Slow Binocular Rivalry as a Potential Endophenotype of Schizophrenia

Pharmacogenetic intervention improves treatment outcomes in Chinese adult men with schizophrenia

To investigate the clinical application value of pharmacogenetic testing in individualized drug therapy for adult male patients with schizophrenia. A total of 186 adult patients with schizophrenia were enrolled and randomised into the pharmacogenetic (PGx) intervention group and the standard care group. In the PGx intervention group, PGx testing was performed, and the medication regimen was adjusted according to the results of the pharmacogenomic analysis. In contrast, in the standard care group, patients were treated according to the physician's medication experience. Differences in the primary indicator of schizophrenia, the Positive and Negative Symptom Scale (PANSS), and the secondary efficacy measures, the Clinical Global Impressions-Severity of Illness scale (CGI-SI) and Clinical Global Impressions-Global Improvement (CGI-GI) scale, were compared between the intervention and standard care groups. At baseline, the PGx intervention group consisted of 109 individuals, while the standard care group had 77 participants. After 12 weeks of treatment, 49 individuals withdrew from the PGx group (a dropout rate of 45.0%), and 34 withdrew from the standard care group (a dropout rate of 44.2%), with no significant difference in dropout rates between the two groups. The PANSS score reduction rate in the PGx intervention group significantly exceeded that of the standard care group during weeks 3, 6, and 12 of follow-up (P < 0.05). At the 12th week, the PGx intervention group achieved a treatment response rate of 81.7%, significantly surpassing the 48.8% of the standard care group (odds ratio of 4.67, 95% confidence interval of 1.96-11.41; P = 0.001). Furthermore, the PGx intervention was significantly more effective than standard care regardless of whether the patient had a first episode or a relapse (P < 0.05). Furthermore, the Global Assessment of Functioning (GAF) scores and the Personal and Social Performance Scale (PSP) score changes in the PGx intervention group were both significantly different from those in the standard care group (P < 0.05). It is noteworthy that the PGx intervention similarly improves the prognostic outcomes for patients with and without a family history of mental disorders. In conclusion, the application of a PGx intervention treatment model based on PGx testing can significantly improve medication efficacy and shorten the time to achieve the effects of medication in schizophrenia.

Faster bi-stable visual switching in psychosis

Bi-stable stimuli evoke two distinct perceptual interpretations that alternate and compete for dominance. Bi-stable perception is thought to be driven at least in part by mutual suppression between distinct neural populations that represent each percept. Abnormal visual perception has been observed among people with psychotic psychopathology (PwPP), and there is evidence to suggest that these visual deficits may depend on impaired neural suppression in the visual cortex. However, it is not yet clear whether bi-stable visual perception is abnormal among PwPP. Here, we examined bi-stable perception in a visual structure-from-motion task using a rotating cylinder illusion in a group of 65 PwPP, 44 first-degree biological relatives, and 43 healthy controls. Data from a 'real switch' task, in which physical depth cues signaled real switches in rotation direction were used to exclude individuals who did not show adequate task performance. In addition, we measured concentrations of neurochemicals, including glutamate, glutamine, and γ-amino butyric acid (GABA), involved in excitatory and inhibitory neurotransmission. These neurochemicals were measured non-invasively in the visual cortex using 7 tesla MR spectroscopy. We found that PwPP and their relatives showed faster bi-stable switch rates than healthy controls. Faster switch rates also correlated with significantly higher psychiatric symptom levels, specifically disorganization, across all participants. However, we did not observe any significant relationships across individuals between neurochemical concentrations and SFM switch rates. Our results are consistent with a reduction in suppressive neural processes during structure-from-motion perception in PwPP, and suggest that genetic liability for psychosis is associated with disrupted bi-stable perception.

Reviving Bistable Perception in Patients With Depression by Decreasing the Overestimation of Prior Precision

Slower perceptual alternations, a notable perceptual effect observed in psychiatric disorders, can be alleviated by antidepressant therapies that affect serotonin levels in the brain. While these phenomena have been well documented, the underlying neurocognitive mechanisms remain to be elucidated. Our study bridges this gap by employing a computational cognitive approach within a Bayesian predictive coding framework to explore these mechanisms in depression. We fitted a prediction error (PE) model to behavioral data from a binocular rivalry task, uncovering that significantly higher initial prior precision and lower PE led to a slower switch rate in patients with depression. Furthermore, serotonin-targeting antidepressant treatments significantly decreased the prior precision and increased PE, both of which were predictive of improvements in the perceptual alternation rate of depression patients. These findings indicated that the substantially slower perception switch rate in patients with depression was caused by the greater reliance on top-down priors and that serotonin treatment's efficacy was in its recalibration of these priors and enhancement of PE. Our study not only elucidates the cognitive underpinnings of depression, but also suggests computational modeling as a potent tool for integrating cognitive science with clinical psychology, advancing our understanding and treatment of cognitive impairments in depression.

State-dependent alterations of implicit emotional dominance during binocular rivalry in subthreshold depression

Binocular rivalry, a visual perception phenomenon where two or more percepts alternate every few seconds when distinct stimuli are presented to the two eyes, has been reported as a biomarker in several psychiatric disorders. It is unclear whether abnormalities of binocular rivalry in depression could occur when emotional rivaling stimuli are used, and if so, whether an emotional binocular rivalry test could provide a trait-dependent or state-dependent biomarker. In the current study, 34 individuals with subthreshold depression and 31 non-depressed individuals performed a binocular rivalry task associated with implicit emotional processing. Participants were required to report their perceived orientations of the rival gratings in the foreground and to neglect emotional face stimuli in the background. The participants were retested after an approximately 4-month time interval. Compared to the non-depressed group, the subthreshold depression group showed significantly longer perceptual dominance durations of the grating with emotional faces as the background (i.e., implicit emotional dominance) at the initial assessment. However, the abnormality was not found at the follow-up assessment. More importantly, we found smaller changes in depressive severity at the follow-up assessment for individuals displaying longer emotional dominance at the initial assessment than for individuals with weaker emotional dominance. The current emotional binocular rivalry test may provide an objective, state-dependent biomarker for distinguishing individuals with subthreshold depression from non-depressed individuals.

Measuring the reliability of binocular rivalry

Binocular rivalry is a widely used tool in sensory and cognitive neuroscience to investigate different aspects of vision and cognition. The dynamics of binocular rivalry (e.g., duration of perceptual dominance phases and mixed percept proportions) differ across individuals; based on rivalry dynamics, it is also possible to calculate an index of ocular dominance (by comparing the perceptual dominance of the images in the two eyes). In this study, we investigated the reliability of binocular rivalry dynamics using different methods for dichoptic stimulation and different rivalry stimuli. For the three main indices we defined (ocular dominance, phase durations and mixed percept proportions), we found a high test-retest reliability across sessions. Moreover, the test-retest reliability of the ocular dominance index was predictable from its internal consistency, supporting its stability over time. Phase durations and mixed percept proportions, in contrast, had worse test-retest reliability than expected based on internal consistency, indicating that these parameters are susceptible to state-dependent changes. Our results support the use of the ocular dominance index and binocular rivalry in the measurement of sensory eye dominance and its plasticity, but advise caution when investigating the association between phase durations or mixed percepts and stable characteristics like psychological traits or disorders.

Slowed alpha oscillations and percept formation in psychotic psychopathology

Introduction

Psychosis is in part defined by disturbances in perception. Recent investigations have implicated the speed of alpha oscillations observed in brain electrical activity as reflective of a sampling rate of the visual environment and perception. Although both slowed alpha oscillations and aberrant percept formation are evident in disorders of psychotic psychopathology such as schizophrenia it is unclear whether slow alpha accounts for abnormal visual perception in these disorders.

Methods

To examine the role of the speed of alpha oscillations in perception in psychotic psychopathology we gathered resting-state magneto-encephalography data from probands with psychotic psychopathology (i.e., schizophrenia, schizoaffective disorder, and bipolar disorder with a history of psychosis), their biological siblings, and healthy controls. We appraised visual perceptual function without the confound of cognitive ability and effort through the use of a simple binocular rivalry task.

Results

We found a slowed pace of alpha oscillations in psychotic psychopathology that was associated with longer percept durations during binocular rivalry, consistent with the assertion that occipital alpha oscillations govern the rate of accumulation of visual information used to generate percepts. Alpha speed varied widely across individuals with psychotic psychopathology and was highly stable across several months indicating that it is likely a trait characteristic of neural function that is relevant to visual perception. Finally, a lower speed of alpha oscillation was associated with a lower IQ and greater disorder symptomatology implying that the effects of the endogenous neural oscillation on visual perception may have wider consequences for everyday functioning.

Discussion

Slowed alpha oscillations in individuals with psychotic psychopathology appear to reflect altered neural functions related to percept formation.

The impact of affective states and traits on perceptual stability during binocular rivalry

Affective states and traits have been associated with different measures of perceptual stability during binocular rivalry. Diverging approaches to measuring perceptual stability as well as to examination of the role of affective variables have contributed to an inconclusive pattern of findings. Here, we studied the influence of affective traits, such as depressiveness and trait anxiety, and states, which were manipulated with a musical mood induction paradigm, on different measures of perceptual stability (dominance ratios and phase durations) during binocular rivalry. Fifty healthy participants reported alternations in two conditions: a biased perception condition with an unequal probability of perceiving stimuli, using an upright versus a tilted face with a neutral expression, and a control condition with equal chances of perceiving stimuli, using Gabors of different orientations. Baseline positive state affect significantly predicted longer phase durations whereas affective traits did not yield any such effect. Furthermore, in an exploratory analysis, induced negative affect attenuated stimulus related bias in predominance ratios. Overall, we found a strong correlation between both measures of perceptual stability (phase durations and dominance ratios). Our findings thus question the distinction between different measures of perceptual stability during binocular rivalry and highlight the role of affective states in its formation.

The Psychosis Human Connectome Project: Design and rationale for studies of visual neurophysiology

Visual perception is abnormal in psychotic disorders such as schizophrenia. In addition to hallucinations, laboratory tests show differences in fundamental visual processes including contrast sensitivity, center-surround interactions, and perceptual organization. A number of hypotheses have been proposed to explain visual dysfunction in psychotic disorders, including an imbalance between excitation and inhibition. However, the precise neural basis of abnormal visual perception in people with psychotic psychopathology (PwPP) remains unknown. Here, we describe the behavioral and 7 tesla MRI methods we used to interrogate visual neurophysiology in PwPP as part of the Psychosis Human Connectome Project (HCP). In addition to PwPP (n = 66) and healthy controls (n = 43), we also recruited first-degree biological relatives (n = 44) in order to examine the role of genetic liability for psychosis in visual perception. Our visual tasks were designed to assess fundamental visual processes in PwPP, whereas MR spectroscopy enabled us to examine neurochemistry, including excitatory and inhibitory markers. We show that it is feasible to collect high-quality data across multiple psychophysical, functional MRI, and MR spectroscopy experiments with a sizable number of participants at a single research site. These data, in addition to those from our previously described 3 tesla experiments, will be made publicly available in order to facilitate further investigations by other research groups. By combining visual neuroscience techniques and HCP brain imaging methods, our experiments offer new opportunities to investigate the neural basis of abnormal visual perception in PwPP.

Decreased Empathy Response to Other's Pain in Parents of Children With Autism Spectrum Disorder

We aimed to investigate pain empathy ability and self-reported empathy among parents of children with autism spectrum disorder (ASD). Twenty-four parents of children with ASD and 26 parents of typically developing children completed the Empathy Quotient (EQ) self-report scale and responded to painful or neutral images during an empathy-for-pain paradigm test. Parents of children with ASD had lower EQ scores, lower accuracy, and longer reaction time (RT) for pain empathy task response (all p < 0.05) compared with controls. There was a negative relationship between cognitive empathy, social skills, total EQ scores, and RT of response in parents of children with ASD. Our findings indicate that self-reported empathy deficits and decreased empathy response to the sight of others' pain in parents of children with ASD are part of a broader autistic phenotype.

Interictal Activity Is Associated With Slower Binocular Rivalry in Idiopathic Generalized Epilepsy

Objective: Perceptual alternations evoked by binocular rivalry (BR) reflect cortical dynamics strongly dependent on the excitatory-inhibitory balance, suggesting potential utility as a biomarker for epileptogenesis. Therefore, we investigated the characteristics of BR in patients with idiopathic generalized epilepsy (IGE) and potential associations with clinical variables. Methods: Sixty-two healthy controls (HCs) and 94 IGE patients completed BR task. Perceptual alternation rates were compared between HC and IGE groups as well as among the HC group and IGE patients stratified according to the presence or absence of interictal activity on the ambulatory electroencephalogram (EEG), termed the abnormal ambulatory EEG group (AB-AEEG, n = 64) and normal ambulatory EEG group (N-AEEG, n = 30), respectively. Results: The IGE patients demonstrated a slower rate of BR perceptual alternation than HC subjects (t = -4.364, p < 0.001). The alternation rate also differed among the HC, AB-AEEG, and N-AEEG groups (F = 44.962, df = 2, p < 0.001), and post hoc comparisons indicated a significantly slower alternation rate in the AB-AEEG group compared with the N-AEEG and HC groups (0.28 vs. 0.46, and 0.43 Hz). Stepwise linear regression revealed positive correlations between the BR alternation rate and both the ambulatory EEG status (β, 0.173; standard error, 0.022 p < 0.001) and Montreal Cognitive Assessment score (β, 0.013; standard error, 0.004; p = 0.003). Receiver operating characteristic curve analysis of the BR alternation rate distinguished AB-AEEG from N-AEEG subjects with 90.00% sensitivity and 76.90% specificity (area under the curve = 0.881; 95% confidence interval = 0.801- 0.961, cut-off = 0.319). Alternatively, Montreal Cognitive Assessment score did not accurately distinguish AB-AEEG from N-AEEG subjects and the area under the receiver operating characteristic curve combining the BR alternation rate and Montreal Cognitive Assessment score was not markedly larger than that of the BR alternation rate alone (0.894, 95% confidence interval = 0.822-0.966, p < 0.001). K-fold cross-validation was used to evaluate the predictive performance of BR alternation rate, MoCA score, and the combination of both, which yielded average AUC values of 0.870, 0.584 and 0.847, average sensitivity values of 89.36, 92.73, and 91.28%, and average specificity values of 62.25, 13.42, and 61.78%, respectively. The number of interictal epileptiform discharges was significantly correlated with the alternation rate in IGE patients (r = 0.296, p = 0.018). A forward stepwise linear regression model identified the number of interictal epileptiform discharges (β, 0.001; standard error, 0.001; p = 0.025) as an independent factor associated with BR alternation rate in these patients. Conclusion: These results suggest that interictal epileptiform discharges are associated with disruptions in perceptual awareness, and that the BR may be a useful auxiliary behavioral task to diagnosis and dynamically monitor IGE patients with interictal discharge.

Binocular Interactions in Glaucoma Patients With Nonoverlapping Visual Field Defects: Contrast Summation, Rivalry, and Phase Combination

Purpose

In glaucoma, visual field defects in the left and right eye may be non-overlapping, resulting in an intact binocular visual field. In clinical management, these patients are often considered to have normal vision. However, visual performance also relies on binocular processing. The aim of this study was to evaluate binocular visual functions in glaucoma patients with intact binocular visual field, normal visual acuity, and stereoscopy.

Methods

We measured in 10 glaucoma patients and 12 age-similar controls: (1) monocular and binocular contrast sensitivity functions (CSF) using a modified quick CSF test to assess binocular contrast summation, (2) dominance during rivalry, and (3) contrast ratio at balance point with a binocular phase combination test. A mirror stereoscope was used to combine the left and right eye image (each 10° horizontally by 12° vertically) on a display.

Results

Area under the monocular and binocular CSF was lower in glaucoma compared to healthy (P < 0.001), but the binocular contrast summation ratio did not differ (P = 0.30). For rivalry, the percentage of time of mixed percept was 9% versus 18% (P = 0.056), the absolute difference of the percentage of time of dominance between the two eyes 19% versus 10% (P = 0.075), and the rivalry rate 8.2 versus 12.1 switches per minute (P = 0.017) for glaucoma and healthy, respectively. Median contrast ratio at balance point was 0.66 in glaucoma and 1.03 in controls (P = 0.011).

Conclusions

Binocular visual information processing deficits can be found in glaucoma patients with intact binocular visual field, normal visual acuity, and stereoscopy.

Neural Mechanism Underlying the Sleep Deprivation-Induced Abnormal Bistable Perception

Quality sleep is vital for physical and mental health. No matter whether sleep problems are a consequence of or contributory factor to mental disorders, people with psychosis often suffer from severe sleep disturbances. Previous research has shown that acute sleep deprivation (SD) can cause transient brain dysfunction and lead to various cognitive impairments in healthy individuals. However, the relationship between sleep disturbance and bistable perception remains unclear. Here, we investigated whether the bistable perception could be affected by SD and elucidated the functional brain changes accompanying SD effects on bistable perception using functional magnetic resonance imaging. We found that the 28-h SD resulted in slower perceptual transitions in healthy individuals. The reduced perceptual transition was accompanied by the decreased activations in rivalry-related frontoparietal areas, including the right superior parietal lobule, right frontal eye field, and right temporoparietal junction. We speculated that SD might disrupt the normal function of these regions crucial for bistable perception, which mediated the slower rivalry-related perceptual transitions in behavior. Our findings revealed the neural changes underlying the abnormal bistable perception following the SD. It also suggested that SD might offer a new window to understand the neural mechanisms underlying the bistable perception.

Does Cortical Inhibition Explain the Correlation Between Bistable Perception Paradigms?

When observers view a perceptually bistable stimulus, their perception changes stochastically. Various studies have shown across-observer correlations in the percept durations for different bistable stimuli including binocular rivalry stimuli and bistable moving plaids. Previous work on binocular rivalry posits that neural inhibition in the visual hierarchy is a factor involved in the perceptual fluctuations in that paradigm. Here, in order to investigate whether between-observer variability in cortical inhibition underlies correlated percept durations between binocular rivalry and bistable moving plaid perception, we used center-surround suppression as a behavioral measure of cortical inhibition. We recruited 217 participants in a test battery that included bistable perception paradigms as well as a center-surround suppression paradigm. While we were able to successfully replicate the correlations between binocular rivalry and bistable moving plaid perception, we did not find a correlation between center-surround suppression strength and percept durations for any form of bistable perception. Moreover, the results from a mediation analysis indicate that center-surround suppression is not the mediating factor in the correlation between binocular rivalry and bistable moving plaids. These results do not support the idea that cortical inhibition can explain the between-observer correlation in mean percept duration between binocular rivalry and bistable moving plaid perception.

Missing the forest because of the trees: slower alternations during binocular rivalry are associated with lower levels of visual detail during ongoing thought

Conscious awareness of the world fluctuates, either through variation in how vividly we perceive the environment, or when our attentional focus shifts away from information in the external environment towards information that we generate via imagination. Our study combined individual differences in experience sampling, psychophysical reports of perception and neuroimaging descriptions of structural connectivity to better understand these changes in conscious awareness. In particular, we examined (i) whether aspects of ongoing thought—indexed via multi-dimensional experience sampling during a sustained attention task—are associated with the white matter fibre organization of the cortex as reflected by their relative degree of anisotropic diffusion and (ii) whether these neurocognitive descriptions of ongoing experience are related to a more constrained measure of visual consciousness through analysis of bistable perception during binocular rivalry. Individuals with greater fractional anisotropy in right hemisphere white matter regions involving the inferior fronto-occipital fasciculus, the superior longitudinal fasciculus and the cortico-spinal tract, described their ongoing thoughts as lacking external details. Subsequent analysis indicated that the combination of low fractional anisotropy in these right hemisphere regions, with reports of thoughts with high levels of external details, was associated with the shortest periods of dominance during binocular rivalry. Since variation in binocular rivalry reflects differences between bottom-up and top-down influences on vision, our study suggests that reports of ongoing thoughts with vivid external details may occur when conscious precedence is given to bottom-up representation of perceptual information.

Difference in binocular rivalry rate between major depressive disorder and generalized anxiety disorder

Binocular rivalry (BR) occurs when monocular images are presented simultaneously to corresponding regions of the two eyes. Rather than forming a stable composite, perception alternates spontaneously between each monocular view. Over recent decades, considerable interest in examining BR in psychiatric populations has demonstrated clear differences in the dynamics of BR when compared to healthy populations. However, the available data with respect to rivalry rates in depression and anxiety are limited, and previous studies have shown inconsistent results. Also, depression and anxiety are highly comorbid and can be difficult to distinguish. Therefore, we aimed to investigate whether patients with depression and anxiety have abnormal rivalry rates and whether rivalry rates differ between these conditions. Thirty-five patients with major depressive disorder (MDD), 30 patients with generalized anxiety disorder (GAD), and 30 control participants matched on sex, age and education were recruited. Our results showed MDD participants had slower BR rates than controls and GAD, and controls were significantly slower than GAD. Our findings raise prospects that BR could be a promising behavioral tool to differentiate depressive and anxiety disorders.

Intra- and inter-hemispheric processing during binocular rivalry in mild glaucoma

Glaucoma is considered a progressive optic neuropathy because of the damage and death of the retinal ganglion cells. It is also a neurodegenerative disease because it affects neural structures in the visual system and beyond, including the corpus callosum–the largest white matter structure involved in inter-hemispheric transfer of information. In this study we probed the dysfunction of the inter-hemispheric processing in patients with mild glaucoma using the phenomenon of binocular rivalry. Patients with mild glaucoma and no measurable visual field defects and age-matched controls underwent a thorough visual assessment. Then they participated in a series of psychophysical tests designed to examine the binocular rivalry derived from intra- and inter-hemispheric processing. Static horizontal and vertical sinewave gratings were presented dichoptically using a double-mirror stereoscope in 3 locations: centrally, to probe inter-hemispheric processing, and peripherally to the left or to the right, to probe intra-hemispheric processing. Although the two groups were matched in functional measures, rivalry rate of the glaucoma group was significantly lower than that of the control group for the central location, but not for the peripheral location. These results were driven mainly by the patients with normal tension glaucoma whose average rivalry rate for the central location (from which information reaches the two hemispheres) was almost half (46% lower) that of the controls. These results indicate a dysfunction in inter-hemispheric transfer in mild glaucoma that can be detected behaviourally before any changes in standard functional measures.

Perceptual awareness and active inference

Perceptual awareness depends upon the way in which we engage with our sensorium. This notion is central to active inference, a theoretical framework that treats perception and action as inferential processes. This variational perspective on cognition formalizes the notion of perception as hypothesis testing and treats actions as experiments that are designed (in part) to gather evidence for or against alternative hypotheses. The common treatment of perception and action affords a useful interpretation of certain perceptual phenomena whose active component is often not acknowledged. In this article, we start by considering Troxler fading - the dissipation of a peripheral percept during maintenance of fixation, and its recovery during free (saccadic) exploration. This offers an important example of the failure to maintain a percept without actively interrogating a visual scene. We argue that this may be understood in terms of the accumulation of uncertainty about a hypothesized stimulus when free exploration is disrupted by experimental instructions or pathology. Once we take this view, we can generalize the idea of using bodily (oculomotor) action to resolve uncertainty to include the use of mental (attentional) actions for the same purpose. This affords a useful way to think about binocular rivalry paradigms, in which perceptual changes need not be associated with an overt movement.

Slower and Less Variable Binocular Rivalry Rates in Patients With Bipolar Disorder, OCD, Major Depression, and Schizophrenia

When two different images are presented to the two eyes dichoptically, observers usually experience a perceptual alternation between the two images. This phenomenon, known as binocular rivalry, has been used as a powerful tool to investigate mechanisms of visual awareness. It was also found that the rates of perceptual alternation are slower in patients with bipolar disorder than in healthy controls (Pettigrew and Miller, 1998; Miller et al., 2003). To investigate the broader clinical relevance of binocular rivalry in psychiatric disorders, we measured the perceptual alternation rates during rivalry in healthy controls (n = 39) and in patients with different types of psychiatric disorders, including bipolar disorder type I (BD, n = 28), obsessive-compulsive disorder (OCD, n = 22), major depression (MD, n = 50), schizophrenia (SCZ, n = 44), and first-degree relatives (FDRs) of SCZ patients (n = 32). Participants viewed competing red-green images on a computer monitor through red-green anaglyph glasses and pressed buttons to record their perceptual alternations. The distributions of the rivalry rates were well described by a lognormal function in all groups. Critically, the median rate of perceptual alternation was 0.27 Hz for BD patients, 0.26 Hz for the OCD patients, 0.25 Hz for the MD patients, and 0.23 Hz and 0.27 Hz for the SCZ patients and their FDRs, respectively. All of which were significantly slower than the rate of 0.41 Hz obtained for the healthy controls, suggesting there may be shared genotypes between these different disorders. While rivalry alternations were generally slower in different types of psychiatric disorders compared to healthy controls, adding variance of rivalry rates in the analysis helped to partially separate among the different patient groups. Our results suggest that the slowing of binocular rivalry is likely due to certain common factors among the patient groups, but more subtle differences between different patient groups could be revealed when additional properties of rivalry dynamics are considered.