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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 Q4 BEHAVIORAL SCIENCES 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
Why We Forget and How to Remember Better: The Science Behind Memory. 为什么我们会忘记以及如何更好地记住:记忆背后的科学。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-12-01 DOI: 10.1097/WNN.0000000000000351
Howard S Kirshner
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引用次数: 0
Longitudinal Imaging in a Patient With Opioid-associated Amnestic Syndrome. 阿片类药物相关AmnesticSyndrome患者的纵向成像。
IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000347
Jed A Barash, Jeremy D Schmahmann, Zhongcong Xie, Michael H Lev, Georges El Fakhri

Since 2012, individuals with a history of opioid misuse have infrequently been observed to develop a sudden-onset amnestic syndrome associated with bilateral hippocampal-restricted diffusion on MRI. Follow-up imaging of this opioid-associated amnestic syndrome (OAS) has revealed persistent hippocampal abnormalities. Given these observations, as well as neuropathological studies demonstrating excessive tau deposition in the hippocampi and other brain regions of individuals with opioid misuse, we describe longitudinal imaging of a patient with a history of OAS from presentation through 53 months later, when tau positron emission tomography (PET) was performed. Our patient was a 21-year-old woman with a history of attention-deficit hyperactivity disorder and substance use disorder, including opioids (intravenous heroin), who was hospitalized for acute-onset, dense anterograde amnesia. Her urine toxicology screen was positive for opiates. On presentation, her brain MRI showed restricted diffusion as well as T2 and fluid-attenuated inversion recovery (FLAIR) hyperintensity of the hippocampi and globi pallidi. On day 3, magnetic resonance spectroscopy of a right hippocampal region of interest showed a mild reduction of N-acetyl aspartate/creatine, slight elevation of choline/creatine, and the appearance of lactate/lipid and glutamate/glutamine peaks. At 4.5 months, there was resolution of restricted diffusion on MRI, although a minimal anterior T2 and FLAIR hyperintense signal in the right hippocampus persisted. However, by 53 months, when mild memory loss was reported, the hippocampi appeared normal on MRI, and [ 18 F]T807 (tau) PET showed no uptake suggestive of tau deposition. This case report supports the investigation into the hypothesis that OAS may follow a trajectory of reversible metabolic injury.

自2012年以来,很少观察到有阿片类药物滥用史的人在MRI上出现与双侧海马受限扩散相关的突发遗忘综合征。阿片类药物相关遗忘综合征(OAS)的随访影像学显示持续的海马异常。鉴于这些观察结果,以及神经病理学研究表明,阿片类药物滥用患者的海马和其他大脑区域存在过量的tau沉积,我们描述了一名有OAS病史的患者从出现到53个月后进行tau正电子发射断层扫描(PET)时的纵向成像。我们的患者是一名21岁的女性,有注意力缺陷多动障碍和物质使用障碍病史,包括阿片类药物(静脉注射海洛因),因急性发作、严重顺行性健忘症住院。她的尿液毒理学检查结果显示鸦片类药物呈阳性。在介绍中,她的大脑MRI显示海马和苍白球的T2和液体衰减反转恢复(FLAIR)高信号扩散受限。第3天,右侧海马感兴趣区域的磁共振波谱显示N-乙酰天冬氨酸/肌酸轻度减少,胆碱/肌酸轻度升高,并出现乳酸/脂质和谷氨酸/谷氨酰胺峰。在4.5个月时,MRI上出现了限制性扩散的消退,尽管右侧海马中持续存在最小的前部T2和FLAIR高信号。然而,到53个月时,当报告轻度记忆丧失时,海马在MRI上显示正常,[18F]T807(tau)PET没有显示提示tau沉积的摄取。该病例报告支持对OAS可能遵循可逆代谢损伤轨迹的假设的调查。
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引用次数: 0
A History of Present Illness. 现病史。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000336
Howard S Kirshner
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引用次数: 0
Differences in Implicit Attitudes in West and East Germans as Measured by the Go/NoGo Association Task and Event-related EEG Potentials. 通过Go/NoGo关联任务和事件相关脑电图电位测量的西德人和东德人内隐态度的差异。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000338
Tobias A Wagner-Altendorf, Arie H van der Lugt, Anna Kroeber, Anna Cirkel, Marcus Heldmann, Thomas F Münte

Background and objective: Implicit social cognition refers to attitudes and stereotypes that may reside outside conscious awareness and control but that still affect human behavior. In particular, the implicit favoritism of an ingroup, to which an individual belongs, as opposed to an outgroup, to which the individual does not belong, characterized as ingroup bias, is of interest and is investigated here.

Method: We used a Go/NoGo association task (GNAT) and behavioral and electroencephalographic (event-related EEG potential [ERP] analysis) measures to investigate the implicit bias toward cities in East Germany, West Germany, and Europe, in 16 individuals each from West and East Germany (mixed gender, M age = 24). The GNAT assesses an individual's Go and NoGo responses for a given association between a target category and either pole (positive or negative) of an evaluative dimension.

Results: Behavioral measures revealed slightly faster reaction times to the combination of European city names and negative, as compared with positive, evaluative words in both groups. ERP analysis showed an increased negativity at 400-800 ms poststimulus in the incongruent conditions of East German city/positive word pairings (in West Germans) and West German city/positive word pairings (in East Germans).

Conclusion: An implicitly moderately negative evaluation of Europe by both groups was exhibited based on the behavioral data, and an increased level of conflict arising from the "incongruent" pairings (ie, as manifestation of an implicitly negative attitude toward East Germany in West Germans, and toward West Germany in East Germans) was exhibited based on the electrophysiological data.

背景和目的:内隐社会认知是指可能存在于意识意识和控制之外,但仍影响人类行为的态度和刻板印象。特别是,与个人不属于的外群体相比,个人所属的内群体的隐性偏袒,被称为内群体偏见,值得关注,并在这里进行了研究。方法:我们使用Go/NoGo关联任务(GNAT)和行为和脑电图(事件相关脑电图电位[ERP]分析)测量来调查来自西德和东德的16名个体(混合性别,M年龄=24)对东德、西德和欧洲城市的内隐偏见。GNAT针对目标类别与评价维度的极点(积极或消极)之间的给定关联,评估个人的Go和NoGo反应。结果:行为测量显示,与两组中的积极评价词相比,对欧洲城市名称和否定词的组合的反应时间略快。ERP分析显示,在东德城市/阳性词配对(在西德)和西德城市/阳性字配对(在东德)的不协调条件下,刺激后400-800ms的负性增加,基于电生理数据,“不协调”配对(即,作为西德人对东德和东德人对西德隐含负面态度的表现)导致的冲突程度增加。
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引用次数: 0
The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration. 冷漠在自发语言和非语言行为中的作用:一项神经变性的跨诊断初步研究。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000345
Kristina S Horne, Amelia Ceslis, Philip Mosley, Robert Adam, Gail A Robinson

Background: Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases.

Objective: To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response).

Method: We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks.

Results: The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring.

Conclusion: Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.

背景:冷漠,以动机或目标导向行为的可量化减少为特征,是在许多神经退行性疾病中观察到的多维综合征。目的:开发一种测量自发行动启动的新任务(即,相当于自发言语任务的非语言任务),并研究冷漠与执行功能(如自愿启动言语和行动以及激活(即发起和维持反应的能力)之间的关系。方法:我们比较了10例神经退行性疾病和临床显著冷漠患者的能量和执行功能表现与年龄匹配的健康对照(HC)。我们还调查了冷漠评估量表(AES)自我报告得分与激励任务表现之间的关系。结果:冷漠个体在新自发行动任务上的任务相关行为显著少于高情商个体,其AES得分与自发任务相关行为呈负相关,为任务的构效度提供了初步证据。此外,无论任务类型或刺激方式如何,冷漠个体在所有激活任务上的表现都比HC表现更差,这表明他们难以长期维持自愿反应。大多数任务也与AES得分呈负相关。然而,冷漠的人在一些执行功能任务上的表现也更差,尤其是那些涉及自我监控的任务。结论:我们的工作提出了一个新的实验任务来测量自发行动启动——冷漠的一个关键症状——并提出了冷漠可能对神经心理缺陷(如能量不足)的贡献。
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引用次数: 0
Altered Allocation of Vertical Attention in Individuals With Autism Spectrum Disorder. 自闭症谱系障碍个体纵向注意力分配的改变。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000342
Alisha J Steigerwald, Bradley J Ferguson, Nanan Nuraini, Joseph C Barnett, Nicole Takahashi, Rachel Zamzow, Kenneth M Heilman, David Q Beversdorf

Background: Typical adults most frequently orient their attention to other people's eyes, whereas individuals with autism spectrum disorder (ASD) orient their attention to other people's mouths. Typical adults also reveal visuospatial biases on tasks such as vertical and horizontal line bisections. Therefore, the difference in face viewing might be related to a more general group difference in the allocation of vertical attention.

Objective: To use vertical line bisection and quadrisection tasks to evaluate whether individuals with ASD have a more downward-oriented vertical attentional bias than do typical individuals.

Method: We recruited 20 individuals with ASD and 20 control participants matched for age (6-23 years), IQ, and sex. We asked the individuals to bisect and quadrisect lines on the top and bottom when the vertical lines were placed at the intersection of their right, left, and center egocentric sagittal planes and their coronal plane. The distances from the true midpoint and quadripoint were measured, and between-group performances were compared.

Results: No significant difference was found between the ASD and control groups for vertical line bisections or lower line quadrisections. However, when the ASD group was compared with the control group for higher line quadrisections, the ASD group exhibited a greater upward deviation.

Conclusion: There is no downward vertical attentional spatial bias associated with ASD that could help to explain these individuals' attentional bias toward the mouth. However, additional studies are required to learn if this atypical upward vertical attentional bias might account for some of the symptoms and signs associated with ASD.

背景:典型的成年人最常将注意力集中在他人的眼睛上,而患有自闭症谱系障碍(ASD)的人则将注意力集中在他人的嘴巴上。典型的成年人在诸如垂直线和水平线平分等任务上也表现出视觉空间偏见。因此,面部观察的差异可能与纵向注意力分配的更普遍的群体差异有关。目的:利用垂直线对分和四边形任务评价ASD个体是否比正常个体有更多的向下定向的垂直注意偏倚。方法:我们招募了20名ASD患者和20名年龄(6-23岁)、智商和性别相匹配的对照组。当垂直线被放置在他们的左、右、中以自我为中心的矢状面和冠状面的交叉处时,我们要求这些人在顶部和底部平分和四边形线。测量到真中点和真四点的距离,并比较组间表现。结果:ASD组与对照组在垂线等分和下线等分上无显著差异。然而,当ASD组与对照组比较更高的线四边形时,ASD组表现出更大的向上偏差。结论:不存在与ASD相关的向下垂直的注意空间偏倚,这可能有助于解释这些个体对嘴的注意偏倚。然而,需要进一步的研究来了解这种非典型的垂直向上的注意力偏向是否可以解释与ASD相关的一些症状和体征。
{"title":"Altered Allocation of Vertical Attention in Individuals With Autism Spectrum Disorder.","authors":"Alisha J Steigerwald,&nbsp;Bradley J Ferguson,&nbsp;Nanan Nuraini,&nbsp;Joseph C Barnett,&nbsp;Nicole Takahashi,&nbsp;Rachel Zamzow,&nbsp;Kenneth M Heilman,&nbsp;David Q Beversdorf","doi":"10.1097/WNN.0000000000000342","DOIUrl":"https://doi.org/10.1097/WNN.0000000000000342","url":null,"abstract":"<p><strong>Background: </strong>Typical adults most frequently orient their attention to other people's eyes, whereas individuals with autism spectrum disorder (ASD) orient their attention to other people's mouths. Typical adults also reveal visuospatial biases on tasks such as vertical and horizontal line bisections. Therefore, the difference in face viewing might be related to a more general group difference in the allocation of vertical attention.</p><p><strong>Objective: </strong>To use vertical line bisection and quadrisection tasks to evaluate whether individuals with ASD have a more downward-oriented vertical attentional bias than do typical individuals.</p><p><strong>Method: </strong>We recruited 20 individuals with ASD and 20 control participants matched for age (6-23 years), IQ, and sex. We asked the individuals to bisect and quadrisect lines on the top and bottom when the vertical lines were placed at the intersection of their right, left, and center egocentric sagittal planes and their coronal plane. The distances from the true midpoint and quadripoint were measured, and between-group performances were compared.</p><p><strong>Results: </strong>No significant difference was found between the ASD and control groups for vertical line bisections or lower line quadrisections. However, when the ASD group was compared with the control group for higher line quadrisections, the ASD group exhibited a greater upward deviation.</p><p><strong>Conclusion: </strong>There is no downward vertical attentional spatial bias associated with ASD that could help to explain these individuals' attentional bias toward the mouth. However, additional studies are required to learn if this atypical upward vertical attentional bias might account for some of the symptoms and signs associated with ASD.</p>","PeriodicalId":50671,"journal":{"name":"Cognitive and Behavioral Neurology","volume":"36 3","pages":"159-165"},"PeriodicalIF":1.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Implications of Moral Neuroscience for Brain Disease: Review and Update. 道德神经科学对脑部疾病的影响:回顾与更新。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000344
Mario F Mendez

The last 2 decades have seen an explosion of neuroscience research on morality, with significant implications for brain disease. Many studies have proposed a neuromorality based on intuitive sentiments or emotions aimed at maintaining collaborative social groups. These moral emotions are normative, deontological, and action based, with a rapid evaluation of intentionality. The neuromoral circuitry interacts with the basic mechanisms of socioemotional cognition, including social perception, behavioral control, theory of mind, and social emotions such as empathy. Moral transgressions may result from primary disorders of moral intuitions, or they may be secondary moral impairments from disturbances in these other socioemotional cognitive mechanisms. The proposed neuromoral system for moral intuitions has its major hub in the ventromedial prefrontal cortex and engages other frontal regions as well as the anterior insulae, anterior temporal lobe structures, and right temporoparietal junction and adjacent posterior superior temporal sulcus. Brain diseases that affect these regions, such as behavioral variant frontotemporal dementia, may result in primary disturbances of moral behavior, including criminal behavior. Individuals with focal brain tumors and other lesions in the right temporal and medial frontal regions have committed moral violations. These transgressions can have social and legal consequences for the individuals and require increased awareness of neuromoral disturbances among such individuals with brain diseases.

在过去的20年里,关于道德的神经科学研究出现了爆炸式增长,这对脑部疾病有着重要的影响。许多研究提出了一种基于直觉情感或情感的神经道德,旨在维持合作的社会群体。这些道德情感是规范性的、义务论的、基于行动的,具有对意向性的快速评估。神经道德回路与社会情绪认知的基本机制相互作用,包括社会知觉、行为控制、心理理论和社会情绪(如共情)。道德越轨可能是由道德直觉的初级障碍引起的,也可能是由这些其他社会情感认知机制的障碍引起的继发性道德障碍。道德直觉的神经道德系统以腹内侧前额叶皮层为主要中枢,并涉及其他额叶区域、前岛叶、颞叶前部结构、右侧颞顶交界处和邻近的颞后上沟。影响这些区域的脑部疾病,如行为变异额颞叶痴呆,可能导致包括犯罪行为在内的道德行为的原发性紊乱。在右侧颞叶和内侧额叶区域有局灶性脑肿瘤和其他病变的个体违反了道德。这些违法行为可能对个人产生社会和法律后果,需要提高对这些患有脑部疾病的人的神经道德障碍的认识。
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引用次数: 0
Event-related Potentials Corresponding to Decision-making Under Uncertain Conditions. 不确定条件下决策的事件相关电位。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-09-01 DOI: 10.1097/WNN.0000000000000346
Danielle C Farrar, Ronald J Killiany, Mark B Moss, Brandi Fink, Andrew E Budson

Background: Decision-making is essential to human functioning, and resolving uncertainty is an essential part of decision-making. Impaired decision-making is present in many pathological conditions, and identifying markers of decision-making under uncertainty will provide a measure of clinical impact in future studies of therapeutic intervention for impaired decision-making.

Objective: To describe EEG event-related potentials (ERPs) correlating with decision-making under uncertain conditions when compared with certain conditions.

Method: We used a novel card-matching task based on the Wisconsin Card Sorting Test to describe the neural correlates of uncertainty, as measured by EEG, in a group of 27 neurotypical individuals. We evaluated 500-ms intervals in the 2 seconds after card presentation to identify ERPs that are associated with maximal uncertainty compared with maximal certainty.

Results: After correcting for multiple comparisons, we identified an ERP in the 500-1000-ms time frame (certain > uncertain, max amplitude 12.73 µV, latency 914 ms) in the left posterior inferior region of the scalp. We also found a P300-like ERP in the left frontal and parietal regions in the 0-500-ms time frame when the individuals received correct versus incorrect feedback (incorrect feedback > correct feedback, max amplitude 1.625 µV, latency 339 ms).

Conclusion: We identified an ERP in the 500-1000-ms time frame (certain > uncertain) that may reflect the resolution of uncertainty, as well as a P300-like ERP when feedback is presented (incorrect feedback > correct feedback). These findings can be used in future studies to improve decision-making and resolve uncertainty on the described markers.

背景:决策对人类的功能至关重要,解决不确定性是决策的重要组成部分。决策受损存在于许多病理条件下,识别不确定性下决策的标记将为未来研究决策受损的治疗干预提供临床影响的衡量标准。目的:比较不确定条件下与确定条件下与决策相关的脑电图事件相关电位(erp)。方法:在威斯康星卡片分类测试的基础上,我们使用了一种新的卡片匹配任务来描述不确定性的神经相关性,通过脑电图测量,在一组27个神经典型个体中。我们在出示卡片后的2秒内评估500毫秒间隔,以识别与最大不确定性和最大确定性相关的erp。结果:经过多次比较校正后,我们在头皮左侧后下区确定了500-1000 ms时间范围内(确定>不确定,最大振幅12.73µV,潜伏期914 ms)的ERP。我们还发现,在0-500 ms的时间范围内,当个体接受正确反馈和错误反馈(错误反馈>正确反馈,最大振幅1.625µV,延迟339 ms)时,左额叶和顶叶区域出现了p300样的ERP。结论:我们发现了500-1000 ms时间框架内(确定>不确定)的ERP可以反映不确定性的解决,以及提供反馈时(错误反馈>正确反馈)的p300样ERP。这些发现可以用于未来的研究,以改善决策和解决所描述的标记的不确定性。
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引用次数: 0
A Selective Hand Posture Apraxia in an Individual With Posterior Cortical Atrophy and Probable Corticobasal Syndrome. 一名患有后皮质萎缩和可能的皮质鼻综合征的患者的选择性手部姿势失调症。
IF 1.4 4区 医学 Q4 BEHAVIORAL SCIENCES Pub Date : 2023-06-01 DOI: 10.1097/WNN.0000000000000339
Tomohiro Omori, Michitaka Funayama, Sachiko Anamizu, Mei Ishikawa, Richi Niida, Hajime Tabuchi

A selective impairment for making hand postures that are required to use specific tools has rarely been reported in individuals with acquired brain injury, and such an impairment has not been documented at all in individuals with degenerative disorders. We describe an individual with posterior cortical atrophy and probable corticobasal syndrome who was unable to use tools because of an inability to make the proper hand posture required for each tool. This individual was, however, able to use the tools properly once her hand postures were corrected, and her ability to manipulate the tools (ie, timing, arm posture, and amplitude) was intact. Also, she had no difficulty with a test of her manipulation knowledge. Areas of hypoperfusion observed by single-photon emission computerized tomography included the anterior intraparietal sulcus in the left parietal lobe, which is an area that has been proposed to control hand postures. This selective impairment might be explained by the reasoning-based hypothesis for apraxia, which attributes hand posture errors in the absence of manipulation errors to dysfunction in one of the three independent pathways that subserve tool use, rather than the manipulation-based hypothesis for apraxia, which attributes hand posture errors to impaired manipulation knowledge. This is the first case with a degenerative disorder that revealed a selective impairment for making hand postures for tool use, which might be explained mainly by apraxia of hand postures along with visuospatial dysfunction (simultanagnosia) and/or sensory disturbance.

在获得性脑损伤患者中,很少有报道称需要使用特定工具才能做出手势的选择性损伤,而在退行性疾病患者中,这种损伤也根本没有记录。我们描述了一名患有后皮质萎缩和可能的皮质基底综合征的患者,他由于无法做出每种工具所需的正确手部姿势而无法使用工具。然而,一旦她的手部姿势得到纠正,并且她操纵工具的能力(即时间、手臂姿势和幅度)完好无损,这个人就能够正确使用工具。此外,她在测试自己的操纵知识方面也没有遇到任何困难。单光子发射计算机断层扫描观察到的低灌注区域包括左顶叶的顶内前沟,这是一个被认为可以控制手部姿势的区域。这种选择性损伤可以用基于推理的失用症假说来解释,该假说将在没有操作错误的情况下的手姿势错误归因于辅助工具使用的三个独立途径之一的功能障碍,而不是基于操作的失用者假说,其将手姿势错误归咎于操作知识受损。这是第一例退行性疾病,显示出对使用工具的手部姿势的选择性损伤,这可能主要是由于手部姿势失用症以及视觉空间功能障碍(同时认知)和/或感觉障碍。
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引用次数: 0
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Cognitive and Behavioral Neurology
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