The diagnostic value of IADL evaluation in the detection of dementia in general practice.

It is assumed that general practitioners can make an important contribution to the diagnosis of dementia. One of the used strategies comprises an evaluation of the Instrumental Activities of Daily Living (IADL). There are contradictory data on the value of this strategy. During one month, 21 Flemish general practitioners evaluated the IADL capacities of all subjects older than 65 years with whom they had contact. Subjects with dementia and/or living in a residential home for the elderly were excluded. Housing and living conditions, medication use and IADL were registered. The general practitioner formulated a clinical evaluation. All subjects with an IADL score > or = 1 and a random sample from the group IADL = 0 underwent a Mini Mental State Examination. Subjects with an IADL score = 4 were referred for neuropsychological and specialist examination. The average age of the 1003 registered subjects was 75.1 years (SD = 6.8). A large majority of them (85%) were totally independent. There was a large discrepancy between the family's and the patient's judgment on the presence of memory problems. There was an inverse correlation between the IADL and MMSE: when the IADL score increased, the MMSE score fell. The diagnostic value of the IADL for the diagnosis of dementia with Camdex-N as a reference standard could not be evaluated because the number of tested subjects was too small. Against the MMSE, sensitivity was 0.81 (SE = 0.03), and specificity was 0.48 (SE = 0.05). The evaluation of the IADL activities had some drawbacks as a detection method for dementia but the use of IADL data may still be clinically valuable in general practice. The correlation between the general practitioner's judgment and that of the specialist was very good. This study showed that the use of the IADL score might change the general practitioner's diagnostic judgment. Furthermore this study confirms the existence of a major threshold for the referral to a specialist of patients with suspected dementia by general practitioners.

Evolution of post-traumatic cervical syringomyelia: case report.

A patient with complete post-traumatic paraplegia below T6 developed urinary problems and late secondary syringolmyelia. The concordance between the appearance of micturition difficulties and the first sensory symptoms leads us to discuss the rôle of important and repeated efforts to obtain reflex micturition, during the development of post-traumatic syringomyelia.

[Role of the involvement of the reticular formation in the dementia of Parkinson's disease]. / Rôle de l'atteinte de la substance réticulée dans la démence de la maladie de Parkinson.

A post mortem study of 14 cases of Parkinson's disease was reported. Seven patients were mentally deteriorated and 7 were not, retrospectively. The semiquantitative study of the cortical lesions of senile dementia of Alzheimer type did not show any recognizable difference between the 2 groups. A greater degree of neuronal cell loss in the nucleus basalis of Meynert in the mentally deteriorated group was confirmed. The incidence of Lewy bodies in the brain stem reticular formation was remarkably increased in the mentally deteriorated group. A study of the reticular formation, including the raphe nuclei and the magnocellular nuclei of mid pons and upper medulla, revealed a significant higher incidence of Lewy bodies throughout the whole reticular formation in the mentally deteriorated group. The possible role of the lesions of the ascending reticular activating system in the mental deterioration is discussed.

[Quantitative whole-body bone scintigraphy. II. Pharmacokinetics of osteotropic radiopharmaceuticals (author's transl)]. / Die quantitative Ganzkörper-Skelettszintigraphie. II. Aussage für die Kinetik osteotroper Radiopharmaka.

85Sr, 99mTc-Sn-pyrophosphate and 99mTc-Sn-methylene-diphosphonate, the most important agents for skeletal imaging, are compared with each other by calculation of the plasma clearance and the urinary excretion and by a series of quantitative whole-body scans. 85Sr the distribution volume in equilibrium is the largest, shifting of activity is demonstrable for several days after injection. 99mTc-Sn-MDP is excreted most quickly, equilibrium is reached early. There is no significant difference in skeletal uptake between the phosphate complexes. The distribution however is different: 85Sr is localized to a greater extent in the extremities, the phosphate complexes more in the trunk, 99mTc-Sn-MDP and 85Sr nearer the joints than 99mTc-Sn-pyrophosphate.