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18 These areas and the area with reduced glucose mechanism in the patient are shown in figure 5. Figure?5 Areas with reduced glucose mechanism in the patient and cerebral areas activated by neuropsychological tests in previous studies. (1) Areas activated in trail making test B to a greater extent than in test A on functional MRI,16 (2); Areas activated in ... The patient had poor scores in the trail making test B, the Weigl test, for counting forward and for visuospatial backward span. The Weigl test and Wisconsin card sorting test19 are sorting tests, and therefore the brain area activated in the respective tasks is likely to be similar. As shown in figure 5, the areas with reduced mechanism were similar to the cerebral areas found to be activated in neuropsychological tests, except for the area in the right dorsolateral prefrontal area, which was not explained by the neuropsychological tests. Association with ��working memory�� Recent studies suggested that the working memory is involved in retaining new information as long-term memory.20 In daily life events commonly occur for which information can be easily recalled when we repeat to rehearse the information in our mind. Studies of phonological working memory by Davachi et al21 and of visuospatial working memory by Ranganath et al20 suggested that maintenance of information in the working memory involves use of long-term memory. Kondo et al22 TGF-beta inhibitor classified 20 healthy volunteers into large-working and small-working memory groups: the patients were asked to solve the calculation while keeping the target word in mind (dual task), and then asked to recall the word. The patients with large working memory recalled more words, and functional MRI showed that the anterior cingulate was activated. Furthermore, in patients with large working memory, the cingulofrontal network was strongly associated with working memory. In our patient, FDG-PET showed reduced metabolism in the anterior cingulate, and ��working memory�� was also reduced. Therefore, the patient may have received a greater load that overwhelmed the reduced ��working memory�� in the dual task of isometric contraction exercise than in the single tasks. She completed the exercise under supervision of a therapist, suggesting that her ��working memory�� was sufficient to complete the task, but not enough to transform the instructions into long-term memory. This may explain the longer time required for motor learning. Association with deep white matter changes Head MRI detected no cerebral stroke, but showed white matter changes around the cerebral ventricle.