A Crossed Pure Agraphia by Graphemic Buffer Impairment following Right Orbito-Frontal Glioma Resection.

Pure agraphias are caused by graphemic buffer damage. The graphemic buffer stores graphemic representations that handle the transition from spelling lexicon to writing or oral spellings. The authors report a case of a crossed pure agraphia, following the post-surgical removal of a right frontal low-grade glioma in a right-handed French patient. He presented a pure agraphia displaying the features of a graphemic buffer impairment. Our patient only made spelling errors, whereas repetition and other oral language abilities remained perfect. We found a greater number of errors for longer stimuli, increased errors for the medially located graphemes, and agraphia for both words and non-words and error types, essentially consisting of omissions, substitutions, and letter transpositions. We also observed no significant effect of word frequency on spelling errors, but word length affected the rate of errors. The particularity of this case was linked to right frontal subcortical injuries in a right-handed subject. To our knowledge, it is the first report of a crossed pure agraphia caused by graphemic buffer impairment. Further studies are needed in order to analyse the role of subcortical structures, particularly the caudate nucleus in the graphemic buffer during writing tasks, as well as the participation of the non-dominant hemisphere in writing language.

Online Behaviours during the COVID-19 Pandemic and Their Associations with Psychological Factors: An International Exploratory Study.

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants (M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h (SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.

Alzheimer's Disease and Face Masks in Times of COVID-19.

Generalized lockdown caused by COVID-19, necessary yesterday, can no longer be that of tomorrow. It will no longer be possible to cram the humblest into cramped areas, but priority must be given to prevention (certainly with physical barriers, hydro-alcoholic gel, face masks), biological diagnosis, isolation, and also the care of any infected person. COVID-19 has hit the most vulnerable first in terms of biological inequality, such as Alzheimer's disease (AD) patients. Those with AD can have sensorial deficits and perception troubles, including visual difficulties and the inability to recognize faces and emotions. Face masks and physical distancing can disrupt facial familiarity and make it more difficult to recognize emotional facial expressions. It can provoke distress, which the visitor can perceive and feel obligated to take off the face mask. This gesture should not be considered as an act of indiscipline, but an act of empathy. Transparent face masks could improve the suffering of AD patients, distraught in the presence of their loved ones whose masks hide their faces. Wearing a mask should not be due to fear of punishment, but as an understanding of the responsibility of each individual in the control of the current pandemic. It may be necessary to convince more citizens of this civic duty, using clear and attractive messaging in order to standardize the wearing of face masks for the general public and to adapt them to the needs of patients.

Could Self-Consciousness Be Enhanced in Alzheimer's Disease? An Approach from Emotional Sensorial Stimulation.

Alzheimer's disease (AD) provides a valuable field of research into impairment of self-consciousness (SC), because AD patients have a reduced capacity to understand their mental world, to experience and relive previous personal events, as well as to interpret thoughts, feelings, and beliefs about themselves. Several studies observed that AD patients had an altered SC, but not a complete abolition of it. Emotions are an integral part of the construction of personal identity, therefore of Self. In general, most studies on emotion in AD patients have observed that emotion is not completely abolished and it lets them better remember autobiographical events with greater emotional charge. The positive effect of autobiographical memories rich in emotional content, evoked directly/automatically by sensorial stimuli such as familiar odors or music, could be used to reestablish/reinforce the permanence and coherence of the Self in AD. We studied the research of empirical evidence supporting the power of the sensorial cues associated with emotion, which could be capable of enhancing the SC in AD. We presented the studies about "Emotional stimulations" using odor, music, or taste cues in AD. All studies have shown to have a positive impact on SC in AD patients such as odor-evoked autobiographical memories, taste/odor-evoked autobiographical memories, emotional sensorial stimulation using musical cues, and multi-sensorial stimulations using healing gardens. We found research supporting the notion that emotional sensorial stimulations can even temporarily exalt memory, affective state, and personal identity, that is, the SC in AD. The emotional sensory stimulations could be used as a tool to activate the SC in AD and hence improve the quality of life of patients and caregivers.

Procedural Learning Improves Cognition in Multiple Sclerosis.

BACKGROUND: Multiple sclerosis (MS) is considered a neurodegenerative disease and an inflammatory demyelinating neuropathology in young population. Procedural memory has been poorly investigated in MS. OBJECTIVE: We assessed whether the MS group was able to develop a motor-cognitive skill, using a procedural task (PLSC) developed in our laboratory, applying a manual and serial reaction time (RT) paradigm to semantic categorization. METHODS: We evaluated 26 MS patients and 26 socio-demographic matched control participants using the PLSC task. RESULTS: Using non-parametric statistical analyses, we observed a significant improvement of semantic categorization RTs with practice (p = 0.002), even with new verbal material to categorize in MS patients (p = 0.006), despite their motor and executive moderate deficits. This same profile of semantic procedural learning in MS was observed in previous studies carried out with Alzheimer's and Parkinson's diseases. Moreover, the visual-motor RTs remained stable or slightly improved over the five blocks in both groups, as well as in the AD groups of previous studies. The MS group showed longer visual-motor reaction times than those of the control group (p < 0.042), except in motor initiation aspect (p = 0.064). Both groups showed no significant differences for any type of error. Additionally, disability level and cognitive performances were not associated with the ratio of semantic procedural learning. CONCLUSION: The present results support the notion that MS patients may be capable of acquiring semantic skill, despite their motor disabilities and executive troubles. This work also addresses the possibilities to improve motor-cognitive skill RTs in neurodegenerative diseases.

Music and emotion in Alzheimer's disease.

BACKGROUND: Alzheimer's disease may compromise several musical competences, though no clear data is available in the scientific literature. Furthermore, music is capable of communicating basic emotions, but little is known about the emotional aspect of music in patients with Alzheimer's disease. We present a systematic investigation of music processing in relation to extra-musical skills, in particular emotional skills in patients with Alzheimer's disease. METHODS: We tested 30 patients with mild or moderate Alzheimer's disease and 30 control subjects. We essentially evaluated (a) musical competences, using the extra-linguistic test, Solfeggio test and the recognition test of musical emotions-elaborated by our research team-and the Seashore test, and (b) emotional capacities using emotional memory and emotional prosody tests-made by our research group. RESULTS: We significantly observed lower total results of every test assessing cognitive, emotional and music competences in Alzheimer's disease patients than those in control subjects, but the score of musical emotion recognition test did not reach to a significant difference between the subjects groups. CONCLUSIONS: Our findings found a global impairment of music competences in Alzheimer patients with cognitive and emotional troubles. Nevertheless, the performances in the recognition test of musical emotions showed a trend towards a performance difference. We can suggest that Alzheimer's disease currently presents an aphaso-agnoso-apractic-amusia syndrome.

Consciencia del otro en patologías neurodegenerativas / Consciousness of others and neurodegenerative diseases

Resumen Hemos elaborado una revisión del estado actual del concepto emergente denominado consciencia del otro en la enfermedad de Alzheimer y la demencia frontotemporal de variante frontal. La consciencia del otro es la consciencia que uno mismo tiene de los otros congéneres y podría considerarse clave para la comprensión de las alteraciones del comportamiento en patologías neurodegenerativas tales como la enfermedad de Alzheimer y las demencias frontotemporales. La consciencia del otro es multifactorial e incluye los siguientes componentes: reconocimiento emocional del rostro, prosodia emocional, pragmática del lenguaje, mentalización, empatía y razonamiento social. Los distintos tipos de demencias afectan de forma heterogénea a los diferentes componentes de la consciencia del otro. En general, los estudios con pacientes de demencia frontotemporal de variante frontal observan más alteraciones de la consciencia del otro que los de los enfermos de Alzheimer. En concreto, en estos últimos se encuentran mayores dificultades en el componente de la pragmática del lenguaje, asociándolo a la severidad de su deterioro cognitivo, pero que no les impide tener un adecuado sentido social. Sin embargo, los estudios con pacientes con demencia frontotemporal de variante frontal observan importantes dificultades en cada uno de los componentes de la consciencia del otro y muestran graves problemas para regular adecuadamente su conducta social. Se necesitarían más estudios para comprender las relaciones de los distintos componentes de la consciencia del otro en las demencias para comprender sus trastornos del comportamiento.

Abstract This review presents data about an emerging concept called «Consciousness of others¼ in Alzheimer's disease and behavioral variant frontotemporal dementia. Consciousness of others is the awareness that one has of others, and it could be considered key in the understanding of behavioral problems in neurodegenerative diseases, such as Alzheimer's disease and frontotemporal dementia. Consciousness of others is multifactorial and it includes the following aspects: emotional face recognition, emotional prosody, pragmatic of language, mentalization, empathy, and social reasoning. Subtypes of dementias heterogeneously affect the different aspects of consciousness of others. In general, patients with a behavioral variant of frontotemporal dementia presented with more problems of consciousness of others than those with Alzheimer's disease. , patients with Alzheimer's disease showed more difficulties in the aspect of language pragmatic, which was associated with the severity of cognitive impairment, but they could maintain a good social sense. However, patients with frontal variant frontotemporal dementia showed problems in every component of the consciousness of others, thus having important problems to properly regulate their social behavior. Further studies are needed for a better knowledge of the complex relationship between different aspects of consciousness of others in dementias for a better understanding of behavioral troubles.

Self-Consciousness in Patients with Behavioral Variant Frontotemporal Dementia.

Self-consciousness (SC) is multifaceted and considered to be the consciousness of one's own mental states. The medial prefrontal cortex may play a critical role in SC. The main aim of this paper was to examine SC in patients with behavioral variant frontotemporal dementia, who are characterized more by changes in personal, social, and emotional conduct and loss of insight than by cognitive disturbances. Control and patient groups of 21 subjects each, matched by age, educational level, gender, and nationality were assessed using a SC questionnaire. It measures several aspects: Personal identity, Anosognosia, Affective state, Body representation, Prospective memory, Introspection, and Moral judgments. The most disturbed ones in patients were Anosognosia, Affective state, and Moral judgments, and the least disturbed aspects were awareness of identity and of body representation. No significant correlations were found between the SC score and any clinical or demographical characteristics. The core deficiency of SC in patients was related to behavioral SC aspects, which are more dependent on orbito-frontal functioning.

Procedural learning of semantic categorization in Parkinson's disease.

This paper studies the procedural learning of semantic categorization in 29 patients with non-demented Parkinson's disease (PD). We investigated whether the PD group was able to develop semantic skill, using a cognitive procedural task developed in our laboratory, applying a manual and serial reaction time paradigm to semantic categorization. The PD group showed similar scores to those of the control group on semantic categorization. Both groups showed reaction time reduction over the semantic procedural task, but the PD group produced longer reaction times than the control subjects. Contrary to our prediction, we observed an improvement in semantic categorization reaction times with practice, even with new verbal material for the PD patients to categorize despite their motor impairments and executive deficits. By contrast, we found a significant negative correlation between axial motor signs and the ratio of semantic procedural learning, but not for lateral motor signs. The present results support the notion that non-demented PD patients may be capable of acquiring comparable semantic skill to those of the control group.

Evaluation of a group cognitive-behavioral dementia caregiver intervention in Latin America.

Research has identified unique cultural factors contributing to dementia caregiving in Latin America but very few caregiver interventions have been systematically piloted and evaluated in this region. The purpose of this study was to examine the effectiveness of a group cognitive-behavioral intervention in improving the mental health of dementia caregivers from Cali, Colombia. Sixty-nine caregivers of individuals with dementia were randomly assigned to the cognitive-behavioral intervention or an educational control condition, both spanning 8 weeks. Compared to controls, the treatment group showed higher satisfaction with life and lower depression and burden over the posttest and 3-month follow-ups although there was no effect of the condition on participants' stress levels.

Utility of neuropsychiatric tools in the differential diagnosis of dementia with Lewy bodies and Alzheimer's disease: quantitative and qualitative findings.

BACKGROUND: Discerning dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) is one of the most common and challenging differential diagnoses at the memory clinic. Although the neuropsychiatric manifestations have been widely reported as one of the main key points in the differential diagnosis between these two diseases, to date no neuropsychiatric questionnaire has been specifically devised for this purpose. METHODS: We administered the Neuropsychiatric Inventory (NPI) and the Columbia University Scale for Psychopathology in Alzheimer's Disease (CUSPAD) to a memory clinic sample of 80 patients with probable DLB and 85 age- and severity-matched patients with probable AD. Diagnosis of probable DLB was supported with a positive dopamine transporter SPECT scan. We examined the usefulness of these two neuropsychiatric tools designed for AD in the differential diagnosis between DLB and AD. We also investigated the correlations between psychotic symptoms and measures of cognitive and functional decline. RESULTS: Auditory hallucinations were very specific of DLB and were usually preceded by visual hallucinations. Misinterpretation of real visual stimuli (illusions) was more frequent in DLB. Delusions were both quantitatively and qualitatively different between DLB and AD: delusional misidentifications were significantly more characteristic of DLB, while paranoid delusions did not show specificity for DLB. CONCLUSIONS: Neuropsychiatric tools are useful to discriminate DLB from AD. Hallucinations and delusions are not only more frequent in DLB than in AD but also have distinct qualitative characteristics and patterns of progression that can help clinicians to make a more accurate differential diagnosis.

Familiar music as an enhancer of self-consciousness in patients with Alzheimer's disease.

The main objective of this paper is to examine the impact of familiar music on self-consciousness (SC) in patients with Alzheimer's disease (AD). For this purpose, two AD groups of 20 patients matched by age, educational level, gender, illness duration, and cognitive state were assessed using an SC questionnaire before and after music intervention. The SC questionnaire measured several aspects: personal identity, anosognosia, affective state, body representation, prospective memory, introspection and moral judgments. One AD group received familiar music stimulation and another AD group unfamiliar music stimulation over three months. The AD patients who received a familiar music intervention showed a stabilization or improvement in aspects of SC. By contrast, control AD group showed a deterioration of most of the SC aspects after unfamiliar music stimulation, except the SC aspects of body representation and affective state. Familiar music stimulation could be considered as an enhancer of SC in patients with Alzheimer's disease.

Técnicas de rehabilitación neuropsicológica en demencias: hacia la ciber-rehabilitación neuropsicológica / Neuropsychological rehabilitation techniques in dementias: towards neuropsychological cyber-rehabilitation

Las técnicas de rehabilitación neuropsicológica están destinadas a paliar el deterioro cognitivo de pacientes que sufren una demencia de severidad leve, sin el uso de psicofármacos. Actualmente, la mayoría de estos programas de intervención cognitiva en demencias está siendo mejorada, a través de la incorporación de los avances en el campo de la Tecnología de la Información y Comunicación (TIC). El objetivo del presente trabajo es la revisión de los avances más recientes en este campo. Describiremos las técnicas de rehabilitación neuropsicológica desde las más clásicas (Terapia de Orientación a la Realidad y la Terapia de Reminiscencias), pasando por las más actuales, como las técnicas para la facilitación de la re-codificación, las técnicas de acondicionamiento del entorno y para el aprendizaje de nueva información (Recuperación Espaciada, Difuminación de los Indicios de Recuperación, Aprendizaje sin Errores y Procedimentalización de Tareas). Esta revisión finaliza con las técnicas ciber-neuropsicológicas, las cuales aplican las últimas novedades de las TIC como la realidad virtual a la rehabilitación neuropsicológica.

Neuropsychological rehabilitation techniques are aimed at palliating the cognitive deterioration of patients suffering from non-severe dementia, without the use of psychotropics. Currently, most such cognitive intervention programs in dementia are being improved through the use of advances in the field of information and communication technology (ICTs). The aim of this paper is to offer a review of the most recent advances in this area. We shall describe Neuropsychological Rehabilitation techniques ranging from the most classical (Reality Orientation Therapy and Reminiscence Therapy), to more updated techniques such as those for facilitating re-encoding, techniques for conditioning the environment and techniques for learning new information (Spaced Retrieval, Vanishing Cues, Errorless learning and procedural techniques). This review ends with cyber-neuropsychological techniques, which apply the latest introductions to ICTs, such as virtual reality.

As técnicas de Reabilitação Neuropsicológica estão destinadas a diminuir, sem o uso de psicofármacos, a disfunção cognitiva de pacientes que sofrem uma demência de severidade leve. Atualmente, a maioria de estes programas de intervenção cognitiva em demências estão sendo melhorados, a través da incorporação dos avances no campo da tecnologia da informação e comunicação (TIC). O escopo do presente trabalho é revisar os avances mais novos neste campo. São descritas as técnicas de Reabilitação Neuropsicológica desde as mais clássicas (Terapia de Orientação à Realidade e a Terapia de Reminiscências), passando pelas técnicas mais atuais como a facilidade da recodificação, as técnicas de acondicionamento do entorno e as técnicas para a aprendizagem de nova informação (Recuperação Espaçada, Difuminação dos Indícios de Recuperação, Aprendizagem sem erros e Procedimentalização de tarefas). Esta revisão termina com as técnicas ciber-neuropsicológicas, as quais aplicam as últimas novidades das TICs como a realidade virtual à reabilitação neuropsicológica.

Improvement of semantic categorization through procedural learning in Alzheimer's disease.

This paper studies the procedural learning of semantic categorization in 20 patients with mild Alzheimer's disease (AD). We investigated if the AD group was able to develop semantic skill using a cognitive procedural task, developed in our laboratory, by applying a manual and serial reaction time paradigm to semantic categorization. The AD group had markedly lower scores than the normal group on semantic categorization and had longer reaction times than the control subjects. Nevertheless, we observed an improvement of semantic categorization reaction times over time with practice, even with new verbal material to categorize, in both the AD and control groups. These results support the notion that AD patients are able to acquire semantic skill without awareness simply by repeated exposure, although their semantic accuracy will not reach normal levels.

Effects of automatic/controlled access processes on semantic memory in Alzheimer's disease.

This study examines the impact of automatic/controlled access processes on the semantic network in 30 patients with Alzheimer's disease (AD). The AD group was compared with a control group using a battery of neuropsychological tests, a variation of Hodges's semantic testing battery, designed to assess semantic knowledge. The AD group had markedly lower scores than the normal group on each semantic test, but with a different degree of deterioration depending on the nature of the processes (controlled/automatic) in accessing the semantic network. AD patients had poorer performances on the explicit semantic tasks mainly involving controlled-process access (e.g., the WAIS Similarities Subtest) than those involving mainly automatic-process access (e.g., the Verbal Automatism test). Analyses of confidence intervals allowed a gradient of impaired performances in increasing order to be elaborated: a) the Verbal Automatism test, b) the WAIS Vocabulary Subtest, c) the WAIS Information Subtest, d) the Letter Fluency Task, e) Naming as a Response to Definition, f) the Category Fluency Task, g) the WAIS Similarities Subtest, and h) the Oral Denomination 80 Test. The results of our study suggest that explicit semantic tasks needing passive or automatic processes to access semantic memory would be better preserved in AD.

Adaptación y validación del test Evaluación Rápida de las Funciones Cognitivas(Gil et al, 1986). Primera versión en castellano con una muestra geriátrica (AU) / First Spanish version of the French test Rapid Assessment of Cognitive Functions (Gil et al, 1986). Adaptation and validation in a geriatric sample

Objetivo: Adaptación y validación de la primera versión en castellano del test Evaluación Rápida de las Funciones Cognitivas (ERFC) de Gil et al (1986). Sujetos y Métodos: Se examinó una muestra de 369 personas mayores sin deterioro mental de tres comunidades autónomas de España. Se utilizaron los siguientes instrumentos de evaluación: ERFC.es (versión en castellano del ERFC francés) y versiones españolas del Mini-Examen Cognoscitivo 30, el test de Ansiedad y Depresión de Goldberg, el Geriatric Mental State, el History and Aetiology Schedule, así como los criterios de demencia del DSM-IV. Los datos normativos se obtuvieron para tres grupos de edad (63-69, 70-75 y > 75 años) y cuatro niveles de escolaridad (analfabetos, estudios primarios, bachillerato y estudios universitarios). Resultados: El ERFC.es cumple criterios de fiabilidad test-retest (r = 0,38), validez de contenido (70%), según la prueba de Morillama por acuerdo entre jueces, validez de constructo (MEC = 0,82 y ERFC = 0,9) y consistencia interna (alfa de Cronbach = 0,8). Obtiene una sensibilidad del 0,92% y una especificidad del 0,86% con el punto de corte de 51/56. Además, las puntuaciones totales del ERFC.es son similares al ERFC, una vez eliminados los ítems nuevos introducidos en nuestra versión. Se observa un efecto mayor de las variables edad y nivel escolar en las puntuaciones del ERFC.es que en la versión original francesa. Conclusiones: Se confirma la validez y la fiabilidad del ERFC.es en una muestra geriátrica sana. Puede considerarse como un instrumento útil para la evaluación rápida de las capacidades cognitivas (AU)

Aim: To adapt and validate the first Spanish version of the French test Rapid Assessment of Cognitive Functions (RACF) (Gil et al, 1986). Subjects and methods: A sample of 369 elderly people without cognitive impairment from three autonomous communities in Spain was evaluated. The following instruments were used: the Spanish version of the French RACF (RACF.sp ) and the Spanish versions of the Mini-Mental State Examination (MMSE), Goldberg’s anxiety and depression scale, the Geriatric Mental State Examination, the History and Etiology Schedule, and the DSM-IV criteria for a diagnosis of dementia. Normative data were obtained for three age groups (63-69, 70-75 and > 75 years) and four educational levels (illiterate, primary school, high school and college/university). Results: The RACF.sp fulfilled the criteria of testretest reliability (r = 0.88), content validity (70%), according to Morillama’s method of inter-rater agreement, construct validity (MMSE = 0.82; RACF = 0.9) and internal consistency reliability (Cronbach’s alpha = 0.8). The sensitivity of the RACF.sp was 0.92% and specificity was 0.86% with a cut-off point of 51/56. RACF.sp scores were similar to those of the RACF, when the new items introduced into the RACF. sp were eliminated. A greater effect of age and educational level was observed in RACF.sp scores than in those of the original RACF. Conclusions: This study confirms the reliability and validity of the RACF.sp in a healthy geriatric sample. The RACF.sp can be considered a useful tool for the rapid assessment of cognitive functions (AU)

La anosognosia en la enfermedad de Alzheimer / Anosognosia in Alzheimer's disease

La anosognosia es un trastorno común, multifactorial y de naturaleza compleja tras daño cerebral, donde los pacientes no son conscientes de su trastorno. En este artículo, revisamos la anosognosia en la enfermedad de Alzheimer (EA). La anosognosia en la EA es considerada como una faceta multidimensional. Se han propuesto varias teorías que pretenden explicar la no toma de consciencia de los déficits neurológicos o cognitivos, como las teorías neuroanatómicas, neurológicas o psicopatológicas. La anosognosia en la EA es frecuente. Numerosos estudios encuentran una correlación significativa entre la gravedad de la demencia y lesiones en el hemisferio cerebral derecho o una disfunción de tipo frontal, pero se dan resultados contradictorios

Anosognosia is a common, multifactorial, complex disorder after brain damage, in which patients remain unaware of their disability. To review data on anosognosia in Alzheimer's disease (AD). Anosognosia in la AD is considered to be multidimensional. Several theoretical frameworks, such as neuroanatomic, neurological or psychopathological theories, aim to explain the lack of unawareness of neurological or cognitive impairment. Anosognosia is frequent in AD. Many studies have found a significant correlation between the severity of dementia and right hemisphere damages or frontal dysfunction, but the results are contradictory