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

Taking advantage of difficulties. Variable rate application based on canopy maps to achieve a sustainable crop protection process

The aim of this work wasto evaluate the use of Variable Rate Application technologies based on prescription maps in commercial vineyards with large intra-parcel variability to achieve a more sustainable distribution of Plant Protection Products (PPP).This research was funded by the project Gophytovid: Optimización del uso de fitosanitarios en viticultura en base a mapas de vigor (Rural development 2014-2020 for Operational Groups)Postprint (published version

“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

Cognitive impairment as predictor of functional dependence in an elderly sample

[Abstract] This retrospective study determines the role of cognitive decline as a predictor of functional dependence. In a representative 600 community-dwellers aged 65 or older, we examined using a logistic regression model, the association between cognitive status (taking into account age and educational level) and dependence on basic and instrumental activities of daily living (ADL and IADL, resp.), controlling for socio-demographic variables and health conditions. The Mini-Mental State Examination (MMSE) scores were compared in participants with functional disability to perform basic and instrumental activities. Cognitive status influenced functional dependence on activities of daily living, basic (OR = 4.1, 95%CI = 2.7–6.1) and instrumental (OR = 5.7, 95%CI = 3.5–9.3), independently of gender, age, educational level and health conditions. Besides, cognitive impairment was associated with the dependence on certain basic (e.g., bathing, toileting) and instrumental (e.g., using the telephone, taking medications, and handling finances) activities. This was a gradual relationship, the highest cognitive decline implied the highest loss of ability at carrying out activities, with a larger impact on basic activities. These findings suggest that cognitive decline can be a predictor for functional dependence, independently of other variables, and turn into a very useful tool indicating the need for support

Prevalence of cognitive impariment: effects of level of education, age, sex, and associated factors

[Abstract] Aims: To examine the prevalence of cognitive impairment in a Spanish elderly population and to analyse its association with some social and medical factors. Methods: We randomly selected a representative sample (n = 600) of people over 65 from Narón Council (A Coruña). Socio-demographic and biomedical data were collected and cognitive status was assessed using the Mini-Mental State Examination (MMSE). Results: We determined variations in the prevalence from 35.2%, when age or level of education distribution was not applied, to 22.2% when they were applied. Women showed a higher probability of cognitive impairment than men. Negative correlation was observed between the age of the subject and the MMSE secore (Spearman correlation p = -0.45, p < 0.001), with the possibility of developing cognitive impairment increasing each year. For our sample, cognitive impairment was associated with an increase of morbidity and mortality in the elderly population. This association was found with the presence of dementia. heart failure. anaemia, stroke and auditory deficits. Conclusions: Knowledge of the real prevalence rates, together with the establishment of adequate preventive and intervention measures, can be factors that may diminish the socio-sanitary impact of cognitive impairment

Accesibility and usability of computer-based cognitive stimulation: Telecognitio®

[Resumen] Introducción: A pesar del gran avance de la tecnología en el campo de la intervención cognitiva computarizada, existen muy pocos estudios que sirvan de guía para la mejora del diseño de este tipo de herramientas dirigidas a las personas mayores. El objetivo principal de este trabajo es realizar una aproximación al grado de adaptación de dos aplicaciones de psicoestimulación utilizadas en nuestro medio. Así´ mismo, a través de la observación de los problemas de uso de estas dos aplicaciones uso en una pequeña muestra de personas mayores, se elabora una tabla de requisitos mínimos que a nuestro juicio deberían cumplir. Finalmente, se presenta Telecognitio®, una aplicación para la estimulación cognitiva de los mayores que incorpora ciertas funcionalidades de interés. Material y métodos: Se evalúa el uso de dos herramientas de intervención cognitiva sobre una muestra de sujetos mayores a través de un cuestionario elaborado al efecto. Se realiza un análisis descriptivo de los resultados obtenidos y se sugieren posibles relaciones entre los resultados y el nivel cognitivo del sujeto. Resultados: Observamos que las personas mayores, especialmente si tienen deterioro cognitivo, presentan dificultades en la comprensión de los enunciados que transmiten las instrucciones para las diferentes actividades. Así mismo, el tiempo para responder a las cuestiones planteadas parece ser insuficiente. Cuando la pantalla es táctil se producen errores, tanto de precisión como de mantenimiento de la presión, aunque el uso de este dispositivo resulte más intuitivo que el ratón convencional. Conclusiones: Las aplicaciones computarizadas de valoración y estimulación cognitiva van a constituirse en herramientas de uso generalizado entre la población de personas mayores, por lo que sería conveniente adaptarlas mejorando su accesibilidad y usabilidad.[Abstract] Introduction: Despite of the huge technological advance in the field of computer-based cognitive interventions, very few applications have been designed to be used by the elderly. The main objective of this study was to assess the adaptability of two psycho-stimulation applications used in geriatrics. A further aim was to design a table of the minimum requirements to be met through the use of these applications in a small sample of elders. In addition, Telecognitios® —an application with some interesting functionalities— is presented. Material and methods: We performed a pilot test of two cognitive intervention tools, which were evaluated by a sample of elderly people through a specifically designed questionnaire. A descriptive study of the results was performed, as well as of the possible correspondence between the subjects’ cognitive status and the results. Results: The results of this study indicate that, in general, elderly people and especially those with cognitive impairment had difficulties in understanding the instructions for the various activities, as well as little time to answer the questions. In the case of a touch screen, errors occurred, both due to accuracy and pulse time, although this device is more intuitive than the conventional mouse. Conclusions: Computer-based cognitive stimulation and evaluation applications will become widely used among the elderly. Therefore, these applications should be adapted for universal accessibility and usability

Prevalence of functional disability in activities of daily living (ADL), instrumental activities of daily living (IADL) and associated factors, as predictors of morbidity and mortality

[Abstract] The aim of this study is to establish the existing relationship among variables referred to the person, specifically age and gender, and the functional dependence in basic ADL and in IADL, as well as the possible relationship it has with the increase of morbidity and mortality in a random sample of 598 individuals older than 65 years. Of these individuals, 34.6% were categorized as dependent for at least one ADL, and 53.5% if we refer to IADL. Regarding the ADL, the risk of dependence increases (odds ratio = OR = 1.089) per year of age, (OR = 2.48) in women’s case; while there is an IADL correlation between age and the score (r = +- 0.527; p < 0.001). A relationship exists between dependence and the days of hospitalization (for ADL: r = +- 0.12, p = 0.018 and IADL: r = +- 0.97, p = 0.003), the number of visits to the doctor (ADL: r = +- 0.27, p < 0.001; IADL: r = +- 0.25, p < 0.001) or the presence of concomitant pathologies such as dementia (ADL: p < 0.001; IADL: p < 0.001). There is a significant association between age, gender and dependence, as well as between dependence and morbidity and mortality, so that dependence could be used as a predictor of both

Graphic Engineering in the Sustainable Preservation of the Municipal Heritage of Montilla (Cordoba, Spain) from the 18th Century: Master Builder Vicente López Cardera in Montilla

The change of territorial organisation in the 18th century in Spain was strongly related to the preservation of the local heritage. Academic architects, military engineers, and master builders coexisted to carry out the design and management of municipal construction works. The evolution of the figure of the master builder and the confrontation with architects and the guilds since the creation of the Royal Academy of Fine Arts of San Fernando posed an inflection point in this aspect. The first aim of the present study was to highlight the figure of Vicente López Cardera, master builder in the Council and Diocese of Córdoba between the late 18th century and the early 19th century, through his work on the municipal interventions in the maintenance of the construction works and infrastructures in Montilla (Córdoba, Spain) around the year 1794. The second aim of the study was to emphasise the role of graphic engineering in the conservation of municipal heritage in the Modern Age through the study of drawings and plans provided by him in the analysed documentation. His thinking in the approach to these works fits with the ideas of social hygienic improvements that began with the Enlightenment as well as with the concept of sustainable development in culture; hence, his work is relevant in the sustainable development planning of cities in the present. With this study, missing heritage elements are also revealed, opening future lines of research that lead to their virtual reconstruction and the promotion of tourism in rural areas

Strengthening Efforts to Protect and Safeguard the Industrial Cultural Heritage in Montilla-Moriles (PDO). Characterisation of Historic Wineries

Industrial heritage is linked to the cultural processes that human society sets through the traces from the past. The conservation and dissemination of this industrial–cultural heritage are crucial for sustainable urban development, and positively influences the transition to resilient and sustainable cities. The wine industry around Montilla has suffered as a result of a sharp reduction of the vineyard area in the last 25 years. Wineries, as one of the historic typologies of wine-making facilities in the Montilla-Moriles Protected Designation of Origin (PDO), as well as their materials and construction techniques, are a reference in the agricultural landscape of Montilla. Many historic wineries are the result of the abandonment and cessation of the wine industry. These buildings are linked to the agrarian activity in this area, mostly wine-making, although in some cases, they coexist with similar production processes, such as milling the fruit of the olive grove. This research characterises and analyses four historic wineries in the Montilla-Moriles PDO, which represent an example of architecture in the wine-making transformation during the 19th–20th centuries. This manuscript contributes to the attainment of some objectives set in one of the Sustainable Development Goals (SDGs), protecting and disseminating the industrial cultural heritage in Montilla-Moriles

A reappraisal of echolalia in aphasia: A case-series study with multimodal neuroimaging

Introduction: Verbal echoes are commonplace in patients with aphasia, yet information on their cognitive and neural mechanisms remains unexplored (Berthier et al., in press). This study aims to instantiate the concept of echolalia (Berthier et al., 2016) by reappraising its relevance in the frame of modern neuroscience in three different types: (1) automatic echolalia (AE) (parrot-like repetition of all verbal stimuli); (2) mitigated echolalia (ME) (changes in echoes for communicative purposes), and (3) effortful echolalia (EE) (echolalia with articulatory struggling, distorted prosody, and increased effort). Methods: Case-series study of three variants of echolalia in three patients with chronic post-stroke aphasia using cognitive testing and multimodal imaging including structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI) during repetition of words and non-words, and resting state fMRI (rsfMRI). Patient 1 had mixed transcortical aphasia (mutism and nil auditory comprehension with intact repetition). Patient 2 had residual Wernicke’s aphasia with mildly impaired auditory comprehension; and patient 3 had Broca’s aphasia with impaired syntactic comprehension. Results: Patient 1 had severe AE associated with two large lesions in the left dorsolateral and mesial frontal lobe and the left temporo-parietal cortex (isolation of speech area). DTI revealed absent left dorsal and ventral streams and full development of right white matter tracts. Using fMRI and rsfMRI a compensatory activity in both cerebral hemispheres (right greater than left) was found. Patient 2 had ME associated with DTI-proven incomplete damage to the left dorsal stream and complete damaged to the left ventral stream. fMRI and rsfMRI revealed compensatory activity via right hemisphere structures. Patient 3 had EE associated to a large lesion in the left perisylvian language core. Discussion:Our study revealed heterogeneous aphasic profiles and cognitive deficits in the different types of echolalia amongst patients with chronic aphasia. In addition, multimodal imaging showed a complex pattern of network rearrangement in both cerebral hemispheres which depended upon the localization of the structural lesion. Our preliminary findings set out a starting point to advance research on echolalia eventually providing hints for neurorehabilitation. References: Berthier ML et al.. P. Coppens and J. Patterson (Eds.). Jones & Bartlett Learning, Burlington, MA (2016) Berthier ML et al. Aphasiology (2017)Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech