Temporal order memory in patients with Korsakoff's syndrome and medial temporal amnesia

Two groups of patients with global amnesia resulting either from Korsakoff's syndrome (KS) or from medial temporal lobe (MTL) damage were compared with groups of matched healthy control subjects on a list discrimination paradigm. Item recognition memory was matched across the amnesic and control groups in order to determine whether KS, but not MTL amnesics are disproportionately impaired on list discrimination as predicted by Parkin's [Functional significance of etiological factors in human amnesia. In: Squire LR, Butters N, editors. Neuropsychology of memory, 2nd ed. New York: The Guilford Press, 1992] hypothesis. However, both patient groups were impaired disproportionately on the temporal order memory task, which is inconsistent with Parkin's hypothesis. It remains possible that the KS patients are more disproportionately impaired than those with MTL damage because both patient groups performed at floor on the list discrimination task. The results are consistent with theories that postulate a critical role for the hippocampus in the kind of associative memory which underlies memory for temporal order, but not in recognition of single items or arbitrary associations between items of similar kinds.     

Interictal and ictal magnetoencephalographic study in patients with medial frontal lobe epilepsy

PURPOSE: To determine whether magnetoencephalography (MEG) has any clinical value for the analysis of seizure discharges in patients with medial frontal lobe epilepsy (FLE). METHODS: Four patients were studied with 74-channel MEG. Interictal and ictal electroencephalographic (EEG) and MEG recordings were obtained. The equivalent current dipoles (ECDs) of the MEG spikes were calculated. RESULTS: In two patients with postural seizures, interictal EEG spikes occurred at Cz or Fz. The ECDs of interictal MEG spikes were localized around the supplementary motor area. In the other two patients with focal motor or oculomotor seizures, interictal EEG spikes occurred at Fz or Cz. The ECDs of interictal MEG spikes were localized at the top of the medial frontal region. The ECDs detected at MEG ictal onset were also localized in the same area as those of the interictal discharges. CONCLUSIONS: In medial FLE patients, interictal and ictal MEG indicated consistent ECD localization that corresponded to the semiology of clinical seizures. Our findings demonstrate that MEG is a useful tool for detecting epileptogenic focus.     

Giant aneurysm causing frontal lobe syndrome

Summary A 67-year-old patient with a completely thrombosed giant aneurysm of the anterior communicating artery is described. The only neurological findings were a disturbance of stance and gait and slight bilateral grasp reflexes. He had had the features of a frontal lobe psychotic syndrome for more than 12 years. Computed tomography demonstrated a primarily hyperdense calcified suprasellar space-occupying lesion. Magnetic resonance imaging proved valuable in establishing the correct diagnosis, which was confirmed post mortem.     

Perception of action boundaries in patients with frontal lobe damage

The prefrontal cortex is known to be involved in action planning and in controlling behaviour. Neuropsychological evidence also supports the idea that the prefrontal cortex is generally involved in processing complex events, such as action knowledge. Actions are represented in memory as sequences of goal-directed discrete events. Complex events can be divided into discrete smaller units and organised in a hierarchical manner. The aim of the present study was to investigate the ability of 9 patients with prefrontal lesion and 12 healthy controls to parse action sequences into meaningful events. Subjects were requested to detect the transitions between events under three different orientation instructions: (1) spontaneous; (2) small events; and (3) large event. Both normal subjects and patients identified significantly more events under the small-oriented condition. However, contrary to normal controls (NCs), patients with prefrontal damage showed considerable difficulties in detecting large event units than small event units. These results strongly suggest that prefrontal cortex is specifically involved in parsing and recognising clusters of action sequences. These findings also show that the way in which instructions orient subjects' attention, has an effect on how action information is encoded and represented in memory.     

Anarchic hand syndrome following resection of a frontal lobe tumor

Anarchic hand syndrome (AHS) is a rare disorder characterized by unwilled, but seemingly purposeful movements of the affected upper limb which are perceived by the patients not to be under their control. It often interferes with goal-directed movements and bimanual tasks. At present there is no effective method of treatment of AHS. We report here a case of AHS following resection of a frontal lobe tumor and describe its effects on the patient's functional activities. The patient used avoidance behavior and mental concentration to overcome the disabling effect of AHS. These strategies appear to be useful in the management of AHS.     

Fluency deficits in patients with Alzheimer's disease and frontal lobe lesions

Fluency tests are widely used in clinical settings to assess cognitive function. Fluency deficits In patients with Alzheimer's disease (AD) are generally attributed to deteriorated language storage. In contrast, patients with lesions to the frontal lobes (FL) of the brain are thought to have poor fluency due to executive deficits of retrieval. This study examined the relationships between fluency performance and cognitive measures of language and executive function in both AD and FL patients. In both groups, fluency performance related to measures of language comprehension and executive control of attention. However, in AD patients, fluency deficits were most closely associated with language and verbal memory deterioration, while in FL patients fluency deficits were more strongly associated with executive measures of strategic planning and attention. Qualitatively different patterns of functional deficits may influence fluency performance in different neuropsychological groups. Caution is therefore urged in the interpretation of poor fluency scores as indicative of either language or executive dysfunction, without additional information about the reasons for poor performance.     

rTMS reveals premotor cortex dysfunction in frontal lobe epilepsy

PURPOSE: Studies of motor cortex excitability provided evidence that focal epilepsies may alter the excitability of cortical areas distant from the epileptogenic zone. In order to explore this hypothesis we studied the functional connectivity between premotor and motor cortex in seven patients with frontal lobe epilepsy and seizure onset zone outside the premotor or motor cortex. METHODS: Low-frequency subthreshold repetitive transcranial magnetic stimulation was applied to the premotor cortex and its impact on motor cortex excitability was measured by the amplitude of motor-evoked potentials in response to direct suprathreshold stimulation of the motor cortex. RESULTS: Stimulation of the premotor cortex of the non-epileptogenic hemisphere resulted in a progressive and significant inhibition of the motor cortex as evidenced by a reduction of motor evoked potential amplitude. On the other hand, stimulation of the premotor cortex of the epileptogenic hemisphere failed to inhibit the motor cortex. The reduced inhibition of the motor cortex by remote areas was additionally supported by the significantly shorter cortical silent periods obtained after stimulation of the motor cortex of the epileptogenic hemisphere. CONCLUSION: These results show that the functional connectivity between premotor and motor cortex or motor cortex interneuronal excitability is impaired in the epileptogenic hemisphere in frontal lobe epilepsy while it is normal in the nonepileptogenic hemisphere.     

Remembering and knowing in patients with frontal lobe injuries

Two experiments compared the performance of patients with pathology restricted to the prefrontal cortex to healthy controls on recognition tests that were followed by the remember/know procedure. Across both experiments, patients recognized roughly as many target items as control participants. Injuries centered in the frontal poles resulted in deficits that were selective to episodic remembering while apparently sparing semantic knowing. Patients with lesions restricted to dorsolateral prefrontal cortex were not impaired at either remembering or knowing. Results demonstrate a dissociation of cognitive function within the prefrontal cortex, and suggest that episodic remembering may share a family resemblance with other neurocognitive functions dependent upon polar aspects of the frontal lobes, such as self-recognition, anticipation, and planning.     

Double dissociation of letter and category fluency following left frontal and temporal lobe lesions

Background: A number of studies have suggested that temporal cortex is critical for the ability to generate exemplars belonging to a particular semantic category (i.e., category fluency), while frontal cortex is critical for generating words beginning with a particular letter (i.e., letter or phonemic fluency). However, previous studies have often focused on relative, quantitative differences in performance across groups of patients and primarily in the oral domain.

Aims: The current study analysed verbal fluency data from two individuals with chronic aphasia, one with a large left temporal lobe lesion and a severe Wernicke's aphasia, and a second individual with a large left frontal lobe lesion and a moderately severe non-fluent aphasia. The goal of the study was to do both qualitative and quantitative analyses of letter and category fluency performance in these two individuals across oral and written fluency domains.

Methods & Procedures: Participants were administered both oral and written versions of letter fluency (FAS) and category fluency conditions (fruits, animals, and supermarket items). Participants were given 90 seconds to generate as many items as possible, and their responses were scored for both overall output, as well as qualitative structure using a clustering analysis.

Outcomes & Results: The individual with an extensive temporal lobe lesion generated a large number of exemplars on the letter fluency task. Some of these items were neologisms (e.g., frest, anth, and swink), but remarkably all adhered to the phonological constraints of the task. However, this individual was very poor at generating items belonging to semantic categories. In contrast, the individual with a large frontal lesion generated many exemplars on the category fluency task but only two items on the letter fluency task. The same pattern was replicated in the written domain in both individuals, and results from the clustering analysis paralleled these quantitative findings.

Conclusions: This report describes two individuals with aphasia who exhibited a double dissociation between letter and category fluency performance in both oral and written domains. The current findings provide further evidence for the notion that left frontal cortex is critical for word retrieval based on phonology, while left temporal cortex is critical for word retrieval based on semantics. The findings have implications for the types of strategies that may be most effective in individuals with lesions to these brain regions critical for word retrieval.     

Exploratory eye movements in schizophrenic patients and patients with frontal lobe lesions

Summary Exploratory eye movements in 20 schizophrenics, 18 patients with frontal lobe lesions (9 right-sided and 9 left-sided) and 20 normal controls were examined with an eye mark recorder while they viewed stationary S-shaped figures. The eye movements made during the subject's first 15-s viewing of an original figure were analyzed. Patients with right frontal lobe lesions (RF) and schizophrenics (S) had lower scores than normal controls (NC) for the number of eye fixations, total eye scanning length and mean eye scanning length. Each subject was then shown two other figures slightly different from the original and was requested to compare them with the original. After comparing them, the subject wastasked the question, Are there any other differences? The eye movements made over the ensuing 5 s in response to this question were scored using the responsive search score (RSS). The RSS was low only in the S group. The subject was also asked to reproduce the original figure before and after making comparisons between the figures. The RF and S groups were poorer at reproduction than the NC group. These findings suggest that there is disordered function of the right frontal lobe in sehizophrenia, and that schizophrenia is due not only to localized damage to one part of the brain but to more widespread damage.     

68例额叶癫痫的外科治疗与长期疗效随访

目的 总结额叶癫痫的术前评估特征,观察远期手术疗效.方法 分析68例额叶癫痫患者的术前评估结果,总结症状学特征、MRI、发作闻期 SPECT、头皮video-EEG、颅内电极EEG检查的定位价值;应用Engel标准进行术后效果分级,随访2-6年,观察术后的远期疗效.结果 不同评估方法口可提供准确定位信息的比例分别为:症状学特征38%,MRI40%,发作间期SPECT 28%,头皮video-EEG44%,颅内电极EEG81%.最常见的病理改变为皮质发育不良44%(30/68).Engel I级的60%(41/68),II级的12%(8/68),Ⅲ级的10%(7/68),Ⅳ～V级的18%(12/68).癫痫灶定位局限于额叶的病例疗效相对好于M时累及其他脑叶的病例(P<0.05).出现短期并发症10例,长期并发症2例.结论 应用术前综合评估方法,有助于准确定位癫痫灶的位置和范围,手术切除癫痫灶疗效稳定.     

Cognitive estimation in patients with probable Alzheimer's disease and alcoholic Korsakoff patients

Cognitive estimation is an important function in daily living. In early studies it was proposed that estimation deficits are associated with frontal lobe damage and executive dysfunctions. In this study, we assessed Alzheimer patients and patients with alcoholic Korsakoff's syndrome with a newly developed cognitive estimation task. We compared their performance with respect to different dimensions of estimation ('size', 'weight', 'quantity', and 'time') and to various error types. Compared to healthy controls, both patient groups were strongly impaired in all tested estimation dimensions, with Alzheimer patients performing generally worse than Korsakoff patients, except for the dimension "time". Alzheimer as well as Korsakoff patients produced so-called 'bizarre errors' and errors in the choice of the correct unit of measurement. In both patient groups cognitive estimation correlated highly with general knowledge. The production of bizarre errors and unit errors correlated with general knowledge as well as with working memory and executive functions. Results support the main assumptions of a model of cognitive estimation, described in the discussion, that specific parts of the semantic memory system as well as executive functions, in form of a plausibility check of the generated answer, are involved in the process of cognitive estimation.     

Generation and recognition of abstract rules in different frontal lobe subgroups

The Left Lateral cortex is known to have a role in inductive reasoning tasks. A more specific hypothesis on its role is that it is crucial in the generation of new abstract rules, rather than in the selection and implementation of a specific rule among a set of previously learned ones. Two new tests - the Generation of Hypotheses test and the Recognition of the Rule test - were administered to 46 patients with focal damage to the frontal cortex. Patients were divided in three frontal subgroups: Left Lateral, Right Lateral and Medial. On the basis of the new hypothesis, it was predicted that (i) the Left Lateral subgroup would fail in the Generation of Hypotheses test but would show spared performance on the Recognition of the Rule test and that (ii) the other frontal subgroups would perform normally on both tests. The findings on the Left Lateral and Right Lateral frontal subgroup were consistent with the predictions. This suggests that the Left Lateral frontal cortex is critical specifically for the generation of hypotheses in inductive reasoning. The Medial frontal subgroup, in contrast with our expectations, was impaired on Generation test; two hypotheses have been raised to explain this finding.     

Visual neglect associated with frontal lobe infarction

Five patients with left-sided visual neglect following focal infarction of the right frontal lobe are presented. Lesion location was assessed using computed tomography or magnetic resonance imaging. The common area of lesion overlap was small, being confined to the dorsal aspect of the inferior frontal gyrus (Brodmann's area 44) and the immediate underlying white matter. This cortical region is part of the homologue of Broca's area in the right hemisphere and is considered to be part of human premotor cortex. The association of neglect with injury to this area suggests it may play an important role in directing attention in visual space.     

Frontal versus dysexecutive syndromes: relevance of an interactionist approach in a case series of patients with prefrontal lobe damage

The concepts of “frontal” and “dysexecutive” syndromes are still a matter of debate in the literature. These terms are often used interchangeably but can be distinguished when considering specific frontal behavioural deficits which occur during social interaction. Despite being of interest for the clinical assessment and care management of patients with anterior brain damage, few studies have tried to disentangle the specificity of each syndrome. We report the case of eight patients with frontal lobe damage who were assigned to one of two groups based on whether or not they showed a dysexecutive syndrome. The nondysexecutive group differed from the dysexecutive group in showing environmental dependency phenomena, behavioural disorders triggered by social interaction. By adopting an interactionist perspective, this pilot study contributes to defining more precisely the distinction between “frontal” and “dysexecutive” syndromes. The discussion focuses on the potential interest of the interactionist approach in designing appropriate methodologies of assessment and rehabilitation of patients with frontal lobe syndrome.     

Face memory impairments in patients with frontal lobe damage

OBJECTIVE: To determine whether damage to prefrontal cortex is associated with face memory impairment. BACKGROUND: Neurophysiologic and functional imaging studies suggest that prefrontal cortex is a key component of a distributed neural network that mediates face recognition memory. However, there have been few attempts to examine the impact of frontal lobe damage on face memory performance. METHODS:Patients with focal frontal lobe lesions and normal control subjects were administered two-alternative forced-choice and single-probe "yes/no" tests of recognition memory for novel faces. Retrograde memory was assessed by using famous faces as stimuli. RESULTS: Compared with control subjects, patients with frontal lobe lesions showed evidence of marked anterograde and relatively mild retrograde face memory impairment. In addition, patients with right frontal lesions demonstrated increased susceptibility to false recognition, consistent with the breakdown of strategic memory retrieval, monitoring, and decision functions. CONCLUSIONS: Prefrontal cortex plays an important role in the executive control of face memory encoding and retrieval. Left and right prefrontal regions seem to make different contributions to recognition memory performance.     

A quantitative study of frontal cortex dendritic microtubules in patients with Alzheimer's disease

The dendritic microtubules (MT) of the frontal cortex layers II and III were studied in 9 patients with Alzheimer's disease (AD) and the results compared with 9 case controls. Dendrites with abnormally oriented MTs and others depleted of these structures were seen. A significant reduction in the number of MTs per unit area was found in AD. It is suggested that microtubular changes in AD can interfere with neuroplasmic transport and thus, be implicated with the dendritic degeneration present in this disease.     

Odor psychophysics in vertebrates

The methods used to obtain psychophysical data on the nasal chemosensory systems of all classes of vertebrates are critically reviewed and a summary of the available data on their odor detection and discrimination abilities is provided. Although there are reliable methods for training at least one member of each class to respond differentially to the presence or absence of odor stimuli, very little is known about the limits of the capacity of any of the three major nasal chemosensory systems (olfactory, vomeronasal and trigeminal) to detect pure compounds. Furthermore, studies in which rigorous procedures are followed for both the maintenance of discriminative responding and the presentation of odor stimuli often fail to determine the sensory system(s) mediating the psychophysical results. This lack of information has impeded progress on several fundamental problems in the study of nasal chemoreception.     

Widespread cortical thinning in children with frontal lobe epilepsy

Purpose: Spread of seizure activity outside the frontal lobe due to cortico‐cortical connections can result in alteration in the cortex beyond the frontal lobe in children with intractable frontal lobe epilepsy (FLE). The aim of this study was to identify regions of reduced cortical thickness in children with intractable FLE. Methods: High‐resolution volumetric T₁‐weighted imaging was performed on 17 children with FLE, who were being evaluated for epilepsy surgery, and 26 age‐matched healthy controls. The cortical thickness of 12 patients with left FLE and 5 patients with right FLE was compared to controls. The clusters of cortical thinning were regressed against age of seizure onset, duration of epilepsy, seizure frequency, and number of medications. Key Findings: In children with left FLE, cortical thinning was present in the left superior frontal, paracentral, precuneus, cingulate, inferior parietal, supramarginal, postcentral, and superior temporal gyri, as well as in the right superior and middle frontal, medial orbitofrontal, supramarginal, postcentral, banks of superior temporal sulcus, and parahippocampal gyri. In children with right FLE, cortical thinning was present in the right precentral, postcentral, transverse temporal, parahippocampal, lingual, and lateral occipital gyri, as well as in the left superior frontal, inferior parietal, postcentral, superior temporal, posterior cingulate, and lingual gyri. In children with left FLE, following exclusion of one outlier, there was no significant association between age at seizure onset, duration of epilepsy, seizure frequency and number of medications with clusters of cortical thinning. In children with right FLE, age at seizure onset, duration of epilepsy, frequency of seizures, and number of medications were not associated with clusters of cortical thinning within the right and left hemispheres. Significance: Cortical changes were present in the frontal and extrafrontal cortex in children with intractable FLE. These changes may be related to spread of seizure activity, large epileptogenic zones involving both frontal and extrafrontal lobes, and development of secondary epileptogenic zones that over time lead to cortical abnormality. Further studies correlating cortical changes with neurocognitive measures are needed to determine if the cortical changes relate to cognitive function.