Modality-specific effects of threat on self-motion perception.

BACKGROUND: Threat and individual differences in threat-processing bias perception of stimuli in the environment. Yet, their effect on perception of one's own (body-based) self-motion in space is unknown. Here, we tested the effects of threat on self-motion perception using a multisensory motion simulator with concurrent threatening or neutral auditory stimuli. RESULTS: Strikingly, threat had opposite effects on vestibular and visual self-motion perception, leading to overestimation of vestibular, but underestimation of visual self-motions. Trait anxiety tended to be associated with an enhanced effect of threat on estimates of self-motion for both modalities. CONCLUSIONS: Enhanced vestibular perception under threat might stem from shared neural substrates with emotional processing, whereas diminished visual self-motion perception may indicate that a threatening stimulus diverts attention away from optic flow integration. Thus, threat induces modality-specific biases in everyday experiences of self-motion.

Multisensory Calibration: A Variety of Slow and Fast Brain Processes Throughout the Lifespan.

From before we are born, throughout development, adulthood, and aging, we are immersed in a multisensory world. At each of these stages, our sensory cues are constantly changing, due to body, brain, and environmental changes. While integration of information from our different sensory cues improves precision, this only improves accuracy if the underlying cues are unbiased. Thus, multisensory calibration is a vital and ongoing process. To meet this grand challenge, our brains have evolved a variety of mechanisms. First, in response to a systematic discrepancy between sensory cues (without external feedback) the cues calibrate one another (unsupervised calibration). Second, multisensory function is calibrated to external feedback (supervised calibration). These two mechanisms superimpose. While the former likely reflects a lower level mechanism, the latter likely reflects a higher level cognitive mechanism. Indeed, neural correlates of supervised multisensory calibration in monkeys were found in higher level multisensory cortical area VIP, but not in the relatively lower level multisensory area MSTd. In addition, even without a cue discrepancy (e.g., when experiencing stimuli from different sensory cues in series) the brain monitors supra-modal statistics of events in the environment and adapts perception cross-modally. This too comprises a variety of mechanisms, including confirmation bias to prior choices, and lower level cross-sensory adaptation. Further research into the neuronal underpinnings of the broad and diverse functions of multisensory calibration, with improved synthesis of theories is needed to attain a more comprehensive understanding of multisensory brain function.

Modality-specific sensory and decisional carryover effects in duration perception.

BACKGROUND: The brain uses recent history when forming perceptual decisions. This results in carryover effects in perception. Although separate sensory and decisional carryover effects have been shown in many perceptual tasks, their existence and nature in temporal processing are unclear. Here, we investigated whether and how previous stimuli and previous choices affect subsequent duration perception, in vision and audition. RESULTS: In a series of three experiments, participants were asked to classify visual or auditory stimuli into "shorter" or "longer" duration categories. In experiment 1, visual and auditory stimuli were presented in separate blocks. Results showed that current duration estimates were repelled away from the previous trial's stimulus duration, but attracted towards the previous choice, in both vision and audition. In experiment 2, visual and auditory stimuli were pseudorandomly presented in one block. We found that sensory and decisional carryover effects occurred only when previous and current stimuli were from the same modality. Experiment 3 further investigated the stimulus dependence of carryover effects within each modality. In this experiment, visual stimuli with different shape topologies (or auditory stimuli with different audio frequencies) were pseudorandomly presented in one visual (or auditory) block. Results demonstrated sensory carryover (within each modality) despite task-irrelevant differences in visual shape topology or audio frequency. By contrast, decisional carryover was reduced (but still present) across different visual topologies and completely absent across different audio frequencies. CONCLUSIONS: These results suggest that serial dependence in duration perception is modality-specific. Moreover, repulsive sensory carryover effects generalize within each modality, whereas attractive decisional carryover effects are contingent on contextual details.

Supervised Multisensory Calibration Signals Are Evident in VIP But Not MSTd.

Multisensory plasticity enables our senses to dynamically adapt to each other and the external environment, a fundamental operation that our brain performs continuously. We searched for neural correlates of adult multisensory plasticity in the dorsal medial superior temporal area (MSTd) and the ventral intraparietal area (VIP) in 2 male rhesus macaques using a paradigm of supervised calibration. We report little plasticity in neural responses in the relatively low-level multisensory cortical area MSTd. In contrast, neural correlates of plasticity are found in higher-level multisensory VIP, an area with strong decision-related activity. Accordingly, we observed systematic shifts of VIP tuning curves, which were reflected in the choice-related component of the population response. This is the first demonstration of neuronal calibration, together with behavioral calibration, in single sessions. These results lay the foundation for understanding multisensory neural plasticity, applicable broadly to maintaining accuracy for sensorimotor tasks.SIGNIFICANCE STATEMENT Multisensory plasticity is a fundamental and continual function of the brain that enables our senses to adapt dynamically to each other and to the external environment. Yet, very little is known about the neuronal mechanisms of multisensory plasticity. In this study, we searched for neural correlates of adult multisensory plasticity in the dorsal medial superior temporal area (MSTd) and the ventral intraparietal area (VIP) using a paradigm of supervised calibration. We found little plasticity in neural responses in the relatively low-level multisensory cortical area MSTd. By contrast, neural correlates of plasticity were found in VIP, a higher-level multisensory area with strong decision-related activity. This is the first demonstration of neuronal calibration, together with behavioral calibration, in single sessions.

Overconfidence in visual perception in parkinson's disease.

Increased dependence on visual cues in Parkinson's disease (PD) can unbalance the perception-action loop, impair multisensory integration, and affect everyday function of PD patients. It is currently unknown why PD patients seem to be more reliant on their visual cues. We hypothesized that PD patients may be overconfident in the reliability (precision) of their visual cues. In this study we tested coherent visual motion perception in PD, and probed subjective (self-reported) confidence in their visual motion perception. Twenty patients with idiopathic PD, 21 healthy aged-matched controls and 20 healthy young adult participants were presented with visual stimuli of moving dots (random dot kinematograms). They were asked to report: (1) whether the aggregate motion of dots was to the left or to the right, and (2) how confident they were that their perceptual discrimination was correct. Visual motion discrimination thresholds were similar (unimpaired) in PD compared to the other groups. By contrast, PD patients were significantly overconfident in their visual perceptual decisions (p = .002 and p < .001 vs. the age-matched and young adult groups, respectively). These results suggest intact visual motion perception, but overestimation of visual cue reliability, in PD. Overconfidence in visual (vs. other, e.g., somatosensory) cues could underlie increased visual dependence and impaired multisensory/sensorimotor integration in PD. It could thereby contribute to gait and balance impairments, and affect everyday activities, such as driving. Future work should investigate and compare PD confidence in somatosensory function. A better understanding of altered sensory reliance might open up new avenues to treat debilitating PD symptoms.

Self-motion perception in Parkinson's disease.

Parkinson's disease (PD), best characterized by its classic motor symptoms, also manifests non-motor symptoms including perceptual impairments. Normal motor and perceptual brain functions interact continuously in an action-perception loop; hence, perceptual and motor dysfunction in PD are likely also intertwined. A vital skill in order to maintain balance, and to move around in the environment is the ability to perceive one's own motion in space (self-motion perception). Self-motion perception is a complex brain process, that requires the integration of information from visual (optic flow), vestibular (gravito-inertial), and somatosensory senses. Yet, not much is known about self-motion perception or multisensory integration in PD. In this review, we highlight the need to better study these important functions in PD. We review perceptual deficits in underlying functions required for adept self-motion perception (visual, vestibular and somatosensory, as well as multisensory integration) and address how these might affect self-motion perception and motor function in PD. We propose that dysfunction of central brain mechanisms, implicated in impaired visual, vestibular and somatosensory function, likely impact self-motion perception in PD. Recent evidence suggests that visual and multisensory integration mechanisms of self-motion perception are indeed impaired in PD. This can affect motor control, gait and balance. Future research is needed to better investigate this important topic. A better understanding of self-motion perception and multisensory integration in PD may aid diagnosis and subtyping and may open new avenues for novel therapies to treat debilitating motor symptoms, including gait and balance impairment, using sensory augmentation devices or sensory retraining.

Self-motion perception in autism is compromised by visual noise but integrated optimally across multiple senses.

Perceptual processing in autism spectrum disorder (ASD) is marked by superior low-level task performance and inferior complex-task performance. This observation has led to theories of defective integration in ASD of local parts into a global percept. Despite mixed experimental results, this notion maintains widespread influence and has also motivated recent theories of defective multisensory integration in ASD. Impaired ASD performance in tasks involving classic random dot visual motion stimuli, corrupted by noise as a means to manipulate task difficulty, is frequently interpreted to support this notion of global integration deficits. By manipulating task difficulty independently of visual stimulus noise, here we test the hypothesis that heightened sensitivity to noise, rather than integration deficits, may characterize ASD. We found that although perception of visual motion through a cloud of dots was unimpaired without noise, the addition of stimulus noise significantly affected adolescents with ASD, more than controls. Strikingly, individuals with ASD demonstrated intact multisensory (visual-vestibular) integration, even in the presence of noise. Additionally, when vestibular motion was paired with pure visual noise, individuals with ASD demonstrated a different strategy than controls, marked by reduced flexibility. This result could be simulated by using attenuated (less reliable) and inflexible (not experience-dependent) Bayesian priors in ASD. These findings question widespread theories of impaired global and multisensory integration in ASD. Rather, they implicate increased sensitivity to sensory noise and less use of prior knowledge in ASD, suggesting increased reliance on incoming sensory information.

Multisensory decisions from self to world.

Classic Bayesian models of perceptual inference describe how an ideal observer would integrate 'unisensory' measurements (multisensory integration) and attribute sensory signals to their origin(s) (causal inference). However, in the brain, sensory signals are always received in the context of a multisensory bodily state-namely, in combination with other senses. Moreover, sensory signals from both interoceptive sensing of one's own body and exteroceptive sensing of the world are highly interdependent and never occur in isolation. Thus, the observer must fundamentally determine whether each sensory observation is from an external (versus internal, self-generated) source to even be considered for integration. Critically, solving this primary causal inference problem requires knowledge of multisensory and sensorimotor dependencies. Thus, multisensory processing is needed to separate sensory signals. These multisensory processes enable us to simultaneously form a sense of self and form distinct perceptual decisions about the external world. In this opinion paper, we review and discuss the similarities and distinctions between multisensory decisions underlying the sense of self and those directed at acquiring information about the world. We call attention to the fact that heterogeneous multisensory processes take place all along the neural hierarchy (even in forming 'unisensory' observations) and argue that more integration of these aspects, in theory and experiment, is required to obtain a more comprehensive understanding of multisensory brain function. This article is part of the theme issue 'Decision and control processes in multisensory perception'.

Contrary neuronal recalibration in different multisensory cortical areas.

The adult brain demonstrates remarkable multisensory plasticity by dynamically recalibrating itself based on information from multiple sensory sources. After a systematic visual-vestibular heading offset is experienced, the unisensory perceptual estimates for subsequently presented stimuli are shifted toward each other (in opposite directions) to reduce the conflict. The neural substrate of this recalibration is unknown. Here, we recorded single-neuron activity from the dorsal medial superior temporal (MSTd), parietoinsular vestibular cortex (PIVC), and ventral intraparietal (VIP) areas in three male rhesus macaques during this visual-vestibular recalibration. Both visual and vestibular neuronal tuning curves in MSTd shifted - each according to their respective cues' perceptual shifts. Tuning of vestibular neurons in PIVC also shifted in the same direction as vestibular perceptual shifts (cells were not robustly tuned to the visual stimuli). By contrast, VIP neurons demonstrated a unique phenomenon: both vestibular and visual tuning shifted in accordance with vestibular perceptual shifts. Such that, visual tuning shifted, surprisingly, contrary to visual perceptual shifts. Therefore, while unsupervised recalibration (to reduce cue conflict) occurs in early multisensory cortices, higher-level VIP reflects only a global shift, in vestibular space.

Multisensory calibration is independent of cue reliability.

Multisensory calibration is fundamental for proficient interaction within a changing environment. Initial studies suggested a visual-dominant mechanism. More recently, a cue-reliability-based model, similar to optimal cue integration, has been proposed. However, a more general, reliability-independent model of fixed-ratio adaptation (of which visual dominance is a subcase) has never been tested. Here, we studied behavior of both humans and monkeys performing a heading-discrimination task. Subjects were presented with either visual (optic-flow), vestibular (motion-platform), or combined (visual-vestibular) stimuli and required to report whether self-motion was to the right/left of straight ahead. A systematic heading discrepancy was introduced between the visual and vestibular cues, without external feedback. Cue calibration was measured by the resulting sensory adaptation. Both visual and vestibular cues significantly adapted in the direction required to reduce cue conflict. However, unlike multisensory cue integration, cue calibration was not reliability based. Rather, a model of fixed-ratio adaptation best described the data, whereby vestibular adaptation was greater than visual adaptation, regardless of relative cue reliability. The average ratio of vestibular to visual adaptation was 1.75 and 2.30 for the human and monkey data, respectively. Furthermore, only through modeling fixed-ratio adaptation (using the ratio extracted from the data) were we able to account for reliability-based cue integration during the adaptation process. The finding that cue calibration does not depend on cue reliability is consistent with the notion that it follows an underlying estimate of cue accuracy. Cue accuracy is generally independent of cue reliability, and its estimate may change with a much slower time constant. Thus, greater vestibular versus visual (fixed-ratio) adaptation suggests lower vestibular versus visual cue accuracy.

Microelectrode recording duration and spatial density constraints for automatic targeting of the subthalamic nucleus.

BACKGROUND: Accurate detection of the boundaries of the subthalamic nucleus (STN) in deep brain stimulation (DBS) surgery using microelectrode recording (MER) is considered to refine localization and may therefore improve clinical outcome. However, MER tends to extend operation time and its cost-utility balance has been debated. OBJECTIVES: To quantify the tradeoff between accuracy of STN localization and the spatial and temporal parameters of MER that effect the operation time using an automated detection method. METHODS: We retrospectively estimated the accuracy of STN detection on data from 100 microelectrode trajectories. Our dense (average step = 0.12 mm) and long (average duration = 22.5 s) MER data was downsampled in the spatial and temporal domains. Then, the STN borders were detected automatically on both the downsampled and original data and compared to each other. RESULTS: With a recording duration of 16 s, average accuracy for detecting STN entry ranged from 0.06 mm for a 0.1-mm step to 0.51 mm for a 1.0-mm step. Smaller effects were found along the temporal axis. For example, a 0.1-mm recording step yielded an STN entry average accuracy ranging from 0.06 mm for a 16-second recording duration to 0.16 mm for 0.1 s. CONCLUSIONS: STN entry detection error was about half of the step size. Sampling duration of STN activity can be minimized to 1 s/record without compromising accuracy. We conclude that bilateral DBS surgery time utilizing MER may be significantly shortened without compromising targeting accuracy.

Rapid cross-sensory adaptation of self-motion perception.

Perceptual adaptation is often studied within a single sense. However, our experience of the world is naturally multisensory. Here, we investigated cross-sensory (visual-vestibular) adaptation of self-motion perception. It was previously found that relatively long visual self-motion stimuli (≳15 sec) are required to adapt subsequent vestibular perception, and that shorter duration stimuli do not elicit cross-sensory (visual↔vestibular) adaptation. However, it is not known whether several discrete short-duration stimuli may lead to cross-sensory adaptation (even when their sum, if presented together, would be too short to elicit cross-sensory adaptation). This would suggest that the brain monitors and adapts to supra-modal statistics of events in the environment. Here we investigated whether cross-sensory (visual↔vestibular) adaptation occurs after experiencing several short (1 sec) self-motion stimuli. Forty-five participants discriminated the headings of a series of self-motion stimuli. To expose adaptation effects, the trials were grouped in 140 batches, each comprising three 'prior' trials, with headings biased to the right or left, followed by a single unbiased 'test' trial. Right, and left-biased batches were interleaved pseudo-randomly. We found significant adaptation in both cross-sensory conditions (visual prior and vestibular test trials, and vice versa), as well as both unisensory conditions (when prior and test trials were of the same modality - either visual or vestibular). Fitting the data with a logistic regression model revealed that adaptation was elicited by the prior stimuli (not prior choices). These results suggest that the brain monitors supra-modal statistics of events in the environment, even for short-duration stimuli, leading to functional (supra-modal) adaptation of perception.

The dynamic boundaries of the Self: Serial dependence in the Sense of Agency.

The feeling of control over one's actions, termed the Sense of Agency (SoA), delineates one's experience as an embodied self. Although this embodied experience is typically perceived as stable over time, recent theoretical accounts highlight the experience-dependent and dynamic nature of the embodied self. In this study we examined how recent experiences modulate SoA (i.e., serial dependence), and disambiguated the unique contributions of previous stimuli and choices on subsequent SoA judgments. In addition, we examined whether these effects persist across different domains of perceptual alteration. We analyzed two independent datasets of the Virtual Hand (VH) task (N = 100 participants) in which a sensorimotor conflict is introduced between the presented visual feedback and the actual movement performed. In Dataset 1, which included only temporal alterations, we found that previous stimuli recalibrate current perception, increasing the likelihood of the current choice to be different than the previous choice. Whereas previous choices induce a repetition bias increasing the likelihood to repeat choices across trials. Thus, previous external stimuli and self-generated choices exert opposing influences on SoA. We replicated these findings in Dataset 2, in which the VH task was tested with alterations in both temporal and spatial domains. In addition, we discovered that previous stimuli from a different perceptual domain exert a recalibration effect similar to stimuli from the same domain. Thus, SoA is constantly shaped by our previous subjective choices and objective stimuli experienced even across different perceptual domains. This highlights how SoA may act as unifying construct organizing our experience of the self over time and across perceptual experiences.

Subthalamic span of beta oscillations predicts deep brain stimulation efficacy for patients with Parkinson's disease.

The significance of oscillations that characterize the subthalamic nucleus in Parkinson's disease is still under debate. Here, we analysed the spectral and spatial characteristics of 314 microelectrode trajectories from 128 patients undergoing subthalamic nucleus deep brain stimulation surgery for Parkinson's disease. We correlated the subthalamic nucleus pathophysiology with the outcome of surgery, as evaluated by the third section of the Unified Parkinson's Disease Rating Scale (motor score), which was subdivided into tremor, rigidity, limb-bradykinesia and axial-bradykinesia subscores. beta-oscillatory activity (13-30 Hz) comprised a continuous stretch within the subthalamic nucleus, and was limited to a distinctly-bounded dorsolateral oscillatory region. Although less consistent and more sporadic, low-frequency (3-7 Hz) power was also increased in the dorsolateral oscillatory region. In contrast, the more ventral subthalamic nucleus was characterized by consistently reduced beta and increased gamma (30-100 Hz) activity. Neuronal responses to passive arm movement (analysed by their alignment to goniometer tracing of the joints' angular displacement) were significantly more common in the dorsolateral oscillatory region than the ventral subthalamic nucleus region (62 versus 25% of sites tested respectively, P<0.01). The length of the dorsolateral oscillatory region recorded in the macroelectrode-implanted trajectory predicted a favourable response to subthalamic nucleus deep brain stimulation (R=0.67, P<0.0001). This correlation was also evident for improvement in the specific symptom subscores of rigidity, limb-bradykinesia and axial-bradykinesia (P<0.05). Similarly, increased subthalamic nucleus beta power was associated with postoperative improvement. In contrast, the preoperative response to levodopa did not correlate with dorsolateral oscillatory region length (P=0.33), however, it did tend to be associated with increased beta (and decreased low frequency) subthalamic nucleus power. Finally, the active macroelectrode contact, independently selected by optimal clinical outcome, coincided with the dorsolateral oscillatory region centre. On average, the location of the active contact was not significantly different from the dorsolateral oscillatory region centre (P=0.10), but was significantly different from the subthalamic nucleus centre (P<0.0001). We conclude that the spatial extent of the dorsolateral oscillatory region, which overlaps the motor territories of the subthalamic nucleus, predicts the outcome of subthalamic nucleus deep brain stimulation. Thus the frequency and spatial characteristics of the subthalamic nucleus trajectory may be used for deep brain stimulation outcome optimization.

Perceptual decisions are biased toward relevant prior choices.

Perceptual decisions are biased by recent perceptual history-a phenomenon termed 'serial dependence.' Here, we investigated what aspects of perceptual decisions lead to serial dependence, and disambiguated the influences of low-level sensory information, prior choices and motor actions. Participants discriminated whether a brief visual stimulus lay to left/right of the screen center. Following a series of biased 'prior' location discriminations, subsequent 'test' location discriminations were biased toward the prior choices, even when these were reported via different motor actions (using different keys), and when the prior and test stimuli differed in color. By contrast, prior discriminations about an irrelevant stimulus feature (color) did not substantially influence subsequent location discriminations, even though these were reported via the same motor actions. Additionally, when color (not location) was discriminated, a bias in prior stimulus locations no longer influenced subsequent location discriminations. Although low-level stimuli and motor actions did not trigger serial-dependence on their own, similarity of these features across discriminations boosted the effect. These findings suggest that relevance across perceptual decisions is a key factor for serial dependence. Accordingly, serial dependence likely reflects a high-level mechanism by which the brain predicts and interprets new incoming sensory information in accordance with relevant prior choices.

Increased influence of prior choices on perceptual decisions in autism.

Autism spectrum disorder (ASD) manifests sensory and perceptual atypicalities. Recent theories suggest that these may reflect a reduced influence of prior information in ASD. Some studies have found reduced adaptation to recent sensory stimuli in ASD. However, the effects of prior stimuli and prior perceptual choices can counteract one-another. Here, we investigated this using two different tasks (in two different cohorts): (i) visual location discrimination and (ii) multisensory (visual-vestibular) heading discrimination. We fit the data using a logistic regression model to dissociate the specific effects of prior stimuli and prior choices. In both tasks, perceptual decisions were biased toward recent choices. Notably, the 'attractive' effect of prior choices was significantly larger in ASD (in both tasks and cohorts), while there was no difference in the influence of prior stimuli. These results challenge theories of reduced priors in ASD, and rather suggest an increased consistency bias for perceptual decisions in ASD.

Levodopa and subthalamic deep brain stimulation responses are not congruent.

There is a consensus that in Parkinson's disease, the extent of preoperative levodopa responsiveness predicts the efficacy of subthalamic nucleus deep brain stimulation (STN DBS). However, this may be the result of statistical methods and primary assumptions. We were able to reproduce previously published correlation results on our data (N = 49 patients). Yet, these same results were demonstrated even after random shuffling of our data. Notably, we did not observe a correlation between STN DBS efficacy and preoperative levodopa responsiveness when using their respective baselines and fractional scores of motor improvement. Furthermore, postoperative responses were not limited by preoperative scores, with tremor demonstrating the greatest discrepancy. We conclude that preoperative levodopa responsiveness does not predict or limit the outcome of STN DBS. These results imply different therapeutic mechanisms for levodopa and STN DBS and therefore question the validity of using substantial preoperative levodopa responsiveness as a selection criterion for STN DBS.

Propofol decreases neuronal population spiking activity in the subthalamic nucleus of Parkinsonian patients.

BACKGROUND: Implantation of deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN) for the treatment of Parkinson disease is often performed using microelectrode recording (MER) of STN population spike activity. The extent to which sedative drugs interfere with MER is unknown. We recorded the population activity of STN neurons during propofol sedation and examined its effect on neuronal activity. METHODS: The procedure was performed during DBS surgery for Parkinson disease. We administered propofol (50 µg/kg/min) at a constant electrode location in the STN until stable sedation was achieved. We recorded the electrical activity, and calculated its root mean square (RMS) before, during, and after the propofol infusions. RESULTS: The activity of 24 electrode trajectories was recorded in 16 patients. The RMS of STN activity decreased significantly after propofol administration in 18 of the 24 trajectories. The average normalized RMS decreased by 23.2%± 9.1% (mean ± SD) during propofol administration (P < 0.001), and returned to baseline 9.3 ± 4.0 minutes after it was stopped. CONCLUSIONS: Propofol administration leads to a significant decrease of STN neuronal activity. Thus, it may interfere with MER identification of the STN borders. However, activity returns to baseline shortly after administration stops. Therefore, propofol can be safely used until shortly before MER for DBS.

Visual self-motion cues are impaired yet overweighted during visual-vestibular integration in Parkinson's disease.

Parkinson's disease is prototypically a movement disorder. Although perceptual and motor functions are highly interdependent, much less is known about perceptual deficits in Parkinson's disease, which are less observable by nature, and might go unnoticed if not tested directly. It is therefore imperative to seek and identify these, to fully understand the challenges facing patients with Parkinson's disease. Also, perceptual deficits may be related to motor symptoms. Posture, gait and balance, affected in Parkinson's disease, rely on veridical perception of one's own motion (self-motion) in space. Yet it is not known whether self-motion perception is impaired in Parkinson's disease. Using a well-established multisensory paradigm of heading discrimination (that has not been previously applied to Parkinson's disease), we tested unisensory visual and vestibular self-motion perception, as well as multisensory integration of visual and vestibular cues, in 19 Parkinson's disease, 23 healthy age-matched and 20 healthy young-adult participants. After experiencing vestibular (on a motion platform), visual (optic flow) or multisensory (combined visual-vestibular) self-motion stimuli at various headings, participants reported whether their perceived heading was to the right or left of straight ahead. Parkinson's disease participants and age-matched controls were tested twice (Parkinson's disease participants on and off medication). Parkinson's disease participants demonstrated significantly impaired visual self-motion perception compared with age-matched controls on both visits, irrespective of medication status. Young controls performed slightly (but not significantly) better than age-matched controls and significantly better than the Parkinson's disease group. The visual self-motion perception impairment in Parkinson's disease correlated significantly with clinical disease severity. By contrast, vestibular performance was unimpaired in Parkinson's disease. Remarkably, despite impaired visual self-motion perception, Parkinson's disease participants significantly overweighted the visual cues during multisensory (visual-vestibular ) integration (compared with Bayesian predictions of optimal integration) and significantly more than controls. These findings indicate that self-motion perception in Parkinson's disease is affected by impaired visual cues and by suboptimal visual-vestibular integration (overweighting of visual cues). Notably, vestibular self-motion perception was unimpaired. Thus, visual self-motion perception is specifically impaired in early-stage Parkinson's disease. This can impact Parkinson's disease diagnosis and subtyping. Overweighting of visual cues could reflect a general multisensory integration deficit in Parkinson's disease, or specific overestimation of visual cue reliability. Finally, impaired self-motion perception in Parkinson's disease may contribute to impaired balance and gait control. Future investigation into this connection might open up new avenues of alternative therapies to better treat these difficult symptoms.

Akineto-rigid vs. tremor syndromes in Parkinsonism.

PURPOSE OF REVIEW: Akinesia, rigidity and low-frequency rest tremor are the three cardinal motor signs of Parkinson's disease and some Parkinson's disease animal models. However, cumulative evidence supports the view that akinesia/rigidity vs. tremor reflect different pathophysiological phenomena in the basal ganglia. Here, we review the recent physiological literature correlating abnormal neural activity in the basal ganglia with Parkinson's disease clinical symptoms. RECENT FINDINGS: The subthalamic nucleus of Parkinson's disease patients is characterized by oscillatory activity in the beta-frequency (approximately 15 Hz) range. However, Parkinson's disease tremor is not strictly correlated with the abnormal synchronous oscillations of the basal ganglia. On the other hand, akinesia and rigidity are better correlated with the basal ganglia beta oscillations. SUMMARY: The abnormal basal ganglia output leads to akinesia and rigidity. Parkinson's disease tremor most likely evolves as a downstream compensatory mechanism.