Objective: To examine the relationship between memory and basic physical mobility in an independent elderly population.
Methods: We evaluated memory and physical mobility in 147 persons aged 60 ...years or older who were physically and cognitively independent. Memory was assessed by using the Rivermead Behavioral Memory Test (RBMT) and a total standardized profile score was used as an index of overall memory status. Additionally, we made a “score independent of walking ability” to exclude the effect of physical mobility on the RBMT score and a “score independent of prospective memory” to exclude the effect of executive function on the RBMT score. Basic physical mobility was assessed by using the Timed Up and Go test (TUG). The score was expressed as the time in seconds to perform the sequence of the action required in TUG.
Results: The TUG score significantly correlated with the total standardized profile score (rs = −0.21, P < 0.05) and the scores independent of walking ability (rs = −0.23, P < 0.01) and prospective memory (rs = −0.23, P < 0.01). Controlling for age, sex, education, and the presence of risk factors of cerebrovascular disease did not change the results.
Conclusions: Memory is associated with basic physical mobility in independent elderly people. Because the TUG score significantly correlated with the scores independent of walking ability and prospective memory, the correlation was not a superficial one due to physical mobility or executive function. Our findings suggest that maintaining basic physical mobility can slow memory decline during aging.
In patients with post‐traumatic stress disorder (PTSD), re‐experiencing the trauma is often induced by external cues in the environment. The cues, which were emotionally neutral for the patients ...before the traumatic event, become fearful ones after the event. This phenomenon is considered to be associated with fear conditioning. The paradigm was set up so that the emotionality changes in the patients with PTSD would be reproduced, and the regional cerebral blood flow (rCBF) measured with positron emission tomography (PET) was compared during exposure to the same stimuli before and after acquisition of fear conditioning. Ten healthy male subjects were asked to look at some emotionally neutral photos, then to watch a video with fearful content that also contained images similar to that presented in the photos, and afterwards to look at the photos again. Five of the 10 subjects felt that the object in the photos was more fearful after watching the video than before, and they were considered to have acquired fear conditioning. In those five subjects, the rCBF in the right amygdala and the left posterior cingulate gyrus after acquisition of fear conditioning significantly increased relative to the rCBF before conditioning. Thus, these regions seem to have a critical role in fear conditioning.
Psychogenic amnesia is characterized by an inability to recall information already stored in the patient’s memory. It is usually related to a stressful or traumatic event that cannot be explained by ...manifest brain damage. To examine the underlying functional disturbance of brain areas in this condition, we performed a positron emission tomography (PET) activation study on a psychogenic amnesic patient and on 12 normal control subjects. A task requiring explicit retrograde memory of faces was compared with a control task. To assess functional modifications associated with the processes of recovery, a second PET study was performed on the patient 12 months after onset. During the task, activation of the right anterior medial temporal region including the amygdala was increased in the psychogenic amnesic patient. Activation of the bilateral hippocampal regions increased only in the control subjects. During recovery, the right anterior medial temporal region became less active while the right hippocampal region became more active. Activation levels also differed in the anterior cingulate cortex, prefrontal cortex and some other cortical regions between control subjects and the patient. These findings suggest that the changes in these limbic and limbic–cortical functions are related to symptoms of the psychogenic amnesia.
Statistical parametric mapping (SPM) was employed to investigate the regional decline in cerebral blood flow (rCBF) as measured by 99mTc-hexamethyl propylene amine oxime (HMPAO) single photon ...emission computed tomography (SPECT) in mild Alzheimer's disease (AD). However, the role of the post reconstruction image processing on the interpretation of SPM, which detects rCBF pattern, has not been precisely studied. We performed 99mTc-HMPAO SPECT in mild AD patients and analyzed the effect of linearization correction for washout of the tracer on the detectability of abnormal perfusion.
Eleven mild AD (NINCDS-ADRDA, male/female, 5/6; mean+/-SD age, 70.6+/-6.2 years; mean+/-SD mini-mental state examination score, 23.9+/-3.41; clinical dementia rating score, 1) and eleven normal control subjects (male/female, 4/7; mean+/-SD age, 66.8+/-8.4 years) were enrolled in this study. 99mTc-HMPAO SPECT was performed with a four-head rotating gamma camera. We employed linearization uncorrected (LU) and linearization corrected (LC) images for the patients and controls. The pattern of hypoperfusion in mild AD on LU and LC images was detected by SPM99 applying the same image standardization and analytical parameters. A statistical inter image-group analysis (LU vs. LC) was also performed.
Clear differences were observed between the interpretation of SPM with LU and LC images. Significant hypoperfusion in mild AD was found on the LU images in the left posterior cingulate gyrus, right precuneus, left hippocampus, left uncus, and left superior temporal gyrus (cluster level, corrected p < 0.005). With the LC images, significant hypoperfusion in AD was found only in the bilateral posterior cingulate gyrus and left precuneus (cluster level, corrected p < 0.005). A pattern of greater rCBF distribution at the high flow cortices and low flow cortices was observed on LC and LU images, respectively, in the case of both controls and mild AD patients.
Hippocampal hypoperfusion could be detected by means of SPM in the LU images but not in the LC images. The results of SPM may vary in 99mTc-HMPAO SPECT with or without linearization correction, which should be carefully evaluated when interpreting the pattern of rCBF changes in mild Alzheimer's disease.
We examined the relation of age at onset and visuocognitive disturbances in Alzheimer disease (AD) using a large sample of patients, quantitative neuropsychological measures, and multivariate ...statistics controlling for gender, education, stage of dementia, and disease duration. Significant positive coefficients were obtained with forward and backward digit and visual spans, visual counting, copying Rey complex figure, and block design task. The results indicated that patients with early-onset AD performed worse than late-onset AD patients on these tasks. There was no significant effect of age at onset on identification of overlapping figures, visual form discrimination, or Raven's colored progressive matrices. These findings confirm the greater attentional and visuospatial impairments in early onset patients when these confounding factors were controlled for, although no significant effect of age at onset in visuoperceptual function was observed.
This study assessed 46 patients with Alzheimer's disease and 21 aged controls using positron emission tomography. Repeated analyses using a general linear model examined the effect of age at onset on ...the pattern of the regional cerebral metabolic rate of glucose (rCMRglc). The results showed significant age effects on the rCMRglc in the fronto-temporo-parietal association cortices and retrosplenial areas. Disease duration, overall cognitive severity or normal aging could not account for the effects. The age effects were delineated as a double dissociation, that is, early-onset patients have a more severe reduction of regional glucose metabolism in the association cortices, while late-onset patients show a more prominent metabolic deficit in the paralimbic area.
Cognitive impairment in patients with idiopathic normal pressure hydrocephalous (iNPH) has not been clearly documented. We performed standardized neuropsychological assessments of 21 patients with ...iNPH and of 42 patients with Alzheimer’s disease (AD) matched to the patients with iNPH 2:1 by age, sex, and Mini-Mental State Examination score. Compared with the AD group, the iNPH group scored significantly higher on the orientation subtest of the Alzheimer’s Disease Assessment Scale and on the general memory and delayed recall subtests of the Wechsler Memory Scale-Revised (WMS-R), and significantly lower on the attention/concentration subtest of the WMS-R and on the digit span, arithmetic, block design and digit symbol substitution subtests of the Wechsler Adult Intelligence Scale-Revised. The impairment of frontal lobe functions is disproportionately severe and memory impairment is disproportionately mild in patients with iNPH compared with AD. Recognition of these features contributes to an early diagnosis, which can lead to a better prognosis.
Statistical parametric mapping (SPM) was employed to investigate the regional decline in cerebral blood flow (rCBF) as measured by^sup 99m^Tc-hexamethyl propylene amine oxime (HMPAO) single photon ...emission computed tomography (SPECT) in mild Alzheimer's disease (AD). However, the role of the post reconstruction image processing on the interpretation of SPM, which detects rCBF pattern, has not been precisely studied. We performed^sup 99m^Tc-HMPAO SPECT in mild AD patients and analyzed the effect of linearization correction for washout of the tracer on the detectability of abnormal perfusion. Eleven mild AD (NINCDS-ADRDA, male/female, 5/6; mean ± SD age, 70.6 ± 6.2 years; mean ± SD mini-mental state examination score, 23.9 ± 3.41; clinical dementia rating score, 1) and eleven normal control subjects (male/female, 4/7; mean ± SD age, 66.8 ± 8.4 years) were enrolled in this study.^sup 99m^Tc-HMPAO SPECT was performed with a four-head rotating gamma camera. We employed linearization uncorrected (LU) and linearization corrected (LC) images for the patients and controls. The pattern of hypoperfusion in mild AD on LU and LC images was detected by SPM99 applying the same image standardization and analytical parameters. A statistical inter image-group analysis (LU vs. LC) was also performed. Clear differences were observed between the interpretation of SPM with LU and LC images. Significant hypoperfusion in mild AD was found on the LU images in the left posterior cingulate gyrus, right precuneus, left hippocampus, left uncus, and left superior temporal gyrus (cluster level, corrected p < 0.005). With the LC images, significant hypoperfusion in AD was found only in the bilateral posterior cingulate gyrus and left precuneus (cluster level, corrected p < 0.005). A pattern of greater rCBF distribution at the high flow cortices and low flow cortices was observed on LC and LU images, respectively, in the case of both controls and mild AD patients. Hippocampal hypoperfusion could be detected by means of SPM in the LU images but not in the LC images. The results of SPM may vary in^sup 99m^Tc-HMPAO SPECT with or without linearization correction, which should be carefully evaluated when interpreting the pattern of rCBF changes in mild Alzheimer's disease.PUBLICATION ABSTRACT
Background: Elderly patients with depression have more ischemic lesions on magnetic resonance imaging (MRI) of the brain than those without depression. Therefore, late onset depression might be ...associated with neurobiological etiology, especially vascular lesions of the brain. Recently nicergoline, which is an ergoline derivative and increases cerebral blood flow, has been reported to be effective for vascular depression. However, it remains unclear whether late onset depression without ischemic lesions or vascular risk factors can be improved by this compound.
Methods: The present study reports the case of a 69‐year‐old woman with depression, which consisted of mild depressive mood, severe loss of drive and appetite, and moderate cognitive impairment that developed over 8 months. Treatment with 150 mg of sulpiride, 40 mg of paroxetine hydrochloride, and 0.5 mg of etizolam everyday for 5 months had no effect on the patient. MRI of the brain showed mild cortical atrophy in the bilateral frontal and parietal lobes with no remarkable ischemic lesions. A mild decrease of relative cerebral blood flow (CBF) in the atrophic regions was shown by 99mTc‐HMPAO single photon emission computed tomography (SPECT). After sulpiride treatment was discontinued, the patient took 15 mg of nicergoline daily in addition to selective serotonin reuptake inhibitor (SSRI) treatment.
Results: The patient's symptoms were improved after 2 weeks and 99mTc‐HMPAO SPECT of the brain showed a slight improvement of relatively decreased CBF in the regions.
Conclusion: Nicergoline might have a therapeutic potential as an augmentation strategy for late onset depression.
We evaluated everyday memory impairment in 24 patients with mild cognitive impairment (MCI) with the Rivermead Behavioral Memory Test (RBMT) and compared the scores with those of 48 age-, sex- and ...education-matched normal controls (NC) and 48 age-, sex- and education-matched Alzheimer disease (AD) patients. Overall everyday memory was impaired in MCI patients but the severity was milder than that in AD patients. The MCI patients showed impairment of everyday memory tasks requiring delayed recall. But they could normally perform tasks immediately after memorizing, except for recalling and retracing a simple new route. The total Profile score correctly classified 100% of the MCI patients and 91.7% of NC, thus demonstrating the usefulness of the RBMT for diagnosing MCI patients. Prospective memory tasks were not useful for detecting the patients with MCI.
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