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While language is frequently explored in stroke and focal lesions, complex language disorders in paroxysmal conditions remain relatively underexplored. Individuals with temporal lobe epilepsy (TLE) often have an impairment of conversational language manifesting as verbosity and attributable to disruption of cognitive-linguistic networks. The micro- and macrolinguistic underpinnings of this disturbance, and the role of epilepsy and cognitive variables, are yet to be explored. We examined the elicited language output of 16 individuals with TLE and 14 healthy controls under separate monologic discourse tasks: a structured and constrained context, elicited by description of the 'Cookie Theft' picture, and an unstructured, unconstrained context, elicited by description of a 'Typical Day'. We hypothesised that language output in the unstructured context would be characterised by verbosity to a greater extent than language elicited in a structured context. Following transcription and coding, detailed multi-level discourse analysis suggested that a constrained context gives rise to microlinguistic disturbances in individuals with TLE, reducing fluency, with more pauses and fillers. Under an unconstrained context, as anticipated, classical aspects of verbosity emerge in those with TLE, manifesting as longer speaking time, a longer duration of pauses, and a higher proportion of repetitive or redundant statements. Macrolinguistic elements such as coherence and informativeness are widely impacted, particularly disturbing language formulation. Correlations suggest that microlinguistic disturbances are closely linked with the immediate impact of seizures on cognitive-linguistic function, while macrolinguistic disturbances are more broadly impacted by disorder severity and word retrieval deficits. These findings suggest that cognitive-linguistic disturbances in TLE produce vulnerability to different psycholinguistic impairments as a function of differing linguistic challenges imposed by constrained and unconstrained discourse contexts. Where constrained, output fluency is primarily affected, while in an unconstrained context disturbed discourse planning and organisation declares itself. We conclude that these patterns reflect a dynamic linguistic system taking shape under specific contextual conditions. [ABSTRACT FROM AUTHOR]

Despite the apparent sociability of human kind, immoral behaviour is ever present in society. The term 'immoral behaviour' represents a complex array of conduct, ranging from insensitivity to topics of conversation through to violent assault and murder. To better understand the neuroscience of immoral behaviour, this review investigates two clinical populations that commonly present with changes in moral behaviour – behavioural‐variant frontotemporal dementia and acquired brain injuries. Based on evidence from these groups, it is argued that rather than a single underlying cause, immoral behaviour can result from three distinct types of cognitive failure: (1) problems understanding others; (2) difficulties controlling behaviour; or (3) deficits in the capacity to make appropriate emotional contributions. Each of these failures is associated with damage to different brain regions. A more nuanced approach to the neuroscience of immoral behaviour has important implications for our understanding of immoral behaviour in a wide range of clinical groups, as well as human society more broadly. [ABSTRACT FROM AUTHOR]

The article offers information on the PITCH training program by the National Health and Medical Research Council, Australia. Topics discussed include information on providing training to residential aged care staff and maximizing dementia care capacity has improved care quality and clinical outcomes for people with dementia; discussions on the program enabling cost efficiencies compared to long-term residential care; and reduces the use of acute health care.

To examine micro- and macrolinguistic underpinnings of circumstantiality in temporal lobe epilepsy (TLE), we examined the elicited narrative output of 15 individuals with TLE and 14 controls. To replicate and extend Field and colleagues' (2000) work, participants were asked to produce five immediately consecutive elicitations of an eight-frame cartoon "Cowboy Story" (Joanette et al., 1986). Following transcription and coding, detailed multi-level discourse analysis demonstrated a typical pattern of compression in controls. The narratives produced by individuals with TLE were less fluent, cohesive, and coherent across trials: producing fewer novel units and more repetitive and extraneous content. Significant group by trial interactions in sample length, spontaneous duration, and statements, were not explained by seizure burden, age, or lexical retrieval deficits. These findings suggest that they do not benefit from repeated engagement with a narrative in the same manner as controls. Disturbed social cognition and pragmatics in TLE might underpin communication inefficiencies. • A multi-centre multi-level discourse analysis examined narrative discourse in temporal lobe epilepsy (TLE). • Individuals with TLE do not benefit from repeating a narrative in the same way that neurologically normal individuals do. • Individuals with TLE fail to compress discourse and instead introduce more repetitive and extraneous content. • Their narratives are less fluent, cohesive, and coherent than controls which reflects inefficient discourse processing. • Disturbed pragmatics in TLE might underpin communication inefficiencies. [ABSTRACT FROM AUTHOR]

Introduction: Immune effector cell-associated neurotoxicity syndrome (ICANS) is a common side-effect of chimeric antigen receptor T-cell (CAR-T) therapy, with symptoms ranging from mild to occasionally life-threatening. The neurological, cognitive, psychiatric and psychosocial sequelae of ICANS are diverse and not well defined, posing a challenge for diagnosis and management. The recovery trajectory of the syndrome is uncertain. Patients are rarely examined in this population pretherapy, adding a layer of complexity to specifying symptoms pertinent solely to CAR-T treatment. We present a protocol of a prospective longitudinal research study of adult patients in a single Australian haematology service undergoing CAR-T therapy. The study will describe neurocognitive features specific to ICANS, characterise the underlying syndrome, capture recovery, identify predictors of differential postinfusion outcomes and determine a set of cognitive instruments necessary to monitor patients acutely., Methods and Analysis: This is a prospective longitudinal study that comprises neuropsychological and neurological examinations occurring prior to CAR-T, during the acute post-treatment period, 28 days, 6 months and 12 months post infusion. Data will be sourced from objective psychometric measures, clinical examinations, self-report questionnaires of psychopathology and accounts of subjective cognitive complaint., Ethics and Dissemination: This study aims to guide diagnosis, management and monitoring of neurocognitive features of CAR-T cell therapy. Results of this study will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences. All procedures involving human subjects/patients were approved by the Peter MacCallum Cancer Centre Human Research Ethics Committee (21/145)., Competing Interests: MAA reports honoraria from AstraZeneca, Janssen, Abbvie, Beigene, Takeda, CSL, Novartis, Kite, Gilead and Roche. Employee of the Walter and Eliza Hall institute which receives Milestone payments in relation to venetoclax. CS reports no disclosures. SvdL reports honoraria from Kite. IR served on scientific advisory boards, received conference travel support and/or speaker honoraria from Roche, Novartis, Merck and Biogen. IR is supported by MS Australia and the Trish Multiple Sclerosis Research Foundation. SR reports no disclosures. FD reports no disclosures. SL reports honoraria from Otsuka and Lundbeck. She has received research support from the National Health and Medical Research Council and Royal Melbourne Hospital. MDowling reports honoraria and conference support from Kite and Gilead and honoraria from Novartis. MDowling also receives royalties from Abbvie in relation to venetoclax via the Walter and Eliza Hall institute. MDickinson reports advisory boards, research funding from Novartis, Kite, BMS and Gilead. TK served on scientific advisory boards for MS International Federation and World Health Organisation, BMS, Roche, Janssen, Sanofi Genzyme, Novartis, Merck and Biogen, steering committee for Brain Atrophy Initiative by Sanofi Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Eisai, Novartis, Biogen, Roche, Sanofi-Genzyme, Teva, BioCSL and Merck and received research or educational event support from Biogen, Novartis, Genzyme, Roche, Celgene and Merck. SJH reports the following disclosures: AbbVie: consultancy, advisory board; Amgen: consultancy, honoraria, advisory board, research funding; Celgene: consultancy, honoraria, advisory board, research funding; CSL Bering: honoraria; GSK: consultancy, research funding, advisory board; Janssen Cilag: consultancy, honoraria, advisory board, research funding; Novartis: consultancy, honoraria, advisory board, research funding; Roche/Genetec: consultancy, honoraria, advisory board; Takeda: consultancy, honoraria, advisory board; Haemalogix: scientific advisory board, research funding; Sanofi: consultancy/advisory role; Terumo: consultancy/advisory role/expert testimony. CM has received conference travel support from Merck, Novartis and Biogen. He has received research support from the National Health and Medical Research Council, Multiple Sclerosis Australia, The University of Melbourne, The Royal Melbourne Hospital Neuroscience Foundation and Dementia Australia., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)