Carmen Morawetz

Assessment of subjective health and health-related quality of life in persons with acquired or degenerative brain injury

Purpose of reviewHealth-related quality of life is a new outcome variable in neurology. Several generic measures aim at assessing this variable in adults with neurological diseases. Disease-specific measures are still rare; however, individuals with neurological diseases frequently suffer from cognitive impairment, yet are often excluded from health-related quality of life investigations. When included in such studies, cognitive functioning is not monitored via neuropsychological evaluation, possibly leading to methodological problems. Papers from May 2004 until July 2005 are reviewed with respect to psychometric quality and information about persons after traumatic brain injury, stroke, Parkinsons disease or dementia. Recent findingsSeveral new cross-sectional and longitudinal outcome studies are reviewed. The Medical Outcome Study Short Form with 36 items, the Sickness Impact Profile and the Nottingham Health Profile were identified as the most frequently used measures in neurology. For traumatic brain injury, two new generic instrument validations (Life Satisfaction Index-A, Subjective Quality of Life Profile) and one internationally validated disease-specific development (Quality of Life after Brain Injury) were found; for stroke, one disease-specific tool (Burden of Stroke Scale) was identified. In Parkinsons disease, the disease-specific health-related quality of life measure Parkinsons Disease Questionnaire-39 is well validated. In dementia, three dementia-specific instruments (Quality of Life for Dementia, Quality of Life in Late-Stage Dementia Scale and Quality of Life in Alzheimers Disease Scale) seem to be valid. SummaryIn neurology, only a few measures have been developed and validated for respondents with cognitive impairment, often showing poorer validity results than studies involving healthy persons. Health-related quality of life assessment should therefore be validated in the specific diseases and, if necessary, combined with a neuropsychological evaluation and a disease-specific health-related quality of life measure.

Changes in Effective Connectivity Between Dorsal and Ventral Prefrontal Regions Moderate Emotion Regulation

Reappraisal, the cognitive reevaluation of a potentially emotionally arousing event, has been proposed to be based upon top-down appraisal systems within the prefrontal cortex (PFC). It still remains unclear, however, how different prefrontal regions interact to control and regulate emotional responses. We used fMRI and dynamic causal modeling (DCM) to characterize the functional interrelationships among dorsal and ventral PFC regions involved in reappraisal. Specifically, we examined the effective connectivity between the inferior frontal gyrus (IFG), dorsolateral PFC (DLPFC), and other reappraisal-related regions (supplementary motor area, supramarginal gyrus) during the up- and downregulation of emotions in response to highly arousing extreme sports film clips. We found DLPFC to be the central node of the prefrontal emotion regulation network, strongly interconnected with the IFG. The DCM analysis further revealed excitatory changes of connection strength from the DLPFC to the IFG and strong inhibitory changes of connection strength between the IFG and DLPFC during reappraisal. These bidirectional changes in connectivity strength indicate a feedback mechanism by which the IFG may select one out of several possible goal-appropriate reappraisals held active in working memory (represented in the DLPFC) and inhibits the DLPFC once the selection process is completed.

Differential activation of the middle-temporal complex to visual stimulation in migraineurs

Objective: Differences between people with and without migraine on various measures of visual perception have been attributed to abnormal cortical processing due to the disease. The aim of the present study was to explore the dynamics of the basic interictal state with regard to the extrastriate, motion-responsive middle temporal area (MT-complex) with functional magnetic resonance imaging (fMRI) at 3 tesla using coherent/incoherent moving dot stimuli. Method: Twenty-four migraine patients (12 with aura [MwA], 12 without aura [MwoA]) and 12 healthy subjects participated in the study. The individual cortical folding pattern was accounted for by using a cortical matching approach. Results: In the inferior-posterior portion of the MT-complex, most likely representing MT, control subjects showed stronger bilateral activation compared to MwA and MwoA patients. Compared with healthy controls MwoA and MwA patients showed significantly stronger activation mainly at the left side in response to visual stimulation in the superior-anterior portion of the MT-complex, representing the medial-superior temporal area (MST). Conclusion: Our findings strengthen the hypothesis that hyperresponsiveness of the visual cortex in migraine goes beyond early visual areas, even in the interictal period.

The effect of strategies, goals and stimulus material on the neural mechanisms of emotion regulation: A meta-analysis of fMRI studies

HIGHLIGHTSVLPFC, anterior insula and SMA were activated independent of regulation strategy.VLPFC and PCC were recruited during up‐ and down‐regulation of emotion.Down‐regulation of emotions was associated with more right‐lateralized activity.Up‐regulating emotions more strongly modulated activity in the ventral striatum.The emotion regulation network was found to be largely stimulus‐independent. ABSTRACT Emotion regulation comprises all extrinsic and intrinsic control processes whereby people monitor, evaluate and modify the occurrence, intensity and duration of emotional reactions. Here we sought to quantitatively summarize the existing neuroimaging literature to investigate a) whether different emotion regulation strategies are based on different or the same neural networks; b) which brain regions in particular support the up‐ and down‐regulation of emotions, respectively; and c) to which degree the neural networks realising emotion regulation depend on the stimulus material used to elicit emotions. The left ventrolateral prefrontal cortex (VLPFC), the anterior insula and the supplementary motor area were consistently activated independent of the regulation strategy. VLPFC and posterior cingulate cortex were the main regions consistently found to be recruited during the up‐regulation as well as the down‐regulation of emotion. The down‐regulation compared to the up‐regulation of emotions was associated with more right‐lateralized activity while up‐regulating emotions more strongly modulated activity in the ventral striatum. Finally, the process of emotion regulation appeared to be unaffected by stimulus material.

Diverting Attention Suppresses Human Amygdala Responses to Faces

Recent neuroimaging studies disagree as to whether the processing of emotion-laden visual stimuli is dependent upon the availability of attentional resources or entirely capacity-free. Two main factors have been proposed to be responsible for the discrepancies: the differences in the perceptual attentional demands of the tasks used to divert attentional resources from emotional stimuli and the spatial location of the affective stimuli in the visual field. To date, no neuroimaging report addressed these two issues in the same set of subjects. Therefore, the aim of the study was to investigate the effects of high and low attentional load as well as different stimulus locations on face processing in the amygdala using functional magnetic resonance imaging to provide further evidence for one of the two opposing theories. We were able for the first time to directly test the interaction of attentional load and spatial location. The results revealed a strong attenuation of amygdala activity when the attentional load was high. The eccentricity of the emotional stimuli did not affect responses in the amygdala and no interaction effect between attentional load and spatial location was found. We conclude that the processing of emotional stimuli in the amygdala is strongly dependent on the availability of attentional resources without a preferred processing of stimuli presented in the periphery and provide firm evidence for the concept of the attentional load theory of emotional processing in the amygdala.

Neural representation of emotion regulation goals

The use of top–down cognitive control mechanisms to regulate emotional responses as circumstances change is critical for mental and physical health. Several theoretical models of emotion regulation have been postulated; it remains unclear, however, in which brain regions emotion regulation goals (e.g., the downregulation of fear) are represented. Here, we examined the neural mechanisms of regulating emotion using fMRI and identified brain regions representing reappraisal goals. Using a multimethodological analysis approach, combining standard activation‐based and pattern‐information analyses, we identified a distributed network of lateral frontal, temporal, and parietal regions implicated in reappraisal and within it, a core system that represents reappraisal goals in an abstract, stimulus‐independent fashion. Within this core system, the neural pattern‐separability in a subset of regions including the left inferior frontal gyrus, middle temporal gyrus, and inferior parietal lobe was related to the success in emotion regulation. Those brain regions might link the prefrontal control regions with the subcortical affective regions. Given the strong association of this subsystem with inner speech functions and semantic memory, we conclude that those cognitive mechanisms may be used for orchestrating emotion regulation. Hum Brain Mapp 37:600–620, 2016.

Effects of spatial frequency and location of fearful faces on human amygdala activity.

Facial emotion perception plays a fundamental role in interpersonal social interactions. Images of faces contain visual information at various spatial frequencies. The amygdala has previously been reported to be preferentially responsive to low-spatial frequency (LSF) rather than to high-spatial frequency (HSF) filtered images of faces presented at the center of the visual field. Furthermore, it has been proposed that the amygdala might be especially sensitive to affective stimuli in the periphery. In the present study we investigated the impact of spatial frequency and stimulus eccentricity on face processing in the human amygdala and fusiform gyrus using functional magnetic resonance imaging (fMRI). The spatial frequencies of pictures of fearful faces were filtered to produce images that retained only LSF or HSF information. Facial images were presented either in the left or right visual field at two different eccentricities. In contrast to previous findings, we found that the amygdala responds to LSF and HSF stimuli in a similar manner regardless of the location of the affective stimuli in the visual field. Furthermore, the fusiform gyrus did not show differential responses to spatial frequency filtered images of faces. Our findings argue against the view that LSF information plays a crucial role in the processing of facial expressions in the amygdala and of a higher sensitivity to affective stimuli in the periphery.

Emotional entrainment, national symbols, and identification: A naturalistic study around the men’s football World Cup

Some theories suggest that collective emotions, in particular emotional entrainment as the feeling of affective attunement with others during rituals, can increase the identification with a social group. Furthermore, emotional entrainment is supposed to emotionally ‘charge’ group symbols that are part of ritual practices and influence group-related attitudes and solidarity even beyond the ritual context. This article tests these assumptions in a naturalistic study around the 2010 Football World Cup, which reliably generates emotional entrainment in a ritualized, nation-focused context. Results indicate that emotional entrainment during the tournament is a predictor of changes in national identification and the perceived emotional significance of national symbols after the tournament. Moreover, emotional entrainment partially mediates the relationship between pre- and post-World Cup national identification and the perception of national symbols.

Sharing self-related information is associated with intrinsic functional connectivity of cortical midline brain regions.

Human beings are social animals and they vary in the degree to which they share information about themselves with others. Although brain networks involved in self-related cognition have been identified, especially via the use of resting-state experiments, the neural circuitry underlying individual differences in the sharing of self-related information is currently unknown. Therefore, we investigated the intrinsic functional organization of the brain with respect to participants’ degree of self-related information sharing using resting state functional magnetic resonance imaging and self-reported social media use. We conducted seed-based correlation analyses in cortical midline regions previously shown in meta-analyses to be involved in self-referential cognition: the medial prefrontal cortex (MPFC), central precuneus (CP), and caudal anterior cingulate cortex (CACC). We examined whether and how functional connectivity between these regions and the rest of the brain was associated with participants’ degree of self-related information sharing. Analyses revealed associations between the MPFC and right dorsolateral prefrontal cortex (DLPFC), as well as the CP with the right DLPFC, the left lateral orbitofrontal cortex and left anterior temporal pole. These findings extend our present knowledge of functional brain connectivity, specifically demonstrating how the brain’s intrinsic functional organization relates to individual differences in the sharing of self-related information.

Effective amygdala-prefrontal connectivity predicts individual differences in successful emotion regulation.

Abstract The ability to voluntarily regulate our emotional response to threatening and highly arousing stimuli by using cognitive reappraisal strategies is essential for our mental and physical well-being. This might be achieved by prefrontal brain regions (e.g. inferior frontal gyrus, IFG) down-regulating activity in the amygdala. It is unknown, to which degree effective connectivity within the emotion-regulation network is linked to individual differences in reappraisal skills. Using psychophysiological interaction analyses of functional magnetic resonance imaging data, we examined changes in inter-regional connectivity between the amygdala and IFG with other brain regions during reappraisal of emotional responses and used emotion regulation success as an explicit regressor. During down-regulation of emotion, reappraisal success correlated with effective connectivity between IFG with dorsolateral, dorsomedial and ventromedial prefrontal cortex (PFC). During up-regulation of emotion, effective coupling between IFG with anterior cingulate cortex, dorsomedial and ventromedial PFC as well as the amygdala correlated with reappraisal success. Activity in the amygdala covaried with activity in lateral and medial prefrontal regions during the up-regulation of emotion and correlated with reappraisal success. These results suggest that successful reappraisal is linked to changes in effective connectivity between two systems, prefrontal cognitive control regions and regions crucially involved in emotional evaluation.