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Cognitive and Behavioral Neurology - shakilayousefi.psychologist


shakilayousefi.psychologist
 
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نوشته شده در تاريخ چهارشنبه ۱٤ اردیبهشت ،۱۳٩٠ توسط شکیلا

Route Learning Performance: Is it a Hippocampus Function?

Cognitive & Behavioral Neurology. 24(1):4-10, March 2011.

doi: 10.1097/WNN.0b013e318218c3d6

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Abstract
Abstract:

Introduction: In temporal lobe epilepsy (TLE), about 30% of the patients do not achieve adequate pharmacologic control of refractory crises, and surgery becomes an alternative. In ablative interventions, neuropsychologic testing of memory is a crucial step. However, evaluations of the right hippocampal functions have not been consistent.

Aim: To assess the hippocampal function in remote orientation and visuospatial memory in patients with refractory temporal epilepsy.

Methods: A controlled study of patients with left (LTLE) or right (RTLE) TLE. The subjects were submitted to a neuropsychologic evaluation through the Route Learning Test and the Childhood Home Test in the preoperative period. The statistical analysis was performed using the Kruskal-Wallis, analysis of variance, χ2, and Mann-Whitney U tests.

Results: There was no significant difference in performance in the remote visuospatial memory (as measured by the Childhood Home Test) across the groups (LTLE, RTLE, and control). Concerning the spatial orientation memory, however, there was a significant difference between the LTLE and controls as compared with the RTLE group (P<0.001), the latter showing a poorer performance.

Conclusions: The study suggests that spatial orientation memory relies on the integrity of the right hippocampus. Nevertheless, further studies are necessary to confirm this hypothesis.

 

 

Effect of Propranolol on Word Fluency in Autism

Cognitive & Behavioral Neurology. 24(1):11-17, March 2011.

doi: 10.1097/WNN.0b013e318204d20e

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Abstract
Abstract:

Objective and Background: Autism is characterized by repetitive behaviors and impaired socialization and communication. Preliminary evidence showed possible language benefits in autism from the β-adrenergic antagonist propranolol. Earlier studies in other populations suggested propranolol might benefit performance on tasks involving a search of semantic and associative networks under certain conditions. Therefore, we wished to determine whether this benefit of propranolol includes an effect on semantic fluency in autism.

Methods: A sample of 14 high-functioning adolescent and adult participants with autism and 14 matched controls were given letter and category word fluency tasks on 2 separate testing sessions; 1 test was given 60 minutes after the administration of 40 mg propranolol orally, and 1 test was given after placebo, administered in a double-blinded, counterbalanced manner.

Results: Participants with autism were significantly impaired compared with controls on both fluency tasks. Propranolol significantly improved performance on category fluency, but not letter fluency among autism participants. No drug effect was observed among controls. Expected drug effects on heart rate and blood pressure were observed in both the groups.

Conclusions: Results are consistent with a selective beneficial effect of propranolol on flexibility of access to semantic and associative networks in autism, with no observed effect on phonological networks. Further study will be necessary to understand potential clinical implications of this finding.

 

 

Personality Characteristics and Motor Skills Attributed to Occupations in Parkinson Disease

Cognitive & Behavioral Neurology. 24(1):18-25, March 2011.

doi: 10.1097/WNN.0b013e318218c5eb

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Abstract
Abstract:

Background: It has previously been speculated that a distinct premorbid personality characterized by introversion, rigidity, and over cautiousness might be associated with Parkinson disease (PD). Only 1 previous study has assessed personality before PD onset, and other data collected retrospectively do not exclude reverse causation.

Objective: We relied on the longest held job reported in an interview to infer personality traits and motor skills for 355 incident PD patients and 335 population controls enrolled in a PD study in California.

Methods: Jobs were coded according to the 1980 US Census Occupational Code and assigned scores for various demands, skills, and aptitudes required by the job.

Results: None of the occupational temperament or interest factors required, expected, or exhibited by workers were related to statistically significantly higher odds of having PD per unit increase in scores, whereas there was some suggestion of differences when the extremes were examined. Analyses of physical aptitude factors showed that PD cases were less likely to have worked in jobs that involved certain motor skills.

Conclusions: This study uses a novel approach to assess personality traits using occupational characteristics. Most job attributes thought to reflect conservativeness; risk taking, stress resistance, and flexibility were not associated with PD in a linear manner. Thus, these occupation-derived traits do not seem to support the existence of a distinct parkinsonian personality. However, the negative associations with jobs requiring certain motor skills are intriguing, and may suggest very early premotor features or a lack of continuous motor training as a risk factor for PD.

 

 

Declines in Problem Solving and Anosognosia in Amyotrophic Lateral Sclerosis: Application of Guilford's Structure of Intellect Theory

Cognitive & Behavioral Neurology. 24(1):26-34, March 2011.

doi: 10.1097/WNN.0b013e3182138454

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Abstract
Abstract:

Background: Amyotrophic lateral sclerosis (ALS) is a multisystem disorder in which frontotemporal dysfunction without overt dementia is relatively common. Accordingly, there is need for a valid, brief, motor-free cognitive examination conducive to the ALS Clinic.

Objective: To validate a brief examination against a comprehensive neuropsychological battery to determine its sensitivity in identifying deficits in judgment and problem solving. We enrolled 13 individuals with intact brief examinations, 25 individuals with 1 or more impaired brief examination measures, and 18 healthy volunteers. Cognitive brief examination measures were classified into factors based on Guilford's Structure of Intellect theory. Cognitive anosognosia ratios were calculated to examine the degree of “unawareness of cognitive deficit.”

Results: Statistically significant correlations were evidenced for each brief examination and comprehensive examination measure categorized by the same Guilford factor. In comparison to healthy controls, insight to level of cognitive abilities was significantly compromised for cognitively impaired ALS patients, with respect to their ratings of their responses to comprehension tasks assessing convergent and divergent production.

Conclusions: Brief examination measures of verbal fluency and problem solving may serve as sensitive indicators of emerging difficulties in ALS patients with frontotemporal dysfunction. The prevalence of cognitive anosognosia warrants further attention because of its impact on treatment compliance, safety and quality of life for ALS patients with frontotemporal dysfunction.

 

 

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Case Reports

Reduplicative Paramnesia After a Right Frontal Lesion

Cognitive & Behavioral Neurology. 24(1):35-39, March 2011.

doi: 10.1097/WNN.0b013e31821129b7

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Abstract
Abstract:

Objective: To report a case of reduplicative paramnesia after a focal lesion localized in the right frontal subcortical region.

Background: It is suggested that a right frontal subcortical lesion alone may be sufficient to cause cognitive disturbance that can develop into reduplicative paramnesia. Clinical data have been scarce.

Method: We describe the clinical, neuropsychological, and neuroradiologic findings of a 69-year-old man with reduplicative paramnesia after a right frontal subcortical lesion.

Results: Observation and neuropsychological study showed visuospatial impairment, visual-dominant memory disturbance, anosognosia for cognitive disturbance, and mild frontal dysfunction with paranoid personality. Diffusion-weighted magnetic resonance imaging study showed a lesion localized in the right inferior posterior frontal subcortical area, and we could define 5 neural pathways involved with the lesion. We supposed that 4 of these were potentially related to reduplicative paramnesia: the medial inferior component of the superior longitudinal fasciculus and the fronto-occipital fasciculus, which are related to visuospatial processing; the anterior thalamic radiation, which is concerned with memory processes; and the uncinate fasciculus, which may be related to abnormal feelings of hyperfamiliarity.

Conclusions: A localized lesion in the right inferior posterior frontal subcortical area can cause cognitive dysfunction that may develop into reduplicative paramnesia. Paranoid personality and the change of the patient's hospital room might have triggered the reduplicative delusion in this case.

 

 

Cerebral Venous Sinus Thrombosis Presenting With Auditory Hallucinations and Illusions

Cognitive & Behavioral Neurology. 24(1):40-42, March 2011.

doi: 10.1097/WNN.0b013e318217b0cd

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Abstract
Abstract:

Objective: Cerebral venous sinus thrombosis may present with seizures or neuropsychiatric symptoms, but does not typically present with hallucinations. We present a case of venous thrombosis of the right sigmoid and transverse sinuses that presented with auditory hallucinations and illusions.

Methods: We describe a 45-year-old woman with a history of myasthenia gravis, stable on oral prednisone and monthly intravenous immunoglobulin infusions, who started on a progesterone/estrogen combination contraceptive pill for menorrhagia 3 weeks before admission and presented with symptoms of headache, fever, and auditory hallucinations and illusions.

Results: The patient's cerebrospinal fluid showed lymphocytic pleocytosis. Two electroencephalograms showed significant right temporal lobe slowing. Magnetic resonance venogram of the brain showed venous sinus thrombosis of the right sigmoid and transverse sinuses. Magnetic resonance imaging showed a cortical venous infarct in the right middle temporal gyrus. The patient's auditory hallucinations and illusions resolved spontaneously weeks after presentation.

Conclusions: This case suggests that auditory hallucinations and illusions should be added to the already broad spectrum of presenting features of cerebral venous sinus thrombosis. The nondominant right middle temporal gyrus may play a role in such auditory hallucinations.

 

 

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