Multisensory integration across the senses in young and old adults

Hazard warning modalities and timing thresholds for older drivers with impaired vision

PURPOSE

We examined collision warning systems with different modalities and timing thresholds, assessing their impact on responses to pedestrian hazards by drivers with impaired contrast sensitivity (ICS).

METHODS

Seventeen ICS (70-84 y, median CS 1.35 log units) and 17 normal vision (NV: 68-73 y, median CS 1.95) participants completed 6 city drives in a simulator with 3 bimodal warnings: visual-auditory, visual-directional-tactile, and visual-non-directional-tactile. Each modality had one drive with early and one with late warnings, triggered at 3.5 s and 2 s time-to-collision, respectively.

RESULTS

ICS participants triggered more early (43 vs 37 %) and late warnings (12 vs 6 %) than NV participants and had more collisions (3 vs 0 %). Early warnings reduced time to fixate hazards (late 1.9 vs early 1.2 s, p < 0.001), brake response times (2.8 vs 1.8 s, p < 0.001) and collision rates (1.2 vs 0.02 %). With late warnings, ICS participants took 0.7 s longer to brake than NV (p < 0.001) and had an 11 % collision rate (vs 0.7 % with early warnings). Non-directional-tactile warnings yielded the lowest collision rates for ICS participants (4 vs auditory 12 vs directional-tactile 15.2 %) in late warning scenarios. All ICS participants preferred early warnings.

CONCLUSIONS

While early warnings improved hazard responses and reduced collisions for ICS participants, late warnings did not, resulting in high collision rates. In contrast, both early and late warnings were helpful for NV drivers. Non-directional-tactile warnings were the most effective in reducing collisions. The findings provide insights relevant to the development of hazard warnings tailored for drivers with impaired vision.

A drift diffusion model analysis of age-related impact on multisensory decision-making processes

Older adults (OAs) are typically slower and/or less accurate in forming perceptual choices relative to younger adults. Despite perceptual deficits, OAs gain from integrating information across senses, yielding multisensory benefits. However, the cognitive processes underlying these seemingly discrepant ageing effects remain unclear. To address this knowledge gap, 212 participants (18-90 years old) performed an online object categorisation paradigm, whereby age-related differences in Reaction Times (RTs) and choice accuracy between audiovisual (AV), visual (V), and auditory (A) conditions could be assessed. Whereas OAs were slower and less accurate across sensory conditions, they exhibited greater RT decreases between AV and V conditions, showing a larger multisensory benefit towards decisional speed. Hierarchical Drift Diffusion Modelling (HDDM) was fitted to participants' behaviour to probe age-related impacts on the latent multisensory decision formation processes. For OAs, HDDM demonstrated slower evidence accumulation rates across sensory conditions coupled with increased response caution for AV trials of higher difficulty. Notably, for trials of lower difficulty we found multisensory benefits in evidence accumulation that increased with age, but not for trials of higher difficulty, in which increased response caution was instead evident. Together, our findings reconcile age-related impacts on multisensory decision-making, indicating greater multisensory evidence accumulation benefits with age underlying enhanced decisional speed.

Linking Dementia Pathology and Alteration in Brain Activation to Complex Daily Functional Decline During the Preclinical Dementia Stages: Protocol for a Prospective Observational Cohort Study

BACKGROUND

Progressive difficulty in performing everyday functional activities is a key diagnostic feature of dementia syndromes. However, not much is known about the neural signature of functional decline, particularly during the very early stages of dementia. Early intervention before overt impairment is observed offers the best hope of reducing the burdens of Alzheimer disease (AD) and other dementias. However, to justify early intervention, those at risk need to be detected earlier and more accurately. The decline in complex daily function (CdF) such as managing medications has been reported to precede impairment in basic activities of daily living (eg, eating and dressing).

OBJECTIVE

Our goal is to establish the neural signature of decline in CdF during the preclinical dementia period.

METHODS

Gait is central to many CdF and community-based activities. Hence, to elucidate the neural signature of CdF, we validated a novel electroencephalographic approach to measuring gait-related brain activation while participants perform complex gait-based functional tasks. We hypothesize that dementia-related pathology during the preclinical period activates a unique gait-related electroencephalographic (grEEG) pattern that predicts a subsequent decline in CdF.

RESULTS

We provide preliminary findings showing that older adults reporting CdF limitations can be characterized by a unique gait-related neural signature: weaker sensorimotor and stronger motor control activation. This subsample also had smaller brain volume and white matter hyperintensities in regions affected early by dementia and engaged in less physical exercise. We propose a prospective observational cohort study in cognitively unimpaired older adults with and without subclinical AD (plasma amyloid-β) and vascular (white matter hyperintensities) pathologies. We aim to (1) establish the unique grEEG activation as the neural signature and predictor of decline in CdF during the preclinical dementia period; (2) determine associations between dementia-related pathologies and incidence of the neural signature of CdF; and (3) establish associations between a dementia risk factor, physical inactivity, and the neural signature of CdF.

CONCLUSIONS

By establishing the clinical relevance and biological basis of the neural signature of CdF decline, we aim to improve prediction during the preclinical stages of ADs and other dementias. Our approach has important research and translational implications because grEEG protocols are relatively inexpensive and portable, and predicting CdF decline may have real-world benefits.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56726.

Sex Differences in Low-Level Multisensory Integration in Developmental Dyslexia

Reading acquisition involves the integration of auditory and visual stimuli. Thus, low-level audiovisual multisensory integration might contribute to disrupted reading in developmental dyslexia. Although dyslexia is more frequently diagnosed in males and emerging evidence indicates that the neural basis of dyslexia might differ between sexes, previous studies examining multisensory integration did not evaluate potential sex differences nor tested its neural correlates. In the current study on 88 adolescents and young adults, we found that only males with dyslexia showed a deficit in multisensory integration of simple nonlinguistic stimuli. At the neural level, both females and males with dyslexia presented smaller differences in response to multisensory compared to those in response to unisensory conditions in the N1 and N2 components (early components of event-related potentials associated with sensory processing) than the control group. Additionally, in a subsample of 80 participants matched for nonverbal IQ, only males with dyslexia exhibited smaller differences in the left hemisphere in response to multisensory compared to those in response to unisensory conditions in the N1 component. Our study indicates that deficits of multisensory integration seem to be more severe in males than females with dyslexia. This provides important insights into sex-modulated cognitive processes that might confer vulnerability to reading difficulties.

Multisensory integration augmenting motor processes among older adults

Objective

Multisensory integration enhances sensory processing in older adults. This study aimed to investigate how the sensory enhancement would modulate the motor related process in healthy older adults.

Method

Thirty-one older adults (12 males, mean age 67.7 years) and 29 younger adults as controls (16 males, mean age 24.9 years) participated in this study. Participants were asked to discriminate spatial information embedded in the unisensory (visual or audial) and multisensory (audiovisual) conditions. The responses made by the movements of the left and right wrists corresponding to the spatial information were registered with specially designed pads. The electroencephalogram (EEG) marker was the event-related super-additive P2 in the frontal-central region, the stimulus-locked lateralized readiness potentials (s-LRP) and response-locked lateralized readiness potentials (r-LRP).

Results

Older participants showed significantly faster and more accurate responses than controls in the multisensory condition than in the unisensory conditions. Both groups had significantly less negative-going s-LRP amplitudes elicited at the central sites in the between-condition contrasts. However, only the older group showed significantly less negative-going, centrally distributed r-LRP amplitudes. More importantly, only the r-LRP amplitude in the audiovisual condition significantly predicted behavioral performance.

Conclusion

Audiovisual integration enhances reaction time, which associates with modulated motor related processes among the older participants. The super-additive effects modulate both the motor preparation and generation processes. Interestingly, only the modulated motor generation process contributes to faster reaction time. As such effects were observed in older but not younger participants, multisensory integration likely augments motor functions in those with age-related neurodegeneration.

Virtual reality as a tool to explore multisensory processing before and after engagement in physical activity

Introduction

This pilot study employed a non-randomized control trial design to explore the impact of physical activity within a virtual reality (VR) environment on multisensory processing among community-dwelling older adults.

Methods

The investigation compared both chronic (over 6 weeks) and acute effects of VR-based physical activity to a reading control group. The evaluation metrics for multisensory processing included audiovisual response time (RT), simultaneity judgments (SJ), sound-induced flash illusion (SIFI), and temporal order judgments (TOJ). A total of 13 older adults were provided with VR headsets featuring custom-designed games, while another 14 older adults were assigned to a reading-based control group.

Results

Results indicated that acute engagement in physical activity led to higher accuracy in the SIFI task (experimental group: 85.6%; control group: 78.2%; p = 0.037). Additionally, both chronic and acute physical activity resulted in quicker response times (chronic: experimental group = 336.92; control group = 381.31; p = 0.012; acute: experimental group = 333.38; control group = 383.09; p = 0.006). Although the reading group showed a non-significant trend for greater improvement in mean RT, covariate analyses revealed that this discrepancy was due to the older age of the reading group.

Discussion

The findings suggest that immersive VR has potential utility for enhancing multisensory processing in older adults. However, future studies must rigorously control for participant variables like age and sex to ensure more accurate comparisons between experimental and control conditions.

Effects of noise and noise reduction on audiovisual speech perception in cochlear implant users: An ERP study

OBJECTIVE

Hearing with a cochlear implant (CI) is difficult in noisy environments, but the use of noise reduction algorithms, specifically ForwardFocus, can improve speech intelligibility. The current event-related potentials (ERP) study examined the electrophysiological correlates of this perceptual improvement.

METHODS

Ten bimodal CI users performed a syllable-identification task in auditory and audiovisual conditions, with syllables presented from the front and stationary noise presented from the sides. Brainstorm was used for spatio-temporal evaluation of ERPs.

RESULTS

CI users revealed an audiovisual benefit as reflected by shorter response times and greater activation in temporal and occipital regions at P2 latency. However, in auditory and audiovisual conditions, background noise hampered speech processing, leading to longer response times and delayed auditory-cortex-activation at N1 latency. Nevertheless, activating ForwardFocus resulted in shorter response times, reduced listening effort and enhanced superior-frontal-cortex-activation at P2 latency, particularly in audiovisual conditions.

CONCLUSIONS

ForwardFocus enhances speech intelligibility in audiovisual speech conditions by potentially allowing the reallocation of attentional resources to relevant auditory speech cues.

SIGNIFICANCE

This study shows for CI users that background noise and ForwardFocus differentially affect spatio-temporal cortical response patterns, both in auditory and audiovisual speech conditions.

The impact of cardiac phases on multisensory integration

The brain continuously processes information coming from both the external environment and visceral signals generated by the body. This constant information exchange between the body and the brain allows signals originating from the oscillatory activity of the heart, among others, to influence perception. Here, we investigated how the cardiac phase modulates multisensory integration, which is the process that allows information from multiple senses to combine non-linearly to reduce environmental uncertainty. Forty healthy participants completed a Simple Detection Task with unimodal (Auditory, Visual, Tactile) and bimodal (Audio-Tactile, Audio-Visual, Visuo-Tactile) stimuli presented 250 ms and 500 ms after the R-peak of the electrocardiogram, that is, systole and diastole, respectively. First, we found a nonspecific effect of the cardiac cycle phases on detection of both unimodal and bimodal stimuli. Reaction times were faster for stimuli presented during diastole, compared to systole. Then, applying the Race Model Inequality approach to quantify multisensory integration, Audio-Tactile and Visuo-Tactile, but not Audio-Visual stimuli, showed higher integration when presented during diastole than during systole. These findings indicate that the impact of the cardiac phase on multisensory integration may be specific for stimuli including somatosensory (i.e., tactile) inputs. This suggests that the heartbeat-related noise, which according to the interoceptive predictive coding theory suppresses somatosensory inputs, also affects multisensory integration during systole. In conclusion, our data extend the interoceptive predictive coding theory to the multisensory domain. From a more mechanistic view, they may reflect a reduced optimization of neural oscillations orchestrating multisensory integration during systole.

Age-related changes to the attentional modulation of temporal binding

During multisensory integration, the time range within which visual and auditory information can be perceived as synchronous and bound together is known as the temporal binding window (TBW). With increasing age, the TBW becomes wider, such that older adults erroneously, and often dangerously, integrate sensory inputs that are asynchronous. Recent research suggests that attentional cues can narrow the width of the TBW in younger adults, sharpening temporal perception and increasing the accuracy of integration. However, due to their age-related declines in attentional control, it is not yet known whether older adults can deploy attentional resources to narrow the TBW in the same way as younger adults. This study investigated the age-related changes to the attentional modulation of the TBW. Thirty younger and 30 older adults completed a cued-spatial-attention version of the stream-bounce illusion, assessing the extent to which the visual and auditory stimuli were integrated when presented at three different stimulus-onset asynchronies, and when attending to a validly cued or invalidly cued location. A 2 × 2 × 3 mixed ANOVA revealed that when participants attended to the validly cued location (i.e., when attention was present), susceptibility to the stream-bounce illusion decreased. However, crucially, this attentional manipulation significantly affected audiovisual integration in younger adults, but not in older adults. These findings suggest that older adults have multisensory integration-related attentional deficits. Directions for future research and practical applications surrounding treatments to improve the safety of older adults' perception and navigation through the environment are discussed.

Age-Related Changes to Multisensory Integration and Audiovisual Speech Perception

Multisensory integration is essential for the quick and accurate perception of our environment, particularly in everyday tasks like speech perception. Research has highlighted the importance of investigating bottom-up and top-down contributions to multisensory integration and how these change as a function of ageing. Specifically, perceptual factors like the temporal binding window and cognitive factors like attention and inhibition appear to be fundamental in the integration of visual and auditory information-integration that may become less efficient as we age. These factors have been linked to brain areas like the superior temporal sulcus, with neural oscillations in the alpha-band frequency also being implicated in multisensory processing. Age-related changes in multisensory integration may have significant consequences for the well-being of our increasingly ageing population, affecting their ability to communicate with others and safely move through their environment; it is crucial that the evidence surrounding this subject continues to be carefully investigated. This review will discuss research into age-related changes in the perceptual and cognitive mechanisms of multisensory integration and the impact that these changes have on speech perception and fall risk. The role of oscillatory alpha activity is of particular interest, as it may be key in the modulation of multisensory integration.

Effects of collision warning characteristics on driving behaviors and safety in connected vehicle environments

With the emerging connected vehicle (CV) technologies, a novel in-vehicle omni-direction collision warning system (OCWS) is developed. For example, vehicles approaching from different directions can be detected, and advanced collision warnings caused by vehicles approaching from different directions can be provided. Effectiveness of OCWS in reducing crash and injury related to forward, rear-end and lateral collision is recognized. However, it is rare that the effects of collision warning characteristics including collision types and warning types on micro-level driver behaviors and safety performance is assessed. In this study, variations in drivers' responses among different collision types and between visual only and visual plus auditory warnings are examined. In addition, moderating effects by driver characteristics including drivers' demographics, years of driving experience, and annual driving distance are also considered. An in-vehicle human-machine interface (HMI) that can provide both visual and auditory warnings for forward, rear-end, and lateral collisions is installed on an instrumented vehicle. 51 drivers participate in the field tests. Performance indicators including relative speed change, time taken to accelerate/decelerate, and maximum lateral displacement are adopted to reflect drivers' responses to collision warnings. Then, generalized estimation equation (GEE) approach is applied to examine the effects of drivers' characteristics, collision type, warning type and their interaction on the driving performance. Results indicate that age, year of driving experience, collision type, and warning type can affect the driving performance. Findings should be indicative to the optimal design of in-vehicle HMI and thresholds for the activation of collision warnings that can increase the drivers' awareness to collision warnings from different directions. Also, implementation of HMI can be customized with respect to individual driver characteristics.

Sustained visual attentional load modulates audiovisual integration in older and younger adults

Previous studies have shown that attention influences audiovisual integration (AVI) in multiple stages, but it remains unclear how AVI interacts with attentional load. In addition, while aging has been associated with sensory-functional decline, little is known about how older individuals integrate cross-modal information under attentional load. To investigate these issues twenty older adults and 20 younger adults were recruited to conduct a dual task including a multiple object tracking (MOT) task, which manipulated sustained visual attentional load, and an audiovisual discrimination task, which assesses AVI. The results showed that response times were shorter and hit rate was higher for audiovisual stimuli than for auditory or visual stimuli alone and in younger adults than in older adults. The race model analysis showed that AVI was higher under the load_3 condition (monitoring two targets of the MOT task) than under any other load condition (no-load [NL], one or three targets monitoring). This effect was found regardless of age. However, AVI was lower in older adults than younger adults under NL condition. Moreover, the peak latency was longer, and the time window of AVI was delayed in older adults compared to younger adults under all conditions. These results suggest that slight visual sustained attentional load increased AVI but that heavy visual sustained attentional load decreased AVI, which supports the claim that attention resource was limited, and we further proposed that AVI was positively modulated by attentional resource. Finally, there were substantial impacts of aging on AVI; AVI was delayed in older adults.

Multisensory visual-vestibular training improves visual heading estimation in younger and older adults

Self-motion perception (e.g., when walking/driving) relies on the integration of multiple sensory cues including visual, vestibular, and proprioceptive signals. Changes in the efficacy of multisensory integration have been observed in older adults (OA), which can sometimes lead to errors in perceptual judgments and have been associated with functional declines such as increased falls risk. The objectives of this study were to determine whether passive, visual-vestibular self-motion heading perception could be improved by providing feedback during multisensory training, and whether training-related effects might be more apparent in OAs vs. younger adults (YA). We also investigated the extent to which training might transfer to improved standing-balance. OAs and YAs were passively translated and asked to judge their direction of heading relative to straight-ahead (left/right). Each participant completed three conditions: (1) vestibular-only (passive physical motion in the dark), (2) visual-only (cloud-of-dots display), and (3) bimodal (congruent vestibular and visual stimulation). Measures of heading precision and bias were obtained for each condition. Over the course of 3 days, participants were asked to make bimodal heading judgments and were provided with feedback (“correct”/“incorrect”) on 900 training trials. Post-training, participants’ biases, and precision in all three sensory conditions (vestibular, visual, bimodal), and their standing-balance performance, were assessed. Results demonstrated improved overall precision (i.e., reduced JNDs) in heading perception after training. Pre- vs. post-training difference scores showed that improvements in JNDs were only found in the visual-only condition. Particularly notable is that 27% of OAs initially could not discriminate their heading at all in the visual-only condition pre-training, but subsequently obtained thresholds in the visual-only condition post-training that were similar to those of the other participants. While OAs seemed to show optimal integration pre- and post-training (i.e., did not show significant differences between predicted and observed JNDs), YAs only showed optimal integration post-training. There were no significant effects of training for bimodal or vestibular-only heading estimates, nor standing-balance performance. These results indicate that it may be possible to improve unimodal (visual) heading perception using a multisensory (visual-vestibular) training paradigm. The results may also help to inform interventions targeting tasks for which effective self-motion perception is important.

Critical review of multisensory integration programs and proposal of a theoretical framework for its combination with neurocognitive training

INTRODUCTION

The main purpose of this manuscript is to critically review the Multisensory Integration (MI) training programs applied to older adults, their characteristics, target sensory systems, efficacy, assessment methods, and results. We also intend to propose an integrated framework to support combined interventions of neurocognitive and sensory training.

AREAS COVERED

A critical review was conducted covering the most relevant literature on the MI training programs applied to older adults. Two MI training programs applied to cognitively healthy older adults were found: (a) audio-visual temporal discrimination training and (b) simultaneity judgment training. Both led to the improvement of the MI between pre- and post-training. However, only the audio-visual temporal discrimination training led to the generalization of the improvements to another MI task.

EXPERT OPINION

Considering the relationship between sensory and cognitive functioning, this review supports the potential advantages of combining MI with neurocognitive training in the rehabilitation of older adults. We suggested that this can be achieved within the framework of Branched Programmed Neurocognitive Training (BPNT). Criteria for deciding the most suitable multisensory intervention, that is, MI or Multisensory Stimulation, and general guidelines for the development of MI intervention protocols with older adults with or without cognitive impairment are provided.

Audiovisual Integration for Saccade and Vergence Eye Movements Increases with Presbycusis and Loss of Selective Attention on the Stroop Test

Multisensory integration is a capacity allowing us to merge information from different sensory modalities in order to improve the salience of the signal. Audiovisual integration is one of the most used kinds of multisensory integration, as vision and hearing are two senses used very frequently in humans. However, the literature regarding age-related hearing loss (presbycusis) on audiovisual integration abilities is almost nonexistent, despite the growing prevalence of presbycusis in the population. In that context, the study aims to assess the relationship between presbycusis and audiovisual integration using tests of saccade and vergence eye movements to visual vs. audiovisual targets, with a pure tone as an auditory signal. Tests were run with the REMOBI and AIDEAL technologies coupled with the pupil core eye tracker. Hearing abilities, eye movement characteristics (latency, peak velocity, average velocity, amplitude) for saccade and vergence eye movements, and the Stroop Victoria test were measured in 69 elderly and 30 young participants. The results indicated (i) a dual pattern of aging effect on audiovisual integration for convergence (a decrease in the aged group relative to the young one, but an increase with age within the elderly group) and (ii) an improvement of audiovisual integration for saccades for people with presbycusis associated with lower scores of selective attention in the Stroop test, regardless of age. These results bring new insight on an unknown topic, that of audio visuomotor integration in normal aging and in presbycusis. They highlight the potential interest of using eye movement targets in the 3D space and pure tone sound to objectively evaluate audio visuomotor integration capacities.

Less is more: Removing a modality of an expected olfactory-visual stimulation enhances brain activation

In recent years, multisensory integration of visual and olfactory stimuli has extensively been explored resulting in the identification of responsible brain areas. As the experimental designs of previous research often include alternating presentations of unimodal and bimodal stimuli, the conditions cannot be regarded as completely independent. This could lead to effects of an expected but surprisingly missing sensory modality. In our experiment, we used a common functional magnetic resonance imaging (fMRI) study design with alternating strong unimodal and bimodal olfactory-visual food stimuli, in addition to a slight overhang of the bimodal stimuli in an effort to examine the effects of removing a visual or olfactory congruent stimulus for older people (41-83 years). Our results suggest that the processing of olfactory and visual stimuli stays intact over a wide age-range and that the utilization of strong stimuli does not lead to superadditive multisensory integration in accordance with the principle of inverse effectiveness. However, our results demonstrate that the removal of a stimulus modality leads to an activation of additional brain areas. For example, when the visual stimulus modality is missing, the right posterior superior temporal gyrus shows higher activation, whereas the removal of the olfactory stimulus modality leads to higher activation in the amygdala/hippocampus and the postcentral gyrus. These brain areas are related to attention, memory, and the search of the missing stimulus. Consequently, careful attention must be paid to the design of a valid, multimodal sensory experiment while also controlling for cognitive expectancy effects that might confound multimodal results.

A Scoping Review of Audiovisual Integration Methodology: Screening for Auditory and Visual Impairment in Younger and Older Adults

With the rise of the aging population, many scientists studying multisensory integration have turned toward understanding how this process may change with age. This scoping review was conducted to understand and describe the scope and rigor with which researchers studying audiovisual sensory integration screen for hearing and vision impairment. A structured search in three licensed databases (Scopus, PubMed, and PsychInfo) using the key concepts of multisensory integration, audiovisual modality, and aging revealed 2,462 articles, which were screened for inclusion by two reviewers. Articles were included if they (1) tested healthy older adults (minimum mean or median age of 60) with younger adults as a comparison (mean or median age between 18 and 35), (2) measured auditory and visual integration, (3) were written in English, and (4) reported behavioral outcomes. Articles that included the following were excluded: (1) tested taste exclusively, (2) tested olfaction exclusively, (3) tested somatosensation exclusively, (4) tested emotion perception, (5) were not written in English, (6) were clinical commentaries, editorials, interviews, letters, newspaper articles, abstracts only, or non-peer reviewed literature (e.g., theses), and (7) focused on neuroimaging without a behavioral component. Data pertaining to the details of the study (e.g., country of publication, year of publication, etc.) were extracted, however, of higher importance to our research question, data pertaining to screening measures used for hearing and vision impairment (e.g., type of test used, whether hearing- and visual-aids were worn, thresholds used, etc.) were extracted, collated, and summarized. Our search revealed that only 64% of studies screened for age-abnormal hearing impairment, 51% screened for age-abnormal vision impairment, and that consistent definitions of normal or abnormal vision and hearing were not used among the studies that screened for sensory abilities. A total of 1,624 younger adults and 4,778 older participants were included in the scoping review with males composing approximately 44% and females composing 56% of the total sample and most of the data was obtained from only four countries. We recommend that studies investigating the effects of aging on multisensory integration should screen for normal vision and hearing by using the World Health Organization's (WHO) hearing loss and visual impairment cut-off scores in order to maintain consistency among other aging researchers. As mild cognitive impairment (MCI) has been defined as a “transitional” or a “transitory” stage between normal aging and dementia and because approximately 3–5% of the aging population will develop MCI each year, it is therefore important that when researchers aim to study a healthy aging population, that they appropriately screen for MCI. One of our secondary aims was to determine how often researchers were screening for cognitive impairment and the types of tests that were used to do so. Our results revealed that only 55 out of 72 studies tested for neurological and cognitive function, and only a subset used standardized tests. Additionally, among the studies that used standardized tests, the cut-off scores used were not always adequate for screening out mild cognitive impairment. An additional secondary aim of this scoping review was to determine the feasibility of whether a meta-analysis could be conducted in the future to further quantitatively evaluate the results (i.e., are the findings obtained from studies using self-reported vision and hearing impairment screening methods significantly different from those measuring vision and hearing impairment in the lab) and to assess the scope of this problem. We found that it may not be feasible to conduct a meta-analysis with the entire dataset of this scoping review. However, a meta-analysis can be conducted if stricter parameters are used (e.g., focusing on accuracy or response time data only).

Systematic Review Registration:https://doi.org/10.17605/OSF.IO/GTUHD.

Virtual Hand Illusion in younger and older adults

Introduction

Embodiment involves experiencing ownership over our body and localizing it in space and is informed by multiple senses (visual, proprioceptive and tactile). Evidence suggests that embodiment and multisensory integration may change with older age. The Virtual Hand Illusion (VHI) has been used to investigate multisensory contributions to embodiment, but has never been evaluated in older adults. Spatio-temporal factors unique to virtual environments may differentially affect the embodied perceptions of older and younger adults.

Methods

Twenty-one younger (18–35 years) and 19 older (65+ years) adults completed the VHI paradigm. Body localization was measured at baseline and again, with subjective ownership ratings, following synchronous and asynchronous visual-tactile interactions.

Results

Higher ownership ratings were observed in the synchronous relative to the asynchronous condition, but no effects on localization/drift were found. No age differences were observed. Localization accuracy was biased in both age groups when the virtual hand was aligned with the real hand, indicating a visual mislocalization of the virtual hand.

Conclusions

No age-related differences in the VHI were observed. Mislocalization of the hand in VR occurred for both groups, even when congruent and aligned; however, tactile feedback reduced localization biases. Our results expand the current understanding of age-related changes in multisensory embodiment within virtual environments.

Exogenous Bimodal Cues Attenuate Age-Related Audiovisual Integration

Previous studies have demonstrated that exogenous attention decreases audiovisual integration (AVI); however, whether the AVI is different when exogenous attention is elicited by bimodal and unimodal cues and its aging effect remain unclear. To clarify this matter, 20 older adults and 20 younger adults were recruited to conduct an auditory/visual discrimination task following bimodal audiovisual cues or unimodal auditory/visual cues. The results showed that the response to all stimulus types was faster in younger adults compared with older adults, and the response was faster when responding to audiovisual stimuli compared with auditory or visual stimuli. Analysis using the race model revealed that the AVI was lower in the exogenous-cue conditions compared with the no-cue condition for both older and younger adults. The AVI was observed in all exogenous-cue conditions for the younger adults (visual cue > auditory cue > audiovisual cue); however, for older adults, the AVI was only found in the visual-cue condition. In addition, the AVI was lower in older adults compared to younger adults under no- and visual-cue conditions. These results suggested that exogenous attention decreased the AVI, and the AVI was lower in exogenous attention elicited by bimodal-cue than by unimodal-cue conditions. In addition, the AVI was reduced for older adults compared with younger adults under exogenous attention.

Narrative review of the multisensory integration tasks used with older adults: inclusion of multisensory integration tasks into neuropsychological assessment

Introduction: Age-related changes in sensory functioning impact the activities of daily living and interact with cognitive decline. Given the interactions between sensory and cognitive functioning, combining multisensory integration (MI) assessment with the neuropsychological assessment of older adults seems promising. This review aims to examine the characteristics and utility of MI tasks in functional and cognitive assessment of older adults, with or without neurocognitive impairment.Areas covered: A literature search was conducted following the quality assessment of narrative review criteria. Results focused on tasks of detection, discrimination, sensory illusion, temporal judgment, and sensory conflict. Studies were not consensual regarding the enhancement of MI with age, but most studies showed that older adults had an expanded time window of integration. In older adults with mild cognitive impairment or major neurocognitive disorder it was a mediating role of the magnitude of visual-somatosensory integration between neurocognitive impairment and spatial aspects of gait.Expert opinion: Recently, some concerns have been raised about how to maximize the ecological validity of the neuropsychological assessment. Since most of our activities of daily living are multisensory and older adults benefit from multisensory information, MI assessment has the potential to improve the ecological validity of the neuropsychological assessment.

Visual-vestibular integration is preserved with healthy aging in a simple acceleration detection task

Aging is associated with a gradual decline in the sensory systems and noisier sensory information. Some research has found that older adults compensate for this with enhanced multisensory integration. However, less is known about how aging influences visual-vestibular integration, an ability that underlies self-motion perception. We examined how visual-vestibular integration changes in participants from across the lifespan (18-79 years old) with a simple reaction time task. Participants were instructed to respond to visual (optic flow) and vestibular (inertial motion) acceleration cues, presented either alone or at a stimulus onset asynchrony. We measured reaction times and computed the violation area relative to the race model inequality as a measure of visual-vestibular integration. Across all ages, the greatest visual-vestibular integration occurred when the vestibular cue was presented first. Age was associated with longer reaction times and a significantly lower detection rate in the vestibular-only condition, a finding that is consistent with an age-related increase in vestibular noise. Although the relationship between age and visual-vestibular integration was positive, the effect size was very small and did not reach statistical significance. Our results suggest that although age is associated with a significant increase in vestibular perceptual threshold, the relative amount of visual-vestibular integration remains largely intact.

The impact of movement sonification on haptic perception changes with aging

Combining multisensory sources is crucial to interact with our environment, especially for older people who are facing sensory declines. Here, we examined the influence of textured sounds on haptic exploration of artificial textures in healthy younger and older adults by combining a tactile device (ultrasonic display) with synthetized textured sounds. Participants had to discriminate simulated textures with their right index while they were distracted by three disturbing, more or less textured sounds. These sounds were presented as a real-time auditory feedback based on finger movement sonification and thus gave the sensation that the sounds were produced by the haptic exploration. Finger movement velocity increased across both groups in presence of textured sounds (Rubbing or Squeaking) compared to a non-textured (Neutral) sound. While young adults had the same discrimination threshold, regardless of the sound added, the older adults were more disturbed by the presence of the textured sounds with respect to the Neutral sound. Overall, these findings suggest that irrelevant auditory information was taken into account by all participants, but was appropriately segregated from tactile information by young adults. Older adults failed to segregate auditory information, supporting the hypothesis of general facilitation of multisensory integration with aging.

Ageing and multisensory integration: A review of the evidence, and a computational perspective

The processing of multisensory signals is crucial for effective interaction with the environment, but our ability to perform this vital function changes as we age. In the first part of this review, we summarise existing research into the effects of healthy ageing on multisensory integration. We note that age differences vary substantially with the paradigms and stimuli used: older adults often receive at least as much benefit (to both accuracy and response times) as younger controls from congruent multisensory stimuli, but are also consistently more negatively impacted by the presence of intersensory conflict. In the second part, we outline a normative Bayesian framework that provides a principled and computationally informed perspective on the key ingredients involved in multisensory perception, and how these are affected by ageing. Applying this framework to the existing literature, we conclude that changes to sensory reliability, prior expectations (together with attentional control), and decisional strategies all contribute to the age differences observed. However, we find no compelling evidence of any age-related changes to the basic inference mechanisms involved in multisensory perception.

Multisensory integration involved in the body perception of community-dwelling older adults

This study investigates how the multisensory integration in body perception changes with increasing age, and whether it is associated with older adults’ risk of falling. For this, the rubber hand illusion (RHI) and rubber foot illusion (RFI) were used. Twenty-eight community-dwelling older adults and 25 university students were recruited. They viewed a rubber hand or foot that was stimulated in synchrony or asynchrony with their own hidden hand or foot. The illusion was assessed by using a questionnaire, and measuring the proprioceptive drift and latency. The Timed Up and Go Test was used to classify the older adults into lower and higher fall-risk groups. No difference was observed in the RHI between the younger and older adults. However, several differences were observed in the RFI. Specifically, the older adults with a lower fall-risk hardly experienced the illusion, whereas those with a higher fall-risk experienced it with a shorter latency and no weaker than the younger adults. These results suggest that in older adults, the mechanism of multisensory integration for constructing body perception can change depending on the stimulated body parts, and that the risk of falling is associated with multisensory integration.

Sensory capability and information integration independently explain the cognitive status of healthy older adults

While there is evidence that sensory processing and multisensory integration change with age, links between these alterations and their relation to cognitive status remain unclear. In this study, we assessed sensory thresholds and performance of healthy younger and older adults in a visuotactile delayed match-to-sample task. Using Bayesian structural equation modelling (BSEM), we explored the factors explaining cognitive status in the group of older adults. Additionally, we applied transcranial alternating current stimulation (tACS) to a parieto-central network found to underlie visuotactile interactions and working memory matching in our previous work. Response times and signal detection measures indicated enhanced multisensory integration and enhanced benefit from successful working memory matching in older adults. Further, tACS caused a frequency-specific speeding (20 Hz) and delaying (70 Hz) of responses. Data exploration suggested distinct underlying factors for sensory acuity and sensitivity d’ on the one side, and multisensory and working memory enhancement on the other side. Finally, BSEM showed that these two factors labelled ‘sensory capability’ and ‘information integration’ independently explained cognitive status. We conclude that sensory decline and enhanced information integration might relate to distinct processes of ageing and discuss a potential role of the parietal cortex in mediating augmented integration in older adults.

How ageing shapes body and space representations: A comparison study between healthy young and older adults

To efficiently interact with the external world, the brain needs to represent the size of the involved body parts - body representations (BR) - and the space around the body in which the interactions with the environment take place - peripersonal space representation (PPS). BR and PPS are both highly flexible, being updated by the continuous flow of sensorimotor signals between the brain and the body, as observed for example after tool-use or immobilization. The progressive decline of sensorimotor abilities typically described in ageing could thus influence BR and PPS representations in the older adults. To explore this hypothesis, we compared BR and PPS in healthy young and older participants. By focusing on the upper limb, we adapted tasks previously used to evaluate BR and PPS plasticity, i.e., the body-landmarks localization task and audio-tactile interaction task, together with a new task targeting explicit BR (avatar adjustment task, AAT). Results show significantly higher distortions in the older rather than young participants in the perceived metric characteristic of the upper limbs. We found significant modifications in the implicit BR of the global shape (length and width) of both upper limbs, together with an underestimation in the arm length. Similar effects were also observed in the AAT task. Finally, both young and older adults showed equivalent multisensory facilitation in the space close to the hand, suggesting an intact PPS representation. Together, these findings demonstrated significant alterations of implicit and explicit BR in the older participants, probably associated with a less efficient contribution of bodily information typically subjected to age-related decline, whereas the comparable PPS representation in both groups could be supported by preserved multisensory abilities in older participants. These results provide novel empirical insight on how multiple representations of the body in space, subserving actions and perception, are shaped by the normal course of life.

Stimulus Specific to Age-Related Audio-Visual Integration in Discrimination Tasks

Age-related audio-visual integration (AVI) has been investigated extensively; however, AVI ability is either enhanced or reduced with ageing, and this matter is still controversial because of the lack of systematic investigations. To remove possible variates, 26 older adults and 26 younger adults were recruited to conduct meaningless and semantic audio-visual discrimination tasks to assess the ageing effect of AVI systematically. The results for the mean response times showed a significantly faster response to the audio-visual (AV) target than that to the auditory (A) or visual (V) target and a significantly faster response to all targets by the younger adults than that by the older adults (A, V, and AV) in all conditions. In addition, a further comparison of the differences between the probability of audio-visual cumulative distributive functions (CDFs) and race model CDFs showed delayed AVI effects and a longer time window for AVI in older adults than that in younger adults in all conditions. The AVI effect was lower in older adults than that in younger adults during simple meaningless image discrimination (63.0 ms vs. 108.8 ms), but the findings were inverse during semantic image discrimination (310.3 ms vs. 127.2 ms). In addition, there was no significant difference between older and younger adults during semantic character discrimination (98.1 ms vs. 117.2 ms). These results suggested that AVI ability was impaired in older adults, but a compensatory mechanism was established for processing sematic audio-visual stimuli.

Perceiving jittering self-motion in a field of lollipops from ages 4 to 95

An internal model of self-motion provides a fundamental basis for action in our daily lives, yet little is known about its development. The ability to control self-motion develops in youth and often deteriorates with advanced age. Self-motion generates relative motion between the viewer and the environment. Thus, the smoothness of the visual motion created will vary as control improves. Here, we study the influence of the smoothness of visually simulated self-motion on an observer's ability to judge how far they have travelled over a wide range of ages. Previous studies were typically highly controlled and concentrated on university students. But are such populations representative of the general public? And are there developmental and sex effects? Here, estimates of distance travelled (visual odometry) during visually induced self-motion were obtained from 466 participants drawn from visitors to a public science museum. Participants were presented with visual motion that simulated forward linear self-motion through a field of lollipops using a head-mounted virtual reality display. They judged the distance of their simulated motion by indicating when they had reached the position of a previously presented target. The simulated visual motion was presented with or without horizontal or vertical sinusoidal jitter. Participants' responses indicated that they felt they travelled further in the presence of vertical jitter. The effectiveness of the display increased with age over all jitter conditions. The estimated time for participants to feel that they had started to move also increased slightly with age. There were no differences between the sexes. These results suggest that age should be taken into account when generating motion in a virtual reality environment. Citizen science studies like this can provide a unique and valuable insight into perceptual processes in a truly representative sample of people.

Age-Related Shifts in Theta Oscillatory Activity During Audio-Visual Integration Regardless of Visual Attentional Load

Audio-visual integration (AVI) is higher in attended conditions than in unattended conditions. Here, we explore the AVI effect when the attentional recourse is competed by additional visual distractors, and its aging effect using single- and dual-tasks. The results showed the highest AVI effect under single-task-attentional-load condition than under no- and dual-task-attentional-load conditions (all P < 0.05) in both older and younger groups, but the AVI effect was weaker and delayed for older adults compared to younger adults for all attentional-load conditions (all P < 0.05). The non-phase-locked oscillation for AVI analysis illustrated the highest theta and alpha oscillatory activity for single-task-attentional-load condition than for no- and dual-task-attentional-load conditions, and the AVI oscillatory activity mainly occurred in the Cz, CP1 and Oz of older adults but in the Fz, FC1, and Cz of younger adults. The AVI effect was significantly negatively correlated with FC1 (r² = 0.1468, P = 0.05) and Cz (r² = 0.1447, P = 0.048) theta activity and with Fz (r² = 0.1557, P = 0.043), FC1 (r² = 0.1042, P = 0.008), and Cz (r² = 0.0897, P = 0.010) alpha activity for older adults but not for younger adults in dual task. These results suggested a reduction in AVI ability for peripheral stimuli and a shift in AVI oscillation from anterior to posterior regions in older adults as an adaptive mechanism.

Multisensory Integration of Emotion in Schizophrenic Patients

Multisensory integration (MSI) of emotion has been increasingly recognized as an essential element of schizophrenic patients' impairments, leading to the breakdown of their interpersonal functioning. The present review provides an updated synopsis of schizophrenics' MSI abilities in emotion processing by examining relevant behavioral and neurological research. Existing behavioral studies have adopted well-established experimental paradigms to investigate how participants understand multisensory emotion stimuli, and interpret their reciprocal interactions. Yet it remains controversial with regard to congruence-induced facilitation effects, modality dominance effects, and generalized vs specific impairment hypotheses. Such inconsistencies are likely due to differences and variations in experimental manipulations, participants' clinical symptomatology, and cognitive abilities. Recent electrophysiological and neuroimaging research has revealed aberrant indices in event-related potential (ERP) and brain activation patterns, further suggesting impaired temporal processing and dysfunctional brain regions, connectivity and circuities at different stages of MSI in emotion processing. The limitations of existing studies and implications for future MSI work are discussed in light of research designs and techniques, study samples and stimuli, and clinical applications.

Multisensory Integration Predicts Balance and Falls in Older Adults

BACKGROUND

Effective integration of concurrent sensory information is crucial for successful locomotion. This study aimed to determine the association of multisensory integration with mobility outcomes in aging.

METHODS

A total of 289 healthy older adults (mean age 76.67 ± 6.37 years; 53% female participants) participated in a visual-somatosensory simple reaction time task. Magnitude of multisensory effects was assessed using probability models, and then categorized into four multisensory integration classifications (superior, good, poor, or deficient). Associations of multisensory integration with falls and balance (unipedal stance) were tested at cross-section and longitudinally using Cox proportional hazards models.

RESULTS

At baseline, the prevalence of falls in the previous year was 24%, and 52% reported an incident fall over a mean follow-up period of 24 ± 17 months. Mean unipedal stance time was 15 ± 11 seconds. Magnitude of multisensory integration was a strong predictor of balance performance at cross-section (β = 0.11; p < .05). Of the cohort, 31% had superior, 26% had good, 28% had poor, and 15% had deficient multisensory effects. Older adults with superior multisensory integration abilities were significantly less likely to report a fall in the past year (17%), compared to the rest of the cohort (28%; χ2 = 4.01; p = .04). Magnitude of multisensory integration was an incremental predictor of incident falls (adjusted hazard ratio = 0.24; p = .01), over and above balance and other known fall risk factors.

CONCLUSIONS

Our study highlights the clinical relevance of multisensory integration in aging; worse visual-somatosensory integration is associated with worse balance and increased risk of incident falls.

Crossmodal Congruency Enhances Performance of Healthy Older Adults in Visual-Tactile Pattern Matching

One of the pivotal challenges of aging is to maintain independence in the activities of daily life. In order to adapt to changes in the environment, it is crucial to continuously process and accurately combine simultaneous input from different sensory systems, i.e., crossmodal or multisensory integration. With aging, performance decreases in multiple domains, affecting bottom-up sensory processing as well as top-down control. However, whether this decline leads to impairments in crossmodal interactions remains an unresolved question. While some researchers propose that crossmodal interactions degrade with age, others suggest that they are conserved or even gain compensatory importance. To address this question, we compared the behavioral performance of older and young participants in a well-established crossmodal matching task, requiring the evaluation of congruency in simultaneously presented visual and tactile patterns. Older participants performed significantly worse than young controls in the crossmodal task when being stimulated at their individual unimodal visual and tactile perception thresholds. Performance increased with adjustment of stimulus intensities. This improvement was driven by better detection of congruent stimulus pairs, while the detection of incongruent pairs was not significantly enhanced. These results indicate that age-related impairments lead to poor performance in complex crossmodal scenarios and demanding cognitive tasks. Crossmodal congruency effects attenuate the difficulties of older adults in visuotactile pattern matching and might be an important factor to drive the benefits of older adults demonstrated in various crossmodal integration scenarios. Congruency effects might, therefore, be used to develop strategies for cognitive training and neurological rehabilitation.

Effects of Repetition Suppression on Sound Induced Flash Illusion With Aging

The sound-induced flash illusion (SiFI) is a classical auditory-dominated multisensory integration phenomenon in which the observer misperceives the number of visual flashes due to the simultaneous presentation of a different number of auditory beeps. Although the SiFI has been documented to correlate with perceptual sensitivity, to date there is no consensus as to how it corresponds to sensitivity with aging. The present study was based on the SiFI paradigm (Shams et al., 2000), adding repeated auditory stimuli prior to the appearance of audiovisual stimuli to investigate the effects of repetition suppression (RS) on the SiFI with aging. The repeated auditory stimuli consisted of one or two of the same auditory stimuli presented twice in succession, which were then followed by the audiovisual stimuli. By comparing the illusions in old and young adults, we aimed to explore the influence of aging on the RS of auditory stimuli on the SiFI. The results showed that both age groups showed SiFI effects, however, the RS performance of the two age groups had different effects on the fusion and fission illusions. The illusion effect in old adults was weaker than in young adults. Specifically, RS only affected fission illusions in the old adults but both fission and fusion illusions in young adults. Thus, the present study indicated that the decreased perceptual sensitivity based on auditory RS could weaken the SiFI effect in multisensory integration and that old adults are more susceptible to RS, showing that old adults perceived the SiFI effect weakly under auditory RS.

The Effect of Ageing on Optimal Integration of Conflicting and Non-Conflicting Visual–Haptic Stimuli

Multisensory integration typically follows the predictions of a statistically optimal model whereby the contribution of each sensory modality is weighted according to its reliability. Previous research has shown that multisensory integration is affected by ageing, however it is less certain whether older adults follow this statistically optimal model. Additionally, previous studies often present multisensory cues which are conflicting in size, shape or location, yet naturally occurring multisensory cues are usually non-conflicting. Therefore, the mechanisms of integration in older adults might differ depending on whether the multisensory cues are consistent or conflicting. In the current experiment, young () and older () adults were asked to make judgements regarding the height of wooden blocks using visual, haptic or combined visual–haptic information. Dual modality visual–haptic blocks could be presented as equal or conflicting in size. Young and older adults’ size discrimination thresholds (i.e., precision) were not significantly different for visual, haptic or visual–haptic cues. In addition, both young and older adults’ discrimination thresholds and points of subjective equality did not follow model predictions of optimal integration, for both conflicting and non-conflicting cues. Instead, there was considerable between subject variability as to how visual and haptic cues were processed when presented simultaneously. This finding has implications for the development of multisensory therapeutic aids and interventions to assist older adults with everyday activities, where these should be tailored to the needs of each individual.

Temporal Metrics of Multisensory Processing Change in the Elderly

Older adults exhibit greater multisensory response time (RT) facilitation by violating the race model more than young adults; this is commonly interpreted as an enhancement in perception. Older adults typically exhibit wider temporal binding windows (TBWs) and points of subjective simultaneity (PSS) that typically lie farther from true simultaneity as compared to young adults when simultaneity judgment (SJ) and temporal-order judgment (TOJ) tasks are utilized; this is commonly interpreted as an impairment in perception. Here we explore the relation between the three tasks in order to better assess audiovisual multisensory temporal processing in both young and older adults. Our results confirm previous reports showing that audiovisual RT, TBWs and PSSs change with age; however, we show for the first time a significant positive relation between the magnitude of race model violation in young adults as a function of the PSS obtained from the audiovisual TOJ task (r: 0.49, p: 0.007), that is absent in older adults (r: 0.13, p: 0.58). Furthermore, we find no evidence for the relation between race model violation as a function of the PSS obtained from the audiovisual SJ task in both young (r: −0.01, p: 0.94) and older adults (r: 0.1, p: 0.66). Our results confirm previous reports that (i) audiovisual temporal processing changes with age; (ii) distinct processes are likely involved in simultaneity and temporal-order perception; and (iii) common processing between race model violation and temporal-order judgment is impaired in the elderly.

Older adults sacrifice response speed to preserve multisensory integration performance

Aging has been shown to impact multisensory perception, but the underlying computational mechanisms are unclear. For effective interactions with the environment, observers should integrate signals that share a common source, weighted by their reliabilities, and segregate those from separate sources. Observers are thought to accumulate evidence about the world's causal structure over time until a decisional threshold is reached. Combining psychophysics and Bayesian modeling, we investigated how aging affects audiovisual perception of spatial signals. Older and younger adults were comparable in their final localization and common-source judgment responses under both speeded and unspeeded conditions, but were disproportionately slower for audiovisually incongruent trials. Bayesian modeling showed that aging did not affect the ability to arbitrate between integration and segregation under either unspeeded or speeded conditions. However, modeling the within-trial dynamics of evidence accumulation under speeded conditions revealed that older observers accumulate noisier auditory representations for longer, set higher decisional thresholds, and have impaired motor speed. Older observers preserve audiovisual localization performance, despite noisier sensory representations, by sacrificing response speed.

Reduced multisensory facilitation in adolescents and adults on the Autism Spectrum

Individuals with autism are reported to integrate information from visual and auditory channels in an idiosyncratic way. Multisensory integration (MSI) of simple, non-social stimuli (i.e., flashes and beeps) was evaluated in adolescents and adults with (n = 20) and without autism (n = 19) using a reaction time (RT) paradigm using audio, visual, and audiovisual stimuli. For each participant, the race model analysis compares the RTs on the audiovisual condition to a bound value computed from the unimodal RTs that reflects the effect of redundancy. If the actual audiovisual RTs are significantly faster than this bound, the race model is violated, indicating evidence of MSI. Our results show that the race model violation occurred only for the typically-developing (TD) group. While the TD group shows evidence of MSI, the autism group does not. These results suggest that multisensory integration of simple information, void of social content or complexity, is altered in autism. Individuals with autism may not benefit from the advantage conferred by multisensory stimulation to the same extent as TD individuals. Altered MSI for simple, non-social information may have cascading effects on more complex perceptual processes related to language and behaviour in autism.

A Simple Target Interception Task as Test for Activities of Daily Life Performance in Older Adults

Previous research showed that a simple target interception task reveals differences between younger adults (YA) and older adults (OA) on a large screen under laboratory conditions. Participants intercept downward moving objects while a horizontally moving background creates an illusion of the object moving in the opposite direction of the background. OA are more influenced by this illusory motion than YA. OA seem to be less able to ignore irrelevant sensory information than YA. Since sensory integration relates to the ability to perform Activities of Daily Living (ADL), this interception task can potentially signal ADL issues. Here we investigated whether the results of the target interception task could be replicated using a more portable setup, i.e., a tablet instead of a large touch screen. For YA from the same, homogeneous population, the main effects were replicated although the task was more difficult in the tablet set-up. After establishing the tablet's validity, we analyzed the response patterns of OA that were less fit than the OA in previous research. We identified three different illusion patterns: a (large) illusion effect (indicating over integration), a reverse illusion effect, and no illusion effect. These different patterns are much more nuanced than previously reported for fit OA who only show over integration. We propose that the patterns are caused by differences in the samples of OA (OA in the current sample were older and had lower ADL scores), possibly modulated by increased task difficulty in the tablet setup. We discuss the effects of illusory background motion as a function of ADL scores using a transitional model. The first pattern commences when sensory integration capability starts to decrease, leading to a pattern of over-integration (illusion effect). The second pattern commences when compensatory mechanisms are not sufficient to counteract the effect of the background motion, leading to direction errors in the same direction as the background motion (reverse illusion). The third pattern commences when the task requirements are too high, leading OA to implement a probabilistic strategy by tapping toward the center of the screen.

Age, cognitive load, and multimodal effects on driver response to directional warning

Inattention can be considered a primary cause of vehicular accidents or crashes, and in-car warning signals are applied to alert the driver to take action even in automated vehicles. Because of age related decline of the older driver's abilities, in-car warning signals may need adjustment to the older driver. We therefore investigated the effects of uni-, bi- and trimodal directional warnings (i.e., light, sound, vibration) on young and older drivers' responses in a driving simulator. A young group of 15 drivers (20-25 years of age) and an older group of 16 drivers (65-79 years of age) participated. In the simulations, warning signal was presented at the left, the center, or the right in front of the participant. With a warning at the left, the center, and the right the correct response was to steer to the right, brake, and steer to the left, respectively. The main results showed the older drivers' responses were slower for each type of warning compared with the young drivers' responses. Overall, the responses were slower with an added cognitively loading task. The only multimodal type of warning inducing overall faster response than its constituent warning types was the vibration-sound, and only for the older drivers. Additionally, with the groups' responses collapsed, such a true multimodal effect on response time also showed for the center vibration-sound warning (i.e., braking response). The only multimodal warning showing clear reduction in response errors compared with its constituent warning types was the vibration-sound for the older drivers during extra cognitive load. The main conclusion is that older drivers can benefit from bimodal warning, as compared with unimodal, in terms of faster and more accurate response. The potential superiority of trimodal warning is nevertheless argued.

Cross-modal association between vowels and colours: A cross-linguistic perspective

Previous studies showed similar mappings between sounds and colours for synaesthetes and non-synaesthetes alike, and proposed that common mechanisms underlie such cross-modal association. The findings between vowels and colours, and between pitch and lightness, were investigated separately, and it was also unknown how language background would influence such association. The present study investigated the cross-modal association between sounds (vowels and pitch) and colours in a tone language using three groups of non-synaesthetes: Cantonese (native), Mandarin (foreign, tonal), and English (foreign, non-tonal). Strong associations were found between /a/ and red, /i/ with light colours, and /u/ with dark colours, and a robust pitch effect with a high tone eliciting lighter colours than a low tone in general. The pitch effect is stronger than the vowel associations. Significant differences among the three language groups in colour choices of other vowels and the strength of association were found, which demonstrate the language-specificity of these associations. The findings support the notion that synaesthesia is a general phenomenon, which can be influenced by linguistic factors.

Audio-Visual Spatiotemporal Perceptual Training Enhances the P300 Component in Healthy Older Adults

In older adults, cognitive abilities, such as those associated with vision and hearing, generally decrease with age. According to several studies, audio-visual perceptual training can improve perceived competence regarding visual and auditory stimuli, suggesting that perceptual training is effective and beneficial. However, whether audio-visual perceptual training can induce far-transfer effects in other forms of untrained cognitive processing that are not directly trained in older adults remains unclear. In this study, the classic P300 component, a neurophysiological indicator of cognitive processing of a stimulus, was selected as an evaluation index of the training effect. We trained both young and older adults on the ability to judge the temporal and spatial consistency of visual and auditory stimuli. P300 amplitudes were significantly greater in the posttraining session than in the pretraining session in older adults (P = 0.001). However, perceptual training had no significant effect (P = 0.949) on the P300 component in young adults. Our results illustrate that audio-visual perceptual training can lead to far-transfer effects in healthy older adults. These findings highlight the robust malleability of the aging brain, and further provide evidence to motivate exploration to improve cognitive abilities in older adults.

Visual-Somatosensory Integration and Quantitative Gait Performance in Aging

Background: The ability to integrate information across sensory modalities is an integral aspect of mobility. Yet, the association between visual-somatosensory (VS) integration and gait performance has not been well-established in aging.

Methods: A total of 333 healthy older adults (mean age 76.53 ± 6.22; 53% female) participated in a visual-somatosensory simple reaction time task and underwent quantitative gait assessment using an instrumented walkway. Magnitude of VS integration was assessed using probability models, and then categorized into four integration classifications (superior, good, poor, or deficient). Associations of VS integration with three independent gait factors (Pace, Rhythm, and Variability derived by factor analysis method) were tested at cross-section using linear regression analyses. Given overlaps in neural circuitry necessary for both multisensory integration and goal-directed locomotion, we hypothesized that VS integration would be significantly associated with pace but not rhythm which is a more automatic process controlled mainly through brainstem and spinal networks.

Results: In keeping with our hypothesis, magnitude of VS integration was a strong predictor of pace (β = 0.12, p < 0.05) but not rhythm (β = −0.01, p = 0.83) in fully-adjusted models. While there was a trend for the association of magnitude of VS integration with variability (β = −0.11, p = 0.051), post-hoc testing of individual gait variables that loaded highest on the variability factor revealed that stride length variability (β = −0.13, p = 0.03) and not swing time variability (β = −0.08, p = 0.15) was significantly associated with magnitude of VS integration. Of the cohort, 29% had superior, 26% had good, 29% had poor, and 16% had deficient VS integration effects.

Conclusions: Worse VS integration in aging is associated with worse spatial but not temporal aspects of gait performance.

Drawing as an Encoding Tool: Memorial Benefits in Younger and Older Adults

Background/Study Context. In a recent study, drawing pictures relative to writing words at encoding has been shown to benefit later memory performance in young adults. In the current study, we sought to test whether older adults' memory might also benefit from drawing as an encoding strategy. Our prediction was that drawing would serve as a particularly effective form of environmental support at encoding as it encourages a more detailed perceptual representation.

METHODS

Participants were presented 30 nouns, one at a time, and asked to either draw a picture or repeatedly write out the word, which was followed by a free recall test for all words (Experiment 1). In Experiment 2, we added an elaborative processing task in which we asked participants to list physical characteristics of the objects. In Experiment 3, we probed recognition memory for the words.

RESULTS

Of the words recalled in Experiment 1, a larger proportion had been drawn than written at encoding, and this effect was larger in older relative to younger adults. In Experiment 2, we demonstrated that drawing improves memory in both younger and older adults more than does an elaborative encoding task consisting of listing descriptive characteristics of the target nouns. In Experiment 3, older and younger adults drew or wrote out words at encoding, and subsequently provided Remember-Know-New recognition memory decisions. We showed that drawing reduced age-related differences in Remember responses.

CONCLUSIONS

We suggest that incorporating visuo-perceptual information into the memory trace, by drawing pictures at study, increases reliance of the memory trace on visual sensory regions, which are relatively intact in normal aging, relative to simply writing out or elaborately encoding words. Overall, results indicate that drawing is a highly valuable form of environmental support that can significantly enhance memory performance in older adults.

Heartbeat-enhanced immersive virtual reality to treat complex regional pain syndrome

Objectives

To develop and test a new immersive digital technology for complex regional pain syndrome (CRPS) that combines principles from mirror therapy and immersive virtual reality and the latest research from multisensory body processing.

Methods

In this crossover double-blind study, 24 patients with CRPS and 24 age- and sex-matched healthy controls were immersed in a virtual environment and shown a virtual depiction of their affected limb that was flashing in synchrony (or in asynchrony in the control condition) with their own online detected heartbeat (heartbeat-enhanced virtual reality [HEVR]). The primary outcome measures for pain reduction were subjective pain ratings, force strength, and heart rate variability (HRV).

Results

HEVR reduced pain ratings, improved motor limb function, and modulated a physiologic pain marker (HRV). These significant improvements were reliable and highly selective, absent in control HEVR conditions, not observed in healthy controls, and obtained without the application of tactile stimulation (or movement) of the painful limb, using a readily available biological signal (the heartbeat) that is most often not consciously perceived (thus preventing placebo effects).

Conclusions

Next to these specific and well-controlled analgesic effects, immersive HEVR allows the application of prolonged and repeated doses of digital therapy, enables the automatized integration with existing pain treatments, and avoids application of painful bodily cues while minimizing the active involvement of the patient and therapist.

Classification of evidence

This study provides Class III evidence that HEVR reduces pain and increases force strength in patients with CRPS.

What You Don't Notice Can Harm You: Age-Related Differences in Detecting Concurrent Visual, Auditory, and Tactile Cues

Objective This research sought to determine whether people can perceive and process three nonredundant (and unrelated) signals in vision, hearing, and touch at the same time and how aging and concurrent task demands affect this ability. Background Multimodal displays have been shown to improve multitasking and attention management; however, their potential limitations are not well understood. The majority of studies on multimodal information presentation have focused on the processing of only two concurrent and, most often, redundant cues by younger participants. Method Two experiments were conducted in which younger and older adults detected and responded to a series of singles, pairs, and triplets of visual, auditory, and tactile cues in the absence (Experiment 1) and presence (Experiment 2) of an ongoing simulated driving task. Detection rates, response times, and driving task performance were measured. Results Compared to younger participants, older adults showed longer response times and higher error rates in response to cues/cue combinations. Older participants often missed the tactile cue when three cues were combined. They sometimes falsely reported the presence of a visual cue when presented with a pair of auditory and tactile signals. Driving performance suffered most in the presence of cue triplets. Conclusion People are more likely to miss information if more than two concurrent nonredundant signals are presented to different sensory channels. Application The findings from this work help inform the design of multimodal displays and ensure their usefulness across different age groups and in various application domains.