Reduced gray matter volume is correlated with frontal cognitive and behavioral impairments in Parkinson's disease.

OBJECTIVE: To identify the brain-volume reductions associated with frontal cognitive and behavioral impairments in Parkinson's disease (PD). METHODS: Forty PD patients without dementia or amnesia (Hoehn and Yahr stage 3) and 10 age-matched controls underwent brain magnetic resonance imaging. Cognitive and behavioral impairments were assessed by using the Frontal Assessment Battery (FAB) and Frontal Systems Behavioral Scale (FrSBe), respectively. We applied voxel-based morphometry to investigate the correlations of regional gray matter volume with FAB, FrSBe, and physical disability. RESULTS: FAB was significantly lower in PD than in controls. FrSBe was significantly higher after PD onset than before, notably in the apathy subscale. FAB and FrSBe were significantly intercorrelated. In PD patients, left inferior frontal volume was positively correlated with FAB, whereas right precentral volume was negatively correlated with FrSBe total score. The brain volumes in both of these regions were not correlated with the Unified PD Rating Scale III. CONCLUSION: Behavioral impairments in PD tended to coexist with progression of frontal cognitive impairment. Regional atrophy within the frontal lobe was associated with both frontal cognitive and behavioral impairments. However, the specific region responsible for behavioral impairment differed from that for frontal cognitive impairment. These associations were independent of physical disability.

Frontal assessment battery and frontal atrophy in amyotrophic lateral sclerosis.

OBJECTIVES: To determine the potential utility of the frontal assessment battery (FAB) in assessing cognitive impairments in amyotrophic lateral sclerosis (ALS), we investigated the association between the FAB score and regional gray matter volume, and ascertained whether the regional brain alterations related to cognitive impairments occur in relatively mild stage of ALS. MATERIALS AND METHODS: Twenty-four ALS patients with a Mini-Mental State Examination score of >23, a normal score on the Self-Rating Depression Scale, little or no disturbance in speech and handling utensils on the ALS Functional Rating Scale (ALSFRS), and normal measures on respiratory tests (respiratory function test and arterial blood gas analysis), and two age-matched normal control groups (one for FAB assessment and the other for brain morphometry) underwent FAB testing and structural magnetic resonance imaging. We applied voxel-based morphometry to investigate the relationship between the FAB score and regional brain alteration, and assessed the relationship between the altered regional brain volume and ALSFRS or respiratory tests. RESULTS: Frontal assessment battery scores were significantly lower in ALS patients than in normal controls. Volume reduction in the right orbitofrontal gyrus in ALS was correlated with a lower FAB score. There was no correlation between the right orbitofrontal gyrus volume and ALSFRS or respiratory tests. CONCLUSIONS: The results suggest that the FAB is an adequate tool for detecting cognitive impairments related to frontal lobe pathology in the relatively mild stage of ALS, independent of physical dysfunctions.

Insular Gray Matter Volume and Objective Quality of Life in Schizophrenia.

Improving quality of life has been recognized as an important outcome for schizophrenia treatment, although the fundamental determinants are not well understood. In this study, we investigated the association between brain structural abnormalities and objective quality of life in schizophrenia patients. Thirty-three schizophrenia patients and 42 age-, sex-, and education-matched healthy participants underwent magnetic resonance imaging. The Quality of Life Scale was used to measure objective quality of life in schizophrenia patients. Voxel-based morphometry was performed to identify regional brain alterations that correlate with Quality of Life Scale score in the patient group. Schizophrenia patients showed gray matter reductions in the frontal, temporal, limbic, and subcortical regions. We then performed voxel-based multiple regression analysis in these regions to identify any correlations between regional gray matter volume and Quality of Life Scale scores. We found that among four subcategories of the scale, the Instrumental Role category score correlated with gray matter volume in the right anterior insula in schizophrenia patients. In addition, this correlation was shown to be mediated by negative symptoms. Our findings suggest that the neural basis of objective quality of life might differ topographically from that of subjective QOL in schizophrenia.

Social cognition and its relationship to functional outcomes in patients with sustained acquired brain injury.

Deficits in social cognition are common after traumatic brain injury (TBI). However, little is known about how such deficits affect functional outcomes. The purpose of this study was to investigate the relationship between social cognition and functional outcomes in patients with TBI. We studied this relationship in 20 patients with TBI over the course of 1 year post-injury. Patients completed neurocognitive assessments and social cognition tasks. The social cognition tasks included an emotion-perception task and three theory of mind tasks: the Faux Pas test, Reading the Mind in the Eyes (Eyes) test, and the Moving-Shapes paradigm. The Craig Handicap Assessment and Reporting Technique was used to assess functional outcomes. Compared with our database of normal subjects, patients showed impairments in all social cognition tasks. Multiple regression analysis revealed that theory of mind ability as measured by the Eyes test was the best predictor of the cognitive aspects of functional outcomes. The findings of this pilot study suggest that the degree to which a patient can predict what others are thinking is an important measure that can estimate functional outcomes over 1 year following TBI.

Regional gray matter reduction correlates with subjective quality of life in schizophrenia.

Subjective quality of life (QOL) has been recognized as an important consideration in schizophrenia. Several symptoms and neurocognitive functions were shown to be correlated with subjective QOL; however its determinants are not well understood. In this study, we investigated the association between brain structural abnormalities and subjective QOL in patients with schizophrenia. Forty-five schizophrenia patients and 48 age, sex, and education-matched healthy participants underwent magnetic resonance imaging (MRI), and the Schizophrenia Quality of Life Scale (SQLS) was used to rate subjective QOL. We performed voxel-based morphometry (VBM) to investigate regional brain alterations. Relative to normal controls, schizophrenia patients exhibited gray matter reductions mainly in the frontal and temporal regions. Worse psychosocial subscale of SQLS was associated with gray matter (GM) reduction in the right dorsolateral prefrontal cortex (DLPFC), and worse motivation/energy subscale was associated with gray matter reduction in the left superior frontal sulcus, left parahippocampal gyrus, and the left inferior temporal gyrus. The correlation between DLPFC GM volume and psychosocial subscale of SQLS disappeared after controlling for severity of psychopathology, while the other correlations remained significant when controlled by demographic and clinical variables. Combining imaging techniques with psychosocial methods would help to elucidate those factors that are associated with QOL.

Frontal lobe-mediated behavioral changes in amyotrophic lateral sclerosis: are they independent of physical disabilities?

OBJECTIVE: Several studies have indicated that frontal cognitive impairment is present in patients with amyotrophic lateral sclerosis (ALS). However, it remains to be elucidated whether the behavioral change is a direct consequence of ALS pathology or the measurements are confounded by the physical impairments. We examined frontal lobe-mediated behavioral dysfunction in daily living in patients with ALS by using the family- and self-rating forms of the Frontal Systems Behavior Scale (FrSBe) and assessed the relationship between the scores and motor impairments or ventilatory status. METHODS: We examined 24 patients with sporadic ALS, who were aged 65.7 ± 10.5 years with mean disease duration of 2.3 ± 1.7 years, Mini-Mental State Examination score of ≥ 24, normal Self-rating Depression Scale, no need of assistance in daily life, normal respiratory function, and normal arterial blood gas analytes. We examined the relationship between FrSBe scores and ALS Functional Rating Scale (ALSFRS), respiratory function, and arterial blood gas analytes. RESULTS: The scores of family- and self-rating FrSBe were significantly higher after onset of ALS than before onset, most notably in apathy. The family-rating FrSBe scores after onset were not correlated with ALSFRS, respiratory function, or arterial blood gas analytes. CONCLUSION: The frontal-lobe-related behavioral dysfunction is present after the onset of ALS, but is independent of physical impairments.

Brain volume and dysexecutive behavior in schizophrenia.

OBJECTIVE: Behaviors associated with frontal/executive impairments are common in patients with schizophrenia. Our aim was to reconfirm that morphological brain abnormalities in schizophrenia patients would overlap the areas underpinning frontal systems behavior, and examine whether any specific association exists between abnormalities of brain structures and frontal behavioral deficits in schizophrenia patients. METHOD: Twenty-six schizophrenia patients and 26 matched healthy controls underwent structural magnetic resonance imaging and their frontal function was assessed by a self-rating questionnaire, Frontal Systems Behavior Scale (FrSBe). We applied voxel-based morphometry (VBM) to investigate regional brain volume alternations. RESULT: Compared with healthy controls, schizophrenia patients showed reduced gray matter volume in multiple frontal and temporal structures, namely, the bilateral dorsolateral prefrontal cortices (DLPFC), bilateral medial prefrontal cortices, left ventrolateral prefrontal cortex, bilateral anterior cingulate cortices, and bilateral superior temporal gyri. The scores on the executive dysfunction subscale of the FrSBe were correlated with volume reduction in the bilateral DLPFC in the patient group. CONCLUSION: Our result suggests that pathology of the DLPFC could be the neural basis of real-life dysexecutive behaviors in schizophrenia patients.

Insight in social behavioral dysfunction in schizophrenia: Preliminary study.

AIM: Previous studies have demonstrated attenuated insight among schizophrenia subjects about having a mental disorder and about their psychopathology. Few studies, however, have investigated in detail patients' unconcern for their social behavioral problems. METHODS: Using the subjective and objective versions of the Frontal Systems Behavior Scale (FrSBe), the nature of awareness of social behavioral problems was investigated in chronic schizophrenia subjects. RESULTS: First, schizophrenia subjects were found to have problems in three major domains of social behavior: apathy, disinhibition, and executive dysfunction. Second, awareness, estimated by the difference between the subjective and objective ratings, was not uniformly disturbed in schizophrenia subjects, although it had a significant interaction with the subjects' estimated IQs: subjects with higher IQs had a tendency to overestimate their problems, while those with lower IQs had the opposite tendency. Third, the same pattern of interaction was demonstrated for the retrospective premorbid ratings of FrSBe. CONCLUSION: Awareness among schizophrenia subjects of their social behavioral problems is affected by their cognitive capacity, and this applies not only to current behaviors but also to the retrospective estimation of their behaviors in the social domain.