PET study of greater visual activation in schizophrenia

Steady-state visually evoked potentials: focus on essential paradigms and future perspectives

After 40 years of investigation, steady-state visually evoked potentials (SSVEPs) have been shown to be useful for many paradigms in cognitive (visual attention, binocular rivalry, working memory, and brain rhythms) and clinical neuroscience (aging, neurodegenerative disorders, schizophrenia, ophthalmic pathologies, migraine, autism, depression, anxiety, stress, and epilepsy). Recently, in engineering, SSVEPs found a novel application for SSVEP-driven brain-computer interface (BCI) systems. Although some SSVEP properties are well documented, many questions are still hotly debated. We provide an overview of recent SSVEP studies in neuroscience (using implanted and scalp EEG, fMRI, or PET), with the perspective of modern theories about the visual pathway. We investigate the steady-state evoked activity, its properties, and the mechanisms behind SSVEP generation. Next, we describe the SSVEP-BCI paradigm and review recently developed SSVEP-based BCI systems. Lastly, we outline future research directions related to basic and applied aspects of SSVEPs.

Abnormal externally guided movement preparation in recent-onset schizophrenia is associated with impaired selective attention to external input

Several theories propose that the primary cognitive impairment in schizophrenia concerns a deficit in the processing of external input information. There is also evidence, however, for impaired motor preparation in schizophrenia. This provokes the question whether the impaired motor preparation in schizophrenia is a secondary consequence of disturbed (selective) processing of the input needed for that preparation, or an independent primary deficit. The aim of the present study was to discriminate between these hypotheses, by investigating externally guided movement preparation in relation to selective stimulus processing. The sample comprised 16 recent-onset schizophrenia patients and 16 controls who performed a movement-precuing task. In this task, a precue delivered information about one, two or no parameters of a movement summoned by a subsequent stimulus. Performance measures and measures derived from the electroencephalogram showed that patients yielded smaller benefits from the precues and showed less cue-based preparatory activity in advance of the imperative stimulus than the controls, suggesting a response preparation deficit. However, patients also showed less activity reflecting selective attention to the precue. We therefore conclude that the existing evidence for an impairment of externally guided motor preparation in schizophrenia is most likely due to a deficit in selective attention to the external input, which lends support to theories proposing that the primary cognitive deficit in schizophrenia concerns the processing of input information.

Early stage vision in schizophrenia and schizotypal personality disorder

Previous studies of visual perception have reported deficits in contrast sensitivity and dot motion discrimination in schizophrenia. We tested whether these deficits also appear in schizotypal personality disorder (SPD). SPD appears to be genetically and symptomatically related to schizophrenia, but without the marked psychosocial impairment associated with psychotic disorders. The present study investigated contrast sensitivity for moving and static gratings, form discrimination and dot motion discrimination in 24 patients with schizophrenia or schizoaffective disorder (SZ), 16 individuals with SPD, and 40 control subjects. SZ, but not SPD subjects, showed impairments on tests of contrast sensitivity for static and moving gratings, form discrimination in noise, and dot motion discrimination. Visual performance did not differ between medicated SZ patients and patients withdrawn from medication. These results confirm early stage visual deficits in schizophrenia regardless of medication status. SPD subjects, in contrast, show intact early stage visual processing despite the presence of marked schizotypal symptoms.

Steady state visual evoked potential abnormalities in schizophrenia

OBJECTIVE

The steady state visual evoked potential (SSVEP) can be used to test the frequency response function of neural circuits. Previous studies have shown reduced SSVEPs to alpha and lower frequencies of stimulation in schizophrenia. We investigated SSVEPs in schizophrenia at frequencies spanning the theta (4Hz) to gamma (40Hz) range.

METHODS

The SSVEPs to seven different frequencies of stimulation (4, 8, 17, 20, 23, 30 and 40Hz) were obtained from 18 schizophrenia subjects and 33 healthy control subjects. Power at stimulating frequency (signal power) and power at frequencies above and below the stimulating frequency (noise power) were used to quantify the SSVEP responses.

RESULTS

Both groups showed an inverse relationship between power and frequency of stimulation. Schizophrenia subjects showed reduced signal power compared to healthy control subjects at higher frequencies (above 17Hz), but not at 4 and 8Hz at occipital region. Noise power was higher in schizophrenia subjects at frequencies between 4 and 20Hz over occipital region and at 4, 17 and 20Hz over frontal region.

CONCLUSIONS

SSVEP signal power at beta and gamma frequencies of stimulation were reduced in schizophrenia. Schizophrenia subjects showed higher levels of EEG noise during photic stimulation at beta and lower frequencies.

SIGNIFICANCE

Inability to generate or maintain oscillations in neural networks may contribute to deficits in visual processing in schizophrenia.

Neural response to emotional salience in schizophrenia

Neuroimaging probes of brain regions implicated in emotion represent an important research strategy for understanding emotional dysfunction in schizophrenia. Anterior limbic structures, such as the ventral striatum and the amygdala, have been implicated in the pathophysiology of schizophrenia and the generation of emotional responses, although few studies to date have used emotion probes to target these areas in schizophrenia. With this goal in mind, emotionally salient visual images were used in a simple, nondemanding task. In all, 13 medicated, schizophrenic patients, five unmedicated patients, and 10 healthy volunteers viewed complex visual pictures and a nonsalient, blank screen while regional cerebral blood flow was measured with the [O-15] water technique. Pictures consisted of real world scenes with aversive, positive, and nonaversive content. Eye movements were recorded simultaneous with scan acquisition. Positron emission tomography images were analyzed for baseline, tonic activity, in addition to phasic changes ('activation') to salient stimuli. Lateral eye movement measures and on-line ratings showed good behavioral compliance with the task. Patients with schizophrenia showed impaired neural responses to salient stimuli in the right ventral striatum (VS), and they exhibited elevated tonic activity levels in the right VS and bilateral amygdala, inversely correlated with overall symptom severity. The patients also showed reduced modulation of visual cortex by salient stimuli. The results show that patients with schizophrenia exhibit impaired neural responses to emotionally salient stimuli in the VS, supporting a role for this structure in the pathophysiology of the illness. Reduced modulation of visual cortex by emotionally salient stimuli also suggests a failure to organize cerebral activity at a global level.

Reduced facilitation effect of collinear flankers on contrastdetection reveals impaired lateral connectivity in the visual cortex of schizophrenia patients

The aim of this study was to investigate lateral connectivity in early visual cortex of schizophrenia patients. Contrast thresholds were measured for centrally presented Gabor patches which were surrounded by two collinear or orthogonal flankers. The healthy subjects (n = 15) showed lower contrast thresholds for central Gabor patches when collinear flankers were presented. This effect was significantly reduced in unmedicated highly functioning schizophrenia patients (n = 20) who performed normally on the continuous performance test. The performance of the patients did not correlate with the positive and negative symptoms. The facilitation effect of collinear flankers is believed to reflect lateral interactions between feature-specific units in early visual cortex (V1). Our results therefore suggest abnormal lateral interactions in early visual cortex of schizophrenia patients.

Hemodynamic responses in visual, motor, and somatosensory cortices in schizophrenia

Recent advances in functional neuroimaging allow comparisons between individuals with schizophrenia and control groups. Previous studies of schizophrenia have used blocked task paradigms and, more recently, "rapid event-related" designs in which stimuli of different types are presented close together in an intermixed fashion. The validity of between-group comparisons in both of these types of paradigms depends on excluding the possibility that observed functional response differences are attributable to altered hemodynamic responses in individuals with schizophrenia. The goal of the current study was to begin a systematic examination of the hemodynamic response in schizophrenia. We administered a flashing checkerboard paradigm with a motor response to 17 individuals with schizophrenia and 24 healthy controls. Both groups showed robust activation of visual, motor, somatosensory, and supplementary motor regions. For the most part, the individuals with schizophrenia demonstrated intact peak amplitude, variance, latency, and linear summation properties in regions activated by this task. We did find some evidence for increased variability in the amplitude and latency of the hemodynamic responses in the visual and somatosensory cortices, although the magnitudes of these group differences were relatively small. These results begin to validate the interpretation of functional neuroimaging studies of schizophrenia in terms of neuronal as opposed to vascular mechanisms.

Four facets of a single brain: behaviour, cerebral blood flow/metabolism, neuronal activity and neurotransmitter dynamics

Is functional neuroimaging a royal way to understand brain function or is it a new phrenology without an exact understanding what we measure? After two decades of imaging revolution, more and more authors ask this question. Brain functions are multidimensional, which can be approached from the point of (1) behavioural measures, (2) brain activation as reflected by blood flow and metabolic changes, (3) electrical activity of cells and cell-populations, and (4) neurotransmitter dynamics (release, receptor binding and reuptake). Using imaging techniques, we must take into consideration that even during the simplest task all of these processes operate in a closely interacting manner. Therefore, before drawing final conclusions about brain functions on the basis of a single aspect of these mechanisms, we must clarify the exact relationship among them. In this paper, we address this issue in order to draw attention to a number of uncertainties and controversies in the relationship of the four facets of brain functions.

Spatial frequency discrimination in schizophrenia

Pathways within the visual system can be distinguished on the basis of selectivity for low or high spatial frequencies. Spatial frequency discrimination was evaluated in 17 medicated male patients with schizophrenia and 19 male control subjects. Subjects were required to discriminate whether pairs of high contrast, sinusoidally modulated gratings were the same or different in spatial frequency. Accuracy performance was compared at high, medium, and low spatial frequencies on tasks matched for control performance. Patients showed a greater performance decrement of 12% on low as compared with 4% on high spatial frequencies. These findings suggest a disturbance of right hemisphere mechanisms involved in spatial perception and attention in schizophrenia.

Spatial frequency discrimination in schizophrenia

Pathways within the visual system can be distinguished on the basis of selectivity for low or high spatial frequencies. Spatial frequency discrimination was evaluated in 17 medicated male patients with schizophrenia and 19 male control subjects. Subjects were required to discriminate whether pairs of high contrast, sinusoidally modulated gratings were the same or different in spatial frequency. Accuracy performance was compared at high, medium, and low spatial frequencies on tasks matched for control performance. Patients showed a greater performance decrement of 12% on low as compared with 4% on high spatial frequencies. These findings suggest a disturbance of right hemisphere mechanisms involved in spatial perception and attention in schizophrenia.

Sex differences in response to red and blue light in human primary visual cortex: a bold fMRI study

Studies using a variety of investigative methods, including functional brain imaging and electroencephalography (EEG), have suggested that changes in central nervous system (CNS) dopamine function result in altered visual system processing. The discovery of abnormal retinal blue cone, but not red cone, electroretinogram in association with cocaine withdrawal and Parkinson's disease suggests that visual system response to blue light might be a marker for CNS dopamine tone. As there are numerous sex-related differences in central nervous system dopamine function, we predicted that blue and red light stimulation would produce sex-specific patterns of response in primary visual cortex when studied using the blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) technique. We analyzed the BOLD response to red and blue light in male and female human volunteers (N=20). Red and blue light responses in primary visual cortex (V1) to stepped intensities of red and blue light were compared by sex for threshold to detectable BOLD signal increase and for stimulus intensity vs. BOLD signal response. Near threshold, males and females showed similar BOLD signal change to red light, but males showed a threefold greater increase (0.52%) to blue light stimulation when compared to females (0.14%). Log-linear regression modeling revealed that the slope coefficients for the red light stimulus intensity vs. signal change curve were not significantly different for males and females (z=0.995, P=0.320), whereas the slope coefficients for the blue light stimulus intensity vs. signal change curve were significantly larger in males (z=2.251, P=0.024). These findings support a sex and color-dependent differential pattern of primary visual cortical response to photic stimulation and suggest a method for assessing the influence of specific dopamine agonist/antagonist medications on visual function.

Visual perception and working memory in schizotypal personality disorder

OBJECTIVE

Patients affected by schizophrenia show deficits in both visual perception and working memory. The authors tested early-stage vision and working memory in subjects with schizotypal personality disorder, which has been biologically associated with schizophrenia.

METHOD

Eleven subjects who met DSM-III-R criteria for schizotypal personality disorder and 12 normal comparison subjects were evaluated. Performance thresholds were obtained for tests of visual discrimination and working memory. Both form and trajectory processing were evaluated for each task.

RESULTS

Subjects with schizotypal personality disorder showed intact discrimination of form and trajectory but were impaired on working memory tasks.

CONCLUSIONS

These data suggest that subjects with schizotypal personality disorder, unlike patients affected by schizophrenia, have relatively intact visual perception. Subjects with schizotypal personality disorder do show specific deficits on tasks of comparable difficulty when working memory demands are imposed. Schizotypal personality disorder may be associated with a more specific visual processing deficit than schizophrenia, possibly reflecting disruption of frontal lobe systems subserving visual working memory operations.

Interhemispheric EEG coherence in never-medicated patients with paranoid schizophrenia: analysis at rest and during photic stimulation

We assessed functional relationships between hemispheres by calculating interhemispheric EEG coherence at rest and during photic stimulation in 18 never-medicated patients with paranoid schizophrenia and 30 control subjects. Although no significant group differences were found in the resting EEG, the schizophrenic patients had significantly higher coherence on EEGs recorded during photic stimulation, compared to the control subjects. In this study, we also examined the changes in interhemispheric coherence from rest to the stimulus condition (i.e., stimulation-related coherence reactivity); the patients were found to show significantly greater coherence reactivity to photic stimulation. These findings provide further evidence that schizophrenic patients have a higher degree of interhemispheric functional connectivity and thus have less lateralized cerebral organization than normal subjects. Our results also suggest that schizophrenic patients have excessive functional reorganization between hemispheres in association with photic stimulation.