D-CARE: The Dementia Care Study: Design of a Pragmatic Trial of the Effectiveness and Cost Effectiveness of Health System-Based Versus Community-Based Dementia Care Versus Usual Dementia Care.

Background/objectives: Although several approaches have been developed to provide comprehensive care for persons living with dementia (PWD) and their family or friend caregivers, the relative effectiveness and cost effectiveness of community-based dementia care (CBDC) versus health system-based dementia care (CBDC) and the effectiveness of both approaches compared with usual care (UC) are unknown.

Design: Pragmatic randomized three-arm superiority trial. The unit of randomization is the PWD/caregiver dyad.

Effects of aging on action-intentional programming.

Background: Action-intentional programs control "when" we initiate, inhibit, continue, and stop motor actions. The purpose of this study was to learn if there are changes in the action-intentional system with healthy aging, and if these changes are asymmetrical (right versus left upper limb) or related to impaired interhemispheric communication.

Methods: We administered tests of action-intention to 41 middle-aged and older adults (61.

Assessment of Mental Status.

Assessing the mental status of patients with a neurobehavioral disorder is a critical element in the diagnosis and treatment of these patients. This assessment should always be performed after the patient's history it taken and a general physical as well as a neurologic examination is completed. The mental status examination commences with observing the patient's appearance and level of consciousness.

Improving clinical cognitive testing: report of the AAN Behavioral Neurology Section Workgroup.

Objective: To evaluate the evidence basis of single-domain cognitive tests frequently used by behavioral neurologists in an effort to improve the quality of clinical cognitive assessment.

Methods: Behavioral Neurology Section members of the American Academy of Neurology were surveyed about how they conduct clinical cognitive testing, with a particular focus on the Neurobehavioral Status Exam (NBSE). In contrast to general screening cognitive tests, an NBSE consists of tests of individual cognitive domains (e.

The Effects of Chronic Right Hemispheric Damage on the Allocation of Spatial Attention: Alterations of Accuracy and Reliability.

Right hemispheric damage (RHD) caused by strokes often induce attentional disorders such as hemispatial neglect. Most patients with neglect over time have a reduction in their ipsilesional spatial attentional bias. Despite this improvement in spatial bias, many patients remain disabled.

Perceptual-motor dysfunction.

Purpose Of Review: This article highlights the importance of integrated perceptual information (motor planning, sequencing, and representation) and discusses the integration of these cognitive domains by means of feedforward and feedback loops in the successful acquisition and execution of voluntary behaviors. The article also discusses the dysfunction in the perceptual-motor process that can occur with neurologic injury, resulting in apraxias, agnosia, hemineglect, and Balint syndrome.

Recent Findings: A combination of functional imaging and lesional studies continues to refine our understanding of the role of the posterior parietal region in the integration of perception with motor action.

Status of neurology medical school education: results of 2005 and 2012 clerkship director survey.

Objective: To survey all US medical school clerkship directors (CDs) in neurology and to compare results from a similar survey in 2005.

Methods: A survey was developed by a work group of the American Academy of Neurology Undergraduate Education Subcommittee, and sent to all neurology CDs listed in the American Academy of Neurology database. Comparisons were made to a similar 2005 survey.

The relationship between semantic knowledge and conceptual apraxia in Alzheimer disease.

Background: Conceptual apraxia (CA), a feature of Alzheimer disease (AD), can be detected by asking participants to identify the correct tool to act on an object. Assessment can be based on either learned associations (a tool selection test) or the mechanical properties that the tool needs to alter the target object (an alternative tool selection test).

Objectives: We wanted to determine whether knowledge of semantic taxonomic relations (intrinsic properties shared by items) correlated with performance on tests for CA in people with AD or amnestic mild cognitive impairment (aMCI).

Acute lorazepam effects on neurocognitive performance.

A double-blind, placebo-controlled, crossover design was employed to determine whether acute lorazepam (2 mg orally) cognitive side effects would emerge in a differential age-dependent fashion in 15 young (mean age=22 years) and 12 older (mean age=64 years) subjects. Acute use of lorazepam is frequently the initial treatment choice for convulsive status epilepticus or repetitive seizure clusters. Cognitive assessment was performed during drug and placebo conditions using a computerized battery of cognitive tests.

Lorazepam effects on Word Memory Test performance: a randomized, double-blind, placebo-controlled, crossover trial.

The Word Memory Test (WMT) is a common measure of symptom validity. To investigate the effects of acute benzodiazepines on WMT scores, oral lorazepam 2 mg (LOR) and placebo were administered 1 week apart in a randomized, double-blind, placebo-controlled, crossover study. A total of 28 participants completed the study and were administered the WMT during each drug condition.

Auditory responsive naming versus visual confrontation naming in dementia.

Dysnomia is typically assessed during neuropsychological evaluation through visual confrontation naming. Responsive naming to description, however, has been shown to have a more distributed representation in both fMRI and cortical stimulation studies. While naming deficits are common in dementia, the relative sensitivity of visual confrontation versus auditory responsive naming has not been directly investigated.

Reversible dementias.

The causes of potentially reversible dementia syndromes are legion, as many perturbations of body chemistry can lead to dysfunction of higher cortical function, including the chemical interventions we call medication. It is vital for the cautious clinician to take a painstaking history to develop a differential diagnosis of potential causally related reversible phenomena. This, coupled with an extensive examination and a widecast net of serological, and when appropriate, cerebrospinal, electrophysiologic, and neuroimaging studies can increase the potential for discovering these mimics of the primary neurodegenerative dementias.

Normal pressure hydrocephalus.

Normal Pressure Hydrocephalus first became recognized as a treatable, reversible disorder in the 1960s. The classic triad of magnetic apraxia, urinary incontinence, and dementia remain relevant into the 21(st) century as being the basis for symptomatic diagnosis and predicting potential benefit from ventriculoperitoneal shunting, though they have been greatly augmented by the addition of modern neuroimaging, particularly MRI. Modern criteria recognize a wider range of diagnostic criteria, and new positive and negative prognostic indicators for treatment benefit have been discovered, though the mainstay remains initial drainage of a large volume of cerebrospinal fluid and monitoring for clinical improvement.

Spatial attentional bias in normal people: object or viewer-centered.

When bisecting radial lines, normal subjects often have a distal bias. To help in explaining this systematic bias, it has been proposed that normal people have an attentional bias to the top of the lines (object centered hypothesis) or toward stimuli falling in the lower portion of the retina (retinotopic hypotheses) or to distal peripersonal space (body centered hypotheses). The primary aim of this study is to test these hypotheses by having normal subjects bisect radial lines, placed in a clockwise distribution in the transverse plane, below eye level.

Art in the eye of the beholder: the perception of art during monocular viewing.

Objective: To explore whether monocular viewing affects judgment of art.

Background: Each superior colliculus receives optic nerve fibers primarily from the contralateral eye, and visual input to each colliculus activates the ipsilateral hemisphere. In previous studies, monocular viewing influenced performance on visual-spatial and verbal memory tasks.

Spatial-attention and emotional evocation: line bisection performance and visual art emotional evocation.

Lesion studies demonstrate that the right temporal-parietal region (RTP) is important for mediating spatial attention. The RTP is also involved in emotional experiences that can be evoked by art. Normal people vary in their ability to allocate spatial attention, thus, people who can better allocate attention might also be more influenced by the emotional messages of the paintings (evocative impact).

Artwork before and after onset of progressive nonfluent aphasia.

Objective: Compare changes in art quality before and after the onset of progressive nonfluent aphasia (PA).

Background: Some patients with left frontotemporal lobar degeneration (FTLD), particularly PA start painting and improve in art despite their disease. There is only 1 case reported of FTLD where the person was an artist before onset.

Ipsilesional attentional-approach neglect or crossover effect.

Patients with ipsilateral neglect (IN) bisect lines toward contralesional space. It has been posited that IN might be induced by an attempt at compensation, as part of the crossover effect, where patients with an ipsilesional bias when bisecting long lines, cross over and develop a contralesional bias on short lines or as a release of an approach (grasp) behavior that might be attentional or intentional. To test these alternative hypotheses we had a patient with IN from a right medial frontal lesion bisect lines that contained no cue, a left-sided cue, a right-sided cue, and bilateral cues.

Lewy body dementia and creativity: case report.

Background: We studied a visual artist with Lewy body dementia (LBD) to learn how this disease influenced his paintings during the course of the disease.

Methods: Study 1 evaluated two paintings of the same subject matter, one that the patient painted before his illness and the other after the onset of this disease. Study 2 evaluated a collection of his paintings from the time before he was ill (1994) until the time he stopped painting when he was suffering with LBD (2002).