Vulnerable consumers: marketing research needs to pay more attention to the brain health of consumers.

We propose here that marketing research should increase consideration of the brain health of consumers, and argue that it would help both extend our current knowledge of vulnerable and other marginalised groups, as well as extend generalizability and external validity of marketing research in general. We show that such a focus would help enrich methodology, especially around causal inference, as well as impact on our understanding of a number of key emerging themes in marketing research. We particularly focus on the consumer behaviour around digitalisation, as well as compulsive buying behaviour. Further, we show that increasing consideration of consumer brain health will further efforts towards inclusivity of marketing, and help continue progress towards marketing research as a force for good.

The role of cortisol in trust behavior: Results from an experimental study on healthy controls and patients with juvenile myoclonic epilepsy.

Trust is one of the foundations of human society and pervades all aspects of human live. Research on humans focused primarily on identifying the biological basis of trust behavior in healthy subjects, and this evidence hints to certain brain areas, hormones, and genetic factors to be fundamentally involved. The contribution of cortisol in trust has not yet elicited much attention in research, especially when specifically examined at basal cortisol levels. Trust has been previously studied in some neurological diseases but not in patients with epilepsy, and the influence of hormones on trust in these diseases remains yet unknown. Against this background, we designed an experimental study with a group of patients with juvenile myoclonic epilepsy and a group of healthy controls to compare trust behavior and plasma cortisol levels between the two groups. This economic game is frequently used in research to operationalize trust behavior. All participants further underwent neuropsychological assessment. Our results showed that there was no significant difference in trust behavior during the trust game, but a trend toward lower trust in patients. Furthermore, there was a significant difference in cortisol levels between groups with lower levels in patients. Interestingly, cortisol levels correlated with trust only in the patient group, but not in the control group. Future studies should specifically differentiate the effect of induced cortisol increases (e.g., acute stress) versus the effect of basal cortisol levels reflecting homeostasis or chronic stress on trust behavior and leverage the potential of comparison between patients and healthy controls.

Social cognition, behaviour and therapy adherence in frontal lobe epilepsy: a study combining neuroeconomic and neuropsychological methods.

Social behaviour of healthy humans and its neural correlates have been extensively studied in social neuroscience and neuroeconomics. Whereas it is well established that several types of epilepsies, such as frontal lobe epilepsy, lead to social cognitive impairments, experimental evidence on how these translate into behavioural symptoms is scarce. Furthermore, it is unclear whether social cognitive or behavioural disturbances have an impact on therapy adherence, which is critical for effective disease management, but generally low in these patients. In order to investigate the relationship between social cognition, social behaviour, and therapy adherence in patients with frontal lobe epilepsies (FLE), we designed a study combining conventional neuropsychological with behavioural economic and functional magnetic resonance imaging (fMRI) methodology. Fifteen patients and 15 healthy controls played a prisoners' dilemma game (an established game to operationalize social behaviour) while undergoing fMRI. Additionally, social cognitive, basic neuropsychological variables, and therapy adherence were assessed. Our results implicate that social behaviour is indeed affected and can be quantified using neuroeconomic methods in patients with FLE. Impaired social behaviour in these patients might be a consequence of altered brain activation in the medial prefrontal cortex and play a role in low therapy adherence. Finally, this study serves as an example of how to integrate neuroeconomic methods in neurology.

Stroke risk factors and treatment variables in rural and urban Austria: An analysis of the Austrian Stroke Unit Registry.

BACKGROUND AND OBJECTIVES: Differences in stroke risk factors and treatment variables between rural and urban regions in Austria were analyzed retrospectively as European data on this topic are scarce. RESEARCH DESIGN AND METHODS: We performed statistical analysis using group comparisons and time series analysis of data of the Austrian Stroke Unit Registry between 2005 and 2016. 87411 patients were divided into three groups (rural, intermediate, urban) according to the degree of urbanisation classification of the European Commission/Eurostat. RESULTS: Patients in the rural group were significantly younger, more often female, had a lower pre-stroke disability, and were more frequently transported by an emergency physician. Vascular risk factors were significantly higher in urban patients, leading to a higher rate of microangiopathic etiology. Onset-to-door (ODT) and Onset-to-treatment times were significantly higher in the rural group, but ODTs decreased over time. Door-to-needle times and time to first vascular imaging were significantly lower in the rural group. Intravenous thrombolysis and rehabilitation rates were lower in urban patients. DISCUSSION AND IMPLICATIONS: Contrary to previous literature predominantly from outside of Europe, vascular risk factors were higher in Austrian urban patients. Further, rural patients had higher intravenous thrombolysis and rehabilitation rates maybe because of lower pre-stroke disability. ODTs in rural patients were generally higher, but they decreased over time, which might be a consequence of better education of the public in noticing early stroke signs, better transportation and education of emergency medical personnel, better advance notification to the receiving hospital and implementation of Stroke Units in rural areas.

The neural correlates of trustworthiness evaluations of faces and brands: Implications for behavioral and consumer neuroscience.

When we buy a product of a brand, we trust the brand to provide good quality and reliability. Therefore, trust plays a major role in consumer behavior. It is unclear, however, how trust in brands is processed in the brain and whether it is processed differently from interpersonal trust. In this study, we used fMRI to investigate the neural correlates of interpersonal and brand trust by comparing the brain activation patterns during explicit trustworthiness judgments of faces and brands. Our results showed that while there were several brain areas known to be linked to trustworthiness evaluations, such as the amygdalae, more active in trustworthiness judgments when compared to a control task (familiarity judgment) for faces, no such difference was found for brands. Complementary ROI analysis revealed that the activation of both amygdalae was strongest for faces in the trustworthiness judgments. The direct comparison of the brain activation patterns during the trustworthiness evaluations between faces and brands in this analysis showed that trustworthiness judgments of faces activated the orbitofrontal cortex, another region that was previously linked to interpersonal trust, more strongly than trustworthiness judgments of brands. Further, trustworthiness ratings of faces, but not brands, correlated with activation in the orbitofrontal cortex. Our results indicate that the amygdalae, as well as the orbitofrontal cortex, play a prominent role in interpersonal trust (faces), but not in trust for brands. It is possible that this difference is due to brands being processed as cultural objects rather than as having human-like personality characteristics.

Risky Decision Making in Juvenile Myoclonic Epilepsy.

It is not known whether patients with juvenile myoclonic epilepsy (JME) differ from healthy people in decision making under risk, i.e., when the decision-making context offers explicit information about options, probabilities, and consequences already from the beginning. In this study, we adopted the Game of Dice Task-Double to investigate decision making under risk in a group of 36 patients with JME (mean age 25.25/SD 5.29 years) and a group of 38 healthy controls (mean age 26.03/SD 4.84 years). Participants also underwent a comprehensive neuropsychological assessment focused on frontal executive functions. Significant group differences were found in tests of psychomotor speed and divided attention, with the patients scoring lower than the controls. Importantly, patients made risky decisions more frequently than controls. In the patient group, poor decision making was associated with poor executive control, poor response inhibition, and a short interval since the last seizure episode. Executive control and response inhibition could predict 42% of variance in the frequency of risky decisions. This study indicates that patients with JME with poorer executive functions are more likely to make risky decisions than healthy controls. Decision making under risk is of major importance in every-day life, especially with regard to treatment decisions and adherence to long-term medical therapy. Since even a single disadvantageous decision may have long-lasting consequences, this finding is of high relevance.

Parkinson Patients' Initial Trust in Avatars: Theory and Evidence.

Parkinson's disease (PD) is a neurodegenerative disease that affects the motor system and cognitive and behavioral functions. Due to these impairments, PD patients also have problems in using the computer. However, using computers and the Internet could help these patients to overcome social isolation and enhance information search. Specifically, avatars (defined as virtual representations of humans) are increasingly used in online environments to enhance human-computer interaction by simulating face-to-face interaction. Our laboratory experiment investigated how PD patients behave in a trust game played with human and avatar counterparts, and we compared this behavior to the behavior of age, income, education and gender matched healthy controls. The results of our study show that PD patients trust avatar faces significantly more than human faces. Moreover, there was no significant difference between initial trust of PD patients and healthy controls in avatar faces, while PD patients trusted human faces significantly less than healthy controls. Our data suggests that PD patients' interaction with avatars may constitute an effective way of communication in situations in which trust is required (e.g., a physician recommends intake of medication). We discuss the implications of these results for several areas of human-computer interaction and neurological research.

Trust behavior in Parkinson's disease: results of a trust game experiment.

BACKGROUND: Parkinson's Disease (PD) is a neurodegenerative disease characterized by motor symptoms, but in which behavioral and cognitive disturbances are also common. Trust, due to its pervasiveness in society, has become a major research topic in several scientific disciplines. However, empirical evidence for trust behavior in neurological patients, and specifically for movement disorders such as PD, is missing. Evidence from healthy subjects, however, indicates that three brain regions are involved in trust perceptions and behavior, namely the limbic system, basal ganglia, and frontal cortex. PD affects all these brain regions. Therefore, we hypothesized that PD patients and healthy controls show differences in trust behavior. METHODS: We conducted an experiment using the trust game, an established paradigm to investigate trust behavior in both patient and healthy populations alike, controlling for risky decision making. Twenty patients suffering from PD diagnosed according to UK PDS Brain Bank criteria and twenty healthy controls (matched for age, gender, education, and income) were recruited. We excluded those suffering from clinically relevant neuropsychiatric comorbidities. RESULTS: We found that PD patients exhibit significantly lower levels of trust than do healthy controls. Importantly, our results cannot be explained by lower levels of risk-taking. Moreover, our results indicate that the trust deficit is independent of medication, disease duration, and severity of motor symptoms. CONCLUSION: Application of a standard procedure for measuring trust behavior revealed that PD patients exhibit lower levels of trust in other humans than do healthy controls. Against this background we make a call for further research to determine the underlying pathophysiology of reduced trust in PD.

The Peripheral Sympathetic Neuron is Intact in Alzheimer's Disease and Behavioral Variant of Frontotemporal Dementia.

INTRODUCTION: The study was undertaken to evaluate the postganglionic sympathetic sudomotor function employing the quantitative sudomotor axon reflex test (QSART) in tauopathies Alzheimer's disease (AD) and behavioral variant of frontotemporal dementia (bvFTD). METHODS: Patients were recruited in a prospective pilot study. A structured history was taken and QSART was recorded. RESULTS: In all, 15 patients with AD (7 female) and 14 patients with bvFTD (9 female) were included. Mean age (±standard deviation) of patients with AD and bvFTD was 74 ± 9 and 71 ± 10 years, respectively. Severe sudomotor dysfunction (Composite Autonomic Severity sudomotor score 3) was present in 3 (20%) patients with AD and 0 (0%) patients with bvFTD (P = .037). The upper extremity was only involved in 1 patient with AD and 1 patient with bvFTD. Sweat results of the 4 recording sites did not differ between both groups. Patients' history correlated with severe autonomic symptoms as assessed with QSART. CONCLUSION: Postganglionic sudomotor involvement in AD and bvFTD is most likely not part of the disease.

Correlation of plasma and salivary oxytocin in healthy young men - experimental evidence.

OBJECTIVES: The neuroactive hormone oxytocin (OT) has significant influence on human behavior, and it has been measured peripherally in venous blood and in saliva in many behavioral neuroscience studies. Assessment of salivary hormone levels is popular due to non-invasiveness, but there is a controversy as to whether OT can be reliably measured in saliva and how possible time lags between plasma and salivary OT levels influence correlation. DESIGN AND METHODS: In order to shed light on the question whether salivary and plasma OT levels correlate, we designed an experiment where healthy young men had to look at a presentation of trustworthy faces on a computer screen (faces were taken from an established database in trust research). During three points in time, plasma and saliva samples were collected and analyzed using ELISA. RESULTS: Plasma and salivary OT levels did not correlate even when considering a time lag of 15 or 30 minutes. CONCLUSIONS: Our results suggest that plasma and salivary OT levels do not correlate in healthy young men, and hence comparison of results across plasma and salivary studies is neither informative nor warranted. However, we recommend replicating this study based on mixed-gender samples.

The phoenix from the ashes: cardiovascular autonomic dysfunction in behavioral variant of frontotemporal dementia.

BACKGROUND: Patients with autonomic failure may experience postural dizziness, syncope, and falls. Identifying symptomatic dysautonomia in dementia is of importance to ensure appropriate management and reduce risk of falls. OBJECTIVE: The aim of this prospective study is to identify cardiovascular autonomic dysfunction in patients suffering from behavioral variant of frontotemporal dementia (bvFTD), compared to Alzheimer's disease (AD). METHODS: Patients were prospectively recruited from 2009 until 2013. Clinical autonomic function tests were carried out in an Autonomic Unit according to Ewing's cardiovascular battery. Parasympathetic tests included resting heart rate variability, deep breathing, and Valsalva. Sympathetic function tests compromised blood pressure regulation on valsalva, cutaneous cold stimulation, and 70° head up tilt including of plasma noradrenaline. RESULTS: 26 patients (17 female) with bvFTD and 18 patients (10 female) with AD were examined. Mean age of bvFTD was 69 ± 11 years, AD 74 ± 9 years. History taking was often not conclusive and did not correlate with autonomic signs. In 42% bvFTD patients and 44% AD patients, autonomic dysfunction was demonstrated. Manifest orthostatic hypotension (OH) was present in 19% of bvFTD and 33% AD patients. Frequency of autonomic dysfunction and orthostatic hypotension did not differ between bvFTD and AD, but were significantly higher than in healthy controls. Autonomic dysfunction was associated with an increased risk of falling (assessed with Tinetti Score). CONCLUSION: This is the first prospective study to elucidate autonomic dysfunction in bvFTD patients. There is a considerable higher frequency of cardiovascular dysfunction and OH in bvFTD. History taking may be not conclusive thus cannot exclude cardiovascular dysautonomia.

Onset of sweating depends on the type of reflex syncope.

Reflex syncope is classified based on the efferent autonomic system as vasodepressant type, cardioinhibitory type and mixed type. We employed quantitative sweat testing to assess differences in sudomotor sympathetic activity in relation to the type of reflex syncope. In cardioinhibitory type sweating started in 7/9 patients after and in vasodepressor type in 11/12 patients before syncope. In mixed type sweating in 20 patients started before and in 10 after syncope. The onset of sweating correlated significantly with the onset of syncope symptoms. These results possibly reflect different onsets of emotional sweating.

Neuromarketing and consumer neuroscience: contributions to neurology.

BACKGROUND: 'Neuromarketing' is a term that has often been used in the media in recent years. These public discussions have generally centered around potential ethical aspects and the public fear of negative consequences for society in general, and consumers in particular. However, positive contributions to the scientific discourse from developing a biological model that tries to explain context-situated human behavior such as consumption have often been neglected. We argue for a differentiated terminology, naming commercial applications of neuroscientific methods 'neuromarketing' and scientific ones 'consumer neuroscience'. While marketing scholars have eagerly integrated neuroscientific evidence into their theoretical framework, neurology has only recently started to draw its attention to the results of consumer neuroscience. DISCUSSION: In this paper we address key research topics of consumer neuroscience that we think are of interest for neurologists; namely the reward system, trust and ethical issues. We argue that there are overlapping research topics in neurology and consumer neuroscience where both sides can profit from collaboration. Further, neurologists joining the public discussion of ethical issues surrounding neuromarketing and consumer neuroscience could contribute standards and experience gained in clinical research. SUMMARY: We identify the following areas where consumer neuroscience could contribute to the field of neurology:First, studies using game paradigms could help to gain further insights into the underlying pathophysiology of pathological gambling in Parkinson's disease, frontotemporal dementia, epilepsy, and Huntington's disease.Second, we identify compulsive buying as a common interest in neurology and consumer neuroscience. Paradigms commonly used in consumer neuroscience could be applied to patients suffering from Parkinson's disease and frontotemporal dementia to advance knowledge of this important behavioral symptom.Third, trust research in the medical context lacks empirical behavioral and neuroscientific evidence. Neurologists entering this field of research could profit from the extensive knowledge of the biological foundation of trust that scientists in economically-orientated neurosciences have gained.Fourth, neurologists could contribute significantly to the ethical debate about invasive methods in neuromarketing and consumer neuroscience. Further, neurologists should investigate biological and behavioral reactions of neurological patients to marketing and advertising measures, as they could show special consumer vulnerability and be subject to target marketing.

Myxoma valvulae arteriae pulmonalis described by Rokitansky: medicohistorical and clinicopathological aspects.

The bicentenary of the birth of Rokitansky, the first true descriptive pathologist, was celebrated in February 2004. Rokitansky gathered many and important specimens that are now displayed in the Federal Museum of Pathological Anatomy in Vienna. On examining Rokitansky's collection we found a myxoma of the pulmonary valve of a 70-year-old woman who died in 1833. Cardiac myxomas are rare but are the most frequent primary heart tumors, appearing even less frequently on cardiac valves. Modern histology has confirmed Rokitansky's diagnosis on gross pathology. The good condition of this 171-year-old specimen was surprising. Thus, Rokitansky described the myxoma 75 years before Ribbert's first description of a myxoma in this rare localization.