Cognition-related EEG abnormalities in nondemented Down syndrome subjects.

Down syndrome (DS) subjects develop Alzheimer disease (AD) histopathology before they develop dementia. We compared the resting and flash stimulated electroencephalogram (EEG) of nondemented adult DS and age-matched control subjects, in search of EEG abnormalities that might correlate with AD histopathology. DS subjects had increased absolute power in all the EEG bands, independent of cognition functions measured by the Mini Mental State Examination and Picture Absurdities Test scores. In the power spectrum of the resting EEG, we found a cognition-related increase in power at 4.5 and 8.8 Hz, indicative of alpha-slowing, as in AD patients. In the stimulated EEG, we found several cognition-related abnormalities, such as decreased responses to 12-Hz stimulation and decreased integral of beta- and gamma-band responses, indicative of decreased responsiveness to photic stimulation, as in AD patients. Therefore, nondemented DS and AD patients share several cognition related EEG abnormalities which are probably due to AD histopathology.

In vitro assessment of prosthetic valve function in mitral valve replacement with chordal preservation techniques.

BACKGROUND AND AIM OF THE STUDY: The importance of chordal preservation techniques in maintaining improved left ventricular function after mitral valve replacement has been well documented clinically. Currently, the choice of prosthetic valve used in chordal preservation is dependent upon the surgeon's preference. However, the transvalvular flow characteristics of common, clinically used prosthetic valves may be influenced by the mitral subvalvular apparatus, and may result in degraded valve function. The goal of this study was to perform an in vitro evaluation of the influence of chordal preservation on the transvalvular and left ventricular flow patterns of common valve prostheses. METHODS: Tissue and mechanical valves have been evaluated under physiologic pulsatile flow with anterior and/or posterior chordal preservation. Flow patterns were assessed by 2-D planar flow visualization, pulsed wave Doppler velocity measurements, 2-D echocardiography, and selected color Doppler flow mapping. Based on changes in transvalvular and left ventricular flow patterns, favorable prosthetic valve/chordal preservation combinations were identified. Additionally, valve orientation was varied to determine optimal orientation. RESULTS: Baseline results without chordal preservation indicate that the anti-anatomic orientation is preferred for the bileaflet valve design while the tilting disc valve should be oriented with the major axis toward the posterior (free) wall of the ventricle, corroborating published conclusions by other investigators. Some form of flow restriction is observed in all test cases with chordal preservation due to the presence of the subvalvular tissue. In general, bioprostheses showed less flow restriction then the mechanical valves, particularly with lateral flow expansion. This flow restriction may influence pressure recovery downstream of the mechanical valves tested. Increased flow constriction is observed with anterior and posterior chordal preservation. CONCLUSIONS: This study favors the use of the St. Jude Medical bileaflet valve orientated in the anti-anatomic position, or the Carpentier-Edwards pericardial valve with chordal preservation.

Severity of dementia correlates with loss of broad-band visual cortical responses.

We have shown that the response to flash stimulation of the occipital electroencephalogram (EEG) in Alzheimer disease (AD) patients is smaller than in normal subjects. To ascertain whether this is a specific feature of AD or a nonspecific effect of dementia, we investigated in AD and multi-infarct dementia (MID) patients the relationship between cognitive function, measured as Mini-Mental State Examination score, and EEG power response, measured as the difference in spectral power between flash-stimulated EEG and resting EEG. Both variables were positively correlated and the regression equations of AD and MID patients were not significantly different, showing nonspecificity. The coupling between cognitive function and power response is discussed in relation to the dynamic binding hypothesis of cognition.

Decreased alpha bandwidth responsiveness to photic driving in Alzheimer disease.

The power spectra of the photically activated occipital EEGs of 9 mildly to moderately demented probable Alzheimer disease (AD) patients (according to NINCDS-ADRDA criteria), 9 normal age-matched control and 27 normal subjects of different ages were compared. In normal subjects, photic stimulation with rhythmic flashes ranging between 2 and 20 Hz elicited a characteristic response in each EEG bandwidth (delta, theta, alpha, beta1 and beta2). The magnitude of each bandwidth response was a function of the frequency of the photic stimulus. In AD patients the alpha bandwidth response curve was significantly smaller than that of age-matched controls (MANOVA main effect of group, P = 0.018); all the other bandwidth response curves were normal. Therefore, in AD there is a selective abnormality in the alpha bandwidth responsiveness to photic stimulation, probably due to AD pathology in the neuronal generator of the alpha rhythm.