Willed action and its impairments

A stress-sensitive frontostriatal circuit supporting effortful reward-seeking behavior

Effort valuation-a process for selecting actions based on the anticipated value of rewarding outcomes and expectations about the work required to obtain them-plays a fundamental role in decision-making. Effort valuation is disrupted in chronic stress states and is supported by the anterior cingulate cortex (ACC), but the circuit-level mechanisms by which the ACC regulates effort-based decision-making are unclear. Here, we show that ACC neurons projecting to the nucleus accumbens (ACC-NAc) play a critical role in effort valuation behavior in mice. Activity in ACC-NAc cells integrates both reward- and effort-related information, encoding a reward-related signal that scales with effort requirements and is necessary for supporting future effortful decisions. Chronic corticosterone exposure reduces motivation, suppresses effortful reward-seeking, and disrupts ACC-NAc signals. Together, our results delineate a stress-sensitive ACC-NAc circuit that supports effortful reward-seeking behavior by integrating reward and effort signals and reinforcing effort allocation in the service of maximizing reward.

Libet's legacy: A primer to the neuroscience of volition

The neuroscience of volition is an emerging subfield of the brain sciences, with hundreds of papers on the role of consciousness in action formation published each year. This makes the state-of-the-art in the discipline poorly accessible to newcomers and difficult to follow even for experts in the field. Here we provide a comprehensive summary of research in this field since its inception that will be useful to both groups. We also discuss important ideas that have received little coverage in the literature so far. We systematically reviewed a set of 2220 publications, with detailed consideration of almost 500 of the most relevant papers. We provide a thorough introduction to the seminal work of Benjamin Libet from the 1960s to 1980s. We also discuss common criticisms of Libet's method, including temporal introspection, the interpretation of the assumed physiological correlates of volition, and various conceptual issues. We conclude with recent advances and potential future directions in the field, highlighting modern methodological approaches to volition, as well as important recent findings.

Sense of agency and its disturbances: A systematic review targeting the intentional binding effect in neuropsychiatric disorders

Sense of agency (SoA) indicates a person's ability to perceive her/his own motor acts as actually being her/his and, through them, to exert control over the course of external events. Disruptions in SoA may profoundly affect the individual's functioning, as observed in several neuropsychiatric disorders. This is the first article to systematically review studies that investigated intentional binding (IB), a quantitative proxy for SoA measurement, in neurological and psychiatric patients. Eligible were studies of IB involving patients with neurological and/or psychiatric disorders. We included 15 studies involving 692 individuals. Risk of bias was low throughout studies. Abnormally increased action-outcome binding was found in schizophrenia and in patients with Parkinson's disease taking dopaminergic medications or reporting impulsive-compulsive behaviors. A decreased IB effect was observed in Tourette's disorder and functional movement disorders, whereas increased action-outcome binding was found in patients with the cortico-basal syndrome. The extent of IB deviation from healthy control values correlated with the severity of symptoms in several disorders. Inconsistent effects were found for autism spectrum disorders, anorexia nervosa, and borderline personality disorder. Findings pave the way for treatments specifically targeting SoA in neuropsychiatric disorders where IB is altered.

Relationship of Neural Correlates of Gait Characteristics and Cognitive Dysfunction in Patients with Mild Cognitive Impairment

Background: Some patients with mild cognitive impairment (MCI) experience gait disturbances. However, there are few reports on the relationship between gait disturbance and cognitive function in patients with MCI. Therefore, we investigated the neural correlates of gait characteristics related to cognitive dysfunction. Methods: Eighty patients diagnosed with MCI from three dementia centers in Gangwon-do, Korea, were recruited for this study. We defined MCI as a Clinical Dementia Rating global score of 0.5 or higher, with a memory domain score of 0.5 or greater. The patients were classified as having either higher or lower MMSE and the groups were based on their Mini Mental Status Examination z-scores. Multiple logistic regression analysis was performed to examine the association between the gait characteristics and cognitive impairment. Analyses included variables such as age, sex, years of education, number of comorbidities, body mass index, and height. Results: Gait velocity, step count, step length, heel-to-heel base support, swing and stance phase duration, and support time were associated with cognitive function. A decrease in gray matter volume in the right pericalcarine area was associated with gait characteristics related to cognitive dysfunction. An increase in the curvature of gray matter in the right entorhinal, right lateral orbitofrontal, right cuneus, and right and left pars opercularis areas was also associated with gait characteristics related to cognitive dysfunction. Conclusion: Since gait impairment is an important factor in determining activities of daily living in patients with mild cognitive impairment, the evaluation of gait and cognitive functions in patients with mild cognitive impairment is important.

The effect of context and reason on the neural correlates of intentions

Many studies have identified networks in parietal and prefrontal cortex that are involved in intentional action. Yet, our understanding of the way these networks are involved in intentions is still very limited. In this study, we investigate two characteristics of these processes: context- and reason-dependence of the neural states associated with intentions. We ask whether these states depend on the context a person is in and the reasons they have for choosing an action. We used a combination of functional magnetic resonance imaging (fMRI) and multivariate decoding to directly assess the context- and reason-dependency of the neural states underlying intentions. We show that action intentions can be decoded from fMRI data based on a classifier trained in the same context and with the same reason, in line with previous decoding studies. Furthermore, we found that intentions can be decoded across different reasons for choosing an action. However, decoding across different contexts was not successful. We found anecdotal to moderate evidence against context-invariant information in all regions of interest and for all conditions but one. These results suggest that the neural states associated with intentions are modulated by the context of the action.

Changes in motor activity level in individuals with frontotemporal dementia

Changes in motor activity are common in individuals with Frontotemporal dementia (FTD). Yet, it remains unclear why some individuals become motorically hyperactive, while others hypoactive even in early stages of the disease. This study aimed to examine the relationship between motor activity level and (1) FTD clinical subtype, and (2) cortical thickness and subcortical volumes. Eighty-two charts were retrospectively reviewed from patients meeting consensus criteria for one of the three main clinical subtypes of FTD: probable bvFTD, semantic variant Primary Progressive Aphasia (PPA), or non-fluent variant PPA. Participants were assigned to one of three groups: (1) hyperactive, (2) hypoactive, or (3) no record of change. Hyperactivity was prevalent among bvFTD (58.5%) and semantic PPA (68.8%) subtypes while hypoactivity was less common in both subtypes (29.3% and 18.8%, respectively). The majority of patients with non-fluent PPA showed no record of change in motor activity (66.7%). The analysis of cortical thickness and subcortical volumes did not identify significant associations with motor activity levels. In conclusion, increased motor activity is highly prevalent among individuals with FTD, especially bvFTD and svPPA subtypes. These findings may inform prognosis and prediction of changes in motor activity, and allow planning for appropriate environmental and behavioural interventions. Future studies with prospective, standardized longitudinal collection of information regarding the type and level of change in motor activity, including wearable measures of actigraphy, may help to further delineate the onset and progression of abnormal motor behaviours and determine neuroanatomic associations in FTD.

Cholinergic nucleus 4 grey matter density is associated with apathy in Parkinson's disease

Objective: The generation and maintenance of goal-directed behavior is subserved by multiple brain regions that receive cholinergic inputs from the cholinergic nucleus 4 (Ch4). It is unknown if Ch4 degeneration contributes to apathy in Parkinson's disease (PD). Method: We analyzed data from 106 pre-surgical patients with PD who had brain MRIs and completed the Frontal Systems Behavior Scales (FrSBe). Eighty-eight patients also completed the Beck Depression Inventory-2nd Edition. Cholinergic basal forebrain grey matter densities (GMD) were measured by applying probabilistic maps to T1 MPRAGE sequences processed using voxel-based morphometry methods. We used linear and hierarchical regression modelling to examine the association between Ch4 GMD and the FrSBe Apathy subscale scores. We used similar methods to assess the specificity of this association and potential associations between Ch4 target regions and apathy. Results: Ch4 GMD (p = .021) and Ch123 GMD (p = .032) were significantly associated with Apathy subscale scores on univariate analysis. Ch4 GMD, but not Ch123 GMD, remained significantly associated with apathy when adjusting for age, sex, levodopa equivalent doses, and disease duration. Centromedial amygdala GMD, which receives cholinergic inputs from Ch4, was also associated with apathy. Ch4 GMD was not associated with depression or disinhibition, nor was it associated with executive dysfunction when adjusting for clinical and demographic variables. Conclusions: Ch4 GMD is specifically associated with apathy in PD. Ch4 degeneration results in cholinergic denervation of multiple cortical and limbic regions, which may contribute to the cognitive and emotional-affective processing deficits that underlie the behavioral symptoms of apathy.

Task-based functional connectivity identifies two segregated networks underlying intentional action

While much of motor behavior is automatic, intentional action is necessary for the selection and initiation of controlled motor acts and is thus an essential part of goal-directed behavior. Neuroimaging studies have shown that self-generated action implicates several dorsal and ventral frontoparietal areas. However, knowledge of the functional coupling between these brain regions during intentional action remains limited. We here studied brain activations and functional connectivity (FC) of thirty right-handed healthy participants performing a finger pressing task instructed to use a specific finger (externally-triggered action) or to select one of four fingers randomly (internally-generated action). Participants performed the task in alternating order either with their dominant right hand or the left hand. Consistent with previous studies, we observed stronger involvement of posterior parietal cortex and premotor regions when contrasting internally-generated with externally-triggered action. Interestingly, this contrast also revealed significant engagement of medial occipitotemporal regions including the left lingual and right fusiform gyrus. Task-based FC analysis identified increased functional coupling among frontoparietal regions as well as increased and decreased coupling between occipitotemporal regions, thus differentiating between two segregated networks. When comparing results of the dominant and nondominant hand we found less activation, but stronger connectivity for the former, suggesting increased neural efficiency when participants use their dominant hand. Taken together, our results reveal that two segregated networks that encompass the frontoparietal and occipitotemporal cortex contribute independently to intentional action.

Sense of agency disturbances in movement disorders: A comprehensive review

Sense of agency refers to the experience that one's self-generated action causes an event in the external environment. Here, we review the behavioural and brain evidence of aberrant experiences of agency in movement disorders, clinical conditions characterized by either a paucity or an excess of movements unrelated to the patient's intention. We show that specific abnormal agency experiences characterize several movement disorders. Those manifestations are typically associated with structural and functional brain abnormalities. However, the evidence is sometimes conflicting, especially when considering results obtained through different agency measures. The present review aims to create order in the existing literature on sense of agency investigations in movement disorders and to provide a coherent overview framed within current neurocognitive models of motor awareness.

How the effects of actions become our own

Every day, we do things that cause effects in the outside world with little doubt about who caused what. To some, this sense of agency derives from a post hoc reconstruction of a likely causal relationship between an event and our preceding movements; others propose that the sense of agency originates from prospective comparisons of motor programs and their effects. Using functional magnetic resonance imaging, we found that the sense of agency is associated with a brain network including the pre-supplementary motor area (SMA) and dorsal parietal cortex. Transcranial magnetic stimulation affected the sense of agency only when delivered over the pre-SMA and specifically when time-locked to action planning, rather than when the physical consequences of the actions appeared. These findings make a prospective theory of the sense of agency more likely.

Lewy Body Degenerations as Neuropsychiatric Disorders

Parkinson disease has historically been conceptualized as a movement disorder. In recent decades, nonmotor and neuropsychiatric symptoms have become increasingly recognized as being of paramount importance for patients with Parkinson disease. Neuropsychiatric phenomena dominate the course of the other major Lewy body disease, dementia with Lewy bodies. In this review, we survey the clinical relevance of nonmotor and neuropsychiatric symptoms to the heterogeneous presentations of Lewy body disease and their significance to ongoing research in this area. We consider how the nature of Lewy body neuropathology may help explicate the basis of nonmotor and neuropsychiatric symptoms in these two disorders.

Functional Connectivity Changes of Key Regions for Motor Initiation in Parkinson's Disease

Akinesia, a cardinal symptom of Parkinson's disease, has been linked to abnormal activation in putamen and posterior medial frontal cortex (pMFC). However, little is known whether clinical severity of akinesia is linked to dysfunctional connectivity of these regions. Using a seed-based approach, we here investigated resting-state functional connectivity (RSFC) of putamen, pMFC and primary motor cortex (M1) in 60 patients with Parkinson's disease on regular medication and 72 healthy controls. We found that in patients putamen featured decreases of connectivity for a number of cortical and subcortical areas engaged in sensorimotor and cognitive processing. In contrast, the pMFC showed reduced connectivity with a more focal cortical network involved in higher-level motor-cognition. Finally, M1 featured a selective disruption of connectivity in a network specifically connected with M1. Correlating clinical impairment with connectivity changes revealed a relationship between akinesia and reduced RSFC between pMFC and left intraparietal lobule (IPL). Together, the present study demonstrated RSFC decreases in networks for motor initiation and execution in Parkinson's disease. Moreover, results suggest a relationship between pMFC-IPL decoupling and the manifestation of akinetic symptoms.

Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life

Background

Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail.

Methods

The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points.

Results

VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36).

Conclusion

We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.

Gait Disorders and Falls in the Elderly

Gait disorders in the elderly may be based on a neurologic deficit at multiples levels, or may be secondary to nonneurologic causes. The physiology and pathophysiology of gait problems are reviewed and bedside examination and investigative tools are discussed. The reader will have an excellent working knowledge of the subject and will know how to diagnose and treat gait disorders and falls.

Prefrontal Contributions to Attention and Working Memory

The processes of attention and working memory are conspicuously interlinked, suggesting that they may involve overlapping neural mechanisms. Working memory (WM) is the ability to maintain information in the absence of sensory input. Attention is the process by which a specific target is selected for further processing, and neural resources directed toward that target. The content of WM can be used to direct attention, and attention can in turn determine which information is encoded into WM. Here we discuss the similarities between attention and WM and the role prefrontal cortex (PFC) plays in each. First, at the theoretical level, we describe how attention and WM can both rely on models based on attractor states. Then we review the evidence for an overlap between the areas involved in both functions, especially the frontal eye field (FEF) portion of the prefrontal cortex. We also discuss similarities between the neural changes in visual areas observed during attention and WM. At the cellular level, we review the literature on the role of prefrontal DA in both attention and WM at the behavioral and neural levels. Finally, we summarize the anatomical evidence for an overlap between prefrontal mechanisms involved in attention and WM. Altogether, a summary of pharmacological, electrophysiological, behavioral, and anatomical evidence for a contribution of the FEF part of prefrontal cortex to attention and WM is provided.

Dissecting the neurofunctional bases of intentional action

Here we challenge and present evidence that expands the what, when, and whether anatomical model of intentional action, which states that internally driven decisions about the content and timing of our actions and about whether to act at all depend on separable neural systems, anatomically segregated along the medial wall of the frontal lobe. In our fMRI event-related paradigm, subjects acted following conditional cues or following their intentions. The content of the actions, their timing, or their very occurrence were the variables investigated, together with the modulating factor of intentionality. Besides a shared activation of the pre-supplementary motor area (pre-SMA) and anterior cingulate cortex (ACC) for all components and the SMA proper for the when component, we found specific activations beyond the mesial prefrontal wall involving the parietal cortex for the what component or subcortical gray structures for the when component. Moreover, we found behavioral, functional, anatomical, and brain connectivity evidence that the self-driven decisions on whether to act require a higher interhemispheric cooperation: This was indexed by a specific activation of the corpus callosum whereby the less the callosal activation, the greater was the decision cost at the time of the action in the whether trials. Furthermore, tractography confirmed that the fibers passing through the callosal focus of activation connect the two sides of the frontal lobes involved in intentional trials. This is evidence of non-unitary neural foundations for the processes involved in intentional actions with the pre-SMA/ACC operating as an intentional hub. These findings may guide the exploration of specific instances of disturbed intentionality.

Apathy following traumatic brain injury: A review

Apathy is a common problem after traumatic brain injury (TBI) and can have a major impact on cognitive function, psychosocial outcome and engagement in rehabilitation. For scientists and clinicians it remains one of the least understood aspects of brain-behaviour relationships encompassing disturbances of cognition, motivation, emotion and action, and is variously an indication of organic brain disease or psychiatric disorder. Apathy can be both sign and symptom and has been proposed as a diagnosis in its own right as well as a secondary feature of other conditions. This review considers previous approaches to apathy in terms of relevant psychological constructs and those neural counterparts most likely to be implicated after TBI. Neurobehavioural disorders of apathy are characterised chiefly by dysfunction of executive control of goal-oriented behaviour or the neural substrates of reward-based and emotional learning. We argue that it is possible to distinguish a primary disorder of apathy as an organic neurobehavioural state from secondary presentations due to an impoverished environment or psychological disturbance which has implications for treatment.

Gait

Gait is one of the keys to functional independence. For a long-time, walking was considered an automatic process involving minimal higher-level cognitive input. Indeed, walking does not take place without muscles that move the limbs and the "lower-level" control that regulates the timely activation of the muscles. However, a growing body of literature suggests that walking can be viewed as a cognitive process that requires "higher-level" cognitive control, especially during challenging walking conditions that require executive function and attention. Two main locomotor pathways have been identified involving multiple brain areas for the control of posture and gait: the dorsal pathway of cognitive locomotor control and the ventral pathway for emotional locomotor control. These pathways may be distinctly affected in different pathologies that have important implications for rehabilitation and therapy. The clinical assessment of gait should be a focused, simple, and cost-effective process that provides both quantifiable and qualitative information on performance. In the last two decades, gait analysis has gradually shifted from analysis of a few steps in a restricted space to long-term monitoring of gait using body fixed sensors, capturing real-life and routine behavior in the home and community environment. The chapter also describes this evolution and its implications.

"Low road" to rehabilitation: a perspective on subliminal sensory neuroprosthetics

Fear can propagate parallelly through both cortical and subcortical pathways. It can instigate memory consolidation habitually and might allow internal simulation of movements independent of the cortical structures. This perspective suggests delivery of subliminal, aversive and kinematic audiovisual stimuli via neuroprosthetics in patients with neocortical dysfunctions. We suggest possible scenarios by which these stimuli might bypass damaged neocortical structures and possibly assisting in motor relearning. Anticipated neurophysiological mechanisms and methodological scenarios have been discussed in this perspective. This approach introduces novel perspectives into neuropsychology as to how subcortical pathways might be used to induce motor relearning.

The Agent Brain: A Review of Non-invasive Brain Stimulation Studies on Sensing Agency

According to philosophy of mind and neuroscientific models, the sense of agency can be defined as the sense that I am the one that is generating an action and causing its effects. Such ability to sense ourselves as causal agents is critical for the definition of intentional behavior and is a primary root for human interaction skills. The present mini-review aims at discussing evidences from non-invasive brain stimulation (NIBS) studies targeting functional correlates of different aspects of agency and evidences on the way stimulation techniques affect such core feature of human subjective experience. Clinical and brain imaging studies helped in defining a neural network mediating agency-related processes, which includes the dorsolateral prefrontal cortex (dlPFC), the cingulate cortex (CC), the supplementary and pre-supplementary motor areas (SMA and pre-SMA), the posterior parietal cortex (PPC) and its inferior regions and the cerebellum. However, while the plurality of those structures mirrors the complexity of the phenomenon, their actual roles with respect to different components of the experience of agency have been primarily explored via correlational techniques, without a clear evidence about their causal significance with respect to the integration of sensorimotor information, intentionalization, and action monitoring processes. Therefore, insights into the specific causal role of different cortical structures can be specified by using NIBS techniques, in order to provide improved understanding into the bases of our ability vs. inability to properly act in complex social contexts.

The What, the When, and the Whether of Intentional Action in the Brain: A Meta-Analytical Review

In their attempt to define discrete subcomponents of intentionality, Brass and Haggard (2008) proposed their What, When, and Whether model (www-model) which postulates that the content, the timing and the possibility of generating an action can be partially independent both at the cognitive level and at the level of their neural implementation. The original proposal was based on a limited number of studies, which were reviewed with a discursive approach. To assess whether the model stands in front of the more recently published data, we performed a systematic review of the literature with a meta-analytic method based on a hierarchical clustering (HC) algorithm. We identified 15 PET/fMRI studies well-suited for this quest. HC revealed the existence of a rostro-caudal gradient within the medial prefrontal cortex, with the more anterior regions (the anterior cingulum) involved in more abstract decisions of whether to execute an action and the more posterior ones (the middle cingulum or the SMA) recruited in specifying the content and the timing components of actions. However, in contrast with the original www-model, this dissociation involves also brain regions well outside the median wall of the frontal lobe, in a component specific manner: the supramarginal gyrus for the what component, the pallidum and the thalamus for the when component, the putamen and the insula for the whether component. We then calculated co-activation maps on the three component-specific www clusters of the medial wall of the frontal/limbic lobe: to this end, we used the activation likelihood approach that we applied on the imaging studies on action contained in the BrainMap.org database. This analysis confirmed the main findings of the HC analyses. However, the BrainMap.org data analyses also showed that the aforementioned segregations are generated by paradigms in which subjects act in response to conditional stimuli rather than while driven by their own intentions. We conclude that the available data confirm that the neural underpinnings of intentionality can be fractionated in discrete components that are partially independent. We also suggest that intentionality manifests itself in discrete components through the boosting of general purpose action-related regions specialized for different aspects of action selection and inhibition.

Quantification of free-living activity patterns using accelerometry in adults with mental illness

Physical activity is disrupted in many psychiatric disorders. Advances in everyday technologies - such as accelerometers in smart phones - opens exciting possibilities for non-intrusive acquisition of activity data. Successful exploitation of this opportunity requires the validation of analytical methods that can capture the full movement spectrum. The study aim was to demonstrate an analytical approach to characterise accelerometer-derived activity patterns. Here, we use statistical methods to characterize accelerometer-derived activity patterns from a heterogeneous sample of 99 community-based adults with mental illnesses. Diagnoses were screened using the Mini International Neuropsychiatric Interview, and participants wore accelerometers for one week. We studied the relative ability of simple (exponential), complex (heavy-tailed), and composite models to explain patterns of activity and inactivity. Activity during wakefulness was a composite of brief random (exponential) movements and complex (heavy-tailed) processes, whereas movement during sleep lacked the heavy-tailed component. In contrast, inactivity followed a heavy-tailed process, lacking the random component. Activity patterns differed in nature between those with a diagnosis of bipolar disorder and a primary psychotic disorder. These results show the potential of complex models to quantify the rich nature of human movement captured by accelerometry during wake and sleep, and the interaction with diagnosis and health.

Goal-directed behaviors in patients with schizophrenia: Concept relevance and updated model

Goal-directed behaviors are formulated to pursue a given objective by constructing a plan and selecting actions that lead to the intended goal, either immediately or over an extended period. This concept is important to the study of human behavior because of its involvement in the majority of complex or novel situations that an individual may encounter, regardless of the cognitive, affective, or social abilities required. In this paper, we aim to demonstrate the relevance of goal-directed behaviors to our understanding of the cognitive deficits and other symptoms associated with schizophrenia. A systematic analysis of this relation may allow us to develop integrative hypotheses regarding positive, negative, and disorganized symptoms of schizophrenia rather than consider them to be distinct issues. In this article, we review previous studies of goal-directed actions in patients with schizophrenia in order to clarify the relevant concepts and provide a theoretical basis for the integration of existing results. Based on available theoretical models and data, we propose an updated model to facilitate further investigation of schizophrenia-related impairments in goal-directed behaviors.

Cognitive Neurostimulation: Learning to Volitionally Sustain Ventral Tegmental Area Activation

Activation of the ventral tegmental area (VTA) and mesolimbic networks is essential to motivation, performance, and learning. Humans routinely attempt to motivate themselves, with unclear efficacy or impact on VTA networks. Using fMRI, we found untrained participants' motivational strategies failed to consistently activate VTA. After real-time VTA neurofeedback training, however, participants volitionally induced VTA activation without external aids, relative to baseline, Pre-test, and control groups. VTA self-activation was accompanied by increased mesolimbic network connectivity. Among two comparison groups (no neurofeedback, false neurofeedback) and an alternate neurofeedback group (nucleus accumbens), none sustained activation in target regions of interest nor increased VTA functional connectivity. The results comprise two novel demonstrations: learning and generalization after VTA neurofeedback training and the ability to sustain VTA activation without external reward or reward cues. These findings suggest theoretical alignment of ideas about motivation and midbrain physiology and the potential for generalizable interventions to improve performance and learning.

Increased Event-Related Potentials and Alpha-, Beta-, and Gamma-Activity Associated with Intentional Actions

Objective: Internally guided actions are defined as being purposeful, self-generated and offering choices between alternatives. Intentional actions are essential to reach individual goals. In previous empirical studies, internally guided actions were predominantly related to functional responses in frontal and parietal areas. The aim of the present study was to distinguish event-related potentials and oscillatory responses of intentional actions and externally guided actions. In addition, we compared neurobiological findings of the decision which action to perform with those referring to the decision whether or not to perform an action.

Methods: Twenty-eight subjects participated in adapted go/nogo paradigms, including a voluntary selection condition allowing participants to (1) freely decide whether to press the response button or (2) to decide whether they wanted to press the response button with the right index finger or the left index finger.

Results: The reaction times were increased when participants freely decided whether and how they wanted to respond compared to the go condition. Intentional processes were associated with a fronto-centrally located N2 and P3 potential. N2 and P3 amplitudes were increased during intentional actions compared to instructed responses (go). In addition, increased activity in the alpha-, beta- and gamma-frequency range was shown during voluntary behavior rather than during externally guided responses.

Conclusion: These results may indicate that an additional cognitive process is needed for intentional actions compared to instructed behavior. However, the neural responses were comparatively independent of the kind of decision that was made (1) decision which action to perform; (2) decision whether or not to perform an action).

Significance: The study demonstrates the importance of fronto-central alpha-, beta-, and gamma oscillations for voluntary behavior.

Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment

Normal maintenance of human motivation depends on the integrity of subcortical structures that link the prefrontal cortex with the limbic system. Structural and functional disruption of different networks within these circuits alters the maintenance of spontaneous mental activity and the capacity of affected individuals to associate emotions with complex stimuli. The clinical manifestations of these changes include a continuum of abnormalities in goal-oriented behaviours known as apathy. Apathy is highly prevalent in Parkinson's disease (and across many neurodegenerative disorders) and can severely affect the quality of life of both patients and caregivers. Differentiation of apathy from depression, and discrimination of its cognitive, emotional, and auto-activation components could guide an individualised approach to the treatment of symptoms. The opportunity to manipulate dopaminergic treatment in Parkinson's disease allows researchers to study a continuous range of motivational states, from apathy to impulse control disorders. Parkinson's disease can thus be viewed as a model that provides insight into the neural substrates of apathy.

Dopamine D1 receptor blockade impairs alcohol seeking without reducing dorsal striatal activation to cues of alcohol availability

INTRODUCTION

Alcohol-associated cues activate both ventral and dorsal striatum in functional brain imaging studies of heavy drinkers. In rodents, alcohol-associated cues induce changes in neuronal firing frequencies and increase dopamine release in ventral striatum, but the impact of alcohol-associated cues on neuronal activity in dorsal striatum is unclear. We previously reported phasic changes in action potential frequency in the dorsomedial and dorsolateral striatum after cues that signaled alcohol availability, prompting approach behavior.

METHODS

We investigated the hypothesis that dopamine transmission modulates these phasic firing changes. Rats were trained to self-administer alcohol, and neuronal activity was monitored with extracellular electrophysiology during "anticipatory" cues that signaled the start of the operant session. Sessions were preceded by systemic administration of the D1-type dopamine receptor antagonist SCH23390 (0, 10, and 20 μg/kg).

RESULTS

SCH23390 significantly decreased firing rates during the 60 s prior to cue onset without reducing phasic excitations immediately following the cues. While neuronal activation to cues might be expected to initiate behavioral responses, in this study alcohol seeking was reduced despite the presence of dorsal striatal excitations to alcohol cues.

CONCLUSIONS

These data suggest that D1 receptor antagonism reduces basal firing rates in the dorsal striatum and modulates the ability of neuronal activation to "anticipatory" cues to initiate alcohol seeking in rats with an extensive history of alcohol self-administration.

The circuitry of abulia: insights from functional connectivity MRI

Background

Functional imaging and lesion studies have associated willed behavior with the anterior cingulate cortex (ACC). Abulia is a syndrome characterized by apathy and deficiency of motivated behavior. Abulia is most frequently associated with ACC damage, but also occurs following damage to subcortical nuclei (striatum, globus pallidus, thalamic nuclei). We present resting state functional connectivity MRI (fcMRI) data from an individual who suffered a stroke leading to abulia. We hypothesized that, although structural imaging revealed no damage to the patient's ACC, fcMRI would uncover aberrant function in this region and in the relevant cortical networks.

Methods

Resting state correlations in the patient's gray matter were compared to those of age-matched controls. Using a novel method to identify abnormal patterns of functional connectivity in single subjects, we identified areas and networks with aberrant connectivity.

Results

Networks associated with memory (default mode network) and executive function (cingulo-opercular network) were abnormal. The patient's anterior cingulate was among the areas showing aberrant functional connectivity. In a rescan 3 years later, deficits remained stable and fcMRI findings were replicated.

Conclusions

These findings suggest that the aberrant functional connectivity mapping approach described may be useful for linking stroke symptoms to disrupted network connectivity.

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A method for single subject functional connectivity analysis is proposed.

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In a case study, resting state fcMRI identifies reproducible disruption that corresponds to clinical deficit.

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Damage to the anterior thalamus results in disrupted functional connectivity in the cingulate cortex.

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Abulia without frontal lesion shows disrupted functional connectivity in the cingulo-opercular and default mode networks.

Insights into human behavior from lesions to the prefrontal cortex

The prefrontal cortex (PFC), a cortical region that was once thought to be functionally insignificant, is now known to play an essential role in the organization and control of goal-directed thought and behavior. Neuroimaging, neurophysiological, and modeling techniques have led to tremendous advances in our understanding of PFC functions over the last few decades. It should be noted, however, that neurological, neuropathological, and neuropsychological studies have contributed some of the most essential, historical, and often prescient conclusions regarding the functions of this region. Importantly, examination of patients with brain damage allows one to draw conclusions about whether a brain area is necessary for a particular function. Here, we provide a broad overview of PFC functions based on behavioral and neural changes resulting from damage to PFC in both human patients and nonhuman primates.

Habitual responding for alcohol depends upon both AMPA and D2 receptor signaling in the dorsolateral striatum

Chronic alcohol self-administration leads to alcohol-seeking behavior that is habitual and insensitive to changes in the value of the earned alcohol. Such behavior has been shown to rely on the dorsolateral region of the striatum in rats but the specific pharmacological control of output from this region is not yet understood. In the following experiments rats were trained to self-administer unsweetened 10% (v/v) ethanol in daily sessions for 8 weeks prior to testing for sensitivity to outcome devaluation. We examined the role of glutamatergic AMPA-receptor activation by testing the effects of the antagonist NBQX (0.3 and 1.0 μg/μl) infused specifically into the dorsolateral striatum (DLS) before devaluation testing. In a separate group of rats we examined the role of dopaminergic D2-receptor activation using the D2-receptor antagonist raclopride (0.2 and 1.0 μg/μl) infused into the DLS before devaluation testing. Following control (saline) infusions rats’ lever-press performance was insensitive to devaluation of ethanol thus showing evidence of habitual responding. NBQX and racolpride each restored goal-directed control of responding at doses that did not impair overall lever-press rates. These data demonstrate that expression of habitual alcohol seeking relies on glutamatergic inputs to the DLS and D2 receptors within the DLS.

Selection and stopping in voluntary action: a meta-analysis and combined fMRI study

Voluntary action control requires selection of appropriate responses and stopping of inappropriate responses. Selection and stopping are often investigated separately, but they appear to recruit similar brain regions, including the pre-supplementary motor area (preSMA) and inferior frontal gyrus. We therefore examined the evidence for overlap of selection and stopping using two approaches: a meta-analysis of existing studies of selection and stopping, and a novel within-subject fMRI study in which action selection and a stop signal task were combined factorially. The novel fMRI study also permitted us to investigate hypotheses regarding a common mechanism for selection and stopping. The preSMA was identified by both methods as common to selection and stopping. However, stopping a selected action did not recruit preSMA more than stopping a specified action, nor did stop signal reaction times differ significantly across the two conditions. These findings suggest that the preSMA supports both action selection and stopping, but the two processes may not require access to a common inhibition mechanism. Instead, the preSMA might represent information about potential actions that is used in both action selection and stopping in order to resolve conflict between competing available responses.

Do basal Ganglia amplify willed action by stochastic resonance? A model

Basal ganglia are usually attributed a role in facilitating willed action, which is found to be impaired in Parkinson's disease, a pathology of basal ganglia. We hypothesize that basal ganglia possess the machinery to amplify will signals, presumably weak, by stochastic resonance. Recently we proposed a computational model of Parkinsonian reaching, in which the contributions from basal ganglia aid the motor cortex in learning to reach. The model was cast in reinforcement learning framework. We now show that the above basal ganglia computational model has all the ingredients of stochastic resonance process. In the proposed computational model, we consider the problem of moving an arm from a rest position to a target position: the two positions correspond to two extrema of the value function. A single kick (a half-wave of sinusoid, of sufficiently low amplitude) given to the system in resting position, succeeds in taking the system to the target position, with high probability, only at a critical noise level. But for suboptimal noise levels, the model arm's movements resemble Parkinsonian movement symptoms like akinetic rigidity (low noise) and dyskinesias (high noise).

A model of reward- and effort-based optimal decision making and motor control

Costs (e.g. energetic expenditure) and benefits (e.g. food) are central determinants of behavior. In ecology and economics, they are combined to form a utility function which is maximized to guide choices. This principle is widely used in neuroscience as a normative model of decision and action, but current versions of this model fail to consider how decisions are actually converted into actions (i.e. the formation of trajectories). Here, we describe an approach where decision making and motor control are optimal, iterative processes derived from the maximization of the discounted, weighted difference between expected rewards and foreseeable motor efforts. The model accounts for decision making in cost/benefit situations, and detailed characteristics of control and goal tracking in realistic motor tasks. As a normative construction, the model is relevant to address the neural bases and pathological aspects of decision making and motor control.

Effects of cortical and striatal dopamine D1 receptor blockade on cued versus noncued behavioral responses

Various lines of evidence suggest that disruptions in brain dopamine (DA) transmission produce behavioral impairments that can be overcome by salient response-eliciting environmental stimuli. We examined here whether D1 receptor blockade within striatal or frontal cortical DA target regions would differentially affect head entry responses elicited by an auditory cue compared with those occurring during noncued intertrial intervals. Rats received 2 drug-free 28-trial daily sessions in which an auditory cue was immediately followed by food delivery. On the following day, separate groups of rats received bilateral infusions of D1 antagonist SCH23390 to the dorsomedial striatum (DMS), nucleus accumbens (NAcc) core, or the medial prefrontal cortex (mPFC). SCH23390 infused into the DMS and NAcc core suppressed noncued head entries but had no effect on head entries in response to the auditory cue. SCH23390 infused to the mPFC did not reduce either cued or noncued approach responses. Systemic administration of the drug, in contrast, reduced the frequency of both cued and noncued approaches. The results are consistent with the notion that has emerged from the Parkinson's literature that reduced DA transmission produces behavioral suppression that can be overcome by salient environmental response elicitors, and extends this notion by showing that D1 receptor transmission within the striatum strongly suppresses noncued responses while leaving the identical behavior intact when cued by an environmental stimulus.

Neural activity in readiness for incidental and explicitly timed actions

Voluntary, self-initiated actions are preceded by slowly increasing neural activity in pre-motor regions of the brain, beginning up to 2s before the onset of muscle movement. This activity is commonly seen in the scalp-recorded readiness potential, and is an index of movement preparation involving both motor programming and non-motor or cognitive processes such as attention. The specific contribution of cognitive processes, thought to occur during the earliest stage of planning, remains somewhat unclear. We suggest that attention to the timing of movement is a key voluntary process contributing to early-stage cortical activity. As a novel approach to examining this, we recorded EEG throughout a time reproduction task in which participants replicated the interval between two tones with two button-press actions. The first action, i.e. the beginning of the reproduced interval, was somewhat incidental to the task of time reproduction and required minimal attention to the time of initiation, while the second action required explicit attention to the time of initiation. Pre-movement neural activity preceding the first, relatively unattended movement was greatly reduced in amplitude and almost absent in the early stage, in contrast with readiness potentials typically seen prior to voluntary movement. Neural activity preceding explicitly timed movements was significantly larger, with effects emerging in the early component of pre-movement activity over frontal and right frontal scalp regions. We propose that attention to movement timing, i.e. the process of orienting attention in time towards the moment of movement initiation, is a key component of voluntary action preparation that is reflected in the early-stage neural activity we typically see prior to voluntary movement.

Goal-independent mechanisms for free response generation: creative and pseudo-random performance share neural substrates

To what extent free response generation in different tasks uses common and task-specific neurocognitive processes has remained unclear. Here, we investigated overlap and differences in neural activity during musical improvisation and pseudo-random response generation. Brain activity was measured using fMRI in a group of professional classical pianists, who performed musical improvisation of melodies, pseudo-random key-presses and a baseline condition (sight-reading), on either two, six or twelve keys on a piano keyboard. The results revealed an extensive overlap in neural activity between the two generative conditions. Active regions included the dorsolateral and dorsomedial prefrontal cortices, inferior frontal gyrus, anterior cingulate cortex and pre-SMA. No regions showed higher activity in improvisation than in pseudo-random generation. These findings suggest that the activated regions fulfill generic functions that are utilized in different types of free generation tasks, independent of overall goal. In contrast, pseudo-random generation was accompanied by higher activity than improvisation in several regions. This presumably reflects the participants' musical expertise as well as the pseudo-random generation task's high load on attention, working memory, and executive control. The results highlight the significance of using naturalistic tasks to study human behavior and cognition. No brain activity was related to the size of the response set. We discuss that this may reflect that the musicians were able to use specific strategies for improvisation, by which there was no simple relationship between response set size and neural activity.

Catatonia - case report and review

Catatonia is a neuro-psychiatric disorder that can occur in medical, psychiatric and drug-induced conditions but is often unrecognised. A 64 year-old woman was admitted to hospital for assessment of a significant deterioration in her ability to communicate and function normally so that she had become completely dependent on others for all activities of daily living for nearly three years. Outpatient medical and psychiatric assessments failed to clarify diagnosis. On admission to a general hospital, the neurology team initially believed she had a Parkinson's-like syndrome but after further investigation and comprehensive multidisciplinary assessment, including neuro-psychiatric review, she was diagnosed with catatonia. She was subsequently admitted to a psychiatric hospital where she received electro-convulsive therapy and changes to her psychotropic medication regimen. She responded well to treatment and within a short period of time was able to function independently again.

The Vegetative State and the Science of Consciousness

Consciousness in experimental subjects is typically inferred from reports and other forms of voluntary behaviour. A wealth of everyday experience confirms that healthy subjects do not ordinarily behave in these ways unless they are conscious. Investigation of consciousness in vegetative state patients has been based on the search for neural evidence that such broad functional capacities are preserved in some vegetative state patients. We call this the standard approach. To date, the results of the standard approach have suggested that some vegetative state patients might indeed be conscious, although they fall short of being demonstrative. The fact that some vegetative state patients show evidence of consciousness according to the standard approach is remarkable, for the standard approach to consciousness is rather conservative, and leaves open the pressing question of how to ascertain whether patients who fail such tests are conscious or not. We argue for a cluster-based 'natural kind' methodology that is adequate to that task, both as a replacement for the approach that currently informs research into the presence or absence of consciousness in vegetative state patients and as a methodology for the science of consciousness more generally.

The Internal Anticipation of Sensory Action Effects: When Action Induces FFA and PPA Activity

Voluntary action – in particular the ability to produce desired effects in the environment – is fundamental to human existence. According to ideomotor theory we can achieve goals in the environment by means of anticipating their outcomes. We aimed at providing neurophysiological evidence for the assumption that performing actions calls for the activation of brain areas associated with the sensory effects usually evoked by the actions. We conducted an fMRI study in which right and left button presses lead to the presentation of face and house pictures. We compared a baseline phase with the same phase after participants experienced the association between button presses and pictures. We found an increase in the parahippocampal place area (PPA) for the response that has been associated with house pictures and fusiform face area (FFA) for the response that has been coupled with face pictures. This observation constitutes support for ideomotor theory.

Opportunities to say 'yes': rare speech automatisms in a case of progressive nonfluent aphasia and apraxia

We describe the investigation of speech automatisms in a man with progressive nonfluent aphasia and apraxias. Occurrence of the automatisms yes and right, were analysed across a range of speech tasks varying in length, propositionality, lexical and articulatory complexity, whether tasks engaged internal generation or external triggering and articulatory distortions, and while completing pantomimes/gestures. No differences were found in occurrence across most tasks but there was a significant interaction between automatism production and apraxic speech errors and during limb praxic tasks, suggesting that production of the automatism was unrelated to linguistic or lexical variables, but was related to the presence of speech apraxia coupled with disinhibition.