Stationary stable cross-correlation pattern and task specific deviations in unresponsive wakefulness syndrome as well as clinically healthy subjects.

Brain dynamics is highly non-stationary, permanently subject to ever-changing external conditions and continuously monitoring and adjusting internal control mechanisms. Finding stationary structures in this system, as has been done recently, is therefore of great importance for understanding fundamental dynamic trade relationships. Here we analyse electroencephalographic recordings (EEG) of 13 subjects with unresponsive wakefulness syndrome (UWS) during rest and while being influenced by different acoustic stimuli. We compare the results with a control group under the same experimental conditions and with clinically healthy subjects during overnight sleep. The main objective of this study is to investigate whether a stationary correlation pattern is also present in the UWS group, and if so, to what extent this structure resembles the one found in healthy subjects. Furthermore, we extract transient dynamical features via specific deviations from the stationary interrelation pattern. We find that (i) the UWS group is more heterogeneous than the two groups of healthy subjects, (ii) also the EEGs of the UWS group contain a stationary cross-correlation pattern, although it is less pronounced and shows less similarity to that found for healthy subjects and (iii) deviations from the stationary pattern are notably larger for the UWS than for the two groups of healthy subjects. The results suggest that the nervous system of subjects with UWS receive external stimuli but show an overreaching reaction to them, which may disturb opportune information processing.

Clinimetric properties of the diagnostic criteria for psychosomatic research among the elderly.

INTRODUCTION: Among the elderly, the availability of tool assessing psychosomatic syndromes is limited. The present study aims at testing inter-rater reliability and concurrent validity of the semi-structured interview for the Diagnostic Criteria for Psychosomatic Research (DCPR-R-SSI) in the elderly of the general population. METHOD: One hundred eight subjects were recruited. Participants received a clinical assessment which included the DCPR-R-SSI, the Illness Attitude Scale (IAS), the Geriatric Depression Scale (GDS), the Psychosocial Index (PSI), the Toronto Alexithymia Scale-20 (TAS-20). Analyses of inter-rater reliability of DCPR-R-SSI and concurrent validity between DCPR-R-SSI and self-administered questionnaires were conducted. RESULTS: DCPR-R-SSI showed excellent inter-rater reliability with a percent of agreement of 90.7% (K Cohen: 0.856 [SE = 0.043], 95% CI: 0.77-0.94). DCPR-R demoralization showed fair concurrent validity with GDS; concurrent validity was also fair between DCPR-R Alexithymia and TAS-20, and between DCPR-R allostatic overload and PSI allostatic load, while the concurrent validity between DCPR-R Disease Phobia and IAS was moderate. CONCLUSION: DCPR-R-SSI represents a reliable and valid tool to assess psychosomatic syndromes in the elderly. DCPR-R is in need of being implemented in the elderly clinical evaluation.

Brain and behaviour in post-acute stroke: Reduction in seeking and posterior cingulate neuronal variability.

INTRODUCTION: Stroke is a complex event on both behavioral and neuronal grounds. Recent investigations evidence the central role of subcortical damage on the post-stroke brain and behavior reorganization. We have conducted an exploratory study combining anatomical lesion analysis, functional analysis of resting state fMRI, and behavioral assessment with focus on exploration as represented by SEEKING. METHOD: 24 stroke inpatients were studied immediately after their clinical stabilization post-stroke; neuronal variability in fMRI along with behavioral outcomes were assessed. These outcomes were compared with a control group of 22 healthy subjects. RESULTS: First, we observed predominant subcortical lesions in our sample with all stroke patients showing subcortical lesions and only some exhibiting additional cortical lesions. Second, we observed significantly reduced neuronal variability in the posterior cingulate cortex (PCC) that did not show any structural damage. Third, our stroke subjects showed reduced SEEKING which was related to reduced PCC neuronal variability in an abnormal way (compared to healthy subjects). This last outcome was assessed by considering the subset of 11 stroke subjects for which fMRI and behavioral outcomes were jointly measured. CONCLUSIONS: Taken together, our findings suggest that damage in subcortical regions may play a central role in abnormalities in both cortical activity (PCC) and associated behavior of post-stroke reorganization. Accounting for these aspects may have significant implications to optimize multidisciplinary rehabilitation processes, particularly during the early steps of recovery, reducing the impact of stroke on the patient and caregiver quality of life.

Morfeo Study II: Clinical Course and Complications in Patients With Long-Term Disorders of Consciousness.

BACKGROUND: The life expectancy of patients with disorders of consciousness (DOCs) is ever-increasing, but little is known about their clinical course over late stages. Several issues (premorbid conditions, complications and pressure sores) are to be considered for their effect on clinical outcome, risk of death and recovery of functional performance. Unfortunately, in late stages of long-term rehabilitation, these aspects are still more neglected than in acute and postacute stages. The aim of this study was to investigate the clinical course and the complications of patients in the late stages of DOCs and to explore the relationship between mortality and specific biomarkers. MATERIALS AND METHODS: A total of 112 patients, admitted over 10 years in a dedicated ward, were retrospectively studied. Sociodemographic data, preadmission and inpatient clinical features were collected. Disability Rating Scale scores, complications including pressure sores and blood markers were assessed monthly. Data were analyzed through descriptive statistics and correlations using SPSS. RESULTS: Most patients were men older than 50 years with a nontraumatic etiology and a history of hypertension (42.86%). The most common complication was pneumonia (76.79%). No association was found between sex and mortality or between etiology and mortality (P > 0.05). Mortality correlated significantly with sepsis (ρ = 0.253), albumin (ρ = -0.558), hemoglobin (ρ = -0.354) and white blood cells (ρ = 0.243). Only 42% of patients remained unchanged at Disability Rating Scale evaluation. CONCLUSIONS: These data confirmed that DOCs are not static conditions and they require ongoing monitoring and assessment of clinical status, level of consciousness and laboratory biomarkers.

Anxious attachment style and hopelessness as predictors of burden in caregivers of patients with disorders of consciousness: a pilot study.

OBJECTIVE: Previous studies on caregivers of patients with disorders of consciousness (DOCs) have highlighted that their overall burden is not related to disease duration or diagnosis, but mainly to their personal characteristics. The aim of this study was to investigate the impact of attachment style and hopelessness on overall burden in caregivers of patients in both vegetative state and minimally conscious state. METHODS AND PROCEDURE: Nineteen caregivers of patients with DOCs, hosted in a long-term care facility, were assessed using the Caregiver Burden Inventory, the Attachment Style Questionnaire, and the Beck Hopelessness Scale. Socio-demographic information was also collected. Data were analysed through descriptive statistics, correlations, one sample t-test and a multiple regression analysis using SPSS. OUTCOMES AND RESULTS: Burden was not associated with duration of caregiving and gender had no effect on overall burden. Multiple regression analysis indicated that preoccupied attachment style and hopelessness together predicted 49% of the total variability of burden (R(2 )= 0.489; adjusted R = 0.43). CONCLUSIONS: These data suggest that caregivers need psychological assessment and support in order to keep under control the level of burden and to help themselves be a better resource for their relatives.