Future thinking in Parkinson's disease: An executive function?

Effects of mental imagery training on cognitive function and brain connectivity in people with Parkinson's disease: A randomized pilot trial

Cognitive impairment is a debilitating problem in Parkinson's disease (PD) with no effective treatment. We developed a personalized mental imagery (MI) intervention focusing on goal-directed activities and examined its effect on everyday cognitive functioning and brain functional connectivity in people with PD in a pilot randomized controlled trial ( ClinicalTrials.gov identifier NCT05495997 ). Thirty nondemented people with PD were randomized to PD-MI and PD-Control groups. During the six-week training period, PD-MI received MI training and PD-Control received psychoeducation on cognitive health in PD. Participants underwent cognitive and functional MRI assessments at baseline, six weeks, and 18 weeks. The primary outcomes included changes in Neuro-QoL Cognitive Function (CF) survey scores and functional connectivity. The PD-MI compared to the PD-Control group showed (1) significant difference in Neuro-QoL-CF scores (F(1,26) = 6.802, p = 0.015) at six weeks which was not sustained at 18 weeks, (2) stronger connectivity between frontoparietal regions (T = 4.1, p = 0.009) during MI tasks at six weeks, and (3) weaker connectivity between visuospatial and motor regions at 18 weeks. Personalized MI training can be effective in facilitating cognitive preparedness for everyday tasks in people with PD. Its long-term effects and feasibility in cognitively impaired PD cohorts need further investigation.

Practice is the best of all instructors-Effects of enactment encoding and episodic future thinking on prospective memory performance in high-functioning adults with autism spectrum disorder

Prospective memory (PM) is the ability to remember to carry out intended actions in the future. The present study investigated the effects of episodic future thinking (EFT) and enactment encoding (EE) on PM performance in autistic adults (ASD). A total of 72 autistic individuals and 70 controls matched for age, gender, and cognitive abilities completed a computerized version of the Dresden breakfast Task, which required participants to prepare breakfast following a set of rules and time restrictions. A two (group: ASD vs. controls) by three (encoding condition: EFT vs. EE vs. standard) between-subjects design was applied. Participants were either instructed to engage in EFT or EE to prepare to the different tasks prior to performing the Dresden breakfast or received standard instructions. Analyses of variance were conducted. Autism-spectrum-disorders (ASD) participants did not differ from control participants in their PM performance, regardless of which strategy they used. Compared to the standard condition, EE but not EFT improved time-based PM performance in all participants. This is the first study to find spared time-based PM performance in autistic individuals. The results confirm earlier results of beneficial effects of EE on PM performance. Findings are discussed with regards to the methodology used, sample composition as well as autistic characteristics.

Taking time to compose thoughts with prefrontal schemata

Under what conditions can prefrontal cortex direct the composition of brain states, to generate coherent streams of thoughts? Using a simplified Potts model of cortical dynamics, crudely differentiated into two halves, we show that once activity levels are regulated, so as to disambiguate a single temporal sequence, whether the contents of the sequence are mainly determined by the frontal or by the posterior half, or by neither, depends on statistical parameters that describe its microcircuits. The frontal cortex tends to lead if it has more local attractors, longer lasting and stronger ones, in order of increasing importance. Its guidance is particularly effective to the extent that posterior cortices do not tend to transition from state to state on their own. The result may be related to prefrontal cortex enforcing its temporally-oriented schemata driving coherent sequences of brain states, unlike the atemporal "context" contributed by the hippocampus. Modelling a mild prefrontal (vs. posterior) lesion offers an account of mind-wandering and event construction deficits observed in prefrontal patients.

Confabulations in a teenager with a right frontal hemispherotomy: Possible underlying mechanisms

Objective: Confabulations, i.e. false memories without intention to deceive, can be observed in adults with frontal brain damage. Confabulations are typically associated with episodic memory and/or executive disorders although the severity of these impairments is highly variable. Confabulations may also be associated with emotional/motivational particularities, as a positive bias seems to prevail in such situations. Several distinct cognitive and socio-affective processes may account for the various types of confabulations and these issues remain open. Method: We present the case of a teenager with an early acquired frontal damage, referred for "strange lies." Besides a standard neuropsychological assessment, we explored (1) source memory, using a reality-monitoring task, (2) episodic autobiographical memory, including both the recollection of the past memories and the ability to imagine future personal events, with an episodic future thinking task (EFT), (3) the sense of self, with questionnaires targeting self-representations, self-esteem and self-competence. Results: The results showed the expected source memory deficits and poor episodic future thinking, whereas episodic autobiographical memory was preserved, contrary to the episodic memory dysfunction usually evidenced in adult confabulators. The confabulations produced by this teenager displayed a clear positive bias, seemed to fit to personal/social goals and to wishful ideations, and were associated with an above average self-esteem and self-representation. Conclusions: These results support the hypothesis of self-identity and emotional regulatory roles of the confabulations. Although the literature on confabulating children/teenagers is nearly non-existent, a more systematic screening of confabulations should be conducted in order to avoid false interpretation to strange discourse or behavior.

Phenomenological characteristics of autobiographical future thinking in nurses with burnout: a case-control study

Objective

Nurses constitute the largest group of healthcare workers worldwide, and job burnout is very common among them. This study aims to explore abnormal future thinking in nurses with burnout. Additionally, the study investigates whether these manifestations worsen as burnout progresses.

Methods

The study was conducted in inpatient ward nurses at a tertiary hospital in Hangzhou, China. In the first phase, two group of nurses were recruited: nurses with burnout (N = 70) and nurses without burnout (N = 70). In the second phase, three groups were recruited according to the burnout levels: mild burnout (N = 43), moderate burnout (N = 42) and severe burnout (N = 43). Data on job burnout were obtained using the Chinese Maslach Burnout Inventory. The Sentence Completion for Events in the Future Test (SCEFT) was employed to measure the content of future thinking, which was evaluated by two raters in terms of the specificity, emotional valence, and concrete content of the imagined future events. The proportions of specific types of events among all the produced events were calculated.

Results

The results revealed that nurses with burnout, compared to nurses without burnout, imagined fewer specific future events, positive events, and events related to relationships and achievement. They also had more omissions. As the level of burnout increased, their impairment in future thinking worsened. Furthermore, the results also revealed that the scores of emotional exhaustion, depersonalization, and personal accomplishment had significant correlations with the proportions of positive events and events related to relationships and achievement/mastery in nurses' future thinking content.

Conclusion

The future thinking ability of nurses with burnout was impaired, and this impairment worsened as the symptoms of burnout progressed. The findings of the present study have important implications for nurse caring and advocate effective interventions targeting positive future thinking to mitigate nurses' burnout.

Mental imagery content is associated with disease severity and specific brain functional connectivity changes in patients with Parkinson's disease

Mental imagery is the mental re-creation of perceptual experiences, events and scenarios, and motor acts. In our previous study, we assessed whether motor imagery (MI) training combined with functional magnetic resonance imaging-based neurofeedback could improve the motor function of nondemented subjects with mild Parkinson's disease (PD) (N = 22). We used visual imagery (VI) (e.g., of scenes or events, but not of self-movements) training without neurofeedback for the control group (N = 22). Notably, both groups showed significant and comparable improvement in motor function after four weeks of daily imagery practice. In this study, we further examined the neural correlates of the motor enhancement as a result of the VI training by analyzing the self-reported VI content during daily practice and relating its quality to the functional connectivity characteristics of the same subjects. We demonstrated that the VI practice encompassed multisensory, spatial, affective, and executive processes all of which are also important for motor function in real life. Subjects with worse global disease severity also showed poorer quality of the VI content. Finally, the quality of the VI content showed significant positive correlations with the functional connectivity changes during the VI tasks in brain areas supporting visuospatial and sensorimotor processes. Our findings suggest that mental imagery training combining VI and MI may enhance motor function in patients with mild PD, and more broadly, underline the importance of incorporating self-reports of thoughts and experiences in neuroimaging studies that examine the brain mechanisms of complex cognitive processes especially in neuropsychiatric patient populations.

Parkinson's disease disrupts the ability to initiate and apply episodic foresight

OBJECTIVE

While Parkinson's disease is associated with impairments in many aspects of prospective cognition, no study to date has tested whether these difficulties extend to problems using episodic foresight to guide future-directed behavior. To provide the first examination of whether people with Parkinson's disease are impaired in their capacity to initiate and apply episodic foresight.

METHOD

People with Parkinson's disease (n = 42), and a demographically matched neurotypical comparison group (n = 42) completed a validated behavioral assessment that met strict criteria for assessing episodic foresight (Virtual Week-Foresight), as well as a broader neurocognitive and clinical test battery.

RESULTS

People with Parkinson's disease were significantly less likely than the comparison group to acquire items that would later allow a problem to be solved and were also less likely to subsequently use these items for problem resolution. These deficits were largely unrelated to performance on other cognitive measures or clinical characteristics of the disorder.

CONCLUSIONS

The ability to engage in episodic foresight in an adaptive way is compromised in Parkinson's disease. This appears to be a stable feature of the disorder, and one that is distinct from other clinical symptoms and neurocognitive deficits. It is now critical to establish exactly why these difficulties exist and how they impact on real-life functional capacity.

The Role of Beta Oscillations in Mental Time Travel

The brain processes short-interval timing but also allows people to project themselves into the past and the future (i.e., mental time travel [MTT]). Beta oscillations index seconds-long-interval timing (i.e., higher beta power is associated with longer durations). Here, we used parietal transcranial alternating current stimulation (tACS) to investigate whether MTT is also supported by parietal beta oscillations and to test the link between MTT and short intervals. Thirty adults performed a novel MTT task while receiving beta and alpha tACS, in addition to no stimulation. Beta tACS corresponded to a temporal underestimation in past but not in future MTT. Furthermore, participants who overestimated seconds-long intervals also overestimated temporal distances in the past-projection MTT condition and showed a stronger effect of beta tACS. These data provide a unique window into temporal perception, showing how beta oscillations may be a common mechanism for short intervals and MTT.

Simulating the situated-self drives hippocampo-cortical engagement during inner narration of events

We often use inner narration when thinking about past and future events. The present paradigm explicitly addresses the influence of the language used in inner narration on the hippocampus-dependent event construction process. We assessed the language context effect during the inner narration of different event types: past, future, daydream, and self-unrelated fictitious events. The language context was assessed via a fluent bilingual population who used inner narration, either in their first language (L1) or second language (L2). Not all inner narration of events elicited hippocampo-cortical activity. In fact, only the angular gyrus and precuneus-retrosplenial cortex were activated by inner narration across all event types. More precisely, only inner narration of events which entailed the simulation of bodily self-location in space (whether or not they were time-marked: past, future, daydream) depended on the hippocampo-cortical system, while inner narration of events that did not entail bodily self-location (self-unrelated fictitious) did not. The language context of the narration influenced the bilinguals' hippocampo-cortical system by enhancing the co-activation of semantic areas with the hippocampus for inner narration of events in the L2. Overall, this study highlights 2 important characteristics of hippocampo-cortical-dependent inner narration of events: The core episodic hippocampal system is activated for inner narration of events simulating self-location in space (regardless of time-marking), and the inner language used for narration (L1 or L2) mediates hippocampal functional connectivity.

Spiritual care for the management of Parkinson's disease: Where we are and how far can we go

An increasing number of studies have investigated the neural networks and brain regions activated by different aspects of religious faith or spiritual practice. The extent to which religiousness and spirituality are dependent on the integrity of neural circuits is a question unique to neurological illnesses. Several studies have reported that neural networks and brain areas represent the various components of religious faith or spiritual activity in recent decades. In addition to research in healthy people, another strategy is to observe if neurological abnormalities caused by stroke, tumour, brain damage, or degenerative sickness are accompanied by an alteration in religiosity or spirituality. Similarly, Parkinson's disease (PD), an ailment characterized by dopaminergic neuron malfunction, has been utilized to explore the role of dopaminergic networks in the practice, experience, and maintenance of religious or spiritual beliefs. Case-control and priming studies have demonstrated a decline in spirituality and religion in people with PD due to dopaminergic degeneration. These studies could not adequately control for confounding variables and lacked methodological rigour. Using qualitative and quantitative assessments, a mixed-method approach might shed additional light on putative religious beliefs alterations in PD. In the current review paper, we discussed the recent research on the impact of PD on spiritual beliefs and spirituality.

Episodic Past, Future, and counterfactual thinking in Relapsing-Remitting Multiple sclerosis

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Performance in episodic past, future or counterfactual thinking in relapsing-remitting MS and controls was explored.

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Behavioral and diffusion weighted imaging were used to evaluate associations between white matter integrity and group differences in performance.

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Relative to controls, MS patients showed reductions in episodic details across all three simulations.

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Reduced white matter integrity in three association tracts predicted this reduction in episodic details during counterfactual simulations.

Multiple sclerosis (MS) is a progressive disease characterized by widespread white matter lesions in the brain and spinal cord. In addition to well-characterized motor deficits, MS results in cognitive impairments in several domains, notably in episodic autobiographical memory. Recent studies have also revealed that patients with MS exhibit deficits in episodic future thinking, i.e., our capacity to imagine possible events that may occur in our personal future. Both episodic memory and episodic future thinking have been shown to share cognitive and neural mechanisms with a related kind of hypothetical simulation known as episodic counterfactual thinking: our capacity to imagine alternative ways in which past personal events could have occurred but did not. However, the extent to which episodic counterfactual thinking is affected in MS is still unknown. The current study sought to explore this issue by comparing performance in mental simulation tasks involving either past, future or counterfactual thoughts in relapsing-remitting MS. Diffusion weighted imaging (DWI) measures were also extracted to determine whether changes in structural pathways connecting the brain’s default mode network (DMN) would be associated with group differences in task performance. Relative to controls, patients showed marked reductions in the number of internal details across all mental simulations, but no differences in the number of external and semantic-based details. It was also found that, relative to controls, patients with relapsing-remitting MS reported reduced composition ratings for episodic simulations depicting counterfactual events, but not so for actual past or possible future episodes. Additionally, three DWI measures of white matter integrity—fractional anisotropy, radial diffusivity and streamline counts—showed reliable differences between patients with relapsing-remitting MS and matched healthy controls. Importantly, DWI measures associated with reduced white matter integrity in three association tracts on the DMN—the right superior longitudinal fasciculus, the left hippocampal portion of the cingulum and the left inferior longitudinal fasciculus—predicted reductions in the number of internal details during episodic counterfactual simulations. Taken together, these results help to illuminate impairments in episodic simulation in relapsing-remitting MS and show, for the first time, a differential association between white matter integrity and deficits in episodic counterfactual thinking in individuals with relapsing-remitting MS.

How do cannabis users mentally travel in time? Evidence from an fMRI study of episodic future thinking

RATIONALE

Episodic future thinking (EFT) is a cognitive function that allows individuals to imagine novel experiences that may happen in the future. Prior studies show that EFT is impaired in different groups of substance users. However, there is no evidence regarding the neurobiological mechanisms of EFT in cannabis users.

OBJECTIVES

We aimed to compare brain activations of regular cannabis users and non-using controls during an EFT fMRI task. Exploratory analyses were also conducted to investigate the association between EFT and cannabis use variables (e.g., duration of use, age onset, frequency of use).

METHODS

Twenty current cannabis users and 22 drug-naïve controls underwent an fMRI scanning session while completing a task involving envisioning future-related events and retrieval of past memories as a control condition. The EFT fMRI task was adapted from the autobiographical interview and composed of 20 auditory cue sentences (10 cues for past and 10 cues for future events). Participants were asked to recall a past or generate a future event, in response to the cues, and then rate their vividness after each response.

RESULTS

We found that cannabis users compared to non-user controls had lower activation within the cerebellum, medial and superior temporal gyrus, lateral occipital cortex, and occipital fusiform gyrus while envisioning future events. Cannabis users rated the vividness of past events significantly lower than non-users (P < 0.005). There were marginal group differences for rating the vividness of future events (P = 0.052). Significant correlations were also found between the medial and superior temporal gyrus activities and behavioral measures of EFT and episodic memory.

CONCLUSIONS

Cannabis users, compared to drug-naïve controls, have lower brain activation in EFT relevant regions. Thus, any attempts to improve aberrant EFT performance in cannabis users may benefit from EFT training.

Compromised future thinking: another cognitive cost of temporal lobe epilepsy

The ability to mentally travel forward through time allows humans to envisage a diverse array of possible events taking place in the future, helping us to choose which pathway to take in life. In epilepsy, we assume that patients use this cognitive ability when deciding between various treatment options, but this assumption has not been robustly tested. The temporal lobes are key contributors to this 'future thinking' and its building blocks include cognitive functions commonly impaired in temporal lobe epilepsy such as memory and language, giving rise to a hypothesis that 'future thinking' is impaired in this patient cohort. Participants were 68 adults: 37 with neurosurgically-naïve, unilateral temporal lobe epilepsy (51% right lateralized) and 31 healthy controls of similar age, sex and intellectual ability to the participants with epilepsy. Future thinking was measured using an imagined experiences task validated in other neurological populations. Tools well-established in temporal lobe epilepsy were used to measure potential cognitive correlates of future thinking. Analysis of variance revealed significantly impoverished future thinking in both left and right temporal lobe epilepsy relative to controls (P = 0.001, η p 2=0.206), with no difference between temporal lobe epilepsy groups (P > 0.05). Future thinking deficits in left temporal lobe epilepsy were paralleled by deficits in scene construction, whereas impoverished future thinking in right temporal lobe epilepsy occurred in the setting of intact scene construction. Deficits in future thinking were associated with reductions in lexical access and episodic autobiographic memory in both epilepsy groups. In sum, future thinking is compromised in both left and right temporal lobe epilepsy. The deficit in left temporal lobe epilepsy is largely explainable by dysfunction in verbal cognitive processes including scene construction. While the basis of the deficits observed with right temporal foci shares features with that of left temporal lobe epilepsy, their intact scene construction raises questions about the role of the left and right temporal lobes in future thinking and scene construction and the relationship between these two constructs, including whether right temporal lobe might play a specific role in future thinking in terms of creative processing. Clinicians should take impaired future thinking into account when counselling temporal lobe epilepsy patients about various treatment options, as they may struggle to vividly imagine what different outcomes might mean for their future selves.

Bringing Advanced Therapies for Parkinson's Disease to the Clinic: An Analysis of Ethical Issues

Advanced therapies for Parkinson’s disease (PD) constitute a broad range of treatments, each presenting specific ethical challenges. Some of these therapies are established and in clinical use, like device-aided therapies, and others, based on advanced therapeutic medicinal products (ATMPs), are still in early stage of clinical trials. This paper focuses on some common ethical issues arising in these two categories of advanced therapies, especially challenges arising when advanced therapies are proposed to PD patients in the form of advanced care, under a clinical trial, or, in case of ATMPs, under the “hospital exemption” rule. The ethical issues covered here relate mainly to ensuring informed consent in these different contexts, to the stakeholder role of patient’s non-professional caretakers, such as family, and to patient safety in treatments under “hospital exemption”. To illustrate the points discussed in connection with “hospital exemption” rule, the example of the EU has been chosen. This paper does not claim completeness of ethical issues raised by bringing advanced therapies for PD to the clinic, but rather presents examples of ethical challenges in this context.

Future and past autobiographical memory in persons with HIV disease

Objective: While HIV disease is associated with impairment in declarative memory, the ability of people with HIV (PWH) to describe past and future autobiographical events is not known. Method: Participants included 63 PWH and 28 seronegative individuals ages 50-78 who completed standardized neurocognitive and everyday functioning assessments. Participants described four events from the recent past and four imagined events in the near future, details from which were classified as internal or external to the main event. Result: PWH produced fewer autobiographical details with small-to-medium effect sizes but did not differ from seronegative participants in meta-cognitive ratings of their performance. Performance of the study groups did not vary across past or future probes or internal versus external details; however, within the entire sample, past events were described in greater detail than future events, and more external than internal details were produced. Within the PWH group, the production of fewer internal details for future events was moderately associated with poorer prospective memory, executive dysfunction, and errors on a laboratory-based task of medication management. Conclusion: Older PWH may experience difficulty generating autobiographical details from the past and simulated events in the future, which may be related to executive dyscontrol of memory processes. Future studies might examine the role of future thinking in health behaviors such as medication adherence and retention in healthcare among PWH. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An asymmetry in past and future mental time travel following vmPFC damage

The role of ventromedial prefrontal cortex (vmPFC) in mental time travel toward the past and the future is debated. Here, patients with focal lesions to the vmPFC and brain-damaged and healthy controls mentally projected themselves to a past, present or future moment of subjective time (self-projection) and classified a series of events as past or future relative to the adopted temporal self-location (self-reference). We found that vmPFC patients were selectively impaired in projecting themselves to the future and in recognizing relative-future events. These findings indicate that vmPFC damage hinders the mental processing of and movement toward future events, pointing to a prominent, multifaceted role of vmPFC in future-oriented mental time travel.

Spontaneous and deliberate future thinking: a dual process account

In this article, we address an apparent paradox in the literature on mental time travel and mind-wandering: How is it possible that future thinking is both constructive, yet often experienced as occurring spontaneously? We identify and describe two 'routes' whereby episodic future thoughts are brought to consciousness, with each of the 'routes' being associated with separable cognitive processes and functions. Voluntary future thinking relies on controlled, deliberate and slow cognitive processing. The other, termed involuntary or spontaneous future thinking, relies on automatic processes that allows 'fully-fledged' episodic future thoughts to freely come to mind, often triggered by internal or external cues. To unravel the paradox, we propose that the majority of spontaneous future thoughts are 'pre-made' (i.e., each spontaneous future thought is a re-iteration of a previously constructed future event), and therefore based on simple, well-understood, memory processes. We also propose that the pre-made hypothesis explains why spontaneous future thoughts occur rapidly, are similar to involuntary memories, and predominantly about upcoming tasks and goals. We also raise the possibility that spontaneous future thinking is the default mode of imagining the future. This dual process approach complements and extends standard theoretical approaches that emphasise constructive simulation, and outlines novel opportunities for researchers examining voluntary and spontaneous forms of future thinking.

Harnessing Visual Imagery and Oculomotor Behaviour to Understand Prospection

Much of the rich internal world constructed by humans is derived from, and experienced through, visual mental imagery. Despite growing appreciation of visual exploration in guiding episodic memory processes, extant theories of prospection have yet to accommodate the precise role of visual mental imagery in the service of future-oriented thinking. We propose that the construction of future events relies on the assimilation of perceptual details originally experienced, and subsequently reinstantiated, predominantly in the visual domain. Individual differences in the capacity to summon discrete aspects of visual imagery can therefore account for the diversity of content generated by humans during future simulation. Our integrative framework provides a novel testbed to query alterations in future thinking in health and disease.

Episodic future thinking together with observational learning benefits prospective memory in high-functioning Korsakoff's syndrome patients

Objective

Patients with Korsakoff’s syndrome (KS) have difficulty carrying out tasks which rely on prospective memory (PM). Since remembering to carry out an action in the future is crucial for living independently, it is of primary interest to develop strategies that improve PM performance in KS patients.

Design

The study employed a computer categorization task as an ongoing activity into which a PM task was embedded. We included episodic future thinking (EFT) and observational learning (Experiment 2) to boost PM.

Methods

Experiment 1 evaluated the efficacy of EFT following written PM task instructions in ten KS patients. Due to floor‐level PM performance in Experiment 1, Experiment 2 included an instructional video demonstrating the PM intention. In Experiment 2, twenty‐six KS patients performed both conditions (EFT and no‐EFT) at least 1 week apart, while twelve controls with alcohol use disorder without KS performed the no‐EFT condition. In Experiment 2, the PM instructions were also shown through video (observational learning component). Mild cognitive impairment was assessed in a short test battery.

Results

Experiment 1 showed overall floor performance in both conditions. Experiment 2 showed that KS patients performed PM tasks less accurately than the control group in the no‐EFT condition. In Experiment 2, where the observational learning component was included, EFT improved PM performance in KS patients. This effect was driven by a sub‐group of high‐functioning KS patients.

Conclusions

This study showed the value of an observational learning component together with EFT in improving PM performance, in relatively high‐functioning KS patients.

Practitioner points

KS patients performed the PM task less accurately than non‐KS controls with alcohol use disorder, confirming PM impairment in this patient population.

Controls with alcohol use disorder performed the PM task at ceiling level.

Showing an instructional video demonstrating the PM intention improved PM performance and later recall of PM task instructions in KS patients.

Episodic future thinking strategy improved PM performance in KS patients with relatively intact cognitive functioning.

A role for the medial temporal lobe subsystem in guiding prosociality: the effect of episodic processes on willingness to help others

Why are we willing to help others? Recent behavioral work on episodic processes (i.e. the ability to represent an event that is specific in time and place) suggests that imagining and remembering scenes of helping a person in need increases intentions to help. Here, we provide insight into the cognitive and neural mechanisms that enhance prosocial intentions via episodic simulation and memory. In Experiment 1, we scanned participants using functional neuroimaging as they imagined and remembered helping episodes, and completed non-episodic control conditions accounting for exposure to the story of need and conceptual priming of helping. Analyses revealed that activity in the medial temporal lobe (MTL) subsystem, as well as the right temporoparietal junction (RTPJ) predicted the effect of conditions on the strength of prosocial intentions. In Experiment 2, we used transcranial magnetic stimulation to disrupt activity in the RTPJ, and better isolate the contribution of MTL subsystem to prosocial intentions. The effect of conditions on willingness to help remained even when activity in the RTPJ was disrupted, suggesting that activity in the MTL subsystem may primarily support this prosocial effect. It seems our willingness to help may be guided, in part, by how easily we can construct imagined and remembered helping episodes.

Advance care planning in Parkinson's disease: ethical challenges and future directions

Recent discoveries support the principle that palliative care may improve the quality of life of patients with Parkinson's disease and those who care for them. Advance care planning, a component of palliative care, provides a vehicle through which patients, families, and clinicians can collaborate to identify values, goals, and preferences early, as well as throughout the disease trajectory, to facilitate care concordant with patient wishes. While research on this topic is abundant in other life-limiting disorders, particularly in oncology, there is a paucity of data in Parkinson's disease and related neurological disorders. We review and critically evaluate current practices on advance care planning through the analyses of three bioethical challenges pertinent to Parkinson's disease and propose recommendations for each.

A Neurobehavioral Approach to Addiction: Implications for the Opioid Epidemic and the Psychology of Addiction

Two major questions about addictive behaviors need to be explained by any worthwhile neurobiological theory. First, why do people seek drugs in the first place? Second, why do some people who use drugs seem to eventually become unable to resist drug temptation and so become "addicted"? We will review the theories of addiction that address negative-reinforcement views of drug use (i.e., taking opioids to alleviate distress or withdrawal), positive-reinforcement views (i.e., taking drugs for euphoria), habit views (i.e., growth of automatic drug-use routines), incentive-sensitization views (i.e., growth of excessive "wanting" to take drugs as a result of dopamine-related sensitization), and cognitive-dysfunction views (i.e., impaired prefrontal top-down control), including those involving competing neurobehavioral decision systems (CNDS), and the role of the insula in modulating addictive drug craving. In the special case of opioids, particular attention is paid to whether their analgesic effects overlap with their reinforcing effects and whether the perceived low risk of taking legal medicinal opioids, which are often prescribed by a health professional, could play a role in the decision to use. Specifically, we will address the issue of predisposition or vulnerability to becoming addicted to drugs (i.e., the question of why some people who experiment with drugs develop an addiction, while others do not). Finally, we review attempts to develop novel therapeutic strategies and policy ideas that could help prevent opioid and other substance abuse.

Is Episodic Future Thinking Important for Instrumental Activities of Daily Living? A Study in Neurological Patients and Healthy Older Adults

OBJECTIVE

Episodic future thinking is the ability to mentally project oneself into the future. This construct has been explored extensively in cognitive neuroscience and may be relevant for adaptive functioning. However, it has not been determined whether the measurement of episodic future thinking might be valuable in a clinical neuropsychological setting. The current study investigated (1) the relationship between episodic future thinking and instrumental activities of daily living (IADLs); and (2) whether episodic future thinking is related to IADLs over and above standard measures of cognition.

METHOD

Sixty-one older adults with heterogeneous neurological conditions and 41 healthy older adults completed a future thinking task (the adapted Autobiographical Interview), a performance-based measure of instrumental activities of daily living (the Independent Living Scales), and standard clinical measures of memory and executive functioning.

RESULTS

Episodic future thinking significantly predicted IADLs after accounting for age, education, gender, and depression (increase in R2 = .050, p = .010). Episodic future thinking significantly predicted IADLs over and above executive functioning (increase in R2 = .025, p = .030), but was not predictive of IADLs over and above memory (p = .157).

CONCLUSIONS

This study suggests that episodic future thinking is significantly associated with IADLs, beyond what can be accounted for by executive functioning. However, episodic future thinking did not predict IADLs over and above memory. Overall, there is limited evidence for the clinical utility of episodic future thinking. The findings suggest that an episodic future thinking task does not provide enough valuable information about IADLs to justify its inclusion in a clinical neuropsychological setting.

The Functions of Prospection - Variations in Health and Disease

Much of human life revolves around anticipating and planning for the future. It has become increasingly clear that this capacity for prospective cognition is a core adaptive function of the mind. Here, we review the role of prospection in two key functional domains: goal-directed behavior and flexible decision-making. We then survey and categorize variations in prospection, with a particular focus on functional impact in clinical psychological conditions and neurological disorders. Finally, we suggest avenues for future research into the functions of prospection and the manner in which these functions can shift toward maladaptive outcomes. In doing so, we consider the conceptualization and measurement of prospection, as well as novel approaches to its augmentation in healthy people and managing its alterations in a clinical context.

Semantic future thinking and executive functions at age 4: The moderating role of frontal brain electrical activity

Previous studies provide conflicting results regarding the relation between future thinking and executive functioning during early childhood. Furthermore, little is known of the neural mechanisms involved in future thinking during early childhood. We examined the moderating role of frontal electroencephalogram (EEG) activity on the relation between executive functioning and semantic future thinking performance in a sample of 4-year-old children. Our results suggest that frontal EEG moderates the relation between executive functioning and semantic future thinking performance, but only for medium to high levels of frontal EEG power values. These results provide emerging evidence regarding the role of both executive functioning and frontal brain electrical activity on semantic future thinking in 4-year-olds.

Addictive behaviors: Why and how impaired mental time matters?

Mental time travel (MTT) allows navigation into the past, the future, and the minds of others, and it subserves future-oriented decision-making. Impaired MTT has been associated with a tendency to over-rely on the present, which is a characteristic of addictive behaviors. We here discuss the possible relationship between impaired autographical memory, future-oriented MTT, shortened time horizons, suboptimal social cognition, and poor decision-making in individuals with drug and gambling use disorders. We elaborate on how impaired MTT could compromise the process of change in addiction recovery and the effectiveness of psychotherapy. We argue that facilitating MTT represents, for individuals with addictive behaviors, an important process to enhance readiness to change, and to improve the quality and the efficiency of psychosocial interventions that focus on "emotional correction."

Remembering and imagining alternative versions of the personal past

Although autobiographical memory and episodic simulations recruit similar core brain regions, episodic simulations engage additional neural recruitment in the frontoparietal control network due to greater demands on constructive processes. However, previous functional neuroimaging studies showing differences in remembering and episodic simulation have focused on veridical retrieval of past experiences, and thus have not fully considered how retrieving the past in different ways from how it was originally experienced may also place similar demands on constructive processes. Here we examined how alternative versions of the past are constructed when adopting different egocentric perspectives during autobiographical memory retrieval compared to simulating hypothetical events from the personal past that could have occurred, or episodic counterfactual thinking. Participants were asked to generate titles for specific autobiographical memories from the last five years, and then, during functional magnetic resonance (fMRI) scanning, were asked to repeatedly retrieve autobiographical memories or imagine counterfactual events cued by the titles. We used an fMRI adaptation paradigm in order to isolate neural regions that were sensitive to adopting alternative egocentric perspectives and counterfactual simulations of the personal past. The fMRI results revealed that voxels within left posterior inferior parietal and ventrolateral frontal cortices were sensitive to novel visual perspectives and counterfactual simulations. Our findings suggest that the neural regions supporting remembering become more similar to those underlying episodic simulation when we adopt alternative egocentric perspectives of the veridical past.

Present and future selves in Parkinson's disease

The study of the self in neuropsychological patients raises not only theoretical questions on the relationships between the self, autobiographical memory (AM), and episodic future thinking but also clinical issues for patients' daily life and care. We addressed this issue in Parkinson's disease patients for whom AM and future thinking impairments have been documented. All patients and controls generated and dated up past and future self-images and provided associated past and future events. Our findings suggest a subtle pattern of preservation/impairment of different dimensions (quantitative and qualitative) of self-images, which rely partially on the episodic quality of past and future events.

A role for affect in the link between episodic simulation and prosociality

Prospection and prosociality are hallmarks of our species. Little is known, however, about how our ability to imagine or simulate specific future events contributes to our capacity for prosociality. Here, we investigated this relationship, revealing how the affective response that arises from a simulated prosocial event motivates a willingness to help a person in need. Across two experiments, people reported being more willing to help in specific situations after simulating future helping events that elicited positive (versus negative or neutral) affect. Positive affect increased engagement of theory of mind for the person in need, which in turn informed prosocial responses. Moreover, the subjective experience of scene imagery and theory of mind systematically couple together depending on the affective valence of future simulations, providing new insight into how affective valence guides a prosocial function of episodic simulation.

Episodic and Semantic Memory Contribute to Familiar and Novel Episodic Future Thinking

Increasing evidence indicates that episodic future thinking (EFT) relies on both episodic and semantic memory; however, event familiarity may importantly affect the extent to which episodic and semantic memory contribute to EFT. To test this possibility, two behavioral experiments were conducted. In Experiment 1, we directly compared the proportion of episodic and semantic memory used in an EFT task. The results indicated that more episodic memory was used when imagining familiar future events compared with novel future events. Conversely, significantly more semantic memory was used when imagining novel events compared with familiar events. Experiment 2 aimed to verify the results of Experiment 1. In Experiment 2, we found that familiarity moderated the effect of priming the episodic memory system on EFT; particularly, it increased the time required to construct a standard familiar episodic future event, but did not significantly affect novel episodic event reaction time. Collectively, these findings support the hypothesis that event familiarity importantly moderates episodic and semantic memory's contribution to EFT.

Unstuck in time: episodic future thinking reduces delay discounting and cigarette smoking

RATIONALE

Delay discounting, or the devaluation of delayed outcomes, appears to play an etiological role in tobacco and other substance-use disorders.

OBJECTIVES

No human studies to our knowledge have been designed to examine whether experimental reductions in delay discounting produce concomitant reduction in drug use.

METHODS

Using methods from prior studies on delay discounting and obesity, we examined the effects of episodic future thinking (EFT; a form of mental prospection) on delay discounting and cigarette self-administration in smokers.

RESULTS

Consistent with prior data, EFT significantly reduced both delay discounting (Cohen's d effect size = 0.65) and the number of cigarette puffs earned in a cigarette self-administration task (d = 0.58).

CONCLUSIONS

The effects of EFT on delay discounting generalize to smokers; EFT also reduces laboratory-based cigarette self-administration. Potential mechanisms of EFT's effects are discussed as well as implications of EFT for clinical treatment of substance-use disorders.

Effects of Episodic Future Thinking and Self-Projection on Children's Prospective Memory Performance

The present study is the first to investigate the benefits of episodic future thinking (EFT) at encoding on prospective memory (PM) in preschool (age: M = 66.34 months, SD = 3.28) and primary school children (age: M = 88.36 months, SD = 3.12). A second aim was to examine if self-projection influences the possible effects of EFT instructions. PM was assessed using a standard PM paradigm in children with a picture-naming task as the ongoing activity in which the PM task was embedded. Further, two first- and two second-order ToM tasks were administered as indicator of children’s self-projection abilities. Forty-one preschoolers and 39 school-aged children were recruited. Half of the participants in each age group were instructed to use EFT as a strategy to encode the PM task, while the others received standard PM instructions. Results revealed a significant age effect, with school-aged children significantly outperforming preschoolers and a significant effect of encoding condition with overall better performance when receiving EFT instructions compared to the standard encoding condition. Even though the interaction between age group and encoding condition was not significant, planned comparisons revealed first evidence that compared to the younger age group, older children’s PM benefitted more from EFT instructions during intention encoding. Moreover, results showed that although self-projection had a significant impact on PM performance, it did not influence the effects of EFT instructions. Overall, results indicate that children can use EFT encoding strategies to improve their PM performance once EFT abilities are sufficiently developed. Further, they provide first evidence that in addition to executive functions, which have already been shown to influence the development of PM across childhood, self-projection seems to be another key mechanism underlying this development.

Deficits in remembering the past and imagining the future in patients with prefrontal lesions

OBJECTIVE

Neuroimaging studies suggest that remembering the past and imagining the future engage a common brain network including several areas of the prefrontal cortex. Although patients with prefrontal damage often are described as blind to the future consequences of their decisions, and inclined to 'live in the here and now', little is known as to how the prefrontal cortex mediates past and future mental time travel.

METHOD

Nine patients with prefrontal lesions and nine healthy controls generated past and future events in response to different time periods. Event transcriptions were scored using the Autobiographical Interview protocol (Levine, Svoboda, Hay, Winocur, & Moscovitch, 2002), which provides a reliable system for categorizing internal (episodic) and external (semantic) information. For each event, participants answered a series of questions to assess self-reported phenomenal characteristics.

RESULTS

Patients with prefrontal lesions exhibited deficits in both remembering past events and imagining future events by generating fewer internal details than controls. This effect of group was larger in the past condition than in the future condition. In contrast, no group differences were seen in the number of external details, which were at the same level for patients and controls for both temporal conditions. There were no group differences in ratings of phenomenal characteristics.

CONCLUSION

Our findings suggest that damage to prefrontal structures adversely affects the retrieval of past and the construction of future events. In particular, prefrontal structures are critical for the production of episodic event-specific details when engaging in past and future mental time travel.

Neural correlates of episodic future thinking impairment in multiple sclerosis patients

BACKGROUND

Recent clinical investigations showed impaired episodic future thinking (EFT) abilities in multiple sclerosis (MS) patients. On these bases, the aim of the current study was to explore the structural and functional correlates of EFT impairment in nondepressed MS patients.

METHOD

Twenty-one nondepressed MS patients and 20 matched healthy controls were assessed with the adapted Autobiographical Interview (AI), and patients were selected on the bases of an EFT impaired score criterion. The 41 participants underwent a functional magnetic resonance imaging (fMRI) session, distinguishing the construction and elaboration phases of the experimental EFT, and the categorical control tests. Structural images were also acquired.

RESULTS

During the EFT fMRI task, increased cerebral activations were observed in patients (relative to healthy controls) within the EFT core network. These neural changes were particularly important during the construction phase of future events and involved mostly the prefrontal region. This was accompanied by an increased neural response mostly in anterior, and also posterior, cerebral regions, in association with the amount of detail produced by patients. In parallel, structural measures corroborated a main positive association between the prefrontal regions' volume and EFT performance. However, no association between the hippocampus and EFT performance was observed in patients, at both structural and functional levels.

CONCLUSION

We have documented significant overlaps between the structural and functional underpinnings of EFT impairment, with a main role of the prefrontal region in its clinical expression in MS patients.

Deconstructing the nature of episodic foresight deficits associated with chronic opiate use

OBJECTIVES

Episodic foresight refers to the capacity to mentally travel forward in time and has been linked to a wide variety of important functional behaviours. Evidence has recently emerged that chronic opiate use is associated with deficits in this critical capacity and that these difficulties are not simply a secondary consequence of broader cognitive dysfunction. The current study aimed to better understand the circumstances in which chronic opiate users might be expected to have problems with episodic foresight, by addressing whether deficits reflect compromised scene construction, self-projection, or narrative ability.

METHODS

Thirty-five chronic opiate users and 35 demographically matched controls completed an imagination task in which they were instructed to imagine and provide descriptions of an atemporal event, a plausible, self-relevant future event, as well as complete a narrative task. These three imagination conditions systematically varied in their demands on scene construction, self-projection, and narrative ability.

RESULTS

Consistent with prior literature, chronic opiate users exhibited reduced capacity for episodic foresight relative to controls. However, this study was the first to show that these difficulties were independent of capacity for scene construction and narration. Instead, a specific impairment in self-projection into the future appears to contribute to the problems with episodic foresight seen in this clinical group.

CONCLUSIONS

Deficits in self-projection into the future may have important implications in therapeutic environments given that many relapse prevention strategies rely heavily on the ability to project oneself into an unfamiliar future, free of problem substance use.

PRACTITIONER POINTS

A reduced capacity for episodic foresight highlights the importance of refining current relapse prevention protocols that place significant demands for mental time travel into the future. Psychosocial treatments should focus on the attainment of more immediate or short-term goals. It is difficult to delineate the effects of specific substances given long-standing drug use history common to chronic opiate users. Conclusions relating to neurological functioning are speculative given the absence of neuroimaging data.

Parkinson's Disease, Religion, and Spirituality

BACKGROUND

There has been increasing interest in recent decades in the interactions between disease, religious faith, and spirituality. An issue specific to neurological disorders is to what extent religiousness and spirituality depend upon the integrity of neuronal pathways.

METHODS

We review recent research that investigates the effects of Parkinson's disease (PD) on religious faith and spirituality. Few studies have addressed this issue, but these few illustrate contrasting methodological approaches that yield different conclusions.

FINDINGS

On the one hand, case-control studies have reported an apparent decrease in both religious practice and beliefs in PD with some influence of laterality of disease onset. In contrast, qualitative studies investigating religious and general coping in PD emphasize that religious faith remains important to patients.

CONCLUSIONS

Methodological pitfalls are found in both approaches. We conclude that there is little evidence to support claims of reduced spirituality and religious faith in PD. We recommend approaches to future studies that could enable a more nuanced understanding of spiritual and religious changes that might occur in PD.

Competing neurobehavioral decision systems theory of cocaine addiction: From mechanisms to therapeutic opportunities

Cocaine dependence is a difficult-to-treat, chronically relapsing disorder. Multiple scientific disciplines provide distinct perspectives on this disorder; however, connections between disciplines are rare. The competing neurobehavioral decision systems (CNDS) theory posits that choice results from the interaction between two decision systems (impulsive and executive) and that regulatory imbalance between systems can induce pathology, including addiction. Using this view, we integrate a diverse set of observations on cocaine dependence, including bias for immediacy, neural activity and structure, developmental time course, behavioral comorbidities, and the relationship between cocaine dependence and socioeconomic status. From the CNDS perspective, we discuss established and emerging behavioral, pharmacological, and neurological treatments and identify possible targets for future treatments. The ability of the CNDS theory to integrate diverse findings highlights its utility for understanding cocaine dependence and supports that dysregulation between the decision systems contributes to addiction.

A reverse order interview does not aid deception detection regarding intentions

Promising recent research suggests that more cognitively demanding interviews improve deception detection accuracy. Would these cognitively demanding techniques work in the same way when discriminating between true and false future intentions? In Experiment 1 participants planned to complete a task, but instead were intercepted and interviewed about their intentions. Participants lied or told the truth, and were subjected to high (reverse order) or low (sequential order) cognitive load interviews. Third-party observers watched these interviews and indicated whether they thought the person was lying or telling the truth. Subjecting participants to a reverse compared to sequential interview increased the misidentification rate and the appearance of cognitive load in truth tellers. People lying about false intentions were not better identified. In Experiment 2, a second set of third-party observers rated behavioral cues. Consistent with Experiment 1, truth tellers, but not liars, exhibited more behaviors associated with lying and fewer behaviors associated with truth telling in the reverse than sequential interview. Together these results suggest that certain cognitively demanding interviews may be less useful when interviewing to detect false intentions. Explaining a true intention while under higher cognitive demand places truth tellers at risk of being misclassified. There may be such a thing as too much cognitive load induced by certain techniques

Amnesia and future thinking: Exploring the role of memory in the quantity and quality of episodic future thoughts

OBJECTIVES

To examine the impact of memory accessibility on episodic future thinking.

DESIGN

Single-case study of neurological patient HCM and an age-matched comparison group of neurologically Healthy Controls.

METHODS

We administered a full battery of tests assessing general intelligence, memory, and executive functioning. To assess autobiographical memory, the Autobiographical Memory Interview (Kopelman, Wilson, & Baddeley, 1990. The Autobiographical Memory Interview. Bury St. Edmunds, UK: Thames Valley Test Company) was administered. The Past Episodic and Future Episodic sections of Dalla Barba's Confabulation Battery (Dalla Barba, 1993, Cogn. Neuropsychol., 1, 1) and a specifically tailored Mental Time Travel Questionnaire were administered to assess future thinking in HCM and age-matched controls.

RESULTS

HCM presented with a deficit in forming new memories (anterograde amnesia) and recalling events from before the onset of neurological impairment (retrograde amnesia). HCM's autobiographical memory impairments are characterized by a paucity of memories from Recent Life. In comparison with controls, two features of his future thoughts are apparent: Reduced episodic future thinking and outdated content of his episodic future thoughts.

CONCLUSIONS

This article suggests neuropsychologists should look beyond popular conceptualizations of the past-future relation in amnesia via focussing on reduced future thinking. Investigating both the quantity and quality of future thoughts produced by amnesic patients may lead to developments in understanding the complex nature of future thinking disorders resulting from memory impairments.

PRACTITIONER POINTS

We highlight the clinical importance of examining the content of future thoughts in amnesic patients, rather than only its quantitative reduction. We propose an explanation of how quantitative and qualitative aspects of future thinking could be affected by amnesia. This could provide a useful approach to understand clinical cases of impaired prospection.

LIMITATIONS

Systematic group investigations are required to fully examine our hypothesis. Although the current study utilized typical future thinking measures, these may be limited and we highlight the need to develop clinically relevant measures of prospection.

Depression and prospection

OBJECTIVES

Prospection, the mental representation of possible futures, is usually adaptive. When it goes awry, however, it disrupts emotion and motivation. A negative view of the future is typically seen as one symptom of depression, but we suggest that such negative prospection is the core causal element of depression. Here, we describe the empirical evidence supporting this framework, and we explore the implications for clinical interventions.

METHODS

We integrate several literatures: Using the database PsycInfo, we retrieved empirical studies with the keywords prospection, prediction, expectation, pessimism, mental simulation, future-thinking, future-directed thinking, foresight, and/or mental time travel, in conjunction with depression, depressed, or depressive.

RESULTS

Three kinds of faulty prospection, taken together, could drive depression: Poor generation of possible futures, poor evaluation of possible futures, and negative beliefs about the future. Depressed mood and poor functioning, in turn, may maintain faulty prospection and feed a vicious cycle. Future-oriented treatment strategies drawn from cognitive-behavioural therapy help to fix poor prospection, and they deserve to be developed further.

CONCLUSIONS

Prospection-based techniques may lead to transdiagnostic treatment strategies for depression and other disorders.