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Cognitive and behavioural deficits associated with the orbitomedial prefrontal cortex in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis, a progressive disease affecting motor neurons, may variably affect cognition and behaviour. We tested the hypothesis that functions associated with orbitomedial prefrontal cortex are affected by evaluating the behavioural and cognitive performance of 18 participants with amyotrophic lateral sclerosis without dementia and 18 healthy, matched controls. We measured Theory of Mind (Faux Pas Task), emotional prosody recognition (Aprosodia Battery), reversal of behaviour in response to changes in reward (Probabilistic Reversal Learning Task), decision making without risk (Holiday Apartment Task) and aberrant behaviour (Neuropsychiatric Inventory). We also assessed dorsolateral prefrontal function, using verbal and written fluency and planning (One-touch Stockings of Cambridge), to determine whether impairments in tasks sensitive to these two prefrontal regions co-occur. The patient group was significantly impaired at identifying social faux pas, recognizing emotions and decision-making, indicating mild, but consistent impairment on most measures sensitive to orbitomedial prefrontal cortex. Significant levels of aberrant behaviour were present in 50% of patients. Patients were also impaired on verbal fluency and planning. Individual subject analyses involved computing classical dissociations between tasks sensitive to different prefrontal regions. These revealed heterogeneous patterns of impaired and spared cognitive abilities: 33% of participants had classical dissociations involving orbitomedial prefrontal tasks, 17% had classical dissociations involving dorsolateral prefrontal tasks, 22% had classical dissociations between tasks of both regions, and 28% had no classical dissociations. These data indicate subtle changes in behaviour, emotional processing, decision-making and altered social awareness, associated with orbitomedial prefrontal cortex, may be present in a significant proportion of individuals with amyotrophic lateral sclerosis without dementia, some with no signs of dysfunction in tasks sensitive to other regions of prefrontal cortex. This demonstration of variability in cognitive integrity supports previous research indicating amyotrophic lateral sclerosis is a heterogeneous disease.

from Brain

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Unintended effects of memory on decision making: A breakdown in access control

A hybrid evaluative-conditioning/source-monitoring paradigm is put forward as an alternative to the standard evaluative-conditioning paradigm. The first experiment paired brand names with a small number of attractive or unattractive female faces and used a likeability rating task as well as a source monitoring task. The second experiment paired words which differed along a masculine–feminine dimension with male and female faces, and used a speeded judgment about whether words were stereotypically masculine or feminine. The third experiment paired words that differed along an active–inactive dimension with male and female faces and used a variation of the Implicit Association Test where judgments about whether words were active or inactive were mixed with judgments about whether faces were male or female. In all three experiments, we observed transfer between the recently acquired information and the judgment task. In addition, the three experiments progressively reduce the probability of demand characteristics. We explain the results in this paradigm, and in many other paradigms, as a breakdown in access control. We also point to several similarities between existing theories of evaluative conditioning and memory phenomena/theories that have gone unnoticed in the evaluative conditioning literature.

from the Journal of Memory and Language

Evaluation of Social Work Communication Skills to Allow People with Aphasia to be Part of the Decision Making Process in Healthcare.

The purpose of this paper is to examine how social workers are trained to interact with individuals with communication barriers in healthcare. Consent to treatment and the right to decide upon a discharge destination are enshrined in law. However, barriers such as aphasia (a communication disorder commonly resulting from a stroke) can mask competency and exclude people from the decision making process. Social workers play a vital role in the healthcare system, providing advocacy, case management, counselling, addressing capacity and assessing the patient as a whole person. But they need to be taught specialized communication skills to carry out this complex role with individuals with aphasia. A literature search and survey of universities revealed that the majority of training in supported communication is taking place in the field and driven by aphasia centres. But does the training meet the needs of social workers and their patients with aphasia, especially when someone needs a healing conversation? Results from two pilot projects show that teaching a set of skills is not sufficient; adaptation of present communication techniques is also needed to ensure that the human worth and dignity of those with communication barriers is maintained and human rights in healthcare are being met.

from Social Work Education

Evaluation of Social Work Communication Skills to Allow People with Aphasia to be Part of the Decision Making Process in Healthcare

The purpose of this paper is to examine how social workers are trained to interact with individuals with communication barriers in healthcare. Consent to treatment and the right to decide upon a discharge destination are enshrined in law. However, barriers such as aphasia (a communication disorder commonly resulting from a stroke) can mask competency and exclude people from the decision making process. Social workers play a vital role in the healthcare system, providing advocacy, case management, counselling, addressing capacity and assessing the patient as a whole person. But they need to be taught specialized communication skills to carry out this complex role with individuals with aphasia. A literature search and survey of universities revealed that the majority of training in supported communication is taking place in the field and driven by aphasia centres. But does the training meet the needs of social workers and their patients with aphasia, especially when someone needs a healing conversation? Results from two pilot projects show that teaching a set of skills is not sufficient; adaptation of present communication techniques is also needed to ensure that the human worth and dignity of those with communication barriers is maintained and human rights in healthcare are being met. [ABSTRACT FROM AUTHOR]

from Social Work Education

An assessment of parents’ decision-making regarding paediatric cochlear implants

Parents of children with severe to profound hearing loss have to make a number of fundamental decisions for their children. These decisions include communication and amplification options. In particular, the parents must decide whether and when their child will receive cochlear implants, and whether these will be implanted unilaterally or bilaterally. The objective of this study was to describe the decision-making needs of parents making the cochlear implant decision for their children. Semi-structured interviews were conducted with eight parents and eight cochlear implant team members at a Canadian cochlear implant centre to document parental and clinician recollections and opinions of the decision-making process related to a unilateral or bilateral cochlear implantation. The results demonstrated that the decision to go ahead with a cochlear implantation was consistently based on the parents’ preferences for spoken communication for their children. Parents reported satisfaction with the cochlear implant decision-making process. Two of eight parents felt that additional information on unilateral cochlear implantation risks and benefits should have been provided. Four of eight parents described how more information on the experiences of other families would have been helpful for their decision. Parental and clinical perceptions of the bilateral implantation decision were highly variable. All parents stated that additional information on bilateral cochlear implantation was needed. Based on the results of the interviews, it is concluded that there is a need for information and resources for bilateral cochlear implantation decision-making.

from the Canadian Journal of Speech-Language Pathology and Audiology

The Anterior Midline Field: Coercion or decision making?

from Brain and Language

To study the neural bases of semantic composition in language processing without confounds from syntactic composition, recent magnetoencephalography (MEG) studies have investigated the processing of constructions that exhibit some type of syntax-semantics mismatch. The most studied case of such a mismatch is complement coercion; expressions such as the author began the book, where an entity-denoting noun phrase is coerced into an eventive meaning in order to match the semantic properties of the event-selecting verb (e.g., ‘the author began reading/writing the book’). These expressions have been found to elicit increased activity in the Anterior Midline Field (AMF), an MEG component elicited at frontomedial sensors at 400 ms after the onset of the coercing noun [Pylkkänen, L., & McElree, B. (2007). An MEG study of silent meaning. Journal of Cognitive Neuroscience, 19, 11]. Thus, the AMF constitutes a potential neural correlate of coercion. However, the AMF was generated in ventromedial prefrontal regions, which are heavily associated with decision-making. This raises the possibility that, instead of semantic processing, the AMF effect may have been related to the experimental task, which was a sensicality judgment. We tested this hypothesis by assessing the effect of coercion when subjects were simply reading for comprehension, without a decision-task. Additionally, we investigated coercion in an adjectival rather than a verbal environment to further generalize the findings. Our results show that an AMF effect of coercion is elicited without a decision-task and that the effect also extends to this novel syntactic environment. We conclude that in addition to its role in non-linguistic higher cognition, ventromedial prefrontal regions contribute to the resolution of syntax-semantics mismatches in language processing.