Dysexecutive Syndrome Research Articles

The 20-item dysexecutive questionnaire after severe traumatic brain injury: Distribution of the total score and its significance

ABSTRACT The Dysexecutive questionnaire (DEX), a 20-item ecological measure used by patients (DEX-S) or significant others (DEX-SO) to assess dysexecutive syndrome, often complements performance-based executive functions (EF) tests. Previous studies highlighted its internal consistency, score variability across samples, weak DEX-S correlations with EF tests, but strong associations with self-assessments of anxiety/depression. This study examined DEX-S and DEX-SO scores from the PariS-TBI study, analyzing data from 76 severe TBI participants and 40 proxies assessed 8-years postinjury compared to matched healthy controls. DEX scores in the control group followed a normal distribution, but severe TBI participants reported significantly higher percentages of very low DEX scores and significantly higher percentages of extremely high scores in both self-reports and proxy-reports. Strong correlations were found between DEX-S and self-reported anxiety/depression (rho = 0.65, p < 0.001). These findings suggest a possible lack of self-awareness in some TBI participants, a probable tendency of some TBI-proxies to underestimate EF difficulties, and the presence of EF difficulties in the TBI group compared to controls. The tendency among some TBI participants and proxies to respond to the DEX questions based on their positive or negative valence (presence of a “valence bias”), rather than specific content, potentially elucidates our results and prior published DEX findings. Trial registration ClinicalTrials.gov identifier: NCT01437683..

Patterns of brain volume and metabolism predict clinical features in the progressive supranuclear palsy spectrum.

Progressive supranuclear palsy (PSP) is a neurodegenerative tauopathy that presents with highly heterogenous clinical syndromes. We perform cross-sectional data-driven discovery of independent patterns of brain atrophy and hypometabolism across the entire PSP spectrum. We then use these patterns to predict specific clinical features and to assess their relationship to phenotypic heterogeneity. We included 111 patients with PSP (60 with Richardson syndrome and 51 with cortical and subcortical variant subtypes). Ninety-one were used as the training set and 20 as a test set. The presence and severity of granular clinical variables such as postural instability, parkinsonism, apraxia and supranuclear gaze palsy were noted. Domains of akinesia, ocular motor impairment, postural instability and cognitive dysfunction as defined by the Movement Disorders Society criteria for PSP were also recorded. Non-negative matrix factorization was used on cross-sectional MRI and fluorodeoxyglucose-positron emission tomography (FDG-PET) scans. Independent models for each as well as a combined model for MRI and FDG-PET were developed and used to predict the granular clinical variables. Both MRI and FDG-PET were better at predicting presence of a symptom than severity, suggesting identification of disease state may be more robust than disease stage. FDG-PET predicted predominantly cortical abnormalities better than MRI such as ideomotor apraxia, apraxia of speech and frontal dysexecutive syndrome. MRI demonstrated prediction of cortical and more so sub-cortical abnormalities, such as parkinsonism. Distinct neuroanatomical foci were predictive in MRI- and FDG-PET-based models. For example, vertical gaze palsy was predicted by midbrain atrophy on MRI, but frontal eye field hypometabolism on FDG-PET. Findings also differed by scale or instrument used. For example, prediction of ocular motor abnormalities using the PSP Saccadic Impairment Scale was stronger than with the Movement Disorders Society Diagnostic criteria for PSP oculomotor impairment designation. Combination of MRI and FDG-PET demonstrated enhanced detection of parkinsonism and frontal syndrome presence and apraxia, cognitive impairment and bradykinesia severity. Both MRI and FDG-PET patterns were able to predict some measures in the test set; however, prediction of global cognition measured by Montreal Cognitive Assessment was the strongest. MRI predictions generalized more robustly to the test set. PSP leads to neurodegeneration in motor, cognitive and ocular motor networks at cortical and subcortical foci, leading to diverse yet overlapping clinical syndromes. To advance understanding of phenotypic heterogeneity in PSP, it is essential to consider data-driven approaches to clinical neuroimaging analyses.

Neurocognitive outcomes in moderately preterm born adolescents

BackgroundEarly preterm (EP) born children are at risk of neurocognitive impairments persisting into adulthood. Less is known about moderately to late (MLP) preterm born children, especially after early childhood. The aim of this study was to assess neurocognitive functioning of MLP adolescents regarding intelligence, executive and attentional functioning, compared with EP and full-term (FT) adolescents. MethodsThis study was part of the Longitudinal Preterm Outcome Project (LOLLIPOP), a large community-based observational cohort study. In total 294 children (81 EP, 130 MLP, and 83 FT) were tested at age 14 to 16 years, regarding intelligence, speed of processing, attention, and executive functions. We used the Dutch version of the Wechsler Intelligence Scale for Children-Third Edition-Dutch Version (WISC-III-NL), the Test of Everyday Attention for Children, and the Behavioural Assessment of the Dysexecutive Syndrome for Children. We assessed differences between preterm-born groups with the FT group as a reference. ResultsCompared to the FT group, MLP adolescents scored significantly lower on two subtasks of the WISC-III-NL, i.e. Similarities and Symbol Search. EP adolescents performed significantly lower on all neuropsychological tests than their FT peers, except for the subtask Vocabulary. The MLP adolescents scored in between FT and EP adolescents on all tasks, except for three WISC-III-NL subtasks. ConclusionsNeurocognitive outcomes of MLP adolescents fell mostly in between outcomes of their EP and FT peers. MLPs generally performed on a low-average to average level, and appeared susceptible to a variety of moderate neurodevelopmental problems at adolescent age, which deserves attention in clinical practice.

Global cognition and executive functions of older adults with type 1 diabetes mellitus without dementia.

This study aimed to characterize the global cognition and executive functions of older adults with type 1 diabetes mellitus in comparison with type 2 diabetes mellitus. This study included 37 patients with type 1 diabetes mellitus aged ≥65 years and 37 age- and sex-matched patients with type 2 diabetes mellitus. Patients with dementia scoring <24 on the Mini-Mental State Examination were excluded. General cognition, memory, classic, and practical executive function were investigated. Patients with type 1 diabetes mellitus demonstrated lower psychomotor speed scores on Trail Making Tests A and B (P < 0.001, P < 0.013) than those with type 2 diabetes mellitus. The dysexecutive syndrome behavioral assessment revealed similar results in patients with types 1 and 2 diabetes mellitus. The Wechsler Memory Scale-Revised verbal episodic memory and Montreal Cognitive Assessment Japanese version were similar in terms of general cognition, but worse delayed recall subset on the latter was associated with type 2 diabetes mellitus (P = 0.038). A worse Trail Making Test-A performance was associated with type 1 diabetes mellitus and age (P < 0.004, P < 0.029). Executive function of psychomotor speed was worse in older outpatient adults without dementia with type 1 diabetes mellitus than in those with type 2 diabetes mellitus but with no significant differences in the comprehensive and practical behavioral assessment of dysexecutive syndrome. Patients with type 1 diabetes had more severely impaired executive function, whereas those with type 2 had greater impaired memory than executive function.

Neurobehavioural rehabilitation of dysexecutive syndrome following traumatic brain injury - a narrative review of management

Background: &#x0D; Traumatic brain injury (TBI) leads to &gt;200,000 hospital admissions in the UK annually. Frontal lobes are frequently affected, leading to a sequela of symptoms affecting behaviour, emotions, and cognition; a cluster of symptoms referred to as dysexecutive syndrome (also known as frontal lobe syndrome). People who survive this, experience long-term sequelae and require long-term support through neurological rehabilitation. The UK has robust guidelines on the medical/physical aspects of rehabilitation following brain injury. However, these guidelines mention little information on the management of neurobehavioural problems following TBI. The aim of this review is to determine what the evidence-based neurobehavioural management of patients with dysexecutive syndrome following TBI is in the UK.&#x0D; &#x0D; Methods: &#x0D; A systematic review of articles using MEDLINE, EMBASE (1974 – present) and Web of Science was conducted. Search terms included frontal lobe syndrome, dysexecutive syndrome, traumatic brain injury, neurorehabilitation, neurological rehabilitation, neurological management, behaviour therapy and behavioural management. Additional references were sourced from the search results and author NH, a medical director within a hospital catering to people with brain injury.&#x0D; &#x0D; Results: &#x0D; 168 results were obtained. 21 articles remained following exclusions: 19 original articles and 2 reviews. Interventions mentioned included: behavioural psychotherapy, memory training, feedback, awareness interventions, goal management training, social skills training, work placements, problem solving training, metacognitive skills, token economy and response cost. Interventions were utilised using a person-centred approach, however, generally there was a lack of consensus as the most effective one. Only 2 studies considered the long-term outcomes of rehabilitation.&#x0D; &#x0D; Discussion:&#x0D; Successful rehabilitation of dysexecutive syndrome post-TBI involves using a person-centred approach, to determine which intervention will target the problem of concern to the patient. Few papers address behavioural rehabilitation of dysexecutive syndrome post-TBI. Further research is required to determine the most effective and beneficial interventions for patients in both the short- and long-term.

Frontal allographic agraphia in a patient with behavioral variant frontotemporal dementia

ABSTRACT We report a patient with behavioral variant frontotemporal dementia who developed agraphia, irritability, perseverative and stereotyped behavior, and dietary changes. MRI revealed bilateral frontal convexity atrophy. Neuropsychological examination showed fluent aphasia with perseverative allographic agraphia, mild semantic impairment, and dysexecutive syndrome. Allographic agraphia featured unidirectional conversion from hiragana (cursive form of Japanese phonograms) and kanji (Japanese morphograms) to katakana (square form of Japanese phonograms), as opposed to mutual (bidirectional) conversion between hiragana and katakana in parieto-occipital gyri lesions. Furthermore, all letters of the word were converted and this whole-word conversion may be characteristic of perseverative behavior in frontotemporal dementia.

Executive functions in patients with obstructive sleep apnea: exploring the prefrontal model

According to the prefrontal model, individuals with obstructive sleep apnea (OSA) manifest behaviours mimicking dysexecutive syndrome as a result of blood gas abnormalities and sleep fragmentation. To compare executive functions in OSA patients with normative values and explore their relationship with blood gas abnormalities and sleep fragmentation. Patients were recruited from the wider community and from a tertiary care hospital. The score obtained in the neuropsychological assessment was compared with Student's t-test for a sample. A multiple linear regression analysis was subsequently estimated, using polysomnographic parameters of hypercapnia, hypoxemia and sleep fragmentation as the predictor variables, and the executive function score as the variable to be predicted. Although the neuropsychological assessment performance of 26% of this sample was classified as executive impairment, indicators of sleep fragmentation and gas abnormalities failed to predict the performance of executive functions. A proportion of the patients with OSA presented performance similar to a dysexecutive syndrome; however, the factors underlying and fostering this type of cognitive manifestation remain unclear. Early treatment for this public health problem could be the best tool available for improving quality of life and preventing health risks.

Disambiguating the macro‐scale anatomy of dysexecutive and behavioral degenerative diseases of the mind

AbstractBackgroundThere is a longstanding ambiguity regarding the clinical diagnosis of dementia syndromes predominantly targeting executive functions versus behavior/personality. This is due to a lack of knowledge about the macro‐scale anatomy underlying these symptomatologies, a partial overlap in clinical features, and the fact that a single underlying pathology can give rise to both phenotypes and vice‐versa.MethodWe included data from patients with genetic, biomarker, and/or autopsy evidence for fronto‐temporal lobar degeneration (FTLD) diagnosed with behavioral variant fronto‐temporal dementia (bvFTD, n = 30) and patients with biomarker and/or autopsy evidence for Alzheimer’s disease (AD) pathology diagnosed with either an initial and predominant dysexecutive (dAD, n = 52), behavioral (bvAD, n = 7), or amnestic (aAD, n = 28) syndrome. We assessed group‐wise differences in clinical/cognitive features and 18Fluorodeoxyglucose‐positron emission tomography (FDG‐PET) patterns. This was followed by a spectral covariance decomposition between FDG‐PET images to yield latent patterns of relative metabolism (“eigenbrains”). These eigenbrains were subsequently linked to clinical/cognitive data and meta‐analytic topics reflecting a wide range of mental abilities. We used a linear discriminant analysis (LDA) to perform eigenbrain‐based diagnostic predictions.ResultdAD and bvFTD patients were the youngest at symptom onset, followed by bvAD, then aAD. dAD patients had worse cognitive performance on nearly all cognitive domains compared to other groups. Hypometabolism was observed across associative cortices in dAD, temporo‐parietal areas in aAD, and fronto‐temporal areas in bvFTD and bvAD (Fig. 1). The spectral covariance decomposition yielded nine eigenbrains which explained 61% of the variance in patterns of FDG‐PET, and only the first three are presented (Fig. 2). These eigenbrains revealed that relative hypometabolism in association cortices, notably lateral parietal areas, associated with dysexecutive symptomatology and a lower likelihood of behavior/personality problems, whereas relative hypometabolism restricted to frontal and temporopolar areas showed opposite associations. The LDA yielded an accuracy of 82.1% in predicting diagnostic category (Fig. 3).ConclusionThis study suggests distinct macro‐scale underpinnings underlying predominant dysexecutive versus behavioral symptomatology in degenerative dementia phenotypes. This has implication for the implementation of clinical and research criteria for these dementia syndromes and highlights the importance of data‐driven techniques to inform the classification of degenerative diseases.

JS03.6.A NEUROTOXICITY IN PATIENTS WITH CNS LYMPHOMAS TREATED WITH CAR T CELL THERAPY. A LOC NETWORK STUDY

Abstract BACKGROUND CAR-T cell therapy represents one of the major progress of the last years in aggressive B-cell lymphomas. Its use in central nervous system (CNS) lymphomas has been limited due to the fear of neurotoxicity but several recent studies have showed promising efficacy in this setting. The aim of this study was to focus on neurotoxicy in CNS lymphoma patients treated with CAR-T cells. MATERIAL AND METHODS Patients with isolated CNS relapse of DLBCL treated with commercial CAR-T cells at Pitié-Salpêtrière hospital were retrospectively selected. We considered only neurological deterioration for which other causes than CAR-T cell toxicity had been reasonably ruled out. RESULTS 30 patients (median age: 65, 17 women, 19 primary, 11 secondary CNS lymphomas) were treated with CAR-T cells (Tisa-cel: N=23, axi-cel, N=7) between May 2020 and December 2022. At the time of CAR-T, 15 (50%) had stable or progressive disease, median Karnofsky Performans Status (KPS) was 70, median Montreal Cognitive Assessment (MoCA) score was 22, and median immune effector cell-associated encephalopathy (ICE) score was 10. 12 (40%) patients didn’t experience any neurotoxicity after CAR-T, whereas 9 (30%), 3 (10%), 2 (7%), 4 (13%) patients experienced grade 1, 2, 3 or 4 toxicity according to ASCTC classification. The signs of neurotoxicity began at a median of 5 days after CAR-T. The most common symptoms were cognitive disorders (N=18), motor deficit (N=4), balance disorders (N=8), consciousness disorders (N=5), epilepsy (N=3) and movement disorders (N=3). Among cognitive symptoms, there was predominantly a worsening of pre-existing symptoms regarding memory impairment (12/15 patients) or dysexecutive syndrome (11/13), while dysgraphia or dyscalculia were most frequently new symptoms (in 14/15 and 7/11 patients). Brain MRI showed pseudo-progression in 4 cases. On lumbar puncture, median IL-6 level and median cellularity were higher in patients with grade 2-3-4 neurotoxicity compared to other patients (243 vs 41 pg/ml, 15 vs 3 cells/mm3). We found no association between risk of neurotoxicity and age, gender, pre-CART KPS, MoCA or ICE score, primary vs secondary CNS lymphoma or type of CAR-T. 12 patients (40%) received steroids, for a median of 10 days, leading to an improvement in a median of 5 days; one received anakinra. Median duration with neurological impairment was 13 days, but was &amp;gt;3 months in 3 patients, including one who finally died from neutoxicity. CONCLUSION The majority of CNS lymphoma patients didn’t experience severe neurotoxicity following CAR-T cell therapy, so that this treatment shouldn’t be contraindicated in this population. However, the percentage of severe and prolonged neurotoxicity is probably higher than in systemic lymphomas and a close neurological follow-up is warranted in these complex situations. Further studies are needed to better predict severe neurotoxicity.

Neuromodulation of Executive Dysfunction in Patients with Acute Stroke Using Transcranial Direct Current Stimulation: Study Protocol for a Triple-Blind, Randomized Sham-Controlled Trial

Research on the benefits of non-invasive brain stimulation in stroke patients to improve executive functions is scarce. The objective of this study was to investigate the effectiveness of transcranial direct current stimulation (tDCS) in combination with cognitive training for the rehabilitation of executive functions in acute and subacute stroke patients as well as to explore the underlying physiological mechanisms. A triple-blinded, randomized-controlled clinical trial will be conducted involving 60 stroke patients with frontal or basal ganglia lesions and a Montreal Cognitive Assessment (MoCA) score less than 26. Participants will be randomly assigned to receive active tDCS (anode over the left dorsolateral prefrontal cortex, cathode at the right supraorbital region, 20 min at 2 mA) or sham tDCS in a 1:1 ratio for 10 sessions, followed by targeted executive function training. The primary efficacy outcome will be the MoCA score, while secondary outcomes will include the five-digit test (inhibitory control), the Digit Span Task (working memory), the abbreviated version of the Wisconsin Card Sorting test (cognitive flexibility), modified Rankin scale (functional state), Beck-II depression inventory, apathy evaluation scale, and the WHOQOL-BREF (quality of life), assessed immediately after the intervention and at 1, 3, 6, and 12 months post-intervention. Additionally, resting-state functional connectivity and blood biomarkers, such as neurotrophins, growth factors, and inflammatory molecules, will be evaluated before and after the intervention. This study will contribute to the investigation of the efficacy of tDCS in rehabilitating executive functions in acute and subacute stroke patients. The multidimensional approach utilized in this study, which includes analysis of resting-state connectivity and neuroplasticity-related blood biomarkers, is expected to provide insights into the underlying brain mechanisms involved in the rehabilitation of dysexecutive syndrome.

Whole-Brain Magnetic Resonance Spectroscopy Reveals Distinct Alterations in Neurometabolic Profile in Progressive Supranuclear Palsy.

Progressive supranuclear palsy (PSP) is an atypical Parkinsonian syndrome characterized by supranuclear gaze palsy, early postural instability, and a frontal dysexecutive syndrome. Contrary to normal brain magnetic resonance imaging in Parkinson's disease (PD), PSP shows specific cerebral atrophy patterns and alterations, but these findings are not present in every patient, and it is still unclear if these signs are also detectable in early disease stages. The aim of the present study was to analyze the metabolic profile of patients with clinically diagnosed PSP in comparison with matched healthy volunteers and PD patients using whole-brain magnetic resonance spectroscopicimaging (wbMRSI). Thirty-nine healthy controls (HCs), 29 PD, and 22 PSP patients underwent wbMRSI. PSP and PD patients were matched for age and handedness with HCs. Clinical characterization was performed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale, PSP rating scale, and DemTect (test for cognitive assessment). In PSP patients a significant reduction in N-acetyl-aspartate (NAA) was detected in all brain lobes. Fractional volume of the cerebrospinal fluid significantly increased in PSP patients compared to PD and healthy volunteers. In PSP much more neuronal degeneration and cerebral atrophy have been detected compared with PD. The most relevant alteration is the decrease in NAA in all lobes of the brain, which also showed a partial correlation with clinical symptoms. However, more studies are needed to confirm the additional value of wbMRSI in clinical practice. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Neurotoxicity in patients with CNS lymphomas treated with CAR‐T cell therapy. A LOC network study

Introduction: CAR-T cell therapy represents one of the major progress of the last years in aggressive B-cell lymphomas. Its use in central nervous system (CNS) lymphomas has been limited due to the fear of neurotoxicity but several recent studies have showed promising efficacy in this setting. The aim of this study was to focus on neurotoxicity in CNS lymphoma patients treated with CAR-T cells. Methods: Patients with isolated CNS relapse of DLBCL treated with commercial CAR-T cells at Pitié-Salpêtrière hospital were retrospectively selected. We considered only neurological deterioration for which other causes than CAR-T cell toxicity had been reasonably ruled out. Results: Thirty patients (median age: 65, 17 women, 19 primary, 11 secondary CNS lymphomas, median of 3 previous lines) received CAR-T cells (Tisa-cel: N = 23, axi-cel, N = 7) between May 2020 and December 2022. At the time of CAR-T, 15 (50%) had stable or progressive disease, median Karnofsky Performance Status (KPS) was 70, median Montreal Cognitive Assessment (MoCA) score was 22 and median immune effector cell-associated encephalopathy (ICE) score was 10. Twelve (40%) patients didn’t experience any neurotoxicity after CAR-T, whereas 9 (30%), 3 (10%), 2 (7%), 4 (13%) patients experienced grade 1, 2, 3 or 4 toxicity according to ASTCT classification. The signs of neurotoxicity began at a median of 5 days after CAR-T. The most common symptoms were cognitive disorders (N = 18), motor deficit (N = 4), balance disorders (N = 8), consciousness disorders (N = 5), seizures (N = 3) and movement disorders (N = 3). Among cognitive symptoms, there was predominantly a worsening of pre-existing symptoms regarding memory impairment (12/15 patients) or dysexecutive syndrome (11/13), while dysgraphia or dyscalculia were most frequently new symptoms (in 14/15 and 7/11 patients). Brain MRI showed pseudo-progression in 4 cases. On lumbar puncture, median IL-6 level and median cellularity were higher in patients with grade 2 to 4 neurotoxicity compared to other patients (243 vs. 41 pg/ml, 15 vs. 3 cells/mm3). We found no association between risk of neurotoxicity and age, gender, pre-CART KPS, MoCA or ICE score, primary vs. secondary CNS lymphoma or type of CAR-T. Twelve patients (40%) received steroids, for a median of 10 days, leading to an improvement in a median of 5 days; one received anakinra. Median duration with neurological impairment was 13 days, but was >3 months in 3 patients, including one who finally died from neurotoxicity. Conclusions: The majority of CNS lymphoma patients didn’t experience severe neurotoxicity following CAR-T cells, so that this treatment shouldn’t be contraindicated in this population. However, the percentage of severe and prolonged neurotoxicity is probably higher than in systemic lymphomas and a close neurological follow-up is warranted in these complex situations. Further studies are needed to better predict severe neurotoxicity. Keyword: Cellular therapies Conflicts of interests pertinent to the abstract. S. Choquet Consultant or advisory role: Kite-Gilead, Novartis

Evaluation of the cognitive outcome after out-of-hospital cardiac arrest: The role of thalamus.

Cardiac arrest survivors develop a variety of neuropsychological impairments and neuroanatomical lesions. The goal of this study is to evaluate if brain voxel-based morphometry and lesional Magnetic Resonance Imaging (MRI) analyses performed in the acute phase of an Out-of-Hospital Cardiac Arrest (OHCA) can be sensitive enough to predict the persistence of neuropsychological disorders beyond 3 months. Survivors underwent a prospective brain MRI during the first month after an OHCA and performed neuropsychological assessments at 1 and 3 months. According to the second neuropsychological assessment, survivors were separated into two subgroups, a deficit subgroup with persistent memory, executive functions, attention and/or praxis disorders (n = 11) and a preserved subgroup, disorders free (n = 14). Brain vascular lesion images were investigated, and volumetric changes were compared with healthy controls. Correlations were discussed between brain MRI results, OHCA data and the second neuropsychological assessment. Analyses of acute ischemic lesions did not reveal significant differences between the two subgroups (p= .35), and correlations with cognitive impairments could not be assessed. voxel-based morphometry analyses revealed a global cerebral volume reduction for the two subgroups and a clear decrease of the right thalamic volume for the deficit subgroup. It was associated with a cognitive dysexecutive syndrome represented by four executive indexes according to the 'Groupe de Réflexion pour l'Evaluation des Fonctions EXécutives' criteria. The right thalamus atrophy seems to be more predictive than the vascular lesions and more specific than a global cerebral volume reduction of post-OHCA neuropsychological executive disorders.

Partial Klüver-Bucy syndrome in a Paediatric patient: A post-neurosurgical and neuropsychological cases.

A variety of cognitive, behavioural, and emotional impairments have been reported in the literature that are associated with the resection of the temporal cortex. Klüver-Bucy syndrome is one infrequently reported disorder in the paediatric population. This paper describes the neuropsychological findings of a female paediatric patient at 7 and 10 years of age with a diagnosis of partial Klüver-Bucy syndrome (pKBS) following total resection of the amygdala and right hippocampus to resect a glioma. The patient presented emotional problems, aggressiveness, hypermetamorphosis, social indifference, and behavioural dysexecutive syndrome, which was found at both 7 and 10 years, but with a decrease in the severity of alterations in attention, impulsivity, hyperactivity, and aggressive behaviour in a second evaluation after she had a neuropsychological intervention. These findings describe the neuropsychological profile of paediatric case with resection of the amygdala and right temporal lobe.

Executive functioning skills of children with listening difficulties

AbstractChildren with normal hearing who present with listening difficulties (LiD) are frequently referred for assessment of auditory processing disorder (APD). Complicating diagnosis is the similarities of APD to other neurodevelopmental disorders, especially attention‐deficit hyperactivity disorder (ADHD). Due to well‐documented deficits in executive functioning (EF) in children with ADHD, we hypothesized that a possible root cause of observed listening deficits may be EF deficits, rather than auditory processing alone. For preliminary investigation into this hypothesis, the current study compared EF skills of children with LiD who were referred for APD assessment, with and without a diagnosis of ADHD. EF skills of 24 children between the ages of 7–16 were assessed utilizing the Behavioral Assessment of Dysexecutive Syndrome in Children, and the Behavior Rating Inventory of Executive Function, 2nd edition. Compelling differences were found between groups of children with LiD. Children without ADHD scored lower on measures of inhibitory control compared to children with a diagnosis of ADHD. Decreased EF skills exhibited in children with LiD, even those without a diagnosis of ADHD, support the need for transdisciplinary identification and management of children with LiD.

The MRI Analysis of 300 Subjects Revealed Grey Matter Atrophy of the Frontal Lobe and Limbic System in Four SARS-CoV-2 Strains (S21.004)

<h3>Objective:</h3> To compare patterns of grey matter atrophy (GMA) in post-COVID syndrome according to four different strains of SARS-CoV-2 <h3>Background:</h3> The neuropsychiatric symptoms of the post-COVID syndrome are frequent and debilitating and represents a major public health concern. Unfortunately, neither the physiopathology nor the underlying cerebral alterations are understood. <h3>Design/Methods:</h3> We analyzed 3T T1 MRI of 300 post-COVID subjects (non-hospitalized, median age 40 years, 209 women, an average of 150 days from diagnosis): 188 infected with the Alpha strain, 29 infected with the P.2-Gamma strain, 61 infected with the P.1+P.1.*-Gamma strain, 22 infected with the Delta strain and 90 healthy controls scanned during the pandemic. We used the Fiocruz database (http://www.genomahcov.fiocruz.br/dashboard/) to separate groups according to the predominant strains by intervals. The CAT12-toolbox/SPM12/MATLAB2019 was used to perform Voxel-Based Morphometry (VBM) analysis and investigate GMA among groups (adjusted for intracranial volume, age, and sex). We reported significant p-values&lt;0.001 corrected for multiple comparisons. <h3>Results:</h3> Overall, all four groups of strains presented GMA atrophy of the bilateral anterior cingula and ventromedial frontal lobes. Besides, Strain P.2-Gamma showed GMA of the right cuneus and left superior occipital gyrus. The P.1+P.1.*-Gamma Strain presented more widespread atrophy (right angular gyrus, fusiform gyrus, frontal operculum and precuneus, and left frontal operculum and precuneus). Interestingly, the Alpha and Delta Strains revealed exclusive frontal lobe GMA. <h3>Conclusions:</h3> Despite the mild acute infection, all four groups presented GMA of the anterior cingula and ventromedial frontal area, suggesting similarities in neurotropism, cerebral injury, and physiopathology. Additionally, different strains showed individual variations of GMA. These findings. The atrophy of the limbic system and frontal lobes may be somehow associated with the highly prevalent neuropsychiatric symptoms (dysexecutive syndrome, depression, and anxiety) in the post-COVID syndrome. Further analyses are necessary to correlate brain atrophy with neuropsychiatric dysfunction and eventually provide therapeutic targets. <b>Disclosure:</b> Lucas Silva has nothing to disclose. Miss Costa has nothing to disclose. Mr. Guimaraes Correa has nothing to disclose. Prof. João has received research support from FAPESP. Mateus Nogueira has nothing to disclose. Dr. Karmann Aventurato has received research support from Coordenadoria de Aperfeiçoamento de Pessoal de Ensino Superior (CAPES). Dr. Alvim has nothing to disclose. Mariana Brito has nothing to disclose. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Biopharma. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for United Medical – Brazil. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Zodiac Pharma . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eurofarma – Brazil . Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Epilepsia. Dr. Cendes has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers in Neurology - Epilepsy. The institution of Dr. Cendes has received research support from São Paulo Research Foundation - FAPESP. The institution of Dr. Cendes has received research support from Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil . The institution of Dr. Cendes has received research support from NIH. Clarissa Yasuda has nothing to disclose.

Teaching Video NeuroImages: Susac syndrome's acute onset callosal disconnection

A 59-year-old right-handed hypertensive diabetic and previously alcoholic man presented acute confusional state followed by apathy, dysexecutive syndrome, clumsy left hand, and apraxic gait. A year later, his wife noticed impaired hearing. Neurologic examination revealed marked callosal apraxia (nondominant limb ideomotor apraxia, disconnection variant) and left stereoagnosis due to callosal disconnection (video). Left hand agraphia was present without aphasia. MRI showed punched out holes through corpus callosum, sparing the calloso-septal interface (figure 1). Audiometry revealed left neurosensorial loss. Fluorescein retinography demonstrated hyperfluorescence of arterial vessel wall (figure 2), confirming the hypothesis of Susac syndrome.1

Impact of dysexecutive syndrome in quality of life in Alzheimer disease: What we know now and where we are headed.

Alzheimer's disease (AD) is a common form of dementia that leads to multiple repercussions in the patient's life. This condition's clinical characteristics include loss of memory, temporal and spatial disorientation, language or executive dysfunction, and subsequent decline of social function. Dysexecutive syndrome (DS), the second most frequent neuropsychological dysfunction in AD, affects multiple brain areas and causes cognitive, behavioral, and emotional difficulties. We aimed to analyze the association between DS and AD and elucidate possible lack of evidence that may urge further research on this theme. Especially when dealing with such a disabling disease, where new findings can directly imply a better prognosis.

Neurofeedback-dependent influence of the ventral striatum using a working memory paradigm targeting the dorsolateral prefrontal cortex.

Executive functions and motivation have been established as key aspects for neurofeedback success. However, task-specific influence of cognitive strategies is scarcely explored. In this study, we test the ability to modulate the dorsolateral prefrontal cortex, a strong candidate for clinical application of neurofeedback in several disorders with dysexecutive syndrome, and investigate how feedback contributes to better performance in a single session. Participants of both neurofeedback (n = 17) and sham-control (n = 10) groups were able to modulate DLPFC in most runs (with or without feedback) while performing a working memory imagery task. However, activity in the target area was higher and more sustained in the active group when receiving feedback. Furthermore, we found increased activity in the nucleus accumbens in the active group, compared with a predominantly negative response along the block in participants receiving sham feedback. Moreover, they acknowledged the non-contingency between imagery and feedback, reflecting the impact on motivation. This study reinforces DLPFC as a robust target for neurofeedback clinical implementations and enhances the critical influence of the ventral striatum, both poised to achieve success in the self-regulation of brain activity.

Appearance of extrapyramidal symptoms in adolescent psychiatry patients during COVID-19 infection.

Since the start of the pandemic, there has been an increase in the incidence of psychiatric morbidity among those infected with coronavirus disease 2019 (COVID-19) and those indirectly affected by COVID-19. There has been a considerable increase in the number of individuals with such psychiatric conditions as depression, acute stress disorders, anxiety, and posttraumatic stress disorder (PTSD). About one-third of patients with COVID-19 are reported to have developed short and long-term neuropsychiatric conditions such as delirium, agitation, altered consciousness, hypoxic encephalopathy encephalitis, dysexecutive syndrome, cerebrovascular complications (e.g., stroke), hypoxic encephalopathy, convulsions, neuromuscular dysfunction, demyelinating processes, or parkinsonism through several pathophysiological mechanisms. Nevertheless, as the pandemic progressed, data on neuropsychiatric manifestations implied that the pathologic capacity of COVID-19 and its association with the onset and/or exacerbation of psychiatric morbidity indicate that COVID-19 is potentially related to neuropsychiatric involvement. Patients with existing mental disorders under psychotropic treatment exposed to the COVID-19 infection have been represented by an increased risk of worsened psychiatric symptoms and expanded drug side effects. The present study aimed to describe five pediatric patients with various psychiatric illness that experienced COVID-19 infection and had potentially associated neuropsychiatric involvement, such as exacerbation of underlying psychiatric symptoms and extrapyramidal side effects. To the best of our knowledge, the present study is the first to describe adolescents with COVID-19 infection that presented with a series of manifestations in the form of an increase in extrapyramidalsymptoms(EPS)during exacerbation of underlying psychiatric disease.