Neuropsychological outcome of ventral capsular/ventral striatal gamma capsulotomy for refractory obsessive-compulsive disorder: a pilot study.

Five refractory obsessive-compulsive patients were assessed using a neuropsychological battery after a modified gamma knife capsulotomy. The surgical technique was not associated with profound cognitive deficits. The authors found improvements in attention, vocabulary, learning, abstract reasoning, and memory.

Permanent global amnesia: case report.

PURPOSE: To present a case of permanent global amnesia related to hippocampal damage. Permanent global amnesia is a very rare condition of unknown etiology; lesions restricted to the hippocampus are uncommon, which hinders investigations of this pattern of memory loss. This case is unusually well documented, as the patient underwent extensive neuropsychological evaluations. CLINICAL FEATURES: A cheerful right-handed, 83-year-old retired electrician was first evaluated in 1990 for progressive difficulty in learning new information and in recalling events over the preceding 3-4 years. Tests over the next 5 years showed that the impairment was confined to episodic declarative memory. New verbal information could be stored only in episodic memory in a restricted manner, limited by short-term memory capacity. A relatively mild retrograde amnesia was detected. Semantic and implicit memory was spared, as were other functions evaluated. The patient's language and executive function were strikingly efficient. Magnetic resonance imaging of the brain showed bilateral atrophy of the hippocampi and amygdalae, ruling out conditions such as tumour growth. A diagnosis of permanent global amnesia was made. In the ensuing years, the retrograde amnesia worsened, but no new deficits were identified. CONCLUSION: This case, the first with a detailed cognitive examination, is evidence of a relatively pure hippocampal pattern for memory loss in permanent global amnesia.

Eye-hand preference dissociation in obsessive-compulsive disorder and dyslexia.

Dyslexia may be a development disturbance in which there are alterations in visual-spatial and visual-motor processing, while obsessive-compulsive disorder (OCD) is a psychiatric disease in which there are alterations in memory, executive function, and visual-spatial processing. Our hypothesis is that these disturbances may be, at least partially, the result of a crossed eye and hand preference. In the present study 16 controls, 20 OCD (DSM-IV criteria) and 13 dyslexic adults (Brazilian Dyslexia Association criteria) were included. All had a neurological examination, the Yale-Brown scale for obsessive-compulsive symptoms application and the Zazzó evaluation for laterality, abridged by Granjon. Results showed a right hand preference for 100% of controls, 84.6% of dyslexics, and 75% of OCD patients and a right eye preference for 73.3% of controls, 69.2% of dyslexics, and 35% of OCD patients. The left eye preference was significantly higher in OCD when compared with the two other groups (p = 0.01) and the left hand preference of OCD patients (25%) was also significant when compared to Brazilian population (4%) or British population (4.5%). It is possible that this crossed preference may be partially the reason for visual-spatial and constructive disturbances observed in OCD.

Eye-hand preference dissociation in obsessive-compulsive disorder and dyslexia

Dyslexia may be a development disturbance in which there are alterations in visual-spatial and visual-motor processing, while obsessive-compulsive disorder (OCD) is a psychiatric disease in which there are alterations in memory, executive function, and visual-spatial processing. Our hypothesis is that these disturbances may be, at least partially, the result of a crossed eye and hand preference. In the present study 16 controls, 20 OCD (DSM-IV criteria) and 13 dyslexic adults (Brazilian Dyslexia Association criteria) were included. All had a neurological examination, the Yale-Brown scale for obsessive-compulsive symptoms application and the Zazzó evaluation for laterality, abridged by Granjon. Results showed a right hand preference for 100 percent of controls, 84.6 percent of dyslexics, and 75 percent of OCD patients and a right eye preference for 73.3 percent of controls, 69.2 percent of dyslexics, and 35 percent of OCD patients. The left eye preference was significantly higher in OCD when compared with the two other groups (p = 0.01) and the left hand preference of OCD patients (25 percent) was also significant when compared to Brazilian population (4 percent) or British population (4.5 percent). It is possible that this crossed preference may be partially the reason for visual-spatial and constructive disturbances observed in OCD

A memória procedural em pacientes obsessivos compulsivos / Procedural memory study in patients with obsessive-compulsive disorder

Introduçao: Enquanto existe uma concordância quanto ao desempenho de pacientes com Transtorno Obsessivo-Compulsivo (TOC) em algumas funçoes cognitivas, tais como atençao, funçao executiva e tarefas visuoespaciais, ainda nao estao claros os aspectos da memória relacionados à funçao frontal. Métodos: A memória procedural e declarativa foram avaliadas em 31 pacientes com TOC , comparadas com 31 adultos normais pareados por gênero, idade e escolaridade, utilizando os testes de : atençao, estória lógica, Estrela em espelho, pré-ativaçao de palavras , Figuras fragmentadas, dígitos diretos e inversos do Wechsler Adult Intelligence Scale e de fluência verbal alternada. Resultados: Os pacientes com TOC tiveram pior desempenho em duas medidas de atençao: rapidez (p=0.05) e exatidao (p=0.04), cometendo mais erros, na pré-ativaçao de palavras (p=0.01) e na evocaçao imediata da estória lógica (p=0.05), porém nao diferiram dos controles no desempenho nos testes de aprendizagem procedural como na Estrela em espelho e nas Figuras Fragmentadas. Conclusao: Estes resultados sugerem que há um processo de codificaçao mais lento, que pode ser visto pelo desempenho na evocaçao imediata da estória lógica. Na memória procedural, a diminuiçao no desempenho está na pré-ativaçao de fragmentos de palavras, mas nao em figuras fragmentadas ou novo aprendizado visuomotor (espelho de estrelas), sugerindo que a porçao dos gânglios da base que faz o engatilhamento das palavras, nao é a mesma que o faz com as figuras. Podem ter um papel importante no TOC , além das funçoes relacionadas ao córtex prefrontal, ao qual se atribuem as funçoes de pré-ativaçao, o córtex ventrolateral, que participa na decisao da evocaçao consciente das palavras. A memória explícita encontrada abaixo dos parâmetros esperados com os normais, sugere que as estruturas temporais mediais sao, em algum momento, solicitadas para fixaçao, e que a recordaçao é um processo no qual os pacientes sao mais vagarosos que os controles. Os resultados na lateralidade necessitam de estudos com maior número de indivíduos e portanto serem ampliados

Applicability of the CERAD neuropsychological battery to Brazilian elderly

There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people