The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale:Comprehensive Assessment of Psychopathology in Down Syndrome

People with Down syndrome (DS) are prone to develop Alzheimer's disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving

The behavioral and psychological symptoms of dementia in down syndrome (BPSD-DS) scale:comprehensive assessment of psychopathology in down syndrome

Behavioral and psychological symptoms of dementia (BPSD) have not been comprehensively studied in people with Down syndrome, despite their high risk on dementia. A novel evaluation scale was developed to identify the nature, frequency and severity of behavioral changes (83 behavioral items in 12 clinically defined sections). Central aim was to identify items that change in relation to the dementia status. Structured interviews were conducted with informants of people with Down syndrome without dementia (DS, N = 149), with questionable dementia (DS + TD, N = 65) and with diagnosed dementia (DS + AD, N = 67). Group comparisons showed a pronounced increase in frequency and severity of items about anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and, eating/drinking behavior. The proportion of individuals presenting an increase was highest in the DS + AD group and lowest in the DS group. Interestingly, among DS + TD individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy and depressive symptoms, suggesting that these changes may be early alarm signals of dementia. The scale may contribute to a better understanding of the changes, adapting daily care/support, and providing suitable therapies to people with Down syndrome. The scale needs to be optimized based on the results and experiences. The applicability, reliability and validity require further study

Somatosensory modulation of perceptual vestibular detection

Vestibular-multisensory interactions are essential for self-motion, navigation and postural stability. Despite evidence suggesting shared brain areas between vestibular and somatosensory inputs, no study has yet investigated whether somatosensory information influences vestibular perception. Here, we used signal detection methods to identify whether somatosensory stimulation might interact with vestibular events in a vestibular detection task. Participants were instructed to detect near-threshold vestibular roll-rotation sensations delivered by galvanic vestibular stimulation in one-half of experimental trials. A vibrotactile signal occurred to the index fingers of both hands in half of the trials, independent of vestibular signals. We found that vibrotactile somatosensory stimulation decreased perceptual vestibular sensitivity. The results are compatible with a gain regulation mechanism between vestibular and somatosensory modalities

Caloric vestibular stimulation modulates nociceptive evoked potentials

Vestibular stimulation has been reported to alleviate central pain. Clinical and physiological studies confirm pervasive interactions between vestibular signals and somatosensory circuits, including nociception. However, the neural mechanisms underlying vestibular-induced analgesia remain unclear, and previous clinical studies cannot rule out explanations based on alternative, non-specific effects such as distraction or placebo. To investigate how vestibular inputs influence nociception, we combined caloric vestibular stimulation (CVS) with psychophysical and electrocortical responses elicited by nociceptive-specific laser stimulation in humans (laser-evoked potentials, LEPs). Cold water CVS applied to the left ear resulted in significantly lower subjective pain intensity for experimental laser pain to the left hand immediately after CVS, relative both to before CVS and to 1 h after CVS. This transient reduction in pain perception was associated with reduced amplitude of all LEP components, including the early N1 wave reflecting the first arrival of nociceptive input to primary somatosensory cortex. We conclude that cold left ear CVS elicits a modulation of both nociceptive processing and pain perception. The analgesic effect induced by CVS could be mediated either by subcortical gating of the ascending nociceptive input, or by direct modulation of the primary somatosensory cortex

The role of delta and theta oscillations during ego-motion in healthy adult volunteers

The successful cortical processing of multisensory input typically requires the integration of data represented in different reference systems to perform many fundamental tasks, such as bipedal locomotion. Animal studies have provided insights into the integration processes performed by the neocortex and have identified region specific tuning curves for different reference frames during ego-motion. Yet, there remains almost no data on this topic in humans. In this study, an experiment originally performed in animal research with the aim to identify brain regions modulated by the position of the head and eyes relative to a translational ego-motion was adapted for humans. Subjects sitting on a motion platform were accelerated along a translational pathway with either eyes and head aligned or a 20° yaw-plane offset relative to the motion direction while EEG was recorded. Using a distributed source localization approach, it was found that activity in area PFm, a part of Brodmann area 40, was modulated by the congruency of translational motion direction, eye, and head position. In addition, an asymmetry between the hemispheres in the opercular-insular region was observed during the cortical processing of the vestibular input. A frequency specific analysis revealed that low-frequency oscillations in the delta- and theta-band are modulated by vestibular stimulation. Source-localization estimated that the observed low-frequency oscillations are generated by vestibular core-regions, such as the parieto-opercular region and frontal areas like the mid-orbital gyrus and the medial frontal gyrus

EP 34. Functional hierarchy within the neural network for optokinetic 'look' nystagmus

Key nodes of neural networks for ocular motor control and visual motion processing have been localized using saccades, smooth pursuit, and optokinetic nystagmus (OKN). Within the context of an independent fMRI study using OKN, 9 bilateral network nodes were localized comprising cortical eye fields in frontal (FEF), supplementary motor (SEF), cingulate (CEF) and parietal cortex (PEF), visual motion centers MT+ and V6, the superior colliculus (SC), the lateral geniculate nucleus (LGN) and the globus pallidus (GP). Here, we examined the network's functional hierarchy as present in the structural co-variation (SCoV) and resting-state (RS) fMRI, and the effect of RS condition (eyes open/closed) on its' functional connectivity (FC). Two publicly available samples were analyzed consisting of the enhanced NKI sample with RS (TR 1.4s) and structural MR data (n = 124; age 46.7 ± 17.6; 40 male) and the "Beijing: eyes open eyes closed sample" measuring RS (TR 2s; n = 48; age 22.5 ± 2.2; 24 male). For the FC analysis, ICA-based denoising (FSL) was applied before spatial preprocessing (SPM) and band-pass filtering. Each bilateral ROI was represented by the first eigenvariate of the respective voxels' time-series and partial correlation were computed using FSLNets. One group t-tests were computed over Fisher's z transformed correlation coefficients. Each ROIs volume was approximated with voxel-based morphometry (VBM8) using non-linearly modulated gray matter density and partial correlations were computed for SCoV. Hierarchical cluster analysis was applied to determine sub-clustering within the OKN network. Edge-wise comparisons between RS conditions were performed using permutation testing and Bonferroni correction. Both FC and SCoV revealed two major subcluster. MT+ and V6 were similar to LGN and SC. The cortical eye fields clustered together with the GP. As effect of RS condition, with eyes closed the CEF switched to the visual subcluster. The edge-wise comparison revealed generally higher FC with eyes open and in particular a decrease of FC between MT+ and PEF, FEF and SEF as well as between V6 and SEF. Hierarchical clustering based on RS and structural data revealed a task-independent sub-division of the network for ocular-motor control and visual motion processing into two streams either involved in top-down (efferent voluntary) ocular-motor control (FEF, PEF, SEF, GP) and in more bottom-up visual target tracking (MT+, V6, LGN, SC) streams. This general network hierarchy was equally present in the RS with eyes open and eyes closed, with the CEF fulfilling a condition specific role in the network. The edge-wise comparison between RS conditions strengthens the evidence for a specific influence of MT+ on the ocular-motor control subcluster. These findings indicate a systematic influence of the resting condition not only on FC of the visual system, but on the state of the whole OKN network, while a general system hierarchy is omnipresent independent of RS condition