The dual-loop model for combining external and internal worlds in our brain

Inferring the 'functions' of tracts: a cautionary note

This scientific commentary refers to ‘The inferior fronto-occipital fasciculus: bridging phylogeny, ontogeny and functional anatomy’ by Giampiccolo et al. (https://doi.org/10.1093/brain/awaf055).

The inferior fronto-occipital fasciculus: bridging phylogeny, ontogeny and functional anatomy

The inferior-fronto-occipital fasciculus (IFOF) is a long-range white matter tract that connects the prefrontal cortex with parietal, posterior temporal and occipital cortices. First identified in the 19th century through the pioneering studies of Mayo and Meynert using blunt dissection, its anatomy and function remain contentious topics. Structurally, its projections are well documented in human blunt dissection and tractography literature, yet its existence has been questioned by tract-tracing studies in macaques. Functionally, while traditional results from direct white matter stimulation during awake surgery suggested a contribution to language, recent evidence from stimulation and lesion data may indicate a broader role in executive control, extending to attention, motor cognition, memory, reading, emotion recognition and theory of mind. This review begins by examining anatomical evidence suggesting that the IFOF evolved in non-human primates to connect temporal and occipital cortices to prefrontal regions involved in context-dependent selection of visual features for action. We then integrate developmental, electrophysiological, functional and anatomical evidence for the human IFOF to propose it has a similar role in manipulation of visual features in our species-particularly when inhibition of overriding but task-irrelevant stimuli is required to prioritize a second, task-relevant stimulus. Next, we introduce a graded model in which dorsal (orbitofrontal, superior and middle frontal to precuneal, angular and supero-occipital projections) and ventral (inferior frontal to posterotemporal, basal temporal and infero-occipital) projections of the IFOF support perceptual or conceptual control of visual representations for action, respectively. Leveraging this model, we address controversies in the current literature regarding language, motor cognition, attention and emotion under the unifying view of cognitive control. Finally, we discuss surgical implications for this model and its impact on predicting and preventing neurological deficits in neurosurgery.

Hubs and interaction: the brain's meta-loop

We must reconcile the needs of the internal world and the demands of the external world to make decisions relevant to homeostasis, well-being, and flexible behavior. Engagement with the internal (eg interoceptive) world is linked to medial brain systems, whereas the extrapersonal space (eg exteroceptive) is associated with lateral brain systems. Using Human Connectome Project data, we found three association tracts connecting the action-related frontal lobe with perception-related posterior lobes. A lateral dorsal tract and a medial dorsal tract interact independently with a ventral tract at frontal and posterior hubs. The two frontal and the two posterior hubs are interconnected, forming a meta-loop that integrates lateral and medial brain systems. The four anatomical hubs correspond to the common nodes of the intrinsic cognitive brain networks such as the default mode network. These functional networks depend on the integration of both realms. Thus, the positioning of functional cognitive networks can be understood as the intersection of long anatomical association tracts. The strength of structural connectivity within lateral and medial brain systems correlates with performance on behavioral tests assessing theory of mind. The meta-loop provides an anatomical framework to associate neurological and psychiatric symptoms with functional and structural changes.

Mechanical and semantic knowledge mediate the implicit understanding of the physical world

Most recent accounts highlight the importance of two aspects of cognition in the implicit understanding of the physical world: semantic knowledge (the ability to recognize, categorize, and relate concepts) and mechanical knowledge (the capability to comprehend how things mechanically work). However, how the human brain may integrate these cognitive processes remains largely unexplored. Here, we use functional magnetic resonance imaging to investigate this integration employing a novel free-viewing task. Participants viewed images depicting object-tool pairs that were either mechanically consistent (e.g., nail - steel hammer) or mechanically inconsistent (e.g., scarf - steel hammer). These pairs were situated on a metal plate atop a table, with a stripped electrical cable in contact with the plate that could be plugged in or out from the electrical line, rendering the tools either electrified or not. Task-based functional connectivity revealed an interplay among specific left-brain regions - the middle temporal (MTG), inferior frontal (IFG), and supramarginal (SMG) gyri - during the processing of mechanical actions and physics principles, associating the activity of these areas with mechanical knowledge (SMG) and object-related semantic knowledge (MTG). Notably, the IFG was active during both types of processing, suggesting a critical role of this region in multi-modal information integration. These findings support the most recent integrated neurocognitive models of physical understanding, deepening our comprehension of how we make sense of the physical world.

Two distinct neural pathways for mechanical versus digital technology

Technology pervades every aspect of our lives, making it crucial to investigate how the human mind deals with it. Here we examine the cognitive and neural foundations of technological cognition. In the first fMRI experiment, participants viewed videos depicting the use of mechanical tools (e.g., a screwdriver) and digital tools (e.g., a smartphone) compared to simple object movements. Results revealed a key dissociation: mechanical tools extensively activated the dorsal and ventro-dorsal visual streams, which are motor- and action-oriented brain systems. Conversely, digital tools largely engaged the ventral visual stream, associated with conceptual and social cognition. A second behavioral experiment showed a pronounced tendency to anthropomorphize digital tools. A third experiment involving a priming task confirmed that digital tools activate the social brain. The discovery of two different neurocognitive systems for mechanical versus digital technology offers new insights into human-technology interaction and its implications for the evolution of the human mind.

Apraxia: From Neuroanatomical Pathways to Clinical Manifestations

PURPOSE OF REVIEW

Apraxia typically involves impairments in gesture production and tool use, affecting daily life activities. This article reviews current conceptualizations and developments in diagnostic and therapy.

RECENT FINDINGS

Apraxia has been studied in various neurological conditions, particularly stroke and dementia, but recent studies show gesturing deficits in psychiatric populations as well. Promising results have emerged from integrative treatment approaches involving intensive practice of gestures or daily activities. However, several reviews have noted the only marginal progress in apraxia therapy research despite new technologies, like virtual reality and brain stimulation, offering fresh opportunities for assessment and therapy. Advances in lesion-symptom mapping and connectivity analyses led to more detailed neuroanatomical models emphasizing parallel and gradual processing. These models facilitate the understanding of underlying mechanisms of motor cognitive performance and its decline. Finally, the digital era prompts the need to study digital tool use in apraxia, with initial efforts underway.

Cerebral Glucose Metabolism Is a Valuable Predictor of Survival in Patients with Lewy Body Diseases

OBJECTIVE

Patients with Lewy body diseases have an increased risk of dementia, which is a significant predictor for survival. Posterior cortical hypometabolism on [18F]fluorodeoxyglucose positron emission tomography (PET) precedes the development of dementia by years. We therefore examined the prognostic value of cerebral glucose metabolism for survival.

METHODS

We enrolled patients diagnosed with Parkinson's disease (PD), Parkinson's disease with dementia, or dementia with Lewy bodies who underwent [18F]fluorodeoxyglucose PET. Regional cerebral metabolism of each patient was analyzed by determining the expression of the PD-related cognitive pattern (Z-score) and by visual PET rating. We analyzed the predictive value of PET for overall survival using Cox regression analyses (age- and sex-corrected) and calculated prognostic indices for the best model.

RESULTS

Glucose metabolism was a significant predictor of survival in 259 included patients (n = 118 events; hazard ratio: 1.4 [1.2-1.6] per Z-score; hazard ratio: 1.8 [1.5-2.2] per visual PET rating score; both p < 0.0001). Risk stratification with visual PET rating scores yielded a median survival of 4.8, 6.8, and 12.9 years for patients with severe, moderate, and mild posterior cortical hypometabolism (median survival not reached for normal cortical metabolism). Stratification into 5 groups based on the prognostic index revealed 10-year survival rates of 94.1%, 78.3%, 34.7%, 0.0%, and 0.0%.

INTERPRETATION

Regional cerebral glucose metabolism is a significant predictor of survival in Lewy body diseases and may allow an earlier survival prediction than the clinical milestone "dementia." Thus, [18F]fluorodeoxyglucose PET may improve the basis for therapy decisions, especially for invasive therapeutic procedures like deep brain stimulation in Parkinson's disease. ANN NEUROL 2024;96:539-550.

Time to bury the chisel: a continuous dorsal association tract system

The arcuate fasciculus may be subdivided into a tract directly connecting frontal and temporal lobes and a pair of indirect subtracts in which the fronto-temporal connection is mediated by connections to the inferior parietal lobe. This tripartition has been advanced as an improvement over the centuries-old consensus that the lateral dorsal association fibers form a continuous system with no discernible discrete parts. Moreover, it has been used as the anatomical basis for functional hypotheses regarding linguistic abilities. Ex hypothesi, damage to the indirect subtracts leads to deficits in the repetition of multi-word sequences, whereas damage to the direct subtract leads to deficits in the immediate reproduction of single multisyllabic words. We argue that this partitioning of the dorsal association tract system enjoys no special anatomical status, and the search for the anatomical substrates of linguistic abilities should not be constrained by it. Instead, the merit of any postulated partitioning should primarily be judged on the basis of whether it enlightens or obfuscates our understanding of the behavior of patients in which individual subtracts are damaged.

Dissection of the Temporofrontal Extreme Capsule Fasciculus Using Diffusion MRI Tractography and Association with Lexical Retrieval

The well-known arcuate fasciculus that connects the posterior superior temporal region with the language production region in the ventrolateral frontal cortex constitutes the classic peri-Sylvian dorsal stream of language. A second temporofrontal white matter tract connects ventrally the anterior to intermediate lateral temporal cortex with frontal areas via the extreme capsule. This temporofrontal extreme capsule fasciculus (TFexcF) constitutes the ventral stream of language processing. The precise origin, course, and termination of this pathway has been examined in invasive tract tracing studies in macaque monkeys, but there have been no standard protocols for its reconstruction in the human brain using diffusion imaging tractography. Here we provide a protocol for the dissection of the TFexcF in vivo in the human brain using diffusion magnetic resonance imaging (MRI) tractography which provides a solid basis for exploring its functional role. A key finding of the current dissection protocol is the demonstration that the TFexcF is left hemisphere lateralized. Furthermore, using the present dissection protocol, we demonstrate that the TFexcF is related to lexical retrieval scores measured with the category fluency test, in contrast to the classical arcuate fasciculus (the dorsal language pathway) that was also dissected and was related to sentence repetition.

Understanding the concept of a novel tool requires interaction of the dorsal and ventral streams

The left hemisphere tool-use network consists of the dorso-dorsal, ventro-dorsal, and ventral streams, each with distinct computational abilities. In the dual-loop model, the ventral pathway through the extreme capsule is associated with conceptual understanding. We performed a learning experiment with fMRI to investigate how these streams interact when confronted with novel tools. In session one, subjects observed pictures and video sequences in real world action of known and unknown tools and were asked whether they knew the tools and whether they understood their function. In session two, video sequences of unknown tools were presented again, followed again by the question of understanding their function. Different conditions were compared to each other and effective connectivity (EC) in the tool-use network was examined. During concept acquisition of an unknown tool, EC between dorsal and ventral streams was found posterior in fusiform gyrus and anterior in inferior frontal gyrus, with a functional interaction between BA44d and BA45. When previously unknown tools were presented for a second time, EC was prominent only between dorsal stream areas. Understanding the concept of a novel tool requires an interaction of the ventral stream with the dorsal streams. Once the concept is acquired, dorsal stream areas are sufficient.

Should concepts of brain functions be based on psychology or anatomy? An echo from Kurt Goldstein

This scientific commentary refers to ‘Joint impact on attention, alertness and inhibition of lesions at a frontal white matter crossroad’ by Kaufmann et al. (https://doi.org/10.1093/brain/awac359).

Speaking in gestures: Left dorsal and ventral frontotemporal brain systems underlie communication in conducting

Conducting constitutes a well-structured system of signs anticipating information concerning the rhythm and dynamic of a musical piece. Conductors communicate the musical tempo to the orchestra, unifying the individual instrumental voices to form an expressive musical Gestalt. In a functional magnetic resonance imaging (fMRI) experiment, 12 professional conductors and 16 instrumentalists conducted real-time novel pieces with diverse complexity in orchestration and rhythm. For control, participants either listened to the stimuli or performed beat patterns, setting the time of a metronome or complex rhythms played by a drum. Activation of the left superior temporal gyrus (STG), supplementary and premotor cortex and Broca's pars opercularis (F3op) was shared in both musician groups and separated conducting from the other conditions. Compared to instrumentalists, conductors activated Broca's pars triangularis (F3tri) and the STG, which differentiated conducting from time beating and reflected the increase in complexity during conducting. In comparison to conductors, instrumentalists activated F3op and F3tri when distinguishing complex rhythm processing from simple rhythm processing. Fibre selection from a normative human connectome database, constructed using a global tractography approach, showed that the F3op and STG are connected via the arcuate fasciculus, whereas the F3tri and STG are connected via the extreme capsule. Like language, the anatomical framework characterising conducting gestures is located in the left dorsal system centred on F3op. This system reflected the sensorimotor mapping for structuring gestures to musical tempo. The ventral system centred on F3Tri may reflect the art of conductors to set this musical tempo to the individual orchestra's voices in a global, holistic way.