The Network Structure of Cognitive Impairment: From Subjective Cognitive Decline to Alzheimer's Disease.

It was proposed that a reorganization of the relationships between cognitive functions occurs in dementia, a vision that surpasses the idea of a mere decline of specific domains. The complexity of cognitive structure, as assessed by neuropsychological tests, can be captured by exploratory graph analysis (EGA). EGA was applied to the neuropsychological assessment of people (humans) with subjective cognitive decline (SCD), mild cognitive impairment (MCI), and Alzheimer's disease (AD; total N = 638). Both sexes were included. In AD, memory scores detach from the other cognitive functions, and memory subdomains reduce their reciprocal relation. SCD showed a pattern of segregated neuropsychological domains, and MCI showed a noisy and less stable pattern. Results suggest that AD drives a reorganization of cognitive functions toward a less-fractionated architecture compared with preclinical conditions. Cognitive functions show a reorganization that goes beyond the performance decline. Results also have clinical implications in test interpretations and usage.

Genuine Memory Deficits as Assessed by the Free and Cued Selective Reminding Test (FCSRT) in the Behavioural Variant of Frontotemporal Dementia. A Systematic Review and Meta-analysis Study.

The current diagnostic criteria for the behavioural variant of frontotemporal dementia (bvFTD) foresee a relative sparing of long-term memory. Although bvFTD patients were thought to report secondary memory deficits associated with prefrontal dysfunctions, some studies indicated the presence of a "genuine memory deficit" related to mesial temporal lobe dysfunctions. Among various neuropsychological tests, the Free and Cue Selective Reminding Test (FCSRT) has been recommended to distinguish genuine from apparent amnesia. We conducted a systematic review and a random effect Bayesian meta-analysis to evaluate the nature and severity of memory deficit in bvFTD. Our objective was to determine whether the existing literature offers evidence of genuine or apparent amnesia in patients with bvFTD, as assessed via the FCSRT. On 06/19/2021, we conducted a search across four databases (PMC, Scopus, Web of Science, and PubMed). We included all studies that evaluated memory performance using the FCSRT in patients with bvFTD, as long as they also included either cognitively unimpaired participants or AD groups. We tested publication bias through the Funnel plot and Egger's test. To assess the quality of studies, we used the Newcastle-Ottawa quality assessment scale adapted for cross-sectional studies. We included 16 studies in the meta-analysis. The results showed that bvFTD patients perform better than AD patients (pooled effects between 0.95 and 1.14), as their memory performance stands between AD and control groups (pooled effects between - 2.19 and - 1.25). Moreover, patients with bvFTD present both genuine and secondary memory disorders. As a major limitation of this study, due to our adoption of a rigorous methodology and stringent inclusion criteria, we ended up with just 16 studies. Nonetheless, our robust findings can contribute to the ongoing discussion on international consensus criteria for bvFTD and the selection of appropriate neuropsychological tools to facilitate the differential diagnosis between AD and bvFTD.

The indirect effect of cognitive reserve on the relationship between age and cognition in pathological ageing: A cross-sectional retrospective study in an unselected and consecutively enrolled sample.

Cognitive reserve (CR) allows individuals to maintain cognitive functionality even in the presence of pathologies. The compensation hypothesis suggests that CR plays an indirect role between age and cognitive decline, contrasting the negative effect of ageing on cognition. We test this hypothesis in an unselected and consecutively enrolled sample of memory clinic attendees (n = 134) who completed the CR Index questionnaire and three neuropsychological tests assessing global cognition (MMSE, FAB, CDT). Participants were divided into two groups based on standard diagnostic criteria (DSM-5): those who were cognitively impaired (n = 92) and those who were preserved (n = 42). A principal component analysis was used to extract a composite measure of global cognitive functioning from the three neuropsychological tests, and mediation analysis was used to examine the relationship between CR, age and global cognitive functioning in the two groups. Results revealed that: (i) age had a significant direct negative effect on the global cognitive score in both groups; (ii) the three socio-behavioural proxies of CR together suppress the direct negative relationship between age and global cognitive score in cognitively impaired patients but not in cognitively preserved participants. This study confirms the association between CR, age and cognition and allows us to validate its role in a population with cognitive impairment and extend findings to a low-to-middle educated population. These results hold important implications for public health and wellness promotion, emphasising the beneficial role of maintaining healthy and active physical, cognitive and social lifestyles.

Visuo-Spatial Working Memory and Mathematical Skills in Children: A Network Analysis Study.

Visuo-spatial working memory is one of the main domain-general cognitive mechanisms underlying mathematical abilities and their development in children. However, if visuo-spatial working memory involves different processes and components, then the term 'mathematics' refers to a broad concept that includes multiple domains and skills. The aim of this present study was to investigate the relationship between different visuo-spatial working memory components and several mathematical abilities in a sample of third- to fifth-grade Italian children. To assess the relationships between different visuo-spatial working memory components and different mathematical abilities, we relied on Network Analysis (NA). Results indicate that some but not all visuo-spatial working memory components are associated with some mathematical abilities.

The correlation between proprioceptive drift and subjective embodiment during the rubber hand illusion: A meta-analytic approach.

In the rubber hand illusion (RHI), participants see a fake hand touched synchronously with their real hand, which is hidden from view. The three-way interaction between vision, touch, and proprioception induces the sensation that the dummy hand belongs to oneself (i.e., subjective embodiment) and the illusory displacement of the real hand towards the fake one (i.e., proprioceptive drift). In the literature, there are mixed results (some positive and some null) regarding the existence of a relationship between subjective embodiment and proprioceptive drift. We conducted a Bayesian meta-analysis to tackle this issue quantitatively. Evidence strongly favours the presence of a correlation between subjective embodiment and proprioceptive drift, supporting the model proposed by Botvinick and Cohen in 1998. However, the correlation is around .35, a value suggesting that the two indices capture different facets of the RHI. This result clarifies the association between the illusory effects produced by the RHI and may be helpful for designing studies having appropriate statistical power.

Look at me now! Enfacement illusion over computer-generated faces.

According to embodied cognition research, one's bodily self-perception can be illusory and temporarily shifted toward an external body. Similarly, the so-called "enfacement illusion" induced with a synchronous multisensory stimulation over the self-face and an external face can result in implicit and explicit changes in the bodily self. The present study aimed to verify (i) the possibility of eliciting an enfacement illusion over computer-generated faces and (ii) which multisensory stimulation condition was more effective. A total of 23 participants were asked to look at a gender-matched avatar in three synchronous experimental conditions and three asynchronous control conditions (one for each stimulation: visuotactile, visuomotor, and simple exposure). After each condition, participants were asked to complete a questionnaire assessing both the embodiment and the enfacement sensations to address different facets of the illusion. Results suggest a stronger effect of synchronous vs. asynchronous stimulation, and the difference was more pronounced for the embodiment items of the questionnaire. We also found a greater effect of visuotactile and visuomotor stimulations as compared to the simple exposure condition. These findings support the enfacement illusion as a new paradigm to investigate the ownership of different face identities and the specific role of visuotactile and visuomotor stimulations with virtual reality stimuli.

Virtual reality technology in neuropsychological testing: A systematic review.

Neuropsychological testing aims to measure individuals' cognitive abilities (e.g. memory, attention), analysing their performance on specific behavioural tasks. Most neuropsychological tests are administered in the so-called 'paper-and-pencil' modality or via computerised protocols. The adequacy of these procedures has been recently questioned, with more specific concerns about their ecological validity, i.e. the relation between test scores observed in the laboratory setting and the actual everyday cognitive functioning. In developing more ecological tasks, researchers started to implement virtual reality (VR) technology as an administration technique focused on exposing individuals to simulated but realistic stimuli and environments, maintaining at the same time a controlled laboratory setting and collecting advanced measures of cognitive functioning. This systematic review aims to present how VR procedures for neuropsychological testing have been implemented in the last years. We initially explain the rationale for supporting VR as an advanced assessment tool, but we also discuss the challenges and risks that can limit the widespread implementation of this technology. Then, we systematised the large body of studies adopting VR for neuropsychological testing, describing the VR tools' distribution amongst different cognitive functions through a PRISMA-guided systematic review. The systematic review highlighted that only very few instruments are ready for clinical use, reporting psychometric proprieties (e.g. validity) and providing normative data. Most of the tools still need to be standardised on large cohorts of participants, having published only limited data on small samples up to now. Finally, we discussed the possible future directions of the VR neuropsychological test development linked to technological advances.

The network of the subjective experience in embodiment phenomena.

INTRODUCTION: Body illusions are designed to temporarily alter body representation by embodying fake bodies or part of them. Despite their large use, the embodiment questionnaires have been validated only for the embodiment of fake hands in the rubber hand illusion (RHI). METHODS: With the current study, we aimed at (1) extending the validation of embodiment questionnaires to a different illusory situation e.g., the full-body illusion (FBI); (2) comparing two methods to explore the questionnaires structures: a classic exploratory factor analysis (EFA) and a modern exploratory graph analysis (EGA). 118 healthy participants completed an FBI procedure where the subjective experience of embodiment was measured with a standard questionnaire. RESULTS: The EFA results in two-factor structures. However, the confirmatory factor analysis (CFA) fit indices do not show a good fit with the data. Conversely, the EGA identified four communities: ownership, agency, co-location and disembodiment; the solution was confirmed by a CFA. CONLCUSIONS: Overall, the EGA seems to be the best fitting method for the present data. Our results confirm the EGA as a suitable substitute for a more classical EFA. Moreover, the emerged structure suggests that the FBI induces similar effects to the RHI, implying that the embodiment sensations are common to different illusory methods.

I am the metre: The representation of one's body size affects the perception of tactile distances on the body.

Humans must ground the perception of one's body in a mental representation to move in space and interact with objects. This representation can be temporarily altered artificially. In the full-body illusion (FBI), participants see a virtual (or filmed) body receiving a tactile stimulation. When participants receive touches on their body similarly to the seen one (i.e., homologous location and synchronous timing), they embody the seen alien body. While the subjective embodiment of alien bodies of different sizes has been already manipulated with the FBI, it remains unexplored whether the body-metric perception is impacted too. We first developed a new setup for the FBI using 360° videos to favour the embodiment. The FBI was induced for bodies of three sizes adopting anatomical and non-anatomical viewpoints, and we measured the subjective embodiment. The results suggest that humans can embody normal size or bigger bodies seen from anatomical viewpoints, but not smaller ones. We then investigated if the FBI modulates the body-metric representation. We found that the resized bodies' vision affects the perception of one's body-metric representation, but this was independent of the embodiment, suggesting that the FBI alters the body representation at different levels with a specific impact.

The longer the reference, the shorter the legs: How response modality affects body perception.

There is a growing interest in the characterization of the internal body model: a stored representation of the metric properties of the body. Tactile Distance Task (TDT) is an experimental procedure for assessing the body metric, based on the perception of distances between tactile stimuli. We aimed at ruling out potential cognitive confounds: the body part being touched, the response estimation method being used, and the replicability of the results. Crucially, we compared two scoring indices (Global shape index vs. Misestimation of the distance) that have been used in the literature assessing the unique contribution of each score. Our data revealed a distortion of body metric perception of the leg. In particular, we found a more substantial reduction in proximo-distal distances rather than in the medio-lateral axis. TDT turned out to be a reliable and replicable method producing consistent results applicable to different body parts. The global shape index was shown to be particularly resistant to contextual experimental factors, while the Misestimation resulted in being affected by the estimation modalities, revealing that the verbal response was the most precise method. Finally, we provided substantial support for the combined use of the two indices as they were shown to give complementary information about body metric representation distortions.

Body illusion and affordances: the influence of body representation on a walking imagery task in virtual reality.

It is well known that our body works as a fundamental reference when we perform visuo-perceptual judgements in spatial surroundings, and that body illusions can modify our perception of size and distance of objects in space. To date, however, few studies have evaluated whether or not a body illusion could have a significant impact on the way individuals perceive to move within the environment. Here, we used a full-body illusion paradigm to verify the hypothesis that an altered representation of the legs of the individuals influences their time-to-walk estimation while imaging to reach objects in a virtual environment. To do so, we asked a group of young healthy volunteers to perform a task in which they were required to imagine walking towards a previously seen target location in a virtual environment, soon after receiving the body illusion; we required participants to use a response button to time their imagined walk from start to end. We found that participants imagined walking faster following the illusion elicited by the vision of longer legs presented from an anatomical perspective, as compared to when experiencing standard legs in the same position.This difference in imagined walking distance decreased when the object to reach was displayed farther, suggesting a fading effect. Furthermore, taking into consideration the baseline error in walking time estimation in VR, we noticed a specific influence of the long anatomical legs in reducing the perceived time needed to reach an object and a general increase in the percentage of error when the same legs are presented in a non-anatomical orientation. These findings provide evidence that body illusions could influence the way individuals perceive their locomotion in the spatial surrounding.

Complexity in neuropsychological assessments of cognitive impairment: A network analysis approach.

In a neuropsychological assessment, each test aims at measuring a single cognitive function. However, test performance depends on an interconnected system of cognitive functions and individual characteristics. For a better understanding of cognitive deficits, it is fundamental to recognize this complexity and study the relationships between test performances. This study aims to evaluate complexity in neuropsychological assessment through network analysis (NA) in 165 healthy older adults, 191 patients with Alzheimer's disease (AD), and 129 patients with vascular encephalopathy (VaE). NA is a flexible method to explore different domains where many variables are correlated with each other, and the relationships are key for understanding the domains. We included general aspects of individual differences (i.e., age, sex, years of education) and the raw scores of a clinically used neuropsychological battery in the network. Healthy subjects showed a segregated pattern, suggesting a good specificity of each test in measuring a specific cognitive function. Moreover, the scores were related to age and education. In the patient groups, the identified patterns changed in a consistent manner, showing less specificity and new relationships between the various tests, thereby reducing the impact of age and education on the performance. In particular, AD patients showed worse performance on the tests but also a different balance between different tasks, suggesting a reorganization of the cognitive system and not a mere decline. These results provide a new perspective in looking at the complexity of cognitive function assessment.

Mirror Box Training in Hemiplegic Stroke Patients Affects Body Representation.

The brain integrates multisensory inputs coming from the body (i.e., proprioception, tactile sensations) and the world that surrounds it (e.g., visual information). In this way, it is possible to build supra-modal and coherent mental representations of our own body, in order to process sensory events and to plan movements and actions in space. Post-stroke acquired motor deficits affect the ability to move body parts and to interact with objects. This may, in turn, impair the brain representation of the affected body part, resulting in a further increase of disability and motor impairment. To the aim of improving any putative derangements of body representation induced by the motor deficit, here we used the Mirror Box (MB). MB is a rehabilitative tool aimed at restoring several pathological conditions where body representation is affected, including post-stroke motor impairments. In this setting, observing the reflection of the intact limb in the mirror, while the affected one is hidden behind the mirror, can exert a positive influence upon different clinical conditions from chronic pain to motor deficits. Such results are thought to be mediated by a process of embodiment of the mirror reflection, which would be integrated into the representation of the affected limb. A group of 45 post-stroke patients was tested before and after performing a MB motor training in two conditions, one with the mirror between the hands and one without it, so that patients could see their impaired limb directly. A forearm bisection task, specifically designed to measure the metric representation of the body (i.e., size), was used as dependent variable. Results showed that, at baseline, the forearm bisection is shifted proximally, compatibly with a shrink of the metric representation of the affected arm towards the shoulder. However, following the MB session bisection scores shifted distally, compatibly with a partial correction of the metric representation of that arm. The effects showed some variability with the laterality of the lesion and the duration of the illness. The present results call for a possible role of the MB as a tool for improving altered body representation following post-stroke motor impairments.