To investigate further the topographical, clinical and temporal correlates of crossed cerebellar diaschisis (CCD) after supratentorial stroke, 55 patients suffering from a single unilateral ischaemic stroke in the carotid artery territory were studied with the quantitative oxygen-15 steady-state technique and positron tomography. Fourteen patients had one or more follow-up studies, contributing a total of 72 studies. The phenomenon of CCD, defined by depressed oxygen consumption in the contralateral cerebellum, was statistically significant in 58% of the studies. It was more prominent when the supratentorial infarct involved the internal capsule or the cortical mantle extensively, consistent with the hypothesis that it results from destruction of the corticopontocerebellar fibres. Although CCD was associated with the presence of hemiparesis, it also occurred in patients without hemiparesis and was not seen in all those with hemiparesis, suggesting that destruction of the pyramidal tract is neither necessary nor sufficient to induce CCD. Finally, CCD tended to persist over long periods of time after a stroke, pointing towards a transneuronal degeneration possibly akin to crossed cerebellar atrophy as a likely explanation for CCD. Nevertheless, CCD could be seen within hours of a stroke and sometimes disappeared within a few days, suggesting a temporal continuum between early, potentially reversible functional hypometabolism (diaschisis) and irreversible degeneration.

The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits.

Objective To study the unawareness of cognitive deficits in patients with mild dementia of Alzheimer type (DAT). Design Retrospective study. We surveyed the medical records of outpatients meeting the NINCDS–ADRDA criteria for probable DAT who were able to complete the Cognitive Difficulties Scale (CDS) and had a close informant relative (IR) who could complete the family form of the same questionnaire. Setting A department of neurology in a general teaching hospital. Subjects Eighty‐eight patients, aged 73.2±8.6 years with a mean MMSE score of 22.5±3.2. Fifty‐two of the 88 patients had a follow‐up examination after a mean interval of 21 months. Methods Awareness of cognitive deficits was mainly assessed as the difference between the scores on the CDS completed by the IR and the patient (Index of Unawareness, IU). Two secondary assessments of unawareness were performed: (1) an assessment by the clinician on the basis of the patient's answers to questions probing the awareness of memory deficits; (2) an evaluation by the IR of the frequency of behavioural manifestations of unawareness in everyday life. SPECT was performed in 78 patients to study the relationship between unawareness and the topography of perfusion deficits. Results Awareness of the cognitive deficits varied greatly between patients, according to the assessment method used and the stage of progression of the disease. Most patients with mild DAT were cognitively aware of their cognitive deficits but failed to appraise their severity and their consequences in everyday life. Decreased awareness was positively correlated with age and perfusion deficits in the frontal regions and negatively with the anxious symptomatology. However, the main correlate of unawareness was apathy. Conclusion The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits. Copyright © 1999 John Wiley & Sons, Ltd.

Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age.

SUMMARYThe Cognitive Difficulties Scale (CDS, McNair and Kahn, 1984) was used to assess memory complaints in 1648 subjects devoid of severe medical or psychiatric disorder. The subjects, aged 4S75 years, were recruited when visiting their general practitioner. The CDS was well accepted and showed a good and stable factorial structure. A weak correlation was found between CDS score and the results of a short neuropsychological battery. A high CDS score was associated with advancing age, low educational level, and psychological motives for visiting. A reduced 26-item version is proposed to shorten the time required to fill in the scale.KEY worn-Memory complaints, memory assessment, Cognitive Difficuities Scale, Age-associated memory impairment.Many people over 50 years of age complain of decreased performance in everyday memory (Kral, 1958). The actual frequency of Such complaints, however, has rarely been evaluated in large-scale Address for correspondence: Professor C. DerouesnC, Department of Neurology n"3, HBpital de la Salgtritre, 47 Boulevard studies (Cutler and Grams, 1989) and its determination is highly dependent on the method of assessment (Cavanaugh, 198687). The assessment of memory complaints is crucial for including people in the recently described age-associated memory impairment construct (Crook a'a, 1986) and to assess the efficacy of drugs for Age-associated de YHBpital,

Objective To compare the quantitative and qualitative aspects of memory complaints in cognitively normal subjects aged under and above 50 years. Setting A memory clinic located in a general hospital in a suburb of Paris offering direct access to subjects. Design Retrospective review of the files of consecutive patients who attended the clinic during one year. Participants Subjects were included if (a) they presented with memory complaints, (b) they had normal general cognitive functioning according to age and educational level, (c) they were devoid of present or past history of neurologic or psychiatric disorders. Methods Subjects rated the severity of memory complaints as major or minor and filled in a 8‐item questionnaire assessing various memory difficulties in everyday life. Relationship between severity of memory complaints and demographic data, memory performance and affective status was compared in 183 non‐depressed, non‐cognitively impaired healthy adults aged 50 years and over, and in 77 younger adults. Results Semiologic aspects and correlates of memory complaints were similar in younger and older adults. No close relationship was found between severity of memory complaints and memory performance. In both age groups, memory complaints were strongly related to affective status, mainly to the severity of anxious symptomatology. Memory complaints were related to gender in younger subjects, and to subjective assessment of well‐being in older. Conclusion Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age. Copyright © 1999 John Wiley & Sons, Ltd.

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