Immediate visual-spatial memory in hemisphere-damaged patients: Impairment of verbal coding and of perceptual processing

A test of immediate visual-spatial memory was administered to 71 normal controls, 140 right and 219 left brain-damaged patients, in order to check if immediate visual recognition is lowered chiefly by an aphasic or by a perceptual disorder. Results showed that both a visual field defect and, even more, a language disturbance impair visual recognition of brain-damaged patiens.     

Major and minor depression in Parkinson's disease: a neuropsychological investigation

Previous studies have failed to distinguish the differential contribution of major and minor depression to cognitive impairment in patients with idiopathic Parkinson's disease (PD). This study was aimed at investigating the relationships among major depression (MD), minor depression (MiD) and neuropsychological deficits in PD. Eighty-three patients suffering from PD participated in the study. MD and MiD were diagnosed by means of a structured interview (SCID-I) based on the DSM-IV criteria, and severity of depression was evaluated by the Beck Depression Inventory. For the neuropsychological assessment, we used standardized scales that measure verbal and visual episodic memory, working memory, executive functions, abstract reasoning and visual-spatial and language abilities. MD patients performed worse than PD patients without depression on two long-term verbal episodic memory tasks, on an abstract reasoning task and on three measures of executive functioning. The MiD patients' performances on the same tests fell between those of the other two groups of PD patients but did not show significant differences. Our results indicate that MD in PD is associated with a qualitatively specific neuropsychological profile that may be related to an alteration of prefrontal and limbic cortical areas. Moreover, the same data suggest that in these patients MiD and MD may represent a gradual continuum associated with increasing cognitive deficits.     

Memory disorder in Korsakoff's psychosis: a neuropathological and neuropsychological investigation of two cases.

Neuropathological findings in the brains of two alcoholic patients with Korsakoff's psychosis are reported. Their memory defects had been studied in detail quantitatively over a period of nine years in one case and three years in the other, relevant details of which are presented. Both patients had had a relatively pure long-term memory impairment in the absence of other cognitive deficits and in the absence of a short-term memory impairment. Their retrograde amnesia for public events and famous faces had been measured and found to have extended backwards over at least twenty-five years. There was severe impairment in anterograde recognition memory for both verbal and non-verbal material. On a newly prepared memory quotient battery both patients had scored well below the bottom of the normal scale (less than 60, where 100 is the mean with a standard deviation of +/- 15). Both patients had also shown the characteristic differential improvement in retention when tested by cued recall and also the characteristic 'prior learning effect', i.e. normal retention of one list of words when tested by cued recall but impaired retention of a second list sharing the same cues as the first list. There had been a slight but significant deterioration in intelligence in one of the patients in the two years prior to his death, although his IQ still fell within the normal range. The other patient remained undeteriorated until his death, and his IQ also was close to an estimated measure of his premorbid IQ. In the brains of both patients there was marked gliosis, shrinkage and discolouration bilaterally in the medial nuclei of the mammillary bodies. In addition there was a thin band of gliosis bilaterally between the wall of the third ventricle and the medial dorsal nucleus, the rostral limit lying anterior to the medial dorsal nucleus. In the patient with no intellectual deterioration these were the only pathological changes that were seen. In neither patient was there evident local loss of nerve cells, gliosis or any other qualitative evidence of abnormality in the hippocampi, the white matter of the temporal lobes or the greater part of the medial dorsal nuclei, although it is difficult to be certain whether there was any overlap between the band of gliosis and the most medial region of the medial dorsal nueleus and other adjacent thalamic nuclei. In the other patient there was also a small zone of softening in the cerebellum and an increase in astrocytes in other regions of the cerebral hemispheres, including the basal ganglia, amygdala, and brain-stem, but without noticeable loss of cells. The question of the minimal lesion for the alcoholic Korsakoff amnesic state, and some aspects of the related anatomy, is discussed in the context of other reports in the literature which are, however, difficult to assess in the absence of details of the specificity, severity and character of the memory disorders.     

Delusions in dementia syndromes: investigation of behavioral and neuropsychological correlates.

A prospective cross-sectional investigation examining the relationship of neuropsychological and behavioral changes to the occurrence of delusions in dementia syndromes was conducted. Nineteen patients had Alzheimer's disease (AD), and 14 had multi-infarct dementia (MID). Patients with and without delusions were compared with regard to demographic characteristics, neuropsychological and neurological features, and a variety of behavioral disturbances. Delusional patients were more aggressive and exhibited more severe activity disturbances than nondelusional patients. Delusional patients were more severely cognitively impaired, but the neuropsychological differences between the two groups were not outstanding. These observations suggest that specific neuropsychological deficits are not compelling predictors of delusions and that delusional patients are more behaviorally disturbed than those without delusions. It is hypothesized that delusions are independent noncognitive manifestations of the neurobiology of AD and MID.     

A five-factor model for motor, psychomotor, and visual-spatial tests used in the neuropsychological assessment of children.

Previous confirmatory factor analysis has supported a distinction between simple and complex motor skill tests in a modified and expanded Halstead Reitan test battery (HRB). The present study used a sample of 722 right-handed boys and girls, aged 9 through 12, and expanded the sample of motor, psychomotor, and visual-spatial tests to further clarify this distinction. Restricted maximum-likelihood factor analysis resulted in correlated factors of Simple Motor Skill, Complex Visual-Spatial Relations, Simple Spatial Motor Operations, Motor Steadiness, and Speeded Motor Sequencing. These results provide additional evidence for the discriminant validity of this particular battery of tests, and explicate further the skills and abilities measured in neuropsychological assessments of children referred for evaluation.     

Reduced cerebral blood flow and impaired visual-spatial function in proximal myotonic myopathy.

OBJECTIVE: To compare brain involvement in myotonic dystrophy (DM) with that of proximal myotonic myopathy (PROMM). BACKGROUND: PROMM is a multisystem disease with many features in common with DM. METHODS: Twenty patients with DM (CTGF[500-700), 20 patients with PROMM, and 20 normal control subjects were studied. Neuropsychological testing was performed in 12 patients with PROMM and in 18 patients with DM; brain MRI was performed in 17 of 20 PROMM patients and 15 of 20 DM patients. Ten patients with PROMM and 11 patients with DM were subjected to H2(15)O PET. RESULTS: Two-thirds of the patients with PROMM and one-half of those with DM were impaired on visual-spatial recall, whereas one-third of the patients with PROMM and less than half of those with DM showed an impairment in visual-spatial construction. Brain MRI was normal, or showed only nonspecific white matter abnormalities in both PROMM and DM patients. PET studies in PROMM patients showed a bilateral decrease in regional cerebral blood flow (rCBF) of the orbitofrontal and medial frontal cortex, whereas DM patients had more widespread hypoperfusion that extended to the dorsolateral frontal cortex and subcortical regions. CONCLUSIONS: Impaired visual-spatial function may be present in proximal myotonic myopathy. This correlates best with a reduction in regional cerebral blood flow observed in H2(15)O PET brain scans rather than with specific structural abnormalities observed on brain MRI.     

Cerebrovascular disease in childhood: neuropsychological investigation of 14 cases

There are few studies about the development of a child after a cerebrovascular accident (CVA), and they usually describe problems such as diminishing in intellectual capacities, difficulties in linguistic and visual-motor skills, as well as in spatial organization and integration. In this study, there were 28 children participating, being 14 placed in the experimental group (EG) after clinical diagnosis and ischemic CVA imaging, and other 14 children without past history of CVA, who formed the control group (CG). The neuropsychological research protocol included an intelligence test, a visual-motor coordination test, human figure drawing, a cortical functions battery and the medical records of the children from the EG. The analysis of the results of this study revealed that the best performances after the CVA are related to the shortest time of functional recovery; CG presented better performances than EG in all the instruments used, in cognitive, perceptual and motor skills. It has been noticed that CVA may lead to intellectual reduction in case of a recurrence of the vascular insult.     

Human callosal function: MRI-verified neuropsychological functions

A commissurotomy patient, with MRI-revealed sparing of some rostral and splenial fibers of the corpus callosum, judged whether pairs of words rhymed. We presented one word in each pair to her left visual field and the other to her right visual field. The 2 words in each pair either sounded and looked alike (R + L +), sounded alike but looked different (R + L -), sounded different but looked alike (R - L +), or both sounded and looked different (R - L -). Although in previous studies the patient has demonstrated little or no ability to transfer information between her brain hemispheres, she was able to perform the rhyming judgment significantly better than chance when the words both looked and sounded alike. However, her accuracy did not differ from chance in the other 3 conditions, or when she was asked to indicate if 2 letters presented to her opposing visual fields were the same or different. A second commissurotomy patient, with an MRI-verified full callosal section, performed at chance in all conditions, and normal control subjects were significantly better than chance in all conditions but R + L -. We discuss the results in terms of the specificity of the information carried by groups of callosal fibers.     

Luria's neuropsychological investigation in organic brain syndrome

A controlled study was conducted on 25 patients diagnosed to be suffering from organic brain syndrome. Luria's Neuropsychological Investigation was administered to detect organicity and to determine its locus. The Bender Visual Motor Gestalt Test served as a control. Luria's test confirmed organicity in all of the proband population and in none of the controls. It also indicated probable locus of the lesion. Administration of Luria's test on a larger population with equivocal cases is suggested.     

Impairment of executive functions in a patient with a focal lesion in the anterior cingulate cortex. Evidence from neuropsychological assessment

Patients with naturally occurring lesions involving the anterior cingulate cortex are rare and there thus exist very few reports of focal lesions in this area. We report a longitudinal study of a new case of selective anterior cingulate damage due to the presence of an angiocavernoma at the junction of the anterior third with the middle third of the right gyrus cinguli. Before surgery, the results of several, different tests suggested a significant impairment of executive functions, including deficits in planning, monitoring of ongoing behavior, and strategy shifting, as well as an exaggerated susceptibility to retroactive interference. Most of these symptoms disappeared completely or almost completely after the surgical removal of the angiocavernoma, although exaggerated susceptibility to interference was found to persist four months after surgery.     

Topiramate effect in catatonia: a case series

The authors describe four cases of catatonia in which topiramate treatment was used. Commonly effective therapies, including benzodiazepines and divalproex, were proven refractory. In all four cases, subjects experienced complete remission of catatonic symptoms and tolerated treatment well. In one case, all psychotropic medications were discontinued because the patient became delirious. The delirium resolved after discovery and treatment of a urinary tract infection. Catatonic agitation relapsed when topiramate was withdrawn but remitted again when topiramate and lorazepam therapy was restored. In two cases, continued topiramate therapy was accompanied by sustained remission. These case reports present a novel approach to the treatment of catatonia.     

Linear discriminant function analysis in neuropsychological research: some uses and abuses.

The present paper addressed the continued misinterpretation and misapplication of linear discriminant function analysis in neuropsychological research. Methodological problems concerning the influence of shrinkage and stepwise selection procedures on LDFA are virtually ignored and affect both the classification and inferential application of LDFA. Throughout the paper examples of potential abuses of LDFA were cited and data from a familiar research problem was employed to demonstrate procedures which enable more accurate interpretation of LDFA results. Linear discriminant function analysis and its multivariate equivalents are powerful and flexible tools for exploring group differences provided appropriate applications and interpretations of results are made.     

Benzodiazepines and catatonia: a case report

The case history of a patient with presumed psychogenic catatonia who responded dramatically to two mg of IM lorazepam is presented. This patient, who had been largely mute and immobile for over a week despite neuroleptic therapy, became freely conversant and mobile within 30 minutes of the administration of lorazepam. This response was repeated the next day after the patient had again become mute and immobile. Catatonia and its diverse etiologies are discussed, with an emphasis on its syndromic nature. The literature on the response of catatonia to the benzodiazepines is reviewed and it is suggested that a trial of benzodiazepines may be helpful in both the evaluation and long term management of patients with catatonia.     

QEEG changes during cardiopulmonary bypass: relationship to postoperative neuropsychological function.

The relationship of changes in intraoperative QEEG and postoperative cognitive function was studied in 32 patients undergoing cardiac surgical procedures requiring cardiopulmonary bypass (CPB). All patients were anesthetized with a high dose narcotic technique in which CPB was carried out using moderate hypothermia. EEG recorded continuously throughout each procedure was analyzed using the neurometric technique. Neuropsychological (NP) evaluations were administered to all patients before, 1 week and 2-3 months postoperatively. A decrement in postoperative performance of 2 standard deviations in two or more tests from preoperative testing was defined as a new cognitive deficit. Of the patients studied, 40.6% demonstrated a new postoperative cognitive deficit at 1 week. At 2-3 months postoperatively, 28.1% continued to show a cognitive deficit. Discriminant analysis of the QEEG as a function of NP performance was calculated at select times during the surgical procedure. QEEG prediction of NP performance was just above chance at the 1 week comparison but excellent for the 2-3 month comparisons. This study suggests that with appropriate monitoring protocols, intraoperative QEEG may predict cognitive dysfunction experienced by patients 2-3 months postoperatively.     

A five-factor model for motor,psychomotor, and visual-spatial tests used in the neuropsychological assessment of children

Abstract

Previous confirmatory factor analysis has supported a distinction between simple and complex motor skill tests in a modified and expanded Halstead Reitan test battery (HRB). The present study used a sample of 722 right-handed boys and girls, aged 9 through 12, and expanded the sample of motor, psychomotor, and visual-spatial tests to further clarify this distinction. Restricted maximum-likelihood factor analysis resulted in correlated factors of Simple Motor Skill, Complex Visual-Spatial Relations, Simple Spatial Motor Operations, Motor Steadiness, and Speeded Motor Sequencing. These results provide additional evidence for the discriminant validity of this particular battery of tests, and explicate further the skills and abilities measured in neuropsychological assessments of children referred for evaluation.