Cognitive Impairment in Tuberculous Meningitis.

BACKGROUND: Cognitive impairment is reported as a common complication in adult tuberculous meningitis (TBM), yet few studies have systematically assessed the frequency and nature of impairment. Moreover, the impact of impairment on functioning and medication adherence has not been described. METHODS: A cognitive test battery (10 measures assessing 7 cognitive domains) was administered to 34 participants with human immunodeficiency virus (HIV)-associated TBM 6 months after diagnosis. Cognitive performance was compared with that a comparator group of 66 people with HIV without a history of tuberculosis. A secondary comparison was made between participants with TBM and 26 participants with HIV 6 months after diagnosis of tuberculosis outside the central nervous system (CNS). Impact on functioning was evaluated, including through assessment of medication adherence. RESULTS: Of 34 participants with TBM, 16 (47%) had low performance on cognitive testing. Cognition was impaired across all domains. Global cognitive performance was significantly lower in participants with TBM than in people with HIV (mean T score, 41 vs 48, respectively; P < .001). These participants also had lower global cognition scores than those with non-CNS tuberculosis (mean global T score, 41 vs 46; P = .02). Functional outcomes were not significantly correlated with cognitive performance in the subgroup of participants in whom this was assessed (n = 19). CONCLUSIONS: Low cognitive performance following HIV-associated TBM is common. This effect is independent of, and additional to, effects of HIV and non-CNS tuberculosis disease. Further studies are needed to understand longer-term outcomes, clarify the association with treatment adherence, a key predictor of outcome in TBM, and develop context-specific tools to identify individuals with cognitive difficulties in order to improve outcomes in TBM.

The statistical mechanics of felt uncertainty under active inference.

Convincing narratives are not confabulations. Presumably they "feel right" to decision-making agents because the probabilities they assign intuitively (i.e., implicitly) to potential outcomes are plausible. Can we render explicit the calculations that would be performed by a decision-making agent to evaluate the plausibility of competing narratives? And if we can, what, exactly, makes a narrative "feel right" to an agent?

Testosterone administration in women increases the size of their peripersonal space.

Peripersonal space (PPS) is the space immediately surrounding the body, conceptualised as a sensory-motor interface between body and environment. PPS size differs between individuals and contexts, with intrapersonal traits and states, as well as social factors having a determining role on the size of PPS. Testosterone plays an important role in regulating social-motivational behaviour and is known to enhance dominance motivation in an implicit and unconscious manner. We investigated whether the dominance-enhancing effects of testosterone reflect as changes in the representation of PPS in a within-subjects testosterone administration study in women (N = 19). Participants performed a visuo-tactile integration task in a mixed-reality setup. Results indicated that the administration of testosterone caused a significant enlargement of participants' PPS, suggesting that testosterone caused participants to implicitly appropriate a larger space as their own. These findings suggest that the dominance-enhancing effects of testosterone reflect at the level of sensory-motor processing in PPS.

Mentalizing the body: spatial and social cognition in anosognosia for hemiplegia.

Following right-hemisphere damage, a specific disorder of motor awareness can occur called anosognosia for hemiplegia, i.e. the denial of motor deficits contralateral to a brain lesion. The study of anosognosia can offer unique insights into the neurocognitive basis of awareness. Typically, however, awareness is assessed as a first person judgement and the ability of patients to think about their bodies in more 'objective' (third person) terms is not directly assessed. This may be important as right-hemisphere spatial abilities may underlie our ability to take third person perspectives. This possibility was assessed for the first time in the present study. We investigated third person perspective taking using both visuospatial and verbal tasks in right-hemisphere stroke patients with anosognosia (n = 15) and without anosognosia (n = 15), as well as neurologically healthy control subjects (n = 15). The anosognosic group performed worse than both control groups when having to perform the tasks from a third versus a first person perspective. Individual analysis further revealed a classical dissociation between most anosognosic patients and control subjects in mental (but not visuospatial) third person perspective taking abilities. Finally, the severity of unawareness in anosognosia patients was correlated to greater impairments in such third person, mental perspective taking abilities (but not visuospatial perspective taking). In voxel-based lesion mapping we also identified the lesion sites linked with such deficits, including some brain areas previously associated with inhibition, perspective taking and mentalizing, such as the inferior and middle frontal gyri, as well as the supramarginal and superior temporal gyri. These results suggest that neurocognitive deficits in mental perspective taking may contribute to anosognosia and provide novel insights regarding the relation between self-awareness and social cognition.

Testosterone facilitates the sense of agency.

Sense of agency (SoA) refers to feelings of being in control of one's actions. Evidence suggests that SoA might contribute towards higher-order feelings of personal control - a key attribute of powerful individuals. Whether testosterone, a steroid hormone linked to power in dominance hierarchies, also influences the SoA is not yet established. In a repeated-measures design, 26 females participated in a double-blind, placebo-controlled trial to test the effects of 0.5 mg testosterone on SoA, using an implicit measure based upon perceived shifts in time between a voluntary action and its outcome. Illusions of control, as operationalized by optimism in affective forecasting, were also assessed. Testosterone increased action binding but there was no significant effect on tone binding. Affective forecasting was found to be significantly more positive on testosterone. SoA and optimistic expectations are basic manifestations of power which may contribute to feelings of infallibility often associated with dominance and testosterone.

Hand preference is selectively related to common and internal carotid arterial asymmetry.

This study documents relationships between handedness and carotid arterial asymmetries. The article is divided into two sections, considering first geometric (n = 195) and then haemodynamic (n = 228) asymmetries. In the geometric study, diameters, lengths, and angles of the common carotid arteries in left and right-handed participants were measured using computed tomography angiography scans. Resistance to blood flow was calculated according to Poiseuille's formula. In the haemodynamic study, peak systolic and end-diastolic velocity, vessel diameter, and volume flow rate of the common, internal, and external carotid arteries were measured in left and right-handed participants, using Doppler ultrasonography. The findings reveal for the first time that the extracranial arteries supplying the cerebral hemispheres are asymmetrical in a direction that increases blood flow to the hemisphere dominant for handedness. Significant handedness interactions were identified in arterial length, diameter, resistance to blood flow, velocity and flow volume rate (p < .001). Arterial resistance and volume flow rates significantly predicted hand preference and proficiency. Our findings reveal a vascular correlate of handedness, but causality cannot be determined from this study alone. These asymmetries appear to be independent of aortic arch anomalies, suggesting a top-down, possibly demand-driven, pattern of development.

Changing definitions of euphoria in multiple sclerosis: A short report.

A recent interest in euphoria in multiple sclerosis (MS) has resulted in a wealth of literature on this topic. However, a marked change in the definition of this symptom appears to have taken place since its first descriptions in the mid-19(th) century. This short report will demonstrate that the 'euphoria' being studied today may not be the same state as that originally observed and described in MS patients and some implications of this possibility are discussed.

Social dominance and the Affective Neuroscience Personality Scales.

The tendency for cohabiting mammals to organise themselves into dominance hierarchies is a well-documented phenomenon and has consistently been linked to the activity of testosterone and cortisol. However, a systematic account of it within the "basic emotion" taxonomy proposed by Panksepp remains uncharted. The Affective Neuroscience Personality Scales (ANPS), developed to measure the influence of basic affective systems on human temperamental variability, were used as a tool through which to dissociate incentives that promote social dominance from other personality stereotypes. 36 Males were assayed for baseline testosterone and cortisol. Dominance, conceptualised as an egocentric incentive for gaining social influence, was found to positively correlate with the testosterone: cortisol ratio but not with any existing subscales of the ANPS. While these findings suggest that trait dominance can be monitored as an independent personality variable according to a distinct bodily hormone pattern, whether this reflects a distinguishable synaptic-neuronal chemical profile remains unresolved.

Investigating the role of social-affective attachment processes in cradling bias: the absence of cradling bias in children with Autism Spectrum Disorders.

Previous studies suggest that leftward cradling bias may facilitate mother-infant relationships, as it preferentially locates the infant in the mother's left hemi-space, which is specialized for several social-affective processes. If leftward cradling bias is mediated by social-affective attachment processes, it should be reduced in humans who are deficient in such processes. Individuals diagnosed with Autism Spectrum Disorders (ASDs) constitute a population with known deficits in social and emotional relating. A pilot study confirmed reduced bias in this group, and in the present study, we elaborated methods to assess also the impact of higher cognitive processes on cradling bias. Direct systematic observation was used to investigate the occurrence of cradling bias in ASD, non-ASD intellectually disabled children and typically developing children. Ninety-three participants aged 5-15 years cradled a life-like doll on four separate occasions. Intelligence and executive functions were assessed. Regression analyses revealed that ASD diagnosis was the only significant predictor of atypical cradling preference. While intellectually disabled and typically developing children clearly preferred to cradle to the left, no preference was evident in the ASD group. Results support the hypothesis that leftward cradling bias is associated with basic social-affective capacities.

Reconsolidation: Turning consciousness into memory.

The purpose of learning is not to maintain records but to generate predictions. Successful predictions remain implicit; only prediction errors ("surprises") attract consciousness. This is what Freud had in mind when he declared that "consciousness arises instead of a memory-trace." The aim of reconsolidation, and of psychotherapy, is to improve predictions about how to meet our needs in the world.

A neuropsychoanalytical approach to the hard problem of consciousness.

A neuropsychoanalytical approach to the hard problem of consciousness revolves around the distinction between the subject of consciousness and objects of consciousness. In contrast to the mainstream of cognitive science, neuropsychoanalysis prioritizes the subject. The subject of consciousness is the indispensable page upon which consciousness of objects is inscribed. This has implications for our conception of the mental. The subjective being of consciousness is not registered in the classical exteroceptive modalities; it is not merely a cognitive representation, not only a memory trace. Rather, the exteroceptive modalities are registered in the subjective being. Cognitive representations are mental solids embedded within subjectivity, the tangible and visible (etc) properties of which are projected onto reality. It is important to recognize that mental solids (e.g., the body-as-object) are no more real than the subjective being they are inscribed in (the body-as-subject). Moreover, pure subjectivity is not without content or quality. This aspect of consciousness is conventionally described quantitatively as the level of consciousness, or wakefulness. But it feels like something to be awake. The primary modality of this aspect of consciousness is affect. Affect supplies the subjectivity that underpins all consciousness. Some implications of this approach are discussed here, in broad brush strokes.

Arousal coherence, uncertainty, and well-being: an active inference account.

Here we build on recent findings which show that greater alignment between our subjective experiences (how we feel) and physiological states (measurable changes in our body) plays a pivotal role in the overall psychological well-being. Specifically, we propose that the alignment or 'coherence' between affective arousal (e.g. how excited we 'feel') and autonomic arousal (e.g. heart rate or pupil dilation) may be key for maintaining up-to-date uncertainty representations in dynamic environments. Drawing on recent advances in interoceptive and affective inference, we also propose that arousal coherence reflects interoceptive integration, facilitates adaptive belief updating, and impacts our capacity to adapt to changes in uncertainty, with downstream consequences to well-being. We also highlight the role of meta-awareness of arousal, a third level of inference, which may permit conscious awareness, learning about, and intentional regulation of lower-order sources of arousal. Practices emphasizing meta-awareness of arousal (like meditation) may therefore elicit some of their known benefits via improved arousal coherence. We suggest that arousal coherence is also likely to be associated with markers of adaptive functioning (like emotional awareness and self-regulatory capacities) and discuss mind-body practices that may increase coherence.

A novel method for objectively classifying sequential emotion within dreams: a proof-of-concept pilot study.

Traditionally, emotions in dreams have been assessed using subjective ratings by human raters (e.g., external raters or dreamers themselves). These methods have extensive support and utility in dream science, yet they have certain innate limitations due to the subjective nature of the rating methodologies. Attempting to circumvent several of these limitations, we aimed to develop a novel method for objectively classifying and quantifying sequential (word-for-word) emotion within a dream report. We investigated whether sentiment analysis, a branch of natural language processing, could be used to generate continuous positive and negative valence ratings across a dream. In this pilot, proof-of-concept study, we used 14 dream reports collected upon awakening following overnight polysomnography. We also collected pre- and post-sleep affective data and personality metrics. Our objectives included demonstrating that (1) valence ratings derived from sentiment analysis (Valence Aware Dictionary for sEntiment Reasoning [VADER]) could be used to visualize (plot) positive and negative emotion fluctuations within a dream, (2) how the visual properties of emotion fluctuations within a dream (peaks and troughs, area under the curve) can be used to generate novel "emotion indicators" as proxies for emotion regulation throughout a dream, and (3) these emotion indicators correlate with sleep, affective, and personality variables known to be associated with dreaming and emotion regulation. We describe 6 novel, objective dream emotion indicators: Total number of Peaks, total number of Troughs, Positive, Negative, and Overall Emotion Intensity (composites from an "area under the curve" method using the trapezoid rule applied to the peaks and troughs), and the Emotion Gradient (a polynomial trendline fitted to the emotion fluctuations in the dream chart). The latter signifies the overall direction of sequential emotion changes within a dream. Results also showed that ⅚ emotion indicators correlated significantly with at least one existing sleep, affective, or personality variable known to be associated with dreaming and emotion regulation. We propose that the novel emotion indicators potentially serve as proxies for emotion regulation processes unfolding within a dream. These preliminary findings provide a methodological foundation for future studies to test and refine the method in larger and more diverse samples.

What I think she thinks about my paralysed body: Social inferences about disability-related content in anosognosia for hemiplegia.

The neuropsychological disorder of anosognosia for hemiplegia (AHP) can offer unique insights into the neurocognitive processes of body consciousness and representation. Previous studies have found associations between selective social cognition deficits and anosognosia. In this study, we examined how such social cognition deficits may directly interact with representations of one's body as disabled in AHP. We used a modified set of previously validated Theory of Mind (ToM) stories to create disability-related content that was related to post-stroke paralysis and to investigate differences between right hemisphere damage patients with (n = 19) and without (n = 19) AHP. We expected AHP patients to perform worse than controls when trying to infer paralysis-related mental states in the paralysis-related ToM stories and explored whether such differences depended on the inference patients were asked to perform (e.g. self or other referent perspective-taking). Using an advanced structural neuroimaging technique, we expected selective social cognitive deficits to be associated with posterior parietal cortex lesions and deficits in self-referent perspective-taking in paralysis-related mentalising to be associated with frontoparietal disconnections. Group- and individual-level results revealed that AHP patients performed worse than HP controls when trying to infer paralysis-related mental states. Exploratory lesion analysis results revealed some of the hypothesised lesions, but also unexpected white matter disconnections in the posterior body and splenium of the corpus collosum associated with a self-referent perspective-taking in paralysis-related ToM stories. The study has implications for the multi-layered nature of body awareness, including abstract, social perspectives and beliefs about the body.

Dreaming is not controlled by hippocampal mechanisms.

Links with the Humanities are to be welcomed, but they cannot be exempted from normal scientific criteria. Any hypothesis regarding the function of dreams that is premised on rapid eye movement (REM)/dream isomorphism is unsupportable on empirical grounds. Llewellyn's hypothesis has the further problem of counter-evidence in respect of its claim that dreaming relies upon hippocampal functions. The hypothesis also lacks face validity.

Cradling bias is absent in children with autism spectrum disorders.

OBJECTIVE: This study investigated relations among empathy and cradling bias in children diagnosed with autism spectrum disorders (ASDs). METHOD: Twenty children with ASDs and 20 typically developing (TD) children, aged 5-15 years old, cradled a doll as if it were an infant s/he was putting to sleep on three separate occasions. We recorded side preference on each occasion. RESULTS: Children with ASDs showed no preference for cradling side whereas TD children showed a strong left-sided preference. To the best of our knowledge, children with ASDs are the only population that does not exhibit cradling bias. CONCLUSION: An absence of cradling bias and empathy deficits in ASD may be related. If so, these data support the hypothesis that leftward cradling is a characteristic of enhanced quality of caregiver-infant interaction and bonding.

Planning to Learn: A Novel Algorithm for Active Learning during Model-Based Planning.

Active Inference is a recently developed framework for modeling decision processes under uncertainty. Over the last several years, empirical and theoretical work has begun to evaluate the strengths and weaknesses of this approach and how it might be extended and improved. One recent extension is the "sophisticated inference" (SI) algorithm, which improves performance on multi-step planning problems through a recursive decision tree search. However, little work to date has been done to compare SI to other established planning algorithms in reinforcement learning (RL). In addition, SI was developed with a focus on inference as opposed to learning. The present paper therefore has two aims. First, we compare performance of SI to Bayesian RL schemes designed to solve similar problems. Second, we present and compare an extension of SI - sophisticated learning (SL) - that more fully incorporates active learning during planning. SL maintains beliefs about how model parameters would change under the future observations expected under each policy. This allows a form of counterfactual retrospective inference in which the agent considers what could be learned from current or past observations given different future observations. To accomplish these aims, we make use of a novel, biologically inspired environment that requires an optimal balance between goal-seeking and active learning, and which was designed to highlight the problem structure for which SL offers a unique solution. This setup requires an agent to continually search an open environment for available (but changing) resources in the presence of competing affordances for information gain. Our simulations demonstrate that SL outperforms all other algorithms in this context - most notably, Bayes-adaptive RL and upper confidence bound (UCB) algorithms, which aim to solve multi-step planning problems using similar principles (i.e., directed exploration and counterfactual reasoning about belief updates given different possible actions/observations). These results provide added support for the utility of Active Inference in solving this class of biologically-relevant problems and offer added tools for testing hypotheses about human cognition.

Approach/avoidance in dreams.

The influential threat simulation theory (TST) asserts that dreaming yields adaptive advantage by providing a virtual environment in which threat-avoidance may be safely rehearsed. We have previously found the incidence of biologically threatening dreams to be around 20%, with successful threat avoidance occurring in approximately one-fifth of such dreams. TST asserts that threat avoidance is over-represented relative to other possible dream contents. To begin assessing this issue, we contrasted the incidence of 'avoidance' dreams with that of their opposite: 'approach' dreams. Because TST states that the threat-avoidance function is only fully activated in ecologically valid (biologically threatening) contexts, we also performed this contrast for populations living in both high- and low-threat environments. We find that 'approach' dreams are significantly more prevalent across both contexts. We suggest these results are more consistent with the view that dreaming is generated by reward-seeking systems than by fear-conditioning systems, although reward-seeking is clearly not the only factor determining the content of dreams.

The future of the Affective Neuroscience Personality Scales: A reflection on seven pressing matters.

The Affective Neuroscience Personality Scales (ANPS) were designed to provide researchers in the mental sciences with an inventory to assess primary emotional systems according to Pankseppian Affective Neuroscience Theory (ANT). The original ANPS, providing researchers with such a tool, was published in 2003. In the present brief communication, about 20 years later, we reflect upon some pressing matters regarding the further development of the ANPS. We touch upon problems related to disentangling traits and states of the primary emotional systems with the currently available versions of the ANPS and upon its psychometric properties and its length. We reflect also on problems such as the large overlap between the SADNESS and FEAR dimensions, the disentangling of PANIC and GRIEF in the context of SADNESS, and the absence of a LUST scale. Lastly, we want to encourage scientists with the present brief communication to engage in further biological validation of the ANPS.

Awareness is in the eye of the observer: Preserved third-person awareness of deficit in anosognosia for hemiplegia.

In recent decades, the research traditions of (first-person) embodied cognition and of (third-person) social cognition have approached the study of self-awareness with relative independence. However, neurological disorders of self-awareness offer a unifying perspective to empirically investigate the contribution of embodiment and social cognition to self-awareness. This study focused on a neuropsychological disorder of bodily self-awareness following right-hemisphere damage, namely anosognosia for hemiplegia (AHP). A previous neuropsychological study has shown AHP patients, relative to neurological controls, to have a specific deficit in third-person perspective taking and allocentric stance (the other unrelated to the self) in higher order mentalizing tasks. However, no study has tested if verbal awareness of motor deficits is influenced by perspective-taking and centrism and identified the related anatomical correlates. Accordingly, two novel experiments were conducted with right-hemisphere stroke patients with (n = 17) and without AHP (n = 17) that targeted either their own (egocentric, experiment 1) or another stooge patients (allocentric, experiment 2) motor abilities from a first-or-third person perspective. In both experiments, neurological controls showed no significant difference in perspective-taking, suggesting that social cognition is not a necessary consequence of right-hemisphere damage. More specifically, experiment 1 found AHP patients more aware of their own motor paralysis (egocentric stance) when asked from a third compared to a first-person perspective, using both group level and individual level analysis. In experiment 2, AHP patients were less accurate than controls in making allocentric judgements about the stooge patient, but with only a trend towards significance and with no difference between perspectives. As predicted, deficits in egocentric and allocentric third-person perspective taking were associated with lesions in the middle frontal gyrus, superior temporal and supramarginal gyri, and white matter disconnections were more prominent with deficits in allocentricity. Behavioural and neuroimaging results demonstrate the intersecting relationship between bodily self-awareness and self-and-other-directed metacognition or mentalisation.