Into the future with little past: exploring mental time travel in a patient with damage to the mammillary bodies/fornix

Objective: Remembering the past and imaging the future are both manifestations of ‘mental time travel’. These processes have been found to be impaired in patients with bilateral hippocampal lesions. Here, we examined the question of whether future thinking is affected by other Papez circuit lesions, namely: damage to the mammillary bodies/fornix. Method: Case (SL) was a 43-year-old woman who developed dense anterograde and retrograde amnesia suddenly, as a result of Wernicke–Korsakoff’s syndrome. A region of interest volumetric Magnetic resonance imaging (MRI) analysis was performed. We assessed past and future thinking in SL and 11 control subjects of similar age and education with the adapted Autobiographical Interview (AI). Participants also completed a battery of neuropsychological tests. Results: Volumetric MRI analyses revealed severely reduced fornix and mammillary body volumes, but intact hippocampi. SL showed substantial, albeit temporally graded retrograde memory deficits on the adapted AI. Strikingly, whilst SL could not provide any specific details of events from the past two weeks or past two years and had impaired recall of events from her late 30s, her descriptions of potential future events were normal in number of event details and plausibility. Conclusions: This dissociation of past and future events’ performance after mammillary body and fornix damage is at odds with the findings of the majority of patients with adult onset hippocampal amnesia. It suggests that these non-hippocampal regions of the Papez circuit are only critical for past event retrieval and not for the generation of possible future events

A national harmonised data collection network for neurodevelopmental disorders: A transdiagnostic assessment protocol for neurodevelopment, mental health, functioning and well-being

BACKGROUND: Children with neurodevelopmental disorders share common phenotypes, support needs and comorbidities. Such overlap suggests the value of transdiagnostic assessment pathways that contribute to knowledge about research and clinical needs of these children and their families. Despite this, large transdiagnostic data collection networks for neurodevelopmental disorders are not well developed. This paper describes the development of a nationally supported transdiagnostic clinical and research assessment protocol across Australia. The vision is to establish a harmonised network for data collection and collaboration that promotes transdiagnostic clinical practice and research. METHODS: Clinicians, researchers and community groups across Australia were consulted using surveys and national summits to identify assessment instruments and unmet needs. A national research committee was formed and, using a consensus approach, selected assessment instruments according to pre-determined criteria to form a harmonised transdiagnostic assessment protocol. RESULTS: Identified assessment instruments were clustered into domains of transdiagnostic assessment needs, which included child functioning/quality of life, child mental health, caregiver mental health, and family background information. From this, the research committee identified a core set of nine measures and an extended set of 14 measures that capture these domains with potential for further modifications as recommended by clinicians, researchers and community members. CONCLUSION: The protocol proposed here was established through a strong partnership between clinicians, researchers and the community. It will enable (i) consensus driven transdiagnostic clinical assessments for children with neurodevelopmental disorders, and (ii) research studies that will inform large transdiagnostic datasets across neurodevelopmental disorders and that can be used to inform research and policy beyond narrow diagnostic groups. The long-term vision is to use this framework to facilitate collaboration across clinics to enable large-scale data collection and research. Ultimately, the transdiagnostic assessment data can be used to inform practice and improve the lives of children with neurodevelopmental disorders and their families

Grey and white matter correlates of recent and remote autobiographical memory retrieval:Insights from the dementias

The capacity to remember self-referential past events relies on the integrity of a distributed neural network. Controversy exists, however, regarding the involvement of specific brain structures for the retrieval of recently experienced versus more distant events. Here, we explored how characteristic patterns of atrophy in neurodegenerative disorders differentially disrupt remote versus recent autobiographical memory. Eleven behavioural-variant frontotemporal dementia, 10 semantic dementia, 15 Alzheimer's disease patients and 14 healthy older Controls completed the Autobiographical Interview. All patient groups displayed significant remote memory impairments relative to Controls. Similarly, recent period retrieval was significantly compromised in behavioural-variant frontotemporal dementia and Alzheimer's disease, yet semantic dementia patients scored in line with Controls. Voxel-based morphometry and diffusion tensor imaging analyses, for all participants combined, were conducted to investigate grey and white matter correlates of remote and recent autobiographical memory retrieval. Neural correlates common to both recent and remote time periods were identified, including the hippocampus, medial prefrontal, and frontopolar cortices, and the forceps minor and left hippocampal portion of the cingulum bundle. Regions exclusively implicated in each time period were also identified. The integrity of the anterior temporal cortices was related to the retrieval of remote memories, whereas the posterior cingulate cortex emerged as a structure significantly associated with recent autobiographical memory retrieval. This study represents the first investigation of the grey and white matter correlates of remote and recent autobiographical memory retrieval in neurodegenerative disorders. Our findings demonstrate the importance of core brain structures, including the medial prefrontal cortex and hippocampus, irrespective of time period, and point towards the contribution of discrete regions in mediating successful retrieval of distant versus recently experienced events

Sleep Outcomes in Paediatric Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prevalence and Contributing Factors

The aim of this systematic review and meta-analysis is to establish the prevalence of sleep disturbances in children that have experienced a mild traumatic brain injury (mTBI) and to explore various psychological and cognitive outcomes that may moderate this relationship. We present the protocol for this systematic review and meta-analysis

A novel cognitive behavioural intervention with Theory of Mind (ToM) training for children with epilepsy: protocol for a case series feasibility study

Abstract Background Children with epilepsy have significant social impairments, yet evidence-based interventions to address these social difficulties are lacking. Emerging research has shown that social difficulties in children with epilepsy relate to underlying impairments in Theory of Mind (ToM). This paper outlines the protocol for a pilot study that will evaluate the feasibility, acceptability, and efficacy of a novel cognitive behavioural intervention with ToM training for children with epilepsy. Methods The intervention will be evaluated in a single-arm case series feasibility study. Ten to 12 children with common forms of epilepsy (8 to 12 years old) will be recruited to participate in 4 small group workshops, held over 4 consecutive weeks. Parents will attend a brief review at the end of each session with their child. Children will complete 4 one-to-one assessments with an investigator assessing ToM and social competence: twice at baseline (4 weeks and 1 day before the intervention), at post-intervention (last day of the intervention) and at follow-up (4 weeks post intervention). Parents will complete online questionnaires at these same 4 time points assessing ToM and social competence of their child. Parents and children will both complete a weekly measure of social competence from baseline 1 to follow-up. Following completion of the intervention, parents will complete two standardised questionnaires assessing treatment acceptability and barriers and facilitators to attendance; children will complete a single questionnaire on treatment acceptability. Information about feasibility outcomes (i.e. recruitment and retention, processing time, suitability of tasks) will be gathered by investigators during the trial. Together, outcomes will be used to refine research methods and make a decision about whether the intervention should be evaluated in a larger scale trial. Discussion To our knowledge, this is the first psychosocial intervention to address social competence problems in children with epilepsy. Findings will provide information about a potentially effective treatment that could improve longer term social outcomes for this group. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12618000974202, registered June 8 2018

Retrograde Memory in Patients with Focal Brain Lesions

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Data_Sheet_1_Outcomes of remotely delivered behavioral insomnia interventions for children and adolescents: systematic review of randomized controlled trials.docx

Pediatric insomnia is common and can be effectively treated with behavioral therapies delivered face-to face. Such treatments could also improve children's mood, cognition, and quality of life, and caregivers' wellbeing. There is a discrepancy between high needs and limited access to pediatric behavioral insomnia treatments, which could be improved by provision of technology enhanced interventions. No study reviewed outcomes of randomized controlled trials (RCTs) of remotely delivered psychological treatments for pediatric insomnia. The current study aimed to examine (i) the outcomes of remotely delivered RCTs for pediatric insomnia/insomnia symptoms and (ii) whether gains made in treatment extend to functional correlates. We conducted a systematic review according to Cochrane and PRISMA guidelines. PsychINFO, PubMed/Medline and Cochrane CENTRAL databases were searched for RCTs reporting on remotely delivered behavioral treatments for insomnia and insomnia symptoms. Data was abstracted and the risk of bias were assessed in November 2022 and November 2023. Seven RCTs (nine manuscripts) involving 786 participants, with the mean age from 19.3 months to 16.9 years, were identified. Four different treatments were used. Risk of bias ranged from low to high and was the highest for the randomization process. Across studies, significant improvements were found in some (but not all) sleep parameters, namely: sleep quality and sleep efficacy on questionnaires and on actigraphy, despite heterogeneity of the treatments used, age of participants and instruments employed to assess outcomes. Improvements gained in treatments delivered remotely was compared to treatments delivered face-to-face in 3 studies and were found to be comparable or slightly lower. No worsening was observed on either objective or subjective measures of sleep, except for sleep onset latency and wake after sleep onset that improved on questionnaires but worsened on actigraphy in one study each. Children's mood improved across studies on parent and self-report measures. Other possible functional gains were understudied. Our study provides preliminary evidence of improved sleep following remotely delivered behavioral treatments for pediatric insomnia, and improvements in children's mood. Further research is needed to develop individualized treatments that will cater for different developmental needs and types of insomnia symptoms and examine not only group but also individual outcomes.</p

Pregnancy-related knowledge and information needs of women with epilepsy : a systematic review

For women with epilepsy (WWE), pregnancy is complicated by considerations such as the potential teratogenicity of antiepileptic drugs (AEDs) versus the risks of having seizures during pregnancy. However, qualitative research suggests that many WWE remain uninformed about the risks associated with epilepsy and pregnancy and may, therefore, be making uninformed decisions about their families. The objectives of this review were to determine the level of patient knowledge, their informational needs, and whether these needs concerning pregnancy and childbirth issues are met among WWE. Electronic databases searched were PsycINFO, MEDLINE, Embase, CINAHL, and Web of Science. Studies were included if they used quantitative methods to survey WWE aged 16. years or older about their knowledge, access to information, or informational needs specifically regarding epilepsy and pregnancy. Twelve studies were identified and assessed for research standards using the Quality Index. Overall Quality Index score was only 7.1 out of 14, indicating significant design limitations of many included studies, including highly selective sampling methods and the use of unvalidated outcome measures. There was a paucity of studies investigating specific areas of women's knowledge and information needs. Overall, WWE reported adequate awareness, but limited knowledge, of key issues regarding pregnancy and childbirth. Across studies, many women reported not receiving information about these issues. Evidence suggested that many WWE wanted to receive more information - particularly about the risks of AEDs for their offspring - well in advance of choosing an AED or planning pregnancy. Women aged under 35. years wanted the most information. Preconception counseling received by many WWE appears insufficient, risking uninformed decision-making about pregnancy. Further research is needed to investigate the barriers that WWE face in accessing, receiving, and retaining appropriate information.10 page(s

Memory for the past after temporal lobectomy: impact of epilepsy and cognitive variables

A few previous studies have revealed impairments in remote memory in patients with temporal lobe epilepsy, but many questions about the importance of lesion side, type of material, seizure history and deficits in other aspects of cognitive functions remain unanswered. In this study, patients who had undergone unilateral (15 right and 15 left) temporal lobectomy (TL) for the relief of epilepsy and 15 control subjects completed a range of public and autobiographical memory tests. Deficits in recall and recognition of details related to past famous world events were observed for both left and right TL groups. In addition, the left TL group showed impaired retrieval of famous names and TL patients as a group generated significantly fewer names of people from their own past. Current seizure- and medication-status influenced performance on a few measures, but duration of epilepsy and age of onset had no significant impact. Underlying cognitive deficits (especially naming ability) contributed to, but could not completely explain difficulties remembering the past. In particular, deficits in the ability to retrieve highly specific information learned in the past, such as names of famous people or details about famous events, remained evident in analyses that controlled for the impact of related cognitive skills.14 page(s