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Associations Between Intertemporal Food Choice and BMI in Adult Women: An fMRI Study Using a Quasi-realistic Design. 成年女性时空食物选择与体重指数之间的关系:采用准现实设计的 fMRI 研究。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-10-22 DOI: 10.1097/WNN.0000000000000377
Anne Sommerfeld, Manfred Herrmann, Marcus Heldmann, Peter Erhard, Thomas F Münte

Background: Impulsivity resulting in unrestrained eating has been implicated as a contributing factor for obesity. Delay discounting (DD) tasks where individuals choose between a smaller immediate reward and a larger delayed reward provide useful data to describe impulsive decision-making and to determine the extent to which delayed rewards are discounted.

Objective: To study the association between body mass index(BMI) and delay discounting for food and money in adult women.

Methods: We used a DD task with real food rewards to investigate impulsive decision-making as related to BMI in participants who self-identified as women. Participants in group A had a mean BMI of 21.4 (n = 14), and participants in group B had a mean BMI of 32.2 (n = 14). Each group was tested in a hungry state during a single session. We performed fMRI during a DD task requiring participants to choose between a food item (one sandwich) constituting a smaller immediate reward and multiple food items (two, three, or four sandwiches) constituting a series of larger delayed rewards available at different intervals. The steepness of the discounting curve for food was determined from these decisions. Participants then completed a monetary discounting task to facilitate a comparison of the discounting of food and monetary rewards.

Results: Participants in group B discounted food rewards more steeply than monetary rewards. Decisions for delayed rewards led to increased activations of brain areas related to executive control on fMRI, such as the head of the caudate nucleus and the anterior cingulate cortex (ACC) in group A, but not group B participants.

Conclusion: Our findings suggest that group B had difficulty deciding against the immediate food rewards due to insufficient recruitment of cortical control areas. Therefore, impulsivity is an important target for behavioral interventions in individuals with obesity.

背景:冲动导致无节制进食被认为是肥胖的一个诱因。延迟折现(DD)任务让个体在较小的即时奖励和较大的延迟奖励之间做出选择,它为描述冲动性决策和确定延迟奖励的折现程度提供了有用的数据:研究成年女性的体重指数(BMI)与食物和金钱延迟折扣之间的关系:方法:我们使用一个有真实食物奖励的延迟贴现任务来研究自我认同为女性的参与者的冲动决策与体重指数之间的关系。A 组参与者的平均体重指数为 21.4(n = 14),B 组参与者的平均体重指数为 32.2(n = 14)。每组都在饥饿状态下进行了一次测试。我们在一项 DD 任务中进行了 fMRI 分析,该任务要求参与者在构成较小即时奖励的一种食物(一个三明治)和构成一系列较大延迟奖励的多种食物(两个、三个或四个三明治)之间做出选择。根据这些决定来确定食物折现曲线的陡峭程度。然后,参与者完成一项货币折扣任务,以便对食物和货币奖励的折扣进行比较:结果:B 组参与者对食物奖励的折现曲线比对金钱奖励的折现曲线更陡。对延迟奖励的决定导致 fMRI 上与执行控制有关的脑区激活增加,如 A 组参与者的尾状核头部和前扣带回皮层(ACC),而 B 组参与者则没有:我们的研究结果表明,由于大脑皮层控制区域的招募不足,B 组参与者难以决定是否立即接受食物奖励。因此,冲动是肥胖症患者行为干预的一个重要目标。
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引用次数: 0
Psychotropic Polypharmacy Leading to Reversible Dementia: A Case Report. 精神药物多药合用导致可逆性痴呆:病例报告。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-10-21 DOI: 10.1097/WNN.0000000000000380
Durjoy Lahiri, Bruna Seixas-Lima, Carlos Roncero, Kathryn Stokes, Swayang Sudha Panda, Howard Chertkow

Psychotropic polypharmacy presents a diagnostic challenge that may be further complicated by inadequate medication history and underappreciation of the cognitive effects of such polypharmacy. Here we present the case of a 57-year-old man who presented to our memory clinic with progressive cognitive decline and a prior neuropsychological evaluation supporting the diagnosis of a neurodegenerative disorder. He was taking multiple psychotropic medications at the time, but the exact dosages were unclear due to a lack of collateral history. He was also taking prescribed opioids and a combination of buprenorphine and naloxone for pain relief, again with unclear dosages at the time of presentation. Brain imaging and cerebrospinal spinal fluid biomarker testing were negative for Alzheimer pathophysiologic processes. Months later, the patient was taken to the emergency room after an overdose caused by overuse of opioid medications. Once he was taken off all psychoactive medications, the patient's cognitive impairment completely reversed, and he became independent in activities of daily living. Psychotropic polypharmacy can have a myriad of cognitive manifestations which need to be better recognized by clinicians. Deprescription of such medications should be attempted whenever clinically appropriate.

精神药物的多重作用给诊断带来了挑战,而不充分的用药史和对这种多重作用的认知影响认识不足可能会使诊断变得更加复杂。在此,我们介绍一例 57 岁的男性病例,他因认知能力逐渐下降到我们的记忆门诊就诊,之前的神经心理学评估支持神经退行性疾病的诊断。他当时正在服用多种精神药物,但由于缺乏旁系病史,具体剂量并不清楚。他还在服用处方阿片类药物以及丁丙诺啡和纳洛酮的复合制剂来缓解疼痛,但在就诊时剂量也不清楚。脑成像和脑脊髓液生物标志物检测均为阴性,未发现阿尔茨海默病的病理生理过程。几个月后,患者因过度使用阿片类药物导致用药过量而被送进急诊室。一旦停用所有精神活性药物,患者的认知功能障碍就完全逆转了,并能独立进行日常生活活动。精神药物的多重药理作用可能会产生无数的认知表现,临床医生需要更好地认识到这一点。只要临床情况允许,就应尝试停用这类药物。
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引用次数: 0
The Impact of Lexical-semantic Impairment on Spoken Verb Production in Individuals With Mild Cognitive Impairment. 词汇语义障碍对轻度认知障碍患者口语动词生成的影响。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-10-03 DOI: 10.1097/WNN.0000000000000378
Joël Macoir, Robert Laforce, Carol Hudon

Background: Although episodic memory is the primary concern in individuals with mild cognitive impairment (MCI), other cognitive functions may also be affected, including language. Language impairment in individuals with MCI has been attributed primarily to the breakdown of semantic representations, difficulties in accessing semantic information, and the weakening of executive functions. However, in most prior studies of word processing in individuals with MCI, researchers have used measures focused on noun production.

Objective: To investigate how verb production tasks might aid in detecting cognitive impairment in individuals with MCI.

Methods: We compared the performance of 45 individuals with MCI and 45 healthy controls on action naming and action fluency tasks.

Results: In the action naming task, the performance of participants with MCI was significantly impaired compared to healthy controls in terms of total score, the number of semantic errors produced, and the use of generic terms. In the action fluency task, participants with MCI produced significantly fewer verbs, fewer clusters, and fewer switches than healthy controls.

Conclusion: The results of our study emphasize the utility of verb production tasks in the identification of cognitive impairment in individuals with MCI and provide evidence of the importance of including action naming and action fluency tasks in the assessment of individuals with MCI.

背景:虽然情节记忆是轻度认知障碍(MCI)患者的主要问题,但其他认知功能也可能受到影响,包括语言。MCI 患者的语言障碍主要归因于语义表征的破坏、获取语义信息的困难以及执行功能的减弱。然而,在之前对 MCI 患者文字处理能力的大多数研究中,研究人员使用的测量方法都侧重于名词的产生:方法:我们比较了45名MCI患者的文字处理能力:我们比较了 45 名 MCI 患者和 45 名健康对照者在动作命名和动作流畅性任务中的表现:在动作命名任务中,与健康对照组相比,MCI患者在总分、语义错误数量和通用术语使用方面的表现明显受损。在动作流畅性任务中,与健康对照组相比,MCI 患者产生的动词数量、词组数量和切换数量都明显较少:我们的研究结果强调了动词制作任务在识别 MCI 患者认知障碍方面的实用性,并证明了在评估 MCI 患者时加入动作命名和动作流畅性任务的重要性。
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引用次数: 0
Social Cognition, Executive Functioning, Mood, and Disability in Cervical Dystonia. 颈性肌张力障碍患者的社交认知、执行功能、情绪和残疾。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000374
Madeleine Diepman, Christina Seery, Shameer Rafee, Rachel Somers, Séan O'Riordan, Michael Hutchinson, Fiadhnait O'Keeffe

Background: Individuals with idiopathic adult-onset isolated cervical dystonia (CD) may have cognitive difficulties and increased mood challenges. Social cognition and executive functioning may be particularly affected.

Objective: To explore social cognition and executive functioning performance in individuals with CD, using the Cambridge Neuropsychological Test Automated Battery (CANTAB), as previous research has used traditional, nondigital neuropsychological assessments. We sought to investigate the relationships between social cognition, executive functioning, mood, and disability in individuals with CD.

Methods: We recruited 37 individuals with CD, including 26 women with an age range of 33 to 69 years (M = 56.64, SD = 8.31) from a dystonia clinic in a hospital neurology department. The individuals completed selected tasks from the CANTAB measuring social cognition and executive functioning. We compared the individuals' performance with CANTAB normative data. Depression, anxiety, disease severity, and disability were measured.

Results: The individuals with CD had significantly lower scores than the CANTAB normative data in both social cognition and executive functioning tasks, with the largest differences evident in problem-solving, attention, and positive emotion bias tasks. Poorer emotion recognition was associated with increased difficulties in problem-solving tasks. The individuals demonstrated a bias toward identifying happiness in facial affect, which was related to a poorer recognition of emotions. Cognitive performance was not related to CD severity or disability or to current mood symptoms.

Conclusion: Difficulties with both social cognition and executive functioning were identified in the individuals with CD, and are likely important targets for clinical interventions.

背景:特发性成人孤立性颈肌张力障碍(CD)患者可能会出现认知困难和情绪问题。社交认知和执行功能可能尤其受到影响:由于之前的研究使用的是传统的非数字神经心理学评估方法,因此我们使用剑桥神经心理学测试自动化电池(CANTAB)来探索 CD 患者的社交认知和执行功能表现。我们试图研究 CD 患者的社会认知、执行功能、情绪和残疾之间的关系:我们从一家医院神经内科的肌张力障碍诊所招募了 37 名 CD 患者,其中包括 26 名女性,年龄在 33 岁至 69 岁之间(M = 56.64,SD = 8.31)。这些患者完成了 CANTAB 中测量社会认知和执行功能的部分任务。我们将他们的表现与 CANTAB 常模数据进行了比较。我们还对抑郁、焦虑、疾病严重程度和残疾情况进行了测量:结果:CD患者在社会认知和执行功能任务中的得分明显低于CANTAB常模数据,其中在问题解决、注意力和积极情绪偏差任务中的差异最大。较差的情绪识别能力与问题解决任务的难度增加有关。这些人在面部情绪中表现出一种识别快乐的偏向,这与较差的情绪识别能力有关。认知能力的高低与抑郁症的严重程度、残疾程度或当前的情绪症状无关:结论:CD患者在社会认知和执行功能方面都存在困难,这可能是临床干预的重要目标。
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引用次数: 0
Articulatory-based Phonemic Paraphasia in Conduction Aphasia: A Dysfunction in Phoneme-to-Articulation Conversion Uncovered Through Crossed Aphasia. 传导性失语症中基于发音器官的音位偏差:通过交叉性失语症发现的音素-发音转换功能障碍
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000371
Hiroaki Kawashima, Michitaka Funayama, Yoshie Inaba, Mikoto Baba

Phonemic paraphasia, a common characteristic of conduction aphasia, has traditionally been attributed to phonological representation dysfunction. An alternative hypothesis posits that phonemic paraphasia arises from difficulty converting phonemes into their corresponding articulatory maneuvers. However, detailed case studies supporting this theory have been lacking. In this report, we present the case of a 61-year-old right-handed man with right temporo-parietal infarction who exhibited crossed aphasia characterized by typical conduction aphasia symptoms (eg, relatively fluent speech with intact comprehension, frequent phonemic paraphasia, and pronounced difficulties in oral repetition) in the absence of distorted articulation, syllable segmentation, and prosody impairment. Despite the frequent occurrence of phonemic paraphasia and articulatory challenges, our patient's phonological representations remained relatively intact. His phonemic paraphasia was often self-corrected to produce correct responses, a feature known as conduit d'approche. During the oral repetition of individual mora (ie, the smallest unit of speech in Japanese), we observed that the patient consistently traced the corresponding Hiragana phonetic symbol accurately, despite his difficulties in articulation. We substantiated this phenomenon through objective assessment and posit that it resulted from an unusual separation of language functions in crossed aphasia-specifically, a disconnection between phonological representations in the right temporo-parietal cortex and speech articulation engrams in the left hemisphere. In this case of conduction aphasia, articulatory-based phonemic paraphasia may be viewed as an inability to convert phonemes into the appropriate articulatory maneuvers rather than as phonological representation dysfunction or apraxia of speech.

音位偏瘫是传导性失语症的常见特征,传统上被认为是语音表征功能障碍所致。另一种假说认为,音位性副失语症是由于将音素转化为相应的发音动作存在困难。然而,一直缺乏支持这一理论的详细病例研究。在本报告中,我们介绍了一名 61 岁右撇子男性患者的病例,他患有右颞顶叶梗塞,表现出交叉性失语,其特征是典型的传导性失语症状(如相对流利的言语和完整的理解力、频繁的音位偏位和明显的口语复述困难),但没有发音歪曲、音节分割和拟声障碍。尽管患者经常出现音位偏误和发音障碍,但他的语音表征仍然相对完整。他的音位偏误经常通过自我纠正来产生正确的反应,这一特征被称为 "conduit d'approche"。在口头重复单个语素(即日语中最小的语音单位)的过程中,我们观察到,尽管患者发音困难,但他始终能准确地描摹出相应的平假名音标。我们通过客观评估证实了这一现象,并认为这是交叉性失语症患者语言功能异常分离的结果--具体来说,就是右侧颞顶叶皮层的语音表征与左侧大脑半球的言语发音印记之间出现了脱节。在这种传导性失语症的病例中,基于发音的音位偏位可被视为无法将音素转换为适当的发音动作,而不是语音表征功能障碍或言语瘫痪。
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引用次数: 0
Threatening an Illusory Limb: An Event-related Potential Study of the Rubber Hand Illusion. 威胁幻肢:橡胶手幻觉的事件相关电位研究。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000372
Marcus Heldmann, Gregor Spitta, Tobias Wagner-Altendorf, Thomas F Münte

Background: The rubber hand illusion (RHI) is a well-established method for studying body ownership: Given adequate concordance of visual, sensory, and proprioceptive stimuli, the individual experiences a rubber hand as his or her own.

Objective: To study the effects of a threat to the rubber hand.

Methods: We created a typical RHI paradigm but added threatening pain: Both the real hand of an individual and the rubber hand were stroked with a brush, either synchronously (RHI-inducing condition) or asynchronously (control condition), but only the rubber hand was then pricked with a needle to create a threatening pain condition. Event-related potentials (ERPs) were recorded in a group of 23 typically-developed individuals. ERP effects were source-localized using low-resolution electromagnetic tomography.

Results: The individuals consistently reported experience of the RHI during the experiment when the brush strokes were applied synchronously to both the real hand and the rubber hand. ERP analysis revealed that synchronous brush stroking gave rise to higher amplitude of frontal ERPs in the 100-200 ms range than asynchronous brush stroking, which was interpreted as reflecting the RHI. In the threatening pain condition, ERPs showed a greater positivity at frontocentral electrodes, source localized in the supplementary motor area (SMA).

Conclusion: SMA activation could reflect a control mechanism over reflexive motor activity, facilitating a possible threat-related response. Further studies should address ERP effects and the extent of the RHI to standard and threat stimuli in a correlative fashion to further elucidate the functional significance of the neurophysiological findings.

背景:橡皮手错觉(RHI)是研究身体所有权的一种行之有效的方法:在视觉、感觉和本体感觉刺激充分协调的情况下,个体会将橡皮手体验为自己的手:研究橡胶手受到威胁的影响:我们创建了一个典型的 RHI 范例,但增加了威胁性疼痛:用刷子同步(RHI 诱导条件)或非同步(对照条件)抚摸个体的真手和橡皮手,但随后只用针刺橡皮手,以产生威胁性疼痛条件。对 23 名发育正常的个体进行了事件相关电位(ERP)记录。ERP效应通过低分辨率电磁断层扫描进行源定位:结果:在实验过程中,当笔触同时作用于真实的手和橡皮手时,这些人一致报告了 RHI 体验。ERP分析显示,与异步毛刷抚摸相比,同步毛刷抚摸引起的100-200毫秒范围内的额叶ERP振幅更高,这被解释为反映了RHI。在威胁性疼痛条件下,ERPs 在前中央电极显示出更大的阳性,其源定位在辅助运动区(SMA):结论:SMA 的激活可能反映了对反射性运动活动的控制机制,促进了可能的威胁相关反应。进一步的研究应探讨ERP效应和RHI对标准和威胁刺激的相关程度,以进一步阐明神经生理学研究结果的功能意义。
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引用次数: 0
Free-listing and Semantic Knowledge: A Tool for Detecting Alzheimer Disease? 自由列表和语义知识:检测阿尔茨海默病的工具?
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000370
Maileen G Ulep, Pierre Liénard

Background: Impairment in semantic knowledge contributes to Alzheimer disease (AD)-related decline. However, the particulars of the impact AD has on specific domains of knowledge remain debatable.

Objective: To investigate the impact of AD on specific semantic categories that are integral to daily functions-living things and man-made objects.

Method: We administered a free-listing task (written version) to 19 individuals with AD and 15 cognitively normal older adults and assessed the task's relationship with other cognitive and functional tests in clinical use. We compared the contents of the lists of salient concepts generated by the AD and control groups.

Results: Group membership (AD or control), after controlling for age, sex, formal education, and an estimate of premorbid intellectual ability, predicted the groups' performance on the free-listing task across two categories. Functional status was inversely related to performance on the free-listing task, holding demographic variables constant. Based on a comparison of the contents of the free lists that were generated by the two groups, it was possible to conclude that, in individuals with AD, conceptual knowledge central to the respective categories was well preserved, whereas the peripheral conceptual material showed evidence of degradation.

Conclusion: The free-listing task, which is an easy-to-administer and cost-effective tool, could aid in the preliminary detection of semantic knowledge dysfunction, revealing concepts that are better preserved and, possibly, the characterization of AD. Cognitive assessment tools that can be applied across cultures are needed, and the free-listing task has the potential to address this gap.

背景:语义知识受损是阿尔茨海默病(AD)相关衰退的原因之一。然而,阿尔茨海默病对特定知识领域的具体影响仍有待商榷:调查阿尔茨海默病对日常功能不可或缺的特定语义类别--生物和人造物品--的影响:我们对 19 名注意力缺失症患者和 15 名认知能力正常的老年人进行了自由列表任务(书面版),并评估了该任务与临床上使用的其他认知和功能测试之间的关系。我们比较了注意力缺失症患者组和对照组所生成的突出概念列表的内容:在控制了年龄、性别、正规教育程度和病前智力估计值后,组别(注意力缺失症或对照组)预测了两组在自由列表任务中的表现。在人口统计学变量不变的情况下,功能状态与自由列表任务的成绩成反比。根据对两组自由列表内容的比较,可以得出结论:在注意力缺失症患者中,各个类别的核心概念知识保存完好,而外围概念材料则有退化的迹象:自由列表任务是一种易于操作且成本效益高的工具,有助于初步检测语义知识功能障碍,揭示保存较好的概念,并有可能确定注意力缺失症的特征。我们需要能够适用于不同文化的认知评估工具,而自由列表任务有可能弥补这一不足。
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引用次数: 0
Cortical Thickness Correlates of Go/No-go and Motor Sequencing in Mild Cognitive Impairment and Suspected Alzheimer Disease Dementia. 轻度认知障碍和疑似阿尔茨海默病痴呆症患者的走/走和运动序列的皮质厚度相关性。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000376
Cierra M Keith, Katharine E Lindberg, Kirk Wilhelmsen, Rashi I Mehta, Camila Vieira Ligo Teixeira, Mark Miller, Melanie Ward, R Osvaldo Navia, William T McCuddy, Liv Miller, Kirk Bryant, Michelle Coleman, Pierre-François D'Haese, Marc W Haut

Background: While the cognitive hallmark of typical Alzheimer disease (AD) is impaired memory consolidation, increasing evidence suggests that the frontal lobes and associated executive functions are also impacted.

Objective: We examined two neurobehavioral executive function tasks and associations with cortical thickness in patients diagnosed with mild cognitive impairment (MCI), suspected AD dementia, and a healthy control group.

Methods: First, we compared group performances on a go/no-go (GNG) task and on Luria's Fist-Edge-Palm (FEP) motor sequencing task. We then examined correlations between neurobehavioral task performance and the thickness of frontal cortical regions, AD signature regions, broader unbiased brain regions, and white matter hyperintensities (WMH).

Results: Participants with MCI performed worse than healthy controls, but better than participants with suspected AD dementia on both tasks. Both GNG and FEP (to a slightly greater extent) tasks showed diffuse associations with most AD signature regions and multiple additional regions within the temporal, parietal, and occipital cortices. Similarly, both tasks showed significant associations with all other cognitive tasks examined. Of the frontal regions examined, only the middle frontal gyrus and pars opercularis were associated with performance on these tasks. Interactions between the precuneus and transtemporal gyri were most predictive of GNG task performance, while the interaction between superior temporal and lingual gyri was most predictive of FEP task performance.

Conclusion: This study replicates difficulties with both GNG and FEP tasks in participants with MCI and AD dementia. Both tasks showed widespread associations with the cortical thickness of various brain structures rather than localizing to frontal regions, consistent with the diffuse nature of AD.

背景:典型阿尔茨海默病(AD)的认知特征是记忆巩固功能受损:虽然典型阿尔茨海默病(AD)的认知特征是记忆巩固受损,但越来越多的证据表明,额叶和相关的执行功能也会受到影响:我们研究了被诊断为轻度认知障碍(MCI)的患者、疑似阿兹海默症痴呆症患者以及健康对照组的两项神经行为执行功能任务及其与皮质厚度的关系:首先,我们比较了各组在 "走/不走"(GNG)任务和卢里亚 "拳锋-手掌"(FEP)运动排序任务上的表现。然后,我们研究了神经行为任务表现与额叶皮质区域厚度、AD特征区域、更广泛的无偏倚脑区和白质高密度(WMH)之间的相关性:MCI患者在两项任务中的表现均不如健康对照组,但优于疑似AD痴呆症患者。GNG和FEP(程度稍高)两项任务均显示出与大多数注意力缺失症特征区域以及颞叶、顶叶和枕叶皮层中的多个其他区域的弥漫性关联。同样,这两项任务与所有其他认知任务也有显著关联。在所研究的额叶区域中,只有额叶中回和厣旁与这些任务的表现相关。楔前回和跨颞回之间的相互作用最能预测 GNG 任务的表现,而颞上回和舌回之间的相互作用最能预测 FEP 任务的表现:本研究重复了 MCI 和 AD 痴呆患者在完成 GNG 和 FEP 任务时遇到的困难。这两项任务都与不同大脑结构的皮质厚度有广泛联系,而不是局限于额叶区域,这与 AD 的弥漫性是一致的。
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引用次数: 0
The Cotard Delusion in a Patient With Neuropsychiatric Systemic Lupus Erythematosus: The Challenges of Autoimmune Psychosis. 神经精神系统性红斑狼疮患者的科塔德妄想症:自身免疫性精神病的挑战。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000375
Alexis García-Sarreón, Angel Escamilla-Ramírez, Yasmin Martínez-López, Kevin A García-Esparza, Nora Kerik-Rotenberg, Jesús Ramírez-Bermúdez

The clinical features of neuropsychiatric systemic lupus erythematosus (NPSLE) are heterogeneous. Furthermore, therapeutic decision-making for NPSLE depends on the recognition of clinical syndromes that have not been sufficiently studied. This report describes the case of a 36-year-old woman with NPSLE who exhibited severe cognitive dysfunction and affective psychosis with persistent nihilistic delusions such as those described in the Cotard delusion. The patient insisted for several months that she was already dead. CSF analysis showed elevated levels of anti-ribosomal P antibodies and a positive determination of oligoclonal bands. Additionally, 18F -FDG PET/CT imaging revealed severe bilateral frontal hypermetabolism suggestive of brain inflammation and occipital hypometabolism. Results from the Systematic Lupus Erythematosus Disease Activity Index 2000 and the Systemic Lupus Erythematosus Disease Activity Score were consistent with an active state of the immunological disease. We then determined by an algorithm that this neuropsychiatric event could be attributed to the activity of the underlying immunological disease. Despite immunosuppressive and symptomatic treatment, only a partial improvement in cognition was achieved. The psychopathological features of the Cotard delusion remained unchanged 4 months after onset. However, we observed rapid remission of affective psychosis and significant improvement in cognition following electroconvulsive therapy. Subsequent follow-up examinations showed a sustained remission. This case describes a protracted form of the Cotard delusion, the diagnostic challenges that arise in the context of SLE, and treatment dilemmas that necessitate collaboration between neurology, psychiatry, and rheumatology.

神经精神系统性红斑狼疮(NPSLE)的临床特征多种多样。此外,非系统性红斑狼疮的治疗决策取决于对尚未得到充分研究的临床综合征的识别。本报告描述了一名36岁女性非系统性红斑狼疮患者的病例,她表现出严重的认知功能障碍和情感性精神病,并伴有持续的虚无主义妄想,如科塔妄想中描述的那些妄想。患者数月来一直坚持认为自己已经死亡。脑脊液分析显示抗核糖体P抗体水平升高,寡克隆抗体阳性。此外,18F-FDG PET/CT 成像显示双侧额叶代谢严重低下,提示脑部炎症和枕叶代谢低下。系统性红斑狼疮疾病活动指数2000和系统性红斑狼疮疾病活动评分的结果与免疫疾病的活动状态一致。然后,我们通过算法确定,这一神经精神事件可归因于潜在免疫疾病的活动。尽管进行了免疫抑制和对症治疗,但患者的认知能力只得到了部分改善。发病 4 个月后,科塔德妄想症的精神病理特征仍未改变。然而,我们观察到,在接受电休克治疗后,情感性精神病迅速缓解,认知能力显著提高。随后的随访检查显示病情持续缓解。本病例描述了科塔德妄想症的一种长期形式、在系统性红斑狼疮背景下出现的诊断难题,以及需要神经内科、精神科和风湿免疫科通力合作的治疗困境。
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引用次数: 0
The Banana Lady and Other Stories of Curious Behavior and Speech. 香蕉夫人和其他奇异言行的故事》。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-09-01 DOI: 10.1097/WNN.0000000000000373
Howard S Kirshner
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引用次数: 0
期刊
Cognitive and Behavioral Neurology
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