Story reading with incidental comprehension and memory: left hemisphere dominance.

BACKGROUND: There are no studies on adults with unilateral brain lesions regarding story reading with incidental/implicit comprehension and memory, in which memory is only assessed through delayed recall. There is a need for validation of cerebral laterality in this type of verbal recall, which includes spontaneous performance (free or uncued condition (UC)), and induced-through-question performance regarding the forgotten units (cued condition (CC)). OBJECTIVES: To explore the effects of unilateral brain lesions, of oral reading with expression (RE) and comprehension (RC) on delayed recall of a story, as either UC or CC; and to validate the ability of UC and CC to discriminate the side of brain injury. METHODS: Data were obtained from 200 right-handed volunteers, among whom 42 had left-hemisphere injury (LHI), 49 had right-hemisphere injury (RHI) and 109 were demographically-matched healthy participants (HP). Patients who were unable to read, understand or speak were excluded. RESULTS: LHI individuals presented impairment of both UC and CC, in relation to the other two groups (non-LHI) with sensitivity and specificity above 70%. LHI and RHI individuals were not significantly different in RE and RC, but they were both different from HP in all the assessments except CC, in which RHI individuals resembled HP. Despite this lack of abnormality in RHI individuals during CC, about half of this group showed impairment in UC. Additionally, whereas RE had a significant effect on UC, the moral of the story (RC) had a significant effect on both UC and CC. CONCLUSIONS: The left hemisphere was dominant for this memory task involving implicit processing.

Story reading with incidental comprehension and memory: left hemisphere dominance / Lectura de una historia con comprensión y memoria incidentales: dominancia del hemisferio izquierdo

ABSTRACT Background: There are no studies on adults with unilateral brain lesions regarding story reading with incidental/implicit comprehension and memory, in which memory is only assessed through delayed recall. There is a need for validation of cerebral laterality in this type of verbal recall, which includes spontaneous performance (free or uncued condition (UC)), and induced-through-question performance regarding the forgotten units (cued condition (CC)). Objectives: To explore the effects of unilateral brain lesions, of oral reading with expression (RE) and comprehension (RC) on delayed recall of a story, as either UC or CC; and to validate the ability of UC and CC to discriminate the side of brain injury. Methods: Data were obtained from 200 right-handed volunteers, among whom 42 had left-hemisphere injury (LHI), 49 had right-hemisphere injury (RHI) and 109 were demographically-matched healthy participants (HP). Patients who were unable to read, understand or speak were excluded. Results: LHI individuals presented impairment of both UC and CC, in relation to the other two groups (non-LHI) with sensitivity and specificity above 70%. LHI and RHI individuals were not significantly different in RE and RC, but they were both different from HP in all the assessments except CC, in which RHI individuals resembled HP. Despite this lack of abnormality in RHI individuals during CC, about half of this group showed impairment in UC. Additionally, whereas RE had a significant effect on UC, the moral of the story (RC) had a significant effect on both UC and CC. Conclusions: The left hemisphere was dominant for this memory task involving implicit processing.

RESUMEN Antecedentes: No existen estudios en adultos con lesiones cerebrales unilaterales sobre la lectura de una historia, con comprensión y memoria incidental/implícita, midiendo sólo el recuerdo diferido. Se necesita validar la lateralidad cerebral en este tipo de recuerdo verbal que incluye: desempeño espontáneo (condición sin claves (CS) o libre) y desempeño inducido con preguntas sobre las unidades olvidadas (condición con claves (CC)). Objetivos: Explorar el efecto de las lesiones cerebrales unilaterales, la lectura expresiva (LE) y la comprensiva (LC), sobre el recuerdo diferido de una historia, sea CS o CC. Validar CS y CC en su capacidad para discriminar el lado de la lesión cerebral. Métodos: Los datos se obtuvieron de 200 voluntarios diestros, 42 con lesiones del hemisferio izquierdo (LHI), 49 con lesiones del hemisferio derecho (LHD), y 109 participantes sanos (PS), equiparados demográficamente. Se excluyeron los pacientes que no pudieron leer, entender o hablar. Resultados: LHI resultó perjudicado respecto de los otros dos grupos (no-LHI) en CS y CC, con una sensibilidad y especificidad superior al 70%. LHI y LHD no se diferenciaron significativamente en LE ni LC, pero ambos fueron diferentes de los PS en todas las evaluaciones excepto CC, en donde LHD se asemejó a los PS. A pesar de esta ausencia de anomalía en LHD durante CC, aproximadamente la mitad de LHD mostró deterioro en CS. Además, mientras que LE tuvo un efecto significativo en CS, la moraleja de la historia (LC) tuvo un efecto significativo tanto en CS como en CC. Conclusiones: El hemisferio izquierdo fue dominante para esta tarea de memoria que involucró procesamiento implícito.

Remembering a name: Neuropsychological validity studies and a computer proposal for detection of anomia.

There are contradictory results or lack of validity studies concerning the naming function and brain laterality. Although anomia is a frequent symptom of memory impairment, and the most relevant symptom of aphasia, few studies have been conducted to evaluate its validity for detecting patients with left-hemisphere damage (LD), as per the MeSH definition. OBJECTIVE: To validate a paper-and-pencil confrontation naming test (CNT) according to side of brain injury; to select a valid and reliable abbreviated CNT wherein the effect of demographic variables is minimized; and to use the selected CNT to develop a computer-aided confrontation-naming evaluation (CACNE). METHODS: Control data were obtained from 213 healthy participants (HP) aged 15 to 89 years. A subsample of 106 HP was demographically matched to 39 patients with LD and 40 patients with right-hemisphere damage (RD). Anomia definition and CNT cues were considered for the CACNE. RESULTS: Test-retest and inter-rater reliability, internal consistency, and validity for detecting LD were demonstrated. A significant age effect was observed in HP. The CACNE was developed to detect anomia in interaction with environmental interventions. CONCLUSION: The inconsistencies observed in the CNT studies were probably due to the presence of anomia in almost 50% of the RD patients.

Existem resultados contraditórios ou falta de estudos de validade relativos à função de nomeação e lateralidade cerebral. Embora a anomia seja um sintoma frequente de comprometimento da memória e o sintoma mais relevante da afasia, poucos estudos foram realizados para avaliar sua validade na detecção de pacientes com lesão no hemisfério esquerdo (LHE) conforme definição do MeSH. OBJETIVO: Validar um teste de nomeação por confrontação (TNC) do tipo papel-e-lápis de acordo com o lado da lesão cerebral. Selecionar um TNC abreviada válida e confiável, na qual o efeito de variáveis ​​demográficas seja minimizado. Usar o TNC selecionado para desenvolver uma avaliação de nomeação por confrontação auxiliada por computador (CACNE). MÉTODOS: Os dados de controle foram obtidos de 213 participantes saudáveis ​​(PS) com idades entre 15 e 89 anos. Uma subamostra de 106 PS foi demograficamente pareada com 39 LHE e 40 pacientes com lesão no hemisfério direito (LHD). A definição de anomia e as pistas do TNC foram consideradas para a CACNE. RESULTADOS: A confiabilidade teste-reteste e interexaminador, consistência interna e validade para a detecção de LHE foram demonstradas. Um efeito significativo da idade foi observado na PS. CACNE foi desenvolvida para detectar anomia em interação com intervenções ambientais. CONCLUSÃO: As inconsistências observadas nos estudos do TNC devem-se provavelmente à presença de anomia em quase 50% dos pacientes com LHD.

Remembering a name: Neuropsychological validity studies and a computer proposal for detection of anomia / Lembrando um nome: estudos de validade neuropsicológica e uma proposta computadorizada para detecção de anomia

ABSTRACT There are contradictory results or lack of validity studies concerning the naming function and brain laterality. Although anomia is a frequent symptom of memory impairment, and the most relevant symptom of aphasia, few studies have been conducted to evaluate its validity for detecting patients with left-hemisphere damage (LD), as per the MeSH definition. Objective: To validate a paper-and-pencil confrontation naming test (CNT) according to side of brain injury; to select a valid and reliable abbreviated CNT wherein the effect of demographic variables is minimized; and to use the selected CNT to develop a computer-aided confrontation-naming evaluation (CACNE). Methods: Control data were obtained from 213 healthy participants (HP) aged 15 to 89 years. A subsample of 106 HP was demographically matched to 39 patients with LD and 40 patients with right-hemisphere damage (RD). Anomia definition and CNT cues were considered for the CACNE. Results: Test-retest and inter-rater reliability, internal consistency, and validity for detecting LD were demonstrated. A significant age effect was observed in HP. The CACNE was developed to detect anomia in interaction with environmental interventions. Conclusion: The inconsistencies observed in the CNT studies were probably due to the presence of anomia in almost 50% of the RD patients.

RESUMO Existem resultados contraditórios ou falta de estudos de validade relativos à função de nomeação e lateralidade cerebral. Embora a anomia seja um sintoma frequente de comprometimento da memória e o sintoma mais relevante da afasia, poucos estudos foram realizados para avaliar sua validade na detecção de pacientes com lesão no hemisfério esquerdo (LHE) conforme definição do MeSH. Objetivo: Validar um teste de nomeação por confrontação (TNC) do tipo papel-e-lápis de acordo com o lado da lesão cerebral. Selecionar um TNC abreviada válida e confiável, na qual o efeito de variáveis ​​demográficas seja minimizado. Usar o TNC selecionado para desenvolver uma avaliação de nomeação por confrontação auxiliada por computador (CACNE). Métodos: Os dados de controle foram obtidos de 213 participantes saudáveis ​​(PS) com idades entre 15 e 89 anos. Uma subamostra de 106 PS foi demograficamente pareada com 39 LHE e 40 pacientes com lesão no hemisfério direito (LHD). A definição de anomia e as pistas do TNC foram consideradas para a CACNE. Resultados: A confiabilidade teste-reteste e interexaminador, consistência interna e validade para a detecção de LHE foram demonstradas. Um efeito significativo da idade foi observado na PS. CACNE foi desenvolvida para detectar anomia em interação com intervenções ambientais. Conclusão: As inconsistências observadas nos estudos do TNC devem-se provavelmente à presença de anomia em quase 50% dos pacientes com LHD.

Validity and features of spontaneous speech in acute aphasia as evaluated with the Brief Aphasia Evaluation: is fluent aphasia more severe than nonfluent aphasia?

PURPOSE: To explore the relationship between the two components of spontaneous speech in the Brief Aphasia Evaluation (BAE) and the rest of the scale represented by its three main factors: The Expression, Comprehension, and Complementary factors. METHODS: BAE has proven validity and reliability. The evaluation of spontaneous speech in this scale comprises two components: Performance Rank (score: 0-3) and Type of Disorder (Fluency [F], Content [C], or Mixed [FC]) when rank < 3. Sixty-seven patients with left brain damage and 30 demographically matched healthy participants (HP) were studied. It was analyzed the correlation between Performance Rank and the three BAE factors and, recoding 3 as 0 and < 3 as 1, the sensitivity/specificity of this component for each factor. The effect of Type of Disorder on the three factors was analyzed. RESULTS: 1) Performance Rank: Correlations of 0.84 (Expression), 0.81 (Comprehension), and 0.76 (Complementary) were observed, with a sensitivity and specificity ≥ 78% for any factor; 2) Type of Disorder: The performance significantly decreased from FC to C and from C to F in Expression (FC < C < F), from FC to C and from FC to F also in Comprehension and Complementary, from patients with any type of disorder to HP. CONCLUSION: Performance Rank was a relevant indicator of aphasia by its consistency with valid and comprehensive dimensions of acute language impairments. A degree difference between F and C was observed, being F a milder disorder; i.e., fluency problems were less severe than retrieval or anomia ones.

Validity and features of spontaneous speech in acute aphasia as evaluated with the Brief Aphasia Evaluation: is fluent aphasia more severe than nonfluent aphasia? / Validez y características del habla espontánea en la afasia aguda evaluada con la Evaluación Breve de la Afasia: ¿Es la afasia fluente más severa que la no fluente?

ABSTRACT Purpose To explore the relationship between the two components of spontaneous speech in the Brief Aphasia Evaluation (BAE) and the rest of the scale represented by its three main factors: The Expression, Comprehension, and Complementary factors. Methods BAE has proven validity and reliability. The evaluation of spontaneous speech in this scale comprises two components: Performance Rank (score: 0-3) and Type of Disorder (Fluency [F], Content [C], or Mixed [FC]) when rank < 3. Sixty-seven patients with left brain damage and 30 demographically matched healthy participants (HP) were studied. It was analyzed the correlation between Performance Rank and the three BAE factors and, recoding 3 as 0 and < 3 as 1, the sensitivity/specificity of this component for each factor. The effect of Type of Disorder on the three factors was analyzed. Results 1) Performance Rank: Correlations of 0.84 (Expression), 0.81 (Comprehension), and 0.76 (Complementary) were observed, with a sensitivity and specificity ≥ 78% for any factor; 2) Type of Disorder: The performance significantly decreased from FC to C and from C to F in Expression (FC < C < F), from FC to C and from FC to F also in Comprehension and Complementary, from patients with any type of disorder to HP. Conclusion Performance Rank was a relevant indicator of aphasia by its consistency with valid and comprehensive dimensions of acute language impairments. A degree difference between F and C was observed, being F a milder disorder; i.e., fluency problems were less severe than retrieval or anomia ones.

RESUMEN Objetivo Explorar la relación entre los dos componentes del habla espontánea en la Evaluación Breve de la Afasia (EBA) y el resto de la escala, representada por sus tres factores principales: Expresión, Comprensión y Complementario. Método EBA ha demostrado validez y confiabilidad. La evaluación del habla espontánea consta de dos componentes: Grado de Desempeño (puntuación: 0-3) y Tipo de Trastorno (Fluidez (F), Contenido (C), o Mixto (FC)) cuando grado<3. Se estudiaron 67 pacientes con lesión cerebral izquierda y 30 participantes sanos (PS), emparejados demográficamente. Se analizó la correlación entre Grado de Desempeño y los tres factores de EBA y, recodificando 3 como 0 y <3 como 1, la sensibilidad/especificidad del componente para cada factor. Se analizó el efecto de Tipo de Trastorno sobre los tres factores. Resultados 1) Grado de Desempeño: Se observaron correlaciones de 0,84 (Expresión), 0,81 (Comprensión), y 0,76 (Complementario), con una sensibilidad y especificidad ≥ 78% para cualquier factor; 2) Tipo de Trastorno: El desempeño disminuyó significativamente desde FC a C y desde C a F en Expresión (FC<C<F); desde FC a C y desde FC a F también en Comprensión y Complementario; desde los pacientes con cualquier tipo de trastorno a PS. Conclusión Grado de Desempeño fue un indicador relevante de la afasia por su consistencia con dimensiones válidas y comprensivas de trastornos agudos del lenguaje. Se observó una diferencia de grado entre F y C, siendo F un trastorno más leve, vale decir, los problemas de fluidez fueron menos severos que los de evocación o anomia.

Relationship between the caregiver's report on the patient's spontaneous-speech and the Brief Aphasia Evaluation. / Relación entre el informe del cuidador sobre el habla espontánea del paciente y la Evaluación Breve de la Afasia.

PURPOSE: To study the relationship between the caregiver's perception about the patient's impairment in spontaneous speech, according to an item of four questions administered by semi-structured interview, and the patient's performance in the Brief Aphasia Evaluation (BAE). METHODS: 102 right-handed patients with focal brain lesions of different types and location were examined. BAE is a valid and reliable instrument to assess aphasia. The caregiver's perception was correlated with the item of spontaneous speech, the total score and the three main factors of the BAE: Expression, Comprehension and Complementary factors. The precision (sensitivity/ specificity) about the caregiver's perception of the patient's spontaneous speech was analyzed with reference to the presence or absence of disorder, according to the professional, on the BAE item of spontaneous speech. RESULTS: The studied correlation was satisfactory, being greater (higher than 80%) for the following indicators: the item of spontaneous speech, the Expression factor and the total score of the scale; the correlation was a little smaller (higher than 70%) for the Comprehension and Complementary factors. Comparing two cut-off points that evaluated the precision of the caregiver's perception, satisfactory results were observed in terms of sensitivity and specificity (>70%) with likelihood ratios higher than three. By using the median as the cut-off point, more satisfactory diagnostic discriminations were obtained. CONCLUSION: Interviewing the caregiver specifically on the patient's spontaneous speech, in an abbreviated form, provides relevant information for the aphasia diagnosis.

OBJETIVO: Estudiar la relación entre la percepción del cuidador sobre el deterioro en el habla espontánea del paciente, según un ítem de cuatro preguntas administradas mediante entrevista semiestructurada, y el desempeño del paciente en la Evaluación Breve de la Afasia (EBA). MÉTODO: Se examinaron 102 pacientes diestros, con lesiones cerebrales focales de diferente tipo y localización. EBA es un instrumento válido y confiable para la medida de la afasia. Se correlacionó la percepción del cuidador con el ítem de habla espontánea, la puntuación total y los tres principales factores de EBA: el factor de Expresión, el de Comprensión y el Complementario. Se analizó la precisión (sensibilidad-especificidad) de la percepción del cuidador sobre el habla espontánea del paciente, respecto de la presencia o ausencia de trastorno, según el profesional, en el ítem de habla espontánea de EBA. RESULTADOS: La correlación estudiada fue satisfactoria, siendo mayor (superior al 80%) para los siguientes indicadores: el ítem de habla espontánea, el factor de Expresión y la puntuación total de la escala; la correlación fue un poco menor (superior al 70%) para el factor de Comprensión y el Complementario. Comparando dos puntos de corte que evaluaron la precisión en la percepción del cuidador, se observaron resultados satisfactorios en términos de sensibilidad y especificidad (>70%), con cocientes de probabilidad superiores a 3. Usando la mediana como punto de corte, se obtuvieron discriminaciones diagnósticas más satisfactorias. CONCLUSIÓN: Entrevistar al cuidador específicamente sobre el habla espontánea del paciente, en forma abreviada, proporciona información relevante para el diagnóstico de la afasia.

Relación entre el informe del cuidador sobre el habla espontánea del paciente y la Evaluación Breve de la Afasia / Relationship between the caregiver's report on the patient's spontaneous-speech and the Brief Aphasia Evaluation

RESUMEN Objetivo Estudiar la relación entre la percepción del cuidador sobre el deterioro en el habla espontánea del paciente, según un ítem de cuatro preguntas administradas mediante entrevista semiestructurada, y el desempeño del paciente en la Evaluación Breve de la Afasia (EBA). Método Se examinaron 102 pacientes diestros, con lesiones cerebrales focales de diferente tipo y localización. EBA es un instrumento válido y confiable para la medida de la afasia. Se correlacionó la percepción del cuidador con el ítem de habla espontánea, la puntuación total y los tres principales factores de EBA: el factor de Expresión, el de Comprensión y el Complementario. Se analizó la precisión (sensibilidad-especificidad) de la percepción del cuidador sobre el habla espontánea del paciente, respecto de la presencia o ausencia de trastorno, según el profesional, en el ítem de habla espontánea de EBA. Resultados La correlación estudiada fue satisfactoria, siendo mayor (superior al 80%) para los siguientes indicadores: el ítem de habla espontánea, el factor de Expresión y la puntuación total de la escala; la correlación fue un poco menor (superior al 70%) para el factor de Comprensión y el Complementario. Comparando dos puntos de corte que evaluaron la precisión en la percepción del cuidador, se observaron resultados satisfactorios en términos de sensibilidad y especificidad (>70%), con cocientes de probabilidad superiores a 3. Usando la mediana como punto de corte, se obtuvieron discriminaciones diagnósticas más satisfactorias. Conclusión Entrevistar al cuidador específicamente sobre el habla espontánea del paciente, en forma abreviada, proporciona información relevante para el diagnóstico de la afasia.

ABSTRACT Purpose To study the relationship between the caregiver's perception about the patient's impairment in spontaneous speech, according to an item of four questions administered by semi-structured interview, and the patient's performance in the Brief Aphasia Evaluation (BAE). Methods 102 right-handed patients with focal brain lesions of different types and location were examined. BAE is a valid and reliable instrument to assess aphasia. The caregiver's perception was correlated with the item of spontaneous speech, the total score and the three main factors of the BAE: Expression, Comprehension and Complementary factors. The precision (sensitivity/ specificity) about the caregiver's perception of the patient's spontaneous speech was analyzed with reference to the presence or absence of disorder, according to the professional, on the BAE item of spontaneous speech. Results The studied correlation was satisfactory, being greater (higher than 80%) for the following indicators: the item of spontaneous speech, the Expression factor and the total score of the scale; the correlation was a little smaller (higher than 70%) for the Comprehension and Complementary factors. Comparing two cut-off points that evaluated the precision of the caregiver's perception, satisfactory results were observed in terms of sensitivity and specificity (>70%) with likelihood ratios higher than three. By using the median as the cut-off point, more satisfactory diagnostic discriminations were obtained. Conclusion Interviewing the caregiver specifically on the patient's spontaneous speech, in an abbreviated form, provides relevant information for the aphasia diagnosis.

Integration of Intention and Outcome for Moral Judgment in Frontotemporal Dementia: Brain Structural Signatures.

BACKGROUND: Moral judgment has been proposed to rely on a distributed brain network. This function is impaired in behavioral variant frontotemporal dementia (bvFTD), a condition involving damage to some regions of this network. However, no studies have investigated moral judgment in bvFTD via structural neuroimaging. METHODS: We compared the performance of 21 bvFTD patients and 19 controls on a moral judgment task involving scenarios that discriminate between the contributions of intentions and outcomes. Voxel-based morphometry was used to assess (a) the atrophy pattern in bvFTD patients, (b) associations between gray matter (GM) volume and moral judgments, and (c) structural differences between bvFTD subgroups (patients with relatively preserved moral judgment and patients with severer moral judgment impairments). RESULTS: Patients judged attempted harm as more permissible and accidental harm as less permissible than controls. The groups' performance on accidental harm was associated with GM volume in the precuneus. In controls, it was al- so associated with the ventromedial prefrontal cortex (VMPFC). Also, both groups' performance on attempted harm was associated with GM volume in the temporoparietal junction. Patients exhibiting worse performance displayed smaller GM volumes in the precuneus and temporal pole. CONCLUSIONS: Results suggest that moral judgment abnormalities in bvFTD are associated with impaired integration of intentions and outcomes, which depends on an extended brain network. In bvFTD, moral judgment seems to critically depend on areas beyond the VMPFC.

Screening executive function and global cognition with the Nine-Card Sorting Test: healthy participant studies and ageing implications.

BACKGROUND: The Nine-Card Sorting Test provides valid and reliable scores when screening executive function, intelligence, and academic achievement. It is also useful for detecting cognitive impairment and dementia in the elderly and for assessing disease evolution and treatment effectiveness. It deals with three non-verbal sorting principles, individually and in pairs. The presence of risk in the ability to discover and organize visual logical stimuli is explored. OBJECTIVES: This study aimed to describe performance on the Nine-Card Sorting Test in a non-clinical sample, to analyze the effect of demographic variables, and to propose suitable (i.e. the simplest and most homogeneous) cut-off points for possible deficits. Combinations in pairs (double arrays) were assessed (range: 0-3). RESULTS: Significant effects of age and education were observed, but no interactions among the demographic variables were seen. Differences between the second and third levels of education and between men and women were not significant. The simplest cut-off points were as follows: (i) the median for people younger than 45 years old was 2, independent of educational level; (ii) the median for people older than 74 years old was 1, independent of educational level; and (iii) the median for people aged 45-74 years old was 1 for the first level of education and 2 for higher levels of education. CONCLUSION: By considering both the statistical nature of the present dependent variable (number of completed categories) and the clear-cut performance of the different samples studied, this neuropsychological test can be defined as a categorical screening for executive function and global cognition. This is advantageous for reporting risk. Of the whole sample, the 25th percentile (score = 1) represented a valid index for possible deficits. Ageing questions are highlighted. The test is also fruitful for studies on visuospatial organization and its facilitatory and inhibitory mechanisms.

Verbal Neuropsychological Functions in Aphasia: An Integrative Model.

A theoretical framework which considers the verbal functions of the brain under a multivariate and comprehensive cognitive model was statistically analyzed. A confirmatory factor analysis was performed to verify whether some recognized aphasia constructs can be hierarchically integrated as latent factors from a homogenously verbal test. The Brief Aphasia Evaluation was used. A sample of 65 patients with left cerebral lesions, and two supplementary samples comprising 35 patients with right cerebral lesions and 30 healthy participants were studied. A model encompassing an all inclusive verbal organizer and two successive organizers was validated. The two last organizers were: three factors of comprehension, expression and a "complementary" verbal factor which included praxia, attention, and memory; followed by the individual (and correlated) factors of auditory comprehension, repetition, naming, speech, reading, writing, and the "complementary" factor. By following this approach all the patients fall inside the classification system; consequently, theoretical improvement is guaranteed.

Contextual social cognition impairments in schizophrenia and bipolar disorder.

BACKGROUND: The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. METHODOLOGY/PRINCIPAL FINDINGS: This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients' depression levels were negatively correlated with performance on empathy tasks. CONCLUSIONS/SIGNIFICANCE: Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.

Integrating intention and context: assessing social cognition in adults with Asperger syndrome.

Deficits in social cognition are an evident clinical feature of the Asperger syndrome (AS). Although many daily life problems of adults with AS are related to social cognition impairments, few studies have conducted comprehensive research in this area. The current study examined multiple domains of social cognition in adults with AS assessing the executive functions (EF) and exploring the intra and inter-individual variability. Fifteen adult's diagnosed with AS and 15 matched healthy controls completed a battery of social cognition tasks. This battery included measures of emotion recognition, theory of mind (ToM), empathy, moral judgment, social norms knowledge, and self-monitoring behavior in social settings. We controlled for the effect of EF and explored the individual variability. The results indicated that adults with AS had a fundamental deficit in several domains of social cognition. We also found high variability in the social cognition tasks. In these tasks, AS participants obtained mostly subnormal performance. EF did not seem to play a major role in the social cognition impairments. Our results suggest that adults with AS present a pattern of social cognition deficits characterized by the decreased ability to implicitly encode and integrate contextual information in order to access to the social meaning. Nevertheless, when social information is explicitly presented or the situation can be navigated with abstract rules, performance is improved. Our findings have implications for the diagnosis and treatment of individuals with AS as well as for the neurocognitive models of this syndrome.

Is the Folstein's Mini-Mental test an aphasia test?

The Mini-Mental State Examination (MMSE) is recognized as a valid screening for dementia. It consists of 29 verbal items from a total of 30. The Brief Aphasia Evaluation (BAE) includes 10 aphasia and 12 orientation items, which are similar to most of the MMSE items. It was studied whether those BAE items (MMSE-like): (a) correlate with the rest of the BAE items (BAE-rest), and (b) differentiate patients with left cerebral lesions (LC) from both patients with right cerebral lesions (RC) and healthy participants (HP). A sample of 109 right-handed volunteers (38 HP, 37 LC, and 34 RC) was studied. The three groups were matched according to gender, age, and education. Patients were similar in multiple variables. The correlation between MMSE-like and BAE-rest was .90. MMSE-like showed a sensitivity and specificity of .81 or above to identify the LC from the other two groups. There is a risk for misdiagnosing aphasia as dementia with the MMSE.

Brief aphasia evaluation (minimum verbal performance): concurrent and conceptual validity study in patients with unilateral cerebral lesions.

INTRODUCTION: Aphasia tests validated according to the brain injury side are necessary, especially for Spanish instruments. OBJECTIVES: To study the concurrent validity of this Brief Aphasia Evaluation (BAE) to differentiate patients with left cerebral lesions (LC) from patients with right cerebral lesions (RC) as well as LC from healthy participants (HP). To study, through an unrestricted-sub-test-factor analysis, the BAE conceptual and content validity to generate a verbal homogeneous construct. MATERIALS AND METHODS: Data were obtained from a sample of 109 right-handed volunteers: 37 LC, 34 RC and 38 HP. The three groups were matched according to gender, age and education. RESULTS: Both groups of patients were similar in type and site of lesion, time since onset of condition, risk factors, presence of hemianopsia and hemiparesis and number of hospital visits. The Cronbach's alpha coefficient indicated an internal consistency of 0.99 for the total score and 0.88 or above for any of the sub-tests. All sub-tests (with loadings of 0.65 or above) grouped in one factor which explained 78% of the variance. The BAE showed a sensitivity and specificity of 0.84 or above to identify the LC (median as cut-off point). CONCLUSIONS: This test of free distribution demonstrated a satisfactory validity.

A novel neuropsychological assessment to discriminate between ischemic and nonischemic dementia.

INTRODUCTION: In the present study we have elaborated a multivariate-multifactor diagnostic method for diagnosis of ischemic and nonischemic dementia, and validated it using different human populations. Our purpose was to improve dementia diagnosis by means of comprehensive neuropsychological assessment and the control of intervening variables. METHODS: Data were obtained from 114 healthy volunteers to 101 patients consecutively referred for suspected dementia. On the basis of neuromorphological criteria, the patient sample was subdivided into those with ischemic lesions (IL: N=12) and without ischemic lesions (non-IL: N=89). The patient groups and the healthy subjects (HS) were matched according to age, education, sex ratio and handedness. A comprehensive neuropsychological battery was administered to all the participants. RESULTS: The two patient groups differed in their Hachinski ischemic score, but not in terms of demographic variables, the Blessed rating scale, Mini Mental State, Geriatric Depression Scale, or other measures. Discriminant analysis selected fifteen neuropsychological variables from the comprehensive battery, and these were found to provide accuracy of classification in 98% of HS and 87% of the patients considered as a whole. Considering the three groups, those variables provided accuracy of classification in 98% of HS, 82% of IL patients and 82% of non-IL patients. Subtests were internally consistent (Cronbach's alpha: 0.87) and a positive association between ischemic lesions and cognitive impairment was observed when the 15 dependent variables were added. DISCUSSION: It is possible to select a combination of cognitive tests that discriminated HS from dementia patients and, within this category, patients with and without ischemic lesions. Analysis of the 15 variables provides an improved method for diagnosis of ischemic vs. nonischemic lesion dementia in humans.

Estudio multivariado del test de bebida en campo abierto con ratas hiponutridas y desipramina com droga antipánico / Open field drink test-multivaried study with undernourished rats and desipramine as an antipanic drug

Los modelos animales de aproximación-evitación son útiles para el estudio inicial de drogas con efecto sobre la ansiedad pero los componentes de la ansiedad valorados por estos modelos continúan pobremente definidos. Los modelos complejos de evaluación permiten inferencias más completas que aquellos que evalúan sólo una conducta. Estudios previos demuestran que el antidepresivo tricíclico desipramina ejerce un selectivo efecto anticonflicto sobre ratas adultas sometidas a un programa de privación proteica en edad perinatal, en parámetros de conducta espontánea (laberinto en cruz elevado) e ingesta condicionada (Geller-Seifter). Dichas ratas hiponutridas muestran alteraciones en la neurotransmisión noradrenérgica que se asemejan a la activación generalizada del sistema noradrenérgico que presentan los pacientes que sufren ataques de pánico. Se evaluó la actividad anticonflicto de la desipramina en una prueba de conflicto etológico: el test de bebida en campo abierto, sin descartar a priori ninguna conducta, bajo un enfoque multivariado. Este enfoque no ha sido considerado en estudios previos de campo abierto y drogas antipánico. Sobre cuatro variables seleccionadas por análisis factorial, la administración de desipramina a una dosis de 10mg/kg por sólo 7 días produjo una significativa interacción dieta × droga, consistente con estudios previos. La interacción fue independiente de los efectos de ambos tratamientos sobre el peso o la ingesta y se expresó, en las ratas hiponutridas, como un decremento en todas las conductas excepto en el tiempo de bebida con respecto a las ratas controles que mostraron, en general, un decremento en todas las conductas excepto en la frecuencia de acicalamiento.

A panic experimental model: validation of a complex operant behavioral method in undernourished rats, with desipramine to provide a template effect profile.

INTRODUCTION: Clinical studies have shown that some antidepressants may be more efficient than benzodiazepines to alleviate anxiety associated with panic disorders; however, operant conflict procedures in rats developed so far seem not particularly able to model human anxiety sensitive to antidepressant treatments. Previous panic models with learned responses did not statistically subtract the effect of confounding factors from the variable of interest. METHODS: Undernourished rats were selected due to their behavioral and neurobiological resemblance to human patients suffering from panic disorder. The Geller-Seifter paradigm represented the stressful environmental condition in adult life. Desipramine (10 mg/kg/day) or saline were administered IP during 7 days under a cross over design (N=10). Five daily 15 min-operant sessions were carried out on each experiment. Unpunished, unrewarded and punished operant behavioral periods were identical both in their duration and in their reward system (the FR1 schedule) in order to measure response suppression, which has not been considered in previous studies with the Geller-Seifter paradigm. The dependent variable was the difference between comparable unpunished and punished periods. RESULTS: A significant Diet x Drug interaction was observed in the dependent variable, which represented the level of "suppression/suppression release" induced by treatments. DISCUSSION: Compared to control rats, deprived rats showed a significant and selective anticonflict effect of desipramine on the stressful and complex operant performance. The animal model of perinatally protein-deprived rats along with the Geller-Seifter's operant behavioral paradigm may represent a more sensitive approach to model human anxiety sensitive to antidepressant treatments by considering the combined impact of both early biological trauma and adult learned experiences under the same design.

[Multivariate study of the Open Field Drink Test using undernourished rats and desipramine as an antipanic drug]. / Estudio multivariado del test de bebida en campo abierto con ratas hiponutridas y desipramina como droga antipánico.

Approach-avoidance animal models are useful as initial screens for drugs affecting anxiety, but the components of anxiety assessed by these models remain poorly defined. Complex models of evaluation allow more complete inferences than those which are obtained when only one behavior is evaluated. Previous studies demonstrate that the tricyclic-antidepressant desipramine exerts a selective anticonflict effect on adult rats submitted to a protein deprivation schedule at perinatal age, in parameters of spontaneous behavior (elevated plus-maze) and conditioned intake (Geller Seifter). These deprived rats show alterations in noradrenergic neurotransmission that resembled the generalized activation of noradrenergic system displayed by patients suffering from panic attacks. The desipramine anticonflict activity was evaluated by a test of ethological conflict: the Open Field Drink Test, without discarding any behavior a priori under a multivaried approach. This approach has not been considered in previous studies with the open field and antipanic drugs. Considering the four variables selected by factorial analysis, desipramine (10 mg/kg/day) administered IP during just 7 days produced a significant diet x drug interaction which was consistent with previous studies. That interaction was independent of the effects of both treatments on weight or intake and was expressed, on deprived rats, as a decrease in all the behaviors, except for the time of drinking, with respect to the control rats, which displayed, in general, a decrease in all the behaviors except for the frequency of grooming.