GABA levels are differentially associated with bimanual motor performance in older as compared to young adults

Baseline GABA+ levels in areas associated with sensorimotor control predict initial and long-term motor learning progress

Synaptic plasticity relies on the balance between excitation and inhibition in the brain. As the primary inhibitory and excitatory neurotransmitters, gamma-aminobutyric acid (GABA) and glutamate (Glu), play critical roles in synaptic plasticity and learning. However, the role of these neurometabolites in motor learning is still unclear. Furthermore, it remains to be investigated which neurometabolite levels from the regions composing the sensorimotor network predict future learning outcome. Here, we studied the role of baseline neurometabolite levels in four task-related brain areas during different stages of motor skill learning under two different feedback (FB) conditions. Fifty-one healthy participants were trained on a bimanual motor task over 5 days while receiving either concurrent augmented visual FB (CA-VFB group, N = 25) or terminal intrinsic visual FB (TA-VFB group, N = 26) of their performance. Additionally, MRS-measured baseline GABA+ (GABA + macromolecules) and Glx (Glu + glutamine) levels were measured in the primary motor cortex (M1), primary somatosensory cortex (S1), dorsolateral prefrontal cortex (DLPFC), and medial temporal cortex (MT/V5). Behaviorally, our results revealed that the CA-VFB group outperformed the TA-VFB group during task performance in the presence of augmented VFB, while the TA-VFB group outperformed the CA-VFB group in the absence of augmented FB. Moreover, baseline M1 GABA+ levels positively predicted and DLPFC GABA+ levels negatively predicted both initial and long-term motor learning progress in the TA-VFB group. In contrast, baseline S1 GABA+ levels positively predicted initial and long-term motor learning progress in the CA-VFB group. Glx levels did not predict learning progress. Together, these findings suggest that baseline GABA+ levels predict motor learning capability, yet depending on the FB training conditions afforded to the participants.

Higher cognitive load interferes with head-hand coordination: virtual reality-based study

Daily life activities often involve decision-based reaching movements in different contexts and circumstances. These activities span a wide array of cognitive load types we face while executing motor functions. Here we use a virtual reality-based neurocognitive testing platform to assess cognitive-induced changes in motor behavior as reflected by modulations in head-hand coordination. Our paradigm is based on the Color Trails Test (CTT), which is designed to assess two types of cognitive functions: Trails A-sustained visual attention (SVA), and Trails B-divided attention (DA). The virtual reality CTT adaptation (VR-CTT) requires execution of large multi-directional hand movements and head rotations. We employed a cross-correlation analysis on hand and head kinematics data collected from 122 healthy participants (ages: 20-90 years; divided as follows: young, middle-aged, and older adults) who completed the VR-CTT. The level of spatial coherence of head-hand movements was found to be high (R ≥ 0.76) in both Trails A and B, in all age groups. However, assessing head-hand phase shifts revealed longer time lags (i.e., in which head leads hand) in Trails B versus Trails A, in all age groups. We conclude that allocating cognitive resources to DA task reduces head-hand synchrony as compared to SVA conditions.

White matter and neurochemical mechanisms underlying age-related differences in motor processing speed

Aging is associated with changes in the central nervous system and leads to reduced life quality. Here, we investigated the age-related differences in the CNS underlying motor performance deficits using magnetic resonance spectroscopy and diffusion MRI. MRS measured N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) concentrations in the sensorimotor and occipital cortex, whereas dMRI quantified apparent fiber density (FD) in the same voxels to evaluate white matter microstructural organization. We found that aging was associated with increased reaction time and reduced FD and NAA concentration in the sensorimotor voxel. Both FD and NAA mediated the association between age and reaction time. The NAA concentration was found to mediate the association between age and FD in the sensorimotor voxel. We propose that the age-related decrease in NAA concentration may result in reduced axonal fiber density in the sensorimotor cortex which may ultimately account for the response slowness of older participants.

Transcranial direct current stimulation enhances motor learning in Parkinson's disease: a randomized controlled trial

Writing training has shown clinical benefits in Parkinson's disease (PD), albeit with limited retention and insufficient transfer effects. It is still unknown whether anodal transcranial direct current stimulation (atDCS) can boost consolidation in PD and how this interacts with medication. To investigate the effects of training + atDCS versus training + sham stimulation on consolidation of writing skills when ON and OFF medication. Second, to examine the intervention effects on cortical excitability. In this randomized sham-controlled double-blind study, patients underwent writing training (one session) with atDCS (N = 20) or sham (N = 19) over the primary motor cortex. Training was aimed at optimizing amplitude and assessed during online practice, pre- and post-training, after 24-h retention and after continued learning (second session) when ON and OFF medication (interspersed by 2 months). The primary outcome was writing amplitude at retention. Cortical excitability and inhibition were assessed pre- and post-training. Training + atDCS but not training + sham improved writing amplitudes at retention in the ON state (p = 0.017, g = 0.75). Transfer to other writing tasks was enhanced by atDCS in both medication states (g between 0.72 and 0.87). Also, training + atDCS improved continued learning. However, no online effects were found during practice and when writing with a dual task. A post-training increase in cortical inhibition was found in the training + atDCS group (p = 0.039) but not in the sham group, irrespective of medication. We showed that applying atDCS during writing training boosted most but not all consolidation outcomes in PD. We speculate that atDCS together with medication modulates motor learning consolidation via inhibitory processes ( https://osf.io/gk5q8/ , 2018-07-17).

Altered Bimanual Kinetic and Kinematic Motor Control Capabilities in Older Women

Older women may experience critical neuromuscular impairments interfering with controlling successful bimanual motor actions. Our study aimed to investigate altered bimanual motor performances in older women compared with younger women by focusing on kinetic and kinematic motor properties. Twenty-two older women and 22 younger women performed bimanual kinetic and kinematic motor tasks. To estimate bimanual kinetic functions, we calculated bimanual maximal voluntary contractions (i.e., MVC) and force control capabilities (i.e., mean force, accuracy, variability, and regularity of the total force produced by two hands) during bimanual hand-grip submaximal force control tasks. For bimanual kinematic performances, we assessed the scores of the Purdue Pegboard Test (i.e., PPT) in both hands and assembly tasks, respectively. For the bimanual MVC and PPT, we conducted an independent t-test between two groups. The bimanual force control capabilities were analyzed using two-way mixed ANOVAs (Group × Force Level; 2 × 2). Our findings revealed that the older women showed less bimanual MVC (p = 0.046) and submaximal force outputs (p = 0.036) and greater changes in bimanual force control capabilities as indicated by a greater force variability (p = 0.017) and regularity (p = 0.014). Further, the older women revealed lower scores of PPT in both the hands condition (p < 0.001) and assembly task condition (p < 0.001). The additional correlation analyses for the older women showed that lower levels of skeletal muscle mass were related to less bimanual MVC (r = 0.591; p = 0.004). Furthermore, a higher age was related to lower scores in the bimanual PPT assembly task (r = -0.427; p = 0.048). These findings suggested that older women experience greater changes in bimanual motor functions compared with younger women.

Afferent Loss, GABA, and Central Gain in Older Adults: Associations with Speech Recognition in Noise

Deficits in auditory nerve (AN) function for older adults reduce afferent input to the cortex. The extent to which the cortex in older adults adapts to this loss of afferent input and the mechanisms underlying this adaptation are not well understood. We took a neural systems approach measuring AN and cortical evoked responses within 50 older and 27 younger human adults (59 female) to estimate central gain or increased cortical activity despite reduced AN activity. Relative to younger adults, older adults' AN response amplitudes were smaller, but cortical responses were not. We used the relationship between AN and cortical response amplitudes in younger adults to predict cortical response amplitudes for older adults from their AN responses. Central gain in older adults was thus defined as the difference between their observed cortical responses and those predicted from the parameter estimates of younger adults. In older adults, decreased afferent input contributed to lower cortical GABA levels, greater central gain, and poorer speech recognition in noise (SIN). These effects on SIN occur in addition to, and independent from, effects attributed to elevated hearing thresholds. Our results are consistent with animal models of central gain and suggest that reduced AN afferent input in some older adults may result in changes in cortical encoding and inhibitory neurotransmission, which contribute to reduced SIN. An advancement in our understanding of the changes that occur throughout the auditory system in response to the gradual loss of input with increasing age may provide potential therapeutic targets for intervention.SIGNIFICANCE STATEMENT Age-related hearing loss is one of the most common chronic conditions of aging, yet little is known about how the cortex adapts to this loss of sensory input. We measured AN and cortical responses to the same stimulus in younger and older adults. In older adults we found hyperexcitability in cortical activity relative to concomitant declines in afferent input that are consistent with central gain. Lower levels of cortical GABA, an inhibitory neurotransmitter, were associated with greater central gain, which predicted poorer SIN. The results suggest that the cortex in older adults may adapt to attenuated sensory input by reducing inhibition to amplify the cortical response, but this amplification may lead to poorer SIN.

Bimanual motor impairments in older adults: an updated systematic review and meta-analysis

This updated systematic review and meta-analysis further examined potential effects of aging on bimanual movements. Forty-seven qualified studies that compared bimanual motor performances between elderly and younger adults were included in this meta-analysis. Moderator variable analyses additionally determined whether altered bimanual motor performances in older adults were different based on the task types (i.e., symmetry vs. asymmetry vs. complex) or outcome measures (i.e., accuracy vs. variability vs. movement time). The random effects model meta-analysis on 80 comparisons from 47 included studies revealed significant negative overall effects indicating more bimanual movement impairments in the elderly adults than younger adults. Moderator variable analyses found that older adults showed more deficits in asymmetrical bimanual movement tasks than symmetrical and complex tasks, and the bimanual movement impairments in the elderly adults included less accurate, more variable, and greater movement execution time than younger adults. These findings suggest that rehabilitation programs for improving motor actions in older adults are necessary to focus on functional recovery of interlimb motor control including advanced motor performances as well coordination.

The interaction between endogenous GABA, functional connectivity, and behavioral flexibility is critically altered with advanced age

The flexible adjustment of ongoing behavior challenges the nervous system’s dynamic control mechanisms and has shown to be specifically susceptible to age-related decline. Previous work links endogenous gamma-aminobutyric acid (GABA) with behavioral efficiency across perceptual and cognitive domains, with potentially the strongest impact on those behaviors that require a high level of dynamic control. Our analysis integrated behavior and modulation of interhemispheric phase-based connectivity during dynamic motor-state transitions with endogenous GABA concentration in adult human volunteers. We provide converging evidence for age-related differences in the preferred state of endogenous GABA concentration for more flexible behavior. We suggest that the increased interhemispheric connectivity observed in the older participants represents a compensatory neural mechanism caused by phase-entrainment in homotopic motor cortices. This mechanism appears to be most relevant in the presence of a less optimal tuning of the inhibitory tone as observed during healthy aging to uphold the required flexibility of behavioral action. Future work needs to validate the relevance of this interplay between neural connectivity and GABAergic inhibition for other domains of flexible human behavior.

An integrated analysis of GABA concentration, interhemispheric phase-based connectivity behavior and in healthy human participants revealed a task-specific association between GABA concentration and motor-cortical connectivity. These results shed light on how GABA is involved in neural oscillations and behavioral performance.

Across the adult lifespan the ipsilateral sensorimotor cortex negative BOLD response exhibits decreases in magnitude and spatial extent suggesting declining inhibitory control

Ipsilateral sensorimotor (iSM1) cortex negative BOLD responses (NBR) are observed to unilateral tasks and are thought to reflect a functionally relevant component of sensorimotor inhibition. Evidence suggests that sensorimotor inhibitory mechanisms degrade with age, along with aspects of motor ability and dexterity. However, understanding of age-related changes to NBR is restricted by limited comparisons between young vs old adults groups with relatively small samples sizes. Here we analysed a BOLD fMRI dataset (obtained from the CamCAN repository) of 581 healthy subjects, gender-balanced, sampled from the whole adult lifespan performing a motor response task to an audio-visual stimulus. We aimed to investigate how sensorimotor and default-mode NBR characteristics of magnitude, spatial extent and response shape alter at every decade of the aging process. A linear decrease in iSM1 NBR magnitude was observed across the whole lifespan whereas the contralateral sensorimotor (cSM1) PBR magnitude was unchanged. An age-related decrease in the spatial extent of NBR and an increase in the ipsilateral positive BOLD response (PBR) was observed. This occurred alongside an increasing negative correlation between subject's iSM1 NBR and cSM1 PBR magnitude, reflecting a change in the balance between cortical excitation and inhibition. Conventional GLM analysis, using a canonical haemodynamic response (HR) function, showed disappearance of iSM1 NBR in subjects over 50 years of age. However, a deconvolution analysis showed that the shape of the iSM1 HR altered throughout the lifespan, with delayed time-to-peak and decreased magnitude. The most significant decreases in iSM1 HR magnitude occurred in older age (>60 years) but the first changes in shape and timing occurred as early as 30 years, suggesting possibility of separate mechanisms underlying these alterations. Reanalysis using data-driven HRs for each decade detected significant sensorimotor NBR into late older age, showing the importance of taking changes in HR morphology into account in fMRI aging studies. These results may reflect fMRI measures of the age-related decreases in transcollosal inhibition exerted upon ipsilateral sensorimotor cortex and alterations to the excitatory-inhibitory balance in the sensorimotor network.

The role of MRS-assessed GABA in human behavioral performance

Understanding the neurophysiological mechanisms that drive human behavior has been a long-standing focus of cognitive neuroscience. One well-known neuro-metabolite involved in the creation of optimal behavioral repertoires is GABA, the main inhibitory neurochemical in the human brain. Converging evidence from both animal and human studies indicates that individual variations in GABAergic function are associated with behavioral performance. In humans, one increasingly used in vivo approach to measuring GABA levels is through Magnetic Resonance Spectroscopy (MRS). However, the implications of MRS measures of GABA for behavior remain poorly understood. In this respect, it is yet to be determined how GABA levels within distinct task-related brain regions of interest account for differences in behavioral performance. This review summarizes findings from cross-sectional studies that determined baseline MRS-assessed GABA levels and examined their associations with performance on various behaviors representing the perceptual, motor and cognitive domains, with a particular focus on healthy participants across the lifespan. Overall, the results indicate that MRS-assessed GABA levels play a pivotal role in various domains of behavior. Even though some converging patterns emerge, it is challenging to draw comprehensive conclusions due to differences in behavioral task paradigms, targeted brain regions of interest, implemented MRS techniques and reference compounds used. Across all studies, the effects of GABA levels on behavioral performance point to generic and partially independent functions that refer to distinctiveness, interference suppression and cognitive flexibility. On one hand, higher baseline GABA levels may support the distinctiveness of neural representations during task performance and better coping with interference and suppression of preferred response tendencies. On the other hand, lower baseline GABA levels may support a reduction of inhibition, leading to higher cognitive flexibility. These effects are task-dependent and appear to be mediated by age. Nonetheless, additional studies using emerging advanced methods are required to further clarify the role of MRS-assessed GABA in behavioral performance.

Neurophysiological modulations in the (pre)motor-motor network underlying age-related increases in reaction time and the role of GABA levels - a bimodal TMS-MRS study

It has been argued that age-related changes in the neurochemical and neurophysiological properties of the GABAergic system may underlie increases in reaction time (RT) in older adults. However, the role of GABA levels within the sensorimotor cortices (SMC) in mediating interhemispheric interactions (IHi) during the processing stage of a fast motor response, as well as how both properties explain interindividual differences in RT, are not yet fully understood. In this study, edited magnetic resonance spectroscopy (MRS) was combined with dual-site transcranial magnetic stimulation (dsTMS) for probing GABA+ levels in bilateral SMC and task-related neurophysiological modulations in corticospinal excitability (CSE), and primary motor cortex (M1)-M1 and dorsal premotor cortex (PMd)-M1 IHi, respectively. Both CSE and IHi were assessed during the preparatory and premotor period of a delayed choice RT task. Data were collected from 25 young (aged 18-33 years) and 28 older (aged 60-74 years) healthy adults. Our results demonstrated that older as compared to younger adults exhibited a reduced bilateral CSE suppression, as well as a reduced magnitude of long latency M1-M1 and PMd-M1 disinhibition during the preparatory period, irrespective of the direction of the IHi. Importantly, in older adults, the GABA+ levels in bilateral SMC partially accounted for task-related neurophysiological modulations as well as individual differences in RT. In contrast, in young adults, neither task-related neurophysiological modulations, nor individual differences in RT were associated with SMC GABA+ levels. In conclusion, this study contributes to a comprehensive initial understanding of how age-related differences in neurochemical properties and neurophysiological processes are related to increases in RT.

Brainstem Dysfunction in Healthy Aging

The brainstem controls sub-cortical and cortical activity and influences the processing of incoming information. The goal of this study was to characterize age related alterations of brainstem-brain interactions during different brain states detected by dynamic analysis of task-free fMRI. 79 young (20-40 years) and 51 older adults (55-80 years) were studied. Internal brainstem structures were segmented using a new multi-contrast segmentation approach. Brain and brainstem gray matter segmentations were warped onto a population template. The ICV-corrected Jacobian determinants were converted into z-score maps and the means from 420 cortical/subcortical/brainstem rois extracted. The fMRI was preprocessed in SPM12/Conn18 and the BOLD signal from 420 cortical/subcortical/brainstem rois extracted. A dynamic task-free analysis approach based on hierarchical cluster analysis was used to identify 15 brain states that were characterized using graph analysis (strength, diversity, modularity). Kruskal-Wallis tests and Spearman correlations were used for statistical analysis. One brain state (cluster 21) occurred more often in older adults (p=0.008). It was characterized by a lower mean modular strength and brainstem-cortical strength in older adults compared to younger adults. Global age related gray matter differences were positively correlated with brain state 21's modular strength. Furthermore, brain state 21 duration was negatively correlated with working memory (r = -0.28, p=0.002). The findings suggest an age related weakening of the within and between network synchronization at the brainstem level during brain state 21 in older adults that negatively affects cortical and subcortical synchronization and working memory performance.