Multimodal visual exploration disturbances in Parkinson's disease detected with an infrared eye-movement assessment system.

Parkinson's disease (PD) reportedly show disturbed visual exploration. However, whether this disturbance is due to dysfunctional visual information processing remains unclear. To clarify the effects of PD on visual information processing when exploring for targets and to compare disease effects with aging effects, we used an infrared eye-movement assessment system. Cognitively normal PD patients (n = 13), healthy age-matched (n = 17) and young controls (n = 36) participated in this study, and were evaluated using two figure-matching tasks representing visual information processing (clock-matching and inverted clock-matching tasks) and saccade tasks representing oculomotor function. With figure-matching tasks, PD patients showed significantly larger numbers of images watched in a single trial compared to healthy age-matched controls on the inverted clock-matching task. No aging effects was found in these variables. In contrast, no disease effect was apparent for reaction time, which was significantly longer in healthy age-matched controls than in healthy young controls. For saccade tasks, PD patients showed significantly smaller saccade size than healthy age-matched controls on the antisaccade task, but no aging effects were evident. Our approaches highlighted that visual exploration disturbance in PD may be due to dysfunctional visual information processing in addition to dysfunctional oculomotor processing. These disease effects may differ from aging effects.

Relation between Resting State Front-Parietal EEG Coherence and Executive Function in Parkinson's Disease.

Objective. To assess the relation between executive dysfunction (ED) in Parkinson's disease (PD) and resting state functional connectivity evaluated using electroencephalography (EEG) coherence. Methods. Sixty-eight nondemented sporadic PD patients were assessed using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) to evaluate executive function. EEG coherence in the left frontoparietal electrode pair (F3-P3) and the right frontoparietal electrode pair (F4-P4) was analyzed in the alpha and theta range. The BADS scores were compared across the coherence groups, and the multiple logistic regression analysis was performed to assess the contribution of confounders. Results. The standardized BADS score was significantly lower in the low F3-P3 coherence group in the alpha range (Mann-Whitney U test, p = 0.032), though there was no difference between F4-P4 coherence group in the alpha range, F3-P3, and F4-P4 coherence groups in the theta range and the standardized BADS score. The multiple logistic regression analysis revealed the significant relation between the F3-P3 coherence group in alpha range and age-controlled standardized BADS score (p = 0.039, 95% CI = 1.002-1.062). Conclusion. The decrease in resting state functional connectivity between the frontal and parietal cortices especially in the left side is related to ED in PD.

Relationship between Postural Deformities and Frontal Function in Parkinson's Disease.

Postural deformities and executive dysfunction (ED) are common symptoms of Parkinson's disease (PD); however, the relationship between postural deformities and ED in patients with PD remains unclear. This study assessed the relationship between postural deformities and ED in patients with PD. Sixty-five patients with sporadic PD were assessed for the severity of postural deformities and executive function. The severity of postural deformities was scored using the United Parkinson's Disease Rating Scale item 28 score: no postural deformity (0), mild postural deformities (1), or severe postural deformities (2-4). Executive function was assessed using the Behavioral Assessment of the Dysexecutive Syndrome (BADS) and an age-controlled standardized BADS score <70 was defined as ED. Age-controlled standardized BADS scores were compared across the three groups using the Kruskal-Wallis test. Relationship between ED and the severity of postural deformities was assessed using the Mann-Whitney U test. Age-controlled standardized BADS score significantly differed among the three groups (P = 0.005). ED was significantly related to the severity of postural deformities (P = 0.0005). The severity of postural deformities was associated with a lower age-controlled standardized BADS score and ED, and these findings suggest that postural deformities were associated with frontal dysfunction in patients with PD.

Relapse with Dysphagia in a Case of Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

Glossopharyngeal and/or vagus nerve involvement is infrequent in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We herein report the case of a 69-year-old Japanese woman who presented with muscle weakness and numbness of the extremities with dysphagia. The serum anti-ganglioside GM1 immunoglobulin IgM antibody levels were elevated, and treatment with intravenous immunoglobulin (IVIg) resulted in a dramatic improvement; the weakness, numbness and dysphagia all resolved. However, relapse comprising dysphagia alone occurred on hospital day 26, and treatment with IVIg again proved extremely effective. IVIg therapy can be effective against cranial nerve involvement in cases of CIDP.

Tumefactive Demyelinating Lesion Differentiated from a Brain Tumor Using a Combination of Magnetic Resonance Imaging and (11)C-methionine Positron Emission Tomography.

A 37-year-old woman gradually developed a gait disturbance due to sensory loss in the left lower extremity three years after being diagnosed with clinically isolated syndrome. Brain magnetic resonance imaging (MRI) demonstrated an incomplete ring-enhanced lesion with perifocal edema in the subcortex of the right parietal lobe. (11)C-methionine positron emission tomography (MET-PET) showed an insignificant uptake in the lesion. The patient was noninvasively diagnosed with tumefactive multiple sclerosis and treated with corticosteroids, and her neurological symptoms and MRI findings improved with treatment. The combination of MRI findings and insignificant uptake on MET-PET is useful for noninvasively differentiating tumefactive demyelinating lesions from brain tumors.

[A case of bilateral ophthalmoplegia caused by focal idiopathic hypertrophic pachymeningitis on the anterior cranial fossa].

A previously healthy 63-year-old man presented with a 2-weeks history of diplopia without headache. Neurological examination revealed total external ophthalmoplegia of the left eye and limitation of abduction of the right eye. Initial cranial MRI showed thickening and enhancement of the dura mater only on the anterior cranial fossa but unremarkable on the cavernous sinus. Idiopathic hypertrophic cranial pachymeningitis was diagnosed in the absence of demonstrable underlying infective, neoplastic, or systemic autoimmune disease by his clinical findings, laboratory tests and radiological examinations. Corticosteroid therapy was initiated with methylprednisolone (1,000 mg/day for 3 days), followed by oral prednisolone and tapering off. Eye movements improved with treatment and completely recovered within 4 weeks after starting administration, and cranial MRI at the 15 days after starting treatment showed improvement. We suggest that his ophthalmoplegia was caused by the inflammation of dura on the cavernous sinus beyond the thickening lesion of cranial MRI. In a case of bilateral ophthalmoplegia with or without headache, it is required to examine the dural thickening and enhancement on the anterior cranial fossa by cranial MRI.

Relation between freezing of gait and frontal function in Parkinson's disease.

INTRODUCTION: Freezing of gait (FOG) is a common symptom of Parkinson's disease (PD). Although the pathophysiological mechanism of FOG is unknown, previous studies have suggested that frontal dysfunction is associated with FOG. The Behavioral Assessment of the Dysexecutive Syndrome (BADS) battery, which is wide-ranging neurological battery composed of six subtests, evaluates frontal function and is more sensitive to executive dysfunction (ED) than other tools in PD patients. This is the first study to assess the relation between FOG in the 'on' state and frontal dysfunction evaluated using BADS. METHODS: Subjects were 65 patients with PD. Multiple logistic regression analysis was used to compare the age-controlled standardized BADS score, age, disease duration, Hoehn and Yahr (HY) stage, levodopa-equivalent daily dose, and Mini-Mental State Examination (MMSE) score across patients with FOG (n = 43) and patients without FOG (n = 22). Score on each of the six BADS subtests were compared across patients with and without FOG using the Mann-Whitney U test. RESULTS: Multiple logistic regression analysis revealed that FOG was related to lower age-controlled standardized BADS score (P = 0.022) and higher HY stage (P = 0.009) but not to disease duration, levodopa equivalent daily dose, or MMSE score. Among the six BADS subtests, score on the Zoo Map Test, which evaluates problem solving and planning, was lower in patients with FOG than in patients without FOG. CONCLUSION: These results support a relation between on-state FOG and frontal dysfunction in PD patients.