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In reply
After reading our article, Dr Mark made 3 comments to which I would like to respond. First, he states that conventional MRI might have missed a small lesion and that "[i]t would have been appropriate for the authors to indicate that conventional MRI may have been insufficient. . . ." Dr Mark is entirely correct; the MRI might have missed a small hemispheric lesion. However, it is not clear that a small hemispheric lesion could induce such a profound behavioral disorder. In addition, I was always taught that no matter what imaging technique one uses, it is always possible to miss a very small lesion. Almost all well-trained neurologists know this; thus, we did not comment on the obvious.
Dr Mark notes a prior report indicating that patients with aphasia may have a within-session decline in the ability to benefit from cues. These cues work because they induce activation of lexical and semantic representations or increase attention and arousal. Normally organisms habituate to stimuli that induce activation or an orienting response. I am not sure that this phenomenon is the same as the cognitive impersistence that we described; that is, a decline in self-generated behavior. However, if there are reports of similar behaviors (and I suspect that there might be), these would only support this construct.
Finally, Dr Mark wants us to change the name from cognitive impersistence to cognitive fatigue. Most dictionaries define fatigue as tiredness or weariness, and persistent as refusing to give up. During cognitive testing, this patient did not appear to be tired or weary—but she did give up.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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