Deficits In Orientation Research Articles

Cognitive aspects of attention disorders in Alzheimer's disease.

Attention deficits are encountered at a very early stage in the development of Alzheimer's disease. While these deficits may be detected using classic clinical tests or even through simple observation, experimental tools enable a more precise evaluation of these deficits, typically by differentiating between conditions in which the quantity of attention needed varies, and by recording response times, which allows for a more precise and modulated measurement. The sensitivity of these tools can be further increased by analysing the intra-individual variability of performance in these experiments, which is particularly significant during the earliest stages of the disease. We present the cognitive aspects of these deficits by regrouping them according to the type of experiment used to highlight each deficit. We therefore distinguish spatial attention orientation deficits, executive control deficits, and sustained attention deficits. In each section, we present some of the more commonly used experiments (spatial cueing, spatial search, dual tasks, conflict tasks, vigilance tests), and draw parallels between these experiments and everyday life.

Visually guided movement with increasing time-on-task: Differential effects on movement preparation and movement execution.

Top-down cognitive control seems to be sensitive to the detrimental effects of fatigue induced by time-on-task (ToT). The planning and preparation of the motor responses may be especially vulnerable to ToT. Yet, effects of ToT specific to the different phases of movements have received little attention. Therefore, in three experiments, we assessed the effect of ToT on a mouse-pointing task. In Experiment 1, there were 16 possible target positions with variable movement directions. In Experiment 2, the layout of the targets was simplified. In Experiment 3, using cuing conditions, we examined whether the effects of ToT on movement preparation and execution were caused by an increased orientation deficit or decreased phasic alertness. In each experiment, initiation of movement (preparatory phase) became slower, movement execution became faster and overall response time remained constant with increasing ToT. There was, however, no significant within-person association between the preparatory and execution phases. In Experiments 1 and 2, we found a decreasing movement time/movement error ratio, suggesting a more impulsive execution of the pointing movement. In addition, ToT was also accompanied with imprecise movement execution as indicated by the increased errors, mainly in Experiment 2. The results of Experiment 3 indicated that ToT did not induce orientation and phasic alerting deficits but rather was accompanied by decreased tonic alertness.

Nursing Knowledge and Practices Regarding Delirium as an Under-Recognized Syndrome in Intensive Care Units (ICU psychosis)

Background: Delirium is an acute and fluctuating change in mental status that characterized by marked disturbance of attention, with associated deficits in memory and orientation, disorganized thinking, perceptual disturbance, anxiety, sleep problems, agitation and motor unrest. The aim of this study was to assess the nurses' knowledge and practices regarding to delirium of critically ill patients in ICU. Design: A descriptive design was used. Subjects: A sample of convenience 64 critical care nurses who were currently available at morning shifts working was recruited for this study. Tool: Delirium awareness and practice in ICUs Questionnaire to measure healthcare professionals’ awareness and practice related to delirium in the ICU. Results: The results revealed that lower significant knowledge score was observed for nurses who were not mentioned the definition of delirium and only one nurse attended training course/lecture about delirium within last year (1.6%), while 98.4% did not attend any training courses/ lecture about delirium last year. Conclusion: Based on this result, it was concluded that delirium was a problem that requires active interventions from the health care providers and it is under-diagnosed syndrome. Recommendations: Condensed training required to optimally manage the condition of delirium is needed for earlier intervention and greater interdisciplinary collaboration and more involvement of psychiatric services are needed.

Impediments in Healthy Ageing: AShort Review

Background: The influence of shared genetic vulnerability is well-known in the development of alcohol use disorder. However, there is a dearth of studies on shared environments. Hence, the present study aimed to ascertain the influence of shared environments in the development of alcohol use disorder. Aim: To examine the influence of adverse childhood experiences, parental bonding, and temperament in the development of alcohol use disorder. Methods: Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Studies were identified through search engines such as PubMed, Embase, and PsychInfo, CINAHL databases. Peer-reviewed articles in English published during 2000 - 2021 were included for the review. Results: About 47 articles were considered for the scoping review. Shared environmental factors such as adverse childhood experiences or childhood trauma within 18 years of life, novelty, adventureseeking, cyclothymia, and immediate need for gratification contribute to alcohol use disorder development. Positive parenting is associated with a lower incidence of AUD. Conclusion: Understanding the influence of shared environments and providing tailor-made psycho-social interventions would reduce the risk and prevent alcohol use disorder development.. Keywords: Temperament, parental bonding, adverse childhood consequences. How to cite: Dwivedi, R. (2021). Impediments in Healthy Ageing: A Short Review. Journal of Psychosocial Wellbeing, 2(2):17-20. Quick Response Code This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Website : www.jpsw.co.in Access this Article online DOI: http://dx.doi.org/10.55242/JPSW.2021.2204 Abstract Background: Healthy and active ageing is one of the prime concerns of psychologists and other mental health professionals. Ageing process can be defined as a natural process leading to generalized disability of functions and failure of adaptive response to stress in the longer run. It makes the individual more prone for any age-related disease. Specific age-related changes like fatigue weak muscles are observed with considerable regularity across time and place because they are developmental. Aim:The objective of this article is to explore the complexities and challenges of healthy ageing with a major focus on cognitive impairments and dysfunctions. Methods: All the review articles related to healthy ageing were reviewed in detail. Articles were identified through search engines such as PubMed, Embase, and PsychInfo databases. Peer-reviewed articles published during 2002 - 2021 were included for the review. Results: Ageing contributes to bring about a number of changes in different aspects of human life as in ones behavior, attitude, intelligence, ability, physical capacity and maturity. Studies have reported that between 2015 and 2050, the proportion of the world's elderly population is estimated to almost double from about 12% to 22%. The report also states that there is an expected increase from 900 million to 2 billion people over the age of 60. Older people face special physical and mental health challenges which need to be recognized and attended. Conclusion: There are a number of risk factors that can challenge the active ageing process and lead to certain physical and psychological disabilities. Cognitive impairment is one of the prime factors which affects the functioning of brain by causing memory problems, attention and orientation deficits, language issues etc. These problems are quite common among the elderly and may lead to a number of neuropsychological changes.

Precursors of Reading Performance and Double- and Triple-Deficit Risks in Spanish

Early literacy skills serve as the best precursors of reading success and risk indicators of the double deficit and triple deficit hypotheses according to the spelling consistency of languages. Our study analyzes the predictive value of phonological awareness, naming speed, and orthographic skills for early reading in Spanish. Participants included 362 Spanish children aged 4 to 5 years. We used data analysis to examine the relationships between these precursors and fluency through a structural equation model and investigated the risk indicators of poor reading performance according to the double deficit and triple deficit hypotheses using binary logistic analysis. Our research delimits a model for the Spanish language that emphasizes the predictive value of phonological awareness, letter-naming fluency, and knowledge of graphemes in early reading. Letter-naming fluency is the best precursor to early reading experiences, and poor early reading performance in children is explained by deficits in phonological awareness, naming speed, and visual orientation. Our findings confirm the risk indicators of the triple deficit hypothesis in the early learning of reading in Spanish.

Percepção dos pacientes com doença renal crônica acerca dos cuidados pré-operatórios na confecção da fístula arteriovenosa

O presente estudo objetivou-se compreender a percepção dos pacientes com Doença Renal Crônica (DRC) acerca dos cuidados pré-operatórios na confecção da Fístula Arteriovenosa (FAV). Trata-se de um estudo descritivo exploratório, com abordagem qualitativa, aplicando-se a Teoria da Adaptação de Callista Roy, a qual compreende o indivíduo como um sistema adaptativo e holístico. A pesquisa foi realizada em uma Clínica de Hemodiálise situada no município de Maracanaú-CE. Participaram 12 Pacientes com DRC em hemodiálise que possuem FAV, a coleta de dados foi realizada no período de setembro a novembro de 2018, utilizando-se um roteiro de entrevista semiestruturada, em forma de gravação. Seguindo a análise do conteúdo, criou-se com os dados a apreensão de três categorias temáticas: “Déficit de orientação antes da cirurgia”; “Medo” e “Desinformação”. Em suma, concluímos que a percepção dos pacientes do paciente com DRC, acerca dos cuidados pré-operatórios da confecção da FAV, permeou o sentimento de medo, ansiedade, relacionada à falta de informação, mostrando que é de suma importância abordagens esclarecedora a respeito da doença e quanto é essencial o início dos cuidados antes da confecção da FAV até o manejo desse acesso, com a finalidade de prolongar o funcionamento deste acesso e evitar complicações futuras.

Patientenorientierung und Patientenbeteiligung in der Forschung – Mängel, Formen und Erwartungen aus Sicht eines Patientenvertreters

The article addresses deficits in patient orientation and patient involvement in medical research from a patient's perspective and provides recommendations for their further development. Researchers often practice patient orientation as well as patient involvement in an unstructured and inconsistent manner. The decision if and how patient involvement takes place is, to a considerable extent, the researchers’ responsibility. This decision should always be part of a patient-oriented alignment of the research project, which researchers pursue regardless of the existence, initiative and participation of a patient organization. Possible modes of involvement are assigned to different phases of the research process. In this article, patient orientation and the choice of the form of involvement is considered to constitute an obligation of researchers and decision makers early in the process. Involvement should take place on a fair basis. Decision makers should consider determining specific requirements for patient orientation, e. g. in their calls for proposals or selection/award criteria.

005 HSDD, Flibanserin, and Eye Dynamics: A Double-blind Randomized Placebo-controlled Clinical Trial

The top-down neurofunctional model of hypoactive sexual desire disorder (HSDD) suggests an attentional visual deficit when looking at attractive stimuli, characterized by a deficit in orientation and disengagement. Little is known, however, about the effect of flibanserin on eye dynamics in women with HSDD. The objective of this experiment is to investigate the effects of flibanserin on eye dynamics in women with HSDD. A total of 24 premenopausal women who met DSM-IV TR criteria for HSDD were randomized to either flibanserin 100mg or placebo over an 8-week study period (N=12, flibanserin, N=12 placebo; N=15 heterosexual; N=9 bisexual; mean age: 32.79 ± 9.17 years). Eye movements were recorded in our standard behavioral task i.e., the Desire Intention Task (DIT), in which individuals are instructed to indicate as rapidly and accurately as possible whether or not each visually presented stimulus (e.g., attractive persons of the opposite sex) is sexually desirable to them at the moment of the experiment. Participants then completed a series of self-reported questionnaires (e.g., demographics, level of sexual desire, well-being, anxiety and depression).

The effectiveness of an operating room etiquette video on medical student comfort in the gynecologic operating room

Background: Medical students spend a large portion of their obstetrics and gynecology (OB/GYN) rotation in the operating room (OR). We identified a deficit in appropriate OR orientation and created a 10-min video reviewing OR etiquette and fundamental skills. Our primary aim was to investigate the effect of this video on medical students' comfort and self-assessed performance in the gynecologic OR. Our secondary aim was to examine if OR personnel rated students' performance higher 8 months after video introduction. Materials and Methods: A prospective, cohort study of 71 3rd- and 4th-year medical students participating in the core OB/GYN clerkship at the University of Pittsburgh Medical Center (UPMC). All medical student participants watched the video once during their clerkship orientation and had continuous online access. Participants completed a pre- and posttest survey assessing their comfort with various OR tasks. After each OR day, participants completed a brief self-assessment of their OR performance. OR staff were surveyed on medical student performance before and after video implementation. Data were analyzed using descriptive statistics, the signed-rank test, and Fisher's exact test via SAS 9.4 (SAS Institute, Inc., Cary, NC, USA). Results: Most students reported improvement on the daily self-assessment. Students without prior surgical experience demonstrated greater improvement in comfort with most OR tasks. OR staff perception of medical students changed favorably after video implementation in several domains. Conclusions: A brief video detailing OR etiquette and fundamental skills is an easily implemented resource to clarify OR tasks that often produce unnecessary anxiety for students. Improved OR staff perception of medical student performance may help streamline OR functioning.

Self-Referential Processing Can Modulate Visual Spatial Attention Deficits in Children With Dyslexia.

Considerable research has shown that children with dyslexia have deficits in visual spatial attention orientation. Additionally, self-referential processing makes self-related information play a unique role in the individual visual spatial attention orientation. However, it is unclear whether such self-referential processing impacts the visual spatial attention orientation of children with dyslexia. Therefore, we manipulated the reference task systematically in the cue-target paradigm and investigated the modulation effect of self-referential processing on visual spatial attention of children with dyslexia. In the self-referential processing condition, we observed that children with dyslexia demonstrated stable cue effects in the visual spatial attention orientation tasks when the Stimulus Onset Asynchronies (SOAs) were set to 100 ms, while other-referential processing weakened the cue effects of the visual spatial attention orientation of children with dyslexia. With cue effect as the index, we also observed that the self-referential processing had a significant larger regulatory effect at the early stage of visual spatial attention orientation, as compared with other-referential processing. These differences have a high-ranked consistency between children with dyslexia and typically developing reader. The results suggested that self-referential processing can regulate the visual spatial attention deficits of children with dyslexia.

AGR - 2 Diagnosis of Posterior Cortical Atrophy Through Inter-Departmental Collaboration

Abstract Objective We present a patient with rapidly progressive visual decline of 2-year duration that interfered with daily functioning. She was evaluated by neuro-ophthalmology and neurology prior to neuropsychological referral. A series of evaluations led to diagnosis of posterior cortical atrophy, demonstrating the importance of inter-departmental collaboration. Method A 66-year old white female presented with a 2-year history of progressive changes to vision and memory. Medical history included hypertension, dyslipidemia, and a strong family history of optic neuropathy causing blindness. She was diagnosed with a left homonymous hemianopia. MRI revealed "significant cortical atrophy more remarkable on the right temporal, parietal, and occipital regions." She reported dressing apraxia, unsteady gait, declines in reading and writing, and difficulty recalling well-learned information. Results She was a good historian, had fluent speech and no apparent comprehension difficulty. Neuropsychological evaluation revealed relatively preserved language and verbal abilities, including confrontation naming, in the presence of otherwise impaired performances across all domains of functioning. She demonstrated agraphia, acalculia, left-right confusion, and difficulties with motor programming. Perceptual and constructional tasks revealed prominent deficits in visual integration, map orientation, form discrimination, and construction of simple geometric designs. She was perseverative and susceptible to verbal and visual stimulus pull. Conclusions The pattern on neuropsychological testing, with prominent visual spatial and perceptual difficulties, was consistent with posterior cortical atrophy. The decline in visual ability is likely exacerbated but not entirely explained by left hemianopia. Neuropsychological, neuroimaging, and visual field evidence demonstrated posterior cortical atrophy in the absence of positive biomarker evidence, leading to initiation of anti-cholinesterase therapy.

A bedside application-based assessment of spatial orientation and memory: approaches and lessons learned

Spatial orientation and memory deficits are an often overlooked and potentially powerful early marker for pathological cognitive decline. Pen-and-paper tests for spatial abilities often do not coincide with actual navigational performance due to differences in spatial perspective and scale. Mobile devices are becoming increasingly useful in a clinical setting, for patient monitoring, clinical decision-making, and information management. The same devices have positional information that may be useful for a scale appropriate point-of-care test for spatial ability. We created a test for spatial orientation and memory based on pointing within a single room using the sensors in mobile phone. The test consisted of a baseline pointing condition to which all other conditions were compared, a spatial memory condition with eyes-closed, and two body rotation conditions (real or mental) where spatial updating were assessed. We examined the effectiveness of the sensors from a mobile phone for measuring pointing errors in these conditions in a sample of healthy young individuals. We found that the sensors reliably produced appropriate azimuth and elevation pointing angles for all of the 15 targets presented across multiple participants and days. Within-subject variability was below 6° elevation and 10° azimuth for the control condition. The pointing error and variability increased with task difficulty and correlated with self-report tests of spatial ability. The lessons learned from the first tests are discussed as well as the outlook of this application as a scientific and clinical bedside device. Finally, the next version of the application is introduced as an open source application for further development.

HSDD, Flibanserin, and Eye Dynamics: A Double-Blind Randomized Placebo-Controlled Clinical Trial [24I

INTRODUCTION: The Cacioppo neurofunctional model of hypoactive sexual desire disorder (HSDD) suggests an attentional visual deficit when looking at attractive stimuli, characterized by a deficit in orientation and disengagement. Little is known, however, about the effect of flibanserin on eye dynamics in women with HSDD. METHODS: A total of 24 premenopausal women who met DSM-IV TR criteria for HSDD were randomized to either flibanserin 100mg or placebo over an 8-week period (N=12, flibanserin, N=12 placebo; N=15 heterosexual; N=9 bisexual; mean age: 32.79 ± 9.17 years). Eye movements were recorded in our standard behavioral task i.e., the Desire Intention Task (DIT), in which individuals are instructed to indicate as rapidly and accurately as possible whether or not each visually presented stimulus (e.g., attractive persons of the opposite sex) is sexually desirable to them at the moment of the experiment. Participants then completed a series of self-reported questionnaires (e.g., demographics, level of sexual desire, well-being, anxiety and depression). RESULTS: Results showed an effect of flibanserin on the re-orientation of attention towards attractive stimuli. More precisely, a 2x2x2 repeated measures ANOVA with visit (baseline, 4 weeks) and visual attentional region of interest (face, torso) as within-subjects factors and treatment group (flibanserin, placebo) as a between-subjects factor revealed a significant interaction for duration of first fixation to the face (F(1,21)=5.046, P=.043, ηp2 = .187) and average stimulus duration of fixation from image onset to response (F(1.21)=4.411, P=.047, ηp2 = .167). CONCLUSION: These results suggest a positive effect of flibanserin, but not placebo, on eye movements during DIT.

Prevalence and determinants of subjective cognitive decline in a representative Greek elderly population.

We studied the prevalence of subjective cognitive decline (SCD) and its determinants in a sample of 1456 cognitively normal Greek adults ≥65years old. Subjects were evaluated by a multidisciplinary team on their neurological, medical, neuropsychological, and lifestyle profile to reach consensus diagnoses. We investigated various types of SCD, including single-question, general memory decline, specific subjective memory decline based on a list of questions and three types of subjective naming, orientation, and calculation decline. In a single general question about memory decline, 28.0% responded positively. The percentage of our sample that reported at least one complaint related to subjective memory decline was 76.6%. Naming difficulties were also fairly common (26.0%), while specific deficits in orientation (5.4%) and calculations/currency handling (2.6%) were rare. The majority (84.2%) of the population reported subjective deficits in at least one cognitive domain. Genetic predisposition to dementia increased the odds for general memory decline by more than 1.7 times. For each one-unit reduction in the neuropsychological composite score (a mean of memory, executive, language, visuospatial, and attention-speed composite scores), the odds for decline in orientation increased by 40.3%. Depression/anxiety and increased cerebrovascular risk were risk factors for almost all SCD types. SCD regarding memory is more frequent than non-memory decline in the cognitively normal Greek elderly population. Genetic predisposition to dementia, lower cognitive performance, affective symptoms, and increased cerebrovascular risk are associated with prevalent SCD. Further prospective research is needed to improve understanding of the evolution of SCD over time.

Quality of life in patients with minimal hepatic encephalopathy.

Minimal hepatic encephalopathy (MHE) represents the mildest type of hepatic encephalopathy (HE). This condition alters the performance of psychometric tests by impairing attention, working memory, psychomotor speed, and visuospatial ability, as well as electrophysiological and other functional brain measures. MHE is a frequent complication of liver disease, affecting up to 80% of tested patients, depending of the diagnostic tools used for the diagnosis. MHE is related to falls, to an impairment in fitness to drive and the development of overt HE, MHE severely affects the lives of patients and caregivers by altering their quality of life (QoL) and their socioeconomic status. MHE is detected in clinically asymptomatic patients through appropriate psychometric tests and neurophysiological methods which highlight neuropsychological alterations such as video-spatial orientation deficits, attention disorders, memory, reaction times, electroencephalogram slowing, prolongation of latency evoked cognitive potentials and reduction in the critical flicker frequency. Several treatments have been proposed for MHE treatment such as non-absorbable disaccharides, poorly absorbable antibiotics such rifaximin, probiotics and branched chain amino acids. However, because of the multiple diagnosis methods, the various endpoints of treatment trials and the variety of agents used in trials, to date the treatment of MHE is not routinely recommended apart from on a case-by-case basis. Aim of this review is analyze the burden of MHE on QoL of patients and provide a brief summary of therapeutic approaches.

A Systematic Review of Cognitive Impairments Associated With Kidney Failure in Adults Before Natural Age-Related Changes.

Recognition of cognitive impairment in chronic kidney disease (CKD) and its impact on functioning in adults is growing. The vast majority of studies to date have been conducted in older populations where CKD is more pronounced; however, the degree to which age-related cognitive changes could be influencing these findings remains unaddressed. This current study thus aimed to review cognitive impairment findings by stage in non-elderly CKD samples. PubMed and Medline via Scopus were searched for cross-sectional or cohort studies and randomized controlled trials that assessed cognitive function in individuals with CKD in any research setting. CKD studies including patients at any illness stage were included providing participants were below 65 years old, were not on peritoneal dialysis and had not undergone a kidney transplant. Fifteen studies, with a total of 9304 participants, were included. Cognitive function broadly deteriorated from stage 1 to stage 5. Early stage CKD was associated with a drop in speed of processing, attention, response speed, and short-term memory abilities. Moderate stage CKD was associated with deficits in executive functioning, verbal fluency, logical memory, orientation and concentration. People with end stage kidney disease manifested significant deficits in all previous cognitive domains, along with cognitive control, delayed and immediate memory, visuospatial impairment, and overall cognitive impairment. Cognitive impairment is evident across the stages of CKD, independent of age-related changes, for both lower-order and higher-order cognitive abilities. These impairments also increase between the stages, suggesting a cumulative effect. Future directions for research are discussed. (JINS, 2019, 25, 101-114).

Brain-Area Specific White Matter Hyperintensities: Associations to Falls in Parkinson's Disease.

Falls are common among people with idiopathic Parkinson's disease (IPD) and are suggested to be associated with white matter hyperintensities (WMH) of the brain. To investigate the contribution of brain area-specific WMH to the risk of falls in IPD. In fifty participants with IPD, occurrence and severity of WMH in specific brain areas were determined using Scheltens (without lateralization) and Age-related white matter changes (ARWMC) (with lateralization) scores. Falls were evaluated with the fall item of the Unified PD Rating Scale (UPDRS). Correlations between area-specific WMH and falls were tested with stepwise backward regression and multivariate regression analyses. In this cohort of participants with IPD, left temporal WMH were associated with occurrence of falls. Frontal WMH of both hemispheres showed tendencies towards significance for the association with falls. According to our study, WMH in the left temporal area are significantly associated with falls in IPD. Potential reasons for this association could be deficits in memory, navigation, orientation, auditory processing, and fear conditioning, which are all associated with pathologies of the left temporal lobe.

Spatial navigation deficits - overlooked cognitive marker for preclinical Alzheimer disease?

Detection of incipient Alzheimer disease (AD) pathophysiology is critical to identify preclinical individuals and target potentially disease-modifying therapies towards them. Current neuroimaging and biomarker research is strongly focused in this direction, with the aim of establishing AD fingerprints to identify individuals at high risk of developing this disease. By contrast, cognitive fingerprints for incipient AD are virtually non-existent as diagnostics and outcomes measures are still focused on episodic memory deficits as the gold standard for AD, despite their low sensitivity and specificity for identifying at-risk individuals. This Review highlights a novel feature of cognitive evaluation for incipient AD by focusing on spatial navigation and orientation deficits, which are increasingly shown to be present in at-risk individuals. Importantly, the navigation system in the brain overlaps substantially with the regions affected by AD in both animal models and humans. Notably, spatial navigation has fewer verbal, cultural and educational biases than current cognitive tests and could enable a more uniform, global approach towards cognitive fingerprints of AD and better cognitive treatment outcome measures in future multicentre trials. The current Review appraises the available evidence for spatial navigation and/or orientation deficits in preclinical, prodromal and confirmed AD and identifies research gaps and future research priorities.

Cervical dystonia: Normal auditory mismatch negativity and abnormal somatosensory mismatch negativity

ObjectivePrevious electrophysiological and psychophysical tests have suggested that somatosensory integration is abnormal in dystonia. Here, we hypothesised that this abnormality could relate to a more general deficit in pre-attentive error/deviant detection in patients with dystonia. We therefore tested patients with dystonia and healthy subjects using a mismatch negativity paradigm (MMN), where evoked potentials generated in response to a standard repeated stimulus are subtracted from the responses to a rare “odd ball” stimulus. MethodsWe assessed MMN for somatosensory and auditory stimuli in patients with cervical dystonia and healthy age matched controls. ResultsWe found a significant group ∗ oddball type interaction effect (F (1, 34) = 4.5, p = 0.04, ρI = 0.63). A follow up independent t-test for sMMN data, showed a smaller sMMN amplitude in dystonic patients compared to controls (mean difference control-dystonia: −1.0 µV ± 0.3, p < 0.00, t = −3.1). However the amplitude of aMMN did not differ between groups (mean difference control-dystonia: −0.2 µV ± 0.2, p = 0.24, t = −1.2). We found a positive correlation between somatosensory MMN and somatosensory temporal discrimination threshold. ConclusionThese results suggest that pre-attentive error/deviant detection, specifically in the somatosensory domain, is abnormal in dystonia. This could underlie some previously reported electrophysiological and psychophysical abnormalities of somatosensory integration in dystonia. SignificanceOne could hypothesize a deficit in pre-conscious orientation towards potentially salient signals might lead to a more conservative threshold for decision-making in dystonia.

Postural and gait disorders in subacute stroke patients: Lateropulsion is the key

Postural disorders after stroke may be partly caused by a wrong referential of verticality, leading to a deficit in the upright orientation (lateropulsion). The part played by lateropulsion in the postural and gait disorders after stroke remained to be investigated. Cohort study of consecutive patients admitted in a neurorehabilitation ward after a first hemispheric stroke, from 2012 to 2017. Retrospective analysis of data collected at one month post-stroke (M1). Many deficits were assessed: spatial neglect, aphasia, apraxia, depression, visual field defect, motor weakness, spasticity, sensory loss, and lateropulsion with the SCP. Balance disorders were assessed with the PASS and gait disorders with the Lindmark Scale. Statistical analyses comprised uni and multivariate analyses. Descriptive data are given in the form median (first-third quartile). Hundred and seventy-eight persons met inclusion criteria: age 63.2 (12.2) years, 57 females, 150 with infarction, 71 with a right hemispheric stroke. At M1, 21 presented a pushing behavior (12%), among them 86% had a right hemisphere stroke. We run a Generalized Linear Model to explain postural and gait disorders by deficits. Lateropulsion was the primary deficit (body orientation) contributing to postural and gait disorders. The second one was weakness. In patients with a right hemisphere stroke, lateropulsion explained 90% of the variance of postural disorders (P < 0.001), and 65% of the variance of gait disorders (P < 0.001). Lateropulsion, which is a sign of biased representation of the vertical, is the primary cause of postural and gait disorders at the subacute phase. A greater attention should be focused on it assessment and rehabilitation.