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Nonparaneoplastic Anti-GAD Limbic Encephalitis: Seizure Outcome and Long-term Neuropsychological Follow-up After Immunotherapy. 非肿瘤性抗GAD肢体脑炎:癫痫发作结果和免疫治疗后的长期神经心理学随访。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-09-01 DOI: 10.1097/WNN.0000000000000313
Martha Spilioti, Andreas Kiryttopoulos, Theodora Panou, Panagiotis Simos, Haris Alexopoulos, Georgios Karafyles, Triantafillos Geroukis, Ioannis Kalevrosoglou, Vasilios Kimiskidis

Antibodies against glutamate decarboxylase (GAD-Abs), especially GAD65 antibodies, are associated with limbic encephalitis (LE) manifested by temporal lobe epilepsy and neuropsychological deficits. We present the case of a 42-year-old Greek woman with nonparaneoplastic anti-GAD LE, discussing the therapeutic management and highlighting the role of neuropsychological assessment. The patient underwent functional and structural brain studies and was investigated longitudinally over a 6-year period with a battery of neuropsychological tests that were designed to document her intellectual function and verbal and visual memory. The patient suffered from refractory temporal-impaired awareness seizures and memory impairment that was mediated by autoimmune nonparaneoplastic LE and comorbid autoimmune disorders (ie, Hashimoto thyroiditis and vitiligo). Neuroimaging studies demonstrated hyperintensities in the medial temporal lobes bilaterally on T2WI MRI sequences. Serial EEGs showed bitemporal intermittent delta activity as well as epileptiform discharges. Tumor blood markers and onconeural antibodies were negative. Immunological screening revealed extremely high GAD-Abs titers in both serum and CSF, as well as the presence of CSF oligoclonal bands. Neuropsychological testing revealed anterograde amnesia with relative preservation of more remote, premorbid memories. The patient underwent first-line immunotherapy followed by immunosuppressive maintenance treatment that led to a reduction of seizures, EEG improvement, and a significant decline in GAD-Abs titers. Neuropsychological evaluations at 5 months, 1 year, and 6 years posttreatment demonstrated improvement, particularly in recent memory and everyday functionality. In this case of anti-GAD LE, the long-term seizure reduction and the improvement of neuropsychological deficits were most likely related to the immunotherapy.

谷氨酸脱羧酶(GAD-Abs)抗体,尤其是GAD65抗体,与以颞叶癫痫和神经心理缺陷为表现的边缘脑炎(LE)有关。我们报告了一例42岁的希腊妇女,患有非肿瘤性抗GAD LE,讨论了治疗方法,并强调了神经心理评估的作用。该患者接受了功能和结构大脑研究,并在6年的时间里进行了一系列神经心理学测试的纵向调查,这些测试旨在记录她的智力功能以及言语和视觉记忆。患者患有难治性颞叶意识障碍性癫痫发作和记忆障碍,这是由自身免疫性非肿瘤性LE和合并自身免疫性疾病(即桥本甲状腺炎和白癜风)介导的。神经影像学研究显示,T2WI MRI序列显示双侧颞叶内侧高信号。连续脑电图显示双时相间歇性δ活动以及癫痫样放电。肿瘤血液标志物和肿瘤神经抗体均为阴性。免疫学筛查显示血清和CSF中GAD Abs滴度极高,并且存在CSF寡克隆带。神经心理学测试显示顺行性健忘症相对保留了更遥远的病前记忆。患者接受了一线免疫治疗,随后进行免疫抑制维持治疗,导致癫痫发作减少,脑电图改善,GAD Abs滴度显著下降。治疗后5个月、1年和6年的神经心理学评估显示,患者的记忆力和日常功能有所改善。在这种抗GAD LE的情况下,长期癫痫发作的减少和神经心理缺陷的改善很可能与免疫疗法有关。
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引用次数: 0
BNT-15: Revised Performance Validity Cutoffs and Proposed Clinical Classification Ranges. BNT-15:修订的绩效有效性截止值和建议的临床分类范围。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-09-01 DOI: 10.1097/WNN.0000000000000304
Kaitlyn Abeare, Laura Cutler, Kelly Y An, Parveen Razvi, Matthew Holcomb, Laszlo A Erdodi

Background: Abbreviated neurocognitive tests offer a practical alternative to full-length versions but often lack clear interpretive guidelines, thereby limiting their clinical utility.

Objective: To replicate validity cutoffs for the Boston Naming Test-Short Form (BNT-15) and to introduce a clinical classification system for the BNT-15 as a measure of object-naming skills.

Method: We collected data from 43 university students and 46 clinical patients. Classification accuracy was computed against psychometrically defined criterion groups. Clinical classification ranges were developed using a z -score transformation.

Results: Previously suggested validity cutoffs (≤11 and ≤12) produced comparable classification accuracy among the university students. However, a more conservative cutoff (≤10) was needed with the clinical patients to contain the false-positive rate (0.20-0.38 sensitivity at 0.92-0.96 specificity). As a measure of cognitive ability, a perfect BNT-15 score suggests above average performance; ≤11 suggests clinically significant deficits. Demographically adjusted prorated BNT-15 T-scores correlated strongly (0.86) with the newly developed z -scores.

Conclusion: Given its brevity (<5 minutes), ease of administration and scoring, the BNT-15 can function as a useful and cost-effective screening measure for both object-naming/English proficiency and performance validity. The proposed clinical classification ranges provide useful guidelines for practitioners.

背景:缩写神经认知测试提供了一种实用的替代全长测试的方法,但通常缺乏明确的解释指南,从而限制了其临床应用。目的:复制波士顿命名测试简表(BNT-15)的有效性截止值,并引入BNT-15的临床分类系统作为对象命名技能的衡量标准。方法:我们收集了43名大学生和46名临床患者的数据。根据心理测量学定义的标准组计算分类准确性。临床分类范围是使用z评分转换开发的。结果:先前提出的有效性临界值(≤11和≤12)在大学生中产生了可比的分类准确性。然而,临床患者需要更保守的临界值(≤10)来控制假阳性率(敏感性0.20-0.38,特异性0.92-0.96)。作为认知能力的衡量标准,完美的BNT-15分数表明表现高于平均水平;≤11表明有临床意义的缺陷。人口统计学调整的按比例分配的BNT-15 T分数与新开发的z分数密切相关(0.86)。结论:鉴于其简短性(
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引用次数: 9
The Repeatable Battery for the Assessment of Neuropsychological Status, While Useful for Measuring Cognitive Changes in Manifest Huntington Disease, May Show Limited Utility in Premanifest Disease. 用于评估神经心理状态的可重复电池,虽然可用于测量显性亨廷顿舞蹈症的认知变化,但可能在显性前疾病中显示出有限的效用。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-09-01 DOI: 10.1097/WNN.0000000000000310
Andrea I Mustafa, Jody Corey-Bloom, Ilex Beltran-Najera, Chase Snell, Jordan Castleton, Haileigh Smith, Paul E Gilbert

Background: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief, standardized neuropsychological test that assesses several areas of cognitive function. Recent studies, although sparse, have examined the use of the RBANS to detect cognitive deficits in individuals with manifest Huntington disease (HD); however, no studies have investigated its utility to detect cognitive deficits in individuals with premanifest HD (PreHD), where cognitive symptoms are thought to be more subtle.

Objective: To assess cognitive deficits in individuals with HD, particularly in individuals with PreHD, using an easily administered, brief but comprehensive, neuropsychological test.

Method: We administered the RBANS to 31 individuals with HD, 29 individuals with PreHD, and 22 healthy controls (HC) at an academic HD clinical research center and collected RBANS Total, Index, and subtest scores for group comparisons.

Results: The HD group had significantly lower RBANS Total, Index, and subtest scores than the HC. The PreHD group had significantly lower RBANS Total scores and Coding subtest scores than the HC, but no other significant group differences were identified.

Conclusion: Our results substantiate previous findings of significant impairment on the RBANS in individuals with HD. In addition, we are the first to demonstrate that, although the RBANS can identify deficits in psychomotor speed and information processing in individuals with PreHD, it does not appear to have the ability to detect impairment in any additional cognitive domains in individuals with PreHD.

背景:用于评估神经心理状态的可重复电池(RBANS)是一种简短、标准化的神经心理学测试,用于评估认知功能的几个领域。最近的研究虽然很少,但已经检查了使用RBANS来检测明显亨廷顿舞蹈症(HD)患者的认知缺陷;然而,没有研究调查其在检测早产HD(PreHD)患者认知缺陷方面的效用,因为认知症状被认为更为微妙。目的:使用一种简单、简短但全面的神经心理学测试来评估HD患者的认知缺陷,特别是PreHD患者。方法:我们在一家学术性HD临床研究中心对31名HD患者、29名PreHD患者和22名健康对照组(HC)进行了RBANS,并收集了RBANS总分、指数和分测验得分进行组间比较。结果:HD组的RBANS总分、指数和亚测验得分均显著低于HC组。PreHD组的RBANS总分和编码子测验得分显著低于HC组,但没有发现其他显著的组间差异。结论:我们的研究结果证实了先前关于HD患者RBANS显著受损的研究结果。此外,我们率先证明,尽管RBANS可以识别患有PreHD的个体在心理运动速度和信息处理方面的缺陷,但它似乎没有能力检测患有PreHD个体在任何其他认知领域的损伤。
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引用次数: 0
Volumetric Assessment of Hippocampus and Subcortical Gray Matter Regions in Alzheimer Disease and Amnestic Mild Cognitive Impairment 阿尔茨海默病和轻度认知障碍患者海马和皮质下灰质区域的容量评估
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-06-01 DOI: 10.1097/WNN.0000000000000296
Tuğberk Andaç Topkan, Nesrin Erdoğan, Berrak Barutcu, E. Cindil, E. T. Tali, Y. Karaman
Background: Quantitative MRI assessment methods have limited utility due to a lack of standardized methods and measures for Alzheimer disease (AD) and amnestic mild cognitive impairment (aMCI). Objective: To employ a relatively new and easy-to-use quantitative assessment method to reveal volumetric changes in subcortical gray matter (GM) regions, hippocampus, and global intracranial structures as well as the diagnostic performance and best thresholds of total hippocampal volumetry in individuals with AD and those with aMCI. Method: A total of 74 individuals—37 with mild to moderate AD, 19 with aMCI, and 18 with normal cognition (NC)—underwent a 3T MRI. Fully automated segmentation and volumetric measurements were performed. Results: The AD and aMCI groups had smaller volumes of amygdala, nucleus accumbens, and hippocampus compared with the NC group. These same two groups had significantly smaller total white matter volume than the NC group. The AD group had smaller total GM volume compared with the aMCI and NC groups. The thalamus in the AD group showed a subtle atrophy. There were no significant volumetric differences in the caudate nucleus, putamen, or globus pallidus between the groups. Conclusion: The amygdala and nucleus accumbens showed atrophy comparable to the hippocampal atrophy in both the AD and aMCI groups, which may contribute to cognitive impairment. Hippocampal volumetry is a reliable tool for differentiating between AD and NC groups but has substantially less power in differentiating between AD and aMCI groups. The loss of total GM volume differentiates AD from aMCI and NC.
背景:定量MRI评估方法的实用性有限,因为对阿尔茨海默病(AD)和遗忘性轻度认知障碍(aMCI)缺乏标准化的方法和措施。目的:采用一种相对较新的、易于使用的定量评估方法,揭示AD和aMCI患者皮质下灰质(GM)区、海马和整体颅内结构的体积变化,以及海马总体积测量的诊断性能和最佳阈值。方法:74例患者(轻度至中度AD 37例,aMCI 19例,认知正常18例)接受3T MRI检查。进行全自动分割和体积测量。结果:与NC组相比,AD组和aMCI组的杏仁核、伏隔核和海马体积较小。这两组的总白质体积明显小于NC组。与aMCI和NC组相比,AD组的GM总体积较小。阿尔茨海默病组的丘脑出现了轻微的萎缩。两组之间尾状核、壳核或苍白球的体积没有显著差异。结论:AD和aMCI组杏仁核和伏隔核萎缩与海马萎缩相当,可能导致认知功能障碍。海马体积测量是区分AD和NC组的可靠工具,但在区分AD和aMCI组方面的作用要小得多。总GM体积的损失是AD与aMCI和NC的区别。
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引用次数: 0
Neurosyphilis Mimicking Behavioral Variant of Frontotemporal Dementia in a 59-Year-Old Man 神经梅毒模拟59岁男性额颞叶痴呆的行为变异
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-06-01 DOI: 10.1097/WNN.0000000000000299
P. Caroppo, C. Villa, A. Del Sole, G. Bernardi, S. Carradori, P. Tiraboschi, G. Giaccone, Sara Prioni
We present the case of a man exhibiting a clinical phenotype of behavioral variant of frontotemporal dementia (bvFTD). The man had developed psychiatric disturbances with verbal aggressiveness over a few months, followed by cognitive and frontal behavioral disorders, fulfilling the clinical criteria for bvFTD. Atrophy and hypometabolism in frontotemporal regions were consistent with the diagnosis. However, serum-screening exams for syphilis infection were positive, and CSF analysis, despite a negative Venereal Disease Research Laboratory Test, suggested the diagnosis of neurosyphilis. After specific antibiotic therapy, the man’s behavioral abnormalities and cognitive deficits notably improved, confirming neurosyphilis as the cause of the clinical phenotype. The cognitive deficits completely recovered 1 year post therapy and remained stable for 2 years. After ∼2½ years from the first treatment, the man’s behavioral disorders mildly worsened, at which time we re-evaluated him. His cognition was stable, and a positive Venereal Disease Research Laboratory Test confirmed the diagnosis of neurosyphilis. With this case, we demonstrated that in some instances, neurosyphilis can mimic frontotemporal dementia. As a cause of treatable dementia, it should be considered in the differential diagnosis of bvFTD, particularly when psychiatric symptoms and a rapid cognitive decline are noted, even in the presence of brain atrophy and/or hypometabolism.
我们提出的情况下,一名男子表现出临床表型的行为变异额颞叶痴呆(bvFTD)。这名男子在几个月的时间里出现了言语攻击等精神障碍,随后出现了认知和额叶行为障碍,符合bvFTD的临床标准。额颞区萎缩和代谢低下与诊断一致。然而,梅毒感染的血清筛查检查呈阳性,尽管性病研究实验室测试呈阴性,但脑脊液分析提示诊断为神经梅毒。经特异性抗生素治疗后,患者的行为异常和认知缺陷明显改善,证实神经梅毒是临床表型的原因。治疗后1年认知缺陷完全恢复,并保持稳定2年。从第一次治疗开始约2年半后,该男子的行为障碍轻度恶化,此时我们对他进行了重新评估。他的认知能力稳定,性病研究实验室检测阳性,确诊为神经梅毒。在这种情况下,我们证明在某些情况下,神经梅毒可以模仿额颞叶痴呆。作为可治疗的痴呆的原因,在bvFTD的鉴别诊断中应考虑到这一点,特别是当注意到精神症状和认知能力迅速下降时,即使存在脑萎缩和/或代谢低下。
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引用次数: 2
Clinical Screening for Posterior Cortical Atrophy 后皮质萎缩的临床筛查
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-06-01 DOI: 10.1097/WNN.0000000000000297
M. Mendez, Youssef I. Khattab, Oleg Yerstein
Background: Posterior cortical atrophy (PCA) is a progressive neurologic syndrome that presents with complex visual deficits. Although PCA is most commonly a form of Alzheimer disease (AD), its early diagnosis is usually delayed due to a lack of understanding for how best to clinically screen for the syndrome. Objective: To identify neurobehavioral screening tasks for PCA—beyond simple visual constructions—that can be administered in clinic or at bedside. Method: We compared the performance of 12 individuals who met neuroimaging-supported consensus criteria for PCA with that of 12 matched individuals with typical AD (tAD) and 24 healthy controls (HC) on clinic/bedside tasks measuring (a) complex figure copying, (b) Balint syndrome, (c) visual object agnosia, (d) color identification, (e) figure–ground discrimination, (f) global–local processing, (g) dressing apraxia, (h) ideomotor apraxia, and (i) Gerstmann syndrome. Results: All of the individuals with PCA were impaired on the figure–ground discrimination task compared with half of the tAD group and no HC. Approximately half of the PCA group had Balint syndrome, dressing apraxia, and ideomotor apraxia compared with none in the tAD group. Difficulty copying a complex figure, global–local processing impairment, and Gerstmann syndrome did not distinguish between the two dementia groups. Conclusion: The figure–ground discrimination task can be used successfully as an overall screening measure for PCA, followed by specific tasks for Balint syndrome and dressing and limb apraxia. Findings reinforce PCA as a predominant occipitoparietal disorder with dorsal visual stream involvement and parietal signs with spatiomotor impairments.
背景:后皮质萎缩(PCA)是一种进行性神经系统综合征,表现为复杂的视觉缺陷。虽然PCA是最常见的阿尔茨海默病(AD)的一种形式,但由于缺乏对如何最好地临床筛查该综合征的了解,其早期诊断通常会延迟。目的:确定可在临床或床边实施的pca的神经行为筛查任务,而不是简单的视觉结构。方法:我们比较了12名符合神经影像学支持的PCA共识标准的个体与12名匹配的典型AD (tAD)个体和24名健康对照(HC)在临床/床边任务中的表现(a)复杂图形复制,(b) Balint综合征,(c)视觉对象失认症,(d)颜色识别,(e)图形-背景辨别,(f)全局-局部处理,(g)穿衣失用症,(h)意念运动失用症,以及(i) Gerstmann综合征。结果:所有PCA患者在图-底辨别任务上均受损,而一半的tAD组和无HC组。大约一半的PCA组有Balint综合征、穿衣失用症和意念运动失用症,而tAD组没有。复制复杂图形困难、整体-局部处理障碍和Gerstmann综合征并不能区分两组痴呆患者。结论:图-底辨别任务可以成功地作为PCA的整体筛查措施,其次是Balint综合征和穿衣肢体失用症的具体筛查任务。研究结果表明,PCA是一种主要的枕顶叶疾病,伴有背视流受累和空间运动障碍的顶叶症状。
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引用次数: 1
Changes in Cognitive Functioning After Surgical Resection of Language-related, Eloquent-area, High-grade Gliomas Under Awake Craniotomy 清醒开颅手术切除语言相关、雄辩区、高级别胶质瘤后认知功能的变化
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-04-27 DOI: 10.1097/WNN.0000000000000307
Kasra Hendi, Mohamad Rahmani, Amirhossein Larijani, Hamideh Ajam Zibadi, S. Raminfard, R. Shariat Moharari, V. Gerganov, Maysam Alimohamadi
Background: Dominant-hemisphere tumors, especially gliomas, as infiltrative tumors, frequently affect cognitive functioning. Establishing a balance between extensive resection, which is proven to result in longer survival, and less extensive resection, in order to maintain more cognitive abilities, is challenging. Objective: To evaluate changes in cognitive functioning before and after surgical resection of language-related, eloquent-area, high-grade gliomas under awake craniotomy. Method: We provided individuals with newly diagnosed high-grade gliomas of the language-related eloquent areas with the same standard of care, including surgical resection of the glioma using intraoperative sensory-motor and cognitive mapping under awake craniotomy, and the same protocol for chemoradiotherapy. Cognitive functioning was assessed using Addenbrooke’s Cognitive Examination—Revised (ACE–R) at four time points (preoperatively, early after surgery, and 3 and 6 months postoperatively). Results: The preoperative evaluation revealed a range of cognitive impairments in 70.7% of the individuals, affecting all of the cognitive subdomains (mostly attention and visuospatial abilities). Overall cognitive functioning (ie, ACE–R score) dropped by 13.5% (P = 0.169) early postoperatively. At the 3-month evaluation, an average of 15.3% (P = 0.182) recovery in cognitive functioning was observed (mostly in verbal fluency: 39.1%). This recovery improved further, reaching 29% (P < 0.001) at the 6-month evaluation. The greatest improvement occurred in verbal fluency: 68.8%, P = 0.001. Conclusion: Extensive resection of eloquent-area gliomas with the aid of modern neuroimaging and neuromonitoring techniques under awake craniotomy is possible without significant long-term cognitive sequela.
背景:优势半球肿瘤,尤其是胶质瘤,作为浸润性肿瘤,经常影响认知功能。在广泛切除(已被证明可延长生存期)和较少广泛切除(以维持更多认知能力)之间建立平衡是一项挑战。目的:探讨清醒开颅术下语言相关、口才区、高级别胶质瘤切除术前后认知功能的变化。方法:我们为新诊断的语言相关雄辩区高级别胶质瘤患者提供相同的护理标准,包括在清醒开颅下使用术中感觉-运动和认知映射手术切除胶质瘤,以及相同的放化疗方案。在四个时间点(术前、术后早期、术后3个月和6个月)使用Addenbrooke 's Cognitive assessment - revised (ACE-R)评估认知功能。结果:术前评估显示70.7%的个体存在一系列认知障碍,影响所有认知子域(主要是注意力和视觉空间能力)。术后早期整体认知功能(即ACE-R评分)下降13.5% (P = 0.169)。在3个月的评估中,平均15.3% (P = 0.182)的认知功能恢复(主要是语言流畅性:39.1%)。在6个月的评估中,这种恢复进一步改善,达到29% (P < 0.001)。最大的改善发生在语言流畅性上:68.8%,P = 0.001。结论:在清醒开颅下,借助现代神经影像学和神经监测技术广泛切除雄辩区胶质瘤是可行的,且无明显的长期认知后遗症。
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引用次数: 1
Disentangling Reversal-learning Impairments in Frontotemporal Dementia and Alzheimer Disease 额颞叶痴呆和阿尔茨海默病的反向学习障碍
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-04-27 DOI: 10.1097/WNN.0000000000000303
Khadija Ahmed, D. Mitchell, M. Blair, K. Coleman, S. Pasternak, R. Ruiz-Garcia, E. Finger
Background: Individuals with frontotemporal dementia (FTD) often present with poor decision-making, which can affect both their financial and social situations. Delineation of the specific cognitive impairments giving rise to impaired decision-making in individuals with FTD may inform treatment strategies, as different neurotransmitter systems have been associated with distinct patterns of altered decision-making. Objective: To use a reversal-learning paradigm to identify the specific cognitive components of reversal learning that are most impaired in individuals with FTD and those with Alzheimer disease (AD) in order to inform future approaches to treatment for symptoms related to poor decision-making and behavioral inflexibility. Method: We gave 30 individuals with either the behavioral variant of FTD or AD and 18 healthy controls a stimulus-discrimination reversal-learning task to complete. We then compared performance in each phase between the groups. Results: The FTD group demonstrated impairments in initial stimulus-association learning, though to a lesser degree than the AD group. The FTD group also performed poorly in classic reversal learning, with the greatest impairments being observed in individuals with frontal-predominant atrophy during trials requiring inhibition of a previously advantageous response. Conclusion: Taken together, these results and the reversal-learning paradigm used in this study may inform the development and screening of behavioral, neurostimulatory, or pharmacologic interventions aiming to address behavioral symptoms related to stimulus-reinforcement learning and response inhibition impairments in individuals with FTD.
背景:额颞叶痴呆(FTD)患者往往表现出决策失误,这会影响他们的经济和社会状况。在FTD患者中,由于不同的神经递质系统与不同的决策改变模式有关,因此对导致决策受损的特定认知障碍的描述可能会为治疗策略提供信息。目的:使用反向学习范式来识别在FTD患者和阿尔茨海默病患者中受损最严重的反向学习的特定认知成分,以便为未来治疗决策失误和行为灵活性相关症状的方法提供信息。方法:我们给30名患有FTD或AD行为变体的个体和18名健康对照者完成一项刺激-辨别逆转学习任务。然后,我们比较了各组在每个阶段的表现。结果:FTD组在初始刺激联想学习中表现出障碍,尽管程度低于AD组。FTD组在经典的反向学习中也表现不佳,在需要抑制先前有利反应的试验中,在额叶萎缩的个体中观察到最大的损伤。结论:综合来看,这些结果和本研究中使用的反向学习范式可能为行为、神经刺激或药理学干预措施的开发和筛选提供信息,这些干预措施旨在解决FTD患者与刺激强化学习和反应抑制障碍相关的行为症状。
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引用次数: 1
Delirium as a Presenting Symptom of COVID–19 谵妄是新冠肺炎的一种症状-19
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-04-26 DOI: 10.1097/WNN.0000000000000305
Bradley T. Tyson, A. Shahein, L. Erdodi, Leigh Tyson, Robert Tyson, R. Ghomi, P. Agarwal
Background: Delirium is a common neurologic manifestation of coronavirus disease 2019 (COVID–19) in older adults who present to the emergency department (ED). Objective: To investigate clinical characteristics associated with delirium as a presenting symptom of COVID–19 in older adults and develop a logistic regression to predict the likelihood of delirium. Method: We compared clinical characteristics in an age- and gender-matched sample of 68 delirious individuals with 68 nondelirious individuals (Mage = 78) who presented to the ED with COVID–19. Results: The delirious group was more likely to have neurologic, psychiatric, and cardiovascular comorbidities; a prior history of delirium; and deliriogenic medications in their medication list. They were less likely to present with respiratory symptoms and more likely to present with sepsis, hypoxia, higher heart rate, and higher sodium. The delirious group had higher mortality (51%) than the nondelirious group (32%). Delirium developed within an average of 2 days of initial COVID–19 symptom onset, with symptom onset to ED within an average of 4 days and symptom onset to death within an average of 11 days. Logistic regression based on five delirium predictors correctly predicted 80% of those with delirium (75% sensitivity at 86% specificity). Conclusion: Our results are largely consistent with prior studies and suggest that delirium is a common, early occurring, and lethal manifestation of COVID–19 in older adults presenting to the ED, in most cases causing acute on chronic neurocognitive dysfunction strongly influenced by inflammatory and hypoxic–ischemic mechanisms.
背景:谵妄是2019冠状病毒病(COVID-19)在急诊科就诊的老年人中常见的神经系统表现。目的:研究老年人中作为新冠肺炎-19症状的谵妄的临床特征,并开发逻辑回归来预测谵妄的可能性。方法:我们比较了68名年龄和性别匹配的谵妄患者和68名新冠肺炎患者(Mage=78)的临床特征。结果:谵妄组更容易出现神经、精神和心血管合并症;既往有谵妄病史;以及药物清单中的致谵妄药物。他们不太可能出现呼吸道症状,更可能出现败血症、缺氧、心率加快和钠含量升高。谵妄组的死亡率(51%)高于非谵妄组(32%)。Delium在最初的COVID-19症状出现后平均2天内出现,症状出现ED平均4天,症状出现死亡平均11天。基于五个谵妄预测因子的Logistic回归正确预测了80%的谵妄患者(75%的敏感性和86%的特异性)。结论:我们的研究结果与先前的研究基本一致,并表明谵妄是新冠肺炎-19在ED老年人中常见、早期发生和致命的表现,在大多数情况下,会导致急性或慢性神经认知功能障碍,受到炎症和缺氧-缺血机制的强烈影响。
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引用次数: 6
White Matter, Behavioral Neurology, and the Influence of Corticocentrism 白质、行为神经病学与皮质偏心症的影响
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-04-22 DOI: 10.1097/WNN.0000000000000302
C. Filley
White matter in the human brain occupies roughly the same volume as gray matter but has received far less attention in behavioral neurology and related disciplines. In particular, the cerebral cortex has long dominated thinking about the organization of brain–behavior relationships. As a result, subcortical structures, including deep gray matter and, most notably, white matter, have been accorded relatively little neuroscientific study compared with the extensive work devoted to the cerebral cortex. The influence of corticocentrism can be explained by several factors, including historical precedent in neurology strongly emphasizing the importance of the cortex, a preponderance of investigative methods that selectively target this structure, and a misinterpretation of comparative neuroanatomic data gathered from normal brains. This paper will describe the background of the corticocentric bias and emphasize that white matter merits its own place within the study of the higher functions. Although corticocentrism continues to exert a powerful impact on behavioral neurology, considerable progress is being made in the study of white matter—a development that promises to expand our knowledge of the normal brain and lead to an improved understanding of how it mediates behavior. In turn, a range of vexing neurologic and psychiatric disorders may become better illuminated by considering pathology within, or dysfunction of, white matter tracts. A complete appreciation of brain–behavior relationships requires an understanding not only of the outermost layer of the cerebral hemispheres, but also of white matter connectivity that links gray matter regions into distributed neural networks that subserve cognition and emotion.
人脑中的白质与灰质的体积大致相同,但在行为神经学和相关学科中受到的关注要少得多。特别是,大脑皮层长期以来一直主导着对大脑行为关系组织的思考。因此,与专门研究大脑皮层的大量工作相比,皮层下结构,包括深灰质,最值得注意的是白质,得到的神经科学研究相对较少。皮质中心主义的影响可以由几个因素来解释,包括神经病学中强烈强调皮质重要性的历史先例、选择性针对这种结构的研究方法的优势,以及对从正常大脑收集的比较神经解剖学数据的误解。本文将描述皮质中心偏向的背景,并强调白质在高等功能研究中有其自身的地位。尽管皮质中心主义继续对行为神经病学产生强大影响,但白质的研究正在取得相当大的进展——这一进展有望扩大我们对正常大脑的了解,并使我们更好地了解它如何介导行为。反过来,通过考虑白质束内的病理学或白质束功能障碍,一系列令人烦恼的神经和精神疾病可能会得到更好的解释。要完全理解大脑与行为的关系,不仅需要了解大脑半球的最外层,还需要了解白质连接,白质连接将灰质区域连接到为认知和情绪服务的分布式神经网络中。
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引用次数: 1
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Cognitive and Behavioral Neurology
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