Unexpected novel events generate an orienting response that plays an important role in some forms of learning and memory. The orienting response involuntarily captures attention and rapidly habituates as events become familiarized. Although evidence from patients with focal lesions and scalp and intracranial event-related brain potential recordings supports the involvement of a distributed neural network involving association cortex and the limbic system in novelty detection, the key neural substrates and temporal dynamics have not been defined. While subjects performed a bi-field visual-selective attention task with random novel stimuli embedded in either attended or unattended visual fields, we measured rapid changes of regional blood oxygenation level-dependent (BOLD) signal to target and novel stimuli using single-trial analysis of event-related functional magnetic resonance imaging with a 4T scanner. Habituation was quantified by serial BOLD signal changes during the first 10 novel stimuli for each subject. Novel stimuli activated the bilateral superior/middle frontal gyrus, temporal-parietal junction, superior parietal lobe, cingulate gyrus, hippocampus, and fusiform gyrus. The superior/middle frontal gyrus and hippocampus showed significant reduction of BOLD signal during the first few novel stimuli, whereas the signals in the fusiform and cingulate gyrus were constant. Prefrontal and hippocampal responses to attended and unattended novel stimuli were comparably habituated. These results, and previous data from lesion studies, support the view that prefrontal and hippocampal regions are involved in rapid automatic detection and habituation to unexpected environmental events and are key elements of the orienting response in humans.

Background: We have developed a new screening test for dementia that runs on an iPad and can be used for mass screening, known as the Cognitive Assessment for Dementia, iPad version (CADi). The CADi consists of items involving immediate recognition memory for three words, semantic memory, categorization of six objects, subtraction, backward repetition of digits, cube rotation, pyramid rotation, trail making A, trail making B, and delayed recognition memory for three words. The present study examined the reliability and validity of the CADi. Methods: CADi evaluations were conducted for patients with dementia, healthy subjects selected from a brain checkup system, and community-dwelling elderly people participating in health checkups. Results: CADi scores were lower for dementia patients than for healthy elderly individuals and correlated significantly with Mini-Mental State Examination scores. Cronbach’s alpha values for the CADi were acceptable (over 0.7), and test–retest reliability was confirmed via a significant correlation between scores separated by a one-year interval. Conclusion: These results suggest that the CADi is a useful tool for mass screening of dementia in Japanese populations.

People are typically quite sensitive about being accepted or excluded by others. Previous studies have suggested that the dorsal anterior cingulate cortex (dACC) is a key brain region involved in the detection of social exclusion. However, this region has also been shown to be sensitive to non-social expectancy violations. We often expect other people to follow an unwritten rule in which they include us as they would expect to be included, such that social exclusion likely involves some degree of expectancy violation. The present event-related functional magnetic resonance imaging (fMRI) study sought to separate the effects of expectancy violation from those of social exclusion, such that we employed an “overinclusion” condition in which a player was unexpectedly overincluded in the game by the other players. With this modification, we found that the dACC and right ventrolateral prefrontal cortex (rVLPFC) were activated by exclusion, relative to overinclusion. In addition, we identified a negative correlation between exclusion-evoked brain activity and self-rated social pain in the rVLPFC, but not in the dACC. These findings suggest that the rVLPFC is critical for regulating social pain, whereas the dACC plays an important role in the detection of exclusion. The neurobiological basis of social exclusion is different from that of mere expectancy violation.

Background and Purpose— Apathy is associated with decreased novelty-seeking behaviors and is a prevailing behavioral symptom after stroke affecting cortical and subcortical regions. We studied the relationship between apathetic state after subcortical stroke and neural orienting response to novel events using an event-related evoked potential (ERP) technique. Methods— Twenty-nine patients with subcortical ischemic stroke were grouped according to whether they showed apathy or not. We analyzed apathy state scaled by the modified Starkstein apathy score and auditory P3 ERP components evoked by task-relevant target stimuli (target P3) and task-irrelevant novel stimuli (novelty P3). Results— The apathetic group showed a significantly lower score of verbal fluency test and global cognitive function test compared with the nonapathetic group. The novelty P3 latency was significantly prolonged, and its amplitude was reduced over the frontal site in the apathy group. The apathy scale was correlated with the novelty P3 latency and amplitude at the frontal site. The target P3 measures were related to global cognitive function. Conclusions— The present study suggests that apathy after subcortical stroke is associated with impaired neural processing of novel events within the frontal–subcortical system and that the novelty P3 is a useful physiological measure for assessing apathy after stroke.

Atherosclerotic stenosis of major intracranial arteries is a leading cause of ischemic stroke in Asia. However, the long-term prognosis of asymptomatic intracranial atherosclerotic stenosis (ICAS) in healthy volunteers has not been fully examined. Here we conducted a longitudinal study to examine the prognosis of healthy volunteers with asymptomatic ICAS and to determine the risk factors for ICAS, including asymptomatic brain parenchymal lesions. We studied 2,807 healthy Japanese volunteers with no history of stroke (mean age, 62.0 years). They were followed for a mean interval of 64.5 months. The degree of ICAS and the presence of asymptomatic brain lesions were assessed by using magnetic resonance imaging. Asymptomatic ICAS was detected in 166 volunteers (5.9%) at the initial examination. Moderate and mild stenoses were observed in 1.5% and 4.4% of patients, respectively. Significant risk factors for ICAS were older age and a history of hypertension, and/or dyslipidemia. During follow-up, ischemic stroke developed in 32 volunteers. Seven strokes occurred in the ICAS group, whose stroke incidence rate was higher than that in the non-ICAS group (0.78% vs. 0.18% per year). According to a Cox regression analysis, asymptomatic ICAS was an independent risk factor for future ischemic stroke after adjustment for age. Furthermore, after asymptomatic brain lesions were taken into account, ICAS was still a significant risk factor for stroke onset. In conclusion, even mild to moderate asymptomatic ICAS was a significant risk factor for future stroke, independent of asymptomatic brain lesions, in a healthy Japanese population. Mild to moderate ICAS might be a therapeutic target for stroke prevention.

Early detection of dementia is crucial because it is the time when intervention is most effective. Therefore, a simple and short test is necessary for primary mass screening in community-based medical facilities. We developed the Cognitive Assessment for Dementia, iPad version (CADi) which consists of 10 simple questions and is self-administered. In this paper we present a revised version which improves the detection of dementia. Two questions of the CADi were replaced in the latest version (CADi2). We examined the validity and reliability of the CADi2 in 27 Alzheimer’s disease patients and age-matched healthy controls. The Alzheimer’s disease patients had lower CADi2 scores and longer total response times to questions compared to the controls. The CADi2 had high sensitivity (0.85−0.96) and specificity (0.81−0.93), and showed significant correlations with existing standard neuropsychological tests. Cronbach’s alpha analysis revealed moderate consistency of the CADi2. These results support the utility of the CADi2 for primary screening for dementia.