Neuropsychiatric Correlates of Cerebral White-Matter Radiolucencies in Probable Alzheimer's Disease

López, Oscar L.; Becker, James T.; Rezek, Donald L.; Wess, Jeanne; Boiler, François; Reynolds, Charles F.; Panisset, Michel

doi:10.1001/archneur.1992.00530320052012

Cited by 59 publications

(27 citation statements)

References 39 publications

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“…72 Positive associations between WM changes and psychiatric symptoms have been reported in subjects without dementia. 73,74 Although previous studies have failed to find a relationship between WM changes and neurobehavioral signs in patients with dementia, 14,21,28,30 the present study clearly demonstrated that WM changes were involved in the development of aberrant motor behaviors. Aberrant motor behaviors, including wandering, pacing, and rummaging, belong to repetitive and excessive behaviors, which are likely to be caused by frontal lobe dysfunction.…”

Section: Discussionsupporting

confidence: 49%

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Hirono

Kitagaki

Kazui

et al. 2000

Stroke

177

123

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Background and Purpose-There have been conflicting results involving the clinical significance of white matter changes in patients with Alzheimer's disease (AD). We studied the association between the volume of white matter hyperintensities (WMHs) on T2-weighted images and cognitive, neurological, and neuropsychiatric symptoms. Methods-The subjects were 76 AD patients who had WMHs but no obvious cerebrovascular diseases. We quantified the volume of WMHs by using fast-fluid-attenuated inversion recovery images and whole brain atrophy by using 3D spoiled gradient-echo images. Effects of WMHs and brain atrophy on dementia severity, cognitive function, neuropsychiatric disturbances, and neurological findings were examined. Results-Whole brain atrophy was significantly associated with dementia severity and cognitive disturbances, as well as with grasp reflex and some kinds of neuropsychiatric disturbances. After we controlled for the effects of brain atrophy, duration of symptoms, and demographic factors, we found that WMH volume was not associated with global cognitive disturbances or dementia severity but was significantly associated with urinary incontinence, grasp reflex, and aberrant motor behaviors. Brain atrophy and WMH volume were not significantly correlated either before or after controlling for age, sex, education, and duration of symptoms. WMH volume was associated with hypertension, but brain atrophy was not positively correlated with any vascular risk factors. Conclusions-Our results support the hypothesis that WMHs in AD patients are superimposed phenomena of vascular origin. WMHs contribute to specific neurological and neuropsychiatric manifestations but not to global cognitive impairment, which is more closely associated with brain atrophy. (Stroke. 2000;31:2182-2188.)

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Section: Discussionsupporting

confidence: 49%

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Hirono

Kitagaki

Kazui

et al. 2000

Stroke

177

123

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“…Although cortical timing and activation are disturbed, local cortical functions are intact. Conventional neuropsychological tests and scales such as the MMSE, with their language and cortical focus, fail to consistently demonstrate a pattern of deficits specific to VaD [5,10,22,54,[56][57][58]. In our study, neurobehavioral measures demonstrated a dissociation between sustained attention and working memory (serial reversal tasks) on the one hand and recognition memory on the other in our group II patients with probable VaD.…”

Section: Discussioncontrasting

confidence: 47%

Dementia with Leukoaraiosis: Clinical Differentiation by Temporoparietal Hypometabolism on <sup>18</sup>FDG-PET Imaging

Mendez

Ottowitz

Brown

et al. 1999

Dement Geriatr Cogn Disord

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Patients with dementia and leukoaraiosis may have either Alzheimer’s disease (AD) with cerebrovascular changes or a form of vascular dementia (VaD). The presence or absence of the characteristic AD pattern of bilateral temporoparietal hypometabolism on ¹⁸FDG-PET was used to differentiate 30 patients with progressive dementia and severe leukoaraiosis. Compared to 18 patients with the typical AD pattern (group I), the remaining 12 (group II) had better recognition memory, and greater difficulty with sustained attention and serial reversals. Better recognition memory, confluent periventricular leukoaraiosis, and poorer sustained attention distinguished all group II patients from group I. Dementia patients with severe leukoaraiosis and bilateral temporoparietal hypometabolism may have predominant AD; those who lack this pattern and have confluent leukoaraiosis may have a greater contribution from VaD.

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“…Both CT and MRI dis played subfrontal white matter lesions. However, Miller's et al [ 18] conclusions regarding the association between MRI white matter lucencies and clinical psychotic symp toms must probably be mitigated, since Lopez et al [19] could not replicate their findings. Though in our patient clear and specific signs of organic disease were found that were thought to have contributed to his psychopathology, the question of whether this organic disease was causing the delusional symptoms cannot be definitively answered by this study.…”

Section: Neuropathologymentioning

confidence: 95%

Delusional Misidentification and Subsequent Dementia: A Clinical and Neuropathological Study

Diesfeldt

Troost

1995

Dement Geriatr Cogn Disord

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An 81-year-old man presented with psychotic episodes involving the delusion that his wife had been replaced by a closely resembling double (the so-called Capgras delusion). A comprehensive neuropsychological investigation revealed no signs of dementia at that time, but in the subsequent course the patient became demented and died 5 years later. Neuropathological and neurochemical examination displayed many diffuse plaques in the cortex that escaped detection by Congo-red but were clearly demonstrated by antibodies raised to β-amyloid protein. Neurofibrillary tangles were absent in the cortex. Antiubiquitin immunohistochemistry revealed some cortical and subcortical Lewy bodies. The hippocampus and the majority of the nigral cells were intact. However, in the frontal and parietal white-matter many small Iacunar infarcts were found due to arteriosclerotic and hypertensive vessel wall changes. Though the etiology of psychotic symptoms in the context of dementia is complex, this study shows the possible significance of white-matter lesions in the pathogenesis of delusions and subsequent dementia.

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Neuropsychiatric Correlates of Cerebral White-Matter Radiolucencies in Probable Alzheimer's Disease

Cited by 59 publications

References 39 publications

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Impact of White Matter Changes on Clinical Manifestation of Alzheimer’s Disease

Dementia with Leukoaraiosis: Clinical Differentiation by Temporoparietal Hypometabolism on <sup>18</sup>FDG-PET Imaging

Delusional Misidentification and Subsequent Dementia: A Clinical and Neuropathological Study

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