A paced visual serial addition test for fMRI

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Abstract

Background and purpose: The Paced Auditory Serial Attention Task (PASAT) is an attention and information processing task used in patients with diffuse brain disorders, like cerebral trauma and multiple sclerosis (MS). Based on the PASAT we used a adapted version of the test to assess several cognitive functions with fMRI. In this study we investigated the activation pattern on a group and individual level and upon parametric stimulation. Methods: Nine young, healthy, right-handed subjects (mean age 24 years) were studied. The test contrasts an adding-and-memory stage with a control stage in a block design, at two different speeds. Group average maps (random effects analysis, p=0.05) were created to identify the brain areas subserving this task. For each area found active in the group map, the percentage of individuals showing activation in that same anatomical area was calculated. Results: Group activation was localized in the superior and inferior parietal lobe bilaterally, the superior frontal gyrus bilaterally, the left medial frontal gyrus, the left inferior frontal gyrus and adjacent part of the insula, the anterior part of the cingulate gyrus and some cerebellar areas. For the main activated areas, 78–100% of the individual subjects showed activation in that same area. Contrasting the low speed with the high speed condition yielded activation with a considerable individual variation. Conclusion: The group mean activated areas were located mainly in the frontal and parietal lobes and those areas were also activated in the majority of the subjects, indicating limited inter-individual variation, rendering this test suitable for clinical applications in a variety of neurological disorders.

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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