Jargonagraphia in a case of frontotemporal dementia.

Jargonagraphia is known to occur after discrete brain lesions but not in primary degenerative dementia. We report a patient with frontotemporal dementia who developed jargonagraphia and nonfluent aphasia. Written output was graphically preserved but consisted of short words intermingled with abstruse neologisms. MRI showed predominant right frontotemporal cortical atrophy accompanied by white matter hyperintensities in the right anterior subcallosal periventricular region. Diagnosis and MRI were corroborated by extensive neuropathological findings obtained 8 months later. The agraphia in this case is discussed with reference to both specific macroscopic and microscopic pathoanatomical lesions. We suggest that jargonagraphia can appear in frontotemporal dementia depending on the localization of lesions.

White matter lesions impair initiation of FAS flow.

Word fluency performance is known to rely on left frontal cortical regions and has also been shown to be affected by lesions in the white matter, which may be seen as white matter hyperintensities (WMH) on magnetic resonance imaging. However, word fluency may be divided into two independent components, initial and late performance, separated in time [J Clin Exp Neuropsychol 1998;20:137-143]. The purpose of the current study was to investigate the relationship between the two components of FAS fluency performance and WMH. Patients varying in degree of memory impairment participated: Alzheimer's disease, mild cognitive impairment and subjective memory disorder. WMH were rated with the Scheltens scale in the periventricular and deep subcortical areas. Results demonstrated that WMH in this sample of patients may be summarized in two indices according to a principal factor analysis, one anterior factor mainly related to WMH in the frontal lobes and adjacent to ventricles, and a second posterior factor related to parietal and occipital WMH. The initial FAS performance was related to anterior WMH, in particular left frontal or lateral periventricular hyperintensities, whereas the late FAS performance was not related to any index of WMH.

Low TENS treatment on post-stroke paretic arm: a three-year follow-up.

OBJECTIVE: To determine whether stroke patients with initial increases in arm motor recovery following low-frequency transcutaneous electrical nerve stimulation (low TENS) treatment go on to show long-term benefits. Also whether the same therapy results in long-term improvements in motor function, spasticity or activities of daily living (ADL). DESIGN: A three-year follow-up study. SUBJECTS: Twenty-eight stroke patients, who had participated in a randomized trial of daily treatment with low-frequency (1.7 Hz) transcutaneous electrical nerve stimulation (low TENS) on the paretic arm for three months starting 6-12 months after stroke. OUTCOMES: Fugl-Meyer Motor Performance Scale for evaluation of changes in arm motor function. A 6-point Ashworth Scale to measure spasticity. Barthel Index to evaluate performance in ADL. RESULTS: Motor function of the paretic arm had deteriorated in both treatment and control groups. Increased spasticity was seen in both groups. ADL score remained at a similar level in the low TENS group, whereas the control group had deteriorated during the same time period. CONCLUSIONS: Low TENS stimulation started 6-12 months after stroke may not have a specific effect on arm motor function years after completion of treatment.

White matter lesions in Alzheimer patients are influenced by apolipoprotein E genotype.

To analyse the influence of apolipoprotein E (APOE) genotype on the extent of white matter lesions (WMLs) in Alzheimer's disease (AD), we examined 60 AD patients with magnetic resonance imaging. The WMLs were rated visually in different brain regions. The patients with the APOE genotype sigma4/4 had more extensive WMLs in the deep white matter than patients with genotypes sigma3/3 and sigma3/4. There was a correlation with age for WMLs in the deep white matter in patients with the APOE sigma3/3 genotype. In patients carrying at least one sigma4 allele, the WMLs showed no age correlation. The results could imply that in APOE allele sigma4 carriers, the WMLs represent a pathological process related to the aetiology of the disease.

Word production: dissociation of two retrieval modes of semantic memory across time.

To identify components that contribute to word-fluency performance, 126 patients referred to a Memory Clinic for suspected cognitive impairment underwent a neuropsychological examination including the Controlled Oral Word Association test (FAS; Benton & Hamsher, 1976). The number of words produced in the FAS test during six consecutive 10-s periods followed a negatively accelerated curve approaching an asymptotic level after about 30 s. The 18 FAS variables (3 letters x 6 periods) were entered into an exploratory factor analysis resulting in two factors. One factor, linked to a semiautomatic and rapid retrieval from semantic memory, loaded on the initial phase of the FAS test. A second factor, linked to an effortful and slow retrieval from semantic memory, loaded on the later phase of the FAS test. Thus, two retrieval modes of semantic memory contribute differently to the initial and later part of the FAS test, which may have theoretical and practical implications.

Stimulation with low frequency (1.7 Hz) transcutaneous electric nerve stimulation (low-tens) increases motor function of the post-stroke paretic arm.

The object of this study is to determine if the functional motor capacity of the paretic extremity can be improved by stimulation with low intensity low frequency (1.7 Hz) transcutaneous electric nerve stimulation (Low-TENS), started 6-12 months after a stroke. Forty-four patients who had a paretic arm as a consequence of their first stroke were included and randomly assigned to either a treatment group (n = 26) or a control group (n = 18). Patients in both groups received physiotherapy at a day-care center, usually twice a week. The treatment group received, in addition, Low-TENS for 60 min, five days a week for three months. Results showed that motor function increased significantly in the treatment group, compared to controls. The Low-TENS did not decrease either pain or spasticity. It is concluded that stimulation by means of Low-TENS could be a valuable complement to the usual training of arm and hand function in the rehabilitation of stroke patients.