1
|
Pandey JP, Baglio F, Mancuso R, Guerini FR, Cabinio M, Isernia S, Clerici M, Agostini S. Biomarkers of neural integrity and immunoglobulin genes influence neurodegeneration in Alzheimer's disease. J Neurol Sci 2024; 464:123167. [PMID: 39142084 PMCID: PMC11347077 DOI: 10.1016/j.jns.2024.123167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/26/2024] [Accepted: 08/04/2024] [Indexed: 08/16/2024]
Abstract
Compelling evidence has been presented in favor of herpes simplex virus type 1 (HSV1) being one of the causative agents of Alzheimer's disease (AD). The success of HSV1 as a pathogen relates to its sophisticated strategies to evade host immunosurveillance. One strategy involves encoding a decoy Fcγ receptor (FcγR) that thwarts the Fcγ-mediated effector functions, such as antibody-dependent cellular cytotoxicity (ADCC), a potent host immunosurveillance mechanism against virally infected cells. The decoy FcγR binds to antibodies of all IgG subclasses, except IgG3; therefore, IgG3 would be expected to play an important role in viral clearance by neutralization and ADCC, and thus contribute to protection from HSV1-spurred diseases. Previous studies have shown significant association between anti-HSV1 IgG3 antibodies and cortical thinning of the areas of the brain typically altered in AD and also targeted by HSV1. The aim of the present investigation was to determine whether GM (γ marker) 5 and GM 21 allotypes, hereditary allelic determinants expressed on IgG3, together with brain biomarkers of neural integrity, contributed to neurodegeneration-as measured by mini-mental state examination (MMSE) score-in patients with AD. Multiple regression analyses showed that the homozygous GM 5/5 genotype, preserved right hippocampus, and right insula thickness were associated with higher MMSE scores (p < 0.001), whereas the opposite pattern and GM 5/21 genotype were associated with worse clinical profiles. Influence of GM 5/21-expressing IgG3 antibodies on the ADCC of HSV1-infected neurons could, at least partially, explain these results.
Collapse
Affiliation(s)
- Janardan P Pandey
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA.
| | | | | | | | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | |
Collapse
|
2
|
Wang H, Zhao Q, Zhang Y, Ma J, Lei M, Zhang Z, Xue H, Liu J, Sun Z, Xu J, Zhai Y, Wang Y, Cai M, Zhu W, Liu F. Shared genetic architecture of cortical thickness alterations in major depressive disorder and schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2024; 135:111121. [PMID: 39154931 DOI: 10.1016/j.pnpbp.2024.111121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/29/2024] [Accepted: 08/15/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) and schizophrenia (SCZ) are heritable brain disorders characterized by alterations in cortical thickness. However, the shared genetic basis for cortical thickness changes in these disorders remains unclear. METHODS We conducted a systematic literature search on cortical thickness in MDD and SCZ through PubMed and Web of Science. A coordinate-based meta-analysis was performed to identify cortical thickness changes. Additionally, utilizing summary statistics from the largest genome-wide association studies for depression (Ncase = 268,615, Ncontrol = 667,123) and SCZ (Ncase = 53,386, Ncontrol = 77,258), we explored shared genomic loci using conjunctional false discovery rate (conjFDR) analysis. Transcriptome-neuroimaging association analysis was then employed to identify shared genes associated with cortical thickness alterations, and enrichment analysis was finally carried out to elucidate the biological significance of these genes. RESULTS Our search yielded 34 MDD (Ncase = 1621, Ncontrol = 1507) and 19 SCZ (Ncase = 1170, Ncontrol = 1043) neuroimaging studies for cortical thickness meta-analysis. Specific alterations in the left supplementary motor area were observed in MDD, while SCZ exhibited widespread reductions in various brain regions, particularly in the frontal and temporal areas. The conjFDR approach identified 357 genomic loci jointly associated with MDD and SCZ. Within these loci, 55 genes were found to be associated with cortical thickness alterations in both disorders. Enrichment analysis revealed their involvement in nervous system development, apoptosis, and cell communication. CONCLUSION This study revealed the shared genetic architecture underlying cortical thickness alterations in MDD and SCZ, providing insights into common neurobiological pathways. The identified genes and pathways may serve as potential transdiagnostic markers, informing precision medicine approaches in psychiatric care.
Collapse
Affiliation(s)
- He Wang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qiyu Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yijing Zhang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Juanwei Ma
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Minghuan Lei
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhihui Zhang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hui Xue
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jiawei Liu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zuhao Sun
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jinglei Xu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Zhai
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Wang
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Mengjing Cai
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou 450000, China.
| | - Wenshuang Zhu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China; Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
| | - Feng Liu
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, China.
| |
Collapse
|
3
|
Lopes da Cunha P, Ruiz F, Ferrante F, Sterpin LF, Ibáñez A, Slachevsky A, Matallana D, Martínez Á, Hesse E, García AM. Automated free speech analysis reveals distinct markers of Alzheimer's and frontotemporal dementia. PLoS One 2024; 19:e0304272. [PMID: 38843210 PMCID: PMC11156374 DOI: 10.1371/journal.pone.0304272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
Dementia can disrupt how people experience and describe events as well as their own role in them. Alzheimer's disease (AD) compromises the processing of entities expressed by nouns, while behavioral variant frontotemporal dementia (bvFTD) entails a depersonalized perspective with increased third-person references. Yet, no study has examined whether these patterns can be captured in connected speech via natural language processing tools. To tackle such gaps, we asked 96 participants (32 AD patients, 32 bvFTD patients, 32 healthy controls) to narrate a typical day of their lives and calculated the proportion of nouns, verbs, and first- or third-person markers (via part-of-speech and morphological tagging). We also extracted objective properties (frequency, phonological neighborhood, length, semantic variability) from each content word. In our main study (with 21 AD patients, 21 bvFTD patients, and 21 healthy controls), we used inferential statistics and machine learning for group-level and subject-level discrimination. The above linguistic features were correlated with patients' scores in tests of general cognitive status and executive functions. We found that, compared with HCs, (i) AD (but not bvFTD) patients produced significantly fewer nouns, (ii) bvFTD (but not AD) patients used significantly more third-person markers, and (iii) both patient groups produced more frequent words. Machine learning analyses showed that these features identified individuals with AD and bvFTD (AUC = 0.71). A generalizability test, with a model trained on the entire main study sample and tested on hold-out samples (11 AD patients, 11 bvFTD patients, 11 healthy controls), showed even better performance, with AUCs of 0.76 and 0.83 for AD and bvFTD, respectively. No linguistic feature was significantly correlated with cognitive test scores in either patient group. These results suggest that specific cognitive traits of each disorder can be captured automatically in connected speech, favoring interpretability for enhanced syndrome characterization, diagnosis, and monitoring.
Collapse
Affiliation(s)
- Pamela Lopes da Cunha
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Fabián Ruiz
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
| | - Franco Ferrante
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Facultad de Ingeniería, Universidad de Buenos Aires (FIUBA), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Lucas Federico Sterpin
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
- Latin American Brain Health (BrainLat) Institute, Universidad Adolfo Ibáñez, Santiago, Peñalolén, Región Metropolitana, Chile
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, United States of America
- Trinity College Dublin, Dublin, Ireland
| | - Andrea Slachevsky
- Faculty of Medicine, Neuroscience and East Neuroscience Departments, Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Program – Institute of Biomedical Sciences (ICBM), University of Chile, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile
- Hospital del Salvador and Faculty of Medicine, Memory and Neuropsychiatric Center (CMYN), Neurology Department, University of Chile, Providencia, Santiago, Chile
- Departamento de Medicina, Servicio de Neurología, Clínica Alemana-Universidad del Desarrollo, Las Condes, Región Metropolitana, Chile
| | - Diana Matallana
- Facultad de Medicina, Departamento de Psiquiatría (Programa PhD Neurociencias), Instituto de Envejecimiento, Pontificia Universidad Javeriana, Bogotá, Colombia
- Centro de Memoria y Cognición, Intellectus, Hospital Universitario San Ignacio Bogotá, San Ignacio, Colombia
- Departamento de Salud Mental, Hospital Universitario Santa Fe de Bogotá, Bogotá, Colombia
| | - Ángela Martínez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Eugenia Hesse
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
- Departamento de Matemática, Universidad de San Andres, Victoria, Buenos Aires, Argentina
| | - Adolfo M. García
- Cognitive Neuroscience Center, Universidad de San Andrés, Victoria, Buenos Aires, Argentina
- Latin American Brain Health (BrainLat) Institute, Universidad Adolfo Ibáñez, Santiago, Peñalolén, Región Metropolitana, Chile
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, United States of America
- Facultad de Humanidades, Departamento de Lingüística y Literatura, Universidad de Santiago de Chile, Estación Central, Santiago, Chile
| |
Collapse
|
4
|
Tondelli M, Ballotta D, Maramotti R, Carbone C, Gallingani C, MacKay C, Pagnoni G, Chiari A, Zamboni G. Resting-state networks and anosognosia in Alzheimer's disease. Front Aging Neurosci 2024; 16:1415994. [PMID: 38903902 PMCID: PMC11188402 DOI: 10.3389/fnagi.2024.1415994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/22/2024] [Indexed: 06/22/2024] Open
Abstract
Background Recent evidence suggests that anosognosia or unawareness of cognitive impairment in Alzheimer's Disease (AD) may be explained by a disconnection between brain regions involved in accessing and monitoring information regarding self and others. It has been demonstrated that AD patients with anosognosia have reduced connectivity within the default mode network (DMN) and that anosognosia in people with prodromal AD is positively associated with bilateral anterior cingulate cortex (ACC), suggesting a possible role of this region in mechanisms of awareness in the early phase of disease. We hypothesized that anosognosia in AD is associated with an imbalance between the activity of large-scale resting-state functional magnetic resonance imaging (fMRI) networks, in particular the DMN, the salience network (SN), and the frontoparietal network (FPN). Methods Sixty patients with MCI and AD dementia underwent fMRI and neuropsychological assessment including the Anosognosia Questionnaire Dementia (AQ-D), a measure of anosognosia based on a discrepancy score between patient's and carer's judgments. After having applied Independent Component Analysis (ICA) to resting fMRI data we performed: (i) correlations between the AQ-D score and functional connectivity in the DMN, SN, and FPN, and (ii) comparisons between aware and unaware patients of the DMN, SN, and FPN functional connectivity. Results We found that anosognosia was associated with (i) weak functional connectivity within the DMN, in posterior and middle cingulate cortex particularly, (ii) strong functional connectivity within the SN in ACC, and between the SN and basal ganglia, and (iii) a heterogenous effect concerning the functional connectivity of the FPN, with a weak connectivity between the FPN and PCC, and a strong connectivity between the FPN and ACC. The observed effects were controlled for differences in severity of cognitive impairment and age. Conclusion Anosognosia in the AD continuum is associated with a dysregulation of the functional connectivity of three large-scale networks, namely the DMN, SN, and FPN.
Collapse
Affiliation(s)
- Manuela Tondelli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Oxford Project to Investigate Memory and Ageing (OPTIMA), Experimental Medicine Division of Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Daniela Ballotta
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Maramotti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Physics, Informatics and Mathematics, University of Modena and Reggio Emilia, Modena, Italy
- Department of Mathematics and Computer Science, University of Ferrara, Ferrara, Italy
| | - Chiara Carbone
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Gallingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Clare MacKay
- Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Pagnoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Chiari
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Giovanna Zamboni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurologia, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
- Oxford Project to Investigate Memory and Ageing (OPTIMA), Experimental Medicine Division of Radcliffe Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
5
|
Yin KF, Gu XJ, Su WM, Chen T, Long J, Gong L, Ying ZY, Dou M, Jiang Z, Duan QQ, Cao B, Gao X, Chi LY, Chen YP. Causal association and mediating effect of blood biochemical metabolic traits and brain image-derived endophenotypes on Alzheimer's disease. Heliyon 2024; 10:e27422. [PMID: 38644883 PMCID: PMC11033073 DOI: 10.1016/j.heliyon.2024.e27422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/17/2024] [Accepted: 02/28/2024] [Indexed: 04/23/2024] Open
Abstract
Background Recent genetic evidence supports that circulating biochemical and metabolic traits (BMTs) play a causal role in Alzheimer's disease (AD), which might be mediated by changes in brain structure. Here, we leveraged publicly available genome-wide association study data to investigate the intrinsic causal relationship between blood BMTs, brain image-derived phenotypes (IDPs) and AD. Methods Utilizing the genetic variants associated with 760 blood BMTs and 172 brain IDPs as the exposure and the latest AD summary statistics as the outcome, we analyzed the causal relationship between blood BMTs and brain IDPs and AD by using a two-sample Mendelian randomization (MR) method. Additionally, we used two-step/mediation MR to study the mediating effect of brain IDPs between blood BMTs and AD. Results Twenty-five traits for genetic evidence supporting a causal association with AD were identified, including 12 blood BMTs and 13 brain IDPs. For BMTs, glutamine consistently reduced the risk of AD in 3 datasets. For IDPs, specific alterations of cortical thickness (atrophy in frontal pole and insular lobe, and incrassation in superior parietal lobe) and subcortical volume (atrophy in hippocampus and its subgroups, left accumbens and left choroid plexus, and expansion in cerebral white matter) are vulnerable to AD. In the two-step/mediation MR analysis, superior parietal lobe, right hippocampal fissure and left accumbens were identified to play a potential mediating role among three blood BMTs and AD. Conclusions The results obtained in our study suggest that 12 circulating BMTs and 13 brain IDPs play a causal role in AD. Importantly, a subset of BMTs exhibit shared genetic architecture and potentially causal relationships with brain structure, which may contribute to the alteration of brain IDPs in AD.
Collapse
Affiliation(s)
- Kang-Fu Yin
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiao-Jing Gu
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei-Ming Su
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ting Chen
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiang Long
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Gong
- Rare Diseases Center, Outpatient Department, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhi-Ye Ying
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Meng Dou
- Chengdu institute of computer application, Chinese Academy of Sciences, Chengdu, 610041, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qing-Qing Duan
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Bei Cao
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xia Gao
- Department of Geriatrics, Dazhou central hospital, Dazhou, 635000, Sichuan, China
| | - Li-Yi Chi
- Department of Neurology, First Affiliated Hospital of Air Force Military Medical University, Xi'an, 710072, Shanxi, China
| | - Yong-Ping Chen
- Department of Neurology, Institute of Brain Science and Brain-inspired Technology, Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| |
Collapse
|
6
|
Franco-O'Byrne D, Santamaría-García H, Migeot J, Ibáñez A. Emerging Theories of Allostatic-Interoceptive Overload in Neurodegeneration. Curr Top Behav Neurosci 2024. [PMID: 38637414 DOI: 10.1007/7854_2024_471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Recent integrative multilevel models offer novel insights into the etiology and course of neurodegenerative conditions. The predictive coding of allostatic-interoception theory posits that the brain adapts to environmental demands by modulating internal bodily signals through the allostatic-interoceptive system. Specifically, a domain-general allostatic-interoceptive network exerts adaptive physiological control by fine-tuning initial top-down predictions and bottom-up peripheral signaling. In this context, adequate adaptation implies the minimization of prediction errors thereby optimizing energy expenditure. Abnormalities in top-down interoceptive predictions or peripheral signaling can trigger allostatic overload states, ultimately leading to dysregulated interoceptive and bodily systems (endocrine, immunological, circulatory, etc.). In this context, environmental stress, social determinants of health, and harmful exposomes (i.e., the cumulative life-course exposition to different environmental stressors) may interact with physiological and genetic factors, dysregulating allostatic interoception and precipitating neurodegenerative processes. We review the allostatic-interoceptive overload framework across different neurodegenerative diseases, particularly in the behavioral variant frontotemporal dementia (bvFTD). We describe how concepts of allostasis and interoception could be integrated with principles of predictive coding to explain how the brain optimizes adaptive responses, while maintaining physiological stability through feedback loops with multiple organismic systems. Then, we introduce the model of allostatic-interoceptive overload of bvFTD and discuss its implications for the understanding of pathophysiological and neurocognitive abnormalities in multiple neurodegenerative conditions.
Collapse
Affiliation(s)
- Daniel Franco-O'Byrne
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Hernando Santamaría-García
- Global Brain Health Institute, University of California-San Francisco, San Francisco, CA, USA
- Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Joaquín Migeot
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile.
- Global Brain Health Institute, University of California-San Francisco, San Francisco, CA, USA.
- Trinity College Dublin, Dublin, Ireland.
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina.
- Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland.
| |
Collapse
|
7
|
Bueichekú E, Diez I, Gagliardi G, Kim CM, Mimmack K, Sepulcre J, Vannini P. Multi-modal Neuroimaging Phenotyping of Mnemonic Anosognosia in the Aging Brain. COMMUNICATIONS MEDICINE 2024; 4:65. [PMID: 38580832 PMCID: PMC10997795 DOI: 10.1038/s43856-024-00497-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/28/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Unawareness is a behavioral condition characterized by a lack of self-awareness of objective memory decline. In the context of Alzheimer's Disease (AD), unawareness may develop in predementia stages and contributes to disease severity and progression. Here, we use in-vivo multi-modal neuroimaging to profile the brain phenotype of individuals presenting altered self-awareness of memory during aging. METHODS Amyloid- and tau-PET (N = 335) and resting-state functional MRI (N = 713) imaging data of individuals from the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4)/Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) Study were used in this research. We applied whole-brain voxel-wise and region-of-interest analyses to characterize the cortical intersections of tau, amyloid, and functional connectivity networks underlying unawareness in the aging brain compared to aware, complainer and control groups. RESULTS Individuals with unawareness present elevated amyloid and tau burden in midline core regions of the default mode network compared to aware, complainer or control individuals. Unawareness is characterized by an altered network connectivity pattern featuring hyperconnectivity in the medial anterior prefrontal cortex and posterior occipito-parietal regions co-locating with amyloid and tau deposition. CONCLUSIONS Unawareness is an early behavioral biomarker of AD pathology. Failure of the self-referential system in unawareness of memory decline can be linked to amyloid and tau burden, along with functional network connectivity disruptions, in several medial frontal and parieto-occipital areas of the human brain.
Collapse
Affiliation(s)
- Elisenda Bueichekú
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ibai Diez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Geoffroy Gagliardi
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chan-Mi Kim
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kayden Mimmack
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
- Department of Radiology, Yale PET Center, Yale Medical School, Yale University, New Haven, CT, USA.
| | - Patrizia Vannini
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
8
|
Toller G, Cobigo Y, Callahan P, Appleby BS, Brushaber D, Domoto-Reilly K, Forsberg LK, Ghoshal N, Graff-Radford J, Graff-Radford NR, Grossman M, Heuer HW, Kornak J, Kremers W, Lapid MI, Leger G, Litvan I, Mackenzie IR, Pascual MB, Ramos EM, Rascovsky K, Rojas JC, Staffaroni AM, Tartaglia MC, Toga A, Weintraub S, Wszolek ZK, Boeve BF, Boxer AL, Rosen HJ, Rankin KP. Multisite ALLFTD study modeling progressive empathy loss from the earliest stages of behavioral variant frontotemporal dementia. Alzheimers Dement 2023; 19:2842-2852. [PMID: 36591730 PMCID: PMC10314956 DOI: 10.1002/alz.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/19/2022] [Accepted: 10/27/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Empathy relies on fronto-cingular and temporal networks that are selectively vulnerable in behavioral variant frontotemporal dementia (bvFTD). This study modeled when in the disease process empathy changes begin, and how they progress. METHODS Four hundred thirty-one individuals with asymptomatic genetic FTD (n = 114), genetic and sporadic bvFTD (n = 317), and 163 asymptomatic non-carrier controls were enrolled. In sub-samples, we investigated empathy measured by the informant-based Interpersonal Reactivity Index (IRI) at each disease stage and over time (n = 91), and its correspondence to underlying atrophy (n = 51). RESULTS Empathic concern (estimate = 4.38, 95% confidence interval [CI] = 2.79, 5.97; p < 0.001) and perspective taking (estimate = 5.64, 95% CI = 3.81, 7.48; p < 0.001) scores declined between the asymptomatic and very mild symptomatic stages regardless of pathogenic variant status. More rapid loss of empathy corresponded with subcortical atrophy. DISCUSSION Loss of empathy is an early and progressive symptom of bvFTD that is measurable by IRI informant ratings and can be used to monitor behavior in neuropsychiatry practice and treatment trials.
Collapse
Affiliation(s)
- Gianina Toller
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Yann Cobigo
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Patrick Callahan
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | - Hilary W. Heuer
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - John Kornak
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | | | | | - Gabriel Leger
- University of California, San Diego, San Diego, CA, USA
| | - Irene Litvan
- University of California, San Diego, San Diego, CA, USA
| | - Ian R. Mackenzie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Julio C. Rojas
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Adam M. Staffaroni
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | | | - Arthur Toga
- University of Southern California, Los Angeles, CA, USA
| | - Sandra Weintraub
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Adam L. Boxer
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Howard J. Rosen
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| | - Katherine P. Rankin
- University of California, San Francisco, Memory and Aging Center, Department of Neurology, San Francisco, CA, USA
| |
Collapse
|
9
|
Legaz A, Prado P, Moguilner S, Báez S, Santamaría-García H, Birba A, Barttfeld P, García AM, Fittipaldi S, Ibañez A. Social and non-social working memory in neurodegeneration. Neurobiol Dis 2023; 183:106171. [PMID: 37257663 PMCID: PMC11177282 DOI: 10.1016/j.nbd.2023.106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023] Open
Abstract
Although social functioning relies on working memory, whether a social-specific mechanism exists remains unclear. This undermines the characterization of neurodegenerative conditions with both working memory and social deficits. We assessed working memory domain-specificity across behavioral, electrophysiological, and neuroimaging dimensions in 245 participants. A novel working memory task involving social and non-social stimuli with three load levels was assessed across controls and different neurodegenerative conditions with recognized impairments in: working memory and social cognition (behavioral-variant frontotemporal dementia); general cognition (Alzheimer's disease); and unspecific patterns (Parkinson's disease). We also examined resting-state theta oscillations and functional connectivity correlates of working memory domain-specificity. Results in controls and all groups together evidenced increased working memory demands for social stimuli associated with frontocinguloparietal theta oscillations and salience network connectivity. Canonical frontal theta oscillations and executive-default mode network anticorrelation indexed non-social stimuli. Behavioral-variant frontotemporal dementia presented generalized working memory deficits related to posterior theta oscillations, with social stimuli linked to salience network connectivity. In Alzheimer's disease, generalized working memory impairments were related to temporoparietal theta oscillations, with non-social stimuli linked to the executive network. Parkinson's disease showed spared working memory performance and canonical brain correlates. Findings support a social-specific working memory and related disease-selective pathophysiological mechanisms.
Collapse
Affiliation(s)
- Agustina Legaz
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Universidad Nacional de Córdoba, Facultad de Psicología, Córdoba, Argentina
| | - Pavel Prado
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile; Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Sebastián Moguilner
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, United States; Trinity College Dublin (TCD), Dublin, Ireland
| | | | - Hernando Santamaría-García
- Pontificia Universidad Javeriana, Medical School, Physiology and Psychiatry Departments, Memory and Cognition Center Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Agustina Birba
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina; Facultad de Psicología, Universidad de La Laguna, Tenerife, Spain; Instituto Universitario de Neurociencia, Universidad de La Laguna, Tenerife, Spain
| | - Pablo Barttfeld
- Cognitive Science Group. Instituto de Investigaciones Psicológicas (IIPsi), CONICET UNC, Facultad de Psicología, Universidad Nacional de Córdoba, Boulevard de la Reforma esquina Enfermera Gordillo, CP 5000. Córdoba, Argentina
| | - Adolfo M García
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, United States; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile; Trinity College Dublin (TCD), Dublin, Ireland
| | - Sol Fittipaldi
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, United States; Trinity College Dublin (TCD), Dublin, Ireland.
| | - Agustín Ibañez
- Cognitive Neuroscience Center (CNC), Universidad de San Andres, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, United States; Trinity College Dublin (TCD), Dublin, Ireland.
| |
Collapse
|
10
|
Maggi G, Vitale C, Delle Curti A, Amboni M, Santangelo G. Unawareness of Apathy in Parkinson's Disease: The Role of Executive Dysfunction on Symptom Recognition. Brain Sci 2023; 13:964. [PMID: 37371442 DOI: 10.3390/brainsci13060964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Altered self-awareness or anosognosia may impact patients' everyday life by interfering with their safe and independent functioning. Symptom awareness has been linked to executive dysfunctions caused by damage to frontal regions. Apathy is a frequent neuropsychiatric manifestation of Parkinson's disease (PD) and is considered a consequence of altered functioning of cortico-subcortical circuitries connecting the prefrontal cortex (PFC) with the basal ganglia. Thus, apathetic PD patients may be not be fully aware of their condition due to shared neuropathophysiological mechanisms. The present study aimed to explore the awareness of apathy in PD patients by comparing the self-reported evaluations with their caregivers' ratings. Moreover, we explored the clinical predictors of possible discrepancies and their consequences on patients' self-reported evaluation of quality of life (QoL). We found a fair agreement between patients' self-reports and caregivers' ratings on apathy scores, with patients reporting less severe apathetic symptoms, especially those related to executive and auto-activation processing, compared to their caregivers' reports. Executive functioning was found to mediate the relationship between disease stage and awareness of the apathetic state. Awareness of executive apathy impacted patients' self-reported QoL. Therefore, PD patients might be unaware of their apathetic symptoms, especially those with worse executive functioning, which plays a key role in metacognitive processes such as self-monitoring and error detection. Anosognosia for apathy in PD patients may affect their QoL perception and leads to misleading self-report evaluations that delay diagnosis and treatment.
Collapse
Affiliation(s)
- Gianpaolo Maggi
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Carmine Vitale
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, 80131 Naples, Italy
- Department of Motor Sciences and Wellness, University "Parthenope", 80133 Naples, Italy
| | - Alessia Delle Curti
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| | - Marianna Amboni
- Institute of Diagnosis and Health, IDC-Hermitage Capodimonte, 80131 Naples, Italy
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100 Caserta, Italy
| |
Collapse
|
11
|
Hirakawa Y, Takeda K, Koyama S, Iwai M, Motoya I, Sakurai H, Kanada Y, Kawamura N, Kawamura M, Tanabe S. Effect of the Lee Silverman Voice Treatment BIG® on motor symptoms in a participant with progressive supranuclear palsy: A case report. Physiother Theory Pract 2023:1-8. [PMID: 37326324 DOI: 10.1080/09593985.2023.2225588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although the Lee Silverman Voice Treatment BIG® (LSVT BIG®) improves motor symptoms in patients with Parkinson's Disease, no reports exist for patients with Progressive Supranuclear Palsy (PSP). OBJECTIVE To describe the effect of LSVT BIG® on the motor symptoms of a participant with PSP. CASE DESCRIPTION The participant was a 74-year-old man with PSP. His goals were to improve limb movement, balance ability, and festinating gait over the 4-week LSVT BIG® program. OUTCOMES All assessments of limb movement and balance ability showed improvements after intervention for the limb and gait subsections of the PSP rating scale. Scores improved from 9 to 5, and 8 to 6, respectively for the Unified Parkinson's Disease Rating Scale (UPDRS) Part 3, from 30 to 21 and for the Berg balance scale (BBS), from 45 to 50 points. The improvements in UPDRS Part 3 and BBS exceeded the minimum detectable change values (7-8 and 2 points, respectively). After intervention, improvements in festinating gait and rapid walking pace were noted on the UPDRS Part 3 (2 to 1 point) and 10-meter walk test (1.65 m/s to 1.10 m/s). CONCLUSION The intervention was effective for the participant but further studies with diverse populations are needed.
Collapse
Affiliation(s)
- Yuichi Hirakawa
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Kazuya Takeda
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Soichiro Koyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masanobu Iwai
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Ikuo Motoya
- Department of Rehabilitation, Kawamura Hospital, Gifu, Japan
| | - Hiroaki Sakurai
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | | | - Mami Kawamura
- Department of Neurology, Kawamura Hospital, Gifu, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| |
Collapse
|
12
|
Leocadi M, Canu E, Paldino A, Agosta F, Filippi M. Awareness impairment in Alzheimer's disease and frontotemporal dementia: a systematic MRI review. J Neurol 2023; 270:1880-1907. [PMID: 36512063 DOI: 10.1007/s00415-022-11518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
This review aims to define awareness impairment and related disturbances in neurodegenerative diseases, including Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) spectrum of disorders. An update of the available scientific literature on the use of magnetic resonance imaging (MRI) in the study of awareness in these disorders is also offered. MRI plays an important role in the characterization of neurodegenerative signatures and can increase our knowledge on brain structural and functional correlates of awareness. In the reviewing process, we established a-priori criteria and we searched the scientific literature for relevant articles on this topic. In summary, we selected 36 articles out of 1340 publications retrieved from PubMed. Based on this selection, this review discusses the multiple terms used to define different or overlapping aspects of awareness impairment, and specifically summarizes recent application of MRI for investigating anosognosia, social cognition, including theory of mind and emotional processing, free will, and autonoetic awareness alterations in different neurodegenerative disorders, with most of these studies focused on AD and FTLD. This systematic review highlights the importance of awareness impairment and related domains in neurodegenerative disorders, especially in AD and FTLD, and it outlines MRI structural and functional correlates in these populations.
Collapse
Affiliation(s)
- Michela Leocadi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
| | - Angela Paldino
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy.
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
13
|
Semenkova A, Piguet O, Johnen A, Schroeter ML, Godulla J, Linnemann C, Mühlhauser M, Sauer T, Baumgartner M, Anderl-Straub S, Otto M, Felbecker A, Kressig RW, Berres M, Sollberger M. The Behavioural Dysfunction Questionnaire discriminates behavioural variant frontotemporal dementia from Alzheimer's disease dementia and major depressive disorder. J Neurol 2023:10.1007/s00415-023-11666-6. [PMID: 36952011 DOI: 10.1007/s00415-023-11666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Early-stage behavioural variant frontotemporal dementia (bvFTD) is often misdiagnosed, highlighting the need for new diagnostic instruments. Based on the revised diagnostic criteria for bvFTD, we developed the Behavioural Dysfunction Questionnaire (BDQ). In this explorative study, we aimed to determine the best scoring and analytical method for the BDQ to discriminate between bvFTD and non-bvFTD patients. MATERIALS AND METHODS 34 patients with early-stage bvFTD, 56 with early-stage Alzheimer's disease dementia (ADD) and 41 with major depressive disorder (MDD) were recruited. We calculated BDQ-items with or without inclusion of a time criterion: (a) without time criterion, (b) with 10 years' time criterion (symptom presence less than 10 years), and (c) with 3 years' time criterion (symptom presentation within the first 3 years). Using these three differently calculated items, we generated six variables, i.e. 3*2 [BDQ-Global Score (BDQ-GS; domains average score); BDQ-Global Domain Score (BDQ-GDS; domains categorical score)]. Then, we performed univariate and bivariate (BDQ-GS and BDQ-GDS combined) ROC analyses. RESULTS Models including BDQ-GS, BDQ-GDS or both variables combined discriminated similarly between groups. In contrast, models without time criterion or with 10 years' time criterion discriminated better than models including variables with 3 years' time criterion. These models discriminated highly (AUC = 85.98-87.78) between bvFTD and MDD and bvFTD and ADD, respectively. CONCLUSION BDQ-scores without any time criterion discriminated highly between early-stage bvFTD and non-bvFTD groups, which could improve the early diagnosis of bvFTD. With its standardised procedure, the BDQ is also appropriate for repeated assessments.
Collapse
Affiliation(s)
- Anna Semenkova
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Olivier Piguet
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Andreas Johnen
- Clinic for Neurology, Münster University Hospital, Münster, Germany
| | - Matthias L Schroeter
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jannis Godulla
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | | | - Thomas Sauer
- University Psychiatric Clinic, Basel, Switzerland
| | | | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
- Department of Neurology, University Hospital Halle, Halle, Germany
| | - Ansgar Felbecker
- Clinic of Neurology und Neurophysiology, Canton Hospital St. Gallen, St. Gallen, Switzerland
| | - Reto W Kressig
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Koblenz, Germany
| | - Marc Sollberger
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
14
|
Buchwitz TM, Ruppert-Junck MC, Greuel A, Maier F, Thieken F, Jakobs V, Eggers C. Exploring impaired self-awareness of motor symptoms in Parkinson's disease: Resting-state fMRI correlates and the connection to mindfulness. PLoS One 2023; 18:e0279722. [PMID: 36827321 PMCID: PMC9955618 DOI: 10.1371/journal.pone.0279722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 12/13/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To further explore the phenomenon of impaired self-awareness of motor symptoms in patients with Parkinson's Disease by using an evaluated measurement approach applied in previous studies, while also examining its connection with dispositional mindfulness and possible correlates of functional connectivity. BACKGROUND Recently, the phenomenon of impaired self-awareness has been studied more intensively by applying different measurement and imaging methods. Existing literature also points towards a possible connection with mindfulness, which has not been examined in a cross-sectional study. There is no data available concerning correlates of functional connectivity. METHODS Non-demented patients with idiopathic Parkinson's Disease without severe depression were tested for impaired self-awareness for motor symptoms following a psychometrically evaluated approach. Mindfulness was measured by applying the German version of the Five Facet Mindfulness Questionnaire. A subset of eligible patients underwent functional MRI scanning. Spearman correlation analyses were performed to examine clinical data. Whole-brain voxelwise regressions between seed-based connectivity and behavioral measures were calculated to identify functional connectivity correlates of impaired self-awareness scores. RESULTS A total of 41 patients with Parkinson's Disease were included. 15 patients successfully underwent resting-state fMRI scanning. Up to 88% of patients showed signs of impaired self-awareness. Awareness for hypokinetic movements correlated with total mindfulness values and three facets, while awareness for dyskinetic movements did not. Three significant clusters between scores of impaired self-awareness in general and for dyskinetic movements were identified linking behavioral measures with the functional connectivity of the inferior frontal gyrus, the right insular cortex, the supplementary motor area, and the precentral gyrus among others. Impaired self-awareness for hypokinetic movements did not have any neural correlate. CONCLUSIONS Clinical data is comparable with results from previous studies applying the same structured approach to measure impaired self-awareness in Parkinson's Disease. Functional connectivity analyses were conducted for the first time to evaluate neural correlates thereof. This data does not support a connection between impaired self-awareness of motor symptoms and dispositional mindfulness.
Collapse
Affiliation(s)
| | - Marina Christine Ruppert-Junck
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Center for Mind, Brain, and Behavior (CMBB), Universities Marburg and Gießen, Marburg, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Franziska Thieken
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Viktoria Jakobs
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany
- Center for Mind, Brain, and Behavior (CMBB), Universities Marburg and Gießen, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop GmbH, Bottrop, Germany
| |
Collapse
|
15
|
Gomez-Andres A, Cunillera T, Rico I, Naval-Baudin P, Camins A, Fernandez-Coello A, Gabarrós A, Rodriguez-Fornells A. The role of the anterior insular cortex in self-monitoring: A novel study protocol with electrical stimulation mapping and functional magnetic resonance imaging. Cortex 2022; 157:231-244. [PMID: 36347086 DOI: 10.1016/j.cortex.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
Becoming aware of one's own states is a fundamental aspect for self-monitoring, allowing us to adjust our beliefs of the world to the changing context. Previous evidence points out to the key role of the anterior insular cortex (aIC) in evaluating the consequences of our own actions, especially whenever an error has occurred. In the present study, we propose a new multimodal protocol combining electrical stimulation mapping (ESM) and functional magnetic resonance imaging (fMRI) to explore the functional role of the aIC for self-monitoring in patients undergoing awake brain surgery. Our results using a modified version of the Stroop task tackling metacognitive abilities revealed new direct evidence of the involvement of the aIC in monitoring our performance, showing increased difficulties in detecting action-outcome mismatches when stimulating a cortical site located at the most posterior part of the aIC as well as significant BOLD activations at this region during outcome incongruences for self-made actions. Based on these preliminary results, we highlight the importance of assessing the aIC's functioning during tumor resection involving this region to evaluate metacognitive awareness of the self in patients undergoing awake brain surgery. In a similar vein, a better understanding of the aIC's role during self-monitoring may help shed light on action/outcome processing abnormalities reported in several neuropsychiatric disorders such as schizophrenia, anosognosia for hemiplegia or major depression.
Collapse
Affiliation(s)
- Alba Gomez-Andres
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Toni Cunillera
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences (UBNeuro), University of Barcelona, Barcelona, Spain
| | - Imma Rico
- Hospital Universitari de Bellvitge (HUB), Neurology Section, Campus Bellvitge, University of Barcelona - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Pablo Naval-Baudin
- Institut de Diagnòstic per la Imatge, Centre Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Angels Camins
- Institut de Diagnòstic per la Imatge, Centre Bellvitge, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Alejandro Fernandez-Coello
- Hospital Universitari de Bellvitge (HUB), Neurosurgery Section, Campus Bellvitge, University of Barcelona - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Andreu Gabarrós
- Hospital Universitari de Bellvitge (HUB), Neurosurgery Section, Campus Bellvitge, University of Barcelona - IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain
| | - Antoni Rodriguez-Fornells
- Cognition and Brain Plasticity Group [Bellvitge Biomedical Research Institute-IDIBELL], L'Hospitalet de Llobregat, Barcelona, Spain; Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain; Institute of Neurosciences (UBNeuro), University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, ICREA, Barcelona, Spain.
| |
Collapse
|
16
|
Hengstschläger A, Sommerlad A, Huntley J. What Are the Neural Correlates of Impaired Awareness of Social Cognition and Function in Dementia? A Systematic Review. Brain Sci 2022; 12:1136. [PMID: 36138872 PMCID: PMC9496823 DOI: 10.3390/brainsci12091136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022] Open
Abstract
Deficits in social cognition and function are characteristic of dementia, commonly accompanied by a loss of awareness of the presence or extent of these deficits. This lack of awareness can impair social relationships, increase patients' and carers' burden, and contribute to increased rates of institutionalization. Despite clinical importance, neural correlates of this complex phenomenon remain unclear. We conducted a systematic search of five electronic databases to identify functional and structural neuroimaging studies investigating the neural correlates of impaired awareness of social cognition and function in any dementia type. We rated study quality and conducted a narrative synthesis of the results of the eight studies that met the predefined eligibility criteria. Across these studies, deficits in awareness of impairments in social cognition and function were associated with structural or functional abnormalities in the frontal pole, orbitofrontal cortex, temporal pole, middle temporal gyrus, inferior temporal gyrus, fusiform gyrus, amygdala, hippocampus, parahippocampal gyrus, and insula. Several identified regions overlap with established neural correlates of social cognition. More research is needed to understand awareness of social cognition and function and how this becomes impaired in dementia to improve neuroscientific understanding, aid the identification of this problematic symptom, and target interventions to reduce burden and improve care.
Collapse
Affiliation(s)
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| |
Collapse
|
17
|
Connectivity Alterations in Vascular Parkinsonism: A Structural Covariance Study. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the structural covariance between the striatum and large-scale brain regions in patients with vascular parkinsonism (VP) compared to Parkinson’s disease (PD) and control subjects, and then explore the relationship between brain connectivity and the clinical features of our patients. Forty subjects (13 VP, 15 PD, and 12 age-and-sex-matched healthy controls) were enrolled in this study. They each underwent a careful clinical and neuropsychological evaluation, DAT-SPECT scintigraphy and 3T MRI scan. While there were no differences between PD and VP in the disease duration and severity, nor in terms of the DAT-SPECT evaluations, VP patients had a reduction in structural covariance between the bilateral corpus striatum (both putamen and caudate) and several brain regions, including the insula, thalamus, hippocampus, anterior cingulate cortex and orbito-frontal cortex compared to PD and controls. VP patients also showed lower scores on several neuropsychological tests. Interestingly, in the VP group, structural connectivity alterations were significantly related to cognitive evaluations exploring executive functions, memory, anxiety and depression. This compelling evidence suggests that structural disconnection in the basal ganglia circuits spreading in critical cortical regions may be involved in the pathophysiology of cognitive impairment in VP.
Collapse
|
18
|
Cosentino S, Shih LC. Does essential tremor increase risk of cognitive impairment and dementia? Yes. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:195-231. [PMID: 35750363 DOI: 10.1016/bs.irn.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Essential Tremor (ET), by definition, is a disorder of movement. Yet over the years, epidemiologic, clinical, pathologic, and neuroimaging studies have converged to reveal a cognitive side of ET. The cognitive symptoms in ET are heterogeneous and are likely to reflect heterogeneous underlying mechanisms. In this chapter, we review and synthesize a diverse set of studies from both population-based settings to cohorts with more detailed investigations into cognition to consider the various mechanisms by which cognitive symptoms may emerge in a subset of individuals with ET. As part of our analysis, we consider questions surrounding ET diagnosis and the possibility of comorbid disease as potential factors that, upon closer examination, appear to strengthen the argument in favor of ET as a risk factor for dementia. Importantly, we also consider the clinical relevance of cognitive impairment in ET. While ET is not universally characterized by significant cognitive deficits, the data from epidemiological, cognitive, neuroimaging, and postmortem neuropathologic studies converge to reveal an increased risk for cognitive impairment and dementia among individuals with ET. We conclude by offering directions for future research, and a neurocognitive framework with which to consider existing findings and to use in the design of novel studies dedicated to clarifying the basis, nature, and course of cognitive impairments in ET.
Collapse
Affiliation(s)
- Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, United States; Department of Neurology, Columbia University Irving Medical Center, New York, United States.
| | - Ludy C Shih
- Department of Neurology, Parkinson's Disease and Movement Disorders Center, Boston Medical Center, Boston, Massachusetts, United States; Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States.
| |
Collapse
|
19
|
Yuan L, Guo Y, Wen S, Deng H. Editorial: Genetic and Epigenetic Basis of Neurodegenerative Diseases. Front Aging Neurosci 2022; 14:958847. [PMID: 35847681 PMCID: PMC9279004 DOI: 10.3389/fnagi.2022.958847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lamei Yuan
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
- Center for Experimental Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Disease Genome Research Center, Central South University, Changsha, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yi Guo
- Department of Medical Information, School of Life Sciences, Central South University, Changsha, China
| | - Shu Wen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Hao Deng
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha, China
- Center for Experimental Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Disease Genome Research Center, Central South University, Changsha, China
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Hao Deng
| |
Collapse
|
20
|
Sunderaraman P, Lee S, Varangis E, Habeck C, Chapman S, Joyce JL, Hartstone W, Brickman AM, Stern Y, Cosentino S. Self-awareness for financial decision making abilities is linked to right temporal cortical thickness in older adults. Brain Imaging Behav 2022; 16:1139-1147. [PMID: 34761323 PMCID: PMC9202645 DOI: 10.1007/s11682-021-00590-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
Everyday financial decision making and the awareness of the integrity of one's financial decision making abilities (or financial awareness) are both critical to study in older adults as they can help identify those at risk for making suboptimal financial decisions and prevent financial loss. In the current study, we examined the cognitive and cortical thickness correlates of financial decision making and financial awareness in 59 community-dwelling participants co-enrolled in a larger study (mean age=68.35 years (SD=5.5), mean education=15.91 (SD=2.36), 61% = women, 67% = White, 30% = Black participants). Data from standardized measures of financial decision making and cognition was investigated along with FreeSurfer (v. 5.3) derived thickness regions. Based on metacognitive frameworks, financial awareness was measured along with a well-validated measure of memory awareness. Results revealed that numeracy, executive functioning and vocabulary were associated with financial decision making, whereas in analysis adjusted for financial decision making, memory awareness relative to cognition was most strongly linked to financial awareness. No significant associations between thickness and financial decision making were found. However, both financial and memory awareness were associated with the same right-hemisphere temporal thickness regions underscoring the idea of a common substrate of awareness. Interestingly, our findings converge with the emerging work on financial exploitation in which the right sided temporal regions have been found to play a prominent role. Incorporating the contributing role of self-awareness in various models of financial exploitation will be an important consideration for future studies.
Collapse
Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA.
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Eleanna Varangis
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian Habeck
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Silvia Chapman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jillian L Joyce
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Whitney Hartstone
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Adam M Brickman
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, USA
- Gertrude. H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
21
|
Valotassiou V, Sifakis N, Tzavara C, Lykou E, Tsinia N, Kamtsadeli V, Sali D, Angelidis G, Psimadas D, Theodorou E, Tsougos I, Papageorgiou SG, Georgoulias P, Papatriantafyllou J. Anosognosia in Dementia: Evaluation of Perfusion Correlates Using 99mTc-HMPAO SPECT and Automated Brodmann Areas Analysis. Diagnostics (Basel) 2022; 12:diagnostics12051136. [PMID: 35626292 PMCID: PMC9140080 DOI: 10.3390/diagnostics12051136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Considerable inconsistency exists regarding the neural substrates of anosognosia in dementia in previous neuroimaging studies. The purpose of this study was the evaluation of anosognosia perfusion correlates across various types of dementia using automated Brodmann areas (BAs) analysis and comparison with a database of normal subjects. (2) Methods: We studied 72 patients: 32 with Alzheimer’s disease, 26 with frontotemporal dementia—FTD (12 behavioral FTD, 9 semantic FTD, 5 Progressive Non-Fluent Aphasia), 11 with corticobasal syndrome, and 3 with progressive supranuclear palsy. Addenbrook’s Cognitive Examination—Revised (ACE-R) mean(±SD) was 55.6(±22.8). For anosognosia measurement, the Anosognosia Questionnaire—Dementia was used. Total anosognosia score mean(±SD) was 22.1(±17.9), cognitive anosognosia score mean(±SD) was 18.1(±15.1) and behavioral–mood anosognosia score mean(±SD) was 3.3(±4.7). (3) Results: Higher anosognosia total score was associated with hypoperfusion in the inferior temporal, anterior cingulate, and inferior frontal cortices of the right hemisphere (BAs 20R, 24R, 32R, 45R). Higher anosognosia cognitive score was correlated with hypoperfusion in the left middle and anterior temporal cortices, and right dorsal anterior cingulate cortex (BAs 21L, 22L, 32R). No association was found with behavioral–mood anosognosia. (4) Conclusions: Automated analysis of brain perfusion Single Photon Emission Computed Tomography could be useful for the investigation of anosognosia neural correlates in dementia.
Collapse
Affiliation(s)
- Varvara Valotassiou
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
- Nuclear Medicine Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece
- Correspondence: or ; Tel.: +30-2413502916; Fax: +302413501851
| | - Nikolaos Sifakis
- Nuclear Medicine Department, “Alexandra” General Hospital, 11528 Athens, Greece;
| | - Chara Tzavara
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Evi Lykou
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
| | - Niki Tsinia
- 1st University Psychiatric Department, Aeginition Hospital, 11528 Athens, Greece;
| | - Vasiliki Kamtsadeli
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
| | - Dimitra Sali
- Neurology Department, Evrokliniki, 11521 Athens, Greece;
| | - George Angelidis
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Dimitrios Psimadas
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Eudoxia Theodorou
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
| | - Ioannis Tsougos
- Medical Physics Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece;
| | | | - Panagiotis Georgoulias
- Nuclear Medicine Department, University Hospital of Larissa, 41110 Larissa, Greece; (C.T.); (G.A.); (D.P.); (E.T.); (P.G.)
- Nuclear Medicine Department, Faculty of Medicine, University of Thessaly, Viopolis, 41500 Larissa, Greece
| | - John Papatriantafyllou
- 3rd Age Day Care Center, IASIS, 16562 Athens, Greece; (E.L.); (V.K.); (J.P.)
- Memory Disorders Clinic, Medical Center, 15125 Athens, Greece
| |
Collapse
|
22
|
Lee S, Jia Y, Snitz BE, Chang CCH, Ganguli M. Assessing Social Cognition in Older Adults: A Population-Based Study. Alzheimer Dis Assoc Disord 2022; 36:103-110. [PMID: 35288520 PMCID: PMC9149050 DOI: 10.1097/wad.0000000000000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In a population-based study of mild cognitive impairment (MCI), to validate the assessment of social cognition in older adults. METHODS Cross-sectional study of 902 adults aged 65+ with mean age 76.6 years (SD 8.06). We created a social cognition composite comprising standardized z scores on the Social Norms Questionnaire and the 10-item Reading the Mind in the Eyes Test. We identified associated factors and compared sensitivity, specificity, and the area under the curve of social cognition, for MCI defined as Clinical Dementia Rating (CDR)=0.5, to those of other cognitive domains. We calculated the impact of including social cognition on the proportion neuropsychologically classified as MCI. RESULTS Better social cognition was associated with younger age, female sex, higher education, better general cognition (mini-mental state examination), fewer depressive symptoms, and lower CDR. Adjusting for demographics, associations with mini-mental state examination, depressive symptoms, anxiety symptoms, and subjective cognitive complaints remained significant. The sensitivity and specificity of social cognition for CDR=0.5 were comparable to those of the traditional 5 cognitive domains. Including social cognition as a sixth domain of cognition resulted in a 5% increase in the proportion classified as MCI. CONCLUSIONS Brief objective assessment of social cognition may enhance cognitive assessment of older adults.
Collapse
Affiliation(s)
- Soyoung Lee
- Department of Psychiatry, School of Medicine, University of Maryland
| | - Yichen Jia
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
| | - Beth E. Snitz
- Department of Neurology, School of Medicine, University of Pittsburgh
| | - Chung-Chou H. Chang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh
- Department of Medicine, School of Medicine, University of Pittsburgh
| | - Mary Ganguli
- Department of Neurology, School of Medicine, University of Pittsburgh
- Department of Psychiatry, School of Medicine, University of Pittsburgh
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
| |
Collapse
|
23
|
Toller G, Mandelli ML, Cobigo Y, Rosen HJ, Kramer JH, Miller BL, Gorno-Tempini ML, Rankin KP. Right uncinate fasciculus supports socioemotional sensitivity in health and neurodegenerative disease. Neuroimage Clin 2022; 34:102994. [PMID: 35487131 PMCID: PMC9125782 DOI: 10.1016/j.nicl.2022.102994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/24/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
The uncinate fasciculus (UF) connects fronto-insular and temporal gray matter regions involved in visceral emotional reactivity and semantic appraisal, but the precise role of this tract in socioemotional functioning is not well-understood. Using the Revised-Self Monitoring (RSMS) informant questionnaire, we examined whether fractional anisotropy (FA) in the right UF corresponded to socioemotional sensitivity during face-to-face interactions in 145 individuals (40 healthy older adults [NC], and 105 patients with frontotemporal lobar degeneration [FTLD] syndromes in whom this tract is selectively vulnerable, including 31 behavioral variant frontotemporal dementia [bvFTD], 39 semantic variant primary progressive aphasia [svPPA], and 35 nonfluent variant primary progressive aphasia [nfvPPA]). Voxelwise and region-of-interest-based DWI analyses revealed that FA in the right but not left UF significantly predicted RSMS score in the full sample, and in NC and svPPA subgroups alone. Right UF integrity did not predict RSMS score in the bvFTD group, but gray matter volume in the right orbitofrontal cortex adjacent to the UF was a significant predictor. Our results suggest that better socioemotional sensitivity is specifically supported by right UF white matter, highlighting a key neuro-affective relationship found in both healthy aging and neurologically affected individuals. The finding that poorer socioemotional sensitivity corresponded to right UF damage in svPPA but was more robustly influenced by gray matter atrophy adjacent to the UF in bvFTD may have important implications for endpoint selection in clinical trial design for patients with FTLD.
Collapse
Affiliation(s)
- Gianina Toller
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Maria Luisa Mandelli
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Yann Cobigo
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Howard J Rosen
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Joel H Kramer
- Memory and Aging Center, University of California, San Francisco, United States.
| | - Bruce L Miller
- Memory and Aging Center, University of California, San Francisco, United States.
| | | | - Katherine P Rankin
- Memory and Aging Center, University of California, San Francisco, United States.
| |
Collapse
|
24
|
Valera-Bermejo JM, De Marco M, Venneri A. Altered Interplay Among Large-Scale Brain Functional Networks Modulates Multi-Domain Anosognosia in Early Alzheimer’s Disease. Front Aging Neurosci 2022; 13:781465. [PMID: 35185517 PMCID: PMC8851037 DOI: 10.3389/fnagi.2021.781465] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022] Open
Abstract
Decline in self-awareness is a prevalent symptom in Alzheimer’s disease (AD). Current data suggest that an early breakdown in the brain’s default mode network (DMN) is closely associated with the main symptomatic features in AD patients. In parallel, the integrity of the DMN has been shown to be heavily implicated in retained self-awareness abilities in healthy individuals and AD patients. However, the global contribution to awareness skills of other large-scale networks is still poorly understood. Resting-state functional magnetic resonance imaging (rs-fMRI) scans were acquired and pre-processed from 53 early-stage AD individuals. A group-level independent component analysis was run to isolate and reconstruct four intrinsic connectivity large-scale brain functional networks, namely left and right central executive fronto-parietal networks (FPN), salience network, and anterior and posterior DMN. Hypothesis-driven seed-based connectivity analyses were run to clarify the region-specific underpinnings of multi-domain anosognosia. Multiple regression models were run on large-scale network- and seed-based connectivity maps, including scores of memory, non-memory and total anosognosia obtained via the Measurement of Anosognosia Questionnaire. Memory anosognosia scores were associated with selective lower fronto-temporal connectivity and higher parieto-temporal connectivity. Non-memory anosognosia scores were associated with higher connectivity between the anterior DMN and the cerebellum, between the left medial prefrontal seeds and the contralateral prefrontal cortex, and between the left hippocampal seed and the left insula; lower connectivity was observed between the right prefrontal cortex and the right lingual seed. Lastly, total anosognosia scores were associated with large-scale network alterations, namely reduced left-FPN expression in the left posterior cingulate, reduced right-FPN expression in the left inferior lingual gyrus and adjacent inferior occipital cortex, and increased right-FPN expression in the right anterior cingulate. Seed-based analyses yielded significant connectivity differences only in the connectivity pattern associated with the left hippocampal seed by displaying lower intercommunication with the right prefrontal cortex, but higher connectivity with the left caudate nucleus. These findings support the hypothesis that alterations in functional connectivity of frontal lobe regions involved in executive-related mechanisms represent the neural correlates of domain-specific anosognosia in early AD. Up-regulated connectivity with subcortical structures appears to contribute to changes in the network dynamics interplay and fosters the appearance of anosognosia.
Collapse
Affiliation(s)
| | - Matteo De Marco
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
- *Correspondence: Annalena Venneri,
| |
Collapse
|
25
|
Borghesani V, DeLeon J, Gorno-Tempini ML. Frontotemporal dementia: A unique window on the functional role of the temporal lobes. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:429-448. [PMID: 35964986 PMCID: PMC9793689 DOI: 10.1016/b978-0-12-823493-8.00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Frontotemporal dementia (FTD) is an umbrella term covering a plethora of progressive changes in executive functions, motor abilities, behavior, and/or language. Different clinical syndromes have been described in relation to localized atrophy, informing on the functional networks that underlie these specific cognitive, emotional, and behavioral processes. These functional declines are linked with the underlying neurodegeneration of frontal and/or temporal lobes due to diverse molecular pathologies. Initially, the accumulation of misfolded proteins targets specifically susceptible cell assemblies, leading to relatively focal neurodegeneration that later spreads throughout large-scale cortical networks. Here, we discuss the most recent clinical, neuropathological, imaging, and genetics findings in FTD-spectrum syndromes affecting the temporal lobe. We focus on the semantic variant of primary progressive aphasia and its mirror image, the right temporal variant of FTD. Incipient focal atrophy of the left anterior temporal lobe (ATL) manifests with predominant naming, word comprehension, reading, and object semantic deficits, while cases of predominantly right ATL atrophy present with impairments of socioemotional, nonverbal semantic, and person-specific knowledge. Overall, the observations in FTD allow for crucial clinical-anatomic inferences, shedding light on the role of the temporal lobes in both cognition and complex behaviors. The concerted activity of both ATLs is critical to ensure that percepts are translated into concepts, yet important hemispheric differences should be acknowledged. On one hand, the left ATL attributes meaning to linguistic, external stimuli, thus supporting goal-oriented, action-related behaviors (e.g., integrating sounds and letters into words). On the other hand, the right ATL assigns meaning to emotional, visceral stimuli, thus guiding socially relevant behaviors (e.g., integrating body sensations into feelings of familiarity).
Collapse
Affiliation(s)
- Valentina Borghesani
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada; Department of Psychology, Université de Montréal, Montréal, QC, Canada.
| | - Jessica DeLeon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States; Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, United States
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States; Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, United States
| |
Collapse
|
26
|
Buchwitz TM, Maier F, Greuel A, Thieken F, Steidel K, Jakobs V, Eggers C. Pilot Study of Mindfulness Training on the Self-Awareness of Motor Symptoms in Parkinson's Disease - A Randomized Controlled Trial. Front Psychol 2021; 12:763350. [PMID: 34916997 PMCID: PMC8670006 DOI: 10.3389/fpsyg.2021.763350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aims to evaluate feasibility and effects of a newly developed mindfulness intervention tailored to specific needs of patients with Parkinson’s disease (PD). Background: The phenomenon of impaired self-awareness of motor symptoms (ISAm) in PD might be reduced by increasing patients’ mindfulness. A PD-specific mindfulness intervention has been developed and evaluated as a potential treatment option: IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”). Methods: IPSUM’s effectiveness is evaluated by comparing an intervention with a waitlist-control group. Applying a pre-post design, patients were assessed before, directly after and 8weeks after treatment. The primary outcome was the change in a quantitative ISAm score from baseline to post-assessment. Secondary outcome measures were PD-related affective changes and neuropsychological test performance. Feasibility was evaluated via feedback forms. Results: In total, 30 non-depressed and non-demented PD patients were included (intervention: n=14, waitlist-control: n=16). ISAm score did not change significantly, but the training group showed greater performance in sustained attention and language tasks over time. Additional changes included greater mindfulness as well as less sleeping problems and anxiety. Cognitive disturbances, apathy, and sleeping problems worsened only in the waitlist-control group. Patients’ feedback regarding the training concept and material was excellent. Conclusion: Insight into Parkinson’s Disease Symptoms by using Mindfulness has not been capable of reducing ISAm in PD patients but appears to be a feasible and effective concept to, among others, support mental health in the mid-term. It has to be noted though that the study was stopped beforehand because of the SARS CoV-2 pandemic. The lack of findings might therefore be caused by a lack of statistical power. The need for further research to better understand the mechanisms of ISAm and its connection to mindfulness in PD is highlighted.
Collapse
Affiliation(s)
| | - Franziska Maier
- Department of Psychiatry, Medical Faculty, University Hospital Cologne, Cologne, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Franziska Thieken
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Kenan Steidel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Viktoria Jakobs
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Universities Marburg and Gießen, Marburg, Germany
| |
Collapse
|
27
|
Hubená P, Horký P, Slavík O. Fish self-awareness: limits of current knowledge and theoretical expectations. Anim Cogn 2021; 25:447-461. [PMID: 34655023 DOI: 10.1007/s10071-021-01566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
Animal self-awareness is divided into three levels: bodily, social, and introspective self-awareness. Research has focused mainly on the introspection of so-called higher organisms such as mammals. Herein, we turn our attention to fish and provide opinions on their self-awareness based on a review of the scientific literature. Our specific aims are to discuss whether fish (A) could have a neural substrate supporting self-awareness and whether they display signs of (B) social and (C) introspective self-awareness. The present knowledge does not exclude the possibility that fish could have a simple neocortex or other structures that support certain higher cognitive processes, as the function of the primate cerebral cortex can be replaced by other neurological structures. Fish are known to display winner, loser, and audience effects, which could be interpreted as signs of social self-awareness. The audience effect may be explained not only by ethological cost and benefit theory but also by the concept of public self-awareness, which comes from human studies. The behavioural and neural manifestations of depression may be induced in fish under social subordination and may be viewed as certain awareness of a social status. The current findings on fish introspective self-awareness have been debated in the scientific community and, therefore, demand replication to provide more evidence. Further research is needed to verify the outlined ideas; however, the current knowledge indicates that fish are capable of certain higher cognitive processes, which raises questions and implications regarding ethics and welfare in fish-related research and husbandry.
Collapse
Affiliation(s)
- Pavla Hubená
- Department of Zoology and Fisheries, Czech University of Life Sciences Prague, Kamýcká 129, Prague 6, 165 00, Suchdol, Czech Republic.
| | - Pavel Horký
- Department of Zoology and Fisheries, Czech University of Life Sciences Prague, Kamýcká 129, Prague 6, 165 00, Suchdol, Czech Republic
| | - Ondřej Slavík
- Department of Zoology and Fisheries, Czech University of Life Sciences Prague, Kamýcká 129, Prague 6, 165 00, Suchdol, Czech Republic
| |
Collapse
|
28
|
Le C, Finger E. Pharmacotherapy for Neuropsychiatric Symptoms in Frontotemporal Dementia. CNS Drugs 2021; 35:1081-1096. [PMID: 34426949 DOI: 10.1007/s40263-021-00854-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Despite significant progress in the understanding of the frontotemporal dementias (FTDs), there remains no disease-modifying treatment for these conditions, and limited effective symptomatic treatment. Behavioural variant frontotemporal dementia (bvFTD) is the most common FTD syndrome, and is characterized by severe impairments in behaviour, personality and cognition. Neuropsychiatric symptoms are common features of bvFTD but are present in the other FTD syndromes. Current treatment strategies therefore focus on ameliorating the neuropsychiatric features. Here we review the rationale for current treatments related to each of the main neuropsychiatric symptoms forming the diagnostic criteria for bvFTD relevant to all FTD subtypes, and two additional symptoms not currently part of the diagnostic criteria: lack of insight and psychosis. Given the paucity of effective treatments for these symptoms, we highlight how contributing mechanisms delineated in cognitive neuroscience may inform future approaches to clinical trials and more precise symptomatic treatments for FTDs.
Collapse
Affiliation(s)
- Christine Le
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
29
|
van der Stelt CM, Fama ME, Mccall JD, Snider SF, Turkeltaub PE. Intellectual awareness of naming abilities in people with chronic post-stroke aphasia. Neuropsychologia 2021; 160:107961. [PMID: 34274379 PMCID: PMC8405585 DOI: 10.1016/j.neuropsychologia.2021.107961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/02/2021] [Accepted: 07/13/2021] [Indexed: 11/21/2022]
Abstract
Anosognosia, or lack of self-awareness, is often present following neurological injury and can result in poor functional outcomes. The specific phenomenon of intellectual awareness, the knowledge that a function is impaired in oneself, has not been widely studied in post-stroke aphasia. We aim to identify behavioral and neural correlates of intellectual awareness by comparing stroke survivors' self-reports of anomia to objective naming performance and examining lesion sites. Fifty-three participants with chronic aphasia without severe comprehension deficits rated their naming ability and completed a battery of behavioral tests. We calculated the reliability and accuracy of participant self-ratings, then examined the relationship of poor intellectual awareness to speech, language, and cognitive measures. We used support vector regression lesion-symptom mapping (SVR-LSM) to determine lesion locations associated with impaired and preserved intellectual awareness. Reliability and accuracy of self-ratings varied across the participants. Poor intellectual awareness was associated with reduced performance on tasks that rely on semantics. Our SVR-LSM results demonstrated that anterior inferior frontal lesions were associated with poor awareness, while mid-superior temporal lesions were associated with preserved awareness. An anterior-posterior gradient was evident in the unthresholded lesion-symptom maps. While many people with chronic aphasia and relatively intact comprehension can accurately and reliably report the severity of their anomia, others overestimate, underestimate, or inconsistently estimate their naming abilities. Clinicians should consider this when administering self-rating scales, particularly when semantic deficits or anterior inferior frontal lesions are present. Administering self-ratings on multiple days may be useful to check the reliability of patient perceptions.
Collapse
Affiliation(s)
- Candace M van der Stelt
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA; Research Division, MedStar National Rehabilitation Hospital, USA
| | - Mackenzie E Fama
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA; Department of Speech, Language and Hearing Sciences, George Washington University, USA
| | - Joshua D Mccall
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA
| | - Sarah F Snider
- Department of Neurology, Georgetown University Medical Center, USA
| | - Peter E Turkeltaub
- Center for Brain Plasticity and Recovery, Georgetown University Medical Center, USA; Department of Neurology, Georgetown University Medical Center, USA; Research Division, MedStar National Rehabilitation Hospital, USA.
| |
Collapse
|
30
|
Legaz A, Abrevaya S, Dottori M, Campo CG, Birba A, Caro MM, Aguirre J, Slachevsky A, Aranguiz R, Serrano C, Gillan CM, Leroi I, García AM, Fittipaldi S, Ibañez A. Multimodal mechanisms of human socially reinforced learning across neurodegenerative diseases. Brain 2021; 145:1052-1068. [PMID: 34529034 PMCID: PMC9128375 DOI: 10.1093/brain/awab345] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Social feedback can selectively enhance learning in diverse domains. Relevant
neurocognitive mechanisms have been studied mainly in healthy persons, yielding
correlational findings. Neurodegenerative lesion models, coupled with multimodal
brain measures, can complement standard approaches by revealing direct
multidimensional correlates of the phenomenon. To this end, we assessed socially reinforced and non-socially reinforced learning
in 40 healthy participants as well as persons with behavioural variant
frontotemporal dementia (n = 21), Parkinson’s
disease (n = 31) and Alzheimer’s disease
(n = 20). These conditions are typified by
predominant deficits in social cognition, feedback-based learning and
associative learning, respectively, although all three domains may be partly
compromised in the other conditions. We combined a validated behavioural task
with ongoing EEG signatures of implicit learning (medial frontal negativity) and
offline MRI measures (voxel-based morphometry). In healthy participants, learning was facilitated by social feedback relative to
non-social feedback. In comparison with controls, this effect was specifically
impaired in behavioural variant frontotemporal dementia and Parkinson’s
disease, while unspecific learning deficits (across social and non-social
conditions) were observed in Alzheimer’s disease. EEG results showed
increased medial frontal negativity in healthy controls during social feedback
and learning. Such a modulation was selectively disrupted in behavioural variant
frontotemporal dementia. Neuroanatomical results revealed extended
temporo-parietal and fronto-limbic correlates of socially reinforced learning,
with specific temporo-parietal associations in behavioural variant
frontotemporal dementia and predominantly fronto-limbic regions in
Alzheimer’s disease. In contrast, non-socially reinforced learning was
consistently linked to medial temporal/hippocampal regions. No associations with
cortical volume were found in Parkinson’s disease. Results are consistent
with core social deficits in behavioural variant frontotemporal dementia, subtle
disruptions in ongoing feedback-mechanisms and social processes in
Parkinson’s disease and generalized learning alterations in
Alzheimer’s disease. This multimodal approach highlights the impact of
different neurodegenerative profiles on learning and social feedback. Our findings inform a promising theoretical and clinical agenda in the fields of
social learning, socially reinforced learning and neurodegeneration.
Collapse
Affiliation(s)
- Agustina Legaz
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina.,Universidad Nacional de Córdoba. Facultad de Psicología, Córdoba, CU320, Argentina
| | - Sofía Abrevaya
- National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina.,Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, CONICET, Buenos Aires, C1021, Argentina
| | - Martín Dottori
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina
| | - Cecilia González Campo
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina
| | - Agustina Birba
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina
| | - Miguel Martorell Caro
- National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina.,Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, CONICET, Buenos Aires, C1021, Argentina
| | - Julieta Aguirre
- Instituto de Investigaciones Psicológicas (IIPsi), CONICET, Universidad Nacional de Córdoba, Córdoba, CB5000, Argentina
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital delSalvador, SSMO & Faculty of Medicine, University of Chile, Santiago, Chile.,Gerosciences Center for Brain Health and Metabolism, Santiago, Chile.,Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Department, ICBM, Neurosciences Department, Faculty of Medicine, University of Chile, Chile.,Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Chile
| | | | - Cecilia Serrano
- Neurología Cognitiva, Hospital Cesar Milstein, Buenos Aires, C1221, Argentina
| | - Claire M Gillan
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA 94158, USA.,Department of Psychology, Trinity College Dublin, Dublin, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Iracema Leroi
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA 94158, USA
| | - Adolfo M García
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina.,Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA 94158, USA.,Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Dublin 2, Ireland.,Faculty of Education, National University of Cuyo, Mendoza, M5502JMA, Argentina.,Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Sol Fittipaldi
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina.,Universidad Nacional de Córdoba. Facultad de Psicología, Córdoba, CU320, Argentina
| | - Agustín Ibañez
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, C1011ACC, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, C1425FQB, Argentina.,Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA 94158, USA.,Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| |
Collapse
|
31
|
Bonaz B, Lane RD, Oshinsky ML, Kenny PJ, Sinha R, Mayer EA, Critchley HD. Diseases, Disorders, and Comorbidities of Interoception. Trends Neurosci 2021; 44:39-51. [PMID: 33378656 DOI: 10.1016/j.tins.2020.09.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
Interoception, the sense of the body's internal physiological state, underpins homeostatic reflexes, motivational states, and sensations contributing to emotional experiences. The continuous nature of interoceptive processing, coupled to behavior, is implicated in the neurobiological construction of the sense of self. Aberrant integration and control of interoceptive signals, originating in the brain and/or the periphery, can perturb the whole system. Interoceptive abnormalities are implicated in the pathophysiology of psychiatric disorders and in the symptomatic expression of developmental, neurodegenerative, and neurological disorders. Moreover, interoceptive mechanisms appear central to somatic disorders of brain-body interactions, including functional digestive disorders, chronic pain, and comorbid conditions. The present article provides an overview of disorders of interoception and suggests future directions for better understanding, diagnosis, and management of these disorders.
Collapse
Affiliation(s)
- Bruno Bonaz
- Université Grenoble Alpes, Inserm, U1216, Grenoble Institute Neurosciences and Division of Hepato-Gastroenterology, CHU Grenoble Alpes, 38000 Grenoble, France.
| | - Richard D Lane
- Department of Psychiatry, University of Arizona, Tucson, AZ 85724-5002, USA; Department of Psychology, University of Arizona, Tucson, AZ 85724-5002, USA; Department of Neuroscience, University of Arizona, Tucson, AZ 85724-5002, USA
| | - Michael L Oshinsky
- National Institute of Neurological Disorders and Stroke/National Institutes of Health, Bethesda, MD 20894, USA
| | - Paul J Kenny
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rajita Sinha
- Yale Stress Center, Yale School of Medicine, New Haven, CT, 06519, USA
| | - Emeran A Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, UK
| |
Collapse
|
32
|
Rijpma MG, Shdo SM, Shany-Ur T, Toller G, Kramer JH, Miller BL, Rankin KP. Salience driven attention is pivotal to understanding others' intentions. Cogn Neuropsychol 2021; 38:88-106. [PMID: 33522407 DOI: 10.1080/02643294.2020.1868984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Interpreting others' beliefs, desires and intentions is known as "theory of mind" (ToM), and is often evaluated using simplified measurement tools, which may not correctly reflect the brain circuits that are required for real-life ToM functioning. We aimed to identify the brain structures necessary to correctly infer intentions from realistic scenarios by administering The Awareness of Social Inference Test, Enriched subtest to 47 patients with behavioural variant frontotemporal dementia, 24 patients with progressive supranuclear palsy syndrome, 31 patients with Alzheimer's syndrome, and 77 older healthy controls. Neuroimaging data was analyzed using voxel based morphometry, and participants' understanding of intentions was correlated with voxel-wise and region-of interest data. We found that structural integrity of the cinguloinsular cortex in the salience network (SN) was more pivotal for accurate ToM than previously described, emphasizing the importance of the SN for selectively recognizing and attending to social cues during ToM inferences.
Collapse
Affiliation(s)
- Myrthe G Rijpma
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Tal Shany-Ur
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Gianina Toller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| |
Collapse
|
33
|
Ranasinghe KG, Toller G, Cobigo Y, Chiang K, Callahan P, Eliazer C, Kramer JH, Rosen HJ, Miller BL, Rankin KP. Computationally derived anatomic subtypes of behavioral variant frontotemporal dementia show temporal stability and divergent patterns of longitudinal atrophy. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12183. [PMID: 34268446 PMCID: PMC8274310 DOI: 10.1002/dad2.12183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/15/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Behavioral variant frontotemporal dementia (bvFTD) can be computationally divided into four distinct anatomic subtypes based on patterns of frontotemporal and subcortical atrophy. To more precisely predict disease trajectories of individual patients, the temporal stability of each subtype must be characterized. METHODS We investigated the longitudinal stability of the four previously identified anatomic subtypes in 72 bvFTD patients. We also applied a voxel-wise mixed effects model to examine subtype differences in atrophy patterns across multiple timepoints. RESULTS Our results demonstrate the stability of the anatomic subtypes at baseline and over time. While they had common salience network atrophy, each subtype showed distinctive baseline and longitudinal atrophy patterns. DISCUSSION Recognizing these anatomically heterogeneous subtypes and their different patterns of atrophy progression in early bvFTD will improve disease course prediction in individual patients. Longitudinal volumetric predictions based on these anatomic subtypes may be used as a more accurate endpoint in treatment trials.
Collapse
Affiliation(s)
- Kamalini G. Ranasinghe
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Gianina Toller
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Yann Cobigo
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Kevin Chiang
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Patrick Callahan
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Caleb Eliazer
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Joel H. Kramer
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Howard J. Rosen
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Katherine P. Rankin
- Department of NeurologyMemory and Aging CenterUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| |
Collapse
|
34
|
Neuroanatomical correlates of self-awareness of highly practiced visuomotor skills. Brain Struct Funct 2021; 226:2295-2306. [PMID: 34228220 DOI: 10.1007/s00429-021-02328-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 06/22/2021] [Indexed: 12/27/2022]
Abstract
Metacognition is the ability to introspect and control ongoing cognitive processes. Despite the extensive investigation of the brain architectures supporting metacognition for perception and memory, little is known about the neural basis of metacognitive capacity for motor function, a vital aspect of human behavior. Here, using functional and structural magnetic resonance imaging (MRI), we examined the brain substrates underlying self-awareness of handwriting, a highly practiced visuomotor skill. Results showed that experienced adult writers generally overestimated their handwriting quality, and such overestimation was more pronounced in men relative to women. Individual variations in self-awareness of handwriting quality were positively correlated with gray matter volume in the left fusiform gyrus, right middle frontal gyrus and right precuneus. The left fusiform gyrus and right middle frontal gyrus are thought to represent domain-specific brain mechanisms for handwriting self-awareness, while the right precuneus that has been reported in other domains likely represents a domain-general brain mechanism for metacognition. Furthermore, the activity of these structurally related regions in a handwriting task was not correlated with self-awareness of handwriting, suggesting the correlation with metacognition was independent of task performance. Together, this study reveals that metacognition for practiced motor skills relies on both domain-general and domain-specific brain systems, extending our understanding about the neural basis of human metacognition.
Collapse
|
35
|
Salamone PC, Legaz A, Sedeño L, Moguilner S, Fraile-Vazquez M, Campo CG, Fittipaldi S, Yoris A, Miranda M, Birba A, Galiani A, Abrevaya S, Neely A, Caro MM, Alifano F, Villagra R, Anunziata F, Okada de Oliveira M, Pautassi RM, Slachevsky A, Serrano C, García AM, Ibañez A. Interoception Primes Emotional Processing: Multimodal Evidence from Neurodegeneration. J Neurosci 2021; 41:4276-4292. [PMID: 33827935 PMCID: PMC8143206 DOI: 10.1523/jneurosci.2578-20.2021] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 12/15/2022] Open
Abstract
Recent frameworks in cognitive neuroscience and behavioral neurology underscore interoceptive priors as core modulators of negative emotions. However, the field lacks experimental designs manipulating the priming of emotions via interoception and exploring their multimodal signatures in neurodegenerative models. Here, we designed a novel task that involves interoceptive and control-exteroceptive priming conditions followed by post-interoception and post-exteroception facial emotion recognition (FER). We recruited 114 participants, including healthy controls (HCs) as well as patients with behavioral variant frontotemporal dementia (bvFTD), Parkinson's disease (PD), and Alzheimer's disease (AD). We measured online EEG modulations of the heart-evoked potential (HEP), and associations with both brain structural and resting-state functional connectivity patterns. Behaviorally, post-interoception negative FER was enhanced in HCs but selectively disrupted in bvFTD and PD, with AD presenting generalized disruptions across emotion types. Only bvFTD presented impaired interoceptive accuracy. Increased HEP modulations during post-interoception negative FER was observed in HCs and AD, but not in bvFTD or PD patients. Across all groups, post-interoception negative FER correlated with the volume of the insula and the ACC. Also, negative FER was associated with functional connectivity along the (a) salience network in the post-interoception condition, and along the (b) executive network in the post-exteroception condition. These patterns were selectively disrupted in bvFTD (a) and PD (b), respectively. Our approach underscores the multidimensional impact of interoception on emotion, while revealing a specific pathophysiological marker of bvFTD. These findings inform a promising theoretical and clinical agenda in the fields of nteroception, emotion, allostasis, and neurodegeneration.SIGNIFICANCE STATEMENT We examined whether and how emotions are primed by interoceptive states combining multimodal measures in healthy controls and neurodegenerative models. In controls, negative emotion recognition and ongoing HEP modulations were increased after interoception. These patterns were selectively disrupted in patients with atrophy across key interoceptive-emotional regions (e.g., the insula and the cingulate in frontotemporal dementia, frontostriatal networks in Parkinson's disease), whereas persons with Alzheimer's disease presented generalized emotional processing abnormalities with preserved interoceptive mechanisms. The integration of both domains was associated with the volume and connectivity (salience network) of canonical interoceptive-emotional hubs, critically involving the insula and the anterior cingulate. Our study reveals multimodal markers of interoceptive-emotional priming, laying the groundwork for new agendas in cognitive neuroscience and behavioral neurology.
Collapse
Affiliation(s)
- Paula C Salamone
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Agustina Legaz
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Lucas Sedeño
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Sebastián Moguilner
- Global Brain Health Institute, University of California-San Francisco, San Francisco, California, and Trinity College Dublin, Dublin, Ireland
- Nuclear Medicine School Foundation, National Commission of Atomic Energy, Mendoza, Argentina
| | | | - Cecilia Gonzalez Campo
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Sol Fittipaldi
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Adrián Yoris
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Magdalena Miranda
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Agustina Birba
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Agostina Galiani
- Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Sofía Abrevaya
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Alejandra Neely
- Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| | - Miguel Martorell Caro
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Florencia Alifano
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, INECO Foundation, Favaloro University, CONICET, Buenos Aires, Argentina
| | - Roque Villagra
- Memory and Neuropsychiatric Clinic, Neurology Department, Hospital del Salvador, SSMO & Faculty of Medicine, University of Chile, Santiago, Chile
| | - Florencia Anunziata
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación Médica M. y M. Ferreyra, INIMEC-CONICET-UNC, Córdoba, Argentina
| | - Maira Okada de Oliveira
- Global Brain Health Institute, University of California-San Francisco, San Francisco, California, and Trinity College Dublin, Dublin, Ireland
- Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP Brazil
- Department of Neurology, Hospital Santa Marcelina, Sao Paulo, SP Brazil
| | - Ricardo M Pautassi
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Facultad de Psicología, Universidad Nacional de Córdoba, Córdoba, Argentina
- Instituto de Investigación Médica M. y M. Ferreyra, INIMEC-CONICET-UNC, Córdoba, Argentina
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic, Neurology Department, Hospital del Salvador, SSMO & Faculty of Medicine, University of Chile, Santiago, Chile
- Gerosciences Center for Brain Health and Metabolism, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Department, ICBM, Neurosciences Department, Faculty of Medicine, University of Chile, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Cecilia Serrano
- Neurología Cognitiva, Hospital Cesar Milstein, Buenos Aires, Argentina
| | - Adolfo M García
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California-San Francisco, San Francisco, California, and Trinity College Dublin, Dublin, Ireland
- Faculty of Education, National University of Cuyo, Mendoza, M5502JMA, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Agustín Ibañez
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Global Brain Health Institute, University of California-San Francisco, San Francisco, California, and Trinity College Dublin, Dublin, Ireland
- Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
| |
Collapse
|
36
|
Bertrand E, van Duinkerken E, Laks J, Dourado MCN, Bernardes G, Landeira-Fernandez J, Mograbi DC. Structural Gray and White Matter Correlates of Awareness in Alzheimer's Disease. J Alzheimers Dis 2021; 81:1321-1330. [PMID: 33935073 DOI: 10.3233/jad-201246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Unawareness of disease is a common feature of Alzheimer's disease (AD), but few studies explored its neural correlates. Additionally, neural correlates according to the object of awareness are unexplored. OBJECTIVE To investigate structural brain correlates in relation to different objects of awareness. METHODS 27 people with AD underwent MRI scanning on a 3T Siemens Prisma. T1-MPRAGE was used to investigate cortical thickness and white matter microstructure was defined by DTI as fractional anisotropy, mean, axial, and radial diffusivity. Preprocessing used FreeSurfer6.0, ExploreDTI, and FSL-TBSS. Awareness of disease, cognitive deficits, emotional state, relationships, and functional capacity were assessed with the short version of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia. Voxel-wise correlations between brain structure and awareness were determined by FSL-PALM. Analyses were corrected for multiple comparisons using Threshold Free Cluster Enhancement and FWE. RESULTS Lower left hemisphere cortical thickness was related to poorer disease awareness uncorrected and corrected for age, sex, and MMSE. In the uncorrected model, mainly right-sided, but also left temporal lower cortical thickness was related to decreased awareness of cognitive deficits. Correcting for age, sex, and MMSE eliminated correlations for the right hemisphere, but extensive correlations in the left hemisphere remained. For white matter integrity, higher right hemisphere MD was related to lower cognitive awareness deficits, and lower FA was related to lower functional capacity awareness. CONCLUSION Findings suggest that extensive regions of the brain are linked to self-awareness, with particular frontal and temporal alterations leading to unawareness, in agreement with theoretical models indicating executive and mnemonic forms of anosognosia in AD.
Collapse
Affiliation(s)
- Elodie Bertrand
- MC2Lab (URP 7536), Institut de Psychologie, Université de Paris, Paris, France.,Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil
| | - Eelco van Duinkerken
- Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.,Center for Epilepsy, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.,Postgraduate Program in Neurology, Hospital Universitário Gaffrée e Guinle -UNIRIO, Rio de Janeiro, Brazil
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Psychology, Universidade do Grande Rio (Unigranrio), Duque de Caxias, Brazil
| | | | - Gabriel Bernardes
- Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil
| | - Jesus Landeira-Fernandez
- Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil
| | - Daniel C Mograbi
- Department of Psychology, Pontifícia Universidade Católica-Rio (PUC-Rio), Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
37
|
Fathy YY, Hoogers SE, Berendse HW, van der Werf YD, Visser PJ, de Jong FJ, van de Berg WDJ. Differential insular cortex sub-regional atrophy in neurodegenerative diseases: a systematic review and meta-analysis. Brain Imaging Behav 2021; 14:2799-2816. [PMID: 31011951 PMCID: PMC7648006 DOI: 10.1007/s11682-019-00099-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The insular cortex is proposed to function as a central brain hub characterized by wide-spread connections and diverse functional roles. As a result, its centrality in the brain confers high metabolic demands predisposing it to dysfunction in disease. However, the functional profile and vulnerability to degeneration varies across the insular sub-regions. The aim of this systematic review and meta-analysis is to summarize and quantitatively analyze the relationship between insular cortex sub-regional atrophy, studied by voxel based morphometry, with cognitive and neuropsychiatric deficits in frontotemporal dementia (FTD), Alzheimer’s disease (AD), Parkinson’s disease (PD), and dementia with Lewy bodies (DLB). We systematically searched through Pubmed and Embase and identified 519 studies that fit our criteria. A total of 41 studies (n = 2261 subjects) fulfilled the inclusion criteria for the meta-analysis. The peak insular coordinates were pooled and analyzed using Anatomic Likelihood Estimation. Our results showed greater left anterior insular cortex atrophy in FTD whereas the right anterior dorsal insular cortex showed larger clusters of atrophy in AD and PD/DLB. Yet contrast analyses did not reveal significant differences between disease groups. Functional analysis showed that left anterior insular cortex atrophy is associated with speech, emotion, and affective-cognitive deficits, and right dorsal atrophy with perception and cognitive deficits. In conclusion, insular sub-regional atrophy, particularly the anterior dorsal region, may contribute to cognitive and neuropsychiatric deficits in neurodegeneration. Our results support anterior insular cortex vulnerability and convey the differential involvement of the insular sub-regions in functional deficits in neurodegenerative diseases.
Collapse
Affiliation(s)
- Yasmine Y Fathy
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ, Amsterdam, Netherlands.
| | - Susanne E Hoogers
- Department of Neurology, Erasmus Medical Center, Postbus, 2040 3000, Rotterdam, CA, Netherlands
| | - Henk W Berendse
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Ysbrand D van der Werf
- Department of Anatomy and Neurosciences, Section Neuropsychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands
| | - Pieter J Visser
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Frank J de Jong
- Department of Neurology, Erasmus Medical Center, Postbus, 2040 3000, Rotterdam, CA, Netherlands
| | - Wilma D J van de Berg
- Department of Anatomy and Neurosciences, Section Clinical Neuroanatomy and Biobanking, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, De Boelelaan 1108, 1081 HZ, Amsterdam, Netherlands
| |
Collapse
|
38
|
Garcia-Cordero I, Migeot J, Fittipaldi S, Aquino A, Campo CG, García A, Ibáñez A. Metacognition of emotion recognition across neurodegenerative diseases. Cortex 2021; 137:93-107. [PMID: 33609899 DOI: 10.1016/j.cortex.2020.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/18/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Metacognition (monitoring) of emotion recognition is fundamental for social interactions. Correct recognition of and confidence in the emotional meaning inferred from others' faces are fundamental for guiding and adjusting interpersonal behavior. Yet, although emotion recognition impairments are well documented across neurodegenerative diseases, the role of metacognition in this domain remains poorly understood. Here, we evaluate multimodal neurocognitive markers of metacognition in 83 subjects, encompassing patients with behavioral variant frontotemporal dementia [bvFTD, n = 18], Alzheimer's disease [AD, n = 27], and demographically-matched controls (n = 38). Participants performed a classical facial emotion recognition task and, after each trial, they rated their confidence in their performance. We examined two measures of metacognition: (i) calibration: how well confidence tracks accuracy; and (ii) a metacognitive index (MI) capturing the magnitude of the difference between confidence and accuracy. Then, whole-brain grey matter volume and fMRI-derived resting-state functional connectivity were analyzed to track associations with metacognition. Results showed that metacognition deficits were linked to basic emotion recognition. Metacognition of negative emotions was compromised in patients, especially disgust in bvFTD as well as sadness in AD. Metacognition impairments were associated with reduced volume of fronto-temporo-insular and subcortical areas in bvFTD and fronto-parietal regions in AD. Metacognition deficits were associated with disconnection of large-scale fronto-posterior networks for both groups. This study reveals a link between emotion recognition and metacognition in neurodegenerative diseases. The characterization of metacognitive impairments in bvFTD and AD would be relevant for understanding patients' daily life changes in social behavior.
Collapse
Affiliation(s)
- Indira Garcia-Cordero
- Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Joaquín Migeot
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Sol Fittipaldi
- Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | | | - Cecilia Gonzalez Campo
- Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Adolfo García
- Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Faculty of Education, National University of Cuyo, Mendoza, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile; Global Brain Health Institute, University of California, San Francisco, USA
| | - Agustín Ibáñez
- Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Chile; Global Brain Health Institute, University of California, San Francisco, USA.
| |
Collapse
|
39
|
Pennington C, Duncan G, Ritchie C. Altered awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies: A systematic review. Int J Geriatr Psychiatry 2021; 36:15-30. [PMID: 32869379 DOI: 10.1002/gps.5415] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 08/09/2020] [Accepted: 08/14/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Altered awareness of cognitive and neuropsychiatric symptoms is a common feature of neurodegeneration, which can significantly impact on quality of life, medication concordance and personal safety. Elucidating how awareness is affected by common alpha-synucleinopathies therefore has significant clinical relevance. We performed a systematic review of the literature on awareness of cognitive and neuropsychiatric symptoms in Parkinson's disease and Dementia with Lewy Bodies. METHODS Searches of PubMed and Web of Science were carried out, using keywords and MeSH subheadings, limited to papers in English dealing with humans. The terms "Parkinson's" or "Lewy body" were used to denote the disease of interest, combined with either "agnosia", "anosognosia", "insight", "metacognition", or "neuropsychology" to denote the neuropsychological area of interest. RESULTS 21 publications investigating awareness of cognitive symptoms, and 18 publications on awareness of neuropsychiatric symptoms were identified. The large majority focused on Parkinson's disease rather than Dementia with Lewy Bodies. Cognitively intact people with Parkinson's disease may over-report cognitive symptoms, whilst those with cognitive impairment under-report symptoms. Awareness of neuropsychiatric symptoms is likely to decline over time, particularly in those with progressive cognitive impairment. CONCLUSIONS Altered awareness of cognitive and neuropsychiatric symptoms is common in Parkinson's disease. Symptom awareness varies significantly between individuals, and appears to be influenced by mood and global cognitive functioning, with executive functioning specifically implicated. There are gaps in our understanding of how dopaminergic medications influence symptom awareness, and a need for longitudinal studies of how awareness changes over time in Parkinson's disease and Dementia with Lewy Bodies.
Collapse
Affiliation(s)
- Catherine Pennington
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon Duncan
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Craig Ritchie
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
40
|
Khalsa DS, Newberg AB. Spiritual Fitness: A New Dimension in Alzheimer's Disease Prevention. J Alzheimers Dis 2021; 80:505-519. [PMID: 33554917 PMCID: PMC8075383 DOI: 10.3233/jad-201433] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Religious and spiritual interventions may have an effect on Alzheimer's disease prevention. Kirtan Kriya meditation has been shown to mitigate the deleterious effects of chronic stress on cognition, reverse memory loss, and create psychological and spiritual wellbeing, which may reduce multiple drivers of Alzheimer's disease risk. OBJECTIVE To detail a new concept in medicine called Spiritual Fitness, a merging of stress reduction, basic wellbeing, and psycho/spiritual wellbeing to prevent Alzheimer's disease. METHODS The literature on the topics mentioned above is described, including an in-depth discussion on why and how each are critical to advancing the future of Alzheimer's disease prevention. The many negative effects of chronic stress, and the benefits of Kirtan Kriya, are reviewed. The four pillars of basic wellbeing, six practical aspects of psychological wellbeing, and the four new non-sectarian features of spiritual fitness are then disclosed. Moreover, instructions on practicing Kirtan Kriya are offered in the Supplementary Material. CONCLUSION Religious and spiritual practices, including Kirtan Kriya, are crucial components in the development of enhanced cognition and well-being, which may help prevent and, in some cases, reverse cognitive decline. The key point of this review is that making a commitment to live a brain longevity lifestyle including spiritual fitness is a critically important way for aging Alzheimer's disease free. We hope that this article will inspire scientists, clinicians, and patients to embrace this new concept of spiritual fitness and make it a part of every multidomain program for the prevention of cognitive disability.
Collapse
Affiliation(s)
| | - Andrew B. Newberg
- Department of Integrative Medicine and Nutritional Sciences, Department of Radiology, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
41
|
Sakurai R, Fujiwara Y, Suzuki H, Ogawa S, Higuchi T, Imanaka K. Changes in self-estimated step-over ability among older adults: A 3-year follow-up study. J Gerontol B Psychol Sci Soc Sci 2020; 76:2003-2012. [PMID: 33279976 DOI: 10.1093/geronb/gbaa219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES There is a growing body of literature examining age-related overestimation of one's own physical ability, which is a potential risk of falls in older adults, but it is unclear what leads them to overestimate. This study aimed to examine 3-year longitudinal changes in self-estimated step-over ability, along with one key risk factor: low frequency of going outdoors (FG), which is a measure of poor daily physical activity. METHOD This cohort study included 116 community-dwelling older adults who participated in baseline and 3-year follow-up assessments. The step-over test was used to measure both the self-estimated step-over bar height (EH) and the actual bar height (AH). Low FG was defined as going outdoors either every few days or less at baseline. RESULTS The number of participants who overestimated their step-over ability (EH>AH) significantly increased from 10.3% to 22.4% over the study period. AH was significantly lower at follow-up than at baseline in both participants with low and high FGs. Conversely, among participants with low FG, EH was significantly higher at follow-up than at baseline, resulting in increased self-estimation error toward overestimation. Regression model showed that low FG was independently associated with increased error in estimation (i.e., tendency to overestimate) at follow-up. DISCUSSION The present study indicated that self-overestimated physical ability in older adults is not only due to decreased physical ability but also due to increased self-estimation of one's ability as a function of low FG. Active lifestyle may be critical for maintaining accurate estimations of one's own physical ability.
Collapse
Affiliation(s)
- Ryota Sakurai
- Health Promotion Science, Tokyo Metropolitan University, Minami-Osawa, Hachioji-shi, Tokyo, Japan.,Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Hiroyuki Suzuki
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Susumu Ogawa
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Sakae-cho, Itabashi-ku, Tokyo, Japan
| | - Takahiro Higuchi
- Health Promotion Science, Tokyo Metropolitan University, Minami-Osawa, Hachioji-shi, Tokyo, Japan
| | - Kuniyasu Imanaka
- Health Promotion Science, Tokyo Metropolitan University, Minami-Osawa, Hachioji-shi, Tokyo, Japan
| |
Collapse
|
42
|
Hauer K, Schwenk M, Englert S, Zijlstra R, Tuerner S, Dutzi I. Mismatch of Subjective and Objective Risk of Falling in Patients with Dementia. J Alzheimers Dis 2020; 78:557-572. [PMID: 33016908 DOI: 10.3233/jad-200572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. OBJECTIVE To analyze mismatch of objective and subjective fall risk and associated factors in PwD. METHOD Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti's Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. RESULTS In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression. CONCLUSION The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.
Collapse
Affiliation(s)
- Klaus Hauer
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Michael Schwenk
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany.,Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Stefan Englert
- Institute of Medical Biometry und Informatics; Department of Medical Biometry at the University of Heidelberg, Heidelberg, Germany
| | - Rixt Zijlstra
- Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, Netherlands
| | - Sabine Tuerner
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| | - Ilona Dutzi
- AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
43
|
Belli E, Nicoletti V, Radicchi C, Bonaccorsi J, Cintoli S, Ceravolo R, Tognoni G. Confabulations in Cases of Dementia: Atypical Early Sign of Alzheimer’s Disease or Misleading Feature in Dementia Diagnosis? Front Psychol 2020; 11:553886. [PMID: 33117224 PMCID: PMC7550794 DOI: 10.3389/fpsyg.2020.553886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022] Open
Abstract
Confabulations, also known as false memories, have been associated with various diseases involving mainly the frontal areas, such as Wernicke–Korsakoff syndrome or frontal epilepsy. The neuropsychological dysfunctions underlying mechanisms of confabulation are not well known. We describe two patients with memory impairment and confabulations at the onset speculating about neuropsychological correlates of confabulations and self-awareness. Both patients, a 77-year-old woman and a 57-years-old man, exhibited confabulations as first symptom of cognitive decline. She later developed memory impairment without awareness of her memory deficits and her cognitive and imaging profile suggested an amnesic mild cognitive impairment due to Alzheimer’s disease (AD). Unlike her, he developed a prevalent involvement of frontal functions despite a clear consciousness of his cognitive deficits. However, the clinical diagnostic hypothesis of behavioral variant of frontotemporal dementia was not supported by imaging findings, which suggested AD. Both patients underwent neuropsychological evaluation including the Confabulation Battery. Despite that the exact anatomical correlation of confabulations is still not defined, imaging data shown by our patients is consistent with recent theories according to which at the origin of confabulatory tendency in AD there is an impairment of the connections between crucial hubs in frontal and mediotemporal areas, mainly involving the right hemisphere. Besides, it would be reasonable to hypothesize that self-awareness and confabulations should not be considered as necessarily associated dimensions.
Collapse
|
44
|
Hauer K, Dutzi I, Gordt K, Schwenk M. Specific Motor and Cognitive Performances Predict Falls during Ward-Based Geriatric Rehabilitation in Patients with Dementia. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5385. [PMID: 32962248 PMCID: PMC7570858 DOI: 10.3390/s20185385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022]
Abstract
The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann-Whitney-U tests, and Chi-square tests between patients with ("in-hospital fallers") and without an in-hospital fall ("in-hospital non-fallers"), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.
Collapse
Affiliation(s)
- Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Centre at the Heidelberg University, 69126 Heidelberg, Germany; (K.H.); (I.D.)
| | - Ilona Dutzi
- Department of Geriatric Research, AGAPLESION Bethanien-Hospital/Geriatric Centre at the Heidelberg University, 69126 Heidelberg, Germany; (K.H.); (I.D.)
| | - Katharina Gordt
- Institute of Sports and Sports Sciences, Heidelberg University, 69120 Heidelberg, Germany;
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, 69115 Heidelberg, Germany
| |
Collapse
|
45
|
Valera-Bermejo JM, De Marco M, Mitolo M, McGeown WJ, Venneri A. Neuroanatomical and cognitive correlates of domain-specific anosognosia in early Alzheimer's disease. Cortex 2020; 129:236-246. [DOI: 10.1016/j.cortex.2020.04.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023]
|
46
|
Nakano H, Murata S, Shiraiwa K, Nonaka K. Increased Time Difference between Imagined and Physical Walking in Older Adults at a High Risk of Falling. Brain Sci 2020; 10:brainsci10060332. [PMID: 32486010 PMCID: PMC7349598 DOI: 10.3390/brainsci10060332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023] Open
Abstract
Walking motor imagery ability is thought to be associated with a fear of falling; however, no studies have compared fall risk and motor imagery ability. This study aimed to ascertain the time difference between imagined and physical walking in older adults at low and high risks of falling. Motor imagery ability was assessed using mental chronometry, which measures the imagined time required for movement. Participants included 31 older adults classified as having a high (n = 15) or low (n = 16) risk of falling based on single leg stance time. The time required for imagined and physical walking was measured using 5 m long walkways with three different widths (15, 25, and 50 cm), and the temporal errors (absolute and constant error) were compared. Physical walking time was significantly longer in the high-risk group than in the low-risk group for the 15 and 25 cm wide walkways. The absolute error between the imagined and physical walking times was significantly larger in the high-risk group than in the low-risk group for the 15 and 25 cm wide walkways. There was also a significant difference in the constant error between the high- and low-risk groups between the imagined and physical walking times for all three walkways. Older adults who may be at a higher risk of falling showed longer walking times during action execution but overestimated their performance (i.e., they believe they would be faster) during motor imagery. Therefore, the time difference between imagined and physical walking could, in part, be useful as a tool for assessing fall risk based on motor imagery.
Collapse
Affiliation(s)
- Hideki Nakano
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, 34 Yamada-cho, Oyake, Yamashina-ku, Kyoto-city, Kyoto 607-8175, Japan; (S.M.); (K.S.)
- Correspondence: ; Tel.: +81-75-571-1111; Fax: +81-75-574-4122
| | - Shin Murata
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, 34 Yamada-cho, Oyake, Yamashina-ku, Kyoto-city, Kyoto 607-8175, Japan; (S.M.); (K.S.)
| | - Kayoko Shiraiwa
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, 34 Yamada-cho, Oyake, Yamashina-ku, Kyoto-city, Kyoto 607-8175, Japan; (S.M.); (K.S.)
| | - Koji Nonaka
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, 3-15-1 Nakatomigaoka, Nara-city, Nara 631-8524, Japan;
| |
Collapse
|
47
|
Brunet HE, Cummings JL, Banks SJ, Miller JB. Awareness of Psychiatric Symptoms in a Mixed Clinical Sample of Older Adults. J Geriatr Psychiatry Neurol 2020; 33:124-134. [PMID: 31401920 DOI: 10.1177/0891988719868311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the neuropsychological correlates and impact on caregiver distress of reduced awareness of mood symptoms in patients with suspected neurodegenerative disease. METHOD Records from a clinical sample of older adults were examined (N = 940). RESULTS More than one-third of patient and caregiver ratings of mood symptoms did not agree (comparing patient and caregiver self-report measures); 27.9% of patients were unaware of depression (UoD) and 16.6% of patients were unaware of anxiety (UoA). The UoD group exhibited poorer verbal memory and executive abilities and the UoA group exhibited poorer verbal memory than those with preserved awareness. Unawareness was not associated with caregiver distress. CONCLUSIONS These findings highlight the importance of capturing informant report in clinical practice with older adults suspected of cognitive impairment. Unawareness of mood symptoms was related to memory dysfunction and-to a lesser extent-to executive abilities and may have implications for addressing patient and caregiver needs for disorders affecting these cognitive systems.
Collapse
Affiliation(s)
- Hannah E Brunet
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Jeffrey L Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA.,School of Allied Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Sarah J Banks
- University of California San Diego, San Diego, CA, USA
| | - Justin B Miller
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| |
Collapse
|
48
|
Tagai K, Nagata T, Shinagawa S, Shigeta M. Anosognosia in patients with Alzheimer's disease: current perspectives. Psychogeriatrics 2020; 20:345-352. [PMID: 31930617 DOI: 10.1111/psyg.12507] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/09/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease characterised by neurocognitive impairments, especially memory impairment, as core symptoms linked to reductions in activities of daily life. As marginal symptoms, neuropsychiatric symptoms (NPSs) appear during the progressive course of the disease. A lack of self-awareness (anosognosia) of cognitive and functional impairments is often seen in patients with AD, and associations between anosognosia and other NPSs have been previously reported. To account for anosognosia pathogenesis neurocognitively, the cognitive awareness model (CAM) has been helpful for explaining the stream of events from sensory input to behavioural/affective and metacognitive outputs. According to CAM, there are three types of anosognosia: (i) primary anosognosia, (ii) executive anosognosia, and (iii) mnemonic anosognosia. These types of anosognosia are generated from different neurocognitive modulations leading to metacognitive outputs or behavioural/affective regulations. Primary anosognosia is considered to be caused by deficits in the metacognitive awareness system (MAS). While preserved MAS function is associated with milder depression and anxiety in AD, a severer depressive mood in patients with mild AD can inversely cause self-underestimation. The modulation of executive anosognosia is thought to be associated with dangerous/disinhibition behaviours and apathy among NPS sub-symptoms, via impairments of comparator mechanism (Cm) within the central executive system. Other neurobehavioral reactions linked to self-awareness include 'denying' and 'confabulation', and each of these reactions is thought to be affected by the MAS and a Cm. Denial of one's own memory impairments appears as a defensive reaction to protect against dysphoric feelings, and the confabulatory comment is instantly reaction constructed by fabrications according to misinterpretations of memory information about oneself. Similarly, the innovative development of a theoretical model (CAM) has contributed to explaining the mechanism of anosognosia and some neurobehavioral outputs from a neurocognitive perspective.
Collapse
Affiliation(s)
- Kenji Tagai
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomoyuki Nagata
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan.,Department of Psychiatry, Airanomori Hospital, Kagoshima, Japan
| | | | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
49
|
Buchwitz TM, Maier F, Greuel A, Eggers C. Improving Self-Awareness of Motor Symptoms in Patients With Parkinson's Disease by Using Mindfulness - A Study Protocol for a Randomized Controlled Trial. Front Psychol 2020; 11:743. [PMID: 32362861 PMCID: PMC7180229 DOI: 10.3389/fpsyg.2020.00743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/26/2020] [Indexed: 12/23/2022] Open
Abstract
Objective This study aims to increase self-awareness in patients with Parkinson’s disease (PD) using a newly developed mindfulness-based intervention, tailored for the specific needs of PD patients. Its impact on self-awareness and patients’ daily lives is currently being evaluated. Background Recently, the phenomenon of impaired self-awareness for motor symptoms (ISAm) and some non-motor symptoms has been described in PD. ISAm can negatively influence patients’ daily lives, e.g., by affecting therapy adherence, and is therefore the main focus of this study. The main goal is the development of IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”), a PD-specific intervention for increasing patients’ mindfulness and thereby reducing ISAm. Methods The effectiveness of IPSUM is evaluated by comparison of an intervention group with a waitlist-control group. A pre-post design with an additional 8-week follow-up measurement is applied, resulting in three measurement points: before, directly after and 8 weeks after completing the intervention protocol. In total, up to 180 non-depressed PD patients without severe cognitive impairment (non-demented) will be included. The primary outcome is a quantitative score for measuring ISAm. Secondary outcome measures are affective changes, neuropsychological performance and self-awareness of cognition. At pre- and post-measurement an fMRI scan is performed to connect behavioral and neurobiological findings. At post- and follow-up-measurement each patient will take part in a semi-structured interview to explore IPSUM’s impact on self-awareness and patients’ everyday lives. Results The conception of the intervention protocol is finished, the resulting 8-week program is presented in detail. It has successfully been tested in the first group of patients, their feedback so far was quite promising. Recruitment is ongoing and a first interim analysis will be performed once 30 patients have completed IPSUM. Conclusion For the first time, the intervention protocol of IPSUM has successfully been tested in a group of PD patients. As the study goes on, more quantitative data is collected for statistical analyses to evaluate its effectiveness. More qualitative data is collected to evaluate feasibility and effectiveness. We hope for this intervention to be capable of reducing the patients’ ISAm and improving their quality of life on many levels.
Collapse
Affiliation(s)
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| |
Collapse
|
50
|
Lenzoni S, Morris RG, Mograbi DC. The Petrified Self 10 Years After: Current Evidence for Mnemonic anosognosia. Front Psychol 2020; 11:465. [PMID: 32256435 PMCID: PMC7090331 DOI: 10.3389/fpsyg.2020.00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
Lack of awareness about disease, its symptoms and consequences, also termed anosognosia, is a common feature of Alzheimer's disease (AD). It has been hypothesized that memory disorder may be a key contributing factor to anosognosia, with people with AD not being able to update their personal information about performance and relying on older consolidated material about ability. This potentially outdated sense of self has been named, as a metaphor, the petrified self. In the current review, evidence from the past 10 years in relation to this concept is critically appraised. In particular, focus is given to empirical evidence produced on anterograde memory deficits about performance, the profile of autobiographical retrograde memory loss and the role of frontal lobes in anosognosia in AD. Finally, wider consequences of this metaphor for the understanding of selfhood in dementia are discussed.
Collapse
Affiliation(s)
- Sabrina Lenzoni
- Department of Psychology, Pontifícia Universidade Católica, Rio de Janeiro, Brazil
| | - Robin G Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Daniel C Mograbi
- Department of Psychology, Pontifícia Universidade Católica, Rio de Janeiro, Brazil.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|