Attentional processing in Parkinson's disease: hyperkentic and akenetic type

Abstracts 1 Archives of Clinical Nemopsychology 15 (2000) 653-850 715 measures. A series of 3 comprehensive neuropsychological evaluations separated by 2 years were completed, the first as a baseline, and the second and third assessments following different medication treatments. An analysis of longitudinal findings revealed a steady decline in cognitive ability over a 2-year period after baseline despite interferon beta treatment, prompting neurological and neuropsychological re-evaluation and subsequent medication change. Comprehensive neurometric assessment revealed significant improvement in cognitive functioning after glatiramer acetate treatment that was consistent with MRI and neurologic observations. These findings effectively illustrate the sensitivity of repeated neuropsychological evaluation in monitoring drug efftcacy and its utility as an important clinical tool in medical decision making. Process analysis of verbal fluency production following nucleus stimulation Trepanier LL, Saint-Cyr JA, Lang AE, Lozano AM. pallidal lesions and subthalamic There has been a renewed interest in neurosurgical interventions for Parkinson’s disease (PD), namely unilateral posteroventral pallidotomy (U-PVP) and chronic bilateral deep brain stimulation of the subthalamic nuclei (SIN-DBS). Recent cognitive outcome studies have indicated that measures of phonemic and/or semantic verbal fluency, already compromised in PD due to frontal-striatal dysfunction, appear to be the most consistently affected neurocognitive functions following these procedures. In order to understand the underlying cognitive processes involved in verbal fluency and hence, the possible nature of these post-operative verbal fluency deficits, a process analysis of pre- and posttest protocols was undertaken in 39 U-PVP patients and in 11 SIN-DBS patients over a l-year follow-up period. Fluency productions were re-analyzed for 2 components: clustering (i.e. the production of words within semantic or phonemic subcategories) and switching (i.e. the ability to shift between clusters). It is thought that clustering and semantic fluency are more related to temporallobe function while switching and phonemic fluency are more related to frontal-lobe function. As expected, post-operative declines were more consistently observed on switching for both surgical procedures, with no recovery of function over 1 year. Lateral&y effects were also noted following UPVP lesions. Left-sided lesions led to declines in switching on phonemic fluency but either side of lesion led to switching difficulties on semantic fluency. Verbal fluency has not recovered in any study published to date and this was found in the present study as well. It can be concluded that neurosurgical interventions for PD further disrupt the functional integrity of frontal-striatal circuitry. Attentional processing in Parkinson’s disease: hyperkentic and akenetic type Kraus CD, Iacono Rp: Burley r Freier K, Raggs M, Jenkins L. Parkinson’s disease (PD) is an idiopathic, progressive, neurologic disorder. This neurologic disorder affects approximately 1 in 100 people over age 60 in the United States (Bondi and Troster, 1997). This disease is a progressive degeneration of the monoaminergic dopaminergic systems (Wolters and Calne, 1989, Mirsky, et al., 1960). Neuropsychological studies regarding cognitive functioning in Parkinson’s disease (PD) have yielded inconsistent results. This inconclusiveness is probably related the fact that these studies have assumed that PD is a single disorder rather than a spectrum of disorders. Hyperkenetic (tremor dominant) and akinetic (axial symptoms) exhibit different symptoms, different neurochemistry and different underlying pathological mechanisms. Two subtypes of Parkinson’s disease were addressed, hyperkinetic and akinetic. In addition, normal aged matched adults were used 716 Abstracts /Archives of Clinical Neuropsychology 1.5 (2000) 653-850 as controls to help identify confounding variables related to normal age related cognitive or attention deficits. Selective attention, sustained attention, divided attention, attentional switching and auditory verbal working memory were assessed for hyperkinetic, akinetic and control groups. It was hypothesized that the hyperkinetic and akinetic PD groups would demonstrate deficits in attention as compared to healthy controls. The akinetic PD group was hypothesized to have greater attentional defits than the hyperkinetic group. The author has proposed an explanation for the differing attentional mechanisms based upon analysis of neuropsychological, neurophysiological and neuroanatomical data. The results confirmed that PD patients have greater deficits in attentional processing than healthy controls. Akinetic patients demonstrated deficits in selective attention, sustained attention, and auditory working memory. Hyperkinetic patients showed deficits in selective attention but tended to look more like healthy controls on sustained attention and auditory working memory. Neuropsychological sequelae of Hallervorden-Spatz Newman SA, Bechtold KT. syndrome Hallervorden-Spatz syndrome (HSS) is a rare, progressive disease often characterized by childhood onset of relentlessly progressive symptoms including dementia, bradykinesia, spasticity and dystonia. Radiological studies have demonstrated pathological levels of iron deposition in the globus pallidus and pars reticulata of the substantia nigra in patients diagnosed with this syndrome. While the neurological and physiological aspects of this disease have been widely studied, few researchers document the neuropsychological impairment resulting from the disorder. We present the neuropsychological findings in a 42-year-old woman diagnosed with adult onset Hallervorden-Spatz syndrome. Results demonstrate a global decline in intellectual functioning as well as impairment in psychomotor speed, motor functioning, executive functioning and confrontational naming. Verbal memory functioning and verbal fluency were found to be grossly within normal limits. Our findings are compared to previous findings in an attempt to gain a further understanding of the impact of this syndrome on neuropsychological functioning. Neuropsychological deficits and neuroimaging markers of CNS involvement Ryan EL, Christopher GE Stephen I;: van Gorp WG. in HIV We present the neuropsychological evaluation of a long-term AIDS survivor who showed evidence of minor cognitive motor disorder as well as abnormalities on magnetic resonance diffusion tensor imaging. The patient was a 44-year-old HIV + business executive with 22 years of education who was referred for assessment due to complaints of memory and difficulty managing his investment portfolio. The patient became aware of his HIV status in the mid-1980s. At the time of the NP evaluation, his CNS viral load was undetectable (< 50) and his CD4 was 620. He was on highly active antiretroviral therapy and Proza (...truncated)