Preliminary validation study of the Russian Birmingham Cognitive Screen.

INTRODUCTION: The Birmingham Cognitive Screen (BCoS) is designed for use with individuals who have acquired language impairment following stroke. Our goal was to develop a Russian version of the BCoS (Rus-BCoS) by translating the battery following cultural and linguistic adaptations and establishing preliminary data on its psychometric properties. METHOD: Fifty patients with left-hemisphere stroke were recruited, of whom 98% were diagnosed with mild to moderate aphasia. To check whether the Rus-BCoS provides stable and consistent scores, internal consistency, test-retest, and interrater types of reliability were determined. Eight participants with stroke and 20 neurologically intact participants were assessed twice. To inspect the discriminative power of the battery, 63 participants without brain impairment were tested with the Rus-BCoS. Additionally, the Russian version of the Montreal Cognitive Assessment (MoCA), Quantitative Assessment of Speech in Aphasia, and Luria's Neuropsychological Assessment Battery were used to examine convergent validity, sensitivity, and specificity of the Rus-BCoS. RESULTS: The internal consistency as well as test-retest and interrater reliability of the Rus-BCoS satisfied criteria for the research use. Performance on a majority of tasks in the battery correlated significantly with independently validated tests that putatively measure similar cognitive processes. Critically, all patients with aphasia returned nonzero scores in at least one task in all the Rus-BCoS sections, with the exception of the Controlled Attention section where two patients with severe executive control deficits could not perform. CONCLUSIONS: The Rus-BCoS shows promise as a comprehensive cognitive screening tool that can be used by clinicians working with Russian-speaking persons experiencing poststroke aphasia after much further validation and development of reliable normative standards. Given a lack of quantitative neuropsychological assessment tools in Russia, however, we contend the Rus-BCoS offers potential benefits to clinicians and patients. However, data from research studies with a broader sample of Russian speakers are needed.

Self-bias modulates saccadic control.

We present novel data on the role of attention in eliciting enhanced processing of stimuli associated with self. Participants were required to make pro- or anti-saccades according to whether learned shape-label pairings matched or mismatched. When stimuli matched participants were required to make an anti-saccade, and when the stimuli mismatched a pro-saccade was required. We found that anti-saccades were difficult to make to stimuli associated with self when compared to stimuli associated with a friend and a stranger. In contrast, anti-saccades to friend-stimuli were easier to make than anti-saccades to stranger-stimuli. In addition, a correct anti-saccade to a self-associated stimulus disrupted subsequent pro-saccade trials, relative to when the preceding anti-saccade was made to other stimuli. The data indicate that self-associated stimuli provide a strong cue for explicit shifts of attention to them, and that correct anti-saccades to such stimuli demand high levels of inhibition (which carries over to subsequent pro-saccade trials). The self exerts an automatic draw on attention.

Domain-specific versus generalized cognitive screening in acute stroke.

Cognitive assessments after stroke are typically short form tests developed for dementia that generates pass/fail classifications (e.g. the MoCA). The Oxford Cognitive Screen (OCS) provides a domain-specific cognitive profile designed for stroke survivors. This study compared the use of the MoCA and the OCS in acute stroke with respect to symptom specificity and aspects of clinical utility. A cross-sectional study with a consecutive sample of 200 stroke patients within 3 weeks of stroke completing MoCA and OCS. Demographic data, lesion side and Barthel scores were recorded. Inclusivity was assessed in terms of completion rates and reasons for non-completion were evaluated. The incidence of cognitive impairments on both the MoCA and OCS sub-domains was calculated and differences in stroke specificity, cognitive profiles and independence of the measures were addressed. The incidence of acute cognitive impairment was high: 76% of patients were impaired on MoCA, and 86% demonstrated at least one impairment on the cognitive domains assessed in the OCS. OCS was more sensitive than MoCA overall (87 vs 78% sensitivity) and OCS alone provided domain-specific information on prevalent post-stroke cognitive impairments (neglect, apraxia and reading/writing ability). Unlike the MOCA, the OCS was not dominated by left hemisphere impairments but gave differentiated profiles across the contrasting domains. The OCS detects important cognitive deficits after stroke not assessed in the MoCA, it is inclusive for patients with aphasia and neglect and it is less confounded by co-occurring difficulties in these domains.

Italian standardization of the Apples Cancellation Test.

Hemispatial neglect due to right parieto-temporo-frontal lesions has a negative impact on the success of rehabilitation, resulting in poor functional gain. Recent research has shown that different types of neglect can impact in a different way on rehabilitation outcomes. The availability of a sensitive test, useful for distinguishing egocentric and allocentric forms of neglect, may be clinically important as all current clinical instruments fail to distinguish between these forms of disturbance, yet they differentially predict outcome. The Apples Test is a new instrument useful to evaluate both egocentric and allocentric forms of neglect. In order to establish Italian norms for this diagnostic instrument the test was administered to a sample of 412 healthy people of both genders (201 M and 211 F), aged from 20 to 80 years enrolled from 14 different rehabilitation centers in Italy. Based on the data, we established pathological performance cut-offs for the accuracy score (total omission errors), the asymmetry score for egocentric neglect (omission error difference), the asymmetry score for allocentric neglect (commission error difference) and execution time. The usefulness of the Apples Test for diagnostic purposes is illustrated by presenting three patients with different forms of neglect (egocentric, allocentric and mixed neglect).

Effects of action relations on the configural coding between objects.

Configural coding is known to take place between the parts of individual objects but has never been shown between separate objects. We provide novel evidence here for configural coding between separate objects through a study of the effects of action relations between objects on extinction. Patients showing visual extinction were presented with pairs of objects that were or were not co-located for action. We first confirmed the reduced extinction effect for objects co-located for action. Consistent with prior results showing that inversion disrupts configural coding, we found that inversion disrupted the benefit for action-related object pairs. This occurred both for objects with a standard canonical orientation (e.g., teapot and teacup) and those without, but where grasping and using the objects was made more difficult by inversion (e.g., spanner and nut). The data suggest that part of the affordance effect may reflect a visuo-motor response to the configural relations between stimuli. Experiment 2 showed that distorting the relative sizes of the objects also reduced the advantage for action-related pairs. We conclude that action-related pairs are processed as configurations.

The relationship between specific cognitive impairment and behaviour in Prader-Willi syndrome.

BACKGROUND: Individuals with Prader-Willi syndrome (PWS) have been shown to demonstrate a particular cognitive deficit in attention switching and high levels of preference for routine and temper outbursts. This study assesses whether a specific pathway between a cognitive deficit and behaviour via environmental interaction can exist in individuals with PWS. METHODS: Four individuals with PWS participated in a series of three single-case experiments including laboratory-based and natural environment designs. Cognitive (computer-based) challenges placed varying demands on attention switching or controlled for the cognitive demands of the tasks while placing no demands on switching. Unexpected changes to routines or expectations were presented in controlled games, or imposed on participants' natural environments and compared with control conditions during which no unexpected changes occurred. Behaviour was observed and heart rate was measured. RESULTS: Participants showed significantly increased temper outburst related behaviours during cognitive challenges that placed demands on attention switching, relative to the control cognitive challenges. Participants showed significantly increased temper outburst related behaviours when unexpected changes occurred in an experimental or the natural environment compared with when no changes occurred. CONCLUSIONS: Difficult behaviours that could be triggered reliably in an individual by a specific cognitive demand could also be triggered via manipulation of the environment. Results suggest that a directional relationship between a specific cognitive deficit and behaviour, via environmental interaction, can exist in individuals with PWS.

The eyes have it: an exploration of eye movements in action disorganisation syndrome.

We examined eye movements in a patient, FK, who has action disorganisation syndrome (ADS), as he performed the everyday task of making a cup of tea. We compared his eye movements with those of a person with Alzheimer's disease and with healthy volunteers. Despite showing very disorganised behaviour many aspects of FK's eye movements were relatively normal. However, unlike normal participants FK made no advance glances to objects that were about to be used, and he made increased numbers of fixations to irrelevant objects during the task. There were also differences in the durations of his eye movements during correct actions and during his perseverative and task-addition responses. We discuss the implications for understanding ADS and the cognitive processes required for correctly performing everyday tasks.

Emotion recognition and duration of untreated first-episode psychosis among patients in Pakistan.

OBJECTIVE: To investigate the impact of duration of untreated psychosis on emotion recognition in patients with first-episode psychosis. METHODS: A sample of 60 patients with schizophrenia, schizoaffective and substance-induced psychoses were selected from psychiatric inpatients and outpatients of 3 hospitals in Lahore and 1 in Faisalabad, Pakistan. Patients were divided into short (n = 28) and long (n = 32) duration of untreated psychosis groups, according to whether they had had symptoms for < 80 or ≥ 80 weeks, respectively. Emotion recognition ability was assessed with the help of the Urdu version of a computerised experimental FEEL (Facially Expressed Emotion Labeling) test using 6 basic emotional expressions that appeared on a computer screen followed by possible responses. RESULTS: Patients with prolonged durations of untreated psychosis showed poorer performance in recognition of facial expressions of emotion than those with short durations of untreated psychosis. This was apparent in general and especially for expressions of anger, surprise, and sadness. First-episode psychosis patients showed higher accuracy rates for recognising positive as opposed to negative emotions. The duration of untreated psychosis correlated positively with positive symptoms of psychosis. Symptom distribution differed across categories of psychosis, but there were similarities in patients with schizophrenia and schizoaffective disorders. CONCLUSIONS: These findings support recourse to early detection and intervention strategies in psychosis and provide valuable information on how first-episode psychosis patients behave in complex emotional and social situations.

A specific pathway can be identified between genetic characteristics and behaviour profiles in Prader-Willi syndrome via cognitive, environmental and physiological mechanisms.

BACKGROUND: Behavioural phenotypes associated with genetic syndromes have been extensively investigated in order to generate rich descriptions of phenomenology, determine the degree of specificity of behaviours for a particular syndrome, and examine potential interactions between genetic predispositions for behaviour and environmental influences. However, relationships between different aspects of behavioural phenotypes have been less frequently researched and although recent interest in potential cognitive phenotypes or endophenotypes has increased, these are frequently studied independently of the behavioural phenotypes. METHOD: Taking Prader-Willi syndrome (PWS) as an example, we discuss evidence suggesting specific relationships between apparently distinct aspects of the PWS behavioural phenotype and relate these to specific endophenotypic characteristics. RESULTS: The framework we describe progresses through biological, cognitive, physiological and behavioural levels to develop a pathway from genetic characteristics to behaviour with scope for interaction with the environment at any stage. CONCLUSIONS: We propose this multilevel approach as useful in setting out hypotheses in order to structure research that can more rapidly advance theory.

Comparing action disorganization syndrome and dual-task load on normal performance in everyday action tasks.

The term 'action disorganization syndrome' has been used to describe patients with selective impairments in carrying out multi-step everyday tasks, which are not linked to motor deficits. We used a range of everyday life tasks to examine the effects on a patient with ADS of having related distractors present during task performance. The presence of related distractors increased omission errors in the patient. In a second experiment we assessed whether we could mimic this pattern of deficit when normal participants carried out the everyday tasks and a secondary task was imposed to place demands on executive processes. Secondary task load produced a general increase in errors in the controls and reduced the number of self-correcting responses, but there were no proportional increases in omission errors. Control participants and patients with ADS may suffer from demands on different processes involved in the performance of everyday actions. We discuss the implications for understanding everyday actions.

From both sides now: crossover effects influence navigation in patients with unilateral neglect.

Unilateral neglect is a challenging disorder that pervades a range of behaviours following stroke and hampers recovery. Although a preponderance of clinical studies measure performance on a range of bedside assessments, including line bisection and cancellation tasks, there have been calls for studies to embrace more relevant functional measures. Here, for the first time, we present data from two separate tasks that characterise the performance of seven patients with unilateral neglect when navigating a power wheelchair. The tasks involved negotiating an obstacle course and steering a central path between gaps of different sizes. Results from the obstacle course confirmed the clinical observation and predicted bias of contralesional errors. However, the second task revealed a robust "crossover" effect. Patients deviated to the ipsilesional side for large gaps but deviated increasingly contralesionally when steering through small gaps in behaviour that was analogous to that previously shown on line bisection tasks. Contrary to being seen as an unintuitive finding, further analysis of these errors suggests that patients are giving disproportionate weight to the location of the ipsilesional object when plotting a midline course between two objects. Our results provide a platform for further studies to investigate the modulation and rehabilitation of this important skill.

Previewing distracters reduces their effective contrast.

In a visual search task, when half the distracters are presented earlier than the remainder ('previewed'), observers find the target item more efficiently than when all the items are presented together -- the preview benefit. We measured psychometric functions for contrast increments on Gabors that were presented as a valid preview for subsequent search, and when they were a non-predictive (dummy) preview. Sensitivity to contrast increments was lower (rightwards shift of the psychometric function) on valid, compared to dummy previews. This is consistent with an account of the preview benefit in terms of active inhibition, equivalent to lowering the contrast of previewed items that are being actively ignored.

A psychophysical investigation into the preview benefit in visual search.

In preview search, half of the distracters are presented ahead of the remaining distracters and the target. Search under these conditions is more efficient than when all the items appear together (Watson & Humphreys, 1997). We investigated the mechanisms contributing to this preview benefit using an orientation discrimination task. In a display of vertical Gabors (all equidistant from fixation) one Gabor (chosen at random) was tilted (left or right). When half the non-tilted Gabors were previewed, thresholds increased less with the number of Gabors, relative to when all the Gabors appeared together (a preview benefit). In a further experiment, orientation noise was added to some of the Gabors. When all Gabors were presented simultaneously, orientation thresholds for the target increased. The effects of noise on thresholds was reduced, however, when the noisy Gabors were presented as a preview. Furthermore, there was less effect of noise in the preview condition than when observers were cued to a subset of Gabors (with a cue presented prior to the Gabors, adjacent to their positions). Visual information can be effectively excluded from the previewed locations to a greater degree than when attention is directed to a subset of display items. The implications for understanding the mechanisms involved in preview search are discussed.

Ideational action impairments in Alzheimer's disease.

We report data from a group of patients with mild Alzheimer's disease on a range of tasks requiring either stored semantic knowledge about objects (e.g., naming object use) or the execution of action to objects (e.g., miming and using objects). We found that the patients were impaired at miming in response to objects, even when they could describe the object's function. On the other hand, copying gestures was not impaired relative to naming gestures, indicating that an ideomotor deficit in action execution, per se, was unlikely to explain the impairments in object use. We suggest instead that the patients had an impairment in stored motor programmes for action, over and above their deficits in semantic knowledge. Despite this, the patients were better at using than at miming to objects, consistent with the view that proprioceptive input (when using objects) can directly constrain selection of the appropriate motor programme for action.

Case mixing and the right parietal cortex: evidence from rTMS.

We investigated the necessary role of the right parietal lobe in visual word recognition using transcranial magnetic stimulation (TMS). TMS was applied to the right posterior parietal lobe and to a control area as participants read aloud words presented either in lower case or in mIxEd-cAsE. The words were presented either with unlimited duration and high contrast (Experiment 1), or with brief presentation and low-contrast (Experiments 2 and 3). In all three experiments, TMS over the parietal area disrupted reading, and in Experiments 2 and 3 this effect was most pronounced for mIxEd-cAsE words. This suggests that the right parietal lobe mediates the recognition of words in unfamiliar formats.

A two-stage account of computing and binding occluded and visible contours: Evidence from visual agnosia and effects of lorazepam.

Previous work has shown that HJA, a patient suffering from visual agnosia, can complete occluded contours whilst being impaired at assigning contours to foreground and background figures (Giersch, Humphreys, Boucart, & Kovacs, 2000). Here we tested whether completed contours are automatically bound with visible contours, after being derived from them. HJA, lorazepam-treated and nontreated healthy participants were asked to match a first reference line with an equal or longer line of identical orientation included in one of two lateral figures. The target line was in the foreground or the background of the figures. The distractor picture included two short collinear line-segments belonging to two different figures, so that participants had to process the occluded parts to discriminate the target from the distractor line. When the target line was in the background, both HJA and lorazepam-treated participants were faster when the length of the reference line corresponded to the length of the occluded part of the target line, relative to when it corresponded to the length of the occluded part plus a visible contour. In contrast, control participants tended to show an advantage for matching a reference line whose length was the same as the visible contours plus the occluded part. However, when the stimuli were displayed for 50 ms only and then masked, controls showed the same results as HJA. These results suggest that responses in the matching tasks are biased by the existence of an early completed occluded line that remains isolated from real contours.

I can see what you are doing: Action familiarity and affordance promote recovery from extinction.

We assessed the effects of three factors on recovery from extinction in patients with lesions including the posterior parietal lobe: (a) whether objects were frequently used together in action versus whether they could be used in action together; (b) whether there was an effect of positioning objects for action; and (c) whether the surface properties of objects mediated performance. There was greater recovery from extinction for objects used frequently together, along with effects produced by objects that could be used together. There were also positive effects of correctly positioning objects for action. There were no effects of surface information on the benefit of reporting both members of a pair, though there were some effects on error trials. The results provide positive evidence for an effect on attention of affordances based on objects falling in plausible co-locations for action. Such affordances may also be influenced by the frequency with which objects are used together and can be generated from edge-based representations of objects (surface colour and depth are not necessary). However, surface-based representations may influence the speed with which action-related properties of objects engage attention.

Don't think twice, it's all right--contralesional dependency for bimanual prehension movements.

In bimanual coordination when moving the hands to two separate objects, subjects tend to initiate and terminate the movements together, even when the targets are at different distances or are of a different size. Additionally, each hand tends to scale its grasp independently to the object to be grasped. Here, we report the performance of a patient, who had previously shown signs of motor neglect, on two experiments investigating coupling and independence in bimanual coordination. The patient showed relatively normal bimanual behaviour for the transport phase of prehension when objects were placed at different distances (Experiment 1), but abnormal behaviour for the grasp component when objects were of different sizes (Experiment 2). Moreover, the contralesional limb demonstrated a dependency of grasp that was related to the object grasped by the ipsilesional limb. We discuss the possible underlying mechanisms of this dependency in relation to competitive motor programming and attentional bias. The results also reinforce the view that the transport and grasp components of prehension are distinct processes.

The effect of target foreknowledge on visual search for categorically separable orientation targets.

This research note assesses the role of target foreknowledge in visual search for categorically defined orientation targets, as first described by Wolfe et al. [Wolfe, J. M., Friedman-Hill, S. R., Stewart, M. I., & O'Connell, K. M. (1992). The role of categorisation in visual search for orientation. Journal of Experimental Psychology: Human Perception and Performance, 18, 34-49]. We compared search with known versus unknown (respond to the odd item) targets. An RT advantage for categorical search only emerged with known targets. The evidence points to an important role for top-down processes in search for categorically--defined orientation targets.

Bimanual coordination and perceptual grouping in a patient with motor neglect.

Motor neglect refers to the underutilisation of a limb contralateral to a brain lesion in the absence of primary motor and sensory deficits. The related problem of motor extinction refers to a contralesional motor deficit that worsens or only becomes apparent when bilateral actions are required. We present a single case (MM) of a patient with motor neglect who also demonstrates a form of motor extinction that is influenced by visual grouping between stimuli. The comparisons of unimanual and bimanual reach to grasp movements towards one or two objects in Experiment 1 showed that MM made relatively normal unimanual contralesional movements but impaired contralesional movements under bimanual action conditions. Experiment 2 demonstrated that motor extinction was improved by asking MM to make bimanual movements towards a single object. In Experiment 3, the effects of object coding on bimanual movement were replicated across conditions that varied the distance between end points for the movements. MM did not show overt visual extinction. We suggest that MM demonstrates a late-acting attentional bias that is expressed in terms of competitive motor activity. Normally, the contralesional limb "loses" the competition for action, but this can be modulated by visual grouping between targets.