Decoding expectation and surprise in dementia: the paradigm of music

Reduced Functional Connectivity in Nucleus Accumbens Subregions Associates With Cognitive Changes in Alzheimer's Disease

BACKGROUND AND PURPOSE

The nucleus accumbens (NAc), an important component of the reward circuit, is believed to play an indispensable role in Alzheimer's disease (AD). This study aimed to explore alterations in the functional connectivity (FC) of NAc subregions in AD patients and to explore their associations with neuropsychological profiles.

METHODS

Total 45 AD patients and 41 healthy controls (HCs) were recruited for this study. Four subregions of the NAc were used as regions of interest for whole-brain FC analysis. Correlation analyses were conducted to explore the relationships between the changed FC of brain regions with significant differences and neuropsychological profiles.

RESULTS

Compared with HCs, decreased FC was observed between NAc subregions and regions of the orbitofrontal cortex (OFC), precuneus (PCUN), insula (INS), cerebellum 8, and putamen in AD patients (Gaussian random field [GRF] corrected, voxel-level p < 0.001, cluster-level p < 0.05). Furthermore, the FC between the left core and left PCUN was correlated with the score of the auditory verbal learning test immediate recall task in AD patients (r = 0.441, p = 0.003, Bonferroni corrected).

CONCLUSION

Disruptions in connectivity between the NAc subregions and important cognitive-related areas may be related to the cognitive deficits observed in AD patients, especially episodic memory function.

Musicality and social cognition in dementia: clinical and anatomical associations

Human musicality might have co-evolved with social cognition abilities, but common neuroanatomical substrates remain largely unclear. In behavioural variant frontotemporal dementia, social cognitive abilities are profoundly impaired, whereas these are typically spared in Alzheimer's disease. If musicality indeed shares a neuroanatomical basis with social cognition, it could be hypothesized that clinical and neuroanatomical associations of musicality and social cognition should differ between these causes of dementia. We recruited 73 participants from the Amsterdam Dementia Cohort (n = 30 female; aged 50-78), of whom 23 had behavioural variant frontotemporal dementia, 22 Alzheimer's disease and 28 were healthy controls. Musicality was assessed using a music-emotion recognition test, melody, tempo, accent and tuning subscores, a musicality summed score, the identification of auditory hedonic phenotypes and music emotion induction using skin conductance responses. Social cognition was assessed across multiple levels, including emotion recognition, theory of mind, socio-emotional sensitivity and understanding of social norms. We used ANCOVA to investigate subgroup differences in musicality and social cognition and linear regressions to investigate associations between musicality and social cognition. All analyses were adjusted for age, sex, musical training and mini mental state examination. Finally, we performed voxel-based morphometry analyses on T1-weighted MRI to study whether regions for musicality and social cognition overlapped anatomically. We found that patients with behavioural variant frontotemporal dementia performed worse on music-emotion recognition (all P < 0.001) and tempo recognition (all P < 0.05) compared with Alzheimer's disease and on musicality summed score (all P = 0.02) compared to controls only. Furthermore, patients with behavioural variant frontotemporal dementia had lower mean skin conductance responses during emotion-inducing music, compared to Alzheimer's disease (all P < 0.045). Worse music emotion recognition scores were associated with worse facial emotion recognition (P < 0.0001), worse theory of mind (P = 0.0005) and worse understanding of social norms (P = 0.01). Melody and tempo recognition were associated with facial emotion recognition and theory of mind, and accent recognition was associated with the theory of mind. Music emotion recognition and tempo recognition were also associated with executive functions. Worse music emotion recognition, melody recognition, tempo recognition, facial emotion recognition and theory of mind scores were all related to atrophy in the anterior temporal regions and the fusiform gyri, which play a role in multisensory integration, and worse tempo recognition was associated with atrophy of the anterior cingulate cortex. These results support the idea that musicality and social cognition may share a neurobiological basis, which may be vulnerable in behavioural variant frontotemporal dementia.

Primary progressive aphasia: six questions in search of an answer

Here, we review recent progress in the diagnosis and management of primary progressive aphasia-the language-led dementias. We pose six key unanswered questions that challenge current assumptions and highlight the unresolved difficulties that surround these diseases. How many syndromes of primary progressive aphasia are there-and is syndromic diagnosis even useful? Are these truly 'language-led' dementias? How can we diagnose (and track) primary progressive aphasia better? Can brain pathology be predicted in these diseases? What is their core pathophysiology? In addition, how can primary progressive aphasia best be treated? We propose that pathophysiological mechanisms linking proteinopathies to phenotypes may help resolve the clinical complexity of primary progressive aphasia, and may suggest novel diagnostic tools and markers and guide the deployment of effective therapies.

Musical experience influences socio-emotional functioning in behavioural variant frontotemporal dementia

Objectives

On phenotypic and neuroanatomical grounds, music exposure might potentially affect the clinical expression of behavioural variant frontotemporal dementia (bvFTD). However, this has not been clarified.

Methods

14 consecutive patients with bvFTD fulfilling consensus diagnostic criteria were recruited via a specialist cognitive clinic. Earlier life musical experience, current musical listening habits and general socio-emotional behaviours were scored using a bespoke semi-quantitative musical survey and standardised functional scales, completed with the assistance of patients' primary caregivers. Associations of musical scores with behavioural scales were assessed using a linear regression model adjusted for age, sex, educational attainment and level of executive and general cognitive impairment.

Results

Greater earlier life musical experience was associated with significantly lower Cambridge Behavioural Inventory (Revised) scores (β ± SE = -17.2 ± 5.2; p = 0.01) and higher Modified Interpersonal Reactivity Index (MIRI) perspective-taking scores (β ± SE = 2.8 ± 1.1; p = 0.03), after adjusting for general cognitive ability. Number of hours each week currently spent listening to music was associated with higher MIRI empathic concern (β ± SE = 0.7 ± 0.21; p = 0.015) and MIRI total scores (β ± SE = 1.1 ± 0.34; p = 0.014).

Discussion

Musical experience in earlier life and potentially ongoing regular music listening may ameliorate socio-emotional functioning in bvFTD. Future work in larger cohorts is required to substantiate the robustness of this association, establish its mechanism and evaluate its clinical potential.

Application of machine learning in measurement of ageing and geriatric diseases: a systematic review

BACKGROUND

As the ageing population continues to grow in many countries, the prevalence of geriatric diseases is on the rise. In response, healthcare providers are exploring novel methods to enhance the quality of life for the elderly. Over the last decade, there has been a remarkable surge in the use of machine learning in geriatric diseases and care. Machine learning has emerged as a promising tool for the diagnosis, treatment, and management of these conditions. Hence, our study aims to find out the present state of research in geriatrics and the application of machine learning methods in this area.

METHODS

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and focused on healthy ageing in individuals aged 45 and above, with a specific emphasis on the diseases that commonly occur during this process. The study mainly focused on three areas, that are machine learning, the geriatric population, and diseases. Peer-reviewed articles were searched in the PubMed and Scopus databases with inclusion criteria of population above 45 years, must have used machine learning methods, and availability of full text. To assess the quality of the studies, Joanna Briggs Institute's (JBI) critical appraisal tool was used.

RESULTS

A total of 70 papers were selected from the 120 identified papers after going through title screening, abstract screening, and reference search. Limited research is available on predicting biological or brain age using deep learning and different supervised machine learning methods. Neurodegenerative disorders were found to be the most researched disease, in which Alzheimer's disease was focused the most. Among non-communicable diseases, diabetes mellitus, hypertension, cancer, kidney diseases, and cardiovascular diseases were included, and other rare diseases like oral health-related diseases and bone diseases were also explored in some papers. In terms of the application of machine learning, risk prediction was the most common approach. Half of the studies have used supervised machine learning algorithms, among which logistic regression, random forest, XG Boost were frequently used methods. These machine learning methods were applied to a variety of datasets including population-based surveys, hospital records, and digitally traced data.

CONCLUSION

The review identified a wide range of studies that employed machine learning algorithms to analyse various diseases and datasets. While the application of machine learning in geriatrics and care has been well-explored, there is still room for future development, particularly in validating models across diverse populations and utilizing personalized digital datasets for customized patient-centric care in older populations. Further, we suggest a scope of Machine Learning in generating comparable ageing indices such as successful ageing index.

Implicit auditory memory in older listeners: From encoding to 6-month retention

Any listening task, from sound recognition to sound-based communication, rests on auditory memory which is known to decline in healthy ageing. However, how this decline maps onto multiple components and stages of auditory memory remains poorly characterised. In an online unsupervised longitudinal study, we tested ageing effects on implicit auditory memory for rapid tone patterns. The test required participants (younger, aged 20-30, and older adults aged 60-70) to quickly respond to rapid regularly repeating patterns emerging from random sequences. Patterns were novel in most trials (REGn), but unbeknownst to the participants, a few distinct patterns reoccurred identically throughout the sessions (REGr). After correcting for processing speed, the response times (RT) to REGn should reflect the information held in echoic and short-term memory before detecting the pattern; long-term memory formation and retention should be reflected by the RT advantage (RTA) to REGr vs REGn which is expected to grow with exposure. Older participants were slower than younger adults in detecting REGn and exhibited a smaller RTA to REGr. Computational simulations using a model of auditory sequence memory indicated that these effects reflect age-related limitations both in early and long-term memory stages. In contrast to ageing-related accelerated forgetting of verbal material, here older adults maintained stable memory traces for REGr patterns up to 6 months after the first exposure. The results demonstrate that ageing is associated with reduced short-term memory and long-term memory formation for tone patterns, but not with forgetting, even over surprisingly long timescales.

Does Amount of Information Support Aesthetic Values?

Obtaining information from the world is important for survival. The brain, therefore, has special mechanisms to extract as much information as possible from sensory stimuli. Hence, given its importance, the amount of available information may underlie aesthetic values. Such information-based aesthetic values would be significant because they would compete with others to drive decision-making. In this article, we ask, "What is the evidence that amount of information support aesthetic values?" An important concept in the measurement of informational volume is entropy. Research on aesthetic values has thus used Shannon entropy to evaluate the contribution of quantity of information. We review here the concepts of information and aesthetic values, and research on the visual and auditory systems to probe whether the brain uses entropy or other relevant measures, specially, Fisher information, in aesthetic decisions. We conclude that information measures contribute to these decisions in two ways: first, the absolute quantity of information can modulate aesthetic preferences for certain sensory patterns. However, the preference for volume of information is highly individualized, with information-measures competing with organizing principles, such as rhythm and symmetry. In addition, people tend to be resistant to too much entropy, but not necessarily, high amounts of Fisher information. We show that this resistance may stem in part from the distribution of amount of information in natural sensory stimuli. Second, the measurement of entropic-like quantities over time reveal that they can modulate aesthetic decisions by varying degrees of surprise given temporally integrated expectations. We propose that amount of information underpins complex aesthetic values, possibly informing the brain on the allocation of resources or the situational appropriateness of some cognitive models.

More Than Meets the Eye: Art Engages the Social Brain

Here we present the viewpoint that art essentially engages the social brain, by demonstrating how art processing maps onto the social brain connectome-the most comprehensive diagram of the neural dynamics that regulate human social cognition to date. We start with a brief history of the rise of neuroaesthetics as the scientific study of art perception and appreciation, in relation to developments in contemporary art practice and theory during the same period. Building further on a growing awareness of the importance of social context in art production and appreciation, we then set out how art engages the social brain and outline candidate components of the "artistic brain connectome." We explain how our functional model for art as a social brain phenomenon may operate when engaging with artworks. We call for closer collaborations between the burgeoning field of neuroaesthetics and arts professionals, cultural institutions and diverse audiences in order to fully delineate and contextualize this model. Complementary to the unquestionable value of art for art's sake, we argue that its neural grounding in the social brain raises important practical implications for mental health, and the care of people living with dementia and other neurological conditions.