MOG antibody-associated encephalitis secondary to Covid-19: case report

Background While Covid-19 predominantly affects the respiratory system, neurological manifestations including encephalitis occur in some patients, possibly affecting the course and outcome of the disease. Here, we describe a unique case of a young man with Covid-19 and transient MOG-positive encephalitis, with a benign course. Case presentation A 22-year-old male, with PCR confirmed Covid-19 infection was admitted because of persistent headache. The clinical examination was normal. Neuropsychological testing revealed distinct executive deficits. Brain MRI and cerebrospinal fluid (CSF) analysis were suggestive for encephalitis. Further laboratory examination revealed a serum MOG antibody titre. The headache improved with analgetic treatment and i.v. methylprednisolone. Consequently, the MOG antibody titer decreased and MRI lesions were resolving. The patient made a full recovery, with no signs of deterioration over the following months. Conclusions Covid-19 manifestations in the CNS include encephalitis with variable course and prognosis. This case highlights a possible association between inflammation due to COVID-19 and transient secondary autoimmunity with transient MOG antibodies and atypical clinical presentation.

Cortical Hyper-Connectivity in a Stroke Patient with Rotated Drawing

In the present case report, we investigated the cortical networks of a patient (DDA) affected by right parietal stroke who showed a constructional phenomenon, in which when coping and recalling from memory a complex figure, the model was reproduced rotated of 90° along the vertical axis. Previous studies suggested that rotation on copy is associated with visuospatial impairments and abnormalities in parietal cortex, whereas rotation on recall might be related to executive deficits and dysfunction of frontal regions. Here, we computed the DDA’s resting-state functional connectivity (FC) derived from cortical regions of the dorsal attention (DAN) and the frontal portion of the executive-control network (fECN), which are involved in the control of visuospatial attention and multiple executive functions, respectively. We observed that, as compared to a control group of right stroke patients without drawing rotation, DDA exhibited selective increased FC of the DAN and fECN, but not of task-irrelevant language network, within the undamaged hemisphere. These patterns might reflect a pathological communication in such networks leading to impaired attentional and executive operations required to reproduce the model in the correct orientation. Notably, such enhancement of FC was not detected in a patient with a comparable neuropsychological profile as DDA, yet without rotated drawing, suggesting that network-specific modulations in DDA might be ascribed to the constructional phenomenon of rotated drawing.

Attentional Cueing and Executive Deficits Revealed by a Virtual Supermarket Task Coupled With Eye-Tracking in Autism Spectrum Disorder

Executive functioning (EF) impairments in Autism Spectrum Disorder (ASD) impact on complex functions, such as social cognition. We assessed this link between EF, attentional cueing, and social cognition with a novel ecological task, “EcoSupermarketX.” Our task had three blocks of increasing executive load and incorporated social and non-social cues, with different degrees of saliency. Performance of ASD and typical neurodevelopment was compared. The ASD showed a significant performance dependence on the presence of contextual cues. Difficulties increased as a function of cognitive load. Between-group differences were found both for social and non-social salient cues. Eye-tracking measures showed significantly larger fixation time of more salient social cues in ASD. In sum, EcoSupermarketX is sensitive to detect EF and attentional cueing deficits in ASD.

sFEra APP: description and usability of a novel tablet application for executive functions training

Executive functions include functions such as planning, working memory, inhibition, mental flexibility, action monitoring and initiation, and are essential to carry out an independent everyday life. Individuals suffering from brain injury, such as a stroke, very commonly experience executive deficits that reduce the capacity to regain functional independence. In recent years, there has been a growing interest in developing tablet computer-based cognitive training programs for stroke patients. In this respect, we described and evaluated the usability of a novel tablet application (app) for executive function training, developed in the context of the MEMORI-net project, a cross-border Italy-Slovenia program for the rehabilitation of stroke patients. We conducted a pilot study with a non-clinical sample of 16 participants to obtain information about the usability of the app. Our descriptive analyses suggest that most users were satisfied with the overall experience and the app was highly usable, even with little previous experience with tablet applications. Acceptability and effectiveness will need to be evaluated in a clinical randomized controlled study.

Selective attention is insensitive to reward and to dopamine in Parkinson’s disease

Patients with Parkinson’s disease exhibit reduced reward sensitivity in addition to early cognitive deficits, among which attention impairments are common. Attention allocation is controlled at multiple levels and recent work has shown that reward, in addition to its role in the top-down goal-directed control of attention, also guides the automatic allocation of attention resources, a process thought to rely on striatal dopamine. Whether Parkinson’s patients, due to their striatal dopamine loss, suffer from an inability to use reward information to guide the allocation of their attention is unknown. To address this question, we tested Parkinson’s patients (n=43) ON and OFF their dopaminergic medication, and compared them to a group of older controls (n=31). We used a standard two-phase attention capture task in which subjects were first implicitly trained to make colour-reward associations. In the second phase, the previously reward-associated colours were used as distractors in a visual search task. We found that patients did not use reward information to modulate their attention; they were similarly distracted by the presence of low and high-reward distractors. However, contrary to our predictions, we did not find evidence that dopamine modulated this inability to use reward to guide attention allocation. Additionally, we found slightly increased overall distractibility in Parkinson’s patients compared to older controls, but interestingly, the degree of distractibility was not influenced by dopamine replacement. Our results suggest that loss of reward-guided attention allocation may contribute to early attention deficits and raise the possibility that this inability to prioritize cognitive resource allocation could contribute to executive deficits more broadly in Parkinson’s disease.