Unilateral hemispheric lesions disrupt parallel processing within the contralateral intact hemisphere: an auditory fMRI study

Outcome of severe COVID-19: spotlight on fatigue, fatigability, multidomain complaints and pattern of cognitive deficits in a case series without prior brain dysfunction and without COVID-19-related stroke and/or cardiac arrest

BACKGROUND

Population-wide surveys and large-scale investigations highlighted the presence of cognitive deficits in the acute and postacute stages of severe COVID-19; a few studies documented their occurrence in cases without prior or COVID-19-related brain damage. The evolution of cognitive deficits in the latter population and their relationship to the post-COVID-19 fatigue syndrome are poorly understood.

CASE PRESENTATION

We report the outcome at 12 months after severe COVID-19 involving an intensive care unit stay and mechanical ventilation in six (five Caucasian and one Asian) patients (age range: 53-71 years, mean age 61.7 ± 6.5 years) without history of prior brain dysfunction and without stroke and/or cardiac arrest during or after COVID-19. All patients reported pervading mental and physical fatigue as well as numerous multidomain complaints, which impacted everyday life. Individual patients described mental fatigability, apathy, and/or anxiety. Standardized neuropsychological tests revealed isolated symptoms of cognitive dysfunction or performance at the lower limit of the norm in the attentional, executive, and/or working memory domains in four of the six patients. Somatic scales documented dyspnoea, muscle weakness, olfactory disorder, and/or minor sleep problems in some, but not all, patients.

CONCLUSION

Fatigue, fatigability, multidomain complaints, cognitive difficulties, or dysfunction, as well as isolated neurobehavioral and/or psychiatric and/or somatic symptoms, tend to occur in the aftermath of severe COVID-19 and persist at 12 months, even in the absence of prior and/or COVID-19-related brain damage. This clinical situation, which impacts everyday life, calls for a detailed investigation of patients' complaints, its neural underpinning, and an elaboration of specific rehabilitation programs.

Evidence of a functional reorganization in the auditory dorsal stream following unilateral hearing loss

Unilateral hearing loss (UHL) generates a disruption of binaural hearing mechanisms, which impairs sound localization and speech understanding in noisy environments. We conducted an original study using fMRI and psychoacoustic assessments to investigate the relationships between the extent of cortical reorganization across the auditory areas for UHL patients, the severity of unilateral hearing loss, and the deficit in binaural abilities. Twenty-eight volunteers (14 UHL patients) were recruited (twenty-two females and six males). The brain imaging analysis demonstrated that UHL induces a shift in aural dominance favoring the better ear, with a cortical reorganization located in the non-primary auditory areas, ipsilateral (same side) to the better ear. This reorganization is correlated not only to the hearing loss severity but also to spatial localization abilities. A regression analysis between brain activity and patient's performance clearly showed that the spatial hearing deficit was linked to a functional alteration of the posterior auditory areas known to process spatial hearing. Altogether, our study reveals that UHL alters the dorsal auditory stream, which is deleterious to spatial hearing.

A brief exposure to rightward prismatic adaptation changes resting-state network characteristics of the ventral attentional system

A brief session of rightward prismatic adaptation (R-PA) has been shown to alleviate neglect symptoms in patients with right hemispheric damage, very likely by switching hemispheric dominance of the ventral attentional network (VAN) from the right to the left and by changing task-related activity within the dorsal attentional network (DAN). We have investigated this very rapid change in functional organisation with a network approach by comparing resting-state connectivity before and after a brief exposure i) to R-PA (14 normal subjects; experimental condition) or ii) to plain glasses (12 normal subjects; control condition). A whole brain analysis (comprising 129 regions of interest) highlighted R-PA-induced changes within a bilateral, fronto-temporal network, which consisted of 13 nodes and 11 edges; all edges involved one of 4 frontal nodes, which were part of VAN. The analysis of network characteristics within VAN and DAN revealed a R-PA-induced decrease in connectivity strength between nodes and a decrease in local efficiency within VAN but not within DAN. These results indicate that the resting-state connectivity configuration of VAN is modulated by R-PA, possibly by decreasing its modularity.

A Brief Exposure to Leftward Prismatic Adaptation Enhances the Representation of the Ipsilateral, Right Visual Field in the Right Inferior Parietal Lobule

A brief exposure to rightward prismatic adaptation (PA) was shown to shift visual field representation within the inferior parietal lobule (IPL) from the right to the left hemisphere. This change in hemispheric dominance could be interpreted as (1) a general effect of discrepancy in visuomotor alignment caused by PA or (2) a direction-specific effect of rightward PA. To test these hypotheses, we compared the effects of rightward and leftward PA on visual representation in normal human subjects. Three groups of normal subjects underwent an fMRI evaluation using a simple visual detection task before and after brief PA exposure using leftward- or rightward-deviating prisms or no prisms (L-PA, R-PA, neutral groups). A two-way ANOVA group × session revealed a significant interaction suggesting that PA-induced modulation is direction specific. Post hoc analysis showed that L-PA enhanced the representation of the right visual field within the right IPL. Thus, a brief exposure to L-PA enhanced right hemispheric dominance within the ventral attentional system, which is the opposite effect of the previously described shift in hemispheric dominance following R-PA. The direction-specific effects suggest that the underlying neural mechanisms involve the fine-tuning of specific visuomotor networks. The enhancement of right hemispheric dominance following L-PA offers a parsimonious explanation for neglect-like symptoms described previously in normal subjects.

Auditory spatial deficits following hemispheric lesions: dissociation of explicit and implicit processing

Auditory spatial deficits occur frequently after hemispheric damage; a previous case report suggested that the explicit awareness of sound positions, as in sound localisation, can be impaired while the implicit use of auditory cues for the segregation of sound objects in noisy environments remains preserved. By assessing systematically patients with a first hemispheric lesion, we have shown that (1) explicit and/or implicit use can be disturbed; (2) impaired explicit vs. preserved implicit use dissociations occur rather frequently; and (3) different types of sound localisation deficits can be associated with preserved implicit use. Conceptually, the dissociation between the explicit and implicit use may reflect the dual-stream dichotomy of auditory processing. Our results speak in favour of systematic assessments of auditory spatial functions in clinical settings, especially when adaptation to auditory environment is at stake. Further, systematic studies are needed to link deficits of explicit vs. implicit use to disability in everyday activities, to design appropriate rehabilitation strategies, and to ascertain how far the explicit and implicit use of spatial cues can be retrained following brain damage.

Dissociable memory- and response-related activity in parietal cortex during auditory spatial working memory

Attending and responding to sound location generates increased activity in parietal cortex which may index auditory spatial working memory and/or goal-directed action. Here, we used an n-back task (Experiment 1) and an adaptation paradigm (Experiment 2) to distinguish memory-related activity from that associated with goal-directed action. In Experiment 1, participants indicated, in separate blocks of trials, whether the incoming stimulus was presented at the same location as in the previous trial (1-back) or two trials ago (2-back). Prior to a block of trials, participants were told to use their left or right index finger. Accuracy and reaction times were worse for the 2-back than for the 1-back condition. The analysis of functional magnetic resonance imaging data revealed greater sustained task-related activity in the inferior parietal lobule (IPL) and superior frontal sulcus during 2-back than 1-back after accounting for response-related activity elicited by the targets. Target detection and response execution were also associated with enhanced activity in the IPL bilaterally, though the activation was anterior to that associated with sustained task-related activity. In Experiment 2, we used an event-related design in which participants listened (no response required) to trials that comprised four sounds presented either at the same location or at four different locations. We found larger IPL activation for changes in sound location than for sounds presented at the same location. The IPL activation overlapped with that observed during the auditory spatial working memory task. Together, these results provide converging evidence supporting the role of parietal cortex in auditory spatial working memory which can be dissociated from response selection and execution.

Potencial Cognitivo P300 em pacientes com lesão isquêmica do hemisfério direito

TEMA: avaliação do potencial cognitivo P300 em indivíduos com lesão de hemisfério direito provocada por acidente vascular cerebral isquêmico. OBJETIVO: caracterizar os achados do potencial cognitivo P300 em indivíduos destros com lesão isquêmica do hemisfério cerebral direito, bem como comparar seus resultados aos obtidos em indivíduos normais. MÉTODO: foram realizadas anamnese, avaliação audiológica convencional e potencial cognitivo (P300), em 17 indivíduos com lesão do hemisfério direito (grupo pesquisa) e 25 normais (grupo controle), com idades entre 20 e 70 anos. RESULTADOS: na análise dos dados qualitativos do P300, não houve diferença estatisticamente significante entre os grupos para o resultado normal. Para a análise dos dados quantitativos, ocorreu diferença estatisticamente significante entre os grupos com relação à latência da onda P300, sendo que o grupo pesquisa apresentou latência maior. Além disso, houve uma tendência estatisticamente significante entre as orelhas direita e esquerda dentro do grupo pesquisa, mostrando aumento de latência da onda P300 na orelha direita. CONCLUSÃO: Indivíduos destros com lesão de hemisfério direito e limiares auditivos normais, apresentaram resultados eletrofisiológicos da audição indicativos de déficit no sistema nervoso auditivo central. Foram observados comprometimentos nas regiões geradoras deste potencial (áreas subcorticais e corticais). Dificuldades auditivas não foram percebidas pelos indivíduos, sugerindo que, provavelmente tal sinal possa estar relacionado à uma heminegligência auditiva. Tornam-se necessários mais estudos que avaliem a via auditiva central destes indivíduos para uma melhor caracterização dos achados eletrofisiológicos.

Interactions between auditory 'what' and 'where' pathways revealed by enhanced near-threshold discrimination of frequency and position

Partially segregated neuronal pathways ("what" and "where" pathways, respectively) are thought to mediate sound recognition and localization. Less studied are interactions between these pathways. In two experiments, we investigated whether near-threshold pitch discrimination sensitivity (d') is altered by supra-threshold task-irrelevant position differences and likewise whether near-threshold position discrimination sensitivity is altered by supra-threshold task-irrelevant pitch differences. Each experiment followed a 2 x 2 within-subjects design regarding changes/no change in the task-relevant and task-irrelevant stimulus dimensions. In Experiment 1, subjects discriminated between 750 Hz and 752 Hz pure tones, and d' for this near-threshold pitch change significantly increased by a factor of 1.09 when accompanied by a task-irrelevant position change of 65 micros interaural time difference (ITD). No response bias was induced by the task-irrelevant position change. In Experiment 2, subjects discriminated between 385 micros and 431 micros ITDs, and d' for this near-threshold position change significantly increased by a factor of 0.73 when accompanied by task-irrelevant pitch changes (6 Hz). In contrast to Experiment 1, task-irrelevant pitch changes induced a response criterion bias toward responding that the two stimuli differed. The collective results are indicative of facilitative interactions between "what" and "where" pathways. By demonstrating how these pathways may cooperate under impoverished listening conditions, our results bear implications for possible neuro-rehabilitation strategies. We discuss our results in terms of the dual-pathway model of auditory processing.

The effect of gaze direction on sound localization in brain-injured and normal adults

This study examined the effects of eye position on sound localization in normal and brain lesion subjects. On the assumption that cerebral lesions may disrupt the representation of or attention to auditory space in the contralesional hemispace, we predicted that subjects with brain lesions would be less accurate in localizing sounds in the contralesional hemispace. In Experiment 1 we showed that gazing to the midline subjects with brain lesions were indeed impaired in localizing sounds in the contralesional hemispace. On the assumption that spatial attention is deployed at the site to which gaze is directed, we predicted that sound localization would be better on the side to which subjects directed their gaze. In Experiment 2, brain lesion subjects performed significantly better in the contralesional hemispace when they directed gaze to that hemispace. This improvement was accompanied by deterioration of performance in the ipsilesional hemispace. When subjects directed gaze to the ipsilesional hemispace, performance in the contralesional hemispace was further impaired. The effect of gaze was also observed in normal subjects in Experiments 2 and 3, independently of response mode (verbal versus pointing responses). These findings are consistent with the hypothesis that sound location may be mapped in eye-centered coordinates and that directing gaze to one hemispace reduces attentional allocation to the other hemispace.

Distinct fMRI responses to laughter, speech, and sounds along the human peri-sylvian cortex

In this event-related fMRI study, 12 right-handed volunteers heard human laughter, sentential speech, and nonvocal sounds in which global temporal and harmonic information were varied whilst they were performing a simple auditory target detection. This study aimed to delineate distinct peri-auditory regions which preferentially respond to laughter, speech, and nonvocal sounds. Results show that all three types of stimuli evoked blood-oxygen-level-dependent responses along the left and right peri-sylvian cortex. However, we observed differences in regional strength and lateralization in that (i) hearing human laughter preferentially involves auditory and somatosensory fields primarily in the right hemisphere, (ii) hearing spoken sentences activates left anterior and posterior lateral temporal regions, (iii) hearing nonvocal sounds recruits bilateral areas in the medial portion of Heschl's gyrus and at the medial wall of the posterior Sylvian Fissure (planum parietale and parietal operculum). Generally, the data imply a differential regional sensitivity of peri-sylvian areas to different auditory stimuli with the left hemisphere responding more strongly to speech and with the right hemisphere being more amenable to nonspeech stimuli. Interestingly, passive perception of human laughter activates brain regions which control motor (larynx) functions. This observation may speak to the issue of a dense intertwining of expressive and receptive mechanisms in the auditory domain. Furthermore, the present study provides evidence for a functional role of inferior parietal areas in auditory processing. Finally, a post hoc conjunction analysis meant to reveal the neural substrates of human vocal timbre demonstrates a particular preference of left and right lateral parts of the superior temporal lobes for stimuli which are made up of human voices relative to nonvocal sounds.