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Fisher L, Munsterman E, Rajpal N, Rhodes E, Hodgson N, Hirschman KB, Massimo L. Caregiving in the face of empathy loss in Frontotemporal Dementia: an integrative review. Aging Ment Health 2024:1-11. [PMID: 39148421 DOI: 10.1080/13607863.2024.2390603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES Frontotemporal Degeneration (FTD) is a common cause of early onset dementia with symptoms often presenting before 65 years of age and adding tremendous burden on caregivers. FTD caregiving research describes patient behavioral symptoms such as apathy and disinhibition as primary sources of poor caregiver psychological health; however, little attention has been paid to other common patient behaviors, such as loss of empathy. To better understand the relationship between empathy loss and FTD caregiver outcomes, this integrative review aimed to address the question: How does the loss of empathy in a person living with FTD (PLwFTD) impact the caregiver? METHOD Quantitative and qualitative articles were found in PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus and were assessed for quality using the Crowe Critical Appraisal Tool (CCAT). Through constant comparative analysis, articles were assessed to abstract common themes in the literature. RESULTS From 333 citations, 8 qualitative and 8 quantitative studies published between 2010 and 2022 were included. Three main themes were uncovered: 1) caregiver emotional reactions to the PLwFTD; 2) caregiver psychological distress; 3) changes in the relationship. CONCLUSION This review emphasizes the detrimental impact of empathy loss on FTD caregivers. Understanding these underexplored consequences is critical in understanding the well-being of caregivers and promoting ways to support caregivers.
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Affiliation(s)
- Lauren Fisher
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Ellen Munsterman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Neetu Rajpal
- Holman Biotech Commons, University of Pennsylvania Libraries, Philadelphia, PA, USA
| | - Emma Rhodes
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen B Hirschman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Massimo
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- NewCourtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA, USA
- Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
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Lindberg O, Li TQ, Lind C, Vestberg S, Almkvist O, Stiernstedt M, Ericson A, Bogdanovic N, Hansson O, Harper L, Westman E, Graff C, Tsevis T, Mannfolk P, Fischer H, Nilsonne G, Petrovic P, Nyberg L, Wahlund LO, Santillo AF. Altered empathy processing in frontotemporal dementia A task-based fMRI study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.21.586051. [PMID: 38585830 PMCID: PMC10996471 DOI: 10.1101/2024.03.21.586051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
A lack of empathy, and particularly its affective components, is a core symptom of behavioural variant frontotemporal dementia (bvFTD). Visual exposure to images of a needle pricking a hand (pain condition) and Q-tips touching a hand (control condition) is an established functional magnetic resonance imaging (fMRI) paradigm used to investigate empathy for pain (EFP; pain condition minus control condition). EFP has been associated with increased blood oxygen level dependent (BOLD) signal in regions known to become atrophic in the early stages in bvFTD, including the anterior insula and the anterior cingulate. We therefore hypothesized that patients with bvFTD would display altered empathy processing in the EFP paradigm. Here we examined empathy processing using the EFP paradigm in 28 patients with bvFTD and 28 sex and age matched controls. Participants underwent structural MRI, task-based and resting-state fMRI. The Interpersonal Reactivity Index (IRI) was used as a measure of different facets of empathic function outside the scanner. The EFP paradigm was analysed at a whole brain level and using two regions-of-interest approaches, one based on a metanalysis of affective perceptual empathy versus cognitive evaluative empathy and one based on the controĺs activation pattern. In controls, EFP was linked to an expected increase of BOLD signal that displayed an overlap with the pattern of atrophy in the bvFTD patients (insula and anterior cingulate). Additional regions with increased signal were the supramarginal gyrus and the occipital cortex. These latter regions were the only ones that displayed increased BOLD signal in bvFTD patients. BOLD signal increase under the affective perceptual empathy but not the cognitive evaluative empathy region of interest was significantly greater in controls than in bvFTD patients. The controĺs rating on their empathic concern subscale of the IRI was significantly correlated with the BOLD signal in the EFP paradigm, as were an informantś ratings of the patientś empathic concern subscale. This correlation was not observed on other subscales of the IRI or when using the patient's self-ratings. Finally, controls and patients showed different connectivity patterns in empathy related networks during resting-state fMRI, mainly in nodes overlapping the ventral attention network. Our results indicate that reduced neural activity in regions typically affected by pathology in bvFTD is associated with reduced empathy processing, and a predictor of patientś capacity to experience affective empathy.
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Affiliation(s)
- Olof Lindberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Tie-Qiang Li
- Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Sweden
- Department of Medical Radiation and Nuclear Medicine, Karolinska University Hospital, Sweden
| | - Cecilia Lind
- Department of community medicine and rehabilitation, geriatrics Umeå university, Umeå university, Sweden
| | | | - Ove Almkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
- Department of Psychology, Stockholm, Sweden
| | - Mikael Stiernstedt
- Umeå center for Functional Brain Imaging (UFBI), Umeå University, Sweden
| | - Anita Ericson
- Department of community medicine and rehabilitation, geriatrics Umeå university, Umeå university, Sweden
| | - Nenad Bogdanovic
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Lund, Sweden
| | - Luke Harper
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Eric Westman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Caroline Graff
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
- Karolinska university hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Solna, Sweden
| | - Theofanis Tsevis
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
- Karolinska university hospital, Stockholm, Sweden
| | - Peter Mannfolk
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Håkan Fischer
- Department of Psychology, Stockholm, Sweden
- Stockholm University Brain Imaging Centre (SUBIC), Stockholm, Sweden
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Nilsonne
- Department of Psychology, Stockholm, Sweden
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Predrag Petrovic
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institute, Sweden
- Center for Cognitive and Computational Psychiatry, Department of Clinical Neuroscience, Karolinska Institute, Sweden
| | - Lars Nyberg
- Umeå center for Functional Brain Imaging (UFBI), Umeå University, Sweden
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
- Department of Medical and Translational Biology, Umeå University, Umeå, Sweden
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Division of Clinical Geriatrics, Centre for Alzheimer Research, Neo, 14183 Huddinge, Sweden
| | - Alexander F Santillo
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
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Prigatano G. Love, anger and Primary Progressive Aphasia: Psychological care for a person with dementia. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-8. [PMID: 38422549 DOI: 10.1080/23279095.2024.2322633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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Panahi S, Mayo J, Kennedy E, Christensen L, Kamineni S, Sagiraju HKR, Cooper T, Tate DF, Rupper R, Pugh MJ. Identifying clinical phenotypes of frontotemporal dementia in post-9/11 era veterans using natural language processing. Front Neurol 2024; 15:1270688. [PMID: 38426171 PMCID: PMC10902457 DOI: 10.3389/fneur.2024.1270688] [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: 08/01/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Frontotemporal dementia (FTD) encompasses a clinically and pathologically diverse group of neurodegenerative disorders, yet little work has quantified the unique phenotypic clinical presentations of FTD among post-9/11 era veterans. To identify phenotypes of FTD using natural language processing (NLP) aided medical chart reviews of post-9/11 era U.S. military Veterans diagnosed with FTD in Veterans Health Administration care. Methods A medical record chart review of clinician/provider notes was conducted using a Natural Language Processing (NLP) tool, which extracted features related to cognitive dysfunction. NLP features were further organized into seven Research Domain Criteria Initiative (RDoC) domains, which were clustered to identify distinct phenotypes. Results Veterans with FTD were more likely to have notes that reflected the RDoC domains, with cognitive and positive valence domains showing the greatest difference across groups. Clustering of domains identified three symptom phenotypes agnostic to time of an individual having FTD, categorized as Low (16.4%), Moderate (69.2%), and High (14.5%) distress. Comparison across distress groups showed significant differences in physical and psychological characteristics, particularly prior history of head injury, insomnia, cardiac issues, anxiety, and alcohol misuse. The clustering result within the FTD group demonstrated a phenotype variant that exhibited a combination of language and behavioral symptoms. This phenotype presented with manifestations indicative of both language-related impairments and behavioral changes, showcasing the coexistence of features from both domains within the same individual. Discussion This study suggests FTD also presents across a continuum of severity and symptom distress, both within and across variants. The intensity of distress evident in clinical notes tends to cluster with more co-occurring conditions. This examination of phenotypic heterogeneity in clinical notes indicates that sensitivity to FTD diagnosis may be correlated to overall symptom distress, and future work incorporating NLP and phenotyping may help promote strategies for early detection of FTD.
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Affiliation(s)
- Samin Panahi
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Jamie Mayo
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Eamonn Kennedy
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Lee Christensen
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Sreekanth Kamineni
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | | | - Tyler Cooper
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - David F. Tate
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Randall Rupper
- VA Salt Lake City Health Care System, Geriatric Research, Education and Clinical Center, Salt Lake City, UT, United States
| | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
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Fitri FI, Lage C, Mollayeva T, Santamaria-Garcia H, Chan M, Cominetti MR, Daria T, Fallon G, Gately D, Gichu M, Giménez S, Zuniga RG, Hadad R, Hill-Jarrett T, O’Kelly M, Martinez L, Modjaji P, Ngcobo N, Nowak R, Ogbuagu C, Roche M, Aguzzoli CS, Shin SY, Smith E, Yoseph SA, Zewde Y, Ayhan Y. Empathy as a crucial skill in disrupting disparities in global brain health. Front Neurol 2023; 14:1189143. [PMID: 38162446 PMCID: PMC10756064 DOI: 10.3389/fneur.2023.1189143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/26/2023] [Indexed: 01/03/2024] Open
Abstract
Brain health refers to the state of a person's brain function across various domains, including cognitive, behavioral and motor functions. Healthy brains are associated with better individual health, increased creativity, and enhanced productivity. A person's brain health is intricately connected to personal, social and environmental factors. Racial, ethnic, and social disparities affect brain health and on the global scale these disparities within and between regions present a hurdle to brain health. To overcome global disparities, greater collaboration between practitioners and healthcare providers and the people they serve is essential. This requires cultural humility driven by empathy. Empathy is a core prosocial value, a cognitive-emotional skill that helps us understand ourselves and others. This position paper aims to provide an overview of the vital roles of empathy, cooperation, and interdisciplinary partnerships. By consciously integrating this understanding in practice, leaders can better position themselves to address the diverse challenges faced by communities, promote inclusivity in policies and practices, and further more equitable solutions to the problem of global brain health.
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Affiliation(s)
- Fasihah Irfani Fitri
- Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Carmen Lage
- Department of Neurology, Marques de Valdecilla University Hospital - Valdecilla Research Institute (IDIVAL), Santander, Spain
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
| | - Tatyana Mollayeva
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Canada Research Chairs, Ottawa, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Acquired Brain Injury Research Lab, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hernando Santamaria-Garcia
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio Bogotá, Bogotá, Colombia
- Pontificia Universidad Javeriana (PhD Program in Neuroscience) Bogotá, Bogotá, Colombia
| | - Melissa Chan
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Social Sciences, University of Luxembourg, Luxembourg, Luxembourg
| | - Marcia R. Cominetti
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Gerontology, Federal University of São Carlos, São Carlos, Brazil
| | - Tselmen Daria
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Gladstone Institutes, San Francisco, CA, United States
| | - Gillian Fallon
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
| | - Dominic Gately
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Muthoni Gichu
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Division of Geriatric Medicine at the Ministry of Health, Nairobi, Kenya
| | - Sandra Giménez
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Multidisciplinary Sleep Unit, Memory Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raquel Gutierrez Zuniga
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Hospital Quirónsalud Valle del Henares, Madrid, Spain
| | - Rafi Hadad
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Rambam Health Care Campus, Haifa, Israel
| | - Tanisha Hill-Jarrett
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Memory and Aging Center, Medical Center, University of California, San Francisco, CA, United States
| | - Mick O’Kelly
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- National College of Art and Design, Dublin, Ireland
| | - Luis Martinez
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Memory and Aging Center, Medical Center, University of California, San Francisco, CA, United States
| | - Paul Modjaji
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
| | - Ntkozo Ngcobo
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Rafal Nowak
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Neuroelectrics (Spain), Barcelona, Spain
| | - Chukwuanugo Ogbuagu
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Faculty of Basic Clinical Sciences, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Moïse Roche
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, Dublin, Ireland
- Division of Psychiatry, UCL, London, United Kingdom
| | - Cristiano Schaffer Aguzzoli
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - So Young Shin
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Nursing, Inje University, Busan, Republic of Korea
| | - Erin Smith
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Stanford University, Stanford, CA, United States
| | - Selam Aberra Yoseph
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yared Zewde
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yavuz Ayhan
- Senior Atlantic Fellow at the Global Brain Health Institute/Trinity College, UCSF, San Francisco, CA, United States
- Department of Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
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Berendzen KM. Understanding social attachment as a window into the neural basis of prosocial behavior. Front Neurol 2023; 14:1247480. [PMID: 37869145 PMCID: PMC10585278 DOI: 10.3389/fneur.2023.1247480] [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: 06/26/2023] [Accepted: 09/12/2023] [Indexed: 10/24/2023] Open
Abstract
The representation and demonstration of human values are intimately tied to our status as a social species. Humans are relatively unique in our ability to form enduring social attachments, characterized by the development of a selective bond that persists over time. Such relationships include the bonds between parents and offspring, pair bonds between partners and other affiliative contacts, in addition to group relationships to which we may form direct and symbolic affiliations. Many of the cognitive and behavioral processes thought to be linked to our capacity for social attachment-including consolation, empathy, and social motivation, and the implicated neural circuits mediating these constructs, are shared with those thought to be important for the representation of prosocial values. This perspective piece will examine the hypothesis that our ability to form such long-term bonds may play an essential role in the construction of human values and ethical systems, and that components of prosocial behaviors are shared across species. Humans are one of a few species that form such long-term and exclusive attachments and our understanding of the neurobiology underlying attachment behavior has been advanced by studying behavior in non-human animals. The overlap in behavioral and affective constructs underlying attachment behavior and value representation is discussed, followed by evidence from other species that demonstrate attachment behavior that supports the overlapping neurobiological basis for social bonds and prosocial behavior. The understanding of attachment biology has broad implications for human health as well as for understanding the basis for and variations in prosocial behavior.
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Affiliation(s)
- Kristen M. Berendzen
- Department of Psychiatry and Biological Sciences, University of California, San Francisco, San Francisco, CA, United States
- Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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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.
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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
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Restrepo-Martínez M, Ramirez-Bermudez J, So I, Coleman K, Finger E. Delusions of love and passion in the behavioral variant of frontotemporal dementia. Neurocase 2023; 29:37-45. [PMID: 38678305 DOI: 10.1080/13554794.2024.2345110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
Erotomania (de Clérambault's syndrome) refers to the delusional belief that another person, usually socially unreachable, is in love with the holder of the delusion. The occurrence of erotomania in Frontotemporal Dementia has rarely been reported. We present the unique case of a 59-year-old woman with a strong family history of early-onset dementia in whom erotomania was the initial manifestation that led to a diagnosis of definite Behavioral Variant of Frontotemporal Dementia with a pathogenic missense mutation in the MAPT gene. Based on this case, we propose a hypothetical model for developing erotomania in patients with FTD.
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Affiliation(s)
- Miguel Restrepo-Martínez
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jesus Ramirez-Bermudez
- Department of Neuropsychiatry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Isis So
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kristy Coleman
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Abstract
OBJECTIVE Behavioral variant frontotemporal dementia (bvFTD) is associated with social and criminal transgressions; studies from countries around the world have documented such behavior in persons with this condition. An overview and analysis of social and criminal transgressions in bvFTD and their potential neurobiological mechanisms can provide a window for understanding the relationship of antisocial behavior and the brain. METHODS This review evaluated the literature on the frequency of social and criminal transgressions in bvFTD and the neurobiological disturbances that underlie them. RESULTS There is a high frequency of transgressions among patients with bvFTD due to impairments in neurocognition, such as social perception, behavioral regulation, and theory of mind, and impairments in social emotions, such as self-conscious emotions and empathy. Additionally, there is significant evidence for a specific impairment in an innate sense of morality. Alterations in these neurobiological processes result from predominantly right-hemisphere pathology in frontal (ventromedial, orbitofrontal, inferolateral frontal), anterior temporal (amygdala, temporal pole), limbic (anterior cingulate, amygdala), and insular regions. CONCLUSIONS Overlapping disturbances in neurocognition, social emotions, and moral reasoning result from disease in the mostly mesial and right-sided frontotemporal network necessary for responding emotionally to others and for behavioral control. With increased sophistication in neurobiological interventions, future goals may be the routine evaluation of these processes among individuals with bvFTD who engage in social and criminal transgressions and the targeting of these neurobiological mechanisms with behavioral, pharmacological, and other interventions.
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Affiliation(s)
- Mario F Mendez
- Departments of Neurology and Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles; and Neurology Service, Neurobehavior Unit, VA Greater Los Angeles Healthcare System
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10
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Shdo SM, Roy ARK, Datta S, Sible IJ, Lukic S, Perry DC, Rankin KP, Kramer JH, Rosen HJ, Miller BL, Seeley WW, Holley SR, Gorno-Tempini ML, Sturm VE. Enhanced positive emotional reactivity in frontotemporal dementia reflects left-lateralized atrophy in the temporal and frontal lobes. Cortex 2022; 154:405-420. [PMID: 35930892 PMCID: PMC9867572 DOI: 10.1016/j.cortex.2022.02.018] [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: 06/28/2021] [Revised: 01/03/2022] [Accepted: 02/16/2022] [Indexed: 01/26/2023]
Abstract
In frontotemporal dementia (FTD), left-lateralized atrophy patterns have been associated with elevations in certain positive emotions. Here, we investigated whether positive emotional reactivity was enhanced in semantic variant primary progressive aphasia (svPPA), an FTD syndrome that targets the left anterior temporal lobe. Sixty-one participants (16 people with svPPA, 24 people with behavioral variant FTD, and 21 healthy controls) viewed six 90-sec trials that were comprised of a series of photographs; each trial was designed to elicit a specific positive emotion, negative emotion, or no emotion. Participants rated their positive emotional experience after each trial, and their smiling behavior was coded with the Facial Action Coding System. Results indicated that positive emotional experience and smiling were elevated in svPPA in response to numerous affective and non-affective stimuli. Voxel-based morphometry analyses revealed that greater positive emotional experience and greater smiling in the patients were both associated with smaller gray matter volume in the left superior temporal gyrus (pFWE < .05), among other left-lateralized frontotemporal regions. Whereas enhanced positive emotional experience related to atrophy in middle superior temporal gyrus and structures that promote cognitive control and emotion regulation, heightened smiling related to atrophy in posterior superior temporal gyrus and structures that support motor control. Our results suggest positive emotional reactivity is elevated in svPPA and offer new evidence that atrophy in left-lateralized emotion-relevant systems relates to enhanced positive emotions in FTD.
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Affiliation(s)
- Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; University of California, Berkeley, Department of Psychology, Berkeley, CA, USA.
| | - Ashlin R K Roy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Samir Datta
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Isabel J Sible
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Sladjana Lukic
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - David C Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
| | - Sarah R Holley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA; San Francisco State University, Department of Psychology, San Francisco, CA, USA.
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Virginia E Sturm
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA.
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11
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Mori K, Ikeda M. Biological basis and psychiatric symptoms in frontotemporal dementia. Psychiatry Clin Neurosci 2022; 76:351-360. [PMID: 35557018 DOI: 10.1111/pcn.13375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/08/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022]
Abstract
Frontotemporal dementia is a neurodegenerative disease characterized by focal degeneration of the frontal and temporal lobes, clinically presenting with disinhibited behavior, personality changes, progressive non-fluent aphasia and/or impaired semantic memory. Research progress has been made in re-organizing the clinical concept of frontotemporal dementia and neuropathological classification based on multiple accumulating proteins. Alongside this progress a list of genetic mutations or variants that are causative or increase the risk of frontotemporal dementia have been identified and some of these gene products are extensively studied. However, there are still a lot of points that need to be overcome, including lack of specific diagnostic biomarker which enable antemortem diagnosis of underlying neurodegenerative process, and lack of disease modifying therapy which could prevent disease progression. Early and precise diagnosis of frontotemporal dementia is urgently required. In this context, how to define prodromal frontotemporal dementia and early differential diagnosis from primary psychiatric disorders are also important issues. In this review we will summarize and discuss current understanding of biological basis and psychiatric symptoms in frontotemporal dementia.
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Affiliation(s)
- Kohji Mori
- Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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12
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Measuring social cognition in frontotemporal lobar degeneration: a clinical approach. J Neurol 2021; 269:2227-2244. [PMID: 34797433 DOI: 10.1007/s00415-021-10889-9] [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: 08/18/2021] [Revised: 10/14/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Alterations in social cognition, a broad term indicating our ability to understand others and adapt our behavior accordingly, have been the focus of growing attention in the past years. Some neurological conditions, such as those belonging to the frontotemporal lobar degeneration (FTLD) spectrum, are associated to varying degrees with social cognition deficits, encompassing problems with theory of mind (ToM), empathy, perception of social stimuli, and social behavior. In this review, we outline a clinical framework for the evaluation of social cognition and discuss its role in the assessment of patients affected by a range of FTLD conditions.
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13
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Mendez MF. Degenerative dementias: Alterations of emotions and mood disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:261-281. [PMID: 34389121 DOI: 10.1016/b978-0-12-822290-4.00012-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Degenerative dementias such as Alzheimer's disease and frontotemporal dementia result in distinct alterations in emotional processing, emotional experiences, and mood. The neuropathology of these dementias extends to structures involved in emotional processing, including the basolateral limbic network (orbitofrontal cortex, anterior temporal lobe, amygdala, and thalamus), the insula, and ventromedial frontal lobe. Depression is the most common emotion and mood disorder affecting patients with Alzheimer's disease. The onset of depression can be a prodromal sign of this dementia. Anxiety can also be present early in the course of Alzheimer's disease and especially among patients with early-onset forms of the disease. In contrast, patients with behavioral variant frontotemporal dementia demonstrate hypoemotionality, deficits in the recognition of emotion, and decreased psychophysiological reactivity to emotional stimuli. They typically have a disproportionate impairment in emotional and cognitive empathy. One other unique feature of behavioral variant frontotemporal dementia is the frequent occurrence of bipolar disorder. The management strategies for these alterations of emotion and mood in degenerative dementias primarily involve the judicious use of the psychiatric armamentarium of medications.
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Affiliation(s)
- Mario F Mendez
- Behavioral Neurology Program, Department of Neurology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States; Neurology Service, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States.
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14
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Chen KH, Hua AY, Lwi SJ, Haase CM, Rosen HJ, Miller BL, Levenson RW. Smaller Volume in Left-Lateralized Brain Structures Correlates with Greater Experience of Negative Non-target Emotions in Neurodegenerative Diseases. Cereb Cortex 2021; 31:15-31. [PMID: 32820325 DOI: 10.1093/cercor/bhaa193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 12/11/2022] Open
Abstract
Subjective emotional experience that is congruent with a given situation (i.e., target emotions) is critical for human survival (e.g., feeling disgusted in response to contaminated food motivates withdrawal behaviors). Neurodegenerative diseases including frontotemporal dementia and Alzheimer's disease affect brain regions critical for cognitive and emotional functioning, resulting in increased experience of emotions incongruent with the situation (i.e., non-target emotions, such as feeling happy when seeing someone grieving). We examined neuroanatomical correlates of subjective experience of non-target emotions in 147 patients with neurodegenerative diseases and 26 healthy individuals. Participants watched three films intended to elicit particular target emotions and rated their experience of negative and positive target and non-target emotions after watching each film. We found that smaller volume in left hemisphere regions (e.g., caudate, putamen, and dorsal anterior insula) was associated with greater experience of negative non-target emotions. Follow-up analyses confirmed that these effects were left-lateralized. No correlates emerged for positive non-target emotions. These findings suggest that volume loss in left-hemisphere regions produces a more diffuse, incongruent experience of non-target emotions. These findings provide a potential neuroanatomical basis for understanding how subjective emotional experience is constructed in the brain and how this can be disrupted in neurodegenerative disease.
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15
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Hua AY, Chen KH, Brown CL, Lwi SJ, Casey JJ, Rosen HJ, Miller BL, Levenson RW. Physiological, behavioral and subjective sadness reactivity in frontotemporal dementia subtypes. Soc Cogn Affect Neurosci 2019; 14:1453-1465. [PMID: 31993653 PMCID: PMC7137727 DOI: 10.1093/scan/nsaa007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/29/2019] [Accepted: 01/08/2020] [Indexed: 12/15/2022] Open
Abstract
Frontotemporal dementia (FTD), a neurodegenerative disease broadly characterized by socioemotional impairments, includes three clinical subtypes: behavioral variant FTD (bvFTD), semantic variant primary progressive aphasia (svPPA) and non-fluent variant primary progressive aphasia (nfvPPA). Emerging evidence has shown emotional reactivity impairments in bvFTD and svPPA, whereas emotional reactivity in nfvPPA is far less studied. In 105 patients with FTD (49 bvFTD, 31 svPPA and 25 nfvPPA) and 27 healthy controls, we examined three aspects of emotional reactivity (physiology, facial behavior and subjective experience) in response to a sad film. In a subset of the sample, we also examined the neural correlates of diminished aspects of reactivity using voxel-based morphometry. Results indicated that all three subtypes of FTD showed diminished physiological responding in respiration rate and diastolic blood pressure; patients with bvFTD and svPPA also showed diminished subjective experience, and no subtypes showed diminished facial behavior. Moreover, there were differences among the clinical subtypes in brain regions where smaller volumes were associated with diminished sadness reactivity. These results show that emotion impairments extend to sadness reactivity in FTD and underscore the importance of considering different aspects of sadness reactivity in multiple clinical subtypes for characterizing emotional deficits and associated neurodegeneration in FTD.
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Affiliation(s)
- Alice Y Hua
- Berkeley Psychophysiology Laboratory, Department of Psychology, University of California, Berkeley, USA
| | - Kuan-Hua Chen
- Berkeley Psychophysiology Laboratory, Department of Psychology, University of California, Berkeley, USA
| | - Casey L Brown
- Berkeley Psychophysiology Laboratory, Department of Psychology, University of California, Berkeley, USA
| | - Sandy J Lwi
- Berkeley Psychophysiology Laboratory, Department of Psychology, University of California, Berkeley, USA
| | - James J Casey
- Berkeley Psychophysiology Laboratory, Department of Psychology, University of California, Berkeley, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
| | - Robert W Levenson
- Berkeley Psychophysiology Laboratory, Department of Psychology, University of California, Berkeley, USA
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