N-back Working Memory Research Articles

0038 Acute Blue Light Exposure Increases Activation in the Pulvinar Nucleus

Abstract Introduction Blue-wavelength light can produce phase-shifts in the circadian rhythm. We have previously shown that morning blue light exposure was associated with advanced onset of sleep time and diminished daytime sleepiness. These changes were associated with increased gray matter volume in the left pulvinar nucleus of the thalamus, a key hub of the visual attention network. However, very little is known about the underlying mechanisms of these light activations. We hypothesized that the pulvinar may be affected more by the acute activating effects of light rather than its effects on melatonin. Therefore, we exposed individuals to blue or amber light while undergoing functional neuroimaging at a time of day when melatonin levels are almost non-existent. Methods Twenty-six healthy individuals (15 male; 11 female; age=24.27, SD=6.27) completed a counterbalanced cross-over study involving two 3T functional MRI sessions separated by one week. During scanning, participants were acutely exposed to either continuous blue light (470 nm; active condition) or amber light (580 nm; placebo) while completing an N-Back working memory task. We contrasted the 2-back versus the 0-back condition and compared the blue and amber sessions using a paired t-test in SPM12. Results Acute blue light (versus amber placebo) during a working memory task was associated with significantly greater activation (p<.05) within the left pulvinar nucleus (k=47 voxels; MNI: x=-14, y=-34, z=8), a region nearly identical to that found in our previous work where we found increased volume with six-weeks of daily blue light exposure. Salivary melatonin levels were unchanged by either light condition. Conclusion Acute exposure to blue-wavelength light (versus amber placebo light) activated a key region of the visual attention network that was previously demonstrated to be enlarged by 6-weeks of daily morning blue light exposure. As melatonin levels remained unchanged by the light in this study, the findings point to an underlying neural mechanism that may lead specifically to activation of the pulvinar, which over time may enhance gray matter volume of that structure. These findings suggest a concordance of functional and structural changes induced by blue light exposure, which have been associated with shifts in sleep and circadian rhythms. Support (If Any)

Effects of Multisession Prefrontal Transcranial Direct Current Stimulation on Long-term Memory and Working Memory in Older Adults.

Transcranial direct current stimulation (tDCS) is a noninvasive form of electrical brain stimulation popularly used to augment the effects of working memory (WM) training. Although success has been mixed, some studies report enhancements in WM performance persisting days, weeks, or even months that are actually more reminiscent of consolidation effects typically observed in the long-term memory (LTM) domain, rather than WM improvements per se. Although tDCS has been often reported to enhance both WM and LTM, these effects have never been directly compared within the same study. However, given their considerable neural and behavioral overlap, this is a timely comparison to make. This study reports results from a multisession intervention in older adults comparing active and sham tDCS over the left dorsolateral pFC during training on both an n-back WM task and a word learning LTM task. We found strong and robust effects on LTM, but mixed effects on WM that only emerged for those with lower baseline ability. Importantly, mediation analyses showed an indirect effect of tDCS on WM that was mediated by improvements in consolidation. We conclude that tDCS over the left dorsolateral pFC can be used as an effective intervention to foster long-term learning and memory consolidation in aging, which can manifest in performance improvements across multiple memory domains.

Dissociative identity state-dependent working memory in dissociative identity disorder: a controlled functional magnetic resonance imaging study.

Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates. This study aims to investigate whether memory function in DID differs between dissociative identity states. Behavioural data and neural activation patterns were assessed in 92 sessions during an n-back working memory task. Participants were people with genuine diagnosed DID (n = 14), DID-simulating controls (n = 16) and a paired control group (post-traumatic stress disorder (n = 16), healthy controls (n = 16)). Both DID groups participated as authentic or simulated neutral and trauma-related identity states. Reaction times and errors of omission were analysed with repeated measures ANOVA. Working memory neural activation (main working memory and linear load) was investigated for effects of identity state, participant group and their interaction. Identity state-dependent behavioural performance and neural activation was found. DID simulators made fewer errors of omission than those with genuine DID. Regarding the prefrontal parietal network, main working memory in the left frontal pole and ventrolateral prefrontal cortex (Brodmann area 44) was activated in all three simulated neutral states, and in trauma-related identity states of DID simulators, but not those with genuine DID or post-traumatic stress disorder; for linear load, trauma-related identity states of those with genuine DID did not engage the parietal regions. Behavioural performance and neural activation patterns related to working memory in DID are dependent on the dissociative identities involved. The narrowed consciousness of trauma-related identity states, with a proneness to re-experiencing traumatising events, may relate to poorer working memory functioning.

Cognitive performance of military men and women during prolonged load carriage

BackgroundThis study evaluated cognitive workload in soldiers undertaking a long duration march wearing different loads.MethodsMilitary participants (n=12 men and n=10 women) performed four 3-hour loaded marches (12.25 km at 4.9...

Associations between neighborhood socioeconomic status, parental education, and executive system activation in youth.

Socioeconomic status (SES) can impact cognitive performance, including working memory (WM). As executive systems that support WM undergo functional neurodevelopment during adolescence, environmental stressors at both individual and community levels may influence cognitive outcomes. Here, we sought to examine how SES at the neighborhood and family level impacts task-related activation of the executive system during adolescence and determine whether this effect mediates the relationship between SES and WM performance. To address these questions, we studied 1,150 youths (age 8-23) that completed a fractal n-back WM task during functional magnetic resonance imaging at 3T as part of the Philadelphia Neurodevelopmental Cohort. We found that both higher neighborhood SES and parental education were associated with greater activation of the executive system to WM load, including the bilateral dorsolateral prefrontal cortex, posterior parietal cortex, and precuneus. The association of neighborhood SES remained significant when controlling for task performance, or related factors like exposure to traumatic events. Furthermore, high-dimensional multivariate mediation analysis identified distinct patterns of brain activity within the executive system that significantly mediated the relationship between measures of SES and task performance. These findings underscore the importance of multilevel environmental factors in shaping executive system function and WM in youth.

Sex-Based Differences in Functional Brain Activity During Working Memory in Survivors of Pediatric Acute Lymphoblastic Leukemia.

BackgroundLong-term survivors of pediatric acute lymphoblastic leukemia are at elevated risk for neurocognitive deficits and corresponding brain dysfunction. This study examined sex-based differences in functional neuroimaging outcomes in acute lymphoblastic leukemia survivors treated with chemotherapy alone.MethodsFunctional magnetic resonance imaging (fMRI) and neurocognitive testing were obtained in 123 survivors (46% male; median [min-max] age = 14.2 years [8.3-26.5 years]; time since diagnosis = 7.7 years [5.1-12.5 years]) treated on the St. Jude Total XV treatment protocol. Participants performed the n-back working memory task in a 3 T scanner. Functional neuroimaging data were processed (realigned, slice time corrected, normalized, smoothed) and analyzed using statistical parametric mapping with contrasts for 1-back and 2-back conditions, which reflect varying degrees of working memory and task load. Group-level fMRI contrasts were stratified by sex and adjusted for age and methotrexate exposure. Statistical tests were 2-sided (P < .05 statistical significance threshold).ResultsRelative to males, female survivors exhibited less activation (ie, reduced blood oxygen dependent–level signals) in the right parietal operculum, supramarginal gyrus and inferior occipital gyrus, and bilateral superior frontal medial gyrus during increased working memory load (family-wise error–corrected P = .004 to .008, adjusting for age and methotrexate dose). Female survivors were slower to correctly respond to the 2-back condition than males (P < .05), though there were no differences in overall accuracy. Performance accuracy was negatively correlated with fMRI activity in female survivors (Pearson’s r = −0.39 to −0.29, P = .001 to .02), but not in males.ConclusionsThese results suggest the working memory network is more impaired in female survivors than male survivors, which may contribute to ongoing functional deficits.

Neural alterations in working memory of mild-moderate TBI: An fMRI study in Malaysia.

Working memory (WM) encompasses crucial cognitive processes or abilities to retain and manipulate temporary information for immediate execution of complex cognitive tasks in daily functioning such as reasoning and decision-making. The WM of individuals sustaining traumatic brain injury (TBI) was commonly compromised, especially in the domain of WM. The current study investigated the brain responses of WM in a group of participants with mild-moderate TBI compared to their healthy counterparts employing functional magnetic resonance imaging. All consented participants (healthy: n=26 and TBI: n=15) performed two variations of the n-back WM task with four load conditions (0-, 1-, 2-, and 3-back). The respective within-group effects showed a right hemisphere-dominance activation and slower reaction in performance for the TBI group. Random-effects analysis revealed activation difference between the two groups in the right occipital lobe in the guided n-back with cues, and in the bilateral occipital lobe, superior parietal region, and cingulate cortices in the n-back without cues. The left middle frontal gyrus was implicated in the load-dependent processing of WM in both groups. Further group analysis identified that the notable activation changes in the frontal gyri and anterior cingulate cortex are according to low and high loads. Though relatively smaller in scale, this study was eminent as it clarified the neural alterations in WM in the mild-moderate TBI group compared to healthy controls. It confirmed the robustness of the phenomenon in TBI with the reproducibility of the results in a heterogeneous non-Western sample.

In memory of Professor Iain Wilkinson: cognitive and neuroimaging endophenotypes in a consanguineous schizophrenia multiplex family.

Schizophrenia endophenotypes may help elucidate functional effects of genetic risk variants in multiply affected consanguineous families that segregate recessive risk alleles of large effect size. We studied the association between a schizophrenia risk locus involving a 6.1Mb homozygous region on chromosome 13q22-31 in a consanguineous multiplex family and cognitive functioning, haemodynamic response and white matter integrity using neuroimaging. We performed CANTAB neuropsychological testing on four affected family members (all homozygous for the risk locus), ten unaffected family members (seven homozygous and three heterozygous) and ten healthy volunteers, and tested neuronal responses on fMRI during an n-back working memory task, and white matter integrity on diffusion tensor imaging (DTI) on four affected and six unaffected family members (four homozygous and two heterozygous) and three healthy volunteers. For cognitive comparisons we used a linear mixed model (Kruskal-Wallis) test, followed by posthoc Dunn's pairwise tests with a Bonferroni adjustment. For fMRI analysis, we counted voxels exceeding the p < 0.05 corrected threshold. DTI analysis was observational. Family members with schizophrenia and unaffected family members homozygous for the risk haplotype showed attention (p < 0.01) and working memory deficits (p < 0.01) compared with healthy controls; a neural activation laterality bias towards the right prefrontal cortex (voxels reaching p < 0.05, corrected) and observed lower fractional anisotropy in the anterior cingulate cortex and left dorsolateral prefrontal cortex. In this family, homozygosity at the 13q risk locus was associated with impaired cognition, white matter integrity, and altered laterality of neural activation.

Having a stimulating lifestyle is associated with maintenance of white matter integrity with age

Brain maintenance refers to the fact that some older adults experience few age-related changes in the brain, which helps maintain their cognition. The goal of this study was to assess maintenance of white matter integrity by testing whether reserve proxies, measuring factors associated to a stimulating lifestyle, affect the maintenance of white matter integrity. Another goal was to measure whether maintenance of white matter integrity explains inter-individual differences in working memory (WM). Forty-one cognitively healthy older adults received a structural magnetic resonance imaging (MRI) examination to measure white matter lesions. They completed an n-back WM task with different loads (1- & 2-back), along with a questionnaire on their lifestyle. There was a positive association between age and volume of white matter lesions. This association was no longer found in those with higher scores on reserve proxies. In addition, smaller volumes of white matter lesions were associated with better performance than expected for age in the 1-back WM task. Better WM is associated with the maintenance of white matter integrity in older adults, which in turn is linked to measures reflecting a stimulating lifestyle throughout life.

The effect of transcranial direct current stimulation on cognitive performance in youth with persistent cognitive symptoms following concussion: a controlled pilot study

ABSTRACT Objective Explore the feasibility, tolerability, and early efficacy of transcranial direct current stimulation (tDCS) as a therapeutic intervention for youth with cognitive persistent post-concussion symptoms (PPCS). Hypothesis tDCS improves performance on a dual task working memory (WM) paradigm in youth with cognitive PPCS. Participants Twelve youth experiencing cognitive PPCS. Design A quasi-randomized pilot trial was used to explore the tolerability of, and performance differences on, a dual N-Back WM task paired with active or sham tDCS over 3 sessions. Measures Accuracy and reaction time on WM task and self-report of tDCS tolerability. Results Trends toward increases in accuracy from Day 1 to 3 seen in both groups. Active tDCS group performed better than sham on Day 2 in N-Back level N2 (p = .019), and marginally better than the sham group on Day 3 in level N3 (p = .26). Participants reported tDCS as tolerable; compared to the active tDCS group, the sham group reported more “considerable” (p = .078) and “strong” symptoms (p = .097). Conclusion tDCS is a promising tool for enhancing WM performance and is a feasible and tolerable adjunct to behavioral interventions in youth with cognitive PPCS. A clinical trial to demonstrate efficacy is warranted.

Longer illness duration is associated with greater individual variability in functional brain activity in Schizophrenia, but not bipolar disorder

BackgroundIndividuals with schizophrenia exhibit greater inter-patient variability in functional brain activity during neurocognitive task performance. Some studies have shown associations of age and illness duration with brain function; however, the association of these variables with variability in brain function activity is not known. In order to better understand the progressive effects of age and illness duration across disorders, we examined the relationship with individual variability in brain activity. MethodsNeuroimaging and behavioural data were extracted from harmonized datasets collectively including 212 control participants, 107 individuals with bipolar disorder, and 232 individuals with schizophrenia (total n = 551). Functional activity in response to an N-back working memory task (2-back vs 1-back) was examined. Individual variability was quantified via the correlational distance of fMRI activity between participants; mean correlational distance of one participant in relation to all others was defined as a ‘variability score’. ResultsGreater individual variability was found in the schizophrenia group compared to the bipolar disorder and control groups (p = 1.52e−09). Individual variability was significantly associated with aging (p = 0.027), however, this relationship was not different across diagnostic groups. In contrast, in the schizophrenia sample only, a longer illness duration was associated with increased variability (p = 0.027). ConclusionAn increase in variability was observed in the schizophrenia group related to illness duration, beyond the effects of normal aging, implying illness-related deterioration of cognitive networks. This has clinical implications for considering long-term trajectories in schizophrenia and progressive neural and cognitive decline which may be amiable to novel treatments.

A parallel-group study of near-infrared spectroscopy-neurofeedback in children with attention deficit hyperactivity disorder

The present study aimed to assess the efficacy of Near-infrared spectroscopy (NIRS) real-time neurofeedback (NF) vs. atomoxetine (AT) in children with attention deficit hyperactivity disorder (ADHD). A parallel-group study was conducted to enroll children with ADHD between 8 and 12 years of age. Participants were assigned into the NIRS group and AT group as their wish. Subjects in the NIRS group received 12 sessions of NF training within 6 weeks, and subjects in the AT group were given oral medication. Changes in Swanson, Nolan, and Pelham-V rating scales (SNAP-IV), and performance of Go/No-Go and N-back working memory tasks at week 3, 6 and 8 were evaluated. Forty-nine patients completed the study, including 18 ADHD in the NIRS group and 31 in the AT group. Total scores of SNAP-IV significantly decreased from baseline to week 3, week 6, and week 8 in both groups. Patients in the NIRS group showed significant lower scores on the inattention subscale of SNAP-IV at week 3 and week 6, compared to the AT group. NIRS group had a shorter reaction time during the Go/No-Go task at week 6 and fewer errors during 2-back than the AT group at week 3. The findings revealed that NIRS real-time NF is more efficacious relative to AT in improving behavioral performance, highlighting its potential role and advantages in treating patients with ADHD.

Substantia nigra iron affects functional connectivity networks modifying working memory performance in younger adults.

Brain iron affects working memory (WM) but the impact of iron content in deep grey matter nuclei on WM networks is unknown. We aimed to test whether deep grey matter nuclei iron concentration can affect resting-state functional connectivity (rsFC) within brain networks modifying WM performance. An N-back WM paradigm was applied in a hundred healthy younger adults. The participants then underwent a resting-state functional magnetic resonance imaging (fMRI) for brain network analysis and quantitative susceptibility mapping (QSM) imaging for assessment of deep grey matter nuclei iron concentration. Higher substantia nigra (SN) iron concentration was associated with lower rsFC between SN and brain regions of the temporal/frontal lobe but with better WM performance after controlling for age, gender and education. A follow-up mediation analysis also indicated that functional connectivity may mediate the link between SN iron and WM performance. Our results suggest that high SN iron concentration may affect communication between the SN and temporal/frontal lobe and is associated with strengthened WM performance in younger adults.

No evidence for changes in GABA concentration, functional connectivity, or working memory following continuous theta burst stimulation over dorsolateral prefrontal cortex

Continuous theta burst stimulation (cTBS) is thought to reduce cortical excitability and modulate functional connectivity, possibly by altering cortical inhibition at the site of stimulation. However, most evidence comes from the motor cortex and it remains unclear whether similar effects occur following stimulation over other brain regions. We assessed whether cTBS over left dorsolateral prefrontal cortex altered gamma aminobutyric acid (GABA) concentration, functional connectivity and brain dynamics at rest, and brain activation and memory performance during a working memory task. Seventeen healthy individuals participated in a randomised, sham-controlled, cross-over experiment. Before and after either real or sham cTBS, magnetic resonance spectroscopy was obtained at rest to measure GABA concentrations. Functional magnetic resonance imaging (fMRI) was also recorded at rest and during an n-back working memory task to measure functional connectivity, regional brain activity (low-frequency fluctuations), and task-related patterns of brain activity. We could not find evidence for changes in GABA concentration (P = 0.66, Bayes factor [BF10] = 0.07), resting-state functional connectivity (P(FWE) > 0.05), resting-state low-frequency fluctuations (P = 0.88, BF10 = 0.04), blood-oxygen level dependent activity during the n-back task (P(FWE) > 0.05), or working memory performance (P = 0.13, BF10 = 0.05) following real or sham cTBS. Our findings add to a growing body of literature suggesting the effects of cTBS are highly variable between individuals and question the notion that cTBS is a universal ‘inhibitory’ paradigm.

Effect of mGluR2 positive allosteric modulation on frontostriatal working memory activation in schizophrenia.

Negative symptoms and cognitive deficits contribute strongly to disability in schizophrenia, and are resistant to existing medications. Recent drug development has targeted enhanced NMDA function by increasing mGluR2/3 signaling. However, the clinical utility of such agents remains uncertain, and markers of brain circuit function are critical for clarifying mechanisms and understanding individual differences in efficacy. We conducted a double-blind, placebo-controlled, randomized cross-over (14 day washout) pilot study evaluating adjunctive use of the mGluR2 positive allosteric modulator AZD8529 (80mg daily for 3 days), in chronic stable patients with schizophrenia (n=26 analyzed). We focused on 3T fMRI response in frontostriatal regions during an n-back working memory task, testing the hypothesis that AZD8529 produces fMRI changes that correlate with improvement in negative symptoms and cognition. We found that AZD8529 did not produce significant group-average effects on symptoms or cognitive accuracy. However, AZD8529 did increase n-back fMRI activation in striatum (p<0.0001) and anterior cingulate/paracingulate (p=0.002). Greater drug-versus-placebo effects on caudate activation significantly correlated with greater reductions in PANSS negative symptom scores (r=−0.42, p=0.031), and exploratory correlations suggested broader effects across multiple symptom domains and regions of interest. These findings demonstrate that fMRI responses to mGluR2 positive modulation relate to individual differences in symptom reduction, and could be pursued for future biomarker development. Negative clinical results at the group level should not lead to premature termination of investigation of this mechanism which may benefit an important subset of individuals with schizophrenia. Imaging biomarkers may reveal therapeutic mechanisms, and help guide treatment towards specific populations.

The role of neural load effects in predicting individual differences in working memory function

Studies of working memory (WM) function have tended to adopt either a within-subject approach, focusing on effects of load manipulations, or a between-subjects approach, focusing on individual differences. This dichotomy extends to WM neuroimaging studies, with different neural correlates being identified for within- and between-subjects variation in WM. Here, we examined this issue in a systematic fashion, leveraging the large-sample Human Connectome Project dataset, to conduct a well-powered, whole-brain analysis of the N-back WM task. We first demonstrate the advantages of parcellation schemes for dimension reduction, in terms of load-related effect sizes. This parcel-based approach is then utilized to directly compare the relationship between load-related (within-subject) and behavioral individual differences (between-subject) effects through both correlational and predictive analyses. The results suggest a strong linkage of within-subject and between-subject variation, with larger load-effects linked to stronger brain-behavior correlations. In frontoparietal cortex no hemispheric biases were found towards one type of variation, but the Dorsal Attention Network did exhibit greater sensitivity to between over within-subjects variation, whereas in the Somatomotor network, the reverse pattern was observed.Cross-validated predictive modeling capitalizing on this tight relationship between the two effects indicated greater predictive power for load-activated than load-deactivated parcels, while also demonstrating that load-related effect size can serve as an effective guide to feature (i.e., parcel) selection, in maximizing predictive power while maintaining interpretability. Together, the findings demonstrate an important consistency across within- and between-subjects approaches to identifying the neural substrates of WM, which can be effectively harnessed to develop more powerful predictive models.

Modulation of brain states on fractal and oscillatory power of EEG in brain–computer interfaces

Objective. Electroencephalogram (EEG) is an objective reflection of the brain activities, which provides potential possibilities for brain state estimation based on EEG characteristics. However, how to mine the effective EEG characteristics is still a distressing problem in brain state monitoring. Approach. The phase-scrambled method was used to generate images with different noise levels. Images were encoded into a rapid serial visual presentation paradigm. N-back working memory method was employed to induce and assess fatigue state. The irregular-resampling auto-spectral analysis method was adopted to extract and parameterize (exponent and offset) the characteristics of EEG fractal components, which were analyzed in the four dimensions: fatigue, sustained attention, visual noise and experimental tasks. Main results. The degree of fatigue and visual noise level had positive effects on exponent and offset in the prefrontal lobe, and the ability of sustained attention negatively affected exponent and offset. Compared with visual stimuli task, rest task induced even larger values of exponent and offset and statistically significant in the most cerebral cortex. In addition, the steady-state visual evoked potential amplitudes were negatively and positively affected by the degree of fatigue and noise levels, respectively. Significance. The conclusions of this study provide insights into the relationship between brain states and EEG characteristics. In addition, this study has the potential to provide objective methods for brain states monitoring and EEG modeling.

Serial dependency bias as memory averaging

It has been established that perceptual reports are influenced by previously reported percepts, a phenomenon described as 'serial dependency in perception'. For example, the reported orientation of a line grating is attracted towards the orientation reported in the previous trial. This process presumably promotes perceptual stability in a noisy and dynamic visual world by integrating visual information sampled from the same object at different points in time. Despite a recent surge in studies illustrating serial dependency effects, it remains unclear whether these biases arise during perception (i.e., stimulus encoding), or within memory (i.e., stimulus maintenance). To distinguish between these possibilities, we sequentially presented four oriented gratings in an n-back working memory task. Participants were retro-actively cued which of the four orientations they should reproduce. In addition to the classic serial dependency effect, our data showed that reports were also biased by subsequently presented orientations. When, for example, the second item in the sequence was the target, its reported orientation was not only influenced by the first item but also by the third and fourth items. This finding excludes the possibility that serial dependency biases arise solely during encoding, since reported stimuli were already stored in memory at the time subsequent, influencing stimuli were presented. Based on data from three studies we propose a new model of serial bias in vision, describing the behavioral report of a perceived target as the result of an attentionally modulated, weighted average between the actual target, task-relevant information preceding and succeeding the target, as well as previous behavioral reports. Supplementary materials such as pre-prints, data, stimulus, and analysis scripts can be found at https://osf.io/54abr/?view_only=2f67d292ed9e4ed6bc731da09b624069

A simple permutation-based test of intermodal correspondence.

Many key findings in neuroimaging studies involve similarities between brain maps, but statistical methods used to measure these findings have varied. Current state‐of‐the‐art methods involve comparing observed group‐level brain maps (after averaging intensities at each image location across multiple subjects) against spatial null models of these group‐level maps. However, these methods typically make strong and potentially unrealistic statistical assumptions, such as covariance stationarity. To address these issues, in this article we propose using subject‐level data and a classical permutation testing framework to test and assess similarities between brain maps. Our method is comparable to traditional permutation tests in that it involves randomly permuting subjects to generate a null distribution of intermodal correspondence statistics, which we compare to an observed statistic to estimate a p‐value. We apply and compare our method in simulated and real neuroimaging data from the Philadelphia Neurodevelopmental Cohort. We show that our method performs well for detecting relationships between modalities known to be strongly related (cortical thickness and sulcal depth), and it is conservative when an association would not be expected (cortical thickness and activation on the n‐back working memory task). Notably, our method is the most flexible and reliable for localizing intermodal relationships within subregions of the brain and allows for generalizable statistical inference.

Affective episodes in recently diagnosed patients with bipolar disorder associated with altered working memory-related prefrontal cortex activity: A longitudinal fMRI study

IntroductionBipolar disorder (BD) is often accompanied by trait-related cognitive impairments, but it is unclear which neurocircuitry abnormalities give rise to these impairments and whether neurocircuitry differences are exacerbated with illness progression. This longitudinal fMRI study of recently diagnosed BD patients investigates whether aberrant working memory (WM) related activity in the cognitive control network is accentuated by new affective episodes. MethodsForty-seven recently diagnosed BD patients in full or partial remission and 38 healthy controls were assessed with neurocognitive tests and fMRI during the performance of a verbal n-back WM task at baseline and follow-up (15.4 months in average). ResultsPatients showed WM-related hypo-activity in dorsal prefrontal cortex (dPFC) and impaired cognitive function within attention and psychomotor speed, WM and executive function, and verbal learning and memory compared to controls at baseline. During the follow-up period, 26 patients experienced at least one affective episode (BD+), while 21 remained in remission (BD-). There was no deterioration in cognitive performance in BD+ compared to BD- patients. Nevertheless, BD+ displayed increased WM-related dPFC activity at follow-up compared with BD- patients. This change in dPFC response was independent of mood symptoms and medication. LimitationsThe study did not account for type or frequency of affective episodes. ConclusionThe study identifies cognitive impairment and WM-related hypo-activity in dPFC early during the course of BD. Increased high-load WM related dPFC activity over the follow-up period in BD+ versus BD- patients in the absence of changes in cognitive performance may reflect an episode-related reduction in PFC efficiency.