Jacoba M. Spikman

This systematic review examines the relationship between social cognition (SC) and social behavior in patients with neurodegenerative diseases. Social behavioral changes impact both patients and caregivers, contributing to increased caregiver burden and institutionalization risks. SC impairments are common in different neurodegenerative diseases and are assumed to underlie social behavioral changes. However, it has not been systematically investigated how SC and social behavior relate to each other, over all neurodegenerative patient groups. A systematic search was performed in the PubMed and PsycINFO databases from inception and extraction up to September 5th, 2023. Analyzing 21 studies, including assessment of the relationship between SC and social behavior with performance-based measures for SC and proxy ratings of social behavior, little evidence was found for a consistent association between SC impairments and social behavior. Weak associations were identified between better emotion recognition and fewer behavioral symptoms r = -.23 CI [-0.42, -0.02] and better emotion recognition and less apathy symptoms r = -.24 CI [-0.46, 0.01]. Disinhibition was more frequently associated with SC aspects than agitation or irritability. Furthermore, affective theory of mind (ToM) was more often associated with social behavior than cognitive ToM. However, the heterogeneity between studies with regard to what aspects of SC and social behavior were measured and with what instruments, and the low number of studies, limit definitive conclusions. This review underscores the need for future research employing standardized, reliable, and ecologically valid measures to more accurately assess the assumed association between SC and social behavior in neurodegenerative diseases.

Objective: Social cognition, particularly emotion recognition, can be impaired in neurological disorders involving brain damage and neurocognitive deficits. However, it remains unclear whether distinctive profiles of social versus general cognitive impairments exist across neurological patient groups: moderate–severe traumatic brain injury (mod–sevTBI), acute ischaemic stroke (AIS), aneurysmal subarachnoid haemorrhage (aSAH), frontal low-grade glioma (LGG), advanced Parkinson’s disease (PD), and behavioural variant frontotemporal dementia (bvFTD). Methods: Data were obtained from scientific studies and clinical records in four Dutch research centres. Neuropsychological testing included emotion recognition [Eckman 60-Faces test (EFT): total score and subscores], memory [Dutch Rey Auditory Verbal Learning Test (DRAVLT): encoding and retrieval], information processing speed, and cognitive control (Trail Making Test A and B). Scores were transformed into Z-scores using normative data and compared across groups. Results: Included were 710 patients: 118 mod-sevTBI, 93 AIS, 121 aSAH, 100 LGG, 147 PD, 131 bvFTD. EFT-total was impaired in all groups ( p < .001), with significant group differences (F(5,704) = 30.8, p < .001). Emotion recognition was the most severely affected domain in bvFTD, mod-sevTBI, AIS, and LGG. Only bvFTD and mod-sevTBI showed impairments in specific emotions, mainly sadness and fear. MANOVA showed overall group differences in general cognition (Wilks’ Lambda = .69, p < .001). Memory encoding was impaired in all groups, but retrieval in none. Information processing speed and cognitive control were impaired only in bvFTD, mod-sevTBI, AIS, and PD. Interpretation: Emotion recognition is significantly affected across six neurological patient groups, with distinct profiles relative to general cognition. These findings support tailored neuropsychological assessment in clinical practice.

Background: While most people fully recover after mild traumatic brain injury (mTBI), a substantial minority experience persistent symptoms and incomplete recovery. This may be prevented by early interventions specifically targeting patients at risk of incomplete recovery. The UPFRONT‐model was developed to identify patients at risk of poor functional outcome. This study aimed to externally validate the UPFRONT‐model in an independent sample. Methods: A prospective, longitudinal, multicenter cohort study with 126 mTBI patients recruited from emergency and neurology departments (ED) of six hospitals in the Netherlands was performed. Predictors in the UPFRONT‐model included educational level, Glasgow Coma Scale (GCS), neck pain at injury, alcohol intoxication, Post Traumatic Amnesia (PTA), pre‐injury mental health, anxiety, depression, coping, and the number and severity of post‐traumatic complaints. Functional recovery at 6 months was assessed using the Glasgow Outcome Scale Extended (GOS‐E). The external validity of the UPRFONT model was assessed with measures of calibration and discrimination. Results: The model showed acceptable discriminative ability (AUC = 0.74), comparable to the development sample (AUC = 0.77). However, calibration revealed systematic underestimation of recovery (predicted: 46%; observed: 75%), with a calibration intercept of 1.52 and a slope of 0.70. Despite differences in some predictor effects, psychological variables were robust and consistent across samples. Conclusion: The UPFRONT‐model demonstrated solid discriminative performance in an external cohort, but tended to underestimate the likelihood of complete recovery. Further validation and optimization are needed before clinical implementation. The model holds promise for early identification of at‐risk patients, enabling targeted interventions following mTBI.

Introduction: Patients with a history of acute Acquired Brain Injury (ABI), including traumatic brain injury and stroke, will encounter the consequences of aging and its concomitant cognitive decline, which might result in a decline of participation level. This study aimed to assess the long-term clinical profile and participation level course in a large cohort of aging ABI patients. Methods: Multi-center observational study (BRAIN-ReADAPT study), recruiting 550 patients aged 50–68 years, at least five years post-ABI. Current participation levels were compared to levels post-ABI to assess the participation level course. Cognitive complaints and psychological factors were measured by validated questionnaires. With group comparisons and regression analyses the influence of demographic and injury-related factors were examined. Results: A decline in participation level was reported by 43% independent of age, sex, type and severity of ABI or injury chronicity. Patients experiencing this decline reported more cognitive complaints (especially mental slowness, memory, concentration difficulties) and experienced higher levels of fatigue and emotional distress, with lower resilience. No difference in current participation level was present between groups, although more restrictions and less satisfaction with participation were reported when a decline in participation was present. Conclusions: A substantial proportion of aging ABI patients experience a secondary decline in participation. This phenomenon is referred to as the post-ABI effect . This effect is not associated with demographic or injury-related characteristics, but resilience might be a mitigating factor. Greater awareness in clinical practice of this post-ABI effect is needed to identify potential targets for treatment to cope with this effect.

Objective: Impairments in social interaction are common symptoms of dementia and necessitate the use of validated neuropsychological instruments to measure social cognition. We aim to investigate the Hinting Task – Dutch version (HT-NL), which measures the ability to infer intentions behind indirect speech to assess Theory of Mind, in dementia. Method: Sixty-six patients with dementia, of whom 22 had behavioral variant frontotemporal dementia (bvFTD), 21 had primary progressive aphasia, and 23 had Alzheimer’s disease (AD), and 99 healthy control participants were included. We examined the HT-NL’s psychometric properties, including internal consistency, between-group differences using analyses of covariance with Bonferroni-adjusted post hoc comparisons, discriminative ability and concurrent validity using the area under the receiver operating characteristic curve (AUC), and construct validity using Spearman rank correlations with other cognitive tests. Results: Internal consistency was acceptable (Cronbach’s α = 0.74). All patient groups scored lower on the HT-NL than the control group. Patients with bvFTD scored lower than patients with AD dementia. The HT-NL showed excellent discriminative ability (AUC = 0.83), comparable to a test of emotion recognition (ΔAUC = 0.03, p = .67). The HT-NL correlated significantly with a test for emotion recognition ( r = .45), and with measures of memory and language ( r = [.31, .40]), but not with measures of information processing speed, executive functioning, or working memory ( r = [.00, .17]). Preliminary normative data are provided. Conclusions: The HT-NL is a psychometrically sound and valid instrument and is useful for identifying Theory of Mind impairments in patients with dementia.

Background: Diffusion weighted imaging (DWI) is used for monitoring purposes for lower-grade glioma (LGG). While the apparent diffusion coefficient (ADC) is clinically used, various DWI models have been developed to better understand the micro-environment. However, the validity of these models and how they relate to each other is currently unknown. Therefore, this study assesses the validity and agreement of these models. Methods: Fourteen post-treatment LGG patients and six healthy controls (HC) underwent DWI MRI on a 3T MRI scanner. DWI processing included diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), white matter tract integrity (WMTI), neurite orientation dispersion and density imaging (NODDI), and fixel-based analysis (FBA). Validity was assessed by delineating surgical cavity, peri-surgical cavity, and normal-appearing white matter (NAWM) in LGG patients, and white matter (WM) in HC. Spearman correlation assessed the agreement between DWI parameters. Results: All obtained parameters differed significantly across tissue types. Remarkably, WMTI showed that intra-axonal diffusivity was high in the surgical cavity and low in NAWM and WM. Most DWI parameters correlated well with each other, except for WMTI-derived intra-axonal diffusivity. Conclusion: This study shows that all parameters relevant for tumour monitoring and DWI-derived parameters for axonal fibre-bundle integrity (except WMTI-IAS-D_a) could be used interchangeably, enhancing inter-DWI model interpretability.

Purpose: Diffuse low-grade gliomas (dLGG) often have a frontal location, which may negatively affect patients’ executive functions (EF). Being diagnosed with dLGG and having to undergo intensive treatment can be emotionally stressful. The ability to cope with this stress in an adaptive, active and flexible way may be hampered by impaired EF. Consequently, patients may suffer from increased mental distress. The aim of the present study was to explore profiles of EF, coping and mental distress and identify characteristics of each profile. Methods: 151 patients with dLGG were included. Latent profile analysis (LPA) was used to explore profiles. Additional demographical, tumor and radiological characteristics were included. Results: Four clusters were found: 1) overall good functioning (25% of patients); 2) poor executive functioning, good psychosocial functioning (32%); 3) good executive functioning, poor psychosocial functioning (18%) and; 4) overall poor functioning (25%). Characteristics of the different clusters were lower educational level and more (micro)vascular brain damage (cluster 2), a younger age (cluster 3), and a larger tumor volume (cluster 4). EF was not a distinctive factor for coping, nor was it for mental distress. Maladaptive coping, however, did distinguish clusters with higher mental distress (cluster 3 and 4) from clusters with lower levels of mental distress (cluster 1 and 2). Conclusion: Four distinctive clusters with different levels of functioning and characteristics were identified. EF impairments did not hinder the use of active coping strategies. Moreover, maladaptive coping, but not EF impairment, was related to increased mental distress in patients with dLGG.

Background: Older adults (OAs) with mild traumatic brain injury (OA-mTBI) are a growing population, but studies on long-term outcomes and quality of life are scarce. Our aim was to determine the health-related quality of life (HRQoL) in OA-mTBI one year after injury and to assess the early predictors of HRQoL. Methods: Data from a prospective follow-up study of 164 older (≥60 years) and 289 younger mTBI patients (p = 0.72). Incomplete recovery (GOSE p = 0.01). In the multivariable analyses, only depression-related symptoms (OR = 1.20 for each symptom, 95% CI = 1.01–1.34, p < 0.01) were predictors of poor HRQoL in OA-mTBI. Conclusions: Similar to younger patients, most OA-mTBI rated their HRQoL as good at one year after injury, although a considerable proportion showed incomplete recovery according to the GOSE, suggesting a disability paradox. Depression-related symptoms emerged as a significant predictor for poor HRQoL and can be identified as an early target for treatment after mTBI.

Angiographically negative subarachnoid hemorrhage (anSAH) has traditionally been considered a benign condition, mainly because of favorable outcomes in the acute stage in comparison to the often negative acute outcomes of aneurysmal subarachnoid hemorrhage. However, a growing body of research in recent years shows that anSAH often leads to cognitive impairments, emotional distress, and difficulties in resuming work or other daily life activities. Therefore, in this position paper, we call for a change in neurological care and a shift in patient communication, emphasizing the importance of addressing patient needs and fostering realistic expectations rather than solely focusing on the benign nature of the condition.