Quantitative indexes of compute tomography were compared in 28 patients with Alzheimer dementia and in 30 elderly persons with no history of neurologic disease. Age-corrected ventricle-brain ratios were abnormal for half of the dementia patients, whereas only a single subject in the control group had ventricles outside the limits of normal variation. Measurement of the distance between the third ventricle and Sylvian fissure indicated that the dementia patients had significantly more atrophy in this area. Employment of quantitative indexes standardized for age may aid in differentiating cerebral atrophy associated with dementia from that associated with normal aging.
Sixty-two patients were classified as having Alzheimer-type dementia (AD) or multi-infarct dementia (MID) on the basis of clinical criteria. Protocols from the Wechsler Adult Intelligence Scale (WAIS) were scored according to a formula reported by Fuld to reflect the effects of scopolamine administration in young adults. The formula correctly classified 13 of 23 AD patients and 37 of 39 MID patients. The formula was similar to Wechsler's deterioration quotient, which produced a greater number of false positives. The formula did not appear to be biased by age, sex, or severity of impairments. Results suggest that the neuropsychological investigation of AD which emphasizes the deficiencies in cholinergic neurotransmission may be a fruitful avenue of further investigation.
30 patient receiving right or left carotid reconstruction and 15 medically matched controls were compared pre- and post-surgically on measures of motor speed, sustained vigilance, verbal memory and verbal and nonverbal intellectual function. The group receiving right sided vessel reconstruction demonstrated the largest post-operative improvement in intellectual function in any of the groups. The findings suggest that increased blood perfusion following right sided endarterectomy facilitates the right hemisphere's exclusive control of bilateral attention/arousal responses. In addition, findings suggest that detection of post-endarterectomy improvement may be dependent on the specific task dimension sampled, e.g., speed vs. cognitive ability and verbal-graphic vs. nonverbal symbol manipulation.
SUMMARY Fourteen patients with severe bilateral carotid artery stenosis underwent carotid endarterectomy. Intra-operative ischemia was monitored by somatosensory evoked potentials (SSEP) bilaterally. Neuropsychological evaluations were completed within two days before operation and 4-9 days after operation. Complete loss of Nl-Pl or P1-N2 components of the SSEP (seen in 4 patients) was associated with a worsening of neuropsychological abilities (p < .01). Two of these patients subsequently had strokes (7 and 35 days after operation). No other patients in the series have had strokes. Patients whose Nl-Pl or P1-N2 amplitudes decreased by 50% or more performed worse after operation than patients with less severe reductions in these amplitudes (p < .02). Time since first ischemic symptoms, age, education, clamp time, pre-operative stroke, and interval from surgery to assessment were not statistically related to changes in neuropsychological abilities. Patients with ischemic events in the week prior to surgery tended to improve in neuropsychological abilities 4-9 days after operation (p < .05). Recentness of ischemic episode, however, was not related to intra-operative SSEP change. Results suggest the potential utility of intra-operative SSEP monitoring and early post-operative neuropsychological assessments both for clinical and research purposes. Stroke Vol 15, No 3, 1984 PERI-OPERATIVE STROKE is the most significant complication attending carotid endarterectomy. Although such strokes result from a number of causes, one recognized mechanism is ischemic damage induced by clamping the internal carotid artery to insert a shunt or to perform the endarterectomy without a shunt.1 A major methodological difficulty in assessing the impact of intra-operative ischemia on peri-operative stroke is the inability to isolate ischemia from other pathogenetic mechanisms and the requirement for large sample sizes because of the low frequency of frank stroke when it is used as the outcome measure. This latter difficulty requires data collection to proceed for long periods to distinguish factors predisposing to peri-operative stroke. The present study is designed to assess and correlate two more versatile outcome measures related to intra-operative ischemia: 1) early postoperative neuropsychological performance, and 2) altered intra-operative evoked cortical potentials.Alterations in the electrical activity of the brain have frequently been demonstrated to occur in response to ischemia. The spontaneous electroencephalogram displays amplitude and mean frequency reductions in the face of ischemia measured by 131 Xenon inhalation techniques during carotid endarterectomy.2 3 Intra-operative monitoring of somatosensory evoked cortical potentials appears to provide promise as an intraoperative monitoring technique, 43 since a firm relationship between evoked cortical potentials and ceFrom the
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