Showing papers in "Journal of Neuropsychiatry and Clinical Neurosciences in 2017"
TL;DR: Clinical and research efforts in veterans should consider TBI mechanism, effects of cumulative TBI, and screening for premilitary TBI.
Abstract: This study randomly sampled post-9/11 military veterans and reports on causes, predictors, and frequency of traumatic brain injury (TBI) (N=1,388). A total of 17.3% met criteria for TBI during military service, with about one-half reporting multiple head injuries, which were related to higher rates of posttraumatic stress disorder, depression, back pain, and suicidal ideation. The most common mechanisms of TBI included blasts (33.1%), objects hitting head (31.7%), and fall (13.5%). TBI was associated with enlisted rank, male gender, high combat exposure, and sustaining TBI prior to military service. Clinical and research efforts in veterans should consider TBI mechanism, effects of cumulative TBI, and screening for premilitary TBI.
135 citations
TL;DR: This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.
Abstract: Motor and vocal tics are relatively common motor manifestations identified as the core features of Tourette's syndrome (TS). Although traditional descriptions have focused on objective phenomenological observations, such as anatomical location, number and frequency of tics, patients' first-person accounts have consistently reported characteristic subjective correlates. These sensory phenomena are often described as a feeling of mounting inner tension or urge to move ("premonitory urge"), which is transiently relieved by tic expression. This article reviews the existing literature on the clinical and neurobiological aspects of the premonitory urge in patients with TS, with focus on its pathophysiology and possible treatment implications.
112 citations
TL;DR: The authors address the full spectrum of TBI severity, and because PTSD more commonly co-occurs with mild TBI, compared with moderate and severe T BI, the authors focus in particular on mild T BI.
Abstract: The events leading to traumatic brain injury (TBI) are often psychologically traumatic (e.g., motor vehicle accidents) or occur within a broader context of psychological trauma, such as military combat or recurrent interpersonal violence. In such cases, posttraumatic stress disorder (PTSD) may develop and serve to complicate TBI recovery. Likewise, brain trauma may impede emotional resolution following psychological trauma exposure. This article addresses comorbid PTSD and TBI, including the epidemiology of PTSD following TBI; the clinical presentation of the comorbidity; potential mechanisms that complicate recovery from psychological trauma and TBI when they co-occur; and considerations for the clinical management of PTSD in the context of TBI, including implications for both psychosocial and psychopharmacological PTSD treatments. Although the authors address the full spectrum of TBI severity, because PTSD more commonly co-occurs with mild TBI, compared with moderate and severe TBI, the authors focus in...
60 citations
TL;DR: Use of probiotics is not associated with lower rates of depression in this national sample, and unadjusted analysis suggested that subjects who consumed probiotics had lower odds of depression.
Abstract: To assess the association of probiotics with depression, a large population-based cross-sectional study was conducted. National Health and Nutrition Examination Survey adult participants from 2005 through 2012 were included. Exposure was defined as having consumed any probiotic food or supplement on any of the interview days. Subjects were classified as depressed if Patient Health Questionnaire scores were ≥10. Of the 18,019 subjects included, 14.11% consumed probiotics. Unadjusted analysis suggested that subjects who consumed probiotics had lower odds of depression (OR=0.58, 95% CI=0.45-0.75). After adjustment for characteristics associated with depression and probiotic exposure, the effect was attenuated (OR=0.82, 95% CI=0.61-1.1) and no longer significant. Use of probiotics is not associated with lower rates of depression in this national sample.
57 citations
TL;DR: MDD was associated with female gender, preinjury depression, postinjury unemployment, and lower brain volume, whereas PTSD was related to shorter posttraumatic amnesia, memory of the traumatic event, and early posttraumatic symptoms.
Abstract: Although major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are prevalent after traumatic brain injury (TBI), little is known about which patients are at risk for developing them. The authors systematically reviewed the literature on predictors and multivariable models for MDD and PTSD after TBI. The authors included 26 observational studies. MDD was associated with female gender, preinjury depression, postinjury unemployment, and lower brain volume, whereas PTSD was related to shorter posttraumatic amnesia, memory of the traumatic event, and early posttraumatic symptoms. Risk of bias ratings for most studies were acceptable, although studies that developed a multivariable model suffered from methodological shortcomings.
56 citations
TL;DR: The C9orf72 mutation was identified as the most frequent genetic cause of frontotemporal dementia (FTD) and the authors provide clinical guidance on diagnosis and genetic testing.
Abstract: The C9orf72 mutation was identified as the most frequent genetic cause of frontotemporal dementia (FTD). In light of multiple reports of predominant psychiatric presentations of FTD secondary to C9orf72 mutation, the American Neuropsychiatric Association Committee on Research reviewed all studies on psychiatric aspects of this mutation to identify clinically relevant features for diagnosis. The most common psychiatric presentation is psychosis (21%−56%), with delusions, and/or multimodal hallucinations. Other presentations include late-onset mania and depression with cognitive impairment or catatonia. However, the frequency of C9orf72 mutations is low in typical schizophrenia or bipolar disorders (<0.1%). The authors provide clinical guidance on diagnosis and genetic testing.
51 citations
TL;DR: This study supports the feasibility of integrating FND research by investigating neuropsychiatric associations with gender, illness duration, and work disability and found men reported higher rates of cognitive complaints and functional weakness, whereas women endorsed increased past physical/sexual trauma.
Abstract: The assessment of functional neurological disorders (FND) requires an interdisciplinary approach. The authors retrospectively reviewed charts for 100 outpatients with FND and used univariate and regression analyses to investigate neuropsychiatric associations with gender, illness duration, and work disability; secondary analyses evaluated for differences across motor FND subtypes. Men reported higher rates of cognitive complaints and functional weakness, whereas women endorsed increased past physical/sexual trauma. Number of self-reported medication allergies/sensitivities positively correlated with illness duration. Individuals with functional weakness compared with other motor FND subtypes exhibited lower rates of past psychiatric hospitalization and head trauma. This study supports the feasibility of integrating FND research.
42 citations
TL;DR: The authors retrospectively evaluated effectiveness and tolerability of cannabis in 19 adults with Tourette syndrome, finding that tics scores decreased, and 18 of the 19 participants were at least "much improved."
Abstract: The authors retrospectively evaluated effectiveness and tolerability of cannabis in 19 adults with Tourette syndrome. Tics scores decreased by 60%, and 18 of the 19 participants were at least "much improved." Cannabis was generally well tolerated, although most participants reported side effects.
41 citations
TL;DR: A hypothetical model is proposed that relates TBI to the development of pathological burden overlapping with some neurodegenerative conditions, in which onset of cognitive/behavioral impairments is hastened in some individuals, but pathological processes stabilize afterward, resulting in a similar course of decline to individuals with dementia who do not have a history of TBI.
Abstract: Traumatic brain injury (TBI) is often considered to be a risk factor for the later development of neurodegenerative conditions, but some findings do not support a link. Differences in research methods, clinical samples, and limitations encountered when assessing and documenting TBI details likely contribute to the mixed reports in the literature. Despite some variability in findings, a review of the literature does provide support for the notion that TBI appears to be associated with earlier onset of some neurodegenerative disorders, although clearly not everyone with a TBI appears to be at an increased risk. Whereas a mechanistic link remains unknown, TBI has been found to initiate an accumulation of pathological processes related to several neurodegenerative disorders. The authors propose a hypothetical model that relates TBI to the development of pathological burden overlapping with some neurodegenerative conditions, in which onset of cognitive/behavioral impairments is hastened in some individuals, bu...
35 citations
TL;DR: The present meta-analysis identified a beneficial effect of high-frequency rTMS on craving associated with nicotine use disorder but not alcohol use disorder.
Abstract: Repetitive transcranial magnetic stimulation (rTMS), a noninvasive, neuromodulatory tool, has been used to reduce craving in different substance use disorders. There are some studies that have reported conflicting and inconclusive results; therefore, this meta-analysis was conducted to evaluate the effect of high-frequency rTMS on craving in substance use disorder and to investigate the reasons behind the inconsistency across the studies. The authors searched clinical trials from MEDLINE, Cochrane databases, and International Clinical Trials Registry Platform. The PRISMA guidelines, as well as recommended meta-analysis practices, were followed in the selection process, analysis, and reporting of the findings. The effect estimate used was the standardized mean difference (Hedge's g), and heterogeneity across the considered studies was explored using subgroup analyses. The quality assessment was done using the Cochrane risk of bias tool, and sensitivity analysis was performed to check the influences on effect size by statistical models. After screening and assessment of eligibility, finally 10 studies were included for meta-analysis, which includes six studies on alcohol and four studies on nicotine use disorder. The random-model analysis revealed a pooled effect size of 0.75 (95% CI=0.29 to 1.21, p=0.001), whereas the fixed-model analysis showed a large effect size of 0.87 (95% CI=0.63 to 1.12, p<0.00001). Subgroup analysis for alcohol use disorder showed an effect size of -0.06 (95% CI=-0.89 to 0.77, p=0.88). In the case of nicotine use disorder, random-model analysis revealed an effect size of 1.00 (95% CI=0.48 to 1.55, p=0.0001), whereas fixed-model analysis also showed a large effect size of 0.96 (95% CI=0.71 to 1.22). The present meta-analysis identified a beneficial effect of high-frequency rTMS on craving associated with nicotine use disorder but not alcohol use disorder.
34 citations
TL;DR: The authors discuss the potential theoretical basis and empiric support for a specific right-hemisphere role in delusion production, drawing on its roles in pragmatic communication; perceptual integration; attentional surveillance and anomaly/novelty detection; and belief updating.
Abstract: Delusions are beliefs that remain fixed despite evidence that they are incorrect. Although the precise neural mechanism of delusional belief remains to be elucidated, there is a predominance of right-hemisphere lesions among patients with delusional syndromes accompanied by structural pathology, suggesting that right-hemisphere lesions, or networks with key nodes in the right hemisphere, may be playing a role. The authors discuss the potential theoretical basis and empiric support for a specific right-hemisphere role in delusion production, drawing on its roles in pragmatic communication; perceptual integration; attentional surveillance and anomaly/novelty detection; and belief updating.
TL;DR: Preliminary findings suggest that CR may forestall the clinical manifestation of CTE.
Abstract: This study conducted a preliminary examination on cognitive reserve (CR) as a modifier of symptom expression in subjects with autopsy-confirmed chronic traumatic encephalopathy (CTE). The sample included 25 former professional football players neuropathologically diagnosed with CTE stage III or IV. Next of kin interviews ascertained age at cognitive and behavioral/mood symptom onset and demographic/athletic characteristics. Years of education and occupational attainment defined CR. High occupational achievement predicted later age at cognitive (p=0.02) and behavioral/mood (p=0.02) onset. Education was not an individual predictor. These preliminary findings suggest that CR may forestall the clinical manifestation of CTE.
TL;DR: The G/G genotype was significantly associated with depression and anxiety symptoms and development of PD, the first study that associates this genotype with PD.
Abstract: An association between Parkinson's disease (PD) and brain-derived neurotrophic factor (BDNF) was suggested by several studies, with contradictory results. BDNF is necessary for the survival of dopaminergic neurons in substantia nigra. Val66Met is a common polymorphism of the BDNF gene that affects cognitive and motor processes. The authors studied 104 Brazilian patients with PD and 96 control participants. The G/G genotype was significantly associated with depression and anxiety symptoms and development of PD. This is the first study that associates this genotype with PD.
TL;DR: What emerges from this highly variable literature is evidence for a normal right-sided "conservative-complex" involving structures sensitive to negativity bias, threat, disgust, and avoidance, and recommendations for further research on politics and the brain.
Abstract: Differences in political ideology are a major source of human disagreement and conflict. There is increasing evidence that neurobiological mechanisms mediate individual differences in political ideology through effects on a conservative-liberal axis. This review summarizes personality, evolutionary and genetic, cognitive, neuroimaging, and neurological studies of conservatism-liberalism and discusses how they might affect political ideology. What emerges from this highly variable literature is evidence for a normal right-sided "conservative-complex" involving structures sensitive to negativity bias, threat, disgust, and avoidance. This conservative-complex may be damaged with brain disease, sometimes leading to a pathological "liberal shift" or a reduced tendency to conservatism in political ideology. Although not deterministic, these findings recommend further research on politics and the brain.
TL;DR: To conclude, Cotard delusions occur in the context of a relatively wide spectrum of neurological, psychiatric, and medical disorders and present with various neural changes.
Abstract: Cotard’s syndrome, a condition in which the patient denies his or her own existence or the existence of body parts, is a rare illness that has been reported in association with several neuropsychiatric diagnoses. The majority of published literature on the topic is in the form of case reports, many of which are several years old. The authors evaluated associated diagnoses, neuroimaging, and treatments recorded in patients diagnosed with Cotard’s syndrome at their institution. A search of the Mayo Clinic database for patients with mention of signs and symptoms associated with Cotard’s in their records between 1996 and 2016 was conducted. The electronic medical records of the identified patients were then reviewed for evidence of a true diagnosis of Cotard’s. Clinical and neuroimaging data were also recorded for these patients. The search identified 18 patients, 14 of whom had Cotard delusions. Two of the 14 were excluded due to them being under age 18. The resulting 12 patients had a median age of 52 years...
TL;DR: Converging evidence indicates that NIBS might be a promising mean to treat patients with alcohol and tobacco use disorders, by acting on craving reduction and other mechanisms such as improvement in cognitive dysfunctions.
Abstract: Non-invasive brain stimulation (NIBS) might be a new approach to treat substance use disorders (SUD). A systematic review and critical analysis was performed to identify potential therapeutic effects of NIBS on addictions. A search of the Medline database was conducted for randomized sham-controlled trials using NIBS in the field of addiction and published until August 2016. Twenty-six studies in various SUD met the inclusion criteria. Converging evidence indicates that NIBS might be a promising mean to treat patients with alcohol and tobacco use disorders, by acting on craving reduction and other mechanisms such as improvement in cognitive dysfunctions.
TL;DR: Post-TBI social functioning and new-onset depression may serve as particularly important predictors for aggression within the first year of TBI, as these factors may afford intervention and subsequent decreased risk of aggression.
Abstract: Few studies have examined clinical correlates of aggression after first-time traumatic brain injury (TBI) within the first year after injury The authors aimed to identify the rates of aggression at 6 and 12 months post-TBI and establish clinical and demographic correlates A total of 103 subjects with first-time TBI were seen within 12 months postinjury and evaluated for aggression Post-TBI social functioning and new-onset depression (within 3 months of the TBI) may serve as particularly important predictors for aggression within the first year of TBI, as these factors may afford intervention and subsequent decreased risk of aggression
TL;DR: This study supports the feasibility of applying a new standard of care for FND by investigating factors related to treatment adherence and clinical improvement over an average follow-up of 7 months.
Abstract: Despite advancements in the assessment and management of functional neurological disorder (FND), the feasibility of implementing a new standard of care remains unclear. Chart reviews were performed for 100 patients with motor FND to investigate factors related to treatment adherence and clinical improvement over an average follow-up of 7 months. Of 81 patients who returned for follow-up, a history of chronic pain disorder inversely correlated with improvement. Of the 50 individuals newly referred for treatment, adherence correlated with improvement, while having abnormal neuroimaging inversely correlated with improvement. This study supports the feasibility of applying a new standard of care for FND.
TL;DR: High-frequency left prefrontal repetitive transcranial magnetic stimulation modulates resting EEG functional connectivity between the left dorsolateral prefrontal cortex and limbic regions, including the subgenual cingulate cortex and parahippocampal gyrus.
Abstract: High-frequency left prefrontal repetitive transcranial magnetic stimulation (rTMS) has been shown to have efficacy in treatment-resistant depression. However, the effects of rTMS on functional connectivity are still not clear. To examine changes in functional connectivity before and after rTMS, resting EEG of 14 patients with treatment-resistant depression was recorded twice at baseline and at week 4, respectively. The EEG data were analyzed using the standardized low-resolution brain electromagnetic tomography (sLORETA). The results reveal that high-frequency left prefrontal rTMS modulates resting EEG functional connectivity between the left dorsolateral prefrontal cortex and limbic regions, including the subgenual cingulate cortex and parahippocampal gyrus.
TL;DR: MRI can readily identify toxic leukoencephalopathy, and, together with diffusion tensor imaging, MRI continues to offer important insights into its nature.
Abstract: Toxic leukoencephalopathy (TL) is a disorder of brain white matter caused by exposure to leukotoxic agents Magnetic resonance imaging (MRI) can readily identify this syndrome, and, together with diffusion tensor imaging, MRI continues to offer important insights into its nature Since the first formal description of TL in 2001, many new leukotoxic disorders have been recognized, and the range of leukotoxins has expanded to include more therapeutic drugs, drugs of abuse, and environmental insults While the understanding of pathophysiology remains incomplete, TL is increasingly common in clinical practice, and the potential long-term cognitive sequelae of toxic white matter injury merit attention
TL;DR: Surprisingly, differences in neuropsychiatric symptom (NPS) severity by ethnicity in subjects with AD, but not with MCI, were found, and in Hispanics with AD a higher frequency in most of the individual NPI-Q symptom items of the scale was observed, except for apathy.
Abstract: In this cross-sectional study, we examined the neuropsychiatric profile of mild cognitive impairment (MCI) and Alzheimer's disease (AD) using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Data were available on 875 controls, 339 MCI cases, and 975 AD participants. Surprisingly, differences in neuropsychiatric symptom (NPS) severity by ethnicity in subjects with AD, but not with MCI, were found. More so, in Hispanics with AD, a higher frequency in most of the individual NPI-Q symptom items of the scale was observed, except for apathy. After adjustment for clinical features, some individual NPI-Q symptoms also showed an association with Hispanic ethnicity in the control group that nearly reached statistical significance. There may be cross-ethnic differences in the neuropsychiatric presentation of AD in Hispanics versus non-Hispanic whites. Future studies are needed to clarify the etiology of these differences, and to assess the need for ethnicity-specific treatment and care-giving interventions.
TL;DR: The authors identified dissociable neural substrates with multimodal imaging: depression implicates the lateral and superior prefrontal cortex; apathy and agitation implicate the dorsal anterior cingulate; psychosis implicates right lateralized frontal and medial temporal areas; and anxiety implicates mesial temporal regions.
Abstract: Alzheimer’s disease (AD) is commonly associated with noncognitive behavioral changes (NCBCs). The authors systematically reviewed whether neuroimaging has helped with understanding the pathophysiology, diagnosis, or management of NCBCs associated with AD, including depression, aggression or agitation, anxiety, apathy, psychosis, and sleep disorder. The authors identified dissociable neural substrates with multimodal imaging: depression implicates the lateral and superior prefrontal cortex; apathy and agitation implicate the dorsal anterior cingulate; psychosis implicates right lateralized frontal and medial temporal areas; and anxiety implicates mesial temporal regions. Frontal white matter changes appear to underlie many NCBCs, emphasizing the preventative management of vascular risk factors. Further delineation of underlying neurocircuitry and pathophysiology in larger data sets might lead to biomarker identification for diagnosis and optimizing treatment targets.
TL;DR: Investigating the relationship between psychological measures and cognitive performance in a patient cohort found that anxiety was the only psychological measure to remain a significant predictor of cognitive performance (p<0.001), particularly memory function.
Abstract: Neurological and psychological symptoms in multiple sclerosis can affect cognitive function. The objective of this study was to explore the relationship between psychological measures and cognitive performance in a patient cohort. In 322 multiple sclerosis patients, psychological symptoms were measured using the Depression Anxiety and Stress Scale, and cognitive function was evaluated using Audio Recorded Cognitive Screen. Multifactor linear regression analysis, accounting for all clinical covariates, found that anxiety was the only psychological measure to remain a significant predictor of cognitive performance (p<0.001), particularly memory function (p<0.001). Further prospective studies are required to determine whether treatment of anxiety improves cognitive impairment.
TL;DR: An educational review of 10 prevalent misconceptions of delirium pertaining to recognition, etiology, natural history, and best management is provided to improve patient care, quality of life, and clinical outcomes substantially.
Abstract: Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive...
TL;DR: Investigation of the relationship between ventrolateral prefrontal cortex activity, cognitive dysfunction, executive dysfunction, and positive emotionality was investigated in conjunction with mu-opioid neurotransmission in a sample of 39 MDD patients suggest that increased endogenous mu-OPioid tone in the VLPFC mediates the relationships between increased trait positive emotionability and more efficient executive functioning.
Abstract: Cognitive dysfunction and anhedonia, the reduced ability to experience pleasure, are commonly comorbid symptoms that are persistent following successful resolution of negative affect in major depressive disorder (MDD). Little is known about whether they share common etiology. In the present study, the relationship between ventrolateral prefrontal cortex (VLPFC) activity, cognitive dysfunction (i.e., executive dysfunction), and positive emotionality was investigated in conjunction with mu-opioid neurotransmission in a sample of 39 MDD patients. Results suggest that increased endogenous mu-opioid tone in the VLPFC mediates the relationship between increased trait positive emotionality and more efficient executive functioning.
TL;DR: Depression may be in the developmental pathway to behavioral dysfunction, triggering a cycle of reciprocal causality in adults with moderate-to-severe traumatic brain injury.
Abstract: Timely treatment of depression and behavioral dysfunction after moderate-to-severe traumatic brain injury (TBI) could improve health, function, and quality of life. The authors hypothesized that 6-month depression would be the stronger contributor to later depression and behavioral dysfunction in a sample of 88 adults with moderate-to-severe TBI. A structural equation modeling cross-lagged panel analysis, adjusting for all 6-month predictors, revealed that 6-month depression had a stronger relationship to 12-month depression (βstand=0.55, p=0.002) and behavioral dysfunction (βstand=0.41, p=0.004) than did 6-month behavioral dysfunction (βstand=0.17, p=0.270, βstand=0.30, p=0.035). Depression may be in the developmental pathway to behavioral dysfunction, triggering a cycle of reciprocal causality.
TL;DR: The results suggest that trait anxiety may consume processing resources and limit the ability to compensate for gait impairments in PD.
Abstract: Threatening situations lead to observable gait deficits in individuals with Parkinson’s disease (PD) who suffer from high trait anxiety levels. The specific characteristics of gait that are affected appear to be similar to behaviors observed while walking during a dual-task (DT) condition. Yet, it remains unclear whether anxiety is similar to a cognitive load. If it were, then those with PD who have high trait anxiety might be expected to be more susceptible to DT interference during walking. Thus, the overall aim of this study was to evaluate whether trait anxiety influences gait during single-task (ST) and DT walking. Seventy participants (high-anxiety PD [HA-PD], N=26; low-anxiety PD [LA-PD], N=26; healthy control [HC], N=18) completed three ST and three DT walking trials on a data-collecting carpet. The secondary task consisted of digit monitoring while walking. Results showed that during both ST and DT gait, the HA-PD group demonstrated significant reductions in walking speed and step length, as well...
TL;DR: A case of a dronabinol-responsive obsessive-compulsive syndrome after thalamic infarct is presented, showing the potential for analysis of structural brain lesions to lead to insights into psychiatric neurobiology.
Abstract: Structural brain lesions can be a rare cause of refractory psychiatric symptoms. The analysis of such cases may lead to insights into psychiatric neurobiology. Here we present a case of a dronabinol-responsive obsessive-compulsive syndrome after thalamic infarct.
TL;DR: Clinical suspicion of comorbid delirium was the strongest predictor of a more thorough general medical workup and Attribution of catatonia to a psychiatric etiology was associated with significantly less diagnostic workup.
Abstract: Although commonly linked to psychiatric disorders, catatonia is frequently identified secondary to neurological and general medical conditions (GMCs). The present study aimed to characterize the diagnostic workup of cases of catatonia in a general hospital setting. The authors performed a retrospective chart review of 54 cases of catatonia, over 3 years. Clinical suspicion of comorbid delirium was the strongest predictor of a more thorough general medical workup. Attribution of catatonia to a psychiatric etiology was associated with significantly less diagnostic workup. Prospective studies should help clarify the relationship between catatonia and delirium and standardize the diagnostic approach to patients presenting with catatonia.
TL;DR: It is argued that the dynamics of the basal ganglia circuit cannot be fully characterized by linear properties such as the firing rate or oscillatory activity, and entropy was introduced as a measure of probabilistic irregularity in the temporal organization of neuronal activity of thebasal ganglia, giving place to the entropy hypothesis of basalganglia pathology.
Abstract: The rate and oscillatory hypotheses are the two main current frameworks of basal ganglia pathophysiology. Both hypotheses have emerged from research on movement disorders sharing similar conceptualizations. These pathological conditions are classified either as hypokinetic or hyperkinetic, and the electrophysiological hallmarks of basal ganglia dysfunction are categorized as prokinetic or antikinetic. Although nonmotor symptoms, including neurobehavioral symptoms, are a key manifestation of basal ganglia dysfunction, they are uncommonly accounted for in these models. In patients with Parkinson’s disease, the broad spectrum of motor symptoms and neurobehavioral symptoms challenges the concept that basal ganglia disorders can be classified into two categories. The profile of symptoms of basal ganglia dysfunction is best characterized by a breakdown of information processing, accompanied at an electrophysiological level by complex alterations of spiking activity from basal ganglia neurons. The authors argue ...