bluuebunny/crossref_metadata_2025 huggingface dataset:
Ciliogenesis in the Uterine Tube of Control and Superovulated Heifers
Authors: Abughrien Badia M. , Dore Michael A.P.
Published: April 2003

Ciliogenesis was investigated in the uterine tube epithelium of control and superovulated heifers during day 1 to day 7 of the oestrous cycle. Seventy-two heifers were used, consisting of four control groups and four superovulated groups. All heifers received cloprostenol (PG) to induce oestrus (day 0). Superovulated heifers received 24 mg pFSH at doses of 4.5, 3.5, 2.5 and 1.5 mg given twice daily. Control and superovulated heifers were slaughtered on days 1, 3, 5 and 7 of the oestrous cycle. Samples from the ampulla, preisthmus and isthmus of the uterine tube were collected and processed for light and electron microscopy, following standard procedures. Both centriolar and acentriolar pathways were involved in the development of basal bodies. Formation of basal bodies and protrusion of ciliary shafts mostly occurred during days 1 and 3 of the oestrous cycle. The centriolar pathways, in which procentrioles generate with the aid of preexisting centrioles, played a minor role in the heifer uterine tube. In the acentriolar pathways, fibrous granules were the first structures which appeared in the course of ciliogenesis and they initially occurred in association with free ribosomes. Subsequently, deuterosomes arose in the aggregates of fibrous granules, and then procentrioles containing microtubules originated around deuterosomes or apart from deuterosomes. Newly formed centrioles migrated to the apical cytoplasm, and ciliary shafts extended first at the periphery of the luminal surface of ciliogenic cells. Deuterosomes as well as rootlet formation were considered to be related to the fibrous granules. Quantitative examinations by light microscopy showed that the number of ciliated cells in the ampullar, preisthmic and isthmic epithelium of the superovulated heifers was significantly higher than in the control heifers during day 1 and day 3 of the oestrous cycle.
Investigation of the Female Canine Urethral Vascular Plexus Using Light and Scanning Electron Microscopy: A Contributing Factor to Urinary Continence
Authors: Augsburger H. , Müller U.
Published: April 2003

The vascular system of the female canine urethra was investigated by means of serial histological sections, vascular corrosion casts and scanning electron microscopy. The urethral vascular plexus, located in the proprial connective tissue between the epithelium and the smooth musculature, consisted of sinusoids. It could be divided distally into two parts defined by a constriction in the transitory region between the third and fourth urethral quarters. The proximal segment of the plexus was composed of interconnected longitudinal tubes, whereas the distal part assumed a more net-like form and was continuous with the vestibular plexus. Small arteries usually ran alongside the sinusoidal vessels for a considerable distance before emptying either directly or through branches into the plexus. This vascular arrangement establishes the vascular plexus as a structure similar to an erectile tissue with an arterial inflow, thereby emphasizing the importance of the plexus as a major contributory component guaranteeing urinary continence.
Delayed Expression of Calbindin D28k during Regeneration of the Periodontal Ruffini Endings of the Rat Incisor following Injury to the Inferior Alveolar Nerve
Authors: Atsumi Yukako , Ajima Hisao , Maeda Takeyasu , Kurisu Kojiro , Wakisaka Satoshi
Published: April 2003

Expression of calbindin D28k (CB)-like immunoreactivity (-LI) was compared with that of protein gene product 9.5 (PGP 9.5), a general neuronal marker, in the periodontal ligament of the rat lower incisor following resection of the inferior alveolar nerve (IAN). In normal animals, the periodontal nerve fibers showing PGP 9.5-LI formed either Ruffini endings with expanded arborization or thin free nerve endings in the alveolar half of the ligament. Thick CB-like immunoreactive (-IR) nerve fibers terminated in a dendritic fashion in the same region, but thin CB-IR nerve fibers were rarely detected. During the 3 days following resection of the IAN, most of the PGP 9.5-IR and all CB-IR nerve fibers disappeared. Regenerated PGP 9.5-IR nerve fibers appeared around 7 days after resection, in contrast to the very small number of regenerated CB-IR nerve fibers. Around 21–28 days following resection, the number and terminal morphology of regenerated PGP 9.5-IR nerve fibers were comparable to those observed in normal animals, but the number of regenerated CB-IR nerve fibers was still smaller. The terminal morphologies of these regenerated CB-IR nerve fibers showed less expansion compared with normal animals at these post-injured periods. The number of regenerated CB-IR nerve fibers increased gradually to return to normal by 56 days following injury. The delayed expression of CB in the regenerated periodontal Ruffini endings suggests that the functional recovery of periodontal Ruffini endings occurred after the regeneration of periodontal Ruffini endings had been completed.
Towards Defining the Role of Glycans as Hardware in Information Storage and Transfer: Basic Principles, Experimental Approaches and Recent Progress
Authors: Solís D. , Jiménez-Barbero J. , Kaltner H. , Romero A. , Siebert H.-C. , von der Lieth C.-W. , Gabius H.-J.
Published: April 2003

The term ‘code’ in biological information transfer appears to be tightly and hitherto exclusively connected with the genetic code based on nucleotides and translated into functional activities via proteins. However, the recent appreciation of the enormous coding capacity of oligosaccharide chains of natural glycoconjugates has spurred to give heed to a new concept: versatile glycan assembly by the genetically encoded glycosyltransferases endows cells with a probably not yet fully catalogued array of meaningful messages. Enciphered by sugar receptors such as endogenous lectins the information of code words established by a series of covalently linked monosaccharides as letters for example guides correct intra- and intercellular routing of glycoproteins, modulates cell proliferation or migration and mediates cell adhesion. Evidently, the elucidation of the structural frameworks and the recognition strategies within the operation of the sugar code poses a fascinating conundrum. The far-reaching impact of this recognition mode on the level of cells, tissues and organs has fueled vigorous investigations to probe the subtleties of protein-carbohydrate interactions. This review presents information on the necessarily concerted approach using X-ray crystallography, molecular modeling, nuclear magnetic resonance spectroscopy, thermodynamic analysis and engineered ligands and receptors. This part of the treatise is flanked by exemplarily chosen insights made possible by these techniques.
Molecular Basis of Human Sperm-Zona pellucida Interaction
Authors: Oehninger Sergio
Published: April 2003

The recognition of carbohydrate sequences by complimentary receptors has been shown to be a critical factor in gamete interaction in many different animal species. We have proposed the hypothesis that, in the human, sperm binding to the zona pellucida requires a ‘selectin-like’ interaction. We have used the hemizona assay (a unique internally controlled bioassay that evaluates tight binding of human sperm to the homologous zona pellucida) and advanced methods of carbohydrate analysis to test this hypothesis. We provide compelling evidence that demonstrates that oligosaccharide recognition is also required for specific, tight human gamete binding. Hapten inhibition tests, zona pellucida lectin-binding studies and removal/modification of functional carbohydrates by chemical and enzymatic methods provide evidence for the involvement of defined carbohydrate moieties in initial binding. Our studies suggest the existence of distinct zona-binding proteins on human sperm that can bind to selectin ligands. Additionally, results suggest a possible convergence in the types of carbohydrate sequences recognized during initial human gamete binding and immune/inflammatory cell interactions. Full characterization of the glycoconjugates that manifest selectin-ligand activity on the human zona pellucida will allow for a better understanding of human gamete interaction in physiological and pathological situations.
Endoscopic Therapy of Chronic and Recurrent Pancreatitis
Authors: Waxman Irving , Freedman Steven D. , Zeroogian John M.
Published: April 2003

Endoscopic pancreatic therapy is emerging as an exciting nonoperative alternative in the management of chronic pancreatitis, in particular in cases where pancreatic duct obstruction due to stones, protein plugs, or strictures is present. Although the preliminary results available are promising, prospective randomized trials comparing endoscopic and surgical techniques are much needed. Furthermore, the published data come from large endoscopic centers with very high levels of technical skill and experience, and, therefore, its widespread clinical use is limited. Time and well-designed prospective randomized clinical trials comparing surgical versus endoscopic techniques will help define the role of these procedures in the treatment of chronic pancreatitis.
Extraesophageal Varices
Authors: Kotfila Ronald , Trudeau Walter
Published: April 2003

Esophageal varices are the most common site of variceal bleeding. However, bleeding from varices that are not located in the esophagus may account for up to 30% of all variceal bleeding. Significant varices can occur in the stomach, duodenum, jejunum, ileum, colon, rectum, and biliary tree. They can also occur at the site of a surgical ostomy. These types of varices bleed less commonly than esophageal varices, but they can also be far more difficult to diagnose and treat. The absence of stigmata of recent esophageal variceal bleeding and certain clues in the patient’s history and clinical presentation should raise the clinician’s suspicion of an extraesophageal site of variceal bleeding. Particularly, patients with extrahepatic causes of portal hypertension, cirrhotic patients with a prior history of gastrointestinal surgery, and patients who present with profound bleeding but without hematemesis need to be evaluated further if an obvious site of esophageal variceal bleeding is not seen on initial endoscopy. In this article, we review the features particular to extraesophageal varices as well as the diagnosis and management of bleeding from these varices. We use the term extraesophageal rather than ectopic because the term ectopic varices implies exclusion of both esophageal and gastric varices.
Management of Periampullary Adenoma
Authors: Norton Ian , Gostout Christopher
Published: April 2003

The periampullary region is the most common site of adenomatous change in the small bowel, particularly in patients with familial adenomatous polyposis (FAP) syndromes. These lesions have been shown to progress to malignancy in a manor analogous to colonic polyps. Following colectomy, the periampullary region is the commonest site of gastrointestinal malignancy in FAP patients. The periampullary region is within easy reach of forward- and side-viewing endoscopes and therefore endoscopic surveillance in FAP patients is both easy and prudent. Furthermore, there is accumulating evidence that endoscopic resection and/or ablation are the treatment of choice for periampullary adenomas. However, the optimal timing of surveillance and best methods of ablation remain to be determined. This paper reviews the literature on the endoscopic management of periampullary adenoma as well as outlining our current approach to this challenging problem.
Genetics of the Immune Response to Gluten in Coeliac Disease
Authors: Sollid Ludvig
Published: April 2003

Accumulating evidence indicates that coeliac disease (CD) is a multifactorial disorder where several heritable factors in conjunction with environmental factors are involved in the disease development. Gluten proteins are a critical environmental factor as the presence of disease in affected individuals is strictly dependent on dietary gluten exposure. Most likely coeliac patients have genetically shaped immune responses to gluten proteins that cause intestinal pathology. Many of the CD genes thus supposedly encode variants of proteins with immune functions. HLA has been identified as a major genetic factor, but yet no further genes have been identified. There probably exist several predisposing non-HLA genes, but available data indicate that the heritable contribution by each of them can be small. Combined genetic and functional studies will hopefully identify additional predisposing genes in the future.
Etiological Role of Mycobacterium in Crohn’s Disease: An Assessment of the Literature
Authors: Hubbard James , Surawicz Christina
Published: April 2003

A possible etiologic role for mycobacteria in Crohn’s disease has been the subject of much investigation. This paper critically reviews the literature exploring 4 major areas: (1) attempts to culture mycobacteria from intestinal specimens; (2) indirect detection of organisms in intestinal specimens by techniques including immunohistochemistry, nucleic acid hybridization and polymerase chain reaction; (3) detection of serum antibodies to mycobacteria, and (4) results of antimycobacterial drug trials in treating patients with Crohn’s disease. While the evidence does not support an etiologic role for mycobacteria in Crohn’s disease, newer techniques may change this conclusion.
Novel Approaches to the Treatment of Nausea and Vomiting
Authors: Ladabaum Uri , Hasler William L.
Published: April 2003

Nausea and vomiting are debilitating symptoms complicating many clinical conditions. Conventional antiemetic agents act as muscarinic, histamine, and dopamine receptor antagonists in the central nervous system. In a retrospective analysis, tricyclic antidepressant drugs demonstrated efficacy in long-term treatment of functional nausea. Some cases of vomiting result from impaired gastrointestinal motor activity. Agents which act on gastric serotonin (5-HT4), dopamine, and motilin receptors accelerate gastric emptying and relieve symptoms in gastroparesis. Recent investigations suggest that some patients with refractory gastroparesis may benefit from gastric electrical pacing. The treatment of acute chemotherapy-induced emesis was revolutionized by 5-HT3 receptor antagonists; however, these agents are less efficacious in delayed vomiting. Neurokinin (NK-1) receptor antagonists show promise in treating delayed chemotherapy-evoked emesis. Furthermore, animal studies indicate a broad spectrum of action for NK-1 antagonists in treating diverse causes of nausea and vomiting. The cyclic vomiting syndrome is characterized by discrete episodes of relentless vomiting separated by asymptomatic intervals and is associated with migraine headaches. Antimigraine therapies including the 5-HT1D receptor agonists sumatriptan reduce the severity of cyclic vomiting attacks. Investigations into these and other novel treatments may provide important advances in the care of difficult cases of nausea and vomiting resulting from disparate illnesses.
Frequency and Clinicopathology Associations of K-ras Mutations in Colorectal Cancer in a Northeast Mexican Population
Authors: Martinez-Garza Sandra , Núñez-Salazar Alfonso , Calderon-Garcidueñas Ana , Bosques-Padilla Francisco , Niderhauser-Garcia Alberto , Barrera-Saldaña Hugo
Published: April 2003

Activation of the ras family gene has been implicated in colorectal tumorigenesis, K-ras being the most frequently altered gene. The frequency of K-ras codon 12, 13 and 61 point mutations in patients with colorectal neoplasias was examined. We employed a polymerase chain reaction-restriction fragment length polymorphism assay and single-strand conformational polymorphism to detect mutations. We found that point mutations at codons 12 and 13 were present in 53% and 39% of the tumors, respectively, but none at codon 61. These results agree with previous reports. Point mutations were more frequent in adenomas than in carcinomas, with villous adenomas presenting a higher incidence of mutations than other adenomas. The association between clinical and histopathological parameters was investigated. Our study is the beginning of a new research line in molecular epidemiology of colorectal cancer and is the first to be carried out in one part of the Mexican population.
Induced-Hyperglycemia Attenuates Erythromycin-Induced Acceleration of Hypertonic Liquid-Phase Gastric Emptying in Type-I Diabetic Patients
Authors: Petrakis Ioannis , Chalkiadakis George , Vrachassotakis Nicolaos , Sciacca Vincenzo , Vassilakis Sofocles , Xynos Evagelos
Published: April 2003

Background: Erythromycin has been found to be a gastrointestinal prokinetic agent of hypertonic liquids, while acute hyperglycemia has been associated with delayed gastric emptying in diabetic patients. Aim: To investigate whether hyperglycemia, per se, reduces gastric motility during erythromycin-induced acceleration on gastric emptying of hypertonic liquids in diabetic patients. Methods: In 12 type-I diabetic patients following a hypertonic radiolabeled liquid meal, gastric emptying was measured scintigraphically during normoglycemia (5–8.9 mmol/l glucose) or hyperglycemia induced by intravenous (16–19 mmol/l) glucose infusion. The tests were performed on 4 separate days in random order after administering either placebo or 200 mg i.v. erythromycin. Results: In the hyperglycemic state compared to normoglycemia, the gastric emptying of the hypertonic liquid was reduced after placebo or erythromycin administration. The lag-phase duration (17.8±5.5 and 7.8±4.5 vs. 10.8±3.4 and 3.7±2.5 min, respectively, p<0.001), the overall gastric emptying time of the half meal (52.8±13 and 24.9±5.5 vs. 42.5±10.5 min and 16.6±6 min, respectively, p<0.001) and the retained percentage of liquid meal in the stomach at 60 and 100 min postprandially (p<0.001) were significantly increased. Conclusions: The erythromycin-induced acceleration on gastric emptying of hypertonic liquids in diabetic patients is related to the plasma glucose level. The induced hyperglycemia reduces the erythromycin-induced acceleration of liquid-phase gastric emptying, decreasing the overall gastric emptying rate. In spite of the inhibitory effect of induced hyperglycemia on the gastric emptying of hypertonic liquids, erythromycin is still able to accelerate the emptying rate and could prove to be a useful prokinetic agent under hyperglycemic conditions.
Effects of Aging and Dementia on the Levels of Thiobarbituric-Acid- Reactive Products Stimulated by L-Glutamic Acid in Human Autopsy and Biopsy Brain Tissue
Authors: Krištofiková Zdena , Majer Emerich , Fales Eugen , Pěkný Ivan , Klaschka Jan
Published: April 2003

Basal and stimulated (by L-glutamic acid, GA) levels of thiobarbituric-acid-reactive products were estimated in the brain tissue (hippocampus, cortex and cerebellum) from autopsy samples of people with Alzheimer disease (AD), multi-infarct dementia (MID) and from nondemented control patients. The experiment was also performed on biopsy brain tissue (cortex) of nondemented controls. The biopsy brain tissue influenced by normal aging in vivo showed a limited susceptibility to undergo lipid peroxidation stimulated by GA in vitro in comparison with the younger tissue. A significant decrease in the ratio of stimulated to basal levels was found in the cerebellum of MID patients in comparison with nondemented controls and AD patients.
Cerebral Blood Flow in White Matter Is Correlated with Systolic Blood Pressure and EEG in Senile Dementia of the Alzheimer Type
Authors: Siennicki-Lantz Arkadiusz , Lilja Bo , Rosén Ingmar , Elmståhl Sölve
Published: April 2003

The presence and functional significance of white matter lesions in the ageing brain and in dementia as well as their relation to blood pressure are often discussed. The aim of this study was to evaluate cerebral blood flow in white matter (WMCBF) and its relation to systemic blood pressure and multichannel EEG. WMCBF was measured in 24 elderly women with senile dementia of Alzheimer’s type (SDAT, median age 85.5, range 68–93) and 20 age-matched controls (median age 86.0, range 79–93) using 99mTc-HMPAO single photon emission CT. A significant low WMCBF could be observed in all analysed regions in SDAT subjects compared to controls, with the greatest decline in the posterior region (parietotemporo-occipital area). Correlations between quantified EEG from the posterior regions and WMCBF were seen. Systolic blood pressure was significantly lower in the SDAT group and was positively correlated with WMCBF in the posterior and anterior brain regions. Whether low systemic blood pressure is the result of cerebral dysfunction is unclear.
Predictive Properties of Referral Communications for Mental Illness and Dementia in a Community
Authors: Nagaratnam Nages , Lewis-Jones Mary
Published: April 2003

As a measure of community awareness, this study examined the predictive properties of the diagnoses in referral communications for mental illness and dementia in elderly people. The patients were referred to the Aged Care Assessment Team from diversified sources over an 18-month period, the referral initiators being the general practitioner (GP), community nurse, family and others. There were 90 patients with dementia and 32 with psychiatric disorders. The referral letters were examined retrospectively as to the content and yield identifying a definite or possible diagnosis of dementia or psychiatric illness. The GP and community nurse had comparable rates of success as compared with the other two groups. The ability of the GP and other groups to diagnose functional psychiatric disorders was generally negative.
Serial Position Effects in Dementia of the Alzheimer Type
Authors: Burkart Martin , Heun Reinhard , Benkert Otto
Published: April 2003

Background: The aim of the present study was to analyse serial position effects for immediate and delayed free recall in patients with dementia of the Alzheimer type and controls. Experiment 1: 44 patients with dementia of the Alzheimer-type and 24 non-demented controls were asked for immediate and delayed free recall of 12 schematic drawings of common objects presented at the rate of 10 s/picture. Steep primacy effects were obtained at all delays in controls. By contrast, primacy effects were significantly impaired in patients with dementia at all delays of recall. Small immediate and delayed recall recency effects were found in both, patients and controls. Experiment 2: 19 patients with dementia of the Alzheimer type and 21 controls were asked for immediate and delayed free picture recall with presentation rates of 10, 5 and 1 s/picture. Again, primacy effects were significantly impaired in demented patients versus controls. With shorter presentation times, immediate recall recency effects were more pronounced than with longer presentation times, and no delayed recall recency effects were found. Conclusions: Primacy effect is impaired for immediate and delayed recall in dementia of the Alzheimer type. By contrast, immediate recall recency effect and possibly also long-term recency effect are preserved. The loss of the primacy effect contributes to the impairment of episodic memory in dementia of the Alzheimer type. Therefore further research is warranted into pharmacological and psychological interventions that might re-establish the primacy effect. Possibly, the orientation of demented patients might be improved by psychological techniques that rely on long-term recency effect.
Possible Neurophysiological Markers of Genetic Predisposition to Alzheimer’s Disease
Authors: Ponomareva N.V. , Fokin V.F. , Selesneva N.D. , Voskresenskaia N.I.
Published: April 2003

Visual-evoked potentials (VEP) to a flash were studied in the first-order relatives of patients with Alzheimer’s disease (AD) (mean age 38.2 ± 2.6 years) in comparison with the patients (mean age 61.9 ± 1.4 years) and age-matched normal controls. It was found that in the relatives of AD patients the latencies of N2, P3, N3 components were delayed compared with the age-matched normal controls. The delay in the latencies of the patients and their relatives concerned the same components but was smaller in the relatives of AD patients. The amplitude of the P2, N2 components was increased in the latter. The neurophysiological alteration in AD patients’ relatives may be considered as signs of a latent neurodegeneration in limbico-reticulo-cortical pathways, which may be connected to the pathological hyperactivity of limbico-reticulo-cortical structures.
Quantitative Electroencephalography and Regional Cerebral Blood Flow: Discriminant Analysis between Alzheimer’s Patients and Healthy Controls
Authors: Rodriguez Guido , Nobili Flavio , Rocca Grazia , de Carli Fabrizio , Gianelli Maria Vittoria , Rosadini Guido
Published: April 2003

Forty-two patients with probable Alzheimer’s disease (AD) and 18 elderly healthy controls underwent quantitative EEG (qEEG) and regional cerebral blood flow (rCBF; 133Xe clearance) examinations. Correlations were sought between relative qEEG band powers and percent rCBF values in a posterior temporoparietal region of interest in either hemisphere. Moreover, stepwise discriminant analysis was applied to study the accuracy of the two techniques in differentiating AD from healthy ageing. rCBF and qEEG were correlated with one another, especially in the right hemisphere (p values ranging from <0.001 to <0.01). Significant correlations were found between Mini Mental State Examination (MMSE) and relative power of both the 2- to 6-Hz and the 6.5- to 12-Hz bands on either side (p < 0.001), and between MMSE and left rCBF (p < 0.005), while the correlation with right rCBF was poorer (p < 0.02). The statistical procedure identified the right values of both examinations for the discriminant analysis. Sensitivity of qEEG and rCBF employed together was 88% and specificity 89%, with a total accuracy of 88.3%. The unrecognized patients (n = 5) were affected by mild AD (4 scoring 3 at the Global Deterioration Scale and 1 scoring 4). qEEG alone showed an accuracy of 77% in the whole group and of 69% in mild AD, and rCBF alone an accuracy of 75% in the whole group and of 71% in mild AD. It is concluded that qEEG and rCBF examinations employed together are accurate tools to differentiate AD from normal ageing, although a lower degree of accuracy is achieved in mildly demented patients.
Comorbidity and Drug Use in Cognitively Impaired Elderly Living in Long-Term Care
Authors: Landi Francesco , Gambassi Giovanni , Lapane Kate L. , Sgadari Antonio , Gifford David , Mor Vincent , Bernabei Roberto
Published: April 2003

Cognitive impairment is associated with an increased mortality in older people. The prevalence and impact of comorbidity on functional status and mortality of demented patients has not been fully elucidated. Using a population-based data set, we describe the prevalence of cognitive impairment, functional status, principal comorbid conditions and 1-year survival for over 300,000 patients admitted to the nursing homes in five US states. Sixty-one percent of patients have some level of cognitive impairment, and this correlates with the degree of physical frailty. Severer cognitive impairment is associated with a higher mortality rate. Yet, patients with cognitive impairment appear to have fewer comorbid conditions and are less likely to receive medications and special treatments than residents with normal cognitive status. Additional studies are needed to understand whether demented patients may paradoxically be considered healthier or, instead, are only neglected.
Procedural Memory in Recent-Onset Parkinson’s Disease
Authors: Thomas-Ollivier V. , Reymann J.M. , Le Moal S. , Schück S. , Lieury A. , Allain H.
Published: April 2003

Parkinson’s disease is accompanied by cognitive disorders which may affect procedural memory. Procedural memory uses a specific knowledge resource that expresses itself through pre-established acting procedures. The aim of this study was to better define the characteristics of procedural memory, first of all, by trying to determine the level of involvement of that memory in the acquisition process (during learning and/or during procedure maintenance), then by specifying the effect of the type of resource involved (verbal or motor). To achieve this, we compared the mnestic performances of 20 recent-onset parkinsonian patients with those of 20 healthy controls, using two memory tasks with a fixed rule (poetry, visuomotor tracking). Result analysis revealed that parkinsonian patients had more difficulty than controls in learning the two rules, regardless of the material involved. Their deficiencies were often associated with an impairment of executive functions, and the procedural memory problems described in parkinsonian patients are linked to the involvement of these resources in the various tasks.
Differential Diagnosis of Aging, Dementia of the Alzheimer Type and Depression with EEG-Segmentation
Authors: Ihl Ralf , Brinkmeyer Jürgen
Published: April 2003

EEG segmentation can be used to measure altered brain function in aging and diseases of the brain. The parameter ‘number of different segments’ makes clear how many different potential fields are involved in brain activity during a given period of time. It should represent effects of aging and disease. To prove this assumption, 11 young and 10 aged controls, 12 patients with mild dementia of the Alzheimer type (DAT), 10 young and 12 aged patients with endogenous depression were included in the study. The number of different segments in the beta frequency band between 16 and 19.75 Hz was measured according to the theory of Lehmann et al. [Clinical Neurophysiology 1987;67:271–288], and the segments were classified by their location on the scalp. The Mann-Whitney U test was used for statistical comparison. Aged controls had more different segments than young controls (n = 21, U = 14, p < 0.0038). Patients with DAT had less different segments than healthy aged controls (n = 22, U = 18.5, p < 0.0061). Aged patients with endogenous depression had more different segments than patients with mild DAT (n = 24, U = 32, p < 0.021). The reduction of the number of different segments in DAT compared to controls and patients suffering from depression may be helpful for differential diagnosis. The higher number of different segments in aged versus young controls could be interpreted as a sign of increased complexity in the aged brain.
Lymphomatosis cerebri Presenting as a Rapidly Progressive Dementia: Clinical, Neuroimaging and Pathologic Findings
Authors: Bakshi Rohit , Mazziotta John C. , Mischel Paul S. , Jahan Reza , Seligson David B. , Vinters Harry V.
Published: April 2003

Primary central nervous system lymphoma (PCNSL) usually presents with clinical and neuroimaging findings consistent with single or multiple intracranial mass lesions. On cranial magnetic resonance imaging (MRI), such lesions are nearly always contrast enhancing, reflecting disruption of the blood-brain barrier at the site of tumor nodules. We describe 2 cases from the UCLA Medical Center who developed a rapidly progressive dementia due to extensive gray and white matter cerebral lesions involving much of the brain. In the patient who came to autopsy, widely infiltrating, focally necrotic B-cell plasmacytoid lymphoma was noted throughout the cerebral neuraxis. MRI findings in case 2 were consistent with diffuse lymphomatous brain infiltration without mass lesions, which was biopsy proven. We conclude that PCNSL may occur in a diffusely infiltrating form which may occur without MRI evidence of mass lesions or blood-brain barrier compromise. We refer to this entity as ‘lymphomatosis cerebri’ and add it to the differential diagnosis of a rapidly progressive dementia.
Localization and Expression of cdc2 and cdk4 in Alzheimer Brain Tissue
Authors: Tsujioka Y. , Takahashi M. , Tsuboi Y. , Yamamoto T. , Yamada T.
Published: April 2003

Two regulators of the eukaryotic cell cycle, cell division cycle 2 (cdc2) and cyclin-dependent kinase 4 (cdk4), have been reported to be related to Alzheimer’s disease (AD) pathology, and especially to hyperphosphorylated τ protein. Using well-characterized polyclonal antibodies which recognize the C termini of cdc2 kinase and cdk4, we examined by immunohistochemistry brain tissues from patients with non-neurological conditions, AD and cerebral infarction. Semiquantitative mRNA analysis by RT-PCR was also done using non-neurological and AD brains. In AD, as previously reported, the antibody to cdc2 showed positive staining of a few intracytoplasmic neurofibrillary tangles (NFTs). In addition, this antibody gave positive immunolabelling in astrocytes and capillaries in all brains studied. In both AD and cerebral infarct cases, the staining of astrocytes was more intense than in non-neurological brain tissue. In all cases, the antibodies to cdk4 showed positive immunolabelling in the nuclei of all cell types except neurons. In AD tissue, the antibody showed additional staining of neuronal nuclei and cytoplasm. In contrast to a previous report, we did not find positive labelling of NFTs with the anti-cdk4 antibody. In infarct areas, particularly strong nuclear staining in glial cells was seen. The relative levels of cdk4 mRNA in AD brains were higher than those in controls. These data suggest that cdc2 kinase appears in glial cells capable of cell division and may play a role in the regulation of amyloid precursor protein processing and NFT formation in neurons. As suggested in a report on rat brain, neuronal expression of cdk4 may reflect some pathological process in damaged cells in AD.
Inheritance of the ApoE ε4 Allele Increases the Rate of Brain Atrophy in Dementia Patients
Authors: Wahlund Lars-Olof , Julin Per , Lannfelt Lars , Lindqvist Johan , Svensson Leif
Published: April 2003

We investigated the influence of the apolipoprotein (ApoE) ε4 allele on the rate of brain atrophy in patients with clinical dementia and in subjects at risk for dementia. Eighty-one subjects, consecutively referred to a memory clinic due to symptoms of dementia, went through a comprehensive examination, including cerebral magnetic resonance imaging. After an initial investigation these subjects were divided into one of six diagnostic groups; Alzheimer’s disease (AD, n = 23), objective cognitive impairment (OCI, n = 27), subjective cognitive impairment (SCI, n = 17), vascular dementia (VaD), frontotemporal dementia (FTD) and unspecified dementia (USD). The last three groups were joined into one diagnostic group designated ‘other dementia’ (OD, altogether n = 14). In order to study the progression of cognitive impairment as well as the rate of atrophy in different brain regions all subjects were reinvestigated after an average period of 16 monhts. Interest was focused on investigating if those subjects with one or two ε4 alleles differed in either dementia progression or rate of brain atrophy compared to those without the ε4 allele. We found that the ApoE ε4 carriers had a statistically significantly larger increase in ventricular volume as compared with the ApoE ε4 noncarriers. In all diagnostic groups the ApoE ε4 carriers showed a greater rate of ventricular volume increase, as compared to the noncarriers. However, this difference was statistically significant only for the OD subjects. No statistical significant changes over time were seen for whole brain volume or volume of the temporal lobes and the medial temporal lobes. The diagnostic groups differed in dementia progression with the AD subjects having the most pronounced reduction in MMSE scores as compared to subjects at risk for AD (OCI and SCI subjects). The presence of ApoE ε4 allele did not influence the change in MMSE in any of the diagnostic groups.
Occurrence of Delirium in Different Regional Brain Syndromes
Authors: Robertsson Barbro , Olsson Lis , Wallin Anders
Published: April 2003

Old age and organic brain disorder are major risk factors for delirium in the elderly. The localization of the brain damage in dementia may be of importance for this risk. The aim of the present study was to investigate the rate of delirium in patients with different regional brain syndromes. Included in the study were 194 demented patients. The occurrence and intensity of four regional brain syndromes were estimated: parietal lobe syndrome, frontal lobe syndrome, subcortical syndrome and global brain syndrome. The analyses showed that the rate of delirium was significantly higher when a global brain syndrome was predominant than when any one of the other syndromes predominated.
Do Delirium and Alzheimer’s Dementia Share Specific Pathogenetic Mechanisms?
Authors: Eikelenboom Piet , Hoogendijk Witte J.G.
Published: April 2003

Dementia is the most common risk factor for delirium in the elderly. Here we will review the evidence that proposed pathogenetic mechanisms for delirium (such as reduced cerebral metabolism, imbalance of the noradrenergic/cholinergic neurotransmission, inflammation, disturbances in neuronal systems which regulate stress and the sleep/wake cycle) are also a part of the pathophysiology of Alzheimer’s disease. In particular, the role of inflammatory mechanisms in both disorders will be discussed.
Clinical Profile of Delirium in Patients Treated for Femoral Neck Fractures
Authors: Edlund Agneta , Lundström Maria , Lundström Gudrun , Hedqvist Birgitta , Gustafson Yngve
Published: April 2003

The incidence of delirium, its predisposing factors, clinical profile, associated symptoms and consequences were investigated in 54 consecutive patients, 19 men and 35 women, mean age 77.1 years, admitted to an ‘ortho-geriatric unit’ with femoral neck fractures. The incidence of postoperative delirium was 15/54 (27.8%) and a logistic regression model found that dementia and a prolonged waiting time for the operation increased the risk of postoperative delirium. Delirium during the night was most common but in 5 patients the delirium was worst in the morning. Patients with delirium suffered more anxiety, depressed mood, emotionalism, delusions and hallucinations. A larger proportion of patients with delirium could not return to their previous dwelling, and a larger proportion of delirious patients were either dead, wheelchair-bound or bedridden at the 6-month follow-up (p < 0.005). The conclusion is that delirium is common and has a serious impact on the outcome after hip fracture surgery.
Cerebrometabolic Aspects of Delirium in Relationship to Dementia
Authors: Blass John P. , Gibson Gary E.
Published: April 2003

Delirium is associated with decreased cerebral metabolism and with cholinergic deficiency. These deficits also occur in Alzheimer’s disease, the most common form of dementia. The clinical, metabolic, and pharmacological similarities between delirium and dementia agree with the suggestion that delirium and dementia can both be thought of as forms of ‘cerebral insufficiency’.
Social and Environmental Contributants to Delirium in the Elderly
Authors: Eriksson Sture
Published: April 2003

Even if the mechanisms and etiology of delirium still require further clarification, this article works on the assumption that delirium is caused by stress factors acting on the brain to such an extent that the brain can no longer cope. Therefore, social and environmental factors involving high levels of stress will cause delirium in the elderly. The influence of these factors is obviously very complex with several potential interacting mechanisms between different factors. Since studies on this subject are limited to certain aspects of the complex topic discussed, only narrowly focussed systematic knowledge on this topic is available. However, it can be concluded that hospital admission for example is an important risk factor for developing delirium.
The Diagnosis of Delirium and DSM-IV
Authors: Tucker G.J.
Published: April 2003

This paper reviews the history of the development of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) using the diagnostic category of delirium as an example. It also attempts to show how clinical practice and experience has molded the current conceptualization of delirium in DSM-IV. The paper presents the process and options the DSM-IV Work Group on Organic Disorders pursued in developing the DSM-IV criteria for the diagnosis of delirium, particularly in relation to ICD-10.
Tau Immunoreactivity Detected in Human Plasma, But No Obvious Increase in Dementia
Authors: Ingelson Martin , Blomberg Mari , Benedikz Eirikur , Wahlund Lars-Olof , Karlsson Evert , Vanmechelen Eugeen , Lannfelt Lars
Published: April 2003

Tau proteins are central to the neuropathology of Alzheimer’s disease and tau levels in cerebrospinal fluid are elevated in affected individuals. In this study, we investigated the presence of tau in plasma from subjects with Alzheimer’s disease (n = 16), frontotemporal dementia (n = 10), vascular dementia (n = 16) and from healthy controls (n = 15). By using an ELISA with monoclonal tau antibodies, tau immunoreactivity was detected in approximately 20% of the subjects. However, no difference between the disease and control groups was seen. After gel filtration of tau immunopositive plasma, the peak reactivity was found in the 160-kD fraction, indicating the source to be tau-like molecules of high-molecular-weight or polymers of low-molecular-weight tau isoforms. We conclude that measurements of tau in plasma cannot be utilized diagnostically for Alzheimer’s disease or for the other dementias investigated.
Posterior Cortical Atrophy Variants of Alzheimer’s Disease
Authors: Aharon-Peretz Judith , Israel Ora , Goldsher Dorit , Peretz Aharon
Published: April 2003

Posterior cortical atrophy (PCA) was first described by Benson in 1988 and, since then, has been regarded as a variant of Alzheimer’s disease. We present 2 patients with symptoms suggestive of PCA and 2 patients with apraxia as the initial manifestation. Primary motor and sensory modalities were intact. Mild memory impairment was present early in the course of the disease and gradually worsened. Parieto-occipital atrophy was evident on brain MRI. HMPAO-SPECT demonstrated parieto-occipital hypoperfusion significantly different from the temporoparietal hypoperfusion usually described in senile dementia of the Alzheimer type. These findings suggest that HMPAO-SPECT can help in diagnosing atypical variants of Alzheimer’s disease. We suggest that PCA represents two clinically related behavioral phenotypes: PCA with predominantly apraxia manifestations and PCA with predominantly visuospatial disturbances.
Behavioral and Psychological Symptoms in Alzheimer’s Disease
Authors: Benoit M. , Dygai I. , Migneco O. , Robert P.H. , Bertogliati C. , Darcourt J. , Benoliel J. , Aubin-Brunet V. , Pringuey D.
Published: April 2003

Fundamental and therapeutic research in Alzheimer’s disease (AD) focused for a long time exclusively on cognitive aspects. However, AD also frequently involves complex disorders of affect and behavior, which are currently grouped under the heading ‘behavioral and psychological signs and symptoms of dementia’ (BPSSD). Several rating tools have been developed over the years on the basis of a variety of source data. Some are derived from psychiatric practise or have specifically been developed for dementia, such as the Neuropsychiatric Inventory (NPI). In this study we prospectively used the NPI to examine BPSSD. Sixty-three French patients (mean age 74.7 years, SD 7.9) with a Mini-Mental State Examination (MMSE) score higher than 10 were examined. BPPSD were detected by NPI in 95.2% of the patients. Anxiety was the most common abnormality (65.1%), followed by apathy and dysphoria (58.7%). The highest frequency × severity NPI score was observed for apathy. In order to identify the relationship between regional cerebral perfusion and apathy, 20 of these AD patients underwent a technetium-99m-bicisate SPECT protocol within the same week as the NPI evaluation. The mean age of this population was 74.4 years (SD 5.3) and the mean MMSE score was 21 (SD 4.1). The apathy NPI score was correlated with right cingulate deficit whereas the highest correlation for the MMSE was with the left temporoparietal area. This stresses the interest to focus on SPECT imaging of AD patients not only in the posterior areas.
A Follow-Up Study of the Family with the Swedish APP 670/671 Alzheimer’s Disease Mutation
Authors: Wahlund Lars-Olof , Basun Hans , Almkvist Ove , Julin Per , Axelman Karin , Shigeta Masahiro , Jelic Vesna , Nordberg Agneta , Lannfelt Lars
Published: April 2003

Objective: To study the progression of Alzheimer’s disease (AD) at a very early stage and to evaluate clinical markers of presymptomatic AD. Setting: Longitudinal study at a university hospital. Subjects: A Swedish family harboring a double mutation at codons 670/671 of the APP gene on chromosome 21 was followed longitudinally for 3 years. Both mutation carriers and noncarriers participated. Outcome Measurements: Results from clinical investigations, electroencephalography, neuropsychological and neuroradiological examinations including magnetic resonance imaging, single-photon emission computed tomography and positron emission tomography were assessed and compared on two or more occasions. Main Outcome: During follow-up, 1 initially asymptomatic mutation carrier who was near the expected age of onset for this family, developed cognitive symptoms, and at the end of the follow-up fulfilled the diagnostic criteria for AD. One mutation carrier with cognitive symptoms at the first examination showed clinical deterioration and was diagnosed with AD. One demented mutation carrier died and was shown to have typical AD neuropathology at autopsy. The two remaining asymptomatic mutation carriers, as well as all the noncarriers were asymptomatic. These mutation carriers who were near the expected age of onset of AD but without clinical signs of the disease, did not show changes in either electrophysiological parameters or volumes of the temporal lobes. However, in these 2 individuals the blood flow in the temporal lobe showed intermediate values between the symptomatic mutation carriers and healthy noncarriers. Two neuropsychological tests showed a deterioration that paralleled clinical symptoms in 1 of the mutation carriers who was close to the expected age of onset and who at the end of the follow-up had clinical signs of AD. In the same subject, brain glucose metabolism was pathologically reduced in the temporal lobes before other clinical symptoms were obvious. Conclusion: In this familial form of AD a reduced temporal lobe glucose metabolism was indicative of AD before the expected clinical onset. Reduced glucose metabolism even preceded the development of subjective or objective cognitive dysfunction and might therefore serve as a clinical marker for AD before the onset of clinical symptoms. Reduced cerebral blood flow in the temporal lobes and cognitive deterioration paralleled the clinical decline in the early stage of the disease.