THIRD INTERNATIONAL CONFERENCE ON ALZHEIMER’S DISEASE

ophthalmologists with simultanagnosia and were undiagnosed until they developedadditionalnon-ophthalmologic complaints. Four developed optic ataxia, and all had mildly impaired smwJth pursuit movements. Seven had language deficits (anemia, decreased auditory comprehension, alexia and agraphia) but were fluent and had relative preservation of sentence repetition and three performed in the normal range on the controlled oral word association test. Two patients scored in the normal range on memory tests, all had preserved insight, color naming, and seven had a negative family history for dementia. Ages at onset were 50, 57, 57, 60, 61, 62, 62, and 69 years. Seven had prominent biparietal/occipital atrophy on scan, while one had generalized atrophy. A control patient without simultanagnosia (but with other cognitive deficits) had more lateral biparietal atrophy. With this UnUsUal, but consistent, clinical, neuropsychological and anatomical profile, these patients could constitute a different biological entity from typical AD, even if the histology may be that of AD. A few similar patients have been reported (Hof, et al., Brain Research, 493: 368-75, 1989) pathologically to have plaques and tangles, but in an unusual distribution, involving the primary visual and visual association areas (Brodmann’s cortical areas 17, 18, and 19). Clinicians should suspect this diagnosis in young patients presenting with slowly progressive visual complaints that can not be explained by the eye examination.

69 CUNICAL AND SPECT PATTERN HETEROGENEITY OF PROGRESSIVE APHASIA, F. Pasquier, 8. Jacob, M. Steinling. and H. Petit. Depts of Neurology, Nuclear Medicine, CHRU, F-59037 Lille, France. Opinions concerning progressive aphasia still diverge: anatomo-clinical entity or initial clinical manifestation of dementia. Among 6 new observations no linguistic pattern emerged but 2 main groups seemed to be discerned according to SPECT pattern and evolution. PATIENTS: 3 males and 3 females presented with isolated progressive language disturbance, associated in 5 cases with calculation troubles. METHOD: SPECT study with Tomomatic 64 and HmPAO-99Tc in 9 paired regions of interest (ROI); calculation of uptake index using cerebellum as internal standard and index of asymmetry (IA) = (right-left) x2 / ((right+left). Cut-off for uptake index &JO. for IA = 4% (Steinling et al, in A. 66s and G. GBraud, Currrent problem in Neurology: 12, J. Libbey 1990, 291-93). RESULTS: Group I: 3 patients had normal uptake index for all ROI but one (.75 < uptake index < .60), respectively left frontal-internal, parieto-occipital, and temporal. IA was > 4% for 2 to 6 ROI. Right ROI were always normal. SPECT was performed 7 to 17 years after appearance of the first signs: stuttering begining at age 45 then progressive impairment of verbal expression and comprehension over the last 3 years in a 62 year-old man: progressive word finding difficulties since 11 years with semantic paraphasias, impaired comprehension and recent problems in spatial orientation in a 72 year-old man but not preventing him to drive, play tennis and bridge at his previous level; progressive word finding difficulties with phonemic paraphasias and dyscalculia since 7 years in a 59 year old woman. Group 2: 3 patients had 5 to 7 uptake index of left ROI < .60 in the frontal and temporal regions, and in the basal ganglia in 2 cases. Uptake index of one or more right ROI (frontal or fronto-temporal) was c.60 and all the IA were > 4% except for occipital region. SPECT was performed 2 to 5 years after the beginning of troubles: progressive dysyntaxia and dyscalculia in a 60 year-old woman, progressive loss of speech and stereotypies in a 74 year-old woman and progressive word finding difficulties leading to quasi disappearance of language in a 64 year- old man. In no case temporo-spatial disorientation, memory impairment, apraxia or agnosia were obvious, but behavioral disturbances appeared in 2 patients. CONCLUSION : if progressive aphasia is heterogeneous, SPECT patterns might help to discern slow and rapid evolution.

70 MAGNETICRESONANCEIMAGING INTHEDIAGNOSIS OFDEMENTIA

IN A UNSELECTED POPULATION OF ELDERLY INDIVIDUALS. PRELIMINARY RESULTS FROM THE AMSTEL PROJECT.

Ph. Scheltens’, F. Barkhof’,H. Weinstein3 C. Jonker’,J. Valk2, E.Ch. Wolrers’.

OePts of Wwr0lcsy”Radiolo&, P*ychiatr?,free vlivcraity “capital, w aox 7057. ,007 WB Insfer&al, The Yctherlandr.

Introduction: Magnetic Resonance Imaging (MRI) has been shown to be valuable in the differential diagnosis of dementia, by ruling out cerebral disorders that cause or mimick dementia and by identifying patients with Alzheimer’s disease (AD). In an unselected population of old individuals (>65 Years), participating in the longitudinal AMSTEL project (1). we investigated the value of several MRI parameters in the differential diagnosis of dementia as assessed by the CAMDEX. Methods: 40 subjects (25 women, 15 men, mean age 78.2 t4.3). with the CAMDEX diagnoses: AD (n=7), AD+MID (n-l), other types of dementia (n=2), depression (n=2), unclassified mild dementia (n=l5), and 13 age matched

controls were investigated by means of MRI. MRI parameters consisted of: periventricular (PVH) and white matter (WMH) hyperintensity scores, cortical atrophy (CA), ventricular megaly (VM), both rated subjectively and objectively by linear measurements, as well as medial temporal and hippocampal atrophy (MTA), rated subjectively (2). Results: MRI parameters did not differ significantly in any of the CAMDEX diagnoses. However, WMH score differed significantly (~~0.05) between groups when pooled as ‘not demented’ (n-15) and ‘demented’ (n-25). MTA did not differ between these groups but was correlated significantly with severity of dementia as measured by the MMSE, howver not with age. Conclusion: Although the study sample is still too small to draw definite conclusions, some remarks can be made. In a unselected population of old individuals the variety of CAMDEX diagnoses and MRI abnormalities is great. MRI does not seem to differentiate between CAMDEX diagnoses in the early stages. However, white matter involvement is significantly associated with ‘dementia’. The value of MTA in the diagnosis of AD (2) could not be validated, probably due to small sample size. As the project continues, it may be able to provide us with more insight into the differential diagnostic value and as well as the course in time of the MRI parameters as mentioned above.

71 HM-PA0 (CERETEC) BRAIN SCANNING IN THE DIAGNOSIS OF ALZHEIMER’S DISEASE. H. Bergman, H. Chertkow, J. Stern, C. Rush, A.M. Clarfield, R. Dixon. Jewish General Hospital and McGill University, Montreal, Quebec, Canada.

The objective of the study was to determine if biparietal decreased uptake in HM-PA0 (Ceretcc) scanning, a pattern found in previous studies in some patients with Alzheimer’s Disease (AD) could be useful in distinguishing patients with AD from normal subjects and from subjects diagnosed with vascular dementia. We studied 42 subjects with a clinical diagnosis of probable AD (Reisberg stage 3-6). 1 I with a diagnosis of vascular dementia and 8 subjects classified as normal. The clinical diagnosis was based on the NINCDS-ARDRA criteria (history, physical exam, laboratory investigation, a battery of neuropsychological tests and CAT Scan). All cases received brain scanning with injection of HM-PA0 (Ceretec), a blood flow tracer which reflects cerebral flow. The scans were analyzed using semi-quantitative measures by a blinded observer.

Of Ihe 42 patients with AD, only 10(23X) had the typical biparietal decreased scan uptake, l&42%) showed no significant abnormality and 15(35%) had other abnormalities, 8 of which were compatible with infarct. 13 of the 42 AD patients exhibited an atypical neuropsychological profile (eg more verbal than nonverbal impairement). Three(23%) of these had typical bipariti decreased uptake on Ceretec scan, 7(54%) showed no significant abnormality while 3(23%) exhibited other scanning abnormalities, 1 of which was compatible with infarct. Of the 8 patients without dementia 2(25%) had biparietal decreased uptake on scan, 3(37.5%) had no significant abnormalities while 3(37.5%) showed other scanning abnormalities. Of the I1 patients with vascular dementia, l(9%) had the typical pattern of decreased biparietal uptake, 1(9%) had no significant abnormalities while 9(82%) had other abnormalities on scan. 8 of the latter were consistent with infarct.

We conclude that hiparietal decreased uptake on Ceretec scanning is neither sensitive nor specific in distinguishing AD from normal patients or from patients with vascular dementia. As well, there is no clear correlation between abnormalities on Ceretec scan and patients with AD presenting with an atypical neuropsychological protile.

72 SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT) IMAGING OF DOPAMINE D2 RECEPTORS IN PARKINSON’S DISEASE (PD): RELATION TO THERAPEUTIC RESPONSE, G. Pizzolato, A. Rossato, M. Dam, F. Chierichetti*, C. Briani, G. Ferlin*, L. Battistin. Dpt of Neurology, University of Padova, Italy and * Nuclear Medicine, We

Hospital of Castelfranco Veneto TV, Italy. wanted to assess if alterations at the

postsynaptic dopamine receptor sites could contribute to the altered therapeutic response to L- Dopa in PD patients. SPECT imaging of D2 receptors using the novel ligand 1231-s-IBZM (123X-(s)-3-iodo- 2-hydroxy-6-methoxybenzamide) was performed in two groups of PD patients, separated on the basis of their response to L-Dopa therapy, and 5 age-matched control subjects. Six PD patients were included in the good-responders group, whereas the second group of 6 patients showed a poor, complicated therapeutic response. SPECT study was performed with a rotating GE AC-400 gamma camera 3 n after i.v. adminiscrat,,,, of 1231-s-IBZM (185 MBq). Specific therapy was