Effects of arousing emotional scenes on the distribution of visuospatial attention: changes with aging and early subcortical vascular dementia

Age-related positivity effect in emotional memory consolidation from middle age to late adulthood

Background

While younger adults are more likely to attend to, process, and remember negative relative to positive information, healthy older adults show the opposite pattern. The current study evaluates when, exactly, this positivity shift begins, and how it influences memory performance for positive, negative, and neutral information.

Methods

A total of 274 healthy early middle-aged (35-47), late middle-aged (48-59), and older adults (>59) viewed scenes consisting of a negative, positive, or a neutral object placed on a plausible neutral background, and rated each scene for its valence and arousal. After 12 h spanning a night of sleep (n = 137) or a day of wakefulness (n = 137), participants completed an unexpected memory test during which they were shown objects and backgrounds separately and indicated whether the scene component was the "same," "similar," or "new" to what they viewed during the study session.

Results and conclusions

We found that both late middle-aged and older adults rated positive and neutral scenes more positively compared to early middle-aged adults. However, only older adults showed better memory for positive objects relative to negative objects, and a greater positive memory trade-off magnitude (i.e., remembering positive objects at the cost of their associated neutral backgrounds) than negative memory trade-off magnitude (i.e., remembering negative objects at the cost of their associated neutral backgrounds). Our findings suggest that while the positivity bias may not emerge in memory until older adulthood, a shift toward positivity in terms of processing may begin in middle age.

Attention to Stimuli of Learned versus Innate Biological Value Relies on Separate Neural Systems

The neural bases of attention, a set of neural processes that promote behavioral selection, is a subject of intense investigation. In humans, rewarded cues influence attention, even when those cues are irrelevant to the current task. Because the amygdala plays a role in reward processing, and the activity of amygdala neurons has been linked to spatial attention, we reasoned that the amygdala may be essential for attending to rewarded images. To test this possibility, we used an attentional capture task, which provides a quantitative measure of attentional bias. Specifically, we compared reaction times (RTs) of adult male rhesus monkeys with bilateral amygdala lesions and unoperated controls as they made a saccade away from a high- or low-value rewarded image to a peripheral target. We predicted that: (1) RTs will be longer for high- compared with low-value images, revealing attentional capture by rewarded stimuli; and (2) relative to controls, monkeys with amygdala lesions would exhibit shorter RT for high-value images. For comparison, we assessed the same groups of monkeys for attentional capture by images of predators and conspecifics, categories thought to have innate biological value. In performing the attentional capture task, all monkeys were slowed more by high-value relative to low-value rewarded images. Contrary to our prediction, amygdala lesions failed to disrupt this effect. When presented with images of predators and conspecifics, however, monkeys with amygdala lesions showed significantly diminished attentional capture relative to controls. Thus, separate neural pathways are responsible for allocating attention to stimuli with learned versus innate value.SIGNIFICANCE STATEMENT Valuable objects attract attention. The amygdala is known to contribute to reward processing and the encoding of object reward value. We therefore examined whether the amygdala is necessary for allocating attention to rewarded objects. For comparison, we assessed the amygdala's contribution to attending to objects with innate biological value: predators and conspecifics. We found that the macaque amygdala is necessary for directing attention to images with innate biological value, but not for directing attention to recently learned reward-predictive images. These findings indicate that the amygdala makes selective contributions to attending to valuable objects. The data are relevant to mental health disorders, such as social anxiety disorders and small animal phobias, that arise from biased attention to select categories of objects.

The influence of stimuli valence, extraversion, and emotion regulation on visual search within real-world scenes

Affective traits, including extraversion and emotion regulation, are important considerations in clinical psychology due to their associations with the occurrence of affective disorders. Previously, emotional real-world scenes have been shown to influence visual search. However, it is currently unknown whether extraversion and emotion regulation can influence visual search towards neutral targets embedded within real-world scenes, or whether these traits can impact the effect of emotional stimuli on visual search. An opportunity sample of healthy individuals had trait levels of extraversion and emotion regulation recorded before completing a visual search task. Participants more accurately identified search targets in neutral images compared to positive images, whilst response times were slower in negative images. Importantly, individuals with higher trait levels of expressive suppression displayed faster identification of search targets regardless of the emotional valence of the stimuli. Extraversion and cognitive reappraisal did not influence visual search. These findings add to our understanding regarding the influence of extraversion, cognitive reappraisal, and expressive suppression on our ability to allocate attention during visual search when viewing real-world scenes.

Explaining age differences in the memory-experience gap

Emotions and symptoms are often overestimated in retrospective ratings, a phenomenon referred to as the "memory-experience gap." Some research has shown that this gap is less pronounced among older compared to younger adults for self-reported negative affect, but it is not known whether these age differences are evident consistently across domains of well-being and why these age differences emerge. In this study, we examined age differences in the memory-experience gap for emotional (positive and negative affect), social (loneliness), and physical (pain, fatigue) well-being. We also tested four variables that could plausibly explain age differences in the gap: (a) episodic memory and executive functioning, (b) the age-related positivity effect, (c) variability of daily experiences, and (d) socially desirable responding. Adults (n = 477) from three age groups (21-44, 45-64, 65+ years old) participated in a 21-day diary study. Participants completed daily end-of-day ratings and retrospective ratings of the same constructs over different recall periods (3, 7, 14, and 21 days). Results showed that, relative to young and middle-aged adults, older adults had a smaller memory-experience gap for negative affect and loneliness. Lower day-to-day variability partly explained why the gap was smaller for older adults. There was no evidence that the magnitude of the memory-experience gap for positive affect, pain or fatigue depended on age. We recommend that future research considers how variability in daily experiences can impact age differences in retrospective self-reports of well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Viewing time and facial trustworthiness perception: Giving it a second thought may not work for older adults

Older adults tend to rate unfamiliar faces higher on trustworthiness than do their younger counterparts. Although the saying goes "look before you leap", it is still unknown whether such a strategy could also apply to facial trustworthiness perception, and our understanding of the time course in facial trustworthiness perception also remains unclear. Here, we have argued that a cognitive controlled process suggested by "socioemotional selectivity theory" could potentially lead to such biased trustworthiness perception. Two experiments were conducted to test the association between viewing time and trustworthiness perception. The first study used hierarchical linear modeling in a sample of younger (N = 30, M_age  = 20.53, SD = 1.61, 50% female) and older (N = 30, M_age  = 63.27, SD = 3.14, 43% female) adults, and found that viewing time and trustworthiness evaluation were positively associated. Using the same stimuli, our second study further manipulated viewing time by two levels (500 ms vs. 3000 ms) and compared younger (N = 28, M_age  = 23.93, SD = 2.68, 50% female) and older (N = 30, M_age  = 64.47, SD = 4.32, 50% female) adults' facial trustworthiness evaluation. As expected, a significant three-way interaction revealed that viewing time only impacted older adults' facial trustworthiness evaluation, and only when given shorter viewing time did older adults show similar facial trustworthiness ratings as younger adults. The present study is the first to directly investigate the relationship between older adults' viewing time on unfamiliar faces and their perception of facial trustworthiness. Findings suggested that a second thought in facial perception may not benefit older adults' trustworthiness evaluation.

Measuring psychological pain: psychometric analysis of the Orbach and Mikulincer Mental Pain Scale

Background

Suicide is a public health concern, with an estimated 1 million individuals dying each year worldwide. Individual psychological pain is believed to be a contributing motivating factor. Therefore, establishing a psychometrically sound tool to adequately measure psychological pain is important. The Orbach and Mikulincer Mental Pain Scale (OMMP) has been proposed; however, previous psychometric analysis on the OMMP has not yielded a consistent scale structure, and the internal consistency of the subscales has not met recommended values. Therefore, the primary purpose of this study was to assess the psychometric properties of the OMMP in a diverse sample.

Methods

A confirmatory factor analysis (CFA) on the 9-factor, 44-item OMMP was conducted on the full sample (n = 1151). Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted on a random subset of the data (n = 576) to identify a more parsimonious structure. The EFA structure was then tested in a covariance model in the remaining subset of participants (n = 575). Multigroup invariance testing was subsequently performed to examine psychometric properties of the refined scale.

Results

The CFA of the original 9-factor, 44-item OMMP did not meet recommended model fit recommendations. The EFA analysis results revealed a 3-factor, 9-item scale (i.e., OMMP-9). The covariance model of the OMMP-9 indicated further refinement was necessary. Multigroup invariance testing conducted on the final 3-factor, 8-item scale (i.e., OMMP-8) across mental health diagnoses, sex, injury status, age, activity level, and athlete classification met all criteria for invariance.

Conclusions

The 9-factor, 44-item OMMP does not meet recommended measurement criteria and should not be recommended for use in research and clinical practice in its current form. The refined OMMP-8 may be a more viable option to use; however, more research should be completed prior to adoption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42409-021-00025-8.

Impact of emotionally negative information on attentional processes in normal aging and Alzheimer's disease

Impairments of emotional processing have been reported in Alzheimer's disease (AD), consistently with the existence of early amygdala atrophy in the pathology. In this study, we hypothesized that patients with AD might show a deficit of orientation toward emotional information under conditions of visual search. Eighteen patients with AD, 24 age-matched controls, and 35 young controls were eye-tracked while they performed a visual search task on a computer screen. The target was a vehicle with implicit (negative or neutral) emotional content, presented concurrently with one, three, or five non-vehicle neutral distractors. The task was to find the target and to report whether a break in the target frame was on the left or on the right side. Both control groups detected negative targets more efficiently than they detected neutral targets, showing facilitated engagement toward negative information. In contrast, patients with AD showed no influence of emotional information on engagement delays. However, all groups reported the frame break location more slowly for negative than for neutral targets (after accounting for the last fixation delay), showing a more difficult disengagement from negative information. These findings are the first to highlight a selective lack of emotional influence on engagement processes in patients with AD. The involvement of amygdala alterations in this behavioral impairment remains to be investigated.

Microsaccadic modulation evoked by emotional events

Saccadic eye movements can allude to emotional states and visual attention. Recent studies have shown that microsaccadic responses (i.e., small fixational eye movements) reflect advanced brain activity during attentional and cognitive tasks. Moreover, the microsaccadic activity related to emotional attention provides new insights into this field. For example, emotional pictures attenuate the microsaccadic rate, and microsaccadic responses to covert attention occur in the direction opposite to a negative emotional target. However, the effects of various emotional events on microsaccadic activity remain debatable. This review introduces visual attention and eye movement studies that support findings on the modulation of microsaccadic responses to emotional events, comparing them with typical microsaccadic responses. This review also discusses the brain neuronal mechanisms governing microsaccadic responses to the attentional shifts triggered by emotion-related stimuli. It is hard to reveal the direct brain pathway of the microsaccadic modulation, especially in advanced (e.g., sustained anger, envy, distrust, guilt, frustration, delight, attraction, trust, and love), but also in basic human emotions (i.e., anger, disgust, fear, happiness, sadness, and surprise). However, non-human primates and human studies can uncover the possible brain pathways of emotional attention and microsaccades, thus providing future research directions. In particular, the facilitated (or reduced) attention is common evidence that microsaccadic activities change under a variety of social modalities (e.g., cognition, music, mental illness, and working memory) that elicit emotions and feelings.

Neural basis of interindividual variability in social perception in typically developing children and adolescents using diffusion tensor imaging

Humans show great interindividual variability in the degree they engage in social relationship. The neural basis of this variability is still poorly understood, particularly in children. In this study, we aimed to investigate the neural basis of interindividual variability in the first step of social behavior, that is social perception, in typically developing children. For that purpose, we first used eye-tracking to objectively measure eye-gaze processing during passive visualization of social movie clips in 24 children and adolescents (10.5 ± 2.9 y). Secondly, we correlated eye-tracking data with measures of fractional anisotropy, an index of white matter microstructure, obtained using diffusion tensor imaging MRI. The results showed a large interindividual variability in the number of fixations to the eyes of characters during visualization of social scenes. In addition, whole-brain analysis showed a significant positive correlation between FA and number of fixations to the eyes,mainly in the temporal part of the superior longitudinal fasciculi bilaterally, adjacent to the posterior superior temporal cortex. Our results indicate the existence of a neural signature associated with the interindividual variability in social perception in children, contributing for better understanding the neural basis of typical and atypical development of a broader social expertise.

Aging and eye tracking: in the quest for objective biomarkers

Recent applications of eye tracking for diagnosis, prognosis and follow-up of therapy in age-related neurological or psychological deficits have been reviewed. The review is focused on active aging, neurodegeneration and cognitive impairments. The potential impacts and current limitations of using characterizing features of eye movements and pupillary responses (oculometrics) as objective biomarkers in the context of aging are discussed. A closer look into the findings, especially with respect to cognitive impairments, suggests that eye tracking is an invaluable technique to study hidden aspects of aging that have not been revealed using any other noninvasive tool. Future research should involve a wider variety of oculometrics, in addition to saccadic metrics and pupillary responses, including nonlinear and combinatorial features as well as blink- and fixation-related metrics to develop biomarkers to trace age-related irregularities associated with cognitive and neural deficits.

Chronic Pain Patients' Gaze Patterns toward Pain-Related Information: Comparison between Pictorial and Linguistic Stimuli

BACKGROUND AND OBJECTIVES

The attentional bias and information processing model explained that individuals who interpret pain stimuli as threatening may increase their attention toward pain-related information. Previous eye tracking studies found pain attentional bias among individuals with chronic pain; however, those studies investigated this phenomenon by using only one stimulus modality. Therefore, the present study investigated attentional engagement to pain-related information and the role of pain catastrophizing on pain attentional engagement to pain-related stimuli among chronic pain patients by utilizing both linguistic and visual stimulus.

MATERIALS AND METHODS

Forty chronic pain patients were recruited from the rehabilitation center, the back pain clinic, and the rheumatology department of Chung-Ang University Hospital in Seoul, Korea. Patients observed pictures of faces and words displaying pain, presented simultaneously with neutral expressions, while their eye movements were measured using the eye tracking system. A t-test and ANOVA were conducted to compare stimulus pairs for the total gaze duration. Results revealed that chronic pain patients demonstrated attentional preference toward pain words but not for pain faces. An ANOVA with bias scores was conducted to investigate the role of pain catastrophizing on attentional patterns. Results indicated that chronic pain patients with high pain catastrophizing scores gazed significantly longer at pain- and anger-related words than neutral words compared to those with low pain catastrophizing scores. The same patterns were not observed for the facial expression stimulus pairs.

CONCLUSIONS

The results of the present study revealed attentional preference toward pain-related words and the significant role of pain catastrophizing on pain attentional engagement to pain-related words. However, different patterns were observed between linguistic and visual stimuli. Clinical implications related to use in pain treatment and future research suggestions are discussed.

Neural and behavioral signature of human social perception

Social behavior is extremely variable among individuals, and the neural basis of this variability is still poorly understood. In this study, we aimed to investigate the neural basis of interindividual variability in the first step of social behavior, that is, social perception. For that purpose, we first used eye-tracking to measure social perception during the passive visualization of socially relevant movie clips. Second, we correlated eye-tracking data with measures of rest cerebral blood flow (CBF) obtained using arterial spin-labeling (ASL) MRI, an index of local rest brain function. The results showed a large interindividual variability in the number of fixations to the eyes of characters during passive visualization of movie clips displaying social interactions. Moreover, individual patterns remained stable across time, suggesting an individual signature of social behavior. Whole-brain analyses showed significant positive correlation between the number of fixations to the eyes and rest CBF: individuals who looked more to the eyes were those with higher rest CBF levels within the right superior temporal regions. Our results indicate the existence of a neural and behavioral signature associated with the interindividual variability in social perception.

Attentional Engagement for Pain-Related Information among Individuals with Chronic Pain: The Role of Pain Catastrophizing

Although the evidence of the attentional bias of chronic pain individuals toward pain-related information is established in the literature, few studies examined the time course of attention toward pain stimuli and the role of pain catastrophizing on attentional engagement toward pain-related information. This study examined the time course of attention to pain-related information and the role of pain catastrophizing on attentional engagement for pain-related information. Participants were fifty young adult participants with chronic pain (35% male, 65% female; M = 21.8 years) who completed self-report questionnaires assessing pain catastrophizing levels (Pain Catastrophizing Scale (PCS)), depression (the Center for Epidemiologic Studies Depression Scale (CES-D)), anxiety (State-Trait Anxiety Inventory (STAI)), and pain disability (the Pain Disability Index: (PDI)). Attentional engagements to pain- and anger-related information were measured by the eye tracker. Significant interaction effects were found between (1) time and stimulus type for pain-related information (F (5, 245) = 11.55, p < 0.001) and (2) bias scores and pain catastrophizing (F (1, 48) = 6.736, p < 0.05). These results indicated that the degree of increase for pain bias scores were significantly greater than anger bias scores as levels of pain catastrophizing increased. Results of the present study provided the evidence for the attentional bias and information processing model which has clinical implications; high levels of pain catastrophizing may impair individuals' ability to cope with chronic pain by increasing attentional engagement toward pain-related information. The present study can add knowledge to attentional bias and pain research as this study investigated the time course of attention and the role of pain catastrophizing on attentional engagement toward pain-related information for adults with chronic pain conditions.

Emotional Content Modulates Attentional Visual Orientation During Free Viewing of Natural Images

Visual attention is the process that enables us to select relevant visual stimuli in our environment to achieve a goal or perform adaptive behaviors. In this process, bottom-up mechanisms interact with top-down mechanisms underlying the automatic and voluntary orienting of attention. Cognitive functions, such as emotional processing, can influence visual attention by increasing or decreasing the resources destined for processing stimuli. The relationship between attention and emotion has been explored mainly in the field of automatic attentional capturing; especially, emotional stimuli are suddenly presented and detection rates or reaction times are recorded. Unlike these paradigms, natural visual scenes may be comprised in multiple stimuli with different emotional valences. In this setting, the mechanisms supporting voluntary visual orientation, under the influence of the emotional components of stimuli, are unknown. We employed a mosaic of pictures with different emotional valences (positive, negative, and neutral) and explored the dynamics of attentional visual orientation, assessed by eye tracking and measurements of pupil diameter. We found that pictures with affective content display increased dwelling times when compared to neutral pictures with a larger effect for negative pictures. The valence, regardless of the arousal levels, was the main factor driving the behavioral modulation of visual orientation. On the other hand, the visual exploration was accompanied by a systematic pupillary response, with the pupil contraction and dilation influenced by the arousal levels, with minor effects driven by the valence. Our results emphasize that arousal and valence should be considered different dimensions of emotional processing both interacting with cognitive processes such as visual attention.

Changing interpretations of emotional expressions in working memory with aging

Working memory (WM) shows significant decline with age. It is interesting to note that some research has suggested age-related impairments can be reduced in tasks that involve emotion-laden stimuli. However, only a few studies have explored how WM for emotional material changes in aging. Here we developed a novel experimental task to compare and contrast how emotional material is represented in older versus younger adults. The task enabled us to separate overall WM accuracy from emotional biases in the content of affective representations in WM. We found that, in addition to overall decline in WM performance, older adults showed a systematic positivity bias in representing information in WM relative to younger adults (positivity effect). They remembered fearful faces as being less fearful than younger adults and interpreted ambiguous facial expressions more positively. The findings show that aging brings a type of positivity bias when picking up affective information for guiding future behavior.

Processing Distracting Non-face Emotional Images: No Evidence of an Age-Related Positivity Effect

Cognitive aging may be accompanied by increased prioritization of social and emotional goals that enhance positive experiences and emotional states. The socioemotional selectivity theory suggests this may be achieved by giving preference to positive information and avoiding or suppressing negative information. Although there is some evidence of a positivity bias in controlled attention tasks, it remains unclear whether a positivity bias extends to the processing of affective stimuli presented outside focused attention. In two experiments, we investigated age-related differences in the effects of to-be-ignored non-face affective images on target processing. In Experiment 1, 27 older (64-90 years) and 25 young adults (19-29 years) made speeded valence judgments about centrally presented positive or negative target images taken from the International Affective Picture System. To-be-ignored distractor images were presented above and below the target image and were either positive, negative, or neutral in valence. The distractors were considered task relevant because they shared emotional characteristics with the target stimuli. Both older and young adults responded slower to targets when distractor valence was incongruent with target valence relative to when distractors were neutral. Older adults responded faster to positive than to negative targets but did not show increased interference effects from positive distractors. In Experiment 2, affective distractors were task irrelevant as the target was a three-digit array and did not share emotional characteristics with the distractors. Twenty-six older (63-84 years) and 30 young adults (18-30 years) gave speeded responses on a digit disparity task while ignoring the affective distractors positioned in the periphery. Task performance in either age group was not influenced by the task-irrelevant affective images. In keeping with the socioemotional selectivity theory, these findings suggest that older adults preferentially process task-relevant positive non-face images but only when presented within the main focus of attention.

The impact of positive, negative and neutral stimuli in a virtual reality cognitive-motor rehabilitation task: a pilot study with stroke patients

Background

Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation, but there is increasing interest in integrating motor and cognitive training to increase similarity to real-world settings. Unfortunately, more research is needed for the definition of which type of content should be used in the design of these tools. One possibility is the use of emotional stimuli, which are known to enhance attentional processes. According to the Socioemotional Selectivity Theory, as people age, the emotional salience arises for positive and neutral, but not for negative stimuli.

Methods

For this study we developed a cognitive-motor VR task involving attention and short-term memory, and we investigated the impact of using emotional images of varying valence. The task consisted of finding a target image, shown for only two seconds, among fourteen neutral distractors, and selecting it through arm movements. After performing the VR task, a recall task took place and the patients had to identify the target images among a valence-matched number of distractors. Ten stroke patients participated in a within-subjects experiment with three conditions based on the valence of the images: positive, negative and neutral. Eye movements were recorded during VR task performance with an eye tracking system.

Results

Our results show decreased attention for negative stimuli in the VR task performance when compared to neutral stimuli. The recall task shows significantly more wrongly identified images (false memories) for negative stimuli than for neutral. Regression and correlation analyses with the Montreal Cognitive Assessment and the Geriatric Depression Scale revealed differential effects of cognitive function and depressive symptomatology in the encoding and recall of positive, negative and neutral images. Further, eye movement data shows reduced search patterns for wrongly selected stimuli containing emotional content.

Conclusions

The results of this study suggest that it is feasible to use emotional content in a VR based cognitive-motor task for attention and memory training after stroke. Stroke survivors showed less attention towards negative information, exhibiting reduced visual search patterns and more false memories. We have also shown that the use of emotional stimuli in a VR task can provide additional information regarding patient’s mood and cognitive status.

Are Age Effects in Positivity Influenced by the Valence of Distractors?

An age-related ‘positivity’ effect has been identified, in which older adults show an information-processing bias towards positive emotional items in attention and memory. In the present study, we examined this positivity bias by using a novel paradigm in which emotional and neutral distractors were presented along with emotionally valenced targets. Thirty-five older and 37 younger adults were asked during encoding to attend to emotional targets paired with distractors that were either neutral or opposite in valence to the target. Pupillary responses were recorded during initial encoding as well as a later incidental recognition task. Memory and pupillary responses for negative items were not affected by the valence of distractors, suggesting that positive distractors did not automatically attract older adults’ attention while they were encoding negative targets. Additionally, the pupil dilation to negative items mediated the relation between age and positivity in memory. Overall, memory and pupillary responses provide converging support for a cognitive control account of positivity effects in late adulthood and suggest a link between attentional processes and the memory positivity effect.

The neural mechanisms underlying the aging-related enhancement of positive affects: electrophysiological evidences

Background: Previous studies reported that old adults, relative to young adults, showed improvement of emotional stability and increased experiences of positive affects.

Methods: In order to better understand the neural underpinnings behind the aging-related enhancement of positive affects, it is necessary to investigate whether old and young adults differ in the threshold of eliciting positive or negative emotional reactions. However, no studies have examined emotional reaction differences between old and young adults by manipulating the intensity of emotional stimuli to date. To clarify this issue, the present study examined the impact of aging on the brain’s susceptibility to affective pictures of varying emotional intensities. We recorded event-related potentials (ERP) for highly negative (HN), mildly negative (MN) and neutral pictures in the negative experimental block; and for highly positive (HP), mildly positive (MP) and neutral pictures in the positive experimental block, when young and old adults were required to count the number of pictures, irrespective of the emotionality of the pictures.

Results: Event-related potentials results showed that LPP (late positive potentials) amplitudes were larger for HN and MN stimuli compared to neutral stimuli in young adults, but not in old adults. By contrast, old adults displayed larger LPP amplitudes for HP and MP relative to neutral stimuli, while these effects were absent for young adults. In addition, old adults reported more frequent perception of positive stimuli and less frequent perception of negative stimuli than young adults. The post-experiment stimulus assessment showed more positive ratings of Neutral and MP stimuli, and reduced arousal ratings of HN stimuli in old compared to young adults.

Conclusion: These results suggest that old adults are more resistant to the impact of negative stimuli, while they are equipped with enhanced attentional bias for positive stimuli. The implications of these results to the aging-related enhancement of positive affects were discussed.

Emotional Arousal and Memory Binding: An Object-Based Framework

Binding various features of an event together and maintaining these connections in memory is an essential component of episodic memories. Previous theories make contradictory predictions about the effects of emotional arousal on memory binding. In this article, I review evidence for both arousal-impaired and arousal-enhanced memory binding and explain these contradictory findings using an object-based framework. According to this framework, emotionally arousing objects attract attention that enhances binding of their constituent features. In contrast, the emotional arousal associated with one object either impairs or has no effect on the associations between that object and other distinct objects or background contextual information. After initial encoding, the attention-grabbing nature of emotionally arousing objects can lead to interference in working memory, making it more difficult to maintain other bound representations. These contrasting effects of arousal on memory binding should help predict which aspects of emotional memories are likely to be accurate and which aspects are likely to be misremembered.

Selective looking at natural scenes: Hedonic content and gender

Choice viewing behavior when looking at affective scenes was assessed to examine differences due to hedonic content and gender by monitoring eye movements in a selective looking paradigm. On each trial, participants viewed a pair of pictures that included a neutral picture together with an affective scene depicting either contamination, mutilation, threat, food, nude males, or nude females. The duration of time that gaze was directed to each picture in the pair was determined from eye fixations. Results indicated that viewing choices varied with both hedonic content and gender. Initially, gaze duration for both men and women was heightened when viewing all affective contents, but was subsequently followed by significant avoidance of scenes depicting contamination or nude males. Gender differences were most pronounced when viewing pictures of nude females, with men continuing to devote longer gaze time to pictures of nude females throughout viewing, whereas women avoided scenes of nude people, whether male or female, later in the viewing interval. For women, reported disgust of sexual activity was also inversely related to gaze duration for nude scenes. Taken together, selective looking as indexed by eye movements reveals differential perceptual intake as a function of specific content, gender, and individual differences.

Distinct effects of positive and negative music on older adults’ auditory target identification performances

Older adults, compared to younger adults, are more likely to attend to pleasant situations and avoid unpleasant ones. Yet, it is unclear whether such a phenomenon may be generalized to musical emotions. In this study, we investigated whether there is an age-related difference in how musical emotions are experienced and how positive and negative music influences attention performances in a target identification task. Thirty-one young and twenty-eight older adults were presented with 40 musical excerpts conveying happiness, peacefulness, sadness, and threat. While listening to music, participants were asked to rate their feelings and monitor each excerpt for the occurrence of an auditory target. Compared to younger adults, older adults reported experiencing weaker emotional activation when listening to threatening music and showed higher level of liking for happy music. Correct reaction times (RTs) for target identification were longer for threatening than for happy music in older adults but not in younger adults. This suggests that older adults benefit from a positive musical context and can regulate emotion elicited by negative music by decreasing attention towards it (and therefore towards the auditory target).

Brain processing of emotional scenes in aging: effect of arousal and affective context

Research on emotion showed an increase, with age, in prevalence of positive information relative to negative ones. This effect is called positivity effect. From the cerebral analysis of the Late Positive Potential (LPP), sensitive to attention, our study investigated to which extent the arousal level of negative scenes is differently processed between young and older adults and, to which extent the arousal level of negative scenes, depending on its value, may contextually modulate the cerebral processing of positive (and neutral) scenes and favor the observation of a positivity effect with age. With this aim, two negative scene groups characterized by two distinct arousal levels (high and low) were displayed into two separate experimental blocks in which were included positive and neutral pictures. The two blocks only differed by their negative pictures across participants, as to create two negative global contexts for the processing of the positive and neutral pictures. The results show that the relative processing of different arousal levels of negative stimuli, reflected by LPP, appears similar between the two age groups. However, a lower activity for negative stimuli is observed with the older group for both tested arousal levels. The processing of positive information seems to be preserved with age and is also not contextually impacted by negative stimuli in both younger and older adults. For neutral stimuli, a significantly reduced activity is observed for older adults in the contextual block of low-arousal negative stimuli. Globally, our study reveals that the positivity effect is mainly due to a modulation, with age, in processing of negative stimuli, regardless of their arousal level. It also suggests that processing of neutral stimuli may be modulated with age, depending on negative context in which they are presented to. These age-related effects could contribute to justify the differences in emotional preference with age.

Immediate effects of exposure to positive and negative emotional stimuli on visual search characteristics in patients with unilateral neglect

The performance of patients with unilateral neglect (UN) in tasks demanding visual attention is characterized by contralesional disadvantage which is markedly unstable in magnitude. Such instability of the attentional system is seen very clearly in clinical practice and thus far has no satisfying explanation. Here we examined the immediate effect of exposure to non-lateralized emotional stimuli on UN patients' attentional bias and performance variability. We tested eight right-hemisphere damaged stroke patients with left-sided neglect and eight age-matched healthy subjects in a visual conjunction-search task, each trial performed immediately after viewing a centrally-presented picture, which was emotionally negative, positive or neutral. Both performance bias and variability in performing the search task was analyzed as a function of the valence of the picture, and a method for analyzing reaction time (RT) variance in a small sample is introduced. Overall, UN subjects, but not controls, were slower and more variable in their RT for left- compared to right-sided targets. In the UN group, detecting left-sided targets was significantly slower in trials that followed presentation of negative pictures as compared to positive pictures, regardless of the fact that both picture types were judged as equally arousing by the patients. Moreover, UN patients exhibited larger performance variance on the left then on the right, and negative emotional stimuli were associated with larger variance asymmetry than positive emotional stimuli. Examining the coefficient of variation pointed to a possible dissociation between the effects of emotional stimuli on the lateralized RT mean (reflecting attentional bias) and on the lateralized RT variance (reflecting system instability). We conclude that emotional stimuli affect the spatial imbalance of both performance speed and stability in UN patients.

Effects of speaker emotional facial expression and listener age on incremental sentence processing

We report two visual-world eye-tracking experiments that investigated how and with which time course emotional information from a speaker's face affects younger (N = 32, Mean age  = 23) and older (N = 32, Mean age  = 64) listeners’ visual attention and language comprehension as they processed emotional sentences in a visual context. The age manipulation tested predictions by socio-emotional selectivity theory of a positivity effect in older adults. After viewing the emotional face of a speaker (happy or sad) on a computer display, participants were presented simultaneously with two pictures depicting opposite-valence events (positive and negative; IAPS database) while they listened to a sentence referring to one of the events. Participants' eye fixations on the pictures while processing the sentence were increased when the speaker's face was (vs. wasn't) emotionally congruent with the sentence. The enhancement occurred from the early stages of referential disambiguation and was modulated by age. For the older adults it was more pronounced with positive faces, and for the younger ones with negative faces. These findings demonstrate for the first time that emotional facial expressions, similarly to previously-studied speaker cues such as eye gaze and gestures, are rapidly integrated into sentence processing. They also provide new evidence for positivity effects in older adults during situated sentence processing.

Can older adults resist the positivity effect in neural responding? The impact of verbal framing on event-related brain potentials elicited by emotional images

Older adults have demonstrated an avoidance of negative information, presumably with a goal of greater emotional satisfaction. Understanding whether avoidance of negative information is a voluntary, motivated choice or an involuntary, automatic response will be important to differentiate, as decision making often involves emotional factors. With the use of an emotional framing event-related potential (ERP) paradigm, the present study investigated whether older adults could alter neural responses to negative stimuli through verbal reframing of evaluative response options. The late positive potential (LPP) response of 50 older adults and 50 younger adults was recorded while participants categorized emotional images in one of two framing conditions: positive ("more or less positive") or negative ("more or less negative"). It was hypothesized that older adults would be able to overcome a presumed tendency to down-regulate neural responding to negative stimuli in the negative framing condition, thus leading to larger LPP wave amplitudes to negative images. A similar effect was predicted for younger adults, but for positively valenced images, such that LPP responses would be increased in the positive framing condition compared with the negative framing condition. Overall, younger adults' LPP wave amplitudes were modulated by framing condition, including a reduction in the negativity bias in the positive frame. Older adults' neural responses were not significantly modulated, even though task-related behavior supported the notion that older adults were able to successfully adopt the negative framing condition.

Emotional attention modulates microsaccadic rate and direction

Involuntary microsaccades and voluntary saccades reflect human brain activities during attention and cognitive tasks. Our eye movements can also betray our emotional state. However, the effects of attention to emotion on microsaccadic activity remain unknown. The present study was conducted in healthy volunteers to investigate the effects of devoting attention to exogenous emotional stimuli on microsaccadic response, with change in pupil size as an index of sympathetic nervous system activity. Event-related responses to unpleasant images significantly inhibited the rate of microsaccade appearance and altered pupil size (Experiment 1). Additionally, microsaccadic responses to covert orienting of attention to emotional stimuli appeared significantly in the anti-direction to a target, with a fast reaction time (Experiment 2). Therefore, we concluded that attentional shifts induced by exogenous emotional stimuli can modulate microsaccadic activities. Future studies of the interaction between miniature eye movements and emotion may be beneficial in the assessment of pathophysiological responses in mental disorders.

Brain responses to emotional images related to cognitive ability in older adults

Older adults have been shown to exhibit a positivity effect in processing of emotional stimuli, seemingly focusing more on positive than negative information. Whether this reflects purposeful changes or an unintended side effect of declining cognitive abilities is unclear. For the present study, older adults displaying a wide range of cognitive abilities completed measures of attention, visual, and verbal memory; executive functioning and processing speed; as well as a socioemotional measure of time perspective. Regression analyses examined the ability of these variables to predict neural responsivity to select emotional stimuli as measured with the late positive potential (LPP), an event-related brain potential (ERP). Stronger cognitive functioning was associated with higher LPP amplitude in response to negative images (i.e., greater processing). This does not support a voluntary avoidance of negative information processing in older adults for this particular measure of attentional allocation. A model is proposed to reconcile this finding with the extant literature that has demonstrated positivity effects in measures of later, controlled attentional allocation.

Affective salience can reverse the effects of stimulus-driven salience on eye movements in complex scenes

In natural vision both stimulus features and cognitive/affective factors influence an observer's attention. However, the relationship between stimulus-driven ("bottom-up") and cognitive/affective ("top-down") factors remains controversial: Can affective salience counteract strong visual stimulus signals and shift attention allocation irrespective of bottom-up features? Is there any difference between negative and positive scenes in terms of their influence on attention deployment? Here we examined the impact of affective factors on eye movement behavior, to understand the competition between visual stimulus-driven salience and affective salience and how they affect gaze allocation in complex scene viewing. Building on our previous research, we compared predictions generated by a visual salience model with measures indexing participant-identified emotionally meaningful regions of each image. To examine how eye movement behavior differs for negative, positive, and neutral scenes, we examined the influence of affective salience in capturing attention according to emotional valence. Taken together, our results show that affective salience can override stimulus-driven salience and overall emotional valence can determine attention allocation in complex scenes. These findings are consistent with the hypothesis that cognitive/affective factors play a dominant role in active gaze control.

Negative emotional outcomes impair older adults' reversal learning

In a typical reversal-learning experiment, one learns stimulus-outcome contingencies that then switch without warning. For instance, participants might have to repeatedly choose between two faces, one of which yields points whereas the other does not, with a reversal at some point in which face yields points. The current study examined age differences in the effects of outcome type on reversal learning. In the first experiment, the participants' task was either to select the person who would be in a better mood or to select the person who would yield more points. Reversals in which face was the correct option occurred several times. Older adults did worse in blocks in which the correct response was to select the person who would not be angry than in blocks in which the correct response was to select the person who would smile. Younger adults did not show a difference by emotional valence. In the second study, the negative condition was switched to have the same format as the positive condition (to select who will be angry). Again, older adults did worse with negative than positive outcomes, whereas younger adults did not show a difference by emotional valence. A third experiment replicated the lack of valence effects in younger adults with a harder probabilistic reversal-learning task. In the first two experiments, older adults performed about as well as younger adults in the positive conditions but performed worse in the negative conditions. These findings suggest that negative emotional outcomes selectively impair older adults' reversal learning.

Preserved emotional modulation of motor response time despite psychomotor slowing in young-old adults

Whereas aging affects cognitive and psychomotor processes negatively, the impact of aging on emotional processing is less clear. Using an "old-new" binary decision task, we ascertained the modulation of response latencies after presentation of neutral and emotional pictures in "young" (M = 27.1 years) and "young-old" adults with a mean age below 60 (M = 57.7 years). Stimuli varied on valence (pleasant, neutral, and unpleasant) and arousal (high and low) dimensions. Young-old adults had significantly longer reaction times. However, young and young-old adults showed the exact same pattern of response time modulation by emotional stimuli: Response latencies were longer for high-arousal than for low-arousal pictures and longer for negative than for positive or neutral stimuli. This result suggests that the specific effects of implicitly processed emotional valence and arousal information on behavioral response time are preserved in young-old adults despite significant age-related psychomotor decline.

How arousal affects younger and older adults' memory binding

A number of recent studies have shown that associative memory for within-item features is enhanced for emotionally arousing items, whereas arousal-enhanced binding is not seen for associations between distinct items (for a review, see Mather, 2007, Perspectives on Psychological Science, 2, 33-52). The costs and benefits of arousal in memory binding have been examined for younger adults but not for older adults. The present experiment examined whether arousal would enhance younger and older adults' within-item and between-item memory binding. The results revealed that arousal improved younger adults' within-item memory binding but not that of older adults. Arousal worsened both groups' between-item memory binding.

Arousal-Biased Competition in Perception and Memory

Our everyday surroundings besiege us with information. The battle is for a share of our limited attention and memory, with the brain selecting the winners and discarding the losers. Previous research shows that both bottom-up and top-down factors bias competition in favor of high priority stimuli. We propose that arousal during an event increases this bias both in perception and in long-term memory of the event. Arousal-biased competition theory provides specific predictions about when arousal will enhance memory for events and when it will impair it, which accounts for some puzzling contradictions in the emotional memory literature.

Emotion Regulation and the Cognitive-Experimental Approach to Emotional Dysfunction

Since the 1980s, there has been a steady growth of interest in the psychological mechanisms that regulate normal emotional experience. In this same period, cognitive-experimental researchers have sought to delineate the information processing biases that characterize emotional disorders. Exciting potential synergies exist between these two areas of investigation. In this article, we consider ways in which reciprocal benefits could be gained by the constructive transfer of theoretical ideas and methodological approaches between emotion regulation researchers and cognitive-experimental investigators. We also discuss how recent innovations within each field can profitably impact upon progress within the other. It is concluded that the overlap in conceptual constructs, and the convergence of complementary investigative techniques, between these two research domains, provide opportunities for creative synthesis that could significantly enrich understanding of normal and abnormal emotion across future years.

Facing the Music or Burying Our Heads in the Sand?: Adaptive Emotion Regulation in Midlife and Late Life

Defenses that keep threatening information out of awareness are posited to reduce anxiety at the cost of longer-term dysfunction. By contrast, socioemotional selectivity theory suggests that preference for positively-valenced information is a late-life manifestation of adaptive emotion regulation. Using longitudinal data on 61 men, we examined links between emotion regulation indices informed by these distinct conceptualizations: defenses in earlier adulthood and selective memory for positively-valenced images in late-life. Use of avoidant defenses in midlife predicted poorer memory for positive, negative, and neutral images nearly 4 decades later. Late-life satisfaction was positively linked with midlife engaging defenses but negatively linked at the trend level with concurrent positive memory bias.

The changing face of emotion: age-related patterns of amygdala activation to salient faces

The present study investigated age-related differences in the amygdala and other nodes of face-processing networks in response to facial expression and familiarity. fMRI data were analyzed from 31 children (3.5-8.5 years) and 14 young adults (18-33 years) who viewed pictures of familiar (mothers) and unfamiliar emotional faces. Results showed that amygdala activation for faces over a scrambled image baseline increased with age. Children, but not adults, showed greater amygdala activation to happy than angry faces; in addition, amygdala activation for angry faces increased with age. In keeping with growing evidence of a positivity bias in young children, our data suggest that children find happy faces to be more salient or meaningful than angry faces. Both children and adults showed preferential activation to mothers' over strangers' faces in a region of rostral anterior cingulate cortex associated with self-evaluation, suggesting that some nodes in frontal evaluative networks are active early in development. This study presents novel data on neural correlates of face processing in childhood and indicates that preferential amygdala activation for emotional expressions changes with age.

Reconciling findings of emotion-induced memory enhancement and impairment of preceding items

A large body of work has revealed that people remember emotionally arousing information better than neutral information. However, previous research has revealed contradictory effects of emotional events on memory for neutral events that precede or follow them: In some studies, emotionally arousing items have impaired memory for immediately preceding or following items, and in others arousing items enhanced memory for preceding items. By demonstrating both emotion-induced enhancement and impairment, Experiments 1 and 2 clarified the conditions under which these effects are likely to occur. The results suggest that emotion-induced enhancement is most likely to occur for neutral items that (a) precede (and so are poised to predict the onset of) emotionally arousing items, (b) have high attentional weights at encoding, and (c) are tested after a delay period of a week rather than within the same experimental session. In contrast, emotion-induced impairment is most likely to occur for neutral items near the onset of emotional arousal that are overshadowed by highly activated competing items during encoding.

Positive gaze preferences in older adults: assessing the role of cognitive effort with pupil dilation

Older adults display positive preferences in their gaze, consistent with their prioritization of emotion regulation goals. While some research has argued that substantial amounts of cognitive effort are necessary for these information-processing preferences to occur, other work suggests that these attentional patterns unfold with minimal cognitive exertion. The current study used an implicit regulatory context (i.e., viewing facial stimuli of varying emotions) to assess how much cognitive effort was required for positive attentional preferences to occur. Effortful cognitive processing was assessed with a direct measure of change in pupil dilation. Results indicated that minimal cognitive effort was expended when older adults engaged in positive gaze preferences. This finding suggests that gaze acts as a rather effortless and economical regulatory tool for individuals to shape their affective experience.

Attentional bias for threat in older adults: moderation of the positivity bias by trait anxiety and stimulus modality

Socioemotional selectivity theory suggests that emotion regulation goals motivate older adults to preferentially allocate attention to positive stimuli and away from negative stimuli. This study examined whether anxiety moderates the effect of the positivity bias on attention for threat. The authors employed the dot probe task to compare subliminal and supraliminal attention for threat in 103 young and 44 older adults. Regardless of anxiety, older but not young adults demonstrated a vigilant-avoidant response to angry faces. Anxiety influenced older adults' attention such that anxious individuals demonstrated a vigilant-avoidant reaction to sad faces but an avoidant-vigilant reaction to negative words.

Effects of regulating emotions on cognitive performance: what is costly for young adults is not so costly for older adults

The authors examined whether instructions to regulate emotions after a disgust-inducing film clip created an equally costly cognitive load across adulthood. Young and older adults across all instructional conditions initially demonstrated increased working memory performance after mood induction, typical of practice effects. Age-group differences emerged at the 2nd postinduction trial. When instructed to down-regulate disgust feelings, older adults' performance continually increased, whereas young adults' performance dropped. Instructions to maintain disgust did not affect working memory performance. Consistent with claims that older adults are more effective at regulating emotions, findings indicate that intentional down-regulation of negative emotions may be less costly in older age.

Consequences of emotional stimuli: age differences on pure and mixed blocks of the emotional Stroop

Background

Studies of aging and emotion suggest that older adults show diminished responsiveness to negative information, possibly resulting from increased emotion regulation, but the mechanisms accounting for this effect are uncertain.

Methods

To examine whether aging affects the allocation of attention to negative stimuli, we compared 20 younger and 20 older adults on 2 versions of the emotional Stroop task: "pure blocks," in which all words in each block were either emotional or neutral, and "mixed blocks," a pseudorandomized design in which either a negative emotional or a neutral category word was always followed by six neutral words. The emotional Stroop task typically elicits slower reaction times for naming the font color of negative emotional words compared to neutral, but no studies have examined the effects of aging on the immediate and sustained components of the emotional Stroop effect.

Results

Both groups showed an emotional Stroop effect on pure blocks manifest as slower RTs on the emotional, relative to the neutral, block. However, only younger adults showed persistent slowing that carried over from emotional words onto subsequent neutral words in mixed blocks.

Conclusion

These results suggest that the consequences of emotional stimuli may differ with age. Younger and older adults showed equivalent interference from the emotional words themselves, but older adults did not show a sustained effect of negative information.

Eye tracking technology: a fresh approach in delirium assessment?

The objective of this paper is to highlight the potential role of eye tracking technology (ETT) in the assessment of delirious patients. Delirium occurs in one in five general hospital admissions (Siddiqi, 2006) and its frequency will increase as society gets older. Despite its frequency and significant independent impact upon morbidity and mortality, delirium remains under studied and is frequently missed, detected late, or misdiagnosed (Farrell & Ganzani, 1995; Inouye, 2001; Kakuma, 2003). Detection is a key target for both clinical and research efforts. Assessment of attention is key to diagnosing delirium, yet nurses and non-research medical staff often fail to correctly identify inattention (Inouye et al., 2001; Lemiengre et al., 2006; Ryan et al., 2008). Eye tracking measures have been used in a plethora of key areas of psychiatric research (Crawford et al., 2005; Corden, Chilvers, & Skuse, 2008; Hardin, Schroth, Pine, & Ernst, 2007; Holzman, Leonard, Proctor, & Hughes, 1973), and provide an accurate and non-invasive method in the assessment of cognitive function. The potential of ETT for direct clinical applications in the assessment of attention and comprehension, key cognitive symptoms of delirium, are promising. This paper considers potential new approaches which recent advancements in non-invasive ETT may bring to the examination and understanding of delirium.

Personal relevance modulates the positivity bias in recall of emotional pictures in older adults

Some studies have suggested that older adults remember more positive than negative valence information, relative to younger adults, whereas other studies have reported no such difference. We tested whether differences in encoding instructions and in personal relevance could account for these inconsistencies. Younger and older adults were instructed either to passively view positive, negative, and neutral pictures or to actively categorize them by valence. On a subsequent incidental recall test, older adults recalled equal numbers of positive and negative pictures, whereas younger adults recalled negative pictures best. There was no effect of encoding instructions. Crucially, when the pictures were grouped into high and low personal relevance, a positivity bias emerged in older adults only for low-relevance pictures, suggesting that the personal relevance of pictures may be the factor underlying cross-study differences.

Arousal-Enhanced Location Memory for Pictures

Four experiments revealed arousal-enhanced location memory for pictures. After an incidental encoding task, participants were more likely to remember the locations of positive and negative arousing pictures than the locations of non-arousing pictures, indicating better binding of location to picture. This arousal-enhanced binding effect did not have a cost for the binding of nearby pictures to their locations. Thus, arousal can enhance binding of an arousing picture's content to its location without interfering with picture-location binding for nearby pictures. In addition, arousal-enhanced picture-location memory binding is not just a side effect of enhanced memory for the picture itself, as it occurs both when recognition memory is good and when it is poor.

Decline or improvement?

We examined age-related differences in facial expression recognition in association with potentially interfering variables such as general cognitive ability (verbal and visuospatial abilities), face recognition ability, and the experiences of positive and negative emotions. Participants comprised 34 older (aged 62-81 years) and 34 younger (aged 18-25 years) healthy Japanese adults. The results showed not only age-related decline in sadness recognition but also age-related improvement in disgust recognition. Among other variables, visuospatial ability was moderately related to facial expression recognition in general, and the experience of negative emotions was related to sadness recognition. Consequently, age-related decline in sadness recognition was statistically explained by age-related decrease in the experience of negative emotions. On the other hand, age-related improvement in disgust recognition was not explained by the interfering variables, and it reflected a higher tendency in the younger participants to mistake disgust for anger. Possible mechanisms are discussed in terms of neurobiological and socio-environmental factors.

Aging and visual search: automatic and controlled attentional bias to threat faces

Using a visual search paradigm, we investigated how age affected attentional bias to emotional facial expressions. In Experiments 1 and 2, participants searched for a discrepant facial expression in a matrix of otherwise homogeneous faces. Both younger and older adults showed a more effective search when the discrepant face was angry rather than happy or neutral. However, when the angry faces served as non-target distractors, younger adults' search was less effective than happy or neutral distractor conditions. In contrast, older adults showed a more efficient search with angry distractors than happy or neutral distractors, indicating that older adults were better able to inhibit angry facial expressions. In Experiment 3, we found that even a top-down search goal could not override the angry face superiority effect in guiding attention. In addition, RT distribution analyses supported that both younger and older adults performed the top-down angry face search qualitatively differently from the top-down happy face search. The current research indicates that threat face processing involves automatic attentional shift and a controlled attentional process. The current results suggest that age only influenced the controlled attentional process.

[What does the language of Alzheimer patients have to do with the language of Paul Celan?]

Being in touch with severely demented patients requires a fundamental transformation in communication habits in medicine and in nursing. There is a need of reorientation away from an interpreting and often deficit-oriented aspect of communication towards attentive observance of unusual verbal and nonverbal signals and resources of the patient. Spontaneous and open communication with the patient outweighs the importance of a goal-oriented exchange of information and poses a significant challenge for all health and social professions. The well-being of persons with dementia depends mainly on the quality of communication and on the design of the milieu and the quality of everyday life. Interaction in nursing seems to be the crucial issue, including both spontaneity and creativity in the interaction partners, while respecting the personal boundaries of both the patient and the nurse in the necessary intimacy of the care environment. This essay shows important aspects and strategies of adequate communication with people with dementia from the perspective of medicine and of nursing. Ways to improve communication skills are shown, referring, among others, to the approaches by Kate Allan and John Killick (research fellows at Dementia Services Development Centre, University of Stirling).