Kari Reinikainen

Subjective memory complaints and personality traits in normal elderly subjects.

Objective: To evaluate the relationship between objectively measured memory functions and subjective complaints of memory disturbance and whether subjective complaints are affected by some personality traits or affective states.

A Follow‐Up Study of Age‐Associated Memory Impairment: Neuropsychological Predictors of Dementia

OBJECTIVE: To examine the clinical course of age‐associated memory impairment (AAMI) and to evaluate the value of neuropsychological tests in predicting cognitive decline in AAMI subjects in a follow‐up period of more than 3 years.

Prevalence of age-associated memory impairment in a randomly selected population from eastern Finland

Article abstract-Aging has multiple effects on memory in normal subjects. However, information on the prevalence of age-associated memory impairment (AAMI) is scanty. We studied the prevalence of AAMI in a randomly selected population of 1,049 subjects aged 60 to 78 years from eastern Finland. Research criteria proposed by the National Institute of Mental Health (NIMH) Work Group were applied. We calculated prevalence rates for AAMI by the inclusion criteria alone (subjective and objective memory impairment and no dementia) as well as by the inclusion and exclusion criteria (evidence of any neurologic or other medical disorder that could produce cognitive deterioration) for the total study population, for both sexes, and for four age groups (60 to 64, 65 to 69, 70 to 74, and 75 to 78 years). Subjective memory impairment was present in 76.3% of the subjects. Prevalence rates for objective memory impairment ranged from 31.9 to 78.4% in individual tests. A total of 564 subjects (239 men, 325 women) were classified as having AAMI by the inclusion criteria alone, giving a prevalence rate of 53.8% (men, 57.4%; women, 51.3%). When we included the exclusion criteria, the prevalence of AAMI decreased to 38.4% (men, 42.5%; women, 35.7%). By both methods, age- and sex-specific prevalence rates were highest in the youngest group, aged 60 to 64 years, and lowest in the oldest group, aged 75 to 78 years. We conclude that the prevalence of AAMI, by the diagnostic criteria of the NIMH Work Group, is high in the elderly Finnish population. AAMI seems likely to be a phenomenon of normal aging rather than a continuum from normal aging to a pathologic state such as Alzheimers disease. NEUROLOGY 1995;45: 741-747

Comparison of oxcarbazepine and carbamazepine: a double-blind study

The antiepileptic efficacy and side-effects of oxcarbazepine (OXC), a new carbamazepine derivate, were evaluated in a double-blind study. Forty ambulatory epileptics with unsatisfactory seizure control or unwanted effects due to phenytoin monotherapy were changed to OXC or carbamazepine (CBZ) and were then followed for 48-50 weeks. Thirty-four of the patients completed the study. The seizure frequencies on the trial drugs were not significantly different and the antiepileptic efficacy of OXC was comparable to CBZ. The incidence of side-effects during the initiation phase was lower with OXC suggesting better tolerability of OXC compared to CBZ.

A post-mortem study of noradrenergic, serotonergic and GABAergic neurons in Alzheimer's disease

Involvement of noradrenergic, serotonergic and GABAergic neurons in Alzheimers disease/senile dementia of Alzheimer type (AD/SDAT) was studied in 20 histologically confirmed AD/SDAT cases by comparing these with 14 control patients. Concentrations of noradrenaline (NA) were decreased significantly in the frontal cortex, temporal cortex, hippocampus and putamen in AD/SDAT. Serotonin (5-HT) levels were significantly lowered in the hippocampal cortex, hippocampus, caudate nucleus and putamen and the concentrations of 5-HIAA, a metabolite of 5-HT, were reduced in 3 cortical areas, thalamus and putamen in patients with AD/SDAT. Furthermore, 5-HIAA/5-HT ratios were in general slightly lower in AD/SDAT reaching significance in the temporal and hippocampal cortex. Glutamic acid decarboxylase (GAD) enzyme activity was not changed significantly in AD/SDAT although patients without evidence of premortem hypoxia and hypovolemia showed a consistent trend for increased GAD activity in the thalamus, striatum and substantia nigra. These findings further confirm the involvement of NA and 5-HT neuronal systems in AD/SDAT. The damage of 5-HT neurons seemed to be more generalized and more severe than that of NA neurons. The possible clinical relevance of these findings is briefly discussed and the need for critical evaluations of the behavioral effects related to these abnormalities described in patients with AD/SDAT is emphasized.

Reduced cholinesterase activity and somatostatin-like immunoreactivity in the cerebrospinal fluid of patients with dementia of the Alzheimer type.

Cholinesterase (ChE) activity and somatostatin-like immunoreactivity (SLI) of the cerebrospinal fluid were determined for 59 patients with dementia of the Alzheimer type (AD/SDAT) and for 19 age-matched control patients with no signs of dementia. Both ChE activities and SLI concentrations of cerebrospinal fluid were reduced significantly in dementia patients compared to the controls. In the AD/SDAT patients cholinesterase and somatostatin-like immunoreactivity levels seemed to be correlated with the severity of dementia. These findings agree with observations of reduced cortical acetylcholinesterase activities and somatostatin values in dementia of the Alzheimer type.

Dopaminergic system and monoamine oxidase-B Activity in Alzheimer's disease

The possible involvement of dopaminergic neurons in dementia of Alzheimer type (AD/SDAT) was studied in autopsied brains from 20 patients with AD/SDAT. Dopamine (DA) concentrations were decreased significantly in the temporal cortex, hippocampal cortex and hippocampus in AD/SDAT patients. Levels of homovanillic acid (HVA) were not altered compared to controls. The HVA/DA ratio was significantly higher in the hippocampus of AD/SDAT patients, suggesting overactivity of the remaining DA neurons. Histological findings of substantia nigra suggesting coexistent pathology of Parkinsons disease (PD) found in 25% of cases were associated with lowered levels of DA in striatum and with reduced HVA in CSF. The activity of monoamine oxidase-B was significantly increased in the cortical areas and in the hippocampus, obviously reflecting the underlying cell loss and substantial gliosis in these areas of the brain. In general, DA neurons seemed to be only mildly involved in AD/SDAT. Coexistent PD pathology can explain the loss of DA in the striatum and the presence of clinical PD symptoms in some patients with AD/SDAT. Otherwise the clinical relevance of these dopaminergic alterations is unclear.

Slowing of electroencephalogram and choline acetyltransferase activity in post mortem frontal cortex in definite alzheimer's disease

Twenty-five (96%) of 26 patients with histologically verified moderate to severe Alzheimers disease had abnormal electroencephalograms. The patients with the slowest (5-6 Hz) dominant occipital rhythms had significantly lower choline acetyltransferase activity in the post mortem frontal cortex than the patients with highest rhythm (8-9 Hz) (analysis of covariance adjusted for the neuropsychological test score). Concentrations of dopamine, noradrenaline or serotonin in the frontal cortex did not differ in the patient groups with the slowest and highest rhythms. Neither did scores of senile plaques or neurofibrillary tangles differ between these groups. In Alzheimer patients, the frequency of the dominant occipital rhythm correlated with the total score of the neuropsychological test (r = 0.58, P less than 0.01) and with the subscales of praxic functions and expressive speech, memory and general reasoning. The results suggest that the cholinergic deficit may contribute to the slowing of the electroencephalogram found in patients with Alzheimers disease.

Analysis and quantitation of the beta-amyloid precursor protein in the cerebrospinal fluid of Alzheimer's disease patients with a monoclonal antibody-based immunoassay.

Abstract: One of the major clinical findings in Alzheimers disease (AD) is the formation of deposits of β‐amyloid protein in amyloid plaques, derived from the β‐amyloid precursor protein (β‐APP). To determine the possible use of β‐APP as a diagnostic marker for AD in CSF, a monoclonal antibody‐based immunoassay specific for this protein was developed. The assay does not differentiate between β‐APP695 and β‐APP751 forms but does preferentially recognize β‐APP751 complexed with a protease. Of the two sets of CSF samples tested, one set, obtained from living patients, gave a slightly lower level of β‐APP in AD and Parkinsons disease patients relative to controls, whereas the other set, composed of postmortem samples, showed no significant differences between the AD and control groups.

Population-Based Dementia Screening Program in Kuopio: The Effect of Education, Age, and Sex on Brief Neuropsychological Tests

A neuropsychological screening battery including the Mini-Mental State Examination and four other brief cognitive tests (Russells Adaptation of the Visual Reproduction Test, Trail Making Test, Verbal Fluency Tests on letters and category, and the Buschke Selective Reminding Test) was administered to a randomly selected population sample of 403 subjects aged 68 to 77 years to evaluate the effect of education, age, and sex on test scores. The difference in neuropsychological screening tests between various education groups (3 years or less, 4 to 6 years, 7 years or more) was statistically highly significant, even after the adjustment for the effect of age. The subscores and total scores were lowest in the minimal education group on every neuropsychological test. Education correlated more strongly than age with all neuropsychological test scores and subscores. The effect of sex on test results was seen only in some subscores of brief neuropsychological tests but not in a single item of the Mini-Mental State Examination. On the basis of our results, the effects of education, age, and sex have to be evaluated before using brief neuropsychological tests in population-based dementia screening. (J Geriatr Psychiatry Neurol 1992;5:162–171).