Volumes of hippocampus, amygdala and frontal lobes in the MRI-based diagnosis of early Alzheimer's disease: correlation with memory functions

We studied the usefulness of measuring volumes of the hippocampus, amygdala and frontal lobes with coronal magnetic resonance imaging (MRI) scans in the diagnosis of early Alzheimer's disease (AD). We examined 32 patients diagnosed according to the NINCDS-ADRDA criteria of probable AD and 16 age-matched healthy cognitively normal controls. The AD patients had mild dementia with a mean score of 22.8 in the Mini-Mental Status Examination (MMSE). We used a 1.5 T magnetic resonance imager and normalized the volumes for brain area. The AD patients had significantly smaller volumes of the right and the left hippocampus (-38%) (ANOVA, p < 0.0001) and the left frontal lobe (-16%, p < 0.05) compared to controls. The reductions in volumes of the right frontal lobe (-13%), the right amygdala (-14%) or the left amygdala (-18%) were not statistically significant. In the discriminant function analysis which included the volumes of the hippocampus, amygdala, and the frontal lobes and age, the volumes of the left and right hippocampus, the left and right frontal lobe, and the right amygdala entered the model and we could correctly classify 92% of the subjects into AD and control groups (Chi-square 42.6, df 5, p < 0.001). By using the volumes of the hippocampus, the frontal lobes or the amygdala on their alone, the correct classification was achieved in 88%, 65% and 58% of the subjects, respectively. In addition, in AD patients the volumes of the left hippocampus correlated significantly with the MMSE score and with immediate and delayed verbal memory; the smaller the volume the more impaired was their performance. Our data indicate that measurements of volumes of the hippocampus might be useful in diagnosis of early AD.

Loss of synaptophysin-like immunoreactivity in the hippocampal formation is an early phenomenon in Alzheimer's disease

We studied a synatophysin-like immunoreactivity in the hippocampal formation of patients with definite Alzheimer's disease, multi-infarct dementia, patients with no evidence of clinical dementia with neuropathological findings fulfilling the criteria of possible Alzheimer's disease, and age-matched nondemented controls. Possible Alzheimer's disease cases were of special interest because they were considered to represent early Alzheimer's disease. We also studied the spatial relationship of synaptophysin-like immunopositivity with amyloid-beta-protein immunopositive senile plaques and anti-paired helical filament immunopositive degenerating neurons locally as well as considering the intrinsic circuits in the hippocampal formation. The synaptophysin-like immunoreactivity was decreased in the hippocampus and the entorhinal cortex in patients with definite and possible Alzheimer's disease but not in multi-infarct dementia patients compared to controls. Equal loss of synapses in possible and definite Alzheimer's disease patients supports the hypothesis that synaptic loss is an early phenomenon in Alzheimer's disease. Unchanged synaptophysin-like immunopositivity in patients with multi-infarct dementia suggests that the loss of synapses is centrally involved in the pathogenesis of Alzheimer's disease and not dementia per se. There was no spatial correlation between loss of synapses and amyloid-beta-protein positive senile plaques. Moreover, we could not find a strict spatial relationship between senile plaques and degenerating neurons. Our results do not support the amyloid cascade hypothesis of Alzheimer's disease that local accumulation of amyloid-beta-protein leads to the loss of synapses.

Testing for mutations in exon 17 of the beta-amyloid precursor protein gene in Finnish Alzheimer patients and normal subjects

Mutations in the beta-amyloid precursor protein gene on chromosome 21 were shown to cause a small proportion of Alzheimer's disease. We studied the occurrence of the point mutations in exon 17 of the beta-amyloid precursor protein gene in a sample of Finnish familial Alzheimer patients and nondemented controls using polymerase chain reaction and a single strand conformation polymorphism technique. In addition, mutations in familial Alzheimer's disease patients were studied by sequencing the amplified products. Interestingly, two probable polymerase chain reaction errors were detected in codons 717 and 693 of the exon 17. However, no mutations in the exon 17 were confirmed adding the study to the body of literature that mutations in the exon 17 are a rare cause of familial Alzheimer's disease.

Long-term study with gabapentin in patients with drug-resistant epileptic seizures

OBJECTIVE

To study the efficacy and safety of gabapentin in long-term treatment.

DESIGN

A 4-year follow-up study of 25 patients with visits at 3-month intervals.

SETTING

The patients were followed up in the outpatient unit of the University Hospital of Kuopio (Finland).

PATIENTS

We treated 25 patients with drug-resistant complex partial seizures and secondarily generalized seizures in an open-label long-term study, using gabapentin as an additional means of therapy after a 3-month double-blind, placebo-controlled phase. Thirteen patients showed no benefit from gabapentin; the study medication was discontinued after 4 to 6 months of treatment. Of the 12 patients who responded enough to continue treatment, five were withdrawn due to different reasons, one because of loss of response.

MAIN OUTCOME MEASURES

The number of patients receiving the study drug in the follow-up and reduction of seizure frequency from baseline level as analyzed by the Wilcoxon test.

RESULTS

Seven patients received gabapentin therapy for more than 4 years. The median follow-up time was 54 months. There was a significant reduction in seizure frequency throughout the follow-up period. Five of seven patients had a greater than 50% seizure frequency reduction at 4 years, representing 20% of the 25 patients who entered the study.

CONCLUSIONS

Gabapentin possesses good efficacy in long-term treatment of patients with partial and secondarily generalized epileptic seizures. It is safe to use, and it is fairly well tolerated even in long-term treatment.

Volumetric MRI analysis of the amygdala and the hippocampus in subjects with age-associated memory impairment: correlation to visual and verbal memory

Age-associated memory impairment (AAMI) is a common but disputed entity. It is unclear whether AAMI is a phenomenon of normal aging or an early sign of Alzheimer's disease. The present study aimed to identify possible structural abnormalities in the medial temporal lobe of AAMI subjects. We measured volumes of the hippocampus and amygdala by MRI in 16 AAMI subjects and in 16 age- and sex-matched controls and correlated the volumes with subjects' performance on two visual memory tasks (the Benton and the Heaton visual retention tests) and on a verbal memory task (the Buschke-Fuld Selective Reminding Test). The mean hippocampal and amygdaloid volumes normalized for brain size per se did not differ between the two study groups. In controls, but not in AAMI subjects, the right hippocampus was larger than the left. Accordingly, the volumetric asymmetry between the right and left hippocampi was smaller in AAMI subjects than in controls (Student's t test, p < 0.05). The volume of the right hippocampus (r = 0.37, n = 32, p < 0.05) and the magnitude of the asymmetry between the right and left hippocampi (r = 0.38, n = 32, p < 0.05) correlated with total score on the Benton test. We also found significant correlations between the amygdaloid volumes and the performance on visual memory tests but not with score on the verbal memory test.(ABSTRACT TRUNCATED AT 250 WORDS)

Decrease in brain choline-containing compounds following a short period of global ischemia in gerbils as detected by 1H NMR spectroscopy in vivo

Cerebral metabolism was studied in the postischaemic gerbil brain using surface coil 31P and 1H NMR spectroscopy. The ratio of choline-containing compounds (Cho) to total creatine (Cr) in the brain decreased from 0.46 +/- 0.02 to 0.32 +/- 0.02 by the fifth day following exposure to 5 min of global ischaemia and it remained at this low level for at least 19 days. The amounts of cerebral Cho as quantified by 1H NMR in vivo were 1.70 +/- 0.15 and 1.09 +/- 0.22 mmol/kg in control and postischaemic animals, respectively. The T2 of Cho was longer in the postischaemic cerebral cortex than in the control one. N-acetyl aspartate (NAA) as determined by 1H NMR in vivo did not differ in the two animal groups. High-resolution 1H NMR of acid-extracted brain cortices showed a decrease in total Cho (glycerophosphocholine, phosphocholine and choline) by 31%, but no changes in NAA, total creatine, taurine and myo-inositol, in the brain cortex seven days postischaemia relative to control animals. The decrease in acid extractable Cho was mainly due to the drop in glycerophosphocholine concentration. 31P NMR indicated normal energy state and phosphomonoester/phosphocreatine (PCr) and phosphodiester/PCr ratios in the in vivo brain 7 days postischaemia. Silver impregnation did not reveal neuronal degeneration but immunohistochemical staining showed a number of glial fibrillary acidic protein expressing astrocytes as indicators of reactive gliosis in the postischaemic cerebral cortex. These data show, for the first time, that a 1H NMR decrease in Cho metabolites takes place as a consequence of brief ischaemic episode even in the absence of obvious neuronal degeneration.

A long-term follow-up study of cerebrospinal fluid somatostatin in delirium

Cerebrospinal fluid somatostatin-like immunoreactivity (CSF SLI) was determined for elderly delirious patients during the acute stage and after 1- and 4-year follow-up periods, and the SLI levels were compared with age-equivalent controls. As a whole group, and also when the group was subdivided according to the severity of cognitive decline at the acute stage, type of delirium or the central nervous system disease, delirious patients showed significant reduction of SLI as compared with the controls. In the follow-up, we observed a further reduction of CSF SLI together with significant correlations in the second, third and fourth samples between SLI levels and Mini-Mental State Examination scores. Our results suggest a role for somatostatinergic dysfunction in the genesis of some symptoms of delirium, and this dysfunction may be linked to the long-term prognosis of delirious patients.

Spatial learning and noradrenaline content in the brain and periphery of young and aged rats

The present experiment studied whether a dysfunction of the noradrenergic neurons is related to spatial learning impairment by investigating the levels of noradrenaline in the brain and periphery as well as the acquisition of water maze task in saline-pretreated young rats, in noradrenergic neurotoxin (DSP-4)-pretreated young rats and in saline-pretreated aged rats. Aged rats, which had an increased escape latency onto the hidden platform, revealed a decreased noradrenaline content in the heart, but not in the hippocampus, striatum, or hypothalamus, whereas DSP-4-pretreated rats had decreased noradrenaline content in the brain; the acquisition of water maze task was not impaired. These results suggest that the peripheral noradrenergic system can show age-related changes different from those in the central noradrenergic system, and they failed to provide support for the hypothesis that decreased activity of the central noradrenergic nerves is related to impairment in the acquisition of the water maze task.

A long-term follow-up study of cerebrospinal fluid acetylcholinesterase in delirium

Cerebrospinal fluid acetylcholinesterase (CSF AChE) was determined for elderly delirious patients during the acute stage and after a 1- and 4-year follow-up periods, and the AChE levels were compared with age-equivalent controls. The AChE levels measured during the index admission correlated with the length of life after delirium, suggesting that cholinergic dysfunction may have prognostic significance in delirious patients. Although the CSF AChE concentrations measured during the index admission were in the same range as in controls, we observed a declining trend in patients with various structural brain diseases during the follow-up period. The decreasing levels may reflect the progression of the underlying dementia in these patients.

Subjective memory complaints and personality traits in normal elderly subjects

OBJECTIVE

To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states.

DESIGN

Cross-sectional two-group comparison.

SETTING

The city of Kuopio in Eastern Finland, considered representative of the urban elderly population of Finland.

PARTICIPANTS

Originally 403 subjects aged 67-78 years from the random sample and then two matched study groups initially including eighteen subjects but only ten in the final analysis.

MEASUREMENTS

Screening and follow-up examinations of subjects with and without subjective memory complaints: (1) Memory functions: Benton's visual retention test and the paired-associated learning subtest of Wechsler Memory Scale. (2) Memory complaints: Memory Complaint Questionnaire. (3) Personality traits and affective state: Two subscales from Minnesota Multiphasic Personality Inventory and Geriatric Depression Scale.

RESULTS

Complaints of memory loss did not correlate with the actual memory performance in the tests. However, those subjects who most emphatically complained of memory disturbance had greater tendencies toward somatic complaining, higher feelings of anxiety about their physical health, and more negative feelings of their own competence and capabilities than those who did not complain of memory deterioration associated with aging.

CONCLUSIONS

The study suggests that subjective feelings of memory impairment are more closely associated with personality traits than with actual memory performance in normal elderly people.

The effects of selective alpha-2 adrenergic agents on the performance of rats in a 5-choice serial reaction time task

The present study investigated how the systemic administration of alpha-2 adrenergic agents that modulate the function of the noradrenergic system in brain, affect rousal and sustained attention. Food-deprivated rats were trained to detect and respond to brief flashes of light presented randomly in one of five spatially diverse locations. The effects of single-dose administrations of dexmedetomidine, an alpha-2 agonist, and atipamezole, an alpha-2 antagonists, on the choice accuracy, errors of omissions, speed of responding, and collection of the reward could be assessed in this task. Dexmedetomidine increased the amount of omissions, speed of response, and decreased the number of premature responses, although it did not markedly lengthen response latencies and food collection latency. Atipamezole increased the number of premature responses. Neither dexmedetomidine nor atipamezole had any effect on choice accuracy of rats in this task. The results suggest that dexmedetomidine decreased behavioral activity and arousal of rats, whereas atipamezole had mild stimulant effect on behavior.

Place of newer antiepileptic drugs in the treatment of epilepsy

There are several new antiepileptic drugs undergoing extensive clinical investigation. Five new drugs--vigabatrin, lamotrigine, gabapentin, felbamate and oxcarbazepine--appear to be the most widely tested and promising agents. Vigabatrin is most effective in drug-resistant partial epilepsy. Vigabatrin is also effective in infantile spasms, but seems to have negative effects on myoclonic epilepsies and absence seizures. Lamotrigine and felbamate seem to be effective in partial epilepsy and in Lennox-Gastaut syndrome. In addition, lamotrigine and felbamate seem to have efficacy in idiopathic generalised epilepsies. Oxcarbazepine appears to be equally as effective as carbamazepine, but less toxic. Gabapentin has few adverse effects and has efficacy in some patients with drug-resistant partial epilepsy. Some of the new antiepileptic drugs modify excitatory or inhibitory amino acid transmission, but some of them may employ new, still unknown mechanisms of action. Depending on the mechanism of action, the therapeutic effectiveness of the antiepileptic drugs may differ in specific epileptic syndromes. Future antiepileptic drugs may thus give us the possibility to design rational polypharmacy for individual patients by combining agents with different spectra of effectiveness. Considering the goal of good tolerability in the development of the new antiepileptic drugs, polypharmacy with these agents is not expected to increase adverse effects significantly.

Preservation of hippocampal NMDA receptors may be crucial for spatial learning after epileptic seizures in rats

Sustained electrical stimulation of the perforant pathway (PP) was used to induce hippocampal seizures in conscious rats. About 4.5 h prior to stimulation, animals were given i.p. injections of either saline or CGP 39551 (10 mg/kg), a competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor. When tested 2 weeks later in water maze, the saline pretreated rats showed a severe impairment in spatial learning whereas the animals treated with CGP 39551 had the same escape latencies as the non-stimulated controls. Histological evaluation of cellular degeneration revealed that the number of somatostatin-immunoreactive (SOM-IR) neurons in both stimulated groups was reduced almost equally, but in the CGP 39551 treated animals pyramidal cell damage was partly protected. However, in contrast to the placebo group, NMDA-sensitive [3H]glutamate binding in strata radiatum and oriens of the CA1 area was not significantly reduced in the CGP 39551 group. Thus, the present results suggest that the CGP 39551 treatment was able to protect against the delayed phase of the excitotoxic cell damage, and that the preservation of NMDA receptors partly accounts for the good learning ability of the CGP 39551 pretreated, PP-stimulated rats.

Circulating immune complexes in sera from patients with Alzheimer's disease and subjects with age-associated memory impairment

Before, we reported a higher frequency of circulating immune complexes (CIC) in the sera from institutionalized Alzheimer's disease (AD), multi-infarct dementia and Down's syndrome patients than from age-matched controls. In this study, we tested the presence of CIC in the sera from an extended series of hospitalized AD patients, AD patients living in the community, from age-associated memory impairment (AAMI) subjects as well as from nursing home and community controls. We used two methods to measure CIC, C1q binding Elisa (C1qB-Elisa) and conglutinin binding (KgB-Elisa). The AD patients showed the highest frequency of positive findings and differed from the controls in KgB (42% vs. 17%) (Chi-square, p = 0.01) and C1qB (30% vs. 11%) (p < 0.05). In severe AD, 14/19 patients were KgB positive and 11/19 were C1qB positive and differed from controls. The frequency of CIC for the patients with moderate or mild dementia, the AAMI subjects and controls was similar. In the multivariate linear regression analysis, high CIC values of the AD patients significantly associated with a long disease duration and a history of recurrent urinary infections but not with age, sex, hospitalization, or the Mini-Mental Status score. We conclude that AD patients with severe dementia frequently show CIC but those with mild or moderate disease do not. The CIC relate to a long disease duration and a history of recurrent urinary infections.

Antiplatelet therapy is effective in primary prevention of myocardial infarction in patients with a previous cerebrovascular ischemic event

OBJECTIVE

A secondary subgroup analysis of the European Stroke Prevention Study of the effect of antiplatelet medication on the risk of myocardial infarction.

DESIGN AND SETTING

A randomized, double-blind placebo-controlled study with two parallel treatment groups (dipyridamole plus aspirin and placebo). Sixteen centers from six countries participated in the study.

PATIENTS

A total of 2500 patients who had had one or more transient ischemic attacks or cerebral infarctions participated.

INTERVENTION

Combination therapy with dipyridamole (75 mg three times a day) and aspirin (330 mg three times a day) was compared with placebo during 24 months' follow-up.

OUTCOME MEASURES

Prevention of fatal and nonfatal myocardial infarction.

RESULTS

A total of 105 myocardial infarctions occurred in the intention-to-treat analysis and 76 occurred in the explanatory analysis. The overall risk reduction of myocardial infarction with the study drugs was approximately 40% in both statistical analyses, but the result was statistically significant only in the intention-to-treat analysis. Therapeutic efficacy was better among male patients, patients younger than 65 years, and patients with hypertension.

CONCLUSION

Combination therapy with dipyridamole and aspirin reduces not only the risk of cerebrovascular ischemic events but also the risk of myocardial infarction.

The induction of LTP increases BDNF and NGF mRNA but decreases NT-3 mRNA in the dentate gyrus

We have investigated the expression of the mRNAs for brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), neurotrophin-3 (NT-3) and neurotrophin-4 (NT-4) in the hippocampus before and after induction of long term potentiation (LTP) of synaptic transmission in the dentate gyrus through stimulation of the perforant path (PP). A unilateral PP stimulation produced a bilateral increase in the mRNA for both BDNF and NGF in granular neurones of the dentate gyrus but not in other neurones in the hippocampus. The mRNA for neurotrophin-3 (NT-3) was bilaterally decreased by LTP but that of NT-4 remained at the basal level. These results suggest that individual neurotrophic factors may play different roles in neuronal plasticity.

Epileptogenic spikes and seizures but not high voltage spindles are induced by local frontal cortical application of gamma-hydroxybutyrate

Combining the methods of microdialysis and EEG recording, we have examined the effect of unilaterally, intracortically applied gamma-hydroxybutyrate (GHB) on frontal cortical EEG activity in freely moving rats. GHB, a natural endogenous GABA metabolite, is known to induce rhythmic spike and wave activity, resembling generalized petit mal epilepsy. Without GHB, spontaneous high voltage spindles (HVS, 6-9 Hz) were observed during awake and immobile behavior in most of the animals (HVS rats), while others never had any HVS. In those both groups of animals intracortical application of GHB induced epileptogenic spikes (< 0.5 Hz) behaviorally accompanied by occasional myoclonic jerks and epileptic discharges (< 2 Hz) with behavioral convulsions and contraversive movements towards the left hindlimb (seizures) but did not induce HVS or spike and waves, as reported after systemic application. In the group of rats with spontaneous occurring HVS the amplitude of the HVS on the side of the microdialysis probe was suppressed by GHB and GHB-induced spikes invading the contralateral cortex frequently triggered and terminated local HVS. The results point to different neural mechanisms for the generation of HVS and spikes and epileptic discharges (seizures) induced after local intracortical application of GHB.

Long-term alterations in NMDA-sensitive L-[3H]glutamate binding in the rat hippocampus following fimbria-fornix lesioning

Subcortical deafferentation of the rat hippocampus has been suggested to offer a model for developing limbic epilepsy. In the present study, the long-term effect of fimbria-fornix lesioning on the density and distribution of hippocampal N-methyl-D-aspartate (NMDA)-sensitive L-[3H]glutamate binding was studied using quantitative autoradiography. Compared to controls of the same age, the fimbria-fornix-lesioned (FFL) rats showed 1 year after lesioning a uniform, 20-33% increase in NMDA receptor density throughout the hippocampus, which was statistically significant in the stratum radiatum of the CA1 area (P = 0.001 and P < 0.05) and in the inner and outer halves of the dentate molecular layer (P < 0.05 for both). The increased receptor density in the FFL rats may reflect a long-term process of regeneration within the hippocampal formation, which could partly account for the maintenance or development of epileptogenity. The control animals, which were over 1 year old, showed lower binding density than young animals in all areas measured, thus suggesting a decrease in NMDA receptor binding during normal aging.

Dose- and parameter-dependent effects of atipamezole, an alpha 2-antagonist, on the performance of rats in a five-choice serial reaction time task

The present study investigated whether atipamezole (ATI), a potent alpha 2-adrenoceptor antagonist that increases the release of noradrenaline in brain, improves attention in rats. Thus, the effects of ATI on the performance of adult male rats in the five-choice serial reaction time task were studied. Food-deprived rats were trained to detect and respond to brief flashes of light presented randomly in one of five spatially diverse locations. The effects of single-dose administration of ATI (0.03-3.0 mg/kg) on the performance of rats under different parametric manipulations of the task were tested: 1) the visual stimuli were presented at unpredictable intertrial intervals (ITIs) or b) the intensity (brightness) of visual stimuli was reduced, thus placing an additional load on attentional processing for animals. Presenting the stimuli earlier than normally or reducing its intensity markedly impaired the choice accuracy of rats. At doses of 0.03, 0.3, and 1.0 mg/kg, ATI improved the choice accuracy of rats when tested using reduced stimulus intensity. ATI 3.0 mg/kg did not affect accuracy performance when tested using reduced stimulus intensity but impaired it when tested using unpredictable ITIs. The other doses of ATI (0.03, 0.3, and 1.0 mg/kg) did not markedly affect choice accuracy of rats tested using unpredictable ITI. Our results could be explained by the assumption that an acute, systemic administration of ATI affects arousal mechanisms and facilitates the processing of visual stimuli related to reward.

The effects of tacrine and zacopride on the performance of adult rats in the working memory task

1. The present study investigated the effects of tacrine (an inhibitor of acetylcholinesterase) and zacopride (the antagonist of 5-HT3 receptors) on the performance of adult rats in a continuous operant delayed non-matching to position task assessing spatial working memory. 2. Adult rats had a decline in the percent correct responses at the longest delays (16 and 30 sec) in this task. Tacrine (1.0 mg/kg) or zacopride (0.0025, 0.05, 1.0 mg/kg) did not increase the percent correct responses at any time delays. The higher dose of tacrine reduced behavioural activity (e.g. the decreased number of trials completed and increased sample press latency) of rats during memory testing, and it slightly increased choice accuracy across all the delays. 3. The combination of zacopride (1.0 mg/kg) and tacrine (1.0 mg/kg) increased the percent correct responses at the shortest delays, but not at the longest delays. 4. These results indicate a non-mnemonic improvement in the accuracy performance of rats, and they suggest that the effects of acute, systemic administrations of zacopride (which is thought to increase the release of acetylcholine) or/and tacrine (which inhibits the breakdown of acetylcholine) do not improve spatial working/short-term memory in rats.

Amino acid levels in the cerebrospinal fluid of newly diagnosed epileptic patients: effect of vigabatrin and carbamazepine monotherapies

We studied the CSF amino acid levels of 42 patients with newly diagnosed epilepsy before treatment with antiepileptic medication and during monotherapy with either vigabatrin or carbamazepine. The present study shows that patients with newly diagnosed epilepsy have elevated levels of the excitatory amino acid glutamate in CSF. Vigabatrin monotherapy effectively prevents the appearance of seizures in patients with high baseline CSF glutamate levels. In these patients, vigabatrin not only elevates the levels of gamma-aminobutyric acid, but also decreases the elevated levels of glutamate in CSF, which may also be important to the antiepileptic efficacy of vigabatrin. Patients with low CSF glutamate levels did not benefit from vigabatrin-induced changes in amino acid levels and successful monotherapy with carbamazepine did not affect CSF amino acid levels. The elevation of gamma-aminobutyric acid is thus not the only way to achieve seizure control and there are several factors underlying the generation and control of seizures. Follow-up of the patients with high baseline glutamate CSF levels will show if the observed abnormalities are related to the severity of epilepsy in individual patients and if early treatment with vigabatrin of these patients could prevent the development of intractable epilepsy.

A prospective study of delirium in elderly patients admitted to a psychiatric hospital

Seventy consecutive elderly patients meeting the DSM-III criteria for non-alcohol delirium were examined during the acute stage and followed to four years later. The mean age of the patients at the beginning of the index admission was 74.8 +/- 6.4 years. The most common aetiologies for delirium were stroke, infections and metabolic disorders. Coexistent structural brain disease predisposing to delirium was found in 57 cases (81%). During the index admission, the cognitive dysfunction associated with delirium ameliorated significantly (mean +/- S.D. Mini Mental State Examination score 9.7 +/- 6.6 at admission and 13.9 +/- 7.2 at discharge, P < 0.001), but during the follow-up period of four years progression of the basic central nervous system disease was observed together with declining cognition and deteriorating functions of daily living. Four patients died during the index admission and 42 patients during the follow-up period. In decreased patients there was a statistically significant connection between the levels of cognitive functioning and functions of daily living at the end of the index admission and the life span after delirium.