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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 Q3 Medicine 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
Anatomical Organization of the Amygdala: A Brief Visual Review 杏仁核的解剖组织:视觉简评
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-11 DOI: 10.1097/wnn.0000000000000364
Amauri Dalla Corte, Giulia Pinzetta, Andressa Goldman Ruwel, Taylor Felipe Alves Maia, Theonas Leal, Leonardo Almeida Frizon, Gustavo Rassier Isolan
The amygdala consists of a collection of nuclei that are deep within the medial temporal lobe. Despite its small size, the amygdala is one of the most densely connected structures in the brain, and it plays a role in many superior neural functions, including neurovegetative control, motor control, memory processing, and neuromodulation. Advances in neuroimaging technology for examining brain activity have opened up new ways of understanding the functional contribution of this structure to emotions, learning, and related memories. Many studies have shown that the amygdala plays a key role in the pathophysiology of neuropsychiatric disorders, such as anxiety disorders, depression, aggression, and temporal epilepsy. This article reviews the anatomical structure of the amygdaloid complex and the connectivity among its subdivisions and with other brain structures, which will serve as a basis for understanding the clinical correlations.
杏仁核由一组位于内侧颞叶深处的核组成。尽管杏仁核体积很小,但它是大脑中连接最紧密的结构之一,在许多高级神经功能中起着重要作用,包括神经植物控制、运动控制、记忆处理和神经调节。用于检查大脑活动的神经成像技术的进步,为理解这一结构对情绪、学习和相关记忆的功能贡献开辟了新的途径。许多研究表明,杏仁核在神经精神疾病(如焦虑症、抑郁症、攻击性和颞叶癫痫)的病理生理学中起着关键作用。本文综述了杏仁核复合体的解剖结构及其分支之间以及与其他脑结构之间的连通性,这将为理解临床相关性提供基础。
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引用次数: 0
New Frontier: The First Year of an Adult Neurodevelopmental Disabilities Clinic 新领域:成人神经发育障碍诊所的第一年
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-11 DOI: 10.1097/wnn.0000000000000362
Jessica S. Sanders, Moriah Mabry, Sharon Scarbro, Christopher M. Filley
As patients with neurodevelopmental disorders (NDDs) transition from pediatric to adult health care systems, they often have difficulty finding physicians to address their NDD-related needs. In response to this care gap, we established a new consultation clinic within a behavioral neurology clinic in an adult neurology department to address the neurodevelopmental concerns of these adult patients. To characterize the population of adult patients with NDDs seen in the adult NDD clinic in its first year. Data were obtained by a retrospective chart review of all patients with NDDs seen in the adult NDD clinic from September 2020 through December 2021. Of the 86 patients who were seen in the adult NDD clinic, the average age was 34 years (SD = 15, range = 18–74 years). Developmental diagnoses included intellectual disability (63%), autism spectrum disorder (47%), Down syndrome (15%), cerebral palsy (9%), and other genetic disorders (26%). Comorbidities addressed included behavioral concerns (34%), anxiety (29%), seizure disorders (22%), and depression (15%). Behavioral and/or mental health concerns prompted 65% of the initial clinic visits. The most common recommendation made was to begin or increase exercise (59%), followed by facilitating connection to community, social, and employment resources. Adults with NDDs have diagnoses, comorbidities, and concerns that are similar to, but also distinct from, those addressed in other adult neurology clinics. This study addresses the need for, and feasibility of, caring for the diverse population of adults with NDDs in an adult neurology setting.
随着神经发育障碍(ndd)患者从儿科过渡到成人卫生保健系统,他们往往很难找到医生来满足他们的ndd相关需求。为了弥补这一护理缺口,我们在成人神经科的行为神经病学诊所内建立了一个新的咨询诊所,以解决这些成年患者的神经发育问题。在成人NDD诊所第一年观察到的NDD成人患者的特征。数据是通过对2020年9月至2021年12月在成人NDD诊所看到的所有NDD患者的回顾性图表审查获得的。在成人NDD门诊就诊的86例患者中,平均年龄为34岁(SD = 15,范围= 18-74岁)。发育诊断包括智力障碍(63%)、自闭症谱系障碍(47%)、唐氏综合症(15%)、脑瘫(9%)和其他遗传疾病(26%)。共病包括行为担忧(34%)、焦虑(29%)、癫痫发作(22%)和抑郁(15%)。行为和/或心理健康问题导致65%的初次就诊。最常见的建议是开始或增加锻炼(59%),其次是促进与社区、社会和就业资源的联系。患有ndd的成人的诊断、合并症和关注点与其他成人神经病学诊所的诊断、合并症相似,但又不同。本研究探讨了在成人神经病学环境中护理不同人群ndd患者的必要性和可行性。
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引用次数: 0
Caring for Patients With Functional Neurological Disorder—A New Paradigm 护理功能性神经紊乱患者--新范例
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-11 DOI: 10.1097/wnn.0000000000000361
M. Lopez, Kristen Mordecai, Anna E. Blanken, W. LaFrance
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引用次数: 0
Predictive Ability of Frontal Assessment Battery for Cognitive Improvement After Shunt Surgery in Individuals With Idiopathic Normal Pressure Hydrocephalus. 额叶评估电池对特发性常压脑积水患者分流术后认知改善的预测能力。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000350
Yuki Asahara, Machiko Suda, Shusaku Omoto, Kazushige Kobayashi, Masamichi Atsuchi, Hiroyasu Nagashima, Masahiko Suzuki

Background: The predictive ability of the Frontal Assessment Battery (FAB) for postoperative cognitive improvement in idiopathic normal pressure hydrocephalus (iNPH) is unstudied.

Objective: To compare the predictive ability of the FAB and the Mini-Mental State Examination (MMSE) for postoperative cognitive improvement in individuals with iNPH after shunt surgery.

Method: We retrospectively reviewed the medical records of individuals with iNPH who had shunt surgery between January 2016 and October 2018. Individuals had completed the tap test and clinical evaluations (FAB, MMSE, Timed Up and Go [TUG]) both before and 24-48 hours after CSF tapping and after surgery. We excluded individuals without complete clinical evaluations and those with shunt surgery performed >6 months after CSF tapping. Factors associated with postoperative FAB and MMSE improvement as per the 2011 iNPH guidelines were extracted using univariate and multivariate logistic regression analyses. Independent variables were baseline FAB and MMSE scores, FAB and MMSE score changes and TUG amelioration rate after CSF tapping, Evans index, age, and days from CSF tapping to surgery and from surgery to postoperative assessment.

Results: The mean number of days from CSF tapping to surgery and from surgery to postoperative assessment were 77.5 (SD = 36.0) and 42.0 (SD = 14.5), respectively. Logistic regression analyses showed significant associations in the univariate analyses of postoperative FAB improvement with baseline FAB scores ( P = 0.043) and with FAB score changes after CSF tapping ( P = 0.047).

Conclusion: The FAB may help predict postoperative cognitive improvement after shunt surgery better than the MMSE.

背景:前额叶评估电池(FAB)对特发性常压脑积水(iNPH)术后认知改善的预测能力尚未研究。目的:比较FAB和简易精神状态检查(MMSE)对分流术后iNPH患者术后认知改善的预测能力。方法:回顾性分析2016年1月至2018年10月间接受分流手术的iNPH患者的医疗记录。患者在脑脊液穿刺前、穿刺后24-48小时及手术后完成穿刺试验和临床评估(FAB、MMSE、Timed Up和Go [TUG])。我们排除了没有完整临床评估的个体和在脑脊液穿刺后进行分流手术>6个月的个体。根据2011年iNPH指南,使用单变量和多变量逻辑回归分析提取与术后FAB和MMSE改善相关的因素。自变量为基线FAB和MMSE评分、脑脊液穿刺后FAB和MMSE评分变化和TUG改善率、Evans指数、年龄、从脑脊液穿刺到手术以及从手术到术后评估的天数。结果:从脑脊液穿刺到手术和从手术到术后评估的平均天数分别为77.5天(SD = 36.0)和42.0天(SD = 14.5)。Logistic回归分析显示,单变量分析显示术后FAB改善与基线FAB评分(P = 0.043)和脑脊液穿刺后FAB评分变化(P = 0.047)有显著相关性。结论:FAB比MMSE能更好地预测分流术后的认知改善。
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引用次数: 0
Can the Ability to Recognize Facial Emotions in Individuals With Neurodegenerative Disease be Improved? A Systematic Review and Meta-analysis. 神经退行性疾病患者识别面部情绪的能力可以提高吗?系统回顾和荟萃分析。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000348
Naz Mirzai, Kévin Polet, Adeline Morisot, Solange Hesse, Alain Pesce, Sandrine Louchart de la Chapelle, Galina Iakimova

Background: Facial emotion recognition (FER) is commonly impaired in individuals with neurodegenerative disease (NDD). This impairment has been linked to an increase in behavioral disorders and caregiver burden.

Objective: To identify interventions targeting the improvement of FER ability in individuals with NDD and investigate the magnitude of the efficacy of the interventions. We also wanted to explore the duration of the effects of the intervention and their possible impacts on behavioral and psychological symptoms of dementia and caregiver burden.

Method: We included 15 studies with 604 individuals who had been diagnosed with NDD. The identified interventions were categorized into three types of approach (cognitive, neurostimulation, and pharmacological) as well as a combined approach (neurostimulation with pharmacological).

Results: The three types of approaches pooled together had a significant large effect size for FER ability improvement (standard mean difference: 1.21, 95% CI = 0.11, 2.31, z = 2.15, P = 0.03). The improvement lasted post intervention, in tandem with a decrease in behavioral disorders and caregiver burden.

Conclusion: A combination of different approaches for FER ability improvement may be beneficial for individuals with NDD and their caregivers.

背景:面部情绪识别(FER)通常在神经退行性疾病(NDD)患者中受损。这种损害与行为障碍和照顾者负担的增加有关。目的:确定旨在改善NDD患者生活自理能力的干预措施,并探讨干预措施的有效性。我们还想探索干预效果的持续时间及其对痴呆行为和心理症状以及照顾者负担的可能影响。方法:我们纳入了15项研究,604名被诊断为NDD的个体。确定的干预措施分为三种类型的方法(认知,神经刺激和药理学)以及联合方法(神经刺激与药理学)。结果:三种方法合并对FER能力的改善有显著的效应量(标准平均差:1.21,95% CI = 0.11, 2.31, z = 2.15, P = 0.03)。这种改善在干预后持续存在,同时行为障碍和照顾者负担也在减少。结论:对NDD患者及其照护者来说,联合使用不同的方法来提高FER能力可能是有益的。
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引用次数: 0
Development of a Speech-based Composite Score for Remotely Quantifying Language Changes in Frontotemporal Dementia. 开发一种基于语音的复合评分,用于远程量化额颞叶痴呆患者的语言变化。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000356
Jessica Robin, Mengdan Xu, Liam D Kaufman, William Simpson, Stella McCaughey, Nadine Tatton, Charles Wolfus, Michael Ward

Background: Changes to speech and language are common symptoms across different subtypes of frontotemporal dementia (FTD). These changes affect the ability to communicate, impacting everyday functions. Accurately assessing these changes may help clinicians to track disease progression and detect response to treatment.

Objective: To determine which aspects of speech show significant change over time and to develop a novel composite score for tracking speech and language decline in individuals with FTD.

Method: We recruited individuals with FTD to complete remote digital speech assessments based on a picture description task. Speech samples were analyzed to derive acoustic and linguistic measures of speech and language, which were tested for longitudinal change over the course of the study and were used to compute a novel composite score.

Results: Thirty-six (16 F, 20 M; M age = 61.3 years) individuals were enrolled in the study, with 27 completing a follow-up assessment 12 months later. We identified eight variables reflecting different aspects of language that showed longitudinal decline in the FTD clinical syndrome subtypes and developed a novel composite score based on these variables. The resulting composite score demonstrated a significant effect of change over time, high test-retest reliability, and a correlation with standard scores on various other speech tasks.

Conclusion: Remote digital speech assessments have the potential to characterize speech and language abilities in individuals with FTD, reducing the burden of clinical assessments while providing a novel measure of speech and language abilities that is sensitive to disease and relevant to everyday function.

背景:言语和语言的改变是额颞叶痴呆(FTD)不同亚型的常见症状。这些变化会影响沟通能力,影响日常功能。准确评估这些变化可能有助于临床医生追踪疾病进展并检测对治疗的反应。目的:确定语音的哪些方面随着时间的推移表现出显著的变化,并开发一种新的综合评分来跟踪FTD患者的语音和语言下降。方法:我们招募了FTD患者,以完成基于图片描述任务的远程数字语音评估。对语音样本进行分析,以得出语音和语言的声学和语言学测量,并测试研究过程中的纵向变化,并用于计算新的综合得分。结果:36名(16岁,20岁;Mage=61.3岁)个体被纳入研究,其中27人在12个月后完成了随访评估。我们确定了八个反映语言不同方面的变量,这些变量显示FTD临床综合征亚型的纵向下降,并基于这些变量开发了一种新的综合评分。由此产生的综合得分显示出随时间变化的显著影响、高的重新测试可靠性,以及与各种其他言语任务的标准得分的相关性。结论:远程数字语音评估有可能表征FTD患者的语音和语言能力,减轻临床评估的负担,同时提供一种对疾病敏感并与日常功能相关的语音和言语能力的新测量方法。
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引用次数: 0
Development of Self-made Gestures as an Adaptive Strategy for Communication in an Individual With Childhood Apraxia of Speech. 在儿童言语失调症个体中,发展自制手势作为一种适应性沟通策略。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000354
Michitaka Funayama, Asuka Nakajima

Individuals with childhood apraxia of speech often exhibit greater difficulty with expressive language than with receptive language. As a result, they may benefit from alternative modes of communication. Here, we present a patient with childhood apraxia of speech who used pointing as a means of communication at age 2 ¼ years and self-made gestures at age 3½, when he had severe difficulties speaking in spite of probable normal comprehension abilities. His original gestures included not only word-level expressions, but also sentence-length ones. For example, when expressing "I am going to bed," he pointed his index finger at himself (meaning I ) and then put both his hands together near his ear ( sleep ). When trying to convey the meaning of "I enjoyed the meal and am leaving," he covered his mouth with his right hand ( delicious ), then joined both of his hands in front of himself ( finish ) and finally waved his hands ( goodbye ). These original gestures and pointing peaked at the age of 4 and then subsided and completely disappeared by the age of 7, when he was able to make himself understood to some extent with spoken words. The present case demonstrates an adaptive strategy for communication that might be an inherent competence for human beings.

儿童言语失用症患者在表达语言方面往往比在接受语言方面表现出更大的困难。因此,他们可能受益于其他交流模式。在这里,我们介绍了一名儿童言语失用症患者,他在2¼岁时使用指指点点作为交流手段,在3½岁时使用自制手势,尽管他的理解能力可能正常,但他在说话时有严重困难。他最初的手势不仅包括单词级别的表达,还包括句子长度的表达。例如,当表达“我要睡觉了”时,他用食指指着自己(意思是我),然后双手合十放在耳朵附近(睡觉)。当他试图传达“我很喜欢这顿饭,要走了”的意思时,他用右手捂住嘴(美味),然后双手合在自己面前(完成),最后挥手(再见)。这些最初的手势和指指点点在4岁时达到顶峰,然后在7岁时消退并完全消失,那时他能够通过口语在一定程度上理解自己。本案例展示了一种适应性的沟通策略,这可能是人类固有的能力。
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引用次数: 0
Aranzio's Seahorse and the Search for Memory and Consciousness. 阿兰齐奥的海马和对记忆和意识的探索。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000352
Howard S Kirshner
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引用次数: 0
Toward a Unified Classification System for Brain-Mind Disorders: Putting Calls for Integrated Clinical Neuroscience Into Action. 建立大脑心智障碍的统一分类系统:将整合临床神经科学的呼吁付诸行动。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000353
Michael P H Stanley, David A Silbersweig, David L Perez

Dividing the brain-mind into the specialized fields of neurology and psychiatry has produced many granular advantages, but these silos have imposed barriers to comprehensively understanding and contextualizing the fundamentals governing mental life and its maladies. Scientific inquiry into these fundamentals cannot reach its full potential without interdigitating the boundaries of two specialties of the same organ for both scholarship and clinical practice. We propose that to truly integrate disorders of the brain and the mind for research and clinical care, we must carefully reexamine the classification of its disorders (nosology) as an instrument to develop a coherent pathological and psychological framework. We call on professional organizations from neurology, psychiatry, behavioral neurology, neuropsychiatry, neuropsychology, and other relevant subspecialties (eg, geriatric psychiatry) to convene a multidisciplinary task force to define the current classification principles of their subspecialties and work toward developing an integrated nosology. The effect of a shared classification system, which we acknowledge is a difficult proposition philosophically and politically, would have transformative potential across educational, clinical, scientific, programmatic, and sociocultural realms. If accomplished, this initiative would provide a definitive step toward reducing stigma (and promoting reimbursement parity) for the full spectrum of complex brain disorders (regardless of traditional neurologic vs psychiatric conceptualizations).

将大脑划分为神经病学和精神病学的专业领域产生了许多细微的优势,但这些筒仓阻碍了全面理解和情境化精神生活及其疾病的基本原理。如果不将学术和临床实践中同一机构的两个专业的界限相互交叉,对这些基本原理的科学探究就无法充分发挥其潜力。我们建议,为了真正将大脑和精神疾病整合到研究和临床护理中,我们必须仔细重新审查其疾病的分类(疾病学),将其作为一种工具,以开发一个连贯的病理和心理框架。我们呼吁来自神经病学、精神病学、行为神经病学、神经精神病学、神经心理学和其他相关子专业(如老年精神病学)的专业组织召集一个多学科工作组,以确定其子专业的当前分类原则,并致力于开发一种综合的疾病学。我们承认,共享分类系统在哲学和政治上都是一个困难的命题,其影响将在教育、临床、科学、计划和社会文化领域具有变革潜力。如果这一举措得以实现,将为减少各种复杂大脑疾病的耻辱感(并促进报销平等)(无论传统的神经与精神概念如何)迈出决定性的一步。
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引用次数: 0
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Cognitive and Behavioral Neurology
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