Clinical Neuroscience

[Dementia and related problems '93. an overview]

TARISKA Péter1

MARCH 20, 1994

Clinical Neuroscience - 1994;47(03-04)

[Based on extensive investigations carried out the epidemiology of dementias in the last decade in Europe the methodology has become unified. The most important elements are: two-step screening in two time periods, population of 4000 or more, unified screening and diagnostic methods. The incidence was 1 p.c. established in the population between the ages of 60–64; the proportion nearly doubled in each 5 year period. Regarding the recently published risk factors of Alzheimer's disease (AD) the possible protective role of smoking and the low educational level seem to be very interesting. In the group of AAMI the biological life events as possible causative factors seem to be of importance. The functional assesment scale of Reisberg is reported from psychometric tests. An outline is given about the clinical diagnostic criteria of AD and vascular dementias based on the widely discussed system published on the latter in 1993. The problems of different clinical subtypes of AD with relevance to biochemical markers are discussed as are the diganostic criteria of Lewy body type dementia. A summary on some new etological results (genetic heterogenety, new possible ways of amyloidogenesis, glutamate-theory, etc.) is given. After highlihgting the importance of the different kinds of psychotherapy and mental training, social factors are stressed, and some ethical conflict situations (driving, coercive measures, etc.) are shortly presented.]

AFFILIATIONS

  1. Országos Pszichiátriai és Neurológiai Intézet Memória Klinikája

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Clinical Neuroscience

[Young neurologists XI. forum]

[Correlation between carotid artery lesions and cerebral perfusion (Carotid Duplex scan and brain SPECT). Stenosis or dissection? Differential diagnostic issues in carotid circulation disorders. AVM diagnosed by 3D TCD. Possible diagnostic errors in supraaortic duplex UH scans and angiography. Causes of diagnostic errors in duplex ultrasound studies of the carotid arteries and ways to avoid them. The role of duplex ultrasonography in the surgical evaluation of common carotid artery occlusion (case report). Follow-up of Moyamoya disease with transcranial Doppler (TCD). Platelet function tests in the acute and chronic phase of cerebral circulatory disease. Multicausal cerebral circulatory disorders. Co-occurrence of parkinsonism and giant aneurysm (case report). Teratoma adultum, germinoma, spinal and cerebral metastases in the background of intermittent headache - 5-year patient follow-up Differential diagnosis of meningeal tumours. Extracranial tumours presenting with symptoms of brain metastasis. Pitfalls in the diagnosis of craniocervical transitional and high cervical space occupying processes. Diagnosis of benign spinal tumours. Spinal dermoid cyst - data on the aetiology of low back pain syndrome. Experimental and clinical potential of brain microdialysis. Treatment of multiple intracranial tumours. Tremor and reflex tests in Parkinson's disease. HMPAO SPECT studies in Parkinson's disease. Aurorix treatment in cases of Parkinson's syndrome complicated with depression. Drug therapy of Parkinson's syndrome with special reference to diurnal performance fluctuations. Jumex in the early phase of Parkinson's syndrome. Conductive education in parkinsonism. Use of biophysical methods in the study of the pathomechanism of neurological diseases. Large blind spot syndrome. Investigation of optokinetic nystagmus in solitary frontal laesio. Hypocalcaemia and epilepsy. Difficulties in the recognition of epileptic seizures. Hypnosis treatment in partial epilepsy. Migraine, depression, anxiety. Verbalization features of headaches. Fahr's disease in our class material. CT scanning of cerebral vascular lesions and differential diagnostic difficulties. Binswanger's disease. CT lesions in patients with psychopathological symptoms. The importance of 3D MR angiography in occlusive cerebral vascular disease. Comparative study of cervical large vessel imaging. Difficulties in the diagnosis of craniocervical transition in a case report. Differential diagnosis of spinal cord disease. History and epidemiology of Parkinson's disease. Recent data on the pathomechanism of parkinsonism; experimental therapies Diagnostic errors in Parkinson's syndrome. Sinemet CR - advances in drug therapy. Oxidant phenotype studies in Parkinson's syndrome patients. Madopar-HBS treatment of patients with Parkinson's syndrome. Co-occurrence of complicated migraine and idiopathic cerebral atrophy. Family study in adreno-leuko-dystrophy. Electrophysiological study of patients with anaemia perniciosa. Cartilage drift into the sacral dura sac. Results of electrophysiological studies in patients with Parkinson's syndrome. EMG-SCAN studies in patients with Parkinson's syndrome. A case of adult myotubular myopathy in our department. Advanced picture of Kugelberg-Welander syndrome. Immunological study of idiopathic inflammatory myopathies. Recessive generalized myotonia (Becker). Differential diagnosis of myotonia in a case report. Glossopharyngeal neuralgia with syncope. Familial occurrence of multisystemic atrophy. Apert syndrome in the light of modern diagnostics. Infant with Reit syndrome (video case presentation). Juvenile cardiogenic stroke. Sneddon syndrome. Cerebrovascular patients in our department in the first half of 1993. Cerebellar haemorrhages. Changes in the assessment of prognosis in the patient population of our department. A case of medial thalamic atrophy thought to be multiple sclerosis. Extrapyramidal damage caused by stroke. Cases of bilateral occipital lobular atrophy. Case of severe brainstem lesion (central pontine myelinolysis). Long-term follow-up of the cellular and humoral immune response in patients with multiple sclerosis. Current problems of Lyme borreliosis in our departmental practice. Listeria monocytogenes as a possible causative agent of purulent meningitis. Incidence of lower limb root pains causing diagnostic difficulty in our department. Peripheral neuropathy in hypereosinophilic syndrome. Eye movement disorders caused by brain stem diseases. Depression in patients with Parkinson's syndrome, with particular reference to the possibility of presuicidal syndrome (RINGEL).]

Clinical Neuroscience

[The history of Hungarian neurology (Part I)]

BEKÉNY György

[Every nation has its great people of whom it is proud. In our country, intellectuals think that Hungarians are particularly talented in music and mathematics. However, our outstanding geneticist believes that the genetic background of different abilities is equal between nations and that the different results are caused by external circumstances. Indeed, the "accumulation" of great Hungarian conductors and musicians in the United States, and the careers of many Nobel Prize-winning mathematicians and physicists in the United States, were made possible by the fact that they had to leave their homeland for political reasons. Contrary to what is suggested above, the first 50 years of a very successful and internationally respected period of Hungarian neuroscience were hampered by these circumstances. All the more reason to appreciate the neurological output of this period. I would be glad if the readers of this work would share this opinion. I have selected those publications for illustration which appeared in the so-called 'world languages'. The only exceptions are monographs, theses and one or two major works, some of which have already been published in a foreign language. Due to the limitations of space, many areas of neuroscience could not be discussed. Thus, I have not been able to write about international greats in neuroanatomy such as Mihály Lenhossék, Apáthy, Szentágothai; about neurophysiologists, especially those working on the cochleovestibular system such as Hőgyes, Bárány, Békésy; about neuroendocrinology or about many details of neurochemistry. The importance of neurosurgery, which is closely related to our subject, calls for a separate presentation. A small monograph on the history of Hungarian neuroscience was published in 1976 by István Környey, a great teacher and scholar of Hungarian neurology. In 1992, Zoltán Nagy published a history of Hungarian neurology in the last century under the title Hungarian Neurology in The Last Century. These historical summaries were important precursors to my present work. ]

Clinical Neuroscience

[Voltage mapping studies of generalized spike- wave patterns associated with absence seizures]

CLEMENS Béla

[In this retrospective study, scalp electric fields of ictal generalized spike-wave discharges were analized by the so-called topographic voltage mapping method. The 17 patients displaying absences (with or without other seizures) belonged to different age groups and diverse epileptic syndromes. Main results: 1. Maps derived at the points of the spike and the wave components belong to different classes. A-type spikes show frontal, P-type spikes show posterior voltage maxima. Also atypical spike (map) configurations exist. 2. A spike maps frequently show a characteristic modification along the GSW pattern. 3. Waves can display bilateral (L) or medial (M) frontal voltage maxima. 4. At least in the time window of several weeks, the dominant spike map pattern and the pattern of the waveform was characteristic to each patient. Configurations of the different spike and wave components show some relation to a limited set of clinical data. The combination of A- spikes with L-waves was found in children who had , typical" absence- epilepsies. On the contrary, irregular spectrum of different spikes and M-waves was found in elder absence patients showing rather unfavorable course of their illness.]

Clinical Neuroscience

[Immunological test for idiopathic inflammatory myopathies]

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[Sceletal muscle biopsy specimens from patients with various inflammatory myopathies – dermatomyositis, polymyositis and inclusion body myositis – have been investigated by immunocytochemical methods with the help of monoclonal antibodies. Conclusions about the pathomechanism of these disorders were saught. In dermatomyositis the humoral immunity and the damage of the small vessels of muscle fibres may play an important role. The appearance of class I MHC antigens on diseased muscle may make the affected tissue a target for cytotoxic T8 cells, and may thus have a role in muscle fibre damage in polymyositis and inclusion body myositis.]

Clinical Neuroscience

[Is there a relationship between CT morphology and the MMS scale achievements in patients with dementia?]

PÉK Márta, BARSI Péter, NAGY Zoltán

[An attempt is made to establish relationships between CT parameters and the achievements on the Mini Mental State (MMS) scale of patients suffering from various types of dementia. The results suggest that the Mini Mental State scores change together in Alzheimer's type of dementias, referring to the global deterioration of functions in contrast to the vascular type of dementias, where the scores on each item change independently of each other. In the combined examination of the two groups the parietal lobe and the volume of the ventricles showed mainly connection with the neuropsychological functions. ]

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Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

[Investigating cognitive impairment in communities of practice – lessons learned]

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[In the “Three Generations for Health” programme, general practitioners were responsible for screening for dementia in their practices using mini-COG and Mini Mental State Examination. The aim was to present the screening results of those included, their assessment by the doctor and the further fate of the patients. After mini-COG test, MMSE test was performed in case of suspected dementia. The examiner categorized the result as abnormal or no abnormal, recorded the referral, and recorded the data in an online interface. Our study is a cross-sectional study; the evolution and distribution of the parameters described in the objectives are described with raw case numbers and proportions. Patients aged 55 years and over were recruited consecutively. Only those cases (29 730) where mini-COG and MMSE test results were available, their assessment by the physician, and referral data to specialist care were analyzed. The Mini-COG test revealed that 64% of the subjects were suspected of cognitive decline. Misclassification occurred in 13 015 cases, with 21% of the Mini-Cog test scores matching cognitive decline and 21% of lesions considered abnormal by GPs. The MMSE test raised the suspicion of dementia in 34% of the sample (10 174 people), with 4 262 (42%) of the participating GPs considering the result abnormal. 11% (2095 people) of people with abnormal Mini-Cog test scores and 17% (1709 people) of people with suspected dementia based on MMSE test scores were referred to specialist care. Our study assessed the practice of detecting cognitive decline in primary health care. The tools adopted for screening for dementia were used by practices, but the assessment of results and referral of suspected cases of dementia to specialist care were below the expected level. There is a need to improve primary care providers’ knowledge of dementia detection and treatment and to strengthen links with specialist care.]

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Clinical Neuroscience

[LGI1 encephalitis: the first Hungarian patient]

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