Who Are You? The Study of Personality in Patients With Anterograde Amnesia

Little is known about the role of declarative memory in the ongoing perception of one’s personality. Seven individuals who developed a rare and severe type of anterograde amnesia following damage to their medial temporal lobes were identified from our neurological patient registry. We examined the stability of their personality ratings on the Big Five Inventory over five retest periods and assessed the accuracy of their ratings via analyses of self–caregiver agreement. The patients portrayed a stable sense of self over the course of 1 year. However, their self-ratings differed from those provided by the caregivers. Intriguingly, these discrepancies diminished when caregivers retrospectively rated the patients’ personalities prior to their brain injury, suggesting that patients’ perceptions of themselves were stuck in the past. We interpret our findings to indicate that the ability to form new declarative memories is not required for maintaining a stable sense of self but may be important for updating one’s sense of self over time.

Proverbs and Aphorisms in Neurorehabilitation: A Literature Review

Introduction: Brain plasticity is not limited to childhood or adolescence, as originally assumed, but continues into adulthood. Understanding this conceptual evolution about the nervous system, neuroscience and neurorehabilitation, researchers have left different proverbs and aphorisms derived of their investigations that are still used in university and postgraduate training. A proverb is defined as a phrase of popular origin traditionally repeated invariably, in which a moral thought, advice or teaching is expressed. On the other hand, an aphorism is understood as a brief and doctrinal phrase or sentence that is proposed as a rule in some science or art. The aim of this paper is to present a compilation of proverbs and aphorisms related to neuroscience and neurorehabilitation, classified chronologically, to illustrate the conceptual evolution about the brain and to improve our understanding about the management of neurological patients through the methods and techniques developed during the 19th, 20th and 21st centuries, as many therapies are based on them. Methods: A literature review was conducted based on the recommendations for Systematic Reviews guidelines for scoping reviews. A computerized search was conducted in the following electronic databases: CINAHL Medical Science, Medline through EBSCO, PubMed, Physiotherapy Evidence Database (PEDro) and Scopus, limiting the search to papers published until April 2021 in English and Spanish. Inverse searches were also carried out based on papers found in the databases. The following data were extracted: technique or approach; author; date of birth and death; proverbs and aphorisms; clinical interpretation. Results: Proverbs and aphorisms linked to authors such as Charles Edward Beevor (1854–1908), Heinrich Sebastian Frenkel (1860–1931), Rudolf Magnus (1873–1927), Nikolai Bernstein (1896–1966), Donald O. Hebb (1904–1985), Elwood Henneman (1915–1996), Wilder Graves Penfield (1891–1976), Humberto Augusto Maturana Romesín (1928), Edward Taub (1931), Janet Howard Carr (1933–2014), Roberta Barkworth Shepherd (1934), Brown & Hardman (1987), Jeffrey A. Kleim and Theresa A. Jones (2008) were compiled. Conclusion: Different authors have developed throughout history a series of proverbs and aphorisms related to neurosciences and neurorehabilitation that have helped to better our understanding of the nervous system and, therefore, in the management of the neurological patient through the methods and techniques developed throughout the 19th, 20th and 21st centuries.

9 When the spark goes out: the neurology of apathy and motivation

Disorders of motivation are common across brain disorders. Clinicians frequently encounter pathological apathy across a range of conditions, including many neurodegenerative conditions such as small cerebrovascular disease, Parkinsons and Alzheimers disease. It is now becoming understood that apathy has a poor prognosis for long-term functional and cognitive outcome. Unfortunately, we understand very little about the mechanisms underlying the syndrome.In this talk, I shall put forward a conceptual framework with which we can begin to understand apathy by considering the processes that normally underlie motivated, goal- directed behavior. In particular Ill focus on the ability to generate options for behavior and effort-based decision making for rewards. Recent studies of the latter have been particularly revealing in both healthy people and neurological patient populations.Several lines of evidence suggest that when we make decisions about how much effort we might invest in actions, we weigh up the costs involved for the potential rewards to be obtained. Functional imaging in healthy people reveals both medial frontal and basal ganglia involvement when individuals make such decisions. In patients with apathy, this evaluation is altered. Apathetic patients show blunted sensitivity to rewards and less inclination to invest effort for low rewards than healthy individuals. Some evidence shows that these factors can be improved by dopaminergic medication. The findings support the view that it might be possible to provide a mechanistic account of the syndrome of apathy which might lead to treatments for the disorder.

What can be expected to be seen in a Neurology ward? Eleven-year experience in a Brazilian university hospital

ABSTRACT Background: Neurological disorders are significant causes of morbidity and mortality worldwide. However, data about general neurological inpatient admissions in Brazil is limited. Objective: To investigate the prevalence of neurological disorders according to disease group and lesion site among patients admitted to a general Neurology ward. Methods: This was an observational and descriptive study. The hospital discharge database for the Neurology ward was surveyed in accordance with the International Classification of Diseases, 10th edition (ICD-10), from September 2008 to October 2019. The final diagnosis was classified into neurological disorder groups and site. Results: Overall, 2,606 clinical neurological patient files were included, with mean length of hospitalization of 16.7 days and a total of 325 readmissions (12.5%). The overall mortality rate in the ward was 3.8% (100 patients). Among all the diagnoses, cerebrovascular disease was the most prevalent (45.8%), followed by inflammatory disorders (22.2%). The brain was the most common lesion site (66.0%), followed by peripheral nerves (10.0%) and meninges and cerebrospinal fluid (7.7%). Conclusions: The disease pattern upon admission showed that a majority of the cases consisted of cerebrovascular disorders and that the brain was the most frequently affected structure, although we observed that a wide variety of cases were admitted, encompassing all neurological disorders.

Semiologia neurológica moderna em 10 passos (Baseados em pacientes reais)

Educative, organized, modern and realistic. This book is different because it took 10 years to write and has a completely original system to teach how to care for patients with neurological, psychiatric and/or neuropsychiatric disorders. It is educative and organized since, after a review of the modern medical interview and the presentation of a proposal for a general physical examination – the physical approach examination (PAE) –, with its main trunk and branches (extra maneuvers, linked according to context), we structured the approach to the neurological patient in ten steps (chapters 3 to 12). Each step is developed using several clinical vignettes of real routine patients, the majority of whom were attended by the author. The idea is that the reader can be proficient in the elaboration of syndromic diagnoses and become able to correctly solve or direct the real cases. After each chapter, an overview of the key points is made. It is modern and realistic since, whenever possible and available, we inform the statistical performance of the interview and of the neurological physical examination maneuvers according to the precepts of evidence-based medicine. Only what should be used in daily practice is emphasized, excluding useless tests and maneuvers. The book can serve mainly as a guide to neurological (and psychiatric) semiology in undergraduate courses, but also as an introductory reading for medical residents in family medicine, psychiatry, neurology, neurosurgery or neuropediatrics. It can also be useful for the continuing education of practicing physicians, especially those in Family Health Strategy.

Sex difference in cerebrospinal fluid/blood albumin quotients in patients with schizophreniform and affective psychosis

Background The importance of cerebrospinal fluid (CSF) diagnostics for psychiatry is growing. The CSF/blood albumin quotient (QAlb) is considered to be a measure of the blood–CSF barrier function. Recently, systematically higher QAlb in males than in females was described in neurological patients. The aim of this study was to investigate whether a sex difference could also be detected in a well-characterized psychiatric cohort. Methods The patient cohort comprised 989 patients, including 545 females and 444 males with schizophreniform and affective syndromes who underwent CSF diagnostics, including QAlb measurement. The basic CSF findings and antineuronal autoantibody data of this cohort have already been published. This re-analysis employed analysis of covariance with age correction for QAlb mean values and chi2-testing for the number of increased age-corrected QAlb levels to investigate sex differences in QAlb. Results The QAlb levels were elevated above reference levels by 18% across all patients, and a comparison between male and female patients revealed a statistically significant sex difference, with increased values in 26% of male patients and a corresponding rate of only 10% in female patients (chi2 = 42.625, p < 0.001). The mean QAlb values were also significantly higher in males (6.52 ± 3.69 × 10–3) than in females (5.23 ± 2.56 × 10–3; F = 52.837, p < 0.001). Discussion The main finding of this study was a significantly higher QAlb level in male compared to female patients with psychiatric disorders, complementing previously described sex differences in neurological patient cohorts. This result indicates bias from some general factors associated with sex and could be partly explained by sex differences in body height, which is associated with spine length and thus a longer distance for CSF flow within the subarachnoid space down the spine from the occipital area to the lumbar puncture site in males compared to females. Hormonal influences caused by different estrogen levels and other sex-specific factors could also play a relevant role. The significance of the study is limited by its retrospective design, absence of a healthy control group, and unavailability of exact measures of spine length.