A double-blind cross-over placebo-controlled trial of the effects of bromocriptine on psychomotor function, cognition, and mood in de novo patients with Parkinson's disease.

The effects of bromocriptine on potentially dissociable functions were investigated in this double-blind placebo-controlled trial in previously untreated Parkinsonian patients. Bromocriptine-induced reductions in response time were independent of variations in the complexity of the cognitive or motor programming components of reaction time tasks. These results suggest that bromocriptime speeds up response initiation, and it may also improve some "early" visual processes. No clear-cut verbal memory, visuospatial or general intellectual changes were produced by bromocriptine; however, further evaluation of the effects of bromocriptine on "executive" cognitive functions is clearly required. Psychiatric distress was significantly reduced when the active drug was administered. While mood improvements could not be statistically dissociated from motor improvements, review of the literature suggested that decreased emotional distress may have arisen through bromocriptine's action on neural circuits modulating mood. Some clinical implications of bromocriptine's effect on mood are mentioned.

Effects of subcortical lesion site on human emotional behavior.

This is the first quantitative group study of recognition, expression, and other social-emotional behaviors after third ventricle damage in humans. Hypothalamic damage often induced appetitive disorders without affecting other emotional functions. In contrast, lesions in several hemispheric sites, especially right medial temporal, impaired emotional recognition; frontal and basal ganglia damage impoverished facial emotional expressions, this deficit being dissociated from general facial-motor impairment. These functional dissociations indicate that social-emotional behavior is regulated by multiple neural circuits, many of which by-pass hypothalamic nuclei. This conclusion is shown to be consistent with (a) the considerable animal evidence linking appetitive-survival behaviors with hypothalamic activity and (b) the accumulating human data on the specific contributions of hemispheric cortical-subcortical systems in the regulation of emotional recognition and expression.

A dyscalculic patient with selectively impaired processing of the numbers 7, 9, and 0.

A patient (J.C) had particular difficulties with the numbers 7, 9, and 0 in aurally and visually presented calculations. These problems were explained in terms of a modified version of the McCloskey, Caramazza, & Basili (1985) model of calculation processes. His calculation difficulties were attributed to degraded semantic representations of the numbers 7 and 9 and to lost knowledge of rules governing calculations involving the number 0. Use of "noncalculation" number processing tasks confirmed that his 7/9 problem was not at the level of acoustic analysis, the auditory input lexicon, the phonological output lexicon, visual analysis, or the orthographic output lexicon.

Voluntary emotional facial expressions in patients with focal cerebral lesions.

This study investigates the voluntary production of emotional facial expressions in 43 brain-damaged and 9 control subjects. The expressions of right- and left-hemisphere lesion groups did not differ significantly, but those of the anterior lesion group were impoverished relative to the posterior lesion and control groups. Deficits of voluntary expression were dissociable from impairments in "non-emotional" facial-motor functions, dysphasia, and unilateral neglect.

Recognition memory for emotional facial expressions in patients with focal cerebral lesions.

A test of memory for emotional facial expressions was administered to 49 brain-damaged and 15 control subjects. On this task, patients with right-hemisphere lesions were more impaired than left-hemisphere patients; also, patients with frontal lobe lesions were more impaired than patients with posterior brain damage. Whereas trends in the data suggested that the anterior group's impaired memory for facial expressions may be dissociable from their deficient recall of facial identity, these two abilities were not dissociable in right-hemisphere patients. No lesion subgroup had selectively preserved recall of specific emotional expressions. There was no correlation between recall and production of facial expressions.

Reactions of patients with focal cerebral lesions to success or failure.

Multiple measures were used to investigate emotional reactions to card sorting in patients with focal cerebral lesions and in matched non-brain-injured controls. Spontaneous facial expressions of patients with anterior lesions were impoverished, relative to the posterior group, on a quantitative index of facial movement. This deficit did not appear to be attributable to group differences on lesion variables, or degree of cognitive deficit. There were also indications that a "non-emotional" facial-motor deficit was not the primary cause. The marked anterior deficit for facial movement was not, however, associated with equally pronounced deficits on qualitative, self-report and heart rate indices of emotional response. Right hemisphere patients differed from left hemisphere patients on only one qualitative measure of emotional reaction, but this may have been due to the stronger negative reactions of dysphasic patients. Left unilateral neglect was not associated with reduced emotional response.

Social, functional, and neuropsychological determinants of the psychiatric symptoms of stroke patients receiving rehabilitation and living at home.

In view of the strong evidence supporting the hypothesis that high Expressed Emotion of a key relative contributes to relapse in psychiatric patients, methods used in Expressed Emotion research were applied in an investigation of psychiatric disorder in stroke patients receiving hospital based rehabilitation and support. Patient mood in 37 stroke patients was related to the critical attitude of a key relative. Patient depression may also have been associated with severity of dysphasia, but no link was found between patient mood and the other measures of cognitive or physical deficit used in this study. Psychiatric distress in the key relative had a rather different causal basis. Relatives' psychiatric disorders were associated with physical burden, cognitive deficit, and severity of dysphasia. This study suggests that, when the patient is dependent for self-care, rehabilitation-assisted recovery may alleviate relative distress more than patient distress.