[Presentation of an assessment battery for visual mental imagery and visual perception]

Visual mental imagery: Evidence for a heterarchical neural architecture

Theories of Visual Mental Imagery (VMI) emphasize the processes of retrieval, modification, and recombination of sensory information from long-term memory. Yet, only few studies have focused on the behavioral mechanisms and neural correlates supporting VMI of stimuli from different semantic domains. Therefore, we currently have a limited understanding of how the brain generates and maintains mental representations of colors, faces, shapes - to name a few. Such an undetermined scenario renders unclear the organizational structure of neural circuits supporting VMI, including the role of the early visual cortex. We aimed to fill this gap by reviewing the scientific literature of five semantic domains: visuospatial, face, colors, shapes, and letters imagery. Linking theory to evidence from over 60 different experimental designs, this review highlights three main points. First, there is no consistent activity in the early visual cortex across all VMI domains, contrary to the prediction of the dominant model. Second, there is consistent activity of the frontoparietal networks and the left hemisphere's fusiform gyrus during voluntary VMI irrespective of the semantic domain investigated. We propose that these structures are part of a domain-general VMI sub-network. Third, domain-specific information engages specific regions of the ventral and dorsal cortical visual pathways. These regions partly overlap with those found in visual perception studies (e.g., fusiform face area for faces imagery; lingual gyrus for color imagery). Altogether, the reviewed evidence suggests the existence of domain-general and domain-specific mechanisms of VMI selectively engaged by stimulus-specific properties (e.g., colors or faces). These mechanisms would be supported by an organizational structure mixing vertical and horizontal connections (heterarchy) between sub-networks for specific stimulus domains. Such a heterarchical organization of VMI makes different predictions from current models of VMI as reversed perception. Our conclusions set the stage for future research, which should aim to characterize the spatiotemporal dynamics and interactions among key regions of this architecture giving rise to visual mental images.

Colors in the mind's eye

The famous "Piazza del Duomo" paper, published in Cortex in 1978, inspired a considerable amount of research on visual mental imagery in brain-damaged patients. As a consequence, single-case reports featuring dissociations between perceptual and imagery abilities challenged the prevailing model of visual mental imagery. Here we focus on mental imagery for colors. A case study published in Cortex showed perfectly preserved color imagery in a patient with acquired achromatopsia after bilateral lesions at the borders between the occipital and temporal cortex. Subsequent neuroimaging findings in healthy participants extended and specified this result; color imagery elicited activation in both a domain-general region located in the left fusiform gyrus and the anterior color-biased patch within the ventral temporal cortex, but not in more posterior color-biased patches. Detailed studies of individual neurological patients, as those often published in Cortex, are still critical to inspire and constrain neurocognitive research and its theoretical models.

Probing the unimaginable: The impact of aphantasia on distinct domains of visual mental imagery and visual perception

Different individuals experience varying degrees of vividness in their visual mental images. The distribution of these variations across different imagery domains, such as object shape, color, written words, faces, and spatial relationships, remains unknown. To address this issue, we conducted a study with 117 healthy participants who reported different levels of imagery vividness. Of these participants, 44 reported experiencing absent or nearly absent visual imagery, a condition known as "aphantasia". These individuals were compared to those with typical (N = 42) or unusually vivid (N = 31) imagery ability. We used an online version of the French-language Battérie Imagination-Perception (eBIP), which consists of tasks tapping each of the above-mentioned domains, both in visual imagery and in visual perception. We recorded the accuracy and response times (RTs) of participants' responses. Aphantasic participants reached similar levels of accuracy on all tasks compared to the other groups (Bayesian repeated measures ANOVA, BF = .02). However, their RTs were slower in both imagery and perceptual tasks (BF = 266), and they had lower confidence in their responses on perceptual tasks (BF = 7.78e5). A Bayesian regression analysis revealed that there was an inverse correlation between subjective vividness and RTs for the entire participant group: higher levels of vividness were associated with faster RTs. The pattern was similar in all the explored domains. The findings suggest that individuals with congenital aphantasia experience a slowing in processing visual information in both imagery and perception, but the precision of their processing remains unaffected. The observed performance pattern lends support to the hypotheses that congenital aphantasia is primarily a deficit of phenomenal consciousness, or that it employs alternative strategies other than visualization to access preserved visual information.

A single case neuroimaging study of tickertape synesthesia

Reading acquisition is enabled by deep changes in the brain's visual system and language areas, and in the links subtending their collaboration. Disruption of those plastic processes commonly results in developmental dyslexia. However, atypical development of reading mechanisms may occasionally result in ticker-tape synesthesia (TTS), a condition described by Francis Galton in 1883 wherein individuals "see mentally in print every word that is uttered (…) as from a long imaginary strip of paper". While reading is the bottom-up translation of letters into speech, TTS may be viewed as its opposite, the top-down translation of speech into internally visualized letters. In a series of functional MRI experiments, we studied MK, a man with TTS. We showed that a set of left-hemispheric areas were more active in MK than in controls during the perception of normal than reversed speech, including frontoparietal areas involved in speech processing, and the Visual Word Form Area, an occipitotemporal region subtending orthography. Those areas were identical to those involved in reading, supporting the construal of TTS as upended reading. Using dynamic causal modeling, we further showed that, parallel to reading, TTS induced by spoken words and pseudowords relied on top-down flow of information along distinct lexical and phonological routes, involving the middle temporal and supramarginal gyri, respectively. Future studies of TTS should shed new light on the neurodevelopmental mechanisms of reading acquisition, their variability and their disorders.

Subtitled speech: Phenomenology of tickertape synesthesia

With effort, most literate persons can conjure more or less vague visual mental images of the written form of words they are hearing, an ability afforded by the links between sounds, meaning, and letters. However, as first reported by Francis Galton, persons with ticker-tape synesthesia (TTS) automatically perceive in their mind's eye accurate and vivid images of the written form of all utterances which they are hearing. We propose that TTS results from an atypical setup of the brain reading system, with an increased top-down influence of phonology on orthography. As a first descriptive step towards a deeper understanding of TTS, we identified 26 persons with TTS. Participants had to answer to a questionnaire aiming to describe the phenomenology of TTS along multiple dimensions, including visual and temporal features, triggering stimuli, voluntary control, interference with language processing, etc. We also assessed the synesthetic percepts elicited experimentally by auditory stimuli such as non-speech sounds, pseudowords, and words with various types of correspondence between sounds and letters. We discuss the potential cerebral substrates of those features, argue that TTS may provide a unique window in the mechanisms of written language processing and acquisition, and propose an agenda for future research.

The connectional anatomy of visual mental imagery: evidence from a patient with left occipito-temporal damage

Most of us can use our "mind's eye" to mentally visualize things that are not in our direct line of sight, an ability known as visual mental imagery. Extensive left temporal damage can impair patients' visual mental imagery experience, but the critical locus of lesion is unknown. Our recent meta-analysis of 27 fMRI studies of visual mental imagery highlighted a well-delimited region in the left lateral midfusiform gyrus, which was consistently activated during visual mental imagery, and which we called the Fusiform Imagery Node (FIN). Here, we describe the connectional anatomy of FIN in neurotypical participants and in RDS, a right-handed patient with an extensive occipito-temporal stroke in the left hemisphere. The stroke provoked right homonymous hemianopia, alexia without agraphia, and color anomia. Despite these deficits, RDS had normal subjective experience of visual mental imagery and reasonably preserved behavioral performance on tests of visual mental imagery of object shape, object color, letters, faces, and spatial relationships. We found that the FIN was spared by the lesion. We then assessed the connectional anatomy of the FIN in the MNI space and in the patient's native space, by visualizing the fibers of the inferior longitudinal fasciculus (ILF) and of the arcuate fasciculus (AF) passing through the FIN. In both spaces, the ILF connected the FIN with the anterior temporal lobe, and the AF linked it with frontal regions. Our evidence is consistent with the hypothesis that the FIN is a node of a brain network dedicated to voluntary visual mental imagery. The FIN could act as a bridge between visual information and semantic knowledge processed in the anterior temporal lobe and in the language circuits.

Testing the therapeutic effects of transcranial direct current stimulation (tDCS) in semantic dementia: a double blind, sham controlled, randomized clinical trial

BACKGROUND

Semantic dementia is a neurodegenerative disease that primarily affects the left anterior temporal lobe, resulting in a gradual loss of conceptual knowledge. There is currently no validated treatment. Transcranial stimulation has provided evidence for long-lasting language effects presumably linked to stimulation-induced neuroplasticity in post-stroke aphasia. However, studies evaluating its effects in neurodegenerative diseases such as semantic dementia are still rare and evidence from double-blind, prospective, therapeutic trials is required.

OBJECTIVE

The primary objective of the present clinical trial (STIM-SD) is to evaluate the therapeutic efficacy of a multiday transcranial direct current stimulation (tDCS) regime on language impairment in patients with semantic dementia. The study also explores the time course of potential tDCS-driven improvements and uses imaging biomarkers that could reflect stimulation-induced neuroplasticity.

METHODS

This is a double-blind, sham-controlled, randomized study using transcranial Direct Current Stimulation (tDCS) applied daily for 10 days, and language/semantic and imaging assessments at four time points: baseline, 3 days, 2 weeks and 4 months after 10 stimulation sessions. Language/semantic assessments will be carried out at these same 4 time points. Fluorodeoxyglucose positron emission tomography (FDG-PET), resting-state functional magnetic resonance imaging (rs-fMRI), T1-weighted images and white matter diffusion tensor imaging (DTI) will be applied at baseline and at the 2-week time point. According to the principle of inter-hemispheric inhibition between left (language-related) and right homotopic regions we will use two stimulation modalities - left-anodal and right-cathodal tDCS over the anterior temporal lobes. Accordingly, the patient population (n = 60) will be subdivided into three subgroups: left-anodal tDCS (n = 20), right-cathodal tDCS (n = 20) and sham tDCS (n = 20). The stimulation will be sustained for 20 min at an intensity of 1.59 mA. It will be delivered through 25cm²-round stimulation electrodes (current density of 0.06 mA/cm²) placed over the left and right anterior temporal lobes for anodal and cathodal stimulation, respectively. A group of healthy participants (n = 20) matched by age, gender and education will also be recruited and tested to provide normative values for the language/semantic tasks and imaging measures.

DISCUSSION

The aim of this study is to assess the efficacy of tDCS for language/semantic disorders in semantic dementia. A potential treatment would be easily applicable, inexpensive, and renewable when therapeutic effects disappear due to disease progression.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03481933. Registered on March 2018.

Benefits from an autobiographical memory facilitation programme in relapsing-remitting multiple sclerosis patients: a clinical and neuroimaging study

While the efficacy of mental visual imagery (MVI) to alleviate autobiographical memory (AM) impairment in multiple sclerosis (MS) patients has been documented, nothing is known about the brain changes sustaining that improvement. To explore this issue, 20 relapsing-remitting MS patients showing AM impairment were randomly assigned to two groups, experimental (n = 10), who underwent the MVI programme, and control (n = 10), who followed a sham verbal programme. Besides the stringent AM assessment, the patients underwent structural and functional MRI sessions, consisting in retrieving personal memories, within a pre-/post-facilitation study design. Only the experimental group showed a significant AM improvement in post-facilitation, accompanied by changes in brain activation (medial and lateral frontal regions), functional connectivity (posterior brain regions), and grey matter volume (parahippocampal gyrus). Minor activations and functional connectivity changes were observed in the control group. The MVI programme improved AM in MS patients leading to functional and structural changes reflecting (1) an increase reliance on brain regions sustaining a self-referential process; (2) a decrease of those reflecting an effortful research process; and (3) better use of neural resources in brain regions sustaining MVI. Functional changes reported in the control group likely reflected ineffective attempts to use the sham strategy in AM.

Effectiveness of a specific cueing method for improving autobiographical memory recall in patients with schizophrenia

Autobiographical memory deficits in schizophrenia have a significant impact on patients' daily life. Our study was aimed at testing the effectiveness of a specific cueing (SC) method for improving autobiographical memory recall in patients with schizophrenia, particularly the phenomenological details of their memories. Twenty-five patients with schizophrenia and 25 comparison participants took part in the study. They recalled 6 specific autobiographical events which occurred during 3 different life periods. After each memory recall, participants were given a general cue which allowed them to add further information to their narration. The SC was then applied by means of a series of specific questions to elicit more precise memory detail. The overall memory specificity as well as the number and richness of 5 categories of memory detail (perceptual/sensory, temporal, contextual, emotional, and cognitive) were assessed before and after the SC phase. Before SC, patients' memories were less specific and less detailed. SC had a beneficial effect on patients' memory recall. The overall memory specificity of patients improved. The gain in the number and richness of memory details was comparable between patients and comparison participants. The difference between groups in terms of the number of memory details was not significant. Richness of details was still lower in patients, except for emotional and cognitive details, which were similarly rich in both groups. The cueing method reduces the autobiographical memory impairment of patients with schizophrenia and paves the way for developing specific cognitive remediation therapies to help patients in their daily life.

Induced brain plasticity after a facilitation programme for autobiographical memory in multiple sclerosis: a preliminary study

This preliminary study tackles the assessment and treatment of autobiographical memory (AbM) in relapsing-remitting multiple sclerosis (RR-MS) patients. Our aim was to investigate cerebral activation changes, following clinical improvement of AbM due to a cognitive training based on mental visual imagery (MVI). We assessed AbM using the Autobiographical Interview (AI) in eight patients and 15 controls. The latter subjects established normative data. The eight patients showed selective defective performance on the AI. Four patients were trained cognitively and underwent pre- and post-AI and fMRI. The remaining four patients took a second AI, at the same interval, but with no intervention in between. Results showed a significant improvement of AbM performance after the facilitation programme that could not be explained by learning effects since the AI scores remained stable between the two assessments in the second group of patients. As expected, AbM improvement was accompanied by an increased cerebral activity in posterior cerebral regions in post-facilitation fMRI examination. We interpret this activation changes in terms of reflecting the emphasis made on the role of MVI in memory retrieval through the facilitation programme. These preliminary significant clinical and neuroimaging changes suggest the beneficial effects of this technique to alleviate AbM retrieval deficit in MS patients.

Colour, face, and visuospatial imagery abilities in low-vision individuals with visual field deficits

This study investigates to what extent visual perception integrity is necessary for visual mental imagery. Sixteen low-vision participants with severe peripheral visual field loss, 16 with severe central field loss, 6 left brain-damaged patients with right homonymous hemianopia, 6 right brain-damaged patients with left homonymous hemianopia, and 16 normally sighted controls performed perceptual and imagery tasks using colours, faces, and spatial relationships. Results showed that (a) the perceptual and mental image>ry disorders vary according to the type of visual field loss, (b) hemianopics had no more difficulties imagining spatial stimuli in their contralesional hemispace than in their ipsilesional one, and (c) the only hemianopic participant to have perceptual and mental imagery impairments suffered from attentional deficits. Results suggest that (a) visual memory is not definitively established, but rather needs perceptual practice to be maintained, and (b) that visual mental imagery may involve some of the attentional-exploratory mechanisms that are employed in visual behaviour.

Vocal response times to real and imagined stimuli in spatial neglect: A group study and single-case report

The relationships between spatial neglect for perceptual objects and representational for imagined items are difficult to explore because of several methodological problems, including the dearth of comparable tests for real and imagined scenes. We asked 19 patients with right brain damage and 12 healthy controls to say whether an auditorily presented French geographical location was left or right of Paris, and recorded their vocal response times. Afterwards, participants performed a similar test with visually presented items. Although several patients had asymmetries of performance on the perceptual version of the test, only one patient was more accurate for right-sided than for left-sided imagined stimuli, thus showing evidence for imaginal neglect. However, this patient performed normally on place description and on mental number line bisection, perhaps as a consequence of different strategies he employed for these tasks. Overall, our results confirm previous evidence showing that imaginal neglect is less frequent than, and often occurs in association with, perceptual neglect. Imaginal neglect may result from the contribution of deficits partly distinct from those implicated in perceptual neglect, such as impaired endogenous orienting of attention or deficits of spatial working memory.