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Dementia and Lower Urinary Tract Dysfunction
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
In practice, dementia can be indicated by test scores, such as 23 or lower of 30 points on the Mini-Mental State Examination (MMSE). Emotional disturbances include depression in about 25% patients, with agitation and restlessness also being common. Motor signs are particularly rare early in the course of the illness. Typically, patients with Alzheimer's disease have MMSE scores of less than 5 even though they can walk into the clinic without assistance. However, as the disease progresses, increased deep tendon reflexes and parkinsonian syndrome may develop. Epilepsy and myoclonus are occasionally noted. Decreased motivation and initiative are also significant features. In most advanced cases, abulia (loss of psychomotor activity) or apallic syndrome (akinetic mutism, vegetative state) occurs, making the patient totally dependent. Urinary disturbances do occur in patients with Alzheimer's disease but are very uncommon at an early stage.
Terminal neurological disorders
Published in Ad (Sandy) Macleod, Ian Maddocks, The Psychiatry of Palliative Medicine, 2018
Ad (Sandy) Macleod, Ian Maddocks
If there is bulbar involvement, chest infections may be the eventual cause of death. Akinetic rigidity is the usual preterminal motor state. During the terminal phase, oral compliance may be compromised. Apomorphine infusions may be useful at this stage at doses of up to 50 mg/24 hours. Very low dosage (8–10 mg/24 hours) may be sufficient.8 Pretreatment with rectal domperidone is preferable as nausea is a major adverse effect of apomorphine.7,8 Nasogastric dispersible co-beneldopa or the topical dopamine agonist rotigotine are possible options at this stage.2 Parenteral anticholineric agents severely aggravate delirium, but are an option if the patient is sedated. Abulia, an impairment of will, or an inability to initiate behaviour and actions (including speech, creating akinetic mutism), is a possible complication of late-stage PD. The phasing out of the dopamine agonists account for this, and apomorphine warrants a trial for this distressing symptom.
Chemosensory Malingering
Published in Alan R. Hirsch, Neurological Malingering, 2018
Another component of the history which may help ferret out the malingerer, is to carefully screen for other nonchemosensory symptoms which often cooccur with olfactory dysfunction. Specifically, olfactory dysfunction has been demonstrated to be the most sensitive and specific indication of traumatic injury to the ventromedial prefrontal cortex (Fujiwara, Schwartz, Gao, Black, and Levine, 2008; Zald, 2006). For instance, due to the neighborhood effect, if head trauma induces olfactory loss then often other indications of frontal lobe dysfunction appear. These include behavioral changes such as a state of abulia, amotivation, inattention, executive dysfunction, anhedonia, and symptoms of pseudobulbar affect. These can manifest in changes in interaction and functioning at work and in social situations.
Postoperative Focal Lower Extremity Supplementary Motor Area Syndrome: Case Report and Review of the Literature
Published in The Neurodiagnostic Journal, 2021
Nicholas B. Dadario, Joanna K. Tabor, Justin Silverstein, Xiaonan R. Sun, Randy S. DAmico
The FAT is a newly described eloquent white matter tract that has demonstrated an important role in SMA syndrome not previously understood. The FAT extends from the SMA to the premotor areas and Brodmann area 44, and links many known hub areas of the salience network—a cingulo-insular-opercular network that mediates the transition between internal and external mental states for stimulus orienting and task switching (Poologaindran et al. 2020). The FAT has known roles in executing internally guided activity, which is necessary for language production and motor planning (Baker et al. 2018; Chang et al. 2020). Many patients commonly demonstrate hemiplegia and mutism when operating outside of the canonical SMA, causing some to investigate a possible role of long-range tracts like the FAT extending from adjacent cerebrum in SMA syndrome. Recent evidence suggests major networks including the default mode network, linked via the cingulum, and the salience network, linked via the FAT, form a structural chain in the medial frontal lobe extending up to the SMA. This chain has been referred to as the prefrontal cognitive initiation “axis,” and integrity of its major connections, the cingulum and FAT, may be necessary to prevent abulia and akinetic mutism (Darby et al. 2018; Poologaindran et al. 2020). In line with these hypotheses, preservation of the FAT when operating on gliomas in the medial frontal lobe has been shown to decrease the likelihood of transient SMA syndrome compared to not preserving the FAT (Briggs et al. 2021).
Cannabis withdrawal induced brief psychotic disorder: a case study during the national lockdown secondary to the COVID-19 pandemic
Published in Journal of Addictive Diseases, 2021
Julen Marín, Xabier Pérez de Mendiola, Sergio Fernández, Juan Pablo Chart
A 29-year-old man voluntarily goes to the psychiatric emergency department asking for help. He suspects that something terrible will happen to him. The patient feels intense anguish and fear of being at home. A depressed mood, apathy, and abulia stand out in the psychopathological examination. The onset of symptoms coincided with the Spanish government's mandatory home confinement to face the COVID-19 pandemic (Figure 1). The lockdown forced him to abruptly interrupt the chronic use of cannabis that he had maintained since adolescence at around 10 Standard Joint Units (SJU)/day.15 During the first days after the cessation of cannabis consumption, he began to present irritability, nervousness, insomnia, depressed mood, and decreased appetite, a clinical picture compatible with a CWS (Table 1). In the following weeks, the patient started to suffer restlessness and persecutory delusions toward his relatives. He thought his parents were trying to kill him. The patient even decided to build a barricade and take refuge in his room to protect himself from his own family. This abnormal behavior was the trigger for his transfer to the emergency room.
Updated perspectives on awake neurosurgery with cognitive and emotional assessment for patients with low-grade gliomas
Published in Expert Review of Neurotherapeutics, 2021
Besides neurocognition, emotional, psychological, and personality changes have recently been evidenced after LGG surgery [45]. Indeed, behavioral modifications such as irritability, hypoactivity, anticipative disturbances, disinterest and indifference to others and own concern have been detected in 40% to 50% of patients [46]. Remarkably, some personality dimensions, e.g., neuroticism (namely, a tendency to negative emotions, excessive respond to anxiety and stress and vulnerability to depression [47]) were significantly predictive of postsurgical behavioral disturbances, as hypoactivity with apathy-abulia (that is, a decrease in the activity associated with an aspontaneity, a slowness of the responsiveness, movement, and a decrease in the motivation) [46]. Again, specific personality modifications have been correlated to white matter tract damage, in particular injury to the left IFOF [46], or injury to the left uncinate fasciculus which was associated with heightened schizotypal traits [48]. Therefore, it is time to incorporate behavioral considerations, for a long time neglected, in the therapeutic management of LGG patients.