Dissociation between the detection and perception of motion in Alzheimer's disease

Sensory processing deficits and related cortical pathological changes in Alzheimer's disease

Alzheimer's disease (AD) is a progressive neurodegenerative disorder primarily affecting cognitive functions. However, sensory deficits in AD start to draw attention due to their high prevalence and early onsets which suggest that they could potentially serve as diagnostic biomarkers and even contribute to the disease progression. This literature review examines the sensory deficits and cortical pathological changes observed in visual, auditory, olfactory, and somatosensory systems in AD patients, as well as in various AD animal models. Sensory deficits may emerge at the early stages of AD, or even precede the cognitive decline, which is accompanied by cortical pathological changes including amyloid-beta deposition, tauopathy, gliosis, and alterations in neuronal excitability, synaptic inputs, and functional plasticity. Notably, these changes are more pronounced in sensory association areas and superficial cortical layers, which may explain the relative preservation of basic sensory functions but early display of deficits of higher sensory functions. We propose that sensory impairment and the progression of AD may establish a cyclical relationship that mutually perpetuates each condition. This review highlights the significance of sensory deficits with or without cortical pathological changes in AD and emphasizes the need for further research to develop reliable early detection and intervention through sensory systems.

Motion perception and its disorders

As we live in a dynamic world, motion is a fundamental aspect of our visual experience. The advent of computerized stimuli has allowed controlled study of a wide array of motion phenomena, including global integration and segmentation, speed and direction discrimination, motion aftereffects, the optic flow that accompanies self-motion, perception of object form derived from motion cues, and point-light biological motion. Animal studies first revealed the existence of a motion-selective region, the middle temporal (MT) area, also known as V5, located in the lateral occipitotemporal cortex, followed by areas such as V5A (also known as MST, the middle superior temporal area), V6/V6A, the ventral intraparietal area, and others. In humans there are rare cases of bilateral lesions of the V5/V5A complex causing cerebral akinetopsia, a severe impairment of motion perception. Unilateral V5/V5A lesions are more common but cause milder asymptomatic deficits, often limited to the contralateral hemifield, while parietal lesions can impair perception of point-light biological motion or high-level motion tasks that are attentionally demanding. Impairments of motion perception have also been described in optic neuropathy, particularly glaucoma, as well as Alzheimer's disease, Parkinson's disease with dementia, and dementia with Lewy body disease. Prematurity with or without periventricular leukomalacia and developmental syndromes such as Williams' syndrome, autism, and dyslexia have also been associated with impaired motion perception, suggesting a developmental vulnerability of the dorsal pathway.

Navigational cue effects in Alzheimer's disease and posterior cortical atrophy

Objective

Deficits in spatial navigation are characteristic and disabling features of typical Alzheimer's disease (tAD) and posterior cortical atrophy (PCA). Visual cues have been proposed to mitigate such deficits; however, there is currently little empirical evidence for their use.

Methods

The effect of visual cues on visually guided navigation was assessed within a simplified real-world setting in individuals with tAD (n = 10), PCA (n = 8), and healthy controls (n = 12). In a repeated-measures design comprising 36 trials, participants walked to a visible target destination (an open door within a built environment), with or without the presence of an obstacle. Contrast and motion-based cues were evaluated; both aimed to facilitate performance by applying perceptual changes to target destinations without carrying explicit information. The primary outcome was completion time; secondary outcomes were measures of fixation position and walking path directness during consecutive task phases, determined using mobile eyetracking and motion capture methods.

Results

Results illustrate marked deficits in patients' navigational ability, with patient groups taking an estimated two to three times longer to reach target destinations than controls and exhibiting tortuous walking paths. There were no significant differences between tAD and PCA task performance. Overall, patients took less time to reach target destinations under cue conditions (contrast-cue: 11.8%; 95% CI: [2.5, 20.3]) and were more likely initially to fixate on targets.

Interpretation

The study evaluated navigation to destinations within a real-world environment. There is evidence that introducing perceptual changes to the environment may improve patients' navigational ability.

Vision in Alzheimer's disease: a focus on the anterior afferent pathway

Visual dysfunction has long been recognized as a manifestation of Alzheimer's disease (AD), particularly in the form of visuospatial impairment during all stages of disease. However, investigations have revealed findings within the anterior (i.e., pregeniculate) afferent visual pathways that rely on retinal imaging and electrophysiologic methodologies for detection. Here we focus on the anterior afferent visual pathways in AD and the measures used for assessment, including optical coherence tomography, electrophysiology, color vision testing and threshold visual field perimetry. A brief summary of higher order visual dysfunction is also included to allow the reader to keep in context the broader findings of afferent visual dysfunction in AD.

The maturation of global motion perception depends on the spatial and temporal offsets of the stimulus

The typical development of motion perception is commonly assessed with tests of global motion integration using random dot kinematograms. There are discrepancies, however, with respect to when typically-developing children reach adult-like performance on this task, ranging from as early as 3 years to as late as 12 years. To address these discrepancies, the current study measured the effect of frame duration (Δt) and signal dot spatial offset (Δx) on motion coherence thresholds in adults and children. Two Δt values were used in combination with seven Δx values, for a range of speeds (0.3-38 deg/s). Developmental comparisons showed that for the longer Δt, children performed as well as adults for larger Δx, and were immature for smaller Δx. When parameters were expressed as speed, there was a range of intermediate speeds (4-12 deg/s) for which maturity was dependent on the values of Δx and Δt tested. These results resolve previous discrepancies by showing that motion sensitivity to a given speed may be mature, or not, depending on the underlying spatial and temporal properties of the motion stimulus.

Visual motion event related potentials distinguish aging and Alzheimer's disease

BACKGROUND

Aging and Alzheimer's disease (AD) disrupt visuospatial processing and visual motion evoked potentials in a manner linked to navigational deficits.

OBJECTIVE

Our goal is to determine if aging and AD have distinct effects on visual cortical motion processing for navigation.

METHODS

We recorded visual motion event related potentials (ERPs) in young (YNC) and older normal controls (ONC), and early AD patients (EADs) who viewed rapidly changing optic flow stimuli that simulate naturalistic changes in heading direction, like those that occur when following a path of self-movement through the environment. After a random series of optic flow stimuli, a vertical motion stimulus was presented to verify sustained visual attention by demanding a rapid push-button response.

RESULTS

Optic flow evokes robust ERPs that are delayed in aging and diminished in AD. The interspersed vertical motion stimuli yielded shorter N200 latencies in EADs, matching those in ONCs, but the EADs' N200 amplitudes remained small.

CONCLUSIONS

Aging and AD have distinct effects on visual sensory processing: aging delays evoked response, whereas AD diminishes responsiveness.

Resting state FDG-PET functional connectivity as an early biomarker of Alzheimer's disease using conjoint univariate and independent component analyses

Imaging cerebral glucose metabolism with positron emission tomography (PET) in Alzheimer's disease (AD) has allowed for improved characterisation of this pathology. Such patterns are typically analysed using either univariate or multivariate statistical techniques. In this work we combined voxel-based group analysis and independent component analysis to extract differential characteristic patterns from PET data of glucose metabolism in a large cohort of normal elderly controls and patients with AD. The patterns were used in conjunction with a support vector machine to discriminate between subjects with mild cognitive impairment (MCI) at risk or not of converting to AD. The method was applied to baseline fluoro-deoxyglucose (FDG)-PET images of subjects from the ADNI database. Our approach achieved improved early detection and differentiation of typical versus pathological metabolic patterns in the MCI population, reaching 80% accuracy (85% sensitivity and 75% specificity) when using selected regions. The method has the potential to assist in the advance diagnosis of Alzheimer's disease, and to identify early in the development of the disease those individuals at high risk of rapid cognitive decline who could be candidates for new therapeutic approaches.

Detection of imminent collisions by drivers with Alzheimer's disease and Parkinson's disease: a preliminary study

The aim of this study was to assess whether patients with neurodegenerative disease, namely Alzheimer's disease (AD) and Parkinson's disease (PD), differed from age-matched, neurologically normal comparison participants in their ability to detect impending collisions. Six AD patients and 8 PD patients, together comprising the neurodegenerative disease group, and 18 comparison participants completed a collision detection simulation task where they must judge whether approaching objects would collide with them or pass by them. The neurodegenerative disease group was less sensitive in detecting collisions than the comparison group, and sensitivity worsened with increasing number of objects in the display and increasing time to contact of those objects. Poor performance on tests of cognition and visual attention were associated with poor collision detection sensitivity. The results of this study indicate that neurodegenerative disease impairs the ability to accurately detect impending collisions and that these decrements are likely the combined result of visual and cognitive disturbances related to disease status.

Visual motion processing in aging and Alzheimer's disease: neuronal mechanisms and behavior from monkeys to man

Aging and Alzheimer's disease (AD) are accompanied by impairments of autonomous navigation and spatial orientation that commonly demand the abandonment of driving and independent living. We have studied the neuronal mechanisms of navigation using single neurons in monkey cerebral cortex, finding a specific population of cells that processes the visual motion patterns of optic flow that provide important cues about self-movement. We have found that AD patients show pronounced deficits in the perceptual processing of optic flow, with different patterns of less severe impairment in mild cognitive impairment and cognitive aging. These perceptual deficits occur in subjects who show difficulties in real-world navigation that can be linked to visual associative processing impairments. Human neurophysiological recordings reveal a robust link between navigational capacity and cortical information processing in aging and AD. We conclude that visual information processing is progressively impaired in aging and AD. We speculate that these behavioral impairments reflect the progress of mechanistically linked cortical pathophysiologies that are manifestations of the fateful transition from cognitive aging to AD.

The sex specificity of navigational strategies in Alzheimer disease

Alzheimer disease (AD) is associated with navigational impairments that limit functional independence. We have now examined the role of cognitive and perceptual mechanisms in the navigational impairment of AD to test the hypothesis that men and women with AD may focus on different navigational cues. We conducted navigational, neuropsychologic, and psychophysical testing in men and women from 3 groups: older normal controls, patients with mild cognitive impairment, and patients with AD. Men and women showed parallel declines in navigational capacities from the older normal control, to the mild cognitive impairment, to the AD groups with men and women making similar numbers of errors but different types of errors. There were small sex differences in neuropsychologic and psychophysical performance but large sex differences in how those measures related to navigational capacity: men showed strong links between visual motion processing and navigation. Women showed strong links between verbal capacities and navigation. The findings of these cross-sectional comparisons suggest that there may be sex differences in the progressive navigational decline of AD: men and women who are impaired to the same degree may suffer somewhat different patterns of decline with men relying more on visuospatial processing and women relying more on verbal mediation.

Defining the nature of motion perception deficits in glaucoma using simple and complex motion stimuli

PURPOSE

The purpose of this study is to determine the nature of motion perception deficits in primary open-angle glaucoma by measuring the sensitivity of simple (luminance-defined) and complex (texture-defined) motion, the latter requiring supplementary neural processing to be resolved. These findings will help address the possible extent of the cortical damage in glaucoma that has been recently demonstrated by anatomic and physiological studies. They also serve the purpose of establishing which motion paradigms would be most appropriate for assessing glaucoma-related functional loss.

METHODS

Direction-identification thresholds for first-order and second-order motion were measured for 26 patients with primary open-angle glaucoma (for both phakic and pseudophakic) and 18 nonglaucomatous observers.

RESULTS

The glaucomatous observers showed significantly increased motion thresholds for both first- and second-order motion conditions when compared with nonglaucomatous observers. However, the relative increase in threshold for first-order motion did not differ significantly from that of second-order motion.

CONCLUSIONS

These findings imply that there is no measurable higher-level cortical function damage caused by the glaucomatous process because no greater loss in second-order motion was observed. Based on the results, we suggest that motion paradigms used to assess functional loss in primary open-angle glaucoma should consist of simple, first-order type stimuli to minimize potential confounds such as those introduced by both the normal and pathologic aging process on complex motion processing (i.e., perimetry using complex motion stimuli).

The Effects of Optical Blur on Motion and Texture Perception

PURPOSE

The purpose of this study is to determine how decreased visual acuity affects performance on tasks of motion and texture perception.

METHODS

Positive diopter lenses were used to match three subjects at five levels of decimal visual acuity (DVA) ranging from an uncorrected DVA of 1.6 to the lowest DVA of 0.2. Performance thresholds were determined at each acuity level for five different psychophysical tasks. The tasks assessed the perception of motion-defined form, global motion, maximum motion displacement (Dmax), texture-defined form, and global texture.

RESULTS

Reducing visual acuity decreased performance on the tasks of motion-defined form identification, texture-defined form identification, and global texture integration. Performance on the Dmax task improved with a reduction in visual acuity. Performance on the global motion task was unaffected by changes in visual acuity.

CONCLUSIONS

Visual acuity should be considered when interpreting the results of developmental or clinical studies of motion and texture perception. The only exception to this is global motion perception, at least when DVA is better than 0.2. The effect of blur on tasks of motion and texture perception may reflect the extent to which high spatial frequency information is required for performance on these tasks.

Motion perception in the ageing visual system: minimum motion, motion coherence, and speed discrimination thresholds

We aimed to address two issues: first, to describe how the perception of motion differs in elderly observers as compared to younger ones; and, second, to see if these changes in motion perception could be accounted for by the known changes in the ability of elderly observers to detect patterns (as indexed via contrast sensitivity). The lower threshold of motion, motion coherence, and speed discrimination were measured, alongside contrast sensitivity, in a group of thirty-two older (mean age 61.5 years) and thirty-two younger (mean age 23.2 years) subjects. The older observers showed losses in their ability to detect slow motions as indexed via the lower threshold of motion for random-dot patterns and for gratings of a range of spatial frequencies. They also were impaired on a test of motion coherence, but only for stimuli of a slow to medium speed, whereas faster speeds showed no decline with age. Finally, at all speeds tested the older observers required greater differences in speed in order to discriminate between patterns moving at different speeds. The pattern of losses on motion perception tasks was not predicted by the deficits of the older groups, such as loss of detection thresholds for high spatial and/or temporal frequencies. It is concluded that these hypotheses do not provide an adequate account of the data, and therefore that the losses occurring with age are complex and probably are a result of the loss of several types of cell.

Neurophysiological and perceptual correlates of navigational impairment in Alzheimer's disease

We assessed visual processing related to navigational impairment in Alzheimer's disease hypothesizing that visual motion evoked responses to optic flow simulating observer self-movement would be linked to navigational performance. Mild Alzheimer's disease and older adult control subjects underwent open-field navigational testing, visual motion perceptual threshold determination and a battery of neuropsychological examinations. We recorded visual motion evoked potentials (EPs) at occipital and parietal sites during centred visual fixation. Randomly moving or stationary pattern pre-stimuli preceded horizontal motion and radial optic flow stimuli to separate motion N200s from pattern onset responses. Radial optic flow evoked N200 responses comparable with those obtained with uniform horizontal motion, despite the variety of motion directions in radial optic flow. Alzheimer's disease patients showed smaller radial optic flow N200s than older adult subjects, and these were greatly diminished when preceded by stationary dots. Combining N200 amplitudes with optic flow perceptual thresholds and contrast sensitivities yielded a strong correlation with navigational impairment in Alzheimer's disease (R2 = 0.95). We conclude that navigational impairment in Alzheimer's disease is linked to a disorder of extrastriate visual cortical motion processing reflected in specific perceptual and neurophysiological measures.

Neural substrates of cognitive and behavioral deficits in atypical Alzheimer's disease

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by a progressive cognitive decline that typically affects first memory and later executive functions, language, and visuospatial skills. This sequence of cognitive deterioration is thought to reflect the progressive invasion of the cerebral cortex by the two major pathological hallmarks of AD, neurofibrillary tangles (NFT) and senile plaques (SP), as well as degree of neuronal and synaptic loss. In atypical AD, prominent and early deficits are found in language, motor abilities, frontal and executive capacities, or visuospatial skills. These atypical clinical features are associated with an unusual pattern of NFT or SP formation that predominantly involves cortical areas usually spared in the course of the degenerative process. In an attempt to classify this highly heterogeneous subgroup, the present article provides an overview of clinicopathological analyses in patients with atypical progression of AD symptomatology with special reference to the relationship between specific cognitive and behavioral deficits and hierarchical patterns of AD lesion distribution within the cerebral cortex. On the basis of these representative examples of a cortical circuit-based approach to explore the mechanisms giving rise to AD neuropsychological expression, we also critically discuss the possibility to develop a matrix linking clinical presentations to degeneration of forward and backward long corticocortical pathways in this disorder.

Disorders of motion and depth

Damage to the human homologue of area MT produces a motion perception deficit similar to that found in the monkey with MT lesions. Even temporary disruption of MT processing with transcranial magnetic stimulation can produce a temporary akinetopsia [127]. Motion perception deficits, however, also are found with a variety of subcortical lesions and other neurologic disorders that can best be described as causing a disconnection within the motion processing stream. The precise role of these subcortical structures, such as the cerebellum, remains to be determined. Simple motion perception, moreover, is only a part of MT function. It undoubtedly has an important role in the perception of depth from motion and stereopsis [112]. Psychophysical studies using aftereffects in normal observers suggest a link between stereo mechanisms and the perception of depth from motion [9-11]. There is even a simple correlation between stereo acuity and the perception of depth from motion [128]. Future studies of patients with cortical lesions will take a closer look at depth perception in association with motion perception and should provide a better understanding of how motion and depth are processed together.

Attentional dynamics and visual perception: mechanisms of spatial disorientation in Alzheimer's disease

Visuospatial disorientation forces Alzheimer's disease patients to abandon independent activities. We found previously that limitations of ambulatory and vehicular navigation are linked to impaired visual motion processing in Alzheimer's disease. We now hypothesize that these perceptual impairments reflect temporal constraints on visual attention. We evaluated attentional, perceptual and neuropsychological capacities in 14 Alzheimer's disease patients and 12 age-matched older normal controls. The temporal dynamics of visual attention were measured using rapid serial visual presentation (RSVP) to assess the attentional blink. Visual processing for spatial orientation was assessed using perceptual thresholds for optic flow, the visual motion seen during observer self-movement. Alzheimer's disease patients show an exaggerated attentional blink during RSVP, identifying the first of two targets but missing the second target depending on the number of intervening distractors. They also show a unique form of attentional masking in which they miss the first target but identify the second, again depending on the number of intervening distractors. Both types of RSVP errors are correlated with selectively elevated optic flow thresholds in Alzheimer's disease patients. This suggests that temporal constraints on visual perception might impair optic flow analysis and contribute to spatial disorientation in Alzheimer's disease. These findings are consistent with two-stage models of visual perception, suggesting that the working memory mechanisms in the second stage provide feedback control of input to category-specific perceptual processors in the first stage.

Motion coherence thresholds in infants--different tasks identify at least two distinct motion systems

Optokinetic nystagmus (OKN) can be demonstrated from birth, but behavioural discrimination tasks such as habituation and preferential looking do not reveal any sensitivity to motion direction until a few weeks of age. This study compared coherence threshold for motion direction for OKN and preferential looking responses using closely comparable stimuli, in infants between 6 and 27 weeks of age. Infants were tested with two random dot motion displays, a uniform area of moving dots for OKN responses and a display in which a region was segmented on one side by differential motion direction for preferential looking responses. Coherence thresholds for each response were determined by a staircase method. For OKN responses, mean coherence thresholds were between 20% and 25%, with no significant improvement in OKN performance throughout the age range. Preferential looking thresholds were significantly higher than OKN thresholds. Preferential looking thresholds improved significantly with age, but remained higher than OKN thresholds throughout the age range tested. Experiments varying direction reversal frequency and stimulus area indicated that these differences were not simply a consequence of the spatial and temporal non-uniformity of the preferential looking stimulus. The differences in sensitivity levels and age trends for OKN and preferential looking responses we have found suggest that different directional mechanisms are involved in the two responses. We discuss the possibility that, in early infancy, OKN and preferential looking reflect the performance of subcortical and cortical directional mechanisms respectively.

Atypical form of Alzheimer's disease with prominent posterior cortical atrophy: a review of lesion distribution and circuit disconnection in cortical visual pathways

In recent years, the existence of visual variants of Alzheimer's disease characterized by atypical clinical presentation at onset has been increasingly recognized. In many of these cases post-mortem neuropathological assessment revealed that correlations could be established between clinical symptoms and the distribution of neurodegenerative lesions. We have analyzed a series of Alzheimer's disease patients presenting with prominent visual symptomatology as a cardinal sign of the disease. In these cases, a shift in the distribution of pathological lesions was observed such that the primary visual areas and certain visual association areas within the occipito-parieto-temporal junction and posterior cingulate cortex had very high densities of lesions, whereas the prefrontal cortex had fewer lesions than usually observed in Alzheimer's disease. Previous quantitative analyses have demonstrated that in Alzheimer's disease, primary sensory and motor cortical areas are less damaged than the multimodal association areas of the frontal and temporal lobes, as indicated by the laminar and regional distribution patterns of neurofibrillary tangles and senile plaques. The distribution of pathological lesions in the cerebral cortex of Alzheimer's disease cases with visual symptomatology revealed that specific visual association pathways were disrupted, whereas these particular connections are likely to be affected to a less severe degree in the more common form of Alzheimer's disease. These data suggest that in some cases with visual variants of Alzheimer's disease, the neurological symptomatology may be related to the loss of certain components of the cortical visual pathways, as reflected by the particular distribution of the neuropathological markers of the disease.