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Cash TV, Lessov-Schlaggar CN, Foster ER, Myers PS, Jackson JJ, Maiti B, Kotzbauer PT, Perlmutter JS, Campbell MC. Replication and reliability of Parkinson's disease clinical subtypes. Parkinsonism Relat Disord 2024; 124:107016. [PMID: 38838453 DOI: 10.1016/j.parkreldis.2024.107016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/24/2024] [Accepted: 05/19/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND We recently identified three distinct Parkinson's disease subtypes: "motor only" (predominant motor deficits with intact cognition and psychiatric function); "psychiatric & motor" (prominent psychiatric symptoms and moderate motor deficits); "cognitive & motor" (cognitive and motor deficits). OBJECTIVE We used an independent cohort to replicate and assess reliability of these Parkinson's disease subtypes. METHODS We tested our original subtype classification with an independent cohort (N = 100) of Parkinson's disease participants without dementia and the same comprehensive evaluations assessing motor, cognitive, and psychiatric function. Next, we combined the original (N = 162) and replication (N = 100) datasets to test the classification model with the full combined dataset (N = 262). We also generated 10 random split-half samples of the combined dataset to establish the reliability of the subtype classifications. Latent class analyses were applied to the replication, combined, and split-half samples to determine subtype classification. RESULTS First, LCA supported the three-class solution - Motor Only, Psychiatric & Motor, and Cognitive & Motor- in the replication sample. Next, using the larger, combined sample, LCA again supported the three subtype groups, with the emergence of a potential fourth group defined by more severe motor deficits. Finally, split-half analyses showed that the three-class model also had the best fit in 13/20 (65%) split-half samples; two-class and four-class solutions provided the best model fit in five (25%) and two (10%) split-half replications, respectively. CONCLUSIONS These results support the reproducibility and reliability of the Parkinson's disease behavioral subtypes of motor only, psychiatric & motor, and cognitive & motor groups.
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Affiliation(s)
- Therese V Cash
- Department of Neurology, Washington University School of Medicine, USA
| | | | - Erin R Foster
- Department of Neurology, Washington University School of Medicine, USA; Department of Psychiatry, Washington University School of Medicine, USA; Program in Occupational Therapy, Washington University School of Medicine, USA
| | - Peter S Myers
- Department of Neurology, Washington University School of Medicine, USA
| | - Joshua J Jackson
- Department of Psychological and Brain Sciences, Washington University in St. Louis, USA
| | - Baijayanta Maiti
- Department of Neurology, Washington University School of Medicine, USA; Department of Radiology, Washington University School of Medicine, USA
| | - Paul T Kotzbauer
- Department of Neurology, Washington University School of Medicine, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, USA; Department of Radiology, Washington University School of Medicine, USA; Department of Neuroscience, Washington University School of Medicine, USA; Program in Occupational Therapy, Washington University School of Medicine, USA; Program in Physical Therapy, Washington University School of Medicine, USA
| | - Meghan C Campbell
- Department of Neurology, Washington University School of Medicine, USA; Department of Radiology, Washington University School of Medicine, USA.
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Filipčíková M, Quang H, Cassel A, Darke L, Wilson E, Wearne T, Rosenberg H, McDonald S. Exploring neuropsychological underpinnings of poor communication after traumatic brain injury: The role of apathy, disinhibition and social cognition. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:433-448. [PMID: 36541559 DOI: 10.1111/1460-6984.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Dysarthria, aphasia and executive processes have been examined for their role in producing impaired communicative competence post traumatic brain injury (TBI). Less understood is the role of emotional dysregulation, that is, apathy and disinhibition, and social cognition, that is, reading and interpreting social cues. METHODS & PROCEDURES In this study, we examined 49 adults with moderate to severe TBI and 18 neurologically healthy adults. We hypothesised that apathy and disinhibition would predict communication outcomes as would social cognition. We also predicted that apathy and disinhibition would influence social cognition. Communication outcomes were measured by the La Trobe Communication Questionnaire (LCQ) and the Social Skills Questionnaire-TBI (SSQ-TBI). Apathy and disinhibition were measured by the Frontal Systems Behavior Scale (FrSBe). We measured four aspects of social cognition: emotion perception and theory of mind using The Awareness of Social Inference Test (TASIT) and the Complex Audio-Visual Evaluation of Affect Test (CAVEAT), empathy using the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Balanced Emotional Empathy Scale (BEES), and alexithymia using the Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire. OUTCOMES & RESULTS Consistent with predictions, the LCQ and SSQ-TBI were associated with disinhibition and the LCQ was also associated with apathy. The LCQ was associated with the full range of social cognition constructs although the SSQ-TBI was not. Finally, apathy and disinhibition predicted a number of social cognition measures. CONCLUSIONS AND IMPLICATIONS These results are discussed in relation to understanding the nature of communication disorders following TBI and how they are measured, as well as the interrelation between emotion dysregulation and social cognition. WHAT THIS STUDY ADDS What is already known on this subject The role of emotional dysregulation and social cognition in producing impaired communicative competence post traumatic brain injury (TBI) is not well understood. Although most adults with severe TBI have minimal or possibly no language impairment, they often struggle with functional communication in everyday situations. Many have been reported to be overtalkative, insensitive, childish and self-centred, displaying an inappropriate level of self-disclosure and making tangential and irrelevant comments. Conversely, some speakers with TBI have been noted to have impoverished communication, producing little language either spontaneously or in response to the speaker's questions and prompts. What this paper adds to existing knowledge We found that both apathy and disinhibition were strongly associated with the Latrobe Communication Questionnaire both empirically and conceptually, despite the LCQ being developed from a different, pragmatic orientation. Disinhibition was also associated with the Social Skills Questionnaire for TBI. We also found that poor social cognition scores predicted communication difficulties. Finally, we found that behavioural dysregulation itself, i.e., both apathy and disinhibition, predicted poor social cognition. What are the potential or actual clinical implications of this work? Our findings highlight the central role that apathy and disinhibition play in both communication and social cognition. These insights point to the importance of remediation to target behavioural and autonomic dysregulation as a means to improve everyday social function.
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Affiliation(s)
| | - Halle Quang
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Anneli Cassel
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Lilly Darke
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Emily Wilson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Hannah Rosenberg
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Filipčíková M, Wearne T, McDonald S. Disinhibited and angry: Investigating the relationship between social disinhibition and the components of aggression following severe TBI. Neuropsychol Rehabil 2024; 34:23-44. [PMID: 36445855 DOI: 10.1080/09602011.2022.2149560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
Social disinhibition and aggression share many similarities. But unlike with aggression, research evidence about social disinhibition following severe traumatic brain injury (TBI) is limited and treatments are missing. Establishing the association between aggression and social disinhibition would facilitate a better conceptualization of these disorders. This study aimed to determine the relationship between social disinhibition and aggression following severe TBI.In this case-control study, 25 individuals with severe TBI and 25 control participants completed the Buss-Perry Aggression Questionnaire (BPAQ), Frontal Systems Behaviour Scale (FrSBe), and Social Disinhibition Interview (SDI).Hierarchical multiple regression analyses revealed that, when controlling for covariates, the inclusion of BPAQ Anger in the model led to a 13% increase in proportion of explained variance of social disinhibition (Adjusted R2 increased from .243 to .363, p < .005). BPAQ Anger was not a significant predictor of SDI scores. Similarly, BPAQ Physical aggression scores did not contribute to the prediction of FrSBe Disinhibition or SDI scores.In conclusion, higher levels of self-reported anger (but no other components of aggression) are associated with higher levels of self-reported social disinhibition. While these findings have potential implications for the treatment of social disinhibition, further research into the possible relationship with aggression should be conducted.
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Affiliation(s)
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, Australia
- School of Psychology, Western Sydney University, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
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Haller OC, Tighe EL, King TZ. Concordance of informant and self-reported ratings on the Frontal Systems Behavior Scale in adult survivors of pediatric brain tumor. Clin Neuropsychol 2024; 38:135-149. [PMID: 36987932 DOI: 10.1080/13854046.2023.2192417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 03/13/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE It has been theorized that pediatric brain tumor survivors may have reduced insight into their executive functioning. Agreement between informants and survivors has been used to probe this theory, but findings have been inconsistent. This study sought to expand on prior work by examining the relationship between participant role and ratings on the Frontal Systems Behavior Scale (FrSBe) among 73 adult survivors and their informants. This study also sought to test whether agreement on scores varied as a function of tumor treatment. METHOD Dyadic mixed effects models examined the relationship between participant ratings on FrSBe subscales and the role of a participant (survivor or informant). Intraclass correlations (ICC) were used to calculate reliable change indices to evaluate significant divergence in self and informant agreement. RESULTS Dyadic mixed effects models showed an insignificant relationship between participant role and ratings on the FrSBe apathy and executive dysfunction subscales. Participant role was related to ratings on the disinhibition subscale of the FrSBe. The ICC for apathy was ICC = .583, for disinhibition ICC = .420, and for executive dysfunction ICC = .373. Significant divergence in scores did not vary by history of chemoradiation. CONCLUSIONS Results demonstrate an effect of role on one FrSBe subscale and weak to moderate agreement between survivor and informant scores, which suggests that agreement between informants and survivors varies by FrSBe domain. The strongest relationship between survivors and informants was seen on apathy, which suggests that apathy is a shared concern for survivors and their families.
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Affiliation(s)
- Olivia C Haller
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Elizabeth L Tighe
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, GA, USA
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
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Yoshida K, Sawamura D, Ogawa K, Mototani T, Ikoma K, Sakai S. Prospective and Retrospective Metacognitive Abilities and Their Association with Impaired Self-awareness in Patients with Traumatic Brain Injury. J Cogn Neurosci 2023; 35:1960-1971. [PMID: 37788321 DOI: 10.1162/jocn_a_02064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Metacognitive impairment often occurs in patients with traumatic brain injury (TBI) and is associated with clinical problems. The aim of this study was to clarify the pathology of metacognitive impairment in TBI patients using a behavioral task, clinical assessment of self-awareness, and lesion-symptom mapping. Metacognitive abilities of TBI patients and healthy controls were assessed using a modified perceptual decision-making task. Self-awareness was assessed using the Patient Competency Rating Scale and the Frontal Systems Behavior Scale. The associations between estimated metacognitive abilities, self-awareness, and neuropsychological test results were examined. The correspondence between metacognitive disabilities and brain lesions was explored by ROI-based lesion-symptom mapping using structural magnetic resonance images. Overall, 25 TBI patients and 95 healthy controls were included in the analyses. Compared with that in healthy controls, the prospective metacognitive ability of TBI patients was lower, with metacognitive evaluations revealing a bias toward overestimating their abilities. Retrospective metacognitive ability showed a negative correlation with self-awareness but not with neuropsychological test results. In the lesion-symptom mapping analysis, the left pFC was associated with lower retrospective metacognitive ability. This study contributes to a better understanding of the pathology of metacognitive and self-awareness deficits in TBI patients and may explain the cause of impaired realistic goal setting and adaptive behavior in these patients.
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Affiliation(s)
- Kazuki Yoshida
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Japan
| | - Daisuka Sawamura
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Japan
| | - Keita Ogawa
- Department of Rehabilitation, Hokkaido University Hospital, Japan
| | - Takuroh Mototani
- Department of Rehabilitation, Hokkaido University Hospital, Japan
| | - Katsunori Ikoma
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Japan
| | - Shinya Sakai
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Japan
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Filipčíková M, Balleine B, Kumfor F, McDonald S. Action control and selection in social disinhibition following severe TBI: a pavlovian-to-instrumental transfer and outcome devaluation study. J Clin Exp Neuropsychol 2023; 45:825-839. [PMID: 38319159 DOI: 10.1080/13803395.2024.2313257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Social disinhibition is a significant sequela of severe traumatic brain injury (TBI). Some research suggests that it could reflect a deficiency in goal-directed behavior. The current study aimed to test whether these inappropriate behaviors tend to be deficient in goal-directed control, that is, triggered more by environmental stimuli than by the known consequences of their actions. METHOD We used a between-group design with 25 adult participants with severe TBI, and 27 control participants. Social disinhibition was measured using Frontal Systems Behavior Scale and Social Disinhibition Interview. Changes in reward-related goal-directed behavior were evaluated using a computer-based task in which we assessed the influence of cues predicting reward and of reward devaluation on choice performance. RESULTS We found no difference in the levels of social disinhibition between the TBI and control groups and, using mixed two-way ANCOVAs, no overall effect of the stimuli or outcome devaluation. However, after combing these groups and splitting them based on their disinhibition levels, a significant interaction between group (High vs Low disinhibition) and reward type (Valued vs Devalued) in sensitivity to outcome devaluation test (F = 5.99, p = .01, ηp2 = .13) appeared. Comparing with the baseline rate of responding, the Low disinhibition group decreased their responding to devalued and increased their responding to still-valued outcomes. In contrast, the High disinhibition group showed the opposite pattern of choice performance. CONCLUSIONS It appears that people with clinical levels of social disinhibition are both prone to outcome-response priming effects and insensitive to changes in the value of the consequences of their actions, that is, despite evidence they were aware of the reduction in the value of their actions's outcomes, people with high-level disinhibition kept performing those actions. This pattern has the hallmarks of a habit suggesting their disinhibition reflects a loss of executive control.
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Affiliation(s)
| | - Bernard Balleine
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Fiona Kumfor
- School of Psychology, Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Skye McDonald
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Levy M, Zurawel M, d’Hardemare V, Moran A, Andelman F, Manor Y, Cohen J, Meshulam M, Balash Y, Gurevich T, Fried I, Bergman H. Subthalamic nucleus physiology is correlated with deep brain stimulation motor and non-motor outcomes. Brain Commun 2023; 5:fcad268. [PMID: 38025270 PMCID: PMC10664412 DOI: 10.1093/braincomms/fcad268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/24/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Subthalamic nucleus deep brain stimulation is commonly indicated for symptomatic relief of idiopathic Parkinson's disease. Despite the known improvement in motor scores, affective, cognitive, voice and speech functions might deteriorate following this procedure. Recent studies have correlated motor outcomes with intraoperative microelectrode recordings. However, there are no microelectrode recording-based tools with predictive values relating to long-term outcomes of integrative motor and non-motor symptoms. We conducted a retrospective analysis of the outcomes of patients with idiopathic Parkinson's disease who had subthalamic nucleus deep brain stimulation at Tel Aviv Sourasky Medical Centre (Tel Aviv, Israel) during 2015-2016. Forty-eight patients (19 women, 29 men; mean age, 58 ± 8 years) who were implanted with a subthalamic nucleus deep brain stimulation device underwent pre- and postsurgical assessments of motor, neuropsychological, voice and speech symptoms. Significant improvements in all motor symptoms (except axial signs) and levodopa equivalent daily dose were noted in all patients. Mild improvements were observed in more posterior-related neuropsychological functions (verbal memory, visual memory and organization) while mild deterioration was observed in frontal functions (personality changes, executive functioning and verbal fluency). The concomitant decline in speech intelligibility was mild and only partial, probably in accordance with the neuropsychological verbal fluency results. Acoustic characteristics were the least affected and remained within normal values. Dimensionality reduction of motor, neuropsychological and voice scores rendered six principal components that reflect the main clinical aspects: the tremor-dominant versus the rigidity-bradykinesia-dominant motor symptoms, frontal versus posterior neuropsychological deficits and acoustic characteristics versus speech intelligibility abnormalities. Microelectrode recordings of subthalamic nucleus spiking activity were analysed off-line and correlated with the original scores and with the principal component results. Based on 198 microelectrode recording trajectories, we suggest an intraoperative subthalamic nucleus deep brain stimulation score, which is a simple sum of three microelectrode recording properties: normalized neuronal activity, the subthalamic nucleus width and the relative proportion of the subthalamic nucleus dorsolateral oscillatory region. A threshold subthalamic nucleus deep brain stimulation score >2.5 (preferentially composed of normalized root mean square >1.5, subthalamic nucleus width >3 mm and a dorsolateral oscillatory region/subthalamic nucleus width ratio >1/3) predicts better motor and non-motor long-term outcomes. The algorithm presented here optimizes intraoperative decision-making of deep brain stimulation contact localization based on microelectrode recording with the aim of improving long-term (>1 year) motor, neuropsychological and voice symptoms.
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Affiliation(s)
- Mikael Levy
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
| | - Mika Zurawel
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Vincent d’Hardemare
- Department of Neurosurgery, Hospital Foundation Rothschild, Paris 75019, France
| | - Anan Moran
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- School of Neurobiology, Biochemistry & Biophysics, George S. Wise Faculty of Life Science, Tel-Aviv University, Tel Aviv 6423906, Israel
| | - Fani Andelman
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yael Manor
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Jacob Cohen
- Department of Otolaryngology Head and Neck Surgery, Rambam Health Care Campus, Haifa 3525408, Israel
| | - Moshe Meshulam
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yacov Balash
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Itzhak Fried
- Movement Disorders Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
- School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagai Bergman
- The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of Jerusalem, Jerusalem 9190401, Israel
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Parsey CM, Kang HJ, Eaton JC, McGrath ME, Barber J, Temkin NR, Donald CLM. Chronic frontal neurobehavioural symptoms in combat-deployed military personnel with and without a history of blast-related mild traumatic brain injury. Brain Inj 2023; 37:1127-1134. [PMID: 37165638 PMCID: PMC10524397 DOI: 10.1080/02699052.2023.2209740] [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: 11/21/2022] [Revised: 03/02/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE This study evaluated frontal behavioural symptoms, via the FrSBe self-report, in military personnel with and without a history of blast-related mild traumatic brain injury (mild TBI). METHODS Prospective observational cohort study of combat-deployed service members leveraging 1-year and 5-year demographic and follow up clinical outcome data. RESULTS The blast mild TBI group (n = 164) showed greater frontal behavioural symptoms, including clinically elevated apathy, disinhibition, and executive dysfunction, during a 5-year follow-up, compared to a group of combat-deployed controls (n = 107) without mild TBI history or history of blast exposure. We also explored changes inbehaviourall symptoms over a 4-year span, which showed clinically significant increases in disinhibition in the blast mild TBI group, whereas the control group did not show significant increases in symptoms over time. CONCLUSION Our findings add to the growing evidence that a proportion of individuals who sustain mild TBI experience persistent behavioural symptoms. We also offer a demonstration of a novel use of the FrSBe as a tool for longitudinal symptom monitoring in a military mild TBI population.
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Affiliation(s)
- Carolyn M. Parsey
- Department of Neurology, University of Washington, School of Medicine, Seattle, WA USA
| | | | - Jessica C. Eaton
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Margaret E. McGrath
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
- Department of Biostatistics, University of Washington, School of Public Health, Seattle, WA USA
| | - Christine L. Mac Donald
- Harborview Medical Center, Seattle WA USA
- Department of Neurological Surgery, University of Washington, School of Medicine, Seattle, WA USA
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Ljunggren S, Winblad S, Samuelsson H, Malmgren K. Decision-making under ambiguity after frontal lobe resection for epilepsy. Epilepsy Behav 2023; 142:109215. [PMID: 37075512 DOI: 10.1016/j.yebeh.2023.109215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Decision-making is crucial to daily life and can impact our society as well as economic conditions. Although the frontal lobes have been identified as important for decision-making, this capacity has only been studied to a limited extent in frontal lobe epilepsy and not at all after frontal lobe resection (FLR) for epilepsy. This study aimed to explore decision-making under ambiguity after FLR for epilepsy. METHODS Fourteen patients having undergone FLR for epilepsy completed the Iowa Gambling Task (IGT) which is a widely used tool to measure decision-making under ambiguity. Iowa Gambling Task scores included in the analysis were: total net score, separate scores from five blocks across the test, and a change score (last block of IGT minus first block). A group of healthy controls (n = 30) was used as a comparison. Associations between IGT and standardized neuropsychological methods for assessment of executive functions, self-rating questionnaires of mental health, fatigue, and behavior linked to frontal lobe dysfunction were also investigated. RESULTS The patient group performed inferior to controls at the final block of the IGT (p =.001).A group difference in IGT change scores was found (p =.005), reflectingthe absence of a positive change in performance over time for the FLR group compared to the control group. Correlations with tests of executive functions as well as self-rating scales were mainly statistically nonsignificant. CONCLUSIONS This study shows that patients having undergone FLR for epilepsy have difficulties with decision-making under ambiguity. The performance illustrated a failure to learn throughout the task. Executive as well as emotional deficits may impact decision-making processes in this patient group and need to be considered in further studies. Prospective studies with larger cohorts are needed.
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Affiliation(s)
- Sofia Ljunggren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
| | - Stefan Winblad
- Department of Psychology, Gothenburg University, Box 500, SE-405 30 Gothenburg, Sweden.
| | - Hans Samuelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Psychology, Gothenburg University, Box 500, SE-405 30 Gothenburg, Sweden.
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, SE-413 45 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
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Brown L, Fish J, Mograbi DC, Ashkan K, Morris R. The self and self-knowledge after frontal lobe neurosurgical lesions. Cortex 2023; 162:12-25. [PMID: 36965336 DOI: 10.1016/j.cortex.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 05/13/2022] [Accepted: 02/09/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Evidence suggests that damage to the frontal lobes can be associated with changes in cognitive and behavioral functioning and reduced awareness that such changes have occurred. In the current study, the Cognitive Awareness Model was used as a theoretical framework to explore knowledge of the self in people with acquired frontal lesions. METHODS Fifteen individuals with focal frontal lobe lesions (FFL) and their nominated informants were compared with fifteen healthy matched control-informant dyads on questionnaire measures designed to assess awareness of difficulties. Questionnaires were adapted to ensure all enabled pre- and post-injury perspectives to be gained from both patient and informant, and to allow novel exploration of awareness of deficits from a third person perspective. RESULTS Individuals with frontal lobe lesions showed adequate awareness of their post-surgery changes, which was substantiated by their informant report. Compared to the control group, the patient group was found to acknowledge more difficulties in current functioning. Perspective-taking ability was limited with both patients and controls being comparatively unreliable in assessing how they were perceived by others. CONCLUSION These results demonstrate that FLL patients are engaging in more atypical behaviors compared to healthy controls, but suggest that they are aware of and acknowledge these difficulties. The importance of obtaining multiple viewpoints when examining an individual's level of awareness and the clinical implications of this are discussed.
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Affiliation(s)
- Laura Brown
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Jessica Fish
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK; Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, UK; Department of Clinical Neuropsychology and Clinical Health Psychology, St George's University Hospitals NHS Foundation Trust, UK
| | - Daniel C Mograbi
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK; Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Brazil
| | | | - Robin Morris
- King's College Institute of Psychiatry, Psychology & Neuroscience, London, UK
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11
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Santamaría-García H, Ogonowsky N, Baez S, Palacio N, Reyes P, Schulte M, López A, Matallana D, Ibanez A. Neurocognitive patterns across genetic levels in behavioral variant frontotemporal dementia: a multiple single cases study. BMC Neurol 2022; 22:454. [PMID: 36474176 PMCID: PMC9724347 DOI: 10.1186/s12883-022-02954-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Behavioral variant frontotemporal dementia (bvFTD) has been related to different genetic factors. Identifying multimodal phenotypic heterogeneity triggered by various genetic influences is critical for improving diagnosis, prognosis, and treatments. However, the specific impact of different genetic levels (mutations vs. risk variants vs. sporadic presentations) on clinical and neurocognitive phenotypes is not entirely understood, specially in patites from underrepresented regions such as Colombia. METHODS Here, in a multiple single cases study, we provide systematic comparisons regarding cognitive, neuropsychiatric, brain atrophy, and gene expression-atrophy overlap in a novel cohort of FTD patients (n = 42) from Colombia with different genetic levels, including patients with known genetic influences (G-FTD) such as those with genetic mutations (GR1) in particular genes (MAPT, TARDBP, and TREM2); patients with risk variants (GR2) in genes associated with FTD (tau Haplotypes H1 and H2 and APOE variants including ε2, ε3, ε4); and sporadic FTD patients (S-FTD (GR3)). RESULTS We found that patients from GR1 and GR2 exhibited earlier disease onset, pervasive cognitive impairments (cognitive screening, executive functioning, ToM), and increased brain atrophy (prefrontal areas, cingulated cortices, basal ganglia, and inferior temporal gyrus) than S-FTD patients (GR3). No differences in disease duration were observed across groups. Additionally, significant neuropsychiatric symptoms were observed in the GR1. The GR1 also presented more clinical and neurocognitive compromise than GR2 patients; these groups, however, did not display differences in disease onset or duration. APOE and tau patients showed more neuropsychiatric symptoms and primary atrophy in parietal and temporal cortices than GR1 patients. The gene-atrophy overlap analysis revealed atrophy in regions with specific genetic overexpression in all G-FTD patients. A differential family presentation did not explain the results. CONCLUSIONS Our results support the existence of genetic levels affecting the clinical, neurocognitive, and, to a lesser extent, neuropsychiatric presentation of bvFTD in the present underrepresented sample. These results support tailored assessments characterization based on the parallels of genetic levels and neurocognitive profiles in bvFTD.
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Affiliation(s)
- Hernando Santamaría-García
- PhD program in Neuroscience, Pontificia Universidad Javeriana, Bogotá, Colombia.
- Memory and cognition Center, Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.
- Department of Neurology, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
| | - Natalia Ogonowsky
- CONICET & Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
| | - Sandra Baez
- Faculty of Psychology, Universidad de los Andes, Bogotá, Colombia
| | - Nicole Palacio
- Integrated Program in Neuroscience, McGill University, Montreal, Canada
| | - Pablo Reyes
- PhD program in Neuroscience, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Michael Schulte
- CONICET & Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina
| | - Andrea López
- Pontificia Universidad Javeriana, Bogotá, Colombia
- Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Agustín Ibanez
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibanez, Santiago de Chile, Chile.
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, & National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.
- Trinity Collegue of Dublin, Dublin, Irland.
- Global Brain Health Insititute, Universidad California San Francisco-Trinity College of Dublin, San Francisco, USA.
- Global Brain Health Insititute, Universidad California San Francisco-Trinity College of Dublin, Dublin, Irland.
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12
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McLaurin KA, Cranston MN, Li H, Mactutus CF, Harrod SB, Booze RM. Synaptic dysfunction is associated with alterations in the initiation of goal-directed behaviors: Implications for HIV-1-associated apathy. Exp Neurol 2022; 357:114174. [PMID: 35863502 PMCID: PMC9990912 DOI: 10.1016/j.expneurol.2022.114174] [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: 08/19/2021] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 02/05/2023]
Abstract
Individuals living with human immunodeficiency virus type 1 (HIV-1) exhibit an increased prevalence of neuropsychiatric comorbities (e.g., apathy) relative to their seronegative counterparts. Given the profound functional consequences associated with apathy, characterizing the multidimensional neuropsychiatric syndrome, and associated neural mechanisms, following chronic HIV-1 viral protein exposure remains a critical need. HIV-1-associated apathy was examined by quantifying goal-directed behaviors, indexed using voluntary wheel running, during the diurnal and nocturnal cycle. Apathetic behaviors in the HIV-1 transgenic (Tg) rat were characterized by a profound decrease in the number of running bouts during both the diurnal and nocturnal cycle, supporting a prominent deficit in the self-initiation of spontaneous behaviors. Additionally, HIV-1 Tg animals exhibited a decreased reinforcing efficacy of voluntary wheel running during the nocturnal cycle. Following the completion of voluntary wheel running, synaptic dysfunction in medium spiny neurons (MSNs) of the nucleus accumbens core (NAcc) was examined as a potential neural mechanism underlying HIV-1-associated apathy. HIV-1 Tg animals displayed prominent synaptic dysfunction in MSNs of the NAcc, characterized by enhanced dendritic branching complexity and a population shift towards an immature dendritic spine phenotype relative to control animals. Synaptic dysfunction, which accounted for 42.0% to 68.5% of the variance in the number of running bouts, was strongly associated with the self-initiation of spontaneous behaviors. Establishment of the relationship between synaptic dysfunction and apathy affords a key target for the development of novel therapeutics and cure strategies for affective alterations associated with HIV-1.
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Affiliation(s)
- Kristen A McLaurin
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Michael N Cranston
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Hailong Li
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Charles F Mactutus
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Steven B Harrod
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America
| | - Rosemarie M Booze
- Cognitive and Neural Science Program, Department of Psychology, University of South Carolina, Columbia, SC 29208, United States of America.
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13
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Alhourani A, Wylie SA, Summers JE, Phibbs FT, Bradley EB, Neimat JS, Van Wouwe NC. Developing Predictor Models of Postoperative Verbal Fluency After Deep Brain Stimulation Using Preoperative Neuropsychological Assessment. Neurosurgery 2022; 91:256-262. [PMID: 35506958 PMCID: PMC9514727 DOI: 10.1227/neu.0000000000001964] [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: 06/30/2021] [Accepted: 01/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) for Parkinson disease provides significant improvement of motor symptoms but can also produce neurocognitive side effects. A decline in verbal fluency (VF) is among the most frequently reported side effects. Preoperative factors that could predict VF decline have yet to be identified. OBJECTIVE To develop predictive models of DBS postoperative VF decline using a machine learning approach. METHODS We used a prospective database of patients who underwent neuropsychological and VF assessment before both subthalamic nucleus (n = 47, bilateral = 44) and globus pallidus interna (n = 43, bilateral = 39) DBS. We used a neurobehavioral rating profile as features for modeling postoperative VF. We constructed separate models for action, semantic, and letter VF. We used a leave-one-out scheme to test the accuracy of the predictive models using median absolute error and correlation with actual postoperative scores. RESULTS The predictive models were able to predict the 3 types of VF with high accuracy ranging from a median absolute error of 0.92 to 1.36. Across all three models, higher preoperative fluency, digit span, education, and Mini-Mental State Examination were predictive of higher postoperative fluency scores. By contrast, higher frontal system deficits, age, Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease scored by the patient, disease duration, and Behavioral Inhibition/Behavioral Activation Scale scores were predictive of lower postoperative fluency scores. CONCLUSION Postoperative VF can be accurately predicted using preoperative neurobehavioral rating scores above and beyond preoperative VF score and relies on performance over different aspects of executive function.
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Affiliation(s)
- Ahmad Alhourani
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Scott A. Wylie
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Jessica E. Summers
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fenna T. Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elise B. Bradley
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joseph S. Neimat
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
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14
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Pertz M, Braunwarth JI, Steinbach J, Wißing S, Thoma P. Social problem solving and trait socioemotional abilities in ambulatory stroke patients. J Clin Exp Neuropsychol 2022; 44:195-209. [PMID: 35856742 DOI: 10.1080/13803395.2022.2101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Stroke has been associated with sociocognitive impairment, so far well documented for emotion recognition and Theory of Mind. However, more complex abilities, such as social problem solving, which directly facilitate appropriate behavior in social situations have been neglected in previous research. METHOD The present study aimed to address this gap by focusing on performance-based social problem solving abilities and self-reported socioemotional abilities (i.e., empathy and alexithymia) in outpatient stroke patients (n = 36) compared to a group of healthy controls (n = 36) equivalent on age, gender, and education. In further analyses, potential lateralization effects and correlations between social problem solving/socioemotional functioning and demographic and clinical data were investigated. RESULTS In the main analyses, patients were impaired in their ability to freely generate appropriate solutions for challenging interpersonal situations depicted in written scenarios but performed on a comparable level as healthy controls when they had to choose the optimal solution presented amidst a range of less optimal options. While showing difficulty in identifying the awkward elements in the scenarios, the patient group nevertheless rated the degree of discomfort attributed to these elements on a level comparable to the control group. On the self-report measures, stroke patients reported overall higher degrees of alexithymia (i.e., an inability to describe and identify one's own and other persons´ emotions) and more personal distress in response to other individuals´ emotional suffering as assessed by self-report. CONCLUSIONS The present results suggest that stroke is associated with a broad impact on socioemotional and social problem solving abilities. As difficulties in social problem solving might be associated with increased psychosocial burden they ought to be addressed in stroke rehabilitation.
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Affiliation(s)
- Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Jana Isabelle Braunwarth
- Faculty of Psychology, Neuropsychological Therapy Centre (NTC), Ruhr University Bochum, Bochum, Germany
| | - Jasmin Steinbach
- Faculty of Psychology, Neuropsychological Therapy Centre (NTC), Ruhr University Bochum, Bochum, Germany
| | | | - Patrizia Thoma
- Faculty of Psychology, Neuropsychological Therapy Centre (NTC), Ruhr University Bochum, Bochum, Germany
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15
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Wong KS, Chou T, Peters AT, Ellard KK, Nierenberg AA, Dougherty DD, Deckersbach T. Convergence between behavioral, neural, and self-report measures of cognitive control: The Frontal Systems Behavior Scale in bipolar disorder. J Psychiatr Res 2022; 150:317-323. [PMID: 35447525 DOI: 10.1016/j.jpsychires.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
The Frontal Systems Behavior Scale (FrSBe) is a self-report measure that assesses difficulties with cognitive and emotional control such as apathetic behavior, lack of inhibitory control, and executive dysfunction. Previous neuroimaging studies highlight the involvement of the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC), and dorsolateral prefrontal cortex (DLPFC) in these processes. In this study, we investigated whether there was convergence across subjective and objective measures of apathy, disinhibition, and executive dysfunction. Specifically, we studied whether ACC, OFC, and DLPFC activation during a modified version of the Multi-Source Interference Task (MSIT), is associated with FrSBe apathy, disinhibition, and executive dysfunction scores, in healthy controls (HC) and individuals with Bipolar Disorder (BD), who commonly exhibit difficulties in these domains. Individuals with BD (n = 31) and HCs (n = 31) with no current or past psychiatric illness completed the FrSBe and the MSIT during fMRI scanning. We investigated task-specific changes in the ACC, DLPFC, and OFC and their correlations with FrSBe apathy, disinhibition, and executive dysfunction subscale scores, respectively. Individuals with BD and the HC group demonstrated greater ACC, DLPFC, and OFC activation during MSIT interference conditions compared with non-interference conditions. Furthermore, there was a significant negative correlation between OFC activation and disinhibition scores, which remained significant after accounting for medication load. Together, these results demonstrate the FrSBe disinhibition subscale, in particular, can be a self-report measure that converges with behavioral and neural markers of disinhibition in BD.
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Affiliation(s)
- Karianne Sretavan Wong
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Tina Chou
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Amy T Peters
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Kristen K Ellard
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA; Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Andrew A Nierenberg
- Dauten Family Center for Bipolar Treatment Innovation, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Darin D Dougherty
- Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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16
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Dickson SS, Husain M. Are there distinct dimensions of apathy? The argument for reappraisal. Cortex 2022; 149:246-256. [PMID: 35181121 PMCID: PMC9021925 DOI: 10.1016/j.cortex.2022.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/17/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023]
Abstract
Apathy is widely accepted to be a multidimensional syndrome. Assessment scales typically probe one or more dimensions but there is no consensus on the precise nature of these domains. Existing major theoretical frameworks include cognitive, behavioural, and emotional dimensions of apathy. While a social domain has also been suggested, it is far less well studied. Here we argue that although most assessment scales have been developed with these theoretical frameworks in mind, few findings actually support the existence of some of the dimensions that have been proposed, with the evidence for separation of cognitive and behavioural dimensions particularly lacking. In our opinion, although there is evidence for behavioural and emotional domains of apathy, the contention that there might be a separate dimension of cognitive or executive apathy is far less robust. Further, while there is some evidence for a social dimension of apathy, this has not been investigated sufficiently to make any definitive conclusion. We argue that there is a pressing need to reconsider different domains of apathy using robust analyses of proposed theoretical dimensions.
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Affiliation(s)
- Shannon S Dickson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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17
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Haller OC, Aleksonis HA, Krishnamurthy LC, King TZ. White matter hyperintensities relate to executive dysfunction, apathy, but not disinhibition in long-term adult survivors of pediatric cerebellar tumor. Neuroimage Clin 2022; 33:102891. [PMID: 34922123 PMCID: PMC8686062 DOI: 10.1016/j.nicl.2021.102891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/20/2021] [Accepted: 11/19/2021] [Indexed: 11/04/2022]
Abstract
Pediatric brain tumor survivors have more executive dysfunction than controls. White matter hyperintensities are positively associated with executive dysfunction. White matter hyperintensities are positively associated with apathy. Multivariate regression supports white matter hyperintensity associations. Survivors appear to drive white matter hyperintensities associations.
White matter hyperintensities (WMHs) have been related to executive dysfunction, apathy and disinhibition in a wide range of neurological populations. However, this relationship has not been examined in survivors of pediatric brain tumor. The goal of this study was to investigate how executive dysfunction, apathy, and disinhibition relate to WMHs in 31 long-term survivors of pediatric cerebellar brain tumor and 58 controls, using informant-report data from the Frontal Systems Behavior Scale. Total WMH volume was quantified using the Lesion Growth Algorithm. Further, periventricular, and subcortical volumes were identified based on proximity to custom ventricle masks generated in FSL. A ratio of WMH volume to whole brain volume was used to obtain normalized WMH volumes. Additionally, a multivariate regression analysis was performed. On average, informant-report scores were within normal limits and only executive dysfunction was significantly higher in survivors compared to controls (t(47.9) = -2.4, p=.023). Informants reported clinically significant levels of apathy in 32.3% of survivors. Informants also reported clinically significant executive dysfunction in 19.4 % of survivors and clinically significant disinhibition in, again, 19.4 % of survivors. Increased volume of WMHs was positively correlated with executive dysfunction (r = 0.33, p = 0.02) and apathy (r = 0.23, p = .04). Similarly, multivariate regression demonstrated correlations with executive dysfunction (p=.05, FDR corrected) and apathy (p=.05, FDR corrected). Exploratory analysis demonstrated an interaction wherein the relationship between total WMHs and executive dysfunction and apathy depends on whether the participant was a survivor. The current findings indicate that increased WMH volumes are associated with higher ratings of apathy and executive dysfunction, and that these results are likely unique to cerebellar brain tumor survivors. WMH burden may serve as a useful marker to identify survivors at risk of executive dysfunction or increased apathy.
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Affiliation(s)
- Olivia C Haller
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Holly A Aleksonis
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lisa C Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA, Decatur, GA, USA; Department of Physics and Astronomy, Georgia State University, Atlanta, GA, USA
| | - Tricia Z King
- Department of Psychology, Georgia State University, Atlanta, GA, USA; Neuroscience Institute, Georgia State University, Atlanta, GA, USA.
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18
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Wakely H, Radakovic R, Bateman A, Simblett S, Fish J, Gracey F. Psychometric Properties of the Revised Dysexecutive Questionnaire in a Non-clinical Population. Front Hum Neurosci 2022; 16:767367. [PMID: 35308604 PMCID: PMC8924056 DOI: 10.3389/fnhum.2022.767367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Aims The aim of this study was to assess the psychometric properties of the revised self-rated version of the Dysexecutive Questionnaire (DEX-R) within a non-clinical sample. Methods The study was hosted online, with 140 participants completing the DEX-R, GAD-2 and PHQ-2. Sixty participants also completed the FrSBe, with 99 additionally completing the DEX-R again 3 weeks later. Correlations with demographic factors and symptoms of anxiety and depression were conducted. Rasch and factor analysis were also used to explore underlying subconstructs. Results The DEX-R correlated highly with the FrSBe, indicating sound concurrent validity. Internal consistency, split-half reliability and test-retest reliability were excellent. Age and symptoms of depression and anxiety correlated with DEX-R scores, with older age associated with less dysexecutive problems. The Rasch analysis confirmed the multidimensionality of the rating scale, and a three-factor structure was found relating to activation-self-regulatory, cognitive and social-emotional processes. Frequencies of responses on DEX-R items varied, many were not fully endorsed indicating specific relevance of most but not all items to patients. Conclusion Interpretations of DEX-R ratings of dysexecutive problems should consider mood and individual variation. Systematic comparison of DEX-R responses between healthy and clinical groups could help identify a suitable cut off for dysexecutive symptoms.
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Affiliation(s)
- Hannah Wakely
- Faculty of Medicine and Health Sciences, Cambridgeshire and Peterborough NHS Foundation Trust, University of East Anglia, Norwich, United Kingdom
| | - Ratko Radakovic
- Faculty of Medicine and Health Sciences, Cambridgeshire and Peterborough NHS Foundation Trust, University of East Anglia, Norwich, United Kingdom
- The Euan MacDonald Centre for Motor Neurone Disease, University of Edinburgh, Edinburgh, United Kingdom
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Aging and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Sara Simblett
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Jessica Fish
- Department of Clinical Neuropsychology and Clinical Health Psychology, St George’s Hospitals NHS Foundation Trust, London, United Kingdom
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Fergus Gracey
- Faculty of Medicine and Health Sciences, Cambridgeshire and Peterborough NHS Foundation Trust, University of East Anglia, Norwich, United Kingdom
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Kassel MT, Lositsky O, Vaidya AR, Badre D, Malloy PF, Greenberg BD, Marsland R, Noren G, Sherman A, Rasmussen SA, McLaughlin NC. Differential assessment of frontally-mediated behaviors between self- and informant-report in patients with obsessive-compulsive disorder following gamma ventral capsulotomy. Neuropsychologia 2022; 170:108211. [DOI: 10.1016/j.neuropsychologia.2022.108211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Adaptation, Validation and Preliminary Standardisation of the Frontal Systems Behaviour Scale - Apathy Subscale and the Dimensional Apathy Scale in Vietnamese Healthy Samples. J Int Neuropsychol Soc 2022; 28:300-310. [PMID: 33752764 DOI: 10.1017/s135561772100031x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Apathy, the reduction of motivation and goal-directed behaviour, is a ubiquitous behavioural syndrome in many neurological disorders. However, apathy measures are limited in non-English speaking countries. The present study aimed to develop a culturally appropriate version of the Vietnamese Frontal Systems Behavioural Scale-Apathy subscale (V-FrSBe-A) and Dimensional Apathy Scale (V-DAS), examine their internal reliability and construct validity (i.e., factor structure, convergent and divergent validity) in a Vietnamese healthy sample and establish preliminary normative cut-offs for clinical and research applications. METHOD In total, 112 healthy subjects and 64 informants completed the self-report and informant report V-FrSBe-A and V-DAS, developed using a translation, back-translation and cultural adaptation procedure. McDonald's omega was applied to examine internal reliability. The internal structure of the V-DAS was evaluated using exploratory structural equation model. For both apathy scales, convergent validity was determined by correlations between scales and between informant and self-report versions. Regarding divergent validity, participants completed the Vietnamese Depression Anxiety Stress Scale-21 and V-FrSBe-Disinhibition for depression and disinhibition assessment. RESULTS Both the V-FrSBe-A and V-DAS were reliable (ωt ≥ .74). Dimensional manifestations of apathy in executive, emotional and initiation domains were confirmed on the V-DAS. Both scales were also valid, convergent with each other and divergent from depression and disinhibition symptoms. Cut-off scores for both scales were higher than their English versions. CONCLUSION The adapted V-FrSBe-A and V-DAS have good reliability and validity for the potential application in clinical groups to advance current knowledge about apathy transculturally and direct more effective clinical care for Vietnamese individuals with neurological disorders.
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21
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Pluim CF, Nakhla MZ, Split M, Filoteo JV, Litvan I, Moore RC, Lessig S, Schiehser DM. Changes in Self- and Informant-Reported Frontal Behaviors in Parkinson's Disease: A Longitudinal Study. J Geriatr Psychiatry Neurol 2022; 35:89-101. [PMID: 33030110 DOI: 10.1177/0891988720964257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Frontal behaviors (i.e., executive dysfunction, disinhibition, apathy) are common in Parkinson's disease (PD). However, it is unclear if patient and informant reports of patient frontal behaviors are in agreement over time. METHOD Sixty-two PD patients without dementia and their informants (87% spouses/partners) completed the self- and informant-versions of the Frontal Systems Behavior Scale at baseline and 2-year follow-up. Dyad ratings were compared and predictors of behavior ratings were examined. RESULTS Patient and informant reports at baseline and follow-up were in agreement, with significant increases in overall frontal behaviors, executive dysfunction, and apathy. Higher levels of baseline patient depression and caregiver burden predicted decrements in patient-reported executive function; worse patient cognition at baseline predicted worsening apathy as rated by informants. CONCLUSIONS PD patients and their informants are concordant in their ratings of worsening frontal behaviors over time. Targeting patient depression, cognition, and caregiver burden may improve decrements in frontal behaviors (executive dysfunction and apathy) in PD.
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Affiliation(s)
- Celina F Pluim
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA
| | - Marina Z Nakhla
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,464916SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Molly Split
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA
| | - J Vincent Filoteo
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, 8784University of California San Diego, La Jolla, CA, USA
| | - Irene Litvan
- Department of Neurosciences, Parkinson and Other Movement Disorders Center, 8784University of California San Diego, La Jolla, CA, USA
| | - Raeanne C Moore
- Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA
| | - Stephanie Lessig
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,Department of Neurosciences, Parkinson and Other Movement Disorders Center, 8784University of California San Diego, La Jolla, CA, USA
| | - Dawn M Schiehser
- Research and Psychology Services, 19979VA San Diego Healthcare System, San Diego, CA, USA.,Department of Psychiatry, 8784University of California San Diego, La Jolla, CA, USA
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Barek LM, Mercy G, Gautier C, Noquet M, Legros-Lafarge E, Fiegl L, Fiard D, Allain P. The use of the French Dimensional Apathy Scale (f-DAS) to assess apathy in schizophrenia: Properties and profiles. J Affect Disord 2021; 294:181-188. [PMID: 34298224 DOI: 10.1016/j.jad.2021.06.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Apathy can be defined as a quantitative reduction of self-generated voluntary and purposeful (or goal-directed) behaviour. The literature underlines the triadic dimensional nature of apathy, but in schizophrenia there are inconsistencies due to difficulty in assessment. The Dimensional Apathy Scale (DAS) and its validation into French (f-DAS) provide measurement of three neurobehavioral apathy subtypes: Executive, Emotional and Initiation, but these subtypes have never been explored in schizophrenia. OBJECTIVE The aims of this study are to assess apathy in schizophrenia with a tri-dimensional tool (the f-DAS), to examine its psychometric properties in schizophrenia and the apathetic profiles of patients with schizophrenia. METHODS One hundred and ten subjects were recruited. Forty-five belonged to the patients' group and fifty-five to the control group. They all completed the Mini-International Neuropsychiatric Interview (M.I.N.I), the French National Reading Test (f-NART), the French Dimensional Apathy Scale (f-DAS), the Lille Apathy Rating Scale (LARS) and the Beck Depression Inventory (BDI II). RESULTS Regarding the total score of the f-DAS and the subscores for each dimension, patients appeared significantly more apathetic than healthy controls. Consistency, validity, concurrent and divergent validity were good. In the patient group, several profiles of apathy were identified. CONCLUSIONS The f-DAS has good psychometric properties and provides reliable and valid dimensional assessment of apathy in schizophrenia. From a dimensional point of view, using the f-DAS we demonstrated that prevalence of apathy could be underestimated in schizophrenia. Patients with schizophrenia are more impaired on the Executive and Initiative dimensions of apathy.
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Affiliation(s)
- Lise M' Barek
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers Cedex 01; Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France.
| | | | - Caroline Gautier
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Malika Noquet
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Emilie Legros-Lafarge
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Centre Hospitalier Esquirol, Limoges, France
| | - Lucia Fiegl
- Centre Référent de Réhabilitation Psychosociale de Limoges (C2RL), Centre Hospitalier Esquirol, Limoges, France
| | - Dominique Fiard
- Institut du Handicap Psychique, Réseau Réhab, Centre Hospitalier, Niort, France
| | - Philippe Allain
- Laboratoire de Psychologie des Pays de la Loire, LPPL EA 4638, SFR Confluences, UNIV Angers, Nantes Université, Maison de la recherche Germaine Tillion, 5 bis Boulevard Lavoisier, 49045 Angers Cedex 01; Département de Neurologie, Centre Hospitalier Universitaire d'Angers, Angers, France
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23
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Zwinkels H, Dirven L, Bulbeck HJ, Grant R, Habets EJJ, Koekkoek JAF, Oberg I, Oliver K, Pace A, Rooney AG, Vos MJ, Taphoorn MJB. Identification of characteristics that determine behavioral and personality changes in adult glioma patients. Neurooncol Pract 2021; 8:550-558. [PMID: 34594569 DOI: 10.1093/nop/npab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Glioma patients may experience behavioral and personality changes (BPC), negatively impacting their lives and that of their relatives. However, there is no clear definition of BPC for adult glioma patients, and here we aimed to determine which characteristics of BPC are relevant to include in this definition. Methods Possible characteristics of BPC were identified in the literature and presented to patients and (former) caregivers in an online survey launched via the International Brain Tumour Alliance. Participants had to rate the relevance of each presented characteristic of BPC, the three characteristics with the most impact on their lives, and possible missing characteristics. A cluster analysis and discussions with experts provided input to categorize characteristics and propose a definition for BPC. Results Completed surveys were obtained from 140 respondents; 35% patients, 50% caregivers, and 15% unknown. Of 49 proposed characteristics, 35 were reported as relevant by at least 25% (range: 7%-44%) of respondents. Patients and caregivers rated different characteristics as most important. Common characteristics included in the top 10 of both patients and caregivers were lack of motivation, change in being socially active, not able to finish things, and change in the level of irritation. No characteristics were reported missing by ≥5 respondents. Three categories of BPC were identified: (1) emotions, needs, and impulses (2) personality traits, and (3) poor judgement abilities. Conclusion The work resulted in a proposed definition for BPC in glioma patients, for which endorsement from the neuro-oncological community will be sought. A next step is to identify or develop an instrument to evaluate BPC in glioma patients.
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Affiliation(s)
- Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, UK
| | - Esther J J Habets
- Department of Medical Psychology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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24
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Myers PS, Jackson JJ, Clover AK, Lessov‐Schlaggar CN, Foster ER, Maiti B, Perlmutter JS, Campbell MC. Distinct progression patterns across Parkinson disease clinical subtypes. Ann Clin Transl Neurol 2021; 8:1695-1708. [PMID: 34310084 PMCID: PMC8351397 DOI: 10.1002/acn3.51436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine specific symptom progression patterns and possible disease staging in Parkinson disease clinical subtypes. METHODS We recently identified Parkinson disease clinical subtypes based on comprehensive behavioral evaluations, "Motor Only," "Psychiatric & Motor," and "Cognitive & Motor," which differed in dementia and mortality rates. Parkinson disease participants ("Motor Only": n = 61, "Psychiatric & Motor": n = 17, "Cognitive & Motor": n = 70) and controls (n = 55) completed longitudinal, comprehensive motor, cognitive, and psychiatric evaluations (average follow-up = 4.6 years). Hierarchical linear modeling examined group differences in symptom progression. A three-way interaction among time, group, and symptom duration (or baseline age, separately) was incorporated to examine disease stages. RESULTS All three subtypes increased in motor dysfunction compared to controls. The "Motor Only" subtype did not show significant cognitive or psychiatric changes compared to the other two subtypes. The "Cognitive & Motor" subtype's cognitive dysfunction at baseline further declined compared to the other two subtypes, while also increasing in psychiatric symptoms. The "Psychiatric & Motor" subtype's elevated psychiatric symptoms at baseline remained steady or improved over time, with mild, steady decline in cognition. The pattern of behavioral changes and analyses for disease staging yielded no evidence for sequential disease stages. INTERPRETATION Parkinson disease clinical subtypes progress in clear, temporally distinct patterns from one another, particularly in cognitive and psychiatric features. This highlights the importance of comprehensive clinical examinations as the order of symptom presentation impacts clinical prognosis.
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Affiliation(s)
- Peter S. Myers
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Joshua J. Jackson
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMissouriUSA
| | - Amber K. Clover
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | | | - Erin R. Foster
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Department of PsychiatryWashington University School of MedicineSt. LouisMissouriUSA
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMissouriUSA
| | - Baijayanta Maiti
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Joel S. Perlmutter
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMissouriUSA
- Department of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
- Department of NeuroscienceWashington University School of MedicineSt. LouisMissouriUSA
- Program in Physical TherapyWashington University School of MedicineSt. LouisMissouriUSA
| | - Meghan C. Campbell
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
- Department of RadiologyWashington University School of MedicineSt. LouisMissouriUSA
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25
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Zirbes C, Jones A, Manzel K, Denburg N, Barrash J. Assessing the Effects of Healthy and Neuropathological Aging on Personality with the Iowa Scales of Personality Change. Dev Neuropsychol 2021; 46:393-408. [PMID: 34283684 DOI: 10.1080/87565641.2021.1956500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Personality changes in older adults with brain disease may be confounded by effects of normal aging. In this cross-sectional study, ratings with the Iowa Scales of Personality Change for 62 healthy older adults (OA-H, aged 60+) were compared to matched older adults with brain diseases (OA-BD). OA-H did not show any significant personality changes from middle age to older adulthood. However, between 10% and 20% of OA-H developed a disturbance in Lack of Stamina, Inflexibility, Lability, and Lack of Insight. Otherwise, the pattern of findings suggesting normal aging effects on personality disturbances in clinical groups are generally minimal.
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Affiliation(s)
- Christian Zirbes
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Andrew Jones
- Department of Computer Science, Princeton University, Princeton, United States
| | - Kenneth Manzel
- Department of Neurology, University of Iowa, Iowa City, United States
| | - Natalie Denburg
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
| | - Joseph Barrash
- Departments of Neurology and Psychological and Brain Sciences, University of Iowa, Iowa City, United States
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26
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Iazzolino B, Pain D, Laura P, Aiello EN, Gallucci M, Radici A, Palumbo F, Canosa A, Moglia C, Calvo A, Mora G, Chiò A. Italian adaptation of the Beaumont Behavioral Inventory (BBI): psychometric properties and clinical usability. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:81-86. [PMID: 34279169 DOI: 10.1080/21678421.2021.1946085] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective. Up to 50% of patients affected by amyotrophic lateral sclerosis (ALS) show behavioral changes within the spectrum of frontotemporal degeneration (FTD). Behavioral dysfunctions in ALS patients negatively impact on management, prognosis and survival. It is, thus, crucial to develop ALS-specific psychometric tools for early detecting alterations in behavior. This study aimed at investigating psychometric properties and feasibility of the Beaumont Behavioral Impairment (BBI), a proxy-report questionnaire designed to screen for FTD-like behavioral symptoms in ALS patients.Methods. Ninety ALS patients were compared to 100 healthy participants (HPs) on the BBI. ALS patients underwent clinical, cognitive, mood/anxiety and further behavioral (Frontal System Behavior Scale, FrSBe; Frontal Behavioral Inventory, FBI) evaluation. Validity, reliability, sensitivity and specificity of the BBI were assessed.Results. The BBI was significantly related to FrSBe and FBI scores, whereas not to other measures. A Principal Component Analysis yielded a mono-component structure; Cronbach's α was .93. The BBI proved to be sensitive to changes in behavior as well as to discriminate between different degrees of dysfunction. By addressing the FrSBe as the gold standard, the BBI reached optimal sensitivity (85.7%) and specificity (79.7%) at a cutoff of 10.5. Moreover, the BBI proved to be more accurate than the FrSBe and the FBI in clinical classifications.Conclusion. The BBI showed high internal consistency, as well as good construct, convergent and divergent validity. Its clinical usability is encouraged in ALS patients as being able to sensitively and specifically detect FTD-like behavioral changes.
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Affiliation(s)
- Barbara Iazzolino
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy
| | - Debora Pain
- Istituti Clinici Scientifici Maugeri, IRCCS Milano, Milan, Italy
| | - Peotta Laura
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy
| | - Edoardo N Aiello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Department of Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Marcello Gallucci
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Alice Radici
- Istituti Clinici Scientifici Maugeri, IRCCS Milano, Milan, Italy
| | - Francesca Palumbo
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy
| | - Antonio Canosa
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Moglia
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Calvo
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.,Neuroscience Institute of Turin (NIT), Turin, Italy
| | - Gabriele Mora
- Istituti Clinici Scientifici Maugeri, IRCCS Milano, Milan, Italy
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,SC Neurologia 1U, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.,Neuroscience Institute of Turin (NIT), Turin, Italy.,Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
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27
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Musa G, Slachevsky A, Muñoz-Neira C, Méndez-Orellana C, Villagra R, González-Billault C, Ibáñez A, Hornberger M, Lillo P. Alzheimer's Disease or Behavioral Variant Frontotemporal Dementia? Review of Key Points Toward an Accurate Clinical and Neuropsychological Diagnosis. J Alzheimers Dis 2021; 73:833-848. [PMID: 31884475 DOI: 10.3233/jad-190924] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most common neurodegenerative early-onset dementias. Despite the fact that both conditions have a very distinctive clinical pattern, they present with an overlap in their cognitive and behavioral features that may lead to misdiagnosis or delay in diagnosis. The current review intends to summarize briefly the main differences at the clinical, neuropsychological, and behavioral levels, in an attempt to suggest which aspects would facilitate an adequate diagnosis in a clinical setting, especially in Latin American and low- and middle-income countries, where the resources needed for a differential diagnosis (such as MRI or biomarkers) are not always available. A timely diagnosis of AD and FTD have significant implications for the medical management and quality of life of patients and careers.
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Affiliation(s)
- Gada Musa
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Department of Physiopathology, ICBM, Department of Neurosciences, Department of East Neuroscience, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile.,Universidad de los Andes, Santiago, Chile.,Capredena, Health and Rehabilitation Center, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Department of Physiopathology, ICBM, Department of Neurosciences, Department of East Neuroscience, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile.,Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile.,Memory and Neuropsychiatric Clinic (CMYN) Neurology Department- Hospital del Salvador and University of Chile, Providencia, Santiago, Chile.,Departamento de Medicina, Servicio de Neurología, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Carlos Muñoz-Neira
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department- Hospital del Salvador and University of Chile, Providencia, Santiago, Chile.,Research into Memory, Brain Sciences and Dementia Group (ReMemBr Group), Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Carolina Méndez-Orellana
- Carrera de Fonoaudiología, Departamento Ciencias de la Salud, Facultad de Medicina, Universidad Católica de Chile, Santiago, Chile
| | - Roque Villagra
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Department of Physiopathology, ICBM, Department of Neurosciences, Department of East Neuroscience, Faculty of Medicine, University of Chile, Providencia, Santiago, Chile.,Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile
| | - Christian González-Billault
- Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile.,Department of Biology, Faculty of Sciences, Universidad de Chile, Santiago, Chile.,The Buck Institute for Research on Aging, Novato, CA, USA
| | - Agustín Ibáñez
- Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile.,Centre of Excellence in Cognition and its Disorders, Australian Research Council (ACR), Sydney, Australia
| | | | - Patricia Lillo
- Gerosciences Center for Brain Health and Metabolism (GERO), Providencia, Santiago, Chile.,Department of Neurology South, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Shamsalinia A, Moradi M, Rad RE, Ghadimi R, Farahani MA, Masoudi R, Rabiei L, Ghaffari F. Design and psychometric evaluation of epilepsy-related apathy scale (E-RAS) in adults with epilepsy: a sequential exploratory mixed methods design. BMC Neurol 2021; 21:121. [PMID: 33731045 PMCID: PMC7967960 DOI: 10.1186/s12883-021-02139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Apathy in patients with epilepsy is associated with a wide range of consequences that reduce the patient’s ability to perform social functions and participate in self-care and rehabilitation programs. Therefore, apathy is one of the important diagnoses of the healthcare team in the process of caring for epileptic patients and its dimensions need to be examined and recognized. Therefore, appropriate instruments with the sociocultural milieu of each community should be provided to health care providers. The aim of the present study was to design and measure epilepsy–related apathy scale (E-RAS) in adults with epilepsy. Methods This study of sequential exploratory mixed methods design was conducted in Iran from April 2019 to December 2019. In the Item generation stage, two inductive (face-to-face and semi-structured interviews with 17 adult epileptic patients) and deductive (literature review) were used. In item reduction, integration of qualitative and literature reviews and scale evaluation were accomplished. For Scale Evaluation, face, content, construct [exploratory factor analysis (EFA) (n = 360) and confirmatory factor analysis (CFA) (n = 200)], convergent and divergent Validity and reliability (internal consistency and stability) were investigated. Results The results of EFA showed that E-RAS has four factors, namely, motivation; self-regulatory; cognition and emotional-effective. These four latent factors accounted for a total of 48.351% of the total variance in the E-RAS construct. The results of CFA showed that the 4-factor model of E-RAS has the highest fit with the data. The results of convergent and divergent validity showed that the values of composite reliability (CR) and average variance extracted (AVE) for the four factors were greater than 0.7 and 0.5, respectively, and the value of AVE for each factor was greater than CR. The Cronbach’s alpha coefficient for the whole scale was obtained 0.815. The results of the test-retest showed that there was a significant agreement between the test and retest scores (P < 0.001). Conclusion E-RAS is a multidimensional construct consisting of 24 items, and has acceptable validity and reliability for the study of epilepsy-related apathy in adult epileptic patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02139-2.
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Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - Reza Ebrahimi Rad
- Department of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Mazandaran, Iran
| | - Reza Ghadimi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center and School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Masoudi
- Community-Oriented Nursing Midwifery Research Center, Department of Adult and Geriatric Nursing, Nursing and Midwifery School, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Leili Rabiei
- Social Determinants of Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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López MB, Arán Filippetti V, Richaud MC. Adult Executive Functioning Inventory (ADEXI): Factor structure, convergent validity, and reliability of a Spanish adaptation. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1380-1386. [PMID: 33587681 DOI: 10.1080/23279095.2021.1880408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although there are several ratings to assess Executive Functions (EF) in adults, most of these are lengthy and comprise items which describe extreme or pathologic behaviors (e.g., ADHD symptoms), proving inadequate for the assessment of EF in general population. The Adult Executive Functioning Inventory (ADEXI) seeks to assess EF taking these limitations into account. The aims of the present study were to analyze the factor structure, the convergent and divergent validity, and the reliability of a Spanish adaptation of the ADEXI in a non-clinical population. The Spanish adaptation of the ADEXI, the Interpersonal Reactivity Index (IRI), the Cognitive Flexibility Scale (CFS), and an adaptation of the Aggression Scale (AS) were administered to 369 healthy adults between 18 and 60-years-old. To analyze the factor structure of the ADEXI, Confirmatory Factor Analysis (CFA) was used. In addition, the relationship between the inventory and the IRI, the CFS and the AS was analyzed. Finally, Cronbach's α index was calculated. CFA showed that the two-factor model including (1) Working memory and (2) Inhibition best fit the data. Significant correlations were found between the ADEXI scores and the CFS, the IRI and the AS, providing additional evidence of construct validity. The internal consistency of the ADEXI was high (α = 0.87). Taken together, our results indicate that the Spanish adaptation of the ADEXI shows satisfactory psychometric properties and would be a valid and reliable measure to assess EF in non-clinical populations both for clinical and research purposes.
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Affiliation(s)
- Mariana Beatriz López
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Centro Interdisciplinario de Investigación en Ciencias de la Salud y del Comportamiento (CIICSAC), Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - Vanessa Arán Filippetti
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Centro Interdisciplinario de Investigación en Ciencias de la Salud y del Comportamiento (CIICSAC), Universidad Adventista del Plata, Libertador San Martín, Argentina
| | - María Cristina Richaud
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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30
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Galvin JE, Cohen I, Greenfield KK, Walker M. The Frontal Behavioral Battery: A Measure of Frontal Lobe Symptoms in Brain Aging and Neurodegenerative Disease. J Alzheimers Dis 2021; 83:721-739. [PMID: 34366351 PMCID: PMC10731583 DOI: 10.3233/jad-210446] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Approximately 90%of persons living with dementia experience behavioral symptoms, including frontal lobe features involving motivation, planning, social behavior, language, personality, mood, swallowing, and gait. OBJECTIVE We conducted a two-stage study with a development sample (n = 586) and validation sample (n = 274) to evaluate a brief informant-rated measure of non-cognitive features of frontal lobe dysfunction: the Frontal Behavioral Battery (FBB). METHODS In the development sample, internal consistency, principal factor analysis, and correlations between the FBB and outcomes were evaluated. In the validation sample, we examined (a) FBB scores by diagnosis, (b) known-group validity by demographics, subjective complaints, and dementia staging, and (c) correlation between FBB and MRI volumes. Receiver operator characteristic curves assessed the ability of the FBB to discriminate individuals with frontal lobe features due to a neurodegenerative disease. RESULTS The FBB characterized 11 distinct frontal lobe features. Individuals with dementia with Lewy bodies and frontotemporal degeneration had the greatest number of frontal lobe features. Premorbid personality traits of extroversion, agreeableness, and openness were associated with fewer frontal lobe behavioral symptoms, while subjective cognitive complaints were associated with greater symptoms. The FBB provided very good discrimination between individuals with and without cognitive impairment (diagnostic odds ratio: 13.1) and between individuals with and without prominent frontal lobe symptoms (diagnostic odds ratio: 84.8). CONCLUSION The FBB may serve as an effective and efficient method to assess the presence of non-cognitive symptoms associated with frontal lobe dysfunction, but in a brief fashion that could facilitate its use in clinical care and research.
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Affiliation(s)
- James E. Galvin
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Iris Cohen
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Keri K. Greenfield
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Marcia Walker
- Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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31
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The Neurological Predictor Scale Predicts Adaptive Functioning via Executive Dysfunction in Young Adult Survivors of Childhood Brain Tumor. J Int Neuropsychol Soc 2021; 27:1-11. [PMID: 32641194 DOI: 10.1017/s1355617720000624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Survivors of childhood brain tumors experience neurological sequelae that disrupt everyday adaptive functioning (AF) skills. The Neurological Predictor Scale (NPS), a cumulative measure of tumor treatments and sequelae, predicts cognitive outcomes, but findings on its relation to informant-reported executive dysfunction (ED) and AF are mixed. Given known effects of frontal-subcortical system disruptions on AF, this study assessed the NPS' relationship with AF as mediated by frontal systems dysfunction, measured by the Frontal Systems Behavior Scale (FrSBe). METHODS 75 participants (Mage = 23.5, SDage = 4.5) were young adult survivors of childhood brain tumors at least 5 years past diagnosis. FrSBe and Scales of Independent Behavior-Revised (SIB-R), a measure of AF, were administered to informants. Parallel multiple mediator models included Apathy and ED as mediators, and age at diagnosis and time between diagnosis and assessment as covariates. RESULTS More complex treatment and sequelae were correlated with poorer functioning. Mediation models were significant for all subscales: Motor Skills (MS), p = .0001; Social Communication (SC), p = .002; Personal Living (PL), p = .004; Community Living (CL), p = .007. The indirect effect of ED on SC and CL was significant; the indirect effect of Apathy was not significant for any subscales. CONCLUSIONS More complex tumor treatment and sequelae were associated with poorer long-term AF via increased ED. Cognitive rehabilitation programs may focus on the role of executive function and initiation that contribute to AF, particularly SC and CL skills, to help survivors achieve comparable levels of independence in everyday function as their peers.
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Kutlubaev M, Ozerova A, Mendelevich V. Disorders of social cognitive functions in patients after stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:9-14. [DOI: 10.17116/jnevro20211211229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Barrash J, Abel TJ, Okerstrom-Jezewski KL, Zanaty M, Bruss JE, Manzel K, Howard M, Tranel D. Acquired Personality Disturbances After Meningioma Resection Are Strongly Associated With Impaired Quality of Life. Neurosurgery 2020; 87:276-284. [PMID: 31642509 DOI: 10.1093/neuros/nyz440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 08/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Some patients experience long-term declines in quality of life following meningioma resection, but associated factors are not well understood. OBJECTIVE To investigate whether long-term declines in quality of life (specifically impaired adaptive functioning) after meningioma resection are associated with specific personality disturbances that often develop with lesions in ventromedial prefrontal cortex (vmPFC). METHODS We studied 38 patients who underwent resection of meningioma, 18 of whom had vmPFC lesions and 20 with lesions elsewhere (non-vmPFC). A total of 30 personality characteristics were rated by spouse or family, and a neuropsychologist blindly rated adaptive functioning an average of 3.8 yr postresection. Relevant personality disturbance was defined by a priori process: the presence of "conjoint personality disturbance" required specific disturbances in at least 2 of 4 types of disturbance: executive disorders, disturbed social behavior, emotional dysregulation, and hypoemotionality. RESULTS Fourteen patients had impaired adaptive functioning: 12 had vmPFC lesions and 2 had non-vmPFC lesions. Fourteen patients had conjoint personality disturbance, and 12 of them had impaired adaptive functioning. By contrast, among the 24 patients who did not have conjoint personality disturbance, only 2 had impaired adaptive functioning. Mediation analysis showed that the association between vmPFC lesions and impaired adaptive functioning was mediated by the negative impact of acquired personality disturbance on adaptive functioning. CONCLUSION Anterior skull base meningiomas plus resection surgery may result in specific personality disturbances that are highly associated with impaired adaptive functioning at long-term follow-up. These patients may benefit from early counseling regarding potential personality changes and their implications for adaptive functioning.
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Affiliation(s)
- Joseph Barrash
- Department of Neurology, University of Iowa, Iowa City, Iowa.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
| | - Taylor J Abel
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Mario Zanaty
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Joel E Bruss
- Department of Neurology, University of Iowa, Iowa City, Iowa
| | - Kenneth Manzel
- Department of Neurology, University of Iowa, Iowa City, Iowa
| | - Matthew Howard
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Daniel Tranel
- Department of Neurology, University of Iowa, Iowa City, Iowa.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa
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Sellers J, Ridner SH, Claassen DO. A Systematic Review of Neuropsychiatric Symptoms and Functional Capacity in Huntington's Disease. J Neuropsychiatry Clin Neurosci 2020; 32:109-124. [PMID: 31466515 DOI: 10.1176/appi.neuropsych.18120319] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neuropsychiatric symptoms are known to increase caregiver burden and decrease patient quality of life among patients with Huntington's disease. Functional capacity is an outcome commonly used in Huntington's disease clinical trials to quantify disease progression or intervention response. Some studies have examined the relationship between neuropsychiatric symptoms and functional capacity; however, this evidence has not been synthesized. The authors reviewed existing evidence on the association between neuropsychiatric symptoms and functional capacity in Huntington's disease. METHODS A systematic review was conducted using PubMed and CINAHL. Articles were included if they described primary research in humans with Huntington's disease, measured one or more neuropsychiatric symptoms and functional capacity, and reported statistical methods to identify associations between the two concepts. Additional eligible articles were identified through reference mining and review of other relevant literature. RESULTS Fourteen articles were eligible for review. Neuropsychiatric symptoms were measured individually, in clusters (i.e., depression, anxiety, and suicide items contributing to a depression cluster score), or with an overall score. Significant associations with decreased functional capacity were found most commonly with depression (N=7, median r=0.48) and apathy (N=5, median r=0.47). Other neuropsychiatric symptoms, clusters, and overall scores were all associated with functional capacity in three or fewer studies. CONCLUSIONS There is some evidence that depression and apathy are associated with decreased functional capacity in Huntington's disease. Other neuropsychiatric symptoms have been infrequently examined. Further knowledge of the relationships between neuropsychiatric symptoms and functional capacity will identify areas for intervention and improvement of outcomes in patients with Huntington's disease.
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Affiliation(s)
- Jessie Sellers
- The Department of Neurology, Vanderbilt University Medical Center, Nashville (Sellers, Claassen); and the School of Nursing, Vanderbilt University, Nashville (Ridner)
| | - Sheila H Ridner
- The Department of Neurology, Vanderbilt University Medical Center, Nashville (Sellers, Claassen); and the School of Nursing, Vanderbilt University, Nashville (Ridner)
| | - Daniel O Claassen
- The Department of Neurology, Vanderbilt University Medical Center, Nashville (Sellers, Claassen); and the School of Nursing, Vanderbilt University, Nashville (Ridner)
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Garcia S, Hampstead BM. HD-tDCS as a neurorehabilitation technique for a case of post-anoxic leukoencephalopathy. Neuropsychol Rehabil 2020; 32:946-966. [PMID: 33208043 DOI: 10.1080/09602011.2020.1845749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Post-anoxic leukoencephalopathy is a rare event that causes global demyelination secondary to anoxic injury. Given the nature and extent of the damage, cognitive and functional deficits are typically chronic even after standard therapies. Here, we describe a novel treatment approach that used high definition transcranial direct-current stimulation (HD-tDCS) with a 62-year-old male who was 5 years post-anoxic leukoencephalopathy secondary to an accidental drug overdose. HD-tDCS was administered over the left lateral prefrontal cortex across 29 daily sessions at 2 mA (20 min/session) in order to address dysexecutive behaviors. Results demonstrated improved delayed memory and trends for improved visuospatial and semantic fluency performance as well as improved insight and daily functioning, all of which returned to baseline by the end of a 10 week no-contact follow up period. Resting state fMRI connectivity results mirrored these changes by showing increased dorsal attention and cingulo-opercular but reduced ventral attention network connectivity after session 29, all of which returned to baseline at follow-up. These findings suggest HD-tDCS may benefit functioning even following serious and pervasive anoxic injury. Findings also suggest the need for continued HD-tDCS for maintenance purposes, though future work is needed to identify optimal dose-response information.
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Affiliation(s)
- Sarah Garcia
- Psychology Department, Stetson University, DeLand, FL, USA
| | - Benjamin M Hampstead
- Mental Health Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.,Research Program on Cognition and Neuromodulation Based Interventions, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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McDonell KE, Ciriegio AE, Pfalzer AC, Hale L, Shiino S, Riordan H, Moroz S, Darby RR, Compas BE, Claassen DO. Risk-Taking Behaviors in Huntington's Disease. J Huntingtons Dis 2020; 9:359-369. [PMID: 33164940 DOI: 10.3233/jhd-200431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risky behaviors are common in Huntington's disease (HD) and can lead to significant adverse consequences. However, the prevalence and scope of these symptoms have not been studied systematically, and no empirically validated measures are available to screen for them. OBJECTIVE To test a novel screening tool designed to assess risk-taking behaviors in HD. METHODS We administered the Risk Behavior Questionnaire (RBQ-HD) to HD patients and caregivers at Vanderbilt University Medical Center between 2018-2019. Patients completed the questionnaire based on self-report; caregivers provided collateral reports. Clinical and demographic information were obtained from the electronic medical record. RESULTS 60 patients and 60 caregivers completed the RBQ-HD. 80% of patients (n = 48) and 91.7% of caregivers (n = 60) reported at least one risky behavior. Adverse social behaviors, impulsive/compulsive behaviors, and reckless driving were the most common behavioral domains reported. Male patients were more likely to report risky behaviors than females (92.3% vs. 70.6%, p = 0.04). The number of risky behaviors reported by patients and caregivers was negatively correlated with patient age (r = -0.32, p = 0.01; r = -0.47, p = 0.0001, respectively). Patient and caregiver reports were highly correlated in matched pairs (n = 30; r = 0.63, p = 0.0002). CONCLUSION These findings emphasize that risky behaviors are highly prevalent in HD and can be effectively identified through the use of a novel screening measure. We hypothesize that early pathological involvement of frontostriatal and mesolimbic networks may be important factors in the development of these behaviors.
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Affiliation(s)
- Katherine E McDonell
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Abagail E Ciriegio
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Anna C Pfalzer
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Hale
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shuhei Shiino
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heather Riordan
- Department of Pediatrics, Division of Child Neurology, Vanderbilt Children's Hospital, United States
| | - Sarah Moroz
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - R Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Daniel O Claassen
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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Development and Feasibility Exploration of a Combined Compensatory and Restorative Approach to Addressing Cognitive Challenges in Early Intervention Psychosis. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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MIURA I, OVERTON ET, NAKAI N, KAWAMATA T, SATO M, TAKUMI T. Imaging the Neural Circuit Basis of Social Behavior: Insights from Mouse and Human Studies. Neurol Med Chir (Tokyo) 2020; 60:429-438. [PMID: 32863321 PMCID: PMC7490602 DOI: 10.2176/nmc.ra.2020-0088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/21/2020] [Indexed: 11/20/2022] Open
Abstract
Social behavior includes a variety of behaviors that are expressed between two or more individuals. In humans, impairment of social function (i.e., social behavior and social cognition) is seen in neurodevelopmental and neurological disorders including autism spectrum disorders (ASDs) and stroke, respectively. In basic neuroscience research, fluorescence monitoring of neural activity, such as immediate early gene (IEG)-mediated whole-brain mapping, fiber photometry, and calcium imaging using a miniaturized head-mounted microscope or a two-photon microscope, and non-fluorescence imaging such as functional magnetic resonance imaging (fMRI) are increasingly used to measure the activity of many neurons and multiple brain areas in animals during social behavior. In this review, we overview recent rodent studies that have investigated the dynamics of brain activity during social behavior at the whole-brain and local circuit levels and studies that explored the neural basis of social function in healthy, in brain-injured, and in autistic human subjects. A synthesis of such findings will advance our understanding of brain mechanisms underlying social behavior and facilitate the development of pharmaceutical and functional neurosurgical interventions for brain disorders affecting social function.
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Affiliation(s)
- Isamu MIURA
- RIKEN Center for Brain Science, Wako, Saitama, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | | | - Nobuhiro NAKAI
- RIKEN Center for Brain Science, Wako, Saitama, Japan
- Department of Physiology and Cell Biology, Kobe University School of Medicine, Kobe, Hyogo, Japan
| | - Takakazu KAWAMATA
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Masaaki SATO
- RIKEN Center for Brain Science, Wako, Saitama, Japan
- Graduate School of Science and Engineering, Saitama University, Saitama, Saitama, Japan
- Department of Neuropharmacology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Toru TAKUMI
- RIKEN Center for Brain Science, Wako, Saitama, Japan
- Department of Physiology and Cell Biology, Kobe University School of Medicine, Kobe, Hyogo, Japan
- Graduate School of Science and Engineering, Saitama University, Saitama, Saitama, Japan
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McDonald S, Wilson E, Wearne T, Darke L, Cassel A, Rosenberg H. The complex audio visual emotion assessment task (CAVEAT): development of a shorter version for clinical use. Disabil Rehabil 2020; 44:1498-1507. [PMID: 32787689 DOI: 10.1080/09638288.2020.1803425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The Complex Audio Visual Emotion Assessment Task (CAVEAT) is a measure of emotion recognition using dynamic, naturalistic videos to assess recognition of 22 different emotional states (11 positive, 11 negative). It has established construct validity and demonstrated sensitivity to emotion perception impairments in those with moderate-severe traumatic brain injury (TBI). Despite this, its lengthy administration has limited its use in clinical practice and rehabilitation. The current paper aimed to develop shortened versions of the CAVEAT and examine their psychometric properties. METHODS The CAVEAT-S A and CAVEAT-S B (22 items each) and the CAVEAT-S AB (44 items) were developed using the original data. Comparability, reliability, construct and predictive validity were examined in the original sample (Study 1: 32 people with TBI and 32 demographically matched control participants) and a replication sample (Study 2: 18 adults with TBI and 21 demographically matched controls). RESULTS All short forms produced comparable accuracy ratings to the full measure, as well as discriminating between people with or without a TBI. Shortened forms all correlated with other measures of emotion perception and social cognition and also predicted psychosocial outcomes in terms of self-reported interpersonal relationships. Internal reliability of the short forms was low relative to the longer forms, especially for the two very short measures. CONCLUSIONS The new shortened forms of the CAVEAT are promising tools that are sensitive and valid for assessing emotion perception in people with TBI for clinical purposes. Their application in other clinical disorders is yet to be examined.Implications for rehabilitationEmotion perception deficits are present in many clinical populations and an important target for rehabilitation.CAVEAT Short provides ecologically valid emotional stimuli. Such stimuli are important for assessing real world function and to set rehabilitation targets.By having parallel versions of CAVEAT, there is the opportunity to test pre and post intervention while minimising practice effects.Alternatively, one version of CAVEAT-S can be used for assessment, while the other is used for training purposes during remediation.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Wilson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Lillian Darke
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Anneli Cassel
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Hannah Rosenberg
- School of Psychology, University of New South Wales, Sydney, Australia
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Campbell MC, Myers PS, Weigand AJ, Foster ER, Cairns NJ, Jackson JJ, Lessov‐Schlaggar CN, Perlmutter JS. Parkinson disease clinical subtypes: key features & clinical milestones. Ann Clin Transl Neurol 2020; 7:1272-1283. [PMID: 32602253 PMCID: PMC7448190 DOI: 10.1002/acn3.51102] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/15/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Based on multi-domain classification of Parkinson disease (PD) subtypes, we sought to determine the key features that best differentiate subtypes and the utility of PD subtypes to predict clinical milestones. METHODS Prospective cohort of 162 PD participants with ongoing, longitudinal follow-up. Latent class analysis (LCA) delineated subtypes based on score patterns across baseline motor, cognitive, and psychiatric measures. Discriminant analyses identified key features that distinguish subtypes at baseline. Cox regression models tested PD subtype differences in longitudinal conversion to clinical milestones, including deep brain stimulation (DBS), dementia, and mortality. RESULTS LCA identified distinct subtypes: "motor only" (N = 63) characterized by primary motor deficits; "psychiatric & motor" (N = 17) characterized by prominent psychiatric symptoms and moderate motor deficits; "cognitive & motor" (N = 82) characterized by impaired cognition and moderate motor deficits. Depression, executive function, and apathy best discriminated subtypes. Since enrollment, 22 had DBS, 48 developed dementia, and 46 have died. Although there were no subtype differences in rate of DBS, dementia occurred at a higher rate in the "cognitive & motor" subtype. Surprisingly, mortality risk was similarly elevated for both "cognitive & motor" and "psychiatric & motor" subtypes compared to the "motor only" subtype (relative risk = 3.15, 2.60). INTERPRETATION Psychiatric and cognitive features, rather than motor deficits, distinguish clinical PD subtypes and predict greater risk of subsequent dementia and mortality. These results emphasize the value of multi-domain assessments to better characterize clinical variability in PD. Further, differences in dementia and mortality rates demonstrate the prognostic utility of PD subtypes.
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Affiliation(s)
- Meghan C. Campbell
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Department of RadiologyWashington University School of MedicineSt. LouisMO
| | - Peter S. Myers
- Department of NeurologyWashington University School of MedicineSt. LouisMO
| | - Alexandra J. Weigand
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMO
| | - Erin R. Foster
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMO
- Department of PsychiatryWashington University School of MedicineSt. LouisMO
| | - Nigel J. Cairns
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Joshua J. Jackson
- Department of Psychological and Brain SciencesWashington University in St. LouisSt. LouisMO
| | | | - Joel S. Perlmutter
- Department of NeurologyWashington University School of MedicineSt. LouisMO
- Department of RadiologyWashington University School of MedicineSt. LouisMO
- Program in Occupational TherapyWashington University School of MedicineSt. LouisMO
- Department of NeuroscienceWashington University School of MedicineSt. LouisMO
- Program in Physical TherapyWashington University School of MedicineSt. LouisMO
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Association of HIV serostatus and metabolic syndrome with neurobehavioral disturbances. J Neurovirol 2020; 26:888-898. [PMID: 32734380 DOI: 10.1007/s13365-020-00878-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/09/2020] [Accepted: 07/03/2020] [Indexed: 12/15/2022]
Abstract
Metabolic syndrome (MetS), a constellation of related metabolic risk factors, is a common comorbidity associated with cognitive difficulty in people living with HIV (PLWH). Neurobehavioral disturbances (e.g., behavioral manifestations of frontal-subcortical dysfunction) are also prevalent in HIV, yet the role MetS might play in HIV-associated neurobehavioral disturbances is unknown. Thus, we examined the link between MetS and neurobehavioral disturbances in PLWH. Participants included 215 adults (117 PLWH, 98 HIV-uninfected), aged 36 to 65 years, from a cohort study at the University of California San Diego. Using the Frontal Systems Behavior Scale, we captured neurobehavioral disturbances (apathy, disinhibition, and executive dysfunction). MetS was defined by the National Cholesterol Education Program's Adult Treatment Panel-III criteria. Covariates examined included demographic, neurocognitive impairment, and psychiatric characteristics. When controlling for relevant covariates, both HIV serostatus and MetS were independently associated with greater apathy and executive dysfunction. HIV, but not MetS, was associated with greater disinhibition. The present findings suggest an additive effect of HIV and MetS on specific neurobehavioral disturbances (apathy and executive dysfunction), underscoring the importance of identifying and treating both HIV and MetS to lessen central nervous system burden among PLWH.
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Lazcano-Ocampo C, Wan YM, van Wamelen DJ, Batzu L, Boura I, Titova N, Leta V, Qamar M, Martinez-Martin P, Ray Chaudhuri K. Identifying and responding to fatigue and apathy in Parkinson’s disease: a review of current practice. Expert Rev Neurother 2020; 20:477-495. [DOI: 10.1080/14737175.2020.1752669] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Claudia Lazcano-Ocampo
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Department of Neurology, Hospital Sotero Del Rio, Santiago, Chile
| | - Yi Min Wan
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Department of Psychiatry, Ng Teng Fong General Hospital, Singapore
| | - Daniel J van Wamelen
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Cognition and Behaviour; Department of Neurology; Nijmegen, Radboud University Medical Centre; Donders Institute for Brain, The Netherlands
| | - Lucia Batzu
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Iro Boura
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Nataliya Titova
- Department of Neurology, Neurosurgery and Medical Genetics, Federal State Budgetary Educational Institution of Higher Education «N.I. Pirogov Russian National Research Medical University» of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Valentina Leta
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
| | - Mubasher Qamar
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
- Queen Elizabeth the Queen Mother Hospital, East Kent Hospitals University NHS Foundation Trust, Margate, UK
| | - Pablo Martinez-Martin
- Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health. Madrid, Spain
| | - K Ray Chaudhuri
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, Denmark Hill, London, UK
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Abstract
Over the past 150 years, the frontal lobes (FLs) have been implicated in the neural mediation of both normal and abnormal moral conduct and social behavior (MCSB). Despite the remarkable advances that have permeated this period up to the present, a comprehensive account of the neural underpinnings of MCSB has stubbornly defied the best minds of psychology, psychiatry, and neurology. The goal of this chapter is to review a few practical and conceptual achievements that have proved heuristically valuable as an impetus for further advance of knowledge. In virtually all cases in which MCSB was compromised by brain damage, the injuries were located (i) in the prefrontal cortices, (ii) in their connections with the temporal poles and anterior insula, or (iii) in related subcortical structures and pathways, such as the thalamic dorsomedial nucleus or the anterior thalamic radiation. The clinicoanatomic associations among these structures originated the "frontal network systems" concept, which satisfactorily explains the occurrence of classical FL syndromes in patients with lesions outside the prefrontal cortices. Overall, clinicoanatomic observational studies and experimental evidence from patients with acquired sociopathy/psychopathy indicate that abnormalities of MCSB are the final common pathway of single or mixed impairments of subordinate psychologic and neural domains that support MCSB. Independent studies on normal volunteers concur with this view, indicating that MCSB is shaped by the dynamic interplay of subordinate psychologic domains, such as moral sensitivity and judgment, and their neural correlates.
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Pluck G, Bravo Mancero P, Ortíz Encalada PA, Urquizo Alcívar AM, Maldonado Gavilanez CE, Chacon P. Differential associations of neurobehavioral traits and cognitive ability to academic achievement in higher education. Trends Neurosci Educ 2020; 18:100124. [PMID: 32085910 DOI: 10.1016/j.tine.2019.100124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND People vary between each other on several neurobehavioral traits, which may have implications for understanding academic achievement. METHODS University-level Psychology or Engineering students were assessed for neurobehavioral traits, intelligence, and current psychological distress. Scores were compared with their grade point average (GPA) data. RESULTS Factors associated with higher GPA differed markedly between groups. For Engineers, intelligence, but not neurobehavioral traits or psychological distress, was a strong correlate of grades. For Psychologists, grades were not correlated with intelligence but they were with the neurobehavioral traits of executive dysfunction, disinhibition, apathy, and positive schizotypy. However, only the latter two were associated independently of psychological distress. Additionally, higher mixed-handedness was associated with higher GPA in the combined sample. CONCLUSIONS Neurological factors (i.e., neurobehavioral traits and intelligence), are differentially associated with university-level grades, depending on the major studied. However, mixed-handedness may prove to be a better general predictor of academic performance across disciplines.
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Affiliation(s)
- Graham Pluck
- Institute of Neurosciences, Universidad San Francisco de Quito, Diego de Robles y Vía Interoceánica, Cumbayá Quito, Ecuador.
| | - Patricia Bravo Mancero
- Facultad de Ciencias de la Educación, Humanas y Tecnologías, Universidad Nacional de Chimborazo, Ecuador.
| | | | | | | | - Paola Chacon
- Institute of Neurosciences, Universidad San Francisco de Quito, Diego de Robles y Vía Interoceánica, Cumbayá Quito, Ecuador.
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Barhwal KK, Boppana S, Vashishtha V, Mahapatra SC. Conscious Abstinence from Smokeless Tobacco Evokes Higher Withdrawal Response and Impairs Cognitive Performance Independent of Sympathetic Response. Ann Neurosci 2020; 27:29-39. [PMID: 32982097 PMCID: PMC7499824 DOI: 10.1177/0972753120927515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION High consumption of smokeless tobacco in adult Indian population increases the risk of developing oral cancers leading to high morbidity and mortality. Though the influence of abstinence from smoking on cognitive performance has been widely studied, the effect of smokeless tobacco on cognitive performance and its association with withdrawal symptoms is less understood. This study comparatively investigates the effect of short-term conscious abstinence and distraction during abstinence from smokeless tobacco consumption on the craving, withdrawal symptoms, sympathetic response, and cognitive performance in tobacco addicts. METHODS Age, sex, education and socioeconomic status matched control (N = 15) and smokeless tobacco addicts (N = 60) were recruited from residential areas in Bhubaneswar for the study. Following randomization of the addicts, conscious abstinence (N = 30) was induced by informed abstinence from tobacco consumption for 8 hours, while distracted cessation (N = 30) was induced by involving the participants in a cognitively engaging task for 8 hours during uninformed tobacco abstinence. RESULTS The results of the study show higher withdrawal symptoms and reduced cognitive performance in volunteers with conscious abstinence which was positively correlated. The decreased cognitive performance in conscious cessation was independent of tobacco-induced increase in the LF:HF ratio and cotinine concentration in saliva. CONCLUSION While conscious abstinence results in higher withdrawal symptoms, distraction during abstinence lowers these symptoms. Inclusion of distraction sessions during cessation can, therefore, be a new element in tobacco control strategies.
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Affiliation(s)
- Kalpana Kumari Barhwal
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Sujwal Boppana
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | | | - Sushil Chandra Mahapatra
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Branco LMT, Zanao TA, de Rezende TJR, Paraguay IBB, Leoni TB, Balthazar MLF, FranÇa MC. Behavioral manifestations in a Brazilian non-demented C9orf72-negative ALS population. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:100-106. [PMID: 31873036 DOI: 10.1080/21678421.2019.1704014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cognitive decline and behavioral changes are common features in amyotrophic lateral sclerosis (ALS) and imply worse prognosis as well as increased disease burden for patients and caregivers. Currently, there is a lack of studies regarding behavioral profile in Brazilian ALS cohorts. We assessed the prevalence and profile of behavioral impairment (ALSbi) in a Brazilian non-demented C9orf72-negative ALS cohort according to broad behavioral assessment and the latest consensus. Among 76 initially recruited consecutive ALS patients, 70 were included, including seven ALS type 8 (VAPB-related ALS) individuals. Patients with Frontotemporal Dementia (FTD) diagnosis were excluded. Sixteen ALS patients (23%) were diagnosed as ALSbi. Among ALS type 8 individuals, 2 (28.6%) were diagnosed as ALSbi. Neuropsychiatric Inventory Questionnaire (NPI) total scores did positively correlate with age, but not with other demographic or clinical data. Apathy was the most prevalent finding in the ALSbi subgroup, although the prevalence (20%) was smaller than reported in previous literature. Dysphoria and anxiety were also prevalent findings in the whole ALS cohort. Future studies with larger cohorts and validated ALS-specific tools are needed in order to expand our knowledge.
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Affiliation(s)
- Lucas M T Branco
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
| | - Tamires A Zanao
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
| | - Thiago J R de Rezende
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
| | - Isabela B B Paraguay
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
| | - Tauana B Leoni
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
| | - Marcio Luiz F Balthazar
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
| | - Marcondes C FranÇa
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas - UNICAMP, Campinas, Brazil
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Chapman KR, Spitznagel MB. Measurement of sexual disinhibition in dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1747-1757. [PMID: 31489715 DOI: 10.1002/gps.5208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/31/2019] [Indexed: 11/07/2022]
Abstract
Sexual disinhibition in dementia is correlated with multiple negative care recipient and caregiver outcomes but remains largely overlooked in the literature. Its prevalence is not well understood, with studies reporting between 1.8% and 25% presence of sexual disinhibition in dementia samples. One reason for the variability in the reported presence of sexual disinhibition may be lack of standardized methods for assessment. Several widely used measures for neuropsychiatric symptoms do not include items to assess sexual disinhibition. When measures do include sexual disinhibition, it is not addressed in a consistent manner. Inconsistency in how questions about sexual disinhibition are phrased is problematic, given that recent work shows it can differentially influence endorsement. Working toward a gold standard of sexual disinhibition measurement in dementia is needed. To this end, a systematic review of the literature to identify potentially appropriate instruments for measurement of sexual disinhibition in this population was conducted through the Web of Science and PubMed databases between January 2019 and February 2019. An overview of the 20 measures identified in this search is provided. Each measure is evaluated for appropriateness of use in dementia samples through broad examination of psychometric properties, structure, and format and the extent to which measure content overlaps with current conceptualizations of sexual disinhibition in dementia. Five common content domains were identified: hypersexuality, lewd/aberrant sexual behavior, inappropriate sexual advances, inappropriate sexual comments, and socially disruptive sexual behavior. No single measure addressed all content domains. Directions for future research are identified and discussed.
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Affiliation(s)
- Kimberly R Chapman
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
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Adams AG, Henry JD, Molenberghs P, Robinson GA, Nott Z, von Hippel W. The relationship between social cognitive difficulties in the acute stages of stroke and later functional outcomes. Soc Neurosci 2019; 15:158-169. [PMID: 31526327 DOI: 10.1080/17470919.2019.1668845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although social cognitive difficulties are common following stroke, the extent to which such difficulties observed in the acute phase are related to long-term socioemotional outcomes remains poorly understood. To address this question empirically, 53 stroke patients completed a measure of Theory of Mind (The Reading the Mind in the Eyes Test) and a cognitive flexibility measure that has been related to social cognitive processes (a Reversal Learning Task) at hospital bedside. These participants then completed measures of socioemotional functioning at a 6-month follow-up. Baseline difficulties on the two measures were found to predict distinct types of socioemotional difficulties. The RMET uniquely predicted self-reported depression and loneliness whereas the Reversal Learning task uniquely predicted peer-reported social behavior, specifically social inappropriateness and stereotyping and prejudice. Importantly, a measure of general cognitive function did not explain variance in these outcome measures, suggesting that social cognitive difficulties are linked to poor socioemotional outcomes. By showing for the first time that social cognitive deficits observed acutely post-stroke are related to longer term functional outcomes, these findings reinforce the importance of including brief social cognitive measures as part of routine post-stroke clinical assessment.
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Affiliation(s)
| | - Julie D Henry
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Pascal Molenberghs
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Gail A Robinson
- School of Psychology, University of Queensland, Brisbane, Australia.,Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Zoie Nott
- School of Psychology, University of Queensland, Brisbane, Australia
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Adams AG, Schweitzer D, Molenberghs P, Henry JD. A meta-analytic review of social cognitive function following stroke. Neurosci Biobehav Rev 2019; 102:400-416. [DOI: 10.1016/j.neubiorev.2019.03.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/14/2019] [Accepted: 03/14/2019] [Indexed: 01/20/2023]
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Lateral parietal cortex in the generation of behavior: Implications for apathy. Prog Neurobiol 2019; 175:20-34. [DOI: 10.1016/j.pneurobio.2018.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 11/20/2018] [Accepted: 12/23/2018] [Indexed: 11/21/2022]
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