"Art, Colors, and Emotions" Treatment (ACE-t): A Pilot Study on the Efficacy of an Art-Based Intervention for People With Alzheimer's Disease.

Increasing evidence suggests that non-pharmacological therapies impact on neuropsychiatric symptoms and quality of life in people with Alzheimer's disease. Among these, art-based interventions seem particularly suitable for elders' rehabilitation as they act both on cognitive functions and quality of life. However, their benefits are not yet appropriately explored. The main aim of this quasi-experimental study was to test the feasibility and the likely efficacy of a novel multi-dimensional visual art intervention for people with Alzheimer's disease (PWAD), named Art, Colors, and Emotions treatment (ACE-t). A group of PWAD (N = 10) was recruited from the Memory Clinic of Don Gnocchi Foundation to take part in the ACE-t. A historical control group that followed a usual care program (N = 10) was used for comparison. We considered both feasibility output (adherence and acceptability) and efficacy outcome measures (neuropsychological and neurobehavioral scales). We observed a good adherence to and acceptability of the ACE-t. The following significant intervention-related changes were also observed in ACE-t with respect to usual care: improvement in general cognition, as assessed with the Alzheimer's Disease Assessment Scale-Cognitive, amelioration in language, and in executive functions, and reduction in Neuropsychiatric Inventory Scale score. In conclusion, ACE-t could be considered as a suitable intervention for the rehabilitation of PWAD, with positive effects on the cognitive and the behavioral status. ACE is a promising new art-based intervention that merits further research, including confirmatory trials of our preliminary results.

Beauty in life: An eye-tracking study on young adults' aesthetic evaluation and vitality judgment of pictorial representations of sleeping and dead subjects.

Preferring life to death is deeply rooted in our biology. With the present study, we explored two questions: (1) Can this inclination be transposed to aesthetics, so that a living being is valued as more beautiful than a non-living being? and (2) Are there any differences in the visual exploration of portrayals of a living compared to a dead human? In particular, are there any specific facial features representing the vitality status of a living or dead subject? By answering both questions, young adults' eye gazing was analyzed while they observed, aesthetically judged, and judged the vitality status of faces extracted from paintings representing a sleeping or dead subject. The aesthetic preference for the stimuli as a function of vitality (living, dead) was assessed both during the eye-tracking study and during a follow-up priming behavioral experiment. The analysis of the responses given during the aesthetic judgment task in the eye-tracking study revealed preference for the sleeping compared to the dead subjects, supporting proclivity to attribute greater aesthetic value to living beings. This evidence was substantially confirmed by the follow-up priming behavioral study, which further showed a significant effect of explicit vitality labeling on the aesthetic evaluation of the portrayals of sleeping subjects. As far as the visual exploration of the stimuli is concerned, the main eye-tracking results revealed great attention to the eye region of both sleeping and dead subjects, which was particularly enhanced for the sleeping compared to the dead subjects. For the latter stimuli, focused attention was also found to the mouth region. These results are discussed in light of different theoretical proposals, including the "embodied" theory of aesthetic perception based on the existence of mirror systems.

An ecological measure to screen executive functioning in MS: the Picture Interpretation Test (PIT) 360°.

Executive functions are crucial for performance of everyday activities. In Multiple Sclerosis (MS), executive dysfunctions can be apparent from the early onset of the disease. Technology-based time-efficient and resource-saving tools for early evaluation of executive functions using an ecological approach are needed to assess functional performance in real-life. The aim was to compare the efficiency of the Picture Interpretation Test 360° (PIT 360°) with traditional measures on executive dysfunction in Persons with Multiple Sclerosis (PwMS) and Healthy Controls (HC). Participants were 31 patients with Relapsing-Remitting MS (mean age = 44.323 ± 13.149; mean Expanded Disability Status Scale = 2) and 39 HC (mean age = 39.538 ± 15.728). All were tested with standard neuropsychological tests of executive functions, PIT 360°, and measures of user experience. While standard neuropsychological tests failed to differentiate between PwMS and HC group, the PIT 360° was successful in detecting executive dysfunction in PwMS. All participants reported the PIT 360° to be an engaging tool and endorsed positive reactions to their experience. Overall, the PIT 360° is a quick, sensitive, and ecological tool that captures real-world executive dysfunction in PwMS. This engaging measure is sensitive for the detection of executive deficits since the early phases of the disease.

Toddlers map the word 'good' to helping agents, but not to fair distributors.

Infants begin to understand some of the meanings of the adjective good at around thirteen months, but it is not clear when they start to map it to concepts in the moral domain. We investigated infants' and toddlers' knowledge of good in the domains of help and fairness. Participants at 20 and 30 months were shown computer animations involving helpful and hindering agents, or agents who performed fair or unfair distributions, and were asked to "pick the good one". Toddlers at 30 months took good as referring to helping, but not to the fair agents. However, when asked "to pick one", they choose the fair distributor. These findings suggest that by 30 months toddlers have started to map good to some socio-moral features, such as a helping disposition, but not to fairness in distributive actions.

Design and implementation of a Serious Game on neurorehabilitation: Data on modifications of functionalities along implementation releases.

The measurement of users' perception of functionalities in the use of Serious Games (SGs) along technology implementation phases may lead to effective changes for developing successful user-centered learning tools in the medical field. In the present data article, data about usability functionalities along two cycles of validation of a SG on neurorehabilitation with final users are described. The key principles of usability model used to collect and analyze data and the evaluation tool are presented. The modifications of the SG to improve usability across implementation phases are detailed. The validation of the SG is described in "Engaged in learning neurorehabilitation: development and validation of a serious game with user-centered design" (Savazzi et al., in press) [1]. The data provided in this article will assist researchers working for developing learning technology to optimize their tools in relation to users' needs and expectations.

The Games for Older Adults Active Life (GOAL) Project for People With Mild Cognitive Impairment and Vascular Cognitive Impairment: A Study Protocol for a Randomized Controlled Trial.

Background: People living with Mild Cognitive Impairment (MCI) and Vascular Cognitive Impairment (VCI) are persons who do not fulfill a diagnosis of dementia, but who have a high risk of progressing to a dementia disorder. The most recent guidelines to counteract cognitive decline in MCI/VCI subjects suggest a multidimensional and multi-domain interventions combining cognitive, physical, and social activities. The purpose of this study is to test an innovative service that provides a multi-dimensional tele-rehabilitation program through a user-friendly web application. The latter has been developed through a participatory design involving MCI specialists, patients, and their caregivers. Particularly, the proposed tele-rehabilitation program includes cognitive, physical, and caregiver-supported social activities. The goal is to promote and preserve an active life style and counteract cognitive decline in people living with MCI/VCI. Methods:The study is a randomized controlled trial. Sixty subjects will be randomly assigned to the experimental group, who will receive the tele-rehabilitation program, or the control group, who will not receive any treatment. The trial protocol comprises three steps of assessment for the experimental group: at the baseline (T_0), after tele-rehabilitation program (T_1) and at follow-up after 12-months (T_2). Differently, the control group will be assessed twice: at the baseline and at 12-months follow-up. Both the experimental and the control group will be assessed with a multidimensional evaluation battery, including cognitive functioning, behavioral, functional, and quality of life measures. The tele-rehabilitation program lasts 8 weeks and includes cognitive exercises 3 days a week, physical activities 2 days a week, and social activities once a week. In addition, group will be given an actigraph (GENEActiv, Activisinghts Ltd., Cambridgshire, UK) to track physical and sleep activity. Discussion:Results of this study will inform on the efficacy of the proposed tele-rehabilitation to prevent or delay further cognitive decline in MCI/VCI subjects. The expected outcome is to counteract cognitive decline and improve both physical functioning and quality of life. Ethics and Dissemination:The study is approved by the Local Ethics Committee and registered in https://clinicaltrials.gov (NCT03383549). Dissemination will include submission to a peer-reviewed journal, patients, and healthcare magazines and congress presentations. Trial Registration: ClinicalTrials.gov ID: NCT03383549 (registration date: 26/dec/2017) Trial Funding: Bando FAS Salute 2014 Regione Toscana Version Identifier: ver 5-16/11/2018.

Mind-Reading Ability and Structural Connectivity Changes in Aging.

The Mind-Reading ability through the eyes is an important component of the affective Theory of Mind (ToM), which allows people to infer the other's mental state from the eye gaze. The aim of the present study was to investigate to which extent age-associated structural brain changes impact this ability and to determine if this association is related to executive functions in elderly subjects. For this purpose, Magnetic Resonance Imaging was used to determine both gray matter and white matter (WM) areas associated with aging. The resulting areas have been included in a subsequent correlation analysis to detect the brain regions whose structure was associated with the Mind-Reading ability through the eyes, assessed with the Italian version of the "Reading the Mind in the Eyes" (RME) test, in a sample of 36 healthy subjects ranging from 24 to 79 years of age. The analysis resulted in three important findings: (1) the performance to the RME test is relatively stable across the decades 20-70 (despite a slight decrease of this ability with aging) and independent from executive functions; (2) structural brain imaging demonstrated the involvement of a great number of cortical ToM areas for the execution of the RME test: the bilateral precentral gyrus, the bilateral posterior insula, the left superior temporal gyrus and the left inferior frontal gyrus, which also showed a significant volume decrease with age; (3) an age and task-related decline in WM connectivity on left fronto-temporal portion of the brain. Our results confirm the age-related structural modifications of the brain and show that these changes have an influence on the Mind-Reading ability through the eyes.

Theory of Mind and the Whole Brain Functional Connectivity: Behavioral and Neural Evidences with the Amsterdam Resting State Questionnaire.

A topic of common interest to psychologists and philosophers is the spontaneous flow of thoughts when the individual is awake but not involved in cognitive demands. This argument, classically referred to as the "stream of consciousness" of James, is now known in the psychological literature as "Mind-Wandering." Although of great interest, this construct has been scarcely investigated so far. Diaz et al. (2013) created the Amsterdam Resting State Questionnaire (ARSQ), composed of 27 items, distributed in seven factors: discontinuity of mind, theory of mind (ToM), self, planning, sleepiness, comfort, and somatic awareness. The present study aims at: testing psychometric properties of the ARSQ in a sample of 670 Italian subjects; exploring the neural correlates of a subsample of participants (N = 28) divided into two groups on the basis of the scores obtained in the ToM factor. Results show a satisfactory reliability of the original factional structure in the Italian sample. In the subjects with a high mean in the ToM factor compared to low mean subjects, functional MRI revealed: a network (48 nodes) with higher functional connectivity (FC) with a dominance of the left hemisphere; an increased within-lobe FC in frontal and insular lobes. In both neural and behavioral terms, our results support the idea that the mind, which does not rest even when explicitly asked to do so, has various and interesting mentalistic-like contents.

Possible association between SNAP-25 single nucleotide polymorphisms and alterations of categorical fluency and functional MRI parameters in Alzheimer's disease.

Synaptosomal-associated protein of 25 kDa (SNAP-25) is an age-regulated vesicular SNARE protein involved in the exocytosis of neurotransmitters from synapses, a process that is altered in Alzheimer's disease (AD). Changes in SNAP-25 levels are suggested to contribute to age-related decline of cognitive function, and single nucleotide polymorphisms (SNPs) in the SNAP-25 gene are present in neuropsychiatric conditions and play a role in determining IQ phenotypes. To verify a possible role of SNAP-25 in AD, we analyzed five gene polymorphisms in patients with AD (n = 607), replicating the study in subjects with amnestic mild cognitive impairment (aMCI) (n = 148) and in two groups of age-matched healthy controls (HC1: n = 615 and HC2: n = 310). Results showed that the intronic rs363050 (A) and rs363043 (T) alleles, as well as the rs363050/rs363043 A-T haplotype are significantly more frequent in AD and aMCI and are associated with pathological scores of categorical fluency in AD. Notably, functional MRI analyses indicated that SNAP-25 genotypes correlate with a significantly decreased brain activity in the cingulate cortex and in the frontal (middle and superior gyri) and the temporo-parietal (angular gyrus) area. SNAP-25 polymorphisms may be associated with AD and correlate with alterations in categorical fluency and a reduced localized brain activity. SNAP-25 polymorphisms could be used as surrogate markers for the diagnosis of AD and of cognitive deficit; these SNPs might also have a possible predictive role in the natural history of AD.

Exploring responses to art in adolescence: a behavioral and eye-tracking study.

Adolescence is a peculiar age mainly characterized by physical and psychological changes that may affect the perception of one's own and others' body. This perceptual peculiarity may influence the way in which bottom-up and top-down processes interact and, consequently, the perception and evaluation of art. This study is aimed at investigating, by means of the eye-tracking technique, the visual explorative behavior of adolescents while looking at paintings. Sixteen color paintings, categorized as dynamic and static, were presented to twenty adolescents; half of the images represented natural environments and half human individuals; all stimuli were displayed under aesthetic and movement judgment tasks. Participants' ratings revealed that, generally, nature images are explicitly evaluated as more appealing than human images. Eye movement data, on the other hand, showed that the human body exerts a strong power in orienting and attracting visual attention and that, in adolescence, it plays a fundamental role during aesthetic experience. In particular, adolescents seem to approach human-content images by giving priority to elements calling forth movement and action, supporting the embodiment theory of aesthetic perception.

When art moves the eyes: a behavioral and eye-tracking study.

The aim of this study was to investigate, using eye-tracking technique, the influence of bottom-up and top-down processes on visual behavior while subjects, naïve to art criticism, were presented with representational paintings. Forty-two subjects viewed color and black and white paintings (Color) categorized as dynamic or static (Dynamism) (bottom-up processes). Half of the images represented natural environments and half human subjects (Content); all stimuli were displayed under aesthetic and movement judgment conditions (Task) (top-down processes). Results on gazing behavior showed that content-related top-down processes prevailed over low-level visually-driven bottom-up processes when a human subject is represented in the painting. On the contrary, bottom-up processes, mediated by low-level visual features, particularly affected gazing behavior when looking at nature-content images. We discuss our results proposing a reconsideration of the definition of content-related top-down processes in accordance with the concept of embodied simulation in art perception.