Pathophysiology underlying diminished attention to novel events in patients with early AD

Specific mechanisms underlying executive and emotional apathy: A phenotyping study

Apathy is a behavioral symptom prevalent both in neuropsychiatric pathologies and in the healthy population. However, the knowledge of the cognitive and neural mechanisms underlying apathy is still very limited, even if clinical and fMRI data support the existence of three forms of apathy (executive, emotional, initiative). These forms could be explained by the alteration of specific mechanisms. This present study's aim is to specify the cognitive and neuronal mechanisms of executive and emotional apathy. We used an EEG study conducted on 68 subjects comprising two groups of young people with specific executive or emotional phenotypes of apathy and one group with no apathy. Despite having symptom of apathy, participants were free of any neurological, metabolic, or psychiatric diagnoses and with high education. Two tasks were used: the DPX for cognitive control and the MID for motivation. Our results showed that distinct mechanisms underlie these two forms of apathy, and, for the first time, we specified these mechanisms. A deficit of the proactive control mode, reflected by a reduced probe-N2 amplitude in AY trials, underlies the executive form of apathy (p < .03), whereas liking motivational blunting, highlighted by a reduced LPP amplitude for financial loss, characterizes the emotional form (p < .04). The main limit of the results is that generalizability to the general population may be reduced since the apathetic samples were chosen for having a specific form of apathy. To conclude, better knowledge of these mechanisms informs new, more targeted treatments, both pharmacological and non-pharmacological, necessary for reducing the debilitating consequences of apathy.

Contextual novelty detection and novelty-related memory enhancement in amnestic mild cognitive impairment

INTRODUCTION

Though novelty processing plays a critical role in memory function, little is known about how it influences learning in memory-impaired populations, such as amnestic Mild Cognitive Impairment (aMCI).

METHODS

21 aMCI patients and 22 age- and education-matched healthy older participants performed two tasks-(i) an oddball paradigm where fractals that were often repeated (60 % of the stimuli), less frequently repeated (20 %), or novel (presented once each) were shown to assess novelty preference (longer viewing time for novel than familiar stimuli), and (ii) a Von Restorff paradigm assessing novelty-related effects on memory. Participants studied 22 lists of 10 words. Among these lists, 18 contained an isolated word different from the others by its distinctive aspect, here the font size (90-point, 120-point or 150-point against 60-point for non-isolated words). The remaining four were control lists without isolated words. After studying each list, participants freely recalled the maximum words possible.

RESULTS

For the oddball task, a group-by-stimulus type ANOVA on median viewing times revealed a significant effect of stimulus type, but not of group. Both groups spent more time on novel stimuli. For the Von Restorff task, both aMCI and healthy controls recalled the isolated words (presented in 120-point or 150-point, but not 90-point) better than others (excluding primacy and recency effects). Novelty-related memory benefit-gain factor-was computed as the difference between the recall scores for isolated and other words. A group-by-font size ANOVA on gain factors revealed no group effect, nor interaction, suggesting that aMCI patients benefited from novelty, alike controls.

CONCLUSION

Novelty preference and the boosting effect of isolation-related novelty on subsequent recall seem preserved despite impaired episodic memory in aMCI patients. This is discussed in the light of contemporary divergent theories regarding the relationship between novelty and memory, as either being independent or parts of a continuum.

The Appraisal Approach to Aging and Emotion: An Integrative Theoretical Framework

To advance our understanding of how emotional experience changes across the adult life span, we propose an integrative theoretical framework: the appraisal approach to aging and emotion (AAAE). AAAE posits that (a) age-related cognitive, motivational, and physical changes fundamentally change the appraisal system in certain ways, and that (b) older adults often deploy appraisal processes in different ways relative to their younger counterparts. As such, we hypothesize that these age-related changes to the appraisal process underlie the finding that older and younger adults tend to experience different emotions. In this paper we integrate findings from the aging literature with appraisal theory, grounding AAAE in theoretical and empirical work relevant to the relationship between aging and appraisal processes. Using our theoretical framework, it is possible to identify critical points of investigation for aging and emotion researchers to further develop our understanding of the proximal-level determinants of age differences in emotion.

Markers of Novelty Processing in Older Adults Are Stable and Reliable

Exploratory behavior and responsiveness to novelty play an important role in maintaining cognitive function in older adults. Inferences about age- or disease-related differences in neural and behavioral responses to novelty are most often based on results from single experimental testing sessions. There has been very limited research on whether such findings represent stable characteristics of populations studied, which is essential if investigators are to determine the result of interventions aimed at promoting exploratory behaviors or draw appropriate conclusions about differences in the processing of novelty across diverse clinical groups. The goal of the current study was to investigate the short-term test-retest reliability of event-related potential (ERP) and behavioral responses to novel stimuli in cognitively normal older adults. ERPs and viewing durations were recorded in 70 healthy older adults participating in a subject-controlled visual novelty oddball task during two sessions occurring 7 weeks apart. Mean midline P3 amplitude and latency, mean midline amplitude during successive 50 ms intervals, temporospatial factors derived from principal component analysis (PCA), and viewing duration in response to novel stimuli were measured during each session. Analysis of variance (ANOVA) revealed no reliable differences in the value of any measurements between Time 1 and 2. Intraclass correlation coefficients (ICCs) between Time 1 and 2 were excellent for mean P3 amplitude (ICC = 0.86), the two temporospatial factors consistent with the P3 components (ICC of 0.88 and 0.76) and viewing duration of novel stimuli (ICC = 0.81). Reliability was only fair for P3 peak latency (ICC = 0.56). Successive 50 ms mean amplitude measures from 100 to 1,000 ms yielded fair to excellent reliabilities, and all but one of the 12 temporospatial factors identified demonstrated ICCs in the good to excellent range. We conclude that older adults demonstrate substantial stability in ERP and behavioral responses to novel visual stimuli over a 7-week period. These results suggest that older adults may have a characteristic way of processing novelty that appears resistant to transient changes in their environment or internal states, which can be indexed during a single testing session. The establishment of reliable measures of novelty processing will allow investigators to determine whether proposed interventions have an impact on this important aspect of behavior.

A Noteworthy Pathology in Children with Learning Disabilities: Late Latency Response Failure in Central Auditory Processing

OBJECTIVES

This study investigates the cortical auditory pathways in children with and without learning disability (LD).

MATERIALS AND METHODS

A prospective, controlled clinical study was conducted on patients diagnosed with LD and was followed-up for a minimum period of 6 months in the Department of Child and Adolescent Psychiatry were included as study group. The control group comprised of age- and gender-matched healthy individuals. After otolaryngological and psychiatric examination, all participants were tested using pure-tone audiometry, tympanometry, acoustic reflex, and cortical auditory evoked potentials. Test results were evaluated and compared for each group.

RESULTS

The study included a total of 60 children (30 children with LD as study group and 30 healthy children as control group) who met the inclusion criteria. When event-related potentials were taken into consideration, P2 and P300 mean amplitudes for right ears and N1 and P300 mean amplitudes for left ears were significantly lower in study group than those in the control group. Likewise, P2 and P300 mean latency in right ears and P1, N1, and P300 mean latency in left ears were prolonged in study group (p<0.05).

CONCLUSION

Patients with LD may have disorders of the cortical auditory processing even if they have normal hearing screening tests. Pathologies in late-latency evoked potentials may have a role in the etiology of these patients.

Dynamic cortical connectivity alterations associated with Alzheimer's disease: An EEG and fNIRS integration study

Emerging evidence indicates that cognitive deficits in Alzheimer's disease (AD) are associated with disruptions in brain network. Exploring alterations in the AD brain network is therefore of great importance for understanding and treating the disease. This study employs an integrative functional near-infrared spectroscopy (fNIRS) – electroencephalography (EEG) analysis approach to explore dynamic, regional alterations in the AD-linked brain network. FNIRS and EEG data were simultaneously recorded from 14 participants (8 healthy controls and 6 patients with mild AD) during a digit verbal span task (DVST). FNIRS-based spatial constraints were used as priors for EEG source localization. Graph-based indices were then calculated from the reconstructed EEG sources to assess regional differences between the groups. Results show that patients with mild AD revealed weaker and suppressed cortical connectivity in the high alpha band and in beta band to the orbitofrontal and parietal regions. AD-induced brain networks, compared to the networks of age-matched healthy controls, were mainly characterized by lower degree, clustering coefficient at the frontal pole and medial orbitofrontal across all frequency ranges. Additionally, the AD group also consistently showed higher index values for these graph-based indices at the superior temporal sulcus. These findings not only validate the feasibility of utilizing the proposed integrated EEG-fNIRS analysis to better understand the spatiotemporal dynamics of brain activity, but also contribute to the development of network-based approaches for understanding the mechanisms that underlie the progression of AD.

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Dynamic brain networks of healthy controls and patients with mild AD are documented via an integrative fNIRS-EEG approach.

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FNIRS-based constraints are employed as spatial priors for EEG source localization.

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Mild AD group reveals weaker connectivity to the orbitofrontal and parietal regions in high alpha band and beta band.

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AD-linked brain networks are characterized by lower degree and clustering coefficient at the frontal area.

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AD group also reveals higher index values for these graph-based indices at the superior temporal sulcus.

Effect of Methylphenidate for Apathy on Visual Attention Scanning Behavior: a Pilot Study

Background

The purpose of this pilot study was to explore the potential of eye-tracking technology in monitoring symptoms and predicting outcomes in apathetic Alzheimer’s disease (AD) patients treated with methylphenidate (MTP).

Methods

Neuropsychological tests and eye-tracking measurements were completed at baseline and following at least four weeks of treatment with MTP (5–10 mg BID). Eye-movements were measured while patients viewed novel and social stimuli. Cognition, behavior, and apathy were assessed using the Standardized Mini-Mental State Exam (sMMSE), Neuropsychiatric Inventory, and Apathy Evaluation Scale (AES), respectively.

Results

Nine patients were included in the analysis (age: median=75, interquartile range=8; sMMSE: median=22, interquartile range=14). Spearman correlations showed that improvement on the AES was associated with increased visual attention towards novel stimuli (ρ₇=−0.809, p=.008). Additionally, lower baseline attention towards social images was associated with improvement on the AES (ρ₇=0.905, p=.001).

Conclusions

Eye-tracking techniques can be developed as an objective and nonverbal method of monitoring symptoms and treatment outcomes in AD patients.

Do Event-Related Evoked Potentials Reflect Apathy Tendency and Motivation?

Apathy is a mental state of diminished motivation. Although the reward system as the foundation of the motivation in the human brain has been studied extensively with neuroimaging techniques, the electrophysiological correlates of motivation and apathy have not been fully explored. Thus, in 14 healthy volunteers, we examined whether event-related evoked potentials (ERP) obtained during a simple number discrimination task with/without rewards reflected apathy tendency and a reward-dependent tendency, which were assessed separately using the apathy scale and the temperament and character inventory (TCI). Participants were asked to judge the size of a number, and received feedback based on their performance in each trial. The P3 amplitudes related to the feedback stimuli increased only in the reward condition. Furthermore, the P2 amplitudes related to the negative feedback stimuli in the reward condition had a positive correlation with the reward-dependent tendency in TCI, whereas the P3 amplitudes related to the positive feedback stimuli had a negative correlation with the apathy score. Our result suggests that the P2 and P3 ERPs to reward-related feedback stimuli are modulated in a distinctive manner by the motivational reward dependence and apathy tendency, and thus the current paradigm may be useful for investigating the brain activity associated with motivation.

Cortical function in Alzheimer's disease and frontotemporal dementia

Objectives

Alzheimer’s disease (AD) and the behavioral variant of frontotemporal dementia (bvFTD) are the most common causes of dementia; however, their overlapping clinical syndromes and involved brain regions make a differential diagnosis difficult. We aimed to identify the differences in the cognition and motor cortex excitability between AD and bvFTD patients.

Methods

Twenty-seven AD patients and 30 bvFTD patients were included in the study. Each participant received a neurological evaluation. Cognitive event-related potentials (P300) were recorded during an auditory oddball task. Next, the excitability of the motor cortex, including the resting, facilitated motor threshold (RMT and FMT) and cortical silent period (CSP), were assessed during transcranial magnetic stimulation (TMS).

Results

The bvFTD patients exhibited significantly longer P300 latencies compared with AD patients. There was a significant negative correlation between cognition and P300 latency in the bvFTD group. The AD patients showed significantly reduced RMT and FMT values compared to the bvFTD group; however, no significant correlation was found between AD severity and the excitability of the motor cortex.

Conclusions

Cognition and motor cortical functions are different between AD and bvFTD patients. Noninvasive electrophysiological examinations have the potential to identify unique pathophysiological features that can be used to differentially diagnose AD and bvFTD patients.

Apathy, Novelty Processing, and the P3 Potential in Parkinson's Disease

Parkinson's disease (PD) is characterized by deficits in goal-directed behavior as well as mood and motivational symptoms, including apathy, depression, and anxiety. The present study investigated novelty processing in PD, using event-related potentials (ERPs) to characterize electrophysiological reflections of visual novelty processing. Since apathy has been associated with decreased novelty processing (P3 potentials) in highly apathetic PD patients, we were particularly interested to see if this relationship exists in a sample of PD patients with heterogeneous levels of apathy. Non-demented patients with PD receiving dopaminergic treatment (n = 14) and healthy control participants (n = 12) completed a three-stimulus oddball task while EEG was recorded. Relative to controls, the PD patients exhibited reductions in centrofrontally distributed P3 potentials when viewing novel distracters during this task. Distracter-related P3 amplitudes evoked by novel distracters were strongly associated with apathy symptoms, even after controlling for the effects of depression, anxiety, and executive function. Executive dysfunction was also predictive of novelty-related P3 processing, yet this relationship was independent from that of apathy. These findings suggest that the brain's electrophysiological response to novelty is closely related to both motivational and cognitive symptoms in PD, even for patients whose apathy symptoms are not excessive. These results have significant implications for our understanding of non-motor symptoms in this clinical population.

Toll-Like Receptor 4 Deficiency Causes Reduced Exploratory Behavior in Mice Under Approach-Avoidance Conflict

Abnormal approach-avoidance behavior has been linked to deficits in the mesolimbic dopamine (DA) system of the brain. Recently, increasing evidence has indicated that toll-like receptor 4 (TLR4), an important pattern-recognition receptor in the innate immune system, can be directly activated by substances of abuse, resulting in an increase of the extracellular DA level in the nucleus accumbens. We thus hypothesized that TLR4-dependent signaling might regulate approach-avoidance behavior. To test this hypothesis, we compared the novelty-seeking and social interaction behaviors of TLR4-deficient (TLR4(-/-)) and wild-type (WT) mice in an approach-avoidance conflict situation in which the positive motivation to explore a novel object or interact with an unfamiliar mouse was counteracted by the negative motivation to hide in exposed, large spaces. We found that TLR4(-/-) mice exhibited reduced novelty-seeking and social interaction in the large open spaces. In less stressful test apparatuses similar in size to the mouse cage, however, TLR4(-/-) mice performed normally in both novelty-seeking and social interaction tests. The reduced exploratory behaviors under approach-avoidance conflict were not due to a high anxiety level or an enhanced fear response in the TLR4(-/-) mice, as these mice showed normal anxiety and fear responses in the open field and passive avoidance tests, respectively. Importantly, the novelty-seeking behavior in the large open field induced a higher level of c-Fos activation in the nucleus accumbens shell (NAcSh) in TLR4(-/-) mice than in WT mice. Partially inactivating the NAcSh via infusion of GABA receptor agonists restored the novelty-seeking behavior of TLR4(-/-) mice. These data suggested that TLR4 is crucial for positive motivational behavior under approach-avoidance conflict. TLR4-dependent activation of neurons in the NAcSh may contribute to this phenomenon.

P300 Amplitude in Alzheimer's Disease: A Meta-Analysis and Meta-Regression

Alzheimer's disease accounts for 60% of all dementia. Numerous biomarkers have been developed that can help in making an early diagnosis. The P300 is an event-related potential that may be abnormal in Alzheimer's disease. Given the possible association between P300 amplitude and Alzheimer's disease and the need for biomarkers in early Alzheimer's disease, the main purpose of this meta-analysis and meta-regression was to characterize P300 amplitude in probable Alzheimer's disease compared to healthy controls. Using online search engines, we identified peer-reviewed articles containing amplitude measures for the P300 in response to a visual or auditory oddball stimulus in subjects with Alzheimer's disease and in a healthy control group and pooled effect sizes for differences in P300 amplitude between Alzheimer's disease and control groups to obtain summary effect sizes. We also used meta-regression to determine whether age, sex, educational attainment, or dementia severity affected the association between P300 amplitude and Alzheimer's disease. Twenty articles containing a total of 646 subjects met inclusion and exclusion criteria. The overall effect size from all electrode locations was 1.079 (95% confidence interval=0.745-1.412, P<.001). The pooled effect sizes for the Cz, Fz, and Pz locations were 1.226 (P<.001), 0.724 (P=.0007), and 1.430 (P<.001), respectively. Meta-regression showed an association between amplitude and educational attainment, but no association between amplitude and age, sex, and dementia severity. In conclusion, P300 amplitude is smaller in subjects with Alzheimer's disease than in healthy controls.

Exploring Visual Selective Attention towards Novel Stimuli in Alzheimer's Disease Patients

Background

Alzheimer's disease (AD) is associated with selective attention impairments, which could contribute to cognitive and functional deficits. Selective attention can be explored through examination of novelty preference.

Aims

In this study, we quantified novelty preference in AD patients by measuring visual scanning behaviour using an eye tracking paradigm.

Methods

Mild-to-moderate AD patients and elderly controls viewed slides containing novel and repeated images simultaneously. The outcome measure was time spent on specific images, with novelty preference defined by greater relative fixation time (RFT) on novel versus repeated images. Cognitive status (Standardized Mini-Mental State Examination, SMMSE) and attention (Digit Span, DS) were also measured.

Results

AD patients (age 79.2 ± 6.7 years, SMMSE 22.2 ± 4.0, n = 41) and controls (age 76.2 ± 6.4 years, SMMSE 28.1 ± 2.0, n = 24) were similar in age, education and sex. Compared with controls, AD patients had lower RFT on novel than on repeated images (F_1,63 = 11.18, p = 0.001). Further, reduced RFT was associated with lower scores on SMMSE (r₆₃ = 0.288, p = 0.020) and DS (r₆₃ = 0.269, p = 0.030). Within individuals, novelty preference was detected in 92.3% of patients and in 100% of controls.

Conclusion

These findings suggest that novelty preference, measured by visual scanning behaviour, can differentiate cognitively healthy and impaired people and may offer a nonverbal, less cognitively demanding method of assessing selective attention.

Ultrasonic Vocalizations in Mice During Exploratory Behavior are Context-Dependent

While rat ultrasonic vocalizations (USVs) are known to vary with anticipation of an aversive vs. positive stimulus, little is known about USVs in adult mice in relation to behaviors. We recorded the calls of adult C57BL/6J male mice under different environmental conditions by exposing mice to both novel and familiar environments that varied in stress intensity through the addition of bright light or shallow water. In general, mouse USVs were significantly more frequent and of longer duration in novel environments. Particularly, mice in dimly-lit novel environments performed more USVs while exhibiting unsupported rearing and walking behavior, and these calls were mostly at high frequency. In contrast, mice exhibited more low frequency USVs when engaging in supported rearing behavior in novel environments. These findings are consistent with data from rats suggesting that low-frequency calls are made under aversive conditions and high-frequency calls occur in non-stressful conditions. Our findings increase understanding of acoustic signals associated with exploratory behaviors relevant to cognitive and motivational aspects of behavior.

Self-directed exploration provides a Ncs1-dependent learning bonus

Understanding the mechanisms of memory formation is fundamental to establishing optimal educational practices and restoring cognitive function in brain disease. Here, we show for the first time in a non-primate species, that spatial learning receives a special bonus from self-directed exploration. In contrast, when exploration is escape-oriented, or when the full repertoire of exploratory behaviors is reduced, no learning bonus occurs. These findings permitted the first molecular and cellular examinations into the coupling of exploration to learning. We found elevated expression of neuronal calcium sensor 1 (Ncs1) and dopamine type-2 receptors upon self-directed exploration, in concert with increased neuronal activity in the hippocampal dentate gyrus and area CA3, as well as the nucleus accumbens. We probed further into the learning bonus by developing a point mutant mouse (Ncs1^P144S/P144S) harboring a destabilized NCS-1 protein, and found this line lacked the equivalent self-directed exploration learning bonus. Acute knock-down of Ncs1 in the hippocampus also decoupled exploration from efficient learning. These results are potentially relevant for augmenting learning and memory in health and disease, and provide the basis for further molecular and circuit analyses in this direction.

Apathy in Parkinson's disease: an electrophysiological study

In Parkinson's disease (PD), apathy (or loss of motivation) is frequent. Nevertheless, the contribution of attentional disorders to its genesis is still not clearly known. We want to determine the relation existing between apathy and attentional disorders by using P300a (or novelty P3) as a marker of the attentional process. The study included 25 patients (13 women and 12 men) with PD for whom we have determined the relationship between automatic attention (represented by P300a) and motor status, apathy, executive dysfunction, mental flexibility, inhibitory control, and depression/anxiety. We have found a correlation between the apathy score and amplitude of novelty P300 during the ON period and also a correlation of the apathy score with a decrease in amplitude of P300 during the OFF period. In a linear regression model, changes in the P300a predicted the severity of apathy independently of any other variable. We concluded firstly that the reduction in amplitude of the P300a wave was a neurophysiological marker of apathy in PD and secondly that apathy led to both dopaminergic denervation (mesolimbic) and nondopaminergic (dorsolateral prefrontal-subcortical) dysfunction.

The clinical utility of the auditory P300 latency subcomponent event-related potential in preclinical diagnosis of patients with mild cognitive impairment and Alzheimer's disease

The present meta-analysis investigated the clinical utility of the auditory P300 latency event-related potential in differentiating patients with Alzheimer's disease (AD), patients with mild cognitive impairment (MCI), and unaffected controls. Effect size estimates were computed from mean P300 latency measurements at midline electrodes between patients and unaffected controls using the random effects restricted maximum likelihood model. The effects of clinical and ERP/EEG methological variables were assessed in a moderator analysis. P300 latency was found to be significantly prolonged in patients with AD (and MCI) compared to unaffected controls. Shortened P300 latencies were observed when comparing patients with MCI to patients with AD. Clinically relevant differences in P300 latency effect sizes were associated with mean age, interstimulus interval, stimulus difference, target frequency, reference electrode, and sampling rate. The meta-analytic findings provide robust statistical evidence for the use of the auditory P300 latency subcomponent as a biological marker of prodromal AD.

Brain activation disturbance for target detection in patients with mild cognitive impairment: an fMRI study

Functional brain imaging in mild cognitive impairment (MCI) reveals differences in activation of task-relevant brain areas between patients and age-matched healthy controls. However, some studies reported hyperactivation and others hypoactivation in MCI compared with controls. The inconsistencies may be explained by compensatory mechanisms due to high complexity of the applied tasks. The oddball task is a simple paradigm that is known to activate a widespread network in the brain, involving attentional and monitoring mechanisms. In the present study, we examined amnestic or amnestic multidomain MCI patients (n = 12) and healthy controls (n = 13) in an auditory oddball task. Participants had to respond to infrequent targets and inhibit response to infrequent novel-nontarget stimuli. Lower stimulus related activation was found in MCI patients compared with healthy controls in parts of the middle temporal gyrus, the temporal pole, regions along the superior temporal sulcus, in the left cuneus, the left supramarginal gyrus, the anterior cingulated cortex and in the left inferior and middle frontal gyrus. Activation for oddball stimuli is assumed to reflect an automatic reflexive engagement of many brain regions in response to potentially important changes in the environment as well as cognitive control to monitor responses. The mechanisms of attention and cognitive control may be severely impaired in MCI and thus, underlie the cognitive deficits of this clinical group.

Visual search patterns in semantic dementia show paradoxical facilitation of binding processes

While patients with Alzheimer's disease (AD) show deficits in attention, manifested by inefficient performance on visual search, new visual talents can emerge in patients with frontotemporal lobar degeneration (FTLD), suggesting that, at least in some of the patients, visual attention is spared, if not enhanced. To investigate the underlying mechanisms for visual talent in FTLD (behavioral variant FTD [bvFTD] and semantic dementia [SD]) patients, we measured performance on a visual search paradigm that includes both feature and conjunction search, while simultaneously monitoring saccadic eye movements. AD patients were impaired relative to healthy controls (NC) and FTLD patients on both feature and conjunction search. BvFTD patients showed less accurate performance only on the conjunction search task, but slower response times than NC on all three tasks. In contrast, SD patients were as accurate as controls and had faster response times when faced with the largest number of distracters in the conjunction search task. Measurement of saccades during visual search showed that AD patients explored more of the image, whereas SD patients explored less of the image before making a decision as to whether the target was present. Performance on the conjunction search task positively correlated with gray matter volume in the superior parietal lobe, precuneus, middle frontal gyrus and superior temporal gyrus. These data suggest that despite the presence of extensive temporal lobe degeneration, visual talent in SD may be facilitated by more efficient visual search under distracting conditions due to enhanced function in the dorsal frontoparietal attention network.

Initial evidence linking synaptic superoxide production with poor short-term memory in aged mice

Unregulated production of reactive oxygen species (ROS) is a marker of cellular and organismal aging linked to cognitive decline in humans and rodents. The sources of elevated ROS contributing to cognitive decline are unknown. Because NADPH oxidase (Nox) inhibition may prevent memory decline with age, we hypothesized that Nox and not mitochondrial sources of synaptic ROS production are linked to individual variance in cognitive performance in aged mice. Young (8 months) and aged (26 months) mice were tested in the novel object recognition task (NORT). Mitochondrial and Nox ROS production was assayed in isolated synaptosomes using spin trapping electron paramagnetic resonance (EPR) spectroscopy. Aged mice exhibited variance in NORT performance, with some performing similar to young mice while others exhibited poorer short-term memory. EPR studies indicated that Nox rather than mitochondria was the major ROS source at the synapse, and Nox-induced but not mitochondrial-induced ROS levels correlated with NORT performance in aged mice. Our findings support the hypothesis that variance in Nox-specific synaptic ROS production may predict short-term memory deficits with age.

Does compensatory neural activity survive old-old age?

One mechanism that may allow older adults to continue to successfully perform certain cognitive tasks is to allocate more resources than their younger counterparts. Most prior studies have not included individuals beyond their 70s. Here, we investigated whether compensatory increases in neural activity previously observed in cognitively high-performing young-old adults would continue into old-old age. Event-related potentials were recorded from 72 cognitively high performing subjects, aged 18 to 96 years old, while they participated in a subject-controlled novelty oddball paradigm in which they determined viewing duration of standard, target, and novel visual stimuli. Compared to young and middle-aged subjects, both young-old and old-old subjects exhibited an impairment of preliminary mismatch/match detection operations, indexed by an attenuated anterior N2 component. This may have placed a greater burden on the subsequent controlled decision-making process, indexed by the P3, necessitating the allocation of more resources. The relationship between age and resource allocation, as measured by P3 amplitude, from midlife to very old age (45-96 years old) followed an inverted u-shaped curve (quadratic function). It peaked between the late 60s and early 70s. Thereafter, there was an inverse relationship between age and resource appropriation. This relationship remained significant after controlling for differences in task performance and MMSE. Examining the size of the P3 component across different age groups suggests that although cognitively high performing adults in their early 80s exhibit a reduction in P3 amplitude, they have a relatively well-preserved capacity to appropriate resources. However, by the late 80s, there is a robust decline (relative to young-old adults) in the size of the P3. Our results indicate that when carrying out controlled processing linked to directing attention to salient events, cognitively high performers reach the boundary of their capacity, albeit relatively late in life. This limits their ability to appropriate additional resources as compensatory activity for age-related impairments in earlier visual processing, and suggests that such a mechanism does not tend to "survive" old-old age.

Visual evoked potentials to pattern, motion and cognitive stimuli in Alzheimer's disease

The aim of our study was to verify reported visual dysfunctions of patients with Alzheimer disease with the use of several variants of VEPs and visual ERPs and to learn whether these methods can be useful in diagnostics of AD. We tested 15 patients (6 women and 9 men, aged from 58 to 87) with mild to moderate Alzheimer disease (12-23 points of Mini Mental State Examination) and 15 age, gender and education level matched controls. The examination consisted of VEPs to pattern-reversal and motion-onset stimulation (to translational and radial movement) and of visual ERPs recorded during an odd-ball test. The subjects were instructed to signalize target stimuli by pressing of a button, which enabled to evaluate also the reaction time. While pattern-reversal VEPs were comparable in patients and controls, there were significantly smaller N2 peak amplitudes of motion-onset VEPs in patients with AD (in particular in radial moving stimuli outside the central 20 deg of the visual field), which suggests a dysfunction of the motion-processing (magnocellular) system or the dorsal cortical stream. ERPs, having significantly longer latencies in patients than in controls, distinguished well both groups. However, the individual AD diagnostics based on ERPs seems to be limited by rather high inter-individual variability of the ERP latencies. The ERPs might, however, be useful in disease progress and therapy effect estimation. Electrophysiological parameters did not correlate with neuropsychological ADAS cog test (Alzheimer Disease Assessment Scale--cognitive part).

Apolipoprotein E ε4-related thickening of the cerebral cortex modulates selective attention

APOE ε4 carriers have thicker cortex in several neocortical areas than ε4 noncarriers (Espeseth T., Westlye L.T., Fjell A.M., Walhovd K.B., Rootwelt H., Reinvang I., 2008. Accelerated age-related cortical thinning in healthy carriers of apolipoprotein E ε4. Neurobiol. Aging 29, 329-340). To investigate potential physiological and cognitive correlates of these anatomical effects structural magnetic resonance imaging (MRI) data were obtained from 20 APOE ε3 homozygotes and 20 ε4 hetero- and homozygotes, and event-related potentials (ERPs) were recorded during a selective attention task (i.e. three-stimulus oddball). Several areas in both hemispheres were thicker in ε4 carriers than in noncarriers. ε4 carriers also had lower amplitudes to distractors (P3a) and lower target detection accuracy than noncarriers. Mean thickness in cortical areas were correlated with P3a amplitudes, which in turn correlated with accuracy. Path analyses showed that APOE-related difference in accuracy was mediated by APOE-related differences in cortical thickness and P3a amplitudes. The results suggest that APOE ε4 modulates the structural integrity of critical nodes in brain attentional networks.

Assessing impulsivity changes in Alzheimer disease

Impulsive behaviors are common in brain-damaged patients including those with neurodegenerative diseases such as Alzheimer disease (AD). The objective of this study was to develop and validate a short version of the UPPS Impulsive Behavior Scale assessing changes on 4 different dimensions of impulsivity, namely urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking, arising in the course of a neurodegenerative disease. To this end, caregivers of 83 probable AD patients completed a short questionnaire adapted from the UPPS Impulsive Behavior Scale. Exploratory and confirmatory factor analyses of the data were performed and revealed that a model with 4 distinct but related latent variables corresponding to 4 different dimensions of impulsivity fit the data best. Furthermore, the results showed that lack of perseverance, followed by lack of premeditation and urgency, increased after the onset of the disease, whereas sensation seeking decreased. Overall, the multifaceted nature of impulsivity was confirmed in a sample of AD patients, whose caregivers reported significant changes regarding each facet of impulsivity. Consequently, the short version of the UPPS Impulsive Behavior Scale opens up interesting prospects for a better comprehension of behavioral symptoms of dementia.

To Ignore or Explore: Top–Down Modulation of Novelty Processing

Attending to novelty is a critical element of human behavior and learning. Novel events can serve as task-irrelevant distracters or as potential sources of engagement by interesting or important aspects of one's environment. An optimally functioning brain should have the capacity to respond differentially to novel events depending on the circumstances in which they occur. In the present study, a subject-controlled variant of the visual novelty oddball paradigm was employed under two different conditions in which novel stimuli were characterized either as distracters from a main task or as potentially meaningful “invitations” to explore the environment. Differences in context, derived from varying the emphasis of task instructions, strongly modulated both the behavioral and electrophysiological response to novelty. This modulation was not observed for processing earlier than the P3 component. Subjects who encountered novel events that served as distracters limited the amount of attention and processing resources they appropriated. Remarkably, under this condition, there were no differences in overall P3 amplitude, late positive slow-wave activity, or viewing duration between rare novel and frequent standard events. In contrast, subjects who encountered novel events as potential opportunities to explore augmented the attention and processing resources directed toward these events (as reflected by a larger P3 amplitude, late positive slow-wave activity, and longer viewing durations). Our results suggest that the processing of novelty within the visual modality involves several stages, including: (1) the relatively automatic detection of unfamiliar, novel stimuli (indexed by the N2); (2) the voluntary allocation of resources determined by the broader context in which a novel event occurs (indexed by the P3); and (3) the sustained processing of novelty (indexed by late positive slow-wave activity). This study provides evidence of the brain's ability to generate differential responses to novel events according to the circumstances under which they are encountered. It also points to a greater degree of top–down modulation of the processing of novelty than has been previously emphasized. We suggest that less commonly studied variables, such as subject control, may provide additional insight into the different ways in which novelty is processed.

Apathy and the processing of novelty in schizophrenia

Apathy is a common negative symptom in schizophrenia that has been associated with poor medication compliance and treatment outcome. Recent studies in neurological patients have observed an association between apathy and reduced attention to novel stimuli. We evaluated whether patients with schizophrenia demonstrate a similar relationship. Participants included 20 patients with schizophrenia and 20 healthy comparison subjects matched for age, sex, handedness, and parental education. A self-paced visual novelty task was presented which assessed the duration that participants looked at frequent standard stimuli, infrequent target stimuli, and novel stimuli. Attention to novelty was defined as the duration of viewing novel relative to standard stimuli. Apathy was assessed with the Marin Apathy Evaluation Scale. Results revealed significantly greater self- and informant-reported apathy, slower reaction time to target stimuli, and longer viewing times to the stimuli, but not reduced attention to the novel stimuli, in the patient group. Although greater self-report of apathy was associated with longer viewing times for all stimuli in the patient group, this was accounted for by depressed mood. The present findings indicate that schizophrenia is associated with slowed information processing, but do not support the hypothesis that apathy in schizophrenia is associated with abnormal processing of novelty.

Cognitive status impacts age-related changes in attention to novel and target events in normal adults

In this study, the authors investigated the relationship between the cognitive status of normal adults and age-related changes in attention to novel and target events. Old, middle-age, and young subjects, divided into cognitively high and cognitively average performing groups, viewed repetitive standard stimuli, infrequent target stimuli, and unique novel visual stimuli. Subjects controlled viewing duration by a button press that led to the onset of the next stimulus. They also responded to targets by pressing a foot pedal. The amount of time spent looking at different kinds of stimuli served as a measure of visual attention and exploratory activity. Cognitively high performers spent more time viewing novel stimuli than cognitively average performers. The magnitude of the difference between cognitively high and cognitively average performing groups was largest among old subjects. Cognitively average performers had slower and less accurate responses to targets than cognitively high performers. The results provide strong evidence that the link between engagement by novelty and higher cognitive performance increases with age. Moreover, the results support the notion of there being different patterns of normal cognitive aging and the need to identify the factors that influence them.

Increased responsiveness to novelty is associated with successful cognitive aging

The animal literature suggests that exposure to more complex, novel environments promotes neurogenesis and cognitive performance in older animals. Studies in humans indicate that participation in intellectually stimulating activities may serve as a buffer against mental decline and help to sustain cognitive abilities. Here, we show that across old adults, increased responsiveness to novel events (as measured by viewing duration and the size of the P3 event-related potential) is strongly linked to better performance on neuropsychological tests, especially those involving attention/executive functions. Cognitively high performing old adults generate a larger P3 response to visual stimuli than cognitively average performing adults. These results suggest that cognitively high performing adults successfully manage the task by appropriating more resources and that the increased size of their P3 component represents a beneficial compensatory mechanism rather than less efficient processing.

Age-related differences in attention to novelty among cognitively high performing adults

Age-related differences in attention to novel events were studied in well-matched, cognitively high performing old, middle-aged and young subjects. Event-related potentials were recorded during a visual novelty oddball task in which subjects controlled viewing durations that served as a behavioral measure of attentional allocation. All age groups had a larger P3 amplitude and longer viewing duration to novel than to standard stimuli, with no age-related differences in the magnitude of these effects, indicating old individuals were as engaged by the processing of novelty as younger adults. Old subjects had a larger, more anteriorly distributed P3 component to novels and standards. The increased P3 amplitude differs from prior reports of a diminished P3 response with processes, including aging, that have a potentially deleterious impact on the brain. We hypothesise that cognitively high performing old individuals successfully manage the task by relying on additional neural resources and perhaps more effortful frontal activity than their younger counterparts.

Reduced prefrontal N-acetylaspartate in stroke patients with apathy

BACKGROUND

Although substantial numbers of stroke patients suffer from apathy, its causes are still poorly understood. Previous studies suggest that dysfunction of the frontal lobes is implicated in the pathophysiology of motivation. Our aim was to investigate the association between proton magnetic resonance spectroscopy (H1-MRS) measurements in unaffected frontal lobes and apathy in a group of first-time stroke patients.

METHODS

31 patients with a first-time ischemic stroke located outside the frontal lobes and 20 healthy subjects were included in the study. The authors performed single voxel H1-MRS in order to measure the N-acetylaspartate/creatine (NAA)/Cr, glutamate+glutamine (Glx)/Cr, choline (Cho)/Cr and myo-inositol (mI)/Cr ratios in the frontal lobes. Patients were assessed between days 7 and 12 post stroke. Diagnosis of apathy was made on the basis of clinical observation, interview and Apathy Scale.

RESULTS

13 out of 31 patients (42%) demonstrated apathy. Patients with apathy had lower NAA/Cr ratios in the right frontal lobe than non-apathetic subjects. The patient group was divided into two subgroups: Those with left hemisphere strokes, and those with right hemisphere strokes. Of these subjects, significantly lowered NAA/Cr ratios were found in the right hemispheres of apathetic patients in the subgroup with left-sided brain lesions.

CONCLUSIONS

These findings point to the association between apathy and frontal lobe integrity, suggest different reactions of the hemispheres and indicate that changes in the NAA/Cr ratio are related to the apathy.

Total sleep deprivation and novelty processing: implications for frontal lobe functioning

OBJECTIVE

Mounting evidence suggests that the frontal lobes are particularly vulnerable to total sleep deprivation (TSD). Detection of novelty involves the frontal lobes. The presentation of rare, novel stimuli elicits an event-related potential (novel P3), which maximizes over anterior regions of the scalp. We hypothesized that TSD would impair novelty detection, resulting in a smaller novel P3 over the frontal region, with a topographic shift toward posterior areas.

METHODS

An auditory novelty oddball task was administered to a TSD group after 36 h of waking and again following recovery sleep, and to a control group after 12 h of waking. EEG was recorded from Fz, Cz and Pz.

RESULTS

A large anterior P3 was elicited in the control group. In the TSD group, this novel P3 was smaller at Fz. A later novel positivity appeared in parietal areas. The novel P3 returned to baseline levels and the late novel P3 was difficult to observe following recovery sleep.

CONCLUSIONS

TSD appears to compromise the usual automatic detection of novelty probably due to frontal deactivation. Participants may compensate by relying on posterior brain mechanisms involving active memory comparison. The late novel P3 component may also reflect a secondary effortful attempt to encode and to categorize novel stimuli.

SIGNIFICANCE

This study suggests that TSD may compromise cognitive functioning in different regions of the brain. The detection of novelty, probably mediated by the frontal lobes, is particularly at risk.

Grouping for behavioral and psychological symptoms in dementia: clinical and biological aspects. Consensus paper of the European Alzheimer disease consortium

Behavioral and psychological symptoms of dementia (BPSD), constitute a major clinical component of Alzheimer's disease (AD). There is a growing interest in BPSD as they are responsible for a large share of the suffering of patients and caregivers, and they strongly determine the patient's lifestyle and management. Better detection and understanding of these symptoms is essential to provide appropriate management. This article is a consensus produced by the behavioral group of the European Alzheimer's Disease Consortium (EADC). The aim of this article is to present clinical description and biological correlates of the major behavioral and psychological symptomatology in AD. BPSD is not a unitary concept. Instead, it should be divided into several symptoms or more likely: groups of symptoms, each possibly reflecting a different prevalence, course over time, biological correlate and psychosocial determinants. There is some clinical evidence for clusters within groups of BPSD. Biological studies indicate that patients with AD and BPSD are associated with variations in the pathological features (atrophy, brain perfusion/metabolism, histopathology) when compared to people with AD without BPSD. An individually tailored approach taking all these aspects into account is warranted as it may offer more, and better, pharmacological and non-pharmacological treatment opportunities.

Long-term abstinence syndrome in heroin addicts: indices of P300 alterations associated with a short memory task

Attentional deficits have been implicated in the pathophysiology of opioid addicts. The P300 component of event-related potentials (ERPs) is considered as a manifestation of attentional operations. The authors' goal was the comparison of P300 elicited during a short memory test between subjects with prolonged heroin abstinence and current heroin users as well as healthy controls. The P300 component was evaluated during the anticipatory period of a short memory task in 20 patients characterized by a past history of opioid dependence (6 months abstinence), in 18 current heroin users and in 20 healthy comparison subjects, matched for age, sex and educational level. Abstinent heroin addicts exhibited significant reduction of P300 amplitude at central frontal region, relative to the other two groups. The findings are discussed in connection to the aim of identifying psychophysiological indices, addressing issues in opioid use disorders, and suggest that knowledge about cognitive operations, such as those reflected by P300 component, could provide further insight into psychophysiological mechanisms underlying the long-term abstinence state of heroin addicts.

The balance between approach and avoidance behaviors in a novel object exploration paradigm in mice

Approach and avoidance are critical components of novelty seeking, which plays an important role in susceptibility to drug abuse and aspects of cognition. This experiment was designed to examine whether brief periods of handling or prior exposure to a novel environment affect various measures of novel object exploration in mice. Forty male C57BL/6J mice were handled by the experimenter or received minimal exposure to human contact. In addition to manipulating the degree of familiarity with the experimenter (handling), we also manipulated the degree of familiarity with the object. All mice were tested over a 3-day period. On day 1, all mice were tested in the open field for 60 min. On day 2, there were two, 30-min sessions. In the first 30-min session, there was no object present. In the second 30-min session, half of the mice were exposed to a novel object. On day 3, all mice were placed in the open field for 30 min followed by a 30-min period in which the object was placed in the center of the open field. Handled mice showed a trend toward more object exploration on day 2 compared to non-handled mice. Mice with prior exposure to the novel object showed more object exploration compared to object-naïve mice on day 3. These results are consistent with the hypothesis that a certain degree of familiarity with the object or with the experimenter decreases avoidance and increases exploration of novel stimuli. In combination, these results show that the approach and avoidance dimensions of novelty seeking can be manipulated experimentally and may be used in subsequent studies to examine the effects of drugs of abuse.

P300 evidence of cognitive inflexibility in female adolescents at risk for recurrent depression

Studies utilizing the P300 event-related potential (ERP) to document potential neurophysiological deficits related to depression have produced variable findings. The present investigation examined the effects of two tasks to determine whether one task would be more sensitive to a history of depression. We examined 124 female subjects, aged 14-20 years. Each subject was assigned to either a history of depression (DEP-Hx) or control group based on the presence versus absence of a DSM-III-R Major Depressive Episode. ERPs were recorded during two auditory oddball tasks. The first task was a simple two-pitch auditory discrimination and the second task was a three-stimulus auditory discrimination. In both tasks, subjects responded to the same rare target tone. Analysis of P300 amplitudes indicated a significant group by task interaction. Simple effects indicated that control subjects exhibited smaller target P300 amplitudes during the three-stimulus task as compared to the two-stimulus task. In contrast, subjects with a history of depression did not show a significant difference in P300 target amplitude between the two tasks. These results suggest that depression history as well as task difficulty/modality may influence the utility of the P300 in documenting the neurophysiological aspects of depression.

Frontal and parietal components of a cerebral network mediating voluntary attention to novel events

Despite the important role that attending to novel events plays in human behavior, there is limited information about the neuroanatomical underpinnings of this vital activity. This study investigated the relative contributions of the frontal and posterior parietal lobes to the differential processing of novel and target stimuli under an experimental condition in which subjects actively directed attention to novel events. Event-related potentials were recorded from well-matched frontal patients, parietal patients, and non-brain-injured subjects who controlled their viewing duration (by button press) of line drawings that included a frequent, repetitive background stimulus, an infrequent target stimulus, and infrequent, novel visual stimuli. Subjects also responded to target stimuli by pressing a foot pedal. Damage to the frontal cortex resulted in a much greater disruption of response to novel stimuli than to designated targets. Frontal patients exhibited a widely distributed, profound reduction of the novelty P3 response and a marked diminution of the viewing duration of novel events. In contrast, damage to posterior parietal lobes was associated with a substantial reduction of both target P3 and novelty P3 amplitude; however, there was less disruption of the processing of novel than of target stimuli. We conclude that two nodes of the neuroanatomical network for responding to and processing novelty are the prefrontal and posterior parietal regions, which participate in the voluntary allocation of attention to novel events. Injury to this network is indexed by reduced novelty P3 amplitude, which is tightly associated with diminished attention to novel stimuli. The prefrontal cortex may serve as the central node in determining the allocation of attentional resources to novel events, whereas the posterior parietal lobe may provide the neural substrate for the dynamic process of updating one's internal model of the environment to take into account a novel event.

Identification of diagnostic evoked response potential segments in Alzheimer's disease

Evoked response potentials (ERPs) to brief flashes of light were analyzed for constituent features that could be used to distinguish individuals with Alzheimer's disease (AD, n = 15) from matched control subjects (n = 17). Statistical k nearest-neighbor methods distinguished AD from control with a maximum sensitivity of 29% and false alarm rate of 12%. The comparable sensitivity/false-alarm values for a statistical projection pursuit method and an extended projection pursuit method, which selectively identify discriminative features for classification, were 75%/18% and 100%/6%, respectively. The results demonstrate that combinations of selected ERP time segments across different electrodes contain signal features that discriminate AD from control subjects with high sensitivity and specificity.

Assessment of P3a and P3b after moderate to severe brain injury

The purpose of the study was to examine the P3a and P3b components of the event-related brain potential (ERP) in patients sustaining moderate to severe brain injury. Electrophysiological and behavioral responses were recorded in brain injured (N = 18) and healthy control (N = 21) participants performance of an auditory 3-stimulus distractor paradigm. Auditory stimuli consisted of a series of repetitive standard tones (75 ms), occasionally interrupted by equiprobable target (25 ms) and distractor sounds (white noise). Tone duration discrimination accuracy was similar in patients and controls, but patients had prolonged reaction times to targets. The reaction time delay was paralleled by a prolongation of P3b latency to targets in the patient group relative to controls. The stimulus and task dependent modulation of ERP responses in the brain injury group was similar to that of controls in terms of the spatial distribution of ERPs over the scalp. However, the brain injury group had attenuated P3a and P3b amplitudes to distractor and target stimuli, respectively. The electrophysiological data suggest a deficit in the allocation of attentional resources to the processing of deviant stimuli in the brain injury group.

Current awareness in geriatric psychiatry. Bibliography

In order to keep subscribers up-to-date with the latest developments in their field, John Wiley &amp: Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of geriatric psychiatry. Each bibliography is divided into 9 sections: 1 Books, Reviews &amp: Symposia; 2 General; 3 Assessment; 4 Epidemiology; 5 Therapy; 6 Care; 7 Dementia; 8 Depression; 9 Psychology. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted