Vascular disease risk factors and findings in patients with Alzheimer's disease.

Vascular risk factors and data of different examinations relating to extracerebral vascular conditions were analysed in demented patients. Data of demented patients subsequently admitted to the Memory Clinic of the National Institute of Psychiatry and Neurology between March 1995 and February 1996 were registered in a specially designed data sheet. Three vascular examinations (ECG, Doppler examination of main extracerebral arteries on the neck, ophthalmoneurological examination) were carried out. The risk factors and vascular alterations were condensed in two factors. Neither the descriptive data nor the two factors showed statistically significant differences in the main groups (probable Alzheimer's disease--n=24, vascular dementia--n=23, mixed forms--n=15). Based on our results: vascular risk factors and pathological changes can occur in probable form of Alzheimer's disease; they can be present in early onset form as well; the most marked changes are in the vascular dementia group; relevant findings lack any correlation with each other in the point of severity of vascular changes. The extremely high cardio-cerebrovascular morbidity in Hungary seems to be reflected in the results. The role of vascular risk factors and (subclinical) pathological findings seem worth exploring further in Alzheimer's disease.

[Molecular genetic markers of Alzheimer dementia]. / Az Alzheimer-dementia molekuláris genetikai markerei.

Alzheimer's dementia (AD) is a progressive neurodegenerative disease which is one of the most common forms of dementia in the above 65 years old age group. Diagnosis is based upon evaluation of cognitive skills, elimination of other dementia associated diseases and on cranial CT examination. However, definitive diagnosis is proved only by neurohistological findings. The etiology of the disease is unknown and effective treatment is not available. Intensive research into the pathomechanism of the disease revealed a connection between increased frequency of apolipoprotein E4 allele and later onset of AD. The aim of the author's research was to characterize apolipoprotein E polymorphisms in AD patients and to examine immunological factors which could play an important role in the development of the disease such as the polymorphism of complement and lipoprotein(a) [Lp(a)] alleles previously had not been investigated. 35 AD patients (26 female, 9 male) were examined (mean age 66.4 years +/- 8.7 SD). 18 of these patients showed late onset of the disease. The E4 allele was significantly more frequent in both early and late onset groups compared to controls (0.29 vs. 0.14 and 0.33 vs 0.09). The high frequency of apo E4 found in the early onset group in this study differs from other international data. Serum lipid, lipoproteins, Lp(a) concentrations and Lp(a) phenotype distribution showed no significant difference compared to controls. Furthermore, it was found that the frequency of complement C4AQ0 (null) and Bf F alleles was higher in the late onset AD group compared to controls (0.35 vs 0.139 and 0.305 vs. 0.225) suggesting an active involvement of the complement system in the pathogenesis of this disease.

Clinical subtypes of Alzheimer's disease.

The authors summarize the data of 60 patients of the Memory Clinic of the National Institute of Psychiatry and Neurology between 6 January 1992 and 6 June 1994 where the probable Alzheimer's disease (NINCDS-ADRDA) was diagnosed. It was examined whether it was possible to isolate homogenous subtypes based on clinical data. Interesting differences of tendency level could be demonstrated in the groups formed on the basis of data published in the literature. Differences of statistical significance level were as follows: occurrence of depression in the groups created on the basis of the patient age at the time of onset of the disease (early-late onset), and of alexia and autotopagnosia in the groups created on the basis of progression rate (slow - quick). The absence of epileptic seizures is extremely interesting. The authors' final conclusion is the following: the clinical symptoms unfortunately do not give sufficient possibility to form homogenous subtypes in the general frame of Alzheimer's disease.

[Clinical symptoms of Alzheimer disease]. / Az Alzheimer-betegség klinikai tünetei.

Data of patients suffering from Alzheimer's disease and checked out in the special unit named Memory Clinic functioning from 1992 in the National Institute of Psychiatry and Neurology are summarized. Age average of the 60 patients was 63 years, the first symptoms of the disease had appeared in 57 p.c. before the age of 65, so the classical presenile form of the ailment is represented too in the material. Predominance of multifocal cortical function disturbances in the symptomatology is characteristic, association of the depression is outstandingly frequent. The atypical features, or those characteristic in diseases of cerebrovascular origin are not infrequently seen (headache, dizziness, slight symptoms of pyramidal lesions). The absence of epileptic seizures It was interesting even in considering the data of the literature too. The main points of clinical diagnostics and differential diagnostics are demonstrated with the aid of case reports. The author's material is the first Hungarian publication in the topics of clinical symptoms of patients suffering from Alzheimer's disease that had been investigated with up-to-date methods. Occurrence of the disease of very great frequency could be supposed to occur at general practitioners, the importance of differential diagnostics and planning of the complex longlasting therapy is extremely great.