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Praschan N, Huffman JC, Stern TA. Psychiatric Aspects of Stroke Syndromes. MASSACHUSETTS GENERAL HOSPITAL COMPREHENSIVE CLINICAL PSYCHIATRY 2025:896-903. [DOI: 10.1016/b978-0-443-11844-9.00081-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Langer KG, Bogousslavsky J. Between neurology and psychiatry: The lively history of right hemisphere syndromes. Rev Neurol (Paris) 2024; 180:568-579. [PMID: 37891135 DOI: 10.1016/j.neurol.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 10/29/2023]
Affiliation(s)
- K G Langer
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY 10016, USA.
| | - J Bogousslavsky
- Neurocentre, Center for Brain and Nervous System Disorders, Swiss Medical Network, Clinique Valmont, Montreux, Switzerland.
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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.
AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.
METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).
RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.
CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Oliveira FFD, Marin SDMC, Bertolucci PHF. Neurological impressions on the organization of language networks in the human brain. Brain Inj 2016; 31:140-150. [PMID: 27740867 DOI: 10.1080/02699052.2016.1199914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND More than 95% of right-handed individuals, as well as almost 80% of left-handed individuals, have left hemisphere dominance for language. The perisylvian networks of the dominant hemisphere tend to be the most important language systems in human brains, usually connected by bidirectional fibres originated from the superior longitudinal fascicle/arcuate fascicle system and potentially modifiable by learning. Neuroplasticity mechanisms take place to preserve neural functions after brain injuries. Language is dependent on a hierarchical interlinkage of serial and parallel processing areas in distinct brain regions considered to be elementary processing units. Whereas aphasic syndromes typically result from injuries to the dominant hemisphere, the extent of the distribution of language functions seems to be variable for each individual. METHOD Review of the literature Results: Several theories try to explain the organization of language networks in the human brain from a point of view that involves either modular or distributed processing or sometimes both. The most important evidence for each approach is discussed under the light of modern theories of organization of neural networks. CONCLUSIONS Understanding the connectivity patterns of language networks may provide deeper insights into language functions, supporting evidence-based rehabilitation strategies that focus on the enhancement of language organization for patients with aphasic syndromes.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
| | - Sheilla de Medeiros Correia Marin
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
| | - Paulo Henrique Ferreira Bertolucci
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
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Byeon H, Koh HW. Health science students' perceptions of motor and sensory aphasia caused by stroke. J Phys Ther Sci 2016; 28:1772-1774. [PMID: 27390413 PMCID: PMC4932054 DOI: 10.1589/jpts.28.1772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/28/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study explored health science students' perceptions of motor aphasia and sensory aphasia caused by stroke to provide basic material for the improvement of rehabilitation practitioners' perceptions of aphasia. [Subjects and Methods] The subjects of this study were 642 freshmen and sophomores majoring in health science. Perceptions of aphasia were surveyed on a semantic differential scale using the Anchoring Vignette Method and the difference in perception of the two types of aphasia was analyzed using multi-dimensional scaling. [Results] The analysis revealed that motor aphasia and sensory aphasia have mutually corresponding images. Motor aphasia had high levels of 'quiet', 'passive' 'dumb', 'unstable' and 'gloomy' images, while sensory aphasia had high levels of 'noisy', 'unstable', 'cheerful', 'sensitive', 'fluctuating in emotions', 'active', 'dumb' and 'gloomy' images. [Conclusion] A systematic education is required to be implemented in the future to improve health science students' negative perceptions of the aftereffects of stroke such as aphasia.
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Affiliation(s)
- Haewon Byeon
- Department of Speech Language Pathology, Nambu University,
Republic of Korea
| | - Hyeung Woo Koh
- Department of Physical Therapy, Jeju Seogwipo Medical
Center, Republic of Korea
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7
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de Oliveira FF, Correia Marin SDM, Ferreira Bertolucci PH. Communicating with the non-dominant hemisphere: Implications for neurological rehabilitation. Neural Regen Res 2014; 8:1236-46. [PMID: 25206418 PMCID: PMC4107603 DOI: 10.3969/j.issn.1673-5374.2013.13.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
Aphasic syndromes usually result from injuries to the dominant hemisphere of the brain. Despite the fact that localization of language functions shows little interindividual variability, several brain areas are simultaneously activated when language tasks are undertaken. Mechanisms of language recovery after brain injury to the dominant hemisphere seem to be relatively stereotyped, including activations of perilesional areas in the acute phase and of homologues of language areas in the non-dominant hemisphere in the subacute phase, later returning to dominant hemisphere activation in the chronic phase. Plasticity mechanisms reopen the critical period of language development, more specifically in what leads to disinhibition of the non-dominant hemisphere when brain lesions affect the dominant hemisphere. The non-dominant hemisphere plays an important role during recovery from aphasia, but currently available rehabilitation therapies have shown limited results for efficient language improvement. Large-scale randomized controlled trials that evaluate well-defined interventions in patients with aphasia are needed for stimulation of neuroplasticity mechanisms that enhance the role of the non-dominant hemisphere for language recovery. Ineffective treatment approaches should be replaced by more promising ones and the latter should be evaluated for proper application. The data generated by such studies could substantiate evidence-based rehabilitation strategies for patients with aphasia.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sheilla de Medeiros Correia Marin
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Pedroso VSP, Souza LCD, Teixeira AL. Síndromes neuropsiquiátricas associadas a acidentes vasculares encefálicos: revisão de literatura. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Revisar as principais síndromes neuropsiquiátricas associadas ao acidente vascular encefálico (AVE), suas características clínicas, impacto sobre a recuperação dos pacientes, tratamento, suas possíveis relações com a fisiopatologia dos AVE e, quando possível, contextualizá-las à realidade brasileira. Métodos Foram realizadas buscas nas bases de dados PubMed/MedLine e SciELO/Lilacs com os termos “stroke” e “cerebrovascular disease” em combinações com “neuropsychiatry”, “neuropsychiatric disorders”, “psychiatry”, “psychiatric disorders”, “depression”, “anxiety” e “dementia”, com ênfase nos últimos dez anos. Resultados Foram revisadas as síndromes neuropsiquiátricas pós-AVE, incluindo depressão, ansiedade, transtorno da expressão emocional involuntária, labilidade emocional, irritabilidade, raiva, reação catastrófica, apatia, demência, mania e psicose, de acordo com os objetivos propostos. Conclusão É notória a escassez de informações sobre o manejo terapêutico das complicações neuropsiquiátricas secundárias aos AVE, especialmente diante do impacto em saúde pública representado pelas doenças cerebrovasculares. Com a evolução da abordagem precoce a esses pacientes e o consequente aumento de sua sobrevida, o aprofundamento do conhecimento sobre o desenvolvimento e o tratamento dos transtornos neuropsiquiátricos parece ter maior potencial para melhorar o desfecho e a qualidade de vida dos indivíduos que sofreram AVE.
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Salas CE. Surviving Catastrophic Reaction after Brain Injury: The Use of Self-Regulation and Self-Other Regulation. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/15294145.2012.10773691] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chriki LS, Bullain SS, Stern TA. The recognition and management of psychological reactions to stroke: a case discussion. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 8:234-40. [PMID: 16964319 PMCID: PMC1557466 DOI: 10.4088/pcc.v08n0407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Correct diagnosis of acute stroke is of paramount importance to clinicians to enable selection of correct treatments and to ensure prevention of acute complications, including recurrent stroke. Timely diagnosis can be difficult in some cases because patients with acute stroke can present with atypical or uncommon symptoms that suggest another cause altogether. Publications on these patients suggest that the following strategies could help to reduce misdiagnosis. First, clinicians should suspect stroke in any patient with abrupt onset of neurological symptoms. Second, clinicians should be aware that some patients will initially present with various uncommon and atypical stroke symptoms. Third, a complete and systematic neurological examination should be routinely done in patients presenting with acute neurological symptoms because this might shed light on the true nature of the problem. Finally, clinicians should be aware that even with the most sophisticated neuroimaging tests, stroke might be missed in the early hours after the event.
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Affiliation(s)
- Jonathan A Edlow
- Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Oliveira FFD, Damasceno BP. Global aphasia as a predictor of mortality in the acute phase of a first stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:277-82. [PMID: 21625750 DOI: 10.1590/s0004-282x2011000300002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 11/29/2010] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To establish whether vascular aphasic syndromes can predict stroke outcomes. METHOD Thirty-seven adults were evaluated for speech and language within 72 hours after a single first-ever ischemic brain lesion, in blind association to CT and/or MR. RESULTS Speech or language disabilities were found in seven (87.5%) of the eight deceased patients and twenty-six (89.7%) of the twenty-nine survivors. Global aphasia was identified in eleven patients, all with left hemisphere lesions (nine mute; five deceased), consisting on a risk factor for death in the acute stroke phase (ρ=0.022). Age (z=1.65; ρ>0.09), thrombolysis (ρ=0.591), infarct size (ρ=0.076) and side (ρ=0.649) did not significantly influence survival. Absence of aphasia did not predict a better evolution, regardless of the affected hemisphere. Prevalence of cardiovascular risk factors was similar for all patient groups. CONCLUSION Global aphasia in acute stroke can adversely affect prognosis, translated into impairment of dominant perisylvian vascular territories, with mutism as an important semiological element.
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Cahana-Amitay D, Albert ML, Pyun SB, Westwood A, Jenkins T, Wolford S, Finley M. Language as a Stressor in Aphasia. APHASIOLOGY 2011; 25:593-614. [PMID: 22701271 PMCID: PMC3372975 DOI: 10.1080/02687038.2010.541469] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.
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Affiliation(s)
- Dalia Cahana-Amitay
- Boston University, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Healthcare System, 150 South Huntington Avenue Boston, MA 02130
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Oliveira FF, Damasceno BP. Short-term prognosis for speech and language in first stroke patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 67:849-55. [DOI: 10.1590/s0004-282x2009000500013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 07/15/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To evaluate the factors that can influence evolution of communication after a first stroke. METHOD: Thirty-seven adult patients were evaluated for speech and language within 72 hours after a single first-ever ischemic brain injury and later on. Patients who were comatose, with decompensated systemic diseases, or history of chronic alcoholism or illicit drug use were not included. Brain CT and/or 2T-MR exams were solicited for topographic correlation. Size of infarct was classified as large or small according to the TOAST classification. RESULTS: Patients who survived had lesser chances of presenting with aphasia or dysarthria 3 months after the stroke if the infarct size was small (p=0.017). Gender, age, schooling, aphasia subtype, infarct side and topography were non-significant in our sample. Subjects with global aphasia or lone cortical dysarthria had a slower evolution. CONCLUSION: Brain injury size was the most influential factor for neurological outcome at 3 months post-stroke.
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Affiliation(s)
- Fabricio F Oliveira
- Department of Neurology, State University of Campinas, Campinas, SP, Brazil.
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Annoni JM, Staub F, Bruggimann L, Gramigna S, Bogousslavsky J. Emotional Disturbances after Stroke. Clin Exp Hypertens 2009; 28:243-9. [PMID: 16833030 DOI: 10.1080/10641960600549173] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Impairment after stroke may have acute and long-lasting psychological implications. Additionally, organic brain dysfunction also appears to play an important role in poststroke affective modifications. Emotional state is multidetermined and can be specifically modified by alteration of some brain networks. This article illustrates a certain number of acute and more chronic emotional disturbances after stroke, such as mood disorders, emotional dyscontrol, and modification of emotional experiences. Some neural mechanisms implicated in these modifications are discussed. The main modifications described are depression anxiety, psychosis, modification of emotional experience, and fatigue.
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Affiliation(s)
- Jean-Marie Annoni
- Department of Neurology, University Hospital, Lausanne, Switzerland.
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Carota A, Bogousslavsky J. Stroke-related psychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:623-651. [PMID: 18804672 DOI: 10.1016/s0072-9752(08)93031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Antonio Carota
- Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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Abstract
SOURCES OF DATA We conducted a systematic review of the current literature for this review, but as there are many gaps in the research literature, we have supplemented this by our own clinical experience. AREAS OF AGREEMENT There is a general agreement that Asperger syndrome (AS) is one of the autistic spectrum disorders, that it is a developmental disorder which is either present at birth or develops shortly after and that there is a strong hereditary component. AREAS OF CONTROVERSY The fundamental impairment of AS is in the social arena, but what causes this is disputed. We propose that it is a disorder of non-verbal communication. Another important area of controversy is the extent to which AS may remit. GROWING POINTS Many people with AS develop secondary psychiatric disorders in adolescence and adulthood, some of which may be linked genetically, notably bipolar disorder [DeLong R, Nohria C (1994) Psychiatric family history and neurological disease in autistic spectrum disorders. Dev Med Child Neurol, 36, 441-448] or be explicable by some other association, but many patients and carers attribute their anxiety and low mood to bullying. The prevalence, treatment and prevention of co-morbid mental health problems are rapidly developing areas of interest. Some people with AS are known to commit offences, and when they commit they are more likely to be violent offences against strangers. How much of a risk that is presented by people with AS, and how to assess this risk, is another growing area of concern. AREAS TIMELY FOR DEVELOPING RESEARCH The social impairments of people with AS include deficits in empathy, self-awareness and executive function. Many of these are quintessentially human characteristics, and the study of people with AS provides opportunities for using neuroimaging to compare people with AS and controls and identify which areas of the brain are concerned with these 'higher functions'. The study of AS, like that of other fronto-striatal disorders, is also throwing light on the role of networks in the brain and on how networks are formed during embryogenesis.
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Affiliation(s)
- Digby Tantam
- Centre for the Study of Conflict and Reconciliation, School of Health and Related Research, Regent's Court, 30 Regent Street, Sheffield, UK.
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Yuan TF, Hoff R. Mirror neuron system based therapy for emotional disorders. Med Hypotheses 2008; 71:722-6. [PMID: 18703289 DOI: 10.1016/j.mehy.2008.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 07/01/2008] [Accepted: 07/02/2008] [Indexed: 01/13/2023]
Abstract
Mirror neuron system (MNS) represents one of the most important discoveries in the area of neuropsychology of past decades. More than 500 papers have been published in this area (PubMed), and the major functions of MNS include action understanding, imitation, empathy, all of which are critical for an individual to be social. Recent studies suggested that MNS can modulate emotion states possibly through the empathy mechanism. Here we propose that MNS-based therapies provide a non-invasive approach in treatments to emotional disorders that were observed in autism patients, post-stroke patients with depression as well as other mood dysregulation conditions.
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Affiliation(s)
- Ti-Fei Yuan
- Department of Anatomy, Li Kai Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong.
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Townend E, Brady M, McLaughlan K. A Systematic Evaluation of the Adaptation of Depression Diagnostic Methods for Stroke Survivors Who Have Aphasia. Stroke 2007; 38:3076-83. [DOI: 10.1161/strokeaha.107.484238] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Ellen Townend
- From the NMAHP Research Unit (E.T., M.B.), Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian (K.N.), Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK
| | - Marian Brady
- From the NMAHP Research Unit (E.T., M.B.), Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian (K.N.), Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK
| | - Kirsty McLaughlan
- From the NMAHP Research Unit (E.T., M.B.), Buchannan House, Glasgow Caledonian University, UK; and the NHS Grampian (K.N.), Department of Speech and Language Therapy, Spynie Hospital, Morayshire, UK
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Townend E, Brady M, McLaughlan K. Exclusion and inclusion criteria for people with aphasia in studies of depression after stroke: a systematic review and future recommendations. Neuroepidemiology 2007; 29:1-17. [PMID: 17898519 DOI: 10.1159/000108913] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS A third of individuals are depressed following stroke. A similar proportion have aphasia. The extent of their inclusion in depression following stroke studies affects the generalizability of findings. METHODS We systematically reviewed published studies (to December 2005) that diagnosed depression following stroke. We identified aphasia screening methods, aphasia exclusion and inclusion criteria and respective numbers of individuals with aphasia. RESULTS Of 129 studies (n = 19,183), aphasia screening methods were only reported by 57 (31 described a published aphasia-specific tool). No mention of aphasia was made in 13 studies. Most studies (92, 71%) reported some exclusion of people with aphasia (49 reported how many: n = 3,082, range = 2-554). Almost half of the studies (60, 47%) actually reported participants with aphasia (37 specified numbers: n = 829, range = 5-60). Aphasia exclusion or inclusion was not associated with sample source (community, acute hospital, other) or study purpose (observation, intervention, screening). Studies that reported screening for aphasia were more likely to describe aphasia exclusion and inclusion criteria and include participants with aphasia. CONCLUSION Aphasia screening, exclusion and inclusion criteria reporting across studies of depression following stroke has been highly inconsistent. This impairs the interpretation of generalizability. Improved aphasia screening and reporting of exclusion and inclusion criteria are urgently recommended.
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Affiliation(s)
- Ellen Townend
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
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Abstract
Stroke is characterized by the sudden loss of circulation to an area of the brain, resulting in a corresponding loss of neurological function. In this article, we will discuss the epidemiology, etiopathophysiology, and symptomatology of different types of cerebrovascular diseases. Specific stroke syndromes will be reviewed to convey the myriad presentations of cerebrovascular disease.
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Affiliation(s)
- Michael S Rafii
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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22
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Nys GMS, van Zandvoort MJE, van der Worp HB, de Haan EHF, de Kort PLM, Jansen BPW, Kappelle LJ. Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 2006; 247:149-56. [PMID: 16716359 DOI: 10.1016/j.jns.2006.04.005] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 02/09/2006] [Accepted: 04/10/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the predictive value of cognitive impairment in the acute phase after stroke as a risk factor for long-term (six to ten months after stroke) depressive symptoms (DS) and a reduced quality of life (QOL), independent of demographic and neurological predictors. METHODS We evaluated 143 patients within the first 3 weeks post-stroke. Predictor variables included domain-specific cognitive function, demographic data, vascular risk factors, lesion characteristics, and clinical factors. Predictor variables associated with long-term DS (Montgomery Asberg Depression Rating Scale >or=7) and QOL (Stroke-Specific Quality of Life Scale) were identified with multiple logistic and linear regression. RESULTS Long-term DS were independently predicted by cognitive impairment at baseline, DS at baseline, female sex, diabetes mellitus, and previous TIA(s). Cognitive impairment, increasing age, and functional dependence predicted a reduced QOL, whereas hypercholesterolaemia predicted a better QOL. Among all cognitive disorders, unilateral neglect was the greatest risk factor for DS after 6 months, whereas a disorder in visual perception and construction affected QOL the most. CONCLUSIONS Cognitive impairment and vascular risk factors are important predictors of long-term DS and QOL after stroke. The prognostic value of cognition suggests a reactive component in the development or continuation of long-term DS.
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Affiliation(s)
- G M S Nys
- Psychological Laboratory, Helmholtz Institute, Utrecht University, The Netherlands.
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23
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Abstract
As we learn more about the relationships between depression and cerebrovascular disease (CVD), a complex picture is emerging in which the chain of causality seems to spiral on itself: progressive or focal brain damage, cognitive impairment, depressive symptoms, dementia, and cardiovascular diseases, all seem to be liable to lead to one or another. Stroke may lead to depression, and the inverse may also be true. Depression may lead to cognitive impairment and cardiovascular diseases, which in turn may lead to subtle brain impairment, thereby causing more depression and cognitive impairments, and so on. In this presentation, we provide a rapid glance at the complexities of such issues.
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Affiliation(s)
- Sebastian Dieguez
- Neurology Department, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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24
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Braun CMJ, Dumont M, Duval J, Hamel-Hébert I. Speech rate as a sticky switch: a multiple lesion case analysis of mutism and hyperlalia. BRAIN AND LANGUAGE 2004; 89:243-252. [PMID: 15010256 DOI: 10.1016/s0093-934x(03)00402-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2003] [Indexed: 05/24/2023]
Abstract
Though it has long been known on the basis of clinical associations and serendipitous observation that speech rate is related to mood and psychomotor baseline, it is less known that speech rate is also related to libido and to immune function. We make the case for a bipolar phenomenon of "psychic tonus," encompassing all these dimensions. The elated, agitated, libidinal, immunofacilitated, and talkative pole is an "approach" disposition primarily activated by the normal left hemisphere-especially, though not exclusively, its frontal lobe. The dejected, lethargic, delibidinized, immunosuppressed, and mute pole is an "avoidance" disposition primarily activated by the normal right hemisphere-especially, though not exclusively, its frontal lobe. In support of this proposed model, we present new evidence, via meta-analysis of previously published single lesion case reports, of a highly significant association between right hemisphere lesions and non-aphasic hyperlalia, and between left hemisphere lesions and non-aphasic mutism.
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Affiliation(s)
- Claude M J Braun
- Centre de Neurosciences de la Cognition, Université du Québec à Montréal, CP 8888 Succ Centre-Ville, Montreal, Que., Canada H3C 3P8.
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25
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Bodini B, Iacoboni M, Lenzi GL. Acute stroke effects on emotions: an interpretation through the mirror system. Curr Opin Neurol 2004; 17:55-60. [PMID: 15090878 DOI: 10.1097/00019052-200402000-00010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The most recent reports on emotional consequences of stroke are hereby reviewed and analyzed. In particular the interpretation of some neurological presentations found in stroke patients, such as athymormia, dysprosody, emotional incontinence and emotional blunting is discussed. As current theories on mental functions do not provide satisfactory explanations for the above syndromes, a novel interpretative framework is proposed, based on neuropsychological experimental data on the 'mirror system'. RECENT FINDINGS Recent findings support both the fundamental role of the mirror system in imitative processes as well as the relevance of imitation for the emotional part of human personality and behavior. SUMMARY The mirror system appears to be of paramount relevance for empathy and social behavior. The model of analysis-by-synthesis is here discussed, together with neurological presentations resulting from stroke induced impairments of the mirror system. Speculations for further researches are also proposed.
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Affiliation(s)
- Benedetta Bodini
- Department of Neurological Sciences, 1st University of Roma 'La Sapienza', Rome, Italy
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26
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Huffman JC, Stern TA. Poststroke Neuropsychiatric Symptoms and Pseudoseizures: A Discussion. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2003; 5:85-88. [PMID: 15156236 PMCID: PMC353042 DOI: 10.4088/pcc.v05n0205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
LESSONS LEARNED AT THE INTERFACE OF MEDICINE AND PSYCHIATRY: The Psychiatric Consultation Service at Massachusetts General Hospital (MGH) sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their thrice-weekly rounds, Dr. Huffman and Dr. Stern discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.
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Affiliation(s)
- Jeff C. Huffman
- Dr. Huffman is Chief Resident at MGH and a Clinical Fellow in Psychiatry at Harvard Medical School. Dr. Stern is Chief of the Psychiatric Consultation Service at MGH and an Associate Professor of Psychiatry at Harvard Medical School
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Huffman J, Stern TA. Acute psychiatric manifestations of stroke: a clinical case conference. PSYCHOSOMATICS 2003; 44:65-75. [PMID: 12515840 DOI: 10.1176/appi.psy.44.1.65] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jeff Huffman
- Department of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, MA 02114, USA
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28
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Abstract
The brain mediates and integrates all cognitive activities, emotional experiences and finally behaviours. Stroke is undoubtedly a privileged disease for human behavioural studies, because of its high incidence. Recent advances in high-resolution magnetic resonance imaging techniques and functional neuroimaging allow both the precise localization of lesions and on-line visualization of the activity of cerebral areas and networks. Nevertheless, the neuropsychiatry of stroke remains uncertain in its relationship with brain dysfunction. Clinical studies on registry populations, single case studies, and functional neuroimaging data provide interesting findings, but differences in methods and great individual intervariability still prevent a complete understanding of emotional perception and behavioural responses in stroke. We adopted an anatomical-functional model as an operational framework in order to systematize the recent literature on emotional, behavioural and mood changes after stroke. The dysfunction of the areas subserving fundamental and executive functions induces behavioural and affective changes (such as depression, anxiety, apathy) that reflect the dysfunction of the whole system. Conversely, lesions in the system of instrumental functions induce signature syndromes (aphasia, anosognosia). At any delay from stroke, the diagnosis and treatment of mood and behavioural changes are a priority for clinicians and healthcare professionals to improve the quality of life of patients.
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Affiliation(s)
- Antonio Carota
- Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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