Declarative memory in early Parkinson's disease: serial position learning effects.

This study tested the question of whether executive failure associated with frontal lobe deficit is associated with, and therefore, may influence declarative memory dysfunction in Parkinson's disease (PD). A variety of memory and 'frontal sensitive' tasks were used. The 'frontal lobe dysfunction' hypothesis was tested in part, by examining the serial position effects (SPE) of word list learning across five successive trials. The relationship between memory and 'frontal sensitive' task scores was tested also. A total of 39 PD patients early in the course of the disease and 31 matched controls were included in the study. The PD subjects showed mild memory deficits in comparison to the healthy control group. In the face of any hypothesized selective 'dysexecutive' syndrome in PD group, the latter groups learning strategy across five trials did not differ from that of the control group. Also, the expected interrelation between memory and 'frontal sensitive' scores was not obtained. Therefore, the hypothesis that frontal dysfunction alone may account for memory impairments in PD is not fully supported.

Visuomotor skill learning on serial reaction time task in patients with early Parkinson's disease.

This study tested the role of basal ganglia in visuomotor skill learning. Thirty-nine patients early in the course of Parkinson's disease (PD) and 30 patients after operation for an aneurysm of the anterior communicating artery (ACoA) were compared with 31 matched control subjects on a Serial Reaction Time test (SRTt). The patients with PD showed impaired visuomotor skill learning across the repeating blocks, in the presence of preserved declarative knowledge of embedded sequences, in contrast to the ACoA group in whom the reverse pattern was observed. The significant correlation in patients with PD between the standard neuropsychological and motor measures and the performance observed in the skill acquisition test, in the ACoA group and control subjects was not observed. The suggestion that this learning impairment could not be attributed to a motor deficit per se was also confirmed more directly for patients with PD. Accuracy of performance after the initial learning phase on the SRTt in patients with PD was associated predominantly with visual span capacity measures. Declarative knowledge of the embedded sequence of the SRTt was correlated to general cognitive and verbal span abilities in the PD group. The impairment observed in the PD group was not the result of a general decline in cognitive functioning, mood disturbances, or the severity of the motor symptoms.

[Disorders of olfactory function in penetrating head injuries sustained during war]. / Poremecaji olfaktivnih funkcija u slucaju penetrantne ratne povrede glave.

Olfactory function was estimated in the group of 37 patients with the penetrating war head injury. In 4 (10.8%) patients mutual anosmia was found. In comparison to healthy volunteers the injured showed worse performance on the level of the tested olfactory parameters. In 9 (24.3%) patients the offered smells were sensed as very unpleasant. The subgroup of patients from Glasgow Coma Scale (GSC) < or = 8 showed the highest degree of olfactive disfunction. The patients with complicated penetrating head injury were less successful at the level of all olfactive qualities comparing to those without injury complications. The localization of the focal penetrating wound, regardless of the kind of a weapon causing the brain injury, was not significantly correlated with the results of olfactometry in distinction from hemisphere lateralization of the lesion. The recovery of the retested was minimal.

[Application of LNNB in patients with closed brain injury]. / Primena neuropsiholoskog upitnika Lurija Nebraska kod bolesnika sa zatvorenom povredom mozga.

Closed brain injury (CBI) has become epidemiological problem with important neuropsychological consequences that, although often not obvious without formal testing, are of great influence on cognitive and social functioning of these patients. We applied Luria Nebrasca Neuropsychological Battery (LNNB) to 24 victims of moderate and severe CVI after they regained proper orientation for time and place, and 75 to 180 days later. There were 18 male and 6 female patients, age from 16 to 55 years. The most impaired functions on first testing were rhythm perception, which can be taken as a measure of attention, memory, Intellectual processes, visual function and arithmetics (in the descending order of scores). On retesting we noted significant recovery in rhythm perception, visual functions, intellectual processes, motor functions, receptive speech and arithmetics. Disorders of attention and concentration showed widespread influence on other neuropsychological functions as a nonspecific factor, especially in spontaneous recovery that stresses the importance of specific rehabilitation measures for attention and concentration. LNNB showed great opportunities for assessment of wide spectrum of neuropsychological functions both in initial and later phases, and also in planning of cognitive and social rehabilitation.

[Aphasia arising from left thalamic haemorrhage]. / Afazija izazvana hemoragijom u levom talamusu.

A patient, aged 58, with sudden loss of speech and right-sided haemiparesis is described. CT brain showed intracerebral haemorrhage in the left thalamus. The examination of speech functions established aphasia characterized by anomia, comprehension disorders, paraphasia, perseveration, reduction of spontaneous speech, dyslexia and agraphia. Relation between thalamic aphasia and cortical aphasic syndromes is discussed. The obtained results are in agreement with the theory that emphasizes a specific role of thalamus in verbal communication.

[Neuropsychological impairments in non-demented patients with multiple sclerosis]. / Neuropsihloski poremecaji kod nedementih bolesnika s multiplom sklerozom.

Neuropsychological investigation of 25 patients with multiple sclerosis was carried out. The aim of the study was the detection of vulnerability of certain neuropsychological functions caused by demyelinating process and estimation of impact of the clinical characteristics of the disease on cognitive functioning. Neuropsychological evaluation was performed by Luria-Nebraska Neuropsychological Battery. The analysis of the Clinical and Factor Scales results revealed that attention, memory and intellectual functions were the most disturbed. In comparison with the achievements of the control group, the group of non-demented patients with multiple sclerosis scored lower on all Clinical Scales. The results of the present neuropsychological examination pointed out that the impairment of neuropsychological functions in patients with multiple sclerosis comprised the two levels of functioning. The first, that was more dependent on neurological deficit and the second, that included mental plan of functioning. The statistical analysis did not reveal significant correlation between neuropsychological achievements and the form and duration of illness.

[Chronic encephalomyelitis caused by Borrelia burgdorferi. Case report]. / Hronicni encefalomijelitis izazvan Borelijom burgdorferi. Prikaz slucaja.

We present a female patient with typical third stage neuroborreliosis with progressive chronic encephalomyelitis. One month after a tick bite, in the first stage of Lyme disease, she had myalgias during ten days and after one year polyarthralgias and polyarthritis. Neurological problems occurred 15 years after the tick bite with headache, nystagmus, intentional tremor and spastic paraparesis with sphincter disturbances. Etiological diagnosis was established after three years. Cytobiochemical findings in cerebrospinal liquor were normal but oligoclonal IgG bands were found. Fluorescent antibody test was positive in serum (1:75) as well as ELISA (1:447). The patient reacted favourably to intravenous crystal penicillin 20 x 10(6) units daily during 18 days. Till now, she is in remission and has only mild paresis of the left leg.

[Rhombencephalitis as a manifestation of neuroborreliosis]. / Rombencefalitis kao manifestacija neuroborelioze.

Rhombencephalitis is a rare neurological manifestation of stage II of Lyme disease. We presented two cases with no recollection of tick bite nor erythema migrans and with cranial nerve nuclei, pyramidal tract and cerebellar tracts involvement of sudden onset, inflammatory syndrome in cerebrospinal liquor, positive oligoclonal bands and elevated IgG index. A spontaneous remission occurred in both cases, but antibiotic was given intravenously for prevention of relapses and disease progression.

[Idiopathic normotensive hydrocephalus. Neuropsychologic evaluation after ventriculo-atrial shunt]. / Idiopatski normotenzivni hidrocefalus. Neuropsioholoska procena ishoda ventrikulo-atriumskog santa.

Two patients with normal-pressure hydrocephalus were assessed with Luria Nebraska Neuropsychological Battery, before ventriculo-atrial shunting and six months later. The best improvement was recorded in attention, visuospatial and intellectual functions. It is well documented that normal-pressure hydrocephalus dementia can be reversible if proper selection for neurosurgical treatment is made. Cognitive outcome of ventriculo-atrial shunting in normal-pressure hydrocephalus is best assessed with the appropriate neuropsychological testing.

[The intrathecal manometric lumbar infusion test (Katzman Test) in the diagnosis of normotensive hydrocephalus]. / Intratekalni manometrijski lumbalni infuzioni test (Kacmonov Test) u dijagnostici normotenzivnog hidrocefalusa.

Over 12-months 17 patients were admitted to the hospital for the presumed diagnosis of normal pressure hydrocephalus (NPH). Four patients had cardinal signs of the syndrome: gait disturbance, dementia and urinary incontinence. Six patients had gait disturbance and dementia. Five patients had gait disturbance and ventricular enlargement on CT scans of the brain, while the last two patients had only urinary incontinence and dementia. All patients underwent neurological examination and CT scans. Clinical and radiological results of these patients were compared with the results of the Katzman's test. Katzman's test was performed in all patients. Physiologic solution of 0.9% NaCl was infused in the lumbal subarachnoid space. The rate of infusion was 1 ml/min during 60 minutes. Cerebrospinal fluid (CSF) pressure was recorded simultaneously using metal aneroid. The test was considered positive if either CSF pressure over 300 mm H2 or undulating waves were recorded at any time of the test. Katzman's test was positive in 12 patients (9 of them with NPH). The undulating waves were recorded in 6 patients (5 with NPH). Four of them experienced tachycardia, hyperventilation, cephalea and mild confusion during the test. The test was positive in all 9 patients with NPH but also in 3 patients with different but pathophysiologically similar disorders. The test was positive in all 4 patients with the characteristic clinical triad of the syndrome and also in all 4 patients with periventricular hypodensity on their CT scans. No patient without gait disturbance had positive test. All except one patient with focal signs or pronounced cortical atrophy, besides with dramatic clinical improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Dexamethasone suppression test in patients with Parkinson's disease.

The Dexamethasone Suppression Test (DST), supposed to effectively distinguish between endogenous and nonendogenous depression, was performed in a group of 34 patients with Parkinson's disease. Abnormal DST results were observed in 50% of the patients. The patients were clinically divided into subgroups of depressed and nondepressed parkinsonians. Abnormal DST results were significantly more frequent in depressed (75%) than in nondepressed parkinsonians (27.7%).

Auditory event-related potentials in different types of dementia.

Auditory event-related potentials were recorded in demented, drug-free patients with Huntington's disease and Alzheimer's disease, as well as in demented and nondemented patients with Parkinson's disease, who were matched for age, duration and stage of the disease. The normal P3 latency at a given age was predicted by using an age regression equation that had been calculated on the basis of the findings in 42 normal adults. Using this procedure, a prolonged P3 latency was found in about two thirds of demented patients, irrespectively of the underlying disease. Although the prolonged P3 latency proved to be useful electrophysiological correlate of dementing illness, no differences were found between the observed groups in respect to other components of the auditory event-related potentials (N1 and P2).

The disturbance of nonverbal functions in dysphasia.

Various modalities of six neuropsychological functions (graphia, calculia, finger gnosis, right-left orientation, praxia and constructive praxia) referred to as parietal or nonverbal have been investigated in the light of speech disorders. We examined 20 patients with brain lesion of vascular origin, who met the diagnostic criteria of mild and moderate dysphagia, 13 patients with Wernicke's and 7 with Broca's dysphasia. Verbal and nonverbal functions in patients with ischemic focuses of the speech area of the left hemisphere were investigated the Boston Diagnostic Aphasia Examination (BDAE). The investigation revealed that the presence and the type of mild and moderate dysphasia had a noteworthy role in pathoplasticity of correlated signs, thus implying in clinical practice a parietal lesion. Generally, poorer and at the same time more heterogeneous results were obtained in patients with Wernicke's dysphasia, mostly on calculia and right-left orientation. Finger agnosia was not considered as an authentic parietal sign, while each modality of graphia was impaired to a varying extent in speech disorders caused by presylvian and retrosylvian lesions. The paper also deals with the significance of lobulus parietalis inferior in speech.

[Thinking disorders in patients with Parkinson's disease]. / Poremacaj misljenja kod bolesnika s Parkinsonovim bolescu.

Wisconsin Card Sorting Test was carried on patients with Parkinson's disease in order to examine their conceptual thinking. On the basis of the Mini Mental State Examination and Self Rating Depression Scale 30 patients without dementia and depression of different aetiology and clinical picture, were selected. The comparison with the control group revealed a less successful Wisconsin Card Sorting test results in patients with Parkinson's disease, regarding the number of successfully tested categories and the number of perseverations. The behaviour of the patients with Parkinson's disease during the test was discussed from the point of view of prefrontal cortex, i.e. break of frontostriate connections.

Alexia with agraphia.

The authors presented a case of relatively pure syndrome of alexia with agraphia in a patient speaking Serbo-Croatian language. Reading disturbances showed some characteristics of a deep dyslexia. Besides severely impaired reading and writing abilities, some components of Gerstamnn's syndrome were also present. Infarction in the posterior half of the left supramarginal and in the anterior half of the left angular gyrus was accurately located by the graphic reconstruction of CT scans.