Neuropsychiatry, neuropsychology, and behavioral neurology最新文献

Objective: To explore neuroanatomic substrates and cognitive factors associated with erotomania through neuropsychologic test data and neurologic studies.

Background: Erotomania is a delusional disorder that has been examined and conceptualized both clinically and psychodynamically. It is believed that neuroanatomic and neuropsychologic correlates can provide important insights into the causes of erotomania.

Method: Two patients with erotomania and the results of their neuropsychologic testing were examined, and neurologic studies also were examined for one of the patients. These data were compared with case studies from the literature.

Results: Neuropsychologic test results suggested that erotomania may be associated with deficits in cognitive flexibility and associative learning that are mediated by frontal-subcortical systems, and with deficits in verbal and visuospatial skills. Neurologic studies suggested abnormalities in temporal areas.

Conclusions: Visuospatial-functioning deficits or limbic lesions, particularly in the temporal lobes, in combination with isolative and ambivalent romantic experiences, may contribute to misinterpretations in erotomania, and deficits in cognitive flexibility may contribute to the maintenance of the delusional belief.

Background: Alzheimer disease (AD) and vascular dementia (VaD) are the two most common age-associated dementias. Neuropsychologic studies have demonstrated visuoconstructional impairment in AD and in VaD.

Objective: This study used the Rey-Osterrieth Complex Figure to assess and compare specific aspects of visuoconstructional deficits in patients with AD, patients with VaD, and normal age-matched subjects.

Method: Thirteen normal controls, 20 patients with AD, and 20 patients with VaD were given a neuropsychologic battery as part of a comprehensive evaluation for dementia. The groups were similar in age and education, and the VaD and AD groups had comparable levels of dementia. Based on their previous research on visual deficits in AD, the authors devised a new scoring system that divided the Rey-Osterrieth Complex Figure into six perceptual categories: right, left, upper, lower, basic gestalt, and inner detail.

Results: Patients with AD and patients with VaD had significant deficits in all six Rey-Osterrieth Complex Figure scoring categories compared with normal controls. Patients with AD exhibited a pattern of deficits similar to that of patients with VaD, with one significant exception: The patients with AD had increased left-sided errors or inattention.

Conclusions: These results suggest that left hemispatial inattention contributes to impaired performance on visuoconstructional tasks in AD.

Objective: To investigate the accuracy of affective prosodic speech identification of 38 right-handed school-aged boys, half of whom had been classified as having depression and the other half as not having depression.

Background: There is support in the literature for relative right posterior hemisphere dysfunction in patients with depression. The literature also suggests that patients with depression may have difficulty processing receptive affective prosodic speech. Less is known, however, regarding the neuropsychology of depression in children. It was hypothesized that children with depression would demonstrate decreased ability in the identification of affective prosody.

Method: Participants were asked to identify happy, angry, sad, and neutral prosodies within congruent and incongruent verbal statements.

Results: As predicted, the ability of boys with depression to identify congruent and incongruent affective prosody was significantly lower compared with boys without depression.

Conclusion: The results of this experiment are discussed in terms of a right-hemisphere dysfunction model for depression in childhood.

Background: Several studies have demonstrated that patients with right hemisphere damage, when compared with left-hemisphere damaged controls, are impaired at comprehending emotional prosody. Critics of these studies, however, note that selection may have been biased because left-hemisphere-damaged subjects had good verbal comprehension.

Objective: To learn whether a subject with a large left hemisphere stroke and global aphasia could comprehend emotional prosody in spoken material.

Method: The authors formally tested speech and language with the Western Aphasia Battery and comprehension of emotional prosody and emotional facial expression with the Florida Affect Battery.

Results: The patient could not perform verbally mediated tests but demonstrated spared ability to match emotional prosody to emotional facial expressions under a variety of conditions.

Conclusions: These observations further support the idea that verbal and emotional communication systems are independent and mediated by different hemispheres.

Objective: The objective of this study was to determine whether the pathophysiological changes associated with Parkinson's disease (PD) lead to an increased vulnerability to react to negative emotional stimuli and hence to depression. It is hypothesized that nondepressed PD patients will demonstrate, associated with particular PD and/or cognitive variables, vulnerability to the interfering effects of negative words on the Emotional (sad) Stroop task (EST).

Background: Depression has been reported to occur frequently in PD, but there is controversy regarding its pathophysiology: psychosocial factors versus neurobiologic ones.

Method: Thirty nondepressed/ nondemented patients with idiopathic PD attending a specialist movement disorders clinic were assessed from their emotional state (Beck's Depression Inventory [BDI], and Hospital Anxiety and Depression Scale) and from their cognitive state (Mini-Mental State Examination, Stroop tasks [including the EST], Modified Card Sorting Test, Word Fluency tasks, Digit Span, and Trail Making tests). In addition, information was gathered on PD-related variables such as severity (Hoehn and Yahr scale), duration of the disease, and type of motor response to dopaminergic drugs. The sample was split into two groups according to the median BDI score to allow for comparisons. One-way ANOVA techniques were used to look for significant differences between variables in the two groups. Bivariate correlations were used to look for significant relationships between variables in each group.

Results: The two groups only differed in parameters measuring emotional state. Only the subjects with higher BDI scores showed significant correlations between EST performance and cognitive and PD-related variables.

Conclusions: Those PD patients with more severe forms of illness and a greater level of prefrontal cognitive dysfunction are more vulnerable to the distracting effects of external negative stimuli. According to the cognitive model of depression, this may ultimately lead to the development of clinical depression.

Objective: This article reviews research on the main characteristics of mismatch negativity (MMN) and its applications in neuropsychiatry.

Background: Event-related potentials (ERPs) have been used to study many aspects of information processing. Mismatch negativity is an early auditory ERP that has been identified as an index of an automatic (preconscious) alerting mechanism stimulating an individual to attend to unexpected environmental events. Disturbances of MMN may relate to abnormalities of auditory information processing contributing to the pathophysiology of neuropsychiatric conditions.

Method: The authors review (1) studies that have evaluated the electrophysiological aspects of MMN and (2) studies that have investigated the different applications of MMN in neuropsychiatry.

Results: The first part of this article describes the characteristics of MMN, its cerebral origins, and electrophysiological parameters. We then discuss the role of "echoic memory" as well as that of attention and vigilance. In the second part of the article, disturbances in MMN associated with schizophrenia, depressive illness, dementing processes, and other neuropsychiatric states are discussed.

Conclusions: MMN is a preconscious cognitive ERP, the main generators and functions of which are well defined. Observations relating to the origins of MMN and its role in early auditory information processing together with its possible behavioral significance, combined with observations of MMN aberrations in psychiatric conditions, may provide novel insights into the pathophysiology of neuropsychiatric states.

Objective: The goal of this study was to more precisely define the nature of the cognitive processing deficits in the patients with Lyme disease.

Background: Lyme disease has been associated with cognitive disturbances.

Method: Sixteen patients who met the Centers for Disease Control's case definition for Lyme disease and 15 age- and education-matched control subjects completed two computerized assessments. The first was a matching procedure that assessed perceptual/motor speed. The second task was an alphabet-arithmetic (AA) test that measured the speed of mental arithmetic. On the matching task, subjects judged as true or false simple identity equations (e.g., B + 0 = B). On the AA task, subjects indicated the veracity of equations of the same form as those of the matching task but which required mental arithmetic (e.g., A + 3 = D). The use of this paradigm permits sensory or motor slowing to be distinguished from slowed cognitive processing speed. Also, the tests do not involve automated or overlearned responses.

Results: Lyme disease patients and healthy controls did not differ in perceptual/motor speed. However, Lyme disease patients' response times were significantly longer than those of healthy controls during the AA task, demonstrating specific impairments in mental activation speed.

Conclusions: These results suggest that Lyme disease patients show specific deficits when initiating a cognitive process. These impairments are independent of sensory, perceptual, or motor deficits.

Objective: This consecutive multiple case study was designed to determine whether cortical lesion sites can predict occurrence of mood or psychomotor disorders in adults and children.

Background: Most of a large body of research supports the contention that left hemisphere lesions result more often than right ones in depression, and that the inverse occurs in mania. However, it is not clear how psychomotor status fits into this picture, nor whether children respond to the same lesions in a similar manner.

Method: Published (n = 88) and unpublished (n = 31) cases of school-aged child and adult patients with focal unilateral cortical lesions and psychomotor agitation or lethargy with or without corresponding mania or depression were reviewed systematically to determine whether lesion location relates systematically to any of those psychiatric conditions. No patients had symptoms prior to detection of their lesion. Manic-depressives and agitated depressives were also excluded.

Results: Patients with mania and/or psychomotor agitation had predominantly right hemisphere lesions. Postlesion hyperactivity (without mania) in children was common but was not more related to lesions in one or the other hemisphere. Adult and child patients with depression and/or psychomotor lethargy had predominantly left hemisphere lesions. The intrahemispherical site of the lesion did not significantly predict the type of mood or psychomotor disorder. Nevertheless, the nonsignificant trend was for right posterorolandic lesions to predict mania or agitation and for left frontal lesions to predict depression or psychomotor lethargy.

Conclusions: These findings support the neuropsychiatric approach to mood and psychomotor disorder in children and adults.

Objective: In a sample of right-handed adults, volumetric magnetic resonance imaging (MRI) was used to reinvestigate hemispheric and sex-linked differences in Sylvian fissure (SF) morphology.

Background: Asymmetries of the SF exist with a predominant leftward asymmetry consistently reported in postmortem studies. These anatomic asymmetries may reflect asymmetric allocation of adjacent opercula, with some investigators positing a relationship with planum temporale asymmetries, as the postcentral SF is more asymmetric than the anterior segment. Sex-related differences have also been reported with reduced asymmetries in women relative to men.

Method: Using in vivo MRI surface renderings, SF asymmetries were studied in a group of consistently right-handed men (n = 12) and women (n = 12). Anterior and postcentral SF lengths were measured.

Results: Overall, there was a significant leftward asymmetry of the horizontal SF (anterior and postcentral) in men and women. Whereas there was a significant leftward asymmetry of the postcentral SF, there was no significant asymmetry of the anterior SF. There was an increase in the parietal operculum anterior to the posterior ascending ramus (PAR) in the left hemisphere and posterior to the PAR in the right hemisphere when SF asymmetries were leftward, with the length of the anterior parietal operculum positively correlated with postcentral SF length.

Conclusions: These findings demonstrate that the SF is asymmetric but that clear sex-related effects do not exist in consistently right-handed subjects.