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Preparatory control in task-switching has been suggested to rely upon a set of distributed regions within a frontoparietal network, with frontal and parietal cortical areas cooperating to implement switch-specific preparation processes. Although recent causal evidences using transcranial magnetic stimulation (TMS) have generally supported this model, alternative evidences from both functional neuroimaging and neurophysiological studies have questioned the switch-specific role of both frontal and parietal cortices. The aim of the present study was to clarify the role of prefrontal and parietal areas supporting preparatory cognitive control in task-switching. Within this purpose, an fMRI study during task-switching performance was conducted to identify the specific brain areas involved in preparatory control during performance of a task-switching paradigm. Then, TMS was applied over the specific coordinates previously identified through fMRI, that is, the anterior portion of the inferior frontal junction (aIFJ) and the intraparietal sulcus (IPS). Results revealed that TMS over the aIFJ disrupted performance in both switch and repeat trails in terms of delayed responses as compared to Sham condition. In contrast, TMS over the IPS selectively interfered performance in switch trials. These findings support a multicomponent model of executive control with the aIFJ being involved in more general switch-unspecific process such as the episodic retrieval of goals, and the IPS being related to the implementation of switch-specific preparation mechanisms for activating stimulus-response mappings. The results help conciliating preceding evidences about the role of a frontoparietal network during task-switching, and support current models about a hierarchical organization within prefrontal cortex.Significance StatementA combined fMRI and TMS study was conducted to clarify the brain areas involved in the executive control of attention during a cueing task-switching paradigm.Functional dissociations were observed during TMS stimulation, with prefrontal and parietal areas playing different roles during task-switching preparation. While the anterior portion of the inferior prefrontal junction seemed to be involved in a general mechanism of memory retrieval for goal identification, the intraparietal sulcus seemed to be engaged in a switch-specific mechanism for the translation of abstract task goals into action rules.The results help conciliating preceding evidences about the role of a frontoparietal network during task-switching, and support current models about a hierarchical organization within prefrontal cortex.

Introduction: A subgroup of patients with autism spectrum disorder (ASD) show self or heteroaggression, dyscontrol episodes, and others are of obsessive-compulsive disorder (OCD) profile; some of them are resistant to medical and behavioural treatment. We describe the long-term outcome in a group of these patients, treated with radiofrequency brain lesions or combined stereotactic surgery and Gamma Knife (GK) radiosurgery. Methods: We reviewed the medical records of 10 ASD patients with pathological aggressiveness and OCD, who had undergone radiofrequency lesions and/or radiosurgery with GK in our institution. Results: The 10 patients had a significant reduction of their symptoms (PCQ 39.9 and 33, OAS 11.8 and 5, CYBOCS-ASD 30.4 and 20), preoperatively and in the last follow-up, respectively; p < 0.005 (in all cases), although all but 2 needed more than 1 treatment to maintain this improvement. Conclusions: We observed a marked improvement in behaviour, quality of life, and relationship with the environment in all our 10 patients after the lesioning treatments, without long-lasting side effects.

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. However, different maneuvers have been performed during the performance of drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response, and to determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, a BMI of 27.90 (SD = 4.19) kg/m2 and a mean AHI of 26.51 (SD = 21.23). Results showed no relationship between severity and MAD recommendation. Also, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the inter-examiner bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

Patients with Obsessive-Compulsive Disorder (OCD) present neuropsychological deficits across different cognitive domains, especially in executive functioning and information processing speed. Some studies have even suggested that speed deficits may underlie poor neuropsychological performance. However, this hypothesis remains unanswered in both OCD general population and OCD refractory subgroup. In addition, it is not clear whether such deficits are secondary to the clinical symptoms or may constitute a primary deficit. The aim of this study was to explore the speed of processing hypothesis in treatment-refractory OCD patients, and to clarify to what extent slowness is related to psychopathological symptoms. Both clinical and neuropsychological examination was conducted to assess 39 OCD refractory patients candidates for neurosurgery and 39 healthy matched individuals. Principal component analysis revealed a three-component structure in the neuropsychological battery being used, including a speed of processing, working memory, and conflict monitoring components. Group comparisons revealed that OCD patients performed significantly worse than healthy individuals in speed measures, but no differences were found in executive tests not influenced by time. Correlation analyses revealed a lack of association between neuropsychological and clinical measures. The results suggest that treatment-refractory OCD patients exhibit a primary deficit in information processing speed independent of clinical symptoms.

Introduction Bradyphrenia is a key cognitive feature in Parkinson's disease (PD). There is no consensus on whether information processing speed is impaired or not beyond motor performance. Objective This study aims to explore which perceptual, motor, or cognitive components of information processing are involved in the slowdown affecting cognitive performance. Methods The study included 48 patients with PD (age: 63, 3 ± 8, 18; HY I‐III; UPDRS 15,46 ± 7,76) and 53 healthy controls (age: 60,09 ± 12,83). Five reaction time (RT) tasks were administered to all participants. The average RT in each of the tasks and the percentage of correct answers were measured. Patients with PD were in "ON state" at the time of the evaluation. Perceptual, motor, and cognitive components were isolated by means of a series of ANCOVAs. Results As expected, the motor component was slowed down in patients with PD. Moreover, while patients with PD showed slower RT than controls in all tasks, differences between groups did not exponentially increase with the increasing task complexity. ANCOVA analyses also revealed that the perceptual and sustained alert component resulted to be slowed down, with no differences being found in any of the remaining isolated cognitive components (i.e., response strategy‐inhibition, decisional, visual search, or interference control). Conclusions The results revealed that slowness of information processing in PD was mainly associated with an impaired processing speed of the motor and perceptual‐alertness components analyzed. The results may help designing new neurorehabilitation strategies, focusing on the improvement of perceptual and alertness mechanisms., The level of cognitive deceleration in PD is determined by a deterioration focused on perceptual and motor components and independently of the task complexity. Alterations in the brain networks involved in alertness to react to stimuli could justify the slowness of information processing in Parkinson´s disease

Severe traumatic brain injury residual cognitive impairments significantly impact the quality of life. EEG-based neurofeedback is a technique successfully used in traumatic brain injury and stroke to rehabilitate cognitive and motor sequelae. There are not individualized comparisons of the effects of EEG-based neurofeedback versus conventional neuropsychological rehabilitation. We present a case study of a traumatic brain injury subject in whom eight sessions of a neuropsychological rehabilitation protocol targeting attention, executive functions, and working memory as compared with a personalized EEG-based neurofeedback protocol focused on the electrodes and bands that differed from healthy subjects (F3, F1, Fz, FC3, FC1, and FCz), targeting the inhibition of theta frequency band (3 Hz−7 Hz) in the same number of sessions. Quantitative EEG and neuropsychological testing were performed. Clear benefits of EEG-based neurofeedback were found in divided and sustained attention and several aspects related to visuospatial skills and the processing speed of motor-dependent tasks. Correlative quantitative EEG changes justify the results. EEG-based neurofeedback is probably an excellent complementary technique to be considered to enhance conventional neuropsychological rehabilitation. post-print 1462 KB

Objective: Phonological and semantic verbal fluency (VF) tasks are frequently used to assess language and executive functions in both clinical and research settings. F, A, and S are the most commonly used letters in phonological tasks across languages and cultures. Unfortunately, the lack of norms for the native Spanish population for these letters, and for certain semantic categories such as “proper names,” may lead to misinterpretation of scores due to demographic differences. The aim of the present study was to provide normative data for F, A, and S and for “proper names,” “animals,” and “fruits and vegetables” for the native Spanish population. Method: 257 healthy subjects took part in the study (ages: 17–100 years, 3–20 years of education). Correlation, multiple regression, and t-tests were used to select the most appropriate variables for stratification. Results: Education was the best predictor of performance in all tasks, followed by age. Given that t-test results showed no differences related to gender, with the only exception of the semantic category “animals,” this variable was not considered for stratification. Consequently, the data were stratified in two education levels (

Background: Parkinson’s disease (PD) patients are known to suffer from subtle cognitive and balance deficits from the early stages although they usually manifest in advanced stages. Postural instability (PI) has been correlated with slower information processing speed. Simple reaction time (SRT) tasks can be used to measure the speed of information processing. The main objective of this study was to examine the usefulness of SRT as a valid predictor of balance in PD, thus providing a simple and complementary assessment method. Methods: This cross-sectional study included 52 PD patients without dementia who were evaluated for balance using the pull test (PT) maneuver and Biodex® limits of stability (LOS). In addition, a reaction time task was used to measure processing speed. Correlation and linear regression analyses were performed. Results: The performance of SRT tasks was correlated with the evaluation of LOS% and PT, suggesting that the SRT may be a predictor of balance performance. Longer reaction time and poorer postural stability were also associated with disease duration but not with age. Conclusions: Poor performance in a simple reaction task can predict altered PI and can complement staging and evaluation in PD patients.

Objective 85 years after the description of the Stroop interference effect, there is still a lack of consensus regarding the cognitive constructs underlying scores from standardized versions of the test. The present work aimed to clarify the cognitive mechanisms underlying direct (word-reading, color-naming, and color-word) and derived scores (interference, difference, ratio, and relative scores) from Golden’s standardized version of the test. Method After a comprehensive review of the literature, five cognitive processes were selected for analysis: speed of visual search, phonemic verbal fluency, working memory, cognitive flexibility, and conflict monitoring. These constructs were operationalized by scoring five cognitive tasks (WAIS-IV Digit Symbol, phonemic verbal fluency [letter A], WAIS-IV Digit Span, TMT B-A, and reaction times to the incongruent condition of a computerized Stroop task, respectively). About 83 healthy individuals (mean age = 25.2 years) participated in the study. Correlation and regression analyses were used to clarify the contribution of the five cognitive processes on the prediction of Stroop scores. Results Data analyses revealed that Stroop word-reading reflected speed of visual search. Stroop color-naming reflected working memory and speed of visual search. Stroop color-word reflected working memory, conflict monitoring, and speed of visual search. Whereas the interference score was predicted by both conflict monitoring and working memory, the ratio score (color-word divided by color-naming) was predicted by conflict monitoring alone. Conclusion The present results will help neuropsychologists to interpret altered patient scores in terms of a failure of the cognitive mechanisms detailed here, benefitting from the solid background of preceding experimental work.

Resumen Antecedentes y objetivos Diversos estudios han puesto de manifiesto las creencias erroneas sobre el dano cerebral en diferentes poblaciones. Nuestro objetivo consiste en valorar el conocimiento que poseen los familiares de los pacientes neuroquirurgicos sobre el dano cerebral adquirido. Material y metodos Participaron 81 familiares de pacientes ingresados durante el periodo comprendido entre febrero y agosto de 2016. Se utilizo la traduccion de un cuestionario aplicado en estudios anteriores en multiples paises (EE. UU., Canada, Reino Unido, Irlanda y Nueva Zelanda). Se registraron algunos datos sociodemograficos (edad, sexo, nivel educativo y patologia del paciente) asi como las respuestas a los 19 items verdadero/falso que constituyen el cuestionario sobre dano cerebral adquirido. El analisis de datos se ha desarrollado mediante una modelizacion grafica con parametro de regularizacion configurando asi una red que muestra el nivel de asociacion de los items del cuestionario a partir del patron de respuestas de los participantes. Resultados El analisis de los datos muestra dos areas conceptuales con una elevada tasa de error en los items asociados: el comportamiento y el manejo de los pacientes, y las expectativas sobre la recuperacion en dano cerebral adquirido. Conclusiones Con este estudio podemos objetivar las areas de falsas creencias sobre el dano cerebral que poseen los familiares de los pacientes atendidos en el servicio de neurocirugia. Este desconocimiento puede suponer un obstaculo en el proceso de recuperacion de los pacientes. Por lo tanto, proponemos hacer hincapie en la informacion sobre el dano cerebral a los familiares de estos pacientes, sobre todo sus sintomas y su evolucion.

Aim To report on the impact of COVID-19 on a brain damage unit. Methods We reviewed the records of all patients admitted to our brain damage unit. The study included all the significant clinical events from the first positive qualitative real-time reverse-transcriptase–polymerase-chain-reaction assay (April 8th, 2020) for SARS-CoV-2 to the day all patients tested negative (June 8th, 2020). Results Of the 20 patients (14 men) (age 57.7 ± 14.9; 2–71 months after brain damage; all with a modified Rankin scale score > 4), 16 tested positive for SARS-CoV-2 and remained positive for a mean of 32.3 days (ranging from 26 to 61). One patient died from COVID-19, while 12 patients were asymptomatic and three suffered mild pneumonia without acute respiratory distress syndrome. All patients received prophylactic subcutaneous heparin. Intravenous methylprednisolone was prescribed for three patients with bilateral pneumonia with excellent results. Conclusions Most positive cases (93.7%) were not severe. The good outcome was most likely due to the use of prophylactic anticoagulation therapy, the early use of methylprednisolone for pneumonia and the previously reported immunosuppression amid patients with brain damage. This study hopes to encourage further study into brain damage immunity.

OBJECTIVE The extent of resection is the most important prognostic factor following brain glioma surgery. However, eloquent areas within tumors limit the extent of resection and, thus, critically affect outcomes. The authors hypothesized that presurgical suppression of the eloquent areas within a tumor by continuous cortical electrical stimulation, coupled with appropriate behavioral training (“prehabilitation”), would induce plastic reorganization and enable a more extensive resection. METHODS The authors report on 5 patients harboring gliomas involving eloquent brain areas within tumors as identified on intraoperative stimulation mapping. A grid of electrodes was placed over the residual tumor, and continuous cortical electrical stimulation was targeted to the functional areas. The stimulation intensity was adjusted daily to provoke a mild functional impairment while the function was intensively trained. RESULTS The stimulation intensity required to impair function increased progressively in all patients, and all underwent another operation a mean of 33.6 days later (range 27–37 days), when the maximal stimulation voltage in all active contacts induced no functional deficit. In all cases, a substantially more extensive resection of the tumor was possible. Intraoperative mapping and functional MRI demonstrated a plastic reorganization, and most previously demonstrated eloquent areas within the tumor were silent, while there was new functional activation of brain areas in the same region or toward the contralateral hemisphere. CONCLUSIONS Prehabilitation with continuous cortical electrical stimulation and appropriate behavioral training prior to surgery in patients with WHO Grade II and III gliomas affecting eloquent areas accelerate plastic changes. This can help maximize tumor resection and, thus, improve survival while maintaining function.

Background: Slowness of information processing has been suggested as a fundamental factor modulating cognitive impairment in multiple sclerosis (MS). However, the contribution of depressive symptoms (DS) to slowness remains unclear. One of the most accepted hypotheses on the impact of depression on the general population suggests that depression interferes only with tasks requiring high cognitive demands. However, no studies have investigated if the same pattern occurs in MS. Objective: The aim of this study was to determine the profile of the contribution of DS to slowness. Methods: Four Reaction Time (RT) tasks requiring an increasing level of cognitive demands were administered to 35 relapsing remitting MS patients with DS, 33 MS patients without DS, 17 depressed non-MS patients and 27 controls. Results: MS patients without DS obtained longer RTs than controls in all the tasks. On the contrary, depressed non-MS patients were slower than controls only in the most demanding task. Finally, MS patients with DS were slower than MS patients without DS not only in the most demanding task but also in the task requiring a lower level of cognitive demands. Conclusion: The contribution of DS to slowness depends on the level of cognitive demands. However, its impact on MS is more deleterious than on the general population.

Introduccion: Los cuidadores familiares de enfermos de Alzheimer (CFEA) sufren sobrecarga y psicopatologias derivadas del cuidado. Objetivo: comparar el estado de sobrecarga, ansiedad, depresion y apoyo social percibido por los CFEA que pertenecen a una asociacion de familiares de enfermos de Alzheimer (AFA) y los que no pertenecen y son atendidos en farmacia comunitaria. Metodos: Estudio observacional transversal. 175 CFEA, divididos en dos grupos. Uno de 25 CFEA captado entre cuidadores que acuden regularmente a una farmacia y no pertenecian a ninguna asociacion (FCIA). El segundo grupo (AFA) de 150 CFEA pertenecientes a 7 AFA de Galicia. Se registraron variables sociodemograficas y se administraron los cuestionarios: inventario de depresion de Beck, STAI-Cuestionario de ansiedad, escala de sobrecarga del cuidador de Zarit, escala Duke-UNC del apoyo social percibido. Resultados: En los dos grupos el perfil de cuidador corresponde con una mujer de 56 anos, familiar de primer grado del EA, con estudios primarios. Sin diferencias significativas entre grupos en edad (p=0,931) ni nivel educativo (p=0,508). Tampoco se encontraron diferencias en estado civil (p=0,468), ni en situacion laboral (p= 0,851). Diferencias significativas: ansiedad, sobrecarga y apoyo social. El grupo AFA obtuvo puntuaciones mas altas en sobrecarga (t=3,162; p=0,002), ansiedad (t=2,054; p=0,046) y apoyo social percibido (t=2,755; p=0,006). Sin diferencias significativas en depresion (t=-0,881; p=0,380). Conclusiones: Los cuidadores familiares del grupo AFA mostraron mayor sobrecarga y ansiedad. Los resultados de este trabajo respaldan la utilidad del farmaceutico comunitario en la deteccion de psicopatologias asociadas al cuidado del EA y la atencion a los cuidadores.

INTRODUCTION: The importance of knowing the pattern of evolution of cognitive deficits in the first months after a traumatic brain injury (TBI) has encouraged the development of numerous longitudinal studies. However, the results of most of them should be taken with caution due to the lack of adequate control of practice effects that can lead to overestimating the genuine recovery of cognitive processes. AIM: To describe the cognitive changes between the acute and subacute phases of the TBI controlling the effect of the practice. PATIENTS AND METHODS: Twenty-two patients were assessed in two different time points after TBI (immediately and after six months) using the following tests: Trail Making Test (A, B, B/A, B-A), Stroop Test (W, C, CW, interference), Digit Symbol-Coding, Symbol Search, Digits Forward and Backward, Verbal Fluency and Short-term Memory. To control for the practice effects, a transformation of the scores was performed applying the procedure proposed by Calamia et al. RESULTS. Before controlling the practice effects, the scores of all tests improved (p > 0.001). However, afterward, the improvement remained only in the Trail Making Test-B, B/A and B-A, Digit Symbol-Coding, Symbol Search, Stroop CW and Digits Backward. CONCLUSIONS: The lack of control of practice effects in longitudinal studies can generate misleading interpretations about the evolution of cognitive deficits. The pattern of recovery after a TBI varies depending on the cognitive process.

A century of research in human brain parcellation has demonstrated that different brain areas are associated with functional tasks. New neuroscientist perspectives to achieve the parcellation of the human brain have been developed to know the brain areas activation and its relationship with different stimuli. This descriptive study aimed to compare brain regions activation by specific tactile input (STI) stimuli according to the Vojta protocol (STI-group) to a non-STI stimulation (non-STI-group). An exploratory functional magnetic resonance imaging (fMRI) study was performed. The 2 groups of participants were passively stimulated by an expert physical therapist using the same paradigm structure, although differing in the place of stimulation. The stimulation was presented to participants using a block design in all cases. A sample of 16 healthy participants, 5 men and 11 women, with mean age 31.31 ± 8.13 years was recruited. Indeed, 12 participants were allocated in the STI-group and 4 participants in the non-STI-group. fMRI was used to map the human brain in vivo while these tactile stimuli were being applied. Data were analyzed using a general linear model in SPM12 implemented in MATLAB. Differences between groups showed a greater activation in the right cortical areas (temporal and frontal lobes), subcortical regions (thalamus, brainstem, and basal nuclei), and in the cerebellum (anterior lobe). STI-group had specific difference brain activation areas, such as the ipsilateral putamen. Future studies should study clinical implications in neurorehabilitation patients. Sin financiación 1.870 JCR (2018) Q2, 69/160 Medicine, General & Internal 0.784 SJR (2018) Q2, 824/2894 Medicine (miscellaneous) No data IDR 2018 UEM

Introduccion: El cuidado diario de un familiar enfermo de Alzheimer (EA) supondra un estres emocional y fisico importante para el cuidador. El resultado puede desembocar en un intenso sentimiento de sobrecarga y conducir a diversas psicopatologias como depresion, ansiedad, agresividad, astenia psicofisica, etc. El aumento en la incidencia de la enfermedad esta provocando escasez de cuidadores y falta de apoyo social e institucional a las familias que se encargan de cuidar a un EA. Objetivos: Revisar las caracteristicas del apoyo que las estructuras sociales y sanitarias prestan a los cuidadores informales (CI) de EA, conocer su perfil, la percepcion que tienen de su situacion y su estado de animo, detectar posibles psicopatologias que les afecten, cuantificar el nivel de sobrecarga, evaluar el apoyo social percibido, el grado de satisfaccion familiar y la relacion con su farmacia habitual. Metodos: Estudio descriptivo transversal en el que participan CI de EA no institucionalizados, reclutados en las asociaciones de familiares de EA de Galicia, mayores de 18 anos y que den su consentimiento informado. Variable principal: puntuacion del test de Zarit de sobrecarga del cuidador. Otras: socio-demograficas, ansiedad (STAI), depresion (Beck) y apoyo social (Duke-UNC) y familiar (APGAR) percibido. Discusion: Los resultados de la metodologia implementada en este estudio pueden servir para desarrollar programas similares en la farmacia comunitaria, en la que los farmaceuticos comunitarios colaboren en la deteccion de posibles psicopatologias, y contribuir, mediante la prestacion de servicios profesionales, a conseguir una mejora en la calidad de vida y estado de salud de los cuidadores.

dies have postulated that it is the basis of the disease as evidenced by its independent and persistent quality and its relation to prognosis. Research on cognitive deficits in psychotic disorders has led to the development of intervention strategies for the cognitive rehabilitation of these patients. Attention, working memory, and executive functions are among the most widely affected functions and are closely related to the functionality of these patients. This work aims to study the effectiveness of cognitive rehabilitation targeting attention, executive functions, and working memory in people diagnosed with a psychotic disorder (mostly schizophrenia). An exhaustive search in PubMed and PsycINFO was conducted up to January 2016. All research papers that were included studied a therapeutic technique to improve one or more of the aforementioned functions in patients over age 16 years diagnosed with psychotic disorder. Studies with methodological diversity were included, which were afterwards organized by levels of evidence. Thirty-four papers were studied, from which we can conclude that cognitive rehabilitation of the aforementioned cognitive functions brings about improvements in cognition. As a result of the influence of cognitive rehabilitation on other variables such as social functioning and symptoms of the disease, the results are promising.

OBJECTIVEObsessive-compulsive disorder (OCD) is a severe psychiatric condition. The authors present their experience with Gamma Knife radiosurgery (GKRS) in the treatment of patients with OCD resistant to any medical therapy.METHODSPatients with severe OCD resistant to all pharmacological and psychiatric treatments who were treated with anterior GKRS capsulotomy were retrospectively reviewed. These patients were submitted to a physical, neurological, and neuropsychological examination together with structural and functional MRI before and after GKRS treatment. Strict study inclusion criteria were applied. Radiosurgical capsulotomy was performed using two 4-mm isocenters targeted at the midputaminal point of the anterior limb of the capsule. A maximal dose of 120 Gy was prescribed for each side. Clinical global changes were assessed using the Clinical Global Impression (CGI) scale, Global Assessment of Functioning (GAF) scale, EQ-5D, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). OCD symptoms were determined by the Yale–Brown Obsessive Compulsive Scale (Y-BOCS).RESULTSTen patients with medically refractory OCD (5 women and 5 men) treated between 2006 and 2015 were included in this study. Median age at diagnosis was 22 years, median duration of illness at the time of radiosurgery was 14.5 years, and median age at treatment was 38.8 years. Before GKRS, the median Y-BOCS score was 34.5 with a median obsession score of 18 and compulsion score of 17. Seven (70%) of 10 patients achieved a full response at their last follow-up, 2 patients were nonresponders, and 1 patient was a partial responder. Evaluation of the Y-BOCS, BDI, STAI-Trait, STAI-State, GAF, and EQ-5D showed statistically significant improvement at the last follow-up after GKRS. Neurological examinations were normal in all patients at each visit. At last follow-up, none of the patients had experienced any significant adverse neuropsychological effects or personality changes.CONCLUSIONSGKRS anterior capsulotomy is effective and well tolerated with a maximal dose of 120 Gy. It reduces both obsessions and compulsions, improves quality of life, and diminishes depression and anxiety.

This study aimed to confirm whether first-episode psychosis patients present a stable trait impairment in theory of mind (ToM) and to examine the potential relationship between ToM and clinical symptomatology and neurocognition. Patients with a first episode of psychosis (N = 160) and healthy controls (N = 159) were assessed with an extensive neuropsychological test battery, which included a mental state decoding task known as "The Reading the Mind in the Eyes" (Eyes test), at baseline and reassessed after 1 and 3 years. The clinical group performed below healthy controls on the Eyes test while not showing test-retest differences between baseline and follow-up administrations. Analyses revealed age, education and premorbid IQ as potential moderators. Poorer performance on the Eyes test was not linked to clinical symptomatology but was associated with greater neurocognitive deficit, particularly related to processing speed. The persistence of ToM deficits in patients suggests that there are trait related metalizing impairments in first episode psychosis. This study shows the influence of processing speed and moderator variables on efficient ToM. This work was supported by the Instituto de Salud Carlos III (FISCP07/00008andPI14/00918) and Fundación Instituto de Investigación Marqués de Valdecilla. No pharmaceutical industry has participated in the study.

Synesthesia is a neural phenomenon in which stimulation in one sensory or cognitive stream leads to associated experiences in a second, unstimulated stream. These activations occur involuntarily, automatically and consistently over time.To estimate the relative frequency of the different modalities of the phenomenon in a Spanish sample.Study performed in educational (55.04%), labor (20.54%) and digital contexts (24.4%) using the Synesthesia Questionnaire created by Artecitta Foundation.The analysis of the responses given by 803 participants suggests that 13.95% of the sample experience any synesthesia. The analysis of the relative frequencies shows that the most frequent modality is spatial sequence synesthesia (44.6%). 33.9% see colors when listening to sounds and/or music, 25.9% associate colors to temporal concepts, 20.5% assign gender and personality to letters and numbers, 10.7% experience grapheme-color synesthesia and 5.4% feel a specific flavor when hearing words.These data suggest that the presence of synesthesia in the Spanish sample under study is high, and that the investigation of the phenomenon and its different modalities needs to be approached on the basis of the current knowledge about its phenomenological variability and its genetic and neurophysiologic characteristics. Likewise, the results are useful to adjust the questionnaire items and increase their discriminative power.Colores, sabores, numeros?: la sinestesia en una muestra española.Introduccion. La sinestesia es un fenomeno neurologico caracterizado por la activacion simultanea de dos sistemas (o atributos) sensoriales, uno de los cuales no ha sido estimulado directamente. Dicha activacion se produce de una forma involuntaria, automatica y consistente a lo largo del tiempo. Objetivo. Estimar la frecuencia relativa de las diferentes modalidades de sinestesia en una muestra española. Sujetos y metodos. Estudio realizado en contextos educativos (55,04%), laborales (20,54%) y digitales (24,4%) mediante el cuestionario de sinestesia de la Fundacion Artecitta. Resultados. El analisis de las respuestas de 803 participantes sugiere que un 13,95% de la muestra estudiada experimenta alguna sinestesia. El analisis de la frecuencia relativa de las diferentes modalidades muestra que la mas frecuente es la que relaciona conceptos temporales con configuraciones espaciales (44,6%). Un 33,9% percibe colores cuando escucha sonidos o musica, un 25,9% asocia colores a los conceptos temporales, un 20,5% asigna genero o personalidad a las letras y numeros, un 10,7% experimenta la modalidad grafema-color, y un 5,4% siente un sabor especifico en su boca al escuchar palabras. Conclusiones. Los datos sugieren que la presencia de sinestesia en la muestra española estudiada es elevada y que la investigacion sobre el fenomeno y sus diferentes modalidades ha de ser abordada basandose en el conocimiento actual sobre su variabilidad fenomenologica y sus bases geneticas y neurofisiologicas. Asimismo, los resultados obtenidos son utiles para ajustar los items del cuestionario y aumentar su capacidad discriminativa.

Although neutral faces do not initially convey an explicit emotional message, it has been found that individuals tend to assign them an affective content. Moreover, previous research has shown that affective judgments are mediated by the task they have to perform. Using functional magnetic resonance imaging in 21 healthy participants, we focus this study on the cerebral activity patterns triggered by neutral and emotional faces in two different tasks (social or gender judgments). Results obtained, using conjunction analyses, indicated that viewing both emotional and neutral faces evokes activity in several similar brain areas indicating a common neural substrate. Moreover, neutral faces specifically elicit activation of cerebellum, frontal and temporal areas, while emotional faces involve the cuneus, anterior cingulated gyrus, medial orbitofrontal cortex, posterior superior temporal gyrus, precentral/postcentral gyrus and insula. The task selected was also found to influence brain activity, in that the social task recruited frontal areas while the gender task involved the posterior cingulated, inferior parietal lobule and middle temporal gyrus to a greater extent. Specifically, in the social task viewing neutral faces was associated with longer reaction times and increased activity of left dorsolateral frontal cortex compared with viewing facial expressions of emotions. In contrast, in the same task emotional expressions distinctively activated the left amygdale. The results are discussed taking into consideration the fact that, like other facial expressions, neutral expressions are usually assigned some emotional significance. However, neutral faces evoke a greater activation of circuits probably involved in more elaborate cognitive processing., This research was supported by a grant from Ministerio de Ciencia y Tecnología, Spain (MICINN-PSI-2009-09067).

Grapheme-color synesthesia is a neurological phenomenon in which viewing achromatic letters/numbers leads to automatic and involuntary color experiences. In this study, voxel-based morphometry analyses were performed on T1 images and fractional anisotropy measures to examine the whole brain in associator grapheme-color synesthetes. These analyses provide new evidence of variations in emotional areas (both at the cortical and subcortical levels), findings that help understand the emotional component as a relevant aspect of the synesthetic experience. Additionally, this study replicates previous findings in the left intraparietal sulcus and, for the first time, reports the existence of anatomical differences in subcortical gray nuclei of developmental grapheme-color synesthetes, providing a link between acquired and developmental synesthesia. This empirical evidence, which goes beyond modality-specific areas, could lead to a better understanding of grapheme-color synesthesia as well as of other modalities of the phenomenon.

The advent of new signal processing methods, such as non-linear analysis techniques, represents a new perspective which adds further value to brain signals' analysis. Particularly, Lempel-Ziv's Complexity (LZC) has proven to be useful in exploring the complexity of the brain electromagnetic activity. However, an important problem is the lack of knowledge about the physiological determinants of these measures. Although a correlation between complexity and connectivity has been proposed, this hypothesis was never tested in vivo. Thus, the correlation between the microstructure of the anatomic connectivity and the functional complexity of the brain needs to be inspected. In this study we analyzed the correlation between LZC and fractional anisotropy (FA), a scalar quantity derived from diffusion tensors that is particularly useful as an estimate of the functional integrity of myelinated axonal fibers, in a group of sixteen healthy adults (all female, mean age 65.56±6.06 years, intervals 58-82). Our results showed a positive correlation between FA and LZC scores in regions including clusters in the splenium of the corpus callosum, cingulum, parahipocampal regions and the sagittal stratum. This study supports the notion of a positive correlation between the functional complexity of the brain and the microstructure of its anatomical connectivity. Our investigation proved that a combination of neuroanatomical and neurophysiological techniques may shed some light on the underlying physiological determinants of brain's oscillations.

The consequences of acquired brain injury include impairments in cognition, emotion and behaviour. Neuro-psychology provides techniques for treating these disorders, but it is still important to establish which of all the available tools are most effective for this purpose.This article reviews existing studies on the effectiveness of neuropsychological rehabilitation, focusing on those areas more often affected after acquired brain injury. The purpose of the article is to guide and orient neuro-psychological rehabilitation of these patients based on the strongest evidence available in the literature. In this second part, we will focus on the rehabilitation of executive functions, the behaviour modification, and psychotherapy applied in this area, as well as the application of new technologies.There is enough evidence to recommend the neuropsychological rehabilitation of executive functions, and the application of the above mentioned tools in patients with acquired brain injury.

The consequences of acquired brain injury include impairments in cognition, emotion, and behaviour. Neuro-psychology provides techniques for treating these disorders, but it is still important to establish which of all the available tools are most effective for this purpose.This article reviews existing studies on the effectiveness of neuropsychological rehabilitation, focusing on those areas more often impaired due to acquired brain injury. The purpose of the article is to guide and orient neuro-psychological rehabilitation of these patients based on the strongest evidence available in the literature. This paper focuses on cognitive domains such as attention and neglect, memory and language.There is enough evidence to recommend the neuropsychological rehabilitation of the above processes in patients with acquired brain injury.

Theoretical models suggest the existence of at least three relatively independent attentional mechanisms implemented in partially segregated brain networks: vigilance, orienting, and executive attention. In this article, we review tasks for assessment, related neuroanatomy, and impairments of these mechanisms. We also exemplify how these attentional networks interact in daily life activities for an efficient adjustment to environmental demands, and how they can be hindered after different pathological states, such as acquired brain injury, degenerative diseases, and developmental changes (in the child and in the aging process). Finally, the importance of speed of information processing as a key modulator of appropriate attentional functioning is discussed.

The aim of this study was to clarify which cognitive mechanisms underlie Trail Making Test (TMT) direct and derived scores. A comprehensive review of the literature on the topic was carried out to clarify which cognitive factors had been related to TMT performance. Following the review, we explored the relative contribution from working memory, inhibition/interference control, task-switching ability, and visuomotor speed to TMT performance. Forty-one healthy old subjects participated in the study and performed a battery of neuropsychological tests including the TMT, the Digit Symbol subtest [Wechsler Adult Intelligence Scale (Third Version) (WAIS-III)], a Finger Tapping Test, the Digits Forward and Backward subtests (WAIS-III), Stroop Test, and a task-switching paradigm inspired in the Wisconsin Card Sorting Test. Correlation and regression analyses were used in order to clarify the joint and unique contributions from different cognitive factors to the prediction of TMT scores. The results suggest that TMT-A requires mainly visuoperceptual abilities, TMT-B reflects primarily working memory and secondarily task-switching ability, while B-A minimizes visuoperceptual and working memory demands, providing a relatively pure indicator of executive control abilities. (JINS, 2009, 15, 438–450.)

Objectives: To evaluate the profile of family caregivers of Alzheimer’s disease patients, identify any signs of psychopathology, quantify the level of perceived burden on the caregiver, and determine the caregiver’s relationship with their pharmacist. Methods: A cross-sectional study was conducted at a community pharmacy in Pontevedra, Spain. Demographic variables were collected, and the following questionnaires were administered: the Beck Depression Inventory-II, STAI-Anxiety Questionnaire, Zarit Burden Scale, family APGAR scale, and the Duke-UNC questionnaire. Results: The typical caregiver profile consists of a 55-year old first degree relative (mostly daughters) with a primary education who belongs to a functional or mildly dysfunctional family. Nearly one quarter (24%) of caregivers had a high perception of burden, with anxiety in 20% of caregivers and symptoms of depression in 20%. Family caregivers usually went to the same pharmacy as the patients (96%), were treated with psychotropic drugs (68%), and interacted with the pharmacist (92%). Conclusion: This study confirmed that psychological distress and burden is present among family caregivers. Care for caregivers should be integrated into patient care as part of a national plan, including grants and subsidies, which will result in better care of Alzheimer’s patients. Pharmacists are the most accessible health care professionals and can provide information about Alzheimer’s disease management to caregivers to ease the burden of care.

Introduccion. La sinestesia es un fenomeno neurologico caracterizado por la activacion simultanea de dos sistemas (o atributos) sensoriales, uno de los cuales no ha sido estimulado directamente. Dicha activacion se produce de una forma involuntaria, automatica y consistente a lo largo del tiempo. Objetivo. Estimar la frecuencia relativa de las diferentes modalidades de sinestesia en una muestra espanola. Sujetos y metodos. Estudio realizado en contextos educativos (55,04%), laborales (20,54%) y digitales (24,4%) mediante el cuestionario de sinestesia de la Fundacion Artecitta. Resultados. El analisis de las respuestas de 803 participantes sugiere que un 13,95% de la muestra estudiada experimenta alguna sinestesia. El analisis de la frecuencia relativa de las diferentes modalidades muestra que la mas frecuente es la que relaciona conceptos temporales con configuraciones espaciales (44,6%). Un 33,9% percibe colores cuando escucha sonidos o musica, un 25,9% asocia colores a los conceptos temporales, un 20,5% asigna genero o personalidad a las letras y numeros, un 10,7% experimenta la modalidad grafema-color, y un 5,4% siente un sabor especifico en su boca al escuchar palabras. Conclusiones. Los datos sugieren que la presencia de sinestesia en la muestra espanola estudiada es elevada y que la investigacion sobre el fenomeno y sus diferentes modalidades ha de ser abordada basandose en el conocimiento actual sobre su variabilidad fenomenologica y sus bases geneticas y neurofisiologicas. Asimismo, los resultados obtenidos son utiles para ajustar los items del cuestionario y aumentar su capacidad discriminativa.