Post-stroke urinary incontinence is associated with behavior control deficits and overactive bladder.

BACKGROUND: Although urinary incontinence in stroke survivors can substantially impact the patient's quality of life, the underlying neuropsychological mechanisms and its neural basis have not been adequately investigated. Therefore, we investigated this topic via neuropsychological assessment and neuroimaging in a cross-sectional study. METHODS: We recruited 71 individuals with cerebrovascular disease. The relationship between urinary incontinence and neuropsychological indices was investigated using simple linear regression analysis or Mann-Whitney U test, along with other explanatory variables, e.g., severity of overactive bladder. Variables with a p-value of <0.1 in the simple regression analysis were entered in the final multiple linear regression model to control for potential confounding factors. To carry out an in-depth examination of the neuroanatomical substrate for urinary incontinence, voxel-based lesion-behavior mapping was performed using MRIcron software. RESULTS: Behavioral control deficits and severity of overactive bladder were closely related to severity of urinary incontinence. The voxel-based lesion-behavior mapping suggests a potential role for ventromedial prefrontal cortex lesioning in the severity of urinary incontinence, although this association is not statistically significant. CONCLUSIONS: Post-stroke urinary incontinence is closely related to two factors: neurogenic overactive bladder, a physiological disinhibition of micturition reflex, and cognitive dysfunction, characterized by behavior control deficits.

Investigating the Link Between Subjective Depth Perception Deficits and Objective Stereoscopic Vision Deficits in Individuals With Acquired Brain Injury.

Individuals with acquired brain injury have reported subjective complaints of depth perception deficits, but few have undergone objective assessments to confirm these deficits. As a result, the literature currently lacks reports detailing the correlation between subjective depth perception deficits and objective stereoscopic vision deficits in individuals with acquired brain injury, particularly those cases that are characterized by a clearly defined lesion. To investigate this relationship, we recruited three individuals with acquired brain injury who experienced depth perception deficits and related difficulties in their daily lives. We had them take neurologic, ophthalmological, and neuropsychological examinations. We also had them take two types of stereoscopic vision tests: a Howard-Dolman-type stereoscopic vision test and the Topcon New Objective Stereo Test. Then, we compared the results with those of two control groups: a group with damage to the right hemisphere of the brain and a group of healthy controls. Performance on the two stereoscopic vision tests was severely impaired in the three patients. One of the patients also presented with cerebral diplopia. We identified the potential neural basis of these deficits in the cuneus and the posterior section of the superior parietal lobule, which play a role in vergence fusion and are located in the caudal region of the dorso-dorsal visual pathway, which is known to be crucial not only for visual spatial perception, but also for reaching, grasping, and making hand postures in the further course of that pathway.

Apathy Level, Disinhibition, and Psychiatric Conditions Are Related to the Employment Status of People With Traumatic Brain Injury.

IMPORTANCE: An understanding of the potential prognostic factors as they relate to the employment status of people with traumatic brain injury (TBI) is necessary so that occupational therapy practitioners can provide the most effective treatment. OBJECTIVE: To examine the impact of apathy, disinhibition, and psychiatric conditions on employment status after TBI. DESIGN: An observational study conducted from March 2015 to March 2020. SETTING: Cognitive dysfunction clinics associated with two general hospitals in Japan. PARTICIPANTS: Japanese people of working age (N = 110, ages 18-65 yr) with TBI. Outcomes and Measures: As an outcome indicator, each participant's employment status was rated on a 3-point scale (i.e., 3 = regular employment, 2 = welfare employment [employed as a person with disabilities or undergoing vocational training in the Japanese welfare employment system, for which a worker is paid under either system], 1 = unemployment). Psychiatric, neuropsychological, and physical assessments were measured as explanatory variables. The impact of various factors on employment status was investigated using linear discriminant regression analysis. RESULTS: The level of apathy, disinhibition, and incidence of psychiatric conditions after TBI, as well as age and years postinjury, were related to employment status. Conclusion and Relevance: Although this is a cross-sectional study, interventions for apathy and disinhibition, as well as management of psychiatric conditions, are recommended to help improve employment status among people with TBI. What This Article Adds: The employment status of people with TBI is related more to apathy, disinhibition, and psychiatric conditions than to intelligence, memory function, or executive function.

Visuospatial working memory dysfunction from tapping span test as a diagnostic tool for patients with mild posterior cortical atrophy.

Posterior cortical atrophy is a rare degenerative condition with prominent visuospatial dysfunction which commonly occurs between ages 50 and 65. A diagnosis of mild posterior cortical atrophy sometimes challenging and can be delayed because there are currently no established neuropsychological examination methods that can easily be used in clinical settings. In this study, we examined whether the tapping span test is a potential diagnostic tool for posterior cortical atrophy and what impairment the tapping span test is indicative of in this condition. Eight patients with mild posterior cortical atrophy were recruited. Age- and severity-matched individuals with amnesic Alzheimer's disease (n = 9) were also recruited as a control group. The participants were subjected to the tapping span test and several visuospatial working memory tests. The results of the tapping span and visuospatial working memory tests were worse for the posterior cortical atrophy group when compared with the control group. The results from the tapping span tests were strongly correlated with those from the visuospatial working memory tests. The tapping span test is a simple and potentially useful diagnostic tool for patients with mild posterior cortical atrophy, as it reflects visuospatial working memory function.

Numeric input operation on electronic devices among individuals with visuospatial working memory impairment.

ABSTRACTIn human-computer interactions, higher-level visuospatial function is likely needed to effectively use the interface. The aim of this study is to clarify whether individuals with visuospatial defects can use electronic devices effectively. We quantitatively and qualitatively analyzed the ability of seven individuals with Bálint syndrome and seven individuals with left-unilateral spatial neglect (USN) to input a digit sequence into a flat touch interface. Control groups consisted of seven individuals with memory deficits and 11 healthy individuals. Participants with Bálint syndrome took longer and had more hesitations than the USN group and the two control groups to input numerical sequences (Steel-Dwass test, p < .01). In addition, participants with Bálint syndrome had a high percentage of hesitations for exploration of the button array on the interface relative to USN and the memory deficit group (Fisher's exact test, p < .05). Regarding neuropsychological data, participants with Bálint syndrome had a lower score for visuospatial working memory than participants with USN and the memory deficits control group (Steel-Dwass test, p < .01). The results shed some light on the relation between visuospatial working memory deficits and the spatial perception of interface layouts and spatial control during electronic device operation.

Dementia trajectory for patients with logopenic variant primary progressive aphasia.

BACKGROUND: The timing of progression of logopenic variant primary progressive aphasia (lvPPA) to severe dementia has not been elucidated. To address this shortcoming, 10 patients with lvPPA were continuously followed. METHODS: Patients were assessed with the annual rate of change in the Clinical Dementia Rating (CDR) sum of boxes and period from lvPPA onset to the onset of benchmark signs, including mild, moderate, or severe dementia, episodic memory deficits, topographical disorientation, difficulties with using controls for electronic appliances, and conceptual apraxia. When severe dementia was evident, we also investigated the incidence of severe cognitive and behavioral signs such as neologistic jargon, difficulties in recognizing family members, pica, and mirror sign. RESULTS: The mean time for patients to reach a particular CDR was as follows: CDR of 1, 4.1 ± 1.3 years post-onset; CDR 2, 5.7 ± 1.6 years; CDR 3, 7.3 ± 1.6 years. The annual rate of change in the CDR sum of boxes was 3.4 ± 1.1, corresponding to 1.7 years for the CDR to increase by 1.0. Difficulties with using electronic controls began at 3.3 ± 1.6 years, episodic memory deficits at 4.0 ± 2.0 years, topographical disorientation at 5.2 ± 2.1 years, and conceptual apraxia at 5.5 ± 2.1 years. For patients who progressed to severe dementia, six could not recognize family members, five exhibited pica, three experienced mirror sign, and one developed neologistic jargon. CONCLUSIONS: Our results suggest that patients with lvPPA progress rapidly to dementia and develop conceptual apraxia, episodic memory deficits, visuospatial deficits, and semantic memory deficits.

Logoclonia might be a Characteristic of Logopenic Variant Primary Progressive Aphasia at an Advanced Stage: Potential Mechanisms Underlying Logoclonia.

Logoclonia, which is the meaningless repetition of a syllable, particularly an end syllable of a word, has been described in patients with dementia for a century. The mechanisms behind logoclonia, however, have yet to be clarified. Among 914 patients with aphasia, five patients presented with logoclonia, all of whom were categorized as having logopenic variant PPA (lvPPA) during the initial stage of their illness and met the clinical criteria for diagnosis of probable Alzheimer's disease. Cognitively, they were all severely impaired when they presented with logoclonia. During the progression from lvPPA to logoclonia in these patients, their naming abilities and phonological output function deteriorated despite their retained speech fluency. Logoclonia might be a characteristic sign of advanced-stage lvPPA. Although logoclonia might be associated with perseveration, deterioration in naming abilities and phonological output function along with retained speech fluency might form the basis for the development of logoclonia.

Prognostic factors for long-term improvement from stroke-related aphasia with adequate linguistic rehabilitation.

In the past decade, several studies have reported potential prognostic factors for aphasia after stroke. However, these reports covered no more than 1 year after stroke onset, even though patients often continue to improve over longer periods. The present study included 121 patients with aphasia who received cognitive-based linguistic rehabilitation for at least 2 years post-onset. All were right-handed and had a lesion only in the left hemisphere. Aphasia outcome was predicted using multiple linear regression analysis. Age at onset, lesion in the left superior temporal gyrus including Wernicke's area, and baseline linguistic abilities including aphasia severity and both phonological and semantic functions were significant predictors of long-term aphasia outcome. These findings suggest that the long-term outcome of aphasia following adequate linguistic rehabilitation can be predicted by age at onset, lesion area, and baseline linguistic abilities and that linguistic rehabilitation is particularly recommended for younger individuals with aphasia.

Layer-by-layer manipulation of anisotropic nanoblocks: orientation-switched superlattices through orthogonal stacking of a and c directions.

Nanometer-scale switching of the crystallographic orientation enables production of novel superlattices for exploration of new functions. Elaborate multilayered architectures of Mn3O4 nanocuboids were constructed by a convective self-assembly process. The nanometric cuboids were accumulated into orientation-switched superlattices on micrometric scales by controlling the a and c directions of the tetragonal crystal periodically. The orthogonal stacking of the tetragonal nanoblocks was achieved through the layer-by-layer manipulation process of two types of 2D arrays with different orientations.

Association between chronic kidney disease and the cognitive function in subjects without overt dementia
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AIM: The association between cognitive function and clinical parameters of chronic kidney disease (CKD) was investigated in Japanese patients without overt dementia in a cross-sectional study. MATERIALS AND METHODS: A population of 497 patients whose cognitive function had been examined using the mini-mental state examination (MMSE) were screened for this study. After the exclusion of 306 subjects who showed overt dementia, the association between the MMSE score and clinical characteristics was investigated in 191 subjects (male: 55%, age: 69 ± 12 years). RESULTS: The mean MMSE score of the study subjects was 26.7 ± 2.0. The MMSE score was negatively correlated with the patients' age and positively with the estimated glomerular filtration rate. It was significantly associated with age and proteinuria based on a multivariate analysis. The scores of "temporal orientation", "attention and calculation", and "remote memory" subitems of MMSE were significantly lower in the subjects ≥ 70 years of age than in those < 70 years of age. The scores of "temporal orientation" (4.3 ± 0.8 vs. 4.7 ± 0.6), "attention and calculation" (2.9 ± 1.6 vs. 3.9 ± 1.5), and "stage command" (2.7 ± 0.5 vs. 2.9 ± 0.3) were significantly lower in the subjects with proteinuria than in those without. CONCLUSION: Cognitive function was disturbed even in CKD patients without overt dementia. Intervention in patients with risk factors is deemed important for preventing future reductions in cognitive and renal functions in CKD patients without dementia.
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Spatial Control of Crystallographic Direction in 2D Microarrays of Anisotropic Nanoblocks on Trenched Substrates.

Elaborate two-dimensional (2D) microarrays of tetragonal Mn3O4 nanocuboids 10-20 nm in size were constructed with parallel trenches 500 nm wide and 500 nm deep on a silicon substrate. By adjusting the conditions, including the dispersion medium, particle concentration, and evaporation rate, the a-face and c-face 2D arrays were selectively deposited on the upper and lower stages of the trenches, respectively. The crystallographic direction of the tetragonal crystal was alternately switched in the 2D microarrays under these specific conditions at the optimal particle concentration and evaporation rate. Spatial switching of their crystallographic direction was achieved via interaction of the anisotropic nanoblocks and the specifically shaped surfaces.

Semantic memory deficits are associated with pica in individuals with acquired brain injury.

Although pica is one of the most prominent signs in individuals with severe cognitive impairment, the mechanisms and neural basis for pica have not been well elucidated. To address this issue, patients with acquired brain injury who showed pica and hyperorality were investigated. Eleven patients with pica, i.e., individuals who eat non-food items, and eight patients with hyperorality but who never eat non-food items were recruited. The cognitive and behavioral assessments and neural substrates of the two groups were compared. For basic cognitive and behavioral functions, two kinds of mental state examination-the mini-mental state examination and the new clinical scale for rating of mental states of the elderly-were administered. For pica-related behavioral features, frontal release signs, semantic memory deficits, and changes in eating behaviors were compared. Compared with the hyperorality group, the pica group had more severe semantic memory deficits and fewer frontal release signs, whereas there was no significant difference in changes in eating behaviors. Individuals in the pica group always had a lesion in the posterior part of the middle temporal gyrus. These findings suggest that semantic memory deficits following temporal lobe damage are associated with pica.

Orientation-Selective Alignments of Hydroxyapatite Nanoblocks through Epitaxial Attachment in a and c Directions.

Nanometric rods of hydroxyapatite (HA) were aligned in selective crystallographic directions by the alternation of adsorbing molecules. The side and end faces of HA nanorods elongated in the c direction were covered with oleic acid (OA) and tetraoctylammonium (TOA) ions, respectively. Alignment in the c direction of the OA-modified nanorods was produced through epitaxial attachment of the bare end faces in toluene because the side faces were hydrophobized with the negatively charged modifier. Another alignment-in the a direction of the TOA-modified HA nanorods-was obtained through the epitaxial attachment of the bare side faces in ethanol due to stabilization of the end faces with the positively charged modifier. Controlled alignments of the nanorods in the a and c directions were achieved through oriented attachment with the selective coverage of the c and a faces with the specific modifiers.

UV-induced epitaxial attachment of TiO2 nanocrystals in molecularly mediated 1D and 2D alignments.

Anatase TiO2 nanocrystals were crystallographically connected through UV-induced epitaxial attachments in 1D and 2D arrays with photocatalytic decomposition of the organic mediator.

Orientation-selective alignments of nanoblocks in a and c directions of a tetragonal system through molecularly mediated manipulation.

Tetragonal Mn3O4 nanocuboids were aligned in selective crystallographic directions by molecularly mediated manipulation. Alignment in the a direction was produced by a face-by-a face assembly of hydrophobic nanocuboids covered with oleic acid. Another 1D array in the c direction was obtained through c face-to-c face assembly with the replacement of the organic modifiers.

Conductive polymer-mediated 2D and 3D arrays of Mn3O4 nanoblocks and mesoporous conductive polymers as their replicas.

Orientation-controlled 2D and 3D microarrays of Mn3O4 nanocuboids that were mediated by a conductive polymer were fabricated by evaporation-induced self-assembly of the oxide nanoblocks and subsequent polymerization of pyrrole in the interparticle spaces. Free-standing mesoporous polypyrroles (PPy) having chain- and square-grid-like nanovoid arrays were obtained as replicas of the composite assemblies by dissolving the oxide nanoblocks. The PPy-mediated manganese oxide arrays exhibited stable electrochemical performance as an ultrathin anode of a lithium-ion secondary battery.

Effectiveness of Use of Button-Operated Electronic Devices Among Persons With Bálint Syndrome.

OBJECTIVE: Little is known about how visuospatial deficits affect the use of electronic devices operated by pressing spatially interspersed buttons. This study aimed to determine whether people with Bálint syndrome can effectively use such devices. METHOD: We quantified the ability of 7 study participants with Bálint syndrome to use button-operated electronic devices by measuring the time required to input digit sequences into three different types of devices. Control groups were 8 participants with amnesia and 8 healthy participants. RESULTS: Participants with Bálint syndrome took longer to input a digit sequence on all three devices than did those in the two control groups. Although we found no significant differences with respect to type of device, 2 of 3 participants with severe Bálint syndrome were able to input one- to five-digit sequences with the electronic calculator. CONCLUSION: Distinctive design features might positively affect the performance of people with Bálint syndrome.

Visuospatial working memory is severely impaired in Bálint syndrome patients.

Although it has been proposed that visuospatial working memory may be impaired in Bálint syndrome patients, neither a systematic study concerning this proposal nor a comparison with patients having right-parietal damage has been made. Visuospatial working memory was assessed for six Bálint syndrome patients and members of two control groups-one composed of individuals with right-parietal damage (n = 15) and a second of age- and gender-matched healthy individuals (n = 26). We placed special emphasis on patients with a mild form of Bálint syndrome who can judge positional relationships between two objects. First, the participants were subjected to delayed visuospatial matching tasks. Next, their visuospatial-temporal integration abilities were assessed using a shape-from-moving-dots task. Visuospatial working memory was impaired for Bálint syndrome patients compared with controls according to the results of the tests. The differences between the Bálint syndrome and control subjects remained when only data for patients with the mild form of Bálint syndrome were included. We conclude that visuospatial working memory may be severely impaired in Bálint syndrome patients and, therefore, might influence their inability to properly execute movements and behaviours associated with daily living.

Formation of Monocrystalline 1D and 2D Architectures via Epitaxial Attachment: Bottom-Up Routes through Surfactant-Mediated Arrays of Oriented Nanocrystals.

Monocrystalline architectures with well-defined shapes were achieved by bottom-up routes through epitaxial attachment of Mn3O4 nanocrystals. The crystallographically continuous 1D chains elongated in the a axis and 2D panels having large a or c faces were obtained by removal of the organic mediator from surfactant-mediated 1D and 2D arrays of Mn3O4 nanocrystals, respectively. Our basal approach indicates that the epitaxial attachment through the surfactant-mediated arrays is utilized for fabrication of a wide variety of micrometric architectures from nanometric crystalline units.

Direction control of oriented self-assembly for 1D, 2D, and 3D microarrays of anisotropic rectangular nanoblocks.

Micrometric linear chains (1D arrays), monolayers (2D arrays), and superstructures (3D arrays) of anisotropic Mn3O4 nanocuboids were selectively produced by oriented self-assembly through evaporation of a dispersion. The 1D arrays were basically formed on a substrate via oriented self-assembly of the rectangular crystals in the ⟨100⟩ direction. The 2D and 3D microarrays were obtained by adjusting the particle concentration of the dispersion. The [001] direction of tetragonal crystal was controlled to be parallel and perpendicular to the substrate by changing the polarity of the medium.