The Predictive Role of the Posterior Cerebellum in the Processing of Dynamic Emotions.

Recent studies have bolstered the important role of the cerebellum in high-level socio-affective functions. In particular, neuroscientific evidence shows that the posterior cerebellum is involved in social cognition and emotion processing, presumably through its involvement in temporal processing and in predicting the outcomes of social sequences. We used cerebellar transcranial random noise stimulation (ctRNS) targeting the posterior cerebellum to affect the performance of 32 healthy participants during an emotion discrimination task, including both static and dynamic facial expressions (i.e., transitioning from a static neutral image to a happy/sad emotion). ctRNS, compared to the sham condition, significantly reduced the participants' accuracy to discriminate static sad facial expressions, but it increased participants' accuracy to discriminate dynamic sad facial expressions. No effects emerged with happy faces. These findings may suggest the existence of two different circuits in the posterior cerebellum for the processing of negative emotional stimuli: a first-time-independent mechanism which can be selectively disrupted by ctRNS, and a second time-dependent mechanism of predictive "sequence detection" which can be selectively enhanced by ctRNS. This latter mechanism might be included among the cerebellar operational models constantly engaged in the rapid adjustment of social predictions based on dynamic behavioral information inherent to others' actions. We speculate that it might be one of the basic principles underlying the understanding of other individuals' social and emotional behaviors during interactions.

Hemispheric functional asymmetries and sex effects in visual bistable perception.

This study investigates bistable perception as a function of the presentation side of the ambiguous figures and of participants' sex, to evaluate left-right hemispheric (LH-RH) asymmetries related to consciousness. In two experiments using the divided visual field paradigm, two Rubin's vase-faces figures were projected simultaneously and continuously 180 s long to the left (LVF) and right (RVF; Experiment 1) or to the upper (UVF) and lower (DVF; Experiment 2) visual hemifields of 48 healthy subjects monitored with eye-tracker. Experiment 1 enables stimulus segregation from the LVF to the RH and from the RVF to the LH, whereas Experiment 2 does not. Results from Experiment 1 show that males perceived the face profiles for more time in the LVF than in the RVF, with an opposite trend for the vase, whereas females show a similar pattern of perception in the two hemifields. A related result confirmed the previously reported possibility to have simultaneously two different percepts (qualia) in the two hemifields elicited by the two identic ambiguous stimuli, which was here observed to occur more frequently in males. Similar effects were not observed in Experiment 2. These findings suggest that the percepts display the processing abilities of the hemisphere currently processing the stimulus eliciting them (e.g., RH-faces), and that females and males reflect in bistable perception, a genuine manifestation of consciousness, the well-known hemispheric asymmetry differences they show in ordinary perception.

The importance of social zeitgeber in paediatric type 1 narcolepsy: What we can learn from the COVID-19 restrictions adopted in Italy?

The lockdown due to the new coronavirus pandemic (COVID-19) has led to unparalleled changes in several aspects of human behaviour. During the lockdown, the general population delayed sleep timing and spent more time in bed; however, little is known on the effects of COVID-19 restriction on children and adolescents suffering type 1 narcolepsy. In the last months of 2019, we performed follow-up actigraphy in 18 type 1 narcolepsy children and adolescents under stable pharmacological treatment with sodium oxybate. We contacted these patients for a follow-up actigraphy during the first Italian lockdown. Actigraphs and the Epworth Sleepiness Scale for children and adolescents (ESS-CHAD) have been sent to participants' homes. Differences in motor activity were analysed through functional linear modelling. During lockdown, type 1 narcolepsy children and adolescents went to bed and woke up later, slept more during the daytime and napped more frequently. No difference emerged in time in bed, estimated total sleep time and nocturnal sleep quality. Similarly, no difference emerged in ESS-CHAD and body mass index. The time-series analysis of motor activity documented reduced activity during the early morning and in the evening during the lockdown period compared with pre-lockdown. Our study objectively showed that type 1 narcolepsy children and adolescents delayed the sleep phase and slept more during the daytime during the lockdown. The analysis of type 1 narcolepsy children and adolescents' behaviour during the lockdown has provided new information that could pave the way to a personalized school programme.

Being creative during lockdown: The relationship between creative potential and COVID-19-related psychological distress in narcolepsy type 1.

The national lockdown imposed in several countries to counteract the coronavirus disease 2019 (COVID-19) pandemic led to an unprecedented situation with serious effects on mental health of the general population and of subjects affected by heterogeneous diseases. Considering the positive association between narcoleptic symptoms and creativity, we aimed at exploring the psychological distress associated with COVID-19 restrictions and its relationship with depressive symptoms and creativity in patients with narcolepsy type 1 (NT1). A total of 52 patients with NT1 and 50 healthy controls, who completed a previous study on creativity, were contacted during the first lockdown period to complete an online survey evaluating psychological distress related to the COVID-19 outbreak, sleep quality, narcolepsy and depressive symptoms, and creative abilities. The patients with NT1 showed an improvement in subjective sleepiness while controls reported worsening of sleep quality during the lockdown. Depression and NT1 symptom severity proved significant predictors of COVID-19-related distress. Creative performance, namely generative fluency, turned out to be a favourable moderator in the relationship between depression and patients' distress, reducing the detrimental effect of depression on the patients' wellbeing. On the contrary, creative originality proved to be a disadvantageous moderator in the relationship between NT1 symptom severity and the distress associated with this traumatic event indicating a higher vulnerability to developing COVID-19-related distress, particularly evident in patients displaying higher originality. Overall, these results highlight a crucial role of creativity in patients with NT1, suggesting that creative potential could be used as a protective factor against the development of distress associated with the lockdown.

A tentative I/O curve with consciousness: Effects of multiple simultaneous ambiguous figures presentation on perceptual reversals and time estimation.

This study was aimed at investigating mechanisms of consciousness using bistable perception. In 4 experimental conditions, 1, 2, 4 or 8 Rubin's face-vase ambiguous figures were presented for 3 min.In Experiment 1, 40 subjects looked at the center of the screen and pressed a specific key correspondent to the figure where they perceived a reversal. In Experiment 2, 32 subjects controlled with eye-tracker performed a similar task in which they pressed the spacebar whenever they perceived a reversal in any of the figures.At the end of each condition subjects estimated its duration. Results showed that changing the number of figures does not alter the number of reversals, producing a flat I/O curve between the two parameters. Estimated time lapse showed a negative correlation with the number of reversals. These findings are discussed considering the relationships between bistable perception, attention, and consciousness, as well as the time perception literature.

Independent perceptual reversals for simultaneously presented ambiguous figures.

In two successive experiments using the divided visual field paradigm with vertical or horizontal division, two ambiguous figures, the Rubin's vase-face or the Necker cube, were projected to the right and left or to the upper and lower visual hemifields of 108 healthy volunteers. Stimulation time was 120 s. The main hypotheses were (a) that different percepts of the same ambiguous figure may be simultaneously experienced in the two hemifields and (b) that the type (vertical vs. horizontal) of visual field division influences the reversal frequency and the temporal interdependence of the percepts. Results from the first experiment showed that the temporal interdependence of reversals was very low for both ambiguous figures, suggesting that during part of the stimulation time the subjects could experience different percepts of the same figure (e.g. a vase in the right and face profiles in the left visual hemifields). The second experiment showed that this perceptual dissociation occurred on average during one third of the stimulation time. In both experiments the type of visual field division did not influence either frequency or temporal interdependence of the reversals. When one single ambiguous figure was presented in the centre of the screen, the number of reversals was approximately the sum of the reversals observed with two figures presented simultaneously each in one hemifield.

Modulation of the dichotic right ear advantage during bilateral but not unilateral transcranial random noise stimulation.

Transcranial electrical stimulation (tES) has been increasingly adopted to modulate perceptual and cognitive functions, but the effects on auditory perception are still relatively uncharted. Starting from the evidence that a stronger right ear advantage effect (REA) in dichotic listening positively correlates with speech sound processing, the present study was aimed at modulating the REA by means of high-frequency transcranial Random Noise Stimulation (hf-tRNS). Stimulation was applied over the auditory cortex (AC) either unilaterally (Experiment 1, N = 50) or bilaterally (Experiment 2, N = 24) during a verbal dichotic listening task. The results confirmed the REA both during the sham and the tRNS session in both Experiments. Importantly, a significant enhancement of the REA was found during bilateral hf-tRNS with respect to sham (Experiment 1). No modulation was found when hf-tRNS was applied over the left or right AC with the reference electrode placed on the contralateral shoulder, with respect to sham (Experiment 2). This finding is discussed in the light of previous stimulation studies facing the modulation of hemispheric asymmetries. Our results suggest that the effectiveness of bilateral hf-tRNS in modulating basic speech processing mechanisms could be exploited in the treatment of language impairments.

Sex-specific effects of posture on the attribution of handedness to an imagined agent.

In a series of previous studies, we found that when participants were required to imagine another person performing a manual action, they imagined a significantly higher proportion of actions performed with their dominant rather than non-dominant hand, which indicates that shared motor representations between the self and the other are involved also during the imagination of others' actions. Interestingly, the activation of lateralized body-specific motor representations (as indexed by the congruence between the participant's handedness and the imagined person's handedness) appeared to be affected by the visual perspective adopted and participants' handedness. Given that past literature indicates that incongruent or unnatural postures interfere with motor imagery, we tested 480 right-handed participants to investigate whether subjects holding their right hand behind their back would have imagined right-handed actions less frequently than those holding their left hand behind their back. Moreover, we examined the effects of participant's sex, action category (simple or complex) and hand shape (open or fist). Contrary to our prediction, female participants holding their right hand behind their back imagined right-handed actions more frequently than those holding their left hand behind their back, whereas no significant effect was observed in male participants. We propose that the muscle contraction needed to keep a hand behind the back could activate the motor representations of that hand so as to increase the likelihood of imagining an action performed with the corresponding hand. Moreover, the sex difference observed is consistent with the greater use of embodied strategies by females than by males.

Functional lateralization in social-emotional processing: The influence of sexual orientation and gender identity on cradling preferences.

The left-cradling bias (i.e., the motor asymmetry for cradling infants on the left side) has often been associated to the right-hemispheric social-emotional specialization, and it has often been reported to be stronger in females than in males. In this study we explored the effects of sexual orientation and gender identity on this lateral bias by means of a web-based investigation in a sample of adults (485 biological females and 196 biological males) recruited through LGBTQIA+ networks and general university forums. We exploited a cradling imagery task to assess participants' cradling-side preference, and standardized questionnaires to assess participants' homosexuality (Klein Sexual Orientation Grid) and gender nonconformity (Gender Identity/Gender Dysphoria Questionnaire for Adults and Adolescents). Results confirmed the expected left-cradling bias across all sexual orientation groups except for heterosexual males. Importantly, higher homosexuality scores were associated with higher proportions of left cradling in males. These results suggest that sexual orientation can influence cradling preference in males, indicating a complex interaction between biological and psychological factors in the laterality of social-emotional processing. Finally, the left-cradling bias seems to confirm its role as a behavioral proxy of social-emotional functional lateralization in humans.

The sound of consciousness: neural underpinnings of auditory perception.

The neural correlates of consciousness (NCC), i.e., patterns of brain activity that specifically accompany a particular conscious experience, have been investigated mainly in the visual system using particularly suited paradigms, such as binocular rivalry and multistable percepts in combination with neural recordings or neuroimaging. Through the same principles, we look here for possible NCC in the auditory modality exploiting the properties of the Deutsch's illusion, a stimulation condition in which a sequence of two specular dichotic stimuli presented in alternation causes an illusory segregation of pitch and side (ear of origin), which can yield up to four different auditory percepts per dichotic stimulus. Using magnetoencephalography in humans, we observed cortical activity specifically accompanying conscious experience of pitch inside an early bilateral network, including the Heschl's gyrus, the middle temporal gyrus, the right inferior, and the superior frontal gyri. The conscious experience of perceived side was instead accompanied by later activity observed bilaterally in the inferior parietal lobe and in the superior frontal gyrus. These results suggest that the NCC are not independent of stimulus features and modality and that, even at the higher cortical levels, the different aspects of a single perceptual scene may not be simultaneously processed.

A neural signature of exposure to masked faces after 18 months of COVID-19.

In the last two years, face-to-face interactions have drastically changed worldwide, because of the COVID-19 pandemic: the persistent use of masks has had the advantage of reducing viral transmission, but it has also had the cost of impacting on the perception and recognition of social information from faces, especially emotions. To assess the cerebral counterpart to this condition, we carried out an EEG experiment, extracting Event-Related Potentials (ERPs) evoked by emotional faces with and without surgical masks. Besides the expected impairment in emotion recognition in both accuracy and response times, also the classical face-related ERPs (N170 and P2) are altered by the presence of surgical masks. Importantly, the effect is stronger in individuals with a lower daily exposure to masks, suggesting that the brain must adapt to an extra constraint in decoding social input, due to masks hiding crucial facial information.

Exploring Addictive Online Behaviors in Patients with Narcolepsy Type 1.

BACKGROUND: Narcolepsy type 1 (NT1) is a rare neurological sleep disorder caused by the loss of neurons that produce hypocretin-a peptide that plays a crucial role in addictive behaviors. We aimed to compare, for the first time, levels of problematic online gaming, problematic social media use, and compulsive Internet use between NT1 patients and healthy controls (HC), and to evaluate the association between anxiety, depression, and emotion dysregulation with addictive online behaviors in NT1 patients. METHODS: A total of 43 patients with NT1 and 86 sex- and age-matched HC participated in an online cross-sectional survey. RESULTS: NT1 patients did not differ from HC in terms of problematic social media use and compulsive Internet use but displayed higher levels of problematic online gaming compared to HC. Higher levels of emotion dysregulation were significantly associated with higher levels of problematic social media use and compulsive Internet use, while none of the tested factors were associated with problematic online gaming. CONCLUSION: NT1 patients and HC had similar levels of problematic social media use and compulsive Internet use, but NT1 patients showed higher levels of problematic online gaming. Emotion dysregulation might be an intervention target for reducing compulsive Internet use and problematic social media use.

Cognitive dysfunction in central disorders of hypersomnolence: A systematic review.

Central disorders of hypersomnolence (CDH) are characterized by excessive daytime sleepiness not related to comorbid sleep or medical disturbances. We systematically examined scientific literature on cognitive functions in patients suffering from CDH. Forty-eight studies proved eligible and were analyzed separately for Narcolepsy Type 1 (NT1), Narcolepsy Type 2 (NT2), Idiopathic hypersomnia (IH) and Kleine-Levin syndrome (KLS). Results were grouped into the cognitive domains of attention, memory, executive functions and higher order cognition. Consistent attention impairments emerged in NT1, NT2 and IH patients, with NT1 patients showing the most compromised profile. Memory functions are largely unimpaired in CDH patients except for KLS patients who display memory deficit. Executive functions and higher-order cognition have been assessed in NT1 while they received little-to-no attention in the other CDH. NT1 patients display high performance in executive functions but exhibit a complex pattern of impairment in higher-order cognition, showing poor decision-making and impaired emotional processing. Moreover, NT1 patients show increased creative abilities. Assessing and monitoring cognitive impairments experienced by CDH patients will allow the design of personalized interventions, parallel to pharmacological treatment, aimed at improving daytime functioning and quality of life of these patients.

Dream Activity in Narcoleptic Patients During the COVID-19 Lockdown in Italy.

Some studies highlighted that patients with narcolepsy type-1 (NT1) experience high lucid dream frequency, and this phenomenon has been associated with a creative personality. Starting from the well-known "pandemic effect" on sleep and dreaming, we presented a picture of dream activity in pharmacologically treated NT1 patients during the Italian lockdown. Forty-three NT1 patients completed a web-survey during Spring 2021 and were compared with 86 matched-controls. Statistical comparisons revealed that: (a) NT1 patients showed greater sleepiness than controls; (b) controls showed higher sleep disturbances than NT1 patients, and this result disappeared when the medication effect in NT1 was controlled; (c) NT1 patients reported higher lucid dream frequency than controls. Focusing on dreaming in NT1 patients, we found that (a) nightmare frequency was correlated with female gender, longer sleep duration, higher intrasleep wakefulness; (b) dream recall, nightmare and lucid dream frequency were positively correlated with sleepiness. Comparisons between low and high NT1 lucid dreamers showed that patients more frequently experiencing lucid dreams reported a greater influence of dreaming during wakefulness, especially concerning problem-solving and creativity. Overall, our results are consistent with previous studies on pandemic dreaming carried out on healthy subjects. Moreover, we confirmed a link between lucidity and creativity in NT1 patients. Considering the small sample size and the cross-sectional design, our findings cannot provide a causal relationship between lucid dreams and the COVID-19 lockdown. Nevertheless, they represent a first contribution to address future studies on this issue, suggesting that some stable characteristics could interact with changes provoked by the pandemic.

A computationally efficient method for the attenuation of alternating current stimulation artifacts in electroencephalographic recordings.

OBJECTIVE: Recent studies suggest that the use of noninvasive closed-loop neuromodulation combining electroencephalography (EEG) and transcranial alternating current stimulation (tACS) may be a promising avenue for the treatment of neurological disorders. However, the attenuation of tACS artifacts in EEG data is particularly challenging, and computationally efficient methods are needed to enable closed-loop neuromodulation experiments. Here we introduce an original method to address this methodological issue. APPROACH: Our alternating current regression (AC-REG) method is an adaptive (time-varying) spatial filtering method. It relies on a data buffer of preset size, on which principal component analysis (PCA) is applied. The resulting components are used to build a spatial filter capable of regressing periodic signals in phase with the stimulation. PCA is performed each time that a new sample enters the buffer, such that the spatial filter can be continuously updated and applied to the EEG data. MAIN RESULTS: The AC-REG accuracy in terms of tACS artifact attenuation was assessed using simulated and real EEG data. Alternative offline processing techniques, such as the superimposition of moving averages (SMA) and the Helfrich method (HeM), were used as benchmark. Using simulations, we found that AC-REG can yield a more reliable reconstruction of the stimulation signal for any frequency between 1 and 80 Hz. Analysis of real EEG data of 18 healthy volunteers showed that AC-REG was able to better recover hidden neural activity as compared to SMA and HeM. Also, significantly higher correlations between power spectrum densities in tACS on and off conditions, respectively, were obtained using AC-REG (r = 0.90) than using SMA (r = 0.80) and HeM (r = 0.86). SIGNIFICANCE: Thanks to its low computational complexity, the AC-REG method can be employed in noninvasive closed-loop neuromodulation experiments, with potential applications both in healthy individuals and in neurological patients.

Creativity in Narcolepsy Type 1: The Role of Dissociated REM Sleep Manifestations.

PURPOSE: A higher creative potential has been reported in narcoleptic patients and linked to lucid dreaming. The aim of the present study was to explore the role of narcolepsy symptoms (presence and severity) in predicting creativity. PATIENTS AND METHODS: Sixty-six consecutive type 1 narcolepsy patients (mean age 38.62 ± 17.05, 31 females) took part in this study. Creative achievement in different life domains and creative beliefs were assessed by a self-reported questionnaire and a scale measuring the creative self, respectively; creative performance was measured through a divergent thinking test (generation of alternative original solutions to an open problem). RESULTS: We found a key effect of hypnagogic hallucinations in modulating creative behaviour. We therefore tested at first whether hypnagogic hallucinations could interact with specific mental states associated with creativity and in particular mind wandering, a factor associated with both creative performance and achievement. Secondly, we verified if hypnagogic hallucinations could influence the definition of creative identity in type 1 narcolepsy patients, which in turn could predict their creative achievement and creative performance. Results showed that spontaneous mind wandering influenced creative achievement through a moderation effect of sleep paralysis and hypnagogic hallucinations. Moreover, sleep paralysis and hypnagogic hallucinations indirectly influenced, through creative identity, both creative achievement and performance (fluency score). CONCLUSION: Our results highlight the role of hypnagogic hallucinations in triggering the process of mind wandering which leads to greater creative success. In addition, this symptom affects creative identity in narcolepsy, leading in turn to higher creative success and creative potential of narcoleptic patients.

Can a Peer Support the Process of Self-Management in Narcolepsy? A Qualitative Narrative Analysis of a Narcoleptic Patient.

INTRODUCTION: Narcolepsy type 1 (NT1) is a chronic and rare sleep disorder typically arising during adolescence and young adulthood. The main symptoms are excessive daytime sleepiness and cataplexy, a prototypical fall down elicited by huge emotions. Social relationships, school, work, and general health perception are frequently impaired in patients, who often show lower quality-of-life scores. We report which management strategies a young patient (DMG) adopted to cope with NT1 during his growth, avoiding exhibiting serious impairments to his global functioning. METHODS: A clinical psychologist explores the history of the patient's disease and the self-acquired strategies used to cope with the symptoms. The patient's global adaptation to the disease, stress-related managing skills, and overall well-being are assessed by standardized scales [Illness Behavior Questionnaire (IBQ); Coping Orientations to Problems Experienced (COPE); and Psychological General Well-Being Index (PGWBI)]. We conducted a qualitative analysis of the patient's narration of his illness according to the procedure of the Grounded Theory. The MAXQDA software program was used to code the verbatim transcript. RESULTS: From the qualitative analysis of the interview, three thematic cores emerged: 1) the disease history; 2) the patient's friendship with AD, a friend of his age diagnosed with NT1 since childhood; 3) the strategies used to deal with his symptoms before the diagnosis of NT1 and the related treatment. From the psychometric tests, the patient presents good coping strategies in dealing with stressful problems and events based mainly on acceptance and positive reinterpretation of the stressful situation. CONCLUSION: This case shows that comparing peers of the same age and suffering from the same illness improve the patient's self-management ability to cope and live well with NT1.

Guessing Meaning From Word Sounds of Unfamiliar Languages: A Cross-Cultural Sound Symbolism Study.

Sound symbolism refers to a non-arbitrary relationship between the sound of a word and its meaning. With the aim to better investigate this relationship by using natural languages, in the present cross-linguistic study 215 Italian and Polish participants were asked to listen to words pronounced in 4 unknown non-indo-European languages (Finnish, Japanese, Swahili, Tamil) and to try to guess the correct meaning of each word, by choosing among 3 alternatives visualized on a computer screen. The alternatives were presented in the mother tongue of participants. Three different word categories were presented: nouns, verbs and adjectives. A first overall analysis confirmed a semantic role of sound symbols, the performance of participants being higher than expected by chance. When analyzed separately for each language and for each word category, the results were significant for Finnish and Japanese, whereas the recognition rate was not significantly better than chance for Swahili and Tamil. Results were significant for nouns and verbs, but not for adjectives. We confirm the existence of sound symbolic processing in natural unknown languages, and we speculate that some possible difference in the iconicity of the languages could be the basis for the difference we found. Importantly, the evidence that there were no differences between Italian and Polish participants allows us to conclude that the sound symbolism is independent of the mother tongue of the listener.

Left hemisphere specialization for duration discrimination of musical and speech sounds.

Hemispheric asymmetries for processing duration of non-verbal and verbal sounds were investigated in 60 right-handed subjects. Two dichotic tests with attention directed to one ear were used, one with complex tones and one with consonant-vowel syllables. Stimuli had three possible durations: 350, 500, and 650 ms. Subjects judged whether the duration of a probe was same or different compared to the duration of the target presented before it. Target and probe were part of two dichotic pairs presented with 1s interstimulus interval and occurred on the same side. Dependent variables were reaction time and accuracy. Results showed a significant right ear advantage for both dependent variables with both complex tones and consonant-vowel syllables. This study provides behavioural evidence of a left hemisphere specialization for duration perception of both musical and speech sounds in line with the current view based on a parameter--rather than domain-specific structuring of hemispheric perceptual asymmetries.