Aphasia rehabilitation based on mirror neuron theory: a randomized-block-design study of neuropsychology and functional magnetic resonance imaging

When watching someone performs an action, mirror neurons are activated in a way that is very similar to the activation that occurs when actually performing that action. Previous single-sample case studies indicate that hand-action observation training may lead to activation and remodeling of mirror neuron systems, which include important language centers, and may improve language function in aphasia patients. In this randomized-block-design experiment, we recruited 24 aphasia patients from, Zhongda Hospital, Southeast University, China. The patients were divided into three groups where they underwent hand-action observation and repetition, dynamic-object observation and repetition, or conventional speech therapy. Training took place 5 days per week, 35 minutes per day, for 2 weeks. We assessed language function via picture naming tests for objects and actions and the Western Aphasia Battery. Among the participants, one patient, his wife and four healthy student volunteers underwent functional magnetic resonance imaging to analyze changes in brain activation during hand-action observation and dynamic-object observation. Results demonstrated that, compared with dynamic-object observation, hand-action observation led to greater performance with respect to the aphasia quotient and affiliated naming sub-tests and a greater Western Aphasia Battery test score. The overall effect was similar to that of conventional aphasia training, yet hand-action observation had advantages compared with conventional training in terms of vocabulary extraction and spontaneous speech. Thus, hand-action observation appears to more strongly activate the mirror neuron system compared with dynamic-object observation. The activated areas included Broca's area, Wernicke's area, and the supramarginal gyrus. These results suggest that hand-action observation combined with repetition might better improve language function in aphasia patients compared with dynamic-object observation combined with repetition. The therapeutic mechanism of this intervention may be associated with activation of additional mirror neuron systems, and may have implications for the possible repair and remodeling of damaged nerve networks. The study protocol was approved by the Ethical Committee of Nanjing Medical University, China(approval number: 2011-SRFA-086) on March 11, 2011. This trial has been registered in the ISRCTN Registry(ISRCTN84827527).

The Remote Testing in Abbiategrasso (RTA) Study Protocol: A Counter-Balanced Crossover Trial to Assess the Feasibility of Direct-to-Home-Neuropsychology with Older People

Background: The Sars-Cov-2 pandemic has accelerated the spreading of telemedicine, including TeleNeuroPsychology (TNP). Also in a non-pandemic scenario, TNP gives the advantage of reaching older subjects, which often have mobility or transportation limitations. Previous studies on the feasibility, acceptability and reliability of TNP provide promising indications. However, it remains unclear how elderly populations in Italy welcome this practice, in particular when carried out “direct-to-home” (DTH neuropsychology—DTH-NP), hence without assistance in setting up, i.e., the videoconference, and which tests validated in Italian populations show good comparability between remote (either by voice phone call or videoconference) and face-to-face administration. Aims: Here we present a study protocol aimed at assessing: 1) the recruitment rate in a study on DTH neuropsychological assessment through voice calls or videoconference, 2) the feasibility and acceptability of a DTH neuropsychological assessment, 3) the comparability between DTH and face-to-face neuropsychological assessments. Methods: Fifty-eight older adults (65 - 85 years) were recruited among donors of the Abbiategrasso Brain Bank and will undergo both a face-to-face and a DTH neuropsychological assessment in a counterbalanced cross-over design (Group 1: remote session first;Group 2: face-to-face session first). Recruitment rate will be first evaluated. Then, the responses to an acceptability questionnaire will be compared between the two administration modalities. Finally, the DTH-face-to-face comparability will be evaluated as good reliability of a DTH neuropsychological assessment and agreement between scores obtained in the two modalities. Discussion and Conclusion: This study protocol aims at describing the procedures allowing a more reliable implementation of DTH-NP in the Italian clinical and research contexts. The inclusion of both phone-call and videoconference DTH neuropsychological assessment will give the opportunity to evaluate the feasibility of DTH-NP also in older adults with low digital skills. The results of the comparability analysis will offer the first evidence in the Italian context on which neuropsychological tests can be reliably delivered DTH, by phone call or videoconference.

Bibliographical Review on Rehabilitation of Executive Functions in Patients With Developmental Coordination Disorder(DCD)

The present study aims to establish a literature review on intervention programs for executive functions(EFs)through the use of fundamental motor skills,from a neuropsychopedagogical perspective in subjects with Developmental Coordination Disorder(DCD).An exploratory study was carried out through an integrative literature review.The research was carried out in the Scientific databases Electronic Library Online(SciELO),Latin American and Caribbean Literature in Health Sciences(LILACS),Virtual Health Library-Psychology Brazil(BVSPSI),Electronic Journals of Psychology(PePSIC),in the periodicals available in the Brazilian Digital Library of Theses and Dissertations(BDTD)and on the website of the Coordination for the Improvement of Higher Education Personnel(CAPES).The covering publications took place from 2018 to 2023,14 articles were selected for analysis.This literature review made it possible to create strategies for stimulating EF and Visuomotor Functions so that educators and other professionals can better deal with students with DCD.It was perceived the need to carry out and develop more empirical research regarding the intervention of EFs and Visuomotor Functions by educators and professionals,with a greater sampling amplitude,to increase the number of studies that enable interventions both in children and in teenagers with DCD.

Neuropsychological Profile of a Patient with Acquired Brain Damage Following Vascular Lesion of the Left Anterior Cingulate Cortex

Stroke is a physiological alteration associated with changes in blood flow that can result in sudden-onset cognitive impairment. It has a heterogenous clinical presentation with varying degrees of severity correlated with specific central nervous system zones or areas, and its prognosis is uncertain. This case study describes a 62-year-old male patient with acquired brain damage of the anterior cingulate cortex as a result of an ischemic event in the territory of the left anterior cerebral artery. Cognitive function was assessed using the neuropsychological executive function and frontal lobe test battery (BANFE-2) as well as other neuropsychological tests. The results show a profile of higher mental functions characterized by the presence of dysexecutive syndrome with marked behavioral alteration and diencephalic amnesia. .

Explanation of disability by ADHD core symptoms or concomitant minimal cerebral dysfunctions

Background:Examine the degree of disability in adult ADHD patients in relation to the core symptoms attention deficits and hyperactivity and concomitant minimal cerebral dysfunctions.Methods:Patients from a psychosomatic rehabilitation hospital(N=1,453)had answered the“ADHS-SB(attention deficit hyperactivity scale)”,the“MCD-scale(minimal cerebral dysfunction self rating scale)”,the“SCL-90R(Symptom Checklist)”,and reported about impairment at work.Results:Psychological distress and the ability to work are primarily related to problems of orientation,cognitive impairment,vegetative lability,emotional problems,disorders of motor function,but only to a lesser degree to hyperactivity and attention deficit.Conclusion:When dealing with ADHD patients,clinicians should take into account the full variety of MCD symptoms as these are decisive in regard to participation and problems in life.

Recent Advances in HIV-Associated Neurocognitive Disorders

HIV-associated neurocognitive disorders (HAND) are chronic complications of HIV infection in the central nervous system. Clinical presentations include asymptomatic neurocognitive impairment (ANI), mild neurocognitive impairment (MND), and HIV-associated dementia (HAD). In the era of combination antiretroviral therapy (cART), the prevalence of HAD has significantly decreased, but the rates of ANI and MND have increased, impairing patients’ daily functioning, medical adherence, employment, driving abilities, risk of HIV transmission, overall quality of life, and posing challenges to society, economy, families, and public health. This article reviews the latest research findings regarding the pathogenesis, clinical diagnosis and treatment, neuroimaging, and neuropsychological assessment of HAND, aiming to provide insights into the prevention and management of HAND.

Efficacy of Children Neuropsychological and Behavioral Scale in Screening for Autism Spectrum Disorders through a Combination of Developmental Surveillance

Objective This study aimed to explore the clinical value of Children Neuropsychological and Behavioral Scale-Revision 2016(CNBS-R2016)for Autism Spectrum Disorder(ASD)screening in the presence of developmental surveillance.Methods All participants were evaluated by the CNBS-R2016 and Gesell Developmental Schedules(GDS).Spearman’s correlation coefficients and Kappa values were obtained.Taking GDS as a reference assessment,the performance of the CNBS-R2016 for detecting the developmental delays of children with ASD was analyzed with receiver operating characteristic(ROC)curves.The efficacy of the CNBS-R2016 to screen for ASD was explored by comparing Communication Warning Behavior with Autism Diagnostic Observation Schedule,Second Edition(ADOS-2).Results In total,150 children aged 12–42 months with ASD were enrolled.The developmental quotients of the CNBS-R2016 were correlated with those of the GDS(r=0.62–0.94).The CNBS-R2016 and GDS had good diagnostic agreement for developmental delays(Kappa=0.73–0.89),except for Fine Motor.There was a significant difference between the proportions of Fine Motor,delays detected by the CNBS-R2016 and GDS(86.0%vs.77.3%).With GDS as a standard,the areas under the ROC curves of the CNBS-R2016 were above 0.95 for all the domains except Fine Motor,which was 0.70.In addition,the positive rate of ASD was 100.0%and 93.5%when the cut-off points of 7 and 12 in the Communication Warning Behavior subscale were used,respectively.Conclusion The CNBS-R2016 performed well in developmental assessment and screening for children with ASD,especially by Communication Warning Behaviors subscale.Therefore,the CNBS-R2016 is worthy of clinical application in children with ASD in China.

Neurological and neuropsychological consequences of electrical and lightning shock： review and theories of causation

Injuries from lightning and electrical injuries involve multiple systems of the body, however neurological symptoms are very widely reported. A disabling neuropsychological syndrome is also noted. This paper presents a comprehensive review of neurological and neuropsychological symptoms. Partial theories of causation for these injuries have been advanced, however, there is no convincing explanation for both delay in onset of symptoms and also the genesis of the neuropsychological syndrome. A theory of causation is proposed which satisfies both these constraints. This theory suggests circulating hormones such as cortisol, together with nitric oxide and oxidant free radicals from glutamatergic hyper-stimulation, act on tissues remote from the injury path including the hippocampus. This theory opens a research path to explore treatment options.

Mismatch negativity,social cognition,and functional outcomes in patients after traumatic brain injury

Mismatch negativity is generated automatically, and is an early monitoring indicator of neuronal integrity impairment and functional abnormality in patients with brain injury, leading to decline of cognitive function. Antipsychotic medication cannot affect mismatch negativity. The present study aimed to explore the relationships of mismatch negativity with neurocognition, daily life and social functional outcomes in patients after brain injury. Twelve patients with traumatic brain injury and 12 healthy controls were recruited in this study. We examined neurocogni-tion with the Wechsler Adult Intelligence Scale-Revised China, and daily and social functional outcomes with the Activity of Daily Living Scale and Social Disability Screening Schedule, re-spectively. Mismatch negativity was analyzed from electroencephalogram recording. The results showed that mismatch negativity amplitudes decreased in patients with traumatic brain injury compared with healthy controls. Mismatch negativity amplitude was negatively correlated with measurements of neurocognition and positively correlated with functional outcomes in patients after traumatic brain injury. Further, the most signiifcant positive correlations were found be-tween mismatch negativity in the fronto-central region and measures of functional outcomes. The most signiifcant positive correlations were also found between mismatch negativity at the FCz electrode and daily living function. Mismatch negativity amplitudes were extremely positive-ly associated with Social Disability Screening Schedule scores at the Fz electrode in brain injury patients. These experimental ifndings suggest that mismatch negativity might efifciently relfect functional outcomes in patients after traumatic brain injury.

Post electrical or lightning injury syndrome: a proposal for an American Psychiatric Association's Diagnostic and Statistical Manual formulation with implications for treatment

In the past, victims of electrical and lightning injuries have been assessed in a manner lacking a system- atic formulation, and against ad hoc criteria, particularly in the area of neuropsychological disability. In this manner patients have, for example, only been partially treated, been poorly or incorrectly diagnosed, and have been denied the full benefit of compensation for their injuries. This paper contains a proposal for diagnostic criteria particularly for the neuropsychological aspects of the post injury syndrome. It pays attention to widely published consistent descriptions of the syndrome, and a new cluster analysis of post electrical injury patients. It formulates a proposal which could be incorporated into future editions of the American Psychiatric Association＇s Diagnostic and Statistical Manual （DSM）. The major neuropsycholog- ical consequences include neurocognitive dysfunction, and memory subgroup dysfunction, with ongoing consequences, and sometimes including progressive or delayed psychiatric, cognitive, and/or neurological symptoms. The proposed diagnostic criteria insist on a demonstrated context for the injury, both specifying the shock circumstance, and also physical consequences. It allows for a certain delay in onset of symptoms. It recognizes exclusory conditions. The outcome is a proposal for a DSM classification for the post electrical or lightning injury syndrome. This proposal is considered important for grounding patient treatment, and for further treatment trials. Options for treatment in electrical or lightning injury are summarised, and future trials are foreshadowed.

Diagnosis advances in vascular cognitive impairment

Vascular cognitive impairment（VCI） encompasses the entire range of cognitive deficits associated with cerebrovascular disease（CVD）, from mild deficits with little or no functional impairment, such as vascular cognitive impairment-no dementia（VCIND）, to full-blown vascular dementia（VaD）. Accurate diagnosis of vascular cognitive impairment is important but may be difficult. In this review we report advances in VCI in the following areas： etiology, subtypes, neuropsychology, biomarkers, neuroimaging, and diagnostic criteria.

The Trail Making Test in Morocco: Normative Data Stratified by Age and Level of Education

The purpose of this study is to design a Moroccan Trail Making Test B;explore the effects of age, education and gender on the performance of the Trail Making Test (TMT);and provide normative information in Moroccan subjects. Our normalization study was conducted on 348 subjects (156 female and 192 male). The subjects were classified into four groups based on age (18 - 39 years, 40 - 59 years, 60 - 69 years and ≥70 years), and three groups based on educational level (3 - 6 years, 7 - 10 years and ≥11 years). The data were analyzed using descriptive statistics through SPSS. The results displayed that increasing age and decreasing levels of education significantly result in a decreased performance on the Trail A, Moroccan Trail B and English Trail B. Only 229 bilingual subjects among the 348 initial subjects completed both versions of Trail B. There was no significant difference on performance between Moroccan Trail B and English Trail B for these subjects.

A neuropsychological evaluation of orthorexia nervosa

Orthorexia nervosa (ON) describes a fixation for proper nutrition and healthy foods that leads to die-tary restrictions and nutritional deficiencies over time. Given symptom overlap among ON, obsessive-compulsive disorder (OCD), and anorexia nervosa (AN), this study examines whether ON has a unique neuropsychological profile. Participants completed symptom checklists and neuropsychological tests chosen for their sensitivity to AN and OCD. Results showed that, across the full sample, ON is independently associated with self-reported weaknesses in Set-Shifting, Emotional Control, Self-Monitoring, and Working Memory. After controlling for AN and OCD variables, high- and low-ON groups differed in total correct trials on the Wisconsin Card Sorting Test. These areas of executive functioning, which are explained in the context of ON symptomatology, represent what would be considered the neuropsychological overlap among OCD and AN profiles.

Can Digital Games Be a Way of Improving the Neuroplasticity in Stroke Damage? Can the Adult Brain Grow New Cells or Rewire Itself in Response to a New Experience?

Exploratory studies developed at several neurosciences laboratories at universities around the world show us through the experience that there is a biological process called neuroplasticity. Because of this oldest concept about the neuronal formation, scientists also thought that if a particular area of the adult brain was damaged, the nerve cells could not form new connections and the functions controlled by this field of the brain would be permanently lost or could not be regenerate. However, studies have overturned this old view, and currently, scientists recognize that the brain continues to reorganize itself by forming new neural connections during the life. This phenomenon is called neuroplasticity that refers to the potential which the brain should be reorganized by creating new neural pathways to adapt, as it needs.

Preoperative and Postoperative Diffusion Tensor Imaging in Patients with Extra-Axial Lesions at the Frontal or Temporal Regions of the Brain and Their Correlations with Neuropsychological Outcomes

The underlying changes in the neuronal connectivity adjacent to brain tumours cannot always be depicted by conventional MR imaging. The hypothesis of this study was that preoperative neuropsychological deficits were associated with impairment of diffusivity in association fibre bundles. Hence, we investigated the potential of combined diffusion tensor imaging (DTI) fibre tracking and fractional anisotropy (FA) values of the fibres to determine changes in association fibres and their correlation to neuropsychological scores. Our study consisted of eighteen patients with extra-axial brain tumours in areas adjacent to the frontal and temporal lobes. They were assessed pre- and postoperatively with DTI and neuropsychological assessments. MR examinations were performed on a 3T-scanner. FA values were calculated for the uncinate fasciculus, arcuate fasciculus, superior fronto-occipital fasciculus, inferior fronto-occipital fasciculus and corticospinal tracts ipsilateral and contralateral to the tumor. These values were compared with neuropsychological scores for language, memory and attention. The analysis revealed marked differences in pre- and post-excision of the tumor in both FA values and neuropsychological scores. Quantitative DTI was able to show significant differences in diffusivity of the association fibres before and after the surgery (P < 0.05). The additional use of DTI-fibre integrity and neuropsychological tests may aid in prognostication and decision making prior to surgery.

Effects of task orientation on subsequent source memory as revealed by functional MRI

Episodic memories are composed of various interrelated elements, including those specific to items of central interest and those pertaining to related features, such as the color, shape, size, spatial location, temporal order, and media or modalities of presentation. Memory about a core item （such as a word, object, or picture） is called item memory while memory about the context or related fea- tures of a core item is defined as source memory. What determines which sources within an episode are successfully remembered is of particular interest to researchers. Behavioral evidence suggests that the orientation of a memory task influences whether the related source of the item will be re- membered later. This study explored changes in the hippocampus and prefrontal cortex while par- ticipants completed two tasks： an item-oriented task and a source-oriented task. We used functional MRI to investigate the neural mechanisms by which task orientation influences source encoding. We found that subsequent source memory effects in the right prefrontal cortex and hippocampus were modulated by task orientation, whereas task orientation modulated item memory effects in the prefrontal cortex. These findings highlight the possibility that the hippocampus contributes to the intentional encoding of item-source associations, whereas the prefrontal cortex is biased toward processing information to which attention is directed.

A network-based cognitive training induces cognitive improvements and neuroplastic changes in patients with relapsing-remitting multiple sclerosis:an exploratory case-control study

Cognitive impairments are commonly observed in patients with multiple sclerosis and are associated with lower levels of quality of life.No consensus has been reached on how to tackle effectively cognitive decline in this clinical population non-pharmacologically.This exploratory case-control study aims to investigate the effectiveness of a hypothesis-based cognitive training designed to target multiple domains by promoting the synchronous co-activation of different brain areas and thereby improve cognition and induce changes in functional connectivity in patients with relapsing-remitting multiple sclerosis.Forty-five patients(36 females and 9 males,mean age 44.62±8.80 years)with clinically stable relapsing-remitting multiple sclerosis were assigned to either a standard cognitive training or to control groups(sham training and nonactive control).The standard training included twenty sessions of computerized exercises involving various cognitive functions supported by distinct brain networks.The sham training was a modified version of the standard training that comprised the same exercises and number of sessions but with increased processing speed load.The non-active control group received no cognitive training.All patients underwent comprehensive neuropsychological and magnetic resonance imaging assessments at baseline and after 5 weeks.Cognitive and resting-state magnetic resonance imaging data were analyzed using repeated measures models.At reassessment,the standard training group showed significant cognitive improvements compared to both control groups in memory tasks not specifically targeted by the training:the Buschke Selective Reminding Test and the Semantic Fluency test.The standard training group showed reductions in functional connectivity of the salience network,in the anterior cingulate cortex,associated with improvements on the Buschke Selective Reminding Test.No changes were observed in the sham training group.These findings suggest that multi-domain training that stimulates multiple brain areas synchronously may improve cognition in people with relapsing-remitting multiple sclerosis if sufficient time to process training material is allowed.The associated reduction in functional connectivity of the salience network suggests that training-induced neuroplastic functional reorganization may be the mechanism supporting performance gains.This study was approved by the Regional Ethics Committee of Yorkshire and Humber(approval No.12/YH/0474)on November 20,2013.

Neuropsychological features of progranulin-associated frontotemporal dementia: a nested case-control study

The distinction between sporadic and genetic behavioural-variant frontotemporal dementia(bvFTD)regarding some neuropsychological(NP)features remains challenging.Specifically,progranulin(GRN)-associated bvFTD frequently presents with early episodic memory impairment and some degree of parietal dysfunction which are supporters of Alzheimer’s disease(AD)diagnosis.In this context,we aimed to characterize the NP profile of GRN-bvFTD as compared to sporadic-bvFTD and AD in patients with mild dementia(Mini-Mental State Examination score≥17 and Clinical Dementia Rating Scale score≤1.We identified 21 patients at Centro Hospitalar e Universitário de Coimbra,Portugal with GRN mutations belonging to fifteen different families.As our focus was bvFTD variants,FTD-related aphasic forms(3 patients)were excluded.The remaining 18 GRN-bvFTD were further matched with 18 sporadic-bvFTD and 18 AD patients according to disease staging,age and education.All patients completed the Mini-Mental State Examination,Montreal Cognitive Assessment(MoCA)and a comprehensive NP assessment battery.Results were converted into z-scores.Differences between groups in individual NP measures and NP domains were assessed through non-parametric tests(Kruskal-Wallis test analysis)and eta squared(ŋ2)was calculated as a measure of effect size.Group comparisons show that GRN patients have worse performances on verbal retrieval processes(P=0.039,ŋ2=0.110)and visuoconstructive abilities(P=0.039,ŋ2=0.190)than sporadic bvFTD forms.When compared to AD,GRN patients present a higher impairment in frontal(P=0.001,ŋ2=0.211)and parietal(P=0.041,ŋ2=0.129)measures and a better performance in memory tasks(P=0.020,ŋ2=0.120).Sporadic-bvFTD forms are worse than AD in frontal measures(P=0.032,ŋ2=0.200),being better in both memory(P=0.010,ŋ2=0.131)and visuospatial skills(P=0.023,ŋ2=0.231).Considering these results,we conclude that GRN-bvFTD patients present a NP profile that associates the typical patterns of FTD and AD deficits.This is particularly expressive in visuoconstructive abilities,which was the more discriminative feature between groups,followed by episodic verbal memory.This study was approved by the Institutional Ethics Committee of Centro Hospitalar e Universitário de Coimbra,Portugal(CE-029/2019)on June 24,2019.

Cognitive correlates of neuroimaging abnormalities in the onset of schizophrenia: A case report

Increasing evidence shows that cognitive impairment and brain abnormalities can appear early in the first episodes of schizophrenia, but it is currently debated how brain changes can correlate with clinical presentation of schizophrenic patients. Of note, this report describes the case of a young schizophrenic male presenting parietal magnetic resonance/positron emission tomography abnormalities and cognitive impairment, documented by specific neuropsychological tests. In our knowledge only few studies have investigated if neuropsychological abnormalities could be concomitant with both structural and functional neuroimaging. This case shows that impairment in specific cognitive domains is associated with structural/functional brain abnormalities in the corresponding brain areas(frontal and parietal lobes), supporting the hypothesis of disconnectivity, involving a failure to integrate anatomical and functional pathways. Future research would define the role of cognitive impairment and neurodegeneration in psychiatric nosography and, in particular, their role in the early phases of illness and long-term outcome of schizophrenic patients.

Cognitive Effects of Late Life Depression: Review of Neuropsychological Findings

Normal aging and depression both slow information processing speed which leads to poorer attentional control, shallower inhibition monitoring, poorer encoding, poorer updating of short term memory, and subsequent poorer learning, set-shifting, error monitoring, inhibition control, and cognitive planning. A combination of aging and depression amplifies these cognitive effects. Deterioration in frontal brain functioning in normal aging is irreversible, but altering of frontal brain function due to depression may be reversible. Since the symptoms are indistinguishable, it is difficult to separate effects of depression and aging with use of neuropsychological tests, even when premorbid history is known. Statistical group effects show more severe cognitive effects in late life depression than in normal aging or depression in younger persons, but no particular cognitive markers of depression in older subjects have been identified. Attention and inhibition are closely related, but their relationship needs to be studied further. It is not clear, whether a problem with inhibition of irrelevant stimuli occurs because of attentional deficits due to late life depression, or if it is a primary consequence of the depression. Further studies on the relationship between inhibition, attention and processing speed involving homogeneous depressed and non-depressed groups of different age may help disentangle this relationship.