Visual strategies underpinning social cognition in traumatic brain injury

Impairments in social cognition after traumatic brain injury (TBI) are well documented but poorly understood (McDonald, 2013). Deficits in emotion perception, particularly facial affect recognition, are frequently reported in the literature (Babbage et al., 2011; Knox & Douglas, 2009), as well as mentalizing impairments and difficulty in understanding sincere and sarcastic exchanges (Channon, Pellijeff & Rule, 2005). To fully understand social impairments, both low-level and high-level processes must be explored. Few studies have focused on low-level perceptual processes in regards to facial affect recognition after TBI, and those that do typically use static social stimuli which lack ecological validity (Alves, 2013). This thesis employed eyetracking technology to explore the visual strategies underpinning the processing of contemporary static and dynamic social cognition tasks in a group of 18 TBI participants and 18 age, gender and education matched controls. The group affected by TBI scored significantly lower on the Movie for the Assessment of Social Cognition (MASC; Dziobek, et al., 2006), the Amsterdam Dynamic Facial Expression Set (ADFES; van der Schalk, Hawk, Fischer & Doosje, 2009), and The Assessment of Social Inference Test (McDonald et al., 2003). These findings suggest that, across a range of reliable assessments, individuals with TBI displayed significant social cognition deficits, including emotion perception and theory of mind, thus presenting strong evidence that social cognition is altered post-TBI. Impairments were not related to low-level visual processing as measured through eye-tracking metrics. This important insight suggests that social cognition changes post-TBI is likely associated with impairments in higher-level cognitive functioning. Interestingly, the group with TBI did display some aberrant fixation patterns in response to one static and one dynamic task but gaze patterns were similar between the groups on the remaining tasks. These non-uniform results warrant further exploration of low-level alterations post-TBI. Findings are discussed in reference to academic and clinical implications

Investigating visual strategies during the recognition of static and dynamic facial affect in TBI and control cohorts

bjectives: Traumatic brain injury (TBI) often precipitates socio-emotional problems which impinge on social relationships. Although socio-emotional impairments are debilitating the mechanisms underpinning these are poorly understood. Social interactions are dynamic yet research frequently employs static assessments. We investigated eye scan patterns of TBI and controls viewing static/dynamic facial expressions. Design: Factorial analysis investigated correct response, reaction time, fixation duration/count to areas of interest (eyes, nose and mouth) across six emotions (anger, disgust, fear, happy, sadness and surprise). Methods: 17 TBI participants were recruited from the NHS and age/gender matched controls were recruited using stratified opportunity sampling. Images from the Amsterdam Dynamic Facial Expression Set (ADFES) were presented on a Tobii T120 Eye Tracker screen. Multivariate and correlational methods were used to analyse data. Static Results: Controls displayed greater fixation durations; counts to eyes were more accurate and quicker identifying emotions than TBI participants. The TBI group focused more on the nose compared to controls. Higher scores on the ADFES correlated with quicker responses across all emotions for all participants and positive relationships between empathy, emotion recognition and fixation patterns were revealed. Gaze-patterns for the six emotions differed slightly between the groups although fearful faces induced more/longer fixations and happy faces the least/shortest fixations. Dynamic Results: Controls were more accurate at identifying emotions than the TBI group but no group differences were found for gaze-patterns. Happy faces induced more/longer fixations and sad faces the least/shortest fixations. A positive correlation between correct scores on the ADFES and empathy scores across all emotions for all participants was established. Conclusions: Irregular gaze-patterns could underpin some socio-emotional problems after TBI, highlighting the potential for innovative rehabilitation approaches. Visual strategies underlying the recognition of static/dynamic emotions may differ. The key limitation was the small sample size which will hopefully be rectified in future wor

Exploring fixation patterns and social cognition after traumatic brain injury

Objectives: Social cognition (SC) impairments after traumatic brain injury (TBI) are pervasive. The movie for the assessment of social cognition (MASC) measures different facets of social interactions over the three stages of SC; social perception, social knowledge retrieval and response selection. The mechanisms underpinning SC deficits after TBI are poorly understood but aberrant eye fixation patterns could play a role. The present research explored fixations across social interactions to determine group differences and correlations between eye tracking and behavioural data. Design: Group differences in response selection during the MASC and fixation duration/count to areas of interest (eyes, nose and mouth) were examined. Methods: 18 TBI participants were recruited from the NHS and age/gender matched controls were recruited using stratified opportunity sampling. The MASC allows for quantification of incorrect answers; excessive theory of mind (ToM), reduced ToM and absence of ToM errors. The MASC was presented on a Tobii T120 eye tracker monitor. Results: TBI participants had significantly lower correct scores on the MASC and higher excessive/reduced errors compared to controls. There was no significant interaction between automated optical inspection (AOI) and group. However, significant main effects of group for fixation duration/count indicated that if AOI was ignored, controls displayed longer/more fixations overall suggesting a difference in visual scanning patterns between TBI and control groups. No significant correlations were established. Conclusions: TBI and controls exhibited disparate visual strategies during the MASC and this effect could underpin some SC impairments displayed by TBI participants. TBI participants also displayed insufficient and over-interpretative mental state reasoning compared to controls but it is unclear why. The present research outlines the multifaceted nature of SC impairments after TBI and highlights potential areas for SC intervention post-TB

“That little doorway where I could suddenly start shouting out”: barriers and enablers to the disclosure of distressing voices

Hearing distressing voices is a key feature of psychosis. The time between voice onset and disclosure may be crucial as voices can grow in complexity. This study investigated barriers and enablers to early voice disclosure. Interviews with 20 voice hearers underwent Thematic Analysis. Beliefs about the effect of disclosure on self and others acted as a barrier and enabler to voices being discussed. Voice hearing awareness should be increased amongst young people, the public and care services. To support earlier disclosure measures need to increase skill amongst those likely to be disclosed to

Dynamic Emotion Recognition and Social Inference Ability in Traumatic Brain Injury: An Eye-Tracking Comparison Study.

Emotion recognition and social inference impairments are well-documented features of post-traumatic brain injury (TBI), yet the mechanisms underpinning these are not fully understood. We examined dynamic emotion recognition, social inference abilities, and eye fixation patterns between adults with and without TBI. Eighteen individuals with TBI and 18 matched non-TBI participants were recruited and underwent all three components of The Assessment of Social Inference Test (TASIT). The TBI group were less accurate in identifying emotions compared to the non-TBI group. Individuals with TBI also scored lower when distinguishing sincere and sarcastic conversations, but scored similarly to those without TBI during lie vignettes. Finally, those with TBI also had difficulty understanding the actor’s intentions, feelings, and beliefs compared to participants without TBI. No group differences were found for eye fixation patterns, and there were no associations between fixations and behavioural accuracy scores. This conflicts with previous studies, and might be related to an important distinction between static and dynamic stimuli. Visual strategies appeared goal- and stimulus-driven, with attention being distributed to the most diagnostic area of the face for each emotion. These findings suggest that low-level visual deficits may not be modulating emotion recognition and social inference disturbances post-TBI

Practitioners’ ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention

Practitioner understanding of patients’ preferences, wishes and needs is essential for personalised health care i.e., focusing on ‘what matters’ to people based on their individual life situation. To develop such an understanding, dementia practitioners need to use communication practices that help people share their experiences, preferences, and priorities. Following the COVID-19 pandemic, dementia support is likely to continue to be delivered both remotely and in-person. This study analysed multiple sources of qualitative data to examine the views of practitioners, people living with dementia and carers, and researchers on how an understanding of what matters to people living with dementia can be developed remotely via telephone and video call. Access to environmental stimuli, the remote use of visual tools, peoples’ tendency to downplay or omit details about their troubles and carers’ ability to disclose privately were interpreted, through thematic analysis, to be factors affecting how practitioners sought to develop understanding remotely. Cumulatively, findings show that while remote support created unique challenges to practitioners’ ability to develop understanding for personalised care, practitioners developed adaptive strategies to overcome some of these challenges. Further research should examine how, when and for whom these adapted practices for remote personalised care work, informing the development of evidence-based guidance and training on how practitioners can remotely develop the understanding required for personalised care

Practitioners' ability to remotely develop understanding for personalised care and support planning: a thematic analysis of multiple data sources from the feasibility phase of the Dementia Personalised Care Team (D-PACT) intervention

Practitioner understanding of patients' preferences, wishes and needs is essential for personalised health care i.e., focusing on 'what matters' to people based on their individual life situation. To develop such an understanding, dementia practitioners need to use communication practices that help people share their experiences, preferences, and priorities. Following the COVID-19 pandemic, dementia support is likely to continue to be delivered both remotely and in-person. This study analysed multiple sources of qualitative data to examine the views of practitioners, people living with dementia and carers, and researchers on how an understanding of what matters to people living with dementia can be developed remotely via telephone and video call. Access to environmental stimuli, the remote use of visual tools, peoples' tendency to downplay or omit details about their troubles and carers' ability to disclose privately were interpreted, through thematic analysis, to be factors affecting how practitioners sought to develop understanding remotely. Cumulatively, findings show that while remote support created unique challenges to practitioners' ability to develop understanding for personalised care, practitioners developed adaptive strategies to overcome some of these challenges. Further research should examine how, when and for whom these adapted practices for remote personalised care work, informing the development of evidence-based guidance and training on how practitioners can remotely develop the understanding required for personalised care

Pink1 and Parkin regulate Drosophila intestinal stem cell proliferation during stress and aging.

Intestinal stem cells (ISCs) maintain the midgut epithelium in Drosophila melanogaster Proper cellular turnover and tissue function rely on tightly regulated rates of ISC division and appropriate differentiation of daughter cells. However, aging and epithelial injury cause elevated ISC proliferation and decreased capacity for terminal differentiation of daughter enteroblasts (EBs). The mechanisms causing functional decline of stem cells with age remain elusive; however, recent findings suggest that stem cell metabolism plays an important role in the regulation of stem cell activity. Here, we investigate how alterations in mitochondrial homeostasis modulate stem cell behavior in vivo via RNA interference-mediated knockdown of factors involved in mitochondrial dynamics. ISC/EB-specific knockdown of the mitophagy-related genes Pink1 or Parkin suppresses the age-related loss of tissue homeostasis, despite dramatic changes in mitochondrial ultrastructure and mitochondrial damage in ISCs/EBs. Maintenance of tissue homeostasis upon reduction of Pink1 or Parkin appears to result from reduction of age- and stress-induced ISC proliferation, in part, through induction of ISC senescence. Our results indicate an uncoupling of cellular, tissue, and organismal aging through inhibition of ISC proliferation and provide insight into strategies used by stem cells to maintain tissue homeostasis despite severe damage to organelles

Risk factors for dementia in the context of cardiovascular disease: A protocol of an overview of reviews

Background Dementia is a major public health priority. Although there is abundant evidence of an associ-ation between dementia and poor cardiovascular health, findings have been inconsistent and uncertain in identifying which factors increase dementia risk in those with cardiovascular disease. Indeed, multiple variables including sociodemographic, economic, health, lifestyle and education may indicate who is at higher vs. lower dementia risk and could be used in prediction modelling. Therefore, the aim of this review is to synthesise evidence on the key risk factors for dementia in those with a history of cardiovascular disease. Methods This is an overview of reviews protocol, registered on PROSPERO (CRD42021265363). Four electronic databases including MEDLINE, EMBASE, PsycINFO, and the Cochrane Database of Systematic Reviews will be searched. Studies will be included if they are systematic reviews and/or meta-analyses that have investigated the risk of incident dementia (all-cause and subtypes including Alzheimer's disease and vascular dementia) in people with a history of coronary heart disease, heart failure, atrial fibrillation, hypertension, hyperli-pidaemia, and vascular stiffness. Study selection will be completed by two independent researchers according to the eligibility criteria, and conflicts resolved by a third reviewer. References will be exported into Covidence for title and abstract sifting, full-text review, and data extraction. Methodological quality will be assessed using the AMSTAR-2 criteria and confidence of evidence will be assessed using the GRADE classification. This overview of reviews will follow PRISMA guidelines. If there is sufficient homogeneity in the data, the results will be pooled, and a meta-analysis conducted to determine the strength ofassociation between each risk factor and incident all-cause dementia and its subtypes for each cardiovascular diagnoses separately.Discussion We will create a comprehensive summary of the key risk factors linking cardiovascular dis-eases to risk of incident dementia. This knowledge is essential for informing risk predictive model development as well as the development of risk reduction and prevention strategies