Hippocampal activity during memory and visual perception: The role of representational content.

The functional organisation of the medial temporal lobe (MTL) has long been described on the basis of cognitive processes such as recollection or familiarity. However, this view has recently been challenged, and researchers have proposed decomposing cognitive phenomena into representations and operations. According to the representational view, representations, such as scenes for the hippocampus and objects for the perirhinal cortex, are critical in understanding the role of MTL regions in cognition. In the present study, 51 healthy young participants underwent functional magnetic resonance imaging (fMRI) while completing a visual-discrimination task. Subsequently, half of the participants performed a patch-cue recognition procedure in which "Rec" responses are believed to reflect the operation of pattern completion, whereas the other half performed a whole-item remember/know procedure. We replicated the previously-reported demonstration that hippocampal involvement in pattern completion is preferential for scenes as compared with objects. In contrast, the perirhinal cortex was more recruited for object processing than for scene processing. We further extended these results to the operations of strength-signal memory and visual discrimination. Finally, the modulation of hippocampal engagement in pattern completion by representational content was found to be specific to its anterior segment. This observation is consistent with the proposal that this segment would process broad/global representations, whereas the posterior hippocampus would perform sharp/local representations. Taken together, these results favour the representational view of MTL functional organisation, but support that this specialisation differs along the hippocampal long-axis.

Semantic and Physical Properties of Peripheral Vision Are Used for Scene Categorization in Central Vision.

Theories of visual recognition postulate that our ability to understand our visual environment at a glance is based on the extraction of the gist of the visual scene, a first global and rudimentary visual representation. Gist perception would be based on the rapid analysis of low spatial frequencies in the visual signal and would allow a coarse categorization of the scene. We aimed to study whether the low spatial resolution information available in peripheral vision could modulate the processing of visual information presented in central vision. We combined behavioral measures (Experiments 1 and 2) and fMRI measures (Experiment 2). Participants categorized a scene presented in central vision (artificial vs. natural categories) while ignoring another scene, either semantically congruent or incongruent, presented in peripheral vision. The two scenes could either share the same physical properties (similar amplitude spectrum and spatial configuration) or not. Categorization of the central scene was impaired by a semantically incongruent peripheral scene, in particular when the two scenes were physically similar. This semantic interference effect was associated with increased activation of the inferior frontal gyrus. When the two scenes were semantically congruent, the dissimilarity of their physical properties impaired the categorization of the central scene. This effect was associated with increased activation in occipito-temporal areas. In line with the hypothesis of predictive mechanisms involved in visual recognition, results suggest that semantic and physical properties of the information coming from peripheral vision would be automatically used to generate predictions that guide the processing of signal in central vision.

Reconfiguration dynamics of a language-and-memory network in healthy participants and patients with temporal lobe epilepsy.

Current theoretical frameworks suggest that human behaviors are based on strong and complex interactions between cognitive processes such as those underlying language and memory functions in normal and neurological populations. We were interested in assessing the dynamic cerebral substrate of such interaction between language and declarative memory, as the composite function, in healthy controls (HC, N = 19) and patients with temporal lobe epilepsy (TLE, N = 16). Our assumption was that the language and declarative memory integration is based on a language-and-memory network (LMN) that is dynamic and reconfigures according to task demands and brain status. Therefore, we explored two types of LMN dynamics, a state reconfiguration (intrinsic resting-state compared to extrinsic state assessed with a sentence recall task) and a reorganization of state reconfiguration (TLE compared to HC). The dynamics was evaluated in terms of segregation (community or module detection) and integration (connector hubs). In HC, the level of segregation was the same in both states and the mechanism of LMN state reconfiguration was shown through module change of key language and declarative memory regions with integrative roles. In TLE patients, the reorganization of LMN state reconfiguration was reflected in segregation increase and extrinsic modules that were based on shorter-distance connections. While lateral and mesial temporal regions enabled state reconfiguration in HC, these regions showed reduced flexibility in TLE. We discuss our results in a connectomic perspective and propose a dynamic model of language and declarative memory functioning. We claim that complex and interactive cognitive functions, such as language and declarative memory, should be investigated dynamically, considering the interaction between cognitive networks.

Interactive mapping of language and memory with the GE2REC protocol.

Previous studies have highlighted the importance of considering cognitive functions from a dynamic and interactive perspective and multiple evidence was brought for a language and memory interaction. In this study performed with healthy participants, we present a new protocol entitled GE2REC that interactively accesses the neural representation of language-and-memory network. This protocol consists of three runs related to each other, providing a link between tasks, in order to assure an interactive measure of linguistic and episodic memory processes. GE2REC consists of a sentence generation (GE) in the auditory modality and two recollecting (2REC) memory tasks, one recognition performed in the visual modality, and another one recall performed in the auditory modality. Its efficiency was evaluated in 20 healthy volunteers using a 3T MR imager. Our results corroborate the ability of GE2REC to robustly activate fronto-temporo-parietal language network as well as temporal mesial, prefrontal and parietal cortices in encoding during sentence generation and recognition. GE2REC is useful because it: (a) requires simultaneous and interactive language-and-memory processes and jointly maps their neural basis; (b) explores encoding and retrieval, managing to elicit activation of mesial temporal structures; (c) is easy to perform, hence being suitable for more restrictive settings, and (d) has an ecological dimension of tasks and stimuli. GE2REC may be useful for studying neuroplasticity of cognitive functions, especially in patients with temporal lobe epilepsy who show reorganization of both language and memory networks. Overall, GE2REC can provide valuable information in terms of the practical foundation of exploration language and memory interconnection.

Hubs disruption in mesial temporal lobe epilepsy. A resting-state fMRI study on a language-and-memory network.

Mesial temporal lobe epilepsy (mTLE) affects the brain networks at several levels and patients suffering from mTLE experience cognitive impairment for language and memory. Considering the importance of language and memory reorganization in this condition, the present study explores changes of the embedded language-and-memory network (LMN) in terms of functional connectivity (FC) at rest, as measured with functional MRI. We also evaluate the cognitive efficiency of the reorganization, that is, whether or not the reorganizations support or allow the maintenance of optimal cognitive functioning despite the seizure-related damage. Data from 37 patients presenting unifocal mTLE were analyzed and compared to 48 healthy volunteers in terms of LMN-FC using two methods: pairwise correlations (region of interest [ROI]-to-ROI) and graph theory. The cognitive efficiency of the LMN-FC reorganization was measured using correlations between FC parameters and language and memory scores. Our findings revealed a large perturbation of the LMN hubs in patients. We observed a hyperconnectivity of limbic areas near the dysfunctional hippocampus and mainly a hypoconnectivity for several cortical regions remote from the dysfunctional hippocampus. The loss of FC was more important in left mTLE (L-mTLE) than in right (R-mTLE) patients. The LMN-FC reorganization may not be always compensatory and not always useful for patients as it may be associated with lower cognitive performance. We discuss the different connectivity patterns obtained and conclude that interpretation of FC changes in relation to neuropsychological scores is important to determine cognitive efficiency, suggesting the concept of "connectome" would gain to be associated with a "cognitome" concept.

The ConDialInt Model: Condensation, Dialogality, and Intentionality Dimensions of Inner Speech Within a Hierarchical Predictive Control Framework.

Inner speech has been shown to vary in form along several dimensions. Along condensation, condensed inner speech forms have been described, that are supposed to be deprived of acoustic, phonological and even syntactic qualities. Expanded forms, on the other extreme, display articulatory and auditory properties. Along dialogality, inner speech can be monologal, when we engage in internal soliloquy, or dialogal, when we recall past conversations or imagine future dialogs involving our own voice as well as that of others addressing us. Along intentionality, it can be intentional (when we deliberately rehearse material in short-term memory) or it can arise unintentionally (during mind wandering). We introduce the ConDialInt model, a neurocognitive predictive control model of inner speech that accounts for its varieties along these three dimensions. ConDialInt spells out the condensation dimension by including inhibitory control at the conceptualization, formulation or articulatory planning stage. It accounts for dialogality, by assuming internal model adaptations and by speculating on neural processes underlying perspective switching. It explains the differences between intentional and spontaneous varieties in terms of monitoring. We present an fMRI study in which we probed varieties of inner speech along dialogality and intentionality, to examine the validity of the neuroanatomical correlates posited in ConDialInt. Condensation was also informally tackled. Our data support the hypothesis that expanded inner speech recruits speech production processes down to articulatory planning, resulting in a predicted signal, the inner voice, with auditory qualities. Along dialogality, covertly using an avatar's voice resulted in the activation of right hemisphere homologs of the regions involved in internal own-voice soliloquy and in reduced cerebellar activation, consistent with internal model adaptation. Switching from first-person to third-person perspective resulted in activations in precuneus and parietal lobules. Along intentionality, compared with intentional inner speech, mind wandering with inner speech episodes was associated with greater bilateral inferior frontal activation and decreased activation in left temporal regions. This is consistent with the reported subjective evanescence and presumably reflects condensation processes. Our results provide neuroanatomical evidence compatible with predictive control and in favor of the assumptions made in the ConDialInt model.

Multimodal assessment of language and memory reorganization: a proof of concept in two patients with drug-resistant temporal lobe epilepsy.

We report two patients suffering from drug-resistant temporal lobe epilepsy to show how their neuroplasticity can be apprehended using a multimodal, integrative and clinically relevant approach. This is a proof of concept based on using multimodal data including: (1) white matter structural connectivity (DTI) of the main tracts involved in language and memory; (2) neurophysiological biomarkers (fMRI-BOLD signal and LI lateralization indices); and (3) cognitive scores as measured during the neuropsychological assessment. We characterized tri-modal data for each patient using a descriptive integrative approach, in terms of reorganization and by comparing with a group of healthy participants. This proof of concept suggests that the inclusion of multimodal data in clinical studies is currently a major challenge. Since the various datasets obtained from MRI neuroimaging and cognitive scores are probably interrelated, it is important to go beyond the mono-modal approach and move towards greater integration of several multimodal data. Multimodal integration of anatomical, functional, and cognitive data facilitates the identification of comprehensive neurocognitive patterns in epileptic patients, thus enabling clinicians to differentiate between reorganization profiles and help to predict post-surgical outcomes for curative neurosurgery.

Gray Matter Volume and Cognitive Performance During Normal Aging. A Voxel-Based Morphometry Study.

Normal aging is characterized by decline in cognitive functioning in conjunction with extensive gray matter (GM) atrophy. A first aim of this study was to determine GM volume differences related to aging by comparing two groups of participants, middle-aged group (MAG, mean age 41 years, N = 16) and older adults (OG, mean age 71 years, N = 14) who underwent an magnetic resonance images (MRI) voxel-based morphometry (VBM) evaluation. The VBM analyses included two optimized pipelines, for the cortex and for the cerebellum. Participants were also evaluated on a wide range of cognitive tests assessing both domain-general and language-specific processes, in order to examine how GM volume differences between OG and MAG relate to cognitive performance. Our results show smaller bilateral GM volume in the OG relative to the MAG, in several cerebral and right cerebellar regions involved in language and executive functions. Importantly, our results also revealed smaller GM volume in the right cerebellum in OG relative to MAG, supporting the idea of a complex cognitive role for this structure. This study provides a broad picture of cerebral, but also cerebellar and cognitive changes associated with normal aging.

Dorsal and ventral stream contribution to the paired-object affordance effect.

Visual extinction, a parietal syndrome in which patients exhibit perceptual impairments when two objects are simultaneously presented in the visual field, is reduced when objects are correctly positioned for action, indicating that action helps patients' visual attention. Similarly, healthy individuals make faster action decisions on object pairs that appear in left/right standard co-location for actions in comparison to object pairs that appear in a mirror location, a phenomenon called the paired-object affordance effect. However, the neural locus of such effect remains debated and may be related to the activity of ventral or dorsal brain regions. The present fMRI study aims at determining the neural substrates of the paired-object affordance effect. Fourteen right-handed participants made decisions about semantically related (i.e. thematically related and co-manipulated) and unrelated object pairs. Pairs were either positioned in a standard location for a right-handed action (with the active object - lid - in the right visual hemifield, and the passive object - pan - in the left visual hemifield), or in the reverse location. Behavioral results showed a suppression of the observed cost of correctly positioning related pairs for action when performing action decisions (deciding if the two objects are usually used together), but not when performing contextual decisions (deciding if the two objects are typically found in the kitchen). Anterior regions of the dorsal stream (e.g. supplementary motor area) responded to inadequate object co-positioning for action, but only when the perceptual task required action decisions. In the ventral cortex, the left lateral occipital complex showed increased activation for objects correctly positioned for action in all conditions except when neither task demands nor object relatedness was relevant for action. Thus, fMRI results demonstrated a joint contribution of ventral and dorsal cortical streams to the paired-affordance effect. They further suggest that this contribution may depend on contextual situations and task demands, in line with flexible views of affordance evocation.

Effect of social leisure activities on object naming in healthy aging A multimodal approach.

Environmental factors contribute to the constitution and maintenance of the cognitive reserve and partially explain the variability of cognitive performance in older individuals. We assessed the role of leisure activities - social and individual - on the access to lexico-semantic representations evaluated through a task of object naming (ON). We hypothesize that compared to individual, social leisure activities explain better the ON performance in the older adults, which is explained by a mechanism of neural reserve. Our results in older adults indicate (a) a significant correlation between leisure social activities and the response time for ON, (b) a significant correlation between link the neural activity of the left superior and medial frontal (SmFG) for ON and leisure social activities. Interestingly, the activity of the left SmFG partially mediates the relationship between social activities and OD performance. We suggest that social leisure activities may contribute to maintain ON performances in healthy aging, through a neural reserve mechanism, in relation with left SmFG activity. This region is typically involved in the access to semantic representations, guided by the emotional state. These results open interesting perspectives on the role of social leisure activities on lexical production during aging.

Effective Connectivity between Ventral Occipito-Temporal and Ventral Inferior Frontal Cortex during Lexico-Semantic Processing. A Dynamic Causal Modeling Study.

It has been suggested that dorsal and ventral pathways support distinct aspects of language processing. Yet, the full extent of their involvement and their inter-regional connectivity in visual word recognition is still unknown. Studies suggest that they might reflect the dual-route model of reading, with the dorsal pathway more involved in grapho-phonological conversion during phonological tasks, and the ventral pathway performing lexico-semantic access during semantic tasks. Furthermore, this subdivision is also suggested at the level of the inferior frontal cortex, involving ventral and dorsal parts for lexico-semantic and phonological processing, respectively. In the present study, we assessed inter-regional brain connectivity and task-induced modulations of brain activity during a phoneme detection and semantic categorization tasks, using fMRI in healthy subject. We used a dynamic causal modeling approach to assess inter-regional connectivity and task demand modulation within the dorsal and ventral pathways, including the following network components: the ventral occipito-temporal cortex (vOTC; dorsal and ventral), the superior temporal gyrus (STG; dorsal), the dorsal inferior frontal gyrus (dIFG; dorsal), and the ventral IFG (vIFG; ventral). We report three distinct inter-regional interactions supporting orthographic information transfer from vOTC to other language regions (vOTC -> STG, vOTC -> vIFG and vOTC -> dIFG) regardless of task demands. Moreover, we found that (a) during semantic processing (direct ventral pathway) the vOTC -> vIFG connection strength specifically increased and (b) a lack of modulation of the vOTC -> dIFG connection strength by the task that could suggest a more general involvement of the dorsal pathway during visual word recognition. Results are discussed in terms of anatomo-functional connectivity of visual word recognition network.

Aging Modulates the Hemispheric Specialization during Word Production.

Although older adults exhibit normal accuracy in performing word retrieval and generation (lexical production; e.g., object naming), they are generally slower in responding than younger adults. To maintain accuracy, older adults recruit compensatory mechanisms and strategies. We focused on two such possible compensatory mechanisms, one semantic and one executive. These mechanisms are reflected at inter- and intra-hemispheric levels by various patterns of reorganization of lexical production cerebral networks. Hemispheric reorganization (HR) changes were also evaluated in relation to increase naming latencies. Using functional magnetic resonance imaging (fMRI), we examined 27 healthy participants (from 30 years to 85 years) during an object naming task, exploring and identifying task-related patterns of cerebral reorganization. We report two main results. First, we observed a left intra-hemispheric pattern of reorganization, the left anterior-posterior aging (LAPA) effect, consisting of supplementary activation of left posterior (temporo-parietal) regions in older adults and asymmetric activation along the left fronto-temporal axis. This pattern suggests that older adults recruit posterior semantic regions to perform object naming. The second finding consisted of bilateral recruitment of frontal regions to maintain appropriate response times, especially in older adults who were faster performers. This pattern is discussed in terms of compensatory mechanism. We suggest that aging is associated with multiple, co-existing compensation and reorganization mechanisms and patterns associated with lexical production.

Age-related differences in brain activity during implicit and explicit processing of fearful facial expressions.

Age-related differences in neural correlates underlying implicit and explicit emotion processing are unclear. Within the framework of the Frontoamygdalar Age-related Differences in Emotion model (St Jacques et al., 2009), our objectives were to examine the behavioral and neural modifications that occur with age for both processes. During explicit and implicit processing of fearful faces, we expected to observe less amygdala activity in older adults (OA) than in younger adults (YA), associated with poorer recognition performance in the explicit task, and more frontal activity during implicit processing, suggesting compensation. At a behavioral level, explicit recognition of fearful faces was impaired in OA compared with YA. We did not observe any cerebral differences between OA and YA during the implicit task, whereas in the explicit task, OA recruited more frontal, parietal, temporal, occipital, and cingulate areas. Our findings suggest that automatic processing of emotion may be preserved during aging, whereas deliberate processing is impaired. Additional neural recruitment in OA did not appear to compensate for their behavioral deficits.

The Self-Pleasantness Judgment Modulates the Encoding Performance and the Default Mode Network Activity.

In this functional magnetic resonance imaging (fMRI) study, we evaluated the effect of self-relevance on cerebral activity and behavioral performance during an incidental encoding task. Recent findings suggest that pleasantness judgments reliably induce self-oriented (internal) thoughts and increase default mode network (DMN) activity. We hypothesized that this increase in DMN activity would relate to increased memory recognition for pleasantly-judged stimuli (which depend on internally-oriented attention) but decreased recognition for unpleasantly-judged items (which depend on externally-oriented attention). To test this hypothesis, brain activity was recorded from 21 healthy participants while they performed a pleasantness judgment requiring them to rate visual stimuli as pleasant or unpleasant. One hour later, participants performed a surprise memory recognition test outside of the scanner. Thus, we were able to evaluate the effects of pleasant and unpleasant judgments on cerebral activity and incidental encoding. The behavioral results showed that memory recognition was better for items rated as pleasant than items rated as unpleasant. The whole brain analysis indicated that successful encoding (SE) activates the inferior frontal and lateral temporal cortices, whereas unsuccessful encoding (UE) recruits two key medial posterior DMN regions, the posterior cingulate cortex (PCC) and precuneus (PCU). A region of interest (ROI) analysis including classic DMN areas, revealed significantly greater involvement of the medial prefrontal cortex (mPFC) in pleasant compared to unpleasant judgments, suggesting this region's involvement in self-referential (i.e., internal) processing. This area may be responsible for the greater recognition performance seen for pleasant stimuli. Furthermore, a significant interaction between the encoding performance (successful vs. unsuccessful) and pleasantness was observed for the PCC, PCU and inferior frontal gyrus (IFG). Overall, our results suggest the involvement of medial frontal and parietal DMN regions during the evaluation of self-referential pleasantness. We discuss these results in terms of the introspective referential of pleasantness judgments and the differential brain modulation based on internally- vs. externally-oriented attention during encoding.

Cerebral Correlates of Emotional and Action Appraisals During Visual Processing of Emotional Scenes Depending on Spatial Frequency: A Pilot Study.

Visual processing of emotional stimuli critically depends on the type of cognitive appraisal involved. The present fMRI pilot study aimed to investigate the cerebral correlates involved in the visual processing of emotional scenes in two tasks, one emotional, based on the appraisal of personal emotional experience, and the other motivational, based on the appraisal of the tendency to action. Given that the use of spatial frequency information is relatively flexible during the visual processing of emotional stimuli depending on the task's demands, we also explored the effect of the type of spatial frequency in visual stimuli in each task by using emotional scenes filtered in low spatial frequency (LSF) and high spatial frequencies (HSF). Activation was observed in the visual areas of the fusiform gyrus for all emotional scenes in both tasks, and in the amygdala for unpleasant scenes only. The motivational task induced additional activation in frontal motor-related areas (e.g. premotor cortex, SMA) and parietal regions (e.g. superior and inferior parietal lobules). Parietal regions were recruited particularly during the motivational appraisal of approach in response to pleasant scenes. These frontal and parietal activations, respectively, suggest that motor and navigation processes play a specific role in the identification of the tendency to action in the motivational task. Furthermore, activity observed in the motivational task, in response to both pleasant and unpleasant scenes, was significantly greater for HSF than for LSF scenes, suggesting that the tendency to action is driven mainly by the detailed information contained in scenes. Results for the emotional task suggest that spatial frequencies play only a small role in the evaluation of unpleasant and pleasant emotions. Our preliminary study revealed a partial distinction between visual processing of emotional scenes during identification of the tendency to action, and during identification of personal emotional experiences. It also illustrates flexible use of the spatial frequencies contained in scenes depending on their emotional valence and on task demands.

NEREC, an effective brain mapping protocol for combined language and long-term memory functions.

Temporal lobe epilepsy can induce functional plasticity in temporoparietal networks involved in language and long-term memory processing. Previous studies in healthy subjects have revealed the relative difficulty for this network to respond effectively across different experimental designs, as compared to more reactive regions such as frontal lobes. For a protocol to be optimal for clinical use, it has to first show robust effects in a healthy cohort. In this study, we developed a novel experimental paradigm entitled NEREC, which is able to reveal the robust participation of temporoparietal networks in a uniquely combined language and memory task, validated in an fMRI study with healthy subjects. Concretely, NEREC is composed of two runs: (a) an intermixed language-memory task (confrontation naming associated with encoding in nonverbal items, NE) to map language (i.e., word retrieval and lexico-semantic processes) combined with simultaneous long-term verbal memory encoding (NE items named but also explicitly memorized) and (b) a memory retrieval task of items encoded during NE (word recognition, REC) intermixed with new items. Word recognition is based on both perceptual-semantic familiarity (feeling of 'know') and accessing stored memory representations (remembering). In order to maximize the remembering and recruitment of medial temporal lobe structures, we increased REC difficulty by changing the modality of stimulus presentation (from nonverbal during NE to verbal during REC). We report that (a) temporoparietal activation during NE was attributable to both lexico-semantic (language) and memory (episodic encoding and semantic retrieval) processes; that (b) encoding activated the left hippocampus, bilateral fusiform, and bilateral inferior temporal gyri; and that (c) task recognition (recollection) activated the right hippocampus and bilateral but predominant left fusiform gyrus. The novelty of this protocol consists of (a) combining two tasks in one (language and long-term memory encoding/recall) instead of applying isolated tasks to map temporoparietal regions, (b) analyzing NE data based on performances recorded during REC, (c) double-mapping networks involved in naming and in long-term memory encoding and retrieval, (d) focusing on remembering with hippocampal activation and familiarity judgment with lateral temporal cortices activation, and (e) short duration of examination and feasibility. These aspects are of particular interest in patients with TLE, who frequently show impairment of these cognitive functions. Here, we show that the novel protocol is suited for this clinical evaluation.

Cerebral Correlates of Abnormal Emotion Conflict Processing in Euthymic Bipolar Patients: A Functional MRI Study.

BACKGROUND: Patients with bipolar disorder experience cognitive and emotional impairment that may persist even during the euthymic state of the disease. These persistent symptoms in bipolar patients (BP) may be characterized by disturbances of emotion regulation and related fronto-limbic brain circuitry. The present study aims to investigate the modulation of fronto-limbic activity and connectivity in BP by the processing of emotional conflict. METHODS: Fourteen euthymic BP and 13 matched healthy subjects (HS) underwent functional magnetic resonance imaging (fMRI) while performing a word-face emotional Stroop task designed to dissociate the monitoring/generation of emotional conflict from its resolution. Functional connectivity was determined by means of psychophysiological interaction (PPI) approach. RESULTS: Relative to HS, BP were slower to process incongruent stimuli, reflecting higher amount of behavioral interference during emotional Stroop. Furthermore, BP showed decreased activation of the right dorsolateral prefrontal cortex (DLPFC) during the monitoring and a lack of bilateral amygdala deactivation during the resolution of the emotional conflict. In addition, during conflict monitoring, BP showed abnormal positive connectivity between the right DLPFC and several regions of the default mode network. CONCLUSIONS: Overall, our results highlighted dysfunctional processing of the emotion conflict in euthymic BP that may be subtended by abnormal activity and connectivity of the DLPFC during the conflict monitoring, which, in turn, leads to failure of amygdala deactivation during the resolution of the conflict. Emotional dysregulation in BP may be underpinned by a lack of top-down cognitive control and a difficulty to focus on the task due to persistent self-oriented attention.