Cognitive and Behavioral Neurology最新文献

Background: Previous research in cognitive science has focused on the encoding and activation of sensory-based object knowledge in the brain during language comprehension, including aspects such as appearance, movement, and taste.

Objective: To investigate how different object-related attributes affect event-related potentials (ERPs), specifically the N400 component, during word processing in an implicit task setting.

Method: We embedded a set of 420 critical nouns within a list of 2,745 total words and asked 240 participants to read each one, but to respond only to words denoting colors. We categorized each noun by attributes such as familiarity, smell, pain, taste, sound, graspability, and motion. We focused primarily on changes in the N400 component, indicative of semantic processing, across nouns with different attributes.

Results: The least familiar stimuli elicited the strongest N400 response, indicating significant ERP variability across familiarity levels with more positive amplitudes for highly familiar stimuli. Among the attributes examined, only the attribute of smell demonstrated a notable, though isolated, increase in N400 amplitude. Other attributes, including pain, taste, sound, graspability, and visual motion showed no significant differences in N400 responses, suggesting a minimal influence on semantic processing in this context.

Conclusion: These results suggest that the specific sensory attributes of objects have limited influence on the N400 component of ERPs in implicit reading tasks, highlighting the complexity of semantic networks in cognitive processing. The subtlety of ERP modulations driven by object-related attributes points to the need for further exploration into how these attributes interact within semantic networks during cognitive tasks.

Here we present the case of a 56-year-old right-handed White male who developed osteomyelitis and empyema after repetitive compulsive excoriation rituals. His recent history included profound personality changes, apathy, loss of empathy, limited insight, behavioral agitation, and episodic memory loss. In addition to these progressive behavioral deficits, he had significant difficulties with executive functioning, leading to the loss of his job and inability to independently perform instrumental activities of daily living. Brain MRI showed asymmetric enlargement of the right lateral ventricle and mild asymmetric parenchymal volume loss in the right hippocampus. 18 F-FDG PET imaging revealed severe hypometabolism in the right hemisphere. Based on this individual's clinical presentation, reported history, and neuroimaging findings, we concluded that his condition was most consistent with a diagnosis of behavioral variant frontotemporal dementia (bvFTD), rather than another psychiatric diagnosis. This case illustrates the importance of differentiating between bvFTD and other psychiatric disorders, as well as the need for further studies to improve clinicians' ability to do so at earlier stages.

CSF1R-related disorder, a catastrophic neurodegenerative disease, arises from genetic mutations in the colony-stimulating CSF1R. Initial misdiagnosis is common, as demonstrated by this case involving a 52-year-old female who presented with symptoms of limb numbness and weakness. Differential diagnosis first indicated Parkinsonism, lacunar infarction, and cervical spondylosis. Subsequently, however, this patient's clinical presentation evolved to include bradykinesia, cognitive decline, and a spectrum of neurological manifestations. A Pan-V2 assay revealed a heterozygous mutation in the CSF1R gene. Craniocerebral MRI showed cerebral infarctions, lacunar infarctions, and leukoaraiosis. Despite symptomatic treatments, our patient's clinical status continued to decline until her family chose to discontinue further medical interventions. This case underscores the diagnostic complexities of early detection of CSF1R-related disorders. It emphasizes the importance of including leukodystrophy in such differential diagnoses and the need for prompt genetic screening in patients who present with progressive leukoencephalopathy, especially when cerebrospinal fluid analysis is unremarkable.

The dorsomedial prefrontal cortex plays a critical role in movement initiation, and damage to this area can impair this function. Here we present the case of an individual who had difficulty with voluntary initiation of liquid swallowing after surgical removal of a glioblastoma from the right dorsomedial prefrontal cortex. This individual had no difficulty swallowing solids, perhaps because of the additional external movement triggers (eg, chewing) involved. Liquid swallowing involves fewer movement triggers and requires a quicker application of force during the oral propulsive phase when liquids are transferred from the oral cavity to the oropharynx. This individual did not have buccofacial apraxia or apraxia of speech, which are often associated with swallowing apraxia linked to damage in the precentral, premotor, and inferior frontal gyri. To our knowledge, few studies have focused on movement initiation impairments affecting the upper extremities and speech, and cases involving swallowing are notably rare.

Background: Evaluation of sensory functions in chronic stroke survivors is essential to plan and implement effective treatment and rehabilitation.

Objective: To investigate the validity and reliability of the Turkish version of the Revised Nottingham Sensory Assessment (rNSA-T) in chronic stroke survivors.

Methods: We applied the World Health Organization's translation protocols to develop the rNAS-T. We then tested its validity and reliability in 85 chronic stroke survivors using criterion validity and consistency for demographic variables, as well as test-retest and inter-rater reliability analyses.

Results: The criterion validity of the rNSA-T was supported by significant correlation between participants' scores on the rNSA-T, the Katz Index of Independence in Activities of Daily Living (Katz-AD) ( r = 0.430-0.674, P < 0.05), and the Rivermead Motor Assessment (RMA) ( r = 0.528-0.773, P < 0.05). rNSA-T results remained consistent across variables of sex and side affected by stroke ( P > 0.05). The test-retest reliability of the rNSA-T was excellent in all subdimensions (ICC = 0.865-1.000), as was the inter-rater reliability (κ = 0.875-1.000).

Conclusion: The rNSA-T is a valid and reliable tool for evaluation of sensory functions in chronic stroke survivors.

Here we report the case of an individual who developed proper- and common-name anomia with no category specificity, alexia with agraphia for kanji (Japanese morphograms), and mild verbal and semantic memory impairment after unilateral herpes simplex encephalitis. Although their common-name anomia, alexia with agraphia, and semantic memory impairment resolved within 2 years, this individual continued to experience proper-name anomia and verbal memory impairment. Encephalitic damage was limited to the left anterior temporal lobe (ATL), amygdala, hippocampus, and parahippocampal gyrus, sparing the mid-fusiform and posterior inferior temporal gyri. Although ATL lesions are not typically associated with semantic memory impairment, we suggest that damage to the left ATL can result in both proper- and common-name anomia, as was evident in the current case. In these cases, proper-name anomia may be more severe and persistent than common-name anomia, which may be mild and significantly improved within several years. In cases of semantic memory deficits, persistent common-name anomia, and severe alexia with agraphia, there is typically more extensive involvement of the temporal lobe than seen in the current case, including the mid-fusiform and posterior inferior temporal gyri.

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.

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.

The emergence of new-onset neuropsychiatric symptoms in middle age presents a diagnostic challenge, particularly when differentiating between a primary psychiatric disorder and an early neurodegenerative disease. The discrepancy between bedside clinical diagnosis and subsequent neuropathological findings in such cases further highlights the difficulty of accurately predicting pathology, especially when there are no evident focal lesions or changes in brain volume. Here we present the case of a 59-year-old woman with inconclusive neuroimaging who exhibited pronounced neuropsychiatric and behavioral symptoms initially suggestive of a mood disorder, then of behavioral variant frontotemporal dementia. However, upon autopsy, we identified coexisting Lewy body disease pathology and tau-related changes, including argyrophilic grain disease and primary age-related tauopathy. This case illustrates the challenges encountered when diagnosing late-onset neuropsychiatric symptoms, emphasizes the link between such symptoms and early-onset dementia and argyrophilic grain disease, and contributes to our understanding of the impact of mixed neuropathology in this population. Accurate diagnosis is essential for the development of molecular-specific therapies and, as well as for accurate prognosis and enrollment in clinical trials.