Influence of age and cognitive demand on motor decision making under uncertainty: a study on goal directed reaching movements

In everyday life, we constantly make decisions about actions to be performed subsequently. Research on motor decision making has provided empirical evidence for an influence of decision uncertainty on movement execution in young adults. Further, decision uncertainty was suggested to be increased in older adults due to limited cognitive resources for the integration of information and the prediction of the decision outcomes. However, the influence of cognitive aging on decision uncertainty during motor decision making and movement execution has not been investigated, yet. Thus, in the current study, we presented young and older adults with a motor decision making task, in which participants had to decide on pointing towards one out of five potential targets under varying cognitive demands. Statistical analyses revealed stronger decreases in correctly deciding upon the pointing target, i.e. task performance, from low to higher cognitive demand in older as compared to young adults. Decision confidence also decreased more strongly in older adults with increasing cognitive demand, however, only when collapsing across correct and incorrect decision trials, but not when considering correct decision trials, only. Further, older adults executed reaching movements with longer reaction times and increased path length, though the latter, again, not when considering correct decision trials, only. Last, reaction time and variability in movement execution were both affected by cognitive demand. The outcomes of this study provide a differentiated picture of the distinct and joint effects of aging and cognitive demand during motor decision making.

Subthreshold repetitive transcranial magnetic stimulation drives structural synaptic plasticity in the young and aged motor cortex

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool commonly used to drive neural plasticity in the young adult and aged brain. Recent data from mouse models have shown that even at subthreshold intensities (0.12 T), rTMS can drive neuronal and glial plasticity in the motor cortex. However, the physiological mechanisms underlying subthreshold rTMS induced plasticity and whether these are altered with normal ageing are unclear.

OBJECTIVE

To assess the effect of subthreshold rTMS, using the intermittent theta burst stimulation (iTBS) protocol on structural synaptic plasticity in the mouse motor cortex of young and aged mice.

METHODS

Longitudinal in vivo 2-photon microscopy was used to measure changes to the structural plasticity of pyramidal neuron dendritic spines in the motor cortex following a single train of subthreshold rTMS (in young adult and aged animals) or the same rTMS train administered on 4 consecutive days (in young adult animals only). Data were analysed with Bayesian hierarchical generalized linear regression models and interpreted with the aid of Bayes Factors (BF).

RESULTS

We found strong evidence (BF > 10) that subthreshold rTMS altered the rate of dendritic spine losses and gains, dependent on the number of stimulation sessions and that a single session of subthreshold rTMS was effective in driving structural synaptic plasticity in both young adult and aged mice.

CONCLUSION

These findings provide further evidence that rTMS drives synaptic plasticity in the brain and uncovers structural synaptic plasticity as a key mechanism of subthreshold rTMS induced plasticity.

Associations of Later-Life Education, the BDNF Val66Met Polymorphism and Cognitive Change in Older Adults

In 358 participants of the Tasmanian Healthy Brain Project, we quantified the cognitive consequences of engaging in varying loads of university-level education in later life, and investigated whether or not BDNF Val66Met affected outcomes. Assessment of neuropsychological, health, and psychosocial function was undertaken at baseline, 12-month, and 24-month follow-up. Education load was positively associated with change in language processing performance, but this effect did not reach statistical significance (P = 0.064). The BDNF Val66Met polymorphism significantly moderated the extent to which education load was associated with improved language processing (P = 0.026), with education load having a significant positive relationship with cognitive change in BDNF Met carriers but not in BDNF Val homozygotes. In older adults who carry BDNF Met, engaging in university-level education improves language processing performance in a load-dependent manner.

Low intensity repetitive transcranial magnetic stimulation modulates skilled motor learning in adult mice

Repetitive transcranial magnetic stimulation (rTMS) is commonly used to modulate cortical plasticity in clinical and non-clinical populations. Clinically, rTMS is delivered to targeted regions of the cortex at high intensities (>1 T). We have previously shown that even at low intensities, rTMS induces structural and molecular plasticity in the rodent cortex. To determine whether low intensity rTMS (LI-rTMS) alters behavioural performance, daily intermittent theta burst LI-rTMS (120 mT) or sham was delivered as a priming or consolidating stimulus to mice completing 10 consecutive days of skilled reaching training. Relative to sham, priming LI-rTMS (before each training session), increased skill accuracy (~9%) but did not alter the rate of learning over time. In contrast, consolidating LI-rTMS (after each training session), resulted in a small increase in the rate of learning (an additional ~1.6% each day) but did not alter the daily skill accuracy. Changes in behaviour with LI-rTMS were not accompanied with long lasting changes in brain-derived neurotrophic factor (BDNF) expression or in the expression of plasticity markers at excitatory and inhibitory synapses for either priming or consolidation groups. These results suggest that LI-rTMS can alter specific aspects of skilled motor learning in a manner dependent on the timing of intervention.

Further education improves cognitive reserve and triggers improvement in selective cognitive functions in older adults: The Tasmanian Healthy Brain Project

Introduction

The strong link between early-life education and subsequent reduced risk of dementia suggests that education in later life could enhance cognitive function and may reduce age-related cognitive decline and protect against dementia.

Methods

Episodic memory, working memory, executive function, and language processing performances were assessed annually over 4 years in 359 healthy older adults who attended university for a minimum of 12 months (intervention) and were compared against 100 healthy adult controls.

Results

Multiple group latent growth curve modeling revealed a significant improvement in language processing capacity over time in the intervention group. No changes were detected for episodic memory, working memory, or executive function.

Discussion

These results suggest that complex mental stimulation resulting from late-life further education results in improved crystallized knowledge but no changes to fluid cognitive functions.

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Early-life educational attainment predicts dementia.

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Early-life educational attainment predicts rate of cognitive decline.

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Late-life education in healthy adults improves language processing capacity.

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Late-life education enhances crystallized knowledge not fluid cognitive abilities.

Influence of Cognitive Functioning on Age-Related Performance Declines in Visuospatial Sequence Learning

Objectives: The aim of this study was to investigate how age-related performance differences in a visuospatial sequence learning task relate to age-related declines in cognitive functioning.

Method: Cognitive functioning of 18 younger and 18 older participants was assessed using a standardized test battery. Participants then undertook a perceptual visuospatial sequence learning task. Various relationships between sequence learning and participants’ cognitive functioning were examined through correlation and factor analysis.

Results: Older participants exhibited significantly lower performance than their younger counterparts in the sequence learning task as well as in multiple cognitive functions. Factor analysis revealed two independent subsets of cognitive functions associated with performance in the sequence learning task, related to either the processing and storage of sequence information (first subset) or problem solving (second subset). Age-related declines were only found for the first subset of cognitive functions, which also explained a significant degree of the performance differences in the sequence learning task between age-groups.

Discussion: The results suggest that age-related performance differences in perceptual visuospatial sequence learning can be explained by declines in the ability to process and store sequence information in older adults, while a set of cognitive functions related to problem solving mediates performance differences independent of age.

Validation of a Dynamic Measure of Current Cognitive Reserve in a Longitudinally Assessed Sample of Healthy Older Adults: The Tasmanian Healthy Brain Project

Cognitive reserve (CR) is a theoretical construct describing the underlying cognitive capacity of an individual that confers differential levels of resistance to, and recovery from, brain injuries of various types. To date, estimates of an individual's level of CR have been based on single proxy measures that are retrospective and static in nature. To develop a measure of dynamic change in CR across a lifetime, we previously identified a latent factor, derived from an exploratory factor analysis of a large sample of healthy older adults, as current CR (cCR). In the present study, we examined the longitudinal results of a sample of 272 older adults enrolled in the Tasmanian Healthy Brain Project. Using results from 12-month and 24-month reassessments, we examined the longitudinal validity of the cCR factor using confirmatory factor analyses. The results of these analyses indicate that the cCR factor structure is longitudinally stable. These results, in conjunction with recent results from our group demonstrating dynamic increases in cCR over time in older adults undertaking further education, lend weight to this cCR measure being a valid estimate of dynamic change in CR over time.

Preconditioning tDCS facilitates subsequent tDCS effect on skill acquisition in older adults

Functional motor declines that often occur with advancing age-including reduced efficacy to learn new skills-can have a substantial impact on the quality of life. Recent studies using noninvasive brain stimulation indicate that priming the corticospinal system by lowering the threshold for the induction of long-term potentiation-like plasticity before skill training may facilitate subsequent skill learning. Here, we used "priming" protocol, in which we used transcranial direct current stimulation (tDCS) applying the cathode over the primary motor cortex (M1) before the anode placed over M1 during unimanual isometric force control training (FORCE_training). Older individuals who received tDCS with the cathode placed over M1 before tDCS with the anode placed over M1 concurrent with FORCE_training showed greater skill improvement and corticospinal excitability increases following the tDCS/FORCE_training protocol compared with both young and older individuals who did not receive the preceding tDCS with the cathode placed over M1. The results suggested that priming tDCS protocols may be used in clinical settings to improve motor function and thus maintain the functional independence of older adults.

Middle-Aged, Non-Elite Marathon Runners: A Profile

A survey of 363 middle-aged non-elite runners who were attempting a first marathon was conducted to assess their reasons for attempting a marathon, the perceived outcomes from running a marathon, and their experiences while running. While most runners began running to improve physical fitness, personal challenge was the main reason for attempting a marathon. Running the marathon was a very positive experience producing feelings of deep personal awareness and satisfaction. Information was obtained relating to the concept of “positive addiction” and the cognitive strategies employed while running.

Construction and Evaluation of Rodent-Specific rTMS Coils

Rodent models of transcranial magnetic stimulation (TMS) play a crucial role in aiding the understanding of the cellular and molecular mechanisms underlying TMS induced plasticity. Rodent-specific TMS have previously been used to deliver focal stimulation at the cost of stimulus intensity (12 mT). Here we describe two novel TMS coils designed to deliver repetitive TMS (rTMS) at greater stimulation intensities whilst maintaining spatial resolution. Two circular coils (8 mm outer diameter) were constructed with either an air or pure iron-core. Peak magnetic field strength for the air and iron-cores were 90 and 120 mT, respectively, with the iron-core coil exhibiting less focality. Coil temperature and magnetic field stability for the two coils undergoing rTMS, were similar at 1 Hz but varied at 10 Hz. Finite element modeling of 10 Hz rTMS with the iron-core in a simplified rat brain model suggests a peak electric field of 85 and 12.7 V/m, within the skull and the brain, respectively. Delivering 10 Hz rTMS to the motor cortex of anaesthetized rats with the iron-core coil significantly increased motor evoked potential amplitudes immediately after stimulation (n = 4). Our results suggest these novel coils generate modest magnetic and electric fields, capable of altering cortical excitability and provide an alternative method to investigate the mechanisms underlying rTMS-induced plasticity in an experimental setting.

Motor learning and cross-limb transfer rely upon distinct neural adaptation processes

Performance benefits conferred in the untrained limb after unilateral motor practice are termed cross-limb transfer. Although the effect is robust, the neural mechanisms remain incompletely understood. In this study we used noninvasive brain stimulation to reveal that the neural adaptations that mediate motor learning in the trained limb are distinct from those that underlie cross-limb transfer to the opposite limb. Thirty-six participants practiced a ballistic motor task with their right index finger (150 trials), followed by intermittent theta-burst stimulation (iTBS) applied to the trained (contralateral) primary motor cortex (cM1 group), the untrained (ipsilateral) M1 (iM1 group), or the vertex (sham group). After stimulation, another 150 training trials were undertaken. Motor performance and corticospinal excitability were assessed before motor training, pre- and post-iTBS, and after the second training bout. For all groups, training significantly increased performance and excitability of the trained hand, and performance, but not excitability, of the untrained hand, indicating transfer at the level of task performance. The typical facilitatory effect of iTBS on MEPs was reversed for cM1, suggesting homeostatic metaplasticity, and prior performance gains in the trained hand were degraded, suggesting that iTBS interfered with learning. In stark contrast, iM1 iTBS facilitated both performance and excitability for the untrained hand. Importantly, the effects of cM1 and iM1 iTBS on behavior were exclusive to the hand contralateral to stimulation, suggesting that adaptations within the untrained M1 contribute to cross-limb transfer. However, the neural processes that mediate learning in the trained hemisphere vs. transfer in the untrained hemisphere appear distinct.

Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis

Transcranial direct current stimulation (tDCS) is an attractive protocol for stroke motor recovery. The current systematic review and meta-analysis investigated the effects of tDCS on motor learning post-stroke. Specifically, we determined long-term learning effects by examining motor improvements from baseline to at least 5 days after tDCS intervention and motor practise. 17 studies reported long-term retention testing (mean retention interval=43.8 days; SD=56.6 days) and qualified for inclusion in our meta-analysis. Assessing primary outcome measures for groups that received tDCS and motor practise versus sham control groups created 21 valid comparisons: (1) 16 clinical assessments and (2) 5 motor skill acquisition tests. A random effects model meta-analysis showed a significant overall effect size=0.59 (p<0.0001; low heterogeneity, T(2)=0.04; I(2)=22.75%; and high classic fail-safe N=240). 4 moderator variable analyses revealed beneficial effects of tDCS on long-term motor learning: (1) stimulation protocols: anodal on the ipsilesional hemisphere, cathodal on the contralesional hemisphere, or bilateral; (2) recovery stage: subacute or chronic stroke; (3) stimulation timing: tDCS before or during motor practise; and (4) task-specific training or conventional rehabilitation protocols. This robust meta-analysis identified novel long-term motor learning effects with tDCS and motor practise post-stroke.

Does transcranial direct current stimulation enhance cognitive and motor functions in the ageing brain? A systematic review and meta- analysis

The use of transcranial direct current stimulation (tDCS) to enhance cognitive and motor functions has enjoyed a massive increase in popularity. Modifying neuroplasticity via non-invasive cortical stimulation has enormous potential to slow or even reverse declines in functions associated with ageing. The current meta-analysis evaluated the effects of tDCS on cognitive and motor performance in healthy older adults. Of the 81 studies identified, 25 qualified for inclusion. A random effects model meta-analysis revealed a significant overall standardized mean difference equal to 0.53 (SE=0.09; medium heterogeneity: I(2)=57.08%; and high fail-safe: N=448). Five analyses on moderator variables indicated significant tDCS beneficial effects: (a) on both cognitive and motor task performances, (b) across a wide-range of cognitive tasks, (c) on specific brain areas, (d) stimulation offline (before) or online (during) the cognitive and motor tasks. Although the meta-analysis revealed robust support for enhancing both cognitive and motor performance, we outline a number of caveats on the use of tDCS.

Age-Specific Effects of Mirror-Muscle Activity on Cross-Limb Adaptations Under Mirror and Non-Mirror Visual Feedback Conditions

Cross-limb transfer (CLT) describes the observation of bilateral performance gains due to unilateral motor practice. Previous research has suggested that CLT may be reduced, or absent, in older adults, possibly due to age-related structural and functional brain changes. Based on research showing increases in CLT due to the provision of mirror visual feedback (MVF) during task execution in young adults, our study aimed to investigate whether MVF can facilitate CLT in older adults, who are known to be more reliant on visual feedback for accurate motor performance. Participants (N = 53) engaged in a short-term training regime (300 movements) involving a ballistic finger task using their dominant hand, while being provided with either visual feedback of their active limb, or a mirror reflection of their active limb (superimposed over the quiescent limb). Performance in both limbs was examined before, during and following the unilateral training. Furthermore, we measured corticospinal excitability (using TMS) at these time points, and assessed muscle activity bilaterally during the task via EMG; these parameters were used to investigate the mechanisms mediating and predicting CLT. Training resulted in significant bilateral performance gains that did not differ as a result of age or visual feedback (both p > 0.1). Training also elicited bilateral increases in corticospinal excitability (p < 0.05). For younger adults, CLT was significantly predicted by performance gains in the trained hand (β = 0.47), whereas for older adults it was significantly predicted by mirror activity in the untrained hand during training (β = 0.60). The present study suggests that older adults are capable of exhibiting CLT to a similar degree to younger adults. The prominent role of mirror activity in the untrained hand for CLT in older adults indicates that bilateral cortical activity during unilateral motor tasks is a compensatory mechanism. In this particular task, MVF did not facilitate the extent of CLT.

Sending your grandparents to university increases cognitive reserve: The Tasmanian Healthy Brain Project

OBJECTIVE

Increasing an individual's level of cognitive reserve (CR) has been suggested as a nonpharmacological approach to reducing the risk for Alzheimer's disease. We examined changes in CR in older adults participating over 4 years in the Tasmanian Healthy Brain Project.

METHOD

A sample of 459 healthy older adults between 50 and 79 years of age underwent a comprehensive annual assessment of current CR, neuropsychological function, and psychosocial factors over a 4-year period. The intervention group of 359 older adults (M = 59.61 years, SD = 6.67) having completed a minimum of 12 months part-time university study were compared against a control reference group of 100 adults (M = 62.49 years, SD = 6.24) who did not engage in further education.

RESULTS

Growth mixture modeling demonstrated that 44.3% of the control sample showed no change in CR, whereas 92.5% of the further education participants displayed a significant linear increase in CR over the 4 years of the study. These results indicate that older adults engaging in high-level mental stimulation display an increase in CR over a 4-year period.

CONCLUSION

Increasing mental activity in older adulthood may be a viable strategy to improve cognitive function and offset cognitive decline associated with normal aging. (PsycINFO Database Record

The Influence of Mirror-Visual Feedback on Training-Induced Motor Performance Gains in the Untrained Hand

The well-documented observation of bilateral performance gains following unilateral motor training, a phenomenon known as cross-limb transfer, has important implications for rehabilitation. It has recently been shown that provision of a mirror image of the active hand during unilateral motor training has the capacity to enhance the efficacy of this phenomenon when compared to training without augmented visual feedback (i.e., watching the passive hand), possibly via action observation effects [1]. The current experiment was designed to confirm whether mirror-visual feedback (MVF) during motor training can indeed elicit greater performance gains in the untrained hand compared to more standard visual feedback (i.e., watching the active hand). Furthermore, discussing the mechanisms underlying any such MVF-induced behavioural effects, we suggest that action observation and the cross-activation hypothesis may both play important roles in eliciting cross-limb transfer. Eighty participants practiced a fast-as-possible two-ball rotation task with their dominant hand. During training, three different groups were provided with concurrent visual feedback of the active hand, inactive hand or a mirror image of the active hand with a fourth control group receiving no training. Pre- and post-training performance was measured in both hands. MVF did not increase the extent of training-induced performance changes in the untrained hand following unilateral training above and beyond those observed for other types of feedback. The data are consistent with the notion that cross-limb transfer, when combined with MVF, is mediated by cross-activation with action observation playing a less unique role than previously suggested. Further research is needed to replicate the current and previous studies to determine the clinical relevance and potential benefits of MVF for cases that, due to the severity of impairment, rely on unilateral training programmes of the unaffected limb to drive changes in the contralateral affected limb.

Duration-dependent effects of the BDNF Val66Met polymorphism on anodal tDCS induced motor cortex plasticity in older adults: a group and individual perspective

The brain derived neurotrophic factor (BDNF) Val66Met polymorphism and stimulation duration are thought to play an important role in modulating motor cortex plasticity induced by non-invasive brain stimulation (NBS). In the present study we sought to determine whether these factors interact or exert independent effects in older adults. Fifty-four healthy older adults (mean age = 66.85 years) underwent two counterbalanced sessions of 1.5 mA anodal transcranial direct current stimulation (atDCS), applied over left M1 for either 10 or 20 min. Single pulse transcranial magnetic stimulation (TMS) was used to assess corticospinal excitability (CSE) before and every 5 min for 30 min following atDCS. On a group level, there was an interaction between stimulation duration and BDNF genotype, with Met carriers (n = 13) showing greater post-intervention potentiation of CSE compared to Val66Val homozygotes homozygotes (n = 37) following 20 min (p = 0.002) but not 10 min (p = 0.219) of stimulation. Moreover, Met carriers, but not Val/Val homozygotes, exhibited larger responses to TMS (p = 0.046) after 20 min atDCS, than following 10 min atDCS. On an individual level, two-step cluster analysis revealed a considerable degree of inter-individual variability, with under half of the total sample (42%) showing the expected potentiation of CSE in response to atDCS across both sessions. Intra-individual variability in response to different durations of atDCS was also apparent, with one-third of the total sample (34%) exhibiting LTP-like effects in one session but LTD-like effects in the other session. Both the inter-individual (p = 0.027) and intra-individual (p = 0.04) variability was associated with BDNF genotype. In older adults, the BDNF Val66Met polymorphism along with stimulation duration appears to play a role in modulating tDCS-induced motor cortex plasticity. The results may have implications for the design of NBS protocols for healthy and diseased aged populations.

Does the Cambridge Automated Neuropsychological Test Battery (CANTAB) Distinguish Between Cognitive Domains in Healthy Older Adults?

The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a semiautomated computer interface for assessing cognitive function. We examined whether CANTAB tests measured specific cognitive functions, using established neuropsychological tests as a reference point. A sample of 500 healthy older (M = 60.28 years, SD = 6.75) participants in the Tasmanian Healthy Brain Project completed battery of CANTAB subtests and standard paper-based neuropsychological tests. Confirmatory factor analysis identified four factors: processing speed, verbal ability, episodic memory, and working memory. However, CANTAB tests did not consistently load onto the cognitive domain factors derived from traditional measures of the same function. These results indicate that five of the six CANTAB subtests examined did not load onto single cognitive functions. These CANTAB tests may lack the sensitivity to measure discrete cognitive functions in healthy populations or may measure other cognitive domains not included in the traditional neuropsychological battery.

Reducing false positive diagnoses in mild cognitive impairment: the importance of comprehensive neuropsychological assessment

BACKGROUND AND PURPOSE

Longitudinal studies of mild cognitive impairment (MCI) report that a sizeable proportion of MCI cases revert to normal levels of functioning over time. The rate of recovery from MCI indicates that existing MCI diagnostic criteria result in an unacceptably high rate of false positive diagnoses and lack adequate sensitivity and specificity.

METHODS

The aim of the present study was to identify a set of neuropsychological measures able to differentiate between true positive cases of MCI from those who were unimpaired at 11 months' follow-up.

RESULTS

A discriminant function analysis identified that a combination of measures of complex sustained attention, semantic memory, working memory, episodic memory and selective attention correctly classified outcome in more than 80% of cases. The rate of false positive diagnoses (5.93%) was considerably lower than is evident in previously published MCI studies.

CONCLUSIONS

The results of the present study indicate that the rate of false positive MCI diagnoses can be significantly reduced through the use of sensitive and specific neuropsychological measures of memory and non-memory functions.

Delayed plastic responses to anodal tDCS in older adults

Despite the abundance of research reporting the neurophysiological and behavioral effects of transcranial direct current stimulation (tDCS) in healthy young adults and clinical populations, the extent of potential neuroplastic changes induced by tDCS in healthy older adults is not well understood. The present study compared the extent and time course of anodal tDCS-induced plastic changes in primary motor cortex (M1) in young and older adults. Furthermore, as it has been suggested that neuroplasticity and associated learning depends on the brain-derived neurotrophic factor (BDNF) gene polymorphisms, we also assessed the impact of BDNF polymorphism on these effects. Corticospinal excitability was examined using transcranial magnetic stimulation before and following (0, 10, 20, 30 min) anodal tDCS (30 min, 1 mA) or sham in young and older adults. While the overall extent of increases in corticospinal excitability induced by anodal tDCS did not vary reliably between young and older adults, older adults exhibited a delayed response; the largest increase in corticospinal excitability occurred 30 min following stimulation for older adults, but immediately post-stimulation for the young group. BDNF genotype did not result in significant differences in the observed excitability increases for either age group. The present study suggests that tDCS-induced plastic changes are delayed as a result of healthy aging, but that the overall efficacy of the plasticity mechanism remains unaffected.

Visual feedback-related changes in ipsilateral cortical excitability during unimanual movement: Implications for mirror therapy

Provision of a mirror image of a hand undertaking a motor task (i.e., mirror therapy) elicits behavioural improvements in the inactive hand. A greater understanding of the neural mechanisms underpinning this phenomenon is required to maximise its potential for rehabilitation across the lifespan, e.g., following hemiparesis or unilateral weakness. Young and older participants performed unilateral finger abductions with no visual feedback, with feedback of the active or passive hands, or with a mirror image of the active hand. Transcranial magnetic stimulation was used to assess feedback-related changes in two neurophysiological measures thought to be involved in inter-manual transfer of skill, namely corticospinal excitability (CSE) and intracortical inhibition (SICI) in the passive hemisphere. Task performance led to CSE increases, accompanied by decreases of SICI, in all visual feedback conditions relative to rest. However, the changes due to mirror feedback were not significantly different to those observed in the other (more standard) visual conditions. Accordingly, the unimanual motor action itself, rather than modifications in visual feedback, appears more instrumental in driving changes in CSE and SICI. Therefore, changes in CSE and SICI are unlikely to underpin the behavioural benefits of mirror therapy. We discuss implications for rehabilitation and directions of future research.

Aging and motor inhibition: a converging perspective provided by brain stimulation and imaging approaches

The ability to inhibit actions, one of the hallmarks of human motor control, appears to decline with advancing age. Evidence for a link between changes in inhibitory functions and poor motor performance in healthy older adults has recently become available with transcranial magnetic stimulation (TMS). Overall, these studies indicate that the capacity to modulate intracortical (ICI) and interhemispheric (IHI) inhibition is preserved in high-performing older individuals. In contrast, older individuals exhibiting motor slowing and a declined ability to coordinate movement appear to show a reduced capability to modulate GABA-mediated inhibitory processes. As a decline in the integrity of the GABA-ergic inhibitory processes may emerge due to age-related loss of white and gray matter, a promising direction for future research would be to correlate individual differences in structural and/or functional integrity of principal brain networks with observed changes in inhibitory processes within cortico-cortical, interhemispheric, and/or corticospinal pathways. Finally, we underscore the possible links between reduced inhibitory functions and age-related changes in brain activation patterns.

Functional role of left PMd and left M1 during preparation and execution of left hand movements in older adults

A disruptive transcranial magnetic stimulation (TMS) approach was used to determine whether the increased frontal activation and reduced hemispheric laterality brain activation patterns observed in older adults during motor tasks play a functional role. Young and older adults abducted their left index finger as soon as possible after a visual imperative signal presented 500 ms after a warning signal. TMS was applied to the dorsal premotor (PMd) or primary motor (M1) cortex in the left or right hemisphere at seven times during response preparation and execution. Both groups exhibited faster reaction times in their left hand after stimulation of the left PMd (i.e., ipsilateral to the responding hand) relative to trials with no TMS, indicating a functional role of the left PMd in the regulation of impulse control. This result also suggests that the function of the left PMd appears to be unaffected by the healthy aging process. Right M1 TMS resulted in a response time delay in both groups. Only for older adults did left M1 stimulation delay responses, suggesting the involvement of ipsilateral motor pathways in the preparation of motor actions in older adults.

Decision making and action implementation: evidence for an early visually triggered motor activation specific to potential actions

To make a decision may rely on accumulating evidence in favor of one alternative until a threshold is reached. Sequential-sampling models differ by the way of accumulating evidence and the link with action implementation. Here, we tested a model's prediction of an early action implementation specific to potential actions. We assessed the dynamics of action implementation in go/no-go and between-hand choice tasks by transcranial magnetic stimulation of the motor cortex (single- or paired-pulse TMS; 3-ms interstimulus interval). Prior to implementation of the selected action, the amplitude of the motor evoked potential first increased whatever the visual stimulus but only for the hand potentially involved in the to-be-produced action. These findings suggest that visual stimuli can trigger an early motor activation specific to potential actions, consistent with race-like models with continuous transmission between decision making and action implementation.

Transfer of ballistic motor skill between bilateral and unilateral contexts in young and older adults: neural adaptations and behavioral implications

Bilateral movement rehabilitation is gaining popularity as an approach to improve the recovery not only of bimanual function but also of unilateral motor tasks. While the neural mechanisms mediating the transfer of bilateral training gains into unimanual contexts are not fully understood, converging evidence from behavioral, neurophysiological, and imaging studies suggests that bimanual movements are not simply the superposition of unimanual tasks undertaken with both (upper) limbs. Here we investigated the neural responses in both hemispheres to bilateral ballistic motor training and the extent to which performance improvements transferred to a unimanual task. Since aging influences interhemispheric interactions during movement production, both young (n = 9; mean age 19.4 yr; 6 women, 3 men) and older (n = 9; 66.3 yr; 7 women, 2 men) adults practiced a bilateral motor task requiring simultaneous "fast-as-possible" abductions of their left and right index fingers. Changes in bilateral and unilateral performance, and in corticospinal excitability and intracortical inhibition, were assessed. Strong transfer was observed between bimanual and unimanual contexts for both age groups. However, in contrast to previous reports of substantial bilateral cortical adaptations following unilateral training, increases in corticospinal excitability following bilateral training were not statistically reliable, and a release of intracortical inhibition was only observed for older adults. The results indicate that the neural mechanisms of motor learning for bilateral ballistic tasks differ from those that underlie unimanual ballistic performance improvement but that aging results in a greater overlap of the neural mechanisms mediating bilateral and unilateral ballistic motor performance.

Premotor-motor interhemispheric inhibition is released during movement initiation in older but not young adults

Neural interactions between contralateral motor regions are thought to be instrumental in the successful preparation, and execution, of volitional movements. Here we investigated whether healthy ageing is associated with a change in functional connectivity, as indicated by the ability to modulate interhemispheric interactions during movement preparation in a manner that assists rapid movement responses. Thirteen young (mean age 22.2 years) and thirteen older (68.5 years) adults rapidly abducted their left index finger as soon as possible in response to a visual imperative signal, presented 500 ms after a visual warning signal.

Interactions between left dorsal premotor cortex (LPMd) and right primary motor cortex (RM1) and between left primary motor cortex (LM1) and RM1 were investigated at six time points between the warning signal and the volitional response using paired-pulse transcranial magnetic stimulation. Relative to the inhibitory interactions measured at rest, both young and older adults released LM1-RM1 inhibition beginning 250 ms after the warning signal, with no significant differences between groups. LPMd-RM1 interactions became facilitatory (from the onset of the imperative signal onwards) in the older, but not the young, group. Regression analyses revealed that for the older adults, modulation of LPMd-RM1 interactions early in the preparation period was associated with faster responses, suggesting that specifically timed modulation of these pathways may be a compensatory mechanism to offset, at least in part, slowing of motor responses. The results suggest a greater reliance on premotor regions during the preparation of simple motor actions with advancing age.

The effect of occupational exposure to manganese dust and fume on neuropsychological functioning in Australian smelter workers

Chronic low-level occupational exposure to manganese (Mn) is reportedly associated with the development of Parkinsonian-like symptoms. In a study of 143 manganese smelter workers, inhalable Mn exposure was associated with lower performances on the Digit Symbol Coding and Stroop tests; respirable Mn exposure was associated with improved Digit Symbol Coding test performance and reduced performance on the Trail Making (Part A), Matrix Reasoning, and Stroop tests. While these relationships reached statistical significance, the magnitude of these effects was significantly smaller than the standard error of measurement of the neuropsychological tests, indicating that these differences are not of clinical significance.

Age-related differences in corticomotor excitability and inhibitory processes during a visuomotor RT task

This study tested the postulation that change in the ability to modulate corticospinal excitability and inhibitory processes underlie age-related differences in response preparation and generation during tasks requiring either rapid execution of a motor action or actively withholding that same action. Younger (n = 13, mean age = 26.0 years) and older adults (n = 13, mean age = 65.5 years) performed an RT task in which a warning signal (WS) was followed by an imperative signal (IS) to which participants were required to respond with a rapid flexion of the right thumb (go condition) or withhold their response (no-go condition). We explored the neural correlates of response preparation, generation, and inhibition using single- and paired-pulse TMS, which was administered at various times between WS and IS (response preparation phase) and between IS and onset of response-related muscle activity in the right thumb (response generation phase). Both groups exhibited increases in motor-evoked potential amplitudes (relative to WS onset) during response generation; however, this increase began earlier and was more pronounced for the younger adults in the go condition. Moreover, younger adults showed a general decrease in short-interval intracortical inhibition during response preparation in both the go and no-go conditions, which was not observed in older adults. Importantly, correlation analysis suggested that for older adults the task-related increases of corticospinal excitability and intracortical inhibition were associated with faster RT. We propose that the declined ability to functionally modulate corticospinal activity with advancing age may underlie response slowing in older adults.

Long-term rehabilitation for chronic stroke arm movements: a randomized controlled trial

Objective: We investigated the effect of long-term practice on motor improvements in chronic stroke patients.

Design: Randomized parallel group controlled study.

Setting: Motor Behavior Laboratory, University of Florida.

Subjects: Eighteen individuals who experienced a stroke more than nine months prior to enrolling.

Interventions: The treatment interventions were bilateral arm movements coupled with active neuromuscular stimulation on the impaired arm for both practice duration groups. The short-term group received one treatment protocol, whereas, over 16 months, the long-term practice group completed 10 treatment protocols. All protocol sessions were 6 hours long (90 minutes 1 day/week/4 weeks) and were separated by 22 days.

Main outcome measures: Repeated data collection on three primary outcome measures (i.e. Box and Block test, fractionated reaction times, and sustained force production) evaluated motor capabilities across rehabilitation times.

Results: Mixed design ANOVAs (Group × Retention Test: 2 × 4; Group × Retention Test × Arm Condition: 2 × 4 × 2) revealed improved motor capabilities for the long-term practice duration group on each primary measure. At the 16-month delayed retention test, when compared to the short-term group, the long-term group demonstrated: (a) more blocks moved (43 v 32), (b) faster premotor reaction times (158 v 208 ms), and (c) higher force production (75 v 45 N).

Conclusion: Sixty hours of rehabilitation over 16 months provided by various bilateral arm movements and coupled active stimulation improved motor capabilities in chronic stroke.

Age-related differences in corticospinal excitability during a Go/NoGo task

Age-related slowing of reaction times (RTs) is well documented but whether the phenomenon reflects deficits in movement preparation and/or response generation processes is unclear. To gain further insight into this issue, transcranial magnetic stimulation (TMS) was used to investigate motor cortex (M1) excitability and short-interval intracortical inhibitory (SICI) processes during a Go/NoGo RT task in younger and older adults. Single- and paired-pulse TMS was delivered over the left M1 during preparation and response generation periods in a right-hand muscle. Younger adults had shorter RTs and a larger increase in corticospinal excitability at response generation period than older adults. SICI modulation for both groups showed a large reduction in inhibition immediately prior to EMG onset. These findings indicate age-related differences in corticospinal excitability during the response generation stage of sensorimotor information processing.

Long-lasting contralateral motor cortex excitability is increased by unilateral hand movement that triggers electrical stimulation of opposite homologous muscles

BACKGROUND/OBJECTIVE

Long-term changes in the motor cortex can be induced by practicing motor tasks with simultaneous application of peripheral nerve stimulation. This combination may augment motor rehabilitation after stroke but has been used primarily during contraction of the affected hand. The authors tested the effect of a right hand movement that electrically stimulated left hand contraction on right motor cortex excitability.

METHODS

Three tasks were used in 15 healthy subjects--a motor and stimulation task (MS(task)), stimulation only task (S(task)), and motor only task (M(task)). The MS(task) consisted of isometric thumb abduction of the right hand that triggered paired electrical stimulation of the left abductor pollicis brevis (APB) and first dorsal interosseus (FDI) motor points. The S(task) was performed 1 week later and matched the stimulation received in the MS(task). The M(task) was performed as a control. Transcranial magnetic stimulation applied to the right motor cortex assessed corticospinal excitability, short latency intracortical inhibition, and intracortical facilitation of the FDI and APB before, immediately after, and 30 minutes after task performance.

RESULTS

Corticospinal excitability increased in the FDI and APB following the MS(task) but not following the S(task) or M(task). The increased excitability present 30 minutes after the MS(task) also correlated with excitability measures recorded 1 week later.

CONCLUSION

A bilateral motor and electrical stimulation task can drive persistent adaptation within the corticospinal system. Hemiplegic subjects who have poor voluntary movement of the affected hand may be able to contract the unaffected hand to activate and train homologous movements.

Aging effects on event and emergent timing in bimanual coordination

There is growing evidence that normal aging may produce declines in some motor tasks but not others. One account of the task-specific aging effects suggests that age-related differences will be evident in tasks that demand high-level processing but not in tasks that can be performed relatively automatically. To test this hypothesis we compared the performance of young and older adults on two bimanual circle drawing tasks that utilize either low-level emergent timing processes (continuous circle drawing) or higher-level event-based timing mechanisms (intermittent circle drawing). The circle drawing tasks were performed with the hands coupled in either a symmetrical or asymmetrical coordination mode and at two individually-determined movement frequencies (comfortable and fast). Older participants were able to match the performance of young adults under both coordination modes and movement frequencies in the bimanual continuous circling task, but showed significantly greater temporal variability when performing the intermittent circling task. The results of the study are in accordance with the view that age-related effects will be observed in tasks in which movement timing is guided by high-level representations but not in tasks involving relatively automatic low-level timing processes.

Absence of cross-limb transfer of performance gains following ballistic motor practice in older adults

The phenomenon of cross-limb transfer, in which unilateral strength training can result in bilateral strength gains, has recently been tested for ballistic movements. Performance gains associated with repetitive motor practice, and the associated transfer, occur within a few minutes. In this study, young and older adults were trained to perform ballistic abductions of their dominant (right) index finger as quickly as possible. Performance was assessed bilaterally before, during, and after this training. Both groups exhibited large performance gains in the right hand as a result of training (P < 0.001; young 84% improvement, older 70% improvement), which were not significantly different between groups (P = 0.40). Transcranial magnetic stimulation revealed that the performance improvements were accompanied by increases in excitability, together with decreases in intracortical inhibition, of the projections to both the trained muscle and the homologous muscle in the contralateral limb (P < 0.05). The young group also exhibited performance improvements as a result of cross-limb transfer in the left (untrained) hand (P < 0.005), equivalent to 75% of the performance increase in the trained hand. In contrast, there were no significant performance gains in the left hand for the older group (P = 0.23). This was surprising given that the older group exhibited a significantly greater degree of mirror activity than the young group (P < 0.01) in the left first dorsal interosseus muscle (FDI) during right hand movements. Our findings suggest that older adults exhibit a reduced capacity for cross-limb transfer, which may have implications for motor rehabilitation programs after stroke.

Bilateral movement training and stroke motor recovery progress: a structured review and meta-analysis

The purpose was to conduct a structured review and meta-analysis to determine the cumulative effect of bilateral arm training on motor capabilities post stroke. Forty-eight stroke studies were selected from three databases with 25 comparisons qualifying for inclusion in our meta-analysis. We identified and coded four types of bilateral arm interventions with 366 stroke patients. A random effects model using the standardized mean difference technique determined a large and significant effect size (0.734; SE=0.125), high fail-safe N (532), and medium variability in the studies (I(2)=63%). Moderator variable analysis on the type of bilateral training revealed two large and significant effects: (a) BATRAC (0.842; SE=0.155) and (b) coupled bilateral and EMG-triggered neuromuscular stimulation (1.142; SE=0.176). These novel findings provide strong evidence supporting bilateral arm training with the caveat that two coupled protocols, rhythmic alternating movements and active stimulation, are most effective.

The behavioural and electrophysiological effects of visual task difficulty and bimanual coordination mode during dual-task performance

The difficulty of a visual three stimulus and a bimanual coordination task was manipulated by varying discrimination difficulty (easy, hard) and coordination mode (in-phase, anti-phase) respectively. Electroencephalographic activity was recorded from 32 sites whilst participants (n = 16) completed four dual-task conditions in counterbalanced order. Longer reaction time and lower accuracy were found for the hard relative to the easy visual task and, for the hard visual task, accuracy was lower under anti-phase relative to in-phase conditions. Amplitude and latency of event-related potential components P3a and P3b were recorded and measured. There was a reduction in P3b amplitude and increase in P3a amplitude for the hard visual task overall and a further reduction in frontal P3b amplitude under the more demanding anti-phase condition. For the easy visual task, however, P3b and P3a amplitude were greater under the anti-phase relative to in-phase coordination condition at left hemisphere frontal sites. These findings suggest that the attentional cost of stabilising anti-phase bimanual coordination is largely associated with top-down automatic processes subserved by the frontal attentional network.

Upper extremity improvements in chronic stroke: coupled bilateral load training

BACKGROUND

The current treatment intervention study determined the effect of coupled bilateral training (i.e., bilateral movements and EMG-triggered neuromuscular stimulation) and resistive load (mass) on upper extremity motor recovery in chronic stroke.

METHODS

Thirty chronic stroke subjects were randomly assigned to one of three behavioral treatment groups and completed 6 hours of rehabilitation in 4 days: (1) coupled bilateral training with a load on the unimpaired hand, (2) coupled bilateral training with no load on the unimpaired hand, and (3) control (no stimulation assistance or load).

RESULTS

Separate mixed design ANOVAs revealed improved motor capabilities by the coupled bilateral groups. From the pretest to the posttest, both the coupled bilateral no load and load groups moved a higher number of blocks and demonstrated more regularity in the sustained contraction task. Faster motor reaction times across test sessions for the coupled bilateral load group provided additional evidence for improved motor capabilities.

CONCLUSIONS

Together these behavioral findings lend support to the contribution of coupled bilateral training with a load on the unimpaired arm to improved motor capabilities on the impaired arm. This evidence supports a neural explanation in that simultaneously moving both limbs during stroke rehabilitation training appears to activate balanced interhemispheric interactions while an extra load on the unimpaired limb provides stability to the system.

Neuromuscular and spatial constraints on bimanual hand-held pendulum oscillations: dissociation or combination?

The present work investigated the effects of spatial and neuromuscular constraints on the mean states and variability of interlimb coordination patterns performed in the para-sagittal plane of motion in a hand-held pendulum oscillation task. Nine right-handed students had to oscillate two pendulums through wrist adduction-abduction movements. Relative movement direction was manipulated by asking participants to perform both isodirectional and non-isodirectional movements. Participants were required to grab the pendulums either with both forearms in the same neutral or supine posture or with one forearm in neutral while the other one was in prone-inversed position. When both forearms were in a similar posture, isodirectional movements were generated predominantly by simultaneous activation of homologous muscle groups whereas non-isodirectional movements mainly resulted from simultaneous activation of non-homologous muscle groups. When forearms were in dissimilar posture, isodirectional movements were generated predominantly by the simultaneous activation of non-homologous muscle groups whereas non-isodirectional movements mainly resulted from simultaneous activation of homologous muscle groups. Standard deviation of relative phase and absolute error of relative phase were analyzed for each forearm posture condition. We hypothesized that neuromuscular and spatial constraints would affect two different aspects of coordination performance, i.e., pattern stability and accuracy, respectively. Comparison of the results obtained for similar and dissimilar postures suggested that changes of pattern stability were mediated by changes in the nature of the muscle activation patterns that gave rise to wrist movement in each condition. On the other hand, the results also showed that movement direction exclusively affected phase shift. The findings are consistent with the conclusion of Park et al. [Park, H., Collins, D. R., & Turvey, M. T. (2001). Dissociation of muscular and spatial constraints on patterns of interlimb coordination. Journal of Experimental Psychology: Human Perception and Performance, 27, 32-47.] that neuromuscular constraints affect variability of relative phase (attractor strength) and spatial constraints affect the shift of relative phase (attractor location).

Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study

The use of activity-dependent interventions has shown some success in promoting recovery of upper limb function in chronic stroke patients. This study compared the neurophysiological and behavioural changes associated with two such rehabilitation protocols: unilateral and bilateral movement training. Twelve chronic stroke patients were randomly assigned to the two training protocols involving six daily practice sessions. Each session consisted of 50 trials of a dowel placement task performed either with both impaired and unimpaired arm moving synchronously (bilateral training group) or with only the impaired arm moving (unilateral training). Kinematic measurements of upper limb movements were made in four unilateral test trials performed prior to and following each practice session. Functional assessments of the impaired upper limb and neurophysiological assessments, using transcranial magnetic stimulation (TMS), of the affected and non-affected cortical hemispheres were made prior to and following the intervention sessions. Individuals receiving bilateral training showed a reduction in movement time of the impaired limb and increased upper limb functional ability compared to individuals receiving unilateral training. In some patients changes to upper limb function were associated with changes to the cortical representation of a target muscle in the non-affected hemisphere. Overall, these findings suggest that a short-term bilateral training intervention may be effective in facilitating upper limb motor function in chronic stroke patients.

The coalition of constraints during coordination of the ipsilateral and heterolateral limbs

Previous work on the coordination between the upper and lower limbs has invariably shown that its accuracy/stability is primarily determined by the mutual direction between limbs in extrinsic space and not by muscle relationships. Here we show that muscle grouping does play a critical role in coordination of the arm and leg, in addition to direction. More specifically, the simultaneous activation of isofunctional muscles and/or limb movements proceeding in the same direction, results in more successful performance than the alternated activation of isofunctional muscles and/or movements occurring in different directions. In the absence of isofunctional muscle coupling, the mutual direction between the limbs plays a more prominent role in determining coordinative accuracy. These coordination constraints can largely account for the observed differences between ipsilateral and heterolateral limb coordination. The findings are discussed in view of the coalition of coordination constraints.