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Consciousness, Memory, and the Human Self: Commentary on "Consciousness as a Memory System" by Budson et al (2022). 意识、记忆和人类自我:布德森等人(2022)对“作为记忆系统的意识”的评论。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000330
Amnon Dafni-Merom, Shahar Arzy

Philosophical theories have attempted to shed light on the intricate relationships between consciousness and memory since long before this became a major theme in psychology and neuroscience. In the December 2022 issue of Cognitive and Behavioral Neurology , Budson, Richman, and Kensinger (2022) introduced a comprehensive theoretical framework pertaining to the origins of consciousness in relation to the memory system, its implications on our real-time perception of the world, and the neuroanatomical correlates underlying these phenomena. Throughout their paper, Budson et al (2022) focus on their theory's explanatory value regarding several clinical syndromes and experimental findings. In this commentary, we first summarize the theory presented by Budson and colleagues (2022). Then, we suggest a complementary approach of studying the relationships between consciousness and memory through the concept of the human self and its protracted representation through time (so-called mental time travel). Finally, we elaborate on Budson and colleagues' (2022) neuroanatomical explanation to their theory and suggest that adding the concepts of brain networks and cortical gradients may contribute to their theory's interpretability.

早在意识和记忆成为心理学和神经科学的主要主题之前,哲学理论就试图阐明意识和记忆之间的复杂关系。在2022年12月出版的《认知与行为神经病学》杂志上,Budson、Richman和Kensinger(2022)介绍了一个全面的理论框架,涉及意识与记忆系统的起源、它对我们对世界的实时感知的影响,以及这些现象背后的神经解剖学相关性。在他们的论文中,Budson等人(2022)专注于他们的理论对几种临床综合征和实验结果的解释价值。在这篇评论中,我们首先总结了Budson及其同事(2022)提出的理论。然后,我们提出了一种互补的方法,通过人类自我的概念及其在时间中的持久表征来研究意识和记忆之间的关系(所谓的心理时间旅行)。最后,我们详细阐述了Budson及其同事(2022)对他们理论的神经解剖学解释,并认为添加大脑网络和皮层梯度的概念可能有助于他们理论的可解释性。
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引用次数: 0
Cognitive and Behavioral Neurology thanks these reviewers for their invaluable service during 2022. 认知与行为神经病学感谢这些评审员在2022年提供的宝贵服务。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000335
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引用次数: 0
A Functional and Neuroanatomical Model of Dehumanization. 去人性化的功能和神经解剖学模型。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000316
Mario F Mendez

The dehumanization of others is a major scourge of mankind; however, despite its significance, physicians have little understanding of the neurobiological mechanisms for this behavior. We can learn much about dehumanization from its brain-behavior localization and its manifestations in people with brain disorders. Dehumanization as an act of denying to others human qualities includes two major forms. Animalistic dehumanization (also called infrahumanization) results from increased inhibition of prepotent tendencies for emotional feelings and empathy for others. The mechanism may be increased activity in the inferior frontal gyrus. In contrast, mechanistic dehumanization results from a loss of perception of basic human nature and decreased mind-attribution. The mechanism may be hypofunction of a mentalization network centered in the ventromedial prefrontal cortex and adjacent subgenual anterior cingulate cortex. Whereas developmental factors may promote animalistic dehumanization, brain disorders, such as frontotemporal dementia, primarily promote mechanistic dehumanization. The consideration of these two processes as distinct, with different neurobiological origins, could help guide efforts to mitigate expression of this behavior.

对他人的非人化是人类的一大祸害;然而,尽管其意义重大,但医生对这种行为的神经生物学机制知之甚少。我们可以从其大脑行为定位及其在大脑疾病患者中的表现中学到很多关于非人化的知识。去人性化作为一种否定他人人格的行为,包括两种主要形式。动物的非人化(也称为非人性化)是由于对情感和对他人同理心的偏好倾向的抑制加剧。其机制可能是额下回活动增加。相反,机械化的非人化是对基本人性的感知丧失和心理归因减少的结果。其机制可能是以腹内侧前额叶皮层和邻近的亚属前扣带皮层为中心的心理化网络功能低下。虽然发育因素可能会促进动物的非人化,但大脑疾病,如额颞叶痴呆,主要促进机械的非人化。将这两个过程视为不同的、具有不同神经生物学起源的过程,可能有助于指导减轻这种行为表达的努力。
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引用次数: 0
Considering Individuals' Hearing Ability Before Administering Cognitive Assessments. 在进行认知评估之前考虑个人的听力。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000328
Bella Brown-Quigley, Laura Gaeta

Sensory impairments such as age-related hearing loss and poor eyesight have been associated with a negative impact on cognitive screening test scores. Many researchers use cognitive tests and consider factors such as vision and cardiac issues but do not account for hearing loss. We reviewed published literature in the field of gerontology to determine if hearing loss was considered in human subjects research that involved the administration of a cognitive battery or screening test. We present evidence for the need to consider hearing loss when administering cognitive screening tests, as well as recommendations for practitioners and researchers.

与年龄相关的听力损失和视力差等感官障碍与认知筛查测试成绩的负面影响有关。许多研究人员使用认知测试,并考虑视力和心脏问题等因素,但没有考虑听力损失。我们回顾了老年病学领域已发表的文献,以确定在涉及认知电池或筛查测试的人类受试者研究中是否考虑了听力损失。我们提出了在进行认知筛查测试时需要考虑听力损失的证据,并为从业者和研究人员提出了建议。
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引用次数: 0
Preliminary Validation Study of the French-Quebec Version of the Mild Behavioral Impairment Checklist. 法国魁北克版轻度行为障碍检查表的初步验证研究。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000321
Émilie Pépin, Noémie Tanguay, Marie-Pier Roy, Joël Macoir, Marie-Andrée Bruneau, Zahinoor Ismail, Carol Hudon

Background: Alzheimer disease dementia may be preceded by cognitive stages during which behavioral and psychological changes can occur. More precisely, behavioral symptoms may be observed during the subjective cognitive decline (SCD) or the mild cognitive impairment (MCI) stages; these symptoms can be measured using the Mild Behavioral Impairment Checklist (MBI-C).

Objective: To validate the French-Quebec version of the MBI-C in individuals ages 60-85 years.

Method: The sample included 60 participants (20 MCI, 20 SCD, 20 cognitively healthy) and their informants. To assess the discriminant validity of the MBI-C, a Kruskal-Wallis analysis with a multiple comparisons test was performed on the MBI-C Total score. To determine convergent validity, Spearman correlations were calculated between the MBI-C subscales and a set of validation tools. Finally, test-retest reliability was assessed with Spearman correlations of MBI-C scores between two test sessions.

Results: All of the analyses indicated satisfactory psychometric properties for the French-Quebec version of the MBI-C.

Conclusion: This validation study reveals that the MBI-C can be used successfully in dementia risk assessments. From now on, the use of a validated MBI-C will be possible in the French-Quebec population.

背景:阿尔茨海默病痴呆之前可能有认知阶段,在此期间可能会发生行为和心理变化。更确切地说,行为症状可以在主观认知能力下降(SCD)或轻度认知障碍(MCI)阶段观察到;这些症状可以使用轻度行为障碍检查表(MBI-C)进行测量。目的:在60-85岁的人群中验证法国魁北克版的MBI-C。方法:样本包括60名参与者(20名MCI,20名SCD,20名认知健康)及其信息提供者。为了评估MBI-C的判别有效性,对MBI-C总分进行了Kruskal-Wallis分析和多重比较测试。为了确定收敛有效性,计算了MBI-C分量表和一组验证工具之间的Spearman相关性。最后,通过两次测试之间MBI-C分数的Spearman相关性来评估重测的可靠性。结果:所有分析均表明法国魁北克版MBI-C具有令人满意的心理测量特性。结论:本验证研究表明,MBI-C可成功用于痴呆风险评估。从现在起,经过验证的MBI-C将有可能在法国魁北克省人群中使用。
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引用次数: 1
Occurrence and Severity of Suicidal Ideation in Adults With Neurofibromatosis Participating in a Mind-Body RCT. 参加身心随机对照试验的神经纤维瘤病成年人自杀意念的发生率和严重程度。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000332
Ethan G Lester, Katherine E Wang, Jaishri O Blakeley, Ana-Maria Vranceanu

Background: Emotional distress can lead to suicidal ideation and potentially suicide completion, yet there is very little literature on suicidal ideation in individuals with a diagnosis of neurofibromatosis (NF; NF1, NF2, and schwannomatosis).

Objective: To examine the baseline occurrence, severity, and clinical correlates of suicidal ideation in adults with NF.

Method: Individuals with NF (N = 220) completed assessments measuring depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), perceived stress (Perceived Stress Scale-10), pain (Graded Chronic Pain Scale and PROMIS Pain Interference Short Form 8a), and general quality of life (World Health Organization Quality of Life-Brief version) before beginning a two-arm, single-blind randomized control trial of a live-video mind-body program for stress management and resiliency.

Results: Nineteen percent (n = 42) of the individuals experienced suicidal ideation (ie, >0; ideation present several days or greater). More individuals with NF2 experienced suicidal ideation compared with those with NF1 or schwannomatosis. All of the clinical variables except pain intensity were significantly correlated ( P < 0.01) with greater suicidal ideation. Suicidal ideation in individuals with NF was comparable to or higher than that in other medical populations (eg, cancer, dermatological, neurologic). Depression and poor psychological quality of life significantly increased the risk for suicidal ideation.

Conclusion: Suicidal ideation was relatively prevalent in individuals with NF seeking participation in a mind-body randomized controlled trial. NF clinicians should be prepared to discuss these concerns and provide resources when suicidal ideation is present.

Clinical trial registration: ClinicalTrials.gov (Identifier NCT03406208).

背景:情绪困扰会导致自杀意念和潜在的自杀完成,但关于神经纤维瘤病(NF;NF1、NF2和神经鞘瘤病)患者自杀意念的文献很少,以及患有NF的成年人自杀意念的临床相关性。方法:患有NF的个体(N=220)完成了测量抑郁(患者健康问卷-9)、焦虑(广泛性焦虑障碍-7)、感知压力(感知压力量表-10)、疼痛(分级慢性疼痛量表和PROMIS疼痛干扰简表8a),和一般生活质量(世界卫生组织生活质量简报版),然后开始一项用于压力管理和恢复的实时视频身心计划的双臂、单盲随机对照试验。结果:19%(n=42)的个体有自杀意念(即>0;意念出现数天或更长时间)。与NF1或神经鞘瘤病患者相比,更多的NF2患者出现自杀意念。除疼痛强度外,所有临床变量均与较大的自杀意念显著相关(P<0.01)。NF患者的自杀念头与其他医学人群(如癌症、皮肤科、神经科)相当或更高。抑郁症和不良的心理生活质量显著增加了产生自杀意念的风险。结论:在寻求参与身心随机对照试验的NF患者中,自杀意念相对普遍。NF临床医生应准备好讨论这些问题,并在出现自杀意念时提供资源。临床试验注册:ClinicalTrials.gov(标识符NCT03406208)。
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引用次数: 0
Commentary on "Consciousness as a Memory System" by Budson, Richman, and Kensinger (2022). 布德森、里奇曼和肯辛格对“作为记忆系统的意识”的评论(2022)。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000326
Howard S Kirshner

Consciouness is a phenomenon that has eluded explanation by generations of physicians and scientists. Many discussions, experiments, and theories about consciousness have been published, but none has adequately explained the phenomenon. In the previous issue, Budson and colleagues (2022) present a theory of consciousness based on explicit memory processes, with consciousness developing in the context of memory function. In the authors' view, consciousness accompanying other cortical processes such as language or visual-spatial function developed only later in evolution. The evidence presented for this evolutionary sequence, however, is very limited. Furthermore, no discussion is directed toward the theory that consciousness involves the intersection between external perceptions and internal bodily states. The authors also develop the concept that most of our actions, and even our personality, are conscious only after the fact; immediate decisions are taken by the unconscious mind-the "horse" rather than the "rider." There is empirical evidence that rapid decisions and responses occur before they become conscious. However, Budson and colleagues (2022) extend the concept of unconscious decision-making to virtually all actions; in so doing, not only do they minimize the phenomenon of self-conscious awareness, but their theory has disturbing ethical implications for personal responsibility, criminal law, free will, and personality.

一代又一代的医生和科学家都无法解释这种现象。许多关于意识的讨论、实验和理论已经发表,但没有一个能充分解释这一现象。在上一期中,Budson及其同事(2022)提出了一种基于外显记忆过程的意识理论,意识在记忆功能的背景下发展。在作者看来,伴随其他皮层过程(如语言或视觉空间功能)的意识是在进化后期才发展起来的。然而,关于这一进化序列的证据非常有限。此外,没有针对意识涉及外部感知和内部身体状态之间交叉的理论进行讨论。作者还提出了一个概念,即我们的大多数行为,甚至我们的个性,都是在事后才有意识的;即时的决定是由无意识的头脑——“马”而不是“骑手”——做出的。有经验证据表明,快速的决定和反应发生在他们意识到之前。然而,Budson及其同事(2022)将无意识决策的概念扩展到几乎所有的行动;在这样做的过程中,他们不仅最大限度地减少了自我意识的现象,而且他们的理论对个人责任、刑法、自由意志和人格都有着令人不安的伦理含义。
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引用次数: 1
Blurred Lines: Memory, Perceptions, and Consciousness: Commentary on "Consciousness as a Memory System" by Budson et al (2022). 模糊的线条:记忆、感知和意识:布德森等人对“意识作为记忆系统”的评论(2022)。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2023-03-01 DOI: 10.1097/WNN.0000000000000325
Hinze Hogendoorn

In the previous issue, Budson, Richman, and Kensinger (2022) put forth the intriguing proposal that consciousness may have evolved from the episodic memory system. In addition to providing a possible evolutionary trajectory for consciousness, I believe that viewing consciousness as an extension of memory in this way is particularly useful for understanding some of the puzzling temporal complexities that are inherent to consciousness. For example, due to neural transmission delays, our conscious experience must necessarily lag the outside world, which creates a paradox for both conscious perception (Do we see the past, rather than the present?) and action (How can we make rapid decisions if it takes so long to become conscious of something?). These paradoxes can be elegantly solved by treating consciousness as a memory system. Finally, the proposal put forth by Budson and colleagues (2022) aligns with the emerging perspective that consciousness, like memory, represents a narrative time line of events rather than any single instant. However, I believe that this conceptualization can be further extended to include not only the past, but also the future. In this way, consciousness can be provocatively viewed as the remembered past, present, and future.

在上一期中,Budson、Richman和Kensinger(2022)提出了一个有趣的建议,即意识可能是从情节记忆系统进化而来的。除了为意识提供一个可能的进化轨迹外,我相信以这种方式将意识视为记忆的延伸,对于理解意识固有的一些令人困惑的时间复杂性特别有用。例如,由于神经传递延迟,我们的意识体验必然滞后于外部世界,这就给意识感知(我们看到的是过去,而不是现在吗?)和行动(如果意识到某件事需要这么长时间,我们如何快速做出决定?)带来了悖论。这些悖论可以通过将意识视为一个记忆系统来优雅地解决。最后,Budson及其同事(2022)提出的建议与新出现的观点一致,即意识和记忆一样,代表了事件的叙事时间线,而不是任何一个瞬间。然而,我相信,这种概念化可以进一步扩展,不仅包括过去,还包括未来。通过这种方式,意识可以被挑衅性地视为记忆中的过去、现在和未来。
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引用次数: 0
Consciousness as a Memory System. 意识作为一个记忆系统。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-12-01 DOI: 10.1097/WNN.0000000000000319
Andrew E Budson, Kenneth A Richman, Elizabeth A Kensinger

We suggest that there is confusion between why consciousness developed and what additional functions, through continued evolution, it has co-opted. Consider episodic memory. If we believe that episodic memory evolved solely to accurately represent past events, it seems like a terrible system-prone to forgetting and false memories. However, if we believe that episodic memory developed to flexibly and creatively combine and rearrange memories of prior events in order to plan for the future, then it is quite a good system. We argue that consciousness originally developed as part of the episodic memory system-quite likely the part needed to accomplish that flexible recombining of information. We posit further that consciousness was subsequently co-opted to produce other functions that are not directly relevant to memory per se, such as problem-solving, abstract thinking, and language. We suggest that this theory is compatible with many phenomena, such as the slow speed and the after-the-fact order of consciousness, that cannot be explained well by other theories. We believe that our theory may have profound implications for understanding intentional action and consciousness in general. Moreover, we suggest that episodic memory and its associated memory systems of sensory, working, and semantic memory as a whole ought to be considered together as the conscious memory system in that they, together, give rise to the phenomenon of consciousness. Lastly, we suggest that the cerebral cortex is the part of the brain that makes consciousness possible, and that every cortical region contributes to this conscious memory system.

我们认为,意识为什么发展,以及通过持续进化,它选择了哪些额外的功能之间存在混淆。考虑情景记忆。如果我们相信情节记忆的进化只是为了准确地代表过去的事件,那么它似乎是一个容易遗忘和错误记忆的可怕系统。然而,如果我们相信情节记忆是为了灵活、创造性地结合和重新排列先前事件的记忆,为未来做计划而发展起来的,那么这是一个很好的系统。我们认为,意识最初是作为情节记忆系统的一部分发展起来的,很可能是实现信息灵活重组所需的部分。我们进一步假设,意识随后被选择产生与记忆本身不直接相关的其他功能,如解决问题、抽象思维和语言。我们认为,这一理论与许多其他理论无法很好解释的现象相兼容,如意识的缓慢速度和事后秩序。我们相信,我们的理论可能对理解一般的有意行为和意识具有深远的意义。此外,我们建议,情景记忆及其相关的感官、工作和语义记忆系统作为一个整体,应该被视为意识记忆系统,因为它们共同产生了意识现象。最后,我们认为大脑皮层是大脑中使意识成为可能的部分,每个皮层区域都有助于这种意识记忆系统。
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引用次数: 15
Somatoform Symptoms in Parkinson Disease. 帕金森病的躯体形式症状。
IF 1.4 4区 医学 Q3 Medicine Pub Date : 2022-12-01 DOI: 10.1097/WNN.0000000000000322
David Glovinsky, Ann L Gruber-Baldini, Seth Himelhoch, Karen E Anderson, Lisa M Shulman

Background: Co-occurring somatoform symptoms complicate the diagnosis and treatment of Parkinson disease (PD).

Objective: To learn more about the relationship between somatoform symptoms and PD by comparing demographic and clinical features across PD groups differing in somatoform symptom severity.

Method: Using standardized Brief Symptom Inventory-18 (BSI-18) scores to measure somatoform symptom severity, we assigned 1093 individuals with PD to one of four subgroups using comparisons to normative means: low (M < -½ SD), average (M ± ½ SD), high (M +½ SD to +1 SD), very high (M > +1 SD). We used demographics and disease severity measures to assess each subgroup.

Results: Most of the individuals with PD (56%) had high or very high somatoform symptom levels. Increased somatoform symptom levels were associated with female gender, lower socioeconomic status, greater disease duration, increased PD severity (Total Unified Parkinson's Disease Rating Scale), greater disability (Older Americans Resource and Services Disability subscale), increased BSI-18 Depression and Anxiety subscale scores, lower cognitive function (Mini-Mental State Examination), lower self-efficacy scores (Self-Efficacy to Manage Chronic Disease Scale), lower quality of life scores (SF-12 Health Status Survey), and greater medical comorbidity (Cumulative Illness Rating Scale-Geriatrics) (all comparisons: P < 0.001). We found no significant between-group differences for age, race, or marital status.

Conclusion: Somatoform symptom severity in individuals with PD is associated with greater PD severity and disability and is more common in females and in individuals with low socioeconomic status. Greater awareness of somatoform symptoms should help improve PD treatment.

背景:同时出现的躯体症状使帕金森病(PD)的诊断和治疗复杂化。目的:通过比较不同躯体症状严重程度的PD组的人口统计学和临床特征,进一步了解躯体症状与PD之间的关系。方法:使用标准化的简要症状清单-18(BSI-18)评分来测量躯体形式症状的严重程度,我们将1093名帕金森病患者分为四个亚组之一,并与标准均值进行比较:低(M<-½SD)、平均(M±½SD),高(M+½SD至+1 SD)、非常高(M>+1 SD)。我们使用人口统计学和疾病严重程度测量来评估每个亚组。结果:大多数PD患者(56%)具有较高或极高的躯体形式症状水平。体型症状水平的增加与女性、较低的社会经济地位、较长的疾病持续时间、PD严重程度的增加(综合帕金森病评定量表)、更大的残疾程度(美国老年人资源和服务残疾分量表)、BSI-18抑郁和焦虑分量表得分的增加、认知功能的降低(小型精神状态检查),较低的自我效能感评分(管理慢性病的自我效能量表)、较低的生活质量评分(SF-12健康状况调查)和较大的医疗共病(累积疾病评定量表老年医学)(所有比较:P<0.001)。我们发现年龄、种族或婚姻状况的组间差异无显著性。结论:帕金森病患者的躯体形式症状严重程度与更严重的帕金森病严重程度和残疾有关,在女性和社会经济地位较低的个体中更常见。提高对身体形态症状的认识应有助于改善帕金森病的治疗。
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引用次数: 0
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Cognitive and Behavioral Neurology
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