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Biomedical subjects

H J Markowitsch

Publications and source records attributed to H J Markowitsch.

At least 19 recordsLinked to original sources
PubMed2000

Massive impairment in executive functions with partial preservation of other cognitive functions: the case of a young patient with severe degeneration of the prefrontal cortex.

Historical bases for the special role of the prefrontal cortex are outlined and the case of a 27-year-old woman with massive bilateral prefrontal damage of unknown etiology is then described. Frontal lobe degeneration was repeatedly examined with magnetic resonance imaging and fluoro-deoxy-D-glucose-positron emission tomography and was found to include both orbital and dorsolateral aspects of the frontal lobes. While the degeneration initially measured was limited to portions of the orbital, medial and dorsolateral parts of both frontal lobes, with right-sided predominance, a second brain scan 15 months later revealed massive shrinkage of both frontal lobes, together with additional involvement of the posterior association cortices. The patient had completed her high-school education and had superior verbal long-term memory, normal short-term memory, and normal priming, but manifested grossly deficient scores in various frontal lobe-sensitive tests. Though a number of neurological examinations were performed, no plausible cause for the damage was established.

Adult↗
PubMed2000

Neuroimaging and behavioral correlates of recovery from mnestic block syndrome and other cognitive deteriorations.

OBJECTIVE: We conducted a follow-up study on a patient with enduring psychic shock-induced cognitive impairment to study by neuropsychological and functional imaging methods the degree of his recovery process on the brain and cognitive levels. BACKGROUND: Based on the assumption that trauma and stress conditions can alter the functions of the nervous systems, we report on a patient whom we studied 2 and 12 months after he suffered "mnestic block syndrome" and additional cognitive deterioration symptoms. METHODS: We report on a patient studied 2 and 12 months after he suffered "mnestic block syndrome" and additional cognitive deterioration symptoms. Magnetic resonance imaging and fluorodeoxyglucose positron emission tomography were used for neural and detailed neuropsychological testing for cognitive deficits. RESULTS: The patient initially manifested severe intellectual decline, including severe anterograde and retrograde amnesia. His symptoms were correlated with major, although selective, reductions in his brain metabolism (2-3 SD below those of controls). Presently, he shows a normal brain metabolism and has regained parts of his memory and many of his other intellectual capabilities. Nevertheless, he still has long-term memory impairments. CONCLUSIONS: This case demonstrates a close relation between brain metabolism and cognitive performance, with major deficits of both at 2 months and major recovery of both at 12 months after a shocking event. It can serve as an example for possible stress-related deteriorations in certain brain regions, which can be partly corrected by psychotherapeutic interventions, passing time, and favorable environmental conditions.

Amnesia↗
PubMed1999

Mnestic block syndrome.

The case of a patient with largely preserved intelligence, but severe and persistent memory impairments is reported. FA, a 46-year-old patient with the diagnosis of prolonged depression was investigated repeatedly over a two year period with neuroradiological, neuropsychological, neuromonitoring and other methods. While no brain damage was detectable in FA, he manifested continued and severe anterograde and retrograde memory disorders together with an inhibition in his thinking processes. Otherwise, his intellectual capabilities were in the normal range, that is he was not pseudo-demented. Various approaches with drug treatment and psychotherapy failed to improve his condition. The condition is interpreted as 'mnestic block syndrome' and is considered to be related to an altered brain metabolism which may include changes in various transmitter and hormonal systems (GABA-agonists, glucocorticoids, acetylcholine). Whether depression contributes to this syndrome is uncertain from FA's cognitive performance, but may be a possibility.

Amnesia, Retrograde↗
PubMed1999

Retrograde amnesia for world knowledge and preserved memory for autobiographic events. A case report.

A patient (PC) with severe and chronic retrograde amnesia for world knowledge (tested with famous events and famous faces), but unimpaired autobiographical memory is described. The 64-year-old man had traumatic brain injury four years prior to the present evaluation. Current brain imaging showed principally damage involving the infero-lateral prefrontal and the lateral temporal regions of the left-hemisphere. PC was of average intelligence, had no depression and only minor language problems, but manifested some additional anterograde memory deficits and performed subaverage in various frontal lobe-sensitive tests. Patient PC represents one of the very few cases with a preserved retrograde episodic and an impaired retrograde knowledge system, showing a dissociation between preserved retrieval of autobiographical events and amnesia for nonpersonal famous events. It is hypothesized that the sparing of autobiographical memories can be linked to the integrity of the right frontal and temporo-polar cortices.

Amnesia, Retrograde↗
PubMed1999

Short-term memory deficit after focal parietal damage.

The neuropsychological symptomatology is reported for a 44-year-old patient of normal intelligence, EE, after removal of a circumscribed left hemispheric tumor the major part of which was located in the angular gyrus and in the subcortical white matter. EE had a distinct and persistent short-term memory impairment together with an equally severe impairment in transcoding numbers. On the other hand, his performance was flawless in calculation tasks and in all other tests involving number processing. Impairments in language tests could be attributed to his short-term memory deficit, which furthermore was characterized by a strong primacy effect in the absence of a recency effect. His graphomotoric output was temporarily inhibited. The patient, with a strong left-sided dominance, manifested a bi-hemispherical activation of the Broca and Wernicke regions in a positron-emission-tomographic investigation when required to produce verbs which he was to derive from nouns. The findings in EE suggest that unilateral and restricted lateral parietal damage can result in a profound short-term memory deficit together with a transcoding deficit for stimuli extending over only a few digits or syllables in the absence of any symptoms of the Gerstmann syndrome.

Adult↗
PubMed1998

Hemispheric asymmetries in category-specific word retrieval.

We examined whether 53 adult non-aphasic patients with either left (22) or right temporal lobe lesions (31) demonstrate dissociable patterns of hemispheric asymmetries in category-specific word fluency tasks. The patients were asked to articulate as many appropriate words as possible within 60 or 90 s in response to six target categories. There was no effect of patient groups on the overall fluency. However, patients with a left-sided temporal lobe lesion were impaired retrieving words to 'initial letters' and to the category 'animals'. Right temporal lobe patients were impaired retrieving 'tools' and words referring to specific visual attributes. There were no fluency differences for 'food-supermarket goods' and 'flat interior'. We conclude that temporal lobe damage can result in category-specific impairments in word retrieval depending on the affected hemisphere.

Adolescent↗
PubMed1998

Episodic and declarative memory: role of the hippocampus.

The fact that medial temporal lobe structures, including the hippocampus, are critical for declarative memory is firmly established by now. The understanding of the role that these structures play in declarative memory, however, despite great efforts spent in the quest, has eluded investigators so far. Given the existing scenario, novel ideas that hold the promise of clarifying matters should be eagerly sought. One such idea was recently proposed by Vargha-Khadem and her colleagues (Science 1997; 277:376-380) on the basis of their study of three young people suffering from anterograde amnesia caused by early-onset hippocampal pathology. The idea is that the hippocampus is necessary for remembering ongoing life's experiences (episodic memory), but not necessary for the acquisition of factual knowledge (semantic memory). We discuss the reasons why this novel proposal makes good sense and why it and its ramifications should be vigorously pursued. We review and compare declarative and episodic theories of amnesia, and argue that the findings reported by Vargha-Khadem and her colleagues fit well into an episodic theory that retains components already publicized, and adds new ones suggested by the Vargha-Khadem et al. study. Existing components of this theory include the idea that acquisition of factual knowledge can occur independently of episodic memory, and the idea that in anterograde amnesia it is quite possible for episodic memory to be more severely impaired than semantic memory. We suggest a realignment of organization of memory such that declarative memory is defined in terms of features and properties that are common to both episodic and semantic memory. The organization of memory thus modified gives greater precision to the Vargha-Khadem et al. neuroanatomical model in which declarative memory depends on perihippocampal cortical regions but not on the hippocampus, whereas episodic memory, which is separate from declarative memory, depends on the hippocampus.

Amnesia↗
PubMed1998

Psychic trauma causing grossly reduced brain metabolism and cognitive deterioration.

While amnesia and other cognitive disturbances are usually caused by structural brain damage, there are a few instances in which environmental stress may induce neuronal death in memory-sensitive brain regions such as the hippocampus. Here we report on a patient who, after a single brief exposure to an event reminding him of a similar stressful event from his childhood, deteriorated immediately and persistently without manifesting structural, but manifesting functional, brain damage as measured by position emission tomography. This patient probably represents the first case in which a direct relation between a single psychic event and the occurrence of brain malfunctioning in cognition is documented by dynamic neuroimaging methods. Psychic shock may cause lasting reductions in brain metabolism with the consequence of severe intellectual malfunctioning.

Adult↗
PubMed1997

Impaired episodic memory retrieval in a case of probable psychogenic amnesia.

A patient with severe, selective retrograde amnesia for personal material diagnosed as probable psychogenic amnesia, was investigated intensively neuropsychologically with cranial computed tomography (CCT), magnetic resonance imaging (MRI), and single photon emission tomography (SPECT). The patient was of average intelligence and memory with no anterograde amnesia. No evidence for structural brain damage was detected in CCT and MRI. SPECT, performed about 3 weeks after the onset of symptoms, demonstrated reduced perfusion in right temporal and frontal areas, that is, in areas which have been suggested as critical for episodic memory retrieval. To study episodic memory retrieval, positron-emission-tomography (PET) blood flow (rCBF) measurements were performed 6 months after the onset of symptoms. During episodic memory retrieval bilateral neuronal activations were observed in the precuneus, the lateral parietal and the right dorsolateral and polar prefrontal cortex. Compared to the results of previous functional imaging studies on episodic memory retrieval, our findings suggest an underlying functional disturbance of brain areas previously demonstrated to be involved in episodic memory retrieval.

Adult↗
PubMed1997

Differential impairments in recalling people's names: a case study in search of neuroanatomical correlates.

The case of a patient with selective left hemispheric medial and lateral temporal lobe damage is described. The patient was of slightly supra-average intelligence and had no problems in normal memory functions, but was severely anomic with respect to people's names. One month post-onset, this deficit held for names of colleagues and friends she had gotten to know during the last 10 years prior to the infarct and for all names confronted with post-infarct. On the other hand, learning of face-name associations was preserved and was independent of the ability to generate context-specific information for the subjects whose names were requested. The results support the existence of category-specific naming impairments, and, moreover, indicate a deficit that has to be differentiated with regard to memory systems. A time-limited, but prolonged engagement of interconnected left medial and adjacent lateral temporal lobe structures in ecphory is stressed for context-restricted information such as proper names.

Anomia↗
PubMed1997

Memory beyond the hippocampus.

Improved neuroanatomical knowledge, technical and methodological innovations (such as PET), and more refined conceptualizations of memory have inspired a reappraisal of theoretical beliefs regarding the role of the hippocampus in memory. In the past few years, it has become apparent that the influence of the medial temporal lobe regions extends beyond memory and that memory processes (such as encoding, consolidation and retrieval) involve not only the hippocampus and the medial temporal and diencephalic regions, but also widely distributed neocortical and perhaps even cerebellar regions.

Animals↗
PubMed1997

[Neuropsychological findings in obsessive-compulsive disorder].

The results of neuropsychological-cognitive investigations in patients with obsessive-compulsive disorder are presented in a meta-analysis. The analysis differentiates between intelligence, attention and concentration, memory executive functions, and visual-spatial and visuo-constructive performance. Changes in intelligence are only rarely manifest in obsessive-compulsive patients, and if so, principally in the visuo-constructive field, possibly including abstract-logical processes of thinking. Similarly, they are largely normal in functions of attention and verbal memory; only complex study designs reveal deficits in comparison to control subjects. Obtained deficits in visual memory should be interpreted as being likely due to deficient visuo-perceptive and visuo-constructive performance. Executive functions have not been studied in depth and are unimpaired in most investigations. Visuo-constructive problems are observed most frequently and might best be attributed to problems in Gestalt perception. It has to be pointed out that up to now techniques and designs of investigation are, in the majority of studies, imperfect and that it seems necessary to consider the existence of subgroups of obsessive-compulsive patients with differing degrees of impairment. Prognosis and evaluation of patients with obsessive-compulsive symptomatology depend considerably on their insight into the irrelevance of their behavioural patterns and on the contents of their predominant thoughts and actions. Transferring the deficit patterns to the brain level points to (a) right hemispheric damage and (b) damage in the frontostriatal system.

Attention↗
PubMed1997

Massive and persistent anterograde amnesia in the absence of detectable brain damage: anterograde psychogenic amnesia or gross reduction in sustained effort?

The case of a young patient with severe and persistent anterograde amnesia of no known cause is reported. Anterograde amnesia arose within a 1-month period and has persisted for more than 1 year. Although a wide variety of neurological and neuroradiological assessments were completed (EEG, evoked potential recordings, Doppler sonography, MRI, PET), no evidence of brain damage was detected. Neuropsychologically, the patient was of high intelligence, had average to above-average short-term memory, and normal retrograde memory abilities, but severe and persistent anterograde amnesia in both verbal and nonverbal domains. Furthermore, he demonstrated grossly reduced long-term concentration. It is likely that a complex chain of interacting variables can produce a syndrome that appears phenomenologically as anterograde amnesia without organically measurable correlates.

Adult↗
PubMed1997

Prefrontal asymmetric interictal glucose hypometabolism and cognitive impairment in patients with temporal lobe epilepsy.

Depressions of regional cerebral metabolism beyond the epileptogenic zone have been demonstrated in patients with intractable temporal lobe epilepsy. However, their clinical relevance, and the causes of prefrontal metabolic asymmetries are less well understood. We investigated 96 temporal lobe epilepsy patients by FDG-PET and neuropsychological assessment who had a corresponding unilateral temporal hypometabolism, left hemisphere speech dominance, full scale IQ of > 70 and no extratemporal lesion in MRIs. The regional glucose metabolism was determined in each patient in homologous regions including prefrontal cortex, and normalized to whole brain metabolism. Regional differences of > 10% were regarded as asymmetrical. Prefrontal metabolic asymmetries were more frequent in patients with left temporal lobe epilepsy (21 left, six right) and a history of secondarily generalized seizures. A multivariate analysis of variance revealed a main effect for prefrontal metabolic asymmetry on neuropsychological 'frontal lobe measures', including verbal and performance intelligence measures. Prefrontal metabolic asymmetry was not related to 'measures of episodic memory', presence of psychiatric symptoms or frontal interictal epileptiform discharges. We conclude that prefrontal metabolic asymmetry is associated with cognitive impairment. Patients with temporal lobe epilepsy of the left speech dominant hemisphere and a history of secondarily generalized seizures are at considerable risk of developing prefrontal metabolic asymmetry.

Adult↗
PubMed1997

Retrieval of old memories: the temporofrontal hypothesis.

Extensive neuropsychological testing is reported on two chronic patients with combined temporopolar and prefrontal damage, dominantly left-hemispheric, and, as control, one chronic patient with bi-hemispheric prefrontal damage. The principal finding is that combined temporofrontal damage, but not substantial prefrontal damage alone, results in marked retrograde memory deficits while leaving intelligence and new learning relatively unimpaired. Although their general world knowledge was good, the temporopolar patients demonstrated retrograde memory impairments on several tests of past events and faces of previously famous people. With respect to retrograde autobiographical memory, one of the temporopolar patients was severely impaired and the other was judged to be moderately impaired. The control patient appeared to be normal. These results, together with corresponding data from related single case and dynamic imaging studies, strongly support a crucial role of the temporofrontal junction area in the ecphory of old memories.

Adult↗