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Bar M, Kassam KS, Ghuman AS, Boshyan J, Schmid AM, Schmidt AM, Dale AM, Hämäläinen MS, Marinkovic K, Schacter DL, Rosen BR, Halgren E. Top-down facilitation of visual recognition. Proc Natl Acad Sci U S A 2006; 103:449-54. [PMID: 16407167 PMCID: PMC1326160 DOI: 10.1073/pnas.0507062103] [Citation(s) in RCA: 961] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Accepted: 11/23/2005] [Indexed: 11/18/2022] Open
Abstract
Cortical analysis related to visual object recognition is traditionally thought to propagate serially along a bottom-up hierarchy of ventral areas. Recent proposals gradually promote the role of top-down processing in recognition, but how such facilitation is triggered remains a puzzle. We tested a specific model, proposing that low spatial frequencies facilitate visual object recognition by initiating top-down processes projected from orbitofrontal to visual cortex. The present study combined magnetoencephalography, which has superior temporal resolution, functional magnetic resonance imaging, and a behavioral task that yields successful recognition with stimulus repetitions. Object recognition elicited differential activity that developed in the left orbitofrontal cortex 50 ms earlier than it did in recognition-related areas in the temporal cortex. This early orbitofrontal activity was directly modulated by the presence of low spatial frequencies in the image. Taken together, the dynamics we revealed provide strong support for the proposal of how top-down facilitation of object recognition is initiated, and our observations are used to derive predictions for future research.
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Research Support, N.I.H., Extramural |
19 |
961 |
2
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Review |
21 |
868 |
3
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Bar M. The proactive brain: using analogies and associations to generate predictions. Trends Cogn Sci 2007; 11:280-9. [PMID: 17548232 DOI: 10.1016/j.tics.2007.05.005] [Citation(s) in RCA: 635] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 04/26/2007] [Accepted: 05/18/2007] [Indexed: 11/20/2022]
Abstract
Rather than passively 'waiting' to be activated by sensations, it is proposed that the human brain is continuously busy generating predictions that approximate the relevant future. Building on previous work, this proposal posits that rudimentary information is extracted rapidly from the input to derive analogies linking that input with representations in memory. The linked stored representations then activate the associations that are relevant in the specific context, which provides focused predictions. These predictions facilitate perception and cognition by pre-sensitizing relevant representations. Predictions regarding complex information, such as those required in social interactions, integrate multiple analogies. This cognitive neuroscience framework can help explain a variety of phenomena, ranging from recognition to first impressions, and from the brain's 'default mode' to a host of mental disorders.
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Research Support, Non-U.S. Gov't |
18 |
635 |
4
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Abstract
The majority of the research related to visual recognition has so far focused on bottom-up analysis, where the input is processed in a cascade of cortical regions that analyze increasingly complex information. Gradually more studies emphasize the role of top-down facilitation in cortical analysis, but it remains something of a mystery how such processing would be initiated. After all, top-down facilitation implies that high-level information is activated earlier than some relevant lower-level information. Building on previous studies, I propose a specific mechanism for the activation of top-down facilitation during visual object recognition. The gist of this hypothesis is that a partially analyzed version of the input image (i.e., a blurred image) is projected rapidly from early visual areas directly to the prefrontal cortex (PFC). This coarse representation activates in the PFC expectations about the most likely interpretations of the input image, which are then back-projected as an "initial guess" to the temporal cortex to be integrated with the bottom-up analysis. The top-down process facilitates recognition by substantially limiting the number of object representations that need to be considered. Furthermore, such a rapid mechanism may provide critical information when a quick response is necessary.
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Review |
22 |
582 |
5
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Aminoff EM, Kveraga K, Bar M. The role of the parahippocampal cortex in cognition. Trends Cogn Sci 2013; 17:379-90. [PMID: 23850264 DOI: 10.1016/j.tics.2013.06.009] [Citation(s) in RCA: 555] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
The parahippocampal cortex (PHC) has been associated with many cognitive processes, including visuospatial processing and episodic memory. To characterize the role of PHC in cognition, a framework is required that unifies these disparate processes. An overarching account was proposed whereby the PHC is part of a network of brain regions that processes contextual associations. Contextual associations are the principal element underlying many higher-level cognitive processes, and thus are suitable for unifying the PHC literature. Recent findings are reviewed that provide support for the contextual associations account of PHC function. In addition to reconciling a vast breadth of literature, the synthesis presented expands the implications of the proposed account and gives rise to new and general questions about context and cognition.
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Review |
12 |
555 |
6
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Abstract
Objects in our environment tend to be grouped in typical contexts. How does the human brain analyze such associations between visual objects and their specific context? We addressed this question in four functional neuroimaging experiments and revealed the cortical mechanisms that are uniquely activated when people recognize highly contextual objects (e.g., a traffic light). Our findings indicate that a region in the parahippocampal cortex and a region in the retrosplenial cortex together comprise a system that mediates both spatial and nonspatial contextual processing. Interestingly, each of these regions has been identified in the past with two functions: the processing of spatial information and episodic memory. Attributing contextual analysis to these two areas, instead, provides a framework for bridging between previous reports.
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22 |
431 |
7
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Abstract
It is proposed that the human brain is proactive in that it continuously generates predictions that anticipate the relevant future. In this proposal, analogies are derived from elementary information that is extracted rapidly from the input, to link that input with the representations that exist in memory. Finding an analogical link results in the generation of focused predictions via associative activation of representations that are relevant to this analogy, in the given context. Predictions in complex circumstances, such as social interactions, combine multiple analogies. Such predictions need not be created afresh in new situations, but rather rely on existing scripts in memory, which are the result of real as well as of previously imagined experiences. This cognitive neuroscience framework provides a new hypothesis with which to consider the purpose of memory, and can help explain a variety of phenomena, ranging from recognition to first impressions, and from the brain's 'default mode' to a host of mental disorders.
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Research Support, N.I.H., Extramural |
16 |
347 |
8
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Bar M, Tootell RB, Schacter DL, Greve DN, Fischl B, Mendola JD, Rosen BR, Dale AM. Cortical mechanisms specific to explicit visual object recognition. Neuron 2001; 29:529-35. [PMID: 11239441 DOI: 10.1016/s0896-6273(01)00224-0] [Citation(s) in RCA: 313] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The cortical mechanisms associated with conscious object recognition were studied using functional magnetic resonance imaging (fMRI). Participants were required to recognize pictures of masked objects that were presented very briefly, randomly and repeatedly. This design yielded a gradual accomplishment of successful recognition. Cortical activity in a ventrotemporal visual region was linearly correlated with perception of object identity. Therefore, although object recognition is rapid, awareness of an object's identity is not a discrete phenomenon but rather associated with gradually increasing cortical activity. Furthermore, the focus of the activity in the temporal cortex shifted anteriorly as subjects reported an increased knowledge regarding identity. The results presented here provide new insights into the processes underlying explicit object recognition, as well as the analysis that takes place immediately before and after recognition is possible.
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313 |
9
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Abstract
First impressions of people's personalities are often formed by using the visual appearance of their faces. Defining how quickly these impressions can be formed has critical implications for understanding social interactions and for determining the visual properties used to shape them. To study impression formation independent of emotional cues, threat judgments were made on faces with a neutral expression. Consequently, participants' judgments pertained to the personality rather than to a certain temporary emotional state (e.g., anger). The results demonstrate that consistent first impressions can be formed very quickly, based on whatever information is available within the first 39 ms. First impressions were less consistent under these conditions when the judgments were about intelligence, suggesting that survival-related traits are judged more quickly. The authors propose that low spatial frequencies mediate this swift formation of threat judgments and provide evidence that supports this hypothesis.
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312 |
10
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Barrett LF, Bar M. See it with feeling: affective predictions during object perception. Philos Trans R Soc Lond B Biol Sci 2009; 364:1325-34. [PMID: 19528014 DOI: 10.1098/rstb.2008.0312] [Citation(s) in RCA: 275] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
People see with feeling. We 'gaze', 'behold', 'stare', 'gape' and 'glare'. In this paper, we develop the hypothesis that the brain's ability to see in the present incorporates a representation of the affective impact of those visual sensations in the past. This representation makes up part of the brain's prediction of what the visual sensations stand for in the present, including how to act on them in the near future. The affective prediction hypothesis implies that responses signalling an object's salience, relevance or value do not occur as a separate step after the object is identified. Instead, affective responses support vision from the very moment that visual stimulation begins.
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Review |
16 |
275 |
11
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Kveraga K, Boshyan J, Bar M. Magnocellular projections as the trigger of top-down facilitation in recognition. J Neurosci 2007; 27:13232-40. [PMID: 18045917 PMCID: PMC6673387 DOI: 10.1523/jneurosci.3481-07.2007] [Citation(s) in RCA: 271] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2007] [Revised: 10/23/2007] [Accepted: 10/24/2007] [Indexed: 11/21/2022] Open
Abstract
Object recognition is traditionally viewed as a hierarchical, bottom-up neural process. This view has been challenged recently by theoretical models and by findings indicating that top-down processes are involved in facilitating recognition. However, how such high-level information can be activated quickly enough to facilitate the bottom-up processing is yet unknown. We propose that such top-down facilitation is triggered by magnocellular information projected early and rapidly to the orbitofrontal cortex. Using human neuroimaging, we show that stimuli designed to bias processing toward the magnocellular pathway differentially activated the orbitofrontal cortex compared with parvocellular-biased stimuli. Although the magnocellular stimuli had a lower contrast than the parvocellular stimuli, they were recognized faster and just as accurately. Moreover, orbitofrontal activity predicted the performance advantage for the magnocellular, but not for the parvocellular-biased, stimuli, whereas the opposite was true in the fusiform gyrus. Last, analyses of effective connectivity using dynamic causal modeling showed that magnocellular-biased stimuli significantly activated pathways from occipital visual cortex to orbitofrontal cortex and from orbitofrontal cortex to fusiform gyrus. Conversely, parvocellular-biased stimuli significantly activated a pathway from the occipital visual cortex to fusiform gyrus. Our findings support the proposal that fast magnocellular projections linking early visual and inferotemporal object recognition regions with the orbitofrontal cortex facilitate object recognition by enabling the generation of early predictions.
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Research Support, N.I.H., Extramural |
18 |
271 |
12
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Chapuis A, Ragnarsson GB, Nguyen HN, Chaney CN, Pufnock JS, Schmitt TM, Duerkopp N, Roberts IM, Pogosov GL, Ho WY, Ochsenreither S, Wölfl M, Bar M, Radich JP, Yee C, Greenberg PD. Transferred WT1-reactive CD8+ T cells can mediate antileukemic activity and persist in post-transplant patients. Sci Transl Med 2013; 5:174ra27. [PMID: 23447018 PMCID: PMC3678970 DOI: 10.1126/scitranslmed.3004916] [Citation(s) in RCA: 258] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Relapse remains a leading cause of death after allogeneic hematopoietic cell transplantation (HCT) for patients with high-risk leukemias. The potentially beneficial donor T cell-mediated graft-versus-leukemia (GVL) effect is often mitigated by concurrent graft-versus-host disease (GVHD). Providing T cells that can selectively target Wilms tumor antigen 1 (WT1), a transcription factor overexpressed in leukemias that contributes to the malignant phenotype, represents an opportunity to promote antileukemic activity without inducing GVHD. HLA-A*0201-restricted WT1-specific donor-derived CD8 cytotoxic T cell (CTL) clones were administered after HCT to 11 relapsed or high-risk leukemia patients without evidence of on-target toxicity. The last four treated patients received CTL clones generated with exposure to interleukin-21 (IL-21) to prolong in vivo CTL survival, because IL-21 can limit terminal differentiation of antigen-specific T cells generated in vitro. Transferred cells exhibited direct evidence of antileukemic activity in two patients: a transient response in one patient with advanced progressive disease and the induction of a prolonged remission in a patient with minimal residual disease (MRD). Additionally, three treated patients at high risk for relapse after HCT survive without leukemia relapse, GVHD, or additional antileukemic treatment. CTLs generated in the presence of IL-21, which were transferred in these latter three patients and the patient with MRD, all remained detectable long-term and maintained or acquired in vivo phenotypic and functional characteristics associated with long-lived memory CD8 T cells. This study supports expanding efforts to immunologically target WT1 and provides insights into the requirements necessary to establish potent persistent T cell responses.
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Research Support, N.I.H., Extramural |
12 |
258 |
13
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Aminoff E, Gronau N, Bar M. The Parahippocampal Cortex Mediates Spatial and Nonspatial Associations. Cereb Cortex 2006; 17:1493-503. [PMID: 16990438 DOI: 10.1093/cercor/bhl078] [Citation(s) in RCA: 243] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The parahippocampal cortex (PHC) has been implicated in the processing of place-related information. It has also been implicated in episodic memory, even for items that are not related to unique places. How could the same cortical region mediate such seemingly different cognitive processes? Both processes rely on contextual associations, and we therefore propose that the PHC should be viewed not as exclusively dedicated for analyzing place-related information, or as solely processing episodic memories, but instead as more generally playing a central role in contextual associative processing. To test this proposal, we created a novel learning paradigm to form new associations among meaningless visual patterns. These new associations were created to emulate either spatial or nonspatial contexts. Both spatial and nonspatial associations activated the PHC more than noncontextual items. Moreover, items from spatial contexts activated the posterior part of the PHC, whereas items from nonspatial contexts activated the anterior PHC. Therefore, we show that the PHC plays a role of processing contextual associations in general, and that these associations are not restricted to spatial information. By modifying the existing view of the PHC function accordingly, the seemingly contradicting processes that activate it can be reconciled under one overarching framework.
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243 |
14
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Kveraga K, Ghuman AS, Bar M. Top-down predictions in the cognitive brain. Brain Cogn 2007; 65:145-68. [PMID: 17923222 PMCID: PMC2099308 DOI: 10.1016/j.bandc.2007.06.007] [Citation(s) in RCA: 214] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 06/07/2007] [Indexed: 11/19/2022]
Abstract
The human brain is not a passive organ simply waiting to be activated by external stimuli. Instead, we propose that the brain continuously employs memory of past experiences to interpret sensory information and predict the immediately relevant future. The basic elements of this proposal include analogical mapping, associative representations and the generation of predictions. This review concentrates on visual recognition as the model system for developing and testing ideas about the role and mechanisms of top-down predictions in the brain. We cover relevant behavioral, computational and neural aspects, explore links to emotion and action preparation, and consider clinical implications for schizophrenia and dyslexia. We then discuss the extension of the general principles of this proposal to other cognitive domains.
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Research Support, N.I.H., Extramural |
18 |
214 |
15
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Abstract
People constantly make snap judgments about objects encountered in the environment. Such rapid judgments must be based on the physical properties of the targets, but the nature of these properties is yet unknown. We hypothesized that sharp transitions in contour might convey a sense of threat, and therefore trigger a negative bias. Our results were consistent with this hypothesis. The type of contour a visual object possesses--whether the contour is sharp angled or curved--has a critical influence on people's attitude toward that object.
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Research Support, Non-U.S. Gov't |
19 |
210 |
16
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Abstract
Humans often evidence little difficulty at recognizing objects from arbitrary orientations in depth. According to one class of theories, this competence is based on generalization from templates specified by metric properties (MPs), that were learned for the various orientations. An alternative class of theories assumes that non-accidental properties (NAPs) might be exploited so that even novel objects can be recognized under depth rotation. After scaling MP and NAP differences so that they were equally detectable when the objects were at the same orientation in depth, the present investigation assessed the effects of rotation on same-different judgments for matching novel objects. Judgments of a sequential pair of images of novel objects, when rendered from different viewpoints, revealed relatively low costs when the objects differed in a NAP of a single part, i.e. a geon. However, rotation dramatically reduced the detectability of MP differences to a level well below that expected by chance. NAPs offer a striking advantage over MPs for object classification and are therefore more likely to play a central role in the representation of objects.
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26 |
141 |
17
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Chiao JY, Iidaka T, Gordon HL, Nogawa J, Bar M, Aminoff E, Sadato N, Ambady N. Cultural specificity in amygdala response to fear faces. J Cogn Neurosci 2009; 20:2167-74. [PMID: 18457504 DOI: 10.1162/jocn.2008.20151] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The human amygdala robustly activates to fear faces. Heightened response to fear faces is thought to reflect the amygdala's adaptive function as an early warning mechanism. Although culture shapes several facets of emotional and social experience, including how fear is perceived and expressed to others, very little is known about how culture influences neural responses to fear stimuli. Here we show that the bilateral amygdala response to fear faces is modulated by culture. We used functional magnetic resonance imaging to measure amygdala response to fear and nonfear faces in two distinct cultures. Native Japanese in Japan and Caucasians in the United States showed greater amygdala activation to fear expressed by members of their own cultural group. This finding provides novel and surprising evidence of cultural tuning in an automatic neural response.
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Research Support, U.S. Gov't, Non-P.H.S. |
16 |
132 |
18
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Abstract
Masked pictures of objects were flashed so briefly that only 13.5% of them could be named. Forced-choice accuracy for the unidentified objects was at chance. When the pictures were shown again, about 15 min and 20 intervening trials later, without any indication of possible repetitions, naming accuracy increased to 34.5%. The priming was completely visual, rather than semantic or verbal, as there was no priming of same-name, different-shape images. This is the first demonstration of facilitatory visual recognition priming by unidentified pictures when the subject could not anticipate if, when, or where the previously unidentified picture was to be shown again. A change in the position of the object reduced but did not eliminate the priming, allowing a speculation that the locus of subliminal visual priming is at an intermediate stage in the ventral cortical pathway for shape recognition.
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127 |
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Bar M, Neta M. Visual elements of subjective preference modulate amygdala activation. Neuropsychologia 2007; 45:2191-200. [PMID: 17462678 PMCID: PMC4024389 DOI: 10.1016/j.neuropsychologia.2007.03.008] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 02/16/2007] [Accepted: 03/01/2007] [Indexed: 11/28/2022]
Abstract
What are the basic visual cues that determine our preference towards mundane everyday objects? We previously showed that a highly potent cue is the nature of the object's contour: people generally like objects with a curved contour compared with objects that have pointed features and a sharp-angled contour. This bias is hypothesized here to stem from an implicit perception of potential threat conveyed by sharp elements. Using human neuroimaging to test this hypothesis, we report that the amygdala, a brain structure that is involved in fear processing and has been shown to exhibit activation level that is proportional to arousal in general, is significantly more active for everyday sharp objects (e.g., a sofa with sharp corners) compared with their curved contour counterparts. Therefore, our results indicate that a preference bias towards a visual object can be induced by low-level perceptual properties, independent of semantic meaning, via visual elements that on some level could be associated with threat. We further present behavioral results that provide initial support for the link between the sharpness of the contour and threat perception. Our brains might be organized to extract these basic contour elements rapidly for deriving an early warning signal in the presence of potential danger.
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Research Support, Non-U.S. Gov't |
18 |
124 |
20
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Abstract
That associative processing provides the vehicle of thought is a long-standing idea. We describe here observations from cognitive neuroimaging that elucidate the neural processing that mediates this element. This account further allows a more specific ascription of a cognitive function to the brain's "default" activity in mindwandering. We extend this account to argue that one primary outcome of associative processing is the generation of predictions, which approximate the immediately relevant future and thus facilitate perception, action, and the progression of thought.
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18 |
111 |
21
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Abstract
In recognizing objects and scenes, partial recognition of objects or their parts can be used to guide the recognition of other objects. Here, the role of individual objects in the recognition of complete figures and the influence of contextual information on the identification of ambiguous objects were investigated. Configurations of objects that were placed in either proper or improper spatial relations were used, and response times and error rates in a recognition task were measured. Two main results were obtained. First, proper spatial relations among the objects of a scene decrease response times and error rates in the recognition of individual objects. Second, the presence of objects that have a unique interpretation improves the identification of ambiguous objects in the scene. Ambiguous objects were recognized faster and with fewer errors in the presence of clearly recognized objects compared with the same objects in isolation or in improper spatial relations. The implications of these findings for the organization of recognition memory are discussed.
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29 |
105 |
22
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Fenske MJ, Aminoff E, Gronau N, Bar M. Top-down facilitation of visual object recognition: object-based and context-based contributions. PROGRESS IN BRAIN RESEARCH 2007; 155:3-21. [PMID: 17027376 DOI: 10.1016/s0079-6123(06)55001-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The neural mechanisms subserving visual recognition are traditionally described in terms of bottom-up analysis, whereby increasingly complex aspects of the visual input are processed along a hierarchical progression of cortical regions. However, the importance of top-down facilitation in successful recognition has been emphasized in recent models and research findings. Here we consider evidence for top-down facilitation of recognition that is triggered by early information about an object, as well as by contextual associations between an object and other objects with which it typically appears. The object-based mechanism is proposed to trigger top-down facilitation of visual recognition rapidly, using a partially analyzed version of the input image (i.e., a blurred image) that is projected from early visual areas directly to the prefrontal cortex (PFC). This coarse representation activates in the PFC information that is back-projected as "initial guesses" to the temporal cortex where it presensitizes the most likely interpretations of the input object. In addition to this object-based facilitation, a context-based mechanism is proposed to trigger top-down facilitation through contextual associations between objects in scenes. These contextual associations activate predictive information about which objects are likely to appear together, and can influence the "initial guesses" about an object's identity. We have shown that contextual associations are analyzed by a network that includes the parahippocampal cortex and the retrosplenial complex. The integrated proposal described here is that object- and context-based top-down influences operate together, promoting efficient recognition by framing early information about an object within the constraints provided by a lifetime of experience with contextual associations.
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Review |
18 |
102 |
23
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Krauss GL, Bar M, Biton V, Klapper JA, Rektor I, Vaiciene-Magistris N, Squillacote D, Kumar D. Tolerability and safety of perampanel: two randomized dose-escalation studies. Acta Neurol Scand 2012; 125:8-15. [PMID: 21883097 DOI: 10.1111/j.1600-0404.2011.01588.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate, for the first time in patients with epilepsy, the tolerability and safety of escalating doses of oral perampanel, a novel, selective, non-competitive AMPA antagonist, as adjunctive therapy for refractory partial-onset seizures. MATERIALS AND METHODS Two consecutive, randomized, double-blind, dose-escalation studies recruited adults (18-70 years) with uncontrolled partial-onset seizures receiving one to three concomitant antiepileptic drugs. In study 206, patients were treated for 12 weeks (8-week dose-titration, 4-week dose-maintenance) with placebo or perampanel (up to 4 mg/day, dosed once- or twice-daily). In study 208, patients received placebo or perampanel once-daily (up to 12 mg) for 16 weeks (12-week titration, 4-week maintenance). RESULTS Overall, 153 patients were randomized into study 206 (perampanel twice-daily, n = 51; perampanel once-daily, n = 51; placebo, n = 51). Study 208 included 48 patients (perampanel once-daily, n = 38; placebo, n = 10). The highest dose in study 206 - 4 mg/day - was well tolerated, with similar proportions of patients tolerating once-daily (82.4%) and twice-daily (82.4%) perampanel and placebo (82.4%) treatments. In study 208 most patients tolerated doses of ≥ 6 mg perampanel once-daily in a Kaplan-Meier analysis. In both studies, the most common adverse events were CNS-related; most were of mild/moderate severity. CONCLUSIONS Perampanel was well tolerated across doses of 4-12 mg/day. The studies showed preliminary evidence of efficacy and identified doses to be evaluated in larger clinical studies.
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Randomized Controlled Trial |
13 |
85 |
24
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Bar M. Predictions: a universal principle in the operation of the human brain. Introduction. Philos Trans R Soc Lond B Biol Sci 2009; 364:1181-2. [PMID: 19527998 DOI: 10.1098/rstb.2008.0321] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Introductory Journal Article |
16 |
81 |
25
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Bar M. A cognitive neuroscience hypothesis of mood and depression. Trends Cogn Sci 2009; 13:456-63. [PMID: 19819753 DOI: 10.1016/j.tics.2009.08.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 08/18/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022]
Abstract
Although mood has a direct impact on mental and physical health, our understanding of the mechanisms underlying mood regulation is limited. Here, I propose that there is a direct reciprocal relation between the cortical activation of associations and mood regulation, whereby positive mood promotes associative processing, and associative processing promotes positive mood. This relation might stem from an evolutionary pressure for learning and predicting. Along these lines, one can think of mood as a reward mechanism that guides individuals to use their brains in the most productive manner. The proposed framework has many implications, most notably for diagnosing and treating mood disorders such as depression; for elucidating the role of inhibition in the regulation of mood; for contextualizing adult hippocampal neurogenesis; and for a general, non-invasive improvement of well-being.
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Research Support, N.I.H., Extramural |
16 |
80 |