The term “acquired brain injury” refers to any type of brain damage that occurs after birth. Two main types of acquired brain injury are stroke and traumatic brain injury (TBI). A stroke occurs when there is a blockage or bleed in the vascular system of the brain, while a TBI results from an external force to the head. Older adults are at a higher risk of both stroke and TBI; thus, overall incidence is increasing as the proportion of older adults in the population is growing. Stroke and TBI result in immediate and long-term cognitive changes. Impairments in the domains of language, attention, memory, executive functions, perception, and social cognition have been documented following stroke and TBI. However, strokes tend to cause focal or selective cognitive disorders, while cognitive deficits following TBI are widespread and can be generalized. Individuals who have suffered a stroke or TBI may also experience psychosocial changes; for example, symptoms of depression and anxiety are common. Functional outcomes, including independence in activities, are varied and are associated with a range of factors including age, injury severity, cognitive disorders, and psychosocial factors. To achieve optimal outcomes for individuals following stroke and TBI, and to reduce the impact of the injury on everyday functioning, a multidisciplinary rehabilitation process is recommended.
Acquired Brain Injury (Stroke and TBI) in Later Life
Megan S. Barker, Emily C. Gibson, and Gail A. Robinson
Autism Spectrum Disorders in Later Life
Ye In (Jane) Hwang, Kitty-Rose Foley, Samuel Arnold, and Julian Trollor
Autism spectrum disorder (ASD), or autism, is a neurodevelopmental disorder that is typically recognized and diagnosed in childhood. There is no established biological marker for autism; rather, the diagnosis is made based on observation of behavioral traits, including (a) persistent deficits in social interaction and communication, and (b) restricted, repetitive patterns of behavior, interests, or activities. Because autism is a spectrum disorder, autistic individuals are a highly heterogeneous group and differ widely in the presentation and severity of their symptoms. The established prevalence of ASD is approximately 1% of the population. Information about autism in adulthood is limited; most of the literature examines childhood and adolescence. While the term “later life” has traditionally been associated with those over the age of 65, a dire lack of understanding exists for those on the autism spectrum beyond early adulthood. Individuals remain on the spectrum into later life, though some mild improvements in symptoms are observed over time. Autistic adults experience high levels of physical and mental health comorbidities. Rates of participation in employment and education are also lower than that of the general population. Quality of life is reportedly poorer for autistic adults than for nonautistic peers, though this is not affected by age. More robust studies of the health, well-being, and needs of autistic adults are needed, especially qualitative investigations of adulthood and aging and longitudinal studies of development over the lifespan.
Brain Basis of Blindsight
The sensation of vision arises from the detection of photons of light at the eye, but in order to produce the percept of the world, extensive regions of the brain are required to process the visual information. The majority of information entering the brain via the optic nerve from the eye projects via the lateral geniculate nucleus (LGN) of the thalamus to the primary visual cortex, the largest visual area, having been reorganized such that one side of the brain represents one side of the world. Damage to the primary visual cortex in one hemisphere therefore leads to a loss of conscious vision on the opposite side of the world, known as hemianopia. Despite this cortical blindness, many patients are still able to detect visual stimuli that are presented in the blind region if forced to guess whether a stimulus is present or absent. This is known as “blindsight.” For patients to gain any information (conscious or unconscious) about the visual world, the input from the eye must be processed by the brain. Indeed, there is considerable evidence from functional brain imaging that several visual areas continue to respond to visual stimuli presented within the blind region, even when the patient is unaware of the stimulus. Furthermore, the use of diffusion imaging allows the microstructure of white matter pathways within the visual system to be examined to see whether they are damaged or intact. By comparing patients who have hemianopia with and without blindsight it is possible to determine the pathways that are linked to blindsight function. Through understanding the brain areas and pathways that underlie blindsight in humans and non-human primates, the aim is to use modern neuroscience to guide rehabilitation programs for use after stroke.
Cerebral Palsy From a Developmental Psychology Perspective
Cerebral palsy (CP) is defined as non-progressive damage to the brain at or around birth, which leads to varying symptoms depending on the extent and location of damage. The leading symptom is sensory-motor impairment of varying expression, but additional perceptual, cognitive, and socio-emotional symptoms are common. CP can be divided into four types, with bilateral spastic being by far the most frequent, followed by the unilateral spastic, the dyskinetic, and the ataxic variants. The intellectual, linguistic, and cognitive profile of CP is extremely variant, but all qualities correlate more or less with CP type and motor impairment. Early diagnosis is important since early intervention may promote all developmental dimensions. Generally, individuals with unilateral spastic CP have the best (almost normal) intellectual, linguistic, and cognitive outcomes, while those with bilateral spastic CP fare the worst. Language perception is often an individual strength, while language expression, and particularly speech, may be heavily impaired. Attention and executive functions are often impaired as compared to typically developing controls, even in those children with normal intellectual functioning. The same holds true for visual perceptual functions, which are impaired in almost half of all children and adolescents with CP. The potential neuropsychological dysfunctions are a risk factor for arithmetic functions and literacy. Obstacles to participate in society are high for individuals with CP and heavily dependent on their motor, language, intellectual, and cognitive functions. However, quality of life is good for most children and adolescents, and they develop a sound self-concept. On the other side, bully experience is more common than amongst typically developing children and is associated with behavior problems and executive dysfunction. The development of children and adolescents with CP is determined by a complex interplay between physical, intellectual, and neuropsychological functions.
Cognition and Mobility With Aging
Karen Z. H. Li, Halina Bruce, and Rachel Downey
Research on the interplay of cognition and mobility in old age is inherently multidisciplinary, informed by findings from life span developmental psychology, kinesiology, cognitive neuroscience, and rehabilitation sciences. Early observational work revealed strong connections between sensory and sensorimotor performance with measures of intellectual functioning. Subsequent work has revealed more specific links between measures of cognitive control and gait quality. Convergent evidence for the interdependence of cognition and mobility is seen in patient studies, wherein cognitive impairment is associated with increased frequency and risk of falling. Even in cross-sectional studies involving healthy young and older adults, the effects of aging on postural control and gait are commonly exacerbated when participants perform a motor task with a concurrent cognitive load. This motor-cognitive dual-task method assumes that cognitive and motor domains compete for common capacity, and that older adults recruit more cognitive capacity than young adults to support gait and posture. Neuroimaging techniques such as magnetic resonance imaging (MRI) have revealed associations between measures of mobility (e.g., gait velocity and postural control) and measures of brain health (e.g., gray matter volumes, cortical thickness, white matter integrity, and functional connectivity). The brain regions most often associated with aging and mobility also appear to subserve high-level cognitive functions such as executive control, attention, and working memory (e.g., dorsolateral prefrontal cortex, anterior cingulate). Portable functional neuroimaging has allowed for the examination of neural functioning during real-time walking, often in conjunction with detailed spatiotemporal measures of gait. A more recent strategy that addresses the interdependence of cognitive and motor processes in old age is cognitive remediation. Cognitive training has yielded promising improvements in balance, walking, and overall mobility status in healthy older adults, and those with age-related neurodegenerative conditions such as Parkinson’s Disease.
Cognitive Intervention in Older Adults With Mild Cognitive Impairment
Benjamin Boller and Sylvie Belleville
Individuals with mild cognitive impairment (MCI) experience cognitive difficulties and many find themselves in a transitional stage between aging and dementia, making this population a suitable target for cognitive intervention. In MCI, not all cognitive functions are impaired and preserved functions can thus be recruited to compensate for the impact of cognitive impairment. Improving cognition may have a tremendous impact on quality of life and help delay the loss of autonomy that comes with dementia. Several studies have reported evidence of cognitive benefits following cognitive intervention in individuals with MCI. Studies that relied on training memory and attentional control have provided the most consistent evidence for cognitive gains. A few studies have investigated the neurophysiological processes by which these training effects occur. More research is needed to draw clear conclusions on the type of brain processes that are engaged in cognitive training and there are insufficient findings regarding transfer to activities of daily life. Results from recent studies using new technologies such as virtual reality provide encouraging evidence of transfer effects to real-life situations.
Cognitive Rehabilitation in Mild and Moderate Dementia
Aleksandra Kudlicka and Linda Clare
The number of people living with dementia is growing, and with limited pharmacological treatment options the importance of psychosocial interventions is increasingly recognized. Cognitive rehabilitation is particularly well placed to address the needs of people living with mild and moderate dementia and their family supporters, as it offers a range of tools to tackle the complexity of the condition. It utilizes powerful approaches of problem solving and goal setting combined with evidence-based rehabilitative techniques for managing cognitive impairments. It also incorporates strategies to address emotional and motivational aspects of dementia that may affect a person’s well-being. It is provided on an individual basis, usually in people’s homes, making it directly applicable to everyday life. It is also genuinely person-centered and flexible as the therapy goals are agreed in a collaborative process between the therapist, person with dementia, and family members. Cognitive rehabilitation does not claim to address underlying pathology, but instead focuses on a person’s functional ability and enjoyment of life. Evidence for effectiveness of cognitive rehabilitation in the context of mild and moderate dementia, mostly Alzheimer’s disease (AD), is gradually accumulating with a number of randomized control trials demonstrating that people with mild and moderate dementia can significantly improve their functioning in targeted areas. For example, the GREAT trial with 475 people with mild to moderate Alzheimer’s, vascular, and mixed dementia completed in 2017 in the United Kingdom demonstrated that cognitive rehabilitation improves everyday functioning in relation to individual therapy goals. There is a growing interest in cognitive rehabilitation and the focus shifts to extending evidence to less-common forms of dementia, particularly in people with non-amnestic presentation. Future efforts need to concentrate on promoting the approach and optimizing application in real-life settings with the aim of maximizing benefits for people living with dementia and their families.
Healthy and Pathological Neurocognitive Aging: Spectral and Functional Connectivity Analyses Using Magnetoencephalography
Gianluca Susi, Jaisalmer de Frutos-Lucas, Guiomar Niso, Su Miao Ye-Chen, Luis Antón Toro, Brenda Nadia Chino Vilca, and Fernando Maestú
Oscillatory activity present in brain signals reflects the underlying time-varying electrical discharges within and between ensembles of neurons. Among the variety of non-invasive techniques available for measuring of the brain’s oscillatory activity, magnetoencephalography (MEG) presents a remarkable combination of spatial and temporal resolution, and can be used in resting-state or task-based studies, depending on the goals of the experiment. Two important kinds of analysis can be carried out with the MEG signal: spectral a. and functional connectivity (FC) a. While the former provides information on the distribution of the frequency content within distinct brain areas, FC tells us about the dependence or interaction between the signals stemming from two (or among many) different brain areas. The large frequency range combined with the good resolution offered by MEG makes MEG-based spectral and FC analyses able to highlight distinct patterns of neurophysiological alterations during the aging process in both healthy and pathological conditions. Since disruption in spectral content and functional interactions between brain areas could be accounted for by early neuropathological changes, MEG could represent a useful tool to unveil neurobiological mechanisms related to the cognitive decline observed during aging, particularly suitable for the detection of functional alterations, and then for the discovery of potential biomarkers in case of pathology. The aging process is characterized by alterations in the spectral content across the brain. At the network level, FC studies reveal that older adults experience a series of changes that make them more vulnerable to cognitive interferences. While special attention has been dedicated to the study of pathological conditions (in particular, mild cognitive impairment and Alzheimer’s disease), the lack of studies addressing the features of FC in healthy aging is noteworthy. This area of research calls for future attention because it is able to set the baseline from which to draw comparisons with different pathological conditions.
Neurocognitive Aging and Brain Signal Complexity
Anthony Randal McIntosh
Brain organization can be measured across multiple spatial and temporal scales where each scale affects the other in the emergent functions that are known as cognition. As a complex adaptive system, the interplay of these scales in the brain represents the information that ultimately supports what one thinks and does. The dynamics of these multiscale operations can be quantified with measures of complexity, which are sensitive to the balance between information that is coded in local cell populations and that is captured in the network interactions between populations. This local versus global balance has its foundation in the structural connectivity of the brain, which is then realized through the dynamics of cell populations and their ensuing interactions with other populations. Considering brain function and cognition in this way enables a different perspective on the changes in cognitive function in aging. Changes in brain signal complexity from childhood to adulthood were assessed in two independent studies. Both showed that maturation is accompanied by an overall increase in signal complexity, which also correlated with more stable and accurate cognitive performance. There was some suggestion that the maximal change occurs in medial posterior cortical areas, which have been considered “network hubs” of the brain. In extending to the study of healthy aging, a scale-dependent change in brain complexity was observed across three independent studies. Healthy aging brings a shift in local and global balance, where more information is coded in local dynamics and less in global interactions. This balance is associated with better cognitive performance and, interestingly, in a more active lifestyle. It also seems that the lack of this shift in local and global balance is predictive of worse cognitive performance and potentially predictive of additional decline indicative of dementia.
The growing field of neuroimaging has offered exciting insights into the inner workings of the human brain in health and disease. Structural neuroimaging techniques provide detailed information about the physical properties and anatomy of the brain and nervous system, including cerebrospinal fluid, blood vessels, and different types of tissue. The most commonly used structural neuroimaging techniques are computed tomography (CT) and structural magnetic resonance imaging (MRI). CT uses X-rays to create a two-dimensional representation of neural tissue, whereas MRI quantifies differences in tissue density by manipulating molecules using magnetic fields, magnetic field gradients, and radio waves. Functional neuroimaging techniques provide a measure of when and where activity is occurring in the brain by quantifying underlying physiological processes. Functional neuroimaging techniques fall into two broad categories: measures of direct brain activity, including electroencephalography (EEG) and magnetoencephalography (MEG), and measures of indirect brain activity, such as positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). Different functional neuroimaging techniques can be used to examine different physiological changes, including electrical activity, magnetic field changes, metabolic and neurotransmitter activity, and indirect measures of blood flow to offer insight into cognitive processing. Structural and functional neuroimaging have made a profound impact on understanding the brain both during normal functioning and in clinical pathology. Overall, neuroimaging is a powerful tool for both research and clinical practice and offers a noninvasive window into the central nervous system of humans in both health and disease.
Temporal Dynamics of Prospective Memory (Event-Related Potentials)
Life is filled with goals or intentions that people hope to realize. Some of these are rather mundane (e.g., remembering to purchase a key ingredient for a recipe when stopping at the market), while others are more significant (e.g., remembering to pick up one’s child from school at the end of the day). Prospective memory represents the ability to form and then realize intentions at an appropriate time. A fundamental aspect of prospective memory is that one is engaged in one or more tasks (i.e., ongoing activities) between the formation of an intention and the opportunity to realize the goal. For instance, in the shopping example, one might form the intention at home and then travel to the market and collect several other items before walking past the desired ingredient. Considerable research has demonstrated that the efficiency of prospective memory declines with age, although age-related differences are not universal. The neurocognitive processes underpinning age-related differences in the formation and realization of delayed intentions have been investigated in studies using event-related brain potentials. This research reveals that age-related differences in prospective memory arise from the disruption of neural systems supporting the successful encoding of intentions, the detection of prospective memory cues, and possibly processes supporting the retrieval of intentions from memory when a cue is encountered or efficiently shifting from the ongoing activity to the prospective element of the task. Therefore, strategies designed to ameliorate age-related declines in prospective memory should target a variety of processes engaged during the encoding, retrieval, and enactment of delayed intentions.
The Social Brain
Halie Olson and Anila D'Mello
Humans are fundamentally social animals, and a large portion of the human brain is dedicated to social cognition—the set of mental functions and processes that scaffold our ability to observe, understand, and interact with others. While early philosophers and scientists relied on observation or isolated cases of brain damage to gain insight into social cognition, the advent of new technologies, including noninvasive neuroimaging, has opened a new window into the brain regions that support social cognition in humans, referred to as the social brain. These technologies have elucidated with new precision that individual brain regions are specialized for a variety of social functions including comprehending language, processing faces and emotions, anticipating what a social partner might do next, and even thinking about others’ thoughts. While the building blocks for the social brain are present from birth, individual regions continue to develop into adulthood and are shaped by experience.
Time Perception in Development
Time is an abstract, unobservable, multifaceted, and elusive concept, whose nature has long posited a major challenge in philosophical and scientific thought. Nonetheless, despite the fact that time is not directly perceived by our senses, a universal human experience of time does exist. People are aware of time passing by; seek ways to measure it; arrange their lives around different timelines; and constantly use verbal expressions referring to time. A key question in developmental science is when and how children develop a sense and a concept of time. Infants are equipped from birth with perceptual time-tracking mechanisms for detecting patterns and changes in the physical environment, and their biological clocks reach an adult-like level already at 3 months of age. Infants have been shown to accurately register the recency, duration, frequency, and rhythmic aspects of events. Infants also gradually become more attuned to inter-sensory (visual/auditory/tactile) temporal relations based on co-occurrences of synchrony, duration, rate, and rhythm. These early abilities establish the foundation for the emergence of a metacognitive awareness and conceptualization of time in later stages of development. Several cognitive components such as attention, memory, and language are crucial in producing and maintaining our subjective perception of time. Additional factors include the social and cultural practices of time, which determine our time perspective and time perception. Verbal interactions relating to time between parents and their children aid the child in grasping distinctions between the past, present, and future, and between proximate and remote past and future times.
Visual Attention With Cognitive Aging
David J. Madden and Zachary A. Monge
Age-related decline occurs in several aspects of fluid, speed-dependent cognition, particularly those related to attention. Empirical research on visual attention has determined that attention-related effects occur across a range of information processing components, including the sensory registration of features, selection of information from working memory, controlling motor responses, and coordinating multiple perceptual and cognitive tasks. Thus, attention is a multifaceted construct that is relevant at virtually all stages of object identification. A fundamental theme of attentional functioning is the interaction between the bottom-up salience of visual features and top-down allocation of processing based on the observer’s goals. An underlying age-related slowing is prominent throughout visual processing stages, which in turn contributes to age-related decline in some aspects of attention, such as the inhibition of irrelevant information and the coordination of multiple tasks. However, some age-related preservation of attentional functioning is also evident, particularly the top-down allocation of attention. Neuroimaging research has identified networks of frontal and parietal brain regions relevant for top-down and bottom-up attentional processing. Disconnection among these networks contributes to an age-related decline in attention, but preservation and perhaps even increased patterns of functional brain activation and connectivity also contribute to preserved attentional functioning.