Search

Introduction: Although emotional dysregulation is a core problem in borderline personality disorder (BPD), few neuropsychological studies have evaluated the impact of emotion. The present study aimed at the comprehensive investigation of verbal memory functions with and without emotionally relevant interference in BPD. BPD patients were expected to perform as well as healthy subjects in standard memory tasks but to show fewer capacities to control for emotionally negative interference., Methods: 47 patients with BPD and 70 healthy control subjects participated. An experimental task assessed verbal memory with respect to standard and emotionally relevant and neutral interference learning conditions. Applied standard tests covered working memory, delayed memory, and word fluency., Results: Memory performances of BPD patients were impaired when negatively valenced interference was conducted but normal in all other conditions. These results remained stable after controlling for comorbid major depression and posttraumatic stress disorder., Discussion: The present findings suggest no general impairment of verbal memory functions in BPD but control and inhibition of interference by emotionally significant material seem to be disturbed.

Introduction: Patients with obsessive-compulsive disorder (OCD) often have difficulties in everyday decision making. In addition, recent research suggests that patients have reduced performance on the Iowa Gambling Task, a laboratory decision-making task with implicit rules that taps emotional feedback processing. Disadvantageous decision making is accompanied by reduced skin conductance responses (SCRs) generated during task performance., Methods: The current study investigates behavioural and SCR data during the Iowa Gambling Task (IGT) and additionally the Game of Dice Task (GDT), a decision-making task with explicit and stable rules. We examined 14 patients with OCD and 15 comparison subjects performing the two decision-making tasks while recording accompanying SCR., Results: Patients showed difficulties on the Iowa Gambling Task but not the Game of Dice Task. This was also confirmed by the SCR results. In the Iowa Gambling Task differences in SCR patterns for patients and comparison subjects were observed, whereas SCRs during the Game of Dice Task did not differ between groups., Conclusions: Behavioural and SCR data indicate that patients with OCD have difficulties in decisions under implicit but not under explicit risk conditions.

Introduction: A substantial proportion of the recently published cases of dissociative disorders have a background of immigration (Fujiwara et al., 2008). Among the dissociative disorders, Ganser syndrome is an uncommon form that has as central symptom the giving of approximate answers to questions (vorbeireden). The predisposing and triggering factors of Ganser syndrome are poorly defined. Furthermore, this condition might cooccur with other psychiatric disorders. Here we describe a patient with a background of immigration, who, after an objectively minor work-related head injury, developed severe and persistent psychiatric symptoms, with features of Ganser syndrome., Methods: The patient was assessed medically, psychiatrically, and by neuropsychological testing., Results: The patient is a man with no known previous psychiatric history, who lived in several countries and encountered a series of stressful experiences in the process of migration. Several years after immigrating to his current country of residency, he developed severe psychiatric symptoms of Major Depressive Disorder, with Psychotic Features and Ganser syndrome. The symptoms, which emerged after a mild head injury, have persisted for more than a year, despite treatment., Conclusions: The similarity between this case and other reports suggests that psychosocial stresses accompanying immigration may have a catalytic effect in triggering and maintaining dissociative symptomatology.

Fourteen patients were investigated 3-4 days after end of their transient global amnesia (TGA) with a number of neuropsychological tests. Their performance was compared with that of a control group, matched for age, education, and profession. It was found that in spite of the common definition of TGA, impairments in both verbal and non-verbal long term memory and verbal fluency persisted and were in fact impaired to such a degree that it seemed unlikely that full recovery would have occurred within the next few days. We propose a major role of stress in the etiology and the recovery process of TGA and consider it likely that stress hormones are of major influence both in the triggering of TGA and the subsequent continuation of cognitive impairments.

The case of a patient suffering from rupture of an aneurysm of the anterior communicating artery is reported. The hematoma was located in the basal forebrain, one of the anatomical regions associated with mnestic functions. Memory and other cognitive functions were studied. The patient performed well on all non-mnestic tests, but showed significant memory impairment. Anterograde memory was deficient not only in recall, but also in recognition. Performance on remote memory tests showed some differentiation. The patient remembered autobiographical material and famous faces correctly, but presented deficits on a Famous Events Test. This dissociation represents a difference in emotional content or familiarity of the material; the performance in tests using material with a higher emotional content was unremarkable. Lesions within the basal forebrain seem to deteriorate anterograde and remote memory, but performance may be inconspicuous if test material of high emotional content or familiarity is used.

A patient with ongoing psychogenic amnesia is described. NN lost his personal identity eight months prior to the reported investigation. All physical and neurological examinations, including magnetic resonance imaging, were unremarkable. Neuropsychological testing revealed above-average intelligence and anterograde memory abilities. No retrograde amnesia for factual knowledge was detected. However, severe persistent amnesia was found for personal events prior to the psychogenic fugue (retrograde episodic amnesia). In contrast, personal episodes subsequent to the fugue were well preserved. For NN, a PET activation study was performed during the following phases: Baseline, a rest or control state; Prefugue, during which sentences containing episodic information of NN's past prior to the fugue were presented; and Postfugue, where episodic information concerned with personal experiences following the fugue was presented. The two activation tasks both led to increases in regional cerebral blood flow in memoryassociated areas in the left hemisphere only. A group of control subjects (n ≥ 7), however, tested in a similar paradigm showed activations in associated regions predominantly in the right hemisphere (Baseline; Impersonal, i.e. information about NN's past that had been presented one hour prior to PET scanning; Personal information about one's own autobiographical events). This suggests that normal controls access personal (autobiographical) episodic information using mainly right hemisphere memory-associated brain regions. NN, in contrast, appears to treat personal episodic information in a neutral (semantic, "left hemisphere") way. Taken together, our findings suggest, for the first time, a functional neuronal correlate for psychogenic amnesia.

Basically, two hospitalized patient groups were a variety of different learning situations which are subdividable into conventional and experimental tests and which covered so-called implicit and explicit memory tests. Furthermore, data from other cases were used for comparison and for support of the proposed hypotheses. The main sample consisted of 15 focal brain-damaged patients (group N) and 15 patients after surgical interventions outside the nervous system (group O). Aside from affective behavior and intelligence, memory tests were used. These included the WMS-r, picture and face recognition tests, the Tower of Hanoi, the Wisconsin Card Sorting Test (WCST), a Concept Comprehensive Test, and word and picture priming tests. A number of significant differences were obtained between the two age, sex, and education matched groups. Above all, intelligence and memory were reduced in parallel in the cortically damaged compared to the well-matched orthopedic group, while attention and concentration did not differ. Even performance in tests such as the Tower of Hanoi and the WCST differed, perhaps explainable by the proportion of frontal lobe damaged patients and the overall decrease in intelligence in group N. Verbal priming was found to a similar degree in both groups. On the other hand, priming of incomplete pictures was significantly poorer in group N than in group O; furthermore, results from MQ- and IQ-based group splitting (independent of their previous N or O affiliations) suggested a direct relation between mnemonic and other cognitive abilities and success in priming. As perceptual, but not verbal priming differed between groups, and explanation of group N results, based primarily on explicit memory processing, is unlikely. It is concluded that non-brain damaged patients in general are able to use a wider repertoire of information encoding strategies which at least in part is memory and intelligence correlated.

The aims of this study were to determine whether stimuli which cannot be detected consciously may nevertheless influence subjects' choices, and whether such an effect is dependent upon stimulus quality and the cerebral hemisphere involved in processing. We subliminally presented words (associated with left hemisphere processing) and faces (associated with right hemisphere processing) to each visual half-field. Subsequently, subjects had to choose among six items. The performance of subjects was compared to that of controls to whom only blank stimuli were presented. Subjects chose the correct word or face significantly more often than controls. For words this effect was significant only when they were subliminally presented to the left hemisphere, whereas subliminal face processing was done by both hemispheres. Our results demonstrate that (i) subliminally presented stimuli influence subjects' choices and thus must have been perceived, and (ii) that cerebral dominance seems to play a role in subliminal perception.

The case of a 46-year old patient with a bilateral medial thalamic infarct, affecting mainly the region of the internal medullary lamina, but not of the mammillothalamic tract, is documented neuropsychologically and neuroradiologically. Testing was done after acute remission. The patient was of average intelligence but manifested a number of verbal memory problems. These are most likely attributable to the selective diencephalic damage and are interpreted as a disconnection syndrome.

A 45-year-old right-handed patient with total callosal agenesis and absence of the anterior commissure was examined neuropsychologically and with magnetic resonance and positron emission tomography (PET with 18FDG) of the brain. PET results showed, in the resting state, a bilateral metabolic reduction in the hippocampal formation and a left hemispheric reduction in the amygdala, thalamus and in the occipital and temporoparietal junction areas of the cerebral cortex. Under speech activation hypermetabolic glucose activity was observed bilaterally in the region of the Wernicke area and within the left Broca area. Neuropsychologically, on the whole the patient behaved normally, the exceptions being an inability to associate olfactory stimuli with words, a clear left ear advantage in dichotic listening, and a similar high performance in recognizing verbal stimuli presented tachistoscopically to either hemisphere. From comparing the patient's behavior with that of other acallosals it appears that highly individual variants of cerebral organization and/or reorganization result from the lack of the brain's main commissural system and that the processing of sensory information deviates considerably especially in cases in whom the two main telencephalic commissures--corpus callosum and anterior commissure--are absent.

In order to establish a model for the possible neuropathology of patients with Alzheimer's disease, various behaviors of rats with different chemical lesions in cholinergic regions were studied and compared with those of sham-operated control rats. A battery of neurological tests was used as well as activity measurements and two learning tasks: a positively reinforced place-learning task with delay periods of Os, 1 min, 15 min, and 2h, and a shock-motivated two-way active avoidance task. While in general no intergroup differences were obtained in performance on the neurological test battery or the rats' activity in an open field, there were marked impairments in the three lesioned groups compared to the control group in the two learning tasks. These deficits were less severe in the two groups with lesions of the medial septal/vertical diagonal band of Broca region and the nucleus basalis of Meynert region, but rather marked in the group with lesions of neurons situated in the pontomesencephalic region, although the amount of ibotenic acid injected had been the same for all groups. We conclude from these data that changes in mesencephalic cholinergic regions might play a significant role in the pathology of Alzheimer's disease. The existence of such regions was recently established for primates as well, thus providing a basis for justifying an animal model of this human disease.

Relationships between the performance in a symmetrically reinforced go-no go task and cellular firing patterns in prefrontal and parietal association areas of the neocortex were studied in six cats. During recordings, animals lay in a box, with their heads fixed to a stereotaxic frame, and performed an auditory go-no go task by pressing a retractable lever in front of them. Units obtained were classified into eight types according to the correlation of their activity changes with aspects of the task and/or with sensory stimuli. These types were (poly-) sensory, reward related, EMG-related, EOG-related, event-related, movement-initiating, expressing expectancy or novelty, and nonspecific or task-unrelated active units. Between the two recording areas a considerable degree of similarity was obtained in unit firing patterns. It was concluded that within the cerebral cortex, and especially within its association areas, a considerable functional overlap exists, that neurons may be involved in the processing of several and rather different phenomena, and that the processing of information at this level of the brain is generally done via widespread, interwoven neuronal nets so that only the average network activity, but not that of a particular, single neuron, represents a stimulus or an event.

From a neuropsychological point of view, hypotheses are offered on the possible action of the brain in the processing of mnemonic information for long-term storage (or for retrieval of long-term stored information). It is argued that strict relations between damage of circumscribed brain structures and amnesia, as they have been suggested in recent case reports, are questionable for several reasons: Firstly, the involved regions differ between cases; secondly, there is some counter-evidence from other cases in which similar neuronal damage failed to result in lasting amnesic disturbances; thirdly, it is hypothesized that even from circumscribed brain damage it is not justifiable to conclude that the lesioned structure is solely or principally responsible for the observed mnemonic changes, as the brain acts in an integrative way, that is, on the basis of a wide-spread network of neuronal information processing. On the basis of these and related arguments, hypotheses and models on mnemonic information processing in the intact and in the damaged brain are derived. With these hypotheses even the frequent observation of interindividual differences in mnemonic information processing finds a possible explanation which is in conformity to known anatomical circuits and connections and to principles of neuronal coding.

The afferent connections of the squirrel monkey's lateral premotor cortex were investigated with the horseradish peroxidase (HRP) technique. Seven monkeys received small, unilateral injections of HRP spaced between the most dorsal and the most lateral region of the premotor cortex. Results are based on six brains, all of which showed a considerable number of labeled neurons both cortically and subcortically. At the cortical level, labeled cells were found both ipsi- and contralateral to the injection site. Heavy labeling occurred in the fields surrounding the prefrontal, central, and precentral cortex, while the temporal regions usually innervated the premotor cortex with a moderate number of cells, and the parietal fields with only a minor number. Surprisingly, in all brains, but especially in those with the more lateral injections, we also found a considerable number of afferents originating from occipital fields, including a few neurons from the striate cortex. Subcortically, a few labeled cells were seen in basal forebrain regions, the amygdala, and the claustrum; a considerable number of thalamic nuclei and also some hypothalamic nuclei contained labeled cells; and within the brainstem, labeling was found most consistently in the locus ceruleus and in the tegmental fields. It is concluded that the (lateral) premotor cortex is involved in sensorimotor integration to a higher degree than has been recognized up to now.

After reviewing the loci of origin for neurons with collateralized axons, some hypotheses on their distribution in the mammalian nervous system, on their functional contributions and on their significance in the course of encephalization are discussed. In principle, the distribution of collateralized neurons seems to be restricted to anatomical circuits subserving unspecific activation of forebrain regions and controlling body balance and movements. Concerning the limbic system, a minor degree of collateralization seems to exist only in less encephalized species. Based on a number of anatomical and functional arguments, it is assumed that the significance of collateralization fades in the course of encephalization.

The performance of juvenile Down syndrome individuals and two groups of oligophrenes was compared in several cognitive tests. All three groups of subjects were of the same CA, the Down's and one group of mentally retarded non-Down's had an average MA of 62, the other group an MA of 86 months. Though the group with the highest mental age usually outperformed the other two, significant differences were rare. It is concluded that at this age Down's and mentally retarded with different etiologies generally have rather similar cognitive abilities and that the intellectual deterioration of Down's, which at a later age inevitably leads to Alzheimer's disease, indeed starts only at a later CA.

The performance in reidentifying photographs was measured in alcoholic Korsakoff patients, in non-amnesic alcoholics and in a control group. The photographs showed well-known and unknown faces and buildings and alcoholic and nonalcoholic beverages. A minimum of 15 min elapsed between the end of the original presentation of the series and the beginning of its second presentation within a large number of additional photographs. Korsakoff patients were significantly inferior in number of correctly reidentified items compared to alcoholics who were in turn significantly inferior to the control group. Korsakoff patients manifested the poorest performance in the reidentification of unknown pictures and of nonalcoholic beverages; they showed, however, comparatively good performance in the reidentification of alcoholic beverages and of known faces. Independent of the category of the stimulus material, the Korsakoff patients had low confidence in their responses. It is concluded from these data that the emotional tone of material to be remembered constitutes a major variable for delayed effective retrieval.

Possible relations between chronic alcohol abuse and impairments in cognitive functioning were tested in six groups of subjects, groups A1, A2, CGy, AA, KO, and CGo: The first three groups were about 35 years old, the last three about 50 years. Groups A1 and A2 each consisted of ten men hospitalized for the treatment of alcohol dependency, group A1 having been detoxified for less than one week, and group A2 for more than five months. Group CGy constituted the matched control group. Group AA consisted of six Alcoholics Anonymous, sober for more than five years, nine Korsakoff patients made up group KO, and group CGo was the control group matched for groups AA and KO. As the main tests, all subjects were given a number of slides showing scenes, humans, or animals, half of which had been rated as neutral while the other half was emotionally arousing (in either a negative or a positive way). In two tests, one after ten minutes, and one after two days, the subjects were required to reidentify those slides which they had seen before, and their galvanic skin response was measured simultaneously. Several psychological tests including one for paired associate learning were given as well. The main results were that alcoholics, whether they had been abstinent for a longer time or not, were inferior to nonalcoholics, but that a prolonged period of soberness nevertheless most likely leads to the recovery of cognitive functions. Though the underlying causes of the cognitive deficits found in the four experimental groups (A1, A2, AA, KO) may be due at least in part to different or even contradictory underlying causes, they provide support for "simple versions" of the so-called continuity and premature aging hypotheses.

The performance of 36 patients, divided into six groups, and 13 control subjects was investigated in paired-associate learning. The patients had right or left prefrontal, right or left anterior lateral temporopolar or medial temporal lobe damage, or lesions restricted to diencephalic areas. As tasks, two lists of paired words had to be learned, with the first list presenting only the word pairs, and the second one embedding the word pairs in sentences of a highly imaginable content. Recall consisted of immediate or delayed (48 hrs) free recall of the first list (condition I), of immediate or delayed recall of the second list (with visual imagery as a learning aid; condition II), and of cued recall (in which the sentence form was presented with a blank space where the word to be recalled had been previously; condition III). Control subjects clearly performed best under all conditions, manifesting a ceiling effect for the second and third ones under immediate recall. Among the brain-damaged groups the diencephalic subjects were poorest and gained only little from the aids given for learning and recall. Of the four patients with medial temporal lobe damage, those two with bilateral lesions were nearly as bad as the diencephalic lesioned subjects. The other patients were markedly inferior to the control subjects, but gained considerably under conditions II and III. These statements hold for immediate and delayed recall, though for the delayed recall conditions all groups showed a reduction in performance which amounted to roughly half of the values they had had under immediate recall. It is concluded that increasing the possibilities for depth of information processing assists brain damaged (as well as normal) subjects in verbal learning, but that the advantage of aiding them at the moment of encoding and retrieval is highest for patients with restricted lesions and/or with lesions not invading the two regions most regularly implicated in long-term information processing (the diencephalon and the medial temporal lobe area).