Seeing and imagining the "same" objects in unilateral neglect

Visual mental imagery: Evidence for a heterarchical neural architecture

Theories of Visual Mental Imagery (VMI) emphasize the processes of retrieval, modification, and recombination of sensory information from long-term memory. Yet, only few studies have focused on the behavioral mechanisms and neural correlates supporting VMI of stimuli from different semantic domains. Therefore, we currently have a limited understanding of how the brain generates and maintains mental representations of colors, faces, shapes - to name a few. Such an undetermined scenario renders unclear the organizational structure of neural circuits supporting VMI, including the role of the early visual cortex. We aimed to fill this gap by reviewing the scientific literature of five semantic domains: visuospatial, face, colors, shapes, and letters imagery. Linking theory to evidence from over 60 different experimental designs, this review highlights three main points. First, there is no consistent activity in the early visual cortex across all VMI domains, contrary to the prediction of the dominant model. Second, there is consistent activity of the frontoparietal networks and the left hemisphere's fusiform gyrus during voluntary VMI irrespective of the semantic domain investigated. We propose that these structures are part of a domain-general VMI sub-network. Third, domain-specific information engages specific regions of the ventral and dorsal cortical visual pathways. These regions partly overlap with those found in visual perception studies (e.g., fusiform face area for faces imagery; lingual gyrus for color imagery). Altogether, the reviewed evidence suggests the existence of domain-general and domain-specific mechanisms of VMI selectively engaged by stimulus-specific properties (e.g., colors or faces). These mechanisms would be supported by an organizational structure mixing vertical and horizontal connections (heterarchy) between sub-networks for specific stimulus domains. Such a heterarchical organization of VMI makes different predictions from current models of VMI as reversed perception. Our conclusions set the stage for future research, which should aim to characterize the spatiotemporal dynamics and interactions among key regions of this architecture giving rise to visual mental images.

Colors in the mind's eye

The famous "Piazza del Duomo" paper, published in Cortex in 1978, inspired a considerable amount of research on visual mental imagery in brain-damaged patients. As a consequence, single-case reports featuring dissociations between perceptual and imagery abilities challenged the prevailing model of visual mental imagery. Here we focus on mental imagery for colors. A case study published in Cortex showed perfectly preserved color imagery in a patient with acquired achromatopsia after bilateral lesions at the borders between the occipital and temporal cortex. Subsequent neuroimaging findings in healthy participants extended and specified this result; color imagery elicited activation in both a domain-general region located in the left fusiform gyrus and the anterior color-biased patch within the ventral temporal cortex, but not in more posterior color-biased patches. Detailed studies of individual neurological patients, as those often published in Cortex, are still critical to inspire and constrain neurocognitive research and its theoretical models.

The connectional anatomy of visual mental imagery: evidence from a patient with left occipito-temporal damage

Most of us can use our "mind's eye" to mentally visualize things that are not in our direct line of sight, an ability known as visual mental imagery. Extensive left temporal damage can impair patients' visual mental imagery experience, but the critical locus of lesion is unknown. Our recent meta-analysis of 27 fMRI studies of visual mental imagery highlighted a well-delimited region in the left lateral midfusiform gyrus, which was consistently activated during visual mental imagery, and which we called the Fusiform Imagery Node (FIN). Here, we describe the connectional anatomy of FIN in neurotypical participants and in RDS, a right-handed patient with an extensive occipito-temporal stroke in the left hemisphere. The stroke provoked right homonymous hemianopia, alexia without agraphia, and color anomia. Despite these deficits, RDS had normal subjective experience of visual mental imagery and reasonably preserved behavioral performance on tests of visual mental imagery of object shape, object color, letters, faces, and spatial relationships. We found that the FIN was spared by the lesion. We then assessed the connectional anatomy of the FIN in the MNI space and in the patient's native space, by visualizing the fibers of the inferior longitudinal fasciculus (ILF) and of the arcuate fasciculus (AF) passing through the FIN. In both spaces, the ILF connected the FIN with the anterior temporal lobe, and the AF linked it with frontal regions. Our evidence is consistent with the hypothesis that the FIN is a node of a brain network dedicated to voluntary visual mental imagery. The FIN could act as a bridge between visual information and semantic knowledge processed in the anterior temporal lobe and in the language circuits.

Spatial Neglect Subtypes, Definitions and Assessment Tools: A Scoping Review

Objective: The objective of this scoping review was to capture the reported definitions for the subtypes of neglect post stroke and map the range of assessment tools employed for each neglect subtype.

Methods: EMBASE, Emcare, Medline, and psychINFO were searched from database inception. Searching included all allied terms and mesh headings for stroke, spatial neglect, measurement, screening tools, psychometric properties. Two reviewers independently screened studies for inclusion. Primary studies with documented protocols of a spatial neglect tool for adults post stroke, with some aspect of validity or reliability were included. Two reviewers independently reviewed the documented protocols of each tool to determine the underlying subtypes and disagreements were resolved through discussion.

Results: There were 371 articles included with 292 tools used for the screening or diagnosis of neglect. The majority of studies (67%) included a tool that did not specify the neglect subtype being assessed, therefore an analysis of the underlying subtypes for each tool is presented.

Conclusions: There is no consistency with the terms used to refer to the syndrome of spatial neglect with over 200 different terms used within the included studies to refer to the syndrome as a whole or one of its subtypes. It is essential to unify the terminology and definition for each neglect subtype. There are hundreds of neglect tools available, however many are not able to differentiate presenting subtypes. It is important for clinicians and researchers to critically evaluate the neglect tools being used for the screening and diagnosis of neglect.

The presence of semantic content in a visual recognition memory task reduces the severity of neglect

Patients with right hemisphere damage often show a lateral bias when asked to report the left side of mental images held in visual working memory (i.e. representational neglect). The neural basis of representational neglect is not well understood. One hypothesis suggests that it reflects a deficit in attentional-exploratory mechanisms, i.e. an inability to direct attention to the left side of the image. Another proposition states that intact visual working memory (VWM) is necessary for correctly creating a mental image. Here we examined two components of VWM in patients with unilateral spatial neglect (USN): memory for identity, and memory for spatial position. We manipulated the strength of memory representations by presenting two distinct categories of objects, in separate blocks. These were familiar namable objects (fruits, etc.), and unfamiliar abstract objects. The former category elicits stronger working-memory traces, thanks to preexisting visual and semantic representations in long-term memory. We hypothesized that if USN patients show a lateralized deficit in VWM, it should be more pronounced for abstract objects, due to their weaker working-memory traces. Importantly, to isolate a spatially lateralized deficit in memory from a failure to fully perceive the object-arrays, we ensured that all included patients perceived every item during the encoding phase. We used a working-memory task: participants viewed object arrays and had to memorize items' identities and spatial positions. Then, single objects were presented requiring 'old/new' recognition, and retrieval of 'old' items' original positions. Our results show a lateral bias in patients' recognition-memory performance. Remarkably, it was threefold milder for namable objects compared to abstract objects. We conclude that VWM lateralized deficit is substantial in USN patients and could play a role in representational neglect.

Hemispheric asymmetries in visual mental imagery

Visual mental imagery is the faculty whereby we can "visualize" objects that are not in our line of sight. Longstanding evidence dating back over thirty years has shown that unilateral brain lesions, especially in the left temporal lobe, can impair aspects of this ability. Yet, there is currently no attempt to identify analogies between these neuropsychological findings of hemispheric asymmetry and those from other neuroscientific approaches. Here, we present a critical review of the available literature on the hemispheric laterality of visual mental imagery, by looking at cross-method patterns of evidence in the domains of lesion neuropsychology, neuroimaging, and direct cortical stimulation. Results can be summarized under three main axes. First, frontoparietal networks in both hemispheres appear to be associated with visual mental imagery. Second, lateralization patterns emerge in the temporal lobes, with the left inferior temporal lobe being the most common finding in the literature for endogenously generated images, especially, but not exclusively, when orthographic material is used to ignite imagery. Third, an opposite pattern of hemispheric laterality emerges when visual mental images are induced by exogenous stimulation; direct cortical electrical stimulation tends to produce visual imagery experiences predominantly when applied to the right temporal lobe. These patterns of hemispheric asymmetry are difficult to reconcile with the dominant model of visual mental imagery, which emphasizes the implication of early sensory cortices. They suggest instead that visual mental imagery relies on large-scale brain networks, with a crucial participation of high-level visual regions in the temporal lobes.

Botallo's error, or the quandaries of the universality assumption

One of the founding principles of human cognitive neuroscience is the so-called universality assumption, the postulate that neurocognitive mechanisms do not show major differences among individuals. Without negating the importance of the universality assumption for the development of cognitive neuroscience, or the importance of single-case studies, here we aim at stressing the potential dangers of interpreting the pattern of performance of single patients as conclusive evidence concerning the architecture of the intact neurocognitive system. We take example from the case of Leonardo Botallo, an Italian surgeon of the Renaissance period, who claimed to have discovered a new anatomical structure of the adult human heart. Unfortunately, Botallo's discovery was erroneous, because what he saw in the few samples he examined was in fact the anomalous persistence of a fetal structure. Botallo's error is a reminder of the necessity to always strive for replication, despite the major hindrance of a publication system heavily biased towards novelty. In the present paper, we briefly discuss variations and anomalies in human brain anatomy and introduce the issue of variability in cognitive neuroscience. We then review some examples of the impact on cognition of individual variations in (1) brain structure, (2) brain functional organization and (3) brain damage. We finally discuss the importance and limits of single case studies in the neuroimaging era, outline potential ways to deal with individual variability, and draw some general conclusions.

A century of imagery research: reflections on Cheves Perky's contribution to our understanding of mental imagery

We review contemporary scientific research on the relationship between visual perception and visual mental imagery in the context of Cheves Perky's (1910) landmark article on imagery and imagination. This body of research has firmly established a strong connection between the psychology of imagery and perception and has contributed a strong voice to the imagery debate. We then use the concept of embodiment to discuss additional avenues of inquiry at which Perky's work hinted. These include a more thorough examination of the relationship between imagery and emotion, the creative, active aspects of imagery and imagination, and the methods we can bring to bear on understanding imagery and imagination as a human experience.

Brain networks of visuospatial attention and their disruption in visual neglect

Visual neglect is a multi-component syndrome including prominent attentional disorders. Research on the functional mechanisms of neglect is now moving from the description of dissociations in patients' performance to the identification of the possible component deficits and of their interaction with compensatory strategies. In recent years, the dissection of attentional deficits in neglect has progressed in parallel with increasing comprehension of the anatomy and function of large-scale brain networks implicated in attentional processes. This review focuses on the anatomy and putative functions of attentional circuits in the brain, mainly subserved by fronto-parietal networks, with a peculiar although not yet completely elucidated role for the right hemisphere. Recent results are discussed concerning the influence of a non-spatial attentional function, phasic alertness, on conscious perception in normal participants and on conflict resolution in neglect patients. The rapid rate of expansion of our knowledge of these systems raises hopes for the development of effective strategies to improve the functioning of the attentional networks in brain-damaged patients.

Visual mental imagery: what the head's eye tells the mind's eye

The demonstration of an implication of attentional/eye gaze systems in visual mental imagery might help to understand why some patients with visual neglect, who suffer from severe attentional deficits, also show neglect for mental images. When normal participants generate mental images of previously explored visual scenes, their oculomotor behavior resembles that used during visual exploration. However, this could be a case of encoding specificity, whereby the probability of retrieving an event increases if some information encoded with the event (in this case its spatial location) is present at retrieval. In the present study, normal participants were invited to conjure up a mental image of the map of France and to say whether auditorily presented towns or regions were situated left or right of Paris. A perceptual version of the task was administered after the imaginal condition. Thus, in the imaginal condition participants had to retrieve information from long-term memory. Vocal response times and, unbeknownst to participants, also eye movements were recorded. Participants tended to produce similar eye movements on the imaginal and on the perceptual conditions of the task. We concluded that some mechanisms involved in spontaneous oculomotor behavior may be shared in exploration of visuospatial mental images. Deficits of these common processes participating in the oculomotor exploration might contribute to imaginal neglect.

Representation and disconnection in imaginal neglect

Patients with neglect failure to detect, orient, or respond to stimuli from a spatially confined region, usually on their left side. Often, the presence of perceptual input increases left omissions, while sensory deprivation decreases them, possibly by removing attention-catching right-sided stimuli (Bartolomeo, 2007). However, such an influence of visual deprivation on representational neglect was not observed in patients while they were imagining a map of France (Rode et al., 2007). Therefore, these patients with imaginal neglect either failed to generate the left side of mental images (Bisiach & Luzzatti, 1978), or suffered from a co-occurrence of deficits in automatic (bottom-up) and voluntary (top-down) orienting of attention. However, in Rode et al.'s experiment visual input was not directly relevant to the task; moreover, distraction from visual input might primarily manifest itself when representation guides somatomotor actions, beyond those involved in the generation and mental exploration of an internal map (Thomas, 1999). To explore these possibilities, we asked a patient with right hemisphere damage, R.D., to explore visual and imagined versions of a map of France in three conditions: (1) 'imagine the map in your mind' (imaginal); (2) 'describe a real map' (visual); and (3) 'list the names of French towns' (propositional). For the imaginal and visual conditions, verbal and manual pointing responses were collected; the task was also given before and after mental rotation of the map by 180 degrees . R.D. mentioned more towns on the right side of the map in the imaginal and visual conditions, but showed no representational deficit in the propositional condition. The rightward inner exploration bias in the imaginal and visual conditions was similar in magnitude and was not influenced by mental rotation or response type (verbal responses or manual pointing to locations on a map), thus suggesting that the representational deficit was robust and independent of perceptual input in R.D. Structural and diffusion MRI demonstrated damage to several white matter tracts in the right hemisphere and to the splenium of corpus callosum. A second right-brain damaged patient (P.P.), who showed signs of visual but not imaginal neglect, had damage to the same intra-hemispheric tracts, but the callosal connections were spared. Imaginal neglect in R.D. may result from fronto-parietal dysfunction impairing orientation towards left-sided items and posterior callosal disconnection preventing the symmetrical processing of spatial information from long-term memory.

[Presentation of an assessment battery for visual mental imagery and visual perception]

INTRODUCTION

The relationship between visual perception and visual mental imagery are at the center of a lively theoretical debate between those postulating common neurocognitive processes between perception and imagery and those who emphasize the differences between these two entities. Neuropsychology can make an important contribution to this debate, by assessing associations and dissociations between perceptual and imaginal deficits in patients with brain damage. However, currently there is no standardized test battery available for such assessments.

MATERIAL AND METHODS

Here we present a battery of paper-and-pencil tests assessing different domains of visual mental imagery and visual perception abilities: object form and color, animals, orthographic material, numbers, faces, and space. We also explored the effects of age, educational level and gender on performance on a group of 103 participants free of neurological damage.

RESULTS

The battery includes two parts: one composed of 14 tests assessing mental imagery and the second part composed of eight tests assessing the abilities of visual perception. We calculated the correlations between the tests, and found that, with the exception of orthographic material, there were generally poor correlations between imagery and perceptual tests.

CONCLUSION

This result seems inconsistent with hypotheses postulating a strict correspondence between perceptual and imagery abilities.

Vocal response times to real and imagined stimuli in spatial neglect: A group study and single-case report

The relationships between spatial neglect for perceptual objects and representational for imagined items are difficult to explore because of several methodological problems, including the dearth of comparable tests for real and imagined scenes. We asked 19 patients with right brain damage and 12 healthy controls to say whether an auditorily presented French geographical location was left or right of Paris, and recorded their vocal response times. Afterwards, participants performed a similar test with visually presented items. Although several patients had asymmetries of performance on the perceptual version of the test, only one patient was more accurate for right-sided than for left-sided imagined stimuli, thus showing evidence for imaginal neglect. However, this patient performed normally on place description and on mental number line bisection, perhaps as a consequence of different strategies he employed for these tasks. Overall, our results confirm previous evidence showing that imaginal neglect is less frequent than, and often occurs in association with, perceptual neglect. Imaginal neglect may result from the contribution of deficits partly distinct from those implicated in perceptual neglect, such as impaired endogenous orienting of attention or deficits of spatial working memory.