Effect of body-part specificity and meaning in gesture imitation in left hemisphere stroke patients.

Previous studies showed that imitation of finger and hand/arm gestures could be differentially impaired after brain damage. However, so far, the interaction between gesture meaning and body part in imitation deficits has not been fully assessed. In the present study, we aimed at filling this gap by testing 36 unilateral left brain-damaged patients with and without apraxia (20 apraxics), and 29 healthy controls on an imitation task of either finger or hand/arm meaningful (MF) gestures and meaningless (ML) movements, using a large sample of stimuli and controlling for the composition of the experimental list. Left-brain damaged patients imitated ML finger worse than hand/arm movements, whereas they did not show the same difference in MF gesture imitation. In addition, apraxic patients imitated finger movements worse than hand/arm movements. Furthermore, apraxic patients' imitation performance was equally affected irrespective of the action meaning, whereas non-apraxic patients showed better imitation performance on MF gestures. Results suggest that MF gestures are processed as a whole, as imitation of these gestures relies on the stored motor programs in long-term memory, independently of the body part involved. In contrast, ML movements seem to be processed through direct visuo-motor transformations, with left-brain damage specifically disrupting imitation performance of the more cognitive demanding finger movements.

Dream Generation and Recall in Daytime NREM Sleep of Patients With Narcolepsy Type 1.

The less rigid architecture of sleep in patients with narcolepsy type 1 (NT1) compared with healthy subjects may provide new insights into some unresolved issues of dream experience (DE), under the assumption that their DE frequencies are comparable. The multiple transition from wakefulness to REM sleep (sleep onset REM period: SOREMP) during the five trials of the Multiple Sleep Latency Test (MSLT) appears of particular interest. In MSLT studies, NT1 patients reported a DE after about 80% of SOREMP naps (as often as after nighttime REM sleep of themselves and healthy subjects), but only after about 30% of NREM naps compared to 60% of daytime and nighttime NREM sleep of healthy subjects. To estimate accurately the "real" DE frequency, we asked participants to report DE ("dream") after each MSLT nap and, in case of failure, to specify if they were unable to retrieve any content ("white dream") or DE did not occur ("no-dream"). The proportions of dreams, white dreams, and no dreams and the indicators of structural organization of DEs reported after NREM naps by 17 adult NT1 patients were compared with those reported by 25 subjects with subjective complaints of excessive daytime sleepiness (sc-EDS), who take multiple daytime NREM naps. Findings were consistent with the hypothesis of a failure in recall after awakening rather than in generation during sleep: white dreams were more frequent in NT1 patients than in sc-EDS subjects (42.86 vs 17.64%), while their frequency of dreams plus white dreams were similar (67.86 and 61.78%) and comparable with that of NREM-DEs in healthy subjects. The longer and more complex NREM-DEs of NT1 patients compared with sc-EDS subjects suggest that the difficulty in DE reporting depends on their negative attitude toward recall of contents less vivid and bizarre than those they usually retrieve after daytime SOREMP and nighttime REM sleep. As this attitude may be reversed by some recall training before MSLT, collecting wider amounts of DE reports after NREM naps would cast light on both the across-stage continuity in the functioning of cognitive processes underlying DE and the difference in content and structural organization of SOREM-DEs preceded by N1 or also N2 sleep.

Structural organization of dream experience during daytime sleep-onset rapid eye movement period sleep of patients with narcolepsy type 1.

STUDY OBJECTIVE: To assess the frequency of dream experience (DE) developed during naps at Multiple Sleep Latency Test (MSLT) by patients with narcolepsy type 1 (NT1) and establish, using story-grammar analysis, the structural organization of DEs developed during naps with sleep onset rapid eye movement (REM) period (SOREMP) sleep compared with their DEs during early- and late-night REM sleep. METHODS: Thirty drug-free cognitively intact adult NT1 patients were asked to report DE developed during each MSLT nap. Ten NT1 patients also spent voluntarily a supplementary night being awakened during the first-cycle and third-cycle REM sleep. Patients provided dream reports, white dreams, and no dreams, whose frequencies were matched in naps with SOREMP versus non-REM (NREM) sleep. All dream reports were then analyzed using story-grammar rules. RESULTS: DE was recalled in detail (dream report) by NT1 patients after 75% of naps with SOREMP sleep and after 25% of naps with NREM sleep. Dream reports were provided by 8 out of 10 NT1 patients after both awakenings from nighttime REM sleep. Story-grammar analysis of dream reports showed that SOREMP-DEs are organized as hierarchically ordered sequences of events (so-called dream-stories), which are longer and more complex in the first and fourth SOREMP naps and are comparable with nighttime REM-DEs. CONCLUSIONS: The similar structural organization of SOREMP-DEs with nighttime REM-DEs indicates that their underlying cognitive processes are highly, albeit not uniformly, effective during daytime SOREMP sleep. Given the peculiar neurophysiology of SOREMP sleep, investigating SOREMP-DEs may cast further light on the relationships between the neurophysiological and psychological processes involved in REM-dreaming.

REM-dreams recall in patients with narcolepsy-cataplexy.

An abundant recall of dreams has been observed in clinical studies on patients with narcolepsy-cataplexy (NC), a neurological disorder characterized by an altered sleep architecture. Laboratory studies have shown that dream experiences developed during 1st-rapid eye movement (REM) sleep by NC patients are longer and more complex than those of healthy subjects. To establish whether these features indicate an earlier optimal functioning of the cognitive processes involved in dream generation rather than a more accurate dream recall, we compared the indicators of length and structural organization in reports of REM-dreams collected from 14 NC patients and their matched controls. During an experimental night two awakenings were provoked after 8 min in 1st- and 3rd-REM sleep; participants were asked to report their dream experience (spontaneous report) and then, if possible, further remembered parts of this experience (prompted report). All reports were analyzed using story-grammar rules, which allow us to identify units larger than single contents and describe their story-like organization. While dream recall (about 90%) was comparable in NC patients and controls, 1st-REM spontaneous reports were longer and more complex in NC patients, half of whom also provided prompted reports. After 3rd-REM awakening more than one third of NC patients and controls gave prompted reports, which were fairly comparable in length and complexity with the spontaneous reports. These findings confirm that the cognitive processes underlying dream generation reach their optimal functioning earlier in the night in NC patients than in normal subjects, and raises the question of whether the dream-stories described in spontaneous and prompted reports are part of the same or distinct REM-dreams.

Sleep and time course of consolidation of visual discrimination skills in patients with narcolepsy-cataplexy.

The level of procedural skills improves in normal individuals when the acquisition is followed by a period of sleep rather than wake. If sleep plays an important role in the consolidation process the advantage it provides should be reduced or delayed when its organization is altered, as in patients with chronic sleep disorders. To test this prediction in patients with narcolepsy-cataplexy (NC), who usually have a more fragmented organization of sleep than normals, we compared the initial, intermediate and delayed level of consolidation of visual skills. Twenty-two drug-naive NC patients and 22 individually-matched controls underwent training at a texture discrimination task (TDT) and were re-tested on the next morning (after a night spent in laboratory with polysomnography) and after another six nights (spent at home). TDT performance was worse in patients than controls at training and at both retrieval sessions and the time course of consolidation was different in NC patients (who improved mainly from next-day to 7th-day retrieval session) compared with controls. Moreover, the less-improving patients at next-day retrieval had a wider disorganization of sleep, probably because of an episode of rapid eye movement (REM) sleep at sleep onset REM, on post-training night more frequently than more-improving patients. These findings suggest that the time course of the consolidation process of procedural skills may be widely influenced by the characteristics of sleep organization (varying night-by-night much more in NC patients than controls) during post-training night.

Story-like organization of REM-dreams in patients with narcolepsy-cataplexy.

Narcolepsy with cataplexy (NC) is a neurological disorder characterized by excessive daytime sleepiness and an altered architecture of sleep. Previous laboratory studies have shown that frightening, bizarre and visually vivid contents are more frequent in dream experiences developed during the first period of REM sleep by NC patients than healthy subjects. As the structural organization of dream experiences of NC patients has not been yet examined, we compared its indicators in dream reports collected from a sample of NC patients and their matched controls. During an experimental night two awakenings were provoked after 8min of REM sleep in the first and third sleep cycle. Dream reports were analyzed using the rules of story grammars, capable of identifying units larger than single contents and describing their story-like organization. While dream recall (about 85%) was comparable in NC patients and controls, 1st-REM dream reports were longer in NC patients. Statistical analyses on the 12 NC patients and their matched controls who reported dreams after both REM periods showed that dream experiences occurring in 1st-REM reports of NC patients were longer and had a more complex organization than those of controls. These findings suggest that the cognitive processes underlying dream generation reach their optimal functioning earlier in the night in NC patients than in normal subjects.

Semantic priming effect during REM-sleep inertia in patients with narcolepsy.

Patients with narcolepsy-cataplexy (NC) present excessive daytime sleepiness (EDS), cataplexy and an altered architecture of nocturnal sleep, with frequent episodes of REM-sleep at sleep onset (SOREM-sleep). This altered organization of nocturnal sleep may be accompanied by some differences in the functioning of the cognitive processes involved in the access, organization and consolidation of information during sleep. This study attempts to ascertain whether the activation of semantic memory during REM-sleep, as measured using a technique of semantic priming (namely, the facilitation of the activation of strongly-related rather than weakly-related and, overall, unrelated pairs of prime-target words) is different in NC patients compared to normal subjects. A lexical decision task (LDT) was carried out twice in wakefulness (at 10a.m. and after a 24h interval) and twice in the period of sleep inertia following awakening from SOREM and 4th-cycle REM-sleep on 12 NC patients and from 1st- and 4th-cycle REM-sleep on 12 matched controls. Reaction time (RT) to target words, taken as a measure of the semantic priming effect, proved to be longer (a) in NC patients than in control subjects; (b) in the period of REM-sleep inertia than in wakefulness; (c) in the first rather than the second session; and (d) for unrelated compared to weakly-related and, overall, strongly-related prime-target pairs. RT in post-REM-sleep sessions was less impaired, compared to waking sessions, and less dependent on the associative strength of prime-target pairs in NC patients than in normal subjects. Finally, RT of NC patients, although longer than that of normal subjects in waking sessions, significantly improved in the second session, as a consequence of either the amount of exercise or the consolidation advantage provided by REM-sleep for the procedural components of the task. The whole picture suggests a greater effectiveness of the activation of semantic memory during (SO)REM-sleep in NC patients rather than in normal subjects, and overall for the organization of new and unexpected relationships (such as those between unrelated pairs) between items of information.

Consolidation effect of repeated processing of declarative knowledge in mental experiences during human sleep.

Sleep may positively influence declarative memory through the processing, which transforms items of declarative knowledge into contents of mental sleep experience (MSE). A prediction from this general hypothesis is that the consolidation level should be higher for the output of items repeatedly processed and transformed into identical or very similar (so-called interrelated) contents of distinct MSEs of the same night rather than for the output of items presumably processed once (that is, all other, non-interrelated contents). Two experiments examined whether and how far the frequency and long-term retention of interrelated contents depend on the repeated processing of given items rather than on the experimental procedure applied for detection of interrelated contents. This procedure entails both multiple awakenings and a verbal report of MSE after awakening. Multiple awakenings could facilitate the re-access and elaboration of some contents into the subsequent (i.e. contiguous) MSE rather than non-contiguous MSEs; verbal reports could enhance the delayed recall of interrelated contents in as much as repeatedly encoded. The first experiment showed that interrelated contents were more frequent and better retained than both non-interrelated and pseudo-interrelated (i.e. by-chance similar or identical) contents, and even more in pairs of contiguous than non-contiguous MSEs collected from the first four periods of REM sleep on each experimental night. The second experiment showed that the frequency and retention rate of interrelated contents, while higher than those of non-interrelated and pseudo-interrelated contents, were not significantly different in pairs of MSEs which were verbally or mentally recalled after awakening provoked during the first four periods of REM sleep in each experimental night. Taken together, these findings indicate that the advantage provided by repeated processing during REM sleep for the consolidation of the output of items of declarative knowledge is conspicuous and largely independent from the experimental procedure, as this only slightly enhances the frequency and retention rate of interrelated contents.

Consolidation effect of the processing of declarative knowledge during human sleep: evidence from long-term retention of interrelated contents of mental sleep experiences.

Sleep may partly exert a positive influence on memory through the processing underlying the transformation of items of declarative knowledge into contents of mental sleep experience (MSE). This hypothesis implies that the level of consolidation (and thus, long-term retention) should be enhanced for those items which are repeatedly processed and transformed into identical or very similar (so-called interrelated) contents of distinct MSEs developed over the same night. To test this prediction, we examined accessibility at delayed recall (i.e., the next morning) of the interrelated contents of MSEs reported (immediate recall) by 14 subjects who were awakened during the first four periods of rapid eye-movement (REM) sleep in two experimental nights. Interrelated contents were much more frequent, and at delayed recall much better retained, than other, non-interrelated contents in report pairs of MSEs. Moreover, they were also more frequent and better retained than by-chance similar or identical contents, as estimated in report pairs of MSEs of different subjects. These findings provide partial but coherent evidence in favour of the hypothesis that a generation effect occurs during sleep, with a further consolidation of the input and the output of MSE processing (respectively, the items of declarative knowledge and the contents of MSEs resulting from their elaboration during sleep).

Incorporation of presleep stimuli into dream contents: evidence for a consolidation effect on declarative knowledge during REM sleep?

Presleep stimuli to be retained for further recall is often incorporated into dream contents. To establish whether processing for insertion into dream contents may improve consolidation, we compared the retention rate at delayed recall of contents resulting from incorporation of presleep sentence-stimuli with those of other contents of the same dream experiences. We hypothesized that association with a cognitive task of recall facilitates access to recently acquired items of declarative knowledge such as presleep stimuli, and triggers the deep elaboration of their semantic features, which involves rehearsal. Twelve subjects were given a task of delayed recall for three nonsense sentences delivered once a time before each of the sleep (re-)onsets over an experimental night. After each awakening in rapid eye movement sleep, subjects were asked to report dream experience and recall the sentence to be retained. In the morning, after spontaneous awakening, subjects were unexpectedly requested to again report their dream experiences and to recall the stimuli. Two pairs of judges independently identified possible incorporations of the stimuli, and parsed dream reports into propositional content units. The proportion of night reports with at least one incorporation of the stimulus delivered (i.e. valid incorporations) was higher than that of reports with contents similar to a stimulus(-i) not yet delivered (forward pseudo-incorporations) or delivered prior to an earlier sleep period (backward pseudo-incorporations). The proportion of content units common to night and morning reports (considered to be better consolidated) was significantly higher for incorporated contents than for other contents, including pseudo-incorporated contents. Instead, the retention at morning recall of words of sentence-stimuli corresponding to incorporated contents was not significantly higher than that of other words. The better retention of incorporated contents provides a partial confirmation (that is, limited to the output of the processing) that a generation effect, which benefits retention of actively processed information, is operative during sleep as well as in waking.