Brain arteriolosclerosis

Brain arteriolosclerosis (B-ASC), characterized by pathologic arteriolar wall thickening, is a common finding at autopsy in aged persons and is associated with cognitive impairment. Hypertension and diabetes are widely recognized as risk factors for B-ASC. Recent research indicates other and more complex risk factors and pathogenetic mechanisms. Here, we describe aspects of the unique architecture of brain arterioles, histomorphologic features of B-ASC, relevant neuroimaging findings, epidemiology and association with aging, established genetic risk factors, and the co-occurrence of B-ASC with other neuropathologic conditions such as Alzheimer's disease and limbic-predominant age-related TDP-43 encephalopathy (LATE). There may also be complex physiologic interactions between metabolic syndrome (e.g., hypertension and inflammation) and brain arteriolar pathology. Although there is no universally applied diagnostic methodology, several classification schemes and neuroimaging techniques are used to diagnose and categorize cerebral small vessel disease pathologies that include B-ASC, microinfarcts, microbleeds, lacunar infarcts, and cerebral amyloid angiopathy (CAA). In clinical-pathologic studies that factored in comorbid diseases, B-ASC was independently associated with impairments of global cognition, episodic memory, working memory, and perceptual speed, and has been linked to autonomic dysfunction and motor symptoms including parkinsonism. We conclude by discussing critical knowledge gaps related to B-ASC and suggest that there are probably subcategories of B-ASC that differ in pathogenesis. Observed in over 80% of autopsied individuals beyond 80 years of age, B-ASC is a complex and under-studied contributor to neurologic disability.

Mid- and Late-Life Leisure-Time Physical Activity and Global Brain Amyloid Burden: The Atherosclerosis Risk in Communities (ARIC)-PET Study

BACKGROUND

Physical activity (PA) may slow the development of dementia by reducing the accumulation of amyloid.

OBJECTIVE

We tested the hypothesis that higher levels of leisure-time PA in mid- or late-life were associated with lower brain amyloid burden in late-life among 326 non-demented participants from the Atherosclerosis Risk in Communities Study of brain florbetapir positron emission tomography (ARIC-PET) ancillary.

METHODS

Self-reported PA was quantified using a past-year recall, interviewer-administered questionnaire in mid-life (1987-1989, aged 45-64 years) and late-life (2011-2013, aged 67-89 years). Continuous PA estimates were classified as 1) any leisure-time PA participation (yes/no); 2) meeting the 2018 United States' PA guidelines (yes/no); and 3) per 1 standard deviation (SD) higher metabolic equivalent of task (MET) minutes per week (MET·min·wk-1). A brain magnetic resonance imaging scan with Florbetapir PET was performed in late-life. Adjusted odds ratios (OR) of elevated amyloid burden, defined as a global cortical standardized uptake value ratio (>1.2), compared to no elevated amyloid burden were estimated according to PA measures.

RESULTS

Among the 326 participants (mean age: 76 years, 42% male, 41% Black), 52% had elevated brain amyloid burden. Mid-life leisure-time PA did not show a statistically significant lower odds of elevated late-life amyloid burden (OR = 0.71, 95% CI: 0.43-1.18). A 1 SD (970 MET. min. wk-1) higher PA level in mid-life was also not significantly associated withelevated amyloid burden (OR = 0.89, 95% CI: 0.69-1.15). Similar estimates were observed for meeting versus not meeting PA guidelines in both mid- and late-life.

CONCLUSION

Self-reported higher mid- and late-life leisure-time PA were not significantly associated with lower amyloid burden. Data show a trend of an association, which is, however, imprecise, suggesting replication in larger studies.

[Results of intelligence investigations in civil pilots with atherosclerotic changes in cerebral vessels]

Intelligence was evaluated in 73 normal civil pilots (control) and 70 with atherosclerotic cerebral vessels including 23 men with atheromas. Intelligence was evaluated with the use of computerized EPI (Gorbov's modification). Pilots with cerebral atherosclerosis tended to slightly decrease mean IQ values in comparison with the normal; IQ values remained high enough to attest professional efficiency. Atheromas did not impact results of the numerical (IQ2) and verbal (IQ3) tests. Hemodynamically negligible stable atheromas did not disturb cognitive functions of the pilots and, therefore, they were certified for continuation of the flight career.

[Individual psychological attributes of civil pilots with atherosclerotic cerebral vessels]

Object of investigation was types of personality of civil pilots. The investigation involved healthy pilots (n = 58, controls) and pilots afflicted with cerebral atherosclerosis (n = 67) including pilots with atherosclerotic plaques (n = 23). The personality questionnaire developed by L.N. Sobchik was used. The investigation showed that signs of personality accentuation in pilots with cerebral atherosclerosis were largely manifested by distortion of individual psychological attributes. This finding may be helpful to members of the medical flight certification board in making prognosis of pilot's health and professional longevity.

Predictors of subjective cognitive difficulties in older adults with atherosclerotic vascular disease

OBJECTIVE

The objective of this study was to describe the relationship among cognitive test performance, psychological symptoms, and subjective cognitive difficulties in older adults with atherosclerotic vascular disease.

METHOD

Participants were 80 adults over the age of 55 with an unequivocal diagnosis of atherosclerotic vascular disease. Participants completed measures of neuropsychological functioning, psychological symptoms, and two measures of subjective cognitive difficulties.

RESULTS

Psychological symptoms were most strongly associated with higher levels of reported cognitive difficulties. Overall neuropsychological functioning was modestly related to subjective cognitive difficulties but did not remain significant after controlling for psychological symptoms.

CONCLUSIONS

In this sample of older adults with atherosclerotic vascular disease, self-reported cognitive difficulties were most strongly related to overall level of psychological distress and not to actual cognitive test scores. Therefore, psychological factors may play an important role in the phenomenon of self-perceived cognitive decline in geriatric populations.

Cognitive and functional impairment in hypertensive brain microangiopathy

Brain microangiopathy, whose neuroimaging expression is represented by age-related white matter changes (ARWMC), is largely due to hypertension and it is, in turn, responsible for geriatric syndromes, including decline in cognitive, functional and motor/gait abilities. This review analyzes the link between hypertension and ARWMC, as well as the complex relationships between ARWMC and cognitive impairment, executive dysfunction, and movement/gait abnormalities. The available evidence supports the hypothesis that these functional consequences of ARWMC are responsible for substantial disability in the elderly. Thus, adequate treatment of hypertension may represent a feasible way to reduce the burden of disability in late life.

Clinically defined vascular depression in the general population

BACKGROUND

Vascular depression is regarded as a subtype of depression, especially in, but not entirely restricted to, the elderly, characterized by a specific clinical presentation and an association with (cerebro)vascular risk and disease. It could have major implications for treatment if subjects at risk for such a depression could be easily identified by their clinical presentation in general practice.

METHOD

We studied the symptom profile of depression in subjects with and without vascular risk factors in two large Dutch community-based studies, the Rotterdam Study and the Amsterdam Study of the Elderly (AMSTEL).

RESULTS

We could not confirm the specific symptom profile in depressed subjects with vascular risk factors in either of the two cohorts. Depressed subjects with vascular risk factors showed more loss of energy and more physical disability than those without vascular risk factors. However, presumed specific symptoms of vascular depression, namely psychomotor retardation and anhedonia, were not significantly associated with any of the vascular risk indicators. Loss of energy was significantly associated with myocardial infarction and peripheral arterial disease.

CONCLUSIONS

In these two large community-based studies we identified some differences between vascular and non-vascular depressed subjects but found no evidence for a specific symptom profile of vascular depression as previously defined.

Vascular risk and low serum B12 predict white matter lesions in patients with major depression

BACKGROUND

While patients with depression have been shown to have a greater incidence of vascular risk factors and structural brain changes, any association with dietary co-factors is unclear.

METHODS

Forty-seven patients with major depression (mean age = 52.8 years, SD = 12.6) and 21 healthy volunteers (mean age = 54.7 years, SD = 9.1) underwent high-resolution magnetic resonance imaging scanning. T2-weighted films were scored for deep white matter (DWM), periventricular (PV), and subcortical (SC) hyperintensities.

RESULTS

There was no difference in lesion severity between patients and control subjects. After controlling for age, vitamin B12 levels were predictive of DWM lesions in patients. DWM and SC lesions were associated with histories of hypertension and diabetes.

LIMITATIONS

A relatively small sample of patients were recruited from specialist services and the findings may not represent those observed in larger or community-based cohorts.

CONCLUSIONS

In patients with major depression, vitamin B12 levels and histories of hypertension and/or diabetes are predictive of white matter lesions.

[Psychological health status and nursing countermeasures of cerebral arterial sclerosis patients]

OBJECTIVE

To estimate the psychological health status of attacking stage patients with cerebral arterial sclerosis(CAS).

METHODS

Sixty in-patients were surveyed by filling up the questionnaire (SCL-90) and compared with the customary model in China.

RESULTS

The symptomatic factor scores of somatization and depression of the patients were obviously higher than those of the customary model (P < 0.001). Their symptomatic factor scores of anxiety and obsessive-compulsive were higher than those of the customary model (P < 0.05). The symptomatic factor score of phobic anxiety was higher than that of the customary model (P < 0.01).

CONCLUSION

Somatization, obsessive-compulsive, depression, anxiety and phobic anxiety are common psychological problems. Corresponding nursing countermeasures are proposed in our study.

Type-2 diabetes and cognitive function in a non-demented population

OBJECTIVES

To study if type-2 (non-insulin-dependent) diabetes mellitus (NIDDM) is associated with cognitive dysfunction independently of clinically diagnosed dementia in an elderly population.

MATERIAL AND METHODS

Cognitive function was investigated with a brief neuropsychological test battery in a non-demented elderly population consisting of 183 NIDDM (World Health Organization, 1985) patients and 732 non-diabetic subjects.

RESULTS

Patients with NIDDM were impaired in the Trail-Making Test parts A and C, which may be a reflection of mildly affected frontal lobe/executive functions. Women with NIDDM performed better than non-diabetic subjects in the Mini-Mental State Examination.

CONCLUSIONS

We conclude that NIDDM per se is not associated with impaired memory in the elderly, and the minor defects observed in tests of frontal lobe/executive functions are unlikely to affect daily living. In the non-demented population aged 69 78 years, NIDDM does not carry a significant risk of cognitive dysfunction, when compared to the non-diabetic subjects.

[Peripheral autonomic disorders in patients with the initial manifestations of cerebral blood supply insufficiency]

267 patients with vascular encephalopathy and initial manifestations of cerebrovascular insufficiency as the result of hypertension and cerebral atherosclerosis were observed by means of complex vegetological methods. The signs of peripheral autonomic insufficiency were revealed in 89% patients with vascular encephalopathy and in 64% ones with initial manifestations of cerebrovascular insufficiency. Cardiovascular tests directed to evaluation of the autonomic insufficiency were suggested to use for the prognosis of decompensation of cerebrovascular blood supply in such patients.

A magnetic resonance imaging study of white matter lesions in depression and Alzheimer's disease

BACKGROUND

White matter changes, as revealed by magnetic resonance imaging (MRI), may occur in depression and Alzheimer's disease.

METHOD

T2-weighted MRI scans were performed in 39 control subjects, 61 subjects with NINCDS/ADRDA Alzheimer's disease and 60 subjects with DSM-III-R major depression. Deep white matter lesions (DWML) and periventricular lesions (PVL) were rated on a standard 0-3 scale by two radiologists blind to clinical diagnosis.

RESULTS

After controlling for differences in vascular risk factors and current blood pressure, DWML were significantly more common in depressed subjects and PVL in Alzheimer's disease subjects compared to controls. DWML were most common in those presenting in late life with their first ever depression and 50% of such subjects had severe (grade 3) DWML.

CONCLUSION

An association between DWML and depression and PVL and Alzheimer's disease is supported. The increase with DWML that occurs with ageing may predispose some elderly subjects to depression.

[The efficacy of treatment with the tranquilizer tranxene in elderly persons with psychoemotional disorders against a background of initial and moderately pronounced atherosclerotic circulatory encephalopathy]

Therapeutic effects of a minor tranquilizer (from the group of benzodiazepines) tranxene were studied in patients presenting with psychoemotional disorders in the presence of the onset moderately severe atherosclerotic dyscirculatory encephalopathy. The patients derived apparent benefit from the treatment administered as per subjective as well as objective evidence: the levels of hypochondria, depression, hysterioidness, psychoasthenicity, got significantly decreased, with positive changes being recordable in EEG as well as REG. The results obtained allow tranxene to be recommended for use in geriatric practice in patients presenting with cerebral atherosclerosis accompanied by psychoemotional disorders.

[Binswanger disease. Tomographic picture and clinical correlations]

The authors explore the correlation between the neuroradiologic and clinical patterns of "subcortical arteriosclerotic encephalopathy" (SAE) or Binswanger's disease. The typical neuroradiologic pattern has been found in 62 of the 1804 CT scans of the department's archive. Available patients were enrolled for neuropsychologic evaluation. The authors point out that there is no correlation whatever between severity of the CT pattern and findings of psychological decline. Therefore SAE may be considered merely a neuroradiologic pattern. The discrepancy between neuroradiologic and clinical pattern depends on the individual history of every single patient as well as on the quality of the neuronal cells involved in vascular pathology. It may in fact be thought that the injury to command neurones plays a fundamental role in bringing about the psychopathologic picture.

[Memory function of patients with cerebral arteriosclerosis evaluated by Rivermead behavioural memory test]

Using Rivermead behavioural memory test, we examined 142 patients with cerebral arteriosclerosis. The results showed that the rate of anomalies of screening score in patients with cerebral arteriosclerosis were significantly higher than that of the control group (P < 0.01). The patients and control scores were significantly different (P < 0.05) in all items except the picture and face recognition. Comparing the screening score with brain CT scan, we found a relationship between brain damage and behavioural memory declination. Also, many persons of control group got low scores with behavioural memory test, suggesting that the Rivermead behavioural memory test be sensitive to memory declination. With its simplicity and sensitivity the Rivermead behavioural memory test may have some practical value in China.

Validity and reliability of the Toronto Alexithymia Scale (TAS) in a population study

Alexithymia refers to the difficulties an individual has to experience and express his feelings. Various self-report questionnaires have been introduced to measure alexithymia, but only a few rigorous validity studies of this concept have been carried out in nonclinical populations. The aim of this study was to evaluate the psychometric properties of the Toronto Alexithymia Scale (TAS) in a population sample of 1560 middle-aged men from eastern Finland. The modified version of the TAS applied in this study had a factor structure that matched the previous results and the theoretical concept of alexithymia. Internal consistency of the total TAS scale, as well as the 8 month retest reliability, were adequate. The TAS correlated fairly well with an interview-based evaluation of alexithymic features. The results suggest that the TAS could be a useful screening instrument for alexithymic features in a population study, but the scale would probably need some revisions.

Neuropsychological deficits in asymptomatic carotid artery stenosis

A total of 20 subjects with asymptomatic carotid artery stenosis (ACAS) and a group of healthy controls were compared as to their cognitive performance. Subjects with ACAS showed substantial deficits on tasks of mental speed, learning, visuospatial abilities, verbal processing and deductive reasoning. The cognitive profile of ACAS--subjects indicated non-specific impairment, possibly related to widespread cerebral vascular disease, of which the presence of ACAS may be one indicator.

[A controlled study of recent memory disturbance in patients with cerebral arteriosclerosis]

"The Clinical Memory Test" was administered to 40 elderly patients with cerebral arteriosclerosis (group A), compared with 40 aged subjects as control (group B), all subjects of both groups were over 60 year old. The results indicate: MQ, directed memory, free recall of pictures and paired-association learning in group A were found significantly less than in group B. This shows the ability of active recall, memory and learning of abstract ideas decreased in the patients of cerebral arterlosclerosis, but it's only quantitative difference between groups A and B, there was not qualitative difference.

[Sermion treatment of middle-aged and elderly patients with initial atherosclerotic encephalopathy]

The authors report results of a clinico-physiological study of the efficacy of a vasoactive agent sermion in patients with initial atherosclerotic encephalopathy indicating a positive effect of course treatment with this agent on the main clinical manifestations of the disease, pulse blood filling, bioelectric activity of the brain, psychomotor rate, mental working capacity, mnemonic function. Considering the established age-related differences in the efficacy of the agent, it is expedient to recommend sermion for long-term employment in the elderly. One should be cautious in instituting the drug in persons suffering of raised intraocular pressure.

Subjective time estimation in relation to age, health, and interhemispheric brain asymmetry

The subjective estimation of time was studied in the population sample of 256 subjects aged 20 to 80 years. Among the elderly, a group of patients with cerebral atherosclerosis and a group of apparently healthy persons were selected. The study also involved 48 patients with remaining manifestations of right- and left-sided stroke. The unoccupied time interval and the interval occupied with performance of verbal tasks were estimated. In both cases, interval durations were 45 s. There was an underestimation of the unoccupied interval in the young group and it was overestimated by the elderly group. With the performance of verbal tasks, the age differences were insignificant. Occupied interval vs unoccupied interval was underestimated to a greater degree. No sex differences were noted. Time estimation in cerebral atherosclerosis without focal disturbances was analogous to the pattern being observed in aging. In left-sided stroke, underestimation of time and estimation accuracy exceeded similar indices in other groups. The relationship was established of the subjective time estimation with non-verbal intellect and several characteristics of brain asymmetry, but not with handedness.

Subcortical arteriosclerotic encephalopathy--a controlled psychometric study

Eleven patients with subcortical arteriosclerotic encephalopathy (SAE) were assessed psychometrically, and the results compared with control subjects without neurological disorders and patients with a single cerebral vascular lesion (CVL). The groups were matched for sex, age, years of education, and in addition for the CVL group, the nature, site and size of the discrete vascular lesion. The SAE patients had mild to moderate impairment in intellectual, memory, receptive language and constructional functions, but individual performance ranged from near normality to severe impairment. The differences between the performance of SAE patients and the controls were significant in the majority of tests. The SAE patients had lower scores than CVL patients on all tests, but in many of these the difference was not significant.

Mental changes in subcortical arteriosclerotic encephalopathy

We describe six patients with chronic hypertension, atherosclerotic vascular disease and periventricular leukoencephalopathy (PVL) on CT. PVL was combined with cortical infarcts in one and with lacunar infarcts in five patients. On neuropsychological examination all patients showed the characteristic features of a subcortical type of mental deterioration. Clinico-radiologic correlation suggests a direct association of PVL and subcortical dementia, and it is argued that prominent cortical features in the dementia of patients with vascular disease and PVL suggest the concomitant presence of Alzheimer's disease.

Prediction of survival by three psychological measures

One hundred and seven elderly female in-patients with confirmed or suspected diagnoses of dementia were assessed by the Paired-Associate Learning Test (PALT), and the Cognitive Assessment Scale (CAS) and Behaviour Rating Scale (BRS) of CAPE. Eighteen months later, 62 patients were still alive. These had significantly better scores on the 'easy' set of PALT and on BRS than the non-survivors; the differences on the 'mediate' and 'hard' sets, and on CAS, while in the predicted direction, were not significant.

Practicable and valid approach to evaluate the efficacy of nootropic drugs by means of rating scales

Starting with the disputable practice of evaluating the efficacy of nootropic drugs the author has developed a strictly experimental examination approach emphasising the internal validity of experiments. The physician's assessment of the global therapeutic effect is suggested as a variable examination factor which should be treated as an independent variable and a valid instrument for judging the effect when arriving at a statistical conclusion. Differentiated rating scales and measurements are suggested as a basis for this judgment. Proven effects are described in a more differentiated manner by means of this method which helps in discussing the validity of results.

[Psychopathology of senile dementias in nursing home residents]

Examination of 163 nursing home residents revealed chronic brain syndrome of different amount in 84%. Demented patients with clinical evidence of arteriosclerosis had significantly higher values of emotional incontinence, dysphoria, depression and vegetative complaints than those without evidence of arteriosclerosis. Correlation of single psychopathologic parameters with other psychopathologic, neurologic and somatic variables resulted in very different correlation profiles for the following symptoms: emotional incontinence, apathy, dysphoria and euphoria. These changes in personality should be considered to a higher degree in dementia research intending more homogeneous subgroups.

Can neuropsychological tests detect the sites of cerebrovascular stenoses and occlusions?

Conventional neuropsychological data may not mirror the site of cerebrovascular stenosis in a patient with mild to moderate symptoms. In this study, three groups of cerebral revascularization candidates failed to differ on an extended Halstead-Reitan battery: patients with symptoms and angiographic results referable to the carotid arterial system, subjects with clinical signs and neuroradiological findings referable to the vertebrobasilar arterial system, and patients with symptoms of cerebral ischemia but negative angiograms. Consistent with previous work, these patients generally were mildly impaired on neuropsychological tests, even though many were not symptomatic at the time of assessment. Neuropsychological tests seem to be sensitive to the presence and severity of cerebral ischemia, but in isolation may not be sufficient to determine the loci of vascular stenoses. The incongruence between angiographic and neuropsychological findings underlines the importance of distinguishing among different levels and types of measurements in defining subgroups of cerebral revascularization candidates. Collaboration among neuroscientists will further our understanding of the interrelationships among neurodiagnostic tests.

Various mental behavioral disorders in Parkinson's disease, primary degenerative senile dementia, and multiple infarction dementia

Following 2-4 years of hospitalization, the mental and physical ability of 21 patients with typical idiopathic PD, 10 patients with atypical Parkinson's syndrome and signs of cerebral arteriosclerosis, 29 patients with MID. and 14 patients with senile dementia of the Alzheimer type were evaluated according to various rating scales. All idiopathic parkinsonian patients had suffered from the disease for over 8 years. All patients were over 70 years of age and continuously subjected to the same environment. EEG and CT was performed. A rating scale consisting of 18 items for evaluation of the mental and physical capacity and ability to cope with daily psychosocial demands was used for each patient. Statistically highly significant differences resulted between the relative good mental ability of patients with idiopathic Parkinson's syndrome, with the exception of some brief pharmacotoxic psychoses, and the lower rating scores of patients with senile dementia of Alzheimer type and multiple infarction dementia. A smaller subgroup of patients with Parkinson's syndrome and additional focal signs in the neurological status and EEG showed moderate mental functional loss and a more frequent incidence of pharmacotoxic psychoses than the patients with idiopathic PD. Just as few congruencies of mental ability were found between patients with idiopathic, typical PD and patients with senile dementia of the Alzheimer type as between idiopathic PD and MID. Permanent dementia is not characteristic of patients with typical idiopathic PD even in advanced age. It is, however, for patients with MID and SDAT.

[Two clinical cases diagnosed provisionally as Binswanger type of vascular dementia--on possibility to its clinical recognition from neuropsychiatric findings and computed tomography (author's transl)]

The diagnosis of subcortical arteriosclerotic encephalopathy of Binswanger should be confirmed neuropathologically by postmortem examination. But we expect that it may be possible to diagnose provisionally as Binswanger's disease on the basis of clinical course and findings including computed tomography. Two cases, 57 years old postman (case 1) and 60 years old housewife (case 2) were reported. They had hypertension for over 20 years in their past history and showed a progressive dementia since before one year and 9 years. Transient syncopal attack and epileptiform seizure revealed occasionally. Psychiatrically either of them were apathetic, aspontaneous and autistic. One of them (case 2) showed a striking paranoid-hallucinatory state. Spastic gait disturbance and dysarthria are found neurologically, and moreover in case 1 revealed the incontinence of urine and feces. Arteriosclerotic changes were seen in the fundi. The EEG showed a slow alpha rhythm with scattered theta- and delta-waves. Laboratory data of blood, urine and CSF were normal. On the basis of these clinical course and findings the diagnosis of Binswanger's type of cerebral arteriosclerosis were suspected. The CT-scan of 2 cases proved a symmetrical enlargement of the lateral ventricles and marginated areas of definite abnormal low density in the white matter of the occipital (case 1) and frontal (case 1 and 2) lobes. Conclusively we may provisionally diagnosed our two cases as Binswanger's disease, also supported by the findings of CT.

[Cerebral arteriosclerosis: neurologic and psychiatric consequences]

Cerebral arteriosclerosis is a frequent, often not sufficiently diagnosed disease in the second half of the life span. Possible causes, diagnosis, and therapy are explicitly shown of its somatic and psycho-pathological symptoms, often acute, and chronically persistent. Particular emphasis is put on acute-care and the therapeutic relevance of socio-and psychotherapy. Finally, consequences for forensic medical opinions are shown.

[Reaction time during ageing and in cerebral arteriosclerosis (author's transl)]

Authors studied 142 test persons aged between 54 and 86 years who were, expected for arteriosclerosis, free of any other disease. Severity of arteriosclerosis was assessed by funduscopy and the test persons divided into four groups: without of arteriosclerosis, mild and medium arteriosclerosis, respectively, and severe arteriosclerosis. The automatic measurement of reaction time was repeated in the majority after certain interval. Results of the two examinations have been compared. It has been found that delay of reaction time showed substantial relationship with the severity of cerebral arteriosclerosis and exceeded the relationship with age. Longitudinal examination gave evidence that during aging delay of reaction time showed an even speed, i.e. age does not influence speed of delay. Contrariwise regression was found to be essentially more rapid in the groups with severe arteriosclerosis with poor incipient values.

[Anginin effect in cerebovascular disorders in the light of psychological studies]

Seventeen patients aged 40 to 69 years with cerebral atherosclerosis and peripheral atherosclerotic changes treated for 6 months with Anginin were investigated psychologically. The purpose of the investigation was assessment of the effects of Anginin on certain higher psychic functions and motor fitness, duration of drug effects, and the influence of patients' attitude on health improvement. The investigations comprised a set of 10 psychometric tests assessing objectively the state of different kinds of memory and motor fitness, that is those functions which are most frequently disturbed in cerebral atherosclerosis, and evaluation of the symptoms associated with the disease (in the light of interviews). Each patient was investigated 4 times with parallel sets of tests: before starting treatment, after 3--4 months of treatment, 6 months after the beginnning of treatment, and 6 months after completion of treatment. Seven patients received placebo during the first 2 months. Statistically analysed results showed that during the treatment immediate and delayed visual and auditory memory increased, visumotor coordination improved and disturbances of attention concentration and motor fitness were alleviated. After 3--4 months of treatment the results of the tests for these functions improved further. The effect of Anginin lasted for 6 months after comletion of treatment showing only a slight tendency for decrease. The analysis of symptoms and comparison of the placebo group with the drug group demonstrated a high influence of the attitude of the patient on health improvement, and the psychotherapeutic effect of the drug was considerable. The good effects were obtained in cases with moderately severe and slight intensity of disturbances.

The effects of hyperbaric and normobaric oxygen on cognitive impairment in the elderly

Eighty-two elderly subjects with significant cognitive impairment were randomly assigned to treatment with either hyperbaric oxygen, hyperbaric air, normobaric oxygen, or normobaric air. Treatment consisted of two 90-minute sessions a day for 15 consecutive days. Subjects were evaluated on measures of memory and intellectual capacity, as well as on psychiatric symptom rating scales. Results immediately after treatment and at one, two, three, and eight weeks following treatment did not show enhanced cognitive functioning or significantly greater symptom reduction in experimental subjects who received either normobaric or hyperbaric oxygen as compared to controls who received hyperbaric or normobaric air. There was also no evidence of differential treatment effects as a function of initial severity of illness, sex, response to a CO2 loading test, or presumed evidence of cerebrovascular disease.