ABSTRACT
The long-term sequelae of acute sarin exposure are not well understood. The largest clinical cohort resulted from the 1994 and 1995 attacks in Japan. Observers noted mostly psychiatric sequelae, with a high prevalence of post-traumatic stress disorder (PTSD). We describe neurocognitive findings that may represent sequelae of low-level sarin exposure in Iraq.
Subject(s)
Chemical Warfare Agents/toxicity , Cognition Disorders/chemically induced , Sarin/toxicity , Adult , Humans , Iraq War, 2003-2011 , Male , Psychomotor Performance/drug effectsABSTRACT
BACKGROUND: Frontotemporal dementia (FTD) is one of the more common presenile dementias. Unlike Alzheimer disease, there are no approved medications to treat this debilitating condition. OBJECTIVE: To report the response of memantine on the behavioral manifestations of FTD. DESIGN: Case series of 3 patients diagnosed with FTD and treated with memantine. RESULTS: All 3 patients showed an improvement in total Neuropsychiatric Inventory score with specific improvements in the subscale scores of apathy, agitation, and anxiety. Memantine was well tolerated in all patients. CONCLUSIONS: This small case series supports the notion that memantine may have a beneficial effect on the neuropsychiatric symptoms of FTD and should be further studied in a prospective clinical trial.
Subject(s)
Behavioral Symptoms/drug therapy , Dementia/drug therapy , Dopamine Agents/therapeutic use , Memantine/therapeutic use , Behavioral Symptoms/etiology , Brain/pathology , Dementia/complications , Dementia/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuropsychological Tests , Positron-Emission TomographyABSTRACT
We present a case of severe posterior headache and diplopia following an epidural steroid injection for lumbar pain.
Subject(s)
Headache/etiology , Injections, Epidural/adverse effects , Pneumocephalus/etiology , Acute Disease , Humans , Low Back Pain/drug therapy , Male , Middle Aged , Steroids/administration & dosage , Steroids/therapeutic use , Subarachnoid SpaceABSTRACT
BACKGROUND: Executive dysfunction (EDF) is common in Alzheimer disease (AD); however, its relationship to other symptoms is difficult to assess in patients with AD. OBJECTIVES: To determine the prevalence of EDF and study its relationship to cognitive, functional, and neuropsychiatric symptoms in patients with AD. DESIGN, SETTING, AND PATIENTS: A retrospective analysis of data from participants in the English Instruments Protocol of the Alzheimer's Disease Cooperative Study. Subjects were drawn from a sample of patients evaluated at tertiary referral centers. RESULTS: A total of 64% of AD patients were classified as having EDF. Patients with EDF performed worse on tests of cognition (P <.001), dementia severity (P <.001), and activities of daily living (P =.01) and had more frequent symptoms of psychosis (P =.03) with greater emergence during the 12-month interval (P =.03) compared with patients with normal executive function. Less than 30% of the variance in executive function performance was explained by cognitive measures. CONCLUSION: These findings support the assessment of executive function in persons with AD and the importance of frontal lobe dysfunction in AD.
Subject(s)
Alzheimer Disease/diagnosis , Cognition Disorders/diagnosis , Neuropsychological Tests , Activities of Daily Living/classification , Activities of Daily Living/psychology , Aged , Alzheimer Disease/epidemiology , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Attention/physiology , Cognition Disorders/epidemiology , Cognition Disorders/psychology , Cross-Sectional Studies , Discrimination Learning/physiology , Female , Frontal Lobe/physiopathology , Humans , Male , Mental Status Schedule/statistics & numerical data , Middle Aged , Problem Solving/physiology , Psychometrics/statistics & numerical data , Reference Values , Retrospective Studies , Statistics as TopicABSTRACT
Dementia with Lewy bodies (DLB) is a relatively recently characterised syndrome with clinical and pathological features that distinguish it from classical Alzheimer's disease. These characteristics include more rapid decline, spontaneous features of parkinsonism, visual hallucinations and fluctuating cognition. This article reviews the clinical syndrome of DLB and the agents used to treat its cognitive, motor and behavioural manifestations. Benefit-risk issues regarding the treatment of DLB are discussed based upon limited randomised, controlled clinical trials with some speculative conclusions being drawn from case reports and case series. We conclude that patients with DLB may respond better to cholinesterase inhibitors than patients with Alzheimer's disease on both cognitive and behavioural measures. Cholinesterase inhibitor therapy may result in reduced caregiver burden and less time institutionalised. These agents are well tolerated with the majority of adverse effects being gastrointestinal in nature. Although neuropsychiatric manifestations are numerous in patients with DLB, antipsychotics should be used infrequently and with caution, although atypical antipsychotics are better tolerated than conventional antipsychotics. Physicians should exhibit caution when prescribing these agents because of the increased risk of extrapyramidal adverse effects. Limited data suggest that the use of levodopa or other dopaminergic agents may be of benefit for the treatment of the parkinsonism that is associated with DLB. However, the increased risk of hallucinations and neuropsychiatric symptoms may negate the potential benefits of increased mobility. There is insufficient evidence to draw conclusions about the use of antidepressants; however, selective serotonin reuptake inhibitors may be of benefit.
