The "facie sympathique" sign in hanging: historical background, forensic review, and perspectives.

The "facie sympathique" is a vital sign first described by Etienne Martin in 1899 referring to unilateral miosis, with or without ptosis, at the opposite side from the knot in hanging. This mark is scarcely reported in legal medicine textbooks and scientific papers. Moreover, when cited, it is referred to differently from its original meaning, both as unilateral contraction (miosis) and dilatation (mydriasis) of the pupil depending on the antemortem firmness of the ligature's neck pressure in hanging with little attention to ptosis. Due to the sympathetic nervous pathway supplying the eye, the review of this ocular sign in hanging supports the importance of revitalizing the "facie sympathique" in research on lesion vitality in mechanical asphyxia.

Cognitive Interventions for Neurodegenerative Disease.

PURPOSE OF REVIEW: To critically review recent research in the development of non-pharmacological interventions to improve cognitive functioning in individuals with Alzheimer's disease (AD) or Parkinson's disease (PD). RECENT FINDINGS: Cognitive interventions can be grouped into three categories: cognitive stimulation (CS), cognitive training (CT), and cognitive rehabilitation (CR). CS confers temporary, nonspecific benefits and might slightly reduce dementia risk for neurologically healthy individuals. CT can improve discrete cognitive functions, but durability is limited and real-world utility is unclear. CR treatments are holistic and flexible and, therefore, most promising but are difficult to simulate and study under rigorous experimental conditions. Optimally effective CR is unlikely to be found in a single approach or treatment paradigm. Clinicians must be competent in a variety of interventions and select those interventions best tolerated by the patient and most relevant to their needs and goals. The progressive nature of neurodegenerative disease necessitates that treatment be consistent, open-ended in duration, and sufficiently dynamic to meet the patient's changing needs as their disease progresses.

Biliary Atresia in an Infant Presenting With Kabuki Syndrome: An Autopsy Report and Review of the Literature.

Biliary atresia (BA) is an inflammatory obliterative cholangiopathy which is very common during neonatal and infancy period. We present an autopsy report of a BA in an infant suffering from a genetic syndrome.

The effects of plasticity-based cognitive rehabilitation on resting-state functional connectivity in chronic traumatic brain injury: A pilot study.

BACKGROUND: Traumatic brain injury (TBI) often results in chronic impairments to cognitive function, and these may be related to disrupted functional connectivity (FC) of the brain at rest. OBJECTIVE: To investigate changes in default mode network (DMN) FC in adults with chronic TBI following 40 hours of auditory processing speed training. METHODS: Eleven adults with chronic TBI underwent 40-hours of auditory processing speed training over 13-weeks and seven adults with chronic TBI were assigned to a non-intervention control group. For all participants, resting-state FC and cognitive and self-reported function were measured at baseline and at a follow-up visit 13-weeks later. RESULTS: No significant group differences in cognitive function or resting-state FC were observed at baseline. Following training, the intervention group demonstrated objective and subjective improvements on cognitive measures with moderate-to-large effect sizes. Repeated measures ANCOVAs revealed significant (p < 0.001) group×time interactions, suggesting training-related changes in DMN FC, and semipartial correlations demonstrated that these were associated with changes in cognitive functioning. CONCLUSIONS: Changes in the FC between the DMN and other resting-state networks involved in the maintenance and manipulation of internal information, attention, and sensorimotor functioning may be facilitated through consistent participation in plasticity-based auditory processing speed training in adults with chronic TBI.

Engagement in Cognitively Stimulating Activities Mediates the Relationship between Openness and Attention/Executive Functions, but Not Memory in Older Adults.

OBJECTIVE: Openness has a positive association with cognitive functioning and engagement in cognitively stimulating activities (CSA). Older adults who engage in more CSA tend to show greater preservation of their cognitive skills; thus, we examined whether: higher Openness would be associated with higher attention/executive functions (AEF) and verbal memory; and CSA would mediate the relationship between Openness and AEF, as well as verbal memory. METHOD: 477 community-dwelling older adults (65+ years) were included in the current cross-sectional study. Composite variables of AEF (TMT-A&B, COWAT, and DSST) and verbal memory (RBANS immediate and delayed verbal memory subtasks) were included. Openness was assessed via the Big-5 Inventory and CSA with the Leisure Activity Questionnaire. METHOD: 477 community-dwelling older adults (65+ years) were included in the current cross-sectional study. Composite variables of AEF (TMT-A&B, COWAT, and DSST) and verbal memory (RBANS verbal memory subtasks) were included. Openness was assessed via the Big-5 Inventory and CSA with the Leisure Activity Questionnaire. RESULTS: Linear regressions indicated a significant positive association between Openness and AEF (ß = .09, p < .01), but not verbal memory (ß = .06, p = .06). A significant partial mediation was demonstrated between Openness, CSA, and AEF (c: ß = .08, p < .05, 95%CI = .02-.14; c': ß = .02, 95%CI = .01-.03). The mediation of Openness, CSA, and verbal memory was not significant (c: ß = .06, p > .05, 95%CI = .01-.11; c': ß = .00, 95%CI = -.01-.01). CONCLUSIONS: The association between Openness and AEF, but not verbal memory, was partially mediated by CSA in healthy older adults. The findings suggest that those who are more open to and highly engaged in CSA may have a later in life advantage in preserving their AEF abilities.

Assessing within-task verbal fluency performance: the utility of individual time intervals in predicting incident mild cognitive impairment.

The current study aimed to determine whether word generation performance on individual within-task 20-second time intervals predicted conversion to Mild Cognitive Impairment (MCI) status. Longitudinal data (Mean follow-up=2.95±1.64 years) was collected from cognitively-healthy community-dwelling older adults (N=344; %female=56.1). Performance on letter and semantic fluency tasks was divided into three consecutive within-task 20-second intervals. Incident MCI status (n=50) was determined via established diagnostic case conference. Fully adjusted Cox proportional-hazards regression models revealed that greater word production on semantic fluency across all time intervals significantly predicted a reduced risk of incident MCI [0-20 seconds (HR=0.906, p=0.002), 21-40 seconds (HR=0.904, p=0.02), and 41-60 seconds (HR=0.892, p=0.017)]. Conversely, on letter fluency, greater word production within the 41-60 second time interval only was significantly associated with reduced risk of incident MCI (HR=0.886, p=0.002). Overall, the clinical use of within-interval performance is supported given evidence of predictive sensitivity and ease of administration.

The effects of neuroplasticity-based auditory information processing remediation in adults with chronic traumatic brain injury.

BACKGROUND: Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE: This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS: Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. RESULTS: The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS: The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury.