Journal of Geriatric Psychiatry and Neurology

This article constitutes a complete translation for the first time of Binswanger's description of the disease given his name, including the gross anatomy, clinical features, the 5-year course of one case, and the differential diagnosis.

As our elderly population continues to increase, diseases that are more prevalent with aging, such as Alzheimer's dis ease, are assuming ever greater relevance for society and the practicing clinician. An important practical situation faced by physicians caring for individuals with Alzheimer's disease is advising the affected individuals, their families, and often the licensing authorities about whether the patient can safely drive an automobile. Surprisingly, there is little guidance on how to arrive at a clinical impression of the fitness of an individual with Alzheimer's disease to drive. This article outlines potential inadequacies in driving skills that may occur with elderly people in general, and more specifically those with Alzheimer's disease. Studies that focused on Alzheimer's disease and driving are then reviewed. We conclude with rec ommendations for dealing with the problem of driving abilities in Alzheimer's disease.

The etiology of dementia can be diagnosed in most patients using a standard clinical approach consisting of physical, neurologic, and mental status examinations, and laboratory testing, lumbar puncture, and neuroimaging. In some cases, however, the clinical presentation or historical data are unusual, or the results of the workup are inconclusive or atypical. A rare cause of dementia may then be present and a complicated evaluation may be necessary to identify the specific disease process. A potentially useful approach to the diagnosis of rare dementing disorders consists of a series of diag nostic algorithms. This approach utilizes results of neuroimaging studies to guide the evaluation through additional diag nostic steps such as specific enzymatic or immunologic assays or biopsy of extraneural tissues. The disorders potentially detected by these algorithms typically have unusual clinical features such as early age of onset, abnormal neurologic signs and symptoms early in the clinical course, early personality and mood changes, extrapyramidal or cerebellar signs and symptoms, seizures, peripheral neuropathy or myopathy, and extraneural abnormalities involving the dermatologic, car diovascular, musculoskeletal, or ocular systems. Accurate diagnosis of these rare causes of dementia is important for medical and psychiatric management, prognosis, and genetic counseling.

Social support, depressive symptoms, and three methods of coping were assessed in 45 patients with Parkinson's disease (PD) and 24 comparably disabled controls. The PD subjects employed significantly fewer cognitive and behavioral coping strategies compared with the controls. Fewer depressive symptoms were related to increased cognitive coping in PD sub jects. Behavioral coping strategies were associated with lesser depression among controls. Avoidance coping methods showed a marginally significant positive association with depressive symptoms in PD subjects. Social support was related to the significant coping predictors in each group, but was not related to depressive symptoms. Although correlational, these results might suggest that active (cognitive and behavioral) coping strategies are superior to avoidance strategies in attenuating the affective distress expected from chronic deteriorative illnesses.

Progressive cognitive impairment is a defining feature of the dementia of Alzheimer's disease (AD), yet disagreement exists over which abilities decline most precipitously and which cognitive tests are most sensitive. In this study, 51 AD patients in the early to middle stages of illness and 22 age-matched normal controls were administered a battery of neu ropsychological tests at 6-month intervals over a 2-year period. While the performance of the normal controls remained stable over the 2 years, the AD patients displayed progressive decline on all tests. The greatest declines occurred on tests requiring lexical/semantic processing (Boston Naming Test) and comprehension of syntactic relationships (Token Test). Performance on visuospatial tests (Wechsler Adult Intelligence Scale-Revised Block Design, Benton Visual Retention Test, Spatial Delayed Recognition Span Test) declined less rapidly. The findings support previous reports that language impairment may be central to the dementia of AD, and that confrontation naming is particularly sensitive to decline in this illness.

This retrospective study evaluated the relationships between normal serum vitamin B12 and folate levels and neuropsy chologic measures in a sample of 60 geriatric inpatients with psychotic depression, nonpsychotic depression, bipolar dis order, and dementia—all consecutively referred for cognitive testing. The psychotic depression subgroup demonstrated numerous significant positive correlations between B12 and cognitive subtests not seen in other diagnostic subgroups, especially those of IQ, and verbal and visual memory. Metabolic factors including vitamin B12 may play specific roles in the cognitive dysfunctions of different geropsychiatric disorders.

Three cases of elderly depressed patients with symptoms of tardive dyskinesia (TD) subsequently treated with electrocon vulsive therapy (ECT) are presented. These cases are discussed in relation to several cases reported in the literature of ECT and TD. The possibility of improvement in symptoms of TD in certain patients is discussed.

Shy-Drager syndrome (SDS) is associated with a myriad of autonomic and neurologic impairments, including sleep dis turbances. A review of the literature reveals that there are no reports of SDS presenting with an abnormality of sleep. The following case report describes a patient who was diagnosed with SDS approximately one decade after initially presenting with a progressive, polysomnographically confirmed disturbance of sleep— specifically, an REM behavioral disorder (RBD).