Effect of midazolam on memory: a study of process dissociation procedure and functional magnetic resonance imaging

To assess the effects of midazolam on explicit and implicit memories, 12 volunteers were randomly divided into the two groups: one with an Observer’s Assessment of Alertness/Sedation score of 3 (mild sedation) and one with a score of 1 (deep sedation). Blood oxygen‐level‐dependent functional magnetic resonance imaging was measured before and during an auditory stimulus, then with midazolam sedation, and then during a second auditory stimulus with continuous midazolam sedation. After 4 h, explicit and implicit memories were assessed. There was no evidence of explicit memory at the two levels of midazolam sedation. Implicit memory was retained at a mild level of midazolam sedation but absent at a deep level of midazolam sedation. At a mild level of midazolam sedation, activation of all brain areas by auditory stimulus (as measured by functional magnetic resonance imaging) was uninhibited. However, a deep level of midazolam sedation depressed activation of the superior temporal gyrus by auditory stimulus. We conclude that midazolam does not abolish implicit memory at a mild sedation level, but can abolish both explicit and implicit memories at a deep sedation level. The superior temporal gyrus may be one of the target areas.     

Cross-modal binding and activated attentional networks during audio-visual speech integration: a functional MRI study

We evaluated the neural substrates of cross-modal binding and divided attention during audio-visual speech integration using functional magnetic resonance imaging. The subjects (n = 17) were exposed to phonemically concordant or discordant auditory and visual speech stimuli. Three different matching tasks were performed: auditory-auditory (AA), visual-visual (VV) and auditory-visual (AV). Subjects were asked whether the prompted pair were congruent or not. We defined the neural substrates for the within-modal matching tasks by VV-AA and AA-VV. We defined the cross-modal area as the intersection of the loci defined by AV-AA and AV-VV. The auditory task activated the bilateral anterior superior temporal gyrus and superior temporal sulcus, the left planum temporale and left lingual gyrus. The visual task activated the bilateral middle and inferior frontal gyrus, right occipito-temporal junction, intraparietal sulcus and left cerebellum. The bilateral dorsal premotor cortex, posterior parietal cortex (including the bilateral superior parietal lobule and the left intraparietal sulcus) and right cerebellum showed more prominent activation during AV compared with AA and VV. Within these areas, the posterior parietal cortex showed more activation during concordant than discordant stimuli, and hence was related to cross-modal binding. Our results indicate a close relationship between cross-modal attentional control and cross-modal binding during speech reading.     

MR磁化传递对比成像观察新生儿轻度窒息

目的观察MR磁化传递对比(MTC)成像在轻度窒息新生儿中的应用价值。方法对15例轻度窒息新生儿(Apgar评分10分,病例组)及25名正常新生儿(对照组)采集脑常规T1WI、3D-T1WI和T1WI-MTC,计算脑磁化率(MTR),配准于标准新生儿脑模板后行统计分析。采用3dRegAna对病例组MTR与Apgar评分进行回归分析。结果相比对照组,病例组右颞极、左颞下回、左额上回、右缘上回、右眶额皮质、左额中叶、右额中回及左上额叶MTR显著降低;右梭状回、右顶叶下回、右枕中回、右颞中回、右颞下回、右颞上极、右楔叶、右角回、右舌回及右颞上回MTR显著增加。回归分析显示,病例组左中央后回、右颞下叶(前)、右额中回、右颞上极、左眶额皮质及右颞下叶(后)MTR与Apgar评分呈正相关,右壳核、右眶额皮质、左杏仁核、右颞下回、左舌回、右舌回、左颞中回、左枕中回、延髓及右梭状回呈负相关。组间MTR差异有统计学意义、且病例组MTR与Apgar评分呈正相关脑区为右额中叶、右颞极,呈负相关脑区则为右舌叶及右梭状回。结论 MR MTC成像能检出轻度窒息新生儿缺血缺氧脑区;缺血缺氧主要导致新生儿右侧脑损害。     

Idiom comprehension: a prefrontal task?

We investigated the neural correlates of idiomatic sentence processing using event-related functional magnetic resonance imaging. Twenty-two healthy subjects were presented with 62 literal sentences and 62 idiomatic sentences, each followed by a picture and were required to judge whether the sentence matched the picture or not. A common network of cortical activity was engaged by both conditions, with the nonliteral task eliciting overall greater activation, both in terms of magnitude and spatial extent. The network that was specifically activated by the nonliteral condition involved the left temporal cortex, the left superior medial frontal gyrus (Brodmann area 9), and the left inferior frontal gyrus (IFG). Activations were also present in the right superior and middle temporal gyri and temporal pole and in the right IFG. In contrast, literal sentences selectively activated the left inferior parietal lobule and the right supramarginal gyrus. An analysis of effective connectivity indicated that the medial prefrontal area significantly increased the connection between frontotemporal areas bilaterally during idiomatic processing. Overall, the present findings indicate a crucial role of the prefrontal cortex in idiom comprehension, which could reflect the selection between alternative sentence meanings.     

Specific brain networks during explicit and implicit decoding of emotional prosody

To better define the underlying brain network for the decoding of emotional prosody, we recorded high-resolution brain scans during an implicit and explicit decoding task of angry and neutral prosody. Several subregions in the right superior temporal gyrus (STG) and bilateral in the inferior frontal gyrus (IFG) were sensitive to emotional prosody. Implicit processing of emotional prosody engaged regions in the posterior superior temporal gyrus (pSTG) and bilateral IFG subregions, whereas explicit processing relied more on mid STG, left IFG, amygdala, and subgenual anterior cingulate cortex. Furthermore, whereas some bilateral pSTG regions and the amygdala showed general sensitivity to prosody-specific acoustical features during implicit processing, activity in inferior frontal brain regions was insensitive to these features. Together, the data suggest a differentiated STG, IFG, and subcortical network of brain regions, which varies with the levels of processing and shows a higher specificity during explicit decoding of emotional prosody.     

Functional Anatomy of Reaching and Visuomotor Learning: A Positron Emission Tomography Study

The purpose of this study was to identify the functional corticalfields involved in reaching for targets in extrapersonal space,and to identify the specific fields representing visual targetinformation in long-term memory. Ten healthy subjects were askedto learn the positions of seven circular targets that were repeatedlyprojected on a screen. The regional cerebral blood flow wasmeasured with positron emission tomography during a rest state,at an early learning stage, at a later learning stage, and finallyat 30 min after the course of learning had been completed. MeanrCBF change images for each task minus rest were calculatedand fields of significant rCBF changes were identified. In all three task states, cortical fields were consistentlyactivated in the left motor and premotor areas, the posteriorpart of the superior parietal lobule, and the right angulargyrus. When learning of the target positions had been achieved,additional fields appeared bilaterally in the posterior partof the superior parietal lobule, the right superior occipitalgyrus, the left motor and premotor areas, the medial aspectof the superior frontal gyrus, the postcentral gyrus, the superiorpart of the cuneus, the inferior part of the angular gyrus,and the anterior part of the insula. The results indicate thatthere are at least two different types of functional fieldsin the posterior part of the superior parietal lobule; one isactive during reaching for the targets when guided by internalrepresentations of target positions; the other likely representsthe storage sites of visual target information that is addressedin long-term memory.     

Being awake intermittently during propofol-induced hypnosis: a study of BIS, explicit and implicit memory

BACKGROUND: Being awake during anaesthesia is a serious complication. An anaesthetic depth monitor must discriminate in real time between wakefulness and unconsciousness. The present study created a period of wakefulness during propofol-induced hypnosis. Bispectral index (BIS), explicit and implicit memories of the awake period were investigated. METHODS: Ten volunteers were studied. The calculated brain concentration of a target controlled infusion of propofol was increased until loss of response (LOR) to verbal command and then propofol was stopped. When fully awake, volunteers were presented with a picture, sound and smell. Propofol infusion was restarted until LOR and then ceased. BIS and the calculated brain concentration of propofol were recorded every minute. A structured interview was conducted for explicit memories after awakening and for explicit as well as implicit memories the day after. RESULTS: Median BIS-index for the transition between awake and asleep and vice versa differed significantly. It was not possible, however, to establish any threshold value or zone for discriminating between wakefulness and LOR due to the large inter-individual variations in BIS-index. No volunteer could explicitly recall any of the stimuli presented during the period of wakefulness. CONCLUSION: The BIS-index decreases with increasing sedation but because of the large individual variations, the real-time BIS-index for the individual subject cannot reliably discriminate wakefulness from unconsciousness during propofol infusion. Propofol causes such profound amnesia that lack of postoperative recall does not assure that episodes of awareness have not occurred during propofol-induced hypnosis.     

Delineation of the middle longitudinal fascicle in humans: a quantitative, in vivo, DT-MRI study

Experimental and imaging studies in monkeys have outlined various long association fiber bundles within the temporoparietal region. In the present study the trajectory of the middle longitudinal fascicle (MdLF) has been delineated in 4 human subjects using diffusion tensor magnetic resonance imaging segmentation and tractography. The MdLF seems to extend from the inferior parietal lobule (IPL), specifically the angular gyrus, to the temporal pole remaining within the white matter of the superior temporal gyrus (STG). Comparison of the superior longitudinal fascicle II-arcuate fascicle (SLF II-AF) with the MdLF in the same subjects revealed that MdLF is located in a medial and caudal position relative to SLF II-AF and that it extends more rostrally. Given the location of MdLF between the IPL (angular gyrus) and the STG, it is suggested that MdLF could have a role in language and attention functions.     

Sound to language: different cortical processing for first and second languages in elementary school children as revealed by a large-scale study using fNIRS

A large-scale study of 484 elementary school children (6-10 years) performing word repetition tasks in their native language (L1-Japanese) and a second language (L2-English) was conducted using functional near-infrared spectroscopy. Three factors presumably associated with cortical activation, language (L1/L2), word frequency (high/low), and hemisphere (left/right), were investigated. L1 words elicited significantly greater brain activation than L2 words, regardless of semantic knowledge, particularly in the superior/middle temporal and inferior parietal regions (angular/supramarginal gyri). The greater L1-elicited activation in these regions suggests that they are phonological loci, reflecting processes tuned to the phonology of the native language, while phonologically unfamiliar L2 words were processed like nonword auditory stimuli. The activation was bilateral in the auditory and superior/middle temporal regions. Hemispheric asymmetry was observed in the inferior frontal region (right dominant), and in the inferior parietal region with interactions: low-frequency words elicited more right-hemispheric activation (particularly in the supramarginal gyrus), while high-frequency words elicited more left-hemispheric activation (particularly in the angular gyrus). The present results reveal the strong involvement of a bilateral language network in children's brains depending more on right-hemispheric processing while acquiring unfamiliar/low-frequency words. A right-to-left shift in laterality should occur in the inferior parietal region, as lexical knowledge increases irrespective of language.     

Bilateral activation of fronto-parietal networks by incrementing demand in a working memory task

Working memory (WM) is known to activate the prefrontal cortex. In the present study we hypothesized that when additional contingencies are added to the instruction of a WM task, this would increase the WM load and result in the activation of additional prefrontal areas. With positron emission tomography we measured regional cerebral blood flow in nine subjects performing a control task and two delayed matching to sample tasks, in which the subjects were matching colours and patterns to a reference picture. The second of the two delayed matching tasks had a more complex instruction than the first, with additional contingencies of how to alternate between the matching of colours and patterns. This task thus required the subjects not only to remember a stimulus to match but also to perform this matching according to a specified plan. Both delayed matching tasks activated cortical fields in the middle frontal gyrus, the frontal operculum, upper cingulate gyrus, inferior parietal cortex and cortex lining the intraparietal sulcus, all in the left hemisphere. When alternated delayed matching was compared to simple delayed matching, increases were located in the right superior and middle frontal gyrus and the right anterior inferior parietal cortex. The increased demand during alternated matching thus resulted in bilateral activation of both dorsolateral prefrontal and inferior parietal cortex. The area in the inferior parietal cortex has previously been coactivated with the dorsolateral prefrontal cortex in several WM tasks, irrespective of the sensory modality of the stimuli, and during tasks involving planning.      

Comparison of a new composite index based on midlatency auditory evoked potentials and electroencephalographic parameters with bispectral index (BIS) during moderate propofol sedation

BACKGROUND AND OBJECTIVE: Derived parameters of the electroencephalogram and auditory evoked potentials can be used to determine depth of anaesthesia and sedation. However, it is not known whether any parameter can identify the occurrence of awareness in individual patients. We have compared the performance of bispectral index and a new composite index derived from auditory evoked potentials and the electroencephalogram (AAI 1.61) in predicting consciousness, explicit and implicit memory during moderate sedation with propofol. METHODS: Twenty-one patients with spinal anaesthesia received intraoperatively propofol at the age-corrected C(50) for loss of consciousness and were presented test words via headphones. Bispectral index and AAI 1.61 (auditory evoked potentials, AEP-Monitor2) were recorded in parallel as well as the Observer's Assessment of Alertness/Sedation-score. Postoperatively, testing for explicit and implicit memory formation was performed. RESULTS: Bispectral index and AAI 1.61 correlated well with loss of consciousness defined by an Observer's Assessment of Alertness/Sedation-score of 2 (identical P(K) of 0.87), but did not allow a prediction of postoperative explicit or implicit recall. CONCLUSIONS: Both bispectral index and AAI may be indices of depth of sedation rather than indicators of memory formation, which persists during propofol sedation even after loss of consciousness.     

Is there implicit memory after propofol sedation?

Recent evidence indicates that implicit memory may be preserved during general anaesthesia. We tested for the presence of explicit and implicit memory in patients undergoing surgical procedures with local or regional anaesthesia and sedation with propofol. Initial i.v. boluses of propofol 0.5 mg kg-1 and fentanyl 1 microgram kg-1 were administered, followed by an infusion of propofol 50 micrograms kg-1 min-1. Administration of one or more doses of propofol 30 mg i.v. during operation was controlled either by the patient or the anaesthetist. At the start of the last skin stitch, patients were presented with a list of 15 stimulus words and the most frequently associated response. The infusion was then discontinued. After 1 h in the recovery area, all patients were tested for free recall, free association, cued recall and recognition on the list presented during surgery (critical list) and a matched list not presented (neutral list). Data of all patients without free recall (explicit memory) were analysed with repeated-measures analysis of variance. Of 36 patients, five demonstrated free recall. For the remaining 31 patients, cued recall and recognition showed no evidence of explicit memory. However, the free association tests demonstrated significant priming. The mean number of critical free associations was 6.6 (SEM 0.4) compared with 5.5 (0.4) neutral free association (P < 0.05). In the absence of explicit memory, implicit memory persists after intraoperative sedation with propofol.      

Dominance for vestibular cortical function in the non-dominant hemisphere

The aim of this (15)O-labelled H(2)O bolus positron emission tomography (PET) study was to analyse the hemispheric dominance of the vestibular cortical system. Therefore, the differential effects of caloric vestibular stimulation (right or left ear irrigation with warm water at 44 degrees C) on cortical and subcortical activation were studied in 12 right-handed and 12 left-handed healthy volunteers. Caloric irrigation induces a direction-specific sensation of rotation and nystagmus. Significant regional cerebral blood flow increases were found in a network within both hemispheres, including the superior frontal gyrus/sulcus, the precentral gyrus and the inferior parietal lobule with the supramarginal gyrus. These areas correspond best to the cortical ocular motor centres, namely the prefrontal cortex, the frontal eye field and the parietal eye field, known to be involved in the processing of caloric nystagmus. Furthermore, distinct temporo-parietal activations could be separated in the posterior part of the insula with the adjacent superior temporal gyrus, the inferior parietal lobule and precuneus. These areas fit best to the human homologues of multisensory vestibular cortex areas identified in the monkey and correspond to the parieto-insular vestibular cortex (PIVC), the visual temporal sylvian area (VTS) and areas 7 and 6. Further cortical activations were seen in the anterior insula, the inferior frontal gyrus and anterior cingulum. The subcortical activation pattern in the putamen, thalamus and midbrain is consistent with the organization of efferent ocular motor pathways. Cortical and subcortical activation of the described areas was bilateral during monaural stimulation, but predominant in the hemisphere ipsilateral to the stimulated ear and exhibited a significant right hemispheric dominance for vestibular and ocular motor structures in right-handed volunteers. Similarly, a significant left hemispheric dominance was found in the 12 left-handed volunteers. Thus, this PET study showed for the first time that cortical and subcortical activation by vestibular caloric stimulation depends (i) on the handedness of the subjects and (ii) on the side of the stimulated ear. Maximum activation was therefore found when the non-dominant hemisphere was ipsilateral to the stimulated ear, i.e. in the right hemisphere of right-handed subjects during caloric irrigation of the right ear and in the left hemisphere of left-handed subjects during caloric irrigation of the left ear. The localization of handedness and vestibular dominance in opposite hemispheres might conceivably indicate that the vestibular system and its hemispheric dominance, which matures earlier during ontogenesis, determine right- or left-handedness.     

不同镇静程度下健康志愿者事件相关电位与意识和记忆的关系

目的探讨不同镇静程度下事件相关电位(ERPs)与意识和记忆的关系。方法 10名志愿者加入本研究。采用异丙酚静脉靶控输注,记录不同镇静清醒(OAA/S)评分、ERPs各波(N1、P3) 波幅及潜伏期、无创血压、心电图、脉搏血氧饱和度。于OAA/S评分3分、2分时给志愿者听学习表内容。志愿者清醒后4 h进行记忆测试。采用加工分离程序(PDP)分离内隐记忆和外显记忆。计算学习表、干扰表包含测验和排除测验的测试成绩,计算外显记忆、内隐记忆成绩。结果与基础值比较, OAA/S评分3分时,N1潜伏期延长,波幅降低;P3波幅降低,潜伏期延长(P<0．05或0．01);OAA/S评分为2分时,N1潜伏期延长,波幅降低,P3消失;OAA/S评分3分时存在外显记忆和内隐记忆;评分2 分时,意识和外显记忆一同消失,内隐记忆存在。与OAA/S评分3分比较,2分时内隐记忆成绩下降 (P<0．01)。P3波幅与外显记忆成绩呈正相关(n=10,P<0．05或0．01)。结论 P3可作为判断镇静状态下意识和外显记忆存在或消失的指标,但不能反映内隐记忆的存在与否。     

Absence of implicit and explicit memory during propofol/remifentanil anaesthesia

BACKGROUND AND OBJECTIVE: High doses of opioid associated with low doses of hypnotic is a popular anaesthetic technique since the use of remifentanil has become widespread. This type of anaesthesia could result in a higher incidence of implicit memory. METHODS: Ten patients were anaesthetised with a target-controlled infusion of remifentanil (target concentration of 8 ng mL(-1)) combined with a target-controlled infusion of propofol with progressive stepwise increases until loss of consciousness was reached. A tape containing 20 words was then played to the patients. Bispectral index (BIS, Aspect Medical Systems, Newton, MA, USA) was continuously monitored during the whole study period. Implicit and explicit memories were tested between 2 and 4 h after recovery. RESULTS: Loss of consciousness was obtained with a mean calculated propofol plasma concentration of 1.3 +/- 0.4 microg mL(-1). At this low hypnotic concentration no implicit or explicit memory was found in the three postoperative memory tests. Median (range) BIS value during word presentation was 93 (80-98). CONCLUSIONS: In our group of young American Society of Anesthesiologists (ASA) I/II patients, no explicit or implicit memory was found when the calculated concentration of propofol combined with a high concentration of remifentanil was maintained at the level associated with loss of consciousness with high BIS values.     

A comparison of the effects of propofol and midazolam on memory during two levels of sedation by using target-controlled infusion

We examined memory during sedation with target-controlled infusions of propofol and midazolam in a double-blinded five-way, cross-over study in 10 volunteers. Each active drug infusion was targeted to sedation level 1 (asleep) and level 4 (lethargic) as determined with the Observer Assessment of Alertness/Sedation scale. At the target level of sedation, drug concentration was clamped for 30 min, during which time neutral words were presented. After 2 h, explicit memory was assessed by recall, and implicit memory by using a wordstem completion test. Venous drug concentrations (mean +/- SD) were 1350 ng/mL (+/-332 ng/mL) for propofol and 208 ng/mL (+/-112 ng/mL) for midazolam during Observer Assessment of Alertness/Sedation scale level 4; and 1620 ng/mL (+/-357 ng/mL) and 249 ng/mL (+/-82 ng/mL) respectively during level 1. The wordstem completion test frequencies at low level sedation were significantly higher than spontaneous frequencies (8.7% + 2.4%; P: < 0.05 in all cases), and lower than during placebo (33.6% + 23%) (P: < 0.05 in all cases, except P: = 0.076 for propofol at level 4). Clinically distinct levels of sedation were accompanied by small differences in venous propofol or midazolam concentrations. This indicates steep concentration-effect relationships. Neutral information is still memorized during low-level sedation with both drugs. The memory effect of propofol and midazolam did not differ significantly. Implications: Implicit memory can occur during different states of consciousness and might lead to psychological damage. In 10 volunteers, implicit memory was investigated during sedation with propofol and midazolam in a double-blinded, placebo-controlled study. To compare the effects of both drugs, they were titrated using a computer-controlled infusion system to produce similar high and low levels of sedation.     

Distribution of cortical activation during visuospatial n-back tasks as revealed by functional magnetic resonance imaging

Human neuroimaging studies conducted during visuospatial working memory tasks have inconsistently detected activation in the prefrontal cortical areas depending presumably on the type of memory and control tasks employed. We used functional magnetic resonance imaging to study brain activation related to the performance of a visuospatial n-back task with different memory loads (0-back, 1-back and 2-back tasks). Comparison of the 2-back versus 0-back tasks revealed consistent, bilateral activation in the medial frontal gyrus (MFG), superior frontal sulcus and adjacent cortical tissue (SFS/SFG) in all subjects and in six out of seven subjects in the intraparietal sulcus (IPS). Activation was also detected in the inferior frontal gyrus, medially in the superior frontal gyrus, precentral gyrus, superior and inferior parietal lobuli, occipital visual association areas, anterior and posterior cingulate areas and in the insula. Comparison between the 1- back versus 0-back tasks revealed activation only in a few brain areas. Activation in the MFG, SFS/SFG and IPS appeared dependent on memory load. The results suggest that the performance of a visuospatial working memory task engages a network of distributed brain areas and that areas in the dorsal visual pathway are engaged in mnemonic processing of visuospatial information.      

An Investigation of Learning during Propofol Sedation and Anesthesia Using the Process Dissociation Procedure

Background: Many studies have shown that patients may remember words learned during apparently adequate anesthesia. Performance on memory tests may be influenced by explicit and implicit memory. We used the process dissociation procedure to estimate implicit and explicit memory for words presented during sedation or anesthesia.

Methods: We investigated intraoperative learning in 72 women undergoing pervaginal oocyte collection during propofol and alfentanil infusion. One word list was played once before infusion, another was played 10 times during surgery. Venous blood was taken for propofol assay at the end of the intraoperative list. Behavioral measures of anesthetic depth (eyelash reflex, hand squeeze response to command) were recorded and used to adjust the dose of anesthetic where clinically appropriate. On recovery, memory was assessed using an auditory word stem completion test with inclusion and exclusion instructions.

Results: The mean blood propofol concentration was 2.5 [mu]g/ml (median, 2.3 [mu]g/ml; range, 0.7-6.1 [mu]g/ml). Mean alfentanil dose was 2.1 mg (median, 2.0 mg; range, 1.2-3.4 mg). Comparison of target and distractor hits in the inclusion condition showed memory for preoperative words only. However, the process dissociation procedure estimates showed explicit (mean, 0.18;P < 0.001) and implicit (mean, 0.05;P < 0.05) memory for the preoperative words, and a small amount of explicit memory for the intraoperative words (mean, 0.06; 95% confidence interval, 0.01-0.10). Memory performance did not differ between the 17 patients who consistently responded to command and eyelash reflex and the 32 patients who remained unresponsive. Blood propofol concentration and alfentanil dose did not correlate with memory for the intraoperative list.     

Absence of explicit and implicit memory in unconscious patients using a TCI of propofol

BACKGROUND: Episodes of implicit memory have been described during propofol anaesthesia. It remains unclear whether implicit memory is caused by short periods of awareness or occurs in an unconscious subject. METHODS: Sixty patients were randomized in an experimental group (EG), a control group (CG) and a reference group (RG). Loss of consciousness (LOC) was obtained by progressive stepwise increases of propofol using a target-controlled infusion device (Diprifusor, Alaris Medical Systems, San Diego, CA). A tape containing 20 words was played to the patients in the CG before the start of anaesthesia and to the patients in the EG at a constant calculated concentration of propofol associated with LOC. The tape was not played to the patients in the RG. Three memory tests were performed postoperatively. RESULTS: Explicit and implicit memories were evidenced in the CG but not in the EG. CONCLUSION: In our group of young ASA I/II patients, in the absence of any noxious stimulus, no implicit or explicit memory was found when the calculated concentration of propofol using a Diprifusor was maintained at the level associated with LOC.     

Working memory of auditory localization

To investigate brain mechanisms of sound location memory, we studied the distribution of brain activation with functional magnetic resonance imaging (fMRI) in subjects performing an audiospatial n-back task with three memory load levels. Working memory processing of audiospatial information activated areas in the superior, middle and inferior frontal gyri, and in the posterior parietal and middle temporal cortices. In a control experiment, fMRI during audio- and visuospatial 2-back task performances revealed only few differentially activated subregions between the two tasks. These results demonstrate that working memory processing of auditory locations involves a distributed network of brain areas and suggest that mnemonic processing of audio- and visuospatial information is directed along a common neural pathway in the posterior parietal and prefrontal cortices.