Motivational Vigor in Parkinson's Disease Requires the Short and Long Duration Response to Levodopa.

BACKGROUND: Impaired movement vigor (bradykinesia) is a cardinal feature of Parkinson's disease (PD) and hypothesized to result from abnormal motivational processes-impaired motivation-vigor coupling. Dopamine replacement therapy (DRT) improves bradykinesia, but the response to DRT is multifaceted, comprising a short-duration response (SDR) and a long-duration response (LDR) only manifesting with chronic treatment. Prior experiments assessing motivation-vigor coupling in PD used chronically treated subjects, obscuring the roles of the SDR and LDR. METHODS: To disambiguate the SDR and LDR, 11 de novo PD subjects (6 male [M]:5 female [F]; mean age, 67) were studied before treatment, after an acute levodopa (l-dopa) dose, and in both the practical "off" (LDR) and "on" (LDR + SDR) states after chronic stable treatment. At each visit, subjects were characterized with a standard battery including the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and an incentivized joystick task to assess motor performance in response to varying rewards. RESULTS: l-Dopa induced a robust SDR and LDR, with further improvement in the combined SDR + LDR state. At baseline, after acute treatment (SDR), and after LDR induction, subjects did not exhibit the normal increase in movement speed with increasing reward. Only in the combined SDR + LDR state was there restoration of motivation-vigor coupling. CONCLUSIONS: Although consistent with prior results in chronically treated PD subjects, the significant improvement in motor performance observed with the SDR and LDR suggests that bradykinesia is not solely secondary to deficient modulation of motivational processes. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Lateral Prefrontal Stimulation of Active Cortex With Theta Burst Transcranial Magnetic Stimulation Affects Subsequent Engagement of the Frontoparietal Network.

BACKGROUND: A critical unanswered question about therapeutic transcranial magnetic stimulation is what patients should do during treatment to optimize its effectiveness. Here, we address this lack of knowledge in healthy participants, testing the hypotheses that stimulating the left dorsolateral prefrontal cortex (dlPFC) while participants perform a working memory task will provide stronger effects on subsequent activation, perfusion, connectivity, and performance than stimulating resting dlPFC. METHODS: After a baseline functional magnetic resonance imaging session to localize dlPFC activation and the associated frontoparietal network (FPN) engaged by an n-back task, healthy participants (N = 40, 67.5% female) underwent 3 counterbalanced sessions, separated by several weeks, during which they received intermittent theta burst stimulation (iTBS) followed by magnetic resonance imaging scans as follows: 1) iTBS to the dlPFC while resting passively (passive), 2) iTBS to the dlPFC while performing the n-back task (active), and 3) iTBS to a vertex site, while not engaged in the n-back task and resting passively (control). RESULTS: We found no difference in n-back performance between the 3 conditions. However, FPN activation was reduced while performing the n-back task in the active condition relative to the passive and control conditions. There was no differential activity in the FPN on comparing passive with control conditions, i.e., there was no effect of the site of stimulation. We found no effects of state or site of stimulation on perfusion or connectivity with the dlPFC. CONCLUSIONS: In this study, the state of the brain while receiving iTBS affected FPN activation, possibly reflecting greater efficiency of FPN network activation when participants were stimulated while engaging the FPN.

The behavioral and neural effects of parietal theta burst stimulation on the grasp network are stronger during a grasping task than at rest.

Repetitive transcranial magnetic stimulation (TMS) is widely used in neuroscience and clinical settings to modulate human cortical activity. The effects of TMS on neural activity depend on the excitability of specific neural populations at the time of stimulation. Accordingly, the brain state at the time of stimulation may influence the persistent effects of repetitive TMS on distal brain activity and associated behaviors. We applied intermittent theta burst stimulation (iTBS) to a region in the posterior parietal cortex (PPC) associated with grasp control to evaluate the interaction between stimulation and brain state. Across two experiments, we demonstrate the immediate responses of motor cortex activity and motor performance to state-dependent parietal stimulation. We randomly assigned 72 healthy adult participants to one of three TMS intervention groups, followed by electrophysiological measures with TMS and behavioral measures. Participants in the first group received iTBS to PPC while performing a grasping task concurrently. Participants in the second group received iTBS to PPC while in a task-free, resting state. A third group of participants received iTBS to a parietal region outside the cortical grasping network while performing a grasping task concurrently. We compared changes in motor cortical excitability and motor performance in the three stimulation groups within an hour of each intervention. We found that parietal stimulation during a behavioral manipulation that activates the cortical grasping network increased downstream motor cortical excitability and improved motor performance relative to stimulation during rest. We conclude that constraining the brain state with a behavioral task during brain stimulation has the potential to optimize plasticity induction in cortical circuit mechanisms that mediate movement processes.

Influence of goals on modular brain network organization during working memory.

Introduction: Top-down control underlies our ability to attend relevant stimuli while ignoring irrelevant, distracting stimuli and is a critical process for prioritizing information in working memory (WM). Prior work has demonstrated that top-down biasing signals modulate sensory-selective cortical areas during WM, and that the large-scale organization of the brain reconfigures due to WM demands alone; however, it is not yet understood how brain networks reconfigure between the processing of relevant versus irrelevant information in the service of WM. Methods: Here, we investigated the effects of task goals on brain network organization while participants performed a WM task that required participants to detect repetitions (e.g., 0-back or 1-back) and had varying levels of visual interference (e.g., distracting, irrelevant stimuli). We quantified changes in network modularity-a measure of brain sub-network segregation-that occurred depending on overall WM task difficulty as well as trial-level task goals for each stimulus during the task conditions (e.g., relevant or irrelevant). Results: First, we replicated prior work and found that whole-brain modularity was lower during the more demanding WM task conditions compared to a baseline condition. Further, during the WM conditions with varying task goals, brain modularity was selectively lower during goal-directed processing of task-relevant stimuli to be remembered for WM performance compared to processing of distracting, irrelevant stimuli. Follow-up analyses indicated that this effect of task goals was most pronounced in default mode and visual sub-networks. Finally, we examined the behavioral relevance of these changes in modularity and found that individuals with lower modularity for relevant trials had faster WM task performance. Discussion: These results suggest that brain networks can dynamically reconfigure to adopt a more integrated organization with greater communication between sub-networks that supports the goal-directed processing of relevant information and guides WM.

Reward influences the allocation but not the availability of resources in visual working memory.

Visual working memory possesses capacity constraints limiting the availability of resources for encoding and maintaining information. Studies have shown that prospective rewards improve performance on visual working memory tasks, but it remains unclear whether rewards increase total resource availability or simply influence the allocation of resources. Participants performed a continuous report visual working memory task with oriented grating stimuli. On each trial, participants were presented with a priority cue, which signaled the item most likely to be probed, and a reward cue, which signaled the magnitude of a performance-contingent reward. We showed that rewards decreased recall error for cued items and increased recall error for noncued items. This tradeoff was due to a change in the probability of successfully encoding a cued versus a noncued item rather than a change in recall precision or the probability of binding errors. Rewards did not modulate performance when priority cues were retroactively presented after the stimulus presentation period, indicating that rewards only affect resource allocation when participants are able to engage proactive control before encoding. Additionally, reward had no effect on visual working memory performance when priority cues were absent and thus unable to guide resource allocation. These findings indicate that rewards influence the flexible allocation of resources during selection and encoding in visual working memory, but do not augment total capacity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reward Accelerates the Preparation of Goal-directed Actions under Conflict.

Our goals sometimes conflict with our prepotent habitual responses, which often leads to impaired performance on a variety of tasks. People are better at exerting cognitive control to overcome prepotent and automatic responses when they are motivated by the prospect of reward. The standard experimental paradigms used to study this phenomenon examine free RTs that allow participants to select a variety of response strategies including delaying response initiation to avoid committing errors. However, this approach makes it difficult to determine which control processes are affected by reward. Does reward lead to improved performance via the inhibition of prepotent responses or the facilitation of goal-directed processing? Here, we use a forced-response paradigm to fix response initiation and systematically vary the time available for the cognitive processing necessary for response preparation. Using a probabilistic model that dissociates the preparation of habitual and goal-directed responses, we obtain evidence across multiple experiments (n = 87 people) that reward selectively accelerates the preparation of goal-directed actions in the context of conflict.

Continuous Theta Burst Stimulation to the Secondary Visual Cortex at 80% Active Motor Threshold Does Not Impair Central Vision in Humans During a Simple Detection Task.

Continuous theta burst stimulation (cTBS) is a powerful form of repetitive transcranial magnetic stimulation capable of suppressing cortical excitability for up to 50 min. A growing number of studies have applied cTBS to the visual cortex in human subjects to investigate the neural dynamics of visual processing, but few have specifically examined its effects on central vision, which has crucial implications for safety and inference on downstream cognitive effects. The present study assessed the safety of offline, neuronavigated cTBS to V2 by examining its effects on central vision performance. In this single-blind, randomized sham-controlled, crossover study, 17 healthy adults received cTBS (at 80% active motor threshold) and sham to V2 1-2 weeks apart. Their central vision (≤8°) was tested at 1-min (T1) and again at 50-min (T50) post-stimulation. Effects of condition (cTBS vs. sham) and time (T1 vs. T50) on accuracy and reaction time were examined using Bayes factor. Bayes factor results suggested that cTBS did not impair stimulus detection over the entire central visual field nor subfields at T1 or T50. Our results offer the first explicit evidence supporting that cTBS applied to V2 does not create blind spots in the central visual field in humans during a simple detection task. Any subtler changes to vision and downstream visual perception should be investigated in future studies.

Interactive effects of incentive value and valence on the performance of discrete action sequences.

Incentives can be used to increase motivation, leading to better learning and performance on skilled motor tasks. Prior work has shown that monetary punishments enhance on-line performance while equivalent monetary rewards enhance off-line skill retention. However, a large body of literature on loss aversion has shown that losses are treated as larger than equivalent gains. The divergence between the effects of punishments and reward on motor learning could be due to perceived differences in incentive value rather than valence per se. We test this hypothesis by manipulating incentive value and valence while participants trained to perform motor sequences. Consistent with our hypothesis, we found that large reward enhanced on-line performance but impaired the ability to retain the level of performance achieved during training. However, we also found that on-line performance was better with reward than punishment and that the effect of increasing incentive value was more linear with reward (small, medium, large) while the effect of value was more binary with punishment (large vs not large). These results suggest that there are differential effects of punishment and reward on motor learning and that these effects of valence are unlikely to be driven by differences in the subjective magnitude of gains and losses.

Reward modulates cortical representations of action.

People are capable of rapid improvements in performance when they are offered a reward. The neural mechanism by which this performance enhancement occurs remains unclear. We investigated this phenomenon by offering people monetary reward for successful performance in a sequence production task. We found that people performed actions more quickly and accurately when they were offered large reward. Increasing reward magnitude was associated with elevated activity throughout the brain prior to movement. Multivariate patterns of activity in these reward-responsive regions encoded information about the upcoming action. Follow-up analyses provided evidence that action decoding in pre-SMA and other motor planning areas was improved for large reward trials and successful action decoding in SMA was associated with improved performance. These results suggest that reward may enhance performance by enhancing neural representations of action used in motor planning.

Theta Burst Transcranial Magnetic Stimulation of Fronto-Parietal Networks: Modulation by Mental State.

Transcranial magnetic stimulation (TMS) treats neuropsychiatric disorders, but effects of stimulation are highly state-dependent and in most therapeutic applications, mental state is not controlled. This exploratory proposal will test the broad hypothesis that when TMS, specifically intermittent theta burst stimulation (iTBS), is applied during a controlled mental state, network changes will be facilitated, compared to stimulation when mental state is uncontrolled. We will focus on the dorsolateral prefrontal cortex (dlPFC) and the associated fronto-parietal network (FPN), which subserves cognitive control, an important neural and behavioral target of therapeutic TMS. After a baseline functional magnetic resonance imaging (fMRI) session, iTBS will be administered to 40 healthy subjects in three sessions over three days in a within-subjects, cross-over design: (1) dlPFC stimulation by iTBS alone, (2) dlPFC stimulation by iTBS while simultaneously performing a cognitive task, and (3) vertex (control) iTBS stimulation. Immediately after each iTBS session, we will measure blood oxygenation level-dependent (BOLD) activation during a cognitive control task ("n-back" task) and during the resting state, using BOLD connectivity and arterial spin labeling (ASL). We will test hypotheses that persisting neural changes and performance enhancement induced by iTBS to the dlPFC, compared to iTBS to the vertex, will affect the FPN, and these effects will be modulated by whether or not subjects receive iTBS when they are engaged in a cognitive control task. Demonstrating this interaction between iTBS and mental state will lay critical groundwork for future studies to show how controlling mental state during TMS can improve therapeutic effects. TRIAL REGISTRATION: Clinicaltrials.gov NCT04010461.

Rewards interact with explicit knowledge to enhance skilled motor performance.

From typing on a keyboard to playing the piano, many everyday skills require the ability to quickly and accurately perform sequential movements. It is well known that the availability of rewards leads to increases in motivational vigor whereby people enhance both the speed and force of their movements. However, in the context of motor skills, it is unclear whether rewards also lead to more effective motor planning and action selection. Here, we trained human participants to perform four separate sequences in a skilled motor sequencing task. Two of these sequences were trained explicitly and performed with precues that allow for the planning of movements, while the other two were trained implicitly. Immediately following the introduction of performance-contingent monetary incentives, participants improved their performance on all sequences consistent with enhancements in motivational vigor. However, there was a much larger performance boost for explicitly trained sequences. We replicated these results in a second, preregistered experiment with an independent sample. We conclude from these experiments that rewards enhance both the planning of movements as well as motivational vigor.NEW & NOTEWORTHY Offering people rewards and incentives typically improves their performance on skilled motor tasks. However, the mechanisms by which motivation impacts motor skills remains unclear. In two experiments, we show that motivation impacts motor sequencing skills in two separate ways. First, the prospect of reward speeds up the execution of all actions. Second, rewards provide an additional boost to motor planning when explicit skill knowledge can be used to prepare movements in advance.

Limiting motor skill knowledge via incidental training protects against choking under pressure.

The paradoxical harmful effects of motivation and incentives on skilled performance ("choking under pressure") are observed in a wide variety of motor tasks. Two theories of this phenomenon suggest that choking under pressure occurs due to maladaptive attention and top-down control, either through distraction away from the task or interference via an overreliance on controlled processing of a skilled task. A third theory, overmotivation (or overarousal), suggests that under pressure, "instinctive" or Pavlovian approach/withdrawal responses compete with the desired response. Only the two former theories predict that choking under pressure would be less likely to occur if an individual is unaware of the skill over which to assert top-down control. Here we show that only participants who train and perform with premovement cues that allowed for preparatory movement planning choke under pressure due to large monetary incentives, and that this effect is independent of the level of skill attained. We provide evidence that this might be due to increased movement variability under performance pressure. In contrast, participants trained incidentally to reduce explicit skill knowledge do not modulate performance on the basis of incentives and appear immune to choking. These results are most consistent with distraction theories of choking and suggest that training strategies that limit awareness may lead to skills that are more robust under performance pressure.

Out of control: diminished prefrontal activity coincides with impaired motor performance due to choking under pressure.

There are three non-exclusive theoretical explanations for the paradoxical collapse of performance due to large financial incentives. It has been proposed that "choking under pressure" is either due to distraction, interference via an increase in top-down control and performance monitoring, or excessive levels of arousal in the face of large losses. Given the known neural architecture involved in executive control and reward, we used fMRI of human participants during incentivized motor performance to provide evidence to support and/or reconcile these competing models in a visuomotor task. We show that the execution of a pre-trained motor task during neuroimaging is impaired by high rewards. BOLD activity occurring prior to movement onset is increased in dorsolateral prefrontal cortex and functional connectivity between this region and motor cortex is likewise increased just prior to choking. However, the extent of this increase in functional connectivity is inversely related to a participant's propensity to choke, suggesting that a failure in exerting top-down influence on motor control underlies choking under pressure due to large incentives. These results are consistent with a distraction account of choking and suggest that frontal influences on motor activity are necessary to protect performance from vulnerability under pressure.

The Effect of Disruption of Prefrontal Cortical Function with Transcranial Magnetic Stimulation on Visual Working Memory.

It is proposed that feedback signals from the prefrontal cortex (PFC) to extrastriate cortex are essential for goal-directed processing, maintenance, and selection of information in visual working memory (VWM). In a previous study, we found that disruption of PFC function with transcranial magnetic stimulation (TMS) in healthy individuals impaired behavioral performance on a face/scene matching task and decreased category-specific tuning in extrastriate cortex as measured with functional magnetic resonance imaging (fMRI). In this study, we investigated the effect of disruption of left inferior frontal gyrus (IFG) function on the fidelity of neural representations of two distinct information codes: (1) the stimulus category and (2) the goal-relevance of viewed stimuli. During fMRI scanning, subjects were presented face and scene images in pseudo-random order and instructed to remember either faces or scenes. Within both anatomical and functional regions of interest (ROIs), a multi-voxel pattern classifier was used to quantitatively assess the fidelity of activity patterns representing stimulus category: whether a face or a scene was presented on each trial, and goal relevance, whether the presented image was task relevant (i.e., a face is relevant in a "Remember Faces" block, but irrelevant in a "Remember Scenes" block). We found a reduction in the fidelity of the stimulus category code in visual cortex after left IFG disruption, providing causal evidence that lateral PFC modulates object category codes in visual cortex during VWM. In addition, we found that IFG disruption caused a reduction in the fidelity of the goal relevance code in a distributed set of brain regions. These results suggest that the IFG is involved in determining the task-relevance of visual input and communicating that information to a network of regions involved in further processing during VWM. Finally, we found that participants who exhibited greater fidelity of the goal relevance code in the non-disrupted right IFG after TMS performed the task with the highest accuracy.

Quantifying the reconfiguration of intrinsic networks during working memory.

Rapid, flexible reconfiguration of connections across brain regions is thought to underlie successful cognitive control. Two intrinsic networks in particular, the cingulo-opercular (CO) and fronto-parietal (FP), are thought to underlie two operations critical for cognitive control: task-set maintenance/tonic alertness and adaptive, trial-by-trial updating. Using functional magnetic resonance imaging, we directly tested whether the functional connectivity of the CO and FP networks was related to cognitive demands and behavior. We focused on working memory because of evidence that during working memory tasks the entire brain becomes more integrated. When specifically probing the CO and FP cognitive control networks, we found that individual regions of both intrinsic networks were active during working memory and, as expected, integration across the two networks increased during task blocks that required cognitive control. Crucially, increased integration between each of the cognitive control networks and a task-related, non-cognitive control network (the hand somatosensory-motor network; SM) was related to increased accuracy. This implies that dynamic reconfiguration of the CO and FP networks so as to increase their inter-network communication underlies successful working memory.

Perfusion MRI indexes variability in the functional brain effects of theta-burst transcranial magnetic stimulation.

Transcranial Magnetic Stimulation (TMS) is an important tool for testing causal relationships in cognitive neuroscience research. However, the efficacy of TMS can be variable across individuals and difficult to measure. This variability is especially a challenge when TMS is applied to regions without well-characterized behavioral effects, such as in studies using TMS on multi-modal areas in intrinsic networks. Here, we examined whether perfusion fMRI recordings of Cerebral Blood Flow (CBF), a quantitative measure sensitive to slow functional changes, reliably index variability in the effects of stimulation. Twenty-seven participants each completed four combined TMS-fMRI sessions during which both resting state Blood Oxygen Level Dependent (BOLD) and perfusion Arterial Spin Labeling (ASL) scans were recorded. In each session after the first baseline day, continuous theta-burst TMS (TBS) was applied to one of three locations: left dorsolateral prefrontal cortex (L dlPFC), left anterior insula/frontal operculum (L aI/fO), or left primary somatosensory cortex (L S1). The two frontal targets are components of intrinsic networks and L S1 was used as an experimental control. CBF changes were measured both before and after TMS on each day from a series of interleaved resting state and perfusion scans. Although TBS led to weak selective increases under the coil in CBF measurements across the group, individual subjects showed wide variability in their responses. TBS-induced changes in rCBF were related to TBS-induced changes in functional connectivity of the relevant intrinsic networks measured during separate resting-state BOLD scans. This relationship was selective: CBF and functional connectivity of these networks were not related before TBS or after TBS to the experimental control region (S1). Furthermore, subject groups with different directions of CBF change after TBS showed distinct modulations in the functional interactions of targeted networks. These results suggest that CBF is a marker of individual differences in the effects of TBS.

The effects of lateral prefrontal transcranial magnetic stimulation on item memory encoding.

Previous neuroimaging research has established that the left ventrolateral prefrontal cortex (VLPFC) is involved in long-term memory (LTM) encoding for individual items. Dorsolateral prefrontal cortex (DLPFC) is implicated less frequently, and one theory that has gained support to explain this discrepancy is that DLPFC is involved in forming item-item relational but not item LTM. Given that neuroimaging results are correlational, complimentary methods such as repetitive transcranial magnetic stimulation (TMS) have been used to test causal hypotheses generated from imaging data. Most TMS studies of LTM encoding have found that disruption of lateral PFC activity impairs subsequent memory. However these studies have lacked methods to precisely localize and directly compare TMS effects from frontal subregions implicated by the neuroimaging literature. Here, we target specific subregions of lateral PFC with TMS to test the prediction from the item/relational framework that temporary disruption of VLPFC during encoding will impair subsequent memory whereas TMS to DLPFC during item encoding will not. Frontal TMS was administered prior to a LTM encoding task in which participants were presented with a list of individual nouns and asked to judge whether each noun was concrete or abstract. After a 40 min delay period, item recognition memory was tested. Results indicate that VLPFC and DLPFC TMS have differential effects on subsequent item memory. VLPFC TMS reliably disrupted subsequent item memory whereas DLPFC TMS led to numerical enhancement in item memory, relative to TMS to a control region.

Disruption of dorsolateral but not ventrolateral prefrontal cortex improves unconscious perceptual memories.

Attentive encoding often leads to more accurate responses in recognition memory tests. However, previous studies have described conditions under which taxing explicit memory resources by attentional distraction improved perceptual recognition memory without awareness. These findings lead to the hypothesis that explicit memory processes mediated by the prefrontal cortex (PFC) can interfere with memory processes necessary for implicit recognition memory. The present study directly tested this hypothesis by applying transcranial magnetic stimulation separately over either dorsolateral (DLPFC) or ventrolateral PFC (VLPFC) in humans before performance of a visual memory task. Disruption of DLPFC function led to improvement in recognition accuracy only in responses in which the participant's awareness of memory retrieval was absent. However, disruption of VLPFC function led to subtle shifts in recollection and familiarity accuracy. We conclude that explicit memory processes mediated by the DLPFC can indirectly interfere with implicit recognition memory.

The effect of theta-burst TMS on cognitive control networks measured with resting state fMRI.

IT HAS BEEN PROPOSED THAT TWO RELATIVELY INDEPENDENT COGNITIVE CONTROL NETWORKS EXIST IN THE BRAIN: the cingulo-opercular network (CO) and the fronto-parietal network (FP). Past work has shown that chronic brain lesions affect these networks independently. It remains unclear, however, how these two networks are affected by acute brain disruptions. To examine this, we conducted a within-subject theta-burst transcranial magnetic stimulation (TBS) experiment in healthy individuals that targeted left anterior insula/frontal operculum (L aI/fO, a region in the CO network), left dorsolateral prefrontal cortex (L dlPFC, a region in the FP network), or left primary somatosensory cortex (L S1, an experimental control region). Functional connectivity (FC) was measured in resting state fMRI scans collected before and after continuous TBS on each day. We found that TBS was accompanied by generalized increases in network connectivity, especially FP network connectivity, after TBS to either region involved in cognitive control. Whole-brain analyses demonstrated that the L dlPFC and L aI/fO showed increased connectivity with regions in frontal, parietal, and cingulate cortex after TBS to either L dlPFC or L aI/fO, but not to L S1. These results suggest that acute disruption by TBS to cognitive control regions causes widespread changes in network connectivity not limited to the targeted networks.