Focal Brain Lesions Causing Acquired Amusia Map to a Common Brain Network.

Music is a universal human attribute. The study of amusia, a neurologic music processing deficit, has increasingly elaborated our view on the neural organization of the musical brain. However, lesions causing amusia occur in multiple brain locations and often also cause aphasia, leaving the distinct neural networks for amusia unclear. Here, we utilized lesion network mapping to identify these networks. A systematic literature search was carried out to identify all published case reports of lesion-induced amusia. The reproducibility and specificity of the identified amusia network were then tested in an independent prospective cohort of 97 stroke patients (46 female and 51 male) with repeated structural brain imaging, specifically assessed for both music perception and language abilities. Lesion locations in the case reports were heterogeneous but connected to common brain regions, including bilateral temporoparietal and insular cortices, precentral gyrus, and cingulum. In the prospective cohort, lesions causing amusia mapped to a common brain network, centering on the right superior temporal cortex and clearly distinct from the network causally associated with aphasia. Lesion-induced longitudinal structural effects in the amusia circuit were confirmed as reduction of both gray and white matter volume, which correlated with the severity of amusia. We demonstrate that despite the heterogeneity of lesion locations disrupting music processing, there is a common brain network that is distinct from the language network. These results provide evidence for the distinct neural substrate of music processing, differentiating music-related functions from language, providing a testable target for noninvasive brain stimulation to treat amusia.

Post-stroke enriched auditory environment induces structural connectome plasticity: secondary analysis from a randomized controlled trial.

Post-stroke neuroplasticity and cognitive recovery can be enhanced by multimodal stimulation via environmental enrichment. In this vein, recent studies have shown that enriched sound environment (i.e., listening to music) during the subacute post-stroke stage improves cognitive outcomes compared to standard care. The beneficial effects of post-stroke music listening are further pronounced when listening to music containing singing, which enhances language recovery coupled with structural and functional connectivity changes within the language network. However, outside the language network, virtually nothing is known about the effects of enriched sound environment on the structural connectome of the recovering post-stroke brain. Here, we report secondary outcomes from a single-blind randomized controlled trial (NCT01749709) in patients with ischaemic or haemorrhagic stroke (N = 38) who were randomly assigned to listen to vocal music, instrumental music, or audiobooks during the first 3 post-stroke months. Utilizing the longitudinal diffusion-weighted MRI data of the trial, the present study aimed to determine whether the music listening interventions induce changes on structural white matter connectome compared to the control audiobook intervention. Both vocal and instrumental music groups increased quantitative anisotropy longitudinally in multiple left dorsal and ventral tracts as well as in the corpus callosum, and also in the right hemisphere compared to the audiobook group. Audiobook group did not show increased structural connectivity changes compared to both vocal and instrumental music groups. This study shows that listening to music, either vocal or instrumental promotes wide-spread structural connectivity changes in the post-stroke brain, providing a fertile ground for functional restoration.

Isn't There Room for Music in Chronic Pain Management?

Chronic pain with its comorbidities, such as depression, insomnia, and social deprivation, is a major cause of disability and health-economic burden. Insufficient response to pain medication and potentially serious adverse effects have led the majority of chronic pain patients to seek relief from non-pharmacological remedies. Along with this trend, pain research has paid increasing interest in critical evaluation of various complementary treatments. Music-based treatments have emerged as an efficacious and safe means to enhance the management of acute and chronic pain. We review the current position of music-based interventions in the treatment of chronic pain and present explanations for the analgesic effects of music through modulation of the primary nociception and discuss the contribution of the mesolimbic dopaminergic system to the affective component of pain perception. We propose ways to translate the novel theoretical understanding into clinical practice in different health care settings, primary health care in particular, and discuss the preconditions of successful implementation. We argue that music interventions provide low-cost, easily applicable complementary pain treatments not requiring heavy utilization of health care resources. Finally, we provide research and quality improvement frameworks and make suggestions to cover the gaps of existing evidence. PERSPECTIVE: This article addresses the current evidence for analgesic effects of music interventions, discusses its neurobiological basis and evaluates potential use of music in treating chronic pain patients in different health care settings. We also propose directions for future research to cover shortages in the currently published data.

Headache and quality of life in Finnish female municipal employees.

OBJECTIVES: Migraine and other specific types of chronic headache impair health-related quality of life (HRQoL). However, undefined headache is common in general population and little is known about its impact on QoL. This study addresses the impact of undefined headache symptoms on quality of life in a population of working-age females. METHODS: This cross-sectional study consisted of 633 female municipal employees. Self-reported headache recurrence was defined by asking whether headache was occasional or recurrent. We assessed quality of life with two different instruments, the generic EUROHIS-QOL 8-item index (EUROHIS-8) and the preference-based instrument EuroQoL (EQ-5D) representing health-related QoL. Anxiety, depressive symptoms and work stress were measured using validated questionnaires. Adjusted hypothesis of linearity was evaluated using bootstrap type analysis of covariance with age, education and number of comorbidities as covariates. RESULTS: In the study population, 76% (n=481) had experienced headache during the past year, and of those 38% (n=184) had recurrent headache. The EQ-5D index decreased linearly with increasing headache symptoms and four out of five EQ-5D dimensions were lowest in recurrent headache group. Females with headache had lower QoL on every EUROHIS-8 item except for conditions of living place, compared to females without headache. These results remained statistically significant after adjustment with age, education and number of comorbidities. There were no differences in prevalence of musculoskeletal disorders between study groups. CONCLUSIONS: This cross-sectional, observational study showed that self-reported recurrent headache is common among Finnish women belonging to active work force. Both health-related and general QoL is best in females without headache and lowest in the recurrent headache group. We conclude that recurrent headache, even when the subjects have low anxiety and depressive symptoms scores, is associated with low HRQoL in working-age females. These results underline the importance of headache, a common and neglected symptom deteriorating female employees' wellbeing.

Right ventral stream damage underlies both poststroke aprosodia and amusia.

BACKGROUND AND PURPOSE: This study was undertaken to determine and compare lesion patterns and structural dysconnectivity underlying poststroke aprosodia and amusia, using a data-driven multimodal neuroimaging approach. METHODS: Thirty-nine patients with right or left hemisphere stroke were enrolled in a cohort study and tested for linguistic and affective prosody perception and musical pitch and rhythm perception at subacute and 3-month poststroke stages. Participants listened to words spoken with different prosodic stress that changed their meaning, and to words spoken with six different emotions, and chose which meaning or emotion was expressed. In the music tasks, participants judged pairs of short melodies as the same or different in terms of pitch or rhythm. Structural magnetic resonance imaging data were acquired at both stages, and machine learning-based lesion-symptom mapping and deterministic tractography were used to identify lesion patterns and damaged white matter pathways giving rise to aprosodia and amusia. RESULTS: Both aprosodia and amusia were behaviorally strongly correlated and associated with similar lesion patterns in right frontoinsular and striatal areas. In multiple regression models, reduced fractional anisotropy and lower tract volume of the right inferior fronto-occipital fasciculus were the strongest predictors for both disorders, over time. CONCLUSIONS: These results highlight a common origin of aprosodia and amusia, both arising from damage and disconnection of the right ventral auditory stream integrating rhythmic-melodic acoustic information in prosody and music. Comorbidity of these disabilities may worsen the prognosis and affect rehabilitation success.

Resting-state language network neuroplasticity in post-stroke music listening: A randomized controlled trial.

Recent evidence suggests that post-stroke vocal music listening can aid language recovery, but the network-level functional neuroplasticity mechanisms of this effect are unknown. Here, we sought to determine if improved language recovery observed after post-stroke listening to vocal music is driven by changes in longitudinal resting-state functional connectivity within the language network. Using data from a single-blind randomized controlled trial on stroke patients (N = 38), we compared the effects of daily listening to self-selected vocal music, instrumental music and audio books on changes of the resting-state functional connectivity within the language network and their correlation to improved language skills and verbal memory during the first 3 months post-stroke. From acute to 3-month stage, the vocal music and instrumental music groups increased functional connectivity between a cluster comprising the left inferior parietal areas and the language network more than the audio book group. However, the functional connectivity increase correlated with improved verbal memory only in the vocal music group cluster. This study shows that listening to vocal music post-stroke promotes recovery of verbal memory by inducing changes in longitudinal functional connectivity in the language network. Our results conform to the variable neurodisplacement theory underpinning aphasia recovery.

Vocal music listening enhances post-stroke language network reorganization.

Listening to vocal music has been recently shown to improve language recovery in stroke survivors. The neuroplasticity mechanisms supporting this effect are, however, still unknown. Using data from a three-arm single-blind randomized controlled trial including acute stroke patients (N=38) and a 3-month follow-up, we set out to compare the neuroplasticity effects of daily listening to self-selected vocal music, instrumental music, and audiobooks on both brain activity and structural connectivity of the language network. Using deterministic tractography we show that the 3-month intervention induced an enhancement of the microstructural properties of the left frontal aslant tract (FAT) for the vocal music group as compared to the audiobook group. Importantly, this increase in the strength of the structural connectivity of the left FAT correlated with improved language skills. Analyses of stimulus-specific activation changes showed that the vocal music group exhibited increased activations in the frontal termination points of the left FAT during vocal music listening as compared to the audiobook group from acute to 3-month post-stroke stage. The increased activity correlated with the structural neuroplasticity changes in the left FAT. These results suggest that the beneficial effects of vocal music listening on post-stroke language recovery are underpinned by structural neuroplasticity changes within the language network and extend our understanding of music-based interventions in stroke rehabilitation.Significance statementPost-stroke language deficits have a devastating effect on patients and their families. Current treatments yield highly variable outcomes and the evidence for their long-term effects is limited. Patients often receive insufficient treatment that are predominantly given outside the optimal time window for brain plasticity. Post-stroke vocal music listening improves language outcome which is underpinned by neuroplasticity changes within the language network. Vocal music listening provides a complementary rehabilitation strategy which could be safely implemented in the early stages of stroke rehabilitation and seems to specifically target language symptoms and recovering language network.

Vocal music enhances memory and language recovery after stroke: pooled results from two RCTs.

OBJECTIVE: Previous studies suggest that daily music listening can aid stroke recovery, but little is known about the stimulus-dependent and neural mechanisms driving this effect. Building on neuroimaging evidence that vocal music engages extensive and bilateral networks in the brain, we sought to determine if it would be more effective for enhancing cognitive and language recovery and neuroplasticity than instrumental music or speech after stroke. METHODS: Using data pooled from two single-blind randomized controlled trials in stroke patients (N = 83), we compared the effects of daily listening to self-selected vocal music, instrumental music, and audiobooks during the first 3 poststroke months. Outcome measures comprised neuropsychological tests of verbal memory (primary outcome), language, and attention and a mood questionnaire performed at acute, 3-month, and 6-month stages and structural and functional MRI at acute and 6-month stages. RESULTS: Listening to vocal music enhanced verbal memory recovery more than instrumental music or audiobooks and language recovery more than audiobooks, especially in aphasic patients. Voxel-based morphometry and resting-state and task-based fMRI results showed that vocal music listening selectively increased gray matter volume in left temporal areas and functional connectivity in the default mode network. INTERPRETATION: Vocal music listening is an effective and easily applicable tool to support cognitive recovery after stroke as well as to enhance early language recovery in aphasia. The rehabilitative effects of vocal music are driven by both structural and functional plasticity changes in temporoparietal networks crucial for emotional processing, language, and memory.

The Impact of Self-Reported Recurrent Headache on Absenteeism and Presenteeism at Work Among Finnish Municipal Female Employees.

PURPOSE: The aim of this cross-sectional, observational study was to determine the impact of self-reported headache on absenteeism and presenteeism in a female working-age population. SUBJECTS AND METHODS: The study population consisted of 594 Finnish female municipal employees, who answered self-administered questionnaires including sociodemographic, lifestyle, health, and work-related data. Sickness absence days were obtained from the official records of the employer. Headache recurrence was defined by asking whether headache was occasional or recurrent. Headache impact was measured by the HIT-6. RESULTS: In our study, 456 (77%) females had headache, and headache was recurrent in 178 (39%). The self-reported recurrence of headache was related to age, AUDIT-C, health-rated quality-of-life, self-rated work ability, depressive symptoms, and work stress (P for linearity <0.001). They also had more depressive symptoms and work stress (P for linearity <0.001). Mental work load was highest in those with recurrent headache (P=0.042), and work engagement was highest in those without headache (P=0.038). There was no statistically significant difference in absenteeism days between the headache groups when adjusted with confounding variables. Presenteeism was associated with the recurrence of headache (P for linearity <0.001). Presenteeism and the HIT-6 score were significantly associated in the recurrent headache group (P=0.009). CONCLUSION: Headache was not related to absenteeism, but the self-reported recurrence of headache was clearly associated with presenteeism in this female working-age population.

Neural architectures of music - Insights from acquired amusia.

The ability to perceive and produce music is a quintessential element of human life, present in all known cultures. Modern functional neuroimaging has revealed that music listening activates a large-scale bilateral network of cortical and subcortical regions in the healthy brain. Even the most accurate structural studies do not reveal which brain areas are critical and causally linked to music processing. Such questions may be answered by analysing the effects of focal brain lesions in patients´ ability to perceive music. In this sense, acquired amusia after stroke provides a unique opportunity to investigate the neural architectures crucial for normal music processing. Based on the first large-scale longitudinal studies on stroke-induced amusia using modern multi-modal magnetic resonance imaging (MRI) techniques, such as advanced lesion-symptom mapping, grey and white matter morphometry, tractography and functional connectivity, we discuss neural structures critical for music processing, consider music processing in light of the dual-stream model in the right hemisphere, and propose a neural model for acquired amusia.

Cognitive and neural mechanisms underlying the mnemonic effect of songs after stroke.

Sung melody provides a mnemonic cue that can enhance the acquisition of novel verbal material in healthy subjects. Recent evidence suggests that also stroke patients, especially those with mild aphasia, can learn and recall novel narrative stories better when they are presented in sung than spoken format. Extending this finding, the present study explored the cognitive mechanisms underlying this effect by determining whether learning and recall of novel sung vs. spoken stories show a differential pattern of serial position effects (SPEs) and chunking effects in non-aphasic and aphasic stroke patients (N = 31) studied 6 months post-stroke. The structural neural correlates of these effects were also explored using voxel-based morphometry (VBM) and deterministic tractography (DT) analyses of structural MRI data. Non-aphasic patients showed more stable recall with reduced SPEs in the sung than spoken task, which was coupled with greater volume and integrity (indicated by fractional anisotropy, FA) of the left arcuate fasciculus. In contrast, compared to non-aphasic patients, the aphasic patients showed a larger recency effect (better recall of the last vs. middle part of the story) and enhanced chunking (larger units of correctly recalled consecutive items) in the sung than spoken task. In aphasics, the enhanced chunking and better recall on the middle verse in the sung vs. spoken task correlated also with better ability to perceive emotional prosody in speech. Neurally, the sung > spoken recency effect in aphasic patients was coupled with greater grey matter volume in a bilateral network of temporal, frontal, and parietal regions and also greater volume of the right inferior fronto-occipital fasciculus (IFOF). These results provide novel cognitive and neurobiological insight on how a repetitive sung melody can function as a verbal mnemonic aid after stroke.

The role of psychosocial risk factors in the burden of headache.

Purpose: Psychosocial risk factors are common in headache patients and affect the impact of headache in multiple ways. The aim of our study was to assess how psychosocial risk factors correlate with the headache impact test-6 (HIT-6). To our knowledge this is the first study to evaluate the impact of several psychosocial factors on the HIT-6 score. Patients and methods: Our study population consisted of 469 Finnish female employees reporting headache during the past year. Psychosocial risk factors were assessed using validated, self-administered questionnaires: the generalized anxiety disorder 7-item scale (GAD-7) for anxiety, the major depression inventory (MDI) for depressive symptoms, the ENRICHD short social support instrument (ESSI) for social isolation, the cynical distrust scale for hostility and the Bergen burnout indicator (BBI-15) for work stress. Results: Exploratory factor analysis of the HIT-6 scores revealed two factors, one describing psychological and quality of life aspects affected by headache and the other describing severity of pain and functional decline. Internal consistency of the HIT-6 was 0.87 (95%CI: 0.85-0.89). Correlations between the total HIT-6 score and all measured psychosocial risk factors except for hostility were weak, but statistically significant. Conclusion: The HIT-6 questionnaire has good construct validity and it describes reliably and independently the impact of headache without interference of psychosocial factors in general working-aged female population.

Complication Burden Index-A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus.

Systemic complications are common in status epilepticus. We have no tools to evaluate total burden of complications and its effect on the outcome of status epilepticus. For Complication Burden Index (CBI) a patient is assessed for 13 complication categories: respiratory, cardiovascular, nervous, renal, hepatic, coagulation, gastrointestinal and musculoskeletal systems, electrolyte/acid-base balance, infection, hypo-/hyperglycemia, skin/allergic reactions, and mental condition. Maximum CBI is 13. CBI was internally validated in a retrospective cohort of 70 consecutive adult patients with generalized convulsive status epilepticus (GCSE) treated in a tertiary hospital over a period of 2 years. Functional outcome at discharge was defined Poor for Glascow Outcome Scale (GOS) 1-3 or worse-than-baseline condition and Good for GOS >3 or return to baseline condition. Relative risks (RRs) and receiver-operating characteristic (ROC) -curves were calculated to obtain optimal cutoff. Functional outcome was poor in 40% and worse-than-baseline in 59%. In-hospital mortality was 7%. Average CBI was 3.8 (range 0-10, median 3). Cutoff value predicting poor functional outcome was a CBI >3 (GOS 1-3 RR 1.84, P = .045, 95% confidence interval [CI 1.01-3.33; ROC-AUC [area under the curve] 0.687, P = .008, sensitivity 64%, specificity 61%; worse-than-baseline condition RR 1.52, P = .04, 95% CI 1.02-2.26; ROC-AUC 0.662, P = .022, sensitivity 56%, specificity 69%). CBI with cutoff >3 and as a continuous variable was associated with GOS1-3 (P = .046, P = .002) and with worse-than-baseline condition (P = .041, P = .004). CBI is a novel tool for comprehensive assessment of status epilepticus complications predicting poor/worse-than-baseline functional outcome with cutoff >3.

Sung melody enhances verbal learning and recall after stroke.

Coupling novel verbal material with a musical melody can potentially aid in its learning and recall in healthy subjects, but this has never been systematically studied in stroke patients with cognitive deficits. In a counterbalanced design, we presented novel verbal material (short narrative stories) in both spoken and sung formats to stroke patients at the acute poststroke stage and 6 months poststroke. The task comprised three learning trials and a delayed recall trial. Memory performance on the spoken and sung tasks did not differ at the acute stage, whereas sung stories were learned and recalled significantly better compared with spoken stories at the 6 months poststroke stage. Interestingly, this pattern of results was evident especially in patients with mild aphasia, in whom the learning of sung versus spoken stories improved more from the acute to the 6-month stages compared with nonaphasic patients. Overall, these findings suggest that singing could be used as a mnemonic aid in the learning of novel verbal material in later stages of recovery after stroke.

The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus.

PURPOSE: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. METHOD: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge. Functional outcome was assessed with Glasgow Outcome Scale (GOS1-3 for poor outcome, GOS > 3 for good outcome) and also defined as condition relative to baseline (worse-than-baseline vs. baseline). Univariate and multivariate regression models were used to analyze the relations between delays and outcome. Delay cut-offs predicting outcome were determined using ROC-Curves. RESULTS: In univariate analysis long onset-to-tertiary-hospital time (p = 0.034) was a significant risk factor for worse-than-baseline condition. Long delays in onset-to-diagnosis (p = 0.032), onset-to-second-stage-medication (p = 0.023), onset-to-consciousness (p = 0.027) and long total-anesthesia-time (0 = 0.043) were risk factors for low GOS score (1-3). Short delay in onset-to-initial-treatment (p = 0.047), long onset-to-anesthesia (p = 0.003) and onset-to-consciousness (p = 0.008) times were risk factors for in-hospital mortality. Multivariate analysis showed no significant factors. Cut-offs for increased risk of poor outcome were onset-to-diagnosis 2.4 h (p = 0.011), onset-to-second-stage-medication 2.5 h (p = 0.001), onset-to-consciousness 41.5 h (p = 0.009) times and total-anesthesia-time 45.5 h (p = 0.003). The delay over 2.1 h in onset-to-tertiary-hospital time increased the risk of worse-than-baseline condition (p = 0.028). CONCLUSIONS: GCSE treatment is a dynamic process, where every delay component needs to be optimized. We suggest that GCSE patients should be handled with high priority and transported directly to hospital ED with neurological expertise. Critical steps in the treatment, such as diagnosing GCSE and starting progressive antiepileptic medication on stages 1 through 3, if needed, should be accomplished within 2.5 h.

Tooth Clenching Induces Abnormal Cerebrovascular Responses in Migraineurs.

Prevalence of masticatory parafunctions, such as tooth clenching and grinding, is higher among migraineurs than non-migraineurs, and masticatory dysfunctions may aggravate migraine. Migraine predisposes to cerebrovascular disturbances, possibly due to impaired autonomic vasoregulation, and sensitization of the trigeminovascular system. The relationships between clenching, migraine, and cerebral circulation are poorly understood. We used Near-Infrared Spectroscopy to investigate bilateral relative oxy- (%Δ[O2Hb]), deoxy- (%Δ[HHb]), and total (%Δ[tHb]) hemoglobin concentration changes in prefrontal cortex induced by maximal tooth clenching in twelve headache-free migraineurs and fourteen control subjects. From the start of the test, migraineurs showed a greater relative increase in right-side %Δ[HHb] than controls, who showed varying reactions, and right-side increase in %Δ[tHb] was also greater in migraineurs (p < 0.001 and p < 0.05, respectively, time-group interactions, Linear mixed models). With multivariate regression model, migraine predicted the magnitude of maximal blood pressure increases, associated in migraineurs with mood scores and an intensity of both headache and painful signs of temporomandibular disorders (pTMD). Although changes in circulatory parameters predicted maximal NIRS responses, the between-group differences in the right-side NIRS findings remained significant after adjusting them for systolic blood pressure and heart rate. A family history of migraine, reported by all migraineurs and four controls, also predicted maximal increases in both %Δ[HHb] and %Δ[tHb]. Presence of pTMD, revealed in clinical oral examination in eight migraineurs and eight controls, was related to maximal %Δ[HHb] increase only in controls. To conclude, the greater prefrontal right-side increases in cerebral %Δ[HHb] and %Δ[tHb] may reflect disturbance of the tooth clenching-related cerebral (de)oxygenation based on impaired reactivity and abnormal microcirculation processes in migraineurs. This finding may have an impact in migraine pathophysiology and help to explain the deleterious effect of masticatory dysfunctions in migraine patients. However, the role of tooth clenching as a migraine trigger calls for further studies.

Tracting the neural basis of music: Deficient structural connectivity underlying acquired amusia.

Acquired amusia provides a unique opportunity to investigate the fundamental neural architectures of musical processing due to the transition from a functioning to defective music processing system. Yet, the white matter (WM) deficits in amusia remain systematically unexplored. To evaluate which WM structures form the neural basis for acquired amusia and its recovery, we studied 42 stroke patients longitudinally at acute, 3-month, and 6-month post-stroke stages using DTI [tract-based spatial statistics (TBSS) and deterministic tractography (DT)] and the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA). Non-recovered amusia was associated with structural damage and subsequent degeneration in multiple WM tracts including the right inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), inferior longitudinal fasciculus (ILF), uncinate fasciculus (UF), and frontal aslant tract (FAT), as well as in the corpus callosum (CC) and its posterior part (tapetum). In a linear regression analysis, the volume of the right IFOF was the main predictor of MBEA performance across time. Overall, our results provide a comprehensive picture of the large-scale deficits in intra- and interhemispheric structural connectivity underlying amusia, and conversely highlight which pathways are crucial for normal music perception.

Functional neural changes associated with acquired amusia across different stages of recovery after stroke.

Brain damage causing acquired amusia disrupts the functional music processing system, creating a unique opportunity to investigate the critical neural architectures of musical processing in the brain. In this longitudinal fMRI study of stroke patients (N = 41) with a 6-month follow-up, we used natural vocal music (sung with lyrics) and instrumental music stimuli to uncover brain activation and functional network connectivity changes associated with acquired amusia and its recovery. In the acute stage, amusic patients exhibited decreased activation in right superior temporal areas compared to non-amusic patients during instrumental music listening. During the follow-up, the activation deficits expanded to comprise a wide-spread bilateral frontal, temporal, and parietal network. The amusics showed less activation deficits to vocal music, suggesting preserved processing of singing in the amusic brain. Compared to non-recovered amusics, recovered amusics showed increased activation to instrumental music in bilateral frontoparietal areas at 3 months and in right middle and inferior frontal areas at 6 months. Amusia recovery was also associated with increased functional connectivity in right and left frontoparietal attention networks to instrumental music. Overall, our findings reveal the dynamic nature of deficient activation and connectivity patterns in acquired amusia and highlight the role of dorsal networks in amusia recovery.

Relationship of musculoskeletal pain and well-being at work - Does pain matter?

BACKGROUND AND AIMS: Musculoskeletal pain is a common symptom and many people even with chronic pain continue to work. The aim of our study is to analyze how musculoskeletal pain affects work well-being by comparing work engagement in employees with or without pain, and how pain-related risk of disability is associated with work engagement. In a separate analysis, we also studied, how psychosocial factors are related to work engagement. METHODS: This is a cross-sectional study of Finnish female employees of the city of Pori, Finland (PORi To Aid Against Threats (PORTAAT) study). Data was collected by trained study nurses and self-administrated questionnaires. Work well-being was measured by work engagement using Utrecht Work Engagement Scale (UWES-9) questionnaire and the burden of pain was measured by using the short version of Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). Study population was divided into four groups: those without pain and the groups with low (I), medium (II) or high (III) ÖMPSQ score, reflecting increasing risk of long term disability due to musculoskeletal pain. The study nurse assessed psychosocial risk factors using defined core questions. RESULTS: We evaluated 702 female employees, 601 (86%) had suffered from musculoskeletal pain over the past 12 months, whereas 101 (14%) reported no pain at all. Pain was chronic (duration at least 3 months) in 465/601 (77%) subjects. Subjects with musculoskeletal pain were older, had higher BMI and were on sick leave more often than subjects without pain. Of the psychosocial risk factors, depression, type D personality, anxiety and hostility were significantly more common among subjects with musculoskeletal pain. Hypertension and the use of non-steroidal anti-inflammatory drugs were significantly more frequent in the musculoskeletal pain group. Quality of sleep and working capability were significantly better among persons without pain. Average weekly working hours were slightly higher among those with musculoskeletal pain. In crude analysis, work engagement (UWES-9) was similar in women without pain and those with musculoskeletal pain (4.96 vs. 4.79; p=0.091). After adjustment for age, education years, BMI, working hours and financial satisfaction, the difference between the groups became statistically significant (p=0.036). Still, there was no difference between the groups of no-pain and low burden of pain (p=0.21, after adjustment). Work engagement was significantly lower in the groups of medium (p=0.024, after adjusted) and high (p<0.001, after adjustment) burden of pain. Linearity across the Linton tertiles was significant (p<0.001). In univariate and multivariate ordered logistic regression analyses relating study variables to the work engagement musculoskeletal pain per se did not enter in the model to explain work engagement. Work and family stress, type D personality and duration of sick leave due to pain reduced work engagement, whereas financial satisfaction, moderate and high leisure time physical activity and higher BMI improved it. CONCLUSIONS: Among women with musculoskeletal pain psychosocial and lifestyle factors significantly correlate with work engagement, while the pain itself does not. IMPLICATIONS: Special attention should be paid to the psychosocial aspects in female employees with musculoskeletal pain to improve work well-being and maintain work ability.

Revisiting the Neural Basis of Acquired Amusia: Lesion Patterns and Structural Changes Underlying Amusia Recovery.

Although, acquired amusia is a common deficit following stroke, relatively little is still known about its precise neural basis, let alone to its recovery. Recently, we performed a voxel-based lesion-symptom mapping (VLSM) and morphometry (VBM) study which revealed a right lateralized lesion pattern, and longitudinal gray matter volume (GMV) and white matter volume (WMV) changes that were specifically associated with acquired amusia after stroke. In the present study, using a larger sample of stroke patients (N = 90), we aimed to replicate and extend the previous structural findings as well as to determine the lesion patterns and volumetric changes associated with amusia recovery. Structural MRIs were acquired at acute and 6-month post-stroke stages. Music perception was behaviorally assessed at acute and 3-month post-stroke stages using the Scale and Rhythm subtests of the Montreal Battery of Evaluation of Amusia (MBEA). Using these scores, the patients were classified as non-amusic, recovered amusic, and non-recovered amusic. The results of the acute stage VLSM analyses and the longitudinal VBM analyses converged to show that more severe and persistent (non-recovered) amusia was associated with an extensive pattern of lesions and GMV/WMV decrease in right temporal, frontal, parietal, striatal, and limbic areas. In contrast, less severe and transient (recovered) amusia was linked to lesions specifically in left inferior frontal gyrus as well as to a GMV decrease in right parietal areas. Separate continuous analyses of MBEA Scale and Rhythm scores showed extensively overlapping lesion pattern in right temporal, frontal, and subcortical structures as well as in the right insula. Interestingly, the recovered pitch amusia was related to smaller GMV decreases in the temporoparietal junction whereas the recovered rhythm amusia was associated to smaller GMV decreases in the inferior temporal pole. Overall, the results provide a more comprehensive picture of the lesions and longitudinal structural changes associated with different recovery trajectories of acquired amusia.