{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:10:13Z","timestamp":1756365013203,"version":"3.44.0"},"reference-count":24,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>We present a patient with no dementia, depression or apathy, who had difficulty in learning self-exercise instructions. The patient was an 80-year-old right-handed woman who was admitted to a rehabilitation unit to receive postoperative rehabilitation after a femoral neck fracture. She was instructed quadriceps isometric exercises to perform 10 repetitions and to hold each stretch for 10\u2005s. She performed the exercise correctly with motivation, but she had difficulty in learning the number of repetitions and the duration of each stretch. She had no history of cerebrovascular accident and the neurological examination was normal. Neuropsychological testing, MRI and <jats:sup>18<\/jats:sup>F-fluoro- D-glucose-positron emission tomography (FDG-PET) were performed to examine the neural mechanisms associated with this difficulty in learning instructions. Neuropsychological tests revealed dysfunction of working memory while other cognitive domains were relatively preserved. Her neuropsychological tests scores were (1) Mini-Mental State Examination: 24 (mild cognitive impairment), (2) Geriatric Depression Scale-15: 2 (no depression), (3) Apathy Scale: 2 (no apathy), (4) digit span forward: 5 (normal), (5) digit span backward: 2 (impaired), (6) visuospatial span forward: 4 (normal), (7) visuospatial span backward: 2 (impaired), (8) frontal assessment battery: 11 (normal), (9) Weigl test: 0 (impaired), (10) trail making test A: 52\u2005s (normal), (11) train making test B: failed (impaired). T2-weighted and fluid-attenuated inversion recovery MRI showed high signal-intensity lesions in the cerebral deep white matter. FDG-PET revealed hypometabolic areas in the bilateral frontal lobes, particularly in the bilateral dorsolateral frontal area, anterior cingulate cortex and orbitofrontal cortex. One of the possible neural mechanisms underlying the learning difficulties in this patient may have been partial blockage of the cingulofrontal network by deep white matter lesions.<\/jats:p>","DOI":"10.1136\/bcr-2013-008577","type":"journal-article","created":{"date-parts":[[2013,7,25]],"date-time":"2013-07-25T09:35:05Z","timestamp":1374744905000},"page":"bcr2013008577","source":"Crossref","is-referenced-by-count":3,"title":["Difficulty with learning of exercise instructions associated with \u2018working memory\u2019 dysfunction and frontal glucose hypometabolism in a patient with very mild subcortical vascular dementia with knee osteoarthritis"],"prefix":"10.1136","volume":"2013","author":[{"given":"Kenji","family":"Takeda","sequence":"first","affiliation":[{"name":"Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenichi","family":"Meguro","sequence":"additional","affiliation":[{"name":"Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naofumi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Nakatsuka","sequence":"additional","affiliation":[{"name":"Department of Geriatric Behavioral Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,7,25]]},"reference":[{"key":"2025082723451660000_2013.jul25_1.bcr2013008577.1","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1093\/ptj\/85.12.1301","article-title":"Physical therapy treatment effectiveness for osteoarthritis of the knee: a randomized comparison of supervised clinical exercise and manual therapy procedures versus a home exercise program","volume":"2013","author":"Deyle","year":"2005","journal-title":"Phys Ther"},{"key":"2025082723451660000_2013.jul25_1.bcr2013008577.2","doi-asserted-by":"crossref","first-page":"477","DOI":"10.2340\/16501977-0808","article-title":"Systematic review of home physiotherapy after hip fracture surgery","volume":"2013","author":"Mehta","year":"2011","journal-title":"J Rehabil Med"},{"key":"2025082723451660000_2013.jul25_1.bcr2013008577.3","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1016\/j.archger.2008.08.003","article-title":"Dementia as a cofactor for geriatric rehabilitation-outcome in patients with osteosynthesis of the proximal femur: a retrospective, matched-pair analysis of 250 patients","volume":"2013","author":"R\u00f6sler","year":"2009","journal-title":"Arch Gerontol Geriatr"},{"key":"2025082723451660000_2013.jul25_1.bcr2013008577.4","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1111\/j.1532-5415.2011.03453.x","article-title":"Depression and functional recovery after a disabling hospitalization in older persons","volume":"2013","author":"Barry","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"2025082723451660000_2013.jul25_1.bcr2013008577.5","doi-asserted-by":"crossref","unstructured":"Lenze EJ Skidmore ER Dew MA . 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