Procedural learning is impaired in patients with prefrontal lesions

Top-down and bottom-up oscillatory dynamics regulate implicit visuomotor sequence learning

Implicit visuomotor sequence learning is crucial for acquiring skills that result in automated behaviors. The oscillatory dynamics underpinning this learning process are not well understood. To address this gap, the current study employed electroencephalography with a medium-density array (64 electrodes) to investigate oscillatory activity associated with implicit visuomotor sequence learning in the Serial Reaction Time task. In the task, participants unknowingly learn a series of finger movements. Eighty-five healthy adults participated in the study. Analyses revealed that theta activity at the vertex and alpha/beta activity over the motor areas decreased over the course of learning. No associations between alpha/beta and theta power were observed. These findings are interpreted within a dual-process framework: midline theta activity is posited to regulate top-down attentional processes, whereas beta activity from motor areas underlies the bottom-up encoding of sensory information from movement. From this model, we suggest that during implicit visuomotor sequence learning, top-down processes become disengaged (indicated by a reduction in theta activity), and modality specific bottom-up processes encode the motor sequence (indicated by a reduction in alpha/beta activity).

Impaired executive functioning mediates the association between aging and deterministic sequence learning

Sensitivity to the fixed ordering of actions and events, or deterministic sequence learning, is an important skill throughout adulthood. Yet, it remains unclear whether age deficits in sequencing exist, and we lack a firm understanding of which factors might contribute to age-related impairments when they arise. Though debated, executive functioning, governed by the frontal lobe, may underlie age-related sequence learning deficits in older adults. The present study asked if age predicts errors in deterministic sequence learning across the older adult lifespan (ages 55-89), and whether executive functioning accounts for any age-related declines. Healthy older adults completed a comprehensive measure of frontal-based executive abilities as well as a deterministic sequence learning task that required the step-by-step acquisition of associations through trial-and-error feedback. Among those who met a performance-based criterion, increasing age was positively correlated with higher sequencing errors; however, this relationship was no longer significant after controlling for executive functioning. Moreover, frontal-based executive abilities mediated the relationship between age and sequence learning performance. These findings suggest that executive or frontal functioning may underlie age deficits in learning judgment-based, deterministic serial operations.

Modulating Visuomotor Sequence Learning by Repetitive Transcranial Magnetic Stimulation: What Do We Know So Far?

Predictive processes and numerous cognitive, motor, and social skills depend heavily on sequence learning. The visuomotor Serial Reaction Time Task (SRTT) can measure this fundamental cognitive process. To comprehend the neural underpinnings of the SRTT, non-invasive brain stimulation stands out as one of the most effective methodologies. Nevertheless, a systematic list of considerations for the design of such interventional studies is currently lacking. To address this gap, this review aimed to investigate whether repetitive transcranial magnetic stimulation (rTMS) is a viable method of modulating visuomotor sequence learning and to identify the factors that mediate its efficacy. We systematically analyzed the eligible records (n = 17) that attempted to modulate the performance of the SRTT with rTMS. The purpose of the analysis was to determine how the following factors affected SRTT performance: (1) stimulated brain regions, (2) rTMS protocols, (3) stimulated hemisphere, (4) timing of the stimulation, (5) SRTT sequence properties, and (6) other methodological features. The primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) were found to be the most promising stimulation targets. Low-frequency protocols over M1 usually weaken performance, but the results are less consistent for the DLPFC. This review provides a comprehensive discussion about the behavioral effects of six factors that are crucial in designing future studies to modulate sequence learning with rTMS. Future studies may preferentially and synergistically combine functional neuroimaging with rTMS to adequately link the rTMS-induced network effects with behavioral findings, which are crucial to develop a unified cognitive model of visuomotor sequence learning.

A direct test of competitive versus cooperative episodic-procedural network dynamics in human memory

Classical lesion studies led to a consensus that episodic and procedural memory arises from segregated networks identified with the hippocampus and the caudate nucleus, respectively. Neuroimaging studies, however, show that competitive and cooperative interactions occur between networks during memory tasks. Furthermore, causal experiments to manipulate connectivity between these networks have not been performed in humans. Although nodes common to both networks, such as the precuneus and ventrolateral thalamus, may mediate their interaction, there is no experimental evidence for this. We tested how network-targeted noninvasive brain stimulation affects episodic-procedural network interactions and how these network manipulations affect episodic and procedural memory in healthy young adults. Compared to control (vertex) stimulation, hippocampal network-targeted stimulation increased within-network functional connectivity and hippocampal connectivity with the caudate. It also increased episodic, relative to procedural, memory, and this persisted one week later. The differential effect on episodic versus procedural memory was associated with increased functional connectivity between the caudate, precuneus, and ventrolateral thalamus. These findings provide direct evidence of episodic-procedural network competition, mediated by regions common to both networks. Enhanced hippocampal network connectivity may boost episodic, but decrease procedural, memory by co-opting resources shared between networks.

Impaired sequential and partially compensated probabilistic skill learning in Parkinson's disease

The striatal dopaminergic dysfunction in Parkinson's disease (PD) has been associated with deficits in skill learning in numerous studies, but some of the findings remain controversial. Our aim was to explore the generality of the learning deficit using two widely reported skill learning tasks in the same group of Parkinson's patients. Thirty-four patients with PD (mean age: 62.83 years, SD: 7.67) were compared to age-matched healthy adults. Two tasks were employed: the Serial Reaction Time Task (SRT), testing the learning of motor sequences, and the Weather Prediction (WP) task, testing non-sequential probabilistic category learning. On the SRT task, patients with PD showed no significant evidence for sequence learning. These results support and also extend previous findings, suggesting that motor skill learning is vulnerable in PD. On the WP task, the PD group showed the same amount of learning as controls, but they exploited qualitatively different strategies in predicting the target categories. While controls typically combined probabilities from multiple predicting cues, patients with PD instead focused on individual cues. We also found moderate to high correlations between the different measures of skill learning. These findings support our hypothesis that skill learning is generally impaired in PD, and can in some cases be compensated by relying on alternative learning strategies.

Disrupted implicit motor sequence learning in schizophrenia and bipolar disorder revealed with ambidextrous Serial Reaction Time Task

BACKGROUND

Impairment of implicit motor sequence learning was shown in schizophrenia (SZ) and, most recently, in bipolar disorder (BD), and was connected to cerebellar abnormalities. The goal of this study was to compare implicit motor sequence learning in BD and SZ.

METHODS

We examined 33 patients with BD, 33 patients with SZ and 31 healthy controls with a use of ambidextrous Serial Reaction Time Task (SRTT), which allows exploring asymmetries in performance depending on the hand used.

RESULTS

BD and SZ patients presented impaired implicit motor sequence learning, although the pattern of their impairments was different. While BD patients showed no signs of implicit motor sequence learning for both hands, the SZ group presented some features of motor learning when performing with the right, but not with the left hand.

CONCLUSIONS

To our best knowledge this is the first study comparing implicit motor sequence learning in BD and SZ. We show that both diseases share impairments in this domain, however in the case of SZ this impairment differs dependently on the hand performing SRTT. We propose that implicit motor sequence learning impairments constitute an overlapping symptom in BD and SZ and suggest further neuroimaging studies to verify cerebellar underpinnings as its cause.

Characterization of brain blood flow and the amplitude of low-frequency fluctuations in major depressive disorder: A multimodal meta-analysis

BACKGROUND

In healthy subjects, there is an association between amplitude of low-frequency fluctuations (ALFF) and regional cerebral blood flow (rCBF). To date, no published meta-analysis has investigated changes in the regional ALFF in medication-free depressed patients.

METHODS

In this study, we aimed to explore whether resting-state rCBF and ALFF changes co-occur in the depressed brain without the potential confound of medication. Using signed differential mapping (SDM), we conducted two meta-analyses, one of rCBF studies and one of ALFF studies, involving medication-free patients with major depressive disorder (MDD). In addition, we conducted a multimodal meta-analysis to identify brain regions that showed abnormalities in both rCBF and ALFF.

RESULTS

A total of 16 studies were included in this series. We identified abnormalities in resting-state rCBF and ALFF in the left insula in medication-free MDD patients compared with healthy controls (HC). In addition, we observed altered resting-state rCBF in the limbic-subcortical-cortical circuit and altered ALFF in the default mode network (DMN) and some motor-related brain regions.

LIMITATIONS

The analysis techniques, patient characteristics and clinical variables of the included studies were heterogeneous.

CONCLUSIONS

The conjoint alterations in ALFF and rCBF in the left insula may represent core neuropathological changes in medication-free patients with MDD and merit further studying.

Blocking trial-by-trial error correction does not interfere with motor learning in human walking

Movements can be learned implicitly in response to new environmental demands or explicitly through instruction and strategy. The former is often studied in an environment that perturbs movement so that people learn to correct the errors and store a new motor pattern. Here, we demonstrate in human walking that implicit learning of foot placement occurs even when an explicit strategy is used to block changes in foot placement during the learning process. We studied people learning a new walking pattern on a split-belt treadmill with and without an explicit strategy through instruction on where to step. When there is no instruction, subjects implicitly learn to place one foot in front of the other to minimize step-length asymmetry during split-belt walking, and the learned pattern is maintained when the belts are returned to the same speed, i.e., postlearning. When instruction is provided, we block expression of the new foot-placement pattern that would otherwise naturally develop from adaptation. Despite this appearance of no learning in foot placement, subjects show similar postlearning effects as those who were not given any instruction. Thus locomotor adaptation is not dependent on a change in action during learning but instead can be driven entirely by an unexpressed internal recalibration of the desired movement.

Implicit motor learning in bipolar disorder

OBJECTIVES

A growing number of publications describe cerebellar abnormalities in patients with bipolar disorder (BD). The aim of the following paper was to examine the functional aspects of that issue by focusing on implicit learning - a cognitive function with significant cerebellar underpinnings.

METHODS

27 patients with BD and 26 healthy controls (HC), matched for age and sex took part in the study. Implicit motor learning was assessed by the serial reaction time task (SRTT), in which participants were unconsciously learning a sequence of motor reactions. The indicators of procedural learning were the decrease of reaction time (RT) across the repetition of the sequence and the rebound of RT when the sequence changed into a random set of stimuli.

RESULTS

BD patients did not present any indicators of the implicit learning, their RT increased across repetitions of the sequence and it decreased when the sequence changed to random. Contrary, in the control group RT decreased across the sequence repetitions and increased when the stimuli begun to appear randomly.

LIMITATIONS

A low subject count and a non-drug naïve patients group, medicated with atypical antipsychotic and mood stabilizers, are the most significant limitations of this study.

CONCLUSIONS

BD patients did not acquire procedural knowledge while performing the task, whereas HC did. To our knowledge this is the first study that shows the impairment of implicit motor learning in patients with BD. This indicates the possible cerebellar dysfunction in this disease and may provide a new neuropsychiatric approach to bipolar disorder.

Cerebellar and prefrontal cortex contributions to adaptation, strategies, and reinforcement learning

Traditionally, motor learning has been studied as an implicit learning process, one in which movement errors are used to improve performance in a continuous, gradual manner. The cerebellum figures prominently in this literature given well-established ideas about the role of this system in error-based learning and the production of automatized skills. Recent developments have brought into focus the relevance of multiple learning mechanisms for sensorimotor learning. These include processes involving repetition, reinforcement learning, and strategy utilization. We examine these developments, considering their implications for understanding cerebellar function and how this structure interacts with other neural systems to support motor learning. Converging lines of evidence from behavioral, computational, and neuropsychological studies suggest a fundamental distinction between processes that use error information to improve action execution or action selection. While the cerebellum is clearly linked to the former, its role in the latter remains an open question.

Procedural learning is impaired in dyslexia: evidence from a meta-analysis of serial reaction time studies

A number of studies have investigated procedural learning in dyslexia using serial reaction time (SRT) tasks. Overall, the results have been mixed, with evidence of both impaired and intact learning reported. We undertook a systematic search of studies that examined procedural learning using SRT tasks, and synthesized the data using meta-analysis. A total of 14 studies were identified, representing data from 314 individuals with dyslexia and 317 typically developing control participants. The results indicate that, on average, individuals with dyslexia have worse procedural learning abilities than controls, as indexed by sequence learning on the SRT task. The average weighted standardized mean difference (the effect size) was found to be 0.449 (CI95: .204, .693), and was significant (p<.001). However, moderate levels of heterogeneity were found between study-level effect sizes. Meta-regression analyses indicated that studies with older participants that used SRT tasks with second order conditional sequences, or with older participants that used sequences that were presented a large number of times, were associated with smaller effect sizes. These associations are discussed with respect to compensatory and delayed memory systems in dyslexia.

Probabilistic sequence learning in mild cognitive impairment

Mild Cognitive Impairment (MCI) causes slight but noticeable disruption in cognitive systems, primarily executive and memory functions. However, it is not clear if the development of sequence learning is affected by an impaired cognitive system and, if so, how. The goal of our study was to investigate the development of probabilistic sequence learning, from the initial acquisition to consolidation, in MCI and healthy elderly control groups. We used the Alternating Serial Reaction Time task (ASRT) to measure probabilistic sequence learning. Individuals with MCI showed weaker learning performance than the healthy elderly group. However, using the reaction times only from the second half of each learning block—after the reactivation phase—we found intact learning in MCI. Based on the assumption that the first part of each learning block is related to reactivation/recall processes, we suggest that these processes are affected in MCI. The 24-h offline period showed no effect on sequence-specific learning in either group but did on general skill learning: the healthy elderly group showed offline improvement in general reaction times while individuals with MCI did not. Our findings deepen our understanding regarding the underlying mechanisms and time course of sequence acquisition and consolidation.

Dopaminergic basis of the psychosis-prone personality investigated with functional magnetic resonance imaging of procedural learning

Previous evidence shows a reliable association between psychosis-prone (especially schizotypal) personality traits and performance on dopamine (DA)-sensitive tasks (e.g., prepulse inhibition and antisaccade). Here, we used blood oxygen level-dependent (BOLD) fMRI and an established procedural learning (PL) task to examine the dopaminergic basis of two aspects of psychosis-proneness (specific schizotypy and general psychoticism). Thirty healthy participants (final N = 26) underwent fMRI during a blocked, periodic sequence-learning task which, in previous studies, has been shown to reveal impaired performance in schizophrenia patients given drugs blocking the DA D2 receptor subtype (DRD2), and to correspond with manipulation of DA activity and elicit fronto-striatal-cerebellar activity in healthy people. Psychosis-proneness was indexed by the Psychoticism (P) scale of the Eysenck Personality Questionnaire-Revised (EPQ-R; 1991) and the Schizotypal Personality Scale (STA; 1984). EPQ-R Extraversion and Neuroticism scores were also examined to establish discriminant validity. We found a positive correlation between the two psychosis-proneness measures (r = 0.43), and a robust and unique positive association between EPQ-R P and BOLD signal in the putamen, caudate, thalamus, insula, and frontal regions. STA schizotypy score correlated positively with activity in the right middle temporal gyrus. As DA is a key transmitter in the basal ganglia, and the thalamus contains the highest levels of DRD2 receptors of all extrastriatal regions, our results support a dopaminergic basis of psychosis-proneness as measured by the EPQ-R Psychoticism.

Dual-tDCS Enhances Online Motor Skill Learning and Long-Term Retention in Chronic Stroke Patients

BACKGROUND

Since motor learning is a key component for stroke recovery, enhancing motor skill learning is a crucial challenge for neurorehabilitation. Transcranial direct current stimulation (tDCS) is a promising approach for improving motor learning. The aim of this trial was to test the hypothesis that dual-tDCS applied bilaterally over the primary motor cortices (M1) improves online motor skill learning with the paretic hand and its long-term retention.

METHODS

Eighteen chronic stroke patients participated in a randomized, cross-over, placebo-controlled, double bind trial. During separate sessions, dual-tDCS or sham dual-tDCS was applied over 30 min while stroke patients learned a complex visuomotor skill with the paretic hand: using a computer mouse to move a pointer along a complex circuit as quickly and accurately as possible. A learning index involving the evolution of the speed/accuracy trade-off was calculated. Performance of the motor skill was measured at baseline, after intervention and 1 week later.

RESULTS

After sham dual-tDCS, eight patients showed performance worsening. In contrast, dual-tDCS enhanced the amount and speed of online motor skill learning compared to sham (p < 0.001) in all patients; this superiority was maintained throughout the hour following. The speed/accuracy trade-off was shifted more consistently after dual-tDCS (n = 10) than after sham (n = 3). More importantly, 1 week later, online enhancement under dual-tDCS had translated into superior long-term retention (+44%) compared to sham (+4%). The improvement generalized to a new untrained circuit and to digital dexterity.

CONCLUSION

A single-session of dual-tDCS, applied while stroke patients trained with the paretic hand significantly enhanced online motor skill learning both quantitatively and qualitatively, leading to successful long-term retention and generalization. The combination of motor skill learning and dual-tDCS is promising for improving post-stroke neurorehabilitation.

Sequence learning in cerebral palsy

We investigated sequence-learning skills in 64 children with cerebral palsy (aged 4.01-14.7 years; 49 with bilateral, two with dystonic, and 13 with unilateral cerebral palsy), compared with a matched control group of typically developing children. Participants' motor and handling abilities were classified according to the Gross Motor Function Classification System and the Manual Ability Classification System. General cognitive, visuoperceptual, and constructive abilities were assessed. Participants performed an experimental computerized version of Corsi Span, followed by a normalized Supraspan sequence. Controls outperformed cerebral palsy participants in visual memory and accuracy. Participants with cerebral palsy were likelier to fail the test (cerebral palsy, 37.5%; control subjects, 5%) and obtain overall lower scores. Sequence learning skills were not related to motor and handling impairments. Failure to learn sequences resulted in an overall lower functioning profile regarding visuoperceptual, verbal, and performance abilities. The ability to fix sequences seemed to split the cerebral palsy group into an overall high-functioning group (successful in sequence learning) and low-functioning (failing) group. Results are discussed in light of a specific implicit memory impairment and the abnormal development of white matter frontostriatal and parietal connections.

Impaired implicit learning and reduced pre-supplementary motor cortex size in early-onset major depression with melancholic features

BACKGROUND

Major depression is a heterogeneous disorder. Biological markers and cognitive tasks have been employed to distinguish clinical subtypes but results have been inconclusive.

METHODS

The current study assessed implicit learning with the Serial Reaction Time Task (SRTT) known to be sensitive to frontostriatal dysfunctions and regional brain volumes of the anterior supplementary motor area (pre-SMA) in participants with early-onset major depression (MD) of either melancholic (n=26) or non-melancholic (n=9) subtype, and 26 matched controls.

RESULTS

Depressive subjects with melancholic features but not those with non-melancholic depression showed implicit learning deficits. This deficit could not be explained in terms of more severe depression or psychomotor retardation. Regional volumes of the right pre-SMA were reduced in depressive subjects with melancholic features.

LIMITATIONS

Medication effects in depressive subjects and the small size of the non-melancholic sample should be taken into consideration when reviewing the implications of these results.

CONCLUSIONS

Deficits in implicit motor sequence learning seem to be an additional characteristic of the melancholic subtype of depression. It might be linked to dysfunction within structural or functionally altered frontostriatal circuits. Use of implicit sequence learning tasks could offer useful diagnostic and aetiological cues for future research.

Incidental and intentional sequence learning in youth-onset psychosis and Attention-Deficit/Hyperactivity Disorder (ADHD)

The goal was to compare incidental and intentional spatial sequence learning in youth-onset psychosis and ADHD. The authors tested 8- to 19-year-olds with psychosis or ADHD and healthy controls on a serial reaction time (RT) task and used manual and oculomotor measures to examine learning. Participants were also administered a block in which they were explicitly instructed to learn a sequence. As in our previous studies with healthy adults and children, oculomotor anticipations and RTs showed learning effects similar to those in the manual modality. Results showed intact sequence-specific learning but fewer oculomotor anticipations in both clinical groups during incidental learning. In intentional learning, only the psychosis group showed impairments compared to controls. There were no interactions between age and diagnosis. Thus, the psychosis group showed relatively preserved incidental learning despite impairments in intentional learning. Additionally, both clinical groups showed impairments in the ability to search for, extract, and anticipate regularities (whether the regularities were there or not), but not in the ability to respond to these regularities when they were there.

Effects of risperidone on procedural learning in antipsychotic-naive first-episode schizophrenia

Studies of procedural learning in medicated schizophrenia patients using predictive saccade paradigms have consistently demonstrated hypometric predictive responses. Findings from antipsychotic-naive schizophrenia patients indicate fewer or no deficits. This pattern of findings suggests that antipsychotic medications might adversely affect frontostriatal systems supporting procedural learning on this task. The accuracy and latency of predictive saccades were assessed in 25 antipsychotic-naive first-episode schizophrenia patients and 22 matched healthy individuals. Patients were retested after 6 weeks of treatment with risperidone. Healthy individuals were reevaluated after a similar time period. The ability to learn to time response initiation in anticipation of target appearance (target prediction) was not impaired in patients before or after treatment. In contrast, although no deficits were evident before treatment initiation, after treatment patients showed a marked decrease in the accuracy of predictive but not sensory-guided responses. The findings from pretreatment testing indicate that procedural learning is a relatively unaffected cognitive domain in antipsychotic-naive first-episode schizophrenia. Although treatment-emergent extrapyramidal symptoms were minimal, these data suggest that D2 antagonism in striatum after risperidone treatment was sufficiently robust to disrupt the generation of planned volitional behavior guided by internalized representations.

Mirror asymmetry of Category and Letter fluency in traumatic brain injury and Alzheimer's patients

In this study we contrasted the Category fluency and Letter fluency performance of 198 normal subjects, 57 Alzheimer's patients and 57 patients affected by traumatic brain injury (TBI). The aim was to check whether, besides the prevalence of Category fluency deficit often reported among Alzheimer's patients, the TBI group presented the opposite dissociation. According to some recent claims, in fact, the deficit of TBI would be equally severe for both fluency types. The inquiry followed different approaches for data analysis, including the evaluation of a unique index (Fluency Type Index or FTI), independent of the overall fluency and aimed at expressing at individual subject level the relationship between Category and Letter fluency. The results confirmed that Alzheimer's patients are more defective on Category than Letter fluency, and also clearly indicated that an opposite pattern applies to TBI patients. TBI seems to cause a relatively more severe impairment of Letter than Category fluency, probably due to its impact on the frontal lobe structures. We discuss whether, on the basis of the statistical distribution of our data, it is worth considering as homogeneous populations broadly defined groups as Alzheimer's or TBI patients.

Dissociation between explicit memory and configural memory in the human medial temporal lobe

Using functional magnetic resonance imaging, the current study explored the differential mnemonic contributions of the hippocampus and surrounding medial temporal lobe (MTL) cortices to explicit recognition memory and configural learning. Using a task that required processing of repeated and novel visuospatial contexts across multiple trials, we examined MTL activation in relation to 3 forms of learning in a single paradigm: 1) context-independent procedural learning, 2) context-dependent configural learning, and 3) explicit recognition memory. Activations in hippocampus and parahippocampal cortex were associated with explicit memory, differentiating between subsequently remembered and forgotten repeated contexts, but were unrelated to context-dependent configural learning. Activations in regions of perirhinal and entorhinal cortex were associated with configural learning of repeated contexts independent from explicit memory for those contexts. Procedural learning was unrelated to activation in any MTL region. The time course of activation across learning further differed in MTL subregions with MTL cortex demonstrating repetition-related decreases and hippocampus repetition-related increases. These repetition effects were differentially sensitive to recognition with only activation in hippocampus and parahippocampal cortex tracking recognized items. These imaging findings converge with studies of amnesia and indicate dissociable roles for hippocampus in learning that supports explicit recognition and for anterior MTL cortex in configural learning.

Aging affects motor skill learning when the task requires inhibitory control

Few studies have examined the influence of aging on motor skill learning (MSL) tasks involving different skills and conditions. Two tasks, each including two different conditions (repeated and nonrepeated), were used: (a) the Mirror Tracing task, requiring the inhibition of an overlearned response and the learning of a new visuomotor association, and (b) the Pursuit Tracking task, mainly requiring the processing of visuospatial stimuli. We hypothesized that older participants would benefit as much as younger participants from the stimuli repetition and that they would exhibit a slower learning rate exclusively on the Mirror Tracing task. As expected, older and younger participants' MSL were not differentially affected by task conditions. They also showed a similar learning rate on the Pursuit Tracking task and a subgroup of older participants exhibited MSL difficulties on the Mirror Tracing task. Problems in the inhibitory control of competing motor memories could explain these age-related MSL difficulties.

Implicit learning of sequential regularities and spatial contexts in corticobasal syndrome

The present study investigated two forms of implicit learning in patients with corticobasal syndrome (CBS): contextual cueing and sequence learning. The former primarily implicates the medial temporal lobe system, and the latter, fronto-striatal-cerebellar circuits. Results revealed relatively preserved contextual cueing in patients with CBS. By contrast, sequence learning showed impairments, which seemed to reflect inability to execute correct responses in the presence of intact learning of the sequence. These findings provide the first characterization of implicit learning systems in CBS, and show that the two systems are differentially affected in patients with CBS.

Verbal fluency, trail making, and Wisconsin Card Sorting Test performance following right frontal lobe tumor resection

Three commonly used clinical tests of frontal-executive function are verbal fluency, the Trail Making Test, and the Wisconsin Card Sorting Test, but few lesion studies of regional specificity within the frontal lobe (FL) exist for them. We examined 20 patients with right FL tumor resection, and mapped their damage to explore brain-behavior relations with greater precision. Across tests, the patients performed poorly and they also showed a deficit in switching but not clustering in verbal fluency. Within the right FL, however, we found none of the regional differences reported in studies of mixed-etiology FL patients, possibly due to the gradual neural reorganization that can occur with brain tumors. We discuss the importance of etiology in examining brain-behavior relations.

Apparent encoding of sequential context in rat medial prefrontal cortex is accounted for by behavioral variability

Simple sequences can be represented via asymmetrically linked neural assemblies, provided that the elements of the sequence are unique. When elements repeat, however (e.g., A-B-C-B-A), the same element belongs to two separate "sequential contexts," and a more complex encoding mechanism is required. To enable correct sequence performance, some neural structure must provide a disambiguating signal that differentiates the two sequential contexts (i.e., B as an element of "A-B" as opposed to "C-B"). The disambiguating signal may derive from a form of working memory, or, in some cases, a simple timing mechanism may suffice. To investigate the possible role of medial prefrontal cortex in complex sequence encoding, rats were trained on a spatial sequence containing two adjacent repeated segments (e.g., A-B-C-D-B-C-E). The double-repeat procedure minimized behavioral differences in the second leg (C) of the repeat subsequence that arise in the first leg (B) because of differences in the entry point (e.g., A-B vs D-B). Far more cells were context sensitive along the first leg than along the second (36 vs 9%), and most of the differences were accounted for by systematic variations in the rat's trajectory, which were much larger along the first leg. There is thus little evidence for sequential context-discriminative activity in the medial prefrontal cortex that cannot plausibly be accounted for by context-dependent behavior. The finding that the rodent medial prefrontal cortex is highly sensitive to sensory-behavioral variables raises doubts about previous experiments that purport to show working memory-related activity in this region.

Cortical networks of procedural learning: evidence from cerebellar damage

The lateral cerebellum plays a critical role in procedural learning that goes beyond the strict motor control functions attributed to it. Patients with cerebellar damage show marked impairment in the acquisition of procedures, as revealed by their performance on the serial reaction time task (SRTT). Here we present the case of a patient affected by ischemic damage involving the left cerebellum who showed a selective deficit in procedural learning while performing the SRTT with the left hand. The deficit recovered when the cortical excitability of an extensive network involving both cerebellar hemispheres and the dorsolateral prefrontal cortex (DLPFC) was decreased by low-frequency repetitive transcranial magnetic stimulation (rTMS). Although inhibition of the right DLPFC or a control fronto-parietal region did not modify the patient's performance, inhibition of the right (unaffected) cerebellum and the left DLPFC markedly improved task performance. These findings could be explained by the modulation of a set of inhibitory and excitatory connections between the lateral cerebellum and the contralateral prefrontal area induced by rTMS. The presence of left cerebellar damage is likely associated with a reduced excitatory drive from sub-cortical left cerebellar nuclei towards the right DLPFC, causing reduced excitability of the right DLPFC and, conversely, unbalanced activation of the left DLPFC. Inhibition of the left DLPFC would reduce the unbalancing of cortical activation, thus explaining the observed selective recovery of procedural memory.

Procedural learning in schizophrenia investigated with functional magnetic resonance imaging

A cerebral basis for the acquisition and retention of procedural knowledge in schizophrenia was examined with 1.5 T functional MRI during an embedded sequence Serial Reaction Time Task (SRTT) in 10 chronic medicated patients and 15 healthy controls. Comparable procedural learning was observed in both groups, suggesting that the impairment reported in previous schizophrenia samples may not be robust. Consistent with previous fMRI reports, procedural learning in the control group was associated with activity in the dorsal striatum, anterior cingulate, parietal cortex and frontal cortex. Greater procedural learning related activity was observed in the control relative to the schizophrenia group in the bilateral frontal, left parietal and bilateral caudate regions. Patients did not activate frontal or parietal areas while responding to the embedded sequence within the SRTT, but greater activation during procedural learning was observed relative to the control sample in the right anterior cingulate, left globus pallidus and the right superior temporal gyrus. Thus, despite comparable instantiation of procedural learning in schizophrenia, the cerebral activation associated with this cognitive skill was abnormal. The paucity of activity in bilateral frontal cortex, left parietal cortex and bilateral caudate nucleus may represent cerebral dysfunction associated with schizophrenia, whereas the hyperactivation of the right superior temporal gyrus, the right anterior cingulate cortex and the left globus pallidus may represent a compensatory cerebral action capable of facilitating near-normal task performance. The results are thus consistent with a neurodevelopmental pathology impinging on fronto-subcortical circuitry.

Learning hierarchically structured action sequences is unaffected by prefrontal-cortex lesion

This study tested the impact of prefrontal-cortex lesion on learning hierarchically structured action sequences. Using a visual-manual serial reaction time task, we had subjects first perform five blocks of trials with a hierarchically structured 14-element action sequence and then tested for sequence-specific learning by introducing a pseudo-random transfer sequence. Relative to control subjects (N = 39), we found that both lateral frontal (N = 16) and medial frontal (N = 18) patients showed reduced overall performance benefits across the training phase. In contrast, the negative transfer test showed significantly increased reaction times in all patient groups, indicating robust sequence-specific learning. This learning was not significantly different from that of the control group. Taken together, the data suggest that learning hierarchically structured action sequences is unimpaired in patients with prefrontal-cortex lesion.

Oculomotor and manual indexes of incidental and intentional spatial sequence learning during middle childhood and adolescence

The goal of this study was to examine incidental and intentional spatial sequence learning during middle childhood and adolescence. We tested four age groups (8-10 years, 11-13 years, 14-17 years, and young adults [18+ years]) on a serial reaction time task and used manual and oculomotor measures to examine incidental sequence learning. Participants were also administered a trial block in which they were explicitly instructed to learn a sequence. Replicating our previous study with adults, oculomotor anticipations and response times showed learning effects similar to those in the manual modality. There were few age-related differences in the sequence learning indexes during incidental learning, but intentional learning yielded differences on all indexes. Results indicate that the search for regularities and the ability to learn a sequence rapidly under incidental conditions are mature by 8 to 10 years of age. In contrast, the ability to learn a sequence intentionally, which requires cognitive resources and strategies, continues to develop through adolescence.

Oculomotor evidence of sequence learning on the serial reaction time task

Manual and oculomotor measures of sequence learning were examined on the serial reaction time (SRT) task Participants were assigned into four groups differing on response modality (manual, oculomotor) and trial type (sequence, pseudorandom). The pattern of manual RTs replicated previous studies. Frequency of anticipatory eye movements followed similar patterns as RTs. Participants made many anticipations, even in pseudorandom blocks, and frequency of anticipations did not depend on presence of concurrent manual responses. Excluding participants with explicit awareness did not change results. Anticipations were negatively related to RTs in both incidental and intentional learning. Anticipations were positively related to sequence recall in intentional, but not incidental, learning. Results suggest that (1) anticipatory eye movements reflected sequence learning and (2) participants made overt and covert shifts of visuospatial attention to likely stimulus locations prior to stimulus onset, whether or not they made manual responses and whether or not there was a sequence.

Reduced size of the pre-supplementary motor cortex and impaired motor sequence learning in first-episode schizophrenia

Increasing evidence suggests that schizophrenia is associated with various morphological and functional abnormalities of the frontal cortex. So far research has concentrated on the dorsolateral and orbitofrontal cortex. Behavioral evidence suggests however that regions responsible for higher motor control are compromised in schizophrenia as well. The current study assessed volumes of the anterior supplementary motor area (pre-SMA) and implicit motor sequence learning in 15 subjects with first-episode schizophrenia and 15 healthy matched controls. Pre-SMA volumes were assessed by three-dimensional structural magnetic resonance imaging (3D-MRI) and manual parcellation according to an established protocol. Implicit motor sequence learning was assessed using the Serial Reaction-Time Task (SRTT). Compared with control subjects, schizophrenia subjects had significantly smaller volumes of the left pre-SMA (16%). Subjects with schizophrenia were severely impaired on sequence-specific implicit motor learning. Size of the left pre-SMA of schizophrenia subjects was significantly related to impaired implicit learning. We conclude that subjects with first-episode schizophrenia have a morphological abnormality of the left pre-SMA that might predispose them to develop disturbances of higher motor control during acute episodes of psychosis. These structural and behavioral abnormalities might be conceptualized within a broader model that views schizophrenia as a disorder of disturbed coordination of thought and action.

Effects of ApoE genotype and mild cognitive impairment on implicit learning

The goals were to investigate implicit learning in mild cognitive impairment (MCI), and to determine the relations of implicit learning systems to apolipoprotein E (ApoE) genotype in healthy controls. Elderly controls grouped by ApoE status (ApoE-e4 allele carriers versus ApoE-e4 allele non-carriers) and MCI patients participated in the study. Individuals in all three groups completed both contextual cueing and serial reaction time (SRT) tasks. In the former, people learn to use repeated spatial configurations to facilitate search for a target, whereas in the latter, they learn to use subtle sequence regularities to respond more quickly and accurately to a series of events. Results revealed that healthy elderly individuals carrying the ApoE-e4 allele showed contextual cueing deficits compared to those who did not carry the ApoE-e4 allele. Further, elderly controls carrying the ApoE-e4 allele revealed similar amounts of contextual cueing as the MCI group, while the non-carriers performed better. Sequence learning, by contrast, was uninfluenced by either MCI or by ApoE genotype in healthy controls. This study provides further support for the medial temporal lobe dysfunction and relative integrity of fronto-striatal systems in MCI, and indicates the influence of ApoE genotype on implicit learning even in healthy older individuals without cognitive impairment.

Dyslexics are impaired on implicit higher-order sequence learning, but not on implicit spatial context learning

Developmental dyslexia is characterized by poor reading ability and impairments on a range of tasks including phonological processing and processing of sensory information. Some recent studies have found deficits in implicit sequence learning using the serial reaction time task, but others have not. Other skills, such as global visuo-spatial processing may even be enhanced in dyslexics, although deficits have also been noted. The present study compared dyslexic and non-dyslexic college students on two implicit learning tasks, an alternating serial response time task in which sequential dependencies exist across non-adjacent elements and a spatial context learning task in which the global configuration of a display cues the location of a search target. Previous evidence indicates that these implicit learning tasks are based on different underlying brain systems, fronto-striatal-cerebellar circuits for sequence learning and medial temporal lobe for spatial context learning. Results revealed a double dissociation: dyslexics showed impaired sequence learning, but superior spatial context learning. Consistent with this group difference, there was a significant positive correlation between reading ability (single real and non-word reading) and sequence learning, but a significant negative correlation between these measures and spatial context learning. Tests of explicit knowledge confirmed that learning was implicit for both groups on both tasks. These findings indicate that dyslexic college students are impaired on some kinds of implicit learning, but not on others. The specific nature of their learning deficit is consistent with reports of physiological and anatomical differences for individuals with dyslexia in frontal and cerebellar structures.

Evaluation of robotic training forces that either enhance or reduce error in chronic hemiparetic stroke survivors

This investigation is one in a series of studies that address the possibility of stroke rehabilitation using robotic devices to facilitate "adaptive training." Healthy subjects, after training in the presence of systematically applied forces, typically exhibit a predictable "after-effect." A critical question is whether this adaptive characteristic is preserved following stroke so that it might be exploited for restoring function. Another important question is whether subjects benefit more from training forces that enhance their errors than from forces that reduce their errors. We exposed hemiparetic stroke survivors and healthy age-matched controls to a pattern of disturbing forces that have been found by previous studies to induce a dramatic adaptation in healthy individuals. Eighteen stroke survivors made 834 movements in the presence of a robot-generated force field that pushed their hands proportional to its speed and perpendicular to its direction of motion--either clockwise or counterclockwise. We found that subjects could adapt, as evidenced by significant after-effects. After-effects were not correlated with the clinical scores that we used for measuring motor impairment. Further examination revealed that significant improvements occurred only when the training forces magnified the original errors, and not when the training forces reduced the errors or were zero. Within this constrained experimental task we found that error-enhancing therapy (as opposed to guiding the limb closer to the correct path) to be more effective than therapy that assisted the subject.

Do children with developmental dyslexia have an implicit learning deficit?

OBJECTIVE

The purpose of this study was to investigate the effects of specific types of tasks on the efficiency of implicit procedural learning in the presence of developmental dyslexia (DD).

METHODS

Sixteen children with DD (mean (SD) age 11.6 (1.4) years) and 16 matched normal reader controls (mean age 11.4 (1.9) years) were administered two tests (the Serial Reaction Time test and the Mirror Drawing test) in which implicit knowledge was gradually acquired across multiple trials. Although both tests analyse implicit learning abilities, they tap different competencies. The Serial Reaction Time test requires the development of sequential learning and little (if any) procedural learning, whereas the Mirror Drawing test involves fast and repetitive processing of visuospatial stimuli but no acquisition of sequences.

RESULTS

The children with DD were impaired on both implicit learning tasks, suggesting that the learning deficit observed in dyslexia does not depend on the material to be learned (with or without motor sequence of response action) but on the implicit nature of the learning that characterises the tasks.

CONCLUSION

Individuals with DD have impaired implicit procedural learning.

Implicit motor learning deficits in dyslexic adults

Children with developmental dyslexia fail to develop age-appropriate reading skills despite adequate intelligence and education. It has been suggested that dyslexics' various literacy, sensory and motor difficulties may be related to impaired cerebellar function. As the cerebellum is involved in motor learning, we measured serial reaction time performance in 40 adults (21 controls, 19 dyslexics). Dyslexic subjects performed comparably to controls during the randomly-ordered reaction time blocks, indicating that the dyslexics were as able as controls to make appropriate stimulus-response associations. However, the dyslexics failed to show the reaction time reduction that the control group showed during the repeated sequences (p = 0.018) and there was a significant group by condition effect when comparing the last two blocks of the sequence condition with the first two blocks of the final random condition (p = 0.008). Furthermore, there was a significant difference between good and poor readers on the degree of learning during the task (p = 0.015). This suggests that some dyslexics may suffer from an implicit motor learning deficit, which could generalize to non-motor learning.

Impaired higher order implicit sequence learning on the verbal version of the serial reaction time task in patients with Parkinson's disease

Although neuroimaging studies have strongly implicated basal ganglia involvement in implicit sequence learning, serial reaction time (SRT) studies with Parkinson's disease (PD) patients have yielded mixed results. The present research sought to examine the ability of people with PD to implicitly learn sequences with different sequential structures and to objectively assess explicit knowledge. A version of the SRT task that reduces motor demands was used to compare 19 patients with PD but not dementia and 37 matched controls. PD patients showed less implicit sequence-specific learning for both sequences and reduced response time improvement over sequential trials for the more complex sequence. A closer examination revealed that the deficit involved higher order sequential associations as well as the learning of pairwise information.

Procedural and declarative memory in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) has been associated with frontostriatal abnormality. This has led to the hypothesis that the disorder is characterized by abnormality of procedural memory. However, evidence for either procedural or declarative memory disturbance has been mixed, and few studies have directly assessed both of these forms of memory in the same patient group. In the present study, we assessed encoding and retrieval in declarative memory using the Rey Auditory Verbal Learning Test (RAVLT), and procedural memory using the Pursuit Rotor Task, in 27 adults with OCD and 29 matched healthy controls. Groups did not differ with respect to salient demographic characteristics or memory on the RAVLT. In contrast, patients with OCD performed significantly better than controls during the early, but not later trial blocks of the Pursuit Rotor Task. This pattern of results indicates intact encoding and retrieval in declarative memory, but abnormally enhanced procedural memory during the early course of learning in OCD. These findings may be consistent with striatal overactivation observed in neuroimaging studies of OCD, as well as the prominent role of the striatum during early stages of procedural memory.

A meta-analytic review of verbal fluency performance following focal cortical lesions

A meta-analysis of 31 studies with 1,791 participants was conducted to investigate the sensitivity of tests of verbal fluency to the presence of focal cortical lesions. Relative to healthy controls, participants with focal frontal injuries had large and comparable deficits on phonemic (r = .52) and semantic (r = .54) fluency. For frontal but not nonfrontal patients, phonemic fluency deficits qualified as differential deficits when compared with IQ and psychomotor speed; phonemic fluency was also more strongly and more specifically related to the presence of frontal lesions than the Wisconsin Card Sorting Test scores. In contrast, temporal damage was associated with a lesser deficit on phonemic fluency (r = .44) but a larger deficit on semantic fluency (r = .61).

Cerebral activation related to skills practice in a double serial reaction time task: striatal involvement in random-order sequence learning

We used functional Magnetic Resonance Imaging (fMRI) to examine the distribution of cerebral activation related to prolonged skill practice. In a bimanual variant of the Serial Reaction Time Task (SRT), simultaneous finger movements of the two hands were made in response to randomly ordered pairs of visual stimuli (Double SRT, DoSRT). Extended practice by a week of daily performance resulted in gradual decrease of reaction times, associated with an increased involvement of the ventral putamen and globus pallidus, reaching statistical significance only on the left side (Statistical Parametric Mapping, SPM99). This increase was complementary to a decrease of cortical activations. The striatal activation after training on random order stimuli indicates that the striatum is not exclusively involved in sequence learning. This extended function implies a role in the acquisition of basic visuomotor skills that includes the specific selection of the appropriate muscles in response to independent stimuli.