Behavioral Neurology Notes

Bedside testing of frontal lobes

2010-09-05T12:31:00.000-07:00

Kramer JH, Quitania L in Miller BL, Cummings JL. The Human Frontal Lobes functions and disorders.

Published tests:
D-Kefs
CANTAB
FAB
EXIT- Executive Interview

bedside tests
fluency -- give F, A, S test and in alternate form give D only. Measure not only number of words produced, but also rule violations (giving responses with a different letter, and proper nouns) and repetitions. Subjects who do worse on category fluency have more likelihood of temporal involvement, and those with letter fluency only are more likely to have frontal involvement. Nonverbal analogue to letter fluency is design fluency. Show a box with five dots and ask them to create in one minute that have four lines that connect the dots. Several variations are used, one is d-kefs.

Mental flexibility-- on Trails B, Stuss et al. enhance the test by counting errors on Part B, which correlates best with DLPFC right sided injury. On DKEFS Trails, subjects alternate with letters and numbers. Older patients maybe asked to shift between numbers and days of the week, with a record of time to complete task and how many sequencing errors are made. Patients who cannot read may get Color Trails instead, connecting colored circles alternating between pink and yellow circles. Alternate form of Trails: Patients get one minute to create, from an array of dots (alternating half filled dots, half unfilled), as many designs as possible with four straight lines connecting dots. In first form, they are asked only to use unfilled dots, in the second, to alternate between filled and unfilled dots. Design and rule violations (ie failure to shift) are recorded.

Abstract reasoning: a) similarities between word pairs (dog/lion, table/chair. anger / joy) and b) proverbs- eg. " An old ox plows a straight row" and "Shallow brooks are noise" and " A beard well lathered is half shaved." Give credit for abstract and accurate answers.

Response inhibition: a) Stroop-- tabulate correct responses in 60 seconds, and the number of inhibition errors. b) Salient responses : Tell patient to to point to his chin while examiner touches nose, or tell patient to point to the ceiling while extending his hand c) Opposite-- when I tap once, you tap twice, and vice versa.

Working memory-- backwards digit span, spelling "world" backwards, serial sevens, saying days of week backwards, months in reverse order.

primitive reflexes-- snout, suck and grasp and glabellar

Complex motor programs
1) fist palm edge task-- perform 10 times, record the number of trials to learn the task, the number of perseverations, and the fluency of the movements.
2) Graphomotor sequences-- alternate m and n (cursive) elicit perseveration, micrographia.
3) Rhythm test-- ask patient to imitate finger taps in complex patterns.

Behavior-- observe and record, use a modified Manchester Behavior Questionnaire to survery based on both information and report. NPI and NPI-Q (short version) can be used (link to certification test: http://www.alz.washington.edu/cgi-bin/broker64)%20.%20May use the Dysexecutive Questionnaire (DEX) http://journals.lww.com/jonmd/Abstract/2008/01000/The_Dysexecutive_Questionnaire_Advanced__Item_and.13.aspx, Frontal Behavior Inventory (FBI) http://www.chumneurologie.org/conferences/FBI/FBI.pdf , and Frontal Systems Behavior Scale (FrSBE)

New Executive Brain VII Summary

2010-09-04T16:15:00.000-07:00

Believes hippocampi is "center" for veridical decision making, DLPFC for adaptive decision making.

Ventral tegmental lesions causing pseudofrontal syndrome

2010-09-04T16:05:00.000-07:00

Goldberg et al. Cortex 1989 Reticulofrontal disconnection
update see Miller Nat Rev Neurosci 2000

DA depletion in midbrain caused frontal disconnection.
"Kevin" had retrograde without anterograde amnesia

Analogy- (partial) to schizophhrenia that also affects mesolimbic (temporal) and mesocortical (frontal) projections. EG argues schizophrenia represents a top down organizing defect ie. a type of auditory agnosia. Behav Brain Sci 1991.

New Executive Brain VI: Syndromes Orbitofrontal (OF) Pseudopsychopathy

2010-09-04T14:15:00.000-07:00

Term is discarded. However, OF lesions inject emotion into analytic decision making, prevent responding like an automaton.

Social interactions: ACC reins in amygdala. In monkeys, ACC is more important than OF in socially appropriate behaviors (Ito et al.).

EG argues, about moral reasoning and the frontal lobes, that understanding temporal relationships is key to understanding causation, and appreciation of consequences of behavior is necessary for moral reasoning. Inferential reasoning of the if.then kind, is at basis both of language and of moral reasoning. Counterfactuals, that is, if I had done this x then y would have happened, are impaired after OF damage.

New Executive Brain 3: Frontal lobe tests

2010-09-04T13:24:00.000-07:00

Real life memory is not memorizing list given to us, but selecting task, and learning contextual information to task we chose. Therefore the memory task is not "working memory" any longer. This may explain the disparity in frontal lobe role in memory in humans and animals. Klingberg "The Overflowing Brain" (2008) gives a nice rendition of state of working memory.

The New Executive Brain V? Emotional brain, basal ganglia etc

2010-09-04T10:14:00.000-07:00

Davidson et al. Left hemisphere lesions produce negative affect especially if they are closer to the frontal pole. Right hemisphere lesions produce euphoria. Left hemisphere activates to happy film, financial gain, right hemisphere to sad film and financial losses. In the Ultimate Game, the right hemisphere activated to unfair offers. Suppression of memories occurs via right or bilateral DLPFC affecting the right hippocampus.Meditation, deactivates left frontal. Vicarious pain (watching others suffer) activates right frontal. (Naomi Eisenberger,et al. Science 2003, study of social exclusion).

Frontal lobes modify attenuate the amygdala (the "pre" prefrontal lobe actor); this done through orbitofrontal cortex. The amygdala also show evidence of valence mirroring that of evolutionarily later frontal lobe, ie left positive valence, right negative. Suppressing negative emotions is left DLPFC on left amygdala, fear engendering stimuli affect right amygdala, and lesion of right amygdala reduces the ability to experience fear. Anxiety may be associated with a large or hyperactive right amygdala. Emotionally charged crimes may be related to large right amygdala. Removal of right amygdala may attenuate ability to appreciate emotion of fear in others' faces.

In gambling experiment, both prefrontal and amygdalaoid lesions interfered with decision making, but only amygdaloid lesion was associated with a change in skin response. Distant threats in a virtual reality environment were mediated by DFPFC, but immediate threats were mediated by amygdala.

Author argues novelty/familiarization dichotomy can tie up loose ends of verbal/nonverbal debate.

Parkinson patients avoid choices leading to bad outcomes (risk aversion) more than selecting ones leading to a good outcome. (Frank et al., Science 2004).

The New Executive Brain 3: Tests of Frontal Function

2010-09-04T09:35:00.000-07:00

In real world, we choose a path and learn information we need; in memory tests we are given a list of words and told to memorize. Difference is role of frontal lobes. Hence, animal experiments show a more pronounced role for frontal memory than human experiments. CVLT allows semantic clustering, which (postulated) may be due to frontal activity. Most working memory tests lack a selection component. Frontal role is to select information and hold it online and manipulate it as long as is needed.

Courtney et al. (Cereb Cortex 1996) showed faces on a grid then another set of faces with "what" question and "where" question, which respectively, activated ventral and dorsal visual stream representations within the frontal lobes (inferior and superior).

"How does an organism decide what information is important enough to be kept online" is a question that has been ignored in almost all neuropsychological paradigms. Goldberg divides decision making into veridical and ambiguous. Veridical is "I spend 300 of 1000 dollars, how much is left?" Ambiguous or adaptive is "Shall I wear gray, blue, or white?" What is the answer? Gertrude Stein asked "What is the question?" Disambiguation may requires prioritizing (remember Buridano's donkey from Luria's books). Individual must be able to disambiguate in multiple ways and switch set ( "White is for spring, but white is not allowed at school so I will wear gray"). Veridical decisions find the truth, adaptive ones find what is best for the organism.

In Cognitive Bias Test, individual is given a card and asked to pick the one "they like the most." Then they were asked to find the choice "most similar to the target" then the one "most different from the target." Frontal lobe is required only for the first condition, the only one requiring disambiguation. Frontal lesions did not affect the second and third conditions. In Alz disease, the disambiguating test declined much faster. Verdejo found same in individuals with substance abuse (altered adaptive but not veridical decision making).

Males made choices on CBT in a context dependent way, that is when the targets changed, so did their choices. Females made context independent choices, that is their choices were stable regardless of target. This is first account of gender differences in adaptive decision making. Males with damaged right frontal lobe performed in an extremely context dependent manner, and males with damaged left frontal lobes performed in an extremely context independent manner. In females, damage to either frontal lobe caused context dependent choices. The Wisconsin Card Sorting Test failed to differentiate laterality of the lesion.

The effects of posterior lesions were less robust than those of frontal lesions, but were nonetheless dimorphic. In males, posterior temporal lesions followed frontal lesions: left sided lesions made males more context independent, and right sided lesions made males more context dependent. In females, posterior lesions were opposite frontal lesions: on either side, they made decision making more context independent.
Goldberg argues that in male laterality is more articulated, but in the female, front-back differences are more articulated.

In functional imaging experiments, when asked to process verbal information, males coactivated front and back in same hemisphere, whereas females coactivated homologous regions across hemispheres. Males have greater functional differentiation of the hemispheres, whereas females have greater functional integration of hemispheres-- note they also have bigger callosa. However, males have larger longitudinal fasciculi within hemispheres (see book for citations).

An overwhelming number favored similarity over novel among humans on the CBT (unlike other primates who picked the novel object). However, that is only true among righthanders. Among lefthanders, many picked the choice that differed from the target, not the one similar to it. J Cogn Neurosci 1994. EG suspects that the 9:1 balance in favor of right handers represents evolutionary needs for stability versus innovation. Functional roles of left handers may be reversed on CBT (Ibid.).

The New Executive Brain 2: Novelty, subroutines, and hemispheres

2010-09-04T08:24:00.000-07:00

1. Yakovlevian torque (see Lemay, Ann Ny Acad Sci 1976) shows the right frontal lobe is wider than and protrudes over the left, and the left occipital lobe is wider than and protrudes over the right. This present in great apes to some degree, and there are gender differences. Other assymetries include the planum temporale is larger in left side in human and this is also true in several other primates. Spindle cells with long axons are more numerous in the right hemisphere. White matter is more organized in the right than left frontal lobes in children and adults (Klingberg et al., 1999, Neuroreport). Dopamine is more prevalent in the left hemisphere, norepinephrine on the right, and estrogen receptors are more prevalent on right (rats) Sandu et al, Exp Neurol 1985. Goldberg argues that hemispheric assymetries exist in animal species and these cannot be based on language since animals lack language. Is language a "special case" of some larger difference?

2. Other right - left approaches (analytic/holistic, sequential/simultaneous processing) are difficult to operationalize and are rejected.

3. Bates E argued that in children, left hemisphere brain damage is inconsequential, but in right hemisphere patients it is devastating (in Bronan SH ed, Changing Nervous System: neurobehavioral consequences of early brain disorders, Oxford University Press, 1999).

4. History of civilisation is right to left shift; translating Vygotsky cultural historical psychology in neuroanatomical terms would reach similar conclusion

5. In neuropsych tests, averaging across six categories of WCST, the five trials of CVLT, and 30 trials of Benton Lines is not accurate anatomically. Should rescore old tests with that in mind.

6. Agnosias: leitmotif is left hemisphere is top down process, unable to recognize unique exemplars of generic categories "associative agnosias." Right hemisphere lesion cannot recognize exemplars as their own selves or as different exemplars of same category ("apperceptive agnosias"). see Goldberg JCEN 1990.

7. Animals may have paw prefence but its closer to 50-50 unlike humans.

8. Frontal function: divide into perseverative (difficulty with cognitive flexibility) unable to transition from one activity to another; and field dependent behavior (echopraxia/echolalia). Traditionally these are known as 2 aspects of executive control, ability to guide behavior by internal representations and ability to shift cognitive sets with exigencies. These may be referred to as "stability" and "plasticity" as well. Author postulates that D1 receptors maintain low level maintenance of current cognitive regime, and D2 receptors respond only to high levels of dopamine and cause destabilizing rapid updating of the cognitive regime, favoring the right hemisphere. On Executive Control Battery, perseveration was twice as common following left hemisphere injury. Echopraxia was twice as severe after right hemisphere injury. However, these differences were present only in men.

4. Authors Goldberg and Costa postulated the right hemisphere is important to cognitive novelty and the left to cognitive subroutines (Brain Lang 1981: 144-173). Information is processed from novel to familiar. . The left hemisphere information is stored in better articulated neural networks and easier to access. The right hemisphere is modified at a slower rate than the let hemisphere. It deals with novelty better due to it contains averaged default representation containing shared poorly differentiated features of many prior situations. The evidence that supports include Bever and Chiarello (Science 1974) who showed untrained musicians process with their right hemispheres, trained ones with their left hemispheres. He discusses obscure / familiar faces as being processed with right and left, (Henson et al, Science 2000). Alex Martin et al. (Hippocampus, 1997) used PET to show that with presentation of meaningful words, nonsense words, real objects and nonsense objects, the right mesiotemporal lobes were activated with first, novel presentation, decreasing with the second exposure. The left hemisphere activation was constant. Learning a complex motor skill activated first the right MFG, then late in training left posterior parietal cortex, left dorsal premotor cortex,and right anterior cerebellar cortex (Shadmehr and Holcomb, Science 1997).

More studies: learning grammar A and B: initial activation occurred in right ventral striatum, left premotor and anterior cingulum, replaced gradually by activation of right DLF and right posterior parietal (Berns et al. 1997 Science). Raichle (cereb Cortex 1994) found on a task of finding appropriate verbs for nouns, in naive condition activated ACC, left prefrontal, left temporal, and right cerebellum, but after practice only left medial occipital was activated. A task with longer processing has right hemisphere to a greater degree.

5. Constructs that are analagous to the novelty/familiarity distinction: Exploration/exploitation ( eg. gambling task, novel learning of task and exploiting task to make money) involved right frontopolar regions and left DLF regions respectively (Daw et al. Nature 2006 and Heekeren et al. Nature 2004). Another distinction is critic and actor; critic learns to predict future awards and actor uses the rewards to guide behavior. The "critic" in an fMRI study is the bilateral putamen and right ventral striatum, and the actor is the left anterior caudate. This resonates with an older idea that the OF lobes appraise value to person and prefrontal cortex navigates the external world.

6. Pathologic augmentation of orientating reaction (PTSD) has ep activity mostly in right hemisphere (Metzger, 2005 in Vasterling and Brewin).

The New Executive Brain by Elkhonon Goldberg I

2010-09-04T07:48:00.000-07:00

Goldberg reviews much more information in this book than can be summarized here, but I would like to go over certain information that would be critical to Goldberg's overall "brain view." I also include random references from the book that are less pertinent but interesting background nonetheless.

Goldberg is a protege of Alexander Luria's, but emigrated from the USSR in the early 1970s, establishing a career in New York, academic, eventually private practice. He opens with a reference to The Creation of Adam, a painting in the Cistine Chapel that Goldberg presents as representing an allegory of the frontal lobes.

1. The left inferior prefrontal cortex becomes active when presented with statements with semantic violations (:"trains are sour"). Hagoort et al., Science 2004. fMRI study. Language and executive functions arose together. Language builds models, executive functions manipulates them and conducts operations on them.

2. Goal formation is action centered about "I need" not "It is." Therefore, formation of goals relates to the emergence of the mental representation of the self, in turn related to the development of the frontal lobes.

3. The dorsomedial thalamus nucelus is the highest point of integration in the thalamus and has many connections with the frontal lobes. It also maintains connections with the hippocampus (memory), the cingulum (emotion and uncertainty), amygdala (relations among individuals in species) and hypothalamus (in charge of homeostatic functions).

4. Goldberg speaks of the "fallacies" of modularity (the high tech revival of 18th century phrenology"). For example, the planum temporale is critical for phonologic processing, but is not narrowly dedicated. Rather, it is critical for auditory analysis in a categorical sense (is the sound a dog barking, a cat meowing , etc.). It activates both when phonological discriminations are made and when environmental sounds are matched with their sources. Fusiform gyrus is associated with facial recognition. Goldberg differentiates between a prior, preordained modularity and a posteriori, resultant modularity. A priori means the area is hard wired for the task. A gradiential view of neocortical organization means that certain tightly integrated neuronal groupings emerge over time, due to cognitive history of individual. This means is has less uniformity, more individual differences and will change over time. The left hemisphere, which has more dedication to "subroutines" has more modularity and the right hemisphere has less. Goldberg published his gradiential theory of modularity in 1989 in JCEN and republished as a book chapter in 1990 (Contemporary Neuropsychology and the Legacy of Luria, 1990). "Modularity is best applied to an evolutionary old structure, the thalamus." Goldberg discusses the "dynamic topology" of cortex and the evolving role of the thalamus in its new inferior position in the hierarchy, which is a reason its function has been elusive.

5. Jordan Grafman et al. showed in an fMRI study that when a cognitive task is characterized by a hierarchy of goals, the regions around the frontal lobes are activated when subjects have to keep in mind the main goal while performing subordinate goals (Nature, 1999). This was supported by D'espositio et al.who showed that increasingly abstract goals activate increasingly anterior portions of the frontal lobes. Anterior prefrontal cortex has a high number of dendritic spines per cell and high spine density, making it ideal for a variety of inputs.

6. E Koechlin et al (Science 2003) introduced the notion of a "hierarchical cascade of executive processes." The control operates in Brodman areas 6 (premotor), 44/45 (inferior frontal) and 46 (middle prefrontal) at level of stimuli, perceptual context, and temporal episode, respectively. Goldberg analogizes to perseveration of elements , features and activities, respectively.

cognitive effects of androgen deprivation

2010-08-10T05:53:00.001-07:00

Cognitive effects of androgen deprivation therapy in an older cohort of men with prostate cancer; Mohile SG, Lacy M, Rodin M, Bylow K, Dale W, Meager MR, Stadler WM; Critical Reviews in Oncology/Hematology 75 (2), 152-9 (Aug 2010)

OBJECTIVE: To determine the baseline prevalence of cognitive impairment in older men treated with ADT and to assess changes in cognitive performance over time. METHODS AND RESULTS: Thirty-two patients (median age of 71 years, range 51-87) were administrated an extensive neuropsychological testing battery prior to ADT initiation, with 21 (65%) completing post-treatment evaluations 6 months later. At baseline, 45% scored>1.5 standard deviations below the mean on>or = 2 neuropsychological measures. Using standardized inferential statistics, no change in cognition was documented following treatment. The Reliable Change Index revealed that, on a case-by-case basis, 38% demonstrated a decline in measures of executive functioning and 48% showed improvement on measures of visuospatial abilities. Within exploratory analyses, patients who scored below expectation at baseline displayed no change in cognition, while patients with average or better scores at baseline displayed improvements in visuospatial planning and timed tests of phonemic fluency. CONCLUSIONS: We found a high prevalence of lower than expected cognitive performance among a sample of patients just starting ADT for prostate cancer. Assessment of baseline cognitive function should be taken into account for future research and to inform clinical management.

neurodoc

Detestable or marvelous: Neuroanatomical correlates of character judgments

2010-07-27T08:48:00.003-07:00

Croft KE, Duff MC, Kovach CK, Anderson SW, Adolphs R, Tranel D.

1. Neuropsychologia. 2010 May;48(6):1789-801. Epub 2010 Mar 6.
Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, IA, USA. kcroft@utdallas.edu

Abstract

As we learn new information about the social and moral behaviors of other people, we form and update character judgments of them, and this can profoundly influence how we regard and act towards others. In the study reported here, we capitalized on two interesting neurological patient populations where this process of complex "moral updating" may go awry: patients with bilateral damage to ventromedial prefrontal cortex (vmPFC) and patients with bilateral damage to hippocampus (HC). We predicted that vmPFC patients, who have impaired emotion processing, would exhibit reduced moral updating, and we also investigated how moral updating might be affected by severe declarative memory impairment in HC patients. The vmPFC, HC, and brain-damaged comparison (BDC) participants made moral judgments about unfamiliar persons before and after exposure to social scenarios depicting the persons engaged in morally good, bad, or neutral behaviors. In line with our prediction, the vmPFC group showed the least amount of change in moral judgments, and interestingly, the HC group showed the most amount of change. These results suggest that the vmPFC and hippocampus play critical but complementary roles in updating moral character judgments about others: the vmPFC may attribute emotional salience to moral information, whereas the hippocampus may provide necessary contextual information from which to make appropriate character judgments. 2010 Elsevier Ltd. All rights reserved.

PMCID: PMC2862792 [Available on 2011/5/1]

Damage to right ventromedial prefronal area abolishes judgment of harmful intent

2010-07-27T08:45:00.001-07:00

Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. lyoung@mit.edu

Neuron. 2010 Mar 25;65(6):845-51.

Abstract

Moral judgments, whether delivered in ordinary experience or in the courtroom, depend on our ability to infer intentions. We forgive unintentional or accidental harms and condemn failed attempts to harm. Prior work demonstrates that patients with damage to the ventromedial prefrontal cortex (VMPC) deliver abnormal judgments in response to moral dilemmas and that these patients are especially impaired in triggering emotional responses to inferred or abstract events (e.g., intentions), as opposed to real or actual outcomes. We therefore predicted that VMPC patients would deliver abnormal moral judgments of harmful intentions in the absence of harmful outcomes, as in failed attempts to harm. This prediction was confirmed in the current study: VMPC patients judged attempted harms, including attempted murder, as more morally permissible relative to controls. These results highlight the critical role of the VMPC in processing harmful intent for moral judgment. (c) 2010 Elsevier Inc. All rights reserved.

Hippocampal damage abolishes stress response

2010-07-27T08:43:00.001-07:00

Department of Psychology, Saint Louis University, St. Louis, MO 63103, USA. tbuchan7@slu.edu

Abstract

The hippocampus (HC) is necessary for learning and memory, but it also plays a role in other behaviors such as those related to stress and anxiety. In support of the latter idea, we show here that bilateral HC damage abolishes the cortisol response to psychosocial stress. We collected salivary cortisol, heart rate, and affective responses to the Trier Social Stress Test (TSST) from 7 participants with bilateral HC lesions, 12 participants with damage outside the HC, and 28 healthy normal comparison participants matched to the HC participants on age and sex. HC participants showed elevated pre-stress cortisol, but no cortisol response to the TSST. Heart rate and affective responses in the HC group were similar to those of the comparison groups. Participants with brain damage outside the HC showed stress responses that were comparable to those of the healthy comparison group. These findings support the idea that the functions of the human HC extend beyond learning and memory, and suggest that the HC is necessary for producing the cortisol response to psychosocial stress.

PMCID: PMC2692817 [Available on 2010/6/1]

Localization of Benton Facial Recognition Test and J. Lo.

2010-07-27T08:41:00.001-07:00

Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City, IA, USA. daniel-tranel@uiowa.edu

Abstract

Two of the most successful and widely used tests developed by Arthur Benton and colleagues are the Facial Recognition Test (FRT) and Judgment of Line Orientation Test (JLO), which probe visuoperceptual and visuospatial functions typically associated with right hemisphere structures, especially parietal, occipitoparietal, and occipitotemporal structures. Taking advantage of a large database of focal lesion patients (the Iowa Neurological Patient Registry), we used a new lesion-deficit mapping technique to investigate the neuroanatomical correlates of FRT and JLO performance. For the FRT, there were 201 patients with relevant data; of these, 38 were impaired on the FRT, and failure was most strongly associated with lesions in the right posterior-inferior parietal and right ventral occipitotemporal (fusiform gyrus) areas. For the JLO, there were 181 patients with relevant data; of these, 23 were impaired on the JLO, and failure was most strongly associated with lesions in the right posterior parietal region. These findings put new empirical teeth in the localizing value of the FRT and JLO tests, and they extend and sharpen previous work that had pointed to right posterior structures as being important for FRT and JLO performance

PMCID: PMC2853018 Free PMC Article

PMID: 19051129 [PubMed - indexed for MEDLINE]

Focality of clock drawing test determined by error type

2010-07-27T08:39:00.001-07:00

Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa, IA, USA. daniel-tranel@uiowa.edu

Abstract

The Clock Drawing Test (CDT) is widely used in clinical neuropsychological practice. The CDT has been used traditionally as a "parietal lobe" test (e.g., Kaplan, 1988), but most empirical work has focused on its sensitivity and specificity for detecting and differentiating subtypes of dementia. There are surprisingly few studies of its neuroanatomical correlates. The authors investigated the neuroanatomical correlates of the CDT, using 133 patients whose lesions provided effective coverage of most of both hemispheric convexities and underlying white matter. On the CDT, 30 subjects were impaired and 87 were unimpaired (16 were "borderline"). Impairments on the CDT were associated with damage to right parietal cortices (supramarginal gyrus) and left inferior frontal-parietal opercular cortices. Visuospatial errors were predominant in patients with right hemisphere damage, whereas time setting errors were predominant in patients with left hemisphere lesions. These findings provide new empirical evidence regarding the neuroanatomical correlates of the CDT, and together with previous work, support the use of this quick and easily administered test not only as a screening measure but also as a good index of focal brain dysfunction. PsycINFO Database Record (c) 2008 APA, all rights reserved.

PMCID: PMC2834527 Free PMC Article

Neurology of lying-- localizaion

2010-07-25T06:03:00.000-07:00

Spence et al. Neuroreport 2001. longer rt's and activation in VLPFC.
Langleben et al. Neuroimage 2002-- guilty knowledge test (GKT) and fMRI showed activation in SFG and ACC.
Ganis et al. Cereb Cortex 2003. right anterior prefrontal cortex was involved in well rehearsed more elaborate lies, whereas a network involving anterior prefrontal cortex involved in spontaneous lies.
Kozel et al J Neuropsychiatry and Clin Neurosci 2005- OF cortex and ACC involved in deceptio
Abe et al. (Brain 2009) noted PD patients are "honest" and have trouble lying, and that left DLPFC is dominant for inhibiting replies, esp truth telling, ie feigning ignorance.
Karim et al. Cereb Cortex-- TMS of left cortex FACILITATES lying perhaps by relieving moral conflict.
Sellal JNNP 1993- reflex epilepsy, patient had seizures when he lied. Had meningioma in right anterior clinoid. Tumor pressed on amygdala.
Hakun et al Neurocase 2008-- fMRI as lie detector-ventrolateral frontal activated even when lying was not demanded explicitly
Seth et al. Neuroimage 2006- MEEG can be used for trial by trial detection of lies.
Modell et al. J Neuropsychiatry and Clin Neurosci 1992-- pathological lying associated with decreased tracer uptake in right thalamus.
Yang et al. Br J Psych 2007. Increased white matter among pathological liars especially OF, IFG, MFG.
Fenelon et al. BMJ 1991 and other cits.-- Munchhausen's s- associated with bilateral frontotemporal atrophy, hyperperfusion of right thalamus, cerebral palsy, high signal in PVWM bihemispheric.
Grezes et al J Neurosci 2004. detecting deception activates amygdala and rostral ACC.
Harada et al. Neurosci Research 2009- moral and lie judgments activate VMPFC, lateral OF, left temporal, left temp-par junction, and right cerebellum.
Etcoff et al. Nature 2000- loss of language due to left MCA stroke was associated with increased ability to detect deception.
Stuss et al. Brain 2001- bilateral esp right OF lesions impaired ability to detect deception.
Autistics have trouble lying.

Go, no go task, parcellated and localized within the VLPFC and pre SMA

2010-07-24T20:06:00.000-07:00

Chikazoe J. Localizing performance of go/no-go tasks to prefrontal cortical subregions. Curr Opin Psych 2010; 23: 267-272.

Author divides go/no go tasks into components including working memory, stimulus-driven attention ( reorienting of attention), error monitoring, top down control processes, and response inhibition. The literature suggests the VLPFC is key to response inhibition (see Buxbaum et al, Hum Brain Mapping 2005). However, DLPFC and pre-SMA also are recruited for this task and for stop-signal and for antisaccade tasks.

Transcranial magnetic stimulation of right VLPFC disrupts response inhibition, but stimulation of left IFG, DLPFC, dorsal premotor cortex, and right angular gyrus does not. Subregions of the VLPFC play different roles. The subregions are posterior IFG, inferior frontal junction, and IFG/insula.

pIFG usually activates with go/no go stimuli. IFJ, located at border of inferior frontal sulcus and precentral sulcus, is associated with processing infrequent stimuli. Thus pIFG is the "core region" for go/no go response inhibition. The same area is involved in reorienting attention (see Corbetta M, Neuron 2008). The reorienting attention network involves pIFG, IFJ, IFG/insula, and temporal parietal junction. This is segregated from a dorsal network involving the frontal eye fields (FEF), and intraparietal sulcus that employs a top down mechanism . pIFG may activate with both networks and provide the communication between the two.

IFJ is involved in stimulus driven attention and is more involved in processing infrequent stimuli, such as infrequent go or infrequent no go on go/no go tasks. By contrast pIFG is only activated on infrequent no go.

IFG insula is activated, but is tough to differentiate from insula and IFG insula is also activated in many other tasks. Its function is not specific and it may be more related to task awareness.

Pre SMA on right is also core to response inhibition. This is true on both lesion studies and TMR studies. Pre SMA is robustly activated during go/no go whether the task is simple or complex or whether the test is oral or manual. Pre SMA is thought to be important to conflict resolution of task. The anteriror cingulate gyrus (ACC) activates for error processing. DLPFC activation may be related to top down processes and working memory.

Hemispheric asymmetry with right sided dominance is noted in most studies especially for pIFG. However the left pre SMA and VLPFC may be important. "Balance" may be disrupted with left sided lesions that can thus cause deficits on task also.

Coin rotation test validation

2010-07-24T10:32:00.001-07:00

Hill BD et al. The Neurologist. 2010; 16: 249-253

Authors validate a longstanding easy test for fine motor processing used for decades at LSU in 86 normals. Task consists of counting number of 180 degree rotations of a quarter in ten seconds by the dominant and nondominant hands. A correction for drops is used, but not that important. Task is to rotate a quarter using thumb and fingers one and two in ten seconds with an examiner using a timer and counting. If the coin is dropped, the subject gets another ten seconds. The adjusted score is the number of rotations in ten seconds minus (0.1 x rotations x drops). Traditionally, LSU has used a cut score of ten to indicate impairment. Authors believe a cut score (for both hands) of 13 is better, with increased sensitivity and some loss of specificity.

Hyperfamiliarity for faces (HFF) in epilepsy- left temporal localization?

2010-06-13T15:03:00.000-07:00

Devinsky O et al. Neurology 2010;74: 970-974

Author reviews literature and attributes the first case to Kraepelin (1886).

Case one-- 46 yo policeman had a GTCS preceded by an aura of anxiety, deja vu and sulfuric smell. One month later the patient developed HFF (everyone seemed familiar), memory problems, distractibility and hyperemotionality for sadness. FRT performance was low average but patient was impaired on Rey O delayed recall.

Case 2- 62 yo rh attorney developed CPS at age 31 with sense of doom, palpitations and nightmares. Seizures involved HFF,

table has 2 more new cases and 5 old cases

Pertinent facts about HFF- specifically absent are delusions, hyperfamiliarity for nonface objects, or auditory hallucinations. Lesions involved left hemisphere (5 cases), bilateral (2 cases) or unknown (2 cases).

Authors cite that the hippocampus is important for recollection and the perirhinal cortex for feeling of familiarity. Deja vu and deja vecu occur more often with right hemisphere lesions establishing "right sided dominance for familiarity." The normal electrical response for familiarity is suppression v. activation for novelty stimulus. Authors speculate the left (impaired) side is unable to recognize faces (nvelty signallig) whereas the right (unipaired) side is in overdrive and falsely signal familiarity. Patients quickly accept their familiarity is false, due to intact right hemisphere structures otherwise. Contrtast to reduplication syndromes (Capgras) with right hemispheric and bifrontal abnormality.

Emotional perception deficits in ALS

2010-06-08T07:12:00.000-07:00

Zimmerman EK, Eslinger PJ, Simmons Z, Barrett AM. Cog Behav Neurol 2007; 20: 79-82

Cognitive deficits occur in up to half of ALS patients, particularly bulbar ALS, including early bulbar ALS patients who are not demented.

13 subjects with bulbar ALS from teh Hershey ALS Center were given 2 tasks: the emotional faces task, in which they were required to point or say the word denoting the emotional facial expression (happy, sad, angry, afraid, disgusted). Second, they were asked to respond to tape recording of emotionally intoned sentenced and identify the emotion conveyed.

The ALS group did worse on the MMSE and GDS, control tasks for dementia and depression. They also did worse on the facial task, especially for faces connoting sad, disgusted and surprised faces. They did normally on the prosody task, but by emotion did worse on the surprised prosody recognition task.

Scales ADHD

2010-06-06T10:08:00.001-07:00

* Conners parent-teacher rating scale

*ADHD Rating Scale

* SNAP IV Parent Teacher Rating (www.adhd.net)

* *** (best)Vanderbilt Assessment Scale (Parents and teachers) (www.nichq.org) this is easy to get online and is free

In adults get

*adult ADHD report scale available at http://www.med.nyu.edu/psych/psychiarist/adhd.html

others

*Conner's Adult ADHD Rating scales

*Adult ADHD rating scale IV

*Wender Utah Rating Scale

*Barfkley's Current Symptoms Scale

Psychosis and EEG abnormalities as manifestations of Hashimoto' sencephalopathy

2010-06-03T10:39:00.001-07:00

Sporis D, Habek M, Mubrin Z et al. Cog Behav Neurol 2007: 20:138-140.

Authors claim there are two forms: a vasculitis type with strokelike manifestations and seizures, and a diffuse progressive type with dementia and psychiatric manifestations. Authors present a 38 year old woman (type 2) with a history of RA, and depression, and a history of hypothyroidism (not mandatory for HE), with acute psychosis with auditory hallucinations and bizarre behavior, a CSF pleocytosis (37 WBC, normal protein) normal memory, EEG showing slowing. Behavioral exam abnormal calculations, constructional praxis, and attention. CSF showed 12 cells. MRi showed punctuate lesions in left frontal gyrus. Treatment with methylprednisoline 1000 mg per day for three days followed by prednisone 50 mg per day for one month resulted in resolution of all symptoms and EEG,

Authors discuss that half of patients have MRI abnormalities that can mimic tumor, granuloma, infection, stroke, degeneration, or leukodystrophy. Several patients had other autoimmune abnormalities including RF, or p ANCA. Etiology of condition is not known.

Isolated inability to write cursively after transient ischemic attack (TIA)

2010-06-03T08:28:00.001-07:00

Popescu I-M, Vaidya NA. Cog Behav Neurol 2007; 131-135. Case report

78 year old right handed truck driver whose TIA was bilateral upper extremity weakness that resolved the same day. Post TIA he could write block letters but not cursively. On neurologic/behavioral examination, he complained of being unable to remember what he had read. He was diagnosed with obstructive sleep apnea. Elemental neurological examination was normal. Behavioral examination showed a normal MMSE (29/30, minus one for recall) with perseverations noted on an alternating programs test and Luria loops. The patient had trouble with cursive copying and writing. MRI could not be done (pacemaker); Spect showed bilateral hypoperfusion of the parietal and occipital lobes. Literature review of lesions suggests implied lesion of left superior parietal area (Alexander et al, Arch neurol 1992), parieto occipital white matter bilaterally (Baxter and Warrington, JNNP 1986). Hanley JR, and Peters , S(Cortex, 1996) showed the opposite , in a patient who had a left hemisphere lesion, with impaired spelling of lower case letters in block and had excellent cursive writing. Ohno et al. (Neurology, 2000) had a patient with pure apractic agraphia due to a thalamic lesion which blocked motor programming, and who could not write kana, kanji, Roman alphabet or Arabic numerals. Otsuki et al. (JNNP, 1999) reported a patient with apractic agraphia due to a hemorrhage in the left superior parietal lobe. Authors believe cursive and block writing are represented differentially.

Finger agnosia in Alzheimer's disease

2010-06-03T06:28:00.001-07:00

Shenal BV, Jackson MD, Crucian GP, Heilman KM. Cog Behav Neurol 2006; 19:202-203.

Authors compared patients with Alzheimer's disease seen at Memory disorders clinic at University of Florida, comparing 38 AD patients and 10 normal age matched controls. Subjects with Alzheimer's disease had trouble naming fingers, especially their index finger (correct answers allowed were index finger, forefinger, and "dog" finger." All normal controls named all three fingers tested (including thumb, index finger, and pinky). AD patients 37 % could not name index finger, 5% could not name their thumb, 13 % could not name their pinky. None could name index finger and not name thumb or pinky.

Stratified by severity, with mild AD patients (mean MMSE of 23), moderate (mean MMSE of 19) and severe (mean MMSE of 11), 14 % of mild patients cold not name their index finger, 45 % of moderates could not, and 54 % of severe patients could not.

Ventromedial prefrontal cortex modulates fatigue after penetrating TBI

2010-05-07T19:05:00.000-07:00

Pardini M, Krueger F, Raymont V, Grafman J. Neurology 2010; 74:749-754.

97 PBI patients and 37 controls from Vietnam Head Injury Study were enrolled. Fatigue was assessed via questionnaires (Krupp Fatigue Scale). CT scan localization of lesions was made to nonfrontal, ventromedial prefrontal, and dorsolateral /lateral prefrontal. All 3 areas were associated with fatigue, but only VM was associated with increasing fatigue with larger lesion volume. Authors note this may allow linkage of fatigue to other ventromedial functions such as effort and reward participation.

Note one of references was a John Deluca functional MRI paper showing role for same area in MS related fatigue J Neurol Sci 2008; 270:28-39.

Cognitive effects of pregabalin in healthy volunteers

2010-05-07T18:55:00.000-07:00

a double blind, placebo controlled trial Salinsky M, Storzbach D, Munoz S. Neurology 2010; 74: 755-761.

32 healthy volunteers were randomized to pregabalin (300 bid) or placebo for twelve weeks and underwent cognitive tests before and after. Subjects on pregabalin showed worse performance on 3 of 6 target cognitive measures, including digit symbol test, Stroop, and Controlled Oral Word Association Test. They were paralleled by changes on the Portland Neurotoxicity Scale.

Parcelling frontal functions

2010-05-02T16:15:00.000-07:00

Van Snellenberg JC, Wager TD. Cognitive and motivational functions of the human prefrontal cortex. from Christensen AL, Goldberg E, Bougakov D. Luria's Legacy in the 21st Century. Oxford, University Press, 2009. pp. 30-61.

Chapter summarized authors' (esp Wager's) meta-analyses of functional imaging studies. These involve working memory, task switching, response inhibition, and emotion. cites Stuss and Alexander, 2007. See chapter.

Luria-- Semantic fragments for repetition and recall

2010-01-31T12:14:00.000-08:00

These stories have layers of meaning and complexity

1. Tolstoy's The Hen and the Golden Eggs- A man had a hen which laid golden eggs. He wanted to get more of the eggs at once, and so he killed the hen. But inside he found nothing; it was just a hen like any other.

2. Tolstoy's The jackdaw and the Pigeons. A jackdaw heard that some pigeons had plenty of food. She painted herself white and flew into the pigeons house. The pigeons thought she was a pigeon, and took her in. However, she forgot herself and cried like a jackdaw. The pigeons then realized she was a jackdaw and sent her away. She went back to her family, but they did not recognize her, and would not have her either.

3. Tolstoy's The Ant and the Pigeon. An ant went down to the stream to drink. A wave swamped him and he began to drown. A pigeon flew past him and threw him a twig. He climbed on the twig and was saved.

The next day, a hunter set a net and caught the pigeon. When he took it from the net, however, the ant crawled up stealthily and bit the hunter on his hand. The hunter cried out and the pigeon flew away.

4. The Lion and the mouse. A lion was asleep and a mouse ran over his body. The lion awoke and caught the mouse. The mouse begged him to let her go. The lion laughed and let her go. The next day, a hunter caught the lion and tied him with a rope to a tree. The mouse came through stealthily, gnawed through the rope, and set the lion free.

5. The Lion and the Fox. The Lion grew old and could no longer hunt animals. So the lion had to learn how to live by cunning. He lay in his den and pretended to be ill. The animals came up to him and he ate them. One day a fox came but would not go into his den. The lion asked her "Why don't you come in?" The fox replied, " I can see tracks coming into your den but none coming out."

6. The Stupid Dog. A dog was walking over a bridge at night and saw the reflection of the moon in the water. The dog decided it was cheese and jumped into the water. But of course, she found nothing and only got wet.

Results patients who had trouble recalling individual words sometimes had no trouble with semantic fragments, and normals had no trouble with 2 successive fragments. Amnesics would present the semantic content of one part of the story but forget the second part (retroactive inhibition).

Luria-- sentence repetition-- aphasia or amnesia??

2010-01-31T11:49:00.000-08:00

AR Luria. The Neuropsychology of Memory VH WInston and Sons, Washington , D.C. 1976 p. 103

Patients with vascular lesions could repeat one sentence, had trouble with the second one. Patient either reverts to first sentence or contaminates elements, displaying "recency effect" but also simplifying the structure of the sentence while maintaining its elements. However, patients with temporal lesions showed no "freezing or inert repetition" as in frontal lesions.

Sentence recall-- Luria

2010-01-31T11:38:00.000-08:00

Although list learning requires multiple presentations, normals can easily recall one and then a second 7 or 8 word sentence (simplified if aphasic) and then repeat both sentences in order.

Examples
first sentence: "Apple trees grew in the garden behind the high fence" or "The hunter killed a wolf on the edge of the forest. " Second sentence : " In Tashkent there was an earthquake and many houses were destroyed" or "In Tushino there was an air display and parachute jumps."

Simpler versions "The boy is cold" or "the girl is asleep" or "the boy hit the dog" or "the girl drinks tea"

Results: Amnesics could repeat the sentences immediately, or after empty or filled pauses, with some trouble if the pause was filled with rapid speech. However, when given a second sentence, they either lost the first or mixed up the elements.

Disturbance of seriality due to left temporal lesions

2010-01-31T11:08:00.000-08:00

Luria in Neuropsychology of memory states that left temporal lesions cause a disturbance of retroactive inhibition in which the last word of the list inhibits recall of predecessors on the list, especially with longer lists. The effect only occurs with lists presented and reproduced verbally. Luria gives original credit to Lashley

Lashley KS. Functional determination of cerebral localization. Arch Neurol Psych 38: 1937.

Learned motor responses.

2010-01-31T10:26:00.000-08:00

Subject is asked to raise his left hand to one tap, and his right hand to 2 taps, or to raise his hand to one tap and to refrain from raising his hand to 2 taps.

More complicated version: patient is asked to respond to a fist with a finger, or to a finger with a fist. Or, he is asked to responnd to two taps with one tap, and to one tap with 2 taps.

More complicated yet. the subject is asked to respond to a weak tap with a powerful hand movement, and to a powerful tap with a weak hand movement. Or, to respond to a short acoustic stimulus with a slow movement, and a long stimulus with a prolonged movement. (cf Marushevskii M, Disturbance of the simplest forms of voluntary action in local lesions of the frontal lobes. in Luria AR, Khomskaya ED (eds), The frontal lobes and the regulation of psychological processes. Moscow, MGU Press, 1966.

Luria's adaptation: He would give one task, and when mastered give a second, then without repeating instructions, go back to the first, and then the second task. Normals had little trouble either learning the task or switching. Neither empty or filled paused had much effect, (except occipital lesions for visual tasks and temporal lesions for auditory tasks). Massive tumors had problems with task.

Patients with thalamic lesions could learn the task, but not do it verbally. These patients learned the task, were not affected by interference, but could not talk about it.

Unadze illusion fixed set test

2010-01-31T10:03:00.000-08:00

From Luria's book Neuropsychology of Memory

Unadze DN. Experimental psychological investigations. Moscow. Nauka. 1966.

A subject is given 2 balls of different sizes to squeeze (one per hand) 10-15 times for several seconds per squeeze. He compares their sizes and reports his finding. Then, without visual inspection he is given 2 balls of equal size and asked to compare the sizes. The result is that the hand that held the larger ball now reports it is holding a smaller ball, and is maintained even after 12-18 trials.

Luria's variation was to test normal, mildly and severely impaired subjects on the test. He found that in severely amnesic subjects only, and only with interference, the fixed set effect was achieved but rapidly forgotten, underlying the importance in interference on somatic memory. Pauses less than 2 minutes had little effect on retention, as with other types of learning.

Gerstmann's syndrome reader

2010-01-30T11:03:00.000-08:00

Kombos T, Picht t, Suess O. Electrical Excitability of the Angular Gyrus. Journal of Clinical Neurophysiology 25(6) December 2008 .
Comment. This is the first report of direct electrical stimulation of AG in humans. Stimulation resulted in responses in contralateral upper extremity in 3/5 patients. No lower extremity stimulation was found.

Anema HA.a, Kessels RPCcd, de Haan EHFe, Kappelle L, Leijten F, van Zandvoort Martine , Dijkerman,H. Differences in finger localisation performance of patients with finger agnosia

19(14) September 2008 .
Comment : 3 patients with AG lesions were able to point with their finger effectively
to a tactile stimulus (body schema intact) but unable to do so with a drawing of hand or to name the finger.
Other body parts did not have this dissociation between body schema and body image.

Tamura I, Kikuchi S, Otsuki M, Tashiro K. The writing of arabic numerals, kanji, and kana in brain-damaged patients. 14(6), 6 May 2003, pp 861-865.
Comment. 4 patients with Gerstmann's syndrome and 4 with Wernicke's aphasia were compared. All patients could copy letters, and were righthanded. Subjects were presented with coins, and then asked to write the respective number value in kana , Kanji and Arabic numerals. For GS patients, kanji writing was better than Arabic, that was better than kana writing. For WA aphasia patients, Arabic numeral writing was better than kana and kanji. Discussion: "In the case of GS, there was a problem in the concept of number. In the case of WA, the concept of number was relatively well preserved." GS subjects made substitution errors in Arabic number writing. Authors postulate a deficiency processing recall of somesthetic graphemes linked to the concept of number.

Wingard E, Barrett A, Crucian G, Doty, L, Heilman, KM. The Gerstmann syndrome in Alzheimer's disease. Journal of Neurology, Neurosurgery & Psychiatry 72(3) March 2002 .
Comment : among 38 patients with Alzheimer's disease, the four constituent components of Gerstmann's syndrome did not cluster together, leading the authors to speculate that their association is fortuitous due to contiguous networks, and that the four features of Gerstmann's syndrome do not share a common network.

Baciul M, Koenig O, Vernier M, Bedoin N, Rubin C, Segebarth C. Categorical and coordinate spatial relations: fMRI evidence for hemispheric specialization. Neuroreport 10(6) April 1999.
Comment: 16 healthy males were examined on a coordinate and a category task using fMRI paradigm. The category task was whether a dot was above or below a horizontal line. The coordinate task was whether the distance between the dot and the line was within a reference distance. The coordinate task related to right AG activation which decreased over time. The category task depended upon Left AG activation which did not decrease over time and in fact increased over time. Results subserve the hypothesis that the left hemisphere subserves the development of new spatial categorization.

Cognition and Fragile X syndrome

2010-01-07T16:44:00.000-08:00

Fragile X problems persist into adulthood (even though it is considered a pediatric disease). Two separate conditions exist. Patients with the premutation (55-200 repeats of the FMR1 gene) have RNA toxicity but not full blown cognitive abnormalities. RNA toxicity can include primary ovarian insufficiency, fragile X associated tremor ataxia syndrome (FXTAS), fibromyalgia, hypothyroidism, and psychiatric issues such as anxiety and depression. Boys in this range can experience shyness, social anxiety disorders, ADHD and autism spectrum disorders. This is due to excess FMR1 gene.

Patients with the full mutation (greater than 200 repeats) have LACK of FMR1 and Fragile X syndrome (opposite of above in which there is excess RNA present). They present with severe cognitive abnormalities. In boys this manifests as autism, in girls as severe learning disabilities. They also have connective tissue disorders, agression, and psychiatric problems as above. Males with FXS usually have IQ below 70 (severe) but 15 % are "high functioning" with IQ above. High functioning is due to mosaicism within cells or within methylation and the degree of impairment is related to the amount of FMRP present. Among girls, 40 % have a normal IQ, 35 % are borderline, and 25 % have an IQ below 70. The activation percentage (pct of normal X that is active) correlates with disease and that and amount of FMRP available also affects functioning of offspring.

FXS is the most common cause of intellectual impairment and of autism spectrum disease. The full mutation occurs in 1:2500 in population, and the premutation occurs in 1:250 girls and 1:800 boys in the general population. Genetics: FXS patients always have their mother as a carrier. Fathers often pass the premutation on, to their daughters and it does not expand to a full mutation. Mothers with premutation often have expansion to full mutation in their offspring, especially if the number of repeats is greater than 100.

See also posts on FXS and FXTAS on www.neurologyminutiae.blogspot.com

Cognition and dystrophinopathy

2010-01-03T17:41:00.000-08:00

Duchenne's muscular dystrophy has associated delayed milestones especially language, global cognitive impairment, and occassionally autism. Becker's muscular dystrophy has less common findings, but also, compared to general population, has more learning disabilities with normal intelligence, autism, attention and behavioral problems. Orofacial problems may occur.

Botteron S, Verdabout CM, Jeannet PY, Kiliardis S. Orofacial dysfunction in Duchenne Muscular Dystrophy. Arch Oral Biol 2009; 54(1): 26-31.

Cyrulnik SE, Fee RJ, De Vivo DC, et al. Delayed developmental language milestones in children with Duchenne's muscular dystrophy. J Pediatr 2007; 150 (5): 474-478.

Hinton VJ, Fee RJ, Goldstein EM, De Vivo DC. Verbal and memory skills in males with Duchenne muscular dystrophy. Dev Med Child Neurology 2007; 49 (2): 123-128.

Young HK, Barton BA, Waisbren S, et al. Cognitive and psychological profile of males with Becker muscular dystrophy. J Child Neurol 2008; 23 (2): 155-162.

Luria audiomotor integrative tasks

2009-12-06T16:00:00.000-08:00

Pitch tests should be kept simple, give 2 sounds ask which is higher or lower.

reproduction of tones

reproduction of rhythmic taps first by imitation, then by verbal instruction, then by reproduction with verbal enforcement

Tactile functions p. 444

discriminative sensation "epicritic" (Head, 1920).
Ideas test with head and point of pin, patient must discriminate which, or use 3 items and ask patient to discriminate. Localize touch by asking patient to point to spot, and make it harder by asking him to point to same spot on the opposite limb. Use Weber's touch compass to discriminate 2 point differentiation threshold in millimeters. Also use it to differentiate Double simultaenous stimulation which is difficult in patients with right parietal injury. Finally measure up and down movements and ability to trace numbers and letters in the hand. Cites Teuber, 1959. Notes that lesions is left hemisphere for are tightly organized in postcentral area, but right hemisphere lesions are more distributed and even left hemisphere lesions occassionally cause left arm abnormalities.

Kinesthetic function (position sense)
simple move a finger, toe, arm and ask whether its up or down (or mimic with other side)
More complicated-- mimic posture in the other hand.

Asterognosis
differentiates from amorphosythesis (denny brown 1952, 1958).

More Luria tests

2009-12-06T15:09:00.001-08:00

from "Higher Cortical Functions in Man" p. 428

Complex motor functions

1. Reaction tests-- basic format is for subject to raise his hand in response to a tap or another stimulus. This then can be the basis of more complex tests.
Abnormalities are rarely seen with simple reaction tests, exceptions being "freezing" in position in htn, motor impersistence in frontal lesions, or premature responses in frontal lesions.
Next step is to respond alternately, eg. raise the left hand to one tap, and the right to two taps, or raise the hand with one tap and refrain from moving the hand with two. Start with strict alternating pattern, eg a-b-a-b-a-b- then suddenly break the stereotype and go out of order eg b-b and see what the patient does. Alternately, can ask for an oral answer to a stimulus eg. to one tap, say "I must" or "left" and to 2 taps "I must not" or "right." The third stage is to tell the subject to respond orally and perform appropriate motor action at same time (cites Kohomskaya, 1956, 1958). Then give a complex response, eg to one stimulus give a weak response, and to another a strong response of same hand.

2. " Raise finger if I raise fist, and fist if I raise my finger"
3. Ask patient to copy a series of figure eg. circle, triangle, square and cross, then a second series eg square square triangle, cross and see if they perseverate. May use five elements. May see forget last response, perseverate, not remember etc. Temporal lobe lesions may make it difficult to copy to verbal instruction but OK to copy from sight. Differentiate the two by asking patient to repeat the command before performing it.

4.

Apathy with subthalamic stimulation (and face recognition)

2009-12-06T09:45:00.000-08:00

apathy evaluation scale
http://www.tbims.org/combi/aes/AES.PDF

Le Jeune et al. Neurology 2009; 73:1746-1751.

Studied STN stimulation in PET study. All had bilateral STN implantation. 12 patients showed worse apathy 3 months after STN stimulation. Motor function was used. The AES was used. PET showed positive correlation with right Brodmann's areas 10 (r frontal middle gyrus) and area 46 (R IFG) and negative correlation with right posterior cingulum (are 31) and left media frontal lobe ( area 9).

Postop neuropsych differed on WCST perseverative errors and Stroop.

raloxifene improves verbal memory in postmenopausal women

2009-12-02T03:02:00.000-08:00

Raloxifene improves verbal memory in late postmenopausal women: a randomized, double-blind, placebo-controlled trial; Jacobsen DE, Samson MM, Emmelot-Vonk MH, Verhaar HJ; Menopause (Nov 2009)

OBJECTIVE:: The aim of this study was to examine the effects of raloxifene compared with those of placebo on verbal memory, mental processing speed, depression, anxiety, and quality of life. METHODS:: A randomized, double-blind, placebo-controlled trial of 213 healthy women 70 years or older was conducted between July 2003 and January 2008 at the University Medical Centre Utrecht, the Netherlands. Participants were randomly assigned to receive raloxifene (60 mg) or placebo daily for 12 months. Measurements were taken at baseline and after 3, 6, and 12 months. The change in scores from baseline was calculated. The main outcome measures were direct and delayed verbal memory (Groningen 15 Words test), mental processing speed (Trails B test), mood/depression (Geriatric Depression Scale), anxiety (State-Trait Anxiety Inventory 1 and 2), and quality of life (Women's Health Questionnaire and EuroQol-5 dimensional questionnaire). RESULTS:: Direct verbal memory improved significantly with raloxifene compared with placebo: the women receiving raloxifene repeated more words in the words A + B test than did the women receiving placebo (P = 0.025). At 12 months, the change from baseline was 16 words in the raloxifene group and 10 words in the placebo group. In the words A test, direct repetition was also significantly better among women receiving raloxifene than among women receiving placebo (P = 0.023), with the change from baseline in the number of words repeated being nine words in the raloxifene group and six words in the placebo group at 12 months. CONCLUSIONS:: In postmenopausal women, raloxifene gave significantly improved verbal memory when compared with placebo.

WHIMS MRI study brain atrophy and estrogen

2009-11-29T11:19:00.001-08:00

NEUROLOGY 2009;72:135-142

1403 women aged 71-89, a subset of WHI trial, were scanned on average four years apart. Frontal lobe volume was less at followup in women in estrogen or estrogen plus progesterone arms. Temporal lobe and total brain volume were not affected as markedly. The adverse effects are most evidentin women experiencing cognitive deficits before initiating hormonetherapy.

The cognitive measure used was the modified MMSE 3M

Teng EL, Chui H. The Modified Mini-Mental State (3MS) Exam. J Clin Psychiatry 1987;48:314–318.

Confabulation and other delusional syndromes

2009-11-29T11:10:00.001-08:00

Confabulation is usually associated withmemory (medial temporal or diencephalic) and executive (bifrontal)dysfunction.^7-9

Benson DF, Djenderedjian A, Miller BL, et al. Neural basis of confabulation. Neurology 1996;46:1239–1243.[Abstract/Free Full Text]
Moscovitch M, Melo B. Strategic recall and the frontal lobes: evidence from confabulation and amnesia. Neuropsychologia 1997;35:1017–1034.[Medline]
Johnson MK, Hayes SM, D'Esposito M, Raye CL. Confabulation. In: Grafman J, Boller F. Handbook of Neuropsychology,

The anterior parahippocampal cortex (perirhinal cortex, Brodmannareas 35 and 36) is activated by familiarity, while the hippocampusand posterior parahippocampal cortex mediate recollection.⁴⁹Perirhinal cortex stimulation evokes déjà vu anddéjà vécu (already experienced).⁵⁰ Further,the right hemisphere dominates in familiarity decisions^14,48;déjà vu is more common with right than left temporallobe seizures or stimulation.^48,51 Lesions that destroy or isolatestimuli from right perirhinal cortex may lead to loss of familiarity(e.g., Capgras syndrome) while hyperfamiliarity (i.e., misidentifyingstrange people as familiar [Fregoli syndrome]) may result fromoveractivity in right perirhinal cortex from stimulation ordisinhibition. Two cases of nondelusional hyperfamiliarity forfaces resulted from left-sided lesions (lateral temporal-occipitaland anterior cingulate),^52,53 possibly disinhibiting right hemisphereareas that imbue faces or places with familiarity.

Gainotti G. Face familiarity feelings, the right temporal lobe and the possible underlying neural mechanisms. Brain Res Rev 2007;56:214–235.[Medline]
Bowles B, Crupi C, Mirsattari SM, et al. Impaired familiarity with preserved recollection after anterior temporal-lobe resection that spares the hippocampus. Proc Natl Acad Sci 2007;104:16382–16387.[Abstract/Free Full Text]
Vignal J-P, Maillard L, McGonigal A, Chauvel P. The dreamy state: hallucinations of autobiographic memory evoked by temporal lobe stimulations and seizures. Brain 2007;130:88–89.[Abstract/Free Full Text]
Mullan S, Penfield W. Illusions of comparative interpretation and emotion. Arch Neurol Psychiatry 1959;81:269–284.[Abstract/Free Full Text]
Vuilleumier P, Mohr C, Valenza N, Wetzel C, Landis T. Hyperfamiliarity for unknown faces after left lateral temporo-occipital venous infarction: a double dissociation with prosopagnosia. Brain 2003;126:889–907.[Abstract/Free Full Text]
Nente F, Carrillo-Mezo R, Mendez MF, Ramirez-Bermudez J. Pathological hyperfamiliarity for others from a left anterior cingulate lesion. J Neuropsychiatry Clin Neurosci 2007;19:345–346.[Free Full Text]

Hughlings Jackson and right hemisphere expression, and callosal syndromes

Jackson JH. Evolution and dissolution of the nervous system. In: Taylor J, ed. Selected Writings of John Hughlings Jackson, Volume 2. New York: Basic Books; 1884/1958:45–75.
Sperry RW, Zaidel E, Zaidel D. Self recognition and social awareness in the deconnected minor hemisphere. Neuropsychologia 1979;17:153–166.[Medline]
Gazzaniga MS. Cerebral specialization and interhemispheric communication. Brain 2000;123:1296–1326.
Gazzaniga MS. The split brain revisited. Sci Am 1998;279:50–55.[Medline]

ego boundaries response to next patient syndrome

Bogousslavsky J, Regli F. Response-to-next-patient-stimulation: a right hemisphere syndrome. Neurology 1988;38:1225–1227.[Abstract/Free Full Text]

Neuropsych and carotid stenosis

2009-11-28T09:43:00.001-08:00

M. Silvestrini, MD, I. Paolino, MD, F. Vernieri, MD, C. Pedone, MD, R. Baruffaldi, MD, B. Gobbi, MD, C. Cagnetti, MD, L. Provinciali, MD and M. Bartolini, MD . Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis. NEUROLOGY 2009;72:1062-1068

Objective: The aim of this study was to investigate whetherthe presence of severe internal carotid artery stenosis maybe associated with different cognitive performance in relationto the side of the stenosis and its hemodynamic consequences.

Methods: Eighty-three patients with asymptomatic severe unilateralinternal carotid stenosis were included. A neuropsychologicalinvestigation including Verbal Fluency using phonemic and categoryaccess, Coloured Progressive Matrices, and Complex Figure TestCopy was performed. Each patient underwent an assessment ofcerebrovascular reactivity (CVR) to hypercapnia with transcranialDoppler ultrasonography using the breath-holding index (BHI).Thirty healthy subjects comparable for demographic characteristicsand vascular risk profile served as controls. Subjects withcarotid stenosis were classified into two groups: preservedCVR (BHI 0.69), 48 patients (25 with left and 23 with rightstenosis); and impaired CVR (BHI <0.69), 35 patients (19with left and 16 with right stenosis).

Results: Subjects with left stenosis and reduced CVR had significantlylower performances at phonemic verbal fluency with respect tocontrols and the other groups of stenosis. In subjects withright stenosis and reduced CVR, scores obtained in ColouredProgressive Matrices and in Complex Figure Test Copy were significantlylower with respect to the other groups.

Conclusions: These results suggest that an alteration of cerebrovascularreactivity may be responsible for reduction in some cognitiveabilities involving the function of the hemisphere ipsilateralto carotid stenosis. Such findings may be of interest for providinga more comprehensive indication to surgical treatment in subgroupsof subjects with asymptomatic carotid stenosis.

Devinsky on localization of Capgras, Fregoli,anosognosia and related conditions

2009-11-27T20:32:00.001-08:00

Neurology 2009 Views and Reviews

ABSTRACT When the delusional misidentification syndromes reduplicativeparamnesia and Capgras syndromes result from neurologic disease,lesions are usually bifrontal and/or right hemispheric. Therelated disorders of confabulation and anosognosis share overlappingmechanisms and anatomic pathology. A dual mechanism is postulatedfor the delusional misidentification syndromes: negative effectsfrom right hemisphere and frontal lobe dysfunction as well aspositive effects from release (i.e., overactivity) of preservedleft hemisphere areas. Negative effects of right hemisphereinjury impair self-monitoring, ego boundaries, and attachingemotional valence and familiarity to stimuli. The uncheckedleft hemisphere unleashes a creative narrator from the monitoringof self, memory, and reality by the frontal and right hemisphereareas, leading to excessive and false explanations. Further,the left hemisphere's cognitive style of categorization, ofteninto dual categories, leads it to invent a duplicate or impostorto resolve conflicting information. Delusions result from righthemisphere lesions. But it is the left hemisphere that is deluded.

(from text of article in Neurology)

Reduplicative paramnesia and Capgras syndrome cases with unilateralbrain lesions strongly implicate the right hemisphere, usuallyfrontal with variable temporal or parietal involvement.

^{Other points of interest}

Luria tests from Higher Cortical Functions in Man

2009-11-27T19:47:00.000-08:00

Motor:
p.417 and on
1. copy hand postures- suggested to do with little visual input.
2. bimanual task-- closes patient eyes, places one hand in posture and asks patient to place opposite hand in same posture.
3. cites Head's test with mirror image imitation and imitation with same (ie left or right hand). Also, do imitation while touching left eye, right ear etc.
4. cites Ozeretskii (1930)- place one hand in fist, the other outstretched and alternate movement (premotor)reciprocal coordination
5. Place both hands in front, alternately tap twice with right hand, once with the left, with smooth transitions, and then switch the sides. Request the test to be done quickly.
6. Ozeretskii again- if one hand is paretic, do "fist ring" of other hand, thrust hand forward alternately making a fist, and a ring, testing premotor again.
7. Eidinova and Pravdina-Vinarskaya-- (1959)-- Start with a bent elbow, straight fingers, and ask patient to extend elbow, and at same time change hand position to a fist, rapidly. repeating. May eventually change the instruction to the opposite.
8. More difficult-- fist edge palm
9. Piano imitation-- ask patient on table to imitate playing piano with thumnb and first finger of one hand, and fingers 1-5 of other at same time. (and various combinations).
10. Doing above tasks with self spoken cues
11. writing alternating components (Russian equivalent of m and n)
12. Observation of everyday tasks (buttoning, lacing a shoe)
13. States that performance of imaginary acts such as pouring tea are sensitive but not equally susceptible to analytics.

Oral praxis p 425
1. Basic exam-- if patient can bare teeth once, ask him to sustain task for a long time.
2. touch tongue to upper lip, protrude it and keep it out for a while, looking for synkinesis, smoothness of movement
3. Stretch lips, roll up tongue, puff the cheeks and alternate these.
4. "Integrative tests" are chewing, spitting, kissing and whistling
5. Rid mouth of actual edible food which may be impossible even though above are preserved.

Selnes and Gordon: Quick office neuropsych testing

2009-11-26T20:36:00.000-08:00

A few novel suggestions by these two:
Orientation: Add time of day to questions to increase sensitivity
Attention: Use forward-reverse digit span rather than serial sevens
Memory-- NCSE (AnnInt Med) 1987 uses 4 words and a recognition memory function is better than three words recall.
Language-- use brief screening test, progress to more difficult
Visuoconstruction-- draw a clock face or Necker cube is better than copy test of MMSE
Perceptualability-- tell time from clock face
Frontal lobe-- 3 hand test of Luria no suggestions
Psychomotor speed-- write alphabet as quickly as possible. Normal isless than 20 seconds, abnormal ismore than 30 seconds.

Clock Drawing Test notes on

2009-11-26T07:27:00.000-08:00

The test incorporates a broad range of cognitive requirements making it an effective screening instrument. These include comprehension, planning, visuoconstruction abilities, motor programming, numerical knowledge, abstract thinking, and concentration.

There are several different tests that are used. One test, using a predrawn circle is standard for some, whereas others use a requirement for the subject to draw the circle. In typical case, subjects are given a circle and asked to place the hands at ten minutes past eleven.

In the Boston Diagnostic Aphasia battery, subjects are given four predrawn clocks, with ticks for the hours and asked to mark each clock to a different time: 1:00, 3:00. 9:15 and 11:30. One point is awarded for placing the hands in correct place, another for correct hand lengths, with three points per clock and maximum twelve points for entire test.

Shulman used a five point scale, with five points for a perfect clock, four for minor visuospatial errors, three for inaccurate representation of 10 minutes past eleven with visuospatial organization is well done, two for disorganized visuospatia representation such that telling ten minutes past eleven is immpossible, and one for inability to discern a clock.

Shulman cited roughly 85 % sensitivity and specificity, noting that the Clock Drawing Test adds frontal, visuospatial constructive ability to MMSE.

The CLOX test is a modified test used in CERAD. The subject is given a blank paper, and told "Draw me a clock and set the hands to 1:45 so that even a child could read them." That is CLOX 1. CLOX 2 the subject is given the clock and told to copy it. On Clox 1, subjects are graded as normal, mildly, moderately, or severely immpaired.

Tests can be used in a variety of settings that are not at first blush apparent, including screening patients undergoing hip replacement surgery for postop delirium, (better than MMSE)or subtyping dementia. Curiously, vascular dementia patients make more segmentation errors on clock test than do Alzheimer's patients.

Dysfluency pearls: Stuttering, cluttering & palilalia

2009-11-22T17:26:00.000-08:00

1. Developmental stuttering usually is made better by singing, repetitive reading of same passage (adaptation) and playing white noice in patient's own ear to prevent him from hearing his own speech . There is no neurologic lesion or evaluatin required.

2. Acquired stuttering can occur with multiple location small brain lesions and does require MRI. Unlike developmental stutterers, acquired stutterers are dysfluent throughout a sentence, not just at the beginning, and are generally not bothered or embarassed by the deficiency.

3. Cluttering is characterized by rapid speech, repetitions, omissions, interjections and disturbed prosody. Sounds and syllables may be inverted or omitted. Clutterers may repeat initia sounds and prolong sounds within the word. Clutterers are not concerned about the problem and usually do not need neurologic evaluation.

4. Palilalia is characterized by compulsive repetition of words and phrases at increasing speed and with a decrescendo phonatory volume, and occurs in Parkinson's disease and pseudobulbar palsy. It improves considerably when the patient speaks with a metronome.

Akinetopsia in posterior cortical variant of Alzheimer's

2009-11-21T13:06:00.001-08:00

Akinetopsia is inability to perceive motion (Zeki, Brain 1991). It occurs due to bilateral lesions at posterior parieto-occipital junction. (Also see Rizzo, Brain Res., 2008). Authors (Tsai and Mendez, Neurology 2009) report 2 patients with degenerative disease that reported double vision with vision as "a series of successive stills" from moving images. Neuropsych testing showed impaired constructions of figures (Rey-Ost.), impaired figure-ground, visual synthesis, search, depth discrimination Akinetopsia was elicited with vision to LEFT and not relieved with alternate eye cover/uncover. Laterality and preference for one lateralization corresponds with primate work.

Origin of delirium in DT's

2009-10-04T07:44:00.001-07:00

Fisher CM. Ethanol in treatment of AWS. The Neurologist 2009; 15: 242-244. In category "Notes from a Legend."

CM Fisher writes in the Neurologist that behaviorist Watson (1925) believed the terror feeling of having one's arms and legs restrained was a primitive inborn reflex and that was re-expressed when alcoholics were restrained and became agitated.

In the same article, Fisher writes about the utility of intravenous and oral alcohol being superior than benzodiazepines in some moderate social drinkers who are admitted and who suffer DT's

Laterality in catamential seizures

2009-09-23T14:47:00.001-07:00

Quigg M et al. Laterality and location influence catamenial seizure expression in women with partial epilepsy. Neurology 2009; 73: 223-227.

Authors studied 100 women enrolled in a clinical trial of hormonal therapy for localization related epilepsy (NIH progesterone trial study group). Extratemporal (10), and multifocal (14) seizures occurred randomly throught the lunar cycle. There were 5 patients with unknown seizure origin, 25 with left temporal seizures, and 29 with right temporal seizures. Patients with left temporal seizures peaked cyclically with onset of menses, whereas right temporal lobe seizures occurred randomly.

Cerebellum and Foreign Accent Syndrome

2009-08-29T14:18:00.000-07:00

Cohen DA, Kurowski K, Steven MS, Blumstein SE, Pascual-Leone A. Paradoxical facilitation . The resolution of foreign accent syndrome after cerebellar stroke. Neurology 2009; 73:566-67.

Background: Lesions are usually left parietal. 2 previous cases were described with cerebellar hypoperfusion that resolved with FAS .

Case: 58 yo woman had left frontoparietal infarct with aphemia and right upper limb paresis. It resolved to right arm ataxia and English with an accent. 2 years later, after a right cerebellar hemorrhagic infarct, the FAS resolved. Her speech was analysed after each stroke. Abnormalities which were detected that comprised the FAS included pathologic prosody, vowel formant freqency, vowel durations, and increased variabilities on these vowel measures, and normal voicing and placement of stop consonants and preservation of the distinction between tense and lax vowels.

Alterations in timing and rhythm of speech, as seen in FAS, are characteristic of cerebellar lesions (see Ivry R., Cerebellar timing systems, Int Rev Neurobiol, 1997; 41: 555-573). The author speculates that the prosodic problems in FAS may " reflect deficits in timing resulting in impairments of speech melody, in maintaining the correct vocal posture for the production of vowels, in maintaining the correct durational patterns of speech, and in producing syllabic stress and quantity."

Re mechanism, the authors propose that the lesioned right cerebellum then gives way to the now dominant left cerebellar hemisphere, which is disinhibited and now functional.

Visual hallunications due to cardiac carcinoid

2009-05-18T07:27:00.000-07:00

Mekuria S, Tan C, Schoenhagen P, et al. Shortness of breath and visual hallucinations. Am J Med 2009; 122: 338-341.

Patient had exertional dyspnea, night sweats, weight loss over six months. Week prior to admission, he developed visual hallucinations including ants crawling on wall and rabbits inside his room. ECHO showed a right heart cardiac tumor, eventually with an elevated urinary 5 HIAA. Brain imaging was negative. Authors postulated hallucinations were due to serotonin from tumor entering circulation, via a patent foramen ovale. Without a right to left shunt, the lung would have metabolized serotonin (adenosine deaminase). Octeotride resulted in less hallucinations, and effects were monitored with serotonin levels. Previous behavioral neurology of carcinoid syndrome includes behavior dysregulation (see Russo et al. Psychosoma Med 2003; 66:422-425).

Problems of neurolinguistics

2009-03-01T11:32:00.000-08:00

In his conclusion, Luria notes that the new field of neurolinguistics presents some difficulties for the would-be practitioner because it requires a skillful level of proficiency in "neurological, psychophysiological, and linguistic knowledge" ( Luria, 1974a, p. 2591).

Semantics, Phonetics and Orienting reaction

2009-03-01T11:29:00.000-08:00

With respect to their goal of defining the dynamics and structure of the semantic system, the authors come to two conclusions:
the words are divided into three groups: (1) the nucleus of the semantic complex, to which is related the key word and words in direct semantic proximity to it (they evoke a specific pain reaction); (2) the periphery of the semantic system to which are related words linked less directly with the key word (evoking a non-specific orienting reaction); and (3) neutral words, which in our experiment did not evoke any specific or orienting reactions.
The correlation of these groups at various stages of the experiments may be different, and if at the beginning of the experiment the nucleus of the semantic system has a relatively generalized character, then later it becomes concentrated and only the key word continues to provoke a specific reaction, while the remaining words, which earlier were included in this nucleus, move into the semantic periphery and begin to evoke only a non-specific orienting reaction. ( Luria & Vinogradova, 1959, pp. 99-100)

Traumatic Aphasia Scheme

2009-03-01T11:10:00.000-08:00

While others might speak of aphasias in general, Luria presents his own organizational schema. First of all, he groups aphasias into three basic groups according to severity: (1) Total Aphasia is characterized by a total block of production and/or comprehension of speech. The disturbance is severe and lasts at least two or three weeks. (2) Well Expressed Aphasia includes those cases where the symptoms are relatively severe but do not involve a total block of speech activity. (3) Subtle, Slight Aphasia involves cases wherein the disturbance is not always evident at all times. It may appear most strongly only during instances of emotional disturbance or fatigue ( Luria, 1970b, pp. 34-35). Because initial trauma to the brain often results in a temporary disturbance of speech activity, Luria is emphatic that judgments with respect to symptoms and severity should be made only during the residual stage, which is the period 2 to 5 months after the trauma.
In addition to grouping by severity, Luria follows the classification schema that was encountered in earlier articles: acoustic aphasia, afferent motor aphasia, efferent motor aphasia, frontal dynamic aphasia, and semantic aphasia.
Of particular interest with respect to the focus of this book is a section wherein Luria, with his usual attention to philosophical bases of research, precedes his presentation of specific types of aphasia with a consideration of "The Structure of Speech Activity." In this brief section, he presents his explanation of when speech phylogenetically became intrinsically linked to thought:
The isolated words of which verbal speech consisted in its earliest stages of development were capable of reflecting separate signs or primitive concepts, but they could not express even elementary thoughts. The meaning of a word shifted depending upon the situation and was nonexistent outside certain situations. Whereas words possessed a nominative function from the beginning, the predicative function derived only from the concrete setting in which they were uttered. A decisive change occurred when speech went from consisting of individual words to consisting of elementary grammatical sentences, when instead of a single word there arose a pair or group of words related to one another, i.e., when the first "syntax" appeared.
The revolution which occurred at this phase in the development of language was truly phenomenal . . . . verbal speech became capable not only of designating an object, but also of formulating a thought. Verbal speech was still bound up with other forms of expression such as gesture and intonation, but with the development of written language thought came to be expressed altogether by means of language and speech became fully capable of performing the predicative function. Speech became an independent system of codes. ( Luria, 1970b, p. 83)
Because the development and structure of speech is so complex, Luria maintains that any consideration of its disturbance cannot be simplified and considered to be merely
disturbances or the speech images of words or . . . the inability to pronounce words. The basic forms of speech disturbances must result from defects in the systems of connections which are concealed behind the word on one hand and in the disintegration of the predicative function of speech on the other. The whole sense of verbal statements resides in this function. Similarly, the cerebral mechanisms which underlie speech processes cannot be at-

Speech and Orienting response

2009-03-01T11:08:00.001-08:00

Frontal Lobes and the Regulation of Arousal Processes" ( 1970) was co-authored with E. D. Khomskaya, and appeared in Attention: Contemporary Theory and Analysis. The article reports on the results of studies conducted with normal subjects and brain lesion patients in an effort to ascertain the role of the frontal lobes in the regulation of arousal processes or the orienting reflex. The orienting reflex is
a complex functional system which includes a series of somatic, sensory, vegetative, electrocephalographic, and other components. While having a certain autonomy, all components of the orienting reflex obey common laws: they appear with the presentation of stimuli which are new for the organism; they have a nonspecific character, i.e., they do not depend on the modality of the stimulus; they disappear in proportion to repetition; and reappear with any changes in the experimental situation. Another no less important factor that elicits orienting reactions, is the significance or signal meaning of the stimuli. ( Luria & Khomskaya, 1970, pp. 303-304)
The authors demonstrate that, anatomically and neurologically, a number of connections exist between the frontal lobes and those structures of the limbic system and brain stem that are responsible for states of wakefulness, arousal, and the orienting reflex. The latter structures provide the efferent link in the system while the afferent link seems to be located at the cortical level.
The most significant finding of the experiments for our purposes is the fact that in humans one can regulate the orienting reflex by means of speech, which does physiologically modify the same:
If, by means of speech, stimuli are given signal meaning, a series of changes in the system of the orienting reflex occurs, namely: extinguished orienting reactions reappear and become more intensive (their latent period is shortened, their strength and duration is increased), they do not extinguish any more, and they arise for a wider range of intensities (as a result of the lowering of the threshold of sensation and the elevation of the threshold of the defense reaction). In this situation, the orienting reactions become more discriminating. They are not responsive to any outside nonsignal stimuli. Similar changes in the system of the orienting reflex occurring with the introduction of verbal instructions are observed in all normal subjects who are in an awake state (grownups and children, beginning from 8-10 years of age). ( Luria & Khomskaya, 1970, p. 304)
The authors indicate that this regulation of the orienting reflex by means of speech is such an essential characteristic of human mental functioning that it "may serve as an important indicator of the normally functioning brain" ( Luria & Khomskaya, 1970, p. 305). The balance of the article recounts their endeavors to test this hypothesis, and their conclusion

Reviewing his research findings on the role of the frontal lobes in the activation processes, verbally programmed behavior, and problem solving activity, Luria notes that "Each human activity starts from definite intention, directed at a definite goal, and is regulated by a definite program which demands that a constant state of cortical tone be maintained" ( Luria, 1973a, p. 5). It is his conclusion that the frontal lobes have vital roles in the state of activation that arises when the brain has some task to perform.
In addition, the frontal lobes are vital in the process whereby the orienting reflex is intensified and stabilized as a result of verbal instruction, so Luria concludes that they have a vital role in specifically human forms of attention.

Cole: implications of functional systems on lesions

2009-03-01T11:06:00.001-08:00

The first is that the cerebral component of any functional cortical system results from the interaction of a constellation of cerebral areas. Thus, a functional system is localizable in the sense that damage to any one of the areas involved destroys the functional system. Defects will appear in the psychological activities dependent upon this functional cortical system. Second, a given psychological activity, for example, reading, may be performed in different ways, that is, by different functional cortical systems. Thus, a psychological activity is not localizable in the sense that if damage to a structure destroys a functional cortical system upon which reading is based another functional system cannot be developed which would carry out that same activity of reading. Third, the most important adaptive functions that man possesses, such as abstraction, computation, and speech itself, depend upon functional cortical systems which are acquired rather than innate. The fourth major assumption is that the most important determinant of functional cortical systems in man is the organization of the social environment. ( Cole & Maltzman, 1969, p. 278)

adynamic aphasia , inner speech and rehab

2009-03-01T10:56:00.000-08:00

"The Mechanism of 'Dynamic Aphasia'" ( 1968) was co-authored with L. S. Tsvetkova, and postulates that dynamic aphasia is a disturbance of "inner speech with its predicative function, which takes place in forming the structure or scheme of a sentence, . . ." ( Luria & Tsvetkova, 1968, p. 297). The article reports on their attempts to test this by experiments with 15 patients with dynamic aphasia and 15 normal subjects. The aphasia patients exhibited more difficulty in naming actions than in naming objects, and could not form sentences out of all the separate words necessary to do so. Normal patients had no difficulty with either task. External cues (such as pieces of paper) assisted the subjects in compensating for this loss of the "linear scheme of the phrase . . ." ( Luria & Tsvetkova, 1968, p.
"Frontal Lobe Syndromes" ( Luria, 1969a) constitutes a chapter in the Handbook of Clinical Neurology, Vol. 2, edited by P. J. Vinken and G. W. Bruyn , and provides a comprehensive consideration of the morphology and functioning of the frontal lobes.
Luria provides such basic information as the fact that the frontal lobes are the youngest portion of the cerebral hemispheres evolutionarily; comprise approximately one third of the total human cerebral cortex; and consist of three main regions: the motor area, the premotor area, and the prefrontal area together with the mediobasal aspects of the frontal region. The complexity of this area of the brain is evidenced by the fact that Layer III of the neocortex in Area 6 of the premotor area contains approximately 207 million pyramidal cells. Because each cell may have 2-3,000 synapses, the reader can gain some appreciation of the multiplicity of connections with other areas of the brain of which the frontal lobes are capable.
The most complex zones of the frontal lobes do not complete their physical development until the individual is 7-12 years of age; and the integrative tertiary zones of cortical development are found in the prefrontal region.
A detailed analysis is presented of the morphological, physiological, and clinical data on each of the three regions of the frontal lobes. Of particular interest are the disturbances of higher mental processes and speech that result from lesions in these regions. These have been presented in the reviews of other articles on the frontal lobe syndrome, but this chapter presents the same in more detail and states:
Analysis of these disturbances shows that they are based on difficulty in performing complex movements generalized in time. There is difficulty in denervating one link and moving on smoothly to the next. This disturbance of "kinetic melodies" is the fundamental symptom of a premotor lesion . . . . ( Luria, 1969a, p. 731)
With respect to how frontal lobe lesions affect speech, Luria states that
If the lesion is situated in the inferior portions of the premotor area of the dominant (left) hemisphere, phenomena similar to the disturbances of kinetic melodies described above may also appear in speech and verbal thinking. The patients of this group begin to have difficulty in fluent speech, their speech becomes interrupted, and difficulties arise in the transition from one element of articulation to another. Similar phenomena of the loss of smoothness (and sometimes of perseveration) may also appear in writing. ( Luria, 1969a, p. 733)
If the symptoms are severe, one has a case of efferent (or kinetic) motor aphasia.
The symptoms of frontal lobe lesions vary somewhat, of course, depending upon the location of the lesion; however, Luria indicates that there are two main symptoms that occur
in almost every massive lesion of the prefrontal regions. The first of these symptoms was a disturbance of the complex forms of active purposive behavior, and the second a disturbance of the critical attitude towards the patient's own defects. Both of these components of the "frontal syndrome" were observed as a rule in all massive lesions of the frontal lobes, although they varied in lesions of the convex and basal portions of the frontal region, and differed depending on the severity of the lesion . . . . ( Luria, 1969a, p. 738)
When such characteristics arise from a lesion of the left prefrontal region, they are manifested in speech activity and verbal thinking and distinguish the aphasia Luria labels dynamic aphasia.
"

Vocate: more on inner speech

2009-03-01T10:51:00.000-08:00

External speech includes the spoken language first of others in the child's social environment and thus is the stage that includes the initial sociocultural origins of spoken language. The child's external speech is initially imitative and then evolves into egocentric speech, which, according to Luria, serves a special function in aiding the child in organizing his behavior, and is characterized by its "coding for self" nature. Such speech is gradually internalized, and becomes internal or inner speech. However, in the process of internalization, it is modified somewhat so that its most distinctive feature becomes its predicative nature and it becomes characterized by its ellipsis, synthesis of meaning, and silence. A. R. Luria presumes a familiarity by his reader with these basic developmental stages,

Vocate: written and inner speech

2009-03-01T10:50:00.001-08:00

the functional and structural features of written speech . . . have . . . one important aspect; they inevitably lead to a considerable development of inner speech. Delaying the direct revelation of speech connections, inhibiting them and showing increased requirements for the preliminary speech act not being revealed at once by training, written speech produces such a rich development of inner speech as could not have a place in the earlier phases of development. Therefore, neuropathologists are not working at random when, desiring to investigate the possibilities of inner speech, they turn to the nature of the written speech of their patients. ( Luria, 1961d, p. 738)
De

Vocate Luria on consciousness

2009-03-01T10:18:00.001-08:00

"'Brain and Conscious Experience'": A Critical Notice from the U.S.S.R. of the Symposium Edited by J. C. Eccles ( 1966)" ( 1967a) is Luria's review for the British Journal of Psychology of the transcript of an international symposium on brain/consciousness called by the Vatican Academy of Sciences and organized by its President, Sir John Eccles.
Luria chides the majority of the prominent participants for their archaic philosophical orientations to the brain/consciousness question, and notes that
In spite of the fact that the definitions of consciousness given by the participants were varied, not one of them understood consciousness as the reflexion of objective reality, as "conscious being" or as complex activity which has a semantic and systematic structure. ( Luria, 1967a, p. 469)
Rather, according to Luria, the participants were roughly divided into two groups: one group, exemplified by Penfield, sought the material basis for consciousness inside the brain and anticipated discovery of the formations in neuronal structure that give rise to this phenomenon; the other group, typified by MacKay, rejected any study of neuronal structure and called for the study of logical systems concerned with the processing of information, which are somehow the basis for conscious experience.
After reviewing the new directions in brain research represented at the symposium, Luria goes on to note that the central problem of the conference was "the question of the role played by the non-specific system of the brain stem in providing an active and waking state for the cerebral hemispheres . . . ." ( Luria, 1967a, p. 471). This problem arises from the knowledge that the non-specific reticular system of the brain stem interacts with the specific or cortical formations of the brain--stimulating and receiving stimulation.

Vocate: More on PD rehab

2009-03-01T10:14:00.001-08:00

The dominance of the cortical level over the sub-cortical level is adduced by Luria's research with Parkinson's disease patients ( 1959b, 1960b, 1961a, 1967d), which demonstrated that it is possible to transfer the control of defective involuntary (sub-cortical) motor behaviors to the voluntary (cortical) motor areas so that the subject can still perform the desired action because the pathology has left the cortical areas intact.
In Parkinson's disease patients:
The injured subcortical apparatus excites repeated tonic responses, and the pathologically perseverating tension of all muscles is an obstacle to the execution of the instruction. It is easy to imagine such a difficulty in carrying out a voluntary movement if one briefly tenses all the muscles of one hand and then tries to move it without relaxing the tension. ( Luria, 1959b, p. 455)
However, if the origin of the motor act is shifted from the automatic movement realm governed by the sub-cortical motor apparatus to the conscious movement domain of the cortical motor areas, the patient is able to carry out the required movements. This may be accomplished by
attaching a symbolic function to his movements. He is asked to reply to the experimenter's questions by beating out the necessary numbers with his finger. If we then ask him, "How many wheels on a car?" or "How many points on a compass?" we see that the same patient who had failed in the previous experiment and could not automatically strike the table with his fingers even two or three times, easily begins to do so, switching his movements into his speech system and subordinating them to the complex dynamic constellation of cortical connections. ( Luria, 1959b, p. 455)
Similarly, the Parkinson's disease patient who is unable to walk more than one or two steps will find that his difficulties
in successive automatic movements may be compensated for temporarily if they are transferred to the cortical level, and if the continuous movement is superseded by a cycle of isolated responses to individual stimuli. Such a patient cannot take several steps on a smooth floor but can easily cross several lines marked on the floor or several objects placed on the floor. ( Luria, 1967d, p. 417)
Such mechanisms force the control of the normally automatic components of walking to the conscious, voluntary control of the cortical level by separating them into individual responses to individual stimuli, thus requiring cortical level processing.

Vocate: What language means (Luria)

2009-03-01T10:11:00.000-08:00

The function of generalisation is the main function of human speech, without which mastery of the experience of preceding generations would be impossible. But it would be wrong to think that this is the only basic function of speech. Language is not only a means of generalisation; it is at the same time the source of thought.
When the child masters language he gains the potentiality to organise anew his perception, his memory; he masters more complex forms of reflection of objects in the external world; he gains the capacity to draw conclusions from his observations, to make deductions, the potentiality of thinking.
When the child names something, pronouncing, for example, "that is a steam engine," he is at the same time analysing with the aid of means developed through many generations . . . . Saying the word "steam engine" (paravoz) he begins to understand that in the movement of the machine named steam (par) plays a role and that it moves other objects. In mastering words and using them the child analyses and synthesises the phenomena of the external world, using not only his personal experience but the experience of mankind. He classifies objects, he begins to perceive them differently and with this to remember them differently.
But the speech mastered by the child does not consist of single words; it consists of complex grammatical combinations, of whole expressions. These expressions allow not only for the analysis and synthesis of perception, but also the connection of things with actions, and still more the posing of things in certain relations with each other. Acquiring forms of developed, connected, speech the child acquires the potentiality not only to form concepts but also to draw conclusions from accepted assumptions, to master logical connections, to cognise laws, far surpassing the boundaries of direct, personal experience; in sum, he masters science, gains the potentiality to foresee and foretell phenomena, which he could not do by merely witnessing them.
What has been said up to now does not fully cover the role of language, the role of speech, in the formation of man's mental processes. Speech activity besides being a means of generalising and the source of thought is also a means of regulating behaviour. ( Luria, 1963c, pp. 85-86)

Vocate: Luria on PD, cerebroasthenia, oligophrenia

2009-03-01T10:08:00.000-08:00

Evidence is then presented on how the directive function of speech is affected in three types of neural disorders: Parkinson's disease, cerebroasthenic syndrome, and oligophrenic children.
The sub-cortical area is damaged in Parkinson's disease, but the cortical motor centers are fully intact. The sub-cortical motor centers' damage causes muscles to exhibit a pathological perseverating tension soon after any initial movement, and thus involuntary action becomes impossible. However, movement can be tied to cortical control by requesting the patient to tap his finger once each time the interviewer says, "Now," and thereby controlled for longer periods. In addition, linking the movement more closely with the patient's speech system by imbuing it with a symbolic function also resulted in the patient demonstrating no difficulty in controlling his execution of movement (finger taps) in response to "How many wheels on a car?" or similar questions.
In cases of cerebroasthenic syndrome, the cortex exhibits a stimulational weakness because neural strength is weakened and equilibrium of the neural processes is impaired. In other words, the cortex itself is in a pathological state, rather than just the sub-cortical processes, as in Parkinson's disease. However, Luria found that the verbal response of a child with this syndrome suffered less than his motor processes. Khomskaya's experiments are presented as evidence that it is the inhibitory or semantic
aspect of speech that is still capable of directing the child's behavior because nonsense syllables or irrelevant utterances had no influence on the child's motor reactions.
The speech system is more drastically affected in cases of oligophrenia. This is a form of deep mental retardation that results from intrauterine or very early childhood damage to the brain, and:
It is particularly characteristic of these children that the dynamics of neural processes underlying speech activity are in their case impaired not less, but more than the dynamics of neural processes which are materialized in simpler sensorimotor reactions. ( Luria, 1959b, p. 458)

Vocate: Luria Developmental and Dissolutiona;

2009-03-01T10:06:00.000-08:00

During the approximately 20 years before his next English publication on the verbal regulation of behavior, Luria expanded and refined his concept of speech being the mechanism whereby behavior is directed. A twopart article appeared in Word ( 1959) entitled "The Directive Function of Speech in Development and Dissolution." As might be anticipated, the two parts reflect his two fundamental strategies: Part I presents the developmental view, and Part II is concerned with the pathological view.
In "Part I: Development of the Directive Function of Speech in Early Childhood" ( 1959a), Luria outlines the stages by which verbal signals gradually supplant the directive influence of the immediate visual signal for the child. Speech has both an excitatory and an inhibitory function; and developmentally, the excitatory precedes the inhibitory. Due to the insufficient mobility of the 3-31/2 year-old child's neurodynamics, the excitatory is still strongest so that if one alternates excitatory and inhibitory

stimuli to a child of that age, the excitatory will come to dominate and motor perseveration will result.
The impulsive or excitatory aspect of speech continues to dominate until approximately 4-41/2 years. Then,
as soon as the directive role passes to the semantic aspect of speech and that aspect becomes dominant, external speech becomes superfluous. The directive role is taken over by those inner connections which lie behind the word, and they now begin to display their selective effect in directing the further motor responses of the child. ( Luria, 1959a, p. 351)
In "Part II: Dissolution of the Regulative Function of Speech in Pathological States of the Brain" ( 1959b), Luria maintains that for external speech to influence behavior, the subject must not only hear the verbal instruction but also:
A number of further conditions must be fulfilled; important among them is the maintenance of the strength, the equilibrium,

Vocate: Characteristics of speech, Luria

2009-03-01T10:02:00.000-08:00

General Characteristics--Spoken Language
1.
Spoken language is a higher mental process, and embodies all the characteristics of such processes:
a.
It has sociocultural origins.
b.
It is a complex functional system built on a functional base of the more elementary sensory systems of the brain, and is capable of controlling such systems.
c.
It arises from a material base that is a "complex functional system of conjointly working cortical zones . . ." ( Luria, 1966b, p. 35).
d.
It evolves through a pattern of developmental stages rather than existing as a static, innate quality of the brain.
e.
It has a mediated structure in that it incorporates auxiliary stimuli ("stimuli artificially introduced into the situation") ( Vygotsky, 1966, p. 24), which are usually produced by the individual himself.
f.
It is distinguished by the fact that the speech system is always a factor in its formation.
g.
It is originally both conscious and voluntary in nature rather than being passive and merely reflexive.

1.
Spoken language is the most readily influenced of all the higher mental processes.
2.
Spoken language can be either excitatory or inhibitory as a stimulus. Developmentally, the excitatory or impulsive aspect precedes the inhibitory or semantic aspect of spoken language.
3.
Functionally, spoken language has three dimensions:
a.
It is a form of social communication.
b.
It is a tool for intellectual activity.
c.
It is a method of organizing or regulating mental processes.
4.
Spoken language's process can be subdivided into two processes: impressive speech or decoding, and expressive speech or encoding.
5.
Spoken language has both a paradigmatic (vertical) and a syntagmatic (horizontal) structure.
6.
Spoken language's semantic component includes both "sense" and "meaning."
7.
Spoken language is sympractic in nature.
As previously noted, the term spoken language is synonymous with Luria's term speech, and is used to reflect the inclusion of psychological activities as well as the code of language in this theoretical unit. Other terminology used above in outlining the general characteristics of spoken language is clarified during discussions of these characteristics in the ensuing chapters concerning various topical areas of Luria's work.

Vocate: Luria on development of language

2009-03-01T10:01:00.001-08:00

supported by extralinguistic (sympractic) aids--knowledge of the situation, facial expression, gestures . . . information can be transmitted by extralinguistic aids, and incomplete expansion, ellipsis, the participation of intonation, and so on, can exist. ( Luria, 1976a, pp. 36-37)
Although this difference may be observed in the successive developmental states of childhood language acquisition, it originates in the historical development of language:
It is an important fact that in the early period of history language did not include all the constructions necessary to express a complex communication. Language itself was an inseparable part of practical activity, it had a relatively simple structure, and the adequate understanding of these relatively simple constructions requires the participation of a "sympractic context"; for this reason, primitive languages could remain unknown without knowledge of the concrete situation in which a particular communication was used, of the gestures that accompanied it, of the intonation with which it was uttered, and so on. That is why, as the famous ethnologist Malinowski ( 1930) pointed out, the expressions used by many peoples standing at a primitive level of social development can be understood only if the concrete situation is known and if their gestures are observed . . . .
Only in the course of its long historical development has language gradually developed its own "synsemantic" forms of expression of relations, and so, as Buhler ( 1934) stated, it has become "a system that includes in itself all the means of expressiveness." Thus the whole evolution of language can with full justification be represented as the path of liberation from dependence on the sympractic context and of gradual formulation of methods increasing the role of the linguistic (grammatically constructed) synsemantic context proper. ( Luria, 1976a, p. 156)
To say

Vocate Luria on oral v written speech

2009-03-01T09:59:00.001-08:00

Careful analysis by Vygotskii ( 1956) and El'konin ( 1954) indicated that written speech represents an entirely new psychological phenomenon, different from oral speech.
Oral speech forms during immediately practical intercourse and its component elements long remain insufficiently conscious, unseparated by the child from general speech activity ( Morozova, 1948; Karpova, 1955). Written speech follows exactly the opposite course. It is always the product of special training, which presupposes the separation of individual words from the flow of living speech and individual sounds from the living word. It also involves abstraction from individual phonations of sounds and the conversion of sounds into stable phonemes. This process of analysis, described in the Soviet literature by Luria ( 1950), Nazarova ( 1952), and others is a necessary technical premise for the act of writing, which from the very beginning requires conscious effort.
Oral speech always originates in close connection with immediate experience, as, for example, in sympractical and situational activity. It relies on intonation and gesture and usually becomes intelligible only if the general setting of the conversation is considered. It permits extensive abbreviation. For a prolonged period it continues to bear traces of the period when the subject was contained in speech and the predicate in a gesture, a tone, or in the immediate situation. Written speech . . . is deprived of this sympractical context, and therefore it must be more detailed, contextual, or, to use Buhler's term, synsemantic. Written speech like a work of art, to paraphrase Leonardo da Vinci, should contain within itself all means of expressiveness and in no way depend on the concrete environment. ( Luria, 1969c, pp. 141142)

Vocate: Luria on speech v language

2009-03-01T09:56:00.000-08:00

Spoken Language
The speech system that reorganizes mental activity to permit the conscious voluntary functioning of higher mental processes is very complex and includes both speech and language. These components are often studied in isolation from each other; yet, as Luria indicates, the origins of speech and language are intertwined:
Under the conditions of primitive society language began to develop as a means of communication; there, in accordance with laws not yet known to us, verbal speech appeared. In the development of verbal speech words gradually became separated from work activities and from signalling gestures; words began to abstract and at the same time to generalize various characteristics of objects. They thus achieved designating and at the same time generalizing-systematizing functions.
In later social history language attained its complex, phonetic, lexical, and grammatical structure and gradually became the objective system of codes which is well known to contemporary linguistics. ( Luria, 1970b, pp. 20-21)
This complexity, which developed gradually, necessitates the separation of "verbal speech" into its speech and language components before one can hope for a clear understanding of the phenomenon:
It was de Saussure who was responsible for the clear differentiation between the concept of language (langue), as an objective system of sounds formed in the course of history, and the concept of speech (parole), by which he understood the process of transmission of information with the aid of the language system . . . . ( Luria, 1976a, p. 10)
The term language is used throughout the book to refer to an "objective system of codes" as Luria defined it; or more precisely to "The culturally determined syntactic systematization of signs and/or symbols" ( Dance, 1979, p. 2). This conceptual definition will assist in understanding the theoretical unit of spoken language although it is not sufficient to delineate the same.

Notes on Donna Vocate

2009-03-01T06:21:00.000-08:00

1. Vygotsky's view was that language arose not in the psychic nor the physical but in social history

2. Every function in the child's cultural development appears twice: first, on the social level, and later, on the individual level; first, between people (interpsychological), and then inside the child (intrapsychological). This applies equally to voluntary attention, to logical memory, and to the formation of concepts. All higher functions originate as actual relations between human individuals. ( Vygotsky, 1978, p. 57)

3. There is reason to believe that voluntary activity, more than highly developed intellect, distinguishes humans from the animals which stand closest to them. ( Vygotsky, 1978, p. 37)

4.General Characteristics--Higher Mental Processes
1.
Higher mental processes have sociocultural origins. Consequently, such processes transcend the individual's experience and reflect the cultural level of the social environment of the individual.
2.
Higher mental processes are complex functional systems built on a functional base of the more elementary sensory systems of the brain, and capable of controlling such systems.
3.
Higher mental processes arise from a material base that is a "complex functional system of conjointly working cortical zones . . ." ( Luria, 1966b, p. 35).
4.
Higher mental processes evolve through a pattern of developmental stages rather than existing as static, innate qualities of the brain.
5.
Higher mental processes have a mediated structure in that they incorporate auxiliary stimuli ("stimuli artificially introduced into the situation" ( Vygotsky, 1966, p. 24), which are usually produced by the individual himself.
6.
Higher mental processes are distinguished by the fact that the speech system is always a factor in their formation.
7.
Higher mental processes are originally both conscious and voluntary in nature rather than being passive and merely reflexive.

Frontal alternating tests Luria

2009-02-28T13:55:00.000-08:00

tap two beats, then switch to three beats

alternating square wave and triangle wave in a connected line

fist palm edge

draw 3 elements is succession to verbal instruction: circle, cross and minus sign. Maintain elements and then have a new command with a switched order of elements

Learning poetry by heart

VISUAL presentation of v oral of a series of letters, numbers, or words or figures

Testing spatial (simultaneous) synthesis and successive synthesis

2009-02-28T13:38:00.000-08:00

Spatial= figure copying, left-right, hand postures, mental rotation
Successive- tapping rhythms, ordering 4 words or symbols, or numbers

Balint's inability to do simultaneous analysis does successive

Sorkina and Homskaya (1960) found such patients could differentiate red and green, then white and yellow, but then if presented with all 4 then respond haphazardly to signals.

Tactile loss of simultaenous synthesis (agnosia) unable to synthesize a whole pattern is described by Delay (1935) and Denny Brown (1952) and called amorphosynthesis.

Other spatial synthesis tests that may be done incorrectly include drawing the direction of an arrow, distinguish symmetrical figures, know which way to draw a line in a geometrical figure, draw letters, production of mirror writing.

Quotes interesting from, about, re Luria and colleagues

2009-02-27T11:32:00.001-08:00

Most taken from Human Brain and Psychological Processes

Gall was " a celebrated anatomist but an equally great dreamer. On a basis of incomplete observations and speculative conclusions he considered that faculties such as love of children, respect for parents, a sense of mental elevation or a feeling of self could be localized in circumscribed areas of the cerebral cortex" p.4

JC Eccles (1951) At what point does the mind "enter the brain" and begin to "interact with it"

"there is no evidence for isolated cerebral centers" Luria p.13

"A function which was initially shared by two people and bore the character of communication between them gradually crystallized and became a means of organization of the mental life of man himself" Vygotsky 1960 cf. p23

"The human brain does not contain any ready made mental faculties. The cerebral cortex is " the organ capable of making new functional organs." Le'ontiev 1961 p. 38

Deutsch (1953) summarized by Pribham (1960) cf p. 33 "Destruction or constant electrical stimulation of the hippocampus in animals leads to considerable disturbance of balanced behavior. Animals are unable to perceive signals giving information concerning its own erroneous reactions so that these are no longer corrected. The normal regulation of behavior is thus disturbed." Aden(1959) and Holmes and Adey (1960) did experiments of ele stimof hiipocampus showing same thing.

Sechenov-- idea that visual scanning was as important to visual perception as was reflection in retina

Yarbuss (1956) An object falling on a single point of retina ceased to be visualized after 2-3 seconds and to be kept as an image for longer than that the eye has to make small movements.

Analysis of Chinese writing bypasses phonology since writing incorporates idea of words rather than the sounds. Writing in Russian has many more mistakes if child is prevented from performing inner or silent speech while writing (Nazarova, 1952).

Structure of writing also changes during stages of learning to write versus already knowing how and doing it as an overlearned process.

Sechenov--1878 Mental processes fall into 2 categories: integration of elements in simultaenous groups, and placing elements in successive series. Simultaneous groups are essential for creating an adequate image of the outside world is generally associated with the visual, kinetic and vestibular apparatuses, responsible for the orientation of the body in space. Conversely, successive stimuli is primarily associated with the motor system on the one hand, and the acoustic system on the other.

Chronologic localization in development requires perfect concrete reflection of outside world (Perception = first signal) in order for speech (verbal semantics=second signal) to develop normally.

Vygotsky: In early development,the direction of dependence of psychological activities is bottom to top (primary simple processes are the basis for more complex ones) but in late stages its top to bottom . For example, a hearing deficit in a child will result in an inability to speak whereas in an adult it will not. Moreover, a lesion of the occipital cortex in a child will not give rise to optic agnosia alone or allowed the formation of other mental activity undisturbed.

A lesion of the brain at different stages of ontogenesis may have completely different consequences. Vygotsky's principle restated p. 62 " In a lesion of a particular 'center' in early childhood, the corresponding 'higher center' in closest relationship to it is secondarily affected, whereas in the case of a similar lesion in an adult it is the dependent lower 'center' that is primarily affected and the specific relationship between the centers is laid down during development. "The theory of constant specific functions of each organ is unsound " (Vygotsky, 1960 p 381.

"The concept (of localization) leads to pessimistic conclusions that the restoration of functions is completely impossible " p. 63. However these conclusions are contrary to the facts repeatedly observed.

Inhibition of wider area is Monakow's diaschisis. Luria interpreted diaschisis as meaning inhibition of the function of neurons situated within the focus and close to it, disturbing their synaptic conduction, and as a result the morphologically intact nerve cells become inactive. Pavlov interpreted the physiologic basis in terms of the theory in terms of limiting protective inhibition, and by Soviet neurologists in investigations of functional asynapsia (Graschchenkov 1946, 1948).

Those 2 studies above, plus others (Luria 1948, Perel'man 1946, Eidinova and Vinarskaya (1959) showed beneficial effects of prostigmine, eserine and galanthamine.

Lashley (1960) regarded speech as one of the most obvious examples of serially organized cerebral activity. Chomsky used Markov chains and mathematical principles to analyze serial or syntactic structures.

History of Neuropsychology

2009-02-26T06:42:00.000-08:00

Benton AR. Neuropsychology Past present and future

Old terms

psychoneurology Bekhterev

brain pathology Kleist

enteroid processes-- old term for gyri of brain till 1820'a

Nemesius-- sensation and perception in anterior ventricles, thinking and reasoning in third ventricle and memory in fourth v (400 AD).

Antonio Guanerio (15th century) - anomia is due to phlegm in fourth v.

Thomas Willis sensation is in corpus striatum , perceptual integration in callosum and memory is in cortex.

Peyronie-- callosum is seat of intellect

Jackson 1878-- to locate the lesions which destroys speech and to locate speech are two different things

Head 1926 =the processes which underlie an act of speech run through the nervous system like a prairie fire from bush to bush.

Brissaud 1897 compared aphasie d'intonation with aphasie d'articulation

Goldstein- related amnesic and conduction aphasia to "abstract attitude"

Kleist- differentiated speech sound deafness and speech meaning deafness (1923-4)

Teuber responsible for term neuropsychology using it in 1948.

Luria on Thinking

2009-02-25T11:59:00.000-08:00

c13 p. 323 Working Brain

Luria engages in historic analysis of constructs and concludes that thinking, ought to be considered as a complex act with component parts, and then it can be considered. Word meaning, the basis of ideas, develops in childhood and gradually becomes abstracted.

Luria states "psychologists are unanimous" that thinking arises when a subject arises for which he has no ready made inborn or habitual solution. Then, thought requires, successively, the restraining of impulsive responses, investigation of the conditions of the problem, analysis of its components, recognition of their most essential features and correlations with each other. Finally is the selection of one from alternative and the creation of a scheme for the performance of a task, or strategy formation. Finally is the choice of methods and operations to put the scheme into effect, the tactics of the solution. The last step is actually the comparison of the results with the original conditions of the task.

Luria on speech, words, repetition, naming m psychology of

2009-02-25T09:30:00.000-08:00

C 12 Working Brain p 307 (random notes)
A word is not an association of an image of an object and a conditioned acoustic complex, but a matrix of multiple cues and connections (semantic, lexical, morphological and acoustic) and in different states any of them could be predominant.
Luria divides speech into expressive and impressive (=receptive). Expressive speech starts with an idea, is coded into a speech scheme, is formulated into operation with "internal speech," and is converted into narrative using rules of grammar. Impressive speech takes incoming speech, decodes it, puts into a speech scheme using internal speech, then into a general idea, and then into a motive. Luria emphasized that speech is also a tool for intellectual activity and a means for regulating or organizing human mental processes. The final step of analysis of expressive speech is to form decisions, draw conclusions, abstract, generalize, and think categorically.
The phasic or acoustic aspect of decoding speech involves an acoustical analysis and reduction into phonemes, and necessary articulatory cues, and articulemes, the fundamental speech unit. Then is the lexical-semantic organization of the speech act with morphologic, semantic or otherwise organized groups. After words the sentence is of varying compexity and has narrative speech, which is a transition of thought to speech (cites Vygotsky, 1936).
Receptive speech occurs with first, decoding phonemes in the temporal cortex. They connect strongly to the postcentral and premotor zones and are thus "adapted for the isolation and identification of the fundamental phonemic characteristics." He differs from Wernicke, who had postulated this step as using the temporal lobe for having "sensory images of words." A lesion here causes "acoustico-gnostic aphasia." Luria speculates but does not draw conclusions on a form of aphasia analagous to Lissauer's associative agnosia, in which the phonemic composition is intact, but the recognition of its meaning is not-- that disorder may have to do with speech/visual analyzers and will be dealt with in a subsequent 1972 publication.
Next is comprehension of a whole phrase or speech expression. This depends on retention of all elements of the speech in the speech memory (analagous to a buffer??) . Otherwise various parts of speech will mutually inhibit each other and only part of the speech can be analysed. Second it depends on simulatenous synthesis of all its elements, and the ability to survey it and place it into a logical scheme. This is essential to understanding speech constructions incorporating complex logicogrammatical relationships, with the aid of case endings, words order and inflections, and prepositions, "which Svedelius called the communication of relationships." Luria emphasizes the role of parietooccipital areas as being important in these quaispatial analyses. Third and most important is the ability to actively analyse its most important elements. This requires searching behavior, intention (ie frontal lobes) formation of a program and checking/monitoring.

REPETITION
p. 314
requires 1) auditory perception 2) precise system of articulation (intact lower postcentral gyrus) disintegration of which causes afferent motor aphasia, or disintegration of articulemes, to be differentiated from efferent motor aphasia or Broca's aphasia 3) ability to switch from one articuleme to another or one word to another (inferior premotor cortex is key) 4) The subordination of articulation to programs, and inhibition of irrelevant alternatives. The frontal lobes are key. They must monitor and regulate. Patients may be unable to reproduce nonsense speech. Luria refers us to (in press) Towards the revision of conduction aphasia.

Naming objects p. 316
requires 1) visual perception which if degraded leads to optic aphasia (se Tsvetkova, 1972 (Russian)). 2) precise acoustic structure of speech connected with speech hearing system of left temporal cortex. Damage leads to literal paraphasias, absence of help of prompting. 3) Most important, discovery of the proper selective meaning and the inhibition of irrelevant alternatives. In pathologic states when "law of strength" is not obeyed is most susceptible. 4) Mobility of nervous processes eg. if a name is found, its not frozen, can switch to another name etc. (Left premotor area is key).

Transition to linear scheme of sentence
impaired with postcentral gyrus lesions. Interesting patients who could not do, had no emg of lips and tongue, until external aids were used, when they did have. This is a rehabv strategy-- use pieces of paper in fragments and organize them into a narrative.

Luria describes the inability to use prepositions as transcortical motor aphasia patients can repeat words but not articulate phrases or preserve spontanous speech.

Luria on Memory

2009-02-25T08:09:00.000-08:00

Working Brain c 11 p 280

Luria laments the lack of effective work on memory processes up to 1960 or so when RNA was linked to memory. Specifically RNA traces remain high in glia for a long time after learning. Luria asks which brain zones contribute to memory, what are the architectonics of memory, and what is the structure of mnestic activity.

Luria cites literature (p283) that learning starts with the imprinting of sensory cues (eg. phonetic). Imprinting is selective, narrow in scope, and short, may be expandable in case of visual memory. The next intermediate step is the conversion of images to a a storable code or category. They are coded with respect to different signs and form multidimensional matrices from which the subject must choose. The process for retrieval is active, not passive. The subject uses language, that helps transfer from short to long term memory (cites Miller, 1969). He then asks what causes forgetting? Mere extinction or decay of traces is countered by idea of "reminiscences" which involve the enhancement of the traces. Then the ideas of proactive and retroactive inhibition became accepted as ideas, the idea being that forgetting is largely the regulator function of irrelevant, interfering actions that inhibit normal recall of traces. Luria cites Soviets Vygotsky and Le'ontiev as noting that recall is usually indirect and accomplished throught the use of "aids." Le'ontiev described it with respect to children's development. Motives and tasks direct what is to be recalled, and coding and categorizations increase the amount that can be recalled. Memory (optimized) requires optimal cortical tone, or vigilance, and intention, and integrity of the highest secondary or tertiary zones.

Which brain zones? Bekhterev (1900, hippocampus) and Grunthal (1939, mammillary bodies) preceded Scoville and Milner. Luria states the hippocampus is a modality independent structure of the archicortex that modulates cortical tone but compare stimuli to traces of past experience, react to changed stimuli and are therefore both "attention" and "memory"
neurons. Luria repeats that patients with pituitary tumors affecting these zones have mild memory disorders. Hippocampal memory disorders are characterized by modality nonspecificity, by primary defect of trace retention (and ability sometimes to compensate by writing down), and disturbances of consciousness.

Experimentally, subjects can repeat 5-6 words and retain it for 1-2 minutes unless there is interfering activity. Luria concludes pathological increased mutual inhibition of traces is the basic physiological factor in primary disturbance of memory observed in deep brain lesions.

Tests" Haptic fixed set illusion -- a patient with a memory disorder is given a large ball to touch with his right hand, and a small ball with his left hand, then given two balls of equal size so the one on the left appears large (fixed set illusion). Interference erases the traces of the illusion. Similarly, if an object is given and then a second object given for comparison, interference will prevent identification of same or different.

Modality specific memory loss
temporal lobe leads to acoustico-mnestic aphasia. Again Luria attributes this to increased inhibition of traces, or emergence of strong and weak traces without selection. He also calls this the "levelling of excitation of the traces."
Frontal lobes again leads to disturbance of intentions, plans, programs, and regulation. The patients are unable to use "aids" to memorize.

Luria on attention

2009-02-24T16:40:00.000-08:00

c. 10 Working Brain p. 256
Begins with a discussion of old papers, including Rubin (Gestalt school) who argued attention does not exist, and idealists (Wundt, Revault d'allones) who describe it as the subject's set or "creative activity" at the other pole.

He then refers to Vygotsky and to the intense biological attentional factors present early in life between a child and mother. The child turns the eyes and the head towards the stimulus, ceases irrelevant activity, and has autonomic and GSR responses which Bekhterev called the concentration reaction and Pavlov the orienting reflex. These are observed in the first few weeks of life, first with the fixation on an external object, then with an active search for it. Luria cites research that infants will cease sucking in response to photic stimulation. Later there is inhibition of the alpha rhythm and strengthening of the evoked potentials. Sokolov and Vinogradova described many features of it. Orienting reflex is directive and selective; after extinction to an acoustic stimulus, OR still occurs to other auditory stimuli. Orienting reflex occurs on any mismatch beween neuronal model and the new stimulus.

Luria then differentiates voluntary attention and OR. The former is not biological but a social act. They are not the product of the biological maturation of the organism, but of forms of activity created in the child in his relations with adults, into the organization of complex regulation of cerebral activity. The mother names the object, the child attends to the object, learns to name it himself, and it now is part of his internal organization of psychological process. Thus Vygotsky's differentiation between elementary and higher forms of attention and its social nature is key.

Vygotsky points out that in young children, involuntary attention competes with voluntary attention, and not till age 4 can the child suppress an involuntary OR to a spoken directive to attend to a different object, eg. Internal voluntary attention is then subordinated not only to adults but also to the child's own inner speech. He cites research by Homskaya that children given a sorting task have higher accuracy when allowed to sort by speech.

Luria then cites EP literature that EP show strengthening with OR, but lasting changes only with spoken instructions.

Luria believes the hippocampus and the caudate nucleus contain the internal maps for comparison that generate the OR. A lesion of them causes a breakdown in selective attention more than memory.

Luria on frontal lobes

2009-02-24T16:29:00.000-08:00

Working brain, p. 250
Frontal lobes maintain and control the general tone of the cortex, but with the aid of internal speech and under the influence of afferent inpulses reaching them from other parts of the cortex, formulates the intention or motor task, ensures its preservation and also its regulatory role, enables the performance of the action programme, and keeps a constant watch over its course.

Damage causes replacement of action programs with direct reactions arising uncontrollably to any stimulus, assuming the character of unsuppressed orienting reactions or echopraxia, the eruption of inert stereotypes, and with massive lesions the comparing role that allows awareness of mistakes and the ability to check the course of action.

The premotor zones the important cerebral apparatus for 'kinetic melodies' or series of skilled movements.

Mutual coordination of the hands occurswith anterior corpus callosum and lesions thereof leave each hand able to perform a task , but the two hands together unable to perform mutually coordinated movements.

Luria on perception

2009-02-24T13:23:00.000-08:00

Isomorphism, as introduced by the Gestalts such as Kohler, believe that during perception, a passive imprint on the retina is then transmitted to the cortex. More recent views of perception regard it as an active, complex process, involving perception, analysis, coding, synthesis, active inspection.

Luria notes a visual image stays on the retina for 1.5 seconds, with an afterimage lasting about 20 seconds (Working Brain p. 232). In patients with damaged occipital areas, the after image lasts a shorter time, but is longer with administration to caffeine (cites Zislina 1955). Thus the visual cortex not only synthesizes elements but also stabilizes them, similar to the temporal lobe after injury with respect to auditory elements.

Associative visual blindness (associative visual agnosia) as opposed to apperceptive agnosia is intact perception, abnormal recognition.

Luria: frontal lobes and memory

2009-02-24T11:22:00.000-08:00

Working brain 210-225.
Patients' actual memories are preserved, but ability to create stable motives, active effort, ability to switch from one trace to another is not preserved. List learning shows an early plateau.

Clinical tests
thematic picture-- will focus on one element and stop. (eg p215 picture of man falling through ice). Picture Unexpected Return p218. Eye movements show absent scanning. Arithmetic-- trouble with serial 7's or 13's; trouble with alternating operations (plus then minus). Only partially effective treatment is dividing into consecutive questions with external supports for each one.

jackson-- Frontal lobes not only are the most recent and largest part of the brain, but the least organized. Lesions can be compensated for or appear asymptomatic. However, Luria divides frontal lobes into the lateral zones, which cause disintegration of motor and in left sided lesions, of speech activity. The medial basal frontal lobes connect to reticular formation and the limbic brain. Luria notes potential effects on olfactory structures, generalized disinhibition and gross changes in affective processes. Impulsiveness and fragmentation occur preventing many tasks.
Some of the terms used by Luria for medial zone lesions include the "oneroid state," diminihsed critical faculty, disturbance of action acceptor apparatus, disturbance of selectivity of mental actions, disturbance of memory and confabulations.

Frontal Lobes and Regulation of Motor Activity

2009-02-24T07:05:00.000-08:00

Luria The working Brain c. 7 p. 187
Luria considers these tertiary zones for the limbic and motor systems and crucial for regulating vigilance and goal linked activity. "expectancy waves" in the frontal lobe precede activity. Speech has an "activating role" which formulates the problem. This increase in cortical tone from the activation role of speech is deficient in patients with frontal lobe lesions (cites numerous publications on which Homskaya is listed as an author). Autonomic changes due to an orienting reflex continue until habituation, interruption or completion of the task. Autonomic components of the orienting reflect evoked by spoken instruction continue after posterior but not anterior lesions. Luria concludes p. 189 "the frontal lobes participate in the regulation of the activation processes lying at the basis of voluntary attention."

Electrophysiologically, the EEG depression of alpha rhythm occurs in response to any spoken instructions but are absent or unstable in patients with frontal lesions, but is preserved in those with posterior lesions. Analagous findings occur with evoked potentials and frontal and posterior lesions.

Luria emphasized that the apathoakineticoabulic syndrome of massive frontal dysfunction does not affect all behavior, just higher cortical function. Orienting reactions to irrelevant stimuli, not intention based, are not only undisturbed but may be intensified. Patients do not reply to questions, make requests, or complete tasks but will lok at door that squeaks to see who is coming in. They may join physician's conversation with a neighbor, even if they won't ask questions directly posed to themselves. Luria concludes that massive injuries to the frontal lobes control only the most complex forms of regulation of conscious activity and in particular, acitivity controlled by motives formulated with the aid of speech (Luria, 1966 a,b 1969 a,b).

Effect of spoken instructions is complex, patients may cease to obey gradually, or repeat and not do command. He may also replace it with an inert stereotype eg. putting a match in his mouth and attempting to smoke it. (note- comparable to apraxic content error). {atient's own speech is also not enough to regulate. If asked to tap, rhythmically, strong, weak, weak, saying is not enough to make patient do it.

Clinical tests for-- echopraxia, usually performed correctly. Different forms of contrasting programs motor task (if I make a fist, you raise your finger). (tap once if I tap twice, tap twice if I tap once). Homskaya (1966) and Maruszewski (1966) show that patients lapse into echopraxia after a short amount of time. Luria's idea, is that each attempt to follow a spoken command leads to a "flood of inert stereotypes." Drawing may be performed correctly on first attempt (circle, square, cross) but changing leads to perseveration. Patients also lose the ability to self monitor results and change if needed. In spite, they recall the task. However, they can monitor the same tasks as OTHERS perform them and notice others' mistakes. (numerous citations p 210 Working Brain)

Luria on nondominant parietal lobe

2009-02-23T16:43:00.001-08:00

The Working Brain p, 160

Luria notes the absence of acalculia but the presence of unawareness of the left visual field in patients with a field defect (unlike left hemisphere lesions). Its also true in spontaneous construction and drawing . Cites Korchazinskaya, 1971 (Unilateral spatial agnosia in brain lesions, dissertation, Moscow). Luria also notes anosognosia, inability to notice and correct mistakes, in patients with right hemisphere (parietal) lesions.

He also discusses the lack of familiarity with known objects or faces, despite intact perception, such as in prosopagnosia. He calls it a paragnosia --replacement of a direct correct perception of an object by uncontrollable guesses about its nature. Constructional apraxia and representations of external space are much more common than in left sided lesions.

Luria cites Sperry's split brain model as evidence that the right hemisphere can neither participate in any extent in speech function or in complex motor acts. Logical reasoning and logical grammatical structures are not affected. However, Luria cites Teuber as evidence that the right hemisphere is less differentiated than the left. For example, sensory agnosia localizes much more sharply in the left hemisphere than the right. In the right hemisphere, disorders are more likely polymodal and polysensory. Problems of the "body schema" are more common in the right hemisphere, including a sense of disproportionality of particular body parts. The right hemisphere does participate in direct visual perceptions and direct visual relationships with the world (Hughlings Jackson, 1874). Dressing apraxia refers to right hemisphere about 80 percent of the time.

Anosognosia,or lack of awareness of deficit (such as hemiplegia) is explained by lack of awareness of deficits not related to speech mechanisms (p. 168).

Disorders of personality and consciousness may include confusion, and disorientation, and subterfuge through humor or speech to hide or disguise the deficit. Lack of logical operation allowed such patients to believe they were in two different places at the same time, without a contradiction in the statement.

Luria hints at a role for the right hemisphere in consciousness, which he will address in a series of papers being prepared for publication.

Luria on amnestic aphasia

2009-02-23T16:30:00.001-08:00

The Working Brain p. 156
goes with " speech memory" and anomia. Luria states that outwardly these patients with parietal lesions resemble those with middle temporal gyrus anomia, but features are different than with audioverbal memory disorder. Instability of the acoustic basis of speech is not present, as patients clearly benefit from prompting with the first sound or syllable (phonemic priming). Every word is a code, or part of a classification or system of values. Since semantic schemes are disturbed, naming is abnormal. In affected or damaged cortex, the "law of strength" is disturbed and weak stimuli evoke similar responses as strong stimuli. A "flood of equally probable possibilities prevents the discovery of the required dominant word." (Luria 1972 Aphasia reconsidered, Cortex 1:1). So paraphasias are common. Tsvetkova (1972) noted the naming problem affects objects not actions. This study was based on reaction time to name qualities, actions, objects . In particular concrete objects are affected. Further , Tsvetkova found that visual representations of the objects were abnormal and drawings or descriptions showed unexpected defects.

Luria: Parietal lobes and complex simultaneous spatial synthesis

2009-02-23T15:55:00.000-08:00

c5 p. 147 Luria The Working Brain

Luria notes this part of the brain is entirely human. It maintains connections with the thalamus and is a supramodal analyser. This is known by electrical stimulation and lesion studies that show no modally specific effects.

Luria compares lesions to those of simultaenous agnosia with an inability to fit together individual elements into a whole, or convert presentation of consecutive elementsinto simultaneous perceptibility. However, in addition, they cannot find their bearings within a system of spatial coordinates especially being able to tell right and left.

Patients get lost, cannot find their bed, cannot tell time from hands of a clock without numbers, find their bearings on a map, tell east from west, reproduce the position of the hand. They cannot draw letters due to inability to retain the required spatial position of the lines of the letters. Patients may write/draw mirror images. Severest form manifests in inability to directly reproduce 3D structures. Less severe forms include inability to reproduce spatial forms from memory. Other tasks are mirror reversal tasks. Constructional apraxia can occur.

Luria states that classical Gerstmann's syndrome ( acalculia, right-left confusion, finger agnosia, central alexia) has deeper roots with more symptoms. Complex logico-grammatical structures may be poorly understood, particularly with embedded constructions, passive actors and objects or sentences with the requirement of understanding the grammatical or spatial relationships among multiple actors.

The syntagmas, or syntactic structures expressing logical relationships is a term credited to the Swedish linguist Svedelius (1897). Communications of relationships occurred late in the evolution of languages, within the previous hundred(s) of years with the aid of inflections, prepositions or word order. All coded logical not concrete relationships, for example, the attributive genitive, "the father's brother." Although others called the inability to understand these relationships "semantic aphasia," Luria considers it a problem of spatial structures transferred to a higher symbolic level and affecting language.

Luria attributes acalculia to the use of internal spatial schemes such as tables, which are dependent for simultaneous synthesis and spatial operations, such as columns, to do arithmetic operations, and the need for right-left orientation to place the remainders in the correct position. Patients are aware of their inability to do complex operations, but are otherwise "intact" for motive, and otherwise.

Luria on temporal cortex

2009-02-23T13:25:00.000-08:00

Destruction of temporal cortex does not cause loss of hearing, but does cause loss of differentiation of combinations of sounds (numerous citations, working brain p. 131). This was also true even with very small lesions. Semernitskaya (1945) noted ability to discern simple sounds but not to repeat series of taps or rhythms, nor to identify same.

Luria discusses the "phonemic system" of language (p134) in which some characteristics of sounds are crucial in one language and unimportant in another; in order to distinguish these sounds of speech in any language it is necessary to code them according to the system, pick out the useful characteristics and to separate them from unimportant features known as variants. He cites Trubezkoi and Jakobson as writing laws about the perception of sounds of speech.

Luria equates "acoustic agnosia" and "sensory aphasia" and believes disturbance of audioverbal memory is closely related. Further he describes "increased mutual inhibition" of auditory traces, a characteristic defect of the pathological state in the temporal cortex." Presenting acoustic stimuli at longer intervals decreases inhibition and thereby decreases errors. Cites unpublished work of Tsvetkova, and of Luria, Sokolov and Klimkovsky (1967) (Neuropsychologia).

Luria attributes the naming defect to difficulty with phonemic imprecision the inability "to profit from the prompting at the beginning of the word." Speech disorder (up to "word salad") as due to some words being phonemically defective, others with wrong word choice, with an unawareness of errors and inability to self correct. An inability to write is similarly due to phonemic frustration at finding required sounds and letters. On the other hand, the ability to write a signature, which is really a motor automatism, is a "clear example of a change in structure and cerebral organization of a process in the course of functional development" (Luria et al. , 1970, Neuropsychologia). He notes the ability of some people to copy sentences but not to write to dictation.

Speech hearing deficits do not imply by any stretch deficit in musical hearing.. Luria has a famous case report of a musician who was aphasic but still performed. Similarly, melodic and intonational aspects of speech are not impaired.

Simultagnosia from The Working Brain by Luria

2009-02-23T13:08:00.000-08:00

Pavlov explained simultaneous agnosiaby saying the cells were "so weakened" that one excited point exerts an inhibitory effect on the other excited point, thus making it apparently nonexistent (Pavlov IP, Pavlov's Wednesday Clinics, vols 1-3, Izd. Akad. Nauk SSSR, Moscow and Leningrad, 1949 (Russian) as cited p. 123. Cites Pribham as saying defect is due to corticofugal projections to inferior temporal lobe.

Luria then took a subject affected with a bullet wound, injected caffeine 0.05 ml of 1 % solution, , with the result that the patient could see two and sometimes three objects for 30-40 minutes (as long as the caffeine lasted) and the visual ataxia disappeared.

Examination of the patient:

cf p.117
Patients obscure pictures. May require tachistoscope to bring out changes with brief exposures if mild case. Defect involves not only perception but also drawing.
Tests-- cannot place a dot in the center of a circle or a cross/ cannot draw a triangle around a triangle.

The "secondary zones" of the left occipital cortex differ from the right insofar as they "retain their intimate connection with speech" unlike the right. Lesions of the left cause an agnosia for letters or reading (optic alexia). In right hemisphere agnosia for objects or faces is more common.

Differences in brain function as child develops

2009-02-22T03:19:00.000-08:00

Working Brain p. 32 Basic perception early

"The yong child thinks in terms of visual forms of perception and memory and thinks by recollecting. At later stages or in adult life, the aid of the functions of abstraction and generalization is so highly developed that even relatively simple processes such as perception and memory are converted into complex forms of logical analysis and synthesis, and the person actually begins to perceive or recollect by reflection."

In "dynamic" Soviet neuropsychology, a lesion of "elementary" cortex such as visual cortex early in life produces more profound changes than later in life because it will affect the "higher areas" above development if it occurs early.

Revision of the concept of "symptom" p. 34

"In order to progress from the establishment of a symptom (loss of a given function) to the localization of a given activity, a long road has to be travelled...the detailed psychological analysis of the structure of the disturbance and the elucidation of the immediate causes of the collapse of the functional system or in other words, a detailed qualification of the symptom observed."

Thw Working Brain function and localization

2009-02-20T10:02:00.000-08:00

AR Luria (1973)

Preface-- "Are man's gnostic processes and motivated actions the result of the work of the whole brain as a single entity, or is 'the working brain' in fact a complex functional system embracing different levels and different components each making its own contribution to the final structure of mental activity." (p.11).

Seld criticizes in advances lack of data on "minor hemisphere" and medial corticobasal structures.

Chapter one cites Broca's postulate based on his cases that the "posterior third of the left inferior frontal gyrus is the 'centre for the motor images of words' identifying the left hemisphere in righthanders as the dominant hemisphere for language. Cites Wernicke that the posterior third of the STG is 'the centre for the sensory images of words' or the 'centre for understanding of speech ' (Wortbegriff). In the "splendid 70's" ie 1870's, and for a half century, there was an attempt to "localize complex psychological processes in local areas of the brain" p.23. However, Luria state (p.25) that "without denying the obvious fact that elementary physiological 'functions' (such as cutaneous sensation, vision, hearing, movement) are represented in clearly defined areas of the cortex, these investigators [Monakow (1914), Head (1926), Goldstein (1927, 1944, 1948)]expressed valid doubts about the applicability of this principle of 'narrow localization' to the brain mechanisms of complex forms of mental activity.

"They therefore postulated that the complex character of "semantics" (Monakow) or "categorical behavior " (Goldstein) are the result of activity of the whole brain rather than the product of the work of local areas of the cerebral cortex... dependent more on the mass of the brain involved than on participation of specific zones of the cerebral cortex (Goldstein, 1944, 1948). ... (Luria then refers to) the decisive role of mass in the performance of mental activity, which have repeatedly burst forth throughout the history of the study of brain as the organ of mind." (cites Flourens, 1824, Goltz 1876-84, Lashley, 1929).

p.27 Reexamination of the concept of 'function'
"Those investigators who have examined the problem of the cortical 'localization' of elementary function by stimulating or excluding local brain areas have understood the term 'function' to mean the function of a particular tissue... when we speak of the function of digestion or the function of respiration it is abundantly clear that this cannot be understood as the function of a particular tissue..the whole of this process is carried out, not as a simple function but as a complete functional system, involving many components belonging to many different levels of the secretory, motor and nervous apparatus. Such a functional system (the term introduced and developed by Anokhin, 1930, 1940, 1949, 1963, 1968a, 1972) differs not only in the complexity of its structure, but also in the mobility of its component parts... for example,(in respiration) if the diaphragm ceases to act, the intercostal muscles are brought into play... THE CONCEPT OF 'FUNCTION' AS A WHOLE FUNCTIONAL SYSTEM IS A SECOND DEFINITION DIFFERING SHARPLY FROM THE DEFINITION OF A FUNCTION AS THE FUNCTION OF A PARTICULAR TISSUE. WHEREAS THE MOST COMPLEX AYTONOMIC AND SOMATIC PROCESSES ARE ORGANIZED AS 'FUNCTIONAL SYSTEMS' OF THIS TYPE, THIS CONCEPT CAN BE APPLIED ON EVEN STRONGER GROUNDS TO THE COMPLEX 'FUNCTIONS' OF BEHAVIOR." Further cites movement, example of Bernshtein, and Lashley mouse removed cerebellum and mouse achieved motor goals by different task, going head over heels.

p.30 Revision of the concept of localization
again, respiration "Pavlov, when discussing the notion of a respiratory centre, was compelled to recognize that 'whereas at the beginning we thought this was something the size of a pinhead in the medulla, now it has proved to be extremely elusive, climbing up into the brain and down into the spinal cord, and at present nobody can draw its boundaries accurately."

"The higher forms of mental processes have a particularly complex structure; they are laid down in ontogeny. Initially they consist of a complete, expanded series of manipulative movements which gradually have become condensed and have acquired the character of inner mental actions (cites Vygotsky 1956, 1960, Galperin 1959). As a rule, they are based on an external system of aids, such as language, the digital system of counting, formed in the process of social history, they are mediated by them, and cannot in general be conceived without their participation (Vygotsky); they are always connected with this reflection of the outside world."

"Two facts sharply distinguish the human brain (p31)... higher forms of conscious activity are based on certain external mechanisms (good examples are the knot we tie in our handkerchief so as to remember something essential, a combination of letters we write so as not to forget an idea, or a multiplication table) these external aids or historically formed devices are essential elements in the establishment of functional connections between the individual parts of the brain, and that by their aid, areas of the brain which previously were independent become the components of a new functional system. THIS CAN BE EXPRESSED MORE VIVIDLY BY SAYING THAT HISTORICALLY FORMED MEASURES FOR THE ORGANIZATION OF HUMAN BEHAVIOR TIE NEW KNOTS IN THE ACTIVITY OF MAN'S BRAIN, AND IT IS THE PRESENCE OF THESE FUNCTIONAL KNOTS, OR , AS SOME PEOPLE CALL THEM, NEW FUNCTIONAL ORGANS (cites Leonti'ev 1959)...

"The second distinguishing feature of the localization of higher mental processes in the human cortex is that it is never static or constant, but moves about essentially during development of the child and at subsequent stages of training... any complex activity is at first expanded in character and requires a number of external aids for its performance, and only later does it gradually become condensed and converted into an automatic motor skill.

(For example, in writing) the initial stages require the memorization of the graphic form of every letter, through a chain of isolated muscle impulses, each of which is responsible for one element of the graphic structure... with practice, the structure is radically altered and writing is converted into a single kinetic melody... In the course, it is not only the functional structure of the process which is changed, but also naturally, its cerebral organization." The participation of the auditory and visual areas of the cortex, essential early, is no longer necessary in its later stages, and the activity starts to depend on a different system of concertedly working zones (cites Luria, Smernitskaya, and Tubylevich, 1970).

Lecture by Luria, 1972

2009-01-17T10:14:00.000-08:00

trans by Cole (internet) link:
http://luria.ucsd.edu/vidaud.html

Reflexology

2008-12-11T17:54:00.000-08:00

Reflexology is not really a part of behavioral neurology. However, it is important as a part of Soviet social psychology history. Reflexology as practiced by Sechenov affected Pavlov and per Bekhterev affected Luria. Understanding the details is less important, in the history of behavioral neurology as understanding a general gmish, or context of reflexology and how it fits into what came later.

Collective Reflexology by Bekhterev was published in 1921, and greatly influenced those who followed, including those who did not agree with it, such as Vygotsky, and those who rose to be more prominent, such as Pavlov. There was no second edition, and it is said that this volume reflects the Revolution in great detail.

At its genesis is the thesis that the mind is the synthesis of the biological brain and the social environment. Evolutionarily, speech enabled abstract thought and writing enabled history. Brain reflexes can be simple (fright or flight)social, primitve (anger, hunger) or complex. Folk psychology or national spirit is said to exist.

According to Sechenov, psychological acts are a series of reflex acts formed through the activity of cerebral structures and which are associated and integrated among themselves. Sechenov started out studying the spinal cord, and reflexes in decapitated frogs scratched on their bellies, and generalized his spinal cord physiology to the brain, postulating connections between sensory inputs and motor responses. Sechenov postulated emotional reflexes as simple reflexes such as those above, complicated by an emotional factor such as hunger, etc. Psychological reflexes are more complex yet, with a psychological factor intervening. Sechenov's physiology research showed eg. central inhibition, an idea that would later permeate Luria's work. Basically, Sechenov reduced psychology to physiology. His students, the so- called Petersburg school, ultimately became muscle physiologists, studying precise rules of excitatory and inhibitory behavior.

Psychophysics further studies the relation between physiology and psychology. eg. the galvanic response, and concerned itself with processes such as fatigue and others.

According to Mecacci, Bekhterev's reductionism was completely different than Sechenov's as it it attempted to explain not only physiology and psychology but also all living phenomena including sociology. Bekhterev was a neurologist, unlike Sechenov and Pavlov ( a gasterenterologist). He supposed that an energy gave rise to physiology, the mind and society. "Associative reflexes" (the equivalent of Pavlov's conditioned reflexes) were due to connections formed between 2 distinct cortical centers. There is a picture (p.20 of Mecacci's book) of someone reading, with connections from the optic nerve to the LGB, the occipital cortex and the language areas. Vygotsky felt the most important part of the work was the elementary (inborn) reflexes such as suck, snout which "form the fundamental nucleus of mental functions."

Pavlov was a GI specialist, who spent the first two decades of his career studying salivation not the brain. Pavlov was criticised for foraying into the CNS and psychology which he did after he won the Nobel Prize. The Central Nervous System (CNS) describing the formation of conditioned reflexes was more conceptual than real and CNS was said to mean "Conceptual Nervous Sytem." It was said by BF Skinner to be analagous to Sherrington's postulate of a synapse in the spinal cord reflex arc, 20 years before the synapse was described. The behavioral act was described in neuroconceptual terms such as inhibition and excitation that were temporary and meant eventually to be replaced by a neurophysiological explanation. The fact that the Soviets misused Pavlov's ideas and made them rigid is not entirely his fault. It was his fault insofar as his ideas wre incompletely expressed and clarified. Later, Konorski and Hebb clarified many of Pavlov's ideas.

Luria utilized the framework of many of Pavlov's idease which only can be understood in the context of. The theory of reciprocal induction is that surrounding an area of excitation is a process of inhibition. Kornilov and Hebb differentiated between elementary and higher cortical activity and from 1925-1935 there was a lot of energy and work going through. Later in the 1950's Pavlov's work became "dogma" that stifled neuropsychological research.

Vygotsky criticises the approaches of Bekhterev (reflexology explains everything), or Kornilov (reactive), Pavlov (conditioned reflexes) and behaviorism (American movement ,independently arising).

Buridano's donkey illustrated the problem. A hungry donkey caught between 2 sacks of hay on either side cannot decide between them and dies of starvation. The 2 sacks produce equal and "opposite" physiological reactions and the behavior of the animal is inhibited. The qualitative leap of "stimulus - means" as illustrated by Leontiev's experiment signified new cerebral connections. Older children could follow rules by grouping colors etc. due to their having "language" a verbal code.

According to Pavlov, a word can assume the value of a conditioned stimulus or an unconditioned stimulus if it caused the pushing of a button. The first signal is activities of analysis and synthesis, and the second signal, peculiar to man, is the activity of analysis and synthesis of words, verbal signals which "make us human." The second signal-- words-- exhibits a strong inhibitory action over the first signal-- sensory analysis -- only in older children. Luria rejected the idea of language as a reflex arc but considered it as standpoint of historical-cultural school as a process that programs and guides behavior not reflexively though. Vygotsky was republished in 1956 and after 1962 there was a Congress that revised the orthodoxy concerning Pavlov.

Genetics of language impairment

2008-12-05T13:27:00.000-08:00

Vernes SC et al. A functional genetic link between distinct developmental language disorders. NEJM 359;22:2337-2345.2008

and editorial Strombsword K. The genetics of speech and language impairment NEJM 359; 22:2381-3 2008.

The editorial notes that virtually all cases of familial language disturbance have complex polygenic multifactorial transmission. In addition assessment methods vary. In 1990, a 3 generation British family had autosomal dominant transmission of oral motor and speech dyspraxia. They carried a mutuation of FOXP2 gene which encodes a transcription factor. That protein may also be associted with oral motor apraxia, low noverbal IQ and nonverbal learning disorders. Vernes et al. above reported that FOXp2 downregulates the expression of CNTNAP2, a gene that encodes a neurexin protein. Further, using nonsense word repetition, CNTNAP2 is associated with a specific language impairment. They also suggested a possible relationship with autism. However, results do have some problems which are reviewed.

Pharmacotherapy in restorative neurology

2008-12-05T13:04:00.001-08:00

Liepert J. Curr Opin Neurol 2008; 21:639-643.

Levodopa, single 100 mg dose. Mixed results when given alone. Floel et al. showed that if given with rTMS, levodopa increased evoked movements into the trained direction. The authors said it could "enhance the ability to encode a motor memory with training." Restermeyer et al in a doubled blinded crossover trial found no differences.

A recent Cochrane review of studies of amphetamines after stroke for motor recovery concluded that it was not possible to determine whether it made a difference.

Walker -Batson et al. studied 21 subacute aphasic patients with 10 mg amphetamines every fourth day with one hour of speech therapy for ten sessions, and assessed subjects with the Porch Index of Communicative ability. Patients receiving amphetamines improved, and even after 6 months had a trend to improvement. Whiting et al. had a study with two patients, one improved, one did not. Mocobemide did not help aphasia after stroke.

Methylphenidate after stroke with Physical therapy improved motor function using Fugl Meyer Scale and reduced depression. (21 patients were studied). In TBI, it improved mental processing speed more than placebo.

Amantadine reduces agitation and aggression and imporves attention and alertness on DRS and FIM in TBI patients. On PET it is associated with increased left prefrontal activity. It helped executive functions in one study.

Reboxetine improves motor skill acquisition. It improves tapping speed and grip strength after a single dose in 10 stroke patients with a session of physiotherapy.

Piracetam 4.8 mg daily in 203 subacute stroke patients decreased aphasia on Aachener Aphasic Test, including written language and "profile level." In 24 patients, speech therapy plus piracetam improved semantic and syntactic structure of speech. PET showed improvement in left appropriate areas including left transverse temporal gyrus, Wernicke's and Broca's area. Cochrane review said piracetam "may be effective."

Donepezil in 26 patietns with poststroke aphasia helped the Aphasia Quotient but not the Communicative Ability Log. In TBI, 18 chronic patients received for 10 weeks and showed improved memory and sustained attention. Rivastigmine did not appear to help TBI patients with memory except a subtype with poor memory.

SSRI fluoxetine helped walking and ADL's in severely disabled stroke patients. In a PET study it caused hyperactivation in ipsilesional motor cortex. Citalopram helped dexterity but not grip strength in affected hand in a group of stroke patients.

Motor adaptation and motor learning in neurorehabilitation

2008-12-05T11:28:00.000-08:00

Amy Bastian Understanding sensorimotor adaptation and learning for rehabilitation. Curr Opin Neurol 2008; 21: 628-633.

Motor adaptation and motor learning are critical for flexibility. Adaptation refers to trial to trial modification of movements based on error feedback, especially change in the pattern or force of direction oof the movement. Once adapted patients cannot revert to prior behavior unless they deadapt. It occurs over tens to hundreds of movements and over minutes to hours, and can occur in all types of movements including reaching, balancing, eye movements and walking. Adaptation may have a rapid and slow phase. Sensory prediction error is the difference between predicted and observed outcome of the movement. They are used to calibrate internal representations of body dynamics and the environment and recalibrate.

Brain may also alter movements to minimize the "costs" including energy demands, fatigue, and others especially during walkingand reaching adaptation.

Lesions are especially important in the cerebellum that decreased trial by trial improvement during adaptation and reduces stored aftereffects. Basal ganglia damage due to PD or HD leaves adaptation intact largely. Cerebral damage slows but does not abolish adaptation with reaching, and does not impair split belt treadmill walking.

Rehabilitation with robots or treadmills are used . In a reaching task, adaptation was rehabilitated more if perturbation (robotic arm) was introduced gradually rather than at full strength. Adaptation after stroke with neglect was long lasting (5 days) in prism task of reaching. Aftereffects can be substantial. After effects can also prove the ability to normalize an action. Learning via repeated adaptation has been less studied than single session learning.

Motor learning is formation of a new motor pattern that occurs via long term practice. One form is tied to adaptation. Motor learning can be blocked by rTMS.

The Orienting Response Part I

2008-08-28T18:03:00.000-07:00

The Orienting Response in Health and Disease

Description
History
Physiology
Modalities—visual, acoustic, somatosensory, motor
Neurochemistry
Anatomy
Lesions
Neglect syndrome extinction, anosognosia, impersistence,

The orienting response is the initial reaction of an organism to a stimulus. The response is based on the strength and physical attributes of the signal such as brightness, hue and contour or higher order features such as complexity, novelty, and significance. The response consists of a large number of muscular, skeletal, autonomic and central nervous system responses that are triggered reflexively after encountering the stimulus.

The orienting response declines in strength over time and after repeated exposures. This diminution in the strength of the response is known as habituation. Habituation involves an inhibition of amplification of the orienting response through the reticular formation. The capacity to habituate allows the organism to shift attention away to other items of importance or interest. Past exposures to the same or related stimuli create an expectancy for future exposure. Small changes in the stimulus after a delay may then trigger a new, heightened orienting response called sensitization, with heightened amplification of the response through reticular activation (groves and Thompson, 1970). Movement of an object that has served as a stimulus or small changes in its physical appearance may trigger a new, heightened orienting response.

Habituation leads to the diminution of the size of the orienting response. The rate of habituation is determined by the same factors that affect the response, including novelty, information content, complexity, and intensity. Habituation allows an organism to respond to new stimuli (shift attention or set). Habituation helps an organism resist distraction, and the introduction of distraction during habituation increases the likelihood of a phasic orienting response ( Waters, McDonald and Koresko, 1977). Amphetamines… the reticular formation.

While any type of stimulus can trigger an orienting response, humans display relatively stronger responses to visually complex shapes, including patterned stimuli and human facial features, from infancy (Fantz, 1958, 1965). Novelty is an important determining factor in the occurrence of the orienting response, possibly due to a mismatch between the incoming stimulus and an existing neuronal template of the external world, a view that has been called the “neuronal model” (Sokolov 1969).

Orienting responses of a primitive sort appear in nonmammalian organisms, which may consist of membrane permeability changes (Kandel 1982).

Stimulus variation is “fundamental” to the elicitation of the response, including changes in the sensory modality or auditory tone of presentation, changes in the stimulus intensity and duration, and stimulus omission (Siddle et al., 1983). However, the factors affect the response differentially. Stimulus intensity increases produce higher amplitude physiologic responses with decreased and slower habituation. Stimulus duration does not affect the amplitude of the response (Raskin et al., 1969). Interstimulus interval is proportional to the size of the stimulus and inversely proportional to the rate of habituation. Long intervals between stimuli (greater than 120-240 sec) may prevent habituation (Schaub, 1965).

Factors that may result in an enhancement of the orienting response and a diminution of the habituation response include not just novelty, but increasing task stimuli complexity, as well as a verbal task demand that stimuli be “learned” in preparation for a future recognition test (Verbaten et al, 1979). The orienting response is a nonspecific response related to readiness and expectancy of stimulus selection. During conditioning (learning), the physiologic response becomes more specific with an increased activation to the conditioned stimulus, but less expectancy response (Ohman, 1983). Thus the orienting response may be associated not just with novelty but with higher order conditioning and learning.

Features of the orienting response include head turning, autonomic sympathetic responses including sweating, papillary dilatation, peripheral vasoconstriction, central vasodilatation, changes in heart rate, and EEG desynchronization (Kimmel et al., 1979). The electrodermal response, measured through changes in skin resistance and sweating, correlates well with the response including habituation and is often used to define the response. The heart rate decelerates and the blood pressure diminishes with the orienting response, unlike the startle response or the defensive response during which the heart rate accelerates and the blood pressure increases; however, otherwise the orienting response resembles the startle and defensive responses. The orienting response occurs during stimulus onset or offset, whereas the startle/defensive reactions occur only during onset, and tend to habituate more rapidly than the orienting response (Jackson, 1974). An important difference is that the defensive response occurs only in relation to high amplitude stimuli and is not changed by ambient differences and changes in information at lower amplitudes (Graham, 1973).

Lacey (1959, 1967) proposed that during the orienting response, during the period of sensory intake, the heart rate decelerates, whereas during subsequently, during preparation for a motoric response, the heart rate activates.

The orienting response represents an organism’s registration of/confrontation with a stimulus, rather than processing of it (Sokolov,? 1976). Cohen (1993) writes that “the orienting response provides a behavioral index of attention.” However, Cohen (1993) has suggested the difficulty of defining a truly novel and/or important stimulus and differentiating them from ambient environmental noise.

History of the Orienting Response:
The orienting response was described by Pavlov but elaborated by Sokolov. It is a reaction to a new or unexpected stimulus or to change in parameters such as intensity, duration, frequency, etc.). It correlates with a generalized physiologic reaction. A basic property is habituation, and it disappears with repeated presentation. It can be seen in EEG, EMG, GSR, psychogalvanic response etc. Sokolov showed that the orienting response is not analysis of a stimulus, but confrontation of it. If a representation of the stimulus is formed, and subsequent presentations "match" the response habituates. If there is discordance, the response reappears. Thus the nervous system has to have an imprint of the external world (that is subject to continuous revision). OS Vinogradov, did further experiments and found that neurons in the hippocampus and other subcortical nuclei would compare stimuli to past traces. Sokolov also noted that tongue and lip activities were active during "inner speech" and was a physiological index for indicating mental planning.

The orienting reaction, as measured by GSR and suppression of alpha rhythm of the EEG, cannot be stabilized by verbal stimuli in patients with frontal lobe lesions. In ordinary individuals, verbal stimuli can prevent the habituation response and thereby prevent the orienting response from disappearing. Conversely , patients with lesions in the posterior sensory cortex have normal habituation of the OR (Homskaya, 1966). Stimuli that would increase the amplitude of visual evoked potentials in normals failed to do so in patients with frontal lobe damage (Simernitskaya and Homskaya, 1966; Simernitskaya, 1970). Animal models of frontal lobe damage also show changes in the OR (Grueninger et al., 1965, Kimble et al., 1965).

Orienting responses are impaired after human dorsolateral (Heilman and Valenstein, 1972) and cingulate gyrus lesions (Watson et al., 1973), as indicated by hypoarousal, spatial neglect, and hypomobility of the neglected side contralateral to the lesion. CM Fisher described the “intermittent interruption of behavior” following ACA stroke (1968).
Neglect, which often includes unilateral hypokinesia and lack of arousal responses, can be seen with lesions of the arcuate region in primates (Kennard and Ectors, 1938, Welch and Stuteville, 1958), in the parietal association areas (Heilman et al, 1971), and lesions of the thalamus, hypothalamus and midbrain (Marshall and Teitelbaum, 1974; Marshall et al, 1971, Segara and Angelo 1970, Watson et al., 1974.

Cohen RA. The Neuropsychology of Attention. (New York, Plenum Press, 1993).

Kennard MA and Ectors L. (1938). Forced circling movements in monkeys following lesions of the frontal lobes. J Neurophysiol 1:45-54.

Welch K and Stuteville P (1958). Experimental production of neglect in monkeys. Brain 81:341-347.

Fantz RL. (1958) Pattern vision in young infants. Psychol Recod 8:43-48.

Fantz RL. (1965) Visual perception from birth as shown by pattern selectivity. Annals of the New York Academy of Sciences, 118:793-814.

Homskaya ED. (1966) Vegetative components of the orienting reflex to indifferent and significant stimuli in patients with lesions of the frontal lobes. In Frontal Lobes and Regulation of Psychological Processes, AR Luria and ED Homskaya (eds), Moscow, Moscow University Press.

Simernitskaya EG and Homskaya ED (1966) Changes in evoked potential to significant stimuli in normal subjects and in lesions of the frontal lobes. In Frontal Lobes and Regulation of Psychological Processes, AR Luria and ED Homskaya (eds), Moscow, Moscow University Press.

Simernitskaya EG (1970) Evoked potentials as an indicator of the active process. Moscow, Moscow University Press.

Fisher CM. (1968) Intermittent interruption of behavior. Trans Am Neurol Assoc 93:209-210.

Graham FK (1973) Habituation and dishabituation of responses innervated by the autonomic nervous system. In Peke HVS, Herz MJ (eds.) Habituation: volume 1: Behavioral studies pp.163-218. New York, Academic Press.

Graham FK, Clifton RK (1966). Heart rate change as a component of the orienting response. Psychological Bulletin 65:305-320.

Graham FK (1979). Distinguishing among orienting, defense and startle reactions. In Kimmel HD, van Olst EH, Orlebeke JF (eds.) The orienting reflex in humans (pp137-167) Hillsdale, New Jersey, Erlbaum.

Groves PM, Thompson RF (1970) Habituation: a dual process theory. Psychological review 77:419-450.

Grueninger WE, Kimble DP, Grueninger J, Ledvine SE (1965) GSR and corticosteroid response in monkeys with frontal ablations. Neuropsychologia 3:205-216.

Heilman KM, Pandya DN, Karol EA, Geschwind N. Auditory inattention. Arch Neurol 1971 24:323-325.

Heilman KM and Valenstein E. Frontal lobe neglect in man. Neurology 22:660-664, 1972.

Jackson JC. Amplitude and habituation of the orienting reflex as a function of stimulus intensity. Psychophysiology 11: 647-659.

Kandel ER and Scwartz JH (1982) Molecular biology of memory. Modulation of transmitter release. Science 218:433-443.

Kimble DP, Bagshaw MH, Pribham KH (1965). The GSR of monkeys during orienting and habituation after selective partial ablations of the cingulated and frontal cortex. Neuropsychologia 3: 121-128.

Kimmel H. Van Olst EH, Orlebeke JF (eds.) The orienting reflex in humans. Hillsdale, New Jersey, Erlbaum.

Lacey JI (1959) Psychophysiological approaches to the evaluation of psychotherapeutic process and outcome. In Rubinstein EA, Parloff MB (eds.). Research in psychotherapy, pp160-208, Washington, D.C>, American Psychological Association.

Lacey, JI, (1967). Somatic response patterning and stress: some revisions in activation theory. In Appley MH and Trumbull R (eds.) Psychological stress: isues in research. New York, Appleton-Century-Crofts.

Marshall JF and Teitelbaum P (1974). Further analysis of sensory inattention following lateral hypothalamic damage in rats J Comp Physiol Psychol. 86:375-395.

Marshall JF, Turner BH and Teitelbaum P (1971) Sensory neglect produced by lateral hypothalamic damage Science 174: 523-525.

Ohman A. (1983). The orienting response during Pavlovian conditioning. In Siddle D (ed.) Orienting and habituation. Perspectives in human research. Pp.315-370. New York, Wiley.

Raskin DC, Kotses H, and Bever J (1969). Autonomic indicators of orienting and defensive reflexes. J Exper Pscyhol 80:423-433.

Schaub RE (1965). The effect of interstimulus interval of GSR adaptation. Psychonomic Science 2: 361-362.

Segarra J and Angelo J (1970). Anatomical determinanants of behavioral change. In Behavioral change in cerebrovascular disease, AL Benton (ed.) New York, Harper and Row.

Siddle DAT and Spinks JA (1979). Orienting response and information processing: some theoretical and empirical problems. In Kimmel HD, Van Olst EH, Orlebeke JF (eds.). The Orienting reflex in humans. Hillsdale, New Jersey, Erlbaum.

Siddle D, Stephenson D, Spinks JA (1983). Elicitation and habituation of the orienting response. In Siddle D (ed.) Orienting and habituation: perspectives in human research (pp. 109-182) New York, Wiley.

Sokolov EN. The modeling properties of the nervous system. In Cole M, and Maltzman I (eds.). A handbook of contemporary Soviet psychology. (pp.671-704). New York, Basic Books, 1969.

Stephenson D (1982). Habituation and systemic desensitization. Unpublished doctoral dissertation, University of Southamptom.

Verbaten MN, Woestenburg JC and Sjouw W (1979). The influence of visual information on habituation of the electrodermal and visual orienting reaction. Biological Psychiatry, 8: 189-201.

Waters WF, McDonald DG, Koresko RO (1977). Habituation of the orienting response: agating mechanism subserving selective attention. Psychophyiology 14(3) 228-236.

Watson RT, Heilman KM, Cauthen JC, King FA (1973). Neglect after cingulectomy. Neurology 23:1003-1007.

Watson RT, Heilman KM, Miller BD, King FA. (1974). Neglect after mesencephalic reticular formation lesions. Neurology 24:294-298.

(from McNamara and Albert, Clinical Neuropsychology (Valenstein and Heilman, eds.) fourth edition. Acetylcholine activity is greater in the left human brain as measured by CAT (Amaducci 1981) in temporal lobes and globus pallidus (Glick et al. 1982). Orbitofrontal also received ACH projections. Dopamine is represented most in the corpus striatum (nigrostriatal tract), the cingulate gyrus (mesolimbic system), and the SMA and prefrontal areas (from ventral tegmental area). Only trace DA is found in occipital area, with the most in motor and premotor areas. D1 receptors on pyramidal cells of layer 3 of the cortex and striate modulate glutaminergic receptors through "triads" wherein DA affects neuronal firing patterns. DA (and NE) runs in an a-p plane. NE projects from locus ceruleus (LC) to whole forebrain with collaterals to somatosensory and motor cortex (all 6 layers) and less to temporal and primary visual cortex. The prefrontal area provides the only afferents back to LC and disinhibit firing of LC and impair regulation. DA and ACH act in concert to affect cognition. Clonidine and physostigmine affect memory in aged monkeys more than either drug alone. DA blockade can be reversed by cholinergic depletion and cholinergic blockade can be reversed by DA depletion. Memory fields in cortex correspnding to D1 receptor projection fields include the sulcus principalis of the monkey and are crucial in delayed response task. These responses are highly dependent on DA concentrations available and with that aspect of working memory. Clonidine improves performance in DR task after lesioning prefrontal cortex, as well as antergograde memory in patients with Korsakoffs syndrome.
(from McNamara and Albert, Clinical Neuropsychology (Valenstein and Heilman, eds.) fourth edition. Hat tip to Kim Meador, AAN notes from 2000 course on physiology of cognition
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Contralesional visual P3 event related potential is consistently abnormal among patients with visual neglect (increased latency and decreased amplitude). (L'Hermitte et al. Arch Neurol 1985 42:567-573). Monkeys with lesion induced neglect have normal early but abnormal late components on the SEP (N2 and P3) (Watson RT et al. Neurology 1986; 36:636-640 and Watson RT et al. Arch Neurol 1977; 34: 224-227). In humans, SEP reliably differentiates those with extinction/tactile neglect/tactile joint sense. (Maugiere et al. Paris Rev Neurol 1987; 143:643-656). VEP's are normal is visual neglect patients who have no conscious knowledge of visual stimulation (Vallar et al. Neurology 1991; 41: 1918-1921). A delay does occur in steady state visual VEP's in contralesional field of neglect patients, especially at high but not low frequencies (Spinelli et al. Neuroreport, 1996) and consistent with loss of contrast sensitivity in neglected field (Angellini et al. 1998 COrtex) and worse in left lower field implying vertical as well as horizontal neglect. VEP and blood flow both improve with direction of head/gaze to right (Nadeau et al. JNNP 1997). PET scan studies of tactile extinction were performed (Remy et al Neurolohy 1999). Left hand stimuli activated SII regions, but not right SM1 region. Bilateral stimuli showed suppression of right SM! but also both SII regions. Compensation is inhibited by overstimulation of both sides. In healthy humans, PET shows selective activation of right prefrontal and parietal cortex irrespective of side stimulated on somatosensory and visual vigilance tasks. Amphetamines decrease habituation in the midbrain, to already detected stimuli thereby increasing vigilance (Cite).
Lesions of the DL frontal cortex modulate the locus ceruleus (LC) and the DLF may be the only cortical afferent to the LC. Clonidine enhances anterograde memory in Korsakoff's patients. Suppression of LC firing suppresses background cortical activity, enhancing stimulus evoked activity, enhancing the signal to noise ratio. The LC is activated by novel stimuli. Lesions of the PFC inhibit attentional switching by impairing afferents to the LC. Clonidine or ritalin, that activate prefrontal cortex through the LC should improve attentional function.
Also called "novelty detection." Novelty detection is crucial for learning and for cognitive flexibility. Novel events are better remembered (von Restorff H 1933). Molecular links of novelty are established to the short arm of chromosome 11 and the D4 receptor gene. Structural network encompasses the dorsolateral prefrontal cortex, temporoparietal junction, hippocampus and cingululate gyrus. Physiological detection is accomplished with an "oddball"task eg. P300 stimulus, MEEG and ERP. Maximal amplitude occurs over the parietal area of scalp. Frontal activation increases with task difficulty. Human lesions typically show inferior parietal, superior temporal, thalamic and cingulate activation. Involuntary and voluntary attention to novelty have different physiologies. The (involuntary) P300 (P3a) has a frontoscalp distribution, peaks in 50 msec (earlier) and habituates over 5-10 presentations. P3a recordings show activation of multiple areas. The hippocampal recorded (voluntary) ERP, like the scalp P3b, does not habituate over repeated presentation of stimulus. Conversely, the hippocampal novelty ERP like the P3a scalp recording, rapidly habituates. The P3a is thought to be a CNS marker of the orienting response. Prefrontal lesions differentially reduce P3a but not P3b. Patients with orbitofrontal damage have an orthogonal response with a heightened p3a amplitude, perhaps correlating with increased startle and and labile behavior. Moreover with prefrontal damage, p3a response is muted over the entire hemisphere. This supports a modulating role for prefrontal cortex over the rest of the hemisphere. The hippocampus is involved in novelty mismatch (Sokolov and Vinogradova). The artery of Uchimara irrigates the hippocampus, especially the posterior part. Patients have normal parietal p3b but abnormal frontal p3a associated with novelty. ERP recordings suggest the prefrontal cortex processes the initial novelty detection and then alerts the hippocampus which fires afterwards. The fibers alerting the hippocampus may traverse the retrosplenial cortex. fMRI as of (old data) depended upon field strength and technique to show the changes seen by other techniques. Norepinephrine may also be important in novelty detection. See post on pharmacotherapy with NE for orienting response. Selected references Benjamin J , Li L, Patterson BD et al. Population and familial association between the D$ dopamine receptor gene and measures of novelty seeking. Nature Genetics 12: 81-84. Chao LL, Knight RT. Human prefrontal lesions increase distractibility to irrelevant sensory inputs. Neuroreport 6:1605-1610. 1995. Ibid. 1998. Contribution of human DL prefrontal cortex ti delay performance. J COgn Neuroscience 10:167-177. Courchesne E. Hillyard SAm Galambos R 1975. Stimulus novelty task relevance and the visual evoked potential in man. EEG Clin Neurophys 39: 131-143. Picton TW 1995. The P300 wave of the human event related potential. J Clin Neurophysiol 9: 456-479. Woods DL , Knight RT. 1986. Electrophysiological evidence of increased distractibility after dorsolateral prefrontal lesions. Neurology 36; 212-216.
AN Sokolov Perception and the Conditioned Reflex (1958). Correlation of psychological with physiologic variables is absent in contemporary Soviet research
AN Sokolov Perception and the COnditioned Reflex (1958).
Bernshtein authored theoretical principles of a new physiology "of activity" as opposed to "of reactions." Every action has a reaction which would be a new stimulus and so on, leading to a "dynamic physiology" that Luria also accepted. Behavior must be plastic and depend on modifications and adjustments In place of a rigid reflex arc, Bernshtein postulated a "reflex ring" with continuous adjustments and corrections. picture p. 93. Petr Anokhin,a student of Bernshtein, elaborated direct physiologic investigation of CR's, eg. in the 1950's by hosting the first EEG conference in the USSR. His work, Biology and Neurophysiology of the Conditioned Reflex (1968) is considered the most important Pavlovian elaboration post Pavlov. His afferent synthesis hypothesis proposes a key momennt when the organic needs of the individual ("dominant motive") are confronted with environmental situation and preceding experience (memory) to elicit a behavior. The CR is inserted into functional organization. So to satisfy hunger, a precise sequence of processes occurs. Author states that today CR is seen as only one process not the only process.
Ivan Pavlov (1849-1936) differentiated himself from both Sechenov and Western physiology and psychiatry. He began as a digestive physiologist for 25 years, studying salivation "psychologic salivation" with various physiologic techniques and won the Nobel Prize in 1904. His trespass into psychology was deemed risky by colleagues and was criticized. BF Skinner in 1938 The Behavior of Organisms interpreted Pavlov in a way that was accepted by Konorski and Hebb. The conditioned reflex is mediated by a complex S-R (stimulus-response) with processes of modulation including excitation, inhibition and reciprocal induction. The modulatory processes of the brain were not observed but were deduced from the S-R. The central nervous system therefore was more virtual than real, and Skinner termed Pavlov's CNS as the "Conceptual Nervous System." Skinner noted that Sherrington had deduced the spinal synapse long before it was actually described, and Pavlov hoped to do analagously with the CNS. The S-R was explained in behavioral terms , but also in neuroconceptual terms and on a third level, on neuronal terms (after observing the physiology). For example, in behavioral terms, the strength of a reflex could be reduced by presenting a second stimulus related to the effector involved. In neuroconceptual terms, the second stimulus coming by different afferents inhibits the conductivity of the impulses specific to the effector. In neuronal terms, the actual pathways are described. On a conceptual level, the importance is that the neuroconceptual models predct that eventually the entire behavior will be explained physiologically. Pavlov was misunderstood, but stated clearly that "it was not our aim to interpret the activity of the hemispheres in terms of the elementary functions of the nervous system." Soviets misunderstood his ideas as applying to all behaviors. Western sources criticised him as well. Konorski and Hebb later accepted Pavlovian models as the models that they were. Konoski chronologically divides Pavlov's life into periods. From 1901-1910, Pavlov elaborated phenomena of the conditioned reflex such as external inhibition, generalization, differentiation. 1910-1920, Pavlov introduced laws of dynamics of cortical processes such as irradiation, concentration, reciprocal induction. From 1920 on, Pavlov focused on processes of excitation and inhibition, types of nervous system and neurosis. The reflex arc is a means by which animals adapt to their environments. Pavloc said investigation of the higher centers ought to be faithful to the same methods used in the lower systems. The conditioned reflex ensures the survival of the individual. Reflexes are derived from the "innate organization" of the nervous system. Instincts are complex systems of unconditioned reflexes. Conditional (conditioned, acquired) reflexes are formed by connections between centers for conditioned reflexes and centers for unconditioned reflexes. Conditioned reflexes can be suppressed, or inhibited, externally (passively or unconditioned) by something that suppresses the formation of the reflex, or internally (or actively) . It can be experimentally extinguished by withholding the conditioned stimulus. There may be a post inhibitory effect afterwards in which other CR are inhibited from being formed. Stimuli similar to the conditioned reflex can cause excitation (generalization of the stimulus). If only one class of the stimuli are reinforced and others are not, there is differentiation of the CR. The signalling action of the reinforced stimulus (duration, intensity, action, etc.) are reinforced, and other stimuli are inhibited. Inhibition of delay occurs if the stimulus is produced a few seconds after the conditioned stimulus, then the action occurs a few seconds later as well. Transmarginal inhibition occurs if some feature of the CS eg intensity, fatigues the nervous system and prevents the formation of the normal CR. The dynamics of the reflex are interactions between excitatory and inhibitory processes. Expansion of excitation to adjacent parts of the nervous system is called irradiation, and then focus at the point where it continues to have an action is called concentration. These 2 functions depends on characteristics of the stimulus especially intensity. In sleep, inhibition irradiates through the CNS and dominates the "equilibrium." The law of reciprocal induction refers to the fact that around an area of excitation there is a zone of inhibition (negative induction), and vice-versa (positive induction forms around an area of inhibition). The analyzer is the functional unit of the receptor and cortical projections that analyse a stimulus. Pavlov counted five sensory analyzers, plus a motor analyzer. The cortex was an analyzer-synthesizer without specific specialization. The analyzers all communicated with each other, but communicated best to other analyzers in close proximity. Pavlov rejected therefore the idea current in neurology of cortical centers, and of physiologists such as Bekhterev that cortical centers existed. Pavlov thought CR operated through subcortical centers. Pavlov used lesion studies to "show" the "diffuse" nature of the cortical analyzer which was the "law of equivalence of all the parts of the hemispheres from the functional point of view." In the last period of his life, Pavlov studied the principal properties of the nervous system, including the strength of the excitation and inhibition, the mobility, and the equilibrium between the two. Strength was the ability to react strongly to a CR, the mobility referred to adaptability to different types of stimuli, and equilibrium was whether there was an equal capacity to deliver positive or negative reflexes. Subjects could be typed into strong subjects (easy to form CR) and weak subjects (hard to form CR) and by balanced (equivalent ability to form positive or negative reflexes) or unbalanced. The latter if inert, could never form CR, if mobile they could adapt and perhaps be able to do so. For a number of years in the USSR, the Pavlovian precepts were accepted in an orthodox manner, uncritically. Later, Westerners and USSR scientists such as Konorski explored them critically. In 1949, Donald Hebb published The Organization of Behavior that discussed the use of physiological models for behavior processes. His concepts of "cell assemblies" borrowed heavily from Pavlov. His book was influenced by Lorente de No's work on reverberating circuitry. Integration of behaviorism and neurophysiology continued with Pribham "neurobehaviorism" and Razran "brain-behaviorism."
The reductionist reflexology of Vladimir M Bekhterev differed from Sechenov. It was not just physiological and psychological but also biological and social. It did not penetrate well into Sechenov/Pavlov labs. Only Bekhterev was truly reflexology in classical Soviet nosology. Bekhterev was a neurologist and psychiatrist who was aware of the German localizationists. He discussed innate and acquired reflexes (which Pavlov called conditioned reflexes). For example, a shock to a dog's leg preceded by a noise would eventually lead to the noise causing the shock. The associative reflex was, according to Bekhterev due to the formation of a connection between two cortical center. His idea appeared simple, and even though Pavlovian ideas were similar, the Pavlovian model was more sophisticated and better accepted. Vygotsky wrote in 1930 that the most important application of reflexology was in the early infantile period"genetic reflexology." Genetic research would permit the study by developmental factors of what factors in personality are social by nature. Ultimately Bekhterev's reflexology was reducing psychology to a chain of reflexes and a schema of higher cortical connections. It fell out of favor for the most part by the mid 19830's.
post from mecacci l, brain and history 1979 Sechenov wrote Reflexes of the brain (1863), Studies of Physiology (1884-1898) and Elements of Thought (1878, 1903). He argued psychological processes reduced to physiologic processes. It derived from German physiologists such as Ernst Brucke, who reduced psychology to chemistry and physics. He also includes Sigmund Exner (outline of a physiological interpretation of psychological phenomena, 1894), Freud (Project for a scientific psychology for neurologists, 1895) and others. In Reflexes, originally titled "An Attempt to explain physiologically the origin of psychological phenomena" the brain is broken down into a machine. The complex human brain has actions that pass from involuntary to voluntary then to psychological. The latter is a series of reflexes that are integrated. What Sechenov did is to move the functional/structural analysis from spinal cord to the brain. p.6 schema stimulus and effector. The reflex apparatus updates itself constantly. Simple reflexes include movement of the leg of a decapitated frog, neonatal suck, and later in ontogeny, walking which is increasingly automatic. Emotional reflexes are triggered by stimuli such as thirst or hunger. Psychological reflexes have a psychological factor that relate to the external world. In man, emotion may intensify behavior, or thought may inhibit them. External factors are always the origin of the psychological processes. Centers in the mesencephalon and medulla inhibit reflexes chemically based on context and past experience, and controlled by the cortex. The higher cerebral reflexes and the lower spinal reflexe each were decomposed into their single elements, and analyzed. Sechenov's students, the Petersburg (Leningrad) schoo, applied it to neuromuscular function. They outlined precise rules by which , studied in the muscle prep, excitatory and inhibitory processes established themselves. "Principle of dominance" Students Tarkhnishvili in 1890 studied gavanic skin response. Danilevsky in 1891 stated the study of electrical phenomena of the brain can be an instrument for the investigation of material processes which are he substrate of subjective psychological processes (beginning of psychophysics).
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op cit 1973. Activation and attention. Luria cites the importance of the brainstem/reticular activating system ascending systems, but wonders about descending systems. Luria cites importance of "frontal" zones in producing "expectancy waves" or contingent negative waves) . EEG, GSR, EP and others by Sokolov (orienting reflex) and Homskaya et al. were important. In general, verbal instructions to mobilize attention (counting, etc.) led to higher eeg frequency including patients with posterior lesions. Patients with frontal lesions, esp. mesial and basal could not evoke these changes. Luria emphasizes not only frontal lesions, but also the role of verbal instruction. Consciousness: Vygotsky showed aoluntary organization of conscious actions have a social origin and cannot be understood just by biological growth. It begins with childhood, when adults begin actions that children learn and finish. After children achieve speech, they give themselves instructions and inner speech is a well developed and important mental act. Frontal lesions that do not affect sensory, motor, or speechfunctions cause deterioration of complex functions that involve internalor external speech. Goal driven behavior is replaced by impulsive or echopraxic movements. Pribham and Anokhin showed impaired complex reaction times. Testing os accomplished through contrasting program motor tasks. Memory: Cites Scoville and Milner the Papez circuit Long discussion not included Rehabiliation Loss of function occurs but so does inhibition of function (diaschisis or functional asynapsia). The latter canbe treated pharmacologically as done on ww I veterans and in children with cerebral palsy. Luria cites Russian sources for overproduction of cholinesterase can be overcome with prostigmine and other antichlinesterase drugs. If the whole functional system is damaged, rehab training should involve the "planned reorganization of functional systems." Doing so requires a careful psychological qualification of the deficit, ways to reorganiza, and step by step sequence of orthopsychological methods.

Nosology and terms associated with "alien hand syndrome"

2008-07-31T02:55:00.000-07:00

taken from Biran I, Chatterjee A. Alien hand syndrome, Arch Neurol 61:292-294, 2004

Categories--3 broad
1) terms implying a conflict of will of hands or opposition of one hand to other (intermanual conflict, diagonistic apraxia, agonistic apraxia)
2) terms implying aberrant movements, stimulus boundedness of hands (compulsive manipulation of tools, anarchic hand, magnetic apraxia)
3) terms describing the subjective reaction to limb (autocriticism, interhemspheric autocriticism, strange hand sign)

original credit for "la main etrangere" Brion and Jedynak, 1972(rev Neurologie (Paris) 126:257-266, describing patients with callosotomy

first revision Wilson et al.Neurology 1977 27:708-715 to "the stranger's hand sign" leading to Bogen's "Alien hand"(se 3rd edition Heilman and Valenstein).

Historically descriptions of the syndrome previously were described by Liepmann ad Goldstein. Akelaitis introduced "diagonistic dyspraxia" in 1940s. Gazzaniga , Bogen and Sperry wrote about it in 1962 in split brain patients. Rebeiz wrote about it in his eponymic syndrome, also called corticobasal ganglionic degeneration, in his seminal article in the late 1960s. Patients with this condition would be more likely to have type 2 above.

Denny-Brown described "repellant" and"magnetic" apraxia in patients with parietal and frontal lesions, and explained them in terms of approach and avoidance behaviors. Magnetic apraxia involves compulsive grasping, repellant apraxia may involve levitation and hyperextension of wrist showing an exaggerated posture.

Neuroendocine aspects of behavioral neurology

2008-07-23T06:13:00.000-07:00

(from McNamara and Albert, Clinical Neuropsychology (Valenstein and Heilman, eds.) fourth edition.

Acetylcholine activity is greater in the left human brain as measured by CAT (Amaducci 1981) in temporal lobes and globus pallidus (Glick et al. 1982). Orbitofrontal also received ACH projections. Dopamine is represented most in the corpus striatum (nigrostriatal tract), the cingulate gyrus (mesolimbic system), and the SMA and prefrontal areas (from ventral tegmental area). Only trace DA is found in occipital area, with the most in motor and premotor areas. D1 receptors on pyramidal cells of layer 3 of the cortex and striate modulate glutaminergic receptors through "triads" wherein DA affects neuronal firing patterns. DA (and NE) runs in an a-p plane. NE projects from locus ceruleus (LC) to whole forebrain with collaterals to somatosensory and motor cortex (all 6 layers) and less to temporal and primary visual cortex. The prefrontal area provides the only afferents back to LC and disinhibit firing of LC and impair regulation.

DA and ACH act in concert to affect cognition. Clonidine and physostigmine affect memory in aged monkeys more than either drug alone. DA blockade can be reversed by cholinergic depletion and cholinergic blockade can be reversed by DA depletion.

Memory fields in cortex correspnding to D1 receptor projection fields include the sulcus principalis of the monkey and are crucial in delayed response task. These responses are highly dependent on DA concentrations available and with that aspect of working memory. Clonidine improves performance in DR task after lesioning prefrontal cortex, as well as antergograde memory in patients with Korsakoffs syndrome.

Outline for Behavioral Neurology Review

2008-07-23T06:11:00.000-07:00

I History of
II Physiology
III Neurochemistry.endocrinology
IV White Matter Tracts
V Symmetry of hemispheres
VI Learning/memory

Pharmacology of the orienting response

2008-07-22T16:40:00.000-07:00

Lesions of the DL frontal cortex modulate the locus ceruleus (LC) and the DLF may be the only cortical afferent to the LC. Clonidine enhances anterograde memory in Korsakoff's patients. Suppression of LC firing suppresses background cortical activity, enhancing stimulus evoked activity, enhancing the signal to noise ratio. The LC is activated by novel stimuli. Lesions of the PFC inhibit attentional switching by impairing afferents to the LC. Clonidine or ritalin, that activate prefrontal cortex through the LC should improve attentional function.