Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances?

In a subgroup of patients with mild traumatic brain injury (TBI) residual symptoms, interfering with outcome and return to work, are found. With neuropsychological assessment cognitive deficits can be demonstrated although the pathological underpinnings of these cognitive deficits are not fully understood. As the admission computed tomography (CT) often is normal, perfusion CT imaging may be a useful indicator of brain dysfunction in the acute phase after injury in these patients.In the present study, directly after admission perfusion CT imaging was performed in mild TBI patients with follow-up neuropsychological assessment in those with complaints and a normal non-contrast CT. Neuropsychological tests comprised the 15 Words test Immediate Recall, Trailmaking test part B, Zoo Map test and the FEEST, which were dichotomized into normal and abnormal. Perfusion CT results of patients with normal neuropsychological test scores were compared to those with abnormal test scores.In total eighteen patients were included. Those with an abnormal score on the Zoo Map test had a significant lower CBV in the right frontal and the bilateral parieto-temporal white matter. Patients with an abnormal score on the FEEST had a significant higher MTT in the bilateral frontal white matter and a significant decreased CBF in the left parieto-temporal grey matter. No significant relation between the perfusion CT parameters and the 15 Words test and the Trailmaking test part B was present.In conclusion, impairments in executive functioning and emotion perception assessed with neuropsychological tests during follow up were related to differences in cerebral perfusion at admission in mild TBI. The pathophysiological concept of these findings is discussed.     

Moral reasoning in autistic individuals: a theoretical review / El razonamiento moral en personas con Trastorno del Espectro Autista: una revisión teórica

Abstract

Individuals diagnosed with an Autism Spectrum Disorder (ASD) often find it difficult to attribute mental states to others and to understand their own and others’ behaviour (Theory of Mind, [ToM]/social cognition). These difficulties can affect their moral judgements. The present article focuses on evidence on moral reasoning and ToM, with the aim of analysing theoretical and review research into autism. The weight intention has in moral reasoning and the causal relation between mental states, actions and outcomes is an essential part of this study. Evidence in the field of autism reports how autistic people would not be able to make moral judgements based on the agent’s intention. Instead, they would reason based on the outcomes of the action. For example, this can be translated into misunderstandings, malicious judgements or ‘over-blaming’ in accidental situations (ambiguous valences). These impairments can confirm the association between ToM and moral reasoning.