Identification of brain region for coordinating speech articulation.
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Apraxias↗
Biomedical subjects
M M Saling
Publications and source records attributed to M M Saling.
Computerized neuropsychological tests in the early detection of dementia: prospective findings.
This longitudinal study examines the sensitivity of 2 computerized neuropsychological tests, delayed matching to sample and paired associate learning, to early dementia of the Alzheimer type (DAT). Normal controls, patients in the early stages of DAT, and individuals with questionable dementia (QD) were studied. At 6 and 12 months after initial presentation, almost half of the QD group exhibited lower scores on the computerized subtests, maintaining their scores on standard testing. Over the same period NC subjects maintained their performance levels, while DAT patients continued to deteriorate. Linear discriminant function analyses of the computerized subtests at 6 and 12 months correctly classified 100% of the early DAT patients. Eighty-four and 79 percent of normal controls were correctly classified at 6 and 12 months respectively. Further development of these subtests for the detection of early dementia and the documentation of ongoing change in DAT is warranted. The findings are discussed in terms of the special sensitivity of these tests to the neuropathology of Alzheimer's Disease.
Aged↗
Does naming contribute to memory self-report in temporal lobe epilepsy?
The present study evaluated the hypothesis (Mayeux et al., 1980) that visual confrontation naming deficits may underlie the memory complaint in patients with temporal lobe epilepsy (TLE). Thirty-nine patients with medically refractory left (n = 23) and right (n = 16) TLE were compared with an epilepsy control group with idiopathic primary generalized epilepsy (n = 38). All subjects completed selected subtests of the Multilingual Aphasia Examination and Wechsler Memory Scale (Form 1) together with a measure specifically designed for quantification of the memory complaint in TLE. Objective verbal memory test performance, confrontation naming, repetition, and comprehension were unrelated to memory self-report. Controlled Oral Word Association was the only measure to exert an influence on memory self-ratings, and this relationship was specific to the TLE group. The hypothesis of Mayeux et al. (1980) was not specifically supported, but the present findings do suggest that cognitive processes reflected in orthographically based and internally generated word retrieval play a role in memory self-report.
Adult↗
Is cerebral concussion a transient phenomenon?
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Amnesia↗
Autosomal dominant rolandic epilepsy and speech dyspraxia: a new syndrome with anticipation.
We describe a family of 9 affected individuals in three generations with nocturnal oro-facio-brachial partial seizures, secondarily generalized partial seizures, and centro-temporal epileptiform discharges, associated with oral and speech dyspraxia and cognitive impairment. The speech disorder was prominent, but differed from that of Landau-Kleffner syndrome and of epilepsy with continuous spike and wave during slow-wave sleep. The electroclinical features of this new syndrome of autosomal dominant rolandic epilepsy resemble those of benign rolandic epilepsy, a common inherited epilepsy of childhood. This family shows clinical anticipation of the seizure disorder, the oral and speech dyspraxia, and cognitive dysfunction, suggesting that the genetic mechanism could be expansion of an unstable triplet repeat. Molecular studies on this syndrome, where the inheritance pattern is clear, could also be relevant to identifying a gene for benign rolandic epilepsy where anticipation does not occur and the mode of inheritance is uncertain.
Adult↗
The assessment of orientation following concussion in athletes.
The purpose of this study was to investigate the sensitivity of orientation and recent memory questions in the diagnosis of concussion. In a prospective study over 7 consecutive years (1985-1991), all players at a professional Australian Rules Football club who sustained a concussive injury (n = 28) were administered a set of questions evaluating orientation and recent memory. Concussion was diagnosed independently on the basis of loss or disturbance of consciousness and clinical symptoms. A control group of age-matched nonconcussed players was administered the same set of questions. The results showed that items evaluating recently acquired information were more sensitive in the assessment of concussion than standard orientation items. The relative sensitivity of orientation questions must be considered when they are used in the clinical diagnosis of concussion in sport.
Australia↗
Computerized delayed matching to sample and paired associate performance in the early detection of dementia.
This study examined the ability of two computerized neuropsychological tests, delayed matching to sample and paired associate learning, to detect early dementia. Three groups of subjects classified by NINCDS-ADRDA criteria and standard neuropsychological tests were studied: normal controls, patients believed to be in early stages of dementia of the Alzheimer type, and a group of questionable dementia subjects who reported memory loss but performed normally on standard measures of cognition. All subjects completed the two computerized tests. The early dementia group performed at a significantly lower level than the other two groups on all standard and computerized measures. A linear discriminant function analysis of the computerized tests classified 100% of the normal controls and 87.5% of the dementia patients into the same groups as standard testing. The majority of questionable dementia subjects were classified as nondemented. The concurrent validity and test-retest reliability of the computerised tests were also investigated. It is suggested that computerized tests are useful when screening for early dementia, and that longitudinal studies are required to evaluate the comparative reliability of the tests.
Journal Article↗
Interictal language fluency in temporal lobe epilepsy.
Mild language production difficulties, particularly in confrontation naming, have been documented previously in patients with left temporal lobe epilepsy (LTLE). These difficulties, however, do not seem to be reflected in the conversational speech of these patients. In order to compare speech fluency in patients with left and right temporal lobe epilepsy (RTLE) experimentally, we studied global pause-to-speech ratios in patients with unilateral temporal lobe epilepsy, using cases with primary generalized epilepsy (PGE) as controls. We hypothesized that left-sides cases would exhibit longer pause durations than right-sided cases. Speech samples were elicited by asking subjects to describe five different New Yorker cartoons, with three repetitions of each description. Phonation was converted to graphic output, and pauses between 200 ms and 4000 ms were summated and divided by total phonation time. This measure did not discriminate significantly between the groups, although the LTLE group tended to pause longer than the RTLE or PGE groups. Increased variability in pause duration in the LTLE group during cycle 1 suggested that some individuals with LTLE are vulnerable to disruption when planning demands are high. A post hoc correlational analysis showed that variation in fluency was primarily explained by orthographically-based lexical retrieval, suggesting that individual differences in fluency are related to limitations in a high-level capacity relevant to the production of speech. It is unlikely that such limitations are specific to LTLE.
Adult↗
Can metamemory be localized?
This comment examines current neuropsychological literature in the field of metamemory. One notion emerging from this literature is that metamemory is mediated by the frontal lobes. We argue that this idea is the result of inadequate conceptual approaches to metamemory and that currently there is no evidence to support the cerebral localization of metamemory.
Brain Damage, Chronic↗
Rey figure distortions reflect nonverbal recall differences between right and left foci in unilateral temporal lobe epilepsy.
Recall of the Rey Complex Figure (RCF) by patients with left (N = 26) or right (N = 18) temporal lobe epilepsy was scored in terms of the qualitative approach developed by Loring, Lee, and Meador. Patients with right temporal lobe epilepsy exhibited significantly more qualitative errors on recall of the RCF than patients with left temporal foci, whereas standard RCF scores failed to differentiate the groups. A linear discriminant function analysis showed that 66% of patients were correctly classified into lateral focus groups on the basis of qualitative scores, with a sensitivity of 50% and specificity of 77%. Although unsuitable for clinical use in its present form, the qualitative approach appears to be a promising one. The findings offer support for the position that some aspects of nonverbal memory are critically dependent on the integrity of the right temporal lobe. The implications of this for reorganization of cerebral representation are examined.
Journal Article↗
Lateralization of verbal memory and unilateral hippocampal sclerosis: evidence of task-specific effects.
This study retrospectively investigated the effect of left (LHS) versus right (RHS) hippocampal sclerosis on verbal memory, measured by means of the Paired Associate Learning and Logical Memory subtests of the Wechsler Memory Scale (WMS) administered as part of a routine preoperative assessment. Patients were selected for the presence of unilateral hippocampal sclerosis by means of preoperative magnetic resonance imaging (MRI) and postoperative neuropathology. The LHS patients (n = 20) were significantly worse on paired associate learning than RHS patients (n = 18), the performance of RHS patients being consistent with normative standards. In contrast, no laterality effect was seen on the immediate and delayed recall of passages; the evidence suggests that both groups performed at a mildly impaired level. It was suggested that the laterality of verbal memory is conditional upon specific task demands in patients with damage to mesial temporal structures.
Adult↗
Localised neuronal migration disorder and intractable epilepsy: a prenatal vascular aetiology.
Localised neuronal heterotopias are an increasingly recognised cause of intractable focal epilepsies. The aetiology of these circumscribed disorders of neuronal migration is often unknown although in some instances proximity to areas of prenatal infarction suggests that severe ischaemia was responsible. A patient is described with intractable complex partial seizures associated with heterotopic grey matter and cerebral hypoplasia confined to the territory of the left posterior cerebral artery; the left hippocampus was spared. Angiography showed a normal left anterior choroidal artery but a hypoplastic left posterior cerebral artery, implicating prenatal ischaemia without frank infarction as the aetiology of the malformation.
Adult↗
Neuropsychological deficit in haemophiliacs with human immunodeficiency virus.
Neuropsychological impairment is widely accepted as being common in acquired immunodeficiency syndrome (AIDS) but infrequent in asymptomatic human immunodeficiency virus (HIV)-infected individuals. The neuropsychological function of a homogenous sample of HIV-infected haemophiliacs was investigated. Neuropsychological impairment, the nature of which is compatible with that described in the existing literature, was found in one of four AIDS cases. Eleven AIDS related complex (ARC) and 12 asymptomatic HIV-infected individuals were free of neuropsychological deficit.
AIDS Dementia Complex↗
Psychogenic amnesia?
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Amnesia, Retrograde↗
The stroke syndrome of striatocapsular infarction.
Striatocapsular infarction has recently been described as a distinct stroke entity and forms an important subgroup of subcortical infarctions. In a prospective study of 50 consecutive patients over a 10 yr period with this syndrome, clinical and neuropsychological features, pathogenesis and outcome were studied to provide information concerning management and prognosis. The most common clinical presentation was that of a stroke affecting mainly the upper limb with cortical signs such as dysphasia, neglect or dyspraxia. Evidence from EEG, angiographic and neuropsychological data supported a vascular/haemodynamic basis for the presence of the acute neuropsychological changes, while the chronic changes were more likely to be due to diaschisis. A study of risk factors and cerebral angiography enabled 4 pathophysiological subgroups to be identified: (1) cardiac emboli to the origin of the middle cerebral artery; (2) severe extra-cranial cranial carotid artery occlusive disease with presumed embolism to the same site and/or involvement of haemodynamic factors; (3) proximal middle cerebral artery abnormalities causing occlusion of multiple lateral striate arteries at their origins; (4) normal angiography where pathogenesis was uncertain. The risk factors of cardiac disease and smoking were significantly increased as compared with age and sex-matched controls with other forms of ischaemic stroke. Stroke or vascular death rate was 2.7% per yr during a mean follow-up period of 2.25 yrs. Predictors of an excellent recovery with return to normal lifestyle were younger age, only brachial or brachiofacial weakness with absence of cortical signs at presentation and minimal change on angiography. This stroke entity deserves particular recognition in the spectrum of subcortical infarctions because of its specific pathogenesis, distinct neuropsychological features and reasonable prognosis.
Cerebral Angiography↗
Acquired childhood aphasia with convulsive disorder (Landau-Kleffner syndrome). A case report.
The Landau-Kleffner syndrome is a rare form of acquired childhood aphasia associated with convulsive disorder. These children are typically misdiagnosed. A 15-year-old girl whose aphasia was not diagnosed until the age of 13 is described. Pitfalls in diagnosis are discussed, particularly with regard to interpretation of the results of audiometric testing. Attention is drawn to the existence of this rare form of aphasia and to the lack of appropriate educational facilities for aphasic children in general.
Adolescent↗
A letter-by-letter reader who could not read nonwords.
Letter-by-letter reading is a neuropsychological syndrome characterized by oral reading which seems to be mediated by explicit naming of constituent letters of the printed string. Thus reading time rises abnormally as a function of the length of the items to-be-read. This syndrome is generally interpreted as indicating a disconnection within the normal reading system prior to the activation of the visual and phonological lexical access routes. The patient retains a subsidiary strategy of spelling words by naming their constituent letters and uses this strategy for planning their pronunciation. If this interpretation is correct then reading aloud in letter-by-letter reading should not be affected by the features of the letter string which are stored lexically as the functional disconnection is postulated to occur prior to this stage. In this paper we report the case of a letter-by-letter reader who shows some signs which are puzzling in terms of current interpretations of the syndrome. They can be summarized as follows: (1) The patient reads words better than he reads nonwords; (2) Concrete words are processed more holistically while abstract words are processed more letter-by-letter; (3) Lexical decisions can be made far more rapidly than words can be read aloud. These three signs are very difficult to account for if reading is accomplished solely through a non-lexical reversed spelling strategy. Our experimental investigations of this patient are reported and alternative models assuming strategic control over the reading mechanism are discussed.
Adult↗
Lateral asymmetry and tactile sensitivity.
Weinstein found in 1963 that the left female breast is more sensitive to tactile stimulation than the right breast. Saling and Cooke in 1984 hypothesized that this asymmetry in breast sensitivity underlies the well-documented leftward bias in maternal cradling behaviour, which is independent of manual specialization. Our interest in the Saling and Cooke hypothesis led to an attempt to replicate Weinstein's 1963 study. His findings were not supported. Further, a review of the literature on the lateral distribution of cutaneous thresholds showed that there is little experimental support for the widely held belief that the left side of the body is uniformly more sensitive than the right.
Adolescent↗