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A person's everyday language can indicate patterns of thought and emotion predictive of mental illness. Here, we discuss how natural language processing methods can be used to extract indicators of mental health from language to help address long-standing problems in psychiatry, along with the potential hazards of this new technology.
Alzheimer’s disease (AD) has long been recognized as a heterogeneous illness, with a common clinical presentation of progressive amnesia and less common “atypical” clinical presentations, including syndromes dominated by visual, aphasic, “frontal,” or apraxic symptoms. Our knowledge of atypical clinical phenotypes of AD comes from clinicopathologic studies, but with the growing use of in vivo molecular biomarkers of amyloid and tau pathology, we are beginning to recognize that these syndromes may not be as rare as once thought. When a clinician is evaluating a patient whose clinical phenotype is dominated by progressive aphasia, complex visual impairment, or other neuropsychiatric symptoms with relative sparing of memory, the differential diagnosis may be broader and a confident diagnosis of an atypical form of AD may require the use of molecular biomarkers. Despite the evolving sophistication in our diagnostic tools, and the acknowledgment of atypical AD syndromes in the 2011 revised diagnostic criteria for AD, the assessment of such patients still poses substantial challenges. We use a case-based approach to review the clinical and imaging phenotypes of a series of patients with typical and atypical AD, and discuss our current approach to their evaluation. One day, we hope that regardless of whether a patient exhibits typical or atypical symptoms of AD pathology, we will be able to identify the condition at a prodromal phase and institute a combination of symptomatic and disease-modifying therapies to support cognitive processes, function, and behavior, and slow or halt progression to dementia.
Visual anosognosia (Anton syndrome) is a rare complication of cortical blindness that results from injury to the visual association cortex, in which patients who are unable to see deny that they are blind. They sometimes confabulate explanations for their visual problems (“there is not enough light to see”), or endanger themselves in efforts to “prove” that they can see (eg, tripping or walking into walls). Without functioning visual-association centers, these patients lack the concept of sight and are unable to acknowledge their impairment. Usually, Anton syndrome is encountered in patients with bilateral occipital infarcts but no other cause for impaired vision. We present an atypical case of Anton syndrome in which the patient's underlying visual deficit was due to advanced glaucoma.
The purpose of this study was to test the hypothesis that orbitofrontal cortical volume would be reduced following anterior cingulotomy for obsessive-compulsive disorder (OCD). Whole brain cortical parcellation was performed on magnetic resonance imaging (MRI) data from nine patients, before and 9(±6) months following anterior cingulotomy. No significant volumetric reductions were found in the orbitofrontal cortex. Exploratory findings of reduced volume in ventral temporo-fusiform and posterior cingulate regions were consistent with chance differences, in the face of multiple comparisons. Therefore, though the circumscribed lesions of anterior cingulotomy have recently been associated with corresponding volumetric reductions in the caudate nucleus, no comparable volumetric reductions are evident in cortical territories. Taken together, these results are most consistent with a model of cingulo-striatal perturbation as a putative mechanism for the efficacy of this procedure. While limitations in sensitivity may have also contributed to these negative findings, the methods employed have previously proven sufficient to detect cortical volumetric abnormalities in OCD. The current results may reflect a relatively diffuse pattern of cortico-cortical connections involving the neurons at the site of cingulotomy lesions. Future functional neuroimaging studies are warranted to assess possible cortical or subcortical metabolic changes associated with anterior cingulotomy, as well as predictors of treatment response.
Motivation implies activation of the organism by external or internal stimuli resulting in goal-directed behaviors. Loss of motivation constitutes the core symptom of apathy, a syndrome frequently found among patients with acute or chronic neurological conditions such as stroke, traumatic brain injury, and dementia. The mechanism of motivated behavior is based on neural structures that attach salience and valence to a given stimulus, and activate and direct an appropriate behavior in response to that stimulus. Dopamine (DA) is considered to play a central role in the mechanism of motivation and regulation of effort-related processes. The classical studies linking DA to motivation were based on stereotaxic injections of neurotoxin into the afferent projections of the mesolimbic and mesocortical pathways, which produced severe aphagia and adipsia. The nucleus accumbens seems to mediate the primary motivational characteristics of feeding and reproductive behavior as well as reward-motivated behaviors.
In August 1988 an increase was noted in the number of cases of cryptosporidiosis identified by the microbiology laboratory at Doncaster Royal Infirmary. By 31 October, 67 cases had been reported. Preliminary investigations implicated the use of one of two swimming pools at a local sports centre and oocysts were identified in the pool water. Inspection of the pool revealed significant plumbing defects which had allowed ingress of sewage from the main sewer into the circulating pool water. Epidemiological investigation confirmed an association between head immersion and illness. The pools were closed when oocysts were identified in the water and extensive cleaning and repair work was undertaken. The pool water was retested for cryptosporidial oocysts and found to be negative before the pool re-opened.
Neuroimaging has advanced our understanding of how the living brain operates, providing structural and functional images of both healthy and diseased brains. This technology pervades today's society, particularly affecting the legal arena. Some judges argue that scientific evidence, which offers insight into the offender's mental state, is crucial because it is the only means of determining whether an offender's punishment is proportional to his crime. Other judges argue that “objective” evidence does not “wholly determine the controversy,” and focus instead on their duty as gatekeepers to independently evaluate scientific evidence. If courts use brain images to make their culpability determinations more objective and sound, these images must meet pertinent legal standards and shed light on medical conditions. For neuroimaging to meet these legal and medical standards with scientific integrity, scientists must convincingly correlate the dynamic images in a person's brain with the way the person is thinking or acting at that moment.
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