Existing literature suggests that age affects recognition of affective facial expressions. Eye-tracking studies highlighted that age-related differences in recognition of emotions could be explained ...by different face exploration patterns due to attentional impairment. Gender also seems to play a role in recognition of emotions. Unfortunately, little is known about the differences in emotion perception abilities across lifespans for men and women, even if females show more ability from infancy.
The present study aimed to examine the role of age and gender on facial emotion recognition in relation to neuropsychological functions and face exploration strategies. We also aimed to explore the associations between emotion recognition and quality of life.
60 healthy people were consecutively enrolled in the study and divided into two groups: Younger Adults and Older Adults. Participants were assessed for: emotion recognition, attention abilities, frontal functioning, memory functioning and quality of life satisfaction. During the execution of the emotion recognition test using the Pictures of Facial Affects (PoFA) and a modified version of PoFA (M-PoFA), subject's eye movements were recorded with an Eye Tracker.
Significant differences between younger and older adults were detected for fear recognition when adjusted for cognitive functioning and eye-gaze fixations characteristics. Adjusted means of fear recognition were significantly higher in the younger group than in the older group. With regard to gender's effects, old females recognized identical pairs of emotions better than old males. Considering the Satisfaction Profile (SAT-P) we detected negative correlations between some dimensions (Physical functioning, Sleep/feeding/free time) and emotion recognition (i.e., sadness, and disgust).
The current study provided novel insights into the specific mechanisms that may explain differences in emotion recognition, examining how age and gender differences can be outlined by cognitive functioning and face exploration strategies.
Cognitive deficits occur in most patients with stroke and are the important predictors of adverse long-term outcome. Early identification is fundamental to plan the most appropriate care, including ...rehabilitation and discharge decisions. The Oxford Cognitive Screen (OCS) is a simple, valid, and reliable tool for the assessment of cognitive deficits in patients with stroke. It contains 10 subtests, providing 14 scores referring to 5 theoretically derived cognitive domains: attention, language, number, praxis, and memory. However, an empirical verification of the domain composition of the OCS subtests in stroke data is still lacking in the literature. A principal component analysis (PCA) was performed on 1,973 patients with stroke who were enrolled in OCS studies in the UK and in Italy. A number of six main components were identified relating to the domains of language and arithmetic, memory, visuomotor ability, orientation, spatial exploration, and executive functions. Bootstrapped split-half reliability analysis on patients and comparison between patients and 498 healthy participants, as that between patients with left and right hemisphere damage, confirmed the results obtained by the principal component analysis. A clarification about the contribution of each score to the theoretical original domains and to the components identified by the PCA is provided with the aim to foster the usability of OCS for both clinicians and researchers.
Recent neuropsychological evidence put forward impaired ability in processing particular aspects of time, such as Mental Time Travel (MTT), in brain damaged patients exhibiting a deficit of spatial ...attention (i.e., neglect) and the possibility to recover this MTT deficit through a manipulation of spatial attention by prism adaptation (PA). The aim of the present study was twofold. First, we explored whether the neglect patients' impairment in MTT is linked with an impairment in functional competences, such as processing temporal duration of everyday activities, motor abilities and independence in daily living. Second, we focused on rehabilitation, investigating the long-term duration of the benefits induced by a PA treatment on both mental time travel and the above-mentioned functional abilities.
To these aims, neglect patients were submitted to a MTT task, as well as to a battery of tests assessing spatial attention, estimation of time duration, motor competence and independence in activities of daily living. All tests were performed before, at the end, and one week after 10 daily sessions of PA treatment inducing a leftward shift of spatial attention.
Results suggest that neglect patients' impairment in MTT ability correlates with spatial attention deficit and with difficulties in producing reasonable temporal estimation of daily life activities. Crucially, the PA treatment induces a long-lasting and stable amelioration of MTT, spatial attention and functional competences.
To describe healthcare-associated infections in inpatient neuro-rehabilitation and their impact on functional outcome, a multicenter observational study with severe acquired brain injury (sABI) ...patients was performed. Patients were divided into infected (INF-group) or not infected (noINF-group) and assessed at admission and discharge, by means of the Glasgow Coma Scale (GCS), the Rancho Los Amigos Levels of Cognitive Functioning Scale (LCF), the Disability Rating Scale (DRS), and the modified Barthel Index (mBI). One hundred-nineteen patients were included in the INF-group, and 109 in the noINF-group. Culture specimens were found positive for bloodstream (43.8%), respiratory tract (25.7%), urinary tract (16.2%), gastro-intestinal system (8.6%) and skin (2.4%) infections. Multiple microorganisms were the most frequent (58.1%) and 55.5% of patients needed functional isolation due to multidrug resistant germs. The functional status of both groups improved after rehabilitation, but multivariable analyses showed that the INF-group showed a significantly lower gain to GCS (p = 0.008), DRS (p = 0.020) and mBI (p = 0.021) compared to the noINF-group. Length of stay (LOS) and number of skipped rehabilitative sessions were not statistically different between the groups; mortality rate was significantly higher in the INF-group (p = 0.04). Infected sABI patients showed longer LOS, significant increased mortality, and a lower functional outcome than not infected patients.
The absence of efficient treatments capable to promote central nervous system recovery in patients in vegetative state (VS) due to a severe acquired brain injury highlights the need of exploring ...alternative neuromodulatory treatments that can lead to neurobehavioral gains. Some encouraging preliminary observations suggest that transcranial direct current stimulation could be effective in disorders of consciousness (DoC) patients, especially when applied on the dorsolateral prefrontal cortex (DLPFC) in patients with minimally conscious state (MCS) but not in those with VS.
The primary aim of the present study was to verify if the application of transcranial random noise stimulation (tRNS) on the DLPFC might favor improvements of consciousness recovery in subacute VS-UWS.
Nine patients with DoC due to traumatic brain injury (
= 1), anoxia (
= 3), and vascular damage (
= 5), have undergone a randomized, double-blind, sham-controlled, neuromodulatory trial with tRNS of bilateral DLPFC. All patients were in a post-acute phase and the DoC onset ranged from 30 days to 4 months. The diagnosis of DoC was based on internationally established criteria from the Multi-Society Task Force on PVS, and classified as VS or MCS using the JFK Coma Recovery Scale-Revised scores (CRS-R). We used CRS-R, Synek Scale, Ad-Hoc semi-quantitative scale and the Clinical Global Impression-Improvement scale to measure behavioral and electrophysiological changes during tRNS intervention. All patients were also treated with daily conventional rehabilitation treatment.
No significant differences emerged between active and sham groups regarding improvements of level of consciousness, as well as on electroencephalographic data. Only one patient showed emergence from VS-UWS, evolving from VS to MCS after the tRNS stimulation, at a distance of 3 weeks from the enrolment into the study.
Repeated applications of tRNS of the DLPFC, even if applied in a subacute phase of VS-UWS state, did not modify behavioral and neurophysiological outcomes differently than sham stimulation.
Background:
Hospital-acquired infections (HAIs) and microbial colonization are a worldwide serious threat for human health. Neurological patients with infections who undergo rehabilitation have a ...significantly poor recovery. The effect of microbial colonization on the functional outcome in severe acquired brain injury (sABI) subjects is still unclear.
Aim:
The aim of this multicenter observational study was to describe the clinical impact of HAIs and colonization on the functional outcome of sABI subjects admitted to inpatient neurorehabilitation.
Methods:
Patients were assigned to three groups: infected (INF), not infected (noINF), and colonized (COL). The Glasgow Coma Scale (GCS), the Rancho Los Amigos Levels of Cognitive Functioning Scale, Disability Rating Scale, and modified Barthel Index (mBI) assessments were performed both at admission and discharge.
Results:
Two hundred sixty-five (92 female/173 male) patients were enrolled: 134 were assigned to INF, 63 to COL, and 68 to noINF. In the INF group, 231 culture specimens were found positive for bloodstream (44.2%), respiratory tract (25.5%), urinary tract (18.6%), gastrointestinal tract (8.3%), skin (3%), and cerebrospinal fluid (0.4%) infections. After rehabilitation, all groups showed a significant improvement in all assessment tests, except for the noINF group that did not show any improvement in GCS. Both noINF and COL groups showed a significantly higher gain in mBI than the INF group (
p
= 0.000). The COL group showed a significantly higher gain than the noINF group in GCS (
p
= 0.001). A significantly lower improvement was detected in the INF group than the COL and noINF groups. The rate of patients who needed functional isolation was higher in the INF group than the COL group. Length of stay (LOS) (in days) was 56 ± 50.7, 88.3 ± 55, and 101.3 ± 73.6 for noINF, INF, and COL groups, respectively. The number of deaths in the INF group was significantly higher (24.6%) than the noINF group (7.4%) (
p
= 0.005) and comparable to the COL group (19%).
Conclusion:
Colonized sABI patients obtained a similar functional outcome to that of subjects who had no infections, even if they needed a significantly higher LOS.
The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention ...and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients.
The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity.
325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification and NIHSS, were given according to standard procedures.
About a third of patients (35.3%) had a performance lower than the cutoff (<22) on the MMSE, whereas 91.6% were impaired in at least one OCS domain, indicating higher incidences of impairment for the OCS. More than 80% of patients showed an impairment in two or more cognitive domains of the OCS. Using the MMSE as a standard of clinical practice, the comparative sensitivity of OCS was 100%. Out of the 208 patients with normal MMSE performance 180 showed impaired performance in at least one domain of the OCS. The discrepancy between OCS and MMSE was particularly strong for patients with milder strokes. As for subtypes of cerebral infarction, fewer patients demonstrated widespread impairments in the OCS in the Posterior Circulation Infarcts category than in the other categories.
Overall, the results showed a much higher incidence of cognitive impairment with the OCS than with the MMSE and demonstrated no false negatives for OCS vs MMSE. It is concluded that OCS is a sensitive screen tool for cognitive deficits after stroke. In particular, the OCS detects high incidences of stroke-specific cognitive impairments, not detected by the MMSE, demonstrating the importance of cognitive profiling.
Brain imaging studies have recently provided some evidence in favor of covert cognitive processes that are ongoing in patients with disorders of consciousness (DoC) (e.g., a minimally conscious state ...and vegetative state/unresponsive wakefulness syndrome) when engaged in passive sensory stimulation or active tasks such as motor imagery. In this exploratory study, we used transcranial magnetic stimulation (TMS) of the motor cortex to assess modulations of corticospinal excitability induced by action observation in eleven patients with DoC. Action observation is known to facilitate corticospinal excitability in healthy subjects, unveiling how the observer's motor system maps others' actions onto her/his motor repertoire. Additional stimuli were non-biological motion and acoustic startle stimuli, considering that sudden and loud acoustic stimulation is known to lower corticospinal excitability in healthy subjects. The results indicate that some form of motor resonance is spared in a subset of patients with DoC, with some significant difference between biological and non-biological motion stimuli. However, there was no covariation between corticospinal excitability and the type of DoC diagnosis (i.e., whether diagnosed with VS/UWS or MCS). Similarly, no covariation was detected with clinical changes between admission and discharge in clinical outcome measures. Both motor resonance and the difference between the resonance with biological/non-biological motion discrimination correlated with the amplitude of the N20 somatosensory evoked potentials, following the stimulation of the median nerve at the wrist (i.e., the temporal marker signaling the activation of the contralateral primary somatosensory cortex). Moreover, the startle-evoking stimulus produced an anomalous increase in corticospinal excitability, suggesting a functional dissociation between cortical and subcortical circuits in patients with DoC. Further work is needed to better comprehend the conditions in which corticospinal facilitation occurs and whether and how they may relate to individual clinical parameters.
The Bells Test is a cancelation task that is widely used for the diagnosis of unilateral spatial neglect (USN). With the aim of fostering more reliable use of this instrument, we set out to develop ...new norms adjusted for the possible influence of age, gender and education. We worked on the original version of the test.
Normative data were collected from 401 healthy participants aged between 20 and 80 years. Individual factors that could affect performance (i.e., gender, age, and years of education) were considered. We computed several indices on the Bells Test including an asymmetry score, an accuracy score and execution time. Multiple regression analyses (for time measures) and generalized linear models (for accuracy measures) were used to check for the influence of individual predictors of performance on the Bells Test.
Data indicated a significant influence of age on the accuracy score and execution time variables and a marginally significant effect of education on the accuracy score variable. Wherever appropriate, cut-offs are provided for the three dependent scores on the Bells Test corrected for age and education.
Based on a large normative sample, the present study provides new normative data on the Bells Test, which could lead to its reliable use in the diagnosis of USN.
Up to now, rehabilitation of unilateral spatial neglect has focused on egocentric forms of neglect, whereas less is known about the possibility to improve allocentric deficits. The present study ...aimed to examine the efficacy of prism adaptation (PA) training on patients with different forms of neglect: egocentric, allocentric, or mixed. Twenty-eight patients were assessed with specific neglect tests before (T0) and after (T1) 10 sessions of PA training. Performance in the Apples Cancellation test was used to identify patients with egocentric (
= 6), allocentric (
= 5), or mixed (
= 17) forms of neglect. In the overall group of patients, PA training produced significant improvements in performance across different neglect tests. In terms of the egocentric-allocentric distinction, the training was effective in reducing omissions in the left part of space in the Apples Cancellation test both for patients with egocentric neglect and mixed neglect. By contrast, errors of commissions (marking the inability to detect the left part of the target stimulus, i.e., allocentric neglect) remained unchanged after PA in patients with allocentric neglect and actually increased marginally in patients with mixed neglect. The PA training is effective in improving egocentric neglect, while it is ineffective on the allocentric form of the disturbance. Notably, the allocentric component of neglect is frequently impaired, although this is most often in conjunction with the egocentric impairment, yielding the mixed form of neglect. This stresses the importance of developing exercises tuned to improving allocentric neglect.
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