Path Integration Deficits during Linear Locomotion after Human Medial Temporal Lobectomy

Vestibular-Dependent Functions Following MRgLITT-A Single-Group Longitudinal Study

BACKGROUND

Temporal lobe epilepsy is the most common pharmaco-resistant type of epilepsy. The chance of obtaining seizure freedom after resective surgery in pharmaco-resistant mesial temporal lobe patients (mTLE) is significantly higher compared to pharmaceutical treatment (at least 50-60% compared to less than 15%). However, some factors (e.g., craniotomy) may prevent epilepsy patients undergoing surgery. A recent advancement in epilepsy surgery, i.e., magnetic resonance guided laser interstitial thermal therapy (MRgLITT), has become an attractive alternative for performance of selective amygdala-hippo-campectomy, especially because of its minimal invasiveness. Among other medial temporal lobe structures, the hippocampus is particularly important for successful processing of vestibular inputs. Nevertheless, it is still unclear whether mTLE patients who underwent MRgLITT perform worse on vestibular-dependent tests, including balancing, spatial orientation and rotational memory.

METHODS

Nine patients (Age 40.1 ± 14.5; 2 females) underwent vestibular-dependent assessments before and after MRgLITT using the following test battery: (I) clinical balancing test (CBT), (II) triangle completion test (TCT) and (III) rotational memory test (RM).

RESULTS

We found significant improvement from pre- to post-surgery in the vestibular-dependent spatial orientation test, namely in the wheelchair condition of the triangle completion test. Additionally, the obtained effect sizes were medium to large in favor of post-surgery assessment for the majority of conditions in the three tests applied in this study, indicating that the assessment of a larger number of patients could also, potentially, lead to significant results in these cases.

CONCLUSIONS

This plausibility study is the first to assess vestibular-dependent balancing, spatial orientation and rotational memory functions before and after MRgLITT in mTLE patients. Even with a small sample of nine patients, significant changes and medium to high effect sizes in favor of surgery were observed. Nevertheless, prospective studies with larger sample sizes are necessary for appropriate estimation of MRgLITT effectiveness in these functional domains.

Lobectomy vs. MRgLITT in Temporal Lobe Epilepsy (TLE): A Pilot Study Investigating Vestibulo-Spatial Functions

Background: About 65 million people worldwide are affected by epilepsy, with temporal lobe epilepsy being the most common type resistant to drugs and often requiring surgical treatment. Although open surgical approaches, such as temporal lobectomy, have been the method of choice for decades, minimally invasive MRgLITT has demonstrated promising results. However, it remains unknown whether patients who underwent one of these two approaches would show better performance on vestibulo-spatial tasks. Methods: Twenty-seven patients were included in three different groups: (1) MRgLITT (37.0 ± 15.1 years, two females), (2) R-OP (44 ± 15.7 years, five females) and (3) No-OP (43 ± 11.2 years, three females)-with no significant differences in age, disease duration and number of medications. Groups were compared on their performance in three vestibular-dependent tests: (1) clinical balance test (CBT), (2) triangle completion test (TCT) and (3) rotational memory (RM) test. Results: Significantly better performance of MRgLITT patients, in comparison to the other two groups (R-OP and No-OP), was found for the TCT. The other tests revealed no significant differences between the groups. Conclusions: Patients who underwent MRgLITT performed significantly better on the vestibular-dependent spatial orientation task (TCT) compared to those who underwent temporal lobectomy (R-OP) and non-operated patients. Speculations about reasons for such an effect-including minimal invasiveness with less "collateral damage", influence of operated side, timing of surgery, sample heterogeneity and others-need to be assessed in detail in larger-scale, prospective longitudinal studies.

Age-related changes in the organization of spontaneously occurring behaviors

Age-related changes in spatial and temporal processing have been documented across a range of species. Rodent studies typically investigate differences in performance between adult and senescent animals; however, progressive loss of neurons in the hippocampus and cortex has been observed to occur as early as after adolescence. Therefore, the current study evaluated the effects of age in three- and ten-month-old female rats on the organization of movement in open field and food protection behaviors, two tasks that have previously dissociated hippocampal and cortical pathology. Age-related differences were observed in general measures of locomotion, spatial orientation, and attentional processing. The results of the current study are consistent with age-related changes in the processing of spatial information and motivation that occur earlier in life than previously anticipated. These observations establish a foundation for future studies evaluating interventions that influence these age-related differences in performance.

Path integration in normal aging and Alzheimer's disease

In this review we discuss converging evidence from human and rodent research demonstrating how path integration (PI) is impaired in healthy aging and Alzheimer's disease (AD), and point to the neural mechanisms that underlie these deficits. Importantly, we highlight that (i) the grid cell network in the entorhinal cortex is crucial for PI in both humans and rodents, (ii) PI deficits are present in healthy aging and are significantly more pronounced in patients with early-stage AD, (iii) compromised entorhinal grid cell computations in healthy older adults and in young adults at risk of AD are linked to PI deficits, and (iv) PI and grid cell deficits may serve as sensitive markers for pathological decline in early AD.

An analysis of distinct navigational domains and topographical disorientation syndromes in ABI: A meta-analysis

Topographical disorientation is the impairment or inability to successfully navigate in three-dimensional space. Differing topographical disorientation syndromes have been associated with distinct lesion sites in the acquired brain injury (ABI) literature. This meta-analysis attempted to investigate the relationship between lesion location and dysfunctions in specific navigational abilities resulting in topographical disorientation in individuals with ABI, as measured by their performance on experimental and neuropsychological tests. It was expected that focal lesions would be associated with a specific navigational deficit in one ability, with relative sparing of other navigational abilities. Twenty-six papers met the inclusion criteria for the analysis. Results indicated that ABI populations performed worse on all measures of navigation, with moderate to large effect sizes. Dysfunctions in three core navigational skills were consistent with the available lesion studies: a feature/landmark processing unit, a spatial processing unit, and a spatial/feature binding and associative learning unit. A sequential processing model was created to attempt to best represent the transfer of information between these units and the process by which navigational knowledge is generated. The model was then used to assess the validity of existing models of navigation and topographical disorientation.

Impairments in path integration, rotational memory and balancing in patients with temporal lobe epilepsy

Objectives

The vestibulo-medial temporal lobe (MTL) axis model proposes that the vestibular system and the MTL are tightly linked both structurally and functionally so that alterations of one structure should entail disturbances in the other. Accordingly, patients with temporal lobe epilepsy (TLE) with their functional and possible structural temporal lobe pathology should show deficits in vestibular-related behaviour. This study aimed at assessing behavioural deficits related to a suspected disturbance of the vestibulo-MTL axis in patients with TLE.

Methods

Twenty patients with TLE (46.7±15.1 years, seven females) and their age-matched and gender-matched controls (46.7±15.1, seven females) underwent three test batteries that challenged vestibular and MTL functions: balancing, path integration (triangle completion test) and rotational memory. In addition, participants underwent a structural MRI for grey matter analysis using voxel-based morphometry.

Results

Compared with controls, patients with TLE showed significantly inferior performance in all three behavioural tests, with large effect sizes. There were no significant grey matter differences between the two groups.

Conclusion

These results indicate a potential disturbance in the vestibulo-MTL axis in TLE; these are to be verified by future large-scale studies. In the current study, these behavioural deficits emerged without evidence of any brain volume differences between the patients and their controls as depicted by high-resolution MRI. This speaks for a dissociation between functional and structural alterations in TLE.

Self-reported navigation ability is associated with optic flow-sensitive regions' functional connectivity patterns during visual path integration

INTRODUCTION

Spatial navigation is a complex cognitive skill that varies between individuals, and the mechanisms underlying this variability are not clear. Studying simpler components of spatial navigation may help illuminate factors that contribute to variation in this complex skill; path integration is one such component. Optic flow provides self-motion information while moving through an environment and is sufficient for path integration. This study aims to investigate whether self-reported navigation ability is related to information transfer between optic flow-sensitive (OF-sensitive) cortical regions and regions important to navigation during environmental spatial tasks.

METHODS

Functional magnetic resonance imaging was used to define OF-sensitive regions and map their functional connectivity (FC) with the retrosplenial cortex and hippocampus during visual path integration (VPI) and turn counting (TC) tasks. Both tasks presented visual self-motion through a real-world environment. Correlations predicting a positive association between self-reported navigation ability (measured with the Santa Barbara Sense of Direction scale) and FC strength between OF-sensitive regions and retrosplenial cortex and OF-sensitive regions and the hippocampus were performed.

RESULTS

During VPI, FC strength between left cingulate sulcus visual area (L CSv) and right retrosplenial cortex and L CSv and right hippocampus was positively associated with self-reported navigation ability. FC strength between right cingulate sulcus visual area (R CSv) and right retrosplenial cortex during VPI was also positively associated with self-reported navigation ability. These relationships were specific to VPI, and whole-brain exploratory analyses corroborated these results.

CONCLUSIONS

These findings support the hypothesis that perceived spatial navigation ability is associated with communication strength between OF-sensitive and navigationally relevant regions during visual path integration, which may represent the transformation accuracy of visual motion information into internal spatial representations. More broadly, these results illuminate underlying mechanisms that may explain some variability in spatial navigation ability.

Resting State Connectivity Between Medial Temporal Lobe Regions and Intrinsic Cortical Networks Predicts Performance in a Path Integration Task

Humans differ in their individual navigational performance, in part because successful navigation relies on several diverse abilities. One such navigational capability is path integration, the updating of position and orientation during movement, typically in a sparse, landmark-free environment. This study examined the relationship between path integration abilities and functional connectivity to several canonical intrinsic brain networks. Intrinsic networks within the brain reflect past inputs and communication as well as structural architecture. Individual differences in intrinsic connectivity have been observed for common networks, suggesting that these networks can inform our understanding of individual spatial abilities. Here, we examined individual differences in intrinsic connectivity using resting state magnetic resonance imaging (rsMRI). We tested path integration ability using a loop closure task, in which participants viewed a single video of movement in a circle trajectory in a sparse environment, and then indicated whether the video ended in the same location in which it started. To examine intrinsic brain networks, participants underwent a resting state scan. We found that better performance in the loop task was associated with increased connectivity during rest between the central executive network (CEN) and posterior hippocampus, parahippocampal cortex (PHC) and entorhinal cortex. We also found that connectivity between PHC and the default mode network (DMN) during rest was associated with better loop closure performance. The results indicate that interactions between medial temporal lobe (MTL) regions and intrinsic networks that involve prefrontal cortex (PFC) are important for path integration and navigation.

Egocentric versus Allocentric Spatial Memory in Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease

BACKGROUND

Diagnosis of behavioral variant frontotemporal dementia (bvFTD) can be challenging, in particular when patients present with significant memory problems, which can increase the chance of a misdiagnosis of Alzheimer's disease (AD). Growing evidence suggests spatial orientation is a reliable cognitive marker able to differentiate these two clinical syndromes.

OBJECTIVE

Assess the integrity of egocentric and allocentric heading orientation and memory in bvFTD and AD, and their clinical implications.

METHOD

A cohort of 22 patients with dementia (11 bvFTD; 11 AD) and 14 healthy controls were assessed on the virtual supermarket task of spatial orientation and a battery of standardized neuropsychological measures of visual and verbal memory performance.

RESULTS

Judgements of egocentric and allocentric heading direction were differentially impaired in bvFTD and AD, with AD performing significantly worse on egocentric heading judgements than bvFTD. Both patient cohorts, however, showed similar degree of impaired allocentric spatial representation, and associated hippocampal pathology.

CONCLUSIONS

The findings suggest egocentric heading judgements offer a more sensitive discriminant of bvFTD and AD than allocentric map-based measures of spatial memory.

Individual Differences in Human Path Integration Abilities Correlate with Gray Matter Volume in Retrosplenial Cortex, Hippocampus, and Medial Prefrontal Cortex

Humans differ in their individual navigational abilities. These individual differences may exist in part because successful navigation relies on several disparate abilities, which rely on different brain structures. One such navigational capability is path integration, the updating of position and orientation, in which navigators track distances, directions, and locations in space during movement. Although structural differences related to landmark-based navigation have been examined, gray matter volume related to path integration ability has not yet been tested. Here, we examined individual differences in two path integration paradigms: (1) a location tracking task and (2) a task tracking translational and rotational self-motion. Using voxel-based morphometry, we related differences in performance in these path integration tasks to variation in brain morphology in 26 healthy young adults. Performance in the location tracking task positively correlated with individual differences in gray matter volume in three areas critical for path integration: the hippocampus, the retrosplenial cortex, and the medial prefrontal cortex. These regions are consistent with the path integration system known from computational and animal models and provide novel evidence that morphological variability in retrosplenial and medial prefrontal cortices underlies individual differences in human path integration ability. The results for tracking rotational self-motion-but not translation or location-demonstrated that cerebellum gray matter volume correlated with individual performance. Our findings also suggest that these three aspects of path integration are largely independent. Together, the results of this study provide a link between individual abilities and the functional correlates, computational models, and animal models of path integration.

Which way and how far? Tracking of translation and rotation information for human path integration

Path integration, the constant updating of the navigator's knowledge of position and orientation during movement, requires both visuospatial knowledge and memory. This study aimed to develop a systems-level understanding of human path integration by examining the basic building blocks of path integration in humans. To achieve this goal, we used functional imaging to examine the neural mechanisms that support the tracking and memory of translational and rotational components of human path integration. Critically, and in contrast to previous studies, we examined movement in translation and rotation tasks with no defined end-point or goal. Navigators accumulated translational and rotational information during virtual self-motion. Activity in hippocampus, retrosplenial cortex (RSC), and parahippocampal cortex (PHC) increased during both translation and rotation encoding, suggesting that these regions track self-motion information during path integration. These results address current questions regarding distance coding in the human brain. By implementing a modified delayed match to sample paradigm, we also examined the encoding and maintenance of path integration signals in working memory. Hippocampus, PHC, and RSC were recruited during successful encoding and maintenance of path integration information, with RSC selective for tasks that required processing heading rotation changes. These data indicate distinct working memory mechanisms for translation and rotation, which are essential for updating neural representations of current location. The results provide evidence that hippocampus, PHC, and RSC flexibly track task-relevant translation and rotation signals for path integration and could form the hub of a more distributed network supporting spatial navigation. Hum Brain Mapp 37:3636-3655, 2016. © 2016 Wiley Periodicals, Inc.

Transformations of Visuospatial Images

Transformations of visuospatial mental images are important for action, navigation, and reasoning. They depend on representations in multiple spatial reference frames, implemented in the posterior parietal cortex and other brain regions. The multiple systems framework proposes that different transformations can be distinguished in terms of which spatial reference frame is updated. In an object-based transformation, the reference frame of an object moves relative to those of the observer and the environment. In a perspective transformation, the observer's egocentric reference frame moves relative to those of the environment and of salient objects. These two types of spatial reference frame updating rely on distinct neural processing resources in the parietal, occipital, and temporal cortex. They are characterized by different behavioral patterns and unique individual differences. Both object-based transformations and perspective transformations interact with posterior frontal cortical regions subserving the simulation of body movements. These interactions indicate that multiple systems coordinate to support everyday spatial problem solving.

Real-space path integration is impaired in Alzheimer's disease and mild cognitive impairment

INTRODUCTION

Path integration (PI) is an important component of spatial navigation that integrates self-motion cues to allow the subject to return to a starting point. PI depends on the structures affected early in the course of Alzheimer's disease (AD) such as the medial temporal lobe and the parietal cortex.

OBJECTIVES

To assess whether PI is impaired in patients with mild AD and amnestic mild cognitive impairment (aMCI) and to investigate the role of the hippocampus, entorhinal and inferior parietal cortex in this association.

METHODS

27 patients with aMCI, 14 with mild AD and 18 controls completed eight trials of Arena Path Integration Task. The task required subjects with a mask covering their eyes to follow an enclosed triangle pathway through two previously seen places: start-place1-place2-start. Brains were scanned at 1.5T MRI and respective volumes and thicknesses were derived using FreeSurfer algorithm.

RESULTS

Controlling for age, education, gender and Mini-Mental State Examination score the aMCI and AD subjects were impaired in PI accuracy on the pathway endpoint (p=0.042 and p=0.013) compared to controls. Hippocampal volume and thickness of entorhinal and parietal cortices explained separately 36-45% of the differences in PI accuracy between controls and aMCI and 28-31% of the differences between controls and AD subjects.

CONCLUSIONS

PI is affected in aMCI and AD, possibly as a function of neurodegeneration in the medial temporal lobe structures and the parietal cortex. PI assessment (as a part of spatial navigation testing) may be useful for identification of patients with incipient AD.

There and Back Again: Hippocampus and Retrosplenial Cortex Track Homing Distance during Human Path Integration

Path integration, the updating of position and orientation during movement, often involves tracking a home location. Here, we examine processes that could contribute to successful location tracking in humans. In particular, we investigate a homing vector model of path integration, whereby a navigator continuously tracks a trajectory back to the home location. To examine this model, we developed a loop task for fMRI, in which participants viewed movement that circled back to a home location in a sparse virtual environment. In support of a homing vector system, hippocampus, retrosplenial cortex, and parahippocampal cortex were responsive to Euclidean distance from home. These results provide the first evidence of a constantly maintained homing signal in the human brain. In addition, hippocampus, retrosplenial cortex, and parahippocampal cortex, as well as medial prefrontal cortex, were recruited during successful path integration. These findings suggest that dynamic processes recruit hippocampus, retrosplenial cortex, and parahippocampal cortex in support of path integration, including a homing vector system that tracks movement relative to home.

SIGNIFICANCE STATEMENT

Path integration is the continual updating of position and orientation during navigation. Animal studies have identified place cells and grid cells as important for path integration, but underlying models of path integration in humans have rarely been studied. The results of our novel loop closure task are the first to suggest that a homing vector tracks Euclidean distance from the home location, supported by the hippocampus, retrosplenial cortex, and parahippocampal cortex. These findings suggest a potential homing vector mechanism supporting path integration, which recruits hippocampus and retrosplenial cortex to track movement relative to home. These results provide new avenues for computational and animal models by directing attention to homing vector models of path integration, which differ from current movement-tracking models.

Deficits in egocentric-updating and spatial context memory in a case of developmental amnesia

Patients with developmental amnesia usually suffer from both episodic and spatial memory deficits. DM, a developmental amnesic, was impaired in her ability to process self-motion (i.e., idiothetic) information while her ability to process external stable landmarks (i.e., allothetic) was preserved when no self-motion processing was required. On a naturalistic and incidental episodic task, DM was severely and predictably impaired on both free and cued recall tasks. Interestingly, when cued, she was more impaired at recalling spatial context than factual or temporal information. Theoretical implications of that co-occurrence of deficits and those dissociations are discussed and testable cerebral hypothesis are proposed.

Medial temporal lobe roles in human path integration

Path integration is a process in which observers derive their location by integrating self-motion signals along their locomotion trajectory. Although the medial temporal lobe (MTL) is thought to take part in path integration, the scope of its role for path integration remains unclear. To address this issue, we administered a variety of tasks involving path integration and other related processes to a group of neurosurgical patients whose MTL was unilaterally resected as therapy for epilepsy. These patients were unimpaired relative to neurologically intact controls in many tasks that required integration of various kinds of sensory self-motion information. However, the same patients (especially those who had lesions in the right hemisphere) walked farther than the controls when attempting to walk without vision to a previewed target. Importantly, this task was unique in our test battery in that it allowed participants to form a mental representation of the target location and anticipate their upcoming walking trajectory before they began moving. Thus, these results put forth a new idea that the role of MTL structures for human path integration may stem from their participation in predicting the consequences of one's locomotor actions. The strengths of this new theoretical viewpoint are discussed.

Differential neural network configuration during human path integration

Path integration is a fundamental skill for navigation in both humans and animals. Despite recent advances in unraveling the neural basis of path integration in animal models, relatively little is known about how path integration operates at a neural level in humans. Previous attempts to characterize the neural mechanisms used by humans to visually path integrate have suggested a central role of the hippocampus in allowing accurate performance, broadly resembling results from animal data. However, in recent years both the central role of the hippocampus and the perspective that animals and humans share similar neural mechanisms for path integration has come into question. The present study uses a data driven analysis to investigate the neural systems engaged during visual path integration in humans, allowing for an unbiased estimate of neural activity across the entire brain. Our results suggest that humans employ common task control, attention and spatial working memory systems across a frontoparietal network during path integration. However, individuals differed in how these systems are configured into functional networks. High performing individuals were found to more broadly express spatial working memory systems in prefrontal cortex, while low performing individuals engaged an allocentric memory system based primarily in the medial occipito-temporal region. These findings suggest that visual path integration in humans over short distances can operate through a spatial working memory system engaging primarily the prefrontal cortex and that the differential configuration of memory systems recruited by task control networks may help explain individual biases in spatial learning strategies.

Differential hippocampal and retrosplenial involvement in egocentric-updating, rotation, and allocentric processing during online spatial encoding: an fMRI study

The way new spatial information is encoded seems to be crucial in disentangling the role of decisive regions within the spatial memory network (i.e., hippocampus, parahippocampal, parietal, retrosplenial,…). Several data sources converge to suggest that the hippocampus is not always involved or indeed necessary for allocentric processing. Hippocampal involvement in spatial coding could reflect the integration of new information generated by “online” self-related changes. In this fMRI study, the participants started by encoding several object locations in a virtual reality environment and then performed a pointing task. Allocentric encoding was maximized by using a survey perspective and an object-to-object pointing task. Two egocentric encoding conditions were used, involving self-related changes processed under a first-person perspective and implicating a self-to-object pointing task. The Egocentric-updating condition involved navigation whereas the Egocentric with rotation only condition involved orientation changes only. Conjunction analysis of spatial encoding conditions revealed a wide activation of the occipito-parieto-frontal network and several medio-temporal structures. Interestingly, only the cuneal areas were significantly more recruited by the allocentric encoding in comparison to other spatial conditions. Moreover, the enhancement of hippocampal activation was found during Egocentric-updating encoding whereas the retrosplenial activation was observed during the Egocentric with rotation only condition. Hence, in some circumstances, hippocampal and retrosplenial structures—known for being involved in allocentric environmental coding—demonstrate preferential involvement in the egocentric coding of space. These results indicate that the raw differentiation between allocentric versus egocentric representation seems to no longer be sufficient in understanding the complexity of the mechanisms involved during spatial encoding.

Angular declination and the dynamic perception of egocentric distance

The extraction of the distance between an object and an observer is fast when angular declination is informative, as it is with targets placed on the ground. To what extent does angular declination drive performance when viewing time is limited? Participants judged target distances in a real-world environment with viewing durations ranging from 36-220 ms. An important role for angular declination was supported by experiments showing that the cue provides information about egocentric distance even on the very first glimpse, and that it supports a sensitive response to distance in the absence of other useful cues. Performance was better at 220-ms viewing durations than for briefer glimpses, suggesting that the perception of distance is dynamic even within the time frame of a typical eye fixation. Critically, performance in limited viewing trials was better when preceded by a 15-s preview of the room without a designated target. The results indicate that the perception of distance is powerfully shaped by memory from prior visual experience with the scene. A theoretical framework for the dynamic perception of distance is presented.

Linear path integration deficits in patients with abnormal vestibular afference

Effective navigation requires the ability to keep track of one's location and maintain orientation during linear and angular displacements. Path integration is the process of updating the representation of body position by integrating internally-generated self-motion signals over time (e.g., walking in the dark). One major source of input to path integration is vestibular afference. We tested patients with reduced vestibular function (unilateral vestibular hypofunction, UVH), patients with aberrant vestibular function (benign paroxysmal positional vertigo, BPPV), and healthy participants (controls) on two linear path integration tasks: experimenter-guided walking and target-directed walking. The experimenter-guided walking task revealed a systematic underestimation of self-motion signals in UVH patients compared to the other groups. However, we did not find any difference in the distance walked between the UVH group and the control group for the target-directed walking task. Results from neuropsychological testing and clinical balance measures suggest that the errors in experimenter-guided walking were not attributable to cognitive and/or balance impairments. We conclude that impairment in linear path integration in UVH patients stem from deficits in self-motion perception. Importantly, our results also suggest that patients with a UVH deficit do not lose their ability to walk accurately without vision to a memorized target location.

Infusion of GAT1-saporin into the medial septum/vertical limb of the diagonal band disrupts self-movement cue processing and spares mnemonic function

Degeneration of the septohippocampal system is associated with the progression of Dementia of the Alzheimer's type (DAT). Impairments in mnemonic function and spatial orientation become more severe as DAT progresses. Although evidence supports a role for cholinergic function in these impairments, relatively few studies have examined the contribution of the septohippocampal GABAergic component to mnemonic function or spatial orientation. The current study uses the rat food-hoarding paradigm and water maze tasks to characterize the mnemonic and spatial impairments associated with infusing GAT1-Saporin into the medial septum/vertical limb of the diagonal band (MS/VDB). Although infusion of GAT1-Saporin significantly reduced parvalbumin-positive cells in the MS/VDB, no reductions in markers of cholinergic function were observed in the hippocampus. In general, performance was spared during spatial tasks that provided access to environmental cues. In contrast, GAT1-Saporin rats did not accurately carry the food pellet to the refuge during the dark probe. These observations are consistent with infusion of GAT1-Saporin into the MS/VDB resulting in spared mnemonic function and use of environmental cues; however, self-movement cue processing was compromised. This interpretation is consistent with a growing literature demonstrating a role for the septohippocampal system in self-movement cue processing.

Dissociable cognitive mechanisms underlying human path integration

Path integration is a fundamental mechanism of spatial navigation. In non-human species, it is assumed to be an online process in which a homing vector is updated continuously during an outward journey. In contrast, human path integration has been conceptualized as a configural process in which travelers store working memory representations of path segments, with the computation of a homing vector only occurring when required. To resolve this apparent discrepancy, we tested whether humans can employ different path integration strategies in the same task. Using a triangle completion paradigm, participants were instructed either to continuously update the start position during locomotion (continuous strategy) or to remember the shape of the outbound path and to calculate home vectors on basis of this representation (configural strategy). While overall homing accuracy was superior in the configural condition, participants were quicker to respond during continuous updating, strongly suggesting that homing vectors were computed online. Corroborating these findings, we observed reliable differences in head orientation during the outbound path: when participants applied the continuous updating strategy, the head deviated significantly from straight ahead in direction of the start place, which can be interpreted as a continuous motor expression of the homing vector. Head orientation-a novel online measure for path integration-can thus inform about the underlying updating mechanism already during locomotion. In addition to demonstrating that humans can employ different cognitive strategies during path integration, our two-systems view helps to resolve recent controversies regarding the role of the medial temporal lobe in human path integration.

A comparison of blindpulling and blindwalking as measures of perceived absolute distance

Blindwalking has become a common measure of perceived absolute distance and location, but it requires a relatively large testing space and cannot be used with people for whom walking is difficult or impossible. In the present article, we describe an alternative response type that is closely matched to blindwalking in several important respects but is less resource intensive. In the blindpulling technique, participants view a target, then close their eyes and pull a length of tape or rope between the hands to indicate the remembered target distance. As with blindwalking, this response requires integration of cyclical, bilateral limb movements over time. Blind-pulling and blindwalking responses are tightly linked across a range of viewing conditions, and blindpulling is accurate when prior exposure to visually guided pulling is provided. Thus, blindpulling shows promise as a measure of perceived distance that may be used in nonambulatory populations and when the space available for testing is limited.

Revisiting the effect of quality of graphics on distance judgments in virtual environments: a comparison of verbal reports and blind walking

In immersive virtual environments, judgments of perceived egocentric distance are significantly underestimated, as compared with accurate performance in the real world. Two experiments assessed the influence of graphics quality on two distinct estimates of distance, a visually directed walking task and verbal reports. Experiment 1 demonstrated a similar underestimation of distances walked to previously viewed targets in both low- and high-quality virtual classrooms. In Experiment 2, participants' verbal judgments underestimated target distances in both graphics quality environments but were more accurate in the high-quality environment, consistent with the subjective impression that high-quality environments seem larger. Contrary to previous results, we suggest that quality of graphics does influence judgments of distance, but only for verbal reports. This behavioral dissociation has implications beyond the context of virtual environments and may reflect a differential use of cues and context for verbal reports and visually directed walking.

MRI- and MRS-derived hippocampal correlates of quantitative locomotor function in older adults

Gait measures have been shown to predict cognitive decline and dementia in older adults. Investigation of the neurobiology associated with locomotor function is needed to elucidate this relationship with cognitive abilities. This study aimed to examine magnetic resonance imaging (MRI; hippocampal volume)- and proton magnetic resonance spectroscopy (MRS; N-acetylaspartate to creatine (NAA/Cr) ratios)-derived hippocampal correlates of quantitative gait function (swing time (seconds), stride length (cm), and stride length variability (standard deviation)) in a subset of 48 nondemented older adults (24 males; mean age=81 years) drawn from the Einstein Aging Study, a community-based sample of individuals over the age of 70 residing in Bronx, New York. Linear regression analyses controlling for age were used to examine hippocampal volume and neurochemistry as predictors of gait function. We found that stride length was associated with hippocampal volume (beta=0.36, p=0.03; overall model R(2)=0.33, p=0.01), but not hippocampal neurochemistry (beta=0.09, p=0.48). Stride length variability was more strongly associated with hippocampal NAA/Cr (beta=-0.38, p=0.01; overall model R(2)=0.14, p=0.04) than hippocampal volume (beta=-0.33, p=0.08). Gait swing time was not significantly related to any neuroimaging measure. These relationships remained significant after accounting for memory and clinical gait impairments. These findings suggest that nondemented older adults exhibit increased stride length variability that is associated with lower levels of hippocampal neuronal metabolism, but not hippocampal volume. Conversely, decreased stride length is associated with smaller hippocampal volumes, but not hippocampal neurochemistry. Distinct neurobiological hippocampal substrates may support decreased stride length and increased stride length variability in older adults.

Where am I and how will I get there from here? A role for posterior parietal cortex in the integration of spatial information and route planning

The ability of an organism to accurately navigate from one place to another requires integration of multiple spatial constructs, including the determination of one's position and direction in space relative to allocentric landmarks, movement velocity, and the perceived location of the goal of the movement. In this review, we propose that while limbic areas are important for the sense of spatial orientation, the posterior parietal cortex is responsible for relating this sense with the location of a navigational goal and in formulating a plan to attain it. Hence, the posterior parietal cortex is important for the computation of the correct trajectory or route to be followed while navigating. Prefrontal and motor areas are subsequently responsible for executing the planned movement. Using this theory, we are able to bridge the gap between the rodent and primate literatures by suggesting that the allocentric role of the rodent PPC is largely analogous to the egocentric role typically emphasized in primates, that is, the integration of spatial orientation with potential goals in the planning of goal-directed movements.

Changes in the limb kinematics and walking-distance estimation after shank elongation: evidence for a locomotor body schema?

When walking, step length provides critical information on traveled distance along the ongoing path [corrected] Little is known on the role that knowledge about body dimensions plays within this process. Here we directly addressed this question by evaluating whether changes in body proportions interfere with computation of traveled distance for targets located outside the reaching space. We studied locomotion and distance estimation in an achondroplastic child (ACH, 11 yr) before and after surgical elongation of the shank segments of both lower limbs and in healthy adults walking on stilts, designed to mimic shank-segment elongation. Kinematic analysis of gait revealed that dynamic coupling of the thigh, shank, and foot segments changed substantially as a result of elongation. Step length remained unvaried, in spite of the significant increase in total limb length ( approximately 1.5-fold). These relatively shorter strides resulted from smaller oscillations of the shank segment, as would be predicted by proportional increments in limb size and not by asymmetrical segmental increment as in the present case (length of thighs was not modified). Distance estimation was measured by walking with eyes closed toward a memorized target. Before surgery, the behavior of ACH was comparable to that of typically developing participants. In contrast, following shank elongation, the ACH walked significantly shorter distances when aiming at the same targets. Comparable changes in limb kinematics, stride length, and estimation of traveled distance were found in adults wearing on stilts, suggesting that path integration errors in both cases were related to alterations in the intersegmental coordination of the walking limbs. The results are consistent with a dynamic locomotor body schema used for controlling step length and path estimation, based on inherent relationships between gait parameters and body proportions.

Vestibular syndrome: a change in internal spatial representation

The vestibular system contributes to a wide range of functions from reflexes to spatial representation. This paper reviews behavioral, perceptive, and cognitive data that highlight the role of changes in internal spatial representation on the vestibular syndrome. Firstly, we review how visual vertical perception and postural orientation depend on multiple reference frames and multisensory integration and how reference frames are selected according to the status of the peripheral vestibular system (i.e., unilateral or bilateral hyporeflexia), the environmental constraints (i.e., sensory cues), and the postural constraints (i.e., balance control). We show how changes in reference frames are able to modify vestibular lesion-induced postural and locomotor deficits and propose that fast changes in reference frame may be considered as fast-adaptive processes after vestibular loss. Secondly, we review data dealing with the influence of vestibular loss on higher levels of internal representation sustaining spatial orientation and navigation. Particular emphasis is placed on spatial performance according to task complexity (i.e., the required level of spatial knowledge) and to the sensory cues available to define the position and orientation within the environment (i.e., real navigation in darkness or visual virtual navigation without any actual self-motion). We suggest that vestibular signals are necessary for other sensory cues to be properly integrated and that vestibular cues are involved in extrapersonal space representation. In this respect, vestibular-induced changes would be based on a dynamic mental representation of space that is continuously updated and that supports fast-adaptive processes.

Update on epilepsy and cerebral localization

The field of epilepsy has contributed significantly to localization of neurologic function, particularly in the neocortex. Methodologies such as cortical stimulation, positron emission tomography, functional MRI, trans-cranial magnetic stimulation, surgical resection, and magnetoencephalography have been used successfully in patients with epilepsy to locate specific functions, primarily for the purpose of defining eloquent cortex before surgical resections. The left hemisphere serves language-related functions and verbal memory in most people, whereas the right hemisphere serves some language function in addition to perceiving most components of music and other forms of nonverbal material. Both hemispheres cooperate in understanding spatial relationships. Studies in patients with developmental abnormalities have enriched our understanding of localization of function within the cortex. Future studies may help us understand the sequence in which specific regions are activated during specific tasks and determine which regions are necessary for tasks and which are supplementary. The ability to predict preoperatively the effect of removal of specific tissues would benefit surgical planning for all patients who undergo cortical resections, including those with epilepsy.

Tailored anteromedial lobectomy in the treatment of refractory epilepsy of the temporal lobe: Long term surgical outcome and predictive factors

OBJECTIVE

To analyze long-term results and to determine prognostic factors on seizure outcome in a series of patients with temporal lobe epilepsy (TLE) who underwent anteromedial temporal lobectomy (AMTL).

MATERIALS AND METHODS

From 1995 to 1998 forty-two patients suffering from non-lesional TLE underwent tailored AMTL at our Institution. We retrospectively reviewed surgical results and calculated predictive factors of good outcome in the long term.

RESULTS

Sixty-four percent of patients were rendered seizure free (median follow up 60 months). Eleven cases (26.2%) had a significant reduction of disabling epileptic episodes. Poor seizure control was observed in four patients (9.5%). Overall surgical morbidity was 4.7%. Medial temporal sclerosis (MTS) was the most common histopathological finding (69% of cases). The presence of unilateral hippocampal abnormalities on qualitative MRI was significantly associated with excellent postoperative outcome (p<0.011). Qualitative preoperative MRI had a positive predictive value of 83% in detecting both MTS at pathological examination and excellent outcome.

CONCLUSIONS

Tailored AMTL is a safe and effective procedure in the treatment of selected patients with medically refractory TLE. Data from preoperative qualitative MRI well correlated with histopathological findings. The presence of unilateral hippocampal atrophy on qualitative MRI was predictive of excellent outcome in the long-term follow up.