The hippocampus and the flexible use and processing of language

Fundamental to all human languages is an unlimited expressive capacity and creative flexibility that allow speakers to rapidly generate novel and complex utterances. In turn, listeners interpret language “on-line,” incrementally integrating multiple sources of information as words unfold over time. A challenge for theories of language processing has been to understand how speakers and listeners generate, gather, integrate, and maintain representations in service of language processing. We propose that many of the processes by which we use language place high demands on and receive contributions from the hippocampal declarative memory system. The hippocampal declarative memory system is long known to support relational binding and representational flexibility. Recent findings demonstrate that these same functions are engaged during the real-time processes that support behavior in-the-moment. Such findings point to the hippocampus as a potentially key contributor to cognitive functions that require on-line integration of multiple sources of information, such as on-line language processing. Evidence supporting this view comes from findings that individuals with hippocampal amnesia show deficits in the use of language flexibly and on-line. We conclude that the relational binding and representational flexibility afforded by the hippocampal declarative memory system positions the hippocampus as a key contributor to language use and processing

Focal ventromedial prefrontal cortex damage impairs convergence in discourse

Conversational partners tend to converge (become more similar) on various speech and discourse characteristics, enhancing social affiliation. We examined convergence in the discourse of eight participants with bilateral ventromedial prefrontal cortex (VMPC) damage and eight healthy comparison participants (NC) each interacting with a clinician. Changes in total words, words/turn, and backchannels were assessed across the interaction by comparing the first ¼ and last ¼ of the session. Preliminary results suggest that convergence was displayed in NC interactions as conversational partners become more similar to one another across variables. In striking contrast, VMPC interactions did not display convergence across any variables

Procedural Memory Following Moderate-Severe Traumatic Brain Injury: Group Performance and Individual Differences on the Rotary Pursuit Task

The impact of traumatic brain injury (TBI) on procedural memory has received significantly less attention than declarative memory. Although to date studies on procedural memory have yielded mixed findings, many rehabilitation protocols (e.g., errorless learning) rely on the procedural memory system, and assume that it is relatively intact. The aim of the current study was to determine whether individuals with TBI are impaired on a task of procedural memory as a group, and to examine the presence of individual differences in performance. We administered to a sample of 36 individuals with moderate-severe TBI and 40 healthy comparisons (HCs) the rotary pursuit task, and then examined their rate of learning, as well as their retention of learning. Our analyses revealed that while individuals with TBI spent a significantly shorter amount of time on target as a group, they did not retain significantly less procedural learning, and as a group their rate of learning was not different from HCs. However, there were high individual differences in both groups, indicating that some individuals might not be able to take advantage of treatment methods designed to leverage intact procedural memory system. Future work is needed to better assess and characterize procedural memory in individuals with TBI across a larger battery of tasks in experimental and clinical setting as memory and learning status may predict rehabilitation success

Medial Temporal Lobe Damage Impairs Representation of Simple Stimuli

Medial temporal lobe (MTL) damage in humans is typically thought to produce a circumscribed impairment in the acquisition of new enduring memories, but recent reports have documented deficits even in short-term maintenance. We examined possible maintenance deficits in a population of MTL amnesics, with the goal of characterizing their impairments as either representational drift or outright loss of representation over time. Patients and healthy comparisons performed a visual search task in which the similarity of various lures to a target was varied parametrically. Stimuli were simple shapes varying along one of several visual dimensions. The task was performed in two conditions, one presenting a sample target simultaneously with the search array and the other imposing a delay between sample and array. Eye-movement data collected during search revealed that the duration of fixations to items varied with lure-target similarity for all participants, i.e., fixations were longer for items more similar to the target. In the simultaneous condition, patients and comparisons exhibited an equivalent effect of similarity on fixation durations. However, imposing a delay modulated the effect differently for the two groups: in comparisons, fixation duration to similar items was exaggerated; in patients, the original effect was diminished. These findings indicate that MTL lesions subtly impair short-term maintenance of even simple stimuli, with performance reflecting not the complete loss of the maintained representation but rather a degradation or progressive drift of the representation over time

Hippocampal Amnesia Impairs All Manner of Relational Memory

Relational memory theory holds that the hippocampus supports, and amnesia following hippocampal damage impairs, memory for all manner of relations. Unfortunately, many studies of hippocampal-dependent memory have either examined only a single type of relational memory or conflated multiple kinds of relations. The experiments reported here employed a procedure in which each of several kinds of relational memory (spatial, associative, and sequential) could be tested separately using the same materials. In Experiment 1, performance of amnesic patients with medial temporal lobe (MTL) damage was assessed on memory for the three types of relations as well as for items. Compared to the performance of matched comparison participants, amnesic patients were impaired on all three relational tasks. But for those patients whose MTL damage was limited to the hippocampus, performance was relatively preserved on item memory as compared to relational memory, although still lower than that of comparison participants. In Experiment 2, study exposure was reduced for comparison participants, matching their item memory to the amnesic patients in Experiment 1. Relational memory performance of comparison subjects was well above amnesic patient levels, showing the disproportionate dependence of all three relational memory performances on the integrity of the hippocampus. Correlational analyses of the various task performances of comparison participants and of college-age participants showed that our measures of item memory were not influenced significantly by memory for associations among the items

Detestable or marvelous? Neuroanatomical correlates of character judgments

As we learn new information about the social and moral behaviors of other people, we form and update character judgments of them, and this can profoundly influence how we regard and act towards others. In the study reported here, we capitalized on two interesting neurological patient populations where this process of complex “moral updating” may go awry: patients with bilateral damage to ventromedial prefrontal cortex (vmPFC) and patients with bilateral damage to hippocampus (HC). We predicted that vmPFC patients, who have impaired emotion processing, would exhibit reduced moral updating, and we also investigated how moral updating might be affected by severe declarative memory impairment in HC patients. The vmPFC, HC, and brain-damaged comparison (BDC) participants made moral judgments about unfamiliar persons before and after exposure to social scenarios depicting the persons engaged in morally good, bad, or neutral behaviors. In line with our prediction, the vmPFC group showed the least amount of change in moral judgments, and interestingly, the HC group showed the most amount of change. These results suggest that the vmPFC and hippocampus play critical but complementary roles in updating moral character judgments about others: the vmPFC may attribute emotional salience to moral information, whereas the hippocampus may provide necessary contextual information from which to make appropriate character judgments

Investigating the Day-to-Day Experiences of Users with Traumatic Brain Injury with Conversational Agents

Traumatic brain injury (TBI) can cause cognitive, communication, and psychological challenges that profoundly limit independence in everyday life. Conversational Agents (CAs) can provide individuals with TBI with cognitive and communication support, although little is known about how they make use of CAs to address injury-related needs. In this study, we gave nine adults with TBI an at-home CA for four weeks to investigate use patterns, challenges, and design requirements, focusing particularly on injury-related use. The findings revealed significant gaps between the current capabilities of CAs and accessibility challenges faced by TBI users. We also identified 14 TBI-related activities that participants engaged in with CAs. We categorized those activities into four groups: mental health, cognitive activities, healthcare and rehabilitation, and routine activities. Design implications focus on accessibility improvements and functional designs of CAs that can better support the day-to-day needs of people with TBI.Comment: In Proceedings The 25th International ACM SIGACCESS Conference on Computers and Accessibility (ASSETS'23

Facial affect recognition in context in adults with and without TBI

IntroductionSeveral studies have reported impaired emotion recognition in adults with traumatic brain injury (TBI), but studies have two major design features that limit application of results to real-world contexts: (1) participants choose from among lists of basic emotions, rather than generating emotion labels, and (2) images are typically presented in isolation rather than in context. To address these limitations, we created an open-labeling task with faces shown alone or in real-life scenes, to more closely approximate how adults with TBI label facial emotions beyond the lab.MethodsParticipants were 55 adults (29 female) with moderate to severe TBI and 55 uninjured comparison peers, individually matched for race, sex, and age. Participants viewed 60 photographs of faces, either alone or in the pictured person’s real-life context, and were asked what that person was feeling. We calculated the percent of responses that were standard forced-choice-task options, and also used sentiment intensity analysis to compare verbal responses between the two groups. We tracked eye movements for a subset of participants, to explore whether gaze duration or number of fixations helped explain any group differences in labels.ResultsOver 50% of responses in both groups were words other than basic emotions on standard affect tasks, highlighting the importance of eliciting open-ended responses. Valence of labels by participants with TBI was attenuated relative to valence of Comparison group labels, i.e., TBI group responses were less positive to positive images and the same was true for negative images, although the TBI group responses had higher lexical diversity. There were no significant differences in gaze duration or number of fixations between groups.DiscussionResults revealed qualitative differences in affect labels between adults with and without TBI that would not have emerged on standard forced-choice tasks. Verbal differences did not appear to be attributable to differences in gaze patterns, leaving open the question of mechanisms of atypical affect processing in adults with TBI

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research