Approaching objects cause confusion in patients with Alzheimer's disease regarding their direction of self-movement

Contrast Sensitivity, Visual Field, Color Vision, Motion Perception, and Cognitive Impairment: A Systematic Review

OBJECTIVES

To examine relationships between visual function (ie, contrast sensitivity, visual field, color vision, and motion perception) and cognitive impairment, including any definition of "cognitive impairment," mild cognitive impairment, or dementia.

DESIGN

Systematic review and meta-analyses.

SETTING AND PARTICIPANTS

Any settings; participants with (cases) or without (controls) cognitive impairment.

METHODS

We searched 4 databases (to January 2024) and included published studies that compared visual function between cases and controls. Standardized mean differences (SMD) with 95% CIs were calculated where data were available. Data were sufficient for meta-analyses when cases were people with dementia. The Joanna Briggs Institute checklists were used for quality assessment.

RESULTS

Fifty-one studies/69 reports were included. Cross-sectional evidence shows that people with dementia had worse contrast sensitivity function and color vision than controls: measured by contrast sensitivity (log units) on letter charts, SMD -1.22 (95% CI -1.98, -0.47), or at varied spatial frequencies, -0.92 (-1.28, -0.57); and by pseudoisochromatic plates, -1.04 (-1.59, -0.49); color arrangement, -1.30 (-2.31, -0.29); or matching tests, -0.51 (-0.78, -0.24). They also performed more poorly on tests of motion perception, -1.20 (-1.73, -0.67), and visual field: mean deviation, -0.87 (-1.29, -0.46), and pattern standard deviation, -0.69 (-1.24, -0.15). Results were similar when cases were limited to participants with clinically diagnosed Alzheimer disease. Sources of bias included lack of clarity on study populations or settings and definitions of cognitive impairment. The 2 included longitudinal studies with follow-ups of approximately 10 years were of good quality but reported inconsistent results.

CONCLUSIONS AND IMPLICATIONS

In the lack of longitudinal data, cross-sectional studies indicate that individuals with cognitive impairment have poorer visual function than those with normal cognition. Additional longitudinal data are needed to understand whether poor visual function precedes cognitive impairment and the most relevant aspects of visual function, dementia pathologies, and domains of cognition.

Multisensory visual-vestibular training improves visual heading estimation in younger and older adults

Self-motion perception (e.g., when walking/driving) relies on the integration of multiple sensory cues including visual, vestibular, and proprioceptive signals. Changes in the efficacy of multisensory integration have been observed in older adults (OA), which can sometimes lead to errors in perceptual judgments and have been associated with functional declines such as increased falls risk. The objectives of this study were to determine whether passive, visual-vestibular self-motion heading perception could be improved by providing feedback during multisensory training, and whether training-related effects might be more apparent in OAs vs. younger adults (YA). We also investigated the extent to which training might transfer to improved standing-balance. OAs and YAs were passively translated and asked to judge their direction of heading relative to straight-ahead (left/right). Each participant completed three conditions: (1) vestibular-only (passive physical motion in the dark), (2) visual-only (cloud-of-dots display), and (3) bimodal (congruent vestibular and visual stimulation). Measures of heading precision and bias were obtained for each condition. Over the course of 3 days, participants were asked to make bimodal heading judgments and were provided with feedback (“correct”/“incorrect”) on 900 training trials. Post-training, participants’ biases, and precision in all three sensory conditions (vestibular, visual, bimodal), and their standing-balance performance, were assessed. Results demonstrated improved overall precision (i.e., reduced JNDs) in heading perception after training. Pre- vs. post-training difference scores showed that improvements in JNDs were only found in the visual-only condition. Particularly notable is that 27% of OAs initially could not discriminate their heading at all in the visual-only condition pre-training, but subsequently obtained thresholds in the visual-only condition post-training that were similar to those of the other participants. While OAs seemed to show optimal integration pre- and post-training (i.e., did not show significant differences between predicted and observed JNDs), YAs only showed optimal integration post-training. There were no significant effects of training for bimodal or vestibular-only heading estimates, nor standing-balance performance. These results indicate that it may be possible to improve unimodal (visual) heading perception using a multisensory (visual-vestibular) training paradigm. The results may also help to inform interventions targeting tasks for which effective self-motion perception is important.

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.

Causal inference accounts for heading perception in the presence of object motion

The brain infers our spatial orientation and properties of the world from ambiguous and noisy sensory cues. Judging self-motion (heading) in the presence of independently moving objects poses a challenging inference problem because the image motion of an object could be attributed to movement of the object, self-motion, or some combination of the two. We test whether perception of heading and object motion follows predictions of a normative causal inference framework. In a dual-report task, subjects indicated whether an object appeared stationary or moving in the virtual world, while simultaneously judging their heading. Consistent with causal inference predictions, the proportion of object stationarity reports, as well as the accuracy and precision of heading judgments, depended on the speed of object motion. Critically, biases in perceived heading declined when the object was perceived to be moving in the world. Our findings suggest that the brain interprets object motion and self-motion using a causal inference framework.

Dissociation of Self-Motion and Object Motion by Linear Population Decoding That Approximates Marginalization

We use visual image motion to judge the movement of objects, as well as our own movements through the environment. Generally, image motion components caused by object motion and self-motion are confounded in the retinal image. Thus, to estimate heading, the brain would ideally marginalize out the effects of object motion (or vice versa), but little is known about how this is accomplished neurally. Behavioral studies suggest that vestibular signals play a role in dissociating object motion and self-motion, and recent computational work suggests that a linear decoder can approximate marginalization by taking advantage of diverse multisensory representations. By measuring responses of MSTd neurons in two male rhesus monkeys and by applying a recently-developed method to approximate marginalization by linear population decoding, we tested the hypothesis that vestibular signals help to dissociate self-motion and object motion. We show that vestibular signals stabilize tuning for heading in neurons with congruent visual and vestibular heading preferences, whereas they stabilize tuning for object motion in neurons with discrepant preferences. Thus, vestibular signals enhance the separability of joint tuning for object motion and self-motion. We further show that a linear decoder, designed to approximate marginalization, allows the population to represent either self-motion or object motion with good accuracy. Decoder weights are broadly consistent with a readout strategy, suggested by recent computational work, in which responses are decoded according to the vestibular preferences of multisensory neurons. These results demonstrate, at both single neuron and population levels, that vestibular signals help to dissociate self-motion and object motion.SIGNIFICANCE STATEMENT The brain often needs to estimate one property of a changing environment while ignoring others. This can be difficult because multiple properties of the environment may be confounded in sensory signals. The brain can solve this problem by marginalizing over irrelevant properties to estimate the property-of-interest. We explore this problem in the context of self-motion and object motion, which are inherently confounded in the retinal image. We examine how diversity in a population of multisensory neurons may be exploited to decode self-motion and object motion from the population activity of neurons in macaque area MSTd.

Different trajectories of decline for global form and global motion processing in aging, mild cognitive impairment and Alzheimer's disease

The visual processing of complex motion is impaired in Alzheimer's disease (AD). However, it is unclear whether these impairments are biased toward the motion stream or part of a general disruption of global visual processing, given some reports of impaired static form processing in AD. Here, for the first time, we directly compared the relative preservation of motion and form systems in AD, mild cognitive impairment, and healthy aging, by measuring coherence thresholds for well-established global rotational motion and static form stimuli known to be of equivalent complexity. Our data confirm a marked motion-processing deficit specific to some AD patients, and greater than any form-processing deficit for this group. In parallel, we identified a more gradual decline in static form recognition, with thresholds raised in mild cognitive impairment patients and slightly further in the AD group compared with controls. We conclude that complex motion processing is more vulnerable to decline in dementia than complex form processing, perhaps owing to greater reliance on long-range neural connections heavily targeted by AD pathology.

Multisensory Integration of Visual and Vestibular Signals Improves Heading Discrimination in the Presence of a Moving Object

Humans and animals are fairly accurate in judging their direction of self-motion (i.e., heading) from optic flow when moving through a stationary environment. However, an object moving independently in the world alters the optic flow field and may bias heading perception if the visual system cannot dissociate object motion from self-motion. We investigated whether adding vestibular self-motion signals to optic flow enhances the accuracy of heading judgments in the presence of a moving object. Macaque monkeys were trained to report their heading (leftward or rightward relative to straight-forward) when self-motion was specified by vestibular, visual, or combined visual-vestibular signals, while viewing a display in which an object moved independently in the (virtual) world. The moving object induced significant biases in perceived heading when self-motion was signaled by either visual or vestibular cues alone. However, this bias was greatly reduced when visual and vestibular cues together signaled self-motion. In addition, multisensory heading discrimination thresholds measured in the presence of a moving object were largely consistent with the predictions of an optimal cue integration strategy. These findings demonstrate that multisensory cues facilitate the perceptual dissociation of self-motion and object motion, consistent with computational work that suggests that an appropriate decoding of multisensory visual-vestibular neurons can estimate heading while discounting the effects of object motion.

SIGNIFICANCE STATEMENT

Objects that move independently in the world alter the optic flow field and can induce errors in perceiving the direction of self-motion (heading). We show that adding vestibular (inertial) self-motion signals to optic flow almost completely eliminates the errors in perceived heading induced by an independently moving object. Furthermore, this increased accuracy occurs without a substantial loss in the precision. Our results thus demonstrate that vestibular signals play a critical role in dissociating self-motion from object motion.

Perceiving Collision Impacts in Alzheimer's Disease: The Effect of Retinal Eccentricity on Optic Flow Deficits

The present study explored whether the optic flow deficit in Alzheimer's disease (AD) reported in the literature transfers to different types of optic flow, in particular, one that specifies collision impacts with upcoming surfaces, with a special focus on the effect of retinal eccentricity. Displays simulated observer movement over a ground plane toward obstacles lying in the observer's path. Optical expansion was modulated by varying [Formula: see text]. The visual field was masked either centrally (peripheral vision) or peripherally (central vision) using masks ranging from 10° to 30° in diameter in steps of 10°. Participants were asked to indicate whether their approach would result in "collision" or "no collision" with the obstacles. Results showed that AD patients' sensitivity to [Formula: see text] was severely compromised, not only for central vision but also for peripheral vision, compared to age- and education-matched elderly controls. The results demonstrated that AD patients' optic flow deficit is not limited to radial optic flow but includes also the optical pattern engendered by [Formula: see text]. Further deterioration in the capacity to extract [Formula: see text] to determine potential collisions in conjunction with the inability to extract heading information from radial optic flow would exacerbate AD patients' difficulties in navigation and visuospatial orientation.

Neuropsychological deficits associated with route learning in Alzheimer disease, MCI, and normal aging

BACKGROUND

The background of route learning (RL) abilities in Alzheimer disease (AD), mild cognitive impairment (MCI), and normal aging needs further study. We searched for neuropsychological and demographical predictors of RL impairment.

METHODS

RL was investigated in a clinical study including subjects classified as early AD (n=37), MCI (n=34), and aged normal controls (n=46). An ecological assessment procedure of RL was employed and landmarks learning and navigational abilities were evaluated. The consortium to establish a registry of Alzheimer's disease test battery was used for neuropsychological assessment.

RESULTS

Almost all AD patients, and most subjects with MCI misidentified landmarks and made navigational errors when following the route without assistance. Moreover, a small subgroup of normal controls also had problems with RL. Poor RL performance was best predicted by impairments in memory and executive functions.

CONCLUSIONS

RL impairment is common in early AD and MCI, and is occasionally also found in normal elderly subjects. Its characteristic appearance is a combination of poor landmark recognition and defective directional guidance. Poor RL can be predicted by neuropsychological testing. In MCI and in a subset of normal aged persons, RL impairment may herald incipient dementia.

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.

Might cortical hyper-responsiveness in aging contribute to Alzheimer's disease?

Our goal is to understand the neural basis of functional impairment in aging and Alzheimer's disease (AD) to be able to characterize clinically significant decline and assess therapeutic efficacy. We used frequency-tagged ERPs to word and motion stimuli to study the effects of stimulus conditions and selective attention. ERPs to word or motion increase when a task-irrelevant 2nd stimulus is added, but decrease when the task is moved to that 2nd stimulus. Spectral analyses show task effects on response power without 2nd stimulus effects. However, phase coherence shows both 2nd stimulus and task effects. Thus, power and coherence are dissociably modulated by stimulus and task effects. Task-dependent phase coherence successively declines in aging and AD. In contrast, task-dependent spectral power increases in aging, only to decrease in AD. We hypothesize that age-related declines in signal coherence, associated with increased power generation, stresses neurons and contributes to the loss of response power and the development of functional impairment in AD.

Visual motion event related potentials distinguish aging and Alzheimer's disease

BACKGROUND

Aging and Alzheimer's disease (AD) disrupt visuospatial processing and visual motion evoked potentials in a manner linked to navigational deficits.

OBJECTIVE

Our goal is to determine if aging and AD have distinct effects on visual cortical motion processing for navigation.

METHODS

We recorded visual motion event related potentials (ERPs) in young (YNC) and older normal controls (ONC), and early AD patients (EADs) who viewed rapidly changing optic flow stimuli that simulate naturalistic changes in heading direction, like those that occur when following a path of self-movement through the environment. After a random series of optic flow stimuli, a vertical motion stimulus was presented to verify sustained visual attention by demanding a rapid push-button response.

RESULTS

Optic flow evokes robust ERPs that are delayed in aging and diminished in AD. The interspersed vertical motion stimuli yielded shorter N200 latencies in EADs, matching those in ONCs, but the EADs' N200 amplitudes remained small.

CONCLUSIONS

Aging and AD have distinct effects on visual sensory processing: aging delays evoked response, whereas AD diminishes responsiveness.

Independent deficits of visual word and motion processing in aging and early Alzheimer's disease

We tested whether visual processing impairments in aging and Alzheimer's disease (AD) reflect uniform posterior cortical decline, or independent disorders of visual processing for reading and navigation. Young and older normal controls were compared to early AD patients using psychophysical measures of visual word and motion processing. We find elevated perceptual thresholds for letters and word discrimination from young normal controls, to older normal controls, to early AD patients. Across subject groups, visual motion processing showed a similar pattern of increasing thresholds, with the greatest impact on radial pattern motion perception. Combined analyses show that letter, word, and motion processing impairments are independent of each other. Aging and AD may be accompanied by independent impairments of visual processing for reading and navigation. This suggests separate underlying disorders and highlights the need for comprehensive evaluations to detect early deficits.

Infusion of GAT1-saporin into the medial septum/vertical limb of the diagonal band disrupts self-movement cue processing and spares mnemonic function

Degeneration of the septohippocampal system is associated with the progression of Dementia of the Alzheimer's type (DAT). Impairments in mnemonic function and spatial orientation become more severe as DAT progresses. Although evidence supports a role for cholinergic function in these impairments, relatively few studies have examined the contribution of the septohippocampal GABAergic component to mnemonic function or spatial orientation. The current study uses the rat food-hoarding paradigm and water maze tasks to characterize the mnemonic and spatial impairments associated with infusing GAT1-Saporin into the medial septum/vertical limb of the diagonal band (MS/VDB). Although infusion of GAT1-Saporin significantly reduced parvalbumin-positive cells in the MS/VDB, no reductions in markers of cholinergic function were observed in the hippocampus. In general, performance was spared during spatial tasks that provided access to environmental cues. In contrast, GAT1-Saporin rats did not accurately carry the food pellet to the refuge during the dark probe. These observations are consistent with infusion of GAT1-Saporin into the MS/VDB resulting in spared mnemonic function and use of environmental cues; however, self-movement cue processing was compromised. This interpretation is consistent with a growing literature demonstrating a role for the septohippocampal system in self-movement cue processing.

Vestibular facilitation of optic flow parsing

Simultaneous object motion and self-motion give rise to complex patterns of retinal image motion. In order to estimate object motion accurately, the brain must parse this complex retinal motion into self-motion and object motion components. Although this computational problem can be solved, in principle, through purely visual mechanisms, extra-retinal information that arises from the vestibular system during self-motion may also play an important role. Here we investigate whether combining vestibular and visual self-motion information improves the precision of object motion estimates. Subjects were asked to discriminate the direction of object motion in the presence of simultaneous self-motion, depicted either by visual cues alone (i.e. optic flow) or by combined visual/vestibular stimuli. We report a small but significant improvement in object motion discrimination thresholds with the addition of vestibular cues. This improvement was greatest for eccentric heading directions and negligible for forward movement, a finding that could reflect increased relative reliability of vestibular versus visual cues for eccentric heading directions. Overall, these results are consistent with the hypothesis that vestibular inputs can help parse retinal image motion into self-motion and object motion components.

Driving strategy alters neuronal responses to self-movement: cortical mechanisms of distracted driving

We presented naturalistic combinations of virtual self-movement stimuli while recording neuronal activity in monkey cerebral cortex. Monkeys used a joystick to drive to a straight ahead heading direction guided by either object motion or optic flow. The selected cue dominates neuronal responses, often mimicking responses evoked when that stimulus is presented alone. In some neurons, driving strategy creates selective response additivities. In others, it creates vulnerabilities to the disruptive effects of independently moving objects. Such cue interactions may be related to the disruptive effects of independently moving objects in Alzheimer's disease patients with navigational deficits.

Distinct visual motion processing impairments in aging and Alzheimer's disease

Aging and Alzheimer's disease (AD) are associated with declines in the visual perception of self-movement that undermine navigation and independent living. We studied 214 subjects' heading direction and speed discrimination using the radial patterns of visual motion in optic flow. Young (YA), middle-aged (MA), and older normal (ON) subjects, and AD patients viewed optic flow in which we manipulated the motion coherence, spatial texture, and temporal periodicity composition of the visual display. Aging and AD were associated with poorer heading and speed perception at lower temporal periodicity, with smaller effects of spatial texture. AD patients were particularly impaired by motion incoherence created by adding randomly moving dots to the optic flow. We conclude that visual motion processing is impaired by distinct mechanisms in aging and the transition to AD, implying distinct neural mechanisms of impairment.