Recently, the vagus nuclei in the brainstem have come into the focus of interest in psychiatric and neurological research mainly for two reasons: Firstly, their function is altered early in the course of Alzheimer's disease (AD; Parvizi et al., 2001). Secondly, in a small pilot study the electrical stimulation of the left vagus nerve in the neck by means of an implanted stimulator has shown to improve cognitive impairments in patients with AD (Sjogren et al., 2002).

Based on these findings a method for the non-ionvasive measurement of far-field potentials from the vagus nuclei evoked by means of an electrical stimulation via a peripheral branch of the nerve in the outer ear is a potentially interesting diagnostic procedure.

Vagus Sensory Evoked Potentials (VSEP) can be elicited in a reliable manner in younger and elderly healthy subjects. VSEP-latencies have been found to increase with age in healthy subjects. In a first clinical application, VSEP-latencies in patients with mild to moderate AD were found to be prolonged as compared to age-matched healthy participants.

This new, none-invasive measure is very easy to apply and may be a disease marker for AD, possibly also in preclinical stages. Further studies are necessary which systematically investigate changes in VSEP measures in patients with neurodegenerative disorders in order to elucidate their diagnostic specifity and validity.

Randomized controlled clinical trials demonstrated efficacy of galantamine-PRC in the treatment of AD-patients. Objectives of this clinical trial were to further study the overall effect of galantamine-PRC on cognition and function in patients with AD.

Open-label, multi-center clinical trial (GAL-DEM-3002). Patients with mild to moderate AD (NINCDS-ADRDA criteria) received 16-24 mg/day galantamine-PRC for 6 months. Primary objectives were to examine the effects on cognitive function using ADAS-cog and DemTect. Response-rate at endpoint was defined as percentage of patients with change in ADAS-cog of 0 or less. Statistical analyses based on intent-to-treat population (LOCF, t-test, Wilcoxon-test for dependent samples).

133 patients (48% with mild, 52% with moderate AD; mean age±SD 75.4±7.8 years; 68% women) were enrolled, 71% of patients completed the study. 53% of the patients received 24mg/day galantamine-PRC. After 6 months mean total scores changed significantly, both in ADAS-cog, from 23.3±9.3 (baseline) to 20.4±9.7 (p<0.0001) and DemTect from 7.3±2.9 to 9.2±4.3 (p<0.0001). The response-rate was 64.2%. CGI demonstrated an improvement or stabilization for 83% of patients. 64% of the patients had at least one AE. Most frequent AEs (>5%) were nausea, vomiting and headache. 28 patients discontinued due to AEs. 15 patients experienced a serious AE with 3 SAEs thereof considered as possibly related to study medication (syncope, hypotension, agitation). 2 deaths (sudden death, renal failure) were rated as unrelated to galantamine-PRC.

This clinical trial supports the evidence from placebo-controlled trials that galantamine-PRC is tolerated and effective in the treatment of AD-patients in a clinical setting.

Galantamine has been demonstrated to be effective and generally safe in patients with Alzheimer's disease and cerebrovascular pathology (AD+CVD) in placebo-controlled trials. The aim of this open-label clinical trial (GAL-GER-5) was to observe cognitive function during long-term treatment with galantamine in patients with AD+CVD.

Open-label, multi-center clinical trial (phase IIIb). Patients with mild to moderate AD+CVD (meeting NINDS-AIREN criteria) received galantamine (4-12 mg bid) for 12 months. Cognitive function was examined using the AKT ("Alters-Konzentrations-Test") and DemTect. Statistics were based on intent-to-treat population (LOCF, t-test and Wilcoxon-test for dependent samples).

84 patients (43% with mild, 56% with moderate AD+CVD; mean age±SD 75.5±6.8 years; 58% women) were enrolled. 80% of the patients completed the study. Modal daily galantamine dose was 16mg for 44%, and 24mg for 51% of the patients. After 12 months mean total score in AKT showed a stabilization from 49.0±6.7 (baseline) to 49.2±6.9 (p=0.7807) and DemTect increased significantly from 7.8±2.0 to 9.4±3.9 (p<0.0001). CGI demonstrated an improvement or stabilization for 71% of patients. 56% of the patients had at least one adverse event (AE). Most frequent AEs with an incidence >5% were nausea and vomiting. 8 patients discontinued due to AEs. 21 patients experienced a SAE with 4 SAEs considered as possibly related to study medication (heart failure, syncope, aggravated dementia, urinary retention).

This open-label study supports evidence from placebo-controlled trials of the efficacy and safety of galantamine in patients with AD+CVD and suggests similar cognitive effects and safety through 12 months.

DAT is chronic, degenerative disease, which decrease quality of patientś life.DAT is one of the most frequent type of dementia (Pidrman, Kolibáš).

The most important signs of DAT are:cognitive deficit, behavioral and psychological symptoms of dementia (depression, apatia, incontinentia…) (Spar, Rue, 2003).

We have 34 patients with DAT in our retrospective study, the age:76,6 years(65-92y).

The goal of our study was follow the efficacy and safety of donepezil, rivastigmine and galantamine during titration phase and continuing phase.

The efficacy of the treatment with inhibitors of cholinesterase we assessed with MMSE and Clock test on first day, 3rd, 6th and 12th months and NPI (Neuropsychiatric Inventory test) during titration and continuing phases.

The safety of the treatment we assessed with the test of side effects, the most frequent were agitation, depression, agression and incontinentia.

Statistically we used CHí test(p=0,05) and ANOVA test.

The efficacy and safety of all inhibitors of cholinesterase were comparable,there were no significant differences and they have very good efficacy during one year treatment.

There were no frequent gastrointestinal side effects during the treatment with rivastigmine during titration and continuinf phase and the result were comparable with donepezil and galantamine without significant differences. There were no imprtant cardiovascular side effects during the long-term treatment with inhibitors of cholinesterase.

The efficacy and safety of all inhibitors of cholinesterase were comparable during titration and long-term treatment and without significant differences.

We conducted a complex clinical and psychological examination of 50 patients with cerebrovascular pathology.

All the patients were divided into four expert-rehabilitation groups (ERG) in accordance with the main indices which characterize psychological state (the state of cognitive functions, visual and motor coordination) and the degree of the expression of neurological deficiency. The aims and tasks were worked out for each ERG, as well as an individual plan of rehabilitation.

The patients of the first ERG (15 persons) differed from the major group in general in the level asthenia, persons of second ERG (10 persons) – in the level of anxiety (Р ≤ 0,05), people of the third ERG (15 persons) – in the level of anxiety and depression (reliably higher). The most significant differences with the major group were characteristic of the patients of the fourth ERG (10 persons). They showed a reliably lower level of the state of cognitive functions, visual and motor coordination, locus of control. Lower indices of cognitive functioning were kept in the fourth ERG in the dynamics during the whole course of earlier stationary rehabilitation, which points to the urgent necessity of the continuation of the whole course of correction and rehabilitation work, including psychosocial rehabilitation, on the following out-patient stage.

The division into the ERG allowed us to join the cases of diseases with similar symptoms and approximately identical technology of psychosocial and rehabilitation measures, their cost and supposed efficiency.

Auditory Processing Disorder (APD) is defined as a disorder in recognition, discrimination, separation, grouping, localisation or ordering of sounds.AP evaluation of children with learning disorders has two goals:1) to rule out an auditory processing disorder (APD) as a contributing factor for impaired cognition and 2) to diagnose APD in children with learning disabilities, in order to ensure appropriate remediation.

46 children were evaluated for Auditory Processing Disorders. 40 of them were fully assessed in 2 sessions each. 6 were lost to follow-up. We applied the: a) Peripheral hearing testing: Otoscopy, PTA, Speech audiometry b) AP battery:, Speech in noise, Duration Pattern Sequence (DPS), Pitch Pattern Sequence (PPS), Random GAP. C) Speech in noise: normative data from our lab. D) DPS,PPS, Random GAP: Standardized tests (Auditec, St. Louis). E) Learning Disability battery: WISC-III, Language tests (phonemic synthesis, non-words).

22 (of 40) 55% are diagnosed with Auditory Processing Disorders (at least 1 of the AP tests is pathological.) All 22 children with APD are already receiving appropriate treatment according to their auditory processing deficits and are being followed up for their progress. APD management strategies include: 1. Signal enhancement strategies 2. Specific Auditory Training 3.Linguistic, cognitive, metacognitive and educational strategies

Identification of underlying specific auditory deficits in the heterogeneous group of LD children may indicate what remedial action is appropriate, since appropriate management of the auditory processing deficits may lead to improved auditory as well as reading skills.

Ischemic neuronal disintegration of the brain tissue is a main risk factor for the development of a vascular dementia (VD). Because of the complexity of cerebrovascular and other factors it is not possible to describe the whole variance of the incidence of VD merely by genetic polymorphisms, however they may explain a part of the complexity. Nevertheless there is hope to identify the contribution of genetic markers in VD.

Data of clinically, neuropsychologically, neuroradiologically and genetically examined patients (n = 236) of a memory clinic were analysed upon the interrelation of clinical diagnosis according to ICD-10 and genetics, differentiated in the diagnostic groups: cognitively healthy persons (XD, n=65), VD (n=56) and Alzheimer´s Disease (AD, n=115).

Comparison of groups was done using descriptive statistics and analysis of variance.

The VD group (n=56) was genetically different compared to both groups, patients with Alzheimer disease (AD, n=115) and cognitively healthy persons (XD, n=65). For VD, there was a statistically significant correlation between some genetic markers and wmL load.

Regarding procentual frequency of the polymorphisms genetic pattern in patients with VD are different to XD but not to the AD group.

The wmL load is higher in VD and AD then in XD.

In general, the results are arguments against dichotomy and for the hypothesis of interaction between VD and AD in older age.

One of the signs of severity of a Vascular Dementia (VD) is white matter lesion load, although white matter lesions also occur in Alzheimer´s Dementia. These lesions reduce some cognitive and executive functions of the brain, that also affect the ability to draw a clock in CDT.

Here we would like to examine if there is a relation beetween WML load and severity of errors in the clock drawing test.

Patients (n = 236) of a memory clinic were examined clinically, neuropsychologically and neuroradiologically and differentiated in the following diagnostic groups according to ICD-10: cognitively healthy persons (XD, n=65), VD (n=56) and Alzheimer´s Disease (AD, n=115).

A large number of neuropsychological tests were done, one of them was the CDT, which was rated with a specially developed 8-point scale developed in our hospital instead of the 6-point scale established by Shulman.

Rating of the WML load was done according to a special 48- point score, also developed in our house.

Comparison of groups was done using descriptive statistics and analysis of variance.

For all the three groups we found a statistically significant correlation between WML load and CDT score on the p< 0,05 level.

Regarding the CDT score there was a highly significant correlation beetween XD/VD and XD/AD, but no correlation beetween VD/AD.

CDT seems to be an interesting tool in estimating wml load in dementias.

The lack of discriminatin beetween VD/AD could be perhaps overcome with an even finer scale.

In clinical practice, psychiatric morbidity often seems to complicate rehabilitation after traumatic brain injury (TBI). The aim of this study was to evaluate the occurrence of psychiatric disorders at 12 months after TBI.

Thirty-eight subjects had been referred to Turku University Hospital because of a recent TBI. Psychiatric disorders were assessed with the Schedules for Clinical Assessment in Neuropsychiatry (SCAN, version 2.1).

Six subjects (15.8%) had a psychiatric disorder with onset after TBI. The rates of these disorders were as follows: major depressive disorder 7.9%, depressive disorder not otherwise specified 5.3%, and posttraumatic stress disorder 2.6%. During the 12-month period before TBI, a psychiatric disorder could be diagnosed retrospectively in 14 subjects (36.8%). The most common disorders were alcohol dependence (18.4%) and major depressive disorder (10.5%). When disorders with onset before TBI and after TBI were considered together, 44.7% of the patients had psychiatric morbidity during the first 12 months after TBI. The lifetime rate of psychiatric disorders was as high as 65.8%.

During the first 12 months after TBI, the development of psychiatric disorders was less common than expected. However, depressive disorders were prevalent. Before TBI, alcohol use disorders were frequently found. As the occurrence of psychiatric disorders seems to be high in individuals with TBI, a need for psychiatric evaluation should be kept in mind when treating patients after TBI.

Depression and dementia are the most frequent mental disorders at senior age. It is assumed that long-term depressions grow into dementia and the relationship between both syndromes has been discussed. The purpose of our study was to establish whether there exists mutual relationship between dementia and depression and whether depression resistant to therapy is a risk factor for dementia development.

25 patients who suffered prolonged phases of depression resistant to therapy were included and monitored for two years. Their average age was 75.4 years (range 65 to 88). The diagnosis of the group was as follows: 11 patients suffered from periodical depressive disorder, 7 patients from depressive phase, 1 patient from bipolar affective disorder and 6 patients from organic depressive disorder. The patients met the diagnostic criteria of severe depression according to ICD-10, the depression grade was assessed by the Geriatric Depression Scale by Yessavage. The diagnosis of dementia was based on clinical examination, CT of the brain, cognitive functions were assessed using the MMSE test.

11 patients of the 25 observed persons with chronified depression symptoms passed into dementia in the course of 2 years. They were 4 patients suffering from periodical depressive disorder, 4 patients with depressive phase and 3 patients with organic depressive disorder.

Our study implies that the development of dementia in depressive patients is significantly more frequent than in non-depressive persons of comparable age. Chronic depression resistant to therapy represents a risk factor for the development of dementia.

A research of an early psychical disorder at children plays an important role in exploration of epilepsy. These children have broad spectrum of various pathological states which manifest early attacks of epilepsy (Betts T.A., 1995). The aim of current research is to learn early psychical disorders at children with epilepsy.

346 children in the age of 3-18 with epilepsy and psychical, behavioral disorders were observed between attacks of epilepsy. The disorders were compared with DSM- IV.

In most cases (54,9%) psychical, behavioral disorders didn't have association with epilepsy and in 45,1% of cases had association with epilepsy. These disorders had four variants: the mental deficiency – 70%, the psychoorganical syndrome – 21,6%, autism spectrum disorders – 2,6% and behavioral disorders – 5,8%.

190 children with psychical disorders had many injury factors in ontogenesis of brain. These factors were complicated pregnancy and childbirth, a trauma in the childbirth, negative heredity (relations these children had the mentally subnormal and addictional problems) and unfavorable environment. Children had the symptomatically, generalizationally and focally forms of the epilepsy.

At children epilepsy may be accompanied by the mental deficiency, psychoorganical syndrome, autism spectrum disorders and behavioral disorders. These conditions have no association with debut of epilepsy but psychical disorders and epilepsy undoubtedly complicate each other making these disorders harder.

To find out the dynamic peculiarities of the formation of non-psychotic (neurotic) disturbances after brain damage, and how non-organic factors conduce to their development.

124 patients with non-psychotic disturbances after brain damage were examined (mean age-35.7±1.11, mean duration-6.23±0.57) by dynamic clinical-psychopathological method. Using specially designed questionnaires the social-psychological states of the patients were assessed. They also completed SCL-90.

The patients distributed into 3 groups according to psychopathological analysis of the neurotic syndromes. 31 of them developed asthenic-depressive disturbances (G1), 57–personality changes (G2), 36-hypochondriacal disturbances(G3). The number of patients after brain trauma in G3 was lower than in G1 (p<0.01) and G2 (p<0.001). After intoxications the number of patients in G3 was higher, than in G1 (p<0.05) and G2 (p<0.001). Significant differences were found by the burdened familial history of mental disorders and premorbid constitutional accentuations of personality between G1 and G3 (p<0.05). 51 patients of the G2 (89.5%) were affected by severe psychogenic factors, but only 10 patients in G1 (32.2%) and 8 patients in G3 (22.2%) had the same influences. So the number of distressed patients in the G2 was higher than in G1 (p<0.001) and G3 (p<0.001). The Hostility by SCL-90 is higher in G2, than in G1 (p<0.05) and G3 (p<0.001).

There is certainly interplay of organic and non-organic factors in the genesis of non-psychotic disturbances after brain damage. The hereditary, constitutional and psychogenic factors are of great importance in the typological formation of the neurotic syndromes after brain damage.

There is an increasing awareness that pathological gambling can occur as an adverse effect of some dopamine agonist, specially pramipexole, used in the treatment of Parkinson disease. The aim of this study is: 1) to make a review of the literature concerning to this issue; 2) to describe a case that developed pathological gambling after increasing dopamine agonist dose in clinical practice.

We systematically searched PubMed database using the following combinations of variables: “compulsive gambling”, “Parkinson disease”, “dopamine agonist” and “gambling”. We also review the clinical record of the patient we identified.

We found 36 articles. 4 of them were excluded because they were not strictly about pathological gambling. They describe an association between treatment with dopamine agonists and reversible impulse control disorders (ICD) such as hypersexuality, addictions, compulsive eating and pathological gambling. Daily doses of dopamine agonists were significantly higher in patients who developed an ICD. Pramipexol was the predominantly reported medication. Our case is about a 46 year old married man with Parkinson disease. After increasing the dose of pramipexole in order to achieve a greater efficacy he gradually developed ICD, pathological gambling type. This led to a change in his antiparkinsonian medication.

As many cases of ICD after using dopamine agonists are being reported in the literature, doctors should aware patients about this potential adverse effect.

One of the major challenges in Asia is the impact of diseases in the aging population. Dementia is a common and disabling disorder in the elderly which has gained growing public health relevance. The Asian populations in developing countries have been known to report a lower prevalence of dementia, partially influenced by their cultural background and traditional societal roles for the elderly. We aim to investigate how living in a developed country with a strong Asian cultural background, influence perceptions on dementia.

We invited in-patients of a tertiary hospital, with no previously diagnosed cognitive impairment, to complete an anonymous, self-filled questionnaire about their perceptions of dementia, societal trends and the current role of elderly in Singapore.

Majority of respondents had strong traditional values and felt a duty of care for elderly within their family. Societal norms still suggests that our elderly would more likely give up position of authority and property for younger members of the family. Our elderly also became significantly less active in society after retirement.

With the rapid development of our society and trend towards nuclear families, the resultant possibility of higher carer stress and pressure for residential placement facilities are likely to grow.

Recent attention models view exogenous and endogenous attention as separate components of attention. Exogenous attention is defined as automatic, involuntary, directed by external stimulation and unaffected by memory load, while endogenous attention is defined as executive, voluntary, directed by voluntary acts and affected by memory load. Methods. Two studies were designed to examine if decline in these two components of attention is similar in normal aging and Huntington's disease (HD). Standardized tests derived from Posner's model of visuospatial attention were administered to normal elderly subjects (n=13), patients with HD (n = 17) and matched control subjects (n = 42).

In healthy elderly subjects, both exogenous and endogenous attention were found to decline within normal limits, and the decrease was greater for endogenous attention, particularly in situations of perceptual conflict. Patients with HD showed marked impairment of endogenous or voluntary attention components, while exogenous or automatic components were preserved.

Our results suggest that anterior executive and posterior automatic neuronal networks for attention are differentially vulnerable to the effects of normal aging and neurodegenerative diseases, despite the fact that both normal aging and HD are characterized by decreased endogenous attention in situations of perceptual conflict.

Triplex ultrasound evaluation of CCA in Alzheimer.

Our study group, consisted of 52 patients (32 male, mean age 68.2+/-2.2 yr), confirmed with Alzheimer dementia (AD) according to DSM IV-R criteria, was evaluated by triplex ultrasonography at the common carotid arteries (CCA) level and, also, by a cerebral CT-scann. The results were compared with a controlled matched group of similar age. In the AD group, 62.2% of patients presented ultrasonographic modifications: a larger CCA diameter (8.2+/-0.6 mm) and an increased arterial impedance (RI 0.82+/-0.05), significantly higher (p<0.001) compared with the values obtained from the controlled group (D 7.2+/-0.5 mm; RI 0.76+/- 0.02). Also, IMTh was more echogenous, diffuse or patchy thickened, with a mean maxIMTh 1.6 +/-0.02 mm in AD group, compared with 0.8+/-0.02 mm in the controlled group. We underline the absence of arterial atherosclerotic plaques in the all length of CCAs in AD group. The augmentation of arterial impedance correlated with the presence of cortical atrophy releved by cerebral CT-scann. In the AD group with these ultrasonographic aspects, we recommended vasodilatator drugs in association with cholinomimetics.

The vascular modifications (increased resistivity and decreased regional cerebral blood flow) in AD, draw attention on the early Doppler evaluation of these cathegory of patients. The ultrasonografic CCAs modifications, even in the stage of minimal cognitive deficit (when the criteria for establishing the diagnosis of dementia are not fulfilled), represent a factor of therapeutic indication for cholinomimetics, with a possible influence in the clinical and mental disease prognosis.