Where did I put that? Patients with amnestic mild cognitive impairment demonstrate widespread reductions in activity during the encoding of ecologically relevant object-location associations

How people with brain injury run and evaluate a SLAM-based smartphone augmented reality application to assess object-location memory

Augmented reality (AR) technology allows virtual objects to be superimposed on the real-world environment, offering significant potential for improving cognitive assessments and rehabilitation processes in the field of visuospatial learning. This study examines how patients with acquired brain injury (ABI) evaluate the functions and usability of a SLAM-based smartphone AR app to assess object-location skills. Ten ABI patients performed a task for the spatial recall of four objects using an AR app. The data collected from 10 healthy participants provided reference values for the best performance. Their perceptions of the AR app/technology and its usability were investigated. The results indicate lower effectiveness in solving the task in the patient group, as the time they needed to complete it was related to their level of impairment. The patients showed lower, yet positive, scores in factors related to app usability and acceptance (e.g., mental effort and satisfaction, respectively). There were more patients reported on entertainment as a positive aspect of the app. Patients' perceived enjoyment was related to concentration and calm, whereas usability was associated with perceived competence, expertise, and a lower level of physical effort. For patients, the sensory aspects of the objects were related to their presence, while for healthy participants, they were related to enjoyment and required effort. The results show that AR seems to be a promising tool to assess spatial orientation in the target patient population.

FDA-approved machine learning algorithms in neuroradiology: A systematic review of the current evidence for approval

Over the past decade, machine learning (ML) and artificial intelligence (AI) have become increasingly prevalent in the medical field. In the United States, the Food and Drug Administration (FDA) is responsible for regulating AI algorithms as "medical devices" to ensure patient safety. However, recent work has shown that the FDA approval process may be deficient. In this study, we evaluate the evidence supporting FDA-approved neuroalgorithms, the subset of machine learning algorithms with applications in the central nervous system (CNS), through a systematic review of the primary literature. Articles covering the 53 FDA-approved algorithms with applications in the CNS published in PubMed, EMBASE, Google Scholar and Scopus between database inception and January 25, 2022 were queried. Initial searches identified 1505 studies, of which 92 articles met the criteria for extraction and inclusion. Studies were identified for 26 of the 53 neuroalgorithms, of which 10 algorithms had only a single peer-reviewed publication. Performance metrics were available for 15 algorithms, external validation studies were available for 24 algorithms, and studies exploring the use of algorithms in clinical practice were available for 7 algorithms. Papers studying the clinical utility of these algorithms focused on three domains: workflow efficiency, cost savings, and clinical outcomes. Our analysis suggests that there is a meaningful gap between the FDA approval of machine learning algorithms and their clinical utilization. There appears to be room for process improvement by implementation of the following recommendations: the provision of compelling evidence that algorithms perform as intended, mandating minimum sample sizes, reporting of a predefined set of performance metrics for all algorithms and clinical application of algorithms prior to widespread use. This work will serve as a baseline for future research into the ideal regulatory framework for AI applications worldwide.

Toward rational use of cognitive training in those with mild cognitive impairment

The term cognitive training includes a range of techniques that hold potential for treating cognitive impairment caused by neurologic injury and disease. Our central premise is that these techniques differ in their mechanisms of action and therefore engage distinct brain regions (or neural networks). We support this premise using data from a single-blind randomized-controlled trial in which patients with mild cognitive impairment were randomized to either mnemonic strategy training (MST) or spaced retrieval training (SRT) as they learned ecologically relevant object-location associations. Both training approaches were highly effective in the short term, but MST demonstrated a clear advantage after days to weeks. MST also increased activation in and functional connectivity between frontal, temporal, and parietal regions as well as the hippocampus. In contrast, patterns of reduced activation and functional connectivity were evident following SRT. These findings support the rational development of cognitive training techniques.

Determining affected memory domains in patients with amnestic mild cognitive impairment using computerized and interactive tests

This study explores different episodic memory domains, namely object, temporal and spatial memory, affected in patients with a clinical diagnosis of single domain amnestic mild cognitive impairment (aMCI). 15 aMCI patients and 25 healthy controls were recruited and tested. Object, spatial, and temporal memory were tested using computerized tasks and again in interactive, real-world tasks. Controls outperformed patients on the object computerized task and showed a trend toward significance for the computerized spatial and temporal tasks, but there was no difference in spatial and temporal memory when using the interactive tasks, indicating the employment of compensatory mechanisms in patients to overcome some of the memory impairments associated with aMCI. These findings highlight that aMCI patients might delay seeking help due to compensatory mechanisms which mask their deficits in real-world situations.

SLAM-based augmented reality for the assessment of short-term spatial memory. A comparative study of visual versus tactile stimuli

The assessment of human spatial short-term memory has mainly been performed using visual stimuli and less frequently using auditory stimuli. This paper presents a framework for the development of SLAM-based Augmented Reality applications for the assessment of spatial memory. An AR mobile application was developed for this type of assessment involving visual and tactile stimuli by using our framework. The task to be carried out with the AR application is divided into two phases: 1) a learning phase, in which participants physically walk around a room and have to remember the location of simple geometrical shapes; and 2) an evaluation phase, in which the participants are asked to recall the location of the shapes. A study for comparing the performance outcomes using visual and tactile stimuli was carried out. Fifty-three participants performed the task using the two conditions (Tactile vs Visual), but with more than two months of difference (within-subject design). The number of shapes placed correctly was similar for both conditions. However, the group that used the tactile stimulus spent significantly more time completing the task and required significantly more attempts. The performance outcomes were independent of gender. Some significant correlations among variables related to the performance outcomes and other tests were found. The following significant correlations among variables related to the performance outcomes using visual stimuli and the participants’ subjective variables were also found: 1) the greater the number of correctly placed shapes, the greater the perceived competence; 2) the more attempts required, the less the perceived competence. We also found that perceived enjoyment was higher when a higher sense of presence was induced. Our results suggest that tactile stimuli are valid stimuli to exploit for the assessment of the ability to memorize spatial-tactile associations, but that the ability to memorize spatial-visual associations is dominant. Our results also show that gender does not affect these types of memory tasks.

Allocentric coordinate spatial representations are impaired in aMCI and Alzheimer's disease patients

Research has reported deficits in egocentric (subject-to-object) and mainly allocentric (object-to-object) spatial representations in the early stages of the Alzheimer's disease (eAD). To identify early cognitive signs of neurodegenerative conversion, several studies have shown alterations in both reference frames, especially the allocentric ones in amnestic-Mild Cognitive Impairment (aMCI) and eAD patients. However, egocentric and allocentric spatial frames of reference are intrinsically connected with coordinate (metric/variant) and categorical (non-metric/invariant) spatial relations. This raises the question of whether allocentric deficit found to detect the conversion from aMCI to dementia is differently affected when combined with categorical or coordinate spatial relations. Here, we compared eAD and aMCI patients to Normal Controls (NC) on the Ego-Allo/Cat-Coor spatial memory task. Participants memorized triads of objects and then were asked to provide right/left (i.e. categorical) and distance based (i.e. coordinate) judgments according to an egocentric or allocentric reference frame. Results showed a selective deficit of coordinate, but not categorical, allocentric judgments in both aMCI and eAD patients as compared to NC group. These results suggest that a sign of the departure from normal/healthy aging towards the AD may be traced in elderly people's inability to represent metric distances among elements in the space.

Impact of 3-Day Combined Anodal Transcranial Direct Current Stimulation-Visuospatial Training on Object-Location Memory in Healthy Older Adults and Patients with Mild Cognitive Impairment

BACKGROUND

Associative object-location memory (OLM) is known to decline even in normal aging, and this process is accelerated in patients with mild cognitive impairment (MCI). Given the lack of curative treatment for Alzheimer's disease, activating cognitive resources during its preclinical phase might prevent progression to dementia.

OBJECTIVE

To evaluate the effects of anodal transcranial direct current stimulation (atDCS) combined with an associative episodic memory training on OLM in MCI patients and in healthy elderly (HE).

METHODS

In a single-blind cross-over design, 16 MCI patients and 32 HE underwent a 3-day visuospatial OLM training paired with either 20 min or 30 s (sham) atDCS (1 mA, right temporoparietal cortex). Effects on immediate (training success) and long-term memory (1-month) were investigated by conducting Mixed Model analyses. In addition, the impact of combined intervention on within-session (online) and on between-session (offline) performance were explored.

RESULTS

OLM training+atDCS enhanced training success only in MCI patients, but not HE (difference n.s.). Relative performance gain was similar in MCI patients compared to HE under atDCS. No beneficial effect was found after 1-month. Exploratory analyses suggested a positive impact on online, but a negative effect on offline performance in MCI patients. In both groups, exploratory post-hoc analyses indicated an association between initially low-performers and greater benefit from atDCS.

CONCLUSION

Cognitive training in MCI may be enhanced by atDCS, but further delineation of the impact of current brain state, as well as temporal characteristics of multi-session atDCS-training application, may be needed to induce longer-lasting effects.

Model-based assessment and neural correlates of spatial memory deficits in mild cognitive impairment

Mild cognitive impairment (MCI) is characterized by subjective and objective memory impairments within the context of generally intact everyday functioning. Such memory deficits are typically thought to arise from medial temporal lobe dysfunction; however, differences in memory task performance can arise from a variety of altered processes (e.g., strategy adjustments) rather than, or in addition to, "pure" memory deficits. To address this problem, we applied the linear ballistic accumulator (LBA: Brown and Heathcote, 2008) model to data from individuals with MCI (n = 18) and healthy older adults (HOA; n = 16) who performed an object-location association memory retrieval task during functional magnetic resonance imaging (fMRI). The primary goals were to 1) assess between-group differences in model parameters indexing processes of interest (memory sensitivity, accumulation speed, caution and time spent on peripheral perceptual and motor processes) and 2) determine whether differences in model-based metrics were consistent with fMRI data. The LBA provided evidence that, relative to the HOA group, those with MCI displayed lower sensitivity (i.e., difficulty discriminating targets from lures), suggestive of memory impairment, and displayed higher evidence accumulation speed and greater caution, suggestive of increased arousal and strategic changes in this group, although these changes had little impact on MCI-related accuracy differences. Consistent with these findings, fMRI revealed reduced activation in brain regions previously linked to evidence accumulation and to the implementation of caution reductions in the MCI group. Findings suggest that multiple cognitive mechanisms differ during memory retrieval in MCI, and that these mechanisms may explain neuroimaging alterations outside of the medial temporal lobes.

Visual versus Verbal Working Memory in Statistically Determined Patients with Mild Cognitive Impairment: On behalf of the Consortium for Clinical and Epidemiological Neuropsychological Data Analysis (CENDA)

OBJECTIVE

Previous research in mild cognitive impairment (MCI) suggests that visual episodic memory impairment may emerge before analogous verbal episodic memory impairment. The current study examined working memory (WM) test performance in MCI to assess whether patients present with greater visual versus verbal WM impairment. WM performance was also assessed in relation to hippocampal occupancy (HO), a ratio of hippocampal volume to ventricular dilation adjusted for demographic variables and intracranial volume.

METHODS

Jak et al. (2009) (The American Journal of Geriatric Psychiatry, 17, 368-375) and Edmonds, Delano-Wood, Galasko, Salmon, & Bondi (2015) (Journal of Alzheimer's Disease, 47(1), 231-242) criteria classify patients into four groups: little to no cognitive impairment (non-MCI); subtle cognitive impairment (SCI); amnestic MCI (aMCI); and a combined mixed/dysexecutive MCI (mixed/dys MCI). WM was assessed using co-normed Wechsler Adult Intelligence Scale-IV (WAIS-IV) Digit Span Backwards and Wechsler Memory Scale-IV (WMS-IV) Symbol Span Z-scores.

RESULTS

Between-group analyses found worse WMS-IV Symbol Span and WAIS-IV Digit Span Backwards performance for mixed/dys MCI compared to non-MCI patients. Within-group analyses found no differences for non-MCI patients; however, all other groups scored lower on WMS-IV Symbol Span than WAIS-IV Digit Span Backwards. Regression analysis with HO as the dependent variable was statistically significant for WMS-IV Symbol Span performance. WAIS-IV Digit Span Backwards performance failed to reach statistical significance.

CONCLUSIONS

Worse WMS-IV Symbol Span performance was observed in patient groups with measurable neuropsychological impairment and better WMS-IV Symbol Span performance was associated with higher HO ratios. These results suggest that visual WM may be particularly sensitive to emergent illness compared to analogous verbal WM tests.

Evidence of parietal hyperactivation in individuals with mild cognitive impairment who progressed to dementia: A longitudinal fMRI study

Hyperactivation, which is defined as a higher level of activation in patients compared to cognitively unimpaired older adults (controls; CTL), might represent an early signature of Alzheimer's Disease (AD). The goal of this study was to assess the presence and location of hyperactivation in individuals with mild cognitive impairment (MCI) who were later diagnosed with dementia, examine how hyperactivation changes longitudinally, and whether it is related to time before dementia. Forty participants, 26 with MCI and 14 CTL were enrolled in the study. Magnetic resonance imaging was used to measure functional activation while participants encoded word-pairs as well as cortical thickness and regional brain volume at study entry (Y0) and two years later (Y2). Clinical follow-up was completed every two years following study entry to identify progressors (pMCI), that is, individuals who later received a diagnosis of dementia. Task-related activation was assessed in pMCI in both hippocampi and in regions showing greater cortical thinning from Y0 to Y2 compared to CTLs. Hyperactivation was found in pMCI individuals in the right supramarginal gyrus. Persons with pMCI also showed hypoactivation in the left hippocampus and left pars opercularis. Both hyper- and hypoactivation were present at Y0 and Y2 and did not change longitudinally. Activation was not associated with time before dementia diagnosis. Smaller volume and thinner cortical thickness were associated with shorter time to diagnosis in the left hippocampus and left pars opercularis. In conclusion, hyperactivation was found in individuals who later progressed to dementia, confirming that it might represent an early biomarker to identify individuals in the prodromal phase of AD and that its understanding could contribute to elucidate the key brain mechanisms that precede dementia.

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Hyperactivation of the right parietal region was found in MCI progressors.

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Hypoactivation was found in the hippocampal and frontal regions.

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This overall pattern was specific to MCI who progressed to dementia.

Associative memory for conceptually unitized word pairs in mild cognitive impairment is related to the volume of the perirhinal cortex

Unitization, that is, the encoding of an association as one integrated entity, has been shown to improve associative memory in populations presenting with associative memory deficit due to hippocampal dysfunction, such as amnesic patients with focal hippocampal lesions and healthy older adults. One reason for this benefit is that encoding of unitized associations would rely on the perirhinal cortex (PrC) and thus minimize the need for hippocampal recruitment. Mild cognitive impairment (MCI) is accompanied by a deficit in associative memory. However, unitization has never been studied to explore the potential benefit in associative memory in MCI, maybe because MCI is characterized by PrC pathology. However, the PrC may potentially still function sufficiently to allow for the successful adoption of unitization. In this study, we aimed at assessing whether unitization could attenuate MCI patients' associative memory deficit, and whether the ability to remember unitized associations would be modulated by the integrity of the PrC in MCI patients. Unitization was manipulated at a conceptual level, by encouraging participants to encode unrelated word pairs as new compound words. Participants also underwent a structural MRI exam, and measures of PrC were extracted (Brodmann Areas [BA] 35 and 36). Results showed that, contrary to healthy controls, MCI patients did not benefit from unitization. Moreover, their memory performance for unitized associations was related to the measure of PrC integrity (BA35), while it was not the case in controls. This finding thus suggests that unitization does not help to attenuate the associative deficit in MCI patients, and brings support to the literature linking unitization to the PrC function.

Mnemonic strategy training increases neocortical activation in healthy older adults and patients with mild cognitive impairment

Learning and memory deficits characterize the diagnosis of amnestic mild cognitive impairment (aMCI), which is widely viewed as a clinical precursor to Alzheimer's type dementia. There is a growing interest in non-pharmacologic interventions, such as mnemonic strategies, for improving learning and memory in patients with aMCI as well as for maintaining functioning in healthy older adults. Using an ecologically relevant object-location association paradigm, we conducted a randomized, controlled, single-blind study in which healthy older adults and patients with aMCI were randomized to either mnemonic strategy training or a control group that was matched for stimulus exposure. We previously reported that mnemonic strategy training resulted in significantly greater learning and memory improvements compared to the matched exposure condition, in both aMCI patients and healthy controls. The current study examined changes in neocortical activation during encoding in a subset of participants who underwent functional magnetic resonance imaging (fMRI) scanning both before and after training. To minimize potential confounds in between-group comparisons, we employed non-linear cortex based alignment and included only correctly encoded stimuli in our analyses. When re-encoding stimuli learned during training (i.e., trained stimuli), we found a general enhancement of activation in right prefrontal and parietal regions, possibly reflecting practice-related improvement in coordinate spatial processing in all but the aMCI exposure group. Left hemisphere activation was typically only evident in the mnemonic strategy trained participants, regardless of diagnostic status, with the ventrolateral prefrontal cortex appearing especially important for strategy use. While encoding relatively novel stimuli, both mnemonic strategy groups (aMCI patients and healthy controls) demonstrated increased activation in a subset of regions showing change for the trained stimuli, indicating a mnemonic strategy-induced change in the processing of new information. These findings could not be explained by repeated exposure since there was little to no activation overlap in the respective exposure control groups. The current results reinforce the potential benefits of cognitive interventions in these growing populations and indicate that neuroplastic change in key rostral and lateral prefrontal regions mediate this behavioral change.

Visual and Verbal Serial List Learning in Patients with Statistically-Determined Mild Cognitive Impairment

Background and Objective

Prior research with patients with mild cognitive impairment (MCI) suggests that visual versus verbal episodic memory test performance may be more sensitive to emergent illness. However, little research has examined visual versus verbal episodic memory performance as related to MCI subtypes.

Research Design and Methods

Patients were diagnosed with non-MCI, amnestic MCI (aMCI), and combined mixed/dysexecutive MCI (mixed/dys MCI). Visual and verbal episodic memory were assessed with the Brief Visuospatial Memory Test-Revised (BVMT-R) and the 12-word Philadelphia (repeatable) Verbal Learning Test (P[r]VLT), respectively.

Results

BVMT-R and P(r)VLT scores yielded similar between-group patterns of performance. Non-MCI patients scored better than other groups on all parameters. aMCI and mixed/dys MCI did not differ on immediate or delayed free recall. Both delayed BVMT-R and P(r)VLT recognition test performance dissociated all three groups. Logistic regression analyses found that BVMT-R delayed free recall and delayed recognition scores correctly classified more patients with MCI (75.40%) than analogous P(r)VLT scores (66.20%). Visual versus verbal memory within-group analyses found no differences among non-MCI patients; P(r)VLT immediate free recall was worse among aMCI patients, but BVMT-R immediate free recall and delayed recognition were worse among mixed/dys MCI patients.

Discussion and Implications

Between-group analyses found convergent patterns of performance such that both tests identified elements of amnesia. However, logistic and within-group analyses found differing performance patterns suggesting that impaired visual episodic memory performance may be specific to emergent illness in mixed/dys MCI. Complementary but divergent neurocognitive networks may underlie visual versus verbal episodic memory performance in some patients with MCI.

Training gains and transfer effects after mnemonic strategy training in mild cognitive impairment: A fMRI study

Prior work has revealed that mnemonic strategy training (MST) can enhance memory for specific content and engages regions in the frontoparietal cognitive control network. Evidence of transfer to novel content is less clear. Here, we provide secondary analysis of functional magnetic resonance imaging (fMRI) data acquired during a randomized controlled trial that compared MST to an active education control condition in patients with amnestic mild cognitive impairment (a-MCI). In the trial, thirty participants with a-MCI were randomized to the education program (EP) or MST, where they learned to apply the technique to face-name associations during four intervening hour long training sessions. Participants underwent pre- and post-training fMRI scans, during which they encoded both the trained (i.e., those used during the four training sessions) and untrained ('novel') face-name associations. The primary cognitive outcome measures revealed significantly improved memory for both trained and novel stimuli - effects supporting near transfer of MST. Relative to pre-training, there were significant and highly similar increases in activation for both trained and novel stimuli, especially in regions associated with the frontoparietal cognitive control network bilaterally, but also in temporal areas related to social cognition and emotional processing. Critically, this pattern of activation was notably different from the EP group. Thus, the changes in activation were consistent with the strategies trained and, combined with the cognitively-based near transfer effects, suggest that MST focused on face-name association enhances performance by engaging cognitive control and social/emotional processing. Finally, our data indicated that our MST is a relevant and efficient intervention to a-MCI.

Context Memory in Alzheimer's Disease: The "Who, Where, and When"

Objective

Context memory, a component of episodic system, refers to the ability to retrieve conditions under which an event has occurred, such as who was present during that event and where and when it occurred. Context memory has been found to be compromised in older adults, an issue that we investigated in Alzheimer's disease (AD).

Methods

Thirty-one participants with AD and 35 older adults were asked to generate three autobiographical events. Afterward, they were asked to remember the names of all people who were evoked during the events, and the names for any location that was mentioned during the events. Participants were also asked to remember the year, season, month and day of the week when the events occurred.

Results

Compared to older adults, participants with AD showed lower memory for "who" (p < .001), "where" (p < .05), and "when" (p < .01). Compared to "who" and "where", both participants with AD and older adults showed pronounced difficulties in remembering the "when".

Conclusion

these findings highlight difficulties in remembering temporal information as an indication of context memory decline in AD. The difficulties in retrieving temporal information are discussed in terms of timing failures and hippocampal degenerations in AD.

Hippocampal place cell dysfunction and the effects of muscarinic M1 receptor agonism in a rat model of Alzheimer's disease

Alzheimer's disease (AD) is a neurodegenerative disease that disproportionately impacts memory and the hippocampus. However, it is unclear how AD pathology influences the activity of surviving neurons in the hippocampus to contribute to the memory symptoms in AD. One well-understood connection between spatial memory and neuronal activity in healthy brains is the activity of place cells, neurons in the hippocampus that fire preferentially in a specific location of a given environment (the place field of the place cell). In the present study, place cells were recorded from the hippocampus in a recently-developed rat model of AD (Tg-F344 AD) at an age (12-20 months) at which the AD rats showed marked spatial memory deficits. Place cells in the CA2 and CA3 pyramidal regions of the hippocampus in AD rats showed sharply reduced spatial fidelity relative to wild-type (WT) rats. In contrast, spiking activity of place cells recorded in region CA1 in AD rats showed good spatial fidelity that was similar to CA1 place cells in WT rats. Oral administration of the M₁ muscarinic acetylcholine receptor agonist VU0364572 impacted place cell firing rates in CA1 and CA2/3 hippocampal regions, but did not improve the spatial fidelity of CA2/3 hippocampal place cells in AD rats. The results indicated that, to the extent the spatial memory impairment in AD rats was attributable to hippocampal dysfunction, the memory impairment was more attributable to dysfunction in hippocampal regions CA2 and CA3 rather than CA1.

Continuous measurement of object location memory is sensitive to effects of age and mild cognitive impairment and related to medial temporal lobe volume

Introduction

We present findings of a novel and ecologically relevant associative memory test, the Object Location Touchscreen Test (OLTT), which was posited as sensitive to early medial temporal lobe compromise associated with mild cognitive impairment (MCI).

Methods

A total of 114 participants, including healthy young and older controls and patients with MCI, completed the OLTT and standard neuropsychological testing. The OLTT required participants to recall the location of objects under free and cued recall conditions, with accuracy evaluated using distance measures (i.e., a continuous error score), and a standard recognition format. Correlations between performance and volumetric data were evaluated from a subset of 77 participants.

Results

Significant age effects were dwarfed by MCI effects across all test conditions. OLTT Cued Recall was strongly and specifically related to the volume of disease-relevant medial temporal lobe regions, generally more than traditional memory tests.

Discussion

The OLTT may be sensitive to early structural compromise in regions affected by Alzheimer's disease.

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Evaluated age and mild cognitive impairment effects using ecologically relevant object location (OL) task.

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Performance evaluated using both continuous and dichotomous measures of accuracy.

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Greater decline in OL memory with mild cognitive impairment than with “healthy” aging.

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Performance, especially continuous measure, reflected medial temporal integrity.

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Novel OL memory task may be sensitive to early structural compromise.

Combined mnemonic strategy training and high-definition transcranial direct current stimulation for memory deficits in mild cognitive impairment

INTRODUCTION

Memory deficits characterize Alzheimer's dementia and the clinical precursor stage known as mild cognitive impairment. Nonpharmacologic interventions hold promise for enhancing functioning in these patients, potentially delaying functional impairment that denotes transition to dementia. Previous findings revealed that mnemonic strategy training (MST) enhances long-term retention of trained stimuli and is accompanied by increased blood oxygen level-dependent signal in the lateral frontal and parietal cortices as well as in the hippocampus. The present study was designed to enhance MST generalization, and the range of patients who benefit, via concurrent delivery of transcranial direct current stimulation (tDCS).

METHODS

This protocol describes a prospective, randomized controlled, four-arm, double-blind study targeting memory deficits in those with mild cognitive impairment. Once randomized, participants complete five consecutive daily sessions in which they receive either active or sham high definition tDCS over the left lateral prefrontal cortex, a region known to be important for successful memory encoding and that has been engaged by MST. High definition tDCS (active or sham) will be combined with either MST or autobiographical memory recall (comparable to reminiscence therapy). Participants undergo memory testing using ecologically relevant measures and functional magnetic resonance imaging before and after these treatment sessions as well as at a 3-month follow-up. Primary outcome measures include face-name and object-location association tasks. Secondary outcome measures include self-report of memory abilities as well as a spatial navigation task (near transfer) and prose memory (medication instructions; far transfer). Changes in functional magnetic resonance imaging will be evaluated during both task performance and the resting-state using activation and connectivity analyses.

DISCUSSION

The results will provide important information about the efficacy of cognitive and neuromodulatory techniques as well as the synergistic interaction between these promising approaches. Exploratory results will examine patient characteristics that affect treatment efficacy, thereby identifying those most appropriate for intervention.

Mild Cognitive Impairment Is Not "Mild" at All in Altered Activation of Episodic Memory Brain Networks: Evidence from ALE Meta-Analysis

The present study conducted a quantitative meta-analysis aiming at assessing consensus across the functional neuroimaging studies of episodic memory in individuals with amnestic mild cognitive impairment (aMCI) and elucidating consistent activation patterns. An activation likelihood estimation (ALE) was conducted on the functional neuroimaging studies of episodic encoding and retrieval in aMCI individuals published up to March 31, 2015. Analyses covered 24 studies, which yielded 770 distinct foci. Compared to healthy controls, aMCI individuals showed statistically significant consistent activation differences in a widespread episodic memory network, not only in the bilateral medial temporal lobe and prefrontal cortex, but also in the angular gyrus, precunes, posterior cingulate cortex, and even certain more basic structures. The present ALE meta-analysis revealed that the abnormal patterns of widespread episodic memory network indicated that individuals with aMCI may not be completely "mild" in nature.

Working memory contributes to the encoding of object location associations: Support for a 3-part model of object location memory

A recent model by Postma and colleagues posits that the encoding of object location associations (OLAs) requires the coordination of several cognitive processes mediated by ventral (object perception) and dorsal (spatial perception) visual pathways as well as the hippocampus (feature binding) [1]. Within this model, frontoparietal network recruitment is believed to contribute to both the spatial processing and working memory task demands. The current study used functional magnetic resonance imaging (fMRI) to test each step of this model in 15 participants who encoded OLAs and performed standard n-back tasks. As expected, object processing resulted in activation of the ventral visual stream. Object in location processing resulted in activation of both the ventral and dorsal visual streams as well as a lateral frontoparietal network. This condition was also the only one to result in medial temporal lobe activation, supporting its role in associative learning. A conjunction analysis revealed areas of shared activation between the working memory and object in location phase within the lateral frontoparietal network, anterior insula, and basal ganglia; consistent with prior working memory literature. Overall, findings support Postma and colleague's model and provide clear evidence for the role of working memory during OLA encoding.

Patterns of effective connectivity during memory encoding and retrieval differ between patients with mild cognitive impairment and healthy older adults

Previous research has shown that there is considerable overlap in the neural networks mediating successful memory encoding and retrieval. However, little is known about how the relevant human brain regions interact during these distinct phases of memory or how such interactions are affected by memory deficits that characterize mild cognitive impairment (MCI), a condition that often precedes dementia due to Alzheimer's disease. Here we employed multivariate Granger causality analysis using autoregressive modeling of inferred neuronal time series obtained by deconvolving the hemodynamic response function from measured blood oxygenation level-dependent (BOLD) time series data, in order to examine the effective connectivity between brain regions during successful encoding and/or retrieval of object location associations in MCI patients and comparable healthy older adults. During encoding, healthy older adults demonstrated a left hemisphere dominant pattern where the inferior frontal junction, anterior intraparietal sulcus (likely involving the parietal eye fields), and posterior cingulate cortex drove activation in most left hemisphere regions and virtually every right hemisphere region tested. These regions are part of a frontoparietal network that mediates top-down cognitive control and is implicated in successful memory formation. In contrast, in the MCI patients, the right frontal eye field drove activation in every left hemisphere region examined, suggesting reliance on more basic visual search processes. Retrieval in the healthy older adults was primarily driven by the right hippocampus with lesser contributions of the right anterior thalamic nuclei and right inferior frontal sulcus, consistent with theoretical models holding the hippocampus as critical for the successful retrieval of memories. The pattern differed in MCI patients, in whom the right inferior frontal junction and right anterior thalamus drove successful memory retrieval, reflecting the characteristic hippocampal dysfunction of these patients. These findings demonstrate that neural network interactions differ markedly between MCI patients and healthy older adults. Future efforts will investigate the impact of cognitive rehabilitation of memory on these connectivity patterns.

Glucose improves object-location binding in visual-spatial working memory

RATIONALE

There is evidence that glucose temporarily enhances cognition and that processes dependent on the hippocampus may be particularly sensitive. As the hippocampus plays a key role in binding processes, we examined the influence of glucose on memory for object-location bindings.

OBJECTIVE

This study aims to study how glucose modifies performance on an object-location memory task, a task that draws heavily on hippocampal function.

METHODS

Thirty-one participants received 30 g glucose or placebo in a single 1-h session. After seeing between 3 and 10 objects (words or shapes) at different locations in a 9 × 9 matrix, participants attempted to immediately reproduce the display on a blank 9 × 9 matrix. Blood glucose was measured before drink ingestion, mid-way through the session, and at the end of the session.

RESULTS

Glucose significantly improves object-location binding (d = 1.08) and location memory (d = 0.83), but not object memory (d = 0.51). Increasing working memory load impairs object memory and object-location binding, and word-location binding is more successful than shape-location binding, but the glucose improvement is robust across all difficulty manipulations. Within the glucose group, higher levels of circulating glucose are correlated with better binding memory and remembering the locations of successfully recalled objects.

CONCLUSIONS

The glucose improvements identified are consistent with a facilitative impact on hippocampal function. The findings are discussed in the context of the relationship between cognitive processes, hippocampal function, and the implications for glucose's mode of action.

Investigating Associative Learning Effects in Patients with Prodromal Alzheimer's Disease Using the Temporal Context Model

The purpose of this study was to investigate associative learning effects in patients with prodromal Alzheimer's disease (prAD) by referring to the Temporal Context Model (TCM; Howard, Jing, Rao, Provyn, & Datey, 2009), in an attempt to enhance the understanding of their associative memory impairment. TCM explains fundamental effects described in classical free-recall tasks and cued-recall tasks involving overlapping word pairs (e.g., A-B, B-C), namely (1) the contiguity effect, which is the tendency to successively recall nearby items in a list, and (2) the observation of backward (i.e., B-A) and transitive associations (i.e., A-C) between items. In TCM, these effects are hypothesized to rely on contextual representation, binding and retrieval processes, which supposedly depend on hippocampal and parahippocampal regions. As these regions are affected in prAD, the current study investigated whether prAD patients would show reduced proportions of backward and transitive associations in free and cued-recall, coupled to a reduced contiguity effect in free-recall. Seventeen older controls and 17 prAD patients performed a cued-recall task involving overlapping word pairs and a final free-recall task. Proportions of backward and transitive intrusions in cued-recall did not significantly differ between groups. However, in free-recall, prAD patients demonstrated a reduced contiguity effect as well as reduced proportions of backward and transitive associations compared to older controls. These findings are discussed within the hypothesis that the contextual representation, binding and/or retrieval processes are affected in prAD patients compared to healthy older individuals.

Object-location memory in adults with autism spectrum disorder

This study tested implicit and explicit spatial relational memory in Autism Spectrum Disorder (ASD). Participants were asked to study pictures of rooms and pictures of daily objects for which locations were highlighted in the rooms. Participants were later tested for their memory of the object locations either by being asked to place objects back into their original locations or into new locations. Proportions of times when participants choose the previously studied locations for the objects irrespective of the instruction were used to derive indices of explicit and implicit memory [process-dissociation procedure, Jacoby, 1991, 1998]. In addition, participants performed object and location recognition and source memory tasks where they were asked about which locations belonged to the objects and which objects to the locations. The data revealed difficulty for ASD individuals in actively retrieving object locations (explicit memory) but not in subconsciously remembering them (implicit memory). These difficulties cannot be explained by difficulties in memory for objects or locations per se (i.e., the difficulty pertains to object-location relations). Together these observations lend further support to the idea that ASD is characterised by relatively circumscribed difficulties in relational rather than item-specific memory processes and show that these difficulties extend to the domain of spatial information. They also lend further support to the idea that memory difficulties in ASD can be reduced when support is provided at test.

Effects of functional tasks exercise on older adults with cognitive impairment at risk of Alzheimer's disease: a randomised controlled trial

OBJECTIVE

the aim of this study was to compare the effects of a functional tasks exercise programme to a cognitive training programme in older adults with mild cognitive impairment.

DESIGN

a single-blind randomised control trial with the intervention group compared with an active control group.

SETTING

out-patient clinic.

PARTICIPANTS

older adults with mild cognitive impairment (n = 83) aged 60 and older living in the community.

METHODS

participants were randomised to either a functional task exercise group (n = 43) or an active cognitive training group (n = 40) for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and 6-month follow-up using Neurobehavioral Cognitive Status Examination, Trail Making Test, Chinese Version Verbal Learning Test, Category Verbal Learning Test, Lawton Instrumental Activities of Daily Living Scale and Problems in Everyday Living Test.

RESULTS

the functional task exercise group showed significant between-group differences in general cognitive functions, memory, executive function, functional status and everyday problem solving ability. The improvements were sustained over time at 6-month follow-up.

CONCLUSION

a functional tasks exercise programme is feasible for improving cognitive functions and functional status of older adults with mild cognitive impairment. This may serve as a cost-effective adjunct to the existing interventions for populations with mild cognitive impairment.

TRIAL REGISTRATION NUMBER

ACTRN12610001025022.

A systematic review of type 2 diabetes mellitus and hypertension in imaging studies of cognitive aging: time to establish new norms

The rising prevalence of type 2 diabetes (T2DM) and hypertension in older adults, and the deleterious effect of these conditions on cerebrovascular and brain health, is creating a growing discrepancy between the "typical" cognitive aging trajectory and a "healthy" cognitive aging trajectory. These changing health demographics make T2DM and hypertension important topics of study in their own right, and warrant attention from the perspective of cognitive aging neuroimaging research. Specifically, interpretation of individual or group differences in blood oxygenation level dependent magnetic resonance imaging (BOLD MRI) or positron emission tomography (PET H2O(15)) signals as reflective of differences in neural activation underlying a cognitive operation of interest requires assumptions of intact vascular health amongst the study participants. Without adequate screening, inclusion of individuals with T2DM or hypertension in "healthy" samples may introduce unwanted variability and bias to brain and/or cognitive measures, and increase potential for error. We conducted a systematic review of the cognitive aging neuroimaging literature to document the extent to which researchers account for these conditions. Of the 232 studies selected for review, few explicitly excluded individuals with T2DM (9%) or hypertension (13%). A large portion had exclusion criteria that made it difficult to determine whether T2DM or hypertension were excluded (44 and 37%), and many did not mention any selection criteria related to T2DM or hypertension (34 and 22%). Of all the surveyed studies, only 29% acknowledged or addressed the potential influence of intersubject vascular variability on the measured BOLD or PET signals. To reinforce the notion that individuals with T2DM and hypertension should not be overlooked as a potential source of bias, we also provide an overview of metabolic and vascular changes associated with T2DM and hypertension, as they relate to cerebrovascular and brain health.

Using neuroimaging to inform clinical practice for the diagnosis and treatment of mild cognitive impairment

Advances in structural and functional neuroimaging techniques have unquestionably improved understanding of the development and progression of Alzheimer disease (AD), with evidence supporting regional (and network) change that underlies cognitive decline across the "healthy" aging/mild cognitive impairment (MCI)/AD spectrum. This review focuses on visual rating scales and volumetric analyses that could be easily integrated into clinical practice, followed by a review of functional neuroimaging findings suggesting that widespread cerebral dysfunction underlies the learning and memory deficits in MCI. Evidence of preserved neuroplasticity in this population and that cognitive rehabilitation techniques may capitalize on this plasticity to improve cognition in those with MCI is also discussed.

Sex and cultural differences in spatial performance between Japanese and North Americans

Previous studies have suggested that Asians perform better than North Americans on spatial tasks but show smaller sex differences. In this study, we evaluated the relationship between long-term experience with a pictorial written language and spatial performance. It was hypothesized that native Japanese Kanji (a complex pictorial written language) educated adults would show smaller sex differences on spatial tasks than Japanese Americans or North Americans without Kanji education. A total of 80 young healthy participants (20 native Japanese speakers, 20 Japanese Americans-non Japanese speaking, and 40 North Americans-non Japanese speaking) completed the Rey Complex Figure Test (RCFT), the Mental Rotations Test (MRT), and customized 2D and 3D spatial object location memory tests. As predicted, main effects revealed men performed better on the MRT and RCFT and women performed better on the spatial object location memory tests. Also, as predicted, native Japanese performed better on all tests than the other groups. In contrast to the other groups, native Japanese showed a decreased magnitude of sex differences on aspects of the RCFT (immediate and delayed recall) and no significant sex difference on the efficiency of the strategy used to copy and encode the RCFT figure. This study lends support to the idea that intensive experience over time with a pictorial written language (i.e., Japanese Kanji) may contribute to increased spatial performance on some spatial tasks as well as diminish sex differences in performance on tasks that most resemble Kanji.

Specific and disease stage-dependent episodic memory-related brain activation patterns in Alzheimer's disease: a coordinate-based meta-analysis

Episodic memory is typically affected during the course of Alzheimer's disease (AD). Due to the pronounced heterogeneity of functional neuroimaging studies on episodic memory impairments in mild cognitive impairment (MCI) and AD regarding their methodology and findings, we aimed to delineate consistent episodic memory-related brain activation patterns. We performed a systematic, quantitative, coordinate-based whole-brain activation likelihood estimation meta-analysis of 28 functional magnetic resonance imaging (fMRI) studies comprising 292 MCI and 102 AD patients contrasted to 409 age-matched control subjects. We included episodic encoding and/or retrieval phases, investigated the effects of group, verbal or image stimuli and correlated mean Mini-Mental-Status-Examination (MMSE) scores with the modelled activation estimates. MCI patients presented increased right hippocampal activation during memory encoding, decreased activation in the left hippocampus and fusiform gyrus during retrieval tasks, as well as attenuated activation in the right anterior insula/inferior frontal gyrus during verbal retrieval. In AD patients, however, stronger activation within the precuneus during encoding tasks was accompanied by attenuated right hippocampal activation during retrieval tasks. Low cognitive performance (MMSE scores) was associated with stronger activation of the precuneus and reduced activation of the right (para)hippocampus and anterior insula/inferior frontal gyrus. This meta-analysis provides evidence for a specific and probably disease stage-dependent brain activation pattern related to the pathognomonic AD characteristic of episodic memory loss.

Cognitive rehabilitation of memory for mild cognitive impairment: a methodological review and model for future research

Several recent reviews have suggested that cognitive rehabilitation may hold promise in the treatment of memory deficits experienced by patients with mild cognitive impairment. In contrast to the previous reviews that mainly focused on outcome, the current review examines key methodological challenges that are critical for designing and interpreting research studies and translating results into clinical practice. Using methodological details from 36 studies, we first examine diagnostic variability and how the use of cutoffs may bias samples toward more severely impaired patients. Second, the strengths and limitations of several common rehabilitative techniques are discussed. Half of the reviewed studies used a multi-technique approach that precludes the causal attribution between any specific technique and subsequent improvement. Third, there is a clear need to examine the dose-response relationship since this information was strikingly absent from most studies. Fourth, outcome measures varied widely and frequently depended on neuropsychological tests with little theoretical justification or ecological relevance. Fifth, we discuss how the variability in each of these other four areas complicates efforts to examine training generalization. Overall, future studies should place greater emphasis on ecologically relevant treatment approaches and outcome measures and we propose a hierarchical model that may aid in this pursuit.

Transcranial direct current stimulation modulates activation and effective connectivity during spatial navigation

BACKGROUND

Allocentric navigation declines with age and neurologic disease whereas egocentric navigation does not; differences that likely arise from maladaptive changes in brain regions mediating spatial (parietal cortex; hippocampus) but not procedural processing (caudate nucleus). Transcranial direct current stimulation (tDCS) holds promise for treating such decline given its ability to modulate neuronal excitability, but its effects have yet to be examined on spatial navigation.

OBJECTIVES/HYPOTHESES

Using healthy young adults as a model, Study 1 intended to validate a novel spatial navigation paradigm using functional magnetic resonance imaging (fMRI). Using these data to determine targets for tDCS, Study 2 aimed to determine if 1) stimulation modulates activation in a polarity-specific manner; 2) stimulation results in global and/or task-specific activation changes; 3) activation changes are accompanied by changes in effective connectivity.

METHODS

All participants underwent fMRI while learning allocentric and egocentric environments. Twelve participants completed Study 1. In Study 2, 16 participants were randomized to 20 min of tDCS (2 mA) using a montage with the anode over PZ and cathode over AF4 (P+F-) or the reverse montage (P-F+).

RESULTS

Study 1 revealed that distinct networks preferentially mediate allocentric and egocentric navigation. Study 2 revealed polarity-dependent changes in activation and connectivity. The P+F- montage increased these measures in spatial regions, especially during allocentric navigation, and the caudate nucleus. Conversely, the P-F+ montage increased activation and connectivity in lateral prefrontal cortices and posterior hippocampus.

CONCLUSIONS

These findings support the neuromodulatory effects of tDCS in non-motor areas and demonstrate proof-of-principle for ameliorating age- and disease-related decline in navigational abilities.

Lateral temporal hyper-activation as a novel biomarker of mild cognitive impairment

Memory dysfunction in mild cognitive impairment (MCI) due to Alzheimer's pathology is primarily associated with episodic memory deficits linked to deterioration of the medial temporal lobes (MTLs). Currently, there is a call to discover novel biomarkers of MCI in order to improve research criteria. Functional activation differences in MCI during episodic memory-task performance are often evidenced in the MTLs, and frontal and parietal lobes, but it has been suggested that examination of working memory (WM) differences may be more useful in detecting MCI. In the current study, MCI and control participants performed a complex WM span (CWMS) task while functional magnetic resonance imaging (fMRI) data were acquired. Results indicated hyper-activation of the lateral temporal lobes, MTLs, and frontal and parietal regions during encoding and maintenance, and hyper-activation of the lateral temporal, frontal, and parietal lobes during CWMS recall for the MCI participants. Medial and lateral temporal differences during encoding and maintenance are consistent with previous findings, but lateral temporal differences are often not elaborated upon. Hyper-activation of the lateral temporal lobes during WM encoding and maintenance, and also during recall, suggests that this region may provide valuable information regarding WM impairment in MCI and Alzheimer's. Given that whole-brain functional imaging of the MTLs is often limited due to artifact and partial voluming of sub-fields, examination of lateral temporal differences may provide a novel biomarker related to WM impairment in MCI.

Mnemonic strategy training improves memory for object location associations in both healthy elderly and patients with amnestic mild cognitive impairment: a randomized, single-blind study

OBJECTIVE

To evaluate the efficacy of mnemonic strategy training versus a matched-exposure control condition and to examine the relationship between training-related gains, neuropsychological abilities, and medial temporal lobe volumetrics in patients with amnestic mild cognitive impairment (aMCI) and age-matched healthy controls.

METHOD

Twenty-three of 45 screened healthy controls and 29 of 42 screened patients with aMCI were randomized to mnemonic strategy or matched-exposure groups. Groups were run in parallel, with participants blind to the other intervention. All participants completed five sessions within 2 weeks. Memory testing for object-location associations (OLAs) was performed during sessions one and five and at a 1-month follow-up. During Sessions 2-4, participants received either mnemonic strategy training or a matched number of exposures with corrective feedback for a total of 45 OLAs. Structural magnetic resonance imaging was performed in most participants, and medial temporal lobe volumetrics were acquired.

RESULTS

Twenty-one healthy controls and 28 patients with aMCI were included in data analysis. Mnemonic strategy training was significantly more beneficial than matched exposure immediately after training, p = .006, partial η2 = .16, and at 1 month, p < .001, partial η2 = .35, regardless of diagnostic group (healthy group or aMCI group). Although patients with aMCI demonstrated gains comparable to the healthy control groups, their overall performance generally remained reduced. Mnemonic strategy-related improvement was correlated positively with baseline memory and executive functioning and negatively with inferior lateral ventricle volume in patients with aMCI; no significant relationships were evident in matched-exposure patients.

CONCLUSION

Mnemonic strategies effectively improve memory for specific content for at least 1 month in patients with aMCI.

Mnemonic strategy training partially restores hippocampal activity in patients with mild cognitive impairment

Learning and memory deficits typify patients with mild cognitive impairment (MCI) and are generally attributed to medial temporal lobe dysfunction. Although the hippocampus is perhaps the most commonly studied neuroanatomical structure in these patients, there have been few attempts to identify rehabilitative interventions that facilitate its functioning. Here, we present results from a randomized, controlled, single-blind study in which patients with MCI and healthy elderly controls (HEC) were randomized to either three sessions of mnemonic strategy training (MS) or a matched-exposure control group (XP). All participants underwent pre- and posttraining fMRI scanning as they encoded and retrieved object-location associations. For the current report, fMRI analyses were restricted to the hippocampus, as defined anatomically. Before training, MCI patients showed reduced hippocampal activity during both encoding and retrieval, relative to HEC. Following training, the MCI MS group demonstrated increased activity during both encoding and retrieval. There were significant differences between the MCI MS and MCI XP groups during retrieval, especially within the right hippocampus. Thus, MS facilitated hippocampal functioning in a partially restorative manner. We conclude that cognitive rehabilitation techniques may help mitigate hippocampal dysfunction in MCI patients.

Impaired context reversal learning, but not cue reversal learning, in patients with amnestic mild cognitive impairment

It has been proposed that reversal learning is impaired following damage to the orbitofrontal and ventromedial frontal cortex (OFC/VMFC) and to the medial temporal lobe (MTL), including the hippocampal formation. However, the exact characteristics of the MTL-associated reversal learning deficit are not known. To investigate this issue, we assessed 30 newly diagnosed patients with amnestic mild cognitive impairment (aMCI) and 30 matched healthy controls. All patients fulfilled the aMCI criteria of the Mayo Clinic Alzheimer's Disease Research Center and underwent head magnetic resonance imaging that confirmed MTL atrophy. Reversal learning was assessed using a novel reinforcement learning task. Participants first acquired and then reversed stimulus-outcome associations based on negative and positive feedback (losing and gaining points). Stimuli consisted of a cue (geometric shapes) and a spatial context (background color or pattern). Neuropsychological assessment included tasks related to the MTL (paired associates learning), dorsolateral prefrontal cortex (DLPFC) (extradimensional shift, One-touch Stockings of Cambridge), and OFC/VMFC (Holiday Apartment Task). Results revealed that, relative to controls, patients with aMCI exhibited a marked reversal learning deficit, which was highly selective for the reversal of context. The acquisition of stimulus-outcome associations and cue reversal learning were spared. Performance on the context reversal learning task significantly correlated with the right hippocampal volume. In addition, patients with aMCI had deficits on tests related to DLPFC but not to OFC/VMFC. However, DLPFC dysfunctions were not associated with context reversal learning. These results suggest that MTL deficits in aMCI selectively affect context reversal learning when OFC/VMFC functions are spared. This deficit is not influenced by the valence of the outcome (positive or negative feedback) and by executive dysfunctions.