuropsychological investigation of two cases.

Neuropathological findings in the brains of two alcoholic patients with Korsakoff's psychosis are reported. Their memory defects had been studied in detail quantitatively over a period of nine years in one case and three years in the other, relevant details of which are presented. Both patients had had a relatively pure long-term memory impairment in the absence of other cognitive deficits and in the absence of a short-term memory impairment. Their retrograde amnesia for public events and famous faces had been measured and found to have extended backwards over at least twenty-five years. There was severe impairment in anterograde recognition memory for both verbal and non-verbal material. On a newly prepared memory quotient battery both patients had scored well below the bottom of the normal scale (less than 60, where 100 is the mean with a standard deviation of +/- 15). Both patients had also shown the characteristic differential improvement in retention when tested by cued recall and also the characteristic 'prior learning effect', i.e. normal retention of one list of words when tested by cued recall but impaired retention of a second list sharing the same cues as the first list. There had been a slight but significant deterioration in intelligence in one of the patients in the two years prior to his death, although his IQ still fell within the normal range. The other patient remained undeteriorated until his death, and his IQ also was close to an estimated measure of his premorbid IQ. In the brains of both patients there was marked gliosis, shrinkage and discolouration bilaterally in the medial nuclei of the mammillary bodies. In addition there was a thin band of gliosis bilaterally between the wall of the third ventricle and the medial dorsal nucleus, the rostral limit lying anterior to the medial dorsal nucleus. In the patient with no intellectual deterioration these were the only pathological changes that were seen. In neither patient was there evident local loss of nerve cells, gliosis or any other qualitative evidence of abnormality in the hippocampi, the white matter of the temporal lobes or the greater part of the medial dorsal nuclei, although it is difficult to be certain whether there was any overlap between the band of gliosis and the most medial region of the medial dorsal nueleus and other adjacent thalamic nuclei. In the other patient there was also a small zone of softening in the cerebellum and an increase in astrocytes in other regions of the cerebral hemispheres, including the basal ganglia, amygdala, and brain-stem, but without noticeable loss of cells. The question of the minimal lesion for the alcoholic Korsakoff amnesic state, and some aspects of the related anatomy, is discussed in the context of other reports in the literature which are, however, difficult to assess in the absence of details of the specificity, severity and character of the memory disorders.

Aged

[Memory disorders and symptoms of frontal dysfunction in 29 patients operated on for an aneurysm of the anterior communicating artery].

Twenty-nine patients operated for an aneurysm of the anterior communicating artery have been submitted to short-term and long-term memory tests and to tests said to be sensitive to frontal lobe dysfunction; anosognosia was also studied. Their performance, as compared to that of 29 matched control subjects, revealed: (a) that this neurological condition induces often memory deficits (with anosognosia) and, even more often, signs of frontal dysfunction; (b) that these deficiencies are not homogeneous, however; and (c) that the classical amnesic syndrome can be observed in some cases. It appears useful to make an in-depth analysis of memory deficits of this kind of patients to reach a better understanding of normal memory processes.

Adult

[Exploration of memory disorders in anxiety states].

According to cognitive model of anxiety, memory process in anxious patients is usually tested by comparing the incidental recall of positive and negative, threatening and non threatening, self and other-referenced words. Contrary to expectation, the results indicate relatively poorer memory for threatening material in anxious patients and no bias in favour of the recall of self referent negative words. At the opposite this memory bias can be evidenced in patients with panic disorder. The bias for anxiety words is better evidenced in the subgroups with the higher arousal level or when there is a mood induction by reading first an anxiogenic text. Consistent with prediction a perceptive pre-attentional bias can be shown for the great majority of the subjects studied in recent researches.

Adult

Possible biochemical basis of memory disorder in Alzheimer disease.

Damage to the hippocampal formation, whether focal or diffuse, leads to severe impairment of short-term memory. The most common presenting symptom of Alzheimer disease is loss of short-term memory, and histologically the hippocampus is characteristically affected. Choline acetyltransferase, which is involved in the synthesis of acetylcholine, is depleted in the hippocampus in the disorder. Anticholinergic drugs administered to normal subjects can simulate some aspects of the memory defect seen in Alzheimer disease. It is postulated that damage to a cholinergic neuronal pathway running to or from the hippocampus underlies the memory disorder. This suggestion implies that it may be possible to improve memory in patients with Alzheimer disease by pharmacological means.

Acetylcholine

Language and memory disorders following closed head trauma.

Patients who suffer closed head trauma may demonstrate communication disorders which have been variously described as aplasia, severe memory impairments, traumatic aphasia, or confusion. The memory and language skills of 14 patients who had suffered closed head trauma were documented after they regained ocnsciousness and at one-month intervals for four monts utilizing the Porch Index of Communicative Ability and the Wechsler Memory Scale. Results indicated that patients initially suffered both reduced memory and language skills. After four months, expressive and receptive language skills were grossly functional for conversational purposes, and all memory taskd with the exception of orientation skills were within normal limits. Significant improvement in both language and memory functioning most often occurred during the first month after regaining consciousness, although gradual improvement in both language and memory skills was noted beyond the one-month period. No significant correlations existed between the length of unconsciousness and the initial and final language and memory scores.

Adult

[An outpatient clinic for memory disorders; initial experiences].

The department of neurology of the Academisch Medisch Centrum started an outpatient memory clinic in 1987 for patients aged 65 and older. Its specific aims are: assessment of elderly patients with memory problems, treatment where appropriate, and advice; clinical research; teaching and training. The clinic has run full-time since 1990. The approach is multidisciplinary. We describe our findings in the first 75 patients who were referred by their general practitioners because of forgetfulness or possible dementia: 72 of them had a complete investigation; 30 patients were not demented; three could be reassured because their performance was within normal limits. Four patients were depressed and they improved on therapy. Forty-two patients were demented. All had a CT scan and comprehensive blood tests but a curable cause for the dementia syndrome was never identified. This result was expected on account of the probably low frequency of 'reversible' causes and patient selection. Secondary prevention was important when a vascular component contributed to the pathogenesis of the mental deterioration (n = 6). Even when no curable condition was found, clarity about diagnosis and prognosis was important not only to the relatives but also to the general practitioner in planning the future management of the patient. Fifty-five of the 72 patients were older than 65 years which means that we do see the patients we are particularly interested in. The clinic offers facilities for clinical research. In the project 'Diagnostiek bij dementiesyndroom' (Diagnostics in dementia syndrome) we investigate the utility of ancillary investigations in relation to the outcome in demented patients.

Aged