Frontal Function Research Articles

Global Neurocognitive and Frontal Functions Analysis and Precision Intrathecal Pressure Measurement to Settle the Diagnostic Dilemma of the Normal Pressure Hydrocephalus: A Preliminary Experience

Normal-pressure hydrocephalus (NPH) is a common condition associated with a cognitive deterioration and possibly involving up to 9%-14% of all nursing home residents older than 65 years old. The purpose of the present paper is to introduce an inclusive study protocol aimed at increasing the diagnostic precision and follow-up accuracy. A total of 28 patients were operated on for NPH in our institution in the period ranging between January 2015 and December 2019. All the patients underwent magnetic resonance imaging of the brain with standard sequences, calculation of the Evans index and corpus callosum angle, and evaluations by means of Montreal Cognitive Assessment (MOCA), Mini-Mental State Examination, and Frontal Assessment Battery (FAB) neuropsychological tests preoperatively and at 1 and 6 months. A preoperative lumbar test infusion (LIT) with fine measurement of the intrathecal pressures at the beginning and at the end of the procedures was performed. MOCA and FAB proved an overall improvement of the neurocognitive conditions at 1 month postoperatively. The mean pressure at the beginning of the LIT, was negatively associated with the neuropsychological outcome variables (Mini-Mental State Examination, FAB, and MOCA) in the 3 different evaluations, with FAB and MOCA at 6 months. We found a strong positive correlation between the Evans index as measured on the first magnetic resonance imaging scan both with the diastolic and systolic pressure at the beginning of the test. Neuropsychological assessment, combined with LIT with intrathecal pressure managements aids the diagnostic process in patients affected by NPH. It allows standardizing in a rigorous fashion the follow-up evaluation of patients undergoing surgery for a ventriculoperitoneal shunt.

Reduction of anticipatory brain activity in anxious people and regulatory effect of response-related feedback.

Elevated anxiety levels degrade task performance, likely because of cognitive function reduction in the frontoparietal brain network. This study aimed to test whether anxiety could impact the frontal cortex anticipatory brain functions and to investigate the possible beneficial effect of response-related feedback on task performance. The electroencephalographic activity was recorded while participants performed two Go/No-go tasks: one with response-related feedback on errors (feedback task) and one task without feedback (standard task). We first tested whether anxiety levels could be associated with pre-stimulus ERP components such as the prefrontal negativity (pN), linked with top-down attentional control, and the Bereitschaftspotential (BP), related to motor preparation. Then, we assessed whether feedback could affect anxious people's brain preparation, reducing the state of uncertainty and improving performance. Results showed that the pN was almost absent and the BP was lower during a standard task in the high anxiety than in the low anxiety group. In the feedback task, these components increased in the high anxious, becoming comparable to the low anxious. Behavioral results showed that false alarms in the high anxiety group were larger than in the low anxiety group during the standard task but became comparable in the feedback task. Similarly, response time in the high anxiety group was slower in the standard task than in the feedback task, and high anxious people were faster in the feedback task than in the standard one. This study contributes to clarifying neural correlates of anxiety, showing brain activity reductions related to action preparation in frontal areas. In addition, response-related feedback tasks could be used to normalize task performance in high anxious people.

A Neuropsychiatric and Neuroimaging Study of Unilateral and Bilateral Striatal Ischemic Lesions.

Neuropsychiatric disorders after striatal territory stroke have not been studied systematically. The investigators aimed to study the spectrum of cognitive and behavioral disorders following striatal infarcts. Different aspects of cognitive functions, including executive, frontal lobe, memory, visuospatial, language, and semantic processing, were assessed among patients with striatal infarct. Structural MRI data sets were obtained 3 months after stroke to delineate affected territories of the striatum. MRIcroGL software was used to acquire multiple layers of images, generate volume renderings, and draw volumes of interest. To determine the brain locus most frequently affected in patients with distinct cognitive disorders, ischemic area distributions in patients with cognitive dysfunction versus those without cognitive impairment were contrasted. Among 60 patients in this study, six different striatal infarction types were significantly associated with seven different cognitive categories (p<0.001). Unilateral caudate lesion was characterized by attention, planning, and executive disorders (38%), and unilateral lentiform infarct was characterized by executive (36%) and frontal (36%) dysfunctions. Bilateral caudate infarcts caused impairments in frontal and executive functions (75%), as well as in autobiographical (50%) and episodic (50%) memory. In those with bilateral caudate plus lentiform infarcts, all components of frontal and executive functions were dramatically impaired. The anteromedial striatum was affected more frequently in patients with language impairment compared with patients with other types of cognitive dysfunction (p<0.001). Following striatal stroke, a wide range of frontal-like cognitive impairments occurred, along with impaired working memory, declarative memory, executive function, speech fluency, and motor function.

A Review on Effect of Physical Activity as an Exogenous Factor and Cognitive Change in Motor Neuron Disease

Motor neuron disease (MND) is a terrible neurodegenerative illness with a poor prognosis and significant impairment. Despite recent advances in symptomatic care, there are few medicines that can affect survival. However, a better understanding of the underlying etiology would substantially aid the task of finding effective treatments. In the etiology of MND, many potential external risk factors have been hypothesized as part of a gene-environment interaction. Following reports of a greater than predicted incidence of MND in professional athletes, there has been an increasing interest in the role of intensive physical exercise in the development of the disease. Current hypotheses about the cellular and genetic causes of MND also support this conclusion. Epidemiological evidence, on the other hand, is contradictory and inconclusive. FTD/motor neuron disease is the name given to a motor neuronopathy that complicates frontotemporal dementia (FTD) (MND). FTD is marked by severe personality changes, abnormal social behavior, and executive difficulties caused by frontal and temporal neocortical atrophy. Bulbar palsy and limb amyotrophy are symptoms of motor neuron disease. Micro vacuolation of the cerebral cortex is the most common histological alteration, along with atrophy of the bulbar neurons and anterior horn cells of the spinal cord. Large pyramidal cortical neurons, surviving cranial nerve nuclei, and anterior horn cells all have ubiquitinated inclusion bodies. Evidence is accumulating that some patients with classical MND/amyotrophic lateral sclerosis (ALS) who are not regarded to be demented show frontal executive function abnormalities. Moreover, frontal lobe abnormalities have been demonstrated by neuroimaging. Keywords: MND, FTD, ALS, motor neuron, behavior, physical activity, cognitive change.

Better Executive Functions Are Associated With More Efficient Cognitive Pain Modulation in Older Adults: An fMRI Study.

Growing evidence suggests that aging is associated with less efficient endogenous pain modulation as demonstrated by reduced conditioned pain modulation, and that these changes may be mediated by differences in frontal functioning. Yet, little is known about potential age-related changes in cognitive pain modulation, such as distraction from pain. In a first session, 30 healthy young (19–35 years) and 30 healthy older (59–82 years) adults completed a battery of neuropsychological tests. In a second session, we acquired functional brain images while participants completed a working memory task with two levels of cognitive load (high vs. low) and concurrently received individually adjusted heat stimuli (warm vs. painful). In both age groups, completing the high load task was associated with a significant reduction in the perceived intensity and unpleasantness of painful stimuli and a reduction in activation of brain regions involved in pain processing. Group comparisons revealed that young adults showed a stronger de-activation of brain regions involved in pain processing during the high load vs. the low load task, such as the right insula, right mid cingulate cortex and left supramarginal gyrus, compared to older adults. Older adults, on the other hand, showed an increased activation in the anterior cingulate cortex during the high load vs. low load task, when compared to young adults. Covariate analyses indicated that executive functions significantly predicted neural pain modulation in older adults: Better executive functions were associated with a more pronounced de-activation of the insula, thalamus and primary somatosensory cortex and increased activation of prefrontal regions during the high vs. low load task. These findings suggest that cognitive pain modulation is altered in older age and that the preservation of executive functions may have beneficial effects on the efficacy of distraction from pain.

Systemic D1-R and D2-R antagonists in non-human primates differentially impact learning and memory while impairing motivation and motor performance.

Dopamine (DA) modulates cognition in part via differential activation of D1 and D2 receptors within the striatum and prefrontal cortex, yet evidence for cognitive impairments stemming from DA blockade or deficiency is inconsistent. Given the predominance of D1 over D2 receptors (R) in the prefrontal cortex of primates, D1-R blockade should more strongly influence frontal executive function (including working memory), while D2-R blockade should impair processes more strongly associated with the dorsal striatum (including cognitive flexibility, and learning). To test how systemic DA blockade disrupts cognition, we administered D1-R and D2-R like antagonists to healthy monkeys while they performed a series of cognitive tasks. Two selective DA receptor antagonist drugs (SCH-23390 hydrochloride: D1/D5-R antagonist; or Eticlopride hydrochloride: D2/D3-R antagonist) or placebo (0.9% saline) were systemically administered. Four tasks were used: (1) 'visually guided reaching', to test response time and accuracy, (2) 'reversal learning', to test association learning and attention, (3) 'self-ordered sequential search' to test spatial working memory, and (4) 'delayed match to sample' to test object working memory. Increased reach response times and decreased motivation to work for liquid reward was observed with both the D1/D5-R and D2/D3-R antagonists at the maximum dosages that still enabled task performance. The D2/D3-R antagonist impaired performance in the reversal learning task, while object and spatial working memory performance was not consistently affected in the tested tasks for either drug. These results are consistent with the theory that systemic D2/D3-R antagonists preferentially influence striatum processes (cognitive flexibility) while systemic D1/D5-R administration is less detrimental to frontal executive function.

Resting-State Electroencephalogram (EEG) Coherence Over Frontal Regions in Paranormal Beliefs.

Paranormal beliefs are defined as the belief in extrasensory perception, precognition, witchcraft, and telekinesis, magical thinking, psychokinesis, superstitions. Previous studies corroborate that executive brain functions underpin paranormal beliefs. To test this hypotheses, neurophysiological studies of brain activity are required. A sample of 20 students (10 girls, Mean±SD age: 22.50±4.07 years) were included in the current study. The absolute power of resting-state electroencephalogram (EEG) was analyzed in intra-hemispheric and inter-hemispheric coherence with eyes open. The paranormal beliefs were determined based on the total score of the revised paranormal belief scale (RPBS). The results of this study demonstrated a significant negative relationship between paranormal beliefs and resting-state EEG in alpha band activity in the frontal lobe (left hemisphere), EEG coherence of alpha and β1, β2, and gamma band activities in the frontal lobe (right hemisphere) and coherence of alpha and β1, β2 and gamma band activities between frontal regions (two hemispheres). In addition, the results showed that coherence of α, α1, β, and β2 band activities between the frontal lobe (right hemispheres) and the EEG coherence of Δ, α1, and beta band activities in the frontal lobe (two hemispheres) predict paranormal beliefs. This study confirms the connection of executive brain functions to paranormal beliefs and determines that frontal brain function may contribute to paranormal beliefs. Paranormal beliefs were negatively related to the EEG coherence.Paranormal beliefs were associated with EEG coherence in the right frontal lobe.We found a negative correlation between paranormal beliefs and the EEG coherence in the frontal lobes.EEG coherence the frontal lobes predicted paranormal beliefs. Paranormal beliefs were negatively related to the EEG coherence. They were associated with EEG coherence in the right frontal lobe. In this study, we found a negative correlation between paranormal beliefs and the EEG coherence in the frontal lobes. EEG coherence the frontal lobes predicted paranormal beliefs.

Nadishodhan pranayama-a cleansing technique: A review article

Practicing yoga like pranayama is becoming more and more important, as well as increased and more well-liked by the scientific community, as a result of the growing interest of the public in health and alternative therapies. One popular yogic breathing technique Nadishodhan Practicing yoga like pranayama is becoming more and more important, as well as increased Pranayama (NSP) is a well-known yogic breathing method that involves breathing through one nostril at a time while physically closing the other. This study attempted to compile published primary scientific information on the advantages of NSP and describe the impacts of independent NSP on numerous physiological, psychological, and general health issues in different populations. The following terms were entered into Google Scholar, PubMed/Medline, Cinahl, and Web of Science: Breathing through the NSPs, anulom-vilom/anuloma-viloma pranayama, and nada-shodhan/nada-shodhan pranayama. This review report includes 48 studies in total. The autonomic nervous system, the cardiopulmonary system, respiratory function, cognitive functioning, spatially memory as well as improved frontal and vertex function, problem-solving skills, motor memory recall, helps with depression and anxiety and other physiological characteristics were reviewed in this research for strong evidence of good effects. There is evidence that NSP Pranayama Studies on this yogic breathing have not found any negative side effects or tolerance issues.

Frontal Executive Function Assessment in Patients with Parkinson Disease Using Frontal Assessment Battery (FAB) at a Tertiary Care Center in Western India

Frontal Executive Function Assessment in Patients with Parkinson Disease Using Frontal Assessment Battery (FAB) at a Tertiary Care Center in Western India

Factors affecting global neurocognitive status and frontal executive functions in the early stage after surgical clipping of unruptured anterior circulation aneurysms with respect to keyhole clipping and conventional clipping.

This study investigated the most significant factor for the preservation of the global neurocognitive status and frontal executive functions in the surgical clipping of unruptured anterior circulation aneurysms, specifically in keyhole and conventional clipping procedures. The prospective study that was performed to examine the effects of aneurysm surgery on the patient's global neurocognitive status and frontal executive functions started on April 2016. After exclusion posterior circulation aneurysms, anterior communicating aneurysms treated by interhemispheric approach, giant aneurysms, and paraclinoid aneurysms, 23 patients who were enrolled before May 2017 were treated by conventional clipping, and 18 patients who were enrolled after June 2017 were treated by keyhole clipping. Two patients were excluded from each group due to missing data. Finally, 21 and 16 patients in each group were analyzed, respectively. Three-tesla magnetic resonance imaging was performed before and after surgery to detect the presence of perioperative cerebral infarctions and brain edema. The Mini-Mental State Examination, Frontal Assessment Battery, and Self-Rating Depression Scale scores were obtained before and 1month after surgery. Logistic regression analyses indicated that anterior communicating and internal carotid artery aneurysms were the most significant factors for poor outcomes and that keyhole clipping for these two types of aneurysm was the most significant factor for the preservation of patient global neurocognitive status. Keyhole clipping was also the most significant factor for the preservation of frontal executive functions in patients. Keyhole clipping may be more favorable than conventional clipping for the preservation of the global neurocognitive status and frontal executive functions. Moreover, it may be the most effective factor for preservation of global neurocognitive status when it is indicated for anterior communicating or internal carotid artery aneurysms.

Frontal lobe functions in schizophrenia: Interest of the Stuss approach

ObjectiveThe term Executive Functions (EFs) refers to the higher-level skills we use every day to control and coordinate our cognitive abilities and behaviours. EFs are mainly supported by the frontal lobes and its connections. EFs are frequently impaired in schizophrenia, but the profiles of executive deficits accompanying schizophrenia remains unclear. The use of specific EFs models might help to shed new light on this issue. Stuss (Stuss & Alexander, 2007; Stuss, 2008, 2011, 2017) proposed an integrative and operant model of EFs which has never been used to explore and characterize deficits in schizophrenia.The aim of this study is to further examine EFs in schizophrenia in the light of the frontal lobe functional approach developed by Stuss (2008, 2011, 2017) in order to question EFs impairment homogeneity and heterogeneity in schizophrenia. MethodsForty-five patients with schizophrenia and fifty-five healthy controls were recruited. They all completed a series of neuropsychological tests selected and adapted to measure the five majors' functions of the frontal lobe described by Stuss (2017). ResultsPatients showed deficits in almost all the frontal functions. Inside each frontal lobe function, correlations were observed between all the corresponding measures. The study of profiles highlighted a heterogeneous functioning in schizophrenia. ConclusionsThe model of Stuss (Stuss & Alexander, 2007; Stuss, 2008, 2011, 2017) allows accurate and specific measures of the frontal functions and observation. Beyond “cold” or “hot” EFs division, this integrative approach is helpful to understand links within neurocognition.

Unravelling the impact of frontal lobe impairment for social dysfunction in myotonic dystrophy type 1

Myotonic dystrophy type 1 is an autosomal dominant multisystemic disorder affecting muscular and extra muscular systems, including the central nervous system. Cerebral involvement in myotonic dystrophy type 1 is associated with subtle cognitive and behavioural disorders, of major impact on socio-professional adaptation. The social dysfunction and its potential relation to frontal lobe neuropsychology remain under-evaluated in this pathology. The neuroanatomical network underpinning that disorder is yet to disentangle. Twenty-eight myotonic dystrophy type 1 adult patients (mean age: 46 years old) and 18 age and sex-matched healthy controls were included in the study. All patients performed an exhaustive neuropsychological assessment with a specific focus on frontal lobe neuropsychology (motivation, social cognition and executive functions). Among them, 18 myotonic dystrophy type 1 patients and 18 healthy controls had a brain MRI with T1 and T2 Flair sequences. Grey matter segmentation, Voxel-based morphometry and cortical thickness estimation were performed with Statistical Parametric Mapping Software SPM12 and Freesurfer software. Furthermore, T2 white matter lesions and subcortical structures were segmented with Automated Volumetry Software. Most patients showed significant impairment in executive frontal functions (auditory working memory, inhibition, contextualization and mental flexibility). Patients showed only minor difficulties in social cognition tests mostly in cognitive Theory of Mind, but with relative sparing of affective Theory of Mind and emotion recognition. Neuroimaging analysis revealed atrophy mostly in the parahippocampal and hippocampal regions and to a lesser extent in basal ganglia, regions involved in social navigation and mental flexibility, respectively. Social cognition scores were correlated with right parahippocampal gyrus atrophy. Social dysfunction in myotonic dystrophy type 1 might be a consequence of cognitive impairment regarding mental flexibility and social contextualization rather than a specific social cognition deficit such as emotion recognition. We suggest that both white matter lesions and grey matter disease could account for this social dysfunction, involving, in particular, the frontal-subcortical network and the hippocampal/arahippocampal regions, brain regions known, respectively, to integrate contextualization and social navigation.

Dopamine influences attentional rate modulation in Macaque posterior parietal cortex

Cognitive neuroscience has made great strides in understanding the neural substrates of attention, but our understanding of its neuropharmacology remains incomplete. Although dopamine has historically been studied in relation to frontal functioning, emerging evidence suggests important dopaminergic influences in parietal cortex. We recorded single- and multi-unit activity whilst iontophoretically administering dopaminergic agonists and antagonists while rhesus macaques performed a spatial attention task. Out of 88 units, 50 revealed activity modulation by drug administration. Dopamine inhibited firing rates according to an inverted-U shaped dose–response curve and increased gain variability. D1 receptor antagonists diminished firing rates according to a monotonic function and interacted with attention modulating gain variability. Finally, both drugs decreased the pupil light reflex. These data show that dopamine shapes neuronal responses and modulates aspects of attentional processing in parietal cortex.

Early Intervention for an At-Risk 16-Month Old Using Visual Communication Analysis (VCA) Leads to Gifted Performance

Many developmental screeners focus heavily on receptive and expressive language skills, and the extent to which an infant can maneuver their environment. Research with young children typically involve motor skills, language, and occasionally simple procedural or problem solving tasks. The current study explores skills infants are expected to attain, and other skills that have never been tested in an infant who is considered &amp;ldquo;at-risk&amp;rdquo; due to moderate developmental delays.&amp;nbsp; &#x0D; &#x0D; Researchers collected data via specialized VCA software, video recordings, and the Vineland-3 pre- and post-study. The participant improved in all areas measured by the Vineland-3. Additionally, despite the participant being introduced to novel and progressively more difficult tasks, his average attention span throughout the entirety of the study was significantly longer than previous research suggests for infants. Researchers also implemented the detour box as a gross measure of frontal function. The participant successfully completed the detour task and multi-step problem solving.&amp;nbsp;

Correlation between changes in Timed Up and Go performance and cognition in older people with mild cognitive impairment: A longitudinal study

BackgroundCompare changes in performance on subtasks of the Timed Up and Go test over 32 months in older adults with and without mild cognitive impairment; analyze the correlation between frontal cognitive functions at baseline and changes in Timed Up and Go subtasks over time. MethodsA longitudinal study was conducted involving 31 older adults (15 with and 16 without cognitive impairment). Functional mobility was assessed at both evaluations using an adapted version of the Timed Up and Go test and the Qualisys motion system. The test was divided into five subtasks: sit-to-stand, walking forward, turn-to-walk, walking back and turn-to-sit. Cognition was assessed at baseline using the Frontal Assessment Battery and the Clock Drawing Test. FindingsSignificant differences in changes in the sit-to-stand subtask over time were found between groups. The difference in the time required to conclude this subtask was greater in the older adults with cognitive impairment. However, the difference in kinematic variables (peak trunk speed and range of motion) was greater in the group without cognitive impairment. Strong and moderate correlations were found between frontal cognitive functions and changes in Timed Up and Go subtasks, especially those involving transitions (sit-to-stand, turn-to-walk and turn-to-sit) in both groups. InterpretationMotor intervention protocols should incorporate the sit-to-stand subtask in older adults with mild cognitive impairment. Moreover, changes in more complex subtasks seem to be related to frontal cognitive performance at baseline. Therefore, treatments that combine motor and cognitive functions should be administered to older adults regardless of cognitive impairment.

Comparison of decision-making under ambiguity in patients with temporal lobe and frontal lobe epilepsy

ObjectiveThe effect of the frontal lobe on cognitive functions is a subject that has been studied frequently. However, cognitive impairments that can be seen in frontal lobe epilepsy are less addressed. In previous studies on decision-making disorders in patients with epilepsy, patients with temporal lobe epilepsy (TLE) were frequently studied, and it was reported that decision-making disorders could be encountered in this patient group. In this study, we aimed to compare the decision-making performance of patients with cryptogenic frontal lobe epilepsy (FLE) and TLE in ambiguous situations. MethodsTwenty patients with TLE (mean age: 34.10 ± 11.71 years) and 20 patients with FLE (mean age: 32.25 ± 11.92 years) were enrolled in the study and their cognitive performance was compared with 20 healthy controls (mean age: 33.15 ± 13.66 years). Neuropsychological tests were performed on the participants for sleep, depression, anxiety, impulsivity, intelligence, attention, language functions, memory and learning, and frontal axis functions. Decision-making performance in ambiguous situations was studied using the Iowa Gambling Task (IGT). ResultsIowa Gambling Task performances of patients with FLE and TLE were found to be worse than in healthy controls (p = 0.049). Although there was no statistically significant difference when the decision-making of patients with TLE and FLE was compared, it was observed that patients with FLE chose higher risk cards compared with those with TLE. The performances of the neuropsychological subgroup tests of patients with TLE and FLE in attention, language functions, memory and learning, and frontal axis functions were found to be significantly worse than in healthy subjects. ConclusionDecision-making in patients with TLE and FLE in ambiguous situations is similarly impaired compared with healthy controls.

Early Intervention for an AtRisk 16-Month Old Using Visual Communication Analysis (VCA) Leads to Gifted Performance

Many developmental screeners focus heavily on receptive and expressive language skills, and the extent to which an infant can maneuver their environment. Research with young children typically involve motor skills, language, and occasionally simple procedural or problem solving tasks. The current study explores skills infants are expected to attain, and other skills that have never been tested in an infant who is considered “at-risk” due to moderate developmental delays. Researchers collected data via specialized VCA software, video recordings, and the Vineland-3 pre- and post-study. The participant improved in all areas measured by the Vineland-3. Additionally, despite the participant being introduced to novel and progressively more difficult tasks, his average attention span throughout the entirety of the study was significantly longer than previous research suggests for infants. Researchers also implemented the detour box as a gross measure of frontal function. The participant successfully completed the detour task and multi-step problem solving

Local Prefrontal Cortex TMS-Induced Reactivity Is Related to Working Memory and Reasoning in Middle-Aged Adults.

IntroductionThe prefrontal cortex (PFC) plays a crucial role in cognition, particularly in executive functions. Cortical reactivity measured with Transcranial Magnetic Stimulation combined with Electroencephalography (TMS-EEG) is altered in pathological conditions, and it may also be a marker of cognitive status in middle-aged adults. In this study, we investigated the associations between cognitive measures and TMS evoked EEG reactivity and explored whether the effects of this relationship were related to neurofilament light chain levels (NfL), a marker of neuroaxonal damage.MethodsFifty two healthy middle-aged adults (41–65 years) from the Barcelona Brain Health Initiative cohort underwent TMS-EEG, a comprehensive neuropsychological assessment, and a blood test for NfL levels. Global and Local Mean-Field Power (GMFP/LMFP), two measures of cortical reactivity, were quantified after left prefrontal cortex (L-PFC) stimulation, and cognition was set as the outcome of the regression analysis. The left inferior parietal lobe (L-IPL) was used as a control stimulation condition.ResultsLocal reactivity was significantly associated with working memory and reasoning only after L-PFC stimulation. No associations were found between NfL and cognition. These specific associations were independent of the status of neuroaxonal damage indexed by the NfL biomarker and remained after adjusting for age, biological sex, and education.ConclusionOur results demonstrate that TMS evoked EEG reactivity at the L-PFC, but not the L-IPL, is related to the cognitive status of middle-aged individuals and independent of NfL levels, and may become a valuable biomarker of frontal lobe-associated cognitive function.

An improved driving ability after attention function training for safe driving via use of a day rehabilitation service in a patient with cerebral infarction

In recent years, the assessment of and support for the safety of driving for people with higher brain dysfunction to allow them to resume car driving have become issues to be addressed in Japan. It is difficult to determine whether or not people with higher brain dysfunction may safely resume car driving; in addition, methods of supporting this resumption have not been established. To support people with higher brain dysfunction and allow them to live at home in areas where public means of transportation may be insufficient, initiatives promoting the resumption of car driving are necessary in healthcare sectors, including day rehabilitation facilities. We provided support to a patient with an attention disorder due to left thalamic infarction, with the aim of achieving sufficient independence to drive a car, in a day rehabilitation facility. We herein report this case from the perspective of a speech-language-hearing therapist. The patient was a right-handed man in his 60s who had higher brain dysfunction with attention disorder as the main symptom. No marked motor paralysis of the extremities was observed. Use of a day rehabilitation service was started approximately two months after the onset of symptoms. Rehabilitation and support aimed at the resumption of car driving were provided approximately one month after the start of the day rehabilitation service use. To determine whether or not the patient was fit to drive a car, higher brain function tests for the intellectual function, attention function, and frontal function, as well as a theoretical evaluation based on the Stroke Drivers' Screening Assessment Japanese Version (J-SDSA) and monitoring of daily behaviors were performed. In addition, after the patient was given permission from an attending physician to drive a car on the condition that the patient did not drive fast and the patient's wife always accompanied him while driving, a safety assessment was also performed. As a result, approximately 10 months later, the J-SDSA theoretical evaluation score showed a passing grade, in contrast to the failing grade he had previously earned. Furthermore, errors in performing household activities due to a decreased attention function became unremarkable with respect to daily behaviors; therefore, we determined, together with the attending physician, that the patient now had sufficient independence to drive a car. In our day rehabilitation facility, the number of requests for advice on car driving from people with higher brain dysfunction living in the community had been increasing. Multisectoral assessments, training, and instruction should be continued in collaboration with attending physicians, other facilities located within the community, and driving schools in order to support people with higher brain dysfunction and help them once again be able to drive a car.

Exploring Cognitive Impairment in Patients With Bilateral Capsular Genu Lesions

The authors investigated for presence of cognitive impairment after occurrence of bilateral lesions of the genu of the internal capsule (GIC). Clinical and neuropsychological features of unilateral GIC lesions have previously been studied, but the cognitive profile of bilateral lesions of the GIC has not been fully explored. An investigation was conducted of neurocognitive deficits and computerized tomography MRI findings among 4,200 stroke patients with bilateral GIC involvement who were admitted to the hospital between January 2010 and October 2018. Eight patients with bilateral lesions of the capsular genu were identified and their data analyzed. Overall, behavioral and cognitive dysfunction were characterized by impairment of frontal, memory, and executive functions. Attention and abstraction were present among all eight patients (100%); apathy, abulia, and executive dysfunctions, among seven (87.5%); global mental dysfunction and planning deficits, among six (75.0%); short-term verbal memory deficits and language dysfunctions, among five (62.5%); long-term verbal memory deficits, among four (50.0%); and spatial memory deficits, reading, writing, counting dysfunctions, and anarthria, among two (25.0%). Four of the patients (50.0%) without a history of cognitive disorder showed severe mental deterioration compatible with the clinical picture of dementia. A clinical picture of dementia was still present in these patients 6 months after stroke. Bilateral lesions of the capsular genu appearing either simultaneously or at different times were significantly associated with executive dysfunctions.