Scene-encoding Task Research Articles

Brain activation during scene encoding fMRI in the Alzheimer’s disease continuum: Association with amyloid and tau burden in PE

Background and Hypothesis:This project assessed brain activation during a scene encoding task in 4 groups: older adults who were cognitively normal (CN), subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia due to Alzheimer’s disease (AD). Associations between scene encoding related brain activation and tau, amyloid, and other biomarkers were analyzed. Our hypothesis was that higher levels of cerebral tau and amyloid would be associated with reduced scene encoding activation. In addition, we hypothesized that scene encoding activation would be significantly different between cognitively normal and cognitively impaired groups.
 Methods:234 individuals from the Indiana Memory and Aging Study (79 CN, 67 SCD, 70 MCI, and 18 AD) completed structural and functional MRI, clinical/cognitive assessment and biomarkers; 155 underwent amyloid ([18F]florbetapir/[18F]florbetaben) PET, while 111 also underwent [18F]flortaucipir PET. For the fMRI scene encoding task, participants were asked to view and remember a set of images. A one-way ANOVA test was used to analyze scene encoding related activation differences among the 4 groups. Regression was used to identify associations between scene encoding activation and tau and amyloid deposition.
 Results:Significant differences in activation were observed between the MCI and CN groups, including less activation in widespread regions during the task and reduced deactivation in the default mode network (DMN) in MCI participants relative to CN. Significant associations between higher amyloid and tau deposition and altered scene encoding activation were also observed.
 Conclusion and Potential Impact:Cognitive decline is associated with activation changes during scene encoding, as well as reduced deactivation in the DMN, especially in the posterior cingulate region. Higher cerebral amyloid and tau deposition predicted decreased scene encoding related activation. These findings are consistent with models linking cognitive status, functional brain activation during episodic encoding, and pathophysiological processes in the AD continuum.

Hippocampal Functional Dynamics Are Clinically Implicated in Autoimmune Encephalitis With Faciobrachial Dystonic Seizures.

This is the first study to investigate functional brain activity in patients affected by autoimmune encephalitis with faciobrancial dystonic seizures (FBDS). Multimodal 3T MRI scans, including structural neuroimaging (T1-weighted, diffusion weighted) and functional neuroimaging (scene-encoding task known to activate hippocampal regions), were performed. This case series analysis included eight patients treated for autoimmune encephalitis with FBDS, scanned during the convalescent phase of their condition (median 1.1 years post-onset), and eight healthy volunteers. Compared to controls, 50% of patients showed abnormal hippocampal activity during scene-encoding relative to familiar scene-viewing. Higher peak FBDS frequency was significantly related to lower hippocampal activity during scene-encoding (p = 0.02), though not to markers of hippocampal microstructure (mean diffusivity, p = 0.3) or atrophy (normalized volume, p = 0.4). During scene-encoding, stronger within-medial temporal lobe (MTL) functional connectivity correlated with poorer Addenbrooke's Cognitive Examination-Revised memory score (p = 0.03). These findings suggest that in autoimmune encephalitis, frequent seizures may have a long-term impact on hippocampal activity, beyond that of structural damage. These observations also suggest a potential approach to determine on-going MTL performance in this condition to guide long-term management and future clinical trials.

Task activation and functional connectivity show concordant memory laterality in temporal lobe epilepsy

ObjectiveIn epilepsy, asymmetries in the organization of mesial temporal lobe (MTL) functions help determine the cognitive risk associated with procedures such as anterior temporal lobectomy. Past studies have investigated the change/shift in a visual episodic memory laterality index (LI) in mesial temporal lobe structures through functional magnetic resonance imaging (fMRI) task activations. Here, we examine whether underlying task-related functional connectivity (FC) is concordant with such standard fMRI laterality measures. MethodsA total of 56 patients with temporal lobe epilepsy (TLE) (Left TLE [LTLE]: 31; Right TLE [RTLE]: 25) and 34 matched healthy controls (HC) underwent fMRI scanning during performance of a scene encoding task (SET). We assessed an activation-based LI of the hippocampal gyrus (HG) and parahippocampal gyrus (PHG) during the SET and its correspondence with task-related FC measures. ResultsAnalyses involving the HG and PHG showed that the patients with LTLE had a consistently higher LI (right-lateralized) than that of the HC and group with RTLE, indicating functional reorganization. The patients with RTLE did not display a reliable contralateral shift away from the pathology, with the mesial structures showing quite distinct laterality patterns (HG, no laterality bias; PHG, no evidence of LI shift). The FC data for the group with LTLE provided confirmation of reorganization effects, revealing that a rightward task LI may be based on underlying connections between several left-sided regions (middle/superior occipital and left medial frontal gyri) and the right PHG. The FCs between the right HG and left anterior cingulate/medial frontal gyri were also observed in LTLE. Importantly, the data demonstrate that the areas involved in the LTLE task activation shift to the right hemisphere showed a corresponding increase in task-related FCs between the hemispheres. SignificanceAltered laterality patterns based on mesial temporal lobe epilepsy (MTLE) pathology manifest as several different phenotypes, varying according to side of seizure onset and the specific mesial structures involved. There is good correspondence between task LI activation and FC patterns in the setting of LTLE, suggesting that reliable visual episodic memory reorganization may require both a shift in nodal activation and a change in nodal connectivity with mesial temporal structures involved in memory.

ID 315 – Altered default mode network connectivity during visual processing in patients with mild cognitive impairment (an fMRI study)

Introduction The object of our study was to detect specific alterations in default mode network (DMN) connectivity when switching from baseline to task condition in 17 patients with mild cognitive impairment (MCI) as compared to 18 healthy controls (HC) and 15 patients with Alzheimer disease (AD) using psychophysiological interactions (PPI) analysis. Methods The fMRI protocol (a complex visual scene-encoding task) was performed using a 1.5 T scanner. PPI analysis was used to assess the effect of the visual task on connectivity with the posterior cingulate/precunes (PCC/P, i.e. the posterior DMN node). Age, gender, education and a measure of atrophy were used as covariates. Results Comparing HC and MCI resulted in a significant difference in the PPI effect in the right superior temporal gyrus (STG) and this difference became stronger in AD. In addition, MCI subjects as compared to AD group showed significant differences in bilateral precuneus. Conclusion and key message We have found specific disturbances in connectivity between the DMN and the ventral visual pathway in MCI patients during the visual processing. These changes were more pronounced in AD patients. Our results indicate the role of the right STG in this pathophysiological mechanism.

Concordance rate between Wada and fMRI tests for visual memory assessment of patients with medically intractable temporal lobe epilepsy

Background: There is not enough evidence to prove either invasive Wada or non-invasive fMRI test predicts postoperative memory changes more accurately in patients with refractory temporal lobe epilepsy (TLE). In this study, concordance between fMRI and Wada test for postoperative assessment of visual memory is investigated. Methods: fMRI test with a novel scene-encoding task were conducted on our cohort of patients. fMRI laterality indices (LI) were then defined as a ratio (L-R)/(L+R) between the number of activated voxels in the left and right of two regions: hippocampus+parahippocampus (Region A) and temporal lobe - (hippocampus+parahippocampus) (Region B). fMRI results were divided into the right (LI < -0.2), left (LI > 0.2) or bilateral (-0.2 < LI <0.2) hemispheric memory dominance and compared to the results of the Wada test. Results: 19 patients were studied (14 left TLE, 3 right TLE and 2 bilateral TLE). The concordance rate between Wada and fMRI tests was 36.8% and 42.1% for regions A and B. Conclusions: Based on the results, the concordance rate between the Wada test and the fMRI test is not high. As a future work, we will investigate the correlation of each test to postoperative memory outcome.

The effect of medial temporal lobe epilepsy on visual memory encoding

Effective visual memory encoding, a function important for everyday functioning, relies on episodic and semantic memory processes. In patients with medial temporal lobe epilepsy (MTLE), memory deficits are common as the structures typically involved in seizure generation are also involved in acquisition, maintenance, and retrieval of episodic memories. In this study, we used group independent component analysis (GICA) combined with Granger causality analysis to investigate the neuronal networks involved in visual memory encoding during a complex fMRI scene-encoding task in patients with left MTLE (LMTLE; N=28) and in patients with right MTLE (RMTLE; N=18). Additionally, we built models of memory encoding in LMTLE and RMTLE and compared them with a model of healthy memory encoding (Nenert et al., 2014). For those with LMTLE, we identified and retained for further analyses and model generation 7 ICA task-related components that were attributed to four different networks: the frontal and posterior components of the DMN, visual network, auditory-insular network, and an “other” network. For those with RMTLE, ICA produced 9 task-related components that were attributed to the somatosensory and cerebellar networks in addition to the same networks as in patients with LMTLE. Granger causality analysis revealed group differences in causality relations within the visual memory network and MTLE-related deviations from normal network function. Our results demonstrate differences in the networks for visual memory encoding between those with LMTLE and those with RMTLE. Consistent with previous studies, the organization of memory encoding is dependent on laterality of seizure focus and may be mediated by functional reorganization in chronic epilepsy. These differences may underlie the observed differences in memory abilities between patients with LMTLE and patients with RMTLE and highlight the modulating effects of epilepsy on the network for memory encoding.

19. Default mode network and extrastriate visual resting state network in patients with Parkinson’s disease dementia

Aims: Using fMRI, we evaluated the default mode network (DMN) and the extrastriate visual resting state network (ESV-RSN) in 14 patients with Parkinson's disease dementia (PDD) as compared with 18 patients with Parkinson's disease (PD) without dementia and 18 healthy controls (HC). Methods: We analyzed the seed-based functional connectivity of both resting state data and deactivations during a visual complex scene-encoding task. Results: Using the posterior cingulate cortex/precuneus as a seed for the DMN analysis, we observed significant decreases of connectivity in the right inferior frontal gyrus in PDD as compared to PD and HC. Using the caudate nucleus as a seed for the ESV-RSN analysis, we found significant decreases of connectivity in the left and right inferior occipital gyrus in PDD as compared to HC. Conclusion: Differences in functional connectivity patterns between PDD and PD/HC were observed in areas known to be engaged in stimulus-driven reorienting of attention and in visual processing. Copyright (C) 2012 S. Karger AG, Basel

Default Mode Network and Extrastriate Visual Resting State Network in Patients with Parkinson’s Disease Dementia

Aims: Using fMRI, we evaluated the default mode network (DMN) and the extrastriate visual resting state network (ESV-RSN) in 14 patients with Parkinson’s disease dementia (PDD) as compared with 18 patients with Parkinson’s disease (PD) without dementia and 18 healthy controls (HC). Methods: We analyzed the seed-based functional connectivity of both resting state data and deactivations during a visual complex scene-encoding task. Results: Using the posterior cingulate cortex/precuneus as a seed for the DMN analysis, we observed significant decreases of connectivity in the right inferior frontal gyrus in PDD as compared to PD and HC. Using the caudate nucleus as a seed for the ESV-RSN analysis, we found significant decreases of connectivity in the left and right inferior occipital gyrus in PDD as compared to HC. Conclusion: Differences in functional connectivity patterns between PDD and PD/HC were observed in areas known to be engaged in stimulus-driven reorienting of attention and in visual processing.

The default mode network integrity in patients with Parkinson’s disease is levodopa equivalent dose-dependent

Disturbances in the default mode network (DMN) have been described in many neurological and psychiatric disorders including Parkinson's disease (PD). The DMN is characterized by basal activity that increases during rest or passive visual fixation and decreases ("deactivates") during cognitive tasks. The network is believed to be involved in cognitive processes. We examined the DMN in PD patients on dopaminergic medication with normal cognitive performance compared to age- and gender-matched healthy controls (HC) using fMRI and three methodological procedures: independent component analysis of resting-state data, analysis of deactivation during a complex visual scene-encoding task, and seed-based functional connectivity analysis. In the PD group, we also studied the effect of dopaminergic medication on the DMN integrity. We did not find any difference between the PD and HC groups in the DMN, but using the daily levodopa equivalent dose as a covariate, we observed an enhanced functional connectivity of the DMN in the posterior cingulate cortex and decreased activation in the left parahippocampal gyrus during the cognitive task. We conclude that dopaminergic therapy has a specific effect on both the DMN integrity and task-related brain activations in cognitively unimpaired PD patients, and these effects seem to be dose-dependent.

Default mode network in patients with parkinson?s disease dementia: an fMRI study

Event Abstract Back to Event Default mode network in patients with parkinson’s disease dementia: an fMRI study Lenka Krajcovicova1*, Michal Mikl1, Radek Marecek1 and Irena Rektorova1 1 First Department of Neurology, St Anne’s Hospital, Czechia We evaluated the default mode network (DMN) and the resting state network involved in visual processing (V-RSN) in 14 patients with Parkinson’s disease dementia (PDD) as compared to 18 patients with Parkinson’s disease (PD) without dementia and 18 healthy controls (HC). For the data processing we used independent component analysis (ICA) of resting state data and fMRI bold signal decreases (deactivations) during the visual complex scene-encoding task. The seed-based functional connectivity (FC) using both ICA and deactivations was then assessed with a seed located in the left posterior cingulate cortex/precuneus (PCC/P) and in the right caudate nucleus (CN). Typical areas involved in the DMN were identified in all three groups. Using the PCC/C as a seed for the FC analysis of deactivations, we observed significant decreases of connectivity in the right inferior frontal gyrus and the left posterior superior temporal sulcus in PDD as compared to PD (p < .05; FWE corrected; cluster level inference). The strength of FC in both areas was positively correlated with overall cognitive performance. The FC analysis of our resting state data with a seed in the CN was significantly decreased in the left inferior occipital gyrus in PDD as compared to HC (p < .05; FWE corrected; cluster level inference). The magnitude of FC in this region was positively correlated with performance of a memory recognition task. Changes in connectivity occurred in areas outside of the DMN that had been described as parts of task-positive networks engaged in reorienting of attention and multisensory integration. In PDD as compared to PD/ HC we further demonstrated disturbances of the resting-state network involved in visual processing. Funding: The study was supported by the MSM 0021622404 research grant. Keywords: Dementia, Neuropsychiatry Conference: XI International Conference on Cognitive Neuroscience (ICON XI), Palma, Mallorca, Spain, 25 Sep - 29 Sep, 2011. Presentation Type: Poster Presentation Topic: Poster Sessions: Neuropsychiatric Applications Citation: Krajcovicova L, Mikl M, Marecek R and Rektorova I (2011). Default mode network in patients with parkinson’s disease dementia: an fMRI study. Conference Abstract: XI International Conference on Cognitive Neuroscience (ICON XI). doi: 10.3389/conf.fnhum.2011.207.00110 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 16 Nov 2011; Published Online: 25 Nov 2011. * Correspondence: Dr. Lenka Krajcovicova, First Department of Neurology, St Anne’s Hospital, Brno, Czechia, krajcovicova@fnusa.cz Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Lenka Krajcovicova Michal Mikl Radek Marecek Irena Rektorova Google Lenka Krajcovicova Michal Mikl Radek Marecek Irena Rektorova Google Scholar Lenka Krajcovicova Michal Mikl Radek Marecek Irena Rektorova PubMed Lenka Krajcovicova Michal Mikl Radek Marecek Irena Rektorova Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

A comparison of two fMRI methods for predicting verbal memory decline after left temporal lobectomy: Language lateralization versus hippocampal activation asymmetry

Language lateralization measured by preoperative functional magnetic resonance imaging (fMRI) was shown recently to be predictive of verbal memory outcome in patients undergoing left anterior temporal lobe (L-ATL) resection. The aim of this study was to determine whether language lateralization or functional lateralization in the hippocampus is a better predictor of outcome in this setting. Thirty L-ATL patients underwent preoperative language fMRI, preoperative hippocampal fMRI using a scene encoding task, and pre- and postoperative neuropsychological testing. A group of 37 right ATL (R-ATL) surgery patients was included for comparison. Verbal memory decline occurred in roughly half of the L-ATL patients. Preoperative language lateralization was correlated with postoperative verbal memory change. Hippocampal activation asymmetry was strongly related to side of seizure focus and to Wada memory asymmetry but was unrelated to verbal memory outcome. Preoperative hippocampal activation asymmetry elicited by a scene encoding task is not predictive of verbal memory outcome. Risk of verbal memory decline is likely to be related to lateralization of material-specific verbal memory networks, which are more closely correlated with language lateralization than with overall asymmetry of episodic memory processes.

Hippocampal volumetry and functional MRI of memory in temporal lobe epilepsy

This study examined the utility of structural and functional MRI at 1.5 and 3 T in the presurgical evaluation and prediction of postsurgical cognitive outcome in temporal lobe epilepsy (TLE). Forty-nine patients undergoing presurgical evaluation for temporal lobe (TL) resection and 25 control subjects were studied. Patients completed standard presurgical evaluations, including the intracarotid amobarbital test (IAT) and neuropsychological testing. During functional imaging, subjects performed a complex visual scene-encoding task. High-resolution structural MRI scans were used to quantify hippocampal volumes. Both structural and functional imaging successfully lateralized the seizure focus and correlated with IAT memory lateralization, with improvement for functional imaging at 3 T as compared with 1.5 T. Ipsilateral structural and functional MRI data were related to cognitive outcome, and greater functional asymmetry was related to earlier age at onset. These findings support continued investigation of the utility of MRI and fMRI in the presurgical evaluation of TLE.

Pre- and postoperative fMRI and clinical memory performance in temporal lobe epilepsy

Objective:The present study aimed to examine and compare memory processing in patients with unilateral temporal lobe epilepsy (TLE) before and after surgery using functional magnetic resonance imaging (fMRI).Methods:Seventeen preoperative patients...

Function lateralization via measuring coherence laterality

A data-driven approach for lateralization of brain function based on the spatial coherence difference of functional MRI (fMRI) data in homologous regions-of-interest (ROI) in each hemisphere is proposed. The utility of using coherence laterality (CL) to determine function laterality was assessed first by examining motor laterality using normal subjects' data acquired both at rest and with a simple unilateral motor task and subsequently by examining mesial temporal lobe memory laterality in normal subjects and patients with temporal lobe epilepsy. The motor task was used to demonstrate that CL within motor ROI correctly lateralized functional stimulation. In patients with unilateral epilepsy studied during a scene-encoding task, CL in a hippocampus–parahippocampus–fusiform (HPF) ROI was concordant with lateralization based on task activation, and the CL index (CLI) significantly differentiated the right side group to the left side group. By contrast, normal controls showed a symmetric HPF CLI distribution. Additionally, similar memory laterality prediction results were still observed using CL in epilepsy patients with unilateral seizures after the memory encoding effect was removed from the data, suggesting the potential for lateralization of pathological brain function based on resting fMRI data. A better lateralization was further achieved via a combination of the proposed approach and the standard activation based approach, demonstrating that assessment of spatial coherence changes provides a complementary approach to quantifying task-correlated activity for lateralizing brain function.

Effects of Illness Duration on Memory Processing of Patients with Temporal Lobe Epilepsy

To examine the effects of illness duration on the neural processing of memory in patients with temporal lobe epilepsy (TLE) by using functional MRI. Twenty-three TLE patients (16 left, seven right) performed a complex visual scene-encoding task during functional MRI. Region-of-interest (ROI) analyses were used to quantity functional activation in the mesial temporal and frontal lobes. The patients' verbal and visual memory performances were evaluated by standardized neuropsychological tests. Analyses included group comparison and correlations of duration of epilepsy with functional activation and memory performance. Compared with normal controls, TLE patients demonstrated reduced activation bilaterally in the mesial temporal lobe (p=0.003), and the reduction was more pronounced on the ipsilateral side of the seizure focus. Moreover, a longer duration of illness was associated with fewer voxels activated in both the left (p=0.038) and right (p=0.017) mesial temporal lobe. Furthermore, the duration of illness was found to be significantly and negatively correlated with both verbal (p=0.020) and visual (p=0.000) memory functioning. TLE seems to affect the memory processes in the mesial temporal lobes progressively (i.e., the longer the duration of illness, the lower the brain activation). In turn, the reduction of brain activation negatively affects memory functioning. Finally, the reduction is not limited to the side of seizure but also is observed in the contralateral hemisphere.

The intersubject and intrasubject reproducibility of FMRI activation during three encoding tasks: implications for clinical applications

The goal of the present study was to evaluate the inter- and intrasubject reproducibility of FMRI activation for three memory encoding tasks previously used in the context of presurgical functional mapping. The primary region of interest (ROI) was the medial temporal lobe (MTL). Comparative ROIs included the inferior frontal and fusiform gyri which are less affected by susceptibility-induced signal losses than the MTL regions. Eighteen subjects were scanned using three memory encoding paradigms: word-pair, pattern, and scene encoding. Nine subjects underwent repeat scanning. Intersubject reproducibility of FMRI activation was evaluated by examining the percent of subjects who showed activation within a given ROI and the range to which individual laterality indices (LIs) varied from the mean. Intrasubject test-retest reproducibility was evaluated by examining the LI test-retest correlation, the average difference between LIs from two separate imaging sessions, and concordance ratios of activation volumes (R(volume) and R(overlap)). For scene encoding the reproducibility of activation volume and LIs within the MTL were as good as or better than the reproducibility within the fusiform and inferior frontal ROIs. For pattern encoding and word-pair encoding, the reproducibility of activation volume and LIs within the MTL tended to be worse compared to the fusiform and inferior frontal ROIs. The differences in FMRI reproducibility appeared more dependent on the task than the susceptibility effects. The results of this study suggest that FMRI-based assessment of the neural substrates of memory using a scene encoding task may be a useful clinical tool.

How Close is fMRI to Providing the Memory Component of the Wada Test?

Functional MRI Predicts Postsurgical Memory following Temporal Lobectomy Rabin ML, Narayan VM, Kimberg DY, Casasanto DJ, Glosser G, Tracy JI, French JA, Sperling MR, Detre JA Brain 2004;127:2286–2298 Temporal lobectomy is an effective therapy for medically refractory temporal lobe epilepsy (TLE), but may be complicated by amnestic syndromes. Therefore, presurgical evaluation to assess the risk/benefit ratio for surgery is required. Intracarotid amobarbital testing (IAT) is currently the most widely used method for assessing presurgical memory lateralization but is relatively invasive. Over the past decade, functional MRI (fMRI) has been shown to correlate with IAT for language lateralization and for memory lateralization in a small number of patients. This study was carried out to compare fMRI during memory encoding with IAT testing for memory lateralization and to assess the predictive value of fMRI during memory encoding for postsurgical memory outcome. Thirty-five patients with refractory TLE undergoing presurgical evaluation for temporal lobectomy and 30 normal subjects performed a complex visual scene-encoding task during fMRI scanning at 1.5 T by using a 10-min protocol. Encoding performance was evaluated with subsequent recognition testing. Twenty-three patients also completed the same task again outside the scanner, an average of 6.9 months after surgery. A region of interest (ROI) analysis was used to quantify activation within hippocampal and a larger mesial temporal lobe ROI consisting of hippocampus, parahippocampus, and fusiform gyrus (HPF), as defined by a published template. Normal subjects showed almost symmetrical activation within these ROIs. TLE patients showed greater asymmetry. Asymmetry ratios (ARs) from the HPF ROI correlated significantly with memory lateralization by IAT. HPF ARs also correlated significantly with memory outcome, as determined by a change in scene recognition between presurgical and postsurgical trials. When absolute activation within the HPF ROI was considered, a significant inverse correlation between activation ipsilateral to temporal lobectomy and memory outcome was observed, with no significant correlation in the contralateral HPF ROI. Although further technical improvements and prospective clinical validation are required, these results suggest that mesial temporal memory activation detected by fMRI during complex visual scene encoding correlates with postsurgical memory outcome and supports the notion that this approach will ultimately contribute to patient management. Pre-operative Verbal Memory fMRI Predicts Post-operative Memory Decline after Left Temporal Lobe Resection Richardson MP, Strange BA, Thompson PJ, Baxendale SA, Duncan JS, Dolan RJ Brain 2004;127:2419–2426 Functional MRI (fMRI) of cognitive tasks depends on technology widely available in the clinical sphere but has yet to show a role in the investigation of patients. We report here the first demonstration of a clinically valuable role for cognitive fMRI. Temporal lobe epilepsy (TLE) is commonly caused by hippocampal sclerosis and is frequently resistant to drug treatment. Surgical resection of the left hippocampus in this setting can cure seizures but may produce significant verbal memory decline, which is hard to predict. We report 10 right-handed TLE patients with left hippocampal sclerosis who underwent left hippocampal resection. We compared currently used data for the prediction of postoperative verbal memory decline in such patients with a novel fMRI assessment of verbal memory encoding. Multiple regression analyses showed that fMRI provided the strongest independent predictor of memory outcome after surgery. At the individual subject level, the fMRI data had high positive predictive value for memory decline.

Functional Inferences Vary with the Method of Analysis in fMRI

Neuroanatomic substrates of specific cognitive functions have been inferred from anatomic distributions of activated pixels during fMRI studies. With declarative memory tasks, interest has focused on the extent to which various medial temporal lobe anatomic structures are activated while subjects encode new information. The aim of this project was to examine how commonly used variations in fMRI data processing methods affect the distribution of activation in anatomically defined medial temporal lobe regions of interest (ROIs) during a complex scene-encoding task. ROIs were drawn on an MRI anatomic template formed from 3D SPGR scans of eight subjects combined in Talairach space. Separate ROIs were drawn for the posterior and anterior hippocampal formation, parahippocampal gyrus, and entorhinal cortex. Twelve different activation maps were created for each subject by using four correlation coefficients and three cluster volumes. Friedman's two-way ANOVA by ranks was used to test the hypothesis that the distribution of activated pixels among defined anatomic ROIs varied as a function of the data processing method. By simply varying the combination of correlation coefficient and cluster volume, significantly different distributions of activation within named medial temporal lobe structures were obtained from the same fMRI datasets (P < 0.015; P < 0.001). The number of subjects studied (n = 8) is in a range commonly found in the literature yet this clearly resulted in spurious associations between processing parameter variations and activation distribution. Using data processing methods that are independent of the arbitrary selection of cutoff values for thresholding activation maps may reduce the likelihood of obtaining spurious results.