Decision-making in multiple sclerosis patients: a systematic review

Background. Multiple sclerosis (MS) is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1) performance of MS patients in decision-making tasks was consistently different from controls and (2) whether this modification was associated with cognitive dysfunction and emotional alterations. Methods. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores) and qualitative measurements (deliberation time and learning from feedback). Results. Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. Conclusions. In MS patients, qualitative and quantitative modifications may be present in any kind of decision- making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings

Jagged1 is altered in alzheimer’s disease and regulates spatial memory processing

Notch signaling plays an instrumental role in hippocampus-dependent memory formation and recent evidence indicates a displacement of Notch1 and a reduction its activity in hippocampal and cortical neurons from Alzheimer's disease (AD) patients. As Notch activation depends on ligand availability, we investigated whether Jagged1 expression was altered in brain specimen of AD patients. We found that Jagged1 expression was reduced in the CA fields and that there was a gradual reduction of Jagged1 in the cerebrospinal fluid (CSF) with the progression of dementia. Given the role of Notch signaling in memory encoding, we investigated whether targeted loss of Jagged1 in neurons may be responsible for the memory loss seen in AD patients. Using a transgenic mouse model, we show that the targeted loss of Jagged1 expression during adulthood is sufficient to cause spatial memory loss and a reduction in exploration-dependent Notch activation. We also show that Jagged1 is selectively enriched at the presynaptic terminals in mice. Overall, the present data emphasizes the role of the Notch ligand, Jagged1, in memory formation and the potential deficit of the signaling ligand in AD patients

Frequency, characterisation and therapies of fatigue after stroke

Post-stroke objective or subjective fatigue occurs in around 50% of patients and is frequent (30%) even after minor strokes. It can last more than one year after the event, and is characterised by a different quality from usual fatigue and good response to rest. Associated risk factors include age, single patients, female, disability, depression, attentional impairment and sometimes posterior strokes, but also inactivity, overweight, alcohol and sleep apnoea syndrome. There are few therapy studies, but treatment may include low-intensity training, cognitive therapy, treatment of associated depression, wakefulness-promoting agents like modafinil, correction of risk factors and adaptation of activitie

Embodied semantics in a second language: critical review and clinical implications

The role of the sensorimotor system in second language (L2) semantic processing as well as its clinical implications for bilingual patients has hitherto been neglected. We offer an overview of the issues at stake in this under-investigated field, presenting the theoretical and clinical relevance of studying L2 embodiment and reviewing the few studies on this topic. We highlight that (a) the sensorimotor network is involved in L2 processing, and that (b) in most studies, L2 is differently embodied than L1, reflected in a lower degree or in a different pattern of L2 embodiment. Importantly, we outline critical issues to be addressed in order to guide future research. We also delineate the subsequent steps needed to confirm or dismiss the value of language therapeutic approaches based on embodiment theories as a complement of speech and language therapies in adult bilinguals

On the Origin of the N400 Effects: An ERP Waveform and Source Localization Analysis in Three Matching Tasks

The question of the cognitive nature and the cerebral origins of the event-related potential (ERP) N400 component has frequently been debated. Here, the N400 effects were analyzed in three tasks. In the semantic task, subjects decided whether sequentially presented word pairs were semantically related or unrelated. In the phonologic (rhyme detection) task, they decided if words were phonologically related or not. In the image categorization task, they decided whether images were categorically related or not. Difference waves between ERPs to unrelated and related conditions (defined here as the N400 effect) demonstrated a greater amplitude and an earlier peak latency effect in the image than in semantic and phonologic tasks. In contrast, spatial correlation analysis revealed that the maps computed during the peak of the N400 effects were highly correlated. Source localization computed from these maps showed the involvement in all tasks of the middle/superior temporal gyrus. Our results suggest that these qualitatively similar N400 effects index the same cognitive content despite differences in the representational formats (words vs. images) and the types of mismatch (semantic vs. phonological) across task

Language specificity of lexical-phonological therapy in bilingual aphasia: A clinical and electrophysiological study

Based on findings for overlapping representations of bilingual people's first (L1) and second (L2) languages, unilingual therapies of bilingual aphasia have been proposed to benefit the untrained language. However, the generalisation patterns of intra- and cross-language and phonological therapy and their neural bases remain unclear. We tested whether the effects of an intensive lexical-phonological training (LPT) in L2 transferred to L1 word production in a Persian-French bilingual stroke patient with Broca's aphasia. Language performance was assessed using the Bilingual Aphasia Test, a 144-item picture naming (PN) task and a word–picture verification (WPV) task. Electroencephalography (EEG) was recorded during PN and WPV in both languages before and after an LPT in French on a wordlist from the PN task. After the therapy, naming improved only for the treated L2 items. The naming performance improved neither in the untrained L2 items nor in the corresponding items in L1. EEG analyses revealed a Language x Session topographic interaction at 540 ms post-stimulus, driven by a modification of the electrophysiological response to the treated L2 but not L1 items. These results indicate that LPT modified the brain networks engaged in the phonological-phonetic processing during naming only in the trained language for the trained items

Dynamics of Brain Activation During an Explicit Word and Image Recognition Task: An Electrophysiological Study

Recent brain imaging studies suggest that semantic processing of words and images may share a common neural network, although modality-specific activation can also be observed. Other studies using event-related potentials (ERPs) report that brain responses to words and images may already differ at ~150 ms following stimulus presentation. The question thus remains, which differences are due to perceptual categorization processes and which differences are due to the semantic ones? Using ERP recordings and spatio-temporal source localization analysis, we investigated the dynamics of brain activation during a recognition task. The stimuli consisted of a randomized set of verbal (words vs. non-words) and pictorial items (line drawings of objects vs. scrambled drawings). After each stimulus, subjects had to decide whether it corresponds to a recognizable word or objects. ERP map series were first analyzed in terms of segments of quasi-stable map topography using a cluster analysis. This showed that verbal and pictorial stimuli elicited different field patterns in two time segments between ~190-400 ms. Before and after this period, map patterns were similar between verbal and pictorial conditions indicating that the same brain structures were engaged during the early and late steps of processing. Source localization analysis of map segments corresponding to the P100 and the N150 components first showed activation of posterior bilateral regions and then of left temporo-posterior areas. During the period differentiating conditions, other patterns of activation, involving mainly left anterior and posterior regions for words and bilateral posterior regions for images, were observed. These findings suggest that, while sharing an initial common network, recognition of verbal and pictorial stimuli subsequently engage different brain regions during time periods generally allocated to the semantic processing of stimul

A pure case of Gerstmann syndrome with a subangular lesion

The four symptoms composing Gerstmann's syndrome were postulated to result from a common cognitive denominator (Grundstörung) by Gerstmann himself. He suggested that it is a disorder of the body schema restricted to the hand and fingers. The existence of a Grundstörung has since been contested. Here we suggest that a common psychoneurological factor does exist, but should be related to transformations of mental images rather than to the body schema. A patient (H.P.) was studied, who presented the four symptoms of Gerstmann's syndrome in the absence of any other neuropsychological disorders. MRI showed a focal ischaemic lesion, situated subcortically in the inferior part of the left angular gyrus and reaching the superior posterior region of T1. The cortical layers were spared and the lesion was seen to extend to the callosal fibres. On the basis of an extensive cognitive investigation, language, praxis, memory and intelligence disorders were excluded. The four remaining symptoms (finger agnosia, agraphia, right-left disorientation and dyscalculia) were investigated thoroughly with the aim of determining any characteristics that they might share. Detailed analyses of the tetrad showed that the impairment was consistently attributable to disorders of a spatial nature. Furthermore, cognitive tests necessitating mental rotation were equally shown to be impaired, confirming the essentially visuospatial origin of the disturbance. In the light of this report, the common cognitive denominator is hypothesized to be an impairment in mental manipulation of images and not in body schem

Second language performances in elderly bilinguals and individuals with dementia: The role of L2 immersion

With the population aging and an increase in the number of senior immigrant citizens in modern societies, public health systems will be increasingly burdened with the need to deal with the care and treatment of bi- or multilingual individuals with cognitive decline and dementia. This raises complex questions such as which language is better preserved in these elderly individuals, particularly for those facing dementias. The main aim of the present investigation was to study in two groups of immigrant populations whether the first language (L1) or the second language (L2) are better preserved. For this purpose, we assessed by means of cognitive and neurolinguistics testing 20 late-bilingual individuals with neurodegenerative dementia of the Alzheimer and mixed type, and compared their results to a matched control group consisting of 19 subjects. Our results suggest that L1 is not better preserved in individuals with dementia. We report a parallel decline of second language across groups, regardless of the presence of dementia, as well as a significant correlation between language immersion and L2 relative performances (r = 0.379, p = 0.03). Moreover our data suggest that individual with dementia may have a relative sparing of syntactic L2 comprehension. These results suggest that these elderly individuals who have lived in a host country for many years, such as the subjects here investigated, may preserve similarly their L2 as much as their L1, irrespectively of the presence or absence of neurodegenerative disease, and even preserve some features of L2 processes in dementia. These results emphasize the role of immersion in language preservation