PSMD is a new, fully automated, and robust imaging marker for SVD. PSMD can easily be applied to large samples and may be of great utility for both research studies and clinical use. Ann Neurol 2016;80:581-592.

Background and PurposeNeurofilament light chain (NfL) is a blood marker for neuroaxonal damage. We assessed the association between serum NfL and cerebral small vessel disease (SVD), which is highly prevalent in elderly individuals and a major cause of stroke and vascular cognitive impairment. MethodsUsing a cross-sectional design, we studied 53 and 439 patients with genetically defined SVD (Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy [CADASIL]) and sporadic SVD, respectively, as well as 93 healthy controls. Serum NfL was measured by an ultrasensitive single-molecule array assay. We quantified magnetic resonance imaging (MRI) markers of SVD, i.e., white matter hyperintensity volume, lacune volume, brain volume, microbleed count, and mean diffusivity obtained from diffusion tensor imaging. Clinical characterization included neuropsychological testing in both SVD samples. CADASIL patients were further characterized for focal neurological deficits (National Institutes of Health stroke scale [NIHSS]) and disability (modified Rankin scale [mRS]). ResultsSerum NfL levels were elevated in both SVD samples (P<1e-05 compared with controls) and associated with all SVD MRI markers. The strongest association was found for mean diffusivity (CADASIL, R2=0.52, P=1.2e-09; sporadic SVD, R2=0.21, P<1e-15). Serum NfL levels were independently related to processing speed performance (CADASIL, R2=0.27, P=7.6e-05; sporadic SVD, R2=0.06, P=4.8e-08), focal neurological symptoms (CADASIL, NIHSS, P=4.2e-05) and disability (CADASIL, mRS, P=3.0e-06). ConclusionsWe found serum NfL levels to be associated with both imaging and clinical features of SVD. Serum NfL might complement MRI markers in assessing SVD burden. Importantly, SVD needs to be considered when interpreting serum NfL levels in the context of other age-related diseases.

The role attention plays in our experience of a coherent, multisensory world is still controversial. On the one hand, a subset of inputs may be selected for detailed processing and multisensory integration in a top-down manner, i.e., guidance of multisensory integration by attention. On the other hand, stimuli may be integrated in a bottom-up fashion according to low-level properties such as spatial coincidence, thereby capturing attention. Moreover, attention itself is multifaceted and can be described via both top-down and bottom-up mechanisms. Thus, the interaction between attention and multisensory integration is complex and situation-dependent. The authors of this opinion paper are researchers who have contributed to this discussion from behavioural, computational and neurophysiological perspectives. We posed a series of questions, the goal of which was to illustrate the interplay between bottom-up and top-down processes in various multisensory scenarios in order to clarify the standpoint taken by each author and with the hope of reaching a consensus. Although divergence of viewpoint emerges in the current responses, there is also considerable overlap: In general, it can be concluded that the amount of influence that attention exerts on MSI depends on the current task as * Equal contribution (ordered alphabetically). ** Equal contribution. *** To whom correspondence should be addressed. E-mail: hartcher@isir.upmc.fr; Ruth.Adam@med.uni-muenchen.de Macaluso et al. / Multisensory Research (2016) well as prior knowledge and expectations of the observer. Moreover stimulus properties such as the reliability and salience also determine how open the processing is to influences of attention.

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Capacity limitations of attentional resources allow only a fraction of sensory inputs to enter our awareness. Most prominently, in the attentional blink the observer often fails to detect the second of two rapidly successive targets that are presented in a sequence of distractor items. To investigate how auditory inputs enable a visual target to escape the attentional blink, this study presented the visual letter targets T1 and T2 together with phonologically congruent or incongruent spoken letter names. First, a congruent relative to an incongruent sound at T2 rendered visual T2 more visible. Second, this T2 congruency effect was amplified when the sound was congruent at T1 as indicated by a T1 congruency × T2 congruency interaction. Critically, these effects were observed both when the sounds were presented in synchrony with and prior to the visual target letters suggesting that the sounds may increase visual target identification via multiple mechanisms such as audiovisual priming or decisional interactions. Our results demonstrate that a sound around the time of T2 increases subjects' awareness of the visual target as a function of T1 and T2 congruency. Consistent with Bayesian causal inference, the brain may thus combine (1) prior congruency expectations based on T1 congruency and (2) phonological congruency cues provided by the audiovisual inputs at T2 to infer whether auditory and visual signals emanate from a common source and should hence be integrated for perceptual decisions.

The fate of subcortical diffusion-weighted imaging (DWI) lesions in stroke patients is highly variable, ranging from complete tissue loss to no visible lesion on follow-up. Little is known about within-lesion heterogeneity and its relevance for stroke outcome. Patients with subcortical stroke and recruited through the prospective DEDEMAS study (NCT01334749) were examined at baseline ( n = 45), six months ( n = 45), and three years ( n = 28) post-stroke. We performed high-resolution structural MRI including DWI. Tissue fate was determined voxel-wise using fully automated tissue segmentation. Within-lesion heterogeneity at baseline was assessed by free water diffusion imaging measures. The majority of DWI lesions (66%) showed cavitation on six months follow-up but the proportion of tissue turning into a cavity was small (9 ± 13.5% of the DWI lesion). On average, 69 ± 25% of the initial lesion resolved without any visually apparent signal abnormality. The extent of cavitation at six months post-stroke was independently associated with clinical outcome, i.e. modified Rankin scale score at six months (OR = 4.71, p = 0.005). DWI lesion size and the free water-corrected tissue mean diffusivity at baseline independently predicted cavitation. In conclusion, the proportion of cavitating tissue is typically small, but relevant for clinical outcome. Within-lesion heterogeneity at baseline on advanced diffusion imaging is predictive of tissue fate.

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BackgroundVertebrate brains are composed of two hemispheres that receive input, compute, and interact to form a unified response. How the partially different processes of both hemispheres are integrated to create a single output is largely unknown. In some cases one hemisphere takes charge of the response selection – a process known as metacontrol. Thus far, this phenomenon has only been shown in a handful of studies with primates, mostly conducted in humans. Metacontrol, however, is even more relevant for animals like birds with laterally placed eyes and complete chiasmatic decussation since visual input to the hemispheres is largely different.Methodology/Principal FindingsHoming pigeons (Columba livia) were trained with a color discrimination task. Each hemisphere was trained with a different color pair and therefore had a different experience. Subsequently, the pigeons were binocularly examined with two additional stimuli that combined the positive color of one hemisphere with a negative color that had been shown to the other, omitting the availability of a coherent solution and confronting the pigeons with a conflicting situation. Some of the pigeons responded to both stimuli, indicating that none of the hemispheres dominated the overall preference. Some birds, however, responded primarily to one of the conflicting stimuli, showing that they based their choice on the left- or right-monocularly learned color pair, indicating hemispheric metacontrol.Conclusions/SignificanceWe could demonstrate for the first time that metacontrol is a widespread phenomenon that also exists in birds, and thus in principle requires no corpus callosum. Our results are closely similar to those in humans: monocular performance was higher than binocular one and animals displayed different modes of hemispheric dominance. Thus, metacontrol is a dynamic and widely distributed process that possibly constitutes a requirement for all animals with a bipartite brain to confront the problem of choosing between two hemisphere-bound behavioral options.