The functional neuroanatomy of multitasking: combining dual tasking with a short term memory task

The Effect of a Cognitive Dual Task on Gait Parameters among Healthy Young Adults with Good and Poor Sleep Quality: A Cross-Sectional Analysis

Background: Sleep quality is known to affect automatic and executive brain functions such as gait control and cognitive processing. This study aimed to investigate the effect of dual tasks on gait spatiotemporal parameters among young adults with good and poor sleep quality. Methods: In total, 65 young adults with a mean age of 21.1 ± 2.5 were assessed for gait analysis during single-task and dual-task conditions. The participants' sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and gait was assessed using the BTS Gaitlab System. The participants were asked to walk at natural speed as a single-task condition, followed by walking while performing a cognitive task as a dual-task condition. The parameters assessed included the gait velocity (m/s), cadence (steps/min), step width (m), and stride length (m). The dual-task cost (DTC) on each gait parameter was calculated. The Mann-Whitney U test was used to compare the differences in the DTC on gait variables between the good and poor sleep quality groups and the Spearman correlation test was used to assess the correlation between total PSQI scores and the DTC. Results: At a significance level of p < 0.05, a significant difference in cadence between the two sleep quality groups was observed, in addition to a positive correlation between sleep quality and the DTC effect on gait mean velocity, cadence, and stride length. Our findings also revealed a greater DTC in participants with poorer sleep quality. Conclusions: These findings contribute to our perception of the significance of sleep quality in gait performance while multitasking in younger populations.

The effect of transcranial direct current stimulation associated with video game training on the postural balance of older women in the community: A blind, randomized, clinical trial

BACKGROUND

Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied.

PURPOSE

To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women.

METHOD

A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test.

RESULTS

Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001).

CONCLUSION

There was an improvement in the postural balance of the three training groups that were independent of tDCS.

DISCUSSION

Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.

Disturbance of information in superior parietal lobe during dual-task interference in a simulated driving task

Performing a secondary task while driving causes a decline in driving performance. This phenomenon, called dual-task interference, can have lethal consequences. Previous fMRI studies have looked at the changes in the average brain activity to uncover the neural correlates of dual-task interference. From these results, it is unclear whether the overall modulations in brain activity result from general effects such as task difficulty, attentional modulations, and mental effort or whether it is caused by a change in the responses specific to each condition due to dual-task interference. To overcome this limitation, here, we used multi-voxel pattern analysis (MVPA) to interrogate the change in the information content in multiple brain regions during dual-task interference in simulated driving. Participants performed a lane-change task in a simulated driving environment, along with a tone discrimination task with either short or long onset time difference (Stimulus Onset Asynchrony, SOA) between the two tasks. Behavioral results indicated a robust dual-task effect on lane-change reaction time (RT). MVPA revealed regions that carry information about the driving lane-change direction (shift right/shift left), including the superior parietal lobe (SPL), visual, and motor regions. Comparison of decoding accuracies across SOA conditions in the SPL region revealed lower accuracy in the short compared to the long SOA condition. This change in accuracy was not observed in the visual and motor regions. These findings suggest that the dual-task interference in driving may be related to the disturbance of information processing in the SPL region.

Brain functional characterization of response-code conflict in dual-tasking and its modulation by age

Crosstalk between conflicting response codes contributes to interference in dual-tasking, an effect exacerbated in advanced age. Here, we investigated (i) brain activity correlates of such response-code conflicts, (ii) activity modulations by individual dual-task performance and related cognitive abilities, (iii) task-modulated connectivity within the task network, and (iv) age-related differences in all these aspects. Young and older adults underwent fMRI while responding to the pitch of tones through spatially mapped speeded button presses with one or two hands concurrently. Using opposing stimulus-response mappings between hands, we induced conflict between simultaneously activated response codes. These response-code conflicts elicited activation in key regions of the multiple-demand network. While thalamic and parietal areas of the conflict-related network were modulated by attentional, working-memory and task-switching abilities, efficient conflict resolution in dual-tasking mainly relied on increasing supplementary motor activity. Older adults showed non-compensatory hyperactivity in left superior frontal gyrus, and higher right premotor activity was modulated by working-memory capacity. Finally, connectivity between premotor or parietal seed regions and the conflict-sensitive network was neither conflict-specific nor age-sensitive. Overall, resolving dual-task response-code conflict recruited substantial parts of the multiple-demand network, whose activity and coupling, however, were only little affected by individual differences in task performance or age.

Immediate and short-term effects of single-task and motor-cognitive dual-task on executive function

OBJECTIVES

Executive function plays an important role in our daily life and can be affected by both single task (acute aerobic exercise or cognitive training) and dual-task (acute motor-cognitive training) interventions. Here we explored the immediate and short-term effect on executive function to texted whether dual-task interventions are more effective at promoting executive function.

METHODS

Forty-six young men were recruited (mean age: 20.65 years) and assigned randomly to aerobic exercise (n = 15), cognitive training (n = 15), or dual-task (n = 16) groups. Executive functions were assessed before, immediately after, and 30 min after intervention using Go/No-go, 2-back, and More-Odd-Shifting tests.

RESULTS

Working memory function improved after all three interventions (significant Time effect, F(2,86) = 7.05, p = 0.001). Performance on the 2-back test was significantly better immediately after dual-task intervention (p = 0.038) and the response time was shorter (p = 0.023). Performance on the More-Odd-Shifting test improved over time (significant Time effect, F(2,86) = 30.698, p = 0.01), both immediately after the dual-task intervention (p = 0.015), and 30 min later (p = 0.001). Shifting-test performance was also better immediately after (p = 0.005) and 30 min after (p < 0.001) aerobic exercise.

CONCLUSION

Executive function was enhanced by single-task (acute aerobic exercise or cognitive training) and dual-task interventions. The effect continued for 30 min after both the single-task aerobic exercise and the dual-task intervention. For short-term intervention, the dual-task was not more effective than either of the single tasks.

Individual differences in everyday multitasking behavior and its relation to cognition and personality

Our ability to multitask-focus on multiple tasks simultaneously-is one of the most critical functions of our cognitive system. This capability has shown to have relations to cognition and personality in empirical studies, which have received much attention recently. This review article integrates the available findings to examine how individual differences in multitasking behavior are linked with different cognitive constructs and personality traits to conceptualize what multitasking behavior represents. In this review, we highlight the methodological differences and theoretical conceptions. Cognitive constructs including executive functions (i.e., shifting, updating, and inhibition), working memory, relational integration, divided attention, reasoning, and prospective memory were investigated. Concerning personality, the traits of polychronicity, impulsivity, and the five-factor model were considered. A total of 43 studies met the inclusion criteria and entered the review. The research synthesis directs us to propose two new conceptual models to explain multitasking behavior as a psychometric construct. The first model demonstrates that individual differences in multitasking behavior can be explained by cognitive abilities. The second model proposes that personality traits constitute a moderating effect on the relation between multitasking behavior and cognition. Finally, we provide possible future directions for the line of research.

Workflow interruption and nurses' mental workload in electronic health record tasks: An observational study

BACKGROUND

Workflow interruptions are common in modern work systems. Electronic health record (EHR) tasks are typical tasks involving human-machine interactions in nursing care, but few studies have examined interruptions and nurses' mental workload in the tasks. Therefore, this study aims to investigate how frequent interruptions and multilevel factors affect nurses' mental workload and performance in EHR tasks.

METHODS

A prospective observational study was conducted in a tertiary hospital providing specialist and sub-specialist care from June 1^st to October 31^st, 2021. An observer documented nurses' EHR task interruptions, reactions and performance (errors and near errors) during one-shift observation sessions. Questionnaires were administered at the end of the electronic health record task observation to measure nurses' mental workload for the electronic health record tasks, task difficulty, system usability, professional experience, professional competency, and self-efficacy. Path analysis was used to test a hypothetical model.

RESULTS

In 145 shift observations, 2871 interruptions occurred, and the mean task duration was 84.69 (SD 56.68) minutes per shift. The incidence of error or near error was 158, while 68.35% of errors were self-corrected. The total mean mental workload level was 44.57 (SD 14.08). A path analysis model with adequate fit indices is presented. There was a relationship among concurrent multitasking, task switching and task time. Task time, task difficulty and system usability had direct effects on mental workload. Task performance was influenced by mental workload and professional title. Negative affect mediated the path from task performance to mental workload.

CONCLUSIONS

Nursing interruptions occur frequently in EHR tasks, come from different sources and may lead to elevated mental workload and negative outcomes. By exploring the variables related to mental workload and performance, we offer a new perspective on quality improvement strategies. Reducing harmful interruptions to decrease task time can avoid negative outcomes. Training nurses to cope with interruptions and improve competency in EHR implementation and task operation has the potential to decrease nurses' mental workload and improve task performance. Moreover, improving system usability is beneficial to nurses to mitigate mental workload.

Mixed emotions to social situations: An fMRI investigation

BACKGROUND

Neuroscience research has generally studied emotions each taken in isolation. However, mixed emotional states (e.g., the co-occurrence of amusement and disgust, or sadness and pleasure) are common in everyday life. Psychophysiological and behavioral evidence suggests that mixed emotions may have response profiles that are distinguishable from their constituent emotions. Yet, the brain bases of mixed emotions remain unresolved.

METHODS

We recruited 38 healthy adults who viewed short, validated film clips, eliciting either positive (amusing), negative (disgusting), neutral, or mixed (a mix of amusement and disgust) emotional states, while brain activity was assessed by functional magnetic resonance imaging (fMRI). We assessed mixed emotions in two ways: first by comparing neural reactivity to ambiguous (mixed) with that to unambiguous (positive and negative) film clips and second by conducting parametric analyses to measure neural reactivity with respect to individual emotional states. We thus obtained self-reports of amusement and disgust after each clip and computed a minimum feeling score (shared minimum of amusement and disgust) to quantify mixed emotional feelings.

RESULTS

Both analyses revealed a network of the posterior cingulate (PCC), medial superior parietal lobe (SPL)/precuneus, and parieto-occipital sulcus to be involved in ambiguous contexts eliciting mixed emotions.

CONCLUSION

Our results are the first to shed light on the dedicated neural processes involved in dynamic social ambiguity processing. They suggest both higher-order (SPL) and lower-order (PCC) processes may be needed to process emotionally complex social scenes.

Abnormal brain activities in multiple frequency bands in Parkinson's disease with apathy

Background

Apathy is among the most prevalent and incapacitating non-motor symptoms of Parkinson's disease (PD). PD patients with apathy (PD-A) have been reported to have abnormal spontaneous brain activity mainly in 0.01-0.08 Hz. However, the frequency-dependence of brain activity in PD-A remains unclear. Therefore, this study aimed to examine whether abnormalities in PD-A are associated with specific frequency bands.

Materials and methods

Overall, 28 patients with PD-A, 19 PD patients without apathy (PD-NA), and 32 gender-, age-matched healthy controls (HCs) were enrolled. We collected resting-state functional magnetic resonance imaging (rs-fMRI) data, demographic information, and neuropsychological assessments, including apathy, depression, anxiety and cognitive function for every participant. The amplitude of low-frequency fluctuation (ALFF), fractional amplitude of low-frequency fluctuation (fALFF), percent amplitude of fluctuation (PerAF), regional homogeneity (ReHo), and degree centrality (DC) were calculated in the conventional (0.01-0.08 Hz), slow-4 (0.027-0.073 Hz), and slow-5 (0.01-0.027 Hz) frequency bands based on statistical parametric mapping (SPM12) and RESTplus V1.25. Two-sample t-tests were performed to compare the differences among the three groups.

Results

PD-A reduced ALFF in the right anterior cingulate gyri in the slow-5 band and decreased fALFF in the right middle frontal gyrus in the conventional band, compared to patients with PD-NA. However, PerAF, ReHo, and DC could not distinguish PD-A from PD-NA in the three bands. PD-A had higher ALFF and fALFF in the left middle occipital gyrus and lower fALFF in the bilateral insula in the slow-5 band compared to the HCs. Furthermore, abnormal DC value in hippocampus and parahippocampus was observed separately in the conventional band and in the slow-4 band between PD-A and HCs. Moreover, PD-A and PD-NA showed lower ReHo in cerebellum in the three bands compared to the HCs.

Conclusion

Our study revealed that PD-A and PD-NA might have different neurophysiological mechanisms. Concurrently, the ALFF in the slow-5 band and fALFF in the conventional band were sensitive in differentiating PD-A from PD-NA. The influence of apathy on the disease can be considered in the future research on PD, with the effects of frequency band taken into account when analyzing spontaneous brain activities in PD-A.

Multitasking in postanesthesia care unit following nurse interruptions, an analysis of the causes and consequences using classification tree: an observational prospective study

BACKGROUND

Postanesthesia Care Unit (PACU) is an environment associated with an important workload which is susceptible to lead to task interruption (TI), leading to task-switching or concurrent multitasking. The objective of the study was to determine the predictors of the reaction of the nurses facing TI and assess those who lead to an alteration of the initial task.

METHODS

We conducted a prospective observational study into the PACU of a university hospital during February 2017. Among 18 nurses, a selected one was observed each day, documenting for each TI the reaction of the nurse (task switching or concurrent multitasking), and the characteristics associated with the TI. We performed classification tree analyses using C5.0 algorithm in order to select the main predictors of the type of multitasking performed and the alteration of the initial task.

RESULTS

We observed 1119 TI during 132 hours (8.5 TI/hour). The main reaction was concurrent multitasking (805 TI, 72%). The short duration of the task interruption (one minute or less) was the most important predictor leading to concurrent multitasking. Other predictors of response to TI were the identity of the task interrupter and the number of nurses present. Regarding the consequences of the task switching, long interruption (more than five minutes) was the most important predictor of the alteration of the initial task.

CONCLUSIONS

By analysing the predictors of the type of multitasking in front of TI, we propose a novel approach to understanding TI, offering new perspective for prevention strategies.

The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies

Dual-task conditions are commonly experienced in daily routines. The aim of the present systematic review is to investigate the effect of dual-task conditions on gait and balance performance in children with cerebral palsy (CP) and to perform meta-analyses where applicable. Five databases, "ProQuest", "PubMed", "OTSeeker", "Scopus", and "PEDro" from the incipient date of databases up to Aug 24, 2020 were searched for studies focusing on the effects of dual-task conditions on gait and balance performance in children with CP. After removing irrelevant articles and applying inclusion and exclusion criteria, nine articles were included in the present systematic review and meta-analysis. The results of the meta-analysis showed that walking speed was slower during dual-task conditions compared to single-task conditions in children with CP (WMD = -0.29 m/s, 95% CI = -0.34, -0.24, P ≤ 0.001) and walking speed decreased in children with CP during dual-task conditions in comparison with the typical development (TD) control group (WMD = -0.19 m/s, 95% CI = -0.23 to -0.15, P ≤ 0.001). The results of subgroup analysis based on the type of task indicated that adding concurrent tasks to walking degrades walking speed under varied dual-task conditions. Additionally, theoretical synthesis of the literature demonstrated that other gait and balance variables are changed by performing cognitive and motor secondary tasks differently. Although these changes may be compensatory strategies to retain their stability, there was not sufficient evidence to reach a firm conclusion. Research gaps and recommendations for future studies are discussed.

The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature

Various studies have investigated the effect of noninvasive brain stimulation methods such as transcranial direct stimulation (tDCS) on postural control in healthy young and older adults. However, the use of different treatment protocols and outcome measures makes it difficult to interpret the research results. This systematic review provides a comprehensive overview of the current literature on the effect of tDCS on postural control. Nine databases were searched for papers assessing the effect of tDCS on postural control in young healthy and/or older adults. The data of included studies were extracted and methodological quality examined using PEDro. Sixteen studies met the inclusion criteria. The results showed that anodal tDCS (a-tDCS) of primary motor cortex may improve dynamic balance in young healthy individuals. In older adults, a-tDCS of dorsolateral prefrontal cortex and cerebellum showed a positive effect on dual task and dynamic balance, respectively. In conclusion, tDCS may improve both static and dynamic balance in younger and older adults. However, due to lack of consensus in the results, caution is required when drawing conclusions with regards to these findings.

Monitoring Multiple Deadlines Relies on Spatial Processing in Posterior Parietal Cortex

Proactively coordinating one's actions is an important aspect of multitasking performance due to overlapping task sequences. In this study, we used fMRI to investigate neural mechanisms underlying monitoring of multiple overlapping task sequences. We tested the hypothesis that temporal control demands in multiple-task monitoring are offloaded onto spatial processes by representing patterns of temporal deadlines in spatial terms. Results showed that increased demands on time monitoring (i.e., responding to concurrent deadlines of one to four component tasks) increasingly activated regions in the left inferior parietal lobe and the precuneus. Moreover, independent measures of spatial abilities correlated with multiple-task performance beyond the contribution of working memory. Together, these findings suggest that monitoring and coordination of temporally overlapping task timelines rely on cortical processes involved in spatial information processing. We suggest that the precuneus is involved in tracking of multiple task timelines, whereas the inferior parietal lobe constructs spatial representations of the temporal relations of these overlapping timelines. These findings are consistent with the spatial offloading hypothesis and add new insights into the neurocognitive mechanisms underlying the coordination of multiple tasks.

Common and distinct neural correlates of dual-tasking and task-switching: a meta-analytic review and a neuro-cognitive processing model of human multitasking

Although there are well-known limitations of the human cognitive system in performing two tasks simultaneously (dual-tasking) or alternatingly (task-switching), the question for a common vs. distinct neural basis of these multitasking limitations is still open. We performed two Activation Likelihood Estimation meta-analyses of neuroimaging studies on dual-tasking or task-switching and tested for commonalities and differences in the brain regions associated with either domain. We found a common core network related to multitasking comprising bilateral intraparietal sulcus (IPS), left dorsal premotor cortex (dPMC), and right anterior insula. Meta-analytic contrasts revealed eight fronto-parietal clusters more consistently activated in dual-tasking (bilateral frontal operculum, dPMC, and anterior IPS, left inferior frontal sulcus and left inferior frontal gyrus) and, conversely, four clusters (left inferior frontal junction, posterior IPS, and precuneus as well as frontomedial cortex) more consistently activated in task-switching. Together with sub-analyses of preparation effects in task-switching, our results argue against purely passive structural processing limitations in multitasking. Based on these findings and drawing on current theorizing, we present a neuro-cognitive processing model of multitasking.

Multitasking behavior and its related constructs: Executive functions, working memory capacity, relational integration, and divided attention

Although prior investigations have revealed cognitive abilities to be important predictors of multitasking behavior, few investigations have been conducted on the relation between executive functions (EFs) and multitasking behavior. The current study examines the underlying cognitive constructs associated with the concept of multitasking behavior. A sample of 202 young adults completed a battery of EFs (shifting, updating, and inhibition), three working memory capacity (WMC) tests, three relational integration tests, two divided attention tests, and a multitasking scenario (Simultaneous Capacity). First, in direct replication attempts, the results replicated the multitasking behavior model (Bühner, König, Pick, & Krumm, 2006) and partially replicated the three-factor and nested factors EFs models (Friedman et al., 2016). Second, hierarchical multiple regression analyses and relative weight analyses revealed that updating, inhibition, relational integration, and divided attention had strong contributions in explaining multitasking behavior variance, whereas shifting and WMC did not show any explanatory power beyond these constructs. Finally, using structural equation modeling, we found that the general EF ability (common EF) representing variance common to shifting, updating, and inhibition highly overlapped with multitasking behavior. Our results are of value not only to shed light on the relevant cognitive correlates of multitasking behavior but also to position multitasking behavior in an established framework of cognitive abilities.

Random topology organization and decreased visual processing of internet addiction: Evidence from a minimum spanning tree analysis

OBJECTIVES

Internet addiction (IA) has been associated with widespread brain alterations. Functional connectivity (FC) and network analysis results related to IA are inconsistent between studies, and how network hubs change is not known. The aim of this study was to evaluate functional and topological networks using an unbiased minimum spanning tree (MST) analysis on electroencephalography (EEG) data in IA and healthy control (HC) college students.

METHODS

In this study, Young's internet addiction test was used as an IA severity measure. EEG recordings were obtained in IA (n = 30) and HC participants (n = 30), matched for age and sex, during rest. The phase lag index (PLI) and MST were applied to analyze FC and network topology. We expected to obtain evidence of underlying alterations in functional and topological networks related to IA.

RESULTS

IA participants showed higher delta FC between left-side frontal and parieto-occipital areas compared to the HC group (p < 0.001), global MST measures revealed a more star-like network in IA participants in the upper alpha and beta bands, and the occipital brain region was relatively less important in the IA relative to the HC group in the lower band. The correlation results were consistent with the MST results: higher IA severity correlated with higher Max degree and kappa, and lower eccentricity and diameter.

CONCLUSIONS

Functional networks of the IA group were characterized by increased FC, a more random organization, and a decrease of relative functional importance of the visual processing area. Taken together, these alterations can help us understand the influence of IA to brain mechanism.

Neural Correlates of Workload Transition in Multitasking: An ACT-R Model of Hysteresis Effect

This study investigated the effect of task demand transitions at multiple levels of analysis including behavioral performance, subjective rating, and brain effective connectivity, while comparing human data to Adaptive Control of Thought-Rational (ACT-R) simulated data. Three stages of task demand were designed and performed sequentially (Low-High-Low) during AF-MATB tasks, and the differences in neural connectivity during workload transition were identified. The NASA Task Load Index (NASA-TLX) and the Instantaneous Self-Assessment (ISA) were used to measure the subjective mental workload that accompanies the hysteresis effect in the task demand transitions. The results found significant hysteresis effects on performance and various brain network measures such as outflow of the prefrontal cortex and connectivity magnitude. These findings would assist in clarifying the direction and strength of the Granger Causality under demand transitions. As a result, these findings involving the neural mechanisms of hysteresis effects in multitasking environments may be utilized in applications of neuroergonomics research. The ability to compare data derived from human participants to data gathered by the ACT-R model allows researchers to better account for hysteresis effects in neuro-cognitive models in the future.

Influence of working memory and executive function on stair ascent and descent in young and older adults

This study assessed the influence of attention division, working memory and executive function on stair ascent and descent in young and older adults. Twenty young (25.5 ± 2.1 yrs) and 20 older adults (68.4 ± 5.4 yrs) ascended and descended a 3-step staircase with no simultaneous cognitive task (single-motor task) or while performing a cognitive task (dual-task condition). The cognitive task involved either 1) recalling a word list of the subject's word-span minus 2 words (SPAN-2) to assess the attention division effect, 2) a word list of subject's word-span (SPAN-O) to assess the working memory effect, or 3) recalling in alphabetical order, a word list of the subject's word-span (SPAN-A) to assess the executive function effect. Word-span corresponds to the longest string of words that can be recalled correctly. The duration of ascent and descent of stairs was used to assess the cognitive-motor interaction. Stair ascent and descent duration did not differ between age groups for the single-motor task, and was similar between single-motor task and SPAN-2 in both groups (p > 0.05). In contrast, stair ascent and descent duration increased with SPAN-O compared with SPAN-2 for both groups (p < 0.01). Stair ascent (p = 0.017) and descent (p = 0.008) were longer in SPAN-A than SPAN-O only in older adults. Healthy aging was not associated with a decrease in the capacity to perform motor-cognitive dual tasks that involved ascending and descending of stairs when the cognitive task only required working memory. However, the decrease in dual-task performance involving executive functioning may reflect a subclinical cognitive decline in healthy older adults.

Dual Task of Fine Motor Skill and Problem Solving in Individuals With Multiple Sclerosis: A Pilot Study

OBJECTIVES

To (1) examine and compare dual-task performance in patients with multiple sclerosis (MS) and healthy controls (HCs) using mathematical problem-solving questions that included an everyday competence component while performing an upper extremity fine motor task; and (2) examine whether difficulties in dual-task performance are associated with problems in performing an everyday internet task.

DESIGN

Pilot study, mixed-design with both a within and between subjects' factor.

SETTING

A nonprofit rehabilitation research institution and the community.

PARTICIPANTS

Participants (N=38) included persons with MS (n=19) and HCs (n=19) who were recruited from a nonprofit rehabilitation research institution and from the community.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participant were presented with 2 testing conditions: (1) solving mathematical everyday problems or placing bolts into divots (single-task condition); and (2) solving problems while putting bolts into divots (dual-task condition). Additionally, participants were required to perform a test of everyday internet competence.

RESULTS

As expected, dual-task performance was significantly worse than either of the single-task tasks (ie, number of bolts into divots or correct answers, and time to answer the questions). Cognitive but not motor dual-task cost was associated with worse performance in activities of everyday internet tasks.

CONCLUSIONS

Cognitive dual-task cost is significantly associated with worse performance of everyday technology. This was not observed in the motor dual-task cost. The implications of dual-task costs on everyday activity are discussed.

Imaging gait analysis: An fMRI dual task study

INTRODUCTION

In geriatric clinical diagnostics, gait analysis with cognitive-motor dual tasking is used to predict fall risk and cognitive decline. To date, the neural correlates of cognitive-motor dual tasking processes are not fully understood. To investigate these underlying neural mechanisms, we designed an fMRI paradigm to reproduce the gait analysis.

METHODS

We tested the fMRI paradigm's feasibility in a substudy with fifteen young adults and assessed 31 healthy older adults in the main study. First, gait speed and variability were quantified using the GAITRite^© electronic walkway. Then, participants lying in the MRI-scanner were stepping on pedals of an MRI-compatible stepping device used to imitate gait during functional imaging. In each session, participants performed cognitive and motor single tasks as well as cognitive-motor dual tasks.

RESULTS

Behavioral results showed that the parameters of both gait analyses, GAITRite^© and fMRI, were significantly positively correlated. FMRI results revealed significantly reduced brain activation during dual task compared to single task conditions. Functional ROI analysis showed that activation in the superior parietal lobe (SPL) decreased less from single to dual task condition than activation in primary motor cortex and in supplementary motor areas. Moreover, SPL activation was increased during dual tasks in subjects exhibiting lower stepping speed and lower executive control.

CONCLUSION

We were able to simulate walking during functional imaging with valid results that reproduce those from the GAITRite^© gait analysis. On the neural level, SPL seems to play a crucial role in cognitive-motor dual tasking and to be linked to divided attention processes, particularly when motor activity is involved.

White Matter Changes-Related Gait and Executive Function Deficits: Associations with Age and Parkinson's Disease

Background: White matter changes (WMC) are a common finding among older adults and patients with Parkinson's disease (PD), and have been associated with, e.g., gait deficits and executive dysfunction. How the factors age and PD influence WMC-related deficits is, to our best knowledge, not investigated to date. We hypothesized that advanced age and presence of PD leads to WMC-related symptoms while practicing tasks with a low complexity level, and low age and absence of PD leads to WMC-related symptoms while practicing tasks with a high complexity level.

Methods: Hundred and thirty-eight participants [65 young persons without PD (50–69 years, yPn), 22 young PD patients (50–69 years, yPD), 36 old persons without PD (70–89 years, oPn) and 15 old PD patients (70–89 years, oPD)] were included. Presence and severity of WMC were determined with the modified Fazekas score. Velocity of walking under single and dual tasking conditions and the Trail Making Test (TMT) were used as gait and executive function parameters. Correlations between presence and severity of WMC, and gait and executive function parameters were tested in yPn, yPD, oPn, and oPD using Spearman's rank correlation, and significance between groups was evaluated with Fisher's z-transformed correlation coefficient.

Results: yPn and yPD, as well as oPn and oPD did not differ regarding demographic and clinical parameters. Severity of WMC was not significantly different between groups. yPn and yPD displayed significant correlations of WMC with executive function parameters at low levels of task complexity, oPn at intermediate, and oPD at high complexity levels.

Conclusion: This study argues for a relevant association of age and PD-related brain pathology with WMC-related gait and executive function deficits.

Brain connectivity and psychiatric comorbidity in adolescents with Internet gaming disorder

Prolonged Internet video game play may have multiple and complex effects on human cognition and brain development in both negative and positive ways. There is not currently a consensus on the principle effects of video game play neither on brain development nor on the relationship to psychiatric comorbidity. In this study, 78 adolescents with Internet gaming disorder (IGD) and 73 comparison subjects without IGD, including subgroups with no other psychiatric comorbid disease, with major depressive disorder and with attention deficit hyperactivity disorder (ADHD), were included in a 3 T resting state functional magnetic resonance imaging analysis. The severity of Internet gaming disorder, depression, anxiety and ADHD symptoms were assessed with the Young Internet Addiction Scale, the Beck Depression Inventory, the Beck Anxiety Inventory and the Korean ADHD rating scales, respectively. Patients with IGD showed an increased functional correlation between seven pairs of regions, all satisfying q < 0.05 False discovery rates in light of multiple statistical tests: left frontal eye field to dorsal anterior cingulate, left frontal eye field to right anterior insula, left dorsolateral prefrontal cortex (DLPFC) to left temporoparietal junction (TPJ), right DLPFC to right TPJ, right auditory cortex to right motor cortex, right auditory cortex to supplementary motor area and right auditory cortex to dorsal anterior cingulate. These findings may represent a training effect of extended game play and suggest a risk or predisposition in game players for over-connectivity of the default mode and executive control networks that may relate to psychiatric comorbidity.

Impairments of Motor Function While Multitasking in HIV

Human immunodeficiency virus (HIV) became a treatable illness with the introduction of combination antiretroviral therapy (CART). As a result, patients with regular access to CART are expected to live decades with HIV. Long-term HIV infection presents unique challenges, including neurocognitive impairments defined by three major stages of HIV-associated neurocognitive disorders (HAND). The current investigation aimed to study cognitive and motor impairments in HIV using a novel multitasking paradigm. Unlike current standard measures of cognitive and motor performance in HIV, multitasking increases real-world validity by mimicking the dual motor and cognitive demands that are part of daily professional and personal settings (e.g., driving, typing and writing). Moreover, multitask assessments can unmask compensatory mechanisms, normally used under single task conditions, to maintain performance. This investigation revealed that HIV+ participants were impaired on the motor component of the multitask, while cognitive performance was spared. A patient-specific positive interaction between motor performance and working memory recall was driven by poor HIV+ multitaskers. Surprisingly, HAND stage did not correspond with multitask performance and a variety of commonly used assessments indicated normal motor function among HIV+ participants with poor motor performance during the experimental task. These results support the use of multitasks to reveal otherwise hidden impairment in chronic HIV by expanding the sensitivity of clinical assessments used to determine HAND stage. Future studies should examine the capability of multitasks to predict performance in personal, professional and health-related behaviors and prognosis of patients living with chronic HIV.

Electrocortical Sources Related to Whole-Body Surface Translations during a Single- and Dual-Task Paradigm

Appropriate reactive motor responses are essential in maintaining upright balance. However, little is known regarding the potential location of cortical sources that are related to the onset of a perturbation during single- and dual-task paradigms. The purpose of this study was to estimate the location of cortical sources in response to a whole-body surface translation and whether diverted attention decreases the N1 event-related potential (ERP) amplitude related to a postural perturbation. This study utilized high-resolution electroencephalography in conjunction with measure projection analysis from ERPs time-locked to backwards surface translation onsets to determine which cortical sources were related to whole-body postural perturbations. Subjects (n = 15) either reacted to whole-body surface translations with (dual task) or without (single task) performing a visual working memory task. For the single task, four domains were identified that were mainly localized within the frontal and parietal lobes and included sources from the prefrontal, premotor, primary and supplementary motor, somatosensory and anterior cingulate cortex. Five domains were estimated for the dual task and also included sources within the frontal and parietal lobes, but the sources also shifted to other locations that included areas within the temporal and occipital lobes. Additionally, mean absolute N1 ERP amplitudes representing the activity from similar locations in both tasks were greater for the single than dual task. The present localization results highlight the importance of frontal, parietal and anterior cingulate cortical areas in reactive postural control and suggest a re-allocation or shift of cortical sources related to reactive balance control in the presence of a secondary task. Thus, this study provides novel insight into the underlying neurophysiology and contribution of cortical sources in relation to the neural control of reactive balance.

Cerebellar volume mediates the relationship between FMR1 mRNA levels and voluntary step initiation in males with the premutation

Recent evidence indicates that adults with a premutation (PM: 55-199 CGG repeats) expansion in the fragile X mental retardation 1 (FMR1) gene show postural control deficits that may reflect disruption to cerebellar motor regions. Less is known about the influence of reduced cerebellar volume and structural changes, and increase in CGG repeat and FMR1 mRNA levels on the attentional demands of step initiation in PM males. We investigated the effects of a concurrent cognitive task on choice stepping reaction time (CSRT) and explored the associations between CSRT performance, cerebellar volume, CGG size, and FMR1 mRNA levels in blood in PM males. We examined 19 PM males (ages 28-75) and 23 matched controls (CGG <44; ages 26-77), who performed a verbal fluency task during CSRT performance and single-task stepping without a secondary cognitive task. Our results provide preliminary evidence that smaller cerebellar volume (β = -2.73, p = 0.002) and increasing CGG repeat length (β = 1.69, p = 0.003) were associated with greater dual-task step initiation times in PM males, but not in controls. There was evidence of a mediating effect of cerebellar volume on the relationship between FMR1 mRNA levels and single-task CSRT performance in PM males (estimate coefficient = 8.69, standard error = 4.42, p = 0.049). These findings suggest increasing CGG repeat and FMR1 mRNA levels have neurotoxic effects on cerebellar regions underlying anticipatory postural responses during stepping. Cerebellar postural changes may be predictive of the increased risk of falls in older PM males.

An Increase in Postural Load Facilitates an Anterior Shift of Processing Resources to Frontal Executive Function in a Postural-Suprapostural Task

Increase in postural-demand resources does not necessarily degrade a concurrent motor task, according to the adaptive resource-sharing hypothesis of postural-suprapostural dual-tasking. This study investigated how brain networks are organized to optimize a suprapostural motor task when the postural load increases and shifts postural control into a less automatic process. Fourteen volunteers executed a designated force-matching task from a level surface (a relative automatic process in posture) and from a stabilometer board while maintaining balance at a target angle (a relatively controlled process in posture). Task performance of the postural and suprapostural tasks, synchronization likelihood (SL) of scalp EEG, and graph-theoretical metrics were assessed. Behavioral results showed that the accuracy and reaction time of force-matching from a stabilometer board were not affected, despite a significant increase in postural sway. However, force-matching in the stabilometer condition showed greater local and global efficiencies of the brain networks than force-matching in the level-surface condition. Force-matching from a stabilometer board was also associated with greater frontal cluster coefficients, greater mean SL of the frontal and sensorimotor areas, and smaller mean SL of the parietal-occipital cortex than force-matching from a level surface. The contrast of supra-threshold links in the upper alpha and beta bands between the two stance conditions validated load-induced facilitation of inter-regional connections between the frontal and sensorimotor areas, but that contrast also indicated connection suppression between the right frontal-temporal and the parietal-occipital areas for the stabilometer stance condition. In conclusion, an increase in stance difficulty alters the neurocognitive processes in executing a postural-suprapostural task. Suprapostural performance is not degraded by increase in postural load, due to (1) increased effectiveness of information transfer, (2) an anterior shift of processing resources toward frontal executive function, and (3) cortical dissociation of control hubs in the parietal-occipital cortex for neural economy.

Reduction of Dual-task Costs by Noninvasive Modulation of Prefrontal Activity in Healthy Elders

Dual tasking (e.g., walking or standing while performing a cognitive task) disrupts performance in one or both tasks, and such dual-task costs increase with aging into senescence. Dual tasking activates a network of brain regions including pFC. We therefore hypothesized that facilitation of prefrontal cortical activity via transcranial direct current stimulation (tDCS) would reduce dual-task costs in older adults. Thirty-seven healthy older adults completed two visits during which dual tasking was assessed before and after 20 min of real or sham tDCS targeting the left pFC. Trials of single-task standing, walking, and verbalized serial subtractions were completed, along with dual-task trials of standing or walking while performing serial subtractions. Dual-task costs were calculated as the percent change in markers of gait and postural control and serial subtraction performance, from single to dual tasking. Significant dual-task costs to standing, walking, and serial subtraction performance were observed before tDCS (p < .01). These dual-task costs were less after real tDCS as compared with sham tDCS as well as compared with either pre-tDCS condition (p < .03). Further analyses indicated that tDCS did not alter single task performance but instead improved performance solely within dual-task conditions (p < .02). These results demonstrate that dual tasking can be improved by modulating prefrontal activity, thus indicating that dual-task decrements are modifiable and may not necessarily reflect an obligatory consequence of aging. Moreover, tDCS may ultimately serve as a novel approach to preserving dual-task capacity into senescence.

Common neural correlates of intertemporal choices and intelligence in adolescents

Converging behavioral evidence indicates that temporal discounting, measured by intertemporal choice tasks, is inversely related to intelligence. At the neural level, the parieto-frontal network is pivotal for complex, higher-order cognitive processes. Relatedly, underrecruitment of the pFC during a working memory task has been found to be associated with steeper temporal discounting. Furthermore, this network has also been shown to be related to the consistency of intertemporal choices. Here we report an fMRI study that directly investigated the association of neural correlates of intertemporal choice behavior with intelligence in an adolescent sample (n = 206; age 13.7-15.5 years). After identifying brain regions where the BOLD response during intertemporal choice was correlated with individual differences in intelligence, we further tested whether BOLD responses in these areas would mediate the associations between intelligence, the discounting rate, and choice consistency. We found positive correlations between BOLD response in a value-independent decision network (i.e., dorsolateral pFC, precuneus, and occipital areas) and intelligence. Furthermore, BOLD response in a value-dependent decision network (i.e., perigenual ACC, inferior frontal gyrus, ventromedial pFC, ventral striatum) was positively correlated with intelligence. The mediation analysis revealed that BOLD responses in the value-independent network mediated the association between intelligence and choice consistency, whereas BOLD responses in the value-dependent network mediated the association between intelligence and the discounting rate. In summary, our findings provide evidence for common neural correlates of intertemporal choice and intelligence, possibly linked by valuation as well as executive functions.

Neural sources of performance decline during continuous multitasking

Multitasking performance costs have largely been characterized by experiments that involve two overlapping and punctuated perceptual stimuli, as well as punctuated responses to each task. Here, participants engaged in a continuous performance paradigm during fMRI recording to identify neural signatures associated with multitasking costs under more natural conditions. Our results demonstrated that only a single brain region, the superior parietal lobule (SPL), exhibited a significant relationship with multitasking performance, such that increased activation in the multitasking condition versus the singletasking condition was associated with higher task performance (i.e., least multitasking cost). Together, these results support previous research indicating that parietal regions underlie multitasking abilities and that performance costs are related to a bottleneck in control processes involving the SPL that serves to divide attention between two tasks.

Anatomo-functional study of the temporo-parieto-occipital region: dissection, tractographic and brain mapping evidence from a neurosurgical perspective

The temporo-parieto-occipital (TPO) junction is a complex brain territory heavily involved in several high-level neurological functions, such as language, visuo-spatial recognition, writing, reading, symbol processing, calculation, self-processing, working memory, musical memory, and face and object recognition. Recent studies indicate that this area is covered by a thick network of white matter (WM) connections, which provide efficient and multimodal integration of information between both local and distant cortical nodes. It is important for neurosurgeons to have good knowledge of the three-dimensional subcortical organisation of this highly connected region to minimise post-operative permanent deficits. The aim of this dissection study was to highlight the subcortical functional anatomy from a topographical surgical perspective. Eight human hemispheres (four left, four right) obtained from four human cadavers were dissected according to Klingler's technique. Proceeding latero-medially, the authors describe the anatomical courses of and the relationships between the main pathways crossing the TPO. The results obtained from dissection were first integrated with diffusion tensor imaging reconstructions and subsequently with functional data obtained from three surgical cases, all resection of infiltrating glial tumours using direct electrical mapping in awake patients. The subcortical limits for performing safe lesionectomies within the TPO region are as follows: within the parietal region, the anterior horizontal part of the superior longitudinal fasciculus and, more deeply, the arcuate fasciculus; dorsally, the vertical projective thalamo-cortical fibres. For lesions located within the temporal and occipital lobes, the resection should be tailored according to the orientation of the horizontal associative pathways (the inferior fronto-occipital fascicle, inferior longitudinal fascicle and optic radiation). The relationships between the WM tracts and the ventricle system were also examined. These results indicate that a detailed anatomo-functional awareness of the WM architecture within the TPO area is mandatory when approaching intrinsic brain lesions to optimise surgical results and to minimise post-operative morbidity.

Longitudinal assessment of chemotherapy-induced alterations in brain activation during multitasking and its relation with cognitive complaints

PURPOSE

To examine whether cognitive complaints after treatment for breast cancer are associated with detectable changes in brain activity during multitasking.

PATIENTS AND METHODS

Eighteen patients who were scheduled to receive chemotherapy performed a functional magnetic resonance imaging multitasking task in the scanner before the start of treatment (t1) and 4 to 6 months after finishing treatment (t2). Sixteen patients who were not scheduled to receive chemotherapy and 17 matched healthy controls performed the same task at matched intervals. Task difficulty level was adjusted individually to match performance across participants. Statistical Parametric Mapping 8 (SPM8) software was used for within-group, between-group, and group-by-time interaction image analyses.

RESULTS

Voxel-based paired t tests revealed significantly decreased activation (P < .05) from t1 to t2 at matched performance in the multitasking network of chemotherapy-treated patients, whereas no changes were noted in either of the control groups. At baseline, there were no differences between the groups. Furthermore, in contrast to controls, the chemotherapy-treated patients reported a significant increase in cognitive complaints (P < .05) at t2. Significant (P < .05) correlations were found between these increases and decreases in multitasking-related brain activation. Moreover, a significant group-by-time interaction (P < .05) was found whereby chemotherapy-treated patients showed decreased activation and healthy controls did not.

CONCLUSION

These results suggest that changes in brain activity may underlie chemotherapy-induced cognitive complaints. The observed changes might be related to chemotherapy-induced damage to the brain or reduced connectivity between brain regions rather than to changes in effort or changes in functional strategy. To the best of our knowledge, this is the first longitudinal study providing evidence for a relationship between longitudinal changes in cognitive complaints and changes in brain activation after chemotherapy.