Real-space navigation testing differentiates between amyloid-positive and -negative aMCI.

OBJECTIVE: To distinguish between patients with amyloid-positive (A+) and -negative (A-) amnestic mild cognitive impairment (aMCI) by simultaneously investigating navigation performance, visual exploration behavior, and brain activations during a real-space navigation paradigm. METHODS: Twenty-one patients with aMCI were grouped into A+ (n = 11) and A- cases by amyloid-PET imaging and amyloid CSF levels and compared to 15 healthy controls. Neuropsychological deficits were quantified by use of the Consortium to Establish a Registry for Alzheimer's Disease-plus cognitive battery. All participants performed a navigation task in which they had to find items in a realistic spatial environment and had to apply egocentric and allocentric route planning strategies. 18F-fluorodeoxyglucose was injected at the start to detect navigation-induced brain activations. Subjects wore a gaze-controlled, head-fixed camera that recorded their visual exploration behavior. RESULTS: A+ patients performed worse during egocentric and allocentric navigation compared to A- patients and controls (p < 0.001). Both aMCI subgroups used fewer shortcuts, moved more slowly, and stayed longer at crossings. Word-list learning, figural learning, and Trail-Making tests did not differ in the A+ and A- subgroups. A+ patients showed a reduced activation of the right hippocampus, retrosplenial, and parietal cortex during navigation compared to A- patients (p < 0.005). CONCLUSIONS: A+ patients with aMCI perform worse than A- patients with aMCI in egocentric and allocentric route planning because of a more widespread impairment of their cerebral navigation network. Navigation testing in real space is a promising approach to identify patients with aMCI with underlying Alzheimer pathology.

Prolonged allocentric navigation deficits indicate hippocampal damage in TGA.

OBJECTIVE: To investigate long-term recovery of allocentric and egocentric spatial orientation as a sensitive marker for hippocampal and extrahippocampal network function in transient global amnesia (TGA). METHODS: A group of 18 patients with TGA performed an established real-space navigation paradigm, requiring allo- and egocentric spatial orientation abilities, 3 days (postacute stage) and 3 months (follow-up) after symptom onset. Visual exploration behavior and navigation strategy were documented by a gaze-controlled, head-fixed camera. Allo- and egocentric spatial orientation performance was compared to that of 12 age-matched healthy controls. Navigation-induced brain activations were measured using [18F]-fluorodeoxyglucose-PET in a subgroup of 8 patients in the postacute stage and compared to those of the controls. RESULTS: In the postacute stage, the patients navigated worse and had higher error rates than controls in allocentric (p = 0.002), but not in egocentric, route planning (p = 0.30), despite complete recovery of verbal (p = 0.58) and figural memory (p = 0.11). Until follow-up, allocentric navigation deficits improved, but higher error rates and reduced use of shortcuts persisted (p < 0.0001). Patients still exhibited relatively more fixations of unique landmarks during follow-up (p = 0.05). PET measurements during the postacute stage showed increased navigation-induced brain activations in the right hippocampus, bilateral retrosplenial, parietal, and mesiofrontal cortices, and cerebellar dentate nucleus in patients compared to controls (p < 0.005). CONCLUSIONS: Patients with TGA show selective and prolonged deficits of allocentric spatial orientation. Activations in right hippocampal and extrahippocampal hubs of the cerebral navigation network functionally substitute for the deficit in creating and updating the internal cognitive map in TGA.

Gaze in Visual Search Is Guided More Efficiently by Positive Cues than by Negative Cues.

Visual search can be accelerated when properties of the target are known. Such knowledge allows the searcher to direct attention to items sharing these properties. Recent work indicates that information about properties of non-targets (i.e., negative cues) can also guide search. In the present study, we examine whether negative cues lead to different search behavior compared to positive cues. We asked observers to search for a target defined by a certain shape singleton (broken line among solid lines). Each line was embedded in a colored disk. In "positive cue" blocks, participants were informed about possible colors of the target item. In "negative cue" blocks, the participants were informed about colors that could not contain the target. Search displays were designed such that with both the positive and negative cues, the same number of items could potentially contain the broken line ("relevant items"). Thus, both cues were equally informative. We measured response times and eye movements. Participants exhibited longer response times when provided with negative cues compared to positive cues. Although negative cues did guide the eyes to relevant items, there were marked differences in eye movements. Negative cues resulted in smaller proportions of fixations on relevant items, longer duration of fixations and in higher rates of fixations per item as compared to positive cues. The effectiveness of both cue types, as measured by fixations on relevant items, increased over the course of each search. In sum, a negative color cue can guide attention to relevant items, but it is less efficient than a positive cue of the same informational value.

"Taller and Shorter": Human 3-D Spatial Memory Distorts Familiar Multilevel Buildings.

Animal experiments report contradictory findings on the presence of a behavioural and neuronal anisotropy exhibited in vertical and horizontal capabilities of spatial orientation and navigation. We performed a pointing experiment in humans on the imagined 3-D direction of the location of various invisible goals that were distributed horizontally and vertically in a familiar multilevel hospital building. The 21 participants were employees who had worked for years in this building. The hypothesis was that comparison of the experimentally determined directions and the true directions would reveal systematic inaccuracy or dimensional anisotropy of the localizations. The study provides first evidence that the internal representation of a familiar multilevel building was distorted compared to the dimensions of the true building: vertically 215% taller and horizontally 51% shorter. This was not only demonstrated in the mathematical reconstruction of the mental model based on the analysis of the pointing experiments but also by the participants' drawings of the front view and the ground plan of the building. Thus, in the mental model both planes were altered in different directions: compressed for the horizontal floor plane and stretched for the vertical column plane. This could be related to human anisotropic behavioural performance of horizontal and vertical navigation in such buildings.

Acrophobia impairs visual exploration and balance during standing and walking.

This review shows that persons with visual height intolerance or acrophobia exhibit typical restrictions of visual exploration and imbalance during stance and locomotion when exposed to heights. Eye and head movements are reduced, and gaze freezes to the horizon. Eye movements tend to be horizontal saccades during stance and vertical saccades during locomotion. Body posture is characterized by a stiffening of the musculoskeletal system with increased open-loop diffusion activity of body sway, a lowered sensory feedback threshold for closed-loop balance control, and increased co-contraction of antigravity leg and neck muscles. Walking is slow and cautious, broad-based, consisting of small, flat-footed steps with less dynamic vertical oscillation of the body and head. Anxiety appears to be the critical symptom that causes the typical but not specific eye and body motor behavior, which can be described as tonic immobility. Guidelines for preventing acrophobia, which could be an add-on to behavioral therapy, are provided.

Visual Search in the Real World: Color Vision Deficiency Affects Peripheral Guidance, but Leaves Foveal Verification Largely Unaffected.

BACKGROUND: People with color vision deficiencies report numerous limitations in daily life, restricting, for example, their access to some professions. However, they use basic color terms systematically and in a similar manner as people with normal color vision. We hypothesize that a possible explanation for this discrepancy between color perception and behavioral consequences might be found in the gaze behavior of people with color vision deficiency. METHODS: A group of participants with color vision deficiencies and a control group performed several search tasks in a naturalistic setting on a lawn. All participants wore a mobile eye-tracking-driven camera with a high foveal image resolution (EyeSeeCam). Search performance as well as fixations of objects of different colors were examined. RESULTS: Search performance was similar in both groups in a color-unrelated search task as well as in a search for yellow targets. While searching for red targets, participants with color vision deficiencies exhibited a strongly degraded performance. This was closely matched by the number of fixations on red objects shown by the two groups. Importantly, once they fixated a target, participants with color vision deficiencies exhibited only few identification errors. CONCLUSIONS: In contrast to controls, participants with color vision deficiencies are not able to enhance their search for red targets on a (green) lawn by an efficient guiding mechanism. The data indicate that the impaired guiding is the main influence on search performance, while foveal identification (verification) is largely unaffected by the color vision deficiency.

Quantification of gait changes in subjects with visual height intolerance when exposed to heights.

INTRODUCTION: Visual height intolerance (vHI) manifests as instability at heights with apprehension of losing balance or falling. We investigated contributions of visual feedback and attention on gait performance of subjects with vHI. MATERIALS AND METHODS: Sixteen subjects with vHI walked over a gait mat (GAITRite®) on a 15-m-high balcony and at ground-level. Subjects walked at different speeds (slow, preferred, fast), during changes of the visual input (gaze straight/up/down; eyes open/closed), and while doing a cognitive task. An rmANOVA with the factors "height situation" and "gait condition" was performed. Subjects were also asked to estimate the height of the balcony over ground level. The individual estimates were used for correlations with the gait parameters. RESULTS: Study participants walked slower at heights, with reduced cadence and stride length. The double support phases were increased (all p < 0.01), which correlated with the estimated height of the balcony (R (2) = 0.453, p < 0.05). These changes were still present when walking with upward gaze or closure of the eyes. Under the conditions walking and looking down to the floor of the balcony, during dual-task and fast walking, there were no differences between the gait performance on the balcony and at ground-level. DISCUSSION: The found gait changes are features of a cautious gait control. Internal, cognitive models with anxiety play an important role for vHI; gait was similarly affected when the visual perception of the depth was prevented. Improvement by dual task at heights may be associated by a reduction of the anxiety level. CONCLUSION: It is conceivable that mental distraction by dual task or increasing the walking speed might be useful recommendations to reduce the imbalance during locomotion in subjects susceptible to vHI.

Visual exploration during locomotion limited by fear of heights.

BACKGROUND: Visual exploration of the surroundings during locomotion at heights has not yet been investigated in subjects suffering from fear of heights. METHODS: Eye and head movements were recorded separately in 16 subjects susceptible to fear of heights and in 16 non-susceptible controls while walking on an emergency escape balcony 20 meters above ground level. Participants wore mobile infrared eye-tracking goggles with a head-fixed scene camera and integrated 6-degrees-of-freedom inertial sensors for recording head movements. Video recordings of the subjects were simultaneously made to correlate gaze and gait behavior. RESULTS: Susceptibles exhibited a limited visual exploration of the surroundings, particularly the depth. Head movements were significantly reduced in all three planes (yaw, pitch, and roll) with less vertical head oscillations, whereas total eye movements (saccade amplitudes, frequencies, fixation durations) did not differ from those of controls. However, there was an anisotropy, with a preference for the vertical as opposed to the horizontal direction of saccades. Comparison of eye and head movement histograms and the resulting gaze-in-space revealed a smaller total area of visual exploration, which was mainly directed straight ahead and covered vertically an area from the horizon to the ground in front of the feet. This gaze behavior was associated with a slow, cautious gait. CONCLUSIONS: The visual exploration of the surroundings by susceptibles to fear of heights differs during locomotion at heights from the earlier investigated behavior of standing still and looking from a balcony. During locomotion, anisotropy of gaze-in-space shows a preference for the vertical as opposed to the horizontal direction during stance. Avoiding looking into the abyss may reduce anxiety in both conditions; exploration of the "vertical strip" in the heading direction is beneficial for visual control of balance and avoidance of obstacles during locomotion.

Fear of heights freezes gaze to the horizon.

Fear of heights is elicited by a glance into an abyss. However, the visual exploration behavior of fearful subjects at height has not been analyzed yet. We investigated eye- and head movements, i.e. visual exploration behavior, of subjects susceptible to fear of heights during exposure to a visual cliff. The movements of eyes and head were recorded in 19 subjects susceptible to fear of heights and 18 controls while standing still on an emergency balcony 20 meters above ground level for periods of 30 seconds. Participants wore mobile, infrared eye-tracking goggles with inertial sensors for recording head movements. Susceptibles exhibited fewer and smaller-amplitude eye-in-head saccades with fixations of longer duration. Spontaneous head movements were reduced by 49% in susceptibles with a significantly lower mean absolute angular velocity (5.3°/s vs. 10.4°/s), and all three dimensions (yaw, pitch and roll) were equally affected. Gaze-in-space--which indicates exploration by coordinated eye-head movements--covered a smaller total area of the visual scene (explored horizontal angle: 19° vs. 32°, vertical: 9° vs. 17°). We hypothesize that the susceptibles suppress eye and head movements to alleviate fear of heights. However, this behavior has the potential disadvantage of impairing the visual stabilization of postural balance.