General practitioners facing dementia: are they fully prepared?

We assessed knowledge about Alzheimer's disease (AD) in a sample of Italian general practitioners (GPs). We first carried out a propedeutic study to verify the ability of an Italian version of the University of Alabama at Birmingham's AD Knowledge Test for Health Professionals to distinguish between 20 AD specialists and 20 non-specialists and to gain reference values. We then administered the test, together with a short questionnaire, to 139 GPs attending an educational programme in November 2000. The cut-off score for discriminating specialists from non-specialists was >/=9. Among the 95 GPs who performed the AD Knowledge Test (68.3% response rate), 21% had a total score >/=9. Our findings suggest that particular focus should be given to dementia in continuing medical education (CME) programmes for GPs.

Hippocampus and parahippocampal gyrus linear measurements based on magnetic resonance in Alzheimer's disease

MRI-based linear measurements of the hippocampus and parahippocampal gyrus complex (HPC) discriminated 39 subjects with probable Alzheimer's disease, from 15 patients with other dementias and 33 miscellaneous controls without evidence of dementia. The best discriminating parameter was the left height of the HPC at the level of the mammillary bodies, with a sensitivity of 79.49% and a specificity of 68.75%. The diagnostic value of these results is discussed considering the volumetric data found in the current literature.

Posttraumatic epilepsy risk factors: one-year prospective study after head injury

PURPOSE

Prospective evaluation of risk factors for posttraumatic epilepsy (PTE) by using clinical, EEG, and brain computed tomography (CT) data in four assessments from the head injury (HI) acute phase to 1 year later; and evaluation of the possible epileptogenic role of hemosiderin as shown by brain magnetic resonance imaging (MRI).

METHODS

Risk factors for PTE were evaluated by using Kaplan-Meier curves, log-rank test, and the Cox model in 137 consecutively enrolled adult inpatients. Percentage differences of patients with brain hyperintense and/or hemosiderin areas shown by MRI 1 year after HI were statistically evaluated by univariate tests considering two subgroups [e.g., patients with (PTE) and without (WLS) late seizures].

RESULTS

The PTE subgroup included 18 patients with at least two seizures between the second and twelfth months. Kaplan-Meier curves demonstrated that Glasgow Coma Scale low score, early seizures, and single brain CT lesions are PTE risk factors, as is the development of an EEG focus 1 month after HI. No significant percentage difference was found between PTE and WLS patients with hemosiderin spots shown by MRI 1 year after HI.

CONCLUSIONS

the Cox model indicates that, for HI patients with early seizures and brain CT single temporal or frontal lesions in the acute phase, the PTE risk is 8.58 and 3.43 times higher, respectively, than for those without. An EEG focus 1 month after HI is a risk factor 3.49 times higher than for patients without such EEG changes. One year after HI, a higher percentage of PTE than WLS patients had cortical MRI hyper-intense areas including hemosiderin.

EEG power spectrum differences in early and late onset forms of Alzheimer's disease

OBJECTIVE

To evaluate the relationship between some EEG spectral parameters and age of onset of Alzheimer's disease (AD).

METHODS

A study on the wakefulness EEG, recorded during eyes closed and open, was carried out on 150 AD patients (NINCDS-ADRDA criteria). Fifty-two normal subjects served as controls.

RESULTS

A significant prevalence of an EEG spectrum characterised by lack of a dominant peak in the 6.5-12 Hz band was found in early AD (EAD). Age of onset correlated inversely with the 1-6.5 Hz relative powers and positively with 6.5-12 Hz relative powers. A similar correlation was also found when a subgroup of mild initial AD was selected. Moreover, evidence of EEG changes peculiar to early onset AD emerged when 3 subgroups (with age of onset < or =60, range 61-69 and > or =70 years) were compared.

CONCLUSION

Irrespective of the severity of disease, this study provides evidence of specific changes of wakeful EEG in patients affected by early-onset AD.

Depression after stroke: an investigation through catamnesis

BACKGROUND

In the early stage of stroke, depression appears to be linked to certain brain areas. The study evaluated the importance of the side of the lesion in depressed patients 3 years after their first stroke.

METHOD

Patients who had suffered a stroke and been discharged after rehabilitation were identified by hospital records. We interviewed 180 patients at home. Demographic as well as socioeconomic data were collected. The North-western University Disability Scale, the Beck Depression Inventory (BDI), the Relatives' Stress Scale, and the Social Dysfunction Rating Scale were applied. The diagnosis was confirmed for each patient by a clinical assessment according to the ICD-10 criteria. Patients with previous psychiatric treatment, comprehension problems, or severe hemi-inattention were excluded.

RESULTS

By using a score of 14 on the BDI as a cutoff, 62 patients (34%) proved to be affected by depressive disorders. Clinical records showed that the location of the lesion was in the right hemisphere for 37 patients and in the left hemisphere for 25 patients. Statistical analysis of the mean scores obtained in this subgroup of depressed patients showed (1) no significant relation between depression and the hemispheric location of the lesion or between depression and level of education; (2) relation between BDI score and social activities; and (3) stress on the relatives that was mainly dependent on both the disability of the patients and their loss of social activities, whereas depression played a minor role.

CONCLUSION

A high percentage of patients have depressive disorders 3 years or more after the stroke, independent of the side. Such mood disorders worsen the relationship between the disabled patients and their relatives and worsen leisure independent of the affected hemisphere.

EEG power spectrum typical of vascular dementia in a subgroup of Alzheimer patients

A statistical comparative study was carried out between two subgroups of patients with dementia, i.e. 22 with Alzheimer's dementia (AD, 44% of the entire Alzheimer group examined) and 36 with vascular dementia (VaD, 97% of the entire vascular group). The selection of the two subgroups was based on a similar EEG spectral profile in the rest eyes closed condition: a great increase in low frequency powers and a dominant activity in the 6.5-12 Hz band. The aim was to identify any possible difference between the two groups analysing the spectral descriptors, of the two conditions eyes closed and open, the demographic figures and the mental deterioration scores. The results are as follows: (i) the spectral profiles and their numerical descriptors of the AD subgroup patients are not distinguishable from the same parametric figures of the VaD patients; (ii) the spectral analysis becomes useful in differentiating the two types of dementia when a dynamic EEG is processed, i.e. the power ratio of recordings during eyes closed and open; (iii) a more severe mental deterioration, especially in attention and spatial and temporal orientation was found in the AD group as compared to the VaD. The findings are explained in the light of the changes in neural mechanisms which underlie both the alpha and slow rhythms.

An EEG power index (eyes open vs. eyes closed) to differentiate Alzheimer's from vascular dementia and healthy ageing

EEG differential power patterns between Alzheimer's (AD, 50 patients) and vascular (VaD, 37 patients) dementia and between these two and 36 healthy ageing subjects, were studied in the 6.5-12 Hz band of the ongoing EEG recorded during the rest eyes closed (REC) and eyes open (REO) conditions. From the EEGs (16 electrodes, 10-20 international system except for Fz, Cz, Pz), a 6.5-12 Hz band, wider than the alpha range (alpha-like), was chosen and processed to include the highest theta frequencies characterising the occipital dominant activity in dementia. A global and occipital EEG Power Index (PI) was calculated and used considering the absolute powers during REC and REO. The MANOVA was used to compare the figures. Bearing in mind that the higher the PI value the greater the difference between the 6.5-12 Hz EEG band powers of REC vs. REO, the results were as follows: (i) in the patients with Alzheimer's and vascular dementia the global and occipital PIs were significantly lower than those in controls; (ii) in the patients with Alzheimer's dementia the same PIs were significantly lower that those of the patients with VaD; (iii) healthy elderly subjects showed significantly lower powers in the 6.5-12 Hz frequencies at T5 and O1 in REO as compared to dementia patients. The pathophysiological implications and the clinical applications of these results are discussed.

Axillary neuropathy in volleyball players: report of two cases and literature review

Two cases of isolated neuropathy, not consequent to acute trauma, of the axillary nerve of young volleyball players are described. Interest in the pathology derives from the rarity of such case reports and the fact that the pathogenesis may be linked to a specific sporting activity. The lesion site is thought to be in the quadrilateral space.

Electrically evoked long-latency responses in human forearm, arm and shoulder muscles

Little is known about electrically evoked long-latency responses (LLR) in muscles other than hand muscles. We obtained LLR in forearm, arm and shoulder muscles by ipsilateral homonymous and heteronymous mixed and pure cutaneous electrical stimulation of the median or ulnar nerve in healthy subjects and in patients with focal unilateral Central Nervous System lesions. Our results point out the important role played by hand afferents in the sensorimotor coordination of multiarticulate upper limb movements.

EEG spectral analysis in vascular and Alzheimer dementia

The role of EEG spectral analysis in the diagnosis of syndromes of dementia is still disputed. Since there have been few studies dealing with the profile of power spectra, the present investigation has focused on this aspect, constructing power spectra taken from 16 derivations and calculated by averaging twenty 2 sec epochs, using a serial array of frequencies from 1 to 32 Hz. The spectral analysis of the EEG, recorded under awake resting eyes closed (REC) and open (REO) conditions, was performed in 50 patients with Alzheimer's disease (AD), 37 with vascular dementia (VaD) and 36 elderly controls. Three spectral profiles were found under REC: (i) type A, showing a dominant 6.5-12 Hz peak (44% AD, 97.3% VaD), although lower than in controls; (ii) type B, lacking a dominant peak in the 6.5-12 Hz band, but characterised by high power in 1-6.5 Hz band (44% AD, 2.7% VaD); (iii) type C, corresponding to a flat, low voltage, spectrum (12% AD). Unlike controls, demented patients showed an increased REO/REC power ratio in the 6.5-12 Hz band, especially in those with type B spectra. AD patients with type B spectra had an earlier age of disease onset.

The influence of depression, social activity, and family stress on functional outcome after stroke

BACKGROUND AND PURPOSE

This study was designed to assess the quality of life after an active poststroke period of rehabilitation and to investigate the possibility of a return to a working environment for those still of working age.

METHODS

The study was conducted on 180 consecutive patients affected by stroke who were hospitalized for the first time and discharged at least 1 year before the study. The group consisted of 65% men and 35% women with a mean age 65.29 years (SD, 11.22). The period between the stroke and the interview ranged from 12 to 196 months, with a mean of 37.5 months. The average Rankin score on discharge from the rehabilitation center was 2.718 (moderate handicap). The interview took place at home after consent obtained by telephone. The questionnaire included general and personal information regarding the individuals, their socioeconomic position, and scales for daily activity, depression, social activity, and stress produced in the family. The control group consisted of 167 age-matched subjects.

RESULTS

A close correlation was observed in all patients between depression, social activity, and stress caused to relatives. The scores on the individual scales were clearly worse than those for control subjects. The patients received approximately 5 months of rehabilitation after the stroke. Differences emerged between men and women for depression and social activities, with the women scoring worse. In reference to daily life, 70% of prestroke ability was required on average after rehabilitation. The daily activity score at the time of the interview was also strongly influenced by the discharge score. The majority of patients were retired. Of the total, 20.64% returned to work, but not always to the same job and often after readapting to new conditions. Of this population, only 31.5% were women. With regard to the population aged younger than 65 years, 21.42% returned to work. Lesions in the dominant hemisphere do not necessarily seem to rule out return to work, even if associated with aphasia. The main discriminating element was the ability to understand language. The patients were often criticized by their cohabitants; the criticisms most often raised concerned apathy, irritability, and self-centeredness. Sexual activity was depressed in almost all cases.

CONCLUSIONS

Despite the progress made in studying cerebral vasculopathies, patients in the aftermath of a stroke still seem to live unsatisfactorily, as they did many years ago. Useful measures include valid treatment against spasticity, psychological assistance, and greater social support.

Acute monophasic focal demyelinating diseases of the central nervous system: longitudinal clinico-neuroradiological study of two patients

We report the clinical features and laboratory-instrumental findings in two patients with acute monophasic demyelinating disease with focal clinical expression: one case of incomplete cervical transverse myelitis and one of focal supratentorial encephalitis. We describe the clinical course and evolution of the neuroradiological findings (CT and MRI) and discuss their pathological meaning and diagnostic value.

[Epidemiologic study on the effectiveness and safety of dihydroergocristine in impaired memory and behavioral functions in aged humans]

Aim of the study was to assess the activity of dihydroergocristine (DHEC, CAS 17479-19-5) in aged patients with impaired cognitive function. Twenty-five university hospital centres and 250 physicians participated in the study. 2,600 patients (1,104 males and 1,496 females, age range 50-80 years) were admitted to the study. Each patient was administered 6 mg/d DHEC for 120 days. Clinical evaluation was made through the SCAG Rating Scale registered at basal time, after 60 and 120 days. Responsivity to treatment was considered high when the final score was reduced by 30% and none if less than 10%. Analysis of results demonstrated that at the end of the study responsivity was high in 73% of cases, moderate in 20.4% and absent in 6.5%. Tolerability was very good as side effects were reported only in 3.16% of patients. Most frequent side effects were: nausea (1.23%), gastralgia (1.11%), headache (0.29%), hypotension (0.12%), vertigo (0.12%) and rash (0.08%). Drop-outs for gastralgia were reported only in 0.53% of the patients.

Autonomic diabetic neuropathy: skin sympathetic response and neurovegetative cardiovascular functionality tests

One hundred and twelve diabetic patients were submitted to several tests for evaluation of autonomic cardiovascular and sudomotor function. It was found that a patient could be positive to one test and negative to others, thus confirming the presence of sectorial lesions which do not affect the autonomic nervous system uniformly. The parasympathetic system is more frequently and precociously affected than the sympathetic system. The tests used for investigating the sympathetic component, the sympathetic skin response (SSR) gives results which are more frequently and precociously altered.

Chronic multifocal demyelinating neuropathy simulating motor neuron disease

We describe a patient with a chronic acquired predominantly motor polyneuropathy. His clinical picture initially led to a diagnosis of lower motor neuron form of amyotrophic lateral sclerosis. However electrophysiological examination revealed multifocal, prevalently proximal, conduction blocks at sites not prone to compression. Distinguishing this unusual polyneuropathy from motor neuron diseases is critical, since the former is a potentially, treatable disorder.

Transcranial Doppler sonography as a diagnostic tool in vascular dementia

Transcranial Doppler monitoring of the flow velocity at the level of the middle cerebral artery was performed in 40 demented patients, 20 with multi-infarct dementia (MID) and 20 with senile dementia of the Alzheimer type (SDAT), and in 25 age-matched controls. The following conditions were evaluated: (1) rest; (2) 60 s hyperventilation; (3) longest possible apnea, and (4) 5 min closed-circuit air rebreathing. We also measured: PaCO2 levels at rest and under stimulus conditions; mean flow velocity and pulsatility index (PI) at rest, and percentage velocity variations. The PIs were higher and the velocity decrease during hyperventilation was lower in all demented patients than in the healthy group; no side-related asymmetry in rest values or in vasomotor responses to CO2 changes was regularly detected in any group. On the contrary, rest flow velocities and vasomotor responses to hypercapnia induced by both apnea and rebreathing tests proved to be lower in MID patients than in SDAT and healthy groups. These alterations were neither exclusive to MID patients nor homogeneous, therefore some caution should be taken when evaluating single cases.

Meningoencephalomyeloradiculoneuritis in one case of Borrelia burgdorferi infection (Lyme disease)

We describe a patient having serologically confirmed Borrelia burgdorferi infection manifesting meningoencephalomyeloradiculoneuritis. The clinical and MRI features suggested a multifocal vascular nervous system involvement. EMG-ENG showed abnormalities consistent with axonal degeneration initially involving the more proximal segments of the lower limb nerves.

Lumbar myelography with iopamidol: a methodological approach to the investigation of side effects

Pathophysiology of adverse reactions occurring during myelography with non-ionic contrast agents, such as iopamidol, seem related to their direct action on the nervous system. The authors try a multivariate approach, involving neurophysiological, neuropsychological and neurochemical parameters on a pilot group of twelve subjects. Any possible change in the above examinations is thoroughly analyzed and correlated to the postulated neurotoxic properties of contrast media.

[On a case of Fahr's disease]

A case of idiopathic Fahr's disease with interesting clinical and neuroradiological findings is described. The nosological identity and the pathogenetic factors of this complex condition are discussed.

Duchenne muscular dystrophy. Morphological study of erythrocytes after treatment with L-alpha-lysophosphatidyl-choline in dystrophic patients and in the carrier state

The percentage of echinocytes in the blood from patients affected by Duchenne muscular dystrophy, in mothers carriers of the dystrophic state, and in Steinert dystrophic patients, has been investigated after addition of low levels of lysolecithin. The echinocyte content was significantly higher in both Duchenne patients and in carriers, and lower in Steinert patients than in controls. The extents of the differences suggest the possibility to use this methodology as a diagnostic test in Duchenne muscular dystrophy.

[Erythrocyte membrane in Duchenne muscular dystrophy. I. Sensitivity to lysolecithin in dystrophic patients and their families]

The percentage of echinocytes in the blood from patients affected by Duchenne muscular Distrophy was studied after red cells treatment with L-alpha-lysophosphatidylcholine. The echinocyte content was significantly higher in Duchenne patients and in the components of their families, as previously demonstrated is lower in Stainert patients. The sensitivity to lysophosphatidylcholine in Duchenne muscular Distrophy is a diagnostic test for carrier condition

Fluidity of erythrocyte membranes from patients with Duchenne muscular dystrophy: studies in intact erythrocytes and in ghosts

We have studied the alterations of fluidity in intact erythrocytes and in erythrocyte membranes from patients with Duchenne muscular dystrophy. The interest of this study was to comparison directly two types of results; these demonstrate an increase of fluidity in the erythrocytic membranes, no changes are present when the label is incorporated in intact erythrocytes. It might be inferred that hypotonic haemolysis removes components that are more weakly bound in Duchenne membranes, and that exert an immobilizing effect on the membrane lipids.

Biophysical studies of erythrocyte membranes from patients with duchenne muscular dystrophy

Lipid-soluble spin labels were used to probe the fluidity of membrane lipids in erythrocyte membranes from patients with Duchenne muscular dystrophy. A greater mobility of spin label motion was noticed at the surface of the Duchenne erythrocyte membranes in comparison with the similary labeled normal human erythrocytes. Changes in the protein conformation and/or protein-lipid organization, as a consequence of an altered membrane lipid fluidity, have been demonstrated by the use of a sulfhydryl group specific protein spin label. Strongly immobilized sulfhydryl groups appear to be located both at the membrane surface and deep within the lipid bilayer. The ratio of the spectral amplitude of the spin label attached to weakly immobilized sulfhydryl groups to that of strongly immobilized SH-groups is significantly greater in Duchenne membranes, compared to those of controls. These studies suggest alterations in lipid-protein organization at the surface of Duchenne erythrocytes, indicating that Duchenne muscular dystrophy may be a disease resulting from a membrane abnormality at the molecular level.

Progressive muscular dystrophy type Duchenne. I. Spin label studies on the physico-chemical state of erythrocyte membranes

Electron spin resonance studies of erythrocyte membranes from patients with Duchenne muscular dystrophy exhibit changes in the physical state of lipids and proteins in membranes when compared to membranes from normal subjects. The results suggest that the alterations in membrane lipid-protein organization are present in this disease.

Progressive muscular dystrophy type Duchenne. II. Viscosity and resistence to erythrolytic compounds of erythrocyte membranes

The transition temperature of erythrocyte ghosts of normal subjects is about 18-20 degrees C. We have studied the viscosity of erythrocyte ghosts of dystrophic children, showing that the transition shifts to lower temperatures (17-18 degrees C). After treatment with erythrocytic compounds like L-Lyso phosphatidyl-Choline dystrophic erythrocytes hemolize at lower Lysophosphatidyl-Choline concentration and at a greater extents than these of normal and carriers subjects.