Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology

Publisher: Society for Behavioral and Cognitive Neurology, Lippincott, Williams & Wilkins


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    Cognitive and behavioral neurology (Online)
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    Document, Periodical, Internet resource
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    Internet Resource, Computer File, Journal / Magazine / Newspaper

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Lippincott, Williams & Wilkins

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The interplay between motor and cognitive functions during performance of concurrent tasks is not fully understood but is known to vary depending on task characteristics and across clinical populations. Our controlled study examined how a concurrent digit span task affected a motor stability and motor overflow task in patients with multiple sclerosis (MS).
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):68-76.
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    ABSTRACT: Our aim was to investigate an association between prenatal sex hormone exposure and dementia diagnosis.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):102-106.
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    ABSTRACT: Our aim was to characterize the association of 2 functional single nucleotide polymorphisms (rs6311 and rs6314) in the serotonin 2A receptor gene (HTR2A) with severity of depression symptoms in children with autism spectrum disorder. These polymorphisms have been shown to be associated with depression symptom severity and response to selective serotonin reuptake inhibitor drugs in adults with diagnosed depressive disorder.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):107-16.
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    ABSTRACT: Conduction aphasia, most often caused by damage to the inferior parietal lobe and arcuate fasciculus, is usually characterized by mildly dysfluent speech with frequent phonemic paraphasic errors, impaired repetition, and impaired word finding and naming, but with relatively spared comprehension. We report an 86-year-old right-handed man with conduction aphasia caused by an infarction that damaged his right temporoparietal region. On testing with the Western Aphasia Battery, however, he named objects almost perfectly. To test his naming ability further, we showed him half the items in the Boston Naming Test; we described or defined the other half of the items, but did not show them to the patient. He performed excellently when naming the objects that he could see, but he had difficulty naming the objects that were only described or defined. These observations suggest that visual word naming may be mediated by a network that is somewhat independent of the networks that mediate spontaneous word finding and word finding based on verbal descriptions or definitions.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):96-101.
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    ABSTRACT: Most patients with tuberous sclerosis complex (TSC) suffer from epilepsy, and many have cognitive and behavioral problems like severe intellectual disability, autism, and hyperactivity. Only rare patients with TSC and autism have a normal intelligence quotient. We report a 13-year-old girl with definite TSC who had early-onset severe epilepsy, autistic behavior, and moderate developmental delay. By school age, however, she had normal intelligence; her intelligence quotient was at least 70 based on a Stanford-Binet test that she refused to complete. She showed good reading, writing, and language comprehension skills, and the special abilities of hyperlexia, hypermnesia, and hypercalculia. However, she did not speak. Criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and her Childhood Autism Rating Scale score of 36 indicated mild to moderate autism. She had severe electroencephalographic abnormalities: hypsarrhythmia, multifocal or generalized epileptiform discharges, and electrical status epilepticus during sleep, with a continuous left temporal focus. Magnetic resonance imaging showed many cortical tubers in all brain lobes, and subependymal nodules. We discuss possible explanations for her lack of speech. Considered as speech apraxia, her mutism could be either a symptom of her TSC or a component of her autism. Another possibility is that long-lasting electrical status epilepticus during sleep led to her autistic behavior and language arrest. Still another possibility is that a disinhibited mammalian target of rapamycin (mTOR) pathway was at the root of all of her neuropsychiatric symptoms.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):88-95.
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    ABSTRACT: We previously reported a randomized, sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation (rTMS) in 48 participants with a medically refractory major depressive disorder. Depression improved most with right-side cranial stimulation, both rTMS and sham, and to a lesser degree with left rTMS. Because depression is often associated with cognitive impairment, in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition, which cognitive domains (language, executive, visuospatial, verbal episodic memory, attention) were affected, and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables, such as right versus left treatment and rTMS versus sham.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):77-87.
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    ABSTRACT: We investigated whether alexithymia is at the root of the decision-making deficit classically reported in pathological gamblers.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):59-67.
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    ABSTRACT: Clinical analyses of patients with acquired dysgraphia provide unique opportunities to understand the cognitive and neural organization of written language production. We report J.B., a 50-year-old woman with peripheral dysgraphia who had prominent dissociations in her ability to write in lowercase versus uppercase and print versus cursive. We gave J.B. a series of tasks that evaluated her skills at writing uppercase and lowercase print and cursive, spelling aloud and in writing, writing numbers and symbols, and visual letter recognition and imagery. She was impaired in printing letters, with lowercase more affected than uppercase, but her cursive writing was relatively intact. This pattern was consistent across letter, word, and nonword writing tasks. She was unimpaired on tasks assessing her visual recognition and imagery of lowercase and uppercase letters. Her writing of numbers was preserved. J.B.'s handwriting disorder was accompanied by a central phonological dysgraphia. Our findings indicate functional independence of graphomotor programs for print and cursive letter styles and for letters and numbers. We discuss the relationship between peripheral and central writing disorders.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):31-47.
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    ABSTRACT: Creutzfeldt-Jakob disease (CJD) is a fatal neurodegenerative disease caused by conformational alteration of the ubiquitous prion protein. Sporadic CJD appears to progress faster if the basal ganglia are shown to be affected on magnetic resonance imaging. Transcranial B-mode sonography (TCS) enables visualization of differences in tissue echogenicity, which can be associated with changes in the cerebral metabolism of various metals. These metabolic changes are considered 1 of the potential mechanisms of the brain damage in CJD; TCS hyperechogenicity may reflect changes in metal homeostasis in CJD. We report a 63-year-old woman who presented with typical sporadic CJD. One month after she fell ill, a magnetic resonance imaging scan of her brain showed diffuse cortical but no obvious basal ganglia involvement. However, TCS revealed moderate hyperechogenicity of both lentiform nuclei. The patient's disease progressed quickly and she died 2 months later. TCS may show basal ganglia alteration early in the disease course of patients with quickly progressing CJD, thus aiding in premortem diagnosis.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):48-50.
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    ABSTRACT: We studied theory of mind (ToM) in patients with mild relapsing-remitting multiple sclerosis (MS), seeking possible dissociations between its 2 components: cognitive ToM (the ability to infer others' intentions) and affective ToM (the ability to infer others' emotional states). We analyzed the relationship of ToM to executive function, depression, and fatigue. Dissociations between cognitive and affective ToM have been found in several neurologic and neuropsychiatric diseases. Most ToM studies in patients with MS have shown general ToM deficits but have not analyzed the cognitive and affective aspects individually. We used the Faux Pas test of ToM and tests of executive function to assess 18 patients with mild relapsing-remitting MS and 16 control participants. Our patients showed deficits in cognitive ToM, but their affective ToM seemed to be spared. Their cognitive ToM deficits were not related to executive dysfunction, depression, or fatigue. Our study is the first differential analysis showing cognitive but not affective ToM deficits in mild relapsing-remitting MS. Further research is needed to determine the exact nature and the real impact of these deficits, and to establish their relationship with the neuropathology and progression of MS.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):25-30.
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    ABSTRACT: From 1868, when Charcot first described the clinical features and the pathologic correlates, up till the present day, multiple sclerosis (MS) has commonly been characterized by the symptoms caused by inflammatory plaques in the white matter of the brain and spinal cord. Early use of magnetic resonance imaging (MRI) to diagnose MS focused on detecting these white matter lesions. By the 1990s, researchers recognized that many patients with MS have cognitive deficits that can cause severe disability, and also determined the associated pathology; these findings shed more light on both the pathogenesis and progression. Since 2004, several lines of evidence have shown that the extent of white matter plaques identified on MRI does not correlate well with cognitive deficits. High-resolution MRI and advances in immunohistochemical techniques have enabled detection of cortical demyelination early in the course, correlating with cognitive deficits. Late in the course, pathologic changes in normal-looking white and gray matter correlate more closely with progressive cognitive deficits than with visual, sensory, and motor symptoms. This finding implies the need to redefine the disease and its progression. In this review, we discuss the histopathologic studies of cortical plaques in MS and early indications about their role in disease definition and progression, describe the role of high-resolution MRI in staging and determining progression of cognitive symptoms, and discuss how advances in these areas are forcing us to rethink diagnosis and determination of progression.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):1-7.
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    ABSTRACT: To study the clinical effectiveness of biofeedback treatment in reducing tics in patients with Tourette syndrome. Despite advances in the pharmacologic treatment of patients with Tourette syndrome, many remain troubled by their tics, which may be resistant to multiple medications at tolerable doses. Electrodermal biofeedback is a noninvasive biobehavioral intervention that can be useful in managing neuropsychiatric and neurologic conditions. We conducted a randomized controlled trial of electrodermal biofeedback training in 21 patients with Tourette syndrome. After training the patients for 3 sessions a week over 4 weeks, we observed a significant reduction in tic frequency and improved indices of subjective well-being in both the active-biofeedback and sham-feedback (control) groups, but there was no difference between the groups in these measurements. Furthermore, the active-treatment group did not demonstrably learn to reduce their sympathetic electrodermal tone using biofeedback. Our findings indicate that this form of biofeedback training was unable to produce a clinical effect greater than placebo. The main confounding factor appeared to be the 30-minute duration of the training sessions, which made it difficult for patients to sustain a reduction in sympathetic tone when their tics themselves were generating competing phasic electrodermal arousal responses. Despite a negative finding in this study, electrodermal biofeedback training may have a role in managing tics if optimal training schedules can be identified.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):17-24.
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    ABSTRACT: Young-onset dementias pose a major challenge to both clinicians and researchers. Cognitive decline may be accompanied by systemic features, leading to a diagnosis of "dementia plus" syndromes. Whipple disease is a rare systemic illness characterized by arthralgias, chronic diarrhea, weight loss, fever, and abdominal pain. Central nervous system involvement, including severe cognitive deterioration, may precede systemic manifestations, appear during the course of the disease, or even be the only symptom. We report a previously highly functional 48-year-old man whom we first suspected of having early-onset neurodegenerative dementia but then diagnosed with Whipple disease based on a detailed clinical and laboratory evaluation. Initial neuropsychological evaluation revealed marked impairment in the patient's fluid intelligence and severe cognitive deficits in his information processing speed, complex attention, memory, visuomotor and construction dexterities, problem solving, and executive functions. At neuropsychological follow-up 21 months later, his information processing speed had improved only slightly and deficits persisted in his other cognitive functions. Repeat brain magnetic resonance imaging at that time showed that he had responded to antibiotic treatment. Because Whipple disease can cause young-onset "dementia plus" syndromes that may leave patients with neurocognitive deficits even after apparently successful treatment, we recommend comprehensive neuropsychological assessment for early detection of residual and reversible cognitive processes and evaluation of treatment response.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):51-6.
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    ABSTRACT: We investigated whether patients with obsessive-compulsive disorder have poorer memory and executive functions than healthy controls. The relatively inconsistent previous findings on this question reflect a lack of well-matched control groups, the inclusion of patients with comorbidity, and the use of noncomparable neuropsychological tests to assess memory and executive functions. We used well-accepted neuropsychological tests of memory and executive functions to assess 42 patients who had obsessive-compulsive disorder without comorbidity, and 42 healthy controls. We matched the patients and controls pairwise by sex, age, and years of education. The patients performed significantly worse than the controls on the Rey Complex Figure Test, which assesses visuospatial memory and organizational skills. This group difference remained after we controlled for age, education, intelligence, and severity of depressive symptoms. The findings indicate that patients with obsessive-compulsive disorder may have impaired visuospatial memory and organizational skills, and these impairments should be considered in treatment. NCT00792038.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 03/2014; 27(1):8-16.
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    ABSTRACT: In view of the negative impact of anxiety on working memory, we induced anxiety in 26 patients with acute stroke and 33 healthy controls, and studied how the anxiety affected their emotional reactivity and how the reactivity affected their verbal and visuospatial working memory. We compared the overall findings with those in 1 of our patients (C.B.) who had presented with an abnormally high level of state anxiety. We gave verbal and visuospatial 1-back tasks under both neutral and anxiogenic conditions, and we compared participants' working memory scores, self-reported levels of state anxiety, and electrodermal activity. When comparing performance in the neutral condition, the control and patient groups exhibited disrupted verbal working memory, which was associated with greater electrodermal activity and higher state anxiety during the anxiogenic condition. Although patient C.B. also had heightened electrodermal activity during the anxiogenic condition, she experienced a significant reduction in her state anxiety. Her verbal working memory was better during the anxiogenic than the neutral condition. Because of the phonological (subvocal speech) nature of verbal working memory, a higher level of anxious apprehension could explain the increase in state anxiety and the corresponding disruption of verbal working memory in our patient and control groups during the anxiogenic condition. C.B.'s lower state anxiety and selective improvement in verbal working memory during the anxiogenic condition suggest that she felt less anxious apprehension.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 12/2013; 26(4):195-207.
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    ABSTRACT: The brain's action-intentional ("when") programming system helps to control when to and when not to initiate an action, when to persist at an action, and when to terminate an action. Motor perseveration is a failure to terminate an action. This disengagement disorder most often results from dysfunction of the executive frontal-subcortical networks that control the action-intentional programming system. Reports of unilateral perseveration are unusual. Here we describe a patient with a form of progressive supranuclear palsy (PSP) who exhibited continuous right-hand motor perseveration. This 68-year-old right-handed man had impaired walking and vertical gaze, consistent with PSP. He often repeated words, and on many motor tasks he showed continuous perseveration of his right but not his left hand. Unilateral motor perseveration may be a sign of PSP, the corticobasal syndrome, or a subtype of these disorders. Future studies of patients with both disorders should use tasks that assess for asymmetric hand perseveration. The mechanism of the unilateral perseveration must also be determined. Bilateral perseveration is found most often in patients with unilateral right frontal-subcortical (basal ganglia) or insula dysfunction. Because patients with PSP or corticobasal syndrome have callosal degeneration, their unilateral perseveration might result from a callosal disconnection of the right frontal lobe from the left hemisphere's premotor and motor as well as speech areas.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 12/2013; 26(4):181-8.
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    ABSTRACT: Many patients with systemic lupus erythematosus have central nervous system involvement. Routine diagnostic studies may not yield evidence of neuropsychiatric dysfunction and are therefore not useful as objective measures to monitor treatment response. We present a case of a 64-year-old woman whom we diagnosed with systemic lupus erythematosus by the American College of Rheumatology criteria after she reported recent cognitive decline. Neuropsychological assessment showed prominent deficits, and an F-18 fluorodeoxyglucose positron emission tomography scan of the brain showed significant abnormalities. Both the neuropsychiatric and scan abnormalities improved dramatically with immunosuppressive treatment. F-18 fluorodeoxyglucose positron emission tomography shows promise in the diagnosis and treatment monitoring of patients who have lupus with neuropsychiatric involvement.
    Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 09/2013; 26(3):161-6.

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