Stage-dependent BDNF serum concentrations in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by cognitive decline and loss of neurons in specific brain regions. Recent findings have suggested an involvement of brain-derived neurotrophic factor (BDNF) in the pathogenesis of AD. BDNF is an endogenous protein involved in the maintenance of neuronal function, synaptic plasticity and structural integrity in the adult brain. To our knowledge, the present pilot study assessed for the first time BDNF serum and CSF concentrations in 30 patients with different stages of AD in comparison to 10 age-matched non-demendet controls. AD patients were divided in two groups according to their MMSE score: Group 1 (n = 15) in early stages with MMSE scores >or=21 (mean of 25.5) and Group 2 (n = 15) with more severe stages of dementia with MMSE scores <21 (mean of 13.3). As main results, we found in patients with early stages of probable AD significantly increased BDNF serum concentrations as compared to more severe stages of AD (p < 0.0001) and age-matched healthy controls (p = 0.028). BDNF serum values in all AD patients correlated significantly with MMSE scores (r = 0.486; p < 0.0001). Levels of BDNF were below the detection limit of the assay in unconcentrated CSF samples of AD patients and non-demendet controls.In summary, BDNF serum values are increased in early stages of Alzheimer's disease, which may reflect a compensatory repair mechanism in early neurodegeneration and could also contribute to increased degradation of beta-amyloid (Abeta). During the course of the disease, BDNF is decreasing, which correlates with the severity of dementia. The decrease of BDNF may constitute a lack of trophic support with an increase of Abeta accumulation and thus contribute to progressive degeneration of specific regions in the AD-affected brain. BDNF should be further evaluated as a candidate marker for clinical diagnosis and therapeutic monitoring in Alzheimer's disease.

Diminished production of proinflammatory cytokines in patients with Alzheimer's disease.

Cerebral inflammation as well as systemic immunological alterations have been reported in Alzheimer's disease (AD). We examined the production of the proinflammatory cytokines interleukin-6, interleukin-12, interferon-gamma, and tumor necrosis factor-alpha in whole blood cell cultures of AD patients and age-matched controls. The production of all measured cytokines after mitogen stimulation is significantly decreased in the AD group compared to controls. The results reflect an attenuated secretory activity of monocytes/macrophages, but also of T-helper cells. The data sustain the assumption that a systemic, possibly age-related alteration of immune mechanisms may play a pathogenetic role in the development of AD.

[Cerebral toxocariasis: a rare cause of cognitive disorders. A contribution to differential dementia diagnosis]. / Zerebrale Toxokariasis: seltene Ursache kognitiver Störungen. Ein Beitrag zur Differenzialdiagnostik der Demenz.

We report on a 65-year-old woman with depressive symptoms and cognitive deficits confirmed by psychometric tests. Routine blood tests, serology, EEG, and cranial computed tomography (CCT) being normal, the CSF revealed an eosinophilic reaction and a positive antibody titre against Toxocara canis. After treatment with two oral courses of albendazole, the eosinophils had disappeared, whereas the antibody titre had increased. One year later, the patient's cognitive symptoms had improved, and new antibodies against toxocara were seen in the peripheral blood. This increase in antibodies represents an expected immunological reaction to the increased exposition to toxocara antigen under effective therapy. The infection might go back to the patient's youth, when she was a shepherd for several years and in close contact to dogs. A review of the literature did not yield other reports of toxocara infections leading to cognitive or other psychiatric symptoms. Taking the toxocara infection as the cause of this patient's cognitive defects, we propose that lumbar punction becomes part of the diagnostic standard in differential diagnosis of dementia.

Increased serum levels of CD95 in Alzheimer's disease.

There is growing evidence for a role of apoptosis in Alzheimer's disease (AD). Recent findings suggest an increased susceptibility of lymphocytes to apoptosis in AD. To prove the hypothesis of systemic alterations in the apoptotic balance in AD, serum and cerebrospinal fluid levels of soluble CD95, which is known to mediate apoptosis, were measured. In the serum, AD patients exhibited significantly higher levels of CD95 than the controls (p = 0.017), suggesting an involvement of peripheral markers in AD.

A case of paranoia with severe consequences. From a historical approach to a multidimensional understanding of chronic delusional disorder.

Following a brief resume of the history of the notion of paranoia, we present the case history of a 67-year-old female patient, who suffered from irreversible physical handicap as a result of chronic delusion. Against the background of the on-going controversy about the existence of paranoia as a distinct illness, we discuss the contemporary understanding of delusional disorders, emphasising the importance of a multidimensional therapeutic approach.

Antibrain antibodies in mental disorder: no evidence for antibodies against synaptic membranes.

Antibody reactivity in serum to synaptic membranes from human was investigated in major depressive disorder (N = 20), paranoid schizophrenia (N = 20), schizoaffective psychosis (N = 20), and in controls (N = 20) using Western and Immunoblots and ELISA technique. None of the patients showed a significant immune response to synaptic membranes. There was a base-line activity in both controls and patients with antibodies directed to a double band of proteins at 66kD. These antibodies may represent natural autoantibodies. The authors conclude from this and other studies that there is at present no proof of antibrain antibodies in mental disorder.

[Sensitive delusion of reference--only of historical significance? A current case example]. / Der sensitive Beziehungswahn--nur noch von historischer Bedeutung? Ein aktuelles Fallbeispiel.

In 1918, Ernst Kretschmer published the monograph "Der Sensitive Beziehungswahn" [The Sensitive Delusion of Reference], one of his most important contributions to psychiatry. It reflects the lively discussion on psychogenic psychoses that was going on at the turn of the century. An actual case is used to demonstrate that even today the "sensitive delusion of reference" can be clearly delimited as a distinct syndrome. On the basis of the current literature, possible reasons for the fact that this diagnosis is relatively rarely made today are discussed. The sensitive delusion of reference is also an example of socio-cultural change in psychiatric diagnosis.