How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well-treated HIV-positive population?

Objectives

Diagnosing neurocognitive impairment (NCI) in HIV infection requires time‐consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI.

Methods

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self‐report forms [Center for Epidemiologic Studies Depression Scale (CES‐D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated.

Results

Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV‐associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV‐associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001).

Conclusions

The EACS screening questions had an NPV of 0.7 for excluding patients with HIV‐associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile

Objectives

The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study.

Methods

The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV‐associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z‐score means) were performed.

Results

Most patients (942; 96.2%) had viral loads < 50 HIV‐1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV‐associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non‐Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration.

Conclusions

In this large sample of aging people living with HIV with well‐controlled infection in Switzerland, baseline HIV‐associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.

Perseveration in Healthy Subjects: An Impressive Classroom Demonstration for Educational Purposes

Perseveration, that is, the inappropriate maintenance of an activity, is not exclusively observed in patients with brain pathology. We present a brief calculation task that requires healthy subjects to add eight numbers sequentially. While the first seven steps of the addition involve the repeated application of a particular rule, this rule does not apply for the last step. However, a high percentage of subjects (approximately 70%) will commit a perseverative error at this last step and hence obtain an incorrect final result. This simple task is a highly informative illustration of the principle of perseverative behavior. When applied in a classroom setting, it is an impressive demonstration of the ease with which perseveration can be evoked in healthy persons.

L-dopa Modulates Striatal Functional Connectivity in Adults with Psychotic-like Experiences: A Randomized Double-blind Placebo-controlled Study

Introduction

According to the dopamine hypothesis functional brain abnormalities and neurochemical alterations may converge to cause psychosis through aberrant salience attribution. Indeed, resting-state functional magnetic resonance imaging (rs-fMRI) has revealed widespread brain disconnectivity across the psychotic spectrum.

Objectives

To advance the understanding of the dopaminergic involvement in intrinsic functional connectivity (iFC) and its putative relationship to the development of psychotic disorders we aimed to investigate the link between L-Dopa, a dopamine precursor, and its modulation of striatal iFC in subthreshold psychosis, i.e. non-clinical psychosis.

Methods

We used a randomized, double-blind placebo controlled study design including in our sample 56 healthy, male, right-handed, subjects with no familiar risk factors for psychosis who were assessed with the Schizotypal Personality Questionnaire (SPQ) and underwent 10 minutes of rs-fMRI scanning. All subjects received either 250 mg of Madopar DR®(200 mg L-Dopa plus 50 mg benserazid, dual release form) or a placebo. We analysed resting-state iFC of 6 striatal seeds, known to evoke dopamine related networks.

Results

The main effect of L-Dopa presented itself (FWE-corrected) as a significant decrease in iFC from the right ventral striatum to the cerebellum and the precuneus cortex, and an increase in iFC to the occipital cortex. Subjects with high SPQ positive symptom sub-scores showed a significant increase of L-Dopa induced connectivity.

Conclusion

We identified striatal functional connectivity being modulated by augmented dopamine availability, and in support of the dopamine hypothesis, we found that those iFC patterns are associated to high scores of psychotic like experiences.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Persistent effects of playing football and associated (subconcussive) head trauma on brain structure and function: a systematic review of the literature

AIM/OBJECTIVE

There is ongoing controversy about persistent neurological deficits in active and former football (soccer) players. We reviewed the literature for associations between football activities (including heading/head injuries) and decline in brain structure/function.

DESIGN

Systematic literature review.

DATA SOURCES

MEDLINE, Embase, PsycINFO, CINAHL, Cochrane-CRCT, SportDiscus, Cochrane-DSR=4 (accessed 2 August 2016).

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Original studies reporting on football-related persistent effects on brain structure/function. Results from neurocognitive testing, neuroimaging and EEG were compared with controls and/or correlated with heading frequency and/or head injuries. Methodological quality was rated for risk-of-bias, including appropriateness of controls, correction for multiple statistical testing and assessment of heading frequency and head injuries.

RESULTS

30 studies with 1691 players were included. Those 57% (8/14) of case-control studies reporting persistent neurocognitive impairment had higher odds for inappropriate control of type 1 errors (OR=17.35 (95% CI (10.61 to 28.36)) and for inappropriate selection of controls (OR=1.72 (1.22 to 2.43)) than studies observing no impairment. Studies reporting a correlation between heading frequency and neurocognitive deficits (6/17) had lower quality of heading assessment (OR=14.20 (9.01 to 22.39)) than studies reporting no such correlation. In 7 of 13 studies (54%), the number of head injuries correlated with the degree of neurocognitive impairment. Abnormalities on neuroimaging (6/8 studies) were associated with subclinical neurocognitive deficits in 3 of 4 studies.

SUMMARY/CONCLUSIONS

Various methodological shortcomings limit the evidence for persistent effects of football play on brain structure/function. Sources of bias include low-quality assessment of heading frequency, inappropriate control for type 1 errors and inappropriate selection of controls. Combining neuroimaging techniques with neurocognitive testing in prospective studies seems most promising to further clarify on the impact of football on the brain.

Perceptual aberrations impair mental own-body transformations

Dysfunctional self and bodily processing have been reported from the schizophrenia spectrum. Here, the authors tested 72 students (40 women) to determine whether performance in a mental own-body transformation task relates to self-rated frequency of spontaneously experienced schizotypal body schema alterations (perceptual aberration). Participants provided speeded left-right decisions concerning the body of a visually depicted human figure (front view vs. back view). For men, reaction times to disembodied perspectives increased with increasing scores on a validated perceptual aberration scale. This finding constitutes behavioral evidence for the clinically postulated association between aberrant bodily experiences during everyday life and aberrant processing in a mental own-body transformation task arguably reflecting mild dysfunction at the temporo-parietal junction.

Blinking and schizotypal thinking

Spontaneous eye blink rate (SBR) is thought to be a biological marker for cerebral dopamine (DA) activity. Accordingly, positive psychotic symptoms have been found to be associated with an increased SBR and negative psychotic symptoms with a decreased SBR. However, modulations of the DA system in patient populations also result from prior neuroleptic treatment. Here, we tested the possible relationship between SBR and positive and negative schizotypal thought. To test the direct influence of DA on SBR in general and as a function of schizotypy, half of a sample of 40 healthy men received levodopa and the other half placebo in a double-blind procedure. SBR did not differ between substance groups suggesting that a pharmacologically induced DA increase in healthy individuals does not generally increase SBR. However, in the levodopa group, increasing SBR correlated with increasing negative schizotypy scores, while no relationship was found between SBR and (1) negative schizotypy in the placebo group, or (2) positive schizotypy in either substance group. We conjecture that a pre-existing hypodopaminergic state in high negative schizotypy scorers, made these individuals susceptible to an increased DA concentration, as it has been observed in Parkinson's disease. Furthermore, the absence of any relationship in the placebo group might suggest that variations in DA concentration as a function of schizotypy are too subtle to influence SBR. Finally, the lack of any association of SBR with positive schizotypy might indicate that SBR and positive schizotypy are mediated by functionally distinct neural circuits.

Attention and interhemispheric transfer: a behavioral and fMRI study

When both detections and responses to visual stimuli are performed within one and the same hemisphere, manual reaction times (RTs) are faster than when the two operations are carried out in different hemispheres. A widely accepted explanation for this difference is that it reflects the time lost in callosal transmission. Interhemispheric transfer time can be estimated by subtracting RTs for uncrossed from RTs for crossed responses (crossed-uncrossed difference, or CUD). In the present study, we wanted to ascertain the role of spatial attention in affecting the CUD and to chart the brain areas whose activity is related to these attentional effects on interhemispheric transfer. To accomplish this, we varied the proportion of crossed and uncrossed trials in different blocks. With this paradigm subjects are likely to focus attention either on the hemifield contralateral to the responding hand (blocks with 80% crossed trials) or on the ipsilateral hemifield (blocks with 80% uncrossed trials). We found an inverse correlation between the proportion of crossed trials in a block and the CUD and this effect can be attributed to spatial attention. As to the imaging results, we found that in the crossed minus uncrossed subtraction, an operation that highlights the neural processes underlying interhemispheric transfer, there was an activation of the genu of the corpus callosum as well as of a series of cortical areas. In a further commonality analysis, we assessed those areas which were activated specifically during focusing of attention onto one hemifield either contra- or ipsilateral to the responding hand. We found an activation of a number of cortical and subcortical areas, notably, parietal area BA 7 and the superior colliculi. We believe that the main thrust of the present study is to have teased apart areas important in interhemispheric transmission from those involved in spatial attention.

Human side preferences in three different whole-body movement tasks☆

Animals turn away from the hemisphere with the more active dopamine (DA) system. For humans, a similar relationship has been assumed. However, results from independent studies were obtained from different tasks and indicated different side preferences. To investigate side preferences between different tasks within the same subject, we assessed in 36 healthy research participants (20 women) (1) long-term spontaneous turning (number of 360 degree turns during 20 h), (2) veering (lateral deviations during walking blindfolded straight forward) and (3) stepping (deviations while stepping blindfolded on a given spot) behavior. We observed a left-sided preference for long-term spontaneous turning behavior and no significant side preference for veering and stepping behavior. The absence of consistent side preferences suggests that DA does not equally control lateralized whole-body movements. We propose that visual control enhanced left-sided movement preferences, probably through an enhanced contribution of the right hemisphere to visuo-spatial behavior. Recently, we reported [Neurosci. Lett. 339 (2003) 115] that levodopa supplementation decreases right-sided veering tendencies, while stepping behavior was unaffected by substance intake. We suggest that veering tendencies, which appeared equally pronounced in either direction, are under dopaminergic control as long as attention is directed towards extrapersonal space. Side preferences in lateralized whole-body movement tasks are thus neither comparable between tasks nor within subjects. We conclude that experimental parameters such as visuo-spatial control and spatial task demands (veering is directed to extrapersonal space and stepping to peripersonal space) determine whether or not the DA system is involved.

Localisation of “unseen” visual stimuli: Blindsight in normal observers?

We developed two experiments on normal subjects to simulate “blindsight”, i.e., above chance localization performance of visual stimuli without phenomenal awareness. In both experiments, visual targets were presented on a computer screen at one of six possible locations, followed by a metacontrast mask. Subjects (1) indicated whether they had seen the target stimulus or not, and (2) guessed at which location the stimulus had been presented. Fifty percent were blank trials. We found that even when subjects did not acknowledge the presence of a stimulus, they nevertheless guessed its location with above chance accuracy. Apparent motion improved both detection and localization performance. Subjective confidence was related to stimulus presence and localisation performance. Thus, simulated blindsight appeared to be based on residual conscious awareness.

Opposite Turning Behavior in Right-Handers and Non-Right-Handers Suggests a Link Between Handedness and Cerebral Dopamine Asymmetries

The strong right hand preference in humans remains a riddle; no lateralized behavior other than fine finger dexterity relates to it. The relation between handedness and language dominance may be far weaker than currently judged; after all, both right-handers and non-right-handers utilize the left brain for speech. There is, however, a lateralized motor preference in animals, turning behavior, that is strongly associated with hemispheric dopamine (DA) asymmetries. Turning consistently occurs towards the side with less DA. The authors tested 69 right-handers and 24 non-right-handers with a device recording spontaneous turning behavior for 20 hr within 3 days. Findings indicate that right-handers preferred left-sided turning and non-right-handers preferred right-sided turning. This result suggests a link between handedness and DA asymmetries.

Associative processing and paranormal belief

In the present study we introduce a novel task for the quantitative assessment of both originality and speed of individual associations. This 'BAG' (Bridge-the-Associative-Gap) task was used to investigate the relationships between creativity and paranormal belief. Twelve strong 'believers' and 12 strong 'skeptics' in paranormal phenomena were selected from a large student population (n > 350). Subjects were asked to produce single-word associations to word pairs. In 40 trials the two stimulus words were semantically indirectly related and in 40 other trials the words were semantically unrelated. Separately for these two stimulus types, response commonalities and association latencies were calculated. The main finding was that for unrelated stimuli, believers produced associations that were more original (had a lower frequency of occurrence in the group as a whole) than those of the skeptics. For the interpretation of the result we propose a model of association behavior that captures both 'positive' psychological aspects (i.e., verbal creativity) and 'negative' aspects (susceptibility to unfounded inferences), and outline its relevance for psychiatry. This model suggests that believers adopt a looser response criterion than skeptics when confronted with 'semantic noise'. Such a signal detection view of the presence/absence of judgments for loose semantic relations may help to elucidate the commonalities between creative thinking, paranormal belief and delusional ideation.

Loose but normal: a semantic association study

An abnormal facilitation of the spreading activation within semantic networks is thought to under-lie schizophrenics' remote associations and referential ideas. In normal subjects, elevated magical ideation (MI) has also been associated with a style of thinking similar to that of schizotypal subjects. We thus wondered whether normal subjects with a higher MI score would judge "loose associations" as being more closely related than do subjects with a lower MI score. In two experiments, we investigated whether judgments of the semantic distance between stimulus words varied as a function of MI. In the first experiment, random word pairs of two word classes, animals and fruits, were presented. Subjects had to judge the semantic distance between word pairs. In the second experiment, sets of three words were presented, consisting of a pair of indirectly related, or unrelated nouns plus a third noun. Subjects had to judge the semantic distance of the third noun to the word pair The results of both experiments showed that higher MI subjects considered unrelated words as more closely associated than did lower MI subjects. We conjecture that for normal subjects high on MI "loose associations" may not be loose after all. We also note that the tendency to link uncommon, nonobvious, percepts may not only be the basis of paranormal and paranoid ideas of reference, but also a prerequisite of creative thinking.

Lateralized direct and indirect semantic priming effects in subjects with paranormal experiences and beliefs

The present investigation tested the hypothesis that, as an aspect of schizotypal thinking, the formation of paranormal beliefs was related to spreading activation characteristics within semantic networks. From a larger student population (n = 117) prescreened for paranormal belief, 12 strong believers and 12 strong disbelievers (all women) were invited for a lateralized semantic priming task with directly and indirectly related prime-target pairs. Believers showed stronger indirect (but not direct) semantic priming effects than disbelievers after left (but not right) visual field stimulation, indicating faster appreciation of distant semantic relations specifically by the right hemisphere, reportedly specialized in coarse rather than focused semantic processing. These results are discussed in the light of recent findings in schizophrenic patients with thought disorders. They suggest that a disinhibition with semantic networks may underlie the formation of paranormal belief. The potential usefulness of work with healthy subjects for neuropsychiatric research is stressed.

Unilateral olfactory perception and magical ideation

We assessed olfactory detection thresholds and discrimination abilities in 40 healthy right-handers (20 women and 20 men). All subjects were also required to complete the Magical Ideation (MI) scale, a well-validated 30-item schizotypy inventory. Over both nostrils, we found elevated thresholds for subjects with high MI scores (at or above the median score of 9.0) compared with those with low scores. In men but not women, specifically left-nostril acuity was inversely correlated to MI raw scores. MI was unrelated to olfactory discrimination performance. These results suggest an association, at least in healthy men, between even moderate signs of schizotypy and deficits in odor detection. The selective impairment of left-nostril performance adds to the growing evidence for left temporal lobe functional abnormalities in people high on MI. This laterality effect is known from previous studies in patients with schizophrenia. However, as a rule, in psychiatric patients olfactory identification rather than simple detection performance was found to be impaired, indicating that the integration of odor information is affected at different levels of processing in schizotypy compared with schizophrenia. Work with completely normal subjects may reasonably complement clinical studies of olfactory perception. Among its advantages are the good subject compliance and the absence of medication effects.

Spatial- and verbal-memory improvement by cold-water caloric stimulation in healthy subjects

We investigated the effects of unilateral cold-water vestibular stimulation on healthy subjects' performance in two cognitive tasks known to be differentially mediated by the two cerebral hemispheres. In a first experiment (right-hemisphere task), subjects memorized object-location associations while being stimulated with cold water in the left ear or right ear or not at all (control group). In the second experiment (left-hemisphere task), subjects memorized a list of sequentially presented function words while being stimulated in the same manner as the subjects in the first experiment. A recall phase followed each encoding phase. In the first experiment, subjects who had been stimulated in the left ear recalled the object locations significantly faster than subjects who had been stimulated in the right ear and those in the control group. The second experiment yielded the reverse pattern: correct word recognition was faster for subjects who had been stimulated in the right ear than for subjects stimulated in the left ear and those of the control group. We suggest that unilateral caloric stimulation leads to a selective activation of contralateral cerebral structures and speeds up cognitive processes mediated by these structures. These results are discussed with respect to findings in neglect patients and functional-imaging studies in healthy subjects.

Brain electric correlates of strong belief in paranormal phenomena: intracerebral EEG source and regional Omega complexity analyses

The neurocognitive processes underlying the formation and maintenance of paranormal beliefs are important for understanding schizotypal ideation. Behavioral studies indicated that both schizotypal and paranormal ideation are based on an overreliance on the right hemisphere, whose coarse rather than focussed semantic processing may favor the emergence of 'loose' and 'uncommon' associations. To elucidate the electrophysiological basis of these behavioral observations, 35-channel resting EEG was recorded in pre-screened female strong believers and disbelievers during resting baseline. EEG data were subjected to FFT-Dipole-Approximation analysis, a reference-free frequency-domain dipole source modeling, and Regional (hemispheric) Omega Complexity analysis, a linear approach estimating the complexity of the trajectories of momentary EEG map series in state space. Compared to disbelievers, believers showed: more right-located sources of the beta2 band (18.5-21 Hz, excitatory activity); reduced interhemispheric differences in Omega complexity values; higher scores on the Magical Ideation scale; more general negative affect; and more hypnagogic-like reveries after a 4-min eyes-closed resting period. Thus, subjects differing in their declared paranormal belief displayed different active, cerebral neural populations during resting, task-free conditions. As hypothesized, believers showed relatively higher right hemispheric activation and reduced hemispheric asymmetry of functional complexity. These markers may constitute the neurophysiological basis for paranormal and schizotypal ideation.

Effects of optokinetically induced rotatory self-motion on spatial perception and representation

OBJECTIVE

Our aim was to investigate the influence of optokinetically induced rotatory self-motion sensation (circular vection [CV]) on asymmetries in real and representational space in normal subjects.

BACKGROUND

Vestibular and optokinetic stimulation (particularly when accompanied by rightward CV) can reduce left-sided hemineglect in patients.

METHOD

Twenty healthy right-handed men were administered a line bisection (LB) task and a stimulus-response compatibility task monitoring mental representation of space (the RULER task). The RULER task required speeded unimanual decisions ("smaller than 6?" vs. "larger than 6?") to foveally presented numbers between 1 and 11. Both tasks were performed in a baseline condition (no stimulation) and with full-field optokinetic stimulation to induce CV to either side.

RESULTS

The bisection marks of both hands were shifted significantly to the left during leftward CV, introducing a pseudoneglect for the left and right hands. Rightward CV did not influence LB. In the RULER task, we found a stimulus-response compatibility, namely, faster right-hand responses to large numbers (i.e., 7-11) and faster left-hand responses to small numbers (i.e., 1-5). Although optokinetic stimulation did not significantly affect subjects' representation of space, the overall pattern of observed deviations was strikingly similar to that obtained in LB.

CONCLUSIONS

Optokinetic stimulation affects healthy subjects' exploration and, to a lesser extent, their representation of space. In contrast to previous studies in neglect patients and healthy subjects, we found that leftward CV rather than rightward CV induced a leftward deviation of the subjective midpoint. This discrepancy is most likely a consequence of the exclusively peripheral visual field stimulation in our experiment. We suggest that the leftward deviation during rightward CV described in former studies may be due to the cuing effect of the leftward moving dots in the central visual field. In the absence of these central cues, the direction of CV seems to be the main determining factor for observed hemispatial effects.

Perceived electrosensitivity and magical ideation

We report, in 40 healthy right-handed men, an association between perceived sensitivity to weak electromagnetic fields and scores on the Magical Ideation scale, assessing experience of and beliefs in forms of causation that are nonexistent according to current scientific standards (r = .48, p =.002). Based on our previous research, we interpret this finding as reflecting human subjects' propensity to assume connections between own organismic state and (objectively unrelated) environmental variables. We emphasize, however, the need for studies which directly assess accuracy in detection of electromagnetic fields as a function of self-rated electrosensitivity.

Beyond re-membering: phantom sensations of congenitally absent limbs

Phantom limbs are traditionally conceptualized as the phenomenal persistence of a body part after deafferentation. Previous clinical observations of subjects with phantoms of congenitally absent limbs are not compatible with this view, but, in the absence of experimental work, the neural basis of such "aplasic phantoms" has remained enigmatic. In this paper, we report a series of behavioral, imaging, and neurophysiological experiments with a university-educated woman born without forearms and legs, who experiences vivid phantom sensations of all four limbs. Visuokinesthetic integration of tachistoscopically presented drawings of hands and feet indicated an intact somatic representation of these body parts. Functional magnetic resonance imaging of phantom hand movements showed no activation of primary sensorimotor areas, but of premotor and parietal cortex bilaterally. Movements of the existing upper arms produced activation expanding into the hand territories deprived of afferences and efferences. Transcranial magnetic stimulation of the sensorimotor cortex consistently elicited phantom sensations in the contralateral fingers and hand. In addition, premotor and parietal stimulation evoked similar phantom sensations, albeit in the absence of motor evoked potentials in the stump. These data indicate that body parts that have never been physically developed can be represented in sensory and motor cortical areas. Both genetic and epigenetic factors, such as the habitual observation of other people moving their limbs, may contribute to the conscious experience of aplasic phantoms.

Processing of spatial locations: hemispace effects during encoding but not recall

Traditionally, functional differences in the visual modality between the two hemispheres are investigated by tachistoscopic procedures. In these experiments, the stimuli reach the contralateral hemisphere first, and results are commonly interpreted on the basis of neuroanatomical access models. However, numerous studies demonstrated that the hemispace where the stimulus is perceived also plays a critical role in producing laterality effects ("hemispace effects"). In the present experiment, subjects were instructed to memorize the relative spatial positions of six figures horizontally aligned on a presentation board. The presentation board was located either to the left, to the right or in front of the subjects (left, right and central learning positions). During a recall phase, each figure was presented in the center of a computer screen and subjects were required to indicate by keypress whether a figure had been located in the left or right half of the presentation board. As in the learning phase, the computer screen was located to the left, the right or in front of the subjects (left, right and central recall positions). We found that the positions of the figures initially memorized in the left hemispace were recalled faster than figures initially memorized in the right hemispace. Hemispatial position during recall had no effect on performance. These results are discussed with respect to hemispheric specialization and theories of hemispace effects.

One hundred years of an ambiguous figure: happy birthday, duck/rabbit

In the present study, Jastrow's famous ambiguous drawing of a duck/rabbit was presented to 100 students along with 11 published variants from later research. The beak/ears of the animal pointed to the right for half of the subjects and to the left for the other half. For each figure subjects were required to rate the ease of bird and of rabbit identification on a 9-point scale. Raw data of subjects' ratings are presented for the convenience of experimenters planning research with a specific bird/rabbit figure. Of the 12 figures, 6 were significantly bird-dominant, 2 were rabbit-dominant, and only 4 figures were truly ambiguous, i.e., a bird was as easily identified as was a rabbit. With the exception of one figure (the whole-body representation of a duck/rabbit), bird and rabbit ratings were not affected by the orientation of the beak/ears. Jastrow's original drawing was the seventh out of the 12 figures in rated ambiguity, suggesting a secure place for it in research on visual ambiguity.

Qualitative hemispheric differences in semantic category matching

A unilateral category matching task with words as stimuli was employed to investigate semantic processing in the right and left hemispheres (RH, LH). An overall right visual field (RVF)/LH dominance was observed and performances were better than chance, also in the left visual field (LVF)/RH. A qualitative analysis of reaction times with individual differences multidimensional scaling (INDSCAL) revealed that LVF/RH INDSCAL solutions were significantly more differentiated in structure than RVF/LH solutions in terms of number and size of dimensions. These findings support a depth of activation hypothesis of hemispheric processing, with the LH rapidly and focally and the RH slowly and diffusely activating the semantic network.

Vestibular stimulation affects dichotic lexical decision performance

We report an experimental attempt to shift, by vestibular stimulation, healthy subjects' right ear advantage (REA) in a dichotic listening (DL) task with words and nonwords as stimuli. Forty right-handed men performed the task under two different conditions, once while sitting in a stationary turning chair (baseline) and once during sinusoidal rotation. In this latter condition, every other stimulation was received during maximal left-to-right (i.e., clockwise), every other during maximal right-to-left (i.e., counterclockwise) acceleration. There was a reliable REA for lexical decision accuracy in the baseline and right-to-left trials but not during left-to-right rotation. While right ear performance was unaffected by rotation, there were more correct lexical decisions to left ear targets exclusively during left-to-right turns (one-tailed P = 0.05). Since there were no parallel shifts in auditory thresholds under the different conditions, this effect is not due to any hypothetical auditory-vestibular interactions on a primary sensory level. The improvement in left ear DL performance, although small in our study, is comparable to the symptom-alleviating effect of caloric vestibular stimulation in patients with left-sided hemispatial neglect and interpreted as a consequence of a rotation-induced attentional shift towards the left hemispace.

Hallucinatory experiences in extreme-altitude climbers

OBJECTIVE

This study attempted a systematic investigation of incidence, type, and circumstances of anomalous perceptual experiences in a highly specialized group of healthy subjects, extreme-altitude climbers.

BACKGROUND

There is anecdotal evidence for a high incidence of anomalous perceptual experiences during mountain climbing at high altitudes.

METHOD

In a structured interview, we asked eight world-class climbers, each of whom has reached altitudes above 8500 m without supplementary oxygen, about hallucinatory experiences during mountain climbing at various altitudes. A comprehensive neuropsychological, electroencephalographic, and magnetic resonance imaging evaluation was performed within a week of the interview (8).

RESULTS

All but one subject reported somesthetic illusions (distortions of body scheme) as well as visual and auditory pseudohallucinations (in this order of frequency of occurrence). A disproportionately large number of experiences above 6000 m as compared to below 6000 m were reported (relative to the total time spent at these different altitudes). Solo climbing and (in the case of somesthetic illusions) life-threatening danger were identified as probable triggers for anomalous perceptual experiences. No relationship between the number of reported experiences and neuropsychological impairment was found. Abnormalities in electroencephalographic (3 climbers) and magnetic resonance imaging (2 climbers) findings were likewise unrelated to the frequency of reported hallucinatory experiences.

CONCLUSIONS

The results confirm earlier anecdotal evidence for a considerable incidence of hallucinatory experiences during climbing at high altitudes. Apart from hypoxia, social deprivation and acute stress seem to play a role in the genesis of these experiences.

Creative, paranormal, and delusional thought: a consequence of right hemisphere semantic activation?

OBJECTIVE

There is a rapidly growing body of evidence for an association between schizophrenic syndromes and the absence of a clear pattern of hemispheric dominance for language. Independent work with healthy subjects suggests that one feature of right hemispheric (RH) linguistic processing is a coarse as opposed to a focused semantic activation. We provide a comprehensive review of the literature to these hitherto unrelated fields of research and present an experiment assessing functional hemispheric asymmetries for language processing in healthy volunteers, differing in the susceptibility to schizophrenia-like experiences and thoughts.

BACKGROUND

Forty right-handed men were administered a lateralized tachistoscopic lexical decision task. They also completed the Magical Ideation (MI) scale, which examines a variety of paranormal experiences and beliefs.

RESULTS

Although the 20 subjects with MI scores below the median displayed the expected right visual field/left hemisphere (RVF/LH) superiority in lexical decision accuracy, the 20 high scorers were equally proficient in both visual fields. Compared to the low scorers, they made significantly more correct decisions in the left visual field/right hemisphere (LVF/RH).

CONCLUSIONS

These results corroborate previous findings of a reduced LH language dominance for subjects scoring high on scales measuring proneness to schizophrenic behavior and thought ("schizotypy"). We propose that this dominance failure, which is commonly observed in patients with acute signs of psychosis, facilitates the emergence of paranormal and delusional ideas by way of RH associative processing characteristics, that is, coarse rather than focused semantic activation. As unfocused semantic processing is also characteristic of creative thinking, the use of the RH semantic system may constitute a selective evolutionary advantage allowing the genes predisposing to schizophrenia to proliferate despite the obvious disadvantages of this devastating disease.

Stimulus-response compatibility in representational space

Spatial stimulus response (S-R) compatibility designates the observation that speeded reactions to unilateral stimuli are faster for the hand ipsilateral than for the hand contralateral to the sensory hemifield containing the stimulus. In two experiments involving presentation of the numbers 1 to 11 in the center of the visual field we show (1) a left-hand reaction time (RT) advantage for numerals < 6 and a right-hand advantage for those > 6 for subjects who conceive of the numbers as distances on a ruler, and (2) a reversal of this RT advantage for subjects who conceive of them as hours on a clock face. While the results in the first task (RULER) replicate a robust finding from the neuropsychology of number processing (the "SNARC effect") those in the second task (CLOCK) show that extension of the number scale from left to right in representational space cannot be the decisive factor for the observed interaction between hand and number size. Taken together, the findings in the two tasks are best accounted for in terms of an interaction between lateralized mental representations and lateralized motor outputs (i.e. an analog of traditional spatial S-R compatibility effects in representational space). We discuss potential clinical applications of the two tasks in patients with neglect of representational space.

Schizotypal thinking and associative processing: a response commonality analysis of verbal fluency

OBJECTIVE

To determine whether people with high scores for schizotypal thinking generate more uncommon words in a letter fluency task than people with low scores.

DESIGN

Prospective study.

SETTING

University psychology department.

PATIENTS

Forty healthy, right-handed students.

INTERVENTIONS

Students were administered the Magical Ideation (MI) Scale and a 2-minute letter fluency task in which they named as many nouns as possible beginning with "A" or "F," in any order.

OUTCOME MEASURES

Total number of words produced and percentage of unique, rare and common words (as determined by the responses of the whole group); scores on MI scale.

RESULTS

Participants with high scores (above the median) on the MI scale generated as many words as those who had low scores. People in both groups also generated a comparable number of unique words (named by only 1 person) and common words (named by 6 or more people). As hypothesized, people with high scores on the MI scale generated more rare words (named by fewer than 6 people) than those with low scores.

CONCLUSIONS

These findings support the view of a disinhibition of semantic network functioning as the neuropsychological basis of creative thought, magical ideation and thought disorder.

[The dose-dependent effects of oral premedication with midazolam]

OBJECTIVE

The aim of this study was to examine the psychological effects, well-being and side effects after various doses of oral midazolam medication.

METHODS

After informed consent has been obtained and following the approval by the institutional ethical committee, 80 adult patients in the ASA physical status I and II were randomly assigned to one of five different premedication groups: 3.75, 7.5, 11.25, 15 mg midazolam, and placebo. The medication was given in a double-blind fashion 60 min before induction of general anaesthesia for various surgical procedures. At 3 definite stages (before premedication, 30 and 60 min after premedication), blood pressure, heart rate, transcutaneous oxygen saturation and respiratory rate were measured. Sedation and well-being were graded according to a 5-point scale, and the subjective anxiety level was assessed according a visual analogue scale (range 0-100 mm). Anterograde and retrograde amnesia were measured by recall of auditive and visual stimuli. Finally, patients were asked whether in case of future surgery they would prefer the same or a different medication.

RESULTS

Demographic data were similar in all groups. There was no significant difference in respiratory rate, oxygen saturation, blood pressure or heart rate. Alertness declined only after 60 min in the groups treated with 7.5 mg and more midazolam. During the entire measurement period, anxiolysis was not different from placebo in any of the midazolam groups. In comparison to placebo, all midazolam groups showed a statistically significant and dose dependent anterograde amnesia for visual stimuli. Subjective well-being scores showed no differences between the groups. Only few side effects were seen following doses of 7.5 mg and higher, including ptosis, strabismus, diplopia, speech disorders, disorientation and vertigo. The majority of patients in all groups indicated a wish for the same medication in case of future anaesthesia for surgical interventions.

CONCLUSIONS

Midazolam administered orally prior to surgical procedures showed marked interindividual variability. Sedation and amnesia were dose-dependent and were evaluated by the patients as acceptable. Anxiolysis was not significantly different from placebo. A dose of 7.5 mg midazolam showed the best relation between desirable and undesirable effects. Adequate attention given to the patient by the anaesthesiologist prior to surgery seems to be as important and beneficial as oral medication with midazolam.

Testing vs. Believing Hypotheses: Magical Ideation in the Judgement of Contingencies

This paper examines the idea that an important dimension of human cognition is the amount of objective evidence required for perception of meaningful patterns. At the clinical extreme of this dimension are patients with hallucinations and delusions who experience perception with no external evidence and see connections between objectively unrelated events. Also, normal individuals exhibit considerable variation along this continuum. The theory proposed here predicts that normal subjects with low evidential criteria will be more likely to accept causal explanations, not only for everyday ''paranormal'' coincidences, but also for random contingencies in a laboratory experiment. This prediction was confirmed when 40 students completed a differential reinforcement of low rates (DRL) task designed to induce superstitious behaviour and were then questioned about their hypotheses concerning the contingencies for successful performance. Participants scoring high on the Magical Ideation scale (indicating greater belief in paranormal phenomena) tested fewer hypotheses during the task, and they ended up believing in more hypotheses regarding illusory contingencies than did their low-scoring peers. We proposed that a continuum of hypothesis-testing behaviour underlies the schizotypy continuum, with ''positive'' schizotypal traits reflecting a Type I error bias and ''negative'' traits a Type II error bias. Differential activation patterns within frontal-limbic networks are tentatively suggested as a physiological correlate of the behavioural continuum.

[Melatonin and coronary heart disease]

The observation of raised nocturnal urinary norepinephrine excretion in patients with coronary heart disease (CHD), together with results of animal experiments showing a suppression of sympathetic activity by melatonin, were the reasons for this investigation. In 15 patients with CHD and 10 controls the concentrations of serum melatonin, serotonin and N-acetylserotonin were determined in samples gained by venopuncture at 14.00 h and 02.00 h. The melatonin secretion was significantly lower at 02.00 h in the patients with CHD than in the controls. Moreover the serotonin concentration was significantly lower at 14.00 h in the patients with CHD, and somewhat, but not significantly, lower at 02.00 h than in the controls. On the other hand, the serum concentrations of N-acetylserotonin showed a tendency towards higher levels in the CHD patients than in the controls. The causes and consequences of the diminished secretion during the night in patients with CHD are discussed.