Forty-three patients with 'late paraphrenia' were subjected to detailed clinical and psychological assessment and computed tomography (CT). The paraphrenics had significantly larger lateral cerebral ventricles and greater cognitive deficits than a group of 40 age-matched normal volunteers. Group comparisons within the patients, between those with particularly large ventricular brain ratio (VBR) (equal or more than two standard deviations above the control mean) and the rest of the group, showed that the extent of ventricular enlargement had no direct bearing on the clinical presentation of the paraphrenic syndrome. The results suggest that ventricular enlargement may have preceded the onset of overt symptoms by a period of years and probably served as a non-specific risk factor for the development of the disorder. The unimodal distribution of VBR values suggests that paraphrenia, at least at a brain structural level, is a unitary condition. It also indicates the presence of subcortical pathology which might be in part responsible for the cognitive dysfunction elicited.
We report a 3.7 year follow-up study carried out on 42 patients with an original diagnosis of late paraphrenia who had had a CT scan and simple tests of cognition in addition to an assessment by means of the Geriatric Mental State Schedule. Mortality was found to be no different than in a control group. Patients showed improvement in target symptoms but exhibited a good deal of residual morbidity, particularly of motor and cognitive function. Cognitive performance, which was previously mildly impaired, showed some futher deterioration, usually falling short of clear-cut dementia. Ventricular size on the CT scan was not a predictor of outcome. The article highlights the organic substrate of late paraphrenia but suggests that the cerebral changes are relatively subtle and slowly progressive.K E Y wow-Paraphrenia, follow-up study.Requests for reprints: Section of Old Age Psychiatry,
Forty patients suffering from senile dementia who had been subjected to detailed clinical and psychological assessment and computed tomography (CT) were followed up for a mean period of 28.78 months. All but one were traced. The deceased (27) were compared with the survivors (12). All males had died at follow-up. The mean age was not statistically significant, but the survivors differed significantly from the deceased in having performed better on a number of clinical and psychological tests, particularly those involving speech functions and constructional ability. Measures of ventricular size and cortical atrophy were not of predictive value, but a new technique of measuring radiological density showed that this was significantly lower in the right parietal region in the original CT scans of those who subsequently died. The study confirms that clinical involvement of the parietal lobes is an indication of poor prognosis and reports the first radiological support for this view. It also suggests that a more directly quantitative approach to computed tomography may yield results which are more useful than those obtained from visual reconstructions.
The brains of 41 late paraphrenics, 16 of whom had first-rank symptoms, were examined by CT. Late paraphrenics with first-rank symptoms had significantly less cortical atrophy than those without them.
SUMMARYThe cortical appearance on CT scan in patients suffering from late paraphrenia was assessed compared to that of age-matched normal controls. There was no difference in overall cortical appearance between the two groups. However, a correlation existed between ventricular size and cortical size and between ventricular size and age in normal controls but this was not present in paraphrenia. The implications of these findings are discussed in relation to a possible structural abnormality in late paraphrenia.K F Y woRD\-Cortical atrophy, ventricular brain ratio, late paraphrenia, CT scan.
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