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Attarha M, de Figueiredo Pelegrino AC, Toussaint PJ, Grant SJ, Van Vleet T, de Villers-Sidani E. Improving Neurological Health in Aging Via Neuroplasticity-Based Computerized Exercise: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e59705. [PMID: 39116435 PMCID: PMC11342015 DOI: 10.2196/59705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Our current understanding of how computerized brain training drives cognitive and functional benefits remains incomplete. This paper describes the protocol for Improving Neurological Health in Aging via Neuroplasticity-based Computerized Exercise (INHANCE), a randomized controlled trial in healthy older adults designed to evaluate whether brain training improves cholinergic signaling. OBJECTIVE INHANCE evaluates whether 2 computerized training programs alter acetylcholine binding using the vesicular acetylcholine transporter ligand [18F] fluoroethoxybenzovesamicol ([18F] FEOBV) and positron emission tomography (PET). METHODS In this phase IIb, prospective, double-blind, parallel-arm, active-controlled randomized trial, a minimum of 92 community-dwelling healthy adults aged 65 years and older are randomly assigned to a brain training program designed using the principles of neuroplasticity (BrainHQ by Posit Science) or to an active control program of computer games designed for entertainment (eg, Solitaire). Both programs consist of 30-minute sessions, 7 times per week for 10 weeks (35 total hours), completed remotely at home using either loaned or personal devices. The primary outcome is the change in FEOBV binding in the anterior cingulate cortex, assessed at baseline and posttest. Exploratory cognitive and behavioral outcomes sensitive to acetylcholine are evaluated before, immediately after, and 3 months following the intervention to assess the maintenance of observed effects. RESULTS The trial was funded in September 2019. The study received approval from the Western Institutional Review Board in October 2020 with Research Ethics Board of McGill University Health Centre and Health Canada approvals in June 2021. The trial is currently ongoing. The first participant was enrolled in July 2021, enrollment closed when 93 participants were randomized in December 2023, and the trial will conclude in June 2024. The study team will be unblinded to conduct analyses after the final participant exits the study. We expect to publish the results in the fourth quarter of 2024. CONCLUSIONS There remains a critical need to identify effective and scalable nonpharmaceutical interventions to enhance cognition in older adults. This trial contributes to our understanding of brain training by providing a potential neurochemical explanation of cognitive benefit. TRIAL REGISTRATION ClinicalTrials.gov NCT04149457; https://clinicaltrials.gov/ct2/show/NCT04149457. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59705.
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Affiliation(s)
- Mouna Attarha
- Posit Science Corporation, San Francisco, CA, United States
| | | | - Paule-Joanne Toussaint
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC, Canada
| | | | | | - Etienne de Villers-Sidani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute-Hospital, McGill University, Montreal, QC, Canada
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DeGutis J, Aul C, Barthelemy OJ, Davis BL, Alshuaib S, Marin A, Kinger SB, Ellis TD, Cronin-Golomb A. Side of motor symptom onset predicts sustained attention deficits and motor improvements after attention training in Parkinson's disease. Neuropsychologia 2023; 190:108698. [PMID: 37806442 DOI: 10.1016/j.neuropsychologia.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/28/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE Parkinson's disease (PD) side of motor symptom onset has been associated with distinct cognitive deficits; individuals with left-side onset (LPD) show more visuospatial impairments, whereas those with right-side onset (RPD) show more verbal impairments. Non-spatial attention is a critical cognitive ability associated with motor functioning that is right hemisphere lateralized but has not been characterized with regard to PD side of onset. We compared individuals with LPD and RPD on non-spatial attention tasks and examined differential responses to a 4-week sustained attention training program. METHOD Participants included 9 with LPD and 12 with RPD, who performed both brief and extended go/no-go continuous performance tasks and an attentional blink task. Participants also engaged in an at-home sustained attention training program, Tonic and Phasic Alertness Training (TAPAT), 5 days/week for 4 weeks. We assessed cognitive and motor symptoms before and after training, and after a 4-week no-contact period. RESULTS At baseline, participants with LPD exhibited worse performance than those with RPD on the extended continuous performance task, indicating specific deficits in sustaining attention. Poorer attention was associated with worse clinical motor scores. Notably, side of onset had a significant effect on clinical motor changes after sustained attention training, with only LPD participants improving after training, and 4/9 showing clinically meaningful improvements. CONCLUSIONS Compared to RPD, participants with LPD had poorer sustained attention pre-training and were more likely to improve on clinical motor functioning after sustained attention training. These findings support mechanistic differences between LPD and RPD and suggest potential differential treatment approaches.
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Affiliation(s)
- Joseph DeGutis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Courtney Aul
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; Boston Attention and Learning Laboratory (BALLAB), VA Boston Healthcare System, Boston, MA, USA
| | - Olivier J Barthelemy
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Breanna L Davis
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shaikhah Alshuaib
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Anna Marin
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Shraddha B Kinger
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
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Salatino A, Zavattaro C, Gammeri R, Cirillo E, Piatti ML, Pyasik M, Serra H, Pia L, Geminiani G, Ricci R. Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques. Neurosci Biobehav Rev 2023; 152:105248. [PMID: 37247829 DOI: 10.1016/j.neubiorev.2023.105248] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION In recent decades, new virtual reality (VR)-based protocols have been proposed for the rehabilitation of Unilateral Spatial Neglect (USN), a debilitating disorder of spatial awareness. However, it remains unclear which type of VR protocol and level of VR immersion can maximize the clinical benefits. To answer these questions, we conducted a systematic review of the use of VR for the rehabilitation of USN. METHOD Studies between 2000 and 2022 that met the inclusion criteria were classified according to their research design and degree of immersion (non-immersive, NIVR; semi-immersive, SIVR; immersive, IVR). RESULTS A total of 375 studies were identified, of which 26 met the inclusion criteria. Improvements were found in 84.6% of the reviewed studies: 85.7% used NIVR, 100% used SIVR and 55.6% used IVR. However, only 42.3% of them included a control group and only 19.2% were randomized control trials (RCT). CONCLUSION VR protocols may offer new opportunities for USN rehabilitation, although further RCTs are needed to validate their clinical efficacy.
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Affiliation(s)
- Adriana Salatino
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; Department of Life Sciences, Royal Military Academy, Hobbema 8, 1000 Brussels, Belgium
| | - Claudio Zavattaro
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Roberto Gammeri
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Emanuele Cirillo
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Luisa Piatti
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Pyasik
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy
| | - Hilary Serra
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Lorenzo Pia
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Giuliano Geminiani
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Raffaella Ricci
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy.
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Carter AR, Barrett A. Recent advances in treatment of spatial neglect: networks and neuropsychology. Expert Rev Neurother 2023; 23:587-601. [PMID: 37273197 PMCID: PMC10740348 DOI: 10.1080/14737175.2023.2221788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Spatial neglect remains an underdiagnosed and undertreated consequence of stroke that imposes significant disability. A growing appreciation of brain networks involved in spatial cognition is helping us to develop a mechanistic understanding of different therapies under development. AREAS COVERED This review focuses on neuromodulation of brain networks for the treatment of spatial neglect after stroke, using evidence-based approaches including 1) Cognitive strategies that are more likely to impact frontal lobe executive function networks; 2) Visuomotor adaptation, which may depend on the integrity of parietal and parieto- and subcortical-frontal connections and the presence of a particular subtype of neglect labeled Aiming neglect; 3) Non-invasive brain stimulation that may modulate relative levels of activity of the two hemispheres and depend on corpus callosum connectivity; and 4) Pharmacological modulation that may exert its effect primarily via right-lateralized networks more closely involved in arousal. EXPERT OPINION Despite promising results from individual studies, significant methodological heterogeneity between trials weakened conclusions drawn from meta-analyses. Improved classification of spatial neglect subtypes will benefit research and clinical care. Understanding the brain network mechanisms of different treatments and different types of spatial neglect will make possible a precision medicine treatment approach.
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Affiliation(s)
- Alex R. Carter
- Department of Neurology, Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - A.M. Barrett
- UMass Chan Medical School and UMass Memorial Healthcare, Worcester, MA, USA
- Central Western MA VA Healthcare System, Worcester, MA, USA
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Mentzelopoulos G, Driscoll N, Shankar S, Kim B, Rich R, Fernandez-Nunez G, Stoll H, Erickson B, Medaglia JD, Vitale F. Alerting attention is sufficient to induce a phase-dependent behavior that can be predicted by frontal EEG. Front Behav Neurosci 2023; 17:1176865. [PMID: 37292166 PMCID: PMC10246752 DOI: 10.3389/fnbeh.2023.1176865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/27/2023] [Indexed: 06/10/2023] Open
Abstract
Recent studies suggest that attention is rhythmic. Whether that rhythmicity can be explained by the phase of ongoing neural oscillations, however, is still debated. We contemplate that a step toward untangling the relationship between attention and phase stems from employing simple behavioral tasks that isolate attention from other cognitive functions (perception/decision-making) and by localized monitoring of neural activity with high spatiotemporal resolution over the brain regions associated with the attentional network. In this study, we investigated whether the phase of electroencephalography (EEG) oscillations predicts alerting attention. We isolated the alerting mechanism of attention using the Psychomotor Vigilance Task, which does not involve a perceptual component, and collected high resolution EEG using novel high-density dry EEG arrays at the frontal region of the scalp. We identified that alerting attention alone is sufficient to induce a phase-dependent modulation of behavior at EEG frequencies of 3, 6, and 8 Hz throughout the frontal region, and we quantified the phase that predicts the high and low attention states in our cohort. Our findings disambiguate the relationship between EEG phase and alerting attention.
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Affiliation(s)
- Georgios Mentzelopoulos
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Nicolette Driscoll
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Sneha Shankar
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - Brian Kim
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Ryan Rich
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | | | - Harrison Stoll
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - Brian Erickson
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
| | - John Dominic Medaglia
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Department of Neurology, Drexel University, Philadelphia, PA, United States
| | - Flavia Vitale
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, PA, United States
- Center for Neurotrauma, Neurodegeneration, and Restoration, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, United States
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Nasiri E, Khalilzad M, Hakimzadeh Z, Isari A, Faryabi-Yousefabad S, Sadigh-Eteghad S, Naseri A. A comprehensive review of attention tests: can we assess what we exactly do not understand? THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
AbstractAttention, as it is now defined as a process matching data from the environment to the needs of the organism, is one of the main aspects of human cognitive processes. There are several aspects to attention including tonic alertness (a process of intrinsic arousal that varies by minutes to hours), phasic alertness (a process that causes a quick change in attention as a result of a brief stimulus), selective attention (a process differentiating multiple stimuli), and sustained attention (a process maintaining persistence of response and continuous effort over an extended period). Attention dysfunction is associated with multiple disorders; therefore, there has been much effort in assessing attention and its domains, resulting in a battery of tests evaluating one or several attentional domains; instances of which are the Stroop color-word test, Test of Everyday Attention, Wisconsin Card Sorting Test, and Cambridge Neuropsychological Test Automated Battery. These tests vary in terms of utilities, range of age, and domains. The role of attention in human life and the importance of assessing it merits an inclusive review of the efforts made to assess attention and the resulting tests; Here we highlight all the necessary data regarding neurophysiological tests which assess human attentive function and investigates the evolution of attention tests over time. Also, the ways of assessing the attention in untestable patients who have difficulty in reading or using a computer, along with the lack of ability to comprehend verbal instructions and executive tasks, are discussed. This review can be of help as a platform for designing new studies to researchers who are interested in working on attention and conditions causing deficits in this aspect of body function, by collecting and organizing information on its assessment.
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Brown J, Kaelin D, Mattingly E, Mello C, Miller ES, Mitchell G, Picon LM, Waldron-Perine B, Wolf TJ, Frymark T, Bowen R. American Speech-Language-Hearing Association Clinical Practice Guideline: Cognitive Rehabilitation for the Management of Cognitive Dysfunction Associated With Acquired Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2455-2526. [PMID: 36373898 DOI: 10.1044/2022_ajslp-21-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive-communication impairments following acquired brain injury (ABI) can have devastating effects on a person's ability to participate in community, social, vocational, and academic preinjury roles and responsibilities. Guidelines for evidence-based practices are needed to assist speech-language pathologists (SLPs) and other rehabilitation specialists in the delivery of cognitive rehabilitation for the adult population. PURPOSE The American Speech-Language-Hearing Association, in conjunction with a multidisciplinary panel of subject matter experts, developed this guideline to identify best practice recommendations for the delivery of cognitive rehabilitation to adults with cognitive dysfunction associated with ABI. METHOD A multidisciplinary panel identified 19 critical questions to be addressed in the guideline. Literature published between 1980 and 2020 was identified based on a set of a priori inclusion/exclusion criteria, and main findings were pooled and organized into summary of findings tables. Following the principles of the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision Framework, the panel drafted recommendations, when appropriate, based on the findings, overall quality of the evidence, balance of benefits and harms, patient preferences, resource implications, and the feasibility and acceptability of cognitive rehabilitation. RECOMMENDATIONS This guideline includes one overarching evidence-based recommendation that addresses the management of cognitive dysfunction following ABI and 11 subsequent recommendations focusing on cognitive rehabilitation treatment approaches, methods, and manner of delivery. In addition, this guideline includes an overarching consensus-based recommendation and seven additional consensus recommendations highlighting the role of the SLP in the screening, assessment, and treatment of adults with cognitive dysfunction associated with ABI. Future research considerations are also discussed.
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Affiliation(s)
| | | | | | | | - E Sam Miller
- Maryland State Department of Education, Baltimore
| | | | | | | | | | - Tobi Frymark
- American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Bowen
- American Speech-Language-Hearing Association, Rockville, MD
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Kaufmann BC, Cazzoli D, Pastore-Wapp M, Vanbellingen T, Pflugshaupt T, Bauer D, Müri RM, Nef T, Bartolomeo P, Nyffeler T. Joint impact on attention, alertness and inhibition of lesions at a frontal white matter crossroad. Brain 2022; 146:1467-1482. [PMID: 36200399 PMCID: PMC10115237 DOI: 10.1093/brain/awac359] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
In everyday life, information from different cognitive domains - such as visuospatial attention, alertness, and inhibition - needs to be integrated between different brain regions. Early models suggested that completely segregated brain networks control these three cognitive domains. However, more recent accounts, mainly based on neuroimaging data in healthy participants, indicate that different tasks lead to specific patterns of activation within the same, higher-order and "multiple-demand" network. If so, then a lesion to critical substrates of this common network should determine a concomitant impairment in all three cognitive domains. The aim of the present study was to critically investigate this hypothesis, i.e., to identify focal stroke lesions within the network that can concomitantly impact visuospatial attention, alertness and inhibition. We studied an unselected sample of 60 first-ever right-hemispheric, subacute stroke patients using a data-driven, bottom-up approach. Patients performed 12 standardized neuropsychological and oculomotor tests, four per cognitive domain. Principal component analyses revealed a strong relationship between all three cognitive domains: 10 of 12 tests loaded on a first, Common Component. Analysis of the neuroanatomical lesion correlates using different approaches (i.e., Voxel-Based and Tractwise Lesion-Symptom Mapping, Disconnectome maps) provided convergent evidence on the association between severe impairment of this Common Component and lesions at the intersection of Superior Longitudinal Fasciculus II and III, Frontal Aslant Tract and, to a lesser extent, the Putamen and Inferior Fronto-Occipital Fasciculus. Moreover, patients with a lesion involving this region were significantly more impaired in daily living cognition, which provides an ecological validation of our results. A probabilistic functional atlas of the multiple-demand network was performed to confirm the potential relationship between patients' lesion substrates and observed cognitive impairments as a function of the MD-network connectivity disruption. These findings show, for the first time, that a lesion to a specific white matter crossroad can determine a concurrent breakdown in all three considered cognitive domains. Our results support the multiple-demand network model, proposing that different cognitive operations depend on specific collaborators and their interaction, within the same underlying neural network. Our findings also extend this hypothesis by showing (1) the contribution of SLF and FAT to the multiple-demand network, and (2) a critical neuroanatomical intersection, crossed by a vast amount of long-range white matter tracts, many of which interconnect cortical areas of the multiple-demand network. The vulnerability of this crossroad to stroke has specific cognitive and clinical consequences; this has the potential to influence future rehabilitative approaches.
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Affiliation(s)
- Brigitte C Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.,Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Manuela Pastore-Wapp
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland
| | | | - Daniel Bauer
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - René M Müri
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland.,Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Tobias Nef
- ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland
| | - Paolo Bartolomeo
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital, 6000 Lucerne, Switzerland.,ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation, University of Bern, 3008 Bern, Switzerland.,Department of Neurology, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
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Cohen ZZ, Gotlieb N, Erez O, Wiznitzer A, Arbel O, Matas D, Koren L, Henik A. Attentional networks during the menstrual cycle. Behav Brain Res 2022; 425:113817. [PMID: 35231499 DOI: 10.1016/j.bbr.2022.113817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 01/20/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
The menstrual cycle is characterized partially by fluctuations of the ovarian hormones estradiol (E2) and progesterone (P4), which are implicated in the regulation of cognition. Research on attention in the different stages of the menstrual cycle is eclectic with discrepancies in attention definitions, and the three attentional networks (alerting, orienting and executive) and their interaction were not explored during the menstrual cycle. In the current study, we used the ANT-I (attentional network test - interactions) to examine naturally cycling women (NC) and women using oral contraceptives (OC). We tested their performance at two time points that fit, in natural cycles, the follicular phase and the luteal phase. We found no differences in performance between the two time points (day 4 / day 18) for the OC group: the response pattern replicated known ANT-I findings. However, the NC group showed differences between the two time points. In the follicular phase, responses replicated known ANT-I results, but in the luteal phase, alertness did not interact with executive and orienting networks, resulting in a larger congruency effect (executive network) when attention was not oriented to the target in alerting and no alerting conditions. Results-driven exploratory regression analysis of E2 and P4 suggested that change in P4 from the follicular phase/day 4 to the luteal phase/day 18 was a mediator for the alerting effect found between groups. In conclusion, the alerting state, found with or without alertness manipulation, suggests that there is a progesterone-mediated activation of the alerting system during the luteal phase.
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Affiliation(s)
- Zahira Z Cohen
- Department of Psychology and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom.
| | - Neta Gotlieb
- Department of Psychology, University of California Berkeley, California, United States.
| | - Offer Erez
- Soroka University Medical Center and School of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Arnon Wiznitzer
- Rabin Medical Center and Sacker faculty of medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Oded Arbel
- Mindfulness Clinic, Beer-Sheva Mental Health Center, Beer-Sheva, Israel.
| | - Devorah Matas
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.
| | - Lee Koren
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.
| | - Avishai Henik
- Department of Psychology and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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11
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Umemura GS, Pinho JP, Duysens J, Krebs HI, Forner-Cordero A. Sleep deprivation affects gait control. Sci Rep 2021; 11:21104. [PMID: 34702960 PMCID: PMC8548553 DOI: 10.1038/s41598-021-00705-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
Different levels of sleep restriction affect human performance in multiple aspects. However, it is unclear how sleep deprivation affects gait control. We applied a paced gait paradigm that included subliminal rhythm changes to analyze the effects of different sleep restriction levels (acute, chronic and control) on performance. Acute sleep deprivation (one night) group exhibited impaired performance in the sensorimotor synchronization gait protocol, such as a decrease in the Period Error between the footfalls and the auditory stimulus as well as missing more frequently the auditory cues. The group with chronic sleep restriction also underperformed when compared to the control group with a tendency to a late footfall with respect to the RAC sound. Our results suggest that partial or total sleep deprivation leads to a decrease in the performance in the sensorimotor control of gait. The superior performance of the chronic sleep group when compared to the acute group suggests that there is a compensatory mechanism that helps to improve motor performance.
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Affiliation(s)
- Guilherme S. Umemura
- grid.11899.380000 0004 1937 0722Biomechatronics Laboratory, Department of Mechatronics and Mechanical Systems of the Escola Politécnica, Universidade de São Paulo (USP), São Paulo, Brazil
| | - João Pedro Pinho
- grid.11899.380000 0004 1937 0722Biomechatronics Laboratory, Department of Mechatronics and Mechanical Systems of the Escola Politécnica, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Jacques Duysens
- grid.5596.f0000 0001 0668 7884Motor Control Laboratory, Movement Control and Neuroplasticity Research Group KU Leuven, Leuven, Belgium
| | - Hermano Igo Krebs
- grid.116068.80000 0001 2341 2786The 77 Lab, Department of Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA USA ,grid.411024.20000 0001 2175 4264Department of Neurology, School of Medicine, University of Maryland, Baltimore, MD USA
| | - Arturo Forner-Cordero
- grid.11899.380000 0004 1937 0722Biomechatronics Laboratory, Department of Mechatronics and Mechanical Systems of the Escola Politécnica, Universidade de São Paulo (USP), São Paulo, Brazil
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12
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Matuz A, van der Linden D, Zsidó A, Csathó Á. Visually guided movement with increasing time-on-task: Differential effects on movement preparation and movement execution. Q J Exp Psychol (Hove) 2021; 75:565-582. [PMID: 34507504 DOI: 10.1177/17470218211048001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Top-down cognitive control seems to be sensitive to the detrimental effects of fatigue induced by time-on-task (ToT). The planning and preparation of the motor responses may be especially vulnerable to ToT. Yet, effects of ToT specific to the different phases of movements have received little attention. Therefore, in three experiments, we assessed the effect of ToT on a mouse-pointing task. In Experiment 1, there were 16 possible target positions with variable movement directions. In Experiment 2, the layout of the targets was simplified. In Experiment 3, using cuing conditions, we examined whether the effects of ToT on movement preparation and execution were caused by an increased orientation deficit or decreased phasic alertness. In each experiment, initiation of movement (preparatory phase) became slower, movement execution became faster and overall response time remained constant with increasing ToT. There was, however, no significant within-person association between the preparatory and execution phases. In Experiments 1 and 2, we found a decreasing movement time/movement error ratio, suggesting a more impulsive execution of the pointing movement. In addition, ToT was also accompanied with imprecise movement execution as indicated by the increased errors, mainly in Experiment 2. The results of Experiment 3 indicated that ToT did not induce orientation and phasic alerting deficits but rather was accompanied by decreased tonic alertness.
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Affiliation(s)
- András Matuz
- Department of Behavioural Sciences, Medical School, University of Pécs, Pécs, Hungary
| | - Dimitri van der Linden
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - András Zsidó
- Institute of Psychology, University of Pécs, Pécs, Hungary
| | - Árpád Csathó
- Department of Behavioural Sciences, Medical School, University of Pécs, Pécs, Hungary
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13
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Ogawa EF, Harris R, DeGutis JM, Ward RE, Brach JS, Halasz I, Travison TG, Bean JF. Evaluating the Feasibility and Effects of a Short-Term Task Specific Power Training With and Without Cognitive Training Among Older Adults With Slow Gait Speed: A Pilot Study. Arch Rehabil Res Clin Transl 2021; 3:100118. [PMID: 34179754 PMCID: PMC8211979 DOI: 10.1016/j.arrct.2021.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the feasibility and efficacy of short-term functional power training and further examine whether the addition of cognitive training targeting sustained attention and inhibitory control would augment the effect on the outcomes. Design: Randomized pilot study. Setting: Clinical research facility. Participants: Community-dwelling primary care patients (N=25) aged >65 years with mobility limitation within the VA Boston Healthcare System. Interventions: Participants were randomly assigned to either functional power training (n=14) or functional power+cognitive training (n=11), offered 3 times a week for 6 weeks. Session durations were either 70 minutes (functional power+cognitive training) or 40 minutes (functional power training). Main Outcome Measures: We evaluated feasibility (dropouts, attendance), mobility performance (Short Physical Performance Battery [SPPB]), leg power [stair climb test]), dynamic balance [figure-of-8], and gait characteristics [gait speed, stance time, step width, swing time, step length, variabilities under single-task and dual-task conditions]). Nonparametric analyses were used to compare overall pre-post changes and between-group differences. Results: Of the 39 veterans screened, 25 were randomized and enrolled. Twenty-one men with a mean age 76±7 years completed the study; 86% were white. Participants had a mean SPPB score of 8.3±1.6 out of 12. For those completing the study, overall attendance was 79%. Among all participants, clinically relevant and/or statistically significant median change in mobility performance (∆1 point), leg power (∆25.0W), dynamic balance (∆-1.1s), and gait characteristics (gait speed [∆0.08s, ∆0.09s], step length [∆1.9cm, ∆3.8cm], and stance time [∆-0.02s, ∆-0.05s] under single- and dual-task, respectively) were observed after 6 weeks of training. There were no statistically significant group differences in dropouts, attendance rate, or any of the outcomes based on cognitive training status. Conclusions: Short-term functional power training with or without a cognitive training led to clinically meaningful improvements in mobility performance, leg power, dynamic balance, and gait characteristics. These findings add to the body of evidence supporting the benefits of functional power training on clinically relevant outcomes. Additional cognitive training did not have an added effect on the study outcomes from our study. Further research is needed.
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Affiliation(s)
- Elisa F Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Joseph M DeGutis
- Department of Psychiatry, Harvard Medical School, Boston, MA.,Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA
| | - Rachel E Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Cambridge, MA.,Spaulding Rehabilitation Hospital, Boston, MA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Thomas G Travison
- Harvard Medical School, Cambridge, MA.,Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA.,Harvard Medical School, Cambridge, MA.,Spaulding Rehabilitation Hospital, Boston, MA
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14
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Esterman M, Stumps A, Jagger-Rickels A, Rothlein D, DeGutis J, Fortenbaugh F, Romer A, Milberg W, Marx BP, McGlinchey R. Evaluating the evidence for a neuroimaging subtype of posttraumatic stress disorder. Sci Transl Med 2020; 12:12/568/eaaz9343. [DOI: 10.1126/scitranslmed.aaz9343] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Michael Esterman
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Anna Stumps
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Audreyana Jagger-Rickels
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - David Rothlein
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
| | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Francesca Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Adrienne Romer
- Research Service, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA 02478, USA
| | - William Milberg
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
| | - Brian P. Marx
- National Center for PTSD, VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Regina McGlinchey
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, MA 02130, USA
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA 02130, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Geriatric Research, Education and Clinical Center (GRECC) and Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA
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15
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Huygelier H, Schraepen B, Lafosse C, Vaes N, Schillebeeckx F, Michiels K, Note E, Vanden Abeele V, van Ee R, Gillebert CR. An immersive virtual reality game to train spatial attention orientation after stroke: A feasibility study. APPLIED NEUROPSYCHOLOGY-ADULT 2020; 29:915-935. [PMID: 32945702 DOI: 10.1080/23279095.2020.1821030] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Immersive virtual reality (IVR) may boost neglect recovery, as it can provide an engaging experience in a 3D environment. We designed an IVR rehabilitation game for neglect patients using the Oculus Rift. Multisensory cues were presented in the neglected visual field in a patient-tailored way. We acquired pilot data in 15 neurologically healthy controls and 7 stroke patients. First, we compared cybersickness before and after VR exposure. Second, we assessed the user experience through a questionnaire. Third, we tested whether neglect symptoms corresponded between the VR game and a computerized cancelation task. Fourth, we evaluated the effect of the multisensory cueing on target discrimination. Last, we tested two algorithms to tailor the game to the characteristics of the neglected visual field. Cybersickness significantly reduced after VR exposure in six stroke patients and was low in healthy controls. Patients rated the user experience neutral to positive. In addition, neglect symptoms were consistent between a computerized cancelation and VR rehabilitation task. The multisensory cue positively affected target discrimination in the game and we successfully presented sensory stimulation to the neglected visual field in a patient-tailored way. Our results show that it is promising to use gamified patient-tailored immersive VR for neglect rehabilitation.
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Affiliation(s)
| | | | | | - Nathalie Vaes
- Scientific Unit, Rehabilitation Hospital RevArte, Antwerp, Belgium
| | | | - Karla Michiels
- Rehabilitation centre Pellenberg, University Hospital Leuven, Leuven, Belgium
| | - Eline Note
- Rehabilitation centre Pellenberg, University Hospital Leuven, Leuven, Belgium
| | | | - Raymond van Ee
- Brain and Cognition, KU Leuven, Leuven, Belgium.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
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16
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Van Vleet T, Bonato P, Fabara E, Dabit S, Kim S, Chiu C, Bisogno AL, Merzenich M, Corbetta M, DeGutis J. Alertness Training Improves Spatial Bias and Functional Ability in Spatial Neglect. Ann Neurol 2020; 88:747-758. [DOI: 10.1002/ana.25862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas Van Vleet
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Paolo Bonato
- Department of Physical Medicine & Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Boston MA USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Eric Fabara
- Wyss Institute for Biologically Inspired Engineering, Harvard University Boston MA USA
| | - Sawsan Dabit
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Sarah‐Jane Kim
- Department of Research and Development Posit Science Inc San Francisco CA USA
| | - Christopher Chiu
- Department of Psychology University of Massachusetts Boston MA USA
| | - Antonio Luigi Bisogno
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
| | - Michael Merzenich
- Department of Research and Development Posit Science Inc San Francisco CA USA
- School of Medicine University of California San Francisco CA USA
| | - Maurizio Corbetta
- Clinica Neurologica, Department of Neuroscience, and Padova Neuroscience Center (PNC) University of Padova Italy
- Department of Neurology, Radiology Neuroscience Washington University School of Medicine St. Louis MO USA
- Venetian Institute of Molecular Medicine, VIMM Padova Italy
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System Boston MA USA
- Department of Psychiatry Harvard Medical School Boston MA USA
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17
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Closed-loop digital meditation for neurocognitive and behavioral development in adolescents with childhood neglect. Transl Psychiatry 2020; 10:153. [PMID: 32424253 PMCID: PMC7235252 DOI: 10.1038/s41398-020-0820-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 11/27/2022] Open
Abstract
Adverse childhood experiences are linked to poor attentive behaviors during adolescence, as well as increased risk for mental health disorders in adults. However, no study has yet tested targeted interventions to optimize neurocognitive processes in this population. Here, we investigated closed-loop digital interventions in a double-blind randomized controlled study in adolescents with childhood neglect, and evaluated the outcomes using multimodal assessments of neuroimaging, cognitive, behavioral, and academic evaluations. In the primary neuroimaging results, we demonstrate that a closed-loop digital meditation intervention can strengthen functional connectivity of the dorsal anterior cingulate cortex (dACC) in the cingulo-opercular network, which is critically developing during the adolescent period. Second, this intervention enhanced sustained attention and interference-resolution abilities, and also reduced behavioral hyperactivity at a 1-year follow-up. Superior academic performance was additionally observed in adolescents who underwent the digital meditation intervention. Finally, changes in dACC functional connectivity significantly correlated with improvements in sustained attention, hyperactivity, and academic performance. This first study demonstrates that closed-loop digital meditation practice can facilitate development of important aspects of neurocognition and real-life behaviors in adolescents with early childhood neglect.
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18
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No effect of cold pressor test-induced arousal on attentional benefits and costs in an endogenous spatial orienting paradigm. Neuropsychologia 2019; 135:107250. [PMID: 31682926 DOI: 10.1016/j.neuropsychologia.2019.107250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/28/2019] [Accepted: 10/30/2019] [Indexed: 01/15/2023]
Abstract
Previous studies have shown that arousal can influence hemispatial bias, suggesting that changes in arousal affect the neural networks involved in spatial attention control. The goal of the present study was to measure the effects of increased arousal on endogenous attentional orienting. We used a Spatial Orienting Paradigm to quantify attentional benefits and costs as measures of attentional orienting and re-orienting responses and exposed participants (N = 25; Experiment 1) to a bilateral feet Cold Pressor Test (CPT) to manipulate arousal. Increases in subjective distress ratings and blood pressure confirmed the effect of CPT on arousal. Although no overall effects of CPT on reaction times in the Spatial Orienting Paradigm were detected, an exploratory analysis of sex-specific effects revealed a left-lateralised decrease in benefits and increase in costs after CPT exposure in the male subsample (N = 11). To confirm these preliminary results, we repeated the experiment in a larger sample (N = 29, all male), but found no effect of CPT on orienting, with moderate to strong evidence in favour of a model excluding all (interaction) effects of CPT exposure (all BFIncl < 0.3). Instead, our replicated results indicate that voluntary orienting is unaffected by CPT-induced increases of arousal. In the light of previous studies, and keeping in mind the interpretative challenges of null results, we discuss how and why our findings may be specific to endogenous as opposed to exogenous orienting and how arousal could possibly lead to the previously established effects on visuospatial bias without simultaneously affecting orienting and the underlying attention control networks.
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19
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Choi HS, Kim DJ, Yang YA. The Effect of a Complex Intervention Program for Unilateral Neglect in Patients with Acute-Phase Stroke: A Randomized Controlled Trial. Osong Public Health Res Perspect 2019; 10:265-273. [PMID: 31673487 PMCID: PMC6816354 DOI: 10.24171/j.phrp.2019.10.5.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The purpose of this study was to examine the combined effects of Prism Adaptation (PA) plus functional electrical stimulation (FES) on stroke patients with unilateral neglect, and suggest a new intervention method for acute-phase stroke patients. Methods There were 30 patients included in this study from April to October 2016 that had unilateral neglect whilst hospitalized following a stroke (diagnosed by a professional). The participants, who were patients receiving occupational therapy, understood the purpose of the study and agreed to participate. The patients were randomly divided into 3 groups: PA plus FES group (Group A), PA group (Group B), and FES group (Group C). Treatments lasted for 50 minutes per day, 5 times per week, for 3 weeks in total. Reevaluation was conducted after 3 weeks of intervention. Results All 3 groups showed unilateral neglect reduction after the intervention, but PA plus FES (complex intervention method) was more effective than PA or FES alone [effect size: Motor-free Visual Perception Test (0.80), Albert test (0.98), CBS (0.92)]. Conclusion The results of this study support further studies to examine complex intervention for the treatment of unilateral neglect.
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Affiliation(s)
- Hyun-Se Choi
- Department of Occupational Therapy, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Deok-Ju Kim
- Department of Occupational Therapy, College of Health & Medical Sciences, Cheongju University, Cheongju, Korea
| | - Yeong-Ae Yang
- Department of Occupational Therapy, College of Biomedical Sciences and Engineering, Inje University, Gimhae, Korea
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20
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Esterman M, Fortenbaugh FC, Pierce ME, Fonda JR, DeGutis J, Milberg W, McGlinchey R. Trauma-related psychiatric and behavioral conditions are uniquely associated with sustained attention dysfunction. Neuropsychology 2019; 33:711-724. [PMID: 31144830 DOI: 10.1037/neu0000525] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE It is increasingly recognized that trauma victims, particularly Veterans, have co-occurring psychological and physical conditions that impact cognition, especially the domains of sustained attention and executive functioning. Although previous work has generally attempted to isolate the unique cognitive effects of common combat-related comorbidities, less work has been done to examine how these conditions co-occur, and whether unique cognitive signatures accompany certain clinical combinations. METHOD To address this gap, we examined how several deployment-related conditions were associated with performance on a well-validated measure of sustained attention (i.e., gradual onset continuous performance task [gradCPT]) and a battery of standard neuropsychological measures in 123 Veterans from the Translational Research Center for TBI and Stress Disorders. Initially, a Principal component analysis was conducted to investigate how comorbid conditions grouped together. RESULTS Several sustained attention measures from the gradCPT were differentially associated with four unique combinations of trauma-related pathology. Specifically, a somatic component representing the combination of current pain, sleep disturbance, and mild traumatic brain injury was associated with a higher rate of failures of attentional engagement. On the other hand, a comorbid posttraumatic stress disorder (PTSD) and mood disorder component (moodPTSD), as well as a substance use disorder component, were associated with higher rates of inhibitory control failures. Increased attentional instability was associated with moodPTSD as well as an anxiety disorder component. In contrast, the cognitive effects of deployment-related trauma were not observed on standard neuropsychological measures. CONCLUSION These findings suggest that unique combinations of trauma-related pathology have dissociable effects on sustained attentional control. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders
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21
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Evans DE, To CN, Ashare RL. The Role of Cognitive Control in the Self-Regulation and Reinforcement of Smoking Behavior. Nicotine Tob Res 2019; 21:747-754. [PMID: 29432572 PMCID: PMC6528155 DOI: 10.1093/ntr/nty029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 02/06/2018] [Indexed: 12/16/2022]
Abstract
Cognitive control (CC)-the ability to regulate attention and memory-plays an important role in a variety of health behaviors, including smoking behavior. In this theoretical review of the literature, we propose a CC and smoking behavior framework that includes (1) the positive influence of CC on the self-regulation of smoking, (2) nicotine-induced improvements in CC that may indirectly reinforce smoking (including withdrawal reversal effects), and (3) the long-term effects of smoking on the brain that may result in reduced CC. Integration of these literatures suggests that CC contributes to both self-regulation (ie, brake pedal) and nicotine-related reinforcement (ie, gas pedal) amid the catastrophic effects of long-term smoking, which may reduce self-regulatory control over smoking while also enhancing indirect reinforcement. Supportive evidence and limitations of this approach will be presented, as well as ideas for future research directions that may fully examine this multifaceted modeling of CC in relation to smoking behavior. IMPLICATIONS There is substantial evidence that CC contributes to self-regulation (ie, brake pedal) and reinforcement (ie, gas pedal) of smoking behavior as well as evidence that long-term smoking may cause reduced CC. The proposed model delineates how these opposing influences of CC may mask the unique contribution of self-regulation and reinforcement in maintaining smoking behavior. Targeting CC for treating nicotine dependence will require more nuanced approaches that consider the independent and combined effects of self-regulation and reinforcement to improve smoking cessation success rates.
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Affiliation(s)
- David E Evans
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
- Department of Psychology, University of South Florida, Tampa, FL
| | - Chan N To
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rebecca L Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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22
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Mitko A, Rothlein D, Poole V, Robinson M, McGlinchey R, DeGutis J, Salat D, Esterman M. Individual differences in sustained attention are associated with cortical thickness. Hum Brain Mapp 2019; 40:3243-3253. [PMID: 30980462 DOI: 10.1002/hbm.24594] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 03/23/2019] [Accepted: 03/25/2019] [Indexed: 01/10/2023] Open
Abstract
Several studies have examined how individual differences in sustained attention relate to functional brain measures (e.g., functional connectivity), but far fewer studies relate sustained attention ability, or cognition in general, to individual differences in cortical structure. Functional magnetic resonance imaging meta-analyses and patient work have highlighted that frontoparietal regions, lateralized to the right hemisphere, are critical for sustained attention, though recent work implicates a broader expanse of brain regions. The current study sought to determine if and where variation in cortical thickness is significantly associated with sustained attention performance. Sustained attention was measured using the gradual onset continuous performance task and the Test of Variables of Attention in 125 adult Veteran participants after acquiring two high-resolution structural MRI scans. Whole-brain vertex-wise analyses of the cortex demonstrated that better sustained attention was associated with increased thickness in visual, somatomotor, frontal, and parietal cortices, especially in the right hemisphere. Network-based analyses revealed relationships between sustained attention and cortical thickness in the dorsal attention, ventral attention, somatomotor, and visual networks. These results indicate cortical thickness in multiple regions and networks is associated with sustained attention, and add to the growing knowledge of how structural MRI can help explain individual differences in cognition.
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Affiliation(s)
- Alex Mitko
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts
| | - David Rothlein
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Victoria Poole
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Meghan Robinson
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts.,Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, Boston, Massachusetts.,Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts.,Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - David Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Esterman
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA RR&D TBI National Research Center, VA Boston Healthcare System, Boston, Massachusetts.,Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, Boston, Massachusetts.,Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
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23
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Walle KM, Nordvik JE, Espeseth T, Becker F, Laeng B. Multiple object tracking and pupillometry reveal deficits in both selective and intensive attention in unilateral spatial neglect. J Clin Exp Neuropsychol 2018; 41:270-289. [DOI: 10.1080/13803395.2018.1536735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kjersti Mæhlum Walle
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Jan Egil Nordvik
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | | | - Frank Becker
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bruno Laeng
- Department of Psychology, University of Oslo, Oslo, Norway
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24
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VanVleet T, Voss M, Dabit S, Mitko A, DeGutis J. Randomized control trial of computer-based training targeting alertness in older adults: the ALERT trial protocol. BMC Psychol 2018; 6:22. [PMID: 29724228 PMCID: PMC5934832 DOI: 10.1186/s40359-018-0233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Healthy aging is associated with a decline in multiple functional domains including perception, attention, short and long-term memory, reasoning, decision-making, as well as cognitive and motor control functions; all of which are significantly modulated by an individual’s level of alertness. The control of alertness also significantly declines with age and contributes to increased lapses of attention in everyday life, ranging from minor memory slips to a lack of vigilance and increased risk of falls or motor-vehicle accidents. Several experimental behavioral therapies designed to remediate age-related cognitive decline have been developed, but differ widely in content, method and dose. Preliminary studies demonstrate that Tonic and Phasic Alertness Training (TAPAT) can improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments. The purpose of the current trial (referred to as the Attention training for Learning Enhancement and Resilience Trial or ALERT) is to compare TAPAT to an active control training condition, include a larger sample of patients, and assess both cognitive and functional outcomes. Methods/design We will employ a multi-site, longitudinal, blinded randomized controlled trial (RCT) design with a target sample of 120 patients with age-related cognitive decline. Patients will be asked to complete 36 training sessions remotely (30 min/day, 5 days a week, over 3 months) of either the experimental TAPAT training program or an active control computer games condition. Patients will be assessed on a battery of cognitive and functional outcomes at four time points, including: a) immediately before training, b) halfway through training, c) within forty-eight hours post completion of total training, and d) after a three-month no-contact period post completion of total training, to assess the longevity of potential training effects. Discussion The strengths of this protocol are that it tests an innovative, in-home administered treatment that targets a fundamental deficit in adults with age-related cognitive decline; employs highly sensitive computer-based assessments of cognition as well as functional abilities, and incorporates a large sample size in an RCT design. Trial registration ClinicalTrials.gov identifier: NCT02416401.
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Affiliation(s)
- Thomas VanVleet
- Posit Science Corporation, San Francisco, CA, USA. .,Department of Veteran Affairs, VA Medical Center, Martinez, CA, USA.
| | - Michelle Voss
- Health, Brain and Cognition Lab, University of Iowa, Iowa City, IA, USA.,Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Sawsan Dabit
- Posit Science Corporation, San Francisco, CA, USA
| | - Alex Mitko
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, MA, USA.,Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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25
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Simons DJ, Boot WR, Charness N, Gathercole SE, Chabris CF, Hambrick DZ, Stine-Morrow EAL. Do "Brain-Training" Programs Work? Psychol Sci Public Interest 2018; 17:103-186. [PMID: 27697851 DOI: 10.1177/1529100616661983] [Citation(s) in RCA: 562] [Impact Index Per Article: 93.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In 2014, two groups of scientists published open letters on the efficacy of brain-training interventions, or "brain games," for improving cognition. The first letter, a consensus statement from an international group of more than 70 scientists, claimed that brain games do not provide a scientifically grounded way to improve cognitive functioning or to stave off cognitive decline. Several months later, an international group of 133 scientists and practitioners countered that the literature is replete with demonstrations of the benefits of brain training for a wide variety of cognitive and everyday activities. How could two teams of scientists examine the same literature and come to conflicting "consensus" views about the effectiveness of brain training?In part, the disagreement might result from different standards used when evaluating the evidence. To date, the field has lacked a comprehensive review of the brain-training literature, one that examines both the quantity and the quality of the evidence according to a well-defined set of best practices. This article provides such a review, focusing exclusively on the use of cognitive tasks or games as a means to enhance performance on other tasks. We specify and justify a set of best practices for such brain-training interventions and then use those standards to evaluate all of the published peer-reviewed intervention studies cited on the websites of leading brain-training companies listed on Cognitive Training Data (www.cognitivetrainingdata.org), the site hosting the open letter from brain-training proponents. These citations presumably represent the evidence that best supports the claims of effectiveness.Based on this examination, we find extensive evidence that brain-training interventions improve performance on the trained tasks, less evidence that such interventions improve performance on closely related tasks, and little evidence that training enhances performance on distantly related tasks or that training improves everyday cognitive performance. We also find that many of the published intervention studies had major shortcomings in design or analysis that preclude definitive conclusions about the efficacy of training, and that none of the cited studies conformed to all of the best practices we identify as essential to drawing clear conclusions about the benefits of brain training for everyday activities. We conclude with detailed recommendations for scientists, funding agencies, and policymakers that, if adopted, would lead to better evidence regarding the efficacy of brain-training interventions.
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Affiliation(s)
- Daniel J Simons
- Department of Psychology, University of Illinois at Urbana-Champaign
| | | | - Neil Charness
- Department of Psychology, Florida State University Institute for Successful Longevity, Florida State University
| | - Susan E Gathercole
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK School of Clinical Medicine, University of Cambridge
| | | | | | - Elizabeth A L Stine-Morrow
- Department of Educational Psychology, University of Illinois at Urbana-Champaign Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign
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26
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Paladini RE, Müri RM, Meichtry J, Nef T, Mast FW, Mosimann UP, Nyffeler T, Cazzoli D. The Influence of Alertness on the Spatial Deployment of Visual Attention is Mediated by the Excitability of the Posterior Parietal Cortices. Cereb Cortex 2018; 27:233-243. [PMID: 28013233 PMCID: PMC5939216 DOI: 10.1093/cercor/bhw390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/01/2016] [Indexed: 12/25/2022] Open
Abstract
With a reduced level of alertness, healthy individuals typically show a rightward shift when deploying visual attention in space. The impact of alertness on the neural networks governing visuospatial attention is, however, poorly understood. By using a transcranial magnetic stimulation twin-coil approach, the present study aimed at investigating the effects of an alertness manipulation on the excitability of the left and the right posterior parietal cortices (PPCs), crucial nodes of the visuospatial attentional network. Participants’ visuospatial attentional deployment was assessed with a free visual exploration task and concurrent eye tracking. Their alertness level was manipulated through the time of the day, that is, by testing chronotypically defined evening types both during their circadian on- and off-peak times. The results revealed an increased excitability of the left compared with the right PPC during low alertness. On the horizontal dimension, these results were accompanied by a significant rightward shift in the center and a bilateral narrowing in the periphery of the visual exploration field, as well as a central upward shift on the vertical dimension. The findings show that the manipulation of non-spatial attentional aspects (i.e., alertness) can affect visuospatial attentional deployment and modulate the excitability of areas subtending spatial attentional control.
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Affiliation(s)
- Rebecca E Paladini
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - René M Müri
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland.,Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland.,Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Jurka Meichtry
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland.,Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland.,Department of Psychology, University of Bern, Bern, Switzerland
| | - Urs P Mosimann
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland.,Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland.,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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27
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Sugimoto S, Fujino Y. Neglected-Field Eye Patching Improves Visual Inattention in Hemispatial Neglect: A Case Study. Prog Rehabil Med 2017; 2:20170012. [PMID: 32789219 DOI: 10.2490/prm.20170012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/13/2017] [Indexed: 11/09/2022] Open
Abstract
Objective Recently, eye patching has been used as a technique for adjusting visual information. However, there are differing opinions regarding the influence of eye patching on visual attention in hemispatial neglect. Studies on eye patching do not usually consider the effects of differences in task difficulty or reaction space. Moreover, to date, no trial has used neglected-field eye patching. We investigated the effect on hemispatial neglect of hemi-visual field eye-patching glasses in a patient with left spatial neglect. Methods The patient was an 86-year-old woman who had suffered a stroke. She had severe left hemiparesis and left spatial neglect. Three types of eye-patching glasses were used: right-field patching, left-field patching, and no patching. The line bisection test, the line crossing test, the star cancellation test, and the letter cancellation test were carried out for the three eye-patching conditions. Results The line bisection test results showed rightward deviations for both left and right patching compared to no patching. For the line crossing test, there were no omission errors for any patching condition. In the star cancellation test, there were small differences between the three patching conditions. However, in the letter cancellation test, the fewest omission errors occurred during left-field patching, with the most notable improvement on the right half of the test paper. Conclusion The results suggest that neglected-field eye patching for hemispatial neglect might improve visual attention, especially the non-spatial aspects.
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Affiliation(s)
- Satoshi Sugimoto
- Department of Physical Therapy, University of Tokyo Health Sciences, Tama City, Tokyo, Japan
| | - Yuji Fujino
- Department of Rehabilitation, Saitama Medical University International Medical Center, Hidaka City, Saitama, Japan
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28
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Esterman M, Thai M, Okabe H, DeGutis J, Saad E, Laganiere SE, Halko MA. Network-targeted cerebellar transcranial magnetic stimulation improves attentional control. Neuroimage 2017; 156:190-198. [PMID: 28495634 PMCID: PMC5973536 DOI: 10.1016/j.neuroimage.2017.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/04/2017] [Accepted: 05/07/2017] [Indexed: 11/22/2022] Open
Abstract
Developing non-invasive brain stimulation interventions to improve attentional control is extremely relevant to a variety of neurological and psychiatric populations, yet few studies have identified reliable biomarkers that can be readily modified to improve attentional control. One potential biomarker of attention is functional connectivity in the core cortical network supporting attention - the dorsal attention network (DAN). We used a network-targeted cerebellar transcranial magnetic stimulation (TMS) procedure, intended to enhance cortical functional connectivity in the DAN. Specifically, in healthy young adults we administered intermittent theta burst TMS (iTBS) to the midline cerebellar node of the DAN and, as a control, the right cerebellar node of the default mode network (DMN). These cerebellar targets were localized using individual resting-state fMRI scans. Participants completed assessments of both sustained (gradual onset continuous performance task, gradCPT) and transient attentional control (attentional blink) immediately before and after stimulation, in two sessions (cerebellar DAN and DMN). Following cerebellar DAN stimulation, participants had significantly fewer attentional lapses (lower commission error rates) on the gradCPT. In contrast, stimulation to the cerebellar DMN did not affect gradCPT performance. Further, in the DAN condition, individuals with worse baseline gradCPT performance showed the greatest enhancement in gradCPT performance. These results suggest that temporarily increasing functional connectivity in the DAN via network-targeted cerebellar stimulation can enhance sustained attention, particularly in those with poor baseline performance. With regard to transient attention, TMS stimulation improved attentional blink performance across both stimulation sites, suggesting increasing functional connectivity in both networks can enhance this aspect of attention. These findings have important implications for intervention applications of TMS and theoretical models of functional connectivity.
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Affiliation(s)
- Michael Esterman
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System, United States; Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States; Geriatric Research Education and Clinical Center (GRECC), Boston Division VA Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | - Michelle Thai
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States
| | - Hidefusa Okabe
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States
| | - Joseph DeGutis
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Elyana Saad
- Boston Attention and Learning Laboratory, VA Boston Healthcare System, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Simon E Laganiere
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, United States
| | - Mark A Halko
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, United States
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29
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English MCW, Maybery MT, Visser TAW. Modulation of Global and Local Processing Biases in Adults with Autistic-like Traits. J Autism Dev Disord 2017; 47:2757-2769. [PMID: 28597188 DOI: 10.1007/s10803-017-3198-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Previous work shows that doing a continuous performance task (CPT) shifts attentional biases in neurotypical individuals towards global aspects of hierarchical Navon figures by selectively activating right hemisphere regions associated with global processing. The present study examines whether CPT can induce similar modulations of attention in individuals with high levels of autistic traits who typically show global processing impairments. Participants categorized global or local aspects of Navon figures in pre- and post-CPT blocks. Post-CPT, high trait individuals showed increased global interference during local categorization. This result suggests that CPT may be useful for temporarily enhancing global processing in individuals with high levels of autistic traits and possibly those diagnosed with autism.
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Affiliation(s)
- Michael C W English
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Murray T Maybery
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Troy A W Visser
- School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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30
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Fortenbaugh FC, Corbo V, Poole V, McGlinchey R, Milberg W, Salat D, DeGutis J, Esterman M. Interpersonal early-life trauma alters amygdala connectivity and sustained attention performance. Brain Behav 2017; 7:e00684. [PMID: 28523226 PMCID: PMC5434189 DOI: 10.1002/brb3.684] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/06/2017] [Accepted: 02/16/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Interpersonal early life trauma (I-ELT) is associated with a myriad of functional impairments in adulthood, increased risk of drug addiction, and neuropsychiatric disorders. While deficits in emotional regulation and amygdala functioning are well characterized, deficits in general cognitive functioning have also been documented. However, the neural underpinnings of cognitive dysfunction in adults with a history of I-ELT and the potential relationship between amygdala-based functional connectivity and behavioral performance are currently poorly understood. This study examined how I-ELT affects the cognitive and neural mechanisms supporting sustained attention. METHODS A total of 66 Veterans (18 with and 48 without a history of I-ELT) completed a nonemotional sustained attention task during functional MRI. RESULTS The individuals with I-ELT showed significant impairments in sustained attention (i.e., higher error rates, greater response variability). This cohort exhibited increased amygdala functional connectivity with the prefrontal cortex and decreased functional connectivity with the parahippocampal gyrus when compared to those without I-ELT. These connections were significantly correlated with individual differences in sustained attention performance. Notably, classification analyses revealed that the pattern of amygdala connectivity across the whole brain was able to classify I-ELT status with 70% accuracy. CONCLUSION These results provide evidence of a lasting negative impact for those with a history of I-ELT on sustained attention ability. They also highlight a critical role for amygdala functioning in cognitive control and sustained attention for those with a history of I-ELT, which may underlie the observed attention deficits in clinical assessments and cognitive tests involving both emotional and nonemotional stimuli.
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Affiliation(s)
- Francesca C Fortenbaugh
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Department of Psychiatry Harvard Medical School Boston MA USA
| | - Vincent Corbo
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Department of Psychology School of Arts and Science Southern New Hampshire University Manchester NH USA
| | - Victoria Poole
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Institute of Aging Research Hebrew SeniorLife Boston MA USA
| | - Regina McGlinchey
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Department of Psychiatry Harvard Medical School Boston MA USA
| | - William Milberg
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Department of Psychiatry Harvard Medical School Boston MA USA
| | - David Salat
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Athinoula A. Martinos Center for Biomedical Imaging Charlestown MA USA
| | - Joseph DeGutis
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Department of Medicine Harvard Medical School Boston MA USA
| | - Michael Esterman
- Translational Research Center for TBI and Stress Disorders (TRACTS) and Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston MA USA.,Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston MA USA.,Department of Psychiatry Boston University School of Medicine Boston MA USA
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31
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Fortenbaugh FC, DeGutis J, Esterman M. Recent theoretical, neural, and clinical advances in sustained attention research. Ann N Y Acad Sci 2017; 1396:70-91. [PMID: 28260249 PMCID: PMC5522184 DOI: 10.1111/nyas.13318] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/27/2016] [Accepted: 01/10/2017] [Indexed: 01/08/2023]
Abstract
Models of attention often distinguish among attention subtypes, with classic models separating orienting, switching, and sustaining functions. Compared with other forms of attention, the neurophysiological basis of sustaining attention has received far less notice, yet it is known that momentary failures of sustained attention can have far-ranging negative effects in healthy individuals, and lasting sustained attention deficits are pervasive in clinical populations. In recent years, however, there has been increased interest in characterizing moment-to-moment fluctuations in sustained attention, in addition to the overall vigilance decrement, and understanding how these neurocognitive systems change over the life span and across various clinical populations. The use of novel neuroimaging paradigms and statistical approaches has allowed for better characterization of the neural networks supporting sustained attention and has highlighted dynamic interactions within and across multiple distributed networks that predict behavioral performance. These advances have also provided potential biomarkers to identify individuals with sustained attention deficits. These findings have led to new theoretical models explaining why sustaining focused attention is a challenge for individuals and form the basis for the next generation of sustained attention research, which seeks to accurately diagnose and develop theoretically driven treatments for sustained attention deficits that affect a variety of clinical populations.
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Affiliation(s)
- Francesca C. Fortenbaugh
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System
- Boston Attention & Learning Laboratory, VA Boston Healthcare System
- Geriatric Research, Education, & Clinical Center (GRECC), VA Boston Healthcare System
- Department of Psychiatry, Harvard Medical School
| | - Joseph DeGutis
- Boston Attention & Learning Laboratory, VA Boston Healthcare System
- Geriatric Research, Education, & Clinical Center (GRECC), VA Boston Healthcare System
- Department of Psychiatry, Harvard Medical School
| | - Michael Esterman
- Neuroimaging Research for Veterans (NeRVe) Center, VA Boston Healthcare System
- Boston Attention & Learning Laboratory, VA Boston Healthcare System
- Geriatric Research, Education, & Clinical Center (GRECC), VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
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32
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Thomas NA, Barone AJ, Flew AH, Nicholls ME. Cross-modal influences on attentional asymmetries: Additive effects of attentional orienting and arousal. Neuropsychologia 2017; 96:39-51. [DOI: 10.1016/j.neuropsychologia.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/21/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
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33
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Tanzer M, Weinbach N, Mardo E, Henik A, Avidan G. Phasic alertness enhances processing of face and non-face stimuli in congenital prosopagnosia. Neuropsychologia 2016; 89:299-308. [PMID: 27364232 DOI: 10.1016/j.neuropsychologia.2016.06.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Michal Tanzer
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noam Weinbach
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elite Mardo
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel; Psychology Department, Haifa University, Haifa, Israel
| | - Avishai Henik
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Galia Avidan
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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Anticipation of Monetary Reward Can Attenuate the Vigilance Decrement. PLoS One 2016; 11:e0159741. [PMID: 27472785 PMCID: PMC4966925 DOI: 10.1371/journal.pone.0159741] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/07/2016] [Indexed: 11/19/2022] Open
Abstract
Motivation and reward can have differential effects on separate aspects of sustained attention. We previously demonstrated that continuous reward/punishment throughout a sustained attention task improves overall performance, but not vigilance decrements. One interpretation of these findings is that vigilance decrements are due to resource depletion, which is not overcome by increasing overall motivation. However, an alternative explanation is that as one performs a continuously rewarded task there are less potential gains/losses as the task progresses, which could decrease motivation over time, producing a vigilance decrement. This would predict that keeping future gains/losses consistent throughout the task would reduce the vigilance decrement. In the current study, we examined this possibility by comparing two versions (continuous-small loss vs. anticipate-large loss) of a 10-minute gradual onset continuous performance task (gradCPT), a challenging go/no-go sustained attention task. Participants began each task with the potential to keep $18. In the continuous-small-loss version, small monetary losses were accrued continuously throughout the task for each error. However, in the anticipate-large-loss version, participants lost all $18 if they erroneously responded to one target that always appeared toward the end of the vigil. Typical vigilance decrements were observed in the continuous-small-loss condition. In the anticipate-large-loss condition, vigilance decrements were reduced, particularly when the anticipate-large loss condition was completed second. This suggests that the looming possibility of a large loss can attenuate the vigilance decrement and that this attenuation may occur most consistently after sufficient task experience. We discuss these results in the context of current theories of sustained attention.
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Van Vleet TM, DeGutis JM, Merzenich MM, Simpson GV, Zomet A, Dabit S. Targeting alertness to improve cognition in older adults: A preliminary report of benefits in executive function and skill acquisition. Cortex 2016; 82:100-118. [PMID: 27372902 DOI: 10.1016/j.cortex.2016.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 01/23/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Efficient self-regulation of alertness declines with age exacerbating normal declines in performance across multiple cognitive domains, including learning and skill acquisition. Previous cognitive intervention studies have shown that it is possible to enhance alertness in patients with acquired brain injury and marked attention impairments, and that this benefit generalizes to improvements in more global cognitive functions. In the current preliminary studies, we sought to test whether this approach, that targets both tonic (over a period of minutes) and phasic (moment-to-moment) alertness, can improve key executive functioning declines in older adults, and enhance the rate of skill acquisition. The results of both Experiments 1 and 2 demonstrate that, compared to active control (AC) training, alertness training significantly enhanced performance in several validated executive function measures. In Experiment 2, alertness training significantly improved skill acquisition compared to AC training in a well-characterized speed of processing (SOP) task, with the largest benefits shown in the most challenging SOP blocks. The results of the current study suggest that targeting intrinsic alertness through cognitive training provides a novel approach to improve executive functions in older adults and may be a useful adjunct treatment to enhance benefits gained in other clinically validated treatments.
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Affiliation(s)
- Thomas M Van Vleet
- Department of Veteran Affairs, VA Medical Center, Martinez, CA, United States; Posit Science, San Francisco, CA, United States.
| | - Joseph M DeGutis
- Department of Veteran Affairs, VA Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Michael M Merzenich
- Posit Science, San Francisco, CA, United States; Department of Physiology, University of California, San Francisco, CA, United States
| | | | - Ativ Zomet
- Posit Science, San Francisco, CA, United States; Vision Sciences Department, University of California, Berkeley, CA, United States
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DeGutis J, Grosso M, VanVleet T, Esterman M, Pistorino L, Cronin-Golomb A. Sustained attention training reduces spatial bias in Parkinson's disease: a pilot case series. Neurocase 2016; 22:179-86. [PMID: 26360648 PMCID: PMC4949393 DOI: 10.1080/13554794.2015.1088035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Individuals with Parkinson's disease (PD) commonly demonstrate lateralized spatial biases, which affect daily functioning. Those with PD with initial motor symptoms on the left body side (LPD) have reduced leftward attention, whereas PD with initial motor symptoms on the right side (RPD) may display reduced rightward attention. We investigated whether a sustained attention training program could help reduce these spatial biases. Four non-demented individuals with PD (2 LPD, 2 RPD) performed a visual search task before and after 1 month of computer training. Before training, all participants showed a significant spatial bias and after training, all participants' spatial bias was eliminated.
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Affiliation(s)
- Joseph DeGutis
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , MA , USA.,b Geriatric Research Education and Clinical Center (GRECC) , Boston Division VA Healthcare System , Boston , MA , USA.,c Department of Medicine , Harvard Medical School , Boston , MA , USA
| | - Mallory Grosso
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , MA , USA.,b Geriatric Research Education and Clinical Center (GRECC) , Boston Division VA Healthcare System , Boston , MA , USA
| | - Thomas VanVleet
- d Department of Medical Research, VA Northern California Healthcare System , Martinez , CA , USA
| | - Michael Esterman
- a Boston Attention and Learning Laboratory , Boston Division VA Healthcare System , Boston , MA , USA.,b Geriatric Research Education and Clinical Center (GRECC) , Boston Division VA Healthcare System , Boston , MA , USA.,e Department of Psychiatry , Boston University School of Medicine , Boston , MA , USA
| | - Laura Pistorino
- f Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
| | - Alice Cronin-Golomb
- f Department of Psychological and Brain Sciences , Boston University , Boston , MA , USA
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Fortenbaugh FC, DeGutis J, Germine L, Wilmer JB, Grosso M, Russo K, Esterman M. Sustained Attention Across the Life Span in a Sample of 10,000: Dissociating Ability and Strategy. Psychol Sci 2015; 26:1497-510. [PMID: 26253551 DOI: 10.1177/0956797615594896] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/15/2015] [Indexed: 11/16/2022] Open
Abstract
Normal and abnormal differences in sustained visual attention have long been of interest to scientists, educators, and clinicians. Still lacking, however, is a clear understanding of how sustained visual attention varies across the broad sweep of the human life span. In the present study, we filled this gap in two ways. First, using an unprecedentedly large 10,430-person sample, we modeled age-related differences with substantially greater precision than have prior efforts. Second, using the recently developed gradual-onset continuous performance test (gradCPT), we parsed sustained-attention performance over the life span into its ability and strategy components. We found that after the age of 15 years, the strategy and ability trajectories saliently diverge. Strategy becomes monotonically more conservative with age, whereas ability peaks in the early 40s and is followed by a gradual decline in older adults. These observed life-span trajectories for sustained attention are distinct from results of other life-span studies focusing on fluid and crystallized intelligence.
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Affiliation(s)
- Francesca C Fortenbaugh
- GRECC & Research Services, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts Department of Psychiatry, Harvard Medical School
| | - Joseph DeGutis
- GRECC & Research Services, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts Department of Medicine, Harvard Medical School
| | - Laura Germine
- Department of Psychology, Harvard University Center for Human Genetic Research, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Mallory Grosso
- GRECC & Research Services, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts
| | - Kathryn Russo
- GRECC & Research Services, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts
| | - Michael Esterman
- GRECC & Research Services, Department of Veterans Affairs, VA Boston Healthcare System, Boston, Massachusetts Department of Psychiatry, Boston University School of Medicine
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Liu P, Yang W, Yuan X, Bi C, Chen A, Huang X. Individual alerting efficiency modulates time perception. Front Psychol 2015; 6:386. [PMID: 25904881 PMCID: PMC4387862 DOI: 10.3389/fpsyg.2015.00386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/18/2015] [Indexed: 11/23/2022] Open
Abstract
Time perception plays a fundamental role in human perceptual and motor activities, and can be influenced by various factors, such as selective attention and arousal. However, little is known about the influence of individual alerting efficiency on perceived duration. In this study, we explored this question by running two experiments. The Attentional Networks Test was used to evaluate individual differences in alerting efficiency in each experiment. Temporal bisection (Experiment 1) and time generalization task (Experiment 2) were used to explore the participants’ perception of duration. The results indicated that subjects in the high alerting efficiency group overestimated interval durations and estimated durations more accurately compared with subjects in the low alerting efficiency group. The two experiments showed that the sensitivity of time was not influenced by individual alerting efficiency. Based on previous studies and current findings, we infer that individual differences in alerting efficiency may influence time perception through modulating the latency of the attention-controlled switch and the speed of the peacemaker within the framework of the internal clock model.
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Affiliation(s)
- Peiduo Liu
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology Southwest University, Chongqing, China
| | - Wenjing Yang
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology Southwest University, Chongqing, China
| | - Xiangyong Yuan
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology Southwest University, Chongqing, China
| | - Cuihua Bi
- School of Educational Science, Research Center of Psychological Development and Application, Sichuan Normal University Chengdu, China
| | - Antao Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology Southwest University, Chongqing, China
| | - Xiting Huang
- Key Laboratory of Cognition and Personality, Ministry of Education, Faculty of Psychology Southwest University, Chongqing, China
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Ready, set, point: the effects of alertness on prism adaptation in healthy adults. Exp Brain Res 2015; 233:1441-54. [PMID: 25702160 DOI: 10.1007/s00221-015-4218-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 01/23/2015] [Indexed: 11/27/2022]
Abstract
Prism adaptation (PA) is a promising rehabilitation technique for visuo-spatial neglect, an attention disorder that is characterized by spatial attention deficits (i.e., deficits in orienting). PA involves visuo-motor adaptation to rightward shifting prism goggles. Following goggle removal, this adaptation results in leftward shifts in visuo-motor aiming and amelioration of spatial neglect. Even though some studies clearly support the beneficial effects of PA for spatial neglect, not all studies find benefits, thus it remains unclear how PA effects could be improved. Taking advantage of the known interactions between orienting and alerting reported in the attention literature (i.e., alerting enhances orienting function; e.g., Ishigami and Klein in J Individ Differ 30:220-237. doi: 10.1027/1614-0001.30.4.220 , 2009, in J Neurosci Methods 190:117-28. doi: 10.1016/j.jneumeth.2010.04.019 , 2010; Robertson et al. in Nature 395:169-72. doi: 10.1038/25993 , 1998), we examined the effects of alerting tones on PA with healthy young and older adults. We found that the effects of alerting on PA with young adults were negative, while there was a positive effect with older adults, specifically on a visuo-motor outcome task. Thus, enhancement of PA effects by alerting may be age specific and task specific. Therefore, we can conclude that while the impact of alerting tones is not always positive, further research in patients with neglect may be warranted.
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40
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Van Vleet TM, Chen A, Vernon A, Novakovic-Agopian T, D'Esposito MT. Tonic and phasic alertness training: a novel treatment for executive control dysfunction following mild traumatic brain injury. Neurocase 2015; 21:489-98. [PMID: 24984231 DOI: 10.1080/13554794.2014.928329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many individuals with traumatic brain injury (TBI) suffer difficulty regulating fundamental aspects of attention (focus, sustained attention) and may also exhibit hypo- or hyper-states of alertness. Deficits in the state of attention may underlie or exacerbate higher order executive dysfunction. Recent studies indicate that computerized cognitive training targeting attentional control and alertness can ameliorate attention deficits evident in patients with TBI or acquired brain injury. The current study examined whether improvements in attentional state following training can also influence performance on higher-order executive function and mood in individuals with mild TBI (mTBI). The current study examined five patients with executive control deficits as a result of mTBI, with or without persistent anxiety. Three patients engaged in ~5 hours of an executive control training task targeting inhibitory control and sustained attention; two additional patients were re-tested following the same period of time. Performance on standard neuropsychological measures of attention, executive function, and mood were evaluated pre- and post-training. The results indicate that tonic and phasic alertness training may improve higher-order executive function and mood regulation in individuals with TBI.
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Abstract
The prefrontal cortex (PFC), a cortical region that was once thought to be functionally insignificant, is now known to play an essential role in the organization and control of goal-directed thought and behavior. Neuroimaging, neurophysiological, and modeling techniques have led to tremendous advances in our understanding of PFC functions over the last few decades. It should be noted, however, that neurological, neuropathological, and neuropsychological studies have contributed some of the most essential, historical, and often prescient conclusions regarding the functions of this region. Importantly, examination of patients with brain damage allows one to draw conclusions about whether a brain area is necessary for a particular function. Here, we provide a broad overview of PFC functions based on behavioral and neural changes resulting from damage to PFC in both human patients and nonhuman primates.
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Affiliation(s)
- Sara M Szczepanski
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Robert T Knight
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, CA 94720, USA; Department of Psychology, University of California, Berkeley, Berkeley, CA 94720, USA
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42
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Merzenich MM, Van Vleet TM, Nahum M. Brain plasticity-based therapeutics. Front Hum Neurosci 2014; 8:385. [PMID: 25018719 PMCID: PMC4072971 DOI: 10.3389/fnhum.2014.00385] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/15/2014] [Indexed: 11/30/2022] Open
Abstract
The primary objective of this review article is to summarize how the neuroscience of brain plasticity, exploiting new findings in fundamental, integrative and cognitive neuroscience, is changing the therapeutic landscape for professional communities addressing brain-based disorders and disease. After considering the neurological bases of training-driven neuroplasticity, we shall describe how this neuroscience-guided perspective distinguishes this new approach from (a) the more-behavioral, traditional clinical strategies of professional therapy practitioners, and (b) an even more widely applied pharmaceutical treatment model for neurological and psychiatric treatment domains. With that background, we shall argue that neuroplasticity-based treatments will be an important part of future best-treatment practices in neurological and psychiatric medicine.
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Affiliation(s)
| | - Thomas M Van Vleet
- Posit Science Corporation San Francisco, CA, USA ; Medical Research, Department of Veteran Affairs Martinez, CA, USA
| | - Mor Nahum
- Posit Science Corporation San Francisco, CA, USA ; Department of Optometry, University of California at Berkeley Berkeley, CA, USA
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43
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Milewski-Lopez A, Greco E, van den Berg F, McAvinue LP, McGuire S, Robertson IH. An evaluation of alertness training for older adults. Front Aging Neurosci 2014; 6:67. [PMID: 24782764 PMCID: PMC3990037 DOI: 10.3389/fnagi.2014.00067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 03/26/2014] [Indexed: 11/17/2022] Open
Abstract
We present an evaluation of a self-administered, biofeedback-aided, alertness training programme called the Alertness: Training for Focused Living (ATFL) Programme, which was developed as part of the Technology Research for Independent Living (TRIL) collaboration. We conducted two studies in order to evaluate the programme. A randomized controlled trial was, first of all, conducted with 40 older adults aged between 60 and 83. A series of five single case studies was then conducted to examine the suitability of the programme for use with people with more severe memory difficulties. In the randomized controlled trial, participants were assigned to the ATFL Programme or to a placebo programme. Aspects of participants' memory, attention and executive functioning were assessed via telephone prior to and following completion of the training programmes and at 1, 3, and 6-month follow-up sessions. Significant improvements in sustained attention and verbal fluency were noted in the ATFL group. The series of single case studies illustrated the importance of tailoring a programme to the needs and abilities of the clients in question. The potential benefits of the ATFL programme in terms of periodically boosting alertness and aiding executive functioning are discussed.
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Affiliation(s)
| | - Eleonora Greco
- Institute of Neuroscience, Trinity College Dublin Dublin, Ireland
| | | | - Laura P McAvinue
- Department of Psychology, University of Limerick Limerick, Ireland
| | - Sarah McGuire
- Institute of Neuroscience, Trinity College Dublin Dublin, Ireland
| | - Ian H Robertson
- Institute of Neuroscience, Trinity College Dublin Dublin, Ireland
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PTSD modifies performance on a task of affective executive control among deployed OEF/OIF veterans with mild traumatic brain injury. J Int Neuropsychol Soc 2013; 19:792-801. [PMID: 23823533 PMCID: PMC4003877 DOI: 10.1017/s1355617713000544] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Individuals with post-traumatic stress disorder (PTSD) show a cognitive bias for threatening information, reflecting dysregulated executive control for affective stimuli. This study examined whether comorbid mild Traumatic Brain Injury (mTBI) with PTSD exacerbates this bias. A computer-administered Affective Go/No-Go task measured reaction times (RTs) and errors of omission and commission to words with a non-combat-related positive or negative valence in 72 deployed United States service members from the wars in Iraq and Afghanistan. Incidents of military-related mTBI were measured with the Boston Assessment of Traumatic Brain Injury-Lifetime. PTSD symptoms were measured with the Clinician-Administered PTSD Scale. Participants were divided into those with (mTBI+, n = 34) and without a history of military-related mTBI (mTBI-, n = 38). Valence of the target stimuli differentially impacted errors of commission and decision bias (criterion) in the mTBI+ and mTBI- groups. Specifically, within the mTBI+ group, increasing severity of PTSD symptoms was associated with an increasingly liberal response pattern (defined as more commission errors to negative distractors and greater hit rate for positive stimuli) in the positive compared to the negative blocks. This association was not observed in the mTBI- group. This study underscores the importance of considering the impact of a military-related mTBI and PTSD severity upon affective executive control.
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Sturm W, Thimm M, Binkofski F, Horoufchin H, Fink GR, Küst J, Karbe H, Willmes K. Combined space and alertness related therapy of visual hemineglect: effect of therapy frequency. Front Hum Neurosci 2013; 7:373. [PMID: 23908613 PMCID: PMC3727078 DOI: 10.3389/fnhum.2013.00373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/27/2013] [Indexed: 11/13/2022] Open
Abstract
The combined efficacy of space- and alertness related training in chronic hemineglect was tested behaviorally and in a longitudinal fMRI study. Earlier results had shown that both space as well as alertness related training as single intervention methods lead to short term improvement which, however, is not stable for longer time periods. The neurobiological data obtained in these studies revealed differential cortical reorganization patterns for the two training approaches thereby leading to the hypothesis that a combination of both trainings might result in stronger and longer lasting effects. The results of our current study, however, - at least at first glance - do not clearly corroborate this hypothesis, because neither alertness training alone nor the combination with OKS on the group level led to significant behavioral improvement, although four of the six patients after alertness and even more after combined training showed a higher percentage of behavioral improvement than during baseline. Despite the lack of clearcut behavioral training induced improvement we found right parietal or fronto-parietal increase of activation in the imaging data immediately after combined training and at follow-up 3 weeks later. The study design had called for splitting up training time between the two training approaches in order to match total training time with our earlier single training studies. The results of our current study are discussed as a possible consequence of reduced training time and intensity of both training measures under the combined training situation.
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Affiliation(s)
- Walter Sturm
- Department of Neurology, Clinical Neuropsychology, Section Neuropsychology, University Hospital RWTH University, Aachen, Germany
| | - M. Thimm
- Department of Neurology, Clinical Neuropsychology, Section Neuropsychology, University Hospital RWTH University, Aachen, Germany
| | - F. Binkofski
- Department of Neurology, Clinical Neuropsychology, Section Neuropsychology, University Hospital RWTH University, Aachen, Germany
| | - H. Horoufchin
- Department of Neurology, Clinical Neuropsychology, Section Neuropsychology, University Hospital RWTH University, Aachen, Germany
| | - G. R. Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM3), Research Center Jülich, Jülich, Germany
| | - J. Küst
- Schmieder Clinic, Neurological Rehabilitation Centre, Allensbach, Germany
| | - H. Karbe
- Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany
| | - K. Willmes
- Department of Neurology, Clinical Neuropsychology, Section Neuropsychology, University Hospital RWTH University, Aachen, Germany
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Bonato M, Deouell LY. Hemispatial neglect: computer-based testing allows more sensitive quantification of attentional disorders and recovery and might lead to better evaluation of rehabilitation. Front Hum Neurosci 2013; 7:162. [PMID: 23641207 PMCID: PMC3640209 DOI: 10.3389/fnhum.2013.00162] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/11/2013] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mario Bonato
- Department of Experimental Psychology, Ghent UniversityGhent, Belgium
| | - Leon Y. Deouell
- Department of Psychology, Edmond and Lily Safra Center for Brain Sciences, The Hebrew University of JerusalemJerusalem, Israel
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Van Vleet TM, DeGutis JM. Cross-training in hemispatial neglect: Auditory sustained attention training ameliorates visual attention deficits. Cortex 2013; 49:679-90. [DOI: 10.1016/j.cortex.2012.03.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/12/2012] [Accepted: 03/13/2012] [Indexed: 11/15/2022]
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Van Vleet TM, DeGutis JM. The nonspatial side of spatial neglect and related approaches to treatment. PROGRESS IN BRAIN RESEARCH 2013; 207:327-49. [PMID: 24309261 DOI: 10.1016/b978-0-444-63327-9.00012-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In addition to deficits in spatial attention, individuals with persistent spatial neglect almost universally exhibit nonspatially lateralized deficits in sustained and selective attention, and working memory. However, nonspatially lateralized deficits in neglect have received considerably less attention in the literature than deficits in spatial attention. This is in spite of the fact that nonspatially lateralized deficits better predict the chronicity and functional disability associated with neglect than spatially lateralized deficits. Furthermore, only a few treatment studies have specifically targeted nonspatially lateralized deficits as a means to improve spatial neglect. In this chapter, we will briefly review several models of spatial attention bias in neglect before focusing on nonspatial deficits and the mechanisms of nonspatial-spatial interactions and implications for treatment. Treatment approaches that more completely address nonspatial deficits and better account for their interactions with spatial attention will likely produce better outcomes.
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Affiliation(s)
- Thomas M Van Vleet
- Department of Veteran Affairs, Martinez, CA, USA; Brain Plasticity Institute at Posit Science Corporation, San Francisco, CA, USA.
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49
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Russell C, Malhotra P, Deidda C, Husain M. Dynamic attentional modulation of vision across space and time after right hemisphere stroke and in ageing. Cortex 2012; 49:1874-83. [PMID: 23245427 PMCID: PMC3701319 DOI: 10.1016/j.cortex.2012.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/21/2012] [Accepted: 10/19/2012] [Indexed: 11/12/2022]
Abstract
Introduction Attention modulates the availability of sensory information to conscious perception. In particular, there is evidence of pathological, spatial constriction of the effective field of vision in patients with right hemisphere damage when a central task exhausts available attentional capacity. In the current study we first examined whether this constriction might be modulated across both space and time in right hemisphere stroke patients without neglect. Then we tested healthy elderly people to determine whether non-pathological ageing also leads to spatiotemporal impairments of vision under conditions of high attention load. Methods Right hemisphere stroke patients completed a task at fixation while attempting to discriminate letters appearing in the periphery. Attentional load of the central task was modulated by increasing task difficulty. Peripheral letters appeared simultaneously with the central task or at different times (stimulus onset asynchronies, SOAs) after it. In a second study healthy elderly volunteers were tested with a modified version of this paradigm. Results Under conditions of high attention load right hemisphere stroke patients have a reduced effective visual field, over a significantly extended ‘attentional blink’, worse for items presented to their left. In the second study, older participants were unable to discriminate otherwise salient items across the visual field (left or right) when their attention capacity was loaded on the central task. This deficit extended temporally, with peripheral discrimination ability not returning to normal for up to 450 msec. Conclusions Dynamically tying up attention resources on a task at fixation can have profound effects in patient populations and in normal ageing. These results demonstrate that items can escape conscious detection across space and time, and can thereby impact significantly on visual perception in these groups.
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Affiliation(s)
- Charlotte Russell
- Centre for Cognition and Neuroimaging, Department of Psychology, Brunel University, Uxbridge, UK.
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50
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Bonato M. Neglect and extinction depend greatly on task demands: a review. Front Hum Neurosci 2012; 6:195. [PMID: 22822394 PMCID: PMC3398353 DOI: 10.3389/fnhum.2012.00195] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 06/14/2012] [Indexed: 11/23/2022] Open
Abstract
This review illustrates how, after unilateral brain damage, the presence and severity of spatial awareness deficits for the contralesional hemispace depend greatly on the quantity of attentional resources available for performance. After a brief description of neglect and extinction, different frameworks accounting for spatial and non-spatial attentional processes will be outlined. The central part of the review describes how the performance of brain-damaged patients is negatively affected by increased task demands, which can result in the emergence of severe awareness deficits for contralesional space even in patients who perform normally on paper-and-pencil tests. Throughout the review neglect is described as a spatial syndrome that can be exacerbated in the presence and severity by both spatial and non-spatial tasks. The take-home message is that the presence and degree of contralesional neglect and extinction can be dramatically overlooked based on standard clinical (paper-and-pencil) testing, where patients can easily compensate for their deficits. Only tasks where compensation is made impossible represent an appropriate approach to detect these disabling contralesional deficits of awareness when they become subtle in post-acute stroke phases.
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Affiliation(s)
- Mario Bonato
- Dipartimento di Psicologia Generale, Università di Padova Padova, Italy
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