Neurobehavioral changes in people with post-stroke aphasia

At present, research on neurobehavioral disorders in people with post-stroke aphasia is scarce, especially in Spanish. The objective of this study is to design a new scale on neurobehavioral change, the Scale of Neurobehavioral Affectation in Aphasia (EANA, in Spanish) and to evaluate 14 people affected by chronic post-stroke aphasia (mean age: 51/ DT: 7.2) together with their main informants. At the same time, psychiatric (Neuropsychiatric Inventory, Hospital Anxiety and Depression Scale, Stroke Aphasic Depression Questionnaire), cognitive (Mini Mental State examination, Informer Test) and functional instruments (Stroke and Aphaisa Quality of Life Scale and Barthel Index) have been used to provide a multidimensional description of the affected persons. The results show statistically significant neurobehavioral changes in multiple domains. According to the EANA, those affected with post-stroke aphasia communicate with less frequently, show more introversion, shyness, dependence and apathy, behave in a more infantile manner ("makes me grimaces"), in addition to showing heightened anxiety and impulsivity. Finally, the informants report more aggressive acts, both verbal (insults) and physical (throwing objects, hitting both objects as persons), that did not occur before the stroke. According to the psychiatric instruments, many of the affected cope with anxiety, agitation and apathy, as well as mild depression. At a cognitive level, affected individuals show mild to moderate deficits, especially in working memory and temporal orientation. Functionally most individuals maintain a medium-high level of functional independence in daily activities. These findings support the inclusion of recommendations for the routine assessment and management of neurobehavioral changes to help optimize long-term recovery in people with stroke and aphasia.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Latinos in Massachusetts: An Update

This research report updates the socioeconomic picture of Latinos in Massachusetts. According to estimates contained in this report, the Latino population in Massachusetts experienced vigorous growth during the first half of the 1990s. Not since the 1990 census has there been a broad profile of this rapidly growing segment of the state’s population. This information should assist the general public in understanding some of the basic issues affecting the Hispanic community. It should also be useful to the many individuals and organizations who are concerned about the future of this community and responsible for informed decision-making: elected officials, policy makers, researchers, community-based programs, advocacy groups, community and labor organizers, the business sector, and the media. The areas covered include statistics on population, age, education, employment, income, and poverty. Additional data on housing, health, criminal justice, social welfare, and other aspects of the Latino experience will be available in future reports

“Need to know” and the right temporal lobe: Impaired access to semantic knowledge in acquired obsessive-compulsive disorder?

Introduction : Idiopathic obsessive-compulsive disorder (I-OCD) has been linked to abnormalities in corticostriatal circuits. Few studies have examined if the same structures are also responsible of acquired OCD (A-OCD) or if damage to anatomically-connected brain regions (e.g., temporal lobes) are also implicated in its pathogenesis. Additionally, there are some discrete obsessive-compulsive (OC) symptoms that by virtue of their presumed low occurrence and difficultly of categorization have received less attention. Amongst these, one intriguing and potentially severe type of obsessive thinking is the so-called “need to know” (NtK), a strong drive to know and obtain given information. In some patients this specific symptom, presumably resulting from impaired access to conceptual knowledge for specific verbal information (proper names, names of places), may be the principal or major feature of OCD symptomatology. We here report the cases of two male patients who developed “NtK” as the only OC symptomatology in association with malignant neoplasms involving the right temporal lobe and connected corticostriatal circuits. Methods : We used Tractotron and Disconnectome map softwares in order to identify the regions of white matter damage overlap across both patients and the proportion of damage (lesion load) of each tract of interest for each patient. We quantified the severity of the disconnection by measuring the proportion of each tract of interest to be affected by each patient´s lesion by using Tractotron software. Additionally, Positron Emission Tomography was used in order to study metabolic abnormalities. The tracts of interest were: the uncinate fasciculus, the anterior commissure, the anterior thalamic radiations, the inferior fronto-occipital fasciculus and the inferior longitudinal fasciculus. Results : There was a high overlap across brain lesions in patients 1 and 2. There was also a high overlap between areas that were affected (disconnected) due to the lesion. As expected, all the a priori selected pathways in the right hemisphere were affected since they cross the anterior part of the temporal lobe. Disconnection maps and metabolic changes in our patients suggest that the expression of OC symptoms underpinned by a semantic deficit due to right temporal damage is secondary to involvement of the uncinate fasciculus linking the temporal pole with the orbitofrontal cortex. Discussion : Data from the present study concur with previous research on A-OCD and current findings in I-OCD which suggest that the temporal lobes participate in the phenomenological expression of OCD. Also, patients with lesions in the anterior temporal lobe are prone to show a specific “Need to Know” symptoms phenomenologically similar to patients with semantic dementia in later stages. The expression of OC symptoms underpinned by a semantic deficit because of anterior right temporal lobe lesion, are due to a disconnection of the uncinate fasciculus and the orbitofrontal cortex. Further research about the neurological underpinnings of specific OCD subtypes, its evaluation and treatment, are essential. References : Berthier ML et al. Neurology. (1996) 47: 353–61. Huey E et al. J Neuropsych Clin Neurosci (2008). 20(4):390-408 Keywords : Emotions & Social Cognition; patients; single case study; adults; psychiatric; lesion mapping, behavioural.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Aphasia with anatomical isolation of the language area: A reanalysis on the light of modern neuroimaging techniques

Introduction : Goldstein (1948) and Geschwind (1968), based in data derived from anatomical post-mortem studies, postulated that the disconnection of the perisylvian language areas (PSLA) from other cortical areas was responsible for impairments in spontaneous speech and language comprehension with preservation of verbal repetition and echolalia (isolation of speech area). Nevertheless, other mechanisms (right hemisphere or bilateral hypotheses) underlying echolalic repetition have been proposed. Herein, we examined the structure and function of the PSLAs in two cases of aphasia with echolalic repetition and isolation of the left PSLA. Methods : Two patients with chronic post-stroke aphasia associated to isolation of the left PSLA were studied. Both patients underwent cognitive-language assessment and multimodal imaging. In patient 1 (p1), structural MRI, diffusion tensor imaging (DTI), functional MRI (fMRI) during repetition of words and non-words, resting state fMRI (rsfMRI) were acquired, whereas only structural MRI was performed in patient 2 (p2). The Tractotron software was used to examine the severity of disconnection in each language-related white matter tract in both patients. We quantified the severity of the disconnection by measuring the proportion of each tract that was affected. 18FDG-PET was also acquired in both patients. Results : P1 had a mixed transcortical aphasia and p2 had a transcortical sensory/anomic aphasia. In both, the MRI showed separate left anterior and posterior lesions with relative preservation of the PSLA. In both, 18FDG-PET revealed significant decrements of metabolic activity in areas of the left PSLA, although some parts showed normal metabolic activity. In p1 the left arcuate fasciculus (AF) and the inferior fronto-occipital fasciculi (IFOF) could not be reconstructed. fMRI showed perilesional activity in the left hemisphere and increased activity in the right during word repetition. rsfMRI showed compensatory activity in both hemispheres (right greater than left). Analysis with the Tractotron software revealed disconnection of both the AF and the IFOF in the left hemisphere of both patients. Discussion : Although some parts of the left PSLA had preserved metabolic activity in both patients, our neuroimaging data revealed that preserved repetition ability did not rely exclusively on the residual activity of the left PSLA. In support, the connectivity between different components of the left PSLA was severely affected. This coupled with the increased metabolic activity of the right PSLA supports the bilateral hypothesis of residual repetition in transcortical aphasias. References : Goldstein, K. (1948). Language and Language Disturbances. Geschwind, et al. (1968). Neuropsychologia 6, 327–340.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Beneficial effects of pharmacological treatment in post-stroke dynamic aphasia: a behavioural and neuroimaging study

Introduction : Dynamic Aphasia (DA) is a rare form of language disorder characterized by reduced spontaneous speech with preservation of other language functions. Two types of DA have been described: language-specific type (type I DA) and domain-general type (type II DA). In type I DA, deficits are selective for word and sentence generation, whereas in type II DA impairments affect discourse generation, narrative, fluency, and non-verbal generation tasks. There is little information on the treatment of DA. Although treatment with a cognitive enhancing drug (bromocriptine) improved outcome in previous studies, pharmacological interventions combining two drugs acting on other neurotransmitter systems in DA have not been reported so far. Methods : We report an open-label pharmacological single case study (n = 1) in a male patient with a chronic type I/II DA secondary to an ischemic infarction in the left fronto-opercular and insular regions. After baseline evaluation, the patient received donepezil 5 mg/day (2 months), donepezil 10 mg/day (2 months), donepezil 10 mg/day plus memantine 20 mg/day (4½ months) followed by a washout period (1½ months). No speech-language therapy was used. A comprehensive cognitive and language evaluation was carried out at baseline and at different endpoints. 18FDG-PET was performed at the four timepoints. Results : Donepezil (5 mg/day) significantly improved type I DA features (normalization of verbs generation, p = 0.01), whereas donepezil (10 mg/day) improved some type II features (normalizing spontaneous speech, verbal fluency and improving generation of novel thoughts, p = 0.004), along with improvement of executive-attentional functioning. Combined therapy further enhanced cognitive function, but did not additionally improved DA. 18 FDG-PET revealed significant reductions of perilesional hypometabolic activity mainly after donepezil (10 mg/day) and washout. Discussion : Treatment with donepezil improved language deficits in a patient with chronic post-stroke type I/II DA. Combined therapy (donepezil plus memantine) further enhanced executive-attentional functioning. Beneficial changes were associated with improvements in perilesional metabolic activity. References : Luria AR et al.Acta Neurologica et Psychiatrica (1967). Robinson G et al. Brain (1998). Keywords : Language; patients; single case study; adults; cerebrovascular; behavioural, functional imaging.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

The senior universities students in Portugal and Brazil

Given the growth in the number of senior universities in Portugal and Brazil, we think it is important to know the audience which frequents these institutions, their motivations, the health impact and whether there are significant differences between the two countries. The authors have created a survey that was applied in person in Portugal and the State of Goiás in Brazil. With this study, it was possible to trace the profile of the students who attend the Senior Universities (US or U3A) in Portugal and universities open to Seniors (UNATI) in Brazil. We also added a study on volunteer teachers in the Portuguese US. We now know that are essentially women, aged 60-75 years and of all social and educational levels. As for the motives are essentially the conviviality, get active and learn. No significant differences were found between the two countries, in groups and in the motivations, with exception to the marital status and the number of courses attendedinfo:eu-repo/semantics/publishedVersio

A comprehensive assessment of food parenting practices: psychometric properties of the portuguese version of the HomeSTEAD family food practices survey and associations with children's weight and food intake

The Home Self-Administered Tool for Environmental Assessment of Activity and Diet (HomeSTEAD) survey evaluates a broad spectrum of food parenting practices related to parental use of control, autonomy support, and structure. This study aims to test the psychometric properties of the Portuguese version of the HomeSTEAD family food practices survey in parents of 3–12 year old children. Data were collected from 184 parents/caregivers. We performed an exploratory factor analysis (EFA), calculated the internal consistency coefficients of each subscale, and tested for associations with children’s food intake and weight. Based on the EFA, 61 items were included in the Portuguese version of the HomeSTEAD family food practices survey, and were distributed among four Coercive Control Practices (16 items); five Autonomy Support Practices (17 items); and nine Structure Practices (28 items). All scales demonstrated an acceptable level of internal consistency. A higher body mass index (BMI) SD score in children was associated with higher levels of restriction and weight talk by parents and distractions during meals. Higher levels of distractions during meals were also associated with higher sweets intake in children. Additionally, higher levels of parental modeling and the establishment of rules and limits were associated with lower intake of sugar-sweetened beverages. These associations provide preliminary evidence of the HomeSTEAD family food practices survey’s construct validity and attest to its potential to assess parental strategies and provide useful information to improve children’s eating

Disparities in Child and Adolescent Psychoactive Medication Prescription Practices by Race and Ethnicity

Key Points: (1) Compared to their non-Latino white counterparts, children and adolescents from racial-ethnic minority groups in the U.S. are less likely to receive prescriptions for psychoactive medication; (2) Racial-ethnic minority children and adolescents are also significantly less likely to receive mental health care; (3) Controlling for access to mental health care and for geographic variation reduces but does not eliminate variations in psychoactive prescriptions by race and ethnicity; (4) Controlling for mental health need and level of impairment does not eliminate variations in psychoactive prescriptions by race and ethnicity; (5) Reducing disparities will require coordinated efforts to educate families and providers, promotion of evidence-based practices, steps to overcome geographic and language barriers, and additional research for understanding the underlying reasons for variations in prescription patterns

Transits of Earth-Like Planets

Transmission spectroscopy of Earth-like exoplanets is a potential tool for habitability screening. Transiting planets are present-day "Rosetta Stones" for understanding extrasolar planets because they offer the possibility to characterize giant planet atmospheres and should provide an access to biomarkers in the atmospheres of Earth-like exoplanets, once they are detected. Using the Earth itself as a proxy we show the potential and limits of the transiting technique to detect biomarkers on an Earth-analog exoplanet in transit. We quantify the Earths cross section as a function of wavelength, and show the effect of each atmospheric species, aerosol, and Rayleigh scattering. Clouds do not significantly affect this picture because the opacity of the lower atmosphere from aerosol and Rayleigh losses dominates over cloud losses. We calculate the optimum signal-to-noise ratio for spectral features in the primary eclipse spectrum of an Earth-like exoplanet around a Sun-like star and also M stars, for a 6.5-m telescope in space. We find that the signal to noise values for all important spectral features are on the order of unity or less per transit - except for the closest stars - making it difficult to detect such features in one single transit, and implying that co-adding of many transits will be essential.Comment: 17 pages, 3 figures, 6 tables, to appear in ApJ (accepted) V2: corrected transit times, corrected values for M4 star radiu