Generalizing post-stroke prognoses from research data to clinical data

Around a third of stroke survivors suffer from acquired language disorders (aphasia), but current medicine cannot predict whether or when they might recover. Prognostic research in this area increasingly draws on datasets associating structural brain imaging data with outcome scores for ever-larger samples of stroke patients. The aim is to learn brain-behaviour trends from these data, and generalize those trends to predict outcomes for new patients. The practical significance of this work depends on the expected breadth of that generalization. Here, we show that these models can generalize across countries and native languages (from British patients tested in English to Chilean patients tested in Spanish), across neuroimaging technology (from MRI to CT), and from scans collected months or years after stroke for research purposes, to scans collected days or weeks after stroke for clinical purposes

Transient and sustained incentive effects on electrophysiological indices of cognitive control in younger and older adults

Preparing for upcoming events, separating task-relevant from task-irrelevant information and efficiently responding to stimuli all require cognitive control. The adaptive recruitment of cognitive control depends on activity in the dopaminergic reward system as well as the frontoparietal control network. In healthy aging, dopaminergic neuromodulation is reduced, resulting in altered incentive-based recruitment of control mechanisms. In the present study, younger adults (18–28 years) and healthy older adults (66–89 years) completed an incentivized flanker task that included gain, loss, and neutral trials. Event-related potentials (ERPs) were recorded at the time of incentive cue and target presentation. We examined the contingent negative variation (CNV), implicated in stimulus anticipation and response preparation, as well as the P3, which is involved in the evaluation of visual stimuli. Both younger and older adults showed transient incentive-based modulation of CNV. Critically, cue-locked and target-locked P3s were influenced by transient and sustained effects of incentives in younger adults, while such modulation was limited to a sustained effect of gain incentives on cue-P3 in older adults. Overall, these findings are in line with an age-related reduction in the flexible recruitment of preparatory and target-related cognitive control processes in the presence of motivational incentives

Arterial dP/dtmax accurately reflects left ventricular contractility during shock when adequate vascular filling is achieved

Background: Peak first derivative of femoral artery pressure (arterial dP/dt max) derived from fluid-filled catheter remains questionable to assess left ventricular (LV) contractility during shock. The aim of this study was to test if arterial dP/dt maxis reliable for assessing LV contractility during various hemodynamic conditions such as endotoxin-induced shock and catecholamine infusion.Methods: Ventricular pressure-volume data obtained with a conductance catheter and invasive arterial pressure obtained with a fluid-filled catheter were continuously recorded in 6 anaesthetized and mechanically ventilated pigs. After a stabilization period, endotoxin was infused to induce shock. Catecholamines were transiently administrated during shock. Arterial dP/dt maxwas compared to end-systolic elastance (Ees), the gold standard method for assessing LV contractility.Results: Endotoxin-induced shock and catecholamine infusion lead to significant variations in LV contractility. Overall, significant correlation (r = 0.51; p < 0.001) but low agreement between the two methods were observed. However, a far better correlation with a good agreement were observed when positive-pressure ventilation induced an arterial pulse pressure variation (PPV) ≤ 11% (r = 0.77; p < 0.001).Conclusion: While arterial dP/dt maxand Ees were significantly correlated during various hemodynamic conditions, arterial dP/dt maxwas more accurate for assessing LV contractility when adequate vascular filling, defined as PPV ≤ 11%, was achieved. © 2012 Morimont et al; licensee BioMed Central Ltd

Sensory sensitivity: Should we consider attention in addition to prediction?

Ward (this issue) proposes a signal detection framework to explore sensory sensitivity across different conditions and links it to the predictive coding theory. More generally, however, perception is determined not only by sensory input and by prediction or prior knowledge, but also by behavioral relevance. We argue that selective attention, the process that allows us to prioritize the processing of behaviorally relevant over irrelevant information, should be taken into account when considering individual differences in sensory sensitivity.status: publishe

Mutual interplay between perceptual organization and attention: a neuropsychological perspective

An efficient representation of the environment requires both the selection of a fraction of the information that reaches our senses and the organization of this information into coherent and meaningful elements. Here we discuss the dynamic interplay between selective attention and perceptual organization, important processes that allow us to perceive a seamless, integrated world. Based on evidence from behavioral and neuroimaging studies with normal observers and neuropsychological patients, we examine whether: (i) perceptual grouping constrains visual attention, determining which objects will be selected and be candidates for explicit report; (ii) visual attention modulates perceptual grouping, determining how elements are grouped to form meaningful wholes. The data suggest that, whilst not being necessary for at least some forms of perceptual grouping, visual attention can nevertheless modulate grouping. We conclude that selection is dynamically set by bottom-up stimulus factors, top-down knowledge and the allocation of attention to space and within grouped regions of objects

Functional connectivity in the normal and injured brain.

The brain is neither uniform nor composed of similar modules but is rather a mosaic of different and highly interconnected regions. Accordingly, knowledge of functional connectivity between brain regions is crucial to understanding perception, cognition, and behavior. Functional connectivity methods estimate similarities between activity recorded in different regions of the brain. They are often applied to resting state activity, thus providing measures that are by nature task independent. The spatial patterns revealed by functional connectivity are not only shaped by the underlying anatomical structure of the brain but also partially depend on the history of task-driven coactivations. Inter-subject differences in functional connectivity may, at least to some degree, underlie variability observed in task performance across healthy subjects and in behavioral impairments in neurological patients. In this respect, recent studies have demonstrated that behavioral deficits in patients with brain injury are not only due to local tissue damage but also due to altered functional connectivity among structurally intact regions connected to the damaged site. Studies based on functional connectivity have the potential to advance basic understanding of how brain lesions induce neuropsychological syndromes. Furthermore, they may eventually suggest improved rehabilitation strategies for patients with brain injury, through the design of individualized treatment and recovery protocols

Parcellation of parietal cortex: convergence between lesion-symptom mapping and mapping of the intact functioning brain.

Spatial-attentional deficits are highly prevalent following stroke. They can be clinically detected by means of conventional bedside tests such as target cancellation, line bisection and the visual extinction test. Until recently, lesion mapping studies and functional imaging of the intact brain did not agree very well on exactly which parietal areas play a key role in selective attention: the inferior parietal lobule or the intraparietal sulcus. Recently, the use of a contrastive approach in patients akin to that commonly used in functional imaging studies in healthy volunteers together with voxel-based lesion-symptom mapping have allowed to bring the patient lesion mapping much closer to the functional imaging results obtained in healthy controls. In this review we focus on converging evidence obtained from patient lesion studies and from fMRI studies in the intact brain in humans. This has yielded novel insights into the functional segregation between the middle third of the intraparietal sulcus, the superior parietal lobule and the temporoparietal junction in the intact brain and also enhanced our understanding of the pathogenetic mechanisms underlying deficits arising in patients

Neuropsychological evidence for a spatial bias in visual short-term memory after left posterior ventral damage.

For the first time, we report a spatial bias in visual short-term memory (VSTM) after left medial and inferior occipito-temporal damage. Our patient D.M. showed a spatial bias in report from VSTM, being more accurate at reporting stimuli presented in her left than her right visual field (Experiment 1). This spatial bias could not be attributed to a visual field deficit (Experiment 2) and was based on the relative rather than the absolute locations of the stimuli (Experiment 3). It was reduced when the transfer of items to VSTM was facilitated-for example, by grouping stimuli (Experiment 4) or by reducing the number of items to be remembered (Experiment 5). The spatial bias was attenuated when items moved from right to centre or left to centre, and D.M. was cued to report the item that would have been on the right or left, had the movement continued (Experiment 6). We conclude that posterior ventral damage can impair both the consolidation of new information in VSTM and the explicit report of consolidated information from VSTM