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INTRODUCTION: Schizophrenia and autism spectrum disorder are distinct neurodevelopmental disorders sharing clinically relevant behaviours. However, early sensory responses show divergent responses. Individuals with schizophrenia typically exhibit cortical hypo-excitability whereas individuals with autism show cortical hyperexcitability. Identifying reliable neurobiological differences between the disorders can diminish misdiagnosis and optimise treatments. METHODS: The pattern glare test (PGT) is a simple measure of behavioural hyperexcitability. It measures the number of illusions seen in a static horizontal grating. We collected PGT data from non-clinical adults varying in traits of autism and schizophrenia (schizotypy). 576 undergraduate students completed an online survey consisting of the Schizotypal Personality Questionnaire - Brief Revised, the Autism Spectrum Quotient, and the PGT. RESULTS: Subclinical autism and schizotypy traits were highly positively correlated. However, only schizotypy scores were significantly predictive of reporting more pattern glare (PG) illusions. When assessing the subcomponents of the schizotypy and autism scores, positive and disorganised schizotypy traits were predictive of reporting more PG illusions. Whereas, subclinical autism factors were not predictive of PG illusions. CONCLUSIONS: High schizotypy performed the PGT in a manner consistent with behavioural hyperexcitability. The PGT distinguished subclinical autistic traits from schizotypy, suggesting potential clinical application.
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Deslumbramiento , Ilusiones , Trastorno de la Personalidad Esquizotípica , Humanos , Trastorno de la Personalidad Esquizotípica/diagnóstico , Trastorno de la Personalidad Esquizotípica/psicología , Masculino , Femenino , Adulto , Adulto Joven , Adolescente , Trastorno Autístico/diagnóstico , Trastorno Autístico/psicología , Trastorno del Espectro Autista/diagnóstico , Trastorno del Espectro Autista/psicología , Encuestas y CuestionariosRESUMEN
OBJECTIVES: Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety. METHODS: Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity. RESULTS: Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety. CONCLUSIONS: The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.
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Terapia Electroconvulsiva , Estimulación Transcraneal de Corriente Directa , Terapia de Exposición Mediante Realidad Virtual , Humanos , Estimulación Transcraneal de Corriente Directa/métodos , Ansiedad/terapia , Trastornos de Ansiedad/terapia , Corteza PrefrontalRESUMEN
The search for robust, reliable biomarkers of schizophrenia remains a high priority in psychiatry. Biomarkers are valuable because they can reveal the underlying mechanisms of symptoms and monitor treatment progress and may predict future risk of developing schizophrenia. Despite the existence of various promising biomarkers that relate to symptoms across the schizophrenia spectrum, and despite published recommendations encouraging multivariate metrics, they are rarely investigated simultaneously within the same individuals. In those with schizophrenia, the magnitude of purported biomarkers is complicated by comorbid diagnoses, medications and other treatments. Here, we argue three points. First, we reiterate the importance of assessing multiple biomarkers simultaneously. Second, we argue that investigating biomarkers in those with schizophrenia-related traits (schizotypy) in the general population can accelerate progress in understanding the mechanisms of schizophrenia. We focus on biomarkers of sensory and working memory in schizophrenia and their smaller effects in individuals with nonclinical schizotypy. Third, we note irregularities across research domains leading to the current situation in which there is a preponderance of data on auditory sensory memory and visual working memory, but markedly less in visual (iconic) memory and auditory working memory, particularly when focusing on schizotypy where data are either scarce or inconsistent. Together, this review highlights opportunities for researchers without access to clinical populations to address gaps in knowledge. We conclude by highlighting the theory that early sensory memory deficits contribute negatively to working memory and vice versa. This presents a mechanistic perspective where biomarkers may interact with one another and impact schizophrenia-related symptoms.
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Esquizofrenia , Trastorno de la Personalidad Esquizotípica , Humanos , Esquizofrenia/diagnóstico , Esquizofrenia/complicaciones , Memoria a Corto Plazo , Trastorno de la Personalidad Esquizotípica/diagnóstico , Trastorno de la Personalidad Esquizotípica/complicaciones , Pruebas Neuropsicológicas , BiomarcadoresRESUMEN
Individuals diagnosed with schizophrenia spectrum disorders (SSD) exhibit a constellation of sensory and perceptual impairments, including hyporeactivity to external input. However, individuals with SSD also report subjective experiences of sensory flooding, suggesting sensory hyperexcitability. To identify the extent to which behavioural indices of hyperexcitability are related to non-psychotic symptoms of schizophrenia, we tested a non-clinical population measured for schizophrenia-like traits (schizotypy), and a behavioural measure of sensory hyperexcitability, specifically the number of illusions seen in the Pattern Glare Test. Two samples totaling 913 individuals completed an online version of the Schizotypal Personality Questionnaire - Brief Revised (SPQ-BR) and the Pattern Glare Test. Individuals with higher schizotypy traits reported more illusions in the Pattern Glare Test. Additionally, one of the three SPQ-BR factors, the disorganized factor, significantly predicted the number of illusions reported. These data illustrate the potential for research in non-clinical samples to inform clinically relevant research.
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Ilusiones , Esquizofrenia , Trastorno de la Personalidad Esquizotípica , Humanos , Trastorno de la Personalidad Esquizotípica/diagnóstico , Deslumbramiento , Ansiedad , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Mild traumatic brain injuries (mTBI) are considered self-limiting and full recovery is expected. Recent studies identify deficits persisting years after mTBI. Large-scale prospective data permit testing the hypothesis that mTBI increases incidence of affective and behavioral symptoms after new, past , or new and past mTBI. SETTING: The study involved secondary analyses of survey responses from the Adolescent Brain Cognitive Development (ABCD) Study. PARTICIPANTS: Adolescents in the ABCD Study ( n = 11 869; Wave 1, aged 9-10 years; Wave 2, aged 11-12 years) whose parents reported a new ( n = 157), past ( n = 1318), or new and past ( n = 50) mTBI on the Ohio State University Traumatic Brain Injury Identification Method short form were compared with controls who had no history of mTBI ( n = 9,667). DESIGN: Multivariable binary logistic regression models examined associations between a new, past, or new and past mTBI and current affective (aggression, depression, anxiety) and behavioral (somatic, thought, social, attention, attention deficit hyperactivity disorder, conduct) disorders while controlling for demographic factors and baseline symptoms. MAIN MEASURES: The primary measure was parental reports of psychiatric and behavioral symptoms on the Child Behavior Checklist. RESULTS: Girls exhibited no significant effects after a new mTBI, although a past mTBI increased anxiety (adjusted odds ratios [aOR] = 1.83, 95% confidence interval [CI: 1.15-2.90]) and attention (1.89 [1.09-3.28]) problems. Girls with new and past mTBIs reported elevated anxiety (17.90 [4.67-68.7]), aggression (7.37 [1.49-36.3]), social (9.07 [2.47-33.30]), thought (7.58 [2.24-25.60]), and conduct (6.39 [1.25-32.50]) disorders. In boys, new mTBI increased aggression (aOR = 3.83, 95% CI [1.42-10.30]), whereas past mTBI heightened anxiety (1.91 [1.42-2.95]), but new and past mTBIs had no significant effects. CONCLUSION: Adolescents are at greater risk of affective and behavioral symptoms after an mTBI. These effects differ as a function of gender and time of injury. Extended screening for mTBI history and monitoring of affective and behavioral disorders after mTBI in adolescents are warranted.
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Conmoción Encefálica , Lesiones Traumáticas del Encéfalo , Masculino , Niño , Femenino , Humanos , Adolescente , Conmoción Encefálica/complicaciones , Conmoción Encefálica/epidemiología , Estudios Prospectivos , Síntomas Afectivos/diagnóstico , Síntomas Afectivos/epidemiología , Síntomas Afectivos/etiología , Factores Sexuales , Lesiones Traumáticas del Encéfalo/diagnóstico , Lesiones Traumáticas del Encéfalo/epidemiologíaRESUMEN
Cognitive neuroscience currently conflates the study of serial responses (e.g., delay match to sample/nonsample, n-back) with the study of sequential operations. In this essay, our goal is to define and disentangle the latter, termed abstract cognitive task sequences (ACTS). Existing literatures address tasks requiring serial events, including procedural learning of implicit motor responses, statistical learning of predictive relationships, and judgments of attributes. These findings do not describe the behavior and underlying mechanism required to succeed at remembering to evaluate color, then shape; or to multiply, then add. A new literature is needed to characterize these sorts of second-order cognitive demands of studying a sequence of operations. Our second goal is to characterize gaps in knowledge related to ACTS that merit further investigation. In the following sections, we define more precisely what we mean by ACTS and suggest research questions that further investigation would be positioned to address.
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Aprendizaje , Aprendizaje Seriado , Cognición , Humanos , Recuerdo Mental , Tiempo de Reacción/fisiología , Aprendizaje Seriado/fisiologíaRESUMEN
A primary goal of translational neuroscience is to identify the neural mechanisms of age-related cognitive decline and develop protocols to maximally improve cognition. Here, we demonstrate how interventions that apply noninvasive neurostimulation to older adults improve working memory (WM). We found that one session of sham-controlled transcranial direct current stimulation (tDCS) selectively improved WM in older adults with more education, extending earlier work and underscoring the importance of identifying individual predictors of tDCS responsivity. Improvements in WM were associated with two distinct electrophysiological signatures. First, a broad enhancement of theta network synchrony tracked improvements in behavioral accuracy, with tDCS effects moderated by education level. Further analysis revealed that accuracy dynamics reflected an anterior-posterior network distribution regardless of cathode placement. Second, specific enhancements of theta-gamma phase-amplitude coupling (PAC) reflecting tDCS current flow tracked improvements in reaction time (RT). RT dynamics further explained inter-individual variability in WM improvement independent of education. These findings illuminate theta network synchrony and theta-gamma PAC as distinct but complementary mechanisms supporting WM in aging. Both mechanisms are amenable to intervention, the effectiveness of which can be predicted by individual demographic factors.
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Envejecimiento/fisiología , Mapeo Encefálico/métodos , Cognición/fisiología , Electroencefalografía , Memoria a Corto Plazo/fisiología , Estimulación Transcraneal de Corriente Directa/métodos , Anciano , Femenino , Humanos , MasculinoRESUMEN
Despite considerable interest in enhancing, preserving, and rehabilitating working memory (WM), efforts to elicit sustained behavioral improvements have been met with limited success. Here, we paired WM training with transcranial direct current stimulation (tDCS) to the frontoparietal network over four days. Active tDCS enhanced WM performance by modulating interactions between frontoparietal theta oscillations and gamma activity, as measured by pre- and post-training high-density electroencephalography (EEG). Increased phase-amplitude coupling (PAC) between the prefrontal stimulation site and temporo-parietal gamma activity explained behavioral improvements, and was most effective when gamma occurred near the prefrontal theta peak. These results demonstrate for the first time that tDCS-linked WM training elicits lasting changes in behavior by optimizing the oscillatory substrates of prefrontal control.
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Electroencefalografía/métodos , Función Ejecutiva/fisiología , Ritmo Gamma/fisiología , Memoria a Corto Plazo/fisiología , Red Nerviosa/fisiología , Lóbulo Parietal/fisiología , Reconocimiento Visual de Modelos/fisiología , Práctica Psicológica , Corteza Prefrontal/fisiología , Reconocimiento en Psicología/fisiología , Ritmo Teta/fisiología , Estimulación Transcraneal de Corriente Directa/métodos , Adulto , Humanos , Red Nerviosa/diagnóstico por imagen , Adulto JovenRESUMEN
Why are some visual stimuli remembered, whereas others are forgotten? A limitation of recognition paradigms is that they measure aggregate behavioral performance and/or neural responses to all stimuli presented in a visual working memory (VWM) array. To address this limitation, we paired an electroencephalography (EEG) frequency-tagging technique with two full-report VWM paradigms. This permitted the tracking of individual stimuli as well as the aggregate response. We recorded high-density EEG (256 channel) while participants viewed four shape stimuli, each flickering at a different frequency. At retrieval, participants either recalled the location of all stimuli in any order (simultaneous full report) or were cued to report the item in a particular location over multiple screen displays (sequential full report). The individual frequency tag amplitudes evoked for correctly recalled items were significantly larger than the amplitudes of subsequently forgotten stimuli, regardless of retrieval task. An induced-power analysis examined the aggregate neural correlates of VWM encoding as a function of items correctly recalled. We found increased induced power across a large number of electrodes in the theta, alpha, and beta frequency bands when more items were successfully recalled. This effect was more robust for sequential full report, suggesting that retrieval demands can influence encoding processes. These data are consistent with a model in which encoding-related resources are directed to a subset of items, rather than a model in which resources are allocated evenly across the array. These data extend previous work using recognition paradigms and stress the importance of encoding in determining later VWM retrieval success.
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Encéfalo/fisiología , Memoria a Corto Plazo/fisiología , Reconocimiento Visual de Modelos/fisiología , Adulto , Ondas Encefálicas , Electroencefalografía , Femenino , Humanos , Masculino , Recuerdo Mental/fisiología , Estimulación Luminosa , Adulto JovenRESUMEN
Visual statistical learning (VSL) refers to the learning of environmental regularities. Classically considered an implicit process, one patient with isolated hippocampal damage is severely impaired at VSL tasks, suggesting involvement of explicit memory. Here, we asked whether memory impairment (MI) alone, absent of clear hippocampal pathology, predicted deficits across different VSL tasks. A classic VSL task revealed no learning in MI participants (Exp. 1), while imposing attentional demands (Exp. 2: flicker detection, Exp. 3: gender/location categorization) during familiarization revealed modest residual VSL. MI with nonspecific neural correlates predicted impaired VSL overall, but attentional processes may be harnessed for rehabilitation.
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Atención/fisiología , Disfunción Cognitiva/fisiopatología , Trastornos de la Memoria/fisiopatología , Aprendizaje por Probabilidad , Percepción Visual/fisiología , Adulto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Transcranial direct current stimulation (tDCS) is a neuromodulatory approach that is affordable, safe, and well tolerated. This review article summarizes the research and clinically relevant findings from meta-analyses and studies investigating the cognitive effects of tDCS in healthy and clinical populations. We recapitulate findings from recent studies where cognitive performance paired with tDCS was compared with performance under placebo (sham stimulation) in single sessions and longitudinal designs where cognitive effects were evaluated following repeated sessions. In summary, the tDCS literature currently indicates that the effects of tDCS on cognitive measures are less robust and less predictable compared with the more consistent effects on motor outcomes. There is also a notable difference in the consistency of single-session and longitudinal designs. In single-session tDCS designs, there are small effects amid high variability confounded by individual differences and potential sham stimulation effects. In contrast, longitudinal studies provide more consistent benefits in healthy and clinical populations, particularly when tDCS is paired with a concurrent task. Yet, these studies are few in number, thereby impeding design optimization. While there is good evidence that tDCS can modulate cognitive functioning and potentially produce longer-term benefits, a major challenge to widespread translation of tDCS is the absence of a complete mechanistic account for observed effects. Significant future work is needed to identify a priori responders from nonresponders for every cognitive task and tDCS protocol.
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Cognición/fisiología , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Estimulación Transcraneal de Corriente Directa , Adulto , Voluntarios Sanos , HumanosRESUMEN
Working memory (WM) capacity falls along a spectrum with some people demonstrating higher and others lower WM capacity. Efforts to improve WM include applying transcranial direct current stimulation (tDCS), in which small amounts of current modulate the activity of underlying neurons and enhance cognitive function. However, not everyone benefits equally from a given tDCS protocol. Recent findings revealed tDCS-related WM benefits for individuals with higher working memory (WM) capacity. Here, we test two hypotheses regarding those with low WM capacity to see if they too would benefit under more optimal conditions. We tested whether supplying a WM strategy (Experiment 1) or providing greater extrinsic motivation through incentives (Experiment 2) would restore tDCS benefit to the low WM capacity group. We also employed functional near infrared spectroscopy to monitor tDCS-induced changes in neural activity. Experiment 1 demonstrated that supplying a WM strategy improved the high WM capacity participants' accuracy and the amount of oxygenated blood levels following anodal tDCS, but it did not restore tDCS-linked WM benefits to the low WM capacity group. Experiment 2 demonstrated that financial motivation enhanced performance in both low and high WM capacity groups, especially after anodal tDCS. Here, only the low WM capacity participants showed a generalized increase in oxygenated blood flow across both low and high motivation conditions. These results indicate that ensuring that participants' incentives are high may expand cognitive benefits associated with tDCS. This finding is relevant for translational work using tDCS in clinical populations, in which motivation can be a concern.
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Encéfalo/fisiología , Estimulación Eléctrica/métodos , Memoria a Corto Plazo/fisiología , Motivación/fisiología , Desempeño Psicomotor/fisiología , Espectroscopía Infrarroja Corta/métodos , Adulto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.
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Lesiones Encefálicas/rehabilitación , Trastornos del Conocimiento/rehabilitación , Terapia Ocupacional , Lesiones Encefálicas/complicaciones , Trastornos del Conocimiento/etiología , Práctica Clínica Basada en la Evidencia , HumanosRESUMEN
Neurostimulation, e.g., transcranial direct current stimulation (tDCS), shows promise as an effective cognitive intervention. In spite of low spatial resolution, limited penetration, and temporary influence, evidence highlights tDCS-linked cognitive benefits in a range of cognitive domains. The left posterior parietal cortex (PPC) is an accessible node in frontoparietal networks engaged during long-term memory (LTM). Here, we tested the hypothesis that tDCS can facilitate LTM by pairing LTM encoding and retrieval with PPC stimulation. Healthy young adults performed a verbal LTM task (California Verbal Learning Task) with four different stimulation parameters. In Experiment 1, we applied tDCS to left PPC during LTM encoding. In Experiment 2, we applied tDCS just prior to retrieval to test the temporal specificity of tDCS during a LTM task. In later experiments, we tested hemispheric specificity by replicating Experiment 1 while stimulating the right PPC. Experiment 1 showed that tDCS applied during LTM encoding improved the pace of list learning and enhanced retrieval after a short delay. Experiment 2 indicated anodal left PPC tDCS only improved LTM when applied during encoding, and not during maintenance. Experiments 3 and 4 confirmed that tDCS effects were hemisphere specific and that no effects were found after right PPC stimulation during encoding. These findings indicate that anodal tDCS to the PPC helps verbal LTM in healthy young adults under certain conditions. First, when it is applied to the left, not the right, PPC and second, when it is applied during encoding.
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Memoria a Largo Plazo/fisiología , Lóbulo Parietal/fisiología , Estimulación Transcraneal de Corriente Directa , Adulto , Femenino , Humanos , Masculino , Tiempo de Reacción/fisiología , Factores de Tiempo , Adulto JovenRESUMEN
The impact of the COVID-19 pandemic on physical and mental health hardly need be reiterated. Yet, there are likely other indirect aftereffects of COVID-19 infection in addition to the direct effects. This article aims to initiate a conversation regarding difficult-to-capture outcomes of the pandemic that are relevant to researchers who test human participants. These considerations encourage collection of additional measures when assessing pre- versus postpandemic patterns of behavior.
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COVID-19 , SARS-CoV-2 , Humanos , Pandemias , COVID-19/epidemiología , Salud MentalRESUMEN
Grapheme-color synesthetes experience color, not physically present, when viewing symbols. Synesthetes cannot remember learning these associations. Must synesthetic percepts be formed during a sensitive period? Can they form later and be consistent? What determines their nature? We tested grapheme-color synesthete, MC2, before, during and after she studied Hindi abroad. We investigated whether novel graphemes elicited synesthetic percepts, changed with familiarity, and/or benefited from phonemic information. MC2 reported color percepts to novel Devanagari and Hebrew graphemes. MC2 monitored these percepts over 6months in a Hindi-speaking environment. MC2 and synesthete DN, reported synesthetic percepts for Armenian graphemes, or Cyrillic graphemes+phonemes over time. Synesthetes, not controls, reported color percepts for novel graphemes that gained consistency over time. Phonemic information did not enhance consistency. Thus, synesthetes can form and consolidate percepts to novel graphemes as adults. These percepts may depend on pre-existing grapheme-color relationships but they can flexibly shift with familiarity.
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Percepción de Color/fisiología , Lenguaje , Aprendizaje , Reconocimiento Visual de Modelos/fisiología , Trastornos de la Percepción/fisiopatología , Adulto , Femenino , Humanos , Estimulación Luminosa , SinestesiaRESUMEN
Color losses of central origin (cerebral achromatopsia and dyschromatopsia) can result from cortical damage and are most commonly associated with stroke. Such cases have the potential to provide useful information regarding the loci of the generation of the percept of color. One available tool to examine this issue is the chromatic visual evoked potential (cVEP). The cVEP has been used successfully to objectively quantify losses in color vision capacity in both congenital and acquired deficiencies of retinal origin but has not yet been applied to cases of color losses of cortical origin. In addition, it is not known with certainty which cortical sites are responsible for the generation of the cVEP waveform components. Here we report psychophysical and electrophysiological examination of a patient with color deficits resulting from a bilateral cerebral infarct in the ventral occipitotemporal region. Although this patient demonstrated pronounced color losses of a general nature, the waveform of the cVEP remains unaffected. Contrast response functions of the cVEP are also normal for this patient. The results suggest that the percept of color arises after the origin of the cVEP and that normal activity in those areas that give rise to the characteristic negative wave of the cVEP are not sufficient to provide for the normal sensation of color.
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Percepción de Color/fisiología , Defectos de la Visión Cromática/fisiopatología , Potenciales Evocados Visuales/fisiología , Lóbulo Occipital/fisiopatología , Lóbulo Temporal/fisiopatología , Pruebas de Percepción de Colores/métodos , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , PsicofísicaRESUMEN
Neurostimulation carries high therapeutic potential, accompanied by an excellent safety profile. In this review, we argue that an arena in which these tools could provide breakthrough benefits is traumatic brain injury (TBI). TBI is a major health problem worldwide, with the majority of cases identified as mild TBI (mTBI). MTBI is of concern because it is a modifiable risk factor for dementia. A major challenge in studying mTBI is its inherent heterogeneity across a large feature space (e.g., etiology, age of injury, sex, treatment, initial health status, etc.). Parallel lines of research in human and rodent mTBI can be collated to take advantage of the full suite of neuroscience tools, from neuroimaging (electroencephalography: EEG; functional magnetic resonance imaging: fMRI; diffusion tensor imaging: DTI) to biochemical assays. Despite these attractive components and the need for effective treatments, there are at least two major challenges to implementation. First, there is insufficient understanding of how neurostimulation alters neural mechanisms. Second, there is insufficient understanding of how mTBI alters neural function. The goal of this review is to assemble interrelated but disparate areas of research to identify important gaps in knowledge impeding the implementation of neurostimulation.
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Many psychiatric and neurological conditions are associated with cognitive impairment for which there are very limited treatment options. Brain stimulation methodologies show promise as novel therapeutics and have cognitive effects. Electroconvulsive therapy (ECT), known more for its related transient adverse cognitive effects, can produce significant cognitive improvement in the weeks following acute treatment. Transcranial magnetic stimulation (TMS) is increasingly used as a treatment for major depression and has acute cognitive effects. Emerging research from controlled studies suggests that repeated TMS treatments may additionally have cognitive benefit. ECT and TMS treatment cause neurotrophic changes, although whether these are associated with cognitive effects remains unclear. Transcranial electrical stimulation methods including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS) are in development as novel treatments for multiple psychiatric conditions. These treatments may also produce cognitive enhancement particularly when stimulation occurs concurrently with a cognitive task. This review summarizes the current clinical evidence for these brain stimulation treatments as therapeutics for enhancing cognition. Acute, or short-lasting, effects as well as longer-term effects from repeated treatments are reviewed, together with potential putative neural mechanisms. Areas of future research are highlighted to assist with optimization of these approaches for enhancing cognition.
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Numerous functional neuroimaging studies have observed lateral parietal lobe activation during memory tasks: a surprise to clinicians who have traditionally associated the parietal lobe with spatial attention rather than memory. Recent neuropsychological studies examining episodic recollection after parietal lobe lesions have reported differing results. Performance was preserved in unilateral lesion patients on source memory tasks involving recollecting the context in which stimuli were encountered, and impaired in patients with bilateral parietal lesions on tasks assessing free recall of autobiographical memories. Here, we investigated a number of possible accounts for these differing results. In 3 experiments, patients with bilateral parietal lesions performed as well as controls at source recollection, confirming the previous unilateral lesion results and arguing against an explanation for those results in terms of contralesional compensation. Reducing the behavioral relevance of mnemonic information critical to the source recollection task did not affect performance of the bilateral lesion patients, indicating that the previously observed reduced autobiographical free recall might not be due to impaired bottom-up attention. The bilateral patients did, however, exhibit reduced confidence in their source recollection abilities across the 3 experiments, consistent with a suggestion that parietal lobe lesions might lead to impaired subjective experience of rich episodic recollection.