Improved Mobility, Cognition, and Disease Severity in Corticobasal Degeneration of an African American Man After 12 Weeks of Adapted Tango: A Case Study.

Corticobasal degeneration (CBD) has no available treatment to slow disease progression and generally resists drug therapy. Corticobasal degeneration has symptoms and decreased quality of life similar to Parkinson disease. Adapted Tango, a successful rehabilitation for Parkinson, may address CBD. A 63-yr-old African American man with CBD (alias: YD; CBD duration = 2 yrs) was evaluated for motor, cognitive, and psychosocial function before, immediately after, 1 mo after, and 6 mos after 12 wks of 20, biweekly 90-min adapted-tango lessons. After intervention, disease-related motor symptoms improved and YD reported fewer problems in nonmotor experiences of daily living, which include mood, cognition, pain, fatigue, etc. Motor symptoms remained above baseline at 6-mo posttest. YD's balance confidence improved after intervention but declined below baseline at 6-mo posttest. Quality of life was maintained despite worsened depression. YD improved or maintained executive function, and visuospatial function and attention at posttest and 1-mo posttest. At posttest, YD maintained mobility and improved on dynamic balance. At 1-mo posttest, most mobility measures had improved relative to baseline. However, YD showed executive function and overall motor decline 6 mos after intervention. Adapted tango may have temporarily slowed disease progression and improved or maintained mobility and cognition. Gains were poorly maintained after 6 mos. Further study is warranted.

Left parietal cortex transcranial direct current stimulation enhances gesture processing in corticobasal syndrome.

BACKGROUND AND PURPOSE: Corticobasal syndrome (CBS) is a clinical entity characterized by higher cortical dysfunctions associated with asymmetric onset of levodopa-resistant parkinsonism, dystonia and myoclonus. One of the most typical and distressful features of CBS is limb apraxia, which affects patients in their everyday life. Transcranial direct current stimulation (tDCS) is a non-invasive procedure of cortical stimulation, which represents a promising tool for cognitive enhancement and neurorehabilitation. The present study investigated whether anodal tDCS over the parietal cortex (PARC), would improve ideomotor upper limb apraxia in CBS patients. METHODS: Fourteen patients with possible CBS and upper limb apraxia were enrolled. Each patient underwent two sessions of anodal tDCS (left and right PARC) and one session of placebo tDCS. Ideomotor upper limb apraxia was assessed using the De Renzi ideomotor apraxia test that is performed only on imitation. RESULTS: A significant improvement of the De Renzi ideomotor apraxia test scores (post-stimulation versus pre-stimulation) after active anodal stimulation over the left PARC was observed (χ(2) = 17.6, P = 0.0005), whilst no significant effect was noticed after active anodal stimulation over the right PARC (χ(2) = 7.2, P = 0.07). A post hoc analysis revealed a selective improvement in the De Renzi ideomotor apraxia score after active anodal stimulation over the left PARC compared with placebo stimulation considering both right (P = 0.03) and left upper limbs (P = 0.01). CONCLUSIONS: These findings indicate that tDCS to the PARC improves the performance of an ideomotor apraxia test in CBS patients and might represent a promising tool for future rehabilitation approaches.

Theory of mind in Parkinson's disease and related basal ganglia disorders: a systematic review.

Theory of mind (ToM), defined as the ability to infer other people's mental states, is a crucial prerequisite of human social interaction and a major topic of interest in the recent neuroscientific research. It has been proposed that ToM is mediated by a complex neuroanatomical network that includes the medial prefrontal cortex, the anterior gyrus cinguli, the sulcus temporalis superior, the temporal poles, and the amygdala. Various neurological and psychiatric diseases are accompanied by aspects of dysfunctional ToM processing. In this review, the association between basal ganglia, involved in the organization of complex cognitive and emotional behavior, and ToM processing is discussed. The purpose of this review is to provide an overview of research on ToM abilities in basal ganglia disorders, especially Parkinson's Disease and related disorders.

A rating scale for neuroleptic malignant syndrome.

The development of a rating scale for neuroleptic malignant syndrome (NMS) is described. The clinical and laboratory features of NMS were categorised into six domains after a thorough literature review and examination of patients. The reliability of this scale was established on 25 NMS patients and 50 control subjects based on chart reviews. A factor analysis supported a six-factor solution. The validity of the scale was indicated by the relationship of the severity rating to duration of illness and outcome. The inter-rater reliability of the scale was established prospectively in 10 subjects. The scale offers a measure of severity of NMS in the clinical setting so as to support the clinical diagnosis, monitor patients and determine their progress. The scale may be applicable not only to NMS or suspected NMS but also to NMS-like syndromes such as lethal catatonia.

Patients with stroke confined to basal ganglia have diminished response to rehabilitation efforts.

Prediction of the functional outcome for patients with stroke has depended on the severity of impairment, location of brain injury, age, and general medical condition. This study compared admission and discharge functional outcome (Functional Independence Measure, FIM) and deficit severity (Fugl-Meyer, F-M) scores in a retrospective study of patients with similar neurologic impairments: homonymous hemianopia, hemisensory loss, and hemiparesis. CT-verified stroke location was the independent variable: cortical (n = 11), basal ganglia and internal capsule (normal cortex and thalamus, n = 13), or combined (cortical, basal ganglia, and internal capsule, n = 22). By 3 months on average after stroke, all groups demonstrated significantly improved motor function as measured by F-M scores. Patients with cortical lesions had the least CT-imaged damage and the best outcome. Patients with combined lesions and more extensive brain injury had significantly higher FIM scores (P < 0.05) than patients with injury restricted to the basal ganglia/ internal capsule. Patients with basal ganglia/internal capsule injury were more likely to have hypotonia, flaccid paralysis, and persistently impaired balance and ambulation performance. While all patients had a comparable rehabilitation experience, these results suggest that patients with stroke confined to the basal ganglia and internal capsule benefited less from therapy. Isolated basal ganglia stroke may cause persistent corticothalamic-basal ganglia interactions that are dysfunctional and impede recovery.

[Prediction of outcome in putaminal hemorrhage].

We obtained information on patients with putaminal hemorrhage (3,638 medically treated cases and 3,372 surgically treated cases). With these data, we have developed easily applicable and clinically useful prediction models for both mortality and activities of daily living (ADL) at three months after admission. We derived these models by Hayashi's discriminant technique for categorical data. Before their derivation, variables generally available on the initial day of hospitalization and possibly related to outcome were examined individually with tests of homogeneity. Neurological grading (NG), age, deformity of cisterns around midbrain, midline shift, hematoma volume, and motor paralysis were identified as candidate predictors of both mortality and ADL. CT classification was also added to the predictors of ADL. Initially, all these factors were included in tentative models, and then those which were found not to contribute substantially to the prediction were deleted. Ultimately, we proposed two models, one for mortality and the other for ADL. The mortality model used NG, hematoma volume, and deformity of cisterns around midbrain as predictors, and the ADL model used age, NG, CT classification, hematoma volume, and motor paralysis. Average correct classification rates were 87% (medical) and 69% (surgical) for mortality, and 64% (medical) and 60% (surgical) for ADL. With these models, we evaluated indications of both kinds of treatment by comparing each predicted ADL of the medically treated cases with that of the surgically treated cases.

[Predicting recovery of ambulatory function after hypertensive putaminal hemorrhage by multivariate analysis of acute-phase clinical data].

In 66 patients with hypertensive putaminal hemorrhage, several acute-phase clinical parameters were subjected to multivariate analysis and the usefulness of such analysis in predicting the eventual recovery of ambulatory function was evaluated. Seven items were studied: age, laterality of the lesion, computed tomography classification, hematoma volume, level of consciousness on admission, severity of motor impairment of the affected leg on admission, and the treatment employed. A numerical prediction of ambulatory function was derived from an equation in which each item was scored and weighted. This value was compared with that of the actual ambulatory ability several months after onset, as rated on a 5-point scale. In these 66 cases, the predicted and actual outcomes were well correlated (r = 0.871). The results indicate that an accurate prognosis can be made on the basis of clinical data obtained in the acute phase of putaminal hemorrhage.

[Deep cerebral lesions: neuro-rehabilitative aspects]. / Lesioni cerebrali profonde: aspetti neuroriabilitativi.

All 21 patients under rehabilitative care, who were followed by the authors, suffered from language and motor deficits, the latter being part of a deficient hemi-syndrome caused by deep vascular cerebral lesions, in both thalamic (8 patients) and basal ganglia (13 patients) sites. All subjects, on entry and 3 months after treatment, underwent a language test, routine tests, De Renzi-Vignolo's Token test and neuromotor evaluation, to study muscle tone, the presence of pathological synergies, sensitivity, active motility and functionality. On entry, patients with thalamic lesions had fewer problems than those with lesions of the basal ganglia at both symbolic and neuromotor levels. A better recovery of the functional capacities in the treatment period was thus achieved.