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Although dysfunction of the visual system and dysfunctional eye movements during sporadic Parkinson's disease have been reported for more than 40 years, they have never been the focus of early and/or differential diagnosis. To date Parkinson's disease-related α-synuclein aggregates, i.e., Lewy pathology, are not known to develop either in the retina or in other components of the visual system. In a clinical context it is currently possible to test the involvement of the respective functional systems by means of optical coherence tomography and video oculography. Moreover, non-motor-related abnormalities are detectable both during psychophysical testing of visuospatial function as well as in the form of measurable deficits of color perception. These deficits of the visual and oculomotor systems could prove to be suitable candidates for diagnosing sporadic Parkinson's disease in its early phase in a non-invasive manner. This article is intended to provide an overview of the fundamental pathophysiological principles and clinical aspects of visual system involvement in sporadic Parkinson's disease together with currently available differential diagnostic options.

Adaptation to a given face leads to face-related, specific after-effects. Recently, this topic has attracted a lot of attention because it clearly shows that adaptation occurs even at the higher stages of visual cortical processing. However, during our every-day life, faces do not appear in isolation, rather they are usually surrounded by other stimuli. Here, we used psychophysical and fMRI adaptation methods to test whether humans adapt to the gender properties of a composite multiple face stimulus as well. As adaptors we used stimuli composed of eight different individual faces, positioned peripherally in a ring around a fixation mark. We found that the gender discrimination of a subsequent centrally presented target face is significantly biased as a result of long-term adaptation to either male or female multiple face stimuli. Similar to our previous results with single-face adaptors (Kovács et al. in Neuroimage 43(1):156-164, 2008), a concurrent functional magnetic resonance imaging adaptation experiment revealed the strongest blood oxygen level-dependent signal adaptation bilaterally in the fusiform face area. Our results suggest that humans extract the statistical features of the multiple face stimulus and this process occurs at the level of occipito-temporal face processing.

Although it is known that sounds can affect visual perception, the neural correlates for crossmodal interactions are still disputed. Previous tracer studies in non-human primates revealed direct anatomical connections between auditory and visual brain areas. We examined the structural connectivity of the auditory cortex in normal humans by diffusion-weighted tensor magnetic resonance imaging and probabilistic tractography. Tracts were seeded in Heschl's region or the planum temporale. Fibres crossed hemispheres at the posterior corpus callosum. Ipsilateral fibres seeded in Heschl's region projected to the superior temporal sulcus, the supramarginal gyrus and intraparietal sulcus and the occipital cortex including the calcarine sulcus. Fibres seeded in the planum temporale terminated primarily in the superior temporal sulcus, the supramarginal gyrus, the central sulcus and adjacent regions. Our findings suggest the existence of direct white matter connections between auditory and visual cortex--in addition to subcortical, temporal and parietal connections.

The concept of perceptual memory refers to the neural and cognitive processes underlying the storage of specific stimulus features such as spatial frequency, orientation, shape, contrast, and color. Psychophysical studies of perceptual memory indicate that observers can retain visual information about the spatial frequency of Gabor patterns independent of the orientation with which they are presented. Compared to discrimination of gratings with the same orientation, reaction times to orthogonally oriented gratings, however, increase suggesting additional processing. Using event-related fMRI we examined the pattern of neural activation evoked when subjects discriminated the spatial frequency of Gabors presented with the same or orthogonal orientation. Blood-oxygen level dependent BOLD fMRI revealed significantly elevated bilateral activity in visual areas (V1, V2) when the gratings to be compared had an orthogonal orientation, compared to when they had the same orientation. These findings suggest that a change in an irrelevant stimulus dimension requires additional processing in primary and secondary visual areas. The finding that the task-irrelevant stimulus property (orientation) had no significant effect on the prefrontal and intraparietal cortex supports a model of working memory in which discrimination and retention of basic stimulus dimensions is based on low-level perceptual memory stores that are located at an early stage in the visual process. Our findings suggest that accessing different stores requires time and has higher metabolic costs.

Corrective saccades are small eye movements that redirect gaze whenever the actual eye position differs from the desired eye position. In contrast to various forms of saccades including pro-saccades, recentering-saccades or memory guided saccades, corrective saccades have been widely neglected so far. The fMRI correlates of corrective saccades were studied that spontaneously occurred during fixation, pursuit or saccadic tasks. Eyetracking was performed during the fMRI data acquisition with a fiber-optic device. Using a combined block and event-related design, we isolated the cortical activations associated with visually guided fixation, pursuit or saccadic tasks and compared these to the activation associated with the occurrence of corrective saccades. Neuronal activations in anterior inferior cingulate, bilateral middle and inferior frontal gyri, bilateral insula and cerebellum are most likely specifically associated with corrective saccades. Additionally, overlapping activations with the established pro-saccade and, to a lesser extent, pursuit network were present. The presented results imply that corrective saccades represent a potential systematic confound in eye-movement studies, in particular because the frequency of spontaneously occurring corrective saccades significantly differed between fixation, pursuit and pro-saccades.

A frequent approach to study interactions of the auditory and the visual system is to measure event-related potentials (ERPs) to auditory, visual, and auditory-visual stimuli (A, V, AV). A nonzero result of the AV - (A + V) comparison indicates that the sensory systems interact at a specific processing stage. Two possible biases weaken the conclusions drawn by this approach: first, subtracting two ERPs from one requires that A, V, and AV do not share any common activity. We have shown before (Gondan and Röder in Brain Res 1073-1074:389-397, 2006) that the problem of common activity can be avoided using an additional tactile stimulus (T) and evaluating the ERP difference (T + TAV) - (TA + TV). A second possible confound is the modality shift effect (MSE): for example, the auditory N1 is increased if an auditory stimulus follows a visual stimulus, whereas it is smaller if the modality is unchanged (ipsimodal stimulus). Bimodal stimuli might be affected less by MSEs because at least one component always matches the preceding trial. Consequently, an apparent amplitude modulation of the N1 would be observed in AV. We tested the influence of MSEs on auditory-visual interactions by comparing the results of AV - (A + V) using (a) all stimuli and using (b) only ipsimodal stimuli. (a) and (b) differed around 150 ms, this indicates that AV - (A + V) is indeed affected by the MSE. We then formally and empirically demonstrate that (T + TAV) - (TA + TV) is robust against possible biases due to the MSE.

Current evidence supports the proposal that the cerebellum mediates the activity of other brain areas involved in the control of eye movements. Most of the evidence so far has concentrated on the vermis and flocculi as the cerebellar agents of oculomotor control. But there is also evidence for an involvement of the cerebellar hemispheres in eye movement control. Straube et al. (Ann Neurol 42:891-898, 1997) showed that lateral hemispheric lesions affect initiation of smooth pursuit (SPEM) and saccadic eye movements. Ron and Robinson (J Neurophysiol 36:1004-1022, 1973) evoked smooth pursuit and saccadic eye movements by electrical stimulation of crus I and II, as well as in the dentate nuclei of the monkey. Functional MRI studies also provide evidence that the cerebellar hemispheres play a significant role in SPEM and saccadic eye movements. To clarify the role of the cerebral hemispheres in eye movement control we compared the eye movement related blood oxygen level dependent (BOLD) responses of 12 patients with cerebellar lesions due to stroke with those of an aged-matched healthy control group. Six patients showed oculomotor abnormalities such as dysmetric saccades or saccadic SPEM during the experiment. The paradigm consisted of alternating blocks of fixation, visually guided saccades and visually guided SPEM. A nonparametric random-effects group analysis showed a degraded pattern of activation in the patient group during the performance of SPEM and saccadic eye movements in posterior parietal areas putatively containing the parietal eye fields.

Using an uncertainty paradigm and functional magnetic resonance imaging (fMRI) we studied the effect of nonspatial selective and divided visual attention on the activity of specific areas of human extrastriate visual cortex. The stimuli were single ovals that differed from an implicit standard oval in either colour or width. The subjects' task was to classify the current stimulus as one of two possible alternatives per stimulus dimension. Three different experimental conditions were conducted: "colour-certainty", "shape-certainty" and "uncertainty". In all experimental conditions, the stimulus differed in only one stimulus dimension per trial. In the two certainty conditions, the subjects knew in advance which dimension this would be. During the uncertainty condition they had no such previous knowledge and had to monitor both dimensions simultaneously. Statistical analysis of the fMRI data (with SPM2) revealed a modest effect of the attended stimulus dimension on the neural activity in colour sensitive area V4 (more activity during attention to colour) and in shape sensitive area LOC (more activity during attention to shape). Furthermore, cortical areas known to be related to attention and working memory processes (e.g., lateral prefrontal and posterior parietal cortex) exhibit higher activity during the condition of divided attention ("uncertainty") than during that of selective attention ("certainty").

Using functional magnetic resonance imaging (fMRI), we explored the binocular interactions occurring when subjects viewed dichoptically presented checkerboard stimuli. A flickering radial checkerboard was presented to each eye of the subject, while T2*-weighted images were acquired over the visual cortex with gradient-echo, echoplanar sequences. We compared responses in striate and extrastriate visual cortex under four conditions: both eyes were stimulated at the same time (binocular condition), each eye was stimulated in alternation (monocular condition) or first the one eye then the other eye was stimulated (left eye first - right eye trailing, or vice versa). The results indicate that only the striate area, in and near the calcarine fissure, shows significant differences for these stimulation conditions. These differences are not evident in more remote extrastriate or associational visual areas, although the BOLD response in the stimulation-rest comparison was robust. These results suggest that the effect could be related to inhibitory interactions across ocular dominance columns in striate visual cortex.

We examined whether the frontal eye fields (FEF) are involved in the suppression of reflexive saccades. Simultaneous recording of horizontal eye movements and functional magnetic resonance imaging enabled us to perform a randomized pro- and antisaccade task and to sort blood oxygenation level dependent (BOLD) time series on the basis of task performance. Saccadic reaction time distributions were comparable across tasks indicating a similar effort in preprocessing of the saccades. Furthermore, we found similar BOLD activation in FEF during both correctly performed pro- and antisaccades. Frontal eye field activation started prior to target presentation and saccade generation. While we observed only few erroneous antisaccades, these were associated with a decrease in BOLD activity prior to target presentation, and increased BOLD activity after target presentation relative to correctly performed antisaccades. These findings are consistent with a role of the FEF in the suppression of reflexive saccades. The increase in activity after target presentation for antisaccade errors can only be indirectly linked to such a role but may also reflect activity related to the generation of a correction saccade. Frontal eye field BOLD activity may further represent general arousal, preparatory set, short-term memory, or salience-map related activity.

Event related potentials (ERPs) were recorded during delayed discrimination of simple spatial frequency gratings in the high and low frequency bands. Analyses of the waveforms N170, P220, N310, P400, and slow wave (SW) indicated significant and regionally specific interaction of spatial frequency and hemisphere for N170 amplitude. This interaction was independent of memory conditions, and appeared to be in the opposite direction of what is predicted by the spatial frequency model of hemispheric asymmetry. Additional interactions between spatial frequency and hemisphere were observed for N310 in the encoding process (reference stimulus) and for SW in the retrieval process (test stimulus). The general hypothesis of an interaction of spatial frequency and hemisphere in visual cognition is supported, but the findings indicate caution in interpreting an increase in physiological measures as an indication of more efficient brain processing. Moreover, several stages of information processing may contribute to the asymmetry observed in behavioral studies, and hemispheric balance may change dynamically during the time course of processing.

We investigated the quantitative relationship between saccadic activity (as reflected in frequency of occurrence and amplitude of saccades) and blood oxygenation level dependent (BOLD) changes in the cerebral cortex using functional magnetic resonance imaging (fMRI). Furthermore, we investigated quantitative changes in cortical activity associated with qualitative changes in the saccade task for comparable levels of saccadic activity. All experiments required the simultaneous acquisition of eye movement and fMRI data. For this purpose we used a new high-resolution limbus-tracking technique for recording eye movements in the magnetic resonance tomograph. In the first two experimental series we varied both frequency and amplitude of saccade stimuli (target jumps). In the third series we varied task difficulty; subjects performed either pro-saccades or anti-saccades. The brain volume investigated comprised the frontal and supplementary eye fields, parietal as well as striate cortex, and the motion sensitive area of the parieto-occipital cortex. All these regions showed saccade-related BOLD responses. The responses in these regions were highly correlated with saccade frequency, indicating that repeated processing of saccades is integrated over time in the BOLD response. In contrast, there was no comparable BOLD change with variation of saccade amplitude. This finding speaks for a topological rather than activity-dependent coding of saccade amplitudes in most cortical regions. In the experiments comparing pro- vs anti-saccades we found higher BOLD activation in the "anti" task than in the "pro" task. A comparison of saccade parameters revealed that saccade frequency and cumulative amplitude were comparable between the two tasks, whereas reaction times were longer in the "anti" task than the pro task. The latter finding is taken to indicate a more demanding cortical processing in the "anti" task than the "pro" task, which could explain the observed difference in BOLD activation. We hold that a quantitative analysis of saccade parameters (especially saccade frequency and latency) is important for the interpretation of the BOLD changes observed with visual stimuli in fMRI.

The processing of optic flow fields in motion-sensitive areas in human visual cortex was studied with BOLD (blood oxygen level dependent) contrast in functional magnetic resonance imaging (fMRI). Subjects binocularly viewed optic flow fields in plane (monoptic) or in stereo depth (dichoptic) with various degrees of disparity and increasing radial speed. By varying the directional properties of the stimuli (expansion, spiral motion, random), we explored whether the BOLD effect reflected neuronal responses to these different forms of optic flow. The results suggest that BOLD contrast as assessed by fMRI methods reflects the neural processing of optic flow information in motion-sensitive cortical areas. Furthermore, small but replicable disparity-selective responses were found in parts of Brodmann's area 19.

The cortical areas underlying successive spatial-frequency discrimination were explored using functional magnetic resonance imaging (fMRI). In a steady-state, block-design paradigm, 12 subjects viewed a single fixation cross during a rest period, followed by an activation period consisting of the presentation of horizontal (distractors) and vertical (targets) sinewave gratings. Two tasks were performed: in the control task, subjects pressed a button after the second vertical grating was presented within each trial; in the discrimination task, subjects decided which target grating had the higher spatial frequency. Post-processing consisted of off-line image registration to correct for head motion, spatial and temporal smoothing, and cross-correlation between each voxel time course and a phase-shifted stimulus time profile. The results indicate that striate, extrastriate, parietal, and prefrontal areas show significant BOLD (blood oxygen level dependent) effects during both discrimination and control tasks, with consistently higher activity levels in the discrimination task.

We present a method for recording saccadic and pursuit eye movements in the magnetic resonance tomograph designed for visual functional magnetic resonance imaging (fMRI) experiments. To reliably classify brain areas as pursuit or saccade related it is important to carefully measure the actual eye movements. For this purpose, infrared light, created outside the scanner by light-emitting diodes (LEDs), is guided via optic fibers into the head coil and onto the eye of the subject. Two additional fiber optical cables pick up the light reflected by the iris. The illuminating and detecting cables are mounted in a plastic eyepiece that is manually lowered to the level of the eye. By means of differential amplification, we obtain a signal that covaries with the horizontal position of the eye. Calibration of eye position within the scanner yields an estimate of eye position with a resolution of 0.2 degrees at a sampling rate of 1000 Hz. Experiments are presented that employ echoplanar imaging with 12 image planes through visual, parietal and frontal cortex while subjects performed saccadic and pursuit eye movements. The distribution of BOLD (blood oxygen level dependent) responses is shown to depend on the type of eye movement performed. Our method yields high temporal and spatial resolution of the horizontal component of eye movements during fMRI scanning. Since the signal is purely optical, there is no interaction between the eye movement signals and the echoplanar images. This reasonably priced eye tracker can be used to control eye position and monitor eye movements during fMRI.

Event-related potentials (ERP) were recorded during perceptual discrimination and short-term memory, varying the interstimulus interval (1-10 s) in delayed spatial frequency discrimination. Accuracy of discrimination remained unimpaired across this time interval, but choice reaction times increased. A brain source localization (BESA) model showed that the activity of the parietal and right temporal sources increased with long retention intervals in a sequential activation pattern where a long-latency component of the parietal source specific to the memory condition was observed, the latency of which matched a memory-related increase in choice reaction times in the cognitive task. It is suggested that the temporal sources are involved in encoding and storage of visual information, and the parietal source is involved in memory retrieval.

We have studied the effects of pursuit eye movements on the functional magnetic resonance imaging (fMRI) responses in extrastriate visual areas during visual motion perception. Echoplanar imaging of 10-12 image planes through visual cortex was acquired in nine subjects while they viewed sequences of random-dot motion. Images obtained during stimulation periods were compared with baseline images, where subjects viewed a blank field. In a subsidiary experiment, responses to moving dots, viewed under conditions of fixation or pursuit, were compared with those evoked by static dots. Eye movements were recorded with MR-compatible electro-oculographic (EOG) electrodes. Our findings show an enhanced level of activation (as indexed by blood-oxygen level-dependent contrast) during pursuit compared with fixation in two extrastriate areas. The results support earlier findings on a motion-specific area in lateral occipitotemporal cortex (human V5). They also point to a further site of activation in a region approximately 12 mm dorsal of V5. The fMRI response in V5 during pursuit is significantly enhanced. This increased response may represent additional processing demands required for the control of eye movements.