Neuropsychiatry, neuropsychology, and behavioral neurology最新文献

Objective: To assess relations between discrete visual perceptual functions commonly affected in patients with neurodegenerative dementia and the performance of instrumental activities of daily living (IADL).

Background: Neuropsychologic measures are often used to predict IADL performances in dementia patients. Prior studies have focused on the contribution of higher-level memory and executive deficits to IADL. The relation between visuoperceptual dysfunction and IADL has not been studied systematically.

Methods: Thirty-five elderly patients with neurodegenerative disorders, most diagnosed with probable Alzheimer disease, participated. Patients completed tasks tapping visual perceptual functions believed to be mediated by occipital lobe structures (shape discrimination), posterior inferotemporal regions (face, object form, and written word discrimination), and the dorsolateral parietal lobe (spatial localization). A knowledgeable caregiver rated IADL performance.

Results: Object form discrimination, but not other visual perceptual functions, correlated significantly ( = 0.60) with performances of visually based IADL (e.g., misjudging distances, driving, and recognizing familiar people), but not with other IADL, when the variance attributable to dementia severity, language disturbance, and other visual perceptual abilities was controlled.

Conclusions: In contrast to prior investigations that have focused primarily on relations of memory and executive control deficits with IADL in neurologically impaired patients, the results of this study highlight the important contribution of bilateral inferotemporal visual perceptual systems for the performance of IADL in elderly patients with neurodegenerative dementia.

Objective: To report about a patient with Huntington disease (HD) in combination with obsessions who was successfully treated with a selective serotonin reuptake inhibitor.

Background: Obsessive compulsive disorder (OCD) has rarely been reported in association with HD, and little is known about the treatment of patients with OCD symptoms and HD.

Methods: We describe a 42-year-old woman who experienced isolated obsessive thoughts about killing her neighbor 10 years after the onset of her genetically confirmed HD.

Results: Sertraline was prescribed at a daily dose of 150 mg with a complete remission of obsessive ideas within 4 weeks of treatment.

Conclusions: The basal ganglia are known to play an important role in the pathogenesis of OCD and HD. Thus, it is conceivable that a degeneration of the caudate nucleus as in HD may also account for obsessive and compulsive symptoms in this disorder. To our knowledge, this is the first report about a patient with HD in combination with obsessions alone who was successfully treated with a selective serotonin reuptake inhibitor. However, the association of OCD with HD warrants further systematic evaluation.

Objective: To determine the mediating effects of developmental instability on individual differences in response to caffeine.

Background: Individual variation of drug effects might reflect broad genomic factors as well as the direct effects of specific alleles. The current study tested the hypothesis that individual differences in developmental instability, in part determined by genomic characteristics, would predict individual variation in the magnitude of caffeine-induced verbal memory deficits. Minor physical anomalies and fluctuating asymmetry were used as measures of developmental instability.

Method: One hundred participants were (1) administered one version of the Rey Auditory Verbal Learning Test; (2) given a dose of caffeine determined by body weight (3 mg/kg); (3) assessed for minor physical anomalies and fluctuating asymmetry; and (4) given an alternate randomized version of the Rey Auditory Verbal Learning Test.

Results: Consistent with predictions, a composite measure of developmental instability predicted the magnitude of caffeine-induced memory decrements.

Conclusions: These results may have important implications for the genetic underpinnings of individual differences in drug effects.

Objective: The purpose of this study was to examine negative symptoms (NSs) in patients with major depressive disorder (MDD) and their relation to depressive symptoms (DSs) and other psychiatric symptoms.

Background: Features similar to NSs were previously described in patients with depression.

Method: The Hamilton Rating Scale for Depression (HRSD), Positive and Negative Symptom Scale (PANSS), Scale for the Assessment of Negative Symptoms (SANS), and Mini-Mental State Examination were administered to 23 patients with MDD and 10 normal control subjects.

Results: As expected, the mean scores of the HRSD, SANS, and negative symptom subscale of the PANSS of the patients with MDD were significantly higher than those of control subjects, validating the clinical significance of NSs as well as DSs in MDD patients. Within the MDD group, although measures of NSs were intercorrelated, there were no other correlations between the measures. Thus, measures of NSs and DSs were not intercorrelated. When the HRSD was divided in two subscales, HRSD negative symptom subscale scores but not HRSD depressive symptom subscale scores were correlated with PANSS negative symptom subscale and SANS total scores as well as with scores on the affective flattening subscale.

Conclusions: These results suggest a high level of NSs in patients with MDD, which are distinct from positive symptoms of depression and may constitute a distinct dimension. Negative symptoms and DSs in MDD may represent separate constructs. Further, the HRSD might have possible subscales in MDD as it does in schizophrenia.

Objective: The current investigation examines the impact of a past history of alcoholism on neurologic examination abnormalities in schizophrenia (SZ).

Background: Individuals with SZ have a high rate of comorbid alcohol use disorders (AUDs), but relatively little is known about the potential adverse consequences of alcoholism for neuropsychological and neurologic functioning in SZ. Recent evidence suggests consistent but subtle neurocognitive differences between groups, with more prominent differences in neurologic examination abnormalities.

Method: Thirty-three male patients with SZ or SZ/AUDs were evaluated using a modified Neurologic Evaluation Scale (NES) and ratings for positive and negative symptoms.

Results: The SZ/AUD group exhibited a greater impairment in the Cognitive-Perceptual factor of the Neurologic Evaluation Scale. Greater impairment in the tandem-Romberg factor or in motor items was not found, nor were groups different based on positive or negative symptoms.

Conclusions: A history of alcoholism in SZ is associated with greater overall neurologic impairment, particularly in the area of cognitive-perceptual dysfunction, an area often found to be impaired in patients with schizophrenia without alcoholism.

Objective: We hypothesized that the distinctive neurobiology of Alzheimer disease (AD) with psychosis would be reflected in more severe abnormalities in frontal and temporal regions on quantitative electroencephalography (QEEG).

Background: Patients with AD and psychosis have more rapid cognitive decline and greater pathologic involvement of frontal and temporal cortex than AD patients without psychotic features.

Method: We evaluated brain function using QEEG in a group of 44 patients who had a diagnosis of probable or possible AD. All patients were administered the Mini-Mental State Examination and the Neuropsychiatric Inventory to assess psychiatric symptoms, including the presence of hallucinations and delusions. Absolute and relative power in patients with and without psychosis were compared to determine if there were regional or global QEEG differences in these two groups.

Results: Patients with psychosis showed greater overall absolute and relative delta power but no regional predominance of slowing compared with those without psychosis. Those with psychosis had a concomitant decrease in relative alpha power. These differences remained after adjustment for different dementia severity in the two groups.

Conclusions: This finding suggests more severe brain dysfunction in patients with psychosis than in those with similar levels of cognitive impairment but without psychosis. The QEEG abnormalities were not regionally specific and involved all areas assessed.

Objective: The purpose of this study was to examine the relations between depression, psychomotor retardation, and negative symptoms in schizophrenia as well as the specific contribution of each of these factors to memory impairment.

Background: It has been suggested that depression overlaps with negative symptomatology in schizophrenia. The relation between psychomotor retardation and negative symptomatology has been unclear.

Method: The Hamilton Depression Rating Scale, The Positive and Negative Symptom Scale for Schizophrenia, and Scale for the Assessment of Negative Symptoms were used to assess depressive and negative symptomatology in a sample of patients with schizophrenia. Verbal memory performance was assessed by a free recall test. Two indices of processing speed were measured. Correlations among variables were computed.

Results: Depression score was correlated with the avolition item from the Scale for the Assessment of Negative Symptoms and with both measures of processing speed. Negative symptomatology was unrelated to processing speed. Memory performance was correlated with depression score, slowing of processing speed, and avolition. Its correlation with depression score and processing speed remained significant when the other factors were partialled out.

Conclusions: Memory performance in schizophrenia may be affected by lack of motivation, psychomotor retardation, and depression. It is suggested that negative symptoms could be split between a volitional component linked to depression and cognitive efficiency and an emotional component unrelated to them.

Objective: This technical report and feasibility study propose a standardized method for collecting neuropsychological data in patients undergoing the deep brain stimulation (DBS) procedure.

Background: Programs for standardizing motor data collected in studies investigating surgical therapies for Parkinson disease are already widely used (e.g., Core Assessment Program for Intracerebral Transplantations). The development and rationale for the proposed Program for Neuropsychological Investigation of Deep Brain Stimulation (PNIDBS) are outlined, and support for the feasibility of these methodologies is provided via preliminary data.

Method: The PNIDBS includes a core battery of neuropsychological tests that assesses a wide range of cognitive functions (attention, language, visuospatial, memory, and executive) as well as depression. Using the PNIDBS, three Parkinson disease and two dystonia patients were evaluated at baseline and after surgery, once with stimulation off and once with stimulation on.

Results: Patients with severe motor disabilities were able to complete the PNIDBS. These preliminary data suggest that the DBS procedure as a whole had a minimal impact on cognitive functioning in most patients studied. There was also some evidence that the one patient who showed cognitive decline after the DBS procedure had demographic and clinical characteristics that may have put him at risk for this decline.

Conclusions: The procedures in the PNIDBS were systematically developed and are feasible to execute. The relatively brief core battery has multiple versions and can be supplemented to meet individual investigator needs. By evaluating the components of the DBS procedure (electrode placement and stimulation), the PNIDBS can address clinical questions regarding the cognitive effects of the DBS procedure as well as investigate basic scientific issues regarding how different cognitive functions are affected when subcortical-prefrontal circuits are manipulated by the DBS procedure.