Daniel Tranel

In some neurological syndromes, acquired personality disturbances are the veritable sine qua non of the condition. Several instruments have been used to evaluate personality changes, and to provide...

Background/Objectives: Cognitive impairment can compromise toothbrushing and other oral self-care functions, increasing the risk of oral diseases and related complications. However, how toothbrushing ability declines across stages of cognitive impairment remains unclear. This study aimed to describe functional deficits in toothbrushing among older adults with different levels of cognitive function. Method: Sixty-five older adults (14 cognitively healthy and 51 with documented cognitive impairment) were classified into five cognitive levels based on Standardized Mini-Mental State Examination scores. Participants completed a toothbrushing task as they normally would at home. Performance was videotaped, coded, and evaluated across four domains (task initiation, completion, thoroughness, and quality) with total scores reflecting overall toothbrushing ability. Overall performance, functional deficits, and assistance needs were analyzed in relation to cognitive levels. Results: Participants averaged 76.5 years of age. Toothbrushing ability declined gradually with worsening cognitive impairment, followed by a sharp deterioration at the profound stage (e.g., SMMSE ≤ 5). Compared with cognitively healthy participants (n = 14), those with mild cognitive impairment (MCI, n = 20) or mild (n = 10), moderate (n = 10), or severe dementia (n = 11) lost an average of 3%, 8%, 12%, and 37% of overall toothbrushing ability, respectively. Brushing efficiency declined earlier and more rapidly, decreasing by 13% in MCI and up to 46% in severe dementia (p < 0.001). All participants with MCI or mild dementia completed the task independently, whereas 20% with moderate dementia and 80% with severe dementia required assistance to initiate or complete the task. Conclusions: Overall toothbrushing ability remains relatively preserved until the later stages of cognitive impairment, but brushing quality deteriorates much earlier and quicker. These findings highlight the importance of early caregiver–patient partnerships, functionally tailored oral self-care rehabilitation, and personalized caregiver training to support oral hygiene among older adults with cognitive impairment.

Structured Objective: General cognitive ability (g), a latent variable derived from cognitive data, can predict life outcomes (e.g., educational attainment and occupational success) among neurologically healthy individuals. The value of g for predicting post-stroke functional outcomes is unknown. We addressed this gap here. Method: We derived g using exploratory structural equation modeling of 15 neuropsychological tests administered to 112 patients with stroke, 69 of whom also had functional outcome data (42 men; mean age = 53.23 years (SD = 10.54)). We used logistic regressions to compare g and individual tests in terms of their ability to predict the Functional Assessment Measure (FAM) and the Functional Independence Measure (FIM; motor and cognitive subscales) at 12 months post-stroke. Results: g was a statistically significant predictor of FAM ( X ² = 6.86, p = 0.013) and the cognitive ( X ² = 11.48, p = 0.002) but not motor FIM subscale ( X ² = 0.93, p = 0.154). Individual tests varied widely in terms of predictive utility ( X ² range: 0.07-21.03), with the most robust predictors being measures of visuospatial functions. Conclusions: Acute measures of cognition, including g, can predict functional independence 12 months after stroke. g and visuospatial ability measures were the most robust predictors. Statement of Research Significance: Research Question: General cognitive ability (or, g) is composite score based on scores on performance-based tests of cognition. In neurologically healthy people, g can predict long-term life outcomes. The value of g measured acutely after stroke for predicting functional outcomes one year later is unknown. We evaluated the utility of g for predicting post-stroke functional outcomes. Main Findings: A g factor based on neuropsychological test data collected from acute stroke patients was a statistically significant predictor of cognitive and psychosocial functional outcomes one year later. Lower g after stroke was linked to higher chance of needing functional assistance. Study Contributions: When neuropsychological test data are collected in the acute post-stroke period, it may be possible to derive a g factor score based on those data. Our findings suggest that this g factor score could help clinicians tailor treatment strategies to a patient’s expected long-term functional outcomes.

Lesion-deficit mapping is a premier technique for dissociating neural correlates of cognitive functions. However, the contribution of domain-general cognition (g) to the performance of virtually all complex behavioral tasks may encumber such efforts. This possibility has been largely unexplored. Here, we examined the influence of g in lesion-deficit mapping using a combination of structural equation modeling, lesion-behavior mapping (LBM), and structural (sLNM) and functional (fLNM) lesion network mapping. We modeled latent variables for visuospatial ability, processing speed, language, and anterograde memory among 473 patients with focal brain damage (age range 20-93, 257 men, 216 women), both with and without g-associated variance embedded within each factor. Lesion-deficit maps for domain-specific cognitive abilities were statistically significantly less spatially inter-correlated after partitioning out g (p = 0.010 for LBM; p = 0.003 for sLNM; p = 0.003 for fLNM). Lesion-deficit maps also implicated the existence of distinct neuroanatomy for specific cognitive domains that was, in many cases, only apparent and clearly distinct from lesion-deficit maps of g after partitioning out the influence of g. Overall, our findings suggest that, if left unaccounted for, domain-general cognitive variance could tangibly affect conclusions about the extent to which different cognitive functions rely on distinct neuroanatomy.

Religion and spirituality (R/S) may be associated with better cognitive health, yet most published studies have been conducted in primarily White populations without investigating association variations by gender and race. A cross-sectional analysis of 1041 community-dwelling diverse older adults from the Philadelphia Healthy Brain Aging (PHBA) cohort study was conducted using multiple regression analysis. We examined associations between facets of R/S and total cognitive scores and performed stratification analysis separately by gender and race to explore potential gender- and race-specific variations. Higher non-organizational R/S was associated with lower cognitive scores, while greater religious and spiritual coping was associated with higher cognitive scores, controlling for age, education, chronic conditions, race, and financial constraints. Across gender and race variations, non-organizational R/S was associated with lower cognitive scores in women alone, with no variations across race. Higher religious and spiritual coping was associated with higher cognitive scores in both Black and White women, but not men, while higher religious and spiritual healing was associated with lower cognitive scores in Black women only. Associations between religious and spiritual facets and cognitive health differ across gender and race; longitudinal studies are needed.

Objectives. Religion and spirituality (R/S) may be associated with better cognitive health, yet most published studies have been conducted in primarily White populations without investigating association variations by gender and race. Methods. A cross-sectional analysis of 1,041 community-dwelling diverse older adults from the Philadelphia Healthy Brain Aging (PHBA) cohort study was conducted using multiple regression analysis. We examined associations between facets of R/S and total cognitive scores and performed stratification analysis separately by gender and race to explore potential gender- and race-specific variations. Results. Higher non-organizational R/S was associated with lower cognitive scores while greater religious and spiritual coping was associated with higher cognitive scores, controlling for age, education, chronic conditions, race, and financial constraints. Across gender and race variations, non-organizational R/S was associated with lower cognitive scores in women alone with no variations across race. Higher religious and spiritual coping was associated with higher cognitive scores in both Black and White women, but not men, while higher religious and spiritual healing was associated with lower cognitive scores in Black women only. Discussion. Associations between religious and spiritual facets and cognitive health differ across gender and race; longitudinal studies are needed.

Identifying lesion sites associated with central poststroke pain (CPSP) may facilitate targeted screening for early symptoms, possibly even paving the way for preventive measures and earlier treatment initiation. Here, we test the hypothesis that damage to a nociceptive pathway extending from the brainstem to the cerebral cortex, and including white matter tracts, is associated with CPSP. We investigated the lesion locations of 72 patients with CPSP relative to poststroke comparison subjects without pain (n = 123), divided into a discovery and independent validation data set. The study included three main analyses: (1) we compared lesion intersection with our a priori region of interest (ROI) between groups with and without CPSP, (2) we performed lesion-symptom mapping to evaluate whether lesions associated with CPSP localize to the a priori ROI, and (3) we used lesion network mapping to infer the broader structural and functional connectivity patterns associated with CPSP lesions. CPSP lesions overlapped the nociceptive pathway ROI to a greater extent than comparison lesions. Lesion-symptom mapping identified a CPSP-associated region overlapping with the ventrocaudal thalamus and adjacent white matter, which was located mostly within the a priori ROI. Lesion network mapping demonstrated that lesions associated with CPSP disrupt nodes and tracts of the nociceptive pathway ROI. Interestingly, the CPSP lesion network results demonstrated connectivity to intereffector nodes of the primary motor cortex, providing a novel link between CPSP and the somato–cognitive action network. Together, these findings indicate that CPSP can be conceptualized as a lesion-associated network disruption of the nociceptive pathway and somato–cognitive action network.

Religious fundamentalism, characterized by rigid adherence to a set of beliefs putatively revealing inerrant truths, is ubiquitous across cultures and has a global impact on society. Understanding the psychological and neurobiological processes producing religious fundamentalism may inform a variety of scientific, sociological, and cultural questions. Research indicates that brain damage can alter religious fundamentalism. However, the precise brain regions involved with these changes remain unknown. Here, we analyzed brain lesions associated with varying levels of religious fundamentalism in two large datasets from independent laboratories. Lesions associated with greater fundamentalism were connected to a specific brain network with nodes in the right orbitofrontal, dorsolateral prefrontal, and inferior parietal lobe. This fundamentalism network was strongly right hemisphere lateralized and highly reproducible across the independent datasets ( r = 0.82) with cross-validations between datasets. To explore the relationship of this network to lesions previously studied by our group, we tested for similarities to twenty-one lesion-associated conditions. Lesions associated with confabulation and criminal behavior showed a similar connectivity pattern as lesions associated with greater fundamentalism. Moreover, lesions associated with poststroke pain showed a similar connectivity pattern as lesions associated with lower fundamentalism. These findings are consistent with the current understanding of hemispheric specializations for reasoning and lend insight into previously observed epidemiological associations with fundamentalism, such as cognitive rigidity and outgroup hostility.

Models of human categorization predict the prefrontal cortex (PFC) serves a central role in category learning. The dorsolateral prefrontal cortex (dlPFC) and ventromedial prefrontal cortex (vmPFC) have been implicated in categorization; however, it is unclear whether both are critical for categorization and whether they support unique functions. We administered three categorization tasks to patients with PFC lesions (mean age, 69.6 years; 5 men, 5 women) to examine how the prefrontal subregions contribute to categorization. These included a rule-based (RB) task that was solved via a unidimensional rule, an information integration (II) task that was solved by combining information from two stimulus dimensions, and a deterministic/probabilistic (DP) task with stimulus features that had varying amounts of category-predictive information. Compared with healthy comparison participants, both patient groups had impaired performance. Impairments in the dlPFC patients were largest during the RB task, whereas impairments in the vmPFC patients were largest during the DP task. A hierarchical model was fit to the participants’ data to assess learning deficits in the patient groups. PFC damage was correlated with a regularization term that limited updates to attention after each trial. Our results suggest that the PFC, as a whole, is important for learning to orient attention to relevant stimulus information. The dlPFC may be especially important for rule-based learning, whereas the vmPFC may be important for focusing attention on deterministic (highly diagnostic) features and ignoring less predictive features. These results support overarching functions of the dlPFC in executive functioning and the vmPFC in value-based decision-making.