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Stelzer J, Lacosse E, Bause J, Scheffler K, Lohmann G. Brainglance: Visualizing Group Level MRI Data at One Glance. Front Neurosci 2019; 13:972. [PMID: 31680793 PMCID: PMC6797611 DOI: 10.3389/fnins.2019.00972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/29/2019] [Indexed: 12/02/2022] Open
Abstract
The vast majority of studies using functional magnetic resonance imaging (fMRI) are analyzed on the group level. Standard group-level analyses, however, come with severe drawbacks: First, they assume functional homogeneity within the group, building on the idea that we use our brains in similar ways. Second, group-level analyses require spatial warping and substantial smoothing to accommodate for anatomical variability across subjects. Such procedures massively distort the underlying fMRI data, which hampers the spatial specificity. Taken together, group statistics capture the effective overlap, rendering the modeling of individual deviations impossible – a major source of false positivity and negativity. The alternative analysis approach is to leave the data in the native subject space, but this makes comparison across individuals difficult. Here, we propose a new framework for visualizing group-level information, better preserving the information of individual subjects. Our proposal is to limit the use of invasive data procedures such as spatial smoothing and warping and rather extract regional information from the individuals. This information is then visualized for all subjects and brain areas at one glance – hence we term the method brainglance. Additionally, our method incorporates a means for clustering individuals to further identify common traits. We showcase our method on two publicly available data sets and discuss our findings.
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Affiliation(s)
- Johannes Stelzer
- Tübingen University Hospital, Tübingen, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Eric Lacosse
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Jonas Bause
- Tübingen University Hospital, Tübingen, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Klaus Scheffler
- Tübingen University Hospital, Tübingen, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Gabriele Lohmann
- Tübingen University Hospital, Tübingen, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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2
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Power and temporal dynamics of alpha oscillations at rest differentiate cognitive performance involving sustained and phasic cognitive control. Neuroimage 2019; 188:135-144. [DOI: 10.1016/j.neuroimage.2018.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/09/2018] [Accepted: 12/01/2018] [Indexed: 11/18/2022] Open
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Seghier ML, Price CJ. Interpreting and Utilising Intersubject Variability in Brain Function. Trends Cogn Sci 2018; 22:517-530. [PMID: 29609894 PMCID: PMC5962820 DOI: 10.1016/j.tics.2018.03.003] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/30/2018] [Accepted: 03/07/2018] [Indexed: 11/30/2022]
Abstract
We consider between-subject variance in brain function as data rather than noise. We describe variability as a natural output of a noisy plastic system (the brain) where each subject embodies a particular parameterisation of that system. In this context, variability becomes an opportunity to: (i) better characterise typical versus atypical brain functions; (ii) reveal the different cognitive strategies and processing networks that can sustain similar tasks; and (iii) predict recovery capacity after brain damage by taking into account both damaged and spared processing pathways. This has many ramifications for understanding individual learning preferences and explaining the wide differences in human abilities and disabilities. Understanding variability boosts the translational potential of neuroimaging findings, in particular in clinical and educational neuroscience.
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Affiliation(s)
- Mohamed L Seghier
- Cognitive Neuroimaging Unit, Emirates College for Advanced Education, PO Box 126662, Abu Dhabi, United Arab Emirates.
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, University College London, Institute of Neurology, WC1N 3BG, London, UK.
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4
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Visualising inter-subject variability in fMRI using threshold-weighted overlap maps. Sci Rep 2016; 6:20170. [PMID: 26846561 PMCID: PMC4742862 DOI: 10.1038/srep20170] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 12/23/2015] [Indexed: 12/04/2022] Open
Abstract
Functional neuroimaging studies are revealing the neural systems sustaining many sensory, motor and cognitive abilities. A proper understanding of these systems requires an appreciation of the degree to which they vary across subjects. Some sources of inter-subject variability might be easy to measure (demographics, behavioural scores, or experimental factors), while others are more difficult (cognitive strategies, learning effects, and other hidden sources). Here, we introduce a simple way of visualising whole-brain consistency and variability in brain responses across subjects using threshold-weighted voxel-based overlap maps. The output quantifies the proportion of subjects activating a particular voxel or region over a wide range of statistical thresholds. The sensitivity of our approach was assessed in 30 healthy adults performing a matching task with their dominant hand. We show how overlap maps revealed many effects that were only present in a subsample of our group; we discuss how overlap maps can provide information that may be missed or misrepresented by standard group analysis, and how this information can help users to understand their data. In particular, we emphasize that functional overlap maps can be particularly useful when it comes to explaining typical (or atypical) compensatory mechanisms used by patients following brain damage.
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5
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Schoeni A, Roser K, Röösli M. Memory performance, wireless communication and exposure to radiofrequency electromagnetic fields: A prospective cohort study in adolescents. ENVIRONMENT INTERNATIONAL 2015; 85:343-51. [PMID: 26474271 DOI: 10.1016/j.envint.2015.09.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND The aim of this study is to investigate whether memory performance in adolescents is affected by radiofrequency electromagnetic fields (RF-EMF) from wireless device use or by the wireless device use itself due to non-radiation related factors in that context. METHODS We conducted a prospective cohort study with 439 adolescents. Verbal and figural memory tasks at baseline and after one year were completed using a standardized, computerized cognitive test battery. Use of wireless devices was inquired by questionnaire and operator recorded mobile phone use data was obtained for a subgroup of 234 adolescents. RF-EMF dose measures considering various factors affecting RF-EMF exposure were computed for the brain and the whole body. Data were analysed using a longitudinal approach, to investigate whether cumulative exposure over one year was related to changes in memory performance. All analyses were adjusted for relevant confounders. RESULTS The kappa coefficients between cumulative mobile phone call duration and RF-EMF brain and whole body dose were 0.62 and 0.67, respectively for the whole sample and 0.48 and 0.28, respectively for the sample with operator data. In linear exposure-response models an interquartile increase in cumulative operator recorded mobile phone call duration was associated with a decrease in figural memory performance score by -0.15 (95% CI: -0.33, 0.03) units. For cumulative RF-EMF brain and whole body dose corresponding decreases in figural memory scores were -0.26 (95% CI: -0.42, -0.10) and -0.40 (95% CI: -0.79, -0.01), respectively. No exposure-response associations were observed for sending text messages and duration of gaming, which produces tiny RF-EMF emissions. CONCLUSIONS A change in memory performance over one year was negatively associated with cumulative duration of wireless phone use and more strongly with RF-EMF dose. This may indicate that RF-EMF exposure affects memory performance.
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Affiliation(s)
- Anna Schoeni
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Katharina Roser
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Department of Epidemiology and Public Health, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Basel, Switzerland.
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6
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Sanfratello L, Caprihan A, Stephen JM, Knoefel JE, Adair JC, Qualls C, Lundy SL, Aine CJ. Same task, different strategies: how brain networks can be influenced by memory strategy. Hum Brain Mapp 2014; 35:5127-40. [PMID: 24931401 DOI: 10.1002/hbm.22538] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/04/2014] [Accepted: 04/15/2014] [Indexed: 11/07/2022] Open
Abstract
Previous functional neuroimaging studies demonstrated that different neural networks underlie different types of cognitive processing by engaging participants in particular tasks, such as verbal or spatial working memory (WM) tasks. However, we report here that even when a WM task is defined as verbal or spatial, different types of memory strategies may be used to complete it, with concomitant variations in brain activity. We developed a questionnaire to characterize the type of strategy used by individual members in a group of 28 young healthy participants (18-25 years) during a spatial WM task. A cluster analysis was performed to differentiate groups. We acquired functional magnetoencephalography and structural diffusion tensor imaging measures to characterize the brain networks associated with the use of different strategies. We found two types of strategies were used during the spatial WM task, a visuospatial and a verbal strategy, and brain regions and time courses of activation differed between participants who used each. Task performance also varied by type of strategy used with verbal strategies showing an advantage. In addition, performance on neuropsychological tests (indices from Wechsler Adult Intelligence Scale-IV, Rey Complex Figure Test) correlated significantly with fractional anisotropy measures for the visuospatial strategy group in white matter tracts implicated in other WM and attention studies. We conclude that differences in memory strategy can have a pronounced effect on the locations and timing of brain activation and that these differences need further investigation as a possible confounding factor for studies using group averaging as a means for summarizing results.
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Affiliation(s)
- Lori Sanfratello
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Miller MB, Donovan CL, Bennett CM, Aminoff EM, Mayer RE. Individual differences in cognitive style and strategy predict similarities in the patterns of brain activity between individuals. Neuroimage 2011; 59:83-93. [PMID: 21651986 DOI: 10.1016/j.neuroimage.2011.05.060] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 11/26/2022] Open
Abstract
Neuroimaging is being used increasingly to make inferences about an individual. Yet, those inferences are often confounded by the fact that topographical patterns of task-related brain activity can vary greatly from person to person. This study examined two factors that may contribute to the variability across individuals in a memory retrieval task: individual differences in cognitive style and individual differences in encoding strategy. Cognitive style was probed using a battery of assessments focused on the individual's tendency to visualize or verbalize written material. Encoding strategy was probed using a series of questions designed to assess typical strategies that an individual might utilize when trying to remember a list of words. Similarity in brain activity was assessed by cross-correlating individual t-statistic maps contrasting the BOLD response during retrieval to the BOLD response during fixation. Individual differences in cognitive style and encoding strategy accounted for a significant portion of the variance in similarity. This was true above and beyond individual differences in anatomy and memory performance. These results demonstrate the need for a multidimensional approach in the use of fMRI to make inferences about an individual.
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Affiliation(s)
- Michael B Miller
- Department of Psychology, University of California, Santa Barbara, CA 93106-9660, USA.
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8
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Miller MB, Donovan CL, Van Horn JD, German E, Sokol-Hessner P, Wolford GL. Unique and persistent individual patterns of brain activity across different memory retrieval tasks. Neuroimage 2009; 48:625-35. [PMID: 19540922 DOI: 10.1016/j.neuroimage.2009.06.033] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022] Open
Abstract
Fourteen subjects were scanned in two fMRI sessions separated by several months. During each session, subjects performed an episodic retrieval task, a semantic retrieval task, and a working memory task. We found that 1) despite extensive intersubject variability in the pattern of activity across the whole brain, individual activity patterns were stable over time, 2) activity patterns of the same individual performing different tasks were more similar than activity patterns of different individuals performing the same task, and 3) that individual differences in decision criterion on a recognition test predicted the degree of similarity between any two individuals' patterns of brain activity, but individual differences in memory accuracy or similarity in structural anatomy did not. These results imply that the exclusive use of group maps may be ineffective in profiling the pattern of activations for a given task. This may be particularly true for a task like episodic retrieval, which is relatively strategic and can involve widely distributed specialized processes that are peripheral to the actual retrieval of stored information. Further, these processes may be differentially engaged depending on individual differences in cognitive processing and/or physiology.
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Affiliation(s)
- Michael B Miller
- Department of Psychology, University of California, Santa Barbara, CA 93106-9660, USA.
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9
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Kirchhoff BA. Individual Differences in Episodic Memory: The Role of Self-initiated Encoding Strategies. Neuroscientist 2009; 15:166-79. [PMID: 19307423 DOI: 10.1177/1073858408329507] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Individuals' abilities to form and retrieve episodic memories vary widely. Consistent with this, there are substantial individual differences in brain activity during encoding and retrieval that are associated with individual differences in memory performance. Growing evidence suggests that individual differences in self-initiated encoding strategy use play an important role in individual differences in episodic memory and brain activity during intentional encoding. This review examines the role of individual differences in self-initiated encoding strategy use in individual differences in episodic memory, and outlines the major findings of brain lesion and functional neuroimaging studies that characterize the neural correlates of individual differences in self-initiated encoding strategy use. The relevance of individual differences in self-initiated encoding strategy use to understanding episodic memory impairments and alterations in brain activity in clinical populations such as individuals with schizophrenia is also discussed.
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Affiliation(s)
- Brenda A. Kirchhoff
- Department of Psychology, University of Missouri-St.
Louis, St. Louis, Missouri
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10
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Godinho F, Magnin M, Frot M, Perchet C, Garcia-Larrea L. Emotional modulation of pain: is it the sensation or what we recall? J Neurosci 2006; 26:11454-61. [PMID: 17079675 PMCID: PMC6674534 DOI: 10.1523/jneurosci.2260-06.2006] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2006] [Revised: 08/30/2006] [Accepted: 08/30/2006] [Indexed: 11/21/2022] Open
Abstract
Emotions modulate pain perception, although the mechanisms underlying this phenomenon remain unclear. In this study, we show that intensity reports significantly increased when painful stimuli were concomitant to images showing human pain, whereas pictures with identical emotional values but without somatic content failed to modulate pain. Early somatosensory responses (<200 ms) remained unmodified by emotions. Conversely, late responses showed a significant enhancement associated with increased pain ratings, localized to the right prefrontal, right temporo-occipital junction, and right temporal pole. In contrast to selective attention, which enhances pain ratings by increasing sensory gain, emotions triggered by seeing other people's pain did not alter processing in SI-SII (primary and second somatosensory areas), but may have biased the transfer to, and the representation of pain in short-term memory buffers (prefrontal), as well as the affective assignment to this representation (temporal pole). Memory encoding and recall, rather than sensory processing, appear to be modulated by empathy with others' physical suffering.
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Affiliation(s)
- Fabio Godinho
- Equipe Mixte INSERM 342, Central Integration of Pain, Hôpital Neurologique Pierre Wertheimer, 69003 Lyon, France.
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11
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Kirchhoff BA, Buckner RL. Functional-anatomic correlates of individual differences in memory. Neuron 2006; 51:263-74. [PMID: 16846860 DOI: 10.1016/j.neuron.2006.06.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Revised: 04/10/2006] [Accepted: 06/01/2006] [Indexed: 10/24/2022]
Abstract
Memory abilities differ greatly across individuals. To explore a source of these differences, we characterized the varied strategies people adopt during unconstrained encoding. Participants intentionally encoded object pairs during functional MRI. Principal components analysis applied to a strategy questionnaire revealed that participants variably used four main strategies to aid learning. Individuals' use of verbal elaboration and visual inspection strategies independently correlated with their memory performance. Verbal elaboration correlated with activity in a network of regions that included prefrontal regions associated with controlled verbal processing, while visual inspection correlated with activity in a network of regions that included an extrastriate region associated with object processing. Activity in regions associated with use of these strategies was also correlated with memory performance. This study reveals functional-anatomic correlates of verbal and perceptual strategies that are variably used by individuals during encoding. These strategies engage distinct brain regions and may separately influence memory performance.
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Affiliation(s)
- Brenda A Kirchhoff
- Department of Psychology, Washington University, Campus Box 1125, One Brookings Drive, St. Louis, Missouri 63130, and Martinos Center, Massachusetts General Hospital, Boston 02129, USA.
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Vigneau M, Beaucousin V, Hervé PY, Duffau H, Crivello F, Houdé O, Mazoyer B, Tzourio-Mazoyer N. Meta-analyzing left hemisphere language areas: phonology, semantics, and sentence processing. Neuroimage 2006; 30:1414-32. [PMID: 16413796 DOI: 10.1016/j.neuroimage.2005.11.002] [Citation(s) in RCA: 1208] [Impact Index Per Article: 67.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 11/08/2005] [Accepted: 11/09/2005] [Indexed: 11/28/2022] Open
Abstract
The advent of functional neuroimaging has allowed tremendous advances in our understanding of brain-language relationships, in addition to generating substantial empirical data on this subject in the form of thousands of activation peak coordinates reported in a decade of language studies. We performed a large-scale meta-analysis of this literature, aimed at defining the composition of the phonological, semantic, and sentence processing networks in the frontal, temporal, and inferior parietal regions of the left cerebral hemisphere. For each of these language components, activation peaks issued from relevant component-specific contrasts were submitted to a spatial clustering algorithm, which gathered activation peaks on the basis of their relative distance in the MNI space. From a sample of 730 activation peaks extracted from 129 scientific reports selected among 260, we isolated 30 activation clusters, defining the functional fields constituting three distributed networks of frontal and temporal areas and revealing the functional organization of the left hemisphere for language. The functional role of each activation cluster is discussed based on the nature of the tasks in which it was involved. This meta-analysis sheds light on several contemporary issues, notably on the fine-scale functional architecture of the inferior frontal gyrus for phonological and semantic processing, the evidence for an elementary audio-motor loop involved in both comprehension and production of syllables including the primary auditory areas and the motor mouth area, evidence of areas of overlap between phonological and semantic processing, in particular at the location of the selective human voice area that was the seat of partial overlap of the three language components, the evidence of a cortical area in the pars opercularis of the inferior frontal gyrus dedicated to syntactic processing and in the posterior part of the superior temporal gyrus a region selectively activated by sentence and text processing, and the hypothesis that different working memory perception-actions loops are identifiable for the different language components. These results argue for large-scale architecture networks rather than modular organization of language in the left hemisphere.
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Affiliation(s)
- M Vigneau
- Groupe d'Imagerie Neurofonctionnelle, UMR 6194, CNRS CEA Caen and Paris 5 Universities, GIP Cyceron, boulevard Henri Becquerel, BP 5229, 14074 Caen Cedex, France
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Kemeny S, Xu J, Park GH, Hosey LA, Wettig CM, Braun AR. Temporal Dissociation of Early Lexical Access and Articulation Using a Delayed Naming Task — An fMRI Study. Cereb Cortex 2005; 16:587-95. [PMID: 16049190 DOI: 10.1093/cercor/bhj006] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Neuroimaging studies of overt speech hold an important practical advantage allowing monitoring of subject performance, particularly valuable in disorders like aphasia. However, speech production is not a monotonic process but a complex sequence of stages. Levelt and colleagues have described these as roughly corresponding to two originally independent systems--conceptual and sensorimotor--that are linked in the formulation and expression of spoken language. In the initial stages a word is chosen to match a concept (lexical selection); in the later stages the sound and motor patterns are encoded and the word is uttered (articulation). It has been difficult to discriminate these stages using conventional neuroimaging techniques. We designed a functional magnetic resonance imaging study in an attempt to do this, by introducing a latency into a conventional naming paradigm, delaying the articulated response. Our results showed that left hemisphere perisylvian areas were active throughout, interacting with visual and heteromodal areas during early lexical access and with motor and auditory areas during overt articulation. These results are consistent with the broadest version of the Levelt model and with that derived from Chomsky's minimalist program in which a core language system interacts with conceptual-intentional systems and articulatory-perceptual systems during the early and late stages of lexical access respectively.
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Affiliation(s)
- Stefan Kemeny
- Language Section, Voice, Speech and Language Branch, National Institute on Deafness and other Communication Disorders, NIDCD, National Institutes of Health, Bethesda, MD 20892, USA.
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14
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Beason-Held LL, Golski S, Kraut MA, Esposito G, Resnick SM. Brain activation during encoding and recognition of verbal and figural information in older adults. Neurobiol Aging 2005; 26:237-50. [PMID: 15582751 DOI: 10.1016/j.neurobiolaging.2004.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2003] [Revised: 02/26/2004] [Accepted: 03/30/2004] [Indexed: 10/26/2022]
Abstract
Positron emission tomography (PET) patterns of cerebral blood flow associated with verbal and figural memory are described in relation to their value as functional probes for studying longitudinal changes that occur in the aging brain. Relative to a matching control task, verbal and figural encoding increase blood flow in prefrontal cortex (PFC), anterior cingulate, insular, lateral and medial temporal, occipital cortex and the cerebellum. Additionally, medial temporal regions exhibited greater activity during figural encoding relative to verbal encoding. During recognition, blood flow increases in prefrontal, cingulate, insular, and lateral temporal and Broca's areas. Analysis of hemispheric asymmetry reveals that the prefrontal cortex exhibits regionally dependent results. Prefrontal region BA 10 demonstrates more bilateral activation during encoding and retrieval, whereas BA 46 shows right greater than left activation during both encoding and retrieval. Overall, the two tasks activate diverse regions within the frontal, temporal and occipital lobes of the brain, including areas that show age-related structural changes, proving their usefulness in the longitudinal assessment of brain function in the elderly.
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Affiliation(s)
- L L Beason-Held
- Laboratory of Personality and Cognition, National Institute on Aging, NIH, NIA/LPC, 5600 Nathan Shock Drive, Baltimore, MD 21224-6825, USA.
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