Subjective Cognitive Dysfunction in Patients with Dizziness and Vertigo.

INTRODUCTION: Patients with vestibular disorders sometimes report cognitive difficulties, but there is no consensus about the type or degree of cognitive complaint. We therefore investigated subjective cognitive dysfunction in a well-defined sample of neuro-otology patients and used demographic factors and scores from a measure of depression, anxiety, and stress to control for potential confounding factors. METHODS: We asked 126 neuro-otology clinic outpatients whether they experienced difficulties with thinking, memory, or concentration as a result of dizziness or vertigo. They and 42 nonvertiginous control subjects also completed the Neuropsychological Vertigo Inventory (NVI, which measures cognitive, emotional, vision, and motor complaints), the Everyday Memory Questionnaire (EMQ), and Depression, Anxiety, and Stress Scales (DASS). RESULTS: In the initial interview questions, 60% of patients reported experiencing cognitive difficulties. Cognitive questionnaire scores were positively correlated with the overall DASS score and to a lesser extent with age and gender. Therefore, we compared patients and controls on the NVI and EMQ, using these mood and demographic variables as covariates. Linear regression analyses revealed that patients scored significantly worse on the total NVI, NVI cognitive composite, and 3 individual NVI cognition subscales (Attention, Space Perception, and Time Perception), but not the EMQ. Patients also scored significantly worse on the NVI Emotion and Motor subscales. CONCLUSIONS: Patients with dizziness and vertigo reported high levels of cognitive dysfunction, affecting attention, perceptions of space and time. Although perceptions of cognitive dysfunction were correlated with emotional distress, they were significantly elevated in patients over and above the impact of depression, anxiety, or stress.

Investigating the Effects of Seizures on Procedural Memory Performance in Patients with Epilepsy.

Memory complaints are frequently reported by patients with epilepsy and are associated with seizure occurrence. Yet, the direct effects of seizures on memory retention are difficult to assess given their unpredictability. Furthermore, previous investigations have predominantly assessed declarative memory. This study evaluated within-subject effects of seizure occurrence on retention and consolidation of a procedural motor sequence learning task in patients with epilepsy undergoing continuous monitoring for five consecutive days. Of the total sample of patients considered for analyses (N = 53, Mage = 32.92 ± 13.80 y, range = 18-66 y; 43% male), 15 patients experienced seizures and were used for within-patient analyses. Within-patient contrasts showed general improvements over seizure-free (day + night) and seizure-affected retention periods. Yet, exploratory within-subject contrasts for patients diagnosed with temporal lobe epilepsy (n = 10) showed that only seizure-free retention periods resulted in significant improvements, as no performance changes were observed following seizure-affected retention. These results indicate general performance improvements and offline consolidation of procedural memory during the day and night. Furthermore, these results suggest the relevance of healthy temporal lobe functioning for successful consolidation of procedural information, as well as the importance of seizure control for effective retention and consolidation of procedural memory.

How frequently is anxiety and depression identified and treated in hospital and community samples of adults with epilepsy?

While it is often stated that psychiatric co-morbidity in PWE is under-recognized and under-treated, little research has directly examined this assertion. The aims of this study were to understand the rates of confirmed diagnosis and treatment of depression and anxiety in people with epilepsy (PWE). Two samples were recruited: a hospital sample of 106 adult outpatients with epilepsy who underwent a structured psychiatric diagnostic interview and a community sample of 273 PWE who completed validated measures of depression and anxiety symptoms online. In the hospital sample, fewer participants who met criteria for an anxiety disorder had received a prior diagnosis compared to those with a depressive disorder (36% vs 67%). In the community sample, the rates of known diagnosis were comparable (65% vs. 69%). Approximately, one-third of PWE with an anxiety disorder (or clinically significant symptoms) were receiving current treatment compared to approximately half of those with depression. These findings confirm the high rates of psychiatric co-morbidity in PWE and indicate that a large proportion of anxiety diagnoses, in particular, are undetected and not receiving either pharmacological or psychological support. Future work is needed to improve the detection and management of psychiatric co-morbidity in PWE, especially for anxiety disorders.

Does collaboration with an intimate partner support memory performance? An exploratory case series of people with epilepsy or acquired brain injury.

BACKGROUND: Intimate couples can become cognitively interdependent over time. If one member of the couple has a neurological condition with associated cognitive impairments, their partner can support or 'scaffold' their cognitive functioning through collaboration. OBJECTIVE: We explored the phenomenon of 'collaborative memory' in a case series of 9 couples in which one member had a neurological condition, specifically an acquired brain injury (ABI; n = 7) or epilepsy (n = 2). METHODS: To investigate collaborative memory, we compared the performance of the patient when remembering alone versus their performance in collaboration with their partner on three memory tasks, assessing anterograde, semantic, and autobiographical memory. RESULTS: We found that across all tasks and participants, collaboration typically increased overall memory performance (total score), but the patient's contribution to the task was typically lower when they collaborated compared with when they performed the task alone. We identified two distinct styles of collaboration which we termed 'survival scaffolding' (where the healthy partner 'takes over' memory recall) and 'stability scaffolding' (where the healthy partner cues and structures the patient's recall). CONCLUSION: This exploratory case series contributes to the sparse literature on memory collaboration in people with neurological conditions. Our findings suggest that there are different styles of collaboration that can both help and hinder memory performance.

Design and validation of two measures to detect anxiety disorders in epilepsy: The Epilepsy Anxiety Survey Instrument and its brief counterpart.

OBJECTIVE: The study objective was to develop and validate the first epilepsy-specific anxiety survey instrument (Epilepsy Anxiety Survey Instrument [EASI]) alongside a briefer screening instrument to detect anxiety disorders in routine clinical practice (brEASI). METHODS: The instruments were developed utilizing a mixed-methods approach in four related studies. Pilot items were developed following qualitative interviews with people with epilepsy (PWE; Study 1) and consultation with multidisciplinary experts in anxiety and epilepsy (Study 2). PWE (n = 314) then completed pilot items alongside existing measures of anxiety and depression (Study 3). Factor analysis was conducted to refine the scale and select well-performing items for a briefer diagnostic screener (brEASI). The brEASI was validated against a gold standard diagnostic interview in 106 PWE recruited from an outpatient epilepsy service (Study 4). Receiver operating characteristic analysis was conducted to determine the brEASI's diagnostic performance. RESULTS: Twenty-six pilot items were generated based on the findings of Studies 1 and 2. Analyses in Study 3 resulted in an 18-item EASI, and eight well-performing items were selected for the brEASI. The area under the curve (AUC) of brEASI was excellent (AUC = 0.89, 95% confidence interval = 0.82-0.94). At a cutoff of 7, it demonstrated a sensitivity of 76% and specificity of 84% for identifying Diagnostic and Statistical Manual of Mental Disorders, 5th edition anxiety disorders. SIGNIFICANCE: The EASI and brEASI represent the first valid and reliable epilepsy-specific anxiety instruments. The EASI has been designed to comprehensively assess anxiety in PWE, whereas the brEASI may be used within busy neurology settings to provide rapid information to aid diagnoses of anxiety disorders. Given the significant prevalence and burden of anxiety in PWE, these tools are important potential solutions to improve the understanding and detection of anxiety in epilepsy.

Testing the effectiveness of cognitive interventions in alleviating accelerated long term forgetting (ALF).

It is well established that when retrieval or other forms of testing follow shortly after the acquisition of new information, long-term memory is improved in healthy subjects (Roediger & Karpicke, 2006). It is not known whether such early interventions would alleviate ALF, a condition in which early retention is normal, but there is a steep decline over longer intervals. A different behavioral intervention (i.e., an interposed recall of a story after a longer delay) was found to prevent subsequent memory loss in a single case with ALF (Jansari, Davis, McGibbon, Firminger, & Kapur, 2010; McGibbon & Jansari, 2013), but this has yet to be replicated. In the present study, we sought to test the effectiveness of early rehearsal as well as a later interposed recall on long term memory. Three men with ALF and 10 matched, healthy males (mean age = 67 yr; mean education = 15 yr) were compared for story recall following 3 early intervention conditions. There were two early rehearsal conditions: Repeated-Recall (2 additional recalls were requested in the initial 30 min interval) and Repeated Recall With Discussion (2 additional recalls plus discussion occurred in the initial 30 min interval) as well as a Control condition, in which there was no additional rehearsal in the first 30 min. Memory for 6 stories (2 in each condition) was tested at 0 min, 30 min, 1 day, 1 week and 4 weeks. In addition, to evaluate the possible sustaining effect of an additional retrieval ("booster recall") between 1 wk and 4 wk delays, 1 story from each of the early intervention conditions was recalled at 2 weeks' delay. Consistent with the profile characteristic of ALF, nonparametric statistics revealed no group differences at 0 or 30 min recalls. For Control stories, the ALF group's recall was impaired by 24 h delay. For stories in either of the early rehearsal conditions, the patients showed better retention, performing within normal limits until the 4 week recall. The "booster recall" session at 2 weeks benefitted the patients' retention at 4 weeks, with patients' mean recall remaining within normal limits only for those stories recalled at 2 weeks. These results indicate that behavioral interventions including early rehearsal in the first several min and a booster recall at a much later time point help to prevent ALF. Confirmation of the usefulness of these interventions in other cases and investigating whether these cognitive techniques can be extended to "real world" applications are the logical next steps.

The impact of sleep characteristics and epilepsy variables on memory performance in patients with focal seizures.

Disturbed sleep can negatively affect overnight memory retention as well as new learning the subsequent day. In healthy participants, positive associations between memory performance and sleep characteristics (e.g., time spent in slow-wave sleep [SWS]) have been detected. In a previous study, we found that SWS was much reduced in patients with focal seizures, but when correlations between memory complaints and various sleep characteristics were considered, the only significant relationship was with the time to onset of rapid eye movement (REM) sleep (i.e., REM latency). In this study, we investigated the relationships between sleep, epilepsy, and objective memory performance variables. Twenty-five patients with focal seizures had their memory tested while undergoing a two-day ambulatory electroencephalography (EEG). The sleep variables of interest were the percentage of time spent in SWS (%SWS) and REM latency. Epilepsy variables included the presence of (1) seizures, (2) interictal epileptiform discharges, and/or (3) hippocampal lesions as well as site of seizure origin (temporal vs extratemporal). Overnight retention (of autobiographical events, a story, and a complex geometric figure) and the ability to learn a word list on day 2 were the measures of memory. A significant positive correlation was found between word-list learning and %SWS during the previous night. A significant negative correlation was observed between REM latency and overnight retention of autobiographical events. Overnight retention scores for the story and geometric figure were not related to sleep characteristics but were negatively affected by the presence of epileptiform activity. Story retention was also worse for temporal lobe epilepsy (TLE) than for patients with extratemporal epilepsy (ETE). Those with hippocampal lesions were more impaired than those without lesions on word-list learning, autobiographical events' retention, and story retention. When multiple contributing factors were entered into regression analyses, %SWS was found to be the best predictor of subsequent word-list learning, whereas the presence of a hippocampal lesion was the best predictor of overnight retention of autobiographical events and a story. These findings provide further evidence of the ways in which particular sleep characteristics are associated with memory and suggest that treatment of sleep disturbances in patients with epilepsy might be helpful for improving their performance.

A qualitative examination and theoretical model of anxiety in adults with epilepsy.

OBJECTIVE: There is an elevated prevalence of anxiety disorders among people with epilepsy, and the comorbidity of anxiety in epilepsy is associated with adverse medical and psychosocial outcomes. Despite its importance, little is known about what psychosocial or epilepsy factors may be associated with the development of anxiety. The aim of this qualitative study was to determine what factors may explain why some people with epilepsy develop anxiety disorders and others do not. METHODS: Adults with epilepsy were recruited from an outpatient epilepsy service. Semistructured interviews were conducted with 26 participants, 15 of whom reported clinically significant levels of anxiety. Grounded theory analysis was used to develop a theoretical model of anxiety development in the context of epilepsy. RESULTS: Qualitative analyses revealed a number of processes that appeared to account for the development of anxiety in the context of epilepsy. These included inflated estimates regarding epilepsy-specific risks and excessive attempts to avoid these risks. Such excessive avoidance often resulted in greater interference with participants' role functioning, thus risking ongoing quality of life. A number of premorbid and contextual factors also appear to be implicated in the development of anxiety. CONCLUSION: This investigation provides a comprehensive account for the development of anxiety in epilepsy, which is consistent with existing theories of anxiety development and maintenance. Importantly, this model provides a foundation for future research and appropriate treatment strategies to address anxiety in people with epilepsy.

Accelerated Long Term Forgetting in patients with focal seizures: Incidence rate and contributing factors.

BACKGROUND: Accelerated Long Term Forgetting (ALF) is usually defined as a memory impairment that is seen only at long delays (e.g., after days or weeks) and not at shorter delays (e.g., 30min) typically used in clinical settings. Research indicates that ALF occurs in some patients with epilepsy, but the incidence rates and underlying causes have not been established. In this study, we considered these issues. METHODS: Forty-four patients with a history of focal seizures were tested at 30min and 7day delays for material from the Rey Auditory Verbal Learning Test (RAVLT) and Aggie Figures Test. Recently published norms from a matched group of 60 control subjects (Miller et al., 2015 ) were used to determine whether patients demonstrated ALF, impairment at 30min or intact memory performance. RESULTS: The incidence of ALF in the epilepsy patients (18%) was >3 times higher than normal on the RAVLT, but no different (7%) from the incidence in normal subjects on the Aggie Figures. A different, but again significantly high, proportion of patients (36%) showed shorter-term memory deficits on at least one task. ALF was found mainly in patients with temporal-lobe epilepsy, but also occurred in one patient with an extratemporal seizure focus. Presence of a hippocampal lesion was the main predicting factor of ALF. CONCLUSIONS: Many patients with a focal seizure disorder show memory deficits after longer delays that are not evident on standard assessment. The present study explored the factors associated with this ALF memory profile. These new findings will enhance clinical practice, particularly the management of patients with memory complaints.

Testing the importance of the Medial Temporal Lobes in human interoception: Does it matter if there is a memory component to the task?

Interoception is the ability to consciously perceive internal bodily states. Neuroimaging suggests that the insula (IC) and anterior cingulate cortex (ACC) mediate interoception, while studies involving patients/animals with brain lesions suggest the medial temporal lobe (MTL) is particularly important. One reason for these contrasting conclusions may lie in the types of interoceptive task used by these different approaches. Some tasks probably require integration of current physiological state with mnemonic information (e.g., how much one last ate), and these may be especially reliant upon MTL processing. We compared one task that probably requires integration - a water load task - with one that likely does not - a heart-rate tracking task - in two individuals with selective MTL damage (and with intact IC and ACC). A group of matched healthy individuals served as controls. The main finding was that individuals with MTL damage, relative to controls, were equally and significantly impaired on both types of interoception task. This suggests that MTL structures are involved in mediating interoception even when using a task (heart rate tracking) that does not seemingly require memory and that in neuroimaging studies activates the IC and ACC. The reasons for this apparent inconsistency with neuroimaging findings and the functional role of the MTL in interoception are discussed.

Determining the relationship between sleep architecture, seizure variables and memory in patients with focal epilepsy.

Sleep has been shown to be important to memory. Both sleep and memory have been found to be abnormal in patients with epilepsy. In this study, we explored the effects that nocturnal epileptiform discharges and the presence of a hippocampal lesion have on sleep patterns and memory. Twenty-five patients with focal epilepsy who underwent a 24-hr ambulatory EEG also completed the Everyday Memory Questionnaire (EMQ). The EEG record was scored for length of time spent in the various sleep stages, time spent awake after sleep onset, and rapid eye movement (REM) latency. Of these sleep variables, only REM latency differed when the epilepsy patients were divided on the bases of either presence/absence of nocturnal discharges or presence/absence of a hippocampal lesion. In both cases, presence of the abnormality was associated with longer latency. Furthermore, longer REM latency was found to be a better predictor of EMQ score than either number of discharges or presence of a hippocampal lesion. Longer REM latency was associated with a smaller percentage of time spent in slow-wave sleep in the early part of the night and may serve as a particularly sensitive marker to disturbances in sleep architecture. (PsycINFO Database Record

Disruption of learning and long-term retention of prose passages in patients with focal epilepsy.

Recent investigations of accelerated long-term forgetting, a condition in which newly acquired memory is normal initially but decays rapidly over days or weeks, indicate that multiple factors might influence whether this phenomenon is seen in patients with epilepsy. Test-based differences such as learning condition or type of memory measure (e.g., recall vs recognition) as well as epilepsy variables (e.g., side, site, or frequency of epileptiform activity) may be important. The present study sought to characterize factors affecting learning and memory for prose passages in patients with focal epilepsy. We enrolled 21 patients with temporal lobe epilepsy, with and without hippocampal lesions, 11 patients with extratemporal epilepsy (ETE), and 29 healthy controls. Two matched passages were used to compare effects of initial learning condition (one exposure versus learning-to-criterion) on subsequent patterns of retention. Recall and recognition were tested at different delays (i.e., immediately, 30min, 24h, and 4days). Regression analyses and one-way ANOVAs indicated that having a left-hemisphere epileptic focus had a negative impact on learning, whilst presence of a hippocampal lesion (irrespective of side) was associated with deterioration in recall for intervals up to 24h postencoding. Learning condition affected patterns of memory decay in that the ETE group showed significant decline in recall between 24h and 4days only when stories were learned to criterion. In contrast with recall, no changes over time were evident in recognition memory, as patients with hippocampal lesions were impaired from 30min onward. Epilepsy variables other than side and site of epilepsy/lesion did not influence performance. In conclusion, the left hemisphere is involved in learning of prose material, and the hippocampus is involved in the consolidation of this material mainly for the first 24h. After this, cortical regions outside the hippocampus become important for recall.

Old dogs with new tricks: Detecting accelerated long-term forgetting by extending traditional measures.

Accelerated long-term forgetting (ALF) is a condition in which normal memory performance is displayed after short delays, but significant memory loss is detected when memory is tested after several days or weeks. This condition has been reported in patients with epilepsy, but there are few normative scores available for its detection in clinical practice. In the present study, we assessed 60 healthy control subjects 18-60years of age on three memory measures [Rey Auditory Verbal Learning (RAVLT), Logical Memory (LM), and Aggie Figures] at delays of 30min and 7days. With these normative values, we determined cutoff scores to look for ALF and then categorized the performance of 15 patients with focal epilepsy on the same tasks. Seven of the patients showed ALF, and, in four of these, no other memory deficits (i.e., deficits at 30min on at least one task) were detected. Of the several demographic and epilepsy factors examined, only higher estimated IQ and older age predicted ALF (and only on one task: RAVLT). The findings provide a useful set of data to be applied in the clinic and some insight into the factors that influence retention within the first week.

The impact of epileptiform abnormalities and hippocampal lesions on retention of recent autobiographical experiences: Adding insult to injury?

Accelerated long term forgetting (ALF), whereby information is rapidly lost over days or weeks has been noted in patients with epileptic conditions. The present study sought to determine which clinical factors underlie such consolidation failure for recent autobiographical experiences in patients with focal epilepsy. We enrolled 21 patients with temporal lobe epilepsy (TLE), with and without hippocampal lesions (TLE(+)=12; TLE(-)=9, respectively), 11 patients with extratemporal epilepsy (ETE) and 29 controls (NC). Recall and recognition were tested at different delays (i.e., 30min, 24h and 4 days). During the study interval, most of the patients underwent concurrent ambulatory EEG monitoring. Analyses of variance indicated Group×Delay interval interactions for recall. The TLE(+) group showed significant decline in recall by 24h delay. On recognition Group by Delay interval was not detected but main effect for Group revealed that the ETE group demonstrated ALF on recognition questions over the interval between 24h and 4 days. Regression analyses confirmed that a hippocampal lesion was particularly disruptive to consolidation over the first 24h, and that seizures were associated with memory decline over longer delays. Our findings show that the retention of autobiographical experiences involves multiple mechanisms, which operate over different timeframes.

Perception of odor-induced tastes following insular cortex lesion.

Lesions of the insula can affect olfaction and gustation. Here, we examined the effect of insula lesions on taste and taste-like experiences generated via smelling (i.e., odor-induced tastes) in patients with focal insula lesions and intact olfaction. From a set of 16 patients with lesions to the insula, we found 7 (6 with right-sided lesions) who performed normally on various olfactory measures. These were compared to 42 normal control subjects on tests of gustatory and odor-induced taste perception as well as control measures. The patients were impaired relative to controls on most gustatory measures. They were also impaired on tests of odor-induced taste perception, primarily for stimuli presented on the left side. Examining cases individually revealed evidence of a dissociation: two patients exhibited no impairment in odor-induced taste perception in spite of gustatory deficits. Together, these findings suggest that the insula mediates taste recognition, hedonics, and intensity judgments as well as odor-induced taste perception. However, the areas responsible for aspects of taste perception and those responsible for odor-induced taste do not fully overlap each other and they are also independent of olfactory areas.

Testing the effectiveness of group-based memory rehabilitation in chronic stroke patients.

Memory complaints are common after stroke, yet there have been very few studies of the outcome of memory rehabilitation in these patients. The present study evaluated the effectiveness of a new manualised, group-based memory training programme. Forty outpatients with a single-stroke history and ongoing memory complaints were enrolled. The six-week course involved education and strategy training and was evaluated using a wait-list crossover design, with three assessments conducted 12 weeks apart. Outcome measures included: tests of anterograde memory (Rey Auditory Verbal Learning Test: RAVLT; Complex Figure Test) and prospective memory (Royal Prince Alfred Prospective Memory Test); the Comprehensive Assessment of Prospective Memory (CAPM) questionnaire and self-report of number of strategies used. Significant training-related gains were found on RAVLT learning and delayed recall and on CAPM informant report. Lower baseline scores predicted greater gains for several outcome measures. Patients with higher IQ or level of education showed more gains in number of strategies used. Shorter time since onset was related to gains in prospective memory, but no other stroke-related variables influenced outcome. Our study provides evidence that a relatively brief, group-based training intervention can improve memory functioning in chronic stroke patients and clarified some of the baseline factors that influence outcome.

The lateralization of gustatory function and the flow of information from tongue to cortex.

Controversy surrounds whether crossed and/or uncrossed fibers carry taste information from tongue to cortex and whether there is hemispheric specialization for gustatory processing. The current study examined these issues in 14 patients with unilateral insula lesions, seven with right-sided and seven with left-sided damage, and in 42 healthy controls. Two tasks were carried out, with tastants applied unilaterally to the tongue tip: (1) taste discrimination; and (2) stimulus sampling followed by judgments of quality, intensity, hedonics and name-recognition, for sweet, salty, bitter and sour tastants. Controls were better at discriminating tastants applied to their right tongue tip relative to their left, and better at taste quality judgments when tastants were applied to their left tongue tip relative to their right. Insula lesions to the left or right side resulted in bilateral impairments in discrimination, quality judgments and naming, when compared to controls. However, the Left insula group was poorer on tasks involving salt, and for ipsilateral hedonic judgments, relative to controls and the Right insula group. These findings are consistent with gustatory information ascending from tongue to cortex both ipsilaterally and contralaterally, and provide preliminary support for hemispheric gustatory specialization.

Identifying cognitive and demographic variables that contribute to carer burden in dementia.

BACKGROUND/AIMS: Carer burden has been associated with other carer-reported factors (e.g. depression), but less is known about the influence of more independent variables. We aimed to determine the impact of cognitive deficits, demographic variables and dementia subtype on carer burden. METHODS: Patients with Alzheimer's dementia (n = 35) or frontotemporal lobar degeneration (n = 61) underwent assessment of anterograde memory, word generation, impulse control and emotion recognition. Age, sex, relationship type, disease duration and diagnosis were also considered. Carers completed the Zarit Burden Interview. RESULTS: In bivariate regression analyses, carer burden was related to age, diagnosis, memory, impulse control and emotion recognition. Stepwise multivariate regression revealed independent contributions by patient age, memory and emotion recognition, explaining 23% of the variance. CONCLUSION: The findings could help refine interventions and carer support.

Taste and odour-induced taste perception following unilateral lesions to the anteromedial temporal lobe and the orbitofrontal cortex.

Odour-induced tastes occur when smelling certain odours (e.g., sweet-smelling vanilla) and may represent a universal form of synaesthesia. If odour-induced tastes are perceptually akin to tastes generated by stimulating taste receptors on the tongue, as perceptual data imply, then these two forms of gustatory experience may also share common processing resources in the brain. In this study, we examine this hypothesis for two secondary gustatory processing areas--the orbitofrontal cortex (OFC) and amygdala. We compared nine patients with anteromedial temporal lobe (AMTL) resections that included the amygdala, and three patients with OFC damage, to a healthy comparison group (n = 42), on tests of olfactory, gustatory, and odour-induced taste perception. While AMTL patients had a range of generally small taste impairments, they were unimpaired on tests of odour-induced taste perception. Two of the three OFC cases had impairments in taste hedonics and discrimination. The case with the most profound gustatory deficit was also mildly impaired on tests of odour-induced taste perception. The OFC findings are consistent with overlaps in circuits supporting taste and odour-induced taste perception, especially those responsible for more perceptual aspects of processing.