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Biomedical subjects

S E Black

Publications and source records attributed to S E Black.

At least 19 recordsLinked to original sources
PubMed1992

Acoustic analysis in the differentiation of Parkinson's disease and major depression.

In its early stages, Parkinson's disease (P.D.) may be difficult to distinguish from major depression (M.D.) leading to inappropriate management. Both illnesses are characterized by psychomotor retardation. The neurovegetative symptoms used to diagnose M.D. are not specific and in P.D. may be due to the physical illness itself. Currently, differentiation of the two disorders relies on subjective clinical observation. Improved diagnostic accuracy based on more objective data is needed. To this end, this study used computerized acoustic analysis to contrast speech patterns in P.D. and M.D. The sample consisted of 30 P.D. patients without depression or dementia, 30 patients with uncomplicated M.D., and 31 normal controls, each 60 years of age or over. Of the acoustic variables studied, M.D. patients had significantly reduced rates of speech compared with P.D. patients. The data suggest that this temporal measure of speech may be useful in the differentiation of P.D. and M.D.

Aged↗
PubMed1992

Anatomical asymmetries and functional laterality.

Anatomical and functional asymmetries were measured using MRI and dichotic, visual field and hand performance laterality tasks in 104 normal right- and left-handed male and female adults. Comprehensive linear and area measures showed consistently larger brains when handedness and language laterality were in the same direction. Right-handers with left cerebral dominance for dichotic listening and left-handers with right cerebral dominance had larger structures. Hand performance was the strongest functional laterality related to anatomical asymmetries. Left hemisphere dominance on this task was associated with larger right frontal and left occipital widths. Dichotic listening or visual field laterality alone was not associated with contralaterally larger temporal, parietal or occipital measurements. Left visual field dominance for reading, interacting with right-handedness, was associated with wider left parietal width. The complex associations between anatomical and functional asymmetries contribute to individual differences in cerebral organization. The demonstrated association of coincident hand performance and language laterality measures with larger anatomical structures may confer biological advantage. Morphometric analysis in vivo may have increasing importance in interpreting behaviour.

Adult↗
PubMed1992

Methodological problems with diagnosis of dementia in community surveys: the choice of items to study higher functions.

The 'global' character of dementia distinguishes it from other organic syndromes but in community surveys memory impairment is the predominant early symptom and the aphasia, apraxia and agnosia triad characteristic of dementia of Alzheimer type disease (DAT) may be hard to demonstrate. Both the Mini-Mental State (MMS) and CAMDEX contain appropriate items but information about how elderly persons in general perform on these tests is limited. This paper examines the relative difficulty of the items in a general practice sample and compares their sensitivity and specificity taking AGECAT organic diagnosis as criterion.

Aged↗
PubMed1991

Posterior cortical dementia with alexia: neurobehavioural, MRI, and PET findings.

A progressive disorder of relatively focal but asymmetric biposterior dysfunction is described in a 54 year old right handed male. Initial clinical features included letter-by-letter alexia, visual anomia, acalculia, mild agraphia, constructional apraxia, and visuospatial compromise. Serial testing demonstrated relentless deterioration with additional development of transcortical sensory aphasia, Gerstmann's tetrad, and severe visuoperceptual impairment. Amnesia was not an early clinical feature. Judgment, personality, insight, and awareness remained preserved throughout most of the clinical course. Extinction in the right visual field to bilateral stimulation was the sole neurological abnormality. Early CT was normal and late MRI showed asymmetrical bioccipitoparietal atrophy with greater involvement of the left hemisphere. Results from positron emission tomography (PET) showed bilaterally asymmetric (left greater than right) occipitotemporoparietal hypometabolism. The metabolic decrement was strikingly asymmetric with a 50% reduction in glucose consumption confined to the left occipital cortex. The picture of occipitotemporoparietal compromise verified by MRI, PET, and neurobehavioural testing would be unusual for such degenerative dementias as Alzheimer's (AD) and Pick's disease, although atypical AD with predominant occipital lobe involvement cannot be excluded. This case supports the concepts of posterior cortical dementia (PCD) as a clinically distinct entity and for the first time documents its corresponding metabolic deficit using PET.

Atrophy↗
PubMed1991

The diagnosis of dementia in the elderly. A comparison of CAMCOG (the cognitive section of CAMDEX), the AGECAT program, DSM-III, the Mini-Mental State Examination and some short rating scales.

The performance of CAMCOG, the cognitive section of the CAMDEX, is compared in a non-random sample of 222 elderly people with diagnoses based on AGECAT and on DSM-III criteria, and with the MMSE and some short rating scales. With a cut-off point of 69/70 and AGECAT organic syndrome as the criterion, the sensitivity of CAMCOG was 97% and the specificity 91%. However, 21% of DSM-III diagnoses of dementia scored above this cut-off; these were mostly mild cases. The correlation between CAMCOG and MMSE scores was 0.87, and the advantage of CAMCOG may be more apparent in longitudinal studies. Multivariate analyses showed that CAMCOG scores are affected by age, sociocultural factors and hearing and visual deficits in addition to dementia, but not by depression. There was a suggestion that individual subsections are differentially affected.

Aged↗
PubMed1990

Sex, handedness, and the morphometry of cerebral asymmetries on magnetic resonance imaging.

Cerebral morphometry of linear measurements and hemispheric, frontal, temporal and parietal areas on MRI of 104 normal adults was analyzed for sex and handedness and right-left differences. The right hemisphere was significantly larger across all groups, but the left frontal width and area was larger in left handers. MANOVA showed separate effects of hand and sex for linear measures; right-handers had larger right anterior frontal, and left parietal and occipital widths. Ratios of L - R/L + R eliminated sex differences related to overall brain size, however, a significant sex-by-hand interaction was shown by the parietal area ratios, indicating larger left side in right-handed males and left-handed females. A 3-dimensional 'torque' was postulated, where the upper and rostral portions of the hemispheres were larger on the right and the lower and caudal parts equal, or slightly larger on the left. The relationship of anatomical asymmetries, sex and handedness is multi-dimensional, and may explain some of the variability of normal cognitive functions and deficits after brain damage.

Adolescent↗
PubMed1990

The evolution of pure alexia: a longitudinal study of recovery.

This case report documents the partial recovery, over a 12-month period, of pure alexia in an adult female following a left occipital infarction. Measures of speed and accuracy were obtained on an oral reading and a lexical decision task immediately postonset and then on 10 subsequent occasions. Explicit letter-by-letter reading was observed only during the first week poststroke but a significant effect of word length was seen in all testing sessions. Reading accuracy was relatively good at all stages and reading latency showed a remarkable decrease over time but did not reach normal reading rates. The inability to use higher-order orthographic knowledge, as manifest in the absence of a word superiority effect, was still noted at one year postonset. We therefore concluded that the change in behavior was attributable to increased proficiency in the use of the adaptive letter-by-letter procedure rather than to the resolution of the underlying deficit. It is suggested that longitudinal neurobehavioral studies add to our understanding of the alexic deficit and provide insight into the recovery process.

Adult↗
PubMed1990

Prevalence rates of dementia in an ageing population: are low rates due to the use of insensitive instruments?

The varying prevalence rates of dementia reported in elderly populations may be partly due to the use of different diagnostic measures. In a recent study in which diagnosis was based on the CAPE, a 12-item questionnaire, the prevalence rate for severe cognitive impairment for the age group 75 years or over was lower than previously reported. In the present study, the performance of the CAPE was examined in an elderly general-practice sample with a higher than usual risk of dementia. The study diagnosis was based on a combination of the diagnosis made by the computer program AGECAT and a clinical diagnosis made by the interviewing psychiatrist. Forty-five per cent of patients with definite or probable dementia, as defined, and 100% of those with possible dementia had scores above the cut-point on the CAPE. The sensitivity of the CAPE was low compared with that of other rating scales. It is concluded that the low reported rate with the CAPE is probably due to only the more severe cases being identified. For comparative purposes it is important to know the level of dementia that the instruments used are detecting.

Aged↗
PubMed1990

Perceptual and conceptual mechanisms in neglect dyslexia. Two contrasting case studies.

The contribution of peripheral, data-driven effects is contrasted with conceptual, 'top-down' effects to the reading performance of 2 subjects with neglect dyslexia following a single right hemisphere lesion. Several tasks were administered, manipulating the physical, lexical or morphemic properties of the stimuli in an attempt to establish whether the attentional deficit disrupts reading at an early or late stage of processing. Both subjects were impaired at detecting elementary stimulus features on the left side of the display but were even more impaired at identifying conjoined features. One subject's performance was influenced by structural manipulations which altered the low-level representation of the stimulus. The other was less affected by structural changes of the stimuli but was influenced by the lexical and morphemic status of the words. This apparent double dissociation is interpreted as arising from a graded attentional deficit at a single locus, early in the reading process where low-level information is detected. When the deficit is not severe sufficient information may be picked up and may interact with higher order lexical knowledge to offset partially the peripheral malfunction. For a severe attentional deficit, top-down knowledge is not engaged as insufficient information is processed on the left-hand side. This hybrid view of attention provides insight into the mechanisms underlying neglect dyslexia and bears on the role of attention in normal visual processing.

Aged↗
PubMed1988

Periventricular and subcortical hyperintensities on magnetic resonance imaging. 'Rims, caps, and unidentified bright objects'.

Magnetic resonance imaging hyper-intensities were classified as periventricular rim, caps, and unidentified bright objects (UBOs). These were quantitated in 100 acute stroke and 23 hemorrhage patients and 59 control subjects selected from 590 consecutive scans. The rims, caps, and ventricular size were rated on a scale from 0 to 3 for severity, and the UBOs were counted. The results indicated that the rim is also frequent in control subjects and increases with age. Unidentified bright objects, caps, and severe rims usually signify pathology, occurring much more frequently in patients with strokes and hemorrhages than in control subjects. Hypertension is a significant risk factor in UBOs and caps, but in rims, the incidence of diabetes is higher. The clinical and pathologic significance of these hyperintensities and their relationship to Binswanger's disease, lacunar state, and "état criblé" is discussed.

Acute Disease↗
PubMed1987

The sensitivity and specificity of MRI in stroke.

We compared MRI and CT in a study of 175 patients; 87 infarcts within a week, 40 from 1 to 40 weeks, 25 a year after onset, and 23 hemorrhages, 18 within 2 weeks and 5 in 4 to 8 weeks. Fifty-nine infarcts and eight hemorrhages had sequential scanning. MRI is more sensitive than CT in the early detection of cerebral infarcts. CT is the method of choice to rule out intracerebral bleeding, but MRI is more specific in later stages of hemorrhage. Periventricular hyperintensity is seen more frequently with diabetes than without. Hyperintense white matter patches are often unrelated to clinical events. MRI is useful in following the evolution of strokes and distinguishing acute and chronic infarcts without contrast agents.

Aged↗
PubMed1987

Cerebral dominance, sex, and callosal size in MRI.

We measured the MRI area of corpus callosum in 104 normal adults, 51 men, 53 women, 52 right- and 52 left-handers. There were no significant sex or handedness differences. Callosal areas did not correlate with brain size nor with measures of lateralization for hand performance, dichotic listening, or visual field preference. The results are contrary to the notion of increased callosal connectivity in left-handers, women, or individuals with less-lateralized function.

Adolescent↗
PubMed1987

Subcortical neglect: quantitation, anatomy, and recovery.

Fifteen patients with right hemispheric subcortical infarcts localized by CT or MRI were evaluated with a neglect testing battery. Trimodal extinction was present in one case, visual extinction in three, tactile in three, and auditory in six. Although frequent (10 cases), hemispatial neglect was rarely severe (3 cases). Three cases recovered completely. Large posterior internal capsule lesions were associated with more frequent impairment on a cancellation test. The probable mechanism of hemispatial neglect was attentional in one case and intentional in six. Visual and auditory extinction is explained by striatonigral mechanisms. Although subcortical structures participate in attentional and intentional behavior, cortical structures can substitute for their functions.

Attention↗
PubMed1986

Cerebral asymmetries on magnetic resonance imaging.

Magnetic Resonance Imaging (MRI) reveals anatomical asymmetries of the sulcal demarcation of the posterior operculum from the parietal cortex that correlate with handedness in normal subjects. The sulcal demarcation is greater on the right in most right handers, but evenly distributed in left handers. This in vivo asymmetry corresponds to the commonly larger planum temporale on the left side. Hand Preference, Hand Performance, Dichotic Listening and Visual Field Preference measures were correlated with several measures of anatomical asymmetries seen on MRI. The sulcal demarcation, anterior frontal width and parietal width correlated best with hand performance, as measured on a dot tapping task. The biological significance of the distribution of anatomical and functional asymmetries is discussed.

Adult↗
PubMed1986

Dorsal midbrain syndrome in multiple sclerosis with magnetic resonance imaging correlation.

We describe the clinical characteristics and a series of magnetic resonance imaging (MRI) studies in a patient with the features of dorsal midbrain syndrome occurring in the setting of multiple sclerosis. A T2-weighted MRI study revealed a discrete abnormality in the tectum of the midbrain whereas a high volume delayed computed tomography (CT) scan was uninformative. In parallel with remission of the clinical findings, the MRI abnormality diminished over time and was no longer visible at one year suggesting that some MRI detected MS lesions can completely disappear with time. This report demonstrates the use of MRI to detect and to follow sequentially sites of known disease activity in MS.

Brain Diseases↗
PubMed1986

Three models of human language.

Three models of human language processing can be discerned in contemporary neurobiology: the Wernicke-Broca model, primarily derived from studies of stroke and other brain lesions; the model developed by Dr. George Ojemann from electrical stimulation mapping of the cerebral cortex; and the linguistic model, evolved from Noam Chomsky's linguistic theories. The Wernicke-Broca model employs a posterior-sensory anterior-motor conception of brain language processing that is substantially different from the more modular conception developed from electrical stimulation mapping. The linguistic model attempts to explain language in terms of hierarchical mental function.

Aphasia↗
PubMed1985

Motor impersistence: a right-hemisphere syndrome.

We studied motor impersistence with a standardized clinical test of sustained actions, both in patients with acute focal stroke lesions, who were matched for age and size of lesion, and normal controls. Patients with right-sided lesions had significantly more impersistence than did those with left-sided lesions. The most discriminating tests were eye-closure, mouth-opening, tongue-protrusion, and gaze to the left. Right central and frontal lesions seemed to be more responsible for motor impersistence than were posterior or left-sided lesions. Although motor impersistence is sometimes seen with diffuse cerebral disease, it is also a sign of right-hemisphere lesions; the phenomenon is probably related to mechanisms of directed attention that are necessary to sustain motor activity.

Adult↗