CONTINUUM Lifelong Learning in Neurology

This article reveals how it is possible for a brain composed of 100 billion highly interconnected, lipid-encased, reticular electrochemical devices to support complex functions such as language and how language disorders can be understood as a reflection of degradation of one or more domains of knowledge.

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Memory Dysfunction

Fernandez-Romero, Roberto MD, MPH, PhD; Spica, D. Malcolm PhD

doi : 10.1212/CON.0000000000001020

Volume 27(6), December 2021, p 1562-1585

This article provides a practical overview of the diagnostic process for patients with memory dysfunction through exploration of the anatomic, physiologic, and psychological aspects of human memory.

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Executive Dysfunction and the Prefrontal Cortex

Jones, David T. MD; Graff-Radford, Jonathan MD

doi : 10.1212/CON.0000000000001009

Volume 27(6), December 2021, p 1586-1601

This article summarizes the cognitive and behavioral functions of the prefrontal cortex with an emphasis on executive cognitive functions and the clinical consequences associated with executive dysfunction. The clinical manifestations of lesions to the lateral prefrontal, orbitofrontal, medial prefrontal, and frontopolar cortex are reviewed.

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Upper Limb Apraxia

Heilman, Kenneth M. MD, FAAN

doi : 10.1212/CON.0000000000001014

Volume 27(6), December 2021, p 1602-1623

Limb apraxia is one of the most common and most disabling disorders caused by brain damage. However, apraxia is one of the least recognized disorders associated with cerebral disease. This article discusses the signs and symptoms of, means of testing for, the pathophysiology of, and possible management of upper limb apraxia.

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Spatial Neglect and Anosognosia After Right Brain Stroke

Barrett, A. M. MD, FAAN, FANA, FASNR

doi : 10.1212/CON.0000000000001076

Volume 27(6), December 2021, p 1624-1645

Up to 80% of survivors of right brain stroke leave acute care without being diagnosed with a major invisible disability. Studies indicate that a generic cognitive neurologic evaluation does not reliably detect spatial neglect, nor does it identify unawareness of deficit after right brain stroke; this article reviews the symptoms, clinical presentation, and management of these two cognitive disorders occurring after right brain stroke.

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Behavioral and Cognitive Aspects of Concussion

Bauer, Russell M. PhD; Jaffee, Michael S. MD, FAAN

doi : 10.1212/CON.0000000000001057

Volume 27(6), December 2021, p 1646-1669

This review provides the reader with an overview of concussion and mild traumatic brain injury (TBI). Key aspects of the pathophysiology, signs, and symptoms, treatment and rehabilitation, and recovery from concussion/mild TBI are reviewed with an emphasis on the variety of factors that may contribute to cognitive concerns following injury.

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Cognitive Rehabilitation

Kirsch-Darrow, Lindsey PhD; Tsao, Jack W. MD, DPhil, FAAN

doi : 10.1212/CON.0000000000001075

Volume 27(6), December 2021, p 1670-1681

This article provides a definition of and introduction to cognitive rehabilitation. It discusses different approaches to cognitive rehabilitation (ie, restorative, compensatory, and metacognitive). It also reviews types of memory impairment and how they can be distinguished to improve treatment design and implementation.

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Psychosis

Julayanont, Parunyou MD; Suryadevara, Uma MD

doi : 10.1212/CON.0000000000001013

Volume 27(6), December 2021, p 1682-1711

Psychosis can manifest in primary psychotic disorders, neurologic diseases, and medical conditions. This article reviews the definition of psychotic symptoms and the evaluation and management of psychosis in primary psychiatric and neurologic disorders frequently seen in neurologic practice.

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Mood Disorders

Datta, Shae MD; Suryadevara, Uma MD; Cheong, Josepha MD

doi : 10.1212/CON.0000000000001051

Volume 27(6), December 2021, p 1712-1737

This comprehensive review of mood disorders brings together the past and current literature on the diagnosis, evaluation, and treatment of the depressive and bipolar disorders. It highlights the primary mood disorders and secondary neurologic causes of mood disorders that are commonly encountered in a clinical setting. As the literature and our understanding evolve, recent additions to the current literature are important to bring forth to the readers.

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Posttraumatic Stress Disorder and Anxiety-Related Conditions

Williamson, John B. PhD; Jaffee, Michael S. MD, FAAN; Jorge, Ricardo E. MD

doi : 10.1212/CON.0000000000001054

Volume 27(6), December 2021, p 1738-1763

This article provides a synopsis of current assessment and treatment considerations for posttraumatic stress disorder (PTSD) and related anxiety disorder characteristics. Epidemiologic and neurobiological data are reviewed as well as common associated symptoms, including sleep disruption, and treatment approaches to these conditions.

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Obsessive-Compulsive Disorders

Mathews, Carol MD

doi : 10.1212/CON.0000000000001011

Volume 27(6), December 2021, p 1764-1784

This article describes the phenomenology and clinical presentation of obsessive-compulsive disorder (OCD), a common but underdiagnosed psychiatric disorder. Guidance for effectively identifying obsessive-compulsive symptoms is provided, and treatment options, including psychotherapy, pharmacologic management, and neuromodulation approaches for treatment-resistant OCD, are discussed.

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Interprofessional Internet Consultations: The Potential Benefits and Perils of eConsults

Kass, Joseph S. MD, JD, FAAN; Rose, Rachel V. JD, MBA

doi : 10.1212/CON.0000000000001019

Volume 27(6), December 2021, p 1785-1789

This article addresses the question of whether neurologists performing interprofessional internet consultations, known as eConsults, face the same malpractice liability as for face-to-face patient care. Because the physician-patient relationship is usually unambiguous, determining the scope of legal liability arising from these relatively new approaches to patient care requires understanding the types of interactions courts have found to establish a patient-physician relationship.

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The Transformation of Documenting and Coding: Evaluation and Management Codes for Outpatient Neurology Services

Villanueva, Raissa MD, MPH, FAAN; Busis, Neil A. MD, FAAN; Cohen, Bruce H. MD, FAAN; Ciccarelli, Luana CPC, CRC

doi : 10.1212/CON.0000000000001090

Volume 27(6), December 2021, p 1790-1808

This article discusses the optimal ways to document and code for outpatient evaluation and management (E/M) codes. Since the changes for Current Procedural Terminology (CPT) codes 99202-99215 were finalized for 2021, they have been modified by the Centers for Medicare & Medicaid Services (CMS) in their Medicare Physician Fee Schedule and by technical corrections issued on March 9, 2021. The 21st Century Cures Act mandated that patients can access their notes and test results immediately. These developments have transformed medical documentation and coding for outpatient E/M services. One year in, the authors have a better understanding of the subtleties of documenting and accurately determining levels of service for outpatient encounters using these new rules and regulations, and they share key insights gained by experience with the new system.

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Twilight and Me: A Soliloquy

Drubach, Daniel Alejandro MD, FAAN

doi : 10.1212/CON.0000000000001091

Volume 27(6), December 2021, p 1809-1817

Dementia with Lewy bodies (DLB) is the third most frequent type of dementia. The range of symptoms it causes is quite broad and includes parkinsonism, autonomic dysfunction, cognitive deficits, visual and auditory hallucinations, dream disturbances, and other unusual manifestations such as "sense of presence," Capgras syndrome, and fluctuations in neurologic status. The author, an experienced behavioral neurologist and previous Continuum author, has been diagnosed with DLB and assumes the dual role of physician and patient. Each role provides a unique perspective. He discusses the importance of hope and fear in coping with the illness.

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