In this special lecture, the author introduced our monography “Talk Dementia” , in which the author talked with Prof Tanabe on dementia based on our own autopsied cases with various dementing illnesses. Of various dementias, some interesting autopsied cases with atypical Alzheimer disease, atypical dementia with Lewy bodies (DLB) , diffuse neurofibrillary tangles with calcification (DNTC) , limbic neurofibrillary tangle dementia (LNTD) , Pick body disease and atypical Pick disease were picked up.

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  Brain lesion rarely produces a simple deficit of a certain mental faculty. It more often produces a pattern of cognitive and behavioral changes reflecting a complex combination of deficits (negative symptom) and apparently irrelevant extra activities (positive symptom) . Since the normal brain which is a super-complex neuronal structure performs its function by realizing a dynamic balance among relatively autonomous multiple functional systems, its damage not only results in hypo-activity of one functional system but also in hyper-activity of others. Many neuropsychological symptom complexes can be understood as manifestation of disturbance of such a dynamic equilibrium.
  Four representative dynamic mechanisms underlying some of the neuropsychological symptoms were discussed based on the author's personal experience.
  These are (1) disturbance of the balance between higher and lower nervous functions, (2) disturbance of the integration and rivalry between the left and right cerebral hemispheres, (3) disturbance of the integration and rivalry between the frontal and parietal functions, and (4) disturbance of integrative activity underlying linguistic capacity.

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  Various types of aberrant social behaviors may occur after brain injury. Some of these behaviors might be understood as psychological reactions to physical impairment or social difficulties. Others might be better understood as direct consequences of brain injury. Apathy, disinhibition, and executive dysfunction are the three major domains of aberrant social behaviors after injury of the prefrontal cortex and its associated subcortical structures. It is proposed that these three domains are specifically associated with medial prefrontal, orbitofrontal, and dorsolateral prefrontal injury, respectively. However, clinico-anatomical correlations are not always clear in many patients, especially in those after traumatic brain injury. Defining the aberrant social behaviors in the framework of cognitive psychology is important to promote understanding of the neurobiological bases of these changes. Regarding apathy, the definition of “ a quantitative reduction of voluntary, goal-directed behaviors” might provide an adequate framework.

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  Impaired social cognition/behavior is one of the most characteristic and frequently observed problems of individuals with brain damage, specifically frontal lobe damage. Two different streams of inter-related problems may lead to impaired sociability of individuals with frontal lobe damage ; impairment in “theory of mind” and diminished control over impulsivity. In this review, intervention techniques how to ameliorate impaired social behaviors were discussed from the clinical and psychiatric viewpoint. Individuals with diminished impulsive control often bring about disinhibitiory behaviors in personal relations, and show “anger burst” once their desires are not fulfilled. Pharmacotherapy including various psychotropic agents is occasionally effective for impulsivity, but more confident evidences are warranted. Cognitive behavioral therapy, one of the most popular psychotherapy techniques for wide range of psychiatric disorders, is also useful for some persons with brain damage. As a rule, individuals with low function/awareness are suitable only for behaviorally-oriented approaches. In contrast, cognitively-oriented approaches could be incorporated for those with high function/awareness. Practical methods of cognitive and behavioral approaches for individuals with frontal lobe damage are briefly discussed. Rewards and punishments underlie and motivate impulsive behaviors. Future important research questions include how to teach future rewards to individuals with frontal lobe damage.

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  We introduced the status quo of interventions in Japan for patients with neurobahavioral disability and social handicap following brain damage and their families. And we discussed what the systematic interventions should be. Behavior therapy and cognitive therapy are applied for remediating various disabilities and handicapps. Communicative function intervenes between higher cortical dysfunctions and adjustment for social and vocatuional life, and the goal of group treatment are improving communication and social skill. Support for families is also important, as the family member suatains the patient.

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  A pathological behavior, termed ‘forced gazing’, was seen in two patients following bilateral frontal lesions. Whenever people came into their sight, the patients were forced to gaze at their faces, specifically people's eyes, and to keep gazing until the people went out of their sight. Forced gazing was inevitably triggered and maintained, without exceptions, by the appearance of people. Suppression of the frontal inhibitory function on the parietal lobes may result in disinhibition of the parietal function so that the patients become extremely dependent on external stimuli. This phenomenon could therefore be attributed to remarkable dependency on the external environment after frontal damages, which may represent a disorder of human autonomy. Since the two patients also showed grasp reflex, instinctive grasp reaction, and compulsive manipulation of tools accompanying their forced gazing, bilateral medial frontal lesions are thought to be most responsible for this behavior. In addition, the lesions extended to the frontal eye field, which were also thought to be responsible.

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  Purpose : This study was aimed at investigating the discourse characteristics of right hemisphere damage(RHD)and clarifying the impact of cognitive dysfunction on those characteristics. Methods : The subjects in this study were 51 patients with RHD and 50 matched healthy control participants. A comic strip story was used to elicit narrative discourse from both groups, and 34 quantitative items were set in order to clarify differences between the characteristics of both groups. In addition, factor analysis was carried out on scores of 5 neuropsychological tests—Japanese Wechsler Adult Intelligence Scale-Revised(WAIS-R), The Behavioral Assessment of the Dysexecutive Syndrome(BADS), Trail Making Test part A(TMT-A), Paced Auditory Serial Addition Task(PASAT), and Reading Span Test(RST)—of the RHD group. Results : Discourse produced by the RHD patients was rated as inefficient and verbose. Five factors were extracted by the factor analysis. We interpreted the first as “planning and monitoring factor,” the second as “working memory and attention factor,” and the third as “general knowledge and vocabulary factor.” These 3 factors were significantly associated with inefficient discourse. Conclusion : The findings suggest that discourse characteristics of RHD patients are attributed to executive dysfunction, attentional disorders, and semantic deficits. These findings indicate that quantitative discourse analysis is an efficient tool for distinguishing the communicative disorder of RHD patients.

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  [Background and Purpose ] The main objective of this study was to compare the hand and finger performance of stroke patients in standing and sitting positions.  
  [ Methods ] Six post-stroke males and 2 females(mean : 68.6 ± 7.0 y)participated in the present study. Inclusion criteria were as follows : right-handed before stroke, right hemiparesis due to left hemisphere lesion induced by stroke, at least 4 months duration after stroke, and ability to stand more than 10 minutes. Tests of dexterity(pegboard test), attention, unilateral spatial neglect, and cognition were studied in comfortable sitting and standing positions. Four subjects started in the standing position, and the other four subjects were tested first in the sitting position. These tests in the first position were performed on one day, and one week later the same tests were performed for the different position on one day.  
  [ Results ] The mean performance time of the pegboard test in the standing position was significantly faster than that of the sitting position(p = 0.017). However, the results of TMT, line cancellation test, line bisection and MMSE in the standing position were not improved compared with the sitting position. Also, in every test there were no differences between the first and second trials.
  [ Conclusion ] The present results showed that the standing position improved performance of the hand and arm in the unaffected side in stroke patients, as opposed to the case of consistent attention, unilateral spatial neglect, and cognition.

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