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    None of the patients with DLB solved an intradimensional shift stage within the test, and at this level their performance was significantly worse than that of the buy levitra now AD group. Interestingly, patients with PD were not impaired on this task compared to their controls. On a more complex visual– attentional discrimination (set shifting) problem, indirectly related to the WCST, and designed to be sensitive to frontal lobe damage, both DLB and AD groups performed much worse than controls. Patients with DLB were also significantly impaired on a visual search task testing focal attentional buy levitra now ability and requiring intact frontostriatal circuits for efficient performance, whereas patients with AD performed at or about control levels. This is the level of the task at which efficient attentional capacity, mediated by frontal lobe structures, is particularly necessary.

    Finally, patients with DLB made more errors than patients with AD on a spatial working memory task that assessed both spatial working memory and the ability to use an efficient search strategy.

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    In one buy levitra now of the first detailed early studies of cognitive and neuroimaging heterogeneity in AD, Foster and colleagues (1984), using positron emission tomography (PET), found that patients with AD who had prominent visuospatial impairment had focal hypometabolism in the right parietal cortex, whereas focal language deficits were associated with marked hypometabolism in the left hemisphere. In a large study of 507 autopsy-confirmed patients with AD, Kanne, Balota, Storandt, McKeel, and Morris correlated three subgroups with different distributions of neuropathology, including frontal cortex/mental control, temporal cortex/verbal memory, and parietal cortex/visuospatial subgroups. In 1983, the National Institutes of Health sponsored a conference that focused on the heterogeneity of AD (Friedland et al., 1984), and an open peer commentary involving several authors was published in 1998 (Cummings, 1996). Metabolic imaging studies suggest a relationship between focal cognitive deficits and metabolic changes in specific brain regions. 512 Clinical heterogeneity of AD has also been studied from a neuroimaging perspective.

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    Recent neuroimaging studies find that auditory hallucinations derive 49 Chapter 4 buy levitra now. Complex visual hallucinations are reported in patients with narcolepsy, brain stem vascular disease, L-DOPA/CARBA-DOPA toxicity, Lewy body dementia, migraine, epilepsy, hallucinogenic-induced states, delirium (particularly delirium tremens), and schizophrenia.247 The presence of prominent visual hallucinations always warrants the search for an excitatory lesion in the visual system. Auditory hallucinations Auditory hallucinations are associated with lesions anywhere along the auditory pathway.

    Complex visual hallucinations are thought to occur from irritating foci acting on cortical integrating centers, defective visual processing, or as a cortical release phenomenon. The brain and psychopathology from a complex neuronal network involving frontal and temporal cortex.248 How they occur, however, remains unclear.