Correlates of memory in Parkinson's disease.

There is much controversy concerning the incidence and nature of dementia, particularly memory impairment, in the parkinsonian patient. Specifically, a question arises with respect to the relationship of numerous personal, neurological, medication, and disability variables to this memory impairment. We administered a recently developed standardized test of recent memory functions to 53 idiopathic parkinsonian patients undergoing Sinemet treatment. Memory scores were correlated with age, sex, education, marital status, length of illness, age at onset of illness, dosage and time on medication, functional status, and the major symptoms of parkinsonism. Of all factors assessed, only increased bradykinesia correlated consistently and pervasively with impaired memory. Some possible explanations are offered.

The olfactory and cognitive deficits of Parkinson's disease: evidence for independence.

In the present study we sought to determine whether the olfactory deficits of parkinsonism are related to the cognitive and perceptual-motor manifestations of the disease. Pearson correlation coefficients were computed among a number of olfactory, neurological, and neuropsychological measures obtained from 58 Parkinson's disease patients, including the University of Pennsylvania Smell Identification Test, a modified Randt memory test, a reaction time test, a finger-tapping test, ratings of motor and neurological function, and selected verbal and performance subtests of the Wechsler Adult Intelligence Scale--Revised. Data from 38 patients with Parkinson's disease who received odor detection threshold testing were also evaluated. The intercorrelation matrix was subjected to a principal components factor analysis which yielded six clear-cut factors: cognitive/memory, gross motor, oral motor, fine motor, olfactory, and tremor. The olfactory factor received strong and nearly exclusive loadings from the olfactory measures (which did not evidence meaningful loadings on any of the other factors). A ten-trial jackknife procedure revealed the factor structure to be stable. Further support of the independence of the olfactory variables from the other measures was provided by multiple regression and canonical correlation analyses. Overall, these findings lend support to the hypothesis that the olfactory disorder of parkinsonism is independent of the cognitive, perceptual-motor, and memory manifestations of the disease.

Depression in multiple sclerosis as a function of length and severity of illness, age, remissions, and perceived social support.

Degree of depression found in 120 spinal multiple sclerosis (MS) outpatients was related significantly to selected illness, demographic, and social variables. The more depressed individuals tended to be more disabled, older, and, in particular, perceived their families and friends as providing less social support than those who were less depressed. Those who had experienced at least one remission were less depressed than those who never had had a remission. Contrary to hypothesized expectations, the results also suggested that the longer a patient has MS, the more depressed he will be. Such results raise implications for psychotherapeutic intervention in this population, as well as suggest the need for future investigations of the MS patient's body image, self-concept, and perception of disability.

Level of aspiration, life satisfaction, and locus of control in older adults.

The relationship of the level of aspiration disparity score to life satisfaction and locus of control in two groups of aged individuals, the young-old (ages 60 to 69) and the old-old (ages 70-79) was studied. Female volunteers (N = 100) between the ages of 60 and 79, who were living in the community and were relatively well functioning, were administered The Rotter Level of Aspiration Test, The Life Satisfaction Index A, The Philadelphia Geriatric Morale Scale, The Internal-External Scale, and The Health Locus of Control Scale. Partial support was found for the hypothesis that a positive disparity score is associated with increased life satisfaction and a more internal locus of control.

Multi-lead spinal cord stimulation for control of motor disorders.

This report presents observations in 160 patients undergoing chronic spinal cord stimulation for various disorders of the motor system and compares the results obtained using older conventional two-electrode bipolar stimulation with a newly developed four-electrode multiple level system. Improvement was noted in 84% of the 75 patients with cerebral palsy, 67% of the 42 patients with dystonia, 62% of the 21 patients with torticollis and 73% of the 22 patients with post-traumatic neurologic loss. Significant improvements were noted when comparing the two-electrode system with the new multiple level electrode. Marked to moderately improved patients increased from 57 to 84% in cerebral palsy, from 44 to 82% in dystonia, from 53 to 75% in torticollis and from 53 to 80% in dystonia, from 53 to 75% in torticollis and from 53 to 80% in posttraumatic neurologic conditions. There was a corresponding marked drop in unimproved patients in each condition.

Urban hospital reaches out to its area's aged.

In the medically underserved Bronx, NY, a hospital's gerontology center provides screening, health education, and outpatient services to elderly residents in the community.

MMPI characteristics associated with cerebral palsy and dystonia musculorum deformans.

The origins of dystonia musculorum deformans are now considered to be organic. However, misdiagnosis of dystonia as a functional psychiatric disorder--usually conversion reaction--has persisted. The present study describes personality traits as measured by the Minnesota Multiphasic Personality Inventory in 30 persons with dystonia and in a control group of 37 persons with cerebral palsy. The data, examined by diagnosis, level of disability, and sex, showed no differences for diagnostic groups or levels of disability. Males scored in the direction of greater psychopathology than did females. The male dystonics showed the highest elevations of MMPI scales of all the groups. Although only one person with dystonia musculorum deformans and none with cerebral palsy produced the profile usually associated with conversion reaction, 36% of all profiles showed two scales above a T score of 70. This finding suggested that young adults with a physically disabling disease may be at higher risk for developing maladaptive personality traits.

Safety and efficacy of chronic stimulation.

It is our conclusion that chronic cerebellar stimulation is both efficacious and safe as a therapeutic measure for selected neurological disease. Improvements in patient selection, with patients chosen who are not as incapacitated as those of our first group, showed make this even more apparent. In order to be certain that calibration of the present stimulating equipment is accurate, each such apparatus should be calibrated by the group treating the patient. We no make this a routine aspect of our follow-up re-examinations.

Levodopa, parkinsonism, and recent memory.

Much controversy has existed concerning behavioral changes attributed to L-dopa treatment in parkinsonian patients. Disagreement existed pertaining to the question of whether improved functioning was temporally limited. The present study proposed to research the shorter and longer range effects of L-dopa onmemory. It was hypothesized that equated nonparkinsonian individuals would perform better than parkinsonian patients on all memory measures, and that shorter range L-dopa would perform better than longer range L-dopa patients. It was also hypothesized that the greater the functional deficiency, and the greater the symptom severity, the poorer memory functioning would be. Level of dosage was hypothesized to have no differential effect on memory functioning. Three groups of 20 subjects were tested. The short term (20 parkinsonian patients on L-dopa for 22 months or less) and the long term (20 parkinsonian patients on L-dopa for 40 months or more) patients were chosen from the neurological clinic at St. Barnabas Hospital, Bronx, N.Y. Testability was assessed by the neurologis and by WAIS Vocabulary performance. The third group consisted of spouses of the patients. All groups were equated with regard to sex, age, education, and where applicable, length of illness, functional status, and symptom severity. The instruments used to measure memory consisted of the Guild Memory Test, the Memory Span for Objects, the Knox Cube, and the Tactile Memory Test. WAIS Vocabulary scaled score was used as a covariate in an analysis of covariance on each of the nine memory subtests. Statistically significant differences were obtained at the .01 level among groups on all measures. Orthogonal comparisons resulted in significant differences at the .01 level between parkinsonian patients and nonparkinsonian subjects on all measures. Short term and long term L-dopa patients differed significantly on six of the nine measures, notably those testing verbal types of memory. Significant correlations were obtained between functional deficiency and eight measures; however, symptom severity correlated with only one measure. None of the memory measures correlated significantly with level of dosage. The major conclusion was reached that all of the initial improvement shown following L-dopa initiation is not sustained permanently; the elevated level of memory functioning appears to be temporally limited.

Tension reduction and alerting in man following chronic cerebellar stimulation for the relief of spasticity or intractable seizures.

Neurologically impaired patients on therapeutic regimens of chronic cerebellar stimulation for periods ranging from 4 to 29 months (mean = 12.8 months) commonly reported amelioration of tension and/or anxiety. Cerebral palsy patients emphasized tension reduction while seizure patients primarily reported increased alertness. Increased alertness and improvement in speech and mood were also noted by many patients. These changes correlated significantly with symptom reduction and functional improvement. Although the mechanisms of these changes are not yet clear, psychological and neurological explanatory hypotheses were presented.

Safety and efficacy of chronic cerebellar stimulation.

It is our conclusion that CCS is both efficacious and safe as a therapeutic measure for neurologic disease. As indications become more concise and patients can be chosen who are not as incapacitated as those in our first group, this should become even more apparent. In order to be certain that calibration of the stimulating equipment is accurate each apparatus should be calibrated by the group treating the patient. We are now making this a routine aspect of our follow-up recheck examinations.

A psychometric study of chronic cerebellar stimulation in man.

Groups of patients with intractable epilepsy or spasticity of varying etiologies underwent psychological testing before and during chronic cerebellar cortex stimulation, a neurosurgical technique designed for the relief of these symptoms. The battery of psychological tests permitted a standardized assessment of intellectual, memory, and perceptual functions. Other behavioral dimensions were assessed through structured interviews. No apparent declines in higher integrative functions followed shorter or longer term cerebellar stimulation. In contrast, stimulated patients tended to show increments in tests of recent memory and verbal output beyond that of unoperated comparison groups. Subjective reports of increased "alertness" and reduced depression and anxiety were also frequently given. Psychological and neural factors may both contribute to the observed behavioral alterations. It was concluded that the cerebellum participates in behavioral functions by modifying cortical and subcortical mechanisms relevant to integrative behavior and emotions. Specific hypotheses were presented.

Chronic cerebellar stimulation in cerebral palsy.

Data are presented for the first 50 patients with cerebral palsy who underwent chronic cerebellar stimulation for symptom alleviation. We observed significant shorter and longer term improvement in spasticity as well as athetosis, speech, and functional status. Continuing increments in improvement were noted as a function of time on stimulation. In many instances, psychometric test scores and behavior also were improved. There was one death in this series. There were no neurologic complications due to cerebellar stimulation. The results of this study warrant the judicious use of cerebellar stimulation for symptomatic and functional relief in cerebral palsy.

Chronic cerebellar stimulation in epilepsy. Clinical and anatomical studies.

Ten of 15 patients subjected to chronic cerebellar stimulation have had previously intractable seizures modified or inhibited up to periods of three years. Stimulation of anterior lobe appears to be more efficacious than stimulation of posterior lobe. Cerebellar biopsies, obtained in five patients at the time of stimulator placement, revealed in every instance a reduction in the molecular layer, decreased or absent Purkinje cells, and decreased stellate cells. One unimproved patient died during a seizure 17 months after stimulation was initiated. Histological examination of the brain did not reveal tissue damage attributable to the stimulator. There is no evidence of any adverse effect of chronic cerebellar stimulation in humans who have undergone stimulation for periods up to three years.

Psychological effects of short term cerebellar stimulation in epilepsy.

The effects of short term cerebellar stimulation on integrative functions as measured by standardized psychological tests were studied. The patient group consisted of 12 epilepsy patients undergoing chronic cerebellar stimulation as treatment for intractable seizures. Three comparison groups included nonstimulated epilepsy patients, stimulated cerebral palsy patients, and stimulated stroke patients. Cerebellar stimulation resulted in some alterations in test performance. Improvements occurred from first to second test administration for both stimulated and nonstimulated subjects, as a probable practice effect. Short term stimulation of the cerebellar cortex does not result in apparent deficits. However, significant improvement in verbal output and in visual-motor performance occurred for the stimulated epilepsy group along with a small decrement in sustained concentration in a numerical task. Preliminary hypotheses were offered to explain the results.

Levodopa and psychometric test performance in parkinsonism-5 years later.

Forty parkinsonian patients on levodopa therapy for a mean of 4 years and 10 months were given a battery of psychometric tests to assess memory cognition, and perception. Three equated control groups consisting of (1) parkinsonian patients not on levodopa, (2) patients on short-term levodopa, a mean of 1 year and 1 month, and (3) spouses, were administered a similar battery. The experimental group performed better than the nonlevodopa and the short-term groups on two subtests of intellectual functioning, but did less well on two tests of recent memory. All three parkinsonian groups consistently did significantly worse than spouses. When sex, age, and other relevant variables are equated, longer term levodopa therapy does not significantly after the overall pattern of psychometrically tested functions generally reported in parkinsonian patients.

The natural history of dystonia.

We have analyzed 226 patients with a diagnosis of dystonia musculorum deformans seen in our clinica between 1955 and 1974. These were evenly divided between male and female, but of the 226 patients, 225 were white and only one was black. Forty-two percent were Jewish, as contrasted with 3% Jewish population in the United States. It is interesting to note that a family history was obtained in 28% of both the Jewish and the non-Jewish groups. Thirty of the patients reported a significant viral infection within 3 months preceding the onset of symptoms. Only six patientss had a history of one or more remissions during the course of their illness. The mean duration of symptoms before examination in this series was 8.6 years with a duration of 1 to 42 years. Fifty-six of the patients had been diagnosed as having conversion hysteria at some time during the course of their illness. The majority of the patients had the onset of symptoms between the ages of 5 and 10, although the age span was from 2 to 45 years of age. Seventy-six of the patients had an IQ statistically significant above average (3). Each symptom, rate of progress of the disease, and various other factors in the history were corrolated with age, sex, ethnic group, mode of onset, and 20 other variables. The most pertinent subgroupings affecting the natural history were the age on onset and the ethnic group and family history. Trunkal involvement was most common in the non-Jewish group with a positive family history. This particular sub-group of patients showed predominately midline symptomatology. In the groups below the age of 13, the onset was almost invariably in one of the four limbs. However, in the group 14 years of age and older, 30% had their initial dystonic symptoms in the neck and a total of 40% of the patients whose onset was at age 14 or later, had marked nuchal symptoms. This clear-cut predominance of limb involvement in the youngest groups is also indicated by the observation that 38% in the youngest group had become confined to a wheelchair because of gait abnormalities, whereas none of those whose age of onset was 14 or older were disabled to this degree by gait abnormality. The most rapidly progressive and incapacitating symptomatology was seen in those patients with onset of symptoms below the age of 8 so that in general the younger the age at onset, the more rapid the progress of the symptoms.

Psychological studies in dystonia musculorum deformans.

Sixty-eight patients with DMD underwent psychometric assessment before or after thalamic surgery. Statistical comparisonss between categories of patients were undertaken as a function of religion, family history, and age at onset of symptoms as independent variables. It was found that Jewish patients, with negative family history, and age at onset of symptoms from 9 to 13 years, scored significantly higher on IQ tests than did all other groups. Other psychological test data revealed no specific personality patterns in the DMD patients, particularly no pattern of conversion hysteria or hysteria. Pre- and postoperative psychological testing in a small group of patients revealed no evidence of any changes in intellectual, cognitive, or personality functions as a consequence of thalamic surgery, involving up to 10 lesions in some instances.