Pragmatic language disorder in Parkinson's disease and the potential effect of cognitive reserve

It is known that patients with Parkinson\u2019s Disease (PD) may show deficits in several areas of cognition, including speech and language abilities. One domain of particular interest is pragmatics, which refers to the capacity of using language in context for a successful communication. Several studies showed that some specific aspects of pragmatics \u2013 both in production and in comprehension \u2013 might be impaired in patients with PD. However, a clear picture of pragmatic abilities in PD is still missing, as most of the existing studies focused on specific aspects of the pragmatic competence rather than on sketching a complete pragmatic profile. Moreover, little is known on the potential role of protective factors in compensating the decline of communicative skills as the disease progresses. The present study has two aims: (1) to provide a complete picture of pragmatic abilities in patients with PD, by using a comprehensive battery (Assessment of Pragmatic Abilities and Cognitive Substrates, APACS) and by investigating the relationship with other aspects of cognitive functioning (e.g., working memory and Theory of Mind) and (2) to investigate whether Cognitive Reserve, i.e., the resilience to cognitive impairment provided by life experiences and activities, may compensate for the progressive pragmatic deficits in PD. We found that patients with PD, compared to healthy matched controls, had worse performance in discourse production and in the description of scenes, and that these impairments were tightly correlated with the severity of motor impairment, suggesting reduced intentionality of engaging in a communicative exchange. Patients with PD showed also an impairment in comprehending texts and humor, suggesting a problem in inferring from stories, which was related to general cognitive impairment. Notably, we did not find any significant difference between patients and controls in figurative language comprehension, a domain that is commonly impaired in other neurodegenerative diseases. This might be indicative of a specific profile of pragmatic impairment in patients with PD, worth of further investigation. Finally, Cognitive Reserve measures showed a high degree of association with pragmatic comprehension abilities, suggesting that the modification of life-styles could be a good candidate for compensating the possible problems in understanding the pragmatic aspects of language experienced by patients with PD

Buildings energy performance and real estate market value: An application of the spatial auto regressive (SAR) model

The paper explores the role of the buildings energy performance in the definition of the real estate market value, taking in consideration the presence of spatial auto-correlation. At this regard, it is necessary to put in evidence that a great heterogeneity exists on the Italian territory with reference to buildings ener-gy performance; for this reason, being able to identify a class of most performing estimation models, suitable to separate the spatial effects from the influence of the building components - including the energy rating - on the value, seems to be an interesting goal. In particular, this work illustrates an experiment based on the Spatial Auto Regressive (SAR) model implemented on a sample of residential units located in the city of Turin and represents a first step of a more wide research program

The Doctrine of Crashworthiness in Texas: Movement toward a Workable Solution Procedure Forum - Comment.

Abstract Forthcoming

A Public Official May Be Granted Punitive Damages without Seeking or Recovering Actual Damages if the Statement is Libelous Per Se.

Abstract forthcoming

Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype?

Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory

Decoding movement kinematics from EEG using an interpretable convolutional neural network

Continuous decoding of hand kinematics has been recently explored for the intuitive control of electroencephalography (EEG)-based Brain-Computer Interfaces (BCIs). Deep neural networks (DNNs) are emerging as powerful decoders, for their ability to automatically learn features from lightly pre-processed signals. However, DNNs for kinematics decoding lack in the interpretability of the learned features and are only used to realize within-subject decoders without testing other training approaches potentially beneficial for reducing calibration time, such as transfer learning. Here, we aim to overcome these limitations by using an interpretable convolutional neural network (ICNN) to decode 2-D hand kinematics (position and velocity) from EEG in a pursuit tracking task performed by 13 participants. The ICNN is trained using both within-subject and cross-subject strategies, and also testing the feasibility of transferring the knowledge learned on other subjects on a new one. Moreover, the network eases the interpretation of learned spectral and spatial EEG features. Our ICNN outperformed most of the other state-of-the-art decoders, showing the best trade-off between performance, size, and training time. Furthermore, transfer learning improved kinematics prediction in the low data regime. The network attributed the highest relevance for decoding to the delta-band across all subjects, and to higher frequencies (alpha, beta, low-gamma) for a cluster of them; contralateral central and parieto-occipital sites were the most relevant, reflecting the involvement of sensorimotor, visual and visuo-motor processing. The approach improved the quality of kinematics prediction from the EEG, at the same time allowing interpretation of the most relevant spectral and spatial features

Clinical features and pathophysiology of disorders of arousal in adults: A window into the sleeping brain

Introduction: Disorders of Arousal (DoA) are NREM parasomnias that have been typically regarded as self-limited childhood manifestations. It is now clear that DoA can persist in adults, often presenting with distinctive characteristics. So far, few studies have described the clinical course and characteristics of DoA in adulthood, therefore a large part of their semiology is ignored. The aim of this study is to describe the clinical manifestations of DoA in an adult population and to provide a pathophysiological interpretation of their features. Methods: We screened our database for all 1,600 adult ( 6515 years) patients with sleep-related motor behaviors between 1995 and 2016. We identified 45 patients with typical DoA episodes, of whom a complete history, neurological examination and diagnostic video-polysomnography (VPSG) were available. All patients provided a detailed description of their episodes (with particular regards to semiology, frequency, and association with stressful life events) in different life periods. VPSG recordings were reviewed and DoA episodes were identified and assigned to three different categories according to their complexity. Results: Our population was composed of 45 adult patients ranging between 15 and 76 years. Sleepwalking was reported by 86% of patients, possibly associated with complex interactions with the environment and violent behaviors in 53% of cases; distressing mental contents were reported by 64%. Recall of the episodes was reported in 77% of patients. Non-restorative sleep was reported in 46% of patients. Stress was a potential episode trigger in 80% of patients. VPSG recordings documented 334 DoA episodes. According to our classification of motor patterns, 282 episodes (84%) were Simple Arousal Movements (SAMs), 34 (10%) Rapid Arousal Movements (RAMs) and 18 (5%) Complex Arousal Movements (CAMs). Discussion: Our study confirms that DoA in adulthood present with distinctive characteristics, such as non-restorative sleep, violence and complex, or bizarre behaviors. Alternative classifications of DoA based on motor patterns could be useful to characterize DoA episodes in adults, as different motor patterns often coexist in the same individual and minor episodes are more common but generally underreported by patients. Prospective studies are needed for a definitive characterization of DoA in adulthood throughout the life course