1/23. Involuntary hand levitation associated with parietal damage: another alien hand syndrome.The alien hand syndrome (AHS) usually consists of an autonomous motor activity perceived as an involuntary and purposeful movement, with a feeling of foreignness of the involved limb, commonly associated with a failure to recognise ownership of the limb in the absence of visual clues. It has been described in association to lesions of the frontal lobes and corpus callosum. However, parietal damage can promote an involuntary, but purposeless, hand levitation, which, sometimes, resembles AHS. In the present study, four patients (cortico-basal ganglionic degeneration - n=2; Alzheimer's disease - n=1 and parietal stroke - n=1) who developed alien hand motor behaviour and whose CT, MRI and/or SPECT have disclosed a major contralateral parietal damage or dysfunction are described. These results reinforce the idea that parietal lobe lesions may also play a role in some patients with purposeless involuntary limb levitation, which is different from the classic forms of AHS.- - - - - - - - - - ranking = 1keywords = hand (Clic here for more details about this article) |
2/23. Paranoid delusions and hallucinations and bright light therapy in Alzheimer's disease.INTRODUCTION: Bright light therapy (BLT) is becoming increasingly popular as an adjunct in the treatment of non-SAD depression and circadian rhythm disturbances in demented patients. Although the rate of side-effects is low, special attention should be paid when treating new groups of patients. We present the case of an 80-year-old woman suffering from dementia of Alzheimer's type (DAT). METHOD: Bright light (2.500 lux) was administered two hours daily between 10 and 12 a.m. for 14 days. Changes in delusion or agitation were recorded using the confusion rating scale (CRS). RESULTS: Out of five patients, three already had delusional symptoms which slightly improved during the course of BLT, one patient never showed delusions before or during BLT, and one patient, which we present here, showed an increase in agitation and developed delusional symptoms. After eight days of treatment, the patient developed conjunctival irritation with marked red eyes and complained about blurred vision. After 12 days of treatment, the patient was disorientated in time and place and after 14 days the patient started to hallucinate and BLT had to be discontinued. The paranoid delusions and hallucinations stopped one day after treatment discontinuation. CONCLUSION: Looking at all the presented evidence, BLT seems to be a useful treatment supplement in DAT patients, when suffering from delusions or agitation. On the other hand, caution should be used when using BLT in demented patients if agitation develops or increases during BLT.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
3/23. Report of three cases of Alzheimer's disease with focal motor symptoms: clinical correlates of neuroimaging findings.We report clinical and neuroimaging findings for three patients suffering from Alzheimer's disease (AD) with focal motor symptoms. These patients initially showed cognitive deficits and subsequently featured myoclonus and awkward movements in the unilateral upper limb while progressing to paresis. paresis was noted in the unilateral upper limb. All patients held the unilateral arm flexed at the wrist and elbow, closely adducted to the body and the hand fisted and pronated. No signs of cerebellar ataxia, sensory disturbance or long tract signs were observed, nor any of the initial non-cognitive behavioural changes typical of frontotemporal dementia. EEGs of these patients showed marked slowing of basic activity without epileptic discharges. MRIs showed progressive brain atrophy in the contralateral frontoparietal lobes as well as the hippocampal formation. Cases 2 and 3 featured extensive long T2 lesions on MRI. 99mTc-HMPAO-SPECT revealed blood flow hypoperfusion in the corresponding regions. The cerebellum and brain stem showed neither morphological abnormalities nor blood flow hypoperfusion. On the basis of these clinical and neuroimaging observations, the focal motor symptoms were attributed to contralateral frontoparietal cortical atrophy with or without white matter lesion.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
4/23. Visuospatial deficits due to impaired visual attention: investigation of two cases of slowly progressive visuospatial impairment.Two patients with slowly progressive visuospatial impairment demonstrated a peculiar type of visuoconstructive deficit. The most prominent manifestation appeared when handling kanji (logogram) characters and other figurative patterns. The patients showed pure agraphia for complex kanji but not for kana (syllabogram) or Arabic numerals. Their abilities to read and understand kanji characters and to orally describe the structure of a kanji character were preserved. They could not draw or copy figures or symbols except for single lines or simple symbols, although they could identify and name the targets easily. They also performed poorly in such visuoconstructive tasks as the block design subtest and matching to sample tests that require the ability to simultaneously attend to multiple saliencies. When asked to copy multiple kana characters scattered on a sheet of paper, they could correctly describe the location of a particular character in relation to the others, but actually wrote each character in grossly mislocated positions. These findings suggest that when the patients start particular tasks, which require detailed visual analysis, their range of visual attention becomes extremely narrow. This task-dependent narrowing and fixation of visual attention might explain some of the visuoconstructive symptoms described in patients with slowly progressive visuospatial impairment.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
5/23. Long-distance caregiving: a case study of an African-American family.A growing number of Americans are managing and monitoring long-distance caregiving for an elderly parent. The authors offer a first-hand experience of caregiving involving an African-American family, which will be useful to both caregivers and practitioners. The challenges that result from long-distance caregiving are discussed. A detailed case study and assessment is followed by suggested strategies for lessening caregiver stress.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
6/23. Progressive agraphia, acalculia, and anomia: a single case report.A case of a 50-year-old, right-handed female, mono-lingual native Spanish-speaker with a university-level education and cognitive changes is reported. Over approximately 2 years, she presented with a progressive deterioration of writing abilities associated with acalculia and anomia. An MRI disclosed a left parietal temporal atrophy. Two years later, further significant cognitive decline consistent with a dementia of the Alzheimer's type was observed. amnesia, executive dysfunction, and ideomotor apraxia were found. writing was severely impaired, and some difficulties in reading were observed. Copying abilities, however, were relatively well preserved, and the patient could drive and go to different city locations without significant spatial orientation difficulties. A second MRI approximately 2 years later showed that brain atrophy had progressed significantly. Spontaneous writing and writing to dictation were impossible. The ability to read words was preserved, but the ability to read pseudowords was lost. Changes in calligraphy were noted. This case clearly illustrates the progression of focal cognitive defects over time and the spread of abnormalities to other domains.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
7/23. Coexistence of alzheimer disease neuropathology with herpes simplex encephalitis.Several unusual features were observed during routine histopathological confirmation of a clinical diagnosis of Alzheimer's disease (AD) in an 85-year-old, right-handed, married male. The patient presented with a 12-year history of slowly progressive cognitive impairment, which increased in severity just prior to death. Detailed postmortem examination of the frontal lobes revealed a significant number of neuritic plaques and neurofibrillary tangles. Multifocal spongiform encephalopathic changes, mononuclear perivascular infiltrates, subcortical demyelination and gliosis were also found. Of particular interest were well-defined neuronal and astrocytic intranuclear inclusion bodies (Cowdry type I and I), suggestive of viral disease. Electron microscopy, immunohistochemical and immunohistofluorescent studies confirmed a herpes simplex type I encephalitis (HSV-I). These histological results and the clinical history of progression suggest that reactivation of a latent viral infection may have contributed to the rapid progression of dementia prior to death. The present analysis underscores the fact that multiple etiologic factors may act simultaneously to produce dementia. While one such process may be identified or diagnosed (in the present case AD), it is necessary to be open to the possibility that another mechanism may come into play during the time course of that illness. A differential diagnosis may be difficult when the symptoms of the two disease processes are very similar. Such may be the case if there is reactivation of a previously undiagnosed herpes virus infection. With the development of PCR and in situ hybridization diagnosis will be simplified and more definitive.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
8/23. Serial positron emission tomography findings in a patient with hydrocephalic dementia and Alzheimer's disease.comorbidity of normal pressure hydrocephalus (NPH) and Alzheimer's disease (AD) is not uncommon. However, few studies have reported the clinical courses of these patients in depth. A 73-year-old woman was confirmed to have AD by a biopsy performed during a shunt operation for NPH after a head trauma. She was followed for 4 years using serial neuropsychological tests and positron emission tomography (PET). Her clinical symptoms remained improved for 2.5 years and then declined. The 1-year minus the presurgical PET scan highlighted the bilateral frontal area, basal ganglia, and thalamus, which may reflect brain regions associated with the improvement of hydrocephalic dementia. On the other hand, the 1-year minus the 4-year scan highlighted the bilateral temporoparietal area and the posterior cingulate gyrus, which may reflect brain regions associated with the aggravation of AD. This subtraction method may be useful for monitoring the clinical course in patients with NPH and AD.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
9/23. Serotonergic treatment for aggression in a Down's syndrome adult showing signs of Alzheimer's disease.Sudden-onset, unprovoked aggression has typically been difficult to reduce or eliminate in persons with mental handicaps or dementia. Several medications have been reported in the literature with varying success, though some risk serious side effects. This study tested the effectiveness of a low dose antidepressant (trazodone) with a serotonin-enhancing diet to reduce aggression while not risking serious side effects. aggression decreased by 96% in a mentally handicapped adult with Down's syndrome showing signs of Alzheimer-type dementia. The benefit was robustly demonstrated using an on-off-on-again design with detailed recording for nearly 4 months.- - - - - - - - - - ranking = 0.18181818181818keywords = hand (Clic here for more details about this article) |
10/23. lewy bodies in the presence of Alzheimer's disease.Large numbers of lewy bodies in the substantia nigra were found in a case of Alzheimer's disease. Parkinsonian symptoms were not recognized. The patient appears to be an example of an association recognized by Woodard but not yet understood. The case is discussed in the context of reported relationships between Parkinson's disease or "lewy body disease" and dementia, on the one hand, and reports linking various forms of psychoses with an unusually high incidence of lewy bodies, on the other.- - - - - - - - - - ranking = 0.090909090909091keywords = hand (Clic here for more details about this article) |
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