Phasic alertness cues modulate visual processing speed in healthy aging

Persistent neurocognitive deficits in cognitively impaired survivors of sepsis are explained by reductions in working memory capacity

Introduction

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Mounting evidence suggests that many cognitively impaired sepsis survivors show long-term neurocognitive deficits in neuropsychological tasks. To date, the underlying mechanisms of these deficits are insufficiently understood. Based on previous evaluations we hypothesized that visual attention and working memory may be affected in a sample of cognitively impaired sepsis survivors.

Methods

We utilized psychophysical whole-and partial-report paradigms based on the computational theory of visual attention (TVA) to determine (i) whether sepsis survivors show changes in basic parameters of visual attention and working memory, (ii) whether the affected parameters are related to neuropsychological test results in a standard battery in sepsis survivors and matched healthy control participants, (iii) whether between-group differences in these basic parameters of visual attention could account for underperformance of sepsis survivors in neuropsychological tests when adjusting for potentially relevant clinical variables.

Results

We showed that, in sepsis survivors, the maximum number of elements consciously maintained in an instant, i.e. the working memory storage capacity K, is reduced (sepsis survivors: M = 3.0; healthy controls: M = 3.4). Moreover, K explained variance in neurocognitive outcomes -17% in attentional and 16 % in executive functions - in a standard neuropsychological battery. The association remained stable when adjusting for clinical variables.

Discussion

Thus, in our sample of cognitively impaired sepsis survivors, a reduction in working memory capacity seems to be a critical determinant of the neurocognitive sequelae. It should be the subject of future work on mechanisms but may also serve as surrogate outcome measure in interventional studies.

Warning signals only support the first action in a sequence

Acting upon target stimuli from the environment becomes faster when the targets are preceded by a warning (alerting) cue. Accordingly, alerting is often used to support action in safety-critical contexts (e.g., honking to alert others of a traffic situation). Crucially, however, the benefits of alerting for action have been established using laboratory tasks assessing only simple choice reactions. Real-world actions are considerably more complex and mainly consist of sensorimotor sequences of several sub-actions. Therefore, it is still unknown if the benefits of alerting for action transfer from simple choice reactions to such sensorimotor sequences. Here, we investigated how alerting affected performance in a sequential action task derived from the Trail-Making-Test, a well-established neuropsychological test of cognitive action control (Experiment 1). In addition to this task, participants performed a classic alerting paradigm including a simple choice reaction task (Experiment 2). Results showed that alerting sped up responding in both tasks, but in the sequential action task, this benefit was restricted to the first action of a sequence. This was the case, even when multiple actions were performed within a short time (Experiment 3), ruling out that the restriction of alerting to the first action was due to its short-lived nature. Taken together, these findings reveal the existence of an interface between phasic alertness and action control that supports the next action.

Lower visual processing speed relates to greater subjective cognitive complaints in community-dwelling healthy older adults

Introduction

Subjective cognitive complaints in older age may reflect subtle objective impairments in basic cognitive functions that might foreshadow broader cognitive problems. Such cognitive functions, however, are not captured by standard neuropsychological testing. Visual processing speed is a basic visual attention function that underlies the performance of cognitive tasks relying on visual stimuli. Here, we test the hypothesis that lower visual processing speed correlates with greater subjective cognitive complaints in healthy older adults from the community.

Methods

To do so, we assessed a sample of 30 healthy, cognitively normal older adults (73.07 ± 7.73 years old; range: 60-82; 15 females) with respect to individual subjective cognitive complaints and visual processing speed. We quantified the degree of subjective cognitive complaints with two widely-used questionnaires: the Memory Functioning Questionnaire and the Everyday Cognition. We used verbal report tasks and the theory of visual attention to estimate a visual processing speed parameter independently from motor speed and other visual attention parameters, i.e., visual threshold, visual short-term memory storage capacity, top-down control, and spatial weighting.

Results

We found that lower visual processing speed correlated with greater subjective complaints and that this relationship was not explained by age, education, or depressive symptoms. The association with subjective cognitive complaints was specific to visual processing speed, as it was not observed for other visual attention parameters.

Discussion

These results indicate that subjective cognitive complaints reflect a reduction in visual processing speed in healthy older adults. Together, our results suggest that the combined assessment of subjective cognitive complaints and visual processing speed has the potential to identify individuals at risk for cognitive impairment before the standard tests show any abnormal results.

Phasic alertness boosts representational momentum

The final location of a moving object is always misremembered in the direction of the object’s motion; this occurrence is called representational momentum. Three experiments were conducted to investigate the effects of phasic alertness on representational momentum by presenting a visual or auditory warning cue. In experiment 1, the mouse pointer paradigm was used, and the results showed that external warning cues increased forward displacement. Experiment 2 indicated that the effects of phasic alertness and speed of motion on representational momentum were independent. In experiment 3, the probe paradigm was used, and the results showed that external warning cues increased forward displacement as well as participants’ sensitivity to the difference between the target and probe positions. These findings prove that phasic alertness boosts rather than reduces representational momentum. We propose that phasic alertness might influence representational momentum by modulating the process of executive control in the retention interval.

Phasic Alertness is Unaffected by the Attentional Set for Orienting

Warning stimuli preceding target stimuli for behaviour improve behavioural performance, which is referred to as phasic alerting. Similar benefits occur due to preceding orienting cues that draw spatial attention to the targets. It has long been assumed that alerting and orienting effects arise from separate attention systems, but recent views call this into question. As it stands, it remains unclear if the two systems are interdependent, or if they function independently. Here, we investigated whether the current attentional set for orienting modulates the effectiveness of alerting. In three experiments, participants classified visual stimuli in a speeded fashion. These target stimuli were preceded by orienting cues that could predict the target’s location, by alerting cues that were neutral regarding the target’s location, or by no cues. Alerting cues and orienting cues consisted of the same visual stimuli, linking alerting cues with the attentional set for orienting. The attentional set for orienting was manipulated in blocks, in which orienting cues were either informative or uninformative about the target’s location. Results showed that while alerting generally enhanced performance, alerting was unaffected by the informativeness of the orienting cues. These findings show that alerting does not depend on the attentional set that controls orienting based on the informational value of orienting cues. As such, the findings provide a simple dissociation of mechanisms underlying phasic alertness and spatial attentional orienting.

Vision through Healthy Aging Eyes

As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual manifestations that include reduced visual acuity, dry eyes, motility changes, a contraction of the visual field, presbyopia, reduced contrast sensitivity, slow dark adaptation, recovery from glare, variation in color vision and a decreased visual processing speed. Highlighting these prevalent issues as well as current and possible future innovations will assist providers to formulate treatments and thereby conserve maximum independence and mobility in the modern mature population.

Baseline levels of alertness influence tES effects along different age-related directions

Normal aging is usually accompanied by several structural and functional physiological changes of the brain, which are closely related to alterations of cognitive functions (e.g., visual short-term memory). As the average age of the population increases, it has become crucial to identify cognitive-behavioural interventions to maintain a healthy level of cognitive performance. Among a variety of approaches, the targeting of specific intrinsic alertness mechanisms has shown a solid rationale and beneficial effects in both healthy and pathological ageing. In a similar vein, the use of non-invasive transcranial electrical stimulation (tES) represents another promising approach to induce an alerting state that can produce advantages in the information processing in the brain and therefore behaviour. Here, we investigated whether time-locked bursts of tES (i.e., transcranial random noise stimulation) were effective in inducing behavioural and physiological changes, consistently with an alertness increase, in both young and older healthy adults. Namely, we expected to find a beneficial alerting effect on visual short-term memory performance as a function of stimulus perceptual salience and tES. The initial results showed that the performance of younger adults was not affected by tES, while older adults scored lower correct responses for high-salience stimuli during real tES with respect to sham stimulation. However, after including a baseline measure of subjective level of alertness in the analyses, a tES-induced memory improvement did emerge in the less alerted younger adults, while only the more alerted older adults were subject to the worsening effect by tES. We discuss these results in consideration of the evidence on critical age-related differences as well as the interaction between neurostimulation and baseline alerting mechanisms.

Phasic alerting increases visual processing speed in amnestic mild cognitive impairment

External warning cues temporarily increase the brain's sensitivity for upcoming events, helping individuals to flexibly adapt their reactions to the requirements of complex visual environments. Previous studies reported that younger and cognitively normal older adults profit from phasic alerting cues. Such an intact phasic alerting mechanism could be even more relevant in individuals with Alzheimer's disease who are characterized by reduced processing capacities. The present study employed a theory of visual attention based verbal whole report paradigm with auditory cues in order to investigate phasic alerting effects in amnestic mild cognitive impairment (aMCI). Patients with aMCI were also compared to a previously reported sample of cognitively normal older adults. In patients with aMCI, visual processing speed was higher in the cue compared to the no-cue condition. Further, visual processing speed was reduced in patients with aMCI compared to cognitively normal older adults. Taken together, the results suggest that the processing system of patients with aMCI exhibits general declines but can still integrate auditory warning signals on a perceptual level.

Right Lateralized Brain Reserve Offsets Age-Related Deficits in Ignoring Distraction

Age-related deterioration of attention decreases the ability to stay focused on the task at hand due to less efficient selection of relevant information and increased distractibility in the face of irrelevant, but salient stimuli. While older (compared with younger) adults may have difficulty suppressing salient distractors, the extent of these challenges differs vastly across individuals. Cognitive reserve measured by proxies of cognitively enriching life experiences, such as education, occupation, and leisure activities, is thought to mitigate the effects of the aging process and account for variability in trajectories of cognitive decline. Based on combined behavioral and neuroimaging (voxel-based morphometry) analyses of demographic, cognitive, and neural markers of aging and cognitive reserve proxy measures, we examine here predictors of variability in the age-related changes in attention function, indexed by ability to suppress salient distraction. Our findings indicate that in healthy (neurotypical), aging gray matter volume within several right lateralized fronto-parietal brain regions varies according to both levels of cognitive reserve (education) and the capacity to effectively select visual stimuli amid salient distraction. Thus, we provide here novel experimental evidence supporting Robertson's theory of a right lateralized neural basis for cognitive reserve.

Continuous, Lateralized Auditory Stimulation Biases Visual Spatial Processing

Sounds in our environment can easily capture human visual attention. Previous studies have investigated the impact of spatially localized, brief sounds on concurrent visuospatial attention. However, little is known on how the presence of a continuous, lateralized auditory stimulus (e.g., a person talking next to you while driving a car) impacts visual spatial attention (e.g., detection of critical events in traffic). In two experiments, we investigated whether a continuous auditory stream presented from one side biases visual spatial attention toward that side. Participants had to either passively or actively listen to sounds of various semantic complexities (tone pips, spoken digits, and a spoken story) while performing a visual target discrimination task. During both passive and active listening, we observed faster response times to visual targets presented spatially close to the relevant auditory stream. Additionally, we found that higher levels of semantic complexity of the presented sounds led to reduced visual discrimination sensitivity, but only during active listening to the sounds. We provide important novel results by showing that the presence of a continuous, ongoing auditory stimulus can impact visual processing, even when the sounds are not endogenously attended to. Together, our findings demonstrate the implications of ongoing sounds on visual processing in everyday scenarios such as moving about in traffic.

Cognitive processes in aging effects on attentional alerting

Alerting, the process of achieving and maintaining a state of optimal vigilance, is crucial for detecting relevant stimuli and task performance. Age-related decline in the ability to use alerting cues is widely reported and attributed to changes in noradrenergic signaling. However, it remains to be determined whether aging affects all forms of alerting cues equally and whether older adults differently modulate their alerting sensitivity based on differences in cue predictivity relevant to the target task. We examined the performance of 135 younger adults and 103 older adults on three versions of the Attention Networks Test, using locational but spatially nonpredictive visual cues, locational spatially predictive visual cues, and spatially predictive auditory cues. Analysis of alerting effects indicated that while older adults derived less benefit from visual alerting cues than younger adults, they used auditory alerting cues equally well. Furthermore, cue spatial predictivity did not impact on aging effects on alerting. This heterogeneity in aging effects on alerting may indicate that they result primarily from cognitive rather than neuromodulatory changes.

Age-related changes in the functional integrity of the phasic alerting system: a pupillometric investigation

Enhanced processing following a warning cue is thought to be mediated by a phasic alerting response involving the locus coeruleus-noradrenergic (LC-NA) system. We examined the effect of aging on phasic alerting using pupil dilation as a marker of LC-NA activity in conjunction with a novel assessment of task-evoked pupil dilation. While both young and older adults displayed behavioral and pupillary alerting effects, reflected in decreased RT and increased pupillary response under high (tone) versus low (no tone) alerting conditions, older adults displayed a weaker pupillary response that benefited more from the alerting tone. The strong association between dilation and speed displayed by older adults in both alerting conditions was reduced in young adults in the high alerting condition, suggesting that in young (but not older) adults the tone conferred relatively little behavioral benefit beyond that provided by the alerting effect elicited by the target. These findings suggest a functioning but deficient LC-NA alerting system in older adults, and help reconcile previous results concerning the effects of aging on phasic alerting.

Phasic alerting effects on visual processing speed are associated with intrinsic functional connectivity in the cingulo-opercular network

Phasic alertness refers to short-lived increases in the brain's "state of readiness", and thus to optimized performance following warning cues. Parametric modelling of whole report task performance based on the computational theory of visual attention (TVA) has demonstrated that visual processing speed is increased in such cue compared to no-cue conditions. Furthermore, with respect to the underlying neural mechanisms, individual visual processing speed has been related to intrinsic functional connectivity (iFC) within the cingulo-opercular network, suggesting that this network's iFC is relevant for the tonic maintenance of an appropriate readiness or alertness state. In the present study, we asked whether iFC in the cingulo-opercular network is also related to the individual ability to actively profit from warning cues, i.e. to the degree of phasic alerting. We obtained resting-state functional magnetic resonance imaging (rs-fMRI) data from 32 healthy young participants and combined an independent component analysis of rs-fMRI time courses and dual regression approach to determine iFC in the cingulo-opercular network. In a separate behavioural testing session, we parametrically assessed the effects of auditory phasic alerting cues on visual processing speed in a TVA-based whole report paradigm. A voxel-wise multiple regression revealed that higher individual phasic alerting effects on visual processing speed were significantly associated with lower iFC in the cingulo-opercular network, with a peak in the left superior orbital gyrus. As phasic alertness was neither related to iFC in other attention-relevant, auditory, or visual networks nor associated with any inter-network connectivity pattern, the results suggest that the individual profit in visual processing speed gained from phasic alerting is primarily associated with iFC in the cingulo-opercular network.