Interaction without intent: the shape of the social world in Huntington’s disease

Huntington’s disease (HD) is an inherited neurodegenerative condition. Patients with this movement disorder can exhibit deficits on tasks involving Theory of Mind (ToM): the ability to understand mental states such as beliefs and emotions. We investigated mental state inference in HD in response to ambiguous animations involving geometric shapes, while exploring the impact of symptoms within cognitive, emotional and motor domains. Forty patients with HD and twenty healthy controls described the events in videos showing random movements of two triangles (i.e. floating), simple interactions (e.g. following) and more complex interactions prompting the inference of mental states (e.g. one triangle encouraging the other). Relationships were explored between animation interpretation and measures of executive functioning, alexithymia and motor symptoms. Individuals with HD exhibited alexithymia and a reduced tendency to spontaneously attribute intentions to interacting triangles on the animations task. Attribution of intentions on the animations task correlated with motor symptoms and burden of pathology. Importantly, patients without motor symptoms showed similar ToM deficits despite intact executive functions. Subtle changes in ToM that are unrelated to executive dysfunction could therefore feature in basal ganglia disorders prior to motor onset.     

‘If you are good,I get better’: the role of social hierarchy in perceptual decision-making

So far, it was unclear if social hierarchy could influence sensory or perceptual cognitive processes. We evaluated the effects of social hierarchy on these processes using a basic visual perceptual decision task. We constructed a social hierarchy where participants performed the perceptual task separately with two covertly simulated players (superior, inferior). Participants were faster (better) when performing the discrimination task with the superior player. We studied the time course when social hierarchy was processed using event-related potentials and observed hierarchical effects even in early stages of sensory-perceptual processing, suggesting early top–down modulation by social hierarchy. Moreover, in a parallel analysis, we fitted a drift-diffusion model (DDM) to the results to evaluate the decision making process of this perceptual task in the context of a social hierarchy. Consistently, the DDM pointed to nondecision time (probably perceptual encoding) as the principal period influenced by social hierarchy.     

A further update on the role of excitotoxicity in the pathogenesis of Parkinson’s disease

Increased levels of extracellular glutamate and hyperactivation of glutamatergic receptors in the basal ganglia trigger a critical cascade of events involving both intracellular pathways and cell-to-cell interactions that affect cell viability and promote neuronal death. The ensemble of these glutamate-triggered events is responsible for excitotoxicity, a phenomenon involved in several pathological conditions affecting the central nervous system, including a neurodegenerative disease such as Parkinson’s disease (PD). PD is an age-related disorder caused by the degeneration of dopaminergic neurons within the substantia nigra pars compacta, with a miscellaneous pathogenic background. Glutamate-mediated excitotoxicity may be involved in a lethal vicious cycle, which critically contributes to the exacerbation of nigrostriatal degeneration in PD. Since excitotoxicity is a glutamate-receptor-mediated phenomenon, growing interest and work have been dedicated to the research for modulators of glutamate neurotransmission that might enable new therapeutic interventions to slow down the neurodegenerative process and ameliorate PD motor symptoms.     

Prospective memory in Parkinson’s disease: the role of the motor subtypes

Journal of Neurology - Prospective memory (PM) is defined as memory for future intentions and it is typically divided into time-based and event-based PM. Deficit of PM has been reported in patients...     

The effect of oxytocin on cooperation in a prisoner’s dilemma depends on the social context and a person’s social value orientation

The interactionist approach to the study of exogenous oxytocin (OT) effects on prosocial behavior has emphasized the need to consider both contextual cues and individual differences. Therefore, an experiment was set up to examine the joint effect of intranasal OT, a salient social cue and the personality trait social value orientation on cooperative behavior in one-shot prisoner’s dilemma games. The outcome of these mixed-motive games is known to be highly dependent on values and on social information that might reveal the partner’s intent. Consistent with an a priori hypothesis, OT and social information interact significantly to affect the behavior of individuals with a proself value orientation: after prior contact with the game partner, OT enhances cooperative behavior, whereas in anonymous conditions, it exacerbates their intrinsic self-interested behavior. These effects of OT do not hold for individuals with a prosocial value orientation, whose cooperation levels appear to be more influenced by prior contact with the game partner. Follow-up hypotheses for why prosocial and proself individuals respond differently to exogenous OT were developed.     

Psychological and social aspects in management of Alzheimer’s patients: an inquiry among caregivers

Abstract. A survey in the cities of Genoa and Savona (Italy) was performed to examine stress levels in caregivers of patients with Alzheimers disease in the context of a project of the Italian Ministry of Health named Cronos. It offered free anticholinesterase inhibitor therapy to patients who addressed dedicated Neurological Units; in this occasion caregivers could be invited to express the main difficulties encountered in managing demented people during an interview conducted by health personnel of the Neurophysiology Service. Caregivers were mainly women, daughters or spouses, with a medium educational level, retired, housekeepers, employees or teachers; they claimed a lowering of economic standard of living of the family owing to extra expenses for assistance. Satisfaction was expressed towards specialists, while support by general practitioners and other sanitary services was usually lacking and money contribution from the government or territorial services was considered inadequate. From the emotional point of view, caregivers claim loss of free time, friendships and hobbies, and feel isolated in the social context; sometimes the patients death is thought of as a solution. A strong need for information and support is clearly emerging and any further interventions should take these requirements into consideration.     

Effects of levodopa oral bolus on the kinematics of the pointing movements in Parkinson’s disease patients

We studied the time-course of a levodopa oral bolus effects on the kinematics of patients affected by a mild akinetic–rigid form of idiopathic Parkinson’s disease (PD). Eleven PD patients were evaluated: a) in OFF–state, that is before their first medication or after its withdrawal, b) in ON–state, that is at 1/2, 1, 2, 3, 4, 5, 6, 24, 30 and 48 hours after the administration of 250 mg of levodopa plus 25mg of carbidopa. The main kinematics (i. e.movement time, peak of velocity, peak of acceleration and peak of deceleration) of pointing movements to six target–stimuli placed on the horizontal plane of a table were recorded. Clinical conditions were assessed according to the Motor Examination section of the Unified Parkinson’s Disease Rating Scale. The levopoda bolus had stable clinical effects only within the first six hours from its administration. The decline of the clinical response was marked by the changes of peak acceleration whereas other kinematics (i. e. movement time and the peak of velocity) changed also in the late observations (24, 30 and 48 hours after drug intake). The dissociation between the persistent improvement on movement time on peak velocity and the rapid deterioration of levodopa effects on early kinematics (i. e. peak acceleration) could be accounted for by a progressive decline in movement programming.     

The role of autosuggestion in geriatric patients’ quality of life: a study on psycho-neuro-endocrine-immunology pathway

Background: There has been no study conducted about the effect of autosuggestion on quality of life for geriatric patients. Our aim was to evaluate the efficacy of autosuggestion for geriatric patients’ quality of life and its impact on psycho-neuro-endocrine-immune pathway.

Methods: Sixty geriatric patients aged ≥60 years in a ward were randomly assigned to either receive autosuggestion or not. Autosuggestion was recorded in a tape to be heard daily for 30 days. Both groups received the standard medical therapy. Primary outcome was quality of life by COOP chart. Secondary outcomes were serum cortisol level, interleukin-2, interleukin-6, interferon-γ, and N-acetylaspartate/creatine ratio in limbic/paralimbic system by magnetic resonance spectroscopy. The study was single blinded due to the nature of the intervention studied.

Results: Out of 60 subjects, 51 finished the study. The autosuggestion group reported better scores than the control one for quality of life, COOP chart 1.95 vs. 2.22 (95% CI, p = 0.02). There were increments of serum cortisol (p = 0.03) and interleukin-6 in the autosuggestion group (p = 0.04). Interleukin-2, interferon-γ, and N-acetylaspartate/creatine ratio in prefrontal cortex showed a tendency to increase in the autosuggestion groups.

Conclusion: Autosuggestion is associated with improvement of geriatrics’ quality of life, serum cortisol level, and adaptive immunity. There is a better trend for neuroplasticity in prefrontal cortex in the autosuggestion group.     

The dentate nucleus in Friedreich’s ataxia: the role of iron-responsive proteins

Frataxin deficiency in Friedreich’s ataxia (FRDA) causes cardiac, endocrine, and nervous system manifestations. Frataxin is a mitochondrial protein, and adequate amounts are essential for cellular iron homeostasis. The main histological lesion in the brain of FRDA patients is neuronal atrophy and a peculiar proliferation of synaptic terminals in the dentate nucleus termed grumose degeneration. This cerebellar nucleus may be especially susceptible to FRDA because it contains abundant iron. We examined total iron and selected iron-responsive proteins in the dentate nucleus of nine patients with FRDA and nine normal controls by biochemical and microscopic techniques. Total iron (1.53 ± 0.53 μmol/g wet weight) and ferritin (206.9 ± 46.6 μg/g wet weight) in FRDA did not significantly differ from normal controls (iron: 1.78 ± 0.88 μmol/g; ferritin: 210.9 ± 9.0 μg/g) but Western blots exhibited a shift to light ferritin subunits. Immunocytochemistry of the dentate nucleus revealed loss of juxtaneuronal ferritin-containing oligodendroglia and prominent ferritin immunoreactivity in microglia and astrocytes. Mitochondrial ferritin was not detectable by immunocytochemistry. Stains for the divalent metal transporter 1 confirmed neuronal loss while endothelial cells reacting with antibodies to transferrin receptor 1 protein showed crowding of blood vessels due to collapse of the normal neuropil. Regions of grumose degeneration were strongly reactive for ferroportin. Purkinje cell bodies, their dendrites and axons, were also ferroportin-positive, and it is likely that grumose degeneration is the morphological manifestation of mitochondrial iron dysmetabolism in the terminals of corticonuclear fibers. Neuronal loss in the dentate nucleus is the likely result of trans-synaptic degeneration.     

“It’s both a strength and a drawback.” How therapists’ personal qualities are experienced in their professional work

ABSTRACT

Objective: The aim of this study was to gain knowledge about how the integration of personal and professional experiences affects therapeutic work. Method: Therapists (N?=?14) who had been recommended by their leaders at their individual workplaces were interviewed twice with semi-structured qualitative interviews, which were then subjected to thematic and Interpretative Phenomenological Analysis. Results: All the therapists in the sample described their personal qualities as an experienced tension between their personal strengths and vulnerabilities in the therapeutic setting. This tension came to expression through four subordinate themes: (a) The tension between perceiving oneself as a helper while dealing with one’s own needs for attention and care; (b) The tension between the ability for embodied listening to the patient while tuning into oneself; (c) The tension between staying present while handling aggression and rejection from clients; and (d) The tension in striving for a constructive balance between closeness and distance. Conclusion: The results point to ways in which the personal selves of the therapists may affect their professional role performance. Drawing upon previous research and literature on the topic, the paper discusses how therapists’ personal qualities are experienced as affecting their work and suggests several implications for psychotherapy training and practice.     

Coexisting pathologies in the brain: influence of vascular disease and Parkinson’s disease on Alzheimer’s pathology in the hippocampus

The finding of more than one coexisting brain pathology in dementia sufferers is not unusual. However, it is unclear how these different diseases may interact or influence the evolution of one another. In this study we analyse the hippocampal expression patterns of hyperphosphorylated tau, paired helical filament (PHF)-related protein, β-amyloid and synaptophysin in a group of Alzheimer’s disease (AD) sufferers with and without additional pathology. Compared to cases with only AD-type pathology we found that the presence of additional vascular disease augmented the accumulation of hyperphosphorylated tau in the CA1 region of the hippocampus without affecting PHF formation in cases with mild AD changes and reduced the extent of PHF formation in the CA2/3 and CA4 regions of the hippocampus in cases with severe AD pathology. We also found that synaptophysin immunoreactivity in the CA4 and dentate gyrus in pure AD was inversely related to the extent of amyloid accumulation but not to neurofibrillary pathology in the same regions. These relationships were lost when additional pathology was present. Memory scores obtained during life correlated closely with hyperphosphorylated tau and PHF-related protein expression in CA1 in pure AD but not in AD with additional pathology. Total amyloid and synaptophysin expression in the hippocampus did not correlate with memory scores in any patient group. Our findings suggest that the interactions of two pathologies in the hippocampus are complex and may differ depending on the stage reached in the evolution of a progressive disease such as AD. Received: 26 July 1999 / Revised, accepted: 12 October 1999     

Intake of copper has no effect on cognition in patients with mild Alzheimer’s disease: a pilot phase 2 clinical trial

Disturbed copper (Cu) homeostasis may be associated with the pathological processes in Alzheimer's disease (AD). In the present report, we evaluated the efficacy of oral Cu supplementation in the treatment of AD in a prospective, randomized, double-blind, placebo-controlled phase 2 clinical trial in patients with mild AD for 12 months. Sixty-eight subjects were randomized. The treatment was well-tolerated. There were however no significant differences in primary outcome measures (Alzheimer's Disease Assessment Scale, Cognitive subscale, Mini Mental Status Examination) between the verum [Cu-(II)-orotate-dihydrate; 8 mg Cu daily] and the placebo group. Despite a number of findings supporting the hypothesis of environmental Cu modulating AD, our results demonstrate that oral Cu intake has neither a detrimental nor a promoting effect on the progression of AD.     

Error processing in patients with Parkinson’s disease: the influence of medication state

Summary. One of the hallmarks of Parkinson’s disease (PD) is a depletion of dopamine. Error processing, as reflected in a component of the event-related potential, the so-called error (related) negativity (Ne or ERN) is likely dependent on the midbrain dopaminergic system. In case of an unfavourable event such as an error, this system is assumed to send an error signal to the mediofrontal cortex, which elicits the Ne. Hence, the Ne should be altered in patients with PD. In fact, we earlier found a reduction of the Ne in medicated patients with PD in different tasks while another group found no such reduction in “off-medication” patients in a flanker task. In the present study, we reinvestigated this issue by measuring the Ne in a large group of treated PD patients in the “on”- and “off”-parkinsonian medication state and in matched control subjects in a flanker task. The Ne was found to be the same in the “on-medication” and “off-medication” state, while the motor score in the Unified Parkinson’s Disease Rating Scale was different. In both medication states the Ne was smaller in the patients than in the controls. The results show that the Ne reduction found earlier is unaffected by short-term differences in parkinsonian medication. The question remains open whether the long-term medication could have contributed to the Ne reduction. Correspondence: Rita Willemssen, Leibniz Research Centre of Working Environment and Human Factors (IfADo), Ardeystr. 67, 44139 Dortmund, Germany