ABSTRACT
Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal-basal ganglia-thalamus-cortical net, in three different levels of their pathway.
Subject(s)
Behavioral Symptoms/etiology , Brain/pathology , Cognition Disorders/etiology , Dementia, Vascular/complications , Stroke/complications , Aged , Aged, 80 and over , Behavioral Symptoms/diagnosis , Behavioral Symptoms/diagnostic imaging , Brain/diagnostic imaging , Brain Mapping , Cognition Disorders/diagnosis , Cognition Disorders/diagnostic imaging , Dementia, Vascular/diagnostic imaging , Diterpenes, Clerodane , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Severity of Illness Index , Stroke/diagnostic imaging , Stroke/pathology , Tomography, Emission-Computed, Single-PhotonABSTRACT
BACKGROUND: Vascular white matter lesions (WML) represent one of the main neuroimage findings in individuals older than 65 years and its clinical significance is still partially understood. OBJECTIVE: To describe and analyze the clinical profile of a high severity sample with WML focusing on the frontal executive control. METHOD: Outpatients (n=20) with high severity WML evaluated with magnetic resonance imaging were selected using the Fazekas scale. RESULTS: Most patients (n=17; 85%) presented an altered Trail Making Test ratio (section B/section A); on verbal fluency, 15 individuals (75%) performed below the cutoff score. Apathy (5.9 +/- 4.65) and depression (3.05+/-3.67) were frequent as assessed by the Neuropsychiatric Inventory. The impairment in functional activities strongly correlated with apathy (r=0.814, p<0.001) and verbal fluency (r=0.744, p<0.001). CONCLUSION: Executive dysfunction, apathy, and ratio depression were the main characteristics found. Extension of WML may have distinct impact on the clinical picture, but further studies with methodological adjustments are necessary to provide more definitive conclusions.
Subject(s)
Cognition Disorders/etiology , Dementia, Vascular/complications , Mental Disorders/etiology , Aged , Brain/pathology , Brain/physiopathology , Cognition Disorders/diagnosis , Cross-Sectional Studies , Dementia, Vascular/pathology , Dementia, Vascular/physiopathology , Executive Function/physiology , Female , Humans , Magnetic Resonance Imaging , Male , Mental Disorders/diagnosis , Neuropsychological Tests , Severity of Illness IndexABSTRACT
BACKGROUND: Vascular white matter lesions (WML) represent one of the main neuroimage findings in individuals older than 65 years and its clinical significance is still partially understood. OBJECTIVE: To describe and analyze the clinical profile of a high severity sample with WML focusing on the frontal executive control. METHOD: Outpatients (n=20) with high severity WML evaluated with magnetic resonance imaging were selected using the Fazekas scale. RESULTS: Most patients (n=17; 85 percent) presented an altered Trail Making Test ratio (section B/section A); on verbal fluency, 15 individuals (75 percent) performed below the cutoff score. Apathy (5.9 ± 4.65) and depression (3.05±3.67) were frequent as assessed by the Neuropsychiatric Inventory. The impairment in functional activities strongly correlated with apathy (r=0.814, p<0.001) and verbal fluency (r=0.744, p<0.001). CONCLUSION: Executive dysfunction, apathy, and ratio depression were the main characteristics found. Extension of WML may have distinct impact on the clinical picture, but further studies with methodological adjustments are necessary to provide more definitive conclusions.
FUNDAMENTO: Lesões vasculares em substância branca (LSB) são um dos principais achados de neuroimagem em indivíduos acima de 65 anos e sua importância em termos clínicos é ainda parcialmente conhecida. OBJETIVO: Descrever e analisar o perfil clínico de amostra com LSB grave enfocando as alterações do controle executivo frontal. MÉTODO: Pacientes ambulatoriais (n=20) avaliados pela ressonância nuclear magnética e com maior proporção de LSB foram selecionados através da escala de Fazekas. RESULTADOS: A maioria dos pacientes (n=17; 85 por cento) apresentou alteração na proporção teste das trilhas (seção B/A); na fluência verbal, 15 indivíduos (75 por cento) apresentaram desempenho abaixo do ponto de corte. Apatia (5,9±4,65) e depressão (3,05±3,67) foram freqüentes na avaliação pelo Inventário Neuropsiquiátrico. O prejuízo nas atividades funcionais correlacionou-se fortemente à apatia (r=0, 814, p<0,001) e à fluência verbal (r=0, 744, p< 0,001). CONCLUSÃO: Disfunção executiva, apatia e depressão foram as principais características encontradas. A extensão e localização das LSB parecem exercer um impacto distinto nas manifestações clínicas, porém estudos futuros com ajustes metodológicos são necessários para conclusões mais definitivas.
