The highest integrative functions and diffuse cerebral atrophy

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Abstract
In 19 subjects with diffuse loss of cerebral tissue due to slowly progressive degenerative disease and in one with loss due to birth injury, impairment of the highest integrative functions was assessed and related to the extent of cerebral tissue loss. The latter was indicated by measurement of the area of the lateral ventricles and of the total intracranial area in pneumoencephalo-grams. In these subjects, impairment was found in all categories of the highest integrative functions previously found to be impaired in subjects with focal loss of tissue from the cerebral hemispheres: the capacity for the expression of needs, appetites, and drives; the mechanisms for goal achievement (learning, memory, categorization, and so on); the capacity to initiate, organize, and maintain appropriate adaptive reactions; and the capacity to maintain organization during stress and to recover promptly from its effects. The degree of impairment of over-all adaptive capacity in subjects with enlarged ventricles was found to be related approximately to the degree of enlargement-i.e., those subjects having evidence of severe diffuse loss of cerebral tissue as indicated by a large ventricle size ratio were the most seriously impaired in their over-all adaptive capacities and also exhibited the poorest performance on laboratory procedures. However, a few subjects with only minor enlargement of the ventricles also demonstrated major impairment of the highest integrative functions. It was inferred that in those subjects the degenerative process had resulted in major neural dysfunction but had hot yet resulted in a loss of brain substance. It is concluded that the degree of impairment of the highest integrative functions is directly related to the total number of inadequately functioning cortical neurons, regardless of whether the defective neurons be aggregated in one area of the homotypical isocortex or diffusely distributed throughout the hemispheres.

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