Dementia with Lewy bodies

Dementia with Lewy bodies (‘Lewy body dementia' or ‘diffuse Lewy body disease') (DLB) is the second commonest form of dementia after Alzheimer’s disease (AD). Characteristic of DLB are: (1) fluctuating cognitive ability with variations in attention and alertness, (2) recurrent visual hallucinations, and (3) motor features including akinesia, rigidity, and tremor. Various brain regions are affected in DLD including cortical and limbic regions. Histopathologically, alpha-synuclein-immunoreactive Lewy bodies (LB) are observed in the substantia nigra and in the cerebral cortex. DLB has affinities both with the parkinsonian syndromes including Parkinson’s disease (PD), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and multiple system atrophy (MSA), and with AD, which can make differential diagnosis difficult. The presence of visual hallucinations may aid differential diagnosis of the parkinsononian syndromes and occipital hypometabolism may be a useful potential method of distinguishing DLB from AD. Treatment of CBD involves managing and reducing the effect of symptoms.

Oculo-visual changes and clinical considerations affecting older patients with dementia

Purpose: Dementia is associated with various alterations of the eye and visual function. Over 60% of cases are attributable to Alzheimer's disease, a significant proportion of the remainder to vascular dementia or dementia with Lewy bodies, while frontotemporal dementia, and Parkinson's disease dementia are less common. This review describes the oculo-visual problems of these five dementias and the pathological changes which may explain these symptoms. It further discusses clinical considerations to help the clinician care for older patients affected by dementia. Recent findings: Visual problems in dementia include loss of visual acuity, defects in colour vision and visual masking tests, changes in pupillary response to mydriatics, defects in fixation and smooth and saccadic eye movements, changes in contrast sensitivity function and visual evoked potentials, and disturbance of complex visual functions such as in reading ability, visuospatial function, and the naming and identification of objects. Pathological changes have also been reported affecting the crystalline lens, retina, optic nerve, and visual cortex. Clinically, issues such as cataract surgery, correcting the refractive error, quality of life, falls, visual impairment and eye care for dementia have been addressed. Summary: Many visual changes occur across dementias, are controversial, often based on limited patient numbers, and no single feature can be regarded as diagnostic of any specific dementia. Nevertheless, visual hallucinations may be more characteristic of dementia with Lewy bodies and Parkinson's disease dementia than Alzheimer's disease or frontotemporal dementia. Differences in saccadic eye movement dysfunction may also help to distinguish Alzheimer's disease from frontotemporal dementia and Parkinson's disease dementia from dementia with Lewy bodies. Eye care professionals need to keep informed of the growing literature in vision/dementia, be attentive to signs and symptoms suggestive of cognitive impairment, and be able to adapt their practice and clinical interventions to best serve patients with dementia.

Evidence for the early clinical relevance of hallucinatory-delusional states in the general population

OBJECTIVE: To analyze, in a general population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters. METHOD: General population-based household surveys of randomly selected adults between 18 and 65 years of age were carried out. SETTING: 52 countries participating in the World Health Organization's World Health Survey were included. PARTICIPANTS: 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated. RESULTS: Compared with isolated delusions and hallucinations, co-occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92-0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0-3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5-14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3-22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9-12.4). Co-occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8-2.3). CONCLUSION: The results suggest that the co-occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state.

Evaluation of a mentored self -help intervention for the management of psychotic symptoms

Cognitive behavioral therapy has been shown to be promising for the treatment of individuals experiencing psychotic symptoms, who are often diagnosed with schizophrenia. Using a non-random non-equivalent comparison group design (n = 26), this study explores whether an individually mentored self-help and self-paced intervention based upon cognitive behavioral approaches to auditory hallucinations or "hearing voices" makes a significant positive difference for individuals with major mental disorder diagnoses and psychotic symptoms who are residing in the community and receiving community mental health services. The mentored self-help intervention uses a workbook (Coleman & Smith, 1997) that stemmed from the British psychiatric survivor and "voice hearers"' movements and from cognitive behavioral approaches to treating psychotic symptoms. Thirty individuals entered the study. Pre- and post-intervention assessments of 15 participants in the intervention group and 11 participants in the comparison group were carried out using standardized instruments, including the Rosenberg Self-Esteem Scale, the Brief Psychiatric Rating Scale, and the Hoosier Assurance Plan Inventory - Adult. Four specific research questions address whether levels of self-esteem, overall psychotic symptoms, depression-anxiety, and disruption in life improved in the intervention group, relative to the comparison group. Pre- and post-assessment scores were analyzed using repeated measures analysis of variance. Results showed no significant difference on any measure, with the exception of the Brief Psychiatric Rating subscale for Anxious Depression, which showed a statistically significant pre-post difference with a strong effect size. A conservative interpretation of this single positive result is that it is due to chance. An alternative interpretation is that the mentored self-help intervention made an actual improvement in the level of depression-anxiety experienced by participants. If so, this is particularly important given high levels of depression and suicide among individuals diagnosed with schizophrenia. This alternative interpretation supports further research on the intervention utilized in this study. ^

Le niveau d'anxiété sociale chez des étudiants universitaires ayant déjà vécu des sensations de présence durant des épisodes de paralysie du sommeil isolée

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Deliberate and spontaneous sensations of disembodiment:capacity or flaw?

Introduction: Hallucinations that involve shifts in the subjectively experienced location of the self, have been termed “out-of-body experiences” (OBEs). Early psychiatric accounts cast OBEs as a specific instance of depersonalisation and derealisation disorder (DPD-DR). However, during feelings of alienation and lack of body realism in DPD-DR the self is experienced within the physical body. Deliberate forms of “disembodiment” enable humans to imagine another’s visuo-spatial perspective taking (VPT), thus, if a strong relationship between deliberate and spontaneous forms of disembodiment could be revealed, then uncontrolled OBEs could be “the other side of the coin” of a uniquely human capacity. Methods: We present a narrative review of behavioural and neuroimaging work emphasising methodological and theoretical aspects of OBE and VPT research and a potential relationship. Results: Results regarding a direct behavioural relationship between VPT and OBE are mixed and we discuss reasons by pointing out the importance of using realistic tasks and recruiting genuine OBEers instead of general DPD-DR patients. Furthermore, we review neuroimaging evidence showing overlapping neural substrates between VPT and OBE, providing a strong argument for a relationship between the two processes. Conclusions: We conclude that OBE should be regarded as a necessary implication of VPT ability in humans, or even as a necessary and potentially sufficient condition for the evolution of VPT.

Visual signs and symptoms of corticobasal degeneration

Corticobasal degeneration is a rare, progressive neurodegenerative disease and a member of the 'parkinsonian' group of disorders, which also includes Parkinson's disease, progressive supranuclear palsy, dementia with Lewy bodies and multiple system atrophy. The most common initial symptom is limb clumsiness, usually affecting one side of the body, with or without accompanying rigidity or tremor. Subsequently, the disease affects gait and there is a slow progression to influence ipsilateral arms and legs. Apraxia and dementia are the most common cortical signs. Corticobasal degeneration can be difficult to distinguish from other parkinsonian syndromes but if ocular signs and symptoms are present, they may aid clinical diagnosis. Typical ocular features include increased latency of saccadic eye movements ipsilateral to the side exhibiting apraxia, impaired smooth pursuit movements and visuo-spatial dysfunction, especially involving spatial rather than object-based tasks. Less typical features include reduction in saccadic velocity, vertical gaze palsy, visual hallucinations, sleep disturbance and an impaired electroretinogram. Aspects of primary vision such as visual acuity and colour vision are usually unaffected. Management of the condition to deal with problems of walking, movement, daily tasks and speech problems is an important aspect of the disease.

Le niveau d'anxiété sociale chez des étudiants universitaires ayant déjà vécu des sensations de présence durant des épisodes de paralysie du sommeil isolée

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Effekter av icke-farmakologiska metoder vid beteendemässiga och psykiska symtom hos personer som lever med Alzheimers sjukdom : En litteraturöversikt

Bakgrund: Alzheimers sjukdom (AD) är den vanligaste formen av demenssjukdomar och antalet människor som insjuknar i AD förväntas öka kraftigt med tiden. Dessutom kännetecknas personer med AD ofta av beteendemässiga och psykiska symtom (BPSD) som kan innefatta agitation, depression, vanföreställningar, oro, ångest, hallucinationer, sömnrubbningar, rastlöshet och apati. Dessa symtom kan orsaka lidande hos patienten och är svåra att hantera för både vårdgivaren och anhöriga, samt försvårar omvårdnadsarbetet. Syftet var att beskriva icke-farmakologiska metoder och effekter av dessa metoder vid omvårdnad av personer med Alzheimers sjukdom som har beteendemässiga och psykiska symtom. Metod: En litteraturöversikt bestående av 16 utvalda kvantitativa forskningsartiklar har genomförts. Artiklarna publicerades mellan år 2006-2016. Resultat. De studerade icke-farmakologiska metoderna var musikterapi, vissa typer av massage, reminiscence-terapi, vårdhundterapi och ljusterapi. Resultaten visade att icke-farmakologiska metoder kan ha en varierande effekt på BPSD. Litteraturöversikten visade att musikintervention var mest effektiv för att minska agitationsbeteende. Individualiserad musik i samband med speciella minnen minskade stress, fobier hos personer med svår demens. Intervention av handmassage, aromaterapi, taktil massage och terapeutisk beröring minskade aggression och agitationsbeteende. Vissa studier visade dock att fotmassageintervention och vårdhundterapi kunde öka verbal aggressivitet hos personer med demens, medan en annan studie visade att djurassisterade aktiviteter kunde minska nedstämdhet medan glädje och generell uppmärksamhet ökade. Effekten av ljusbehandling var förbättrad sömn, minskad depression, agitation och ätstörningar. Slutsats. Icke-farmakologiska metoder kan minska beteendemässiga och psykiska symtom hos personer med Alzheimers sjukdom, dock med varierande effekt. De varierande resultaten kan tolkas som att icke-farmakologiska metoder bör individanpassas och att det behövs vidare forskning inom området.

Mémoire de source, propension à halluciner et psychose : identification de marqueurs cognitifs et cliniques chez une population à haut risque génétique

Les déficits cognitifs sont centraux à la psychose et sont observables plusieurs années avant le premier épisode psychotique. L’atteinte de la mémoire épisodique est fréquemment identifiée comme une des plus sévères, tant chez les patients qu’avant l’apparition de la pathologie chez des populations à risque. Chez les patients psychotiques, l’étude neuropsychologique des processus mnésiques a permis de mieux comprendre l’origine de cette atteinte. Une altération des processus de mémoire de source qui permettent d’associer un souvenir à son origine a ainsi été identifiée et a été associée aux symptômes positifs de psychose, principalement aux hallucinations. La mémoire de source de même que la présence de symptômes sous-cliniques n’ont pourtant jamais été investiguées avant l’apparition de la maladie chez une population à haut risque génétique de psychose (HRG). Or, leur étude permettrait de voir si les déficits en mémoire de source de même que le vécu d’expériences hallucinatoires sont associés à l’apparition de la psychose ou s’ils en précèdent l’émergence, constituant alors des indicateurs précoces de pathologie. Afin d’étudier cette question, trois principaux objectifs ont été poursuivis par la présente thèse : 1) caractériser le fonctionnement de la mémoire de source chez une population HRG afin d’observer si une atteinte de ce processus précède l’apparition de la maladie, 2) évaluer si des manifestations sous-cliniques de symptômes psychotiques, soit les expériences hallucinatoires, sont identifiables chez une population à risque et 3) investiguer si un lien est présent entre le fonctionnement en mémoire de source et la symptomatologie sous-clinique chez une population à risque, à l’instar de ce qui est documenté chez les patients. Les résultats de la thèse ont permis de démontrer que les HRG présentent une atteinte de la mémoire de source ciblée à l’attribution du contexte temporel des souvenirs, ainsi que des distorsions mnésiques qui se manifestent par une fragmentation des souvenirs et par une défaillance de la métacognition en mémoire. Il a également été observé que les expériences hallucinatoires sous-cliniques étaient plus fréquentes chez les HRG. Des associations ont été documentées entre certaines distorsions en mémoire et la propension à halluciner. Ces résultats permettent d’identifier de nouveaux indicateurs cliniques et cognitifs du risque de développer une psychose et permettent de soulever des hypothèses liant l’attribution de la source interne-externe de l’information et le développement de la maladie. Les implications empiriques, théoriques, méthodologiques et cliniques de la thèse sont discutées.

A Rare Cause of Confusion: Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis

An 81-year-old female patient required numerous admissions for symptoms of confusion, visual hallucinations, myoclonus and seizures, which were treated as stroke, infections and viral encephalitis with some improvement after treatment but with recurrence that caused her to be readmitted to hospital. On the last admission, she was found to have very high antithyroid antibodies and a diagnosis of Hashimoto’s encephalopathy was made, with an overwhelming response to steroids.

First-episode psychosis in a 15 year-old female with clinical presentation of anti-NMDA receptor encephalitis: a case report and review of the literature

BACKGROUND: Anti-NMDA receptor encephalitis is an autoimmune disease that was identified in 2007, and manifests in a stepwise manner with psychiatric, neurological and autonomic symptoms. The disease is caused by autoantibodies against NMDA receptors. It can have a paraneoplastic origin, mainly secondary to ovarian teratomas, but it can also be unrelated to the tumor. This disease can affect both sexes and all ages. CASE PRESENTATION: Here, we present a case of a 15 year-old female adolescent with first-episode psychosis with anti-NMDA receptor encephalitis not related to tumor, which manifested with delusion, hallucinations, panic attacks, agitation, and neurological symptoms, and later with autonomic instability. She was treated with immunotherapy and psychiatric medication resulting in improvement of her main psychiatric and neurological symptoms. CONCLUSION: Our main objective in presenting this case is to alert clinicians to this challenging and recent disease that has a clinical presentation that might resemble a functional psychiatric condition and can be underdiagnosed in the context of child and adolescent psychiatry

Relación de biomarcadores de dosis interna con síntomas neurológicos y de conducta en pintores de carros de la ciudad de Bogotá, 2015

Introducción: El uso de solventes orgánicos es muy frecuente en diferentes industrias y sectores económicos a nivel mundial, estos generan una importante exposición ocupacional asociándose con efectos mutagénicos, carcinógenos, teratogénicos y otros trastornos principalmente de tipo neurológico y de conducta. Objetivo: Determinar la relación entre la presencia de biomarcadores de dosis interna para solventes orgánicos y la existencia de síntomas neurológicos y de conducta en pintores de carros de la ciudad de Bogotá. Materiales y Métodos: Estudio de corte transversal una muestra de 122 individuos, 62 expuestos y 60 en el grupo control. Se incluyeron variables sociodemográficas, ocupacionales, clínicas y los resultados de biomarcadores en orina para benceno, tolueno y xileno (ácido S-fenilmercapturico, ácido hipúrico y orto, para y meta-metilhipúrico respectivamente). Para el análisis de la información se obtuvieron medidas de tendencia central y dispersión. Se utilizó análisis de correlación de Spearman y la prueba Chi cuadrado de asociación para establecer la relación entre la exposición ocupacional y los síntomas presentes obtenidos de la aplicación del cuestionario Q 16. El nivel de significación para las pruebas fue 0.05. Resultados: Los valores del ácido hipúrico estuvieron por encima de los límites permisibles en 17,74% (11) de los trabajadores y los de ácido p-metilhipúrico en el 12,90% (8) de ellos. No se registraron valores de ácido fenil-mercaptúrico por fuera del límite permitido. El 25% (15) de la población expuesta manifestó síntomas neurológicos. Se encontró una relación significativa entre los siguientes síntomas y la presencia de biomarcadores: ácido hipúrico y somnolencia (p=0.009), perdida del deseo sexual (p= 0 .019); ácido metilhipúrico y olvida hacer cosas importantes (p=0 .019), pérdida de fuerza en brazos o piernas (p= 0.013) e insomnio (p= 0.028); ácido fenil-mercaptúrico y alucinaciones (p= 0.000). Dos síntomas tuvieron una relación significativa tanto para el ácido hipúrico como para el ácido metilhipúrico: anormalmente cansado (p= 0.001 y 0.046) y dificultad para abotonarse (p= 0.045 y 0.002). Conclusiones. La presencia de síntomas neurológicos y de conducta son indicadores importantes de la exposición a solventes orgánicos. La aparición y detección temprana de estos permitirán establecer medidas de promoción y prevención al igual que programas de vigilancia epidemiológica.