摘要:

ObjectiveViolence is a global problem that poses a major challenge to individuals and society. This document is a consensus statement on neurobehavioral aspects of violence as one approach to its understanding and control.BackgroundThis consensus group was convened under the auspices of the Aspen Neurobehavioral Conference, an annual consensus conference devoted to the understanding of issues related to mind and brain. The conference is supported by the Brain Injury Association and by individual philanthropic contributions. Participants were selected by conference organizers to represent leading opinion in neurology, neuropsychology, psychiatry, trauma surgery, nursing, evolutionary psychology, medical ethics, and law.MethodsA literature review of the role of the brain in violent behavior was conducted and combined with expert opinion from the group. The major goal was to survey this field so as to identify major areas of interest that could be targeted for further research. Additional review was secured from the other attendees at the Aspen Neurobehavioral Conference.ResultsThe group met in the spring of 1998 and 1999 for two 5-day sessions, between which individual assignments were carried out. The consensus statement was prepared after the second meeting, and agreement on the statement was reached by participants after final review of the document.ConclusionsViolence can result from brain dysfunction, although social and evolutionary factors also contribute. Study of the neurobehavioral aspects of violence, particularly frontal lobe dysfunction, altered serotonin metabolism, and the influence of heredity, promises to lead to a deeper understanding of the causes and solution of this urgent problem.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectivesThe objectives of this study were to determine whether minimizing requisite processing resources to learn a word list would differentially improve recall of older adults and to examine the associations between memory and nonmemory cognitive abilities.BackgroundIt has been hypothesized that a reduction in general processing resources contributes to age-related declines in memory and other cognitive abilities.MethodsTwenty-four young adults and 47 older adults were administered two semantically related word lists, one list with words blocked into their categories and the other with categories intermixed. Tests of attention and working memory, language, and abstract reasoning were interspersed with the memory tasks. Participants were classified as young (age range: 17–30 years), young-old (age range: 65–73 years), and old-old (age range: 74–87 years) to compare the effects of list condition (i.e., blocked vs. unblocked) on recall performance. Correlation and regression analyses were used to examine the cognitive correlates of recall performance.ResultsExpected age differences in recall performance were observed. Based on the resource-reduction hypothesis of cognitive aging, we hypothesized that the blocked presentation of the to-be-remembered list would minimize processing demands and therefore differentially benefit recall in older elderly participants. Contrary to our prediction, however, the relative benefits of blocked list presentation on recall measures were comparable for young and older participants. Correlations and regression analyses revealed that recall performance was more strongly associated with word finding ability than with working memory or abstract reasoning skills.ConclusionsResults suggest that level of recall of a semantically related word list and use of semantic clustering as an encoding strategy are associated more strongly with general word finding skills than with processing capacity.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe goal of this study was to evaluate behavior and cognition in a consecutive series of patients who developed obsessive-compulsive disorder (OCD) after suffering a traumatic brain injury (TBI).BackgroundBecause OCD is a rare sequelae of TBI, the phenomenology of obsessions and compulsions, the comorbid psychiatric disorders, the performance on cognitive tests, and the neural correlates have not been well characterized.MethodsTen adult patients who met DSM-IV diagnostic criteria for OCD after suffering either mild (6 cases), moderate (2 cases), or severe (2 cases) TBI were studied using structured psychiatric rating scales (i.e., Yale-Brown Obsessive Compulsive Scale), cognitive tests, and magnetic resonance imaging (MRI).ResultsGlobal severity of OCD ranged from moderate to severe, and all patients had multiple obsessions and compulsions. There was a high frequency of aggressive, contamination, need for symmetry/exactness, somatic, and sexual obsessions as well as cleaning/washing, checking, and repeating compulsions. Unusual features such as obsessional slowness (3 cases) and compulsive exercising (3 cases) were also documented. Comorbid psychiatric diagnoses were common and included posttraumatic stress disorder, anxiety with panic attacks, depression, and intermittent explosive disorder. Compared with 10 age-matched normal controls, the OCD group had poor performance on tests of general intelligence, attention, learning, memory, word-retrieval, and executive functions; these cognitive deficits were more pervasive among patients displaying obsessional slowness. All OCD patients with mild TBI had normal MRI scans, whereas focal contusions in the frontotemporal cortices, subcortical structures (caudate nucleus), or both were found in OCD patients with moderate and severe TBI.ConclusionsPosttraumatic OCD has a relatively specific pattern of symptoms even in patients with mild TBI and is associated with a variety of other psychiatric disorders, particularly non-OCD anxiety. The patterns of cognitive deficits and MRI findings suggest dysfunction of frontal-subcortical circuits.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe current investigation was designed to examine the influence of disease course on the specific patterns of acquisition and retrieval impairments in multiple sclerosis (MS).BackgroundRecent investigations of learning and memory in MS have shown that many subjects have impaired verbal and visual new learning abilities, but normal long-term recall and recognition. However, heterogeneity in the learning and memory abilities of subjects has been documented. Some evidence in the literature suggests that this heterogeneity may be in part attributable to clinical variables, such as disease course.MethodsVerbal and visual learning and memory tests, modified to equate MS groups with healthy controls on initial acquisition of information, were administered to 64 individuals with clinically definite MS (relapse-remitting = 21; primary progressive = 18; secondary progressive = 25), and to 20 healthy control participants. Recall and recognition performance then was evaluated at 30 minutes, at 90 minutes, and at 1 week for the verbal learning task, and at 30 minutes and at 90 minutes for the visual learning task.ResultsResults indicate that the two progressive forms of MS result in significantly greater deficits in regard to the acquisition of new verbal information, with the secondary progressive group showing a significantly higher failure rate in regard to meeting the learning criterion. Performance for recognition measures was not significantly different among groups, whereas recall performance of the primary progressive group was significantly below that of the control group and of the secondary progressive group. When testing new learning with visuospatial information, individuals with relapse–remitting MS and secondary progressive MS required more trials than control participants to learn the same amount of visual information. Visual recall and recognition performance did not differ between groups. No group differences in rates of forgetting for visuospatial material was observed after equating for acquisition.ConclusionsResults of the current study indicate that the primary problem in MS with regard to memory functioning is in the acquisition of new information. Our findings support previous research showing verbal memory deficits with a progressive disease course and visuospatial memory deficits in relapse-remitting MS. However, the detailed analysis of new learning and memory performed in the current study indicated that the primary progressive group may be showing difficulty in their ability to use newly learned information. The pattern of new learning deficits observed between MS disease subtypes in the current study was determined to be unrelated to the duration of MS and to the physical severity of the disease. The degree of physical disability observed in patients with MS does not appear to be related to the degree of cognitive decline because of the distinct patterns and severity of memory dysfunction noted within each disease type, independent of physical disability.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveDifficulty in pantomiming the use of tools is observed in patients with Alzheimer disease. Patients with Alzheimer disease tend to use their body parts as objects when they try to pantomime the use of tools. The body-parts-as-objects phenomenon was thought to consist of appropriate gross movement of patients' arms despite inappropriate patterns of handling tools with their hands. However, the mechanism has not been investigated fully.MethodsThe authors examined 11 healthy individuals and 24 patients with Alzheimer disease for ability to recognize tools, to pantomime the use of tools, to use actual tools, and to select an appropriate photograph of a handling pattern of the tool.ResultsIn comparison with the patients with Alzheimer disease, the healthy individuals had higher scores for all tasks. The authors classified the patients into group A (patients with higher pantomime scores), group B (patients with middle level scores), and group C (patients with lower scores). Frequency of use of body parts as objects for patients in group B was higher than that of patients in group A and in group C. The mean Mini-Mental State Examination score for patients in group A was higher than that of patients in group B and in group C. In comparison with patients in group A, patients in group B showed lower scores on the hand-posture discrimination task without a tool, even after controlling the Mini-Mental State Examination score.ConclusionsThe authors conclude that body-parts-as-objects responses in patients with Alzheimer disease occur because general cognition is lowered or because retrieval ability of the appropriate holding posture for tools is impaired.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundChronic vagus nerve stimulation (VNS) is effective in the management of treatment-resistant epilepsy. Open-trial evidence suggests that VNS has clinically significant antidepressant effects in some individuals who experience treatment-resistant major depressive episodes. However, limited information regarding the effects of VNS on neurocognitive performance exists.ObjectiveThe primary aim of this study was to determine whether VNS leads to neurocognitive deterioration.MethodA neuropsychological battery was administered to 27 patients with treatment-resistant depression before and after 10 weeks of VNS. Thirteen neurocognitive tests sampled the domains of motor speed, psychomotor function, language, attention, memory, and executive function.ResultsNo evidence of deterioration in any neurocognitive measure was detected. Relative to baseline, improvement in motor speed (finger tapping), psychomotor function (digit-symbol test), language (verbal fluency), and executive functions (logical reasoning, working memory, response inhibition, or impulsiveness) was found. For some measures, improved neurocognitive performance correlated with the extent of reduction in depressive symptoms, but VNS output current was not related to changes in cognitive performance.ConclusionsVagus nerve stimulation in treatment-resistant depression may result in enhanced neurocognitive function, primarily among patients who show clinical improvement. Controlled investigation is needed to rule out the contribution of practice effects.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to identify the relation between the cognitive benefit seen with the cholinesterase inhibitor metrifonate and changes in brain metabolism as visualized with [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET).BackgroundThe regional metabolic correlates of treatment with cholinesterase inhibitors are poorly understood.MethodsSix patients with mild to moderate Alzheimer disease (AD) were evaluated before and after treatment with the long-lasting cholinesterase inhibitor metrifonate. Patients were given 60 or 80 mg of metrifonate per day (based on weight) for 6 to 12 weeks. Clinical evaluations included the cognitive portion of the Alzheimer's Disease Assessment Scale (ADAS-cog), the Mini-Mental State Examination (MMSE), and the Neuropsychiatric Inventory. Imaging was carried out using FDG-PET. The PET studies, registered to a probabilistic anatomic atlas, were normalized across the group's mean intensity levels and subjected to voxel-by-voxel subtraction of the posttreatment minus pretreatment studies. Subvolume thresholding corrected random lobar noise to produce a three-dimensional functional significance map.ResultsThe criteria for cognitive improvement with treatment were met for the MMSE (>2 points improvement from baseline), and the drawing subscale of the ADAS-cog was significantly improved with treatment. The three-dimensional significance map revealed a significant metabolic increase of the dorsolateral frontoparietal network on the left and bilateral temporal cortex with metrifonate treatment.ConclusionThe clinical benefits observed in AD with cholinesterase inhibitor therapy are associated with a metabolic increase of heteromodal cognitive and medial temporal networks.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe aim was to describe the short-term (6 months) effects of olanzapine on behavioral and motor clinical manifestations in a group of 11 patients with Huntington disease.MethodAn open-pilot study of olanzapine (5 mg) in patients with clinical and genetic diagnosis of Huntington disease was used. The Unified Huntington Disease Rating Scale for clinical assessment and the Total Functional Capacity score for the disease-stage evaluation were used. A statistical analysis was performed to compare the effects of olanzapine on the Unified Huntington Disease Rating Scale scores at time 0 (baseline) and at time 1 (6 months). Comparisons of motor scores, of single behavioral items, and of TFC scores were performed within the group.ResultsThe behavioral assessment score of items regarding depression, anxiety, irritability, and obsessions showed a significant improvement (range ofp, 0.013–0.048). Given the total behavioral scores (sum of all the items investigated), five patients significantly improved their behavioral score after a 6-month treatment (range of p, 0.013–0.047). Choreic movements improved, although not significantly (0.05 ≤p≤ 1).ConclusionsOlanzapine is a potentially useful antipsychotic drug, with significant short-term effects on behavioral changes, mainly in patients with severe psychiatric symptoms at the onset. It might be considered as a possible therapeutic choice for treatment of Huntington disease.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe authors report the case of a patient in whom kleptomania developed in the course of a right frontolimbic behavior syndrome after undergoing surgery.BackgroundKleptomania is a behavior abnormality that is classified as an impulse-control disorder; however, little is known about its organic correlates.MethodHistory included neurologic data, neuropsychological data, electroencephalographic data, and magnetic resonance images.ResultsObservation of kleptomania associated with a large sellar craniopharyngioma with right-sided extension suggests that the site of a lesion may be crucial for the development of an impulse-control disorder.ConclusionsThe authors discuss kleptomania in the context of functional deficits associated with damage to orbitofrontal—subcortical circuits, and they suggest that kleptomania is a neuropsychiatric symptom that can be conceptualized as being an uncommon compulsive display of impulse dyscontrol.

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0894-878X    

出版商:OVID    

年代:2001

数据来源: OVID