HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH Psychiatric Bulletin Advances in Psychiatric Treatment All RCPsych Journals		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Electronic Letters to:

PAPERS: AIMEE SPECTOR, LENE THORGRIMSEN, BOB WOODS, LINDSAY ROYAN, STEVE DAVIES, MARGARET BUTTERWORTH, and MARTIN ORRELL Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: Randomised controlled trial The British Journal of Psychiatry 2003; 183: 248-254 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Neurobiology of cognitive stimulation in dementia

Ernest H. Friedman   (15 September 2003)

Neurobiology of cognitive stimulation in dementia 15 September 2003
Ernest H. Friedman, Psychiatrist Case Western Reserve University Send letter to journal: Re: Neurobiology of cognitive stimulation in dementia friedman{at}en.com Ernest H. Friedman	Spector et al (2003;183:248-254) in a randomised trial of cognitive stimulation therapy in dementia, demonstrated improvement in assessments of cognitive function and quality of life in the treated group. Neurobiological features are suggested by dopamine (DA)D2 receptors, but not D3 or D4 receptors, involved in the rewarding effects of brain stimulation through attention to temporal signals highlighting significant stimuli (1). This hypothesis is supported by: a reduced density of D2 receptors in dementia (2,3); optimum response organisation and working memory at intermediate DA tone in a mediofrontostriatal activation system; and a study demonstrating that auditory training induces asymmetrical changes in cortical neural activity. This strategy is supported by: the association of the reduction of blood pressure with longer, less recurrent speech hesitation pauses of about 2 seconds linked to prefrontal cortex modulation of DA during the delayed alternation task; reports that the microvascular response to the onset of neuronal activity is delayed consistently by about 3 seconds and is linked to increased coherence of electroencephalograph gamma-band activity (30-50 Hz or broader, centered on 40 Hz) associated with the execution of more complex tasks; and a 2.5- to 3-second delay period for inhibition shapes the temporal flow of information in the prefrontal cortex. The fact that rate and variability in duration of speech hesitation pauses correlate with the left and right hemisphere respectively (1), prompts the analysis of pauses on a time-base to determine the benefit of cognitive stimulation therapy versus anti-dementia drugs on asymmetrical brain functions. References 1. Friedman EH. Re: pulse pressure and risk of Alzheimer disease in persons aged 75 years and older. Stroke 2003;34:e107. 2. Barbanti P, Fabbrini G, Ricci A, et al. Reduced density of dopamine D2- like receptors on peripheral blood lymphocytes in Alzheimer's disease. Mech Ageing Dev 2000;120:65-75. 3. Allard P, Englund E, Marcusson J. Caudate nucleus dopamine d(2) receptors in vascular dementia. Dement Geriatr Cogn Disord 2002;14:22-25. Sincerely, Ernest H. Friedman, MD Intellectual property: US patent 4,543,957 and related US and global patents and software copyrights.