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Biomedical subjects

C Kennard

Publications and source records attributed to C Kennard.

At least 19 recordsLinked to original sources

The functional anatomy of remembered saccades: a PET study.

Studies of patients with damage to the dorsolateral prefrontal cortex (DLPFC) and the basal ganglia have shown that these areas are involved in the control of remembered saccades. However, although positron emission tomography (PET) studies of remembered saccades have demonstrated extensive cortical and subcortical activation, they have failed to detect any significant increase in regional cerebral blood flow (rCBF) in these areas. This study was designed to see if these areas could be activated. Eight right-handed male volunteers were studied using H2(15)O PET. Comparison of the rCBF in the remembered saccade task to a rest control state revealed significant activation in both the DLPFC and the basal ganglia, and also the frontal eye fields, the supplementary motor area, the posterior parietal lobe, the cingulate cortex, the striate cortex, the extrastriate cortex and the superior temporal lobe. These findings confirm that remembered saccades are controlled by an extensive cortical and subcortical network, which includes the DLPFC and the basal ganglia.

Adult

Colour identification and colour constancy are impaired in a patient with incomplete achromatopsia associated with prestriate cortical lesions.

We have examined visual functions, including colour vision, in a patient with bilateral cortical lesions involving mainly the fusiform and lingual gyri, areas known to be involved in the central processing of chromatic stimuli. The patient has near normal (6/9) acuity, and his responses to tests of binocular function and spatial vision are normal, as are his discrimination of changes in target speed and surface lightness. He does, however, exhibit minor losses in the upper visual field, mild prosopagnosia and topographical agnosia, all conditions commonly associated with cerebral achromatopsia. Colour matches and spectral response data establish that his cone photoreceptors have normal spectral characteristics and his spectral sensitivity measured against a white background reveals normal postreceptoral chromatic function. The patient's colour discrimination for differences in wavelength, hue or saturation is, however, impaired and his colour naming is significantly disturbed, particularly for blues and greens. We have determined the areas of the chromaticity chart that correspond to his naming categories for surface colours, and show that changes in illuminant cause him to alter the names of surface colours in a manner consistent with the changes in their chromaticities. Other subjects with normal or congenital red-green deficient colour vision make many fewer name changes under changes in illuminant. We conclude that the patient's colour constancy is impaired as a consequence of abnormal central processing of colour vision.

Cerebral Infarction

Oculomotor function in amyotrophic lateral sclerosis: evidence for frontal impairment.

Saccadic eye movements, fixation, and smooth pursuit were recorded in 17 subjects with amyotrophic lateral sclerosis (ALS) and 11 age-matched controls using a magnetic scleral search coil. Reflexive, remembered and antisaccades, and smooth pursuit at four target velocities were studied. Subjects with ALS showed significantly elevated error rates (distractibility) and latency in the antisaccade and remembered saccade paradigms but no abnormality of reflexive saccades. The frequency of small saccades that intruded on steady fixation (square-wave jerks) was also increased in ALS subjects. Peak velocity gain of smooth pursuit and performance on the Wisconsin Card Sort Test did not differ significantly between the two groups. These findings are consistent with prefrontal dysfunction in ALS and provide an independent source of support for the thesis that the pathology of this condition invades frontal cortex.

Adult

The internal control of action and Parkinson's disease: a kinematic analysis of visually-guided and memory-guided prehension movements.

This paper reports two experiments which examined the effects of Parkinson's disease (PD) upon the sensorimotor mechanisms used to control prehension movements. Transport and grasp kinematics for visually-guided and memory-guided prehension movements were examined in healthy control subjects and compared against those of patients with idiopathic PD. Two research questions were addressed: (1) Are patients with PD particularly susceptible to distraction by non-relevant objects? (2) Are patients with PD especially reliant on external feedback when executing goal-directed actions? The results indicated that the patient group were no more susceptible to distraction by non-relevant objects than the control group. In contrast, the patients with PD were shown to be significantly impaired when executing memory-guided reaches. Furthermore, the deficits exhibited by the PD group on memory-guided reaches were confined solely to those markers associated with the transport component of the prehension movement. That is, while both controls and patients with PD widened their grip aperture on memory-guided trials, the magnitude of this adjustment was comparable across the two groups. The implications of these findings for theories of visuomotor processing in sufferers of PD and the control of prehension movements more generally are discussed.

Aged

Serial reaction time learning and Parkinson's disease: evidence for a procedural learning deficit.

This paper presents evidence in support of a serial reaction time (SRT) deficit associated with Parkinson's disease, and related to the acquisition or execution of serial-order information. Eleven patients with idiopathic Parkinson's disease, and 10 age-matched but otherwise healthy control subjects, were compared on a variant of the SRT task introduced by Nissen and Bullemer (Cognit. Psychol. 19, 1-32, 1987). The results of this study clearly demonstrate that PD patients produce a quite different pattern of RT performance to that of control subjects. Such a pattern of results may reflect either: (1) a deficit in the patients' ability to learn the temporal order information provided by a repeating sequence of target locations in the SRT task; or (2) a deficit in the patients' ability to express temporal order information provided by the repeating sequence of target locations in the SRT task.

Aged

Saccadic abnormalities in psychotic patients. I. Neuroleptic-free psychotic patients.

Most of the previous research reporting abnormalities of rapid re-fixation eye movements (saccades) in patients with schizophrenia has used patients receiving neuroleptic medication. In this study non-neuroleptically medicated schizophrenics were compared with other psychiatric patients using a variety of saccadic paradigms to determine the specificity of saccadic dysfunction. The patient groups consisted of schizophrenics (N = 18), bipolar affectives (N = 18), anxiety neurotics (N = 10) and normal controls (N = 31), none of whom had received neuroleptic medication for the preceding 6 months. Four behavioural paradigms, reflexive, predictive, remembered and ANTI were used to elicit saccades. The primary abnormality in the schizophrenic group was a significantly increased rate of distractibility in the ANTI (saccades made towards the target rather than in an opposite direction) and REM (saccades made prior to the imperative cue) paradigms. The major neuropsychological variable predictive of these errors was Wisconsin card sort perseverative errors. These data, in conjunction with findings from previous neurological research, would seem to provide converging evidence towards dysfunction of prefrontal cortex in schizophrenia.

Adult

Saccadic abnormalities in psychotic patients. II. The role of neuroleptic treatment.

The effects of dopamine-antagonistic neuroleptic (NL) medication on saccadic eye movements were compared in matched groups of 40 NL-treated and 18 NL-free schizophrenic patients and in 18 NL-treated and 14 NL-free bipolar affective patients. Manipulation of the saccadic paradigm yielded data on four types of saccade: those reflexively elicited by novel stimuli (REFLEX saccades), those directed towards the remembered location of a target now extinguished (REM) or towards the location where a predictably alternating target is expected to appear (PRED), or ANTI saccades, directed away from the stimulus to the mirror image location. Extensive psychiatric, neurological and neuropsychological assessments were also carried out on all subjects. The saccades of NL-treated patients, regardless of diagnosis, were less spatially accurate than those of NL-free patients, with a greater tendency to fall short of the target when generated towards the locus of a mentally represented target. This effect was greatest with a predictably alternating target, especially during periods when target visibility was withdrawn, only a temporal cue remaining. This pattern of impairment which is also found in early stages of Parkinson's disease is likely to be due to deficiency of striatal dopamine. Its best clinical predictors were disease duration, and Webster-Parkinsonism scores. Failure to suppress reflexive saccades to the stimulus in the REM and ANTI paradigms were more closely associated with schizophrenia than with NL treatment and were best predicted by negative symptoms and Wisconsin perseverative errors, both of which are widely regarded as indicators of frontal lobe dysfunction.

Adult

Responses to temporal visual stimuli in migraine: the critical flicker fusion test.

Reports of sensitivity to striped patterns and to flickering lights are not uncommon in migraineurs. Only recently, however, have objective methods been used to assess the visual sensitivity of these patients, with emphasis on their responses to spatial stimuli; responses to temporal information have been largely neglected on an experimental level. The "critical flicker fusion" (CFF) test was performed by 25 migraineurs with aura, 25 migraineurs without aura, and 25 control subjects. The CFF test is a quick, simple technique which provides information concerning the temporal responsiveness of the visual system; a sensitivity threshold is measured. A significant group difference between the migraineurs without aura and the control subjects emerged (p = 0.01). Control subjects had the highest CFF threshold, migraineurs with aura the next highest, and migraineurs without aura the lowest threshold.

Adult

An effect of structured backgrounds on smooth pursuit eye movements in patients with cerebral lesions.

The oculomotor smooth pursuit system is driven by the slip of the target image upon the retina arising from errors in matching eye and target velocities. However, pursuit of an object moving against a structured background causes most retinal flow to be in the direction opposite to target movement. Central mechanisms allow these distracting signals to be overridden effortlessly. To isolate the anatomical substrate of this capacity we studied the effect of the presence of a structured background upon smooth pursuit in 26 patients with focal cerebral lesions. In normal control subjects, studies confirmed that a background has little effect upon pursuit. Eye movements were recorded by the scleral search coil method or by infra-red oculography. The target was a bright spot moving horizontally in a triangular waveform of amplitude +/- 11.25 degrees visual angle, at either 10, 20, 30 or 36.5 degrees/s. Data were collected in darkness and with a structured background: 14 patients showed a significant reduction of gain with a structured background, while the remaining 12 showed little or no effect. Comparison of the location of the cerebral lesions in these two groups suggested that lesions in the inferior parietal cortex (area 40) or in white matter containing parieto-frontal connections result in disruption of pursuit in the presence of a background.

Adult

Eye movements.

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Electronystagmography

Abnormal refractoriness in patients with Parkinson's disease after brief withdrawal of levodopa treatment.

Two pairwise matched groups of patients with mild to moderate Parkinson's disease and a group of normal age matched controls were used to investigate the effects on simple and choice reaction time (RT) of brief withdrawal of levodopa therapy. Comparisons within and across these groups disclosed a selective effect of levodopa withdrawal. After about 12 hours of levodopa deprivation, patients exhibited an exaggeration of normal refractoriness, the well established tendency for RT to increase progressively as the delay between a response and the next imperative signal is reduced below 0.5 s. Increased refractoriness was at least as great for simple as choice RT. Choice RT on trials involving repetition (as opposed to alternation) of the previous response, however, showed no tendency towards greater impairment by brevity of the recovery period or by withdrawal of medication, eliminating an effector based account. With longer recovery periods, RT was unaffected by medication; indeed, unmedicated patients were as fast as normal subjects under these conditions. Even at the briefest delays, fully medicated patients did not differ from normal controls. The paper concludes with a critical review of chronometric studies of medication effects in Parkinson's disease.

Analysis of Variance

Repetitive paroxysmal nystagmus and vertigo.

A 55-year-old woman had paroxysms of vertigo and visual blurring associated with complex combined torsional, horizontal, and vertical nystagmus. These episodes occurred regularly at 2-minute intervals, each attack lasting for 15 seconds. Between attacks, there was a much finer asymptomatic nystagmus whose components were in the opposite direction to those associated with the paroxysmal attacks. A brain MRI revealed an arteriovenous malformation in close proximity to the left vestibular nucleus, with evidence of previous bleeding. Caloric testing demonstrated a left-sided vestibular paresis. We suggest that neurons in this patient's damaged left vestibular nucleus are usually underactive but regularly produce pathologic brief bursts of hyperactivity causing episodic reversal and gross exacerbation of her resting nystagmus. Treatment with low-dose carbamazepine was successful in abolishing both the paroxysms of nystagmus and the symptoms of vertigo and visual disturbance.

Arteriovenous Malformations

Residual colour vision in a human hemianope: spectral responses and colour discrimination.

We present data for a patient, GY, with a right hemianopia caused by traumatic damage to the left occipital cortex. Previous studies have established that this patient has residual vision which enables him to detect and localize transient stimuli presented to his 'blind' hemifield. We have now examined spectral responses associated with this residual vision by using two-colour incremental threshold methods to measure II-spectral functions, and a white light background to examine spectral data for 'colour-opponent' characteristics. We report that both methods yield normal spectral response characteristics for GY's 'blind' hemifield. We have also investigated the patient's ability to identify, verbally, coloured stimuli presented to his 'blind' hemifield, and found that, in 'forced choice' experiments, he achieves a high proportion of correct responses to large stimuli. The patient reported that in threshold detection measurements his responses were based on the presence or absence of a percept associated with transient light stimulation of the 'blind' hemifield (residual vision), whereas colour naming was achieved without conscious perception of colour ('blindsight').

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