Neurocognition of centenarians: neuropsychological study of élite centenarians.

OBJECTIVE: The aim of this study was to evaluate the cognitive state of highly selected Polish centenarians and analyze the mechanisms of their functioning. METHODS: The selected centenarian group (10 persons) and a reference group (20 persons) who started aging (65 years) were examined with a sensitive set of neuropsychological tests and tasks in clinical-experimental assessment. RESULTS: As expected, the centenarians' cognitive functions were different from those of the subjects who started aging, however, not in all aspects. For instance, the former scored significantly lower in the area of linguistic functions but the ability to plan and controlled perform complex visuospatial task with use of simultaneous and sequential strategies was preserved despite unfavorable symptoms of natural aging such as permanence attention as well as prolonged action time. CONCLUSIONS: The results suggest that the studied centenarians show a dominant right-hemispheric pattern functioning not only in relation to perception, but also to planning and executing complex activities. The study and description of preserved neurocognition of centenarians was possible due to introducing a special procedure sensitive to the preserved functions.

The rate of conversion of mild cognitive impairment to dementia: predictive role of depression.

BACKGROUND: Mild cognitive impairment (MCI) is a condition referring to the persons with cognitive deficits measurable in some form or another, but not meeting criteria for dementia, and who have an increased risk of becoming demented. OBJECTIVE: To establish the rate of progression to dementia in MCI, to investigate the risk of conversion for amnestic vs multiple-domains subtypes, and to identify the predictors of progression. METHODS: MCI (n = 105) individuals enrolled in a longitudinal study received annual clinical and psychometric examinations for up to a mean of 3 years. The diagnosis of MCI according to Mayo Clinic Petersen's Criteria was conducted by a panel of specialists. RESULTS: After 3 years of follow-up, 23 of 105 subjects with MCI were diagnosed with dementia. 40 showed cognitive decline not dementia, 34 were stable and showed no cognitive decline or improvement, while eight showed cognitive improvement. CONCLUSIONS: We conclude that conversion rate from MCI to DSM-IIIR dementia was 21.9% over a period of 3 years. The occurrence of depressive symptoms may constitute a predictor for those who are more likely to progress to dementia. The risk of conversion to dementia was higher among the subjects with an evidence of impairment extending beyond memory than with those who suffered only from memory deficits, and the subjects who converted to dementia in this subtype had significantly higher baseline plasma total homocysteine levels than non-converters.

Prevalence of major and minor depression in elderly persons with mild cognitive impairment--MADRS factor analysis.

OBJECTIVE: The aim of the study was to detect the prevalence of depressive syndromes and symptoms in the sample of elderly persons with Mild Cognitive Impairment (MCI), and to analyse Montgomery-Asberg Depression Rating (MADRS) item scores. METHOD: The subjects of the study were 102 consecutive out-patients with MCI. All subjects were assessed by an experienced psychiatrist and MADRS was applied. Major and minor depressive episodes were defined according to DSM-IV criteria. Factor analysis was used to analyse baseline MADRS item scores. RESULTS: Three patient groups emerged according to the depressive symptoms distribution and severity scores basis: those with major depression constituted 19.6% (n = 20), with minor depression 26.5% (n = 27), and with very few depressive symptoms 53.9% (n = 55). Three interpretable MADRS factors were identified, using the factor analysis with Varimax rotation: the first consisting of apparent and reported sadness, inability to feel, pessimistic thoughts, the second consisting of inner tension, reduced sleep, reduced appetite, suicidal thoughts, and the third with concentration difficulties and lassitude. CONCLUSIONS: It was concluded that both major and minor depression is common in MCI. Three MADRS factors were identified and labelled as anhedonia-pessimism, anxiety-vegetative, and cognitive-inhibition.

Homocysteine, apolipoproteine E and methylenetetrahydrofolate reductase in Alzheimer's disease and mild cognitive impairment.

BACKGROUND: Alzheimer's disease (AD) is the most common dementia disorder in elderly people. Currently, the only known genetic factor associated with the development of sporadic AD is the apolipoprotein E (ApoE) 4 allele. There is a need to identify other environmental and genetic risk factors that could modulate the risk of developing sporadic AD. OBJECTIVE: To analyse the correlation between the ApoE and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism and plasma homocysteine levels and vitamins (B(12) and folic acid) concentrations in serum from patients with AD and mild cognitive impairment (MCI) as compared with control group. METHODS: The study was carried out in 99 AD patients, 98 subjects with MCI and 100 healthy subjects. Diagnosis of probable AD was made according to the NINCDS-ADRDA and DSM-IV criteria. The following factors were analysed: age, gender, duration of disease, concentration of plasma total homocysteine, folic acid and vitamin B(12) in the serum and the polymorphism of MTHRF and ApoE genes. The results obtained were analysed by multivariate analysis of regression. RESULTS: We found that plasma total homocysteine is increased in AD patients (p < 0.0001) and depended on the MTHFR T/T genotype in the presence of low folate levels (p < 0.05). The increased frequency of ApoE4 allele in the AD population was independent of homocysteine, folic acid and vitamin B(12) levels and MTHFR status. CONCLUSIONS: We conclude that the concentration of plasma total homocysteine is increased in AD patients. This may be associated with the T/T genotype in the MTHFR gene; however, the distribution of the MTHRF C677T polymorphism in the Polish population does not differ in AD and controls.

Behavioural pathology in Alzheimer's disease with special reference to apolipoprotein E genotype.

The aim of this study was to define the co-occurrence of behavioural symptoms and Alzheimer's disease (AD) in relation to apolipoprotein E (APOE) genotype. Probable AD patients from the Alzheimer's Day Clinic (n = 139) were assessed with the 'Behavioural Pathology in Alzheimer's Disease' rating scale, and their APOE genotype was determined. This study demonstrated no relationship between presence of the APOE epsilon4 allele and any of the behavioural symptoms assessed, including delusions, hallucinations, depression, activity disturbances, aggressiveness and anxiety. Activity disturbances, delusions, hallucinations and aggressiveness paralleled the severity of AD, increasing in frequency with the severity of the dementia. The prevalence of delusions, hallucinations, aggressiveness and depression were found to be associated with lower levels of education.

[Vascular risk factors in demented elderly: analysis of Alzheimer Clinic materials]. / Naczyniowe czynniki ryzyka wybranych zespolów otepiennych--analiza materialu Poradni Alzheimerowskiej.

UNLABELLED: In recent years evidence is increasing that vascular disease is associated with cognitive impairment and dementia. Moreover, presence of cerebrovascular disease may intensify the clinical symptoms of Alzheimer's disease (AD). The aim of the study was to determine the prevalence of vascular risk factors in age and sex matched patients with dementia. We studied 109 patients with AD and 37 patients vascular dementia (VD). DSM-III-R test for dementia, NINCDS-ADRDA guidelines for AD and NINDS-ARIEN for VD were applied. RESULTS: Mean age of dementia onset in AD and VD was 65.8 SD 7.8 and 67.4 SD 7.0 years (p > 0.05), the duration of dementia, MMS and GDS for patients with AD and VD was not significantly different. Arterial hypertension was associated in 51.3% VD and 30.3% AD (p < 0.05), hypotension in 11.1 and 23.6% respectively (p > 0.05), atrial fibrillation was similar in AD and VD, coronary artery disease was presents 64.8% AD and 46.8 VD (p > 0.05) and type 2 diabetes in 21.6% and 10.1% (p > 0.05) respectively. No significant differences in serum lipid profile were found in both groups, except two times higher incidence of normal HDL-cholesterol concentration in AD compare to VD. The relation between alcohol consumption, cigarette smoking and head trauma was similar in both types of dementia. CONCLUSION: Vascular disease and AD have to some extent a shared aetiology, and risk factors that they have in common increase the risk of both disorders independently and vascular disease is perhaps involved in the aetiology of AD.

[Frequency and intensity of behavioral and psychological symptoms in the course of Alzheimer's disease]. / Czestosc oraz intensywnosc wystepowania zaburzen psychicznych i zachowania w otepieniu o róznym nasileniu w przebiegu choroby Alzheimera.

The aim of the study was: 1) to estimate the occurrence and intensity of some psychopathological symptoms in the course of Alzheimer's disease, and 2) to examine whether the occurrence of behavioral and psychological symptoms increases with the deepening of dementia process among persons with Alzheimer's disease living in their homes with outpatient treatment. The study was conducted among 94 persons (38 men and 56 women ageing from 52 to 86 years (x = 72.4 +/- 6.9), with education: from 2 to 17 years (x = 11.2 +/- 3.7). Three subgroups were selected for study with regard to the intensity of dementia process, estimated according to Clinical Dementia Rating (CDR): very mild (n = 16, x = 71.4 +/- 6.7), mild (n = 43, x = 72.6 +/- 7.9), moderate (n = 35, x = 72.5 +/- 6.9). Subjects in group II and III fulfill diagnostic criteria of dementia according to ICD-10, DSM IV and criteria of probable AD according to NINCDS-ADRDA. In the estimation of occurrence of behavioral and psychological disturbances: Alzheimer's Disease Assessment Scale--non-cognitive behavior (ADAS-non-cog) and subscale "Change in Personality, Interests, Drive" of Blessed Dementia Scale were used. The results have shown that with the progress of dementia process, the occurrence of the following psychopathological symptoms such as: hallucinations, intensive motor activity, purposeless hyperactivity, pacing, rigidity increases and there is a relinquishment of hobbies. In addition, regardless of the stage of dementia, such behaviors as: apathy, depression, tearfullness, impaired emotional control and disturbances of appetite were observed relatively frequently.

[Patterns of cognitive impairment and apolipoprotein genotype in persons with Alzheimer's disease]. / Wzorce aktywnosci poznawczej a polimorfizm apolipoproteiny E w chorobie Alzheimera.

The aim of this study was to test the possible relationship between patterns of cognitive deficits--especially impairment of memory processes--and ApoE genotype in patients with AD. Fifty seven right-handed subjects (31 males and 26 females) were tested in this study. The age of subjects ranged from 50 to 79, the education lasted from 11 to 16 years. All subjects were diagnosed as probable AD patients on the basis of DSM IV and NINCDS-ADRDA criteria. Each subject was examined for: 1) ApoE genotype, 2) general level of activity (GDS and MMSE), 3) neuropsychological evaluation of cognitive processes, using full test battery. 37 patients had at least one of ApoE epsilon 4 allele (e2/4, 3 and 4/4) and 20 patients had none of ApoE 4 allele (e 2/3 and 3/3). The group of tested subjects were subdivided into 2 groups. The first group was comprised by 31 patients with 3-rd stage (according to GDS) of mental activity. Twenty six patients with 4-th stage were included into the second group. Those subgroups did not significantly differ if age, education, gender or ApoE allele were considered. Experimental data were normalized and then analyzed using a statistical package SPSS/PC+. The analysis of variance showed that the type of test, stage of disease and two-way interaction ApoE x type of test were highly significant (P < 0.0001). Some results were obvious and not surprising (e.g. that results of patients with 4-th stage were much worse than the results of patients with stage 3-rd). It turned out that the best results were obtained by our patients in naming tests, the worst--in learning test with distraction. Patients with ApoE epsilon 4 performed better than patients with none ApoE epsilon 4 in the Rey's test, in the similarity test and in the test which required repeating numbers starting from the last one. The differences between the subgroups of patients with different ApoE alleles were confirmed by different distributions of correlations. All statistical analyses were repeated for more homogenous group of patients (only with stage 3-rd). The pattern of results resembled the previous one (i.e. better performance in the same tests) with one exception: additionally, in delayed recall test patients with none ApoE epsilon 4 performed much better that ApoE epsilon 4. Our results showed that some cognitive processes depended on ApoE genotype. Patients with none ApoE epsilon 4 genotype had less severe deficits in delayed recall of new information. On the other hand, working memory appeared to be less affected in patients with ApoE epsilon 4 genotype. Independent of genotype, both group showed similar impairment of learning ability without deficits in remote memory.

[Alpha2-macroglobulin gene polymorphism in patients with Alzheimer's disease]. / Polimorfizm genu alpha 2-makroglobuliny u osób z choroba Alzheimera.

Recent studies suggest that alpha 2-macroglobulin (alpha 2 m) may play a role in the pathogenesis of Alzheimer's Disease (AD). The presence of alpha 2-macroglobulin G/G genotype is thought to increase the risk of AD. The aim of the study was to analyse alpha 2 m polymorphism in two groups: AD patients (n = 60, F = 41, M. = 19, mean age 73.3 +/- 6.3) and non-demented control group (n = 58, F = 36, M. = 22, mean age 73.1 +/- 8.3, mean MMSE score 27). Frequencies of genotypes A/A, A/G, G/G in AD group were: 0.46: 0.42: 0.12. In control group those frequencies were: 0.40: 0.48: 0.12. The lack of statistically significant difference between G/G frequencies in both groups of patients may suggest that alpha 2-macroglobulin G/G genotype is not a risk factor for AD.

[Paranoid syndrome in a patient with tumor in anterior part of corpus callosum. Case report]. / Zespól paranoidalny u chorego z guzem okolicy przedniej czesci spoidla mózgu. Opis przypadku.

The reported case was a patient with tumour situated in the region of the corpus callosum, with symptoms diagnosed initially as affective syndrome and later on as paranoid syndrome. With this diagnosis he was treated for 12 years in psychiatric out-patient clinics and hospitals with antidepressants and and neuroleptics. Brain imaging (CT and MRI) performed only after an epileptic seizure demonstrated a tumour in the anterior part of the corpus callosum with a broad oedema area. Neuropsychological examination revealed disturbances of emotional-motivation processes and defects in cognitive functions. Following surgical treatment only a slight improvement of functioning was noted. Histological diagnosis (PNET) suggested that the tumour was expanding during many years. Much earlier diagnosis with neurosurgical intervention could result in a better therapeutic effect.

[Assessment of blood flow velocity during cognitive stimulation in persons with suspected hydrocephalus]. / Badanie predkosci przeplywu krwi w czasie stymulacji poznawczej u osób z podejrzeniem wodoglowia.

The aim of this work is to evaluate middle cerebral arteries (MCA) blood flow velocity changes during performance of linguistic and visuospatial cognitive tasks. Two groups were investigated: eight patients with suspected hydrocephalus without perceptible cognitive disturbances, and eight healthy persons. Blood flow velocity in left and right MCA was recorded with transcranial Doppler sonography while the examined patients were performing three different tasks. The analysis of the results showed differences between the groups concerning both increase of blood flow velocity values and performance patterns. Compared to healthy individuals less increase in blood flow velocity during performance of all tasks and no difference in haemodynamic changes between both hemispheres during task performance were observed in patients with hydrocephalus. The results obtained suggest, that the pattern of functional lateralization in brain in patients with suspected hydrocephalus is probably changed.

Frontotemporal dementia: An attempt at clinical characteristics.

The clinical recognition of frontotemporal dementia (FTD) depends on its differentiation from Alzheimer's disease (AD). From 212 patients primarily diagnosed as probable AD, 24 cases with mild dementia, absence of disturbances the presence of which would have prevented a full neuropsychological assessment, and brain CT with detailed visualization of hippocampus atrophy were chosen. On the basis of neuropsychological examination the patients were divided into two groups: 11 cases with predominant deficit in frontal system tasks (FTD group) and 13 cases with changes in cognitive functions typical of AD (AD group). Age at onset, duration, behavioral changes, psychotic symptoms, depression, speech disorders, neurologic deficit and hippocampal atrophy were analyzed in both groups. Statistically significant differences for behavioral disturbances and hippocampal atrophy were found. Early behavioral changes and lack of early hippocampal atrophy on CT may be useful features for differentiating between FTD and AD, especially when SPECT is not available.

[Dynamics of blood flow velocity in middle cerebral arteries in dyslexic persons]. / Dynamika przeplywu krwi w tetnicach srodkowych mózgu u osób z dysleksja.

The aim of our study was to investigate the blood flow in middle cerebral arteries during the different forms of cognitive activity in dyslectic persons. Two group of subjects were tested. The first group consisted of 10 students with school difficulties, diagnosed neuropsychologically as having a particular form of dyslexia, i.e. dysgraphy or dysorthography. 6 of them were right lateralized and 4--left lateralized. The second contained 10 students without such problems. 7 of them were right lateralized and 3--left lateralized. We used four kinds of cognitive tasks, during which the blood flow velocity in MCA in left and right hemisphere was measured with the Transcranial Doppler method. The analysis of the results showed differences between the groups of blood flow velocity levels, without a difference in performance profile. The dysgraphic persons had significantly higher blood flow velocity in the right hemisphere compared to the reference group. The results suggest particularly important role of right hemisphere in dyslexic persons, which is consistent with results obtained by other authors. The analysis of lateralization showed that this factor influences significantly the blood flow velocity level--the left lateralized persons showed lower rise of blood flow velocity than the right lateralized, regardless of the kind of task and measured hemisphere.

[Multi-stage method for the diagnosis of low-pressure hydrocephalus]. / Wieloetapowa metoda rozpoznawania wodoglowia niskocisnieniowego.

Multistage method of low-pressure hydrocephalus diagnosis, elaborated in our department, is discussed. The method consists of four stages: I Clinical and neuropsychological examinations, standard computerized tomography. II Somatosensory evoked potentials. III Determination of water concentration and distribution in fluid compartments of the brain by utilising new mathematical formula. IV Three-phase complementary test. The application of this method allows to eliminate many false diagnoses and may contribute to lower costs of treatment.

[Evaluation of perceptive activity in persons with low pressure hydrocephalus treated surgically. Preliminary report]. / Ocena aktywnosci poznawczej osób z wodoglowiem niskocisnieniowym leczonych operacyjnie. Doniesienie wstepne.

Preliminary assessment of perceptive activity was carried out in patients with low-pressure hydrocephalus diagnosed clinically. The purpose of the study was establishing of the valuable tests for the neuropsychological diagnosis making possible finding of perceptive processes most frequently disturbed in low-pressure hydrocephalus. The studied group comprised 53 patients operated on for this hydrocephalus. In only 9 cases the condition of the patient made possible a detailed study of the perceptive processes. In this group the tests were carried out three times: before, immediately and after a longer time after insertion of ventriculoperitoneal shunt. The results showed differences in the level of general perceptive functioning in the whole group. In the subgroup studied in detail no general perception deterioration was found, and the usual disturbances were noted in the memorization of new information and in visuospatial orientation. Late after the operation the greatest improvement was observed in the most disturbed functions.

[The effect of stereotaxic injuries on the medial temporal brain structures on memorization of successively or simultaneously presented material]. / Wplyw stereotaktycznych uszkodzen przysrodkowych struktur skroniowych mózgu na zapamietywanie materialu prezentowanego w sposób sukcesywny i symultatywny.

Effect of stereotaxic injuries to the medial temporal brain structures on memorization of material presented successively or simultaneously was studied. The study aimed at testing whether stereotaxic damage to the hippocampus and amygdala results in a memory deficit and whether functions subserved by those structures depend on type and organization of the memorized material. The results indicate that even small damage to the medial temporal lobe structures may result in a deficit in memorization ability. The greatest impairment was observed for successive presentation of nonverbal stimuli.

[Cerebral blood changes during neuropsychological tests administered by Doppler sonography. Preliminary report]. / Zmiany krazenia mózgowego w czasie testów neuropsychologicznych oceniane na drodze przezczaszkowej ultrasonografii dopplerowskiej. Doniesienie wstepne.

The preliminary studies on cerebral blood flow changes during neuropsychologic tests were carried out using transcranial Doppler sonography (TCD). The procedure with the standardized cerebral activation in order to obtain the control brain activity level was elaborated and tested. Blood flow velocity changes were measured during two groups of tests: linguistic with left dominant hemisphere and visual-spatial with right dominant hemisphere. Similar dynamics of blood flow changes was observed with all kinds of brain activation with the maximum velocity increase of 15-20%. The velocity measured in the dominant hemisphere was about 8-10% above the contralateral side. TCD seems to be complementary to the neuropsychologic tests useful especially in diagnosis of different types of dementia.

Memory impairment in patients with stereotaxic lesions to the hippocampus and amygdala.

The study aimed at testing: (1) whether stereotaxic damage to the hippocampus and amygdala results in a memory deficit, (2) whether the memory functions subserved by the hippocampus are lateralized and (3) whether time limited storage of sensory information is impaired after focal hippocampal and amygdalar lesions. Seven patients with unilateral stereotaxic damage to the anterior part of hippocampus and unilateral or bilateral damage to the medial part of amygdala and 11 control subjects with no brain damage participated in the research. They were presented with memory tests that required either remembering a spatial arrangement of simultaneously presented verbal vs nonverbal stimuli or a temporal order of sequentially presented items. Moreover, a sensory information storage test was used. The results indicate that even small damage limited to the anterior part of the hippocampus and medial part of the amygdala results in a mild memory deficit. Memory impairment was not related to the side of hippocampal lesion. This suggests that memory function subserved by the hippocampus is not lateralized. Differential effects of left and right lobectomies found in previous studies were, thus, probably due to the damage to temporal cortex. The results showed, however, that sensory information storage limited to 3 s is not impaired after focal damage to the hippocampus and amygdala. A clear lateralization effect showing right hemisphere advantage in that function was found.

[Changes of cognitive and emotional processes during immunostimulatory treatment in subacute sclerosing panencephalitis]. / Zmiany w zakresie procesów poznawczych i emocjonalnych podczas leczenia immunostymulujacego chorych z podostrym stwardniajacym zapaleniem mózgu (SSPE).

In 35 cases of SSPE sensibilized neuropsychological testing was done before and after 6 months of immunostimulatory and virostatic treatment. Three groups of patients were studied. All groups received isoprinosine, one group was given additionally TFX-thymus extract Polfa, and another group received additionally Propionibacterium granulosum KP-45. A tendency for improvement of verbal function and emotional status was observed only in the group receiving isoprinosine with propionibacterium. In both remaining groups, receiving only isoprinosine or isoprinosine with TFX worsening was noted, particularly in the isoprinosine-only group. This was particularly evident in the visuospatial orientation. Prolongation of survival time in SSPE owing to specific treatment increases the need for psychoreactive and therapeutic influences for stimulation of cognitive processes.