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10 results

  • Use of Alzheimer’s Disease Cerebrospinal Fluid Biomarkers in A Tertiary Care Memory Clinic

  • Part of
  • Michael Stiffel, David Bergeron, Karim Mourabit Amari, Élizabeth Poulin, Xavier Roberge, Synthia Meilleur-Durand, Leila Sellami, Pierre Molin, Yannick Nadeau, Marie-Pierre Fortin, Stéphanie Caron, Stéphane Poulin, Louis Verret, Rémi W. Bouchard, Charlotte Teunissen, Robert Jr Laforce
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 49 / Issue 2 / March 2022
    Published online by Cambridge University Press:
    13 April 2021, pp. 203-209
    • Article
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  • Introduction:

    Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers are promising tools to help identify the underlying pathology of neurocognitive disorders. In this manuscript, we report our experience with AD CSF biomarkers in 262 consecutive patients in a tertiary care memory clinic.

    Methods:

    We retrospectively reviewed 262 consecutive patients who underwent lumbar puncture (LP) and CSF measurement of AD biomarkers (Aβ1–42, total tau or t-tau, and p-tau181). We studied the safety of the procedure and its impact on patient’s diagnosis and management.

    Results:

    The LP allowed to identify underlying AD pathology in 72 of the 121 patients (59%) with early onset amnestic mild cognitive impairment (aMCI) with a high probability of progression to AD; to distinguish the behavioral/dysexecutive variant of AD from the behavioral variant of frontotemporal dementia (bvFTD) in 25 of the 45 patients (55%) with an atypical neurobehavioral profile; to identify AD as the underlying pathology in 15 of the 27 patients (55%) with atypical or unclassifiable primary progressive aphasia (PPA); and to distinguish AD from other disorders in 9 of the 29 patients (31%) with psychiatric differential diagnoses and 19 of the 40 patients (47%) with lesional differential diagnoses (normal pressure hydrocephalus, encephalitis, prion disease, etc.). No major complications occurred following the LP.

    Interpretation:

    Our results suggest that CSF analysis is a safe and effective diagnostic tool in select patients with neurocognitive disorders. We advocate for a wider use of this biomarker in tertiary care memory clinics in Canada.

  • Rare Bilateral Caudate Infarction in a Patient with a Common Circle of Willis Variant

  • Mimma G. Anello, Timothy L. Miao, Sachin K. Pandey, Jennifer L. Mandzia
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 46 / Issue 5 / September 2019
    Published online by Cambridge University Press:
    31 July 2019, pp. 593-594
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  • A 62-year-old male presented to hospital with acute aphasia. His past medical history was significant for a previous left middle cerebral artery stroke, from which he fully recovered, hypertension, dyslipidemia, coronary artery disease, one episode of atrial fibrillation postoperatively, and thalidomide exposure in utero. Although initially he was thought to be aphasic, on further examination, he demonstrated significant abulia. His level of consciousness was normal, and neurological examination was otherwise unremarkable. A CT angiogram of the head and neck was performed. The patient was not a candidate for acute therapy, as he had established stroke on imaging, and the time of onset was unclear.

  • Aggression, DRD1 polymorphism, and lesion location in penetrating traumatic brain injury

  • Matteo Pardini, Frank Krueger, Colin A. Hodgkinson, Vanessa Raymont, Maren Strenziok, Mario Amore, Eric M. Wassermann, David Goldman, Jordan H. Grafman
  • Journal:
    CNS Spectrums / Volume 19 / Issue 5 / October 2014
    Published online by Cambridge University Press:
    11 March 2014, pp. 382-390
  • Objective

    This study evaluated whether structural brain lesions modulate the relationship between pathological aggression and the dopaminergic system in traumatic brain injury (TBI). While converging evidence suggests that different areas of the prefrontal cortex modulate dopaminergic activity, to date no evidence exists of a modulation of endogenous dopaminergic tone by lesion localization in penetrating TBI (pTBI).

    Methods

    This study included 141 male Caucasian veterans who suffered penetrating pTBI during their service in Vietnam and 29 healthy male Caucasian Vietnam veterans. Participants were genotyped for 3 functional single nucleotide polymorphisms (SNPs): dopamine receptor D1 (DRD1) rs686, dopamine receptor D2 (DRD2) rs4648317, and catechol-O-methyltransferase (COMT) Val158Met. Patients underwent brain CT scans and were divided into medial prefrontal cortex, lateral prefrontal cortex, and posterior cortex lesion groups. Long-term aggression levels were evaluated with the agitation/aggression subscale of the Neuropsychiatric Inventory.

    Results

    Our data showed that carriers of more transcriptionally active DRD1 alleles compared to noncarriers demonstrated greater aggression levels due to medial prefrontal cortex lesions but reduced aggression levels due to lateral prefrontal cortex lesions independently of DRD2 rs4648317 or COMT Val158Met genotypes.

    Conclusions

    Our results suggest that the relationship between pTBI-related aggression and the dopaminergic system is modulated by lesion location. Potentially lesion location could represent an easy-to-use, widely available, para-clinical marker to help in the development of an individualized therapeutic approach to pTBI-related pathological aggression.

  • 35 - Pharmacotherapyof behavioral disturbances

  • from Section III - Treatments in Behavioral Neurology & Neuropsychiatry
  • Edited by David B. Arciniegas, C. Alan Anderson, Christopher M. Filley
  • Book:
    Behavioral Neurology & Neuropsychiatry
    Published online:
    05 February 2013
    Print publication:
    24 January 2013, pp 566-586

  • Summary

    This chapter focuses on the basic principles of computed tomography (CT) and magnetic resonance imaging (MRI) used for imaging the brain structure. Indications for brain imaging in Behavioral Neurology & Neuropsychiatry (BN&NP) patients include: poison or toxin exposures, dementia or cognitive decline of unknown etiology, delirium, brain injuries of any type with ongoing symptoms, new-onset psychiatric symptoms, abnormal neurological findings suggesting brain pathology, and new-onset atypical psychosis. Imaging of the brain with MRI depends on the polar characteristics of the water molecule and its unique behavior within a strong magnetic field. Factors important to consider when choosing an imaging modality include type of suspected pathology, acuity of the illness, and desired planes of section. Doppler ultrasound (US) evaluation has been used successfully in clinical neurology as a screening tool to evaluate internal carotid artery (ICA) disease.

  • 24 - Neuropsychologicalassessment

  • from Section II - Neurobehavioral and Neuropsychiatric Assessment
  • Edited by David B. Arciniegas, C. Alan Anderson, Christopher M. Filley
  • Book:
    Behavioral Neurology & Neuropsychiatry
    Published online:
    05 February 2013
    Print publication:
    24 January 2013, pp 394-405

  • Summary

    This chapter reviews conceptual issues and definitions of the executive function. It is argued that executive function is a multidimensional construct and it is suggested that subspecialists in Behavioral neurology (BN) & Neuropsychiatry (NP) regard executive function principally as a cognitive domain. Executive function requires the integrated actions of the frontal-subcortical circuits, open-loop connections to other neocortical areas, limbic and paralimbic structures, thalamic nuclei, pontocerebellar networks, modulatory neurochemical projections from mesencephalic and ventral forebrain structures, and the white matter connections within and between all of these areas. As such, executive dysfunction is more accurately understood as dysfunction within or across these networks. The distributed structural and functional anatomy of executive function renders it vulnerable to disruption by many conditions affecting the brain. Finally, the chapter briefly discusses neuropsychological tests and bedside assessments of executive function.

  • 16 - Executivefunction

  • from Section I - Structural and Functional Neuroanatomy
  • Edited by David B. Arciniegas, C. Alan Anderson, Christopher M. Filley
  • Book:
    Behavioral Neurology & Neuropsychiatry
    Published online:
    05 February 2013
    Print publication:
    24 January 2013, pp 225-249

  • Summary

    This chapter outlines behavioral measures related to the control of attention and functional theories of attention based on such measures. It focuses on the control of visual attention in both normal and neurologically impaired individuals. The major types of attention are: spatial attention, in which stimuli are selected based on their position in space; object-based attention, in which stimuli are selected based on their identity; attentional selection in visual working memory, in which attention selects items that will be remembered; and executive attention, in which attention is involved in choosing which task or behavior an observer will perform. The chapter provides evidence for a number of cerebral sites that appear to be involved in the overall control of attention. Understanding how these sites interact and how they relate to functional theories of attentional control increases understanding of normal and disordered attentional control processes.

  • 9 - Motivation

  • from Section I - Structural and Functional Neuroanatomy
  • Edited by David B. Arciniegas, C. Alan Anderson, Christopher M. Filley
  • Book:
    Behavioral Neurology & Neuropsychiatry
    Published online:
    05 February 2013
    Print publication:
    24 January 2013, pp 134-143

  • Summary

    This chapter focuses on aspects of structural and functional neuroanatomy relevant to Behavioral Neurology & Neuropsychiatry (BN&NP). It considers the general structure of the brain from the brainstem through the cerebral cortex, including a review of white matter anatomy, the cerebral vasculature, and the ventricular system. The brainstem comprises the medulla oblongata, pons and cerebellum, and midbrain. Each of these areas and the neurobehaviorally salient structures they contain are reviewed briefly in the chapter. The reticular formation (which is contributed to by several brainstem substructures) and the cranial nerves (some, but not all, of which are located within the brainstem) also are discussed in the chapter. The diencephalon includes the thalamus, metathalamus (medial and lateral geniculate nuclei), epithalamus (habenula, stria medullaris, and pineal body), and subthalamus. The chapter considers briefly the thalamus, hypothalamus (and pituitary), and the epithalamus.

  • 8 - Attention

  • from Section I - Structural and Functional Neuroanatomy
  • Edited by David B. Arciniegas, C. Alan Anderson, Christopher M. Filley
  • Book:
    Behavioral Neurology & Neuropsychiatry
    Published online:
    05 February 2013
    Print publication:
    24 January 2013, pp 115-133

  • Summary

    Neurology and psychiatry are securely established medical specialties with well-demarcated areas of clinical and research expertise. Behavioral neurology (BN) is widely held to have begun with the work of Norman Geschwind in the mid-twentieth century. A neuropsychiatric approach to patient care began to reemerge and steadily gain momentum as physicians increasingly appreciated the neurologic bases of psychiatric disease and the psychiatric aspects of neurologic disease. The prospect of BN and neuropsychiatry (NP) drawing together finds considerable support in academia. Annual scholarly meetings are held conjointly by the Society for Behavioral and Cognitive Neurology and the American Neuropsychiatric Association in order to disseminate new research findings and educate practitioners. Traumatic brain injury occupies a major portion of the practice of many subspecialists in BN&NP and additional studies are needed to better define the best methods of neurorehabilitation.

  • 28 - Electroencephalography

  • from Section II - Neurobehavioral and Neuropsychiatric Assessment
  • Edited by David B. Arciniegas, C. Alan Anderson, Christopher M. Filley
  • Book:
    Behavioral Neurology & Neuropsychiatry
    Published online:
    05 February 2013
    Print publication:
    24 January 2013, pp 442-458

  • Summary

    The genetic contribution to many neuropsychiatric disorders is disclosed by obtaining a family history. Patients with dissociative and conversion disorders often present to subspecialists in Behavioral Neurology & Neuropsychiatry (BN&NP). BN&NP remains a bastion of bedside medicine in an increasingly technological medical world. The clinician should screen for other symptoms when a dissociative or conversion disorder diagnosis is under consideration. Clinicians should routinely ask about nocturnal sleep timing and duration, sleep quality, and excessive daytime sleepiness. Many patients presenting with psychiatric symptoms have a remote history of traumatic brain injury (TBI), and a screening question about TBI should be routine in the psychiatric evaluation. Patients with many cerebral diseases, including incipient degenerative disease, cerebrovascular disease, multiple sclerosis, and past mild TBI, experience cognitive problems that are distressing and noticeable to others but not of a severity sufficient to warrant a diagnosis of dementia.