RESUMO
Despite a growing literature, experiments directly related to attachment are still needed. We explored brain processes involved in two aspects of attachment, distress and comfort. Seventy-eight healthy adult males with different attachment styles (secure, avoidant, and anxious) viewed distress, comfort, complicity-joy and neutral images (picture database BAPS-Adult) in an fMRI block design. ROIs from the modules described in the functional Neuro-Anatomical Model of Attachment (Long et al. 2020) were studied. Secure participants used more co- and self-regulation strategies and exhibited a higher activation of the reward network in distress and comfort viewing, than insecure participants. Avoidant participants showed the lower brain activations. Their approach and reward modules were the least activated in distress and comfort. Anxious participants presented both higher activations of the approach and aversion modules during complicity-joy. In addition, comfort and complicity-joy were processed differently according to attachment styles and should be differentiated among positive stimuli to disentangle attachment processes.
RESUMO
Cognitive performance of older adults is very often inferior to that of younger adults on a variety of laboratory tests assessing basic functions such as memory, inhibition, or attention. Classic hypotheses and theories share the idea that these cognitive deficits are irreversible, due to profound cerebral changes. In this review article, we develop a more positive conception of aging, according to which cognitive deficits are not all irreversible, and can even be partially if not completely reversible. To this end, we present some of the most illustrative research on the reversibility of the effects of aging on cognition. We show how subtle contextual manipulations can change older adults' motivation and strategy, which improve their cognitive performance. We also show that guidance toward the selection of the most appropriate strategy, whether explicit as in selectivity paradigms or implicit as in dual-task procedures, can increase older adults' cognitive performance. We finally describe the hypotheses and theories that both account for low cognitive performance in old age and ways to reverse the effects of cognitive aging.
Assuntos
Transtornos Cognitivos , Envelhecimento Cognitivo , Disfunção Cognitiva , Humanos , Idoso , Cognição , EnvelhecimentoRESUMO
BACKGROUND: There are currently no recommendations on the therapeutic management of Parkinson's disease (PD) patients at the end of life. OBJECTIVE: To describe a cohort of patients with PD who benefited from continuous subcutaneous apomorphine infusion (CSAI) initiation at the end of their life as comfort care. METHODS: This real-life cohort includes 14 PD patients, who benefited from 24-h, low-dose CSAI (0.5-3âmg/h) in the context of terminal care. Patient's comfort (pain, rigidity, and/or ability to communicate) and occurrence of CSAI-related side-effects (nausea/vomiting, cutaneous and behavioral manifestations) were evaluated based on medical records. RESULTS: All patients (age 62-94 years, disease duration 2-32 years) presented with late-stage PD and a compromised oral route. Treatment lasted from a few hours to 39 days. CSAI led to substantial functional improvement, with a good safety profile. Overall clinical comfort was deemed improved by the medical team, the patient, and/or caregivers. CONCLUSIONS: CSAI might be a promising approach in PD terminal care, as it reduces motor symptoms and overall discomfort, with an apparent good safety profile. Use of the apomorphine pen, sublingual film or a classic syringe pump might be considered when apomorphine pumps are not available. Larger observational cohorts and randomized controlled trials are needed to establish the efficacy and tolerability of apomorphine in the context of terminal care and more broadly, in an advance care planning perspective.