$324 17.4Degenerative and neurological disorders studies. CGIC ratings revealed a reduced rate of deterioration in the nicergoline group, statistically not significant. IADL and PSMS were not significantly affected; their mean total score was anyway only mildly impaired at study beginning. ADAS non-cog and total score closely reflected ADAS-cog changes. In the reduced patient cohort treated for 12 months, the ADAS-eog score difference between treatments after 3, 6, 9, 12 months was 0.89, 1.07, 1.45 and 1.64 respectively, increasingly in favour of nieergoline. Placebo patients remained almost unchanged from baseline to month 6, exhibiting the full extent of their deterioration (4.8 points) in the second half of the trial; nicergoline patients improved in the first 6 months and then slowly deteriorated. The placebo response profile over 12 months is well in line with similar long-term observations of the natural progression of the disease, alternating intervals of relative stability and periods of decline, particularly in the less severe stages of the disease. The cognitive deterioration observed with nicergoline was not only less pronounced than with placebo, but also tended to increasingly differentiate from placebo throughout the whole length of the study. The CGIC scores did not reflect as clearly the same difference between the two groups of patients. ADAS-non cog and total scores were in accordance. IADL and PSMS deteriorated with both treatment, at a slightly faster pace in the placebo group. Safety and tolerability record was uneventful. These data indicate that nicergoline is a safe and well tolerated drug with a positive effect on the cognitive symptoms of mild to moderate Alzheimer's disease and suggest a reduced rate of deterioration in this group of patients. • Idiopathic vs symptomatic REM sleep behavior disorder: a report of two cases T. Paparrigopoulos 1, T. Zabelis 2, A. Papageorgiou 2, C.R. Soldatos 1 . ]Department of Psychiatry, Sleep Research Unit, Athens University, Egi- nition Hospital," 2Department of Neurology, Athens University, Eginition Hospital, Athens, Greece Objective: REM Sleep Behavior Disorder (RBD) is a relatively rare syndrome characterized by the intermittent absence of REM sleep atonia and the appearance of motor activity, at times vigorous and injurious, associated with violent dreams. It affects mainly middle aged males and is either idiopathic or symptomatic of various neurological diseases such as neurodegenerative diseases, ischemic lesions etc.. Brainstem tumors as a cause of RBD have been rarely reported. To date, only three cases of an association of RBD with brainstem tumors have been reported by Schenck et al. We report a fourth case of a 59 year old man with RBD due to a neurinoma of the left pontocerebellar angle and we compare it to another 74 year old patient with idiopathic RBD. Case Report h A 59 year old man, was referred to our clinic because of vivid dreams accompanied by violent behavior during sleep since the age of 53. Enacting his dreams, he swears at his "enemies", he punches and kicks his bed partner, or he may injure himself crashing into objects and failing out of bed. This aberrant behavior is recurring nightly over the last six years and almost invariably between 2-3 am. Since the age of 52, one year before the onset of the violent behavior during sleep, he noticed weakening of hearing on the left that gradually progressed to almost complete left deafness. On admission, the standard neurological examination did not reveal any abnormality apart from the aforementioned left deafness. A laboratory work-up was unremarkable. 24 hour EEG monitoring was within the normal range; brainstem auditory evoked potentials were mildly delayed. A videotaped polysomnographic recording, showed lack of muscle atonia during almost every REM sleep stage throughout the night, and bursts of muscle twitchings recorded electromyographically on the submental muscles as well as those of the upper and lower extremities, in the absence of epileptic activity. Subsequently, an MRI examination revealed a 2.3 cm tumor in the left pontocerebellar angle that upon removal proved to be a neurinoma. RBD was treated with administration of 1 mg clonazepam at bedtime with immediate and remarkable effectiveness. Case Report 2: A 74 year old man was admitted to our clinic for vigorous sleep behavior that lasted for over ten years. The patient was mostly unaware of his bizarre behavior, although he recollects that he has vivid dreams and sometimes fails out of bed. On admission, a medical and neuropsychiatric screening did not reveal any pathological findings, The patient underwent a brain CT-scan which was normal and a polysomnographic evaluation that showed limb and body movements associated with REM sleep and absence of any epileptic activity. Idio- pathic RBD was diagnosed and effectively treated with 1 mg clonazepam at bedtime. Conclusions: a) This is the fourth case reported in the world literature of a brainstem lesion associated with RBD; b) an extensive clinical and laboratory work-up (MRI, polysonmographic study) should be per- formed to distinguish between idiopathic and symptomatic RBD that may manifest identical clinical symptoms; c) these cases can be easily misdiagnosed as nocturnal epilepsy, sleep terrors or sleepwalking, and delay treatment. • Treatment with seleglUne in Alzhelmer's disease - SPECT evaluations M.D. Gheorghe, G. Grigorescu. Central Military Clinic Hospital, Department of Psychiatry, Bucharest, Romania Objective: Selegiline efficacy on cognitive impairment in mild stages of Alzheimer Disease with early onset (DSM-IV and NINCDS/ADRDA criteria) by neuropsychological and SPECT assessment. Method: 30 patients diagnosed as suffering from mild stage of AD with onset before 65 years underwent clinical (psychiatrical and neuro- logical), biological (hematological, hepatic, renal, B12 levels, folio acid, T3, T4, HIV), neuropsychological (FAST, MMSE) and paraclinie (CT, SPECT) assessed. Selegiline was administered 10 mg/day, as single early dose, for 12 months. Clinical assessments were recorded at inclusion period and after 6 month of treatment. Results: In 9 patients (30%) had presented a temporo-parietal hy- poperfusion in dominant hemisphere. Selegiline stops the worsening of cognitive impairment (MMSE = +27). In all cases we noted an enhancement of vigilance and improvement of the orientation capacity in time and space, especially in those patients with temporo-parietal hypoperfusion. We established a correlation between improvement of vigilance and orientation capacity and the improvement of cerebral perfusion which was observed by SPECT imagining. No worsening of cognitive performances was noticed over this time. In 5%, an increase in BP values was noted. Conclusions: Monotherapy with Selegiline 10 mg/day in mild forms of AD reduces the cognitive impairment and improves the cerebral perfusion by mechanisms enough documented in those patients. References [1] Gauthier S.: Clinical Diagnosis and Management of Aizheimer's Disease, Eds. Martin Dunitz Ltd. 1996. [2] D~n~il~ L, GheorgheM.D., Ploaie P.: AlzheimerDisease,Eds. Milit. Bucharest, 1996. • T h e effect of vinpocetine In vascular dementia J. Leszek, A. Kiejna, K. Matyszczak. Medical University of Wroclaw, Clinic of Psychiatry, Wroctaw, Poland Vascular dementia is the second most common type of dementia in the elderly after the dementia Alzheimer type. Common drugs used in vascular dementia are cerebral vasodilators, and one of them in vinpoeetine. The aim of the study is to evaluate usefulness of vinpocetine in vascular dementia. The effect of vinpocetine was evaluated in the cohort of 35 patients aged 47-79 years old (average 67 4- 77), 15 males and 20 females. Within this group 20 patients suffered from vascular dementia, and 15 from other types of dementia, including Alzheimer type. All of them were treated with vinpocetine in dose of 5 to 10 mg three times a day (daily dose 15-30 mg). A level dementia was evaluated before the treatment, and every four weeks till eight months. The MMSE