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Long-term survival was examined for 218 patients with Alzheimer's disease (AD) and 115 patients with multi-infarct dementia (MID). The 14-year survival rate for AD was 2.4% versus an expected rate of 16.6%, and for MID 1.7% versus 13.3% expected. MID showed a more malignant natural course than AD. Men carried a less favourable survival prognosis than women, both in AD and MID: the relative risk of dying for women was half that for men in both diseases. In MID, advanced disability indicated a relative risk of dying over twice as high. In both diseases the risk of death was substantially higher in the event of occurrence of primitive reflexes.

White matter low attenuation (WMLA) on computed tomography (CT) and the central conduction time (CCT) measured by median nerve-somato-sensory evoked potentials were examined in 12 multi-infarct dementia (MID) patients, 10 patients with multiple infarcts (MI) without dementia and 11 age-matched controls. Patients with deep vascular lesions without cortical infarcts on CT were included. In MID, prolongation of CCT and moderate to severe WMLA were observed. The CCT and WMLA in MI patients were intermediate. The CCT was longer when the WMLA was more extensive. The result suggests that white matter disease in MID is concerned to the occurrence of dementia by disturbing axonal conduction.

Introduction Predictive factors for occurrence of vascular dementia may help identify patients at increased risk of developing this condition. Our purpose was to evaluate the prognostic value of early EEG findings in patients after first ischemic cerebral stroke on the development of dementia. Material and methods We performed routine EEG recordings in 199 consecutive non-demented patients with first-ever ischemic stroke, within 48 h of the event. The patients were subsequently followed for their mental state for 2 years. Survival analysis, wherein onset of dementia was the end-point, was performed on the total sample population and conducted separately on those who had normal EEG at time of the event and on those who had abnormal EEG findings (focal or diffuse slowing). Results Patients with abnormal EEG at baseline had 2.6 times the risk of developing dementia than those who had normal EEG; this odds ratio was statistical significant (CL: 1.3-5.1, p = 0.003). Development of dementia was not related to any specific EEG abnormal pattern. Conclusions Abnormal EEG performed close to the first ischemic stroke appears to be an indicator of subsequent cognitive decline, probably because it indicates cortical involvement by the stroke or an underlying indolent cerebral degeneration.

This review concerns the fundamental cerebral lesions in cases of vascular dementia. Extracerebral vascular alterations are dominated by atherosclerosis with or without thrombosis. In addition, occlusion of extracerebral arteries can be induced by thrombo-embolism and in rare cases by other vascular diseases, chiefly arteritis. Intracerebral microangiopathies are usually of arteriolosclerotic or hyalinotic types in which there is degeneration of smooth muscle cells of the media and deposition of components of extracellular matrix, chiefly collagens. Ageing, chronic hypertension, hyperlipidemias and diabetes are important factors inducing vascular lesions. The vascular lesions, often combined with systemic factors, may produce various ischemic and edematous alterations of the brain parenchyma. Occlusion and obliteration of arteries (macroangiopathy) are associated with large infarcts, whereas microangiopathy may cause lacunar infarcts and some forms of white matter degeneration. Cases of vascular dementia usually present many types of lesions in the brain parenchyma and its arterial supply. The extent and location of the injuries differ considerably from case to case. Location of the lesions, volume of destroyed tissue, multiplicity and bilateral occurrence are most important parameters underlying the clinical manifestations in vascular dementia. A strategic location of a small injury is in some cases of particular importance.

We prospectively investigated 131 consecutive cases (both in- and outpatients) of suspected dementia to evaluate the relative frequency of different types of dementia in Chinese patients. Dementia was confirmed in 110 cases (84.0%). In contrast to the Western series, vascular dementia (39.1%) was slightly more frequent than the Alzheimer's disease (36.4%). Twelve cases (10.9%) of potentially treatable dementia were found. Careful clinical observation was the most useful part of the evaluation. CT scan of brain was the most useful laboratory test.

The membrane fluidity of platelets isolated from 15 patients with probable Alzheimer's disease (AD), 11 patients with probable multi-infarct dementia (MID), and 7 neurologically healthy controls was studied by electron spin resonance (ESR) spectroscopy employing spin label techniques. Spin label I(12, 3) probed the shallow site (hydrophilic region) and spin label I(5, 10) the deeper site (hydrophobic region) of the platelet membrane. With both probes, a significant increase in membrane fluidity was observed in patients with AD and MID, as compared to age-matched controls. However, there were no significant differences in fluidity between AD and MID patients. Our results suggest an increased platelet membrane fluidity in dementias, but the change seems not to be specific to AD.

An internal capsule genu infarct has been rarely reported to cause cognitive impairment and behavioral changes. This clinical picture can be explained on anatomical and functional basis because important subcortical-cortical pathways traverse the internal capsule genu. We report 2 previously non-demented patients who developed acute confusional state, abulia, and moderate cognitive decline after the occurrence of an infarct in the capsular genu.Clinical, neuropsychological, and MRI evaluation at baseline and 12-month follow-up.Abulia and cognitive impairment were still present 1 year after stroke. In 1 patient there were associated multiple lacunar infarcts and leukoaraiosis. In the other an old small left frontal infarct was also present. In both moderate cortical atrophy co-existed.We hypothesize that co-existing lesions, possibly associated with a sub-clinical reduction of cognitive functions, facilitate the development of a persistent clinically evident mental deficit after the occurrence of an infarct in the capsular genu.

Introduction - The regulatory role of apolipoprotein E in lipid transport and metabolism was utilized to investigate the allelic association between the apolipoprotein E4 (apoE4) allele and vascular dementia (VD) in a selected sample of Hungarian patients with multiple deep subcortical infarcts and leukoaraiosis. Material and methods - Thirty-four Caucasian VD cases and 79 healthy control probands were involved in this study according to the criteria of ICD-10 and NINDS-AIREN International Workshop Diagnostic Criteria. The genomic DNA was isolated from whole blood and the apoE alleles were determined by polymerase chain reaction. Results - The E2, E3 and E4 allele frequencies in the VD group were 5%, 76%, and 19%, respectively; and significant (P

Objectives – To examine differences in cerebrovascular reactivity between multi-infarct and Alzheimer types of dementia. Patients and methods – Using transcranial Doppler, measurements of flow velocity in the middle cerebral arteries during apnea, thumb-to-finger opposition and verbal and design discrimination tasks were recorded in patients with multi-infarct (n = 10; mean age 68 + 7.5 years) and Alzheimer types of dementia (n = 10; mean age 62±9.1 years). Controls were 20 healthy subjects matched for age and sex. Results – Cerebral reactivity to apnea was significantly lower (P

Objectives - Our aim was to investigate the diagnostic impact of skin biopsies in CADASIL patients. Materials and methods - Eight consenting CADASIL patients belonging to a German-Caucasian kindred were assessed clinically, genetically, by MRI and skin biopsy. Skin biopsy results were compared to 5 patients suffering from sporadic leucoencephalopathies (control group). Results - Six CADASIL patients presented with symptoms ranging from migraine to severe tetraparesis with dementia. Two clinically unaffected patients had abnormal MRIs. On MRI 7 patients showed various degrees of leucoencephalopathy. One 22-year-old woman with migraine had a normal MRI. Granular, electron dense, osmiophilic material (GEM) was found in skin biopsies of all 8 patients including the 22-year-old woman with migraine and a normal MRI. As shown by genetic linkage analysis she was carrying the disease haplotype. GEM was not found in the control group. Conclusion - Our findings substantiate the impact of skin biopsies in defining the carrier status in CADASIL families.

The purpose of this study was to test the improved sensitivity of P3 abnormality in the detection of dementia using a variety of auditory stimuli. Improved detection was obtained using auditory stimuli that differed in their cognitive attributes and by using several P3 measures. These measures included P3 latencies and amplitudes relative to pure tone evoked P3s. Fourteen demented patients (mean age 79.2 years) and a matched normative group were tested. Abnormality of P3 latency for pure tone targets was found in ten patients, equivalent to a hit-rate of 72%. The hit-rate could be further increased by using phonemically and phonetically different types of auditory stimuli, thought to vary in their cognitive attributes. These findings underscore the importance of using a variety of stimuli in testing demented patients.

The discrepancy between current and premorbid ability is a relevant indicator of acquired mental impairment, which itself is closely related to general cerebral dysfunction. The use of tests sensitive to cerebral dysfunction, raises relatively few problems compared with tests being resistant that are used to estimate premorbid mental ability. For premorbid ability, verbal tests assessing knowledge, especially vocabulary, have been shown to be valid. A test, possibly more insensitive to brain dysfunction than the ones usually administered, is the multiple choice vocabulary test (MWT = Mehrfachwahl-Wortschatz-Test). At present only German versions are available. They are presented in some detail because of their advantages. Construction of the MWT is simple, and it can be easily administered in about five minutes. The results correlate fairly well with global IQ in healthy adults (median of r = 0.72 in 22 samples) and are more insensitive to current disturbances than such tests as the WAIS vocabulary test. The limitations of premorbid tests with respect to diagnostic validity are discussed. It is concluded, that studies which do not control premorbid intelligence have to be considered as a "malpractice" and should not be accepted by scientists.

Introduction – Delusions occur frequently during the course of Alzheimer's disease (AD) and multi-infarct dementia (MID). Their clinical significance and their relationship with progression of disease and involvement of selected cerebral areas are still unclear. The aim of the study was to determine the clinical and CT correlates of delusions in patients with dementia. Material and methods – A series of 67 probable AD and 32 MID patients, underwent computed tomographic scans, psychometric tests, neurologic and psychiatric examination, and blood and serum tests. Results – Twenty-four patients were found to have delusions during the clinical evaluation. Delusional patients showed a significantly higher age when compared with non-delusional patients. The results of a multiple logistic regression (with stepwise deletion of the redundant variables) of the CT lesions on the presence of delusions, showed that only the presence of isolated white matter lesions in the frontal lobes were significantly related to the occurrence of delusions (Exp B = 3.42; Beta = 1.2; S.E. = 0.6; Sig T = 0.04). Frontal white matter changes were significantly related to delusions when a multiple regression analysis, entering age and total number of lesions at CT scans, was carried out. Conclusions – We found that focal lesions in the frontal areas were the only variable that appeared to be significantly and independently associated with delusional disorders.

Introduction - Despite the current interest in criteria for vascular dementia, global, as opposed to focal, cognitive change after cerebral infarction has rarely been studied. Material and methods - We documented the neuropsychological changes one to three weeks and three months post infarct in 25 unselected patients with acute, first cerebral infarcts. Results Improvements were seen in processes thought to have a large subcortical component and in those mediated in the right hemisphere. Memory was relatively lightly affected. Conclusion - The minimal deficits seen in memory and the predominance of subcortical changes are at variance with the currently suggested criteria for vascular dementia. Further data of this kind are needed before firm criteria can be proposed for the global pattern of cognitive changes expected in vascular dementia.

Bromocriptine stimulates growth hormone (GH) secretion at the hypothalamus and suppresses prolactin (PRL) secretion at the pituitary level. We administered bromocriptine to 30 patients with dementia of the Alzheimer type (DAT), 30 patients with multi-infarct dementia (MID) and 22 age matched healthy controls, and compared response patterns of GH and PRL. Incomplete PRL suppressive responses (suppression rate < 50%) were seen in 36.7% of DAT patients and in 30.0% of MID patients, indicating that both groups had the same degree of pituitary dysfunctions. Blunted GH responses (< 5 ng/ml) were seen in 93.3% of DAT patients, in 63.3% of MID patients and in 31.8% of the controls. The results indicate that neuroendocrine regulation of GH is more selectively and severely damaged in DAT patients than in MID patients at the hypothalamus.

Neuropsychiatric symptoms such as delusions and misidentifications have been reported in dementia ranging from 10% to 73% in Alzheimer's disease (AD) patients and up to 40% in multi-infarct dementia (MID) patients. The aim of this study was to investigate in 61 AD and 31 MID patients both the frequency and the content of delusions during the course of illness and to evaluate the relationship between these and both functional and mental decline. The results indicated that delusion experiences had occurred in 45% of AD patients and in 38% of MID patients, occurring most frequently during the first year of illness. Patients who experienced psychiatric symptoms showed higher mini mental state examination scores and were less impaired in functional disability measures. With regard to the content, no significant differences were observed between AD and MID patients; 53% of psychotic symptoms were found to be paranoid delusions while 47% were misidentification delusions.

Twenty-five patients with various types of gait disorders of multi-infarct dementia (MID) were reported. The types of gait disorders consisted of lower body parkinsonism (LBP) plus ataxia (6 patients), LBP plus apraxia (5 patients), and a combination of LBP plus ataxia and apraxia (14 patients). Hypertension occurred in 23 (92%) of the 25 patients. Nevertheless, individual stroke risk factors and the locations of infarcts were not significantly different between the subgroups. Ventriculomegaly and "leuko-araiosis" as demonstrated by computed tomography occurred in more than 80% of patients in each subgroup. Atrophy of the superior vermis was seen in 16 (80%) of 20 patients with ataxia as compared to 2 (40%) of the 5 patients without ataxia (p < 0.005). These data suggest that LBP and apraxia of MID were probably determined by the presence of ventriculomegaly or leuko-araiosis or both, and the presence of ataxic component of gait disorder most probably indicates the presence of vermian atrophy.

A multicentre, double-blind, between-patient study was carried out to evaluate the efficacy and tolerability of oxiracetam (800 mg tablet), in comparison with placebo, each given twice daily for 12 weeks to patients suffering from primary degenerative, multi-infarct or mixed dementia. Efficacy was assessed by a neuropsychological battery (simple reaction time, controlled associations, short story, Raven's Progressive Matrices, token test, digit span, word list learning), administered at the beginning and at the end of the study, and by a quality of life scale, administered at entry and after 6 and 12 weeks treatment. Sixty-five patients (28 men, 37 women, mean age 71 yrs) were enrolled; 58 completed the study: 2 on oxiracetam were withdrawn because of poor tolerability, 2 (one in each group) were withdrawn for poor compliance, one (on oxiracetam) for the occurrence of a transient ischaemic attack (defined as not related to the treatment) and 2 for administrative reasons. A significantly (p < 0.01) different effect in favour of oxiracetam was observed on the quality of life scale, and confirmed by significant (defined according to the Bonferroni technique) differences in some neuropsychological tests (e.g. controlled associations, short story). Four patients in the oxiracetam group complained of a total of 5 unwanted effects, and 1 on placebo complained of 3 unwanted effects, but none of them was withdrawn from the study.

A battery of neuropsychological tests was examined to establish its value in differentiating mild dementia from depression. The battery was applied to 84 subjects: 31 dementia patients of several etiologies, 31 patients with major depression and 22 volunteers whose age and educational level was similar to that of the patients. The battery consisted of tests for immediate, recent and remote memory, the Mini Mental State examination, a screening test for language disorders, and tests measuring abstraction, calculation, judgement, praxic and gnosic functions. The results showed significant differences among the three groups in all memory tests. Deficits of abstraction, calculation, praxis and language functions were strongly associated with dementia. The epidemiological analysis of efficiency increment, with determination of sensitivity and specificity, showed a highly significant enhancement of efficiency for diagnostic purposes when the results of the tests were combined. These findings suggest that the entire battery of neuropsychological tests should be applied, and their results compared using the efficiency increment procedure, in order to establish a firm differential diagnosis between dementia and depression, and/or to detect the former when it is at a mild early stage.

CT Scan of 30 patients with multi-infarct dementia (MID) were compared with age- and sex-matched controls. Infarcts were seen in 93% of MID cases and 10% of controls. A marked difference in the occurrence of white matter low attenuation was seen between the groups. All the parameters of cerebral atrophy studied showed a statistically significant correlation with the presence of dementia.