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.

The neurocognitive impact of loneliness and social networks on social adaptation.

Social adaptation arises from the interaction between the individual and the social environment. However, little empirical evidence exists regarding the relationship between social contact and social adaptation. We propose that loneliness and social networks are key factors explaining social adaptation. Sixty-four healthy subjects with no history of psychiatric conditions participated in this study. All participants completed self-report questionnaires about loneliness, social network, and social adaptation. On a separate day, subjects underwent a resting state fMRI recording session. A hierarchical regression model on self-report data revealed that loneliness and social network were negatively and positively associated with social adaptation. Functional connectivity (FC) analysis showed that loneliness was associated with decreased FC between the fronto-amygdalar and fronto-parietal regions. In contrast, the social network was positively associated with FC between the fronto-temporo-parietal network. Finally, an integrative path model examined the combined effects of behavioral and brain predictors of social adaptation. The model revealed that social networks mediated the effects of loneliness on social adaptation. Further, loneliness-related abnormal brain FC (previously shown to be associated with difficulties in cognitive control, emotion regulation, and sociocognitive processes) emerged as the strongest predictor of poor social adaptation. Findings offer insights into the brain indicators of social adaptation and highlight the role of social networks as a buffer against the maladaptive effects of loneliness. These findings can inform interventions aimed at minimizing loneliness and promoting social adaptation and are especially relevant due to the high prevalence of loneliness around the globe. These findings also serve the study of social adaptation since they provide potential neurocognitive factors that could influence social adaptation.

Orbitofrontal and limbic signatures of empathic concern and intentional harm in the behavioral variant frontotemporal dementia.

Perceiving and evaluating intentional harms in an interpersonal context engages both cognitive and emotional domains. This process involves inference of intentions, moral judgment, and, crucially, empathy towards others' suffering. This latter skill is notably impaired in behavioral variant frontotemporal dementia (bvFTD). However, the relationship between regional brain atrophy in bvFTD and deficits in the above-mentioned abilities is not well understood. The present study investigated how gray matter (GM) atrophy in bvFTD patients correlates with the perception and evaluation of harmful actions (attribution of intentionality, evaluation of harmful behavior, empathic concern, and moral judgment). First, we compared the behavioral performance of 26 bvFTD patients and 23 healthy controls on an experimental task (ET) indexing intentionality, empathy, and moral cognition during evaluation of harmful actions. Second, we compared GM volume in patients and controls using voxel-based morphometry (VBM). Third, we examined brain regions where atrophy might be associated with specific impairments in the patient group. Finally, we explored whether the patients' deficits in intentionality comprehension and empathic concern could be partially explained by regional GM atrophy or impairments in other relevant factors, such as executive functions (EFs). In bvFTD patients, atrophy of limbic structures (amygdala and anterior paracingulate cortex--APC) was related to impairments in intentionality comprehension, while atrophy of the orbitofrontal cortex (OFC) was associated with empathic concern deficits. Intentionality comprehension impairments were predicted by EFs and orbitofrontal atrophy predicted deficits in empathic concern. Thus, although the perception and evaluation of harmful actions are variously compromised in bvFTD, deficits in empathic concern may be central to this syndrome as they are associated with one of the earliest atrophied region. More generally, our results shed light on social cognition deficits in bvFTD and may have important clinical implications.

Tumor disembrioplástico neuroepitelial: experiencia en 18 casos / Dysembryoplastic neuroepithelial tumor: experience in 18 cases

El tumor disembrioplástico neuroepitelial es una lesión muy infrecuente del sistema nervioso central, la cual fue descrita por primera vez en 1988 por Daumas-Duport e incluida en la última clasificación de tumores cerebrales de la Organización Mundial de la Salud. Nosotros comunicamos 18 casos consecutivos de DNT, en los que analizamos sus características clínicas y discutimos su diagnóstico diferencial con otras lesiones histológicamente similares asociados a epilepsia fármaco-resistente crónica. La edad media al momento de la operación y al inicio de la epilepsia fueron 27,9 años y 16,9 años respectivamente. Todos los pacientes presentaron epilepsia parcial compleja y sólo un paciente tuvo un leve déficit motor. La localización fue siempre supratentorial, 16 casos temporales y 2 frontales. La resonancia magnética (RM) mostró de regla una lesión quística, usualmente poliquística. Cinco pacientes tuvieron una cirugía previa en otra institución, 3 reacciones subtotales y 2 biopsias. Ningún paciente tuvo el diagnóstico de DNT previo a la segunda cirugía. Las operaciones fueron resecciones del DNT incluyendo el tejido epileptógeno. Un paciente con un DNT frontal localizado en ganglios basales tuvo la resección sub-total. El período de seguimiento varió entre 0.5 y 7 años (media 3,7 años). En nuestro grupo de 14 pacientes, 10 están libres de crisis y 3 presentan una reducción mayor a un 75 por ciento de sus crisis. Ningún paciente ha mostrado evidencia de recurrencia en el seguimiento con RM. La larga historia de epilepsia en nuestra serie indica que el DNT es una lesión que ha permanecido largo tiempo en el encéfalo, con lento o nulo crecimiento. El resultado post-operatorio sugiere que el DNT tiene un execlente pronóstico. Sin embargo, es aún necesario un mayor período de seguimiento, para establecer su real pronóstico en la era de la RM

Aspectos epidemiológicos de la otitis media crónica en el Servicio de Salud Metropolitano Occidente / Epidemiologic aspects of chronic otitis media at the West Metropolitan Service

Se analizaron 840 fichas clínicas de consultantes al Servicio de Otorrinolaringología, encontrándose 171 casos de otitis media crónica (20,4%), de los cuales 23 eran otitis media crónica colesteatomatosa (13,4). El sexo femenino fue el predominante tanto en los consultantes totales como en los casos de otitis media crónica (56,8% y 60,2% respectivamente). El grupo etario más afectado fue el de 5 a 24 años. Las otitis medias crónicas se presentaron en el 32,0% de los consultantes rurales y sólo en el 18,7% de los urbanos. El 40,9% tuvieron compromiso bilateral con importante riesgo de sordera. El tratamiento quirúrgico se practicó en el 20,4% de los casos. Sólo el 5,3% de los pacientes abandonaron el tratamiento y los controles