The involvement of rTPJ in intention attribution during social decision making: A TMS study

The mini-Ultimatum Game (mini-UG) is a bargaining game used to assess the reactions of a responder to unfair offers made by a proposer under different intentionality conditions. Previous studies employing this task showed the activation of responders' right temporoparietal junction (rTPJ), which could be related to its involvement in judgments of intentionality. To verify this hypothesis, in the present study we applied online transcranial magnetic stimulation (TMS) over the rTPJ in responders during the mini-UG, in which we manipulated intention attribution implicitly. A cover story was employed to induce participants to believe they were interacting with another agent. We expected that interfering with the rTPJ could affect the ability of responders to assume proposers' perspective, producing higher rates of rejections of unfair offers when offers are perceived as independent from responders' intentionality to inequality. Twenty-six healthy women voluntarily participated in the study. In the mini-UG, an unfair distribution of the proposer (8/2 offer) was pitted against one of three alternative offers: fair-alternative (5/5), no-alternative (8/2), hyperfair-alternative (2/8). During the task, a train of TMS pulses was delivered at proposers' offer presentation in blocks of active (rTPJ) or control (Vertex) stimulation according to an ABAB design. As expected, findings showed that rejection of the no-alternative offers was higher under TMS stimulation of the rTPJ compared with the control TMS. This effect was modulated by the degree of trustworthiness in the cover story. These data contribute defining the mechanisms and brain areas underpinning social decision making as assessed by bargaining tasks.

Long-term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta-analytic study

BACKGROUND AND PURPOSE

The prognosis of prolonged (28 days to 3 months post-onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long-term outcome of post-anoxic pDoC and identify the possible predictive value of demographic and clinical information.

METHOD

This is a systematic review and meta-analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross-sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non-survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered.

RESULTS

Twenty-seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness.

CONCLUSIONS

Patients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision-making on patient management.

Spontaneous eye blinking during an auditory, an interoceptive and a visual task: The role of the sensory modality and the attentional focus

Previous evidence suggested that spontaneous eye blinking changes as a function of the attentional focus. In particular, eye blink rate (EBR) tends to increase when attention is directed to internal versus environmental processing. Most studies on this issue compared eye blinking during visual and mental imagery tasks, and interpreted the increase in EBR as a mechanism to focus cognitive resources on internal processing by disengaging attention from interfering information. However, since eye blinking also depends on the sensory modality of the task, the findings might be influenced by a modality-specific effect. In the present Registered Report we aim at investigating whether the environmental versus internal attentional focus can affect spontaneous blinking behaviour in non-visual tasks as well, in conditions where visual stimuli are not relevant. In a within-subject design, healthy participants performed an interoceptive task (i.e., heartbeat counting) and an auditory task in which pre-recorded heartbeats were presented aurally; during both tasks irrelevant visual stimuli were also presented. In a further control condition with the same auditory and visual stimuli, the participants were required to focus their attention on visual stimuli. Participants' EBR was recorded during each task by means of an eye-tracking system. We found that, although the interoceptive task was more difficult than the auditory and visual tasks, participants' EBR decreased by a comparable level in all tasks with respect to a rest condition, with no differences between internal versus environmental conditions. The present findings do not support the idea that EBR is modulated by an internal versus external focus of attention, at least in presence of controlled visual stimulation.

Memory biases in Alzheimer's disease and mild cognitive impairment. A systematic review and metanalysis

Several studies demonstrated that individuals are more likely to remember emotional than neutral information; this phenomenon is known as emotional enhancement of memory (EEM). Adults generally tend to remember negative information more efficiently than neutral or positive items. In contrast, healthy elders seem to show an opposite bias for positive information, but results are inconsistent, also because during aging, elaboration of emotional information could change as a consequence of cognitive impairment. In this systematic review and meta-analysis, we conducted literature search of studies investigating emotion memory biases in mild cognitive impairment (MCI) and Alzheimer's disease (AD) on PubMed, Scopus and PsycINFO databases following PRISMA guidelines. The findings showed that emotional memory biases are still present despite the presence of cognitive impairment, both in MCI and at least in early stages of AD. However, the direction of emotion memory biases is not consistent across studies. These results suggest that patients with cognitive impairment might still benefit from EEM and help to define targets of intervention for cognitive rehabilitation in pathological aging.

Cognitive reserve and coping strategies predict the level of perceived stress during COVID-19 pandemic: A cross-sectional study

The COVID-19 pandemic and the measures to avert contagion heavily impacted individuals' mental health. In the present cross-sectional study, we investigate the relationship between cognitive reserve, coping modalities and the perceived stress during a chronic stage of COVID-19 pandemic by online administration of three standardized questionnaires in a sample of healthy volunteers covering a large lifespan (18–85 years). We found that positive orientation to problems and higher levels of cognitive reserve were associated with lower levels of stress. Conversely, coping strategies involving negation, substance consumption, and appeal to other people and religion to face everyday life, together with higher education, were associated with higher levels of stress. These results shade light on the long-term psychological consequences of COVID-19 and call for the development of psychological interventions improving coping and cognitive reserve, to preserve and restore mental health following the pandemic.

Brain hemodynamic response in Examiner-Examinee dyads during spatial short-term memory task: an fNIRS study

The Corsi Block-Tapping test (CBT) is a measure of spatial working memory (WM) in clinical practice, requiring an examinee to reproduce sequences of cubes tapped by an examiner. CBT implies complementary behaviors in the examiners and the examinees, as they have to attend a precise turn taking. Previous studies demonstrated that the Prefrontal Cortex (PFC) is activated during CBT, but scarce evidence is available on the neural correlates of CBT in the real setting. We assessed PFC activity in dyads of examiner–examinee participants while completing the real version of CBT, during conditions of increasing and exceeding workload. This procedure allowed to investigate whether brain activity in the dyads is coordinated. Results in the examinees showed that PFC activity was higher when the workload approached or reached participants’ spatial WM span, and lower during workload conditions that were largely below or above their span. Interestingly, findings in the examiners paralleled the ones in the examinees, as examiners’ brain activity increased and decreased in a similar way as the examinees’ one. In the examiners, higher left-hemisphere activity was observed suggesting the likely activation of non-spatial WM processes. Data support a bell-shaped relationship between cognitive load and brain activity, and provide original insights on the cognitive processes activated in the examiner during CBT.

The role of the right premotor cortex and temporo-parietal junction in defensive responses to visual threats

Previous neuroimaging studies demonstrated that several brain areas are involved in detecting threats and activating defensive responses to threatening stimuli. The right premotor cortex (PM) is mainly activated during freezing, whereas the right temporoparietal junction (TPJ) is involved in attentional orienting towards threat. The aim of the present study was to test the possibility to modulate attentional orienting and defensive responses to threatening stimuli by interfering with the activity of the right TPJ and PM with cathodal. The results demonstrated that after sham stimulation the participants were slower to respond to threatening than to non-threatening stimuli, consistent with the idea that the experimental paradigm induced a freeze-like response to threatening stimuli. Active tDCS over PM reversed this response pattern, whereas TPJ stimulation wiped out the difference between responses to threatening and non-threatening stimuli. Our findings demonstrated that inhibitory stimulation of PM favours active defensive responses to threatening stimuli whereas TPJ inhibitory stimulation reduces attentional prioritizing of threatening stimuli. In conclusion, our study showed that it is possible to modulate responses to threatening stimuli by interfering with activity of at least two cortical regions of the brain network involved in dealing with threats.

Non-invasive brain stimulation in generalized anxiety disorder: A systematic review

In the last years, several studies using non-invasive brain stimulation (NIBS) techniques demonstrated that the dorsolateral prefrontal cortex (DLPFC) plays a key role in the neurobiological bases of anxiety disorders. Both transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) applied primarily over the prefrontal cortex have been shown to modulate anxiety symptomatology and attention allocation in the generalized anxiety disorder. A literature search on PubMed and PsycINFO databases following PRISMA guidelines identified 4 TMS studies (one open-label study and three randomized trials with active/sham conditions) and one tDCS case report study that have applied NIBS in patients with GAD. All the studies targeted the DLPFC except one in which the parietal cortex has been stimulated. Overall, the findings would suggest that NIBS could ameliorate anxiety symptoms and that improvements remained stable in the follow-up. Although a limited number of NIBS studies has been conducted on patients with anxiety disorders, these techniques could represent promising tools for the study of neurofunctional basis of anxiety disorders. Further sham-controlled studies are needed to clarify the mechanisms of action of NIBS in order to optimize stimulation protocols and to verify their effectiveness for treating anxiety symptoms.

The role of the dorsolateral prefrontal cortex in early threat processing: a TMS study

Previous studies demonstrated that excitatory (high frequency) offline transcranial magnetic stimulation (TMS) over the left and right dorsolateral prefrontal cortex (DLPFC) modulates attention allocation on threatening stimuli in non-clinical samples. These studies only employed offline TMS protocol that did not allow investigating the effect of the stimulation on the early stage of threat processing. In this study, the role of the right and left dorsolateral prefrontal cortex in early threat processing was investigated in high and low anxious individuals by means of an inhibitory single-pulse online TMS protocol. Our results demonstrated the role of the left DLPFC in an early stage of threat processing and that this effect is modulated by individuals' anxiety level. The inhibitory stimulation of the left DLPFC determined a disengagement bias in high anxious individuals, while the same stimulation determined an attentional avoidance in low anxious individuals. The findings of the present study suggest that right and left DLPFC are differently involved in early threat processing of healthy individuals.

Dysfunctional Freezing Responses to Approaching Stimuli in Persons with a Looming Cognitive Style for Physical Threats

Immobilizing freezing responses are associated with anxiety and may be etiologically related to several anxiety disorders. Although recent studies have sought to investigate the underlying mechanisms in freezing responses that are so problematic in many forms of anxiety, cognitive factors related to anxiety have not been investigated. This study was designed to investigate the potential moderating role of a well-documented cognitive vulnerability to anxiety, the Looming Cognitive Style (i.e., LCS; Riskind et al., 2000), which assesses the extent to which individuals tend to routinely interpret ambiguous threats (e.g., physical or social threats) in a biased manner as approaching. We assessed participants' Reaction Times (RTs) when they made judgments about images of animals that differed in threat valence (threat or neutral) and motion direction (approach or recede). As expected, LCS for concerns about the approach of physical dangers appeared to moderate freeze reactions. Individuals who were high on this LCS factor tended to generally exhibit a freeze-response (slower RTs) and this was independent of the threat valence or motion direction of the animals. These general freezing reactions were in stark contrast to those of individuals who were low on the LCS factor for concerns about the approach of physical dangers. These participants tended to exhibit more selective and functional freezing responses that occurred only to threatening animals with approach motion; they did not exhibit freezing to neutral stimuli or any stimuli with receding motion. These findings did not appear to be explicable by a general slowing of RTs for the participants with high LCS. Moreover, the LCS factor for concerns about social threats (such as rejection or embarrassment) was not related to differences in freezing; there was also no additional relationship of freezing to behavioral inhibition scores on the Behavioral Inhibition System and the Behavioral Activation System Scales (BIS/BAS). It may prove fruitful to further explore cognitive factors related to anxiety to develop a more comprehensive understanding of how these factors are associated with anxiety-related freezing responses.

Eye movements reveal mechanisms underlying attentional biases towards threat

Mechanisms underlying attentional biases towards threat (ABTs), such as attentional avoidance and difficulty of disengagement, are still unclear. To address this issue, we recorded participants' eye movements during a dot detection task in which threatening or neutral stimuli served as peripheral cues. We evaluated response times (RTs) in trials where participants looked at the central fixation cross (not at the cues), as they were required, and number and duration of (unwanted) fixations towards threatening or neutral cues; in all analyses trait anxiety was treated as a covariate. Difficulty in attentional disengagement (longer RTs) was found when peripheral threatening stimuli were presented for 100 ms. Moreover, we observed significantly shorter (unwanted) fixations on threatening than on neutral peripheral stimuli, compatible with an avoidance bias, for longer presentation times. These findings demonstrate that, independent of trait anxiety levels, disengagement bias occurs without eye movements, whereas eye movements are implied in threat avoidance.

Attentional biases toward threat: the concomitant presence of difficulty of disengagement and attentional avoidance in low trait anxious individuals

Attentional biases toward threats (ABTs) have been described in high anxious individuals and in clinical samples whereas they have been rarely reported in non-clinical samples (Bar-Haim et al., 2007; Cisler and Koster, 2010). Three kinds of ABTs have been identified (facilitation, difficulty of disengagement, and avoidance) but their mechanisms and time courses are still unclear. This study aimed to understand ABTs mechanisms and timing in low trait anxiety (LTA) and high trait anxiety (HTA) anxious individuals. In particular, in an exogenous cueing task we used threatening or neutral stimuli as peripheral cues with three presentation times (100, 200, or 500 ms). The main results showed that HTA individuals have an attentional facilitation bias at 100 ms (likely automatic in nature) whereas LTA individuals show attentional avoidance and difficulty to disengage from threatening stimuli at 200 ms (likely related to a strategic processing). Such findings demonstrate that threat biases attention with specific mechanisms and time courses, and that anxiety levels modulate attention allocation.

Inducing closing-in phenomenon in healthy young adults: the effect of dual task and stimulus complexity on drawing performance

Closing-in (CI) is the tendency to act very close to the model in tasks such as drawing, 3D construction, gesture imitation, or writing. Closing-in is observed in degenerative and focal brain diseases, but also in normally developing children. In the present paper, three experiments were conducted to evaluate whether CI can be triggered during a copying task in normal young adults by increasing stimulus complexity and attentional load. Participants were required to copy complex lines in one of three conditions: without interfering activities (baseline), during counting, or during execution of a 2-back short-term memory task. In Experiment 1, participants were required to reproduce horizontally aligned stimuli, starting from a dot placed below each stimulus and proceeding from left to right; in Experiment 2, stimuli were again horizontally aligned, but the starting dot was placed above each stimulus, and writing proceeded from right to left; in Experiment 3, stimuli were aligned vertically and copying proceeded in upward direction. Results from all experiments showed that when normal young adults are engaged in an attentional-demanding concurrent activity, they tend to approach to the model, whereas the effect of stimulus complexity disappeared with unusual writing direction (Experiments 2 and 3). These findings demonstrate that even in normal young adults, a reduction in available attentional resources can release an attraction toward the model.