Theory of mind and pragmatic abilities in dementia.

OBJECTIVE: "Theory of Mind" (ToM) is the capacity to attribute mental states to oneself and to others and to interpret behavior in terms of mental states. Deficits in both ToM and pragmatic abilities have been described in patients with neurologic disorders, such as frontal lobe lesions and right hemisphere strokes, but have not been assessed in demented patients. METHODS: This study examined ToM and pragmatic abilities in a consecutive series of 34 patients with probable Alzheimer disease (AD) using a second-order false belief story, 11 short stories assessing understanding of social situations, and a test of pragmatic abilities assessing both indirect requests and-conversational implications. RESULTS: Sixty-five percent of AD patients with mild dementia could not pass a second-order false belief task, whereas no failures were found in a group of 10 age-comparable healthy controls. AD patients who did not pass the second-order false belief task had more severe deficits on tests of verbal anterograde memory, verbal comprehension, abstract thinking, and naming, as compared with AD patients who passed the task. AD patients also showed significantly more severe pragmatic deficits than age-comparable healthy controls, and there was a significant association between ToM and pragmatic deficits. On the other hand, there were no significant associations between ToM or pragmatic deficits, and behavioral problems frequently reported in AD such as depression, delusions, apathy, and irritability. CONCLUSIONS: This initial exploratory investigation demonstrated significant deficits in both ToM and pragmatic abilities in a consecutive series of AD patients with mild dementia.

[Hashimoto's encephalitis: a new case with spontaneous remission]. / Encefalitis de Hashimoto: un nuevo caso con remisión espontánea.

Hashimoto's encephalopathy is a poor understood neurological disorder associated with thyroid disease. We describe a 12 years old woman with a relapsing clinical picture characterized by acute onset confusion, tremor, convulsive seizures and a stroke-like episode associated with autoimmune thyroid disease. High titers of antithyroid antibodies were detected in her serum. Neurologic investigation showed a marked slowing of the basic activity in EEG, diminished perfusion of left hemisphere in brain SPECT, mild CSF protein level without pleocytosis, and normal brain CT and cerebral angiogram. The clinical course was favorable without corticosteroid therapy. Antithyroid antibodies and EEG were normal after one-year follow-up. We suggest that antithyroid antibody levels should be checked in any unexplained acute or subacute encephalopathy, especially when a relapsing course, stroke-like exacerbation, seizures, tremor or elevation of the CSF protein are found.

Impairments of social cognition and decision making in Alzheimer's disease.

OBJECTIVE: To investigate the nature of deficits in social cognition and real-life decision making in a group of patients with Alzheimer's disease (AD). DESIGN: A comprehensive neuropsychological and psychiatric assessment, including the Moral Judgment Interview and the Bechara's Card Test, was carried out in 25 patients with AD and 20 age-comparable normal controls. SETTING: Outpatient clinic. RESULTS: AD patients had significantly lower scores in the Moral Judgment Interview and obtained significantly less earnings in the card test when compared to the normal control group. The Moral Judgment Interview score correlated significantly with Raven's Progressive Matrices and Block Design, whereas the card test correlated significantly with both the Benton Visual Retention Test and the Buschke Selective Reminding Test. No significant correlations were observed between the experimental tasks and the psychiatric variables. CONCLUSIONS: AD patients demonstrated significant deficits on tasks assessing social cognition and real-life decision making. These impairments correlated with deficits on specific neuropsychological tasks, but not with behavioral problems frequently found in AD patients.

Encefalitis de hashimoto: un nuevo caso con remisión espontánea / Hashimoto encephalitis: a new case with spontaneous remission

La encefalopatía de Hashimoto es un síndrome poco frecuente en el cual se asocian manifestaciones neurológicas y enfermedad de origen tiroideo. Describimos el caso de una mujer de 12 años de edad con un cuadro clínico recidivante caracterizado por síndrome confusional agudo, temblor, crisis convulsiva y episodio seudoictal asociado a una enfermedad tiroidea autoinmune. Los anticuerpos antitiroideos estaban elevados en el plasma. Los estudios neurológicos demostraron un enlentecimiento de la actividad basal en el EEG, una disminución de la perfusión en el hemisferio izquierdo en la SPECT cerebral y una ligera elevación de las proteínas en el líquido cefalorraquídeo, con una TAC craneal y una angiografía cerebral normales. La evolución clínica fue favorable sin tratamiento corticoideo. La titulación de anticuerpos antitiroideos y el EEG son normales tras un año de seguimiento evolutivo. La determinación de anticuerpos antitiroideos debe ser valorada en aquellos pacientes que presenten un cuadro de encefalopatía aguda o subaguda, especialmente si cursa de forma fluctuante, con clínica seudoictal, crisis convulsivas, temblor o elevación de las proteínas del líquido cefalorraquídeo (AU)

No disponible

Neuropsychological correlates of apathy and depression in patients with dementia.

OBJECTIVE: To investigate the association between apathy and depression, and specific cognitive deficits in AD. BACKGROUND: Apathy and depression are frequent behavioral disorders in patients with AD. However, the neuropsychological correlates of these disorders have rarely been examined. METHODS: A comprehensive neuropsychological and psychiatric evaluation was carried out in 72 patients with AD with apathy and depression, 29 patients with AD with apathy only, 31 patients with AD with depression only, and 52 patients with AD with neither apathy nor depression (control group). RESULTS: Patients with apathy had significantly lower scores on tests of verbal memory, naming, set shifting, and verbal fluency compared with patients without apathy. The association of depression and apathy produced significantly more severe deficits compared with apathy only on a test of abstract thinking. Finally, depression in the absence of apathy was not associated with more severe cognitive impairments compared with the AD control group. CONCLUSIONS: Apathy, but not depression, is associated with significantly more severe frontal lobe related cognitive deficits in AD.

[Paralysis of the nucleus of the third cranial nerve secondary to a mesencephalic hematoma]. / Parálisis nuclear del III par craneal secundario a hematoma mesencefálico.

INTRODUCTION: The oculomotor disorders due to mesencephalic pathology are very varied. Function of the third cranial nerve may be affected at the level of the nucleus, in the mesencephalic fascicular portion, interpeduncular fossa, pathway anterior to the posterior communicating artery, sinus cavernosus, sphenoid fissure and orbit. Paralysis of the common oculomotor nerve is the least common of these. Generally it is secondary to ischemic, or sometimes to hemorrhagic vascular pathology. CLINICAL CASE: We present the case of a hypertensive woman with an oculomotor nerve syndrome associated with limitation of horizontal gaze of the contralateral eye and reactive head inclination due to a mesencephalic haematoma. CONCLUSION: The three neuro-ophthalmological findings seen in our patient have rarely been described in the literature. We consider the clinical observation of this case and the study of the organization of the oculomotor nerve nucleus to be of interest for publication.

[Chronic inflammatory demyelinating polyneuropathy associated with prostatic adenocarcinoma]. / Polirradiculoneuropatía desmielinizante inflamatoria crónica asociada a adenocarcinoma prostático.

INTRODUCTION AND CLINICAL CASE: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disorder of unknown cause. CIDP most often occurs alone and not as a complication of other disorders but may accompany plasma cell dyscrasias, human immunodeficiency virus infection, systemic lupus erythematosus and others diseases. The association of CIDP and carcinoma has rarely been reported and its relevance is debated. CONCLUSION: We report one patient with CIDP and prostatic adenocarcinoma. Steroids therapy were effective.

[Diagnostic value of magnetic resonance in neurosyphilis]. / Valor diagnóstico de la resonancia magnética en la neurosífilis.

Syphilis is an ever changing disease with an increasing incidence in the last years. Diagnosis of neurological damage remains on cerebrospinal fluid studies and serologic test in patients with appropriate clinical manifestations. Modern neuroimaging techniques are now available in the diagnostic workup of patients with neurosyphilis. Our experience with such techniques in two patients with meningo-vascular syphilis and general paresis points out to the role of magnetic resonance imaging in disclosing ischemic lesions in these patients, although these lesions were not absolutely specific of the disease.