Promoting Growth in Behavioral Neurology: A Path Forward.

Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand.

Altered Allocation of Vertical Attention in Individuals With Autism Spectrum Disorder.

Background: Typical adults most frequently orient their attention to other people's eyes, whereas individuals with autism spectrum disorder (ASD) orient their attention to other people's mouths. Typical adults also reveal visuospatial biases on tasks such as vertical and horizontal line bisections. Therefore, the difference in face viewing might be related to a more general group difference in the allocation of vertical attention.

The Effects of Transcutaneous Vagus Nerve Stimulation on Functional Connectivity Within Semantic and Hippocampal Networks in Mild Cognitive Impairment.

Better treatments are needed to improve cognition and brain health in people with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Transcutaneous vagus nerve stimulation (tVNS) may impact brain networks relevant to AD through multiple mechanisms including, but not limited to, projection to the locus coeruleus, the brain's primary source of norepinephrine, and reduction in inflammation. Neuropathological data suggest that the locus coeruleus may be an early site of tau pathology in AD.

ONE-TIME PAROXYSM of ARTISTIC TALENT in FOCAL EPILEPSY.

Despite having unremarkable artistic talent, an 8-year-old male with chronic focal epilepsy from the right lateral frontal lobe drew a complex visual pattern during a 15-minute spell when he looked physically unwell. He underwent epilepsy surgery shortly thereafter and has been seizure-free since. In the ensuing 16 years of follow-up there have been no other such artistic incidents.

Hemodialyzed Individuals' Left Spatial Attentional Bias Is Normalized Following Successful Kidney Transplantation.

Background: Healthy people have a leftward spatial attentional bias, called pseudoneglect. Individuals with end-stage renal disease (ESRD) who are receiving hemodialysis often demonstrate an increase in their leftward spatial attentional bias. Whereas a successful kidney transplant often improves the cognitive functions of individuals who previously received hemodialysis, the effect of a kidney transplant on this abnormal allocation of spatial attention has not been investigated.

Emotional and Neuropsychiatric Disorders Associated with Alzheimer's Disease.

Alzheimer's disease is associated with impairments in emotional communication including comprehension and production of facial emotional expressions, comprehension of affective prosody, and alexithymia. It is also associated with disorders of emotional experience including mood disorders (depression and anxiety), agitation/aggression, and psychosis. Agitation/aggression and psychosis are particularly disruptive, are associated with earlier institutionalization, and pose a major challenge to institutional management.

The Allocation of Vertical Attention in Patients with End-Stage Renal Disease Receiving Dialysis.

: Alterations of spatial attention can have adverse effects, such a greater probability of accidents. Patients with end-stage renal disease (ESRD) receiving dialysis have stronger left-sided spatial attentional bias, suggesting that this disorder or treatment alters the brain networks that mediate spatial attention. The hemispheric networks that mediate the allocation of horizontal attention may also influence the allocation of vertical attention.

Upper Limb Apraxia.

Purpose Of Review: Limb apraxia is one of the most common and most disabling disorders caused by brain damage. However, apraxia is one of the least recognized disorders associated with cerebral disease. This article discusses the signs and symptoms of, means of testing for, the pathophysiology of, and possible management of upper limb apraxia.

Kidney transplantation and action-intentional improvements: Evidence from an ERP study.

Reaction slowing observed in dialyzed patients results from deficits in initiating and sustaining motor response mobilization. The present study aimed at investigating whether these deficits are reversible following successful kidney transplantation. To achieve this goal, behavioral and electrophysiological (EEG) data were assessed from healthy control participants as well as kidney transplant and dialyzed patients performing a series of reaction time tasks.

Disorders of facial emotional expression and comprehension.

One of the most important means of communicating emotions is by facial expressions. About 30-40 years ago, several studies examined patients with right and left hemisphere strokes for deficits in expressing and comprehending emotional facial expressions. The participants with right- or left-hemispheric strokes attempted to determine if two different actors were displaying the same or different emotions, to name the different emotions being displayed, and to select the face displaying an emotion named by the examiner.

Emotion and mood disorders associated with epilepsy.

Epilepsy is a disorder characterized by recurrent seizures. Epilepsy can alter mood and emotions. Treatments for epilepsy can also alter mood and emotions.

Proof of concept: digital clock drawing behaviors prior to transcatheter aortic valve replacement may predict length of hospital stay and cost of care.

Aims: Reduced pre-operative cognitive functioning in older adults is a risk factor for postoperative complications, but it is unknown if preoperative digitally-acquired clock drawing test (CDT) cognitive screening variables, which allow for more nuanced examination of patient performance, may predict lengthier hospital stay and greater cost of hospital care. This issue is particularly relevant for older adults undergoing transcatheter aortic valve replacement (TAVR), as this surgical procedure is chosen for intermediate-risk older adults needing aortic replacement. This proof of concept research explored if specific latency and graphomotor variables indicative of planning from digitally-acquired command and copy clock drawing would predict post-TAVR duration and cost of hospitalization, over and above age, education, American Society of Anesthesiologists (ASA) physical status classification score, and frailty.

Normative References for Graphomotor and Latency Digital Clock Drawing Metrics for Adults Age 55 and Older: Operationalizing the Production of a Normal Appearing Clock.

Background: Relative to the abundance of publications on dementia and clock drawing, there is limited literature operationalizing 'normal' clock production.

Objective: To operationalize subtle behavioral patterns seen in normal digital clock drawing to command and copy conditions.

Methods: From two research cohorts of cognitively-well participants age 55 plus who completed digital clock drawing to command and copy conditions (n = 430), we examined variables operationalizing clock face construction, digit placement, clock hand construction, and a variety of time-based, latency measures.

Spatial artistic displays of emotional valence.

While right-left hemispheric valence dichotomies have been demosntrated in various lesion stidues, it not entirely known if these dichotomies are portrayed in art. We examined 192 paintings to learn if there is an association between paintings that portray happy-positive or sad-negative scenes and the agent looking to the right or left side relative to their head's midsagittal plane. There were 38 paintings with a positive valence and 32 with a negative valence in which the eyes were turned rightward or leftward.

Right up- left down.

Background: When performing the clock-drawing test healthy participants often draw the clock face using a counter clockwise movement. The reason for this circular directional bias is not known. These actions may be related to the development of motor or attentional programs that associate leftward with downward movements, and rightward with upward movements.

Pilot Investigation: Older Adults With Atrial Fibrillation Demonstrate Greater Brain Leukoaraiosis in Infracortical and Deep Regions Relative to Non-Atrial Fibrillation Peers.

Background: This pilot study explored differences in distribution of white matter hyperintensities (called leukoaraiosis; LA) in older adults (mean age = 67 years) with atrial fibrillation (AF) vs. non-AF peers measured by: (1) depth distribution; (2) anterior-posterior distribution; (3) associations between LA and cortical thickness; and (4) presence of lacunae and stroke.

Methods: Participant data (AF = 17; non-AF peers = 17) were acquired with the same magnetic resonance imaging protocols.

Musical hallucinations with a right frontotemporal stroke.

have been reported in association with psychiatric diseases, brain stem strokes, deafness, degenerative diseases, intoxications, pharmacologic agents, and epilepsy. We present a patient who in the absence of these disorders developed musical hallucinations from an infarction of the right hemisphere that primarily injured his right frontal and anterior temporal lobes. This report discusses some of the possible mechanisms for this patient's presentation.

Hugo Liepmann, Parkinson's disease and upper limb apraxia.

It has now been 100 years since Hugo Liepmann, in his classic 1920 paper described limb kinetic, ideomotor, and ideational apraxia. There are now several rating scales used to assess and grade the signs and symptoms associated with Parkinson's disease; however, none of these assesses patients for the presence of these disabling forms of upper limb apraxia. This paper, reviews the four types of apraxia that can be associated with Parkinson's disease, how they can be tested, the disabilities associated with these disorders and possible treatments.

Degenerative dementia with proximal radial and lower vertical spatial neglect.

A 75 year-old man had a two-year history of progressive memory loss, trouble with finances and getting lost. On examination, he scored 16/30 in MoCA test, noticeably impaired on the attentional tasks. His screening bloodtests werenormal.

Feeling and Looking Down: Impact of Depressive Symptoms on the Allocation of Vertical Attention.

Background: Emotions and moods are often expressed using verbal, vertical spatial metaphors (eg, "I'm feeling down"). The reason for using these vertical metaphors is unknown; however, when individuals experience depressive symptoms, they often become self-reflective and ruminative. These mental activities are associated with activation of the default network, including the parietal lobes.

Proactive interference apraxic agraphia: a writing and drawing disorder associated with corticobasal syndrome.

Proactive interference is when a previously performed task impairs performance on a current task. It is often associated with memory tasks and has not been reported to interfere with writing or drawing. We evaluated a left-handed man diagnosed with corticobasal syndrome who had a two-year history of progressive agraphia.

Upper Vertical Spatial Neglect With A Right Temporal Lobe Stroke.

Individuals with a hemispheric infarction often reveal inattention to, or neglect of, contralesional lateral space (ie, hemispatial neglect). Individuals with a bilateral ventral temporal-occipital lesion have been shown to demonstrate upper vertical neglect, and those with a bilateral parietal-occipital lesion have been shown to demonstrate lower vertical neglect. However, to our knowledge, there have been no reports of individuals with vertical neglect from a unilateral hemispheric lesion.