Emotion Processing in Peripheral Neuropathic Pain: An Observational Study.

BACKGROUND: In clinical practice, the implementation of tailored treatment is crucial for assessing the patient's emotional processing profile. Here, we investigate all three levels of analysis characterizing emotion processing, i.e., recognition, representation, and regulation, in patients with peripheral neuropathic pain (PNP). METHODS: Sixty-two patients and forty-eight healthy controls underwent quantitative sensory testing, i.e., psychophysical tests to assess somatosensory functions such as perception of cold (CDT), heat-induced pain (HPT), and vibration (VDT), as well as three standardized tasks to assess emotional processing: (1) the Ekman 60-Faces Test (EK-60F) to assess recognition of basic facial emotions, (2) the Reading the Mind in the Eyes Test (RME) to assess the ability to represent the feelings of another person by observing their eyes, and (3) the 20-item Toronto Alexithymia Scale (TAS-20) to assess emotional dysregulation, i.e., alexithymia. RESULTS: General Linear Model analysis revealed a significant relationship between left index finger VDT z-scores in PNP patients with alexithymia. The RME correlated with VDT z-scores of the left little finger and overall score for the EK-60F. CONCLUSIONS: In patients with PNP, emotion processing is impaired, which emphasizes the importance of assessing these abilities appropriately in these patients. In this way, clinicians can tailor treatment to the needs of individual patients.

Psychometric Properties of the Detachment and Compartmentalization Inventory (DCI) in an Italian Community Sample.

The Detachment and Compartmentalization Inventory (DCI) is a valid and reliable self-report instrument that assesses these two distinct forms of dissociative symptoms. However, there is limited research on the cross-cultural validation of the DCI. Therefore, this study aimed to develop an Italian translation of the DCI and examine its internal structure and psychometric properties (including internal consistency, convergent validity, and test-retest reliability) within an Italian-speaking community sample. The sample consisted of 1276 adults (887 females; mean age: 29.57 ± 10.96 years), who completed the DCI and other self-report measures evaluating dissociative experiences and childhood trauma. Confirmatory factor analyses supported the original two-factor model (χ2169 = 1312.80, RMSEA = 0.073, 95%CI 0.069-0.077; CFI = 0.94; TLI = 0.94; SRMR = 0.04). Additionally, the DCI exhibited good internal consistency, test-retest reliability, and convergent validity with another measure of dissociation. The study also confirmed the association between DCI scores and the severity of childhood trauma. Finally, a Receiver Operating Characteristic (ROC) curve analysis demonstrated that the DCI effectively distinguishes individuals who screened positively for dissociative disorders. Overall, these findings indicate that the Italian translation of the DCI possesses satisfactory psychometric properties, suggesting its utility as a screening tool for assessing detachment and compartmentalization experiences.

Altered connectivity between the central executive network and the salience network in delusion-prone individuals: A resting state eLORETA report.

Although the Triple Network (TN) model has been proposed as a valid neurophysiological framework for conceptualizing delusion-like experiences, the neurodynamics of TN in relation to delusion proneness have been relatively understudied in nonclinical samples so far. Therefore, the main aim of the current study was to investigate the functional connectivity of resting state electroencephalography (EEG) in subjects with high levels of delusion proneness. Twenty-one delusion-prone (DP) individuals and thirty-seven non-delusion prone (N-DP) individuals were included in the study. The exact Low-Resolution Electromagnetic Tomography (eLORETA) software was used for all EEG analyses. Compared to N-DP participants, DP individuals showed an increas of theta connectivity (T = 3.618; p = 0.045) between the Salience Network (i.e., the left anterior insula) and the Central Executive Network (i.e., the left posterior parietal cortex). Increased theta connectivity was also positively correlated with the frequency of delusional experiences (rho = 0.317; p = 0.015). Our results suggest that increased theta connectivity between the Salience Network and the Central Executive Network may underline brain correlates of altered resting state salience detection, information processing, and cognitive control processes typical of delusional thinking.

Altered EEG Patterns in Individuals with Disorganized Attachment: An EEG Microstates Study.

Over the past years, different studies provided preliminary evidence that Disorganized Attachment (DA) may have dysregulatory and disintegrative effects on both autonomic arousal regulation and brain connectivity. However, despite the clinical relevance of this construct, few studies have investigated the specific alterations underlying DA using electroencephalography (EEG). Thus, the main aim of the current study was to investigate EEG microstate parameters of DA in a non-clinical sample (N = 50) before (pre) and after (post) the administration of the Adult Attachment Interview (AAI). Two EEG eyes-closed Resting State (RS) recordings were performed before and after the AAI, which was used for classifying the participants [i.e., Disorganized/Unresolved (D/U) or Organized/Resolved (O/R) individuals] and to trigger the attachment system. Microstates parameters (i.e., Mean Duration, Time Coverage and Occurrence) were extracted from each recording using Cartool software. EEG microstates clustering analysis revealed 6 different maps (labeled A, B, C, D, E, F) in both groups (i.e., D/U and O/R individuals) and in both conditions (i.e., pre-AAI and post-AAI). In the pre-AAI condition, compared to O/R individuals, D/U participants showed a shorter Mean Duration and Time Coverage of Map F; in the post-AAI condition, a significant reduction in the Mean Duration of Map E was also observed in D/U individuals. Finally, in the "within" statistical analysis (i.e., pre-AAI vs. post-AAI), only the D/U group exhibited a significant increase in Time Coverage of Map F after the AAI. Since these maps are associated with brain networks involved in emotional information processing and mentalization (i.e., Salience Network and Default Mode Network), our result might reflect the deficit in the ability to mentalize caregiver's interaction as well as the increased sensitivity to attachment-related stimuli typically observed in individuals with a D/U state of mind.

Emotional competencies and psychological distress: Is loneliness a mediating factor?

Emotional competencies, such as emotion regulation and empathy, are essential for social interaction. Impairment of these skills has been associated with increased rates of anxiety/depressive symptoms and loneliness, which has been defined as the discrepancy between the desired and actual quality and quantity of social relationships a person maintains. The aim of the present study was to shed light on the associations between these constructs and to examine the possible mediating role of loneliness in the relationship between emotional competencies and anxiety/depressive symptoms in a sample of non-clinical individuals. A total of 298 participants were recruited for this study and were asked to complete a series of measures assessing difficulties in emotion regulation, empathy, loneliness, and anxiety/depressive symptoms. Regression and mediation models were tested to analyze the associations between these variables. Results showed that reduced emotional competencies in emotion regulation and empathy were both directly and indirectly associated with increased anxiety/depressive symptoms and emotional loneliness, which in turn was related to higher levels of psychological distress (with a partial mediation of loneliness). Overall, the present findings seem to indicate that emotional competencies play a key role in the experience of loneliness and psychological distress. Therefore, individuals reporting high levels of loneliness in combination with anxious/depressive symptoms should receive appropriate assessment and treatment of emotion regulation and empathic skills.

Psychophysiological and Neurophysiological Correlates of Dropping Objects from Hands in Carpal Tunnel Syndrome.

BACKGROUND: Dropping objects from hands (DOH) is a common symptom of carpal tunnel syndrome (CTS). We evaluated the clinical, neurophysiological, and psychophysiological features of 120 CTS patients to elucidate the DOH pathophysiology. Forty-nine healthy controls were included. METHODS: In the patients, the Boston Carpal Tunnel Questionnaire (BCTQ), the Douleur Neuropathique 4 questions (DN4), and a numeric rating scale for pain (NRS) were evaluated. In patients and controls, we evaluated bilateral median and ulnar motor and sensory nerve conduction studies, cutaneous silent period and cutaneomuscular reflexes (CMR) of the abductor pollicis brevis, cold-detection threshold (CDT) and heat-pain detection threshold (HPT) at the index, little finger, and dorsum of the hand, and vibratory detection threshold at the index and little finger by quantitative sensory testing. RESULTS: CTS with DOH had higher BCTQ, DN4 and NRS, lower median sensory action potential, longer CMR duration, lower CDT and higher HPT at all tested sites than controls and CTS without DOH. Predictive features for DOH were abnormal CDT and HPT at the right index and dorsum (OR: 3.88, p: 0.03) or at the little finger (OR: 3.27, p: 0.04) and a DN4 higher than 4 (OR: 2.16, p < 0.0001). CONCLUSIONS: Thermal hypoesthesia in median and extra-median innervated territories and neuropathic pain are predictive of DOH in CTS.

Parental overcontrol is associated with dysmorphic concern severity: A cross-sectional study.

BACKGROUND: Dysmorphic concern (DC) is a symptom affecting both clinical and non-clinical populations, with a severe impact on individuals' physical and psychological well-being. While Childhood Trauma (CT) has been identified as a risk factor for DC, there is a lack of research on a specific form of CT, that is, parental overcontrol. Therefore, the current study aimed to investigate the association between DC and parental overcontrol in a community sample of adults, controlling for other forms of CT and potential confounding variables. METHOD: 714 adults (508 females; mean age: 30.29 ± 11.67 years; age range: 18-77) participated in an online survey including the Body Image Concern Inventory (BICI), the Overcontrol subscale of the Measure Of Parental Style, and the Childhood Trauma Questionnaire - Short Form (CTQ-SF). RESULTS: Parental overcontrol was independently associated with DC symptoms (ß = 0.111; p = .005; CI = [0.119;0.666]), even after controlling for other forms of CT and sociodemographic and clinical confounding variables. LIMITATIONS: The cross-sectional design of the study, the unbalanced sex ratio, the retrospective self-reported data about parental overcontrol and CT should be considered. CONCLUSIONS: This finding suggests that parental overcontrol may play a role in the development and maintenance of DC symptoms, remarking the urge to take more into account parental overcontrol in the assessment of CT.

Child Maltreatment, Abuse, and Neglect: An Umbrella Review of Their Prevalence and Definitions.

Objective: Child maltreatment (CM) is a recognized public health problem, and epidemiologic data suggest that it is a widespread phenomenon, albeit with widely varying estimates. Indeed, CM as well as child abuse (CA) and neglect (CN) are complex phenomena that are difficult to study for several reasons, including terminological and definitional problems that pose a hurdle to estimating epidemiological rates. Therefore, the main aim of this umbrella review is to revise recent review data on the epidemiology of CM, CA, and CN. A second aim was to revise the definitions used. Method: A systematic search of three databases was performed in March 2022. Recent reviews (published in the last 5 years: 2017-March 2022) addressing the epidemiological rates of CM, CA, and/or CN were included. Results: Of the 314 documents retrieved by the selected search strategy, the eligibility assessment yielded a total of 29 eligible documents. Because of the great heterogeneity among them, a qualitative rather than a quantitative synthesis was performed. Conclusions: The data from this umbrella review show that the different age groups, methods, and instruments used in the literature to collect the data on the epidemiology of CM make it difficult to compare the results. Although definitions appear to be quite homogeneous, CM categorization varies widely across studies. Furthermore, this umbrella review shows that the CM reviews considered do not examine some particular forms of CM such as parental overprotection. The results are discussed in detail throughout the paper.

The role of early attachment experiences in modulating defensive peripersonal space.

Selecting appropriate defensive behaviours for threats approaching the space surrounding the body (peripersonal space, PPS) is crucial for survival. The extent of defensive PPS is measured by recording the hand-blink reflex (HBR), a subcortical defensive response. Higher-order cortical areas involved in PPS representation exert top-down modulation on brainstem circuits subserving HBR. However, it is not yet known whether pre-existing models of social relationships (internal working models, IWM) originating from early attachment experiences influence defensive responses. We hypothesized that organized IWM ensure adequate top-down regulation of brainstem activity mediating HBR, whereas disorganized IWM are associated with altered response patterns. To investigate attachment-dependent modulation on defensive responses, we used the Adult Attachment Interview to determine IWM and recorded HBR in two sessions (with or without the neurobehavioral attachment system activated). As expected, the HBR magnitude in individuals with organized IWM was modulated by the threat proximity to the face, regardless of the session. In contrast, for individuals with disorganized IWM, attachment system activation enhances HBR regardless of the threat position, suggesting that triggering emotional attachment experiences magnifies the threatening valence of external stimuli. Our results indicate that the attachment system exerts a strong modulation on defensive responses and the magnitude of PPS.

Doll Therapy Intervention Reduces Challenging Behaviours of Women with Dementia Living in Nursing Homes: Results from a Randomized Single-Blind Controlled Trial.

Background: Doll therapy (DT) is a non-pharmacological intervention for the treatment of the behavioural and psychological symptoms of dementia (BPSD). We designed a single-blind randomized controlled trial of the 30-day efficacy of DT in reducing the BPSD, professional caregivers' distress and patients' biomarkers of stress, and in improving the exploration and caregiving behaviours. Methods: We randomly assigned 134 women with moderate-to-severe dementia living in nursing homes (NHs) to a DT intervention (DTI, 67) or a sham intervention with a cube (SI, 67). Results: From the first to the 30th session, the DTI group showed a significant decrease in the Neuropsychiatric Inventory-NH (NPI-NH) total score and in the NPI-NH-Distress score compared to the SI group (both p < 0.001). We observed a greater interest in the doll than in the cube, a greater acceptance of a separation from the nurse among DTI participants, and caregiving and exploratory behaviours towards the doll. There were no differences between the groups in the stress biomarkers. Conclusions: Consistent with attachment theory, our findings support the 30-day efficacy of DT, as this non-pharmacological intervention promotes perceptions of security by creating a situation in which patients feel confident and engaged in a caregiving relationship with the doll and reduces the challenging behaviours that are stressful for professional caregivers.

Assessment of Unresolved/Disorganized State of Mind in Relation to Attachment: A ROC Curve Study Using the Adult Attachment Interview and the Measure of Parental Style.

Objective: The main objective of the present study was to use the Receiver Operating Characteristic (ROC) curve analysis to identify cut-off points for a self-report measure assessing parental style, i.e., the Measure of Parental Style (MOPS), that are able to discriminate individuals with disorganized internal working models (IWMs) of attachment with adequate accuracy, in terms of sensitivity and specificity. Establishing cut-off points for the MOPS could provide clinicians and researchers with a valuable tool to investigate the role of disorganized IWMs as a link between parental styles and mental health. Method: A sample of 90 university students (mean age = 21.21 ± 2.05, females = 66) was enrolled in the study. We used the Adult Attachment Interview (AAI) to assess disorganized IWM and the MOPS to assess parental styles. Subsequently, we used ROC curve analysis to pursue the objective of the study. Results: The ROC curve analysis showed that the MOPS total score (i.e., the combination of maternal and paternal dimensions) was able to discriminate individuals with disorganized IWMs from individuals with organized IWMs (AUC= 0.77). Specifically, a score ≥ 25 (Youden index= 0.497) categorized individuals with a sensitivity of 0.69 (69% of participants with disorganized IWMs were correctly identified) and a specificity of 0.81 (19% of participants were incorrectly identified as having disorganized IWMs). Conclusions: Although the AAI has demonstrated high psychometric properties for assessing attachment representations in adulthood, its use is difficult when studies with large samples are to be conducted. As an alternative to the AAI, the MOPS can be used in studies with large populations, but no cut-off has yet been proposed. Here, we have identified cut-off points for the MOPS that are capable of detecting disorganized IWMs of attachment with adequate accuracy, and we suggest that this self-report is a useful brief instrument for detecting disorganized IWMs when time constraints prevent the use of the AAI (e.g., in studies with large samples or epidemiological studies).

Decreased brain network global efficiency after attachment memories retrieval in individuals with unresolved/disorganized attachment-related state of mind.

The main aim of the study was to examine how brain network metrics change after retrieval of attachment memories in individuals with unresolved/disorganized (U/D) attachment-related state of mind and those with organized/resolved (O/R) state of mind. We focused on three main network metrics associated with integration and segregation: global (Eglob) efficiency for the first function, local (Eloc) efficiency and modularity for the second. We also examined assortativity and centrality metrics. Electroencephalography (EEG) recordings were performed before and after the Adult Attachment Interview (AAI) in a sample of 50 individuals previously assessed for parenting quality. Functional connectivity matrices were constructed by means of the exact Low-Resolution Electromagnetic Tomography (eLORETA) software and then imported into MATLAB to compute brain network metrics. Compared to individuals with O/R attachment-related state of mind, those with U/D show a significant decrease in beta Eglob after AAI. No statistically significant difference among groups emerged in Eloc and modularity metrics after AAI, neither in assortativity nor in betweenness centrality. These results may help to better understand the neurophysiological patterns underlying the disintegrative effects of retrieving traumatic attachment memories in individuals with disorganized state of mind in relation to attachment.

Perceived parental over-protection in non clinical young adults is associated with affective vulnerability: A cross-sectional study.

OBJECTIVE: High levels of perceived parental over-protection are hypothesized to be related to relational problems, psychological distress, and development of psychiatric symptoms. Here, the main aim was to extend previous findings investigating the unique contribution of parental over-protection in predicting affective vulnerability. METHOD: 296 students were recruited and tested individually. All participants were administered self-report measures assessing parental styles [i.e., The Measure of Parental Style (MOPS)], several clinical dimensions (i.e., depressive symptoms, trait anxiety and alexithymia), and a checklist assessing socio-demographic variables. RESULTS: Affective vulnerability was investigated combining anxiety, depression and alexithymia through principal axis factoring which accounted for 70.90% of the variance of the data. All MOPS subscale were positively associated with all clinical dimensions (r > 0.13; p < 0.05) and with the Affective Vulnerability factor (r > 0.25; p < 0.001). Among different forms of dysfunctional parenting, only maternal (ß = 0.19; p = 0.007) and paternal (ß = 0.18; p = 0.010) over-protection were independently associated with Affective Vulnerability in the linear regression analysis, even when controlling for sex, age, and education. CONCLUSIONS: All forms of dysfunctional parenting investigated were associated with affective vulnerability. However, at a multivariate level, only maternal and paternal over-protection remained independently associated with affective vulnerability. This study contributes to our understanding of the role of parental over-protection as a risk factor for the development of affective vulnerability and on the potentially pathogenic role played by this parental style in the development of clinical and sub-clinical conditions.

eStroop: Implementation, Standardization, and Systematic Comparison of a New Voice-Key Version of the Traditional Stroop Task.

The Stroop effect is a well-documented phenomenon, demonstrating both interference and facilitation effects. Many versions of the Stroop task were created, according to the purposes of its applications, varying in numerous aspects. While many versions are developed to investigate the mechanisms of the effect itself, the Stroop effect is also considered a general measure of attention, inhibitory control, and executive functions. In this paper, we implement "eStroop": a new digital version based on verbal responses, measuring the main processes involved in the traditional effect. eStroop features four categories of stimuli in four different colors: (1) geometrical shapes, (2) neutral words, (3) congruent words, and (4) incongruent words. The results of the administration to 307 University students confirm the Stroop effect and offer baseline data for future research and clinical testing. Direct comparisons with other recent versions of the task are discussed, offering insights into differences and similarities between different task variables.

The relationship between alexithymia, sensory phenotype and neurophysiological parameters in patients with chronic upper limb neuropathy.

In this study, we investigated the relationship between sensory abnormalities evaluated by quantitative sensory testing (QST) and alexithymia, depression and anxiety in patients with neuropathic pain involving the upper limbs. We enrolled 62 patients (34 with carpal tunnel syndrome, 7 with brachial plexopathy, 3 with cervical painful radiculopathy, 5 with ulnar entrapment neuropathy at elbow and 13 with post-burn hypertrophic scars) and 48 healthy controls. All underwent nerve conduction studies (NCS), evaluation of cold, heat pain and vibration detection threshold (VDT) by QST and evaluation of alexithymia by Toronto Alexithymia Scale (TAS-20), depression by Beck Depression Inventory II (BDI-II), anxiety by State-Trait Anxiety Inventory (STAI-Y), level of psychological distress by 12-item General Health Questionnaire (GHQ-12) and perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS). The general linear model analysis revealed a significant relationship between TAS-20 overall and TAS-20 sub-score for difficulty identifying feelings and VDT z-scores in the left index with no interaction by year of education and sensory NCS results. Our results demonstrated the association between impairment of vibratory sensation of the left hand, reflecting cutaneous mechanoceptor dysfunction, and alexithymia, particularly the difficulty to identify feelings. The importance of delivering to patients with neuropathic pain personalized care that takes into account not only the neurophysiological aspects but also the aspects of mental functioning is discussed.

On the (lack of) association between theory of mind and executive functions: a study in a non-clinical adult sample.

We investigated in a sample of non-clinical adults the association between Theory of Mind (ToM) and Executive Functions (EFs), that is the set of skills that allow people to control and modulate lower-level cognitive processes in order to produce appropriate behaviour. To this aim, we assessed both affective (i.e., understanding other people's emotions and feelings) and cognitive (i.e., understanding others' beliefs and intentions) ToM, as well four subcomponents of EFs, that is Updating, Shifting, Inhibition, and Access. The association between ToM and non-verbal fluid intelligence, verbal reasoning, and cognitive estimation abilities was also investigated. Eighty-one healthy participants were recruited, and a set of psychometrically validated tests was administered. Multiple regression analyses were run to assess significant predictors of ToM performance when potentially confounding predictors (sociodemographic variables) were controlled for. Results showed a lack of association between affective/cognitive ToM and EFs, whereas non-verbal fluid intelligence for cognitive ToM and verbal reasoning for affective ToM were found to be significant predictors of ToM performance. These results represent a contribution toward a deeper understanding of the ToM-EFs relationships and highlight the importance of broadening the analysis of these relationships to the role played by other domain-general functions in both affective and cognitive ToM.

The role of alexithymia in social cognition: Evidence from a non-clinical population.

BACKGROUND: Alexithymia is a personality construct characterised by difficulty in identifying and describing one's emotions. We investigated whether people with alexithymia, who struggle with emotion-processing abilities, have diminished emotion-related social cognitive competencies, where social cognition encompasses the set of abilities that allows one to navigate one's social environment. METHODS: We assessed alexithymia and four components of social cognition: recognition of others' emotions, representation of others' affective and cognitive mental states, empathy, and regulation of one's own feelings. We investigated whether alexithymia could significantly predict each of these components, beyond the effect of other individual difference variables (i.e., anxiety/depressive symptoms), which have been previously associated with both social cognition and alexithymia. Two hundred six participants were recruited. Multiple hierarchical regression analyses were performed to assess the possible relationships between alexithymia and social cognition skills. RESULTS: Alexithymia significantly predicted emotion recognition, empathy, and emotional regulation, even after controlling for the effect of potentially competing factors (i.e., anxiety/depressive symptoms). Alexithymia did not predict representation of others' affective and cognitive mental states. LIMITATIONS: The present study adopted a cross-sectional design, which does not permit us to draw firm conclusions about the causality of the emergent relationships. CONCLUSIONS: These data provide support for the argument that recognising others' emotions and feelings relies on the ability to identify correctly one's own feelings. Our results also indicate the importance of taking into consideration individual differences in levels of alexithymia when investigating social cognition in non-clinical populations, as alexithymia appears to be clearly related to social cognitive functioning.

Theory of Mind Performance Predicts tDCS-Mediated Effects on the Medial Prefrontal Cortex: A Pilot Study to Investigate the Role of Sex and Age.

Transcranial Direct Current Stimulation (tDCS) has become an increasingly promising tool for understanding the relationship between brain and behavior. The purpose of this study was to investigate whether the magnitude of sex- and age-related tDCS effects previously found in the medial prefrontal cortex (mPFC) during a Theory of Mind (ToM) task correlates with social cognition performance; in particular, we explored whether different patterns of activity would be detected in high- and low-performing participants. For this, young and elderly, male and female participants were categorized as a low- or high-performer according to their score on the Reading the Mind in the Eyes task. Furthermore, we explored whether sex- and age-related effects associated with active tDCS on the mPFC were related to cognitive functioning. We observed the following results: (i) elderly participants experience a significant decline in ToM performance compared to young participants; (ii) low-performing elderly females report slowing of reaction time when anodal tDCS is applied over the mPFC during a ToM task; and (iii) low-performing elderly females are characterized by lower scores in executive control functions, verbal fluency and verbal short-term memory. The relationship between tDCS results and cognitive functioning is discussed in light of the neuroscientific literature on sex- and age-related differences.

Doll therapy intervention for women with dementia living in nursing homes: a randomized single-blind controlled trial protocol.

BACKGROUND: Doll therapy is a non-pharmacological intervention for people with dementia aimed to reduce distressing behaviours. Reliable results on the efficacy of Doll therapy for people with dementia are needed. The concept of attachment theorised by Bowlby has been proposed to explain the Doll therapy process, but it has not been proven to influence the response to doll presentation. METHODS/DESIGN: This single-blind, randomised controlled trial will involve people with dementia living in nursing homes of the Canton Ticino (Switzerland). Participants will be randomised to one of two interventions: Doll Therapy Intervention or Sham Intervention with a non-anthropomorphic object, using a 1:1 allocation ratio. The two interventions will consist of 30 daily sessions lasting an hour at most, led by a trained nurse for an hour at most. We will enrol 64 participants per group, according to power analysis using an estimated medium effect size (f = 0.25), an alpha level of 0.05, and a power of 0.8. The primary goal is to test the efficacy of the Doll Therapy Intervention versus the Sham Intervention as the net change in the following measures from baseline to 30 days (blinded outcomes): the Neuropsychiatric Inventory-Nursing Home administered by a trained psychologist blinded to group assignment, the professional caregivers' perceived stress scale of the Neuropsychiatric Inventory-Nursing Home, patients' physiological indices of stress (salivary cortisol, blood pressure and heart rate) and interactive behaviours. The secondary goal is to assess the relationship between attachment styles of people with dementia (detected by means of the Adult Attachment Interview to the patients' offspring) and their caregiving behaviours shown during the Doll Therapy Intervention. DISCUSSION: This is the first single-blind, randomised controlled trial on the efficacy of Doll therapy for dementia and an explanatory model of the response of people with dementia to doll presentation. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03224143. Retrospectively registered on 21 July 2017.

Aging, sex and cognitive Theory of Mind: a transcranial direct current stimulation study.

Aging is accompanied by changes in cognitive abilities and a great interest is spreading among researchers about aging impact on social cognition skills, such as the Theory of Mind (ToM). Transcranial direct current stimulation (tDCS) has been used in social cognition studies founding evidence of sex-related different effects on cognitive ToM task in a young people sample. In this randomized, double-blind, sham-controlled study, we applied one active and one sham tDCS session on the medial prefrontal cortex (mPFC) during a cognitive ToM task, including both social (i.e., communicative) and nonsocial (i.e., private) intention attribution conditions, in sixty healthy aging individuals (30 males and 30 females). In half of the participants the anode was positioned over the mPFC, whereas in the other half the cathode was positioned over the mPFC. The results showed that: (i) anodal tDCS over the mPFC led to significant slower reaction times (vs. sham) for social intention attribution task only in female participants; (ii) No effects were found in both females and males during cathodal stimulation. We show for the first time sex-related differences in cognitive ToM abilities in healthy aging, extending previous findings concerning young participants.