Cognitive and Behavioral Neurology最新文献

Background: Facial emotion recognition (FER) deficits in Alzheimer disease (AD) are associated with atypical eye-gaze strategies and exacerbated behavioral and psychological symptoms of dementia (BPSD). This results in increased caregiver burden and impacts social interactions and quality of life.

Objective: To evaluate the effects of Training of Affect Recognition (TAR), a targeted cognitive remediation program, on FER, eye-gaze patterns, and BPSD in individuals with AD, as well as caregiver burden. We hypothesized improvements in emotional processing and associated clinical outcomes.

Methods: Twenty-four patient-caregiver dyads participated in this single-blind randomized controlled pilot study. Each patient was assigned to participate in the TAR program (ie, the AD-TAR group; n = 12) or to receive cognitive stimulation intervention twice weekly for 6 weeks (ie, the AD-CS group; n = 12). We assessed FER using static (n = 24) and dynamic (n = 16) stimuli with eye-tracking. We used the Neuropsychiatric Inventory to assess BPSD and the Zarit Burden Interview to assess caregiver burden. Each assessment was completed at baseline, post-intervention, and 1-month follow-up.

Results: The AD-TAR group showed improvements in static FER accuracy and recognition speed, as well as increased dynamic FER speed. There were concomitant beneficial changes in eye-gaze strategies in static FER and reinforced observation strategies for dynamic FER. Reductions in BPSD and caregiver burden persisted at the 1-month follow-up.

Conclusion: Targeted FER remediation is a promising intervention for improving emotional processing in AD, with potential clinical implications for managing BPSD and enhancing quality of life for individuals with AD and their caregivers.

Background: Evaluation of cognitive health is an important aspect of clinical care for individuals with neurologic and/or psychiatric conditions. To our knowledge, prior studies have not established normative data for cognitive health among adults residing in the Philippines.

Objective: This study aimed to adapt a multidomain cognitive testing protocol optimized for cultural relevance and establish empirically derived normative data adjusted for demographic factors using regression-based methods.

Methods: We recruited healthy Filipino adults ages 18-65 years. Study participants underwent a multidomain cognitive testing protocol examining seven neurocognitive domains. We generated normative scoring systems using regression-based methods using age, sex assigned at birth, level of education, and body mass index as predictors. We defined statistical significance as p<0.05.

Results: Two hundred ninety-six sex-matched participants with a mean age of 40.7 years (SD 12.7) and 10.81 years of education (SD 4.3) completed the multidomain cognitive testing protocol. In all domains, lower age, higher level of education, and female sex were associated with better test performance. For grip strength, male sex and higher body mass index were significantly associated with better performance.

Conclusion: This study provides support for a multidomain cognitive test protocol designed for diverse populations. Furthermore, we established normative data for the clinical interpretation of neurocognitive performance in the Filipino population.

Background: Apathy is a common neuropsychiatric syndrome in neurodegenerative dementias, though its underlying mechanisms are not well understood. It is characterized, in part, by a reduction in self-initiated action (ie, voluntary actions instigated by internal or external stimuli). The sense of agency (SoA) refers to the feeling of control over one's actions and the outcomes of those actions. Experimentally, SoA can be measured using the intentional binding effect, where the perceptual attraction of a voluntary action to an immediate effect of that action is indicative of increased SoA.

Objective: The current study aimed to investigate aberrant SoA as a potential mechanism contributing to apathy.

Method: Thirty-eight participants with mild cognitive impairment or Alzheimer disease, frontotemporal dementia, Lewy body disease or Parkinson disease (LBD/PD), and healthy controls were recruited for this study. We used the total score on the Apathy Evaluation Scale to index apathy severity across participants.

Results: Our results did not show an association between apathy and intentional binding. However, there were significant group-based differences. Compared to healthy controls, participants in the LBD/PD group demonstrated significantly more intentional binding driven by a pronounced perceptual attraction of their actions to the subsequent outcomes.

Conclusion: These findings suggest altered sensorimotor and cognitive control processes that may be associated with the self-initiation deficits seen in individuals with neurodegenerative dementias and apathy.

Background: Unilateral spatial neglect (USN) has been rigorously studied because it significantly affects multiple aspects of life. Research on anosognosia for spatial neglect (ASN), however, is limited.

Objective: To investigate whether the frequency and severity of ASN vary based on task, using items from the Catherine Bergego Scale (CBS) and the Behavioral Inattention Test (BIT).

Methods: Forty-four individuals with initial right hemisphere damage and a positive result on the CBS or BIT were included in the current study. The frequency of ASN was calculated for each item, followed by an analysis of the level of agreement between assessments conducted by the examiner and patient self-assessments using the Kappa coefficient.

Results: The frequency of ASN varied between the CBS (36.0%-74.2%) and the BIT (26.7%-85.7%). On the CBS, the knowledge of left limbs ( k = 0.205), moving (collisions) ( k = 0.184), and finding personal belongings ( k = 0.143) tasks demonstrated significant concordance. Similarly, on the BIT, the letter cancellation ( k = 0.198), star cancellation ( k = 0.143), figure and shape copying ( k = 0.350), and representational drawing ( k = 0.475) tasks showed significant concordance.

Conclusion: These findings suggest that the type of USN and task characteristics may influence the frequency and severity of ASN. Increased awareness of these findings may result in rehabilitation interventions that consider these factors for individuals with USN.

Genetic variants in MSL3 lead to Basilicata-Akhtar syndrome, typically characterized by developmental delay and other multisystem symptoms. Here we report on the neurodevelopmental profile of a 12-year-old female who was diagnosed and followed over a period of years by a multidisciplinary team of clinicians in medical genetics, neurology, neuropsychology, and other specialties. The patient underwent a battery of standardized tests to comprehensively assess her functioning at various ages. She had global developmental delay, pervasive motor weaknesses, and specific concomitant medical issues, but her overall clinical presentation was less severe than that of other individuals with MSL3 syndrome. Since she did not exhibit substantial global impairment, we will discuss the nuances of her neurocognitive profile, including uneven strengths (eg, expressive language, comprehension, problem-solving) and limitations (eg, motor, attention, social, processing speed, learning). We will differentiate between the medical, psychiatric, and neurocognitive functions of a child with this rare condition over time by evaluating her development across several domains. We will also draw comparisons to other individuals with MSL3 syndrome, as well as those with more common conditions. This case report adds to the existing knowledge of MSL3 syndrome, illustrates the importance of serial and detailed assessments, and may assist in treatment planning and management for other individuals with this condition.

Impulsivity and compulsivity are multidimensional transdiagnostic constructs with relevance to neurocognitive and other neuropsychiatric disorders. Broadly, impulsivity is the tendency to react quickly, while compulsivity is the tendency to perform repetitive and contextually inappropriate behaviors. Multiple cortical and subcortical neural pathways, neurotransmitter systems, synaptic plasticity changes, genetic factors, and epigenetic interactions influence decision-making, reward processing, and cognitive control. In this narrative review, we discuss the neural circuitry and disease mechanisms implicated in impulsivity and compulsivity, including emerging evidence of the cerebellum's influence on traditional reward circuitry. We also discuss current and emerging treatments, including neuromodulation targeted to the relevant network abnormalities. This high-level overview of impulsivity and compulsivity from a neurobiological perspective highlights the importance of furthering the understanding of the neural components and circuitry involved. Greater insight into the dynamics that modulate impulsivity and compulsivity may inform new therapeutics.

Background: Perseveration, an inappropriate continuation of a response, is a well-established clinical sign of neurological dysfunction. The shoulder-tapping sign (STS) is a newly described and easily identified motor perseveration.

Objective: Investigate the diagnostic utility of the STS for identifying neurocognitive disorders in patients referred for neuropsychological evaluation.

Method: We administered a five-step verbal command from the Commands subtest of the Boston Diagnostic Aphasia Examination ("Tap each shoulder twice with two fingers keeping your eyes shut") to 400 consecutive patients ( MAGE = 67.3, SD = 10.9) with suspected cognitive decline. The STS sign was considered positive if the patient tapped either shoulder more than twice. The STS was analyzed as a measure of neurocognitive disorder and compared with the final diagnosis. Analysis included calculations of sensitivity, specificity, and positive and negative likelihood ratios with 95% confidence intervals.

Results: The STS was positive in 23% of our sample, 96% of whom met criteria for a neurocognitive disorder. The STS was seen in 38% with dementia, 21% with mild neurocognitive disorder, and 4% with no neurocognitive diagnosis. As a diagnostic marker of neurocognitive disorders, the STS had a specificity of 0.96 and sensitivity of 0.28. Positive and negative likelihood ratios were 6.15 and 0.76, respectively.

Conclusions: The STS is a highly specific indicator of neurocognitive disorders. Despite low sensitivity, the brevity and potential diagnostic yield make it a valuable addition to the cognitive assessment toolkit. When positive, the STS can be a defining feature of neurocognitive disorders in brief mental status examinations.