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Promoting Growth in Behavioral Neurology: A Path Forward. 促进行为神经学的发展:前进之路。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-06-01 DOI: 10.1097/WNN.0000000000000368
James R Bateman, Sylvia Josephy-Hernandez, Liana G Apostolova, Sheldon Benjamin, A M Barrett, Bradley F Boeve, Andrew E Budson, Zeina Chemali, Chi-Ying R Lin, Kirk R Daffner, Michael D Geschwind, Kenneth M Heilman, Argye E Hillis, Samantha K Holden, Michael S Jaffee, Isaiah Kletenik, Marissa Natelson Love, Lauren R Moo, Victoria S Pelak, Daniel Z Press, Liliana Ramirez-Gomez, Howie J Rosen, Jeremy D Schmahmann, Sanjeev N Vaishnavi, Charles C Windon, Roy H Hamilton, David L Perez

Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand. In this commentary, we provide a brief history of BNNP followed by an outline of the current challenges and opportunities for BNNP from the behavioral neurologist's perspective across clinical, research, and educational spheres. We provide a practical guide for promoting BNNP and addressing the shortage of behavioral neurologists to facilitate the continued growth and development of the subspecialty. We also urge a greater commitment to recruit trainees from diverse backgrounds so as to dismantle persistent obstacles that hinder inclusivity in BNNP-efforts that will further enhance the growth and impact of the subspecialty. With rapidly expanding diagnostic and therapeutic approaches across a range of conditions at the intersection of neurology and psychiatry, BNNP is well positioned to attract new trainees and expand its reach across clinical, research, and educational activities.

行为神经学和神经精神病学(BNNP)是一个试图了解大脑与行为关系的领域,包括基本的大脑组织原理,以及大脑结构和连通性可能被破坏,从而导致行为、认知、情感、感知和社会认知异常的多种方式。在北美,自 2006 年以来,神经病学亚专科联合委员会已将神经病学亚专科列为一个综合亚专科。尽管如此,学术医学中心和社区机构中行为神经学家的数量仍跟不上日益增长的临床和研究需求。在这篇评论中,我们简要介绍了 BNNP 的历史,然后从行为神经学家的角度概述了 BNNP 目前在临床、研究和教育领域面临的挑战和机遇。我们为推广 BNNP 和解决行为神经学家短缺问题提供了实用指南,以促进该亚专科的持续增长和发展。此外,我们还呼吁加大力度招募来自不同背景的受训人员,以消除阻碍 BNNP 包容性的顽固障碍--这些努力将进一步促进该亚专科的发展和影响。随着神经病学和精神病学交汇处一系列病症的诊断和治疗方法的迅速扩展,BNNP 已做好充分准备吸引新学员并扩大其在临床、研究和教育活动方面的影响力。
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引用次数: 0
Investigating the Link Between Subjective Depth Perception Deficits and Objective Stereoscopic Vision Deficits in Individuals With Acquired Brain Injury. 研究后天性脑损伤患者主观深度知觉缺陷与客观立体视觉缺陷之间的联系。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-06-01 DOI: 10.1097/WNN.0000000000000369
Michitaka Funayama, Tomohito Hojo, Yoshitaka Nakagawa, Shin Kurose, Akihiro Koreki

Individuals with acquired brain injury have reported subjective complaints of depth perception deficits, but few have undergone objective assessments to confirm these deficits. As a result, the literature currently lacks reports detailing the correlation between subjective depth perception deficits and objective stereoscopic vision deficits in individuals with acquired brain injury, particularly those cases that are characterized by a clearly defined lesion. To investigate this relationship, we recruited three individuals with acquired brain injury who experienced depth perception deficits and related difficulties in their daily lives. We had them take neurologic, ophthalmological, and neuropsychological examinations. We also had them take two types of stereoscopic vision tests: a Howard-Dolman-type stereoscopic vision test and the Topcon New Objective Stereo Test. Then, we compared the results with those of two control groups: a group with damage to the right hemisphere of the brain and a group of healthy controls. Performance on the two stereoscopic vision tests was severely impaired in the three patients. One of the patients also presented with cerebral diplopia. We identified the potential neural basis of these deficits in the cuneus and the posterior section of the superior parietal lobule, which play a role in vergence fusion and are located in the caudal region of the dorso-dorsal visual pathway, which is known to be crucial not only for visual spatial perception, but also for reaching, grasping, and making hand postures in the further course of that pathway.

后天性脑损伤患者曾报告过深度知觉障碍的主观主诉,但很少有人接受过客观评估来确认这些障碍。因此,目前缺乏有关后天性脑损伤患者主观深度知觉障碍与客观立体视觉障碍之间相关性的详细报告,尤其是那些有明确病变的病例。为了研究这种关系,我们招募了三名后天性脑损伤患者,他们在日常生活中都有深度知觉障碍和相关的困难。我们对他们进行了神经学、眼科学和神经心理学检查。我们还让他们进行了两种立体视觉测试:霍华德-多尔曼式立体视觉测试和拓普康新客观立体测试。然后,我们将测试结果与两个对照组进行了比较:一个是大脑右半球受损组,另一个是健康对照组。三名患者在两项立体视觉测试中的表现均严重受损。其中一名患者还出现了大脑复视。我们在楔叶和顶叶上部后段发现了这些缺陷的潜在神经基础,它们在会聚融合中起作用,位于背-背视觉通路的尾部区域,众所周知,背-背视觉通路不仅对视觉空间感知至关重要,而且在该通路的进一步过程中对伸手、抓握和做出手的姿势也至关重要。
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引用次数: 0
A Pilot Study of the Convergent and Discriminant Validity of the Dutch Version of the Parametric Go/No-Go Task. 荷兰语版 "去/不去 "参数任务的收敛性和区分性试点研究。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-06-01 DOI: 10.1097/WNN.0000000000000363
Joan E van Horn, Anna van der Schoot, Julia Wilpert, Hessel J Engelbregt, Nico Brand

Background: The parametric go/no-go (PGNG) task is a computerized task that is designed to measure cognitive flexibility, response inhibition, and working memory. The PGNG task has been shown to measure core executive functions (EFs) in a psychometrically sound, brief, and ecologically valid manner.

Objective: To analyze the psychometric properties of the Dutch version of the PGNG task in a convenience sample of nonclinical adults.

Method: The sample consisted of 74 highly educated adults, with an average age of 36 years. Forty-two participants completed test battery A to investigate the task's convergent validity; 36 participants completed test battery B to investigate the task's discriminant validity. The results were analyzed using a repeated-measures ANOVA, Friedman's test, paired-samples t test, and correlation analyses.

Results: Level 3 of the PGNG task places increased demands on sustained attention, response inhibition, and set-shifting. Several moderate correlations between level 3 and a complex EFs measure supported the convergent validity of this level of the PGNG task. The convergent validity of levels 1 and 2 was not supported. No significant correlations were found between PGNG levels and non-EF tests, supporting discriminant validity.

Conclusion: Our study included a rather homogenous sample of highly educated participants, which might explain the convergent validity of level 3 of the Dutch version of the PGNG task. Hence, to overcome these potentially confounding factors, the Dutch version of the PGNG task should be investigated in a larger and more heterogeneous population in terms of age and educational level.

背景介绍参数去/不去(PGNG)任务是一项计算机化任务,旨在测量认知灵活性、反应抑制和工作记忆。PGNG 任务已被证明能以心理计量学上可靠、简短和生态学上有效的方式测量核心执行功能(EFs):在非临床成年人样本中分析荷兰语版 PGNG 任务的心理测量特性:样本由 74 名受过高等教育的成年人组成,平均年龄为 36 岁。42 名参与者完成了 A 测试单元,以研究任务的收敛效度;36 名参与者完成了 B 测试单元,以研究任务的区分效度。测试结果采用重复测量方差分析、弗里德曼检验、配对样本 t 检验和相关分析进行分析:结果:PGNG 任务的第 3 级对持续注意、反应抑制和集合转换的要求更高。第 3 级任务与复杂 EFs 测量之间的一些中等相关性支持了该级 PGNG 任务的收敛有效性。而第 1 级和第 2 级的收敛有效性则得不到支持。PGNG水平与非EF测试之间没有发现明显的相关性,这支持了判别效度:我们的研究包括了一个受过高等教育的相当单一的样本,这可能是荷兰语版 PGNG 任务第 3 级的收敛有效性的原因。因此,为了克服这些潜在的干扰因素,荷兰版 PGNG 任务应在年龄和教育水平方面更具异质性的人群中进行调查。
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引用次数: 0
Barriers to the use of Methylphenidate in Pediatric Neuro-oncology Services. 儿童神经肿瘤服务中使用哌甲酯的障碍。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-06-01 DOI: 10.1097/WNN.0000000000000357
Alexander J Hagan, Simon Bailey, Sarah J Verity

Background: Survivors of childhood CNS tumors are at a significant risk of chronic and multifaceted neurocognitive late effects. Recent findings indicate the potential utility of methylphenidate in addressing neurocognitive and academic plateauing and improving quality-of-life outcomes in this clinical population. However, the prescription of methylphenidate in neuro-oncology services remains inconsistent.

Objective: To explore the neurocognitive assessment and rehabilitative interventions (including the use of methylphenidate) offered to survivors of childhood CNS tumors within mainland UK.

Method: We used a semi-structured questionnaire to gather qualitative data from clinical psychologists and neuropsychologists within National Health Service pediatric neuro-oncology principal treatment centers (PTCs) during May 2018. Thematic analytical methods were used to explore themes within the collected data.

Results: Eleven (58%) of the 19 PTCs returned the completed questionnaire. Respondents reported inadequate resource of psychology in many pediatric neuro-oncology PTCs, which limited the provision of methylphenidate to a restricted proportion of the patient group (i.e., those with the most profound neurocognitive difficulties). Respondents reported an interest in exploring the utility of methylphenidate in their patient group yet described a lack of appropriate evidence of its efficacy. In addition, respondents highlighted the need for the provision of accessible research summaries and treatment protocols addressing the use of methylphenidate.

Conclusion: We anticipate that national collaboration between clinicians and researchers working in the cancer survivorship field will support the advancement of interventions such as methylphenidate for the growing clinical population of survivors of childhood CNS tumors.

背景:儿童中枢神经系统肿瘤的幸存者具有慢性和多方面神经认知晚期影响的显著风险。最近的研究结果表明,哌甲酯在解决该临床人群的神经认知和学术停滞以及改善生活质量方面具有潜在的效用。然而,神经肿瘤服务中哌甲酯的处方仍然不一致。目的:探讨英国大陆儿童中枢神经系统肿瘤幸存者的神经认知评估和康复干预措施(包括哌甲酯的使用)(PTC)。专题分析方法用于探讨收集数据中的专题。结果:19例PTC中有11例(58%)返回了完整的问卷。受访者报告称,在许多儿科神经肿瘤学PTC中,心理学资源不足,这将哌甲酯的提供限制在患者组的有限比例(即那些有最严重神经认知困难的患者)。受访者表示有兴趣探索哌甲酯在其患者群体中的效用,但缺乏适当的疗效证据。此外,答复者强调,有必要提供可查阅的研究摘要和治疗方案,以解决哌甲酯的使用问题。结论:我们预计,从事癌症生存领域工作的临床医生和研究人员之间的国家合作将支持哌甲酯等干预措施的发展,以应对儿童中枢神经系统肿瘤幸存者的临床增长。
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引用次数: 0
Consciousness: How Our Brains Turn Matter Into Meaning. 意识:我们的大脑如何将物质转化为意义。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-06-01 DOI: 10.1097/WNN.0000000000000367
Howard S Kirshner
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引用次数: 0
The Covenant of Water. 《水的盟约》。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-03-01 DOI: 10.1097/WNN.0000000000000360
Howard S Kirshner
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引用次数: 0
Progress in Primary Progressive Aphasia: A Review. 原发性进行性失语症的研究进展:综述。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-03-01 DOI: 10.1097/WNN.0000000000000365
Andrew Kertesz, Elizabeth Finger, David G Munoz

We present a review of the definition, classification, and epidemiology of primary progressive aphasia (PPA); an update of the taxonomy of the clinical syndrome of PPA; and recent advances in the neuroanatomy, pathology, and genetics of PPA, as well as the search for biomarkers and treatment. PPA studies that have contributed to concepts of language organization and disease propagation in neurodegeneration are also reviewed. In addition, the issues of heterogeneity versus the relationships of the clinical phenotypes and their relationship to biological, pathological, and genetic advances are discussed, as is PPA's relationship to other conditions such as frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, Pick disease, and amyotrophic lateral sclerosis. Arguments are presented in favor of considering these conditions as one entity versus many.

我们对原发性进行性失语症(PPA)的定义、分类和流行病学进行了综述;对 PPA 临床综合征的分类进行了更新;对 PPA 的神经解剖学、病理学和遗传学的最新进展以及生物标志物和治疗方法的研究进行了综述。此外,还回顾了对神经变性中的语言组织和疾病传播概念做出贡献的 PPA 研究。此外,还讨论了异质性与临床表型的关系及其与生物学、病理学和遗传学进展的关系等问题,以及 PPA 与其他疾病(如额颞叶痴呆症、皮质基底变性、进行性核上性麻痹、皮克病和肌萎缩侧索硬化症)的关系。本文提出了支持将这些疾病视为一个实体而非多个实体的论点。
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引用次数: 0
Poststroke Executive Function in Relation to White Matter Damage on Clinically Acquired CT Brain Imaging. 脑卒中后执行功能与临床CT脑成像白质损伤的关系。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-03-01 DOI: 10.1097/WNN.0000000000000355
Georgina Hobden, Margaret Jane Moore, Grant Mair, Sarah T Pendlebury, Nele Demeyere

Background: Executive function (EF) impairments are prevalent post stroke and are associated with white matter (WM) damage on MRI. However, less is known about the relationship between poststroke EF and WM damage on CT imaging.

Objective: To investigate the relationship between poststroke EF and WM damage associated with stroke lesions and WM hypointensities (WMHs) on clinically acquired CT imaging.

Method: This study analyzed data from the Oxford Cognitive Screening Program, which recruited individuals aged ≥18 years with a confirmed stroke from an acute stroke unit. The individuals completed a follow-up assessment 6 months post stroke. We included individuals with a CT scan showing a visible stroke who completed follow-up EF assessment using the Oxford Cognitive Screen-Plus rule-finding task. We manually delineated stroke lesions and quantified then dichotomized WM damage caused by the stroke using the HCP-842 atlas. We visually rated then dichotomized WMHs using the Age-Related White Matter Changes Scale.

Results: Among 87 stroke survivors (M age = 73.60 ± 11.75; 41 female; 61 ischemic stroke), multivariable linear regression showed that stroke damage to the medial lemniscus ( B = -8.86, P < 0.001) and the presence of WMHs ( B = -5.42, P = 0.005) were associated with poorer EF 6 months post stroke after adjusting for covariates including age and education.

Conclusion: Poorer EF was associated with WM damage caused by stroke lesions and WMHs on CT. These results confirm the importance of WM integrity for EF post stroke and demonstrate the prognostic utility of CT-derived imaging markers for poststroke cognitive outcomes.

背景:执行功能(EF)损伤在中风后普遍存在,并与MRI上的白质(WM)损伤有关。然而,关于脑卒中后EF和WM损伤之间的关系,在CT成像上知之甚少。目的:探讨脑卒中后EF与脑卒中病变相关的WM损害及临床CT表现的WM低强度(WMHs)的关系。方法:本研究分析了牛津认知筛查项目的数据,该项目从急性卒中单位招募了年龄≥18岁的确诊卒中患者。受试者在中风后6个月完成了随访评估。我们纳入了CT扫描显示可见中风的个体,他们使用Oxford Cognitive Screen Plus规则查找任务完成了后续EF评估。我们手动描绘了中风病变,并使用HCP-842图谱对中风引起的WM损伤进行量化,然后进行二分法。结果:87例脑卒中幸存者(Mage=73.60±11.75;41例女性;61例缺血性脑卒中)中,多变量线性回归显示,在校正了包括年龄和教育程度在内的协变量后,卒中后6个月,内侧丘系的损伤(B=-8.86,P<0.001)和WMH的存在(B=-5.42,P=0.005)与EF较差有关。结论:EF较差与脑卒中病变引起的WM损伤和CT上的WMH有关。这些结果证实了WM完整性对脑卒中后EF的重要性,并证明了CT衍生的成像标记物对脑卒中认知结果的预后效用。
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引用次数: 0
Barriers to Alzheimer Disease Clinical Trial Participation in a Minority Population. 少数群体参与阿尔茨海默病临床试验的障碍。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-03-01 DOI: 10.1097/WNN.0000000000000359
Anson Y Lee, Julia R Jahansooz, Darrell Guittu, Rexton Suzuki, Lauren Pak, Kyle M Ishikawa, Connor Goo, John J Chen, Enrique Carrazana, Jason Viereck, Kore K Liow

Background: Alzheimer disease (AD), the most common neurodegenerative disorder in the United States, disproportionately burdens minority populations.

Objective: To explore barriers to AD clinical trial participation by Asian and Native Hawaiian patients diagnosed with AD or mild cognitive impairment.

Method: We surveyed 187 patients with a Mini-Mental State Examination score ≥14 between January 2022 and June 2022. The score cutoff for clinical trial eligibility was set by the institution. Individuals also completed a 15-question telephone survey that assessed demographics, barriers to clinical trial participation, and clinical trial improvement methods.

Results: Forty-nine patients responded, with a response rate of 26%. Asian and Native Hawaiian patients were less likely than White patients to participate in AD trials. The main barrier to participation was a lack of information about AD trials. Providing additional information regarding AD trials to patients and family members were listed as the top two reasons patients would consider participating in a clinical trial.

Conclusion: Insufficient information about AD clinical trials is the primary barrier to participation among Asian and Native Hawaiian patients, followed by difficulty coordinating transportation and, in the case of Asians, the time required for clinical trials. Increased outreach, education, and assistance with logistics in these populations should be pursued to improve rates of participation in clinical trials.

背景:阿尔茨海默病(AD)是美国最常见的神经退行性疾病,给少数群体带来了不成比例的负担。目的:探讨被诊断为AD或轻度认知障碍的亚裔和夏威夷原住民患者参与AD临床试验的障碍。方法:我们调查了2022年1月至2022年6月期间187名迷你精神状态检查得分≥14的患者。临床试验资格的分数线由该机构设定。个人还完成了一项15个问题的电话调查,评估了人口统计学、临床试验参与障碍和临床试验改进方法。结果:49名患者有反应,有效率为26%。亚裔和夏威夷原住民患者参与AD试验的可能性低于白人患者。参与的主要障碍是缺乏有关AD试验的信息。向患者及其家属提供有关AD试验的额外信息被列为患者考虑参加临床试验的两大原因。结论:关于AD临床试验的信息不足是亚洲和夏威夷原住民患者参与的主要障碍,其次是难以协调交通,对于亚洲人来说,临床试验所需的时间也很长。应加强对这些人群的宣传、教育和后勤援助,以提高临床试验的参与率。
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引用次数: 0
Cognitive Intra-individual Variability in the Laboratory Is Associated With Greater Executive Dysfunction in the Daily Lives of Older Adults With HIV. 实验室中的认知个体内变异性与艾滋病毒感染老年人日常生活中更大的执行功能障碍有关。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2024-03-01 DOI: 10.1097/WNN.0000000000000358
Natalie C Ridgely, Steven Paul Woods, Troy A Webber, Andrea I Mustafa, Darrian Evans

Background: Executive dysfunction, which is common among persons with HIV (PWH), can have an adverse impact on health behaviors and quality of life. Intra-individual variability (IIV) is a measure of within-person variability across cognitive tests that is higher in PWH and is thought to reflect cognitive dyscontrol.

Objective: To assess whether cognitive IIV in the laboratory is associated with self-reported executive dysfunction in daily life among older PWH.

Method: Participants included 71 PWH aged ≥50 years who completed six subtests from the Cogstate battery and two subscales from the Frontal Systems Behavior Scale (FrSBe; self-report version). Cognitive IIV was calculated from the Cogstate as the coefficient of variation derived from age-adjusted normative T scores.

Results: Cognitive IIV as measured by the Cogstate showed a significant, positive, medium-sized association with current FrSBe ratings of executive dysfunction but not disinhibition.

Conclusion: Higher cognitive IIV in the laboratory as measured by the Cogstate may be related to the expression of HIV-associated symptoms of executive dysfunction in daily life for older PWH.

背景:执行功能障碍在HIV感染者中很常见,它会对健康行为和生活质量产生不利影响。个体内变异性(IIV)是衡量认知测试中个体内变异的指标,在PWH中更高,被认为反映了认知功能障碍。目的:评估实验室中的认知IIV是否与老年PWH自我报告的日常生活中的执行功能障碍有关。方法:参与者包括71名年龄≥50岁的PWH,他们完成了Cogstate电池组的6个子测验和额叶系统行为量表(FrSBe;自报版)的2个子测验。认知IIV是根据Cogstate计算的,作为根据年龄调整的标准T评分得出的变异系数。结果:Cogstate测量的认知IIV与当前执行功能障碍的FrSBe评分有显著、积极、中等程度的相关性,但与去抑制无关。结论:Cogstate测量的实验室中较高的认知IIV可能与老年PWH在日常生活中执行功能障碍的HIV相关症状的表达有关。
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引用次数: 0
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Cognitive and Behavioral Neurology
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