Showing papers in "Behavioural Neurology in 1992"

Thought and language

Abstract: From aphasics' self records, common experience, changes in signification of sentences according to a verbal or non-verbal context, animals and non speaking children performances, it seems possible to get some evidence that thought is distinct from language even though there is a permanent interaction between both in normal adult human beings. Some considerations on formalisation of language suggests that the more formalised it is, the less information it contains. If it is true, it is not reasonable to hope that a formalised language like that used by computers may be a model for thought. Finally, the lack of status of thought, as far as it is a subjective experience and the impossibility of giving it a definition as far as it exceeds language, make it clear that in spite of progress in scientific psychology, thought, per se, is not an object for science.

Do Some Cases of Anorexia Nervosa Reflect Underlying Autistic-Like Conditions?

Abstract: In a sample of 51 teenagers with anorexia nervosa (AN)-which included 24 cases constituting the total population of AN cases born in 1970-several had shown social, communicative and behaviour patterns suggestive of autistic-like conditions as children, long before the onset of AN. One of the three boys in the AN group had Asperger syndrome. Three of the 48 girls had histories suggesting high functioning autism and continued to show many features typical of autism. Two further girls had Tourette syndrome and obsessive-compulsive traits in combination with social interaction problems. Eighteen other girls met criteria for obsessive-compulsive personality disorder (OCPD) and most of these also had had moderate-severe childhood social interaction problems. In a sex- and age-matched comparison group from the same schools, two girls had OCPD, but none had autistic-like conditions or Tourette syndrome. The results are discussed in the context of a recently suggested link between Asperger syndrome, Tourette syndrome and obsessive-compulsive problems, and it is suggested that AN in a subgroup of cases might represent a disorder belonging in the same class as autism and autistic-like conditions.

Cognitive Retardation in a Patient with Preservation of Psychomotor Speed

Abstract: We describe a patient (R.S.) who after a bout of probable TB exhibited an unusual pattern of response retardation, although given time he was able to score at a satisfactory level. He was strikingly slow to initiate speaking and to carry out higher level cognitive tasks, at a time when he could complete a variety of psychomotor activities at normal speed. He showed many similarities with patients previously described as having subcortical dementia. The selective preservation of psychomotor responding in the context of his gross bradyphrenia, however, was unexpected.

Imitation in autism. A preliminary research note

Abstract: Previous studies have claimed that children with autism are poor imitators and a lack of imitative capacity has been included by some investigators as one early sign of autism. Presented here are results from a pilot study focusing on observed imitation after presenting 15 tasks to five children with autism (mental age 25-51 months). Imitation tasks involving simple object manipu­ lation, vocal responses, facial and manual gestures, and object substitution were presented to each child. The performance of the children with autism is compared with (1) three normaI4-year-old children (for allIS tasks), and (2) observations from 28 healthy l-year-olds (for 10 of the tasks used). The findings indicate that the autistic group displayed the highest level of imi­ tation on object manipulation and vocal tasks while object substitution, facial, and motor imitation acts seemed to be difficult for children with autism. However, the small number of children included as well as the individual variation observed among the autistic subjects precludes any definite conclusions from these pilot observations. It is hypothesized that imitation in chil­ dren with autism has to be studied separately for different domains and probably also for different subgroups within the autistic population.

Factors affecting the clinical measurement of visuo-spatial neglect.

Abstract: The present study examined a battery of tests to evaluate unilateral spatial neglect; the tests included different tasks involving several modalities of spatial exploration mapping perceptual, motor, attentional and personal or extrapersonal space dimensions. The subjects, 121 right-brain-damaged patients with unilateral neglect, were studied in seven laboratories in four European countries. Relationships among the various tests were examined by correlations, a cluster analysis and by an analysis of individual cases. Different sensitivity was found among various tests for detecting neglect performances. Both the cluster analysis and the single case analysis clearly showed a segregation between personal and extrapersonal neglect. Analysis of the large cluster, including a variety of tests of extra personal neglect, together with the study of single cases, suggests the possibility of differentiating the various manifestations of spatial neglect which can be interpreted on the basis of the descriptions of other individual cases previously reported in the literature. Finally, the present study indicated the relative stability of neglect following the acute phase and its independence from age.

Partnership and Depression in Parkinson’s Disease

Abstract: In this study, the influence of partnership on depression and coping with Parkinson's disease has been investigated. Twenty-three single female patients, 46 married patients (23 female, 23 male) with unimpaired partnership and 42 patients (21 female, 21 male) whose partnership had worsened since the onset of disease, were compared with regard to depression and self reported extent of psychosocial distress. Single female patients tended to have higher depression scores than patients in a stable partnership, especially in items concerning personal worthlessness and senselessness of life. Patients differed in the extent of distress concerning social behavior, psychological problems/anxiety and efficiency. Within the group of single female patients two subgroups emerged: (1) patients with low extent of distress in all aspects; (2) patients who were highly distressed by psychological problems and physical disability but weakly distressed from social interaction. Male and female patients living in a stable partnership reported only a generally low to moderate extent of distress. More than half of the male and female patients who reported an impairment of their relationship also had scores of moderate to severe depression. These patients also had the highest extent of distress in each of the aspects assessed. The results are discussed with regard to possible interactive effects of the disease, quality of the partnership and availability of coping strategies.

Obsessive–compulsive symptoms in neurologic disease: a review

Abstract: Obsessive-compulsive disorder (OCD) is an increasingly recognized disorder with a prevalence of 2-3% (Robins et al., 1984). Once thought to be psychodynamic in origin, OCD is now generally recognized as having a neurobiological cause. Although the exact pathophysiology of OCD in its pure form remains unkown, there are numerous reports of obsessive-compulsive symp­ toms arising in the setting of known neurological disease. In this paper, we review the reported cases of obsessive-compulsive symptoms associated with neurologic diseases and outline the known facts about the underlying neurobiology ofOCD. Finally, we synthesize these findings into a proposed theory of the pathophysiology of OCD, in both its pure form and when it accompa­ nies other neurological illness.

Ideational and ideomotor apraxia: a qualitative analysis.

Abstract: This paper reviews research into both ideational and ideomotor apraxia focusing on the qualitative aspects of limb apraxia. The criteria based on a distinction between different type of movements which have been used to distinguish between ideational (IA) and ideomotor apraxia (IMA) are reviewed together with an evaluation of the most frequent methods of testing and their effects on patients responses. Finally a list of the types of response reported in the literature is presented and their relationship with IA and IMA is proposed.

Possession states: approaches to clinical evaluation and classification

Abstract: The fields of anthropology and sociology have produced a large quantity of literature on possession states, physicians however rarely report on such phenomena. As a result clinical description of possession states has suffered, even though these states may be more common and less deviant than supposed. Both ICD-10 and DSM-IV may include specific criteria for possession disorders. The authors briefly review Western notions about possession and kindred states and present guidelines for evaluation and classification.

Hallucinations and parkinsonian motor fluctuations.

Abstract: Thirty patients with Parkinson's disease experiencing hallucinations during long-term treatment were compared with 20 parkinsonian patients without hallucinations. No differences were found in the duration of disease, L-dopa treatment or disease severity between the two groups. The hallucinators however, were significantly older and more cognitively impaired. Visual hallucinations occurring only during "off periods of immobility" were relatively common and improved concurrently with parkinsonian disabilities after L-dopa. Although visual hallucinations were commonest auditory hallucinations occurred in one third of the hallucinators. with additional help from relatives and carers were then asked to establish whether or not they had experienced hal­ lucinations, and if so detailed descriptions were obtained. The patients were divided into those who had experi­ enced hallucinations and those who had not. Dementia and depression were assessed using the mini-mental test (Fol­ stein et ai., 1975) and DSM-III-R criteria (APA, 1987), respectively. The relationship between the mental and motor states, in particular relation to simultaneous fluctu­ ations in motor and mental disabilities were also studied. The two groups of patients were compared using Student's t-test for paired data. RESULTS Fifty patients were included in the study. Forty-two had on-off fluctuations. Thirty patients had hallucinations and 20 patients denied ever experiencing them. The general features of these two populations of patients are shown in Table I. There were no statistically significant differences between hallucinators and non-hallucinators in terms of the type or duration of parkinsonian symptoms, severity of the disease as judged by Hoehn-Yahr scale, duration of motor fluctuations, L-dopa treatment duration or L-dopa dose. However significant differences were found between the two groups when looking at age (p< 0.001), and degree of cognitive deterioration (p < 0.001). Elderly patients were much more prone to develop hallucinations.

Recognition memory in psychotic patients

Abstract: Preliminary data are reported from experiments in which Warrington's (1984) Recognition Memory Tests were given to patients with misidentification delusions including the Capgras type and to psychotic patients. The results showed a profound impairment on face recognition for most groups, especially those with the Capgras delusion. It was rare to find a patent whose score on the word test was anything but normal.

Two Forms of Palilalia: A Clinicoanatomical Study

Abstract: The clinical and neuroradiological findings of three patients with marked palilalia due to different neurological disorders are reported. These cases and others in the literature suggest the possibility of different variations. “Spasmodic, heterophonic palilalia” is typically observed in Parkinson's syndrome and pseudobulbar palsy: the content of palilalia is characteristically changed by interruption. “Atonic, homophonic, autoecholalic palilalia” is mainly seen in Pick's disease, and is not affected by external interruption.

The clinical features of 67 patients with clinically definite Steele-Richardson-Olszewski syndrome.

Abstract: The clinical features of 67 patients with probable Steele-Richardson-Olszewski syndrome have been analysed. Bradykinesia was present in 92.5% of cases at the time of initial assessment and the two commonest presenting complaints were walking difficulties and stiffness. Only 11 patients had a supranuclear gaze palsy when first seen. Forty-nine patients developed cognitive impairment in the course of their illness based on neuropsychological testing. In addition to the classical clinical findings occasional other findings included focal dystonia, tonic inhibition of levator palpebrae and blepharospasm, respiratory disturbances and impaired hearing. Only nine cases responded at all to levodopa therapy.

The role of the caudate in nonmotor behaviors in Huntington's disease

Abstract: Neuropsychologic data suggest an important role for the caudate nucleus (CN) in behavioral impairments in Huntington's disease (HD). These include abnormalities in executive function, egocentric visuospatial representations, communication, and retrieval of declarative memories, changes in personality, and psychiatric disturbances. Animal paradigms of CN lesions support a role for the CN in some of these behaviors. Current theories of basal ganglia function add explanatory value to the role of the CN in these behaviors. A disconnection of the caudate from limbic structures, including the amygdala may account for many nonmotor behaviors observed in HD.

Hemifacial Display of Emotion in the Resting State

Abstract: The human face at rest displays distinguishable asymmetries with some lateralization of emotion or expression. The asymmetrical nature of the resting face was examined by preparing hemifacial composites, left–left, right–right, along with normal facial orientation. The left side and right side composites were constructed by using the lateral half of one side of the face and its mirror-reversal. The left side facial composites were found to be more emotional than the right side or normal facial orientations of neutral expressions.

Basal ganglia mineralization in Alzheimer's disease : a comparative study of clinical, neuroradiological and neuropathological findings

Abstract: Fifty patients from a longitudinal study on 178 cases of Alzheimer's disease were examined at postmortem. The clinical features, CT-scans and neuropathological findings of five patients, with verified Alzheimer's disease, who had bilateral basal ganglia mineralization (BGM; 2 male, 3 female; age 78–91 years) were compared with the data of five age- and sex-matched Alzheimer patients without BGM and of five control subjects. Persecutory and other delusions (4 patients), persistent depression (2), parkinsonism (4), myoclonus (1) and epileptic seizures (1) were observed more frequently in the patients with BGM than was expected. The BGM-group had significantly lower counts of large neurons in the pallidum internum than the demented patients without BGM or the control group. We did not find other differences between the dementia groups regarding the CT-scans, or plaque, tangle and neuron counts in neocortex and brainstem. We suggest that the combined effects of Alzheimer pathology and BGM might lead to an increased manifestation of psychotic and motor disturbances.

Irrelevant, Incidental and Core Features in the Retrograde Amnesia Associated with Korsakoff’s Psychosis: A Review

Abstract: A brief review of the literature on retrograde amnesia in Korsakoff's syndrome is presented. Various explanations of the phenomenon are discussed including the notions that it results from the effects of “state-dependency”, that it occurs as a result of a progressive learning problem and that it arises through a failure in contextual processing. None of these hypotheses can satisfactorily account for the length and temporal gradient of alcoholic amnesics retrograde amnesia. Although some evidence points towards the hypothesis that anterograde and retrograde amnesia might result from separate and independent impairments, this view is presently unproven and leaves open what causes the form and duration of Korsakoffs retrograde amnesia.

Empirical research on déjà vu experiences: a review

Abstract: A deja vu experience is a dissociative phenomenon, which can be characterized as a subjectively inappropriate impression of familiarity of the present with an undefined past. This paper reviews empirical studies on deja vu experiences and summarizes the most salient findings. Overall, the findings appear to be inconsistent and inconclusive. The authors conclude that the available empirical research is of limited significance due to various methodological and conceptual issues. In order to evaluate the clinical psychiatric relevance of deja vu experiences, further research which also addresses its qualitative features is warranted.

Crossed aphasia in a dextral without "minor" hemisphere signs.

Abstract: A case of severe aphasia after right hemisphere stroke, confirmed by CT, in an unambiguously dextral patient is reported. The patient showed no limb apraxia, and performed well on a test of "closure" (Mooney faces). Extensive testing revealed no signs of visuo-spatial neglect. We conclude that "pure" crossed aphasia can occur in the absence of symptoms normally associated with right hemisphere lesions.

Lithium intoxication presenting as a mixed misidentification syndrome.

Abstract: A case is reported of lithium intoxication presenting with a mixed misidentification syndrome including features of Capgras syndrome. CT scanning showed cerebral atrophy, greater on the right, consistent with earlier evidence, suggesting that misidentification syndromes are more common with right hemisphere lesions.

A 54-point verbal-performance IQ discrepancy on the WISC-R: cognitive functioning of a child from an alternative school

Abstract: Marked WISC-R verbal-performance discrepancy commonly leads to the assumption that such children have brain pathology or cognitive disorders. Children without brain dysfunction may also exhibit wide discrepancy, but a discrepancy score of 30 is assumed to occur in only 2% of the population. The actual investigation presents an 11-year-old child showing a 54-point discrepancy between the two scales of the WISC-R. Results of wide ranging testing and other considerations strongly suggested that this child didn't manifest any kind of brain dysfunction. It was concluded that the particular academic environment of the child, an alternative school, exerted a very strong influence on her results on the WISC-R. This conclusion is furthermore supported by the results of a follow-up evaluation, done 1 year after the child has been transferred to a traditional school, which revealed a WISC-R verbal-performance discrepancy of only 12 points.

Sleep disturbances and epileptiform activity in a subpopulation of children with attention deficit hyperactivity disorder (ADHD): a literature review generating an hypothesis with implications for drug therapy.

Abstract: The use of electroencephalography and sleep studies in attention deficit hyperactivity disorder (ADHD), and the associated behavioral disorders is reviewed. Based on the available literature, we propose a hypothesis indicating four subtypes of ADHD. The usefulness of EEGs and sleep laboratory indices in detecting a subgroup of patients with submaximal responses to methylphenidate is also discussed.

Dementia of frontal lobe type and amyotrophy.

Abstract: Dementia of frontal lobe type may precede motor signs in a number of adult patients with amyotrophy. Neuropathological studies have shown neuron loss, spongiosis and gliosis mainly in layers II and III of the frontal and temporal lobes, together with myelin pallor of the subcortical white matter. Golgi studies revealed loss of dendritic spines on the apical dendrite of layer III pyramidal neurons, decreased numbers of dendrites, amputation and tortuosities of dendrites, and distal and proximal dendritic swellings and enlargements. Calbindin D-28K immunocytochemistry revealed a marked decrease in the number of cortical immunoreactive neurons and loss of immunoreactivity in dendrites of the remaining cells. These features indicate that pyramidal and non-pyramidal neurons in layers II and III are severely damaged, and suggest that cortical processing is seriously impaired in patients with frontal lobe type dementia.

Gilles de la Tourette Syndrome—A Case Report from Guyana in South America

Abstract: A case of the Gilles de la Tourette syndrome from Guyana in South America is presented. The patient had a positive family history as well as coprolalia, echolalia, and attention deficit disorder with hyperactivity. The family history and cross-cultural similarity emphasise the biological factors in the aetiology of the syndrome.

Single-photon emission computerized tomography (SPECT) in neuropsychiatry: a review.

Abstract: Cranial single-photon emission computerized tomography (SPECT or SPET) can now give regional cerebral blood flow images with a resolution approaching that of positron emission tomography (PET). In this paper, the use of high resolution SPECT neuroimaging in neuropsychiatric disorders, including Alzheimer's disease, multi-infarct dementia, Pick's disease, progressive supranuclear palsy, Korsakoff's psychosis, Creutzfeld-Jakob disease, Parkinson's disease, Huntington's disease, schizophrenia, mood disorders, obsessive-compulsive disorder, HIV infection and AIDS is reviewed. Finally, further potential research and clinical uses, based on ligand studies, are outlined.

Absence of neurobehavioral disturbance in a focal lesion of the left paracentral lobule

Abstract: The case of a right-handed woman with an infarcation confined to the left paracentral lobule and sparing the supplementary motor area (SMA) is reported. She presented with a right leg monoplegia and displayed no mutism. The absence of any associated neurobehavioral disturbances (mutism, forced grasping, reduced spontaneous arm activity or aphasia raises the possibility that the left SMA has discrete neurobehavioral functions.

A Case of Epilepsy and Psychosis in the Seventeenth Century

Abstract: A seventeenth-century painter left an account of his seizures, trances and visions; in 1923 Freud commented on this "demonological neurosis" without discussing the seizures. Attention is drawn to the concurrence of epilepsy and psychosis in this early autobiographical source.

A socio behavioural perspective for understanding and managing behaviour problems in children with epilepsy.

Abstract: In this paper, reasons for the occurrence of interictal behaviour disturbance in children with epilepsy, and the management of such problems, are considered. The search for a direct relationship between epilepsy related variables and behaviour disorders is far from conclusive. While such a relationship may exist with respect to ictal behaviour problems, this line of investigation is of limited value in respect of its implications for the management of interictal problems. In the latter case it is proposed that organic factors may be considered to be a risk factor. In addition, the negative psychosocial sequelae of a diagnosis of epilepsy can result in conditions which are likely to foster the development of inappropriate behaviours. Learning theory would further suggest that environmental contingencies have a role to play in the shaping and maintenance of such behaviours. This broader framework for conceptualising the development and maintenance of interictal behaviour disorders has clear management implications. Clinical examples of the successful application of this approach to the management of persistent behavioural problems in two young people with epilepsy are presented.

A patient with difficulty of object recognition: semantic amnesia for manipulable objects.

Abstract: We studied a patient who had recognition difficulty for manipulable objects. MRI showed a lesion in the left occipito-parietotemporal area. Differential diagnosis of agnosia, aphasia and apraxia is discussed. We believe this “object meaning amnesia” constitutes a distinct subtype of semantic amnesia.

Interhemispheric transfer in Down's syndrome.

Abstract: Callosal agenesics and callosotomized epileptics manifest markedly increasing simple visual reaction time (SVRT) from conditions of ipsilateral to contralateral stimulus-response relation (SRR). In the contralateral SRR, a response is presumed possible because of presence of other commissures (anterior, intercollicular). The SRR effect is prolonged presumably because the remaining commissures are less efficient than the corpus callosum in relaying necessary visual or motor information. Consequently, the SRR effect is believed to correspond to callosal relay time (CRT) in the normal subject. However, both callosal agenesics and callosotomy patients manifest general slowing of SVRT in addition to a prolonged SRR effect. These patients have massive extra-callosal damage which could plausibly cause both the SVRT and the CUD prolongation. If such were the case, the CRT inference would be in jeopardy. A test of the CRT inference is therefore required where patients with massive diffuse extra-callosal brain damage and normal callosi would show marked general SVRT prolongation and a normal SRR effect. Four trisomy-21 (T21) males were compared to age and sex-matched normal controls. General SVRT was highly significantly prolonged in T21, but the CUD was nearly identical in both groups.