Manifestations, social impact, and decay of conceptual beliefs: A cultural perspective

INTRODUCTION

Believing comprises multifaceted processes that integrate information from the outside world through meaning-making processes with personal relevance.

METHODS

Qualitative Review of the current literature in social cognitive neuroscience.

RESULTS

Although believing develops rapidly outside an individual's conscious awareness, it results in the formation of beliefs that are stored in memory and play an important role in determining an individual's behavior. Primal beliefs reflect an individual's experience of objects and events, whereas conceptual beliefs are based on narratives that are held in social groups. Conceptual beliefs can be about autobiographical, political, religious, and other aspects of life and may be encouraged by participation in group rituals. We hypothesize that assertions of future gains and rewards that transcend but are inherent in these codices provide incentives to follow the norms and rules of social groups.

CONCLUSION

The power of conceptual beliefs to provide cultural orientation is likely to fade when circumstances and evidence make it clear that what was asserted no longer applies.

Evolution of neurodegeneration in patients with normal pressure hydrocephalus: a monocentric follow up study

BACKGROUND

The aim of this study was to examine in patients with idiopathic and neurodegenerative normal pressure hydrocephalus (NPH) if motor and cognitive performance as well as changes in biomarkers in cerebrospinal fluid (CSF) evolve differently.

METHODS

41 patients with a typical clinical and MR-/CT-morphological presentation of NPH divided into an Alzheimer-negative (AD-, n = 25) and an Alzheimer-positive (AD+, n = 16) group according to neurodegenerative biomarkers (S100 protein, neuron-specific enolase, β-amyloid 1-42, Tau protein, phospho-Tau, protein-level and CSF pressure) in CSF. Follow-up of cognitive and gait functions before and after a spinal tap of 40-50 ml CSF of up to 49 months. Clinical, motor, neuropsychological and CSF biomarkers were analyzed using a repeated multifactorial analysis of variance (ANOVA) with post-hoc testing.

RESULTS

Gait and neuropsychological performance and CSF biomarkers evolved differently between the AD- and AD+ patients. In particular, the AD+ patients benefited from the spinal tap regarding short-term memory. In contrast, gait parameters worsened over time in the AD+ patients, although they showed a relevant improvement after the first tap.

CONCLUSIONS

The results substantiate the recently reported association between a tap-responsive NPH and CSF changes of Alzheimer disease. Furthermore, they suggest that the AD changes in CSF manifest in an age-related fashion in AD- patients presenting with NPH.

Bridging the gap between believing and memory functions

Believing has recently been recognized as a fundamental brain function linking a person’s experience with his or her attitude, actions and predictions. In general, believing results from the integration of ambient information with emotions and can be reinforced or modulated in a probabilistic fashion by new experiences. Although these processes occur in the subliminal realm, humans can become aware of what they believe and express it verbally. We explain how believing is interwoven with memory functions in a multifaceted fashion. Linking the typically rapid and adequate reactions of a subject to what he/she believes is enabled by working memory. Perceptions are stored in episodic memory as beneficial or aversive events, while the corresponding verbal descriptions of what somebody believes are stored in semantic memory. After recall from memory of what someone believes, personally relevant information can be communicated to other people. Thus, memory is essential for maintaining what people believe.

Human interaction with the divine, the sacred, and the deceased: topics that warrant increased attention by psychologists

Humans have likely been attempting to communicate with entities believed to exist, such as the divine, sacred beings, and deceased people, since the dawn of time. Across cultures and countries, many believe that interaction with the immaterial world is not only possible but a frequent experience. Most religious traditions across the globe focus many rituals and activities around prayer to an entity deemed divine or sacred. Additionally, many people–religious, agnostic, and atheists alike–report communication with their departed loved ones. During highly stressful times associated with natural disasters, war, pandemics, and other threats to human life, the frequency and intensity of these activities and associated experiences substantially increase. Although this very human phenomenon seems to be universal, the empirical literature on the topic within psychology is thin. This paper discussed the topic and reviews what we know from the professional literature about how people perceive communication with these unseen entities. It highlights the perceptual and social cognition evidence and discussed the role of attribution theory, which might help us understand the beliefs, motivations, and practices of those engaged with communication with the unseen. Empirical laboratory research with mediums is discussed as well, examining the evidence for communication with the deceased. Final reflections and suggestions for future research are also offered.

Believing and social interactions: effects on bodily expressions and personal narratives

The processes of believing integrate external perceptual information from the environment with internal emotional states and prior experience to generate probabilistic neural representations of events, i.e., beliefs. As these neural representations manifest mostly below the level of a person's conscious awareness, they may inadvertently affect the spontaneous person's bodily expressions and prospective behavior. By yet to be understood mechanisms people can become aware of these representations and reflect upon them. Typically, people can communicate the content of their beliefs as personal statements and can summarize the narratives of others to themselves or to other people. Here, we describe that social interactions may benefit from the consistency between a person's bodily expressions and verbal statements because the person appears authentic and ultimately trustworthy. The transmission of narratives can thus lay the groundwork for social cooperation within and between groups and, ultimately, between communities and nations. Conversely, a discrepancy between bodily expressions and narratives may cause distrust in the addressee(s) and eventually may destroy social bonds.

Believing Processes during the COVID-19 Pandemic: A Qualitative Analysis

Cognition, emotion, emotional regulation, and believing play a special role in psychosocial functioning, especially in times of crisis. So far, little is known about the process of believing during the COVID-19 pandemic. The aim of this study was to examine the process of believing (using the Model of Credition) and the associated psychosocial strain/stress during the first lockdown in the COVID-19 pandemic. An online survey via LimeSurvey was conducted using the Brief Symptom Inventory-18 (BSI-18), the Pittsburgh Sleep Quality Index (PSQI), and a dedicated Believing Questionnaire, which assesses four parameters of credition (propositions, certainty, emotion, mightiness) between April and June, 2020, in Austria. In total, n = 156 mentally healthy participants completed all questionnaires. Negative credition parameters were associated with higher global symptom load (from BSI-18): narratives: r = 0.29, p < 0.001; emotions r = 0.39, p < 0.001. These findings underline the importance of credition as a link between cognition and emotion and their impact on psychosocial functioning and stress regulation in implementing novel strategies to promote mental health.

Believing processes during the COVID-19 pandemic in individuals with bipolar disorder: An exploratory study

BACKGROUND

Believing or “credition” refers to psychological processes that integrate the cognitions and emotions that influence our behavior. In the credition model by Angel and Seitz, four parameters are postulated: proposition, certainty, emotion and mightiness. It is assumed that believing processes are influenced by both the individual as well as socio-cultural factors and external circumstances. External or environmental circumstances can include threatening situations such as the ongoing pandemic. It has been hypothesized that believing processes related to the pandemic differ between individuals with bipolar disorder (BD) and healthy controls (HC).

AIM

To investigate credition in individuals with BD during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Psychiatrically stable individuals with BD (n = 52) and age- and sex matched HC (n = 52) participated in an online survey during the first lockdown of the COVID-19 pandemic. The survey took place between April 9^th and June 4^th, 2020, in Austria. Participants completed the Brief Symptom Inventory-18, the Beck Depression Inventory-II, the Altman Self-Rating Mania Scale, the Pittsburgh Sleep Quality Index and a dedicated Believing Questionnaire assessing four parameters of credition (proposition, certainty, emotion and mightiness). The MAXQDA software was used to analyze the qualitative data. Statistical analyses included analyses of variance, a multivariate analysis of variance and a multivariate analysis of co-variance.

RESULTS

Individuals with BD reported significantly more negative propositions [F (1,102) = 8.89, P = 0.004, η²_p = 0.08] and negative emotions [Welch´s F (1,82.46) = 18.23, P < 0.001, η²_p = 0.18], while HC showed significantly more positive propositions [F (1,102) = 7.78, P = 0.006, η²_p = 0.07] and emotions [F (1,102) = 14.31, P < 0.001, η²_p = 0.12]. In addition, individuals with BD showed a higher incongruence between their propositions and their emotions [F (1,102) = 9.42, P = 0.003, η²_p = 0.08] and showed strong correlations between the parameters of the Believing Questionnaire and their psychiatric symptoms (r = 0.51-0.77, all P < 0.001). Positive as well as negative emotions and propositions were associated with scores measuring symptoms of depression, anxiety and sleep quality.

CONCLUSION

Believing parameters were associated with psychiatric symptoms in BD during the pandemic. Findings broaden knowledge about the susceptibility of believing processes for ambient challenges in individuals with BD.

Reversal of Acute Spinal Cord Ischemia by Intravenous Thrombolysis

Acute non-traumatic ischemic myelopathy is a devastating condition with a typically poor outcome occurring in adults, adolescents and even children [1-3]. The acute onset of paraplegia and sensory loss are suggestive of spinal ischemia with little recovery potential [1, 4, 5]. Due to the lack of sufficient data there are no standardized guidelines regarding the acute treatment of spinal ischemia. While intravenous thrombolysis is a well established and effective treatment in cerebral ischemia, its efficacy in spinal cord ischemia has not yet been proven [5]. We report the case of a young female patient with acute spinal cord ischemia in whom treatment with systemic thrombolysis lead to a complete reversal of paraplegia.

Believing processes around COVID-19 vaccination: An exploratory study investigating workers in the health sector

BACKGROUND

The processes underlying believing have been labeled "creditions", which are important brain functions between emotion and cognition. Creditions are influenced by both internal and external factors, one of which is the coronavirus disease 2019 (COVID-19) pandemic and the vaccination against the disease.

METHODS

To investigate believing processes shortly before the implementation of a mandatory vaccination in Austria, both vaccinated and unvaccinated workers in the health sector (WHS) were surveyed in December 2021/January 2022. In total, 1,062 vaccinated and 97 unvaccinated WHS (920 females) completed the online survey. Beliefs were assessed using the parameters of the credition model (narrative, certainty, emotion, and mightiness) with regard to (1) the COVID-19 pandemic in general, and (2) the vaccination. Type of emotion and narrative were divided into positive, negative, and indifferent. Moreover, the congruence between emotion and narrative was calculated.

RESULTS

The vaccination rate of the sample was 91.6%, with a significantly higher percentage of men being in the group of vaccinated (21.1%) as compared to unvaccinated individuals (12.4%). Pertaining beliefs about the COVID-19 vaccination, unvaccinated WHS reported more negative and less positive emotions as well as content of narrative than vaccinated WHS. In addition, they showed higher levels of certainty as well as mightiness while believing and felt less sufficiently informed about governmental and workplace-related COVID-19 measures. The groups did not differ in the type of emotion or content of narrative in their beliefs about the pandemic in general.

CONCLUSION

In conclusion, unvaccinated WHS had more negative and less positive emotions and thoughts than vaccinated WHS in their beliefs about the COVID-19 vaccination and their motivations for not having received it. They were more certain about their beliefs and felt stronger negative emotions in their beliefs compared to vaccinated individuals. Providing unvaccinated WHS with adequate information might be helpful in reducing their mental burden.

Structural Connectivity Remote From Lesions Correlates With Somatosensory Outcome Poststroke

[Figure: see text].

Beliefs: A challenge in neuropsychological disorders

INTRODUCTION

Beliefs have recently been defined as the neural product of perception of objects and events in the external world and of an affirmative internal affective state reflecting personal meaning. It is, however, undetermined in which way diseases of the brain affect these integrative processes.

METHODS

Here, the formation and updating of abnormal beliefs in cerebral disorders are described.

RESULTS

It will be shown that well-defined neuropsychological syndromes resulting from brain lesions also interfere with the neural processes that enable the formation, up-dating and communication of beliefs. Similarly, in neuropsychiatric disorders abnormal and delusional beliefs appear to be caused by altered perception and/or misattribution of aversive meaning.

CONCLUSION

Given the importance of beliefs for ordinary social behaviour, abnormal beliefs are a challenge in neuropsychological disorders.

Deficient visuomotor hand coordination in normal pressure hydrocephalus

Objective

To investigate if visuomotor coordination of hand movements is impaired in patients with normal pressure hydrocephalus (NPH) identified by dedicated testing procedures.

Methods

Forty-seven patients admitted for diagnostic workup for suspected NPH were studied prospectively with MRI, testing of cognitive and motor functions, lumbar puncture, and visuomotor coordination of hand movements using the PABLO^R-device before and after a spinal tap of 40–50 ml CSF. Statistical analyses were carried out with repeated measures ANOVA and non-parametric correlation analyses.

Results

Fourteen patients were found to suffer from ideopathic NPH. They were severely impaired in visuomotor control of intermittent arm movements in comparison to patients who were found not to be affected by NPH (n = 18). In the patients with NPH the deficient arm control was improved after the spinal tap in proportion to the improvement of gait. There was no improvement of cognitive and motor functions in the patients not affected by NPH, while the patients with possible NPH (n = 15) showed intermediate deficit and improvement patterns.

Interpretation: Our data underline the importance of a multiparametric assessment of NPH and provide evidence for a motor control deficit in idiopathic NPH involving leg and arm movements. It is suggested that this motor control deficit resulted from an affection of the output tracts from the supplementary motor area in the periventricular vicinity.

Association of Cerebrospinal Fluid S100B Protein with Core Biomarkers and Cognitive Deficits in Prodromal and Mild Alzheimer's Disease

BACKGROUND

Increased expression of the astroglial Ca2+-binding protein S100B has been observed in various neurodegenerative diseases and also seems to play a role in the unfolding of pathophysiological events at early stages of Alzheimer's disease (AD).

OBJECTIVE

To examine the association of cerebrospinal fluid (CSF) levels of S100B with 1) established CSF core biomarkers total tau (tau), hyperphosphorylated tau (p-tau), and amyloid β1-42 (Aβ1-42) as well as neuron-specific enolase (NSE) CSF levels and 2) cognition in early AD and mild cognitive impairment (MCI) due to AD (MCI-AD).

METHODS

Retrospective study assessing 49 pooled charts of Memory Clinic and inpatients diagnosed with AD (N = 26) and MCI-AD (N = 23) according to the National Institute of Aging and Alzheimer's Disease Association (NIA-AA) criteria. Neuropsychological testing was performed with the Consortium to Establish a Registry for AD (CERAD)-Plus battery.

RESULTS

CSF levels of S100B correlated with NSE, but not the other CSF parameters. Stepwise multiple linear regression, adjusted for age, sex, and educational level, revealed that only increased CSF S100B was independently associated with lower CERAD-Plus total and Mini-Mental Status Examination scores together with poorer performance in wordlist learning (delayed recall and overall performance). We found no independent associations with other CSF biomarkers or cognitive domains.

CONCLUSION

Our data suggest that CSF S100B may have a diagnostic value particularly at early stages of AD reflecting the significance of neuroinflammatory/astroglial processes. Thus, CSF S100B may complement the established array of available AD biomarkers to improve early stage diagnosis.

Normal Pressure Hydrocephalus Associated with Alzheimer's Disease

OBJECTIVE

The aim was to investigate whether neurodegenerative biomarkers in cerebrospinal fluid (CSF) differentiate patients with suspected normal pressure hydrocephalus (NPH) who respond to CSF drainage from patients who do not respond.

METHODS

Data from 62 consecutive patients who presented with magnetic resonance imaging changes indicative of NPH were studied with regard to cognitive and gait functions before and after drainage of 40-50ml of CSF. Additionally, S100 protein, neuron-specific enolase, β-amyloid protein, tau protein and phospho-tau were determined in CSF. Statistical analyses were carried out with ANOVA and multiple linear regression.

RESULTS

Patients with CSF constellations typical for Alzheimer's disease (n = 28) improved significantly in cognitive and gait-related functions after CSF drainage. In contrast, those patients without a CSF constellation typical for Alzheimer's disease (n = 34) did not improve in cognitive and gait-related functions after CSF drainage. In addition, positive CSF biomarkers for Alzheimer's disease predicted these improvements.

INTERPRETATION

Our data suggest an association between Alzheimer's disease and NPH changes, supporting the recently suggested dichotomy of a neurodegenerative NPH and a true idiopathic NPH, with the latter appearing to be rare. ANN NEUROL 2020;88:703-711.

Reduced gray matter volume in the left prefrontal, occipital, and temporal regions as predictors for posttraumatic stress disorder: a voxel-based morphometric study

The concept of acute stress disorder (ASD) was introduced as a diagnostic entity to improve the identification of traumatized people who are likely to develop posttraumatic stress disorder (PTSD). Neuroanatomical models suggest that changes in the prefrontal cortex, amygdala, and hippocampus play a role in the development of PTSD. Using voxel-based morphometry, this study aimed to investigate the predictive power of gray matter volume (GMV) alterations for developing PTSD. The GMVs of ASD patients (n = 21) were compared to those of PTSD patients (n = 17) and healthy controls (n = 18) in whole-brain and region-of-interest analyses. The GMV alterations seen in ASD patients shortly after the traumatic event (T1) were also correlated with PTSD symptom severity and symptom clusters 4 weeks later (T2). Compared with healthy controls, the ASD patients had significantly reduced GMV in the left visual cortex shortly after the traumatic event (T1) and in the left occipital and prefrontal regions 4 weeks later (T2); no significant differences in GMV were seen between the ASD and PTSD patients. Furthermore, a significant negative association was found between the GMV reduction in the left lateral temporal regions seen after the traumatic event (T1) and PTSD hyperarousal symptoms 4 weeks later (T2). Neither amygdala nor hippocampus alterations were predictive for the development of PTSD. These data suggest that gray matter deficiencies in the left hemispheric occipital and temporal regions in ASD patients may predict a liability for developing PTSD.

Belief formation - A driving force for brain evolution

The topic of belief has been neglected in the natural sciences for a long period of time. Recent neuroscience research in non-human primates and humans, however, has shown that beliefs are the neuropsychic product of fundamental brain processes that attribute affective meaning to concrete objects and events, enabling individual goal setting, decision making and maneuvering in the environment. With regard to the involved neural processes they can be categorized as empirical, relational, and conceptual beliefs. Empirical beliefs are about objects and relational beliefs are about events as in tool use and in interactions between subjects that develop below the level of awareness and are up-dated dynamically. Conceptual beliefs are more complex being based on narratives and participation in ritual acts. As neural processes are known to require computational space in the brain, the formation of inceasingly complex beliefs demands extra neural resources. Here, we argue that the evolution of human beliefs is related to the phylogenetic enlargement of the brain including the parietal and medial frontal cortex in humans.

Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany-Updated series of 120 cases

BACKGROUND

Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth.

AIMS

To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage.

METHODS

Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used.

RESULTS

One-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0-3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay.

CONCLUSION

Administration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.

Spontaneous Arm Movement Activity during Sleep in Epileptic and Non-Epileptic Patients

PURPOSE

Epilepsy has a complex interaction with sleep. The purpose of this study was to explore the relation between spontaneous arm movements and sleep architecture in patients with epilepsy.

METHODS

This prospective study included 53 patients with suspected epilepsy (44 ± 18 years; 30 females, 23 males) and 55 age-matched patients with non-epileptic seizures (42 ± 15: 27 females, 28 males). Twenty-four-hour-video-electroencephalography recordings were combined with accelerometry of movement activity of both arms using actiwatches.

RESULTS

Patients with suspected epilepsy showed a higher occurrence of epileptic discharges (p = 0.0001) and abnormal focal slowing (p = 0.027) in the electroencephalogram (EEG) than the patients with non-epileptic seizures. Also, the epilepsy patients showed a shorter rapid eye movement-sleep duration compared to controls (0.0001). Accelerometry revealed that the patients with epilepsy moved their dominant right arm more frequently during the night (p = 0.014) than the controls, although there was no difference in arm movement activity during day time.

CONCLUSION

The patients with reported epilepsy exhibited higher spontaneous arm movement activity during sleep. This may be related to abnormal sleep architecture or abnormal EEG activity but was not related to epileptic seizures.

Cytoarchitecture, probability maps, and functions of the human supplementary and pre-supplementary motor areas

The dorsal  mesial frontal cortex contains the supplementary motor area (SMA) and the pre-supplementary motor area (pre-SMA), which play an important role in action and cognition. Evidence from cytoarchitectonic, stimulation, and functional studies suggests structural and functional divergence between the two subregions. However, a microstructural map of these areas obtained in a representative sample of brains in a stereotaxic reference space is still lacking. In the present study we show that the dorsal mesial frontal motor cortex comprises two microstructurally different brain regions: area SMA and area pre-SMA. Area-specific cytoarchitectonic patterns were studied in serial histological sections stained for cell bodies of ten human postmortem brains. Borders of the two cortical areas were identified using image analysis and statistical features. The 3D reconstructed areas were transferred to a common reference space, and probabilistic maps were calculated by superimposing the individual maps. A coordinate-based meta-analysis of functional imaging data was subsequently performed using the two probabilistic maps as microstructurally defined seed regions. It revealed that areas SMA and pre-SMA were strongly co-activated with areas in precentral, supramarginal and superior frontal gyri, Rolandic operculum, thalamus, putamen and cerebellum. Both areas were related to motor functions, but area pre-SMA was involved in more complex processes such as learning, cognitive processes and perception. The here described subsequent analyses led to converging evidence supporting the microstructural, and functional segregation of areas SMA and pre-SMA, and maps will be made available to the scientific community to further elucidate the microstructural substrates of motor and cognitive control.

From Believing to Belief: A General Theoretical Model

Cognitive neuroscience research has begun to explore the mental processes underlying what a belief and what believing are. Recent evidence suggests that believing involves fundamental brain functions that result in meaningful probabilistic representations, called beliefs. When relatively stable, these beliefs allow for guidance of behavior in individuals and social groups. However, they are also fluid and can be modified by new relevant information, interpersonal contact, social pressure, and situational demands. We present a theoretical model of believing that can account for the formation of both empirically grounded and metaphysical beliefs.

Posterior and prefrontal contributions to the development posttraumatic stress disorder symptom severity: an fMRI study of symptom provocation in acute stress disorder

Acute stress disorder (ASD) is predictive of the development of posttraumatic stress disorder (PTSD). In response to symptom provocation, the exposure to trauma-related pictures, ASD patients showed increased activation of the medial posterior areas of precuneus and posterior cingulate cortex as well as of superior prefrontal cortex in a previous study. The current study aimed at investigating which activated areas are predictive of the development of PTSD. Nineteen ASD patients took part in an fMRI study in which they were shown personalized trauma-related and neutral pictures within 4 weeks of the traumatic event. They were assessed for severity of PTSD 4 weeks later. Activation contrasts between trauma-related and neutral pictures were correlated with subsequent PTSD symptom severity. Greater activation in, among others, right medial precuneus, left retrosplenial cortex, precentral and right superior temporal gyrus as well as less activation in lateral, superior prefrontal and left fusiform gyrus was related to subsequently increased PTSD severity. The results are broadly in line with neural areas related to etiological models of PTSD, namely multisensory associative learning recruiting posterior regions on the one hand and failure to reappraise maladaptive cognitions, thought to involve prefrontal areas, on the other.

Violations of Expectations As Matter for the Believing Process

For the purpose of this communication it is postulated that violation of expectation means a disturbing event or conflict interfering with a previously established mental state that affords a firm belief or confident feeling. According to this hypothesis a violation of an expectation contradicts predictions and intentions that have been attained on stored experiences, valuations, and actual mood. We will argue that the notion of belief as static or stable which is usually described by expressions such as "my belief" or "our general belief" has to be extended to accommodate the process of belief formation. The credition model emphasizes the procedural aspect of belief by which the "process of believing" becomes similar to other psychological processes. We will describe that the "violation of expectation" can be decoded from the credition perspective and has brain functional correlates.

Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany – A national case collection

Background

Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran that reverses its anticoagulant effects within minutes. It may exhibit the potential for patients under dabigatran therapy suffering ischemic stroke to regain eligibility for thrombolysis with rt-PA and may inhibit lesion growth in patients with intracerebral hemorrhage on dabigatran.

Aims

To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of ischemic stroke or intracranial hemorrhage.

Methods

Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January to August 2016 were used.

Results

Thirty-one patients presenting with signs of stroke received idarucizumab in 22 stroke centers. Nineteen patients treated with dabigatran presented with ischemic stroke and 12 patients suffered from intracranial bleeding. In patients receiving rt-PA thrombolysis following idarucizumab, 79% benefitted from i.v. thrombolysis with a median improvement of five points in NIHSS. No bleeding complications occurred. Hematoma growth was observed in 2 out of 12 patients with intracranial hemorrhage. The outcome was favorable with a median NIHSS improvement of 5.5 points and mRS 0–3 in 67%. Overall, mortality was low with 6.5% (one patient in each group).

Conclusion

Administration of rt-PA after reversing dabigatran activity with idarucizumab in case of ischemic stroke is feasible, easy to manage, effective, and appears to be safe. In dabigatran-associated intracranial hemorrhage, idarucizumab has the potential to prevent hematoma growth and improve outcome. Idarucizumab represents a new therapeutic option for patients under dabigatran treatment presenting with ischemic stroke or intracranial hemorrhage.

Processes of believing: Where do they come from? What are they good for?

Despite the long scholarly discourse in Western theology and philosophy on religion, spirituality, and faith, explanations of what a belief and what believing is are still lacking. Recently, cognitive neuroscience research addressed the human capacity of believing. We present evidence suggesting that believing is a human brain function which results in probabilistic representations with attributes of personal meaning and value and thereby guides individuals’ behavior. We propose that the same mental processes operating on narratives and rituals constitute belief systems in individuals and social groups. Our theoretical model of believing is suited to account for secular and non-secular belief formation.

Processes of believing: Where do they come from? What are they good for?

Despite the long scholarly discourse in Western theology and philosophy on religion, spirituality, and faith, explanations of what a belief and what believing is are still lacking. Recently, cognitive neuroscience research addressed the human capacity of believing. We present evidence suggesting that believing is a human brain function which results in probabilistic representations with attributes of personal meaning and value and thereby guides individuals' behavior. We propose that the same mental processes operating on narratives and rituals constitute belief systems in individuals and social groups. Our theoretical model of believing is suited to account for secular and non-secular belief formation.

Motor Recovery as Assessed with Isometric Finger Movements and Perfusion Magnetic Resonance Imaging after Acute Ischemic Stroke

Objective. Recovery from hemiparetic stroke is variable. An important goal for clinicians and clinical researchers is to identify predictors of recovery. The initial phase after acute ischemic stroke is considered to be of major importance for neurological outcome. The authors sought to determine in patients with acute ischemic stroke whether early motor recovery, as measured by repetitive isometric index-thumb oppositions, is correlated with ischemic lesion volume. Methods. Thirty-six acute hemiparetic stroke patients with residual hand function were investigated. The European Stroke Scale (ESS) score was determined on admission and at discharge. Performance of repetitive index finger-thumb pinch movements was measured daily during the 1st 8 days after stroke onset. Brain ischemia volume was determined digitally in time-to-peak magnetic resonance images of per-fusion. Results. The recovery of patients with ( P = 0.002) and without ( P < 0.001) thrombolysis as assessed with the ESS was paralleled by an increase in isometric grip force and movement rate ( P < 0.05). Recovery was predicted by the area of moderately impaired perfusion indicated by the per-fusion mismatch volume ( r = 0.578, P < 0.001). Conclusions. In acute stroke, recovery of hand function is predicted by the volume of salvageable ischemic tissue, as determined by the perfusion mismatch.

Functional Neuroimaging in Stroke Recovery and Neurorehabilitation: Conceptual Issues and Perspectives

Background

In stroke, functional neuroimaging has become a potent diagnostic tool; opened new insights into the pathophysiology of ischaemic damage in the human brain; and made possible the assessment of functional–structural relationships in postlesion recovery.

Summary of review

Here, we give a critical account on the potential and limitation of functional neuroimaging and discuss concepts related to the use of neuroimaging for exploring the neurobiological and neuroanatomical mechanisms of poststroke recovery and neurorehabilitation. We identify and provide evidence for five hypotheses that functional neuroimaging can provide new insights into: adaptation occurs at the level of functional brain systems; the brain–behaviour relationship varies with recovery and over time; functional neuroimaging can improve our ability to predict recovery and select individuals for rehabilitation; mechanisms of recovery reflect different pathophysiological phases; and brain adaptation may be modulated by experience and specific rehabilitation. The significance and application of this new evidence is discussed, and recommendations made for investigations in the field.

Conclusion

Functional neuroimaging is an important tool to explore the mechanisms underlying brain plasticity and, thereby, to guide clinical research in neurorehabilitation.

Same Intervention-Different Reorganization: The Impact of Lesion Location on Training-Facilitated Somatosensory Recovery After Stroke

BACKGROUND

The brain may reorganize to optimize stroke recovery. Yet relatively little is known about neural correlates of training-facilitated recovery, particularly after loss of body sensations.

OBJECTIVE

Our aim was to characterize changes in brain activation following clinically effective touch discrimination training in stroke patients with somatosensory loss after lesions of primary/secondary somatosensory cortices or thalamic/capsular somatosensory regions using functional magnetic resonance imaging (fMRI).

METHODS

Eleven stroke patients with somatosensory loss, 7 with lesions involving primary (S1) and/or secondary (S2) somatosensory cortex (4 male, 58.7 ± 13.3 years) and 4 with lesions primarily involving somatosensory thalamus and/or capsular/white matter regions (2 male, 58 ± 8.6 years) were studied. Clinical and MRI testing occurred at 6 months poststroke (preintervention), and following 15 sessions of clinically effective touch discrimination training (postintervention).

RESULTS

Improved touch discrimination of a magnitude similar to previous clinical studies and approaching normal range was found. Patients with thalamic/capsular somatosensory lesions activated preintervention in left ipsilesional supramarginal gyrus, and postintervention in ipsilesional insula and supramarginal gyrus. In contrast, those with S1/S2 lesions did not show common activation preintervention, only deactivation in contralesional superior parietal lobe, including S1, and cingulate cortex postintervention. The S1/S2 group did, however, show significant change over time involving ipsilesional precuneus. This change was greater than for the thalamic/capsular group (P = .012; d = -2.43; CI = -0.67 to -3.76).

CONCLUSION

Different patterns of change in activation are evident following touch discrimination training with thalamic/capsular lesions compared with S1/S2 cortical somatosensory lesions, despite common training and similar improvement.

Between- and within-site variability of fMRI localizations

This study provides first data about the spatial variability of fMRI sensorimotor localizations when investigating the same subjects at different fMRI sites. Results are comparable to a previous patient study. We found a median between-site variability of about 6 mm independent of task (motor or sensory) and experimental standardization (high or low). An intraclass correlation coefficient analysis using data quality measures indicated a major influence of the fMRI site on variability. In accordance with this, within-site localization variability was considerably lower (about 3 mm). We conclude that the fMRI site is a considerable confound for localization of brain activity. However, when performed by experienced clinical fMRI experts, brain pathology does not seem to have a relevant impact on the reliability of fMRI localizations. Hum Brain Mapp 37:2151-2160, 2016. © 2016 Wiley Periodicals, Inc.

Role of the first and second person perspective for control of behaviour: Understanding other people's facial expressions

Humans typically make probabilistic inferences about another person's affective state based on her/his bodily movements such as emotional facial expressions, emblematic gestures and whole body movements. Furthermore, humans deduce tentative predictions about the other person's intentions. Thus, the first person perspective of a subject is supplemented by the second person perspective involving theory of mind and empathy. Neuroimaging investigations have shown that the medial and lateral frontal cortex are critical nodes in the circuits underlying theory of mind, empathy, as well as intention of action. It is suggested that personal perspective taking in social interactions is paradigmatic for the capability of humans to generate probabilistic accounts of the outside world that underlie a person's control of behaviour.

Recovery Potential After Acute Stroke

In acute stroke, the major factor for recovery is the early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue. Subsequently, neurorehabilitative training critically improves clinical recovery due to augmention of postlesional plasticity. Neuroimaging and electrophysiology studies have revealed that the location and volume of the stroke lesion, the affection of nerve fiber tracts, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks are relevant biomarkers of post-stroke recovery. However, associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and, thereby, compromise the potential for recovery.

Intravenous levetiracetam in clinical practice--Results from an independent registry

PURPOSE

Most common clinical studies with antiepileptic drugs do not reflect medical everyday practice due to their strict in- and exclusion criteria and specifications of treatment regimens. Here we present a large non-interventional registry with the intention to evaluate the spectrum of applications in daily use and the efficacy and tolerability of intravenously given levetiracetam (LEV-iv).

METHODS

In a prospective approach of 17 neurological and neuropediatric centres in Germany LEV-iv treated patients of all ages were included over a period of 10 months. The observational period was 10 days with daily documentation of LEV-iv administration, type and frequency of seizures, currently used drugs and doses, and adverse events (AEs). In addition, treatment efficacy and tolerability were assessed by patients and physicians at study end as well as practicability of LEV-iv using a five-step scale.

RESULTS

In 95 patients LEV-iv was administered, 93 were included into the analysis. The median LEV-iv dose was 1500 mg (range 110-6000 mg) per day. Median age was 66 years (range 0.7-90.3 years). The majority of patients (n=70, 75%) suffered from status epilepticus (SE, n=55, 59%) and acute seizure clusters (n=15, 16%). Of those with SE, 41 patients (75%) had SE for the first time. Acute seizure clusters and SE terminated in 83% after LEV-iv administration. A total of 29 adverse events were reported in 17 of the 95 patients from the safety set. Ten of these were at least possibly related to LEV-iv treatment. Slight decrease of blood pressure during the infusion (3 patients each) was captured most frequently. No serious side effect was observed. Physicians rated the efficacy and tolerability of LEV-iv treatment as good or very good in 78% and 82% of the cases, respectively.

CONCLUSION

In this large observational study of everyday practise the use of LEV-iv exhibited a remarkable good response and tolerability in patients with acute onset seizures (mostly SE). Further randomized controlled studies, like the established status epilepticus trial (ESET) are needed to confirm these findings.

Anterior and posterior subareas of the dorsolateral frontal cortex in socially relevant decisions based on masked affect expressions

Socially-relevant decisions are based on clearly recognizable but also not consciously accessible affective stimuli. We studied the role of the dorsolateral frontal cortex (DLFC) in decision-making on masked affect expressions using functional magnetic resonance imaging. Our paradigm permitted us to capture brain activity during a pre-decision phase when the subjects viewed emotional expressions below the threshold of subjective awareness, and during the decision phase, which was based on verbal descriptions as the choice criterion. Using meta-analytic connectivity modeling, we found that the preparatory phase of the decision was associated with activity in a right-posterior portion of the DLFC featuring co-activations in the left-inferior frontal cortex. During the subsequent decision a right-anterior and more dorsal portion of the DLFC became activated, exhibiting a different co-activation pattern. These results provide evidence for partially independent sub-regions within the DLFC, supporting the notion of dual associative processes in intuitive judgments.

Anterior and posterior subareas of the dorsolateral frontal cortex in socially relevant decisions based on masked affect expressions

Socially-relevant decisions are based on clearly recognizable but also not consciously accessible affective stimuli. We studied the role of the dorsolateral frontal cortex (DLFC) in decision-making on masked affect expressions using functional magnetic resonance imaging. Our paradigm permitted us to capture brain activity during a pre-decision phase when the subjects viewed emotional expressions below the threshold of subjective awareness, and during the decision phase, which was based on verbal descriptions as the choice criterion. Using meta-analytic connectivity modeling, we found that the preparatory phase of the decision was associated with activity in a right-posterior portion of the DLFC featuring co-activations in the left-inferior frontal cortex. During the subsequent decision a right-anterior and more dorsal portion of the DLFC became activated, exhibiting a different co-activation pattern. These results provide evidence for partially independent sub-regions within the DLFC, supporting the notion of dual associative processes in intuitive judgments.

Stroke in patients with occlusion of the internal carotid artery: options for treatment

Ischemic stroke may occur in patients in whom vascular imaging shows the ipsilateral internal carotid artery (ICA) to be occluded. In younger patients this is often due to carotid artery dissection, while in older people this most likely results from cardiac embolism or thrombosis secondary to high-grade stenosis at the carotid bifurcation. Interventional techniques aim at recanalization of the carotid artery for early restoration of cerebral blood flow and secondary prevention of future strokes. In chronic ICA occlusion the ischemic infarct may be related to hemodynamic compromise. In this situation, extracranial-intracranial bypass surgery was introduced, but its role remains still unclear. Ischemic stroke may also occur in patients with a chronic occlusion of the contralateral ICA. This situation demands the usual stroke treatment, but surgical and neuroradiological interventions face a higher risk than unilateral vascular pathology. Medical treatment supports stroke prevention in carotid artery occlusion.

Posterior Midline Activation during Symptom Provocation in Acute Stress Disorder: An fMRI Study

Functional imaging studies of patients with post-traumatic stress disorder showed wide-spread activation of midline cortical areas during symptom provocation, i.e., exposure to trauma-related cues. The present study aimed at investigating neural activation during exposure to trauma-related pictures in patients with acute stress disorder (ASD) shortly after the traumatic event. Nineteen ASD patients and 19 healthy control participants were presented with individualized pictures of the traumatic event and emotionally neutral control pictures during the acquisition of whole-brain data with a 3-T fMRI scanner. Compared to the control group and to control pictures, ASD patients showed significant activation in midline cortical areas in response to trauma-related pictures including precuneus, cuneus, postcentral gyrus, and pre-supplementary motor area. The results suggest that the trauma-related pictures evoke emotionally salient self-referential processing in ASD patients.

Beyond the lesion: neuroimaging foundations for post-stroke recovery

A shift is emerging in the way in which we view post-stroke recovery. This shift, supported by evidence from neuroimaging studies, encourages us to look beyond the lesion and to identify viable brain networks with capacity for plasticity. In this article, the authors review current advances in neuroimaging techniques and the new insights that they have contributed. The ability to quantify salvageable tissue, evidence of changes in remote networks, changes of functional and structural connectivity, and alterations in cortical thickness are reviewed in the context of their impact on post-stroke recovery. The value of monitoring spared structural connections and functional connectivity of brain networks within and across hemispheres is highlighted.

Antiglycine receptor-related stiff limb syndrome in a patient with chronic lymphocytic leukaemia

We report a 61-year-old man presenting with rapidly progressive stiffness and painful muscle spasms in the lower extremity muscles. The patient was diagnosed with chronic lymphocytic leukaemia (CLL) approximately a year before symptom onset. Electromyography displayed continuous motor unit activity and immunocytochemistry showed a positive staining for antiglycine receptor (anti-GlyR) antibodies. The clinical course was complicated by autonomic instability and cardiac arrest, but stabilised under continuous therapy with plasma exchange and symptomatic treatment with baclofen and clonazepam. Anti-GlyR antibodies induce rare, but severe, variants of stiff person syndrome that can be of paraneoplastic origin and life threatening due to autonomic dysfunction.

In search of the trauma memory: a meta-analysis of functional neuroimaging studies of symptom provocation in posttraumatic stress disorder (PTSD)

Notwithstanding some discrepancy between results from neuroimaging studies of symptom provocation in posttraumatic stress disorder (PTSD), there is broad agreement as to the neural circuit underlying this disorder. It is thought to be characterized by an exaggerated amygdalar and decreased medial prefrontal activation to which the elevated anxiety state and concomitant inadequate emotional regulation are attributed. However, the proposed circuit falls short of accounting for the main symptom, unique among anxiety disorders to PTSD, namely, reexperiencing the precipitating event in the form of recurrent, distressing images and recollections. Owing to the technical demands, neuroimaging studies are usually carried out with small sample sizes. A meta-analysis of their findings is more likely to cast light on the involved cortical areas. Coordinate-based meta-analyses employing ES-SDM (Effect Size Signed Differential Mapping) were carried out on 19 studies with 274 PTSD patients. Thirteen of the studies included 145 trauma-exposed control participants. Comparisons between reactions to trauma-related stimuli and a control condition and group comparison of reactions to the trauma-related stimuli were submitted to meta-analysis. Compared to controls and the neutral condition, PTSD patients showed significant activation of the mid-line retrosplenial cortex and precuneus in response to trauma-related stimuli. These midline areas have been implicated in self-referential processing and salient autobiographical memory. PTSD patients also evidenced hyperactivation of the pregenual/anterior cingulate gyrus and bilateral amygdala to trauma-relevant, compared to neutral, stimuli. Patients showed significantly less activation than controls in sensory association areas such as the bilateral temporal gyri and extrastriate area which may indicate that the patients' attention was diverted from the presented stimuli by being focused on the elicited trauma memory. Being involved in associative learning and priming, the retrosplenial cortex may have an important function in relation to trauma memory, in particular, the intrusive reexperiencing of the traumatic event.

Variability of clinical functional MR imaging results: a multicenter study

PURPOSE

To investigate intersite variability of clinical functional magnetic resonance (MR) imaging, including influence of task standardization on variability and use of various parameters to inform the clinician whether the reliability of a given functional localization is high or low.

MATERIALS AND METHODS

Local ethics committees approved the study; all participants gave written informed consent. Eight women and seven men (mean age, 40 years) were prospectively investigated at three experienced functional MR sites with 1.5- (two sites) or 3-T (one site) MR. Nonstandardized motor and highly standardized somatosensory versions of a frequently requested clinical task (localization of the primary sensorimotor cortex) were used. Perirolandic functional MR variability was assessed (peak activation variability, center of mass [COM] variability, intraclass correlation values, overlap ratio [OR], activation size ratio). Data quality measures for functional MR images included percentage signal change (PSC), contrast-to-noise ratio (CNR), and head motion parameters. Data were analyzed with analysis of variance and a correlation analysis.

RESULTS

Localization of perirolandic functional MR activity differed by 8 mm (peak activity) and 6 mm (COM activity) among sites. Peak activation varied up to 16.5 mm (COM range, 0.4-16.5 mm) and 45.5 mm (peak activity range, 1.8-45.5 mm). Signal strength (PSC, CNR) was significantly lower for the somatosensory task (mean PSC, 1.0% ± 0.5 [standard deviation]; mean CNR, 1.2 ± 0.4) than for the motor task (mean PSC, 2.4% ± 0.8; mean CNR, 2.9 ± 0.9) (P < .001, both). Intersite variability was larger with low signal strength (negative correlations between signal strength and peak activation variability) even if the task was highly standardized (mean OR, 22.0% ± 18.9 [somatosensory task] and 50.1% ± 18.8 [motor task]).

CONCLUSION

Clinical practice and clinical functional MR biomarker studies should consider that the center of task-specific brain activation may vary up to 16.5 mm, with the investigating site, and should maximize functional MR signal strength and evaluate reliability of local results with PSC and CNR.

Differential grey matter changes in sensorimotor cortex related to exceptional fine motor skills

Functional changes in sensorimotor representation occur in response to use and lesion throughout life. Emerging evidence suggests that functional changes are paralleled by respective macroscopic structural changes. In the present study we used voxel-based morphometry to investigate sensorimotor cortex in subjects with congenitally malformed upper extremities. We expected increased or decreased grey matter to parallel the enlarged or reduced functional representations we reported previously. More specifically, we expected decreased grey matter values in lateral sensorimotor cortex related to compromised hand function and increased grey matter values in medial sensorimotor cortex due to compensatory foot use. We found a medial cluster of grey matter increase in subjects with frequent, hand-like compensatory foot use. This increase was predominantly seen for lateral premotor, supplementary motor, and motor areas and only marginally involved somatosensory cortex. Contrary to our expectation, subjects with a reduced number of fingers, who had shown shrinkage of the functional hand representation previously, did not show decreased grey matter values within lateral sensorimotor cortex. Our data suggest that functional plastic changes in sensorimotor cortex can be associated with increases in grey matter but may also occur in otherwise macroscopically normal appearing grey matter volumes. Furthermore, macroscopic structural changes in motor and premotor areas may be observed without respective changes in somatosensory cortex.