Deep brain stimulation (DBS) is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient’s personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual’s mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient’s responsibility for action and competence of decision and raises a number of questions that need further research.

The present study provides detailed insights into the anxiety levels during an MRI examination, which may aid in developing effective anxiety-reduction strategies. Additionally, the findings show that measuring anxiety continuously throughout the entire examination using electrophysiology in combination with measuring anxiety subjectively prior to and after the scan provides a more complete assessment of MRI-related anxiety.

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ObjectivesThe present study explores the differences in gait parameters in elderly subjects with or without cognitive impairment measured by means of ambulatory actigraphy while performing a single and a dual task.MethodsSixty-nine participants of which 23 individuals were diagnosed with Alzheimer’s disease (AD), 24 individuals with mild cognitive impairment (MCI), and 22 healthy controls performed a single and dual walking task while wearing a wrist-worn accelerometer. Objective measures of gait features such as walking speed, cadence (i.e., number of steps per minute), and step variance (i.e., variance in time between two consecutive steps) were derived and analyzed.ResultsWhile differences in several gait parameters, namely walking speed, were found between MCI and AD patients, no differences between healthy elderly and MCI patients were found.ConclusionWalking speed seems to be a gait-related feature that differs significantly between MCI and AD patients and thus could be used as an additional measurement in clinical assessment. However, differences in gait may not be salient enough in the early stages of dementia to be detected by actigraphy. More research comparing different methods to measure gait in early stages of dementia under different dual task conditions is neccessary.

Clinical practice still relies heavily on traditional paper-and-pencil testing to assess a patient's cognitive functions. Digital technology has the potential to be an efficient and powerful alternative, but for many of the existing digital tests and test batteries the psychometric properties have not been properly established. We validated a newly developed digital test battery consisting of digitized versions of conventional neuropsychological tests. Two confirmatory factor analysis models were specified: a model based on traditional neuropsychological theory and expert consensus and one based on the Cattell-Horn-Carroll (CHC) taxonomy. For both models, the outcome measures of the digital tests loaded on the cognitive domains in the same way as established in the neuropsychological literature. Interestingly, no clear distinction could be made between the CHC model and traditional neuropsychological model in terms of model fit. Taken together, these findings provide preliminary evidence for the structural validity of the digital cognitive test battery.

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The Trail Making Test (TMT) is used in neuropsychological clinical practice to assess aspects of attention and executive function. The test consists of two parts (A and B) and requires drawing a trail between elements. Many patients are assessed with their non-dominant hand because of motor dysfunction that prevents them from using their dominant hand. Since drawing with the non-dominant hand is not an automatic task for many people, we explored the effect of hand use on TMT performance. The TMT was administered digitally in order to analyze new outcome measures in addition to total completion time. In a sample of 82 healthy participants, we found that non-dominant hand use increased completion times on the TMT B but not on the TMT A. The average completion time increased by almost 5 seconds, which may be clinically relevant. A substantial number of participants who performed the TMT with their non-dominant hand had a B/A ratio score of 2.5 or higher. In clinical practice, an abnormally high B/A ratio score may be falsely attributed to cognitive dysfunction. With our digitized pen data, we further explored the causes of the reduced TMT B performance by using new outcome measures, including individual element completion times and interelement variability. These measures indicated selective interference between non-dominant hand use and executive functions. Both non-dominant hand use and performance of the TMT B seem to draw on the same, limited higher-order cognitive resources.