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Duarte IC, Dionísio A, Oliveira J, Simões M, Correia R, Dias JA, Caldeira S, Redondo J, Castelo-Branco M. Neural underpinnings of ethical decisions in life and death dilemmas in naïve and expert firefighters. Sci Rep 2024; 14:13222. [PMID: 38851794 PMCID: PMC11162493 DOI: 10.1038/s41598-024-63469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024] Open
Abstract
When a single choice impacts on life outcomes, faculties to make ethical judgments come into play. Here we studied decisions in a real-life setting involving life-and-death outcomes that affect others and the decision-maker as well. We chose a genuine situation where prior training and expertise play a role: firefighting in life-threatening situations. By studying the neural correlates of dilemmas involving life-saving decisions, using realistic firefighting situations, allowed us to go beyond previously used hypothetical dilemmas, while addressing the role of expertise and the use of coping strategies (n = 47). We asked the question whether the neural underpinnings of deontologically based decisions are affected by expertise. These realistic life-saving dilemmas activate the same core reward and affective processing network, in particular the ventromedial prefrontal cortex, nucleus accumbens and amygdala, irrespective of prior expertise, thereby supporting general domain theories of ethical decision-making. We found that brain activity in the hippocampus and insula parametrically increased as the risk increased. Connectivity analysis showed a larger directed influence of the insula on circuits related to action selection in non-experts, which were slower than experts in non rescuing decisions. Relative neural activity related to the decision to rescue or not, in the caudate nucleus, insula and anterior cingulate cortex was negatively associated with coping strategies, in experts (firefighters) suggesting practice-based learning. This shows an association between activity and expert-related usage of coping strategies. Expertise enables salience network activation as a function of behavioural coping dimensions, with a distinct connectivity profile when facing life-rescuing dilemmas.
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Affiliation(s)
- Isabel C Duarte
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Ana Dionísio
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Joana Oliveira
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal
| | - Marco Simões
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Faculty of Science and Technology, Center for Informatics and Systems of University of Coimbra (CISUC), University of Coimbra, Coimbra, Portugal
| | - Rita Correia
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
- Faculty of Science and Technology, Center for Informatics and Systems of University of Coimbra (CISUC), University of Coimbra, Coimbra, Portugal
| | - Joana A Dias
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Salomé Caldeira
- Centre for Prevention and Treatment of Psychological Trauma (CPTTP), Department of Psychiatry, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - João Redondo
- Centre for Prevention and Treatment of Psychological Trauma (CPTTP), Department of Psychiatry, Coimbra University Hospital Centre (CHUC), Coimbra, Portugal
| | - Miguel Castelo-Branco
- Institute for Nuclear Sciences Applied to Health (ICNAS), Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal.
- Faculty of Medicine (FMUC), University of Coimbra, Coimbra, Portugal.
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Cai W, Young CB, Yuan R, Lee B, Ryman S, Kim J, Yang L, Henderson VW, Poston KL, Menon V. Dopaminergic medication normalizes aberrant cognitive control circuit signalling in Parkinson's disease. Brain 2022; 145:4042-4055. [PMID: 35357463 PMCID: PMC10200291 DOI: 10.1093/brain/awac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 08/21/2023] Open
Abstract
Dopaminergic medication is widely used to alleviate motor symptoms of Parkinson's disease, but these medications also impact cognition with significant variability across patients. It is hypothesized that dopaminergic medication impacts cognition and working memory in Parkinson's disease by modulating frontoparietal-basal ganglia cognitive control circuits, but little is known about the underlying causal signalling mechanisms and their relation to individual differences in response to dopaminergic medication. Here we use a novel state-space computational model with ultra-fast (490 ms resolution) functional MRI to investigate dynamic causal signalling in frontoparietal-basal ganglia circuits associated with working memory in 44 Parkinson's disease patients ON and OFF dopaminergic medication, as well as matched 36 healthy controls. Our analysis revealed aberrant causal signalling in frontoparietal-basal ganglia circuits in Parkinson's disease patients OFF medication. Importantly, aberrant signalling was normalized by dopaminergic medication and a novel quantitative distance measure predicted individual differences in cognitive change associated with medication in Parkinson's disease patients. These findings were specific to causal signalling measures, as no such effects were detected with conventional non-causal connectivity measures. Our analysis also identified a specific frontoparietal causal signalling pathway from right middle frontal gyrus to right posterior parietal cortex that is impaired in Parkinson's disease. Unlike in healthy controls, the strength of causal interactions in this pathway did not increase with working memory load and the strength of load-dependent causal weights was not related to individual differences in working memory task performance in Parkinson's disease patients OFF medication. However, dopaminergic medication in Parkinson's disease patients reinstated the relation with working memory performance. Our findings provide new insights into aberrant causal brain circuit dynamics during working memory and identify mechanisms by which dopaminergic medication normalizes cognitive control circuits.
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Affiliation(s)
- Weidong Cai
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Christina B Young
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rui Yuan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Byeongwook Lee
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sephira Ryman
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeehyun Kim
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Laurice Yang
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Victor W Henderson
- Wu Tsai Neurosciences Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kathleen L Poston
- Wu Tsai Neurosciences Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Vinod Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
- Wu Tsai Neurosciences Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
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Gavelin HM, Domellöf ME, Leung I, Neely AS, Launder NH, Nategh L, Finke C, Lampit A. Computerized Cognitive Training in Parkinson's Disease: A Systematic Review and Meta-Analysis. Ageing Res Rev 2022; 80:101671. [PMID: 35714854 DOI: 10.1016/j.arr.2022.101671] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/01/2022]
Abstract
Cognitive impairment is a central non-motor symptom of Parkinson's disease (PD), and there are no established treatments. Computerized cognitive training (CCT) is a safe and efficacious strategy but its efficacy in PD is unclear. We aimed to investigate the efficacy of CCT on cognitive, psychosocial and daily function, and assess potential effect moderators in people with PD without dementia. Randomized controlled trials of CCT were included in multivariate meta-analyses and meta-regressions. Seventeen studies (16 trials) encompassing 679 participants were included. The pooled effect of CCT relative to control was small and statistically significant for overall cognitive function (g=0.16; 95% CI 0.02-0.29). There was robust evidence for benefit on clinical measures of global cognition across 10 trials (g=0.33; 95% CI 0.19-0.48), especially in PD with mild cognitive impairment (PD-MCI), as well as on individual cognitive domains. Greater CCT dose and PD-MCI population were associated with larger effect sizes, but no statistically significant differences were found between subgroups. There was no significant difference in the efficacy of home-based compared to supervised training. Our findings suggest that CCT is associated with cognitive benefits in PD, including when delivered remotely. Larger, well-powered trials are warranted to examine what specific CCT regimens are most likely to promote cognitive and everyday functioning in the long-term.
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Affiliation(s)
- Hanna M Gavelin
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia; Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Isabella Leung
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Camperdown, Australia; Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown, Australia
| | | | - Nathalie H Launder
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
| | - Leila Nategh
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, University of Melbourne, Parkville, Australia; Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
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Wu J, Zhang M, Dang Q, Chang Q, Yuan Q, Zhang Z, Ding G, Lu C, Guo T. Nonverbal cognitive control training increases the efficiency of frontal-subcortical collaboration for bilingual language control. Neuropsychologia 2022; 169:108204. [DOI: 10.1016/j.neuropsychologia.2022.108204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 02/21/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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Ophey A, Wenzel J, Paul R, Giehl K, Rehberg S, Eggers C, Reker P, van Eimeren T, Kalbe E, Kambeitz-Ilankovic L. Cognitive Performance and Learning Parameters Predict Response to Working Memory Training in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2235-2247. [PMID: 36120792 PMCID: PMC9661332 DOI: 10.3233/jpd-223448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Working memory (WM) training (WMT) is a popular intervention approach against cognitive decline in patients with Parkinson's disease (PD). However, heterogeneity in WM responsiveness suggests that WMT may not be equally efficient for all patients. OBJECTIVE The present study aims to evaluate a multivariate model to predict post-intervention verbal WM in patients with PD using a supervised machine learning approach. We test the predictive potential of novel learning parameters derived from the WMT and compare their predictiveness to other more commonly used domains including demographic, clinical, and cognitive data. METHODS 37 patients with PD (age: 64.09±8.56, 48.6% female, 94.7% Hoehn & Yahr stage 2) participated in a 5-week WMT. Four random forest regression models including 1) cognitive variables only, 2) learning parameters only, 3) both cognitive and learning variables, and 4) the entire set of variables (with additional demographic and clinical data, 'all' model), were built to predict immediate and 3-month-follow-up WM. RESULT The 'all' model predicted verbal WM with the lowest root mean square error (RMSE) compared to the other models, at both immediate (RMSE = 0.184; 95% -CI=[0.184;0.185]) and 3-month follow-up (RMSE = 0.216; 95% -CI=[0.215;0.217]). Cognitive baseline parameters were among the most important predictors in the 'all' model. The model combining cognitive and learning parameters significantly outperformed the model solely based on cognitive variables. CONCLUSION Commonly assessed demographic, clinical, and cognitive variables provide robust prediction of response to WMT. Nonetheless, inclusion of training-inherent learning parameters further boosts precision of prediction models which in turn may augment training benefits following cognitive interventions in patients with PD.
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Affiliation(s)
- Anja Ophey
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Cologne, Germany
| | - Julian Wenzel
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Riya Paul
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Kathrin Giehl
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Cologne, Germany
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-2), Jülich, Germany
| | - Sarah Rehberg
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Cologne, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior - CMBB, Universities of Marburg and Gießen, Marburg, Germany
- Department of Neurology, Knappschaftskrankenhaus Bottrop, Bottrop, Germany
| | - Paul Reker
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thilo van Eimeren
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Cologne, Germany
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Elke Kalbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
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Ophey A, Rehberg S, Giehl K, Eggers C, Reker P, van Eimeren T, Kalbe E. Predicting Working Memory Training Responsiveness in Parkinson's Disease: Both "System Hardware" and Room for Improvement Are Needed. Neurorehabil Neural Repair 2021; 35:117-130. [PMID: 33410387 DOI: 10.1177/1545968320981956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. Patients with Parkinson's disease (PD) are highly vulnerable to develop cognitive dysfunctions, and the mitigating potential of early cognitive training (CT) is increasingly recognized. Predictors of CT responsiveness, which could help to tailor interventions individually, have rarely been studied in PD. This study aimed to examine individual characteristics of patients with PD associated with responsiveness to targeted working memory training (WMT). Methods. Data of 75 patients with PD (age: 63.99 ± 9.74 years, 93% Hoehn & Yahr stage 2) without cognitive dysfunctions from a randomized controlled trial were analyzed using structural equation modeling. Latent change score models with and without covariates were estimated and compared between the WMT group (n = 37), who participated in a 5-week adaptive WMT, and a waiting list control group (n = 38). Results. Latent change score models yielded adequate model fit (χ2-test p > .05, SRMR ≤ .08, CFI ≥ .95). For the near-transfer working memory composite, lower baseline performance, younger age, higher education, and higher fluid intelligence were found to significantly predict higher latent change scores in the WMT group, but not in the control group. For the far-transfer executive function composite, higher self-efficacy expectancy tended to significantly predict larger latent change scores. Conclusions. The identified associations between individual characteristics and WMT responsiveness indicate that there has to be room for improvement (e.g., lower baseline performance) and also sufficient "hardware" (e.g., younger age, higher intelligence) to benefit in training-related cognitive plasticity. Our findings are discussed within the compensation versus magnification account. They need to be replicated by methodological high-quality research applying advanced statistical methods with larger samples.
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Affiliation(s)
| | | | | | - Carsten Eggers
- University Hospital of Marburg, Marburg, Germany.,Universities of Marburg and Gießen, Marburg, Germany
| | | | - Thilo van Eimeren
- University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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