Categorical and coordinate spatial processing in the imagery domain investigated by rTMS

Enhancement of neural regeneration as a therapeutic strategy for Alzheimer's disease (Review)

Alzheimer's disease (AD), the most common cause of dementia worldwide, has gradually become a global health concern for society and individuals with the process of global ageing. Although extensive research has been carried out on AD, the etiology and pathological mechanism of the disease are still unclear, and there is no specific drug to cure or delay AD progression. The exploration of enhancing nerve regeneration in AD has gradually attracted increasing attention. In the current review, the existing therapeutic strategies were summarized to induce nerve regeneration which can increase the number of neurons, and improve the survival of neurons, the plasticity of synapses and synaptic activity. The strategies include increasing neurotrophic expression (such as brain-derived neurotrophic factor and nerve growth factor), inhibiting acetylcholinesterase (such as donepezil, tacrine, rivastigmine and galanthamine), elevating histone deacetylase levels (such as RGFP-966, Tasquinimod, CM-414 and 44B), stimulating the brain by physiotherapy (such as near-infrared light, repetitive transcranial magnetic stimulation, and transcranial direct current stimulation) and transplanting exogenous neural stem cells. However, further evaluations need to be performed to determine the optimal treatment. The present study reviews recent interventions for enhancing adult neurogenesis and attempts to elucidate their mechanisms of action, which may provide a theoretical basis for inducing nerve regeneration to fight against AD.

Repetitive Transcranial Magnetic Stimulation in the Treatment of Alzheimer's Disease and Other Dementias

Dementia is a debilitating impairment of cognitive functions that affects millions of people worldwide. There are several diseases belonging to the dementia spectrum, most prominently Alzheimer’s disease (AD), vascular dementia (VD), Lewy body dementia (LBD) and frontotemporal dementia (FTD). Repetitive transcranial magnetic stimulation (rTMS) is a safe, non-invasive form of brain stimulation that utilizes a magnetic coil to generate an electrical field and induce numerous changes in the brain. It is considered efficacious for the treatment of various neuropsychiatric disorders. In this paper, we review the available studies involving rTMS in the treatment of these dementia types. The majority of studies have involved AD and shown beneficial effects, either as a standalone, or as an add-on to standard-of-care pharmacological treatment and cognitive training. The dorsolateral prefrontal cortex seems to hold a central position in the applied protocols, but several parameters still need to be defined. In addition, rTMS has shown potential in mild cognitive impairment as well. Regarding the remaining dementias, research is still at preliminary phases, and large, randomized studies are currently lacking.

Elucidating the Risk Factors for Progression from Amyloid-Negative Amnestic Mild Cognitive Impairment to Dementia

BACKGROUND

Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer's disease from Alzheimer's disease-mimicking conditions. Around 15-20% of patients with clinically probable Alzheimer's disease have been found to have no significant Alzheimer's pathology on amyloid PET. However, a limited number of studies had been conducted on this subpopulation in terms of clinical progression.

OBJECTIVE

We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI).

METHODS

This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloid-negative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET.

RESULTS

During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer's diseaselike pattern despite the lack of evidence for significant Alzheimer's disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices.

CONCLUSION

Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer's disease-mimicking dementia are warranted.

Right hemisphere occipital rTMS impairs working memory in visualizers but not in verbalizers

Distinguishing between verbal and visual working memory processes is complicated by the fact that the strategy used is hard to control or even assess. Many stimuli used in working memory tasks can be processed via verbal or visual coding, such as the digits in the digit span backwards task (DSB). The present study used repetitive transcranial magnetic stimulation (rTMS) to examine the use of visual processing strategies in the DSB. A total of 47 German university students took part in the study, 23 spontaneously using a verbal processing strategy and 24 using a visual strategy. After rTMS to the right occipital cortex, visualizers showed a significantly stronger mean performance decrease compared to verbalizers. The results indicate that the visual cortex is more critical for visualizers compared to verbalizers in the DSB task. Furthermore, the favored processing modality seems to be determined by the preference for a cognitive strategy rather than the presentation modality, and people are aware of the applied strategy. These findings provide insight into inter-individual differences in working memory processing and yield important implications for laboratory studies as well as clinical practice: the stimulus does not necessarily determine the processing and the participant can be aware of that.

Constructional apraxia

Since the classic papers of Kleist, Mayer Gross, and Critchley, constructional apraxia (CA) has been considered to be a typical sign of a parietal lobe lesion, and as a precious tool to appreciate the spatial abilities subserved by this lobe. However, the development of more sophisticated neuropsychologic models and methods of investigation has revealed several problematic aspects. It has become increasingly clear that CA is a heterogeneous construct that can be examined with very different tasks, that are only mildly interconnected, and tap various kinds of visuospatial, perceptual, attentional, planning, and motor mechanisms. On the basis of these considerations, the relationships between parietal lobe functions and constructional activities must be considered, taking into account on the one hand the heterogeneity of the tasks and of the cognitive functions requested by different kinds of constructional activities and, on the other hand, the plurality of functions and of processing streams linking different parts of the parietal lobes to the occipital and frontal lobes.

Repetitive Transcranial Magnetic Stimulation as an Alternative Therapy for Cognitive Impairment in Alzheimer's Disease: A Meta-Analysis

BACKGROUND

Recent studies have indicated that repetitive transcranial magnetic stimulation (rTMS) could improve cognitive function in people with Alzheimer's disease (AD). Yet the results are inconclusive.

OBJECTIVE

This meta-analysis aimed to evaluate recent rTMS studies conducted in mild to moderate AD patients.

METHODS

PubMed, Embase, MEDLINE databases and Science Direct were searched for studies of rTMS treatment on AD patients with cognitive impairment published before February 2015. The relevant primary outcomes of cognition were extracted from those included studies. A crude standardized mean difference (SMD) with 95% confidence interval (CI) was calculated by using random effect models.

RESULTS

Seven studies with a total of 94 mild to moderate AD patients were included in this meta-analysis. A significant overall rTMS treatment effect on cognition was found for all AD patients (p = 0.0008, SMD = 1.00, 95% CI = 0.41-1.58). Stratification analysis showed that this effect is stimulation frequency- and hemisphere-dependent. High frequency stimulation (>1.0 Hz) (p <  0.05) but not low frequency stimulation (≤1.0 Hz) (p >  0.05) was significantly effective in improving the cognition of AD patients. Further, rTMS stimulation on right dorsolateral prefrontal cortex (DLPFC) and bilateral DLPFC (p <  0.05), but not on the left DLPFC (p >  0.05) was significantly effective in improving cognitive function of AD patients. A significant effect was observed in the rTMS subgroup (p <  0.05), rather than in the rTMS+drug subgroup (p >  0.05).

CONCLUSION

This meta-analysis supports that high frequency rTMS stimulation on right- or bilateral-DLPFC has significant therapeutic effect on cognitive function in patients with mild to moderate AD. Due to small number of studies included, more well-controlled rTMS studies should be evaluated in AD patients in the future.

The Influence of Visual Experience on Visual and Spatial Imagery

Differences are reported between blind and sighted participants on a visual-imagery and a spatial-imagery task, but not on an auditory-imagery task. For the visual-imagery task, participants had to compare object forms on the basis of a (verbally presented) object name. In the spatial-imagery task, they had to compare angular differences on the basis of the position of clock hands on two clock faces, again only on the basis of verbally presented clock times. Interestingly, there was a difference between early-blind and late-blind participants on the visual-imagery and the spatial-imagery tasks: late-blind participants made more errors than sighted people on the visual-imagery task, while early-blind participants made more errors than sighted people on the spatial-imagery task. This difference suggests that, for visual (form) imagery, people use the channel currently available (haptic for the blind; visual for the sighted). For the spatial-imagery task in this study reliance on haptic processing did not seem to suffice, and people benefited from visual experience and ability. However, the difference on the spatial-imagery task between early-blind and sighted people in this study might also be caused by differences in experience with the analogue clock faces that formed the basis for the spatial judgments.

Frames of reference and categorical/coordinate spatial relations in a "what was where" task

The aim of this study was to explore how people use egocentric (i.e., with respect to their body) and allocentric (i.e., with respect to another element in the environment) references in combination with coordinate (metric) or categorical (abstract) spatial information to identify a target element. Participants were asked to memorize triads of 3D objects or 2D figures, and immediately or after a delay of 5 s, they had to verbally indicate what was the object/figure: (1) closest/farthest to them (egocentric coordinate task); (2) on their right/left (egocentric categorical task); (3) closest/farthest to another object/figure (allocentric coordinate task); (4) on the right/left of another object/figure (allocentric categorical task). Results showed that the use of 2D figures favored categorical judgments over the coordinate ones with either an egocentric or an allocentric reference frame, whereas the use of 3D objects specifically favored egocentric coordinate judgments rather than the allocentric ones. Furthermore, egocentric judgments were more accurate than allocentric judgments when the response was Immediate rather than delayed and 3D objects rather than 2D figures were used. This pattern of results is discussed in the light of the functional roles attributed to the frames of reference and spatial relations by relevant theories of visuospatial processing.

Resting-state fMRI reveals enhanced functional connectivity in spatial navigation networks after transcranial direct current stimulation

A number of studies have established that transcranial direct current stimulation (tDCS) modulates cortical excitability. We previously demonstrated polarity dependent changes in parietal lobe blood oxygen level dependent (BOLD) fMRI in a group of young adults during a spatial navigation task [15]. Here we used resting state functional connectivity (rsFC) to examine whether analogous changes were also evident during the resting state. Participants were randomized to either a parietal-anodal, frontal-cathodal (P+F-) or the opposite montage (P-F+) and received 20min of tDCS (2mA) before undergoing resting-state fMRI. rsFC was evaluated between the groups by placing a seed in the medial superior parietal lobule (mSPL), which was under the target electrode. rsFC between the mSPL and a number of other areas involved in spatial navigation, scene processing, and sensorimotor processing was significantly higher in the P+F- than the P-F+ group. Thus, the modulatory effects of tDCS were evident during rest and suggest that stimulation primes not just the underlying neocortex but an extended network that can be recruited as necessary during active task performance.

Age effect in generating mental images of buildings but not common objects

Imagining a familiar environment is different from imagining an environmental map and clinical evidence demonstrated the existence of double dissociations in brain-damaged patients due to the contents of mental images. Here, we assessed a large sample of young and old participants by considering their ability to generate different kinds of mental images, namely, buildings or common objects. As buildings are environmental stimuli that have an important role in human navigation, we expected that elderly participants would have greater difficulty in generating images of buildings than common objects. We found that young and older participants differed in generating both buildings and common objects. For young participants there were no differences between buildings and common objects, but older participants found easier to generate common objects than buildings. Buildings are a special type of visual stimuli because in urban environments they are commonly used as landmarks for navigational purposes. Considering that topographical orientation is one of the abilities mostly affected in normal and pathological aging, the present data throw some light on the impaired processes underlying human navigation.

Hemispheric lateralization in top-down attention during spatial relation processing: a Granger causal model approach

Magnetoencephalography was recorded during a matching-to-sample plus cueing paradigm, in which participants judged the occurrence of changes in either categorical (CAT) or coordinate (COO) spatial relations. Previously, parietal and frontal lobes were identified as key areas in processing spatial relations and it was shown that each hemisphere was differently involved and modulated by the scope of the attention window (e.g. a large and small cue). In this study, Granger analysis highlighted the patterns of causality among involved brain areas--the direction of information transfer ran from the frontal to the visual cortex in the right hemisphere, whereas it ran in the opposite direction in the left side. Thus, the right frontal area seems to exert top-down influence, supporting the idea that, in this task, top-down signals are selectively related to the right side. Additionally, for CAT change preceded by a small cue, the right frontal gyrus was not involved in the information transfer, indicating a selective specialization of the left hemisphere for this condition. The present findings strengthen the conclusion of the presence of a remarkable hemispheric specialization for spatial relation processing and illustrate the complex interactions between the lateralized parts of the neural network. Moreover, they illustrate how focusing attention over large or small regions of the visual field engages these lateralized networks differently, particularly in the frontal regions of each hemisphere, consistent with the theory that spatial relation judgements require a fronto-parietal network in the left hemisphere for categorical relations and on the right hemisphere for coordinate spatial processing.

A penny for your thoughts! patterns of fMRI activity reveal the content and the spatial topography of visual mental images

Visual mental imagery is a complex process that may be influenced by the content of mental images. Neuropsychological evidence from patients with hemineglect suggests that in the imagery domain environments and objects may be represented separately and may be selectively affected by brain lesions. In the present study, we used functional magnetic resonance imaging (fMRI) to assess the possibility of neural segregation among mental images depicting parts of an object, of an environment (imagined from a first-person perspective), and of a geographical map, using both a mass univariate and a multivariate approach. Data show that different brain areas are involved in different types of mental images. Imagining an environment relies mainly on regions known to be involved in navigational skills, such as the retrosplenial complex and parahippocampal gyrus, whereas imagining a geographical map mainly requires activation of the left angular gyrus, known to be involved in the representation of categorical relations. Imagining a familiar object mainly requires activation of parietal areas involved in visual space analysis in both the imagery and the perceptual domain. We also found that the pattern of activity in most of these areas specifically codes for the spatial arrangement of the parts of the mental image. Our results clearly demonstrate a functional neural segregation for different contents of mental images and suggest that visuospatial information is coded by different patterns of activity in brain areas involved in visual mental imagery.

Frontal-executive constructional apraxia: when delayed recall is better than copying

In assessments of visuospatial function and memory, patients are often required to copy a figure and later to reproduce that figure from memory. Whereas most people perform better on a copying task than when drawing from memory, in this study we describe an unusual pattern of performance in which patients are better at drawing from memory than copying. Consecutive patients in a neurocognitive disorders clinic were given a battery of clinical cognitive tests that included copying a figure of intersecting pentagons and then drawing the figure from memory. Patterns of drawing performance at the two time points were compared to the profile of other cognitive deficits.

RESULTS

A subgroup of four patients with frontal dysfunction showed marked improvement in drawings at a delay compared to copying. Prior studies have indicated that most patients have declines in drawing performance at a delay. The unusual pattern of better performance at a delay compared to an initial copy occurred in patients with frontal dysfunction. These patients' visuoconstructive deficit and subsequent improvement could be related to either a failure to disengage when a model is present, to memory consolidation with increased reliance on top-down processing in the delay condition, or to relative preservation of global versus local aspects of a stimulus in memory. The addition of a task to assess drawing after a delay to a standard clinical screening battery such as the Mini-Mental Status Examination (MMSE) provides the opportunity to evaluate this phenomenon that may be indicative of frontal-executive dysfunction.

Sex differences in the weighting of metric and categorical information in spatial location memory

According to the Category Adjustment model, remembering a spatial location involves the Bayesian combination of fine-grained and categorical information about that location, with each cue weighted by its relative certainty. However, individuals may differ in terms of their certainty about each cue, resulting in estimates that rely more or less on metric or categorical representations. To date, though, very little research has examined individual differences in the relative weighting of these cues in spatial location memory. Here, we address this gap in the literature. Participants were asked to recall point locations in uniform geometric shapes and in photographs of complex, natural scenes. Error patterns were analyzed for evidence of a sex difference in the relative use of metric and categorical information. As predicted, women placed relatively more emphasis on categorical cues, while men relied more heavily on metric information. Location reproduction tasks showed a similar effect, implying that the sex difference arises early in spatial processing, possibly during encoding.

Focusing narrowly or broadly attention when judging categorical and coordinate spatial relations: a MEG study

We measured activity in the dorsal system of the human cortex with magnetoencephalography (MEG) during a matching-to-sample plus cueing paradigm, where participants judged the occurrence of changes in either categorical or coordinate spatial relations (e.g., exchanges of left versus right positions or changes in the relative distances) between images of pairs of animals. The attention window was primed in each trial to be either small or large by using cues that immediately preceded the matching image. In this manner, we could assess the modulatory effects of the scope of attention on the activity of the dorsal system of the human cortex during spatial relations processing. The MEG measurements revealed that large spatial cues yielded greater activations and longer peak latencies in the right inferior parietal lobe for coordinate trials, whereas small cues yielded greater activations and longer peak latencies in the left inferior parietal lobe for categorical trials. The activity in the superior parietal lobe, middle frontal gyrus, and visual cortex, was also modulated by the size of the spatial cues and by the type of spatial relation change. The present results support the theory that the lateralization of each kind of spatial processing hinges on differences in the sizes of regions of space attended to by the two hemispheres. In addition, the present findings are inconsistent with the idea of a right-hemispheric dominance for all kinds of challenging spatial tasks, since response times and accuracy rates showed that the categorical spatial relation task was more difficult than the coordinate task and the cortical activations were overall greater in the left hemisphere than in the right hemisphere.

Retinotopic mapping of categorical and coordinate spatial relation processing in early visual cortex

Spatial relations are commonly divided in two global classes. Categorical relations concern abstract relations which define areas of spatial equivalence, whereas coordinate relations are metric and concern exact distances. Categorical and coordinate relation processing are thought to rely on at least partially separate neurocognitive mechanisms, as reflected by differential lateralization patterns, in particular in the parietal cortex. In this study we address this textbook principle from a new angle. We studied retinotopic activation in early visual cortex, as a reflection of attentional distribution, in a spatial working memory task with either a categorical or a coordinate instruction. Participants were asked to memorize a dot position, with regard to a central cross, and to indicate whether a subsequent dot position matched the first dot position, either categorically (opposite quadrant of the cross) or coordinately (same distance to the centre of the cross). BOLD responses across the retinotopic maps of V1, V2, and V3 indicate that the spatial distribution of cortical activity was different for categorical and coordinate instructions throughout the retention interval; a more local focus was found during categorical processing, whereas focus was more global for coordinate processing. This effect was strongest for V3, approached significance in V2 and was absent in V1. Furthermore, during stimulus presentation the two instructions led to different levels of activation in V3 during stimulus encoding; a stronger increase in activity was found for categorical processing. Together this is the first demonstration that instructions for specific types of spatial relations may yield distinct attentional patterns which are already reflected in activity early in the visual cortex.

Effects of low versus high frequencies of repetitive transcranial magnetic stimulation on cognitive function and cortical excitability in Alzheimer's dementia

The aim of the study was to compare the long-term efficacy of high versus low frequency repetitive transcranial magnetic stimulation (rTMS), applied bilaterally over the dorsolateral prefrontal cortex (DLPFC), on cognitive function and cortical excitability of patients with Alzheimer's disease (AD). Forty-five AD patients were randomly classified into three groups. The first two groups received real rTMS over the DLPFC (20 and 1 Hz, respectively) while the third group received sham stimulation. All patients received one session daily for five consecutive days. In each session, rTMS was applied first over the right DLPFC, immediately followed by rTMS over the left DLPFC. Mini Mental State Examination (MMSE), Instrumental Daily Living Activity (IADL) scale and the Geriatric Depression Scale (GDS) were assessed before, after the last (fifth) session, and then followed up at 1 and 3 months. Neurophysiological evaluations included resting and active motor threshold (rMT and aMT), and the duration of transcallosal inhibition (TI) before and after the end of the treatment sessions. At base line assessment there were no significant differences between groups in any of the rating scales. The high frequency rTMS group improved significantly more than the low frequency and sham groups in all rating scales (MMSE, IADL, and GDS) and at all time points after treatment. Measures of cortical excitability immediately after the last treatment session showed that treatment with 20 Hz rTMS reduced TI duration. These results confirm that five daily sessions of high frequency rTMS over the left and then the right DLPFC improves cognitive function in patients with mild to moderate degree of AD. This improvement was maintained for 3 months. High frequency rTMS may be a useful addition to therapy for the treatment of AD.

The relationship between allocentric and egocentric frames of reference and categorical and coordinate spatial information processing

We report two experiments on the relationship between allocentric/egocentric frames of reference and categorical/coordinate spatial relations. Jager and Postma (2003) suggest two theoretical possibilities about their relationship: categorical judgements are better when combined with an allocentric reference frame and coordinate judgements with an egocentric reference frame (interaction hypothesis); allocentric/egocentric and categorical/coordinate form independent dimensions (independence hypothesis). Participants saw stimuli comprising two vertical bars (targets), one above and the other below a horizontal bar. They had to judge whether the targets appeared on the same side (categorical) or at the same distance (coordinate) with respect either to their body-midline (egocentric) or to the centre of the horizontal bar (allocentric). The results from Experiment 1 showed a facilitation in the allocentric and categorical conditions. In line with the independence hypothesis, no interaction effect emerged. To see whether the results were affected by the visual salience of the stimuli, in Experiment 2 the luminance of the horizontal bar was reduced. As a consequence, a significant interaction effect emerged indicating that categorical judgements were more accurate than coordinate ones, and especially so in the allocentric condition. Furthermore, egocentric judgements were as accurate as allocentric ones with a specific improvement when combined with coordinate spatial relations. The data from Experiment 2 showed that the visual salience of stimuli affected the relationship between allocentric/egocentric and categorical/coordinate dimensions. This suggests that the emergence of a selective interaction between the two dimensions may be modulated by the characteristics of the task.

Does hemineglect affect visual mental imagery? Imagery deficits in representational and perceptual neglect

To give new insight about the relationship between imagery processes and different types of hemispatial neglect, we assessed different mental imagery abilities in a sample of right- and left-brain-damaged patients. Furthermore, because of reports of a mental representation disorder for environments in patients affected by representational neglect we also tested their navigational imagery ability. We found that patients with no signs of perceptual or representational neglect performed flawlessly on our imagery tasks regardless of whether they had left- or right-sided lesions. By contrast, patients affected by neglect failed most of the tests; in particular, representational neglect patients failed one test of mental transformation and tests requiring the manipulation of cognitive maps. These results suggest there is a specific relationship between hemispatial neglect and deficits in visual mental imagery and demonstrate that the right hemisphere plays a specific role in visual mental imagery.

Hemispheric asymmetries in categorical perception of orientation in infants and adults

Orientation CP is the faster or more accurate discrimination of two orientations from different categories (e.g., oblique1 and vertical1) compared to two orientations from the same category (e.g., oblique1 and oblique2), even when the degree of difference is equated across conditions. Here, we assess whether there are hemispheric asymmetries in this effect for adults and 5-month-old infants. Experiment 1 identified the location of the vertical-oblique category boundary. Experiment 2, using a visual search task with oriented lines found that adult search was more accurate when the target and distractors were from different orientation categories, compared to targets and distractors of an equivalent physical difference taken from the same category. This effect was stronger for targets lateralized to the left visual field (LVF) than the right visual field (RVF), indicating a right hemisphere (RH) bias in adult orientation CP. Experiment 3, replicated the RH bias using different stimuli and also investigated the impact of visual and verbal interference on the category effect. Experiment 4, using the same visual search task, found that infant search was also faster when the target and distractors were from different orientation categories than the same, yet this category effect was stronger for RVF than LVF lateralized targets, indicating a LH bias in orientation CP at 5 months. These findings are contrasted to equivalent studies on the lateralization of color CP (e.g., Gilbert, Regier, Kay, & Ivry, 2005). The implications for theories on the contribution of the left and right hemispheres of the infant and adult brain to categorical computations are discussed.

Cognitive effects of high-frequency repetitive transcranial magnetic stimulation: a systematic review

Transcranial magnetic stimulation (TMS) was introduced as a non-invasive tool for the investigation of the motor cortex. The repetitive application (rTMS), causing longer lasting effects, was used to study the influence on a variety of cerebral functions. High-frequency (>1 Hz) rTMS is known to depolarize neurons under the stimulating coil and to indirectly affect areas being connected and related to emotion and behavior. Researchers found selective cognitive improvement after high-frequency (HF) stimulation specifically over the left dorsolateral prefrontal cortex (DLPFC). This article provides a systematic review of HF-rTMS studies (1999–2009) stimulating over the prefrontal cortex of patients suffering from psychiatric/neurological diseases or healthy volunteers, where the effects on cognitive functions were measured. The cognitive effect was analyzed with regard to the impact of clinical status (patients/healthy volunteers) and stimulation type (verum/sham). RTMS at 10, 15 or 20 Hz, applied over the left DLPFC, within a range of 10–15 successive sessions and an individual motor threshold of 80–110%, is most likely to cause significant cognitive improvement. In comparison, patients tend to reach a greater improvement than healthy participants. Limitations concern the absence of healthy groups in clinical studies and partly the absence of sham groups. Thus, future investigations are needed to assess cognitive rTMS effects in different psychiatric disorders versus healthy subjects using an extended standardized neuropsychological test battery. Since the pathophysiological and neurobiological basis of cognitive improvement with rTMS remains unclear, additional studies including genetics, experimental neurophysiology and functional brain imaging are necessary to explore stimulation-related functional changes in the brain.

What is the link between language and spatial images? Behavioral and neural findings in blind and sighted individuals

In order to find objects or places in the world, multiple sources of information, such as visual input, auditory input and asking for directions, can help you. These different sources of information can be converged into a spatial image, which represents configurational characteristics of the world. This paper discusses the findings on the nature of spatial images and the role of spatial language in generating these spatial images in both blind and sighted individuals. Congenitally blind individuals have never experienced visual input, yet they are able to perform several tasks traditionally associated with spatial imagery, such as mental scanning, mental pathway completions and mental clock time comparison, though perhaps not always in a similar manner as sighted. Therefore, they offer invaluable insights into the exact nature of spatial images. We will argue that spatial imagery exceeds the input from different input modalities to form an abstract mental representation while maintaining connections with the input modalities. This suggests that the nature of spatial images is supramodal, which can explain functional equivalent results from verbal and perceptual inputs for spatial situations and subtle to moderate behavioral differences between the blind and sighted.

The two sides of the mental clock: the Imaginal HemiSpatial Effect in the healthy brain

When subjects are asked to compare the mental images of two analog clocks telling different times (the mental clock test), they are faster to process angles formed by hands located in the right than in the left half of the dial. In the present paper, we demonstrate that this Imaginal HemiSpatial Effect (IHSE) can be also observed in two modified versions of the mental clock test: in Experiment 1 subjects had to imagine the position occupied by two numbers within a clock face and to judge if the subtended angle was smaller or greater than 90 degrees , while in Experiment 2 subjects were asked to match two imagined positions on a clock face with two visually presented locations. The finding of the IHSE in these tasks suggested that it is a genuine phenomenon related to spatial imagery tasks, and is consistent with recent neuroimaging evidence that the left parietal lobe is mainly involved in the generation of spatial mental images.

Is there continuity between categorical and coordinate spatial relations coding? Evidence from a grid/no-grid working memory paradigm

We ask the question whether the coding of categorical versus coordinate spatial relations depends on different neural networks showing hemispheric specialization or whether there is continuity between these two coding types. The 'continuous spatial coding' hypothesis would mean that the two coding types rely essentially on the same neural network consisting of more general-purpose processes, such as visuo-spatial attention, but with a different weighting of these general processes depending on exact task requirements. With event-related fMRI, we have studied right-handed male subjects performing a grid/no-grid visuo-spatial working memory task inducing categorical and coordinate spatial relations coding. Our data support the 'continuous spatial coding' hypothesis, indicating that, while based on the same fronto-parieto-occipital neural network than categorical spatial relations coding, the coding of coordinate spatial relations relies more heavily on attentional and executive processes, which could induce hemispheric differences similar to those described in the literature. The results also show that visuo-spatial working memory consists of a short-term posterior store with a capacity of up to three elements in the parietal and extrastriate cortices. This store depends on the presence of a visible space categorization and thus can be used for the coding of categorical spatial relations. When no visible space categorization is given or when more than three elements have to be coded, additional attentional and executive processes are recruited, mainly located in the dorso-lateral prefrontal cortex.