Misidentification of persons in dementia is a symptom of delusionally misidentifying familiar persons who are “obviously understandable”, in the stage where generalized cognitive impairment is not so severe. By speculating the patientsʼ subjective experiences from their behavior and “narrative”, the following inferences are made about the pathogenesis underlying this peculiar symptom. Misidentifications occur more frequently in DLB than in AD, which suggests that some biological factors work. The misidentification observed in DLB is characterized by a co-occurrence of duplication phenomenon, which in turn may be caused by the fluctuation of the arousal level that makes it difficult to distinguish between imagination and reality.
  In AD the psychological factor is presumed to mainly work as a cause of misidentification symptom. That is subconscious craving to escape from the unpleasant present situation, and to make a harsh reality temporarily less distressing. In also DLB, the psychological factors work as in AD, and in AD, vise versa, the biological factors work as in DLB. Ultimately speaking, the misidentification of persons observed in dementia is thought to have an adaptive role for patients in severe mental distress.

  Epilepsy surgery is a treatment option for patients with epilepsy who failed multiple antiepileptic drugs. After detailed investigations for probing the epileptic focus and surrounding functional brain regions, tailor-made resection of the epileptic focus is performed seeking for seizure freedom. We have combined the state-of-art systems neuroscience methods to explore and preserve the language network, such as a less invasive electrical cortical stimulation method, signal analyses and decoding of electrocorticogram (ECoG) , cortico-cortical evoked potential (CCEP) , anatomical fiber tractography and longitudinal neuropsychologic evaluation. We here report the comprehensive language mapping of the dual language pathway, its clinical application to awake brain surgery, and the novel findings for neural basis of the language dual stream with emphasis on the semantic aspect. According to recent function and connectivity studies, the basal temporal language area at and around the anterior fusiform gyrus is one of the crucial regions for semantic memory and is involved in the ventral language pathway. In order to improve the QOL of patients in terms of language and semantic functions, a comprehensive multidisciplinary longitudinal study in a large cohort is warranted to delineate the brain plasticity related to these important higher brain functions.

  We report a case of somatoparaphrenia following a hemorrhage of the left basal ganglia, thalamus, insula, anterior part of the frontal and parietal lobe. The patient, who is in his sixties and a right handed male, presented severe right hemiplegia, sensory disturbance and moderate aphasia, but there were no obvious anosognosia for hemiplegia, unilateral spatial neglect and personal neglect. It is very unique that the symptoms of somatoparaphrenia initially appeared only in the right upper limb, expanded to whole left half of the body and the symptoms continued for a long period. The self-portrait given as an assignment were expressed only for a half of the body of the patient. Moreover, similar behavior was also observed in portraits for others and still-life paintings. This would be ascribed to the image projection of the self-body into another personʼs body or objects. As the pathogenesis of his somatoparaphrenia, some kind of suppressive response in order to reject the paralysis or disabilities can be assumed. In the present case, the delusional belief might be retained for a long period and fixed deeply, since the somatoparaphrenia could be hardly expressed due to the loss of speaking ability, which caused the lack of corrections or critical comments for the wrong belief.

  Neuropsychology of three gogi-aphasia cases due to non-degenerative etiology were investigated compared to early language profiles of semantic dementia (SD) patients. A case with completely damaged anterior left temporal lobe after severe head trauma has suffered narrow comprehension of words revealed by literal interpretation of idioms. The other case with left dominant temporal lobe atrophy including both hippocampi after herpes simplex encephalitis has showed mild word finding difficulty and reading and writing difficulties on kanji words. Another case after left posterior cerebral artery infarction including temporal and occipital lobes has felt unfamiliar whenever he heard the unremembered names of objects accompanied with reading and writing difficulties in kanji words. Each profile of the standardized linguistic assessment revealed partial coincidence of deterioration patterns of SD patients. Each patient has suffered from daily problems caused by semantic deficits combined with each cognitive impairment, though the level of aphasia was even milder than SD patients.

  We studied a patient, N.A., who showed pure autotopagnosia and dressing disorder following Creutzfeldt-Jakob disease. In our previous report, we had administered tests to examine N.A.ʼs ability to localize his own or otherʼs body parts. He had shown selective inability to localize his own body parts, and we had concluded that his pure autotopagnosia owed to impairment of recognition of the spatial position of his body parts in the egocentric reference frame. In this report, we probed an effective examination method for clarifying autotopagnosia considering reported cases, because a comprehensive test battery for autotopagnosia has not yet been established.
  We also studied the dressing disability in N.A. and in a control patient, Y.O., who showed dressing disorder without pure autotopagnosia. The dressing disorder demonstrated by N.A. in terms of jacket folding, putting arms into jacket sleeves, and taking off a jacket were likely related to dysfunctions in recognizing the form and size of clothes as they corresponded to his body. Y.O. showed impaired mental rotation, which produced errors in recognizing the directions of a jacket when he put it on. We concluded that N.A. showed dysfunctions in body form and size representation which resulted in dressing disorder and pure autotopagnosia. These results suggest that a new examination method needs to be created to clarify disorders of body form and size representation.

  The judgement regarding driving resumption or cessation due to brain disease or traumatic brain injury (TBI) is that a comprehensive driving evaluation including in-hospital tests such as neuropsychological tests, as well as driving simulators and on-road tests is required. Individual medical judgement is required in cases of homonymous hemianopia, unilateral spatial neglect, and severe sensory impairment. It is also important to ensure that the patient does not have a disease or condition that causes his or her license to be revoked or suspended. Patients with dementia should have their license revoked, and symptomatic epilepsy, hypoglycemia, depressive states, and sleep apnea syndromes will require confirmation on the degree of the symptoms. Patients with aphasia have difficulty interpreting the results of neuropsychological tests, however, the use of tests such as the Trail Making Test Part-A, Rey-Osterrieth complex figure test, Tapping span test, Visual Cancellation task Figure-A・B, Continuous Performance Test, may prove effective. If a patient is assessed as “fit to drive” by a comprehensive evaluation, we advise they contact the police for a safe driving consultation (Consultation Dial : # 8080) . On the other hand, if they exhibit some anxiety factors, the driving resumption is put on hold, and after a period of 3 to 6 months, re-evaluation is recommended after recovery.

  According to the authorʼs estimation, epidemiological studies on aphasia are limited to cerebrovascular diseases, and there are about 254, 220. The scores of MMSE and Symbol Search, Digit Span, Letter-Number Sequencing of WAIS-III were significantly lower in the aphasia group than in the non-aphasia group in the study conducted by the author (Sato, 2018) . It was suggested that the aphasia may be disadvantageous in the work of processing symbols that are not such as Kana and Kanji, in a short time, and the manipulation and processing of phonological representations of numbers and linguistic sounds. It seems that the aspects such as character and phoneme operation processing, which are weak points of these aphasia groups, also have an effect on driving situations. Language is involved in all parts of the driving process, and understands road signs, destination markers, etc. according to the driving conditions that change every moment during driving, and sometimes uses voice instructions to make judgments and operations. This suggests that the cognitive processing required at a high level, such as continuous processing within a short time, may be a heavy load for aphasia patients. In addition, it may be combined with other higher brain dysfunction, which requires close scrutiny. People with aphasia are often paralyzed, but it takes time to get used to driving a car equipped with a corresponding auxiliary device. It is presumed that the cognitive load is high until driving skill becomes proficient, so caution is required.

  Recently, the number of elderly people is rapidly increasing and it is becoming medical and social problems how to handle drivers with dementia in Japan. Previously, various attempts and examination are performed in clinic settings, it has not resolved about that problems. From March 12, 2017 new Traffic Act started, and it was required to have an examination on cognitive function testing without waiting for update when the elderly driver 75 years or older violated license update every three years and the specific traffic violation. As a result, it was made mandatory that they received medical screening if drivers were suspected dementia by police officer.
  But in medical settings, many physicians feel difficulty and dilemma, because it is difficult to predict the risks of traffic accidents or violations from medical assessment. In addition, there is not gold standard for the battery of fitness to drive. Therefore, we discussed and commented on the problem about association between dementia and the driving behavior.

  We report a case of Foreign Accent Syndrome (FAS) with a lesion posterior to the central sulcus. A right-handed woman in her 60s developed a subcortical hemorrhage in the left superior temporal gyrus. She had fluent aphasia and prosodic disturbances, including abnormal accents and prolonged sounds. Her speech resembled “Japanese spoken with an English accent”. She basically put the accent nucleus on the third mora from the word-final position, or she sometimes pronounced the test words with the long vowel of the word-final mora. We examined the mechanism underlying these prosody disturbances to analyze its relationship with FAS from the linguistic and neuropsychological points of view. We wish to present two possibilities as the pathomechanism for FAS ; one derived from phonetic implementation error with a left frontal lobe lesion ; and the other, from recall failure of proper accent with the left temporal lobe lesion.

  The hallmarks of thalamic aphasia based on the previous case reports include word-finding difficulties and verbal paraphasias, in particular, irrelevant verbal paraphasias, despite normal articulation, intact repetition, and mild comprehension deficits. However, no group study has been conducted on whether thalamic aphasia frequently involves irrelevant verbal paraphasias compared with the other types of aphasia and potential mechanisms underlying those irrelevant verbal paraphasias has yet to be elucidated. Here we approached the nature of thalamic aphasia by investigating its accompanying irrelevant verbal paraphasias. Compared with aphasic patients with the other types, patients with thalamic aphasia showed the higher ratio of irrelevant verbal paraphasias among the total errors as well as to the relevant verbal paraphasias. In our previous case report on thalamic aphasia, a close relationship between irrelevant verbal paraphasias and selective attentional dysfunction was observed, suggesting selective attentional dysfunction, which is deeply associated with thalamic damage, led to development of irrelevant verbal paraphasias. With the previously proposed mechanisms behind thalamic aphasia, the characteristic speech found in thalamic aphasia might reflect word-finding errors due to inability to activate semantic fields that is related to the target word as well as inability to suppress words that are irrelevant to the target word.

  This report considers two cases presenting with somatosensory deficits due to lesions, including lesions of the parietal operculum. Both cases had severe deficits in basic somatosensory modalities but were capable of correctly identifying the cortical somatosensory modalities of three-dimensional geometric shapes, textures, and everyday objects at better than chance level. These results are inconsistent with the hierarchical model of somatosensory processing. The patients were also capable of dexterous movements, sufficient for completing everyday activities without inconvenience. This finding is contrary to the belief that somatosensory deficits impair motor control. In one of the two cases, the patient was observed to correctly respond to these tests, despite a complete lack of awareness of cortical somatosensation. This paper discusses the mechanism of these phenomena based on theories of the two streams of tactile information processing and the function of the secondary somatosensory cortex.

  I briefly reviewed the rehabilitation of gait disorders, especially freezing of gait (FOG) , in patients with Parkinson's disease (PD) and considered applications of cue techniques, including external and internal cueing. The therapeutic intervention methods give each different system a chance to start movements, for example gait. The different systems are the external loop, including the cerebellum, parietal cortex and lateral premotor cortex, and the internal loop, which includes the basal ganglia and supplementary motor area. The external loop starts the movement to induce external stimulation during the processing of voluntary movement. The internal loop voluntarily activates well-learned and self-guided movements. Interventions for external cueing are widely known, but those for internal cueing remain unclear. However, techniques for external cueing may not be effective because of executive dysfunction. On the other hand, internal rhythmic exercises, such as tapping for spontaneous exercise, are performed poorly by PD patients. For internal rhythm formation disorders, the effectiveness of internal cueing has also been reported in recent years. I summarized why such a complex phenomenon occurs based on a neural network specific to PD patients. In addition, I will introduce some of our studies and case reports on the internal cue approach. This paper confirms the importance of therapeutic intervention tailored to each individual PD patient.

  Various kinds of memory are proposed and defined in the fields of psychology and medical sciences. Among them, current paper includes the concepts and schemes which are useful for the clinical assessment of memory impairment in brain-damaged patients. The author secondly described the essentials to qualitatively analyze the results of recent memory tasks, taking word-list recall task for example. Finally, several evaluation methods for everyday memory are presented, and an issue about everyday memory impairment is mentioned.

  Dementia is a clinical syndrome which consists of various diseases. It is important to make a differential diagnosis of the disease to plan treatments and care for the patient. Each dementing disease shows a characteristic pattern in the cognitive impairments. When clinicians perform the neuropsychological examination for the patient, they should evaluate the results not only quantitatively but also qualitatively, i.e, they should consider the meaning of the profile of deficits in the multiple domains of cognitive functions.

  The Behavioural Inattention Test (BIT) is a test battery that is used mainly for evaluation of neglect in peripersona (lreaching) space. In some patients, severity and characteristics of unilateral spatial neglect (USN) may appear differently between desktop tests and activities of daily living (Azouvi et al., 2003) . Such discrepancies may be due to differences of the distance from the body to the targets and the visual angle of the objects observed. We introduced a virtual reality (VR) task to simulate activities in the extrapersonal space and to predict neglect errors in that space (neglect beyond reaching space) . The patient was a right-handed woman in her 70s, who showed left USN both on the Catherine Bergego Scale (Japanese edition) and in the far space line cancellation task 4.5 years after the onset of right thalamic hemorrhage. Her total BIT scores were, however, within the normal range (BIT conventional subtest score : 140 points ; BIT behavioural subtest score : 81 points) . Her performance of the VR task was compared with those of eleven elderly healthy subjects (71.2 ± 4.0 years) . The total VR task score was lower in the USN patient than in the elderly healthy group. Furthermore, the USN patient made more errors and had greater mean neck rotation angle (rightward bias) than the elderly healthy subjects. These results suggest that use of VR tasks like ours can contribute to developing a means to predict neglect errors in extrapersonal space.

  Purpose : To clarify the relationship between healthy aging and cognitive function using voxel-based morphometry (VBM) .
  Methods : A total of 120 healthy subjects, who were randomly chosen from each age-group between 20 and 70 years old in the healthy-aging cohort study of Brain and Mind Research Center, Nagoya University, were included in this study. Addenbrookeʼs Cognitive Examination-Revised (ACE-R) was performed to test cognitive function. Only participants with total score greater than 83 were included. Anatomical T1 images were taken using a 3-tesla MRI scanner. After preprocessing, gray-matter-volume (GMV) , white-matter-volume (WMV) , and cerebrospinal-fluid-volume (CSFV) were calculated. Influencing factors for age were estimated among sub-scores of ACE-R and each volumes, and then brain regions corresponding to significant factors were examined by VBM.
  Results : Factors associated with age included GMV (β＝－0.42, p＜0.001) , CSFV (β＝0.39, p＜0.001) , and the score of delayed recall (β＝－0.29, p＜0.001) as identified using multiple regression analysis. A linear or cubic approximation was constructed and compared between age-GMV and agedelayed recall, which showed relatively slow decline of the delayed recall compared to GMV loss. VBM results showed widespread negative correlation between gray matter and age (FWE p＜0.05) . The score of delayed recall was also negatively correlated with gray matter in wide areas of the brain including bilateral frontal cortices, temporal cortices, insula, hippocampus, and cuneus (FWE p＜0.05) , although no areas showed correlation when age was used as a covariate.
  Conclusions : Among ACE-R sub-scores, delayed recall was the factor significantly influenced by healthy aging, and showed mild decrease compared to GMV loss. VBM showed that decreased score of delayed recall was correlated to wide areas of the brain, although areas specific to delayed-recall could not be identified independent of age in this study.

  Necker cube copying (NCC) is used to assess the visual perception of children ; however, there are few reports concerning the characteristics of NCC drawing among children with learning disabilities. In this study, we examined whether the achievement targets of NCC defined using a qualitative scoring system and the characteristics of the drawing process are usable as indexes for assessing visual perception. The subjects were divided into an “over threshold group” and “under threshold group” based on the achievement targets, and a “drawing a face first group” and “NOT drawing a face first group” based on the characteristics of drawing a cube. The results of the Matching Familiar Figures Test (MFFT) were then analyzed according to group. The results showed no significant difference between the over and under threshold groups. On the other hand, reaction times of MFFT were significantly longer among the drawing a face first group than the NOT group. This difference between the two groups indicates that drawing a face of a cube or not can be used to assess visual perception. These results suggest that children who do not draw a face first may have weakness in visual perception, and that NCC can be used for assessing visual perception through observation of the drawing process.

  A left-handed, congenital deaf, adult male patient showed sign language aphasia due to right cerebral hemorrhage and ischemic right temporal lobe lesion caused by Moyamoya disease. Moderate left hemiparesis, unilateral space neglect, attention disorder, left homonymous quarter visual deficit were observed without limb segmental apraxia. Aphasia was observed in sign language, speech and writing. Mistakes in hand shape forming, inadequate hand or arm movement patterns, and expression or mimicking with finger characters showed phonological illusion. He could draw basic pictures, write numbers and names although showing construction disability. A speech therapist who can translate sign language was responsible for the training of this patient. The training included matching tasks where the patient had to match the therapistʼs signs to the correct word or picture cards. Writing training, conversation training using sign language and letters, and communication training using a mobile phoneʼs e-mail function were also applied. After the training, the patientʼs ability to express himself using both finger letters and phonetic languages had improved. Communication using a mobile phone also became possible. It was extremely difficult to manage the rehabilitation for such a rare case as this as there is no preliminary report. A speech therapist who can also translate sign language took on in this case.