Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation

OBJECTIVES

Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety.

METHODS

Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity.

RESULTS

Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety.

CONCLUSIONS

The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.

Capturing postpandemic changes in research participants

The impact of the COVID-19 pandemic on physical and mental health hardly need be reiterated. Yet, there are likely other indirect aftereffects of COVID-19 infection in addition to the direct effects. This article aims to initiate a conversation regarding difficult-to-capture outcomes of the pandemic that are relevant to researchers who test human participants. These considerations encourage collection of additional measures when assessing pre- versus postpandemic patterns of behavior.

The Rehabilitation Potential of Neurostimulation for Mild Traumatic Brain Injury in Animal and Human Studies

Neurostimulation carries high therapeutic potential, accompanied by an excellent safety profile. In this review, we argue that an arena in which these tools could provide breakthrough benefits is traumatic brain injury (TBI). TBI is a major health problem worldwide, with the majority of cases identified as mild TBI (mTBI). MTBI is of concern because it is a modifiable risk factor for dementia. A major challenge in studying mTBI is its inherent heterogeneity across a large feature space (e.g., etiology, age of injury, sex, treatment, initial health status, etc.). Parallel lines of research in human and rodent mTBI can be collated to take advantage of the full suite of neuroscience tools, from neuroimaging (electroencephalography: EEG; functional magnetic resonance imaging: fMRI; diffusion tensor imaging: DTI) to biochemical assays. Despite these attractive components and the need for effective treatments, there are at least two major challenges to implementation. First, there is insufficient understanding of how neurostimulation alters neural mechanisms. Second, there is insufficient understanding of how mTBI alters neural function. The goal of this review is to assemble interrelated but disparate areas of research to identify important gaps in knowledge impeding the implementation of neurostimulation.

Gender Differences in Adolescents' Affective Symptoms and Behavioral Disorders After Mild Traumatic Brain Injury

OBJECTIVE

Mild traumatic brain injuries (mTBI) are considered self-limiting and full recovery is expected. Recent studies identify deficits persisting years after mTBI. Large-scale prospective data permit testing the hypothesis that mTBI increases incidence of affective and behavioral symptoms after new, past , or new and past mTBI.

SETTING

The study involved secondary analyses of survey responses from the Adolescent Brain Cognitive Development (ABCD) Study.

PARTICIPANTS

Adolescents in the ABCD Study ( n = 11 869; Wave 1, aged 9-10 years; Wave 2, aged 11-12 years) whose parents reported a new ( n = 157), past ( n = 1318), or new and past ( n = 50) mTBI on the Ohio State University Traumatic Brain Injury Identification Method short form were compared with controls who had no history of mTBI ( n = 9,667).

DESIGN

Multivariable binary logistic regression models examined associations between a new, past, or new and past mTBI and current affective (aggression, depression, anxiety) and behavioral (somatic, thought, social, attention, attention deficit hyperactivity disorder, conduct) disorders while controlling for demographic factors and baseline symptoms.

MAIN MEASURES

The primary measure was parental reports of psychiatric and behavioral symptoms on the Child Behavior Checklist.

RESULTS

Girls exhibited no significant effects after a new mTBI, although a past mTBI increased anxiety (adjusted odds ratios [aOR] = 1.83, 95% confidence interval [CI: 1.15-2.90]) and attention (1.89 [1.09-3.28]) problems. Girls with new and past mTBIs reported elevated anxiety (17.90 [4.67-68.7]), aggression (7.37 [1.49-36.3]), social (9.07 [2.47-33.30]), thought (7.58 [2.24-25.60]), and conduct (6.39 [1.25-32.50]) disorders. In boys, new mTBI increased aggression (aOR = 3.83, 95% CI [1.42-10.30]), whereas past mTBI heightened anxiety (1.91 [1.42-2.95]), but new and past mTBIs had no significant effects.

CONCLUSION

Adolescents are at greater risk of affective and behavioral symptoms after an mTBI. These effects differ as a function of gender and time of injury. Extended screening for mTBI history and monitoring of affective and behavioral disorders after mTBI in adolescents are warranted.

Working memory and sensory memory in subclinical high schizotypy: An avenue for understanding schizophrenia?

The search for robust, reliable biomarkers of schizophrenia remains a high priority in psychiatry. Biomarkers are valuable because they can reveal the underlying mechanisms of symptoms and monitor treatment progress and may predict future risk of developing schizophrenia. Despite the existence of various promising biomarkers that relate to symptoms across the schizophrenia spectrum, and despite published recommendations encouraging multivariate metrics, they are rarely investigated simultaneously within the same individuals. In those with schizophrenia, the magnitude of purported biomarkers is complicated by comorbid diagnoses, medications and other treatments. Here, we argue three points. First, we reiterate the importance of assessing multiple biomarkers simultaneously. Second, we argue that investigating biomarkers in those with schizophrenia-related traits (schizotypy) in the general population can accelerate progress in understanding the mechanisms of schizophrenia. We focus on biomarkers of sensory and working memory in schizophrenia and their smaller effects in individuals with nonclinical schizotypy. Third, we note irregularities across research domains leading to the current situation in which there is a preponderance of data on auditory sensory memory and visual working memory, but markedly less in visual (iconic) memory and auditory working memory, particularly when focusing on schizotypy where data are either scarce or inconsistent. Together, this review highlights opportunities for researchers without access to clinical populations to address gaps in knowledge. We conclude by highlighting the theory that early sensory memory deficits contribute negatively to working memory and vice versa. This presents a mechanistic perspective where biomarkers may interact with one another and impact schizophrenia-related symptoms.

People with high schizotypy experience more illusions in the Pattern Glare Test: Consistent with the hyperexcitability hypothesis

Individuals diagnosed with schizophrenia spectrum disorders (SSD) exhibit a constellation of sensory and perceptual impairments, including hyporeactivity to external input. However, individuals with SSD also report subjective experiences of sensory flooding, suggesting sensory hyperexcitability. To identify the extent to which behavioural indices of hyperexcitability are related to non-psychotic symptoms of schizophrenia, we tested a non-clinical population measured for schizophrenia-like traits (schizotypy), and a behavioural measure of sensory hyperexcitability, specifically the number of illusions seen in the Pattern Glare Test. Two samples totaling 913 individuals completed an online version of the Schizotypal Personality Questionnaire - Brief Revised (SPQ-BR) and the Pattern Glare Test. Individuals with higher schizotypy traits reported more illusions in the Pattern Glare Test. Additionally, one of the three SPQ-BR factors, the disorganized factor, significantly predicted the number of illusions reported. These data illustrate the potential for research in non-clinical samples to inform clinically relevant research.

Can brain stimulation enhance cognition in clinical populations? A critical review

Many psychiatric and neurological conditions are associated with cognitive impairment for which there are very limited treatment options. Brain stimulation methodologies show promise as novel therapeutics and have cognitive effects. Electroconvulsive therapy (ECT), known more for its related transient adverse cognitive effects, can produce significant cognitive improvement in the weeks following acute treatment. Transcranial magnetic stimulation (TMS) is increasingly used as a treatment for major depression and has acute cognitive effects. Emerging research from controlled studies suggests that repeated TMS treatments may additionally have cognitive benefit. ECT and TMS treatment cause neurotrophic changes, although whether these are associated with cognitive effects remains unclear. Transcranial electrical stimulation methods including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are in development as novel treatments for multiple psychiatric conditions. These treatments may also produce cognitive enhancement particularly when stimulation occurs concurrently with a cognitive task. This review summarizes the current clinical evidence for these brain stimulation treatments as therapeutics for enhancing cognition. Acute, or short-lasting, effects as well as longer-term effects from repeated treatments are reviewed, together with potential putative neural mechanisms. Areas of future research are highlighted to assist with optimization of these approaches for enhancing cognition.

Caught in the ACTS: Defining Abstract Cognitive Task Sequences as an Independent Process

Cognitive neuroscience currently conflates the study of serial responses (e.g., delay match to sample/nonsample, n-back) with the study of sequential operations. In this essay, our goal is to define and disentangle the latter, termed abstract cognitive task sequences (ACTS). Existing literatures address tasks requiring serial events, including procedural learning of implicit motor responses, statistical learning of predictive relationships, and judgments of attributes. These findings do not describe the behavior and underlying mechanism required to succeed at remembering to evaluate color, then shape; or to multiply, then add. A new literature is needed to characterize these sorts of second-order cognitive demands of studying a sequence of operations. Our second goal is to characterize gaps in knowledge related to ACTS that merit further investigation. In the following sections, we define more precisely what we mean by ACTS and suggest research questions' further investigation would be positioned to address.

Individual predictors and electrophysiological signatures of working memory enhancement in aging

A primary goal of translational neuroscience is to identify the neural mechanisms of age-related cognitive decline and develop protocols to maximally improve cognition. Here, we demonstrate how interventions that apply noninvasive neurostimulation to older adults improve working memory (WM). We found that one session of sham-controlled transcranial direct current stimulation (tDCS) selectively improved WM in older adults with more education, extending earlier work and underscoring the importance of identifying individual predictors of tDCS responsivity. Improvements in WM were associated with two distinct electrophysiological signatures. First, a broad enhancement of theta network synchrony tracked improvements in behavioral accuracy, with tDCS effects moderated by education level. Further analysis revealed that accuracy dynamics reflected an anterior-posterior network distribution regardless of cathode placement. Second, specific enhancements of theta-gamma phase-amplitude coupling (PAC) reflecting tDCS current flow tracked improvements in reaction time (RT). RT dynamics further explained inter-individual variability in WM improvement independent of education. These findings illuminate theta network synchrony and theta-gamma PAC as distinct but complementary mechanisms supporting WM in aging. Both mechanisms are amenable to intervention, the effectiveness of which can be predicted by individual demographic factors.

Addressing the Gender Gap in Research: Insights from a Women in Neuroscience Conference

There has been growing interest in quantifying the proportion of women participating in scientific conferences, publications, and committees. Numbers reveal persistent disparities, but offer few cures to the root causes of the gender gaps in research. Toward remediation, we outline five lessons learned through organizing two conferences for Women in Neuroscience (WiN). These recommendations build on participants' comments, and aim to better support women in their scientific paths and help provide equal opportunity.

Impaired visual working memory and reduced connectivity in undergraduates with a history of mild traumatic brain injury

Mild traumatic brain injury (mTBI), or concussion, accounts for 85% of all TBIs. Yet survivors anticipate full cognitive recovery within several months of injury, if not sooner, dependent upon the specific outcome/measure. Recovery is variable and deficits in executive function, e.g., working memory (WM) can persist years post-mTBI. We tested whether cognitive deficits persist in otherwise healthy undergraduates, as a conservative indicator for mTBI survivors at large. We collected WM performance (change detection, n-back tasks) using various stimuli (shapes, locations, letters; aurally presented numbers and letters), and wide-ranging cognitive assessments (e.g., RBANS). We replicated the observation of a general visual WM deficit, with preserved auditory WM. Surprisingly, visual WM deficits were equivalent in participants with a history of mTBI (mean 4.3 years post-injury) and in undergraduates with recent sports-related mTBI (mean 17 days post-injury). In seeking the underlying mechanism of these behavioral deficits, we collected resting state fMRI (rsfMRI) and EEG (rsEEG). RsfMRI revealed significantly reduced connectivity within WM-relevant networks (default mode, central executive, dorsal attention, salience), whereas rsEEG identified no differences (modularity, global efficiency, local efficiency). In summary, otherwise healthy current undergraduates with a history of mTBI present behavioral deficits with evidence of persistent disconnection long after full recovery is expected.

Predicting Working Memory Training Benefits From Transcranial Direct Current Stimulation Using Resting-State fMRI

The effects of transcranial direct current stimulation (tDCS) on working memory (WM) performance are promising but variable and contested. In particular, designs involving one session of tDCS are prone to variable outcomes with notable effects of individual differences. Some participants benefit, whereas others are impaired by the same tDCS protocol. In contrast, protocols including multiple sessions of tDCS more consistently report WM improvement across participants. The objective of the current project was to test whether differences in resting-state connectivity between stimulation site and two WM-relevant networks [default mode network (DMN) and central executive network (CEN)] could account for initial and longitudinal responses to tDCS. Healthy young adults completed 5 days of visual WM training during sham or anodal right frontal tDCS. The behavioral data showed that only the active tDCS group significantly improved over the visual WM training period. There were no significant correlations between initial response to tDCS and resting-state activity. DMN activity in the anterior cingulate cortex significantly correlated with WM training slope. These data underscore the importance of sampling in studies applying tDCS; homogeneity (e.g., of gender, special population, and WM capacity) may produce more consistent data in a single experiment with limited power, whereas heterogeneity is important in determining the mechanism(s) and potential for tDCS-linked protocols. This issue is a limitation in tDCS findings that continues to hamper its optimization and translational value.

No tDCS augmented working memory training benefit in undergraduates rewarded with course credit

BACKGROUND

The goal of working memory (WM) training is to expand capacity of this executive function. Transcranial direct current stimulation (tDCS) paired with WM training is more consistent than either alone. We have reported that tDCS targeting frontal and/or parietal regions enhanced theta phase locking, reduced alpha power, and strengthened theta-gamma phase amplitude coupling.

OBJECTIVE

To determine whether tDCS to frontal or parietal sites optimized WM training gains we pre-registered a tDCS-WM training study.

METHODS

80 undergraduates were randomly assigned to one of four anodal tDCS montages: frontal (F4), parietal (P4), alternating (P4-F4), and sham (P4 or F4). Participants completed 5-training sessions over one week and returned for follow-up testing after 30 days of no-contact.

RESULTS

No group showed significant improvement in trained or transfer task performance at the end of training nor at follow-up.

CONCLUSIONS

This null finding marks a failure to replicate in undergraduates training benefits observed in graduate students. We argue that motivation is essential to elicit improved performance in training protocols.

Frontoparietal theta-gamma interactions track working memory enhancement with training and tDCS

Despite considerable interest in enhancing, preserving, and rehabilitating working memory (WM), efforts to elicit sustained behavioral improvements have been met with limited success. Here, we paired WM training with transcranial direct current stimulation (tDCS) to the frontoparietal network over four days. Active tDCS enhanced WM performance by modulating interactions between frontoparietal theta oscillations and gamma activity, as measured by pre- and post-training high-density electroencephalography (EEG). Increased phase-amplitude coupling (PAC) between the prefrontal stimulation site and temporo-parietal gamma activity explained behavioral improvements, and was most effective when gamma occurred near the prefrontal theta peak. These results demonstrate for the first time that tDCS-linked WM training elicits lasting changes in behavior by optimizing the oscillatory substrates of prefrontal control.

Replacing tDCS with theta tACS provides selective, but not general WM benefits

Working memory (WM) can be improved after repeated training sessions paired with noninvasive neurostimulation techniques. Previously, we reported that WM training paired with tDCS succeeded behaviorally by enhancing anterior-posterior theta phase coherence and reducing alpha power. Here, in two experiments we tested several theta and alpha frequencies and two transcranial alternating current stimulation (tACS) montages in an effort to shortcut WM training while preserving behavioral gains. In Experiment 1, in separate sessions participants received online tACS at two frequencies derived from the previous study with the respective goal of improving and impairing WM performance. We selected the mean group peak value theta (7 Hz) to benefit WM and alpha (11 Hz) to impair WM. Stimulation (tACS) over right frontoparietal sites (F4-P4) during 3-back WM tasks (object, spatial) produced no behavioral consequences. In Experiment 2 we stimulated at a slower theta frequency (4.5 Hz), which was also significant in our prior study, and tested whether frontoparietal or bifrontal montages would be more effective at improving WM. This experiment revealed selectively improved object WM after right frontoparietal tACS alone. In summary, one session of tACS failed to produce the magnitude or breadth of WM gains observed after 4-10 tDCS-WM training sessions. In short, despite looking for loopholes we found little tACS savings.

Individual differences reveal limited mixed-category effects during a visual working memory task

Using stimuli from different categories may expand the capacity limits of working memory (WM) by spreading item representations across distinct neural populations. We explored this mixed-category benefit by correlating individuals' behavioral performance with fMRI measures of category information during uniform- and mixed-category trials. Behaviorally, we found weak evidence for a mixed-category benefit at the group-level, although there was a high degree of individual variability. To test whether distinct neural patterns elicited superior performance in some individuals, we correlated a multivariate measure of neural category information with multiple behavioral metrics. This revealed a widespread positive relationship, intuitive for hit rate and working memory capacity, but counterintuitive for false alarm rate. Overall, these data suggest that mixed-category effects may support working memory performance, but unexpectedly, not all participants show this benefit. Only some people may be able to take advantage of representing mixed-category information in a differentiable way.

Visual statistical learning deficits in memory-impaired individuals

Visual statistical learning (VSL) refers to the learning of environmental regularities. Classically considered an implicit process, one patient with isolated hippocampal damage is severely impaired at VSL tasks, suggesting involvement of explicit memory. Here, we asked whether memory impairment (MI) alone, absent of clear hippocampal pathology, predicted deficits across different VSL tasks. A classic VSL task revealed no learning in MI participants (Exp. 1), while imposing attentional demands (Exp. 2: flicker detection, Exp. 3: gender/location categorization) during familiarization revealed modest residual VSL. MI with nonspecific neural correlates predicted impaired VSL overall, but attentional processes may be harnessed for rehabilitation.

Frontoparietal tDCS Benefits Visual Working Memory in Older Adults With Low Working Memory Capacity

Working memory (WM) permits maintenance of information over brief delays and is an essential executive function. Unfortunately, WM is subject to age-related decline. Some evidence supports the use of transcranial direct current stimulation (tDCS) to improve visual WM. A gap in knowledge is an understanding of the mechanism characterizing these tDCS linked effects. To address this gap, we compared the effects of two tDCS montages designed on visual working memory (VWM) performance. The bifrontal montage was designed to stimulate the heightened bilateral frontal activity observed in aging adults. The unilateral frontoparietal montage was designed to stimulate activation patterns observed in young adults. Participants completed three sessions (bilateral frontal, right frontoparietal, sham) of anodal tDCS (20 min, 2 mA). During stimulation, participants performed a visual long-term memory (LTM) control task and a visual WM task. There was no effect of tDCS on the LTM task. Participants receiving right unilateral tDCS showed a WM benefit. This pattern was most robust in older adults with low WM capacity. To address the concern that the key difference between the two tDCS montages could be tDCS over the posterior parietal cortex (PPC), we included new analyses from a previous study applying tDCS targeting the PPC paired with a recognition VWM task. No significant main effects were found. A subsequent experiment in young adults found no significant effect of either tDCS montage on either task. These data indicate that tDCS montage, age and WM capacity should be considered when designing tDCS protocols. We interpret these findings as suggestive that protocols designed to restore more youthful patterns of brain activity are superior to those that compensate for age-related changes.

Task demands, tDCS intensity, and the COMT val158met polymorphism impact tDCS-linked working memory training gains

Working memory (WM) training paired with transcranial direct current stimulation (tDCS) can improve executive function in older adults. The unclear mechanism of tDCS likely depends on tDCS intensity, and task relevant genetic factors (e.g., for WM: COMT val¹⁵⁸met, DAT, BDNF val⁶⁶met). Higher tDCS intensity does not always lead to greater cognitive gains, and genetic polymorphisms may modulate tDCS-linked WM improvements. To evaluate these factors, 137 healthy older adults provided DNA samples and received Visual and Spatial WM training paired with tDCS (sham, 1, 1.5, 2 mA). After one session of tDCS, significant group differences in WM performance were predicted by COMT val¹⁵⁸met status. One month after training, there was a significant interaction of tDCS intensity, COMT genotype, and WM task. Specifically, val/val homozygotes benefited most from 1.5 mA tDCS on Visual WM and from 1 mA tDCS on Spatial WM. For met/met homozygotes, 2 mA resulted in significantly poorer performance compared to 1.5 mA on Spatial WM. While this pattern was observed with relatively small sample sizes, these data indicate that variations in COMT val¹⁵⁸met may predict the nature of WM improvement after initial and longitudinal tDCS. This contributes to our understanding of the underlying mechanism by which tDCS affects behaviour.

Induced and Evoked Human Electrophysiological Correlates of Visual Working Memory Set-Size Effects at Encoding

The ability to encode, store, and retrieve visually presented objects is referred to as visual working memory (VWM). Although crucial for many cognitive processes, previous research reveals that VWM strictly capacity limited. This capacity limitation is behaviorally observable in the set size effect: the ability to successfully report items in VWM asymptotes at a small number of items. Research into the neural correlates of set size effects and VWM capacity limits in general largely focus on the maintenance period of VWM. However, we previously reported that neural resources allocated to individual items during VWM encoding correspond to successful VWM performance. Here we expand on those findings by investigating neural correlates of set size during VWM encoding. We hypothesized that neural signatures of encoding-related VWM capacity limitations should be differentiable as a function of set size. We tested our hypothesis using High Density Electroencephalography (HD-EEG) to analyze frequency components evoked by flickering target items in VWM displays of set size 2 or 4. We found that set size modulated the amplitude of the 1st and 2nd harmonic frequencies evoked during successful VWM encoding across frontal and occipital-parietal electrodes. Frontal sites exhibited the most robust effects for the 2nd harmonic (set size 2 > set size 4). Additionally, we found a set-size effect on the induced power of delta-band (1-4 Hz) activity (set size 2 > set size 4). These results are consistent with a capacity limited VWM resource at encoding that is distributed across to-be-remembered items in a VWM display. This resource may work in conjunction with a task-specific selection process that determines which items are to be encoded and which are to be ignored. These neural set size effects support the view that VWM capacity limitations begin with encoding related processes.

Enhancing Everyday Cognition in Older Adults via Working Memory Training and Transcranial Direct Current Stimulation

Date Presented 4/8/2016

In older adults, we paired the neuroscience approaches working memory training and transcranial direct current stimulation (tDCS) with the occupational therapy goal of improved everyday cognition. Five laboratory sessions of training + tDCS elicited lasting gains on everyday cognitive tasks assessed in participants’ homes.

Primary Author and Speaker: Jaclyn Stephnes

Contributing Author: Marian E. Berryhill

Working memory capacity differentially influences responses to tDCS and HD-tDCS in a retro-cue task

There is growing interest in non-invasive brain stimulation techniques. A drawback is that the relationship between stimulation and cognitive outcomes for various tasks are unknown. Transcranial direct current stimulation (tDCS) provides diffuse current spread, whereas high-definition tDCS (HD-tDCS) provides more targeted current. The direction of behavioral effects after tDCS can be difficult to predict in cognitive realms such as attention and working memory (WM). Previously, we showed that in low and high WM capacity groups tDCS modulates performance in nearly equal and opposite directions on a change detection task, with improvement for the high capacity participants alone. Here, we used the retro-cue paradigm to test attentional shifting among items in WM to investigate whether WM capacity (WMC) predicted different behavioral consequences during anodal tDCS or HD-tDCS to posterior parietal cortex (PPC). In two experiments, with 24 participants each, we used different stimulus categories (colored circles, letters) and stimulation sites (right, left PPC). The results showed a significant (Experiment 1) or trending (Experiment 2) WMC x stimulation interaction. Compared to tDCS, after HD-tDCS the retro-cueing benefit was significantly greater for the low WMC group but numerically worse for the high WMC group. These data highlight the importance of considering group differences when using non-invasive neurostimulation techniques.

Older Adults Improve on Everyday Tasks after Working Memory Training and Neurostimulation

BACKGROUND

Aging is associated with decline in executive function (EF), upper-level cognitive abilities such as planning, problem solving, and working memory (WM). This decline is associated with age-related volume loss and reduced functional connectivity in the frontal lobes. Cognitive training interventions aim to counter these losses, but often fail to elicit benefits beyond improvements on trained tasks. Recent interventions pairing WM training with transcranial direct current stimulation (tDCS) have improved WM and elicited transfer to untrained EF tasks. Limitations in previous work include exclusive use of laboratory-based computer training and testing and poor characterization of the mechanism(s) of durable tDCS-linked change.

OBJECTIVE/HYPOTHESIS

To determine if tDCS-linked WM training improves performance on ecologically valid transfer measures administered in participants' homes. To explore intervention-based changes using neuroimaging (fNIRS) and genotyping (COMT val158met).

METHODS

90 healthy older adult participants completed 5 sessions of WM training paired with tDCS (Sham, 1 mA tDCS, 2 mA tDCS; 15 min). At follow-up, we assessed performance change on laboratory-based and ecologically valid tasks.

RESULTS

All participants showed improvement on trained tasks. Importantly, 2 mA of tDCS induced significantly greater far transfer gains after 1 month without contact. Gains were observed on standard far transfer tasks along with ecologically valid far transfer tasks, and stimulation was well tolerated by all participants. FNIRS and genotyping results were less conclusive, but provide promising avenues for future research initiatives.

CONCLUSION

These findings highlight the translational value for tDCS-based interventions in healthy older adults interested in maintaining cognitive function.

Cognitive Rehabilitation After Traumatic Brain Injury: A Reference for Occupational Therapists

Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.

Intraparietal regions play a material general role in working memory: Evidence supporting an internal attentional role

Determining the role of intraparietal sulcus (IPS) regions in working memory (WM) remains a topic of considerable interest and lack of clarity. One group of hypotheses, the internal attention view, proposes that the IPS plays a material general role in maintaining information in WM. An alternative viewpoint, the pure storage account, proposes that the IPS in each hemisphere maintains material specific (e.g., left--phonological; right--visuospatial) information. Yet, adjudication between competing theoretical perspectives is complicated by divergent findings from different methodologies and their use of different paradigms, perhaps most notably between functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). For example, fMRI studies typically use full field stimulus presentations and report bilateral IPS activation, whereas EEG studies direct attention to a single hemifield and report a contralateral bias in both hemispheres. Here, we addressed this question by applying a regions-of-interest fMRI approach to elucidate IPS contributions to WM. Importantly, we manipulated stimulus type (verbal, visuospatial) and the cued hemifield to assess the degree to which IPS activations reflect stimulus specific or stimulus general processing consistent with the pure storage or internal attention hypotheses. These data revealed significant contralateral bias along regions IPS0-5 regardless of stimulus type. Also present was a weaker stimulus-based bias apparent in stronger left lateralized activations for verbal stimuli and stronger right lateralized activations for visuospatial stimuli. However, there was no consistent stimulus-based lateralization of activity. Thus, despite the observation of stimulus-based modulation of spatial lateralization this pattern was bilateral. As such, although it is quantitatively underspecified, our results are overall more consistent with an internal attention view that the IPS plays a material general role in refreshing the contents of WM.

Longitudinal neurostimulation in older adults improves working memory

An increasing concern affecting a growing aging population is working memory (WM) decline. Consequently, there is great interest in improving or stabilizing WM, which drives expanded use of brain training exercises. Such regimens generally result in temporary WM benefits to the trained tasks but minimal transfer of benefit to untrained tasks. Pairing training with neurostimulation may stabilize or improve WM performance by enhancing plasticity and strengthening WM-related cortical networks. We tested this possibility in healthy older adults. Participants received 10 sessions of sham (control) or active (anodal, 1.5 mA) tDCS to the right prefrontal, parietal, or prefrontal/parietal (alternating) cortices. After ten minutes of sham or active tDCS, participants performed verbal and visual WM training tasks. On the first, tenth, and follow-up sessions, participants performed transfer WM tasks including the spatial 2-back, Stroop, and digit span tasks. The results demonstrated that all groups benefited from WM training, as expected. However, at follow-up 1-month after training ended, only the participants in the active tDCS groups maintained significant improvement. Importantly, this pattern was observed for both trained and transfer tasks. These results demonstrate that tDCS-linked WM training can provide long-term benefits in maintaining cognitive training benefits and extending them to untrained tasks.

The strategy and motivational influences on the beneficial effect of neurostimulation: a tDCS and fNIRS study

Working memory (WM) capacity falls along a spectrum with some people demonstrating higher and others lower WM capacity. Efforts to improve WM include applying transcranial direct current stimulation (tDCS), in which small amounts of current modulate the activity of underlying neurons and enhance cognitive function. However, not everyone benefits equally from a given tDCS protocol. Recent findings revealed tDCS-related WM benefits for individuals with higher working memory (WM) capacity. Here, we test two hypotheses regarding those with low WM capacity to see if they too would benefit under more optimal conditions. We tested whether supplying a WM strategy (Experiment 1) or providing greater extrinsic motivation through incentives (Experiment 2) would restore tDCS benefit to the low WM capacity group. We also employed functional near infrared spectroscopy to monitor tDCS-induced changes in neural activity. Experiment 1 demonstrated that supplying a WM strategy improved the high WM capacity participants' accuracy and the amount of oxygenated blood levels following anodal tDCS, but it did not restore tDCS-linked WM benefits to the low WM capacity group. Experiment 2 demonstrated that financial motivation enhanced performance in both low and high WM capacity groups, especially after anodal tDCS. Here, only the low WM capacity participants showed a generalized increase in oxygenated blood flow across both low and high motivation conditions. These results indicate that ensuring that participants' incentives are high may expand cognitive benefits associated with tDCS. This finding is relevant for translational work using tDCS in clinical populations, in which motivation can be a concern.

Real-world objects are more memorable than photographs of objects

Research studies in psychology typically use two-dimensional (2D) images of objects as proxies for real-world three-dimensional (3D) stimuli. There are, however, a number of important differences between real objects and images that could influence cognition and behavior. Although human memory has been studied extensively, only a handful of studies have used real objects in the context of memory and virtually none have directly compared memory for real objects vs. their 2D counterparts. Here we examined whether or not episodic memory is influenced by the format in which objects are displayed. We conducted two experiments asking participants to freely recall, and to recognize, a set of 44 common household objects. Critically, the exemplars were displayed to observers in one of three viewing conditions: real-world objects, colored photographs, or black and white line drawings. Stimuli were closely matched across conditions for size, orientation, and illumination. Surprisingly, recall and recognition performance was significantly better for real objects compared to colored photographs or line drawings (for which memory performance was equivalent). We replicated this pattern in a second experiment comparing memory for real objects vs. color photos, when the stimuli were matched for viewing angle across conditions. Again, recall and recognition performance was significantly better for the real objects than matched color photos of the same items. Taken together, our data suggest that real objects are more memorable than pictorial stimuli. Our results highlight the importance of studying real-world object cognition and raise the potential for applied use in developing effective strategies for education, marketing, and further research on object-related cognition.

Enhanced long-term memory encoding after parietal neurostimulation

Neurostimulation, e.g., transcranial direct current stimulation (tDCS), shows promise as an effective cognitive intervention. In spite of low spatial resolution, limited penetration, and temporary influence, evidence highlights tDCS-linked cognitive benefits in a range of cognitive domains. The left posterior parietal cortex (PPC) is an accessible node in frontoparietal networks engaged during long-term memory (LTM). Here, we tested the hypothesis that tDCS can facilitate LTM by pairing LTM encoding and retrieval with PPC stimulation. Healthy young adults performed a verbal LTM task (California Verbal Learning Task) with four different stimulation parameters. In Experiment 1, we applied tDCS to left PPC during LTM encoding. In Experiment 2, we applied tDCS just prior to retrieval to test the temporal specificity of tDCS during a LTM task. In later experiments, we tested hemispheric specificity by replicating Experiment 1 while stimulating the right PPC. Experiment 1 showed that tDCS applied during LTM encoding improved the pace of list learning and enhanced retrieval after a short delay. Experiment 2 indicated anodal left PPC tDCS only improved LTM when applied during encoding, and not during maintenance. Experiments 3 and 4 confirmed that tDCS effects were hemisphere specific and that no effects were found after right PPC stimulation during encoding. These findings indicate that anodal tDCS to the PPC helps verbal LTM in healthy young adults under certain conditions. First, when it is applied to the left, not the right, PPC and second, when it is applied during encoding.

The steady-state visual evoked potential reveals neural correlates of the items encoded into visual working memory

Visual working memory (VWM) capacity limitations are estimated to be ~4 items. Yet, it remains unclear why certain items from a given memory array may be successfully retrieved from VWM and others are lost. Existing measures of the neural correlates of VWM cannot address this question because they measure the aggregate processing of the entire stimulus array rather than neural signatures of individual items. Moreover, this cumulative processing is usually measured during the delay period, thereby reflecting the allocation of neural resources during VWM maintenance. Here, we use the steady-state visual evoked potential (SSVEP) to identify the neural correlates of individual stimuli at VWM encoding and test two distinct hypotheses: the focused-resource hypothesis and the diffuse-resource hypothesis, for how the allocation of neural resources during VWM encoding may contribute to VWM capacity limitations. First, we found that SSVEP amplitudes were larger for stimuli that were later remembered than for items that were subsequently forgotten. Second, this pattern generalized so that the SSVEP amplitudes were also larger for the unprobed stimuli in correct compared to incorrect trials. These data are consistent with the diffuse-resource view in which attentional resources are broadly allocated across the whole stimulus array. These results illustrate the important role encoding mechanisms play in limiting the capacity of VWM.

Hits and misses: leveraging tDCS to advance cognitive research

The popularity of non-invasive brain stimulation techniques in basic, commercial, and applied settings grew tremendously over the last decade. Here, we focus on one popular neurostimulation method: transcranial direct current stimulation (tDCS). Many assumptions regarding the outcomes of tDCS are based on the results of stimulating motor cortex. For instance, the primary motor cortex is predictably suppressed by cathodal tDCS or made more excitable by anodal tDCS. However, wide-ranging studies testing cognition provide more complex and sometimes paradoxical results that challenge this heuristic. Here, we first summarize successful efforts in applying tDCS to cognitive questions, with a focus on working memory (WM). These recent findings indicate that tDCS can result in cognitive task improvement or impairment regardless of stimulation site or direction of current flow. We then report WM and response inhibition studies that failed to replicate and/or extend previously reported effects. From these opposing outcomes, we present a series of factors to consider that are intended to facilitate future use of tDCS when applied to cognitive questions. In short, common pitfalls include testing too few participants, using insufficiently challenging tasks, using heterogeneous participant populations, and including poorly motivated participants. Furthermore, the poorly understood underlying mechanism for long-lasting tDCS effects make it likely that other important factors predict responses. In conclusion, we argue that although tDCS can be used experimentally to understand brain function its greatest potential may be in applied or translational research.

Invalid retro-cues can eliminate the retro-cue benefit: Evidence for a hybridized account

The contents of visual working memory (VWM) are capacity limited and require frequent updating. The retrospective cueing (retro-cueing) paradigm clarifies how directing internal attention among VWM items boosts VWM performance. In this paradigm a cue appears prior to retrieval, but after encoding and maintenance. The retro-cue effect (RCE) refers to superior VWM after valid versus neutral retro-cues. Here we investigated the effect of the invalid retro-cues' inclusion on VWM performance. We conducted 2 pairs of experiments, changing both probe type (recognition and recall) as well as presence and absence of invalid retro-cue trials. Furthermore, to fully characterize these effects over time, we used extended post-retro-cue delay durations. In the first set of experiments, probing VWM using recognition indicated that the RCE remained consistent in magnitude with or without invalid retro-cue trials. In the second set of experiments, VWM was probed with recall. Here, the RCE was eliminated when invalid retro-cues were included. This finer-grained measure of VWM fidelity showed that all items were subject to decay over time. We conclude that the invalid retro-cues impaired the protection of validly cues items, but they remain accessible, suggesting greater concordance with a prioritization account.

Synesthetic grapheme-color percepts exist for newly encountered Hebrew, Devanagari, Armenian and Cyrillic graphemes

Grapheme-color synesthetes experience color, not physically present, when viewing symbols. Synesthetes cannot remember learning these associations. Must synesthetic percepts be formed during a sensitive period? Can they form later and be consistent? What determines their nature? We tested grapheme-color synesthete, MC2, before, during and after she studied Hindi abroad. We investigated whether novel graphemes elicited synesthetic percepts, changed with familiarity, and/or benefited from phonemic information. MC2 reported color percepts to novel Devanagari and Hebrew graphemes. MC2 monitored these percepts over 6months in a Hindi-speaking environment. MC2 and synesthete DN, reported synesthetic percepts for Armenian graphemes, or Cyrillic graphemes+phonemes over time. Synesthetes, not controls, reported color percepts for novel graphemes that gained consistency over time. Phonemic information did not enhance consistency. Thus, synesthetes can form and consolidate percepts to novel graphemes as adults. These percepts may depend on pre-existing grapheme-color relationships but they can flexibly shift with familiarity.

The locus of color sensation: cortical color loss and the chromatic visual evoked potential

Color losses of central origin (cerebral achromatopsia and dyschromatopsia) can result from cortical damage and are most commonly associated with stroke. Such cases have the potential to provide useful information regarding the loci of the generation of the percept of color. One available tool to examine this issue is the chromatic visual evoked potential (cVEP). The cVEP has been used successfully to objectively quantify losses in color vision capacity in both congenital and acquired deficiencies of retinal origin but has not yet been applied to cases of color losses of cortical origin. In addition, it is not known with certainty which cortical sites are responsible for the generation of the cVEP waveform components. Here we report psychophysical and electrophysiological examination of a patient with color deficits resulting from a bilateral cerebral infarct in the ventral occipitotemporal region. Although this patient demonstrated pronounced color losses of a general nature, the waveform of the cVEP remains unaffected. Contrast response functions of the cVEP are also normal for this patient. The results suggest that the percept of color arises after the origin of the cVEP and that normal activity in those areas that give rise to the characteristic negative wave of the cVEP are not sufficient to provide for the normal sensation of color.

COMT and ANKK1-Taq-Ia genetic polymorphisms influence visual working memory

Complex cognitive tasks such as visual working memory (WM) involve networks of interacting brain regions. Several neurotransmitters, including an appropriate dopamine concentration, are important for WM performance. A number of gene polymorphisms are associated with individual differences in cognitive task performance. COMT, for example, encodes catechol-o-methyl transferase the enzyme primarily responsible for catabolizing dopamine in the prefrontal cortex. Striatal dopamine function, linked with cognitive tasks as well as habit learning, is influenced by the Taq-Ia polymorphism of the DRD2/ANKK1 gene complex; this gene influences the density of dopamine receptors in the striatum. Here, we investigated the effects of these polymorphisms on a WM task requiring the maintenance of 4 or 6 items over delay durations of 1 or 5 seconds. We explored main effects and interactions between the COMT and DRD2/ANKK1-Taq-Ia polymorphisms on WM performance. Participants were genotyped for COMT (Val(158)Met) and DRD2/ANKK1-Taq-Ia (A1+, A1-) polymorphisms. There was a significant main effect of both polymorphisms. Participants' WM reaction times slowed with increased Val loading such that the Val/Val homozygotes made the slowest responses and the Met/Met homozygotes were the fastest. Similarly, WM reaction times were slower and more variable for the DRD2/ANKK1-Taq-Ia A1+ group than the A1- group. The main effect of COMT was only apparent in the DRD2/ANKK1-Taq-Ia A1- group. These findings link WM performance with slower dopaminergic metabolism in the prefrontal cortex as well as a greater density of dopamine receptors in the striatum.

Differential frontal involvement in shifts of internal and perceptual attention

BACKGROUND

Perceptual attention enhances the processing of items in the environment, whereas internal attention enhances processing of items encoded in visual working memory. In perceptual and internal attention cueing paradigms, cues indicate the to-be-probed item before (pre-cueing) or after (retro-cueing) the memory display, respectively. Pre- and retro-cues confer similar behavioral accuracy benefits (pre-: 14-19%, retro-: 11-17%) and neuroimaging data show that they activate overlapping frontoparietal networks. Yet reports of behavioral and neuroimaging differences suggest that pre- and retro-cueing differentially recruit frontal and parietal cortices (Lepsien and Nobre, 2006).

OBJECTIVE/HYPOTHESIS

This study examined whether perceptual and internal attention are equally disrupted by neurostimulation to frontal and parietal cortices. We hypothesized that neurostimulation applied to frontal cortex would disrupt internal attention to a greater extent than perceptual attention.

METHODS

Cathodal transcranial direct current stimulation (tDCS) was applied to frontal or parietal cortices. After stimulation, participants completed a change detection task coupled with either pre- or retro-cues.

RESULTS

Cathodal tDCS across site (frontal, parietal) hindered performance. However, frontal tDCS had a greater negative impact on the retro-cued trials demonstrating greater frontal involvement during shifts of internal attention.

CONCLUSIONS

These results complement the neuroimaging data and provide further evidence suggesting that perceptual and internal attention are not identical processes. We conclude that although internal and perceptual attention are mediated by similar frontoparietal networks, the weight of contribution of these structures differs, with internal attention relying more heavily on the frontal cortex.

Individual differences in autistic trait load in the general population predict visual working memory performance

Prior studies have reported instances of both intact and impaired working memory (WM) performance in people with autism spectrum disorder (ASD). In order to investigate the relation between autistic traits that extend into the normal population and WM, 104 normal college-aged students who varied in their levels of autistic traits were tested. The loading of ASD-associated traits in the normal population leads to differing predictions about WM performance. ASD traits related to a local processing style (or "attention to detail") might enhance WM while ASD-associated traits related to difficulty switching attention and reorienting focus (or "social interaction") might impair WM performance. To assess these predictions, participants filled out the Autism Spectrum Quotient (AQ) and performed a working memory task with both visual and verbal variants. AQ scores were then broken into "attention to detail" and "social interaction" factors, as proposed by Hoekstra and colleagues. The results showed that AQ scores did not predict verbal WM performance but they did predict visual WM performance. The social interaction and attention to detail factors of the AQ had opposing relationships with visual WM performance: A higher level of social difficulty was associated with significantly poorer visual WM performance while a higher level of attention to detail was associated with enhanced visual WM performance. Further investigation of the relation between AQ and WM using the original five-factor model proposed by Baron-Cohen and colleagues (2001) revealed an association between impoverished imagination and visual WM overall.

Insights from neuropsychology: pinpointing the role of the posterior parietal cortex in episodic and working memory

The role of posterior parietal cortex (PPC) in various forms of memory is a current topic of interest in the broader field of cognitive neuroscience. This large cortical region has been linked with a wide range of mnemonic functions affecting each stage of memory processing: encoding, maintenance, and retrieval. Yet, the precise role of the PPC in memory remains mysterious and controversial. Progress in understanding PPC function will require researchers to incorporate findings in a convergent manner from multiple experimental techniques rather than emphasizing a particular type of data. To facilitate this process, here, we review findings from the human neuropsychological research and examine the consequences to memory following PPC damage. Recent patient-based research findings have investigated two typically disconnected fields: working memory (WM) and episodic memory. The findings from patient participants with unilateral and bilateral PPC lesions performing diverse experimental paradigms are summarized. These findings are then related to findings from other techniques including neurostimulation (TMS and tDCS) and the influential and more abundant functional neuroimaging literature. We then review the strengths and weaknesses of hypotheses proposed to account for PPC function in these forms of memory. Finally, we address what missing evidence is needed to clarify the role(s) of the PPC in memory.

tDCS selectively improves working memory in older adults with more education

Cognitive performance, including performance on working memory (WM) tasks declines with age. Changes in brain activations are one presumed contributor to WM decline in the healthy aging population. In particular, neuroimaging studies show that when older adults perform WM tasks there tends to be greater bilateral frontal activity than in younger adults. We hypothesized that stimulating the prefrontal cortex in healthy older adults would improve WM performance. To test this hypothesis we employed transcranial direct current stimulation (tDCS), a neurostimulation technique in which small amounts of electrical current are applied to the scalp with the intent of modulating the activity in underlying neurons. Across three testing sessions we applied sham stimulation or anodal tDCS to the left (F3) or right (F4) prefrontal cortex to healthy older adults as they performed trials of verbal and visual 2-back WM tasks. Surprisingly, tDCS was uniformly beneficial across site and WM task, but only in older adults with more education. In the less educated group, tDCS provided no benefit to verbal or visual WM performance. We interpret these findings as evidence for differential frontal recruitment as a function of strategy when older adults perform WM tasks.

Parietal contributions to visual working memory depend on task difficulty

The nature of parietal contributions to working memory (WM) remain poorly understood but of considerable interest. We previously reported that posterior parietal damage selectively impaired WM probed by recognition (Berryhill and Olson, 2008a). Recent studies provided support using a neuromodulatory technique, transcranial direct current stimulation (tDCS) applied to the right parietal cortex (P4). These studies confirmed parietal involvement in WM because parietal tDCS altered WM performance: anodal current tDCS improved performance in a change detection task, and cathodal current tDCS impaired performance on a sequential presentation task. Here, we tested whether these complementary results were due to different degrees of parietal involvement as a function of WM task demands, WM task difficulty, and/or participants' WM capacity. In Experiment 1, we applied cathodal and anodal tDCS to the right parietal cortex and tested participants on both previously used WM tasks. We observed an interaction between tDCS (anodal, cathodal), WM task difficulty, and participants' WM capacity. When the WM task was difficult, parietal stimulation (anodal or cathodal) improved WM performance selectively in participants with high WM capacity. In the low WM capacity group, parietal stimulation (anodal or cathodal) impaired WM performance. These nearly equal and opposite effects were only observed when the WM task was challenging, as in the change detection task. Experiment 2 probed the interplay of WM task difficulty and WM capacity in a parametric manner by varying set size in the WM change detection task. Here, the effect of parietal stimulation (anodal or cathodal) on the high WM capacity group followed a linear function as WM task difficulty increased with set size. The low WM capacity participants were largely unaffected by tDCS. These findings provide evidence that parietal involvement in WM performance depends on both WM capacity and WM task demands. We discuss these findings in terms of alternative WM strategies employed by low and high WM capacity individuals. We speculate that low WM capacity individuals do not recruit the posterior parietal lobe for WM tasks as efficiently as high WM capacity individuals. Consequently, tDCS provides greater benefit to individuals with high WM capacity.

Bilateral parietal cortex damage does not impair associative memory for paired stimuli

Recent neuroimaging and neuropsychological findings indicate that the posterior parietal cortex (PPC) plays an important, albeit undefined, role in episodic memory. Here we ask whether this region is specifically involved in associative aspects of episodic memory. Experiment 1 tested whether PPC damage affects the ability to learn and retrieve novel word pair associations. Experiment 2 tested whether PPC damage affects the retrieval of object-location associations, in a spatial fan task. In both experiments, patients showed normal levels of associative memory. These findings demonstrated that PPC damage did not prevent association memory for verbal items. Finally Experiment 3 tested whether PPC damage affects memory for nonverbal audio-visual pairs. The patients performed with normal accuracy, but with significantly reduced confidence. These findings indicate that the PPC does not have a central role in association formation per se and, instead, indicate that the PPC is involved in other aspects of episodic memory.

Shifting attention among working memory representations: testing cue type, awareness, and strategic control

It is well known that visual working memory (VWM) performance is modulated by attentional cues presented during encoding. Interestingly, retrospective cues presented after encoding, but prior to the test phase also improve performance. This improvement in performance is termed the retro-cue benefit. We investigated whether the retro-cue benefit is sensitive to cue type, whether participants were aware of their improvement in performance due to the retro-cue, and whether the effect was under strategic control. Experiment 1 compared the potential cueing benefits of abrupt onset retro-cues relying on bottom-up attention, number retro-cues relying on top-down attention, and arrow retro-cues, relying on a mixture of both. We found a significant retro-cue effect only for arrow retro-cues. In Experiment 2, we tested participants' awareness of their use of the informative retro-cue and found that they were aware of their improved performance. In Experiment 3, we asked whether participants have strategic control over the retro-cue. The retro-cue was difficult to ignore, suggesting that strategic control is low. The retro-cue effect appears to be within conscious awareness but not under full strategic control.

At the intersection of attention and memory: the mechanistic role of the posterior parietal lobe in working memory

Portions of the posterior parietal cortex (PPC) play a role in working memory (WM) yet the precise mechanistic function of this region remains poorly understood. The pure storage hypothesis proposes that this region functions as a short-lived modality-specific memory store. Alternatively, the internal attention hypothesis proposes that the PPC functions as an attention-based storage and refreshing mechanism deployable as an alternative to material-specific rehearsal. These models were tested in patients with bilateral PPC lesions. Our findings discount the pure storage hypothesis because variables indexing storage capacity and longevity were not disproportionately affected by PPC damage. Instead, our data support the internal attention account by showing that (a) normal participants tend to use a rehearsal-based WM maintenance strategy for recall tasks but not for recognition tasks; (b) patients with PPC lesions performed normally on WM tasks that relied on material-specific rehearsal strategies but poorly on WM tasks that relied on attention-based maintenance strategies and patient strategy usage could be shifted by task or instructions; (c) patients' memory deficits extended into the long-term domain. These findings suggest that the PPC maintains or shifts internal attention among the representations of items in WM.

A selective working memory impairment after transcranial direct current stimulation to the right parietal lobe

The role of the posterior parietal cortex in working memory (WM) is poorly understood. We previously found that patients with parietal lobe damage exhibited a selective WM impairment on recognition but not recall tasks. We hypothesized that this dissociation reflected strategic differences in the utilization of attention. One concern was that these findings, and our subsequent interpretation, would not generalize to normal populations because of the patients' older age, progressive disease processes, and/or possible brain reorganization following injury. To test whether our findings extended to a normal population we applied transcranial direct current stimulation (tDCS) to right inferior parietal cortex. tDCS is a technique by which low electric current applied to the scalp modulates the resting potentials of underlying neural populations and can be used to test structure-function relationships. Eleven normal young adults received cathodal, anodal, or sham stimulation over right inferior posterior parietal cortex and then performed separate blocks of an object WM task probed by recall or recognition. The results showed that cathodal stimulation selectively impaired WM on recognition trials. These data replicate and extend our previous findings of preserved WM recall and impaired WM recognition in patients with parietal lobe lesions.

A calendar savant with episodic memory impairments

Patients with memory disorders have severely restricted learning and memory. For instance, patients with anterograde amnesia can learn motor procedures and retain some restricted ability to learn new words and factual information. However, such learning is inflexible and frequently inaccessible to conscious awareness. Here we present a case of patient AC596, a 25-year-old male with severe episodic memory impairments, presumably due to anoxia during a preterm birth. In contrast to his poor episodic memory, he exhibits savant-like memory for calendar information that can be flexibly accessed by day, month, and year cues. He also has the ability to recollect the exact date of a wide range of personal experiences over the past 20 years. The patient appears to supplement his generally poor episodic memory by using memorized calendar information as a retrieval cue for autobiographical events. These findings indicate that islands of preserved memory functioning, such as a highly developed semantic memory system, can exist in individuals with severely impaired episodic memory systems. In this particular case, our patient's memory for dates far outstripped that of normal individuals and served as a keen retrieval cue, allowing him to access information that was otherwise unavailable.