Alzheimer's Disease with Markedly Elevated Arsenic and Other Metals Masquerading as Organic Brain Syndrome and Affective Disorder

SynopsisAn attempt was made to assess in detail subjects screened as suffering from dementia among a North London community sample of elderly people. Forty-eight (80 %) subjects were interviewed, 7 (12%) were found to have died and 5 (8%) either refused interview or were lost to follow-up. By clinicians' diagnosis of the 48 interviewed, 22 subjects (46%) had probable Alzheimer's disease, one had multi-infarct dementia, five had mixed dementia, five had secondary dementia, 10 had a dementia which could not be further classified and 5 were not demented. No subject had a reversible condition. The prevalence rate for clinical dementia was 6·1 %, and for Alzheimer's disease 3·1 %. According to AGECAT diagnosis the prevalence of organicity was 5·7%. The AGECAT diagnoses and psychiatrists' diagnoses were significantly associated (P < 0·003) and AGECAT was more likely to identify as organic those subjects with dementia diagnosed by psychiatrists as Alzheimer's disease, than those not so diagnosed (P < 0·04). A short psychometric battery, including the MMSE in two versions, was administered and its acceptability to a community sample evaluated. This detailed clinical investigation showed that the Dementia Diagnostic Scale of the Short-CARE was a specific predictor of clinical dementia or death at the time of follow-up, whereas the more inclusive Organic Brain Syndrome scale was a more satisfactory first phase screening instrument.

Download Full-text

Enhanced Auditory Steady-State Response Using an Optimized Chirp Stimulus-Evoked Paradigm

Sensors ◽

10.3390/s19030748 ◽

2019 ◽

Vol 19 (3) ◽

pp. 748

Author(s):

Xiaoya Liu ◽

Shuang Liu ◽

Dongyue Guo ◽

Yue Sheng ◽

Yufeng Ke ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Clinical Practice ◽

Steady State ◽

Affective Disorder ◽

Healthy Subjects ◽

Signal To Noise Ratio ◽

Mental Diseases ◽

40 Hz

Objectives: It has been reported recently that gamma measures of the electroencephalogram (EEG) might provide information about the candidate biomarker of mental diseases like schizophrenia, Alzheimer’s disease, affective disorder and so on, but as we know it is a difficult issue to induce visual and tactile evoked responses at high frequencies. Although a high-frequency response evoked by auditory senses is achievable, the quality of the recording response is not ideal, such as relatively low signal-to-noise ratio (SNR). Recently, auditory steady-state responses (ASSRs) play an essential role in the field of basic auditory studies and clinical uses. However, how to improve the quality of ASSRs is still a challenge which researchers have been working on. This study aims at designing a more comfortable and suitable evoked paradigm and then enhancing the quality of the ASSRs in healthy subjects so as to further apply it in clinical practice. Methods: Chirp and click stimuli with 40 Hz and 60 Hz were employed to evoke the gamma-ASSR respectively, and the sound adjusted to 45 dB sound pressure level (SPL). Twenty healthy subjects with normal-hearing participated, and 64-channel EEGs were simultaneously recorded during the experiment. Event-related spectral perturbation (ERSP) and SNR of the ASSRs were measured and analyzed to verify the feasibility and adaptability of the proposed evoked paradigm. Results: The results showed that the evoked paradigm proposed in this study could enhance ASSRs with strong feasibility and adaptability. 1) ASSR waves in time domain indicated that 40 Hz stimuli could significantly induce larger peak-to-peak values of ASSRs compared to 60 Hz stimuli (p < 0.01**); ERSP showed that obvious ASSRs were obtained at each lead for both 40 Hz and 60 Hz, as well as the click and chirp stimuli. 2) The SNR of the ASSRs were –3.23 ± 1.68, –2.44 ± 2.90, –4.66 ± 2.09, and –3.53 ± 3.49 respectively for 40 Hz click, 40 Hz chirp, 60 Hz click and 60 Hz chirp, indicating the chirp stimuli could induce significantly better ASSR than the click, and 40 Hz ASSRs had the higher SNR than 60 Hz (p < 0.01**). Limitation: In this study, sample size was small and the age span was not large enough. Conclusions: This study verified the feasibility and adaptability of the proposed evoked paradigm to improve the quality of the gamma-ASSR, which is significant in clinical application. The results suggested that 40 Hz ASSR evoked by chirp stimuli had the best performance and was expected to be used in clinical practice, especially in the field of mental diseases such as schizophrenia, Alzheimer’s disease, and affective disorder.

Download Full-text

The Function of the Hypothalamic–Pituitary–Adrenal Axis in Alzheimer's Disease

The British Journal of Psychiatry ◽

10.1192/bjp.165.5.650 ◽

1994 ◽

Vol 165 (5) ◽

pp. 650-657 ◽

Cited By ~ 14

Author(s):

John T. O'Brien ◽

Isaac Schweitzer ◽

David Ames ◽

Maree Mastwyk ◽

Peter Colman

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Hpa Axis ◽

Cell Loss ◽

Time To Peak ◽

Show Evidence ◽

Organic Brain ◽

Suppression Test ◽

Dexamethasone Suppression ◽

Normal Controls

BackgroundTo investigate an association between HPA axis dysfunction, depression and cognitive impairment, we assessed subjects with mild Alzheimer's disease (AD).MethodSixteen non-depressed subjects with AD according to NINCDS/ADRDA criteria and 18 normal controls underwent the insulin hypoglycaemia (IH) test and the dexamethasone suppression test (DST).ResultsThe AD subjects showed a blunted response of adrenocorticotrophic hormone (ACTH) to IH compared with controls (P = 0.019). ACTH response (area under curve) correlated with a score for cognitive ability (CAMCOG) (r = 0.64, P < 0.01). AD subjects had a shorter time to peak cortisol level than controls (P = 0.004), although total cortisol response was normal.ConclusionsThe AD subjects show evidence of adrenal hyper-responsiveness and normal immediate (rate-sensitive) glucocorticoid feedback. An association between HPA axis dysfunction and organic brain pathology in AD subjects may be mediated by cell loss in the hippocampus.

Download Full-text

Diagnostic Criteria Used in St. Louis to Determine Four Major Groups

The Final Months ◽

10.1093/med-psych/9780195029116.003.0002 ◽

1981 ◽

pp. 7-16

Author(s):

Eli Robins

Keyword(s):

Affective Disorder ◽

Diagnostic Criteria ◽

Drug Dependence ◽

Organic Brain Syndrome ◽

Organic Brain

This chapter outlines the diagnostic criteria used in this study of 134 suicides, including affective disorder, alcoholism, organic brain syndrome, schizophrenia, and drug dependence, as well as the prevalence of each of these conditions in the sample. It also explores the sex and race demographics of the sample.

Download Full-text

Potentially modifiable factors associated with agitation and aggression in Alzheimer’s disease: results of the ICTUS study

International Psychogeriatrics ◽

10.1017/s1041610218001990 ◽

2019 ◽

Vol 31 (10) ◽

pp. 1509-1516 ◽

Cited By ~ 2

Author(s):

Adelaide de Mauleon ◽

Maria Soto ◽

Pierre Jean Ousset ◽

Fati Nourhashemi ◽

Benoit Lepage ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Affective Disorder ◽

Positive Impact ◽

Neuropsychiatric Symptoms ◽

Cognitive Status ◽

Community Dwelling ◽

Factors Associated ◽

Modifiable Factors ◽

The Impact

ABSTRACTObjectives:To study potentially modifiable factors associated with the severity of agitation or aggression (A/A) symptoms among Alzheimer’s disease (AD) patients.Design:Data from the Impact of Cholinergic Treatment Use (ICTUS) study, European longitudinal prospective observational study.Setting:Community dwelling outpatients included in 29 European memory clinics.Participants:1375 participants with probable AD (Mini-Mental State Examination score of 10–26) with an informal caregiver.Measurements:At baseline and twice yearly over the two-year follow-up, patients underwent comprehensive clinical and neuropsychological assessments: sociodemographic data, cognitive status, functional impairment, and assessment of neuropsychiatric symptoms based on Neuro-Psychiatric Inventory (NPI). The ZARIT scale assessed the caregiver’s burden. The variable of interest was the severity of the item of A/A of the NPI. To study factors associated to the severity of A/A symptoms six months later, a multivariate mixed regression model was used.Results:Frequency of A/A symptom varied from 30% to 34% at each visit. Two factors were found to be independently associated with the severity of A/A: (1) the presence of affective disorder (anxiety, depression, and/or irritability) that increased the severity of the A/A by 0.89 point (coefficient:0.89; 95% Confidence Interval (CI) = [0.48,1.30], p < 0.001), and (2) a severe caregiver burden that increased the severity of the A/A by 1.08 point (coefficient:1.08; 95% CI = [0.69,1.47], p < 0.001).Conclusion:Research should evaluate whether the identification and treatment of an affective disorder along with the evaluation and optimal management of the caregiver would have a positive impact on the course of A/A in mild to moderate AD patients.

Download Full-text

Commentary: Insulin Resistance as a Link Between Affective Disorder and Alzheimer's Disease: A Hypothesis in Need of Further Refinement

The Journals of Gerontology Series A ◽

10.1093/gerona/59.2.m185 ◽

2004 ◽

Vol 59 (2) ◽

pp. M185-M187

Author(s):

C. G. Lyketsos ◽

H. Lee

Keyword(s):

Alzheimer’S Disease ◽

Insulin Resistance ◽

Alzheimer's Disease ◽

Affective Disorder

Download Full-text

Diagnosing Alzheimer’s disease in Kraepelin’s clinic, 1909–1912

History of the Human Sciences ◽

10.1177/0952695118758879 ◽

2018 ◽

Vol 31 (2) ◽

pp. 42-64 ◽

Cited By ~ 3

Author(s):

Lara Keuck

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Senile Dementia ◽

Theory And Practice ◽

Brain Diseases ◽

Psychiatric Clinic ◽

Aged Patients ◽

History Of ◽

Organic Brain ◽

Histopathological Investigation

Existing accounts of the early history of Alzheimer’s disease have focused on Alois Alzheimer’s (1864–1915) publications of two ‘peculiar cases’ of middle-aged patients who showed symptoms associated with senile dementia, and Emil Kraepelin’s (1856–1926) discussion of these and a few other cases under the newly introduced name of ‘Alzheimer’s disease’ in his Textbook of Psychiatry. This article questions the underpinnings of these accounts that rely mainly on publications and describe ‘presenility’ as a defining characteristic of the disease. Drawing on archival research in the Munich psychiatric clinic, in which Alzheimer and Kraepelin practised, this article looks at the use of the category as a diagnostic label in practice. It argues that the first cases only got their exemplary status as key referents of Alzheimer’s disease in later readings of the original publications. In the 1900s, the published cases rather functioned as material to think about the limits of the category of senile dementia. The examination of paper technologies in the Munich psychiatric clinic reveals that the use of the clinical diagnosis of Alzheimer’s disease was not limited to patients of a certain age and did not exclude ‘senile’ cases. Moreover, the archival records reflect that many diagnoses of Alzheimer’s disease were noted in the medical records as suspicions rather than conclusions. Against this background, the article argues that in theory and practice, Alzheimer’s disease was not treated as a well-defined disease entity in the Munich clinic, but as an exploratory category for the clinical and histopathological investigation of varieties of organic brain diseases.

Download Full-text