The author reported a late 50s male who showed irritability due to bilateral orbitofrontal lesions after clipping of ruptured aneurysm of anterior communicating artery, and discussed the measure to control irritability of such case. It is suspected that importance of keeping consistent attitude, when we take care for uncontrollable emotion.

  From twenty-year experiences in building a system of official support services for persons with neurocognitive disorders in Japan, the most important point indicated through them is the role played by researchers of neuropsychological sciences. It may seem surprising that they have built a nationwide supporting system as understanding laws and ordinances relating to mental health, and have conducted support services by themselves with administrative officers in a five-year model project. Essentially, researchers have, no doubt, the potent ability to do so. Furthermore, it is also shown that the scientific society they are joining have a social role as a platform by facilitating discussions for support service among different professions.
  Regarding the provision of opportunities for participation in society for persons with neurocognitive disorders, the official supporting system for persons with a desire for employment is relatively maintained well. It should be said, however, that participation in society in person having higher disorder severity is still far enough. Nevertheless, considering the present situation, we can find notable supporting activities for such persons by private corporations including an informal style and also by the person concerned everywhere in Japan. It is an important issue to be considered how the public structure takes in and develops such private activities.

  We reported a case of cerebral infarction with Somatoparaphrenia.
  The patient was a right-handed 78-year-old man.
  The brain Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) showed a large infarction of the right cerebral hemisphere feeded by the right middle cerebral artery.
  The patient was preceded by left hemiplegia, hypesthesia of the left half of the body, subluxation of the left shoulder, left shoulder pain, Pusher syndrome, and left hemispatial neglect, and the loss of body-ownership of the affected upper limb appeared 2 months after the onset.
  We supported him psychologically and sympathized with him for the loss of body-ownership of the affected upper limb.
  We tried to improve the ability of sensorimotor integration to facilitate his body schema and body image, while showing the whole body, including the affected upper limb, using a full-length mirror during exercises.
  To connect both viewpoints, together the patient and the therapist could share the patientʼs reflection in the mirror. Then, they could perceive the reflection objectively, from the viewpoint of a third person.
  Symptoms of Somatoparaphrenia successfully disappeared by multimodal intervention using a full-length mirror, which could be used to project his viewpoints.
  The Functional Independence Measure (FIM) score improved from 22 points on admission to 63 points at discharge.
  We discussed the background of the above improvements with reference to related documents.

  This study aims to identify factors that may contribute independently to repeated falls in patients with Parkinsonʼs disease (PD) , specifically focusing on falls self-efficacy and cognition of punishment.
  Nineteen PD subjects participated in this study, and they were assigned two groups depending on the frequency of falls in the previous year (falling group and non-falling group) . Factors suggested as independent valuables included disease duration, medication status, the Hoehn & Yahr stage classification (H & Y) , the Movement Disorder Society Unified Parkinsonʼs Disease Rating Scale (UPDRS) : total score, sub-score by part, retropulsion test, and posture and walking items (PIGD) , the Functional Balance Scale (FBS) , the total score for the motor items, the total score for the cognition items and their sub-scores in the Functional Independence Measure (FIM) , the Iowa Gambling Task (IGT) , the Japanese version of Falls Efficacy Scale (FES-J) , and other neuropsychological tests. Mann-Whitney U test was used to compare these factors between groups. The falling group had significantly lower scores on the FIM (cognition, problem-solving ability, social interaction) , MoCA-J, and IGT. On the other hand, no significant difference was found on the FES-J between the two groups. Despite balance impairments and repeated falls in patients with PD, they had not reduced falls self-efficacy. Furthermore, the frequent fallers showed an inability of cognition of punishment.

  It is well known that resection of a cerebellar tumor may cause cerebellar mutism syndrome (CMS) , presenting with various symptoms including mutism, affective/behavioral changes, cognitive dysfunctions, dysarthria, and language difficulties. Here we report a patient with cerebellitis who developed symptoms similar to CMS. The patient was a 9-year-and-9-month-old right-handed girl who was admitted to a hospital because of sudden onset of fever and subsequently diagnosed with cerebellitis. Several days following the onset, she became completely mute and showed affective disturbance. Her mutism started to improve around 4 months after the onset, and by 7 months following the onset she could produce single words and very simple sentences with monotonous disfluent speech. Affective-behavioral problems, dysarthria, and cognitive and language dysfunctions also remained. The symptoms of her language and communication dysfunctions consisted of word-finding difficulties, reduced amount of speech and poor sentence structures. Over the following three years her affective, cognitive and language performances have gradually improved, although they have not reached their age-appropriate levels. These findings suggest that cerebellitis can cause cognitive and language impairments similar to post-operative CMS. We also wish to stress the importance of assessing the long-term clinical prognosis of subsequent cognitive and language disturbances, and providing an individualized rehabilitation program for CMS following acute cerebellitis.

  To maintain a decent quality of life (QOL) , including returning to work after brain tumor surgery, preserving higher motor functions is crucial. Awake surgery for brain tumors has become a widely accepted neurosurgical method world-wide. It is, however, applied mainly to speech and simple motor function, and intraoperative tasks for higher motor functions have not been established. Here, we have developed two tasks for evaluation of motor functions of the parietal lobe, the PEG & COIN task, which evaluates grasping and approaching, and the sponge-control task, which assesses somatosensory-dependent movement. Either or both of the tasks were used in 4 cases. They were effective in all cases in cortical and subcortical electrical stimulation mapping, as well as intraoperative monitoring of the functions. The first 2 cases evaluated only with the PEG & COIN task demonstrated abnormality in somatosensory dependent movement after surgery. The other 2 cases with combined usage of the two tasks, however, successfully preserved postoperative coordinated movement. Although our experience is still limited, we believe that the two would be promising intraoperative tasks during awake surgery, evaluating higher motor functions of the parietal lobe and eventually leading to preservation of patientsʼ QOL.