Mentalizing imagery therapy for depressed family dementia caregivers: Feasibility, clinical outcomes and brain connectivity changes.

BACKGROUND: Family dementia caregivers experience high rates of depression and anxiety that often go untreated due to time demands. We aimed to determine the feasibility of a brief, 4-week Mentalizing Imagery Therapy intervention, which couples mindfulness with guided imagery practices aimed at bolstering mentalizing capacity, to reduce caregiver psychological symptoms and to explore potential impact on dorsolateral prefrontal cortex connectivity. METHODS: Twenty-four family dementia caregivers with moderate depression symptoms (a score of 10 in Patient Health Questionnaire-9) were assigned to either group Mentalizing Imagery Therapy (MIT, n = 12) or a waitlist augmented by optional relaxation exercises (n = 12). Participants completed questionnaires to measure depression and anxiety at baseline and followup, and those eligible also underwent resting state functional magnetic resonance (fMRI) brain imaging at these time points. RESULTS: Eleven of 12 caregivers assigned to MIT completed the intervention and attended weekly groups 98% of the time. MIT home practice logs indicated average practice of 5 ± 2 sessions per week for 23 ± 8 min per session. All participants in waitlist completed the post-assessment. MIT participants exhibited significantly greater improvement than waitlist on self-reported depression and anxiety symptoms (p<.05) after 4 weeks. Neuroimaging results revealed increased dorsolateral prefrontal cortex connectivity with a putative emotion regulation network in the MIT group (p = .05) but not in waitlist (p = 1.0). LIMITATIONS: Sample size limitations necessitate validation of findings in larger, randomized controlled trials. CONCLUSIONS: A 4-week group MIT program was feasible for caregivers, with high levels of participation in weekly group meetings and home practice exercises.

Grief, Mindfulness and Neural Predictors of Improvement in Family Dementia Caregivers.

Background: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement. Methods: Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable. Results: Grief and depression symptoms were correlated (r = 0.50, p = 0.01), and both were negatively correlated with mindfulness (r = -0.70, p = 0.0002; r = -0.52, p = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus. Conclusions: Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.

Optimized neural coding? Control mechanisms in large cortical networks implemented by connectivity changes.

Using functional magnetic resonance imaging, we show that a distributed fronto-parietal visuomotor integration network is recruited to overcome automatic responses to both biological and nonbiological cues. Activity levels in these areas are similar for both cue types. The functional connectivity of this network, however, reveals differential coupling with thalamus and precuneus (biological cues) and extrastriate cortex (nonbiological cues). This suggests that a set of cortical areas equally activated in two tasks may accomplish task goals differently depending on their network interactions. This supports models of brain organization that emphasize efficient coding through changing patterns of integration between regions of specialized function.

Facing puberty: associations between pubertal development and neural responses to affective facial displays.

Adolescence is marked by profound psychosocial and physiological changes. Although investigations into the interactions between these forces have begun to shed light on the neural correlates of affective processing during the transition to adolescence, relatively little is known about the relationship between pubertal development and emotion perception at the neural level. In the current longitudinal study, 45 neurotypical participants were shown affective facial displays while undergoing fMRI, at ages 10 and 13. Neural responses to emotional expressions at both time points were then correlated with a self-report measure of pubertal development, revealing positive associations with activity in amygdala, thalamus and visual cortical areas at age 10 that increased in magnitude and extent by age 13. At the latter time point, pubertal development was additionally correlated with enhanced responses to faces in temporal pole, ventrolateral prefrontal cortex (PFC) and dorsomedial PFC. Longitudinal comparisons revealed that the relationships between pubertal development and activity in the amygdala, hippocampus and temporal pole were significantly stronger during early adolescence than late childhood. These results suggest that pubertal development per se is linked to neural processing of socioemotional stimuli, particularly with respect to the integration of complex perceptual input and higher order cortical processing of affective content.

Reactivity of alpha rhythms to eyes opening is lower in athletes than non-athletes: a high-resolution EEG study.

In the present study, we tested the hypothesis that compared with non-athletes, elite athletes are characterized by a reduction of reactivity of electroencephalographic (EEG) alpha rhythms (about 8-12 Hz) to eyes opening in the condition of resting state, as a possible index of spatially selective cortical activation (i.e. "neural efficiency"). EEG data (56 channels; Eb-Neuro©) were recorded in 18 elite karate athletes and 28 non-athletes during resting state eyes-closed and eyes-open conditions. The EEG data were spatially enhanced by surface Laplacian estimation. Cortical activity was indexed by task-related power decrease (TRPD), namely the alpha power during the eyes-open referenced to the eyes-closed resting condition. Low-frequency alpha TRPD (about 8-10 Hz) was lower in the elite karate athletes than in the non-athletes in frontal (p<0.00002), central (p<0.008) and right occipital (p<0.02) areas. Similarly, high-frequency alpha TRPD (about 10-12 Hz) was lower in the elite karate athletes than in the non-athletes in frontal (p<0.00009) and central (p<0.01) areas. These results suggest that athletes' brain is characterized by reduced cortical reactivity to eyes opening in the condition of resting state, in line with the "neural efficiency" hypothesis. The present study motivates future research evaluating the extent to which this general functional brain feature is related to heritable trait or intensive visuo-motor training of elite athletes.

Resting state cortical rhythms in athletes: a high-resolution EEG study.

The present electroencephalographic (EEG) study tested the working hypothesis that the amplitude of resting state cortical EEG rhythms (especially alpha, 8-12 Hz) was higher in elite athletes compared with amateur athletes and non-athletes, as a reflection of the efficiency of underlying back-ground neural synchronization mechanisms. Eyes closed resting state EEG data were recorded in 16 elite karate athletes, 20 amateur karate athletes, and 25 non-athletes. The EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by low-resolution brain electromagnetic tomography (LORETA). Statistical results showed that the amplitude of parietal and occipital alpha 1 sources was significantly higher in the elite karate athletes than in the non-athletes and karate amateur athletes. Similar results were observed in parietal and occipital delta sources as well as in occipital theta sources. Finally, a control confirmatory experiment showed that the amplitude of parietal and occipital delta and alpha 1 sources was stronger in 8 elite rhythmic gymnasts compared with 14 non-athletes. These results supported the hypothesis that cortical neural synchronization at the basis of eyes-closed resting state EEG rhythms is enhanced in elite athletes than in control subjects.

"Neural efficiency" of experts' brain during judgment of actions: a high-resolution EEG study in elite and amateur karate athletes.

Here we tested two working hypotheses on spatially selective cortical activation ("neural efficiency") in experts: (i) compared to non-athletes, elite karate athletes are characterized by a reduced cortical activation during the judgment of karate actions; (ii) compared to non-athletes and elite karate athletes, amateur karate athletes are characterized by an intermediate cortical activation during the judgment of karate actions. Electroencephalographic (EEG) data were recorded in 16 elite karate athletes, 15 amateur athletes and 17 non-athletes. They observed a series of 120 karate videos. At the end of each video, the subjects had to judge the technical/athletic level of the exercise by a scale from 0 to 10. The mismatch between their judgment and that of the coach indexed the degree of action judgment. The EEG cortical sources were estimated by sLORETA. With reference to a pre-stimulus period, the power decrease of alpha (8-12 Hz) rhythms during the video indexed the cortical activation (event-related desynchronization, ERD). Regarding the hypothesis of reduced activity in elite karate athletes, low- and high-frequency alpha ERD was less pronounced in dorsal and "mirror" pathways in the elite karate athletes than in the non-athletes. Regarding the hypothesis of intermediate cortical activity in amateur karate athletes, low- and high-frequency alpha ERD was less pronounced in dorsal pathways across the non-athletes, the amateur karate athletes, and the elite karate athletes. In conclusion, athletes' judgment of observed sporting actions is related to less pronounced alpha ERD, as a possible index of "neural efficiency" in experts engaged in social cognition.

"Neural efficiency" of athletes' brain for upright standing: a high-resolution EEG study.

"Neural efficiency" hypothesis posits that neural activity is reduced in experts. Here we tested the hypothesis that compared with non-athletes, elite athletes are characterized by a reduction of cortical activation during an engaging upright standing. EEG (56 channels; Be-plus Eb-Neuro and stabilogram (RGM) data were simultaneously recorded in 10 elite karate, 10 elite fencing athletes, and 12 non-athletes during a simple bipodalic (standard Romberg) and a more engaging monopodalic upright standing. Balance was indexed by body "sway area". The EEG data were spatially enhanced by surface Laplacian estimation. Cortical activity was indexed by task-related power decrease (TRPD) of EEG alpha power (8-12Hz) during monopodalic referenced to bipodalic condition. The body "sway area" was larger during the monopodalic than bipodalic upright standing in all groups. Low-frequency alpha TRPD (about 8-10Hz) was lower in amplitude in the karate and fencing athletes than in the non-athletes at left central, right central, middle parietal, and right parietal areas (p<0.01). Similarly, the amplitude of high-frequency alpha TRPD (10-12Hz) was lower in the karate and fencing athletes than in the non-athletes at right frontal, left central, right central, and middle parietal areas (p<0.03). These results suggest that during monopodalic referenced to less engaging bipodalic condition, the power decrease (i.e. the desynchronization) of cortical activity at alpha rhythms is largely reduced in elite athletes than in non-athletes, in line with the "neural efficiency" hypothesis. The present study extends our understanding of the physiological mechanisms at the basis of the "neural efficiency" for engaging upright standing in elite athletes.

The self across the senses: an fMRI study of self-face and self-voice recognition.

There is evidence that the right hemisphere is involved in processing self-related stimuli. Previous brain imaging research has found a network of right-lateralized brain regions that preferentially respond to seeing one's own face rather than a familiar other. Given that the self is an abstract multimodal concept, we tested whether these brain regions would also discriminate the sound of one's own voice compared to a friend's voice. Participants were shown photographs of their own face and friend's face, and also listened to recordings of their own voice and a friend's voice during fMRI scanning. Consistent with previous studies, seeing one's own face activated regions in the inferior frontal gyrus (IFG), inferior parietal lobe and inferior occipital cortex in the right hemisphere. In addition, listening to one's voice also showed increased activity in the right IFG. These data suggest that the right IFG is concerned with processing self-related stimuli across multiple sensory modalities and that it may contribute to an abstract self-representation.

Multimodal action representation in human left ventral premotor cortex.

We used functional magnetic resonance imaging (fMRI) to investigate the neural systems responding to the sight and to the sound of an action. Subjects saw a video of paper tearing in silence (V), heard the sound of paper tearing (A), and saw and heard the action simultaneously (A + V). Compared to a non-action control stimulus, we found that hearing action sounds (A) activated the anterior inferior frontal gyrus and middle frontal gyrus in addition to primary auditory cortex. The anterior inferior frontal gyrus, which is known to be activated by environmental sounds, also seems to be involved in recognizing actions by sound. Consistent with previous research, seeing an action video (V) compared with seeing a non-action video activated the premotor cortex, intraparietal cortex, and the pars opercularis of the inferior frontal gyrus. An A + V facilitation effect was found in the ventral premotor cortex on the border of areas 44, 6, 3a, and 3b for the action stimuli but not for the control stimuli. This region may be involved in integrating multimodal information about actions. These data provide evidence that the ventral premotor cortex may provide an action representation that abstracts across both agency (self and other) and sensory modality (hearing and seeing). This function may be an important precursor of language functions.

Cortical alpha rhythms are correlated with body sway during quiet open-eyes standing in athletes: a high-resolution EEG study.

Electroencephalographic (EEG; Be-plus Eb-Neuro) and stabilogram (RGM) data were simultaneously recorded in 19 elite karate and 18 fencing athletes and in 10 non-athletes during quiet upright standing at open- and closed-eyes condition in order to investigate the correlation between cortical activity and body sway when the visual inputs are available for balance. Our working hypothesis is that, at difference of non-athletes, athletes are characterized by enhanced cortical information processing as indexed by the amplitude reduction of EEG oscillations at alpha rhythms (about 8-12 Hz) during open- referenced to closed-eyes condition (event-related desynchronization, ERD). Balance during quiet standing was indexed by body "sway area". Correlation between alpha ERD and event-related change of the sway area was computed by a non-parametric test (p<0.05). It was found that alpha ERD (10-12 Hz) is stronger in amplitude in the karate and fencing athletes than in the non-athletes at ventral centro-parietal electrodes of the right hemisphere (p<0.02). Furthermore, there was a statistically significant correlation in the karate athletes between right ventral centro-parietal alpha ERD and body sway area (r=0.61; p<0.008): specifically, the greater the alpha ERD, the greater the percentage reduction of the body sway area when the visual inputs were available. These results suggest that parasylvian alpha ERD of the right hemisphere may reflect the cortical information processing for the balance in elite athletes subjected to a long training for equilibrium control.

Listening to speech activates motor areas involved in speech production.

To examine the role of motor areas in speech perception, we carried out a functional magnetic resonance imaging (fMRI) study in which subjects listened passively to monosyllables and produced the same speech sounds. Listening to speech activated bilaterally a superior portion of ventral premotor cortex that largely overlapped a speech production motor area centered just posteriorly on the border of Brodmann areas 4a and 6, which we distinguished from a more ventral speech production area centered in area 4p. Our findings support the view that the motor system is recruited in mapping acoustic inputs to a phonetic code.