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Pediatrics 2017; of preterm birth in women with singleton pregnancy and 140(4):e20170044 herbs to lower cholesterol discount ayurslim online mastercard. Prevention of preterm and later neurodevelopmental risk in the very preterm parturition planetary herbals quality 60 caps ayurslim with amex. Efect of antibiotic use on Sepsis in a National Cohort of Very Low Birth Weight antimicrobial antibiotic resistance and late-onset neonatal Infants herbals that cause insomnia purchase ayurslim with paypal. Fetal, neonatal, and infant microbiome: bowel disease exacerbation: A multicenter validation study. De Cristófano A Uso adecuado de antibióticos en antibiotic use and protective efects of breastfeeding role of neonatología. Ryan Darby, * Simon Laganiere, * Alvaro Pascual-Leone, Sashank Prasad and 1,2,5 Michael D. Focal brain injury can sometimes lead to bizarre symptoms, such as the delusion that a family member has been replaced by an imposter (Capgras syndrome). How a single brain lesion could cause such a complex disorder is unclear, leading many to speculate that concurrent delirium, psychiatric disease, dementia, or a second lesion is required. Here we instead propose that Capgras and other delusional misidentiﬁcation syndromes arise from single lesions at unique locations within the human brain connectome. This hypothesis is motivated by evidence that symptoms emerge from sites functionally connected to a lesion location, not just the lesion location itself. First, 17 cases of lesion-induced delusional misidentiﬁcations were identiﬁed and lesion locations were mapped to a common brain atlas. Second, lesion network mapping was used to identify brain regions functionally connected to the lesion locations. Third, regions involved in familiarity perception and belief evaluation, two processes thought to be abnormal in delu sional misidentiﬁcations, were identiﬁed using meta-analyses of previous functional magnetic resonance imaging studies. We found that all 17 lesion locations were functionally connected to the left retrosplenial cortex, the region most activated in functional magnetic resonance imaging studies of familiarity. Similarly, 16 of 17 lesion locations were functionally connected to the right frontal cortex, the region most activated in functional magnetic resonance imaging studies of expectation violation, a component of belief evaluation. This connectivity pattern was highly speciﬁc for delusional misidentiﬁcations compared to four other lesion induced neurological syndromes (P 5 0. Finally, 15 lesions causing other types of delusions were connected to expectation violation (P 5 0. Our results provide potential neuroanatomical correlates for impaired familiarity perception and belief evaluation in patients with delusional misidentiﬁcations. More generally, we demonstrate a mechanism by which a single lesion can cause a complex neuropsychiatric syndrome based on that lesion’s unique pattern of functional connectivity, without the need for pre-existing or hidden pathology. Third, and per striking and least understood syndromes encountered in haps most challenging, it is difﬁcult to explain how a single neurology and psychiatry (for an example of a patient’s brain lesion could disrupt multiple different network func description, see Supplementary Video 1). In Capgras syn tions as required by the ‘two hit’ and other theories drome, a patient is able to identify and recognize a familiar (Coltheart, 2007, 2010). Due in part to these difﬁculties, person, such as a spouse or parent, but experiences that it has been suggested that only patients with pre-existing person as unfamiliar, leading to the bizarre conclusion that psychiatric disease (Devine et al. In Fregoli syndrome, factors (Ellis and Young, 1990) are susceptible to lesion a stranger is believed to be a familiar person in disguise induced delusional misidentiﬁcations. Similar delusional misidentiﬁca Recently, we developed and validated a technique termed tions can occur for non-human animals (Darby and lesion network mapping for investigating lesion-induced Caplan, 2016) and personally relevant locations and build neurological symptoms (Boes et al. Here, we his original report, Capgras proposed that dysfunction of apply this technique towards understanding lesion-induced brain regions involved in the experience of familiarity must delusional misidentiﬁcations. It re locations causing delusional misidentiﬁcations would be mains unclear which brain regions are involved in this ab connected to regions involved in familiarity processing normal sense of familiarity, although dysfunction of the and belief evaluation. In addition to impaired famil Materials and methods iarity perception, other theories have proposed deﬁcits in theory of mind (Hirstein, 2010), personal relatedness Patient cases from the literature (Feinberg, 2011), or autobiographical memory (Staton To identify patients with delusional misidentiﬁcations for per et al. Patients were required to have a delusional belief involving mal perception leading to the speciﬁc bizarre content for a the sense of under-familiarity for a person (Capgras) or place given delusion; and (ii) impaired belief evaluation, which (reduplicative amnesia), or the feeling of over-familiarity for a allows the abnormal delusional belief to form (Coltheart, person (Fregoli) or place (reduplicative paramnesia). Other models propose that belief and percep criteria included clinical data sufﬁcient to determine the nature tion are integrated into a single process, such as prediction of the delusion, an acute, localized neurological injury (ischae error (Corlett et al. While each theory proposes abnormal familiarity Patients with pre-existing psychiatric or neurological disease perception and belief evaluation, a neurobiological explan were excluded. Fifteen patients were identiﬁed using these cri ation for how this might occur in patients with delusional teria (Supplementary Table 1).
Alternative image onto follow-up images herbals biz purchase ayurslim 60caps otc, allowing “compression maps” to herbs and uses buy cheap ayurslim 60 caps on-line manual and automated image analysis techniques are in (88 aasha herbals buy generic ayurslim 60caps online, 90, 104) provide rates of atrophy in different regions. These merit comparison with the forgoing methods hold considerable potential to reduce user input, outcome measures in future multicenter studies to determine the especially with multiple scans per subject, however, more most powerful markers of disease progression. Sample size estimates depend on the degree of homogeneity of disease severity in subjects, method of data 2. Although higher field on digitized images is the best validated and recommended strengths (3T and above) may improve contrast and resolution method. There are some published data on sample would encourage pursuit of these interests. In the future, automated registration assurance should be the responsibility of and managed by an algorithms might increase the comparability of findings between independent image-analysis coordinating center. To date, there is little (97, 98) According to accelerated approval regulations for serious or life experience with this technique in dementia. Foster, Eric Reinman, Mony de Leon, Michael Weiner (ex officio), and Zaven Khachaturian (Secretary). Alzheimer’s Association Neuroimaging Work Group Consensus Report Page 7 of 15 brain. In clinical studies, the reliability of image during standardized behavioral tasks (for example, visual, (120) interpretation needs to be further studied. However, studies performed during mental rest currently have the best established C. The extent found in studies of patients with probable Alzheimer’s of hypometabolism correlates with severity of cognitive (108, 109) (122) disease. This decline was not observed in a study of impairment and often shows right/left hemispheric (123, 124) normal aging, and it is not yet clear whether this decline will be asymmetry. Approaches to data display including a relatively short average follow-up period of 3 years, include: questions about the extent to which these patients referred from 1. Use of region of interest sampling, which requires a co registered structural image for the guidance of sample the full range of metabolic findings. Use of more than one marker (for (145, 146) of the greater resolution and sensitivity of the technique. Assisting in the Discovery of New Treatments needed to evaluate drug effectiveness. Particularly exciting are to the best-established structural brain imaging measurements of recent developments in small molecule probes for the putative in disease progression. Report of the Quality Standards (121) Subcommittee of the American Academy of Neurology. Neurology their magnitude and spatial extent, and they are also correlated with the severity of the symptoms caused by damage 2001;56(9):1143–1153. Criteria for the diagnosis of ischemic vascular dementia decrease in the activity or density of terminal neuronal fields or proposed by the State of California Alzheimer’s Disease perisynaptic glial cells, an abnormality in glucose metabolism Diagnostic and Treatment Centers [see comments]. Neurology itself, the combined effects of atrophy and partial-volume 1992;42:473–480. Patterns of brain atrophy in frontotemporal normalization for the variation in absolute measurements. Patterns of temporal lobe atrophy in semantic dementia treatment effect in a randomized, placebo-controlled clinical and Alzheimer’s disease. Patterns of cerebral atrophy in primary progressive of patients with Alzheimer’s disease. Evidence for early vulnerability of the medial and inferior atrophy in fronto-temporal dementia. Neurobiol Aging 2003;24(1): aspects of the temporal lobe in an 82-year-old patient with 95–103. Annals of Neurology 2000;47(4): hippocampal volumetry in the diagnosis of Alzheimer’s disease. Quantification of magnetic temporal lobe atrophy predicts Alzheimer’s disease in patients with resonance scans for hippocampal and parahippocampal atrophy in minor cognitive impairment. The radiologic prediction of Alzheimer disease: patients with early Alzheimer’s disease.
Cognitive training In a small study by van´t Hooft and co-workers herbals kidney stones purchase 60 caps ayurslim with amex, children with acquired brain injury (including brain tumor patients) were randomized to queen herbals generic 60 caps ayurslim fast delivery regular cognitive (and metacognitive) training (daily 30-minute exercises in specific attention and memory techniques with a coach) herbs to grow indoors order ayurslim 60caps with visa, vs control (doing a freely chosen daily interactive activity for 30 minutes). After a 17-week intervention, positive effects were found in measures of sustained and selective attention, as well as memory performance (van’t Hooft et al. A larger randomized multi-center study examined the effects of a cognitive remediation program (20 two-hour sessions over 4-5 months), including cognitive and metacognitive training, on brain-irradiated childhood cancer patients and found a modest positive effect on academic achievement and parent-reported attention, but not in tests of selective attention, working memory or vigilance (Butler et al. A drawback was the substantial time commitment needed from all involved, with only 60% of participants in the intervention arm completing the entire program. Computerized cognitive training In a randomized, single-blind, waiting list controlled study, Conklin and coworkers evaluated a computerized intervention using Cogmed. Cogmed is a computerized game-like intervention, where repetitive visual–spatial and verbal working memory exercises of graded difficulty are used. The intervention period consisted of 25 home-based sessions (30-45 min each), over 5 to 9 weeks, with weekly telephone-based coaching. Improvements from pre to post-intervention tests were seen in measures of working memory, attention, processing speed and executive function, but not in academic fluency. A cross-sectional study of video gaming showed that young adults who played computer games had better spatial and temporal visual attention, as well as increased visual attention capacity, compared to non-gamers (Green and Bavelier 2003). Furthermore, the non gamers improved their visual attention capacity after training action video games for just 10 days, compared to a control group playing slower paced video games (Tetris) (Green and Bavelier 2003). A longitudinal study in adults examined structural changes in the brain after 2 months of daily video gaming. Interestingly, a game with a prominent navigation component was used, and the cortical areas affected are thought to be involved in navigation. Another study compared different types of games and found that children playing action video games had shorter reaction times (without making more errors), compared to those playing non-action video games, and the authors concluded that action video gamers had enhanced attentional resources (Dye et al. There is however, some debate as to whether improvements seen are a result of bias due to study design flaws. Concerns also persist about whether video games foster aggression or addictive play (Calvert et al. Active video gaming (exergaming) In a Dutch study, children and young adults with acquired brain damage exercised using active video gaming (Nintendo Wii), for two hours per week for 12 weeks. Test results before and after were compared, and showed improvements in processing speed, attention, and response inhibition tests (de Kloet et al. A study of the effects of a single bout of physical activity studied different combinations of physical activity and cognitive engagement, and compared active video gaming to sedentary video gaming or watching a video (Best 2012). The physical activity level was found important for improving executive function, but with no added effect from increasing the cognitive engagement level (Best 2012). The authors 30 Magnus Sabel speculated however, that the activity chosen to deliver high physical activity but low cognitive engagement, could have been more cognitively demanding than intended. This speculation might be true, since a similar study found a significant improvement in executive function (cognitive flexibility) from cognitively engaging physical activity, compared to simple aerobic activity or control (Benzing et al. It should be noted that both studies examined the acute effects of exercise, and not the effects of long-term physical activity. Physical activity A positive correlation of physical exercise with better cognitive function, including executive function and memory, has been demonstrated in multiple studies, in both children and the elderly (Barnes et al. Some studies provide correlative evidence, others are cross-sectional studies and some are randomized intervention trials. A meta-analysis of randomized controlled trials in adults found aerobic exercise to be associated with modest improvements in attention, processing speed, executive function and memory, but not in working memory (Smith et al. In a randomized study involving pediatric brain tumor survivors previously treated with radiotherapy, Riggs and coworkers found that aerobic exercise, (three 90-minute sessions per week for 12 consecutive weeks) increased the hippocampal volume, and specific white matter tracts. However, several other studies have investigated the cognitive effects of physical activity in other pediatric populations. A dose-response benefit from exercise on executive function (planning) and mathematical academic achievement 31 Brain tumors in children was found, but not in reading or attention (Davis et al. Schmidt and coworkers explored the impact of cognitive engagement during physical activity on cognitive outcome, by randomizing 10 to 12-year-olds to one of three different interventions. Interestingly, although the two high-level physical activities reached the same level of physical exertion, the team game group had a stronger improvement in certain aspects of executive function (shifting) but not in others (updating and inhibition), compared to the other two groups (Schmidt et al.
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