History of “Frontal” Syndromes and Executive Dysfunction

Author(s):  
Jonathan DeRight
2019 ◽  
Vol 11 (1) ◽  
pp. 80-86
Author(s):  
Ezgi Bakırcıoğlu-Duman ◽  
Zeynep Acar ◽  
Gülçin Benbir ◽  
Hande Yüceer ◽  
Hürtan Acar ◽  
...  

Morvan syndrome (MoS) is typically characterized by neuromyotonia, sleep dysfunction, dysautonomia, and cognitive dysfunction. However, MoS patients with mild peripheral nerve hyperexcitability (PNH) or encephalopathy features have been described. A 46-year-old woman presented with a 2-month history of constipation, hyperhidrosis, and insomnia. Neurologic examination revealed muscle twitching and needle electromyography showed myokymic discharges in all limbs. No clinical or electrophysiological features of neuromyotonia were present. Although the patient denied any cognitive symptoms, neuropsychological assessment revealed executive dysfunction, while other cognitive domains were preserved. Cranial and spinal MRIs were unrevealing and tumor investigation proved negative. Polysomnography examination revealed total insomnia, which was partially reversed upon immune-modulatory therapy. Investigation of a broad panel of antibodies revealed serum leucine-rich glioma inactivated protein 1 and contactin-associated protein 2 antibodies. The features of this case indicate that the presentation of PNH syndromes may show significant variability and that MoS patients may not necessarily exhibit full-scale PNH and encephalopathy symptoms.


Author(s):  
Sean W. Taylor ◽  
Roger M. Smith ◽  
Giovanna Pari ◽  
Wendy Wobeser ◽  
John P. Rossiter ◽  
...  

A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.


2015 ◽  
Vol 27 (11) ◽  
pp. 1913-1918 ◽  
Author(s):  
Andrew Gleason ◽  
Matthew Lewis ◽  
Sook Meng Lee ◽  
Stephen Macfarlane

ABSTRACTBackground:Domestic squalor has been associated with alcohol misuse but little work has explored this. Executive dysfunction is commonly observed in squalor and is also associated with alcohol misuse. Hoarding can accompany squalor, but it is unclear whether hoarding is also linked with alcohol misuse. This study compared neuropsychology and hoarding status of individuals living in squalor with and without a history of alcohol misuse.Methods:A subgroup analysis was conducted on a series of 69 neuropsychological reports of people living in squalor. Data on cognitive profiles, basic demographics, alcohol use, and hoarding were extracted and analyzed.Results:Alcohol misuse was reported in 25 of the 69 participants (36%). Alcohol misusers were significantly younger (mean age 66.2 years, SD = 10.7) than non-misusers (mean age 75.6 years, SD = 10.3) (p < 0.00) and significantly more likely to be male (p = 0.01). No significant differences between the two subgroups were found for estimated premorbid intellectual functioning, Mini Mental State Examination (MMSE) scores, or individual neuropsychological domains. Alcohol misusers were more likely to be living in squalor without hoarding than squalor with hoarding (p = 0.01).Conclusions:Alcohol misusers living in squalor were less likely to hoard than non-misusers. This finding suggests that alcohol misuse may be a risk factor for squalor via failure to maintain one's environment rather than through intentional accumulation of objects. The similar cognitive profile among those with and without a history of alcohol misuse could represent a common pattern of executive dysfunction that predisposes individuals to squalor regardless of underlying alcohol misuse diagnosis.


2015 ◽  
Vol 2 (6) ◽  
Author(s):  
Paulo Jannuzzi Cunha ◽  
Paula Approbato de Oliveira ◽  
Mariana Cortezzi ◽  
Geraldo F. Busatto ◽  
Sandra Scivoletto

2019 ◽  
Vol 34 (6) ◽  
pp. 877-877
Author(s):  
L Crocker ◽  
A Keller ◽  
S Jurick ◽  
V Merritt ◽  
S Hoffman ◽  
...  

Abstract Objective Suicidal ideation (SI) is highly prevalent in Veterans and reducing Veteran suicide is a national priority. The present study examined factors associated with SI in combat-exposed Veterans in order to inform suicide prevention efforts. Method Combat-exposed Iraq/Afghanistan-era Veterans (N = 77) completed questionnaires detailing demographic characteristics and combat-related experiences, as well as structured interviews assessing history of mild traumatic brain injury (mTBI), current posttraumatic stress disorder (PTSD), and suicidality in the past month. Veterans also underwent a comprehensive neuropsychological assessment. Analyses examined differences between endorsers versus non-endorsers of current SI, as well as predictors of SI, with a focus on cognitive variables. Results There were no SI group differences in demographic variables, levels of combat exposure, or rates of PTSD, or mTBI history. However, independent samples t-tests indicated that those who endorsed SI demonstrated worse executive functioning relative to those who denied SI (t(75) = 2.74, p = .008), whereas no group differences were observed on measures of attention/processing speed or memory. A logistic regression analysis predicting SI indicated that executive functioning remained a significant predictor of SI (B = .94, OR = 2.55, p = .047) even when adjusting for age, years of education, level of combat exposure, history of mTBI, and PTSD diagnosis. Conclusions Executive dysfunction may make it difficult for Veterans to inhibit maladaptive negative thoughts (particularly suicidal thoughts), regulate emotions, and problem solve in stressful situations, thus contributing to suicidality. Interventions addressing executive dysfunction in combat-exposed Veterans with SI may be a promising adjunct to current suicide prevention efforts.


2012 ◽  
Vol 43 (3) ◽  
pp. 539-551 ◽  
Author(s):  
J. G. Keilp ◽  
M. Gorlyn ◽  
M. Russell ◽  
M. A. Oquendo ◽  
A. K. Burke ◽  
...  

BackgroundExecutive dysfunction, distinct from other cognitive deficits in depression, has been associated with suicidal behavior. However, this dysfunction is not found consistently across samples.MethodMedication-free subjects with DSM-IV major depressive episode (major depressive disorder and bipolar type I disorder) and a past history of suicidal behavior (n = 72) were compared to medication-free depressed subjects with no history of suicidal behavior (n = 80) and healthy volunteers (n = 56) on a battery of tests assessing neuropsychological functions typically affected by depression (motor and psychomotor speed, attention, memory) and executive functions reportedly impaired in suicide attempters (abstract/contingent learning, working memory, language fluency, impulse control).ResultsAll of the depressed subjects performed worse than healthy volunteers on motor, psychomotor and language fluency tasks. Past suicide attempters, in turn, performed worse than depressed non-attempters on attention and memory/working memory tasks [a computerized Stroop task, the Buschke Selective Reminding Task (SRT), the Benton Visual Retention Test (VRT) and an N-back task] but not on other executive function measures, including a task associated with ventral prefrontal function (Object Alternation). Deficits were not accounted for by current suicidal ideation or the lethality of past attempts. A small subsample of those using a violent method in their most lethal attempt showed a pattern of poor executive performance.ConclusionsDeficits in specific components of attention control, memory and working memory were associated with suicidal behavior in a sample where non-violent attempt predominated. Broader executive dysfunction in depression may be associated with specific forms of suicidal behavior, rather than suicidal behavior per se.


2018 ◽  
Vol 24 (7) ◽  
pp. 653-661 ◽  
Author(s):  
Dace N. Almane ◽  
Qianqian Zhao ◽  
Paul J. Rathouz ◽  
Melissa Hanson ◽  
Daren C. Jackson ◽  
...  

AbstractObjectives:Rates of cognitive, academic and behavioral comorbidities are elevated in children with epilepsy. The contribution of environmental and genetic influences to comorbidity risk is not fully understood. This study investigated children with epilepsy, their unaffected siblings, and controls to determine the presence and extent of risk associated with family relatedness across a range of epilepsy comorbidities.Methods:Participants were 346 children (8–18 years),n=180 with recent-onset epilepsy, their unaffected siblings (n=67), and healthy first-degree cousin controls (n=99). Assessments included: (1) Child Behavior Checklist/6-18 (CBCL), (2) Behavior Rating Inventory of Executive Function (BRIEF), (3) history of education and academic services, and (4) lifetime attention deficit hyperactivity disorder (ADHD) diagnosis. Analyses consisted of linear mixed effect models for continuous variables, and logistic mixed models for binary variables.Results:Differences were detected between the three groups of children across all measures (p<.001). For ADHD, academic problems, and executive dysfunction, children with epilepsy exhibited significantly more problems than unaffected siblings and controls; siblings and controls did not differ statistically significantly from each other. For social competence, children with epilepsy and their unaffected siblings displayed more abnormality compared with controls, with no statistically significant difference between children with epilepsy and unaffected siblings. For behavioral problems, children with epilepsy had more abnormality than siblings and controls, but unaffected siblings also exhibited more abnormalities than controls.Conclusions:The contribution of epilepsy and family relatedness varies across specific neurobehavioral comorbidities. Family relatedness was not significantly associated with rates of ADHD, academic problems and executive dysfunction, but was associated with competence and behavioral problems. (JINS, 2018,24, 1–9)


Author(s):  
Serhii Lytvyn

The aim of this study was to determine the effect of tolerance of uncertainty on the executive functions in people with psychological trauma. To study the neuropsychological correlates of tolerance of uncertainty in people with psychological trauma, 55 subjects aged 21 to 66 years (25 men and 30 women) were involved. The control sample included 56 subjects aged 22–67 years (21 men and 35 women). Research methods: "New questionnaire of tolerance-intolerance of uncertainty", "Iowa Gambling Task", Clinician-Administered PTSD Scale for DSM-IV (CAPS-DX), Method of verbal-color interference (Stroop test). Results: psychological trauma causes a decrease in the level of tolerance of uncertainty (ToU), an increase in the level of intolerance of uncertainty (IoU) and an increase in the level of interpersonal intolerance of uncertainty (IIoU). ToU can be seen as a protective factor in the case of psychological trauma. ToU can alleviate the manifestations of executive dysfunction (when treating both ambivalent and indeterminate stimuli) in people with a history of psychological trauma. IoU can be considered as a psychological construct that interferes with the normal functioning of executive functions in the control group (persons without a history of psychological trauma). Psychological trauma causes an increase in the level of IIoU in a way that is not associated with executive dysfunction.


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