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Nilsen HY, Jørstad AKL, Ryan SJ, Moe MC, Grimstad K, Aamodt AH, Holmøy T, Jørstad ØK. En kvinne i 60-årene som ikke lenger gjenkjente det hun så. Tidsskr Nor Laegeforen 2023; 143:23-0198. [PMID: 37938009 DOI: 10.4045/tidsskr.23.0198] [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: 11/09/2023] Open
Abstract
BACKGROUND Neurological disorders can present with a vast array of visual disturbances. The constellation of symptoms and findings in this patient prompted workup for unusual causes of both stroke and neurodegenerative disorder. CASE PRESENTATION A woman in her sixties presented with visual disturbances, followed by weakness in her right arm and aphasia three days later. Her close acquaintances had suspected progressive cognitive decline during the previous year. CT and MRI showed an occluded left posterior cerebral artery with a subacute occipito-temporal infarction. The finding of extensive white matter lesions and segmental arterial vasoconstriction necessitated further workup of vasculitis and hereditary small vessel disease, which were ruled out. The stroke aetiology was considered to be atherosclerotic intracranial large vessel disease. FDG-PET scan revealed decreased metabolism in the left hemisphere, and cerebrospinal biomarkers had slightly decreased beta-amyloid. The findings were suggestive of early Alzheimer's disease or primary progressive aphasia, but currently inconclusive. INTERPRETATION Based on clinical-anatomical correlation, the patient's visual disturbances, in this case right hemianopsia and object agnosia, were solely related to the stroke and not to a neurodegenerative disorder. Knowledge and interpretation of visual agnosias can in many cases be clinically valuable.
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Affiliation(s)
| | | | | | - Morten Carstens Moe
- Øyeavdelingen, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
| | | | - Anne Hege Aamodt
- Nevrologisk avdeling, Oslo universitetssykehus, og, Institutt for nevromedisin og bevegelsesvitenskap, NTNU
| | - Trygve Holmøy
- Nevrologisk avdeling, Akershus universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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Horiike S, Nishi R, Maekawa T, Sagisaka T. [Simultanagnosia caused by cerebral infarction in the right temporal stem, right lateral thalamus, and right pulvinar regions]. Rinsho Shinkeigaku 2023; 63:643-649. [PMID: 37779025 DOI: 10.5692/clinicalneurol.cn-001846] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A 76-year-old male patient was admitted to our hospital for the treatment of acute cerebral infarction in the right temporal stem, right lateral thalamus, and right pulvinar regions. Although his overall cognitive function was almost normal, he exhibited reduced visual sensitivity in the homonymous lower left quadrant of the visual field, left unilateral spatial neglect (USN), and simultanagnosia. Left USN improved 4 months after the onset of infarction; however, simultanagnosia persisted. To the best of our knowledge, this is the first case of simultanagnosia caused by cerebral infarction in the right temporal stem, right lateral thalamus, and right pulvinar regions.
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Terry C, Lecci L. A - 180 Anosognosia across the Spectrum of Alzheimer's Pathology and Validation of a New Measure. Arch Clin Neuropsychol 2023; 38:1353. [PMID: 37807343 DOI: 10.1093/arclin/acad067.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Two studies were performed to validate a brief, new method for assessing informant-patient discrepancies to quantify cognitive insight, and to compare it to an empirically supported model - the Cognitive Awareness Model (CAM). METHOD Study 1 included 31 (52% male; Mage = 69.42) patients from an outpatient neuropsychological assessment clinic. Seven patients were diagnosed with probable Alzheimer's dementia (PAD), 15 mild cognitive impairment (MCI), and 9 no diagnosis (i.e., healthy controls; HC). The Cognitive Coding Form (CCF) was compared with several measures to assess convergent and discriminant validity. Study 2 entailed archival data extraction of 240 patients (80 HC, 80 MCI, and 80 PAD; 53.3% female; Mage = 72.8) to examine the ability of the CCF to predict various cognitive domains, including executive functioning (Trail-Making Test Form B). RESULTS In study 1, the 8-item CCF demonstrated good convergent and discriminant validity with established measures. Study 2 identified that both patient-reported cognitive concerns and, to a greater degree, CCF informant-patient discrepancy scores, can distinguish HCs from those with MCI and PAD. Further, a regression indicated that depression (Geriatric Depression Scale; 5.5%; β = -0.38, p < 0.001) and TMT-B (13%; β = -0.43, p < 0.001), together accounted for 18.5% of the variance in insight (R2 = 0.19, F(2,219) = 26.10, p < 0.001), supporting the CAM. CONCLUSIONS In addition to establishing an efficient measure of insight with high clinical utility (the CCF), these studies inform the literature on the role of insight in predicting performance in those with Alzheimer's pathology.
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Sakurai Y. Tactually-related cognitive impairments: sharing of neural substrates across associative tactile agnosia, agraphesthesia, and kinesthetic reading difficulty. Acta Neurol Belg 2023; 123:1893-1902. [PMID: 36336779 DOI: 10.1007/s13760-022-02130-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION A precise understanding of the neural substrates underlying tactually-related cognitive impairments such as bilateral tactile agnosia, bilateral agraphesthesia, kinesthetic alexia and kinesthetic reading difficulty is currently incomplete. In particular, recent data have implicated a role for the lateral occipital tactile visual region, or LOtv, in tactile object naming (Amedi et al. Cerebral Cortex 2002). Thus, this study set out to examine the degree to which the LOtv may be involved in tactually-related cognitive impairments by examining two unique cases. METHODS To assess whether LOtv or the visual word form area (VWFA) is involved in tactually-related cognitive impairments, the average activation point of LOtv and that of VWFA were placed on the single-photon emission computed tomography (SPECT) cerebral blood flow images of two patients: one with bilateral associative tactile agnosia, bilateral agraphesthesia, and ineffective kinesthetic reading, and the other with kinesthetic reading difficulty. RESULTS The average LOtv coordinate was involved in the area of hypoperfusion in both patients, whereas that of VWFA was not included in any of the hypoperfused areas. CONCLUSIONS The results support the view that interruption of LOtv or disconnection to LOtv and to VWFA may cause these tactually-related cognitive impairments. Further, bilateral associative tactile agnosia and bilateral agraphesthesia are attributable toward the damage of the occipital lobe, whereas unilateral or predominantly one-sided associative tactile agnosia and agraphesthesia are attributable toward the damage of the parietal lobe.
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Affiliation(s)
- Yasuhisa Sakurai
- Department of Neurology, Mitsui Memorial Hospital, 1, Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan.
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Walters K, Federico P, Hahn C. Auditory Agnosia in Autoimmune Encephalitis. Can J Neurol Sci 2023; 50:784-786. [PMID: 35929447 DOI: 10.1017/cjn.2022.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Kristin Walters
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paolo Federico
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Hahn
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Compagne C, Trimaille H, Bonnet M, Ferrero L, Magnin É, Tannou T. [Willingness to age in place and anosognosia of risks in Alzheimer's disease]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:363-375. [PMID: 38093573 DOI: 10.1684/pnv.2023.1119] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Alzheimer's disease leads to an alteration of decision-making abilities which may increase risk-taking behaviours, particularly associated anosognosia. Anticipating the progression of the disease raises a number of questions, particularly in relation to aging in place. Our qualitative study aimed to identify the arguments used by older patients with Alzheimer's disease when choosing a place to age. The study included 22 older adults, living at home, and diagnosed as mild dementia. The patients' arguments in favour of ageing in place were based mainly on the preservation of internal security, through the familiarity of places and relations as well as the maintenance of their independence and their lifestyle habits, allowing stability in their daily lives. Despite the identification of memory loss, the associated risks were minimized or hidden from the reflection on the choice of the place to age.
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Affiliation(s)
- Charline Compagne
- Université de Franche-Comté, UR LINC, Besançon, France, CHU de Besançon, CIC-1431 Inserm, Besançon, France
| | - Hélène Trimaille
- Université de Franche-Comté, UR LINC, Besançon, France, CHU de Besançon, CIC-1431 Inserm, Besançon, France
| | - Magalie Bonnet
- Université de Franche-Comté,laboratoire de psychologie, Besançon, France
| | | | - Éloi Magnin
- Université de Franche-Comté, UR LINC, Besançon, France, Service de neurologie,CHU de Besançon, Besançon, France, Centremémoire ressources et recherche (CMRR), CHU de Besançon, France
| | - Thomas Tannou
- Université de Franche-Comté, UR LINC, Besançon, France, CIUSS Centre-Sud de l'Île-de-Montréal, Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, Canada
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Hughes SB, Churchill E, Smirnova A, Hall A, Culbert B, Snell C, Wright BA, Gilbert PE, Corey-Bloom J. Anosognosia in HD: Comparison of self-report and caregiver ratings with objective performance measures. Parkinsonism Relat Disord 2023; 107:105272. [PMID: 36610230 PMCID: PMC9933916 DOI: 10.1016/j.parkreldis.2022.105272] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/08/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Individuals with Huntington's disease (HD) commonly experience anosognosia, a lack of awareness of deficits. Thus, it is important to examine the accuracy of patient vs caregiver ratings on the basis of objective performance-based measures. METHODS The Anosognosia Scale (AS) was given to 33 patients with manifest HD and their caregivers. The AS consists of 8 items in which individuals rate their global abilities relative to same-aged peers. Scores range from very impaired to excellent. Caregiver and patient ratings were then correlated with objective measures. RESULTS Caregivers' evaluations of patients' cognitive and motoric abilities were more highly correlated with objective measures than patients' ratings. Specifically, caregivers' AS item scores were highly correlated with objective measures of walking (Unified Huntington Disease Rating Scale (UHDRS) tandem walking score [r = 0.57, p = .001] vs. patient [r = 0.39, p = .031]); dexterity (UHDRS pronation supination score [r = 0.55, p = .011] vs. patient [r = 0.18, p = .393]); speech (UHDRS dysarthria score [r = 0.55, p = .004] vs. patient [r = 0.03, p = .854]); memory (MoCA score [r = -.45, p = .048] vs. patient [r = -.11, p = .963]); attention (Trails Making Test A score [r = 0.58, p = .004] vs. patient [r = 0.08, p = .686]); and word retrieval (category fluency ([r = -.58, p = .004] vs. patient [r = -.02, p = 1.00]). Moreover, both the UHDRS total motor score (TMS) (F(1,29) = 7.50, p = .010) and the Mini Mental Status Exam (MMSE) (F(1,31) = 5.40, p = .027) were significant predictors of patient levels of anosognosia. CONCLUSIONS Our findings indicate that caregivers may be better able to rate HD patients' cognitive and motor abilities than patients themselves. Both cognitive and motor severity are significant predictors of levels of anosognosia in HD.
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Affiliation(s)
- Shelby B Hughes
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
| | - Emma Churchill
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Anna Smirnova
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Andrew Hall
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Braden Culbert
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Chase Snell
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Brenton A Wright
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Paul E Gilbert
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, La Jolla, CA, USA; San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
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Kudo S, Funayama M, Kurose S, Shimizu Y, Takata T, Mimura M. Shadowing Behavior May Be Associated with an Inability to Recognize the External World: A Case Report of Shadowing in a Patient with Posterior Cortical Atrophy. J Alzheimers Dis 2023; 94:1323-1330. [PMID: 37458035 PMCID: PMC10473056 DOI: 10.3233/jad-230257] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 07/18/2023]
Abstract
Although shadowing behavior- when one individual closely follows another- is routinely documented among patients with dementia, its mechanisms have yet to be elucidated. In particular, there have been no detailed descriptions of patients with shadowing behavior. To propose its potential backgrounds, we describe a patient with posterior cortical atrophy who exhibited prominent shadowing behavior. He also experienced severe difficulties recognizing external stimuli, including visuospatial dysfunction, several types of agnosia, difficulties in verbal comprehension, disorientation, and its associated depression. This shadowing behavior may be adaptive relative to his extreme difficulty with recognizing the world around him.
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Affiliation(s)
- Shun Kudo
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Yusuke Shimizu
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Taketo Takata
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, Ashikaga-City, Tochigi, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
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Guieysse T, Lamothe R, Houot M, Razafimahatratra S, Medani T, Lejeune FX, Dreyfus G, Klarsfeld A, Pantazis D, Koechlin E, Andrade K. Detecting Anosognosia from the Prodromal Stage of Alzheimer's Disease. J Alzheimers Dis 2023; 95:1723-1733. [PMID: 37718816 PMCID: PMC10578267 DOI: 10.3233/jad-230552] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Though not originally developed for this purpose, the Healthy Aging Brain Care Monitor (HABC-M) seems a valuable instrument for assessing anosognosia in Alzheimer's disease (AD). OBJECTIVES Our study aimed at 1) investigating the validity of the HABC-M (31 items), and its cognitive, psychological, and functional subscales, in discriminating AD patients from controls; 2) exploring whether the HABC-M discrepancy scores between the self-reports of patients/controls in these different domains and the respective ratings provided by their caregivers/informants correlate with an online measure of self-awareness; 3) determining whether the caregiver burden level, also derived from the HABC-M, could add additional support for detecting anosognosia. METHODS The HABC-M was administered to 30 AD patients and 30 healthy controls, and to their caregivers/informants. A measure of online awareness was established from subjects' estimation of their performances in a computerized experiment. RESULTS The HABC-M discrepancy scores distinguished AD patients from controls. The cognitive subscale discriminated the two groups from the prodromal AD stage, with an AUC of 0.88 [95% CI: 0.78;0.97]. Adding the caregiver burden level raised it to 0.94 [0.86;0.99]. Significant correlations between the HABC-M and online discrepancy scores were observed in the patients group, providing convergent validity of these methods. CONCLUSIONS The cognitive HABC-M (six items) can detect anosognosia across the AD spectrum. The caregiver burden (four items) may corroborate the suspicion of anosognosia. The short-hybrid scale, built from these 10 items instead of the usual 31, showed the highest sensitivity for detecting anosognosia from the prodromal AD stage, which may further help with timely diagnosis.
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Affiliation(s)
- Thomas Guieysse
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Roxane Lamothe
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Marion Houot
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Centre of Excellence of Neurodegenerative Disease (CoEN), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Solofo Razafimahatratra
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Takfarinas Medani
- Signal & Image Processing Institute, University of Southern California, Los Angeles, CA, USA
| | - François-Xavier Lejeune
- Paris Brain Institute (Institut du Cerveau, ICM), Data Analysis Core, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | | | - André Klarsfeld
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
| | - Dimitrios Pantazis
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Etienne Koechlin
- Laboratoire de Neurosciences Cognitives et Computationnelles, École Normale Supérieure, Paris, France
| | - Katia Andrade
- Department of Neurology, Institute of Memory and Alzheimer’s Disease (IM2A), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Laboratory of Brain Plasticity, CNRS UMR 8249, ESPCI Paris - PSL, Paris, France
- FrontLab, Paris Brain Institute, ICM, Pitié Salpêtrière GH, Paris, France
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Formica C, De Salvo S, Corallo F, Latella D, Mìcchia K, Bonanno L, Quartarone A, Marino S. Case report of anosognosia for hemiplegia: A fMRI study. Medicine (Baltimore) 2022; 101:e32526. [PMID: 36596042 PMCID: PMC9803421 DOI: 10.1097/md.0000000000032526] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study is to verify the functional activation in a patient with anosognosia for hemiplegia following left brain lesions. METHODS We report a case of a 53-year-old right-handed female patient. She came to our rehabilitative unit with a diagnosis of an ischemic major stroke in the left internal carotid artery and important hemiplegia to the right side. She underwent functional magnetic resonance imaging (fMRI), during which she performed a motor imagery task. RESULTS The fMRI assessment showed an ischemic lesion in the frontotemporal and insular left areas. In the fMRI experiment, we revealed activation of the residual neural patterns of both hemispheres. CONCLUSION We underlined an interest in the compensation mechanism that involved neural networks near brain lesions and some areas of the contro-lesional hemisphere, suggesting that the synaptic plasticity permitted an intra and inter-hemispheric reorganization of the cerebral system.
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Affiliation(s)
| | | | | | - Desiree Latella
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- * Correspondence: Desiree Latella, IRCCS Centro Neurolesi “Bonino-Pulejo”, S.S. 113 Via Palermo, C.da Casazza, Messina 98124, Italy (e-mail: )
| | - Katia Mìcchia
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Lilla Bonanno
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | | | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
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Barrett AM. Spatial Neglect and Anosognosia After Right Brain Stroke. Continuum (Minneap Minn) 2021; 27:1624-1645. [PMID: 34881729 DOI: 10.1212/con.0000000000001076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke. RECENT FINDINGS Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available. SUMMARY This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.
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Pagliari D, Marra A, Cosentini R. Atypical manifestations of COVID-19: to know signs and symptoms to recognize the whole disease in the Emergency Department. Intern Emerg Med 2021; 16:1407-1410. [PMID: 33389567 PMCID: PMC7778701 DOI: 10.1007/s11739-020-02574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Danilo Pagliari
- Medical Officer of the Carabinieri Corps, Carabinieri Officers School, Rome, Italy.
- Department of Emergency Medicine, Ospedale Papa Giovanni XXIII, Piazza OMS-Organizzazione Mondiale Della Sanità, 1, 24127, Bergamo, Italy.
| | - Alessio Marra
- Department of Emergency Medicine, Ospedale Papa Giovanni XXIII, Piazza OMS-Organizzazione Mondiale Della Sanità, 1, 24127, Bergamo, Italy
| | - Roberto Cosentini
- Department of Emergency Medicine, Ospedale Papa Giovanni XXIII, Piazza OMS-Organizzazione Mondiale Della Sanità, 1, 24127, Bergamo, Italy
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"Anosognosia for prospective and retrospective memory deficits: Assessment and theoretical considerations": Correction to Chapman et al. (2019). Neuropsychology 2021; 35:668. [PMID: 33983762 DOI: 10.1037/neu0000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Reports an error in "Anosognosia for prospective and retrospective memory deficits: Assessment and theoretical considerations" by Silvia Chapman, Nicoletta Beschin, Stephanie Cosentino, Mitchell S. V. Elkind, Sergio Della Sala and Gianna Cocchini (Neuropsychology, 2019[Oct], Vol 33[7], 1020-1031). In the article (http://dx.doi.org/10.1037/neu0000568), the racial and ethnic description of the participants was missing. The following text has been added to the first paragraph under the "Participants" heading in the "Method" section: "The racial and ethnic distribution of the participants was 76.5% (n = 39) White, 13.7% (n = 7) Black, 5.9% (n = 3) Hispanic, and 3.9% (n = 2) Asian." The online version of this article has been corrected. (The following abstract of the original article appeared in record 2019-33671-001.) Objective: Patients who suffer from memory loss after an Acquired Brain Injury (ABI) may also suffer from anosognosia, or unawareness of their memory loss. How we define and measure anosognosia can have critical implications for its study and clinical assessment. Commonly used measures often lack standardization and reliability checks for responses. Moreover, these methods rely heavily on cognitive abilities (e.g., language abilities) that are often affected after brain injury. The aim of this study is to elucidate how to best conceptualize and detect anosognosia for memory loss by introducing a new method of assessment, the Visual-Analogue Test for Anosognosia for memory impairment (VATAmem). Method: A total of 51 patients (M = 61 years, M = 13 years of education) with memory difficulties after ABI were recruited from outpatient clinics. A total of 73 informants were also recruited (M = 51 years old, M = 13 years of education). Both patients and informants evaluated the severity of patients' everyday memory mistakes on the VATAmem, for prospective and retrospective memory deficits by using visual analogue scales, vignettes, and check questions to ensure reliability. Results and Conclusion: A total of 30% of the patients were deemed unaware of their memory deficits. Patients were less aware of their prospective (29%) than their retrospective memory difficulties (18%). The new method of assessment provided by the VATAmem reduced possible false positives and enhanced reliability. We conclude that careful consideration of methodology is a key step to interpreting anosognosia findings within a theoretical framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Melis M, Haehner A, Mastinu M, Hummel T, Tomassini Barbarossa I. Molecular and Genetic Factors Involved in Olfactory and Gustatory Deficits and Associations with Microbiota in Parkinson's Disease. Int J Mol Sci 2021; 22:ijms22084286. [PMID: 33924222 PMCID: PMC8074606 DOI: 10.3390/ijms22084286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/14/2021] [Accepted: 04/17/2021] [Indexed: 12/11/2022] Open
Abstract
Deficits in olfaction and taste are among the most frequent non-motor manifestations in Parkinson’s disease (PD) that start very early and frequently precede the PD motor symptoms. The limited data available suggest that the basis of the olfactory and gustatory dysfunction related to PD are likely multifactorial and may include the same determinants responsible for other non-motor symptoms of PD. This review describes the most relevant molecular and genetic factors involved in the PD-related smell and taste impairments, and their associations with the microbiota, which also may represent risk factors associated with the disease.
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Affiliation(s)
- Melania Melis
- Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy; (M.M.); (M.M.)
| | - Antje Haehner
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University of Dresden, 01307 Dresden, Germany; (A.H.); (T.H.)
| | - Mariano Mastinu
- Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy; (M.M.); (M.M.)
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, Technical University of Dresden, 01307 Dresden, Germany; (A.H.); (T.H.)
| | - Iole Tomassini Barbarossa
- Department of Biomedical Sciences, University of Cagliari, Monserrato, 09042 Cagliari, Italy; (M.M.); (M.M.)
- Correspondence: ; Tel.: +39-070-675-4144
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Pacella V, Scandola M, Beccherle M, Bulgarelli C, Avesani R, Carbognin G, Agostini G, Thiebaut de Schotten M, Moro V. Anosognosia for theory of mind deficits: A single case study and a review of the literature. Neuropsychologia 2020; 148:107641. [PMID: 33058921 PMCID: PMC7116409 DOI: 10.1016/j.neuropsychologia.2020.107641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/01/2020] [Revised: 08/20/2020] [Accepted: 09/29/2020] [Indexed: 12/11/2022]
Abstract
Being aware of one's own ability to interact socially is crucial to everyday life. After a brain injury, patients may lose their capacity to understand others' intentions and beliefs, that is, the Theory of Mind (ToM). To date, the debate on the association between ToM and other cognitive deficits (in particular executive functions and behavioural disorders) remains open and data regarding awareness of ToM deficits are meagre. By means of an ad-hoc neuropsychological battery of tests, we report on a patient who suffers from ToM deficits and is not aware of these disorders, although aware of his other symptoms. The study is accompanied by a review of the literature (PRISMA guidelines) demonstrating that ToM deficits are independent of executive functions. Furthermore, an advanced lesion analysis including tractography was executed. The results indicate that: i) ToM deficits can be specific and independent of other cognitive symptoms; ii) unawareness may be specific for ToM impairment and not involve other disorders and iii) the medial structures of the limbic, monitoring and attentional systems may be involved in anosognosia for ToM impairment.
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Affiliation(s)
- Valentina Pacella
- Social and Cognitive Neuroscience Laboratory, Department of Psychology, Sapienza University of Rome, via dei Marsi 78, 00185, Rome, Italy; NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Michele Scandola
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Maddalena Beccherle
- Social and Cognitive Neuroscience Laboratory, Department of Psychology, Sapienza University of Rome, via dei Marsi 78, 00185, Rome, Italy; NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Cristina Bulgarelli
- Department of Rehabilitation, IRCSS Sacro Cuore-Don Calabria Hospital, via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Renato Avesani
- Department of Rehabilitation, IRCSS Sacro Cuore-Don Calabria Hospital, via Don A. Sempreboni 5, 37024, Negrar, Verona, Italy.
| | - Giovanni Carbognin
- Department of Radiology, IRCSS Sacro Cuore-Don Calabria Hospital, via Don A. Sempreboni 5, 37024, GC, Italy.
| | - Giulia Agostini
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Rue Léo Saignat 146, 33000, Bordeaux, France.
| | - Valentina Moro
- NPSY.Lab-VR, Department of Human Sciences, University of Verona, Lungadige Porta Vittoria 17, 37129, Verona, Italy.
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Moradi K, Golbakhsh M, Haghighi F, Afshari K, Nikbakhsh R, Khavandi MM, Faghani S, Badripour A, Etemadi A, Ashraf-Ganjouei A, Bagheri S, Dehpour AR. Inhibition of phosphodiesterase IV enzyme improves locomotor and sensory complications of spinal cord injury via altering microglial activity: Introduction of Roflumilast as an alternative therapy. Int Immunopharmacol 2020; 86:106743. [PMID: 32619958 DOI: 10.1016/j.intimp.2020.106743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/06/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023]
Abstract
Despite the great search for an effective approach to minimize secondary injury in spinal cord injury (SCI) setting, there have been limited advances. Roflumilast is a selective inhibitor of phosphodiesterase 4 with potent anti-inflammatory properties. Here, we sought to explore Roflumilast efficacy in the improvement of locomotor and sensory deficits of SCI. In an animal setting, 50 male rats were randomly assigned to five groups: an SCI group receiving Placebo, three SCI groups receiving Roflumilast at the doses of 0.25, 0.5, and 1 mg/kg prior to T9 vertebra laminectomy, and a sham-operated group. Locomotor, mechanical, and thermal activities were evaluated for 28 days. At the end of the study, spinal cord samples were taken to assess the relative ratio of microglial subtypes, including M1 and M2, histopathological changes, levels of pro-inflammatory (TNF-α and IL-1β) and anti-inflammatory (IL-10) biomarkers, and cAMP level. Repeated measure analysis revealed significant effect for time-treatment interaction on locomotion [F (24, 270) = 280.7, p < 0.001], thermal sensitivity [F (16, 180) = 4.35, p < 0.001], and mechanical sensitivity [F (16, 180) = 7.96, p < 0.001]. As expected, Roflumilast significantly increased the expression of spinal cAMP. H&E staining exhibited lesser histopathological disruptions in Roflumilast-treated rodents. We also observed a significant reduction in the M1/M2 ratio (p values < 0.001) as well as in pro-inflammatory biomarkers following the administration of Roflumilast to the injured rats. Furthermore, IL-10 level was increased in rodents receiving 1 mg/kg of the reagent. In conclusion, the increased spinal cAMP following Roflumilast therapy might attenuate neuroinflammation via altering microglial activity; therefore, it could be considered as an alternative therapeutic agent for SCI complications.
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Affiliation(s)
- Kamyar Moradi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Golbakhsh
- Department of Orthopedic Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farinaz Haghighi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Khashayar Afshari
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajan Nikbakhsh
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Khavandi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Faghani
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Badripour
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Etemadi
- Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayna Bagheri
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Kamath V, Chaney GAS, DeRight J, Onyike CU. A meta-analysis of neuropsychological, social cognitive, and olfactory functioning in the behavioral and language variants of frontotemporal dementia. Psychol Med 2019; 49:2669-2680. [PMID: 30520407 DOI: 10.1017/s0033291718003604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Though meta-analyses of neuropsychological and social cognitive deficits in behavioral variant frontotemporal dementia (bvFTD) have been conducted, no study has comprehensively characterized and compared the neuropsychological, social cognitive, and olfactory profiles in the behavioral and language variants of FTD. METHODS Our search yielded 470 publications meeting inclusion criteria representing 11 782 FTD patients and 19 451 controls. For each domain, we calculated Hedges' g effect sizes, which represent the mean difference between the patient and control group divided by the pooled standard deviation. The heterogeneity of these effects was assessed with Cochran's Q-statistic using a random-effects model. Meta-regressions were employed to analyze the influence of demographic and disease characteristics. RESULTS Though semantic variant primary progressive aphasia patients showed the greatest impairment across all task types, the three groups showed similar cognitive effect sizes once contributions from the language subdomain were excluded from analysis. Contrary to expectation, the magnitude of deficits in executive functioning, social cognition and olfaction were comparable between the three subgroups. Among indices, a metric of executive errors distinguished the behavioral variant of FTD from the language phenotypes. CONCLUSIONS These data indicate that social cognitive and traditional executive functioning measures may not capture differences between FTD syndromes. These results have important implications for the interpretation of neuropsychological assessments, particularly when applied to the differential diagnosis of FTD. It is hoped that these findings will guide clinical and research assessments and spur new studies focused on improving the measurement of FTD syndromes.
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Affiliation(s)
- Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | | | - Jonathan DeRight
- Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Tringale KR, Nguyen TT, Karunamuni R, Seibert T, Huynh-Le MP, Connor M, Moiseenko V, Gorman MK, Marshall A, Tibbs MD, Farid N, Simpson D, Sanghvi P, McDonald CR, Hattangadi-Gluth JA. Quantitative Imaging Biomarkers of Damage to Critical Memory Regions Are Associated With Post-Radiation Therapy Memory Performance in Brain Tumor Patients. Int J Radiat Oncol Biol Phys 2019; 105:773-783. [PMID: 31408667 PMCID: PMC6876859 DOI: 10.1016/j.ijrobp.2019.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/17/2019] [Revised: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE We used quantitative magnetic resonance imaging to prospectively analyze the association between microstructural damage to memory-associated structures within the medial temporal lobe and longitudinal memory performance after brain radiation therapy (RT). METHODS AND MATERIALS Patients with a primary brain tumor receiving fractionated brain RT were enrolled on a prospective trial (n = 27). Patients underwent high-resolution volumetric brain magnetic resonance imaging, diffusion-weighted imaging, and neurocognitive testing before and 3, 6, and 12 months post-RT. Medial temporal lobe regions (hippocampus; entorhinal, parahippocampal, and temporal pole white matter [WM]) were autosegmented, quantifying volume and diffusion biomarkers of WM integrity (mean diffusivity [MD]; fractional anisotropy [FA]). Reliable change indices measured changes in verbal (Hopkins Verbal Learning Test-Revised) and visuospatial (Brief Visuospatial Memory Test-Revised [BVMT-R]) memory. Linear mixed-effects models assessed longitudinal associations between imaging parameters and memory. RESULTS Visuospatial memory significantly declined at 6 months post-RT (mean reliable change indices, -1.3; P = .012). Concurrent chemotherapy and seizures trended toward a significant association with greater decline in visuospatial memory (P = .053 and P = .054, respectively). Higher mean dose to the left temporal pole WM was significantly associated with decreased FA (r = -0.667; P = .002). Over all time points, smaller right hippocampal volume (P = .021), lower right entorhinal FA (P = .023), greater right entorhinal MD (P = .047), and greater temporal pole MD (BVMT-R total recall, P = .003; BVMT-R delayed recall, P = .042) were associated with worse visuospatial memory. The interaction between right entorhinal MD (BVMT-R total recall, P = .021; BVMT-R delayed recall, P = .004) and temporal pole FA (BVMT-R delayed recall, P = .024) significantly predicted visuospatial memory performance. CONCLUSIONS Brain tumor patients exhibited visuospatial memory decline post-RT. Microstructural damage to critical memory regions, including the hippocampus and medial temporal lobe WM, were associated with post-RT memory decline. The integrity of medial temporal lobe structures is critical to memory performance post-RT, representing possible avoidance targets for memory preservation.
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Affiliation(s)
- Kathryn R Tringale
- Department of Radiation Medicine and Applied Sciences; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Roshan Karunamuni
- Department of Radiation Medicine and Applied Sciences; Center for Multimodal Imaging and Genetics
| | - Tyler Seibert
- Department of Radiation Medicine and Applied Sciences; Center for Multimodal Imaging and Genetics
| | | | | | | | | | | | | | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, La Jolla, California
| | | | - Parag Sanghvi
- Department of Radiation Medicine and Applied Sciences
| | - Carrie R McDonald
- Department of Radiation Medicine and Applied Sciences; Department of Psychiatry; Center for Multimodal Imaging and Genetics
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences; Center for Multimodal Imaging and Genetics.
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19
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Morishima R, Bandoh M, Sunami Y, Isozaki E. [Progressive supranuclear palsy-Richardson syndrome with visual attention disturbance (Holmes and Horrax) and ataxie optique (Garcin): a case report]. Rinsho Shinkeigaku 2019; 59:730-735. [PMID: 31656263 DOI: 10.5692/clinicalneurol.cn-001273] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
[Background] Supranuclear extraorbital muscle palsy is the core feature of progressive supranuclear palsy (PSP), and ordinarily presents as spontaneous vertical gaze constriction. However, higher visual function associated with visuospatial cognition in PSP patients was not previously considered. [Case presentation] We present a 72-year old right-handed man with PSP- Richardson syndrome (PSP-RS) and abnormal higher visual function. His symptoms began 2 years previously and included the use of small steps while walking, forgetfulness, and postural instability. Neurological examination revealed supranuclear vertical gaze limitation, akinesia, and lead-pipe rigidity without laterality. Neuro-ophthalmological examination showed abnormal ocular movement consistent with PSP, and no visual abnormality was observed. General cognitive functions, including attention and prominent visuospatial orientation and visual attention disturbances, were assessed using neuropsychological tests and concomitant spatial agraphia and impaired configuration using figure copying. Although he presented with mildly decreased and monotonous speech with palilalia, he showed no apparent aphasia, apraxia, visual object agnosia, or Bálint's 'optische Ataxie' i.e. visual ataxia under fixation. Brain MRI revealed atrophy of the mesencephalic tegmentum, bilateral frontal lobe, and bilateral hippocampus. N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography revealed decreased cerebral blood flow in the bilateral frontal lobe, lateral temporal lobe, and basal ganglia. Dopamine transporter single photon emission CT revealed uptake attenuation in the bilateral striatum. 123I-metaiodobenzyl-guanidine myocardium scintigraphy results were normal. [Discussion] The patient's symptoms indicated classical PSP-RS accompanied with a combination of disturbances in spatial orientation and visual attention as noted by Holmes and Horrax and 'ataxie optique' by Garcin. Thus, as observed in this patient, many clinically diagnosed PSP patients with undiagnosed higher visual dysfunction, masked by limited eye movement may exist. These symptoms may further our understanding about posterior cortical atrophy and tauopathy including not only PSP but also corticobasal syndrome and Alzheimer disease.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Mitsuaki Bandoh
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Yoko Sunami
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital
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Karner S, Stenner H, Spate M, Behrens J, Krakow K. Effects of a robot intervention on visuospatial hemineglect in postacute stroke patients: a randomized controlled trial. Clin Rehabil 2019; 33:1940-1948. [PMID: 31409126 DOI: 10.1177/0269215519865993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/23/2022]
Abstract
OBJECTIVE To evaluate the effects of an intervention using the robot device PARO on visuospatial hemineglect and activities of daily living, and its acceptance during stroke rehabilitation. PARO is an interactive robotic toy with the appearance of a baby seal, which can move, produce sounds, and react to speech and touch. DESIGN A randomized controlled trial. SETTING Hospital for neurorehabilitation. SUBJECTS Patients above 60 years old who have suffered their first stroke within the previous three months with left hemineglect (n = 39). INTERVENTIONS The PARO group (n = 21) was exposed to PARO over a period of two weeks, three times per week. The participants of the control group (n = 18) were read to aloud. OUTCOME MEASURE Visuospatial hemineglect was measured by a cancellation test and a Line Bisection Test, and independence in the activities of daily living was assessed by Scores of Independence Index for Neurological and Geriatric Rehabilitation (SINGER) test. The acceptance of PARO was also evaluated. Data were collected blinded at three times: baseline (T0), after two weeks of interventions (T1), and after additional two weeks as follow-up (T2). RESULTS Improvement of hemineglect at T1 and T2 was significantly higher in the PARO group (T1: mean (SD) = 6.23 (3.81); T2: mean (SD) = 7.85 (3.68)) compared to the control group (T1: mean (SD) = 2.66 (4.19); T2: mean (SD) = 3.33 (4.16)) (T1: P < 0.05; T2: P < 0.05). CONCLUSION The study showed that the use of the PARO is well accepted and can help to improve neglect symptoms in patients with subacute stroke.
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Affiliation(s)
- Susanne Karner
- Institute of Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Hanna Stenner
- Asklepios Neurological Hospital Falkenstein, Königstein, Germany
| | - Melanie Spate
- Asklepios Neurological Hospital Falkenstein, Königstein, Germany
| | - Johann Behrens
- Institute of Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Karsten Krakow
- Asklepios Neurological Hospital Falkenstein, Königstein, Germany
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Martín Juan A, Madrigal R, Porta Etessam J, Sáenz-Francés San Baldomero F, Santos Bueso E. Anton-Babinski syndrome, case report. Arch Soc Esp Oftalmol (Engl Ed) 2018; 93:555-557. [PMID: 29859732 DOI: 10.1016/j.oftal.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
CLINICAL CASE A 22 year-old woman complained about blurred vision after an episode of recovered cardiorespiratory arrest. She had bilateral low visual acuity («count fingers») and no ophthalmological or visual pathways changes. She also had an apparent lack of awareness of the deficit. The Magnetic Resonance Imaging (MRI) showed ischaemic changes in both occipital lobes. As a result, she was diagnosed with Anton-Babinski syndrome. DISCUSSION This is a rare disease that should be suspected in strange or poorly congruent visual loss. It is usually due to an ischaemic injury in this region of brain, manifesting itself with low vision not perceived by the patient (visual confabulation). It can simulate a non-organic visual loss or psychiatric disease.
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Affiliation(s)
- A Martín Juan
- Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - R Madrigal
- Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Porta Etessam
- Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - F Sáenz-Francés San Baldomero
- Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - E Santos Bueso
- Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Abstract
BACKGROUND Parkinson's disease is a progressive neurodegenerative disorder. Aspartame (l-aspartyl-l-phenylalanine methyl ester), a low calorie sweetener used in foods and beverages. OBJECTIVES This study investigated the effect of chronic aspartame intake on Parkinsonism induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). METHOD Forty-eight mice (24 males and 24 females): control, aspartame, MPTP, and aspartame + MPTP groups tested by Y-maze, stepping, forced swimming and olfactory preference tests. Brain tissues examined for dopamine content, tyrosine hydroxylase, inducible nitric oxide synthase (iNOS), glutathione peroxidase, phosphorylated tau and α-synuclein protein. Histopathological evaluation of brain sections at the level of basal ganglia was done. RESULTS Decreased dopamine content, tyrosine hydroxylase expression, glutathione peroxidase expression and increased iNOS, tau and α-synuclein expression in groups received aspartame, MPTP or both agents simultaneously in both males and females group. CONCLUSIONS Increased dopaminergic degeneration and complications with chronic aspartame consumption and more injury in male groups.
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Affiliation(s)
- Shaimaa Nasr Amin
- a Department of Medical Physiology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Sherif Sabry Hassan
- b Department of Medical Education , School of Medicine, California University of Science & Medicine , San Bernardino , CA , USA
- c Department of Anatomy, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Laila Ahmed Rashed
- d Department of Biochemistry, Faculty of Medicine , Cairo University , Cairo , Egypt
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Castaldi E, Tinelli F, Cicchini GM, Morrone MC. Supramodal agnosia for oblique mirror orientation in patients with periventricular leukomalacia. Cortex 2018; 103:179-198. [PMID: 29655042 PMCID: PMC6004039 DOI: 10.1016/j.cortex.2018.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 01/11/2023]
Abstract
Periventricular leukomalacia (PVL) is characterized by focal necrosis at the level of the periventricular white matter, often observed in preterm infants. PVL is frequently associated with motor impairment and with visual deficits affecting primary stages of visual processes as well as higher visual cognitive abilities. Here we describe six PVL subjects, with normal verbal IQ, showing orientation perception deficits in both the haptic and visual domains. Subjects were asked to compare the orientation of two stimuli presented simultaneously or sequentially, using both a two alternative forced choice (2AFC) orientation-discrimination and a matching procedure. Visual stimuli were oriented gratings or bars or collinear short lines embedded within a random pattern. Haptic stimuli comprised two rotatable wooden sticks. PVL patients performed at chance in discriminating the oblique orientation, both for visual and haptic stimuli. Moreover when asked to reproduce the oblique orientation, they often oriented the stimulus along the symmetric mirror orientation. The deficit generalized to stimuli varying in many low level features, was invariant for spatiotopic object orientation, and also occurred for sequential presentations. The deficit was specific to oblique orientations, and not for horizontal or vertical stimuli. These findings show that PVL can affect a specific network involved with the supramodal perception of mirror symmetry orientation.
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Affiliation(s)
- Elisa Castaldi
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Francesca Tinelli
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy
| | | | - M Concetta Morrone
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy.
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Abstract
RATIONALE Verbal auditory agnosia is the selective inability to recognize verbal sounds. Patients with this disorder lose the ability to understand language, write from dictation, and repeat words with reserved ability to identify nonverbal sounds. However, to the best of our knowledge, there was no report about verbal auditory agnosia in adult patient with traumatic brain injury. PATIENT CONCERNS He was able to clearly distinguish between language and nonverbal sounds, and he did not have any difficulty in identifying the environmental sounds. However, he did not follow oral commands and could not repeat and dictate words. On the other hand, he had fluent and comprehensible speech, and was able to read and understand written words and sentences. DIAGNOSIS Verbal auditory agnosia INTERVENTION:: He received speech therapy and cognitive rehabilitation during his hospitalization, and he practiced understanding of verbal language by providing written sentences together. OUTCOMES Two months after hospitalization, he regained his ability to understand some verbal words. Six months after hospitalization, his ability to understand verbal language was improved to an understandable level when speaking slowly in front of his eyes, but his comprehension of verbal sound language was still word level, not sentence level. LESSONS This case gives us the lesson that the evaluation of auditory functions as well as cognition and language functions important for accurate diagnosis and appropriate treatment, because the verbal auditory agnosia tends to be easily misdiagnosed as hearing impairment, cognitive dysfunction and sensory aphasia.
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Affiliation(s)
- Jong Min Kim
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Seung Beom Woo
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Zeeihn Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
| | - Sung Jae Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University School of Medicine
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital
- Department of Pharmacology, Kyungpook National University, School of Medicine, Daegu, Korea
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Tokida H, Kanaya Y, Shimoe Y, Imagawa M, Fukunaga S, Kuriyama M. [Auditory agnosia associated with bilateral putaminal hemorrhage: A case report of clinical course of recovery]. Rinsho Shinkeigaku 2017; 57:441-445. [PMID: 28740065 DOI: 10.5692/clinicalneurol.cn-001046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/07/2023]
Abstract
A 45-year-old right-handed man with a past history (10 years) of putaminal hemorrage presented with auditory agnosia associated with left putaminal hemorrhage. It was suspected that the auditory agnosia was due to bilateral damage in the acoustic radiations. Generalized auditory agnosia, verbal and non-verbal (music and environmental), was diagnosed by neuropsychological examinations. It improved 4 months after the onset. However, the clinical assessment of attention remained poor. The cognition for speech sounds improved slowly, but once it started to improve, the progress of improvement was rapid. Subsequently, the cognition for music sounds also improved, while the recovery of the cognition for environmental sounds remained delayed. There was a dissociation in recovery between these cognitions. He was able to return to work a year after the onset. We also reviewed the literature for cases with auditory agnosia and discuss their course of recovery in this report.
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Affiliation(s)
- Haruki Tokida
- Department of Rehabilitation, Brain Attack Center Ota Memorial Hospital
| | - Yuhei Kanaya
- Department of Neurology, Brain Attack Center Ota Memorial Hospital
| | - Yutaka Shimoe
- Department of Neurology, Brain Attack Center Ota Memorial Hospital
| | - Madoka Imagawa
- Department of Rehabilitation, Fukuyama Memorial Hospital
| | - Shinya Fukunaga
- Department of Sensory Sciences, Kawasaki University of Medical Welfare
| | - Masaru Kuriyama
- Department of Neurology, Brain Attack Center Ota Memorial Hospital
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Avondino E, Antoine P. Heterogeneity of Cognitive Anosognosia and its Variation with the Severity of Dementia in Patients with Alzheimer's Disease. J Alzheimers Dis 2016; 50:89-99. [PMID: 26638866 DOI: 10.3233/jad-150496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently, the lack of awareness of deficits, i.e., anosognosia, is a major obstacle in the healthcare circuit that delays the diagnosis of Alzheimer's disease (AD). However, a clear framework is lacking in the literature related to this phenomenon in terms of its definition, mechanisms, and objects. The aim of this study is to assess the different levels of cognitive anosognosia using a prediction-performance procedure and to identify the potential correlates of these levels. A sample of patients with probable AD was divided into three groups according to the severity of dementia (mild (MiD), moderate (MoD), and moderately severe (MSD) dementia), ranked according to the results of the Mini-Mental State Examination. We observed the following three scores: the real score, the prediction score, and the anosognosia score. These scores were calculated based on the prediction-performance task MISAwareness from the Dementia Rating Scale for cognitive processes (i.e., Attention, Initiation, Conceptualization, Construction, and Memory). We obtained a strong plateau effect between the MiD and MoD groups for anosognosia scores for actual performance or prediction for both the level of overall functioning and for specific processes. The sole exception was the result for memory processes. Moreover, the profiles of the patients' responses on the Memory subscale were substantially different and, indeed, opposite from those for the other processes. The main results confirm the multidimensionality of anosognosia and its variability with the stage of dementia and specifically implicate memory processes that indicate a cleavage between memory and other cognitive functions.
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Abstract
Individual of legal age with schizophrenia presenting anosognosia was abandoned, as a result of a court decision. Close family members were not allowed to provide medical follow-up, treatment, protection regarding his vulnerability, and preserve the dignity of their loved one. The issue was the court's prioritization of the autonomy of the individual over his mental health status. The purpose of this case study was to identify the pitfalls of a court case seeking medical follow-up and treatment for a family member with schizophrenia and anosognosia. The method was qualitative and the design was descriptive and instrumental, linking the law to the life experience resulting from the procedures for its implementation. This study examined the difference between clinical and medical-legal evaluation of the examinee. The application of the Therapeutic Jurisprudence principles to the high number of schizophrenia cases with anosognosia, the abandonment of the mentally ill, and family crisis call healthcare providers and the Judiciary for an improvement action of the process of guardianship.
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Abstract
Clinicians often have difficulty distinguishing between various forms of dementia to achieve a correct diagnosis. Little research has been done to examine whether awareness of one's cognitive deficits, or metacognitive monitoring, might differ between dementia diagnoses, thereby providing an additional means of differentiating between dementia subtypes. We review articles examining metacognitive comparisons between two of the most common dementia subtypes: Alzheimer's disease and frontotemporal dementia. Greater monitoring deficits were apparent in frontotemporal dementia than in Alzheimer's disease, and participants with frontotemporal dementia were less likely to utilize task experience to update and improve the accuracy of subsequent monitoring judgments. Results provide evidence for the utility of metacognitive measures as a means of distinguishing between Alzheimer's disease and frontotemporal dementia.
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Abstract
BACKGROUND Anosognosia is a lack of awareness of personal deficits that is commonly observed in people with a traumatic brain injury (TBI). OBJECTIVE The purpose of this paper is to examine whether self-appraisal of executive functioning differs for students with and without TBI. METHODS Students who had survived a TBI and those who had never had a TBI filled out the Behavior Rating Inventory of Executive Functioning from three different perspectives. Each participant was paired with an observer who was familiar with the person's behavior. Self-appraisal ratings, observer ratings of the participant, and reflective appraisal of how the participant thought the observer would rate them were compared. RESULTS For the students without TBI, reflective appraisal was significantly correlated with self-appraisal but observer appraisal was not. For students with TBI, neither reflected appraisal nor observer appraisal correlated with self-appraisal. Both TBI and non-TBI participants overestimated their problems on measures of Inhibition, Shifting, Emotional Control, Initiation, and Planning/Organizing. TBI participants underestimated their problems on measures of Working Memory, Organization, and Task Monitoring relative to the non-TBI group. CONCLUSIONS Students with TBI do not accurately perceive how others perceive their behavior.
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Lötsch J, Ultsch A, Eckhardt M, Huart C, Rombaux P, Hummel T. Brain lesion-pattern analysis in patients with olfactory dysfunctions following head trauma. Neuroimage Clin 2016; 11:99-105. [PMID: 26937377 PMCID: PMC4753812 DOI: 10.1016/j.nicl.2016.01.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
Abstract
The presence of cerebral lesions in patients with neurosensory alterations provides a unique window into brain function. Using a fuzzy logic based combination of morphological information about 27 olfactory-eloquent brain regions acquired with four different brain imaging techniques, patterns of brain damage were analyzed in 127 patients who displayed anosmia, i.e., complete loss of the sense of smell (n = 81), or other and mechanistically still incompletely understood olfactory dysfunctions including parosmia, i.e., distorted perceptions of olfactory stimuli (n = 50), or phantosmia, i.e., olfactory hallucinations (n = 22). A higher prevalence of parosmia, and as a tendency also phantosmia, was observed in subjects with medium overall brain damage. Further analysis showed a lower frequency of lesions in the right temporal lobe in patients with parosmia than in patients without parosmia. This negative direction of the differences was unique for parosmia. In anosmia, and also in phantosmia, lesions were more frequent in patients displaying the respective symptoms than in those without these dysfunctions. In anosmic patients, lesions in the right olfactory bulb region were much more frequent than in patients with preserved sense of smell, whereas a higher frequency of carriers of lesions in the left frontal lobe was observed for phantosmia. We conclude that anosmia, and phantosmia, are the result of lost function in relevant brain areas whereas parosmia is more complex, requiring damaged and intact brain regions at the same time.
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Affiliation(s)
- Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe - University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; Fraunhofer Project Group Translational Medicine and Pharmacology (IME-TMP), Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Alfred Ultsch
- DataBionics Research Group, University of Marburg, Hans-Meerwein-Straße, 35032 Marburg, Germany
| | - Maren Eckhardt
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Caroline Huart
- Department of Otorhinolaryngology, Universite Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Philippe Rombaux
- Department of Otorhinolaryngology, Universite Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Thomas Hummel
- Smell & Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Fetscherstrasse 74, 01307 Dresden, Germany
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Kobayashi Y, Muramatsu T, Sato M, Hayashi H, Miura T. [Simultanagnosia and scene agnosia induced by right posterior cerebral artery infarction: a case report]. Rinsho Shinkeigaku 2015; 55:722-727. [PMID: 26369377 DOI: 10.5692/clinicalneurol.cn-000731] [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: 06/05/2023]
Abstract
A 68-year-old man was admitted to our hospital for rehabilitation of topographical disorientation. Brain magnetic resonance imaging revealed infarction in the right medial side of the occipital lobe. On neuropsychological testing, he scored low for the visual information-processing task; however, his overall cognitive function was retained. He could identify parts of the picture while describing the context picture of the Visual Perception Test for Agnosia but could not explain the contents of the entire picture, representing so-called simultanagnosia. Further, he could morphologically perceive both familiar and new scenes, but could not identify them, representing so-called scene agnosia. We report this case because simultanagnosia associated with a right occipital lobe lesion is rare.
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Gambina G, Valbusa V, Corsi N, Ferrari F, Sala F, Broggio E, Condoleo MT, Surdo V, Errera P, Cagnin AC, Moretto G, Moro V. The Italian validation of the Anosognosia Questionnaire for Dementia in Alzheimer's disease. Am J Alzheimers Dis Other Demen 2015; 30:635-44. [PMID: 25792664 PMCID: PMC10852577 DOI: 10.1177/1533317515577185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 11/15/2022]
Abstract
Although the Anosognosia Questionnaire-Dementia (AQ-D) is one of the main instruments for assessing awareness in Alzheimer's disease (AD), the normative data were until now limited to people from Argentina and Japan. This study aims to validate this instrument in an European context, in particular in an Italian sample. In a multicenter project (Verona, Padova, and Trapani), 130 patients with AD and their caregivers participated in the study. Psychometric characteristics of AQ-D are confirmed indicating that the scale permits the early identification of anosognosia and the correct care management of patients. Indeed, anosognosia results to be present also in patients with very mild AD (moderate: 44.44%; mild: 47.17%; and very mild: 23.73%). Moreover, the results indicate that deficits in awareness may vary in severity and that different types of anosognosia may be identified.
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Affiliation(s)
- G Gambina
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - V Valbusa
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - N Corsi
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - F Ferrari
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - F Sala
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - E Broggio
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - M T Condoleo
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - V Surdo
- Psychogeriatric and Alzheimer Unit, ASP Trapani, Trapani, Italy
| | - P Errera
- Psychogeriatric and Alzheimer Unit, ASP Trapani, Trapani, Italy
| | - A C Cagnin
- Department of Neuroscience, Neurology Clinic, University Medical School of Padova, Padova, Italy
| | - G Moretto
- Department of Neuroscience, Alzheimer's Disease Center, Neurology d.O., University Hospital of Verona, Verona, Italy
| | - V Moro
- Department of Philosophy, Education and Psychology, NPSY.Lab-VR, University of Verona, Verona, Italy
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Scribano Parada MDLP, Buonanotte CF. [Asomatognosia as a manifestation of migraine with aura. case report and review]. Rev Fac Cien Med Univ Nac Cordoba 2015; 72:44-50. [PMID: 26273948] [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: 06/04/2023] Open
Abstract
INTRODUCTION For years the study of migraine with aura was surprised by the versatility of its presentation. Auras are manifested with the gradual development of neurological symptoms ranging from visual impairment to perception disorders. The latter are rare forms of presentation being the reason for this article. CASE REPORT the case of a female patient of 53 years diagnosed with migraine with aura which makes an autobiographical account of their crises, with special emphasis on a variant of asomatognosia as manifestation is presented. It then discusses the asomatognosia as a phenomenon belonging to the altered body image and the different concepts related to these clinical forms and a brief overview of the possible anatomical locations of these conditions do. CONCLUSION Migraine with aura may manifest with varied previous symptoms before the pain. The asomatognosia is an uncommon presentation. A field of interests for research also include an effort to define the specificity and location of the lesion as a method for better understanding of how injuries to very specific areas of the brain affect perception and memory.
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Affiliation(s)
| | - Carlos Federico Buonanotte
- Jefe del Servicio de Neurología del Hospital Nacional de Clínicas. Facultal de Ciencias Médicas, Universidad Nacional de Córdoba. Córdoba, Argentina
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Bocanegra Y, Trujillo-Orrego N, Pineda D. [Dementia and mild cognitive impairment in Parkinson's disease: a review]. Rev Neurol 2014; 59:555-569. [PMID: 25501454] [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: 06/04/2023]
Abstract
INTRODUCTION. The cognitive disorders in Parkinson's disease (PD) have traditionally been associated with the presence of dementia in later stages of the disease. Recent studies, however, consider that cognitive impairment can appear as of early stages. Knowing the cognitive profile of PD furthers our understanding of the clinical phenotype, making it easier to reach a timely diagnosis and favouring intervention on the symptoms from the initial stages. AIM. To present a review of the literature on mild cognitive impairment (MCI) and dementia associated with PD. DEVELOPMENT. Several studies report that patients with PD who have a prolonged time to progression develop dementia. Yet, there have also been reports claiming that, as of the early stages, patients can present subtle cognitive alterations known as MCI. The initial neuropsychological profile is mainly of a non-amnesic type, characterised by executive dysfunction, alterations affecting attention, operative memory deficit and faulty retrieval of information. When patients develop dementia, disorders will arise in the storage of information, in semantic fluency, and in visuospatial and visuoperceptual skills. Currently there are criteria available for diagnosing the MCI and dementia associated with PD, as well as valid reliable instruments for detecting those disorders. CONCLUSIONS. Cognitive symptoms are frequent in PD. From the initial stages of the disease onwards patients may present MCI that is mainly characterised by a fronto-subcortical cognitive profile, whereas dementia usually develops at later stages, when a pattern of posterior cortical cognitive disorder is also observed.
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Affiliation(s)
- Yamile Bocanegra
- Universidad de Antioquia UDEA- Universidad de San Buenaventura USB., Medellin, Colombia
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35
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Perales J. [On the measurement of anosognosia in Alzheimer's disease]. Rev Neurol 2014; 59:576. [PMID: 25501460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Portellano-Ortiz C, Turró-Garriga O, Gascón-Bayarri J, Piñán-Hernández S, Moreno-Cordón L, Viñas-Díez V, Reñé-Ramírez R, Conde-Sala JL. [The influence of anosognosia and depression on the perceived quality of life of patients with Alzheimer's disease: a 12 months follow-up]. Rev Neurol 2014; 59:193-204. [PMID: 25156023] [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: 06/03/2023]
Abstract
INTRODUCTION Anosognosia and depression can influence perceptions of the patient's quality of life (QoL-p) in Alzheimer's disease (AD). AIM To explore changes in perceived QoL-p in AD and the influence that depression and anosognosia can have on both patient and caregiver ratings. PATIENTS AND METHODS Observational, analytical and longitudinal study over 12 months of a consecutive sample of 221 outpatients. Mean age was 77.8 ± 7.3 years and there were 140 women (63.3%). Instruments: Quality of Life in AD, Anosognosia Questionnaire-Dementia, Geriatric Depression Scale, Disability Assessment for Dementia, Neuropsychiatric Inventory, Mini-Mental State Examination and Global Deterioration Scale. Effect size of the differences between two means was calculated, and a linear regression analysis involving the factors associated with perceived QoL-p was performed. RESULTS Patients with anosognosia had less depression and higher scores on the Quality of Life in AD, as compared with patients without anosognosia, and regardless of antidepressant drug treatment. Caregiver ratings of QoL-p were more negative. In the linear regression the largest discrepancies between patient and caregiver ratings of QoL-p were associated with anosognosia, depression, and functional status, factors that explained 35.3, 7.9 and 11.3% of the variance, respectively. CONCLUSIONS Anosognosia was associated with less depression and better perceived quality of life in patients.
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Tsuruya N, Kobayakawa M. [Disorders of body schema]. Brain Nerve 2014; 66:351-361. [PMID: 24748082] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A variety of disorders have been associated with the concept of body schema. However, this concept has been interpreted in many ways, and there is no consensus on the nature and cognitive mechanisms of body schema. Historically, two major issues have been discussed. One was the body-specificity of the body schema, and the other was the relationship between input and output modality. Autotopagnosia, an inability to localize and orient different parts of the body, has been a focus of attention because it is thought to provide insight into the function of body schema. Although there have not been many cases of pure autotopagnosia, a double dissociation indicating the independence of body-specific system. There are a few working hypotheses for cognitive models of body schema, which can explain the different types of autotopagnosia. One model includes multiple representation subsystems for body processing, while another assumes the use of intrinsic and extrinsic egocentric coordinates to maintain on-line processing for body state. The consistency of these accounts should be examined in light of extensive neuroimaging and psychological data, to construct a plausible model for body schema.
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Affiliation(s)
- Natsuko Tsuruya
- Department of Psychological Informatics, College of Informatics and Human Communication, Kanazawa Institute of Technology
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Ghika J, Diéguez S, Assal F, Demonet JF. [Mirror behaviors in dementia: the many mirror signs]. Rev Med Suisse 2013; 9:2095-2099. [PMID: 24383283] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mirror behaviors in advanced dementia are: the mirror sign of Abely and Delmas, where the patient stares at his face (environment-driven behavior of Lhermitte); non recognition of the self in the mirror (autoprosopagnosia and/or delirious auto-Capgras); mirror agnosia of Ramachandran and Binkofski where the patient do not understand the concept of mirror and its use; the psychovisual reflex, or reflex pursuit of the eyes when passively moving a minrror in front of a patient (intact vision); mirror writing (procedural learning). We describe four demented patients with mirror behaviors assessing brain mechanisms of self recognition, social brain and mental and visuo-spatial manipulation of images and objects.
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Affiliation(s)
| | - Sebastian Diéguez
- Laboratory for Cognitive and Neurological Sciences, Unité de Neurologie, Département de médecine, Université de Fribourg
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Fletcher PD, Downey LE, Agustus JL, Hailstone JC, Tyndall MH, Cifelli A, Schott JM, Warrington EK, Warren JD. Agnosia for accents in primary progressive aphasia. Neuropsychologia 2013; 51:1709-15. [PMID: 23721780 PMCID: PMC3724054 DOI: 10.1016/j.neuropsychologia.2013.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 05/14/2013] [Accepted: 05/17/2013] [Indexed: 11/18/2022]
Abstract
As an example of complex auditory signal processing, the analysis of accented speech is potentially vulnerable in the progressive aphasias. However, the brain basis of accent processing and the effects of neurodegenerative disease on this processing are not well understood. Here we undertook a detailed neuropsychological study of a patient, AA with progressive nonfluent aphasia, in whom agnosia for accents was a prominent clinical feature. We designed a battery to assess AA's ability to process accents in relation to other complex auditory signals. AA's performance was compared with a cohort of 12 healthy age and gender matched control participants and with a second patient, PA, who had semantic dementia with phonagnosia and prosopagnosia but no reported difficulties with accent processing. Relative to healthy controls, the patients showed distinct profiles of accent agnosia. AA showed markedly impaired ability to distinguish change in an individual's accent despite being able to discriminate phonemes and voices (apperceptive accent agnosia); and in addition, a severe deficit of accent identification. In contrast, PA was able to perceive changes in accents, phonemes and voices normally, but showed a relatively mild deficit of accent identification (associative accent agnosia). Both patients showed deficits of voice and environmental sound identification, however PA showed an additional deficit of face identification whereas AA was able to identify (though not name) faces normally. These profiles suggest that AA has conjoint (or interacting) deficits involving both apperceptive and semantic processing of accents, while PA has a primary semantic (associative) deficit affecting accents along with other kinds of auditory objects and extending beyond the auditory modality. Brain MRI revealed left peri-Sylvian atrophy in case AA and relatively focal asymmetric (predominantly right sided) temporal lobe atrophy in case PA. These cases provide further evidence for the fractionation of brain mechanisms for complex sound analysis, and for the stratification of progressive aphasia syndromes according to the signature of nonverbal auditory deficits they produce. Deficits of accent processing can be a presenting feature of primary progressive aphasia. Accent agnosia can dissociate from a generalised auditory agnosia. Progressive aphasia syndromes show different profiles of accent processing deficits.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jason D. Warren
- Correspondence to: Dementia Research Centre, UCL Institute of Neurology, University College London, 8 – 11 Queen Square London, United Kingdom WC1N 3BG. Tel.: +44 203 448 4773; fax: +44 203 448 3104.
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Weijers NR, Rietveld A, Meijer FJA, de Leeuw FE. Macrosomatognosia in frontal lobe infarct-a case report. J Neurol 2013; 260:925-6. [PMID: 23314406 DOI: 10.1007/s00415-012-6827-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 12/24/2012] [Accepted: 12/27/2012] [Indexed: 11/30/2022]
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Ichikawa H, Ohno H, Murakami H, Ishigaki S, Ohnaka Y, Kawamura M. Self-rated anosognosia score may be a sensitive and predictive indicator for progressive brain atrophy in amyotrophic lateral sclerosis: an X-ray computed tomographic study. Eur Neurol 2012; 69:158-65. [PMID: 23257903 DOI: 10.1159/000345371] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Accepted: 10/07/2012] [Indexed: 11/19/2022]
Abstract
We investigated whether a self-rated anosognosia score can be an indicator for progression of brain atrophy in patients with amyotrophic lateral sclerosis (ALS). Scores for 16 patients were compared with the ventricular areas of the bilateral anterior and inferior horns measured on x-ray computed tomography. Longitudinal enlargement was expressed as a monthly increase in size: (ventricular size at the initial scan - ventricular size at the follow-up scan)/scan interval (months). The anosognosia scores ranged from -4 to 3 and 3-18 in patients with and without frontotemporal lobar degeneration (FTLD), respectively (p = 0.0011). Anosognosia scores were significantly correlated with sizes of anterior (r = 0.704, p = 0.0016) and inferior (r = 0.898, p < 0.0001) horns. In non-demented patients for whom follow-up CT scans were available (n = 7), the scores were significantly correlated with the longitudinal increase in inferior horn size (r = 0.754, p = 0.0496), but not with that of anterior horn size (r = -0.166, p = 0.7111). In conclusion, anosognosia in ALS is associated with greater anterior and inferior horn sizes, reflecting frontotemporal lobar atrophy. Moreover, mild anosognosia in ALS patients without FTLD may predict impending inferior horn enlargement, reflecting medial temporal atrophy.
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Affiliation(s)
- Hiroo Ichikawa
- Department of Neurology, Brain Nerve Center, Showa University Fujigaoka Hospital, Tokyo, Japan.
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Abstract
Two main varieties of recognition disorders are distinguished in neuropsychology: agnosias and semantic disorders. The term agnosias is generally used to denote recognition defects limited to a single perceptual modality (which is itself apparently intact), whereas the term semantic disorders is used to denote recognition defects involving all the sensory modalities in a roughly similar manner. Brain tumors can be one of the aetiologies underlying agnosias and semantic disorders. However, due to the heterogeneity and the rarity of recognition disorders, their investigation can be useful only to suggest or exclude the oncological nature of a brain lesion, but not to systematically monitor the clinical outcome in tumor patients. Furthermore, the relevance of recognition disorders as a hint toward a diagnosis of brain tumor varies according to the type of agnosia and of semantic disorder and the localization of the underlying brain pathology. The hypothesis that a variety of agnosia (or of semantic disorder) may be due to a neoplastic lesion can, therefore, be advanced if it is consistent with our knowledge about the usual localization and the growing patterns of different types of brain tumors.
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Affiliation(s)
- Guido Gainotti
- Center for Neuropsychological Research, Department of Neurosciences, Policlinico Gemelli, Catholic University of Rome, Largo A. Gemelli, 800168 Rome, Italy.
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Abstract
Stroke is the leading cause of acquired motor disability in the adult. Neuropsychological sequelae are common after vascular brain injury. While left cortical signs and symptoms are clearly evident at neurological examination, right hemispheric dysfunction must be carefully pursued and sometimes can be underrecognized. Indeed, patients with right hemispheric strokes present later to an emergency department and have a lower chance of receiving intravenous recombinant tissue plasminogen activator. For a better comprehension of clinical signs and symptoms in right acute hemispheric stroke, in this chapter we present a review of the principle clinical syndromes.
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Martinaud O, Pouliquen D, Gérardin E, Loubeyre M, Hirsbein D, Hannequin D, Cohen L. Visual agnosia and posterior cerebral artery infarcts: an anatomical-clinical study. PLoS One 2012; 7:e30433. [PMID: 22276198 PMCID: PMC3262828 DOI: 10.1371/journal.pone.0030433] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 12/19/2011] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate systematically the cognitive deficits following posterior cerebral artery (PCA) strokes, especially agnosic visual disorders, and to study anatomical-clinical correlations. Methods and Findings We investigated 31 patients at the chronic stage (mean duration of 29.1 months post infarct) with standardized cognitive tests. New experimental tests were used to assess visual impairments for words, faces, houses, and objects. Forty-one healthy subjects participated as controls. Brain lesions were normalized, combined, and related to occipitotemporal areas responsive to specific visual categories, including words (VWFA), faces (FFA and OFA), houses (PPA) and common objects (LOC). Lesions were located in the left hemisphere in 15 patients, in the right in 13, and bilaterally in 3. Visual field defects were found in 23 patients. Twenty patients had a visual disorder in at least one of the experimental tests (9 with faces, 10 with houses, 7 with phones, 3 with words). Six patients had a deficit just for a single category of stimulus. The regions of maximum overlap of brain lesions associated with a deficit for a given category of stimuli were contiguous to the peaks of the corresponding functional areas as identified in normal subjects. However, the strength of anatomical-clinical correlations was greater for words than for faces or houses, probably due to the stronger lateralization of the VWFA, as compared to the FFA or the PPA. Conclusions Agnosic visual disorders following PCA infarcts are more frequent than previously reported. Dedicated batteries of tests, such as those developed here, are required to identify such deficits, which may escape clinical notice. The spatial relationships of lesions and of regions activated in normal subjects predict the nature of the deficits, although individual variability and bilaterally represented systems may blur those correlations.
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Kawai Y, Kawamura M. [Visuospatial agnosia]. Nihon Rinsho 2011; 69 Suppl 8:355-358. [PMID: 22787812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Yoshinari Kawai
- Department of Neurology, Nagoya University Graduate School of Medicine
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Zhang Q, Kaga K, Hayashi A. Auditory agnosia due to long-term severe hydrocephalus caused by spina bifida - specific auditory pathway versus nonspecific auditory pathway. Acta Otolaryngol 2011; 131:787-92. [PMID: 21413843 DOI: 10.3109/00016489.2011.553631] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 27-year-old female showed auditory agnosia after long-term severe hydrocephalus due to congenital spina bifida. After years of hydrocephalus, she gradually suffered from hearing loss in her right ear at 19 years of age, followed by her left ear. During the time when she retained some ability to hear, she experienced severe difficulty in distinguishing verbal, environmental, and musical instrumental sounds. However, her auditory brainstem response and distortion product otoacoustic emissions were largely intact in the left ear. Her bilateral auditory cortices were preserved, as shown by neuroimaging, whereas her auditory radiations were severely damaged owing to progressive hydrocephalus. Although she had a complete bilateral hearing loss, she felt great pleasure when exposed to music. After years of self-training to read lips, she regained fluent ability to communicate. Clinical manifestations of this patient indicate that auditory agnosia can occur after long-term hydrocephalus due to spina bifida; the secondary auditory pathway may play a role in both auditory perception and hearing rehabilitation.
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Affiliation(s)
- Qing Zhang
- National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Japan
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Kanzaki J, Harada T, Kanzaki S. [A case of transient auditory agnosia and schizophrenia]. Nihon Jibiinkoka Gakkai Kaiho 2011; 114:133-138. [PMID: 21516711 DOI: 10.3950/jibiinkoka.114.133] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report a case of transient functional auditory agnosia and schizophrenia and discuss their relationship. A 30-year-old woman with schizophrenia reporting bilateral hearing loss was found in history taking to be able to hear but could neither understand speech nor discriminate among environmental sounds. Audiometry clarified normal but low speech discrimination. Otoacoustic emission and auditory brainstem response were normal. Magnetic resonance imaging (MRI) elsewhere evidenced no abnormal findings. We assumed that taking care of her grandparents who had been discharged from the hospital had unduly stressed her, and her condition improved shortly after she stopped caring for them, returned home and started taking a minor tranquilizer.
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Affiliation(s)
- Jin Kanzaki
- Department of Otorhinolaryngology, International University of Health and Welfare, Atami
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Goudour A, Samson S, Bakchine S, Ehrle N. Agnosic or semantic impairment in very mild Alzheimer's disease? Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2011; 18:230-253. [PMID: 21360357 DOI: 10.1080/13825585.2010.540643] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The present study investigated object recognition impairment and the existence of category effects in patients with mild Alzheimer's disease. A battery of tests was designed to assess the deterioration of semantic memory and/or the existence of agnosia by evaluating visual and auditory naming, knowledge of structural descriptions (pre-semantic representation of an object within each perceptual system) and conceptual knowledge. The group of Alzheimer's patients were impaired in all experimental tests as compared to healthy participants. This result suggests an impairment of multiple levels of object integration processing even at an early stage of the disease. The patients also demonstrated a category effect with massive difficulties in recognizing human actions and musical instruments as compared to the other categories. This study provides an innovative clinical tool for exploring the recognition of visual and auditory objects at different levels of representation, allowing for the description of early signs of Alzheimer disease.
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Affiliation(s)
- Amandine Goudour
- Service de Neurologie & CMRR Champagne-Ardenne, Centre Hospitalier Universitaire de Reims, France
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Diesfeldt HFA. [Associative visual agnosia. The less visible consequences of a cerebral infarction]. Tijdschr Gerontol Geriatr 2011; 42:17-28. [PMID: 21400959] [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: 05/30/2023]
Abstract
After a cerebral infarction, some patients acutely demonstrate contralateral hemiplegia, or aphasia. Those are the obvious symptoms of a cerebral infarction. However, less visible but burdensome consequences may go unnoticed without closer investigation. The importance of a thorough clinical examination is exemplified by a single case study of a 72-year-old, right-handed male. Two years before he had suffered from an ischemic stroke in the territory of the left posterior cerebral artery, with right homonymous hemianopia and global alexia (i.e., impairment in letter recognition and profound impairment of reading) without agraphia. Naming was impaired on visual presentation (20%-39% correct), but improved significantly after tactile presentation (87% correct) or verbal definition (89%). Pre-semantic visual processing was normal (correct matching of different views of the same object), as was his access to structural knowledge from vision (he reliably distinguished real objects from non-objects). On a colour decision task he reliably indicated which of two items was coloured correctly. Though he was unable to mime how visually presented objects were used, he more reliably matched pictures of objects with pictures of a mime artist gesturing the use of the object. He obtained normal scores on word definition (WAIS-III), synonym judgment and word-picture matching tasks with perceptual and semantic distractors. He however failed when he had to match physically dissimilar specimens of the same object or when he had to decide which two of five objects were related associatively (Pyramids and Palm Trees Test). The patient thus showed a striking contrast in his intact ability to access knowledge of object shape or colour from vision and impaired functional and associative knowledge. As a result, he could not access a complete semantic representation, required for activating phonological representations to name visually presented objects. The pattern of impairments and preserved abilities is considered to be a specific difficulty to access a full semantic representation from an intact structural representation of visually presented objects, i.e., a form of visual object agnosia.
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