Stavros Baloyannis

Golgi method is been using for more than 140 years so far for the study of the individual morphological and morphometric characteristics and parameters of the cells of the central nervous system. Although other methods came to light, Golgi method is still unique and one of the most powerful tools in the hands of the neuroscientists. What makes Golgi method unique is the capacity to stain all components of the brain tissue, including neurons, glial cells and the vasculature. The cell soma, the dendritic arborization including the spines and at least a part of the axon are usually visible, providing a panoramic view of the entire neural element. Golgi method can be combined with modern and sophisticated techniques which can reduce the human interference and produce accurate 3D models of the neuronal elements of the central nervous system.

The ultimate, and arguably the hardest, challenge to human knowledge consists of understanding how neurons and their connections give rise to feelings, emotions, and logical thinking. Neurons are themselves complex computational machines. Theories of dendritic, somatic, and axonal functions have matured well beyond the traditional scheme of “input– integration–output”. Single neurons and their arbors are now considered sophisticated time filters, coincidence detectors, internally distributed devices of local memory storage, and dynamic metabolic assemblies with high internal spatial specificity. The first step in the pathway of morphological analysis of individual neurons is the neuronal staining either with intracellular labeling techniques, or with the traditional silver staining methods. Another fundamental step is the tracing into a three-dimensional (3D) digital representation of the branching dendrites and/or axons, and the last and crucial step is the mathematical and statist...

This paper aims to describe how radial artery obstruction can support blood circulation in an ischemic area. A dramatic case is described. Furthermore aims to describe that fatigue, atherosclerosis and toxic substances like in alcoholism may reduce blood flow and energy supply in the cortex and other brain areas and thus unconsciously modify our usual civilized behavior. Intense mental and physical fatigue was described as: "vital exhaustion".

Background: Alzheimer's Disease (AD) and Vascular Dementia (VaD) are the most common causes of dementia in older people. Both diseases appear to have similar clinical symptoms, such as deficits in attention and executive function, but specific cognitive domains are affected. Current cohort studies have shown a close relationship between αβ deposits and age-related macular degeneration (Johnson et al., 2002; Ratnayaka et al., 2015). Additionally, a close link between the thinning of the retinal nerve fiber (RNFL) and AD patients has been described, while it has been proposed that AD patients suffer from a non-specific type of color blindness (Pache et al., 2003). Methods: Our study included 103 individuals divided into three groups: A healthy control group (n = 35), AD (n = 32) according to DSM-IV-TR, NINCDS-ADRDA criteria, and VaD (n = 36) based on ΝΙΝDS-AIREN, as well as Magnetic Resonance Imaging (MRI) results. The severity of patient's cognitive impairment, was measured w...

Objective: The pathology of dementia as well as Alzheimer’s disease (AD) is close related to the metabolism of lipids. During the aging and neurodegeneration the physicochemical properties of the membranes change, which may cause imbalancies in the proportion of membrane lipids and finally lead to the pathogenesis of dementia and AD. Gangliosides are acidic glycosphingolipids that are localized on the outer layer of plasma membranes. Increasing evidence suggest that gangliosides act as modulators of cell functions including cell growth, apoptosis and differentiation. Anti-ganglioside antibodies have been reported in patients with many immune-mediated neurological disorders and are very much connected with inflammation, Aβ pathology and probably with neurodegenerationBackground: The aim of the present study was to investigate the levels of antibodies against GM, GD1b and GQ1b gangliosides in demented patients and to correlate them with clinical parameters of the disease (age, severit...

The levels of interleukin 1beta, interleukin 6, and interleukin 10 were elevated in the serum of patients with dementia. No statistically significant correlation was recorded in the interleukin levels among patients with Alzheimer's disease and vascular dementia. Also, no significant correlation was observed in the interleukin levels in the serum and the severity of dementia. However, a significant correlation was found between IL-6 and tumor necrosis factor-alpha (TNF-alpha) levels and age. The levels of IL-1beta and IL-6 were positively correlated with hypertension, and IL-2 levels were negatively correlated. No correlation was found between depressive symptoms and levels of cytokines in the serum.

Alzheimer’s disease is a progressive neurodegenerative disorder leading gradually in profound dementia, with all the tragic consequence on the everyday life and the social behavior of the patients. The pathogenetic background of the disease is quite enigmatic, implicating several innate mechanisms and additional exterior factors formatting a chain of pathogenetic processes, resulting in synaptic loss, selective neuronal loss and serious decline of the mental faculties eventually. Among the pathogenetic factors the oxidative stress and the mitochondrial dysfunction may play a substantial role in the initial stage of the disease. Mitochondrial alterations may be induced by amyloid toxicity, which by the oxidative stress initiates a chain of pathological procedures resulting in profound dementia. In early cases of Alzheimer’s disease we attempted to describe in electron microscopy the mitochondrial alterations in the perikaryon of neurons and astrocytes as well as in the dendritic prof...

Being is the ontological essence of the human person. The long and continuous process of self-identification, starting from the very beginning of the human life aims at knowing the real Being. The phenomenology of Being has been extensively studied, analyzed and discussed in the fields of philosophy, psychology, ethics and sociology in the course of the history of self-knowledge. In Heraclitean philosophy the Being was associated with the Word (λόγος), in Empedoclean one it was implicated in the rivalry between Love and Strife, in Platonic philosophy the human Being has eternal self-identity and it is related with the Self-Knowing, the self-control and the establishment of the inner peace and harmony. According to Aristotle, the purpose of the human Being is to live for the virtue. In Neo-Platonists, Being was involved in the struggle between soul and flesh, expecting the eventual victory of the spiritual over the carnal entity. In the Skepticism, the Being is aiming at searching fo...

Galen of Pergamum (130-200 A.D.) was one of the greatest authorities in Medicine. Hippocrates first and Galen later traced the scientific approach in Medicine and were the founders of the modern Medicine. Galen by his extensive scientific work contributed greatly in the fields of anatomy, correlative anatomy, experimental research, topographic diagnostics and neurosciences. In addition, his scientific orientation was influenced by philosophy, given that he was educated under the special philosophical atmosphere of the Hellenistic era. Galen was one of the most productive authors. He composed, more than five hundred dissertations on medicine, psychology, philosophy, medical ethics, logic and grammar. His work exercised great influence in Medieval medicine and contributed substantially in shaping the profile of the modern medicine. In the field of neurosciences Galen’s contribution was much valuable. He was an expert anatomist of the nervous system. Galen, Herophilus and Erasistratus ...

Schizophrenia is a brain disorder that affects more than 21 million people worldwide. Ventricle enlargement and reduction in the volume of the temporal lobe overall and in medial temporal structures constitutes the main macroscopic findings, whilst synaptic and spinal changes as well as gliosis in the hippocampal formation, the prefrontal and the entorhinal cortex stand among cardinal microscopic findings in the schizophrenic brains. In recent years, accumulated evidence comes to light about the role of cerebellum in the pathophysiology of schizophrenia. The present study is based on the morphological analysis and 3D neuronal reconstruction of the Purkinje cells from 10 schizophrenic brains and 10 normal controls. Significant morphological alterations such as loss of distal and terminal dendritic branches and decrease of the density of the dendritic spines constitute the main morphological findings found in the present study. The present findings may be added to accumulated evidence...

The regulation of the body weight involves a substantial number of peripheral and central mechanisms which control feeding behavior and energy expenditure. Among the various peripheral components leptin, which is produced by white adipose tissue, has a potent effect on feeding behavior and regulation of energy homeostasis. A substantial body of evidence suggests that leptin resistance is associated with obesity, since leptin plays a negative feedback signal role to the brain, causing an inhibition of food intake and provoking of loss of body weight. However, when the leptin levels decrease, feeding is disinhibited, in order to promote the maintenance of a relatively stable body weight. The effect of leptin is mediated through leptin receptors, which are localized in several nuclei in the ventrobasal hypothalamus, including the arcuate nucleus., which can affect various endocrine, autonomic and behavioral responses. Leptin also activates several regions, which seems to be involved in regulation of energy balance. Various neuronal networks in the hypothalamus are involved in central regulation of food intake and energy balance including ventromedial and lateral hypothalamic areas, which integrate sensory inputs from the viscera mediated through leptin, ghrelin, serotonin, dopamine and insulin, which mostly target hypothalamic nuclei, modulating energy control. In addition, leptin, ghrelin, insulin prolactin, estrogens, glucocorticoids restin and melanocortin system seems to play a very important role in controlling long term energy balance by food intake and energy depletion and expenditure. Neurons of the arcuate nucleus influenced by adiposity signals synthesizes neuropeptdie Y (NPY) which is a potent orexigenic and anabolic compound promoting hyperphagia and weight gain and reducing at the same time energy expenditure. Neurons containing NPY express both leptin and insulin receptors. Endogeneous levels of NPY in the arcuate nucleus increase normally during the night and decrease at daylight. The neurons of the arcuate nucleus of the hypothalamus are involved also in expressing proopiomelanocortin and cocain apmhetamin regulated transcript, which exert an anorectic effect. Anorectic effect is expressed, on the other hand, by the brain derived neurotrophic factor (BDNF), which in addition to promote synaptogenesis in the neuronal circuits, enhancing neuronal plasticity, affects also both glucose and lipid metabolism, reducing the body weight and food intake. Leptins increases BDNF transcripts, whereas fasting decreases them, suggesting that BDNF may act as regulatory component of leptin signalling system. Hypothalamic neurons retain synaptic plasticity throughout life, which is an important factor for the adaptation of the changeable feeding conditions and modulating the responses to body energy fuels. It is suggested that the amygdala modulates the hypothalamus with regards to regulation of food intake. Anatomic descriptions of amygdaloid lesions resulting in hyperphagia and obesity have been rather inconsistent and often contradictory. Numerous studies have examined the effects of amygdaloid lesions on food intake and body weight in rats, resulting in a similar collection of inconsistent and contradictory results. Central nucleus lesions have similarly been reported to result in either weight gain, aphagia or weight loss, or no change in food intake. Lesions of the posterodorsal amygdala may have the same effect with the lesions of the ventromedial hypothalamus inducing to hyperphagia and increase of body weight, mainly in females. Amygdala on the other hand, due to many afferent inputs from the olfactory bulb, may direct goal-oriented feeding behavior. The mesencephalic central tegmental area, which lies medial to the substantia nigra and ventral to the red nucleus, contributes substantially to the acquisition and learning of appetitive behavior. That area receives glutaminergic inputs from the prefrontal cortex, the lateral hippocampus and the stria terminalis. The brain stem plays an important role in autonomicaly organized nutrient supply by parasympathetic processes, through the dorsal nucleus of the vagus nerve. In addition it can terminate ingestion in aversive taste impulses and in mechanical or noxious properties of food, through the nucleus of the solitary tract and its central pathways. Ghrelin receptors are detected in the neurons of the nucleus of the tract solitarius of the medulla, which play an important role in cumulative food intake. In conclusion the central regulatory mechanisms of feeding behaviour and energy balance play a very important role in the maintenance of the stability of body weight. Any case of obesity necessitates a detailed investigation of the hypothalamic and pituitary glad function as well as a thorough assessment of the frontal and temporal lobe function in association with a methodical and systematic approaching of the neuropsychological profile of the patient.

Heraclitus is one of the great Ionian thinkers, who lived around the beginning of the fifth century BC. in Ephesus, the second great Ionian city. His style of life has had an obvious melancholic character and his death was tragic. Although he has been one of the most creative and influential pre-Socratic philosophers , his surviving work consists of more than hundred twenty fragmentary epigrammatic mentionings of him by his successors, philosophers and early Christian authors, that scholars have been able to extract them from their manuscripts. Heraclitus as an author has a distinctive and powerful style, characterized by linguistic density, resonance, metaphor, symbolism, aphorism and opacity, thus most of his fragments might be translated in many ways. Heraclitus as a philosopher presents himself as the delivered of Logos, which is accessible to thought because it is «common». Logos is a central idea of fundamental importance for the uncovering of the Being. On the human soul Heraclitus claims that one would never discover the limits of psyche, should one transverse every road. In addition he insists that psyche possesses a logos which increases itself and «a dry psyche is wiser and best». According to Heraclitus psyche, understanding the truths, has unlimited resources. Psyche itself is the source not only of life, but also of reason and rational control. Heraclitus frequently asserts the unity of opposites, thus «the road up and down is one and the same road» and «in the circumference of the circle beginning and end are the same». Sometimes Heraclitus expresses an obvious mysticism stateing that «nature loves to hide» and «an unapparent harmony is stronger than an apparent one» and even more than that «immortals are mortals, mortals are immortals, living their death, dying their life. Heraclitus claims that everything is in flux, like the constant flow of a river and he insists that «nobody can step twice into the same river». The universe is a continuous state of dynamic equilibrium, whereas at the same time «all things are one». Fire is the underlying principle of all things. The world as a whole is an everlastingly repeated sequence of cycles, each of which emerges out of fire and ends in fire. According to Heraclitus Logos-Truth-Nature-Eternity are the crucial existential principles for the Being and the «Wise is one thing, to be acquainted with true judgment, how all things are steered through all». The influence of Heraclitus' doctrines on other philosophers was extensive. Heraclitus could be characterized as the first existential philosopher, whose ideas have been revitalized in a more systematic and acceptable way in the fields of the modern existential philosophy.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder, characterized by irreversible memory decline, concerning no rarely spatial memory and orientation, alterations of the mood and personality, gradual loss of motor skills, and substantial loss of capacities obtained by previous long education. We attempted to describe the morphological findings of the mammillary bodies in early cases of AD. Samples were processed for electron microscopy and silver impregnation techniques. The nuclei of the mammillary bodies demonstrated a substantial decrease in the neuronal population and marked abbreviation of dendritic arbors. Decrease in spine density and morphological abnormalities of dendritic spines was also seen. Synaptic alterations were prominent. Alzheimer’s pathology, such as deposits of amyloid-β peptide and neurofibrillary degeneration, was minimal. Electron microscopy revealed mitochondrial alterations and fragmentation of Golgi apparatus, associated frequently with s...

Summary Heraclitus is one of the greatest Ionian thinkers, who lived and flourished around the beginning of the fifth century BC, in Ephesus. His style of life has had an obvious melancholic character and his personality was characterized by honesty, gentleness, broadmind, strength and magnanimity. Although Heracletus has been one of the most creative and influential pre-Socratic philosophers, his surviving work consists of more than hundred twenty epigrammatic authentic fragments, in Ionic dialect, mentioned by his successors, philosophers and early Christian authors. Heracletus’ thoughts and doctrines have a multidimensionality, since he does not know a fixed level, working in a broad spectrum of subjects, in reference to everyday. Heracletus has been influencing the philosophy and the literature for ages, from Plato, Aristotle, Stoics, Sextus Empiricus, Porphyrius to Hölderlin, Hegel, Nietzche, Heidenger,Whitehead, Jung, Eliot, Ibsen and Kafka. Heraclitus as an author is among th...

Objective: Mamillary bodies are implicated in selective memory and learning, showing a significant volume reduction in Wernicke’s encephalopathy, Alzheimer’s disease and aging. We attempted to describe the morphological alterations of the neuronal networks of the nuclei of the mamillary bodies in Alzheimer’s disease, focusing our study on dendritic arborisation and synaptic morphology. Methods: We applied Golgi technique, Golgi-Nissl method and electron microscopy in specimens of mamillary bodies derived from 12 early cases of Alzheimer’s disease, 6 men and 6 women. Results: Decrease of the neuronal population was noticed mostly in the medial mamillary nucleus associated with marked loss of the tertiary dendritic branches. The dendritic spines were substantially decreased. Giant spines were frequently seen. No Alzheimer’s type pathology was noticed. Electron microscopy revealed poverty in synaptic vesicles in the prosynaptic terminals. Mitochondrial alterations were seen in the majo...

The epidemiologic profile of multiple sclerosis (MS), one of the most common diseases of the central nervous system, is not well defined in northern Greece. We analyzed retrospectively the records of the MS patients admitted in our Neurology Department, between the years 1979-2008. We studied a total of 1180 MS patients, with an average annual rate of 39 ± 11.8 MS patients, demonstrating a female to male ratio of 1.6:1. The estimated prevalence of MS in Thessaloniki, the largest city in northern Greece, on December 31 2008, was 57:100,000 placing the area in the high-risk zone while it was 6,8:100,000 on December 31, 1981, in the medium-risk zone. The mean age during the exacerbation of the disease was 28 ± 9 years for females and 31 ± 8 years for males, with significant difference between means (t = 5,8, p < 0,001). The average annual rate of attacks was 1.6 ± 0.7 per 100.000 population. Patients' admissions was significantly less in winter with comparison to the other seaso...

Introduction: Retzius-Cajal neuron is the prominent neuron of the layer I of the brain’s cortex. This is a large multipolar solitary neuron, mostly surrounded by astrocytes. Methods: The structural morphology of the layer I of the temporal and occipital areas of the cortex of twenty cases of Alzheimer’s disease was studied in rapid Golgi staining, Golgi-Nissl method and electron microscopy. Results: In case of Alzheimer’s disease Cajal-Retzius neuron, was dramatically reduced in comparison with normal controls brains of the same age. The electron microscopy revealed alterations of dendritic branches, decrease in spite density and morphological alterations of the mitochondria in the soma, the dendrites and the dendritic spines of Retzius-Cajal neurons. Tau pathology in the form of paired helical filaments were very rare in Retzius-Cajal neurons. The synapses between the Retzius-Cajal neurons and the corticipetal fibers were dramatically reduced. Conclusions: Retzius-Cajal neurons ser...

And Jesus went into the temple of God, and cast out all them that sold and bought in the temple, and overthrew the tables of the moneychangers, and the seats of them that sold doves, And said unto them, It is written, My house shall be called the house of prayer; but ye have made it a den of thieves» (Matth.21, 12-13). Summary The economic prosperity is an important factor for the amelioration of the quality of life of people and soci-eties, but it is not the main factor of human wellbeing and happiness, since prosperity is not always synony-mous with happiness. It is true that the man endeavors for centuries to improve his economic status, increas-ing the incomes, fighting the poverty and the financial insecurity, minimizing any financial risk and attempting to establish eventually a rational economic equilibrium. It is true, that the financial stability and the prudent anticipation of financial crashes are essential conditions for a reliable social prosperity. In the contrary, fin...

Alzheimer’s disease (AD) is a neurodegenerative disorder of the brain, inducing progressive severe presenile and senile cognitive decline, resulting in vegetative stage eventually. From the etiological point of view the main causative factor, remains unknown, in spite of the steady augmentation of the research efforts. Golgi staining revealed the substantial alterations of the dendritic branches and the tremendous loss of spines even in the initial stages of the disease. Electron microscopy reveals morphological changes of the mitochondria in neurons and astrocytes associated with fragmentation of cisternae of Golgi complex and pathological alteration of the dendritic spines, even in areas of the brain, which demonstrate minimal tau pathology and few amyloid β deposits. It is attempted to describe the ultrastructural alterations of the cerebellar cortex in early cases of AD, focusing the study mostly on mitochondria, Golgi apparatus, dendritic branches, dendritic spines and synapses...

Μany patients complain for chronic fatigue, sometimes debilitating, associated with anorexia, sleep disturbances, muscular weakness, muscular pains and mild, cognitive impairment, concerning mostly the concentration, the active attention and the memory. In some of them the clinical and laboratory investigation are both unremarkable, no suggestive of any underlying disease. These complains if persit for more than six months may be attributed to chronic fatigue syndrome (CFS), a clinically defined condition, the etiopathogenetic background of which remains elusive. The predominant symptom is always disabling fatigue, that causes a substantial and sometimes persistent reduction in activity level. We have studied 128 patients, 45 men and 80 women, who have appealed for medical care for the presenting complaint of chronic fatigue, in the decade 1980-1990. Although, repeated clinical and laboratory examinations, were unremarkable, some of the patients (15,6%) devepoped well defined diseases within the first five.years from the initial complains, suggesting that the debilitating fatigue was simply the general initial manifestation of one of the following underlyng disorders, multiple sclerosis, neoplasms, Alzheimer's disease, depression and myasthenia. We have the feeling that the chronic fatigue syndrome (CFS) is consisted of a heterogeneous group of various underlying disorders and the patients suffered from it should be monitored closely and every complaint or laboratory data should be carefully evaluated. The final management approach would have to be individualized according to the specific symptoms of the patients, that impose the specific therapeutical needs. Nevertheless acceptance of the patients illness experience and continuous psychological support and attention to symptomatic treatment are essential.

Intellectual activity, productive work and systematic of physical activity, increase the neuronal plasticity and ameliorate the mental condition in aging, mild cognitive impairment and early stages of Alzheimer's disease. It is well known that during the mental and physical activity spines on the dendritic branches receive the majority of excitatory synaptic connections in the brain. The synaptic density, the magnitude of the dendritic arborization and the capacity of the creation and projection of new dendritic spines, on the other hand, play a crucial role in expanded synaptogenesis and in dynamic neuronal plasticity. Altered dendritic spines are a substantial characteristic of aging and debilitating diseases of the brain being at the same time the intrinsic cause of the accompanying neurological disturbances. Newly formed filopodia decrease in length and frequency, in advanced aging and they become rare in early cases of Alzheimer's disease, in which the synaptic density decreases dramatically on the secondary and tertiary dendritic branches. Although the cause of Alzheimer's disease remains enigmatic, in spite of the continuously ongoing research on the field, there is, a substantial body of increasing evidence, which pleads in favor of the possible implication of mitochondrial dysfunction in the pathogenesis of several late-onset neurodegenerative disorders, including Alzheimer's disease. Mitochondria are vital organelles, for the maintenance of cell's homeostasis and viability, by virtue of providing most of the energy for the cellular processes. It is important that mitochondria play a critical role in maintaining cellular calcium homeostasis and cellular signaling cascades for both apoptotic and necrotic cell death pathways. Normally, the number of mitochondria in dendrites correlates with synapse development and may play an important role in the morphogenesis of the spines, as well as in the synaptic plasticity. The contribution of the occupational activities, either in the intellectual field or in the physical one is of essential importance in maintaining a continuous influx of information in the brain, which increases the excitatory input to dendritic spines. The role of continuous mental and physical activity in improving the function of the neuronal circuits in the frontal, parietal, temporal and occipital lobe is well documented in clinical cases as well as in experimental models. The occupational activity on the other hand may improve at the same time the harmonization of the collaboration of the various functional centers in the cortex of the lobes of the brain hemispheres by the creation newformed connecting neuronal circuits, new tracks and new long neuronal pathways. A substantial body of evidence, derived from population-based follow up studies, suggest that occupational complexity is related to lower risk of dementia even in cases of low education. Low education has been associated with high risk of Alzheimer's disease, since it is also related, in the majority of the cases, with low or rare professional occupation or with hand work exclusively, without any further intellectual expectation. In treating Alzheimer's disease, occupational therapy plays a fundamental role in ameliorating the cognitive, the physical and the emotional condition of the patients, since meaningful activities, occupational attainment and environmental modification give a dynamic dimension in the everyday life of the patients, stimulating and motivating his higher mental faculties. It is well known that pharmaceutical treatment of the Alzheimer's disease has always a limited in time beneficial effect, lasting six or nine monthes in the majority of the cases. In contrast, continuous occupation within the limits of the patient's capacities and continuous education inducing mental enhancement may be beneficial for longer period of time, increasing the self-esteem and ameliorating, at the same time, the quality of the everyday life of the patient. Encephalos 2010, 47(4):159-169.

Recent advances in mobile phone technology have placed an impressive array of sensing and communication equipment at the hands of an ever-growing number of people. One of the areas which can potentially be transformed by the availability of what is essentially a cheap, ubiquitous networked sensor, is that of remote diagnosis of movement disorders, such as Parkinson's disease. This work describes a smartphone-based method for detecting and quantifying the hand tremor associated with movement disorders using signals from the accelerometer and gyroscope embedded in the patient's phone. Our approach is web-based and user-friendly, requiring minimal user interaction. In clinical experiments with twenty subjects, we found that by combining both accelerometer and gyroscope signals, we were able to correctly identify those with hand tremor, using very simple signal metrics.

ABSTRACT Unawareness of the disease or anosognosia is a common symptom among many neuropsychiatric patients and may affect the quality of life and treatment compliance in patients suffering from AD and make them to behave unsafely. Although generalized cognitive impairment may be a prerequisite for anosognosia in dementia, not all patients with cognitive impairment, present anosognosia. Deficit in regional cerebral blood flow (rCBF) can be seen in different brain regions in dementia with a typical posterior temporoparietal defect in patients with Alzheimer's disease. Although functional brain imaging methods such as single photon emission computed tomography (SPECT) have relatively limited spatial resolution, they offer the potential advantage of being able to assess functional connectivity patterns, associated with neural networks involved in awareness. We try to determine the brain regions that contributed to unawareness in patients with Alzheimer's disease, using SPECT. This study will focus on awareness deficits in cognitive and behavioral domains, rather than personality.