Prevalence of Victimisation in Autistic Individuals: A Systematic Review and Meta-Analysis.

Autistic individuals are at an increased risk of experiencing victimisation. Previous reviews have focussed specific types of victimisation. Thus, a clearer picture considering the range of victimisation experiences autistic people face is required. This systematic review aims to identify the prevalence of victimisation in autistic individuals considering a variety of victimisation types (e.g., bulling, sexual victimisation, and crime) in both adults and children from clinical and community settings. Through systematic searches of relevant databases, 291 studies met the criteria for review. Of those, 34 studies met the inclusion criteria: a) quantitative studies, b) involving autistic individuals, c) reporting prevalence rates of victimisation. Meta-analysis found a pooled prevalence rate of victimisation of 44% in autistic individuals. Subgroup analysis examined moderating factors as high heterogeneity was present. This found the pooled prevalence rates for bullying to be 47%, 16% for child abuse, 40% for sexual victimisation, 13% for cyberbullying, and 84% for multiple forms of victimisation in autistic individuals, though heterogeneity remained. Correction for participants' age, reporter used, and the population which the sample was recruited from did not reduce heterogeneity. Although heterogeneity impedes the definitive interpretation of the findings, this review illustrates the need for strategies and interventions to reduce the incidence of victimisation.

The Dark Tetrad, Intimate Partner Violence and the Mediating Role of Moral Disengagement.

PURPOSE: Research suggests that physical, psychological, and/or sexual focussed Intimate Partner Violence (IPV) is related to the dark triad (DT) traits of Machiavellianism, psychopathy, and narcissism. This study extends these findings by considering the addition of everyday sadism into the four-dimension dark tetrad (DTET), testing the possibility that moral disengagement (MD) mediates the relationship between these variables. It was also examined whether the DTET provided incremental validity to the more general personality traits Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, Openness (HEXACO) to predict IPV. METHOD: Males and females (N = 416) from the general population completed five questionnaires in an online survey (HEXACO-60, MMEA, PMDS, CTS2S, SD4). RESULTS: A principal component factor-analysis found that sexual IPV did not load as an individual factor and distinct form of violence on the CTS2S scale so was excluded from this study. Four hierarchical multiple regressions were conducted, using the demographics, HEXACO and either the DTET traits or an overall DTET variable as predictor variables, and either physical or psychological IPV as the dependent variables. Only psychopathy predicted physical and psychological IPV; MD mediated the relationship between psychopathy and psychological IPV. Although the DTET added incremental validity over HEXACO to predict physical IPV, HEXACO low Agreeableness was the strongest predictor of psychological IPV. CONCLUSIONS: Those higher in psychopathy may show different offending trajectories for physical and psychological IPV dependent upon the use of MD processes. Despite the DTET adding incremental validity over the HEXACO dimensions, some HEXACO elements better explain the relationship between personality and psychological IPV than the DTET.

Apostates as a Hidden Population of Abuse Victims.

The term "apostate" describes the term used by the religious to describe individuals raised within religious families who once identified as religious, but who have ceased to believe in the existence of God, gods or follow their religious belief, and now identify as non-religious. Given the strong feelings families can have about the rejection of their shared faith, and the difficulty that police forces may have in identifying and understanding the complexities of violence toward the apostate, this study sought to examine the possibility that apostates represent a hidden population of abuse victims within religious households. We recruited 228 persons (102 males, 119 females) from an online survey with the support of "Faith to Faithless"-a service within Humanists UK, which supports people that leave their religious faith. Individuals were screened using a modified version of the Conflict Tactics Scale to quantify their experience of assault and negotiation. It was found that persons who identified as apostates experienced more assault (i.e., harmful violence) than non-religious persons. Within this sample, Muslim apostates were significantly more likely to be victimized than Christian apostates. Disclosure of being abused for identifying as an apostate within a religious household to law enforcement was extremely uncommon, thereby preventing detection or prosecution of abusive acts committed by family members and limiting public awareness of this issue. These results are discussed in the context of the broader culture of honor-based (izzat) violence, which occurs across the Eastern Mediterranean, Middle East, and North Africa, and is also seen in some Protestant Christian subcultures, and common to all Abrahamic religions, rather than Islam alone. This study highlights that within a multicultural society, there remain hidden populations of abuse victims who are vulnerable due to religious, cultural, and traditional constraints made by abusive family members.

The Hexaco-60, the Dark Triad and Scholastic Cheating.

Previous studies have found inconsistent results regarding the personality predictors of scholastic cheating. This study investigated whether personality was a predictor of scholastic cheating using the HEXACO-60 personality inventory and the Dark Triad (DT). A sample of 252 students completed the online questionnaire. Results from a one-way ANOVA showed that scholastic cheating was more common in associate degree/diploma/foundation students and undergraduate students than postgraduate students. Year of study or student status (local or international students) had no effect on scholastic cheating. MANOVA showed that academic qualification, year of study, and student status had no effect on reasons for cheating. A structural equation model (SEM) found that scholastic cheating was positively predicted by unmitigated achievement and psychopathy. Psychopathy emerged as the strongest significant predictor of scholastic cheating. These results supported the view that dark personality is relevant for understanding scholastic cheating.

Individual differences, ADHD, adult pathological demand avoidance, and delinquency.

BACKGROUND: Pathological Demand Avoidance (PDA) is a developmental disorder involving challenging behaviour clinically linked to Autism Spectrum Disorder (ASD). Many of the problematic features of PDA are often seen in persons with attention deficit hyperactivity disorder and impulsivity. ADHD and impulsivity are also common in the backgrounds of offenders. AIMS: Method and procedure: We examined if self-reported ASD, ADHD, impulsivity, and general personality traits such as low conscientiousness and low emotional stability predicted self-reported PDA scores, and which constructs contributed to the prediction of delinquency, recruiting 132 participants (mean age 34.6 years, SD = 10.9, range 18-68), of whom 126 cases had complete data. OUTCOMES AND RESULTS: Many of these constructs, but particularly ADHD (r = 0.71, p < 0.001) were significant correlates of PDA, the correlation between ASD and PDA was small, and did not predict PDA. Multiple regression indicated that a combination of higher attention deficit, antagonism, and lower emotional stability predicted 65 % of an individual's PDA score, but that their PDA score did not contribute to the prediction of delinquency. CONCLUSIONS AND IMPLICATIONS: This research indicates that, for community adult populations, self-reported individual differences in ADHD, emotional instability, and antagonism appear to better predict PDA than ASD. The association PDA has with delinquency may reflect these constructs, which are also correlates of offending.

Neurological impact of emboli during adult cardiac surgery.

OBJECTIVES: This study draws on advances in Doppler ultrasound bubble sizing to investigate whether high volumes of macro-bubbles entering the brain during cardiac surgery increase the risk of new cerebral microbleeds (CMBs), ischemic MR lesions, or post-operative cognitive decline (POCD). METHODS: Transcranial Doppler (TCD) ultrasound recordings were analysed to estimate numbers of emboli and macrobubbles (>100 µm) entering the brain during cardiac surgery. Logistic regression was used to explore the hypothesis that emboli characteristics affect the incidence of new brain injuries identified through pre- and post-operative MRI and neuropsychological testing. RESULTS: TCD, MRI, and neuropsychological test data were compared between 28 valve and 18 CABG patients. Although valve patients received over twice as many emboli per procedure [median: 1995 vs. 859, p = .004], and seven times as many macro-bubbles [median: 218 vs. 28, p = .001], high volumes of macrobubbles were not found to be significantly associated with new CMBs, new ischaemic lesions, or POCD. The odds of acquiring new CMBs increased by approximately 5% [95% CI: 1 to 10%] for every embolus detected in the first minute after the release of the aortic cross-clamp (AxC). Logistic regression models also confirmed previous findings that cardiopulmonary bypass time and valve surgery were significant predictors for new CMBs (both p = .03). Logistic regression analysis estimated an increase in the odds of acquiring new CMBs of 6% [95% CI: 1 to 12%] for every minute of bypass time over 91 mins. CONCLUSIONS: This small study provides new information about the properties and numbers of bubbles entering the brain during surgery, but found no evidence to substantiate a direct link between large numbers of macrobubbles and adverse cognitive or MR outcome. Clinical Trial Registration URL - http://www.isrctn.com. Unique identifier: 66022965.

Corrigendum: The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision.

[This corrects the article DOI: 10.3389/fpsyt.2019.00805.].

Perceptions of Restrictiveness in Forensic Mental Health: Do Demographic, Clinical, and Legal Characteristics Matter?

Where safe, forensic mental health systems should provide care in the least restrictive environment possible. Doing so can maximize patient autonomy and empowerment while minimizing unnecessary social disconnection and stigmatization. This study investigated whether patients' perceptions of restrictiveness were associated with demographic, clinical, and legal characteristics. The Forensic Restrictiveness Questionnaire (FRQ) was used to measure perceptions of restrictiveness in 235 patients in low-, medium-, and high-secure settings in England. The results showed that restrictiveness scores were significantly higher for patients who experienced an adverse event in the past week or were diagnosed with a personality disorder compared to those with a mental illness. A regression analysis suggested that only diagnosis was predictive of FRQ scores when controlling for perceptions of ward atmosphere and quality of life. Age, length of stay, ethnicity, level of security, legal section, and offence type were not associated with FRQ scores. Future research should investigate the roles that individual symptoms, insight into illness, mood, personality, and expectations of care have in influencing perceptions of restrictiveness.

The Forensic Restrictiveness Questionnaire: Development, Validation, and Revision.

Introduction: Forensic psychiatric care is often practiced in closed institutions. These highly regulated, secure, and prescriptive environments arguably reduce patient autonomy, self-expression, and personhood. Taken together these settings are restrictive as patients' active participation in clinical, organizational, community, and personal life-worlds are curtailed. The consequences of patients' experiences of restrictiveness have not been explored empirically. This study aimed to develop a psychometrically-valid measure of experiences of restrictiveness. This paper presents the development, validation, and revision of the Forensic Restrictiveness Questionnaire (FRQ). Methods: In total, 235 patients recruited from low, medium, and high secure hospitals across England completed the FRQ. The dimensionality of the 56-item FRQ was tested using Principle Axis Factor Analysis and parallel analysis. Internal consistency was explored with Cronbach's α. Ward climate (EssenCES) and quality of life (FQL-SV) questionnaires were completed by participants as indicators of convergent validity. Exploratory Factor Analysis (EFA) and Cronbach's α guided the removal of items that did not scale adequately. Results: The analysis indicated good psychometric properties. EFA revealed a unidimensional structure, suggesting a single latent factor. Convergent validity was confirmed as the FRQ was significantly negatively correlated with quality of life (Spearman's ρ = -0.72) and ward climate (Spearman's ρ = -0.61). Internal consistency was strong (α = 0.93). Forty-one items were removed from the pilot FRQ. The data indicate that a final 15-item FRQ is a valid and internally reliable measure. Conclusion: The FRQ offers a novel and helpful method for clinicians and researchers to measure and explore forensic patients' experiences of restrictiveness within secure hospitals.

Empathy at the Heart of Darkness: Empathy Deficits That Bind the Dark Triad and Those That Mediate Indirect Relational Aggression.

The dark triad (DT) traits-psychopathy, narcissism and Machiavellianism-have collectively been linked to reduced empathy and increased aggression; however, their association with distinct empathic subtypes remains unclear; and unique links to indirect relational aggression (IRA) have not been delineated. Moreover, whether dark traits should be conceptualized individually, as a dyad or as a triad with a dark core centered around the absence of empathy is debated. The current study examines (i) whether impaired empathy indeed represents a common "dark core" binding Machiavellianism, narcissism, and psychopathy, and (ii) this core explains associations between the dark traits and IRA. Participants (N = 301, 262 F/39 M) completed measures of the DT traits, cognitive and affective empathy components and IRA (Social Exclusion, Malicious Humor and Guilt Induction). The individual traits model without links between narcissism and IRA showed the best fit, suggesting that, at least in the context of IRA, the DT traits are best viewed as three independent personality traits. Distinct cognitive and affective empathy deficits and capacities are seen in the DT. Peripheral responsivity was the only type of empathy deficit associated with all dark traits, but unrelated to IRA. Psychopathy was the strongest indicator of impaired empathy and all IRAs; however, only online simulation, an affect-related cognitive empathy facet, partially mediated the relationships of psychopathy and Machiavellianism with IRA. Whilst the unique pathways for the dark triad traits suggest stronger alignment of psychopathy and Machiavellianism in their empathic deficits and indirect aggression; the data do not support the notion that an unempathic dark core underpinning all three traits drives indirect aggression. This is the first paper delineating the specific empathic deficits involved using a facet approach and their link to indirect forms of aggression. Results therefore inform theoretical models of aggression in the DT and offer some clarity on the debates surrounding the unempathic dark core in the DT.

The Measurement of Adult Pathological Demand Avoidance Traits.

Pathological ("extreme") demand avoidance (PDA) involves obsessively avoiding routine demands and extreme emotional variability. It is clinically linked to autism spectrum disorder (ASD). The observer-rated EDA Questionnaire (EDA-Q) for children was adapted as an adult self-report (EDA-QA), and tested in relation to personality and the short-form Autism Screening Questionnaire (ASQ). Study 1 (n = 347) found the EDA-QA reliable, univariate, and correlated with negative affect, antagonism, disinhibition, psychoticism, and ASQ scores. Study 2 (n = 191) found low agreeableness, greater Emotional Instability, and higher scores on the full ASQ predicted EDA-QA. PDA can screened for using this tool, occurs in the general population, and is associated with extremes of personality. Future studies will examine if PDA occurs in other clinical populations.

Perioperative Cerebral Microbleeds After Adult Cardiac Surgery.

Background and Purpose- Cerebral microbleeds (CMBs) have been observed using magnetic resonance imaging in patients with cardiovascular risk factors, cognitive deterioration, small vessel disease, and dementia. They are a well-known consequence of cerebral amyloid angiopathy, chronic hypertension, and diffuse axonal injury, among other causes. However, the frequency and location of new CMBs postadult cardiac surgery, in association with cognition and perioperative risk factors, have yet to be studied. Methods- Pre- and postsurgery magnetic resonance susceptibility-weighted images and neuropsychological tests were analyzed from a total of 75 patients undergoing cardiac surgery (70 men; mean age, 63±10 years). CMBs were identified by a neuroradiologist blinded to clinical details who independently assessed the presence and location of CMBs using standardized criteria. Results- New CMBs were identified in 76% of patients after cardiac surgery. The majority of new CMBs were located in the frontal lobe (46%) followed by the parietal lobe (15%), cerebellum (13%), occipital lobe (12%), and temporal lobe (8%). Patients with new CMBs typically began with a higher prevalence of preexisting CMBs ( P=0.02). New CMBs were associated with longer cardiopulmonary bypass times ( P=0.003), and there was a borderline association with lower percentage hematocrit ( P=0.04). Logistic regression analysis suggested a ≈2% increase in the odds of acquiring new CMBs during cardiac surgery for every minute of bypass time (odds ratio, 1.02; 95% CI, 1.00-1.05; P=0.04). Postoperative neuropsychological decline was observed in 44% of patients and seemed to be unrelated to new CMBs. Conclusions- New CMBs identified using susceptibility-weighted images were found in 76% of patients who underwent cardiac surgery. CMBs were globally distributed with the highest numbers in the frontal and parietal lobes. Our regression analysis indicated that length of cardiopulmonary bypass time and lowered hematocrit may be significant predictors for new CMBs after cardiac surgery. Clinical Trial Registration- URL: http://www.isrctn.com . Unique identifier: 66022965.

The influence of impulsivity and the Dark Triad on self-reported aggressive driving behaviours.

The present study tested the role of Dark Triad traits (DT; narcissism, psychopathy, and Machiavellianism) as potential contributors to self-reported aggressive driving alongside driving anger, general aggression, impulsiveness, and attributions of malign driving intent. Members of the general community (N = 168) completed an online survey battery measuring these characteristics, and a proxy measure of aggressive driving. Regression analyses revealed that psychopathy, a history of physical aggression towards others, and the "progress impeded" aspect of driving anger, accounted for 50.8% of the variance in self-reported aggressive driving behaviours. The remaining variables were not significant. A structural equation model found all measures fitted into a single model in which impulsivity and the DT predicted general aggression, general aggression fully mediated the effect of the DT on driving anger, and general aggression and progress impedance predicted self-reported aggressive driving (GFI = 0.925). These results indicate tendencies toward expressing aggression physically, frustration at goals being impeded, and a callous, impulsive nature can predispose an individual to aggressive driving behaviours. Implications of these findings and recommendations for research are discussed.

Childhood Bullying, Paranoid Thinking and the Misappraisal of Social Threat: Trouble at School.

Experiences of bullying predict the development of paranoia in school-age adolescents. While many instances of psychotic phenomena are transitory, maintained victimization can lead to increasingly distressing paranoid thinking. Furthermore, paranoid thinkers perceive threat in neutral social stimuli and are vigilant for environmental risk. The present paper investigated the association between different forms of bullying and paranoid thinking, and the extent to which school-age paranoid thinkers overestimate threat in interpersonal situations. Two hundred and thirty participants, aged between eleven and fourteen, were recruited from one secondary school in the UK. Participants completed a series of questionnaires hosted on the Bristol Online Survey tool. All data were collected in a classroom setting in quiet and standardized conditions. A significant and positive relationship was found between experiences of bullying and paranoid thinking: greater severity of bullying predicted more distressing paranoid thinking. Further, paranoid thinking mediated the relationship between bullying and overestimation of threat in neutral social stimuli. Exposure to bullying is associated with distressing paranoid thinking and subsequent misappraisal of threat. As paranoid thinkers experience real and overestimated threat, the phenomena may persist.

A Case Study Approach to Reducing the Risks of Child Sexual Exploitation (CSE).

The risk of child sexual exploitation is a growing concern, both within community and child care settings. Within community services working with vulnerable young people, the risks of exploitation are pervasive and present a constant management problem for professionals. This makes the need for focused educational interventions within such settings all the more vital. This case study aims to describe the assessment, formulation, intervention, and outcomes of a young female considered to be at risk of sexual exploitation. It was hypothesised that, after completion of a psychoeducational group designed to enhance knowledge and skills around child sexual exploitation, positive outcomes would be seen in psychometric assessment, risk-taking behavior, and risk awareness. Results demonstrated no clinically significant change for measures of impulsivity, resourcefulness, or self-reported difficulties. A significant increase was seen for self-reported self-esteem, and all outcomes revealed a positive direction of change. Observational accounts of behavioral and attitudinal change produced more positive results, revealing an increase in prosocial behaviors and a reduction in risk-taking behaviors. Outcomes are discussed in relation to the individual's history and the residential care environment. Implications for future research and practice are outlined, and the study limitations are considered.

The SAPAS, Personality Traits, and Personality Disorder.

Many argue that current categorical personality disorder (PD) classification systems should be more dimensional and consider personality traits. The present study examined whether a brief PD screening tool, the Standardized Assessment of Personality: Abbreviated Scale (SAPAS) primarily screened for traits of low emotional stability, low extraversion, and low agreeableness, rather than PD per se. A general community sample (n = 237) completed the SAPAS, a personality trait measure, and the International Personality Disorder Examination (IPDE) screening questionnaire. Regressions showed that the SAPAS provided substantial incremental validity over personality trait scores in predicting total IPDE scores, indicating that the SAPAS captures variance unique to PD, rather than just extremes of general disposition. The SAPAS is an empirically valid rapid PD screen for nonclinical populations, correctly identifying 78% of individuals who screen positively for PD on the IPDE. However, the SAPAS was not effective for screening antisocial PD, limiting its utility in forensic settings.

Sense of control and adolescents' aggression: The role of aggressive cues.

The misperception of aggressive cues is considered a risk factor for inducing adolescent aggression. Poor coping with life stress is also considered a major influence on aggression. The current study examined the relationship between subjective sense of control and adolescent aggression, considering influences upon the perception of these aggressive cues. In Study 1, 60 participants took part in a 2 (sense of control: high sense of control vs. low sense of control) × 2 (aggressive cue: aggressive vs. neutral) between-subjects contextual experiment. The result found that a lower sense of control led to an increase in adolescents' aggression; only in the low-sense-of-control condition did exposure to aggressive cues boost aggression. In Study 2, the catalytic effect of aggressive cues was further explored by an experiment in which 40 adolescents were randomly assigned to a low- or high-sense-of-control condition to test the importance of aggressive cues. The results suggest that adolescents in the low-sense-of-control condition show a higher salience for aggressive cues.

Myths and legends: the reality of rape offences reported to a UK police force / Mitos y leyendas: la realidad de los delitos de violación denunciados a la policía británica

Rape myths affect many aspects of the investigative and criminal justice systems. One such myth, the ‘real rape’ myth, states that most rapes involve a stranger using a weapon attacking a woman violently at night in an isolated, outdoor area, and that women sustain serious injuries from these attacks. The present study examined how often actual offences reported to a central UK police force over a two year period matched the ‘real rape’ myth. Out of 400 cases of rape reported, not a single incident was found with all the characteristics of the ‘real rape’ myth. The few stranger rapes that occurred had a strong link to night-time economy activities, such as the victim and offender both having visited pubs, bars, and clubs. By contrast, the majority of reported rape offences (280 cases, 70.7%) were committed by people known to the victim (e.g., domestic and acquaintance rapes), occurred inside a residence, with most victims sustaining no physical injuries from the attack. The benefits of these naturalistic findings from the field for educating people about the inaccuracy of rape myths are discussed (AU)

Los mitos sobre la violación influyen en muchos aspectos de los sistemas judiciales de investigación y penales. Uno de esos mitos, el referido a la 'violación real', sostiene que la mayoría de las violaciones implican la participación de un extraño armado que ataca a una mujer de forma violenta durante la noche, en un lugar aislado al aire libre y que las mujeres sufren heridas graves a consecuencia de los ataques. Este estudio analizó la frecuencia con la que coincidían los delitos reales denunciados a la policía en el centro del Reino Unido con el mito de la 'violación real' durante un periodo de dos años. De los 400 casos de violación denunciados, no se encontró ninguno que tuviera las características del mito de la 'violación real'. Las escasas violaciones por extraños acaecidas estaban vinculadas a actividades laborales nocturnas, como que la víctima y el agresor hubieran estado en pubs, bares y clubs. Por el contrario, la mayoría de las violaciones denunciadas (280 casos, 70.7%) las cometieron personas conocidas de la víctima (por ejemplo, violaciones domésticas o por conocidos) y tenían lugar en el domicilio, sin que la mayoría de las víctimas sufrieran lesiones a consecuencia del ataque. Se comenta la utilidad de estos resultados con casos reales para instruir a la gente acerca de la inexactitud de los mitos de la violación (AU)

Paranoid thinking, cognitive bias and dangerous neighbourhoods: Implications for perception of threat and expectations of victimisation.

BACKGROUND: Paranoid thinking is prevalent in the non-clinical population and cognitive mechanisms of heuristic reasoning and jumping to conclusions bias contributes to its formation and maintenance. AIMS: This study investigated the degree to which paranoia, perceived environmental risk, heuristic reasoning and jumping to conclusions bias (measured with the beads task) contribute to misinterpretation of neutral stimuli, and whether this informed judgements regarding vulnerability to threat and crime. It is also investigated whether impulsiveness is a confounding factor on the beads task. METHODS: Two hundred participants were recruited using a snowball-sampling method for a quantitative cross-sectional study. Participants reported demographic information, three psychometric questionnaires and two experimental tasks via an online paradigm hosted by the Bristol Online Survey tool. RESULTS: Participants with high paranoia scores perceived their environment to be more dangerous than those with low scores. Participants with high paranoia scores also overestimated threat in neutral stimuli and had high expectations of future victimisation. Jumping to conclusions on the beads task did not predict fear of crime outcomes, but was predicted by impulsivity. CONCLUSION: Participants who demonstrated paranoid thinking were more likely to reside in perceived dangerous neighbourhoods and overestimate threat. While this could indicate a paranoid heuristic, it is a potentially rational response to prior experiences of crime and victimisation. Implications and suggestions for future research are discussed.

Impact of perioperative infarcts after cardiac surgery.

BACKGROUND AND PURPOSE: Brain injury after cardiac surgery is a serious concern for patients and their families. The purpose of this study was to use 3-T fluid attenuated inversion recovery MRI to characterize new and preexisting cerebral ischemic lesions in patients undergoing cardiac surgery and to test whether the accumulation of new ischemic lesions adversely affects cognition. METHODS: Digital comparison of before and after fluid attenuated inversion recovery MRI images was performed for 77 cardiac surgery patients. The burden of preexisting versus new ischemic lesions was quantified and compared with the results of baseline and postoperative neuropsychological testing. RESULTS: After surgery, new lesions were identified in 31% of patients, averaging 0.5 lesions per patient (67 mm(3) [0.004%] of brain tissue). Patients with preexisting lesions were 10× more likely to receive new lesions after surgery than patients without preexisting lesions. Preexisting ischemic lesions were observed in 64% of patients, averaging 19.4 lesions (1542 mm(3) [0.1%] of brain tissue). New lesions in the left hemisphere were significantly smaller and more numerous (29 lesions; median volume, 44 mm(3); volume range, 5-404 mm(3)) than those on the right (10 lesions; median volume, 128 mm(3); volume range, 13-1383 mm(3)), which is consistent with a cardioembolic source of particulate emboli. Overall, the incidence of postoperative cognitive decline was 46% and was independent of whether new lesions were present. CONCLUSIONS: New lesions after cardiac surgery added a small (≈4%) contribution to the burden of preexisting cerebrovascular disease and did not seem to affect cognitive function. CLINICAL TRIAL REGISTRATION URL: http://public.ukcrn.org.uk. Unique identifier: UKCRN ID: 11702.