A paced visual serial addition test for fMRI
Introduction
fMRI is used to study cognitive processes. In certain diseases, like multiple sclerosis (MS) and traumatic brain injuries, diffuse pathological processes are present. Patients with diffuse cerebral damage show a lower test score on the Paced Auditory Addition Test (PASAT developed by Gronwall [1]) than healthy controls [2], for example, after cerebral concussion [1]. The level of performance on the PASAT is also lower in patients with disorders characterized by lesions diffusely distributed over the brain, like in MS [3]. Attention demanding (controlled) information processing underlying more complex cognitive skills is in general more slowed in MS patients [4]. To be able to assess cognitive deterioration by means of fMRI, we used a task based on multiple cognitive abilities, requiring the support of various brain areas throughout the brain. Since the PASAT and the Paced Visual Serial Addition Test (PVSAT) [21], a visual version of the test, fits the above requirements, we developed an fMRI version of this task.
The PASAT test consists of 60 random digits which are sequentially presented from audio tape. The subject is instructed to add the last digit to the preceding one, for every number heard. The resulting sum has to be vocalized before the next digit is presented. Different presentation rates have been used (typically 2 or 3 s/digit) [1]. The PASAT imposes high demands on the subject's working memory capacity, requiring controlled information processing (attention), visual memory, good auditory functioning and calculating abilities [5].
The purpose of our study was to administer an attention task in an fMRI setting, and to study the inter-individual variation and the parametric qualities of the brain activity. We hypothesized that the activated areas, when attending to and processing visual stimuli, would be located mainly in the parietal and frontal lobes.
Section snippets
Data acquisition
Imaging was performed on a 1.5-T MR system with a standard circularly polarized head coil. Anatomical imaging included a transverse 3D gradient echo T1-weighted sequence (15/7/1 [TR/TE/excitations]; flip angle, 8°; in plane resolution 0.86×0.86; slice thickness, 2 mm; number of slices, 82). For fMRI, a whole brain echo planar imaging (EPI) sequence (4000/60/1; flip angle, 90°; in plane resolution 3.44×3.44 mm; slice thickness, 4.0 mm, number of slices, 36) was used, planned parallel to the
Results
The whole group random effect analysis of the processing information stages (both speeds together) contrasted with the control staged showed bilateral (left size larger than the right) activation in superior and inferior parietal lobe (BA 7/40), superior frontal gyrus (BA 6) bilaterally (L>R), left medial frontal gyrus (BA 9), left inferior frontal gyrus (BA 44, 47) and adjacent part of insula, the anterior part of the cingulate gyrus (BA 32), and several areas in the cerebellum. For details of
Discussion
We adapted a test that assesses attention, information processing, visual memory, working memory and calculating abilities for fMRI. Brain activity, supposedly associated with those functions, was found in the following areas: bilaterally in the superior and inferior parietal lobe, bilaterally in the superior frontal gyrus, in the left medial frontal gyrus, left inferior frontal gyrus and adjacent part of the insula, the cingulate gyrus (anterior part), and several cerebellar areas. The
Acknowledgements
This work was supported in part by grants 96-278 and 97-330 from Stichting Vrienden MS Research (to R.H.C.L.). and by grant no 970-10-039 from the NWO (to S.A.R.B.)
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