Shuren and Grafman provide a thoughtful review of our current understanding of the cognitive basis of reasoning. Clearly, a better understanding of the basic mechanisms and subprocesses of reasoning should make it possible to evaluate reasoning abilities in different neurologic disorders.
Ellis and colleagues find that elevated human immunodeficiency virus (HIV) RNA levels in cerebrospinal fluid (CSF) (>200 copies/mL) predict subsequent progression to cognitive impairment. Monitoring CSF viral load and therapy to reduce HIV RNA levels in CSF may be of clinical value. Editorial comment is provided by Kenneth L. Tyler, MD, and Justin C. McArthur, MBBS, MPH.
Álvarez-Lafuente and colleagues present persuasive data in support of the view that there is a an active human herpesvirus 6 variant A infection in a statistically significant number of patients with multiple sclerosis. The significance of this finding and its pathogenic significance are reviewed.
Verpillat et al, in their study of the largest series of patients with frontotemporal dementia (FTD), found that tau plays a primary role in the cause of this disorder. Further, their observations establish that the H1 haplotype of the tau gene and the ϵ2 allele of apolipoprotein interact and increase the risk of FTD. These findings provide important new data to better understand the pathogenesis of this emerging, important class of the dementias.
Tsuboi and colleagues report a missense mutation in exon 10 of the tau gene in an American and a French family. Affected members in both families had more clinical similarities than differences. The mutation described in these 2 families seems to have independent origins. Thus, this study is a unique genealogical and molecular genetic analysis.
Chantal et al, using magnetic resonance spectroscopy (MRS), have correlated regional cerebral metabolic alterations and neuropsychological dysfunctions in patients with early Alzheimer disease. A significant reduction of N-acetylaspartate/H2O in the left medial temporal lobes correlated with a loss of verbal memory, among other findings. These MRS findings are a useful means of following the natural history of disease and provide a noninvasive means of quantitating change.
Hoenicka and colleagues have searched for mutations in Park1 and Park5 genes and for new or described mutations in the Park2 gene in families with Parkinson disease in Spain. Six different mutations in the Park2 gene in 5 of the families with recessive inheritance are described, and 2 of these mutations, V56E and C212Y, have not been previously reported. The authors' observations provide important new phenotype/genotype correlations.
Praticò and colleagues have studied levels of isoprostane, a specific marker of in vivo lipid peroxidation, in patients with mild cognitive impairment (MCI). Significantly higher levels of isoprostane in cerebrospinal fluid, plasma, and urine were found in patients with MCI compared with cognitively normal elderly subjects. Elevated levels of isoprostane may identify a subgroup of patients with MCI with increased lipid peroxidation, who are at increased risk for developing Alzheimer disease.
Chaves et al describe 10 patients with spontaneous intracranial internal carotid artery (ICA) dissection. They find that patients with ICA can have ischemic stroke with or without subarachnoid hemorrhage on initial examination, and intracranial ICA stenosis or occlusion should be considered in the differential diagnosis, especially in young patients. Importantly, some patients survive with mild or moderate deficits.
O'Suilleabhain and Dewey report their experience with patients with Parkinson disease (PD) having excessive daytime somnolence. An increase in somnolence is found in patients with PD and is related to PD stage, levodopa dose, and the use of a dopamine agonist. Of interest, they find that most of the variability in sedation levels in PD as well as in control patients is due to as yet unidentified factors.
Saper et al describe their experience with intranasal civamide for treatment of episodic cluster headaches. Various headache parameters were evaluated and, in general, they concluded that intranasal civamide solution at a dose of 50 µg may have some effect in preventing episodic cluster headaches.
Berg and colleagues have studied the relevance of the sonographic phenotype of the substantia nigra in healthy adults. Postmortem studies show that the echogenicity of the substantia nigra is correlated with its iron content. Thus, these studies set the stage for the potential of transcranial sonography as a susceptibility marker for the development of nigral injury and increased iron content that can be detected early in life prior to the onset of Parkinson disease.
This Month in Archives of Neurology. Arch Neurol. 2002;59(6):907-908. doi:10.1001/archneur.59.6.907