Differential diagnosis of behavioral variant of fronto-temporal dementia (bvFTD).

BACKGROUND: The aim of the paper is the differential diagnosis of various types of Fronto-Temporal Dementia (FTD), with the focus on its behavioural variant (bvFTD). MATERIAL/METHOD: Screening was done in order to assess the depth of dementia with the short version of MMSE, while evaluation of various variants of FTD was performed with the use of such neuropsychological tests as Newcomb and Chicago Fluency Tests, Wechsler Memory Scale-III (WMS-III), Western Aphasia Battery (WAB-R), and the Boston Naming Test (BNT). Behaviour was evaluated with a Polish version of the Frontal Behavioral Inventory (FBInv). The inventory consists of 24 questions which enable an evaluation of social behaviour disorders. The study included 112 patients--68 men and 46 women treated in the Reintegrative-Training Centre of the Foundation for Persons with Brain Dysfunctions in Kraków and in the Clinic for Developmental Psychiatry, Psychotic Disorders and Old Age Psychiatry, of the Medical University at Gdansk, who were suffering from various types of dementia. RESULTS: It was found that FTD patients scored the highest, while the VAD patients scored somewhat lower in the FBInv. At the same time the scores obtained by PPA patients were higher in comparison to the control groups, but not as high as in the case of patients with FTD. In the process of the neurotherapy of FTD patients we found a reduction of the behavioral disturbances, despite the progression of the illness. CONCLUSIONS: The results obtained in the present study confirmed the diagnostic value of FBInv in the differential diagnosis of various types of FTD and in the evaluation of neurotherapy efficacy.

Speech intelligibility in cerebral palsy children attending an art therapy program.

BACKGROUND: Dysarthia is a common sequela of cerebral palsy (CP), directly affecting both the intelligibility of speech and the child's psycho-social adjustment. Speech therapy focused exclusively on the articulatory organs does not always help CP children to speak more intelligibly. The program of art therapy described here has proven to be helpful for these children. MATERIAL/METHODS: From among all the CP children enrolled in our art therapy program from 2005 to 2009, we selected a group of 14 boys and girls (average age 15.3) with severe dysarthria at baseline but no other language or cognitive disturbances. Our retrospective study was based on results from the Auditory Dysarthria Scale and neuropsychological tests for fluency, administered routinely over the 4 months of art therapy. RESULTS: All 14 children in the study group showed some degree of improvement after art therapy in all tested parameters. On the Auditory Dysarthia Scale, highly significant improvements were noted in overall intelligibility (p<0.0001), with significant improvement (p<0.001) in volume, tempo, and control of pauses. The least improvement was noted in the most purely motor parameters. All 14 children also exhibited significant improvement in fluency. CONCLUSIONS: Art therapy improves the intelligibility of speech in children with cerebral palsy, even when language functions are not as such the object of therapeutic intervention.

Behavioral and psychological symptoms and the progression of dementia of the Alzheimer type in nursing home residents.

BACKGROUND: Behavioral and psychological symptoms are common in the course of dementia of the Alzheimer's type (DAT). Some behavioral and psychological symptoms may be predictors of the progression of dementia and cognitive impairment in DAT. However, studies on this topic face serious methodological problems. The aim of our study was to investigate how aggressive and impulsive behaviors correlate with the progression of dementia and related cognitive impairments in DAT patients. MATERIAL/METHODS: Using the Cohen-Mansfield Agitation Inventory (CMAI) and the ADAS-cog we examined 39 nursing home residents diagnosed with mild to moderate DAT. Of these participants, 26 were re-evaluated with the ADAS-cog two years after baseline. RESULTS: Aggressive and impulsive behaviors correlated with the degree of cognitive impairment. However, we also found that particular ADAS-cog items correlated differently with the CMAI score. Moreover, various CMAI categories were differently related to cognitive disorders. Impairments in cognitive functioning best explain the fluctuations of verbal aggression and physical agitation (non-aggressive). At baseline, the more demented subjects had a higher general score on the CMAI scale and showed greater rates of physical aggression, verbal aggression and non-aggressive physical agitation. CONCLUSIONS: Particular items of the CMAI scale significantly differentiated our subjects in terms of progression of cognitive impairment. Aggressive behaviors in patients with DAT are linked to both the severity of dementia and the rate of its progression. At the same time, significant differences were noted with respect to particular behaviors.

Disturbances of speech and language in patients aroused from long-term coma subsequent to traumatic brain injury.

Background. The purpose of this study was to characterize the speech and language disturbances seen in patients with traumatic brain injury aroused from long-term coma at the Rehabilitation Clinic of the Bydgoszcz Academy of Medicine. Material and methods. The research covered 94 patients (30 women, 64 men, average age 34.7). Speech and language disturbances were diagnosed with basic neuropsychological batteries and authorial methods, and classified as akinetic mutism, global aphasia, sensory aphasia, motor aphasia, dysarthria, or dysphonia. The patients were examined 3 times: at admission, after one month, and after two months. Results. The patients displayed various speech and language disturbances. In the first examination, 47 persons (50.0%) presented with dysarthria. Post-traumatic aphasia was seen in 28 persons (29.8%). Akinetic mutism was somewhat less common (12 persons, 12.8%) and dysphonia least common (6 persons, 6.3%). In the second examination there were numerous shifts between groups, and 15 persons no longer had any disturbances (16.0%). These trends continued in the third examination. Dysphonia was seen in 4 persons (4.3%), akinetic mutism in only 3 (3.2%). 23 persons (24.5%) did not show any speech and language disturbances. Conclusions. Patients aroused from long-term coma display various speech and language disturbances. A significant number have dysarthria and/or aphasia, somewhat fewer have akinetic mutism. Dysphonia is also seen. Mutism often resolves spontaneously, as does dysphonia, while the symptoms of aphasia and dysarthria are more persistent.