Distractibility with advancing age and Parkinson's disease

Age differences in inhibitory and working memory functioning: limited evidence of system interactions

Debate persists regarding the nature of age-related deficits in inhibition, and whether inhibitory functioning depends on working memory systems. The current research aimed to measure age-related differences in inhibition and working memory, characterize the relationship between inhibitory functions and working memory performance, and determine how these relationships are affected by age. Toward these ends, we measured performance on a range of established paradigms in 60 young adults (18-30 years) and 60 older adults (60-88 years). Our findings support age-related increases in reflexive inhibition (based on the fixation offset effect and inhibition of return) and age-related decrements in volitional inhibition (based on several paradigms: antisaccade, Stroop, flanker, and Simon). This evidence of stronger reflexive inhibition combined with weaker volitional inhibition suggests that age-related deterioration of cortical structures may allow subcortical structures to operate less controlled. Regarding working memory, older adults had lower backward digit scores and lower forward and backward spatial scores. However, of the 32 analyses (16 in each age group) that tested for dependence of inhibitory functioning on working memory functioning, only one (in young adults) indicated that inhibition performance significantly depended on working memory performance. These results indicate that inhibition and working memory function largely independently in both age groups, and age-related working memory difficulties cannot account for age-related declines in inhibitory control.

Automatic and controlled attentional orienting toward emotional faces in patients with Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative motor disorder that can associate with deficits in cognitive and emotional processing. In particular, PD has been reported to be mainly associated with defects in executive control and orienting attentional systems. The deficit in emotional processing mainly emerged in facial expression recognition. It is possible that the defects in emotional processing in PD may be secondary to other cognitive impairments, such as attentional deficits. This study was designed to systematically investigate the different weight of automatic and controlled attentional orienting mechanisms implied in emotional selective attention in PD. To address our purpose, we assessed drug-naïve PD patients and age-matched healthy controls with two dot-probe tasks that differed for stimuli duration. Automatic and controlled attentions were evaluated with stimuli lasting 100 ms and 500 ms, respectively. Furthermore, we introduced an emotion recognition task to investigate the performance in explicit emotion classification. The stimuli used in both the tasks dot-probe and emotion recognition were expressive faces displaying neutral, disgusted, fearful, and happy expressions.Our results showed that in PD patients, compared with healthy controls, there was 1) an alteration of automatic and controlled attentional orienting toward emotional faces in both the dot-probe tasks (with short and long durations), and 2) no difference in the emotion recognition task. These findings suggest that, from the early stages of the disease, PD can yield specific deficits in implicit emotion processing task (i.e., dot-probe task) despite a normal performance in explicit tasks that demand overt emotion recognition.

Neurocognitive functioning of patients with early-stage Parkinson's disease

Parkinson's disease (PD) is a neurological disorder commonly associated with motor deficits. However, cognitive impairment is also common in patients with PD. Cognitive concerns in PD may affect multiple domains of neurocognition and vary across different stages of the disease. Extant research has focused mainly on cognitive deficits in middle to late stages of PD, whereas few studies have examined the unique cognitive profiles of patients with early-stage PD. This study addressed this gap in the published literature and examined neurocognitive functioning and functional capacity of patients with de novo PD, focusing on the unique pattern of cognitive deficits specific to the early stage of the disease. Results indicated that the pattern of cognitive deficits in patients with PD (n = 55; mean age = 72.93) was significantly different from healthy controls (n = 59; mean age = 71.88). Specifically, tasks related to executive functioning, attention, and verbal memory demonstrated the most pronounced deficits in patients with early-stage PD. Clinical implications of these findings are discussed.

The LC-NE system as a potential target for neuromodulation to ameliorate non-motor symptoms in Parkinson's disease

Parkinson's disease (PD) is associated with severe motor symptoms but also with several non-motor symptoms (NMS). A substantial reduction of norepinephrine (NE) levels in various brain regions reflecting an extensive loss of innervation from the LC has been assumed as causal for the development of NMS and specifically of attentional impairments in PD. Transcutaneous auricular vagus nerve stimulation (taVNS) is a new, non-invasive neurostimulation method supposed to modulate the LC-NE system in humans. In the current opinion paper, we introduce taVNS as a systemic approach to directly affect NE neurotransmission in healthy as well as clinical populations and discuss its potential as therapeutic option for the treatment of NMS, specifically attentional deficits, in patients with PD. Here, we first describe the LC-NE system and discuss how LC-NE dysfunction might affects cognition in PD before detailing the mode of action of taVNS and proposing its use to modulate cognitive deficits in these patients.

A Comprehensive Meta-analysis on Short-term and Working Memory Dysfunction in Parkinson's Disease

A previous meta-analysis demonstrated short-term memory (STM) and working memory (WM) dysfunction in patients with Parkinson's disease (PD). However, considerable research on the topic that calls into question the extent of such impairments in PD has since been published. The aim of the present quantitative review was to provide the largest statistical overview on STM and WM dysfunction in Parkinson's disease (PD), while simultaneously providing novel insights on moderating factors of effect size heterogeneity in PD. The systematic literature search in PubMed, PsycINFO, PsycArticles, Scopus and Web of Science databases allowed us to estimate 350 effect sizes from 145 empirical studies that reported STM and WM scores for patients with PD against healthy controls. The outcomes indicated general dysfunction in the visuospatial domain and poor verbal WM in PD. Subgroup analyses suggested that mild cognitive impairment is associated with STM and WM difficulties in PD. Furthermore, meta-regression analyses revealed that disease duration accounted for more than 80% of the visuospatial STM effect size variance (β = 0.136, p < .001, R² = .8272), larger daily levodopa equivalent dose was associated with WM dysfunction (verbal: β = -0.001, p = .016, R² = .1812; visuospatial: β = 0.003, p = .069, R² = .2340), and years of education partially explained the verbal STM effect size variance (β = -0.027, p = .040, R² = .1171). Collectively, these findings advance our understanding of underlying factors that influence STM and WM functioning in PD, while at the same time providing novel directions for future research.

Response-level processing during visual feature search: Effects of frontoparietal activation and adult age

Previous research suggests that feature search performance is relatively resistant to age-related decline. However, little is known regarding the neural mechanisms underlying the age-related constancy of feature search. In this experiment, we used a diffusion decision model of reaction time (RT), and event-related functional magnetic resonance imaging (fMRI) to investigate age-related differences in response-level processing during visual feature search. Participants were 80 healthy, right-handed, community-dwelling individuals, 19–79 years of age. Analyses of search performance indicated that targets accompanied by response-incompatible distractors were associated with a significant increase in the nondecision-time (t0) model parameter, possibly reflecting the additional time required for response execution. Nondecision time increased significantly with increasing age, but no age-related effects were evident in drift rate, cautiousness (boundary separation, a), or in the specific effects of response compatibility. Nondecision time was also associated with a pattern of activation and deactivation in frontoparietal regions. The relation of age to nondecision time was indirect, mediated by this pattern of frontoparietal activation and deactivation. Response-compatible and -incompatible trials were associated with specific patterns of activation in the medial and superior parietal cortex, and frontal eye field, but these activation effects did not mediate the relation between age and search performance. These findings suggest that, in the context of a highly efficient feature search task, the age-related influence of frontoparietal activation is operative at a relatively general level, which is common to the task conditions, rather than at the response level specifically.

Independent control processes? Evidence for concurrent distractor inhibition and attentional usage of distractor information

Interference evoked by a distractor presented prior to a target stimulus is reduced when the distractor-target SOA is increased, suggesting inhibition of distractor-related activation. Distractor processing is also assumed to be (strategically) adjusted to the proportions of congruent and incongruent target-distractor combinations, yielding a larger distractor interference effect when the proportion of congruent trials is higher (i.e., Proportion Congruent Effect, PCE). To explore the interplay of proportion congruent-based processing adjustment and the time course of distractor-related activation we varied the proportions of congruent and incongruent trials as well as the distractor-target SOA. To control for item-specific priming we kept distractor-related contingencies (i.e., frequency of individual distractor-target conjunctions) constant for a subset of the stimuli (and used a different subset to manipulate the proportions of congruent and incongruent trials). A PCE occurred, even for the subset of stimuli associated with constant distractor-related contingencies, thus ruling out item-specific contingency learning. Distractor interference was reduced when the SOA was increased, but this reduction did not differ between the proportion congruent conditions, as confirmed by a Bayesian analysis. Our results are consistent with independent processes pertaining to usage of distractor information for biasing response selection and distractor inhibition during the SOA. Alternative interpretations of the independent effects of the PC manipulation and the distractor-target SOA are discussed.

Volunteering in the Community: Potential Benefits for Cognitive Aging

Objectives

This review aims to advance understanding of the potential benefits of volunteering in the community for older adults' cognitive functioning by taking an in-depth look at the relevant evidence to date.

Method

This review describes the main pathways through which volunteering could plausibly benefit cognitive functioning and critically examines research that has specifically investigated links between volunteering and cognition. Fifteen articles that assessed in adults aged ≥ 55 years the relationship between volunteering (predictor) and cognitive functioning (outcome) were identified via literature database searches.

Results

On balance, evidence from the small number of relevant studies to date supports the idea that volunteering can protect against cognitive aging with respect to global functioning and at least some specific cognitive domains. Studies that used robust designs and assessed domain-specific cognitive functioning produced the largest effect sizes.

Discussion

To help advance the field, this review puts forward recommendations for future research, with an emphasis on the need for robust study designs and specific investigations into the nature and extent of the cognitive benefits of volunteering. Through that work, researchers can determine how a simple and accessible activity like volunteering can best be used to help reduce the burden of age-related cognitive decline.

Computerized testing in Parkinson's disease: Performance deficits in relation to standard clinical measures

OBJECTIVE

This study assessed deficits associated with Parkinson's disease (PD) at two time points separated by 1 year using a computerized neuropsychological battery, and determined interrelationships with conventional clinical measures of cognitive functioning (Montreal Cognitive Assessment; MoCA) and motor impairment (Part III of the Unified PD Rating Scale; UPDRS), as well as other factors known to influence cognitive dysfunction in PD.

METHOD

Participants included 37 with PD and 47 controls. Linear mixed-effects models were developed for each computerized task.

RESULTS

Results showed that the PD group performed worse than controls on all of the computerized tasks at both time points. In contrast, MoCA scores differed between PD and controls only at follow-up. However, the MoCA detected decline over the year in the PD group, whereas only one of the computerized tasks did. In both groups, higher MoCA scores predicted better performance on some but not all of the computerized tasks. Surprisingly, UPDRS-rated motor impairment did not predict performance on any of the computerized tasks, and aside from older age, which predicted poorer performance on all but one task, the other factors-education, affective and impulsivecompulsive symptoms, sleep quality, dopaminergic medication-generally had no relationship with performance on the computerized tasks.

CONCLUSIONS

The presence of performance deficits for all of the computerized tasks in the PD group compared to controls, but not for the MoCA at initial testing, indicates that the computerized battery was better able to detect deficits. However, in contrast to the MoCA, the current results call into question the suitability of the computerized battery as measured here for tracking decline.

Processing Distracting Non-face Emotional Images: No Evidence of an Age-Related Positivity Effect

Cognitive aging may be accompanied by increased prioritization of social and emotional goals that enhance positive experiences and emotional states. The socioemotional selectivity theory suggests this may be achieved by giving preference to positive information and avoiding or suppressing negative information. Although there is some evidence of a positivity bias in controlled attention tasks, it remains unclear whether a positivity bias extends to the processing of affective stimuli presented outside focused attention. In two experiments, we investigated age-related differences in the effects of to-be-ignored non-face affective images on target processing. In Experiment 1, 27 older (64-90 years) and 25 young adults (19-29 years) made speeded valence judgments about centrally presented positive or negative target images taken from the International Affective Picture System. To-be-ignored distractor images were presented above and below the target image and were either positive, negative, or neutral in valence. The distractors were considered task relevant because they shared emotional characteristics with the target stimuli. Both older and young adults responded slower to targets when distractor valence was incongruent with target valence relative to when distractors were neutral. Older adults responded faster to positive than to negative targets but did not show increased interference effects from positive distractors. In Experiment 2, affective distractors were task irrelevant as the target was a three-digit array and did not share emotional characteristics with the distractors. Twenty-six older (63-84 years) and 30 young adults (18-30 years) gave speeded responses on a digit disparity task while ignoring the affective distractors positioned in the periphery. Task performance in either age group was not influenced by the task-irrelevant affective images. In keeping with the socioemotional selectivity theory, these findings suggest that older adults preferentially process task-relevant positive non-face images but only when presented within the main focus of attention.

The boundary condition for observing compensatory responses by the elderly in a flanker-task paradigm

This study aimed to establish a baseline condition to observe ERP responses for older adults in a conventional flanker-task paradigm, in which neither a reversal response rule toward a target nor a color-coded target was employed. In addition, this study aimed to examine whether the previous finding of the compensatory responses reflected on event-related potential (ERP) for older adults in performing a flanker task was due to the specific demand of the reversal response rule toward a target or simply due to the pop-out effect with a singleton target manipulation. The results of the current study showed that (1) some of the previously thought-to-be compensatory ERP responses might not really reflect compensatory responses; (2) the previous finding of age-related ERP compensatory responses was mainly due to the manipulation of the reversal response rule condition; and (3) in some scenarios of flanker-task paradigms, older adults were just as capable as younger adults in conquer with the flanker interference even though no ERP compensatory responses were found.

Benefits of regular aerobic exercise for executive functioning in healthy populations

Research suggests that regular aerobic exercise has the potential to improve executive functioning, even in healthy populations. The purpose of this review is to elucidate which components of executive functioning benefit from such exercise in healthy populations. In light of the developmental time course of executive functions, we consider separately children, young adults, and older adults. Data to date from studies of aging provide strong evidence of exercise-linked benefits related to task switching, selective attention, inhibition of prepotent responses, and working memory capacity; furthermore, cross-sectional fitness data suggest that working memory updating could potentially benefit as well. In young adults, working memory updating is the main executive function shown to benefit from regular exercise, but cross-sectional data further suggest that task-switching and post error performance may also benefit. In children, working memory capacity has been shown to benefit, and cross-sectional data suggest potential benefits for selective attention and inhibitory control. Although more research investigating exercise-related benefits for specific components of executive functioning is clearly needed in young adults and children, when considered across the age groups, ample evidence indicates that regular engagement in aerobic exercise can provide a simple means for healthy people to optimize a range of executive functions.

Evidence inhibition responds reactively to the salience of distracting information during focused attention

Along with target amplification, distractor inhibition is regarded as a major contributor to selective attention. Some theories suggest that the strength of inhibitory processing is proportional to the salience of the distractor (i.e., inhibition reacts to the distractor intensity). Other theories suggest that the strength of inhibitory processing does not depend on the salience of the distractor (i.e., inhibition does not react to the distractor intensity). The present study aimed to elucidate the relationship between the intensity of a distractor and its subsequent inhibition during focused attention. A flanker task with a variable distractor-target stimulus-onset asynchrony (SOA) was used to measure both distractor interference and distractor inhibition. We manipulated the intensity of the distractor in two separate ways, by varying its distance from the target (Experiment 1) and by varying its brightness (Experiment 2). The results indicate that more intense distractors were associated with both increased interference and stronger distractor inhibition. The latter outcome provides novel support for the reactive inhibition hypothesis, which posits that inhibition reacts to the strength of distractor input, such that more salient distractors elicit stronger inhibition.

The pattern of attentional deficits in Parkinson's disease

BACKGROUND

Cognitive impairment without dementia is frequent in Parkinson's disease. It often presents as a dysexecutive syndrome with deficient attentional resource allocation. The nature of attention deficits in Parkinson's disease has rarely been investigated with robust, theory-based tasks. The main objective of the present study was to investigate attention disorders in Parkinson's disease patients by applying a paradigm based on a model of attention. We also sought to identify the main demographic and clinical characteristics associated with attention deficits in Parkinson's disease.

METHODS

Eighty non-demented Parkinson's disease patients and 60 healthy controls participated in the study. Attention was assessed in a computer-controlled reaction time paradigm. The test session comprised a simple reaction time task and four choice reaction time tasks: a go/no-go task, a one-dimension, focused-attention task, a two-dimension, divided-attention task and an alternating task. Performance was assessed by composite measures: (i) cognitive reaction time, corresponding to the difference between the simple reaction time and the choice reaction time in the given condition, and (ii) reaction time variability, corresponding to the sum of the coefficients of variance of the reaction times. Accuracy was also considered.

RESULTS

Apart from an overall slowing and greater reaction time variability, Parkinson's disease patients were only significantly impaired in the alternating condition. This set-shifting impairment was associated with their performance in the go/no-go and divided-attention conditions.

CONCLUSION

Our systematic assessment of the different attentional subcomponents revealed that mental flexibility is particularly impaired in non-demented Parkinson's disease patients.

The epidemiology and clinical manifestations of dysexecutive syndrome in Parkinson's disease

This mini-review summarizes the evidence of the cognitive and behavioral features of dysexecutive syndrome in Parkinson’s disease (PD). Deficits in response inhibition, set-shifting, mental flexibility, and strategy have been frequently described from the earliest stages of PD, although there are inconsistencies in study findings due to the complexity of the executive function (EF) construct and methodological limitations. Behavioral disorders of PD, e.g., apathy, distractibility, perseverative behavior, and impulse-control disorders, may be viewed as the other side of dysexecutive syndrome. Despite the interrelationship between the cognitive and behavioral domains, some reports reveal that the two syndromes may be dissociated, suggesting that both aspects must be clinically assessed. EFs are widely associated with the prefrontal areas, although dysexecutive syndrome may be observed in patients with damage to other brain regions. EFs drive numerous abilities essential to daily life, such as prospective remembering and language comprehension, which may be impaired in PD subjects. Considering the impact of dysexecutive syndrome on independence and quality of life, early detection of executive impairment is crucial in the management of PD.

Identity-based inhibitory processing during focused attention

Recent data suggest that the operating principles governing inhibition of distractor-related activity may deviate from dominant models describing inhibitory processing during selective attention. Here we aimed to gain a better understanding of these data in order to determine whether they actually defy premises of current models. In addition to providing evidence against noninhibitory accounts of the data (see especially Experiment 6), the results support three main novel findings that challenge current theories. First, the data provide evidence that inhibition overpowered excitation from ongoing external input (Experiments 1-4), which suggests that inhibitory control processes are more powerful than current models indicate. Second, negative effects emerged even when targets appeared alone (Experiment 5), which suggests that selection does not play an essential role in triggering inhibitory processing. Third, relatively early distractor-related activity was affected, which supports a role for inhibition prior to action control (Experiment 3). These findings suggest a need to revise current models describing inhibition of distracting information during selective attention.

Speech, voice and language in Parkinson’s disease: changes and interventions

SUMMARY This article covers recent developments in the understanding of communication changes in idiopathic Parkinson’s disease and selected issues in intervention. By contrast to earlier narrow considerations of voice and speech, the effects on communication of cognitive–linguistic and prosody perception and production are also highlighted. Decline can occur from the earliest stages, even when listeners perceive no frank changes. Communication may be relatively trouble-free in one-to-one quiet clinical situations but declines in multi-talker, dual/competing task situations. Assessment should reflect this to gain more accurate insights into daily living performance. Currently, therapies focusing on attention-to-effort in voice production and on monitoring the sense of effort and loudness production appear to be most successful. Medical and surgical treatments have little effect on intelligibility and communication and may even exacerbate the situation.

Factor analysis of attentional set-shifting performance in young and aged mice

Background

Executive dysfunction may play a major role in cognitive decline with aging because frontal lobe structures are particularly vulnerable to advancing age. Lesion studies in rats and mice have suggested that intradimensional shifts (IDSs), extradimensional shifts (EDSs), and reversal learning are mediated by the anterior cingulate cortex, the medial prefrontal cortex, and the orbitofrontal cortex, respectively. We hypothesized that the latent structure of cognitive performance would reflect functional localization in the brain and would be altered by aging.

Methods

Young (4 months, n = 16) and aged (23 months, n = 18) C57BL/6N mice performed an attentional set-shifting task (ASST) that evaluates simple discrimination (SD), compound discrimination (CD), IDS, EDS, and reversal learning. The performance data were subjected to an exploratory factor analysis to extract the latent structures of ASST performance in young and aged mice.

Results

The factor analysis extracted two- and three-factor models. In the two-factor model, the factor associated with SD and CD was clearly separated from the factor associated with the rest of the ASST stages in the young mice only. In the three-factor model, the SD and CD loaded on distinct factors. The three-factor model also showed a separation of factors associated with IDS, EDS, and CD reversal. However, the other reversal learning variables, ID reversal and ED reversal, had somewhat inconsistent factor loadings.

Conclusions

The separation of performance factors in aged mice was less clear than in young mice, which suggests that aged mice utilize neuronal networks more broadly for specific cognitive functions. The result that the factors associated with SD and CD were separated in the three-factor model may suggest that the introduction of an irrelevant or distracting dimension results in the use of a new/orthogonal strategy for better discrimination.

Famous faces demand attention due to reduced inhibitory processing

People have particular difficulty ignoring distractors that depict faces. This phenomenon has been attributed to the high level of biological significance that faces carry. The current study aimed to elucidate the mechanism by which faces gain processing priority. We used a focused attention paradigm that tracks the influence of a distractor over time and provides a measure of inhibitory processing. Upright famous faces served as test stimuli and inverted versions of the faces as well as upright non-face objects served as control stimuli. The results revealed that although all of the stimuli elicited similar levels of distraction, only inverted distractor faces and non-face objects elicited inhibitory effects. The lack of inhibitory effects for upright famous faces provides novel evidence that reduced inhibitory processing underlies the mandatory nature of face processing.

Age-related changes in processing faces from detection to identification: ERP evidence

We examined the ability of people 70 to 90 years old to apply global, configural, and featural face-processing strategies. In addition we investigated age-related changes in the ability to categorize faces at basic, subordinate, and individual levels. Using the N170 potential as index of early face processing and the P300 component as index of categorical decision making and effort, we found significant age-related perceptual changes which slowed and somewhat impaired face processing. Specifically, older participants had problems integrating face features into global structures, demonstrating enhanced dependence on distal global information. They did not apply configural computations by default while processing faces which suggests that, unless identification is required, they process faces only at a basic level. These perceptual changes could be the cause for slower and less accurate subordinate categorization, particularly when it is based on details. At the neural levels face processing was not right-lateralized, reflecting excessive involvement of the left hemisphere in perception leading to a more general reduction of interhemispheric asymmetry. In addition we found excessive but nonselective activation of frontal regions adding support to the view that executive control and particularly inhibition of irrelevant input are reduced in the elderly.

From the cell to the clinic: a comparative review of the partial D₂/D₃receptor agonist and α2-adrenoceptor antagonist, piribedil, in the treatment of Parkinson's disease

Though L-3,4-dihydroxyphenylalanine (L-DOPA) is universally employed for alleviation of motor dysfunction in Parkinson's disease (PD), it is poorly-effective against co-morbid symptoms like cognitive impairment and depression. Further, it elicits dyskinesia, its pharmacokinetics are highly variable, and efficacy wanes upon long-term administration. Accordingly, "dopaminergic agonists" are increasingly employed both as adjuncts to L-DOPA and as monotherapy. While all recognize dopamine D(2) receptors, they display contrasting patterns of interaction with other classes of monoaminergic receptor. For example, pramipexole and ropinirole are high efficacy agonists at D(2) and D(3) receptors, while pergolide recognizes D(1), D(2) and D(3) receptors and a broad suite of serotonergic receptors. Interestingly, several antiparkinson drugs display modest efficacy at D(2) receptors. Of these, piribedil displays the unique cellular signature of: 1), signal-specific partial agonist actions at dopamine D(2)and D(3) receptors; 2), antagonist properties at α(2)-adrenoceptors and 3), minimal interaction with serotonergic receptors. Dopamine-deprived striatal D(2) receptors are supersensitive in PD, so partial agonism is sufficient for relief of motor dysfunction while limiting undesirable effects due to "over-dosage" of "normosensitive" D(2) receptors elsewhere. Further, α(2)-adrenoceptor antagonism reinforces adrenergic, dopaminergic and cholinergic transmission to favourably influence motor function, cognition, mood and the integrity of dopaminergic neurones. In reviewing the above issues, the present paper focuses on the distinctive cellular, preclinical and therapeutic profile of piribedil, comparisons to pramipexole, ropinirole and pergolide, and the core triad of symptoms that characterises PD-motor dysfunction, depressed mood and cognitive impairment. The article concludes by highlighting perspectives for clarifying the mechanisms of action of piribedil and other antiparkinson agents, and for optimizing their clinical exploitation.