Behavioural Neurology - Volume 25, issue 2

Authors: Bottini, Gabriella | Berlingeri, Manuela | Basilico, Stefania | Passoni, Serena | Danelli, Laura | Colombo, Nadia | Sberna, Maurizio | Franceschi, Massimo | Sterzi, Roberto | Paulesu, Eraldo

Article Type: Research Article

Abstract: We explored the neuropsychological and neuromorphometrical differences between probable Alzheimer's disease patients showing a good or a bad response to nine months treatment with donepezil. Before treatment, the neuropsychological profile of the two patient groups was perfectly matched. By the ninth month after treatment, the BAD-responders showed a decline of the MMSE score together with a progressive impairment of executive functions. A voxel-based morphometry investigation (VBM), at the time of the second …neuropsychological assessment, showed that the BAD-responders had larger grey and white matter atrophies involving the substantia innominata of Meynert bilaterally, the ventral part of caudate nuclei and the left uncinate fasciculus, brain areas belonging to the cholinergic pathways. A more widespread degeneration of the central cholinergic pathways may explain the lack of donepezil efficacy in those patients not responding to a treatment that operates on the grounds that some degree of endogeneous release of acetylcholine is still available. Show more

Keywords: Acetilcholinesterase inhibitors, Alzheimer's disease, donepezil, MRI, voxel-based morphometry

DOI: 10.3233/BEN-2011-0359

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 61-72, 2012

Authors: Jacquemot, Charlotte | Dupoux, Emmanuel | Robotham, Laura | Bachoud-Lévi, Anne-Catherine

Article Type: Research Article

Abstract: Speech production impairment is a frequent deficit observed in aphasic patients and rehabilitation programs have been extensively developed. Nevertheless, there is still no agreement on the type of rehabilitation that yields the most successful outcomes. Here, we ran a detailed meta-analysis of 39 studies of word production rehabilitation involving 124 patients. We used a model-driven approach for analyzing each rehabilitation task by identifying which levels of our model each task tapped into. We found that (1) …all rehabilitation tasks are not equally efficient and the most efficient ones involved the activation of the two levels of the word production system: the phonological output lexicon and the phonological output, and (2) the activation of the speech perception system as it occurs in many tasks used in rehabilitation is not successful in rehabilitating word production. In this meta-analysis, the effect of the activation of the phonological output lexicon and the phonological output cannot be assessed separately. We further conducted a rehabilitation study with DPI, a patient who suffers from a damage of the phonological output lexicon. Our results confirm that rehabilitation is more efficient, in terms of time and performance, when specifically addressing the impaired level of word production. Show more

Keywords: Word production, aphasia, rehabilitation, model-driven approach, meta-analysis, case study

DOI: 10.3233/BEN-2012-0358

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 73-101, 2012

Authors: van Koningsbruggen, Martijn G. | Peelen, Marius V. | Davies, Eilir | Rafal, Robert D.

Article Type: Research Article

Abstract: The current paper describes a rare case of a patient who suffered from unilateral apraxia of eye closure as a result of a bilateral stroke. Interestingly, the patient's ability to voluntarily close both eyelids (i.e. blinking) was not affected, indicating that different neural mechanisms control each type of eye closure. The stroke caused damage to a large part of the right frontal cortex, including the motor cortex, pre-motor cortex and the frontal eye field (FEF). The …lesion in the left hemisphere was restricted to the FEF. In order to further study the neural mechanisms of eye closure, we conducted an fMRI study in a group of neurological healthy subjects. We found that all areas of the oculomotor cortex were activated by both left and right winking, including the FEF, supplementary eye field (SEF), and posterior parietal cortex (PPC). Blinking activated FEF and SEF, but not PPC. Both FEF and PPC were significantly more active during winking than blinking. Together, these results provide evidence for a critical role of the FEF in voluntary unilateral eye closure. Show more

Keywords: Apraxia, stroke, winking, saccade, fMRI

DOI: 10.3233/BEN-2011-0355

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 103-109, 2012

Authors: Obeso, Ignacio | Casabona, Enrique | Bringas, Maria Luisa | Álvarez, Lázaro | Jahanshahi, Marjan

Article Type: Research Article

Abstract: Changes of cognitive function in PD have been extensively documented and defined as a 'frontal' type executive dysfunction. One of the main components of this executive dysfunction is the impairment of verbal fluency. The aim of the present study was to assess semantic and phonemic fluency in a large sample of PD patients and to investigate the effect of clinical and sociodemographic variables on verbal fluency in this patient group. Three hundred patients with idiopathic Parkinson's …disease who were consecutive referrals to our clinic and 50 age and education matched healthy controls completed the phonemic and semantic verbal fluency tasks. Both phonemic and semantic verbal fluency were significantly impaired in PD patients relative to matched controls. Stage of illness, presence of depression, education and age influenced verbal fluency measures. Regression analyses established that global measures of cognitive ability (MMSE) and executive function (FAB) and side of onset of motor symptoms predicted 36–37% of variance of phonemic or semantic verbal fluency measures. Thus, future studies aimed at assessing cognitive functioning in PD patients treated by deep brain stimulation (DBS) should adequately take into account several factors (stage of illness, depression, executive functioning) which may potentially influence performance on verbal fluency tasks. Show more

Keywords: Verbal fluency, phonemic, semantic, Parkinson's disease, executive function, cognition

DOI: 10.3233/BEN-2011-0354

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 111-118, 2012

Authors: Lima, Alisson Menezes Araújo | de Campos Cordeiro Hirata, Fabiana | de Bruin, Gabriela Sales | Mota, Rosa Maria Salani | de Bruin, Veralice Meireles Sales

Article Type: Research Article

Abstract: The aim of this study is to evaluate the acute effect of playing games on executive function and motor ability in Parkinson's disease (PD). Consecutive cases with PD were studied with the Unified Parkinson Disease Rating Scale (UPDRS), Mini-Mental State examination (MMSE), Beck Depression Inventory (BDI), Stroop test, finger tapping and 14-meter walk test. After randomization, patients performed a game of dominoes and were tested before and after experiment being further categorized as control, winners or …non-winners. Forty patients, 27 male (67.5%), aged 48 to 84 years (63.2 ± 8.5), Hoehn & Yahr I to III were included. Twenty-eight (70%) presented depressive symptoms (BDI > 10). Groups (Control N=13; Winners =14 and Non-winners=13) were not different regarding age, disease duration, age at onset, BMI, MMSE scores, depressive symptoms, levodopa dose, and previous practice of games. Winners presented significantly better results on executive function (Stroop test, p=0.002) and on motor activity (Finger tapping, p=0.01). Non-winners showed a trend of better performance in the 14-meter-walk test. This study shows that the practice of a non-reward game acutely improved memory and motor skills in PD. Our results suggest a role for the reward system in the modulation of the dopaminergic function of the basal ganglia in these patients. Show more

Keywords: Parkinson, game, dopamine, memory, depression

DOI: 10.3233/BEN-2011-0353

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 119-125, 2012

Authors: Eslinger, Paul J. | Moore, Peachie | Antani, Shweta | Anderson, Chivon | Grossman, Murray

Article Type: Research Article

Abstract: We investigated the occurrence of goal-directed motivational change in the form of apathy in patients with frontotemporal dementia (FTD), particularly those with behavioral variant social and executive deficits (bvFTD). Standardized behavioral inventory was employed to survey and compare apathy ratings from patients and caregivers. In cases of bvFTD, apathy ratings were further related to measures of social cognition, executive function, and atrophy on brain MRI. Results indicated that caregivers rated bvFTD patients as …having significantly elevated apathy scores though patient self-ratings were normal. Caregiver and self-ratings of FTD samples with progressive nonfluent aphasia and semantic dementia did not differ from healthy controls and their informants. In the bvFTD sample, caregiver apathy scores were not correlated with general cognitive screening or depression scores, but were significantly correlated with social cognition and executive function measures. Voxel-based morphometry revealed that apathy ratings in bvFTD were related to prominent atrophy in the right caudate (including the ventral striatum), the right temporo-parietal junction, right posterior inferior and middle temporal gyri, and left frontal operculum- anterior insula region. Findings suggest that bvFTD is associated with a significant breakdown in goal-directed motivated behavior involving disruption of cortical-basal ganglia circuits that is also related to social and executive function deficits. Show more

Keywords: Frontotemporal dementia, apathy, social cognition, executive function, frontal, parietal, caudate

DOI: 10.3233/BEN-2011-0351

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 127-136, 2012

Authors: Huepe, David | Riveros, Rodrigo | Manes, Facundo | Couto, Blas | Hurtado, Esteban | Cetkovich, Marcelo | Escobar, Maria | Vergara, Viviana | Parrao, Teresa | Ibañez, Agustin

Article Type: Research Article

Abstract: This study examines performance of schizophrenia patients, unaffected relatives and controls in social cognition, cognitive and psychiatric scales looking for possible markers of vulnerability in schizophrenia. Performance of schizophrenia patients from multiplex families, first-degree relatives, and matched controls was compared and, subsequently, discriminant analysis method was used for identifying the best predictors for group membership. By using Multigroup Discriminant Analyses on the three groups, the best predictors were PANSS, Premorbid Adjustment Scale, …Faux Pas test, and a face/emotion categorizing task. This model obtained 82% correct global classification, suggesting that the combination of psychiatric scales and neuropsychological/social cognition tesks are the best approach for characterizing this disease. Although preliminary, our results suggest that social cognition tasks are robust markers of schizophrenia family impairments, and that combining clinical, social and neuropsychological measures is the best approach to asses patients and relatives vulnerability. Show more

Keywords: Schizophrenia, multiplex family, social cognition, neuropsychology, first degree relatives

DOI: 10.3233/BEN-2011-0350

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 137-150, 2012

Authors: Gibbons, Chris | Oken, Barry | Fried-Oken, Melanie

Article Type: Research Article

Abstract: We describe a 57 year old, right handed, English speaking man initially diagnosed with progressive aphasia. Language assessment revealed inconsistent performance in key areas. Expressive language was reduced to a few short, perseverative phrases. Speech was severely apraxic. Primary modes of communication included gesture, pointing, gaze, physical touch and leading. Responses were 100% accurate when he was provided with written words, with random or inaccurate responses for strictly auditory/verbal input. When instructions …to subsequent neuropsychological tests were written instead of spoken, performance improved markedly. A comprehensive audiology assessment revealed no hearing impairment. Neuroimaging was unremarkable. Neurobehavioral evaluation utilizing written input led to diagnoses of word deafness and frontotemporal dementia, resulting in very different management. We highlight the need for alternative modes of language input for assessment and treatment of patients with language comprehension symptoms. Show more

Keywords: Word deafness, augmentative communication

DOI: 10.3233/BEN-2012-0356

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 151-154, 2012

Authors: Tei, Hideaki

Article Type: Research Article

Abstract: I describe four patients who successfully escaped from the hospital to their own home during the acute phase of ischemic stroke. This is a very rare phenomenon (seen in 0.35% of 1150 consecutive patients with first ischemic stroke within 24 h after onset), but the patients had rather uniform clinical characteristics. All were male, around 60 years old, had moderate to severe aphasia (Wernicke's in 2 patients, Broca's in 1, and transcortical motor in 1), and …cerebral infarction of the left middle cerebral artery territory. None had significant motor weakness, hemispatial neglect, or hemianopia at the time of escape. Overall functional outcome was good for all but one patient, but aphasia persisted in three. Although none of the four patients sustained serious injury during the escape, patients with such clinical characteristics must be managed cautiously to prevent serious consequences. Show more

Keywords: Acute ischemic stroke, escape from hospital to home, aphasia

DOI: 10.3233/BEN-2012-0357

Citation: Behavioural Neurology, vol. 25, no. 2, pp. 155-157, 2012