Domain specificity of error monitoring: An ERP study in young and older adults.

Metacognition refers to the ability to monitor and control one's cognitive processes, which plays an important role in decision-making throughout the lifespan. It is still debated whether metacognitive abilities decline with age. Neuroimaging evidence suggests that metacognition is served by domain-specific mechanisms. These domains may differentially decline with increasing age. The current investigates whether the error-related negativity (ERN) and the error positivity (Pe) which reflect error detection and error awareness, respectively, differ across perceptual and memory domains in young and older adults. In total, 38 young adults and 37 older adults completed a classic Flanker Task (perceptual) and an adapted memory-based version. No difference in ERN amplitude was found between young and older adults and across domains. Perceptual ERN peaked earlier than Memory ERN. Memory ΔERN was larger than Perceptual ΔERN. Pe was smaller in older adults and ΔPe was larger for perceptual than memory flanker. Memory Pe peaked earlier in young as compared to older adults. Multivariate analyses of whole scalp data supported cross-domain differences. During the task, ERN decreased in young but not in older adults. Memory Pe decreased in young adults but increased in older adults while no significant change in perceptual Pe was found. The study's findings suggest that neural correlates of error monitoring differ across cognitive domains. Moreover, it was shown that error awareness declines in old age but its within-task dynamics vary across cognitive domains. Possible mechanisms underlying metacognition impairments in aging are discussed.

Experiences of cognitive stimulation therapy (CST) in Brazil: a qualitative study of people with dementia and their caregivers.

OBJECTIVES: There is a lack of investment in psychosocial treatments for people with dementia in Brazil. Cognitive Stimulation Therapy (CST) is a group-based intervention that has shown to have benefits on activities of daily living and mood for people with dementia in Brazil. This study aims to explore the experiences and perceived changes following CST groups. METHODS: Individual interviews were conducted with the participants of the group (n = 12) and their caregivers (n = 11). Framework analysis was used to inspect the data. RESULTS: Two main themes have emerged: 'Personal benefits of being part of the group', containing two subthemes: 'Benefits for caregivers' and 'Benefits for person with dementia' and 'Day-to-day changes', containing seven subthemes; 'Memory', Sociability', 'Language', 'Mood', 'Orientation', 'Everyday activities' and 'Behavioural and psychological symptoms'. CONCLUSION: Results suggest that CST groups led to perceived personal benefits for the people with dementia and caregivers and that there are perceived changes for the participants of the groups.

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer's disease.

OBJECTIVES: To investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness in a non-clinically depressed sample of participants with mild to moderate Alzheimer's disease (AD) in Brazil. METHODS: People with AD (PwAD) aged 60 years or older were recruited from an outpatient unit at the Center of AD of the Federal University of Rio de Janeiro, Brazil. Measures of awareness of condition (Assessment Scale of the Psychosocial Impact of the Diagnosis of Dementia), cognitive function (Mini-Mental State Examination), mood state (Cornell Scale for Depression in Dementia), and functionality (Pfeffer Functional Activities Questionnaire) were applied to 264 people with mild to moderate AD and their caregivers. Hypotheses were tested statistically using SEM approach. Three competing models were compared. RESULTS: The first model, in which the influence of mood state and cognitive function on awareness was mediated by functionality, showed a very good fit to the data and a medium effect size. The competing models, in which the mediating variables were mood state and cognitive function, respectively, only showed poor model fit. CONCLUSION: Our model supports the notion that the relationship between different factors and awareness in AD is mediated by functionality and not by depressive mood state or cognitive level. The proposed direct and indirect effects on awareness are discussed, as well as the missing direct influence of mood state on awareness. The understanding of awareness in dementia is crucial and our model gives one possible explanation of its underlying structure in AD.

Effects of DBT-based interventions on alexithymia: a systematic review.

While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.

Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial.

OBJECTIVES: Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial. METHODS: 47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention. RESULTS: Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability. CONCLUSIONS: These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects. CLINICAL IMPLICATIONS: Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers.

Spontaneous alternation and stereotypical behaviour in deer mice: response to escitalopram and levetiracetam.

Obsessive-compulsive disorder is varyingly associated with cognitive impairment, that is, deficits in spatial working memory, although it seems unlikely that this is generalised across all domains of functioning. Further, it is unclear whether symptoms will respond to potentially novel, non-serotonergic drugs that have shown promise as so-called cognitive enhancers. Here, we studied low (Norm-N; n = 31) and compulsive-like high (Comp-H; n = 34) stereotypical deer mice (Peromyscus maniculatus bairdii) to establish (1) whether there is a relationship between stereotypical intensity and working memory ability as measured by spontaneous T-maze arm alternation and (2) if and how stereotypy and its association with changes in working memory, would respond to the known anti-compulsive agent, escitalopram, and the proposed cognitive enhancer, levetiracetam. After assessing the stereotypical and alternation behaviour of all animals at baseline, they were divided into three socially housed drug exposure groups, that is, water control (n = 11 per phenotype), escitalopram 50 mg/kg/d (n = 11 per phenotype) and levetiracetam 75 mg/kg/d (Norm-N: n = 9; Comp-H: n = 12). Drugs were administered for 28 days before stereotypy and alternation assessment were repeated. The present data indicate a weak negative relationship between stereotypical intensity and spontaneous alternation. While levetiracetam increased the time spent engaging in normal rodent activity by Comp-H, but not Norm-N animals, neither of the interventions affected the expression of Comp-H behaviour or the alternation behaviour of deer mice. In conclusion, this work points to some degree of cognitive involvement in Comp-H expression, which should be explored to further our understanding of compulsive-like stereotypy.

Suicidal Ideation in Bipolar Disorder: The Relation with Clinical and Sociodemographic Variables.

INTRODUCTION: Bipolar disorder (BD) has the highest risk of suicide among all mental disorders. Thus, identifying factors related to suicidal ideation is essential for a better assessment of the risk of suicide in BD. OBJECTIVE: To analyze the relationship between suicidal ideation and clinical and sociodemographic characteristics in BD patients. METHOD: This is a cross-sectional study that included eighty individuals with BD. Information regarding sociodemographic data and history of attempted suicide were collected, and the Hamilton Depression Scale, Young Mania Rating Scale, Positive And Negative Syndrome Scale/positive symptom subscale, Clinical Global Impressions Scale for use in bipolar illness, Insight Scale for Affective Disorders, and Barratt Impulsiveness Scale were administered. The presence and severity of suicidal ideation were assessed using the Beck Scale for Suicidal Ideation. RESULTS: All regression models significantly predicted suicidal ideation. In the model that had the lowest AIC score and the highest cross-validity, the severity of depressive and of manic symptoms (standardized ß = 0.49, p < 0.001; standardized ß = 0.42, p = 0.007), the insight level (standardized ß = - 0.38, p = 0.012) and previous suicide attempt (standardized ß = 0.20, p = 0.036) acted as predictors of suicidal ideation, while degree of impulsivity (ß standardized = 0.13, p = 0.229) and educational level (standardized ß = - 0.16, p = 0.108) did not give a significant contribution. CONCLUSION: According to our results, more severe depression and mania symptoms, higher level of insight and a history of suicide attempt indicate the occurrence of suicidal ideation in BD.

Stereotypy and spontaneous alternation in deer mice and its response to anti-adenosinergic intervention.

Repetitive behavioral phenotypes are a trait of several neuropsychiatric disorders, including obsessive-compulsive disorder (OCD). Such behaviors are typified by complex interactions between cognitive and neurobiological processes which most likely contribute to the suboptimal treatment responses often observed. To this end, exploration of the adenosinergic system may be useful, since adenosine-receptor modulation has previously shown promise to restore control over voluntary behavior and improve cognition in patients presenting with motor repetition. Here, we employed the deer mouse (Peromyscus maniculatus bairdii) model of compulsive-like behavioral persistence, seeking to investigate possible associations between stereotypic motor behavior and cognitive flexibility as measured in the T-maze continuous alternation task (T-CAT). The effect of istradefylline, a selective adenosine A2A receptor antagonist at two doses (10 and 20 mg kg-1  day-1 ) on the expression of stereotypy and T-CAT performance in high (H) and non-(N) stereotypical animals, was investigated in comparison to a control intervention (six groups; n = 8 or 9 per group). No correlation between H behavior and T-CAT performance was found. However, H but not N animals presented with istradefylline-sensitive spontaneous alternation and stereotypy, in that istradefylline at both doses significantly improved the spontaneous alternation scores and attenuated the stereotypical expression of H animals. Thus, evidence is presented that anti-adenosinergic drug action improves repetitive behavior and spontaneous alternation in stereotypical deer mice, putatively pointing to a shared psychobiological construct underlying naturalistic stereotypy and alterations in cognitive flexibility in deer mice.

Cerebral effects of glucagon-like peptide-1 receptor blockade before and after Roux-en-Y gastric bypass surgery in obese women: A proof-of-concept resting-state functional MRI study.

AIM: To assess the effects of Roux-en-Y gastric bypass surgery (RYGB)-related changes in glucagon-like peptide-1 (GLP-1) on cerebral resting-state functioning in obese women. MATERIALS AND METHODS: In nine obese females aged 40-54 years in the fasted state, we studied the effects of RYGB and GLP-1 on five a priori selected networks implicated in food- and reward-related processes as well as environment monitoring (default mode, right frontoparietal, basal ganglia, insula/anterior cingulate and anterior cingulate/orbitofrontal networks). RESULTS: Before surgery, GLP-1 receptor blockade (using exendin9-39) was associated with increased right caudate nucleus (basal ganglia network) and decreased right middle frontal (right frontoparietal network) connectivity compared with placebo. RYGB resulted in decreased right orbitofrontal (insula/anterior cingulate network) connectivity. In the default mode network, after surgery, GLP-1 receptor blockade had a larger effect on connectivity in this region than GLP-1 receptor blockade before RYGB (all PFWE < .05). Results remained similar after correction for changes in body weight. Default mode and right frontoparietal network connectivity changes were related to changes in body mass index and food scores after RYGB. CONCLUSIONS: These findings suggest GLP-1 involvement in resting-state networks related to food and reward processes and monitoring of the internal and external environment, pointing to a potential role for GLP-1-induced changes in resting-state connectivity in RYGB-mediated weight loss and appetite control.

Modeling Quality of Life in Alzheimer Disease: The Impact of Cognitive, Functional, and Mood Variables in Self and Carers' Perceptions.

Quality of life (QoL) includes complex interactions between objective and subjective factors. Through structural equation modeling, we analyzed people with Alzheimer disease (PwAD) and carers' ratings to identify the factors associated with PwAD QoL. We included 264 PwAD and their carers. Model 1, carers' ratings of PwAD QoL, showed a bidirectional association with worse depressive symptoms, lower functionality, and impairment on awareness being linked. These variables were associated with burden and all of them directly affecting carers' ratings of PwAD QoL. Model 2, PwAD self-reported QoL, had the same bidirectional associations among the same variables with all of them influencing PwAD self-reported QoL. However, the interpretations of these similar associations should be different. The path analysis increased the understanding of the relationship between QoL and cognition, functionality, mood, awareness, and burden. Our findings bring together a number of consistent predictors and confirm their different effects in PwAD and carers' point of view about QoL.

Self-awareness in Dementia: a Taxonomy of Processes, Overview of Findings, and Integrative Framework.

PURPOSE OF REVIEW: Self-awareness, the capacity of becoming the object of one's own awareness, has been a frontier of knowledge, but only recently scientific approaches to the theme have advanced. Self-awareness has important clinical implications, and a finer understanding of this concept may improve the clinical management of people with dementia. The current article aims to explore self-awareness, from a neurobiological perspective, in dementia. RECENT FINDINGS: A taxonomy of self-awareness processes is presented, discussing how these can be structured across different levels of cognitive complexity. Findings on self-awareness in dementia are reviewed, indicating the relative preservation of capacities such as body ownership and agency, despite impairments in higher-level cognitive processes, such as autobiographical memory and emotional regulation. An integrative framework, based on predictive coding and compensatory abilities linked to the resilience of self-awareness in dementia, is discussed, highlighting possible avenues for future research into the topic.

Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial.

OBJECTIVE: The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit. METHODS: A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured. RESULTS: PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden. CONCLUSIONS: CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.

Awareness of deficit following traumatic brain injury: A systematic review of current methods of assessment.

Background: Awareness of deficit plays an important role in adjustment following a brain injury and has been noted to impact on engagement with and outcome of rehabilitation. However, there are challenges associated with the assessment of awareness. Aim: To systematically review all instruments used to assess intellectual awareness of deficits following Traumatic Brain Injury (TBI) in adults, and evaluate instrument characteristics (e.g., the format and focus of measures of awareness) and assessment methods adopted. Results: Thirty-four studies, all rated as fair to good quality, were identified and within these twenty-three different assessment tools were adopted. The most common method of assessment was patient-proxy discrepancy, with three frequently used instruments employed in a total of 22 of the 34 studies. Across studies, variability was noted regarding the type of assessment method dependent on various sample demographics (e.g., age of sample) and injury characteristics (e.g., time post injury). Conclusions: There is no consensus on the preferred instrument to assess intellectual awareness of deficits after TBI. Continued instrument development should attempt to incorporate multiple perspectives and assessment should take into account demographic and injury-related factors. An insightful avenue for future research would be to determine which factors are likely to impact awareness measurement.

Theoretical, and epistemological challenges in scientific investigations of complex emotional states in animals.

This review brings to light critical epistemological and theoretical considerations when studying complex emotional states in animals. We discuss anthropomorphic and Umwelt perspectives of nonhuman animals and the ways in which distinct theories of consciousness and neural processing may restrict the potential for the development of knowledge on the topic. Within the same line of argumentation, we consider influences of the debate between monism and dualism and psychology's behaviorism and cognitive theories. Finally, we contrast the affective consciousness, higher-order emotional consciousness, and constructed emotion theories to further our understanding of complex emotional states in animals.

Awareness in Dementia: Development and Evaluation of a Short Version of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD-s) in Brazil.

Awareness of disease is defined as the recognition of changes caused by the deficits related to the disease process. We aimed to examine the psychometric properties of the short versions of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD-s), a multidimensional awareness scale. Using a cross-sectional design, we included 201 people with dementia and their family caregivers. The creation of the short versions was based on items with higher loadings on each factor, the correlations between the short versions and demographic or clinical variables and the relevance of the item to the respondent population. Three short versions were created: version 1 and 3, with 12 items and version 2, with 16 items. The short versions correlated very strongly with the full scale and with the 4 factors of the original scale, maintaining the multidimensional nature of the ASPIDD. Loss of awareness was associated with worse quality of life, decreased functionality and cognitive level, and higher caregiver burden across the short versions. Considering the appropriateness of the items and their clinical relevance, we recommend version 3 for use. With only 12 items, the time required for the completion of the scale is short, while maintaining robust psychometric properties.

Cognitive stimulation therapy for brazilian people with dementia: examination of implementation' issues and cultural adaptation.

Objectives: The prevalence of dementia has been increasing particularly in developing countries. However, people with dementia (PwD) in Brazil are currently offered no psychosocial treatment upon diagnosis. Cognitive stimulation therapy (CST) that originated in the UK has proven benefits on cognition and quality of life in PwD. We investigate the possible issues for the implementation of CST for the Brazilian population and its cultural appropriateness. Method: Individual interviews and focus groups were conducted with PwD, their caregivers and health professionals (n = 37). Data were recorded and transcribed, before being analyzed using Framework Analysis. Results: Regarding the issues for implementation of CST in the Brazilian population, two main themes emerged, 'Barriers' and 'Facilitators', along with nine subthemes. Overall, the activities and materials were seen as being appropriate for use with the Brazilian population, some minor changes were suggested. Conclusions: The results indicate that CST is appropriate for use in the Brazilian population, only some cultural adaptations are necessary. In the stakeholders' opinions, CTS intervention is needed in Brazil, due to the lack of treatment options for PwD in developing countries.

Clinical and Cognitive Correlates of Insight in Bipolar Disorder.

Insight is greatly impaired in Bipolar Disorder (BD), especially during mania. Cognitive impairment is also present in BD. Despite that, few studies have investigated a possible association between these two aspects. The main goal of the current study is to compare BD affective states regarding performance in cognitive testing and investigate clinical and cognitive predictors for insight loss in BD. The study investigated a sample of 65 patients who were evaluated in one of the BD phases (mania, euthymia or depression). All the subjects underwent neuropsychological evaluation and completed the Insight Scale for Affective Disorders (ISAD). The relationship between level of insight and clinical/cognitive variables was analyzed through multiple regression models. No significant differences were found among BD phases regarding performance on cognitive testing. Insight was more impaired in mania then in depression or euthymia. Predictors for loss of insight were: severity of manic symptoms and impairments in selective attention (Symbol search test), divided attention (Trail making test) and inhibition (Stroop test). The sample size is a potential limitation of the current study. Nevertheless, the results suggest this had limited impact, with group differences being detected for a number of variables. The results found have important clinical importance, suggesting, for example, that rehabilitation of specific cognitive skills may improve insight in BD.

The impact of dementia, depression and awareness on activities of daily living in a sample from a middle-income country.

OBJECTIVE: Previous studies have indicated that dementia and depression have a considerable impact on the functional capacity of older adults, also influencing awareness about ability. The purpose of the current study was to investigate the impact of dementia, depression and awareness on activities of daily living (ADL) in a sample from a middle-income country. METHODS: The current study explored impairments in basic, instrumental and advanced ADL using a factorial design comparing four groups: people with dementia and depression, people with dementia without depression, older adults with depression but no dementia and healthy older adults. For each type of ADL, self-report and informant report was contrasted in order to investigate the issue of lack of awareness in relation to ADL. RESULTS: Results indicate that dementia is associated with impairments in all types of ADL. Advanced ADL were also reduced in depressed participants. In addition, in the case of instrumental and basic ADL, informant report indicated less preserved abilities than participant self-report, particularly in people with dementia. CONCLUSIONS: The findings highlight the importance of developing interventions and compensatory strategies to prevent loss of ADL in dementia, also suggesting that early intervention in older adults with depression should focus on advanced ADL to prevent social isolation and withdrawal. Finally, the findings indicate that self-information about ADL may be compromised in dementia, so clinicians exploring disability should consider fully different aspects of ADL in this group. Copyright © 2017 John Wiley & Sons, Ltd.

Implicit Behavioral Change in Response to Cognitive Tasks in Alzheimer Disease.

BACKGROUND AND OBJECTIVE: Lack of awareness about impairments is commonly found in Alzheimer disease (AD), but recent evidence suggests that patients may respond to the experience of illness despite limited awareness. In this study, we explored whether implicit emotional responses to experiences of failure in cognitive tasks would result in longer-term change in behavior. METHODS: Twenty-two patients with AD were seen 1 week after a previous session in which they performed computer tasks that had been manipulated to be either too difficult (failure condition) or very easy (success condition) for them. At the second session, both types of tasks were set to have medium difficulty and were administered so that the participants decided how long to persist on each task. Task persistence was determined by relative time spent doing the tasks, considering that participants would be more likely to stop performing tasks in which they had experienced failure during the first session. RESULTS: Task persistence in the second session was not affected by performance in the first session. However, when participants' awareness of performance in the first session was taken into account, differences were found in persistence between tasks in the second session. During the second session, participants stopped performing tasks after a sequence of errors. There were no self-reported changes in motivation or enjoyment in response to task failure. CONCLUSIONS: These findings suggest that implicit learning of task valence may be compromised in AD, but that initial moments of awareness of performance may influence long-term adaptation in unaware patients.

Memory and executive functions correlates of self-awareness in traumatic brain injury.

OBJECTIVE: The purpose of this study was to investigate the contribution of executive functions (EF) components and episodic and working memory variables, as well as clinical and demographic factors, to awareness of cognitive ability in traumatic brain injury (TBI). METHODS: Sixty-five TBI patients (mild: n = 26; moderate/severe: n = 39) took part in the study. Independent stepwise regression models were calculated for EF and memory predictors, with awareness being measured by patient/informant discrepancy in the Patient Competency Rating Scale. RESULTS: Models with EF variables indicated that semantic verbal fluency and age are the best predictors of awareness, whereas models including mnemonic functions suggested verbal delayed episodic recall and TBI severity as predictors. CONCLUSIONS: These results are discussed in relation to clinical implications, such as the need to focus efforts of rehabilitation in the cognitive abilities related to awareness, and theoretical models.