Advertisement

Clinical Manifestations as a Determinant of Dementia

  • Richard M. Torack
Part of the Monographien aus dem Gesamtgebiete der Psychiatrie book series (PSYCHIATRIE, volume 20)

Abstract

The terminal phase of the slow inexorable process that disintegrates the human mind results in the most profound form of depravity known to mankind. Physical disability with a variable painful overlay certainly creates widespread sentiment of sympathy. Mental retardation evokes universal grief for a life that could have been. However, the transformation of a viable functioning intellectual animal into a vegetative being without awareness, and without responsiveness represents the ultimate degradation not only for the human but for any other animal species. There is nothing very subtle about its impact; yet it has inspired some of the most poignant poetry and prose every recorded. For example, Shakespeare speaks for King Lear abouthis mental confusion:

Does any here know me? This is not Lear: Does Lear walk thus? speak thus? Where are his eyes? Either his notion weakens, or his discernings Are lethargied. Ha! waking? Tis not so. Who is it than can tell me who I am?

and finally about the welcome of death:

Vex not his ghost: 0! let him pass; he hates him That would upon the rack of this tough world Stretch him out longer. (Shakespeare.) Early clinicians also speak passionately of dementia.

Keywords

Limbic System Senile Dementia Normal Pressure Hydrocephalus Normal Pressure Hydrocephalus Affective Psychosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams, R.D., Fisher, C.M., Hakim, S., Ojemann, R.G., Sweet, W.H. (1965): Symptomatic occult hydrocephalus with normal cerebrospinal fluid pressure. N. Engl. J. Med. 273, 117–126PubMedCrossRefGoogle Scholar
  2. Avery, L. (1945): Common factors precipitating mental symptoms in the aged. Arch. Neurol. Psychiatry 54, 312–314PubMedGoogle Scholar
  3. Bleuler, E. (1924): Textbook of Psychiatry. (Translated by A.A. Brill). New York: MacMillan, p. 277Google Scholar
  4. Bowen, D.M., Smith, C.B., White, P., Davison, A.N. (1976): Neurotransmitter-related enzymes and indices of hypoxia in senile dementia and other abiotrophies. Brain 99, 459–496PubMedCrossRefGoogle Scholar
  5. Brierly, J.B., Corsellis, J.A.N., Hierons, R., Nevin, S. (1960): Subacute encephalitis of later adult life mainly affecting the limbic areas. Brain 83, 357–368CrossRefGoogle Scholar
  6. Brownell, B., Oppenheimer, D.R. (1965): An ataxic form of subacute presenile polioencephalopathy (Creutzfeldt-Jakob disease). J. Neurol. Neurosurg. Psychiatry 25, 350–361CrossRefGoogle Scholar
  7. Brun, A., Gustafson, L. (1976): Distribution of cerebral degeneration in Alzheimer’s disease. Arch. Psychiatr. Nervenkr. 223, 15–33PubMedCrossRefGoogle Scholar
  8. Clouston, T.S. (1884): Clinical Lectures on Mental Disease. Philadelphia: Leas and SonCrossRefGoogle Scholar
  9. Clouston, T.S. (1911): Unsoundness of Mind. New York: DuttonGoogle Scholar
  10. Coblentz, J.M., Mattis, S., Zingesser, L.H., Kasoff, E.S., Wisnieski, H.M., Katzman, R. (1973): Presenile dementia. Arch. Neurol. 29, 299–308PubMedCrossRefGoogle Scholar
  11. Corsellis, J.A.N. (1962): Mental Illness and the Aging Brain. London: OxfordGoogle Scholar
  12. Corsellis, J.A.N., Goldberg, G.J., Norton, A.R. (1968): Limbic encephalitis and its association with carcinoma. Brain 91, 481–496PubMedCrossRefGoogle Scholar
  13. Creutzfeldt, H.G. (1920): Über eine eigenartige herdförmige Erkrankung des Zentralnervensystems. Z. Neurol. Psychiatr. 57, 1–18CrossRefGoogle Scholar
  14. Davies, P., Maloney, A.J.F. (1976): Selective loss of central cholinergic neurons in Alheimer’s disease. Lancet 2, 1403PubMedCrossRefGoogle Scholar
  15. Drachman, D.A., Adams, R.D. (1962): Herpes simplex and acute inclusionbody encephalitis. Arch. Neurol. 7, 45–63PubMedCrossRefGoogle Scholar
  16. Fischer, O. (1910): Die presbyophrene Demenz, deren anatomische Grundlage und klinische Abgrenzung. Z. Neurol. Psychiatr. 3, 371–471CrossRefGoogle Scholar
  17. Friedman, H.M., Allen, N. (1969): Chronic effects of complete limbic lobe destruction in man. Neurology 19, 679–690PubMedGoogle Scholar
  18. Gajdusek, D.C., Gibbs, C.J., Jr., Alpers, M. (1966): Experimental transmission of Kuru-like syndrome to chimpanzees. Nature 209, 794–796PubMedCrossRefGoogle Scholar
  19. Gascon, G.G., Gilles, F. (1973): Limbic dementia. J. Neurol. Neurosurg. Psychiatry 36, 421–430PubMedCrossRefGoogle Scholar
  20. Gibbs, C.J., Jr., Gajdusek, D.C., Asher, D.M., Alpers, M.P., Beck, E., Daniel, P.M., Matthews, W.B. (1968): Creutzfeldt-Jakob disease (spongiform encephalopathy): transmission to the chimpanzee. Science 161, 388–389PubMedCrossRefGoogle Scholar
  21. Gibbs, C.J., Jr. (1976): Personal CommunicationGoogle Scholar
  22. Goodman, L. (1953): Alzheimer’s disease. A clinico-pathologic analysis of twenty-three cases with a theory on pathogenesis. J. Nerv. Ment. Dis. 118, 97–130PubMedCrossRefGoogle Scholar
  23. Hakim, S., Adams, R.D. (1965): The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: observations on cerebrospinal fluid hydrodynamics. J. Neurol. Sci. 2, 307–327PubMedCrossRefGoogle Scholar
  24. Hartman, B.K. (1973): Immunofluorescence of dopamine-beta-hydroxylase. Application of improved methodology to the localization of the peripheral and central noradrenergic nervous system. J. Histochem. Cytochem. 21, 312–332PubMedCrossRefGoogle Scholar
  25. Heidenhain, A. (1928): Klinische und anatomische Untersuchungen über eine eigenartige organische Erkrankung des Zentralnervensystems im Präsenium. Z. Neurol. Psychiatr. 118, 49–114CrossRefGoogle Scholar
  26. Hooper, M.W., Vogel, F.S. (1976): The limbic system in Alzheimer’s disease. Am. J. Pathol. 85, 1–13Google Scholar
  27. Jacob, H. (1970): Muscular twitchings in Alzheimer’s disease. In: Alzheimer’s Disease and Related Conditions. Wolstenholme, G.E.W., O’Connor, M.E. (eds.). London: Churchill, pp. 75–89Google Scholar
  28. Jakob, A. (1921): Über eigenartige Erkrankungen des Zentralnervensystems mit bemerkenswerten anatomischen Befunden. Z. Neurol. Psychiatr. 64, 147–228CrossRefGoogle Scholar
  29. James, A.E., Strecker, E.P., Novak, G.R. (1973): Correlation of serial cisternograms and cerebrospinal fluid pressure measurements in experimental communicating hydrocephalus. Neurlogy 23, 1226–1233Google Scholar
  30. Janowsky, D.S., Khaled, El-Sousef M., Davis, J.M., Hubbard, B., Sekerke, H.J. (1972): Cholinergic reversal of manic symptoms. Lancet 1, 1236–1237PubMedCrossRefGoogle Scholar
  31. Jansens, G. (1911): Ein Fall der Alzheimerschen Krankheit. Cas. Beitr. Psych. Neurol. Bladen 4 and 5Google Scholar
  32. Jelgersma, H.C. (1964): Ein Fall von juveniler hereditärer Demenz vom Alzheimer-Typ mit Parkinsonismus und Klüver-Bucy-Syndrom. Arch. Psychiatr. Nervenkr. 205, 262–266PubMedCrossRefGoogle Scholar
  33. Jones, D.P., Nevin, S. (1954): Rapidly progressive cerebral degeneration (subacute vascular encephalopathy) with mental disorder, focal disturbances and myoclonic epilepsy. J. Neurol. Neurosurg. Psychiatry 17, 148–159PubMedCrossRefGoogle Scholar
  34. Kay, D.W.K., Roth, M., Hopkins, B. (1955): Affective disorders arising in the senium 1. Their association with organic cerebral degeneration. J. Ment. Sci. 101, 302–316PubMedGoogle Scholar
  35. Kay, D.W.K.(1962): Outcome and cause of death in mental disorders of old age; a long-term follow-up of functional and organic psychoses. Acta Psychiatr. Scand. 38, 249–276Google Scholar
  36. Kay, D.W.K., Bergmann, K., Foster, E., Garside, R.F. (1966): A four year follow-up of a random sample of old people originally seen in their own homes. A physical, social, and psychiatric enquiry. Proc. 4th World Cong. Psychiatry, pt 3, pp. 1668–1670Google Scholar
  37. Kay, D.W.K. (1972): Epidemiological aspects of organic brain disease in the aged. In: Aging and the Brain. Gaitz, C.M. (ed.). New York: Plenum Press, pp. 15–27Google Scholar
  38. Kral, V.A. (1962): Senescent forgetfulness;benign and malignant. Can. Med. Assoc. J. 86, 257–260PubMedGoogle Scholar
  39. Kral, V.A. (1967): Stress reactions in old age. Laval Med. 38, 561–566PubMedGoogle Scholar
  40. Kral, V.A. (1973): Psychiatric problems in the aged: a reconsideration. Can. Med. Assoc. J. 108, 584–590PubMedGoogle Scholar
  41. Klatzo, I., Gajdusek, D.C., Zigas, V. (1959): Pathology of Kuru. Lab. Invest. 8, 799–847PubMedGoogle Scholar
  42. Klüver, H., Bucy, P.C. (1939): Preliminary analysis of functions of the temporal lobes in monkeys. Arch. Neurol. Psychiatry 42, 979–1000Google Scholar
  43. Klüver, H. (1958): The “Temporal Lobe Syndrome” produced by bilateral ablations. In: Neurological Basis of Behavior. Woltensholme, G.E.W., O’Connor, M.E. (eds.). Boston: Little Brown, pp. 175–182Google Scholar
  44. Krücke, W., Beck, E., Vitzthum, H.G. (1973): Creutzfeldt-Jakob disease. Some unusual morphological features reminiscent of Kuru. Z. Neurol. 206, 1–24PubMedCrossRefGoogle Scholar
  45. Larson, T., Sjogren, T., Jacobson, G. (1963): Senile dementia, a clinical, sociomedical, and genetic study. Acta Psychiatr. Scand. 39(Suppl. 167), 1–257Google Scholar
  46. Lauter, H., Meyer, J.E. (1968): Clinical and nosological concepts of senile dementia. In: Senile Dementia. Müller, C., Ciompi, L. (eds.). Bern: Huber, pp. 13–26Google Scholar
  47. Lhermitté, J., Nicolas, M. (1924): La démence sénile et ses formes anatomo-cliniques. L’Encephale 19, 583–654Google Scholar
  48. Libow, L.S. (1973): Pseudo-senility: acute and reversible organic brain syndromes. J. Am. Geriatr. Soc. 21, 112–120PubMedGoogle Scholar
  49. Lorenzo, A.V., Bresnan, M.J., Barlow, C.F. (1974): Cerebrospinal fluid absorption deficit in normal pressure hydrocephalus. Arch. Neurol. 30, 387–393PubMedCrossRefGoogle Scholar
  50. Lowenberg, K., Rothschild, D. (1931): Alzheimer’s disease. Its occurrence on the basis of a variety of etiological factors. Am. J. Psychiatry 11, 269–285Google Scholar
  51. Maudsley, H. (1868): The Physiology and Pathology of Mind. London: MacMillanGoogle Scholar
  52. McCarron, M.M., McCormick, R.A. (1965): Acute Organic Disorder Accompanied by Mental Symptoms. Calif. Dept. of Mental HygieneGoogle Scholar
  53. McHugh, P. (1964): Occult hydrocephalus. Q. J. Med. 33, 297–308PubMedGoogle Scholar
  54. Mercier, C. (1905): Sanity and Insanity. London: Walter ScottGoogle Scholar
  55. Messert, B., Baker, N.H. (1966): Syndrome or progressive spastic ataxia and apraxia associated with hydrocephalus. Neurology 16, 440–452PubMedGoogle Scholar
  56. Messert, B., Wannamaker, B.B. (1974): Reappraisal of the adult occult hydrocephalus syndrome. Neurology 24, 224–231PubMedGoogle Scholar
  57. Milhorat, T.H. (1972): Hydrocephalus and the Cerebrospinal Fluid. Baltimore: Williams and WilliamsGoogle Scholar
  58. Moses, S.G., Robins, E. (1975): Regional distribution of norepinephrine and dopamine in brains of depressive suicides. Psychopharmacol. Bull. 1, 327–337Google Scholar
  59. Nauta, W.J.H. (1962): Neural association of the amygdaloid complex in the monkey. Brain 85, 505–519PubMedCrossRefGoogle Scholar
  60. Nevin, S., McNenemey, W.H., Behrman, S., Jones, D.P. (1960): Subacute spongiform encephalopathy — a subacute form of encephalopathy attributable to vascular dysfunction (spongiform cerebral atrophy). Brain 83, 519–563PubMedCrossRefGoogle Scholar
  61. Ojemann, R.G., Fisher, C.M., Adams, R.D., Sweet, W.H., New, P.F.J. (1969): Further experience with the syndrome of “normal” pressure hydrocephalus. J. Neurosurg. 31, 279–294PubMedCrossRefGoogle Scholar
  62. Papez, J.W. (1937): A proposed mechanism of emotion. Arch. Neurol. Psychiatry 38, 725–743Google Scholar
  63. Pearce, J. (1974): The extrapyramidal disorder of Alzheimer’s disease. Eur. Neurol. 12, 94–103PubMedCrossRefGoogle Scholar
  64. Perry, E.K., Perry, R.H., Blessed, G., Tomlinson, B. (1977): Necropsy evidence of central cholinergic deficits in senile dementia. Lancet 1, 189PubMedCrossRefGoogle Scholar
  65. Pilleri, G. (1966): The Klüver-Bucy syndrome in man. A clinico-anatomical contribution to the function of the medial temporal lobe structures. Psychiatr. Neurol. Med. Psychol. 152, 65–103CrossRefGoogle Scholar
  66. Post, F. (1951): The outcome of mental breakdown in old age. Br. Med. J. 1, 436–440PubMedCrossRefGoogle Scholar
  67. Post, F. (1962): The significance of affective symptoms in old age. Maudsley Mono No. 10. London: Oxford UniversityGoogle Scholar
  68. Post, F. (1966): Somatic and psychic factors in the treatment of elderly psychiatric patients. J. Psychosom. Res. 10, 13–18PubMedCrossRefGoogle Scholar
  69. Post, F. (1968): The development and progress of senile dementia in relationship to the functional psychiatric idsorders of later life. In: Senile Dementia. Muller, C., Ciompi, L. (eds.). Bern: Huber, pp. 85–100Google Scholar
  70. Reis, D.J. (1974): Consideration of some problems encountered in relating specific neurotransmitters to specific behaviors or disease. J. Psychiatr. Res. 11, 145–148PubMedCrossRefGoogle Scholar
  71. Roos, R., Gajdusek, D.C., Gibbs, C.J. (1973): The clinical characteristics of transmissible Creutzfeldt-Jakob disease. Brain 96, 1–20PubMedCrossRefGoogle Scholar
  72. Rose, F.C., Symonds, C.P. (1960): Persistent memory defect following encephalitis. Brain 83, 206–212CrossRefGoogle Scholar
  73. Roth, M. (1955): The natural history of mental disorder in old age. J. Ment. Sci. 101, 289–301Google Scholar
  74. Roth, M., Tomlinson, B.E., Blessed, G. (1967): The relationship between quantitative measures of dementia and of degenerative changes in the cerebral grey matter of elderly subjects. Proc. R. Soc. Med. 60, 254–258PubMedGoogle Scholar
  75. Roth, M., Myers, D.H. (1969): The diagnosis of dementia. Br. J. Hosp. Med. 2, 705–717Google Scholar
  76. Rothschild, D. (1956): Senile psychoses and psychoses with cerebral arteriosclerosis. In: Mental Disorders in Later Life. Palo Alto: Stanford University Press, 2nd edition, pp. 289–331Google Scholar
  77. Savage, G. (1920): Mental disorders associated with old age. J. Nerv. Ment. Dis. 51, 217–230CrossRefGoogle Scholar
  78. Scoville, W.B., Milner, B. (1957): Loss of recent memory after bilateral hippocampal lesions. J. Neurol. Neurosurg. Psychiatry 20, 11–21PubMedCrossRefGoogle Scholar
  79. Seidler, H., Malamud, N. (1963): Creutzfeldt-Jakob disease. Clinico pathologic report of 15 cases and review of the literature (with special reference to a related disorder designated as subacute spongiform encephalopathy). J. Neurophatol. Exp. Neurol. 22, 381–402CrossRefGoogle Scholar
  80. Shakespeare, W. (1947): The Tragedy of King Lear. Brooke, T., Phelps, W.L. (eds.). New Haven: Xale University PressGoogle Scholar
  81. Shenkin, H.A., Greenberg, J., Bouzarth, W.F., Gutterman, P., Morsales, J.O. (1973): Ventricular shunting for relief of senile symptoms. J. Am. Med. Assoc. 225, 1486–1489CrossRefGoogle Scholar
  82. Shildkraut, J.J. (1965): The catecholamine hypothesis of affective disorders: a review of supporting evidence. Am. J. Psychiatry 122, 509–522Google Scholar
  83. Shopsin, B., Wilk, S., Sathananthan, G., Gershon, S., Davis, K. (1974): Catecholamines and affective disorders revised: a critical assessment. J. Nerv. Ment. Dis. 158, 369–383PubMedCrossRefGoogle Scholar
  84. Sjögren, H. (1964): Paraphrenic melancholic and psychoneurotic states in the presenile-senile period of life. Acta Psychiatr. Scand. (Suppl.) 176, 1–64Google Scholar
  85. Skae, D., Clouston, T.S. (1974): Morisonian lectures on insanity for 1873. J. Ment. Sci. 20, 1Google Scholar
  86. Spillane, J.A., White, P., Goodhardt, M.J., Flack, R.H.A., Bowen, D.M., Davison, A.N. (1977): Selective vulnerability of neurons in organic dementia. Nature 226, 558–559CrossRefGoogle Scholar
  87. Sohn, R.S., Siegel, B.A., Gado, M., Torack, R.M. (1973): Alzheimer’s disease with abnormal cerebrospinal fluid flow. Neurology 23, 1058–1065PubMedGoogle Scholar
  88. Sourander, P., Sjögren, H. (1970): The concept of Alzheimer’s disease and its clinical implications. In: Alzheimer’s Disease and Related Conditions. Wolstenholme, G.E.W., O’Connor, M.E. (eds.). London: Churchill, pp. 11–32Google Scholar
  89. Strecker, E.A., Ebaugh, F.G. (1951): Practical Clinical Psychiatry. Philadelphia: Blakiston, 7th editionGoogle Scholar
  90. Strecker, E.P., James, A.E., Konigsmark, B., Merz, T. (1974): Autoradiographic observations in experimental communicating hydrocephalus. Neurology 24, 192–197PubMedGoogle Scholar
  91. Taylor, James (1931): Selected Writings of John Hughlings Jackson. Basic Books, New York, 2, 13,414–416Google Scholar
  92. Terzian, H., Ore dalle, G. (1955): Syndrome of Klüver and Bucy reproduced in man by bilateral removal of the temporal lobes. Neurology 5, 373–380PubMedGoogle Scholar
  93. Tomlinson, B.E., Blessed, G., Roth, M. (1970): Observations on the brains of demented old people. J. Neurol. Sci. 11, 205–242PubMedCrossRefGoogle Scholar
  94. Torack, R.M. (1975): The role of norepinephrine in the function of the area postreme HI. Participation of nerve endings in altered uptake and release of tritiated norepinephrine. In: Brain-Endocrine Interaction II. Knigge, K.M., Scott, D.E., Kobayashi, H., Ishii, S. (eds.). Basel: Karger, pp. 204–216Google Scholar
  95. Traub, R., Gajdusek, D.C., Gibbs, C.J., Jr. (1977): Transmissible virus dementia. In: Aging and Dementia. Smith, W.L., Kinsbourne, M. (eds.). Jamaica: Spectrum, pp. 91–172Google Scholar
  96. Weller, R.O., Wisnieski, H. (1969): Histological and ultrastructural changes with experimental hydrocephalus in adult rabbits. Brain 92, 819–828PubMedCrossRefGoogle Scholar
  97. Wood, H.C. (1887): Nervous Diseases and their Disorders. Philadelphia: LippincottGoogle Scholar
  98. Worster-Drought, C., Greenfield, J.G., McNenemey, W.H. (1944): A form of familial dementia with spastic paralysis. Brain 67, 38–43CrossRefGoogle Scholar
  99. Yakovlev, P.I. (1948): Motility, behavior, and the brain. Stereodynamic organization and neural co-ordinates of behavior. J. Nerv. Ment. Dis. 107, 313–335PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1978

Authors and Affiliations

  • Richard M. Torack
    • 1
  1. 1.School of Medicine, Department of PathologyWashington UniversitySt. LouisUSA

Personalised recommendations