Willed action and its impairments

Release of premotor activity after repetitive transcranial magnetic stimulation of prefrontal cortex

In the present study we aimed to explore by means of repetitive transcranial magnetic stimulation (rTMS) the reciprocal influences between prefrontal cortex (PFC) and premotor cortex (PMC). Subjects were asked to observe on a computer monitor different pictures representing manipulations of different kind of tools. They had to produce a movement (go condition) or to keep the resting position (no-go condition) at the appearance of different cue signals represented by different colors shown alternatively on the hands manipulating the tools or on the picture background. Motor evoked potentials (MEPs) were collected at the offset of the visual stimuli before and after a 10 minute, 1 Hz rTMS train applied to the dorsolateral PFC (Experiment 1), to the PMC (Experiment 2) or to the primary motor cortex (Experiment 3). Following rTMS to the PFC, MEPs increased in the go condition when the cue for the go command was presented on the hand. In contrast, following rTMS to the PMC, in the same condition, MEPs were decreased. rTMS to the primary motor cortex did not produce any modulation. Results are discussed according to the presence of a visual-motor matching system in the PMC and to the role of the PFC in the attention-related processes. We hypothesize that the perceptual analysis for action selection within the PFC was modulated by rTMS and its temporary functional inactivation in turn influenced the premotor areas for motor programming.

Dissociating what and when of intentional actions

Recent brain imaging research revealed that internally guided actions involve the frontomedian wall, in particular the preSMA and the rostral cingulate zone (RCZ). However, a systematic decomposition of different components of intentional action is still lacking. We propose a new paradigm to dissociate two components of internally guided behavior: Which action to perform (selection component) and when to perform the action (timing component). Our results suggest a neuro-functional dissociation of intentional action timing and intentional action selection. While the RCZ is more strongly activated for the selection component, a part of the superior medial frontal gyrus is more strongly activated for the timing component. However, in a post hoc conducted signal strength analysis we did also observe an interaction between action timing and action selection, indicating that decisional processes concerning action timing and action selection are not completely dissociated but interdependent. Altogether this study challenges the idea of a unitary system supporting voluntary action and instead suggests the existence of different neuroanatomically dissociable subfunctions.

Levodopa improves time-based prospective memory in Parkinson's disease

The present study was aimed at investigating the effect of acute levodopa administration on the performance of a group of individuals with Parkinson's disease (PD) on a time-based prospective memory task. Twenty PD patients and 15 healthy controls were administered a task that required executing three actions after 10 min had elapsed in three consecutive trials. Scores were computed for correct recall of the intention to perform the actions and for correct execution of the actions. PD participants were evaluated after a 12-hr drug wash-out in two conditions: (1) after levodopa administration ("on"); (2) without drug administration ("off"). In the "on" condition, PD patients were significantly more accurate in retrieving the intention to perform the actions than in the "off" condition and their performance was actually comparable to that of healthy controls. The increased accuracy in complying with the prospective memory task following levodopa medication supports the idea that dopamine depletion plays a role in the prospective memory deficits observed in PD patients.

On the time-course and frequency selectivity of the EEG for different modes of response selection: evidence from speech production and keyboard pressing

OBJECTIVE

To compare brain activity in the alpha and beta bands in relation to different modes of response selection, and to assess the domain generality of the response selection mechanism using verbal and non-verbal tasks.

METHODS

We examined alpha and beta event-related desynchronization (ERD) to analyze brain reactivity during the selection of verbal (word production) and non-verbal motor actions (keyboard pressing) under two different response modes: externally selected and self-selected.

RESULTS

An alpha and beta ERD was observed for both the verbal and non-verbal tasks in both the externally and the self-selected modes. For both tasks, the beta ERD started earlier and was longer in the self-selected mode than in the externally selected mode. The overall pattern of results between the verbal and non-verbal motor behaviors was similar.

CONCLUSIONS

The pattern of alpha and beta ERD is affected by the mode of response selection suggesting that the activity in both frequency bands contributes to the process of selecting actions. We suggest that activity in the alpha band may reflect attentional processes while activity in the beta band may be more closely related to the execution and selection process.

SIGNIFICANCE

These results suggest that a domain general process contributes to the planning of speech and other motor actions. This finding has potential clinical implications, for the use of diverse motor tasks to treat disorders of motor planning.

Paradoxical kinesia at war

Paradoxical kinesia is the sudden transient ability of a patient with Parkinson's disease to perform a task he was previously unable to perform, usually when facing an immediate threat. The sensory cues governing this behavior and the prevalence in real life situations are unknown. The objective of this study was to determine the occurrence of paradoxical kinesia in Parkinson's disease (PD) patients whose residential area was suddenly a war zone, under a life threatening missile attack, necessitating immediate evacuation. Fifty PD patients were interviewed during and immediately following the war. Only two patients experienced paradoxical kinesia, one war related and the other historical, both in response to visual cues. In contrast, an auditory stimulus in the form of a frightening loud siren, warning patients of an imminent missile attack, did not induce paradoxical kinesia. When questioned about their general function during wartime, patients reported significant increases in OFF time (P < 0.01), dyskinesia (P < 0.009), anxiety (P < 0.002), and depression (P < 0.01) as compared with their performance before the war. Paradoxical kinesia is uncommon, even in the face of danger. Visual, but not auditory, triggers appear to be needed to prompt its occurrence.

Developing a verbal protocol method for collecting and analysing reports of workers' thoughts during manual handling tasks

Concurrent and retrospective verbal protocol methods were used to collect thoughts from 18 participants during a manual handling task involving the repeated transfer of loads between locations at two tables. The effectiveness of qualitative and quantitative methods of analysing the reported information was tested in the study. A simple taxonomy was developed to investigate the content of the reports (including reports on postures and loads) and determine how the participants approached the task (whether they made plans, described actions or evaluated their completion of the task). References to posture were obtained in the verbal protocol reports, indicating that the participants had some awareness of their postures during parts of the task. There were similarities in the content of the concurrent and retrospective reports, but there were differences in the amount of detail between the methods and differences in the way the reports were constructed. There could be some scope for developing the quantitative analysis of the frequencies of references to classes of information, though this can only be recommended for concurrent reports on tasks of short duration. The analyses of qualitative data gave a deeper insight into the reports, such as identifying factors that can be important when planning to handle a load, or illustrating how participants can change their focus of attention periodically throughout the task. The relative strengths of the concurrent and retrospective methods are described, along with ideas for improving the quality of information collected in future studies. A number of potential problems with the interpretation of the reported information are explained.

The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease

Alzheimer's disease (AD) is generally understood as primarily affecting cognition while sparing motor function, at least until the later stages of the disease. Studies reported over the past 10 years, however, have documented a prevalence of falls in AD patients significantly higher than in age-matched normal elders; also persons with AD have been observed to have different walking patterns with characteristics that increase gait instability. Recent work in cognitive neuroscience has begun to demonstrate the necessity of intact cognition, particularly executive function, for competent motor control. We put the pieces of this puzzle together and review the current state of knowledge about gait and cognition in general along with an exploration of the association between dementia, gait impairment and falls in AD. We also briefly examine the current treatment of gait instability in AD, mainly exercise, and propose a new approach targeting cognition.

Topography, independent component analysis and dipole source analysis of movement related potentials

The objective of this study was to test, in single subjects, the hypothesis that the signs of voluntary movement-related neural activity would first appear in the prefrontal region, then move to both the medial frontal and posterior parietal regions, progress to the medial primary motor area, lateralize to the contralateral primary motor area and finally involve the cerebellum (where feedback-initiated error signals are computed). Six subjects performed voluntary finger movements while DC coupled EEG was recorded from 64 scalp electrodes. Event-related potentials (ERPs) averaged on the movements were analysed both before and after independent component analysis (ICA) combined with dipole source analysis (DSA) of the independent components. Both a simple topographic analysis of undecomposed ERPs and the ICA/DSA analysis suggested that the original hypothesis was inadequate. The major departure from its predictions was that, while activity over many brain regions did appear at the expected times, it also appeared at unexpected times. Overall, the results suggest that the neuroscientific 'standard model', in which neural activity occurs sequentially in a series of discrete local areas each specialized for a particular function, may reflect the true situation less well than models in which large areas of brain shift simultaneously into and out of common activity states.

Cortical regions involved in the generation of musical structures during improvisation in pianists

Studies on simple pseudorandom motor and cognitive tasks have shown that the dorsolateral prefrontal cortex and rostral premotor areas are involved in free response selection. We used functional magnetic resonance imaging to investigate whether these brain regions are also involved in free generation of responses in a more complex creative behavior: musical improvisation. Eleven professional pianists participated in the study. In one condition, Improvise, the pianist improvised on the basis of a visually displayed melody. In the control condition, Reproduce, the participant reproduced his previous improvisation from memory. Participants were able to reproduce their improvisations with a high level of accuracy, and the contrast Improvise versus Reproduce was thus essentially matched in terms of motor output and sensory feedback. However, the Improvise condition required storage in memory of the improvisation. We therefore also included a condition FreeImp, where the pianist improvised but was instructed not to memorize his performance. To locate brain regions involved in musical creation, we investigated the activations in the Improvise-Reproduce contrast that were also present in FreeImp contrasted with a baseline rest condition. Activated brain regions included the right dorsolateral prefrontal cortex, the presupplementary motor area, the rostral portion of the dorsal premotor cortex, and the left posterior part of the superior temporal gyrus. We suggest that these regions are part of a network involved in musical creation, and discuss their possible functional roles.

Willed action in schizophrenia

This study examined stimulus-driven and willed action in schizophrenic patients and healthy controls using an easy finger-tap task and a more demanding peg-placement task under unimanual, bimanual and dual-task conditions. Peg-placement externally cued by a metronome was also examined, as were practice effects. Patients with marked negative symptoms placed fewer pegs unimanually with and without practice and benefited most from metronome-cueing. Under dual-task conditions, when the participants placed pegs while concurrently finger-tapping, finger-tapping slowed down relative to unimanual scores in patients more than controls. Number of pegs placed also dropped off in controls and the patients with fewer negative symptoms. However, patients with more severe negative symptoms placed just as many pegs, and sometimes more, in the dual-task, compared to the unimanual, condition. These patients appeared to be using their finger-tapping just like an 'external' pacing-stimulus for peg-placement, thus rendering their peg-placement more stimulus-driven than willed. In contrast, patients with fewer negative symptoms and controls tried to self-generate maximal performance on both finger-tapping and peg-placement, with deleterious effects on both tasks. That the patients with marked negative symptoms performed best when their actions were more stimulus-driven than willed strengthens the case that negative schizophrenic symptoms reflect a disorder of willed action.

A "good parent" function of dopamine: transient modulation of learning and performance during early stages of training

While extracellular dopamine (DA) concentrations are increased by a wide category of salient stimuli, there is evidence to suggest that DA responses to primary and conditioned rewards may be distinct from those elicited by other types of salient events. A reward-specific mode of neuronal responding would be necessary if DA acts to strengthen behavioral response tendencies under particular environmental conditions or to set current environmental inputs as goals that direct approach responses. As described in this review, DA critically mediates both the acquisition and expression of learned behaviors during early stages of training, however, during later stages, at least some forms of learned behavior become independent of (or less dependent upon) DA transmission for their expression.

Proprioceptive and sensorimotor performance in Parkinson's disease

We explored the effects of random whole-body vibration on leg proprioception in Parkinson's disease (PD). In earlier studies it was found that this treatment leads to improved postural control in these patients. Thus, one could speculate that these effects result from modified proprioceptive capabilities. Twenty-eight PD patients were subdivided in one experimental and one control group. Proprioceptive performance was analyzed using a tracking task basing on knee extension and flexion movements. Treatment consisted of 5 series of random whole-body vibration taking 60 seconds each. Control subjects had a rest period instead. Prominent over- and undershooting errors were found in both groups representing proprioceptive impairments. No significant differences became evident, however, either between pre- and post-tests or between experimental and control group. One might therefore conclude that spontaneous improvements in postural control are not directly connected with proprioceptive changes. Nevertheless, one also should keep in mind the general aspects and difficulties of analyzing proprioception.

A double-blind placebo-controlled experimental study of nicotine: II--Effects on response inhibition and executive functioning

RATIONALE

Smokers may show abnormal functioning in prefrontal cortex during acute abstinence, reflecting deficient activity in mesocorticolimbic circuitry. Cognitive correlates of this putatively include impaired response inhibition and other aspects of executive functioning.

OBJECTIVES

To investigate whether inhibitory control and other executive functions in smokers are impaired during acute abstinence relative to post-nicotine.

METHODS

145 smokers were tested twice after overnight abstinence-once after nicotine and once after placebo lozenges (order counterbalanced, double-blind)-on an antisaccade task, a continuous performance task (CPT), a delayed response spatial working memory task and a verbal fluency test.

RESULTS

Compared with placebo, nicotine was associated with better inhibitory control on the antisaccade task and fewer impulsive responses to filler stimuli (motor errors) on the CPT; at the first assessment only, nicotine also reduced impulsive responses to 'catch' stimuli on the CPT. However, it did not affect CPT response bias (an index of impulsive vs cautious decision-making), spatial working memory, or verbal fluency.

CONCLUSIONS

Smoking abstinence appears to be associated with a difficulty in inhibiting prepotent motor responses, and with nicotine to attenuate this difficulty. However, more 'cognitive' forms of inhibitory control (e.g. decision-making) and the other aspects of executive function tested here appear to be unaffected.

Impact of cognitive task on the posture of elderly subjects with Alzheimer's disease compared to healthy elderly subjects

The aims of this study were to analyze the effects of cognitive task on static posture in Alzheimer's disease (AD) and in healthy elderly (HE) subjects and to evaluate whether those effects were greater in AD subjects than in HE subjects. We performed a posturographic analysis on 13 subjects with mild AD (mean age, 79.7+/-5.1 years, Mini-Mental State Examination scores between 18 and 23) and on 17 HE subjects (mean age, 78.5+/-4.4 years). After watching a video sequence, the subjects were asked to maintain a stable upright posture while standing on a force platform. Then, the postural sway was measured during the following two conditions: (1) quiet standing and (2) both standing and answering questions about the video sequence. We were interested in the center of pressure (CoP) area and path. For each group, the single task was compared to the dual task for the CoP area and path. We also compared the variability of both CoP area (variation of the CoP area between the single and the dual task) and path (variation of the CoP path between the single and the dual task) between the two groups. We showed that there was no significant difference between the single and the dual task in HE subjects concerning the CoP area and path, in contrast to the AD group, and that variability of both the CoP area and path were significantly greater in the AD subjects than in the HE subjects. This finding may contribute to the risk of falls in AD patients.

Extended habit training reduces dopamine mediation of appetitive response expression

A wide range of behaviors is impaired after disruption of dopamine (DA) transmission, yet behaviors that are reflexive, automatic, or elicited by salient cues often remain intact. Responses triggered by strong external cues appear to be DA independent. Here, we examined the possibility that a single behavior may become DA independent as a result of extended training. Rats were trained to execute a head-entry response to a cue signaling food delivery. Vulnerability of the response to D1 or D2 receptor blockade was assessed on day 3, 7, or 17 of 28-trial-per-day training. During the early stages of training, the D1 receptor antagonist R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine hydrochloride (SCH 23390) increased response latencies; however, the same behavior was unaffected by SCH 23390 in animals tested during the later stages of training. Other aspects of behavior such as locomotion and head-entry responses during the uncued intertrial interval remained vulnerable to SCH 23390 throughout the experiment. This D1-mediated response was unaffected by the D2 antagonist raclopride, even at a dose that strongly suppressed locomotion. The results provide strong evidence that a D1-dependent behavior becomes less dependent on DA with extended training. A number of fundamental neurobiological changes occur as behaviors become learned habits; at least for some responses, this change involves a shift from D1-mediated to D1-independent responding.

Differences Between Intention-Based and Stimulus-Based Actions

Abstract: Actions carried out in response to exogenous stimuli and actions selected endogenously on the basis of intentions were compared in terms of their behavioral (movement timing) and electrophysiological (EEG) profiles. Participants performed a temporal bisection task that involved making left or right key presses at the midpoint between isochronous pacing signals (a sequence of centrally-presented letters). In separate conditions, the identity of each letter either (1) prescribed the location of the subsequent key press response (stimulus-based) or (2) was determined by the location of the preceding key press, in which case participants were instructed to generate a random sequence of letters (intention-based). The behavioral results indicated that stimulus-based movements occurred earlier in time than intention-based movements. The EEG results revealed that activity reflecting stimulus evaluation and response selection was most pronounced in the stimulus-based condition, whereas activity associated with the general readiness to act was strongest in the intention-based condition. Together, the behavioral and electrophysiological findings provide evidence for two modes of action planning, one mediated by stimulus-response bindings and the other by action-effect bindings. The comparison of our results to those of an earlier study ( Waszak et al., 2005 ) that employed spatially congruent visuo-motor mappings rather than symbolic visuo-motor mappings suggests that intention-based actions are controlled by similar neural pathways in both cases, but stimulus-based actions are not.

Visual search deficits in Parkinson's disease are attenuated by bottom-up target salience and top-down information

Patients with Parkinson's disease (PD), a degenerative disorder primarily affecting the nigrostriatal dopamine system, exhibit deficits in selecting task-relevant stimuli in the presence of irrelevant stimuli, such as in visual search tasks. However, results from previous studies suggest that these deficits may vary as a function of whether selection must rely primarily on the "bottom-up" salience of the target relative to background stimuli, or whether "top-down" information about the identity of the target is available to bias selection. In the present study, moderate-to-severe medicated PD patients and age-matched controls were tested on six visual search tasks that systematically varied the relationship between bottom-up target salience (feature search, noisy feature search, conjunction search) and top-down target knowledge (Target Known versus Target Unknown). Comparison of slope and intercepts of the RT x set size function provided information about the efficiency of search and non-search (e.g., decision, response) components, respectively. Patients exhibited higher intercepts than controls as bottom-up target salience decreased, however these deficits were disproportionately larger under Target Unknown compared to Target Known conditions. Slope differences between PD and controls were limited to the Target Unknown Conjunction condition, where patients exhibited a shallower slope in the target absent condition, indicating that they terminated search earlier. These results suggest that under conditions of high background noise, medicated PD patients were primarily impaired in decision and/or response processes downstream from the target search itself, and that the deficit was attenuated when top-down information was available to guide selection of the target signal.

Neuropharmacology of cognition and memory: A unifying theory of neuromodulator imbalance in psychiatry and amnesia

The case of HM, a man with intractable epilepsy who became amnesic following bilateral medial temporal lobe surgery nearly half a century ago has instigated ongoing research and theoretical speculation on the nature of memory and the role of the hippocampus. Neuropsychological testing showed that although HM had extensive anterograde memory loss he could still acquire motor and cognitive skills implicitly, but could not remember the context of this learning. This has lead to declarative and procedural descriptions of the memory process. Cholinergic and monoaminergic neurotransmitter systems have also been implicated in the memory process and anticholinergic drugs traditionally have been associated with impairment of declarative memory. The cholinergic hypothesis of Alzheimer's disease is a classic example of an application of these neuropharmacological findings. In schizophrenia, preattentive deficits have been amply demonstrated by unconscious priming studies. Memory processes are also impaired in these patients. Dopamine, glutamate and even cholinergic dysfunction has been implicated in the clinical picture of schizophrenia. The present paper will attempt to bring together both the anatomical and pharmacological data from these disparate fields of research under a cohesive theory of cognition and memory. A hypothesis is presented for an inverse relationship between monoaminergic and cholinergic systems in the modulation of implicit (unconscious) and explicit (conscious) cognitive processes. It is postulated that muscarinic cholinergic receptors and monoaminergic systems facilitate unconscious and conscious processes, respectively, and they disfacilitate conscious and unconscious processes, respectively (the purported inverse relationship). In fact, the muscarinic and monoaminergic modulations of a neural network are proposed to be finely balanced such that, if, the activity of one receptor system is modified then this by necessity has effects on the other system. It takes into account receptor subtypes and their effects mediated through excitatory and inhibitory G-protein complexes. For example, m1/D2 and D1/m4 paired receptor subtypes, colocalized on separate neurons would have opposing functional effects. A theory is then presented that the critical underlying pathophysiology of schizophrenia involves a hypofunctional muscarinic cholinergic system, which induces abnormal facilitation of monoaminergic subsystems such as dopamine (e.g., a decrease in m1R function would potentiate D2R function). This extends the idea of an inverted U function for optimal monoaminergic concentrations. Not only would this impair unconscious preattentive processes, but according to the hypothesis, explicit cognition as well including memory deficits and would underlie the mechanism of psychosis. Contrary to current thinking a different view is also presented for the role of the hippocampus in the memory process. It is postulated that long-term explicit memory traces in the neocortex are laid down by phasic coactivation of forebrain projecting monoaminergic systems above some basal firing rate, such as the rostral serotonergic raphe, which projects diffusely to the cortex and according to a modified Hebbian principle. This is the proposed principal function of the hippocampal theta rhythm. The phasic activation of the cholinergic basal forebrain is mediated by projections from a separate cortical structure, possibly the lateral prefrontal cortex. Phasic muscarinic receptor activation is proposed to strengthen implicit memory traces (at a synaptic level) in the neocortex. Thus, the latter are spared by medial temporal surgery explaining the dissociation of explicit from implicit memory.

Cognitive- and movement-related potentials recorded in the human basal ganglia

Sources of potentials evoked by cognitive processing of sensory and motor activities were studied in 9 epilepsy surgery candidates with electrodes implanted in the basal ganglia (BG), mostly in the putamen. Several contacts were also located in the pallidum and the caudate. The recorded potentials were related to a variety of cognitive and motor activities (attentional, decisional, time estimation, sensory processing, motor preparation, and so on). In five different tests, we recorded P3-like potentials evoked by auditory and visual stimuli and sustained potential shifts in the Bereitschaftspotential and Contingent Negative Variation protocols. All of the studied potentials were generated in the BG. They were recorded from all over the putamen. Various potentials on the same lead or nearby contacts were recorded. A functional topography in the BG was not displayed. We presume that the cognitive processes we studied were produced in clusters of neurons that are organized in the basal ganglia differently than the known functional organization, e.g., of motor functions. The basal ganglia, specifically the striatum, may play an integrative role in cognitive information processing, in motor as well as in nonmotor tasks. This role seems to be nonspecific in terms of stimulus modality and in terms of the cognitive context of the task.

Expanding the response space in chronic schizophrenia: the relevance of left prefrontal cortex

OBJECTIVE

This study probed the ability of people with chronic schizophrenia to control their behavior in time by requiring them to deliberately vary responses within the temporal domain (i.e., to avoid regular inter-response intervals).

METHODS

Thirteen schizophrenia patients performed single finger movements (at moments of their own choosing) in an event-related functional magnetic resonance imaging paradigm. Their performance was computed using the coefficient of variation of inter-response interval duration.

RESULTS

Task performance was positively correlated with activation of left lateral prefrontal cortex. Post hoc analyses revealed an inverse correlation between activation in this region and severity of attentional impairment.

CONCLUSION

These findings implicate left lateral prefrontal cortex in the modulation of the temporal response space in schizophrenia and imply greater attentional (executive) impairment among those who fail to modulate their behavior in time.

The influence of working memory load on phase specific patterns of cortical activity

This study investigated patterns of cortical activity associated with the temporally separated encoding, maintenance and retrieval phases of a working memory (WM) task. Eighteen healthy subjects completed a variable load version of the Sternberg Item Recognition Task. Brain regions showing activity on average across load were determined for each task phase. In addition, brain regions showing activity that increased linearly with load were determined for encoding and retrieval. Although previous fMRI studies have used event-related designs to isolate phase specific activity, this study differed in that design and analysis methods were optimized to ensure low multicollinearity between the conditions of interest: the duration of the intermediate phase (maintenance) was varied and load was selectively modeled for the encoding and retrieval phases. The brain areas showing activity on average across load for each phase combine to encompass regions identified in previous studies that have not attempted to separate phase specific activity. Encoding is associated with extensive load dependent activity, with the most robust activity in bilateral occipital and posterior parietal regions. Retrieval is associated with more selective load dependent activity, primarily in the anterior supplementary motor region and the right posterior cerebellum. The analysis strategies employed in this study could be used to further delineate the phases of WM that are most severely compromised in clinical populations with WM disturbances.

Executive dysfunction in Parkinson's disease is associated with altered pallidal-frontal processing

Executive dysfunction in Parkinson's disease is well documented, but it is still unclear whether this results from (i) prefrontal dysfunction, (ii) striatal dysfunction, or (iii) altered striatal outflow to the prefrontal cortex. To clarify this issue, we used H(2)(15)O PET to asses six nondemented and nondepressed patients with Parkinson's disease and six matched controls while they performed a task involving executive function, random number generation (RNG), and a control counting task. To assess the effect of increasing task demands, each task was performed at three rates. Both groups showed significant increase in nonrandomness of responses during RNG at faster rates, which was differentially greater for the patients at the faster rate. The controls showed significant activation of the lateral and medial prefrontal cortex and superior and medial parietal cortex during RNG relative to counting. For the same comparison, the patients did not show any activity in medial frontal structures. The controls showed significantly greater mesial frontotemporal activation during counting than RNG, whereas the patients did not show any modulation of regional cerebral blood flow (rCBF) in these areas with task. With faster rates of RNG, the controls showed rCBF increase in the right internal segment of globus pallidus (GPi) and a decrease in frontal cortex. The patients showed the opposite pattern of subcortical and frontal rCBF change with faster rates. The results suggest that executive dysfunction in Parkinson's disease is associated with a failure to modulate frontal activation with increased task demands (nature of task or rate), a deficit associated with altered rCBF in the GPi, the final basal ganglia output pathway to frontal cortex rather than any intrinsic prefrontal dysfunction.

Intention-based and stimulus-based mechanisms in action selection

Human actions can be classified as being either more stimulus-based or more intention-based. According to the ideomotor framework of action control, intention-based actions primarily refer to anticipated action effects (in other words response-stimulus [R-S] bindings), whereas stimulus-based actions are commonly assumed to be more strongly determined by stimulus-response [S-R] bindings. We explored differences in the functional signatures of both modes of action control in a temporal bisection task. Participants either performed a choice response by pressing one out of two keys in response to a preceding stimulus (stimulus-based action), or pressed one out of two keys to produce the next stimulus (intention-based action). In line with the ideomotor framework, we found intention-based actions to be shifted in time towards their anticipated effects (the next stimulus), whereas stimulus-based actions were shifted towards their preceding stimulus. Event-related potentials (ERPs) in the EEG revealed marked differences in action preparation for the two tasks. The data as a whole provide converging evidence for functional differences in the selection of motor actions as a function of their triggering conditions, and support the notion of two different modes of action selection, one being exogenous or mainly stimulus-driven, the other being endogenous or mainly intention-driven.

The basal ganglia: anatomy, physiology, and pharmacology

The basal ganglia are perceived as important nodes in cortico-subcortical networks involved in the transfer, convergence, and processing of information in motor, cognitive, and limbic domains. How this integration might occur remains a matter of some debate, particularly given the consistent finding in anatomic and physiologic studies of functional segregation in cortico-subcortical loops. More recent theories, however, have raised the notion that modality-specific information might be integrated not spatially, but rather temporally, by coincident processing in discrete neuronal populations. Basal ganglia neurotransmitters, given their diverse roles in motor performance, learning, working memory, and reward-related activity are also likely to play an important role in the integration of cerebral activity. Further work will elucidate this to a greater extent, but for now, it is clear that the basal ganglia form an important nexus in the binding of cognitive, limbic, and motor information into thought and action.

fMRI studies of temporal attention: allocating attention within, or towards, time

Attention is distributed in time as well as space. Moreover, attention can be actively directed both within, and towards, time. This review article summarises behavioural and neuroanatomical correlates of temporal aspects of attention. Orienting attention to particular moments in time, or selectively attending to temporal rather than non-temporal stimulus features, improves behavioural measures of performance. These effects are accompanied by specific increases in activity of functionally specialised, and anatomically discrete, brain regions. Left parietal cortex is associated with orienting attention to specific moments in time. Pre-supplementary motor area (SMA) is associated with selectively attending to, and estimating, time. Frontal operculum is associated with all of these processes as well as being activated when attentional resources are limited by time itself. The frontal operculum therefore plays a pivotal role in the multi-faceted interaction between time and attention.

Willed action and attention to the selection of action

Actions are said to be 'willed' if we consciously pay attention to their selection. It has been suggested that they are associated with activations in the dorsal prefrontal cortex (area 46). However, because previous experiments typically used a 'free selection' paradigm to examine this hypothesis, it is unclear whether the results reflected the attention to the selection of action or the freedom of choice allowed by the tasks. In this experiment, we minimized the difference of working memory demand across task conditions by using novel stimuli in each trial. We found that activation in the dorsal prefrontal cortex on a free selection task was not significantly different from that induced by another task that required attention to the selection of action, although the responses were externally specified. This suggests that the dorsal prefrontal cortex is in fact associated with attention to the selection of action, but does not play a unique role in the generation of internally initiated actions. However, the presupplementary motor area (pre-SMA) may subserve this function as activity in this region was found to be tightly associated with the free selection of responses.

Doing without deliberation: automatism, automaticity, and moral accountability

Actions performed in a state of automatism are not subject to moral evaluation, while automatic actions often are. Is the asymmetry between automatistic and automatic actions justified? In order to answer this question we need a model of moral accountability that does justice to our intuitions about a range of modes of agency, both pathological and non-pathological. Our aim in this paper is to lay the groundwork for the development of such a model.

Adaptation to tempo changes in sensorimotor synchronization: effects of intention, attention, and awareness

Adaptation to tempo changes in sensorimotor synchronization is hypothesized to rest on two processes, one (phase correction) being largely automatic and the other (period correction) requiring conscious awareness and attention. In this study, participants tapped their finger in synchrony with auditory sequences containing a tempo change and continued tapping after sequence termination. Their intention to adapt or not to adapt to the tempo change was manipulated through instructions, their attentional resources were varied by introducing a concurrent secondary task (mental arithmetic), and their awareness of the tempo changes was assessed through perceptual judgements. As predicted, period correction was found to be strongly dependent on all three variables, whereas phase correction depended only on intention.

From facial cue to dinner for two: the neural substrates of personal choice

The current experiment examined the neural substrates of response selection, comparing conditions that required participants to make criterion-free selections from sets of same-sex faces (i.e., inconsequential decision) to choosing a dinner date from opposite-sex faces (i.e., consequential decision). In each of these tasks, either a single face (i.e., no choice) or two or three faces (i.e., free choice) appeared for selection. The results revealed that regions of dorsal premotor cortex (PMd) and parietal cortex bilaterally, as well as an area along the medial surface of the superior frontal gyrus, were activated by both consequential and inconsequential decisions, thereby providing evidence for a common selection network. Consequential decisions were further indexed by activation of the insula/ventrolateral prefrontal cortex (BA 47) and the paracingulate gyrus (BA 32). The implications of these findings for current accounts of response selection and social-cognitive functioning are considered.

Theory of mind, social development, and psychosis

The difficulty in interpreting other people's mental states found in children with autism and in people affected by schizophrenia may be explained in terms of a unique mental process called Theory of Mind. The paper discusses the main operational issues of such a peculiar aspect of social cognition, the Theory of Mind, and its implication in schizophrenia, including a review of its related neural structures. Theory of Mind abilities may be a relevant aspect of social interaction involving people affected by schizophrenia, and they need to be further investigated in clinical research.

Age-Related Differences in Response Preparation: The Role of Time Uncertainty

This study explored the ability of younger and older participants to use a variable preparatory interval (PI) to enhance reaction time (RT) performance. In Experiment 1, 30 seniors and 15 young adults completed simple and choice RT tasks with short and long variable PIs. RT decreased with increasing PI duration in both younger and older adults, but the PI effect was larger in elderly individuals. The results of Experiment 2 (20 seniors and 20 young adults) showed an equivalent preparatory effect in older and younger adults when the probability of the shortest PI was increased. These findings suggest that older adults do not prepare as well as younger adults for unlikely events and that time uncertainty affects age-related differences in response preparation.

Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer's disease

OBJECTIVES

To evaluate how cognitive function and divided attention affect gait in Alzheimer's disease (AD).

DESIGN

Cross-sectional intervention study with subjects serving as their own controls.

SETTING

Inpatient unit and outpatient clinic for patients with dementia located at a Veterans Affairs Medical Center.

PARTICIPANTS

Twenty-eight patients diagnosed with probable AD.

INTERVENTION

Performance of a cognitive task (repeating random digits) while walking.

MEASUREMENTS

Neuropsychological measures including clock drawing, verbal fluency, and digit span were obtained along with the Clinical Dementia Rating and Mini-Mental State Examination, the measures of dementia severity. Gait speed and stride-to-stride variability of gait rhythm were measured, once during normal walking and once during dual-task walking.

RESULTS

During usual walking, subjects walked slowly and with greater gait variability than older adults without AD. Gait speed was significantly reduced (P<.012) and gait variability increased with dual-task walking (P<.007). The effect on gait variability was larger than the effect on gait speed (P<.015). Executive and neuropsychological function were significantly (P<.02) associated with the increased gait variability that occurred when walking with divided attention but not with gait speed or usual, single-task walking measures of gait.

CONCLUSION

Divided attention markedly impairs the ability of patients with AD to regulate the stride-to-stride variations in gait timing. This susceptibility to distraction and its effect on stride time variability, a measure of gait unsteadiness, could partially explain the predilection to falling observed in patients with dementia. The results also support the concept that persons with AD have significant impairments in the cognitive domain of attention and that locomotor function relies upon cognitive, especially executive, function.

Cognitive executive function in dystonia

Dystonia is a movement disorder considered to result from basal ganglia dysfunction. The aim of this study was to investigate the functional significance of frontal hyperactivity demonstrated in dystonia in imaging studies by examining executive function and working memory, in which the prefrontal cortex is known to be involved. We assessed 10 patients with idiopathic dystonia and 12 age- and IQ-matched normal controls. All subjects completed tests of first letter, category, and alternating category word fluency, the Wisconsin Card Sorting Test, the Stroop Colour Word Naming Test, the Missing Digit Test of working memory, a test of random number generation, a test requiring generation of self-ordered random number sequences, the Paced Serial Addition Test, a test of conditional associative learning, and finger tapping and peg insertion under unimanual, bimanual, and dual task conditions. The patients with dystonia did not differ significantly from controls on any measures of executive function or working memory used other than category word fluency and the extent of decline in tapping with one hand under dual task conditions when simultaneously inserting pegs with the other hand. For this small sample, the results suggest that unlike other movement disorders associated with fronto-striatal dysfunction such as Parkinson's disease or Huntington's disease, dystonia was not associated with deficits on the tests of executive function or working memory used. A more detailed investigation of cognitive function in a larger sample of patients is required.

Inhibition of ongoing responses following frontal, nonfrontal, and basal ganglia lesions

The authors investigated the role of the frontal lobes and the basal ganglia in the inhibition of ongoing responses. Seventeen patients with frontal lesions (FG), 20 patients with lesions outside the frontal cortex (NFG), 8 patients with lesions to the basal ganglia (BG), and 20 orthopedic controls (OG) performed the stop-signal task that allows the estimation of the time it takes to inhibit an ongoing reaction (stop signal reaction time [SSRT]). The FG and the BG showed significantly longer SSRTs than the OG. Within the FG, patients with right and bilateral lesions showed significantly longer SSRTs than patients with left lesions. Results provide evidence for a role of the frontal lobes and the basal ganglia in the inhibition of ongoing responses.

Abulia: a delphi survey of British neurologists and psychiatrists

Abulia is the relatively uncommon yet debilitating lack of spontaneous, goal-directed behaviour that is seen predominantly with lesions of the basal ganglia and the frontal lobes. We sought to confirm the existence of abulia as an entity recognized by clinicians, to generate a set of items characteristic of the condition, and to see how clinicians differentiate between overlapping disorders. The Delphi technique was used to survey consultant neurologists and psychiatrists at three hospitals in London. The study consisted of two phases: semi- structured interviews of a small group of neurologists and psychiatrists, followed by a survey of a larger group of consultants using postal questionnaires. Both neurologists and psychiatrists recognized abulia to be a distinct clinical entity but its status as a syndrome was unclear. Features such as difficulty in initiating and sustaining spontaneous movements and reduction in emotional responsiveness, spontaneous speech, and social interaction were identified as being characteristic of abulia. The information generated by this study may help to develop a working classification for disorders of diminished drive and motivation, and instruments for clinical assessment and decision making.

Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model

BACKGROUND

Incentive-motivation models of addiction suggest impairment of functional activity in mesocorticolimbic reward pathways during abstinence. This study tested implications for subjective and behavioral responses to nondrug incentives, cue-elicited craving, and prefrontal cognitive functions, particularly response inhibition.

METHODS

We tested 26 smokers after smoking and after overnight abstinence in counterbalanced order; 26 nonsmokers were also tested twice. Measures included a simple card-sorting test performed with and without financial incentive (the CARROT), the Snaith Hamilton Pleasure Scale as an index of subjective reward responsiveness, ratings of subjective craving and withdrawal before and after exposure to a cigarette, an index of oculomotor response inhibition (saccadic vs. antisaccadic eye movements), verbal fluency, and reversed digit span.

RESULTS

Compared with the smoking condition, and independently of withdrawal severity, abstinence was associated with reduced cue reactivity, pleasure expectancies, responsiveness to financial incentive, and response inhibition (antisaccadic eye movements). Verbal fluency and reversed digit span were unaffected, contrary to findings elsewhere with heavier smokers. Nonsmokers' scores either fell between those of abstainers and recent smokers or approximated those of recent smokers.

CONCLUSIONS

The data were in general consistent with behavioral predictions derived from the incentive-motivational model of addiction and suggest that abstinence may be associated with impairments of motivation and response inhibition, which are independent of other subjectively experienced withdrawal symptoms.

Interference with performance of a response selection task that has no working memory component: an rTMS comparison of the dorsolateral prefrontal and medial frontal cortex

It has been suggested that the dorsolateral prefrontal cortex (DLPFC) is involved in free selection (FS), the process by which subjects themselves decide what action to perform. Evidence for this proposal has been provided by imaging studies showing activation of the DLPFC when subjects randomly generate responses. However, these response selection tasks have a hidden working memory element and it has been widely reported that the DLPFC is activated when subjects perform tasks which involve working memory. The primary aim of this experiment was to establish if the DLPFC is genuinely involved in response selection. We used repetitive transcranial magnetic stimulation (rTMS) to investigate whether temporary interference of the DLPFC could disrupt performance of a response selection task that had no working memory component. Subjects performed tasks in which they made bimanual sequences of eight nonrepeating finger movements. In the FS task, subjects chose their movements at random while a computer monitor displayed these moves. This visual feedback obviated the need for subjects to maintain their previous moves "on-line." No selection was required for the two control tasks as responses were cued by the visual display. The attentional demands of the control tasks varied. In the high load (HL) version, subjects had to maintain their attention throughout the sequence, but this requirement was absent in the low load (LL) task. rTMS over the DLPFC slowed response times on the FS task and at the end of the sequence on the HL task, but had no effect on the LL task. rTMS over the medial frontal cortex (MFC) slowed response times on the FS task but had no effect on the HL task. This suggests that a response selection task without a working memory load will depend on the DLPFC and the MFC. The difference appears to be that the DLPFC is important when selecting between competing responses or when concentrating if there is a high attentional demand, but that the MFC is only important during the response selection task.

Movement-related potentials in the basal ganglia: a SEEG readiness potential study

OBJECTIVES

The brain potentials preceding and accompanying self-paced acral limb movements (Bereitschaftspotential/readiness potential (RP) paradigm) were studied in 12 patients.

METHODS

Intracranial electrodes were implanted in order to explore intractable epilepsy. The electrodes were introduced into sites corresponding to the electroclinical characteristics of each patient's epileptic seizures. In 7 patients, several depth electrodes were implanted orthogonally, in the temporal, fronto-orbital and prefrontal cortex. In 4 patients, subdural strip electrodes were used for the exploration of the fronto-temporal convexity. There were no RPs recorded in these areas. No contacts were placed in the central region known to generate cortical RP. In all the patients, one or two diagonal electrodes passed through or touched the basal ganglia to reach the amygdala and the hippocampus. The putamen was explored in 11 patients (in 3 of them bilaterally); the caudate head was explored in two patients, and the pallidum was explored in two patients.

RESULTS

RP with a clear amplitude gradient was present in all explored structures, however a phase reversal was never observed. RP was observed in the caudate in all recordings, and in the pallidum in one patient. It was recorded in the putamen in 8 out of the 11 explored patients. RPs were displayed contralaterally to the movement 9 times in 13 explorations, and ipsilaterally 4 times in 9 explorations. The shape of RP resembled the RP shape in the cortex and on the scalp. Movement accompanying potentials (MAPs) were also present in all 3 explored structures. The electrophysiological characteristics of MAP differed from RP, indicating separate generators. In the basal ganglia, RPs preceded the onset of movement by 500-1500 ms, at an average of 1080 (+/-330) ms. It seems that the RP in the basal ganglia starts slightly later than the RP in the motor cortices. That should be definitely demonstrated in patients with simultaneous recordings from cortical and subcortical structures. RP and MAP were displayed synchronously in the cortex and in the basal ganglia during most of the premovement period, as well as during the execution of movement. RP generators were reported by several authors in other deeply located structures, i.e. in the thalamus and in the brain-stem.

CONCLUSIONS

Based on all these recordings, we presume that the RPs recorded on the scalp are generated simultaneously in several cortical as well as subcortical structures.

Neural correlates of advance movement preparation: a dipole source analysis approach

This study examined cortical motor structures that are involved in preprogramming and execution of movements. In two independent experiments a response precuing task was employed that combined the recording of movement-related brain potentials (MRPs) with spatio-temporal source localization. Behavioral and MRP results indicated the utilization of advance information about movement direction and hand. Dipole source modeling of foreperiod MRPs revealed a reliable three-dipole solution with sources located in lateral and medial brain regions anterior to the precentral gyrus. These dipoles were located in the lateral premotor area (PMA) and supplementary/cingulate motor areas (SMA/CMA). Activity of the medial dipole increased with the extent of advance motor preparation, whereas lateral dipole activity revealed parallel preparation of both response hands when only partial information about movement direction was available. The dissociation in the strength and the onset of medial and lateral dipole activity indicated two phases of motor preparation. We propose that medial motor areas like SMA and CMA are involved in the assembling and selection of abstract movement programs, whereas lateral PMA and primary motor cortex are involved in effector-specific motor preparation.

Conditioned blocking and schizophrenia: a replication and study of the role of symptoms, age, onset-age of psychosis and illness-duration

Measures of selective attention processing like latent inhibition (LI) and conditioned blocking (CB) are disturbed in some patients with schizophrenia. [LI is the delay in learning about the associations of a stimulus that has been associated with no event (versus de novo learning); CB is the delay in learning the associations of a stimulus-component when the other component has already started to acquire these associations.] We proposed: (1) to replicate the reported decreases of CB in patients without paranoid-hallucinatory symptoms; (2) to see if CB depends on the age of illness-onset and its duration, as reported for LI. We studied 101 young and old, acute and chronically ill patients with schizophrenia, of whom 62 learned a modified 'mouse-in-house' CB task, and compared them with 62 healthy controls matched for age, education and socio-economic background. CB was more evident in patients with a diagnosis of paranoid schizophrenia than other subtypes. An unusual persistence of high CB scores through testing was associated with productive symptoms (including positive thought disorder). Reduced CB related to the expression of (a) Schneider's first rank symptoms of ideas-of-reference and (b) to negative symptoms like poor rapport and poor attention. CB was less evident in the older patients and those with an earlier illness-onset. In contrast to the similar LI test of selective attention, CB is found in patients with paranoid schizophrenia and its expression is not related closely to illness duration. This implies that the two tests reflect the activity of different underlying processes. We suggest that reduced CB on initial test-trials in nonparanoid schizophrenia reflects the unusual persistence of controlled information processing strategies that would normally become automatic during conditioning. In contrast, continued CB during testing reflects an unusual persistence of automatic processing strategies.

Abnormalities in the awareness and control of action

Much of the functioning of the motor system occurs without awareness. Nevertheless, we are aware of some aspects of the current state of the system and we can prepare and make movements in the imagination. These mental representations of the actual and possible states of the system are based on two sources: sensory signals from skin and muscles, and the stream of motor commands that have been issued to the system. Damage to the neural substrates of the motor system can lead to abnormalities in the awareness of action as well as defects in the control of action. We provide a framework for understanding how these various abnormalities of awareness can arise. Patients with phantom limbs or with anosognosia experience the illusion that they can move their limbs. We suggest that these representations of movement are based on streams of motor commands rather than sensory signals. Patients with utilization behaviour or with delusions of control can no longer properly link their intentions to their actions. In these cases the impairment lies in the representation of intended movements. The location of the neural damage associated with these disorders suggests that representations of the current and predicted state of the motor system are in parietal cortex, while representations of intended actions are found in prefrontal and premotor cortex.

Orienting attention in time: behavioural and neuroanatomical distinction between exogenous and endogenous shifts

Temporal orienting of attention is the ability to focus resources at a particular moment in time in order to optimise behaviour, and is associated with activation of left parietal and premotor cortex [Coull, J. T., Nobre, A. C. Where and when to pay attention: the neural systems for directing attention to spatial locations and to time intervals as revealed by both PET and fMRI. Journal of Neuroscience, 1998, 18, 7426-7435]. In the present experiment, we explored the behavioural and anatomical correlates of temporal orienting to foveal visual stimuli, in order to eliminate any spatial attention confounds. We implemented a two-way factorial design in an event-related fMRI study to examine the factors of trial validity (predictability of target by cue), length of delay (cue-target interval), and their interaction. There were two distinct types of invalid trial: those where attention was automatically drawn to a premature target and those where attention was voluntarily shifted to a delayed time-point. Reaction times for valid trials were shorter than those for invalid trials, demonstrating appropriate allocation of attention to temporal cues. All trial-types activated a shared system, including frontoparietal areas bilaterally, showing that this network is consistently associated with attentional orienting and is not specific to spatial tasks. Distinct brain areas were sensitive to cue-target delays and to trial validity. Long cue-target intervals activated areas involved in motor preparation: supplementary motor cortex, basal ganglia and thalamus. Invalid trials, where temporal expectancies were breached, showed enhanced activation of left parietal and frontal areas, and engagement of orbitofrontal cortex bilaterally. Finally, trial validity interacted with length of delay. Appearance of targets prematurely selectively activated visual extrastriate cortex; while postponement of target appearance selectively activated right prefrontal cortex. These findings suggest that distinct brain areas are involved in redirecting attention based upon sensory events (bottom-up, exogenous shifts) and based upon cognitive expectations (top-down, endogenous shifts).

Covert visual spatial orienting and saccades: overlapping neural systems

We used functional magnetic resonance imaging (fMRI) to investigate the functional anatomical relationship between covert orienting of visual spatial attention and execution of saccadic eye movements. Brain areas engaged by shifting spatial attention covertly and by moving the eyes repetitively toward visual targets were compared and contrasted directly within the same subjects. The two tasks activated highly overlapping neural systems and showed that common parietal and frontal regions are more activated during the covert task than the overt oculomotor condition. The possible nature of the relationship between these two operations is discussed.