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Emotional incontinence and executive function in ischemic stroke: A case-controlled study

Published online by Cambridge University Press:  01 January 2009

W.K. TANG ,
YANGKUN CHEN ,
WYNNIE W.M. LAM ,
VINCENT MOK ,
ADRIAN WONG ,
GABOR S. UNGVARI ,
Y.T. XIANG  and
KA SING WONG
W.K. TANG*
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
YANGKUN CHEN
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
WYNNIE W.M. LAM
Affiliation:
Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Hong Kong SAR, China
VINCENT MOK
Affiliation:
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
ADRIAN WONG
Affiliation:
Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Hong Kong SAR, China
GABOR S. UNGVARI
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
Y.T. XIANG
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
KA SING WONG
Affiliation:
Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Hong Kong SAR, China
*
*Correspondence and reprint requests to: W.K. Tang, Department of Psychiatry, Shatin Hospital, Shatin, N.T., Hong Kong SAR, China. E-mail: [email protected].
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Abstract

Frontal and basal ganglia infarcts and executive dysfunction are thought to be involved in the pathophysiology of poststroke emotional incontinence (PSEI). The study examined whether patients with PSEI have more frontal and/or basal ganglia infarcts and impairment in executive function. A total of 516 Chinese patients with acute ischemic stroke consecutively admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were screened for PSEI 3 months after the index stroke. According to Kim’s criteria, 39 (7.6%) had PSEI. Thirty-nine stroke patients without PSEI served as matched control group. The PSEI group had significantly more frontal and/or basal ganglia infarcts, had lower Chinese Frontal Assessment Battery scores, required more time to complete the Stroop Test, and made more omission and commission errors in the Go–NoGo test. There was no significant correlation between frontal or basal ganglia infarcts and executive function. The correlation between frontal infarct and severity of PSEI was .420. Further follow-up and functional imaging studies are warranted to explore the relationship between PSEI, brain infarcts, and executive dysfunction. (JINS, 2009, 15, 62–68.)

Keywords

Affective symptomsDepressionCryingNeuropsychologyCerebrovascular disordersEmotions
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 15 , Issue 1 , January 2009 , pp. 62 - 68
Copyright
Copyright © INS 2009

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References

REFERENCES

Andersen, G., Vestergaard, K., & Riis, J.O. (1993). Citalopram for post-stroke pathological crying. Lancet, 342, 837–839.CrossRefGoogle ScholarPubMed
Andersen, G., Vestergaard, K., & Lauritzen, L. (1994). Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke, 25, 1099–1104.Google Scholar
Andersen, G. (1997). Post-stroke depression and pathological crying: Clinical aspects and new pharmacological approaches. Aphasiology, 11, 651–664.Google Scholar
Asfora, W.T., DeSalles, A.A., Abe, M., & Kjellberg, R.N. (1989). Is the syndrome of pathological laughing and crying a manifestation of pseudobulbar palsy? Journal of Neurology, Neurosurgery & Psychiatry, 52, 523–525.CrossRefGoogle ScholarPubMed
Black, D.W. (1982). Pathological laughter: A review of literature. Journal of Nervous and Mental Disease, 170, 67–71.CrossRefGoogle Scholar
Brott, T., Adams, H.P., Olinger, C.P., Marler, J.R., Barsan, W.G., Biller, J., Spilker, J., Holleran, R., Eberle, R., Hertzberg, V., Rorick, M. ,Moomaw, C.J., & Walker, M. (1989). Measurement of acute cerebral infarctions: A clinical examination scale. Stroke, 20, 864–870.Google Scholar
Brown, K.W., Sloan, R.L., & Pentland, B. (1998). Fluoxetine as a treatment for post-stroke emotionalism. Acta Psychiatrica Scandinavica, 98, 455–458.CrossRefGoogle ScholarPubMed
Caplan, L.R. (2000). Caplan’s stroke: A clinical approach. Boston, MA: Butterworth-Heinemann.Google Scholar
Ceccaldi, M., Poncet, M., Milandre, L., & Rouyer, C. (1994). Temporary forced laughter after unilateral strokes. European Neurology, 34, 36–39.CrossRefGoogle ScholarPubMed
Chiu, H.F.K, Lee, H.C.B., & Chung, D. (1994). Reliability and validity of the Cantonese version of the Mini-Mental State Examination: A preliminary study. Hong Kong Journal of Psychiatry, 4, 25–28.Google Scholar
Chiu, H.F., Chan, C.K., Lam, L.C., Ng, K.O., Li, S.W., Wong, M., & Chan, W.F. (1997). The modified Verbal Fluency Test: A validation study in Hong Kong. Journals of Gerontology, Series B-Psychological Sciences & Social Sciences, 52, 247–250.Google Scholar
Choi-Kwon, S., Han, S.W., Kwon, S.U., Kang, D.W., Choi, J.M., & Kim, J.S. (2006). Fluoxetine treatment in poststroke depression, emotional incontinence, and anger proneness: A double-blind, placebo-controlled study. Stroke, 37, 156–161.CrossRefGoogle ScholarPubMed
Cummings, J.L. (1993). Frontal-subcortical circuits and human behaviours. Archives of Neurology, 50, 873–880.Google Scholar
Cummings, J.L. (1995). Anatomic and behavioral aspects of frontal-subcortical circuits. Annals of the New York Academy of Sciences, 769, 1–13.CrossRefGoogle ScholarPubMed
Dark, F.L., McGrath, J.J., & Ron, M.A. (1996). Pathological laughing and crying. The Australian and New Zealand Journal of Psychiatry, 30, 472–479.Google Scholar
Dubois, B., Slachevsky, A., Litivan, I., & Pillon, B. (2000). The FAB: A frontal assessment battery at bedside. Neurology, 55, 1621–1626.Google Scholar
Fazekas, F., Chawluk, J.B., Alavi, A., Hurtig, H.I., & Zimmerman, R.A. (1987). MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. American Journal of Roentgenology, 149, 351–356.Google Scholar
Feinstein, A., Feinstein, K., Gray, T., & O’Connor, P. (1997). Prevalence and neurobehavioral correlates of pathological laughing and crying in multiple sclerosis. Archives of Neurology, 54, 1116–1121.CrossRefGoogle ScholarPubMed
Feinstein, A., Connor, P., Gray, T., & Feinstein, K. (1999). Pathological laughing and crying in multiple sclerosis: A preliminary report suggesting a role for prefrontal cortex. Multiple Sclerosis, 5, 69–73.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Ghaffar, O., Chamelian, L., & Feinstein, A. (2008). Neuroanatomy of pseudobulbar affect: A quantitative MRI study in multiple sclerosis. Journal of Neurology, 255, 406–412.Google Scholar
Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G., & Curtiss, G. (1993). Wisconsin Card Sorting Test manual revised and expanded. Psychological Assessment Resources, Inc., Florida, USA.Google Scholar
House, A., Dennis, M., Molyneux, A., Warlow, C., & Hawton, K. (1989). Emotionalism after stroke. British Medical Journal, 298, 991–994.Google Scholar
Kim, J.S. (1997). Pathologic laughter after unilateral stroke. Journal of the Neurological Sciences, 148, 121–125.Google Scholar
Kim, J.S. & Choi-Kwon, K.S. (2000). Poststroke depression and emotional incontinence: Correlation with lesion location. Neurology, 54, 1805–1810.Google Scholar
Kim, J.S. (2002). Post-stroke emotional incontinence after small lenticulocapsular stroke: Correlation with lesion location. Journal of Neurology, 49, 805–810.Google Scholar
Langworthy, O.R. & Hesser, F.H. (1940). Syndrome of pseudobulbar palsy. Anatomic and physiologic analysis. Archives of Internal Medicine, 64, 106–121.CrossRefGoogle Scholar
Lopez, O.L., Zivkovic, S., Smith, G., Becker, J.T., Meltzer, C.C., & DeKosky, S.T. (2001). Psychiatric symptoms associated with cortical-subcortical dysfunction in Alzheimer’s disease. Journal of Neuropsychiatry & Clinical Neurosciences, 13, 56–60.Google Scholar
Malloy, P., Bihrle, A., & Duffy, J. (1993). The orbitomedial frontal syndrome. Archives of Clinical Neuropsychology, 8, 185–201.CrossRefGoogle ScholarPubMed
Marin, R.S., Butters, M.A., Mulsant, B.H., Pollock, B.G., & Reynolds, C.F. 3rd. (2003). Apathy and executive function in depressed elderly. Journal of Geriatric Psychiatry & Neurology, 16, 112–116.CrossRefGoogle ScholarPubMed
McCullagh, S., Moore, M., Gawel, M., & Feinstein, A. (1999). Pathological laughing and crying in amyotrophic lateral sclerosis: An association with prefrontal cognitive dysfunction. Journal of the Neurological Sciences, 169, 43–48.Google Scholar
Mok, V.C., Wong, A., Lam, W.W., Fan, Y.H., Tang, W.K., Kwok, T., Hui, A.C., & Wong, K.S. (2004). Cognitive impairment and functional outcome after stroke associated with small vessel disease. Journal of Neurology, Neurosurgery & Psychiatry, 75, 560–566.Google Scholar
Mok, V.C., Wong, A., Yim, P., Fu, M., Lam, W.W., Hui, A.C., Yau, C., & Wong, K.S. (2004). The validity and reliability of Chinese frontal assessment battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct. Alzheimer Disease & Associated Disorders, 18, 68–74.CrossRefGoogle ScholarPubMed
Morris, P.L.P., Robinson, R.G., & Raphae, B. (1993). Emotional lability after stroke. The Australian and New Zealand Journal of Psychiatry, 27, 601–605.Google Scholar
Muller, U., Murai, T., Bauer-Wittmund, T., & von Cramon, D.Y. (1999). Paroxetine versus citalopram treatment of pathological crying after brain injury. Brain Injury, 13, 805–811.Google Scholar
Murai, T., Barthel, H., Berrouschot, J., Sorger, D., von Cramon, D.Y., & Muller, U. (2003). Neuroimaging of serotonin transporters in post-stroke pathological crying. Psychiatry Research, 123, 207–211.Google Scholar
Parvizi, J., Anderson, S.W., Martin, C.O., Damasio, H., & Damasio, A.R. (2001). Pathological laughter and crying: A link to the cerebellum. Brain, 124, 1708–1719.Google Scholar
Piamarta, F., Iurlaro, S., Isella, V., Atzeni, L., Grimaldi, M., Russo, A., Forapani, E., & Appollonio, I. (2004). Unconventional affective symptoms and executive functions after stroke in the elderly. Archives of Gerontology & Geriatrics, 9(Suppl), 315–323.Google Scholar
Robinson, R.G., Parikh, R.M., Lipsey, J.R., Starkstein, S.E., & Price, T.R. (1993). Pathological laughing and crying following stroke: Validation of a measurement scale and a double-blind treatment study. American Journal of Psychiatry, 150, 286–293.Google Scholar
Ross, E.D. & Stewart, R.S. (1987). Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism. Journal of Nervous and Mental Disease, 175, 165–172.Google Scholar
Rubia, K., Russell, T., Overmeyer, S., Brammer, M.J., Bullmore, E.T., Sharma, T., Simmons, A., Williams, S.C., Giampietro, V., Andrew, C.M., & Taylor, E. (2001). Mapping motor inhibition: Conjunctive brain activations across different versions of Go/No-Go and Stop tasks. Neuroimage, 13, 250–261.Google Scholar
Schacher, R. & Logan, G.D. (1990). Impulsivity and inhibitory control in normal development and childhood psychopathology. Developmental Psychology, 26, 710–720.CrossRefGoogle Scholar
Schiffer, R. & Pope, L.E. (2005). Review of pseudobulbar affect including a novel and potential therapy. Journal of Neuropsychiatry & Clinical Neurosciences, 17, 447–454.Google Scholar
Stroop, J.R. (1992). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662.Google Scholar
Tang, W.K., Chan, S.S.M., Chiu, H.F.K., Ungvari, G.S., Wong, K.S., Kwok, T.C.Y., Wong, K.T., Richards, P.S., & Ahuja, A.T. (2004). Emotional incontinence in Chinese stroke patients: Diagnosis, frequency, and clinical and radiological correlates. Journal of Neurology, 251, 865–869.Google Scholar
Tang, W.K., Chan, S.S., Chiu, H.F., Ungvari, G.S., Wong, K.S., Kwok, T.C., Mok, V., Wong, K.T., Richards, P.S., & Ahuja, A.T. (2006). Frequency and clinical determinants of poststroke cognitive impairment in nondemented stroke patients. Journal of Geriatric Psychiatry & Neurology, 19, 65–71.Google Scholar
Tekin, S. & Cummings, J.L. (2002). Frontal-subcortical neuronal circuits and clinical neuropsychiatry: An update. Journal of Psychosomatic Research, 53, 647–654.Google Scholar
Vataja, R., Pohjasvaara, T., Mantyla, R., Ylikoski, R., Leppavuori, A., Leskela, M., Kalska, H., Hietanen, M., Aronen, H.J., Salonen, O., Kaste, M., & Erkinjuntti, T. (2003). MRI correlates of executive dysfunction in patients with ischaemic stroke. European Journal of Neurology, 10, 625–631.Google Scholar
Wilson, S.A.K. (1924). Some problems in neurology. The Journal of Neurology and Psychopathology, 4, 299–333.Google Scholar