The False Recognition Test, a new tool for the assessment of false memories, with normative data from an Italian sample.

INTRODUCTION: False memory can be defined as remembering something that did not happen. To a certain extent it is a normal phenomenon, but its occurrence seems to increase in healthy and pathological aging, possibly providing relevant clues on some clinical conditions in the spectrum of dementia. We adapted a well-established Deed-Roediger-McDermott paradigm, frequently used in experimental contexts, to devise a new neuropsychological assessment tool, the False Recognition Test (FRT), that can investigate classical facets of episodic memory performance (i.e. free recall and recognition), and assess proneness to produce semantically related and non-semantic false memories. Here we describe the FRT and provide normative data and correction grids to consider the possible effects of age, gender, and education on the FRT scores. METHOD: Two-hundred and thirty-two Italian healthy individuals (99 male) aged 18-91 years, with different educational levels (from primary to university) underwent the FRT, together with validated tests for cognitive screening and episodic memory assessment and one scale for depression. RESULTS: Multiple linear regression analysis revealed that age and education significantly influenced performance on FRT. From the derived linear equations, we provide correction grids for the raw scores of the FRT, and equivalent scores estimated using a nonparametric method. Correlational analysis showed significant associations between FRT subscores and cognitive, executive and memory functions, and depression. CONCLUSION: The FRT may constitute a useful instrument for both clinical and research purposes.

The involvement of rTPJ in intention attribution during social decision making: A TMS study.

The mini-Ultimatum Game (mini-UG) is a bargaining game used to assess the reactions of a responder to unfair offers made by a proposer under different intentionality conditions. Previous studies employing this task showed the activation of responders' right temporoparietal junction (rTPJ), which could be related to its involvement in judgments of intentionality. To verify this hypothesis, in the present study we applied online transcranial magnetic stimulation (TMS) over the rTPJ in responders during the mini-UG, in which we manipulated intention attribution implicitly. A cover story was employed to induce participants to believe they were interacting with another agent. We expected that interfering with the rTPJ could affect the ability of responders to assume proposers' perspective, producing higher rates of rejections of unfair offers when offers are perceived as independent from responders' intentionality to inequality. Twenty-six healthy women voluntarily participated in the study. In the mini-UG, an unfair distribution of the proposer (8/2 offer) was pitted against one of three alternative offers: fair-alternative (5/5), no-alternative (8/2), hyperfair-alternative (2/8). During the task, a train of TMS pulses was delivered at proposers' offer presentation in blocks of active (rTPJ) or control (Vertex) stimulation according to an ABAB design. As expected, findings showed that rejection of the no-alternative offers was higher under TMS stimulation of the rTPJ compared with the control TMS. This effect was modulated by the degree of trustworthiness in the cover story. These data contribute defining the mechanisms and brain areas underpinning social decision making as assessed by bargaining tasks.

Spontaneous eye blinking during an auditory, an interoceptive and a visual task: The role of the sensory modality and the attentional focus.

Previous evidence suggested that spontaneous eye blinking changes as a function of the attentional focus. In particular, eye blink rate (EBR) tends to increase when attention is directed to internal versus environmental processing. Most studies on this issue compared eye blinking during visual and mental imagery tasks, and interpreted the increase in EBR as a mechanism to focus cognitive resources on internal processing by disengaging attention from interfering information. However, since eye blinking also depends on the sensory modality of the task, the findings might be influenced by a modality-specific effect. In the present Registered Report we aim at investigating whether the environmental versus internal attentional focus can affect spontaneous blinking behaviour in non-visual tasks as well, in conditions where visual stimuli are not relevant. In a within-subject design, healthy participants performed an interoceptive task (i.e., heartbeat counting) and an auditory task in which pre-recorded heartbeats were presented aurally; during both tasks irrelevant visual stimuli were also presented. In a further control condition with the same auditory and visual stimuli, the participants were required to focus their attention on visual stimuli. Participants' EBR was recorded during each task by means of an eye-tracking system. We found that, although the interoceptive task was more difficult than the auditory and visual tasks, participants' EBR decreased by a comparable level in all tasks with respect to a rest condition, with no differences between internal versus environmental conditions. The present findings do not support the idea that EBR is modulated by an internal versus external focus of attention, at least in presence of controlled visual stimulation.

Memory biases in Alzheimer's disease and mild cognitive impairment. A systematic review and metanalysis.

Several studies demonstrated that individuals are more likely to remember emotional than neutral information; this phenomenon is known as emotional enhancement of memory (EEM). Adults generally tend to remember negative information more efficiently than neutral or positive items. In contrast, healthy elders seem to show an opposite bias for positive information, but results are inconsistent, also because during aging, elaboration of emotional information could change as a consequence of cognitive impairment. In this systematic review and meta-analysis, we conducted literature search of studies investigating emotion memory biases in mild cognitive impairment (MCI) and Alzheimer's disease (AD) on PubMed, Scopus and PsycINFO databases following PRISMA guidelines. The findings showed that emotional memory biases are still present despite the presence of cognitive impairment, both in MCI and at least in early stages of AD. However, the direction of emotion memory biases is not consistent across studies. These results suggest that patients with cognitive impairment might still benefit from EEM and help to define targets of intervention for cognitive rehabilitation in pathological aging.

Long-term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta-analytic study.

BACKGROUND AND PURPOSE: The prognosis of prolonged (28 days to 3 months post-onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long-term outcome of post-anoxic pDoC and identify the possible predictive value of demographic and clinical information. METHOD: This is a systematic review and meta-analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross-sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non-survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered. RESULTS: Twenty-seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness. CONCLUSIONS: Patients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision-making on patient management.

Cognitive reserve and coping strategies predict the level of perceived stress during COVID-19 pandemic: A cross-sectional study.

The COVID-19 pandemic and the measures to avert contagion heavily impacted individuals' mental health. In the present cross-sectional study, we investigate the relationship between cognitive reserve, coping modalities and the perceived stress during a chronic stage of COVID-19 pandemic by online administration of three standardized questionnaires in a sample of healthy volunteers covering a large lifespan (18-85 years). We found that positive orientation to problems and higher levels of cognitive reserve were associated with lower levels of stress. Conversely, coping strategies involving negation, substance consumption, and appeal to other people and religion to face everyday life, together with higher education, were associated with higher levels of stress. These results shade light on the long-term psychological consequences of COVID-19 and call for the development of psychological interventions improving coping and cognitive reserve, to preserve and restore mental health following the pandemic.

Engagement of a parieto-cerebellar network in prism adaptation. A double-blind high-definition transcranial direct current stimulation study on healthy individuals.

Prism Adaptation (PA) is a non-invasive method to investigate visuomotor control. Recent neurostimulation studies have proposed an interpretation of the mechanisms underlying PA based on functioning of brain networks, instead of focusing on single brain areas. To test the functioning of the network during a classical PA procedure, here we used for the first time High-Definition transcranial Direct Current Stimulation (HD-tDCS) to simultaneously inhibit or facilitate brain activity in two main nodes of the network, namely the parietal cortex and the cerebellum, in healthy individuals. The main results showed that simultaneous anodal HD-tDCS over the two regions reduced terminal errors during exposure to prism glasses as compared to cathodal and sham stimulation. Conversely, cathodal HD-tDCS reduced after-effect as compared to anodal and sham stimulation following prism removal. Overall, these results provide new insights on the network related to the deployment of PA mechanisms and demonstrate the feasibility of using non-invasive HD-tDCS to modulate the adaptive mechanisms of PA.

"Health Comes First": Action Tendencies to Health-Related Stimuli in People with Health-Anxiety as Revealed by an Emotional Go/No-Go Task.

The processing of health-related stimuli can be biased by health anxiety and anxiety sensitivity but, at the moment, it is far from clear whether health-related stimuli can affect motor readiness or the ability to inhibit action. In this preliminary study, we assessed whether different levels of health anxiety and anxiety sensitivity affect disposition to action in response to positive and negative health-related stimuli in non-clinical individuals. An emotional go/no-go task was devised to test action disposition in response to positive (wellness-related), and negative (disease-related) stimuli in non-clinical participants who also underwent well-validated self-report measures of health anxiety and anxiety sensitivity. The main results showed that both health anxiety and anxiety sensitivity biased participants' responses. Importantly, safety-seeking and avoidance behaviors differently affected action disposition in response to positive and negative stimuli. These preliminary results support the idea that health anxiety and anxiety sensitivity could determine a hypervigilance for health-related information with a different perturbation of response control depending on the valence of the stimuli. Health anxiety and health anxiety disorder do form a continuum; thus, capturing different action tendencies to health-related stimuli could represent a valuable complementary tool to detect processing biases in persons who might develop a clinical condition.

Brain hemodynamic response in Examiner-Examinee dyads during spatial short-term memory task: an fNIRS study.

The Corsi Block-Tapping test (CBT) is a measure of spatial working memory (WM) in clinical practice, requiring an examinee to reproduce sequences of cubes tapped by an examiner. CBT implies complementary behaviors in the examiners and the examinees, as they have to attend a precise turn taking. Previous studies demonstrated that the Prefrontal Cortex (PFC) is activated during CBT, but scarce evidence is available on the neural correlates of CBT in the real setting. We assessed PFC activity in dyads of examiner-examinee participants while completing the real version of CBT, during conditions of increasing and exceeding workload. This procedure allowed to investigate whether brain activity in the dyads is coordinated. Results in the examinees showed that PFC activity was higher when the workload approached or reached participants' spatial WM span, and lower during workload conditions that were largely below or above their span. Interestingly, findings in the examiners paralleled the ones in the examinees, as examiners' brain activity increased and decreased in a similar way as the examinees' one. In the examiners, higher left-hemisphere activity was observed suggesting the likely activation of non-spatial WM processes. Data support a bell-shaped relationship between cognitive load and brain activity, and provide original insights on the cognitive processes activated in the examiner during CBT.

Subliminal determinants of cue-guided choice.

By anticipating potential rewards, external cues can guide behavior to achieve a goal. Whether the conscious elaboration of these cues is necessary to elicit cue-guided choices is still unknown. The goal of the present study is to test whether the subliminal presentation of a visual cue previously paired with a reward is sufficient to bias responses that can lead to the same or a similar reward. To this aim, three experiments compared the subliminal and supraliminal presentation of reward-associated cues during a Pavlovian-to-Instrumental Transfer task. In line with previous evidence, results showed that the supraliminal presentation of reward-associated Pavlovian cues biased participant's choice towards motivationally similar rewards (general transfer) as well as towards rewards sharing the precise sensory-specific properties of the cue (outcome-specific transfer). In striking contrast, subliminal cues biased choice only towards motivationally similar rewards (general transfer). Taken together, these findings suggest that cue-guided choices are modulated by the level of perceptual threshold (i.e., subliminal vs supraliminal) of reward-associated cues. Although conscious elaboration of the cue is necessary to guide choice towards a specific reward, subliminal processing is still sufficient to push towards choices sharing the motivational properties of the cue. Implications for everyday life, clinical conditions, and theoretical accounts of cue-guided choices are discussed.

Danger is in the eyes of the beholder: The effect of visible and invisible affective faces on the judgment of social interactions.

Previous studies demonstrated that observation of facial expressions can modulate threat detection while looking at neutral or emotion-related scenes. Similarly, stimuli presented outside conscious awareness could influence social judgments of neutral novel stimuli. The two-fold aim of this study was: i) to evaluate whether observation of seen emotional faces could affect the judgment of social interactions without contextual cues (visible prime condition), and ii) whether this effect could also emerge when the emotional faces were made not visible by means of continuous flash suppression (invisible prime condition). We found that both seen and unseen faces are able to affect the judgment of ambiguous social interactions although this effect was particularly evident when affective faces were clearly visible. The present findings supported the idea that both conscious and unconscious processing of emotional faces have an important role in modulating perceivers' affective state and their judgment of social interactions.

Left inferior parietal and posterior temporal cortices mediate the effect of action observation on semantic processing of objects: evidence from rTMS.

Previous studies showed that motor information related to tool use (i.e., functional actions) could affect processing of objects semantic properties, whereas motor information related to grasping or moving tool (i.e., structural actions) cannot. However, little is known about the neural correlates mediating such interaction between motor and semantic information. Here, healthy participants performed a semantic judgment task requiring identification of semantic relations among objects, after observing a functional, a structural or a pointing action prime. In a within-subject design, during prime presentation the participants underwent repetitive transcranial magnetic stimulation (rTMS) over the left supramarginal gyrus (SMG), the left posterior middle temporal gyrus (pMTG) or received sham stimulation. Results showed that in the sham condition observing functional actions (vs. structural and pointing actions) favoured processing of semantic relations based on function similarity (i.e., taxonomic relations), but not of relations based on co-occurrence within an event schema (i.e., thematic relations). Moreover, stimulation of both left SMG and pMTG abolished the effect of functional action primes worsening subsequent judgment about taxonomic relations, and this effect was greater after pMTG stimulation. rTMS did not affect processing of thematic semantic relations. We suggest that action observation triggers activation of functional motor information within left inferior parietal cortex, and that integration between functional motor and conceptual information in left temporal cortex could impact high-level semantic processing of tools.

The role of the right premotor cortex and temporo-parietal junction in defensive responses to visual threats.

Previous neuroimaging studies demonstrated that several brain areas are involved in detecting threats and activating defensive responses to threatening stimuli. The right premotor cortex (PM) is mainly activated during freezing, whereas the right temporoparietal junction (TPJ) is involved in attentional orienting towards threat. The aim of the present study was to test the possibility to modulate attentional orienting and defensive responses to threatening stimuli by interfering with the activity of the right TPJ and PM with cathodal. The results demonstrated that after sham stimulation the participants were slower to respond to threatening than to non-threatening stimuli, consistent with the idea that the experimental paradigm induced a freeze-like response to threatening stimuli. Active tDCS over PM reversed this response pattern, whereas TPJ stimulation wiped out the difference between responses to threatening and non-threatening stimuli. Our findings demonstrated that inhibitory stimulation of PM favours active defensive responses to threatening stimuli whereas TPJ inhibitory stimulation reduces attentional prioritizing of threatening stimuli. In conclusion, our study showed that it is possible to modulate responses to threatening stimuli by interfering with activity of at least two cortical regions of the brain network involved in dealing with threats.

Non-invasive brain stimulation in generalized anxiety disorder: A systematic review.

In the last years, several studies using non-invasive brain stimulation (NIBS) techniques demonstrated that the dorsolateral prefrontal cortex (DLPFC) plays a key role in the neurobiological bases of anxiety disorders. Both transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) applied primarily over the prefrontal cortex have been shown to modulate anxiety symptomatology and attention allocation in the generalized anxiety disorder. A literature search on PubMed and PsycINFO databases following PRISMA guidelines identified 4 TMS studies (one open-label study and three randomized trials with active/sham conditions) and one tDCS case report study that have applied NIBS in patients with GAD. All the studies targeted the DLPFC except one in which the parietal cortex has been stimulated. Overall, the findings would suggest that NIBS could ameliorate anxiety symptoms and that improvements remained stable in the follow-up. Although a limited number of NIBS studies has been conducted on patients with anxiety disorders, these techniques could represent promising tools for the study of neurofunctional basis of anxiety disorders. Further sham-controlled studies are needed to clarify the mechanisms of action of NIBS in order to optimize stimulation protocols and to verify their effectiveness for treating anxiety symptoms.

Modulating interoception by insula stimulation: A double-blinded tDCS study.

Interoception consists in the perception and processing of internal body signals, such as heartbeat. Previous neuroimaging studies revealed that attention to heartbeat activated bilateral insula and premotor regions. In the present double-blind study, we aimed at testing the role of insula in interoception by means of transcranial direct current stimulation (tDCS) interfering with its activity. Sixteen healthy participants responded to a questionnaire to evaluate the tendency to be internally focused and performed a heartbeat counting task before and after tDCS in three sessions (left insula stimulation, right insula stimulation, sham stimulation). Real and reported heartbeat were recorded and used to calculate the accuracy scores. A significant interaction between stimulation condition and time (pre- and post-stimulation) was found due to a significant improvement of the interoceptive accuracy in the sham condition only. Our results demonstrated that stimulation over the insula reduced the possibility to improve the precision with which individuals detect internal signals.

Bi-cephalic parietal and cerebellar direct current stimulation interferes with early error correction in prism adaptation: Toward a complex view of the neural mechanisms underlying visuomotor control.

Prism Adaptation (PA) represents a valid tool to assess short-term visuomotor plasticity. Two adaptive processes are involved during PA: recalibration, contributing to early error compensation, and spatial realignment, contributing to after-effect development. Classical models on PA posit that adaptive mechanisms underlying PA rely on segregated regions in the brain. Indeed, they ascribe recalibration to the activity of the Posterior Parietal Cortex (PPC) and spatial realignment to the activity of the Cerebellum. The present experiment challenges the idea of a clear-cut separation of the role of the brain areas involved in PA, proposing an interpretation in terms of interrelated brain regions. To this purpose we interfered with the activity of the PPC and the Cerebellum by means of complementary protocols of stimulation. Bi-cephalic transcranial Direct Current Stimulation was delivered simultaneously on the PPC and the Cerebellum during PA in two groups of participants receiving real stimulation with opposite polarities (anode on PPC and cathode on Cerebellum or vice-versa) and in a control group (Sham stimulation). Differences in mean errors between groups were analyzed. Results show that the two groups of real stimulation exhibited larger displacements in early error compensation compared to the Sham Group, but they did not differ from each other. No group difference was found in late error compensation and after-effect. In conclusion, the present findings provide the first direct evidence that a brain circuit connecting the PPC and the Cerebellum is involved in early stages of visuomotor adaptation, and pave the way for updating classical models of PA.

Cerebellar contribution to spatial realignment: A tDCS study during multiple-step prism adaptation.

Several processes are devoted to error reduction in response to a visual displacement, such as the one induced by wedge prisms. Strategic calibration and spatial realignment contribute to the iteratively process that allows a progressive adjustment of motor commands to reduce the magnitude of errors. Isolating the specific contributions to motor behaviour coming from these distinct processes is not possible using traditional single-step Prism Adaptation (PA), where participants are directly exposed to full prismatic shift. Here, we selectively investigated the effect of realignment on motor behaviour by means of a PA paradigm (the multiple-step PA) that allows to elude the development of strategic calibration. We tested for a specific cerebellar contribution to realignment by means of transcranial Direct Current Stimulation (tDCS) in healthy subjects. Confirming and expanding previous imaging and stimulation results, our study causally demonstrates cerebellar involvement in spatial realignment. Additionally, our results point to a possible contribution of the cerebellum in automatic online control. The role of a cortico-cerebellar network accounting for this results and possible clinical applications are proposed and discussed.

Attentional biases for threat after fear-related autobiographical recall.

BACKGROUND: Previous studies suggested that affective state could enhance stimulus salience and modulate attention allocation for mood-congruent information, but contrasting data have been reported on the effects of mood induction on attentional biases for threat (ABTs) in non-clinical individuals. OBJECTIVE: We aimed to assess whether laboratory-induced negative mood can increase individuals' tendency to allocate attention on threatening stimuli, thus determining a difficulty in attentional disengagement from threat. We also aimed at assessing whether level of trait anxiety could modulate the effect of mood induction on attentional biases. METHODS: We used an autobiographical episode recall procedure for mood induction (fear, happiness and neutral episode recall), and an exogenous cueing task with threatening and non-threatening images to assess attentional biases in 120 undergraduate students. RESULTS: Participants showed a significant difficulty in disengaging attention from threat after recalling fear-related episodes, independently from their trait anxiety level. CONCLUSIONS: These findings clarify that the ABTs are not exclusive to anxiety disorders or high trait anxiety individuals, and could also arise in non-clinical individuals in a fearful context.

The effect of bicephalic stimulation of the dorsolateral prefrontal cortex on the attentional bias for threat: A transcranial direct current stimulation study.

Previous stimulation studies demonstrated that the dorsolateral prefrontal cortex (DLPFC) is involved in threat processing. According to a model of emotional processing, an unbalance between the two DLPFCs, with a hyperactivation of right frontal areas, is involved in the processing of negative emotions and genesis of anxiety. In the present study, we investigated the role of the right and left DLPFC in threat processing in healthy women who also completed the State-Trait Anxiety Inventory (STAI). We simultaneously modulated the activity of the right and left dorsolateral prefrontal cortex by applying bicephalic transcranial direct current stimulation (tDCS) before participants completed a modified version of the classic Posner task using threatening and nonthreatening stimuli as spatial cues. Anodal stimulation on the right DLPFC with a simultaneous cathodal stimulation over the left side induced a disengagement bias in individuals with low STAI scores and a facilitation bias in individuals with high STAI scores. Anodal stimulation on the left DLPFC with the simultaneous cathodal stimulation over the right side did not affect threat processing. The findings of the present study provided specific support to the hypothesis that unbalanced activation between left and right hemispheres with enhanced activation of the right DLPFC is critical in early top-down threat processing in healthy individuals.