Cerebral Biopsy in the Investigation of Presenile Dementia

Abstract

In most instances presenile dementia is based on well-defined organic diseases and it is not necessary to resort to cerebral biopsy to establish a diagnosis. These organic disorders cover a wide spectrum and include cerebro-vascular disease, tumours, trauma and well-defined degenerative states such as Huntington's chorea, vitamin deficiencies, endocrine disturbances, infections (bacterial and viral) and poisons such as alcohol, lead, barbiturates, bromides and carbon monoxide. The effects of liver and kidney failure as well as the hypercapnia of pulmonary insufficiency account for others.

Psychotic symptoms in patients with dementia

“…Twelve studies, none of which used standardized criteria to diagnose psychotic symptoms, concentrated on patients with presenile dementia (Coblentz et al, 1973;Rosenstock, 1970;Chen et al, 1991;Nott and Fleminger, 1975;Liston, 1979;Sim and Sussman, 1962;Sim et al, 1966;Goodman, 1953;Sjogren et al, 1952;Eiden and Lechner, 1950;Rubin et al, 1993;Stern et al, 1987), finding a prevalence between l8Y0 (Sim and Sussman, 1962;Simetal., 1966)and41.2% (Rubin,etal., 1993).The lack of standardized instruments and operational criteria limits the amount of useful information which can be abstracted from these studies other than the existence of psychotic symptoms as a common problem.…”

Multi‐infarct dementia in Down's syndrome

“…The history, clinical examination and high Hachinski score suggest that deterioration is due to multi-infarct dementia, though SG is also likely to have the histopathological features of Alzheimer's disease. The relatively early presentation of seizures within her illness is suggestive of multi-infarct dementia; in Alzheimer's disease, seizures tend to be a late manifestation (Sim et al 1966). The Hachinski ischaemic index cannot be viewed as diagnostic, since this was based on a small number of subjects from the general population in which the cause of dementia was ascertained not by autopsy study but through cerebral blood flow measurement (Hachinski 1975).…”

EEG and cognitive impairment in presenile dementia

“…The rating scales for the psychiatric symptoms used have been presented (and validated) previously (Gustaf- son & Risberg 1974, Gustafson 1975). The diagnosis of the first three patient groups was based on a scoring schedule in which the criteria were selected from previous studies on AD (Sjogren, Sjogren & Lindgren 1952, Brion 1966, Sjogren & Sourander 1970, Lauter 1968, Pick's disease ( Mansvelt 1954, Escourolle 1958, Sim et al 1966) and CVD ( Rotschild 1956, Mayer-Gross, Slater & Roth 1969, Hachinski et al 1974, 1975. The diagnosis of the first three patient groups was based on a scoring schedule in which the criteria were selected from previous studies on AD (Sjogren, Sjogren & Lindgren 1952, Brion 1966, Sjogren & Sourander 1970, Lauter 1968, Pick's disease ( Mansvelt 1954, Escourolle 1958, Sim et al 1966) and CVD ( Rotschild 1956, Mayer-Gross, Slater & Roth 1969, Hachinski et al 1974, 1975.…”

“…In the present paper, the clinical material has been separated into four clinical groups ( Table 2): Alzheimer's disease (AD), Pick's disease, cerebrovascular dementia (CVD) and a mixed group containing patients with Jacob-Creutzfeldt's disease, hydrocephalic dementia or encephalitis. The diagnosis of the first three patient groups was based on a scoring schedule in which the criteria were selected from previous studies on AD (Sjogren, Sjogren & Lindgren 1952, Brion 1966, Sjogren & Sourander 1970, Lauter 1968, Pick's disease ( Mansvelt 1954, Escourolle 1958, Sim et al 1966) and CVD ( Rotschild 1956, Mayer-Gross, Slater & Roth 1969, Hachinski et al 1974, 1975. The clinical diagnoses were based on observations and information collected over years from the start of the investigations until 1977 or until the patient's death.…”