Autor: Ineco

Recently (Roca et al., 2010), we used the relationship with general intelligence (Spearman’s g) to define two sets of frontal lobe or «executive » tests. For one group, including Wisconsin Card Sorting and Verbal Fluency, reduction in g entirely explained the deficits found in frontal patients. For another group, including tests of social cognition and multitasking, frontal deficits remained even after correction for g. Preliminary evidence suggested a link of the latter tasks to more anterior frontal regions. Here we develop this distinction in the context of behavioural-variant frontotemporal dementia (bvFTD), a disorder which progressively affects frontal lobe cortices. In bvFTD, some executive tests, including tests of social cognition and multitasking, decline from the early stage of the disease, while others, including classical executive tests such as Wisconsin Card Sorting, Verbal Fluency or Trail Making Test part B, show deficits only later on. Here we show that, while deficits in the classical executive tests are entirely explained by g, deficits in the social cognition and multitasking tests are not. The results suggest a relatively selective cognitive deficit at mild stages of the disease, followed by more widespread cognitive decline well predicted by g.

Research suggests that individuals with different attachment patterns process social information differently, especially in terms of facial emotion recognition. However, few studies have explored social information processes in adolescents. This study examined the behavioral and ERP correlates of emotional processing in adolescents with different attachment orientations (insecure attachment group and secure attachment group; IAG and SAG, respectively). This study also explored the association of these correlates to individual neuropsychological profiles. METHODOLOGY/PRINCIPAL FINDINGS: We used a modified version of the dual valence task (DVT), in which participants classify stimuli (faces and words) according to emotional valence (positive or negative). Results showed that the IAG performed significantly worse than SAG on tests of executive function (EF attention, processing speed, visuospatial abilities and cognitive flexibility). In the behavioral DVT, the IAG presented lower performance and accuracy. The IAG also exhibited slower RTs for stimuli with negative valence. Compared to the SAG, the IAG showed a negative bias for faces; a larger P1 and attenuated N170 component over the right hemisphere was observed. A negative bias was also observed in the IAG for word stimuli, which was demonstrated by comparing the N170 amplitude of the IAG with the valence of the SAG. Finally, the amplitude of the N170 elicited by the facial stimuli correlated with EF in both groups (and negative valence with EF in the IAG).

CONCLUSIONS/SIGNIFICANCE: Our results suggest that individuals with different attachment patterns process key emotional information and corresponding EF differently. This is evidenced by an early modulation of ERP components’ amplitudes, which are correlated with behavioral and neuropsychological effects. In brief, attachments patterns appear to impact multiple domains, such as emotional processing and EFs.

Several factors make diagnosis of a possible behavioural variant of frontotemporal dementia (bvFTD) particularly challenging, especially the overlap of certain symptomatic dimensions such as apathy, disinhibition, depression, anhedonia, stereotyped behaviour, and psychosis between bvFTD and several psychiatric disorders that appear in late adulthood. We discuss the most frequent psychiatric conditions that can simulate early bvFTD symptoms, including late onset bipolar disorder, late onset schizophrenia-like psychosis, late onset depression, and attention deficit hyperactivity disorder in middle and older age.

Socioeconomic status (SES) is a multidimensional concept comprising a variety of interacting factors that influence health in a dynamic manner over the entire lifespan. When looking at its association with health, the quasi-universal pattern is that of increasing level of morbidity as SES decreases, and stroke is no exception.(1,2) In the last 3 decades evidence has accumulated showing how both individual and neighborhood SES independently affect stroke incidence.(3-6) A combination of adverse lifestyle factors, detrimental physical and social environments, and perhaps lower access to primary health care are likely to contribute to this excess risk. Several studies, including that of Brown et al.(7) in this issue of Neurology(®), have looked at survival poststroke as a function of SES. This question is of importance; are the consequences of stroke also borne disproportionately by the poor the way that stroke occurrence is?

The preserved «implicit awareness » in patients with Alzheimer disease (AD) presenting anosognosia has opened a new branch of research regarding explicit-implicit integration. The behavioral variant of frontotemporal dementia (bvFTD), contrary to AD, would present impaired anosognosia-related implicit awareness due to a dysfunctional implicit integration of contextual information caused by an abnormal fronto-insular-temporal network. Loss of insight and anosognosia are pervasive in bvFTD, but no reports have assessed the implicit emotional awareness in this condition. We emphasize the need to investigate and extend our knowledge of implicit contextual integration impairments and their relation with anosognosia in bvFTD vs AD.

To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.

Although neuromyelitis optica (NMO) is classically recognized as an affectation of optic nerves and spinal cord, recent reports have shown brain atrophy and cognitive dysfunction in this condition. Importantly, femotion-related brain regions appear to be impaired in NMO. However, no studies of NMO’ emotional processing have been published. The goal of the current study was to investigate facial emotion recognition in 10 patients with NMO and 10 healthy controls by controlling for relevant cognitive factors. Consistent with previous reports, NMO patients performed poorly across cognitive domains (divided attention, working memory, and information-processing speed). Our findings further evidence the relative inability of NMO patients to recognize negative emotions (disgust, anger, and fear), in comparison to controls, with these deficits not explained by other cognitive impairments. Results provide the first evidence that NMO may impair the ability to recognize negative emotions. These impairments appear to be related to possible damage in brain regions underling emotional networks, including the anterior cingulate cortex, amygdala, and medial prefrontal cortex. Findings increased both our understanding of NMO’s cognitive impairment, and the neural networks underlying negative emotions.

Although the notion of world language has been variously defined, most accounts acknowledge inter-user performance variability as a key aspect of the construct. The sociocultural aspects of such a phenomenon have been extensively treated in the literature. However, comparatively little attention has been paid to its neurocognitive underpinnings. This paper addresses the biopsychological bases of performance variability among word-language users, focusing on bilingual speakers of English. Available evidence reveals four neurocognitive determinants of variability, namely manner of appropriation, age of acquisition, level of proficiency, and degree of formal similarity between the native and the non-native language. In its concluding section, the paper highlights the benefits of incorporating neurocognitive evidence into the study and conceptualization of world languages.

BACKGROUND: Medical practitioners such as physicians are continuously exposed to the suffering and the distress of patients. Understanding the way pain perception relates to empathetic dispositions and professional quality of life can contribute to the development of strategies aimed at protecting health professionals from burnout and compassion fatigue. In the present study we investigate the way individual dispositions relate to behavioral measures of pain sensitivity, empathy, and professional quality of life. METHODS: A secure Web-based series of self-report measures and a behavioral task were administered to 1,199 board-certified physicians. Additionally, surveys were used to obtain measures of demographic and professional background; dispositional empathy (empathic concern, personal distress, and perspective taking); positive (compassion satisfaction) and negative (burnout and secondary traumatic stress) aspects of their professional life. In the behavioral task, participants were asked to watch a series of video clips of patients experiencing different levels of pain and provide ratings of pain intensity and induced personal distress. RESULTS: Perceived pain intensity was significantly lower among more experienced physicians but similar across specialty fields with varying demands of emotional stress. Watching videos of patients in pain, however, elicited more personal distress among physicians in highly demanding medical fields, despite comparable empathy dispositions with other fields. The pain of male patients was perceived as less intense than the pain of female patients, and this effect was more marked for female physicians. The effect of dispositional empathy on pain perception and induced personal distress was different for each sub-component, with perspective taking and empathic concern (EC) being predictive of the behavioral outcomes. Physicians who experience both compassion satisfaction and fatigue perceive more pain and suffer more personal distress from it than those who only suffer the negative aspects of professional quality of life. CONCLUSIONS: Professional experience seems to desensitize physicians to the pain of others without necessarily helping them down-regulate their own personal distress. Pain perception is also related with specific aspects of empathy and varies depending on context, as is the case with the gender of their patients. Minimum levels of empathy appear necessary to benefit from the positive aspects of professional quality of life in medicine.

Bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) in adults share clinical symptoms. Both disorders present with executive functioning impairment. The detection of executive dysfunction usually requires the administration of an extensive neuropsychological battery. The Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) is an efficient tool, which has been demonstrated to be useful for the detection of executive deficits in other diseases involving the prefrontal cortex. This study assessed the usefulness of the IFS in detecting the executive dysfunction of BD and ADHD adults, by means of a receiver-operating characteristic curve analysis and a multigroup discriminant function analysis. Twenty-four BD, 25 ADHD patients and 25 controls were assessed with a battery that included the IFS and other measures of executive functioning. Our results showed that both patient groups performed significantly lower than controls on the IFS total score. Using a 27.5 point cut-off score, the IFS showed good sensitivity and acceptable specificity to detect executive impairments in BD and ADHD patients. The IFS discriminated between controls and each patient group more reliably than other executive functions measures. Our results suggest that this tool could be a useful instrument to assess executive functions in BD and ADHD patients.