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Reduplicative paramnesia.

A striking behavioral abnormality is described in three individuals who had severe head trauma. At a point when general mnestic capabilities had returned to a near normal level, the patients persistently relocated the hospital at another geographical site, even in the face of compelling counter-evidence. The strong parallels in the etiology and course of the three cases justify the positing of a syndrome, here termed reduplicative paramnesia. A neuropsychologic analysis of the disorder stresses the cognitive operations entailed in geographical localization and confabulation. Clinical-pathologic considerations underline the role of right hemisphere and frontal lobe structures in the syndrome.

Adult↗

Cognitive impairments in Parkinson's disease.

The clinical neuropsychologic profiles of patients with Parkinson's disease and patients with SDAT show both overlap and dissociation. Speech, language, and certain memory skills are examples of dissociable differences, especially in the early stages of the disease. Furthermore the presence of depression, evidence of cognitive slowing, and absence of aphasia in patients with Parkinson's disease suggest prominent subcortical involvement. It is probably premature to categorize all of the cognitive changes in patients with Parkinson's disease as subcortical, however. Some skills, such as visuospatial and executive functions, are impaired in both disorders, and although the etiologic bases for task failure may differ for each, this issue remains open-ended. Another problem is that often the evidence for or against the cortical/subcortical distinction is insufficient and in some cases based on a single measure thought to be representative of a given cognitive domain. Most importantly there are few comparative studies that provide unequivocal support for making a cortical/subcortical distinction. Failure to equate for level of cognitive impairment or functional disability between dementias and strict adherence to cross-sectional study designs further compromise efforts to characterize each syndrome precisely. Whitehouse suggested that a prospective study of several different dementias studied in parallel, examining a wide range of cognitive skills, is required before the cortical/subcortical classification scheme can be validated. A critical component is an autopsy program to confirm diagnoses and provide clinicopathologic correlation. It is possible that the diverse nature of the cognitive impairment in patients with Parkinson's disease is not a methodologic artifact but reflects multiple disease subtypes. Ross, Mahler, and Cummings proposed three dementia syndromes in patients with Parkinson's disease: one that is relatively mild and meets the criteria for subcortical dementia, a second that is more severe and shows a wider range of cognitive impairment but is still neuropathologically distinct from SDAT, and a third severe dementia with both subcortical and cortical involvement that may reflect basal ganglia and Alzheimer-type pathology.

Cognition Disorders↗

[Prevalence of potentially reversible cognitive function disorders in patients of a memory dysfunction clinic].

UNLABELLED: Potentially reversible dementias are rarely detected in out-patient care facilities. Actual reversibility is virtually not known and has been occasionally reported in literature. AIM: To determine the prevalence of potentially reversible dementias among patients seen at the ambulatory care facility and to estimate their "real life" reversibility. METHOD: A retrospective analysis of medical records of 258 outpatients attending the Memory Clinic of the Central University Hospital of Lódź in the years 2002-2003. RESULTS: Potentially reversible dementia was diagnosed in 18 (5 women, mean age 60.9 +/- 4.9) subjects yielding 7% of all the subjects presented. These patients were significantly younger and the severity of their cognitive deficits milder as compared to the "non-reversible" cases. Treatment was successful only in 3 cases what translates into only 1.5% of those diagnosed as demented. Twenty seven cases with cognitive deficit but no dementia (depression or drugs side-effects) were claimed as potentially reversible and treated, in most cases (22 out of 27), successfully. However, within the 2 years period of follow-up in 13 of the 22 cases, the development of dementia was observed. CONCLUSIONS: Potentially reversible dementia is a rare phenomenon in ambulatory care facility. The majority of potentially reversible cases can be found among younger and less impaired patients. Even in cases treated successfully, the risk of developing dementia within 2 years is very high.

Aged↗

[Clinico-psychological study of the functions of attention and memory in patients in the early recovery period after reconstructive surgery on the cerebral vessels and their dynamics during treatment with oxygen baths].

Using psychological methods memory and attention were examined in a control group (normal subjects) and in patients at the early rehabilitation period following reconstructive surgery on cerebral vessels before and after therapy with oxygen baths. The psychological methods of examination were found to be valuable in terms of both diagnosis and assessment of the time-course of the studied parameters at various stages of the treatment. The use of oxygen baths was shown to be effective in disorders of memory and attention.

Adult↗

Memory, language, and ageing.

This overview provides both theoretical and empirical reasons for emphasizing practice and familiar skills as a practical strategy for enhancing cognitive functioning in old age. Our review of empirical research on age-related changes in memory and language reveals a consistent pattern of spared and impaired abilities in normal old age. Relatively preserved in old age is memory performance involving highly practised skills and familiar information, including factual, semantic and autobiographical information. Relatively impaired in old age is memory performance that requires the formation of new connections, for example, recall of recent autobiographical experiences, new facts or the source of newly acquired facts. This pattern of impaired new learning versus preserved old learning cuts across distinctions between semantic memory, episodic memory, explicit memory and perhaps also implicit memory. However, familiar verbal information is not completely preserved when accessed on the output side rather than the input side: aspects of language production, namely word finding and spelling, exhibit significant age-related declines. This emerging pattern of preserved and impaired abilities presents a fundamental challenge for theories of cognitive ageing, which must explain why some aspects of language and memory are more vulnerable to the effects of ageing than others. Information-universal theories, involving mechanisms such as general slowing that are independent of the type or structure of the information being processed, require additional mechanisms to account for this pattern of cognitive aging. Information-specific theories, where the type or structure of the postulated memory units can influence the effects of cognitive ageing, are able to account for this emerging pattern, but in some cases require further development to account for comprehensive cognitive changes such as general slowing.

Adult↗

Intrusive memories in depression and posttraumatic stress disorder.

This study compared the stressors and consequent intrusive memories reported by matched samples of patients with posttraumatic stress disorder (PTSD) and major depression. Although intrusive memories were slightly more common among PTSD patients, both quantitative and qualitative measures revealed few differences between the groups. PTSD patients were more likely to have experienced personal illness or assault, and depressed patients family deaths and illness, and interpersonal events. Factor analysis of the associated emotions and memory characteristics suggested the existence of specific links between fear and reliving, and helplessness and out-of-body experiences. Possible inhibitory relationships between fear and sadness, and between guilt and anger, were also noted.

Adult↗

[Neuropsychological assessment in the diagnosis and differential diagnosis of fronto-temporal dementia].

Clinical diagnosis of fronto-temporal dementia (FTD) and its rare variants (semantic dementia and primary progressive aphasia) represents a special challenge bearing in mind its difficulties and is important due to therapeutic differences with the most common Alzheimer's dementia. Of note, cholinesterase inhibitors commonly prescribed in Alzheimer's disease are not effective in FTD and a novel drug, memantine, has not been evaluated as yet. Neuropsychological evaluation is an important add-on to neurological, psychiatric and neuroimaging assessments in the clinical diagnosis of FTD. In this paper, we have described characteristics of neuropsychological deficits observed in FTD (such as attention, language, visuospatial and memory impairments) as well as tools used (tests) in clinical practice. Special attention is paid to the utility of neuropsychological examination in the differential diagnosis of FTD versus Alzheimer's disease, vascular dementia and other, less common forms of dementia.

Alzheimer Disease↗

A prospective, open-label trial of memantine in the treatment of cognitive, behavioral, and memory dysfunction in pervasive developmental disorders.

BACKGROUND: This pilot study examined the effectiveness of memantine hydrochloride in improving cognitive functioning and behavioral symptoms in children with pervasive developmental disorders (PDDs). METHOD: Subjects aged 3-12 years inclusive were enrolled in this 8-week, open-label study. Expressive and receptive language, nonverbal IQ, and nonverbal memory measures were administered at baseline and after 8 weeks of treatment with 0.4 mg/kg of memantine hydrochloride. Throughout the study, the Aberrant Behavior Checklist (ABC) was sent in weekly by parents as a measure of behavioral change. RESULTS: Twelve of 14 subjects completed the study. Significant improvement from baseline was noted on the memory test (Children's Memory Scale Dot Learning Subtest). There were no significant differences from baseline on measures of expressive or receptive language or nonverbal IQ. There were significant improvements on a number of ABC subscales, including hyperactivity, lethargy, and irritability. There were no overall significant statistical differences from baseline on the Clinical Global Improvement-Severity (CGI-S) scale. On the Clinical Global Improvement-Improvement (CGI-I), 4 of 14 subjects showed minimal improvement, and none was deemed "much-improved" or "very much improved." CONCLUSIONS: This small, prospective, open-label study suggests that memantine may be useful in the treatment of memory functioning and some behavioral symptoms in PDDs. The investigators did not see the same degree of change as endorsed by caretakers. Controlled studies are needed to substantiate and clarify these preliminary findings.

Child↗

Early cognitive changes and nondementing behavioral abnormalities in Parkinson's disease.

Early cognitive changes in patients with PD are often subtle and influenced by factors that interact with the disease process, including age and age of disease onset, medication, and the specific constellation of motor symptoms. These factors notwithstanding, there is ample evidence that specific cognitive changes occur early in the course of PD. Whereas language processing deficits are infrequent, subtle changes in olfaction and contrast sensitivity have been repeatedly observed. Executive function deficits are often prominent and, as an integral part of many tasks, also influence performance on a wide range of cognitive measures. This is particularly true for memory and visuospatial dysfunction, two areas that rely heavily on executive demands. Finally, depressive symptoms are also frequent in the early stages of the disease. The significance of early behavioral changes and their prognostic implications are largely unknown and need to be assessed prospectively.

Age of Onset↗

[Neuropsychological characteristics of selective attention in children with nonverbal learning disabilities].

OBJECTIVE: To investigate the neuropsychological characteristics of selective attention such as attention control, working memory and attention persistence of frontal lobe in children with nonverbal learning disabilities (NLD). METHODS: With Auditory Detection Test (ADT), Wisconsin Card Sorting Test (WCST) and C-WISC, 14 children with NLD and 23 controls were tested and the results of sub-tests of C-WISC were analyzed with factor analysis. ADT was mainly applied to test the ability of auditory discernment and the function of dominance lateralization in the cerebra; WCST was employed to test the function of working memory which was based on the frontal lobe, and, C-WISC, to test the intelligent structure and characteristics. RESULTS: Compared with control group, the correct response rate of ADT in NLD group was much lower (P < 0.01), and the number of incorrect response was much larger (P < 0.01). Children with NLD had deficits of auditory selective attention. Moreover, the number of categories achieved (CA) and perseverative error (PE) of WCST were much lower (P < 0.05), which indicated that children with NLD had the disorders of selective attention and performance function. Factor analysis showed that perceptual organization (PO) related to visual space and freedom from distractibility (FD) related to attention persistence in NLD group were obviously lower than those in control group (P < 0.01, P < 0.05). These findings further supported the above-mentioned results. CONCLUSIONS: Children with NLD had attention control disorder and working memory disorder mainly in frontal lobe; we suppose that the disorder in right frontal lobe was distinctive.

Attention↗

Executive neurocognition, memory systems, and borderline personality disorder.

Borderline Personality Disorder (BPD) is a common, disabling, and burdensome psychiatric condition. It is characterized by turbulent fluctuations of negative emotions and moods, unstable and conflictual interpersonal relationships, an incoherent and often contradictory sense of self, and impulsive, potentially lethal self-injurious behaviors. The neurobehavioral facets of BPD have not been extensively studied. However, clinical theoreticians and researchers have proposed that the symptoms and behaviors of BPD are, in part, associated with disruptions in basic neurocognitive processes. This review summarizes and evaluates research that has investigated the relationship between executive neurocognition, memory systems, and BPD. Three historical phases of research are delineated and reviewed, and the methodological and conceptual challenges this body of investigation highlights are discussed. Laboratory-based assessment of executive neurocognition and memory systems is integral to an interdisciplinary approach to research in BPD. Such an approach holds promise in elucidating the neurobehavioral facets, development, diagnostic boundaries, prevention, and optimal interventions for this debilitating and enigmatic disorder.

Borderline Personality Disorder↗

Psychological changes following surgery for tumors in the temporal lobe.

Twenty patients with a tumor in the temporal lobe underwent extensive neuropsychological testing pre- and postoperatively, with special regard to verbal and nonverbal memory. All patients had bilateral abnormalities preoperatively. Contralateral functions tended to improve after surgery, contrary to the outcome expected in patients with bilateral abnormalities due to atrophic lesions. Computerized tomography was the most useful neurodiagnostic test in correctly identifying the nature of the lesion in these patients.

Adolescent↗

Source monitoring in alcoholism.

Recent research on the neural bases of source memory suggests that this type of memory is relevant to the neuropsychological assessment of neurobehavioral disorders. Source memory refers to the ability to discriminate the origin or source of information (e.g., did I think of the idea or did I read about it). We examined source monitoring in abstinent alcoholic patients (N = 53) and nonalcoholic controls (N = 34) and report significant impairments in the alcoholic patients' ability to remember the source of recently presented information. Decrements in source memory were uncorrelated with alcoholic patients' neuropsychological deficits on the Wisconsin Card Sorting Test or the Benton Facial Recognition Test. Using qualitative measures of brain CT scans in a subsample of 39 alcoholic patients, we found that source memory was correlated with Sylvian fissure ratings in the left hemisphere. We propose that source memory decrements are another area of neuropsychological functioning affected in chronic alcoholism. Tasks of source memory may offer the neuropsychologist a valuable new tool for evaluating cognitive functions in neurobehavioral disorders.

Adult↗

Executive functioning and working memory in fetal alcohol spectrum disorder.

The goal of this report is to critically review research on executive functioning (EF) and working memory in individuals with fetal alcohol spectrum disorder (FASD). Individuals with FASD exhibit EF deficits in the areas of cognitive flexibility, planning and strategy use, verbal reasoning, some aspects of inhibition, set shifting, fluency, working memory, and, recently, on tests of emotion-related or hot EF. Some researchers have linked prenatal alcohol exposure to abnormalities in the development of the frontal cortex of affected individuals or animals. One common finding is that these EF deficits persist regardless of whether the individual has facial dysmorphology. Furthermore, EF deficits are not simply due to a low IQ in these individuals. More research with larger sample sizes, smaller age ranges, and consistent measurement tools is needed in this area to ameliorate some inconsistencies in the literature. Furthermore, researchers should now focus on studying the pattern of weakness in EF in individuals with FASD as well as relations among working memory and EF, which will help to identify specific areas of weakness, to enhance diagnosis, and to improve treatment. There is limited research on the development of EF in individuals with FASD, which can have important implications for understanding of how these deficits unfold from childhood through adulthood.

Adolescent↗

Cognition in schizophrenia: impairments, determinants, and functional importance.

Recent findings support and add to earlier findings of cognitive dysfunction in schizophrenia. Deficits across neurocognitive domains such as attention, working memory, language skills, and executive functioning tend to be moderate, with the most pronounced deficits found in verbal learning and memory. All these neurocognitive domains are related to adaptive and social skills, with executive functions and verbal learning and memory showing more variance across more domains than other neuro-cognitive variables. Negative symptoms and neurocognitive domains, although correlated, are distinct and have differential pathways of change with treatment. General psychopathology symptoms, such as depression and anxiety, may become important treatment targets as strategies are developed for translating cognitive enhancement to real-world functional performance.

Antipsychotic Agents↗

[Cognitive manifestations of Alzheimer's disease].

Cognitive features in dementia of the Alzheimer's type (DAT) appear highly heterogeneous. Neuropsychological models seem useful to characterize the cognitive decline. Functional imaging may identify anatomoclinical correlations. Memory impairment is the major symptom in DAT, associated with cortical dysfunctions (aphasia, apraxia, agnosia) and deficits in executive functions. Various evolutive profiles increase this clinical heterogeneity. The use of standardized and validated psychometrical tools appears very important for diagnosis and follow-up of cognitive decline. The MMSE, for example, deserves to be included in the everyday clinical practice.

Alzheimer Disease↗

Relation between intracranial pressure, computed tomographic lesion, and neuropsychological outcome.

Long-term neuropsychological recovery of 24 severe head-injured patients was examined and correlated with acute measurements of intracranial pressure (ICP) and diffuse computed tomographic (CT) lesions. Intracranial hypertension (ICP greater than or equal to 20 mm Hg) was present acutely in 12 patients and absent in 12 patients. CT diagnoses of diffuse swelling (DS) was present in 12 patients, and diffuse axonal injury (DAI) in 12 patients. During chronic recovery, neuropsychological dysfunctioning was found in all cases. Patients with acute ICP elevations showed more intellectual and memory losses than those without acute ICP elevations. No neuropsychological differences were found between patients with DS and DAI injuries. The findings suggest secondary brain insults caused by intracranial hypertension may be more disruptive to long-term neuropsychological functioning than diffuse lesion type.

Accidents, Traffic↗

Long term cognitive effects of stereotactic thalamotomy on non-parkinsonian dyskinetic patients.

Pre- and postoperative neuropsychological evaluation focusing on processing, memory, attentional and emotional deficits was performed on 10 non-parkinsonian dyskinetic patients undergoing single radiofrequency ventralateral (VL) unilateral thalamotomy. Patients carried a diagnosis of either familial tremor or multiple sclerosis and it was found that only in the cases of familial tremor was there no residual loss on long-term evaluation with consistent improvement postoperatively.

Adult↗