Effectiveness of feedback-based technology on physical and cognitive abilities in the elderly.

Aging raises a social and health challenge because the passing of time causes changes in cognitive and physical functions that impair functionality and quality of life. In addition, advancements in technology and information technology have led to the development of new techniques for retraining based on the feedback technology provides. To solve the negative consequences of aging, a randomized clinical trial was carried out to assess the effectiveness of a protocol using feedback-based technology to improve physical and cognitive functions in older adults. For the purpose of this study, 200 patients were selected from a Social and Community Services Center in the province of Seville and only 46 of them became participants of the study (after applying the inclusion criteria). These patients were divided into two groups: control and experimental. Physical and cognitive abilities were assessed using the Miniexamen cognoscitivo Test (an adaptation of the MiniMental examination test), Yesevage's Depression Scale, Oddball Test, Attention Network Test, Berg Scale, Tinetti Scale, and Timed Up and Go Test. The intervention applied to the experimental group consisted of a supervised protocol using the Nintendo® Wii video game console and the Wii-Fit© video game during 16 sessions, 2 times a week with a duration of 30 min per session. The control group did not receive any treatment. The experimental group showed statistically significant improvements in all the physical variables (balance, gait, autonomy, and fall risk), as other authors had proven, and in memory and reaction times; there were no improvements in attention networks. The control group (placebo) even showed a decrease in their functions, with worse results on the Timed up and Go test Scale. The intervention using feedback-based technology has been proven effective in improving physical and cognitive abilities and in preventing and promoting healthy aging.

Mediterranean Diet and its Effects on Silent Brain Infarcts in a Cohort of Patients With Atrial Fibrillation.

Background and Aims: The benefits of Mediterranean Diet (MeDiet) in prevention of cardiovascular diseases (CVD) in general and ischemic stroke (IS) have been extensively studied and reported. We hypothesize that the consumption of nutrients typical of MeDiet would also reduce the rate of silent brain infarcts (SBI) among AF patients. Methods and Results: Patients with a history of AF who scored 0 to 1 in the CHADS2 score, ⩾50 years and with absence of neurological symptoms were selected from Seville urban area using the Andalusian electronic healthcare database. A 3T brain MRI was performed to all participants. Demographic and clinical data and food-frequency questionnaire (FFQ) were collected. Of the 443 scanned patients, 66 presented SBI. Of them 52 accepted to be scheduled for a clinical visit and were included in the diet sub study and 41 controls were matched per age and sex. There were no statistically significant differences in baseline characteristics. After logistic regression analysis, we found that a higher consumption of fiber from fruit was independently associated with a lower risk of SBI, while a higher consumption of high glycemic load (GL) foods was associated with a higher risk of SBI in a population with AF. Conclusion: Our findings support that MeDiet could be suggested as a prevention strategy for SBI in patients with AF.

Association of blood-based biomarkers with radiologic markers and cognitive decline in atrial fibrillation patients.

BACKGROUND: Atrial fibrillation (AF) has been associated with an increased risk of silent brain infarcts (SBI) and cognitive impairment, even in patients with low embolic risk. We aimed to test the association between 11 blood-biomarkers representing different AF-related pathways, and SBI, white matter hyperintensities (WMH), and cognitive decline in patients with AF and low embolic risk. METHODS: The present study followed a cross-sectional design. 70 patients with a history of AF and CHADS2 score ≤1, and 10 controls with neither AF nor SBI were included. All patients underwent a 3T brain MRI. Cortical and large subcortical ischemic lesions were considered presumed embolic origin lesions. White matter hyperintensities (WMH) were measured according to the Fazekas scale. A subset of patients underwent cognitive evaluation with the MoCA test. Circulating proteins were measured under blind conditions in a laboratory at Roche Diagnostics, Germany. RESULTS: 45 patients presented SBI in the MRI, and 25 did not. Ang-2, FGF-23, and BMP-10 were increased in patients with SBI. Ang-2 was elevated only in patients with embolic infarcts, whereas FGF-23 and BMP-10 tended to be elevated in patients with both types of infarcts. Ang-2 (OR = 1.56 [0.94-2.59], p = 0.087), and BMP-10 (OR = 4.83 [0.99-23.60], p = 0.052) were the biomarkers that showed the highest association with SBI when entered in a multivariable logistic regression model corrected by age. No biomarker was found associated with WMH or mild cognitive impairment. CONCLUSIONS: BMP-10, and Ang-2 were increased in patients with SBI. Its usefulness to detect SBI in AF patients should be further explored.

Effect of the side of presentation in the visual field on phase-locked and nonphase-locked alpha and gamma responses.

Recent studies have suggested that nonphase-locked activity can reveal cognitive mechanisms that cannot be observed in phase-locked activity. In fact, we describe a concomitant decrease in nonphase-locked alpha activity (desynchronization) when stimuli were processed (alpha phase-locked modulation). This desynchronization may represent a reduction in "background activity" in the visual cortex that facilitates stimulus processing. Alternatively, nonphase-locked gamma activity has been hypothesized to be an index of shifts in attentional focus. In this study, our main aim was to confirm these potential roles for nonphase-locked alpha and gamma activities with a lateralized Go/NoGo paradigm. The results showed that nonphase-locked alpha modulation is bilaterally represented in the scalp compared to the contralateral distribution of the phase-locked response. This finding suggests that the decrease in background activity is not limited to neural areas directly involved in the visual processing of stimuli. Additionally, gamma activity showed a higher desynchronization of nonphase-locked activity in the ipsilateral hemisphere, where the phase-locked activity reached the minimum amplitude. This finding suggests that the possible functions of nonphase-locked gamma activity extend beyond shifts in attentional focus and could represent an attentional filter reducing the gamma representation in the visual area irrelevant to the task.

Deficits in Early Sensory and Cognitive Processing Are Related to Phase and Nonphase EEG Activity in Multiple Sclerosis Patients.

Currently, there is scarce knowledge about the relation between spectral bands modulations and the basis of cognitive impairment in multiple sclerosis (MS). In this sense, analyzing the evoked or phase activity can confirm results from traditional event-related potential (ERP) studies. However, studying the induced or nonphase activity may be necessary to elucidate hidden compensatory or affected cognitive mechanisms. In this study, 30 remitting-relapsing multiple sclerosis patients and 30 healthy controls (HCs) matched in sociodemographic variables performed a visual oddball task. The main goal was to analyze phase and nonphase alpha and gamma bands by applying temporal spectral evolution (TSE) and its potential relation with cognitive impairment in these patients. The behavioural results showed slower reaction time and poorer accuracy in MS patients compared to controls. In contrast, the time-frequency analysis of electroencephalography (EEG) revealed a delay in latency and lower amplitude in MS patients in evoked and induced alpha compared to controls. With respect to the gamma band, there were no differences between the groups. In summary, MS patients showed deficits in early sensorial (evoked alpha activity) and cognitive processing (induced alpha activity in longer latencies), whereas the induced gamma band supported the hypothesis of its role in translation of attentional focus (induced activity) and did not show strong activity in this paradigm (visual oddball).

Reliability analysis of individual visual P1 and N1 maps indicates the heterogeneous topographies involved in early visual processing among human subjects.

There is a lack of studies regarding the reliability of the event-related components (ERPs) of an electroencephalogram (EEG) used to assess cognitive processing in human subjects. To explore the reliability scores for the P1 and N1 components in two sessions (separated by an average of 116 days), twenty subjects performed a visual lateralized detection paradigm and EEG recording (58 channels) were employed. The session factor did not modulate the P1/N1 latencies. The visual field factor (left (LVF) or right (RVF)) was a determinant for the P1 and N1 topographical distributions as shown in previous studies. Moreover, topographical maps of the grand average showed a very strong correlation level between sessions (>0.9). Finally, individual maps demonstrated that the classic contralateral pattern for the P1 and N1 components was not always present in all subjects. In particular, compared to the N1 component, the P1 component exhibited a more complex set of individual topographical distributions, revealing that some steps are more heterogeneous among human subjects in early visual processing.

Individual test-retest reliability of evoked and induced alpha activity in human EEG data.

Diverse psychological mechanisms have been associated with modulations of different EEG frequencies. To the extent of our knowledge, there are few studies of the test-retest reliability of these modulations in the human brain. To assess evoked and induced alpha reliabilities related to cognitive processing, EEG data from twenty subjects were recorded in 58 derivations in two different sessions separated by 49.5 ± 48.9 (mean ± standard deviation) days. A visual oddball was selected as the cognitive task, and three main parameters were analyzed for evoked and induced alpha modulations (latency, amplitude and topography). Latency and amplitude for evoked and induced modulations showed stable behavior between the two sessions. The correlation between sessions for alpha evoked and induced topographies in the grand average (group level) was r = 0.923, p<0.001; r = 0.962, p<0.001, respectively. The within-subject correlation values for evoked modulation ranged from 0.472 to 0.974 (mean: 0.766), whereas induced activity showed a different range, 0.193 to 0.892 (mean: 0.655). Individual analysis of the test-retest reliability showed a higher heterogeneity in the induced modulation, probably due to the heterogeneous phases found in the second case. However, despite this heterogeneity in phase values for induced activity relative to the onset of the stimuli, an excellent correlation score was obtained for group topography, with values that were better than those of the grand average evoked topography. As a main conclusion, induced alpha activity can be observed as a stable and reproducible response in the cognitive processing of the human brain.

Prevalence and risk factors of silent brain infarcts in patients with AF detected by 3T-MRI.

BACKGROUND: Silent brain infarcts (SBI), a finding on neuroimaging, are associated with higher risk of future stroke. Atrial Fibrillation (AF) has been previously identified as a cause of SBI. OBJECTIVES: The aim of this study is to determine the prevalence of and risk factors for SBI in patients with AF and low-to-moderate embolic risk according to CHADS2 and CHA2DS2VASc score. METHODS: Patients with a history of AF based on medical records who scored 0-1 in the CHADS2 score were selected from the Seville urban area using the Andalusian electronic healthcare database (DIRAYA). Demographic and clinical data were collected and a 3T brain MRI was performed on patients older than 50 years and with absence of neurological symptoms. RESULTS: 66 of the initial 443 patients (14.9%) and 41 of the 349 patients with low risk according to CHA2DS2VASc score (11.7%) presented at least 1 SBI. After adjusted multivariable analysis, an older age (OR 3.84, 95% CI 1.07-13.76) and left atrial (LA) enlargement (OR 3.13, 95% CI 1.15-8.55) were associated with SBI in the whole cohort, while only LA enlargement was associated with SBI in the low-risk cohort (OR 3.19, 95% CI 1.33-7.63). CONCLUSIONS: LA enlargement on echocardiogram was associated with SBI in patients with AF and low or moderate embolic risk according to CHADS2 and in the low-risk population according to CHA2DS2VASc. Although further studies are needed, a neuroimaging screening might be justified in these patients to guide medical therapies to improve stroke prevention.

The effect of prioritization over cognitive-motor interference in people with relapsing-remitting multiple sclerosis and healthy controls.

The cognitive-motor interference (CMI) produced by simultaneous performance of a cognitive and a motor task has been proposed as a marker of real-life impairment of people with Multiple Sclerosis (pwMS), yet there is no consensus on the dual task (DT) procedure. This study aimed to compare DT performance of pwMS and healthy controls (HC) under different instructions and to examine its association with neuropsychological and clinical variables. PwMS (N = 23; relapsing-remitting course) and HC (N = 24) completed the cognitive (Verbal Fluency) and motor (walking) tasks under three conditions: independently or as single task (ST), both tasks simultaneously at best capacity or double prioritization (DT-DP), and only the cognitive task at best capacity while walking at preferred speed or cognitive prioritization (DT-CP). Compared to HC, pwMS walked significantly slower and produced less correct words under all conditions. The distance walked by pwMS and HC significantly differed between conditions (DT-CP< DT-DP< ST). PwMS produced more words during ST respective to DT-DP and DT-CP, with no difference between both DT conditions. HC showed no differences in cognitive performance between conditions. Motor and cognitive dual-task costs (DTC) were similar between groups. Only in pwMS, the cognitive DTC of DT-DP was different from zero. CMI measures correlated with neuropsychological, symptomatic, physiological (cognitive event-related potentials) and clinical variables. These results suggest that cognitive performance while walking is impaired in pwMS, but not in HC. CMI over cognitive performance might be a potential early marker of cognitive decline in pwMS, which may be enhanced by the instruction to prioritize both tasks in DT.

Can Salient Stimuli Enhance Responses in Disorders of Consciousness? A Systematic Review.

PURPOSE OF REVIEW: Diagnostic classification of patients with disorders of consciousness (DoC) is based on clinician's observation of volitional behaviours. However, patients' caregivers often report higher levels of responsiveness with respect to those observed during the clinical assessment. Thus, increasing efforts have been aimed at comprehending the effects of self-referential and emotional stimuli on patients' responsiveness. Here we systematically reviewed the original experimental studies that compared behavioural and electrophysiological responses with salient vs. neutral material in patients in vegetative state/unresponsive wakefulness syndrome or in minimally conscious state. RECENT FINDINGS: Most of the reviewed studies showed that salient stimuli (i.e. patient's own or familiar faces, patient's own name, and familiar voices) seem to elicit a higher amount of behavioural or electrophysiological responses with respect to neutral pictures or sounds. Importantly, a quite high percentage of patients seem to respond to salient stimuli only. The present review could foster use of personally salient stimuli in assessing DoC. However, the low overall quality of evidence and some limitations in the general reviewing process might induce caution in transferring these suggestions into clinical practice.

El Attention Network Test en el estudio de los déficits cognitivos de pacientes con trastorno por déficit de atención / The Attention Network Test in the study of cognitive impairment of ADHD patients

Introducción: El Attention Network Test (ANT) se ha aplicado en el estudio de las posibles alteraciones atencionales en diversas neuropatologías en los últimos años. Este test permite el análisis de diversas redes implicadas en el proceso atencional (alerta, orientación y sistema ejecutivo). Desarrollo: La aplicación particular del ANT en pacientes con trastorno por déficit de atención muestra que es posible encontrar diversas alteraciones de las tres redes atencionales según los estudios e incluso, en algunos casos, la ausencia de alteraciones en ellas. Las posibles causas de esta heterogeneidad pueden deberse a variaciones metodológicas en la aplicación del test, otras condiciones patológicas no consideradas de los pacientes y el análisis de redes sugerido por los creadores del modelo y que se ha demostrado en diversos estudios que puede llevar a interpretaciones erróneas. Conclusiones: A pesar de los resultados todavía poco concluyentes con la aplicación del ANT en el trastorno por déficit de atención, este test muestra múltiples aplicaciones que permitirán desentrañar los diversos déficits cognitivos que están presentes en los pacientes con trastorno por déficit de atención. Entre ellos, el test puede analizar diversos mecanismos que pueden estar afectados en estos pacientes (la alerta tónica y fásica, la expectativa temporal o espacial, el grado de interferencia de los estímulos distractores, el parpadeo atencional o la inhibición de retorno). El ANT puede ayudar a una mejor caracterización de los pacientes con trastorno por déficit de atención más allá de las formas clásicas consideradas hasta ahora (inatento o combinado)

Introduction: The Attention Network Test (ANT) has been applied to the study of potential attentional impairments in diverse neuropathologies in the last years. This test allows analyzing of different networks involved in attentional processing (alerting, orientation and executive system). Development: A specific application of ANT in ADHD patients shows that it is possible to find diverse impairments in the three attentional networks and even some studies revealed no alterations. Potential causes of this heterogeneity in the results could be based in methodological variations between studies, other pathological conditions in the participants and the network effects calculation that has been probed that could be wrongly interpreted. Conclusions: Despite the lack of conclusive results, this test shows multiple applications that would allow disentangling diverse cognitive impairments in ADHD patients. ANT could analyze diverse cognitive mechanisms that could be compromised in these patients (tonic and phasic alerting, temporal and spatial expectancy, degree of interference of the distractor stimuli, attentional blinking o inhibition of return). This test could help to perform a better characterization of ADHD patients further than the classical forms considered nowadays (unattended and combined)

Multiple evoked and induced alpha modulations in a visual attention task: Latency, amplitude and topographical profiles.

Alpha event-related desynchronization (ERD) has been widely applied to understand the psychophysiological role of this band in cognition. In particular, a considerable number of publications have described spectral alterations in several pathologies using this time-frequency approach. However, ERD is not capable of specifically showing nonphase (induced) activity related to the presentation of stimuli. Recent studies have described an evoked and induced activity in the early phases (first 200 ms) of stimulus processing. However, scarce studies have analyzed induced and evoked modulations in longer latencies (>200 ms) and their potential roles in cognitive processing. The main goal of the present study was to analyze diverse evoked and induced modulations in response to visual stimuli. Thus, 58-channel electroencephalogram (EEG) was recorded in 21 healthy subjects during the performance of a visual attention task, and analyses were performed for both target and standard stimuli. The initial result showed that phase-locked and nonphase locked activities coexist in the early processing of target and standard stimuli as has been reported by previous studies. However, more modulations were evident in longer latencies in both evoked and induced activities. Correlation analyses suggest that similar maps were present for evoked and induced activities at different timepoints. In the discussion section, diverse proposals will be stated to define the potential roles of these modulations in the information processing for this cognitive task. As a general conclusion, induced activity enables the observation of cognitive mechanisms that are not visible by ERD or ERP modulations.

Altered individual behavioral and EEG parameters are related to the EDSS score in relapsing-remitting multiple sclerosis patients.

Functional neuroanatomy of cognitive impairment in multiple sclerosis is currently still a challenge. During the progression of the disease, several cognitive mechanisms deteriorate thus diminishing the patient's quality of life. A primary objective in the cognitive assessment of multiple sclerosis (MS) patients is to find reliable measures utilizing diverse neuroimaging techniques. Moreover, especially relevant in the clinical environment is finding technical approaches that could be applied to individual participants and not only for group analysis. A 64-channel electroencephalographic recording (EEG) was made with thirty participants divided into three groups of equivalent size (N = 10) (healthy control, low-EDSS (1-2.5) and moderate-EDSS (4-6)). Correlation analysis was applied to multiple measures: behavior, neuropsychological tests (Paced Auditory Serial Addition Test, 3 seconds (PASAT-3s) and the Symbol Digit Modality Test (SDMT)), Expanded Disability Status Scale (EDSS), even-related potential (P3) and event-related desynchronization (ERD) parameters and the correlation scores between individual participant's P3/ERD maps and the healthy grand average P3/ERDmaps. Statistical analysis showed that diverse parameters exhibited significant correlations. A remarkable correlation was the moderate score found between SDMT and EDSS (r = -0.679, p = 0.0009). However, the strongest correlation was between the value of integrated measures (reaction time, P3 and ERD latency) and EDSS (r = 0.699, p = 0.0006). In regard to correlations for grand average maps between groups, the P3 component exhibited a lower score according to a more deteriorated condition (higher EDSS). In contrast, ERD maps remained stable with an increase of EDSS. Lastly, a Z-transformation of individual values of all variables included in the study exhibited heterogeneity in cognitive alterations in the multiple sclerosis participants.

Retest reliability of individual alpha ERD topography assessed by human electroencephalography.

BACKGROUND: Despite the immense literature related to diverse human electroencephalographic (EEG) parameters, very few studies have focused on the reliability of these measures. Some of the most studied components (i.e., P3 or MMN) have received more attention regarding the stability of their main parameters, such as latency, amplitude or topography. However, spectral modulations have not been as extensively evaluated considering that different analysis methods are available. The main aim of the present study is to assess the reliability of the latency, amplitude and topography of event-related desynchronization (ERD) for the alpha band (10-14 Hz) observed in a cognitive task (visual oddball). Topography reliability was analysed at different levels (for the group, within-subjects individually and between-subjects individually). RESULTS: The latency for alpha ERD showed stable behaviour between two sessions, and the amplitude exhibited an increment (more negative) in the second session. Alpha ERD topography exhibited a high correlation score between sessions at the group level (r = 0.903, p<0.001). The mean value for within-subject correlations was 0.750 (with a range from 0.391 to 0.954). Regarding between-subject topography comparisons, some subjects showed a highly specific topography, whereas other subjects showed topographies that were more similar to those of other subjects. CONCLUSION: ERD was mainly stable between the two sessions with the exception of amplitude, which exhibited an increment in the second session. Topography exhibits excellent reliability at the group level; however, it exhibits highly heterogeneous behaviour at the individual level. Considering that the P3 was previously evaluated for this group of subjects, a direct comparison of the correlation scores was possible, and it showed that the ERD component is less reliable in individual topography than in the ERP component (P3).

Reduced Attention Allocation during Short Periods of Partially Automated Driving: An Event-Related Potentials Study.

Research on partially automated driving has revealed relevant problems with driving performance, particularly when drivers' intervention is required (e.g., take-over when automation fails). Mental fatigue has commonly been proposed to explain these effects after prolonged automated drives. However, performance problems have also been reported after just a few minutes of automated driving, indicating that other factors may also be involved. We hypothesize that, besides mental fatigue, an underload effect of partial automation may also affect driver attention. In this study, such potential effect was investigated during short periods of partially automated and manual driving and at different speeds. Subjective measures of mental demand and vigilance and performance to a secondary task (an auditory oddball task) were used to assess driver attention. Additionally, modulations of some specific attention-related event-related potentials (ERPs, N1 and P3 components) were investigated. The mental fatigue effects associated with the time on task were also evaluated by using the same measurements. Twenty participants drove in a fixed-base simulator while performing an auditory oddball task that elicited the ERPs. Six conditions were presented (5-6 min each) combining three speed levels (low, comfortable and high) and two automation levels (manual and partially automated). The results showed that, when driving partially automated, scores in subjective mental demand and P3 amplitudes were lower than in the manual conditions. Similarly, P3 amplitude and self-reported vigilance levels decreased with the time on task. Based on previous studies, these findings might reflect a reduction in drivers' attention resource allocation, presumably due to the underload effects of partial automation and to the mental fatigue associated with the time on task. Particularly, such underload effects on attention could explain the performance decrements after short periods of automated driving reported in other studies. However, further studies are needed to investigate this relationship in partial automation and in other automation levels.

Efectos específicos de la rehabilitación cognitiva en pacientes con esclerosis múltiple remitente-recidivante / Specific effects of cognitive rehabilitation in relapsing-remitting multiple sclerosis patients

Fundamento y objetivo: se ha demostrado la existencia de deterioro cognitivo en pacientes con esclerosis múltiple. Este estudio pretende comprobar si es posible generar mejoras en la capacidad atencional de estos pacientes y analizar si esta mejora es generalizable a más de un mecanismo atencional. Material y método: se distribuyó en dos grupos a 26 pacientes con esclerosis múltiple remitente-recidivante (EMRR): un grupo de tratamiento que participó en un programa de estimulación basado en el Attention Process Training durante 3 meses, y otro grupo control patológico que no recibió el programa. Completaron el estudio 18 controles sanos. Los beneficios de la aplicación del programa se evaluaron empleando dos pruebas computarizadas de evaluación, una de atención sostenida y otra de atención selectiva. Resultados: los pacientes del grupo de tratamiento mostraron mejoras en los tiempos de reacción tras la aplicación del programa solo en la tarea de atención selectiva. No se encontró ninguna mejora en la tarea de atención sostenida. Conclusiones: únicamente en la tarea de atención selectiva se obtuvo una mejora significativa en pacientes con EMRR. Esta asimetría en los beneficios del programa de estimulación cognitiva muestra las dificultades en la generalización de los beneficios a todos los mecanismos atencionales y el alto grado de especificidad en la rehabilitación de las funciones cognitivas (AU)

Background and objective: Cognitive impairment in patients with multiple sclerosis has been shown vastly. The aim of this study was to assess whether it is possible to generate improvements in attentional capacity of these patients, and to determine whether this improvement is generalizable to more than one attentional mechanism. Materials and method: 26 patients with relapsing-remitting multiple sclerosis (RRMS) were distributed in two groups. A treatment group who participated in a stimulation program based on the Attention Process Training program for three months. And another pathological control group who did not receive the program. 18 healthy controls completed the study. The benefits of implementing the program were evaluated using two computerized evaluation tasks, a sustained attention one and another of selective attention. Results: Patients in the treatment group showed improvements in reaction times after application of the program only in the selective attention task. No improvement was found in the sustained attention task. Conclusions: Only the selective attention task showed a significant improvement in patients with RRMS. This asymmetry in the benefits of cognitive stimulation program shows the difficulties in generalizing the benefits to all attentional mechanisms, as well as the high degree of specificity in the rehabilitation of cognitive functions (AU)

Disentangling the attention network test: behavioral, event related potentials, and neural source analyses.

BACKGROUND: The study of the attentional system remains a challenge for current neuroscience. The "Attention Network Test" (ANT) was designed to study simultaneously three different attentional networks (alerting, orienting, and executive) based in subtraction of different experimental conditions. However, some studies recommend caution with these calculations due to the interactions between the attentional networks. In particular, it is highly relevant that several interpretations about attentional impairment have arisen from these calculations in diverse pathologies. Event related potentials (ERPs) and neural source analysis can be applied to disentangle the relationships between these attentional networks not specifically shown by behavioral measures. RESULTS: This study shows that there is a basic level of alerting (tonic alerting) in the no cue (NC) condition, represented by a slow negative trend in the ERP trace prior to the onset of the target stimuli. A progressive increase in the CNV amplitude related to the amount of information provided by the cue conditions is also shown. Neural source analysis reveals specific modulations of the CNV related to a task-related expectancy presented in the NC condition; a late modulation triggered by the central cue (CC) condition and probably representing a generic motor preparation; and an early and late modulation for spatial cue (SC) condition suggesting specific motor and sensory preactivation. Finally, the first component in the information processing of the target stimuli modulated by the interaction between orienting network and the executive system can be represented by N1. CONCLUSIONS: The ANT is useful as a paradigm to study specific attentional mechanisms and their interactions. However, calculation of network effects is based in subtractions with non-comparable experimental conditions, as evidenced by the present data, which can induce misinterpretations in the study of the attentional capacity in human subjects.

Estudio longitudinal del beneficio de un programa de rehabilitación atencional en pacientes con esclerosis múltiple / Longitudinal assessment of the benefit from an attentional rehabilitation program in multiple sclerosis patients

Fundamento y objetivo: los programas de rehabilitación cognitiva están rindiendo resultados esperanzadores en la recuperación del deterioro cognitivo en pacientes con esclerosis múltiple (EM). En el presente proyecto de investigación se pretende analizar si un programa adaptado en nuestra unidad hospitalaria permite mejorar la atención visual de los pacientes con EM. Material y método: un total de 20 pacientes con EM fueron distribuidos en dos grupos: a) grupo tratamiento (participaron en un programa de rehabilitación durante 3 meses) y b) grupo control patológico (no participaron el programa). Se completó el estudio con un grupo de control sano con variables sociodemográficassimilares. El programa de rehabilitación fue una adaptación del Attention Process Training (APT). Los beneficiosde la aplicación del programa se evaluaron empleando un test de atención selectiva computarizado. Resultados: los pacientes del grupo de tratamiento mostraron mejoras en los tiempos de reacción tras la aplicación del programa; en cambio, los pacientes del grupo de control patológico o los controles sanos no. El beneficio del programa de rehabilitación se mantuvo hasta 4 meses después del cese de su aplicación. Conclusiones: el programa de rehabilitación produce mejoras en la capacidad de atención selectiva de los pacientes con EM que se mantienen incluso meses después de la aplicación del programa (AU)

Background and objective: Cognitive rehabilitation programs are producing hopeful results in the recovery of the cognitive impairment in multiple sclerosis patients (MS). The main aim in the present research project is to analyze if a rehabilitation program customized in our clinical unit allows improving attention system in MS patients. Materials and method: 20 patients with MS were distributed in two groups: a) Treatment (these patients received a rehabilitation program for three months), and b) Pathological (no program was applied). A third healthy control group was included with similar sociodemographical parameters. Cognitive rehabilitation program was adapted from the Attention Program Training (APT). Benefits from the application of the program were assessed by a computerized selective attention test. Results: Patients from treatment group experienced a benefit in reaction time after the application of the rehabilitation program. This benefit lasted four months after the completion of the rehabilitation program. Conclusions: Cognitive rehabilitation program induces benefits in the selective attention in multiple sclerosis patients and persist even months after the end of the treatment (AU)

Neural correlates of alerting and orienting impairment in multiple sclerosis patients.

BACKGROUND: A considerable percentage of multiple sclerosis patients have attentional impairment, but understanding its neurophysiological basis remains a challenge. The Attention Network Test allows 3 attentional networks to be studied. Previous behavioural studies using this test have shown that the alerting network is impaired in multiple sclerosis. The aim of this study was to identify neurophysiological indexes of the attention impairment in relapsing-remitting multiple sclerosis patients using this test. RESULTS: After general slowing had been removed in patients group to isolate the effects of each condition, some behavioral differences between them were obtained. About Contingent Negative Variation, a statistically significant decrement were found in the amplitude for Central and Spatial Cue Conditions for patient group (p<0.05). ANOVAs showed for the patient group a significant latency delay for P1 and N1 components (p<0.05) and a decrease of P3 amplitude for congruent and incongruent stimuli (p<0.01). With regard to correlation analysis, PASAT-3s and SDMT showed significant correlations with behavioral measures of the Attention Network Test (p<0.01) and an ERP parameter (CNV amplitude). CONCLUSIONS: Behavioral data are highly correlated with the neuropsychological scores and show that the alerting and orienting mechanisms in the patient group were impaired. Reduced amplitude for the Contingent Negative Variation in the patient group suggests that this component could be a physiological marker related to the alerting and orienting impairment in relapsing-remitting multiple sclerosis. P1 and N1 delayed latencies are evidence of the demyelination process that causes impairment in the first steps of the visual sensory processing. Lastly, P3 amplitude shows a general decrease for the pathological group probably indexing a more central impairment. These results suggest that the Attention Network Test give evidence of multiple levels of attention impairment, which could help in the assessment and treatment of relapsing-remitting multiple sclerosis patients.