Empathy and Impaired Socioemotional Self-Perception in Frontotemporal Dementia.

OBJECTIVE: Impaired empathy is a core feature of behavioral variant frontotemporal dementia (bvFTD). Patients with bvFTD are also prominently impaired in experiencing self-conscious emotions. The investigators explored whether impaired empathy in bvFTD, such as self-conscious emotions, may result from impaired self-consciousness in social situations (socioemotional self-perception). METHODS: This pilot study evaluated 25 patients with bvFTD and compared them with 25 patients with Alzheimer's disease who had comparable dementia severity. Their caregivers completed the Social Dysfunction Scale (SDS), which quantifies empathy, and an extensive intake interview that included questions regarding self-consciousness and insight. The patients completed two measures of self-perception in social situations, the Schutte Self-Report Emotional Intelligence Test (SSEIT) scale and the Embarrassability Scale (EMB). RESULTS: Caregivers of patients with bvFTD, but not of patients with Alzheimer's disease, reported a high correlation between significantly decreased empathy (SDS) and decreased self-consciousness (intake interview questions). Consistent with lack of insight, the patients with bvFTD, unlike the patients with Alzheimer's disease, did not report decreases on the SSEIT and EMB measures. CONCLUSIONS: These preliminary findings suggest that impaired socioemotional self-perception plays a role in the loss of empathy among patients with bvFTD. A lack of self-consciousness in social situations may contribute to a loss of empathy resulting from an inability to co-represent another's emotion in relation to oneself.

Bipolar Disorder Among Patients Diagnosed With Frontotemporal Dementia.

OBJECTIVE: Previous studies have documented manic and hypomanic symptoms in behavioral variant frontotemporal dementia (bvFTD), suggesting a relationship between bipolar disorder and bvFTD. METHODS: The investigators conducted a literature review as well as a review of the psychiatric histories of 137 patients with bvFTD, and patients with a prior diagnosis of bipolar disorder were identified. The clinical characteristics of patients' bipolar disorder diagnosis, family history, features of bvFTD, and results from fluorodeoxyglucose positron emission tomography (FDG-PET), as well as autopsy findings, were evaluated. RESULTS: Among the 137 patients, 14 (10.2%) had a psychiatric diagnosis of bipolar disorder, eight of whom met criteria for bipolar disorder (type I, N=6; type II, N=2) 6-12 years preceding onset of classic symptoms of progressive bvFTD. Seven of the eight patients with bipolar disorder had a family history of mood disorders, four had bitemporal predominant hypometabolism on FDG-PET, and two had a tauopathy involving temporal lobes on autopsy. Three additional patients with late-onset bipolar I disorder proved to have a nonprogressive disorder mimicking bvFTD. The remaining three patients with bvFTD had prior psychiatric symptoms that did not meet criteria for a diagnosis of bipolar disorder. The literature review and the findings for one patient further suggested a shared genetic mutation in some patients. CONCLUSIONS: Manic or hypomanic episodes years before other symptoms of bvFTD may be a prodrome of this dementia, possibly indicating anterior temporal involvement in bvFTD. Other patients with late-onset bipolar disorder exhibit the nonprogressive frontotemporal dementia phenocopy syndrome. Finally, a few patients with bvFTD have a genetic predisposition for both disorders.

Bilingualism Delays Expression of Alzheimer's Clinical Syndrome.

OBJECTIVE: To evaluate the effects of bilingualism on the emergence of Alzheimer's clinical syndrome. BACKGROUND: Studies have proposed an increase in cognitive and neural reserve from the management and control of two languages, with a consequent delayed expression of dementia. METHODS: In a clinic with a large immigrant population, we identified 253 patients with probable Alzheimer's disease (AD) with intermediate or high evidence of AD pathophysiological process. These patients were reviewed for demographic variables, native language (L1) other than English, ages of onset and presentation, Mini-Mental State Examination (MMSE), digit spans, word fluencies, naming, and memory. RESULTS: Among these patients, 74 (29.2%) were bilinguals with various L1s (Farsi, Spanish, Chinese, Tagalog, Arabic, others). When compared to the 179 monolingual AD patients, those who were bilingual had significant delays in ages of onset and presentation of approximately 4 years (p = 0.003). These delays persisted despite bilinguals having worse MMSE scores on presentation. There were no significant group differences on other variables except for worse naming in English among bilinguals versus monolinguals. Caregiver/informants reported that 66 (89.2%) of the 74 bilingual AD patients had gradually regressed to the predominant use of their L1. CONCLUSIONS: In line with published reports worldwide, we found that bilingualism delays the expression of Alzheimer's clinical syndrome. We also found frequent reversion to the first learned language. These findings suggest that, among bilinguals, the availability of an L1 "back-up" either facilitates compensation or masks emergence of the early symptoms of dementia.

Intersectional Effects of Race and Educational Attainment on Memory Function of Middle-Aged and Older Adults With Alzheimer's Disease.

BACKGROUND: High educational attainment may protect individuals, particularly middle-aged and older adults, against a wide range of health risks, including memory decline with age; however, this protection is less clear in patients with Alzheimer's disease (AD). In addition, this effect may differ across racial groups. According to the Marginalized-Related Diminished Return (MDR) theory, for example, the protective effect of high educational attainment on mental and physical health shows a weaker protective effect for racial minority groups, particularly Black people compared to White individuals. OBJECTIVES: This longitudinal study used data of middle-aged and older adults with AD with two aims: first, to test the association between educational attainment and memory, and second, to explore racial differences in this association in the USA. METHODS: Data came from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. The total sample was 1673 American middle-aged and older adults. The independent variable was educational attainment measured as years of education. The main outcome was memory operationalized as Rey Auditory Verbal Learning Test (RAVLT) Verbal Forgetting percentage (VF%). Age, gender, and follow-up duration were covariates. Race was the effect modifier. Linear regression model was utilized to analyze the data. RESULTS: Of all participants, 68 (4.1%) were Black, and the remaining were White, with a mean age of 75 years old. In the pooled sample, educational attainment did not show a significant association with memory, independent of confounders. Educational attainment showed a significant interaction with race on memory, with higher educational attainment having a different effect on memory in White patients compared to Black patients. CONCLUSION: The effect of higher educational attainment on memory differs for Black patients with AD compared to White patients. To prevent cognitive disparities by race, we need to go beyond racial inequality in access to resources (e.g., education) and minimize diminished returns of educational attainment for racial minorities. To tackle health inequalities, social policies should not be limited to equalizing socioeconomic status but also help minority groups leverage their available resources, such as educational attainment, and secure tangible outcomes.

Not Race or Age but Their Interaction Predicts Pre-Adolescents' Inhibitory Control.

BACKGROUND: African American pre-adolescents are at a higher risk of risky behaviors such as aggression, drug use, alcohol use, and subsequent poor outcomes compared to Caucasian pre-adolescents. All these high-risk behaviors are connected to low levels of inhibitory control (IC). AIM: We used the Adolescent Brain Cognitive Development (ABCD) data to compare Caucasian and African American pre-adolescents for the effect of age on pre-adolescents IC, a driver of high-risk behaviors. METHODS: This cross-sectional analysis included 4,626 pre-adolescents between ages 9 and 10 from the ABCD study. Regression was used to analyze the data. The predictor variable was age measured in months. The main outcome was IC measured by a stop-signal task (SST). Race was the effect modifier. RESULTS: Overall, age was associated with IC. Race also showed a statistically significant interaction with age on pre-adolescents' IC, indicating weaker effects of age on IC for African American than Caucasian pre-adolescents. CONCLUSION: Age-related changes in IC are more pronounced for Caucasian than African American pre-adolescents. To eliminate the racial gap in brain development between African American and Caucasian pre-adolescents, we should address structural and societal barriers that alter age-related development for racial minority pre-adolescents. Social and public policies, rather than health policies, are needed to address structural and societal barriers that hinder African American adolescents' brain development. Interventions should add resources to the urban areas that many African American families live in so their children can have better age-related brain development. Such changes would be essential given IC in pre-adolescents is a predictor of a wide range of behaviors.

Parental Education, Household Income, Race, and Children's Working Memory: Complexity of the Effects.

Background. Considerable research has linked social determinants of health (SDoHs) such as race, parental education, and household income to school performance, and these effects may be in part due to working memory. However, a growing literature shows that these effects may be complex: while the effects of parental education may be diminished for Blacks than Whites, household income may explain such effects. Purpose. Considering race as sociological rather than a biological construct (race as a proxy of racism) and built on Minorities' Diminished Returns (MDRs), this study explored complexities of the effects of SDoHs on children's working memory. Methods. We borrowed data from the Adolescent Brain Cognitive Development (ABCD) study. The total sample was 10,418, 9- and 10-year-old children. The independent variables were race, parental education, and household income. The primary outcome was working memory measured by the NIH Toolbox Card Sorting Test. Age, sex, ethnicity, and parental marital status were the covariates. To analyze the data, we used mixed-effect regression models. Results. High parental education and household income were associated with higher and Black race was associated with lower working memory. The association between high parental education but not household income was less pronounced for Black than White children. This differential effect of parental education on working memory was explained by household income. Conclusions. For American children, parental education generates unequal working memory, depending on race. This means parental education loses some of its expected effects for Black families. It also suggests that while White children with highly educated parents have the highest working memory, Black children report lower working memory, regardless of their parental education. This inequality is mainly because of differential income in highly educated White and Black families. This finding has significant public policy and economic implications and suggests we need to do far more than equalizing education to eliminate racial inequalities in children's cognitive outcomes. While there is a need for multilevel policies that reduce the effect of racism and social stratification for middle-class Black families, equalizing income may have more returns than equalizing education.

Prefrontal Cortex Response to Threat: Race by Age Variation in 9-10 Year Old Children.

BACKGROUND: Considerable research has suggested that race and age are two major determinants of brain development, including but not limited to development of the prefrontal cortex (PFC). Minorities' Diminished Returns (MDRs), however, suggests that race (as a proxy of racism) may interact with various determinants of human and brain development. Minimal knowledge, however, exists on whether age and race also interact on shaping PFC response to threat among American children. PURPOSE: Using data from a task-based functional brain imaging study and considering race as a sociological rather than a biological construct, we investigated combined effects of race and age on prefrontal cortical (PFC) response to threat. We explored racial heterogeneities in the association between age and PFC response to threat by comparing Black and White children. METHODS: This study used the task-based functional Magnetic Resonance Imaging (fMRI) data from the Adolescents Brain Cognitive Development (ABCD) study, a national, landmark, multi-center brain imaging investigation of 9-10 years old children in the US. The primary outcomes were mean beta weights of n-back runs measuring PFC response to threating versus neutral face contrast in the following regions of interest (ROIs): left hemisphere-lateral orbito-frontal, left hemisphere -superior-frontal, right hemisphere -caudal middle frontal, and right hemisphere -superior frontal cortex. The independent variable was age. Covariates were sex, ethnicity, family socioeconomic status, and neighborhood socioeconomic status. Race was the focal moderator. To analyze the data, we used linear regression models without and with interactions and SES as covariates. RESULTS: We included 5,066 9-10 years old children. Age and race did not show direct effects on PFC response to threatening relative to neutral faces. While ethnicity, sex, and socioeconomic status were controlled, age and race showed a systematic interaction on PFC response to threatening relative to neutral faces. CONCLUSIONS: For American children, race and age do not have direct effects but multiplicative effects on PFC response to threat. The results may be reflective of social inequalities in how Black and White children are socialized and developed. The results are important given the role of the PFC in regulating the limbic system response to threat. Coordinated work of the limbic system and PFC is a core element of children's behavioral and emotional development. Future research is needed on how social stratification and racism shape emotion processing and regulation of American children in response to threat.

African American Children's Diminished Returns of Subjective Family Socioeconomic Status on Fun Seeking.

Background: Reward sensitivity (fun-seeking) is a risk factor for a wide range of high-risk behaviors. While high socioeconomic status (SES) is known to reduce reward sensitivity and associated high-risk behaviors, less is known about the differential effects of SES on reward sensitivity. It is plausible to expect weaker protective effects of family SES on reward sensitivity in racial minorities, a pattern called Minorities' Diminished Returns (MDRs). Aim: We compared Caucasian and African American (AA) children for the effects of subjective family SES on children's fun-seeking. Methods: This was a cross-sectional analysis of 7061 children from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was subjective family SES. The main outcome was children's fun-seeking measured by the behavioral approach system (BAS) and behavioral avoidance system (BIS). Age, gender, marital status, and household size were the covariates. Results: In the overall sample, high subjective family SES was associated with lower levels of fun-seeking. We also found a statistically significant interaction between race and subjective family SES on children's fun-seeking in the overall sample, suggesting that high subjective family SES is associated with a weaker effect on reducing fun-seeking among AA than Caucasian children. In race-stratified models, high subjective family SES was protective against fun-seeking of Caucasian but not AA children. Conclusion: Subjective family SES reduces the fun-seeking for Caucasian but not AA children.

Parental Human Capital and Adolescents' Executive Function: Immigrants' Diminished Returns.

Racial minorities, particularly non-Hispanic Blacks in the US, experience weaker effects of family socioeconomic position (SEP) on tangible outcomes, a pattern called Minorities' Diminished Returns (MDRs). These MDRs are frequently shown for the effects of family SEP on immigrant adolescents' school performance. As a result of these MDRs, immigrant adolescents from high SEP families show worse than expected cognitive outcomes, including but not limited to poor school performance. However, the existing knowledge is minimal about the role of executive function in explaining diminished returns of family SEP on adolescents' outcomes. To investigate racial differences in the effects of parental human capital on adolescents' executive function, we compared non-Hispanic White non-immigrant and immigrant adolescents for the effect of parental human capital on adolescents' executive function. This was a cross-sectional analysis that included 2,723 non-twin non-Hispanic White adolescents from the Adolescent Brain Cognitive Development (ABCD) study. The independent variable was parental human capital (parental educational attainment), treated as a continuous measure with a higher score reflecting higher subjective socioeconomic status. The primary outcome was adolescents' executive function measured by the stop-signal task (SST). Age, sex, parental marital status, parental employment, family income, and financial difficulties. Immigration status was the effect modifier. Overall, high parental human capital was associated with higher task-based executive function. Immigration status showed statistically significant interactions with parental human capital on adolescents' executive function outcomes. This interaction term suggested that high parental human capital has a smaller effect on increasing immigrants' executive function compared to non-immigrant adolescents. The boosting effect of parental human capital on executive function is diminished for immigrants compared to non-immigrant adolescents. To minimize the inequalities in executive function-related outcomes such as school performance, we need to address the diminishing returns of existing resources for immigrants. Not only should we equalize groups based on their SEP but also equalize the marginal returns of their existing SEP. Such efforts require public policies that aim for equal processes. As such, social policies should address structural and societal barriers such as xenophobia, segregation, racism, and discrimination that hinder immigrant families' ability to effectively utilize their resources. In a fair society, immigrant and non-immigrant families should be equally able to leverage their SEP resources and turn them into tangible outcomes.

Reward Responsiveness in the Adolescent Brain Cognitive Development (ABCD) Study: African Americans' Diminished Returns of Parental Education.

(1) Background: Reward responsiveness (RR) is a risk factor for high-risk behaviors such as aggressive behaviors and early sexual initiation, which are all reported to be higher in African American and low socioeconomic status adolescents. At the same time, parental education is one of the main drivers of reward responsiveness among adolescents. It is still unknown if some of this racial and economic gap is attributed to weaker effects of parental education for African Americans, a pattern also called minorities' diminished returns (MDRs). (2) Aim: We compared non-Hispanic White and African American adolescents for the effects of parent education on adolescents RR, a psychological and cognitive construct that is closely associated with high-risk behaviors such as the use of drugs, alcohol, and tobacco. (3) Methods: This was a cross-sectional analysis that included 7072 adolescents from the adolescent brain cognitive development (ABCD) study. The independent variable was parent education. The main outcome as adolescents' RR measured by the behavioral inhibition system (BIS) and behavioral activation system (BAS) measure. (4) Results: In the overall sample, high parent education was associated with lower levels of RR. In the overall sample, we found a statistically significant interaction between race and parent education on adolescents' RR. The observed statistical interaction term suggested that high parent education is associated with a weaker effect on RR for African American than non-Hispanic White adolescents. In race-stratified models, high parent education was only associated with lower RR for non-Hispanic White but not African American adolescents. (5) Conclusion: Parent education reduces RR for non-Hispanic White but not African American adolescents. To minimize the racial gap in brain development and risk-taking behaviors, we need to address societal barriers that diminish the returns of parent education and resources in African American families. We need public and social policies that target structural and societal barriers, such as the unequal distribution of opportunities and resources. To meet such an aim, we need to reduce the negative effects of social stratification, segregation, racism, and discrimination in the daily lives of African American parents and families. Through an approach like this, African American families and parents can effectively mobilize their resources and utilize their human capital to secure the best possible tangible outcomes for their adolescents.

A Web-Based Pharmacogenomics Search Tool for Precision Medicine in Perioperative Care.

Background: Precision medicine represents an evolving approach to improve treatment efficacy by modifying it to individual patient's gene variation. Pharmacogenetics, an applicable branch of precision medicine, identifies patient's predisposing genotypes that alter the clinical outcome of the drug, hence preventing serious adverse drug reactions. Pharmacogenetics has been extensively applied to various fields of medicine, but in the field of anesthesiology and preoperative medicine, it has been unexploited. Although the US Food and Drug Administration (FDA) has a table of pharmacogenomics biomarkers and pharmacogenetics, this table only includes general side effects of the included drugs. Thus, the existing FDA table offers limited information on genetic variations that may increase drug side effects. Aims: The purpose of this paper is to provide a web-based pharmacogenomics search tool composed of a comprehensive list of medications that have pharmacogenetic relevance to perioperative medicine that might also have application in other fields of medicine. Method: For this investigation, the FDA table of pharmacogenomics biomarkers in drug labeling was utilized as an in-depth of drugs to construct our pharmacogenetics drug table. We performed a literature search for drug-gene interactions using the unique list of drugs in the FDA table. Publications containing the drug-gene interactions were identified and reviewed. Additional drugs and extracted gene-interactions in the identified publications were added to the constructed drug table. Result: Our tool provides a comprehensive pharmacogenetic drug table including 258 drugs with a total of 461 drug-gene interactions and their corresponding gene variations that might cause modifications in drug efficacy, pharmacokinetics, pharmacodynamics and adverse reactions. This tool is freely accessible online and can be applied as a web-based search instrument for drug-gene interactions in different fields of medicine, including perioperative medicine. Conclusion: In this research, we collected drug-gene interactions in a web-based searchable tool that could be used by physicians to expand their field knowledge in pharmacogenetics and facilitate their clinical decision making. This precision medicine tool could further serve in establishing a comprehensive perioperative pharmacogenomics database that also includes different fields of medicine that could influence the outcome of perioperative medicine.

Historical perspective of neurology in Iran.

Iran is an ancient country, known as the cradle of civilization. The history of medicine in Iran goes back to the existence of a human in this country, divided into three periods: pre-Islamic, medieval, and modern period. There are records of different neurologic terms from the early period, while Zoroastrian (religious) prescription was mainly used until the foundation of the first medical center (Gondishapur). In the medieval period, with the conquest of Islam, prominent scientists were taught in Baghdad, like Avicenna, who referred to different neurologic diseases including stroke, paralysis, tremor, and meningitis. Several outstanding scientists developed the medical science of neurology in Iran, the work of whom has been used by other countries in the past and present. In the modern era, the Iranian Neurological Association was established with the efforts of Professor Jalal Barimani in 1991.

Impact of delayed treatment on exacerbations of multiple sclerosis among Puerto Rican patients.

BACKGROUND: There are limited data on multiple sclerosis (MS) patients in underserved groups, including Puerto Rico. In this study, we analyzed the characteristic of MS symptoms and number of relapses in Puerto Rican patients. We then compare these characteristics with MS patients from the US. The number of MS relapses is highly correlated with the treatment onset and adherence. Patients in Puerto Rico have been experiencing lengthy treatment delay. We will discuss the possible causes of such delay and its impact on MS prognosis. METHODS: This retrospective cohort study consisted of the evaluation of 325 medical records from MS patients attending the Caribbean Neurological Center from 2014 to 2019. We gathered symptoms and comorbidities data as binary objects. The treatment delay was calculated based on the mean value of days between diagnosis and treatment onset for these groups of patients. RESULTS: We found that on average, the treatment delay for MS patients in Puerto Rico (PR) to receive their medication was 120 days. The most common MS subtype was relapsing-remitting 72.8%, with a mean of 1.684 relapses per year. Initial symptoms were sensory 54%, visual 33.1%, motor 28.8%, coordination 23.2%, fatigue 9.7%, memory 7.3%, depression 6.5%, urinary 4.9%, gastrointestinal 2.4%, and sexual dysfunction 1.6%. The most common comorbidities were hypertension 18.4%, asthma 13.6%, and thyroid disease 12.8%. When we compared the comorbidities between the two populations, immune thrombocytopenia had the highest percent change with the value of almost 200% (0.001% of US patient vs. 0.8% of Puerto Rican MS patients). CONCLUSION: Patients from Puerto Rico had a 33% higher relapse rate compared to the one reported for MS patients in the US. This higher rate may be related to the long delay in receiving their medications. They also had a higher rate of complex comorbidities such as immune thrombocytopenia or thyroid disease. Our findings provide a proof of concept that delay in receiving medications can increase the number of relapses and complex comorbidities among MS patients.