1/54. Reversible cerebral hypoperfusion observed with Tc-99m HMPAO SPECT in reversible dementia caused by hypothyroidism.A 69-year-old man had hypothyroid dementia as a result of I-131 therapy and an overdose of methimazole. Tc-99m HMPAO SPECT revealed diffuse cerebral hypoperfusion. The findings of brain SPECT normalized with the disappearance of symptoms and a return to the euthyroid state. There was a 25% or 26% reduction of the mean cerebral blood flow during dementia. This may be the first report in which SPECT brain imaging revealed reversible hypoperfusion associated with reversible hypothyroid dementia.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/54. The many faces of confusion. Timing and collateral history often hold the key to diagnosis.Recognition of a patient's state of confusion is only the beginning of a clinical odyssey that can implicate a huge spectrum of diagnostic possibilities. Among these are delirium, depression, dementia, and sensory deprivation. However, with appropriate physical examination and laboratory studies, collateral history, and clarification of time course for the symptom complex, the cause of confusion need not remain confusing.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
3/54. naltrexone treatment of dementia with severe self-injurious behaviors: a single case study.The results of studies of the opiate antagonist naltrexone (NLTX) in the treatment of self-injurious behavior (SIB) in various psychiatric populations have been equivocal. The majority of studies has relied on small samples, many of which lacked scientific rigor and none of which occurred in a nursing facility. The present study investigates the use of NLTX on a patient with severe SIB who resides in a nursing facility. The patient is a 38-year-old male with a history of heavy drug and alcohol abuse. He has been in either a state hospital or nursing facility since age 21. The patient overdosed on alcohol and drugs in 1990, which led to a prolonged coma with organic brain damage.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
4/54. Hyperthyroid dementia: clinicoradiological findings and response to treatment.Dementia associated with hyperthyroidism is less well documented than is hypothyroid dementia. Therapeutic response of hyperthyroid dementia and associated cerebral circulatory and/or metabolic abnormalities has not been elucidated. We described a patient with hyperthyroid dementia and clinicoradiological response to treatment. Single photon emission computed tomographic (SPECT) study was repeated and analyzed semiquantitatively. A 67-year-old man experienced progressive impairments of attention, memory, constructive skills and behavior as well as hand tremor and weight loss of two-year duration. Laboratory findings were compatible with Graves' disease. The initial SPECT showed diffuse tracer uptake defect with an accentuation in the bilateral temporoparietal regions. Clinical and SPECT findings both suggested concurrent "possible" Alzheimer's disease. However, initial treatment with a beta-blocker improved behavior and attention-related cognitive functions as well as tracer uptake in the frontal lobes. Subsequent treatment with additional methimazole then improved memory and constructive abilities when a euthyroid state was established. Uptake defect in the temporoparietal regions also responded gradually to the medication. We suggest that the present patient represent hyperthyroid dementia, which responds favorably to treatment with regard to clinical symptoms and SPECT findings. We also suggest that thyroid function be measured in patients with "possible" Alzheimer's disease because treatable hyperthyroid dementia may not be identified.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
5/54. Severe involvement of the ambient gyrus in a case of dementia with argyrophilic grain disease.We report here the severe involvement of the ambient gyrus in a case of argyrophilic grain (AG) dementia (AGD). The patient was a 78-year-old man who was first presented with prosopagnosia (agnosia of the face) at age 68, which was followed by progressive mental decline and the patient's death in a state of tetraplegia. The postmortem study showed severe atrophy of the medial temporal lobe with anterior gradient, most prominent in the ambient gyrus. Histologically, numerous AGs, pretangles and coiled bodies were detected by Gallyas-Braak (G-B) silver staining and also by immunostaining with various anti-tau antibodies in the affected area. Tau-immunoreactive ballooned neurons were also present. Neuronal loss and gliosis with laminar sponginess were evident in the ambient gyrus. Diffuse plaques were seen in the neocortex and frequently associated with clusters of AGs, which were morphologically distinct from neuritic plaques. neurofibrillary tangles were localized in the entorhinal area. Vascular lesions were very scanty. Thus, this case fulfilled the morphological criteria of AGD.It is still unclear whether AG itself causes neuronal degeneration leading to dementia. The present case may reflect the importance of the ambient gyrus in the center of neuronal degeneration in AGD.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
6/54. Relearning of verbal labels in semantic dementia.Semantic dementia is a degenerative disorder of temporal neocortex characterised by loss of word and object concepts. There is limited evidence that temporary relearning of lost vocabulary may be possible, attributed to sparing of hippocampal structures. However, learning is variable across patients and factors underlying learning success are poorly understood. The study investigated relearning of object names in two severely anomic semantic dementia patients. Following memory models that assume that hippocampal memories require some neocortical representation to underpin them it was predicted that relearning would be influenced by patients' residual semantic information about stimuli. Experiment 1 confirmed that residual knowledge influenced learning success. On the assumption that neocortical knowledge encompasses concepts of space and time, as well as words and objects, it was predicted that learning would be affected by the availability of contextual (temporo-spatial) information. Experiment 2 demonstrated effective learning of object names, attributed to the patient's use of temporal order and spatial position knowledge. Retention of object names over months was linked to the patient's capacity for autobiographical experiential (temporo-spatial contextual) association. The findings indicate that relearning of lost vocabulary is possible in semantic dementia, indicating a role of the medial temporal lobes in the acquisition of semantic information. Effective learning does not imply reinstatement of lost concepts, but, it is argued, does involve some reacquisition of meaning. The findings challenge the traditional semantic-episodic memory dichotomy and are consistent with a "levels of meaning" account of semantic memory.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
7/54. Dementia. Legal issues in consent.BACKGROUND: Doctors must generally obtain a patient's consent for a medical procedure before it is undertaken. When a patient has impaired mental capacity, the doctor may be uncertain whether the patient is competent to consent and decide that consent must be obtained from someone else. recent legislation gives legal authority to people appointed by the patient, or by the state; or a relative or carer, to consent (or refuse) on behalf of the patient. OBJECTIVE: This paper explains the general legal requirements to obtain consent; a how a patient's competence is assessed; and the people who may legally consent (or refuse) on behalf of an incompetent patient. A case study illustrates how the legal principles are applied in practice.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
8/54. Cholinergic denervation in a pure multi-infarct state: observations on cadasil.Circumstantial evidence suggests that vascular dementia (VaD) may be associated with cholinergic denervation. The specificity of this association has been difficult to assess because many of the patients are elderly and have the additional cholinergic lesions of aging and AD. A patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (cadasil) who died at age 36 showed that pure white matter infarcts, similar to those seen in VaD, can cause cortical cholinergic denervation, but in patterns that vary from those seen in AD.- - - - - - - - - - ranking = 4keywords = state (Clic here for more details about this article) |
9/54. Atypical late-onset dementia characterized by limbic degeneration with coiled bodies and argyrophilic threads.This report concerns an autopsy case of late-onset dementia with atypical neuropathological features. The patient was a Japanese man who was 83 years old at the age of death. At 73 years, he developed behavioral disorders, including emotional changes, and dementia. He died at the age of 83. A neuropathological study revealed largely confined involvement of the limbic regions, characterized by degeneration consisting of neuronal loss with a spongy state and gliosis. Massive tau-positive oligodendroglial coiled bodies and argyrophilic threads were also observed mainly in these regions. Although the clinicopathological findings of the present case showed some similarities to those of a unique subtype of frontotemporal dementia, including mesolimbocortical dementia, argyrophilic grain disease, corticobasal degeneration and dementia with tangles, there seems to be no suitable category of neurodegenerative disease into which our case can be classified. Further study is needed to determine whether the present case could be classified as an atypical case of these diseases or represents a new entity.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
10/54. Dementia-like presentation of striatal hypermetabolic state with antistriatal antibodies responsive to steroids.BACKGROUND: Hypermetabolic lesions of the striatum are rare. They usually involve autoimmunity and are associated with choreatic disorders such as Sydenham chorea, lupus, and the antiphospholipid antibody syndrome. PATIENT: A 48-year-old woman was initially seen with a 1-year history of progressive changes in personality and attention. There were minor associated involuntary movements. Negative routine investigation results, including regular autoimmune serologies and magnetic resonance imaging, led to the diagnosis of a frontal dementia. Positron emission tomographic results demonstrated hypermetabolism in the left striatum. Western blot technique results demonstrated plasma antistriatal antibodies. Treatment with corticosteroids induced a resolution of her attentional deficits and a return of her personality to its premorbid state. The repeated positron emission tomographic scan results were near normal, and the titer of antistriatal antibodies was significantly reduced. CONCLUSION: Autoimmune striatal dysfunction can initially appear with a clinical picture suggestive of a degenerative dementia. Recognition of the underlying etiology and treatment was possible because of abnormalities uncovered on positron emission tomographic images.- - - - - - - - - - ranking = 5keywords = state (Clic here for more details about this article) |
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