Differential age-related decline in conflict-driven task-set shielding from emotional versus non-emotional distracters

Functional Coupling of the Locus Coeruleus Is Linked to Successful Cognitive Control

The locus coeruleus (LC) is a brainstem structure that sends widespread efferent projections throughout the mammalian brain. The LC constitutes the major source of noradrenaline (NE), a modulatory neurotransmitter that is crucial for fundamental brain functions such as arousal, attention, and cognitive control. This role of the LC-NE is traditionally not believed to reflect functional influences on the frontoparietal network or the striatum, but recent advances in chemogenetic manipulations of the rodent brain have challenged this notion. However, demonstrations of LC-NE functional connectivity with these areas in the human brain are surprisingly sparse. Here, we close this gap. Using an established emotional stroop task, we directly compared trials requiring response conflict control with trials that did not require this, but were matched for visual stimulus properties, response modality, and controlled for pupil dilation differences across both trial types. We found that LC-NE functional coupling with the parietal cortex and regions of the striatum is substantially enhanced during trials requiring response conflict control. Crucially, the strength of this functional coupling was directly related to individual reaction time differences incurred by conflict resolution. Our data concur with recent rodent findings and highlight the importance of converging evidence between human and nonhuman neurophysiology to further understand the neural systems supporting adaptive and maladaptive behavior in health and disease.

It is not always positive: emotional bias in young and older adults

Healthy ageing has been associated with a bias toward positive information and greater psychological well-being. However, to what extent this positivity bias also applies to prioritizing positive information under emotional competition is unclear. Old and young adults performed a word-face interference task, in which they responded to the valence of positive and negative target-words while ignoring happy or angry distractor-faces that could be affectively congruent or incongruent. A control condition with scrambled neutral distractor-faces was also used. Findings showed small facilitation effects with faster responses when targets and distractors were affectively congruent and large interference effects with slower responses when targets and distractors were affectively incongruent compared to the control condition. Importantly, whereas for younger adults there was a similar pattern of interference from happy and angry distractor-faces, for older adults there was greater interference from angry distractor-faces. The present findings are discussed in the context of emotional bias literature.

Deficits in emotion processing in Alzheimer's disease: a systematic review

Emotional processing involves the ability of the individual to infer emotional information. There is no consensus about how Alzheimer’s disease (AD) affects emotional processing. Objective: Our aim is to systematically review the impact of AD on emotion processing.

Conflict monitoring and adaptation to affective stimuli as a function of ageing

The current study investigated whether preference for positive affect would be observed in the context of a higher order control process with increasing age given the premise of affective prioritization with ageing. The study examined how affect interacted with cognitive control mechanisms across young, middle-aged and older adults. Conflict monitoring and adaptation for affective stimuli was examined with a face-word Stroop task using happy and fearful facial expressions. The participants' task was to detect the emotional expression (Happy or Fear) of the face shown with a distractor word (Happy or Fear) written across the face. Reaction time and accuracy data was analysed to compare adaptation effect and Stroop interference as a function of age, valence and previous trial congruence. The results demonstrated a stronger adaptation effect for negative affect in young adults and for positive affect in middle-aged adults and older adults. These results can be explained in terms of the socio-emotional selectivity theory of affective bias in the elderly and the involvement of attentional control mechanisms. This study empirically demonstrates shifts in affective bias towards positive affect with ageing through the implicit recruitment of cognitive control.

Age Differences in the Subcomponents of Executive Functioning

OBJECTIVES

Across the life span, deficits in executive functioning (EF) are associated with poor behavioral control and failure to achieve goals. Though EF is often discussed as one broad construct, a prominent model of EF suggests that it is composed of three subdomains: inhibition, set shifting, and updating. These subdomains are seen in both younger (YA) and older adults (OA), with performance deficits across subdomains in OA. Therefore, our goal was to investigate whether subdomains of EF might be differentially affected by age, and how these differences may relate to broader global age differences in EF.

METHODS

To assess these age differences, we conducted a meta-analysis at multiple levels, including task level, subdomain level, and of global EF. Based on previous work, we hypothesized that there would be overall differences in EF in OA.

RESULTS

Using 1,268 effect sizes from 401 articles, we found overall differences in EF with age. Results suggested that differences in performance are not uniform, such that variability in age effects emerged at the task level, and updating was not as affected by age as other subdomains.

DISCUSSION

These findings advance our understanding of age differences in EF, and stand to inform early detection of EF decline.

Role of the locus coeruleus arousal system in cognitive control

Cognitive control lies at the core of human adaptive behaviour. Humans vary substantially in their ability to execute cognitive control with respect to optimally facing environmental challenges, although the neural origins of this heterogeneity are currently not well understood. Recent theoretical frameworks implicate the locus coeruleus noradrenergic arousal system (LC-NE) in that process. Invasive neurophysiological work in rodents has shown that the LC-NE is an important homeostatic control centre of the body. LC-NE innervates the entire neocortex and has particularly strong connections with the cingulate gyrus. In the present study, using a response conflict task, functional magnetic resonance imaging and concurrent pupil dilation measures (a proxy for LC-NE firing), we provide empirical evidence for a decisive role of the LC-NE in cognitive control in humans. We show that the level of individual behavioural adjustment in cognitive control relates to the level of functional coupling between LC-NE and the dorsomedial prefrontal cortex, as well as dorsolateral prefrontal cortex. Moreover, we show that the pupil is substantially more dilated during conflict trials requiring behavioural adjustment than during no conflict trials. In addition, we explore a potential relationship between pupil dilation and neural activity during choice conflict adjustments. Our data provide novel insight into arousal-related influences on cognitive control and suggest pupil dilation as a potential external marker for endogenous neural processes involved in optimising behavioural control. Our results may also be clinically relevant for a variety of pathologies where cognitive control is compromised, such as anxiety, depression, addiction and post-traumatic stress disorder.

Impact of emotionally negative information on attentional processes in normal aging and Alzheimer's disease

Impairments of emotional processing have been reported in Alzheimer's disease (AD), consistently with the existence of early amygdala atrophy in the pathology. In this study, we hypothesized that patients with AD might show a deficit of orientation toward emotional information under conditions of visual search. Eighteen patients with AD, 24 age-matched controls, and 35 young controls were eye-tracked while they performed a visual search task on a computer screen. The target was a vehicle with implicit (negative or neutral) emotional content, presented concurrently with one, three, or five non-vehicle neutral distractors. The task was to find the target and to report whether a break in the target frame was on the left or on the right side. Both control groups detected negative targets more efficiently than they detected neutral targets, showing facilitated engagement toward negative information. In contrast, patients with AD showed no influence of emotional information on engagement delays. However, all groups reported the frame break location more slowly for negative than for neutral targets (after accounting for the last fixation delay), showing a more difficult disengagement from negative information. These findings are the first to highlight a selective lack of emotional influence on engagement processes in patients with AD. The involvement of amygdala alterations in this behavioral impairment remains to be investigated.

Cognitive Ageing in Developing Societies: An Overview and a Cross-sectional Study on Young, Middle-aged and Older Adults in the Indian Context

Cognitive ageing in developing societies is marked with psychosocial issues such as education, occupation, lifestyle, social support, social interaction and exclusion that may affect cognitive–affective–behavioural changes with ageing. We also present a study based on cognitive profiling of young (N = 79), middle-aged (N = 54) and older adults (N = 43) in India, which examined learning and memory for verbal and visuospatial information, overall cognitive functions, subjective complaints about cognitive difficulties, neuropsychiatric problems, anxiety and emotion regulation. The study shows cognitive changes compared to young and comparable rate of learning and retrieval among middle-aged and older adults for verbal and visuospatial material, correlated with general cognitive ability. The subjective complaints were not correlated with the objective measures of cognitive functions, highlighting the importance of both to show early cognitive changes. The relationship between cognitive functions and emotion regulation or behavioural/emotional changes was observed for young and middle-aged adults but not for older adults. Findings are discussed in the context of the lifespan perspective of cognitive ageing, cognitive reserve, psychosocial environment and social–emotional selectivity theory.

Emotional conflict adaptation predicts intrusive memories

Why do some individuals experience intrusive emotional memories following stressful or traumatic events whereas others do not? Attentional control may contribute to the development of such memories by shielding attention to ongoing tasks from affective reactions to task-irrelevant emotional stimuli. The present study investigated whether individual differences in theability to exert cognitive control are associated with experiencing intrusive emotional memories after laboratory trauma. Sixty-one healthy women provided self-reported and experimentally derived measures of attentional control. They then viewed a trauma film in the laboratory and recorded intrusive memories for one week using a diary. Gaze avoidance during trauma film exposure was associated with more intrusive memories. Greater attentional control over emotion prior to film viewing, as assessed with the experimental task, predicted fewer intrusive memories while self-reported attentional control was unrelated to intrusive memories. Preexisting capacity to shield information processing from distraction may protect individuals from developing intrusive emotional memories following exposure to stress or trauma. These findings provide important clues for prevention and intervention science.

Emotional Response Inhibition Is Greater in Older Than Younger Adults

Emotional information rapidly captures our attention and also often invokes automatic response tendencies, whereby positive information motivates approach, while negative information encourages avoidance. However, many circumstances require the need to override or inhibit these automatic responses. Control over responses to emotional information remains largely intact in late life, in spite of age-related declines in cognitive control and inhibition of responses to non-emotional information. The goal of this behavioral study was to understand how the aging process influences emotional response inhibition for positive and negative information in older adults. We examined emotional response inhibition in 36 healthy older adults (ages 60–89) and 44 younger adults (ages 18–22) using an emotional Go/No-Go task presenting happy (positive), fearful (negative), and neutral faces. In both younger and older adults, happy faces produced more approach-related behavior (i.e., fewer misses), while fearful faces produced more avoidance-related behavior, in keeping with theories of approach/avoidance-motivated responses. Calculation of speed/accuracy trade-offs between response times and false alarm rates revealed that younger and older adults both favored speed at the expense of accuracy, most robustly within blocks with fearful faces. However, there was no indication that the strength of the speed/accuracy trade-off differed between younger and older adults. The key finding was that although younger adults were faster to respond to all types of faces, older adults had greater emotional response inhibition (i.e., fewer false alarms). Moreover, younger adults were particularly prone to false alarms for happy faces. This is the first study to directly test effects of aging on emotional response inhibition. Complementing previous literature in the domains of attention and memory, these results provide new evidence that in the domain of response inhibition older adults may more effectively employ emotion regulatory ability, albeit on a slower time course, compared to younger adults. Older adults’ enhanced adaptive emotion regulation strategies may facilitate resistance to emotional distraction. The present study extends the literature of emotional response inhibition in younger adulthood into late life, and in doing so further elucidates how cognitive aging interacts with affective control processes.

Aging and Sequential Strategy Interference: A Magnetoencephalography Study in Arithmetic Problem Solving

This study investigated age-related changes in the neural bases of sequential strategy interference. Sequential strategy interference refers to decreased strategy interference (i.e., poorer performance when the cued strategy is not the best) after executing a poorer strategy relative to after a better strategy. Young and older adults performed a computational estimation task (e.g., providing approximate products to two-digit multiplication problems, like 38 × 74) and were matched on behavioral sequential strategy interference effects. Analyses of magnetoencephalography (MEG) data revealed differences between young and older adults in brain activities underlying sequential strategy interference. More specifically, relative to young adults, older adults showed additional recruitments in frontal, temporal, and parietal regions. Also, age-related differences were found in the temporal dynamics of brain activations, with modulations occurring both earlier and later in older than young adults. These results suggest that highly functioning older adults rely on additional mechanisms to process sequential strategy interference as efficiently as young adults. Our findings inform mechanisms by which highly functioning older adults obtain as good performance as young adults, and suggest that these older adults may compensate deleterious effects of aging to efficiently execute arithmetic strategies.

Early Emotional Attention is Impacted in Alzheimer's Disease: An Eye-Tracking Study

Emotional deficits have been repetitively reported in Alzheimer's disease (AD) without clearly identifying how emotional processing is impaired in this pathology. This paper describes an investigation of early emotional processing, as measured by the effects of emotional visual stimuli on a saccadic task involving both pro (PS) and anti (AS) saccades. Sixteen patients with AD and 25 age-matched healthy controls were eye-tracked while they had to quickly move their gaze toward a positive, negative, or neutral image presented on a computer screen (in the PS condition) or away from the image (in the AS condition). The age-matched controls made more AS mistakes for negative stimuli than for other stimuli, and triggered PSs toward negative stimuli more quickly than toward other stimuli. In contrast, patients with AD showed no difference with regard to the emotional category in any of the tasks. The present study is the first to highlight a lack of early emotional attention in patients with AD. These results should be taken into account in the care provided to patients with AD, since this early impairment might seriously degrade their overall emotional functioning.

Disentangling cognition and emotion in older adults: the role of cognitive control and mental health in emotional conflict adaptation

OBJECTIVE

Recent research suggests cognition has a bidirectional relationship with emotional processing in older adults, yet the relationship is still poorly understood. We aimed to examine a potential relationship between late-life cognitive function, mental health symptoms, and emotional conflict adaptation. We hypothesized that worse cognitive control abilities would be associated with poorer emotional conflict adaptation. We further hypothesized that a higher severity of mental health symptoms would be associated with poorer emotional conflict adaptation.

METHODS

Participants included 83 cognitively normal community-dwelling older adults who completed a targeted mental health and cognitive battery, and emotion and gender conflict-adaptation tasks.

RESULTS

Consistent with our hypothesis, poorer performance on components of cognitive control, specifically attention and working memory, was associated with poorer emotional conflict adaptation. This association with attention and working memory was not observed in the non-affective-based gender conflict adaptation task. Mental health symptoms did not predict emotional conflict adaptation, nor did performance on other cognitive measures.

CONCLUSION

Our findings suggest that emotion conflict adaptation is disrupted in older individuals who have poorer attention and working memory. Components of cognitive control may therefore be an important potential source of inter-individual differences in late-life emotion regulation and cognitive affective deficits. Copyright © 2016 John Wiley & Sons, Ltd.

Dissociable early attentional control mechanisms underlying cognitive and affective conflicts

It has been well documented that cognitive conflict is sensitive to the relative proportion of congruent and incongruent trials. However, few studies have examined whether affective conflict processing is modulated as a function of proportion congruency (PC). To address this question we recorded event-related potentials (ERP) while subjects performed both cognitive and affective face-word Stroop tasks. By varying the proportion of congruent and incongruent trials in each block, we examined the extent to which PC impacts both cognitive and affective conflict control at different temporal stages. Results showed that in the cognitive task an anteriorly localized early N2 component occurred predominantly in the low proportion congruency context, whereas in the affective task it was found to occur in the high proportion congruency one. The N2 effects across the two tasks were localized to the dorsolateral prefrontal cortex, where responses were increased in the cognitive task but decreased in the affective one. Furthermore, high proportions of congruent items produced both larger amplitude of a posteriorly localized sustained potential component and a larger behavioral Stroop effect in cognitive and affective tasks. Our findings suggest that cognitive and affective conflicts engage early dissociable attentional control mechanisms and a later common conflict response system.

Female but not male young heavy drinkers display altered performance monitoring

Difficulties in monitoring ongoing behaviour may be linked to real-life problematic drinking behaviours. Prior research suggests female heavy drinkers in particular display greater cognitive control deficits. Here, we examine trial-to-trial behavioural adaptations in a conflict monitoring task, relative to drinking behaviour and sex. Heavy drinkers (n=31, 16 male) and controls (n=35, 18 male) completed an Eriksen flanker task while brain electrical activity was recorded. For reaction time, error rates, and N2 and P3 amplitude of the event-related potential, trial-to-trial conflict adaptation was evidenced by a differential response to the current (congruent vs. incongruent) trials dependent on the identity of the previous trial. For the proportion of errors, heavy drinkers showed increased conflict adaptation compared to controls. Conflict adaptation for N2 (indexing monitoring) was larger for female heavy drinkers than controls, and the opposite was observed for males. There were no interactions involving group or sex for the P3 (indexing inhibition). The results suggest a compensatory response, such that heavy drinkers are required to increase performance monitoring in order to achieve the same behavioural outcome as controls. We also confirm the importance of sex as a factor in the relationship between behavioural control and heavy alcohol use.

Age-related differences in early novelty processing: using PCA to parse the overlapping anterior P2 and N2 components

Previous work demonstrated age-associated increases in the anterior P2 and age-related decreases in the anterior N2 in response to novel stimuli. Principal component analysis (PCA) was used to determine if the inverse relationship between these components was due to their temporal and spatial overlap. PCA revealed an early anterior P2, sensitive to task relevance, and a late anterior P2, responsive to novelty, both exhibiting age-related amplitude increases. A PCA factor representing the anterior N2, sensitive to novelty, exhibited age-related amplitude decreases. The late P2 and N2 to novels inversely correlated. Larger late P2 amplitude to novels was associated with better behavioral performance. Age-related differences in the anterior P2 and N2 to novel stimuli likely represent age-associated changes in independent cognitive operations. Enhanced anterior P2 activity (indexing augmentation in motivational salience) may be a compensatory mechanism for diminished anterior N2 activity (indexing reduced ability of older adults to process ambiguous representations).

Selective control of attention supports the positivity effect in aging

There is emerging evidence for a positivity effect in healthy aging, which describes an age-specific increased focus on positive compared to negative information. Life-span researchers have attributed this effect to the selective allocation of cognitive resources in the service of prioritized emotional goals. We explored the basic principles of this assumption by assessing selective attention and memory for visual stimuli, differing in emotional content and self-relevance, in young and old participants. To specifically address the impact of cognitive control, voluntary attentional selection during the presentation of multiple-item displays was analyzed and linked to participants' general ability of cognitive control. Results revealed a positivity effect in older adults' selective attention and memory, which was particularly pronounced for self-relevant stimuli. Focusing on positive and ignoring negative information was most evident in older participants with a generally higher ability to exert top-down control during visual search. Our findings highlight the role of controlled selectivity in the occurrence of a positivity effect in aging. Since the effect has been related to well-being in later life, we suggest that the ability to selectively allocate top-down control might represent a resilience factor for emotional health in aging.

Reactive and Proactive Control Adjustments under Increased Depressive Symptoms: Insights from the Classic and Emotional-Face Stroop Task

The current research investigated differences in reactive and proactive cognitive control as a function of depressive symptomatology. Three participant groups with varying symptom levels (Beck Depression Inventory–II, BDI–II score) completed both the classic and an emotional-face Stroop task separately under speed and accuracy instructions. All groups made equivalent speed–accuracy trade-offs independent of task, suggesting that proactive adjustments are unaffected by depressive symptoms. Additionally, groups made equivalent reactive control adjustments (Stroop effects, congruency sequence effects) in the classic Stroop task, suggesting that these reactive control adjustments are spared across a wide range of BDI–II scorers. In contrast, the high BDI–II group displayed a selective impairment in the resolution of conflict in the emotional-face Stroop task. Thus, while proactive control and many aspects of reactive control were unaffected by the level of depressive symptoms, specific impairments occurred when current task demands required the trial-to-trial regulation of emotional processing.

Very mild Alzheimer׳s disease is characterized by increased sensitivity to mnemonic interference

Early pathology and tissue loss in Alzheimer׳s disease (AD) occurs in the hippocampus, a brain region that has recently been implicated in relational processing irrespective of delay. Thus, tasks that involve relational processing will especially tax the hippocampal memory system, and should be sensitive to even mild dysfunction typical of early AD. Here we used a short-lag, short-delay memory task previously shown to be sensitive to hippocampal integrity in an effort to discriminate cognitive changes due to healthy aging from those associated with very mild AD. Young adults, healthy older adults, and individuals with very mild AD (N=30 for each group) participated in our investigation, which entailed attempting to find an exact match to a previously presented target among a series of stimuli that varied in perceptual similarity to the target stimulus. Older adults with very mild AD were less accurate than healthy older adults, who, in turn, were impaired relative to young adults. Older adults with very mild AD were also particularly susceptible to interference from intervening lure stimuli. A measure based on this finding was able to explain additional variance in differentiating those in the very mild stage of AD from healthy older adults after accounting for episodic memory and global cognition composite scores in logistic regression models. Our findings suggest that cognitive changes in early stage AD reflect aging along with an additional factor potentially centered on sensitivity to interference, thereby supporting multifactorial models of aging.

Comparing neural substrates of emotional vs. non-emotional conflict modulation by global control context

The efficiency with which the brain resolves conflict in information processing is determined by contextual factors that modulate internal control states, such as the recent (local) and longer-term (global) occurrence of conflict. Local “control context” effects can be observed in trial-by-trial adjustments to conflict (congruency sequence effects: less interference following incongruent trials), whereas global control context effects are reflected in adjustments to the frequency of conflict encountered over longer sequences of trials (“proportion congruent effects”: less interference when incongruent trials are frequent). Previous neuroimaging and lesion studies suggest that the modulation of conflict-control processes by local control context relies on partly dissociable neural circuits for cognitive (non-emotional) vs. emotional conflicts. By contrast, emotional and non-emotional conflict-control processes have not been contrasted with respect to their modulation by global control context. We addressed this aim in a functional magnetic resonance imaging (fMRI) study that varied the proportion of congruent trials in emotional vs. non-emotional conflict tasks across blocks. We observed domain-general conflict-related signals in the dorsal anterior cingulate cortex (dACC) and pre-supplementary motor area and, more importantly, task-domain also interacted with global control context effects: specifically, the dorsal striatum and anterior insula tracked control-modulated conflict effects exclusively in the emotional domain. These results suggest that, similar to the neural mechanisms of local control context effects, there are both overlapping as well as distinct neural substrates involved in the modulation of emotional and non-emotional conflict-control by global control context.

Conflict adaptation in prefrontal cortex: now you see it, now you don't

Daily life requires people to monitor and resolve conflict arising from distracting information irrelevant to current goals. The highly influential conflict monitoring theory (CMT) holds that the anterior cingulate cortex (ACC) detects conflict and subsequently triggers the dorsolateral prefrontal cortex (DLPFC) to regulate that conflict. Multiple lines of evidence have provided support for CMT. For example, performance is faster on incongruent trials that follow other incongruent trials (iI), and is accompanied by reduced ACC and increased DLPFC activation (the conflict adaptation effect). In this fMRI study, we explored whether ACC-DLPFC conflict signaling can result in behavioral adjustments beyond on-line contexts. Participants completed a modified version of the Stroop conflict adaptation paradigm which tested for conflict adaptation effects on the current (N) trial associated with not only the immediately preceding (N - 1) trial, but also 2-back (N - 2) trials. Results demonstrated evidence for direct relationships between ACC activity on N - 2 trials and both N trial DLPFC activity and behavioral adjustment when intervening trials were congruent (i.e., icI). In contrast, when N - 1 trials were incongruent (i.e., iiI), ACC-DLPFC signaling failed and conflict adaptation was absent. These results provide new evidence demonstrating that the conflict monitor-controller maintains previously experienced conflict in the service of subsequent behavioral adjustment. However, the processing of multiple, temporally proximal conflict signals takes a toll on the working memory (WM) system, which appears to require resetting in order to adapt our behavior to frequently changing environmental demands.

Impaired conflict adaptation in an emotional task context following rostral anterior cingulate cortex lesions in humans

Recent brain imaging studies have implicated the rostral ACC (rACC) in the resolution of conflict between competing response tendencies in emotional task contexts, but not in neutral task contexts. This study tested the hypothesis that the rACC is necessary for such context-specific conflict adaptation. To this end, a group of patients with lesions of the rACC, a group of brain-damaged controls, and a group of normal controls classified the emotional expression (emotional task context) or the gender (neutral task context) of faces while ignoring congruent and incongruent words written across the faces. In all three groups, performance was worse with incongruent as compared with congruent stimuli in both task contexts. In the two control groups, this congruency effect was reduced following incongruent trials in both task contexts. By contrast, the rACC group displayed such conflict adaptation only in the neutral, but not in the emotional, task context. These results show that the rACC is necessary for conflict adaptation in emotional but not in neutral task contexts and suggest that the regulation of behavior is context specific.

The emotion paradox in the aging brain

This paper reviews age differences in emotion processing and how they may relate to age-related changes in the brain. Compared with younger adults, older adults react less to negative situations, ignore irrelevant negative stimuli better, and remember relatively more positive than negative information. Older adults' ability to insulate their thoughts and emotional reactions from negative situations is likely due to a number of factors, such as being less influenced by interoceptive cues, selecting different emotion regulation strategies, having less age-related decline in prefrontal regions associated with emotional control than in other prefrontal regions, and engaging in emotion regulation strategies as a default mode in their everyday lives. Healthy older adults' avoidance of processing negative stimuli may contribute to their well-maintained emotional well-being. However, when cardiovascular disease leads to additional prefrontal white matter damage, older adults have fewer cognitive control mechanisms available to regulate their emotions, making them more vulnerable to depression. In general, although age-related changes in the brain help shape emotional experience, shifts in preferred strategies and goal priorities are also important influences.

Physiologic and Clinical Principles behind Noninvasive Resuscitation Techniques and Cardiac Output Monitoring

Clinical assessment and vital signs are poor predictors of the overall hemodynamic state. Optimal measurement of the response to fluid resuscitation and hemodynamics has previously required invasive measurement with radial and pulmonary artery catheterization. Newer noninvasive resuscitation technology offers the hope of more accurately and safely monitoring a broader range of critically ill patients while using fewer resources. Fluid responsiveness, the cardiac response to volume loading, represents a dynamic method of improving upon the assessment of preload when compared to static measures like central venous pressure. Multiple new hemodynamic monitors now exist that can noninvasively report cardiac output and oxygen delivery in a continuous manner. Proper assessment of the potential future role of these techniques in resuscitation requires understanding the underlying physiologic and clinical principles, reviewing the most recent literature examining their clinical validity, and evaluating their respective advantages and limitations.