Enhanced stimulus strength improves visual cognition in aging and Alzheimer's disease

Neurovisual rehabilitation in multiple sclerosis: Why a close integration of low-vision rehabilitation and neuropsychological rehabilitation may be effective for visual complaints

OBJECTIVE

The quality of life of people with multiple sclerosis (MS) is often affected by visual complaints. A previous study suggested that visual complaints are not likely to be related to specific visual functions, but by a global decline of cognitive and visual functioning. In this study, we further explore this hypothesis, by investigating the relation between visual functions and global cognitive functioning, aiming to provide recommendations for rehabilitation for visual complaints.

DESIGN

Cross-sectional study.

SETTING

A rehabilitation centre for partially sighted and blind people and a MS centre at a university hospital.

PARTICIPANTS

102 people with MS.

MAIN MEASURE

Correlations between assessments of visual functions (acuity, contrast sensitivity, visual field, smooth pursuit and saccades) and composite scores of a neuropsychological assessment (tests with a visual component and without a visual component).

RESULTS

All composite scores correlated with visual acuity, contrast sensitivity and the sensitivity of the monocular field, but not with smooth pursuit and saccades. Similar patterns were found in various subgroups. Results showed that visual functions that related to visual complaints correlated with a diffuse decline of global cognitive functioning and that visual and cognitive functioning may decline concurrently in people with MS.

CONCLUSIONS

Visual complaints may occur as a result of a diffuse decline of the integrity of a cerebral network involved in vision and cognition. People with MS with visual complaints may benefit from neurovisual rehabilitation, in which low-vision rehabilitation and neuropsychological rehabilitation are closely intertwined.

Alzheimer's disease: a continuum with visual involvements

Introduction

Alzheimer's disease (AD) is the most common form of dementia affecting the central nervous system, and alteration of several visual structures has been reported. Structural retinal changes are usually accompanied by changes in visual function in this disease. The aim of this study was to analyse the differences in visual function at different stages of the pathology (family history group (FH+), mild cognitive impairment (MCI), mild AD and moderate AD) in comparison with a control group of subjects with no cognitive decline and no family history of AD.

Methods

We included 53 controls, 13 subjects with FH+, 23 patients with MCI, 25 patients with mild AD and, 21 patients with moderate AD. All were ophthalmologically healthy. Visual acuity (VA), contrast sensitivity (CS), colour perception, visual integration, and fundus examination were performed.

Results

The analysis showed a statistically significant decrease in VA, CS and visual integration score between the MCI, mild AD and moderate AD groups compared to the control group. In the CS higher frequencies and in the colour perception test (total errors number), statistically significant differences were also observed in the MCI, mild AD and moderate AD groups with respect to the FH+ group and also between the control and AD groups. The FH+ group showed no statistically significant difference in visual functions compared to the control group. All the test correlated with the Mini Mental State Examination score and showed good predictive value when memory decline was present, with better values when AD was at a more advanced stage.

Conclusion

Alterations in visual function appear in subjects with MCI and evolve when AD is established, being stable in the initial stages of the disease (mild AD and moderate AD). Therefore, visual psychophysical tests are a useful, simple and complementary tool to neuropsychological tests to facilitate diagnosis in the preclinical and early stages of AD.

S. Identification of Alzheimer's Disease by Imaging: A Comprehensive Review

In developing countries, there is more concern for Alzheimer's disease (AD) by public health professionals due to its catastrophic effects on the elderly. Early detection of this disease helps in starting the therapy soon and slows down the progression of the disease. Imaging techniques are considered to be the best solutions for its detection. Brain imaging was initially used to diagnose AD. Different techniques for identifying protein accumulation in the nervous system, a sign of Alzheimer's disease, are identified by MRI imaging. Although they were initially attributed to cortical dysfunction, visual system impairments in Alzheimer's patients were also found in the early 1970s. Several non-invasive approaches reported for screening, prevention, and therapy were unsuccessful. It is vitally necessary to develop new diagnostic methods in order to accurately identify patients who are in the early stages of this disease. It would be wonderful to have a quick, non-invasive, affordable, and easily scalable Alzheimer's disease screening. Researchers may be able to identify biomarkers for Alzheimer's disease and understand more about its aetiology with imaging and data processing. This study clarifies the need for medical image processing and analysis strategies which aid in the non-invasive diagnosis of AD.

Healthy aging impairs face discrimination ability

Face images enable individual identities to be discriminated from one another. We aimed to quantify age-related changes in different aspects of face identity discrimination. Face discrimination sensitivity was measured with a memory-free “odd-one-out” task. Five age groups (N = 15) of healthy adults with normal vision were tested: 20, 50-59, 60-69, 70-79, and 80-89. Sensitivity was measured for full-face images (all features visible), external features (head-shape, hairline), internal features (nose, mouth, eyes, and eyebrows) and closed-contour shapes (control object). Sensitivity to full-faces continuously declined by approximately 13% per decade, after 50 years of age. When age-related differences in visual acuity were controlled, the effect of age on face discrimination sensitivity remained. Sensitivity to face features also deteriorated with age. Although the effect for external features was similar to full-faces, the rate of decline was considerably steeper (approximately 3.7 times) for internal, relative to external, features. In contrast, there was no effect of age on sensitivity to shapes. All age groups demonstrated the same overall pattern of sensitivity to different types of face information. Healthy aging was associated with a continuous decline in sensitivity to both full-faces and face features, although encoding of internal features was disproportionately impaired. This age-related deficit was independent of differences in low-level vision. That sensitivity to shapes was unaffected by age suggests these results cannot be explained by general cognitive decline or lower-level visual deficits. Instead, healthy aging is associated with a specific decline in the mechanisms that underlie face discrimination.

Coarse-to-Fine(r) Automatic Familiar Face Recognition in the Human Brain

At what level of spatial resolution can the human brain recognize a familiar face in a crowd of strangers? Does it depend on whether one approaches or rather moves back from the crowd? To answer these questions, 16 observers viewed different unsegmented images of unfamiliar faces alternating at 6 Hz, with spatial frequency (SF) content progressively increasing (i.e., coarse-to-fine) or decreasing (fine-to-coarse) in different sequences. Variable natural images of celebrity faces every sixth stimulus generated an objective neural index of single-glanced automatic familiar face recognition (FFR) at 1 Hz in participants' electroencephalogram (EEG). For blurry images increasing in spatial resolution, the neural FFR response over occipitotemporal regions emerged abruptly with additional cues at about 6.3-8.7 cycles/head width, immediately reaching amplitude saturation. When the same images progressively decreased in resolution, the FFR response disappeared already below 12 cycles/head width, thus providing no support for a predictive coding hypothesis. Overall, these observations indicate that rapid automatic recognition of heterogenous natural views of familiar faces is achieved from coarser visual inputs than generally thought, and support a coarse-to-fine FFR dynamics in the human brain.

Measurement of individual differences in face-identity processing abilities in older adults

BACKGROUND

Face-identity processing declines with age. Few studies have examined whether face-identity processing abilities can be measured independently from general cognitive abilities in older adults (OA). This question has practical implications for the assessment of face-identity processing abilities in OA and theoretical implications for the notion of face processing as a specific ability. The present study examined the specificity of face memory and face matching abilities in OA aged 50 + .

METHODS

Performance of younger adults (YA) and OA was measured on face tasks: Cambridge Face Memory Task (CFMT), the Glasgow Face Matching Task (GFMT), holistic processing; and tasks of general cognition: fluid intelligence, selective attention, and mental rotation. Data were analyzed using multiple regression models encompassing (i) the CFMT/GFMT and measures of general cognition; and (ii) all face processing tasks.

RESULTS

Across the two age groups, models encompassing all face tasks were significant and accounted for more variance in the data than models encompassing the CFMT/GFMT and measures of general cognition. General cognitive abilities accounted for 17% of variance for the GFMT (p < 0.01) and 3% for the CFMT (p > 0.05).

DISCUSSION

Our results suggest that face memory can be measured independently from general cognition using the CFMT in OA. Implications for the notion of a general face processing factor across the adult lifespan are discussed.

Visual Search Efficiency in Mild Cognitive Impairment and Alzheimer's Disease: An Eye Movement Study

BACKGROUND

Visual search abilities are essential to everyday life activities and are known to be affected in Alzheimer's disease (AD). However, little is known about visual search efficiency in mild cognitive impairment (MCI), a transitive state between normal aging and dementia. Eye movement studies and machine learning methods have been recently used to detect oculomotor impairments in individuals with dementia.

OBJECTIVE

The aim of the present study is to investigate the association between eye movement metrics and visual search impairment in MCI and AD.

METHODS

127 participants were tested: 43 healthy controls, 51 with MCI, and 33 with AD. They completed an eyetracking visual search task where they had to find a previously seen target stimulus among distractors.

RESULTS

Both patient groups made more fixations on the screen when searching for a target, with longer duration than controls. MCI and AD fixated the distractors more often and for a longer period of time than the target. Healthy controls were quicker and made less fixations when scanning the stimuli for the first time. Machine-learning methods were able to distinguish between controls and AD subjects and to identify MCI subjects with a similar oculomotor profile to AD with a good accuracy.

CONCLUSION

Results showed that eye movement metrics are useful for identifying visual search impairments in MCI and AD, with possible implications in the early identification of individuals with high-risk of developing AD.

Systemic delivery of a specific antibody targeting the pathological N-terminal truncated tau peptide reduces retinal degeneration in a mouse model of Alzheimer's Disease

Retina and optic nerve are sites of extra-cerebral manifestations of Alzheimer's Disease (AD). Amyloid-β (Aβ) plaques and neurofibrillary tangles of hyperphosphorylated tau protein are detected in eyes from AD patients and transgenic animals in correlation with inflammation, reduction of synapses, visual deficits, loss of retinal cells and nerve fiber. However, neither the pathological relevance of other post-translational tau modifications-such as truncation with generation of toxic fragments-nor the potential neuroprotective action induced by their in vivo clearance have been investigated in the context of AD retinal degeneration. We have recently developed a monoclonal tau antibody (12A12mAb) which selectively targets the neurotoxic 20-22 kDa NH2-derived peptide generated from pathological truncation at the N-terminal domain of tau without cross-reacting with its full-length normal protein. Previous studies have shown that 12A12mAb, when intravenously (i.v.)-injected into 6-month-old Tg2576 animals, markedly improves their AD-like, behavioural and neuropathological syndrome. By taking advantage of this well-established tau-directed immunization regimen, we found that 12A12mAb administration also exerts a beneficial action on biochemical, morphological and metabolic parameters (i.e. APP/Aβ processing, tau hyperphosphorylation, neuroinflammation, synaptic proteins, microtubule stability, mitochondria-based energy production, neuronal death) associated with ocular injury in the AD phenotype. These findings prospect translational implications in the AD field by: (1) showing for the first time that cleavage of tau takes part in several pathological changes occurring in vivo in affected retinas and vitreous bodies and that its deleterious effects are successfully antagonized by administration of the specific 12A12mAb; (2) shedding further insights on the tight connections between neurosensory retina and brain, in particular following tau-based immunotherapy. In our view, the parallel response we detected in this preclinical animal model, both in the eye and in the hippocampus, following i.v. 12A12mAb injection opens novel diagnostic and therapeutic avenues for the clinical management of cerebral and extracerebral AD signs in human beings.

Stereoscopic Depth Perception and Visuospatial Dysfunction in Alzheimer's Disease

With visuospatial dysfunction emerging as a potential marker that can detect Alzheimer's disease (AD) even in its earliest stages and with disturbance in stereopsis suspected to be the prime contributor to visuospatial deficits in AD, we assessed stereoscopic abilities of patients with AD and mild cognitive impairment (MCI). Whereas previous research assessing patients' stereoacuity has yielded mixed results, we assessed patients' capacity to process coarse disparities that can convey adequate depth information about objects in the environment. We produced two virtual cubes at two different distances from the observer by manipulating disparity type (absolute vs. relative), disparity direction (crossed vs. uncrossed) and disparity magnitude, then had participants judge the object that appeared closer to them. Two patient groups performed as well as, or even better than elderly controls, suggesting that AD patients' coarse disparity processing capacity is capable of supporting common tasks involving reaching, grasping, driving, and navigation. Results may help researchers narrow down the exact cause(s) of visuospatial deficits in AD and develop and validate measures to assess visuospatial dysfunction in clinical trials and disease diagnosis.

Incident dementia and faster rates of cognitive decline are associated with worse multisensory function summary scores

INTRODUCTION

We created a summary score for multiple sensory (multisensory) impairment and evaluated its association with dementia.

METHODS

We studied 1794 adults aged 70 to 79 who were dementia-free at enrollment and followed for up to 10 years in the Health, Aging, and Body Composition Study. The multisensory function score (0 to 12 points) was based on sample quartiles of objectively measured vision, hearing, smell, and touch summed overall. Risk of incident dementia and cognitive decline (measured by two cognitive tests) associated with the score were assessed in regression models adjusting for demographics and health conditions.

RESULTS

Dementia risk was 2.05 times higher (95% confidence interval [CI] 1.50-2.81) comparing "poor" to "good" multisensory score tertiles and 1.45 times higher comparing the "middle" to "good" tertiles (95% CI 1.09-1.91). Each point worse in the multisensory function score was associated with faster rates of cognitive decline (P < .05).

CONCLUSIONS

Worsening multisensory function, even at mild levels, was associated with accelerated cognitive aging.

Elevation of pS262-Tau and Demethylated PP2A in Retina Occurs Earlier than in Hippocampus During Hyperhomocysteinemia

Hyperhomocysteinemia is an independent risk factor of Alzheimer's disease (AD), which is not diagnosed for many years before onset due to lack of peripherally detectable early biomarkers. Visual dysfunction is prevalent in AD patients and correlates with the severity of cognitive defects. Importantly, alterations in eyes can be non-invasively detected. To search for early biomarkers in eyes from high risk factors of AD, we injected homocysteine (Hcy) into the rats via vena caudalis for 3, 7, and 14 days, respectively, and characterized the chronological order of the AD-like pathologies appearing in retina and the hippocampus during the progression of hyperhomocysteinemia, and their correlations with cognitive impairment. We found that administration of Hcy for 14 days, but not 3 or 7 days, induced hyperhomocysteinemia, although a gradually increased blood Hcy level was detected. In retina and/or the hippocampus, significant loss of retinal ganglion cells and stenosis of retinal arteries with the AD-like tau and amyloid-β (Aβ) pathologies and memory deficit were shown only in the 14-day Hcy group. Interestingly, accumulation of Ser262 hyperphosphorylated tau (pS262-tau) but not Aβ with decreased methylation of protein phosphatase-2A catalytic subunit (M-PP2Ac) and increased de-methylated PP2Ac (DM-PP2Ac) was detected in retina of the 3-day Hcy group, in which the retinal pathologies were preceded by those of the hippocampus. These findings suggest that elevated pS262-tau and DM-PP2Ac and reduced M-PP2Ac in retina may serve as surveillance biomarkers for diagnosis of the hyperhomocysteinemia-induced AD in the early stage.

Age Differences in Face Processing: The Role of Perceptual Degradation and Holistic Processing

OBJECTIVES

We simultaneously investigated the role of three hypotheses regarding age-related differences in face processing: perceptual degradation, impaired holistic processing, and an interaction between the two.

METHODS

Young adults (YA) aged 20-33-year olds, middle-age adults (MA) aged 50-64-year olds, and older adults (OA) aged 65-82-year olds were tested on the context congruency paradigm, which allows measurement of face-specific holistic processing across the life span (Meinhardt-Injac, Persike & Meinhardt, 2014. Acta Psychologica, 151, 155-163). Perceptual degradation was examined by measuring performance with faces that were not filtered (FSF), with faces filtered to preserve low spatial frequencies (LSF), and with faces filtered to preserve high spatial frequencies (HSF).

RESULTS

We found that reducing perceptual signal strength had a greater impact on MA and OA for HSF faces, but not LSF faces. Context congruency effects were significant and of comparable magnitude across ages for FSF, LSF, and HSF faces. By using watches as control objects, we show that these holistic effects reflect face-specific mechanisms in all age groups.

DISCUSSION

Our results support the perceptual degradation hypothesis for faces containing only HSF and suggest that holistic processing is preserved in aging even under conditions of reduced signal strength.

Vegetable Freshness Perception in Dementia with Lewy Bodies and Alzheimer's Disease

Introduction

Although various visual function deficits have been reported in patients with Alzheimer's disease (AD) and dementia with Lewy bodies (DLB), vegetable freshness perception has not been thoroughly examined.

Objective

To investigate vegetable freshness perception in patients with AD and DLB and to clarify the relationship between vegetable freshness perception and various visuoperceptual functions.

Methods

We enrolled 37 patients with probable DLB, 58 patients with probable AD, and 32 age-matched healthy controls. We assessed vegetable freshness perception and visuoperceptual functions, including vegetable brightness perception, contrast sensitivity, color perception, and stereopsis. Patients with DLB showed disproportionate deficits in vegetable freshness perception and vegetable luminance perception compared to patients with AD and controls. Analyses of the groups with higher and lower vegetable freshness perceptions revealed significant differences in contrast sensitivity and visual texture recognition.

Results

In the vegetable freshness test, we found significant differences among the 3 groups (F = 30.029, p < 0.0001); the extent of impairment in patients with DLB was greater than that in patients with AD. In patients with DLB, the vegetable freshness judgments were significantly correlated with texture judgment scores and contrast sensitivity.

Conclusion

Our findings revealed significantly impaired vegetable freshness perception in patients with DLB. Vegetable freshness perception may be related to visual texture recognition in patients with DLB.

Age-related changes in amplitude, latency and specialization of ERP responses to faces and watches

Healthy aging is associated with impairments in face recognition. While earlier research suggests that these impairments arise during memory retrieval, more recent findings suggest that earlier mechanisms, at the perceptual stage, may also be at play. However, results are often inconsistent and very few studies have included a non-face control stimulus to facilitate interpretation of results with respect to the implication of specialized face mechanisms vs. general cognitive factors. To address these issues, P100, N170 and P200 event-related potentials (ERPs) were measured during processing of faces and watches. For faces, age-related differences were found for P100, N170 and P200 ERPs. For watches, age-related differences were found for N170 and P200 ERPs. Older adults showed less selective and less lateralized N170 responses to faces, suggesting that ERPs can detect age-related de-differentiation of specialized face networks. We conclude that age-related impairments in face recognition arise in part from difficulties in the earliest perceptual stages of visual information processing. A working model is presented based on coarse-to-fine analysis of visually similar exemplars.

Changes in visual function and retinal structure in the progression of Alzheimer's disease

BACKGROUND

Alzheimer's Disease (AD) can cause degeneration in the retina and optic nerve either directly, as a result of amyloid beta deposits, or secondarily, as a result of the degradation of the visual cortex. These effects raise the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. This study aimed to detect retinal changes and associated functional changes in three groups of patients consisting of AD patients with mild disease, AD patients with moderate disease and healthy controls by using non-invasive psychophysical ophthalmological tests and optical coherence tomography (OCT).

METHODS

We included 39 patients with mild AD, 21 patients with moderate AD and 40 age-matched healthy controls. Both patients and controls were ophthalmologically healthy. Visual acuity, contrast sensitivity, colour perception, visual integration, and choroidal thicknesses were measured. In addition, OCT and OCT angiography (OCTA) were applied.

FINDINGS

Visual acuity, contrast sensitivity, colour perception, and visual integration were significantly lower in AD patients than in healthy controls. Compared to healthy controls, macular thinning in the central region was significant in the mild AD patients, while macular thickening in the central region was found in the moderate AD group. The analysis of macular layers revealed significant thinning of the retinal nerve fibre layer, the ganglion cell layer and the outer plexiform layer in AD patients relative to controls. Conversely, significant thickening was observed in the outer nuclear layer of the patients. However, mild AD was associated with significant thinning of the subfovea and the nasal and inferior sectors of the choroid. Significant superonasal and inferotemporal peripapillary thinning was observed in patients with moderate disease.

CONCLUSIONS

The first changes in the mild AD patients appear in the psychophysical tests and in the central macula with a decrease in the central retinal thickness. When there was a disease progression to moderate AD, psychophysical tests remained stable with respect to the decrease in mild AD, but significant thinning in the peripapillary retina and thickening in the central retina appeared. The presence of AD is best indicated based on contrast sensitivity.

Perceptual Similarity Can Drive Age-Related Elevation of False Recognition

Older adults consistently show elevated rates of false recognition of new items that are related to studied items. This finding has been largely attributed to a greater tendency for older adults to rely on conceptual gist during memory recognition tasks. However, perceptual factors may also be implicated considering that related items are not only conceptually but also perceptually similar. While some findings do suggest that age-related increases in false recognitions can be driven by perceptual factors, little is known about the nature and circumstances under which these factors operate. To address this gap, we measured basic visual ability as well as false recognition for four different image categories (upright faces, inverted faces, chairs, houses) in younger (n = 34) and older (n = 34) adults. Each image category represented different levels of variability in perceptual similarity and pre-experimental exposure. Perceptual similarity was objectively defined on the basis of the low-level properties of the images. We found evidence that perceptual similarity can contribute to elevated rates of false recognition in older adults. Our results also suggest that declines in basic visual abilities influence elevated false recognition in older adults for perceptually similar but not perceptually dissimilar items. We conclude that both perceptual and conceptual similarity can drive age-related differences in false recognition.

Executive Functions in Alzheimer Disease: A Systematic Review

Alzheimer's disease is a severe irreversible syndrome, characterized by a slow and progressive cognitive decline that interferes with the standard instrumental and essential functions of daily life. Promptly identifying the impairment of particular cognitive functions could be a fundamental condition to limit, through preventive or therapeutic interventions, the functional damages found in this degenerative dementia. This study aims to analyse, through a systematic review of the studies, the sensitivity of four experimental paradigms (Wisconsin Card Sorting Test, Stroop Task, Go/No-Go Task, and Flanker Task) considered as golden standard instruments for executive functions assessment in elderly subjects affected by Alzheimer dementia. This review was carried out according to the PRISMA method. Forty-five studies comparing the executive performance of patients with Alzheimer's dementia (diagnosed according to different classification criteria for dementia) and healthy elderly patients both over the age of sixty, were selected. For the research, PubMed, PsycINFO, PsycArticles databases were used. The study highlighted the importance of using standard protocols to evaluate executive dysfunction in Alzheimer's disease. The Stroop task allows discriminating better between healthy and pathological aging.

Disappearance of Biased Visual Attention in Infants: Remediated Tonic Neck Reflex or Maturating Visual Asymmetry?

Typically, infants younger than four months fail to attend to the left side of their spatial field, most likely due to an innate asymmetrical tonic neck reflex (ATNR). In a critical transition, by four months of age, infants begin to reach and develop depth perception; and, by five months, they tend to monitor the entire spatial field. However, this developmental transition can be delayed. Moreover, there is always a residual right-sided spatial bias under cognitive load, a phenomenon that may also occur among adult stroke patients. While causative factors of biased visual attention in both infants and brain-injured adults may vary, mechanisms of remediation may be similar. This literature review addresses whether the infant's emergence of attention toward a full visual spatial field and the associated shift from monocular to binocular vision occurs because of (a) increased left side reaching, loosening the rarely mentioned high muscle tension ATNR or (b) maturational resolution of visual asymmetry in motion perception. More research is needed to investigate the origins of the infants' visual control system and factors involved in its development, especially because Alzheimer and dementia patients may also show primitive two-dimensional vision and deficits in perceiving objects-in-motion that seem to mirror infant visual perception.

Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review

BACKGROUND

Cognitive screening tests frequently rely on items being correctly heard or seen. We aimed to identify, describe, and evaluate the adaptation, validity, and availability of cognitive screening and assessment tools for dementia which have been developed or adapted for adults with acquired hearing and/or vision impairment.

METHOD

Electronic databases were searched using subject terms "hearing disorders" OR "vision disorders" AND "cognitive assessment," supplemented by exploring reference lists of included papers and via consultation with health professionals to identify additional literature.

RESULTS

1,551 papers were identified, of which 13 met inclusion criteria. Four papers related to tests adapted for hearing impairment; 11 papers related to tests adapted for vision impairment. Frequently adapted tests were the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MOCA). Adaptations for hearing impairment involved deleting or creating written versions for hearing-dependent items. Adaptations for vision impairment involved deleting vision-dependent items or spoken/tactile versions of visual tasks. No study reported validity of the test in relation to detection of dementia in people with hearing/vision impairment. Item deletion had a negative impact on the psychometric properties of the test.

CONCLUSIONS

While attempts have been made to adapt cognitive tests for people with acquired hearing and/or vision impairment, the primary limitation of these adaptations is that their validity in accurately detecting dementia among those with acquired hearing or vision impairment is yet to be established. It is likely that the sensitivity and specificity of the adapted versions are poorer than the original, especially if the adaptation involved item deletion. One solution would involve item substitution in an alternative sensory modality followed by re-validation of the adapted test.

Eyetracking Metrics in Young Onset Alzheimer's Disease: A Window into Cognitive Visual Functions

Young onset Alzheimer's disease (YOAD) is defined as symptom onset before the age of 65 years and is particularly associated with phenotypic heterogeneity. Atypical presentations, such as the clinic-radiological visual syndrome posterior cortical atrophy (PCA), often lead to delays in accurate diagnosis. Eyetracking has been used to demonstrate basic oculomotor impairments in individuals with dementia. In the present study, we aim to explore the relationship between eyetracking metrics and standard tests of visual cognition in individuals with YOAD. Fifty-seven participants were included: 36 individuals with YOAD (n = 26 typical AD; n = 10 PCA) and 21 age-matched healthy controls. Participants completed three eyetracking experiments: fixation, pro-saccade, and smooth pursuit tasks. Summary metrics were used as outcome measures and their predictive value explored looking at correlations with visuoperceptual and visuospatial metrics. Significant correlations between eyetracking metrics and standard visual cognitive estimates are reported. A machine-learning approach using a classification method based on the smooth pursuit raw eyetracking data discriminates with approximately 95% accuracy patients and controls in cross-validation tests. Results suggest that the eyetracking paradigms of a relatively simple and specific nature provide measures not only reflecting basic oculomotor characteristics but also predicting higher order visuospatial and visuoperceptual impairments. Eyetracking measures can represent extremely useful markers during the diagnostic phase and may be exploited as potential outcome measures for clinical trials.

Tau accumulation in the retina promotes early neuronal dysfunction and precedes brain pathology in a mouse model of Alzheimer's disease

Background

Tau is an axon-enriched protein that binds to and stabilizes microtubules, and hence plays a crucial role in neuronal function. In Alzheimer’s disease (AD), pathological tau accumulation correlates with cognitive decline. Substantial visual deficits are found in individuals affected by AD including a preferential loss of retinal ganglion cells (RGCs), the neurons that convey visual information from the retina to the brain. At present, however, the mechanisms that underlie vision changes in these patients are poorly understood. Here, we asked whether tau plays a role in early retinal pathology and neuronal dysfunction in AD.

Methods

Alterations in tau protein and gene expression, phosphorylation, and localization were investigated by western blots, qPCR, and immunohistochemistry in the retina and visual pathways of triple transgenic mice (3xTg) harboring mutations in the genes encoding presenilin 1 (PS1M146 V), amyloid precursor protein (APPSwe), and tau (MAPTP301L). Anterograde axonal transport was assessed by intraocular injection of the cholera toxin beta subunit followed by quantification of tracer accumulation in the contralateral superior colliculus. RGC survival was analyzed on whole-mounted retinas using cell-specific markers. Reduction of tau expression was achieved following intravitreal injection of targeted siRNA.

Results

Our data demonstrate an age-related increase in endogenous retinal tau characterized by epitope-specific hypo- and hyper-phosphorylation in 3xTg mice. Retinal tau accumulation was observed as early as three months of age, prior to the reported onset of behavioral deficits, and preceded tau aggregation in the brain. Intriguingly, tau build up occurred in RGC soma and dendrites, while tau in RGC axons in the optic nerve was depleted. Tau phosphorylation changes and missorting correlated with substantial defects in anterograde axonal transport that preceded RGC death. Importantly, targeted siRNA-mediated knockdown of endogenous tau improved anterograde transport along RGC axons.

Conclusions

Our study reveals profound tau pathology in the visual system leading to early retinal neuron damage in a mouse model of AD. Importantly, we show that tau accumulation promotes anterograde axonal transport impairment in vivo, and identify this response as an early feature of neuronal dysfunction that precedes cell death in the AD retina. These findings provide the first proof-of-concept that a global strategy to reduce tau accumulation is beneficial to improve axonal transport and mitigate functional deficits in AD and tauopathies.

Visual word recognition across the adult lifespan

The current study examines visual word recognition in a large sample (N = 148) across the adult life span and across a large set of stimuli (N = 1,187) in three different lexical processing tasks (pronunciation, lexical decision, and animacy judgment). Although the focus of the present study is on the influence of word frequency, a diverse set of other variables are examined as the word recognition system ages and acquires more experience with language. Computational models and conceptual theories of visual word recognition and aging make differing predictions for age-related changes in the system. However, these have been difficult to assess because prior studies have produced inconsistent results, possibly because of sample differences, analytic procedures, and/or task-specific processes. The current study confronts these potential differences by using 3 different tasks, treating age and word variables as continuous, and exploring the influence of individual differences such as vocabulary, vision, and working memory. The primary finding is remarkable stability in the influence of a diverse set of variables on visual word recognition across the adult age spectrum. This pattern is discussed in reference to previous inconsistent findings in the literature and implications for current models of visual word recognition. (PsycINFO Database Record

Linking cognitive and visual perceptual decline in healthy aging: The information degradation hypothesis

Several hypotheses attempt to explain the relation between cognitive and perceptual decline in aging (e.g., common-cause, sensory deprivation, cognitive load on perception, information degradation). Unfortunately, the majority of past studies examining this association have used correlational analyses, not allowing for these hypotheses to be tested sufficiently. This correlational issue is especially relevant for the information degradation hypothesis, which states that degraded perceptual signal inputs, resulting from either age-related neurobiological processes (e.g., retinal degeneration) or experimental manipulations (e.g., reduced visual contrast), lead to errors in perceptual processing, which in turn may affect non-perceptual, higher-order cognitive processes. Even though the majority of studies examining the relation between age-related cognitive and perceptual decline have been correlational, we reviewed several studies demonstrating that visual manipulations affect both younger and older adults' cognitive performance, supporting the information degradation hypothesis and contradicting implications of other hypotheses (e.g., common-cause, sensory deprivation, cognitive load on perception). The reviewed evidence indicates the necessity to further examine the information degradation hypothesis in order to identify mechanisms underlying age-related cognitive decline.

One of the most well-established age-related changes in neural activity disappears after controlling for visual acuity

Numerous studies using a variety of imaging techniques have reported age-related differences in neural activity while subjects carry out cognitive tasks. Surprisingly little attention has been paid to the potential impact of age-associated changes in sensory acuity on these findings. Studies in the visual modality frequently report that their subjects had "normal or corrected- to-normal vision." However, in most cases, there is no indication that visual acuity was actually measured, and it is likely that the investigators relied largely on self-reported visual status of subjects, which is often inaccurate. We investigated whether differences in visual acuity influence one of the most commonly observed findings in the event-related potentials literature on cognitive aging, a reduction in posterior P3b amplitude, which is an index of cognitive decision-making/updating. Well-matched young (n=26) and old adults (n=29) participated in a visual oddball task. Measured visual acuity with corrective lenses was worse in old than young adults. Results demonstrated that the robust age-related decline in P3b amplitude to visual targets disappeared after controlling for visual acuity, but was unaffected by accounting for auditory acuity. Path analysis confirmed that the relationship between age and diminished P3b to visual targets was mediated by visual acuity, suggesting that conveyance of suboptimal sensory data due to peripheral, rather than central, deficits may undermine subsequent neural processing. We conclude that until the relationship between age-associated differences in visual acuity and neural activity during experimental tasks is clearly established, investigators should exercise caution attributing results to differences in cognitive processing.

Psychological Aspects of Glaucoma

Glaucoma is a group of optic neuropathies that is more prevalent among the elderly population and commonly associates with comorbidities, including mental disorders in that population. This article reviews the relationship between glaucoma and mental disorders. In it, we discuss the coexistence of glaucoma and mental illnesses, including Alzheimer's disease, depression, and personality disorder. We also focus on the proper treatment approaches for glaucoma patients with mental comorbidity and poor treatment adherence. We summarize some cautiously recommended psychotherapeutic medications, while also discussing the psychologically adverse effects of antiglaucoma medications.

Trail Making Test performance contributes to subjective judgment of visual efficiency in older adults

Introduction. The determinant factors that influence self-reported quality of vision have yet to be fully elucidated. This study evaluated a range of contextual information, established psychophysical tests, and in particular, a series of cognitive tests as potentially novel determinant factors.

Materials & Methods. Community dwelling adults (aged 50+) recruited to Wave 1 of The Irish Longitudinal Study on Ageing, excluding those registered blind, participated in this study (N = 5,021). Self-reports of vision were analysed in relation to visual acuity and contrast sensitivity, ocular pathology, visual (Choice Response Time task; Trail Making Test) and global cognition. Contextual factors such as having visited an optometrist and wearing glasses were also considered. Ordinal logistic regression was used to determine univariate and multivariate associations.

Results and Discussion. Poor Trail Making Test performance (Odds ratio, OR = 1.36), visual acuity (OR = 1.72) and ocular pathology (OR = 2.25) were determinant factors for poor versus excellent vision in self-reports. Education, wealth, age, depressive symptoms and general cognitive fitness also contributed to determining self-reported vision.

Conclusions. Trail Making Test contribution to self-reports may capture higher level visual processing and should be considered when using self-reports to assess vision and its role in cognitive and functional health.

Recognition of faces and names: multimodal physiological correlates of memory and executive function

We sought to characterize electrophysiological, eye-tracking and behavioral correlates of face-name recognition memory in healthy younger adults using high-density electroencephalography (EEG), infrared eye-tracking (ET), and neuropsychological measures. Twenty-one participants first studied 40 face-name (FN) pairs; 20 were presented four times (4R) and 20 were shown once (1R). Recognition memory was assessed by asking participants to make old/new judgments for 80 FN pairs, of which half were previously studied items and half were novel FN pairs (N). Simultaneous EEG and ET recording were collected during recognition trials. Comparisons of event-related potentials (ERPs) for correctly identified FN pairs were compared across the three item types revealing classic ERP old/new effects including 1) relative positivity (1R > N) bi-frontally from 300 to 500 ms, reflecting enhanced familiarity, 2) relative positivity (4R > 1R and 4R > N) in parietal areas from 500 to 800 ms, reflecting enhanced recollection, and 3) late frontal effects (1R > N) from 1000 to 1800 ms in right frontal areas, reflecting post-retrieval monitoring. ET analysis also revealed significant differences in eye movements across conditions. Exploration of cross-modality relationships suggested associations between memory and executive function measures and the three ERP effects. Executive function measures were associated with several indicators of saccadic eye movements and fixations, which were also associated with all three ERP effects. This novel characterization of face-name recognition memory performance using simultaneous EEG and ET reproduced classic ERP and ET effects, supports the construct validity of the multimodal FN paradigm, and holds promise as an integrative tool to probe brain networks supporting memory and executive functioning.

Ophthalmologic Psychophysical Tests Support OCT Findings in Mild Alzheimer's Disease

Purpose. To analyze in mild Alzheimer's disease (MAD) patients, GDS-4 (Reisberg Scale), whether or not some psychophysical tests (PTs) support OCT macular findings in the same group of MAD patients reported previously. Methods. Twenty-three MAD patients and 28 age-matched control subjects with mean Mini Mental State Examination of 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision were included. Best-corrected visual acuity (VA), contrast sensitivity (CS) (3, 6, 12, and 18 cpds), color perception (CP), and perception digital test (PDT) were tested in one eye of each patient. Results. In comparison with the controls, MAD patients presented (i) a significant decrease in VA, PDT, and CS for all spatial frequencies analyzed, especially the higher ones, and (ii) a significant increase in unspecific errors on the blue axis (P < 0.05 in all instances). In MAD patients, a wide aROC curve was plotted in all PTs. Conclusions. In MAD, CS, VA, and the tritan axis in CP were impaired. The PTs with the greatest predictive value are the higher spatial frequencies in CS and tritan unspecific errors in CP. PT abnormalities are consistent with the structural findings reported in the same MAD patients using OCT.

Effect of visual cues on the resolution of perceptual ambiguity in Parkinson's disease and normal aging

Parkinson's disease (PD) and normal aging have been associated with changes in visual perception, including reliance on external cues to guide behavior. This raises the question of the extent to which these groups use visual cues when disambiguating information. Twenty-seven individuals with PD, 23 normal control adults (NC), and 20 younger adults (YA) were presented a Necker cube in which one face was highlighted by thickening the lines defining the face. The hypothesis was that the visual cues would help PD and NC to exert better control over bistable perception. There were three conditions, including passive viewing and two volitional-control conditions (hold one percept in front; and switch: speed up the alternation between the two). In the Hold condition, the cue was either consistent or inconsistent with task instructions. Mean dominance durations (time spent on each percept) under passive viewing were comparable in PD and NC, and shorter in YA. PD and YA increased dominance durations in the Hold cue-consistent condition relative to NC, meaning that appropriate cues helped PD but not NC hold one perceptual interpretation. By contrast, in the Switch condition, NC and YA decreased dominance durations relative to PD, meaning that the use of cues helped NC but not PD in expediting the switch between percepts. Provision of low-level cues has effects on volitional control in PD that are different from in normal aging, and only under task-specific conditions does the use of such cues facilitate the resolution of perceptual ambiguity.

At the interface of sensory and motor dysfunctions and Alzheimer's disease

Recent evidence indicates that sensory and motor changes may precede the cognitive symptoms of Alzheimer's disease (AD) by several years and may signify increased risk of developing AD. Traditionally, sensory and motor dysfunctions in aging and AD have been studied separately. To ascertain the evidence supporting the relationship between age-related changes in sensory and motor systems and the development of AD and to facilitate communication between several disciplines, the National Institute on Aging held an exploratory workshop titled "Sensory and Motor Dysfunctions in Aging and AD." The scientific sessions of the workshop focused on age-related and neuropathologic changes in the olfactory, visual, auditory, and motor systems, followed by extensive discussion and hypothesis generation related to the possible links among sensory, cognitive, and motor domains in aging and AD. Based on the data presented and discussed at this workshop, it is clear that sensory and motor regions of the central nervous system are affected by AD pathology and that interventions targeting amelioration of sensory-motor deficits in AD may enhance patient function as AD progresses.

Visuo-cognitive skill deficits in Alzheimer's disease and Lewy body disease: A comparative analysis

Dementia is a chronic neurodegenerative disorder characterized by progressive cognitive loss. Alzheimer's disease (AD) and the Lewy body disease are the two most common causes of age-related degenerative dementia. Visuo-cognitive skills are a combination of very different cognitive functions being performed by the visual system. These skills are impaired in both AD and dementia with Lewy bodies (DLB). The aim of this review is to evaluate various studies for these visuo-cognitive skills. An exhaustive internet search of all relevant medical databases was carried out using a series of key-word applications, including The Cochrane Library, MEDLINE, PSYCHINFO, EMBASE, CINAHL, AMED, SportDiscus, Science Citation Index, Index to Theses, ZETOC, PEDro and occupational therapy (OT) seeker and OT search. We reviewed all the articles until March 2013 with key words of: Visual skills visual cognition dementia AD, but the direct neurobiological etiology is difficult to establish., Dementia of Lewy body disease. Although most studies have used different tests for studying these abilities, in general, these tests evaluated the individual's ability of (1) visual recognition, (2) visual discrimination, (3) visual attention and (4) visuo-perceptive integration. Performance on various tests has been evaluated for assessing these skills. Most studies assessing such skills show that these skills are impaired in DLB as compared with AD. Visuo-cognitive skills are impaired more in DLB as compared with AD. These impairments have evident neuropathological correlations, but the direct neurobiological etiology is difficult to establish.

Monitoring the capacity of working memory: executive control and effects of listening effort

In two experiments, we used an interruption-and-recall (IAR) task to explore listeners' ability to monitor the capacity of working memory as new information arrived in real time. In this task, listeners heard recorded word lists with instructions to interrupt the input at the maximum point that would still allow for perfect recall. Experiment 1 demonstrated that the most commonly selected segment size closely matched participants' memory span, as measured in a baseline span test. Experiment 2 showed that reducing the sound level of presented word lists to a suprathreshold but effortful listening level disrupted the accuracy of matching selected segment sizes with participants' memory spans. The results are discussed in terms of whether online capacity monitoring may be subsumed under other, already enumerated working memory executive functions (inhibition, set shifting, and memory updating).

Eye movement analysis and cognitive processing: detecting indicators of conversion to Alzheimer's disease

A great amount of research has been developed around the early cognitive impairments that best predict the onset of Alzheimer's disease (AD). Given that mild cognitive impairment (MCI) is no longer considered to be an intermediate state between normal aging and AD, new paths have been traced to acquire further knowledge about this condition and its subtypes, and to determine which of them have a higher risk of conversion to AD. It is now known that other deficits besides episodic and semantic memory impairments may be present in the early stages of AD, such as visuospatial and executive function deficits. Furthermore, recent investigations have proven that the hippocampus and the medial temporal lobe structures are not only involved in memory functioning, but also in visual processes. These early changes in memory, visual, and executive processes may also be detected with the study of eye movement patterns in pathological conditions like MCI and AD. In the present review, we attempt to explore the existing literature concerning these patterns of oculomotor changes and how these changes are related to the early signs of AD. In particular, we argue that deficits in visual short-term memory, specifically in iconic memory, attention processes, and inhibitory control, may be found through the analysis of eye movement patterns, and we discuss how they might help to predict the progression from MCI to AD. We add that the study of eye movement patterns in these conditions, in combination with neuroimaging techniques and appropriate neuropsychological tasks based on rigorous concepts derived from cognitive psychology, may highlight the early presence of cognitive impairments in the course of the disease.

Slowing of information processing in Alzheimer disease: motor as well as cognitive factors

OBJECTIVE

To use Sternberg's Additive Factor Method to determine whether patients with mild Alzheimer disease (AD) are slow in information processing and/or response execution.

METHODS

We gave an odd-even categorization task to 16 patients with probable mild AD and 17 age-matched healthy controls. We recorded reaction and movement times to stimuli varying for noise, target set size, stimulus-response compatibility, and fore-period interval, to probe the cognitive and motor stages of information processing.

RESULTS

Both groups performed the task accurately, indicating good preservation of odd-even categorization in mild AD. The AD group's reaction times were similar to the controls' across conditions, and not selectively affected in any of the cognitive stages of the Additive Factor Method. However, the AD group's movement times were slower than the controls' across conditions.

CONCLUSIONS

AD patients' performance on a task requiring categorization ability was slowed more by motor than cognitive components of information processing. When evaluating the performance of patients with AD in reaction-time paradigms, we should not attribute group differences solely to differences in cognitive processing. Execution components should also be considered.

Vision-fair neuropsychological assessment in normal aging, Parkinson's disease and Alzheimer's disease

We examined performance of healthy older and younger adults and individuals with Alzheimer's disease (AD) and Parkinson's disease (PD) on digit cancellation, a task putatively sensitive to cognitive impairment, but possibly affected by visual impairment, particularly in contrast sensitivity. Critical contrast thresholds were established to create custom stimulus arrays that were proximally matched across individuals. Age- and PD-related differences in search were fully accounted for by the sensory deficit. Increased contrast benefited AD patients, but could not override cognitive impairment. We conclude that visually fair neuropsychological testing can effectively compensate for normal age- and PD-related visual changes that affect cognitive performance.

The hidden effect of hearing acuity on speech recall, and compensatory effects of self-paced listening

OBJECTIVE

The purpose of this research was to determine whether negative effects of hearing loss on recall accuracy for spoken narratives can be mitigated by allowing listeners to control the rate of speech input.

DESIGN

Paragraph-length narratives were presented for recall under two listening conditions in a within-participants design: presentation without interruption (continuous) at an average speech-rate of 150 words per minute; and presentation interrupted at periodic intervals at which participants were allowed to pause before initiating the next segment (self-paced).

STUDY SAMPLE

Participants were 24 adults ranging from 21 to 33 years of age. Half had age-normal hearing acuity and half had mild- to-moderate hearing loss. The two groups were comparable for age, years of formal education, and vocabulary.

RESULTS

When narrative passages were presented continuously, without interruption, participants with hearing loss recalled significantly fewer story elements, both main ideas and narrative details, than those with age-normal hearing. The recall difference was eliminated when the two groups were allowed to self-pace the speech input.

CONCLUSION

Results support the hypothesis that the listening effort associated with reduced hearing acuity can slow processing operations and increase demands on working memory, with consequent negative effects on accuracy of narrative recall.

Luminance affects age-related deficits in object detection: implications for computerized psychological assessments

As psychological instruments are converted for administration on computers, differences in luminance and contrast of these displays may affect performance. Specifically, high-luminance assessments may mask age-group differences that are apparent under lower luminance conditions. We examined the effects of luminance and contrast on object detection using computerized and naturalistic assessments. Younger and older adults displayed more differences in performance across differing contrast levels in conditions that were matched for luminance, despite the conditions appearing perceptually different. These findings indicate that computerized assessments should be created with luminance levels that are similar to those of the tasks they purport to simulate in order to enhance their validity.

The effect of stimulus intensity on response time and accuracy in dynamic, temporally constrained environments

The ability to make accurate judgments and execute effective skilled movements under severe temporal constraints are fundamental to elite performance in a number of domains including sport, military combat, law enforcement, and medicine. In two experiments, we examine the effect of stimulus strength on response time and accuracy in a temporally constrained, real-world, decision-making task. Specifically, we examine the effect of low stimulus intensity (black) and high stimulus intensity (sequin) uniform designs, worn by teammates, to determine the effect of stimulus strength on the ability of soccer players to make rapid and accurate responses. In both field- and laboratory-based scenarios, professional soccer players viewed developing patterns of play and were required to make a penetrative pass to an attacking player. Significant differences in response accuracy between uniform designs were reported in laboratory- and field-based experiments. Response accuracy was significantly higher in the sequin compared with the black uniform condition. Response times only differed between uniform designs in the laboratory-based experiment. These findings extend the literature into a real-world environment and have significant implications for the design of clothing wear in a number of domains.

Bingo! Externally supported performance intervention for deficient visual search in normal aging, Parkinson's disease, and Alzheimer's disease

External support may improve task performance regardless of an individual's ability to compensate for cognitive deficits through internally generated mechanisms. We investigated if performance of a complex, familiar visual search task (the game of bingo) could be enhanced in groups with suboptimal vision by providing external support through manipulation of task stimuli. Participants were 19 younger adults, 14 individuals with probable Alzheimer's disease (AD), 13 AD-matched healthy adults, 17 non-demented individuals with Parkinson's disease (PD), and 20 PD-matched healthy adults. We varied stimulus contrast, size, and visual complexity during game play. The externally supported performance interventions of increased stimulus size and decreased complexity resulted in improvements in performance by all groups. AD also obtained benefit from increasing contrast, presumably by compensating for their contrast sensitivity deficit. The general finding of improved performance across healthy and afflicted groups suggests the value of visual support as an easy-to-apply intervention to enhance cognitive performance.

Relation of Parkinson's disease subtypes to visual activities of daily living

Visual perceptual problems are common in Parkinson's disease (PD) and often affect activities of daily living (ADLs). PD patients with non-tremor symptoms at disease onset (i.e., rigidity, bradykinesia, gait disturbance or postural instability) have more diffuse neurobiological abnormalities and report worse non-motor symptoms and functional changes than patients whose initial symptom is tremor, but the relation of motor symptom subtype to perceptual deficits remains unstudied. We assessed visual ADLs with the Visual Activities Questionnaire in 25 non-demented patients with PD, 13 with tremor as the initial symptom and 12 with an initial symptom other than tremor, as well as in 23 healthy control participants (NC). As expected, the non-tremor patients, but not the tremor patients, reported more impairment in visual ADLs than the NC group, including in light/dark adaptation, acuity/spatial vision, depth perception, peripheral vision and visual processing speed. Non-tremor patients were significantly worse than tremor patients overall and on light/dark adaptation and depth perception. Environmental enhancements especially targeted to patients with the non-tremor PD subtype may help to ameliorate their functional disability.

Event-related potential markers of brain changes in preclinical familial Alzheimer disease

OBJECTIVES

Event-related potentials (ERPs) can reflect differences in brain electrophysiology underlying cognitive functions in brain disorders such as dementia and mild cognitive impairment. To identify individuals at risk for Alzheimer disease (AD) we used high-density ERPs to examine brain physiology in young presymptomatic individuals (average age 34.2 years) who carry the E280A mutation in the presenilin-1 (PSEN1) gene and will go on to develop AD around the age of 45.

METHODS

Twenty-one subjects from a Colombian population with familial AD participated: 10 presymptomatic subjects positive for the PSEN1 mutation (carriers) and 11 siblings without the mutation (controls). Subjects performed a visual recognition memory test while 128-channel ERPs were recorded.

RESULTS

Despite identical behavioral performance, PSEN1 mutation carriers showed less positivity in frontal regions and more positivity in occipital regions, compared to controls. These differences were more pronounced during the 200-300 msec period. Discriminant analysis at this time interval showed promising sensitivity (72.7%) and specificity (81.8%) of the ERP measures to predict the presence of AD pathology.

CONCLUSIONS

Presymptomatic PSEN1 mutation carriers show changes in brain physiology that can be detected by high-density ERPs. The relative differences observed showing greater frontal positivity in controls and greater occipital positivity in carriers indicates that control subjects may use frontally mediated processes to distinguish between studied and unstudied visual items, whereas carriers appear to rely more upon perceptual details of the items to distinguish between them. These findings also demonstrate the potential usefulness of ERP brain correlates as preclinical markers of AD.

Visual spatial cognition in neurodegenerative disease

Visual spatial impairment is often an early symptom of neurodegenerative disease; however, this multi-faceted domain of cognition is not well-assessed by most typical dementia evaluations. Neurodegenerative diseases cause circumscribed atrophy in distinct neural networks, and accordingly, they impact visual spatial cognition in different and characteristic ways. Anatomically-focused visual spatial assessment can assist the clinician in making an early and accurate diagnosis. This article will review the literature on visual spatial cognition in neurodegenerative disease clinical syndromes, and where research is available, by neuropathologic diagnoses. Visual spatial cognition will be organized primarily according to the following schemes: bottom-up/top-down processing, dorsal/ventral stream processing, and egocentric/allocentric frames of reference.