Visual mismatch negativity highlights abnormal pre-attentive visual processing in mild cognitive impairment and Alzheimer's disease

Pre-attentive Visual Processing in Alzheimer's Disease: An Event-related Potential Study

INTRODUCTION

While identifying Alzheimer's Disease (AD) in its early stages is crucial, traditional neuropsychological tests tend to lack sensitivity and specificity for its diagnosis. Neuropsychological studies have reported visual processing deficits of AD, and event-related potentials (ERPs) are suitable to investigate pre-attentive processing with superior temporal resolution.

OBJECTIVE

This study aimed to investigate visual attentional characteristics of adults with AD, from pre-attentive to attentive processing, using a visual oddball task and ERPs.

METHODS

Cognitively normal elderly controls (CN) and patients with probable AD (AD) were recruited. Participants performed a three-stimulus visual oddball task and were asked to press a designated button in response to the target stimuli. The amplitudes of 4 ERPs were analyzed. Mismatchnegativity (vMMN) was analyzed around the parieto-occipital and temporo-occipital regions. P3a was analyzed around the fronto-central regions, whereas P3b was analyzed around the centro-parietal regions.

RESULTS

Late vMMN amplitudes of the AD group were significantly smaller than those of the CN group, while early vMMN amplitudes were comparable. Compared to the CN group, P3a amplitudes of the AD group were significantly smaller for the infrequent deviant stimuli, but the amplitudes for the standard stimuli were comparable. Lastly, the AD group had significantly smaller P3b amplitudes for the target stimuli compared to the CN group.

CONCLUSION

Our findings imply that AD patients exhibit pre-attentive visual processing deficits, known to affect later higher-order brain functions. In a clinical setting, the visual oddball paradigm could be used to provide helpful diagnostic information since pre-attentive ERPs can be induced by passive exposure to infrequent stimuli.

Subjective Cognitive Impairment in 55-65-Year-Old Adults Is Associated with Negative Affective Symptoms, Neuroticism, and Poor Quality of Life

Although subjective cognitive impairment (SCI) is increasingly recognized clinically and in research as a risk factor for mild cognitive impairment and dementia (particularly Alzheimer’s disease), it is etiologically heterogeneous and potentially treatable. Compared to mild cognitive impairment and Alzheimer’s disease, SCI however remains poorly characterized with debate continuing regarding its clinical relevance. The primary aim of this study was to improve the characterization of SCI within the general public by investigating functions sometimes omitted clinically or in research, namely visual attention-related information processing speed (RT) and its intra-individual variability (IIV_RT), general cognition, depression, anxiety, memory, quality of life (QOL), and neuroticism. Compared to individuals without SCI, those with SCI were more likely to reveal higher scores of anxiety, depression, and neuroticism and poorer perceived physical, psychological, and environmental QOL. Within-group analysis identified no significant relationships between any of the above variables for the non-SCI group whereas for the SCI group, poorer Cognitive Change Index scores were significantly correlated with slower RT, raised IIV_RT, poorer memory, negative affective symptoms, higher neuroticism scores, and poorer QOL. This indicates that reports of perceived memory changes in SCI can also be associated with other characteristics, namely objectively measured detrimental change in other aspects of brain function and behavior. This outcome emphasizes the importance of a multi-function approach to characterizing and understanding SCI. Thus, although the effect of RT and IIV_RT is not strong enough to differentiate SCI from non-SCI at group level, slowing and raised IIV_RT do appear to characterize some people with SCI.

Visual Event-Related Potentials in Mild Cognitive Impairment and Alzheimer's Disease: A Literature Review

BACKGROUND

Cognitive deficits are correlated with increasing age and become more pronounced for people with mild cognitive impairment (MCI) and dementia caused by Alzheimer's disease (AD). Conventional methods to diagnose cognitive decline (i.e., neuropsychological testing and clinical judgment) can lead to false positives. Tools such as electroencephalography (EEG) offer more refined, objective measures that index electrophysiological changes associated with healthy aging, MCI, and AD.

OBJECTIVE

We sought to review the EEG literature to determine whether visual event-related potentials (ERPs) can distinguish between healthy aging, MCI, and AD.

METHOD

We searched Medline and PyscInfo for articles published between January 2005 and April 2018. Articles were considered for review if they included participants aged 60+ who were healthy older adults or people with MCI and AD, and examined at least one visually elicited ERP component.

RESULTS

Our search revealed 880 records, of which 34 satisfied the inclusion criteria. All studies compared cognitive function between at least two of the three groups (healthy older adults, MCI, and AD). The most consistent findings related to the P100 and the P3b; while the P100 showed no differences between groups, the P3b showed declines in amplitude in MCI and AD.

CONCLUSION

Visually elicited ERPs can offer insight into the cognitive processes that decline in MCI and AD. The P3b may be useful in identifying older adults who may develop MCI and AD, and more research should examine the sensitivity and specificity of this component when diagnosing MCI and AD.

Dysfunction of Pre-Attentive Visual Information Processing in Drug-Naïve Women, But Not Men, During the Initial Episode of Major Depressive Disorder

Women are twice as likely as men to develop depression. Few studies have explored gender difference in cognitive function of patients with MDD. The gender difference in the pre-attentive information processing of MDD patients is still poorly understood. To examine the gender differences in change detection, 30 medication-free MDD patients (15 women) and 30 age and education matched controls (15 women) were recruited. The deviant-standard reverse oddball paradigm (50 ms/150 ms) was used to obtain the visual mismatch negativity (vMMN) in first episode MDD patients. Compared to men with MDD, women with MDD showed a significantly decreased increment vMMN, while no gender difference in decrement vMMN was found. The increment vMMN amplitude in MDD women was smaller than in healthy women, whereas no difference was found in decrement vMMN. Neither increment nor decrement vMMN differed between MDD men and healthy men. The mean amplitude of increment vMMN was not correlated with symptoms of MDD in MDD patients and MDD women. To conclude, the dysfunction of visual information processing existed at pre-attentive stage in MDD women.

Automatic Change Detection in Older and Younger Women: A Visual Mismatch Negativity Study

BACKGROUND

In comparison to controlled (attentional) processing, relatively little is known about the age-related changes of the earlier (preattentive) processes. An event-related potential (ERP) index of preattentive (automatic) visual processing, the visual mismatch negativity (vMMN) is a good candidate for analyzing age-related differences in the automatic processing of visual events.

OBJECTIVE

So far results concerning age-related changes in vMMN have been equivocal. Our aim was to develop a method resulting in a reliable vMMN in a paradigm short enough to use in the applied field.

METHODS

We investigated an older (mean age: 66.4 years, n = 15) and a younger (mean age: 22.4 years, n = 15) group of healthy women. ERPs were obtained for checkerboard onset patterns in a passive oddball condition (during which participants performed a tracking task). One of the checkerboards was frequent (standard; p = 0.8), and the other was rare (deviant; p = 0.2).

RESULTS

vMMN emerged over posterior locations in the latency range of 100-300 ms in both age groups. The amplitude of the earlier part of the vMMN was similar in the older and the younger participants, but latency was longer in the older group. The later part of the vMMN was slightly diminished in the elderly.

CONCLUSION

Automatic detection of violated sequential regularities, reflected by the vMMN, emerged in the two age groups (earlier vMMN). However, detection of stimulus change, a preattentive visual process delayed in the elderly, and identification of the specific change was compromised in the older participants.

The mismatch negativity as an index of cognitive decline for the early detection of Alzheimer's disease

Evidence suggests that Alzheimer's disease (AD) is part of a continuum, characterized by long preclinical phases before the onset of clinical symptoms. In several cases, this continuum starts with a syndrome, defined as mild cognitive impairment (MCI), in which daily activities are preserved despite the presence of cognitive decline. The possibility of having a reliable and sensitive neurophysiological marker that can be used for early detection of AD is extremely valuable because of the incidence of this type of dementia. In this study, we aimed to investigate the reliability of auditory mismatch negativity (aMMN) as a marker of cognitive decline from normal ageing progressing from MCI to AD. We compared aMMN elicited in the frontal and temporal locations by duration deviant sounds in short (400 ms) and long (4000 ms) inter-trial intervals (ITI) in three groups. We found that at a short ITI, MCI showed only the temporal component of aMMN and AD the frontal component compared to healthy elderly who presented both. At a longer ITI, aMMN was elicited only in normal ageing subjects at the temporal locations. Our study provides empirical evidence for the possibility to adopt aMMN as an index for assessing cognitive decline in pathological ageing.

A frontal attention mechanism in the visual mismatch negativity

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We examine frontal mechanisms underlying the visual mismatch negativity.

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EEG and fMRI activity was examined in respect to unattended oddball stimuli.

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Left inferior frontal gyrus was associated with changes in the stimuli.

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Our findings correspond to similarly implicated regions in the auditory domain.

Automatic detection of environmental change is a core component of attention. The mismatch negativity (MMN), an electrophysiological marker of this mechanism, has been studied prominently in the auditory domain, with cortical generators identified in temporal and frontal regions. Here, we combined electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) to assess whether the underlying frontal regions associated with auditory change detection also play a role in visual change detection. Twenty healthy young adults completed a visual MMN task in separate EEG and fMRI sessions. Region of interest analyses were conducted on left and right middle frontal (MFG) and inferior frontal (IFG) gyri, i.e., the frontal areas identified as potential auditory MMN generators. A significant increase in activation was observed in the left IFG and MFG in response to blocks containing deviant stimuli. These findings suggest that a frontal mechanism is involved in the detection of change in the visual MMN. Our results support the notion that frontal mechanisms underlie attention switching, as measured via MMN, across multiple modalities.

Mismatch negativity latency as a biomarker of amnestic mild cognitive impairment in chinese rural elders

The aim was to evaluate the mismatch negativity (MMN) component, a correlate of the automatic detection of changes in the acoustic environment, in healthy adults, and adults with amnestic mild cognitive impairment (aMCI). Forty-three aMCI subjects and 43 healthy Chinese older adults were arranged into experimental group and control group, respectively. Their MMN amplitude and latency were measured at the FZ, FCZ, and CZ electrode sites under a passive auditory oddball task. The results showed that the latencies obtained from the FZ, FCZ, and CZ electrode sites were significantly longer in the aMCI adults than in the control adults (P  < 0.01) while there were no significant differences in MMN amplitude between two groups (P  > 0.05). The MMN latency was found to be a sensitive and specific biomarker of aMCI.

Visual mismatch negativity: a predictive coding view

An increasing number of studies investigate the visual mismatch negativity (vMMN) or use the vMMN as a tool to probe various aspects of human cognition. This paper reviews the theoretical underpinnings of vMMN in the light of methodological considerations and provides recommendations for measuring and interpreting the vMMN. The following key issues are discussed from the experimentalist's point of view in a predictive coding framework: (1) experimental protocols and procedures to control "refractoriness" effects; (2) methods to control attention; (3) vMMN and veridical perception.

Impairment in preattentive processing among patients with hypertension revealed by visual mismatch negativity

Objective. Patients with hypertension show deficits in cognitive function. However, the neural mechanisms underlying the preattentive information processing in hypertensive patients are poorly understood. We seek to investigate whether hypertensive patients have impairments in preattentive information processing. Methods. We compared visual mismatch negativity (vMMN) between 15 hypertensive patients and 15 age-matched healthy controls, which was elicited by the change of visual duration randomly presented in both peripheral visual fields. In addition, the global cognitive function for all participants was assessed with Mini-Mental State Examination (MMSE). Results. The vMMN in deviant-standard comparison was observed at occipital-temporal regions. Compared with normal healthy controls, the amplitude of vMMN was significantly decreased in hypertensive patients (P < 0.05). Meanwhile, the vMMN peak latency was delayed in the hypertensive group (P < 0.05). However, the MMSE scores of patients with hypertension were not significantly different from those of controls (P > 0.05), and there was no significant correlation between the mean amplitude of vMMN and SBP, DBP, and MMSE in hypertensive individuals, respectively. Conclusions. These data indicate dysfunction of automatically change detection processing in patients with hypertension. Moreover, the changes of vMMN provide a more objective and reliable assessment for cognitive impairment in hypertensive patients.

vMMN for schematic faces: automatic detection of change in emotional expression

Our brain is able to automatically detect changes in sensory stimulation, including in vision. A large variety of changes of features in stimulation elicit a deviance-reflecting event-related potential (ERP) component known as the mismatch negativity (MMN). The present study has three main goals: (1) to register vMMN using a rapidly presented stream of schematic faces (neutral, happy, and angry; adapted from Öhman etal., 2001); (2) to compare elicited vMMNs to angry and happy schematic faces in two different paradigms, in a traditional oddball design with frequent standard and rare target and deviant stimuli (12.5% each) and in an version of an optimal multi-feature paradigm with several deviant stimuli (altogether 37.5%) in the stimulus block; (3) to compare vMMNs to subjective ratings of valence, arousal and attention capture for happy and angry schematic faces, i.e., to estimate the effect of affective value of stimuli on their automatic detection. Eleven observers (19–32 years, six women) took part in both experiments, an oddball and optimum paradigm. Stimuli were rapidly presented schematic faces and an object with face-features that served as the target stimulus to be detected by a button-press. Results show that a vMMN-type response at posterior sites was equally elicited in both experiments. Post-experimental reports confirmed that the angry face attracted more automatic attention than the happy face but the difference did not emerge directly at the ERP level. Thus, when interested in studying change detection in facial expressions we encourage the use of the optimum (multi-feature) design in order to save time and other experimental resources.

Visual mismatch negativity in the dorsal stream is independent of concurrent visual task difficulty

The manipulation of attention can produce mismatch negativity-like components that are not necessarily connected to the unintentional sensory registration of the violation of probability-based regularity. For clinical purposes, attentional bias should be quantified because it can vary substantially among subjects and can decrease the specificity of the examination. This experiment targets the role of attention in the generation of visual mismatch negativity (vMMN). The visual regularity was generated by a sequence of two radial motions while subjects focused on visual tasks in the central part of the display. Attentional load was systematically varied and had three levels, no-load, easy, and difficult. Rare, deviant, and frequent standard motions were presented with a 10/60 ratio in oddball sequences. Data from 12 subjects was recorded from 64 channels and processed. vMMN was identified within the interval of 142-198 ms. The mean amplitude was evaluated during the aforementioned interval in the parietal and fronto-central regions. A general linear model for repeated measures was applied to the mean amplitude with a three-factor design and showed a significant difference [F (1, 11) = 17.40, p = 0.002] between standard and deviant stimuli and between regions [F (1, 11) = 8.40, p = 0.01]; however, no significant effect of the task [F (2, 22) = 1.26, p = 0.30] was observed. The unintentional detection of irregularity during the processing of the visual motion was independent of the attentional load associated with handling the central visual task. The experiment did not demonstrate an effect of attentional load manipulation on mismatch negativity (MMN) induced by the motion-sequence, which supports the clinical utility of this examination. However, used stimulation paradigm should be further optimized to generate mismatch negativity that is stable enough to be usable not only for group comparisons but also for a single subject assessment.

Task difficulty affects the predictive process indexed by visual mismatch negativity

Visual mismatch negativity (MMN) is an event-related brain potential (ERP) component that is elicited by prediction-incongruent events in successive visual stimulation. Previous oddball studies have shown that visual MMN in response to task-irrelevant deviant stimuli is insensitive to the manipulation of task difficulty, which supports the notion that visual MMN reflects attention-independent predictive processes. In these studies, however, visual MMN was evaluated in deviant-minus-standard difference waves, which may lead to an underestimation of the effects of task difficulty due to the possible superposition of N1-difference reflecting refractory effects. In the present study, we investigated the effects of task difficulty on visual MMN, less contaminated by N1-difference. While the participant performed a size-change detection task regarding a continuously-presented central fixation circle, we presented oddball sequences consisting of deviant and standard bar stimuli with different orientations (9.1 and 90.9%) and equiprobable sequences consisting of 11 types of control bar stimuli with different orientations (9.1% each) at the surrounding visual fields. Task difficulty was manipulated by varying the magnitude of the size-change. We found that the peak latencies of visual MMN evaluated in the deviant-minus-control difference waves were delayed as a function of task difficulty. Therefore, in contrast to the previous understanding, the present findings support the notion that visual MMN is associated with attention-demanding predictive processes.

The mismatch negativity (MMN)--a unique window to disturbed central auditory processing in ageing and different clinical conditions

In this article, we review clinical research using the mismatch negativity (MMN), a change-detection response of the brain elicited even in the absence of attention or behavioural task. In these studies, the MMN was usually elicited by employing occasional frequency, duration or speech-sound changes in repetitive background stimulation while the patient was reading or watching videos. It was found that in a large number of different neuropsychiatric, neurological and neurodevelopmental disorders, as well as in normal ageing, the MMN amplitude was attenuated and peak latency prolonged. Besides indexing decreased discrimination accuracy, these effects may also reflect, depending on the specific stimulus paradigm used, decreased sensory-memory duration, abnormal perception or attention control or, most importantly, cognitive decline. In fact, MMN deficiency appears to index cognitive decline irrespective of the specific symptomatologies and aetiologies of the different disorders involved.

Event-related potentials for the diagnosis of mild cognitive impairment and Alzheimer's disease

INTRODUCTION

Alzheimer's disease (AD) and the nosological entity of mild cognitive impairment (MCI) constitute a major public health concern. The diagnostic approach and therapeutic management of these disorders may be significantly improved by recent advances in the field of event-related potentials (ERPs).

AREAS COVERED

The authors performed a PubMed search in order to identify full-length, original research articles on the experimental and clinical application of ERPs in AD and MCI. The major part of the retrieved articles concerns the application of auditory and, to a lesser extent, visual ERPs for the early diagnosis of AD and MCI. Particular emphasis was placed on the role of ERPs in identifying the subgroup of MCI patients who will subsequently convert to AD. Other areas covered include the contribution of ERPs in the differential diagnosis of dementia types, the utility of ERPs for monitoring pharmacological treatment in AD and the correlation between ERPs and the results of neuropsychological testing.

EXPERT OPINION

The reviewed evidence suggests that ERPs hold promise as an electrophysiological tool for the early and accurate diagnosis of AD and MCI. However, certain methodological issues need to be resolved before ERPs enter the arena of clinical practice.

Exploring the Role of Low Level Visual Processing in Letter-Speech Sound Integration: A Visual MMN Study

In contrast with for example audiovisual speech, the relation between visual and auditory properties of letters and speech sounds is artificial and learned only by explicit instruction. The arbitrariness of the audiovisual link together with the widespread usage of letter-speech sound pairs in alphabetic languages makes those audiovisual objects a unique subject for crossmodal research. Brain imaging evidence has indicated that heteromodal areas in superior temporal, as well as modality-specific auditory cortex are involved in letter-speech sound processing. The role of low level visual areas, however, remains unclear. In this study the visual counterpart of the auditory mismatch negativity (MMN) is used to investigate the influences of speech sounds on letter processing. Letter and non-letter deviants were infrequently presented in a train of standard letters, either in isolation or simultaneously with speech sounds. Although previous findings showed that letters systematically modulate speech sound processing (reflected by auditory MMN amplitude modulation), the reverse does not seem to hold: our results did not show evidence for an automatic influence of speech sounds on letter processing (no visual MMN amplitude modulation). This apparent asymmetric recruitment of low level sensory cortices during letter-speech sound processing, contrasts with the symmetric involvement of these cortices in audiovisual speech processing, and is possibly due to the arbitrary nature of the link between letters and speech sounds.

Automatic change detection during the performance of a continuous visual task

The brain's automatic detection of change within the visual environment can be examined by recording visual mismatch negativity (vMMN), a negative deflection in the visual event-related potential evoked by infrequent deviant stimuli presented within a sequence of common standard stimuli. In this study, we examine whether automatic visual change detection occurs even when the visual cortex is concurrently processing other visual information at the focus of attention. We ensured that attention was strongly engaged upon a highly demanding and continuous central task, while at the same time presenting in the peripheral field a sequence of task-irrelevant standard stimuli interspersed by infrequent deviant stimuli. A significant vMMN was evoked. However, decreasing the rarity of deviation resulted in the abolition of the vMMN response.

Gait, aging and dementia

Cognitive impairment has been recognized as a risk factor for falls and for increasing the severity of injury following a fall, but the mechanisms by which cognitive impairment influences gait and postural control have been unclear. A recent report that galantamine improves gait parameters in older adults may help to untangle this.