Cognitive Task Performance During Titration Predicts Deep Brain Stimulation Treatment Efficacy: Evidence From a Case Study

Device titration is a major challenge when using deep brain stimulation (DBS) to treat behavioral disorders. Unlike in movement disorders, there is no reliable real-time clinical feedback for changes in complex behaviors resulting from DBS. Here, a female patient receiving DBS of the nucleus accumbens for the treatment of morbid obesity underwent cognitive testing via the flanker task alongside traditional methods of device titration. One set of stimulation parameters administered during titration resulted in acute cognitive improvement (p = 0.033) and increased frontal engagement as measured by electroencephalography (left anterior: p = 0.007, right anterior: p = 0.005) relative to DBS-OFF. The same parameters resulted in the most weight-loss during long-term continuous stimulation (47.8 lbs lost in 129 days) compared to the results of other stimulation settings. Diffusion tensor imaging analyses showed increased connectivity to dorsal attention networks and decreased connectivity to the default mode network for optimal parameters (p < 0.01). Our results provide evidence that targeted cognitive testing is a potentially useful tool for capturing acute effects of DBS stimulation during titration and predicting long-term treatment outcomes.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT01512134.

Cognitive-Emotional and Inhibitory Deficits as a Window to Moral Decision-Making Difficulties Related to Exposure to Violence

In the present review, we illustrate how exposure to violence results in an increased probability of developing functional impairments of decision mechanisms necessary for moral behavior. We focus in particular on the detrimental effects of exposure to violence on emotional (e.g., Empathy), cognitive (e.g., Theory of Mind), and inhibitory control abilities. Relying on studies that document impaired moral behavior in individuals with deficits in these abilities, we propose a "model" of how exposure to violence can affect moral behavior. We then discuss how impaired moral decision making can also be a factor increasing the likelihood of reiterating violence: agents who lack abilities such as understanding and resonating with others' emotions or inhibitory control, can lead to an increase of violent displays. Thus, if not properly addressed, the noxious effects of exposure to violence on morality can lead to a violence generating cycle. We conclude proposing that interventions targeted at improving moral behavior can maximize their efficacy focusing on mitigating the impact of violence on the basic cognitive, emotional, and inhibitory abilities discussed.