Cortical control of inhibition of return: evidence from patients with inferior parietal damage and visual neglect

Disengagement of attention with spatial neglect: A systematic review of behavioral and anatomical findings

The present review examined the consequences of focal brain injury on spatial attention studied with cueing paradigms, with a particular focus on the disengagement deficit, which refers to the abnormal slowing of reactions following an ipsilesional cue. Our review supports the established notion that the disengagement deficit is a functional marker of spatial neglect and is particularly pronounced when elicited by peripheral cues. Recent research has revealed that this deficit critically depends on cues that have task-relevant characteristics or are associated with negative reinforcement. Attentional capture by task-relevant cues is contingent on damage to the right temporo-parietal junction (TPJ) and is modulated by functional connections between the TPJ and the right insular cortex. Furthermore, damage to the dorsal premotor or prefrontal cortex (dPMC/dPFC) reduces the effect of task-relevant cues. These findings support an interactive model of the disengagement deficit, involving the right TPJ, the insula, and the dPMC/dPFC. These interconnected regions play a crucial role in regulating and adapting spatial attention to changing intrinsic values of stimuli in the environment.

Intracortical recordings reveal vision-to-action cortical gradients driving human exogenous attention

Exogenous attention, the process that makes external salient stimuli pop-out of a visual scene, is essential for survival. How attention-capturing events modulate human brain processing remains unclear. Here we show how the psychological construct of exogenous attention gradually emerges over large-scale gradients in the human cortex, by analyzing activity from 1,403 intracortical contacts implanted in 28 individuals, while they performed an exogenous attention task. The timing, location and task-relevance of attentional events defined a spatiotemporal gradient of three neural clusters, which mapped onto cortical gradients and presented a hierarchy of timescales. Visual attributes modulated neural activity at one end of the gradient, while at the other end it reflected the upcoming response timing, with attentional effects occurring at the intersection of visual and response signals. These findings challenge multi-step models of attention, and suggest that frontoparietal networks, which process sequential stimuli as separate events sharing the same location, drive exogenous attention phenomena such as inhibition of return.

Characterization of attentional event-related potential from REM sleep behavior disorder patients based on explainable machine learning

BACKGROUND AND OBJECTIVE

Idiopathic rapid eye movement sleep behavior disorder (iRBD) is a prodromal stage of neurodegeneration and is associated with cortical dysfunction. The purpose of this study was to investigate the spatiotemporal characteristics of cortical activities underlying impaired visuospatial attention in iRBD patients using an explainable machine-learning approach.

METHODS

An algorithm based on a convolutional neural network (CNN) was devised to discriminate cortical current source activities of iRBD patients due to single-trial event-related potentials (ERPs), from those of normal controls. The ERPs from 16 iRBD patients and 19 age- and sex-matched normal controls were recorded while the subjects were performing visuospatial attentional task, and converted to two-dimensional images representing current source densities on flattened cortical surface. The CNN classifier was trained based on overall data, and then, a transfer learning approach was applied for the fine-tuning to each patient.

RESULTS

The trained classifier yielded high classification accuracy. The critical features for the classification were determined by layer-wise relevance propagation, so that the spatiotemporal characteristics of cortical activities that were most relevant to cognitive impairment in iRBD were revealed.

CONCLUSIONS

These results suggest that the recognized dysfunction in visuospatial attention of iRBD patients originates from neural activity impairment in relevant cortical regions and may contribute to the development of useful iRBD biomarkers based on neural activity.

The role of primary motor cortex in manual inhibition of return: A transcranial magnetic stimulation study

Inhibition of return (IOR) is a behavioural phenomenon characterised by longer response times (RTs) to stimuli presented at previously cued versus uncued locations. The neural mechanisms underlying IOR effects are not fully understood. Previous neurophysiological studies have identified a role of frontoparietal areas including posterior parietal cortex (PPC) in the generation of IOR, but the contribution of primary motor cortex (M1) has not been directly tested. The present study investigated the effects of single-pulse transcranial magnetic stimulation (TMS) over M1 on manual IOR in a key-press task where peripheral (left or right) targets followed a cue at the same or opposite location at different SOAs (100/300/600/1000 ms). In Experiment 1, TMS was applied over right M1 on a randomized 50% of trials. In Experiment 2, active or sham stimulation was provided in separate blocks. In the absence of TMS (non-TMS trials in Experiment 1 and sham trials in Experiment 2), evidence of IOR was observed in RTs at longer SOAs. In both experiments, IOR effects differed between TMS and non-TMS/sham conditions, but the effects of TMS were greater and statistically significant in Experiment 1 where TMS and non-TMS trials were randomly interspersed. The magnitude of motor-evoked potentials was not altered by the cue-target relationship in either experiment. These findings do not support a key role of M1 in the mechanisms of IOR but suggest the need for further research to elucidate the role of the motor system in manual IOR effects.

Task relevance and negative reward modulate the disengagement deficit of patients with spatial neglect

Though motivational value is a recognized trigger of approach and avoidance behavior, less is known about the potential of reward to capture attention. We here explored whether positive or negative reward modulates the characteristic deficit of patients with left spatial neglect to disengage attention from an ipsilesional distracter. We built our study on recent observations showing that the disengagement deficit is exaggerated for distracters with target-defining features, indicating that task-relevance captures attention. Patients with left neglect and matched healthy controls were asked to react to lateralized, colored targets preceded by a peripheral cue. Crucially, the cue either possessed the color of the target and was thus task-relevant, or was followed by a positive, negative, or neutral symbolic reward. Neglect patients only exhibited a disengagement deficit when cues were task-relevant or were followed by a negative reward. This finding indicates that attentional selection is driven by task-relevance and negative reward, possibly through interactions between limbic and attention networks.

Detection of Stroke-Induced Visual Neglect and Target Response Prediction Using Augmented Reality and Electroencephalography

We aim to build a system incorporating electroencephalography (EEG) and augmented reality (AR) that is capable of identifying the presence of visual spatial neglect (SN) and mapping the estimated neglected visual field. An EEG-based brain-computer interface (BCI) was used to identify those spatiospectral features that best detect participants with SN among stroke survivors using their EEG responses to ipsilesional and contralesional visual stimuli. Frontal-central delta and alpha, frontal-parietal theta, Fp1 beta, and left frontal gamma were found to be important features for neglect detection. Additionally, temporal analysis of the responses shows that the proposed model is accurate in detecting potentially neglected targets. These targets were predicted using common spatial patterns as the feature extraction algorithm and regularized discriminant analysis combined with kernel density estimation for classification. With our preliminary results, our system shows promise for reliably detecting the presence of SN and predicting visual target responses in stroke patients with SN.

Reward-driven modulation of spatial attention in the human frontal eye-field

Attentional selection and the decision of where to make an eye-movement are driven by various factors such as the representation of salience, task goal, and stimulus relevance, as well as expectations or predictions based on past experience. Brain systems implicated in these processes recruit cortico-subcortical areas including the Frontal Eye-Field (FEF), parietal cortex, or superior colliculus. How these areas interact to govern attention remains elusive. Priority maps of space have been observed in several brain regions, but the neural substrates where different sources of information are combined and integrated to guide attentional selection has not been elucidated. We investigated here the neural mechanisms subserving how reward cues influence the voluntary deployment of attention, in conditions where stimulus-driven capture and task-related goals compete for attention selection. Using fMRI in a visual search task in n = 23 participants, we found a selective modulation of FEF by the reward value of distractors during attentional shifts, particularly after high-predictive cueing to invalid locations. Reward information also modulated FEF connectivity to superior colliculus, striatum, and visual cortex. We conclude that FEF may occupy a central position within brain circuits integrating different sources of top-down biases for the generation of spatial saliency maps and guidance of selective attention.

Transcranial Magnetic Stimulation of the Right Superior Parietal Lobule Modulates the Retro-Cue Benefit in Visual Short-Term Memory

Several studies have shown enhanced performance in change detection tasks when spatial cues indicating the probe's location are presented after the memory array has disappeared (i.e., retro-cues) compared with spatial cues that are presented simultaneously with the test array (i.e., post-cues). This retro-cue benefit led some authors to propose the existence of two different stores of visual short-term memory: a weak but high-capacity store (fragile memory (FM)) linked to the effect of retro-cues and a robust but low-capacity store (working memory (WM)) linked to the effect of post-cues. The former is thought to be an attention-free system, whereas the latter would strictly depend on selective attention. Nonetheless, this dissociation is under debate, and several authors do not consider retro-cues as a proxy to measure the existence of an independent memory system (e.g., FM). We approached this controversial issue by altering the attention-related functions in the right superior parietal lobule (SPL) by transcranial magnetic stimulation (TMS), whose effects were mediated by the integrity of the right superior longitudinal fasciculus (SLF). Specifically, we asked whether TMS on the SPL affected the performance of retro cues vs. post-cues to a similar extent. The results showed that TMS on the SPL, mediated by right SLF-III integrity, produced a modulation of the retro-cue benefit, namely a memory capacity decrease in the post-cues but not in the retro-cues. These findings have strong implications for the debate on the existence of independent stages of visual short-term memory and for the growing literature showing a key role of the SLF for explaining the variability of TMS effects across participants.

Visual and motor neglect: Clinical and neurocognitive aspects

Attention allows us to prioritize the processing of external information according to our goals, but also to cope with sudden, unforeseen events. Attention processes rely on the coordinated activity of large-scale brain networks. At the cortical level, these systems are mainly organized in fronto-parietal networks, with functional and anatomical asymmetries in favor of the right hemisphere. Dysfunction of these right-lateralized networks often produce severe deficit of spatial attention, such as visual neglect. Other brain-damaged patients avoid moving the limbs contralateral to their brain lesion, even in the absence of sensorimotor deficits (motor neglect). This paper first summarizes past and current evidence on brain networks of attention; then, it presents clinical and experimental findings on visual and motor neglect, and on the possible mechanisms of clinical recovery.

Microstructural white matter connectivity underlying the attentional networks system

Nowadays, there is considerable controversy regarding the structural connectivity underlying the attentional networks system (i.e., alerting and vigilance, orienting, and executive control). The present study aimed at further examining and dissociating the white matter connectivity underlying attentional and vigilance functioning by overcoming some critical limitations in previous research. To this end, we performed virtual in vivo dissections of attention-related white matter tracts from thirty healthy adults. Participants completed two sessions of the Attentional Networks Test for Interactions and Vigilance, a suitable task to assess simultaneously phasic alertness, orienting, executive control, and the executive component of vigilance (i.e., the ability to detect infrequent critical signals). Whereas we found a consistent correlation between phasic alertness and both the right dorsolateral prefrontal caudate tract and the splenium of the corpus callosum, evidence obtained for white matter connectivity underlying orienting, executive control, and executive vigilance, was either weak at the best, inconsistent, or null. White matter connectivity seemed to support nevertheless the most reliable performance: overall reaction time for attentional functioning was significantly associated with the left cingulate fasciculus and overall reaction time for executive vigilance was significantly linked to the bilateral superior longitudinal fasciculus I. The present outcomes provide interesting, consistent, and reliable evidence concerning the structural connectivity underlying the alerting network. We still consider that further evidence is necessary to better understand the controversial relationship between attentional/vigilance processes and microstructural white matter connectivity though.

Inhibition of return: An information processing theory of its natures and significance

Inhibition of return (IOR) is an inhibitory aftereffect of visuospatial orienting, typically resulting in slower responses to targets presented in an area that has been recently attended. Since its discovery, myriad research has sought to explain the causes and effects underlying this phenomenon. Here, we briefly summarize the history of the phenomenon, and describe the early work supporting the functional significance of IOR as a foraging facilitator. We then shine a light on the discordance in the literature with respect to mechanism-in particular the lack of theoretical constructs that can consistently explain innumerable dissociations. We then describe three diagnostics (central arrow targets, locus of slack logic and the psychological refractory period, and performance in speed-accuracy space) used to support our theory that there are two forms of inhibition of return-the form which is manifest being contingent upon the activation state of the reflexive oculomotor system. The input form, which operates to decrease the salience of inputs, is generated when the reflexive oculomotor system is suppressed; the output form, which operates to bias responding, is generated when the reflexive oculomotor system is not suppressed. Then, we subject a published data set, wherein inhibitory effects had been generated while the reflexive oculomotor system was either active or suppressed, to diffusion modelling. As we hypothesized, based on the aforementioned theory, the effects of the two forms of IOR were best accounted for by different drift diffusion parameters. The paper ends with a variety of suggestions for further research.

The Visual Scanning Test: a newly developed neuropsychological tool to assess and target rehabilitation of extrapersonal visual unilateral spatial neglect

PURPOSE

Visual unilateral spatial neglect (VUSN) is a neuropsychological condition commonly experienced after stroke whereby patients are unable to attend to stimuli on the controlesional side of their space. VUSN can occur in the personal, peripersonal, and/or extrapersonal portion of patient's space. Traditional paper-and-pencil neuropsychological tests are widely used to evaluate VUSN, but they assess peripersonal VUSN. Instead, personal and extrapersonal neglect are less easily evaluated. The aim of this study was to present normative values for the Visual Scanning Test (VST), a new neuropsychological tool to quantitatively assess the extrapersonal VUSN.

METHODS

Eighty-six healthy subjects took part in the study (61 female), with a mean age of 52.8 years (SD = 17.0) and a mean of 14.0 years of education (SD = 5.2). The VST involved a visual search for a target between similar visual distractors, projected in the far space. The test was administered twice to each participant, with an interval of 2 weeks. From the recorded data, it was possible to obtain indexes related to the reaction times and to the accuracy of the performance on the VST.

RESULTS

Multiple linear regression analysis revealed that age and education significantly influenced VST-derived indexes. From the regression analysis, a correction grid for raw scores was built. Adjusted scores were then ranked, and by means of a non-parametric procedure, tolerance limits (both outer and inner one-sided) were defined.

CONCLUSIONS

The present study provided normative data for the VST in an Italian population useful for both clinical and research purposes.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03931798.

Functional Specialization in the Attention Network

Spatial attention is comprised of neural mechanisms that boost sensory processing at a behaviorally relevant location while filtering out competing information. The present review examines functional specialization in the network of brain regions that directs such preferential processing. This attention network includes both cortical (e.g., frontal and parietal cortices) and subcortical (e.g., the superior colliculus and the pulvinar nucleus of the thalamus) structures. Here, we piece together existing evidence that these various nodes of the attention network have dissociable functional roles by synthesizing results from electrophysiology and neuroimaging studies. We describe functional specialization across several dimensions (e.g., at different processing stages and within different behavioral contexts), while focusing on spatial attention as a dynamic process that unfolds over time. Functional contributions from each node of the attention network can change on a moment-to-moment timescale, providing the necessary cognitive flexibility for sampling from highly dynamic environments.

What Neuroscientific Studies Tell Us about Inhibition of Return

An inhibitory aftermath of orienting, inhibition of return (IOR), has intrigued scholars since its discovery about 40 years ago. Since then, the phenomenon has been subjected to a wide range of neuroscientific methods and the results of these are reviewed in this paper. These include direct manipulations of brain structures (which occur naturally in brain damage and disease or experimentally as in TMS and lesion studies) and measurements of brain activity (in humans using EEG and fMRI and in animals using single unit recording). A variety of less direct methods (e.g., computational modeling, developmental studies, etc.) have also been used. The findings from this wide range of methods support the critical role of subcortical and cortical oculomotor pathways in the generation and nature of IOR.

The causal role of the left parietal lobe in facilitation and inhibition of return

Following non-informative peripheral cues, responses are facilitated at the cued compared to the uncued location at short cue-target intervals. This effect reverses at longer intervals, giving rise to Inhibition of Return (IOR). The integration-segregation hypothesis (Lupiáñez, 2010) suggests that peripheral cues always produce an onset-detection cost regardless the behavioral cueing effect that is measured - either facilitation or IOR. In the present study, we used transcranial magnetic stimulation (TMS) to investigate the causal contribution of this detection cost to performance. We used a cueing paradigm with a target discrimination task that was preceded by a non-informative peripheral cue. The presence-absence of a central intervening event was manipulated. Online TMS to the left superior parietal lobe (compared to an active vertex stimulation) lead to an overall more positive effect (faster responses for cued as compared to uncued trials), by putatively impairing the detection cost contribution to performance. The data revealed a strong association between overall RT and the TMS effect, and also between overall RT and the integrity of the first branch of the left superior longitudinal fascicule. These results have critical implications not only for the open debate about the mechanism/s underlying spatial orienting effects, but also for the growing literature demonstrating that white matter connectivity is crucial for explaining inter-individual behavioral variability.

Where is the "where" in the brain? A meta-analysis of neuroimaging studies on spatial cognition

Spatial representations are processed in the service of several different cognitive functions. The present study capitalizes on the Activation Likelihood Estimation (ALE) method of meta-analysis to identify: (a) the shared neural activations among spatial functions to reveal the "core" network of spatial processing; (b) the specific neural activations associated with each of these functions. Following PRISMA guidelines, a total of 133 fMRI and PET studies were included in the meta-analysis. The overall analysis showed that the core network of spatial processing comprises regions that are symmetrically distributed on both hemispheres and that include dorsal frontoparietal regions, presupplementary motor area, anterior insula, and frontal operculum. The specific analyses revealed the brain regions that are selectively recruited for each spatial function, such as the right temporoparietal junction for shift of spatial attention, the right parahippocampal gyrus, and the retrosplenial cortex for navigation and spatial long-term memory. The findings are integrated within a systematic review of the neuroimaging literature and a new neurocognitive model of spatial cognition is proposed.

Traffic symbol recognition modulates bodily actions

Traffic signals, i.e., iconic symbols conveying traffic rules, generally represent spatial or movement meanings, e.g., “Stop”, “Go”, “Bend warning”, or “No entry”, and we visually perceive these symbols and produce appropriate bodily actions. The traffic signals are clearly thought to assist in producing bodily actions such as going forward or stopping, and the combination of symbolic recognition through visual perception and production of bodily actions could be one example of embodied cognition. However, to what extent our bodily actions are associated with the symbolic representations of commonly used traffic signals remains unknown. Here we experimentally investigated how traffic symbol recognition cognitively affects bodily action patterns, by employing a simple stimulus-response task for traffic sign recognition with a response of either sliding or pushing down on a joystick in a gamepad. We found that when operating the joystick, participants’ slide reaction in response to the “Go” traffic symbol was significantly faster than their push reaction, while their response time to the “Stop” signal showed no differences between sliding and pushing actions. These results suggested that there was a possible association between certain action patterns and traffic symbol recognition, and in particular the “Go” symbol was congruent with a sliding action as a bodily response. Our findings may thus reveal an example of embodied cognition in visual perception of traffic signals.

Influence of reward learning on visual attention and eye movements in a naturalistic environment: A virtual reality study

Rewards constitute crucial signals that motivate approach behavior and facilitate the perceptual processing of objects associated with favorable outcomes in past encounters. Reward-related influences on perception and attention have been reliably observed in studies where a reward is paired with a unidimensional low-level visual feature, such as the color or orientation of a line in visual search tasks. However, our environment is drastically different and composed of multidimensional and changing visual features, encountered in complex and dynamic scenes. Here, we designed an immersive virtual reality (VR) experiment using a 4-frame CAVE system to investigate the impact of rewards on attentional orienting and gaze patterns in a naturalistic and ecological environment. Forty-one healthy participants explored a virtual forest and responded to targets appearing on either the left or right side of their path. To test for reward-induced biases in spatial orienting, targets on one side were associated with high reward, whereas those on the opposite side were paired with a low reward. Eye-movements recording showed that left-side high rewards led to subsequent increase of eye gaze fixations towards this side of the path, but no such asymmetry was found after exposure to right-sided high rewards. A milder spatial bias was also observed after left-side high rewards during subsequent exploration of a virtual castle yard, but not during route turn choices along the forest path. Our results indicate that reward-related influences on attention and behavior may be better learned in left than right space, in line with a right hemisphere dominance, and could generalize to another environment to some extent, but not to spatial choices in another decision task, suggesting some domain- or context-specificity. This proof-of-concept study also outlines the advantages and the possible drawbacks of the use of the 3D CAVE immersive platform for VR in neuroscience.

Placeholders dissociate two forms of inhibition of return

Decades of research using Posner's classic spatial cueing paradigm has uncovered at least two forms of inhibition of return (IOR) in the aftermath of an exogenous, peripheral orienting cue. One prominent dissociation concerns the role of covert and overt orienting in generating IOR effects that relate to perception- and action-oriented processes, respectively. Another prominent dissociation concerns the role of covert and overt orienting in generating IOR effects that depend on object- and space-based representation, respectively. Our objective was to evaluate whether these dichotomies are functionally equivalent by manipulating placeholder object presence in the cueing paradigm. By discouraging eye movements throughout, Experiments 1A and 1B validated a perception-oriented form of IOR that depended critically on placeholders. Experiment 2A demonstrated that IOR was robust without placeholders when eye movements went to the cue and back to fixation before the manual response target. In Experiment 2B, we replicated Experiment 2A's procedures except we discouraged eye movements. IOR was observed, albeit only weakly and significantly diminished relative to when eye movements were involved. We conclude that action-oriented IOR is robust against placeholders but that the magnitude of perception-oriented IOR is critically sensitive to placeholder presence when unwanted oculomotor activity can be ruled out.

Peripheral stimuli generate different forms of inhibition of return when participants make prosaccades versus antisaccades to them

Inhibition of return (IOR) is usually viewed as an inhibitory aftermath of visual orienting typically seen in the form of slower responses to targets presented in a previously oriented to location. As shown by Taylor and Klein (2000. Journal of Experimental Psychology: Human Perception and Performance, 26, 1639-1656), the nature of the inhibitory effects resulting from an uninformative cue seem to be contingent on the activation state of the oculomotor system. Here we contrast target discrimination performance following either a prosaccade or antisaccade in the spatial cueing paradigm. Our findings suggest that the level of activation of the reflexive oculomotor system determines the dynamics of the inhibitory effect, wherein an effect nearer to the input end of processing is observed when the reflexive oculomotor system is actively suppressed, and an effect nearer to the output end of processing is observed when the reflexive oculomotor system is actively engaged. These effects interact differently with the Simon effect-providing converging evidence that they are dissociable inhibitory phenomena.

White matter microstructure of attentional networks predicts attention and consciousness functional interactions

Attention is considered as one of the pre-requisites of conscious perception. Phasic alerting and exogenous orienting improve conscious perception of near-threshold information through segregated brain networks. Using a multimodal neuroimaging approach, combining data from functional MRI (fMRI) and diffusion-weighted imaging (DWI), we investigated the influence of white matter properties of the ventral branch of superior longitudinal fasciculus (SLF III) in functional interactions between attentional systems and conscious perception. Results revealed that (1) reduced integrity of the left hemisphere SLF III was predictive of the neural interactions observed between exogenous orienting and conscious perception, and (2) increased integrity of the left hemisphere SLF III was predictive of the neural interactions observed between phasic alerting and conscious perception. Our results combining fMRI and DWI data demonstrate that structural properties of the white matter organization determine attentional modulations over conscious perception.

Cortico-thalamic disconnection in a patient with supernumerary phantom limb

Supernumerary phantom limb (SPL) designates the experience of an illusory additional limb occurring after brain damage. Functional neuroimaging during SPL movements documented increased response in the ipsilesional supplementary motor area (SMA), premotor cortex (PMC), thalamus and caudate. This suggested that motor circuits are important for bodily related cognition, but anatomical evidence is sparse. Here, we tested this hypothesis by studying an extremely rare patient with chronic SPL, still present 3 years after a vascular stroke affecting cortical and subcortical right-hemisphere structures. Anatomical analysis included an advanced in vivo reconstruction of white matter tracts using diffusion-based spherical deconvolution. This reconstruction demonstrated a massive and relatively selective disconnection between anatomically preserved SMA/PMC and the thalamus. Our results provide strong anatomical support for the hypothesis that cortico-thalamic loops involving motor-related circuits are crucial to integrate sensorimotor processing with bodily self-awareness.

Structural white-matter connections mediating distinct behavioral components of spatial neglect in right brain-damaged patients

Spatial neglect is a neuropsychological syndrome in which patients fail to perceive and orient to stimuli located in the space contralateral to the lesioned hemisphere. It is characterized by a wide heterogeneity in clinical symptoms which can be grouped into distinct behavioral components correlating with different lesion sites. Moreover, damage to white-matter (WM) fiber tracts has been suggested to disconnect brain networks that mediate different functions associated with spatial cognition and attention. However, it remains unclear what WM pathways are associated with functionally dissociable neglect components. In this study we examined nine patients with a focal right hemisphere stroke using a series of neuropsychological tests and diffusion tensor imaging (DTI) in order to disentangle the role of specific WM pathways in neglect symptoms. First, following previous work, the behavioral test scores of patients were factorized into three independent components reflecting perceptual, exploratory, and object-centered deficits in spatial awareness. We then examined the structural neural substrates of these components by correlating indices of WM integrity (fractional anisotropy) with the severity of deficits along each profile. Several locations in the right parietal and frontal WM correlated with neuropsychological scores. Fiber tracts projecting from these locations indicated that posterior parts of the superior longitudinal fasciculus (SLF), as well as nearby callosal fibers connecting ipsilateral and contralateral parietal areas, were associated with perceptual spatial deficits, whereas more anterior parts of SLF and inferior fronto-occipital fasciculus (IFOF) were predominantly associated with object-centered deficits. In addition, connections between frontal areas and superior colliculus were found to be associated with the exploratory deficits. Our results provide novel support to the view that neglect may result from disconnection lesions in distributed brain networks, but also extend these notions by highlighting the role of dissociable circuits in different functional components of the neglect syndrome. However these preliminary findings require replication with larger samples of patients.

Memory instruction interacts with both visual and motoric inhibition of return

In the item-method directed forgetting paradigm, the magnitude of inhibition of return (IOR) is larger after an instruction to forget (F) than after an instruction to remember (R). In the present experiments, we further investigated this increased magnitude of IOR after F than after R memory instructions, to determine whether this F > R IOR pattern occurs only for the motoric form of IOR, as predicted, or also for the visual form. In three experiments, words were presented in one of two peripheral locations, followed by either an F or an R memory instruction. Then, a target appeared either at the same location as the previous word or at the other location. In Experiment 1, participants maintained fixation throughout the trial until the target appeared, at which point they made a saccade to the target. In Experiment 2, they maintained fixation throughout the entire trial and made a manual localization response to the target. The F > R IOR difference in reaction times occurred for both the saccadic and manual responses, suggesting that memory instructions modify both motoric and visual forms of IOR. In Experiment 3, participants made a perceptual discrimination response to report the identity of a target while the eyes remained fixed. The F > R IOR difference also occurred for these manual discrimination responses, increasing our confidence that memory instructions modify the visual form of IOR. We relate our findings to postulated differences in attentional withdrawal following F and R instructions and consider the implications of the findings for successful forgetting.

Attentional dynamics mediated by subcortical mechanisms

Following a salient cue that attracts attention to a specific spatial location, perceptual processing of information at that location is facilitated if the interval between the cue and target is brief, or, is inhibited if the interval between the cue and target is long. The mechanisms mediating these attentional dynamics continue to be the subject on ongoing debate. On one classic account, facilitation and inhibition of return (IOR) are two ends of a continuum, generated by the same underlying mechanism. Other accounts have postulated that these two attentional processes emerge from independent systems. To address these alternatives, we report data from three experiments in which a cue and its ensuing target are presented to the same or different eyes at varying cue-target intervals. Whereas the onset of facilitation was apparent earlier when the cue and target shared the eye-of-origin, the onset of IOR was not affected by the eye to which the cue and target were presented. This finding implicates at least some, if not full, independence in the system(s) that give rise to attentional facilitation and IOR, and, moreover, suggests that facilitation may be more reliant on subcortical levels of the visual pathways than IOR.

In search of a reliable electrophysiological marker of oculomotor inhibition of return

Inhibition of return (IOR) operationalizes a behavioral phenomenon characterized by slower responding to cued, relative to uncued, targets. Two independent forms of IOR have been theorized: input-based IOR occurs when the oculomotor system is quiescent, while output-based IOR occurs when the oculomotor system is engaged. EEG studies forbidding eye movements have demonstrated that reductions of target-elicited P1 components are correlated with IOR magnitude, but when eye movements occur, P1 effects bear no relationship to behavior. We expand on this work by adapting the cueing paradigm and recording event-related potentials: IOR is caused by oculomotor responses to central arrows or peripheral onsets and measured by key presses to peripheral targets. Behavioral IOR is observed in both conditions, but P1 reductions are absent in the central arrow condition. By contrast, arrow and peripheral cues enhance Nd, especially over contralateral electrode sites.

Effector-dependent neglect and splenial disconnection: a spherical deconvolution tractography study

We present the case of a patient with left homonymous hemianopia and chronic left neglect consequent to a stroke in the occipito-temporal regions of the right hemisphere. When the patient performed cancellation tasks with her right (dominant) hand, she had severe and persistent left neglect at retest 7 and 8 years after onset. However, her performance on line bisection was invariably within normal limits. Strikingly, performance on cancellation tests reverted to normal when the patient used her left hand. White matter tractography using spherical deconvolution demonstrated damage to the splenium of the corpus callosum, as well as a relative preservation of the right fronto-parietal network. Effector-dependent neglect may occur because splenial disconnection deprives the right fronto-parietal network from visual information processed by the left hemisphere. Consequently, spatial exploration reverts to normal when the patient uses her left hand, thus involving more directly the fronto-parietal attentional networks in the right-hemisphere.

Visual neglect: is there a relationship between impaired spatial working memory and re-cancellation?

In visual search tasks, neglect patients tend to explore and repeatedly re-cancel stimuli on the ipsilesional side, as if they did not realize that they had previously examined the rightward locations favoured by their lateral bias. The aim of this study was to explore the hypothesis that a spatial working memory deficit explains these ipsilesional re-cancellation errors in neglect patients. For the first time, we evaluated spatial working memory and re-cancellation through separate and independent tasks in a group of patients with right hemisphere damage and a diagnosis of left neglect. Results showed impaired spatial working memory in neglect patients. Compared to the control group, neglect patients cancelled fewer targets and made more re-cancellations both on the left side and on the right side. The spatial working memory deficit appears to be related to re-cancellations, but only for some neglect patients. Alternative interpretations of re-exploration of space are discussed.

Damage to the medial motor system in stroke patients with motor neglect

Background and objectives: Motor neglect (MN) is a clinically important condition whereby patients with unilateral brain lesions fail to move their contralateral limbs, despite normal muscle strength, reflexes, and sensation. MN has been associated with various lesion sites, including the parietal and frontal cortex, the internal capsule, the lenticulostriate nuclei, and the thalamus. In the present study, we explored the hypothesis that MN depends on a dysfunction of the medial motor system by performing a detailed anatomical analysis in four patients with MN.

Methods: Ten patients participated in the study: four with MN, four with left visual neglect but without MN, and three patients with left hemiplegia without MN. We used specific scales for clinical and neuropsychological assessment. We drew the lesion borders directly onto the original brain images of each patient, and plotted the lesions on anatomical atlases for gray and white matter.

Results: Lesion locations were highly heterogeneous in our MN patients, and included frontal and parietal sites, basal ganglia, and white matter. The only consistently damaged structure across all MN patients was the cingulum bundle, a major pathway of the medial motor system important for motor initiative, and a key connection with limbic structures crucial for motivational aspects of actions. Three MN patients with additional damage to lateral fronto-parietal networks had also signs of contralesional visual neglect. The cingulum bundle was intact in all the control patients with visual neglect or hemiplegia.

Conclusions: Cingulum damage may induce MN through unilateral dysfunction of the medial motor system. Additional lateral fronto-parietal dysfunction can result in the association with visual neglect.

On the role of eye movement monitoring and discouragement on inhibition of return in a go/no-go task

Inhibition of return (IOR) most often describes the finding of increased response times to cued as compared to uncued targets in the standard covert orienting paradigm. A perennial question in the IOR literature centers on whether the effect of IOR is on motoric/decision-making processes (output-based IOR), attentional/perceptual processes (input-based IOR), or both. Recent data converge on the idea that IOR is an output-based effect when eye movements are required or permitted whereas IOR is an input-based effect when eye movements are monitored and actively discouraged. The notion that the effects of IOR may be fundamentally different depending on the activation state of the oculomotor system has been challenged by several studies demonstrating that IOR exists as an output-, or output- plus input-based effect in simple keypress tasks not requiring oculomotor responses. Problematically, experiments in which keypress responses are required to visual events rarely use eye movement monitoring let alone the active discouragement of eye movement errors. Here, we return to an experimental method implemented by Ivanoff and Klein (2001) whose results demonstrated that IOR affected output-based processes when, ostensibly, only keypress responses occurred. Unlike Ivanoff and Klein, however, we assiduously monitor and discourage eye movements. We demonstrate that actively discouraging eye movements in keypress tasks changes the form of IOR from output- to input-based and, as such, we strongly encourage superior experimental control over or consideration of the contribution of eye movement activity in simple keypress tasks exploring IOR.

Effects of pro-cholinergic treatment in patients suffering from spatial neglect

Spatial neglect is a neurological condition characterized by a breakdown of spatial cognition contralateral to hemispheric damage. Deficits in spatial attention toward the contralesional side are considered to be central to this syndrome. Brain lesions typically involve right fronto-parietal cortices mediating attentional functions and subcortical connections in underlying white matter. Convergent findings from neuroimaging and behavioral studies in both animals and humans suggest that the cholinergic system might also be critically implicated in selective attention by modulating cortical function via widespread projections from the basal forebrain. Here we asked whether deficits in spatial attention associated with neglect could partly result from a cholinergic deafferentation of cortical areas subserving attentional functions, and whether such disturbances could be alleviated by pro-cholinergic therapy. We examined the effect of a single-dose transdermal nicotine treatment on spatial neglect in 10 stroke patients in a double-blind placebo-controlled protocol, using a standardized battery of neglect tests. Nicotine-induced systematic improvement on cancellation tasks and facilitated orienting to single visual targets, but had no significant effect on other tests. These results support a global effect of nicotine on attention and arousal, but no effect on other spatial mechanisms impaired in neglect.

Cortical control of Inhibition of Return: exploring the causal contributions of the left parietal cortex

Inhibition of Return (IOR) refers to longer response times (RTs) when processing information from an already inspected spatial location. This effect encourages orienting towards novel locations and may be hence adaptive to efficiently explore our environment. In a previous study (Bourgeois, Chica, Valero-Cabre, & Bartolomeo, 2013), we demonstrated that repetitive Transcranial Magnetic Stimulation (rTMS) over right hemisphere parietal sites, such as the intra-parietal sulcus (IPS), or the temporo-parietal junction (TPJ), lastingly interfered with manual but not saccadic IOR, for ipsilateral right-sided targets. For contralateral left-sided targets, rTMS over the right IPS, but not over the right TPJ, impaired both manual and saccadic IOR. In the present study, we investigated hemispheric differences in the cortical control of IOR by stimulating left parietal sites with the same design. Contrary to the stimulation of the right hemisphere, rTMS over the left IPS or TPJ did not produce significant modulations of either manual or saccadic IOR. This evidence extends to IOR the validity of current models of hemispheric asymmetries in the control of visuospatial attention.

Inhibition of Return Impairs Phosphene Detection

Efficient visual exploration requires the ability to select possible target locations via spatial attention and to deselect previously inspected locations via inhibition of return (IOR). Although a great deal is known about the effects of spatial attention on processing in visual cortex, much less is known about the effects of IOR on early visual areas. One possibility is that IOR acts in an opposite way to spatial attention, such that, whereas spatial attention enhances target related neural signals in visual cortex, IOR suppress target-related signals. Using a novel dual-coil TMS protocol, we found that IOR reduced the probability of detecting a TMS-induced phosphene in extrastriate cortex (V5). Specifically, a nonpredictive spatial precue presented 500 or 800 msec before stimulation significantly reduced the probability of detecting a phosphene when the precue appeared contralaterally to the site of stimulation (i.e., ipsilaterally to the potential location of the phosphene), compared with ipsilaterally or centrally presented cues. This result demonstrates that IOR facilitates visual exploration by directly affecting the strength of target-related signals in extrastriate visual cortex. This result is consistent with neurophysiological models of attention, which postulate that IOR modulates perception by biasing competition between sensory representations.

Two cognitive and neural systems for endogenous and exogenous spatial attention

Orienting of spatial attention is a family of phylogenetically old mechanisms developed to select information for further processing. Information can be selected via top-down or endogenous mechanisms, depending on the goals of the observers or on the task at hand. Moreover, salient and potentially dangerous events also attract spatial attention via bottom-up or exogenous mechanisms, allowing a rapid and efficient reaction to unexpected but important events. Fronto-parietal brain networks have been demonstrated to play an important role in supporting spatial attentional orienting, although there is no consensus on whether there is a single attentional system supporting both endogenous and exogenous attention, or two anatomical and functionally different attentional systems. In the present paper we review behavioral evidence emphasizing the differential characteristics of both systems, as well as their possible interactions for the control of the final orienting response. Behavioral studies reporting qualitative differences between the effects of both systems as well as double dissociations of the effects of endogenous and exogenous attention on information processing, suggest that they constitute two independent attentional systems, rather than a single one. Recent models of attentional orienting in humans have put forward the hypothesis of a dorsal fronto-parietal network for orienting spatial attention, and a more ventral fronto-parietal network for detecting unexpected but behaviorally relevant events. Non-invasive neurostimulation techniques, as well as neuropsychological data, suggest that endogenous and exogenous attention are implemented in overlapping, although partially segregated, brain circuits. Although more research is needed in order to refine our anatomical and functional knowledge of the brain circuits underlying spatial attention, we conclude that endogenous and exogenous spatial orienting constitute two independent attentional systems, with different behavioral effects, and partially distinct neural substrates.

Brain networks of visuospatial attention and their disruption in visual neglect

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

Visual search in spatial neglect studied with a preview paradigm

Impaired visual search is a hallmark of spatial neglect. When searching for an unique feature (e.g., color) neglect patients often show only slight visual field asymmetries. In contrast, when the target is defined by a combination of features (e.g., color and form) they exhibit a severe deficit of contralesional search. This finding suggests a selective impairment of the serial deployment of spatial attention. Here, we examined this deficit with a preview paradigm. Neglect patients searched for a target defined by the conjunction of shape and color, presented together with varying numbers of distracters. The presentation time was varied such that on some trials participants previewed the target together with same-shape/different-color distracters, for 300 or 600 ms prior to the appearance of additional different-shape/same-color distracters. On the remaining trials the target and all distracters were shown simultaneously. Healthy participants exhibited a serial search strategy only when all items were presented simultaneously, whereas in both preview conditions a pop-out effect was observed. Neglect patients showed a similar pattern when the target was presented in the right hemifield. In contrast, when searching for a target in the left hemifield they showed serial search in the no-preview condition, as well as with a preview of 300 ms, and partly even at 600 ms. A control experiment suggested that the failure to fully benefit from item preview was probably independent of accurate perception of time. Our results, when viewed in the context of existing literature, lead us to conclude that the visual search deficit in neglect reflects two additive factors: a biased representation of attentional priority in favor of ipsilesional information and exaggerated capture of attention by ipsilesional abrupt onsets.