TRIALS OF DRUG THERAPY
IN ADULT DOWN PERSONS
Renato COCCHI, a neurologist and a medical
psychologist.
This research, though published 18
years ago, did not lose anything of its interest. Many of its elements were
subsequently developed in other investigations on the Down syndrome (other 49 articles in this site). Several symptoms deserve still further deepening.
Summary.
Ten adult Down subjects (5 M + 5 F; age
range: 16-25 years and 11 months; 9 standard trisomy 21 + one only clinical
diagnosis, all raised in their family; 2 with symptoms of senile dementia of
Alzheimer type) were given an individualized drug therapy, lasting from 6
months to 6 years.
There were improvements on the physical
state, in the motility, in the language, in the socialization and in the
comprehension, even if in different degrees in each person.
The results were discussed and put in
relationship with the still youth age of such subjects.
Key words: Syndrome of Down, stress,
adult, drug therapy, physical health, motility, language, sociability,
cognitive development, school learning.
Drug modulation of stress answers
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When the age of the school obligation ended,
the parents of a Down kid are nearly let to themselves.
If they were lucky, they found a centre of
protected work.
Some times their working needs force them to
let the kid in one of those Daily Centres where their son can pass part of the
day, with several disable persons of other type, often more burdening.
These Daily Centres however, according to
what I heard from the parents, are rare and their way of functioning is not
always what the same parents would prefer.
Frequently it happens that there are not any
available solutions of any kind, in not-far from home, and the Down child
remains entirely in charge of his family.
Excluding these problems of social placing,
even too important, there are three questions without any answer, from a
medical and educational point of view.
The first one is if all the possible for the
intellectual development of their son were already done.
The second is if it is possible, even if he
doesn't get new abilities, at least, maintain as long as possible, which
already reached.
Finally the third, when signs of
intellectual regression started as visible, if we can stop them, or at least we
can slow them.
I shall try to give some answers to all
these three questions with also the support of a little survey of mine. This
regards the subject Down who started a drug treatment in Pesaro, after they
were 16 years old.
No pretension of having found definitive
solutions, but, as we may see, what I shall report here could have part, in
coherent way, within the already outlined theoretical frame of reference
(Cocchi, 1987). {Later on, I developed this frame, and I supported it with many
investigations. See <www.sstree-cocchi.net/Siwn.htm>].
A personal survey.
1. Male, with chromosomal diagnosis as 47 XY
+21, seen first when he was 16. He attends a professional school. He shows some
depressive symptoms, is a little fat, has clumsy motility, and suffers from
constipation.
Starting drug therapy: Glutamine, Pyridoxine
glutarate, Thiamine, Carbamazepine, Oxazepam, Viloxazine.
Four months later: He is less constipated,
with more controlled appetite, understands more, speaks more, and answers more
to the point. Now he has a more slender figure.
Therapeutic variation: Increased daily
dosing of viloxazine, oxazepam and carbamazepine.
Other 10 months later he is reduced in
weight and grown in height, agrees to taste new foods, sweats less,
comprehension
improved.
Therapeutic variation: The carbamazepine
doubles.
Four months after the last checkup: He has
less introversion, chats more, more serene, has more strength and physical
resistance, more slim and more cute. Therapy variation: the oxazepam is
substituted with clobazam and it is added 5-hydroxytriptophan.
After five months he was noted as more
sociable, and this fact was observing both in the school and in the
Rehabilitation Centre he attends. Now he would go out always, even by himself.
His language still improved, his skin is less fat, his bowel function is now
normal. He became still taller and currently he is 157.5cm height.
No therapeutic variations.
Seven months later he is serene and calm,
more autonomous, goes at school and returns by himself. Now he uses to tell
much and to do questions. All find him more beautiful. I added vitamin E to
drug therapy.
After other five months the situation
stabilized, if it is excluded the fact that is a little timid. The motility is
always a little slow. Weigh and height, are stable. Now he eats more raw
vegetables.
This was the last checkup I did. The young
had two years and seven months of drug therapy. About surely the therapy
stopped.
2. Female of 18 years, without chromosomal analysis
(only clinical diagnosis) with typical physical features of the syndrome. She
is obese, often loses her faeces, is afraid groundless, is irritable,
unsociable, with difficulties in falling asleep, not educated, with much simple
language. Since some time she increased her temper tantrums. She doesn't help
in family housework even for that a few that she could do. Nearly always
cooled.
I started the drug therapy with pyridoxine
glutarate, carbamazepine, viloxazine, delorazepam.
The first checkup occurred 20 months later,
and she has always taken the therapy. To lose her faeces is now a rare event.
The facial Down features mitigated, and she reduced her weight. Her fears
disappeared and now she is more calm. Nearly missing the cold, she speaks some
more, and in the morning she redoes the beds.
Therapeutic variation: The pyridoxine
glutarate increased and vitamin E was added.
After other 12 months she did the second
checkup and the parents observed that some days she speaks more. Mow she is
calm, her menses come regularly and much less painful. More exact when she is
doing housework. Now she uses to eat raw vegetables, but she is constipated
Therapeutic variation: Hanging vitamin E,
she had added calcium tetrahydrofolate and pyridoxole dimaleate.
Eleven months later, at the third checkup
she has increased of the number of housework she succeeded to do. Some whim
occurs. Now she inclines again to grow fat. She is much in touch with her
mother. Perhaps her squint appears less. Her health did well off, and her
language did not change. Now she eats much bread and pasta.
Therapy variation; Hanging pyridoxole
dimaleate, glutamine + pemolina and pyritinol were added.
The fourth checkup occurred 13 months later.
Her weight is lower, to times she has temper tantrums, perhaps she speaks a
little less and uses to do less housework. Now she agrees to go in the village
centre. Surely she has few squint. Her skin is more fine, and her health did
well off. She started to play with her nephews. She remembers by herself of the
drugs she has to take and not does any confusion.
Therapy variation; Hanging glutamine +
pemoline, I substituted it with s-Adenosi1-l-methionine.
She had six years of drug therapy, and she
is going on.
3. Female, 18 years and 11 months old at the
first consultation, with chromosomal diagnosis 47 XX +21.
Her language is well developed, had fewer
marks of the Down features, good motility ( She attends a dance school) but she
fears to bike. Her health is well off, only some pallor in just before her
menstrual cycle, running regularly. She keeps her mouth a little open.
Completely autonomous, she helps the parents in managing a hotel. Usually she
is not bored. Her weight is 54.8 kg and has some squint.
I prescribed carbamazepine, pyridoxine
glutarate, diazepam, and a B + C polyvitaminic.
Seven months later: She speaks more, has her
mouth less open, less pale, pays more attention and is more ready to
understand. As for health, she did well off. She always used going to dance;
Nobody observed any difference in the quality of her work.
Therapeutic variation: Replaced the
polyvitaminic with pyridoxine; Carbamazepina increased, while the pyridoxine
glutarate doubled.
After other five months the parents reported
she is a little more adult, more interested in new things. Now, she has more
will of writing, and is more participating in the family's activity,
More sure and autonomous, she did not show
anymore early-morning nausea. Her language improved by speaking more and
better.
Her face has always a nice rosy colour, her
hair is less fat, her feet grew, and her fingers are less stumpy. She has
always much appetite and her weight is now 58kg while her height grew one cm,
and now she is 143.5 cm tall. She is dating with a boyfriend.
Therapeutic variation: I added thiamine.
Other seven months later, no further
improvement s were observed. Therapy variation: I reduced the pyridoxine
glutarate and I added
S-adenosi1-L-methionine.
Therapy lasted 19 months and presumably is
going on.
4. Female, with chromosomal diagnosis 47 XX
+21, went at consultation for the time first when she was 21 years and five
months.
She takes enough easily illnesses from
cooling. Not educated, she is a very shortsighted person with a light squint.
At home she helps by doing some housework. She has restlessness periods, does
not speak fluently, her motility is enough developed, but she doesn't run the
bike because she cannot succeed to pedal. To times she is sad, she sleeps calm,
but often, in the morning, she is more irritable. She feared the dogs.
Since long time, she has the habit of
stimulating the intern of the mouth with her fingers and often she bits her
thumbs; her mouth is normally a little open. Her language equals that of a
child of nearly three years. Now, she is 150cm tall, and 59kg of weight.
Starting therapy: Glutamine + pemoline,
viloxazine, diazepam, pyridoxine and pyridoxine glutarate.
After four months the parents find her more
calms, more serene, with more open eyes. In the mornings she has less
excitation. She bits less her thumbs, and has a better control of her diet. Her
fear of dogs did not low. Her language did not improve, but some stuttering
reappeared.
Therapeutic variation: I increased glutamine
+ pemoline and I added thiamine.
After other four months she has her eyes more
open. Now, she listens and she understands more, inclines to speak more and
stammers less. Her health did well off. Moreover, she is even less biting her
thumbs, bears better the presence of extraneous persons, speaks less as alone,
doesn't want to go out, because, she says "people look at her" Her
height and weight unchanged.
This was the last checkup, and the drug
therapy has been surely interrupted. She had eight months follow-up.
5. Male, with chromosomal diagnosis 47 XY
+21, and 23 years and four months at first consultation. He learned to read and
to write like a child who ended the second elementary class and knows also to
do little addition and subtraction. He plays discreetly the guitar, by reading
the music.
Now, he has difficulties in falling asleep,
talks to himself, catches still upper respiratory tract infections with some
easiness.
Usually, he eats much, of all, but few raw
vegetables. Sometimes he suffers from colic. He is strong, but light
overweighted. Autonomous, he dresses by himself, goes well in the bicycle. He
is afraid of new situations and he refused to come to Pesaro by flying a part
of the travel.
In some moments, he is sad
Starting therapy: Pyridoxine glutarate, B
and C vitamins compound, Vitamin E, Carbamazepine, Clobazam.
Four months later it was observed: He sleeps
well, has bruxism, more stuttering (always modestly), suffers less from the
heat, eats more fruit, no more illnesses from cooling, starts to taste new
vegetables. Now, he has less colic, less sadness moments, and bears better new
situations. Now, he has less melancholy, has spoken much, but speaks still by
himself.
Therapeutic variation: Glutamine added.
After other six months the parents reported:
He came here by the aeroplane; Now he is closer to adulthood; He improved his
ability of criticizing and of judging, is more autonomous. Bruxism missing, but
he stammers as first, eats normally vegetable and yields. As for his health, he
did well, with a modest flu episode in winter. The colic disappeared, he has
less melancholy, nearly missing the fear of the new situations. His weight
decreased, his face is more oval, and more nice.
Therapeutic variation: H vitamin added.
Fourteen months later, the parents observed
an only episode of fever. He has increased his
dictionary, but does labour to use
expressive language (The beginning of some apraxia-aphasia?). Now he is
attending a piano course, following his application. The ability of using
criticism and of self-criticism improved. He
feels more easy in new situations. From some time, there appeared some vocal
guttural tics, while the bruxism definitely stopped. In this time he grew of a
couple of kg. His skin is more smooth and he has less dandruff.
Therapeutic variation; Hanging E vitamin and
clobazam, I added
S-adenosi1-L-methionin, tetrahydrofolates
and diazepam.
When he came for the check after other 11
months, his health did altogether well, with some cough and an only fever
episode. His language is more exact, even if he inclines to think to loud
voice. Now he explains quite better and his stuttering decreased. He has many
friends, with them he talks about sport, a topic to which he is much interested
in, showing, over than an optimal memory, his own competence.
Now he doesn't accept as more supine
reproaches or observations. He uses to
becoming irritated, when he is not to the
centre of attention. No more colic, his lingual lines are less sinks. He is an
untiring walker. In this time he does again some work in falling asleep. The
vocal tics did not vary.
Therapeutic variation: Glutamine, pyridoxine
glutarate, diazepam and B-C vitamins stopped. I prescribed glutamine +
pemoline, viloxazine,
pyridoxine and delorazepam.
He had 35 months follow-up, and the drug
therapy continues.
6. Male, with chromosomal diagnosis 47 XY
+21, 18 years and nine months at first consultation.
He attends the third year of the junior high
school, but true level of learning is that of a not ended second elementary
school. The typical syndrome features are not particularly marked. His language
is discreet, but he is a little timid young. He suffers of contact allergy,
bruxism, and has moments of irritability. His weight 56.6 kg and is 156 cm
tall.
Starting therapy with glutamine, thiamine,
pyridoxine glutarate, oxazepam.
After three months of drug therapy there was
an improvement of the language, and of the behaviour. Now he is more calm, the
bruxism missed, the motility more harmonious, but he is
still timid. His bowel function is more
regulated, he suffers less from the heat and is less weaken.
His eight is now 52.2kg.
Therapeutic variation: I added pyridoxine.
Other four months later, the parents noted
that he speaks better and has a better way to express, is more
calm, even when he is the sleeping. The face
is more beautiful and he is taller (157.5cm) for which he appears more
handsome, while his weight instead slightly increased (53.8kg). School learning
improved, as the
teachers told. More sociable, he moved even
in a more harmonic way,
less tired, and more autonomous. He did not
have any allergic episode. Understanding is improved too.
Therapeutic variations: Hanging thiamine and
pyridoxine, I added a compound
of thiamine + pyridoxine + cyanocobalamin,
and E vitamin.
At the checkup done after three months, the
parents described him as more mature and more reflexive. He does more sensibly
and reality linked talks, answers to the point, understands more complicated
topics. As for his
health he is doing well, with one only flu
episode. Even at school they
observed the difference of the social
behaviour. He walks much better, is more
independent and has less tiredness. The
allergy did not come back, but he returned as constipated.
Therapeutic variation; Hanging oxazepam, and
substituted with diazepam, with addition of H vitamin.
Three months later, at the checkup the
parents said that he did not take the H vitamin, because they did not find it
in the pharmacies. His penis is now more proportionated, his fingers are
longer, his face is different ("All people say it"), not more
constipated, any more allergies. He reasons
better and says new things. Now he dresses
entirely by himself. At school he pays more attention and his concentration is
more sustained.
This was the last checkup. I treated him for
14 months, nearly surely
The drug therapy stopped.
7. Female, with chromosomal diagnosis 47 XX
+21, and
16 years and 7 months at first consultation.
Often she has cold, constipation, suffers
from the cold, is myopic with squint.
She is attending the third year of the
junior high school, but the level of learning is that of the end of second
elementary school.
She has bruxism, days of pallor, lips easily
chapping. Her motility is clumsy and she cannot ride a bicycle. Her menses are
painful and not regular. She does not like to have her hair combed.
Your height is 141cm, and her weight is
56.8kg. Food intake is too much.
Starting therapy: Glutamine, pyridoxine
glutarate, carbamazepine,
pyridoxine, oxazepam.
Three months later the parents reported that
she is more vivacious and more serene, speaks more and is moving little best.
She had less cold and perhaps she suffers less from the
cool. Her lips are less chapped, bruxism
reduced, hairs are
less fat. In the morning she is more
quickens.
Therapeutic variation; The pyridoxine
glutarate dobled and
thiamine and biotin were added.
After other three months the menses occur in
a more regular way, she speaks more and better, understands even more. Her face
did not change but her fingers became longer, and her food intake reduced,
her bowel function regulated, she does not
mourn anymore of the cool, her squint is less evident, she has fewer days than
pallor, and bruxism diminished again.
Now, she does fewer whims, and her teachers
found her as more activated. Her weight and height did not change.
Therapeutic variation; Pyridoxine and
thiamine were replaced with a compound of
pyridoxine + thiamine + cyanocobalamin,
while carbamazepine doubled.
Three months later she goes on with the
language improvement, and now she walks more and in a more harmonic way.
Less timid, she has a better eye in doing
little housework. Bruxism disappeared. The face is more beautiful, and she is
happy and serene. As for her health she is doing well off, with nearly missed
cold.
Her squint improved, her skin is more
beautiful, fingers are more
longs, her neck is less stumpy. Her weight
reduced and it is now 55.4kg. Now, her food choice widened.
Therapeutic variation: Diazepam replaced
oxazepam and I added E vitamin.
After ten months, besides the progress in
the motility and in the language, she has more desire in doing: She remembers
and "sees" the housework to have to be done. Everyone says that she
is more beautiful. As for her health, she is well off, with her bowel function
as regulated, and her squint visible only when she is tired. The skin is more
fine and her weight reduced (54.2kg). Now she pays attention to her body shape.
Lingual furrows are less sinks and menses
are regular and less painful.
Therapeutic variation: Glutamine and the
compound of Bl + B6 + B12 vitamins get reduced, but tetrahydrofolates and
S-adenosil-l-methionine were added, and diazepam increased. In drug therapy
lasted 17 months and goes on.
8. Female, with chromosomal diagnosis 47 XX
+21, 25 years and eight months at first consultation.
Worsened since 4-5 years, she is even losing
her sight for an accentuated
convexity of the eyeball.
She has some moments when she stops, as if
she did not know how to go forward and this concerns both sequences of movement
and the language, the use of which always lessens. In past, she had
attended the fifth elementary school and
learned reading class and writing, but she did not learn to do little
arithmetic operations.
She had epileptic fits in past, but the EEG
is now normal since 10 years. CAT made in the 1967 and referred as negative.
The face has become less expressive, and
unintentional movements of chewing type appeared.
Starting therapy: Glutamine, pyridoxine,
carbamazepine, biotin and diazepam.
Two months later the parents reported that
some days she is more present, she stops less, inclines to speak more and
better, her face is more expressive and she has restarted to bike. The
unintentional movements of her mouth did not change.
Therapeutic variation: Carbamazepine doubled
and acetyIcarnitine added.
After other seven months, she took the drug
therapy for other three months, till the surgical intervention on the eyes. She
speaks more, works more, does no show any chewing movements, and her lips are less
chaps. Stopping of the therapy was decided by her mother, having said that the
daughter did improve.
She took the drug therapy for six months,
from three
months she stopped it, waiting for new
events.
9. Male, 25 years and 11 months old at first
consultation sex, with chromosomal diagnosis 47 XY +21.
Since three years he does not speak and walk
anymore. He can walk only if one can put him out of balance, by pulling him,
and the need of regain his balance get him able to start walking.
Before losing fully his language, he had
progressively accentuated stuttering.
Now, he is depressed, with groundless
weeping, inclines to diarrhoea, shows moments where he is biting his fingers,
keeps much reduced his facial mimicry.
Starting therapy: Glutamine, cabamazepine,
chlordemetyldiazepam, viloxazine,
and a compound of B and C vitamins.
Two months later he has recovered to walk by
himself, mainly in the evening. Now he is more calm, he laughs, tries to speak,
even if without any result, has stopped of biting his fingers, is less rigid in
his movements, his bowel function improved. He is always not tuned to the
morning.
Therapeutic variation: I increased
carbamazepine and I added pyridoxine and acetylcarnitine.
After other six months he is much more
autonomous: He goes to bed, wakes up, eats and goes to the bathroom by himself.
Now he walks even in the morning, without difficulties and has recovered to fit
his shoes by himself. His face is more expressive, and his colic pains are
rare.
I did not modify the therapy. He was
followed for eight months, nearly surely continues the drug therapy.
10. Male, with chromosomal diagnosis 47 XY
+21, seen for the first time when he was 22 years and seven months.
He ended the junior high school, and he
reads well, knows writing a few, did not learn how to do simple arithmetic. His
language is well developed, but he inclines to the repetitiveness, and speaks
only of
what interests him.
He catches easily upper respiratory tract
infections. His weight is oversized (82.6kg), and he has his neck and hands
stumpy. With calm character, he shows close
into himself. He is autonomous, and does shave with the safety razor. Her lips
become easily chapped, but he has also much pimples, and tics of the eyes. He
is frequently tired. He attends a
Diurnal Centre.
Starting therapy: Glutamine, pyridoxine,
pyridoxine glutarate,
S-adenosi1-L-metihonina, biotin and
diazepam.
Seven months later the parents observed that
he is lowered in weight, more sociable and more paying attention, more moving,
more speaking and with less isolation.
Now he eats more
vegetable. His health did better, his neck
is less stumpy, and has less pimples and fewer tics, with fewer chapped lips.
Now he enjoys playing football, which never did in past.
Therapeutic variation: Tetrahydrotolates
were added. He took drug therapy for seven months, and is going on.
Summary of the results.
In the Table 1 it is shown a synthesis of
data encompassing both epidemiological features and their quantitative
transcription (symbols: ( = ) as unchanged; (+) for modest improvement; (++)
for discreet improvement; (+++) for notable improvement; (-) for worsening.
Table 1: The synthesis of the results.
|
No. |
Gender
|
Age |
Chromos.. diagnosis |
Therapy length (months) |
Health |
Motility
|
Language |
Social behaviour
|
Comprehnsion/ School learning |
|
|
|
||||||||
|
1 |
M |
16 |
47XY+21 |
31 |
++ |
= |
+++ |
++ |
++ |
|
2 |
F |
18 |
n.n. |
72 |
++ |
= |
+ |
++ |
+ |
|
3 |
F |
18 |
47XX+21 |
18 |
++ |
= |
++ |
= |
++ |
|
4 |
F |
21 |
47XX+21 |
21 |
+ |
= |
+ |
= |
= |
|
5 |
M |
23 |
47XY+21 |
35 |
++ |
+ |
++ |
+++ |
++ |
|
6 |
M |
18 |
47XY+21 |
18 |
++ |
+ |
+++ |
++ |
+++ |
|
7 |
F |
16 |
47XX+21 |
17 |
++ |
++ |
++ |
++ |
++ |
|
8 |
F |
25 |
47XX+21 |
6 |
= |
++ |
+ |
= |
+ |
|
9 |
M |
25 |
47XY+21 |
8 |
+++ |
++ |
= |
+ |
= |
|
10 |
M |
22 |
47XY+21 |
7 |
++ |
++ |
++ |
++ |
= |
Discussion.
A series of only 10 cases could not be as
representative. On the other hand, in at least eight of them, I am dealing with
first cases of adult Downs treated by drugs. So, after the other treatments
(psychomotor and pedagogical rehabilitation, and so on) were considered
concluded as for their optimal period of working.
We should therefore concede that, if in
these eight cases there were some positive results, these last were creditable
to the drug action, unless we cannot find other possible explanations.
The cases no. 8 and no. 9, already reported
elsewhere (Cordella, 1987; Cocchi and Cordella, 1987), whith typical symptoms
of Alzheimer's Type Dementia detected, the results are surely creditable to the
drug therapies prescribed.
The doses used, are within the range
specified by myself in another text (Cocchi, 1987). The drugs' choice is always
tailored according to the presumable current neurochemical unbalance of the
individual. It reenters in a complex topic that I propose to clarify, drug by
drug, by starting from this issue of our magazine (Tornati, 1988).
The aspects influenced by the therapy were
as follows: the health, the language and the ability of comprehension; in a
measure
apparently smaller (in several Ss the
behaviour was already well developed)
motility and sociability.
Though being achieved positive results, in
almost evident degree, in
all persons, a part of these subjects, by
themselves or for choice of the parents stopped the therapy.
To the base of this event, I may suppose
various motivations, the more simple of them are:
- The persons did not understand that the
extrachromosome is there, and will stay there all the life, and as the age
becomes higher the troubles deriving from this anomaly will increase, for a
process of the summation. Therefore a reached result does not stay definitely
so, but it will miss in almost short times, if we do nothing to maintain it
since possible;
- someone has frightened the parents with
the usual tale (as stupid or interested in) about the toxicity of the drugs. I
already faced this problem, (Cocchi,
1986) but he is hard to fight an uncritical
prejudice. It would be enough however
to do this little reasoning: Considering the
consumption of the psychodrugs is always more increasing, but contemporarily
always the average life of the persons is increasing too, in the nations that
consume more psychodrugs, how these two facts parallel themselves? Apart from
that I am prescribing mainly
physiological substances, and when I use
psychodrugs, I prescribe all them in lower dosing.
Three were the questions placed in the
introduction to this investigation. I believe that we can give positive answers
to the question about still possible
cognitive improvement in adult Down. The
same for the question about possible regression of intellectual deterioration
clearly began.
Such conditions can have treatment with
drugs, at least as I
experienced, in individual with less than 30
years.
By now, I cannot give an answer to second
question, even if it should be positive, when we consider that I could have
given a positive answer to third one, which foresaw a well worse condition.
Current trials, in subject already gone into
the quarter or the fifth decade
of life, will clarify better this
perspective, which yet, always
, will be always limited in the time.
As for the normal subjects, we can postpone
(until when?) the
mental deterioration, but cannot avoid it
(Savoldi, Zerbi and Cocchi, 1986) and I do not know that the elixir of life is
already discovered.
Bibiiografia
Cocchi R.: La farmacoterapia come ulteriore
ausilio nel trattamento del cerebropatico gravissimo. Atti del convegno
"II cerebropatico gravissimo", Castelfranco Veneto, 1986. (Ristampato
in appedice in: Cocchi R., Belacchi C., Cercolani P. (a cura di): Risultati di
8 anni di terapia famacologica nella sindrome di Down. GISSTIMMAI, Pesaro,
1987; 195-201.
Cocchi R.: Terapia farmacologica nella
sindrome di Down; inquadramento teorico. In; Cocchi R., Belacchi C., Cercolani
P. (a cura di); Risultati di 8 anni di terapia farmacologica nella sindrome di
Down. GISSTIMMAI, Pesare 1987; 19-41.
Cocchi R., Cordella L.; Evoluzione
demenziale in soggetti Down: 3 casi clinici. Presentato al III congresso
nazionale della Societą' Italiana di Psico-Geriatria, Sorrento 1987 (in
stampa).
Cordella L.; Sindrome di Down e demenza di Alzheimer.
In; Cocchi R., Belacchi C., Cercolani P. (a cura di); Risultati di 8 anni di
terapia farmacologica nella sindrome di
Down. GISSTIMMAI, Pesare 1987; 181-194.
Savoldi F., Zerbi F., Cocchi R.;
Sull'entitą' clinica di pseudodemenza. In: Pavoni E., Saraceni F. (a cura di):
L'invecchiamento tra paura e desiderio. Voi.I, Idelson, Napoli 1986; 251-256.
Tornati A.: La vitamina B6: caratteristiche
e impiego clinico. Riv. Ital. Disturbo Intellet. 1988, 1; 71-79.
Text printed in Italian on Ri. It. Disturbo.
Intellet. 1988, 1: 57-69.
Posted on Internet on 15 July 2005. Copyright by
Renato Cocchi, 2005.
Author's address: dr Renato
Cocchi, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
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