Martin Haupt

Alzheimer's disease: identical phenotype of familial and non-familial cases

SummaryNinety outpatients with Alzheimers disease according to ICD-10 diagnostic draft criteria were studied to test the hypothesis that cases with a familial aggregation are different from cases without such an aggregation with respect to cognitive impairment. In all cases the diagnosis of Alzheimers disease was confirmed by prospective observation within 12 months of initial evaluation. Patients were divided into two groups: one consisting of 23 patients with a familial aggregation, the other consisting of 67 patients without secondary cases among first-degree relatives. By means oft-tests differences in impairment of cognitive functions between the groups were calculated. The results did not yield statistically significant differences between the groups for any of the neuropsychologically investigated cognitive deficits. Thus the hypothesis that the presence of a familial aggregation may lead to a distinct phenotype in Alzheimers disease was not confirmed.

Is Impaired Recall in Dementia of the Alzheimer Type a Consequence of a Contextual Retrieval Deficit

Eighty-eight patients with mild to moderate dementia of the Alzheimer type were tested in a word list and a spatial pattern recall task. With increasing degree of dementia severity we found a decline in the initial recall scores while learning curves over five consecutive trials remained normal in the mildly demented patients. Furthermore, there was a loss of the primacy effect in the word list task in our moderately demented patients. These findings are consistent with the pattern that have been reported after medial temporal lobe dysfunction. The data are discussed in the framework of cognitive dual process theories of memory as indicators of a contextual retrieval deficit.

Alzheimer's Disease: Is There Evidence of Phenomenological Subtypes?

A sample of 90 patients with mild or moderate dementia in Alzheimers disease was examined for subtypes within the cognitive phenomenology and course of the disorder. Language, memory, praxia, and per

Symptom Progression in Alzheimer's Disease

above, we are not aware of any policy that specifically permits CPR to be withheld for any reason other than a DNR order. In summary, then, policies about CPR in nuring homes are heterogeneous, constantly evolving, and often vague. Under what conditions a potentially “life-sustaining therapy” may be withheld are unclear, and the “default” position in the US is often to “do it all,” sometimes with little regard for the particular circumstances of the patient. We would be most interested in how our British colleagues resolve this frequent contradiction between common sense and [implicit or express) policy.

Clinical diagnosis of Alzheimer’s disease: DSM-III-R, ICD-10 — what else?

Four sets of diagnostic criteria for Alzheimer’s disease were applied in parallel to 150 patients with suspected or manifest but not severe mental deterioration and were validated against the final diagnosis derived from the subsequent course within a 12 to 24 months follow-up period. DSM-III-R criteria for Primary Degenerative Dementia of the Alzheimer Type and NINCDS-ADRDA criteria for Probable Alzheimer’s Disease were superior to ICD-10 criteria for Dementia in Alzheimer Disease in terms of sensitivity, specificity, and relative predictive value of positive classification.

Stability of Cognitive Symptoms in Dementia of the Alzheimer Type

In a longitudinal study of 90 out-patients with a clinical diagnosis of Alzheimers disease (ICD 10) we found 11 patients with isolated cognitive symptoms that remained stable from baseline to 1-year

Depression in Alzheimer's Disease Significantly Improved under Treatment with Mianserine

To the EditorDepression is a frequent unspecific behavioral concomitant of Alzheimer’s disease. Typically, the mood disorder is shortlived and fluctuating but may meet the diagnostic criteria for major depression in up to 30% of all cases.’ The efficacy of antidepressant treatment in demented patients has been observed using compounds such as monoamine-oxidase or imi~ramine.~ There are no reports on the effects of the tetracyclic antidepressant mianserine on depression in Alzheimer’s disease although this compound, a dipyrazinoazepine derivate, may be particularly useful in elder patients because it shows little vegetative and almost no anticholinergic side effects. In our outpatient clinic a 79-year-old woman, with clinically diagnosed moderate Alzheimer’s disease (NINCDSADRDA), complaining of depressed mood, low self-esteem, and anxiety showed markedly reduced drive and mentioned occasional suicidal thoughts. She had lost interest in social activities during the past 4 weeks. The criteria for major depression (DSM-111-R) were fulfilled. Treatment was begun with mianserine 10 mg/day and after 1 week was raised to 20 mg/day. Two weeks after initial treatment, her symptoms of anxiousness, depression, drive, and self-esteem had improved clinically. According to her husband, suicidal thoughts were no longer present, and she had even started to participate in some activities (taking a walk, visiting friends). Six weeks after initial treatment, further substantial improvement of depression was clinically demonstrable. The patient could enjoy social activities in daily living. During the follow-up assessment over 6 weeks, no relevant side effects, such as tiredness, sedation or ortho-