Hostname: page-component-7c8c6479df-8mjnm Total loading time: 0 Render date: 2024-03-28T12:42:57.268Z Has data issue: false hasContentIssue false

Dementia associated with dorsal midbrain lesion

Published online by Cambridge University Press:  26 February 2009

K.J. Meador
Affiliation:
Department of Neurology, Medical College of Georgia and VA Medical Center, Augusta, GA 30912 Department of Pharmacology/Toxicology, Medical College of Georgia and VA Medical Center, Augusta, GA 30912
D.W. Loring
Affiliation:
Department of Neurology, Medical College of Georgia and VA Medical Center, Augusta, GA 30912
K.D. Sethi
Affiliation:
Department of Neurology, Medical College of Georgia and VA Medical Center, Augusta, GA 30912
F. Yaghmai
Affiliation:
Department of Pathology, Medical College of Georgia and VA Medical Center, Augusta, GA 30912
S.D. Styren
Affiliation:
Department of Psychiatry, Western Psychiatric Institute and Clinic and University of Pittsburgh Medical School, Pittsburgh, PA 15213 Department of Neurology, Western Psychiatric Institute and Clinic and University of Pittsburgh Medical School, Pittsburgh, PA 15213
S.T. DeKosky
Affiliation:
Department of Psychiatry, Western Psychiatric Institute and Clinic and University of Pittsburgh Medical School, Pittsburgh, PA 15213 Department of Neurology, Western Psychiatric Institute and Clinic and University of Pittsburgh Medical School, Pittsburgh, PA 15213

Abstract

Although the dorsal midbrain has been implicated in cognitive processes in animals, its role in humans is unclear. We report the neuropsychological and postmortem neuropathological findings of a 52-yr-old university professor who developed a profound dementia in association with a focal dorsal midbrain lesion. The patient's disorder appeared to result from a tuberculous granuloma based on the clinical course and autopsy results. Neuropsychologically, he exhibited a generalized impairment across most of the cognitive domains assessed. His deficits were not explained by impaired arousal, specific sensory or motor defects, depression, or hydrocephalus. Although there are inherent limitations to a single-case investigation, our observations are consistent with animal studies that have demonstrated that focal dorsal midbrain lesions may result in cognitive impairment. We propose that the dorsal midbrain is involved in cognitive processing via modulation of thalamocortical networks. (JINS, 1996, 2, 359–367.)

Type
Research Article
Copyright
Copyright © The International Neuropsychological Society 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Appollonio, I.M., Grafman, J., Schwartz, V., Massaquoi, S., & Hallett, M. (1993). Memory in patients with cerebellar degeneration. Neurology, 43, 15361544.Google Scholar
Barbaresi, P., Conti, F., & Manzoni, T. (1982). Axonal branching in the periaqueductal gray projections to the thalamus: A fluorescent retrograde double-labeling study in the cat. Brain Research, 252, 137141.Google Scholar
Benton, A.L. & Hamsher, K. de S. (1978). Multilingual aphasia examination. lowa City, lA: Department of Neurology, University Hospitals.Google Scholar
Benton, A.L., Varney, N., Hamsher, K. de S., & Spreen, O. (1983). Contributions to neuropsychological assessment. New York: Oxford University Press.Google Scholar
Brodal, A. (1981). Neurological anatomy in relation to clinical medicine (3rd ed.). New York: Oxford University Press.Google Scholar
Carpenter, W.B. (1853). Principles of human physiology (5th Amer. ed.; From 4th London ed.). Philadelphia: Blanchard & Lea.Google Scholar
Carstens, E., Leah, J., Lechner, J., & Zimmerman, M. (1990). Demonstration of extensive brain stem projections to medial and lateral thalamus and hypothalamus in the rat. Neuroscience, 35, 609626.Google Scholar
Cummings, J.L. (1986). Subcortical dementia. Neuropsychology, neuropsychiatry, and pathophysiology. British Journal of Psychiatry, 149, 682697.Google Scholar
Fudge, J.L, Perry, P.J., Garvey, M.J., & Kelly, M.W. (1990). A comparison of the effect of fluoxetine and trazodone on the cognitive functioning of depressed outpatients. Journal Affective Disorders, 18, 275280.Google Scholar
Goldberg, E., Antin, S.P., Bilder, R.M., Hughes, J.E.O., & Mattis, S. (1981). Retrograde amnesia: Possible role of mesencephalic reticular activation in long-term memory. Science, 213, 13921394.Google Scholar
Grafman, J., Litvan, I., Massaquoi, S., Stewart, M., Sirigu, A., & Hallett, M. (1992). Cognitive planning deficit in patients with cerebellar atrophy. Neurology, 42, 14931496.Google Scholar
Hannay, H.J. & Levin, H.S. (1985). Selective reminding test: An examination of the equivalence of four forms. Journal Clinical Experimental Neuropsychology, 7, 251263.Google Scholar
Jasper, H.H. (1977). Wilder Penfield: His legacy to neurology. The centrencephalic system. Canadian Medical Association Journal, 116, 13711372.Google Scholar
Katz, D.I., Alexander, M.P., & Mandell, A.M. (1987). Dementia following strokes in the mesencephalon and diencephalon. Archives Neurology, 44, 11271133.Google Scholar
Kim, S.G., Ugurbil, K., & Strick, P.L. (1994). Activation of a cerebellar output nucleus during cognitive processing. Science, 265, 949951.Google Scholar
Levine, D.N., Grek, A., & Calvanio, R. (1985). Dementia after surgery for cerebellar stroke: An unrecognized complication of acute hydrocephalus? Neurology, 35, 568571.Google Scholar
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.Google Scholar
Loring, D.W., Martin, R.C., Meador, K.J., & Lee, G.P. (1990). Psychometric construction of the Rey-Ostcrricth complex figure: Methodological considerations and interratcr reliability. Archives Clinical Neuropsychology, 5, 114.Google Scholar
Magoun, H.W. (1962). The waking brain (2nd cd.). Springfield, IL: Thomas.Google Scholar
Mantyh, P.W. (1983). Connections of midbrain periaqucductal gray in the monkey. I. Ascending efferent projections. Journal Neurophysiology, 49, 567581.Google Scholar
MeCormick, D.A. (1992). Neurotransmitter actions in the thalamus and cerebral cortex and their role in neuromodulation of thalamocortical activity. Progress in Neurobiology, 39, 337388.Google Scholar
Mesulam, M.M., Mufson, E.J., Levey, A., & Wainer, B.H. (1983). Cholinergic innervation of cortex by the basal forcbrain: Cytochemistry and cortical connections of the scptal area, diagonal band nuclei, nucleus basalis (substantia innominata), and hypothalamus in the rhesus monkey. Journal of Comparative Neurology, 214, 170197.Google Scholar
Nashold, B.S. (1970). Phosphcncs resulting from stimulation of the midbrain in man. Archives Ophthalmology, 84, 433435.Google Scholar
Nashold, B.S., Wilson, W.P., & Slaughter, D.G. (1969). Sensations evoked by stimulation in the midbrain of man. Journal of Neurosurgery, 30, 1424.Google Scholar
Penfield, W. (1952). Epileptic automatism and the centrencephalic integrating system. Research Publication Association for Research in Nervous Mental Disease, 30, 513528.Google Scholar
Penfield, W. (1954). Mechanisms of voluntary movement. Brain, 77, 117.Google Scholar
Penfield, W. (1958). Centrencephalic integrating system. Brain, 81, 231234.Google Scholar
Penfield, W. (1959). Consciousness and centrencephalic organization. In Bogacrt, L. & Rademecker, J. (Eds.), Proceedings of the First International Congress of Neurological Sciences (pp. 718). London: Pergamon.Google Scholar
Peselow, E.D., Corwin, J., Fieve, R.R., Rotrosen, J., & Cooper, T.B. (1991). Disappearance of memory deficits in outpatient depressives responding to imipramine. Journal Affective Disorders, 21, 173183.Google Scholar
Plum, F. & Posner, J.B. (1982). The diagnosis of stupor and coma (3rd ed.). Philadelphia: F. A. Davis Co.Google Scholar
Reichling, D.B. & Basbaum, A.I. (1991). Collateralization of periaqucductal gray neurons to forcbrain or diencephalon and to the medullary nucleus raphe magnus in the rat. Neuroscience, 42, 183200.Google Scholar
Rinvik, E. & Wiberg, M. (1990). Demonstration of a reciprocal connection between the periaqueductal gray matter and the reticular nucleus of the thalamus. Anatomical Embryology, 181, 577584.Google Scholar
Ryding, E., Decety, J., Sjoholm, H., Stenberg, G., & Ingvar, D.H. (1993). Motor imagery activates the cerebellum regionally. A SPECT rCBF study with 99mTc-HMPAO. Cognitive Brain Research, 1, 9499.Google Scholar
Steriade, M., Datta, S., Paré, D., Oakson, G., & Curró, Dossi R.. (1990). Neuronal activities in brain-stem cholinergic nuclei related to tonic activation processes in thalamocortical systems. Journal of Neuroscience, 10, 25412559.Google Scholar
Steriade, M., McCormick, D.A., & Sejnowski, T.J. (1993). Thalamocortical oscillations in the sleeping and aroused brain. Science, 262, 679685.Google Scholar
Steriade, M., Paré, D., Parent, A., & Smith, Y. (1988). Projections of cholinergic and non-cholinergic neurons of the brain stem core to relay and associational thalamic nuclei in the cat and macaque monkey. Neuroscience, 25, 4167.Google Scholar
Thompson, R. (1993). Centrcnccphalic theory, the general learning system, and subcortical dementia. In Crinella, F.M. & Yu, J. (Eds.), Brain mechanisms. Papers in memory of Robert Thompson Vol. 702 (pp. 197223). New York: New York Academy of Sciences.Google Scholar
Thompson, R., Bjelajac, V.M., Huestis, P.W., Crinella, F.M., & Yu, J. (1987a). Puzzle-box learning impairments in young rats with lesions to the “general learning system.” Psychobiology, 17, 7788.Google Scholar
Thompson, R., Bjelajac, V.M., Huestis, P.W., et al. (1989). Inhibitory deficits in rats rendered “mentally retarded” by early brain damage. Psychobiology, 17, 6167.Google Scholar
Thompson, R., Gibbs, R.B., Ristic, G.A., et al. (1986a). Learning deficits in rats with early ncurotoxic lesions to the globus pal lidus, substantia nigra, median raphe or pontine reticular formation. Physiology Behavior, 37, 141151.Google Scholar
Thompson, R., Harmon, D., & Yu, J. (1985). Deficits in response inhibition and attention in rats rendered mentally retarded by early subcortical brain damage. Developmental Psychobiology, 18, 483499.Google Scholar
Thompson, R., Huestis, P.W., Crinella, F.M., & Yu, J. (1986b). The neuroanatomy of mental retardation in the white rat. Neuroscience Biobehavioral Reviews, 11, 317338.Google Scholar
Thompson, R., Huestis, P.W., Crinella, F.M., & Yu, J. (1987b). Further lesion studies on the neuroanatomy of mental retardation in the white rat. Neuroscience Biobehavioral Reviews, 11, 415440.Google Scholar
Thompson, R., Huestis, P.W., Shea, C.N., Crinella, F.M., & Yu, J. (1990). Brain structures important for solving a sawdust digging problem in the rat. Physiology Behavior, 48, 107111.Google Scholar
Torack, R.M. & Morris, J.C. (1988). The association of ventral tegmental area histopathology with adult dementia. Archives of Neurology, 45, 497501.Google Scholar
Walshe, F.M.R. (1957). The brain-stem conceived as the “highest level” of function in the nervous system; with particular reference to the “automatic apparatus” of Carpenter (1850) and to the “centrencephalic integrating system” of Penfield. Brain, 80, 510539.Google Scholar
Wechsler, D. (1974). Wechsler Intelligence Scale for Children-Revised (W1SC-R). New York: The Psychological Corporation.Google Scholar
Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence Scale-Revised. New York: The Psychological Corporation.Google Scholar
Wilson, W.P. & Nashold, B.S. (1973). Evoked photic responses from the human thalamus and midbrain. Confinia Neurologica, 35, 338345.Google Scholar