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Cerebral amyloid angiopathy presenting as a diffuse leukoencephalopathy
Abstracts / Journal of the Neurological Sciences 333 (2013) e292–e357
activity were tested using Y-maze, object recognition and open field tests. Brain α-7nAChR protein level was measured by western blot. Results: LPS significantly reduced alternation % in Y-maze, pattern separation in object recognition test and locomotor activity in open field test. TQ significantly improved these LPS-induced cognitive functions and locomotor activity impairment. 10 mg/kg TQ significantly increased α-7nAChRs protein level compared to the other groups. Conclusion: This study demonstrates beneficial in vivo effects of TQ by improving learning, memory and locomotor activity in a model of chronic neuroinflammation. These effects were accompanied by significant increase in α-7nAChRs protein expression level. These results confirm the impact of neuroinflammation on the cholinergic signaling and suggest TQ as a potential promising treatment for AD. doi:10.1016/j.jns.2013.07.1263
Abstract — WCN 2013 No: 2523 Topic: 5 — Dementia Cerebral amyloid angiopathy presenting as a diffuse leukoencephalopathy I. Moreiraa, S. Fontesa, R. Taipab, C. Crutoa, M. Melo-Piresb, C. Correiaa. a Neurology Department, Portugal; bNeuropathology Unit, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal Introduction: Amyloidosis is a heterogeneous group of disorders, with extracellular deposits of misfolded proteins, in a fibrillar configuration. Amyloid deposits in brain can take many forms: senile plaques (in Alzheimer's disease), amyloidomas (mimicking brain tumours) or cerebral amyloid angiopathy (CAA) by β-amyloid deposits in meningeal and cortical vessels. Spontaneous cerebral hemorrhage is the usual presentation of CCA. CAA presenting with subacute encephalopathy associated to diffuse white matter disease is extremely rare. Clinical case: A 75 year-old man without relevant medical or toxic exposure history began with progressive attention and memory difficulty. One year later presented with moderate headaches, confabulation and urinary retention. Objectively had symmetrical head and limbs resting tremor, without pyramidal, sensory or cerebellar signs. Brain MRI showed bilateral fronto-temporal-insular symmetrical white matter lesions, with mass effect, extending to external capsules and sparing basal nuclei. Electroencephalogram suggested diffuse brain dysfunction. CSF had 0.71 g/L of proteins without cells. Metabolic, microbiological, immunological and occult malignancies investigation were negative. Brain MRI one month later showed lesion expansion. He didn't improve with methylprednisolone 1 g during 5 days. Brain biopsy diagnosed Aβ cerebral amyloid angiopathy. Patient died by an urosepsis 1.5 month after diagnosis. Discussion: CAA manifested as diffuse white matter disease is a rare and challenging condition. An inflammatory process is thought to be related to the vascular deposits of Aβ in this presentation. We didn't identify an inflammatory process in the biopsy. In our case the patient didn't respond to steroids, the proposed standard treatment, and there was a fast worsening of the condition. doi:10.1016/j.jns.2013.07.1264
Abstract — WCN 2013 No: 2560 Topic: 5 — Dementia Synergistic effects of rTMS and cognitive training in Alzheimer's Disease A.-K. Brema, L. Schilberga,b, C. Freitasa, N. Atkinsona, E. Seligsona, A. Pascual-Leonea,c. aBeth Israel Deaconess Medical Center, Harvard Medical
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School, Boston, MA, USA; bUniversity of Maastricht, Maastricht, The Netherlands; cInstitut Universitari de Neurorehabilitacion Guttman, Universidad Autonoma de Barcelona, Barcelona, Spain Background: Current treatment options for Alzheimer's Disease (AD) show limited benefits. Transcranial Magnetic Stimulation (TMS) can be used to explore brain alterations and has a modulatory impact on brain plasticity and may therefore enhance the effects of therapy. We are evaluating a novel device, which combines rTMS with computerized cognitive therapy (NeuroAD™, Neuronix Ltd., Israel). Objectives: Evaluate rTMS for enhancement of cognitive training effects. Compare TMS-measures in mild AD and healthy controls (HC). Patients and methods: Measures: Alzheimer's Disease Assessment Scale (ADAS–Cog), Clinical Global Impression of Change (CGIC), Activities of Daily Living (ADAS–ADL), motor threshold (MT), brain reactivity and plasticity, brain–scalp distances (BSD). Patients received 6 weeks of daily active or sham treatment. During active treatment computerized cognitive training was combined with rTMS in an interweaved fashion. The six stimulated regions were related each with the treated brain sites. Results: MTs in AD and HC were comparable, while baseline reactivity as well as maximum MEP change was significantly different. BSD was significantly reduced in M1 and was correlated with brain reactivity. While SICI and ICF were comparable, LICI was reduced in AD. The real treatment group improved significantly in ADAS–Cog as compared to sham after treatment (real: −6.74 ± 3.25; sham: 0.66 ± 2.91). Non-significant improvement was observed in CGIC, while groups improved similarly in ADAS–ADL. Treatment groups did not change significantly regarding M1 reactivity and plasticity after training. Conclusions: NeuroAD is a promising tool to enhance therapy effects. Alterations in TMS–EMG measures are associated with brain atrophy.
doi:10.1016/j.jns.2013.07.1265
Abstract — WCN 2013 No: 2602 Topic: 5 — Dementia Cholesterol and ultrasensitive C-reactive protein serum levels among patients suffering memory recall deficit M. Sierra-Beltrána, J.L. Romero-Floresb, C.M. Hernàndez-Càrdenasc, S. Feria-Piñad. aIntegral Diagnosis and Treatment Center, Mexico; b Gastroenterology Department, Medica Sur Hospital, Mexico; cCritical Care Medicine, INCMNSZ, Mexico; dInternal Medicine, Medica Sur Hospital, Mexico City, Mexico Background: Metabolic syndrome patients have been shown to suffer arteriolar intracranial arteriosclerosis. This in turn leads to subcortical dysfunction expressed as memory recall deficit. So far, until now, memory deficit hasn't been studied among those patients with subtle cholesterol disturbances. Objective: To present a series of cases of patients with serum cholesterol fraction levels and memory recall deficit. Material and methods: 16 patients with complaints of subtle memory recall deficit undertook a routine medical checkup at Medica Sur Hospital Integral and Diagnosis Center, which included clinical laboratories tests and image studies assessments. Results: It has been observed that memory recall deficit was more frequently reported in patients with low HDL cholesterol serum levels, rather LDL cholesterol serum levels. Ultrasensitive C-reactive protein serum levels were higher than 1.7 Mg/L. Only two patients
activity were tested using Y-maze, object recognition and open field tests. Brain α-7nAChR protein level was measured by western blot. Results: LPS significantly reduced alternation % in Y-maze, pattern separation in object recognition test and locomotor activity in open field test. TQ significantly improved these LPS-induced cognitive functions and locomotor activity impairment. 10 mg/kg TQ significantly increased α-7nAChRs protein level compared to the other groups. Conclusion: This study demonstrates beneficial in vivo effects of TQ by improving learning, memory and locomotor activity in a model of chronic neuroinflammation. These effects were accompanied by significant increase in α-7nAChRs protein expression level. These results confirm the impact of neuroinflammation on the cholinergic signaling and suggest TQ as a potential promising treatment for AD. doi:10.1016/j.jns.2013.07.1263
Abstract — WCN 2013 No: 2523 Topic: 5 — Dementia Cerebral amyloid angiopathy presenting as a diffuse leukoencephalopathy I. Moreiraa, S. Fontesa, R. Taipab, C. Crutoa, M. Melo-Piresb, C. Correiaa. a Neurology Department, Portugal; bNeuropathology Unit, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal Introduction: Amyloidosis is a heterogeneous group of disorders, with extracellular deposits of misfolded proteins, in a fibrillar configuration. Amyloid deposits in brain can take many forms: senile plaques (in Alzheimer's disease), amyloidomas (mimicking brain tumours) or cerebral amyloid angiopathy (CAA) by β-amyloid deposits in meningeal and cortical vessels. Spontaneous cerebral hemorrhage is the usual presentation of CCA. CAA presenting with subacute encephalopathy associated to diffuse white matter disease is extremely rare. Clinical case: A 75 year-old man without relevant medical or toxic exposure history began with progressive attention and memory difficulty. One year later presented with moderate headaches, confabulation and urinary retention. Objectively had symmetrical head and limbs resting tremor, without pyramidal, sensory or cerebellar signs. Brain MRI showed bilateral fronto-temporal-insular symmetrical white matter lesions, with mass effect, extending to external capsules and sparing basal nuclei. Electroencephalogram suggested diffuse brain dysfunction. CSF had 0.71 g/L of proteins without cells. Metabolic, microbiological, immunological and occult malignancies investigation were negative. Brain MRI one month later showed lesion expansion. He didn't improve with methylprednisolone 1 g during 5 days. Brain biopsy diagnosed Aβ cerebral amyloid angiopathy. Patient died by an urosepsis 1.5 month after diagnosis. Discussion: CAA manifested as diffuse white matter disease is a rare and challenging condition. An inflammatory process is thought to be related to the vascular deposits of Aβ in this presentation. We didn't identify an inflammatory process in the biopsy. In our case the patient didn't respond to steroids, the proposed standard treatment, and there was a fast worsening of the condition. doi:10.1016/j.jns.2013.07.1264
Abstract — WCN 2013 No: 2560 Topic: 5 — Dementia Synergistic effects of rTMS and cognitive training in Alzheimer's Disease A.-K. Brema, L. Schilberga,b, C. Freitasa, N. Atkinsona, E. Seligsona, A. Pascual-Leonea,c. aBeth Israel Deaconess Medical Center, Harvard Medical
e343
School, Boston, MA, USA; bUniversity of Maastricht, Maastricht, The Netherlands; cInstitut Universitari de Neurorehabilitacion Guttman, Universidad Autonoma de Barcelona, Barcelona, Spain Background: Current treatment options for Alzheimer's Disease (AD) show limited benefits. Transcranial Magnetic Stimulation (TMS) can be used to explore brain alterations and has a modulatory impact on brain plasticity and may therefore enhance the effects of therapy. We are evaluating a novel device, which combines rTMS with computerized cognitive therapy (NeuroAD™, Neuronix Ltd., Israel). Objectives: Evaluate rTMS for enhancement of cognitive training effects. Compare TMS-measures in mild AD and healthy controls (HC). Patients and methods: Measures: Alzheimer's Disease Assessment Scale (ADAS–Cog), Clinical Global Impression of Change (CGIC), Activities of Daily Living (ADAS–ADL), motor threshold (MT), brain reactivity and plasticity, brain–scalp distances (BSD). Patients received 6 weeks of daily active or sham treatment. During active treatment computerized cognitive training was combined with rTMS in an interweaved fashion. The six stimulated regions were related each with the treated brain sites. Results: MTs in AD and HC were comparable, while baseline reactivity as well as maximum MEP change was significantly different. BSD was significantly reduced in M1 and was correlated with brain reactivity. While SICI and ICF were comparable, LICI was reduced in AD. The real treatment group improved significantly in ADAS–Cog as compared to sham after treatment (real: −6.74 ± 3.25; sham: 0.66 ± 2.91). Non-significant improvement was observed in CGIC, while groups improved similarly in ADAS–ADL. Treatment groups did not change significantly regarding M1 reactivity and plasticity after training. Conclusions: NeuroAD is a promising tool to enhance therapy effects. Alterations in TMS–EMG measures are associated with brain atrophy.
doi:10.1016/j.jns.2013.07.1265
Abstract — WCN 2013 No: 2602 Topic: 5 — Dementia Cholesterol and ultrasensitive C-reactive protein serum levels among patients suffering memory recall deficit M. Sierra-Beltrána, J.L. Romero-Floresb, C.M. Hernàndez-Càrdenasc, S. Feria-Piñad. aIntegral Diagnosis and Treatment Center, Mexico; b Gastroenterology Department, Medica Sur Hospital, Mexico; cCritical Care Medicine, INCMNSZ, Mexico; dInternal Medicine, Medica Sur Hospital, Mexico City, Mexico Background: Metabolic syndrome patients have been shown to suffer arteriolar intracranial arteriosclerosis. This in turn leads to subcortical dysfunction expressed as memory recall deficit. So far, until now, memory deficit hasn't been studied among those patients with subtle cholesterol disturbances. Objective: To present a series of cases of patients with serum cholesterol fraction levels and memory recall deficit. Material and methods: 16 patients with complaints of subtle memory recall deficit undertook a routine medical checkup at Medica Sur Hospital Integral and Diagnosis Center, which included clinical laboratories tests and image studies assessments. Results: It has been observed that memory recall deficit was more frequently reported in patients with low HDL cholesterol serum levels, rather LDL cholesterol serum levels. Ultrasensitive C-reactive protein serum levels were higher than 1.7 Mg/L. Only two patients