Beyond visual integration: sensitivity of the temporal-parietal junction for objects, places, and faces

One important role of the TPJ is the contribution to perception of the global gist in hierarchically organized stimuli where individual elements create a global visual percept. However, the link between clinical findings in simultanagnosia and neuroimaging in healthy subjects is missing for real-world global stimuli, like visual scenes. It is well-known that hierarchical, global stimuli activate TPJ regions and that simultanagnosia patients show deficits during the recognition of hierarchical stimuli and real-world visual scenes. However, the role of the TPJ in real-world scene processing is entirely unexplored. In the present study, we first localized TPJ regions significantly responding to the global gist of hierarchical stimuli and then investigated the responses to visual scenes, as well as single objects and faces as control stimuli. All three stimulus classes evoked significantly positive univariate responses in the previously localized TPJ regions. In a multivariate analysis, we were able to demonstrate that voxel patterns of the TPJ were classified significantly above chance level for all three stimulus classes. These results demonstrate a significant involvement of the TPJ in processing of complex visual stimuli that is not restricted to visual scenes and that the TPJ is sensitive to different classes of visual stimuli with a specific signature of neuronal activations.

Persistent neurocognitive deficits in cognitively impaired survivors of sepsis are explained by reductions in working memory capacity

Introduction

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Mounting evidence suggests that many cognitively impaired sepsis survivors show long-term neurocognitive deficits in neuropsychological tasks. To date, the underlying mechanisms of these deficits are insufficiently understood. Based on previous evaluations we hypothesized that visual attention and working memory may be affected in a sample of cognitively impaired sepsis survivors.

Methods

We utilized psychophysical whole-and partial-report paradigms based on the computational theory of visual attention (TVA) to determine (i) whether sepsis survivors show changes in basic parameters of visual attention and working memory, (ii) whether the affected parameters are related to neuropsychological test results in a standard battery in sepsis survivors and matched healthy control participants, (iii) whether between-group differences in these basic parameters of visual attention could account for underperformance of sepsis survivors in neuropsychological tests when adjusting for potentially relevant clinical variables.

Results

We showed that, in sepsis survivors, the maximum number of elements consciously maintained in an instant, i.e. the working memory storage capacity K, is reduced (sepsis survivors: M = 3.0; healthy controls: M = 3.4). Moreover, K explained variance in neurocognitive outcomes -17% in attentional and 16 % in executive functions - in a standard neuropsychological battery. The association remained stable when adjusting for clinical variables.

Discussion

Thus, in our sample of cognitively impaired sepsis survivors, a reduction in working memory capacity seems to be a critical determinant of the neurocognitive sequelae. It should be the subject of future work on mechanisms but may also serve as surrogate outcome measure in interventional studies.

Abnormal network connections to early visual cortex in posterior cortical atrophy

INTRODUCTION

Posterior Cortical Atrophy (PCA), a visual variant of Alzheimer's disease, initially manifests with higher-order visual disorders and parieto/temporo-occipital atrophy. Recent studies have shown remote functional impairment in both distant brain networks and along the calcarine sulcus (V1). Functional alteration in the calcarine differs along its length, reflecting center to periphery visual space differences. Herein, we aim to connect between these two sets of findings by looking at the retinotopic patterns of functional connectivity between large-scale brain networks and V1, comparing patients with normally sighted subjects.

METHODS

Resting state functional magnetic resonance imaging (fMRI) and T1 anatomical scans were obtained from 11 PCA patients and 17 age-matched healthy volunteers. Default mode network (DMN) and fronto parietal network (FPN) were defined and differences between the networks in patients and healthy controls were evaluated at the whole brain level, specifically their connectivity to V1.

RESULTS

Connectivity patterns within the DMN and the FPN were similar between the groups, although differences were found in regions within and beyond the networks. Focusing on V1, in the control group we identified the expected pattern of a distributed connectivity along eccentricity, with foveal regions showing stronger connectivity to the FPN and peripheral regions showing stronger connectivity to the DMN. However, in PCA patients we could not identify a clear difference in connectivity along the eccentricities.

CONCLUSION

Lost specialization of function along the calcarine in PCA patients may have further implications on large-scale networks or vice versa. This impairment, distant from the core pathology, might explain patients' visual disabilities.

A hypoarousal model of neurological post-COVID syndrome: the relation between mental fatigue, the level of central nervous activation and cognitive processing speed

BACKGROUND

Knowledge on the nature of post-COVID neurological sequelae often manifesting as cognitive dysfunction and fatigue is still unsatisfactory.

OBJECTIVES

We assumed that cognitive dysfunction and fatigue in post-COVID syndrome are critically linked via hypoarousal of the brain. Thus, we assessed whether tonic alertness as a neurocognitive index of arousal is reduced in these patients and how this relates to the level of central nervous activation and subjective mental fatigue as further indices of arousal.

METHODS

40 post-COVID patients with subjective cognitive dysfunction and 40 matched healthy controls underwent a whole-report paradigm of briefly presented letter arrays. Based on report performance and computational modelling according to the theory of visual attention, the parameter visual processing speed (VPS) was quantified as a proxy of tonic alertness. Pupillary unrest was assessed as a measure of central nervous activation. The Fatigue Assessment Scale was applied to assess subjective mental fatigue using the corresponding subscale.

RESULTS

VPS was reduced in post-COVID patients compared to controls (p = 0.005). In these patients, pupillary unrest (p = 0.029) and mental fatigue (p = 0.001) predicted VPS, explaining 34% of the variance and yielding a large effect with f2 = 0.51.

CONCLUSION

In post-COVID patients with subjective cognitive dysfunction, hypoarousal of the brain is reflected in decreased processing speed which is explained by a reduced level of central nervous activation and a higher level of mental fatigue. In turn, reduced processing speed objectifies mental fatigue as a core subjective clinical complaint in post-COVID patients.

Neurofunctional Correlates of Activities of Daily Living in Patients with Posterior Cortical Atrophy

BACKGROUND

Research on posterior cortical atrophy (PCA) has focused on cognitive decline, especially visual processing deficits. However, few studies have examined the impact of PCA on activities of daily living (ADL) and the neurofunctional and neuroanatomic bases of ADL.

OBJECTIVE

To identify brain regions associated with ADL in PCA patients.

METHODS

A total of 29 PCA patients, 35 typical Alzheimer's disease (tAD) patients, and 26 healthy volunteers were recruited. Each subject completed an ADL questionnaire that included basic and instrumental subscales (BADL and IADL, respectively), and underwent hybrid magnetic resonance imaging and 18F fluorodeoxyglucose positron emission tomography. Voxel-wise regression multivariable analysis was conducted to identify specific brain regions associated with ADL.

RESULTS

General cognitive status was similar between PCA and tAD patients; however, the former had lower total ADL scores and BADL and IADL scores. All three scores were associated with hypometabolism in bilateral parietal lobes (especially bilateral superior parietal gyri) at the whole-brain level, PCA-related hypometabolism level, and PCA-specific hypometabolism level. A cluster that included the right superior parietal gyrus showed an ADL×group interaction effect that was correlated with the total ADL score in the PCA group (r = -0.6908, p = 9.3599e-5) but not in the tAD group (r = 0.1006, p = 0.5904). There was no significant association between gray matter density and ADL scores.

CONCLUSION

Hypometabolism in bilateral superior parietal lobes contributes to a decline in ADL in patients with PCA and can potentially be targeted by noninvasive neuromodulatory interventions.

Lower visual processing speed relates to greater subjective cognitive complaints in community-dwelling healthy older adults

Introduction

Subjective cognitive complaints in older age may reflect subtle objective impairments in basic cognitive functions that might foreshadow broader cognitive problems. Such cognitive functions, however, are not captured by standard neuropsychological testing. Visual processing speed is a basic visual attention function that underlies the performance of cognitive tasks relying on visual stimuli. Here, we test the hypothesis that lower visual processing speed correlates with greater subjective cognitive complaints in healthy older adults from the community.

Methods

To do so, we assessed a sample of 30 healthy, cognitively normal older adults (73.07 ± 7.73 years old; range: 60-82; 15 females) with respect to individual subjective cognitive complaints and visual processing speed. We quantified the degree of subjective cognitive complaints with two widely-used questionnaires: the Memory Functioning Questionnaire and the Everyday Cognition. We used verbal report tasks and the theory of visual attention to estimate a visual processing speed parameter independently from motor speed and other visual attention parameters, i.e., visual threshold, visual short-term memory storage capacity, top-down control, and spatial weighting.

Results

We found that lower visual processing speed correlated with greater subjective complaints and that this relationship was not explained by age, education, or depressive symptoms. The association with subjective cognitive complaints was specific to visual processing speed, as it was not observed for other visual attention parameters.

Discussion

These results indicate that subjective cognitive complaints reflect a reduction in visual processing speed in healthy older adults. Together, our results suggest that the combined assessment of subjective cognitive complaints and visual processing speed has the potential to identify individuals at risk for cognitive impairment before the standard tests show any abnormal results.

How Effective are Pictures in Eliciting Information from People Living with Dementia? A Systematic Review

OBJECTIVES

Decline in language and cognitive functioning often deprives people living with moderate-to-severe dementia of self-reporting their quality of life (QoL) on the written and verbal formats of questionnaires. This systematic review aimed to evaluate the effectiveness of pictorial tools as an alternative method for enabling people living with dementia to self-report their QoL.

METHODS

PubMed, PsycINFO, CINAHL, and EMBASE were searched. Primary research studies reporting on information elicitation from people living with dementia through pictures were deemed eligible. Six studies satisfied the inclusion criteria. Methodological quality of the studies was evaluated through Downs and Black checklist. Data was extracted according to population, intervention, comparator, and outcomes (PICO) and results were summarized and supplemented by narrative synthesis.

RESULTS

Compared to usual communication methods, pictorial tools were found to have a superior effect on comprehension of conversations and decision-making abilities, minimal effect on preference consistency, and an undeterminable effect on discourse features.

CONCLUSIONS

There is consistent evidence that pictures enhance comprehension and might facilitate decision-making abilities.

CLINICAL IMPLICATIONS

QoL information can be elicited more effectively through pictorial tools. Future studies warrant development of pictorial versions of standardized QoL tools which will assist the inclusion of people living with severe dementia.

Clinical Screening for Posterior Cortical Atrophy

BACKGROUND

Posterior cortical atrophy (PCA) is a progressive neurologic syndrome that presents with complex visual deficits. Although PCA is most commonly a form of Alzheimer disease (AD), its early diagnosis is usually delayed due to a lack of understanding for how best to clinically screen for the syndrome.

OBJECTIVE

To identify neurobehavioral screening tasks for PCA-beyond simple visual constructions-that can be administered in clinic or at bedside.

METHOD

We compared the performance of 12 individuals who met neuroimaging-supported consensus criteria for PCA with that of 12 matched individuals with typical AD (tAD) and 24 healthy controls (HC) on clinic/bedside tasks measuring (a) complex figure copying, (b) Balint syndrome, (c) visual object agnosia, (d) color identification, (e) figure-ground discrimination, (f) global-local processing, (g) dressing apraxia, (h) ideomotor apraxia, and (i) Gerstmann syndrome.

RESULTS

All of the individuals with PCA were impaired on the figure-ground discrimination task compared with half of the tAD group and no HC. Approximately half of the PCA group had Balint syndrome, dressing apraxia, and ideomotor apraxia compared with none in the tAD group. Difficulty copying a complex figure, global-local processing impairment, and Gerstmann syndrome did not distinguish between the two dementia groups.

CONCLUSION

The figure-ground discrimination task can be used successfully as an overall screening measure for PCA, followed by specific tasks for Balint syndrome and dressing and limb apraxia. Findings reinforce PCA as a predominant occipitoparietal disorder with dorsal visual stream involvement and parietal signs with spatiomotor impairments.

The Birthday Party Test (BPT): A new picture description test to support the assessment of simultanagnosia in patients with acquired brain injury

There is broad consensus on the utility of complex pictures in the assessment of simultanagnosia in patients with acquired brain injury (ABI). To overcome various shortcomings of current instruments, we have developed the Birthday Party Test (BPT); a picture description test that contains a neutral scene, a balanced representation of events, and provides clear instructions and a scoring-aid. We have applied the BPT in a large group of patients with ABI (n = 502) and in an age-matched healthy control group (n = 194). Our results show that performance on the BPT was associated with a range of descriptive, neuropsychological and clinical characteristics and that poor test performance appeared to be more common in patients with etiologies that have an increased risk of bilateral damage. Furthermore, we assume a high correspondence between test performance on the BPT and the assessor's clinical judgment of likely having simultanagnosia in preliminary analyses. This study shows the potential usefulness of the BPT to support diagnostic decision making in simultanagnosia. The BPT is made freely available to facilitate its broad application in the clinical assessment of patients with visual impairment and to enable a further evaluation of its utility and validity in future studies.

Brain structural and functional anomalies associated with simultanagnosia in patients with posterior cortical atrophy

Simultanagnosia is a common symptom of posterior cortical atrophy, and its association with brain structural and functional changes remains unclear. In our study, 18 posterior cortical atrophy patients with simultanagnosia, 29 patients with Alzheimer’s disease and 20 cognitively normal controls were recruited and subjected to full neuropsychological evaluation, including simultanagnosia tests, and structural and resting-state functional MRI. The gray matter volume was assessed by voxel-based morphometry, while the intrinsic functional connectivity was evaluated using the reduced gray matter volume regions of interest as the seed. In contrast to the patients with Alzheimer’s disease, those with posterior cortical atrophy showed the following: (1) markedly lower simultanagnosia test scores, (2) an altered regional gray matter volume of the left middle occipital gyrus and ventral occipital areas, and (3) lowered intrinsic functional connectivity with the left middle occipital gyrus, left lingual gyrus and right middle occipital gyrus separately. Additionally, the gray matter volume of the left middle occipital gyrus and left inferior occipital gyrus were each correlated with simultanagnosia in posterior cortical atrophy patients. The intrinsic functional connectivity of the left middle occipital gyrus with the right superior occipital gyrus and that of the right middle occipital gyrus with the left superior parietal gyrus were also correlated with simultanagnosia in posterior cortical atrophy patients. In summary, this study indicated that simultanagnosia is associated with gray matter reductions and decreased functional connectivity in the left middle occipital gyrus and the left inferior occipital gyrus in patients with posterior cortical atrophy.

Visuospatial working memory dysfunction from tapping span test as a diagnostic tool for patients with mild posterior cortical atrophy

Posterior cortical atrophy is a rare degenerative condition with prominent visuospatial dysfunction which commonly occurs between ages 50 and 65. A diagnosis of mild posterior cortical atrophy sometimes challenging and can be delayed because there are currently no established neuropsychological examination methods that can easily be used in clinical settings. In this study, we examined whether the tapping span test is a potential diagnostic tool for posterior cortical atrophy and what impairment the tapping span test is indicative of in this condition. Eight patients with mild posterior cortical atrophy were recruited. Age- and severity-matched individuals with amnesic Alzheimer's disease (n = 9) were also recruited as a control group. The participants were subjected to the tapping span test and several visuospatial working memory tests. The results of the tapping span and visuospatial working memory tests were worse for the posterior cortical atrophy group when compared with the control group. The results from the tapping span tests were strongly correlated with those from the visuospatial working memory tests. The tapping span test is a simple and potentially useful diagnostic tool for patients with mild posterior cortical atrophy, as it reflects visuospatial working memory function.

Phasic alerting increases visual processing speed in amnestic mild cognitive impairment

External warning cues temporarily increase the brain's sensitivity for upcoming events, helping individuals to flexibly adapt their reactions to the requirements of complex visual environments. Previous studies reported that younger and cognitively normal older adults profit from phasic alerting cues. Such an intact phasic alerting mechanism could be even more relevant in individuals with Alzheimer's disease who are characterized by reduced processing capacities. The present study employed a theory of visual attention based verbal whole report paradigm with auditory cues in order to investigate phasic alerting effects in amnestic mild cognitive impairment (aMCI). Patients with aMCI were also compared to a previously reported sample of cognitively normal older adults. In patients with aMCI, visual processing speed was higher in the cue compared to the no-cue condition. Further, visual processing speed was reduced in patients with aMCI compared to cognitively normal older adults. Taken together, the results suggest that the processing system of patients with aMCI exhibits general declines but can still integrate auditory warning signals on a perceptual level.

Object recognition and visual object agnosia

The term visual agnosia is used to refer to recognition disorders that are confined to the visual modality, that are not due to an impairment in sensory functions, and that cannot be explained by other cognitive deficits or by general reduction in intellectual ability. Here, we describe the different types of visual agnosia that have been reported (form agnosia, integrative agnosia, associative agnosia, transformational and orientation agnosia as well as category-specific impairments such as pure alexia and prosopagnosia) and how they relate to the current understanding of visual object recognition. Together with related disorders such as simultanagnosia, texture agnosia, aphantasia, and optic aphasia, these visual perceptual impairments can have severe consequences for those affected. We suggest how in-depth assessment can be carried out to determine the type and the extent of these impairments. In the context of clinical assessment, a step-by-step approach reflecting a posterior to anterior gradient in visual object recognition, from more perceptual to more memory-related processes, is suggested. Individually tailored interventions targeting the identified impairments can be initiated based on the results of the assessment.

Superior Parietal Lobule: A Role in Relative Localization of Multiple Different Elements

Simultanagnosia is an impairment in processing multiple visual elements simultaneously consecutive to bilateral posterior parietal damage, and neuroimaging data have specifically implicated the superior parietal lobule (SPL) in multiple element processing. We previously reported that a patient with focal and bilateral lesions of the SPL performed slower than controls in visual search but only for stimuli consisting of separable lines. Here, we further explored this patient's visual processing of plain object (colored disk) versus object consisting of separable lines (letter), presented in isolation (single object) versus in triplets. Identification of objects was normal in isolation but dropped to chance level when surrounded by distracters, irrespective of eccentricity and spacing. We speculate that this poor performance reflects a deficit in processing objects' relative locations within the triplet (for colored disks), aggravated by a deficit in processing the relative location of each separable line (for letters). Confirming this, performance improved when the patient just had to detect the presence of a specific colored disk within the triplets (visual search instruction), while the inability to identify the middle letter was alleviated when the distracters were identical letters that could be grouped, thereby reducing the number of ways individual lines could be bound.

Convergence Along the Visual Hierarchy Is Altered in Posterior Cortical Atrophy

Purpose

Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome manifesting with visuospatial processing impairment. We recently suggested that abnormal population receptive field properties are associated with the symptoms of PCA patients. Specifically, simultanagnosia, the inability to perceive multiple items simultaneously, can be explained by smaller peripheral population receptive fields, and foveal crowding, in which nearby distractors interfere with object perception, may result from larger foveal population receptive fields. These effects occurred predominantly in V1, even though atrophy mainly involves high-order areas. In this study, we used connective field modeling to better understand these inter-area interactions.

Methods

We used functional magnetic resonance imaging to scan six PCA patients and eight controls while they viewed drifting bar stimuli. Resting-state data were also collected. Connective field modeling was applied for both conditions: once when the source was V1 and the targets were extrastriate areas and once for the opposite direction. The difference between the two was defined as convergence magnitude.

Results

With stimulus, the convergence magnitude of the controls increased along the visual pathway, suggesting that spatial integration from V1 becomes larger up the visual hierarchy. No such slope was found in the PCA patients. The difference between the groups originated mainly from the dorsal pathway. Without stimulus, the convergence magnitude was negative, slightly more so for the PCA patients, with no slope, suggesting constant divergence along the visual hierarchy.

Conclusions

Atrophy in one part of the visual system can affect other areas within the network through complex intervisual area interactions, resulting in modulation of population receptive field properties and an ensemble of visuocognitive function impairments.

Posterior Cortical Atrophy: Characteristics From a Clinical Data Registry

Background: Posterior cortical atrophy (PCA) is a neurodegenerative syndrome that presents with higher-order visual dysfunction with relative sparing of memory and other cognitive domains, and it is most commonly associated with Alzheimer's disease pathology. There is a lack of data regarding the presentation of PCA to non-cognitive specialists. Therefore, we collected clinical data from neuro-ophthalmologists regarding the presentation of PCA to their practices and compared data to published cohorts and a published survey of cognitive specialists.

Methods: Members of the North American Neuro-Ophthalmology Society Listserv (NANOSnet) were invited to complete an online, retrospective, chart-review data-entry survey regarding their patients with PCA, and REDCap was used for data collection.

Results: Data for 38 patients were entered by 12 neuro-ophthalmologists. Patient mean age at presentation was 67.8 years, and 74% of patients were women. Difficulty reading was reported at presentation by 91% of patients, and poor performance on color vision, stereopsis, and visual field testing (performed reliably by 36/38 patients) were common findings. Most patients who were treated were treated with donepezil and/or memantine.

Conclusions: Compared to published data from cognitive specialists, patients presenting to neuro-ophthalmology with PCA were more likely to be older and female and have a reading complaint. Reliable visual field testing was the norm with homonymous defects in the majority of patients. The neuro-ophthalmologist plays an important role in diagnosing PCA in older adults with unexplained visual signs and symptoms, and future studies of PCA should involve multiple specialists in order to advance our understanding of PCA and develop effective treatments.

Impairments of attention in Alzheimer's disease

Alzheimer's Disease (AD) is characteristically perceived as primarily being a disorder of episodic memory, with prominent attentional impairments more typically being associated with other neurodegenerative conditions, such as Dementia with Lewy Bodies. However, attention is also affected early on in Alzheimer's, particularly in individuals with young onset and atypical syndromes. In addition, some initial symptoms that are apparently due to episodic memory loss may be secondary to failures of attentional processes. This review delineates the various attentional impairments that can be observed in patients with AD, and addresses them through the conceptual framework of attention proposed by Posner and Petersen. It also describes how current knowledge of the development of AD has influenced our understanding of how these deficits arise. Finally, there is a brief summary of the effects of current AD treatments on attentional processes, and how future pharmacological approaches might better target these deficits.

Prevalence of Mathematical and Visuospatial Learning Disabilities in Patients With Posterior Cortical Atrophy

Importance

Increased prevalence of language-based learning disabilities (LDs) has been previously reported in patients with primary progressive aphasia (PPA). This study hypothesized that patients with focal neurodegenerative syndromes outside the language network, such as posterior cortical atrophy (PCA), would have a higher rate of nonlanguage LDs, congruent with their mainly visuospatial presentation.

Objective

To investigate the prevalence and type of LD (language and/or mathematical and visuospatial) in a large cohort of patients with PCA compared with patients with logopenic variant PPA (lvPPA) and amnestic Alzheimer disease (AD).

Design, Setting, and Participants

This case-control study reviewed 279 medical records from a university-based clinic and research center for patients with neurodegenerative diseases for LD history, including patients with PCA (n = 95), patients with lvPPA (n = 84), and a matched cohort with amnestic AD (n = 100). No records were excluded. The study compared cognitive and neuroimaging features of patients with PCA with and without LDs. A review of the records of patients presenting from March 1, 1999, to August 31, 2014, revealed 95 PCA cases and 84 lvPPA cases. Then 100 patients with amnestic AD from this same period were chosen for comparison, matching against the groups for age, sex, and disease severity. Data analysis was performed from September 8, 2013, to November 6, 2017.

Main Outcomes and Measures

Prevalence of total LD history and prevalence of language and mathematical or visuospatial LD history across all cohorts.

Results

A total of 179 atypical AD cases (95 with PCA and 84 with lvPPA) and 100 disease control cases (amnestic AD) were included in the study. The groups were not statistically different for mean (SD) age at first visit (PCA, 61.9 [7.0] years; lvPPA, 65.1 [8.7] years; amnestic AD, 64.0 [12.6] years; P = .08), mean (SD) age at first symptom (PCA, 57.5 [7.0] years; lvPPA, 61.1 [9.0] years; amnestic AD, 59.6 [13.7] years; P = .06), or sex (PCA, 66.3% female; lvPPA, 56.0% female; amnestic AD, 57.0% female; P = .30) but differed on non-right-hand preference (PCA, 18.3%; lvPPA, 20.2%; amnestic AD, 7.7%; P = .04), race/ethnicity (PCA, 88.3% white; lvPPA, 99.0% white; amnestic AD, 80.0% white; P < .001), and mean (SD) educational level (PCA, 15.7 [3.2] years; lvPPA, 16.2 [3.3] years; amnestic AD, 14.8 [3.5] years; P = .02). A total of 18 of the 95 patients with PCA (18.9%) reported a history of LD, which is greater than the 3 of 100 patients (3.0%) in the amnestic AD cohort (P < .001) and the 10.0% expected rate in the general population (P = .007). In the PCA cohort, 13 of 95 patients (13.7%) had a nonlanguage mathematical and/or visuospatial LD; this rate was greater than that in the amnestic AD (1 of 100 [1.0%]; P < .001) and lvPPA (2 of 84 [2.4%]; P = .006) cohorts and greater than the 6.0% expected general population rate of mathematical LD (P = .003). Compared with the patients with PCA without LDs, the group with LDs had greater preservation of global cognition and a more right-lateralized pattern of atrophy.

Conclusions and Relevance

Nonlanguage mathematical and visuospatial LDs were associated with focal, visuospatial predominant neurodegenerative clinical syndromes. This finding supports the hypothesis that neurodevelopmental differences in specific brain networks are associated with phenotypic manifestation of later-life neurodegenerative disease.

Improvement of Main Cognitive Functions in Patients with Alzheimer's Disease after Treatment with Coconut Oil Enriched Mediterranean Diet: A Pilot Study

BACKGROUND

Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder (mainly in women), and new therapies are needed. In this way, ketone bodies are a direct source of cellular energy and can be obtained from coconut oil, postulating that coconut oil could be a new non-pharmacological alternative in AD patients.

OBJECTIVE

The aim of this study is to detect changes in the main cognitive functions of patients with AD after following a coconut oil enriched Mediterranean diet, and to determine whether there are differences in function of stage or sex.

METHODS

A prospective, longitudinal, qualitative, analytic, experimental study was carried out in 44 patients with AD, who were randomly divided into two homogenous groups of 22 patients each: an experimental group of patients who followed a coconut oil enriched Mediterranean diet for 21 days and a control group. In order to determine the cognitive changes after the intervention, we carried out the 7 Minute Screen, which analyses temporal orientation, visuospatial and visuoconstructive abilities, and semantic and episodic memory.

RESULTS

After intervention with coconut oil, improvements in episodic, temporal orientation, and semantic memory were observed, and it seems that the positive effect is more evident in women with mild-moderate state, although other improvements in males and severe state were also shown.

CONCLUSIONS

The isocaloric coconut oil enriched Mediterranean diet seems to improve cognitive functions in patients with AD, with differences according to patient sex and degree of severity of the disease, although more studies in this line are needed.

Phasic alerting effects on visual processing speed are associated with intrinsic functional connectivity in the cingulo-opercular network

Phasic alertness refers to short-lived increases in the brain's "state of readiness", and thus to optimized performance following warning cues. Parametric modelling of whole report task performance based on the computational theory of visual attention (TVA) has demonstrated that visual processing speed is increased in such cue compared to no-cue conditions. Furthermore, with respect to the underlying neural mechanisms, individual visual processing speed has been related to intrinsic functional connectivity (iFC) within the cingulo-opercular network, suggesting that this network's iFC is relevant for the tonic maintenance of an appropriate readiness or alertness state. In the present study, we asked whether iFC in the cingulo-opercular network is also related to the individual ability to actively profit from warning cues, i.e. to the degree of phasic alerting. We obtained resting-state functional magnetic resonance imaging (rs-fMRI) data from 32 healthy young participants and combined an independent component analysis of rs-fMRI time courses and dual regression approach to determine iFC in the cingulo-opercular network. In a separate behavioural testing session, we parametrically assessed the effects of auditory phasic alerting cues on visual processing speed in a TVA-based whole report paradigm. A voxel-wise multiple regression revealed that higher individual phasic alerting effects on visual processing speed were significantly associated with lower iFC in the cingulo-opercular network, with a peak in the left superior orbital gyrus. As phasic alertness was neither related to iFC in other attention-relevant, auditory, or visual networks nor associated with any inter-network connectivity pattern, the results suggest that the individual profit in visual processing speed gained from phasic alerting is primarily associated with iFC in the cingulo-opercular network.

Neural Mechanisms of Visual Dysfunction in Posterior Cortical Atrophy

Posterior cortical atrophy (PCA) is characterized predominantly by visual dysfunction that arises from bilateral impairments in occipital, parietal, and temporal regions of the brain. PCA is clinically identified based primarily on visual symptoms and neuroimaging findings. Region-specific gray and white matter deficits have been discussed in detail, and are associated with clinical manifestations that present with similar patterns of perfusion and metabolic findings. Here, we discuss both structural and functional changes in the ventral and dorsal visual streams along with their underlying relationships. We also discuss the most recent developments in neuroimaging characteristics and summarize correlations between distinct neuroimaging presentations.

Distinctive Correspondence Between Separable Visual Attention Functions and Intrinsic Brain Networks

Separable visual attention functions are assumed to rely on distinct but interacting neural mechanisms. Bundesen's “theory of visual attention” (TVA) allows the mathematical estimation of independent parameters that characterize individuals' visual attentional capacity (i.e., visual processing speed and visual short-term memory storage capacity) and selectivity functions (i.e., top-down control and spatial laterality). However, it is unclear whether these parameters distinctively map onto different brain networks obtained from intrinsic functional connectivity, which organizes slowly fluctuating ongoing brain activity. In our study, 31 demographically homogeneous healthy young participants performed whole- and partial-report tasks and underwent resting-state functional magnetic resonance imaging (rs-fMRI). Report accuracy was modeled using TVA to estimate, individually, the four TVA parameters. Networks encompassing cortical areas relevant for visual attention were derived from independent component analysis of rs-fMRI data: visual, executive control, right and left frontoparietal, and ventral and dorsal attention networks. Two TVA parameters were mapped on particular functional networks. First, participants with higher (vs. lower) visual processing speed showed lower functional connectivity within the ventral attention network. Second, participants with more (vs. less) efficient top-down control showed higher functional connectivity within the dorsal attention network and lower functional connectivity within the visual network. Additionally, higher performance was associated with higher functional connectivity between networks: specifically, between the ventral attention and right frontoparietal networks for visual processing speed, and between the visual and executive control networks for top-down control. The higher inter-network functional connectivity was related to lower intra-network connectivity. These results demonstrate that separable visual attention parameters that are assumed to constitute relatively stable traits correspond distinctly to the functional connectivity both within and between particular functional networks. This implies that individual differences in basic attention functions are represented by differences in the coherence of slowly fluctuating brain activity.

Simultanagnosia and object individuation

Simultanagnosic patients have difficulty in perceiving multiple objects when presented simultaneously. In this review article, I discuss how neuropsychological research on simultanagnosia has been inspirational for two interconnected lines of research related to the core mechanisms by which the visual system processes cluttered scenes. First, I review previous studies on enumeration tasks indicating that, despite their inability to identify multiple objects, simultanagnosic patients can enumerate up to 2-3 elements as efficiently as healthy individuals (the so-called "subitizing" phenomenon). This intriguing observation is one of the first results to support the existence of an "object individuation" mechanism that can spatially tag a limited set of objects simultaneously, and resonates with recent research on the brain dynamics of enumeration in healthy individuals. Second, I further develop the implications of the dissociation between object identification and object enumeration in simultanagnosia specifically for the distinction between object identification and individuation. The latter distinction has been the subject of recent neuroimaging research that has provided fine-grained information on the spatial as well as temporal aspects of object individuation and recognition. The lessons learned from neuropsychological research on exact enumeration in simultanagnosia can be generalized to the normal functioning of the human mind, and have provided insightful clues for cognitive neuroscience.