1/20. A treatment selection model for weight reduction in adults with acquired brain injury: applications and preliminary findings.This article presents a unique method for providing weight management assistance to persons who have experienced an acquired brain injury (ABI). Most of the available literature on this topic deals with weight loss methods for individuals who are not faced with the cognitive and behavioural challenges inherent in this population. A treatment selection protocol will be described that allows for appropriate selection of behavioural weight loss interventions. Interventions are based upon specific cognitive and behavioural difficulties that individuals with acquired brain injury may present. A detailed case study will also be presented depicting successful use of the treatment selection model with an adult male with an acquired brain injury.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/20. Variability of neuropsychological deficits associated with carbon monoxide poisoning: four case reports.Carbon monoxide (CO) poisoning is associated with variable neuropsychological deficits, depending on levels of CO exposure and individual differences. Studies to date have reported variable findings, as their subjects have been exposed to different levels of CO from different poisoning sources. Four unique case studies are presented, all of whom experienced the same level of CO poisoning (17-29%) in the same accident. Two of the individuals were brothers with an identical genetic disorder (i.e. syndactylism) and the other two were brother/sister. The results indicated: (1) variable neuropsychological deficits despite similar levels of CO poisoning; (2) consistent estimated decline in intelligence; (3) similar memory decline for the two brothers, but not for the brother and sister; and (4) consistent late-onset emotional-behavioural difficulties. The results also suggested that the neuropsychological and emotional-behavioural deficits had an impact on the individual's ability to work.- - - - - - - - - - ranking = 0.66666666666667keywords = behaviour (Clic here for more details about this article) |
3/20. Neuropsychological consequences of cerebellar tumour resection in children: cerebellar cognitive affective syndrome in a paediatric population.Acquired cerebellar lesions in adults have been shown to produce impairments in higher function as exemplified by the cerebellar cognitive affective syndrome. It is not yet known whether similar findings occur in children with acquired cerebellar lesions, and whether developmental factors influence their presentation. In studies to date, survivors of childhood cerebellar tumours who demonstrate long-term deficits in cognitive functions have undergone surgery as well as cranial irradiation or methotrexate treatment. Investigation of the effects of the cerebellar lesion independent of the known deleterious effects of these agents is important for understanding the role of the cerebellum in cognitive and affective development and for informing treatment and rehabilitation strategies. If the cerebellar contribution to cognition and affect is significant, then damage in childhood may influence a wide range of psychological processes, both as an immediate consequence and as these processes fail to develop normally later on. In this study we evaluated neuropsychological data in 19 children who underwent resection of cerebellar tumours but who received neither cranial irradiation nor methotrexate chemotherapy. Impairments were noted in executive function, including planning and sequencing, and in visual-spatial function, expressive language, verbal memory and modulation of affect. These deficits were common and in some cases could be dissociated from motor deficits. Lesions of the vermis in particular were associated with dysregulation of affect. Behavioural deficits were more apparent in older than younger children. These results reveal that clinically relevant neuropsychological changes may occur following cerebellar tumour resection in children. Age at the time of surgery and the site of the cerebellar lesion influence the neurobehavioural outcome. The results of the present study indicate that the cerebellar cognitive affective syndrome is evident in children as well as in adults, and they provide further clinical evidence that the cerebellum is an essential node in the distributed neural circuitry subserving higher-order behaviours.- - - - - - - - - - ranking = 0.66666666666667keywords = behaviour (Clic here for more details about this article) |
4/20. Is accurate self-monitoring necessary for people with acquired neurological problems to benefit from the use of differential reinforcement methods?Challenging behaviour exhibited by people with acquired neurological problems must be managed if their maximum rehabilitation potential is to be achieved. Differential reinforcement of low rates of responding (DRL) appears to be an effective method for this. The effectiveness of DRL in the presence of severe cognitive deficits, including disorders of attention and memory, is nevertheless surprising. Indeed, such difficulties may prevent individuals with brain injury benefiting from operant conditioning procedures because of impairment of the central executive component of working memory. Consequently, use of other behavioural techniques such as response cost and self-monitoring training (SMT) have been adopted, as it has been argued they circumvent neuropsychological constraints to learning by directing attention to aspects of behaviour not being monitored. DRL, however, may be more desirable as it involves minimal intrusion; is concerned with establishment of pro-social behaviour; and treatment gains can occur rapidly and be maintained for long periods following withdrawal. Whether DRL is dependent upon accurate self-monitoring is addressed through the study of three people participating in rehabilitation. This shows DRL can be effective, despite severe cognitive impairments, but SMT facilitates greater improvements in selective attention. How DRL may circumvent cognitive impairment is discussed.- - - - - - - - - - ranking = 1.3333333333333keywords = behaviour (Clic here for more details about this article) |
5/20. Genetically confirmed clinical Huntington's disease with no observable cell loss.Huntington's disease (HD) results from neurodegeneration of the neostriatum. The mutation on chromosome 4 is an expansion in a triplet repeat (CAG)(n) located within the IT15 gene. Only six patients have been reported with clinical features of HD in association with limited neuropathology. Of these, only one has had the diagnosis confirmed by genetic (dna) testing. We describe a patient with the clinical phenotype and genetically confirmed HD but unexpected limited neuropathology. The patient was seen because of aggressive behaviour and memory problems of two years duration. The differential diagnosis included HD although there was no family history. dna testing was positive for the HD mutation. Clinical follow up three months later confirmed classic features of HD. Progression of the disease was rapid with death three years later. Neuropathology revealed a largely intact neostriatum with bilateral ischaemic damage and cell loss in the external globus pallidus. Such pathology alone could explain the clinical features of HD. This is only the second report of genetically confirmed clinically manifest HD with little evidence of HD neuropathology. There are several unusual features which could not have been predicted by the clinical picture, in particular the progressive course of bilateral ischaemic changes restricted to the external globus pallidus. The potential to miss other HD cases at post-mortem examination, and the implications of this for family members, are discussed.- - - - - - - - - - ranking = 0.33333333333333keywords = behaviour (Clic here for more details about this article) |
6/20. Cognitive decline over time following electrical injury.Electrical injury (EI) is on the rise in the US, with more than 2400 injuries occurring annually. Consequences of EI often include diffuse neurological damage and a myriad of emotional and behavioural sequelae. While delayed onset of cognitive dysfunction is frequently alluded to in the literature, few cases have been published that document the progressive neuropsychological manifestations of EI over time. This paper offers a case study of a 49 year-old female who suffered a high voltage EI and who underwent neuropsychological evaluations at 6 and 56 months post-injury. Comparison of test results suggested a progressive pattern of global decline in cognitive functioning, with particular impairment in memory, verbal learning, abstract reasoning and sensory-motor functions. This case study illustrates the delayed onset and progression of neuropsychological dysfunction that may occur following EI, as well as the importance of long-term follow-up with patients after high voltage EI.- - - - - - - - - - ranking = 0.33333333333333keywords = behaviour (Clic here for more details about this article) |
7/20. Donepezil in a chronic drug user--a potential treatment?The objective of the current study was to explore the potential cognitive benefits of an anticholinesterase inhibitor, donepezil, in a former chronic drug user. A neuropsychological test battery composed of the vocabulary and matrix reasoning subtests of the Wechsler adult intelligence scale-III, measures of everyday executive functioning (behavioural assessment of the dysexecutive syndrome [BADS]), and verbal learning and memory tasks (california verbal learning test-II; Rivermead behavioural memory test) was completed at baseline, at 3 months after introducing donepezil, and at 3 months after donepezil was discontinued. After donepezil treatment, substantial improvements were found on tasks of nonverbal fluid reasoning (i.e. matrix reasoning) and other executive functioning tests (i.e. BADS). At entry into the study, poor academic performance and subjective problems with memory and concentration were reported, particularly after amphetamine use (i.e. MDMA and crystal methamphetamine); after donepezil treatment, dramatic increases in memory, concentration and academic achievement were observed. The finding of improvements in tests of executive functioning and in academic performance in this case study, together with the minimal adverse side effects of donepezil, warrants the investigation of controlled studies of cholinergic enhancement in chronic amphetamine and other drug users.- - - - - - - - - - ranking = 0.66666666666667keywords = behaviour (Clic here for more details about this article) |
8/20. Pure post-stroke cerebellar cognitive affective syndrome: a case report.Cerebellar pathology commonly shows important motor signs and less evident cognitive dysfunction. The 'cerebellar cognitive affective syndrome' is characterised by impairment on executive function, spatial cognition, language and behaviour. We report the case of a man with acute onset of transitory motor features and severe mental disorders. Cranial CT and brain MRI revealed extended cerebellar lesions. Neuropsychological assessment disclosed deficits of attention, executive function and memory. Auditory event-related potentials showed abnormal P300. These data suggest a pure "cerebellar cognitive affective syndrome"and strengthen the hypothesis of cerebellar cognitive function modulation.- - - - - - - - - - ranking = 0.33333333333333keywords = behaviour (Clic here for more details about this article) |
9/20. Disorganised memory after right dorsolateral prefrontal damage.Neurophysiological and functional brain imaging studies suggest the importance of dorsolateral area 9/46 for modality-independent working memory. However, the behavioural manifestations following isolated damage to this area have not been clearly outlined. Here, we describe the dramatic derangement of pragmatic memory after circumscribed lesion of the right area 9/46. A 52 year-old woman had suffered a traumatic brain injury 13 years ago and sought help for what she thought was a severe memory disorder. She regularly missed appointments and had gradually lost all her friends. She had tried different strategies to compensate for her memory problem, such as writing notes on her wrist or using electronic organizers. intelligence, attention, verbal long-term memory, and executive functions were normal. Furthermore, experimental exploration demonstrated intact time estimation, attribution of memories to ongoing reality, and anticipation of outcomes. However, she failed to rehearse and manipulate information in working memory (n-back task), confirming the findings of functional imaging studies that the mid-dorsolateral prefrontal cortex is involved in mental manipulation of information. This case exemplifies that an isolated lesion of the right area 9/46 may induce severe failure to schedule actions and memory retrieval, a disorder leading to severely disorganised behaviour and disability.- - - - - - - - - - ranking = 0.66666666666667keywords = behaviour (Clic here for more details about this article) |
10/20. Follow-up of neuropsychological function recovery in a 9-year-old girl with anoxic encephalopathy: a window on the brain re-organization processes.OBJECTIVE: To investigate comprehensive neuropsychological outcome, disabilities in daily life and individual recovery processes in a case of anoxic encephalopathy. DESIGN: A 9-year-old child's functional outcome after anoxic coma was evaluated in a follow-up study with assessments at 5, 9 and 12 months post-injury. A comprehensive neuropsychological protocol was administered. Qualitative methods of analysis and ecological observation were associated with standard and non-standard quantitative measures. RESULTS: The child presented pervasive functional deficits with prevalence of gnosic, praxic and self-regulatory dysfunction. Dissociated functional recovery was documented in 12 months time. Improvement of self-regulatory abilities was likely a 'propeller' of global system re-organization. CONCLUSION: A descriptive longitudinal study of functional and ecological behavioural changes after anoxic coma provides insight into the re-adaptation processes in the brain connected to post-lesion ecological and training experiences. Contextual factors and their relations to functional improvements deserve further study.- - - - - - - - - - ranking = 0.33333333333333keywords = behaviour (Clic here for more details about this article) |
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