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Orso B, Mattei C, Arnaldi D, Massa F, Serafini G, Plantone D, Doglione E, Grafman J, Nobili F, Pardini M. Clinical and MRI Predictors of Conversion From Mild Behavioural Impairment to Dementia. Am J Geriatr Psychiatry 2020; 28:755-763. [PMID: 31928846 DOI: 10.1016/j.jagp.2019.12.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/13/2019] [Accepted: 12/13/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE As an analogy with mild cognitive impairment (MCI), the mild behavioral impairment (MBI) construct has been proposed as a diagnostic label for those presenting late-onset behavioral symptoms. To date, however, the clinical, cognitive, and structural imaging features associated with an increased risk of conversion from MBI to dementia are poorly understood. METHODS We retrospectively analyzed the cognitive performance and structural brain MRI of 113 subjects, with a clinical follow-up of at least 4 years available. Subjects were randomly assigned to a Group A (56 subjects; age: 65.4 ± 7.9 years, 15 females, MMSE score: 28.4 ± 2.3)) or to a Group B (57 subjects, age: 66.6 ± 6.4, 17 females, MMSE score: 28.0 ± 1.4). In the Group A, cognitive and structural variables were compared between converters (at 4 years) and nonconverters and then verified in the Group B group. RESULTS In the Group A, 14 patients converted to behavioral-variant of frontotemporal dementia (bv-FTD) and 4 to Alzheimer's Disease (AD). Converters presented at baseline lower executive function scores and total Theory of Mind (ToM scores), as well as more severe focal frontal atrophy. In the Group B, 13 subjects converted to bv-FTD and none to AD. The combination of the variables identified in the Group A significantly (p <0.001) discriminated between converters and nonconverters in the Group B with a sensitivity of 0.615 and a specificity of 1 (total accuracy 91.22%). CONCLUSION The combined presence of executive deficit, impaired ToM, and presence of isolated frontal atrophy was associated with risk of progression from MBI to a clinically evident neurodegenerative condition, mainly bv-FTD, over a 4-year period.
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Affiliation(s)
- B Orso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy
| | - C Mattei
- Bozen Civic Hospital (Chiara Mattei), Bozen, Italy
| | - D Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy; Policlinico S. Martino IRCCS (Dario Arnaldi, Gianluca Serafini, Flavio Nobili, Matteo Pardini), Genova, Italy
| | - F Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy
| | - G Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy; Policlinico S. Martino IRCCS (Dario Arnaldi, Gianluca Serafini, Flavio Nobili, Matteo Pardini), Genova, Italy
| | - D Plantone
- Neurology Unit, Di Venere Hospital (Domenico Plantone), Bari, Italy
| | - E Doglione
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy
| | - J Grafman
- Cognitive Neuroscience Laboratory, Shirley Ryan Ability Lab (Jordan Grafman), Chicago, IL
| | - F Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy; Policlinico S. Martino IRCCS (Dario Arnaldi, Gianluca Serafini, Flavio Nobili, Matteo Pardini), Genova, Italy
| | - M Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa (Beatrice Orso, Dario Arnaldi, Federico Massa, Gianluca Serafini, Elisa Doglione, Flavio Nobili, Matteo Pardini), Italy; Policlinico S. Martino IRCCS (Dario Arnaldi, Gianluca Serafini, Flavio Nobili, Matteo Pardini), Genova, Italy.
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Hogeveen J, Salvi C, Grafman J. 'Emotional Intelligence': Lessons from Lesions. Trends Neurosci 2016; 39:694-705. [PMID: 27647325 DOI: 10.1016/j.tins.2016.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 01/12/2023]
Abstract
'Emotional intelligence' (EI) is one of the most highly used psychological terms in popular nomenclature, yet its construct, divergent, and predictive validities are contentiously debated. Despite this debate, the EI construct is composed of a set of emotional abilities - recognizing emotional states in the self and others, using emotions to guide thought and behavior, understanding how emotions shape behavior, and emotion regulation - that undoubtedly influence important social and personal outcomes. In this review, evidence from human lesion studies is reviewed in order to provide insight into the necessary brain regions for each of these core emotional abilities. Critically, we consider how this neuropsychological evidence might help to guide efforts to define and measure EI.
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Affiliation(s)
- J Hogeveen
- MIND Institute, University of California-Davis, Sacramento, CA, USA; Department of Psychiatry & Behavioral Sciences, University of California-Davis, Sacramento, CA, USA.
| | - C Salvi
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Psychology, Northwestern University, Evanston, IL, USA
| | - J Grafman
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Psychology, Northwestern University, Evanston, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Hogeveen J, Grafman J, Aboseria M, David A, Bikson M, Hauner K. Effects of High-Definition and Conventional tDCS on Response Inhibition. Brain Stimul 2016; 9:720-729. [DOI: 10.1016/j.brs.2016.04.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/08/2016] [Accepted: 04/16/2016] [Indexed: 11/28/2022] Open
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Hogeveen J, Bird G, Chau A, Krueger F, Grafman J. Acquired alexithymia following damage to the anterior insula. Neuropsychologia 2016; 82:142-148. [PMID: 26801227 PMCID: PMC4752907 DOI: 10.1016/j.neuropsychologia.2016.01.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/06/2016] [Accepted: 01/17/2016] [Indexed: 12/31/2022]
Abstract
Alexithymia is a subclinical condition characterized by impaired awareness of one's emotional states, which has profound effects on mental health and social interaction. Despite the clinical significance of this condition, the neurocognitive impairment(s) that lead to alexithymia remain unclear. Recent theoretical models suggest that impaired anterior insula (AI) functioning might be involved in alexithymia, but conclusive evidence for this hypothesis is lacking. We measured alexithymia levels in a large sample of brain-injured patients (N=129) and non-brain-injured control participants (N=33), to determine whether alexithymia can be acquired after pronounced damage to the AI. Alexithymia levels were first analysed as a function of group, with patients separated into four groups based on AI damage: patients with >15% damage to AI, patients with <15% damage to AI, patients with no damage to AI, and healthy controls. An ANOVA revealed that alexithymia levels varied across groups (p=0.009), with >15% AI damage causing higher alexithymia relative to all other groups (all p<0.01). Next, a multiple linear regression model was fit with the degree of damage to AI, the degree of damage to a related region (the anterior cingulate cortex, ACC), and the degree of damage to the whole brain as predictor variables, and alexithymia as the dependent variable. Critically, increased AI damage predicted increased alexithymia after controlling for the other two regressors (ACC damage; total lesion volume). Collectively, our results suggest that pronounced AI damage causes increased levels of alexithymia, providing critical evidence that this region supports emotional awareness.
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Affiliation(s)
- J Hogeveen
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - G Bird
- MRC Social, Genetic, and Developmental Psychology Centre, King's College London, London, United Kingdom; Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - A Chau
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - F Krueger
- Molecular Neuroscience Department, George Mason University, Fairfax, VA, USA; Department of Psychology, George Mason University, Fairfax, VA, USA
| | - J Grafman
- Cognitive Neuroscience Laboratory, Rehabilitation Institute of Chicago, Chicago, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Neurology, Feinberg School of Medicine, Northwestern University, USA.
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Abstract
We tested an architect with a lesion to the right prefrontal cortex in a real-world architectural design/planning task that required him to develop a new design for our lab space and compared his performance to an age- and education-matched architect. The patient understood the task and even observed that "this is a very simple problem." His sophisticated architectural knowledge base was still intact and he used it quite skilfully during the problem structuring phase. However, the patient's problem-solving behaviour differed from the control's behaviour in the following ways: (1) he was unable to make the transition from problem structuring to problem solving; (2) as a result preliminary design did not start until two thirds of the way into the session; (3) the preliminary design phase was minimal and erratic, consisting of three independently generated fragments; (4) there was no progression or lateral development of these fragments; (5) there was no carry-over of abstract information into the preliminary design or later phases, and (6) the patient did not make it to the detailing phase. This suggests that the key to understanding our patient's deficit is to understand the cognitive processes and mechanisms involved in the preliminary design phase. We appeal to a theory of design problem solving (Goel, 1995) that associates cognitive processes involved in preliminary design with "lateral" state transformations and argues that "ill-structured" representational and computational systems are necessary to support these transformations. We conclude that the neural basis of this system is selectively damaged in our patient.
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Affiliation(s)
- V Goel
- York University, Toronto, Canada
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Knutson KM, Krueger F, Dal Monte O, Raymont V, Snyder AD, Kirsch HE, Wassermann EM, Grafman J. Gustatory cortical lesions affect motivation for snack foods. Cogn Neurosci 2012; 3:131-8. [PMID: 24168694 DOI: 10.1080/17588928.2012.688018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Most neuropsychological research using food as a reward uses single-bid auctions. We wished to determine whether focal brain lesions would affect the ability and motivation to win snack food items in a computerized auction allowing multiple bids. This allowed us to assess participants' abilities under more complex conditions. We enrolled 154 male penetrating traumatic brain injury (pTBI) veterans, mean age 58, from the Vietnam Head Injury Study registry, and 53 male uninjured veterans, mean age 59. We used voxel-based lesion symptom mapping (VLSM) to identify effects of brain lesions on the ability to win items and on participants' answers to statements regarding their level of motivation and evaluation of how well they performed. Number of items won was not significantly associated with any lesions; however, lesions in gustatory cortex (GC) affected motivation and self-evaluation. Our findings provide further evidence of the primary GC's role in motivation for food and drink.
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Affiliation(s)
- K M Knutson
- a Cognitive Neuroscience Section , National Institutes of Neurological Disorders and Stroke, National Institutes of Health , Bethesda , Maryland
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Pardini M, Krueger F, Hodgkinson C, Raymont V, Ferrier C, Goldman D, Strenziok M, Guida S, Grafman J. Prefrontal cortex lesions and MAO-A modulate aggression in penetrating traumatic brain injury. Neurology 2011; 76:1038-45. [PMID: 21422455 DOI: 10.1212/wnl.0b013e318211c33e] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study investigates the interaction between brain lesion location and monoamine oxidase A (MAO-A) in the genesis of aggression in patients with penetrating traumatic brain injury (PTBI). METHODS We enrolled 155 patients with PTBI and 42 controls drawn from the Vietnam Head Injury Study registry. Patients with PTBI were divided according to lesion localization (prefrontal cortex [PFC] vs non-PFC) and were genotyped for the MAO-A polymorphism linked to low and high transcriptional activity. Aggression was assessed with the aggression/agitation subscale of the Neuropsychiatric Inventory (NPI-a). RESULTS Patients with the highest levels of aggression preferentially presented lesions in PFC territories. A significant interaction between MAO-A transcriptional activity and lesion localization on aggression was revealed. In the control group, carriers of the low-activity allele demonstrated higher aggression than high-activity allele carriers. In the PFC lesion group, no significant differences in aggression were observed between carriers of the 2 MAO-A alleles, whereas in the non-PFC lesion group higher aggression was observed in the high-activity allele than in the low-activity allele carriers. Higher NPI-a scores were linked to more severe childhood psychological traumatic experiences and posttraumatic stress disorder symptomatology in the control and non-PFC lesion groups but not in the PFC lesion group. CONCLUSIONS Lesion location and MAO-A genotype interact in mediating aggression in PTBI. Importantly, PFC integrity is necessary for modulation of aggressive behaviors by genetic susceptibilities and traumatic experiences. Potentially, lesion localization and MAO-A genotype data could be combined to develop risk-stratification algorithms and individualized treatments for aggression in PTBI.
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Affiliation(s)
- M Pardini
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke-NIH, Bethesda, MD, USA
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Abstract
BACKGROUND The Vietnam Head Injury Study (VHIS) is a prospective, longitudinal follow-up of 1,221 Vietnam War veterans with mostly penetrating head injuries (PHIs). The high prevalence (45%-53%) of posttraumatic epilepsy (PTE) in this unique cohort makes it valuable for study. METHODS A standardized multidisciplinary neurologic, cognitive, behavioral, and brain imaging evaluation was conducted on 199 VHIS veterans plus uninjured controls, some 30 to 35 years after injury, as part of phase 3 of this study. RESULTS The prevalence of seizures (87 patients, 43.7%) was similar to that found during phase 2 evaluations 20 years earlier, but 11 of 87 (12.6%) reported very late onset of PTE after phase 2 (more than 14 years after injury). Those patients were not different from patients with earlier-onset PTE in any of the measures studied. Within the phase 3 cohort, the most common seizure type last experienced was complex partial seizures (31.0%), with increasing frequency after injury. Of subjects with PTE, 88% were receiving anticonvulsants. Left parietal lobe lesions and retained ferric metal fragments were associated with PTE in a logistic regression model. Total brain volume loss predicted seizure frequency. CONCLUSIONS Patients with PHI carry a high risk of PTE decades after their injury, and so require long-term medical follow-up. Lesion location, lesion size, and lesion type were predictors of PTE.
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Affiliation(s)
- V Raymont
- Henry M Jackson Foundation, National Naval Medical Center, Bethesda, MD, USA
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Zamboni G, Grafman J, Krueger F, Knutson K, Huey E. Anosognosia for behavioral disturbances in frontotemporal dementia and corticobasal syndrome: A voxel-based morphometry study. Dement Geriatr Cogn Disord 2010; 29:88-96. [PMID: 20150729 PMCID: PMC2840246 DOI: 10.1159/000255141] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with syndromes of the frontotemporal dementia spectrum are frequently unaware of their behavioral changes. METHODS Seventy patients with a clinical diagnosis of behavioral variant frontotemporal dementia (bv-FTD, n = 27), aphasic variant frontotemporal dementia (a-FTD, n = 12) and corticobasal syndrome (CBS, n = 31) participated in the study. Anosognosia for behavioral disturbances was measured as discrepancy between caregiver's and patient's ratings on the Frontal Systems Behavior Scale for present and premorbid behavioral symptoms. Voxel-based morphometry analysis of MRI data was performed to explore the association between anosognosia and gray matter loss. RESULTS Although behavioral symptoms were reported in all the groups, the comparison between present and premorbid anosognosia revealed that bv-FTD patients not only underestimated their present behavioral disturbances compared to their caregivers, but also overestimated their premorbid behavioral disturbances. Across all groups, the degree of anosognosia for present behavioral impairment correlated with gray matter atrophy in a posterior region of the right superior temporal sulcus (adjacent to the temporoparietal junction). CONCLUSION These results confirm the role of the right temporoparietal cortex in the genesis of anosognosia and suggest that, in clinical syndromes of the frontotemporal dementia spectrum, anosognosia is associated with the dysfunction of temporoparietal mechanisms of self versus others knowledge.
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Affiliation(s)
- G. Zamboni
- Cognitive Neuroscience Section, NINDS, NIH, Bethesda, Md., USA
- Università di Modena e Reggio Emilia, Modena, Italy
| | - J. Grafman
- Cognitive Neuroscience Section, NINDS, NIH, Bethesda, Md., USA
| | - F. Krueger
- Cognitive Neuroscience Section, NINDS, NIH, Bethesda, Md., USA
| | - K.M. Knutson
- Cognitive Neuroscience Section, NINDS, NIH, Bethesda, Md., USA
| | - E.D. Huey
- Cognitive Neuroscience Section, NINDS, NIH, Bethesda, Md., USA
- Litwin-Zucker Research Center for the Study of Alzheimer's Disease and Memory Disorders, Great Neck, N.Y., USA
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Tovar-Moll F, Bramati IE, Moll J, Canavagh A, Tierney M, Grafman J. Specific patterns of white matter tract damage in fronto-temporal dementia and cortico-basal degeneration. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71028-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Huey ED, Goveia EN, Paviol S, Pardini M, Krueger F, Zamboni G, Tierney MC, Wassermann EM, Grafman J. Executive dysfunction in frontotemporal dementia and corticobasal syndrome. Neurology 2009; 72:453-9. [PMID: 19188577 DOI: 10.1212/01.wnl.0000341781.39164.26] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the pattern of executive dysfunction in frontotemporal dementia (FTD) and corticobasal syndrome (CBS) and to determine the brain areas associated with executive dysfunction in these illnesses. METHOD We administered the Delis-Kaplan Executive Function System (D-KEFS), a collection of standardized executive function tests, to 51 patients with behavioral-variant FTD and 50 patients with CBS. We also performed a discriminant analysis on the D-KEFS to determine which executive function tests best distinguished the clinical diagnoses of FTD and CBS. Finally, we used voxel-based morphometry (VBM) to determine regional gray matter volume loss associated with executive dysfunction. RESULTS Patients with FTD and patients with CBS showed executive dysfunction greater than memory dysfunction. Executive function was better preserved in the patients with CBS than the patients with FTD with the exception of tests that required motor, visuospatial ability, or both. In patients with CBS, dorsal frontal and parietal and temporal-parietal cortex was associated with executive function. In FTD, tests with a language component (Verbal Fluency) were associated with left perisylvian cortex, sorting with the left dorsolateral prefrontal cortex, and reasoning (the Twenty Questions task) with the left anterior frontal cortex. The Twenty Questions test best distinguished the clinical diagnoses of CBS and FTD. CONCLUSIONS The neuroanatomic findings (especially in frontotemporal dementia [FTD]) agree with the previous literature on this topic. Patients with FTD and patients with corticobasal syndrome (CBS) show disparate performance on higher-order executive functions, especially the Twenty Questions test. It may be difficult to distinguish motor and visuospatial ability from executive function in patients with CBS using tests with significant motor and visuospatial demands such as Trail Making.
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Affiliation(s)
- E D Huey
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1440, USA
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Knutson K, Zamboni G, Tierney M, Grafman J. Neural correlates of caregiver burden in cortical basal syndrome and frontotemporal dementia. Dement Geriatr Cogn Disord 2008; 26:467-74. [PMID: 18984957 PMCID: PMC2596937 DOI: 10.1159/000167268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2008] [Indexed: 11/19/2022] Open
Abstract
AIMS To determine areas of atrophy in patients that are associated with caregiver burden. METHODS We measured caregiver burden, dementia and neuropsychiatric scores in 22 patients with corticobasal syndrome (CBS) and 25 with frontotemporal dementia (FTD), and in 14 healthy controls. We used voxel-based morphometry to correlate caregiver burden with gray matter loss. RESULTS Increased dementia and behavioral disturbances contributed to higher burden scores in CBS patients, while behavioral disturbances alone significantly affected burden scores in frontal-variant FTD (FTD-fv) patients. In CBS patients, caregiver burden scores correlated with atrophy in left inferior and middle temporal gyri. CONCLUSIONS Caregivers of FTD-fv patients had significantly higher burden scores than caregivers of CBS patients. Damage to areas important in semantic knowledge appears critical in increased burden for CBS caregivers.
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Affiliation(s)
- K.M. Knutson
- Cognitive Neuroscience Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., USA
| | - G. Zamboni
- Cognitive Neuroscience Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., USA;,Dipartimento di Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - M.C. Tierney
- Cognitive Neuroscience Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., USA
| | - J. Grafman
- Cognitive Neuroscience Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., USA;,*Jordan Grafman, PhD, Cognitive Neuroscience Section, National Institutes of Neurological Disorders and Stroke National Institutes of Health, Building 10, Room 7D43, MSC 1440, 10 Center Drive, Bethesda, MD 20892-1440 (USA), Tel. +1 301 496 0220, Fax +1 301 480 2909, E-Mail
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Abstract
BACKGROUND Aberrant social behavior is a defining symptom of frontotemporal dementia (FTD) and may eventually occur in all syndromes composing the FTD spectrum. Two main behavioral abnormalities have been described: apathy and disinhibition, but their neuroanatomical correlates remain underspecified. METHODS Sixty-two patients with a clinical diagnosis of FTD participated in the study. Voxel-based morphometry of MRI data was performed to explore the association between gray matter loss and severity of the two behavioral profiles as measured by the Apathy and Disinhibition subscales of the Frontal Systems Behavior Scale. RESULTS Compared with a group of controls, the FTD group showed extensive bilateral atrophy predominantly involving frontal and temporal lobes. Within the FTD group, the severity of apathy correlated with atrophy in the right dorsolateral prefrontal cortex. The severity of disinhibition correlated with atrophy in the right nucleus accumbens, right superior temporal sulcus, and right mediotemporal limbic structures. CONCLUSIONS Prefrontal and temporal regions are differentially associated with apathy and disinhibition. Our results support the view that successful execution of complex social behaviors relies on the integration of social knowledge and executive functions, represented in the prefrontal cortex, and reward attribution and emotional processing, represented in mesolimbic structures.
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Affiliation(s)
- G Zamboni
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, NIH, Bldg. 10, Room 7D43, MSC 1440, Bethesda, MD 20892-1440, USA.
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Abstract
OBJECTIVE To evaluate driving competency and the relationship between neuropsychiatric symptoms and driving behavior in frontotemporal dementia (FTD) patients. METHODS Fifteen patients with a diagnosis of FTD and 15 healthy controls were administered a driving simulation task. Measures of driving performance and neuropsychiatric symptoms were assessed. RESULTS The FTD patients received more speeding tickets, ran more stop signs and were involved in more off-road crashes and collisions than the controls. The patients' overall average speed was significantly higher. Driving performance was correlated with agitated behavior. CONCLUSIONS Behavioral changes characteristic of FTD patients have an impact on their driving skills leading to inappropriate driving behavior.
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Affiliation(s)
- V de Simone
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA
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Spina S, Murrell JR, Huey ED, Wassermann EM, Pietrini P, Baraibar MA, Barbeito AG, Troncoso JC, Vidal R, Ghetti B, Grafman J. Clinicopathologic features of frontotemporal dementia with progranulin sequence variation. Neurology 2007; 68:820-7. [PMID: 17202431 DOI: 10.1212/01.wnl.0000254460.31273.2d] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Frontotemporal lobar degeneration with ubiquitin-immunoreactive (ub-ir) inclusions (FTLD-U) has been associated with frontotemporal dementia (FTD) and ALS. Recently, mutations in Progranulin (PGRN), predicted to cause premature truncation of the PGRN coding sequence, were found in patients with inherited FTLD-U and ub-ir neuronal intranuclear inclusions (NII). OBJECTIVE To describe clinical, pathologic, and genetic features of three FTD patients having either a family history of FTD (A.III.1 and B.II.1) or of ALS (C.III.1). METHODS Patients underwent a single clinical assessment, MRI, and [(18)F]fluorodeoxyglucose PET brain scan. Neuropathologic examination and genetic analyses were carried out. RESULTS Patients presented clinically with the behavioral variant of FTD. Language dysfunctions were marked with comprehension being particularly affected. Neuroimaging revealed frontotemporal atrophy and glucose hypometabolism, with predominant left-side involvement, in Patients A.III.1 and B.II.1. Subject C.III.1 displayed mild atrophy and symmetric anterior hypometabolism. All patients were neuropathologically diagnosed with FTLD-U. Ub-ir NII were noted in Patients A.III.1 and B.II.1 but were absent in Patient C.III.1. The following PGRN sequence variations were found: IVS6-2A-->G (A.III.1), R493X (B.II.1), and R433W (C.III.1). IVS6-2A-->G may lead to skipping of exon 7 with consequent frameshift of the coding sequence and premature termination of PGRN translation. CONCLUSIONS We have found two PGRN mutations associated with FTD, in affected individuals who are members of families with possible autosomal dominant FTD. A third PGRN sequence variation (R433W) was found in an FTD patient with family history of ALS.
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Affiliation(s)
- S Spina
- Indiana Alzheimer Disease Center, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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17
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Henkel K, Danek A, Grafman J, Kassubek J. Voxel-basierte Morphometrie bei Chorea-Akanthozytose. Akt Neurol 2005. [DOI: 10.1055/s-2005-919291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Abstract
BACKGROUND Data from the human motor cortex suggest that, depending on polarity, direct current (DC) brain polarization can depress or activate cortical neurons. Activating effects on the frontal lobe might be beneficial for patients with frontal lobe disorders. This phase 1 study tested the safety of frontal DC, including its effects on frontal and other brain functions. METHODS The authors applied 20 minutes of anodal, cathodal, or sham DC to the left prefrontal cortex in three groups of right-handed subjects and looked for effects on global measures of processing and psychomotor speed, emotion, and verbal fluency, a measure of local cortical function. In one experiment (n = 30), the authors tested before and after 1 mA DC and monitored EEG in 9 subjects. In two other experiments using 1 mA (n = 43) and 2 mA (n = 30), the authors tested before and then starting 5 minutes after the onset of DC. RESULTS All subjects tolerated DC well. There were no significant effects on performance with 1 mA DC. At 2 mA, verbal fluency improved significantly with anodal and decreased mildly with cathodal DC. There were no clinically significant effects on the other measures. CONCLUSIONS Limited exposure to direct current polarization of the prefrontal cortex is safe and can enhance verbal fluency selectively in healthy subjects. As such, it deserves consideration as a procedure to improve frontal lobe function in patients.
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Affiliation(s)
- M B Iyer
- Brain Stimulation Unit and Cognitive Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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19
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Abstract
Complex social behavior and the relatively large size of the prefrontal cortex are arguably two of the characteristics that distinguish humans from other animals. Grafman presented a framework concerning how the prefrontal cortex (PFC) controls complex behavior using stored structured event complexes (SECs). We report behavioral and imaging data from a modified go/no-go paradigm in which subjects had to classify words (semantic) and phrases (SEC) according to category. In experimental trials, subjects classified items according to social or nonsocial activity; in control trials, they classified items according to font. Subjects were faster to classify social than nonsocial semantic items, with the reverse pattern evident for the social and nonsocial SEC items. In addition, the conditions were associated with different patterns of PFC activation. These results suggest that there are different psychological and neural substrates for social and nonsocial semantic and SEC representations.
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Affiliation(s)
- J N Wood
- National Institutes of Health, Bethesda, MD 20892-1440, USA
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20
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Rosen VM, Caplan L, Sheesley L, Rodriguez R, Grafman J. An examination of daily activities and their scripts across the adult lifespan. Behav Res Methods Instrum Comput 2003; 35:32-48. [PMID: 12723778 DOI: 10.3758/bf03195495] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In two normative studies, we examined daily scripted activities from the perspective that scripts are frequency-based knowledge structures. In Study 1 individuals recorded their daily activities for 7 consecutive days. Fifteen activities that were reported with low, moderate, and high frequency were selected for Study 2, in which individuals generated a script for each activity. The 18 most frequently generated events from each script are reported, along with their centrality and distinctiveness rankings and the number of individuals reporting each event. Overall, the mean number of events generated increased with increasing script frequency, suggesting that script representations are subject to frequency effects. Also, we found a high level of consistency across the three age groups in the events generated in each script and in their corresponding rankings of centrality and distinctiveness. Finally, we found no evidence of age or gender bias in the frequency or recency of engaging in each of the scripted activities.
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Affiliation(s)
- V M Rosen
- Geriatric Psychiatry Branch, National Institute of Mental Health, Bethesda, Maryland 20892, USA.
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21
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Affiliation(s)
- J Grafman
- Cognitivre Neuroscience Section, NINDS/NIH, Building 10, Room 5C205, MSC 1440, Bethesda, MD 20892-1440, USA.
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22
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Frattali C, Duffy JR, Litvan I, Patsalides AD, Grafman J. Yes/no reversals as neurobehavioral sequela: a disorder of language, praxis, or inhibitory control? Eur J Neurol 2003; 10:103-6. [PMID: 12535005 DOI: 10.1046/j.1468-1331.2003.00545.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study identifies a linguistic phenomenon suggestive of damage to fronto-subcortical circuitry. Our objective was to determine the occurrence and neuroradiological/neurobehavioral correlates of yes/no reversals in corticobasal degeneration (CBD), and document occurrence of reversals in other neurological conditions. In a prospective study, we evaluated 34 CBD patients using a neuropsychologic battery and magnetic resonance imaging. Patients were subdivided into two groups: those with (n = 11) and without (n = 23) yes/no reversals. In a retrospective study conducted during the period of 1991-2001, we identified 33 patients for whom yes/no reversals occurred to compare correlates with prospective study findings. In the prospective study, 11 patients (32.3%) had yes/no reversals. Significant between-group differences were found in scores of lexical fluency (P = 0.02) and prehension (P = 0.03). Prehension scores correlated with facial praxis (P < 0.0001) and upper limb praxis scores (P < 0.0001) in the yes/no reversal group only. In the retrospective study, nine CBD patients and 24 non-CBD patients had yes/no reversals, with damage to fronto-subcortical areas present in all patients. Results suggest an association with deficits in mental flexibility and inhibitory control. High within-group correlations of lexical fluency and prehension with praxis scores suggest a relationship of yes/no reversals with multiple factors.
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Affiliation(s)
- C Frattali
- Department, W G Magnuson Clinical Center, NIH, Bethesda, MD 20892-1604, USA.
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23
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Arnold MC, Papanicolaou DA, O'Grady JA, Lotsikas A, Dale JK, Straus SE, Grafman J. Using an interleukin-6 challenge to evaluate neuropsychological performance in chronic fatigue syndrome. Psychol Med 2002; 32:1075-1089. [PMID: 12214788 DOI: 10.1017/s0033291702006086] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with acute infections experience a range of symptoms including fatigue, malaise, muscle aches, and difficulties with concentration and memory that are usually self-limited. This cluster of symptoms is otherwise, similar to those that characterize chronic fatigue syndrome (CFS). The goal of the present study was to evaluate the cognitive and psychological functioning of CFS patients and normal controls (NCs) when they both were experiencing acute influenza-like symptoms. To induce influenza-like symptoms, we administered interleukin-6 (IL-6), a cytokine that temporarily activates the acute phase immunological and endocrine responses. METHODS Nineteen patients who met the 1994 International CFS Study Group Criteria and ten normal controls (NCs) completed routine clinical evaluations, neuropsychological tests of short-term memory, selective attention, and executive control, and self-ratings of somatic symptoms and psychological mood before, shortly following, and 1 day after IL-6 administration. RESULTS CFS patients consistently reported more somatic symptoms, even when both groups perceived that they were ill. Both groups somatic symptoms increased during the IL-6 challenge, but the CFS patients symptoms increased more rapidly than controls. In general, the CFS patients performed similarly to NCs on the cognitive measures before, during, and after the IL-6. In contrast to predictions, IL-6 provocation did not impair the cognitive performance of either CFS patients or NCs. CONCLUSIONS The IL-6 provocation exacerbated the patients self-reported symptoms but did not reveal notable cognitive impairments between patients and controls during cytokine-induced acute influenza-like symptoms.
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Affiliation(s)
- M C Arnold
- National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development and National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1440, USA
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24
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Jurado MA, Junqué C, Vallejo J, Salgado P, Grafman J. Obsessive-compulsive disorder (OCD) patients are impaired in remembering temporal order and in judging their own performance. J Clin Exp Neuropsychol 2002; 24:261-9. [PMID: 11992208 DOI: 10.1076/jcen.24.3.261.986] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Obsessive-compulsive disorder (OCD) has been related to frontostriatal dysfunction, but some inconsistencies between studies and a relative paucity of neuropsychological research still characterizes the study of OCD. We compared 28 patients with OCD and matched healthy controls on two neuropsychological tests sensitive to frontal dysfunction: temporal ordering and a "feeling-of-doing" (FOD) judgment about ordering. The OCD group performed significantly worse than controls in the temporal ordering task despite showing normal recognition memory. Patients were also impaired in "feeling-of-doing" judgments suggesting they have a lack of self-awareness of their performance. Thus, the results of the current study reinforces previous research that indicates that OCD patients fail on tasks that require adequate functioning of the frontal-striatal pathways.
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Affiliation(s)
- M A Jurado
- Dpt. Psiquiatria i Psicobiologia clínica, Universitat de Barcelona, Spain.
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25
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Romero SG, Manly CF, Grafman J. Investigating cognitive neuroplasticity in single cases: lessons learned from applying functional neuroimaging techniques to the traditional neuropsychological case study framework. Neurocase 2002; 8:355-68. [PMID: 12499410 DOI: 10.1076/neur.8.4.355.16187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We summarize two case studies as a context for discussing the use of neuroimaging as a convergent methodology in the study of neuroplasticity in single subjects. Throughout this paper we argue for a different approach for including neuroimaging in these types of study. Previous case studies of neuroplasticity in patients (ours as well as others reported elsewhere) have added neuroimaging to the traditional neuropsychological framework of comparing patient results with matched control groups, and synthesized results through descriptions of anatomical and behavioral dissociations. This type of approach is referred to as the comparison approach. We advocate a different approach that builds on findings from previous behavioral skill learning research. Specifically, we propose adding neuroimaging throughout learning or recovery of the ability of interest and making inferences from systematic changes in activation topography and intensity that occur within the context of predicted behavioral changes. We dub this approach the online approach. This approach should allow future investigators to circumvent many of the interpretation pitfalls that are common in comparison studies.
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Affiliation(s)
- S G Romero
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
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26
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Morgen K, Martin R, Stone RD, Grafman J, Kadom N, McFarland HF, Marques A. FLAIR and magnetization transfer imaging of patients with post-treatment Lyme disease syndrome. Neurology 2001; 57:1980-5. [PMID: 11739813 DOI: 10.1212/wnl.57.11.1980] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine patterns of abnormalities on cerebral MRI that may characterize subgroups of patients with post-treatment Lyme disease syndrome (PTLDS) and to help identify pathomechanisms of disease. METHODS The authors analyzed the distribution of cerebral lesions in a cohort of 27 patients with PTLDS. A subgroup of eight patients with PTLDS was further studied using whole-brain magnetization transfer ratio measures to identify abnormalities not seen on T2-weighted images. RESULTS Four patients had focal neurologic deficits, relapsing-remitting disease, and lesions in a distribution typical of MS. Twenty-three patients presented with nonfocal symptoms such as fatigue, subjective memory deficits, and mood disturbance. Twelve of these patients had normal MRI, including the more sensitive fluid-attenuated inversion recovery sequence, 10 had primarily punctate and subcortical lesions, and one patient had multiple periventricular lesions. CONCLUSIONS In a portion of patients with post-treatment Lyme disease syndrome, white-matter hyperintensities tend to occur in subcortical arteriolar watershed areas and are not specific. Magnetization transfer ratio analysis did not provide evidence for structural abnormalities of the brain parenchyma in patients with nonfocal disease.
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Affiliation(s)
- K Morgen
- Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1400, USA
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27
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Abstract
Patients with prefrontal cortex lesions are impaired on a variety of planning and problem-solving tasks. We examined the problem-solving performance of 27 patients with focal frontal lobe damage on the Water Jug task. The Water Jug task has never been used to assess problem-solving ability in neurologically impaired patients nor in functional neuroimaging studies, despite sharing structural similarities with other tasks sensitive to prefrontal cortex function, including the Tower of Hanoi, Tower of London, and Wisconsin Card Sorting Task (WCST). Our results demonstrate that the Water Jug task invokes a unique combination of problem-solving and planning strategies, allowing a more precise identification of frontal lobe lesion patients' cognitive deficits. All participants (patients and matched controls) appear to be utilizing a hill-climbing strategy that does not require sophisticated planning; however, frontal lobe lesion patients (FLLs) struggled to make required "counterintuitive moves" not predicted by this strategy and found within both solution paths. Left and bilateral FLLs were more impaired than right FLLs. Analysis of the left hemisphere brain regions encompassed by the lesions of these patients found that poor performance was linked to left dorsolateral prefrontal cortex damage. We propose that patients with left dorsolateral prefrontal cortex lesions have difficulty making a decision requiring the conceptual comparison of nonverbal stimuli, manipulation of select representations of potential solutions, and are unable to appropriately inhibit a response in keeping with the final goal.
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Affiliation(s)
- M K Colvin
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke/NIH, Room 5C205, Building 10, 10 Center Drive, MSC 1440, Bethesda, MD 20892, USA
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28
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Abstract
Chronic fatigue syndrome (CFS) patients and controls were compared on a variety of mood state, personality, and neuropsychological measures, including memory, word finding, and attentional tasks that required participants to focus, sustain, or divide their attention, or to perform a combination of these functions. CFS patients demonstrated a selective deficit on 3 measures of divided attention. Their performance on the other neuropsychological tests of intelligence, fluency, and memory was no different than that of normal controls despite their reports of generally diminished cognitive capacity. There was an inverse relation between CFS patient fatigue severity and performance on 1 of the divided attention measures. Given these findings, it is probable that CFS patients will report more cognitive difficulties in real-life situations that cause them to divide their effort or rapidly reallocate cognitive resources between 2 response channels (vision and audition).
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Affiliation(s)
- S Ross
- Department of Psychology, American University, Washington, DC, USA
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29
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Hilsabeck RC, LeCompte DC, Marks AR, Grafman J. The Word Completion Memory Test (WCMT): a new test to detect malingered memory deficits. Arch Clin Neuropsychol 2001. [DOI: 10.1093/arclin/16.7.669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Hilsabeck RC, LeCompte DC, Marks AR, Grafman J. The Word Completion Memory Test (WCMT): a new test to detect malingered memory deficits. Arch Clin Neuropsychol 2001; 16:669-78. [PMID: 14589785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
In recent years, much research has focused on developing tests to detect malingering. A drawback of existing tests is their poor ability to detect malingerers possessing more "sophisticated" knowledge of neuropsychological deficits. The current study presents preliminary validation data on a new measure, the Word Completion Memory Test (WCMT), which is the first malingering test to utilize a sophisticated coaching methodology in its development. The WCMT was administered to control participants, memory-impaired patients, and coached simulators. The coached simulators were provided with specific information about and examples of memory deficits commonly experienced following closed head injury (CHI; e.g., anterograde vs. retrograde amnesia). They also read a detailed scenario describing the lifestyle and motivations likely experienced by CHI litigants, and then practiced their roles by taking a quiz about their deficits. Results showed that 93% of coached simulators and 100% of control and memory-impaired participants were correctly classified by the WCMT.
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Affiliation(s)
- R C Hilsabeck
- University of California, San Diego, CA 92103-8707, USA.
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31
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Grafman J, Romero S. Appearances may not be deceiving: calculation deficits due to a brain structure abnormality in neurologically normal children. Brain 2001; 124:1681-2. [PMID: 11522571 DOI: 10.1093/brain/124.9.1681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Litvan I, Phipps M, Pharr VL, Hallett M, Grafman J, Salazar A. Randomized placebo-controlled trial of donepezil in patients with progressive supranuclear palsy. Neurology 2001; 57:467-73. [PMID: 11502915 DOI: 10.1212/wnl.57.3.467] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE There is no effective treatment for progressive supranuclear palsy (PSP). Because results of immunochemical and pharmacologic studies suggest that the cholinergic system may play a role in the cognitive and motor features of PSP, the authors investigated the effects of donepezil (10 mg/day), an acetylcholinesterase inhibitor, in 21 patients with PSP (mean age +/- SD; 65.7 +/- 4.7 years) by a randomized, double-blind, placebo-controlled crossover trial. METHODS Donepezil and placebo were administered for 6 weeks each with a 1-month washout period. Patients were evaluated before and at the end of each treatment phase. Outcome measures evaluated neuropsychiatric, global cognitive, frontal, memory, motor, and activities of daily living (ADL) status. RESULTS Two patients withdrew during the washout phase because of unrelated medical problems. Donepezil-induced systemic side effects were transient and generally mild. Because of worsening of motor function, three patients received 5 mg/day of donepezil. All patients achieved blood and CSF therapeutic levels of donepezil. While the patients were taking donepezil, their Double Memory Test scores improved, whereas their ADL/mobility scores significantly worsened. CONCLUSION The findings suggest that acetylcholinesterase inhibitors such as donepezil have at best selective, modest effects on cognition in patients with PSP. In light of its deleterious effects on ADL/mobility, donepezil is not recommended for this patient population.
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Affiliation(s)
- I Litvan
- Cognitive Neuropharmacology Unit, Henry M. Jackson Foundation, Bethesda 20817-1844, USA.
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33
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Abstract
Patients with frontal lobe lesions are known to encounter severe problems in the organisation of their behaviour in everyday life. Script generation tasks assess the subject's conceptual ability to formulate and evaluate a coherent and structured plan of action. In the present study, we investigated to what extent neuropsychological deficits observed at the conceptual level of action knowledge lead to impairments in action execution. We examined seven patients with prefrontal cortex damage and sixteen normal subjects. Subjects were first asked to verbally formulate a plan of action and then to use this knowledge for 'executing' the actions in a virtual 3-dimensional interactive apartment presented on a computer screen. The results indicated that the presence of the realistic context improved patients' performance. However, specific impairments were observed in patients in the execution condition, namely actions slips, omissions, failure in initiating actions and purposeless displacements. Moreover, an analysis of planning time showed that, differently of the patients group, normal subjects spent more time during plan execution as compared to plan generation. These results suggest that after a frontal lobe lesion a defective formulation of a routine plan might affect the execution of the corresponding course of actions.
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Affiliation(s)
- T Zalla
- CNRS, Institut des Sciences Cognitives, 67, Boulevard Pinel, 69675 Cedex, Bron, France
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34
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Milne E, Grafman J. Ventromedial prefrontal cortex lesions in humans eliminate implicit gender stereotyping. J Neurosci 2001; 21:RC150. [PMID: 11404442 PMCID: PMC6762729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
Patients with prefrontal cortex lesions and controls were administered an implicit association task (IAT) that measured the degree of association between male and female names and their stereotypical attributes of strength and weakness. They also completed three questionnaires measuring their explicit judgment regarding gender-related stereotypical attributes. There were no between-group differences on the explicit measures. On the IAT, patients with dorsolateral lesions and controls showed a strong association, whereas patients with ventromedial prefrontal cortex lesions had a significantly lower association, between the stereotypical attributes of men and women and their concepts of gender. This finding provides support for the hypothesis that patients with ventromedial prefrontal lesions have a deficit in automatically accessing certain aspects of overlearned associated social knowledge.
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Affiliation(s)
- E Milne
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1440, USA
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35
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Shafiq M, Nee L, Grafman J, Tresser N, Lee VM, Trojanowski JQ, Lippa CF. Frontotemporal dementia: report of a familial case. Neurology 2001; 56:S31-4. [PMID: 11402148 DOI: 10.1212/wnl.56.suppl_4.s31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors describe a 49-year-old woman (R.K.) who presented with one year of progressive frontal lobe dysfunction, including signs of expressive aphasia. Signs of parkinsonism were absent until late in the clinical course. Neuropsychologic testing and neuroimaging studies are described. The patient died at age 55, after 7 years of symptoms. Family history was remarkable for a mother who died at the age of 45, after experiencing 7 years of progressive aphasia. R.K.'s brain showed asymmetric frontotemporal atrophy, which was more severe on the left side. Histopathologic analysis was remarkable for numerous tau-positive neurons with some classic-appearing Pick bodies and many ballooned neurons. Tau-positive glial cells were also present. The authors suggest that the abnormal tau aggregates are related to the symptoms experienced by affected members of this family.
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Affiliation(s)
- M Shafiq
- Department of Neurology, MCP-Hahnemann University, Philadelphia, PA, USA
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36
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Abstract
We report a positron emission tomography (PET) study in a 37-year-old, right handed, bilingual (English and American Sign Language) male with left frontal lobe damage, without evidence of language or general intellectual dysfunction. A brain MRI scan demonstrated an atrophic lesion of the left dorsolateral prefrontal, orbital, and opercular cortices extending from the frontal pole to precentral gyrus and including parts of anterior cingulate cortex, due to an probable infantile encephalitis. H(2) (15)O PET scans found evidence of increased right hemisphere activity compared to normal controls during spontaneous generation of narrative in both English and ASL. Neuropsychological data were within normal limits with the exception of visuospatial function. The results suggest the possibility that plasticity, unmasking of neural pathways, and or other adaptations of language function in the right hemisphere may have occurred, and are discussed with regard to the crowding hypothesis.
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Affiliation(s)
- M C Tierney
- Cognitive Neuroscience Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, Room 5C 205, Bethesda, MD 20892, USA
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37
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Pharr V, Uttl B, Stark M, Litvan I, Fantie B, Grafman J. Comparison of apraxia in corticobasal degeneration and progressive supranuclear palsy. Neurology 2001; 56:957-63. [PMID: 11294936 DOI: 10.1212/wnl.56.7.957] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe ideomotor apraxia in patients with corticobasal degeneration and those with progressive supranuclear palsy, two parkinsonian disorders that are often misdiagnosed due to the overlap in their clinical features, and to determine whether systematic apraxia testing is useful for differential diagnosis. METHODS Fourteen patients fulfilling National Institute of Neurological Disorders and Stroke-Society for Progressive Supranuclear Palsy clinical criteria for progressive supranuclear palsy, 13 patients fulfilling modified Lang criteria for corticobasal degeneration, and 12 normal healthy control subjects were given the Test of Oral and Limb Apraxia, which was scored according to the Florida Apraxia Battery for occurrence of various types of apraxic errors. RESULTS Both patients with progressive supranuclear palsy and corticobasal degeneration committed a greater number of apraxic errors than normal healthy control subjects on both transitive and intransitive tasks (p < 0.001 in both cases), but apraxia was much more severe in patients with corticobasal degeneration than progressive supranuclear palsy (p < 0.001). The index of apraxia severity, in combination with the assessment of the two key features of progressive supranuclear palsy (falls and vertical gaze palsy), correctly classified all patients. CONCLUSIONS Patients with corticobasal degeneration show more severe ideomotor apraxia than patients with progressive supranuclear palsy, and systematic assessment of ideomotor apraxia facilitates the differential diagnosis between patients with progressive supranuclear palsy and those with corticobasal degeneration.
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Affiliation(s)
- V Pharr
- Cognitive Neuropharmacology Unit, Defense & Veteran Head Injury Program, Henry M. Jackson Foundation, Rockville, MD, USA
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38
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Abstract
In a previous study we showed that learning in eyeblink classical conditioning (EBCC) is normal in Parkinson's disease (PD) and that the serial reaction time task (SRTT) is only marginally impaired. Since pathological lesions are more widespread in the atypical parkinsonian disorder of progressive supranuclear palsy (PSP) than in PD, we hypothesized that PSP patients may show more profound deficits in the EBCC and SRTT learning tasks. We therefore investigated EBCC with a delay and two trace paradigms, an SRTT and the California Verbal Learning Test (CVLT) in eight patients with PSP and an age-matched control group. In all EBCC paradigms, we found a significant difference between groups with no significant learning in PSP patients. In the SRTT, implicit learning may have been impaired, but verbal and manual sequence recall were only marginally impaired. Verbal memory was significantly worse in PSP patients than in the control group. Our study shows a dissociated pattern of learning abilities in PSP, where the EBCC as a measure of implicit learning is impaired, the explicit sequence detection in the SRTT is relatively preserved, and the verbal memory impaired. We hypothesize that the PSP patients' deficits in EBCC learning may be due to lesions of deep cerebellar nuclei. There may be a clinical role for EBCC in distinguishing PD and PSP patients.
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Affiliation(s)
- M Sommer
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
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39
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Xu B, Grafman J, Gaillard WD, Ishii K, Vega-Bermudez F, Pietrini P, Reeves-Tyer P, DiCamillo P, Theodore W. Conjoint and extended neural networks for the computation of speech codes: the neural basis of selective impairment in reading words and pseudowords. Cereb Cortex 2001; 11:267-77. [PMID: 11230098 DOI: 10.1093/cercor/11.3.267] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The computation of speech codes (i.e. phonology) is an important aspect of word reading. Understanding the neural systems and mech- anisms underlying phonological processes provides a foundation for the investigation of language in the brain. We used high-resolution three-dimensional positron emission tomography (PET) to investigate neural systems essential for phonological processes. The burden of neural activities on the computation of speech codes was maximized by three rhyming tasks (rhyming words, pseudowords and words printed in mixed letter cases). Brain activation patterns associated with these tasks were compared with those of two baseline tasks involving visual feature detection. Results suggest strong left lateralized epicenters of neural activity in rhyming irrespective of gender. Word rhyming activated the same brain regions engaged in pseudoword rhyming, suggesting conjoint neural networks for phonological processing of words and pseudowords. However, pseudoword rhyming induced the largest change in cerebral blood flow and activated more voxels in the left posterior prefrontal regions and the left inferior occipital-temporal junction. In addition, pseudoword rhyming activated the left supramarginal gyrus, which was not apparent in word rhyming. These results suggest that rhyming pseudowords requires active participation of extended neural systems and networks not observed for rhyming words. The implications of the results on theories and models of visual word reading and on selective reading dysfunctions after brain lesions are discussed.
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Affiliation(s)
- B Xu
- Epilepsy Research Branch and Cognitive Neuroscience Section, NINDS, the National Institutes of Health, Bethesda, MD 20892, USA.
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40
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Abstract
The authors utilized repetitive transcranial magnetic stimulation (rTMS) in 16 normal volunteers to investigate the role of the left dorsolateral prefrontal cortex (PFC) in analogic reasoning. rTMS over the left and right PFC, over the left motor cortex, and sham stimulation over the left PFC were administered during memory and analogic reasoning conditions. rTMS over the left PFC led to a significant reduction in response times only in the analogy condition without affecting accuracy. These results indicate that the left PFC is relevant for analogic reasoning and that rTMS applied to the PFC can speed up solution time.
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Affiliation(s)
- B Boroojerdi
- Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
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Lippa CF, Zhukareva V, Kawarai T, Uryu K, Shafiq M, Nee LE, Grafman J, Liang Y, St George-Hyslop PH, Trojanowski JQ, Lee VMY. Frontotemporal dementia with novel tau pathology and a Glu342Valtau mutation. Ann Neurol 2001. [DOI: 10.1002/1531-8249(200012)48:6<850::aid-ana5>3.0.co;2-v] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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42
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Bushara KO, Grafman J, Hallett M. Neural correlates of auditory-visual stimulus onset asynchrony detection. J Neurosci 2001; 21:300-4. [PMID: 11150347 PMCID: PMC6762435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Intersensory temporal synchrony is an ubiquitous sensory attribute that has proven to be critical for binding multisensory inputs, sometimes erroneously leading to dramatic perceptual illusions. However, little is known about how the brain detects temporal synchrony between multimodal sensory inputs. We used positron emission tomography to demonstrate that detecting auditory-visual stimulus onset asynchrony activates a large-scale neural network of insular, posterior parietal, prefrontal, and cerebellar areas with the highest and task-specific activity localized to the right insula. Interregional covariance analysis further showed significant task-related functional interactions between the insula, the posterior thalamus, and superior colliculus. Based on these results and the available electrophysiological and anatomical connectivity data in animals, we propose that the insula, via its known short-latency connections with the tectal system, mediates temporally defined auditory-visual interaction at an early stage of cortical processing permitting phenomena such as the ventriloquist and the McGurk illusions.
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Affiliation(s)
- K O Bushara
- National Institute of Neurological Disorders and Stroke, Human Motor Control Section, and Cognitive Neuroscience Section, National Institutes of Health, Bethesda, Maryland 20892-1428, USA
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Dickson DW, Anderton B, Morris H, Hodges J, Bak TH, Dubois B, Pillon B, Bak T, Rafal R, Grafman J, Golbe LI, Steele J, Maraganore DM, Vidailhet M, Rivaud-Pechoux S, Livan I, Pierrot-Deseilligny C, Fowler CJ, Lynch T, Bergeron C, Bhatia K, Rossor MN, Wenning GK, Mathias CJ, Klockgether T, Abele M, Wullner U, Lantos P, Brooks DJ, Caparros-Lefebvre D. International Medical Workshop covering progressive supranuclear palsy, multiple system atrophy and cortico basal degeneration. Mov Disord 2001. [DOI: 10.1002/mds.1074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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44
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Lippa CF, Zhukareva V, Kawarai T, Uryu K, Shafiq M, Nee LE, Grafman J, Liang Y, St George-Hyslop PH, Trojanowski JQ, Lee VM. Frontotemporal dementia with novel tau pathology and a Glu342Val tau mutation. Ann Neurol 2000; 48:850-8. [PMID: 11117541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
It is unclear how tau gene mutations cause frontotemporal dementia (FTD) with parkinsonism linked to chromosome 17 (FTDP-17), but those in exon 10 (E10) or the following intron may be pathogenic by altering E10 splicing, perturbing the normal 1:1 ratio of four versus three microtubule-binding repeat tau (4R:3R tau ratio) and forming tau inclusions. We report on a 55-year old woman with frontotemporal dementia and a family history of FTDP-17 in whom we found a novel E12 (Glu342Val) tau gene mutation, prominent frontotemporal neuron loss, intracytoplasmic tau aggregates, paired helical tau filaments, increased 4R tau messenger RNA, increased 4R tau without E2 or E3 inserts, decreased 4R tau with these inserts, and a 4R:3R tau ratio greater than 1 in gray and white matter. Thus, this novel Glu342Val mutation may cause FTDP-17 by unprecedented mechanisms that alter splicing of E2, E3, and E10 to preferentially increase 4R tau without amino terminal inserts and promote aggregation of tau filaments into cytopathic inclusions.
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Affiliation(s)
- C F Lippa
- Department of Neurology, Medical College of Pennsylvania- Hahnemann University, Philadelphia 19129, USA
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Pietrini P, Guazzelli M, Basso G, Jaffe K, Grafman J. Neural correlates of imaginal aggressive behavior assessed by positron emission tomography in healthy subjects. Am J Psychiatry 2000; 157:1772-81. [PMID: 11058474 DOI: 10.1176/appi.ajp.157.11.1772] [Citation(s) in RCA: 182] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Neurodegenerative or traumatic lesions of the frontal lobes often lead to abnormally aggressive behavior. The authors hypothesized that the imaginal evoking of scenarios involving aggressive behavior would be associated with a modulation of the functional activity in the human frontal cortex. METHOD Regional cerebral blood flow (rCBF) determinations by positron emission tomography and psychophysiological measures of emotional responsivity were obtained in a group of 15 young healthy volunteers with good visual imagery abilities and no history of abnormal behavior while they imagined the same scenario with four variations involving emotionally neutral behavior and aggressive behavior. RESULTS Compared to the imagined neutral scenario, the imagined scenarios involving aggressive behavior were associated with significant emotional reactivity and rCBF reductions in the ventromedial prefrontal cortex, suggesting that a functional deactivation of this cortical area occurs when individuals respond to the eliciting of imagined aggressive behavior. CONCLUSIONS These results in healthy subjects further expand previous findings from animal and human studies by providing an in vivo functional demonstration of the involvement of the orbitofrontal cortex in the expression of aggressive behavior. They are also consistent with the hypothesis that a functional alteration of this cortical region may be present in individuals with pathological aggressive behavior.
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Affiliation(s)
- P Pietrini
- Cognitive Neuroscience Section, NINDS, NIH, Bethesda, MD 20892-1440, USA
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46
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Abstract
There are at least four major forms of functional neuroplasticity that can be studied in humans: homologous area adaptation, cross-modal reassignment, map expansion, and compensatory masquerade. Homologous area adaptation is the assumption of a particular cognitive process by a homologous region in the opposite hemisphere. Cross-modal reassignment occurs when structures previously devoted to processing a particular kind of sensory input now accepts input from a new sensory method. Map expansion is the enlargement of a functional brain region on the basis of performance. Compensatory masquerade is a novel allocation of a particular cognitive process to perform a task. By focusing on these four forms of functional neuroplasticity, several fundamental questions about how functional cooperation between brain regions is achieved can be addressed.
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Affiliation(s)
- J Grafman
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1440, USA.
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Koechlin E, Corrado G, Pietrini P, Grafman J. Dissociating the role of the medial and lateral anterior prefrontal cortex in human planning. Proc Natl Acad Sci U S A 2000; 97:7651-6. [PMID: 10852964 PMCID: PMC16600 DOI: 10.1073/pnas.130177397] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The anterior prefrontal cortex is known to subserve higher cognitive functions such as task management and planning. Less is known, however, about the functional specialization of this cortical region in humans. Using functional MRI, we report a double dissociation: the medial anterior prefrontal cortex, in association with the ventral striatum, was engaged preferentially when subjects executed tasks in sequences that were expected, whereas the polar prefrontal cortex, in association with the dorsolateral striatum, was involved preferentially when subjects performed tasks in sequences that were contingent on unpredictable events. These results parallel the functional segregation previously described between the medial and lateral premotor cortex underlying planned and contingent motor control and extend this division to the anterior prefrontal cortex, when task management and planning are required. Thus, our findings support the assumption that common frontal organizational principles underlie motor and higher executive functions in humans.
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Affiliation(s)
- E Koechlin
- Cognitive Neuroscience Section, National Institute of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD 20892-1440, USA
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48
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Zalla T, Koechlin E, Pietrini P, Basso G, Aquino P, Sirigu A, Grafman J. Differential amygdala responses to winning and losing: a functional magnetic resonance imaging study in humans. Eur J Neurosci 2000; 12:1764-70. [PMID: 10792453 DOI: 10.1046/j.1460-9568.2000.00064.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The amygdala has been shown to respond to many distinct types of affective stimuli, including reward and punishment feedback in animals. In humans, winning and losing situations can be considered as reward and punishment experiences, respectively. In this study, we used functional magnetic resonance imaging (fMRI) to measure regional brain activity when human subjects were given feedback on their performance during a simple response time task in a fictitious competitive tournament. Lexical stimuli were used to convey positive 'win' or negative 'lose' feedback. The frequency of positive and negative trials was parametrically varied by the experimenters independently from the subjects' actual performance and unbeknownst to them. The results showed that the parametric increase of winning was associated with left amygdala activation whereas the parametric increase of losing was associated with right amygdala activation. These findings provide functional evidence that the human amygdala differentially responds to changes in magnitude of positive or negative reinforcement conveyed by lexical stimuli.
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Affiliation(s)
- T Zalla
- Cognitive Neuroscience Section, NINDS, National Institutes of Health, Bethesda, MD 20892-1440, USA
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49
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Wharton CM, Grafman J, Flitman SS, Hansen EK, Brauner J, Marks A, Honda M. Toward neuroanatomical models of analogy: a positron emission tomography study of analogical mapping. Cogn Psychol 2000; 40:173-97. [PMID: 10790322 DOI: 10.1006/cogp.1999.0726] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Several brain regions associated with analogical mapping were identified using (15)O-positron emission tomography with 12 normal, high intelligence adults. Each trial presented during scanning consisted of a source picture of colored geometric shapes, a brief delay, and a target picture of colored geometric shapes. Analogous pictures did not share similar geometric shapes but did share the same system of abstract visuospatial relations. Participants judged whether each source-target pairing was analogous (analogy condition) or identical (literal condition). The results of the analogy-literal comparison showed activation in the dorsomedial frontal cortex and in the left hemisphere; the inferior, middle, and medial frontal cortices; the parietal cortex; and the superior occipital cortex. Based on these results as well as evidence from relevant cognitive neuroscience studies of reasoning and of executive working memory, we hypothesize that analogical mapping is mediated by the left prefrontal and inferior parietal cortices.
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Affiliation(s)
- C M Wharton
- Cognitive Neuroscience Section, National Institutes of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1440, USA
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50
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Abstract
Patients with frontal lobe brain damage are reportedly impaired on tasks that require plan development and execution. In this study, we examined the performance of 15 patients diagnosed with frontal lobe dementia and 14 patients with focal frontal lobe lesions on the Tower of London planning task. Patients with frontal lobe dementia committed a significantly higher number of rule violations, made more moves, and demonstrated longer solution time latencies compared to their matched controls. Patients with frontal lobe lesions demonstrated significantly delayed solution times and also made more moves compared to their matched controls. Frontal lobe lesion patient performance suggests an impairment in execution-related processes, while frontal lobe dementia patients appear to be impaired in both plan development and execution. Despite these findings, the identification of a specific cognitive impairment that induces these planning problems remains elusive.
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Affiliation(s)
- D Carlin
- Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
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