Age Deficits in Associative Memory are not Alleviated by Multisensory Paradigms.

OBJECTIVES: Age deficits in memory are widespread, this impacts individuals at a personal level, and investigating memory has been a key focus in cognitive ageing research. Age deficits occur in memory for an episode, where information from the environment is integrated through the senses into an episodic event via associative memory. Associating items in memory has been shown to be particularly difficult for older adults but can often be alleviated by providing support from the external environment. The current investigation explored the potential for increased sensory input (multimodal stimuli) to alleviate age deficits in associative memory. Here, we present compelling evidence, supported by Bayesian analysis, for a null age-by-modality interaction. METHODS: Across three pre-registered studies, young and older adults (n = 860) completed associative memory tasks either in single modalities or in multimodal formats. Study 1 used either visual text (unimodal) or video introductions (multimodal) to test memory for name-face associations. Studies 2 and 3 tested memory for paired associates. Study 2 used unimodal visual presentation or cross modal visual-auditory word pairs in a cued recall paradigm. Study 3 presented word pairs as visual only, auditory only or audiovisual and tested memory separately for items (individual words) or associations (word pairings). RESULTS: Typical age deficits in associative memory emerged, but these were not alleviated by multimodal presentation. DISCUSSION: The lack of multimodal support for associative memory indicates that perceptual manipulations are less effective than other forms of environmental support at alleviating age deficits in associative memory.

The effect of unisensory and multisensory information on lexical decision and free recall in young and older adults.

Studies using simple low-level stimuli show that multisensory stimuli lead to greater improvements in processing speed for older adults than young adults. However, there is insufficient evidence to explain how these benefits influence performance for more complex processes such as judgement and memory tasks. This study examined how presenting stimuli in multiple sensory modalities (audio-visual) instead of one (audio-only or visual-only) may help older adults to improve their memory and cognitive processing compared to young adults. Young and older adults completed lexical decision (real word vs. pseudoword judgement) and word recall tasks, either independently, or in combination (dual-task), with and without perceptual noise. Older adults were better able to remember words when encoding independently. In contrast, young adults were better able to remember words when encoding in combination with lexical decisions. Both young and older adults had better word recall in the audio-visual condition compared with the audio-only condition. The findings indicate significant age differences when dealing with multiple tasks during encoding. Crucially, there is no greater multisensory benefit for older adults compared to young adults in more complex processes, rather multisensory stimuli can be useful in enhancing cognitive performance for both young and older adults.

Does audio-visual information result in improved health-related decision-making compared with audio-only or visual-only information? Protocol for a systematic review and meta-analysis.

INTRODUCTION: Making health-related decisions can be difficult due to the amount and complexity of information available. Audio-visual information may improve memory for health information but whether audio-visual information can enhance health-related decisions has not been explored using quantitative methods. The objective of this systematic review is to understand how effective audio-visual information is for informing health-related decision-making compared with audio-only or visual-only information. METHODS AND ANALYSIS: Randomised controlled trials (RCTs) will be included if they include audio-visual and either audio-only or visual-only information provision and decision-making in a health setting. Studies will be excluded if they are not reported in English. Twelve databases will be searched including: Ovid MEDLINE, PubMed and PsychINFO. The Cochrane Risk of Bias tool (V.7) will be used to assess risk of bias in included RCTs. Results will be synthesised primarily using a meta-analysis; where quantitative data are not reported, a narrative synthesis will be used. ETHICS AND DISSEMINATION: No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines. This review is funded by the Economic and Social Research Council. PROSPERO REGISTRATION NUMBER: CRD42021255725.

The Influence of the Type of Background Noise on Perceptual Learning of Speech in Noise.

OBJECTIVES: Auditory perceptual learning studies tend to focus on the nature of the target stimuli. However, features of the background noise can also have a significant impact on the amount of benefit that participants obtain from training. This study explores whether perceptual learning of speech in background babble noise generalizes to other, real-life environmental background noises (car and rain), and if the benefits are sustained over time. DESIGN: Normal-hearing native English speakers were randomly assigned to a training (n = 12) or control group (n = 12). Both groups completed a pre- and post-test session in which they identified Bamford-Kowal-Bench (BKB) target words in babble, car, or rain noise. The training group completed speech-in-babble noise training on three consecutive days between the pre- and post-tests. A follow up session was conducted between 8 and 18 weeks after the post-test session (training group: n = 9; control group: n = 7). RESULTS: Participants who received training had significantly higher post-test word identification accuracy than control participants for all three types of noise, although benefits were greatest for the babble noise condition and weaker for the car- and rain-noise conditions. Both training and control groups maintained their pre- to post-test improvement over a period of several weeks for speech in babble noise, but returned to pre-test accuracy for speech in car and rain noise. CONCLUSION: The findings show that training benefits can show some generalization from speech-in-babble noise to speech in other types of environmental noise. Both groups sustained their learning over a period of several weeks for speech-in-babble noise. As the control group received equal exposure to all three noise types, the sustained learning with babble noise, but not other noises, implies that a structural feature of babble noise was conducive to the sustained improvement. These findings emphasize the importance of considering the background noise as well as the target stimuli in auditory perceptual learning studies.

Low-Frequency Repetitive Transcranial Magnetic Stimulation to Right Parietal Cortex Disrupts Perception of Briefly Presented Stimuli.

Right parietal cortex has recently been linked to the temporal resolution of attention. We therefore sought to investigate whether disruption to right parietal cortex would affect attention to visual stimuli presented for brief durations. Participants performed a visual discrimination task before and after 10 minutes repetitive transcranial magnetic stimulation (1 Hz) to right or central parietal cortex as well as 20 minutes after the second block of trials. Participants reported the spatial frequency of a masked Gabor patch presented for a brief duration of 60, 120, or 240 ms. We calculated error magnitudes by comparing accuracy to a guessing model. We then compared error magnitudes to blocks with no stimulation, producing a measure of baselined performance. Baselined performance was poorer at longer stimulus durations after right parietal than central parietal stimulation, suggesting that right parietal cortex is involved in attention to briefly presented stimuli, particularly in situations where rapid accumulation of visual evidence is needed.

Evaluation of Clinical Outcomes with Phosphodiesterase-5 Inhibitor Therapy for Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation.

Few studies have evaluated the use of phosphodiesterase-5 inhibitors (PDE5-i) for right ventricular (RV) dysfunction after left ventricular assist device (LVAD) implantation. The study purpose was to examine the impact of postoperative inpatient PDE5-i therapy on clinical outcomes in patients with LVADs. This single-center, retrospective cohort study screened 445 LVAD recipients between January 2011 and May 2015 for eligibility. Subjects receiving post-LVAD PDE5-i were compared with those who did not. The primary outcome was the proportion of all-cause hospital readmission at 30 days. Additional outcomes assessed included duration of intravenous inotrope or inhaled epoprostenol therapy, length of stay, duration of mechanical ventilation, overall survival, and improvement in the degree of postoperative RV dysfunction. Comparative analyses were performed before and after propensity score (PS) matching. Three-hundred and eighteen patients were included; 208 received post-LVAD inpatient PDE5-i and 110 patients did not. There was no difference in the rate of readmission at 30 days before or after PS matching. No significant differences were found between groups with regard to inotrope or epoprostenol duration, lengths of stay, duration of mechanical ventilation, overall survival, or improvement in the degree of RV dysfunction after PS matching. In the current study, the use of PDE5-i for adjunctive treatment of post-LVAD RV dysfunction was not associated with improved clinical outcomes.

Can auditory objects be subitized?

In vision, humans have the ability to mentally "tag" approximately 4 objects, allowing us to monitor, attend, and interact with them. As a consequence, we can rapidly and accurately enumerate up to 4 objects-a process known as subitizing. Here, we investigate whether a similar ability exists for tagging auditory stimuli and find that only 2 or 3 auditory stimuli can be enumerated with high accuracy. We assess whether this high accuracy indicates the existence of an auditory subitizing mechanism, and if it is influenced by factors known to influence visual subitizing. On the basis of accuracy, Experiments 1 and 2 reveal a potential auditory subitizing mechanism only when stimuli are spatially separated, as is the case for visual subitizing. Experiment 3 failed to show any evidence of auditory subitizing when objects were separated in time, rather than space. All three experiments provide only limited evidence for an age-related decline in auditory enumeration of small numbers of objects. This suggests that poor auditory tagging does not contribute significantly to older adults' difficulties in multitalker conversations. We hypothesize that although auditory subitizing might occur, it is restricted to approximately 2 spatially separated objects due to the difficulty of parsing the auditory scene into its constituent parts. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Controversies and advances in the management of ventilator associated pneumonia.

INTRODUCTION: Although national surveillance data suggests that the incidence of ventilator associated pneumonia (VAP) is down-trending, it remains one of the most commonly encountered hospital acquired infections in the United States and worldwide. Its association with increased healthcare costs and worsened patient outcomes warrants continued effort to improve the care of patients with VAP. Areas covered: The increasing prevalence of multi-drug resistant bacteria further drives the need to explore advances in diagnostic and treatment options. In this review, controversies pertaining to the definition and diagnosis of VAP as well as empiric treatment strategies will be discussed along with several developments related to rapid microbiologic testing methods and the use of non-traditional antimicrobial agents. Expert commentary: The application of rapid diagnostic techniques to identify microbial pathogens is perhaps one of the most impactful advancements in the treatment of serious nosocomial infections. This technology has the potential to reduce inappropriate initial antimicrobial therapy, unnecessary antimicrobial exposure, and mortality in patients with VAP. In addition, the anticipated approval of new antimicrobial agents within the next several years will provide a much-needed expansion of available treatment options in an era of growing antimicrobial resistance.

Perception and Cognition in the Ageing Brain: A Brief Review of the Short- and Long-Term Links between Perceptual and Cognitive Decline.

Ageing is associated with declines in both perception and cognition. We review evidence for an interaction between perceptual and cognitive decline in old age. Impoverished perceptual input can increase the cognitive difficulty of tasks, while changes to cognitive strategies can compensate, to some extent, for impaired perception. While there is strong evidence from cross-sectional studies for a link between sensory acuity and cognitive performance in old age, there is not yet compelling evidence from longitudinal studies to suggest that poor perception causes cognitive decline, nor to demonstrate that correcting sensory impairment can improve cognition in the longer term. Most studies have focused on relatively simple measures of sensory (visual and auditory) acuity, but more complex measures of suprathreshold perceptual processes, such as temporal processing, can show a stronger link with cognition. The reviewed evidence underlines the importance of fully accounting for perceptual deficits when investigating cognitive decline in old age.

Visual search in depth: The neural correlates of segmenting a display into relevant and irrelevant three-dimensional regions.

Visual perception is facilitated by the ability to selectively attend to relevant parts of the world and to ignore irrelevant regions or features. In visual search tasks, viewers are able to segment displays into relevant and irrelevant items based on a number of factors including the colour, motion, and temporal onset of the target and distractors. Understanding the process by which viewers prioritise relevant parts of a display can provide insights into the effect of top-down control on visual perception. Here, we investigate the behavioural and neural correlates of segmenting a display according to the expected three-dimensional (3D) location of a target. We ask whether this segmentation is based on low-level visual features (e.g. common depth or common surface) or on higher-order representations of 3D regions. Similar response-time benefits and neural activity were obtained when items fell on common surfaces or within depth-defined volumes, and when displays were vertical (such that items shared a common depth/disparity) or were tilted in depth. These similarities indicate that segmenting items according to their 3D location is based on attending to a 3D region, rather than a specific depth or surface. Segmenting the items in depth was mainly associated with increased activation in depth-sensitive parietal regions rather than in depth-sensitive visual regions. We conclude that segmenting items in depth is primarily achieved via higher-order, cue invariant representations rather than through filtering in lower-level perceptual regions.

Searching for a talking face: the effect of degrading the auditory signal.

Previous research (e.g., McGurk & MacDonald, 1976) suggests that faces and voices are bound automatically, but recent evidence suggests that attention is involved in a task of searching for a talking face (Alsius & Soto-Faraco, 2011). We hypothesized that the processing demands of the stimuli may affect the amount of attentional resources required, and investigated what effect degrading the auditory stimulus had on the time taken to locate a talking face. Twenty participants were presented with between 2 and 4 faces articulating different sentences, and had to decide which of these faces matched the sentence that they heard. The results showed that in the least demanding auditory condition (clear speech in quiet), search times did not significantly increase when the number of faces increased. However, when speech was presented in background noise or was processed to simulate the information provided by a cochlear implant, search times increased as the number of faces increased. Thus, it seems that the amount of attentional resources required vary according to the processing demands of the auditory stimuli, and when processing load is increased then faces need to be individually attended to in order to complete the task. Based on these results we would expect cochlear-implant users to find the task of locating a talking face more attentionally demanding than normal hearing listeners.

Attending to the possibilities of action.

Actions taking place in the environment are critical for our survival. We review evidence on attention to action, drawing on sets of converging evidence from neuropsychological patients through to studies of the time course and neural locus of action-based cueing of attention in normal observers. We show that the presence of action relations between stimuli helps reduce visual extinction in patients with limited attention to the contralesional side of space, while the first saccades made by normal observers and early perceptual and attentional responses measured using electroencephalography/event-related potentials are modulated by preparation of action and by seeing objects being grasped correctly or incorrectly for action. With both normal observers and patients, there is evidence for two components to these effects based on both visual perceptual and motor-based responses. While the perceptual responses reflect factors such as the visual familiarity of the action-related information, the motor response component is determined by factors such as the alignment of the objects with the observer's effectors and not by the visual familiarity of the stimuli. In addition to this, we suggest that action relations between stimuli can be coded pre-attentively, in the absence of attention to the stimulus, and action relations cue perceptual and motor responses rapidly and automatically. At present, formal theories of visual attention are not set up to account for these action-related effects; we suggest ways that theories could be expected to enable action effects to be incorporated.

The prognosis of allocentric and egocentric neglect: evidence from clinical scans.

We contrasted the neuroanatomical substrates of sub-acute and chronic visuospatial deficits associated with different aspects of unilateral neglect using computed tomography scans acquired as part of routine clinical diagnosis. Voxel-wise statistical analyses were conducted on a group of 160 stroke patients scanned at a sub-acute stage. Lesion-deficit relationships were assessed across the whole brain, separately for grey and white matter. We assessed lesions that were associated with behavioural performance (i) at a sub-acute stage (within 3 months of the stroke) and (ii) at a chronic stage (after 9 months post stroke). Allocentric and egocentric neglect symptoms at the sub-acute stage were associated with lesions to dissociated regions within the frontal lobe, amongst other regions. However the frontal lesions were not associated with neglect at the chronic stage. On the other hand, lesions in the angular gyrus were associated with persistent allocentric neglect. In contrast, lesions within the superior temporal gyrus extending into the supramarginal gyrus, as well as lesions within the basal ganglia and insula, were associated with persistent egocentric neglect. Damage within the temporo-parietal junction was associated with both types of neglect at the sub-acute stage and 9 months later. Furthermore, white matter disconnections resulting from damage along the superior longitudinal fasciculus were associated with both types of neglect and critically related to both sub-acute and chronic deficits. Finally, there was a significant difference in the lesion volume between patients who recovered from neglect and patients with chronic deficits. The findings presented provide evidence that (i) the lesion location and lesion size can be used to successfully predict the outcome of neglect based on clinical CT scans, (ii) lesion location alone can serve as a critical predictor for persistent neglect symptoms, (iii) wide spread lesions are associated with neglect symptoms at the sub-acute stage but only some of these are critical for predicting whether neglect will become a chronic disorder and (iv) the severity of behavioural symptoms can be a useful predictor of recovery in the absence of neuroimaging findings on clinical scans. We discuss the implications for understanding the symptoms of the neglect syndrome, the recovery of function and the use of clinical scans to predict outcome.

Spatial and temporal attention deficits following brain injury: a neuroanatomical decomposition of the temporal order judgement task.

We investigated spatial and temporal deficits following brain injury using the temporal order judgement (TOJ) task. Patients judged the order in which two letters appeared to the left and right of fixation. We measured the extent of any spatial bias and the temporal resolution of the decision. Temporal and spatial deficits on the TOJ task were significantly correlated. The spatial bias on the TOJ task was also correlated with the spatial bias on a neglect task and with unilateral deficits on an extinction task, but not with extinction itself. These spatial deficits were all associated with damage to contralateral temporoparietal cortex. In contrast, the temporal resolution of TOJs was linked specifically to deficits in processing multiple stimuli on the neglect and extinction tasks and to damage to the right parietal lobe and the cerebellum. These data suggest that spatial and temporal deficits on the TOJ task reflect different underlying processes.

Action relations facilitate the identification of briefly-presented objects.

The link between perception and action allows us to interact fluently with the world. Objects which 'afford' an action elicit a visuomotor response, facilitating compatible responses. In addition, positioning objects to interact with one another appears to facilitate grouping, indicated by patients with extinction being better able to identify interacting objects (e.g. a corkscrew going towards the top of a wine bottle) than the same objects when positioned incorrectly for action (Riddoch, Humphreys, Edwards, Baker, & Willson, Nature Neuroscience, 6, 82-89, 2003). Here, we investigate the effect of action relations on the perception of normal participants. We found improved identification of briefly-presented objects when in correct versus incorrect co-locations for action. For the object that would be 'active' in the interaction (the corkscrew), this improvement was enhanced when it was oriented for use by the viewer's dominant hand. In contrast, the position-related benefit for the 'passive' object was stronger when the objects formed an action-related pair (corkscrew and bottle) compared with an unrelated pair (corkscrew and candle), and it was reduced when spatial cues disrupted grouping between the objects. We propose that these results indicate two separate effects of action relations on normal perception: a visuomotor response to objects which strongly afford an action; and a grouping effect between objects which form action-related pairs.

Action-related objects influence the distribution of visuospatial attention.

Previous studies have shown that attention is drawn to the location of manipulable objects and is distributed across pairs of objects that are positioned for action. Here, we investigate whether central, action-related objects can cue attention to peripheral targets. Experiment 1 compared the effect of uninformative arrow and object cues on a letter discrimination task. Arrow cues led to spatial-cueing benefits across a range of stimulus onset asynchronies (SOAs: 0 ms, 120 ms, 400 ms), but object-cueing benefits were slow to build and were only significant at the 400-ms SOA. Similar results were found in Experiment 2, in which the targets were objects that could be either congruent or incongruent with the cue (e.g., screwdriver and screw versus screwdriver and glass). Cueing benefits were not influenced by the congruence between the cue and target, suggesting that the cueing effects reflected the action implied by the central object, not the interaction between the objects. For Experiment 3 participants decided whether the cue and target objects were related. Here, the interaction between congruent (but not incongruent) targets led to significant cueing/positioning benefits at all three SOAs. Reduced cueing benefits were obtained in all three experiments when the object cue did not portray a legitimate action (e.g., a bottle pointing towards an upper location, since a bottle cannot pour upwards), suggesting that it is the perceived action that is critical, rather than the structural properties of individual objects. The data suggest that affordance for action modulates the allocation of visual attention.

The one that does, leads: action relations influence the perceived temporal order of graspable objects.

Perception and action are influenced by the "possibilities for action" in the environment. Neuropsychological studies (e.g., Riddoch, Humphreys, Edwards, Baker, & Willson, 2003) have demonstrated that objects that are perceived to be interacting (e.g., a corkscrew going toward the top of a wine bottle) are perceptually integrated into a functional unit, facilitating report of both objects. In addition, patients with parietal damage tend to report the "active" item of the pair (the corkscrew in the above example) when the objects are positioned for action, overriding their spatial bias toward the ipsilesional side. Using a temporal order judgment task we show for the first time that normal viewers judge that active objects appear earlier when they are positioned correctly for action. This effect is not dependent on a learned relationship between objects, or on the active object being integrated at a perceptual level with the object it is paired with. The data suggest that actions afforded by a correctly positioned active object permeate normal perceptual judgments.

Action relationships concatenate representations of separate objects in the ventral visual system.

Objects in the real world are encountered in contexts where they interact together. Though it is known that neurons in the ventral visual stream mediate the recognition of individual objects, we have minimal knowledge of how multiple objects are processed at a neural level. We examined the neural response to pairs of objects using functional magnetic resonance imaging (fMRI). Objects positioned to interact together activated bilateral lateral occipital complex (LOC) and fusiform gyrus. This occurred irrespective of whether the objects were attended. In LOC, the effect of positioning objects for action was found regardless of whether the objects formed a familiar or unfamiliar action pair. In the fusiform gyrus activation was found when objects formed a familiar action pair. No changes were apparent in visuomotor (premotor and parietal) regions which might reflect a motor-based response to objects. These results show that ventral-stream regions respond to the interaction between objects, as well as to the sensory and functional properties of individual objects.

Attention and its coupling to action.

We discuss two commentaries that we have received on our target article (Humphreys et al., 2010). We elaborate on the evidence for action effects on extinction and discuss whether these effects occur pre or post the selection of a response. In addition, we discuss the neural basis of the effects of action relations on extinction and on the generalization of results on action relations to real-world examples.