Showing papers by "Kenneth M. Heilman published in 1993"
Journal Article•
TL;DR: How to assess patients for neglect, the pathophysiology of neglect, and the treatment of neglect are discussed.
810 citations
177 citations
01 Jan 1993
132 citations
TL;DR: Following a right basal ganglia lesion, a right-handed man, age 75, was unable to recite familiar verses and could comprehend automatic speech, but propositional speech was preserved in both French and Hebrew.
Abstract: Following a right basal ganglia lesion, a right-handed man, age 75, was unable to recite familiar verses. Serial automatic speech, singing, recitation of rhymes, and swearing were impaired, and only idioms and social greetings were preserved. Speech no longer contained overused phrases and he could comprehend automatic speech. In contrast, propositional speech was preserved in both French and Hebrew. Right basal ganglia lesions may impair production but not comprehension of automatic speech.
101 citations
TL;DR: It is found that RHD patients showed reduced facial expressivity in comparison to both LHD and NHD subjects during spontaneous conversation, which supports the hypothesis that the right hemisphere mediates facialexpressivity during spontaneous social interaction.
82 citations
Journal Article•
59 citations
TL;DR: An amnestic man who had a lesion located primarily in the right diagonal band of Broca with physostigmine and lecithin was treated, and a follow-up double-blind, placebo-controlled study failed to demonstrate that cholinergic treatment improved memory.
Abstract: Cholinergic deficient states, such as in Alzheimer's disease, are associated with amnesia. Therapeutic trials with cholinergic augmentation in Alzheimer's disease have had only equivocal results, but mechanisms other than cholinergic deficiency may contribute to the memory deficit. Normally the diagonal band of Broca provides much of the hippocampal cholinergic input. To learn if amnesia secondary to cholinergic deficiency can be ameliorated by cholinergic augmentation, we treated an amnestic man who had a lesion located primarily in the right diagonal band of Broca with physostigmine and lecithin. During the initial best-dose-finding phase, he demonstrated an inverted U-shaped curve for immediate recall of word lists, with peak performances at 3.0 and 3.5 mg of physostigmine. Single photon emission tomography showed decreased blood flow in the medial temporal region ipsilateral to the lesion at baseline, with a reversal of the asymmetry on 3.5 mg of physostigmine. A follow-up double-blind, placebo-controlled study on 3.5 mg of physostigmine, however, failed to demonstrate that cholinergic treatment improved memory.
53 citations
TL;DR: Baseline memory functions were impaired before treatment and remained impaired relative to normals during replacement therapy in spite of improvement with repeated testing, suggesting that the memory changes associated with primary hypothyroidism may not be reversed by thyroid hormone replacement therapy.
Abstract: A 63-year-old female exhibited primary hypothyroidism, both upon clinical examination and laboratory tests. A full neuropsychological exam and repeated, multiple measures of affect, memory, concentration, and problem solving were used to establish baselines prior to treatment and to assess change during the first 7 months of thyroid hormone replacement therapy. Additionally, thyroid hormone and metabolites T3, T4, TSH, and T3 (resin uptake) were regularly assessed. Results indicated that establishing stable baselines before treatment, long-term repeated assessments during treatment, and the use of control subjects are crucial to understanding the neuropsychological changes associated with hypothyroidism. Certain measures of depression, anxiety, attention, and concentration changed from severely impaired to normal levels following an explanation of the diagnosis but before actual treatment. Baseline memory functions were impaired before treatment and remained impaired relative to normals during replacement therapy in spite of improvement with repeated testing. However, replacement therapy may have arrested the progression of memory deterioration as no further decline was evident at a 7-month follow-up. Our data suggest that the memory changes associated with primary hypothyroidism may not be reversed by thyroid hormone replacement therapy.
51 citations
TL;DR: The results support previous theories that there are two routes to visual naming, one via the semantic system and one directly from the internal visual representation to the lexicon and suggest that it is the earliest language deficit in some patients with AD.
Abstract: Patients with Alzheimer9s disease (AD) frequently exhibit anomia early in the course of the disease. Current theories of naming describe lexical retrieval in visual confrontation naming as requiring processing through the semantic system before lexical access. We report on three patients with AD who demonstrated severely impoverished spontaneous speech, impaired list generation, but preserved visual confrontation naming. Extensive investigation of one of these patients revealed an impairment of semantic knowledge. Our results support previous theories that there are two routes to visual naming, one via the semantic system and one directly from the internal visual representation to the lexicon. We labeled this aphasia resulting from an impaired semantic system but a preserved direct route to the lexical system as “nonoptic aphasia” and suggest that it is the earliest language deficit in some patients with AD.
38 citations
TL;DR: It is found that when writing or drawing, right handers moved their left elbow more than their right, suggesting that it is the lateralized movement representations that may be primarily responsible for writing hand preference.
TL;DR: All three of these parameters were investigated in a patient with AD, a 65-year-old, right-handed woman, who developed "blurriness" affecting the right side of her vision that progressively worsened over the next several years until she could not see to her right.
Abstract: ocal loss of primary sensory functions is unusual in Alzheimer's disease (AD)' especially early on F in the clinical course. Although visual manifestations are frequently described, visual field loss is rarely reported.' Recently, Nadeau and Heilman3 described a man with a stroke-induced left superior quadrantanopsia that was present when he gazed into left hemispace but improved when he looked to the right. There was no evidence of hemispatial neglect. They ascribed his deficit to a modality-specific hemispheric inattention. As the attention network is often impaired in AD, this may be a mechanism contributing to visual disturbances in AD patients. C ~ g a n , ~ Faden and Townsend,' and Levine, Lee, and Fisher6 have reported a total of four patients with AD and visual field defects, but no single patient had formal visual field testing, a brain tissue specimen taken, and evaluation for visual loss secondary to hemispheric inattention. We investigated all three of these parameters in a patient with AD. The patient, a 65-year-old, right-handed woman, first noted difficulty spelling written words 6 years before our initial exam. Thereafter she developed \"blurriness\" affecting the right side of her vision. This progressively worsened over the next several years until she could not see to her right. With time her memory, language, and praxis skills gradually declined. She had a history of well controlled hypertension and hypothyroidism treated with verapamil and synthroid, a left radical mastectomy in 1976, but no history of stroke or transient ischemic attacks. Her Hachinski Ischemia Score7 was 3. On exam, her blood pressure was 152/70 mm Hg with a normal general exam. Her Mini-Mental State Exam score was 8. She was oriented only to name and city, recalled zero of three words in 3 minutes, and produced empty spontaneous speech with semantic and phonemic paraphasias. She was apraxic, showed poor copying and geography skills, finger anomia, right tactile extinction, a dressing apraxia, and missed letters on the right side in a letter cancellation task. On elemental neurologic exam, she had a right homonymous hemianopia that did not change with head or trunk rotation into right, left, or central hemi~pace.~ Visual acuity was 20/40 bilaterally. Fundoscopic exam was normal. Slight ocular apraxia and optic ataxia were
Journal Article•
TL;DR: Specific suggestions to address problems in the three stages of Alzheimer's disease from the time of medical diagnosis to the end of life are discussed.
Abstract: Patients with a diagnosis of Alzheimer's disease and their families need the assistance of a case manager to deal with the issues of long-term care. The case manager assists with education, planning, linking to formal and informal resources, and addressing emotional needs in the family unit. This article discusses specific suggestions to address problems in the three stages of Alzheimer's disease from the time of medical diagnosis to the end of life.