Mind Your Data: Privacy and Legal Matters in eHealth.

The health care sector can benefit considerably from developments in digital technology. Consequently, eHealth applications are rapidly increasing in number and sophistication. For successful development and implementation of eHealth, it is paramount to guarantee the privacy and safety of patients and their collected data. At the same time, anonymized data that are collected through eHealth could be used in the development of innovative and personalized diagnostic, prognostic, and treatment tools. To address the needs of researchers, health care providers, and eHealth developers for more information and practical tools to handle privacy and legal matters in eHealth, the Dutch national Digital Society Research Programme organized the "Mind Your Data: Privacy and Legal Matters in eHealth" conference. In this paper, we share the key take home messages from the conference based on the following five tradeoffs: (1) privacy versus independence, (2) informed consent versus convenience, (3) clinical research versus clinical routine data, (4) responsibility and standardization, and (5) privacy versus solidarity.

Affective traits of psychopathy are linked to white-matter abnormalities in impulsive male offenders.

OBJECTIVE: Psychopathy is a personality disorder typified by lack of empathy and impulsive antisocial behavior. Psychopathic traits may partly relate to disrupted connections between brain regions. The aim of the present study was to link abnormalities in microstructural integrity of white-matter tracts to the severity of different psychopathic traits in 15 male offenders with impulse control problems and 10 without impulse control problems. METHOD: Psychopathic traits were assessed using the Psychopathy Checklist-revised (PCL-R). Diffusion-weighted MRI was used to examine white-matter tracts. Fractional anisotropy (FA), an index of white-matter integrity, was calculated for each voxel. Clusters of voxels showing a significant relationship with psychopathy severity were submitted to probabilistic tractography. RESULTS: No significant correlations between psychopathy severity and FA were present in the whole group of impulsive and nonimpulsive offenders. In impulsive offenders, interpersonal-affective traits (PCL-R Factor 1) were negatively correlated with FA in the anterior and posterior temporal lobe and orbitofrontal area. Further analyses indicated that elevated affective traits (PCL-R Facet 2) were specifically related to reduced FA in the right temporal lobe. CONCLUSIONS: Our findings suggest that white-matter abnormalities in temporal and frontotemporal tracts may be linked to the interpersonal-affective deficits of psychopathy in offenders with relatively severe impulse control problems. Our study offers novel insights into the relationships between the four facets of psychopathy and disrupted structural connectivity, and may provide new leads for further characterization of different subtypes of antisocial populations. (PsycINFO Database Record

Prefrontal activation may predict working-memory training gain in normal aging and mild cognitive impairment.

Cognitive training has been shown to result in improved behavioral performance in normal aging and mild cognitive impairment (MCI), yet little is known about the neural correlates of cognitive plasticity, or about individual differences in responsiveness to cognitive training. In this study, 21 healthy older adults and 14 patients with MCI received five weeks of adaptive computerized working-memory (WM) training. Before and after training, functional Near-Infrared Spectroscopy (fNIRS) was used to assess the hemodynamic response in left and right prefrontal cortex during performance of a verbal n-back task with varying levels of WM load. After training, healthy older adults demonstrated decreased prefrontal activation at high WM load, which may indicate increased processing efficiency. Although MCI patients showed improved behavioral performance at low WM load after training, no evidence was found for training-related changes in prefrontal activation. Whole-group analyses showed that a relatively strong hemodynamic response at low WM load was related to worse behavioral performance, while a relatively strong hemodynamic response at high WM load was related to higher training gain. Therefore, a 'youth-like' prefrontal activation pattern at older age may be associated with better behavioral outcome and cognitive plasticity.

Transfer and maintenance effects of online working-memory training in normal ageing and mild cognitive impairment.

Working memory (WM) is one of the cognitive functions that is susceptible to ageing-related decline. Interventions that are able to improve WM functioning at older age are thus highly relevant. In this pilot study, we explored the transfer effects of core WM training on the WM domain and other cognitive domains in 23 healthy older adults and 18 patients with amnestic mild cognitive impairment (MCI). Performance on neuropsychological tests was assessed before and after completion of the online five-week adaptive WM training, and after a three-month follow-up period. After training, both groups improved on the Digit Span and Spatial Span, gains that were maintained at follow-up. At an individual level, a limited number of participants showed reliable training gain. Healthy older adults, and to a lesser extent MCI patients, additionally improved on figural fluency at group level, but not at individual level. Results furthermore showed that global brain atrophy and hippocampal atrophy, as assessed by MRI, may negatively affect training outcome. Our study examined core WM training, showing gains on trained and untrained tasks within the WM domain, but no broad generalisation to other cognitive domains. More research is needed to evaluate the clinical relevance of these findings and to identify participant characteristics that are predictive of training gain.

An exploratory study of the effects of spatial working-memory load on prefrontal activation in low- and high-performing elderly.

Older adults show more bilateral prefrontal activation during cognitive performance than younger adults, who typically show unilateral activation. This over-recruitment has been interpreted as compensation for declining structure and function of the brain. Here we examined how the relationship between behavioral performance and prefrontal activation is modulated by different levels of working-memory load. Eighteen healthy older adults (70.8 ± 5.0 years; MMSE 29.3 ± 0.9) performed a spatial working-memory task (n-back). Oxygenated ([O2Hb]) and deoxygenated ([HHb]) hemoglobin concentration changes were registered by two functional Near-Infrared Spectroscopy (fNIRS) channels located over the left and right prefrontal cortex. Increased working-memory load resulted in worse performance compared to the control condition. [O2Hb] increased with rising working-memory load in both fNIRS channels. Based on the performance in the high working-memory load condition, the group was divided into low and high performers. A significant interaction effect of performance level and hemisphere on [O2Hb] increase was found, indicating that high performers were better able to keep the right prefrontal cortex engaged under high cognitive demand. Furthermore, in the low performers group, individuals with a larger decline in task performance from the control to the high working-memory load condition had a larger bilateral increase of [O2Hb]. The high performers did not show a correlation between performance decline and working-memory load related prefrontal activation changes. Thus, additional bilateral prefrontal activation in low performers did not necessarily result in better cognitive performance. Our study showed that bilateral prefrontal activation may not always be successfully compensatory. Individual behavioral performance should be taken into account to be able to distinguish successful and unsuccessful compensation or declined neural efficiency.

Very-low-frequency oscillations of cerebral hemodynamics and blood pressure are affected by aging and cognitive load.

Spontaneous slow oscillations occur in cerebral hemodynamics and blood pressure (BP), and may reflect neurogenic, metabolic or myogenic control of the cerebral vasculature. Aging is accompanied by a degeneration of the vascular system, which may have consequences for regional cerebral blood flow and cognitive performance. This degeneration may be reflected in a reduction of spontaneous slow oscillations of cerebral hemodynamics and BP. Therefore, we aimed to establish the dependency of slow oscillations of cerebral hemodynamics and BP on the factors age and cognitive load, by using functional near-infrared spectroscopy (fNIRS). Fourteen healthy young (23-32 years) and 14 healthy older adults (64-78 years) performed a verbal n-back working-memory task. Oxygenated and deoxygenated hemoglobin concentration changes were registered by two fNIRS channels located over left and right prefrontal cortex. BP was measured in the finger by photoplethysmography. We found that very-low-frequency oscillations (0.02-0.07 Hz) and low-frequency oscillations (0.07-0.2 Hz) of cerebral hemodynamics and BP were reduced in the older adults compared to the young during task performance. In young adults, very-low-frequency oscillations of cerebral hemodynamics and BP reduced with increased cognitive load. Cognitive load did not affect low-frequency oscillations of the cerebral hemodynamics and BP. Transfer function analysis indicated that the relationship between BP and cerebral hemodynamic oscillations does not change under influence of age and cognitive load. Our results suggest aging-related changes in the microvasculature such as declined spontaneous activity in microvascular smooth muscle cells and vessel stiffness. Moreover, our results indicate that in addition to local vasoregulatory processes, systemic processes also influence cerebral hemodynamic signals. It is therefore crucial to take the factors age and BP into consideration for the analysis and interpretation of hemodynamic neuroimaging data.

Effects of aging on cerebral oxygenation during working-memory performance: a functional near-infrared spectroscopy study.

Working memory is sensitive to aging-related decline. Evidence exists that aging is accompanied by a reorganization of the working-memory circuitry, but the underlying neurocognitive mechanisms are unclear. In this study, we examined aging-related changes in prefrontal activation during working-memory performance using functional Near-Infrared Spectroscopy (fNIRS), a noninvasive neuroimaging technique. Seventeen healthy young (21-32 years) and 17 healthy older adults (64-81 years) performed a verbal working-memory task (n-back). Oxygenated and deoxygenated hemoglobin concentration changes were registered by two fNIRS channels located over the left and right prefrontal cortex. Increased working-memory load resulted in worse performance compared to the control condition in older adults, but not in young participants. In both young and older adults, prefrontal activation increased with rising working-memory load. Young adults showed slight right-hemispheric dominance at low levels of working-memory load, while no hemispheric differences were apparent in older adults. Analysis of the time-activation curve during the high working-memory load condition revealed a continuous increase of the hemodynamic response in the young. In contrast to that, a quadratic pattern of activation was found in the older participants. Based on these results it could be hypothesized that young adults were better able to keep the prefrontal cortex recruited over a prolonged period of time. To conclude, already at low levels of working-memory load do older adults recruit both hemispheres, possibly in an attempt to compensate for the observed aging-related decline in performance. Also, our study shows that aging effects on the time course of the hemodynamic response must be taken into account in the interpretation of the results of neuroimaging studies that rely on blood oxygen levels, such as fMRI.