Behavioral and Socio-Emotional Disorders in Intellectual Giftedness: A Systematic Review

This work systematically reviewed past literature to investigate the association between intellectual giftedness and socio-emotional and/or behavioral disorders. Nineteen studies met the inclusion criteria, 17 of which have children and/or adolescents as participants, and 12 have a non-gifted control group. Socio-emotional problems, such as withdrawal, were found in 3 out of 8 studies; internalizing disorders, such as anxiety, were found in 5 out of 9; externalizing disorders, such as hyperactivity, were found in 3 out of 5. The most investigated comorbidity was attention-deficit/hyperactivity disorder. A univocal conclusion on the relationship between intellectual giftedness and socio-emotional/behavioral problems cannot be drawn, principally because of the heterogeneity of participants' age, informants, and instruments. The review highlights the need for future studies to use multi-informant and comprehensive assessments, to reach more robust findings, and suggests that age and discrepancy between verbal and non-verbal intellectual abilities should be considered critical factors.

Gender oncology: recommendations and consensus of the Italian Association of Medical Oncology (AIOM)

BACKGROUND

Following the development of gender medicine in the past 20 years, more recently in the field of oncology an increasing amount of evidence suggests gender differences in the epidemiology of cancers, as well as in the response and toxicity associated with therapies. In a gender approach, critical issues related to sexual and gender minority (SGM) populations must also be considered.

MATERIALS AND METHODS

A working group of opinion leaders approved by the Italian Association of Medical Oncology (AIOM) has been set up with the aim of drafting a shared document on gender oncology. Through the 'consensus conference' method of the RAND/University of California Los Angeles (UCLA) variant, the members of the group evaluated statements partly from the scientific literature and partly produced by the experts themselves [good practice points (GPPs)], on the following topics: (i) Healthcare organisation, (ii) Therapy, (iii) Host factors, (iv) Cancer biology, and (v) Communication and social interventions. Finally, in support of each specific topic, they considered it appropriate to present some successful case studies.

RESULTS

A total of 42 articles met the inclusion criteria, from which 50 recommendations were extracted. Panel participants were given the opportunity to propose additional evidence from studies not included in the research results, from which 32 statements were extracted, and to make recommendations not derived from literature such as GPPs, four of which have been developed. After an evaluation of relevance by the panel, it was found that 81 recommendations scored >7, while 3 scored between 4 and 6.9, and 2 scored below 4.

CONCLUSIONS

This consensus and the document compiled thereafter represent an attempt to evaluate the available scientific evidence on the theme of gender oncology and to suggest standard criteria both for scientific research and for the care of patients in clinical practice that should take gender into account.

A meta-analysis of non-invasive brain stimulation (NIBS) effects on cerebellar-associated cognitive processes

Non-invasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES), have provided valuable insights into the role of the cerebellum in cognitive processes. However, replicating findings from studies involving cerebellar stimulation poses challenges. This meta-analysis investigates the impact of NIBS on cognitive processes associated with the cerebellum. We conducted a systematic search and analyzed 66 studies and 91 experiments involving healthy adults who underwent either TMS or transcranial direct current stimulation (tDCS) targeting the cerebellum. The results indicate that anodal tDCS applied to the medial cerebellum enhances cognitive performance. In contrast, high-frequency TMS disrupts cognitive performance when targeting the lateral cerebellar hemispheres or when employed in online protocols. Similarly, low-frequency TMS and continuous theta burst stimulation (cTBS) diminish performance in offline protocols. Moreover, high-frequency TMS impairs accuracy. By identifying consistent effects and moderators of modulation, this meta-analysis contributes to improving the replicability of studies using NIBS on the cerebellum and provides guidance for future research aimed at developing effective NIBS interventions targeting the cerebellum.

Long-term Memory of Sensory Experiences from the First Pregnancy, its Peri-partum and Post-partum in Women with Autism Spectrum Disorders without Intellectual Disabilities: A Retrospective Study

PURPOSE

To explore the recalled experience of pregnancy and motherhood in women diagnosed with Autism Spectrum Disorders (ASD) without intellectual disabilities, focusing on sensory perceptions and mood.

METHODS

We retrospectively evaluated, through an ad-hoc structured interview, the sensory sensitivity during the pre-partum, the peri-partum, and the post-partum of thirty-three mothers with ASD and thirty-two neurotypical mothers. Participants also underwent a psychometric assessment about autistic traits, general sensory sensitivity, and post-partum depressive symptomatology.

RESULTS

Mothers with ASD recalled a higher sensitivity than the comparison group across the three time-points; however, during the peri-partum their recalled hypersensitivity decreases, and in the post-partum it returned as high as before childbirth. The difference in the length of recall between groups did not statistically influence our results. Higher levels of autistic traits correlated with higher depressive post-partum symptomatology.

CONCLUSIONS

Mothers with ASD seem to recall their experience of pregnancy, childbirth, and post-partum period differently from neurotypical mothers, particularly in terms of hypersensitivity. The correlation with depressive symptoms and the potential role of oxytocin and of long-term memory (encoding and recollection) are discussed. Further exploring these aspects might give fundamental hints to provide tailored support to mothers with ASD during pregnancy and motherhood.

Impact of physical activity on response to stress in people aged 65 and over during COVID-19 pandemic lockdown

BACKGROUND

The outbreak of the COVID-19 pandemic has negatively affected the lives of many people. In particular, restrictions of physical activity (PA) due to pandemic-related lockdown have impacted their psychological status. The aim of this work was to investigate the relationship between PA habits, before the pandemic and during the lockdown, and responses to stress due to home isolation during the lockdown, in older people.

METHODS

To this aim, an online survey addressed to people aged 65 years and over was conducted during the first pandemic wave in Italy (Study 1). To explore the effect of PA restrictions on responses to stress over time, the survey was replicated during the second wave (Study 2). A group of 72 and 43 participants, from 65 to 88 years, completed the two studies, respectively. The survey required the completion of the International Physical Activity Questionnaire, and of two questionnaires on stress response, namely, the Impact of Event Scale-Revised and the Perceived Stress Scale. The correlation between the questionnaires' scores was examined.

RESULTS

Study 1 demonstrated that higher levels of PA during the lockdown, related to working and walking activities, were associated with fewer stress-related symptoms and lower stress perception. In parallel, greater reduction of PA, during lockdown compared to the pre-pandemic period, was associated with more stress-related symptoms. People who spent more time at rest (sitting) before and during the pandemic lockdown were those who showed higher psychological impact. Study 2 confirmed the benefits of maintaining working activities during lockdown, but also showed that during the second pandemic wave people were more resilient to PA restrictions and home isolation, even if conducting a sedentary lifestyle.

CONCLUSIONS

Maintaining good levels of PA during lockdown was a protective factor against developing stress-related symptoms in older people. On the other hand, more resilient response to stress emerged in this population during the second wave.

Impaired cognitive control in patients with brain tumors

Though the assessment of cognitive functions is proven to be a reliable prognostic indicator in patients with brain tumors, some of these functions, such as cognitive control, are still rarely investigated. The objective of this study was to examine proactive and reactive control functions in patients with focal brain tumors and to identify lesioned brain areas more at "risk" for developing impairment of these functions. To this end, a group of twenty-two patients, candidate to surgery, were tested with an AX-CPT task and a Stroop task, along with a clinical neuropsychological assessment, and their performance was compared to that of a well-matched healthy control group. Although overall accuracy and response times were similar for patients and control groups, the patient group failed more on the BX trials of the AX-CPT task and the incongruent trials of the Stroop task, specifically. Behavioral results were associated with the damaged brain areas, mostly distributed in right frontal regions, by means of a lesion-symptom mapping multivariate approach. This analysis showed that a white matter cluster in the right prefrontal area was associated with lower d'-context values on the AX-CPT, which reflect the fact that these patients rely more on later information (reactive processes) to respond to unexpected and conflicting stimuli, than on earlier contextual cues (proactive processes). Taken together, these results suggest that patients with brain tumors present an unbalance between proactive and reactive control strategies in more interfering conditions, in association with right prefrontal white matter lesions.

Impact of Perceived Stress and Immune Status on Decision-Making Abilities during COVID-19 Pandemic Lockdown

The ability to make risky decisions in stressful contexts has been largely investigated in experimental settings. We examined this ability during the first months of COVID-19 pandemic, when in Italy people were exposed to a prolonged stress condition, mainly caused by a rigid lockdown. Participants among the general population completed two cognitive tasks, an Iowa Gambling Task (IGT), which measures individual risk/reward decision-making tendencies, and a Go/No-Go task (GNG), to test impulsivity, together with two questionnaires, the Perceived Stress Scale and the Depression, Anxiety and Stress Scales. The Immune Status Questionnaire was additionally administered to explore the impact of the individual health status on decision making. The effect of the questionnaires scores on task performance was examined. The results showed that higher levels of perceived stress and a more self-reported vulnerable immune status were associated, separately, with less risky/more advantageous choices in the IGT in young male participants but with more risky/less advantageous choices in older male participants. These effects were not found in female participants. Impulsivity errors in the GNG were associated with more anxiety symptoms. These findings bring attention to the necessity of taking into account decision-making processes during stressful conditions, especially in the older and more physically vulnerable male population.

Transcranial Magnetic Stimulation Trains at 1 Hz Frequency of the Right Posterior Parietal Cortex Facilitate Recognition Memory

Neuroimaging, neuropsychological, and brain stimulation studies have led to contrasting findings regarding the potential roles of the lateral parietal lobe in episodic memory. Studies using brain stimulation methods reported in the literature do not offer unequivocal findings on the interactions with stimulation location (left vs. right hemisphere) or timing of the stimulation (encoding vs. retrieval). To address these issues, active and sham 1 Hz repetitive transcranial magnetic stimulation (rTMS) trains of 600 stimuli were applied over the right or left posterior parietal cortex (PPC) before the encoding or before the retrieval phase of a recognition memory task of unknown faces in a group of 40 healthy subjects. Active rTMS over the right but not the left PPC significantly improved non-verbal recognition memory performance without any significant modulation of speed of response when applied before the retrieval phase. In contrast, rTMS over the right or the left PPC before the encoding phase did not modulate memory performance. Our results support the hypothesis that the PPC plays a role in episodic memory retrieval that appears to be dependent on both the hemispheric lateralization and the timing of the stimulation (encoding vs. retrieval).

Efficacy of a Training on Executive Functions in Potentiating Rehabilitation Effects in Stroke Patients

Cognitive impairment after a stroke has a direct impact on patients' disability. In particular, impairment of Executive Functions (EFs) interferes with re-adaptation to daily life. The aim of this study was to explore whether adding a computer-based training on EFs to an ordinary rehabilitation program, regardless of the specific brain damage and clinical impairment (motor, language, or cognitive), could improve rehabilitation outcomes in patients with stroke. An EF training was designed to have minimal motor and expressive language demands and to be applied to a wide range of clinical conditions. A total of 37 stroke patients were randomly assigned to two groups: a training group, which performed the EF training in addition to the ordinary rehabilitation program (treatment as usual), and a control group, which performed the ordinary rehabilitation exclusively. Both groups were assessed before and after the rehabilitation program on neuropsychological tests covering multiple cognitive domains, and on functional scales (Barthel index, Functional Independence Measure). The results showed that only patients who received the training improved their scores on the Attentional Matrices and Phonemic Fluency tests after the rehabilitation program. Moreover, they showed a greater functional improvement in the Barthel scale as well. These results suggest that combining an EF training with an ordinary rehabilitation program potentiates beneficial effects of the latter, especially in promoting independence in activities of daily living.

Functional Role of Cerebellar Gamma Frequency in Motor Sequences Learning: a tACS Study

Although the role of the cerebellum in motor sequences learning is widely established, the specific function of its gamma oscillatory activity still remains unclear. In the present study, gamma (50 Hz)-or delta (1 Hz)-transcranial alternating current stimulation (tACS) was applied to the right cerebellar cortex while participants performed an implicit serial reaction time task (SRTT) with their right hand. The task required the execution of motor sequences simultaneously with the presentation of a series of visual stimuli. The same sequence was repeated across multiple task blocks (from blocks 2 to 5 and from blocks 7 to 8), whereas in other blocks, new/pseudorandom sequences were reproduced (blocks 1 and 6). Task performance was examined before and during tACS. To test possible after-effects of cerebellar tACS on the contralateral primary motor cortex (M1), corticospinal excitability was assessed by examining the amplitude of motor potentials (MEP) evoked by single-pulse transcranial magnetic stimulation (TMS). Compared with delta stimulation, gamma-tACS applied during the SRTT impaired participants' performance in blocks where the same motor sequence was repeated but not in blocks where the new pseudorandom sequences were presented. Noteworthy, the later assessed corticospinal excitability was not affected. These results suggest that cerebellar gamma oscillations mediate the implicit acquisition of motor sequences but do not affect task execution itself. Overall, this study provides evidence of a specific role of cerebellar gamma oscillatory activity in implicit motor learning.

Bacteriotherapy in children with recurrent upper respiratory tract infections

OBJECTIVE

Children with recurrent upper-airway infections (UI) represent a social issue for their economic burden and negative impact on families. Bacteriotherapy is a new therapeutic strategy that could potentially prevent infections. The current study tested the hypothesis that recurrent UI may be prevented by bacteriotherapy.

PATIENTS AND METHODS

This open study was conducted in an outpatient clinic, enrolling 80 children (40 males, mean age 5.26±2.52 years) suffering from recurrent UI. Children were treated with a nasal spray containing Streptococcus salivarius 24SMB and Streptococcus oralis 89a, 2 puffs per nostril twice a day for a week; this course was repeated for 3 months. The evaluated parameters were: number of UI and number of school and work absences; these outcomes were compared with those recorded in the past year.

RESULTS

The mean number of UI significantly diminished: from 5.98 (2.30) in the past year to 2.75 (2.43) after treatment (p<0.0001). The number of school and work absences significantly diminished (from 4.50±2.81 to 2.80±3.42 and from 2.33±2.36 to 1.48±2.16 respectively; p<0.0001 for both).

CONCLUSIONS

This preliminary experiment suggests that bacteriotherapy using Streptococcus salivarius 24SMB and Streptococcus oralis89a nasal spray could prevent recurrent UI in children.

Reward motivation and neurostimulation interact to improve working memory performance in healthy older adults: A simultaneous tDCS-fNIRS study

Several studies have evaluated the effect of anodal transcranial direct current stimulation (tDCS) over the prefrontal cortex (PFC) for the enhancement of working memory (WM) performance in healthy older adults. However, the mixed results obtained so far suggest the need for concurrent brain imaging, in order to more directly examine tDCS effects. The present study adopted a continuous multimodal approach utilizing functional near-infrared spectroscopy (fNIRS) to examine the interactive effects of tDCS combined with manipulations of reward motivation. Twenty-one older adults (mean age = 69.7 years; SD = 5.05) performed an experimental visuo-spatial WM task before, during and after the delivery of 1.5 mA anodal tDCS/sham over the left prefrontal cortex (PFC). During stimulation, participants received performance-contingent reward for every fast and correct response during the WM task. In both sessions, hemodynamic activity of the bilateral frontal, motor and parietal areas was recorded across the entire duration of the WM task. Cognitive functions and reward sensitivity were also assessed with standard measures. Results demonstrated a significant impact of tDCS on both WM performance and hemodynamic activity. Specifically, faster responses in the WM task were observed both during and after anodal tDCS, while no differences were found under sham control conditions. However, these effects emerged only when taking into account individual visuo-spatial WM capacity. Additionally, during and after the anodal tDCS, increased hemodynamic activity relative to sham was observed in the bilateral PFC, while no effects of tDCS were detected in the motor and parietal areas. These results provide the first evidence of tDCS-dependent functional changes in PFC activity in healthy older adults during the execution of a WM task. Moreover, they highlight the utility of combining reward motivation with prefrontal anodal tDCS, as a potential strategy to improve WM efficiency in low performing healthy older adults.

Subclinical executive function impairment in children with asymptomatic, treated phenylketonuria: A comparison with children with immunodeficiency virus

In this study we compared the neuropsychological profile of phenylketonuria (PKU) and human immunodeficiency virus (HIV) to examine the specificity of the executive function (EF) impairment reported in these two patologies. A total of 55 age-matched children and adolescents were assessed, including 11 patients with PKU, 16 patients with HIV and 28 healthy controls, underwent a neuropsychological assessment. Although neither the PKU nor the HIV group scored below the normative ranges, both groups showed lower scores in neuropsychological tests engaging EFs than controls. In addition, compared to patients with PKU the HIV group performed significantly worse in the Trail-Making Test A, Corsi Span and Verbal Fluency. These findings suggest that EF impairments in PKU (a) are limited to EFs (i.e., working memory and attentional shifting), (b) are not simply due to generalized processing speed deficits and

Structural hemispheric asymmetries underlie verbal Stroop performance

Performance on tasks involving cognitive control such as the Stroop task is often associated with left lateralized brain activations. Based on this neuro-functional evidence, we tested whether leftward structural grey matter asymmetries would also predict inter-individual differences in combatting Stroop interference. To check for the specificity of the results, both a verbal Stroop task and a spatial one were administered to a total of 111 healthy young individuals, for whom T1-weighted magnetic resonance imaging (MRI) images were also acquired. Surface thickness and area estimations were calculated using FreeSurfer. Participants' hemispheres were registered to a symmetric template and Laterality Indices (LI) for the surface thickness and for the area at each vertex in each participant were computed. The correlation of these surface LI measures with the verbal and spatial Stroop effects (incongruent-congruent difference in trial performance) was assessed at each vertex by means of general linear models at the whole-brain level. We found a significant correlation between performance and surface area LI in an inferior posterior temporal cluster (overlapping with the so-called visual word form area, VWFA), with a more left-lateralized area in this region associated with a smaller Stroop effect only in the verbal task. These results point to an involvement of the VWFA for higher-level processes based on word reading, including the suppression of this process when required by the task, and could be interpreted in the context of cross-hemispheric rivalry.

The Neural Bases of Event Monitoring across Domains: a Simultaneous ERP-fMRI Study

The ability to check and evaluate the environment over time with the aim to detect the occurrence of target stimuli is supported by sustained/tonic as well as transient/phasic control processes, which overall might be referred to as event monitoring. The neural underpinning of sustained attentional control processes involves a fronto-parietal network. However, it has not been well-defined yet whether this cortical circuit acts irrespective of the specific material to be monitored and whether this mediates sustained as well as transient monitoring processes. In the current study, the functional activity of brain during an event monitoring task was investigated and compared between two cognitive domains, whose processing is mediated by differently lateralized areas. Namely, participants were asked to monitor sequences of either faces (supported by right-hemisphere regions) or tools (left-hemisphere). In order to disentangle sustained from transient components of monitoring, a simultaneous EEG-fMRI technique was adopted within a block design. When contrasting monitoring versus control blocks, the conventional fMRI analysis revealed the sustained involvement of bilateral fronto-parietal regions, in both task domains. Event-related potentials (ERPs) showed a more positive amplitude over frontal sites in monitoring compared to control blocks, providing evidence of a transient monitoring component. The joint ERP-fMRI analysis showed that, in the case of face monitoring, this transient component relies on right-lateralized areas, including the inferior parietal lobule and the middle frontal gyrus. In the case of tools, no fronto-parietal areas correlated with the transient ERP activity, suggesting that in this domain phasic monitoring processes were masked by tonic ones. Overall, the present findings highlight the role of bilateral fronto-parietal regions in sustained monitoring, independently of the specific task requirements, and suggest that right-lateralized areas subtend transient monitoring processes, at least in some task contexts.

Quality of Life and Anxious-depressive Symptoms in Cancer Patients Undergoing Mindfulness-based Interventions: Feasibility and Preliminary Outcomes on Prospective Single-centre Case-control Study (MIND4ME St.)

Background

Mindfulness based interventions (MBIs) have shown efficacy in improving psychological symptoms including depression and anxiety in cancer patients (pts). The study aimed to explore feasibility and reproducibility of MBIs in an Italian Cancer Centre measuring biochemical and psychological parameters.

Methods

In this pilot prospective case-control study, we recruited newly diagnosed pts receiving adjuvant chemotherapy (CT). A MBIs program was designed consisting of 2.5 hours weekly for 8 weeks and, including meditation, yoga and body scan. Material for 45 minutes (mn) home daily practice was provided. Primary endpoint was to evaluate feasibility. Secondary endpoints were assessment of quality of life (QoL), psychological and biochemical outcomes of stress, tested at baseline (W0), W4, W8, W24, W48. PSS (Perceived Stress Reduction), POMS (profile of mood states scores), EuroQoL (EQ-5D-3L) were administered.

Results

Ten pts underwent MBIs program arm. We present preliminary results, while data of control arm are being collected. All pts were female, two pts (20%) dropped out. Median age was 56 years. All received adjuvant CT, 5/8 received radiotherapy and hormone therapy. Mean of sessions attending was 6.8 (76%). Median daily practice was 30 mn. EQ-5D item for depression and anxiety showed decreasing trend in mean score from moderate to light (P = 0.15) and significant improvement of auto-perceived QoL was observed comparing W0 and W8 (P = 0.02)

Conclusions

In a sensitive setting such as start CT, we found high pts compliance to MBIs. Improvement in self-perceived QoL after starting program was found and comparing anxious-depressive symptoms outcomes with control arm is still needed.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Developmental Trajectories of Internally and Externally Driven Temporal Prediction

The ability to generate temporal prediction (TP) is fundamental to our survival since it allows us to selectively orient our attention in time in order to prioritize relevant environmental information. Studies on adult participants showed that externally and internally driven mechanisms can be engaged to establish TP, both resulting in better behavioural performance. However, few studies on children have investigated the ability to engage internally and externally driven TP, especially in relation to how these mechanisms change across development. In this study, 111 participants (88 children between six and eleven years of age, and 23 adults) were tested by means of a simple reaction time paradigm, in which temporal cueing and neutral conditions were orthogonally manipulated to induce externally and internally driven TP mechanisms, as well as an interaction between the two. Sequential effects (SEs) relative to both tasks were also investigated. Results showed that all children participating in the study were able to implement both external and internal TP in an independent fashion. However, children younger than eight years were not able to combine both strategies. Furthermore, in the temporal cueing blocks they did not show the typically-observed asymmetric SE pattern. These results suggest that children can flexibly use both external and internal TP mechanisms to optimise their behaviour, although their successful combined use develops only after eight years of age.

Does predictability matter? Effects of cue predictability on neurocognitive mechanisms underlying prospective memory

Prospective memory (PM) represents the ability to successfully realize intentions when the appropriate moment or cue occurs. In this study, we used event-related potentials (ERPs) to explore the impact of cue predictability on the cognitive and neural mechanisms supporting PM. Participants performed an ongoing task and, simultaneously, had to remember to execute a pre-specified action when they encountered the PM cues. The occurrence of the PM cues was predictable (being signaled by a warning cue) for some participants and was completely unpredictable for others. In the predictable cue condition, the behavioral and ERP correlates of strategic monitoring were observed mainly in the ongoing trials wherein the PM cue was expected. In the unpredictable cue condition they were instead shown throughout the whole PM block. This pattern of results suggests that, in the predictable cue condition, participants engaged monitoring only when subjected to a context wherein the PM cue was expected, and disengaged monitoring when the PM cue was not expected. Conversely, participants in the unpredictable cue condition distributed their resources for strategic monitoring in more continuous manner. The findings of this study support the most recent views—the “Dynamic Multiprocess Framework” and the “Attention to Delayed Intention” (AtoDI) model—confirming that strategic monitoring is a flexible mechanism that is recruited mainly when a PM cue is expected and that may interact with bottom-up spontaneous processes.

Spatiotemporal Neurodynamics Underlying Internally and Externally Driven Temporal Prediction: A High Spatial Resolution ERP Study

Temporal prediction (TP) is a flexible and dynamic cognitive ability. Depending on the internal or external nature of information exploited to generate TP, distinct cognitive and brain mechanisms are engaged with the same final goal of reducing uncertainty about the future. In this study, we investigated the specific brain mechanisms involved in internally and externally driven TP. To this end, we employed an experimental paradigm purposely designed to elicit and compare externally and internally driven TP and a combined approach based on the application of a distributed source reconstruction modeling on a high spatial resolution electrophysiological data array. Specific spatiotemporal ERP signatures were identified, with significant modulation of contingent negative variation and frontal late sustained positivity in external and internal TP contexts, respectively. These different electrophysiological patterns were supported by the engagement of distinct neural networks, including a left sensorimotor and a prefrontal circuit for externally and internally driven TP, respectively.

Assessing inter- and intra-individual cognitive variability in patients at risk for cognitive impairment: the case of minimal hepatic encephalopathy

Recent evidence reveals that inter- and intra-individual variability significantly affects cognitive performance in a number of neuropsychological pathologies. We applied a flexible family of statistical models to elucidate the contribution of inter- and intra-individual variables on cognitive functioning in healthy volunteers and patients at risk for hepatic encephalopathy (HE). Sixty-five volunteers (32 patients with cirrhosis and 33 healthy volunteers) were assessed by means of the Inhibitory Control Task (ICT). A Generalized Additive Model for Location, Scale and Shape (GAMLSS) was fitted for jointly modeling the mean and the intra-variability of Reaction Times (RTs) as a function of socio-demographic and task related covariates. Furthermore, a Generalized Linear Mixed Model (GLMM) was fitted for modeling accuracy. When controlling for the covariates, patients without minimal hepatic encephalopathy (MHE) did not differ from patients with MHE in the low-demanding condition, both in terms of RTs and accuracy. Moreover, they showed a significant decline in accuracy compared to the control group. Compared to patients with MHE, patients without MHE showed faster RTs and higher accuracy only in the high-demanding condition. The results revealed that the application of GAMLSS and GLMM models are able to capture subtle cognitive alterations, previously not detected, in patients' subclinical pathologies.

An investigation of the neural circuits underlying reaching and reach-to-grasp movements: from planning to execution

Experimental evidence suggests the existence of a sophisticated brain circuit specifically dedicated to reach-to-grasp planning and execution, both in human and non-human primates (Castiello, 2005). Studies accomplished by means of neuroimaging techniques suggest the hypothesis of a dichotomy between a “reach-to-grasp” circuit, involving the anterior intraparietal area, the dorsal and ventral premotor cortices (PMd and PMv – Castiello and Begliomini, 2008; Filimon, 2010) and a “reaching” circuit involving the medial intraparietal area and the superior parieto-occipital cortex (Culham et al., 2006). However, the time course characterizing the involvement of these regions during the planning and execution of these two types of movements has yet to be delineated. A functional magnetic resonance imaging study has been conducted, including reach-to-grasp and reaching only movements, performed toward either a small or a large stimulus, and Finite Impulse Response model (Henson, 2003) was adopted to monitor activation patterns from stimulus onset for a time window of 10 s duration. Data analysis focused on brain regions belonging either to the reaching or to the grasping network, as suggested by Castiello and Begliomini (2008). Results suggest that reaching and grasping movements planning and execution might share a common brain network, providing further confirmation to the idea that the neural underpinnings of reaching and grasping may overlap in both spatial and temporal terms (Verhagen et al., 2013). But, although responsive for both actions, they show a significant predominance for either one of the two actions and such a preference is evident on a temporal scale.

Object size modulates fronto-parietal activity during reaching movements

In both monkeys and humans, reaching-related sensorimotor transformations involve the activation of a wide fronto-parietal network. Recent neurophysiological evidence suggests that some components of this network host not only neurons encoding the direction of arm reaching movements, but also neurons whose involvement is modulated by the intrinsic features of an object (e.g. size and shape). To date, it has yet to be investigated whether a similar modulation is evident in the human reaching-related areas. To fill this gap, we asked participants to reach towards either a small or a large object while kinematic and electroencephalographic signals were recorded. Behavioral results showed that the precision requirements were taken into account and the kinematics of reaching was modulated depending on the object size. Similarly, reaching-related neural activity at the level of the posterior parietal and premotor cortices was modulated by the level of accuracy determined by object size. We therefore conclude that object size is engaged in the neural computations for reach planning and execution, consistent with the results from physiological studies in non-human primates.

Co-registering kinematics and evoked related potentials during visually guided reach-to-grasp movements

Background

In non-human primates grasp-related sensorimotor transformations are accomplished in a circuit involving the anterior intraparietal sulcus (area AIP) and both the ventral and the dorsal sectors of the premotor cortex (vPMC and dPMC, respectively). Although a human homologue of such a circuit has been identified, the time course of activation of these cortical areas and how such activity relates to specific kinematic events has yet to be investigated.

Methodology/Principal Findings

We combined kinematic and event-related potential techniques to explicitly test how activity within human grasping-related brain areas is modulated in time. Subjects were requested to reach towards and grasp either a small stimulus using a precision grip (i.e., the opposition of index finger and thumb) or a large stimulus using a whole hand grasp (i.e., the flexion of all digits around the stimulus). Results revealed a time course of activation starting at the level of parietal regions and continuing at the level of premotor regions. More specifically, we show that activity within these regions was tuned for specific grasps well before movement onset and this early tuning was carried over - as evidenced by kinematic analysis - during the preshaping period of the task.

Conclusions/Significance

Data are discussed in terms of recent findings showing a marked differentiation across different grasps during premovement phases which was carried over into subsequent movement phases. These findings offer a substantial contribution to the current debate about the nature of the sensorimotor transformations underlying grasping. And provide new insights into the detailed movement information contained in the human preparatory activity for specific hand movements.

Automatic temporal expectancy: a high-density event-related potential study

How we compute time is not fully understood. Questions include whether an automatic brain mechanism is engaged in temporally regular environmental structure in order to anticipate events, and whether this can be dissociated from task-related processes, including response preparation, selection and execution. To investigate these issues, a passive temporal oddball task requiring neither time-based motor response nor explicit decision was specifically designed and delivered to participants during high-density, event-related potentials recording. Participants were presented with pairs of audiovisual stimuli (S1 and S2) interspersed with an Inter-Stimulus Interval (ISI) that was manipulated according to an oddball probabilistic distribution. In the standard condition (70% of trials), the ISI lasted 1,500 ms, while in the two alternative, deviant conditions (15% each), it lasted 2,500 and 3,000 ms. The passive over-exposition to the standard ISI drove participants to automatically and progressively create an implicit temporal expectation of S2 onset, reflected by the time course of the Contingent Negative Variation response, which always peaked in correspondence to the point of S2 maximum expectation and afterwards inverted in polarity towards the baseline. Brain source analysis of S1- and ISI-related ERP activity revealed activation of sensorial cortical areas and the supplementary motor area (SMA), respectively. In particular, since the SMA time course synchronised with standard ISI, we suggest that this area is the major cortical generator of the temporal CNV reflecting an automatic, action-independent mechanism underlying temporal expectancy.

Effect of duration of breastfeeding on neuropsychological development at 10 to 12 years of age in a cohort of healthy children

AIM

The aim of this article was to explore the effect of duration of breastfeeding on neurocognitive development.

METHOD

The long-term effect of breastfeeding on neurodevelopment was examined through a battery of neuropsychological tests in 1403 children (693 females, 710 males; mean age 11 y 9mo [SD 6mo], range: 10y 3mo-12y 8mo) who were originally recruited at 6 to 12 weeks of age for a clinical trial on acellular pertussis vaccines. An estimated IQ was obtained from scores of the vocabulary, similarities, block design, and coding tests. Breastfeeding data had been prospectively collected throughout the first year of life. Duration of exclusive breastfeeding was defined as the time during which children received breast milk without receiving any supplemental formula or food. Children were assessed at 10 to 12 years of age. We adjusted the analysis on test scores for multiple potential confounders.

RESULTS

Multivariate analysis showed a significant association between exclusive breastfeeding duration and test scores in the vocabulary (odds ratio [OR] 0.05; confidence interval [CI] 0.00-0.10; p=0.04) and similarities (OR 0.06; CI 0.01-0.11; p=0.03) tests. These associations have a negligible effect size, however. Scores on one writing praxis test subcategory decreased with increasing duration of both exclusive breastfeeding (OR -0.06; CI -0.11 to -0.01; p=0.03) and breastfeeding irrespective of consumption of other foods (OR -0.06; CI -0.11 to -0.01; p=0.03). A negative association was also found between one subcategory of the California verbal learning test and breastfeeding duration longer than 6 months (OR -0.21; CI -0.42 to -0.01; p=0.04).

INTERPRETATION

Breastfed healthy children may perform better on neuropsychological tests in the language domain at 10 to 12 years of age. However, the effect of breast milk on neuropsychological performance in healthy children may have a limited clinical relevance and is confounded by parental education.

Electrophysiological correlates of strategic monitoring in event-based and time-based prospective memory

Prospective memory (PM) is the ability to remember to accomplish an action when a particular event occurs (i.e., event-based PM), or at a specific time (i.e., time-based PM) while performing an ongoing activity. Strategic Monitoring is one of the basic cognitive functions supporting PM tasks, and involves two mechanisms: a retrieval mode, which consists of maintaining active the intention in memory; and target checking, engaged for verifying the presence of the PM cue in the environment. The present study is aimed at providing the first evidence of event-related potentials (ERPs) associated with time-based PM, and at examining differences and commonalities in the ERPs related to Strategic Monitoring mechanisms between event- and time-based PM tasks.

The addition of an event-based or a time-based PM task to an ongoing activity led to a similar sustained positive modulation of the ERPs in the ongoing trials, mainly expressed over prefrontal and frontal regions. This modulation might index the retrieval mode mechanism, similarly engaged in the two PM tasks. On the other hand, two further ERP modulations were shown specifically in an event-based PM task. An increased positivity was shown at 400–600 ms post-stimulus over occipital and parietal regions, and might be related to target checking. Moreover, an early modulation at 130–180 ms post-stimulus seems to reflect the recruitment of attentional resources for being ready to respond to the event-based PM cue. This latter modulation suggests the existence of a third mechanism specific for the event-based PM; that is, the “readiness mode”.

Sociocognitive factors associated with nonadherence to medication after hospital discharge

Poor adherence to prescribed medication is a well-known problem and continues to be a major challenge in all medical specialties. Unlike previous studies that have mainly focused on nonadherence behaviors in specific diseases, this study sought to examine socio-cognitive factors associated with nonadherence behavior in a sample of a general clinical population. A questionnaire investigating socio-demographic and cognitive factors and a telephone follow-up interview were administered to 84 patients recruited in a General Medicine Unit before their discharge. Half of the participants were informed about that follow-up procedure. One month after hospital discharge, 42% of uninformed patients reported nonadherence behaviors, as against 21% of informed patients. Middle-aged patients and short-term treatments were associated significantly more often with nonadherence. Among cognitive factors, patients' perceived risks and benefits of nonadherence, personal susceptibility to diseases, subjective health value, and reported memory failures were significantly associated with adherence. We conclude that a patient's perception may be more important than medication load, illness severity, and complexity of regimen in influencing medication adherence, and that a telephone call follow-up helps in monitoring medication adherence after hospital discharge.

The time course of temporal discrimination: An ERP study

OBJECTIVE

The question of how temporal information is processed by the brain is still a matter of debate. This study aimed to elucidate the brain electrical activity associated with a visual temporal discrimination task.

METHODS

For this purpose, 44 participants were required to compare pairs of sequentially presented time intervals: a fixed standard interval (1000ms), and an equal-to-standard, longer (1200ms) or shorter (800ms) comparison interval. Behavioural data and event-related potentials (ERPs) were analyzed.

RESULTS

Long intervals were more rapidly identified than short intervals. The amplitude of the contingent negative variation (CNV) found at frontocentral sites before the end of the comparison interval was significantly affected by the difference between its duration and the standard one. The amplitude and the scalp distribution of ERPs registered after the offset of the comparison interval were linearly modulated by its absolute duration.

CONCLUSIONS

ERP components associated with the offset of the comparison intervals clarified the involvement of working memory processes and different brain structures in temporal discrimination.

SIGNIFICANCE

This study further improves our understanding of the cognitive processes and neural substrates underlying temporal discrimination in healthy subjects and lays the ground for the investigation of clinical samples with time processing deficits.

Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines

OBJECTIVE

Thimerosal, a mercury compound used as a preservative in vaccines administered during infancy, has been suspected to affect neuropsychological development. We compared the neuropsychological performance, 10 years after vaccination, of 2 groups of children exposed randomly to different amounts of thimerosal through immunization.

METHODS

Children who were enrolled in an efficacy trial of pertussis vaccines in 1992-1993 were contacted in 2003. Two groups of children were identified, according to thimerosal content in vaccines assigned randomly in the first year of life (cumulative ethylmercury intake of 62.5 or 137.5 microg), and were compared with respect to neuropsychological outcomes. Eleven standardized neuropsychological tests, for a total of 24 outcomes, were administered to children during school hours. Mean scores of neuropsychological tests in the domains of memory and learning, attention, executive functions, visuospatial functions, language, and motor skills were compared according to thimerosal exposure and gender. Standard regression coefficients obtained through multivariate linear regression analyses were used as a measure of effect.

RESULTS

Nearly 70% of the invited subjects participated in the neuropsychological assessment (N = 1403). Among the 24 neuropsychological outcomes that were evaluated, only 2 were significantly associated with thimerosal exposure. Girls with higher thimerosal intake had lower mean scores in the finger-tapping test with the dominant hand and in the Boston Naming Test.

CONCLUSIONS

Given the large number of statistical comparisons performed, the few associations found between thimerosal exposure and neuropsychological development might be attributable to chance. The associations found, although statistically significant, were based on small differences in mean test scores, and their clinical relevance remains to be determined.

Aging and prospective memory: the role of working memory and monitoring processes

BACKGROUND AND AIMS

Remembering to execute an earlier planned action is essential in everyday life, and is a prerequisite for independent living in old age. The purpose of the present study was to determine the influence of age in performing a prospective memory (PM) task and to analyze the differential contribution of working memory and attentional monitoring demands.

METHODS

In Experiment 1, a group of young and two groups of old adults were assigned to one of two low-demanding conditions: a picture-naming task (only-Naming) and a picture-naming plus a PM task (Naming+PM). In Experiment 2, a group of young and two groups of old adults performed one of two high-demanding conditions, in which working memory and attentional monitoring processes were examined, using a listening span-like task and a 1-back task within the PM paradigm of Experiment 1.

RESULTS

Prospective memory performance declined with age even in the low-demanding condition (Experiment 1). Young participants showed PM failures only when the 1-back task was added to the low-demanding condition. Older participants exhibited a marked decline, particularly in the working memory load condition.

CONCLUSIONS

These results suggest that even low-demanding prospective memory tasks are resource-consuming in old age, and that working memory efficiency, affected by the aging process, plays a crucial role in the successful accomplishment of PM actions.

Adeno-tonsillar surgery in Italy

Indications to surgery for adeno-tonsillar inflammatory disorders and analysis of the effectiveness of surgical treatment, compared with watchful waiting strategy, continue to be the subject of scientific debate. The present investigation focuses on the surgical activity of 14 Italian Otorhinolaryngological Units between 1999 and 2004. Surgical interventions (adeno-tonsillectomy, adenoidectomy, tonsillectomy) on 26915 children (age range: 2-11 years) were considered. Data on adeno-tonsillar interventions were analysed in relation to other interventions of ENT interest, performed in the same units and in the same period. Adeno-tonsillar interventions accounted for 35.4% of all operations of ENT interest. Adeno-tonsillectomy accounted for 56.6% of overall adeno-tonsillar operations, adenoidectomy 31.6%, tonsillectomy 11.8%. The percentage for the three interventions was homogeneous in the period of the study and in the recruited units. The percentage of children who underwent adeno-tonsillar surgery in paediatric units was higher as compared to general units, as far as concerns the overall number of operations performed. In southern Italy, the number of adeno-tonsillar interventions, in general, and of adeno-tonsillectomy, in particular, was higher compared to that in northern Italy. Results of the present study suggest that environmental factors, cultural issues and local health demands, may influence indications and, therefore, the different incidence of the operations under consideration in the units taking part in the investigation.

Safety of electronic molecular resonance adenoidectomy

Adenoidectomy is one of the most frequent operations in children. In order to reduce hospital stay costs, today, this procedure is performed as day surgery. Even though adenoidectomy is not considered risky, some minor complications may occur, the most important being bleeding (0.5-8% incidence). The surgical technique used can influence considerably postoperative pain and time to recovery. This aspect is essential in the management of day surgery patients, for whom the need of safe and rapid maneuvers associated with early recovery determines the choice of the surgical procedure. Recently, we developed a surgical technique based on the use of an electronic molecular resonance tool associated with bendable suction electrocautery. This study was carried out on 600 patients, divided into two groups, the first undergoing ablation using the molecular resonance tool and the second undergoing curette adenoidectomy. The two groups were homogeneous for age, sex, surgical indications, and grade of adenoid hypertrophy. The following parameters were considered: duration of surgery, importance of intraoperative bleeding, time to cicatrization, incidence of bleeding complications. Duration of surgery and intra- and postoperative bleeding were much lower in the first group than in the group undergoing traditional adenoidectomy. In addition, rhinopharyngeal complete cicatrization, defined as absolute absence of pseudomembrane, was much quicker in the first group, as assessed by postoperative endoscopy. Another major advantage offered by the molecular resonance tool is the accuracy of surgery performed under visual control in a practically bloodless field. To sum up, this method, thanks to its technical features and safety, is particularly indicated in children and in patients with coagulation disorders.

Acute mastoiditis: a 10 year retrospective study

This retrospective study reviews our experience in the management of acute otomastoiditis over 10 years. During the study period we identified 40 cases in children aged 3 months-15 years with a peak incidence in the second year of life. Sixty per cent of them had a history of acute otitis media (AOM). All the children were already receiving oral antibiotic therapy. Otalgia, fever, poor feeding and vomiting were the most common symptoms, all the children had evidence of retroauricolar inflammation. Computerized tomography (CT) and magnetic resonance imaging (MRI) were used to support the diagnosis and to evaluate possible complications. Streptococcus pneumoniae was the most common isolated bacterium. All the patients received intravenous antibiotics, 65% of children received only medical treatment, 35% also underwent surgical intervention. Mean length of hospital stay was 12.3 days. Cholesteathoma was diagnosed in one child. We conclude from our study that acute otomastoiditis is a disease mainly affecting young children, that develops from AOM resistant to oral antibiotics. Adequate initial management always requires intravenous antibiotics, conservative surgical treatment with miryngotomy is appropriate in children not responding within 48 h from beginning of therapy. Mastoidectomy should be performed in all the patients with acute coalescent mastoiditis or in case of evidence of intracranial complications.

Monothermal air caloric test in children

We compared the efficacy of bithermal (BAT) and monothermal cold (MCAT) and warm (MWAT) air caloric tests in identifying labyrinthine function anomalies in the child. At first, we established confidence intervals of normality for both monothermal tests in 40 children (22 males, 18 females) aged 6-14 years, clinically healthy and normal as previously shown by BAT. Subsequently, we compared the results of BAT with those of MCAT and MWAT performed in 46 children (22 males, 24 females) aged 6-14 years, affected by multiple labyrinthine diseases. These results confirmed that, as in the adult, MCAT alone should not be used in the evaluation of labyrinthine function in vertiginous patients. As to MWAT, we obtained good sensitivity and specificity with respect to BAT (83% and 90% for 90% probability; 78% and 92.5% for 95% probability). Sensitivity values increased or decreased depending on the disease causing vertiginous symptoms, with decreased or increased number of false negatives. In our opinion, MWAT cannot replace BAT for the study of labyrinthine function in children. MWAT alone can be used when vertigo is ascribable to vestibular neuritis or to endogenous disease (dysmetabolic, dyscrasic, dysendocrine).