Distinct latent symptom profiles in late-onset depressive symptoms in community-dwelling older adults.

OBJECTIVES: To examine the symptom profiles of late-onset depressive symptoms in a sample of older adults. METHOD: The sample included 1,192 participants from the National Alzheimer's Coordinating Center Data Set. Participants were ≥65 years old, community-dwelling, and without cognitive impairment or a prior history of depression. Depressive symptoms were assessed using the Geriatric Depression Scale, 15-item (GDS-15). Latent class analysis (LCA) was used to identify and group participants based on profiles of depressive symptoms. RESULTS: LCA revealed three distinct symptom profiles: (1) an Anhedonia/Amotivation profile with a higher probability of endorsing a combination of low positive emotion and amotivation (6%), (2) an Amotivation/Withdrawal profile with a high probability of endorsing only amotivational depressive symptoms (35%), and (3) an asymptomatic profile with no probability of endorsing any depressive symptoms (59%). Amotivational depressive symptoms were observed across both symptomatic profiles, while depressed mood (e.g. sadness) did not predominantly characterize any profile in this sample. There were also significant differences among symptom profiles in terms of demographic and clinical characteristics. CONCLUSIONS: Findings highlight the importance of understanding depression at the symptom pattern level. A profile-based diagnostic approach may help improve the recognition of depressive symptoms in older adults.

The Combined Use of Neuropsychiatric and Neuropsychological Assessment Tools to Make a Differential Dementia Diagnosis in the Presence of "Long-Haul" COVID-19.

The longer term neurocognitive/neuropsychiatric consequences of moderate/severe COVID-19 infection have not been explored. The case herein illustrates a complex web of differential diagnosis. The onset, clinical trajectory, treatment course/response, serial neuroimaging findings, and neuropsychological test data were taken into account when assessing a patient presenting 8 months post-COVID-19 (with premorbid attention-deficit hyperactivity disorder, diabetes mellitus, mood difficulties, and a positive family history of vascular dementia). Her acute COVID-19 infection was complicated by altered mental status associated with encephalopathy and bacterial pneumonia. After recovery from COVID-19, the patient continues to experience persisting cognitive and emotive difficulties despite an ongoing psychopharmacotherapy regimen (16 + years), psychotherapy (15 + sessions), and speech-language pathology SLP; 2 × week/for 12 weeks). The purpose of her most recent and comprehensive neuropsychological evaluation was to determine the presence/absence of neurocognitive disorder. The patient is a 62-year-old Caucasian woman. Cognitive screening was completed 3 months post-acute COVID-19 as part of an SLP evaluation, and a full neuropsychological evaluation was conducted 8 months post-COVID-19 recovery on an outpatient basis (in person). The patient had serial neuroimaging. Initial neurological evaluation during acute COVID-19 included unremarkable brain computed tomography (CT)/magnetic resonance imaging. However, follow-up CT (without contrast) revealed, in part, "asymmetric perisylvian atrophy on the left." Full neuropsychological evaluation at 8 months post-COVID-19 recovery revealed a dysexecutive syndrome characterized by language dysfunction and affective theory-of-mind deficit, consistent with dementia. There is need for careful use of differential diagnosis in COVID-19 patients with multiple risk factors that make them more susceptible to long-term neurological complications post-COVID-19. Differential diagnosis should involve multidisciplinary assessment (e.g., neuropsychology, SLP, neurology, and psychiatry).

Empathy for joy recruits a broader prefrontal network than empathy for sadness and is predicted by executive functioning.

Empathy encompasses the ability to contemplate and vicariously share in the emotional life of others, and is critical for social interaction, and may enhance subjective happiness. OBJECTIVE: While a few theoretical models propose that executive function may play a role in empathy, it is unknown how variation in executive function, and underlying variation in key large-scale brain network nodes, such as the dorsolateral prefrontal cortex node within the executive control network-or the medial prefrontal cortex (PFC) node within the mentalizing/theory of mind network-may account for individual differences in empathy capacity. METHOD: The relationship between individual differences in executive capacity-parsed into working memory, inhibition, and cognitive flexibility subdomains-and magnitude of activity in a priori identified PFC subregions during a functional MRI-based ecologically valid empathy induction paradigm, was investigated. Empathic happiness (i.e., vicarious joy) and empathic concern (i.e., vicarious sadness) in response to the life circumstances of actual people were measured at separate time points as brain functional MRI was obtained. Participants also completed executive-heavy clinical neuropsychological tasks outside of the scanner. RESULTS: Frontopolar PFC was activated across both types of empathy. However, empathic happiness related to engagement of a much broader network of prefrontal cortex subregions relative to empathic concern: spawning frontopolar, dorsolateral, and medial aspects. PFC activation during both types of empathy was positively predicted by working memory capacity. CONCLUSION: Activation in core aspects of the working memory-executive control network, and core happiness-related aspects of the mentalizing brain network (i.e., medial PFC and precuneus) predicted greater empathy capacity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Measuring change in anhedonia using the "Happy Faces" task pre- to post-repetitive transcranial magnetic stimulation (rTMS) treatment to left dorsolateral prefrontal cortex in Major Depressive Disorder (MDD): relation to empathic happiness.

We investigated whether repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex (DLPFC) would reduce anhedonia in a sample of 19 depressed adults (Mage = 45.21, SD = 11.21, 63% women) randomized to either active or sham rTMS. To track anhedonia, patients completed the Snaith-Hamilton Pleasure Scale (SHAPS)1 and a novel behavioral task called "Happy Faces," which required patients to interpret neutral versus various intensities of positively valenced human facial expressions. Patients had to indicate dichotomously whether any degree of positive emotion was expressed. We expected that more anhedonic patients would struggle most with low intensity happy faces; often incorrectly calling them neutral. Patients also completed a self-report measure of "empathic happiness"-i.e., vicarious joy. Measures were completed pre- to post-treatment. Results indicate rTMS to DLPFC related to improvement in interpretation of subtle forms of happiness in active rTMS patients relative to sham. Furthermore, empathic happiness and anhedonia score were significantly antagonistic across all patients.

The Heterogeneity of Empathy: Possible Treatment for Anhedonia?

Traditionally, empathy has been described as a process by which an individual "tries on" the negative emotion of others (i. e., empathic concern). A corpus of empirical work has been devoted to the study of this particular form of empathy. However, in this paper, the heterogeneity model of empathy is proposed as a method for counteracting the lack of attention paid to "positive-valence empathy"-our ability to respond to the negative and positive emotion of others with appropriate positive affect. Both empathic concern and positive-valence empathy are argued to have distinguishable behavioral manifestations and at least partially distinguishable neurobiological underpinnings. The potential value of positive-valence empathy induction for therapeutic purposes is also discussed.

The Measurement of Positive Valence Forms of Empathy and Their Relation to Anhedonia and Other Depressive Symptomatology.

Construct validity of a brief self-report measure of "positive-valence empathy" (the tendency to exude positive emotion as a means to stimulate positive affect in others, and/or to vicariously share in another's positive emotion; Light et al., 2009) was attained utilizing a sample of 282 healthy adults. Positive-valence empathy may have unique predictive ability for differentiating depression versus depression with anhedonia. Confirmatory factor analyses revealed a two-factor structure for the final 15-item Light-Moran Positive Empathy Scale (PES), with an 8-item "Empathic Happiness" subscale (e.g., "I find that other people's happiness easily rubs off on me") and a 7-item "Empathic Cheerfulness" subscale (e.g., "I enjoy making others feel good"). "Empathic Happiness" was a significantly better predictor of overall depressive symptomatology (Beck et al., 1996) than anhedonia (Snaith et al., 1995). The Light-Moran PES-15 may have real-world impact and predictive utility for well-being.

Fronto-striatal activity predicts anhedonia and positive empathy subtypes.

The dorsolateral prefrontal cortex, globus pallidus, and nucleus accumbens are important components of the reward circuit in the brain; and prior research suggests individuals with damage to these regions feel less pleasure (i.e., are anhedonic). However, little is known about how these brain regions relate to vicarious pleasure. Pilot fMRI data were collected from 20 participants (Mage = 22, SD = 7.0, 63% female) during a validated empathy induction paradigm that utilized video clips extracted from the television show "Extreme Makeover: Home Edition" to elicit empathic happiness (i.e. vicarious happiness) when targets display positive affect, and either empathic cheerfulness (i.e. the tendency to want to cheer someone up) or empathic concern (i.e. vicarious sadness) when targets display negative affect. Participants also completed the novel "Happy Faces" task-a behavioral measure of anhedonia-while fMRI was collected. fMRI data during task completion were used to predict trait empathy measured via self-report outside of the scanner, and accuracy on the "Happy Faces" task. Results indicate that globus pallidus activity during empathic concern-eliciting video clips significantly predicted self-reported trait empathic cheerfulness (R2 = 26%, p = 0.045). Furthermore, greater dorsolateral prefrontal cortex (DLPFC) activity during the Happy Faces task predicted accurate performance on the task (R2 = 34%, p < .05); and greater nucleus accumbens shell activity during the Happy Faces task predicted greater trait empathic happiness (R2 = 38%, p < .05). These results suggest that fronto-striatal circuitry contributes to our experience of anhedonia, empathic happiness, and empathic cheerfulness.

Childhood Affective Indicators of Risk for Adulthood Psychopathology: The New York High-Risk Project Findings.

There are relatively few investigations of the emotion expressivity of children at risk for the later development of schizophrenia and schizophrenia-spectrum disorders. Using data from the New York High-Risk Project, we compared children's emotional expressivity during a semi-structured videotaped interview. Data were coded for 173 child subjects: 61 with schizophrenic parents (HRSz); 54 with affectively ill parents (HRAff); and 58 with psychiatrically "normal" parents (NC). A child's affective responses were rated for the presence of discrete positive, negative, or neutral emotions by coders naive to group membership. Responses were also rated for anxiety, flat affect, inappropriate affect, and emotional withdrawal/disengagement. Compared with the two other two groups, HRSz children displayed significantly more negative affect in response to questions regarding their most negative experiences and, when questioned about their self-concept, they displayed significantly less positive affect. Both HRSz and HRAff children showed more inappropriate affect than NC children. Significantly more HRSz children were rated as demonstrating a lack of emotional engagement. Children making inappropriate displays of positive affect while discussing a negative topic were most likely to manifest a psychiatric disorder as an adult. These findings suggest that inappropriate affect may be a nonspecific indicator of risk for psychopathology. Emotional withdrawal in childhood may be a potential indicator of risk for schizophrenia.

"Top-Down" Mu-Opioid System Function in Humans: Mu-Opioid Receptors in Ventrolateral Prefrontal Cortex Mediate the Relationship Between Hedonic Tone and Executive Function in Major Depressive Disorder.

Cognitive dysfunction and anhedonia, the reduced ability to experience pleasure, are commonly comorbid symptoms that are persistent following successful resolution of negative affect in major depressive disorder (MDD). Little is known about whether they share common etiology. In the present study, the relationship between ventrolateral prefrontal cortex (VLPFC) activity, cognitive dysfunction (i.e., executive dysfunction), and positive emotionality was investigated in conjunction with mu-opioid neurotransmission in a sample of 39 MDD patients. Results suggest that increased endogenous mu-opioid tone in the VLPFC mediates the relationship between increased trait positive emotionality and more efficient executive functioning.

Patterns of frontoparietal activation as a marker for unsuccessful visuospatial processing in healthy aging.

Visuospatial abilities are sensitive to age-related decline, although the neural basis for this decline (and its everyday behavioral correlates) is as yet poorly understood. fMRI was employed to examine age-related differences in patterns of functional activation that underlie changes in visuospatial processing. All participants completed a brief neuropsychological battery and also a figure ground task (FGT) assessing visuospatial processing while fMRI was recorded. Participants included 16 healthy older adults (OA; aged 69-82 years) and 16 healthy younger adults (YA; aged 20-35 years). We examined age-related differences in behavioral performance on the FGT in relation to patterns of fMRI activation. OA demonstrated reduced performance on the FGT task and showed increased activation of supramarginal parietal cortex as well as increased activation of frontal and temporal regions compared to their younger counterparts. Performance on the FGT related to increased supramarginal gyrus activity and increased medial prefrontal activity in OAs, but not YAs. Our results are consistent with an anterior-posterior compensation model. Successful FGT performance requires the perception and integration of multiple stimuli and thus it is plausible that healthy aging may be accompanied by changes in visuospatial processing that mimic a subtle form of dorsal simultanagnosia. Overall, decreased visuospatial processing in OA relates to an altered frontoparietal neurobiological signature that may contribute to the general phenomenon of increasingly fragmented execution of behavior associated with normal aging.

Electromyographically assessed empathic concern and empathic happiness predict increased prosocial behavior in adults.

The relation between empathy subtypes and prosocial behavior was investigated in a sample of healthy adults. "Empathic concern" and "empathic happiness", defined as negative and positive vicarious emotion (respectively) combined with an other-oriented feeling of "goodwill" (i.e. a thought to do good to others/see others happy), were elicited in 68 adult participants who watched video clips extracted from the television show Extreme Makeover: Home Edition. Prosocial behavior was quantified via performance on a non-monetary altruistic decision-making task involving book selection and donation. Empathic concern and empathic happiness were measured via self-report (immediately following each video clip) and via facial electromyography recorded from corrugator (active during frowning) and zygomatic (active during smiling) facial regions. Facial electromyographic signs of (a) empathic concern (i.e. frowning) during sad video clips, and (b) empathic happiness (i.e. smiling) during happy video clips, predicted increased prosocial behavior in the form of increased goodwill-themed book selection/donation.

Relationships between changes in sustained fronto-striatal connectivity and positive affect in major depression resulting from antidepressant treatment.

OBJECTIVE Deficits in positive affect and their neural bases have been associated with major depression. However, whether reductions in positive affect result solely from an overall reduction in nucleus accumbens activity and fronto-striatal connectivity or the additional inability to sustain engagement of this network over time is unknown. The authors sought to determine whether treatment-induced changes in the ability to sustain nucleus accumbens activity and fronto-striatal connectivity during the regulation of positive affect are associated with gains in positive affect. METHOD Using fMRI, the authors assessed the ability to sustain activity in reward-related networks when attempting to increase positive emotion during performance of an emotion regulation paradigm in 21 depressed patients before and after 2 months of antidepressant treatment. Over the same interval, 14 healthy comparison subjects underwent scanning as well. RESULTS After 2 months of treatment, self-reported positive affect increased. The patients who demonstrated the largest increases in sustained nucleus accumbens activity over the 2 months were those who demonstrated the largest increases in positive affect. In addition, the patients who demonstrated the largest increases in sustained fronto-striatal connectivity were also those who demonstrated the largest increases in positive affect when controlling for negative affect. None of these associations were observed in healthy comparison subjects. CONCLUSIONS Treatment-induced change in the sustained engagement of fronto-striatal circuitry tracks the experience of positive emotion in daily life. Studies examining reduced positive affect in a variety of psychiatric disorders might benefit from examining the temporal dynamics of brain activity when attempting to understand changes in daily positive affect.

Reduced right ventrolateral prefrontal cortex activity while inhibiting positive affect is associated with improvement in hedonic capacity after 8 weeks of antidepressant treatment in major depressive disorder.

BACKGROUND: Anhedonia, a reduced ability to experience pleasure, is a chief symptom of major depressive disorder and is related to reduced frontostriatal connectivity when attempting to upregulate positive emotion. The present study examined another facet of positive emotion regulation associated with anhedonia-namely, the downregulation of positive affect-and its relation to prefrontal cortex (PFC) activity. METHODS: Neuroimaging data were collected from 27 individuals meeting criteria for major depressive disorder as they attempted to suppress positive emotion during a positive emotion regulation task. Their PFC activation pattern was compared with the PFC activation pattern exhibited by 19 healthy control subjects during the same task. Anhedonia scores were collected at three time points: at baseline (time 1), 8 weeks after time 1 (i.e., time 2), and 6 months after time 1 (i.e., time 3). Prefrontal cortex activity at time 1 was used to predict change in anhedonia over time. Analyses were conducted utilizing hierarchical linear modeling software. RESULTS: Depressed individuals who could not inhibit positive emotion-evinced by reduced right ventrolateral prefrontal cortex activity during attempts to dampen their experience of positive emotion in response to positive visual stimuli-exhibited a steeper anhedonia reduction slope between baseline and 8 weeks of treatment with antidepressant medication (p < .05). Control subjects showed a similar trend between baseline and time 3. CONCLUSIONS: To reduce anhedonia, it may be necessary to teach individuals how to counteract the functioning of an overactive pleasure-dampening prefrontal inhibitory system.

Empathy is associated with dynamic change in prefrontal brain electrical activity during positive emotion in children.

Empathy is the combined ability to interpret the emotional states of others and experience resultant, related emotions. The relation between prefrontal electroencephalographic asymmetry and emotion in children is well known. The association between positive emotion (assessed via parent report), empathy (measured via observation), and second-by-second brain electrical activity (recorded during a pleasurable task) was investigated using a sample of one hundred twenty-eight 6- to 10-year-old children. Contentment related to increasing left frontopolar activation (p < .05). Empathic concern and positive empathy related to increasing right frontopolar activation (ps < .05). A second form of positive empathy related to increasing left dorsolateral activation (p < .05). This suggests that positive affect and (negative and positive) empathy both relate to changes in prefrontal activity during a pleasurable task.

Dynamic variation in pleasure in children predicts nonlinear change in lateral frontal brain electrical activity.

Individual variation in the experience and expression of pleasure may relate to differential patterns of lateral frontal activity. Brain electrical measures have been used to study the asymmetric involvement of lateral frontal cortex in positive emotion, but the excellent time resolution of these measures has not been used to capture second-by-second changes in ongoing emotion until now. The relationship between pleasure and second-by-second lateral frontal activity was examined with the use of hierarchical linear modeling in a sample of 128 children ages 6-10 years. Electroencephalographic activity was recorded during "pop-out toy," a standardized task that elicits pleasure. The task consisted of 3 epochs: an anticipation period sandwiched between 2 play periods. The amount of pleasure expressed during the task predicted the pattern of nonlinear change in lateral frontal activity. Children who expressed increasing amounts of pleasure during the task exhibited increasing left lateral frontal activity during the task, whereas children who expressed contentment exhibited increasing right/decreasing left activity. These findings indicate that task-dependent changes in pleasure relate to dynamic, nonlinear changes in lateral frontal activity as the task unfolds.

Reduced capacity to sustain positive emotion in major depression reflects diminished maintenance of fronto-striatal brain activation.

Anhedonia, the loss of pleasure or interest in previously rewarding stimuli, is a core feature of major depression. While theorists have argued that anhedonia reflects a reduced capacity to experience pleasure, evidence is mixed as to whether anhedonia is caused by a reduction in hedonic capacity. An alternative explanation is that anhedonia is due to the inability to sustain positive affect across time. Using positive images, we used an emotion regulation task to test whether individuals with depression are unable to sustain activation in neural circuits underlying positive affect and reward. While up-regulating positive affect, depressed individuals failed to sustain nucleus accumbens activity over time compared with controls. This decreased capacity was related to individual differences in self-reported positive affect. Connectivity analyses further implicated the fronto-striatal network in anhedonia. These findings support the hypothesis that anhedonia in depressed patients reflects the inability to sustain engagement of structures involved in positive affect and reward.