Memory versus intelligence in dementia screening--MMSE.

The Mini-Mental State exam is a widely used screening instrument for dementia. Recent research has suggested that errors in classification reported for this instrument may be due to premorbid levels of intelligence and education, Thirty-one ambulatory patients diagnosed with Alzheimer's disease were administered a standard neuropsychological testing battery. MMSE scores and intelligence are significantly correlated. However when memory ability is partialed out, the covariance of MMSE and intellectual abilities does not add any further information to that already provided by the memory scores.

The earliest signs of Alzheimer's disease.

Insufficient clarity of definition of the clinical features in the earliest stages of developing Alzheimer's disease (AD) has impeded the execution of clinical and biologic studies into this major public health problem. Defining the earliest signs of a disease with such an insidious onset can prove to be a most elusive task, particularly in a disease whose very nature renders the patients' self-report unreliable. We therefore administered a structured interview to the close family caregivers of 83 patients with probable AD, in order to investigate the earliest perceived signs of illness in the patients. In 44 (53%) of patients, the earliest objective sign of change was not memory impairment. The initial sign of change was of a psychiatric type in 27 (32.5%); of a neurologic type in nine (10.9%); and of a noncoping type in eight (9.6%). Such nonmemory signs, as perceived by caregivers, preceded objective memory impairment by a mean of 1.8 years. In 39 patients (47%), memory impairment was the initial perceived sign of illness. These findings suggest that the earliest clinical manifestations of AD may, in many cases, significantly predate objective signs of memory impairment.

Headache as a presentation of angina: reproduction of symptoms during angioplasty.

We report a case of angina presenting as headache in a 59-year-old man. Headaches were relieved by nitroglycerin and were reproduced by occlusion of the first obtuse marginal artery during angioplasty. Headaches resolved after successful angioplasty. The temporal relationship between coronary artery occlusion and the headache suggests that headache angina is due to referred pain rather than a generalized vasospastic disorder.

Transesophageal echocardiography and its potential for esophageal damage.

The purpose of this study was to determine whether the pressure produced by contact between a transesophageal echocardiography (TEE) probe and the esophagus was sufficient to cause esophageal damage. The authors studied the effects of sustained contact and associated surface pressure on the esophagus by a TEE probe in anesthetized dogs and humans. Contact pressure between the tip of the probe and the esophageal wall in dogs was measured using a previously described flat balloon of Silastic fitted to the end of a TEE probe and the recording system calibrated with a mercury manometer. In the dog studies, the probe was inserted, maximally flexed, and its position fixed for 4, 6, 8, and 12 h. The maximum surface pressure generated by contact between a probe and the esophageal wall was 10 mmHg. Subsequent pathologic studies failed to reveal either gross or microscopic evidence of tissue damage. The same system was used in short-term patient studies with the surface contact pressure transducer connected to a Camino Catheter 420 Digital Pressure Monitor. In five of six patients contact pressure was less than 17 mmHg despite maximal rotation of the TEE controls. However, one of the six patients developed very high contact pressure, up to 60 mmHg, between the probe and the esophagus. This patient had no history of esophageal disease but did have intrathoracic pathology.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic tissue characterization of human hypertrophied hearts in vivo with cardiac cycle-dependent variation in integrated backscatter.

Integrated ultrasonic backscatter (IB) is a noninvasive measure of the acoustic properties of myocardium. Previous experimental studies have indicated that altered acoustic properties of the myocardium are reflected by the magnitude of variation of IB during the cardiac cycle. In our study, cardiac cycle-dependent variation of IB was noninvasively measured using a quantitative IB imaging system in 12 patients with uncomplicated pressure-overload hypertrophy and 13 patients with hypertrophic cardiomyopathy. Sixteen normal subjects served as a control. The magnitude of cardiac cycle-dependent variation of IB for the posterior wall was 6.0 +/- 0.9 dB in normal subjects, 5.7 +/- 0.8 dB in the patients with uncomplicated pressure-overload hypertrophy, and 6.7 +/- 2.1 dB in the patients with hypertrophic cardiomyopathy. There were no significant differences among any of these groups. In contrast, the magnitude of cardiac cycle-dependent variation of IB for the septum was significantly smaller in the patients with uncomplicated pressure-overload hypertrophy (2.8 +/- 1.3 dB) and in the patients with hypertrophic cardiomyopathy (3.1 +/- 2.3 dB) than in normal subjects (4.9 +/- 1.0 dB). The magnitude of cardiac cycle-dependent variation of IB was smaller as the wall-thickness index increased (r = -0.53, p less than 0.01, n = 82 for all data). This IB measure also correlated with percent-systolic thickening of the myocardium (r = 0.67, p less than 0.01, n = 82). Thus, alteration in the magnitude of cardiac cycle-dependent variation of IB was observed in hypertrophic hearts and showed apparent regional myocardial differences.

Age related decline in aluminum-activated human platelet adenylate cyclase: post-receptor changes in cyclic AMP second messenger signal amplification in normal aging and dementia of the Alzheimer type.

Low, micromolar concentrations of aluminum (in the presence of NaF) were shown to strongly activate human platelet adenylate cyclase and provided a useful probe for evaluating cyclic AMP second messenger function distal to the receptor: The effect of normal aging and disease state on second messenger activity in man was studied by measurements of the aluminum-activated enzyme. A significant decline in aluminum-stimulated platelet adenylate cyclase activity in older, healthy subjects was observed. An age-associated decline in NaF-stimulated cyclic AMP synthesis was also demonstrated for normal, non-demented subjects. These findings suggest an age-associated lesion at the level of the guanine nucleotide regulatory protein/catalytic subunit of the adenylate cyclase complex. However, for patients with Alzheimer's disease no such decline in platelet adenylate cyclase activity was detected, and increased sensitivity to both aluminum and NaF was demonstrated.

The cyclic AMP second messenger system in man: the effects of heredity, hormones, drugs, aluminum, age and disease on signal amplification.

The intracellular effects of a number of hormonal signals are mediated by the cyclic AMP second messenger system in man and the ubiquitous distribution of hormone-stimulated adenylate cyclase suggests the importance of this enzyme complex in normal aging and pathophysiological states. Various vectors including heredity, endogenous catecholamines, steroid hormones, and drugs affect the activity of hormone-stimulated adenylate cyclase in man. The effect of heredity was studied using lymphocytes obtained from monozygotic twin pairs and age and sex-matched sib pairs. Only for forskolin-stimulated activity is a significant proportion of individual variance attributable to heredity, suggesting the relative stability of the catalytic subunit. Beta-adrenergic and prostaglandin E-1 activity are "state" characteristics and their activities are controlled by environmental parameters. A significant reduction in isoproterenol-stimulated cyclic AMP accumulation between the menses and luteal phase of the menstrual cycle is observed in lymphocytes obtained from 11 female subjects. The lowest level of beta-adrenergic receptor activity is associated with the highest levels of progesterone and estradiol hormone levels in blood. Lithium at therapeutic concentrations markedly inhibits adenylate cyclase activity in platelet membranes. Moreover, marked individual differences are observed in sensitivity to lithium as determined by Dixon plot derived Ki values for 9 normal, healthy subjects. Human adenylate cyclase obtained from platelets and lymphocytes is activated by micromolar amounts of aluminum in the presence of NaF. Irreversible activation of adenylate cyclase by aluminum is suggested as a possible mechanism of this metal's neurotoxicity. The biochemical basis for the age-associated decline in beta-adrenergic responsiveness in man is discussed. Several investigations suggest a deficit at two levels in the adenylate cyclase complex: an impaired coupling of the receptor/N protein subunits and an additional lesion distal to the receptor at the level of N/C coupling. Perfusion studies with salbutamol suggest that the decline in beta-adrenergic sensitivity is general and not restricted to lymphocytes. Possible abnormalities in cyclic AMP signal amplification and recognition in various disease states is discussed. Increased prostaglandin E-1-stimulated cyclic AMP accumulation is observed in lymphocytes obtained from patients with Alzheimer's disease compared to age-matched controls and correlated with severity of the disease state.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute desensitization of lymphocyte beta-adrenergic-stimulated adenylate cyclase in old age and Alzheimer's disease.

The effect of prior incubation with a single concentration of isoproterenol (10(-4) M) for 2 hours at 37 degrees C on isoproterenol-stimulated cyclic AMP accumulation in intact lymphocytes from young, old and subjects with Alzheimer's disease was studied. In lymphocytes from all three subjects groups prior incubation of cells with isoproterenol resulted in a significant reduction of cyclic AMP accumulation upon subsequent stimulation with isoproterenol.

Alzheimer's disease: isoproterenol and prostaglandin E1-stimulated cyclic AMP accumulation in lymphocytes.

Reduced lymphocyte beta-adrenergic receptor activity was observed in patients with Alzheimer's disease and in aged controls; a parallel decline in lymphocytic prostaglandin E1 receptor activity was seen in the aged controls. In the Alzheimer patients, however, such lymphocytic prostaglandin E1 receptor activity was significantly raised and correlated with a rating scale for severity of dementia.

A case of rapid mood cycling with estrogen: implications for therapy.

In a patient with a severe depressive episode that did not respond to antidepressants, rapid mood cycling abruptly developed during a clinical trial of estrogen. This association may provide a further suggestion of estrogen's antidepressant activity and its possible use in certain situations of resistant depression.

[Parkinson's disease and mental deterioration. Apropos of 30 cases]. / Maladie de Parkinson et détérioration intellectuelle. A propos de 30 cas.

The influence of Parkinson illness on intellectual faculties is appreciated in different ways. The existence of a real parkinson dementia is contested by some who see in the intellectual impoverishment of these patients a simple decline in efficiency. This is often partial and linked to neurological consequences which are not always taken into account by psychometric tests. 30 parkinson patients are beeing examined in this light. In spite of the small number, quite clear tendencies are apparent and which confirm the possible existence of these two types of phenomena, one beeing dementia and the other simply weakness without authentic senility. Risk factors are also isolated which emphasize age and accidents due to L-Dopa intolerance.