摘要:

Objective:This goal of this study was to evaluate reading ability by assessing eye movements during reading among patients with Alzheimer disease (AD) compared with normal elderly controls.Background:Reading is disturbed in patients with AD. These patients may have changes in reading ability early in the course of their disease before clinical alexia or abnormalities are apparent on standard reading tasks.Method:Reading competence was evaluated by recording eye movements during reading in 14 patients with mild to moderate clinically probable AD and 14 age‐ and education‐matched controls.Results:All patients with AD could recognize letters and words and could understand written material of similar difficulty. Despite successful reading comprehension among the patients with AD, their oculographs showed slowed reading and irregular eye movements. Compared with controls, the patients with AD did not differ in saccadic duration; however, they had significantly longer fixation times, more forward saccades per line of text, and more saccadic regressions. In addition, increased reading difficulty significantly correlated with a scale of dementia severity in the patients with AD.Conclusions:This pattern of eye movements corresponds to increased text difficulty and probably represents difficulty with lexical‐semantic access in AD. These results suggest that disordered eye movements can signal difficulties in reading ability in AD even before complaints of reading difficulty or abnormalities on reading tests and may be a means of identifying linguistic impairment early in this disorder.(NNBN 2000;13:77‐82)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The purpose of this study was to evaluate symptoms associated with impaired insight in patients with Alzheimer disease (AD).Background:Although unawareness of deficits is common in AD, the relation of awareness to psychiatric and behavioral disturbances has not been extensively studied.Method:We conducted a cross‐sectional investigation of 91 patients with probable AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. Awareness of cognitive and functional deficits was measured with the Inaccurate Insight item from the Neurobehavioral Rating Scale. Psychiatric and behavioral symptoms were measured using factor scores and individual items from the Neurobehavioral Rating Scale. Global cognitive deficits were measured using the Mini‐Mental State Examination (MMSE).Results:Stepwise regression analysis showed that insight was associated with MMSE score, depression/anxiety factor score, and agitation/disinhibition factor score. Variables not associated with awareness of deficits included patient age, behavioral retardation factor score, verbal output disturbance factor score, and psychosis factor score. Post hoc analyses showed a positive relation (i.e., greater insight, more symptomatology) between deficit awareness and symptoms of depressed mood and anxiety. There was a negative relation (i.e., greater insight, less symptomatology) between insight and symptoms of hostility, agitation, inattention, and tension. In a follow‐up stepwise regression analysis, increased deficit awareness was associated with a higher MMSE score, greater depressed mood, and decreased agitation.Conclusions:These findings suggest that patients with AD may experience symptoms of depressed mood in relation to increased awareness of decrements in functioning. The data also indicate that patients with poor insight demonstrate greater agitated behavior. Consistent with previous research, impaired insight was higher in the later stages of the illness.(NNBN 2000;13:83‐88)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:Simple and complex visuomotor performance of the right and left sides of the body was investigated in 37 children with left hemisphere lesions, 35 children with right hemisphere lesions, 53 developmentally dyslexic children, 29 developmentally hyperactive children, and 35 “normal” children who had endured a very mild head injury with no sequelae.Background:Lateralized soft signs, EEG topography, metabolic brain imaging, and neuropsychological test profiles suggest a predominance of left hemisphere dysfunction in dyslexia and right hemisphere dysfunction in hyperactivity.Method:Nine measures of lateralized performance were drawn from the Purdue pegboard, Letter cancellation, Rey complex figure, Wechsler Intelligence Scale for Children (WISC) Mazes, and WISC Picture completion tests.Results:The children with left hemisphere lesions manifested significantly weaker performance on test components involving the right body side, relative to the normal controls, on the Purdue pegboard, Rey complex figure (delayed recall condition), and WISC Picture completion tests, and the dyslexic children on the former two. The children with right hemisphere lesions manifested significantly weaker performance on test components involving the left body side, relative to the normal controls, on the WISC Mazes test, as did the hyperactive children.Conclusions:We propose that (1) contralateral performance decrement results from a unilateral cortical lesion in children, and (2) developmental dyslexia may comprise a slight predominance of left hemisphere dysfunction and developmental hyperactivity of right hemisphere dysfunction.(NNBN 2000;13:89‐100)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The neurocognitive sequelae of therapeutic cranial irradiation are not well characterized in adults with primary brain tumors. To address this problem, we prospectively examined neuropsychological findings during two phases of radiation effects.Background:Investigations of radiation effects have revealed variable outcomes that range from no radiation‐associated morbidity to severe cognitive impairment, but have relied on case reports or retrospective studies of late‐delayed changes in white matter or in cognition. No reliable radiographic or neurocognitive tools exist to describe the multiple phases of radiation effects.Method:Twenty adult patients (median age, 39 years) from a university hospital were treated with radiotherapy (RT) for low‐grade primary brain tumors. Prospective longitudinal neuropsychological studies were compared at baseline (after surgery and before irradiation) and at 3, 6, and 12 months after RT to examine early‐delayed effects, including verbal memory changes in 20 patients and visual memory changes in 11 patients. We also examined cognitive changes during the late‐delayed phase for up to 3 years after RT and determined whether early‐delayed memory deficit predicted late‐delayed memory deficit in a small subset of patients. A comprehensive neuropsychological battery was used, including verbal and visual memory tests designed to compare learning, storage, and retrieval.Results:Patients demonstrated normal verbal memory at baseline, decrement, and then rebound in verbal retrieval. Deficit at baseline and recovery up to 1 year after RT defined visual memory. Together, these observations constitute a double dissociation of memory functions. No changes over time were observed in other neurocognitive tests or in fatigue or mood measures. Time‐dependent patterns of each long‐term memory test were examined in relation to lesion site in individual patients.Conclusions:The double dissociation of memory functions after RT may provide markers for the damaging and facilitative early‐delayed effects of RT. Late‐delayed effects were not predicted based on early‐delayed changes in a small sample.(NNBN 2000;13:101‐111)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:This study aimed to examine cognitive functioning in postpolio syndrome (PPS) after controlling for the effects of depression and illness behavior.Background:Few studies have investigated the possible cognitive sequelae of PPS, despite widespread documented subjective complaints of “mental fatigue.”Method:A total of 23 PPS sufferers, 20 polio survivors without PPS, and 22 matched controls were compared using the Beck Depression Inventory‐II; the Illness Behaviour Questionnaire; a chronic fatigue syndrome symptom checklist; and several measures of memory, attention, and concentration, including the Brown‐Petersen Task, Stroop Test, Austin Maze, California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, and Symbol‐Digit Modalities Test.Results:In those participants with a medically confirmed diagnosis of PPS, there was a significantly higher level of depressive and hypochondriacal symptomatology as compared with the other two groups. Nevertheless, no significant differences existed between the three groups on neuropsychological measures.Conclusions:These results indicate that the attention and memory difficulties reported by PPS sufferers may be linked to the physical or psychological manifestations of the illness rather than to objective decrements in cognitive performance.(NNBN 2000;13:112‐118)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:To determine the cognitive effects of daily repetitive transcranial magnetic stimulation (rTMS) administered under the conditions of a treatment trial for major depression.Background:Although daily left dorsal prefrontal rTMS has improved mood in some patients with treatment‐refractory depression, potential cognitive side effects of extended daily treatment have not been systematically studied.Method:In a randomized double‐blind treatment study, 10 subjects (mean age, 42 ± 15 years) with an episode of major depression received either 2 weeks of low‐frequency (1 Hz) or high‐frequency (20 Hz) rTMS (800 pulses, 20 trains over 20 minutes, 80% of motor threshold, 5 days per week) to the left dorsolateral prefrontal cortex and then were crossed over to the other treatment condition. Patients received cognitive testing at baseline and after the first and second weeks of low‐ or high‐frequency rTMS, which was examined by repeated‐measures ANOVA.Results:Of 16 cognitive measures tested after 1 or 2 weeks of rTMS compared with baseline status, none showed deterioration, and the only significant main treatment effect indicated improvement on a list‐recall test from pre‐ to post‐rTMS after 1 week (p<0.05).Conclusions:These preliminary data suggest no gross deleterious cognitive effects of 2 weeks of 1‐ or 20‐Hz rTMS at 80% of motor threshold over the left prefrontal cortex. Further cognitive studies of the effects of rTMS at other parameters used in clinical trials for mood disorders remain to be undertaken.(NNBN 2000;13:119‐124)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The objective of this study was to examine the central nervous system changes that may occur after acceleration/deceleration injuries in motor vehicle accidents.Background:Occupants of motor vehicles involved in a collision often develop a disabling syndrome consisting of head, neck, and back pain; impaired short‐term memory and concentration; fatigue and a loss of stamina; poor balance; and a change in personality. Injury victims experience a loss of motivation, emotional lability, and a decrease in libido. The major features of this injury syndrome are subjective, and there usually are few objective findings on physical examination. The pathogenesis of this syndrome is poorly understood, but it is hypothesized that the collision impact produces an inertial strain injury to the anterior regions of the brain which depresses the functions of the frontotemporal lobes, at the same time, sensitizing somatosensory neural afferent systems. Damage to the orbital surfaces of the frontotemporal lobes, in particular, impairs the gating mechanisms that normally limit sensory input to the brain and further promotes central sensitization. The psychiatric disorders that emerge in the wake of these injuries are likely grounded in these pathologic events.Method:The current literature on the biomechanics of head injury and the associated brain imaging findings in minor head injury are reviewed. A summary of some of the biochemical sequelae of strain injury to the brain is also provided, with an emphasis on the changes in energy metabolism and excitatory amino acid release.Results and Conclusions:Early intervention to arrest the injury‐induced metabolic cascade, and treatment with agents that activate cerebral metabolism may mitigate the symptoms of this injury syndrome.(NNBN 2000;13:125‐135)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:In this case study, the significance of perfusion abnormalities in catatonia is examined.Background:Recurrent catatonic symptoms are frequently observed in psychiatric disorders, but the predictors of relapse of the catatonic symptoms remain unknown. Perfusion abnormalities have been reported during catatonic states; however, little is known about brain functioning of catatonic patients during remission.Method:A catatonic patient was evaluated by clinical interview, behavioral examination, and functional neuroimaging (single photon emission computed tomography) to determine diagnosis and brain perfusion.Results:The patient exhibited persistent hypoperfusion of the basal ganglia even after achieving symptomatic remission.Conclusions:These findings predict a secondary cause and may predict a chronic course.(NNBN 2000;13:136‐139)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:This study evaluated the possible pathologic relation between Kleine‐Levin syndrome (KLS) and mood disorders.Background:A 28‐year‐old man with a remote history of KLS had the sudden onset of a manic episode with psychotic features after the end of hypersomnolence.Method:The patient received an extensive laboratory examination, including single photon emission computed tomography and magnetic resonance imaging.Results:Single photon emission computed tomography showed decreased tracer perfusion in the basal ganglion, hypothalamus, and right frontotemporal region. Magnetic resonance imaging revealed a cystic lesion in the pineal region.Conclusions:Hypothalamic dysfunction has been described in KLS and mood disorders, but pineal gland dysfunction has been mentioned only rarely. The clinical and neuroimaging findings suggest the need for further study of KLS.(NNBN 2000;13:140‐142)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Objective:The goal of this investigation was to describe the neuropsychological and magnetic resonance imaging (MRI) findings in a patient with an extramedullary plasmacytoma that extensively infiltrated the cerebral dura, especially over the frontal region.Background:Extramedullary plasmacytomas are rare tumors that have been reported to involve the dura matter in only a small number of cases. In most of the reported occurrences, the dura plasmacytomas were successfully treated with a combination of surgery and irradiation, without prominent cognitive sequelae.Method:MRI of the brain and neuropsychological tests were conducted approximately 13 months after the patient underwent radiotherapy. In addition, measures of frontal lobe personality characteristics were obtained before and after radiotherapy.Results:MRI findings revealed extensive enhancement around the anterior frontal lobes and prominent involvement of the anterior longitudinal fissure. Results from neuropsychological testing indicated mild to moderately impaired performance on tests of working memory, complex attention, and cognitive flexibility. Further, the patient reported experiencing personality changes consistent with frontal lobe dysfunction as part of the initial symptoms of the disease, which remained unchanged after treatment.Conclusions:Our findings are the first to describe cognitive sequelae of dural plasmacytomas. In addition, results from this case study reveal that plasmacytomas of the frontal dura produce personality changes similar to those observed in patients with significant frontal lobe injury. Finally, plasmacytomas that significantly infiltrate the frontal lobes may be insensitive to radiotherapy and result in residual cognitive and personality abnormalities.(NNBN 2000;13: 143‐147)

ISSN:0894-878X    

出版商:OVID    

年代:2000

数据来源: OVID