Nora Silvana Vigliecca

Contextual social cognition impairments in schizophrenia and bipolar disorder.

Background The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal Findings This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/Significance Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.

Integrating intention and context: assessing social cognition in adults with Asperger syndrome.

Deficits in social cognition are an evident clinical feature of the Asperger syndrome (AS). Although many daily life problems of adults with AS are related to social cognition impairments, few studies have conducted comprehensive research in this area. The current study examined multiple domains of social cognition in adults with AS assessing the executive functions (EF) and exploring the intra and inter-individual variability. Fifteen adults diagnosed with AS and 15 matched healthy controls completed a battery of social cognition tasks. This battery included measures of emotion recognition, theory of mind (ToM), empathy, moral judgment, social norms knowledge, and self-monitoring behavior in social settings. We controlled for the effect of EF and explored the individual variability. The results indicated that adults with AS had a fundamental deficit in several domains of social cognition. We also found high variability in the social cognition tasks. In these tasks, AS participants obtained mostly subnormal performance. EF did not seem to play a major role in the social cognition impairments. Our results suggest that adults with AS present a pattern of social cognition deficits characterized by the decreased ability to implicitly encode and integrate contextual information in order to access to the social meaning. Nevertheless, when social information is explicitly presented or the situation can be navigated with abstract rules, performance is improved. Our findings have implications for the diagnosis and treatment of individuals with AS as well as for the neurocognitive models of this syndrome.

Primary empathy deficits in frontotemporal dementia.

Loss of empathy is an early central symptom and diagnostic criterion of the behavioral variant frontotemporal dementia (bvFTD). Although changes in empathy are evident and strongly affect the social functioning of bvFTD patients, few studies have directly investigated this issue by means of experimental paradigms. The current study assessed multiple components of empathy (affective, cognitive and moral) in bvFTD patients. We also explored whether the loss of empathy constitutes a primary deficit of bvFTD or whether it is explained by impairments in executive functions (EF) or other social cognition domains. Thirty-seven bvFTD patients with early/mild stages of the disease and 30 healthy control participants were assessed with a task that involves the perception of intentional and accidental harm. Participants were also evaluated on emotion recognition, theory of mind (ToM), social norms knowledge and several EF domains. BvFTD patients presented deficits in affective, cognitive and moral aspects of empathy. However, empathic concern was the only aspect primarily affected in bvFTD that was neither related nor explained by deficits in EF or other social cognition domains. Deficits in the cognitive and moral aspects of empathy seem to depend on EF, emotion recognition and ToM. Our findings highlight the importance of using tasks depicting real-life social scenarios because of their greater sensitivity in the assessment of bvFTD. Moreover, our results contribute to the understanding of primary and intrinsic empathy deficits of bvFTD and have important theoretical and clinical implications.

Comparing Moral Judgments of Patients With Frontotemporal Dementia and Frontal Stroke

IMPORTANCE Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups. OBSERVATIONS This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the control participants. There were no differences between the 2 conditions. CONCLUSIONS AND RELEVANCE Both disorders involved impairments in integrating intention and outcome information for moral judgment. This study was the first, to our knowledge, to directly compare a social cognition domain in 2 frontal pathologies with different etiology. Our results highlighted the importance of comparing patients with vascular lesions and patients with neurodegenerative diseases.

Acute ethanol exposure during pregnancy in rats: Effects upon a multiple learning task

Pregnant rats received 4.8 g/kg of 20% (v/v) ethanol IP or identical volume of saline during gestational Day 8. No signs of gross physical teratogenesis were evident in the offspring as expressed by litter size, weight and external malformations at birth. However, when offspring were subjected to a multiple fixed ratio-4/differential reinforcement of low rate of responding 10-sec ( FR 4/DRL 10 sec) schedule of reinforcement at 60 days of age, significant differences were observed in the performance of DRL 10-sec schedule that required visual discrimination and response inhibition, but not in the FR 4 schedule that required a relatively simple nondiscrimination task of active-response. Bar press rates were unaffected by prenatal treatment since no differences between groups were found in the number of total responses performed on either component of the multiple schedule. Present results are discussed in terms of either response perseveration or a lower aptitude to deal with low rates of responding-discrimination learning tasks on the animals prenatally exposed to alcohol.

Brief aphasia evaluation (minimum verbal performance): Concurrent and conceptual validity study in patients with unilateral cerebral lesions

Introduction: Aphasia tests validated according to the brain injury side are necessary, especially for Spanish instruments. Objectives: To study the concurrent validity of this Brief Aphasia Evaluation (BAE) to differentiate patients with left cerebral lesions (LC) from patients with right cerebral lesions (RC) as well as LC from healthy participants (HP). To study, through an unrestricted-sub-test-factor analysis, the BAE conceptual and content validity to generate a verbal homogeneous construct. Materials and methods: Data were obtained from a sample of 109 right-handed volunteers: 37 LC, 34 RC and 38 HP. The three groups were matched according to gender, age and education. Results: Both groups of patients were similar in type and site of lesion, time since onset of condition, risk factors, presence of hemianopsia and hemiparesis and number of hospital visits. The Cronbachs alpha coefficient indicated an internal consistency of 0.99 for the total score and 0.88 or above for any of the sub-tests. All sub-tests (with loadings of 0.65 or above) grouped in one factor which explained 78% of the variance. The BAE showed a sensitivity and specificity of 0.84 or above to identify the LC (median as cut-off point). Conclusions: This test of free distribution demonstrated a satisfactory validity.

Is the Folstein's Mini-Mental test an aphasia test?

The Mini-Mental State Examination (MMSE) is recognized as a valid screening for dementia. It consists of 29 verbal items from a total of 30. The Brief Aphasia Evaluation (BAE) includes 10 aphasia and 12 orientation items, which are similar to most of the MMSE items. It was studied whether those BAE items (MMSE-like): (a) correlate with the rest of the BAE items (BAE-rest), and (b) differentiate patients with left cerebral lesions (LC) from both patients with right cerebral lesions (RC) and healthy participants (HP). A sample of 109 right-handed volunteers (38 HP, 37 LC, and 34 RC) was studied. The three groups were matched according to gender, age, and education. Patients were similar in multiple variables. The correlation between MMSE-like and BAE-rest was .90. MMSE-like showed a sensitivity and specificity of .81 or above to identify the LC from the other two groups. There is a risk for misdiagnosing aphasia as dementia with the MMSE.

A novel neuropsychological assessment to discriminate between ischemic and nonischemic dementia

INTRODUCTION In the present study we have elaborated a multivariate-multifactor diagnostic method for diagnosis of ischemic and nonischemic dementia, and validated it using different human populations. Our purpose was to improve dementia diagnosis by means of comprehensive neuropsychological assessment and the control of intervening variables. METHODS Data were obtained from 114 healthy volunteers to 101 patients consecutively referred for suspected dementia. On the basis of neuromorphological criteria, the patient sample was subdivided into those with ischemic lesions (IL: N=12) and without ischemic lesions (non-IL: N=89). The patient groups and the healthy subjects (HS) were matched according to age, education, sex ratio and handedness. A comprehensive neuropsychological battery was administered to all the participants. RESULTS The two patient groups differed in their Hachinski ischemic score, but not in terms of demographic variables, the Blessed rating scale, Mini Mental State, Geriatric Depression Scale, or other measures. Discriminant analysis selected fifteen neuropsychological variables from the comprehensive battery, and these were found to provide accuracy of classification in 98% of HS and 87% of the patients considered as a whole. Considering the three groups, those variables provided accuracy of classification in 98% of HS, 82% of IL patients and 82% of non-IL patients. Subtests were internally consistent (Cronbachs alpha: 0.87) and a positive association between ischemic lesions and cognitive impairment was observed when the 15 dependent variables were added. DISCUSSION It is possible to select a combination of cognitive tests that discriminated HS from dementia patients and, within this category, patients with and without ischemic lesions. Analysis of the 15 variables provides an improved method for diagnosis of ischemic vs. nonischemic lesion dementia in humans.

Verbal Neuropsychological Functions in Aphasia: An Integrative Model

A theoretical framework which considers the verbal functions of the brain under a multivariate and comprehensive cognitive model was statistically analyzed. A confirmatory factor analysis was performed to verify whether some recognized aphasia constructs can be hierarchically integrated as latent factors from a homogenously verbal test. The Brief Aphasia Evaluation was used. A sample of 65 patients with left cerebral lesions, and two supplementary samples comprising 35 patients with right cerebral lesions and 30 healthy participants were studied. A model encompassing an all inclusive verbal organizer and two successive organizers was validated. The two last organizers were: three factors of comprehension, expression and a “complementary” verbal factor which included praxia, attention, and memory; followed by the individual (and correlated) factors of auditory comprehension, repetition, naming, speech, reading, writing, and the “complementary” factor. By following this approach all the patients fall inside the classification system; consequently, theoretical improvement is guaranteed.

Screening executive function and global cognition with the Nine‐Card Sorting Test: healthy participant studies and ageing implications

The Nine‐Card Sorting Test provides valid and reliable scores when screening executive function, intelligence, and academic achievement. It is also useful for detecting cognitive impairment and dementia in the elderly and for assessing disease evolution and treatment effectiveness. It deals with three non‐verbal sorting principles, individually and in pairs. The presence of risk in the ability to discover and organize visual logical stimuli is explored.