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ABSTRACT: The correlations between (a) the patients' memory complaints, (b) the informants' rating of the patients' cognitive impairment, and (c) cognitive performance according to the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) were examined in 163 patients with probable or possible Alzheimer's disease. The patients' complaints were weakly correlated with informants' view (p < 0.05), closely correlated with depressive mood (p < 0.0001), but not with cognitive performance or the stage of dementia. The results of Clinical Dementia Rating, Mini-Mental State Examination and the Cambridge Cognitive Examination were significantly correlated with the informants' rating of cognitive impairment (p < 0.0001). These results are in line with previous studies and confirm (1) the suitability of CAMDEX for the structured examination of dementia patients and their caregivers, (2) the association between affective disturbances and the perception of cognitive deficits, and (3) the importance informants' rating for the valid evaluation of demented patients.
Fortschritte der Neurologie · Psychiatrie 06/1996; 64(6):228-33. · 0.74 Impact Factor
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ABSTRACT: Primary degenerative dementia of the Alzheimer type (DAT) and multiinfarct dementia (MID) exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography. The pulsatility indices, as angle-independent parameters of peripheral vascular resistance, measured in middle cerebral and basilar arteries of patients with MID, were significantly increased (P < 0.005) with respect to cases of primary DAT and to healthy age-matched controls. Approximately 75% of all MID patients exhibited small-vessel disease rather than thromboembolism from the extracranial arteries and the heart, as judged by extracranial and transcranial Doppler sonographies, computerized cerebral tomographies, EEGs, and, if necessary, 2-D echocardiographies.
Angiology 02/1995; 46(2):129-35. · 1.51 Impact Factor
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ABSTRACT: We report on clinical observations from a 10-bed psychiatric acute ward where predominantly patients with concurrent physical diseases are treated. Of 287 patients admitted within 18 months we detected serious physical illness previously unrecognized or at least not sufficiently diagnosed in 15 cases (5.2%; age 17-88 years; 4 m, 11 f). Six patients suffered from acute neurological disease. One or more extracerebral disorders were found in nine cases. 14 of the 15 patients presented with organic mental syndromes classified according to ICD-9 (acute organic psychosis: n = 8, chronic organic psychosis: n = 6). The physical diseases unknown at admission were the only cause of the acute organic psychoses while they were contributing to the development of psychiatric symptoms in the majority of the other patients. In 14 patients the diagnosis of the previously unrecognized illnesses led to a significant change of therapy. At discharge 10 patients had improved with regard to their somatic and mental state while in two cases only the physical symptoms had remitted. One patient remained completely unchanged and two patients died from their serious diseases. Our case studies illustrate the fact that a relevant proportion of newly admitted psychiatric patients suffers from life-threatening medical illnesses. These require prompt and specific interventions and can only be detected by early and thorough physical examination.
Psychiatrische Praxis 10/1992; 19(5):171-7. · 1.64 Impact Factor
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ABSTRACT: Until recently, the management of impotence was mainly concerned with the distinction of psychogenic from organic causes of erectile failure. Patients with the former were offered psychosexual counselling, while surgery, principally in the form of prosthesis implantation, was reserved for those with organic impotence. With the identification of pharmacologic regimes that can successfully induce erection, it has become necessary to distinguish between vascular and neurogenic causes of erectile failure, since it is mainly the latter patient group that can profit from an intracavernosal injection therapy with papaverine and phentolamine. Neurogenic erectile failure is further classified according to lesion localization and underlying disease.
Der Nervenarzt 12/1989; 60(11):661-9. · 0.68 Impact Factor
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ABSTRACT: Primary degenerative dementia of the Alzheimer type and multiinfarct dementia exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by transcranial Doppler sonography. The pulsatility indices, as angle-independent parameters of peripheral vascular resistence, measured in middle cerebral and basilar arteries of patients with multiinfarct dementia were significantly increased (p less than 0.005) compared with cases of primary degenerative dementia of the Alzheimer type and with healthy age-matched controls.
Biological Psychiatry 11/1989; 26(6):590-4. · 8.28 Impact Factor
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ABSTRACT: We have retrospectively investigated 71 patients with ICD-9 diagnoses 293.0 or 293.1, who were treated in our clinic in 1987, with respect to the maximum severity of altered consciousness. On the basis of an available neurological grading into "clouding of consciousness", "confusional state", "delirium", "stupor", and "coma", and from knowledge of the underlying somatic disease, we have developed prognostic criteria: Disorders of heart and circulation associated with acute organic mental disorder (with altered consciousness) carry a fair prognosis for recovery of the mental disorder in approximately two-thirds of all patients affected, even in advanced age. The same statement is valid with respect to drug-induced acute organic mental disorders, whereas most cases of cerebrovascular disorders with mental disturbances proceed to chronic forms of organic mental disorder. We believe that the clinical descriptive terms referred to above allow easy grading of states of acutely/subacutely altered consciousness, thereby providing prognostic criteria for the course of the disease.
Der Nervenarzt 07/1989; 60(6):344-8. · 0.68 Impact Factor
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ABSTRACT: The past 15 years have witnessed an explosion of new knowledge concerning the anatomy, neurophysiology, and pharmacology of the lower urinary tract. Knowledge of the localization of a neurologic lesion-suprapontine, suprasacral, cauda equina, or peripheral nerves-rather than the type of disease allows a more "rational approach" to the diagnosis and therapy of neurogenic voiding disorders. More specifically, advances in pharmacological understanding enable us, at least in theory, to treat voiding disorders according to their types of dysfunction: drugs to promote bladder emptying that exert their predominant effect on bladder and bladder outlet respectively, and those promoting bladder storage with the corresponding objectives. We discuss the problem that many theoretically sound drugs are, in fact, not clinically efficacious, probably due to incomplete understanding of the physiology of normal micturition and its neurogenic disorders.
Der Nervenarzt 04/1989; 60(3):127-34. · 0.68 Impact Factor
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ABSTRACT: We report on two cases of self-induced intoxication with the anticholinergic agent biperiden (oral ingestion of at least 200 mgs. in case 1, and of 60 mgs. in combination with 300-400 mgs levomepromazine in case 2). An acute delirious state and other somatic symptoms of a toxic anticholinergic action dominated the clinical picture. Serial measurements of biperiden serum levels revealed values up to 50-fold (case 1) and 15-fold (case 2) of those usually observed under therapeutic doses of biperiden. In both cases, the intoxication was controlled by the application of physostigmine and general therapeutic measures. We discuss the prognosis of biperiden intoxications, and the clinical symptomatology and therapy of drug-induced anticholinergic syndromes.
Fortschritte der Neurologie · Psychiatrie 05/1988; 56(4):133-6. · 0.74 Impact Factor
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Der Nervenarzt 03/1988; 59(2):73-84. · 0.68 Impact Factor
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ABSTRACT: Dementia--a syndrome of acquired intellectual deterioration--is an etiologically non-specific condition which is permanent, progressive, or reversible. In the evaluation of demented patients, a careful exposure history will determine the possible role of drugs, metals, or toxins. The physical examination may reveal focal deficits in cases of intracranial mass lesions and spasticity or ataxia of the lower limbs if hydrocephalus is present. Coexistance of dementia and peripheral neuropathy usually indicates a toxic or metabolic disorder. Asterixis, myoclonus, and postural tremor are common in toxic-metabolic dementias, while resting tremor, choreoathetosis, and rigidity occur in progressive extrapyramidal disorders. EEG is focally abnormal in cases of cerebral mass lesions and exhibits generalized slowing in toxic-metabolic encephalopathies. CT will aid in the identification of hydrocephalus, subdural hematomas, and intracranial mass lesions. A thorough laboratory evaluation including complete blood count, erythrocyte sedimentation rate, electrolytes, blood urea nitrogen and blood sugar, liver and thyroid tests, calcium and phosphorus levels, B12 and folate levels, serum copper and ceruloplasmin, VDRL, chest X-ray, electrocardiogram, and lumbar puncture may demonstrate treatable disorders that are adversely affecting intellectual function. Elderly individuals are particularly susceptible to the effects of toxic or metabolic disorders, and a mild dementia might be exaggerated by relatively minor fluctuations in metabolic status. Treatable causes of dementia should be considered in all demented patients.
Der Nervenarzt 04/1987; 58(3):137-49. · 0.68 Impact Factor
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ABSTRACT: Primary degenerative dementia of the Alzheimer type and multi-infarct dementia exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography. The pulsatility indices, as angle-independent parameters of peripheral vascular resistance, measured in middle cerebral and basilar arteries of patients with multi-infarct dementia (MID), were significantly increased (p < 0.005) with respect to cases of primary degenerative dementia of the Alzheimer type and to healthy age-matched controls. Approximately 75% of all MID patients exhibited small vessel disease rather than thromboembolism from the extracranial arteries and the heart, as judged by extracranial and transcranial Doppler sonographies, computerized cerebral tomographies, EEGs, and, if necessary, 2-D echocardiographies.
Molecular and Chemical Neuropathology 19(1-2):15-23.
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ABSTRACT: Dementia of the Alzheimer type, senile onset (SDAT), and multi-infarct dementia (MID) exhibit differences in cerebrovascular blood flow velocity profiles, which were investigated by means of transcranial Doppler sonography. The pulsatility indices (PI), as angle-independent parameters of peripheral vascular resistance measured in the basal cerebral arteries, were significantly increased in MID patients with respect to SDAT cases. In an analysis of the correlations between several variables and the magnitude of PI, we found strong inverse correlations of the CAMCOG score, and strong direct correlations of the blood pressure and the duration of illness, with the PI of all basal cerebral arteries only in MID patients. In SDAT patients, we found a direct correlation between the Hachinski ischemia score and the PI of all basal cerebral arteries. All 3 ischemia scores (Hachinski, Rosen, Loeb and Gandolfo) were significantly correlated with the PI of the middle cerebral and basilar arteries. By analyzing the correlations of the single items of the 3 different ischemia scores with the PI values obtained, we only found a clearcut correlation with the item focal neurological signs. Thus, our findings stress the relative importance of a concomitant cerebrovascular factor in the development of dementia in old age, even in patients with probable SDAT. A raise of the PI in the basal cerebral arteries allows early suspicion of a cerebrovascular factor even in only slight dementia so that possible risk factors for further aggravation of this type of vascular dementia might be detected and treated early in the course of disease.
Dementia (Basel, Switzerland) 7(1):41-6.
