[Frontal lobe dementia. Clinical-pathologic case reports]. / Frontallappen-Demenzen. Klinisch-pathologische Fallberichte.

Frontal lobe dementia (FLD) is characterised clinically by personality changes and a progressive speech disorder finally leading to mutism. In the course of the disease also other neurological syndromes may occur such as parkinsonism, a partial Klüver-Bucy-syndrome or a degeneration of motoneurons (FLD + MND). The latter leads to death within about three years. The clinical diagnosis of FLD is supported by functional (SPECT) and morphological (CT, MRI) investigations. From 1988 to 1997, 9 cases of FLD (6 female, 3 male) were clinically diagnosed at our department of Gerontology, LNK Linz. In two of these cases the clinical diagnosis was confirmed histopathologically. Characteristically, all except one patients showed a presenile beginning of the disease. The clinical course was slowly progressive with a mean duration of about 10 years. Special attention was given to additional signs and symptoms of motor neuron disease, parkinsonism and hyperorality. Six patients suffered from FLD + MND; parkinsonism (rigid-akinetic type) and a partial Klüver-Bucy-syndrome were diagnosed in 5 cases each. In histopathological investigations the incidence of FLD seems to increase. This type of dementia should be considered as an important diagnosis differential of presenile dementia-syndromes.

[Histopathologic studies in dementia--comparison with clinical findings]. / Histopathologische Untersuchungen bei Demenz--Vergleich zum klinischen Befund.

This paper compares the clinical diagnosis of dementia with the result of the neuropathological brain examination in 23 patients. Aim of this investigation was a verification of the clinical diagnosis. The diagnosis was based on the clinical findings, the Mini Mental State Examination, DSM-III-R classification of dementia, the NINCDS-ADRDA-criteria, results of laboratory tests, EEG, CCT and sonography. A total of 70% of the clinical diagnosis corresponded to the neuropathological results. In 25% of these cases which clinically showed the characteristics of Alzheimer's disease histopathological findings delineated dementia of non-Alzheimer-type. These results underline the importance of additional histopathological investigations in the diagnosis of dementia.

Therapeutic results with Cerebrolysin in the treatment of dementia.

BACKGROUND: In the present study patients suffering from dementia were treated with an infusion therapy using the neurotrophic drug Cerebrolysin. The effectiveness of the therapy was examined under conditions of daily clinical practice. METHODS: 645 Patients were treated with 30 ml Cerebrolysin daily. The average period of treatment was 17.8 days. Prior to treatment patients were diagnosed according to DSM-III-R. In addition a differential diagnostic examination using the Hachinski Ischemic Score was performed. Clinical symptoms and the Clinical Global Impression (CGI) were determined before and after therapy. RESULTS: Cerebrolysin therapy led to a significant (p < 0.001) improvement in memory for 62% of the patients. 65% showed improvement in concentration, 50% in mood and fatigue, and 47% improved in vertigo. An improvement in the Clinical Global impression was observed in approximately 80% of the patients. The improvement of symptoms was significantly larger (p < 0.05) in younger, less afflicted patients than in the older, more seriously ill patients. The unusual good tolerance of Cerebrolysin was especially noteworthy. CONCLUSIONS: The present study confirms the results of earlier clinical studies with Cerebrolysin in the treatment of Alzheimer patients and patients with vascular dementia in which similar responder rates were observed. The significant dependence of therapeutic success on the length and severity of illness confirms that timely pharmacological intervention leads to best therapeutic results.

[Necrotizing herpes simplex encephalitis as the cause of a progressive dementia syndrome]. / Nekrotisierende Herpes-simplex-Enzephalitis als Ursache eines progredienten dementiellen Syndroms.

HISTORY AND FINDINGS: A 65-year-old woman was twice hospitalized because of disorientation and insomnia with depression. In the course of antidepressive treatment the symptoms regressed each time so that the diagnosis was made of pseudo-dementia during depression. About a year after the first admission the symptoms recurred, despite continued antidepressive treatment. Clinical criteria now suggested Alzheimer-type dementia as the diagnosis. COURSE AND TREATMENT: The symptoms of dementia increased markedly and generalized seizures requiring anticonvulsive drugs occurred after 4 months. Although IgG antibodies against Herpes simplex virus (HSV) were demonstrated in cerebrospinal fluid (CSF), no antiviral treatment was instituted because HSV encephalitis appeared unlikely at this stage. But the patient's mental and physical state further deteriorated in subsequent months. During an attack of pneumonia the patients became somnolent and went into status epilepticus. Repeat virological examination of CSF now revealed IgG and IgM antibodies against HSV, confirming encephalitis. Her condition markedly improved over 12 days on aciclovir, 750 mg 3 times daily intravenously. 6 weeks later the pneumonia recurred, as did the encephalitis, with apnoeic phases and massive left heart failure. The patient died a few days later. Immunohistochemical tests of brain tissue were positive for HSV type II. CONCLUSIONS: This case report demonstrates that an investigation on dementia must include a complete liquor analysis. If HSV encephalitis is suspected, an antiviral therapy must be administered immediately. Even in adults who seem to have normal immunity HSV type II can cause HSV encephalitis.

[Effectiveness of power toothbrushes]. / Effektivität elektrischer Zahnbürsten.

Three power toothbrushes with different mechanical principles (blend-a-dent master-vertical oscillating system, blend-a-dent medic electric elliptical oscillating system, interplak-contra-rotationsystem of the bristle-tuft) and a conventional hand toothbrush were investigated in 60 oral hygiene-motivated persons in a three-month-study. Efficiency was tested by two parameters (plaque index, papillary-bleeding index) under statistically identical conditions. The study showed no major differences in efficiency between the power toothbrushes and the manual toothbrush. --For the whole study the power toothbrush with an elliptical oscillating system showed the best results. --Power toothbrushes are not more effective in plaque removal than a manual toothbrush. The great statistical variation of the investigated parameters in each group shows that an optimal brushing technique was more important than the choice of a certain toothbrush. --The investigation of the interproximal areas showed that a toothbrush alone is not effective enough. The additional use of dental floss and/or interdental cleaners for optimal oral hygiene is essential.