Structural modifications of intracerebral small vessels in various types of dementia.

Previous and recent studies stress the importance of small intracerebral vessel lesions in the pathogeny of some forms of dementia. The observations on this subject and included in our study refer to adult patients (32-86 years) selected only on the criterion of clinical diagnosis of dementia. To diagnose most of the cases, clinical experimental data and clinico-psychomotor tests were used. Classical neuropathological techniques were performed for the morphological study of their brains. All types of cerebral vessels were affected in various percentages by the different types of lesions. Vessel wall sclerosis of all types of intracerebral vessels was noticed in 50% of the cases, the thickening of the arteriolar wall with or without sclerosis in 25% of cases and exclusively capillary fibrosis in 21.4% of cases. Other types of vascular changes were present in a small number of cases. No correlation could be made between a certain type of vascular lesion and the age or diagnosis of the patient. Nevertheless, we could observe that wall sclerosis was more frequently found in groups with the oldest patients with vascular diseases (VD, MD), the thickening of the arteriolar wall in patients aged 60-74 years with vascular diseases, and capillary changes in older patients with dementia of Alzheimer type. No preferential location of the vascular lesions could be observed in our group of patients.

The effect of clonidine in the treatment of acute mania.

Twenty hospitalized patients have been treated for acute mania with doses of 450-750 micrograms/day of clonidine (an alpha 2-adrenergic agonist), for one month. The tolerance to the given doses was excellent. A marked decrease of the manic symptoms was noted in 65% of the patients during the first 10 days of the treatment. The response was prompt and maintained for the whole period of the research, the clonidine being efficient on the whole scale of the manic syndrome. The sedating effect was much lower than in the case of neuroleptics; it is quite likely that the clonidine could represent an advance in the acute treatment of manic patients.

White matter changes in old age dementia.

This is the clinico-morphological study of 70 patients above age 60 with the clinical diagnosis of dementia made on clinico-psychometric criteria for the assessment of the deterioration-dementia state, and in some cases, using the Hachinski scale. For morphological macro- and microscopic examinations of the brain, the classic neuropathologic techniques were used. Although no case selection was carried out, the number of cases was uniformly distributed between the ages of 60-74 years. The sample was also relatively uniform with regard to the patients' sex. Morphologically, our patient group included cases with vascular dementia (VD-33%), mixed dementia (MD-14.3%), Alzheimer-type dementia (ATD-20%), isolated SAE (17%), other cases (15.7%). Myelinic pallors and rarefactions were present in 41.4% of all cases of which: as a single lesion in 41.4%, associated with VD in 34.5%, with MD in 17.2% and with ATD in 6.9%. Microscopic background of myelinic changes was represented by acute (perivascular and pericellular edema) and chronic (myelinic destruction, gliosis, perivascular hematic pigment) edematous lesions. In 10.3% of cases with myelinic changes, marked dilation and blood stasis in large periventricular and/or subcortical vessels with subsequent cerebral edema, generally overlapping critical zones of venous circulation could be observed. The size and severity of the myelinic lesions were not clearly correlated to the intra- and extraparenchymatous vascular changes. However, the myelinic involvement was more in cases with lesions, mainly atherosclerotic, of the vessel walls. The possible intervention of the venous factor in the development of subcortical arteriosclerotic encephalopathy (SAE) is discussed among other etiopathogenic factors.

Open clinical study of Clopixol-Acuphase (zuclopenthixol acetate) treatment followed by Clopixol Depot in acute psychoses with long-term course tendency.

The evolution of 28 patients displaying acute forms of psychoses (schizophrenia, mania, exacerbation of psychosis in chronic cases) was studied under the treatment with Acuphase Acetate continued with Clopixol Depot. In both therapies a tioxantenic neuroleptic is involved for the acute form of the illness (Acuphase) and for the maintenance treatment (Clopixol Depot). The assessment of the results was carried out on individual observation files using Global Rating Scale (G.R.S.), B.P.R.S. and paraclinical measurement to appreciate the biological tolerance. Favourable effects of treatment were evident in the first 4 days and in six cases even within the first 24 hours. The whole group of patients showed a significant decrease of morbidity evolving from a high severity to a medium and reduced one. The biological tolerance was very good, 6 to 12 months' care.

Serum immunoglobulin (A, G, M) levels in primary bipolar affective disorders.

Quantitative determination of serum immunoglobulins (A, G, M) was made in patients with primary bipolar affective disorders (PBAD) and adequate control samples. Considering the modified immunoglobulin levels, the immune factors may be incriminated in the etiopathogenesis of the disease.

Cerebral dysfunction revealed by EEG mapping in the schizoform epileptic psychosis.

Twenty schizophrenia-like psychotic patients suspected of epilepsy were explored using EEG techniques (recordings in the 10-20 International System, source derivation, EEG mapping and EEG spectral reaction mapping by photic and somesthetic stimulation). In 16 of them, latent epileptic disorders were found. EEG spiking foci could be located either: (a) in temporal, (b) fronto-basal, or (3) in the sagittal-line leads. A corresponding associated dysrhythmia was clearly revealed by EEG mapping. On EEG spectral reaction mapping a suggestive aberrant displacement of the area of maximal sensory response was found. These EEG disorders were in significant relation with the psychotic syndrome observed in the respective group of patients: (a) patients with fronto-basal (temporal anterior) foci were prevalently paranoid; (b) patients with temporal lobe foci were prevalently depressive; (c) patients with sagittal line (singular) foci presented a predominantly expansive, hypomanic behaviour. The study shows the importance of normal fronto-limbic circuits for the preservation of mental health.

Assessment of various psychopharmacological combinations in the treatment of presenile and senile primary degenerative dementia.

The effects of various psychopharmacological combinations were used in a sample of 90 patient fulfilling the DMS-III criteria for presenile or senile primary degenerative dementia divided into 3 equal subgroups. Regardless of the drug combination used, an improvement of verbal test performances was noticed.

[Clonidine treatment in manic episodes]. / Tratamentul cu clonidina în episoadele maniacale.

The authors have treated 20 patients hospitalized for acute manic disorders with 450-750 micrograms of clonidine per day for a period of one month. The tolerance to the drug was excellent. A marked decrease in manic symptoms was noted in 65% of the patients after the first ten days of therapy. The response was rapid and was maintained for the entire duration of the study, and clonidine was efficient for all the symptoms of the manic syndrome. The supra-sedation effect was much lower than with neuroleptics, and clonidine could be considered to represent a practical progress in the acute therapy of manic patients. Clonidine, usually employed as an anti-hypertensive drug, is an alpha-2-adrenergic agonist. It is believed that this property decreases the neural transmission by noradrenaline by stimulating pre-synapsis inhibitor receptors.

The importance of cerebral lesions of vascular origin in the morphopathologic picture of old age dementia.

Our study refers to the complex neuropathologic examination of 70 demented patients (40 males and 30 females) above 60 years of age. Proportion of different types of cerebral damage with vascular pathogeny showed that 78% of the vascular dementia cases had as morphological background various aspects of multi-infarct dementia; softenings of variable size and lacunae, associated or not with myelinic rarefactions and pallor specific to subcortical arteriosclerotic encephalopathy; the remaining cases pointed to single anoxic lesion and/or subcortical encephalopathy. Perfect clinico-morphological diagnostic concordance has not always been reached in our sample--as in literature cases--often due to the dementia subtypes overlapping, and to the fact that the same clinical syndrome may show in different cerebral lesions. Likewise, no correlation has been found between lesion type, site or size and clinical picture or dementia course, which was also reported by other authors. On a morphopathogenic basis, we support the view that necrotic lesions of ischemic origin--multi-infarct and lacunar dementias--should be distinguished from myelinic rarefactions and pallor in the white matter, whose pathogeny is still controversial. Due attention is paid to the importance of the venous factor in the development of subcortical encephalopathy.