Behavioural Neurology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Qualitative Characteristics of Depression in Parkinson’s Patients and Controls Sun, 16 Aug 2015 08:04:29 +0000 Background. Depression is common in Parkinson’s disease (PD); in light of typical PD pathology it may differ phenomenologically from depression in the general population. Objective. To assess depressive symptoms in PD patients and control groups and compare symptom profiles. Methods. After postal screening of 10,000 citizens of Lübeck, 642 participants were examined and the Beck Depression Inventory (BDI) was sufficiently answered by 477 subjects. Based on motor examinations, we distinguished PD patients, Healthy Controls (HC, no motor impairment), and Disease Controls (DC, motor impairment other than PD). Results. The sample comprised 331 men and 311 women, aged 65 ± 8 years. Out of the overall sample, 198 (41.5%) had a BDI score ≥9. BDI results above 9 points occurred in 34.5% of HC, 50.3% of DC, and 42.4% of PD patients. Compared to the control groups (HC, DC) the PD patients endorsed more “dissatisfaction” and “loss of appetite” but less “feelings of guilt,” “self-hate,” and “loss of libido.” Conclusion. Depressive symptoms are more frequent in PD patients compared to HC but not DC. Interestingly, the distribution of individual symptoms of the BDI differs between groups with an emphasis on loss of pleasure/enjoyment in the PD group, a symptom typically considered to be dopaminergically transmitted. Cleo Kritzinger, Eva-Juliane Vollstedt, Katja Hückelheim, Anne Lorwin, Julia Graf, Sinem Tunc, Christine Klein, and Meike Kasten Copyright © 2015 Cleo Kritzinger et al. All rights reserved. Magnetic Resonance Imaging Studies of Postpartum Depression: An Overview Tue, 11 Aug 2015 12:46:37 +0000 Postpartum depression is a frequent and disabling condition whose pathophysiology is still unclear. In recent years, the study of the neural correlates of mental disorders has been increasingly approached using magnetic resonance techniques. In this review we synthesize the results from studies on postpartum depression in the context of structural, functional, and spectroscopic magnetic resonance studies of major depression as a whole. Compared to the relative wealth of data available for major depression, magnetic resonance studies of postpartum depression are limited in number and design. A systematic literature search yielded only eleven studies conducted on about one hundred mothers with postpartum depression overall. Brain magnetic resonance findings in postpartum depression appear to replicate those obtained in major depression, with minor deviations that are not sufficient to delineate a distinct neurobiological profile for this condition, due to the small samples used and the lack of direct comparisons with subjects with major depression. However, it seems reasonable to expect that studies conducted in larger populations, and using a larger variety of brain magnetic resonance techniques than has been done so far, might allow for the identification of neuroimaging signatures for postpartum depression. Marco Fiorelli, Franca Aceti, Isabella Marini, Nicoletta Giacchetti, Enrica Macci, Emanuele Tinelli, Valentina Calistri, Valentina Meuti, Francesca Caramia, and Massimo Biondi Copyright © 2015 Marco Fiorelli et al. All rights reserved. Recent Insights on Prevalence and Corelations of Hypoactive Delirium Mon, 10 Aug 2015 09:32:29 +0000 Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research. Vaios Peritogiannis, Maria Bolosi, Charalampos Lixouriotis, and Dimitrios V. Rizos Copyright © 2015 Vaios Peritogiannis et al. All rights reserved. Management of Gliomas: Overview of the Latest Technological Advancements and Related Behavioral Drawbacks Sun, 09 Aug 2015 13:49:45 +0000 The advancements in basic sciences and the availability of sophisticated technological aids to surgical removal of gliomas have led over the last few years to the rise of innovative surgical strategies, the identification of better prognostic/predictive biomolecular factors, and the development of novel drugs and all are meant to profoundly impact the outcome of patients diagnosed with these aggressive tumours. Unfortunately, the treatment protocols available nowadays still confer only a small survival advantage at a potentially high cost in terms of overall well-being. In this review we identified the potential and limits of the most promising research trends in the management of glioma patients, also highlighting the related externalities. Finally, we focused our attention on the imbalance between the technical and behavioral aspects pertinent to this research area, which ultimately represent the two sides of the same coin. L. Ganau, M. Paris, G. K. Ligarotti, and M. Ganau Copyright © 2015 L. Ganau et al. All rights reserved. Abstract Word Definition in Patients with Amnestic Mild Cognitive Impairment Sun, 09 Aug 2015 13:25:09 +0000 The aims of this study were to investigate concrete and abstract word definition ability (1) between patients with amnestic mild cognitive impairment (aMCI) and normal adults and (2) between the aMCI subtypes (i.e., amnestic single-domain MCI and amnestic multidomain MCI; asMCI and amMCI) and normal controls. The 68 patients with aMCI (29 asMCI and 39 amMCI) and 93 age- and education-matched normal adults performed word definition tasks composed of five concrete (e.g., train) and five abstract nouns (e.g., jealousy). Task performances were analyzed on total score, number of core meanings, and number of supplementary meanings. The results were as follows. First, the aMCI patients scored significantly poorer than the normal controls in only abstract word definition. Second, both subtypes of aMCI performed worse than the controls in only abstract word definition. In conclusion, a definition task of abstract rather than concrete concepts may provide richer information to show semantic impairment of aMCI. Soo Ryon Kim, SangYun Kim, Min Jae Baek, and HyangHee Kim Copyright © 2015 Soo Ryon Kim et al. All rights reserved. Cognitive Impairments in LRRK2-Related Parkinson’s Disease: A Study in Chinese Individuals Thu, 06 Aug 2015 11:37:29 +0000 Background. LRRK2 S1647T has been identified as a polymorphic risk variant for Parkinson’s disease (PD) in Chinese individuals. As LRRK2 is the most common genetic cause for PD, it has drawn great interest regarding whether cognitive impairments in PD are related with LRRK2. Purpose. This study aimed to explore the effects of LRRK2 S1647T polymorphism on cognitive function in PD. Method. 90 PD patients were randomly recruited. They underwent a series of clinical evaluations and genetic testing for the LRRK2 S1647T polymorphism. Global intellect and five cognitive domains (language fluency, visuospatial function, attention, memory, and executive function) were compared between S1647T carriers and noncarriers. Results. No differences in motor features were found between two groups, but the executive function evaluation showed that Stroop word colour test time (SWCT-TIME) scores were lower in LRRK2 S1647T carriers than in noncarriers (). However, multiple linear regression analysis indicated that the correlation between S1647T polymorphism and SWCT-TIME scores did not reach significant level (). Conclusion. Our findings suggest that cognitive impairments are not correlated with different LRRK2 S1647T polymorphisms in Chinese PD individuals. Yifan Zheng, Zhong Pei, Yanmei Liu, Hongyan Zhou, Wenbiao Xian, Yingying Fang, Ling Chen, and Qi Wu Copyright © 2015 Yifan Zheng et al. All rights reserved. The Effect of Spatial Working Memory Deterioration on Strategic Visuomotor Learning across Aging Tue, 28 Jul 2015 12:59:27 +0000 Objective. To evaluate the effect of age-related cognitive changes in a visuomotor learning task that depends on strategic control and contrast it with the effect in a task principally depending on visuomotor recalibration. Methods. Participants performed a ball throwing task while donning either a reversing dove prism or a displacement wedge prism, which mainly depend on strategic control or visuomotor recalibration, respectively. Visuomotor performance was then analysed in relation to rule acquisition and reversal, recognition memory, visual memory, spatial planning, and spatial working memory with tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Results. The results confirmed previous works showing a detrimental effect of age on visuomotor learning. The analyses of the cognitive changes observed across age showed that both strategic control and visuomotor recalibration had significant negative correlations only with the number of errors in the spatial working memory task. However, when the effect of aging was controlled, the only significant correlation remaining was between the reversal adaptation magnitude and spatial working memory. Discussion. These results suggest that spatial working memory decline across aging could contribute to age-dependent deterioration in both visuomotor learning processes. However, spatial working memory integrity seems to affect strategic learning decline even after controlling for aging. Luis A. Uresti-Cabrera, Rosalinda Diaz, Israel Vaca-Palomares, and Juan Fernandez-Ruiz Copyright © 2015 Luis A. Uresti-Cabrera et al. All rights reserved. A Longitudinal Examination of the Hopelessness Theory of Depression in People Who Have Multiple Sclerosis Tue, 28 Jul 2015 11:47:43 +0000 Purpose. Hopelessness theory predicts that negative attributional style will interact with negative life events over time to predict depression. The intention of this study was to test this in a population who are at greater risk of negative life events, people with Multiple Sclerosis (MS). Method. Data, including measures of attributional style, negative life events, and depressive symptoms, were collected via postal survey in 3 phases, each one a year apart. Results. Responses were received from over 380 participants at each study phase. Negative attributional style was consistently able to predict future depressive symptoms at low to moderate levels of association; however, this ability was not sustained when depressive symptoms at Phase 1 were controlled for. No substantial evidence to support the hypothesised interaction of negative attributional style and negative life events was found. Conclusions. Findings were not supportive of the causal interaction proposed by the hopelessness theory of depression. Further work considering other time frames, using methods to prime attributional style before assessment and specifically assessing the hopelessness subtype of depression, may prove to be more fruitful. Intervention directly to address attributional style should also be considered. I. I. Kneebone, S. Guerrier, E. Dunmore, E. Jones, and C. Fife-Schaw Copyright © 2015 I. I. Kneebone et al. All rights reserved. Attitudes toward Physician-Nurse Collaboration in Pediatric Workers and Undergraduate Medical/Nursing Students Sun, 26 Jul 2015 13:09:16 +0000 The purpose of this study was to compare the attitudes of pediatric workers and undergraduate medical/nursing students toward collaboration. Attitude toward collaboration was measured using an adaptation of the Jefferson Scale of Attitude toward Physician-Nurse Collaboration. The 656 questionnaires were gathered from pediatrician, pediatric interns, and medical students (PIS) and pediatric nurses, nursing interns, and nursing students (NIS). Results showed a statistically significant difference in the total mean scores in attitudes towards collaboration with NIS scoring higher. Among the participants of PIS, the pediatricians obtained the highest mean scores, while, among the participants of NIS, the pediatric nurses got higher mean scores than nursing interns. It is desirable that medical and nurse schools should include interprofessional education in their curriculum to increase the understanding of the complementary roles of physicians and nurses and to encourage establishment of an interdependent relationship between them. Yong Wang, Yong-fang Liu, Hao Li, and Tingyu Li Copyright © 2015 Yong Wang et al. All rights reserved. Referral Practices for Cognitive Behavioral Therapy for Insomnia: A Survey Study Tue, 21 Jul 2015 09:26:28 +0000 This study examined referring practices for cognitive behavioral therapy for insomnia (CBTI) by physicians at University of Michigan Hospitals and Weill Cornell Medical College of Cornell University. A five-item questionnaire was sent via email that inquired about the physician’s patient load, number of patients complaining of insomnia, percent referred for CBTI, and impressions of what is the most effective method for improving sleep quality in their patients with insomnia. The questionnaire was completed by 239 physicians. More physicians believed a treatment other than CBTI and/or medication was most effective (N = 83). “Sleep hygiene” was recommended by a third of the sample. The smallest number of physicians felt that CBTI alone was the most effective treatment (N = 22). Additional physician education is needed. Deirdre A. Conroy and Matthew R. Ebben Copyright © 2015 Deirdre A. Conroy and Matthew R. Ebben. All rights reserved. Social Attitudes toward Cerebral Palsy and Potential Uses in Medical Education Based on the Analysis of Motion Pictures Tue, 14 Jul 2015 07:21:49 +0000 This study presents how motion pictures illustrate a person with cerebral palsy (CP), the social impact from the media, and the possibility of cerebral palsy education by using motion pictures. 937 motion pictures were reviewed in this study. With the criteria of nondocumentary movies, possibility of disability classification, and availability, the total number of motion pictures about CP was reduced to 34. The geographical distribution of movie number ever produced is as follows: North America 12, Europe 11, India 2, East Asia 6, and Australia 3. The CP incidences of different motor types in real world and in movies, respectively, are 78–86%, 65% (Spastic); 1.5–6%, 9% (Dyskinetic); 6.5–9%, 26% (Mixed); 3%, 0% (Ataxic); 3-4%, 0% (Hypotonic). The CP incidences of different Gross Motor Function Classification System (GMFCS) levels in real world and in movies, respectively, are 40–51%, 47% (Level I + II); 14–19%, 12% (Level III); 34–41%, 41% (Level IV + V). Comparisons of incidence between the real world and the movies are surprisingly matching. Motion pictures honestly reflect the general public’s point of view to CP patients in our real world. With precise selection and medical professional explanations, motion pictures can play the suitable role making CP understood more clearly. Marek Jóźwiak, Brian Po-Jung Chen, Bartosz Musielak, Jacek Fabiszak, and Andrzej Grzegorzewski Copyright © 2015 Marek Jóźwiak et al. All rights reserved. Rehabilitation Outcomes: Ischemic versus Hemorrhagic Strokes Sun, 12 Jul 2015 10:56:44 +0000 Background. Ischemic and hemorrhagic strokes have different pathophysiologies and possibly different long-term cerebral and functional implications. Hemorrhagic strokes expose the brain to irritating effects of blood and ischemic strokes reflect localized or diffuse cerebral vascular pathology. Methods. Participants were individuals who suffered either an ischemic () or hemorrhagic stroke () within the past six months and were involved in a postacute neurorehabilitation program. Participants completed three months of postacute neurorehabilitation and the Mayo Portland Adaptability Inventory-4 (MPAI-4) at admission and discharge. Admission MPAI-4 scores and level of functioning were comparable. Results. Group ANOVA comparisons show no significant group differences at admission or discharge or difference in change scores. Both groups showed considerably reduced levels of productivity/employment after discharge as compared to preinjury levels. Conclusions. Though the pathophysiology of these types of strokes is different, both ultimately result in ischemic injuries, possibly accounting for lack of findings of differences between groups. In the present study, participants in both groups experienced similar functional levels across all three MPAI-4 domains both at admission and discharge. Limitations of this study include a highly educated sample and few outcome measures. Robert Perna and Jessica Temple Copyright © 2015 Robert Perna and Jessica Temple. All rights reserved. Processing Sentences with Literal versus Figurative Use of Verbs: An ERP Study with Children with Language Impairments, Nonverbal Impairments, and Typical Development Sun, 12 Jul 2015 09:34:59 +0000 Forty native Italian children (age 6–15) performed a sentence plausibility judgment task. ERP recordings were available for 12 children with specific language impairment (SLI), 11 children with nonverbal learning disabilities (NVLD), and 13 control children. Participants listened to verb-object combinations and judged them as acceptable or unacceptable. Stimuli belonged to four conditions, where concreteness and congruency were manipulated. All groups made more errors responding to abstract and to congruent sentences. Moreover, SLI participants performed worse than NVLD participants with abstract sentences. ERPs were analyzed in the time window 300–500 ms. SLI children show atypical, reversed effects of concreteness and congruence as compared to control and NVLD children, respectively. The results suggest that linguistic impairments disrupt abstract language processing more than visual-motor impairments. Moreover, ROI and SPM analyses of ERPs point to a predominant involvement of the left rather than the right hemisphere in the comprehension of figurative expressions. Maria Luisa Lorusso, Michele Burigo, Virginia Borsa, and Massimo Molteni Copyright © 2015 Maria Luisa Lorusso et al. All rights reserved. Changes of Motivational Variables in Patients with Multiple Sclerosis in an Exercise Intervention: Associations between Physical Performance and Motivational Determinants Sun, 12 Jul 2015 08:34:33 +0000 Objectives. This study examines the effects of a standardized fitness training on motivational factors such as the intention to be physically active, self-efficacy, perceived barriers, counterstrategies, and exercise specific social support in patients with progressive Multiple Sclerosis (MS) and the relation of these factors to physical performance. Methods. Moderately disabled patients with secondary or primary progressive MS (Expanded Disability Status Scale of 4–6) were randomized to a training group or a waitlist control group. Patients completed on average 20 sessions of training tailored to their individual fitness at baseline over a course of 8–12 weeks. Motivational variables (stage of change according to the transtheoretical model (TTM), self-efficacy, perceived barriers, counterstrategies, and exercise specific social support) were assessed via questionnaires at baseline and follow-up. Results. Forty patients completed the trial. We found significant effects on stages of change and self-efficacy and a trend in counterstrategies . Significant correlations between change of physical performance during the exercise training and change in the TTM, perceived barriers, and counterstrategies were detected. Conclusion. This study indicates that tailored individual endurance training could stabilize self-efficacy and increase exercise motivation in patients with progressive MS. Motivational variables were related to the physical performance. Wiebke Geertz, Anna-Sophie Dechow, Stefan Patra, Christoph Heesen, Stefan M. Gold, and Karl-Heinz Schulz Copyright © 2015 Wiebke Geertz et al. All rights reserved. Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson’s Disease: A Systematic Review Tue, 07 Jul 2015 07:21:46 +0000 Parkinson’s disease (PD) is a serious condition with a major negative impact on patient’s physical and mental health. Postural instability is one of the cardinal difficulties reported by patients to deal with. Neuroanatomical, animal, and clinical studies on nonparkinsonian and parkinsonian subjects suggest an important correlation between the presence of balance dysfunction and multiple mood disorders, such as anxiety, depression, and apathy. Considering that balance dysfunction is a very common symptom in PD, we can presume that by its management we could positively influence patient’s state of mind too. This review is an analysis of nonpharmacological methods shown to be effective and successful for improving balance in patients suffering from PD. Strategies such as general exercise, robotic assisted training, Tai Chi, Qi Gong, Yoga, dance (such as tango or ballet), box, virtual reality-based, or neurofeedback-based techniques and so forth can significantly improve the stability in these patients. Beside this physical outcome, many methods have also shown effect on quality of life, depression level, enjoyment, and motivation to continue in practicing the method independently. The purpose of this review is to provide information about practical and creative methods designed to improve balance in PD and highlight their positive impact on patient’s psychology. Rastislav Šumec, Pavel Filip, Kateřina Sheardová, and Martin Bareš Copyright © 2015 Rastislav Šumec et al. All rights reserved. Amyloid β Enhances Typical Rodent Behavior While It Impairs Contextual Memory Consolidation Wed, 01 Jul 2015 09:32:41 +0000 Alzheimer’s disease (AD) is associated with an early hippocampal dysfunction, which is likely induced by an increase in soluble amyloid beta peptide (Aβ). This hippocampal failure contributes to the initial memory deficits observed both in patients and in AD animal models and possibly to the deterioration in activities of daily living (ADL). One typical rodent behavior that has been proposed as a hippocampus-dependent assessment model of ADL in mice and rats is burrowing. Despite the fact that AD transgenic mice show some evidence of reduced burrowing, it has not been yet determined whether or not Aβ can affect this typical rodent behavior and whether this alteration correlates with the well-known Aβ-induced memory impairment. Thus, the purpose of this study was to test whether or not Aβ affects burrowing while inducing hippocampus-dependent memory impairment. Surprisingly, our results show that intrahippocampal application of Aβ increases burrowing while inducing memory impairment. We consider that this Aβ-induced increase in burrowing might be associated with a mild anxiety state, which was revealed by increased freezing behavior in the open field, and conclude that Aβ-induced hippocampal dysfunction is reflected in the impairment of ADL and memory, through mechanisms yet to be determined. Karla Salgado-Puga, Roberto A. Prado-Alcalá, and Fernando Peña-Ortega Copyright © 2015 Karla Salgado-Puga et al. All rights reserved. Mental Fatigue and Executive Dysfunction in Patients with Cushing’s Syndrome in Remission Sun, 28 Jun 2015 12:02:31 +0000 Patients with Cushing’s syndrome (CS) in remission often suffer from impaired quality of life and cognitive dysfunction. The primary aim was to investigate the occurrence of mental fatigue, characterized by mental exhaustion and long recovery time following mentally strenuous tasks, in patients with CS in remission. The secondary aim was to examine whether the newly developed parts C and D of the trail making test (TMT) are more sensitive, compared to the conventional parts A and B, to evaluate attention and executive function. This was a cross-sectional study including 51 patients with CS in remission and 51 controls. All subjects completed the self-administrated mental fatigue scale (MFS) and performed all four parts of the TMT. The patients had worse outcome on all components of the MFS except for sensitivity to noise. After adjustment for mental fatigue, depression, and anxiety, the patients performed worse only on part D of the TMT (). Mental fatigue is common in patients with CS in remission and can be captured by using the MFS. The most demanding part of the TMT, part D, is more useful to capture cognitive deficits in patients with CS in remission compared to the conventional parts A and B. Eleni Papakokkinou, Birgitta Johansson, Peter Berglund, and Oskar Ragnarsson Copyright © 2015 Eleni Papakokkinou et al. All rights reserved. Mental State Inferences Abilities Contribution to Verbal Irony Comprehension in Older Adults with Mild Cognitive Impairment Thu, 25 Jun 2015 09:41:28 +0000 Objective. The present study examined mentalizing capacities as well as the relative implication of mentalizing in the comprehension of ironic and sincere assertions among 30 older adults with mild cognitive impairment (MCI) and 30 healthy control (HC) subjects. Method. Subjects were administered a task evaluating mentalizing by means of short stories. A verbal irony comprehension task, in which participants had to identify ironic or sincere statements within short stories, was also administered; the design of the task allowed uniform implication of mentalizing across the conditions. Results. Findings indicated that participants with MCI have second-order mentalizing difficulties compared to HC subjects. Moreover, MCI participants were impaired compared to the HC group in identifying ironic or sincere stories, both requiring mental inference capacities. Conclusion. This study suggests that, in individuals with MCI, difficulties in the comprehension of ironic and sincere assertions are closely related to second-order mentalizing deficits. These findings support previous data suggesting a strong relationship between irony comprehension and mentalizing. G. Gaudreau, L. Monetta, J. Macoir, S. Poulin, R. Jr. Laforce, and C. Hudon Copyright © 2015 G. Gaudreau et al. All rights reserved. Higher Body Mass Index Is Associated with Subjective Olfactory Dysfunction Thu, 25 Jun 2015 06:17:35 +0000 Background. Morbidly obese patients demonstrate altered olfactory acuity. There has been no study directly assessing Body Mass Index (BMI) in patients with olfactory dysfunction. Our purpose was to compare BMI in a group of patients with subjective olfactory dysfunction to those without subjective olfactory complaints. Methods. Retrospective matched case-control study. Sixty patients who presented to a tertiary care otolaryngology center with subjective smell dysfunction over one year were identified. Neoplastic and obstructive etiologies were excluded. Demographics, BMI, and smoking status were reviewed. Sixty age, gender, and race matched control patients were selected for comparison. Chi-square testing was used. Results. 48 out of 60 patients (80%) in the olfactory dysfunction group fell into the overweight or obese categories, compared to 36 out of 60 patients (60%) in the control group. There was a statistically significant difference between the olfactory dysfunction and control groups for this stratified BMI .  Conclusion. This study suggests high BMI is associated with olfactory dysfunction. Prospective clinical research should examine this further to determine if increasing BMI may be a risk factor in olfactory loss and to elucidate what role olfactory loss may play in diet and feeding habits of obese patients. Z. M. Patel, J. M. DelGaudio, and S. K. Wise Copyright © 2015 Z. M. Patel et al. All rights reserved. Ageing and Neurodegenerative Disorders Mon, 22 Jun 2015 06:25:02 +0000 Laura Piccardi, Giuseppe Curcio, Liana Palermo, and Ming-Chyi Pai Copyright © 2015 Laura Piccardi et al. All rights reserved. Sources of Discomfort in Persons with Dementia: Scale and Initial Results Sun, 21 Jun 2015 07:18:22 +0000 The Sources of Discomfort Scale (SODS) assesses discomfort manifestations based on source of discomfort, thus making it both distinct from and complementary to pain assessments for persons with dementia. Sources were categorized as pertaining to physical discomfort, to body position, and to environmental sources. Body position sources of discomfort were related to poor functional status and to pain. The SODS scores were not related to cognitive functioning, and sources of discomfort other than those pertaining to body position were not correlated with pain. This paper demonstrates a direct and enhanced method to detect the manifestations of discomfort separately from pain indicators in a population with advanced dementia. The determination of the source of discomfort has direct implications for intervention. Jiska Cohen-Mansfield, Khin Thein, Marcia S. Marx, Maha Dakheel-Ali, and Barbara Jensen Copyright © 2015 Jiska Cohen-Mansfield et al. All rights reserved. Effects of Different Types of Cognitive Training on Cognitive Function, Brain Structure, and Driving Safety in Senior Daily Drivers: A Pilot Study Tue, 16 Jun 2015 13:58:03 +0000 Background. Increasing proportion of the elderly in the driving population raises the importance of assuring their safety. We explored the effects of three different types of cognitive training on the cognitive function, brain structure, and driving safety of the elderly. Methods. Thirty-seven healthy elderly daily drivers were randomly assigned to one of three training groups: Group V trained in a vehicle with a newly developed onboard cognitive training program, Group P trained with a similar program but on a personal computer, and Group C trained to solve a crossword puzzle. Before and after the 8-week training period, they underwent neuropsychological tests, structural brain magnetic resonance imaging, and driving safety tests. Results. For cognitive function, only Group V showed significant improvements in processing speed and working memory. For driving safety, Group V showed significant improvements both in the driving aptitude test and in the on-road evaluations. Group P showed no significant improvements in either test, and Group C showed significant improvements in the driving aptitude but not in the on-road evaluations. Conclusion. The results support the effectiveness of the onboard training program in enhancing the elderly’s abilities to drive safely and the potential advantages of a multimodal training approach. Takayuki Nozawa, Yasuyuki Taki, Akitake Kanno, Yoritaka Akimoto, Mizuki Ihara, Ryoichi Yokoyama, Yuka Kotozaki, Rui Nouchi, Atsushi Sekiguchi, Hikaru Takeuchi, Carlos Makoto Miyauchi, Takeshi Ogawa, Takakuni Goto, Takashi Sunda, Toshiyuki Shimizu, Eiji Tozuka, Satoru Hirose, Tatsuyoshi Nanbu, and Ryuta Kawashima Copyright © 2015 Takayuki Nozawa et al. All rights reserved. Brain Signals of Face Processing as Revealed by Event-Related Potentials Tue, 16 Jun 2015 12:27:19 +0000 We analyze the functional significance of different event-related potentials (ERPs) as electrophysiological indices of face perception and face recognition, according to cognitive and neurofunctional models of face processing. Initially, the processing of faces seems to be supported by early extrastriate occipital cortices and revealed by modulations of the occipital P1. This early response is thought to reflect the detection of certain primary structural aspects indicating the presence grosso modo of a face within the visual field. The posterior-temporal N170 is more sensitive to the detection of faces as complex-structured stimuli and, therefore, to the presence of its distinctive organizational characteristics prior to within-category identification. In turn, the relatively late and probably more rostrally generated N250r and N400-like responses might respectively indicate processes of access and retrieval of face-related information, which is stored in long-term memory (LTM). New methods of analysis of electrophysiological and neuroanatomical data, namely, dynamic causal modeling, single-trial and time-frequency analyses, are highly recommended to advance in the knowledge of those brain mechanisms concerning face processing. Ela I. Olivares, Jaime Iglesias, Cristina Saavedra, Nelson J. Trujillo-Barreto, and Mitchell Valdés-Sosa Copyright © 2015 Ela I. Olivares et al. All rights reserved. Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study Tue, 16 Jun 2015 08:59:08 +0000 Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen’s MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction , favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration. Hellen Livia Drumond Marra, Martin Luiz Myczkowski, Cláudia Maia Memória, Débora Arnaut, Philip Leite Ribeiro, Carlos Gustavo Sardinha Mansur, Rodrigo Lancelote Alberto, Bianca Boura Bellini, Adriano Alves Fernandes da Silva, Gabriel Tortella, Daniel Ciampi de Andrade, Manoel Jacobsen Teixeira, Orestes Vicente Forlenza, and Marco Antonio Marcolin Copyright © 2015 Hellen Livia Drumond Marra et al. All rights reserved. Isoflavone Attenuates the Caspase-1 and Caspase-3 Level in Cell Model of Parkinsonism Tue, 16 Jun 2015 08:45:34 +0000 The study has investigated the effect of isoflavone attenuates the caspase-1 and caspase-3 level in cell model of Parkinsonism. The subjects were PC12 cells. They were randomly divided into six groups: control, MPP+ (250 μmol/L), isoflavone (10 μM), isoflavone (10 μM) + MPP+ (250 μmol/L), Z-YVAD-CHO (10 nM) + MPP+ group, and Z-DEVD-CHO (10 nM) + MPP+ group. Cell viability was measured by MTT methods; the content of tyrosine hydroxylase was measured by immunocytochemistry method of avidinbiotin peroxidase complex; apoptosis ratio was measured by flow cytometry. The results showed that cell viability in the MPP+ group was lower than in all other five groups. There was no difference in cell viability between isoflavone + MPP+ and control group. Optical density of TH positive cells in isoflavone group was higher than in control, isoflavone + MPP+, and MPP+ only groups. The apoptosis ratio in the isoflavone + MPP+ group and control group and the Z-YVAD-CHO + MPP+ and Z-DEVD-CHO + MPP+ group was similar, which was lower than in the MPP+ group. The lowest apoptosis ratio was found in the isoflavone only group. Jian-xin Xu, Hai-ping Song, Qing-Xia Bu, De-Peng Feng, Xiao-Fan Xu, Qian-Ru Sun, and Xue-Li Li Copyright © 2015 Jian-xin Xu et al. All rights reserved. Normal Hearing Ability but Impaired Auditory Selective Attention Associated with Prediction of Response to Donepezil in Patients with Alzheimer’s Disease Tue, 16 Jun 2015 07:49:39 +0000 Background. Alzheimer’s disease (AD) patients have a poor response to the voices of caregivers. After administration of donepezil, caregivers often find that patients respond more frequently, whereas they had previously pretended to be “deaf.” We investigated whether auditory selective attention is associated with response to donepezil. Methods. The subjects were40 AD patients, 20 elderly healthy controls (HCs), and 15 young HCs. Pure tone audiometry was conducted and an original Auditory Selective Attention (ASA) test was performed with a MoCA vigilance test. Reassessment of the AD group was performed after donepezil treatment for 3 months. Results. Hearing level of the AD group was the same as that of the elderly HC group. However, ASA test scores decreased in the AD group and were correlated with the vigilance test scores. Donepezil responders (MMSE 3+) also showed improvement on the ASA test. At baseline, the responders had higher vigilance and lower ASA test scores. Conclusion. Contrary to the common view, AD patients had a similar level of hearing ability to healthy elderly. Auditory attention was impaired in AD patients, which suggests that unnecessary sounds should be avoided in nursing homes. Auditory selective attention is associated with response to donepezil in AD. Yoshitaka Ouchi, Kenichi Meguro, Kyoko Akanuma, Yuriko Kato, and Satoshi Yamaguchi Copyright © 2015 Yoshitaka Ouchi et al. All rights reserved. Personal Strengths and Health Related Quality of Life in Dementia Caregivers from Latin America Tue, 16 Jun 2015 07:17:36 +0000 The research literature has begun to demonstrate associations between personal strengths and enhanced psychosocial functioning of dementia caregivers, but these relationships have not been examined in the context of dementia caregivers in Latin America. The present study examined whether personal strengths, including resilience, optimism, and sense of coherence, were associated with mental and physical health related quality of life (HRQOL) in 130 dementia caregivers in Mexico and Argentina. Structural equation modeling found that the personal strengths collectively accounted for 58.4% of the variance in caregiver mental HRQOL, and resilience, sense of coherence, and optimism each had unique effects. In comparison, the personal strengths together accounted for 8.9% of the variance in caregiver physical HRQOL, and only sense of coherence yielded a unique effect. These results underscore the need to construct and disseminate empirically supported interventions based in part on important personal strengths, particularly sense of coherence, for this underrepresented group. Stephen K. Trapp, Paul B. Perrin, Richa Aggarwal, Silvina Victoria Peralta, Miriam E. Stolfi, Eliana Morelli, Leticia Aracely Peña Obeso, and Juan Carlos Arango-Lasprilla Copyright © 2015 Stephen K. Trapp et al. All rights reserved. The Tree-Drawing Test (Koch’s Baum Test): A Useful Aid to Diagnose Cognitive Impairment Mon, 15 Jun 2015 14:07:12 +0000 Objective. To study the Tree-Drawing Test in a group of demented patients and compare it with a group of mild cognitively impaired patients (MCI) and controls. Methods. Consecutive outpatients were classified as affected by dementia (Alzheimer’s disease (AD), frontotemporal dementia (FTD), and vascular dementia (VD)) or by MCI. Patients and controls underwent the Tree-Drawing Test and MMSE. Results. 118 AD, 19 FTD, 46 VD, and 132 MCI patients and 90 controls were enrolled. AD patients draw trees globally smaller than other patients and controls. FTD patients draw trees with a wider space occupation than AD and MCI patients but smaller than controls as well as VD patients. Trees drawn by MCI patients are intermediate in size between AD patients and controls. The trunk-to-crown ratio of trees drawn by cognitive impaired patients is greater than controls while the tree size-relative-to-page space index is significantly smaller. The tree size-relative-to-page space index of trees drawn by AD patients is smaller than that of the other cognitively impaired patients. Tree height and the trunk-to-crown ratio are independent predictors of cognitive impairment. Conclusions. Trees drawn by cognitively impaired patients are different from those drawn by healthy subjects with a progressive differentiation from mild to more relevant degrees of cognitive impairment. Michelangelo Stanzani Maserati, Corrado Matacena, Luisa Sambati, Federico Oppi, Roberto Poda, Maddalena De Matteis, and Roberto Gallassi Copyright © 2015 Michelangelo Stanzani Maserati et al. All rights reserved. Different Temporal Patterns of Specific and General Autobiographical Memories across the Lifespan in Alzheimer’s Disease Mon, 15 Jun 2015 13:39:22 +0000 We compared specific (i.e., associated with a unique time and space) and general (i.e., extended or repeated events) autobiographical memories (AbM) in Alzheimer’s disease (AD). The comparison aims at investigating the relationship between these two components of AbM across the lifespan and the volume of cerebral regions of interest within the temporal lobe. We hypothesized that the ability to elicit specific memories would correlate with hippocampal volume, whereas evoking general memories would be related to lateral temporal lobe. AbM was assessed using the modified Crovitz test in 18 patients with early AD and 18 matched controls. The proportions of total memories—supposed to reflect the ability to produce general memories—and specific memories retrieved were compared between AD patients and controls. Correlations to MRI volumes of temporal cortex were tested. We found different temporal patterns for specific and general memories in AD patients, with (i) relatively spared general memories, according to a temporal gradient that preserved remote memories, predominantly associated with right lateral temporal cortex volume. (ii) Conversely, the retrieval of specific AbMs was impaired for all life periods and correlated with bilateral hippocampal volumes. Our results highlight a shift from an initially episodic to a semantic nature of AbMs during AD, where the abstracted form of memories remains. Nathalie Philippi, François Rousseau, Vincent Noblet, Anne Botzung, Olivier Després, Benjamin Cretin, Stéphane Kremer, Frédéric Blanc, and Liliann Manning Copyright © 2015 Nathalie Philippi et al. All rights reserved. Are Absence Epilepsy and Nocturnal Frontal Lobe Epilepsy System Epilepsies of the Sleep/Wake System? Sun, 14 Jun 2015 07:11:22 +0000 System epilepsy is an emerging concept interpreting major nonlesional epilepsies as epileptic dysfunctions of physiological systems. I extend here the concept of reflex epilepsy to epilepsies linked to input dependent physiological systems. Experimental and clinical reseach data were collected to create a coherent explanation of underlying pathomechanism in AE and NFLE. We propose that AE should be interpreted as epilepsy linked to the corticothalamic burst-firing mode of NREM sleep, released by evoked vigilance level oscillations characterized by reactive slow wave response. In the genetic variation of NFLE the ascending cholinergic arousal system plays an essential role being in strong relationship with a gain mutation of the nicotinic acethylcholin receptors, rendering the arousal system hyperexcitable. I try to provide a more unitary interpretation for the variable seizure manifestation integrating them as different degree of pathological arosuals and alarm reactions. As a supporting hypothesis the similarity between arousal parasomnias and FNLE is shown, underpinned by overlaping pathomechanism and shared familiarity, but without epileptic features. Lastly we propose that both AE and NFLE are system epilepsies of the sleep-wake system representing epileptic disorders of the antagonistic sleep/arousal network. This interpretation may throw new light on the pathomechanism of AE and NFLE. Péter Halász Copyright © 2015 Péter Halász. All rights reserved.