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Cortex; a Journal Devoted To the Study... Oct 2023The ability to select between potential actions is central to the complex process of tool use. After left hemisphere stroke, individuals with limb apraxia make more hand...
The ability to select between potential actions is central to the complex process of tool use. After left hemisphere stroke, individuals with limb apraxia make more hand action errors when gesturing the use of tools with conflicting hand actions for grasping-to-move and use (e.g., screwdriver) relative to tools that are grasped-to-move and used with the same hand action (e.g., hammer). Prior research indicates that this grasp-use interference effect is driven by abnormalities in the competitive action selection process. The goal of this project was to determine whether common mechanisms and neural substrates support the competitive selection of task-appropriate responses in both tool and non-tool domains. If so, the grasp-use interference effect in a tool use gesturing task should be correlated with response interference effects in the classic Eriksen flanker and Simon tasks, and at least partly overlapping neural regions should subserve the 3 tasks. Sixty-four left hemisphere stroke survivors (33 with apraxia) participated in the tool- and non-tool interference tasks and underwent T1 anatomical MRI. There were robust grasp-use interference effects (grasp-use conflict test) and response interference effects (Eriksen flanker and Simon tasks), but these effects were not correlated. Lesion-symptom mapping analyses showed that lesions to the left inferior parietal lobule, ventral premotor cortex, and insula were associated with grasp-use interference. Lesions to the left inferior parietal lobule, postcentral gyrus, insula, caudate, and putamen were associated with response interference in the Eriksen flanker task. Lesions to the left caudate and putamen were also associated with response interference in the Simon task. Our results suggest that the selection of hand posture for tool use is mediated by distinct cognitive mechanisms and partly distinct neuroanatomic substrates from those mapping a stimulus to an appropriate motor response in non-tool domains.
Topics: Humans; Psychomotor Performance; Neuroanatomy; Brain Mapping; Functional Laterality; Stroke; Magnetic Resonance Imaging; Apraxias
PubMed: 37598647
DOI: 10.1016/j.cortex.2023.06.012 -
Frontiers in Pharmacology 2023Epirubicin is widely used in many malignancies with good efficacy and tolerability. However, investigations about adverse events (AEs) using real-world information are...
Epirubicin is widely used in many malignancies with good efficacy and tolerability. However, investigations about adverse events (AEs) using real-world information are still insufficient. We extracted Epirubicin-related reports submitted between the first quarter of 2014 and first quarter of 2023 from FAERS database. Four algorithms were utilized to evaluate whether there was a significant correlation between Epirubicin and AEs. After de-duplicating, a total of 3919 cases were extracted. Among the 3919 cases, we identified 1472 AEs, 253 of which were found to be adverse drug reactions (ADRs) associated with Epirubicin. We analysed the occurrence of Epirubicin-induced ADRs and found several unexpected significant ADRs, such as hepatic artery stenosis, hepatic artery occlusion, intestinal atresia and so on. Interestingly, we found gait apraxia, a neurological condition, was also significantly associated with Epirubicin. To our knowledge, there haven't studies that have reported an association between gait disorders and the usage of epirubicin. Our study identified new unexpected significant ADRs related to Epirubicin, providing new perspectives to the clinical use of Epirubicin.
PubMed: 37781696
DOI: 10.3389/fphar.2023.1249845 -
The Clinical Neuropsychologist Nov 2023Mood- and stress-related disorders commonly cause attentional and memory impairments in middle-aged individuals. In memory testing, these impairments can be mistakenly...
Mood- and stress-related disorders commonly cause attentional and memory impairments in middle-aged individuals. In memory testing, these impairments can be mistakenly interpreted as symptoms of dementia; thus, more reliable diagnostic approaches are needed. The present work defines the discriminant accuracy of the Dementia Apraxia Test (DATE) between psychiatric conditions and early-onset Alzheimer's disease (AD) on its own and in combination with memory tests. The consecutive sample included 50-70-year-old patients referred to dementia investigations for recent cognitive and/or affective symptoms. The DATE was administered and scored as a blinded measurement, and a receiver operating curve analysis was used to define the optimal diagnostic cut-off score. A total of 24 patients were diagnosed with probable AD (mean age 61 ± 4) and 23 with a psychiatric condition (mean age 57 ± 4). The AD patients showed remarkable limb apraxia, but the psychiatric patients mainly performed at a healthy level on the DATE. The test showed a total discriminant accuracy of 87% for a total sum cut-off of 47 (sensitivity 79% and specificity 96%). The limb subscale alone reached an accuracy of 91% for a cut-off of 20 (sensitivity 83% and specificity 100%). All memory tests were diagnostically less accurate, while the combination of the limb praxis subscale and a verbal episodic memory test suggested a correct diagnosis in all but one patient. Apraxia testing may improve the accuracy of differentiation between AD and psychiatric aetiologies. Its potential in severe and chronic psychiatric conditions should be examined in the future.
PubMed: 36829305
DOI: 10.1080/13854046.2023.2181223 -
American Journal of Speech-language... Oct 2023This investigation was designed to systematically examine the acquisition, maintenance, and response generalization effects of Sound Production Treatment (SPT) delivered...
PURPOSE
This investigation was designed to systematically examine the acquisition, maintenance, and response generalization effects of Sound Production Treatment (SPT) delivered via telehealth in comparison to existing in-person outcomes for SPT.
METHOD
A multiple-baseline design across behaviors and participants was used with two individuals with chronic apraxia of speech (AOS) and aphasia. Accuracy of target speech sounds in treated and untreated words within phrases served as the dependent variable.
RESULTS
Both participants demonstrated positive gains for treatment and generalization items. Participant 1 demonstrated gains for both sets of treatment items with the application of treatment, but production accuracy at 2 and 6 weeks posttreatment was inconsistent. Participant 2 demonstrated large gains for both sets of treatment items with good maintenance at 2 and 6 weeks posttreatment. Effect sizes for both participants were similar to the traditional (in-person) SPT effect size benchmarks.
CONCLUSIONS
The positive outcomes from this study indicate that individuals with AOS can benefit from SPT delivered via telehealth. These findings warrant further research examining the effects of SPT through telehealth and should include individuals with AOS with varying severity. This investigation serves as the first telehealth study to systematically examine treatment outcomes for SPT.
Topics: Humans; Speech Therapy; Aphasia; Apraxias; Treatment Outcome; Telemedicine; Speech
PubMed: 37541301
DOI: 10.1044/2023_AJSLP-22-00301 -
Surgical Case Reports Dec 2023Mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare...
BACKGROUND
Mitral-aortic intervalvular fibrosa (MAIVF) is a fibrous region connecting the anterior mitral leaflet (AML) and aortic valve. Pseudoaneurysm of the MAIVF is a rare condition that has been reported as a sequela of infective endocarditis (IE) and surgical trauma. Here, we report a case of a ruptured pseudoaneurysm of the MAIVF, along with some literature reviews.
CASE PRESENTATION
A 65-year-old man diagnosed with moderate aortic regurgitation five years previously had a fever of unknown origin. He suddenly developed headache and apraxia and was transported to our hospital. He was diagnosed with intracranial hemorrhage and admitted. One week after admission, echocardiography revealed aorto-mitral discontinuity and protrusion with severe regurgitant flow from left ventricular outflow tract to the left atrium. The AML was suspected to have ruptured. However, intraoperatively, the AML structure was preserved. A ruptured pseudoaneurysm of the MAIVF was also observed. Therefore, we successfully performed pseudoaneurysm repair using a bovine pericardial patch, aortic valve replacement, and mitral annuloplasty.
CONCLUSIONS
P-MAIVF is a rare but potentially life-threatening complication of IE, for which timely diagnosis and prompt appropriate therapeutic intervention are required. In the present case, although neither obvious active IE nor history of previous IE could be identified, healed IE was considered based on the clinical course. The patient had intracranial hemorrhage (ICH) with well-controlled heart failure and underwent elective surgical repair more than one month after the onset of ICH, while the clinical course after the surgical procedure was uneventful.
PubMed: 38044395
DOI: 10.1186/s40792-023-01789-3 -
Pediatric Neurology Feb 2024Individuals with childhood apraxia of speech (CAS) were reported to have genetic variations related to gluten sensitivity and some neuroanatomic changes, which could be...
BACKGROUND
Individuals with childhood apraxia of speech (CAS) were reported to have genetic variations related to gluten sensitivity and some neuroanatomic changes, which could be associated with alterations in neurotransmitters levels such as glutamate and gamma-aminobutyric acid (GABA). The aim was to measure the levels of antigliadin immunoglobulin A (IgA) antibody, glutamate, and GABA in the plasma of children with CAS compared with children with delayed language development (DLD) and neurotypical (NT) children.
METHODS
The participants (N = 120) were in three groups: Group I for CAS (N = 30), Group II for DLD (N = 60), and Group III for NT (N = 30). The abilities of children in Groups I and II were evaluated. The plasma levels of antigliadin IgA, glutamate, and GABA were determined by enzyme-linked immunosorbent assay.
RESULTS
The intelligence quotient and expressive language age in Group I were low compared with Group II (P = 0.001; 0.004). The levels of antigliadin IgA and glutamate in Group I were higher compared with the other two groups, whereas the level of GABA was lower (P < 0.0001). An imbalance between glutamate and GABA was found in Group I. In Group II, no measures differed from NTs except lower GABA levels (P = 0.0007).
CONCLUSIONS
The elevated levels of antigliadin IgA antibody and glutamate demonstrated high sensitivity and specificity, differentiating children with CAS from children with DLD and NT children. The low levels of GABA contributed to the imbalance between the excitatory and inhibitory neurotransmitters' levels detected in children with CAS.
Topics: Child; Humans; Speech; Glutamic Acid; Apraxias; Malabsorption Syndromes; Immunoglobulin A; Glutens; gamma-Aminobutyric Acid; Neurotransmitter Agents
PubMed: 38154236
DOI: 10.1016/j.pediatrneurol.2023.11.012 -
Cold Spring Harbor Molecular Case... Dec 2023Rare genetic conditions are challenging for the primary care provider to manage without proper guidelines. This clinical review is designed to assist the pediatrician,...
Rare genetic conditions are challenging for the primary care provider to manage without proper guidelines. This clinical review is designed to assist the pediatrician, family physician, or internist in the primary care setting to manage the complexities of 16p11.2 deletion syndrome. A multidisciplinary medical home with the primary care provider leading the care and armed with up-to-date guidelines will prove most helpful to the rare genetic patient population. A special focus on technology to fill gaps in deficits, review of case studies on novel medical treatments, and involvement with the educational system for advocacy with an emphasis on celebrating diversity will serve the rare genetic syndrome population well.
Topics: Child; Humans; Adolescent; Chromosome Deletion; Chromosome Disorders; Autistic Disorder; Intellectual Disability; Chromosomes, Human, Pair 16
PubMed: 38050025
DOI: 10.1101/mcs.a006316 -
Parkinsonism & Related Disorders Jun 2024Patients with classic-onset corticobasal syndrome (CBS) present with asymmetric limb apraxia and parkinsonism. We have, however, observed patients who initially present...
INTRODUCTION
Patients with classic-onset corticobasal syndrome (CBS) present with asymmetric limb apraxia and parkinsonism. We have, however, observed patients who initially present with speech and/or language (SL) problems and several years later develop CBS (i.e., SL-onset CBS). We aimed to compare clinical, neuroimaging and pathological characteristics of classic-onset CBS with SL-onset CBS.
METHODS
We conducted a retrospective cohort study of 62 patients who met criteria for CBS (17 presented with classic-onset CBS and 45 had SL-onset CBS). We compared demographics, clinical characteristics, and grey and white matter volume loss with SPM12 between groups and assessed pathology and corticobasal degeneration (CBD) pathological lesion counts in patients who had died and undergone autopsy.
RESULTS
Median age at CBS diagnosis was 66.4 years in classic-onset CBS and 73.6 years in SL-onset CBS. Classic-onset CBS had higher frequencies of dystonia, myoclonus, and alien limb phenomenon, while SL-onset CBS had a higher frequency of vertical supranuclear gaze palsy. Both groups showed smaller frontoparietal volumes than controls, with SL-onset CBS having greater volume loss in the left supplementary motor area than classic-onset CBS. All three classic-onset CBS cases with autopsy (100 %) had CBD pathology while 8/21 of SL-onset CBS cases (38 %) had CBD. Pathological lesion burden (including astrocytic plaques) did not differ between classic-onset and SL-onset CBS.
CONCLUSION
Classic-onset and SL-onset CBS appear to be different syndromes, with the former being a more profuse motor syndrome. The more widespread volume loss in SL-onset CBS likely reflects longer disease course.
PubMed: 38875956
DOI: 10.1016/j.parkreldis.2024.107025 -
MedRxiv : the Preprint Server For... Apr 2024Apraxia is a core feature of Alzheimer's disease, but the pathomechanism of this characteristic symptom is not well understood. Here, we systematically investigated...
OBJECTIVES
Apraxia is a core feature of Alzheimer's disease, but the pathomechanism of this characteristic symptom is not well understood. Here, we systematically investigated apraxia profiles in a well-defined group of patients with Alzheimer's disease (AD; N=32) who additionally underwent PET imaging with the second-generation tau PET tracer [18F]PI-2620. We hypothesized that specific patterns of tau pathology might be related to apraxic deficits.
METHODS
Patients (N=32) with a biomarker-confirmed diagnosis of Alzheimer's disease were recruited in addition to a sample cognitively unimpaired controls (CU ; N=41). Both groups underwent in-depth neuropsychological assessment of apraxia (Dementia Apraxia Screening Test; DATE and the Cologne Apraxia Screening; KAS). In addition, static PET imaging with [18F]PI-2620 was performed to assess tau pathology in the AD patients. To specifically investigate the association of apraxia with regional tau-pathology, we compared the PET-data from this group with an independent sample of amyloid-negative cognitively intact participants (CU N=54) by generation of z-score-deviation maps as well as voxel- based multiple regression analyses.
RESULTS
We identified significant clusters of tau-aggregation in praxis-related regions (e.g., supramarginal gyrus, angular gyrus, temporal, parietal and occipital regions) that were associated with apraxia. These regions were similar between the two apraxia assessments. No correlations between tau-tracer uptake in primary motor cortical or subcortical brain regions and apraxia were observed.
CONCLUSIONS
These results suggest that tau deposition in specific cortical brain regions may induce local neuronal dysfunction leading to a dose-dependent functional decline in praxis performance.
PubMed: 38645131
DOI: 10.1101/2024.04.09.24305535 -
Journal of Speech, Language, and... May 2024The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of...
PURPOSE
The purposes of this review article were to provide an introduction to and "bird's-eye" overview of the current evidence base for treatment of childhood apraxia of speech (CAS), identify some gaps and trends in this rapidly growing literature, and formulate some future research directions, in order to advance the evidence base and clinical practice for children with CAS.
METHOD
Following a brief introduction outlining important concepts, a narrative review of the CAS treatment literature is provided, and trends and future directions are identified based on this review. The review is organized around four fundamental treatment research questions: (a) "Does Treatment X work?", (b) "Does Treatment X work better than Treatment Y?", (c) "For whom does Treatment X work?", and (d) "What does 'work' mean, anyway?"
RESULTS
A wide range of CAS treatments with varying degrees of evidence for efficacy exists. Research is beginning to emerge that compares different treatments and seeks to determine optimal treatment parameters. Few studies to date have explored child-level predictors of treatment response, and the evidence base currently is limited in scope with respect to populations and outcomes studied.
CONCLUSIONS
A growing evidence base supports the efficacy of a number of treatments for CAS. However, many important gaps in the literature were identified that warrant redoubled and sustained research attention. Research is beginning to emerge that addresses treatment optimization, comparison, candidacy, and outcomes. Suggestions for future research are offered, and the concept of a hypothesized pathway was applied to CAS to illustrate how components of an intervention can effect change in a clinical goal and can help guide development and refinement of treatments for children with CAS.
PubMed: 38768073
DOI: 10.1044/2024_JSLHR-23-00233