Tests Of Frontal Function Research Articles

The association of multimorbidity and neuropsychological test scores in Canadian cohorts recruited in 1991 and 2015

AbstractBackgroundMultimorbidity is associated with cognitive decline. Little information exists regarding whether the relationship between multimorbidity and cognitive decline has changed over the last few decades.ObjectiveTo compare estimates of the association between multimorbidity (MM) and performance on cognitive tests in two prospective cohorts of Canadian community‐dwelling older adults recruited 24 years apart.MethodWe analyzed the two datasets separately, including participants ≥65 years from both baseline and first follow‐up of the Canadian Study of Health and Aging (CSHA, 1991 – 2001; first follow up in 1996) and the Canadian Longitudinal Study on Aging (CLSA, 2015 – ongoing; first follow up in 2018). We excluded participants with baseline dementia. In both cohorts, we defined MM as two or more conditions from a list of 14. The neuropsychological tests were Animal Naming Test (ANT) and the Rey Auditory Verbal Learning Test (RAVL) for both cohorts. Tests of frontal function were the Digit Symbol Substitution Test (DSST) in the CSHA and the Mental Alternation Task (MAT) in the CLSA. We performed multilevel linear modelling. We controlled for confounders, which were detected using a Directed Acyclic Graph.ResultWe included 497 participants from the CSHA and 9308 from the CLSA. The mean age was 78.0 in the CSHA and 72.0 in the CLSA, and male accounted for 36.4% in the CSHA and 50.2 in the CLSA. Mean MM was 2.1 in both cohorts, with a higher prevalence of MM in women (CSHA 63.9%; CLSA 64.2%) than in men (CSHA 55.8%; CLSA 59.5%). When comparing both cohorts, we found that baseline MM was not associated with changes in the Z‐scores for the ANT (CSHA: 0.16, CI95: ‐0.014 to 0.34; CLSA: ‐0.002, CI95: ‐0.044 to 0.04), RAVL delayed recall (CSHA ‐0.033, CI95: ‐0.23 to 0.16; CLSA: 0.031, IC95: ‐0.013 to 0.074), or DSST in CSHA (0.1, CI95: ‐0.084 to 0.29) / MAT in CLSA (0.008, CI95: ‐0.035 to 0.052).ConclusionWe did not find differences in Z‐scores changes over 5 years follow up in the CSHA and 3 years follow up in the CLSA, for three neuropsychological tests among Canadians ≥65 years recruited over two decades apart.

Relationship among the quality of cognitive abilities, depression symptoms, and various aspects of handgrip strength in the elderly

Background/Aim. Both the cognitive and physical functioning changes occur within the normal aging, suggesting possible common biological processes. The aging process is often characterized by a reduction of adaptive responses, an increasing vulnerability and functional limitations. The aim of this study was to determine if there were correlations between particular cognitive abilities (verbal ability, spatial ability, processing speed, memory, verbal fluency, divergent thinking, memory, attention, executive functions, conceptualization, orientation, computation), depression symptoms and different dynamometric parameters of muscle contraction, during handgrip (HG) of both hands, in the elderly population. Methods. The sample consisted of 98 participants, 16 males and 82 females, aged from 65 to 85. Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Frontal Function Test (Go/No-Go), Categorical and Phonemic fluency tests and Geriatric Depression Scale Short Form (GDS-SF). Physical measures were assessed by Handgrip Dynamometry Tests (HG), and included: the maximum force (Fmax), maximal rate of force development (RFDmax), static endurance HG time realized at 50% of maximal HG force (tFmax50%) of dominant (Do) and non-dominant (NDo) hand. Results. Higher MoCA score was followed by higher values of muscle endurance of dominant hands. Higher values of F max of dominant hand were associated with higher values of Alternating Trail Making that is by visuoconstructive abilities (MoCA). The variable Categorical fluency was in a small, positive correlation with Fmax. No correlation of depressive symptoms with HG parameters was found except in the subgroup of female subjects. Conclusion. Better cognitive performance was associated with better HG muscle strength. Therefore, HG strength can be a useful tool in geriatric practice in monitoring not only physical, but also cognitive function status and de-cline. The link between lower cognitive functioning and lower values of HG variables, emphasize the need for in-creased awareness about it in clinical practice.

Photobiomodulation improves the frontal cognitive function of older adults.

The frontal lobe hypothesis of age-related cognitive decline suggests that the deterioration of the prefrontal cortical regions that occurs with aging leads to executive function deficits. Photobiomodulation (PBM) is a newly developed, noninvasive technique for enhancing brain function, which has shown promising effects on cognitive function in both animals and humans. This randomized, sham-controlled study sought to examine the effects of PBM on the frontal brain function of older adults. Thirty older adults without a neuropsychiatric history performed cognitive tests of frontal function (ie, the Eriksen flanker and category fluency tests) before and after a single 7.5-minute session of real or sham PBM. The PBM device consisted of three separate light-emitting diode cluster heads (633 and 870nm), which were applied to both sides of the forehead and posterior midline, and delivered a total energy of 1349J. Significant group (experimental, control)×time (pre-PBM, post-PBM) interactions were found for the flanker and category fluency test scores. Specifically, only the older adults who received real PBM exhibited significant improvements in their action selection, inhibition ability, and mental flexibility after vs before PBM. Our findings support that PBM may enhance the frontal brain functions of older adults in a safe and cost-effective manner.

A 7-year observation of the effect of subthalamic deep brain stimulation on impulse control disorder in patients with Parkinson's disease

IntroductionPrevious studies have reported improvement of impulse control disorders (ICDs) after subthalamic nucleus (STN) deep brain stimulation (DBS) as well as some de novo ICDs. However, it is not clear how STN DBS changes ICDs in the long-term. Methods materialsEighty-nine patients with Parkinson's disease (PD) who had received a bilateral STN DBS from 2005 to 2009 and were included in our previous study were followed for 7 years with the modified Minnesota Impulsive Disorders Interview (mMIDI). Their mMIDI scores, medication, and frontal function tests measured preoperatively and at 1 and 7 years postoperatively were compared. ResultsA total of 61 patients were analyzed after excluding 10 and 18 patients due to death and lost to follow-up, respectively. The numbers of the patients with an ICD at each point were 8, 10, and 7, respectively. All preoperative ICDs disappeared after DBS. De novo ICDs within 1 year after DBS disappeared except for 1 patient. Six of the seven patients, who reported ICDs 7 years after the DBS developed that ICD between 1 and 7 years. Their total levodopa equivalent daily dose (LEDD) and dopamine agonist dose were not higher compared to the other 54 patients without ICDs. There was no correlation with the frontal lobe dysfunction and the electrode position in the subthalamus. ConclusionSTN DBS improves baseline ICDs and results in the development of “transient” de novo ICDs in the short-term. In addition, there is a unique group of the patients who develop ICDs a long time after DBS.

Comparison of motor and non-motor features between essential tremor and tremor dominant Parkinson's disease

BackgroundDifferential diagnosis of tremor disorders, including essential tremor (ET) and Parkinson's disease-tremor dominant type (PD-TDT), requires further investigation. Therefore, the current study aimed to compare non-motor and tremor features in order to differentiate between ET and PD-TDT. MethodsTwenty-eight patients with classic ET and 24 patients with typical PD-TDT were retrospectively enrolled in a multi-stage investigation process. Tremor features including surface electromyogram (EMG) were analyzed in detail. For non-motor symptom analyses, the global cognition test, frontal function test, and non-motor symptoms scale (NMSS) were administered, in addition to collecting patient history data. ResultsPatients with PD-TDT presented with more asymmetric tremor, whereas patients with ET presented with more symmetric tremor. Leg tremor was observed only in patients with PD-TDT. Surface EMG analyses of arm tremor demonstrated considerable overlaps in tremor type, tremor frequency, and contractive patterns. However, patients with PD-TDT were significantly more likely to exhibit resting tremor, and experienced alternative contraction patterns only for kinetic tremor, which was in contrast to patients with ET. For non-motor symptom analyses, patients with PD-TDT had more non-motor symptoms compared to patients with ET (mean=5.0 vs. 2.6; P=0.002). Specifically, patients with PD-TDT exhibited higher frequencies of hyposmia, REM sleep behavior disorder (RBD)-like symptom, urinary frequency, and memory disturbance. Age- and gender- matched analyses for the severity of NMSS scores did not indicate significant differences. However, patients with PD-TDT displayed slightly lower scores of frontal function test compared to patients with ET. ConclusionsCareful and detailed evaluations of both tremor features and non-motor symptoms are required in order to distinguish between ET and PD-TDT.

Comparison of Cognitive Function between Patients with Restless Legs Syndrome and Healthy Controls

Recent studies have reported that moderate to severe restless legs syndrome (RLS) patients may have significant cognitive deficits, primarily in executive functioning, compared with healthy control subjects.1-4 Electrophysiological studies also support the existence of cognitive dysfunction in RLS patients. For example, a recent event-related potential (ERP) study showed that underlying cognitive dysfunction, associated with a working memory deficit characterized by increased reaction time and lower amplitude of the P300 component, was evident in patients with severe RLS.5,6 In contrast, other studies found no difference in cognitive function between RLS patients and controls. RLS subjects performed better than sleep-restricted controls on a test of verbal fluency.7 In middle-aged and elderly subjects, individuals with mild RLS were found to have no differences in multiple domains of cognitive functioning when compared to those without RLS.8,9 This discrepancy may be attributable to several factors, such as differences in study samples, the use of different age groups (patients of middle vs. older age), the types of neuropsychological tests administered (full batteries vs. selected tests of frontal function), and medication effects (unmedicated vs. medicated). It has been reported that comorbid psychiatric conditions such as depression and anxiety are common in patients with RLS.10-12 Epidemiological studies report a 2to 4-fold risk of a deReceived: November 22, 2014 Revised: December 10, 2014 Accepted: December 15, 2014

Shape Changes of the Basal Ganglia and Thalamus in Alzheimer's Disease: A Three-Year Longitudinal Study

A large number of Alzheimer's disease (AD) studies have focused on medial temporal and cortical atrophy, while changes in the basal ganglia or thalamus have received less attention. The aim of this study was to investigate the existence of progressive topographical shape changes in the basal ganglia (caudate nucleus, putamen, and globus pallidus) and thalamus concurrent with AD disease progression over three years. This study also examined whether declines in volumes of the basal ganglia or thalamus might be responsible for cognitive decline in patients with AD. Thirty-six patients with early stage AD and 14 normal control subjects were prospectively recruited for this study. All subjects were assessed with neuropsychological tests and MRI at baseline and Years 1 and 3. A longitudinal shape analysis of the basal ganglia and thalamus was performed by employing a boundary surface-based shape analysis method. AD patients exhibited specific regional atrophy in the right caudate nucleus and the bilateral putamen at baseline, and as the disease progressed, regional atrophic changes in the left caudate nucleus were found to conform to a distinct topography after controlling the total brain volume. Volumetric decline of the caudate nucleus and putamen correlated with cognitive decline in frontal function after controlling for age, gender, education, follow-up years, and total brain volume changes. Our findings suggest that shape changes of the basal ganglia occurred regardless of whole brain atrophy as AD progressed and were also responsible for cognitive decline that was observed from the frontal function tests.

Predictors of Cognitive Decline in the Early Stages of Parkinson's Disease: A Brief Cognitive Assessment Longitudinal Study

Our objectives were to perform a longitudinal assessment of mental status in early stage Parkinson's disease (PD) patients, with brief neuropsychological tests, in order to find predictive factors for cognitive decline. Sixty-one, early stage, and nondemented patients were assessed twice, over a 2-year interval, with a global cognitive test (mini-mental state examination (MMSE)) and a frontal function test (frontal assessment battery (FAB)) and motor function scales. Dementia and hallucinations were diagnosed according to the DSM-IV criteria. Cognitive function scores did not decrease significantly, except for FAB lexical fluency score. Four patients presented with dementia at followup. The MMSE score below cut-off, worse gait dysfunction, the nontremor motor subtype, and hallucinations were significantly related to dementia. Rigidity and speech dysfunction were related to dementia and a decrease in FAB scores. We can conclude that decline in the MMSE and FAB scores is small and heterogeneous in the early stages of PD. Scores below cut-off in the MMSE could be helpful to predict dementia. Nontremor motor deficits could be predictive factors for frontal cognitive decline and dementia.

Neuropsychological Status in Older Adults Influences Susceptibility to False Memories

In 2 experiments we examined the influence of frontal lobe function on older adults' susceptibility to false memory in a categorized list paradigm. Using a neuropsychological battery of tests developed by Glisky, Polster, and Routhieaux (1995), we designated older adults as having high- or low-frontal function. Young and older adults studied and were tested on categorized lists using free report cued recall and forced report cued recall instructions, with the latter requiring participants to produce responses even if they had to guess. Under free report cued recall instructions, frontal lobe function was a strong predictor of false memories in older adults: Older adults who scored low on tests of frontal functioning demonstrated much higher levels of false recall than younger adults, whereas levels of false recall in high-frontal older adults were more similar to those of young adults. However, after forced report cued recall, high- and low-frontal older adults performed similarly to each other, and both demonstrated higher levels of false recall than young adults. On a final recognition test, high-frontal older adults in both the free report cued recall and forced report cued recall conditions were more successful than low-frontal older adults in using source information to reduce memory errors. The results indicate that older adults show higher levels of false recall than younger adults, but type of test (free report or forced report) and neuropsychological status of older adults mediate these effects. Low-frontal older adults are particularly susceptible to producing false memories on free report tests that entail source monitoring.

Microstructural white matter abnormality and frontal cognitive dysfunctions in juvenile myoclonic epilepsy

Previous neuroimaging studies provide growing evidence that patients with juvenile myoclonic epilepsy (JME) have both structural and functional abnormalities of the thalamus and frontal lobe gray matter. However, limited data are available regarding the issue of white matter (WM) involvement, making the microstructural WM changes in JME largely unknown. In the present study we investigated changes of WM integrity in patients with JME, and their relationships with cognitive functions and epilepsy-specific clinical factors. We performed diffusion tensor imaging (DTI) and neuropsychological assessment in 25 patients with JME and 30 control subjects matched for age, gender, and education level. Between-group comparisons of fractional anisotropy (FA) and mean diffusivity (MD) were carried out in a whole-brain voxel-wise manner by using tract-based spatial statistics (TBSS). In addition, both FA and MD were correlated with cognitive performance and epilepsy-specific clinical variables to investigate the influence of these clinical and cognitive factors on WM integrity changes. Neuropsychological evaluation revealed that patients with JME had poorer performance than control subjects on most of the frontal function tests. TBSS demonstrated that, compared to controls, patients with JME had significantly reduced FA and increased MD in bilateral anterior and superior corona radiata, genu and body of corpus callosum, and multiple frontal WM tracts. Disease severity, as assessed by the number of generalized tonic-clonic seizures in given years, was negatively correlated with FA and positively correlated with MD extracted from regions of significant differences between patients and controls in TBSS. Our findings of widespread disturbance of microstructural WM integrity in the frontal lobe and corpus callosum that interconnects frontal cortices could further support the pathophysiologic hypothesis of thalamofrontal network abnormality in JME. These WM abnormalities may implicate frontal cognitive dysfunctions and disease progression in JME.

Different Performances on a Confrontational Naming Test in Patients with Alzheimer's Disease and Mild Cognitive Impairment

Background: We analyzed the performance on a naming test and the correlations between the scores on the naming test and neuropsychological test scores in patients with mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD). Methods: The subjects included 69 patients with MCI and 33 patients with mild AD. We performed general cognitive functions, the Korean version of the Boston Naming Test (K-BNT), the digit span test, the Rey figure copy test (RCFT), the Seoul Verbal Learning Test (SVLT), and frontal function tests. The detailed items of the K-BNT were analyzed for the two subject groups, and the correlations between the K-BNT scores and those of the neuropsychological tests were examined. Results: Significant differences were observed on the item for the number of correct answers after two syllables on the KBNT task in patients with AD and MCI (p<0.05). A qualitative analysis of the incorrect K-BNT responses showed that both the AD and MCI groups made semantic errors more than visuoperceptual and phonemic errors. Significant correlations were found among the Mini-Mental State Examination, the Global Deterioration Scale, clinical dementia rating, digit span, SVLT delayed recall, RCFT and RCFT delayed recall, and the Stroop test color reading items (p<0.01). Conclusion: Our result suggests that semantic errors gradually increase with the progress of cognitive disability in the state preceding AD among patients with MCI.

Initial neuropsychological impairments in patients with the E46K mutation of the α-synuclein gene (PARK 1)

IntroductionIn 2004 we described the mutation E46K of the α-Synuclein (SNCA). These patients show Parkinson's disease with early cognitive impairment, sleep disorders and autonomic dysfunction. ObjectiveThe main objective is to identify early neuropsychological impairments in patients with the E46K mutation. MethodsThis is a longitudinal neuropsychological study of 4 of the 5 surviving patients with E46K mutation by semi-structured interviews and the following scales: Mattis Dementia Rating Scale (MDRS), semantic and phonemic verbal fluency tests (VFT), Benton Visual Retention Test (BVRT), Stroop Test (STROOP), Clock drawing test (CLOCK), WAIS III Letter and Number sequencing (WAIS III LN), Rey Auditory Verbal Learning Test (RAVLT) and Benton Judgement of Line Orientation Test (BJLOT). Motor status was assessed by UPDRS III. ResultsMotor status: Patients 1, 2 and 3 present mild to moderate Parkinson disease of 7, 8 and 3years of evolution respectively, patient 4 is asymptomatic.Cognitive status: Patient 2 and 3 both refer cognitive decline while patient 1 presents no cognitive complaints, however they all show a progressive cognitive decline across various tasks. Tests of frontal function showed the first alterations in all patients but fluctuate. The first cognitive complaints coincide with deterioration of tasks of posterior cortical basis. Patient 4 presents a normal performance on all tests. Patient 1, 2 and 3 have all presented visual hallucinations. ConclusionsA fluctuating frontal impairment is observed at early stages. Prominent visuospatial alterations and visual hallucinations suggest that posterior cortical dysfunction might be a distinct early feature of the cognitive impairment observed in patients with this mutation.

Detailed descriptions of routes traveled, but not map‐like knowledge, correlates with tests of hippocampal function in older adults

We examined hippocampal contribution to remote spatial memory in older adults by correlating their performance on tests sensitive to hippocampal damage with their description of routes they traversed many times or only once, and with their map-like knowledge of downtown Toronto. We found that performance on table-top tests of spatial location (Smith and Milner (1981) Neuropsychologia 19:781-793) and on paired-associate learning, and the number of Internal Details on the Autobiographical Interview (Levine et al., (2002) Psychol Aging 17:677-689), all correlated significantly with the number and type of perceptual details used in describing routes one has traversed, but not with map-like knowledge of Toronto. No significant correlations were found with performance on tests of frontal function (WCST, phonemic fluency, and backward digit span). We conclude that the hippocampus is implicated in vivid re-experiencing of a familiar route, but not with map-like knowledge of a large-scale environment. These findings are interpreted as consistent with Multiple Trace Theory's prediction that it is the degree of detail of a retrieved memory that is crucially dependent on the hippocampus.

Korean Version of Frontal Assessment Battery: Psychometric Properties and Normative Data

Background: We developed the Korean version of the Frontal Assessment Battery (FAB-K), evaluated its psychometric properties and constructed normative data for Korean elders. Methods: FAB-K was administered to 300 Alzheimer’s disease (AD) patients and 635 normal controls. Reliability of FAB-K was evaluated by testing its internal consistency, test-retest and inter-rater reliabilities. Validity of FAB-K was evaluated by testing discriminant validity for AD and concurrent validity with other frontal function tests. Age- and education-specific normative data of FAB-K were developed. Results: Cronbach’s α, inter-rater reliability and test-retest reliability of FAB-K were 0.802, 0.980 (p < 0.001) and 0.820 (p < 0.001), respectively. FAB-K exhibited significant correlations with the scores of MMSE and other frontal function tests (p < 0.01). Total and item scores of FAB-K were lower in AD patients than in controls and became worse as clinical dementia rating increased (F = 192.026, d.f. = 4, p < 0.001). The optimal cut-off score of FAB-K for AD was determined as 10/11, where sensitivity and specificity for AD were 0.717 and 0.827, respectively. Normative data were stratified by 3 age groups and 4 education groups. Conclusion: The FAB-K is a valid and reliable instrument for evaluating frontal dysfunction, and may be useful for screening AD.

Tentative de diagnostic différentiel des psychoses fonctionnelles non affectives au moyen des tests neuropsychologiques dans une population congolaise

Objectives Schizophrenia, Schizophreniform Disorder and Brief Psychotic Disorder constitute the main part of non-affective functional psychoses of the forth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM-IV primarily recognizes the same symptoms in them; it differentiates them only by the disease duration. It is thus difficult to make the differential diagnosis of the three affections at the beginning of the disease. However, they do not have the same prognosis and Schizophrenia, famous for its poor prognosis, requires energetic and early treatment which requires an early positive diagnosis. Hence the need to lay out tools for differential diagnosis other than symptoms. The authors studied the possibility to make the differential diagnosis of the three affection through neuropsychological assessment. Subjects and methods The sample comprised 70 schizophrenics, 68 patients with Brief Psychotic Disorder and 50 with Schizophreniform Disorder, all Congolese people, recruited in “Centre neuro-psychopathologique” of the university of Kinshasa and the mental health center “Téléma” in Kinshasa, from 5 August 2003 to 14 March 2005. Neuropsychological performances of the three patients groups at a conventional neuropsychological battery for schizophrenics were compared. A principal components analysis provided the cognitive factors used to compare the three patients groups. The comparison based on the one way analysis of variances (ANOVA), Tukey's test and multivariate discriminant analysis, whilst controlling for demographic variables, clinical syndromes and neuroleptics side effects. Results Five cognitive factors were identified: factor 1 with high loadings on tests of frontal functions, nonverbal memory and nonverbal general intelligence, factor 2 with high loadings on tests measuring the time and speed of execution of mental tasks, factor 3 measuring frontal controlled processes, factor 4 measuring verbal memory and factor 5 measuring attention. The multivariate discriminant analysis was conclusive (F = 2.55; df = 2; P = 0.0055). However the overall error count estimate was too high (53%) and no convincing neuropsychological profile specific to each of the three affections could be released. Only verbal memory – not frontal functions nor attention – affirmed some discriminant power. Clinical variables showed more important differences between the patients groups. The founded differences showed that Brief Psychotic Disorder was different from Schizophrenia and Schizophreniform Disorder. The discrimination between Schizophrenia and Schizophreniform Disorder was less obvious; we failed especially to identify patients with Schizophreniform Disorder. Conclusions The used neuropsychological tests could not be used without caution in making differential diagnosis of the studied affections, however the importance of the 15 words of Rey, measuring verbal memory is highlighted. Other types of variables, e.g. the clinical one, could be more recommended to make the differential diagnosis between the three affections.

P‐128: Selective attention in cognitively normal older adults and patients with amnestic mild cognitive impairment and mild Alzheimer's disease: Evaluation of cognitive tests of frontal function and saccadic eye movements

P‐128: Selective attention in cognitively normal older adults and patients with amnestic mild cognitive impairment and mild Alzheimer's disease: Evaluation of cognitive tests of frontal function and saccadic eye movements

P2-079: Evaluation of psychometric tests of frontal function and saccadic eye movements in normal elderly

P2-079: Evaluation of psychometric tests of frontal function and saccadic eye movements in normal elderly

Frontal injury: Impairments of fundamental processes lead to functional consequences

Frontal functions, or impairments, have achieved the status of pornography: everyone knows them when they see them, but there is little agreement on their exact defining properties. Patients with frontal lobe lesions have impairments in planning, monitoring, sequencing, and inhibiting responses. They cannot organize complex behaviors. They are somehow simultaneously unaware and distractible, irritable and apathetic, violent and passive, impulsive and perseverative. They lack empathy, self-awareness, and emotional regulation. Patients often are incapacitated by frontal impairments that paradoxically are not at all obvious to most observers. To understand the effects of frontal lesions, science has sacrificed countless rats and nonhuman primates. Neuropsychology and Neurology have sanctified a few tests as the tests of frontal function, and then spent money, time, and the mental health of countless graduate students and research assistants trying to tease out of those tests some basic knowledge of frontal functions. Experimental Psychology has brought novel constructs to the problem of defining frontal functions, and modern neuroimaging has merged the traditional clinical and the novel experimental with imaging technology. (A quick PubMed search of “fMRI and frontal lobes” on October 12, 2005 retrieved 4,646 articles, the most recent, “An fMRI study of the Trail Making Test”.) Yet, confronted with a patient with a large right prefrontal lesion who cannot hold a job or even be relied upon to buy the groceries he set out to buy, we have precious few tools to define his problem and almost nothing to offer to fix it.

Anterior brain dysfunctioning as a risk factor in alcoholic behaviors.

This study assessed the relationship between neuropsychological and electrophysiological functioning and four alcohol-related measures: the Michigan Alcoholism Screening Test (MAST), the age at which the first drink was taken, frequency of drinking to "get high", and frequency of drinking to "get drunk". Ninety-one young adult men with no history of alcohol dependence were recruited. Subjects completed a variety of alcohol-related scales and a battery of neuropsychological tests. Resting EEG activity was also recorded. Stepwise regression analysis found that neuropsychological tests commonly regarded as measuring frontal and/or temporal neocortex functioning predicted the age at which subjects took their first drink and their scores on the MAST. Tests of frontal functioning, along with tests of memory, also predicted the frequency with which subjects reported drinking to "get drunk". Tests of memory also predicted the frequency at which subjects drank to "get high". On two of the alcohol measures, including age at which the first drink was taken and frequency of drinking to "get high", left-frontal slow alpha EEG activity was a significant predictor. These results suggest that markers of anterior brain functioning/dysfunctioning are associated with self-reports of alcohol-related behaviors, and that disturbances in the integrity of the anterior neocortex may be a risk factor in the development of alcohol-related behaviors.

Neuropsychological functions in progressive supranuclear palsy, multiple system atrophy andParkinson′s disease

Few studies have compared cognitive functions in multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and Parkinson's disease (PD). To compare the results of cognitive function tests in the three diseases and examine their relation with the severity of parkinsonism. Clinic-based open prospective study. Global cognitive function tests and tests specific for frontal lobe functions were used in 25 cases of each disease. UPDRS III was used to measure the severity of parkinsonism. ANOVA was done for group comparisons, followed by t-test for independent samples with Bonferroni correction. Pearson's correlation test was done to assess the relation between severity of parkinsonism and cognitive functions. The severity of parkinsonism was worst in PD followed by PSP and least in MSA. Patients with PSP exhibited the worst performance in both sets of cognitive tests. Even though patients with MSA did better than PD in global function tests, they performed worse than PD in some frontal function tests. There was a negative correlation between severity of parkinsonism and scores in cognitive tests in the MSA group but not in others. Global and frontal dysfunction was worst in PSP. The frontal dysfunction in MSA was more severe than PD, correlated with the severity of parkinsonism and was worse in clinically probable than possible cases of MSA. The severity of cognitive dysfunction in these diseases may be related to the distribution and extent of pathological changes affecting the striato-frontal circuits in them.