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Journal of Medical Case Reports Jan 2022The relatively isolated atrophy of the temporal lobes leads to a clinical radiological pattern, referred to as the temporal variant of frontotemporal dementia. While...
BACKGROUND
The relatively isolated atrophy of the temporal lobes leads to a clinical radiological pattern, referred to as the temporal variant of frontotemporal dementia. While semantic dementia and behavioral variant frontotemporal dementia are classically related to this syndrome, the logopenic variant of primary progressive aphasia has been less commonly reported. This case report aims to give a pictorial description of a case in which a patient with asymmetric temporal lobe atrophy presented with the logopenic variant of primary progressive aphasia and complex rituals of cleanliness.
CASE PRESENTATION
We report on the case of a 68-year-old, right-handed White woman with complex rituals and progressive speech impairment. The obsessive-compulsive rituals represented an exacerbation of lifelong preoccupations with cleanliness and orderliness that were praised by her relatives. Neuropsychological assessment revealed a striking impairment of language and memory, with relative sparing of tool-use praxis and visuospatial skills. Magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography scans showed bilateral asymmetrical temporal lobe atrophy and hypometabolism. A year later, she was still able to entertain conversation for a short while, but her vocabulary and fluency had further declined. Praxis and visuospatial skills remained intact. She did not experience pathological elation, delusions, or hallucinations. The disease followed a relentless progression into a partial Klüver-Bucy syndrome, abulia, and terminal dementia. She died from acute myocardial infarction 8 years after the onset of aphasia. The symptoms and their temporal course supported a diagnosis of logopenic variant of primary progressive aphasia due to asymmetric temporal variant frontotemporal lobar degeneration.
CONCLUSIONS
This report gives a pictorial description of a temporal variant of frontotemporal dementia in a patient who presented with worsening of a lifelong obsessive-compulsive disorder and logopenic variant of primary progressive aphasia.
Topics: Aged; Aphasia, Primary Progressive; Atrophy; Female; Frontotemporal Dementia; Humans; Magnetic Resonance Imaging; Temporal Lobe
PubMed: 35045865
DOI: 10.1186/s13256-021-03228-z -
Neuron Mar 2009Beginning approximately a decade and a half ago, it was suggested that some structures that are considered to be part of the "medial temporal lobe memory system" could... (Review)
Review
Beginning approximately a decade and a half ago, it was suggested that some structures that are considered to be part of the "medial temporal lobe memory system" could play a role in perception as well. The implications of this view, interpreted broadly, are that medial temporal lobe structures may be understood as an extension of the ventral visual stream and that their functions cannot be described exclusively in terms of memory. Considerable evidence now supports the view that medial temporal lobe structures are involved in nonmnemonic aspects of cognition, such as perception. This discovery allows for a fuller understanding of the involvement of these structures in mental phenomena than does a purely mnemonic account of their function. See the related review by Suzuki, "Perception and the Medial Temporal Lobe: Evaluating the Current Evidence," in this issue of Neuron.
Topics: Animals; Humans; Memory; Models, Biological; Perception; Temporal Lobe
PubMed: 19285463
DOI: 10.1016/j.neuron.2009.02.007 -
Medicine Sep 2018Temporal lobe necrosis as result of radiation for nasopharyngeal cancer (NPC) occurs up to 28% of NPC patients. The only effective mitigation is by strict adherence to...
Temporal lobe necrosis as result of radiation for nasopharyngeal cancer (NPC) occurs up to 28% of NPC patients. The only effective mitigation is by strict adherence to temporal lobe dose tolerances during radiotherapy planning, which in turn hinges on accurate temporal lobe delineation. We aim to improve the accuracy and to standardize temporal lobe contouring for patients receiving head and neck radiotherapy for NPC in a tertiary teaching hospital in Singapore.The baseline data were obtained from 10 patients in the diagnostic phase and the effect of interventions were measured in 37 patients who underwent head and neck radiotherapy over a 6-month period.We conducted the project based on the Clinical Practice Improvement Program methodology. The baseline pooled mean percentage variation in temporal lobe contouring was 39.9% (0.8%-60.2%). There was a low level of temporal lobe contouring concordance and this provided the impetus for implementation of strategies to improve the accuracy and reproducibility of temporal lobe contouring. The interventions included supervision and training of radiation therapists and residents in temporal lobe contouring, and standardization of temporal lobe contouring with a protocol and contouring atlas.Thirty-seven patients were treated during the study period from June to November 2014. Following implementation of the first set of interventions, the pooled mean percentage variation in temporal lobe contouring decreased but was not sustained. The implementation of the second set of interventions resulted in a decrease from 39.9% (January to September 2014) to 17.3% (October to November 2014) where P = .004 using t test. Weekly variation was seen throughout the study period but the decrease was sustained after standardizing and providing a contouring atlas for temporal lobe contouring.Temporal lobe contouring can be standardized through effective implementation of a temporal lobe contouring protocol and atlas.
Topics: Adult; Clinical Protocols; Female; Health Plan Implementation; Humans; Male; Middle Aged; Nasopharyngeal Neoplasms; Program Evaluation; Quality Improvement; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Temporal Lobe
PubMed: 30235702
DOI: 10.1097/MD.0000000000012381 -
NeuroImage Jul 2017The temporal lobe has been implicated in multiple cognitive domains through lesion studies as well as cognitive neuroimaging research. There has been a recent increased...
The temporal lobe has been implicated in multiple cognitive domains through lesion studies as well as cognitive neuroimaging research. There has been a recent increased interest in the structural and connective architecture that underlies these functions. However there has not yet been a comprehensive exploration of the patterns of connectivity that appear across the temporal lobe. This article uses a data driven, spectral reordering approach in order to understand the general axes of structural connectivity within the temporal lobe. Two important findings emerge from the study. Firstly, the temporal lobe's overarching patterns of connectivity are organised along two key structural axes: medial to lateral and anteroventral to posterodorsal, mirroring findings in the functional literature. Secondly, the connective organisation of the temporal lobe is graded and transitional; this is reminiscent of the original work of 19 Century neuroanatomists, who posited the existence of some regions which transitioned between one another in a graded fashion. While regions with unique connectivity exist, the boundaries between these are not always sharp. Instead there are zones of graded connectivity reflecting the influence and overlap of shared connectivity.
Topics: Adult; Diffusion Tensor Imaging; Female; Humans; Image Processing, Computer-Assisted; Male; Middle Aged; Temporal Lobe; Young Adult
PubMed: 28411156
DOI: 10.1016/j.neuroimage.2017.04.016 -
Social Cognitive and Affective... Jan 2017Besides the prefrontal cortex, the insula and medial structures of the temporal lobe are thought to be involved in risky decision-making. However, their respective...
Besides the prefrontal cortex, the insula and medial structures of the temporal lobe are thought to be involved in risky decision-making. However, their respective contributions to decision processes remain unclear due to the lack of studies involving patients with isolated insular damage. We assessed adult patients who underwent resection of the insula (n = 13) or of the anterior temporal lobe (including medial structures) (n = 13) as part of their epilepsy surgery, and a group of healthy volunteers (n = 20), on the Iowa Gambling Task (IGT) and on the Cups Task. Groups were matched on sociodemographic, estimated-IQ and surgery-related factors. On the IGT, patients with temporal lobe resection performed significantly worse than both the insular and healthy control groups, as they failed to learn which decks were advantageous on the long-term. On the Cups Task, the insular and temporal groups both showed impaired sensitivity to expected value in the loss domain, when compared with healthy controls. These findings provide clinical evidence that the insula and mesiotemporal structures are specifically involved in risky decision-making when facing a potential loss, and that temporal structures are also involved in learning the association between behavior and consequences in the long-term.
Topics: Adult; Cerebral Cortex; Decision Making; Drug Resistant Epilepsy; Female; Gambling; Humans; Male; Middle Aged; Neuropsychological Tests; Temporal Lobe; Young Adult
PubMed: 27798255
DOI: 10.1093/scan/nsw152 -
Trends in Cognitive Sciences May 2011Neuroimaging and lesion studies have seemed to converge on the idea that the hippocampus selectively supports recollection. However, these studies usually involve a...
Neuroimaging and lesion studies have seemed to converge on the idea that the hippocampus selectively supports recollection. However, these studies usually involve a comparison between strong recollection-based memories and weak familiarity-based memories. Studies that avoid confounding memory strength with recollection and familiarity almost always find that the hippocampus supports both recollection and familiarity. We argue that the functional organization of the medial temporal lobe (MTL) is unlikely to be illuminated by the psychological distinction between recollection and familiarity and will be better informed by findings from neuroanatomy and neurophysiology. These findings indicate that the different structures of the MTL process different attributes of experience. By representing the widest array of attributes, the hippocampus supports recollection-based and familiarity-based memory of multiattribute stimuli.
Topics: Animals; Diagnostic Imaging; Humans; Memory; Models, Neurological; Temporal Lobe
PubMed: 21481629
DOI: 10.1016/j.tics.2011.03.005 -
Journal of Biosciences 2020Persons with drug refractory TLE have the option of being managed by surgery. They may develop memory impairment with specific etiology of mesial temporal sclerosis and...
Persons with drug refractory TLE have the option of being managed by surgery. They may develop memory impairment with specific etiology of mesial temporal sclerosis and anterior temporal lobe resection (ATLR). The study evaluated the semantic verbal memory outcomes in pre- and post-surgery temporal lobe epilepsy (TLE) patients using functional MRI and voxel morphometric methods. Twenty consecutive persons with drug-resistant epilepsy (DRE) and 20 healthy controls were recruited after obtaining the institute ethics approval. The fMRI scans were performed on a 1.5 T MR Scanner using standardized semantic verbal memory tasks using a native Hindi paradigm, before and after an anterior temporal lobectomy (in cases). A task-based functional connectivity (FC) was estimated using a conn toolbox. Data analysis was carried out using the statistical parametric imaging (SPM12) and CAT12 toolbox. Post-surgery TLE group showed increased robust FC in the right middle and posterior temporal regions as compared to pre-surgery session. A significant reduction in grey matter volume was observed in the left temporal lobe post-operatively as compared to presurgery and healthy control groups. In the post-surgery TLE group, neuropsychological scores were reduced in specific PGI domains such as visuospatial, working memory, and executive functioning. Our results may help in understanding of memory reorganization in TLE post-operatively.
Topics: Adult; Case-Control Studies; Drug Resistant Epilepsy; Female; Humans; Magnetic Resonance Imaging; Male; Memory; Temporal Lobe; Tuberous Sclerosis; Young Adult
PubMed: 32515356
DOI: No ID Found -
The Journal of Comparative Neurology Dec 2005This article presents a three-factor anatomical model of human idea generation and creative drive, focusing on interactions between the temporal lobes, frontal lobes,... (Review)
Review
This article presents a three-factor anatomical model of human idea generation and creative drive, focusing on interactions between the temporal lobes, frontal lobes, and limbic system. Evidence is drawn from functional imaging, drug studies, and lesion analysis. Temporal lobe changes, as in hypergraphia, often increase idea generation, sometimes at the expense of quality. Frontal lobe deficits may decrease idea generation, in part because of rigid judgments about an idea's worth. These phenomena are clearest in verbal creativity, and roughly parallel the pressured communication of temporal lobe epilepsy, mania, and Wernicke's aphasia-compared to the sparse speech and cognitive inflexibility of depression, Broca's aphasia, and other frontal lobe lesions. The phenomena also shape non-linguistic creativity, as in that of frontotemporal dementia. The appropriate balance between frontal and temporal activity is mediated by mutually inhibitory corticocortical interactions. Mesolimbic dopamine influences novelty seeking and creative drive. Dopamine agonists and antagonists have opposite effects on goal-directed behavior and hallucinations. Creative drive is not identical to skill-the latter depends more on neocortical association areas. However, drive correlates better with successful creative output than skill does. Traditional neuroscientific models of creativity, such as the left brain - right brain hemispheric model, emphasize skills primarily, and stress art and musical skill at the expense of language and mathematics. The three-factor model proposed here predicts findings in a broad range of normal and pathological states and can be tested in many experimental paradigms.
Topics: Creativity; Dopamine; Drive; Frontal Lobe; Humans; Imagination; Limbic System; Logistic Models; Models, Neurological; Temporal Lobe
PubMed: 16254989
DOI: 10.1002/cne.20768 -
Neuron Mar 2009A dominant view in the learning and memory literature states that a subset of anatomically related structures within the medial temporal lobe (MTL), including the... (Review)
Review
A dominant view in the learning and memory literature states that a subset of anatomically related structures within the medial temporal lobe (MTL), including the hippocampus, entorhinal, perirhinal, and parahippocampal cortices, forms a functionally related system specialized for declarative memory but not for perception. However, recent reports challenge this view, suggesting instead that the medial temporal lobe is not only important for memory, but also critical for certain forms of perception. In this review, I argue that little or no conclusive evidence currently exists to support the latter view. Experimental studies that have examined the perceptual functions of the MTL in monkeys are inconclusive because they fail to isolate perceptual from mnemonic task demands. Evaluation of conflicting results from studies in human amnesic patients suggests that extraneous damage to extra-MTL areas may underlie the reported perceptual deficits in the group of amnesic patients at the heart of this debate. See the related Review from Baxter, "Involvement of Medial Temporal Lobe Structures in Memory and Perception," in this issue of Neuron.
Topics: Animals; Humans; Perception; Temporal Lobe
PubMed: 19285462
DOI: 10.1016/j.neuron.2009.02.008 -
Cerebral Cortex (New York, N.Y. : 1991) Jun 2023The prefrontal cortex (PFC) has long been associated with arbitrating between approach and avoidance in the face of conflicting and uncertain motivational information,...
The prefrontal cortex (PFC) has long been associated with arbitrating between approach and avoidance in the face of conflicting and uncertain motivational information, but recent work has also highlighted medial temporal lobe (MTL) involvement. It remains unclear, however, how the contributions of these regions differ in their resolution of conflict information and uncertainty. We designed an fMRI paradigm in which participants approached or avoided object pairs that differed by motivational conflict and outcome uncertainty (complete certainty vs. complete uncertainty). Behavioral data and decision-making parameters estimated using the hierarchical drift diffusion model revealed that participants' responding was driven by conflict rather than uncertainty. Our neural data suggest that PFC areas contribute to cognitive control during approach-avoidance conflict by potentially adjusting response caution and the strength of evidence generated towards either choice, with differential involvement of anterior cingulate cortex and dorsolateral prefrontal cortex. The MTL, on the other hand, appears to contribute to evidence generation, with the hippocampus linked to evidence accumulation for stimuli. Although findings within perirhinal cortex were comparatively equivocal, some evidence suggests contributions to perceptual representations, particularly under conditions of threat. Our findings provide evidence that MTL and PFC regions may contribute uniquely to arbitrating approach-avoidance conflict.
Topics: Humans; Hippocampus; Temporal Lobe; Prefrontal Cortex; Magnetic Resonance Imaging; Motivation
PubMed: 36944537
DOI: 10.1093/cercor/bhad080