Neurovascular Neuropsychology (eBook)

Joanne R. Festa, PhD Stroke and Critical Care Division, Department of Neurology Neurological Institute, New York Presbyterian Hospital Columbia University, College of Physicians and Surgeons New York, NY, USA Ronald M. Lazar, PhD Stroke and Critical Care Division, Departments of Neurology and Neurological Surgery Neurological Institute, New York Presbyterian Hospital Columbia University, College of Physicians & Surgeons New York, NY, USA

Foreword 6
Preface 8
Contents 10
Contributors 12
Historical Perspective 16
Stroke and Clinical-Anatomic Cognitive Syndromes 16
From Arteriosclerotic Dementia to Vascular Cognitive Impairment 17
References 20
Neurovascular Geography and Mapping the Consequences of Its Injury 22
Neurovascular Anatomy 22
Autoregulation 24
Diagnostic Studies 25
Brain Imaging 25
Computerized Tomography 25
Magnetic Resonance Imaging 26
Other Imaging Studies of Blood Flow and Metabolism 29
Cerebral Angiography 29
Duplex and Transcranial Doppler Ultrasonography 30
References 32
Ischemic and Intracerebral Hemorragic Stroke 33
Introduction 33
Pathophysiology of Stroke Syndromes 33
Vascular Structures and Territories 34
Specific Stroke Syndromes 35
Left Internal Carotid Stroke 35
Broca’s Aphasia 36
Wernicke’s Aphasia 39
Global Aphasia 40
Conduction Aphasia 40
Anomic Aphasia 41
Transcortical Aphasias 41
Transcortical Motor Aphasia 41
Transcortical Sensory Aphasia 42
Mixed Transcortical Aphasia 42
Subcortical Aphasias 42
Pure Alexia with Agraphia 45
Gerstmann and Angular Gyrus Syndromes 45
Pure Alexia Without Agraphia 46
Disorders of the Right Hemisphere 47
Neglect, Anosognosia 48
Mechanism of Hemineglect 49
Recovery and Therapy of Hemineglect 50
Post Stroke Delirium 51
Constructional Impairment 51
Dressing Impairment 53
Spatial and Topographical Impairment 53
Motor Impersistence 54
Right Hemisphere Language and Communication Impairments 54
Short-Term Memory Impairments 55
Bilateral Syndromes 55
Cortical Auditory Syndromes 55
Cortical Deafness 55
Cortical Blindness, Visual Agnosia, Prosopagnosia, Optic Aphasia 56
Balint’s Syndrome 57
Prosopagnosia 57
Bithalamic Syndromes 57
Cerebellar Syndromes 58
References 59
Cerebral Aneurysms and Subarachnoid Hemorrhage 63
Introduction/Background 63
Neuropathology/Pathophysiology 63
Diagnostic Criteria 64
Subarachnoid Hemorrhage 64
Unruptured Aneurysms 65
Characteristic Neurobehavioral Syndrome 65
Relatively Rare Neurobehavioral Syndromes Following Aneurysmal SAH 68
Unruptured Aneurysms 69
Supporting Laboratory Studies Following SAH 69
Treatment and Prognosis 69
References 70
Neuropsychological Effects of Brain Arteriovenous Malformations 73
Introduction 73
Neuropathology and Pathophysiology 73
Demographics and Epidemiology 74
Natural History 75
Hemorrhage 75
Seizure 76
Headache 76
Neurological/Neuropsychological Deficits 76
Related Vascular Anomalies 78
Imaging Studies 78
Angiography 79
CT and MR 79
Disease Course 80
Treatment and Prognosis 80
Embolization 81
Neurosurgery 81
Radiosurgery 82
Superselective Wada testing and Electrocortical Stimulation Mapping 83
AVM and Cerebral Reorganization 84
Conclusions 84
References 85
Vascular Cognitive Impairment 89
Introduction 89
Vascular Cognitive Impairment: Historical and Modern Perspectives 89
Empirical Support for the Construct of VCI 91
Conversion from Mild Cognitive Disability to Dementia 91
Mild Cognitive Disabilities and Vascular Risk Factors 92
Cognitive Tests Predicting Conversion of VCI to VaD 92
Neuropsychology of VCI 92
VCI and Post-Stroke Cognitive Disabilities 93
VCI and Subcortical White Matter Disease 93
Biomarkers for Vascular Cognitive Impairment 94
Arterial Integrity and VCI 94
Blood Biomarkers and VCI 95
Treatment and Public Health Issues 96
Summary 97
References 97
Vascular Dementia 101
Subtypes of Vascular Dementia 102
The Challenge of Diagnosis 103
The Neuropsychology of Dementia Secondary to Small Vessel Disease: Differentiation From AD 107
Mechanisms of Injury 108
The Comorbidity Dilemma 109
The Neuropsychology of Dementia Secondary to Small Vessel Disease: More Recent Studies 110
Areas for Future Research 112
References 113
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) and Mitochondrial Encephalomyopathy Lactic Acidosis and Stroke-like Episodes (MELAS) 117
CADASIL 117
Definition and Genetic and Pathological Aspects 117
Main Clinical Features and Neurobehavioral Symptoms 119
Cerebral Tissue Lesions and Cognitive Dysfunction in CADASIL 120
Treatment 123
MELAS 124
References 125
Carotid Artery Occlusion and Stenosis 129
Introduction 129
Pathophysiology 130
Characteristic Neurobehavioral Syndrome 132
Supporting Laboratory Studies 133
Carotid Stenosis 134
Angiography 134
CTA and MRA 134
Carotid Duplex Ultrasound 135
Transcranial Doppler (TCD) 136
Carotid Occlusion 136
Cognition and Revascularization 137
Carotid Endarterectomy and Cognition 138
Carotid Artery Stenting 139
EC-IC Bypass 139
Conclusion 141
References 142
Cardiac Arrest 148
Introduction 148
Epidemiology and Clinical Burden 148
Neuropathology 149
Acute Prediction of Survival and Quality of Recovery 150
Examination 150
Laboratory Studies 151
Electrophysiology 151
Neuroimaging 151
Summary 153
Course of Recovery 153
Residual Deficits 154
Treatment 158
Quality of Life 159
References 159
Congestive Heart Failure/Heart Transplant 164
Introduction 164
Pathophysiology 166
Characteristic Neurobehavioral Syndrome 167
Supporting Laboratory Study 169
Treatment 169
References 172
Cognition After Cardiac Surgery 176
Introduction 176
Methodological Issues 176
The Syndrome of Post-Cabg Cognitive Impairment 177
Baseline Cognitive Abnormalities 178
Incidence of Early Cognitive Decline 178
Pathophysiology of Early Cognitive Changes 179
Microemboli 179
Hypoperfusion 180
Atrial Fibrillation 180
Anesthesia 180
Depression 181
Late Cognitive Decline 181
Pathophysiology of Late Cognitive Decline 182
Normal Aging 182
Alzheimer’s Disease 182
Progression of Cerebrovascular Disease 182
Neuropathological Studies 183
Neuroimaging 184
Magnetic Resonance Imaging 184
Diffusion Weighted Imaging Studies 184
Cognitive Change After Cardiac Procedures Other Than CABG 185
Conclusions 185
References 186
Pulmonary Disease and Lung Transplantation 190
Overview of Pulmonary Disease 190
Types of Pulmonary Disease 190
Obstructive Pulmonary Disease 190
Infected Obstructive Lung Diseases 191
Occupational/Environmental Pulmonary Disease 191
Interstitial/Inflammatory Pulmonary Disease 192
Pulmonary Circulation Disorder 192
Measuring Pulmonary Function 192
Neurocognitive Deficits Associated With Pulmonary Disease 193
Cerebral Compromise Associated With Pulmonary Disease 196
End-Stage Pulmonary Disease 196
Lung Transplantation 198
Change in Allocation Policy 198
Living Lobar Transplants 199
Criteria for Referral for Lung Transplant Evaluation 199
Components of Transplant Evaluation and Contraindications to Transplant 199
Role of Neuropsychology in Lung Transplant Evaluations 200
Summary 201
References 201
Diabetes and Hypertension 204
Introduction 204
Neuropathology and Pathophysiology 205
Large Vessel Disease 205
Small Vessel Disease 206
Brain Atrophy 206
Intermediary Metabolic, Inflammatory and Oxidative Mechanism: Hypertension 207
Intermediary Physiologic Changes in Type II Diabetes 207
Hyperinsulinemia 208
Diabetes and Genetic Susceptibility 208
Characteristic Neurobehavioral Syndromes 209
Diabetes: Special Considerations 210
Type 1 Diabetes 210
Type 2 Diabetes 210
Plasma Glucose Dose Effects 210
Conclusion 211
References 212
Neurovascular Consequences of Systemic Disease - Collagen Vascular Disease 216
Introduction 216
Atherosclerosis 216
Antiphospholipid Antibodies 217
Neuropathology/Pathophysiology 218
Vasculopathy in Systemic Lupus Erythematosis 218
Cytokines 218
Adhesion Molecules 219
Antiphospholipid Antibodies and NPSLE 219
Characteristic Neurobehavioral Syndromes in SLE 220
Cerebrovascular Disease 220
Cerebrovascular Disease Related to Atherosclerosis in SLE Patients 220
Cerebrovascular Disease Related to aPL Antibodies in SLE Patients 221
Cognitive Dysfunction 222
Supporting Laboratory Studies 224
Imaging 224
Cerebrospinal Fluid Evaluation 225
Autoantibody Testing 225
Neuropsychological Testing 226
Disease Course, Treatment, and Prognosis 227
Cerebrovascular Disease 227
Cognitive Dysfunction 228
References 228
Neurovascular Disease and Mood Disorders 234
Introduction 234
Neuropathology/Pathophysiology 235
Diagnostic Criteria 236
Mood Disorder Assessment 237
Natural History 240
The Impact of Mood Disorders 243
Treatment 244
Pharmacotherapy 244
Psychotherapy 246
Electroconvulsive Therapy 248
Access to Treatment 248
Future Directions 249
References 250
Functional Imaging in Stroke Recovery 257
Introduction 257
Impact of Stroke on Functional Networks 258
Imaging Stroke Recovery 259
Mechanisms of Recovery 261
References 264
Pharmacological Treatment for Cognitive Disorders of Neurovascular Origin 267
Introduction 267
Cognition 268
Catecholamine Role in Cognitive Function 269
Norepinephrine Anatomy and Physiology 270
Dopamine (DA) 271
Serotonin 273
Acetylcholine (ACh) 274
Glutamate 274
Enhancement of Specific Cognitive Skills 275
Executive Skills 275
Attention 278
Memory 279
Vascular Dementia 280
Language 281
Post-Stroke Depression and Cognition 283
Summary 283
References 284
Neuropsychological Rehabilitation 292
Introduction 292
Impact of Cognitive Deficits Post-Stroke 292
Framework for Rehabilitation 294
Focal Cognitive/Perceptual Deficit Syndromes 296
Attention 296
Pathophysiology and Mechanisms 296
Current Research 297
Direct Remediation of Non-Spatial Attention 297
Compensatory Strategies for Non-Spatial Attention Deficits 298
Clinical Applications and Future Directions 299
Spatial Neglect 299
Pathophysiology and Mechanisms 299
Current Research 300
Direct Remediation of Spatial Neglect 300
Compensatory Strategies for Spatial Neglect 301
Clinical Applications and Future Directions 302
Memory 303
Pathophysiology and Mechanisms 303
Current Research 303
Direct Remediation of Memory Function 303
Compensatory Strategies for Improving Memory Function 303
Clinical Application and Future Research 305
Executive Function 305
Pathophysiology and Mechanisms 305
Current Research 306
Direct Skill Training 306
External Compensatory Strategies to Treat Executive Function Impairments 307
Clinical Application and Future Research 307
Language and Communication Disorders 307
Pathophysiology and Mechanism 307
Current Research 308
Clinical Application and Future Research 309
Conclusions 310
References 310
Index 317