Behavioural Neurology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Quantitative Evaluation of the Use of Actigraphy for Neurological and Psychiatric Disorders Tue, 19 Aug 2014 07:53:21 +0000 http://www.hindawi.com/journals/bn/2014/897282/ Quantitative and objective evaluation of disease severity and/or drug effect is necessary in clinical practice. Wearable accelerometers such as an actigraph enable long-term recording of a patient’s movement during activities and they can be used for quantitative assessment of symptoms due to various diseases. We reviewed some applications of actigraphy with analytical methods that are sufficiently sensitive and reliable to determine the severity of diseases and disorders such as motor and nonmotor disorders like Parkinson’s disease, sleep disorders, depression, behavioral and psychological symptoms of dementia (BPSD) for vascular dementia (VD), seasonal affective disorder (SAD), and stroke, as well as the effects of drugs used to treat them. We believe it is possible to develop analytical methods to assess more neurological or psychopathic disorders using actigraphy records. Weidong Pan, Yu Song, Shin Kwak, Sohei Yoshida, and Yoshiharu Yamamoto Copyright © 2014 Weidong Pan et al. All rights reserved. Inhibitory Effect of NMDA Receptors in the Ventral Tegmental Area on Hormonal and Eating Behavior Responses to Stress in Rats Thu, 07 Aug 2014 07:18:25 +0000 http://www.hindawi.com/journals/bn/2014/294149/ Background. Stress and its consequences are among the causes of accidents. Objective. The effects of intraventral tegmental area (I-VTA) memantine on the plasma corticosterone and eating parameters disturbance induced by acute stress were investigated. Methods. Male Wistar rats (W: 250–300 g) were divided into control and experiential groups, each of which received memantine either intra-VTA or peripherally. One week after bilateral cannulation, the rats received memantine (1 and 5 μg/Rat) five min before electroshock stress. The other experimental groups received memantine (1 and 5 mg/kg) intraperitoneally 30 min before stress. The control groups received saline or memantine but did not experience stress. Food and water intake and plasma corticosterone level were recorded. Results. Results showed that stress decreases food intake but does not change water intake and increase in plasma corticosterone level. Intraperitoneal memantine administration slightly inhibits the stress effects on food intake. However, water intake and plasma corticosterone level were increased. Intra-VTA memantine reduces the effects of stress on corticosterone and water intake. Conclusion. It could be concluded that inhibition of glutamate NMDA receptors in the VTA by memantine leads to the inhibition of the eating behavior parameters and plasma corticosterone level disturbance induced by stress in rats. Zohreh Sadat Nasihatkon, Maryam Khosravi, Zahra Bourbour, Hedayat Sahraei, Mina Ranjbaran, Seyedeh Maryam Hassantash, Mohammad Sahraei, and Kefayat Baghlani Copyright © 2014 Zohreh Sadat Nasihatkon et al. All rights reserved. Correlation Analysis of Sleep Quality and Youth Ischemic Stroke Tue, 05 Aug 2014 13:02:57 +0000 http://www.hindawi.com/journals/bn/2014/246841/ Objective. To study risk factors related to ischemic stroke (IS) in youth and the influence of sleep quality on youth ischemic stroke incidence. Methods. 223 patients aged 18 to 45 years who were admitted to Puyang People’s Hospital from June 2011 to February 2013 with a first-ever ischemic stroke were selected as the research cases. 158 young people with a normal physical examination were selected as the control group. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to analyse the correlation between sleep quality and youth IS incidence. The US National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (MRS) scores were used to assess cases’ state of illness and prognosis three months after IS. Results. Univariate and multivariate logistic regression analysis showed that the association of these risk factors with youth IS incidence, from highest to lowest, was hypertension, hyperlipidaemia, smoking history, high homocysteine, the quality of sleep, family history of stroke, and alcoholism. Poor sleep quality ranked fifth among all risk factors and was positively correlated with poor prognosis for youth IS patients. Conclusion. The results of this study showed that sleep quality is an important factor in the pathogenesis and prognosis of youth IS. Shunqing Zhang, Cheng Chang, Juan Zhang, Bo Song, Hui Fang, and YuMing Xu Copyright © 2014 Shunqing Zhang et al. All rights reserved. Memory Functioning in Children with Epilepsy: Frontal Lobe Epilepsy, Childhood Absence Epilepsy, and Benign Epilepsy with Centrotemporal Spikes Sun, 03 Aug 2014 12:53:16 +0000 http://www.hindawi.com/journals/bn/2014/218637/ Specific cognitive deficits have been identified in children with epilepsy irrespective of results on intelligence tests. Memory deficits are traditionally attributed to temporal lobe epilepsy, whereas the impact of frontal lobe epilepsy on memory functions has remained controversial. The aim of this study was the examination of memory abilities in other childhood common epilepsy syndromes (frontal lobe epilepsy (FLE), childhood absence epilepsy (CAE), and benign epilepsy with centrotemporal spikes (BECTS)) and the influence of epilepsy-related variables. Memory was examined in 90 children with epilepsy (each epilepsy group consisted of 30 children), aged 6–15, and compared with 30 control children. Children with FLE showed significant deficits in verbal and visual memory. In addition, type of epilepsy, earlier age at epilepsy onset, and longer active duration of epilepsy were associated with memory problems. Seizure frequency and treatment, however, did not influence memory performance. This study indicates that children with FLE show greater risk of developing memory deficits than children with CAE or BECTS, thus highlighting the importance of assessing also memory functions in frontal lobe epilepsy. Ana Filipa Lopes, José Paulo Monteiro, Maria José Fonseca, Conceição Robalo, and Mário Rodrigues Simões Copyright © 2014 Ana Filipa Lopes et al. All rights reserved. Restless Leg Syndrome and Sleep Quality in Lumbar Radiculopathy Patients Tue, 08 Jul 2014 00:00:00 +0000 http://www.hindawi.com/journals/bn/2014/245358/ Background. To investigate the frequency of restless leg syndrome (RLS), sleep quality impairment, depression, fatigue, and sleep behavior disorder and to determine the effects of surgery on these parameters in radiculopathy patients resistant to conservative treatment. Methods. The present study included 66 lumbar radiculopathy patients, who were resistant to conservative treatment and had indication of surgery. Five different questionnaires were performed to assess depression (the Beck Depression Inventory (BDI)), sleep quality (the Pittsburgh Sleep Quality Index (PSQI)), fatigue (the Fatigue Severity Scale (FSS)), and presence of RLS and rapid eye movement sleep behavior disorder (RBD). The same questionnaires were also performed on a control group . Results. Of the radiculopathy patients, 68.1% had RLS and 92.4% had fatigue. Of the controls, 16.4% had RLS and 59% had fatigue. RBD was present in 8 (12.1%) patients and 3 (4.9%) controls. The PSQI revealed that sleep quality was impaired in 46 (69.7%) patients and 35 (57.4%) controls . The number of individuals having substantial depression according to the BDI was significantly higher in the patients than in the controls. Conclusions. There was a significant increase in the frequency of RLS, which was significantly decreased in the postoperative period in the radiculopathy patients. Ersoy Kocabicak, Murat Terzi, Kursad Akpinar, Kemal Paksoy, Ibrahim Cebeci, and Omer Iyigun Copyright © 2014 Ersoy Kocabicak et al. All rights reserved. Thalamic Lesions: A Radiological Review Wed, 02 Jul 2014 08:40:11 +0000 http://www.hindawi.com/journals/bn/2014/154631/ Background. Thalamic lesions are seen in a multitude of disorders including vascular diseases, metabolic disorders, inflammatory diseases, trauma, tumours, and infections. In some diseases, thalamic involvement is typical and sometimes isolated, while in other diseases thalamic lesions are observed only occasionally (often in the presence of other typical extrathalamic lesions). Summary. In this review, we will mainly discuss the MRI characteristics of thalamic lesions. Identification of the origin of the thalamic lesion depends on the exact localisation inside the thalamus, the presence of extrathalamic lesions, the signal changes on different MRI sequences, the evolution of the radiological abnormalities over time, the history and clinical state of the patient, and other radiological and nonradiological examinations. Dimitri Renard, Giovanni Castelnovo, Chantal Campello, Stephane Bouly, Anne Le Floch, Eric Thouvenot, Anne Waconge, and Guillaume Taieb Copyright © 2014 Dimitri Renard et al. All rights reserved. Attention Deficit Hyperactivity Disorder: A Neglected Issue in the Developing World Wed, 25 Jun 2014 07:11:55 +0000 http://www.hindawi.com/journals/bn/2014/694764/ Background. Attention deficit hyperactivity disorder (ADHD) is a neglected illness in a developing country. Objectives. The objectives of this study are to investigate the prevalence and pattern of ADHD among children in a Nigeria. Methods. A structured self-administered questionnaire was used to collect information from the parents of children (and older children) who attended children outpatients’ clinic during the study period. The DSM-IV-TR diagnostic criteria for attention deficit hyperactivity disorder were used. Results. Two hundred and seventy-three (273) out of 282 questionnaires were filled completely, giving a response rate of 96.8%. Nine (9) children fulfilled the stated criteria for ADHD giving a prevalence rate of 3.2%. There is no association between gender and ADHD (). Conclusions. The prevalence of ADHD in our setting is 3.2%, which is similar to that obtained elsewhere in the world. J. M. Chinawa, O. I. Odetunde, Herbert A. Obu, A. T. Chinawa, Muideen O. Bakare, and F. A. Ujunwa Copyright © 2014 J. M. Chinawa et al. All rights reserved. Blood Injury and Injection Phobia: The Neglected One Tue, 24 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/bn/2014/471340/ Blood injury and injection (BII) phobia is a unique phobia associated with a diphasic cardiovascular response. The aim of this survey was to report the prevalence of BII phobia, its heritability, and clinical characteristics among the males and females in the Indian subcontinent. An interview and a survey were conducted using a developed BII phobia 21-item questionnaire among 3261 participant males () and females (). Cronbach’ alpha (α) of 0.972 of internal consistency was reported. The prevalence of BII phobia and associated fainting in females was slightly more than double in the males with a significant gender related effect. Similar avoidance behaviours involving hospital visits were reported for both males and females. The relative frequency of BII phobia among first and third degree relatives was found to be higher than among second degree relatives. Depression was found highly comorbid with BII phobia while a low rate of obsessive compulsion disorder (OCD) and social anxiety disorder (SAD) was reported. Morbidity associated with BII phobia may increase dramatically when other medical problems coincide with it. Ab Latif Wani, Anjum Ara, and Sajad Ahmad Bhat Copyright © 2014 Ab Latif Wani et al. All rights reserved. Negative Emotions in Migraineurs Dreams: The Increased Prevalence of Oneiric Fear and Anguish, Unrelated to Mood Disorders Tue, 24 Jun 2014 00:00:00 +0000 http://www.hindawi.com/journals/bn/2014/919627/ Background. Migraineurs brain has shown some functional peculiarities that reflect not only in phonophobia, and photophobia, but also in mood and sleep. Dreaming is a universal mental state characterized by hallucinatory features in which imagery, emotion, motor skills, and memory are created de novo. We evaluated dream contents and associated emotions in migraineurs. Materials and Methods. 412 subjects: 219 controls; and 148 migraineurs (66 with aura, MA; 82 without aura, MO), and 45 tension type headache patients (TTH). A semistructured retrospective self-reported questionnaire was used to evaluate dreams. The Generalized Anxiety Disorder Questionnaire (GAD-7), and the Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depression. Results. Migraineurs showed increased levels of anxiety ( for MA versus controls, for MO versus controls). Fear and anguish during dreaming were more frequently reported by migraine patients compared to controls, independently by anxiety and depression scores. Discussion. The brain of migraineurs seems to dream with some peculiar features, all with a negative connotation, as fear and anguish. It may be due to the recorded negative sensations induced by recurrent migraine pain, but it may just reflect a peculiar attitude of the mesolimbic structures of migraineurs brain, activated in both dreaming and migraine attacks. F. De Angeli, C. Lovati, L. Giani, C. Mariotti D'Alessandro, E. Raimondi, V. Scaglione, D. Castoldi, E. Capiluppi, and C. Mariani Copyright © 2014 F. De Angeli et al. All rights reserved. Apathy and Emotion-Based Decision-Making in Amnesic Mild Cognitive Impairment and Alzheimer’s Disease Sun, 22 Jun 2014 12:16:58 +0000 http://www.hindawi.com/journals/bn/2014/231469/ Background. Apathy and reduced emotion-based decision-making are two behavioral modifications independently described in Alzheimer’s disease (AD) and amnestic mild cognitive impairment (aMCI). Objectives. The aims of this study were to investigate decision-making based on emotional feedback processing in AD and aMCI and to study the impact of reduced decision-making performances on apathy. Methods. We recruited 20 patients with AD, 20 participants with aMCI, and 20 healthy controls. All participants completed the Lille apathy rating scale (LARS) and the Iowa gambling task (IGT). Results. Both aMCI and AD participants had reduced performances on the IGT and were more apathetic compared to controls without any difference between aMCI and AD groups. For the entire sample, LARS initiation dimension was related to IGT disadvantageous decision-making profile. Conclusions. We provide the first study showing that both aMCI and AD individuals make less profitable decisions than controls, whereas aMCI and AD did not differ. Disadvantageous decision-making profile on the IGT was associated with higher level of apathy on the action initiation dimension. The role of an abnormal IGT performance as a risk factor for the development of apathy needs to be investigated in other clinical populations and in normal aging. Sophie Bayard, Jean-Pierre Jacus, Stéphane Raffard, and Marie-Christine Gely-Nargeot Copyright © 2014 Sophie Bayard et al. All rights reserved. Insulin Blocks Glutamate-Induced Neurotoxicity in Differentiated SH-SY5Y Neuronal Cells Sun, 15 Jun 2014 05:29:07 +0000 http://www.hindawi.com/journals/bn/2014/674164/ Insulin is a cytokine which promotes cell growth. Recently, a few published reports on insulin in different cell lines support the antiapoptotic effect of insulin. But the reports fail to explain the role of insulin in modulating glutamate-mediated neuronal cell death through excitotoxicity. Thus, we examined the neuroprotective effect of insulin on glutamate-induced toxicity on differentiated SH-SY5Y neuronal cells. Changes in cell viability were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) based assay, while apoptotic damage was detected by acridine orange/ethidium bromide and Hoechst staining. Intracellular reactive oxygen species (ROS) accumulation and morphological alterations were also measured. Treatment with glutamate induced apoptosis, elevated ROS levels and caused damage to neurons. Insulin was able to attenuate the glutamate-induced excitotoxic damage to neuronal cells. Madhavan Nampoothiri, Neetinkumar D. Reddy, Jessy John, Nitesh Kumar, Gopalan Kutty Nampurath, and Mallikarjuna Rao Chamallamudi Copyright © 2014 Madhavan Nampoothiri et al. All rights reserved. Brain and Language: Evidence for Neural Multifunctionality Mon, 09 Jun 2014 05:07:05 +0000 http://www.hindawi.com/journals/bn/2014/260381/ This review paper presents converging evidence from studies of brain damage and longitudinal studies of language in aging which supports the following thesis: the neural basis of language can best be understood by the concept of neural multifunctionality. In this paper the term “neural multifunctionality” refers to incorporation of nonlinguistic functions into language models of the intact brain, reflecting a multifunctional perspective whereby a constant and dynamic interaction exists among neural networks subserving cognitive, affective, and praxic functions with neural networks specialized for lexical retrieval, sentence comprehension, and discourse processing, giving rise to language as we know it. By way of example, we consider effects of executive system functions on aspects of semantic processing among persons with and without aphasia, as well as the interaction of executive and language functions among older adults. We conclude by indicating how this multifunctional view of brain-language relations extends to the realm of language recovery from aphasia, where evidence of the influence of nonlinguistic factors on the reshaping of neural circuitry for aphasia rehabilitation is clearly emerging. Dalia Cahana-Amitay and Martin L. Albert Copyright © 2014 Dalia Cahana-Amitay and Martin L. Albert. All rights reserved. Posterior AD-Type Pathology: Cognitive Subtypes Emerging from a Cluster Analysis Thu, 05 Jun 2014 18:33:48 +0000 http://www.hindawi.com/journals/bn/2014/259358/ Background. “Posterior shift” of the neuropathological changes of Alzheimer's disease (AD) produces a syndrome (posterior cortical atrophy) (PCA) dominated by high-level visual deficits. Objective. To explore in patients with AD-type pathology whether a data-driven analysis (cluster analysis) based on neuropsychological findings resulted in the emergence of different subgroups of patients; in particular to find out whether it was possible to identify patients with visuospatial deficits consistent with the hypothesis that PCA is a “dorsal stream” syndrome or, rather, whether there were subgroups of patients with different types of impairment within the high-level visual domain. Methods. 23 PCA and 16 DAT patients were studied. By a principal component analysis performed on a wide range of neuropsychological tasks, 15 variables were obtained that loaded onto five main factors (memory, language, perceptual, visuospatial, and calculation) which entered a hierarchical cluster analysis. Results. Four clusters of cognitive impairment emerged: visuospatial/perceptual, memory, perceptual/calculation, and language. Only in the first cluster a visuospatial deficit clearly emerged. Conclusions. AD pathology produces not only variants dominated by memory (DAT) and, to a lesser extent, visuospatial deficit (PCA), but also other distinct syndromic subtypes with disorders in visual perception and language which reflect a different vulnerability of specific functional networks. Antonella Cappa, Nicoletta Ciccarelli, Eleonora Baldonero, Marialuisa Martelli, and Maria Caterina Silveri Copyright © 2014 Antonella Cappa et al. All rights reserved. Heterogeneity of Radiological Spectrum in Tacrolimus-Associated Encephalopathy after Lung Transplantation Tue, 27 May 2014 08:21:32 +0000 http://www.hindawi.com/journals/bn/2014/931808/ Background. Tacrolimus-associated encephalopathy (TAC-E) is usually described under the term of posterior reversible encephalopathy syndrome (PRES). However, a large amount of data has suggested that TAC-E is not a homogenous entity: indeed, TAC-E which is often presented with atypical and potentially misleading imaging characteristics does not always correspond to PRES. Objective. We aimed to identify the spectrum of brain MR imaging of TAC-E and discuss the underlying pathophysiological features. Methods. From September 2008 to October 2010, the neurological statuses of 45 patients, who underwent lung transplantation with TAC as posttransplantation immunosuppressive therapy, were regularly assessed in a prospective study. MRI was repeatedly performed, until recovery, in patients who developed central neurological symptoms. Results. Symptoms suggestive of encephalopathy occurred in five out of 45 patients (11.1%). According to our MRI study, two patients presented with reversible bilateral and relatively symmetric subcortical white matter edema with proximal vasospasms on MRA; however, three other patients were characterized by coexistence of two different lesions including laminar cortical infarcts with hemorrhagic transformation not typically found in PRES and reversible deep white matter edema, associated with distal vasospasms on MRA. Conclusions. It is considered that the mechanism of TAC-E would be more heterogenous than commonly perceived. Qisi Wu, Christian Marescaux, Xinyue Qin, Romain Kessler, and Jun Yang Copyright © 2014 Qisi Wu et al. All rights reserved. Delaying Onset of Dementia: Are Two Languages Enough? Sun, 18 May 2014 10:42:18 +0000 http://www.hindawi.com/journals/bn/2014/808137/ There is an emerging literature suggesting that speaking two or more languages may significantly delay the onset of dementia. Although the mechanisms are unknown, it has been suggested that these may involve cognitive reserve, a concept that has been associated with factors such as higher levels of education, occupational status, social networks, and physical exercise. In the case of bilingualism, cognitive reserve may involve reorganization and strengthening of neural networks that enhance executive control. We review evidence for protective effects of bilingualism from a multicultural perspective involving studies in Toronto and Montreal, Canada, and Hyderabad, India. Reports from Toronto and Hyderabad showed a significant effect of speaking two or more languages in delaying onset of Alzheimer’s disease by up to 5 years, whereas the Montreal study showed a significant protective effect of speaking at least four languages and a protective effect of speaking at least two languages in immigrants. Although there were differences in results across studies, a common theme was the significant effect of language use history as one of the factors in determining the onset of Alzheimer’s disease. Moreover, the Hyderabad study extended the findings to frontotemporal dementia and vascular dementia. Morris Freedman, Suvarna Alladi, Howard Chertkow, Ellen Bialystok, Fergus I. M. Craik, Natalie A. Phillips, Vasanta Duggirala, Surampudi Bapi Raju, and Thomas H. Bak Copyright © 2014 Morris Freedman et al. All rights reserved. Does Repeated Ticking Maintain Tic Behavior? An Experimental Study of Eye Blinking in Healthy Individuals Thu, 08 May 2014 13:34:49 +0000 http://www.hindawi.com/journals/bn/2014/753020/ Tics in Tourette syndrome (TS) are often preceded by “premonitory urges”: annoying feelings or bodily sensations. We hypothesized that, by reducing annoyance of premonitory urges, tic behaviour may be reinforced. In a experimental design in healthy participants, we studied the effects of premonitory urges (operationalized as air puffs on the eye) and tic behaviour (deliberate eye blinking after a puff or a sound) on changes in subjective evaluation of air puffs and EMG responses on the m. orbicularis oculi. The experimental group with air puffs + blinking experienced a decrease in subjective annoyance of the air puff, but habituation of the EMG response was blocked and length of EMG response increased. In the control groups (air puffs without instruction to blink, no air puffs), these effects were absent. When extrapolating to the situation in TS patients, these findings suggest that performance of tics is reinforced by reducing the subjective annoyance of premonitory urges, while simultaneously preventing habituation or even inducing sensitisation of the physiological motor response. Daniel J. V. Beetsma, Marcel A. van den Hout, Iris M. Engelhard, Marleen M. Rijkeboer, and Danielle C. Cath Copyright © 2014 Daniel J. V. Beetsma et al. All rights reserved. The Cognitive Neurology of Bilingualism in the Age of Globalization Thu, 08 May 2014 07:14:53 +0000 http://www.hindawi.com/journals/bn/2014/536727/ Jubin Abutalebi and Brendan S. Weekes Copyright © 2014 Jubin Abutalebi and Brendan S. Weekes. All rights reserved. Can Tics be Performed Convincingly by an Actor? Wed, 07 May 2014 09:33:04 +0000 http://www.hindawi.com/journals/bn/2014/893859/ Background. In the German movie “Vincent will Meer” a healthy actor portrays a man with Tourette’s syndrome. Objective. The aim of this study was to investigate whether the performance of tics is convincing and whether this judgment depends on whether he/she suffers from tics or not. Methods. While the movie was broadcasted in German cinemas, we put an online survey (including 28 questions on different aspects related to the observation, performance, and authenticity of tics) on the web pages of the German self-help group. 276/296 surveys submitted could be used for further analyses. Results. 95.7% of all participants felt that the performance of tics was convincing. However, people with tics () were less convinced compared to those who had never met a person with tics () (). Conclusions. Our results further support the hypothesis that tics are not “abnormal” but “physiological” movements that are only misplaced both in time and context. Kirsten R. Müller-Vahl, Laura Riemann, Hermann Krämer, and Alexander Münchau Copyright © 2014 Kirsten R. Müller-Vahl et al. All rights reserved. Bilingual Language Control and General Purpose Cognitive Control among Individuals with Bilingual Aphasia: Evidence Based on Negative Priming and Flanker Tasks Wed, 07 May 2014 06:59:23 +0000 http://www.hindawi.com/journals/bn/2014/679706/ Background. Bilingualism results in an added advantage with respect to cognitive control. The interaction between bilingual language control and general purpose cognitive control systems can also be understood by studying executive control among individuals with bilingual aphasia. Objectives. The current study examined the subcomponents of cognitive control in bilingual aphasia. A case study approach was used to investigate whether cognitive control and language control are two separate systems and how factors related to bilingualism interact with control processes. Methods. Four individuals with bilingual aphasia performed a language background questionnaire, picture description task, and two experimental tasks (nonlinguistic negative priming task and linguistic and nonlinguistic versions of flanker task). Results. A descriptive approach was used to analyse the data using reaction time and accuracy measures. The cumulative distribution function plots were used to visualize the variations in performance across conditions. The results highlight the distinction between general purpose cognitive control and bilingual language control mechanisms. Conclusion. All participants showed predominant use of the reactive control mechanism to compensate for the limited resources system. Independent yet interactive systems for bilingual language control and general purpose cognitive control were postulated based on the experimental data derived from individuals with bilingual aphasia. Tanya Dash and Bhoomika R. Kar Copyright © 2014 Tanya Dash and Bhoomika R. Kar. All rights reserved. Textbook of Clinical Neuropsychiatry and Behavioral Neuroscience: Third Edition, by David P. Moore & Basant K. Puri, Hodder Arnold, London, 2012, ISBN-13 978-1-4441-2134-6 (Hardback) Tue, 06 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/bn/2014/680658/ Jubin Abutalebi Copyright © 2014 Jubin Abutalebi. All rights reserved. Perseveration Found in a Human Drawing Task: Six-Fingered Hands Drawn by Patients with Right Anterior Insula and Operculum Damage Wed, 30 Apr 2014 11:35:01 +0000 http://www.hindawi.com/journals/bn/2014/405726/ Background. Perseveration has been observed in a number of behavioural contexts, including speaking, writing, and drawing. However, no previous report describes patients who show perseveration only for drawing a human figure. Objective. The present report describes a group of patients who show body awareness-related cognitive impairment during a human figure drawing task, a different presentation from previously described neuropsychological cases. Methods. Participants were 15 patients who had a frontal lobe brain tumour around the insula cortex of the right hemisphere and had subsequently undergone a neurosurgical resective operation. Participants were asked to draw a human figure in both “hands-down” and “hands-up” configurations. Results. Eight of the 15 patients drew a human figure with six fingers during the “hands-up” and the “hands-down” human figure drawing tasks (one patient drew eight fingers). A statistical analysis of potential lesion areas revealed damage to the right anterior frontal insula and operculum in this group of patients relative to the five-finger drawing group. Conclusions. Our findings reveal a newly described neuropsychological phenomenon that could reflect impairment in attention directed towards body representations. Chiharu Niki, Takashi Maruyama, Yoshihiro Muragaki, and Takatsune Kumada Copyright © 2014 Chiharu Niki et al. All rights reserved. Executive and Language Control in the Multilingual Brain Tue, 29 Apr 2014 13:37:15 +0000 http://www.hindawi.com/journals/bn/2014/527951/ Neuroimaging studies suggest that the neural network involved in language control may not be specific to bi-/multilingualism but is part of a domain-general executive control system. We report a trilingual case of a Cantonese (L1), English (L2), and Mandarin (L3) speaker, Dr. T, who sustained a brain injury at the age of 77 causing lesions in the left frontal lobe and in the left temporo-parietal areas resulting in fluent aphasia. Dr. T’s executive functions were impaired according to a modified version of the Stroop color-word test and the Wisconsin Card Sorting Test performance was characterized by frequent perseveration errors. Dr. T demonstrated pathological language switching and mixing across her three languages. Code switching in Cantonese was more prominent in discourse production than confrontation naming. Our case suggests that voluntary control of spoken word production in trilingual speakers shares neural substrata in the frontobasal ganglia system with domain-general executive control mechanisms. One prediction is that lesions to such a system would give rise to both pathological switching and impairments of executive functions in trilingual speakers. Anthony Pak-Hin Kong, Jubin Abutalebi, Karen Sze-Yan Lam, and Brendan Weekes Copyright © 2014 Anthony Pak-Hin Kong et al. All rights reserved. Preclinical Polymodal Hallucinations for 13 Years before Dementia with Lewy Bodies Sun, 27 Apr 2014 12:52:01 +0000 http://www.hindawi.com/journals/bn/2014/694296/ Objective. We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations. Background. Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood. Methods. The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage. Results. The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB. Conclusions. This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder. Carlo Abbate, Pietro Davide Trimarchi, Silvia Inglese, Niccolò Viti, Alessandra Cantatore, Lisa De Agostini, Federico Pirri, Lorenza Marino, Renzo Bagarolo, and Daniela Mari Copyright © 2014 Carlo Abbate et al. All rights reserved. Mapping Remote Subcortical Ramifications of Injury after Ischemic Strokes Thu, 24 Apr 2014 09:09:24 +0000 http://www.hindawi.com/journals/bn/2014/215380/ Background. The extent of brain damage in chronic stroke patients is traditionally defined as the necrotic tissue observed on magnetic resonance image (MRI). However, patients often exhibit symptoms suggesting that functional impairment may affect areas beyond the cortical necrotic lesion, for example, when cortical symptoms ensue after subcortical damage. This observation suggests that disconnection or diaschisis can lead to remote cortical dysfunction that can be functionally equivalent to direct cortical lesions. Objective. To directly measure subcortical disconnection after stroke. Methods. We describe a principled approach utilizing the whole brain connectome reconstructed from diffusion MRI to evaluate the reduction of apparent white matter fiber density in the hemisphere affected by the stroke compared with the spared hemisphere. Results. In eight chronic stroke patients, we observed subcortical disconnection extending beyond the location of tissue necrosis and affecting major white matter pathways underlying the necrotic area. Conclusions. We suggest that it is possible to detect and quantify previously unappreciated areas of subcortical and cortical disconnection. Specifically, this method can be used to evaluate the relationship between lesion location and symptoms, with emphasis on a connectivity-based approach. Leonardo Bonilha, Travis Nesland, Chris Rorden, Paul Fillmore, Ruwan P. Ratnayake, and Julius Fridriksson Copyright © 2014 Leonardo Bonilha et al. All rights reserved. Assessment of Early Cognitive Impairment in Patients with Clinically Isolated Syndromes and Multiple Sclerosis Mon, 14 Apr 2014 15:58:57 +0000 http://www.hindawi.com/journals/bn/2014/637694/ Objective. The aim of our study was to investigate the frequency and pattern of cognitive impairment in patients with clinically isolated syndromes and definite diagnosis of multiple sclerosis within the last 2 years. Methods. We assessed the cognitive status of 46 patients aged 18–49 years with clinically isolated syndromes or definite diagnosis of multiple sclerosis who have onset of their symptoms within the last 2 years. Patients were matched with 40 healthy participants for age, sex, and educational level. Neuropsychological assessment was performed by stroop test, paced auditory serial addition test (PASAT), controlled oral word association test (COWAT), clock drawing test, trail making test (TMT), faces symbol test (FST). Hamilton Depression Scale and Modified Fatigue Impact Scale were used to quantify the severity of any depression and fatigue the subjects might suffer. Results. 19.6% of early MS/CIS group failed at 4 and more tests and had significant cognitive impairment focused on attention, executive functions, memory, and learning. No significant relationship was found between cognitive impairment and disability and fatigue scores. Discussion. Cognitive impairment can be present from the earliest stage of multiple sclerosis. It should be considered among the main manifestations of MS even in the earliest stages of the disease. Leyla Baysal Kıraç, Özgül Ekmekçi, Nur Yüceyar, and Ayşe Sağduyu Kocaman Copyright © 2014 Leyla Baysal Kıraç et al. All rights reserved. Dyscalculia, Dysgraphia, and Left-Right Confusion from a Left Posterior Peri-Insular Infarct Thu, 10 Apr 2014 12:35:04 +0000 http://www.hindawi.com/journals/bn/2014/823591/ The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI) showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation. S. Bhattacharyya, X. Cai, and J. P. Klein Copyright © 2014 S. Bhattacharyya et al. All rights reserved. Syntactic Comprehension in Patients with Amyotrophic Lateral Sclerosis Sun, 06 Apr 2014 11:15:28 +0000 http://www.hindawi.com/journals/bn/2014/230578/ Recent neuropsychological studies of patients with amyotrophic lateral sclerosis (ALS) have demonstrated that some patients have aphasic symptoms, including impaired syntactic comprehension. However, it is not known if syntactic comprehension disorder is related to executive and visuospatial dysfunction. In this study, we evaluated syntactic comprehension using the Syntax Test for Aphasia (STA) auditory comprehension task, frontal executive function using the Frontal Assessment Battery (FAB), visuospatial function using Raven’s Coloured Progressive Matrices (RCPM), and dementia using the Hasegawa Dementia Scale-Revised (HDS-R) in 25 patients with ALS. Of the 25 patients, 18 (72%) had syntactic comprehension disorder (STA score < IV), nine (36%) had frontal executive dysfunction (FAB score < 14), six (24%) had visuospatial dysfunction (RCPM score < 24), and none had dementia (HDS-R score < 20). Nine of the 18 patients with syntactic comprehension disorder (50%) passed the FAB and RCPM. Although sample size was small, these patients had a low STA score but normal FAB and RCPM score. All patients with bulbar onset ALS had syntactic comprehension disorder. These results indicate that it might be necessary to assess syntactic comprehension in patients with bulbar onset ALS. The implications of these findings are discussed in relation to the pathological continuum of ALS. Kentarou Yoshizawa, Nao Yasuda, Michinari Fukuda, Yumi Yukimoto, Mieko Ogino, Wakana Hata, Ikuyo Ishizaka, and Mari Higashikawa Copyright © 2014 Kentarou Yoshizawa et al. All rights reserved. Vocabulary Is an Appropriate Measure of Premorbid Intelligence in a Sample with Heterogeneous Educational Level in Brazil Tue, 01 Apr 2014 07:35:05 +0000 http://www.hindawi.com/journals/bn/2014/875960/ Crystallized intelligence refers to one’s knowledge base and can be measured by vocabulary tests. Fluid intelligence is related to nonverbal aspects of intelligence, depends very little on previously acquired knowledge, and can be measured by tests such as Block Design (BD) and Raven Colored Matrices (RCM). Premorbid intelligence quotient (IQ) refers to one’s intellectual ability level previous to the onset of disorders like mild cognitive impairment (MCI) and Alzheimer’s disease (AD) and it is important to estimate disease severity. The objective was to compare performance in tests that measure crystallized and fluid intelligence in healthy subjects and patients with amnestic MCI (aMCI) and AD. One hundred forty-four participants (aMCI (), AD (), and healthy controls ()) were submitted to neuropsychological tests (WAIS-III vocabulary, BD, and RCM). There were significant among groups, except for vocabulary, indicating a relative stability of crystallized intelligence in the continuum from normal to pathological cognitive decline. Vocabulary seems to be stable during the progression of the disease and useful as a measure of premorbid intelligence, that is, to estimate previous function in relation to the level of education and, as a collateral measure of cognition in people with low education. Maira Okada de Oliveira, Ricardo Nitrini, Mônica Sanches Yassuda, and Sonia Maria Dozzi Brucki Copyright © 2014 Maira Okada de Oliveira et al. All rights reserved. The Nature of Lexical-Semantic Access in Bilingual Aphasia Sun, 30 Mar 2014 08:25:03 +0000 http://www.hindawi.com/journals/bn/2014/389565/ Background. Despite a growing clinical need, there are no clear guidelines on assessment of lexical access in the two languages in individuals with bilingual aphasia. Objective. In this study, we examined the influence of language proficiency on three tasks requiring lexical access in English and Spanish bilingual normal controls and in bilingual individuals with aphasia. Methods. 12 neurologically healthy Spanish-English bilinguals and 10 Spanish-English bilinguals with aphasia participated in the study. All participants completed three lexical retrieval tasks: two picture-naming tasks (BNT, BPNT) and a category generation (CG) task. Results. This study found that across all tasks, the greatest predictors for performance were the effect of group and language ability rating (LAR). Bilingual controls had a greater score or produced more correct responses than participants with bilingual aphasia across all tasks. The results of our study also indicate that normal controls and bilinguals with aphasia make similar types of errors in both English and Spanish and develop similar clustering strategies despite significant performance differences between the groups. Conclusions. Differences between bilingual patients and controls demonstrate a fundamental lexical retrieval deficit in bilingual individuals with aphasia, but one that is further influenced by language proficiency in the two languages. Swathi Kiran, Isabel Balachandran, and Jason Lucas Copyright © 2014 Swathi Kiran et al. All rights reserved. Late Onset Bipolar Disorder due to a Lacunar State Thu, 27 Mar 2014 12:14:35 +0000 http://www.hindawi.com/journals/bn/2014/780742/ Objective. To describe a patient with a new onset bipolar disorder (BD) type II, secondary to a lacunar state. Background. Poststroke BD is rare and mainly associated with lesion in the prefrontal-striatal-thalamic circuit. Materials and Methods. A 51-year-old woman came to our attention for a mood disorder of recent onset. At 49, she had suffered acute left-sided limb weakness that improved spontaneously four days later. Arterial hypertension was subsequently diagnosed. After 6 months, she began to suffer from alternating brief periods of expansive and elevated mood with longer periods of depressed mood, with a suicide attempt. We performed extensive laboratory and instrumental investigations, as well as, psychiatric consultation, and a cognitive assessment, which was repeated 9 months later. Results. Brain magnetic resonance disclosed leukoaraiosis and a lacunar state of the basal ganglia. Transcranial Doppler showed a patent foramen ovale. A psychiatric consultation led to the diagnosis of BP type II. Neuropsychological evaluation detected deficits in attention/executive functions, verbal fluency, and memory. Nine months later, after specific psychiatric therapy, the psychiatric symptoms were remarkably improved. Conclusion. Our case sheds light on the role of the basal ganglia in mood disorders and the importance of ruling out brain injury in late onset BP. Elena Antelmi, Margherita Fabbri, Lucia Cretella, Maria Guarino, and Andrea Stracciari Copyright © 2014 Elena Antelmi et al. All rights reserved.