Impaired Visuospatial Function Research Articles

Cross-Sectional Analysis of Periodontal Disease and Cognitive Impairment Conducted in a Memory Clinic: The Pearl Study.

Periodontal disease (PeD) is a risk factor of Alzheimer's disease and is associated with cognitive decline in older adults. However, the relationships between subitems of neuropsychological tests and PeD have not been fully clarified. To evaluate associations between PeD and subitems of neuropsychological tests. We performed a cross-sectional analysis of data of 183 participants (women: 50%, mean age: 79 years) from a clinical study. We enrolled patients who visited our memory clinic and assessed demographics, dementia-related risk factors, neuropsychological tests, brain magnetic resonance images, and a dental screening check. We evaluated the relationships between cognitive function and PeD using multivariable logistic regression analyses. Participants with dementia were less likely to make periodical visits to the dentist, had fewer teeth, had less frequent tooth brushing habits, and were more likely to have PeD. Impaired cognitive function was significantly associated with an increasing degree of PeD. In multivariable logistic regression analyses, impaired visuospatial function and attention were associated with twice the risk of moderate or severe PeD compared with individuals with preserved visuospatial function and attention (odds ratio: 2.11, 95% confidence interval: 1.04-4.29, p = 0.037). Impaired word recall and recognition and following commands were associated with increased risk of PeD (odds ratio: 2.80, 95% confidence interval: 1.41-5.32, p = 0.003). Cognitive decline, such as impaired visuospatial function, attention, word recall and recognition, and inability to follow commands were independently and strongly associated with PeD. These items can be assessed easily on a daily basis.

Modifiable Lifestyle Activities Affect Cognition in Cognitively Healthy Middle-Aged Individuals at Risk for Late-Life Alzheimer's Disease.

It is now acknowledged that Alzheimer's disease (AD) processes are present decades before the onset of clinical symptoms, but it remains unknown whether lifestyle factors can protect against these early AD processes in mid-life. We asked whether modifiable lifestyle activities impact cognition in middle-aged individuals who are cognitively healthy, but at risk for late life AD. Participants (40-59 years) completed cognitive and clinical assessments at baseline (N = 206) and two years follow-up (N = 174). Mid-life activities were measured with the Lifetime of Experiences Questionnaire. We assessed the impact of lifestyle activities, known risk factors for sporadic late-onset AD (Apolipoprotein E ɛ4 allele status, family history of dementia, and the Cardiovascular Risk Factors Aging and Dementia score), and their interactions on cognition. More frequent engagement in physically, socially, and intellectually stimulating activities was associated with better cognition (verbal, spatial, and relational memory), at baseline and follow-up. Critically, more frequent engagement in these activities was associated with stronger cognition (verbal and visuospatial functions, and conjunctive short-term memory binding) in individuals with family history of dementia. Impaired visuospatial function is one of the earliest cognitive deficits in AD and has previously associated with increased AD risk in this cohort. Additionally, conjunctive memory functions have been found impaired in the pre-symptomatic stages of AD. These findings suggest that modifiable lifestyle activities offset cognitive decrements due to AD risk in mid-life and support the targeting of modifiable lifestyle activities for the prevention of AD.

Decreased cortical thickness and normal regional homogeneity underlying cognitive impairment in cerebral small vessel disease

Cerebral small vessel disease (CSVD) is the most common cause of vascular cognitive impairment (CI). However, the cognitive performance of individuals with CSVD varies considerably. Early identification of neuroimaging changes related to CI caused by CSVD is important for the prediction and management of CI. The present study aimed to explore the early alterations in cortical thickness and regional homogeneity (ReHo) related to CI in people with CSVD. A total of 106 participants with CSVD with CI, 77 participants with CSVD without CI, and 121 control participants underwent neuropsychological tests and multimodal magnetic resonance imaging scans. Cortical thickness was analyzed using FreeSurfer software, and ReHo patterns were explored using the DPARSF toolbox in brain regions that exhibited alterations in cortical thickness. The CSVD with CI group exhibited decreased cortical thickness but normal ReHo in the right anterior cingulate gyrus (ACG), right cuneus, bilateral insula, and right middle temporal gyrus compared with that in the other two groups. Specifically, both cortical thickness and ReHo in the right ACG were significantly associated with memory performance in CSVD patients with CI. In addition, impaired visuospatial function occurred earlier than the decline of global function in CSVD patients and was related to cortical thinning in the right middle temporal gyrus. In conclusion, decreased cortical thickness but normal ReHo in the right ACG, right cuneus, bilateral insula, and right middle temporal gyrus are characteristic alterations related to the development of CI in CSVD patients. These findings may contribute to the early prediction of CI in CSVD patients.

Effect of altitude zone exposure on visuospatial function in military aircrew member.

Introductionvisuospatial is a type of high-level visual perception necessary for identification, information integration, analysing of visual and spatial forms, details, structures and spatial relation. These functions are required in order to successfully complete aviation-related tasks, such as analysing movement, distance perception, and spatial navigation. The aim of this study is to examine whether hypobaric hypoxia can significantly influence changes in visuospatial function, thus increasing the risk of accident or serious incident during flight operation.Methodsthis study is a quasi-experiment of pre-post study including before and after hypobaric hypoxia simulated through an altitude chamber. In this study, 42 military aircrews were exposed to different altitude zones at ground level, 10,000 ft (ft) and 25,000 ft respectively, for five minutes. At each altitude zone, the participants were instructed to complete a clock drawing test as a measurement for visuospatial function. The results were analysed using the McNemar non-parametric test.Resultsamong the 42 subjects, six show impaired visuospatial function at 10,000 ft and 26 participants show it at 25,000 ft. There were significant increased on the proportion of impaired visuospatial function between the ground level to 10,000 ft (p=0.031), 10,000 to 25,000 ft (p=0.0001) and ground level to 25,000 ft (p=0.0001).Conclusionhypobaric hypoxia may have a significant influence on visuospatial function, starting from as early as 10,000 ft to 25,000 ft. This decrease of visuospatial function could affect human cognitive performance when flying and increase the risk of aviation accidents.

<p>Impaired Cognitive Abilities in Siblings of Patients with Temporal Lobe Epilepsy</p>

PurposePatients with temporal lobe epilepsy (TLE) are at high risk of cognitive impairment. In addition to persistent seizures and antiepileptic drugs (AEDs), genetic factors also play an important role in the progression of cognitive deficits in TLE patients. Defining a cognitive endophenotype for TLE can provide information on the risk of cognitive impairment in patients. This study investigated the cognitive endophenotype of TLE by comparing neuropsychological function between patients with TLE, their unaffected siblings, and healthy control subjects.Patients and MethodsA total of 46 patients with TLE, 26 siblings, and 33 control subjects were recruited. Cognitive function (ie, general cognition, short- and long-term memory, attention, visuospatial and executive functions, and working memory) was assessed with a battery of neuropsychological tests. Differences between groups were evaluated by analysis of covariance, with age and years of education as covariates. The Kruskal–Wallis test was used to evaluate data that did not satisfy the homogeneity of variance assumption. Pairwise comparisons were adjusted by Bonferroni correction, with a significance threshold of P<0.05.ResultsPatients with TLE showed deficits in the information test (P<0.001), arithmetic test (P=0.003), digit symbol substitution test (P=0.001), block design test (BDT; P=0.005), and backward digit span test (P=0.001) and took a longer time to complete the Hayling test Part A (P=0.011) compared to controls. Left TLE patients tended to have worse executive function test scores than right TLE patients. The siblings of TLE patients showed deficits in the BDT (P=0.006, Bonferroni-corrected) relative to controls.ConclusionPatients with TLE exhibit cognitive impairment. Executive function is worse in patients with left TLE than in those with right TLE. Siblings show impaired visuospatial function relative to controls. Thus, cognitive deficits in TLE patients have a genetic component and are independent of seizures or AED use.

Neuropsychological, clinico‐pathologic, neuroimaging, and biomarker profiles of the MGH FTD Unit posterior cortical atrophy (PCA) cohort

AbstractBackgroundObjective: To present comprehensive data on the MGH FTD Unit PCA cohort. PCA is a neurodegenerative clinical syndrome usually arising from Alzheimer’s Disease (AD) neuropathologic changes (ADNC). While visuoperceptual and spatial problems are typical early presenting symptoms, patients also report problems with spelling, calculation, and word retrieval. Due to significant heterogeneity in the syndrome, further classification of PCA by subtypes based on predominant cognitive impairments (dorsal, ventral, caudal, dominant parietal) has also been proposed. We launched our multidisciplinary MGH PCA program in 2008 to address the special care needs of this population, and to advance our scientific understanding of PCA and its treatment.Methods39 participants were recruited for research participation based on clinical diagnostic criteria consistent with PCA, including a dominant hemisphere variant (i.e., progressive Gerstmann‐like syndrome minimal visuospatial disturbance). Participants underwent structured review of symptoms and history; systematic neurological exam; comprehensive neuropsychological and speech‐language assessments; multimodal imaging (MRI and/or functional MRI and FDG, amyloid, and tau PET); and CSF analysis. Some patients have come to autopsy. We used the Neuropsychological Assessment Rating (NAR) scale to quantify performance in cognitive domains pertinent to PCA and for subtype classification.ResultsOf seven individuals for whom we have autopsy‐confirmed neuropathology, five had ADNC; one had lobar atrophy and tau pathology in a cortico‐basal degeneration (CBD) distribution; and one had Frontotemporal Lobar Degeneration TDP43 Type A (GRN mutation). 22 patients had biomarkers consistent with ADNC (17 with elevated PiB PET imaging signal, 5 with AD‐like CSF ). Mean NAR domain scores (impairment level ratings: 0=Normal, .5=questionable/very mild, 1=mild, 2= moderate, 3=severe) revealed relatively normal Attention/Processing Speed (0.2); mildly impaired Executive Function (0.8) and Memory (1.1); questionably/very mildly impaired Language (0.5); and moderately impaired Visuospatial Function (2).ConclusionThe MGH PCA program has a robust cohort of patients with a comprehensive data set that includes standardized characterization of the PCA neurocognitive and neurologic profiles, high‐resolution MRI (structural, functional), multimodal PET imaging, CSF biomarkers, and in some cases neuropathology. This data set will allow for detailed examination and improved understanding of this atypical neurodegenerative syndrome. Additional analyses are ongoing, including tau imaging profiles.

Abstract WP493: Post-Stroke Chinese Pure Alexia: Prominent Shape-Similar Errors and Associated Neuropsychological Profiles

Objective: To describe the characteristics of post-stroke Chinese pure alexia and associated neuropsychological profiles. Methods: All patients with post-stroke pure alexia from the neurology department of our hospital were enrolled from June 2018 to July 2019. Brain MRI was performed to evaluate the stroke radiologically. The Aphasia Battery of Chinese (ABC) was used to evaluate the general language functions. A Chinese individual character reading test including 68 commonly used characters was used to evaluate the ability to read individual Chinese characters. The numbers of correct reading and misreading were recorded, and the error types of misreading were analyzed. MMSE, auditory verbal learning test, cube copying task, clock drawing test, and picture copying tests were performed to evaluate other cognitive impairments. Results: A total of 5 male patients were included, with a median age of 58 years (50-64 years). They all had Chinese pure alexia with intact verbal comprehension and speech and relatively preserved writing skills. The etiologies were all acute infarction involving the left temporo-parietal lobe and splenium of corpus callosum. In the Chinese individual character reading test, the median number of correct reading was 21 (18-44) out of 68 characters, with many shape-similar errors (one character was read as another one with a similar shape but different meaning and pronunciation). The percentage of shape-similar errors among all type errors was 81.5%, 60.0%, 23.7%, 18.5%, and 57.9% respectively, and 43.1% overall, much higher than other type errors. All the patients had obvious impairment in memory and visuospatial function with an exception that one patient had relatively preserved visuospatial ability. Conclusion: Shape-similar error is a remarkable feature of Chinese pure alexia. Chinese pure alexia is associated with impaired visuospatial function, but visuospatial dysfunction is not necessary for the development of Chinese pure alexia.

Cerebellum and cognition in Friedreich ataxia: a voxel-based morphometry and volumetric MRI study.

Recent studies have suggested the presence of a significant atrophy affecting the cerebellar cortex in Friedreich ataxia (FRDA) patients, an area of the brain long considered to be relatively spared by neurodegenerative phenomena. Cognitive deficits, which occur in FRDA patients, have been associated with cerebellar volume loss in other conditions. The aim of this study was to investigate the correlation between cerebellar volume and cognition in FRDA. Nineteen FRDA patients and 20 healthy controls (HC) were included in this study and evaluated via a neuropsychological examination. Cerebellar global and lobular volumes were computed using the Spatially Unbiased Infratentorial Toolbox (SUIT). Furthermore, a cerebellar voxel-based morphometry (VBM) analysis was also carried out. Correlations between MRI metrics and clinical data were tested via partial correlation analysis. FRDA patients showed a significant reduction of the total cerebellar volume (p = 0.004), significantly affecting the Lobule IX (p = 0.001). At the VBM analysis, we found a cluster of significant reduced GM density encompassing the entire lobule IX (p = 0.003). When correlations were probed, we found a direct correlation between Lobule IX volume and impaired visuo-spatial functions (r = 0.58, p = 0.02), with a similar correlation that was found between the same altered function and results obtained at the VBM (r = 0.52; p = 0.03). With two different image analysis techniques, we confirmed the presence of cerebellar volume loss in FRDA, mainly affecting the posterior lobe. In particular, Lobule IX atrophy correlated with worse visuo-spatial abilities, further expanding our knowledge about the physiopathology of cognitive impairment in FRDA.

Neuropsychological rehabilitation of patients with symptoms of depression after ischemic stroke

Introduction Depression significantly affects the effects of rehabilitation, quality of life, as well as patients’ mortality. The estimated prevalence of post-stroke depression is approximately 25%–70%. Aim To examine when neuropsychological rehabilitation after stroke affects the cognitive functions of people suffering from depression. Material and methods 42 persons after ischemic stroke suffering from depression took part in the study. The participants were in 3 weeks daily neurological rehabilitation care. Mood disorders were measured by Beck depression inventory. Cognitive functions were examined using verbal fluency test and following psychological tests: mini mental state examination, color trail test and Benton visual retention test. Results and discussion Mood disorders were diagnosed in 70% of patients. The neuropsychological diagnosis revealed existing memory disorders, low resistance to distractors (30.9% participants), impaired visuospatial function (78.7%), impaired ability to recognize visual stimuli with preserved normal vision, weakened executive functions, in particular planning, initiating and sustaining activities (85.6%), rigid thinking, slackening, difficulty with focusing on the task, problems with selective attention and increased levels of anxiety. Verbal fluency deficits was diagnosed in 92.9% of patients. Significant improvements were observed for all cognitive domains after neuropsychological rehabilitation. The biggest improvement was noted in the attentional domain (73.8%), the least – in the visuo-spatial functions (21.4%). Conclusions Depression is a frequent and important problem among patients with stroke, as a post-stroke depression is present in at least 30% of survivors from stroke. Psychological complications such as emotional, behavioral and cognitive disorders, can have a negative effects on the social functioning and the overall quality of life of stroke survivors.

Visuospatial memory in patients with obsessive-compulsive disorder

Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder. The previous studies have been conducted to elucidate visuospatial and nonverbal memory deficits in OCD patients. However, they did not reach equivocal results which need to be replicated. Objectives: The current study examines the visuospatial memory in male patients with OCD as compared to normal healthy controls. Materials and Methods: It is a cross-sectional hospital-based study, in which 15 OCD patients and 15 age-, sex-, and education-matched normal healthy controls were chosen by purposive sampling technique. All the participants underwent the Extended Complex Figure Test (ECFT) for the assessment of visuospatial memory. Results: Significant difference was found between OCD patients and normal healthy controls on various domains of ECFT. OCD patients performed poorly on copy condition (t = −4.46; P< 0.001), immediate recall (t = −5.20; P< 0.001), delayed recall (t = −5.18; P< 0.001), recognition task (P < 0.001), and matching task (P < 0.001) than the controls. Conclusion: Visuospatial memory was significantly impaired in OCD that included disturbed encoding and impaired visuospatial functioning. Hence, it is important to understand the significance of visuospatial memory in the pathophysiology for OCD diagnosis and therapeutic decision.

Single-subject gray matter graph properties and their relationship with cognitive impairment in early- and late-onset Alzheimer's disease.

Abstract We investigated the relationships between gray matter graph properties and cognitive impairment in a sample of 215 patients with Alzheimer's disease (AD) and also whether age of disease onset modifies such relationships. We expected that more severe cognitive impairment in AD would be related to more random graph topologies. Single-subject gray matter graphs were constructed from T1-weighted magnetic resonance imaging scans. The following global and local graph properties were calculated: betweenness centrality, normalized clustering coefficient γ, and normalized path length λ. Local clustering, path length, and betweenness centrality measures were determined for 90 anatomically defined areas. Regression models with as interaction term age of onset (i.e., early onset when patients were ≤65 years old and late onset when they were >65 years old at the time of diagnosis)×graph property were used to assess the relationships between cognitive functioning in five domains (memory, language, visuospatial, attention, and executive). Worse cognitive impairment was associated with more random graphs, as indicated by low γ, λ, and betweenness centrality values. Three interaction effects for age of onset×global graph property were found: Low γ and λ values more strongly related to memory impairment in early-onset patients; low beta values were significantly related to impaired visuospatial functioning in late-onset patients. For the local graph properties, language impairment showed the strongest relationship with decreased clustering coefficient in the left superior temporal gyrus across the entire sample. Our study shows that single-subject gray matter graph properties are associated with individual differences in cognitive impairment.

Cognitive Impairment in Native Chinese with Spinocerebellar Ataxia Type 3

Background: Previous studies have shown cognitive impairment in patients with spinocerebellar ataxia type 3 (SCA3). However, there is a lack of data on Chinese patients with SCA3. Method: We investigated 22 native Chinese with SCA3 and 18 controls matched for age, education as well as mental status. Cognitive assessments were carefully carried out to measure verbal fluency, memory, attention, executive function, visuospatial and visuoconstructive functions. Results: The most common impairments of cognition in native Chinese with SCA3 were disruption of phonemic verbal fluency and frontal executive dysfunction. Deficits in semantic fluency were detected in about 31.8% patients. Impaired visuospatial function and verbal memory were also found in native Chinese with SCA3. The degree of ataxia, CAG repeat length and education were found to correlate with cognitive performance. Multivariate binary logistic regression suggested that an oculomotor disorder and depression are predictors of cognitive impairment. Conclusion: Native Chinese with SCA3 had cognitive impairment of frontal executive function, temporal and parietal functions. An oculomotor disorder might be an index of cognitive dysfunction.

57. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections perceived as conversion disorder. A case study of a young woman

There is growing evidence that obsessive–compulsive disorder and/or tics is associated with immune response following streptococcal infections (PANDAS, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). This case report describes a woman with debut of headaches and anorexia at age 15. Two years later after throat infections, she developed acute severe motor and vocal tics and difficulties in walking but MR and EEG were normal. Symptoms persisted five months until 2 weeks penicillin V treatment was initiated due to elevated streptococcus titers in serum. Treatment resulted in several months of improvement, however after termination symptoms gradually reoccurred. In addition a range of psychiatric symptoms including auditory and visual hallucinations were diagnosed. At the age of 22 she occasionally used crutches and had a magnitude of motor symptoms, relapsing-remitting attacks of pain, confusion and regressive behaviors and thus was diagnosed with conversion disorder by a psychiatrist. However, laboratory check-up showed increased concentration of calcium-calmodulin dependent protein (CaM) kinase II activity in serum and CSF, supportive of a PANDAS diagnose. Flow cytometry of CSF showed increase of phosphatidylserine containing microparticles and HMGB-1, and scanning electron microscopy displayed spherical particles with a diameter of about 1 μm. Neuropsychological assessment revealed impaired visuospatial functioning and signs of cognitive deterioration. Current treatment with Amoxicillin with clavulanic acid has not resulted in improvement and intravenous immune globulin treatment (IVIG) is planned.

Early neuropsychological discriminants for Lewy body disease: an autopsy series

ObjectiveTo determine which neuropsychological test measures and which symptoms at presentation might best differentiate dementia with Lewy bodies (DLB) from Alzheimer's disease (AD).MethodsCases were from the Columbia University Alzheimer's Disease...

Corticobasal Syndrome Presenting With Partial Gerstmann’s Syndrome and Digit Agnosia

Back to table of contents Previous article Next article LettersFull AccessCorticobasal Syndrome Presenting With Partial Gerstmann’s Syndrome and Digit AgnosiaMichele Poletti, Claudio Lucetti, Andrea Vergallo, and Ubaldo BonuccelliMichele PolettiSearch for more papers by this author, Claudio LucettiSearch for more papers by this author, Andrea VergalloSearch for more papers by this author, and Ubaldo BonuccelliSearch for more papers by this authorPublished Online:1 Apr 2013https://doi.org/10.1176/appi.neuropsych.12060155AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Gerstmann’s syndrome (GS) is a clinical picture characterized by finger agnosia, left–right confusion, agraphia, and acalculia, associated with focal left posterior-inferior parietal lesions.1 Partial presentations of GS have been reported in neurodegenerative diseases,2,3 as we describe in a patient presenting with GS and digit agnosia as early symptoms.A 62-year-old, right-handed woman, with 8 years of formal education, came to our attention because of mild cognitive difficulties involving limb praxis. The neurological examination detected upper limb tremor, more left-lateralized; global bradykinesia; rigidity of left limbs; bilateral focal myoclonus, stimulus-sensitive, more evident on the left limbs; and gait apraxia; the alien limb phenomenon was not present. Instrumental examinations detected bilateral temporo-parietal alterations (EEG), cortical atrophy (RMI), bilateral hypometabolism in the frontal-temporal-parietal cortices, and bilateral striatal degeneration (DAT-SCAN).The neuropsychological assessment detected executive difficulties, impaired visuospatial functions, and bilateral ideomotor limb apraxia, and therefore focused on GS. The patient showed finger agnosia (Two-Point Finger test,1 Finger Agnosia test,1 In-Between test)1 and toe agnosia;4 that is, digit agnosia. She also presented acalculia (being unable to count backward from 10 to 0 and perform multiplication tables), Left–Right Confusion (3/5 in the two-stage command1 and 2/5 in relation to experimenter body) and agraphia (5/20 correct words in dictation; no signs of alexia), although limb motor difficulties hampered its examination.Although only a pathological examination could confirm the clinical diagnosis, her clinical picture was suggestive of a parkinsonism, probably a corticobasal syndrome (CBS); a progressive neurodegenerative disease with atrophy, gliosis, and tau-immunoreactive pathology of both gray and white matter of neocortex, basal ganglia, and substantia nigra, and clinically characterized by asymmetric akinesis and rigidity; dystonia of the upper limb; apraxia, myoclonus, and dementia.5The neuropsychological assessment evidenced digit agnosia and at least a partial GS; indeed, although her limb motor difficulties hampered the examination of agraphia, it appeared likely. Interestingly, the neuropsychological pattern of CBS partially overlaps the clinical presentation of GS as regards acalculia, number processing, and agraphia, and both CBS and GS are associated with parietal lesions.1,5 Despite their possible phenotypic overlapping, only two cases of pathologically-confirmed corticobasal degeneration and partial presentation of GS have been described.2 The current study confirmed that GS, including digit agnosia, may characterize the early clinical stages of a neurodegenerative disease affecting parietal lobes, as CBS.Dept. of Neuroscience, University of Pisa, Via Rome, Pisa, ItalyNeurology Unit, Versilia Hospital, Via Aurelia, Lido di Camaiore (LU), ItalyCorrespondence: Prof. Ubaldo Bonuccelli, Department of Neuroscience, University of Pisa, Italy; e-mail: u.[email protected]unipi.itReferences1 Rusconi E, Pinel P, Dehaene S, et al.: The enigma of Gerstmann’s syndrome revisited: a telling tale of the vicissitudes of neuropsychology. Brain 2010; 133:320–332Crossref, Medline, Google Scholar2 Wingard EM, Barrett AM, Crucian GP, et al.: The Gerstmann syndrome in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2002; 72:403–405Crossref, Medline, Google Scholar3 Tang-Wai DF, Josephs KA, Boeve BF, et al.: Pathologically confirmed corticobasal degeneration presenting with visuospatial dysfunction. Neurology 2003; 61:1134–1135Crossref, Medline, Google Scholar4 Tucha O, Steup A, Smely C, et al.: Toe agnosia in Gerstmann syndrome. J Neurol Neurosurg Psychiatry 1997; 63:399–403Crossref, Medline, Google Scholar5 Mahapatra RK, Edwards MJ, Schott JM, et al.: Corticobasal degeneration. Lancet Neurol 2004; 3:736–743Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited BySome evidence on Gerstmann’s syndrome: A case study on a variant of the clinical disorderBrain and Cognition, Vol. 148 Volume 25Issue 2 Spring 2013Pages E70-E70 Metrics PDF download History Published online 1 April 2013 Published in print 1 April 2013

Blindness or Agnosia: Review of Posterior Cortical Atrophy and a Difficult Case

The Objective was to brie fly review the rare condition Posterior Cortical Atrophy (PCA) and demonstrate a difficult case suffering from both visual disturbances due to glaucoma and visual agnosia due to PCA. The short review was made by Pub Med search including “Posterior Cortical Atrophy” and the reference lists from the obtained articles were scrutinized for relevant literature not retrieved from PubMed. PCA is a slowly progressing neurodegenerative disorder that is very disabling due to disturbances of higher visual functions, although memory might be relatively preserved until late in the course. Some previous authors have underscored, that to diagnose a patient with PCA one must rule out that the patient is suffering from an eye disease. We demonstrate a difficult case suffering from both glaucoma and PCA. The diagnostic characteristics for PCA are described, and neuroimaging including positron emission tomography (PET) with the amyloid binding ligand (11C) Pittsburgh compound B (PiB), and results from treatment of PCA are presented. Caution should be advised when patients with impaired visual acuity develop signs of cognitive dysfunction, and a full neuropsychological examination should be performed whenever there is doubt of the significance of visual impairment and impaired visuospatial functions. doi:10.4021/jnr91w

Blindness or Agnosia: Review of Posterior Cortical Atrophy and a Difficult Case

The Objective was to brie fly review the rare condition Posterior Cortical Atrophy (PCA) and demonstrate a difficult case suffering from both visual disturbances due to glaucoma and visual agnosia due to PCA. The short review was made by Pub Med search including “Posterior Cortical Atrophy” and the reference lists from the obtained articles were scrutinized for relevant literature not retrieved from PubMed. PCA is a slowly progressing neurodegenerative disorder that is very disabling due to disturbances of higher visual functions, although memory might be relatively preserved until late in the course. Some previous authors have underscored, that to diagnose a patient with PCA one must rule out that the patient is suffering from an eye disease. We demonstrate a difficult case suffering from both glaucoma and PCA. The diagnostic characteristics for PCA are described, and neuroimaging including positron emission tomography (PET) with the amyloid binding ligand (11C) Pittsburgh compound B (PiB), and results from treatment of PCA are presented. Caution should be advised when patients with impaired visual acuity develop signs of cognitive dysfunction, and a full neuropsychological examination should be performed whenever there is doubt of the significance of visual impairment and impaired visuospatial functions. J Neurol Res. 2012;2(2):54-58 doi: https://doi.org/10.4021/jnr91w

Parkinson’s disease showing progressive conduction aphasia

Patients with Parkinson's disease (PD) may develop progressive dementia late in their clinical course. Dementia in PD is mostly related to neuropathological findings of extensive Lewy bodies (LBs), with or without the coexistence of Alzheimer's disease (AD) pathology. Aphasia has been reported in patients with LB diseases with AD pathology; however, there have been no reports of typical PD patients developing progressive aphasia during their clinical course. We describe a female PD patient who later developed progressive conduction aphasia characterized by phonemic paraphasia and disturbance in repetition of short sentences without disturbance in writing or auditory comprehension. No episodes of fluctuations of attention, memory complaints, or planning errors were observed. She experienced episodes of visual hallucination. Her low scores on the Mini-Mental State Examination suggested impairment of orientation and attention, and her scores on Raven's Coloured Progressive Matrices test indicated impaired visuospatial functions. However, her cognitive deficits were not sufficiently severe to impair her daily life. Brain magnetic resonance images revealed atrophy of the left superior temporal gyrus and widening of the left sylvian fissure. [(18)F]-fluorodeoxyglucose positron emission tomography revealed glucose hypometabolism in the left cerebral hemisphere. These findings may be related to conduction aphasia. During the progression of PD lesions, the brainstem LB is assumed to take an upward course, extend to the limbic system, and then extend to the neocortex. Conduction aphasia observed in our patient may be associated with an unusual progression of the LB pathology from the brainstem to the left temporoparietal lobe.

Visuospatial function in early Alzheimer's disease: Preliminary study.

Alzheimer’s disease (AD) is the most frequent cause of dementia, accounting for 55% of all cases. AD patients gradually lose functional capacity, manifesting deficits in attention, language, temporal and direction orientation, mood, socialization and visuospatial function. The visuospatial function entails identification of a stimulus and its location. AD patients can present deficits in visuo-spatial skills during initial stages of the disease, but in the course of clinical evolution this function can become severely impaired. One of the neuropsychological tests indicated to evaluate the visuospatial function is the VOSP (The Visual Object and Space Perception Battery).ObjectivesThe aim of this preliminary study was to detect visuospatial dysfunction in early AD patients using the VOSP, and assess its sensitivity in a Brazilian sample.ResultsControls outperformed AD patients on all neuropsychological evaluations, except the Corsi block tapping task and cancellation task-errors. The AD patients performed significantly worse on all object perception and two space perception (Number Location and Cube Analyses) subtests of the VOSP.ConclusionThe AD patients demonstrated impaired visuospatial function in several aspects. The subtests of the VOSP were found to be sensitive for detecting this impairment in mild cases.

The association of visual field deficits and visuo-spatial neglect in acute right-hemisphere stroke patients.

Visuo-spatial neglect (VSN) after stroke is associated with a poor prognosis for rehabilitation. The co-existence of a visual field deficit (VFD) with VSN may be associated with impaired visuo-spatial functioning and thereby poor functional outcome. To determine whether the presence of a VFD (i) exacerbates VSN and (ii) influences recovery of VSN. A prospective study of consecutive acute (<7 days), right-hemisphere stroke patients who were able to undergo detailed assessment of visuo-spatial functioning and visual fields. Clinical assessment and a standardized neuropsychological test was administered by one observer, followed by independent assessment of visual fields by a second observer. Patients were followed up for 12 weeks with 4-weekly re-assessments. 44 consecutive patients (23 women) with a first in a lifetime, acute hemisphere stroke were recruited. Twenty had VSN and VFD, seven VSN only, one VFD only and 17 had normal visual fields and no neglect. The finding of a VFD was significantly associated with the presence of VSN (P<0.0001). Patients with both VFD and VSN had a significantly lower score on the behavioural inattention test. One month post-stroke, this difference was no longer significant. Recovery of VSN and VFD was maximal in the first month, however VSN recovery continued for up to 12 weeks. Patients with VSN and a VFD on admission had a greater mortality at 1 and 3 months. The presence of a VFD does appear to exacerbate neglect in the acute stroke patient; this effect is no longer seen after 1 month. Recovery of VSN continues independent of a VFD. Patients with neglect and a VFD have an increased mortality, probably because of greater neurological impairment.