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Abstract Background Patient and Public Involvement (PPI) in aphasia research requires researchers to include people with aphasia as research partners from the beginning of the study. Yet the quality of reporting on the level and type of involvement is poorly documented in the absence of a framework to guide PPI in aphasia research. This study aimed to extract the items and statements relevant for the development of the People with Aphasia and Other Layperson Involvement (PAOLI) framework for designing and implementing PPI in aphasia research, in collaboration with people with aphasia. Method The method recommended by the EQUATOR network was followed. This involved: (1) evidence from a scoping review, (2) a thematic analysis of the in-depth interviews, of people with stroke and aphasia, on the topics to be included in the pilot draft, (3) a two round Delphi survey for item/statement selection and (4) an experts’ consensus meeting. The research team involved two PPI partners with chronic stroke-induced aphasia. The research process involved co-design and was informed by the Dialogue model. Results Twenty-three panellists, from 13 countries, voted in round one with 87% (20/23) responding in round two. The final PAOLI framework includes the following 17 items (with 66 descriptive statements): establish collaborations, recruit patients, gain informed consent, organize induction meetings, train patient partners, create communication links, engage communication partners, conceptualize topics, establish research priorities, reach consensus, work with co-design methods, develop proposals, assist with dissemination of results, promote implementation of the outcomes, support patient partners and promote self-evaluation, monitor progress and assess impact of the patient involvement. These items were considered by the panellists as the most relevant for the involvement of people with aphasia as research partners. Conclusion The PAOLI is the first international consensus framework for guiding patient involvement in aphasia research. Researchers are encouraged to adopt the framework to improve the quality of their research by promoting the meaningful involvement of people with aphasia within the research team from the start.

(1) Background: Bilingualism has been reported to shape the brain by inducing cortical changes in cortical and subcortical language and executive networks. Similar yet different to bilingualism, diglossia is common in Switzerland, where the German-speaking population switches between an everyday spoken Swiss German (CH-GER) dialect and the standard German (stGER) used for reading and writing. However, no data are available for diglossia, defined as the use of different varieties or dialects of the same language, regarding brain structure. The aim of our study is to investigate if the presence of this type of diglossia has an impact on the brain structure, similar to the effects seen in bilingualism. (2) Methods: T1-weighted anatomical MRI scans of participants were used to compare the grey matter density and grey matter volume of 22 early diglossic CH-GER-speaking and 20 non-diglossic French-speaking right-handed university students, matched for age, linguistics and academic background. The images were processed with Statistical Parametric Mapping SPM12 and analyzed via voxel- and surface-based morphometry. (3) Results: A Bayesian ANCOVA on the whole brain revealed no differences between the groups. Also, for the five regions of interest (i.e., planum temporale, caudate nucleus, ACC, DLPFC and left interior parietal lobule), no differences in the cortical volume or thickness were found using the same statistical approach. (4) Conclusion: The results of this study may suggest that early diglossia does not shape the brain structure in the same manner as bilingualism.

Plain English Summary Patient and Public Involvement (PPI) is the active collaboration between researchers and patient groups when conducting research. PPI in aphasia research after stroke is growing in importance. Aphasia is the communication difficulty after stroke that negatively affects speaking and/or understanding, reading and/or writing. People with aphasia are usually involved in a tokenistic way in research teams. Tokenism is including people in the research process, who are usually at a disadvantage, by pretending that their involvement gives the appearance of equality. To avoid tokenism researchers must ensure equal opportunities for patient partners with communication challenges to contribute as PPI researchers. This requires a supportive environment, easy access to information and opportunities for making informed choices. This study aimed to explore the views of people who live with chronic stroke and aphasia on whether they would like to be involved in PPI projects and in what manner. All participants had experience of the research process prior to the stroke event. The research team included a person who lived with chronic aphasia after her stroke. She was named the PPI partner. Interviews were completed online with eight people with chronic stroke. Four with aphasia and four without. Interviews were analyzed and generated four themes (RISI): (1) the kinds of Restrictions patient participants face due to stroke, (2) their preferred levels of Involvement, (3) the Support they need for active and meaningful engagement and (4) their views on the Impact of PPI on research outcomes. The findings were mapped onto the International Classification of Functioning and Disability framework of the World Stroke Organization to depict how an individual’s health status, limitations in activity and environmental barriers for active participation influence their engagement within the research team. People living with chronic stroke, either with aphasia or without, are willing to be involved as patient partners. But researchers need to provide the necessary support suited to their communicative and other stroke-related needs. An aphasia inclusive PPI model will encourage meaningful research activities that make an impact, avoid research waste, rejuvenate the researcher-patient relationship dynamics, translate research outcomes into everyday life, and empower communities of people living with stroke and aphasia.

Abstract Introduction The paper examines the discrimination of lexical stress contrasts in a foreign language from a neural perspective. The aim of the study was to identify the areas associated with word stress processing (in comparison with vowel processing), when listeners of a fixed‐stress language have to process stress in a foreign free‐stress language. Methods We asked French‐speaking participants to process stress and vowel contrasts in Spanish, a foreign language that the participants did not know. Participants performed a discrimination task on Spanish word pairs differing either with respect to word stress (penultimate or final stressed word) or with respect to the final vowel while functional magnetic resonance imaging data was acquired. Results Behavioral results showed lower accuracy and longer reaction times for discriminating stress contrasts than vowel contrasts. The contrast Stress > Vowel revealed an increased bilateral activation of regions shown to be associated with stress processing (i.e., supplementary motor area, insula, middle/superior temporal gyrus), as well as a stronger involvement of areas related to more domain‐general cognitive control functions (i.e., bilateral inferior frontal gyrus). The contrast Vowel > Stress showed an increased activation in regions typically associated with the default mode network (known for decreasing its activity during attentionally more demanding tasks). Conclusion When processing Spanish stress contrasts as compared to processing vowel contrasts, native listeners of French activated to a higher degree anterior networks including regions related to cognitive control. They also show a decrease in regions related to the default mode network. These findings, together with the behavioral results, reflect the higher cognitive demand, and therefore, the larger difficulties, for French‐speaking listeners during stress processing as compared to vowel processing.

Abstract Linguistic processes in the bilingual brain are partially shared across languages, and the degree of neural overlap between the languages is influenced by several factors, including the age of acquisition, relative language proficiency, and immersion. There is limited evidence on the role of linguistic distance on the performance of the language control as well as domain-general cognitive control systems. The present study aims at exploring whether being bilingual in close and distant language pairs (CLP and DLP) influences language control and domain-general cognitive processes. We recruited two groups of DLP (Persian–English) and CLP (French–English) bilinguals. Subjects performed language nonswitching and switching picture-naming tasks and a nonlinguistic switching task while EEG data were recorded. Behaviorally, CLP bilinguals showed a lower cognitive cost than DLP bilinguals, reflected in faster reaction times both in language switching (compared to nonswitching) and nonlinguistic switching. ERPs showed differential involvement of cognitive control regions between the CLP and DLP groups during linguistic switching vs. nonswitching at 450 to 515 ms poststimulus presentation. Moreover, there was a difference between CLP and DLP groups from 40 to 150 ms in the nonlinguistic task. Our electrophysiological results confirm a stronger involvement of language control and domain-general cognitive control regions in CLP bilinguals.

Background and aims: Porphyrias constitute a group of rare genetic diseases due to various, mostly autosomal dominant mutations, causing enzymatic deficiency in heme biosynthesis. As a result, neurotoxic porphyrin precursors and light-sensitive porphyrins accumulate, while dysfunction in their targets determines the disease symptoms. Variegate porphyria (VP), one of the acute hepatic porphyrias, is caused by a protoporphyrinogen oxidase (PPOX) mutation. During acute attacks, among other factors, triggered by drugs, stressors, or fasting, an increase in urinary and fecal porphobilinogen (PBG), aminolevulinic acid (ALA), and porphyrins occurs, damaging the autonomous, peripheral, or central nervous system. The disease remains often latent or displays minimal symptoms usually overlooked, exposing undiagnosed patients to potentially serious complications in the presence of the aforementioned triggers.Case report: This 46-year-old woman presented, some days after a bariatric surgery, with severe flaccid tetraparesis and neuropathic pain, initially misdiagnosed as a functional neurological disorder. The severe axonal sensorimotor polyneuropathy led to further investigations, disclosing high urinary porphobilinogen, ALA, and porphyrin levels due to a new PPOX mutation. Retrospectively, it appeared that the patient had had typical VP symptoms (abdominal pain, fragile skin, and dark urine episodes) for years prior to the surgery. Treated with carbohydrate load, neurorehabilitation, and analgesics, she slowly recovered to full mobility, with partial autonomy in her daily life activities, although fatigue and severe pain persisted, preventing her from returning to work.Conclusion: This case documents gastric bypass surgery as a trigger of severe VP invalidating neurological symptoms and illustrates how the delayed diagnosis and post-interventional complications could have been prevented by screening for porphyria cardinal symptoms prior to the intervention. Likewise, this cost-effective screening should be performed before any treatment influencing the diet, which would dramatically improve the porphyria diagnosis rate and outcome.

Abstract Background The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak. Methods An online survey was conducted in Cameroon from June–December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time. Results Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53–3.21; p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34; p

Abstract Background Macrosomatognosiais the illusory sensation of a substantially enlarged body part. This disorder of the body schema, also called “Alice in wonderland syndrome” is still poorly understood and requires careful documentation and analysis of cases. The patient presented here is unique owing to his unusual macrosomatognosia phenomenology, but also given the unreported localization of his most significant lesion in the right thalamus that allowed consistent anatomo-clinical analysis. Case presentation This 45-years old man presented mainly with long-lasting and quasi-delusional macrosomatognosia associated to sensory deficits, both involving the left upper-body, in the context of a right thalamic ischemic lesion most presumably located in the ventral posterolateral nucleus. Fine-grained probabilistic and deterministic tractography revealed the most eloquent targets of the lesion projections to be the ipsilateral precuneus, superior parietal lobule,but also the right primary somatosensory cortex and, to a lesser extent, the right primary motor cortex. Under stationary neurorehabilitation, the patient slowly improved his symptoms and could be discharged back home and, later on, partially return to work. Conclusion We discuss deficient neural processing and integration of sensory inputs within the right ventral posterolateral nucleus lesion as possible mechanisms underlying macrosomatognosia in light of observed anatomo-clinical correlations. On the other hand, difficulty to classify this unique constellation of Alice in wonderland syndrome calls for an alternative taxonomy of cognitive and psychic aspects of illusory body-size perceptions.

Laughter and yawning can both occur spontaneously and are highly contagious forms of social behavior. When occurring contagiously, laughter and yawning are usually confounded with a social situation and it is difficult to determine to which degree the social situation or stimulus itself contribute to its contagion. While contagious yawning can be reliably elicited in lab when no other individuals are present, such studies are more sparse for laughter. Moreover, laughter and yawning are multimodal stimuli with both an auditory and a visual component: laughter is primarily characterized as a stereotyped vocalization whereas yawning is a predominantly visual signal and it is not known to which degree the visual and auditory modalities affect the contagion of laughter and yawning. We investigated how these two sensory modalities contribute to the contagion of laughter and yawning under controlled laboratory conditions in the absence of a social situation that might confound their contagion. Subjects were presented with naturally produced laughter and yawning in three sensory modalities (audio, visual, audio-visual), and we recorded their reaction to these stimuli. Contagious responses differed for laughter and yawning: overall, laughter elicited more contagious responses than yawning, albeit mostly smiling rather than overt laughter. While the audio-visual condition elicited most contagious responses overall, laughter was more contagious in the auditory modality, and yawning was more contagious in the visual modality. Furthermore, laughter became decreasingly contagious over time, while yawning remained steadily contagious. We discuss these results based on the ontogenetic and phylogenetic trajectories of laughter and yawning.

The impact of aphasia on the everyday life of Greek-speaking people with aphasia (PWA) is often underestimated by rehabilitation clinicians. This study explores the adaptation and psychometric properties of the Greek (GR) version of The Aphasia Impact Questionnaire-21 (AIQ-21-GR) to address this issue. The aim of this study is to determine the reliability and validity of the Greek version of the AIQ-21. The AIQ-21-GR was administered to 69 stroke survivors, 47 with aphasia and 22 without aphasia. The data were analyzed to determine reliability and validity. Content validity was based on the Consensus-based Standards for the selection of health Measurement Instruments guidelines. The AIQ-21-GR shows high levels of reliability and validity. The results confirmed high scores of internal consistency (Cronbach’s α = 0.91) and indicated good known—groups validity (Mann–Whitney U = 202, p < 001). Content validity achieved high scores with an overall median score of 4 [Q25 = 4, Q75 = 5]. The psychometric properties of the AIQ-21-GR support the reliability and validity of the tool for investigating the impact of aphasia on the quality of life of Greek-speaking PWA. The AIQ-21-GR can be used for setting functional goals in collaboration with PWA and as a patient reported outcome measure for functional communication training.

Primary progressive aphasia (PPA) is a neurodegenerative disorder with a progressive loss of language. Long-term support requires speech therapy but also individually set training programs. Here we propose an 8-month individualized speech-training program which alternates 3-week periods of transcranial direct current stimulation (tDCS) treatment with intensive daily language exercises and a 3-week period without tDCS treatment and a less intensive language exercise from home in a patient with non-fluent variant PPA (nfvPPA). The endpoints were the following: adherence to this program, language data after 8 months, questionnaires related to emotional valence, and brain volume changes. The results showed a persistent adherence after 8 months and a positive compliance reported by both the patient and the partner. The language evaluation showed a clinical stabilization. Moreover, a significant and positive influence of tDCS on mood was observed. This is, to our knowledge, the first ever published report of a combined neuromodulation and language training during the course of 8 months. Our finding suggests the feasibility of programs integrating hospital speech therapy, home training, and tDCS modulation in PPA. Further studies should be conducted in order to disentangle the contextual influences on language performance from the tDCS intervention effects and to address the observation of an initial improvement and a subsequent stabilization effect of language performances.

Background and Aims: Timely administration of recombinant tissue plasminogen activator (r-tPA) improves clinical outcomes in acute ischemic stroke patients. This study aims to explore the influence of the systematic presence on site of a neurologist compared with telestroke management on door-to-needle time in acute ischemic stroke outside of working hours (OWH).Methods: This retrospective cohort study included all r-tPA-treated patients in the emergency rooms of two Swiss stroke units, Nyon Hospital [Groupement Hospitalier de l'Ouest Lémanique (GHOL)] and Fribourg Hospital [Hôpital de Fribourg (HFR)], between February 2014 and September 2018. Door-to-needle time was analyzed for patients admitted during working hours (WH' weekdays 08:00–18:00) and OWH (weekdays 18:00–08:00, weekends, and public holidays). The latter was compared between centers; OWH, every patient was evaluated prior to thrombolysis by a neurologist on site in GHOL, while HFR adopted distance neurological supervision with teleradiology, performed by telephone evaluation of relevant clinical information with online real-time access to brain imaging.Results: Data were analyzed for 157 patients in HFR and 101 patients in GHOL. No statistically significant differences in baseline characteristics were found for the 258 r-tPA-treated acute ischemic stroke patients, in terms of age, gender, cardiovascular risk factors (hypertension, diabetes, and atrial fibrillation), and pre-Modified Rankin Scale (pre-mRs) between centers, with the exception of smoking and anticoagulation status. Patients in HFR presented with more severe strokes {median National Institutes of Health Stroke Scale (NIHSS) [6 (SD 6.88) (GHOL), 8 (SD 6.98) (HFR), p = 0.005]}. No significant differences in baseline characteristics were found as per admission time independently of the center. Door-to-needle time was significantly longer in the HFR cohort when compared with GHOL, irrespective of admission time. Both centers demonstrated significantly longer median door-to-needle time OWH. However, analysis of the door-to-needle time differences between WH and OWH showed no significant interaction using robust ANCOVA WRS2 analysis (p = 0.952) and a Bayesian model (BF01 = 3.97).Conclusions: On-site systematic evaluation by a neurologist did not appear to influence door-to-needle time OWH, suggesting distance supervision may be time-efficient in thrombolysis. This supports existing prospective studies in hyperacute telestroke management. The relevance lies in optimizing resource use considering the increasing demand for emergency neurological management.

This preliminary investigation aimed to assess beta (β) oscillation, a marker of the brain GABAergic signaling, as a potential objective pain marker, hence contributing at the same time to the mechanistic approach of pain management. This case–control observational study measured β electroencephalographic (EEG) oscillation in 12 right-handed adult male with chronic neuropathic pain and 10 matched controls (∼55 years). Participants were submitted to clinical evaluation (pain visual analog scale, Hospital Anxiety, and Depression scale) and a 24-min high-density EEG recording (BIOSEMI). Data were analyzed using the EEGlab toolbox (MATLAB), SPSS, and R. The global power spectrum computed within the low (Lβ, 13–20 Hz) and the high (Hβ, 20–30 Hz) β frequency sub-bands was significantly lower in patients than in controls, and accordingly, Lβ was negatively correlated to the pain visual analog scale (R = −0.931, p = 0.007), whereas Hβ correlation was at the edge of significance (R = −0.805; p = 0.053). Patients’ anxiety was correlated to pain intensity (R = 0.755; p = 0.003). Normalization of the low and high β global power spectrum (GPS) to the GPS of the full frequency range, while confirming the significant Lβ power decrease in chronic neuropathic pain patients, vanished the significance of the Hβ decrease, as well as the correlation between Lβ power and pain intensity. Our results suggest that the GABAergic Lβ EEG oscillation is affected by chronic neuropathic pain. Confirming the Lβ GPS decrease and the correlation with pain intensity in larger studies would open new opportunities for the clinical application of gamma-aminobutyric acid-modifying therapies.

Abstract Introduction There is increasing evidence linking periodontal infections to Alzheimer's disease (AD). Saliva sampling can reveal information about the host and pathogen interactions that can inform about physiological and pathological brain states. Methods A cross‐sectional cohort of age‐matched participants (78) was segmented according to their chemosensory (University of Pennsylvania Smell Identification Test; UPSIT) and cognitive scores (Mini‐Mental State Exam; MMSE and clinical dementia rating; CDR). Mid‐morning saliva was sampled from each participant and processed for microbiome composition and cytokine analysis. Linear discriminant analysis (LDA) was used to unravel specific changes in microbial and immunological signatures and logistic regression analysis (LRA) was employed to identify taxa that varied in abundance among patient groups. Results Using olfaction we distinguish in the cognitively normal population a segment with high chemosensory scores (CNh, 27) and another segment with chemosensory scores (CNr, 16) as low as mild cognitive impairment (MCI, 21) but higher than the AD group (17). We could identify stage‐specific microbial signatures changes but no clearly distinct cytokine profiles. Periodontal pathogen species as Filifactor villosus decline with the increasing severity of AD, whereas opportunistic oral bacteria such as Leptotrichia wadei show a significant enrichment in MCI. Conclusions The salivary microbiome indicates stage‐dependent changes in oral bacteria favoring opportunistic species at the expense of periodontal bacteria, whereas the inflammatory profiles remain mainly unchanged in the sampled population.

The present document represents the position of Swiss health-care associations, clinical and research centers, research-supporting foundations, and the association Alzheimer Switzerland regarding the care of persons with dementia and Alzheimer’s disease. We claim that dementia is not part of normal aging but a disease developing more frequently in old age; early diagnosis and treatment of dementia is paramount; all patients with dementia have the right to receive state-of-the-art treatments; more intense information, education, and counseling on dementia are necessary; media should provide balanced and fair reporting of scientific discoveries on Alzheimer’s and dementia; all patients with dementia have the right to be treated; anti-dementia drugs should be used and accompanied by listening, compassion, and understanding.

The role of the sensorimotor system in second language (L2) semantic processing as well as its clinical implications for bilingual patients has hitherto been neglected. We offer an overview of the issues at stake in this under-investigated field, presenting the theoretical and clinical relevance of studying L2 embodiment and reviewing the few studies on this topic. We highlight that (a) the sensorimotor network is involved in L2 processing, and that (b) in most studies, L2 is differently embodied than L1, reflected in a lower degree or in a different pattern of L2 embodiment. Importantly, we outline critical issues to be addressed in order to guide future research. We also delineate the subsequent steps needed to confirm or dismiss the value of language therapeutic approaches based on embodiment theories as a complement of speech and language therapies in adult bilinguals.

We propose a method of orthographic visualisation strategy in a poststroke severe aphasia person with dissociation between oral and written expression. fMRI results suggest that such strategy may induce the engagement of alternative nonlanguage networks and visual representations may help improving oral output. This choice of rehabilitation method can be based on the remaining capacities and, therefore, on written language. Most notably, no study so far addressed how orthographic visualisation strategy during speech rehabilitation might influence clinical outcomes in nonfluent aphasia and apraxia patients.

Background: Quality of Life (QoL) questionnaires are used to describe the impact of aphasia on stroke survivors’ life. People with aphasia (PWA) are traditionally excluded from research, potentially leading to a mismatch between the factors chosen in the tools and the realistic needs of PWA. The purpose of this review was to determine the direct involvement of PWA in the creation of QoL and aphasia impact-related questionnaires (AIR-Qs). Methods: A scoping review methodology was conducted by an expert librarian and two independent reviewers on health sciences based on the Preferred Reporting Items for Systematic Reviews and Metanalyses extension for Scoping Reviews (PRISMA-ScR) protocol, through a literature search in five databases: Medline Complete, PubMed, PsychINFO, Scopus, and Google Scholar. Search terms included ‘stroke’, ‘people with aphasia’, ‘communication’, ‘well-being’, and ‘quality of life’. Results: Of 952 results, 20 studies met the eligibility criteria. Of these, only four AIR-Qs studies (20%) were found reporting the direct involvement of PWA, while no QoL tools did so. Evidence showed involvement in the creation phase of AIR-Q, mainly in a consultation role. Conclusions: There is an absence of a framework for conducting and reporting the involvement of PWA in qualitative participatory research studies, which limits effectiveness to promote equitable best practice in aphasia rehabilitation.

Word retrieval in bilingual speakers partly depends on executive control systems in the left prefrontal cortex – including dorsolateral prefrontal cortex (DLPFC). We tested the hypothesis that DLPFC modulates word production of words specifically in a second language (L2) by measuring the effects of anodal transcranial direct current stimulation (anodal-tDCS) over the DLPFC on picture naming and word translation and on event-related potentials (ERPs) and their sources. Twenty-six bilingual participants with “unbalanced” proficiency in two languages were given 20 min of 1.5 mA anodal or sham tDCS (double-blind stimulation design, counterbalanced stimulation order, 1-week intersession delay). The participants then performed the following tasks: verbal and non-verbal fluency during anodal-tDCS stimulation and first and second language (L1 and L2) picture naming and translation [forward (L1 → L2) and backward (L2 → L1)] immediately after stimulation. The electroencephalogram (EEG) was recorded during picture naming and translation. On the behavioral level, anodal-tDCS had an influence on non-verbal fluency but neither on verbal fluency, nor on picture naming and translation. EEG measures revealed significant interactions between Language and Stimulation on picture naming around 380 ms post-stimulus onset and Translation direction and Stimulation on translation around 530 ms post-stimulus onset. These effects suggest that L2 phonological retrieval and phoneme encoding are spatially and temporally segregated in the brain. We conclude that anodal-tDCS stimulation has an effect at a neural level on phonological processes and, critically, that DLPFC-mediated activation is a constraint on language production specifically in L2.

The role of nonverbal communication in patients with post-stroke language impairment (aphasia) is not yet fully understood. This study investigated how aphasic patients perceive and produce co-speech gestures during face-to-face interaction, and whether distinct brain lesions would predict the frequency of spontaneous co-speech gesturing. For this purpose, we recorded samples of conversations in patients with aphasia and healthy participants. Gesture perception was assessed by means of a head-mounted eye-tracking system, and the produced co-speech gestures were coded according to a linguistic classification system. The main results are that meaning-laden gestures (e.g., iconic gestures representing object shapes) are more likely to attract visual attention than meaningless hand movements, and that patients with aphasia are more likely to fixate co-speech gestures overall than healthy participants. This implies that patients with aphasia may benefit from the multimodal information provided by co-speech gestures. On the level of co-speech gesture production, we found that patients with damage to the anterior part of the arcuate fasciculus showed a higher frequency of meaning-laden gestures. This area lies in close vicinity to the premotor cortex and is considered to be important for speech production. This may suggest that the use of meaning-laden gestures depends on the integrity of patients’ speech production abilities.

Background. Multiple sclerosis (MS) is frequently associated with cognitive and behavioural deficits. A growing number of studies suggest an impact of MS on decision-making abilities. The aim of this systematic review was to assess if (1) performance of MS patients in decision-making tasks was consistently different from controls and (2) whether this modification was associated with cognitive dysfunction and emotional alterations. Methods. The search was conducted on Pubmed/Medline database. 12 studies evaluating the difference between MS patients and healthy controls using validated decision-making tasks were included. Outcomes considered were quantitative (net scores) and qualitative measurements (deliberation time and learning from feedback). Results. Quantitative and qualitative decision-making impairment in MS was present in 64.7% of measurements. Patients were equally impaired in tasks for decision-making under risk and ambiguity. A correlation to other cognitive functions was present in 50% of cases, with the highest associations in the domains of processing speed and attentional capacity. Conclusions. In MS patients, qualitative and quantitative modifications may be present in any kind of decision-making task and can appear independently of other cognitive measures. Since decision-making abilities have a significant impact on everyday life, this cognitive aspect has an influential importance in various MS-related treatment settings.

Aging is associated with a shift from an automatic to a more cortical postural control strategy, which goes along with deteriorations in postural stability. Although balance training has been shown to effectively counteract these behavioral deteriorations, little is known about the effect of balance training on brain activity during postural tasks in older adults. We, therefore, assessed postural stability and brain activity using fMRI during motor imagery alone (MI) and in combination with action observation (AO; i.e., AO+MI) of a challenging balance task in older adults before and after 5 weeks of balance training. Results showed a nonsignificant trend toward improvements in postural stability after balance training, accompanied by reductions in brain activity during AO+MI of the balance task in areas relevant for postural control, which have been shown to be over-activated in older adults during (simulation of) motor performance, including motor, premotor, and multisensory vestibular areas. This suggests that balance training may reverse the age-related cortical over-activations and lead to changes in the control of upright posture toward the one observed in young adults.

Notch signaling plays an instrumental role in hippocampus-dependent memory formation and recent evidence indicates a displacement of Notch1 and a reduction its activity in hippocampal and cortical neurons from Alzheimer's disease (AD) patients. As Notch activation depends on ligand availability, we investigated whether Jagged1 expression was altered in brain specimen of AD patients. We found that Jagged1 expression was reduced in the CA fields and that there was a gradual reduction of Jagged1 in the cerebrospinal fluid (CSF) with the progression of dementia. Given the role of Notch signaling in memory encoding, we investigated whether targeted loss of Jagged1 in neurons may be responsible for the memory loss seen in AD patients. Using a transgenic mouse model, we show that the targeted loss of Jagged1 expression during adulthood is sufficient to cause spatial memory loss and a reduction in exploration-dependent Notch activation. We also show that Jagged1 is selectively enriched at the presynaptic terminals in mice. Overall, the present data emphasizes the role of the Notch ligand, Jagged1, in memory formation and the potential deficit of the signaling ligand in AD patients.

Because of the worldwide aging of populations, Alzheimer’s disease and other dementias constitute a devastating experience for patients and families as well as a major social and economic burden for both healthcare systems and society. Multiple potentially modifiable cardiovascular and lifestyle risk factors have been associated with this disease. Thus, modifying these risk factors and identifying protective factors represent important strategies to prevent and delay disease onset and to decrease the social burden. Based on the cognitive reserve hypothesis, evidence from epidemiological studies shows that low education and cognitive inactivity constitute major risk factors for dementia. This indicates that a cognitively active lifestyle may protect against cognitive decline or delay the onset of dementia. We describe a newly developed preventive programme, based on this evidence, to stimulate and increase cognitive activity in older adults at risk for cognitive decline. This programme, called “BrainCoach”, includes the technique of “motivational interviewing” to foster behaviour change. If the planned feasibility study is successful, we propose to add BrainCoach as a module to the already existing “Health Coaching” programme, a Swiss preventive programme to address multiple risk factors in primary care.

Aphasia in bilingual patients is a therapeutic challenge since both languages can be impacted by the same lesion. Language control has been suggested to play an important role in the recovery of first (L1) and second (L2) language in bilingual aphasia following stroke. To test this hypothesis, we collected behavioral measures of language production (general aphasia evaluation and picture naming) in each language and language control (linguistic and nonlinguistic switching tasks), as well as fMRI during a naming task at one and four months following stroke in five bilingual patients suffering from poststroke aphasia. We further applied dynamic causal modelling (DCM) analyses to the connections between language and control brain areas. Three patients showed parallel recovery in language production, one patient improved in L1, and one improved in L2 only. Language-control functions improved in two patients. Consistent with the dynamic view of language recovery, DCM analyses showed a higher connectedness between language and control areas in the language with the better recovery. Moreover, similar degrees of connectedness between language and control areas were found in the patients who recovered in both languages. Our data suggest that engagement of the interconnected language-control network is crucial in the recovery of languages.

BACKGROUND:Co-speech gestures are omnipresent and a crucial element of human interaction by facilitating language comprehension. However, it is unclear whether gestures also support language comprehension in aphasic patients. Using visual exploration behavior analysis, the present study aimed to investigate the influence of congruence between speech and co-speech gestures on comprehension in terms of accuracy in a decision task. METHOD:Twenty aphasic patients and 30 healthy controls watched videos in which speech was either combined with meaningless (baseline condition), congruent, or incongruent gestures. Comprehension was assessed with a decision task, while remote eye-tracking allowed analysis of visual exploration. RESULTS:In aphasic patients, the incongruent condition resulted in a significant decrease of accuracy, while the congruent condition led to a significant increase in accuracy compared to baseline accuracy. In the control group, the incongruent condition resulted in a decrease in accuracy, while the congruent condition did not significantly increase the accuracy. Visual exploration analysis showed that patients fixated significantly less on the face and tended to fixate more on the gesturing hands compared to controls. CONCLUSION:Co-speech gestures play an important role for aphasic patients as they modulate comprehension. Incongruent gestures evoke significant interference and deteriorate patients' comprehension. In contrast, congruent gestures enhance comprehension in aphasic patients, which might be valuable for clinical and therapeutic purposes.