Analyzing aphasia data in a multidimensional symptom space

The utility of single-case vs. group studies has been debated in neuropsychology for many years. The purpose of the present study is to illustrate an alternative approach to group studies of aphasia, in which the same symptom dimensions that are commonly used to assign patients to classical taxonomies (fluency, naming, repetition, and comprehension) are used as independent and continuous predictors in a multivariate design, without assigning patients to syndromes. One hundred twenty-six Italian-speaking patients with aphasia were first classified into seven classic aphasia categories, based on fluency, naming, auditory comprehension, and repetition scales. There were two goals: (1) compare group analyses based on aphasia types with multivariate analyses that sidestep classification and treat aphasic symptoms as continuous variables; (2) present correlation-based outlier analyses that can be used to identify individuals who occupy unusual positions in the multivariate "symptom space." In the service of the first goal, group performance on an external validation measure (the Token Test) was assessed in three steps: analyses of variance based on aphasia type, regressions using the same cut-offs for fluency, naming, comprehension and repetition as independent but dichotomous predictors, and regressions using the same subscales as continuous predictors (with no cut-offs). More variance in Token Test performance was accounted for when symptoms were treated as continuous predictors than with the other two methods, though use of independent but dichotomous predictors accounted for more variance than aphasia taxonomies. Thus, if we by-pass classical taxonomies and treat patients as points in a multidimensional symptom space, better predictions are obtained. Outlier analyses show that group results depend on heterogeneity among patients, which can be used as a search tool to identify potentially interesting dissociations. Hence this multivariate group approach is complementary to and compatible with single-case methods.     

Coordinate high-frequency pattern of stimulation and calcium levels control the induction of LTP in striatal cholinergic interneurons

Current evidence appoints a central role to cholinergic interneurons in modulating striatal function. Recently, a long-term potentiation (LTP) of synaptic transmission has been reported to occur in these neurons. The relationship between the pattern of cortico/thalamostriatal fibers stimulation, the consequent changes in the intracellular calcium concentration ([Ca2+]i), and the induction of synaptic plasticity was investigated in striatal cholinergic interneurons from a rat corticostriatal slice preparation by means of combined electrophysiological intracellular recordings and microfluorometric techniques. Different protocols of stimulation were considered, varying both the frequency and the duration of the train of stimuli. High-frequency stimulation (HFS) (three trains at 100 Hz for 3 sec, 20-sec interval) induced a rise in [Ca2+]i, exceeding by fivefold the resting level, and caused a LTP of synaptic transmission. Tetanic stimulation delivered at lower frequencies (5-30 Hz) failed to induce long-term changes of synaptic efficacy. The observed elevation in [Ca2+]i during HFS was primarily mediated by L-type high-voltage activated (HVA)-Ca2+ channels, as it was fully prevented by nifedipine. Conversely, blockade of NMDA and AMPA glutamate receptor did not affect either LTP or the magnitude of the [Ca2+]i rise. Interestingly, the pharmacological analysis of the post-tetanic depolarizing postsynaptic potential (DPSP) revealed that LTP was attributable, to a large extent, to the potentiation of the GABA(A)-mediated component. In conclusion, the expression of LTP in striatal cholinergic interneurons is a selective response to a precise stimulation pattern of induction requiring a critical rise in [Ca2+]i.     

Discrimination of voice versus place contrasts in aphasia

A phoneme discrimination test based upon CCVC (consonant-consonant-vowel-consonant) syllables was administered to 36 aphasics, 91 brain-damaged subjects, and 42 normal controls, in normal listening conditions. Errors in the discrimination of voice and place contrasts were determined, and the scores (voice-minus-place errors) obtained by the four experimental groups were compared statistically. Aphasic patients, when compared with the other groups, show a greater difficulty in discriminating place than voice contrasts. Some implications of these findings are discussed.     

Social cognition and real-life functioning in patient samples with 22q11.2 deletion syndrome with or without psychosis,compared to a large sample of patients with schizophrenia only and healthy controls

Patients with the 22q11.2 deletion syndrome (DS) show an increased risk of developing a psychotic illness lifetime. 22q11.2DS may represent a reliable model for studying the neurobiological underpinnings of schizophrenia. The study of social inference abilities in a genetic condition at high risk for psychosis, like 22q11.2DS, may shed light on the relationships between neurocognitive processes and patients' daily general functioning. The study sample consisted of 1736 participants, divided into four groups: 22q11.2DS patients with diagnosis of psychotic disorder (DEL SCZ, N = 20); 22q11.2DS subjects with no diagnosis of psychosis (DEL, N = 43); patients diagnosed with schizophrenia without 22q11.2DS (SCZ, N = 893); and healthy controls (HC, N = 780). Social cognition was assessed through The Awareness of Social Inference Test (TASIT) and general functioning through the Specific Levels of Functioning (SLoF) scale. We analysed data through regression analysis. The SCZ and DEL groups had similar levels of global functioning; they both had significantly lower SLoF Total scores than HC (p < .001); the DEL SCZ group showed significantly lower scores compared to the other groups (SCZ, p = .004; DEL, p = .003; HC, p < .001). A significant deficit in social cognition was observed in the three clinical groups. In the DEL SCZ and SCZ groups, TASIT scores significantly predicted global functioning (p < .05). Our findings of social cognition deficit in psychosis-prone patients point to the possible future adoption of rehabilitation programmes, like Social Skills Training and Cognitive Remediation, during premorbid stages of psychosis.     

Critical stages in mental development: Childhood breath holding spells (BHS)

The authors present the first part of a study on children with BHS (Breath Holding Spells) syndrome. These children were chosen in order to examine a “pathological” situation in infancy that was as close as possible to a “normal” one, and in which obvious somatic symptoms were associated with emotional states. Children with BHSS are not considered to have serious psychological disturbances, even if they are constantly referred to as intolerant of separation, stubborn, oppositional, or easy to temper tantrum. A reduced ability to tolerate frustration is evident in these children both from the patients' history and clinical observation. Parents usually relate BHS to situations in which the child is denied something or gets scolded. The children were observed during three sessions, both with and without the mother, according to a grid used at our Center. Patients are presented to illustrate certain recurrent features in play and interaction with mother. The data suggest that these children stagnate in an area of incomplete mental representation; something makes them oscillate between two states; in one of them, the mental representation of the object and of the bond with it is possible; in the other, the mental representation of the separation, which entails the recognition of the object, is felt as dangerous.     

Psychological well-being in adolescence: the contribution of interpersonal relations and experience of being alone

This study investigated the influence of loneliness and relationships with parents and friends on the psychological well-being or adolescent malaise. Data were collected via two questionnaires (LLCA-Marcoen, Goossens & Caes, 1987; TRI-Bracken, 1996) from a sample of 330 Italian adolescents, males and females, aged between 11 and 19. As hypothesized, results showed that a positive relationship with friends and parents promotes psychological well-being in adolescents and reduces malaise. In addition, the study showed that the adolescents were able to distinguish between different states of loneliness; on one hand they could recognize the pain of isolation and social refusal, and on the other, they could recognize the pleasant dimension of loneliness, according to the age and sex. Therefore loneliness can be a risk for the adolescent's well-being if it is caused by social refusal, but it can also be a developmental need (parallel to the need for attachment), and can promote psychological well-being when adolescents choose to be alone.     

The suppression of reflexive visual and auditory orienting when attention is otherwise engaged

Two experiments were conducted to examine whether abrupt onsets are capable of reflexively capturing attention when they occur outside the current focus of spatial attention, as would be expected if exogenous orienting operates in a truly automatic fashion. The authors established a highly focused attentional state by means of the central presentation of a stream of visual or auditory characters, which participants sometimes had to monitor. No intramodal reflexive cuing effects were observed in either audition or vision when participants performed either an exogenous visual or auditory orthogonal cuing task together with the central focused attention task. These results suggest that reflexive unimodal orienting is not truly automatic. The fact that cuing effects were eliminated under both unimodal and cross-modal conditions is consistent with the view that auditory and visual reflexive spatial orienting are controlled by a common underlying neural substrate.     

Spatial coding and central patterns: is there something special about the eyes?

In this study we investigated in a Simon-like task whether task-irrelevant spatial information, delivered by centrally presented patterns, interfered with response selection in the same way as laterally presented stimuli. Second, we asked whether such interference was equal for different kinds of stimuli. Participants were required to respond to the colour of two framed squares, two arrows, or two schematic eyes by pressing one of two lateralized response keys. The results consistently show that the Simon effect occurs independently of the nature of the stimulus, as classically reported for lateralized stimuli. Response times were influenced by the direction and frame-relative position of the stimuli, being faster for responses corresponding to the direction indicated by the stimuli than for noncorresponding responses regardless of stimulus types. Contrary to findings with lateralized nondirectional stimuli, such an effect increased with increasing RTs indicating that for centrally presented patterns the extraction of spatial information is time consuming.