Associations between repetitive negative thinking and resting-state network segregation among healthy middle-aged adults

Background

Repetitive Negative Thinking (RNT) includes negative thoughts about the future and past, and is a risk factor for depression and anxiety. Prefrontal and anterior cingulate cortices have been linked to RNT but several regions within large-scale networks are also involved, the efficiency of which depends on their ability to remain segregated.

Methods

Associations between RNT and system segregation (SyS) of the Anterior Salience Network (ASN), Default Mode Network (DMN) and Executive Control Network (ECN) were explored in healthy middle-aged adults (N = 341), after undergoing resting-state functional magnetic resonance imaging. Regression analyses were conducted with RNT as outcome variable. Explanatory variables were: SyS, depression, emotional stability, cognitive complaints, age and sex.

Results

Analyses indicated that RNT was associated with depression, emotional stability, cognitive complaints, age and segregation of the left ECN (LECN) and ASN. Further, the ventral DMN (vDMN) presented higher connectivity with the ASN and decreased connectivity with the LECN, as a function of RNT.

Conclusion

Higher levels of perseverative thinking were related to increased segregation of the LECN and decreased segregation of the ASN. The dissociative connectivity of these networks with the vDMN may partially account for poorer cognitive control and increased self-referential processes characteristic of RNT.

Functional improvement in chronic stroke patients when following a supervised home-based computerized cognitive training

BACKGROUND

Computerized Cognitive Training (CCT) is an effective treatment for cognitive impairment in the post-acute stage of stroke. However, it is still not clear if it is suitable for chronic stage.

OBJECTIVES

To explore if patients with cognitive deficit following stroke may benefit from CCT.

METHODS

Thirty patients post-stroke between 24 and 62 years old were randomized into two groups (A and B) to receive two different types of CCT. All patients were tested with a neuropsychological battery and functional questionnaires, before and after each CCT and also 6 months after the end of the study. In phase I, Group A received a customized CCT and Group B received a non-customized CCT, over 6 weeks. Three months after, each group received the other intervention (phase II).

RESULTS

After phase I, between-group analyses revealed that Group A showed a relative decrease in subjective complaints. In contrast, Group B showed improvement in performance-based measures. After phase II, the decrease in subjective complaints continued in Group A, and both groups showed improvement in performance-based measures.

CONCLUSIONS

Patients with chronic stroke improved cognitive functioning after performing supervised home-based multi-domain computerized cognitive training.

Loneliness experience through COVID‐19 pandemic and lockdown is related with resting‐state brain networks functional connectivity

Background

Method

Result

Conclusion

tDCS-Induced Memory Reconsolidation Effects and Its Associations With Structural and Functional MRI Substrates in Subjective Cognitive Decline

Previous evidence suggests that transcranial direct current stimulation (tDCS) to the left dorsolateral prefrontal cortex (l-DLPFC) can enhance episodic memory in subjects with subjective cognitive decline (SCD), known to be at risk of dementia. Our main goal was to replicate such findings in an independent sample and elucidate if baseline magnetic resonance imaging (MRI) characteristics predicted putative memory improvement. Thirty-eight participants with SCD (aged: 60-65 years) were randomly assigned to receive active (N = 19) or sham (N = 19) tDCS in a double-blind design. They underwent a verbal learning task with 15 words (DAY-1), and 24 h later (DAY-2) stimulation was applied for 15 min at 1.5 mA targeting the l-DLPFC after offering a contextual reminder. Delayed recall and recognition were measured 1 day after the stimulation session (DAY-3), and at 1-month follow-up (DAY-30). Before the experimental session, structural and functional MRI were acquired. We identified a group∗time interaction in recognition memory, being the active tDCS group able to maintain stable memory performance between DAY-3 and DAY-30. MRI results revealed that individuals with superior tDCS-induced effects on memory reconsolidation exhibited higher left temporal lobe thickness and greater intrinsic FC within the default-mode network. Present findings confirm that tDCS, through the modulation of memory reconsolidation, is capable of enhancing performance in people with self-perceived cognitive complaints. Results suggest that SCD subjects with more preserved structural and functional integrity might benefit from these interventions, promoting maintenance of cognitive function in a population at risk to develop dementia.

Meaning in Life: A Major Predictive Factor for Loneliness Comparable to Health Status and Social Connectedness

Objective: Loneliness is the subjective distress of feeling alone and has a strong impact on wellbeing and health. In addition to well-known predictors like isolation and poor health, a better understanding of the psychological determinants of loneliness would offer effective targets for future complementary interventions. Methods: In this cross-sectional observational study (N = 2,240), we compared the explanatory power of several important risk factors of loneliness with the affective, motivational, and cognitive aspects of the Meaning in Life (MiL) construct. Different nested linear models were compared including socio-demographic, lifestyles, social-connectedness, and self-rated health variables, to assess the overlapping and non-overlapping explanatory power of each of them. Results: Health status and MiL were found to be the most important predictors of loneliness, followed by social connectedness and, with a much lower weight, lifestyles, and socio-demographic factors. Within the MiL factor, the most cognitive component, sense of coherence, had a greater explanatory power than the more affective and motivational ones. Conclusion: Reduced MiL, the capacity of an individual to attach "value and significance" to life, is a crucial predictor to the feeling of loneliness. These results suggest that programs aiming to combat loneliness should go well beyond situational interventions and include more cognitive, value-centered interventions that enable individuals to define and pursue a meaningful vital plan.

The paradoxical effect of COVID-19 outbreak on loneliness

As in previous periods of quarantine, lockdown confinement measures dictated to control SARS-CoV-2 would be expected to negatively affect mental health. We investigated the immediate effects (over a 10 day period) of a strict nationwide stay-at-home order imposed in Spain, one of the countries most affected by the COVID-19 pandemic. Focusing our analysis on the feelings of loneliness, we obtained our measures within a social context characterised by strong and continuous public and governmental support for increasing social bonds and cooperation in order to face the common public threat. Leveraging data from the Barcelona Brain Health Initiative, a prospective population-based study cohort, the short UCLA Loneliness Scale was administered to 1604 participants 2 years and 1 year before the stay-at-home lockdown and repeated, on average, 10 days after the official confinement order issued by the Spanish government. Ratings of loneliness remained stable during the 2 years before lockdown; however, they decreased significantly during the early stages of home confinement. This effect was particularly significant for the item 'feeling excluded from others' and was also observed among individuals who were confined alone. Overall, the results suggest that gestures and manifestations of appreciation by people for the labour and efforts of certain individuals, along with official campaigns designed to promote feelings of inclusion and belonging, may have beneficial effects on feelings of loneliness, a negative emotional state strongly regarded as a risk factor for impaired mental and general health status. Further assessments during the later stages of home confinement are now warranted.

Meaning in life: resilience beyond reserve

Background

The contribution of psychological factors to brain health and resilience remains poorly investigated. Furthermore, their possible interaction with ‘classical’ cognitive reserve (CR) estimates in predicting perceived mental health and cognitive status has not been specifically addressed.

Methods

We obtained data from 1081 adults responding to questionnaires on the three meaning in life (MiL) dimensions: purpose in life (PiL), sense of coherence (SoC), and engagement with life (EwL). A questionnaire on CR variables was also administered. The outcome measures were self-reported cognitive function and affective status (depression, stress, and anxiety). Multiple linear regression analyses were used to evaluate the association between sociodemographic variables, MiL dimensions, and CR with the two selected outcomes. Mediation analyses, adjusted for age and gender, were applied to determine whether the MiL dimensions mediated the putative effects of CR on self-reported mental and cognitive health.

Results

All three MiL components, but not CR estimates, correlated with the self-reported affective status of the participants. Higher CR, PiL, and SoC (but not EwL) scores significantly correlated with higher perceived cognitive function. Notably, the observed association between the CR measures and self-reported cognitive function was mediated by PiL and SoC.

Conclusions

Psychological MiL dimensions mediate the association between classic CR estimates and self-perceived cognitive function. Further studies on CR could consider including formal measures of such psychological factors to better understand their unique or synergistic contributions, as well as investigate the associated mechanisms maintaining brain function at older ages.

Electronic supplementary material

The online version of this article (10.1186/s13195-018-0381-z) contains supplementary material, which is available to authorized users.

A customized home-based computerized cognitive rehabilitation platform for patients with chronic-stage stroke: study protocol for a randomized controlled trial

BACKGROUND

Stroke patients usually suffer primary cognitive impairment related to attention, memory, and executive functions. This impairment causes a negative impact on the quality of life of patients and their families, and may be long term. Cognitive rehabilitation has been shown to be an effective way to treat cognitive impairment and should be continued after hospital discharge. Computerized cognitive rehabilitation can be performed at home using exercise programs that advance with predetermined course content, interval, and pace. We hypothesize that computerized rehabilitation might be improved if a program could customize course content and pace in response to patient-specific progress. The present pilot study is a randomized controlled double-blind crossover clinical trial aiming to study if chronic stroke patients with cognitive impairment could benefit from cognitive training through a customized tele-rehabilitation platform ("Guttmann, NeuroPersonalTrainer"®, GNPT®).

METHODS/DESIGN

Individuals with chronic-stage stroke will be recruited. Participants will be randomized to receive experimental intervention (customized tele-rehabilitation platform, GNPT®) or sham intervention (ictus.online), both with the same frequency and duration (five sessions per week over 6 weeks). After a washout period of 3 months, crossover will occur and participants from the GNPT® condition will receive sham intervention, while participants originally from the sham intervention will receive GNPT®. Patients will be assessed before and after receiving each treatment regimen with an exhaustive neuropsychological battery. Primary outcomes will include rating measures that assess attention difficulties, memory failures, and executive dysfunction for daily activities, as well as performance-based measures of attention, memory, and executive functions.

DISCUSSION

Customized cognitive training could lead to better cognitive function in patients with chronic-stage stroke and improve their quality of life.

TRIAL REGISTRATION

NCT03326349 . Registered 31 October 2017.

Tissue Quantification of CA 125 in Epithelial Ovarian Cancer

The objectives of this study were the determination of CA 125 in the cytosol of healthy and carcinomatous ovarian tissue by immunoanalysis, analysis of its correlation with the biological characteristics of ovarian carcinoma, determination of serum CA 125 levels, and study of the prognostic value of the marker in cytosol. The levels of the marker depend not only on the tumor's production rate, so its determination in tissue can indicate more accurately if the tumor is a producer of the marker and establish its value for the prognosis of the disease. Determination of CA 125 in tissue was performed by immunoanalysis in 50 ovarian epithelial cancer samples, 13 benign pathology samples and 32 healthy ovary samples. The presurgical serum level of the marker was also obtained. The correlation between the CA 125 level in the cytosol and the different biological characteristics of the ovarian carcinoma, the serum levels of the marker and survival were analyzed. The CA 125 level proved to be higher in malignant tissue (p<0.0001). There was a significant association between the tissue marker and histological type (high CA 125 was associated with serous and endometrioid tumors) and between the marker and survival. No relation with stage was found. There was a correlation between the CA 125 level in the cytosol and serum, both variables being dependent, with a correlation coefficient of 0.44. This good correlation speaks in favor of the usefulness of CA 125 determination in serum in the follow-up of ovarian cancer. Tumors having high tissue expression of CA 125 were found to have a double relative risk of death, independently of tumor stage.

Advancing Telemedicine Services for the Aging Population: The challenge of Interoperability

We reflect on our experiences in two projects in which we developed interoperable telemedicine applications for the aging population. While technically data exchange could be implemented technically, uptake was impeded by a lack of working procedures. We argue that development of interoperable health technology for the aging population should go accompanied by a thorough study into working protocols by consulting all end-users and stakeholders.

Intelligent Therapy Assistant (ITA) for cognitive rehabilitation in patients with acquired brain injury

Background

This paper presents the design, development and first evaluation of an algorithm, named Intelligent Therapy Assistant (ITA), which automatically selects, configures and schedules rehabilitation tasks for patients with cognitive impairments after an episode of Acquired Brain Injury. The ITA is integrated in “Guttmann, Neuro Personal Trainer” (GNPT), a cognitive tele-rehabilitation platform that provides neuropsychological services.

Methods

The ITA selects those tasks that are more suitable for the specific needs of each patient, considering previous experiences, and improving the personalization of the treatment. The system applies data mining techniques to cluster the patients according their cognitive impairment profile. Then, the algorithm rates every rehabilitation task, based on its cognitive structure and the clinical impact of executions done by similar patients. Finally, it configures the most suitable degree of difficulty, depending on the impairment of the patient and his/her evolution during the treatment.

Results

The ITA has been evaluated during 18 months by 582 patients. In order to evaluate the effectiveness of the ITA, a comparison between the traditional manual planning procedure and the one presented in this paper has been done, taking into account: a) the selected tasks assigned to rehabilitation sessions; b) the difficulty level configured for the sessions; c) and the improvement of their cognitive capacities after completing treatment.

Conclusions

The obtained results reveal that the rehabilitation treatment proposed by the ITA is as effective as the one performed manually by therapists, arising as a new powerful support tool for therapists. The obtained results make us conclude that the proposal done by the ITA is very close to the one done by therapists, so it is suitable for real treatments.

Cognitive neurorehabilitation based on interactive video technology

Cognitive impairment is the main cause of disability in developed societies. New interactive technologies help therapists in neurorehabilitation in order to increase patients' autonomy and quality of life. This work proposes Interactive Video (IV) as a technology to develop cognitive rehabilitation tasks based on Activities of Daily Living (ADL). ADL cognitive task has been developed and integrated with eye-tracking technology for task interaction and patients' performance monitoring.

[Complications after endothelial keratoplasty: three years of experience]

OBJECTIVE

To study the complications after Descemet's stripping automated endothelial keratoplasty (DSAEK).

METHODS

Retrospective study of 75 eyes in 67 patients with Fuchs' endothelial dystrophy or bullous keratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. All surgical and post-surgical complications, as well as the endothelial cell density were recorded.

RESULTS

Graft detachment was the most common complication: 17 cases (22.5%); 16 of them resolved with reintroduction of air in the anterior chamber. The rate of detachment in cases without capsular support (8 eyes) increased up to 50%. Five cases had primary graft failure and, in 2 cases, a medium term failure was observed. Only one case of endothelial rejection was observed (1.3%). Five eyes (6.5%) developed a pupillary block, but of them were solved with the aspiration of the air. In one eye (1.3%), a posterior capsule rupture was observed during the phacoemulsification. This case ended with a retinal detachment. The endothelial cell loss was 42.75%.

CONCLUSIONS

DSAEK is an effective surgical technique to resolve the corneal oedema due to endothelial failure; however, complications are not uncommon. Graft detachment is the most common complication, but is usually resolved with re-bubbling. There is an evident learning curve and the surgical trauma to the endothelium is the most important factor that influences the endothelial cell loss.

[Functional results after endothelial queratoplasty: three years of experience]

OBJECTIVE

To study the refractive and visual results after Descemet's stripping automated endothelial queratoplasty (DSAEK).

METHODS

Retrospective study of 75 eyes in 67 patients with Fuchs' endothelial dystrophy or bullous queratopathy operated on in the Instituto de Oftalmología La Arruzafa from March, 2007 until March, 2010. Phacoemulsification and IOL implantation was involved in 30 cases. We divided all cases into three groups, depending on the potential visual acuity: A (≤ 0.1), B (0.1-0.5) and C (≥ 0.5). Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA) and refraction were measured.

RESULTS

Mean CDVA improved 3 lines compared to preoperative values (P<.01). Astigmatism increased by 0.5 dioptres (P=.21). A slight myopic change was found in cases where the donor disc was≥8.5mm, as well as in the cases in which phacoemulsification was associated. No correlation between CDVA and donor disc thickness was found. In the group of patients who only had corneal oedema, the mean CDVA was 0.8. No patients ended with less than 0.6 of CDVA and the mean UCVA was 0.5.

CONCLUSIONS

After DSAEK, CDVA improved with a slight hyperopic change, without significant changes in astigmatism. Donor disc thickness does not influence the CDVA. DSAEK is an effective surgical technique to restore a good visual acuity in cases with corneal oedema due to endothelial failure.

Upper limb portable motion analysis system based on inertial technology for neurorehabilitation purposes

Here an inertial sensor-based monitoring system for measuring and analyzing upper limb movements is presented. The final goal is the integration of this motion-tracking device within a portable rehabilitation system for brain injury patients. A set of four inertial sensors mounted on a special garment worn by the patient provides the quaternions representing the patient upper limb’s orientation in space. A kinematic model is built to estimate 3D upper limb motion for accurate therapeutic evaluation. The human upper limb is represented as a kinematic chain of rigid bodies with three joints and six degrees of freedom. Validation of the system has been performed by co-registration of movements with a commercial optoelectronic tracking system. Successful results are shown that exhibit a high correlation among signals provided by both devices and obtained at the Institut Guttmann Neurorehabilitation Hospital.

[Colostomy morbidity in children with anorectal malformations (ARM)]

OBJECTIVE

To describe the incidence and type of complications presented in the patients with ARM treated with a colostomy.

MATERIAL AND METHODS

The patients data with diagnostic of ARM and colostomy beetween 1994 and 2005 were revised.

RESULTS

The colostomy was carried out in other centers in 185 patients (75.2%) and in our institution in 61 (24.8%). Two hundred eleven (85.8%) had a sigmoid colostomy. Only 124 patients had a diverting colostomy. Sigmoid colon was erroneously used as transverse in 2 cases. The space among the ostomies was very scarce in 10 and excessive in 5. The colostomy complications were retraction in 7, prolapse in 7, closure of the distal opening in 5, proximal stenosis in 3, ostomy necrosis in 1 and the paraostomal hernia in 2. Complications related to the colostomy closure were intestinal occlusion in 1, abscess of abdominal wall in 1 and incisional hernia in 2.

CONCLUSIONS

The colostomy morbidity in patients with ARM is flashy. This procedure should not be considered a procedure of little complexity by the implications that has in the treatment of the patients with ARM.

[Clinical trial of tiapride in patients with dyskinesia (author's transl)]

Twenty-five patients with various forms of dyskinesia were given tiapride for three months. Maximal dosage was 900 mg per day. A double-blind trial of tiapride versus placebo showed significantly better results in the group given tiapride. The forms of dyskinesia which responded best to tiapride were the following: iatrogenic dyskinesia, tics (Gilles de la Tourette syndrome), and chronic chorea (Huntington disease). Patients with complex dyskinesia resulting from neonatal encephalopathy or vascular disease were not improved. The protocol used in l-dopa-induced dyskinesia is described. Changes in dyskinesia and "on-off" effect following variations in tiapride and l-dopa dosage are detailed. An unequivocal, although minor, tiapride-induced parkinson syndrome was recorded in a few patients. No instances of tiapride-induced dyskinesia or akathisia were seen. The other side-effects were either psychic (depression, drowsiness, agitation) or endocrinologic (menstrual disorders, overeating, galactorrhea).