Is PDQ-39 a reliable measure of quality of life of patients at advanced stages of Parkinson's disease considered for Deep Brain Stimulation.

Purpose: Parkinson's disease (PD) significantly impedes, especially at its advanced stages, the health-related quality of life (QoL) of patients. The Parkinson's disease questionnaire (PDQ-39) is a widely-used measure assessing the impact of the disease on the patients' QoL. To date, the reliability of PDQ-39 has not been selectively evaluated for patients at a particular delineated stage of the PD progression. Against this backdrop, the study aimed firstly to evaluate comprehensively the internal consistency reliability of PDQ-39 and the constituent scales specifically for patients at the advanced stages of PD who were candidates for Deep Brain Stimulation (DBS) surgery, and secondly, to compare the Cronbach's alpha coefficients with those reported in other studies conducted with patients across all stages of the PD progression. Methods: The sample included 36 Bulgarian patients (29 men and 7 women) at advanced stages of PD (Hoehn and Yahr stage 4), PD duration, M = 11.06, SD = 3.50). The internal consistency reliability of the questionnaire and the constituent scales was assessed using three criteria: Cronbach's alpha coefficients, inter-item and item-total correlations. Results: The internal consistency reliability indicators were satisfactory for the entire instrument and for most of the scales and similar to those reported in previous studies. None of the scales had low internal consistency reliability results across the three criteria. Except for the Communication scale, seven of the eight scales had Cronbach's alpha values that were satisfactory or marginally below the cut off score. All scales had acceptable inter-item correlations. Three of the scales (Emotional Well-Being, Cognition and Communication) contained more than one item with non-satisfactory item-total correlations. With minor exceptions, the removal of the items with low item-total correlations either did not improve or improved marginally or even decreased the Cronbach's alpha coefficients of the respective scale. The Communication scale was the only scale with a Cronbach's alpha coefficient that was both low and comparatively different to other studies and had as well low item-total correlations for all constituent items, thus showing non-satisfactory results on two of the three internal consistency reliability estimates. In contrast, the Mobility scale met all three internal consistency reliability criteria. Conclusion: PDQ-39 is a reliable tool for assessing the QoL of patients at advanced stages of PD across multiple health-related domains. The questionnaire can be recommended for inclusion in the best practice guidelines for evaluating DBS candidacy and the efficacy of DBS treatment for patients' QoL.

Transformation of Visual Representations Across Ventral Stream Body-selective Patches.

Although the neural processing of visual images of bodies is critical for survival, it is much less well understood than face processing. Functional imaging studies demonstrated body selective regions in primate inferior temporal cortex. To advance our understanding of how the visual brain represents bodies, we compared the representation of animate and inanimate objects in two such body patches with fMRI-guided single unit recordings in rhesus monkeys. We found that the middle Superior Temporal Sulcus body patch (MSB) distinguishes to a greater extent bodies from non-bodies than the anterior Superior Temporal Sulcus body patch (ASB). Importantly, ASB carried more viewpoint-tolerant information about body posture and body identity than MSB, while MSB showed greater orientation selectivity. Combined with previous work on faces, this suggests that an increase in view-tolerant representations, coupled with a refined individuation, along the visual hierarchy is a general property of information processing within the inferior temporal cortex.

Application of functional magnetic resonance imaging in psychiatric clinical evaluation: Controversies and avenues.

RATIONALE, AIMS, AND OBJECTIVES: In this study, we have attempted to replicate the findings of altered emotional processing in depressed patients compared with healthy controls by means of functional magnetic resonance imaging during passive viewing of positive, negative, and neutral pictures from the International Affective Pictures System. METHODS: Nineteen medicated depressed patients and 19 sex and age-matched healthy controls underwent functional magnetic resonance imaging during presentation of affective pictures in a block design. The differences between the blood oxygen level dependent signal elicited in the tree conditions were compared. Within-group and between-group analyses were performed with stringent criteria for statistical inference (P < .05 with family-wise error correction). RESULTS: In medicated depressed patients, positive pictures compared with neutral pictures activated predominantly the posterior cingulate cortex and precuneus, as well as occipital and middle temporal areas mainly on the left side, while in healthy controls, only the occipito-temporal areas demonstrated significant activation. The negative pictures elicited stronger activation of occipital and temporal regions in both groups and of inferior frontal gyrus only in control subjects. The difference between the groups did not reach statistical significance. Positive correlation was demonstrated between activation levels of clusters located in left precuneus/posterior cingulate cortex and left inferior/middle occipital gyrus and Montgomery-Asberg Depression Rating Scale scores in patients while viewing positive compared with neutral pictures. CONCLUSIONS: Although the within-group analysis demonstrated significant activations in both groups with apparent discrepancies, the between-group analysis did not reach statistical significance under the stringent criteria for statistical inference. These results are further contextualized in the critical debate on the methodological issues of clinical evaluation in psychiatry, more specifically the validity and consistency of the applied methods and the limitations existing in the attempts to provide sound cross-disciplinary validation of the diagnostic tools by means of neuroscience.

Stimulus features coded by single neurons of a macaque body category selective patch.

Body category-selective regions of the primate temporal cortex respond to images of bodies, but it is unclear which fragments of such images drive single neurons' responses in these regions. Here we applied the Bubbles technique to the responses of single macaque middle superior temporal sulcus (midSTS) body patch neurons to reveal the image fragments the neurons respond to. We found that local image fragments such as extremities (limbs), curved boundaries, and parts of the torso drove the large majority of neurons. Bubbles revealed the whole body in only a few neurons. Neurons coded the features in a manner that was tolerant to translation and scale changes. Most image fragments were excitatory but for a few neurons both inhibitory and excitatory fragments (opponent coding) were present in the same image. The fragments we reveal here in the body patch with Bubbles differ from those suggested in previous studies of face-selective neurons in face patches. Together, our data indicate that the majority of body patch neurons respond to local image fragments that occur frequently, but not exclusively, in bodies, with a coding that is tolerant to translation and scale. Overall, the data suggest that the body category selectivity of the midSTS body patch depends more on the feature statistics of bodies (e.g., extensions occur more frequently in bodies) than on semantics (bodies as an abstract category).

Tolerance of macaque middle STS body patch neurons to shape-preserving stimulus transformations.

Functional imaging studies in human and nonhuman primates have demonstrated regions in the brain that show category selectivity for faces or (headless) bodies. Recent fMRI-guided single unit studies of the macaque face category-selective regions have increased our understanding of the response properties of single neurons in these face patches. However, much less is known about the response properties of neurons in the fMRI-defined body category-selective regions ("body patches"). Recently, we reported that the majority of single neurons in one fMRI-defined body patch, the mid-STS body patch, responded more strongly to bodies compared with other objects. Here we assessed the tolerance of these neurons' responses and stimulus preference for shape-preserving image transformations. After mapping the receptive field of the single neurons, we found that their stimulus preference showed a high degree of tolerance for changes in the position and size of the stimulus. However, their response strongly depended on the in-plane orientation of a body. The selectivity of most neurons was, to a large degree, preserved when silhouettes were presented instead of the original textured and shaded images, suggesting that mainly shape-based features are driving these neurons. In a human psychophysical study, we showed that the information present in silhouettes is largely sufficient for body versus nonbody categorization. These data suggest that mid-STS body patch neurons respond predominantly to oriented shape features that are prevalent in images of bodies. Their responses can inform position- and retinal size-invariant body categorization and discrimination based on shape.

Fine-grained stimulus representations in body selective areas of human occipito-temporal cortex.

Neurophysiological and functional imaging studies have investigated the representation of animate and inanimate stimulus classes in monkey inferior temporal (IT) and human occipito-temporal cortex (OTC). These studies proposed a distributed representation of stimulus categories across IT and OTC and at the same time highlighted category specific modules for the processing of bodies, faces and objects. Here, we investigated whether the stimulus representation within the extrastriate (EBA) and the fusiform (FBA) body areas differed from the representation across OTC. To address this question, we performed an event-related fMRI experiment, evaluating the pattern of activation elicited by 200 individual stimuli that had already been extensively tested in our earlier monkey imaging and single cell studies (Popivanov et al., 2012, 2014). The set contained achromatic images of headless monkey and human bodies, two sets of man-made objects, monkey and human faces, four-legged mammals, birds, fruits, and sculptures. The fMRI response patterns within EBA and FBA primarily distinguished bodies from non-body stimuli, with subtle differences between the areas. However, despite responding on average stronger to bodies than to other categories, classification performance for preferred and non-preferred categories was comparable. OTC primarily distinguished animate from inanimate stimuli. However, cluster analysis revealed a much more fine-grained representation with several homogeneous clusters consisting entirely of stimuli of individual categories. Overall, our data suggest that category representation varies with location within OTC. Nevertheless, body modules contain information to discriminate also non-preferred stimuli and show an increasing specificity in a posterior to anterior gradient.

Probabilistic and single-subject retinotopic maps reveal the topographic organization of face patches in the macaque cortex.

Face perception is crucial to survival among social primates. It has been suggested that a group of extrastriate cortical regions responding more strongly to faces than to nonface objects is critical for face processing in primates. It is generally assumed that these regions are not retinotopically organized, as with human face-processing areas, showing foveal bias but lacking any organization with respect to polar angle. Despite many electrophysiological studies targeting monkey face patches, the retinotopic organization of these patches remains largely unclear. We have examined the relationship between cortical face patches and the topographic organization of extrastriate cortex using biologically relevant, phase-encoded retinotopic mapping stimuli in macaques. Single-subject fMRI results indicated a gradual shift from highly retinotopic to no topographic organization from posterior to anterior face patches in inferotemporal cortex. We also constructed a probabilistic retinotopic atlas of occipital and ventral extrastriate visual cortex. By comparing this probabilistic map to the locations of face patches at the group level, we showed that a previously identified posterior lateral temporal face patch (PL) is located within the posterior inferotemporal dorsal (PITd) retinotopic area. Furthermore, we identified a novel face patch posterior PL, which is located in retinotopically organized transitional area V4 (V4t). Previously published coordinates of human PITd coincide with the group-level occipital face area (OFA), according to a probabilistic map derived from a large population, implying a potential correspondence between monkey PL/PITd and human OFA/PITd. Furthermore, the monkey middle lateral temporal face patch (ML) shows consistent foveal biases but no obvious polar-angle structure. In contrast, middle fundus temporal (MF), anterior temporal and prefrontal monkey face patches lacked topographic organization.

Perceptual learning of simple stimuli modifies stimulus representations in posterior inferior temporal cortex.

Practicing simple visual detection and discrimination tasks improves performance, a signature of adult brain plasticity. The neural mechanisms that underlie these changes in performance are still unclear. Previously, we reported that practice in discriminating the orientation of noisy gratings (coarse orientation discrimination) increased the ability of single neurons in the early visual area V4 to discriminate the trained stimuli. Here, we ask whether practice in this task also changes the stimulus tuning properties of later visual cortical areas, despite the use of simple grating stimuli. To identify candidate areas, we used fMRI to map activations to noisy gratings in trained rhesus monkeys, revealing a region in the posterior inferior temporal (PIT) cortex. Subsequent single unit recordings in PIT showed that the degree of orientation selectivity was similar to that of area V4 and that the PIT neurons discriminated the trained orientations better than the untrained orientations. Unlike in previous single unit studies of perceptual learning in early visual cortex, more PIT neurons preferred trained compared with untrained orientations. The effects of training on the responses to the grating stimuli were also present when the animals were performing a difficult orthogonal task in which the grating stimuli were task-irrelevant, suggesting that the training effect does not need attention to be expressed. The PIT neurons could support orientation discrimination at low signal-to-noise levels. These findings suggest that extensive practice in discriminating simple grating stimuli not only affects early visual cortex but also changes the stimulus tuning of a late visual cortical area.

Heterogeneous single-unit selectivity in an fMRI-defined body-selective patch.

Although the visual representation of bodies is essential for reproduction, survival, and social communication, little is known about the mechanisms of body recognition at the single neuron level. Imaging studies showed body-category selective regions in the primate occipitotemporal cortex, but it is difficult to infer the stimulus selectivities of the neurons from the population activity measured in these fMRI studies. To overcome this, we recorded single unit activity and local field potentials (LFPs) in the middle superior temporal sulcus body patch, defined by fMRI in the same rhesus monkeys. Both the spiking activity, averaged across single neurons, and LFP gamma power in this body patch was greater for bodies (including monkey bodies, human bodies, mammals, and birds) compared with other objects, which fits the fMRI activation. Single neurons responded to a small proportion of body images. Thus, the category selectivity at the population level resulted from averaging responses of a heterogeneous population of single units. Despite such strong within-category selectivity at the single unit level, two distinct clusters, bodies and nonbodies, were present when analyzing the responses at the population level, and a classifier that was trained using the responses to a subset of images was able to classify novel images of bodies with high accuracy. The body-patch neurons showed strong selectivity for individual body parts at different orientations. Overall, these data suggest that single units in the fMRI-defined body patch are biased to prefer bodies over nonbody objects, including faces, with a strong selectivity for individual body images.

Stimulus representations in body-selective regions of the macaque cortex assessed with event-related fMRI.

Functional imaging studies in humans and monkeys have shown category-selective regions in the temporal cortex, in particular for faces and bodies. Although the body-selective regions have been well studied in humans, little is understood about the functional properties of such regions in macaques. To address this, we first mapped body-selective activations in the visual cortex of four rhesus monkeys in a block design fMRI study and identified two regions in the middle and anterior Superior Temporal Sulcus (STS) that were more strongly activated by monkey bodies compared to well-controlled manmade objects. These two regions partially overlapped with regions that were more activated by faces than manmade objects. Secondly, using an event-related, single image fMRI design we measured the activations to 200 images of 10 stimulus classes (monkey bodies, human bodies, mammals, birds, monkey faces, human faces, body-like sculptures, fruits/vegetables, and two sets of control objects). Multivoxel-pattern analyses showed that both body-selective regions primarily distinguished faces from other inanimate and animate objects, including bodies. Another distinction was present between inanimate objects and bodies in the middle STS body region. The category-based clustering was less pronounced in the anterior compared to the middle STS body-selective regions. In addition, both body-selective regions showed further selectivity for different "subclasses" of the broad body category such as monkeys, human, mammals and birds. Overall, these data indicate strong spatial clustering of animate categories in the macaque STS with a surprisingly marked distinction between faces and bodies within body-selective regions which was stronger than between manmade objects and bodies.

Integration of shape and motion cues in biological motion processing in the monkey STS.

To correctly perceive biological actions, the movement pattern generated in the course of the action has to be linked to the configuration of the actor. Recently, we showed that in humans, motion and configuration cues are processed separately in occipito-temporal cortex, and that both cues are integrated in the extrastriate (EBA) and fusiform (FBA) body areas (Jastorff and Orban, 2009). Using the same factorial design as in our human study, we performed fMRI experiments in awake monkeys to compare biological motion processing in the two species. Point-light displays of monkeys engaged in various actions were presented in a 2×2 factorial design. One factor manipulated the configuration of the stimuli, the other, the kinematics. As in humans, the two factors were anatomically segregated in the superior temporal sulcus (STS) rostral to the MT/V5 complex, with the effect of configuration significant along the lower bank and that of kinematics significant in the fundus and the upper bank of the STS. Moreover, voxels showing a significant interaction between the two factors were mainly confined to body-selective patches within the STS, mimicking our human findings. Importantly, this study reports for the first time differential activation for biological actions presented as point-light displays in the monkey. Moreover, our results suggest that the processing mechanisms of biological actions are remarkably similar in humans and macaque monkeys, and provide the basis for linking existing and future single-cell physiology in the monkey with human functional imaging.