Categoría: Papers con abstracts

Socioeconomic status (SES) is a multidimensional concept comprising a variety of interacting factors that influence health in a dynamic manner over the entire lifespan. When looking at its association with health, the quasi-universal pattern is that of increasing level of morbidity as SES decreases, and stroke is no exception.(1,2) In the last 3 decades evidence has accumulated showing how both individual and neighborhood SES independently affect stroke incidence.(3-6) A combination of adverse lifestyle factors, detrimental physical and social environments, and perhaps lower access to primary health care are likely to contribute to this excess risk. Several studies, including that of Brown et al.(7) in this issue of Neurology(®), have looked at survival poststroke as a function of SES. This question is of importance; are the consequences of stroke also borne disproportionately by the poor the way that stroke occurrence is?

The preserved «implicit awareness » in patients with Alzheimer disease (AD) presenting anosognosia has opened a new branch of research regarding explicit-implicit integration. The behavioral variant of frontotemporal dementia (bvFTD), contrary to AD, would present impaired anosognosia-related implicit awareness due to a dysfunctional implicit integration of contextual information caused by an abnormal fronto-insular-temporal network. Loss of insight and anosognosia are pervasive in bvFTD, but no reports have assessed the implicit emotional awareness in this condition. We emphasize the need to investigate and extend our knowledge of implicit contextual integration impairments and their relation with anosognosia in bvFTD vs AD.

To better understand clinical empathy and what factors can undermine its experience and outcome in care-giving settings, a large-scale study was conducted with 7,584 board certified practicing physicians. Online validated instruments assessing different aspects of empathy, distress, burnout, altruistic behavior, emotional awareness, and well-being were used. Compassion satisfaction was strongly associated with empathic concern, perspective taking and altruism, while compassion fatigue (burnout and secondary traumatic stress) was more closely related to personal distress and alexithymia. Gender had a highly selective effect on empathic concern, with women displaying higher values, which led to a wide array of negative and devalued feelings. Years of experience did not influence dispositional measures per se after controlling for the effect of age and gender. Participants who experienced compassion fatigue with little to no compassion satisfaction showed the highest scores on personal distress and alexithymia as well as the strongest indicators of compassion fatigue. Physicians who have difficulty regulating their negative arousal and describing and identifying emotions seem to be more prone to emotional exhaustion, detachment, and a low sense of accomplishment. On the contrary, the ability to engage in self-other awareness and regulate one’s emotions and the tendency to help others, seem to contribute to the sense of compassion that comes from assisting patients in clinical practice.

Even though cerebellar activation has been described during theory of mind (ToM) tasks in neuroimaging studies, no previous studies have investigated ToM in a group of patients with cerebellar strokes. In the present study, we assessed 11 patients with cerebellar infarction on a variety of executive tests and with the Faux Pas test of ToM. Even if cerebellar patients showed significant deficits on executive tasks relative to a control group, no significant differences were found between the groups on the Faux Pas test. This is the first group study to demonstrate that focal cerebellar lesions do not affect ToM.

Executive dysfunction may result from prefrontal circuitry involvement occurring in both neurodegenerative diseases and psychiatric disorders. Moreover, multiple neuropsychiatric conditions, may present with overlapping behavioral and cognitive symptoms, making differential diagnosis challenging, especially during earlier stages. In this sense, cognitive assessment may contribute to the differential diagnosis by providing an objective and quantifiable set of measures that has the potential to distinguish clinical conditions otherwise perceived in everyday clinical settings as quite similar. OBJECTIVE: The goal of this study was to investigate the utility of the INECO Frontal Screening (IFS) for differentiating bv-FTD patients from patients with Major Depression. METHODS: We studied 49 patients with bv-FTD diagnosis and 30 patients diagnosed with unipolar depression compared to a control group of 26 healthy controls using the INECO Frontal Screening (IFS), the Mini Mental State Examination (MMSE) and the Addenbrooke’s Cognitive Examination-Revised (ACE-R). RESULTS: Patient groups differed significantly on the motor inhibitory control (U=437.0, p<0.01), verbal working memory (U=298.0, p<0.001), spatial working memory (U=300.5, p<0.001), proverbs (U=341.5, p<0.001) and verbal inhibitory control (U=316.0, p<0.001) subtests, with bv-FTD patients scoring significantly lower than patients with depression. CONCLUSION: Our results suggest the IFS can be considered a useful tool for detecting executive dysfunction in both depression and bv-FTD patients and, perhaps more importantly, that it has the potential to help differentiate these two conditions.

Hierarchical predictive coding suggests that attention in humans emerges from increased precision in probabilistic inference, whereas expectation biases attention in favor of contextually anticipated stimuli. We test these notions within auditory perception by independently manipulating top-down expectation and attentional precision alongside bottom-up stimulus predictability. Our findings support an integrative interpretation of commonly observed electrophysiological signatures of neurodynamics, namely mismatch negativity (MMN), P300, and contingent negative variation (CNV), as manifestations along successive levels of predictive complexity. Early first-level processing indexed by the MMN was sensitive to stimulus predictability: here, attentional precision enhanced early responses, but explicit top-down expectation diminished it. This pattern was in contrast to later, second-level processing indexed by the P300: although sensitive to the degree of predictability, responses at this level were contingent on attentional engagement and in fact sharpened by top-down expectation. At the highest level, the drift of the CNV was a fine-grained marker of top-down expectation itself. Source reconstruction of high-density EEG, supported by intracranial recordings, implicated temporal and frontal regions differentially active at early and late levels. The cortical generators of the CNV suggested that it might be involved in facilitating the consolidation of context-salient stimuli into conscious perception. These results provide convergent empirical support to promising recent accounts of attention and expectation in predictive coding.

Vascular dementia (VaD) is one of the most prevalent causes of dementia, and it is frequently misdiagnosed and undertreated in clinical practice. Because neuropsychological outcome depends, among other factors, on the size and location of the vascular brain injury, characterizing the cognitive profile of VaD has been especially challenging. Yet, there has been sufficient evidence to show a marked impairment of attention and executive functions, in particular in relation to Alzheimer disease. Being able to detect these deficits at bedside is crucial for everyday clinical practice, and yet, brief cognitive screening toots such as the Mini-Mental Sate Examination (MMSE) may overlook at cognitive deficits typical of patients with VaD. The Addenbrooke’s Cognitive Examination Revised (ACE-R) is also a brief cognitive screening tool designed to incorporate the items of the MMSE and further extend the test to assess orientation, attention, verbal fluency, memory, language, and visuospatial abilities. In this study, we investigated the ability of the Spanish version of the ACE-R to detect the cognitive impairment showed in patients with subcortical ischemic vascular dementia, and we compared its usefulness to that of the MMSE in this population. Scores on these tests were compared to those of patients with Alzheimer disease and matched healthy controls. The 88-point cut-off proposed for the ACE-R was associated with a sensitivity of 100% and a specificity of 100% for the detection of cognitive impairment, demonstrating a stronger capacity than the MMSE (sensitivity of 42% with its 23-point cut-off score). We also found that the verbal fluency subtest of the ACE-R may be potentially useful in discriminating patients with subcortical ischemic vascular dementia from patients with AD. We discuss the utility of these findings in the context of everyday clinical practice and we propose that future studies should evaluate the potential usefulness of combining the ACE-R with a brief screening tool of executive functioning.

Individual differences in theory of mind (ToM) are affected by a variety of factors. We investigated the relationship between empathy, sex and fluid intelligence (FI) as predictors of ToM in a random probabilistic sample of secondary students. First, we explored whether sex, as well as high, average or low levels of empathy and FI affect ToM performance. Furthermore, we assessed the contribution of empathy, sex and FI in predicting ToM by using a path analysis. This method allows testing of causal models of directed dependencies among a set of variables. The causal dependencies of empathy, sex and fluid intelligence were confirmed and identified. In addition, the model confirmed the direct effect of empathy, sex and fluid intelligence on ToM; and the indirect effect of sex mediated by empathy. Thus, individual differences in ToM levels are partially attributable to sex, empathy and fluid intelligence variability, raising important considerations for clinical research as well as ToM‟s theoretical models of domain specificity.

We sought to investigate the decision making profile of Primary Progressive Aphasia (PPA) by assessing patients diagnosed with this disease (n = 10), patients diagnosed with behavioral variant frontotemporal dementia (bvFTD, n = 35), and matched controls (n = 14) using the Iowa Gambling Task, a widely used test that mimics real-life decision making. Participants were also evaluated with a complete neuropsychological battery. Patients with PPA were unable to adopt an advantageous strategy on the IGT, which resulted in a flat performance, different to that exhibited by both controls (who showed advantageous decision making) and bvFTD patients (who showed risk-appetitive behavior). The decision making profile of PPA patients was not associated with performance on language tasks and did not differ between sub-variants of the disease (namely, semantic dementia and progressive nonfluent aphasia). Investigating decision making in PPA is crucial both from a theoretical perspective, as it can shed light about the way in which language interacts with other cognitive functions, as well as a clinical standpoint, as it could lead to a more objective detection of impairments of decision making deficits in this condition.

Is it permissible to harm one to save many? Classic moral dilemmas are often defined by the conflict between a putatively rational response to maximize aggregate welfare (i.e., the utilitarian judgment) and an emotional aversion to harm (i.e., the non-utilitarian judgment). Here, we address two questions. First, what specific aspect of emotional responding is relevant for these judgments? Second, is this aspect of emotional responding selectively reduced in utilitarians or enhanced in non-utilitarians? The results reveal a key relationship between moral judgment and empathic concern in particular (i.e., feelings of warmth and compassion in response to someone in distress). Utilitarian participants showed significantly reduced empathic concern on an independent empathy measure. These findings therefore reveal diminished empathic concern in utilitarian moral judges.