Academic literature on the topic 'Apraxia – Diagnosis'

Acoustic analysis provides objective quantitative measures of speech that enable a comprehensive and accurate understanding of motor disorders and complement the traditional measures. This paper aims to distinguish between normal and pathological speech, more specifically between apraxia of speech and spastic dysarthria in native Spanish speaking patients using acoustic parameters. Participants (4 aphasic with apraxia of speech, 4 with spastic dysarthria, and 15 without speech disorders) performed three different tasks: repeating the syllable sequence [pa-ta-ka], repeating the isolated syllable [pa] and repeating the vowel sequence [i-u]. The results showed that the normative values of motor control, in general, coincide with those obtained in previous research on native English speakers. They also show that damage to motor control processes results in a decrease in the rate of alternating and sequential movements and an increase in the inter-syllabic time for both types of movements. A subset of the acoustic parameters analyzed, those that measure motor planning processes, enable differentiation between normal population and apraxic and dysarthric patients, and between the latter. The differences between the pathological groups support the distinction between motor planning and motor programming as described by van der Merwe's model of sensorimotor processing (1997).

Childhood verbal apraxia has not been identified or treated sufficiently in children with Down syndrome but recent research has documented that symptoms of childhood verbal apraxia can be found in children with Down syndrome. But, it is not routinely diagnosed in this population. There is neither an assessment tool in Turkish nor any research on childhood verbal apraxia although there is a demand not only for children with Down syndrome but also for normally developing children. The study examined if it was possible to determine oral-motor difficulties and childhood verbal apraxia features in children with Down syndrome through a survey. The survey was a parental report measure. There were 329 surveys received. Results indicated that only 5.6% of children with Down syndrome were diagnosed with apraxia, even though many of the subject children displayed clinical features of childhood verbal apraxia. The most frequently reported symptoms of childhood verbal apraxia in literature were displayed by the children with Down syndrome in the study. Parents could identify childhood verbal apraxia symptoms using parent survey. This finding suggests that the survey can be developed that could serve as a screening tool for a possible childhood verbal apraxia diagnosis in Turkey.

A case is described in which a patient had pseudoneurological symptoms that were present only upon direct observation or when the patient was in clinical test situations. The differential diagnosis of apraxia is discussed as well as clinical suggestions for evaluating patients with suspected factitious apraxia.

A 23-year-old woman had presented initially to a podiatrist complaining of poorly fitting shoes during her adolescence. After extensive neurological review, she was diagnosed with ataxia with oculomotor apraxia type 2. This is a progressive autosomal recessive ataxia associated with cerebellar atrophy, peripheral neuropathy and an elevated serum α-fetoprotein. Within Europe, it is the most frequent autosomal recessive ataxia after Friedreich’s ataxia and is due to mutations in the senataxin (SETX) gene. The age of onset is approximately 15 years.The diagnosis of oculomotor apraxia type 2 is often challenging. We provide a framework for assessing a young ataxic patient with or without oculomotor apraxia and review clues that will aid diagnosis. The prognosis, level of disability, cancer and immunosuppression risk all markedly differ between the conditions. Patients and their families need the correct diagnosis for genetic counselling, management and long-term surveillance with appropriate subspecialty services.

Peak articulatory velocity of the lower lip and temporal coordination between the upper and lower lips were studied in 5 neurologically impaired subjects with speech behaviors consistent with a diagnosis of apraxia of speech. Differences in velocity and the timing between the movement onset of the two lips were compared for accurate and inaccurate productions of words. Peak articulatory velocity also was measured during the production of the syllable [pæ] and during a nonverbal movement. There were no systematic differences across accurate and inaccurate productions of words in peak articulatory velocity or movement onsets of the two lips. Furthermore, there were no systematic changes in movement velocity related to speech rate. We conclude that some apraxic speakers do not have a defect in the ability to produce high movement velocities.

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Objetivos: avaliar as praxias verbal e não-verbal em pacientes com doença de Alzheimer (DA) e identificar os erros práxicos verbais em diferentes fases da doença, além de verificar a similaridade entre as suas ocorrências. Métodos: foram avaliados 90 indivíduos, 30 em cada fase da DA (leve, moderada e grave), submetidos às escalas: Escala clínica da demência (CDR), Mini-exame do estado mental (MEM) e avaliação das atividades instrumentais de vida diária de Lawton, além da avaliação das praxias, por meio das tarefas de agilidade oral do teste de Boston, para a comparação com os dados de normalidade, e do Protocolo de Avaliação da Apraxia Verbal e Não-verbal, para a comparação do desempenho entre os três grupos. Resultados: Em relação à população estudada, 66 pacientes eram mulheres, a média da idade foi de 80,2 ±7,2 e da escolaridade de 4,2 ±3,5 anos. As médias de agilidade oral (verbal e não-verbal) dos grupos estudados foram significativamente menores do que as da população normal. As alterações práxicas verbais e não-verbais aumentaram com a progressão da doença. Quanto aos tipos de erros, os erros de omissão e substituição apresentaram maiores médias, seguidos de ensaio, repetição, autocorreção e adição. O erro do tipo adição determinou padrões de erros diferentes entre as fases da doença. Conclusões: os pacientes com DA apresentaram apraxia verbal e não-verbal que aumentaram com a gravidade demência.
Purpose: to assess the speech and orofacial apraxia in Alzheimer’s disease (AD) and identify praxic speech errors at different stages of the disease and to verify the similarity among their occurrences. Methods: thirty subjects in each stage of AD (mild, moderate and severe) were submitted to the following assessment: Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE) and Lawton Instrumental Activities of Daily Living, and praxis tasks, using the oral agility subtest of the Boston diagnostic aphasia examination and the protocol assessment speech and orofacial apraxias. Results: there were 66 women, the mean age was 80,2±7,2 years and means educational was 4,2 ±3,5 years. The means in the oral agility task of AD patients were significantly lower than of the normal population. Difficulties in verbal and nonverbal praxis increased with the progression of the disease. Regarding the types of errors, omission and substitution were more common, followed by trial-and-error, repetition, self-correction and addition. The error type addition determined different patterns of errors between stages of the disease. Conclusions: the speech and orofacial praxias of patients with AD were impaired and deteriorated according to the stage of the disease.
TEDE
BV UNIFESP: Teses e dissertações

Purpose: The occurrence of similar speech and non-speech behaviors in some children with autism and Childhood Apraxia of Speech (CAS) calls for the consideration of CAS in some children with autism. The majority of research on CAS has been conducted with children who are otherwise typically developing. The purpose of this study was to determine whether and to what extent children with autism are being diagnosed with or suspected to have CAS as well as what assessment and treatment methods are currently being used with these children. Method: A nationwide survey of speech-language pathologists (SLPs) working with children ages 0-6 years was distributed through snowball sampling, e-mail distribution lists and Facebook discussion pages. The survey requested information on numbers of children served with autism and suspected CAS as well as the criteria used to identify CAS in children with autism and the treatment methods being used in intervention. Results: 132 surveys were received and analyzed. SLPs from across the United States participated in the study. The mean number of children with autism currently served per participant was 6 children and the mean number of children with autism and suspected CAS per participant was 1. Participants reported suspected CAS in 16% of children with autism. SLPs working in the field the longest and those serving more total children with autism were suspecting CAS in children with autism more often than other participants. Of the total participants, 80% indicated that they would begin assessment for CAS in a child with autism as soon as they notice specific signs of CAS. The most common markers used were difficulty combining and sequencing phonemes and inconsistent production of speech sounds. Participants reported using a wide range of assessment tools to assess for CAS in a child with autism. Participants tended to rely upon informal assessment measures for this population; the most common assessment tool was a connected speech sample. The most commonly used intervention technique with this population was AAC; participants also reported high familiarity with PROMPT as a treatment for CAS. The least commonly used intervention technique was integral stimulation; 62% of the participants indicated that they have no knowledge of the technique. Conclusion: Results revealed that on average, SLPs are suspecting CAS in approximately 1 in 5 children with autism but much fewer children with autism have a second diagnosis of CAS. The decision of when to assess a child with autism for CAS as well as the assessment tools used varied greatly across participants. Participants reported using up to 22 different diagnostic markers to identify CAS in a child with autism. It was also discovered that not all of the traditional diagnostic markers for CAS should necessarily be considered diagnostic markers of CAS in a child with autism (e.g. suprasegmental abnormalities). With no scientific research to date regarding treatment efficacy for the treatment of CAS in children with autism, SLPs are forced to rely on anecdotal data when selecting a treatment to target CAS in a child with autism; SLPs may not be using the most effective treatment methods for this population. Results of the study support continued investigation of CAS in children with autism. There is a strong need for the development of clear diagnostic guidelines for CAS in a child with autism as well as reliable assessment tools that should be used. Further studies are needed to identify the most effective treatment approach for children with CAS and autism and how an SLP should incorporate that treatment into an overall comprehensive treatment approach for autism.

Eating problems and nutritional status were studied in a consecutive series of 104 stroke patients admitted to emergency hospital care. During their stay in hospital eating problems were observed in 46 patients. Certain common types of eating problems were identified: aberrant eating behaviour as regards chewing,lokalization or swallowing, eating small amounts, hoarding of food in the mouth, leakage of food from the mouth and unawareness of eating problems. Poor nutritional status occurred in 16 % of the patients on admission and in 22 % on discharge from the stroke unit. A subgroup of 32 patients hospitalized for 21 days or longer was studied for three weeks. On at least one occasion during these three weeks a poor nutritional status was observed in 18 patients, of whom 17 had eating problems. All subjects who had eating problems during their hospital stay, plus those patients without eating problems but with neurological deficits and those living in a nursing home one year after the stroke (n=36) were selected for a longitudinal study 18 months after the onset of stroke. Eating problems were identified in 23 of these patients during their hospital stay while 21 had such problems when they were followed up. Two patients who could not eat due to severe dysphagia (after a stroke) for three years and 18 months respectively, were successfully trained to eat normally. One patient exhibited impaired oral and hypopharyngeal function and the other impaired hypo- pharyngeal function and a spastic crico-pharyngeal muscle. In both patients training in swallowing was the main remedical measure and one of them also had a myotomy of the spastic muscle.

[2] s., s. 1-45: sammanfattning, s. 49-130: Härtill 6 uppsatser

digitalisering@umu

Problématique : L'apraxie de la parole est un trouble neuromoteur de la parole affectant la planification et la programmation des mouvements nécessaires à la production de la parole. Elle est caractérisée par la présence de difficultés articulatoires et prosodiques. Le terme apraxie progressive de la parole (PAOS) regroupe les syndromes neurodégénératifs liés au vieillissement où l'apraxie de la parole survient en tant que symptôme initial isolé (apraxie primaire progressive de la parole; PPAOS) ou prédominant (apraxie progressive de la parole dominante; DAOS). Bien que la reconnaissance de ces syndromes en tant qu'entités distinctes ait connu un essor important au cours de la dernière décennie, il existe encore beaucoup de variabilité dans l'application, et l'utilisation même, de ces termes. Le diagnostic différentiel et la prise en charge de ces syndromes sont entravés par une caractérisation initiale et évolutive des habiletés de langage et de parole qui demeure incomplète dans la littérature. De plus, la compréhension des déficits sur le plan de la parole et des interactions entre eux est également encore peu développée. Enfin, la quasi-totalité des études est basée sur des locuteurs anglophones, ce qui limite la généralisation des connaissances aux locuteurs d'autres langues. Une étude approfondie des atteintes des habiletés de communication, de leur évolution et des déficits les sous-tendant chez les locuteurs québécois francophones atteints de PAOS est donc nécessaire. Objectifs : L'objectif général de la présente thèse est de décrire les habiletés de communication et leur évolution chez des locuteurs québécois francophones atteints de PAOS. Il se décline selon les trois sous-objectifs suivants : (a) Décrire les habiletés de parole et de langage chez les locuteurs québécois francophones atteints de PAOS; (b) Raffiner la compréhension de l'origine fonctionnelle des déficits prosodiques chez les locuteurs atteints de PPAOS et de l'interaction entre le débit et la précision articulatoire chez ceux-ci; (c) Décrire l'évolution des habiletés de parole et de langage chez les locuteurs québécois francophones atteints de PAOS. Méthodologie : Ce projet doctoral se décline en trois études complémentaires permettant respectivement de répondre aux sous trois sous-questions ci-haut : 1) une étude de série de cas incluant 9 locuteurs atteints de PAOS (5 PPAOS, 4 DAOS) et 30 locuteurs contrôles appariés; 2) une étude expérimentale investiguant l'interaction entre les habiletés prosodiques et articulatoires chez 4 locuteurs atteints de la forme primaire de la condition (PPAOS) et 4 locuteurs contrôles, issus de l'étude 1; 3) une étude longitudinale où 4 locuteurs atteints de PAOS (2 PPAOS, 2 DAOS) ayant participé à l'étude 1 ont été réévalués tous les 6 mois pendant 18 mois. Les participants ont complété une batterie d'évaluation de la parole et du langage, et des analyses perceptuelles et acoustiques ont été complétées a posteriori. Des analyses statistiques ont permis de comparer les locuteurs atteints de PAOS aux locuteurs contrôles (études 1 et 2) et des analyses visuelles ont permis de décrire leur évolution (étude 3). Résultats : L'étude 1 a révélé des atteintes sur les plans articulatoires et prosodiques chez les locuteurs québécois francophones atteints de PAOS, notamment une articulation imprécise et inconstante, un débit ralenti, des groupes articulatoires plus courts et des difficultés de production de la prosodie linguistique. Les résultats de l'étude 2 suggèrent que les locuteurs PPAOS présentent une réduction du débit, de la précision articulatoire et de la capacité à accélérer le débit. De plus, ils suggèrent une influence des facteurs articulatoires sur le débit, mais pas du débit sur la précision articulatoire. Les résultats de l‘étude 3 montrent une dégradation des habiletés articulatoires et prosodiques chez tous les locuteurs PAOS. L'évolution de certaines difficultés semble dépendre du délai depuis l'apparition des symptômes alors qu'elle semble plutôt influencée par le sous-type de PAOS pour d'autres. Deux parcours évolutifs différents sont observés et semblent liés à la présence ou au développement précoce de difficultés grammaticales. Conclusion : Ce projet a permis d'identifier les caractéristiques clés de la PAOS chez les locuteurs québécois francophones, de mettre en lumière certaines mesures pouvant orienter le diagnostic différentiel entre la PPAOS et la DAOS et de caractériser l'évolution de plusieurs habiletés de langage et de parole chez ces locuteurs. De plus, elle a permis d'approfondir la compréhension de l'interaction entre les habiletés articulatoires et prosodiques chez les locuteurs atteints de PPAOS. Les résultats contribueront à faciliter l'identification, le diagnostic différentiel précoce, l'établissement du pronostic et la prise en charge de la PAOS.
Background: Apraxia of speech is a neuromotor speech disorder affecting the planning and programming of motor speech movements. It is characterized by articulation and prosodic difficulties. The term progressive apraxia of speech (PAOS) includes neurodegenerative syndromes associated with aging where apraxia of speech occurs as an initial symptom either in isolation (primary progressive apraxia of speech; PPAOS) or predominant to concomitant aphasia (dominant progressive apraxia of speech; DAOS). Although the recognition of these syndromes as separate entities has grown significantly over the past decade, there is still a great deal of variability in the application, and use, of these terms. The differential diagnosis and management of these syndromes are hampered by an incomplete initial and evolutive characterization of language and speech skills. In addition, the understanding of speech deficits and the interactions between them is also still poorly developed. Finally, almost all the studies are based on English speakers, which limits the generalization of knowledge to speakers of other languages. An in-depth study of the impairment of communication skills, their progression, and their underlying deficits in Quebec French speakers with PAOS is necessary. Aims: The general objective of this thesis was to describe the communication skills and their evolution in Quebec French speakers with PAOS. It addressed the following three sub-questions: a) What are the fine motor speech and language characteristics of these speakers?; b) What is the relationship between articulatory and prosodic difficulties in PPAOS?; c) Are there different paths in the progression of communication impairments in Quebec French speakers with PAOS? Results: Results from Study 1 revealed articulation and prosodic impairments in Quebec French speakers with PAOS, including articulatory imprecision and variability, slowed speech rate, shorter articulatory groups and difficulty expressing linguistic prosody. Speakers with PAOS differed from healthy speakers on all articulatory and prosodic measures. The results also suggested that some measures of articulatory precision, oral comprehension of sentences and written naming could distinguish speakers with PPAOS from speakers with DAOS. No prosodic measure appeared to distinguish the two subgroups in this study. The results from Study 2 suggested that, compared to control speakers, PPAOS speakers exhibit slower speech rate, reduced articulatory accuracy and reduced ability to speed up their speech rate. They also suggest that articulatory factors may influence speech rate, but that speech rate does not influence articulatory accuracy. Syllable frequency and structure significantly influenced speech rate and articulatory precision, but increased speech rate did not have a significant influence on articulatory accuracy. Results from Study 3 revealed a deterioration in articulatory and prosodic skills in all PAOS speakers over time. The progression of some deficits seemed related to the post-onset time while the progression of other deficits seemed more related to the PAOS subtype. Two different paths of progression were observed in this study. They seemed linked to the presence or early development of grammatical difficulties. Conclusion: This doctoral thesis presents key characteristics of Quebec French speakers with PAOS, highlights metrics that may potentially guide the differential diagnosis between PPAOS and DAOS and describes the progression of several motor speech and language skills in PAOS. In addition, it deepens the understanding of the interaction between articulatory and prosodic skills in speakers with PPAOS. The results have important implications for the identification, early differential diagnosis, prognosis, and management of speakers with PAOS.

Background: Diagnostic accuracy and reliability of acquired apraxia of speech (AOS) in the presence of co-occurring aphasia and/or dysarthria is crucial for appropriate treatment selection and clinical decision making. However, overlapping symptomology and lack of operationalization of AOS assessment methods have contributed to inadequate interrater reliability of perceptual measures differentially diagnostic of AOS. Purpose: This study investigated factors influencing the operationalization of AOS assessment methods, primarily interrater reliability of perceptual characteristics of differentially diagnostic (i.e., phonetic and prosodic errors) measures in order to inform assessment methods in AOS with concomitant aphasia. In addition, several other factors influencing the operationalization of AOS assessment methods were explored including: the utility of a pre-existing stimulus readily available in a standardized aphasia assessment (WAB-R), interrater reliability of non-discriminatory characteristics of AOS (i.e., auditory groping and false starts), the influence of alternating motion rates (AMRs) and sequential motion rates (SMRs) on a diagnosis of AOS, and the influence of the WAB-R subtests on error production by diagnostic group. Methods: Forty participants presenting with varying aphasia subtypes and severities and potential motor speech impairment were included. Speech production errors were analyzed by four raters using narrow transcription methods in response to the WAB-R spoken language subtest stimuli (Naming, Repetition, and Spontaneous Speech subtests) of the WAB-R. Interrater reliability of perceptual measurement of both differentially diagnostic and non-discriminatory features of AOS when using consistent stimuli (WAB-R), measures (Apraxia of Speech Rating Scale) and trained raters using narrow transcription methods were examined. In addition, percentage agreement of AOS diagnoses with and without the inclusion of AMRs/SMRs, as well as the influence of WAB-R subtest on error production across groups with AOS with concomitant aphasia and those with aphasia only were also examined. Results: Both differentially diagnostic as well as non-discriminatory speech characteristics were shown to demonstrate adequate interrater reliability across a variety of aphasia subtypes and severities of both AOS and aphasia. Adequate agreement between a diagnosis of AOS with and without the inclusion of AMRs/SMRs was reported as well as a lack of significant differences of phonetic and prosodic error production between subtests. Conclusion: The current work provides preliminary evidence of adequate interrater reliability of perceptual features of AOS using consistent stimuli (WAB-R), measures (Apraxia of Speech Rating Scale), and trained raters using narrow transcription. Findings from this work also support the inclusion of the AMRs/SMRs in AOS assessment and highlight the importance of their role when assessing individuals with borderline/mild motor speech impairments. These preliminary results support the consistency and operationalization of assessment methods through the investigation of reliability of perceptual measurements of differentially diagnostic characteristics of AOS in the presence of aphasia.

A droopy eyelid is a common problem. Causes may range from simple and non-progressive disorders such as congenital ptosis to progressive multisystemic disorders such as mitochondrial disease. Myasthenia gravis is a very important and treatable cause of ptosis that should always be considered in the differential diagnosis. Apraxia of eyelid opening can be confused with ptosis or blepharospasm, leading to delay of the diagnosis. Horner’s syndrome has different causes and management. Knowledge of the anatomy and physiology of the eyelids is crucial for understanding the pathological processes that affect them.

Having droopy eyelids is a common problem. Causes may range from disorders that are simple and not progressive, such as congenital ptosis, to progressive, multisystemic disorders, such as mitochondrial disease. Myasthenia gravis (MG) is a very significant and treatable cause of ptosis that should always be part of the differential diagnosis. Apraxia of the eyelid opening can be confused with ptosis or blepharospasm, leading to a delay in reaching the correct diagnosis. Horner’s syndrome has different causes and management approaches. Knowledge of the anatomy and physiology of the eyelids is crucial for understanding the pathological processes that affect them.

Corticobasal syndrome is a clinical diagnosis based on the presence of one or more movement disorders suggestive of basal ganglia dysfunction, typically asymmetrical, with evidence of associated cortical dysfunction. This is a pathologically heterogeneous group of disorders that can share a common phenotype. Corticobasal degeneration is one of these pathologies, representing one of the rarest forms of atypical parkinsonism. When confronted with a patient with higher cortical dysfunction, specific assessment for apraxia, cortical sensory loss, and cognition is indicated. Corticobasal syndrome is currently untreatable, regardless of the nature of the underlying pathology, and in most cases progression is fast with significant disability that is typically unresponsive to levodopa.

Non-Alzheimer dementias are commonly distinguished from Alzheimer disease by younger age at onset (midlife or earlier), positive family history, and presentations characterized by non-amnesic cognitive deficits, psychiatric states (such as depression, compulsions, paranoia, and hallucinations) and motor dysfunctions (like parkinsonism, ataxia, and apraxia). Missed diagnosis is a common problem, with the conditions being mistaken for psychiatric or movement disorder. Timely diagnosis depends on methodical examinations that characterize the chronology and tempo of key symptoms, family history, and neurological features, and brain images that reveal telltale patterns of atrophy or dysfunction. Genetic, blood, and CSF assays, and EEG are indicated where family history is positive or illness progression rapid. As non-Alzheimer dementias pose many clinical and psychosocial problems, optimal care requires a multidisciplinary team, empowered carers, and leverage of community resources. The latest discoveries in neuroimaging, particularly amyloid-PET, tau-PET, and clinical genetics, promise improvements in diagnostics and new therapeutic opportunities.

Supranuclear ophthalmoplegia results from an interruption of the saccadic, pursuit, optokinetic, or vergence inputs to the ocular motor nuclei. In this chapter, we begin by reviewing potential causes for difficulty reading. We next review the neuro-ophthalmic and neurologic features of progressive supranuclear palsy, which can include a vertical supranuclear ophthalmoplegia, convergence insufficiency, square-wave jerks, upper-eyelid retraction, reduced blink rate, apraxia of eyelid opening, and blepharospasm. We then discuss the differential diagnosis of progressive supranuclear palsy and point out clinical features that help to differentiate these conditions. Lastly, we present a practical approach to the management of the visual symptoms commonly caused by progressive supranuclear palsy.

This chapter discusses Parkinson's disease (PD). PD is primarily characterized by motor symptoms; these include bradykinesia with rigidity and/or rest tremor according to the latest diagnostic criteria. Dr James Parkinson noted that the disease came on gradually, beginning in the hands and arms before moving through the rest of the body, and observed the weariness, inconvenience, and anguish it provoked in its victims. Nowadays, an increasingly more prominent role is being given to non-motor symptoms of PD; efforts are accordingly being made to produce a reclassification of clinical subtypes. Parkinsonism is principally divided into primary and secondary types. While potential causes of secondary parkinsonism should always be investigated and, when possible, treated, primary parkinsonism embraces a number of neurodegenerative disorders of multifactorial origin. The most common type of primary parkinsonism is PD. Another group of degenerative disorders is labelled atypical parkinsonism. The designation ‘atypical’ mainly refers to the poor levodopa response and the early manifestation of additional clinical features such as ophthalmoparesis, dysautonomia, apraxia, or dementia. Finally, the differential diagnosis of parkinsonism also encompasses a wide range of rare hereditary degenerative disorders that should be taken into account if the clinical presentation is not typical.

This chapter deals with four diseases affecting the central nervous system (CNS) for which neurologists are primarily involved as consultants. It follows the same approach as the chapters that focus on single diseases but does so more briefly. Brain tumors are estimated to have an incidence of 12/100,000 per year (Scharre, 2000). The incidence is highest in old age, peaking between 60 and 80 years of age. Almost 50% of intracranial tumors are gliomas, 10% to 15% are meningiomas, 5% to 7% are pituitary adenomas, and 5% to 6% are metastatic tumors. Brain tumors produce signs and symptoms in a variety of ways, including direct invasion, compression, hemorrhage, and edema. Motor, sensory, visual, and gait disturbances are frequent manifestations of brain tumors. In addition, headache and focal or generalized seizures are quite common. The psychiatric manifestations of brain tumors reflect their location; the type of brain damage they produce; patients’ reactions to their symptoms or diagnosis; and the effects of treatments such as steroids, chemotherapy, and radiation. Tumors in specific brain regions have been linked to specific psychiatric manifestations. Frontal lobe tumors are most closely associated with behavioral changes,sometimes referred to as the frontal lobe syndrome or executive dysfunction syndrome. Temporal lobe tumors are most closely associated with personality change, irritability, and hallucinations (especially auditory), as well as with a variety of language disorders. Patients with language disorders associated with temporal lobe tumors can experience catastrophic reactions when their deficits interfere with communication. Parietal lobe tumors typically are associated with cognitive deficits such as apraxia, neglect syndromes of the contralateral body or space, and unformed visual hallucinations such as streaks or flashes of light. When evaluating brain tumor patients with psychiatric symptoms and signs, careful evaluation and differential diagnosis are critical. In hospitalized and seriously ill patients, it is especially important to rule out delirium, particularly when the psychiatric phenomena are intermittent and vary in intensity. Serial observations and repeated mental status examinations are the basis for the diagnosis of delirium, but an electroencephalogram (EEG) is also helpful, because in most cases of delirium it reveals generalized slowing involving brain areas far from the location of the brain tumor.