Age-related decline in emotional perspective-taking: Its effect on the late positive potential.

Aging is associated with changes in cognitive and affective functioning, which likely shape older adults' social cognition. As the neural and psychological mechanisms underlying age differences in social abilities remain poorly understood, the present study aims to extend the research in this field. To this purpose, younger (n = 30; Mage = 26.6), middle-aged (n = 30; Mage = 48.4), and older adults (n = 29; Mage = 64.5) performed a task designed to assess affective perspective-taking, during an EEG recording. In this task, participants decided whether a target facial expression of emotion (FEE) was congruent or incongruent with that of a masked intervener of a previous scenario, which portrayed a neutral or an emotional scene. Older adults showed worse performance in comparison to the other groups. Regarding electrophysiological results, while younger and middle-aged adults showed higher late positive potentials (LPPs) after FEEs congruent with previous scenarios than after incongruent FEEs, older adults had similar amplitudes after both. This insensitivity of older adults' LPPs in differentiating congruent from incongruent emotional context-target FEE may be related to their difficulty in generating information about others' inner states and using that information in social interactions.

Age-related changes in social decision-making: An electrophysiological analysis of unfairness evaluation in the Ultimatum Game.

This study examines age-related differences in behavioral and neural responses to unfairness. Our sample was composed of younger, middle-aged, and older adults, who performed the Ultimatum Game in the proposer role, and in the respondent role during an EEG recording. We administered neurocognitive tests to identify whether patterns in decision-making are associated with age-related changes in cognition. Despite the worse performance in measures of executive functioning, older adults had the best economic strategy by accepting more unfair offers than younger and middle-aged adults. Regarding electrophysiological results, while younger adults showed higher medial frontal negativity (MFN) amplitudes after unfair than after fair offers, middle-aged and older adults had similar amplitudes after both conditions. Our results suggest that aging may be accompanied by an insensitivity to unfairness, which may underlie their higher rates of unfair offers acceptance.

Language improvement one week after thrombolysis in acute stroke.

OBJECTIVES: Language recovery following acute stroke is difficult to predict due to several evaluation factors and time constraints. We aimed to investigate the predictors of aphasia recovery and to identify the National Institute of Health and Stroke Scale (NIHSS) items that best reflect linguistic performance, 1 week after thrombolysis. MATERIALS AND METHODS: We retrieved data from a prospective registry of patients with aphasia secondary to left middle cerebral artery (MCA) stroke treated with intravenous thrombolysis. Complete recovery at day 7 (D7) was measured in a composite verbal score (CVS) (Σ Language+Questions+Commands NIHSS scores). Lesion size was categorized by the Alberta Stroke Program Early CT score (ASPECTS) and vascular patency by ultrasound. CVS was correlated with standardized aphasia testing if both were performed within a two-day interval. RESULTS: Of 228 patients included (age average 67.32 years, 131 men), 72% presented some language improvement that was complete in 31%. Total recovery was predicted by ASPECTS (OR=1.65; 95% CI, 1.295-2.108; P < 0.00) and baseline aphasia severity (OR=0.439; 95% CI, 0.242-0.796; P < 0.007). CVS correlated better with standardized aphasia measures (aphasia quotient, severity, comprehension) than NIHSS_Language item. CONCLUSIONS: Lesion size and initial aphasia severity are the main predictors of aphasia recovery one week after thrombolysis. A NIHSS composite verbal score seems to capture the global linguistic performance better than the language item alone.

Sequential brief neuropsychological evaluation of migraineurs is identical to controls.

BACKGROUND: Evidence of attack-related cognitive dysfunction in migraine is growing. Controversy exists on whether cognitive dysfunction, mainly executive, may persist between attacks. Measuring the impact of cognitive function is gaining importance in clinical and research settings in migraine. OBJECTIVE: To compare the performance of interictal migraine patients to controls in an assembled neuropsychological battery focused on executive functions and to study the practice effect of its repeated applications. METHOD: Assembly of the battery that was then applied twice within 6 weeks to interictal migraineurs and matched healthy controls. RESULTS: Migraine patients (n = 24) and controls (n = 24) had similar performance in both applications of the battery. There was a slight practice effect between the first and second evaluation, significant in Stroop Interference test (P = 0.002, multiplicity corrected); a meaningful score change was determined for each raw test scores. CONCLUSIONS: Interictal migraineurs and controls performance is identical in a brief cognitive battery focused on executive functions. Repeated applications produced a practice effect that was quantified.

How subjective are subjective language complaints.

BACKGROUND AND PURPOSE: Subjective language complaints (SLC) are common during ageing but have not been investigated in detail. We aim to determine their association with demographic and clinical variables and objective cognitive performance. METHODS: A sample of 479 individuals aged 50 years or above (average 66 ± 9.1 years), followed in primary care, with no history of brain disorder were asked two questions concerning SLC, fulfilled a depression scale and undertook a battery of cognitive tests. Response to questions regarding proper name retrieval (PNR) and word finding difficulties (WFD) was studied and their contribution to each measure of the battery calculated by repeated linear regression analysis, adjusting for age, sex, education, living alone and depressive symptoms. RESULTS: Word finding difficulties (47.6%) were more frequently reported than problematic PNR (10.9%). Both were more common in women, in subjects with depressive symptoms and in those living alone, but were unrelated with age or education. Both symptoms contributed significantly to the variance in tests of semantic fluency and episodic memory. PNR was also associated with immediate phonological memory. CONCLUSIONS: Subjective language complaints are especially common amongst individuals living alone and/or with depressive symptoms. They are associated with a worse cognitive performance in some memory and language-executive tests. Further studies are needed to understand their predictive value for cognitive decline.

Cut-off scores in MMSE: a moving target?

BACKGROUND: Cognitive tests are known to be influenced by language, culture and education. In addition, there may be an impact of 'epoch' in cognition, because there is secular increase in scores of IQ tests in children. If we assume this is a long lasting process, then it should persist later in life. METHODS: To test this hypothesis, we compared the performance of two cohorts of individuals (>or=50 years of age), evaluated 20 years apart using the Mini-Mental State Examination (MMSE). RESULTS: Study population included 135 participants in 1988 and 411 in 2008. MMSE scores were higher in 2008 than in 1988 for literacy x age-matched subgroups, the difference being significant for participants with lower literacy. Score variance was explained by literacy (beta = 0.479, t = 14.598, P = 0.00), epoch (beta = 0.34, t = 10.33, P = 0.00) and age (beta = -0.142, t = -4.184, P = 0.00). CONCLUSION: The present results are in accordance with a lifelong secular improvement in cognitive performance. The operational cut-off values may change with time, which may have clinical impact in the diagnosis of disorders like mild cognitive impairment or dementia.

Headaches associated with refractive errors: myth or reality?

INTRODUCTION: Headache and refractive errors are very common conditions in the general population, and those with headache often attribute their pain to a visual problem. The International Headache Society (IHS) criteria for the classification of headache includes an entity of headache associated with refractive errors (HARE), but indicates that its importance is widely overestimated. OBJECTIVES: To compare overall headache frequency and HARE frequency in healthy subjects with uncorrected or miscorrected refractive errors and a control group. METHODS: We interviewed 105 individuals with uncorrected refractive errors and a control group of 71 subjects (with properly corrected or without refractive errors) regarding their headache history. We compared the occurrence of headache and its diagnosis in both groups and assessed its relation to their habits of visual effort and type of refractive errors. RESULTS: Headache frequency was similar in both subjects and controls. Headache associated with refractive errors was the only headache type significantly more common in subjects with refractive errors than in controls (6.7% versus 0%). It was associated with hyperopia and was unrelated to visual effort or to the severity of visual error. With adequate correction, 72.5% of the subjects with headache and refractive error reported improvement in their headaches, and 38% had complete remission of headache. Regardless of the type of headache present, headache frequency was significantly reduced in these subjects (t = 2.34, P =.02). CONCLUSIONS: Headache associated with refractive errors was rarely identified in individuals with refractive errors. In those with chronic headache, proper correction of refractive errors significantly improved headache complaints and did so primarily by decreasing the frequency of headache episodes.

Behavioral response to headache: a comparison between migraine and tension-type headache.

OBJECTIVE: To compare patients with migraine and tension-type headache in their behavior during the attacks and the maneuvers used to relieve the pain. BACKGROUND: Patients with headache often perform nonpharmacological measures to relieve the pain, but it is not known if these behaviors vary with the diagnosis, clinical features, and pathogenesis. METHODS: One hundred consecutive patients with either migraine (n = 72 ) or tension-type headache (n = 28) were questioned (including the use of a checklist) concerning their usual behavior during the attacks and nonpharmacological maneuvers performed to relieve the pain. The results of the two types of headache were compared. RESULTS: Patients with migraine tended to perform more maneuvers than individuals with tension-type headache (mean, 6.2 versus 3). These maneuvers included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet, and becoming immobile during the attacks. The only measure predominantly reported by patients with tension-type headache was scalp massage. However, the benefit derived from these measures was not significantly different between the two groups (except for a significantly better response to isolation, local pressure, local cold stimulation, and symptomatic medication in migraineurs). CONCLUSIONS: The behavior of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed to prevent its worsening or to improve associated symptoms. These behavioral differences may be due to the different pathogenesis of the attacks or to different styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.

[Cluster headache]. / Cefaleia em salvas.

We present a review of 60 cases of cluster headache. Most patients were males, ranging from 19 to 65 years of age at the time of the first visit. Headaches consisted of short-lasting (from 15 to 210 minutes), intense, unilateral pain attacks, most frequently in the periorbital area, with ipsilateral autonomic signs (rhinorrhea, ptosis, tearing and conjunctival injection). Between attacks, patients were completely free of pain. The attacks occurred in bouts lasting 1 to 6 months, in which patients had daily headaches (one to three times a day). Headaches responded well to oxygen or ergotamine. Prophylactic therapy in most cases consisted of verapamil, also with a good response. We present this review in order to draw attention to this relatively rare form of headache with a specific therapy.

Loss of topographic memory and prosopagnosia during migraine aura.

We report the case of a 28-year-old woman with a past history of acephalalgic migraine. She had a complex migraine aura with left-sided scintillating scotomas, hemianopia, left-sided paresthesias, a loss of topographic and procedural memory, and prosopagnosia. The rarity of right hemisphere cognitive dysfunction during the aura, its diagnostic difficulties, and differential diagnosis are discussed.

Acquired procedural dyscalculia associated to a left parietal lesion in a child.

We report the case of an 11-year-old boy who developed an anarithmetia in association with a left temporo-parietal tumor. His oral and written language were normal as well as his ability to judge magnitudes, process numbers, read operation signs and retrieve number facts. He had a specific difficulty in performing the procedures of subtraction, especially when it involved borrowing. These skills had been mastered before the present illness. This case shows that the components of calculation can be dissociated by brain lesions sustained during childhood, while arithmetic abilities are being acquired, thus reinforcing findings from developmental dyscalculias, that suggest a modular organisation of those skills during development.

Childhood aphasias.

The study of acquired childhood aphasia has shown that the aphasic syndromes found in adults are reproducible in children with identical lesion sites and that some brain areas are essential for aphasia recovery. Besides, language deficits and learning difficulties are very common in the long-term follow-up of those children. This suggests that the adult pattern of cerebral organization for speech is established early in life and alternative organizations have a lasting price. Yet in contradiction with this, children with focal lesions sustained pre- or perinatally do not show developmentally the aphasic syndromes observed in older children and adults. One possible explanation is that the areas responsible for learning a function are different from those subserving that function as a more mature stage of development. Concerning specific language impairment in children, there is a growing evidence that such syndromes are genetically determined, but there is still a missing link between this predisposition and the structural/functional defects underlying them. The finding that these children are often impaired in other areas of mental development indicates that there may be a more basic cognitive defect underlying their language disorders.

EEG monitoring during endovascular embolization of cerebral arteriovenous malformations.

Arteriovenous malformations (AVMs) may have a bad prognosis. Endovascular embolization with cyanocrylate represents nowadays an important initial step in a staged treatment, that later may include surgery or radiotherapy. Embolization may induce significant changes in the dynamics of the cerebral circulation, some of which may provoke neurological sequelae. Therefore assessment of potential complications is usually done by using a superselective amytal test, during which small doses of amytal are injected directly in the pedicle that is going to be embolized. In spite of an extensive use of the EEG during endovascular embolization its evaluation in terms of benefits and limitations is not available. Such evaluation is therefore the aim of this work. EEG monitoring was performed during endovascular embolization of 19 patients; a large majority of patients presented large AVMs, with Spetzler indexes around IV or V. The main results were as follows: (1) EEG changes at baseline were significantly correlated with the AVM size and the Spetzler index but were unable to predict the difficulties in the embolization; (2) during amytal tests EEG positivity reached 35% and consisted mainly in ipsilateral slow focal activity; (3) in some cases embolization was performed in spite of transient EEG changes. It was found that focal or diffuse abnormalities in the lower frequency range, even when slight, could be followed by clinical hazards (3 out of 11 cases); (4) EEG monitoring was important in the prediction, evaluation and prognosis of clinical complications.

Aphasia following right hemisphere lesion in a woman with left hemisphere injury in childhood.

The case of a 56-year-old woman who became aphasic following a right temporoparietal lesion is reported. At the age of 2, this woman had an acute infantile hemiplegia on the right side of the body and it was reported by relatives that a deterioration of language was also noted. There was a slow recovery of these deficits and she was considered as having normal language only at age 7. Although it is difficult to be sure about the hand preference of the patient before the stroke at age 2, the relatives were quite positive saying, that she previously preferred the right hand and that she became left handed. The CT scan showed an old left frontal ischemic lesion and a recent right temporoparietal lesion. This case illustrates the ability of the right hemisphere to take over functions of the left when a left lesion occurs in early stages of language acquisition. Although this is an accepted model for recovery, this is the only case in the literature with a documented early focal lesion of the left hemisphere. Other evidence comes from studies performed in populations where severe epilepsy may contribute to particular functional organization.

Extratrigeminal ice-pick status.

We describe six patients with an identical type of headache, consisting of short episodes (lasting around 1 week) of daily attacks of ice-pick-like pain, recurring every minute in the same points of the scalp. In all of them, the pain was felt outside the cutaneous area of the trigeminal nerve (retroauricular, parietal, and occipital regions). All patients were examined in the emergency department of a general hospital over a period of 7 years because of these acute headaches. None of them had a history of migraine. Although this pain is identical to idiopathic stabbing headache, it differs from it by its temporal profile (in "status"), its posterior (extratrigeminal) location, and its lack of association with migraine. While the bouts were usually severe and recurred in two patients, all had a self-limited benign course and responded promptly to indomethacin.

Atypical dominance for language in developmental dysphasia.

The authors report an association between developmental language disorder and acquired aphasia in a 13-year-old right-handed boy. Acquired aphasia was caused by a right-frontal abscess (crossed aphasia). It was non-fluent, with a disorder of auditory comprehension, an unusual feature of prerolandic lesions. This case shows that developmental language impairment can be associated not only with an atypical cerebral dominance, but also with unusual patterns of intrahemispheric specialization. The rapid and complete recovery of this boy's aphasia suggests that the cerebral plasticity for acquired lesions can be normal in such cases.

Headaches during intracranial endovascular procedures: a possible model of vascular headache.

We report a series of 11 patients who developed headaches during intracranial endovascular procedures performed for the treatment of arteriovenous malformations (10 cases) or aneurysms (1 case). Headache was precipitated either by balloon inflation (3 cases) or by embolization (8 cases), and had a very constant pattern. In all cases the pain started suddenly, reaching maximum intensity at once. Headache was focal, unilateral, ipsilateral to the occluded artery, nonthrobbing and short-lasting (usually less than 10 minutes). It was not associated with gastrointestinal, autonomic, or aura-like symptoms. Headache localization depended upon the catheterized artery, being constant for each of the major vascular territories. Yet, in all patients pain was felt in the cutaneous territory of the ophthalmic division of the trigeminal nerve. The occurrence of headache was not associated with cortical deficit nor cortical irritation (assessed both clinically and by the EEG) and therefore seems to be directly related to the stimulation of the arterial wall. This type of pain can be used as a model of pure vascular headache. Its study can contribute not only to understand the pattern of intracranial vascular innervation but also to understand or to refute the vascular components of migraine.