Theory of mind in older adults: the nature of the decline

Successful social interaction depends (among others) on one's ability to understand other people's emotional states (known as "affective-Theory-of-Mind"; aToM). A decline in this ability could be associated with changes in awareness with age. Awareness can be estimated by comparing one's subjective and objective abilities. Here we explored the sequence of changes in aToM with age, with reference to objective and subjective capacities. One hundred and eight participants were divided into three age groups: young (18-39), adults (60-69), and elders' group (70-86). Objective aToM performance was assessed using the Frith-Happé animation task (including meaningful and meaningless interactions). The subjective performance was evaluated by a Short Subjective ToM Questionnaire (sToM10). The results in the animation task showed reduction in the ability to correctly categorize meaningless interaction among the adult participants (compared to young) and a further decrease in the ability to correctly categorize meaningful interactions among the elderly participants (compared to young participants). Subjective aToM results revealed that while older participants reported a reduction in general ability to infer feelings in others, they could not report a decrease in their ability to recognize specific feelings. Our results may indicate a unique characteristic of aToM decline, which may start in adults (60-69; only reflected when the social demands are high) and further aggravates as people grow older (70th and above). In addition, results of the self-report questionnaire may indicate that while the elders are fully aware of their general decline in aToM ability, awareness of their capability to identify specific emotions is impaired.

New Contemplation Upon Subjective Memory Complaints as a Self- Report Criterion for MCI Diagnosis

BACKGROUND

Subjective memory complaints are a key component in mild cognitive impairment (MCI) diagnosis. However, studies that examined memory awareness among MCI participants have published contradictory results. One possible explanation for the inconsistent findings could be the disregard from the multidimensional structure of subjective memory.

OBJECTIVES

The present study is directed at assessing subjective memory among healthy and MCI participants, referring to three main types of memory: episodic, semantic, and working memory.

METHODS

Participants were 123 adults (aged 50-90). They were divided into two groups, the MCI group, and the control group, according to their objective cognitive performance in RAVL or Mo- CA tests. All participants filled a subjective memory questionnaire, assessing their awareness of episodic, semantic, and working memory.

RESULTS

MCI participants estimated their semantic memory as significantly lower in comparison to the estimation of the healthy controls. By contrast, MCI participants showed an overestimation of their episodic memory capabilities compared to the control group. No significant difference was found between groups (MCI and healthy controls) in evaluating their working memory. In addition, for both groups, Pearson's correlation revealed a significant negative correlation between age and semantic memory evaluation. Such correlation was not found for subjective episodic memory.

DISCUSSION

Findings suggest that while people with MCI exhibit poor awareness of their episodic and working memory capabilities, their awareness of their decrease in semantic memory is apparently intact. Therefore, it is suggested that when using the self-report criterion for MCI diagnosis, clinicians should consider the patient's' semantic memory complaints.

Medical Help-Seekers with Anxiety from Deterioration in Memory are Characterized with Risk Factors for Cognitive Decline

Objectives: Anxiety and subjective memory complaints (SMC) are major risk factors for Mild Cognitive Impairment (MCI) and dementia. However, the association between anxiety, SMC and medical help-seeking due to complaints is not clear. Here, we assessed anxiety which rose specifically by memory examination and compared it between help-seekers in memory clinics (HS) and non-help seekers (NHS).Methods: Twenty HS (60% female) were recruited from a memory Clinic, and 55 NHS (63% female) were recruited from the community. Participants (aged 59-82) completed objective memory assessment, Subjective Memory questionnaire, depression questionnaire and State-Trait Anxiety questionnaire. State-anxiety was assessed immediately following memory testing (indicating anxiety triggered by testing memory). For statistical evaluation, we used non-parametric tests.Results: HS participants reported significantly higher levels of state-anxiety and had more SMC compared to the NHS. No differences in objective memory tests and trait-anxiety were found.Conclusions: People who are seeking help in memory clinics (even those who do not meet any criteria for memory decline) are liable to be at high risk for MCI and dementia.Clinical Implications: We recommend that HS with SMC should be treated as a high-risk group, even if they do not show objective memory deficits.

[Behavior disturbances in emergency psychiatry or fronto-temporal dementia diagnosis? A challenge for psychiatrists]

INTRODUCTION

The diagnosis of fronto-temporal dementia (FTD) represents a challenge for the psychiatrist, especially since this insidious pathology partly mimics other psychiatric diseases.

CASE-REPORT

We present a clinical case that illustrates the difficulty of FTD diagnosis particularly well. A 32 year-old woman without previous medical history presented with psychomotor agitation, logorrhea and flight of ideas. The criteria for bipolar disorder according to DSM IV were met and the patient was referred to an outpatient clinic where a mood stabilizer was initiated (lithium, 400 mg/day). An in-depth interview with her husband revealed mild but progressive modification of her personality and behavior over the course of two years. She showed signs of mild fatigue and irritability that evolved into a loss of interest for both leisure and domestic activities. In addition, she showed increasing erratic behavior and emergence of frequent episodes of verbal abuse. After the birth of her second child, the patient's clinical state worsened with the appearance of uninhibited behavior, loss of personal hygiene, sleep disturbances and nightmares. The patient was forced to stop her work as a cleaner, a steady employment that she had maintained for 10 years. The hypomanic state worsened and psychotic symptoms such as delusions and echolalia appeared within a few weeks. These events culminated in a first hospitalization in a psychiatric unit. We evoked both diagnoses of schizoaffective disorder and psychotic disorder not otherwise specified. In the following months, we conducted neurological examinations on account of the progressive deterioration of her cognitive functions. Neuroradiological results (CT scan with contrast agents, MRI, cerebral scintigraphy) coupled with her clinical evolution (neurological examination and neuropsychological testing) permitted diagnosis of fronto-temporal dementia.

DISCUSSION

Fronto-temporal dementia usually presents itself as an autosomal dominant disease in 89% of reported cases, with an insidious onset associated with thymic symptoms and behavioral disturbances. The first consultation often concludes with a suspicion of a psychiatric disorder in 33% of the cases (unipolar and bipolar depressive disorders, psychotic disorders, alcohol dependence). The clinical description of such a heterogenic and neuro-psychiatric disorder should be widely disseminated, so that psychiatrists can distinguish early symptoms and diminish the risk of misdiagnosis of FDT.

CONCLUSION

Such case reports emphasize the importance for psychiatrists to be aware of the clinical prodromal FDT symptoms, particularly since the neuro-imaging data of dementia are often delayed.

The cost of stress: a dilemma with healthy mutation carriers

Literature poses the question of whether people bear a prior physiological tendency to react to stress that makes them more susceptible to onset of diseases or whether traumatic events are powerful enough to trigger a physiological reaction that ultimately induces a disease. Creutzfeldt-Jakob disease (CJD) is a neurodegenerative disorder with a sudden and rapid onset and progression. Thus far, no therapeutic or prophylactic treatment has been available. Recently, it was found that apparently healthy mutation carriers of CJD demonstrate higher anxiety levels than noncarriers from the same families. Furthermore, there seems to be a connection between stressful life events and the onset of CJD. Over the past few years, people whose relatives died due to CJD are becoming increasingly interested in genetic consultation based on a fear that they too are carrying the mutation. The dilemma of "cost-benefit" of making available such information in this unique stressed population is discussed.

The role of stress and anxiety in the onset of familial Creutzfeldt-Jakob Disease (CJD): review

Creutzfeldt-Jakob Disease (CJD) is considered to be a sudden and fatal degenerative brain disorder that leads to death within a few months. In the last decade, we have studied the course of familial CJD (fCJD) among Jews of Libyan descent, one of the largest clusters of fCJD in the world. Recently, we published results that included the identification of abnormal anxiety levels in healthy CJD E200K mutation carriers that were significantly different from those of healthy non-carriers from the same families. All participants were first-degree relatives of patients known to have been carriers of the E200K mutation and had died from CJD, and none of the participants was aware of his/her genetic make-up. In the current review, it is suggested that an abnormality in anxiety levels among the healthy fCJD mutation carriers may reflect the clinical presentation of the disease onset especially during and after any stressful experience. This hypothesis is supported by a summary of relevant literature, dealing with psychological, physiological, and cellular aspects.

High b-value diffusion imaging of dementia: Application to vascular dementia and alzheimer disease

Alzheimer's disease (AD) and Vascular Dementia (VaD) are the most common types of dementia and are progressive diseases affecting millions of people. Despite the high sensitivity of MRI to neurological disorders it has not thus far been found to be specific for the detection of either of these pathologies. In the present study high b-value q-space diffusion-weighted MRI (DWI) was applied to VaD and AD. Controls (N=4), VaD patients (N=8) and AD patients (N=6) were scanned with high b-value DWI, which emphasizes the water component which exhibits restricted diffusion. VaD patients were found to present major WM loss while, in AD, the major pathology found was GM changes, as expected. Also, WM changes in VaD and AD were of a different pattern, more specific to frontal and temporal areas in AD and more widespread in VaD. This pattern of WM changes may be utilized as a diagnosis criterion. Conventional diffusion tensor imaging did not show significant changes between either of the groups and controls. These results demonstrate the potential of high b-value DWI in the diagnosis of dementia.

Prefrontal and parietal regions are involved in naming of objects seen from unusual viewpoints

Object naming is commonly used for demonstrating semantic memory abilities, known to be affected in normal aging. Yet, neuropsychological assessments of older people do not reflect irregularities. The authors used a test with 2 levels of naming complexity by 2 kinds of stimuli: common objects pictured from a conventional viewpoint (usual condition) or from an unconventional viewpoint (unusual condition). The authors studied naming performance with 129 healthy participants, aged 20-85 years. For the usual stimuli, the success rate was high (90.9%), with no reduction in performance until 65 years of age. However, for the unusual stimuli, there was a marked reduction in performance with age. Brain activity was studied on 11 healthy young participants (20-30 years of age) using functional magnetic resonance imaging. The usual condition activated brain regions associated with visual perception, language, and memory. Additional brain regions associated with semantic searching and decision making were obtained in the unusual condition in the prefrontal cortex (Brodmann's area [BA] 9 and BA 47) and anterior cingulate (BA 32). The results suggest that the poor naming performance for unusual-viewed objects in older people might be related to the shrinkage of frontal gray matter with age.

Presymptomatic signs in healthy CJD mutation carriers

Creutzfeldt-Jacob disease (CJD) is a rapidly progressing dementia with neurological, psychiatric and cognitive symptoms. We focused our study on the familial CJD form among Libyan Jews (the E200K mutation), trying to identify preclinical neuropsychological signs in mutation carriers to facilitate early diagnosis of the disease. A wide range of neuropsychological tests was administered to 27 healthy volunteers, all first-degree relatives of genetic CJD patients. Thirteen of our participants were gene mutation carriers (E200K) and 14 controls. The healthy mutation carriers reported significantly lower Trait and higher State anxiety scores. Repeated Measure analysis showed statistical significance. The Anxiety Index (State-Trait Anxiety Score) progressed with age in the carriers' group but not in the controls. Since this was more pronounced in the older subjects, we suggest that abnormal stress mechanisms precede the clinical onset of CJD. Cognitive differences have also been found between carriers and controls, especially in visual recognition of pictured objects. Both kinds of differences (anxiety levels and cognitive deficits) were most pronounced in elderly subjects. This study is the first to show any dysfunction in healthy CJD mutation carriers.

High b value q-space-analyzed diffusion MRI in vascular dementia: a preliminary study

High b value diffusion weighted magnetic resonance imaging (high-b DWI) was used to characterize white matter changes in the brain of patients with vascular dementia (VaD). Hyperintense white matter areas detected by T2-weighted magnetic resonance imaging (MRI) represent lesions, also termed leukoaraiosis that are very common in VaD as well as in other types of dementia. Therefore, the role of white matter changes in the cognitive and memory decline that occurs in VaD patients is still under debate. High-b DWI, analyzed using the q-space approach, is a more sensitive MRI method for detection of white matter changes. High-b DWI revealed massive white matter loss in VaD patients that surpassed the boundaries of T2 hyperintensities. This technique, therefore, might serve as a better indication for the extensive nerve fiber loss in the white matter that is caused by vascular disease.

Validation of a Hebrew selective reminding test

We developed a Hebrew version for the Buschke Selective Reminding Memory Test, with three parallel forms. This Hebrew version was administered in counterbalanced order to 24 normal subjects aged 14-77 years. We studied the reliability between parallel forms, and the validity and sensitivity memory reduction in normal aging. Data were compared to American norms. The three Hebrew forms were found to be of equal difficulty, with correlation coefficients of .6 to .7 (p's < .01). Age affected the great majority of memory performances, i.e., lower performance with increasing age. Test performance was equivalent to American norms within 6%. We conclude that this Hebrew version is reliable and valid, and can be used on Hebrew-speaking populations to assess memory functions.

Effects of prenatal exposure to gamma rays on circling and activity behavior in prepubertal and postpubertal rats

The study departs from the finding that postural asymmetries in low-weight female neonates are greatly increased following prenatal lesions inflicted by gamma irradiation at day 15. Given that amphetamine-induced rotation in adult rats could be predicted by their infantile axial asymmetry we expected a greater tendency for circling in rats exposed at day 15. To examine this prediction, Sprague-Dawley rats were exposed to a single dose of gamma radiation at 1.5 Gy with a dose-rate of 0.15 Gy/min. The dose was delivered on one of the embryonic days (E15, 17 or 19) throughout the whole body of pregnant dams. Sham prenatal exposure of controls consisted of placing pregnant rats in the same environment for 10 min. All rats were tested during the active part of the circadian cycle. At postnatal day 27 (P27) exposed pups did not differ in rates of either spontaneous or d-amphetamine-induced circling from the shams. At P57, in keeping with our prediction, E15 rats manifested enhanced rotation and higher net asymmetry. However, E17 also showed higher gyration tendency compared to their shams while exposed E19 rats did not differ from their shams. The role of intrinsic DAergic imbalance presumably sharpened by irradiation at E15 and of neocortical deficit inflicted at E15 and E17 are discussed.

Dissociation between startle and prepulse inhibition in rats exposed to gamma radiation at day 15 of embryogeny

The role of prenatal trauma in disordered sensory gating was explored in albino rats of the Sprague-Dawley strain. Pregnant rats were exposed to 1.5 Gy (0.15 Gy/min) of the whole-body gamma radiation on days 15, 17, or 19 of gestation. Controls were sham-exposed during 10 min in the same conditions. Exposed and control offsprings were evaluated for the auditory startle response (ASR) and its gating by either the habituation process or by the preceding weak sensory stimulus in the prepulse inhibition of startle (PPI) procedure. The tests were conducted when the animals reached 27 and 57 days of age. A noticeable hyperresponding and delayed habituation of startle were found in rats exposed at E15, with meager effects in rats exposed at E17 and E19. Maximal deficit was obtained on tests conducted on P57 but not on P27. However, in rats pretreated with amphetamine, dysfunctional startle was unmasked already on the P27 test. By contrast, PPI was insensitive to the damaging effect of prenatal irradiation at either period. This dissociation is reminiscent of one observed in patients with posttraumatic stress disorder (PTSD).

Calcium channel currents in Xenopus oocytes injected with rat skeletal muscle RNA

1. Ba2+ currents (IBa) through voltage-dependent Ca2+ channels were studied in Xenopus laevis oocytes injected with heterologous RNA extracted from skeletal muscle (SkM) of young rats, using the two-electrode voltage clamp technique. 2. With 40 or 50 mM-extracellular Ba2+, native oocytes of most frogs displayed IBa between -5 and -20 nA at 0 mV. However, in 'variant' native oocytes of four frogs, IBa exceeded -30 nA and reached up to -100 nA. In oocytes injected with SkM RNA, IBa of up to -250 nA was observed. 3. In SkM RNA-injected oocytes and 'variant' native oocytes, the decay of IBa displayed two kinetic components. The faster component was selectively blocked by 40-100 microM-Ni2+ and thus was termed the Ni(2+)-sensitive IBa. The slower component was Ni2+ resistant, being inhibited only 10-20% by 100-200 microM-Ni2+. The half-activation and the half-inactivation voltages of the Ni(2+)-sensitive IBa were more negative (by 14.5 and 28.7 mV, respectively) than those of the Ni(2+)-resistant IBa. 4. Neither Ni(2+)-sensitive nor Ni(2+)-resistant IBa in native or SkM RNA-injected oocytes were affected by dihydropyridine antagonists nifedipine and (+) PN 200-110 (1-10 microM), by the dihydropyridine agonist (-)Bay K 8644 (0.01-2 microM), or by verapamil below 50 microM. IBa was blocked by diltiazem (half-block at about 500 microM). Thus, the pharmacology of IBa in SkM RNA-injected and in native oocytes was not characteristic of the L-type Ca2+ channel abundant in the skeletal muscle. 5. Destruction of the RNA coding for the channel-forming alpha 1-subunit of the SkM L-type Ca2+ channel using a hybrid arrest method failed to selectively suppress the appearance of either Ni(2+)-sensitive or Ni(2+)-resistant IBa in SkM RNA-injected oocytes. 6. Our results suggest that the appearance of large voltage-dependent Ba2+ currents in SkM RNA-injected oocytes is not due to the expression of the alpha 1-subunit of the SkM L-type Ca2+ channel. The possibility that the expression of a channel-forming subunit of another Ca2+ channel type underlies one of these currents cannot be rejected. However, since the Ba2+ currents in SkM RNA-injected oocytes resemble those observed in native oocytes, we suggest that their appearance may be the result of an enhanced activity of the native Ca2+ channels, possibly due to the expression of the 'auxiliary' subunits of the SkM Ca2+ channel that form complexes with a native alpha 1-subunit.

Specific block of calcium channel expression by a fragment of dihydropyridine receptor cDNA

Although the structure of rabbit skeletal muscle dihydropyridine (DHP) receptor, deduced from cDNA sequence, indicates that this protein is the channel-forming subunit of voltage-dependent calcium channel (VDCC), no functional proof for this prediction has been presented. Two DNA oligonucleotides complementary to DHP-receptor RNA sequences coding for putative membrane-spanning regions of the DHP receptor specifically suppress the expression of the DHP-sensitive VDCC from rabbit and rat heart in Xenopus oocytes. However, these oligonucleotides do not suppress the expression of the DHP-insensitive VDCC and of voltage-dependent sodium and potassium channels. Thus, the gene for DHP receptor of rabbit skeletal muscle is closely related, or identical to, a gene expressed in heart that encodes a component of the DHP-sensitive VDCC. The DHP-sensitive and DHP-insensitive VDCCs are distinct molecular entities.