relative cerebral perfusion in relation to anosognosia in alzheimer's disease
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S22 THIRD INTERNATIONAL CONFERENCE ON ALZHEIMER’S DISEASE
we will focus on SPECT findings in 40 patients who underwent two or more examinations during a b-14 months clinical, psychometric, and instrumental follow-up study. With regard to the relationship between worsening of psychometric and cerebral perfusion indexes, we found that in about 50% of the oatients SPECT imaoes clearlv showed more severe A---- a
rCBF alterations at the follow-up study, with respect to baseline evaluation, despite very slow progression of the disease as detected by the Mini- Mental State (MMS) score (no or one-point change during the evaluation period). This “as the more frequent finding in the group of less severely affected patients at entry into the study (MMS score above 18). On the other side, the group of patients “ho showed a clear deterioration of cognitive performances (4 to 5 points decrease at the MMS score), this was accompanied by a clear progression of SPECT defects. This observation of concomitant SPECT and psychometric deterioration in the follow- up study was the common finding in patients with moderate to severe dementia at entry. Our results suggest that SPECT imaging is, because of its sensitivity, of clinical value in evaluating the progression of the disease, particularly in the early stages of AD. This finding could be of relevance when studies are planned to evaluate the efficacy of possible therapeutic approches to AD.
91 RELATIVE CEREBRAL PERFUSION IN RELATION To ANOSOGNOSIA IN ALZHEIMER’S DISEASE B.R. Reed, W.J. Jagust, L. Coulter. Department of Neurology, University of California, Davis and Lawrence Berkeley Laboratory, Berkeley, CA USA
‘Ike determinants of anosognosia in dementia have been little imestigated, and are not known. In this study we raied awareness of memory loss in patients with Alzheimer’s disease (AD), and analyzed these ratings in relation to relative regional cerebral blood flow (ICBF) as measured by Single photon Emission Computed Tomography (SPECT).
Subjects were. 20 patients meeting NINCDS criteria for probable or possible Alzheimer’s disease. We used a four point rating scaleto measure awareness of memory loss: Full awareness (read) admission of significant memory loss), Shallow awareness (inconsistent awareness or recognition of trivial losses only), None (bland denial of loss), Denies awareness (denial of loss with anger or hostility at the inquiry).
studies of relative rCBF were mad’ using tbe tracer N-isopropyl .p iodoamphetamine (IMP). Patients wen’ studied with eyes open and ears unoccluded using a multidetector scanner (resolution 14mm) ten mirutes after injection of a 5 mCi bolus of IMP. Two tomographic levels, corresponding to 7 (OM+7) and 5 cm (0X4+5) above and parallel to fhe orbitomeatal line were studied. Regions of interest (ROI’s) were dmwn separately for each hemisphere in superior (dorsolate.raI) frontal cortex. inferior (orbital) frontal cortex, parietal cortex, temporal cortex, and occipital cortex and activity densities (c umts/mm3) were. calculated for these regions. Data were analyzed in the form 0: ROI ratios, consisting of the activity density in a specific ROI divided by the achvity density in the mean of all occipital cortex.
Awareness ratings were distributed as follows; 6 Full awareness, 10 Shallow Awareness, and 4 No Awareness. Group differences on the 8 rCBF regional ratios were tested using one-way ANOVAs. Groups differed on the ratio for right superior frontal perfusion only (F(2,16) = 5.9, p < .025). Post hoc tests showed that perfusion ratios values were higher for Full (M = 1.08, m = .13) than for Shallow a = .87, SQ = .17) and None @d = .79, Sp = lo), which did not differ from each other. A repeated measures ANOVA using
three within subjects factors (left/right. dnterior/posterior, OM+5/OM+7) examined whether the groups differed I tn hemispheric ICBF or on bilateral frontal or bilateral temporoparietal fl)F. No main effect, or two wq or three way interaction was significant.
These data suggest that in Alzbeimer’s disease diminished relative right superior frontal lobe perfusion is associated with anosognosia. This is consistent with the suggestion that anosognosia (and poor metamemory) in amnesia may result from the combination of amnesia and frontal loh: dysfunction, and may represent one factor in the determination of inpaired awareness in AD.
92 PATTERNS OF MAGNETIC RESONANCE AND SPECT IMAGINGS IN ALZHEIMER’S DISEASE AND VASCULAR DEMENTIA.5
Scarpino 0, ‘Ascoli G, Del Gobbo M, ‘Fornarelli D, Guidi M, ‘Lanza R, Maidani M, “Manta A, “Rossi R, Paciaruni L, *Salvolini U.
Centro di Neumlogia e “Servizio di Radiologia, INRCA - Ancona, *Servizio di Neuroradiologia, Ospedale Generale - Ancona - Italia
The aim of this study was to find out possible correlation between functional and anatomical imaging techniques and clinical investigations in subjects with dementia of Alzheimer’s type and with vascular dementia. Forty consecutive patients affected by dementia of Alzheimer’s type (DAT), multi-infarct dementia (MID) and Binswanger’s disease underwent neuropsychological, MR and SPECT investigations.The clinical diagnosis was based on medical history, Hachinski Ischemia Scale Score and according to DSM-III R and NINCDS-ADRDA criteria. Mini Mental State examination and a complex test battery (memory, attention, temporal orientation, abstract/conceptual reasoning, language, gnosic and praxic abilities) were performed to evaluate the characteristics of cognitive impairment. The severity of hypoperfusion revealed by SPECT investigation was saictly correlated with cognitive impairment in demented of Alzheimer’s type. The abnormal perfusion was mostly located in these patients in the temporal-ptietal area bilaterally and only in the severe cases the alterations involved the frontal regions. In vascular demented patients hypoperfused regions revealed by SPECT were related to vascular lesions showed by MR imagings. The data from MRI in DAT patients did not follow the mental deterioration, sometimes providing evidence of typical vascular lesions, not normally expected in a degenerative disorder. This last rises a question about the possible role of vascular factors (amyloid angiopathy) in concurring with primary degeneration to produce the different clinical manifestations of DAT. As neuro-pathological data taken from cerebral biopsy are rarely available, the integration of multiple clinical and instrumental testing is hoped for diagnostic and pathogenetic insights of diseases producing cognitive impairment.
93 SLOWLY PROGRESSIVE APHASIA WITHOUT DEMENTIA:
DIFFERENTIATION FROM ALZHEIMER’S DISEASE BY MEANS OF MAGNETIC RESONANCE IMAGING.
M. De Boer, E.Ch. Walters, Ph. Scheltens. ??Dept. of Neurology, Free University Hospital, PO Box 7057, 1007 MB
Amsterdam. The Netherlands.
Slowly progressive aphasia may be the presenting symptom of several degenerative cerebral disorders, of which Alzheimer’s disease (AD), Pick’s disease and Slowly Progressive Aphasia without Dementia (SPAWD) are the most important. When aphasia is the first symptom of AD other symptoms of dementia will follow shortly after. Furthermore, the presence of aphasia in AD is associated with a rapidly progressive course. SPAWD, on the other hand. is a relative benign disorder. When faced with a patient with isolated aphasia, not resulting from cerebral infarction, it is prognosticaly important to know whether AD will develop.
Recently, atrophy of the medial temporal lobes including the hippocampus on MRI has been shown to be a sensitive diagnostic marker for AD (I). We investigated whether the presence or absence of such atrophy could help in establishing or ruling out the diagnosis AD in patients presenting with isolated aphasia.
Two right handed men aged 63 and 80 years were examined because Of a gradually progressive aphasia, existing more than two years. The former suffered from Wernicke aphasia, the latter from anemia. Results of non-verbal neuropsychological tests were reported as normal. TcHMPAO SPECT of the brain showed hypoperfusion of the left hemisphere in the older patient and mild bi-temporal hypoperfusion in the youngest, both compatible with AD.
However, on coronal TI weighted MR images, severe atrophy of the superior temporal lobes was seen, more pronounced on Ihe left side than on the right side, while both medial temporal lobes, the parahippocampal gyri and the hippocampus appeared normal. Based on these observations AD was considered less likely. A two year follow up has shown progression of aphasia in both patients, without development of dementia.
It is concluded that absence of medial temporal lobe and hippocampal atrophy on MR imaging in patients presenting with aphasia might reduce the probability of subsequent development of AD.
94 CORTICOBASAL GANGLIONIC DEGENERATION: A CASE WITH PERFUSION AND D&RECEPTOR SPECT STUDY. GB Frisoni, A Biancheni. G Pizzolato*. G Ferlin**. L Battistin*, M Trabucchi. AlT.heimer’s Disease Care Unit. 1st. S. Cuore-FBF, Brescia, Italy. * Clin Neural. Univ Padova, Italy. ** Serv Med Nucl, Osp Castelfranco Veneto, Padova, Italy. The case is described of a patient wilb clinically diagnosed corlicobasal ganglionic degeneration, a complex degenerative disease of the strialonigral structures insensitive to L-DOPA replacement therapy!. The first symptoms in Lhis patients appeared at a very early age (43 years) with left limh apraxia, rigidity and tremor, frontal reflexes, hyperreflexia with Babinski sign, facial apraxia, disarihria, and frontality on neuropsychological tesls. Diagnosis was