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Frontiers in Neurology 2022Verbal auditory agnosia is rarely caused by mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Lactate acidosis, which is the...
INTRODUCTION
Verbal auditory agnosia is rarely caused by mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Lactate acidosis, which is the adverse effect of metformin, has proposed links to mitochondrial dysfunction and may trigger clinical features of mitochondrial diseases.
CASE PRESENTATION
A 43-year-old right-handed man presented to our emergency department with acute onset fever and headache accompanied by impaired hearing comprehension. He could communicate well through handwritten notes but could not understand what others were saying. He had been diagnosed as having diabetes mellitus 2 months prior to this event. Vildagliptin 100 mg/day and metformin 1,700 mg/day were prescribed for glucose control. Laboratory tests revealed elevated lactate levels in serum and cerebrospinal fluid of the patient. Brain MRI disclosed bilateral temporal lesions. Acute encephalitis with temporal involved was initially diagnosed and acyclovir was given empirically. However, follow-up MRI after acyclovir treatment revealed a progression of prior lesions. Further mitochondrial genome analysis revealed a mitochondrial DNA point mutation at position 3,243 (m.3243A > G) with 25% heteroplasmy, which is compatible with MELAS. His clinical symptoms and serum lactate levels were improved after discontinuing the metformin use.
CONCLUSIONS
To our knowledge, this is the first report of a patient having late-onset MELAS syndrome that manifested as acute verbal auditory agnosia, which was identified after the patient began using metformin. Metformin is known to inhibit mitochondrial function and could trigger clinical features of MELAS syndrome. We encourage clinicians to maintain a high level of awareness that diabetes mellitus can be caused by mitochondrial disease and to exercise caution in the prescription of metformin.
PubMed: 35401420
DOI: 10.3389/fneur.2022.863047 -
New Microbes and New Infections Mar 2022There are few data on the range and severity of symptoms of SARS-CoV-2 infection or the impact on life quality in infected, previously healthy, young adults such as...
There are few data on the range and severity of symptoms of SARS-CoV-2 infection or the impact on life quality in infected, previously healthy, young adults such as Swiss Armed Forces personnel. It is also unclear if an app can be used to remotely monitor symptoms in persons who test positive. Using a smartphone app called ITITP (Illness Tracking in Tested Persons) and weekly pop-up questionnaires, we aimed to evaluate the spectrum, duration, and impact of symptoms reported after a positive SARS-CoV-2 test according to sex, age, location, and comorbidities, and to compare these to responses from persons who tested negative. We followed up 502 participants (57% active participation), including 68 (13.5%) positive tested persons. Hospitalisation was reported by 6% of the positive tested participants. We found that positives reported significantly more symptoms that are typical of COVID-19 compared to negatives. These symptoms with odds ratio (OR > 1) were (OR 3.35; 95% CI: 1.16, 9.65; p = 0.03), (OR 5.45; 95% CI: 1.22, 24.34; p = 0.03) and a (OR 18.24; 95% CI: 4.23, 78.69; p < 0.001). Using a random forest model, we showed that was the single symptom that was rated as having a significant impact on daily activities, whereas the other symptoms, although frequent, had less impact. The study showed that the use of an app was feasible to remotely monitor symptoms in persons infected with SARS-CoV-2 and could be adapted for other settings and new pandemic phases such as the current Omicron wave.
PubMed: 35287272
DOI: 10.1016/j.nmni.2022.100967 -
Neuropsychologia Jun 2022In right-handed adults, face processing is lateralized to the right hemisphere and visual word processing to the left hemisphere. According to the many-to-many account...
In right-handed adults, face processing is lateralized to the right hemisphere and visual word processing to the left hemisphere. According to the many-to-many account (MTMA) of functional cerebral organization this lateralization pattern is partly dependent on the acquisition of literacy. Hence, the MTMA predicts that: (i) processing of both words and faces should show no or at least less lateralization in individuals with developmental dyslexia compared with controls, and (ii) lateralization in word processing should be normal in individuals with developmental prosopagnosia whereas lateralization in face processing should be absent. To test these hypotheses, 21 right-handed adults with developmental dyslexia and 21 right-handed adults with developmental prosopagnosia performed a divided visual field paradigm with delayed matching of faces, words and cars. Contrary to the predictions, we find that lateralization effects in face processing are within the normal range for both developmental dyslexics and prosopagnosics. Moreover, the group with developmental dyslexia showed right hemisphere lateralization for word processing. We argue that these findings are incompatible with the specific predictions of the MTMA.
Topics: Adult; Dyslexia; Facial Recognition; Functional Laterality; Humans; Pattern Recognition, Visual; Prosopagnosia; Visual Perception
PubMed: 35278463
DOI: 10.1016/j.neuropsychologia.2022.108208 -
Brain Sciences Feb 2022Dementia is a neurodegenerative disease that leads to the development of cognitive deficits, such as aphasia, apraxia, and agnosia. It is currently considered one of the...
Dementia is a neurodegenerative disease that leads to the development of cognitive deficits, such as aphasia, apraxia, and agnosia. It is currently considered one of the most significant major medical problems worldwide, primarily affecting the elderly. This condition gradually impairs the patient's cognition, eventually leading to the inability to perform everyday tasks without assistance. Since dementia is an incurable disease, early detection plays an important role in delaying its progression. Because of this, tools and methods have been developed to help accurately diagnose patients in their early stages. State-of-the-art methods have shown that the use of syntactic-type linguistic features provides a sensitive and noninvasive tool for detecting dementia in its early stages. However, these methods lack relevant semantic information. In this work, we propose a novel methodology, based on the semantic features approach, by using sentence embeddings computed by Siamese BERT networks (SBERT), along with support vector machine (SVM), K-nearest neighbors (KNN), random forest, and an artificial neural network (ANN) as classifiers. Our methodology extracted 17 features that provide demographic, lexical, syntactic, and semantic information from 550 oral production samples of elderly controls and people with Alzheimer's disease, provided by the DementiaBank Pitt Corpus database. To quantify the relevance of the extracted features for the dementia classification task, we calculated the mutual information score, which demonstrates a dependence between our features and the MMSE score. The experimental classification performance metrics, such as the accuracy, precision, recall, and F1 score (77, 80, 80, and 80%, respectively), validate that our methodology performs better than syntax-based methods and the BERT approach when only the linguistic features are used.
PubMed: 35204032
DOI: 10.3390/brainsci12020270 -
Medicine Feb 2022The new vaccines are emergently authorized and currently approved for use to protect against the coronavirus disease 2019 (COVID-19) pandemic and serious adverse events...
RATIONALE
The new vaccines are emergently authorized and currently approved for use to protect against the coronavirus disease 2019 (COVID-19) pandemic and serious adverse events are uncommon. Moyamoya disease (MMD) with autoimmune disease is a rare entity and usually presents with intracranial hemorrhage in adults.
PATIENT CONCERNS
We reported a 40-year-old female patient with Sjogren disease and autoimmune thyroiditis, who had received the second dose of Moderna (mRNA-1273) vaccination. Three days later, she presented with left intraventricular and intracerebral hemorrhage as a complication.
DIAGNOSIS
After a series of diagnostic workups, left intracranial hemorrhage was associated with MMD.
INTERVENTIONS
Emergent external ventricular drainage and subsequent stereotactic evacuation of hematoma with insertion of intracranial pressure monitoring were performed.
OUTCOMES
Under the care of the neurocritical care team, her physical condition improved gradually. The neurological sequelae was noted by defects of cognitive function, apraxia, agnosia, and impaired executive function. She was discharged after eight weeks with a follow-up in the vascular neurology clinic planning for performing revascularization.
LESSONS
To the best of our knowledge, no similar case has been reported before, and this is the first case of MMD complicated with intracerebral and intraventricular hemorrhage after mRNA-1273 vaccination. It is noticeable to assess the vaccine safety surveillance and raise the alertness about moyamoya in patients with autoimmune diseases during the COVID-19 pandemic. Further studies for risk evaluation of COVID-19 vaccines in patients with autoimmune diseases might be required in the future.
Topics: 2019-nCoV Vaccine mRNA-1273; Adult; COVID-19; Cerebral Hemorrhage; Female; Humans; Intracranial Hemorrhages; Moyamoya Disease; Pandemics; RNA, Messenger; SARS-CoV-2; Sjogren's Syndrome; Thyroiditis, Autoimmune
PubMed: 35147099
DOI: 10.1097/MD.0000000000028756 -
European Review For Medical and... Jan 2022COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected...
OBJECTIVE
COVID-19 infection can cause impairments in many cognitive areas. The aim of the present study was to evaluate the cognitive functions of patients who had been infected with COVID-19.
PATIENTS AND METHODS
The demographic and infection-related characteristics of patients who had been infected with COVID-19 were determined. Their cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) findings were recorded. The Mini-Mental State Evaluation (MMSE), clock drawing test, forward and backward digit span tests, visual memory test, and Frontal Assessment Battery were applied to the patients. Finger agnosia and ideomotor apraxia were also determined.
RESULTS
The study included 176 patients [100 female (56.8%), 76 male (43.2%), mean age 66.09±13.96 years]. About half of the patients were hospitalized for symptoms of COVID-19 infection (n=82, 46.6%). One third of these patients required intensive care (n=26, 14.8%). While 50 (45.9%) of the 109 patients diagnosed with dementia before infection were hospitalized, 32 (47.8%) of the 67 patients without a diagnosis of dementia required hospitalization (p=0.46). The most common neurological finding during COVID-19 infection was insomnia (n=36, 20.5%). The MMSE and visual memory test scores of the patients who were hospitalized for severe respiratory distress were lower than those whose treatment at home was completed (respectively 17.92±7.69/20.59±7.01, p=0.02; 2.53 ±1.73/3.69±2.80, p=0.01). The patients with moderate to severe cognitive impairment had significantly higher CRP levels at admission than the others (37.52±43.09/20.93±31.74, p=0.01, respectively).
CONCLUSIONS
Cognitive damage in COVID-19 infection may be caused by ACE receptor density in the pial, hippocampal, and amygdala areas. In addition, the reason why people with severe dementia have a milder infection might be explained by the atrophy in these areas.
Topics: Aged; Aged, 80 and over; C-Reactive Protein; COVID-19; Cognitive Dysfunction; Critical Care; Cross-Sectional Studies; Dementia; Electroencephalography; Female; Hospitalization; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; SARS-CoV-2; Severity of Illness Index; Sleep Initiation and Maintenance Disorders
PubMed: 35113443
DOI: 10.26355/eurrev_202201_27894 -
Cortex; a Journal Devoted To the Study... Feb 2022An 84-year-old man manifested false recognition/misidentification of unfamiliar person after cardiogenic cerebral infarction. He had good visual and hearing acuity, no...
An 84-year-old man manifested false recognition/misidentification of unfamiliar person after cardiogenic cerebral infarction. He had good visual and hearing acuity, no hemianopsia, unilateral spatial neglect and visual object agnosia. However, he was unable to remember faces of his rehabilitation therapists, and repeatedly misidentified other patients' visitors and therapists as his family members and friends, without recognizing his mistakes. General cognitive function was preserved with Hasegawa dementia score-revised (HDS-R) 25/30 (cut-off score 20). In terms of recognition of faces, tasks not requiring recognition of facial identity, such as interpreting facial emotions, and gender and age assessment, were relatively preserved, but recognition of family members and celebrities was severely impaired, and matching unfamiliar faces was slightly impaired. Semantic information of family and friends was retained. Although his symptoms resembled associative prosopagnosia, they differed from general associative prosopagnosia in having phonagnosia. MRI lesions were localized in the frontal and temporal lobes including the right anterior temporal lobe, and not in the right occipital and temporal lobes considered to the lesion site of multimodal people recognition disorders manifesting inability of utilization of visual (face) and auditory (voice) cues for person identification. In addition to the facial cognitive impairment, impaired exploratory (monitoring) function of the frontal lobe on the temporal lobe may also contribute to the false recognition/misidentification of this case.
Topics: Aged, 80 and over; Agnosia; Cerebral Infarction; Cognition; Humans; Male; Prosopagnosia; Temporal Lobe
PubMed: 35051711
DOI: 10.1016/j.cortex.2021.12.005 -
Brain Sciences Dec 2021The aim of this article is to discuss the logic and assumptions behind the concept of neural reuse, to explore its biological advantages and to discuss the implications... (Review)
Review
The aim of this article is to discuss the logic and assumptions behind the concept of neural reuse, to explore its biological advantages and to discuss the implications for the cognition of a brain that reuses existing circuits and resources. We first address the requirements that must be fulfilled for neural reuse to be a biologically plausible mechanism. Neural reuse theories generally take a developmental approach and model the brain as a dynamic system composed of highly flexible neural networks. They often argue against domain-specificity and for a distributed, embodied representation of knowledge, which sets them apart from modular theories of mental processes. We provide an example of reuse by proposing how a phylogenetically more modern mental capacity (mental rotation) may appear through the reuse and recombination of existing resources from an older capacity (motor planning). We conclude by putting arguments into context regarding functional modularity, embodied representation, and the current ontology of mental processes.
PubMed: 34942954
DOI: 10.3390/brainsci11121652 -
Neuropsychologia Jan 2022In recent years, the number of face identity matching tests in circulation has grown considerably and these are being increasingly utilized to study individual...
In recent years, the number of face identity matching tests in circulation has grown considerably and these are being increasingly utilized to study individual differences in face cognition. Although many of these tests were designed for testing typical observers, recent studies have begun to utilize general-purpose tests for studying specific, atypical populations (e.g., super-recognizers and individuals with prosopagnosia). In this study, we examined the capacity of four tests requiring binary face-matching decisions to study individual differences between healthy observers. Uniquely, we used performance of the patient PS (Rossion, 2018), a well-documented case of acquired prosopagnosia (AP), as a benchmark. Two main findings emerged: (i) PS could exhibit typical rates of accuracy in all tests; (ii) compared to age-matched controls and when considering both accuracy and speed to account for potential trade-offs, only the KFMT - but not the EFCT, PICT or GFMT - was able to detect PS's severe impairment. These findings reflect the importance of considering both accuracy and response times to measure individual differences in face matching, and the need for comparing tests in terms of their sensitivity, when used as a measure of human cognition and brain functioning.
Topics: Face; Humans; Neuropsychological Tests; Pattern Recognition, Visual; Photic Stimulation; Prosopagnosia; Reaction Time
PubMed: 34919897
DOI: 10.1016/j.neuropsychologia.2021.108119 -
Continuum (Minneapolis, Minn.) Dec 2021Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive... (Review)
Review
PURPOSE OF REVIEW
Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke.
RECENT FINDINGS
Stroke and occupational therapy practice guidelines stress a quality standard for spatial neglect assessment and treatment to reduce adverse outcomes for patients, their families, and society. Neurologists may attribute poor outcomes associated with spatial neglect to stroke severity. However, people with spatial neglect are half as likely to return to home and community, have one-third the community mobility, and require 3 times as much caregiver supervision compared with similar stroke survivors. Multiple randomized trials support a feasible first-line rehabilitation approach for spatial neglect: prism adaptation therapy; more than 20 studies reported that this treatment improves daily life independence. Evidence-based treatment of anosognosia is not as developed; however, treatment for this problem is also available.
SUMMARY
This article guides neurologists' assessment of right brain cognitive disorders and describes how to efficiently assemble and direct a treatment team to address spatial neglect and unawareness of deficit.
Topics: Agnosia; Brain; Humans; Perceptual Disorders; Stroke; Stroke Rehabilitation
PubMed: 34881729
DOI: 10.1212/CON.0000000000001076