Summary
Limbic lobe involvement in presenile dementia was studied from a neuropathological and neuropsychiatric viewpoint. The material consisted of seven cases of Alzheimer's disease, four cases of Pick's disease, and four cases of Jacob-Creutzfeldt's disease. These three groups showed different patterns of distribution of the degeneration characteristic for each group, in particular for the first two. Among the groups, these patterns differed with regard to involvement both of nonlimbic and limbic areas. Thus the Alzheimer group had a mainly temporoparieto-occipital and posterior cingulate gyrus involvement. The Pick group in many respects showed an inverse distribution with frontotemporal and anterior cingulate gyrus accentuation of the damage. Basal temporal limbic areas were involved in both groups. The Jacob-Creutzfeldt group had a less schematic lesion pattern, without involvement of limbic areas. From a neuropsychiatric aspect, these differences were reflected in symptoms that could be referred both to areas spared and those more pronouncedly destroyed by the degenerative process. Thus the Alzheimer group long retained emotional qualities that were lost early in the Pick group. The possible relationship between neurotransmitters and regional accentuation of the degeneration is discussed.
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Bannister, R., Sever, P., Gross, M.: Cardiovascular reflexes and biochemical responses in progressive autonomie failure. Brain 100, 327–344 (1977)
Berlyne, N.: Confabulation. Br. J. Psychiatry 120, 31–39 (1972)
Bird, E. D., Iversen, L. L.: Huntington's chorea. Post-mortem measurement of glutamic acid decarboxylase, choline acetyltransferase and dopamine in basal ganglia. Brain 97, 457–472 (1974)
Björklund, A.: Aspects on the functional anatomy of the central catecholamine systems. Acta Psychiatr. Scand. [Suppl. 64] 56, 80–84 (1977)
Boyd, W. D., Graham-White, J., Blackwood, G., Glen, I., McQueen, J.: Clinical effects of choline in Alzheimer senile dementia. Lancet 1977 II, 711
Bowen, D. M., Smith, C. E., White, P., Davison, A. N.: Neurotransmitter-related enzymes and indices of hypoxia in senile dementia and other abiotrophies. Brain 99, 459–496 (1976)
Brierley, J. B.: Clinico-pathological correlations in amnesia. Geront. Clin. 3, 97–109 (1961)
Brown, H. M., Lighthill, J. A.: Selective anterior cingulotomy: A psychosurgical evaluation. J. Neurosurg. 29, 513–519 (1968)
Brun, A.: The subpial granular layer of the foetal cerebral cortex in man. Acta Pathol. Microbiol. Scand. Suppl.vol. 179 (1965)
Brun, A., Gottfries, C. G., Roos, B. E.: Studies of the monoamine metabolism in the central nervous system in Jacob-Creutzfeldt's disease. Acta Neurol. Scand. 47, 642–645 (1971)
Brun, A., Gustafson, L.: Distribution of cerebral degeneration in Alzheimer's disease. Arch. Psychiatr. Nervenkr. 223, 15–33 (1976)
Brun, A., Gustafson, L., Ingvar, D. H.: Neuropathological findings related to neuropsychiatric symptoms and regional cerebral blood flow in presenile dementia. In: VIIth International Congress of Neuropathology, Budapest, pp. 101–105. Amsterdam: Excerpta Medica 1975
Corsellis, J. A. N.: The pathology of dementia. Br. J. Hosp. Med. 3, 695–702 (1969)
Corsellis, J. A. N.: The limbic areas in Alzheimer's disease and in other conditions associated with dementia. In: Alzheimer's disease and related conditions, Wolstenholme, O'Connor, eds. A Ciba foundation symposium, pp. 37–50. London: Churchill 1970
Corsellis, J. A. N., Goldberg, G. J., Norton, A. R.: ‘Limbic encephalitis’ and its association with carcinoma. Brain 91, 481–496 (1968)
Crosby, E., Humphrey, T., Lauer, E.: Correlative anatomy of the nervous system. New York: McMillan 1962
Davies, P., Maloney, A. J. F.: Selective loss of central cholinergic neurons in Alzheimer's disease. Lancet 1976 II, 1404
De Feudis, F. V.: Central cholinergic systems and behaviour. London: Acad. Press 1974
Delay, J., Brion, S.: Le syndrome de Korsakoff. Paris: Masson and Cie 1969
Divac, I.: Neostriatum and functions of prefrontal cortex. Acta Neurobiol. Exp. (Warsz.) 32, 461–477 (1972)
Drachman, D. A.: Memory and cognitive function in man: Does the cholinergic system have a specific role? Neurology 27, 783–790 (1977)
Drachman, D. A., Leavitt, J.: Human memory and the cholinergic system. Arch. Neurol. 30, 113–121 (1974)
Enna, S. J., Bird, E. D., Bennett, J. P., Bylund, D. B., Yamamura, H. I., Iversen, L. L., Snyder, S. H.: Huntington's chorea: Changes in neurotransmitter receptors in the brain. N. Engl. J. Med. 294, 1305–1309 (1976)
Gascon, G. G., Gilles, F.: Limbic dementia. J. Neurol. Neurosurg. Psychiatry 36, 421–430 (1973)
Gibbs, C. J., Jr., Gajdusek, D. C.: Isolation and characterisation of the subacute spongiform virus encephalopathies of man: Kuru and Creutzfeldt-Jacob disease. J. Clin. Pathol. [Suppl. 6] 25, 84–96 (1972)
Girgis, M.: The orbital surface of the frontal lobe and the brain and mental disorders. Acta Psychiatr. Scand. [Suppl.] 222, 58 (1971)
Glees, P., Griffith, H. B.: Bilateral destruction of the hippocampus (cornu ammonis) in the case of dementia. Psychiatr. Neurol. Med. Psychol. (Leipz.) 123, 193–204 (1952)
Gustafson, L.: Psychiatric symptoms in dementia with onset in the presenile period. Acta Psychiatr. Scand. [Suppl.] 257, 8–35 (1975)
Gustafson, L., Brun, A., Ingvar, D. H.: Presenile dementia: Clinical symptoms, pathoanatomical findings and cerebral blood flow. In: Cerebral vascular disease (J. S. Meyer, H. Lechner, M. Reivich, eds.), pp. 5–9. Amsterdam: Excerpta Medica 1977
Gustafson, L., Risberg, J.: Regional cerebral blood flow related to psychiatric symptoms in dementia with onset in the presenile period. Acta Psychiatr. Scand. 50, 516–538 (1974)
Gustafson, L., Risberg, J., Johanson, M., Fransson, M., Maximilian, V. A.: Effects of Piracetam on regional cerebral blood flow and mental functions in patients with organic dementia. Psychopharmacology 56, 115–117 (1978)
Hagberg, B., Ingvar, D. H.: Cognitive eduction in presenile dementia related to regional abnormalities of the cerebral blood flow. Br. J. Psychiatry 128, 209–222 (1976)
Hooper, M. W., Vogel, F. S.: The limbic system in Alzheimer's disease. A neuropathological investigation. Am. J. Pathol. 85, 1–13 (1976)
Ingvar, D. H., Gustafson, L.: Regional cerebral blood flow in organic dementia with early onset. Acta Neurol. Scand. [Suppl. 43] 46, 42–73 (1970)
Jamada, M., Mehraein, P.: Verteilungsmuster der senilen Veränderungen im Gehirn. Arch. Psychiatr. Z. Ges. Neurol. 211, 308–324 (1968)
Johannesson, G., Brun, A., Gustafson, L., Ingvar, D. H.: EEG in presenile dementia related to cerebral blood flow and autopsy findings. Acta Neurol. Scand. 56, 89–103 (1977)
Kelly, D.: Psychosurgery and the limbic system. Postgrad. Med. J. 49, 825–833 (1973)
Kirschbaum, W. R.: Jacob-Creutzfeldt disease. New York: Elsevier 1968
Lewis, P. R., Shute, C. C. D.: The cholinergic limbic system: Projections to hippocampal formation, medial cortex, nuclei of the ascending cholinergic reticular system and the subformical organ and supra-optic crest. Brain 90, 521–540 (1967)
Luria, A. R.: The working brain. An introduction to neuropsychology. London: Penguin 1973
May, W. W.: Creutzfeldt-Jacob disease. Acta Neurol. Scand. 44, 1–32 (1968)
McGeer, P. L., McGeer, E. G.: Enzymes associated with the metabolism of catecholamines, acetylcholine and GABA in human controls and patients with Parkinson's disease and Huntington's chorea. J. Neurochem. 26, 65–76 (1976)
Mehraein, P., Rothemund, E.: Neuromorphologische Grundlagen des amnestischen Syndroms. Arch. Psychiatr. Nervenkr. 222, 153–176 (1976)
Meyer, V.: Psychological effects of brain damage. In: Handbook of abnormal psychology (H. J. Eysenck, ed.). London: Pittman 1960
Meyer, A., Leigh, D., Bagg, C. E.: A rare presenile dementia associated with cortical blindness (Heidenhain's syndrome). J. Neurol. Neurosurg. Psychiatry 17, 129–133 (1954)
Milner, B.: Amnesia following operation on the temporal lobes. In: Amnesia (C. W. Whitty, O. L. Zangwill, eds.). London: Butterworths 1959
Nauta, W. J. H.: Connections of the frontal lobe with the limbic system. In: Surgical approaches in psychiatry (Laitinen, Livingston, eds.), pp. 303–314. Lancaster: Medical and Technical Publishing 1973
Nilsson, A., Risberg, J., Johanson, M., Gustafson, L.: Regional changes of cerebral blood flow during Haloperidol therapy in patients with paranoid symptoms. Acta Neurol. Scand. [Suppl. 64] 56, 478–479 (1977)
Obrist, E. D., Thompson, H. K., Shan Wang, H., Wilkinson, W. E.: Regional cerebral blood flow estimated by 133 Xenon inhalation. Stroke 6, 245–256 (1975)
Perry, E. K., Perry, R. H., Blessed, G., Tomlinson, B. E.: Necropsy evidence of central cholinergic deficits in senile dementia. Lancet 1977 I, 189
Peters, G.: Neuropathologie und Psychiatrie. In: Psychiatrie der Gegenwart, Band 1/I, Teil A, pp. 286–324. Berlin-Heidelberg-New York: Springer 1967
Pilleri, G.: The Klüver-Bucy syndrome in man. A clinico-anatomical contribution to the function of the medial temporal lobe structures. Psychiatr. Neurol. Med. Psychol. (Leipz.) 152, 65–103 (1966)
Risberg, J., Ali, Z., Wilson, E. M., Wills, E. L., Halsey, J. H.: Regional cerebral blood flow by 133 Xenon inhalation. Preliminary evaluation of an-initial slope index in patients with unstable flow compartments. Stroke 6, 142–148 (1975)
Russell, G. V.: Interrelationships within the limbic and center-encephalic system. In: Elect. stim. of brain (D. E. Sheer, ed.). University of Texas 1961
Schenk, V. W. D.: Anatomical investigation. In: A family with Pick's disease (J. Sanders, V. W. D. Schenk, P. van Veen, eds.). Akademie van Wetenschaftl. Verhandel. Natururkunde, Sectie 2, 38, Amsterdam (1940)
Shy, G. M., Drager, G. A.: A neurological syndrome associated with orthostatic hypotension. Arch. Neurol. 2, 511–527 (1960)
Sjögren, T., Sjögren, H., Lindgren, Å. G. H.: Morbus Alzheimer and morbus Pick. A genetic, clinical and patho-anatomical study. Copenhagen: Munksgaard 1952
Sourander, P., Sjögren, H.: The concept of Alzheimer's disease and its clinical implications. In: Alzheimer's disease and related conditions (G. E. Wolstenholme, M. O'Connor, eds.). A Ciba foundation symposium. London: Churchill 1970
Spillane, J. A., White, P., Goodhardt, M. J., Flack, R. H. A., Bowen, D. M., Davison, A. N.: Selective vulnerability of neurones in organic dementia. Nature 266, 558–559 (1977)
Tow, P. M., Whitty, C. W. M.: Personality changes after operation on the cingulate gyrus in man. J. Neurol. Neurosurg. Psychiatry 16, 186–193 (1953)
Ule, G.: Pathologisch-anatomische Befunde bei Korsakow-Psychosen und ihre Bedeutung für die Lokalisationslehre in der Psychiatrie. Aerztl. Wochenschr. 13, 6–13 (1958)
Victor, M., Adams, R. D., Collins, G. H.: The Wernicke-Korsakoff syndrome, a clinical and pathological study of 245 patients, 82 with post-mortem examinations. Philadelphia: Davis 1971
Ward, A. A.: The anterior cingulate gyrus and personality. The frontal lobes. Res. Publ. Ass. Nerv. Ment. Dis. 27, 438–445 (1948)
Weiss, B. L., Foster, F. G., Kupfer, D. J.: Cholinergic involvement in neuropsychiatric syndromes. Biology of cholinergic functions, pp. 603–614. New York: Raven 1976
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Supported by the Swedish Medical Research Council, projects 12X-2037, 25X-3950, and 21P-5144
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Brun, A., Gustafson, L. Limbic lobe involvement in presenile dementia. Arch. Psychiat. Nervenkr. 226, 79–93 (1978). https://doi.org/10.1007/BF00345945
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DOI: https://doi.org/10.1007/BF00345945