Mental deterioration

Aniracetam (6), launched in 1993 in both Japan and Italy for the treatment of cognition disorders, is in Phase II trials in the United States as of this writing. In clinical studies it has been shown to cause some improvement in elderly patients with mild to moderate mental deterioration (63), and in geriatric patients with cerebral insufficiency (64). In a multicenter double-blind placebo-controUed trial involving 109 patients with probable AD, positive effects were observed in 36% of patients after six months of treatment (65), a result repeated in a separate study of 115 patients (66). A review of the biological and pharmacokinetic properties, and clinical results of aniracetam treatment in cognitively impaired individuals is available (49). 

Parkinson s disease (PD) has highly characteristic neuropathologic findings and clinical presentation, including motor deficits and, in some cases, mental deterioration. 

In humans concentrations of 159ppm and 48 ppm have been reported as fatal after 10 min and 30min, respectively. A concentration of 20 ppm was considered intolerable after 1 minute, and Ippm for 10 minutes was irritating. Symptoms of exposure include severe irritation of the eyes and respiratory tract, with hemorrhagic exudate of the bronchi and trachea and pulmonary edema. Repeated exposures may also cause dizziness, loss of appetite, mental deterioration, and weight loss. ... 

Potassium bromide ingested in large doses can cause CNS depression. Other symptoms of chronic intake are mental deterioration and an acne-type skin eruption. 

Severe thiamine vitamin Bf) deficiency results in beriberi. The symptoms can include growth retardation, muscular weakness, apathy, edema, and heart failure. Neurological symptoms, such as personality changes and mental deterioration, also may be present in severe cases. Because of the role played by thiamine in metabolic processes in all cells, a mild deficiency may occur when energy needs are increased. Since thiamine is widely distributed in food, beriberi is rare except in communities existing on a single staple cereal food. The disease does occur with some frequency in alcoholics, whose poor diet may lead to an inadequate daily intake of thiamine. 

The devastating mental deterioration that characterizes Alzheimer s disease has been attributed to a mishandling of the neurotransmitter acetylchohne. Inhibitors of acetylcholinesterase, the enzyme that catabolizes that substance, would be expected to help restore deficient acetylcholine levels. Several partly reduced acridines have shown some activity in treating Alzheimer s disease. At least one of these, tacrine (14-5), is now approved for use in patients. The initial step in the synthesis of the first of these consists of the sodium amide catalyzed condensation of isatin (14-1) with cyclohexanone. The reaction can be visualized by assuming the first step to involve an attack of amide on isatin to give an amido-amide such as (14-2) (note that no attempt has been made to account for charges). This can then react with... 

The best known and the commonest sphingolipi-dosis is Tay-Sachs disease.366-368 Several hundred cases have been reported since it was first described in 1881. A terrible disease, it is accompanied by mental deterioration, blindness, paralysis, dementia, and death by the age of three. About 15 children a year are born in North America with this condition, and the world figure must be 5-7 times this. The defect is in the a subunit of the (3-hexosaminidase A (point 7 in Fig. 20-10)366,366a with accumulation of ganglioside GM2- Somewhat less severe forms of the disease are caused by different mutations in the same gene369 or in a protein activator. Sandhoff disease, which resembles Tay-Sachs disease, is caused by a defect in the (3 subunit, which is present in both P-hexosaminidases A and B.368 Mutant "knockout" mice that produce only ganglioside GM3 as the major ganglioside in their central nervous system die suddenly from seizures if they hear a loud sound. This provides further evidence of the essential nature of these components of nerve membranes.3693... 

Many food constituents including peppermint, spearmint, and tea contain 4-phenylpyridine, another close relative.775 While administration of L-dopa to replace the deficit in the basal ganglia seemed the ideal treatment for Parkinson disease, mental deterioration is not stopped, and for some patients the drug loses its effectiveness in about three years. Based on the new information about MPTP, treatment with extra vitamin E as an antioxidant along with an MAO inhibitor is being tested as a way to prevent further damage from environmental toxins.776... 

Demyelination. The role of myelin in the nervous system is to aid in signal transduction. Myelin acts like an electrical insulator by preventing loss of ion current, and intact myelin is critical for the fast saltatory nerve conduction discussed above. Neurotoxicants that target the synthesis or integrity of PNS myelin may cause muscle weakness, poor coordination, and paralysis. In the brain, white matter tracts that connect neurons within and between hemispheres may be destroyed, in a syndrome known as toxic leukoencephalopathy. A multifocal distribution of brain lesions is reflected in mental deterioration, vision loss, speech disturbances, ataxia (inability to coordinate movements), and paralysis. 

Copper deficiency may present as hematological changes (anemia, leukopenia, and neutropenia) and skeletal demineralization. In severe cases, such as in Menkes syndrome, copper deficiency is further manifested as hypothermia, depigmentation of hair and skin, progressive mental deterioration, and growth retardation. Factors predisposing to copper deficiency include malabsorption states, protein-losing enteropathy, nephrotic syndrome, copper-free parenteral nutrition, and copper-deficient enteral nutrition. 

Hachinski VC, Lassen NA, Marshall J (1974) Multi-infarct dementia. A cause of mental deterioration in the elderly. Lancet 2 207-210... 

A CT scan or MRI of the brain following a strokelike episode reveals a lucency (an area of luminosity) that is consistent with infarction. Later, cerebral atrophy and calcifications may be observed on brain imaging studies. The vascular territories of focal brain lesions and the prior medical history of these patients differ substantially from those of typical patients with stroke. Serial MRI studies often demonstrate lesion resolution, differentiating these lesions from typical ischemic strokes. An electroencephalogram is often performed when seizures are a concern. This is especially necessary in MELAS since patients occasionally have intractable status epilepticus as a terminal condition. Mental deterioration usually progresses after repeated episodic attacks. Psychiatric abnormalities (e.g., altered mental status, schizophrenia) may accompany the strokelike episodes. The encephalopathy may progress to... 

A clinical study of hospitalized drug-treated patients found many suffering from mental deterioration typical of a chronic organic brain syndrome that the researchers labeled dysmentia (Wilson et ah, 1983). Tardive dysmentia consists of unstable mood, loud speech, and [inappropriately close] approach to the examiner. It is probably a variant of hypomanic dementia.1 The mental abnormalities in the study by Wilson et al. (1983) correlated positively with TD symptoms measured on the Abnormal Involuntary Movement Scale. In addition, length of neuroleptic treatment correlated with three measures of dementia unstable mood, loud speech, and euphoria. The authors stated, It is our hypothesis that certain of the behavioral changes observed in schizophrenic patients over time represent a behavioral equivalent of tardive dyskinesia, which we will call tardive dysmentia (p. 188). The tendency in the literature, perhaps in search of a euphemism, has been to use the term tardive dysmentia even when a full-blown dementing syndrome is described. 

Vitamin B3, also known as niacin, helps maintain the normal function of the skin, nerves, and digestive system. The disease pellagra results from a severe niacin deficiency. People with pellagra experience mouth sores, skin irritation, and mental deterioration. Niacin has the following formula C6H5N02. Often vitamin... 

TypeC is characterized by a slow course with neurological symptoms and gradual mental deterioration. A rare event is the development of neonatal cholestasis (243) or an HCC (242). 

Repeated inhalation exposure of low concentrations may cause dizziness, weakness, congestion of the lungs, conjunctivitis, hoarseness, loss of appetite, mental deterioration, weight loss, and possibly enlarged thyroid glands. 

MPS III A Sanfilippo A Profound mental deterioration, hyperactivity, relatively mild somatic manifestations Heparan V-sulfatase Heparan sulfate... 

Copper Neutropenia, leukopenia, hypochromic anemia, osteoporosis, hair and skin depigmentation, dermatitis, anorexia, diarrhea, mental deterioration, hypercholesterolemia Wilson s disease liver cirrhosis, diarrhea, vomiting, metallic taste Decreased high iron or vitamin C intake, corticosteroid use Increased infection, rheumatoid arthritis, pregnancy, oral contraceptives, decreased biliary excretion... 

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