Natalie Wee | Duke-NUS Graduate Medical School (original) (raw)
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Papers by Natalie Wee
Journal of the Neurological Sciences, 2016
Anxiety is prevalent in patients with Parkinson&a... more Anxiety is prevalent in patients with Parkinson's disease (PD) and may affect patients' quality of life. Yet, little is known about the neural basis of anxiety in PD, and none have used a longitudinal design. 73 patients with mild PD were recruited and followed up for 18months. A whole-brain analysis was first used to identify brain regions associated with anxiety symptoms, followed by a regional analysis focusing on a priori hypothesised regions at baseline. A multivariate generalized estimating equations analysis was then conducted to determine the longitudinal association between grey matter (GM) volumetric changes of these significant regions and changes of anxiety symptoms. At baseline, anxiety symptom severity was associated with decreased GM volumes in the bilateral precuneus and anterior cingulate cortex (ACC). Over 18months, increased severity of anxiety symptoms was associated with decreased GM volume in the left precuneus and ACC, independent of age, gender, education, depressive symptom severity or use of psychiatric medication. These results mainly implicate the precuneus and ACC in the pathogenesis of anxiety in PD. We speculate that these structural changes could reflect the disrupted default mode network due to PD pathology, contributing to spontaneous anxiety-related self-focused thoughts.
Parkinsonism & Related Disorders, 2016
Apathy is one of the most common behavioural disorders in Parkinson&a... more Apathy is one of the most common behavioural disorders in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring apathy symptoms at 6-monthly intervals using the Starkstein Apathy Scale, as well as measures of motor and non-motor symptoms, cognitive function, and functional disability at baseline. Mixed-effects models were used to characterise the individual trajectories of apathy symptom severity, and linear regression with stepwise elimination procedure was used to select significant baseline predictors. Clinically significant levels of apathy were present in 42.7% of our sample at baseline, with symptom severity remaining relatively stable on average over the course of 18 months. Male gender, lower educational attainment, higher depression symptom severity, more severe functional disability, and the presence of dyskinesias at study entry predicted increasing apathy over the subsequent 18 months. Patients with these factors are at risk for progression of apathy, which may be prevented by treating depression and functional disability. Further studies are needed to address both the specific neurobiological pathways and psychosocial factors underpinning apathy in PD.
Parkinsonism & Related Disorders, 2015
Depression and anxiety are common in Parkinson's ... more Depression and anxiety are common in Parkinson's disease (PD) and contribute significantly to a reduced quality of life in PD patients. Though they often co-exist, it is unclear whether depression and anxiety result from a shared pathological process. We studied the longitudinal course and determinants of depression and anxiety in PD in order to understand which factors contribute to the development of these symptoms. We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring depressive and anxiety symptoms at 6 monthly intervals using the Geriatric Depression Scale and Hospital Anxiety and Depression Scale - 'Anxiety' subscale. Univariate and multivariate Generalised Estimating Equations were used to investigate the course of depression and anxiety and their association with demographic factors, motor measures, non-motor symptoms, and pharmacological factors. Depression and anxiety were co-morbid in 13.5% of the sample. Depressive symptoms remained relatively stable while anxiety symptoms improved over the course of 18 months. Severity of depressive symptoms was associated with female gender, motor fluctuations, apathy, and anxiety, while severity of anxiety was associated with older age, higher educational attainment, shorter disease duration, younger age of disease onset, and excessive daytime sleepiness. Although depression and anxiety are frequently co-morbid in PD, they were dissociable from each other. They had distinct trajectories and different longitudinal relationships with demographic, motor, and non-motor factors that were unique to each disorder.
STUDY OBJECTIVES: Visual short-term memory (VSTM) is an important measure of information process... more STUDY OBJECTIVES:
Visual short-term memory (VSTM) is an important measure of information processing capacity and supports many higher-order cognitive processes. We examined how sleep deprivation (SD) and maintenance duration interact to influence the number and precision of items in VSTM using an experimental design that limits the contribution of lapses at encoding.
DESIGN:
For each trial, participants attempted to maintain the location and color of three stimuli over a delay. After a retention interval of either 1 or 10 seconds, participants reported the color of the item at the cued location by selecting it on a color wheel. The probability of reporting the probed item, the precision of report, and the probability of reporting a nonprobed item were determined using a mixture-modeling analysis. Participants were studied twice in counterbalanced order, once after a night of normal sleep and once following a night of sleep deprivation.
SETTING:
Sleep laboratory.
PARTICIPANTS:
Nineteen healthy college age volunteers (seven females) with regular sleep patterns.
INTERVENTIONS:
Approximately 24 hours of total SD.
MEASUREMENTS AND RESULTS:
SD selectively reduced the number of integrated representations that can be retrieved after a delay, while leaving the precision of object information in the stored representations intact. Delay interacted with SD to lower the rate of successful recall.
CONCLUSIONS:
Visual short-term memory is compromised during sleep deprivation, an effect compounded by delay. However, when memories are retrieved, they tend to be intact.
Journal of Vision, Sep 12, 2011
The process of encoding a visual scene into working memory has previously been studied using bina... more The process of encoding a visual scene into working memory has previously been studied using binary measures of recall. Here, we examine the temporal evolution of memory resolution, based on observers' ability to reproduce the orientations of objects presented in brief, masked displays. Recall precision was accurately described by the interaction of two independent constraints: an encoding limit that determines the maximum rate at which information can be transferred into memory and a separate storage limit that determines the maximum fidelity with which information can be maintained. Recall variability decreased incrementally with time, consistent with a parallel encoding process in which visual information from multiple objects accumulates simultaneously in working memory. No evidence was observed for a limit on the number of items stored. Cuing one display item with a brief flash led to rapid development of a recall advantage for that item. This advantage was short-lived if the cue was simply a salient visual event but was maintained if it indicated an object of particular relevance to the task. These cuing effects were observed even for items that had already been encoded into memory, indicating that limited memory resources can be rapidly reallocated to prioritize salient or goal-relevant information.
PloS one, 2012
Adaptation aftereffects have been found for low-level visual features such as colour, motion and ... more Adaptation aftereffects have been found for low-level visual features such as colour, motion and shape perception, as well as higher-level features such as gender, race and identity in domains such as faces and biological motion. It is not yet clear if adaptation effects in humans extend beyond this set of higher order features. The aim of this study was to investigate whether objects highly associated with one gender, e.g. high heels for females or electric shavers for males can modulate gender perception of a face. In two separate experiments, we adapted subjects to a series of objects highly associated with one gender and subsequently asked participants to judge the gender of an ambiguous face. Results showed that participants are more likely to perceive an ambiguous face as male after being exposed to objects highly associated to females and vice versa. A gender adaptation aftereffect was obtained despite the adaptor and test stimuli being from different global categories (objects and faces respectively). These findings show that our perception of gender from faces is highly affected by our environment and recent experience. This suggests two possible mechanisms: (a) that perception of the gender associated with an object shares at least some brain areas with those responsible for gender perception of faces and (b) adaptation to gender, which is a high-level concept, can modulate brain areas that are involved in facial gender perception through top-down processes.
Media Coverage by Natalie Wee
Journal of the Neurological Sciences, 2016
Anxiety is prevalent in patients with Parkinson&a... more Anxiety is prevalent in patients with Parkinson's disease (PD) and may affect patients' quality of life. Yet, little is known about the neural basis of anxiety in PD, and none have used a longitudinal design. 73 patients with mild PD were recruited and followed up for 18months. A whole-brain analysis was first used to identify brain regions associated with anxiety symptoms, followed by a regional analysis focusing on a priori hypothesised regions at baseline. A multivariate generalized estimating equations analysis was then conducted to determine the longitudinal association between grey matter (GM) volumetric changes of these significant regions and changes of anxiety symptoms. At baseline, anxiety symptom severity was associated with decreased GM volumes in the bilateral precuneus and anterior cingulate cortex (ACC). Over 18months, increased severity of anxiety symptoms was associated with decreased GM volume in the left precuneus and ACC, independent of age, gender, education, depressive symptom severity or use of psychiatric medication. These results mainly implicate the precuneus and ACC in the pathogenesis of anxiety in PD. We speculate that these structural changes could reflect the disrupted default mode network due to PD pathology, contributing to spontaneous anxiety-related self-focused thoughts.
Parkinsonism & Related Disorders, 2016
Apathy is one of the most common behavioural disorders in Parkinson&a... more Apathy is one of the most common behavioural disorders in Parkinson's disease (PD) and contributes significantly to a reduced quality of life in PD patients. We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring apathy symptoms at 6-monthly intervals using the Starkstein Apathy Scale, as well as measures of motor and non-motor symptoms, cognitive function, and functional disability at baseline. Mixed-effects models were used to characterise the individual trajectories of apathy symptom severity, and linear regression with stepwise elimination procedure was used to select significant baseline predictors. Clinically significant levels of apathy were present in 42.7% of our sample at baseline, with symptom severity remaining relatively stable on average over the course of 18 months. Male gender, lower educational attainment, higher depression symptom severity, more severe functional disability, and the presence of dyskinesias at study entry predicted increasing apathy over the subsequent 18 months. Patients with these factors are at risk for progression of apathy, which may be prevented by treating depression and functional disability. Further studies are needed to address both the specific neurobiological pathways and psychosocial factors underpinning apathy in PD.
Parkinsonism & Related Disorders, 2015
Depression and anxiety are common in Parkinson's ... more Depression and anxiety are common in Parkinson's disease (PD) and contribute significantly to a reduced quality of life in PD patients. Though they often co-exist, it is unclear whether depression and anxiety result from a shared pathological process. We studied the longitudinal course and determinants of depression and anxiety in PD in order to understand which factors contribute to the development of these symptoms. We conducted a prospective longitudinal study of 89 mild PD patients over 18 months, measuring depressive and anxiety symptoms at 6 monthly intervals using the Geriatric Depression Scale and Hospital Anxiety and Depression Scale - 'Anxiety' subscale. Univariate and multivariate Generalised Estimating Equations were used to investigate the course of depression and anxiety and their association with demographic factors, motor measures, non-motor symptoms, and pharmacological factors. Depression and anxiety were co-morbid in 13.5% of the sample. Depressive symptoms remained relatively stable while anxiety symptoms improved over the course of 18 months. Severity of depressive symptoms was associated with female gender, motor fluctuations, apathy, and anxiety, while severity of anxiety was associated with older age, higher educational attainment, shorter disease duration, younger age of disease onset, and excessive daytime sleepiness. Although depression and anxiety are frequently co-morbid in PD, they were dissociable from each other. They had distinct trajectories and different longitudinal relationships with demographic, motor, and non-motor factors that were unique to each disorder.
STUDY OBJECTIVES: Visual short-term memory (VSTM) is an important measure of information process... more STUDY OBJECTIVES:
Visual short-term memory (VSTM) is an important measure of information processing capacity and supports many higher-order cognitive processes. We examined how sleep deprivation (SD) and maintenance duration interact to influence the number and precision of items in VSTM using an experimental design that limits the contribution of lapses at encoding.
DESIGN:
For each trial, participants attempted to maintain the location and color of three stimuli over a delay. After a retention interval of either 1 or 10 seconds, participants reported the color of the item at the cued location by selecting it on a color wheel. The probability of reporting the probed item, the precision of report, and the probability of reporting a nonprobed item were determined using a mixture-modeling analysis. Participants were studied twice in counterbalanced order, once after a night of normal sleep and once following a night of sleep deprivation.
SETTING:
Sleep laboratory.
PARTICIPANTS:
Nineteen healthy college age volunteers (seven females) with regular sleep patterns.
INTERVENTIONS:
Approximately 24 hours of total SD.
MEASUREMENTS AND RESULTS:
SD selectively reduced the number of integrated representations that can be retrieved after a delay, while leaving the precision of object information in the stored representations intact. Delay interacted with SD to lower the rate of successful recall.
CONCLUSIONS:
Visual short-term memory is compromised during sleep deprivation, an effect compounded by delay. However, when memories are retrieved, they tend to be intact.
Journal of Vision, Sep 12, 2011
The process of encoding a visual scene into working memory has previously been studied using bina... more The process of encoding a visual scene into working memory has previously been studied using binary measures of recall. Here, we examine the temporal evolution of memory resolution, based on observers' ability to reproduce the orientations of objects presented in brief, masked displays. Recall precision was accurately described by the interaction of two independent constraints: an encoding limit that determines the maximum rate at which information can be transferred into memory and a separate storage limit that determines the maximum fidelity with which information can be maintained. Recall variability decreased incrementally with time, consistent with a parallel encoding process in which visual information from multiple objects accumulates simultaneously in working memory. No evidence was observed for a limit on the number of items stored. Cuing one display item with a brief flash led to rapid development of a recall advantage for that item. This advantage was short-lived if the cue was simply a salient visual event but was maintained if it indicated an object of particular relevance to the task. These cuing effects were observed even for items that had already been encoded into memory, indicating that limited memory resources can be rapidly reallocated to prioritize salient or goal-relevant information.
PloS one, 2012
Adaptation aftereffects have been found for low-level visual features such as colour, motion and ... more Adaptation aftereffects have been found for low-level visual features such as colour, motion and shape perception, as well as higher-level features such as gender, race and identity in domains such as faces and biological motion. It is not yet clear if adaptation effects in humans extend beyond this set of higher order features. The aim of this study was to investigate whether objects highly associated with one gender, e.g. high heels for females or electric shavers for males can modulate gender perception of a face. In two separate experiments, we adapted subjects to a series of objects highly associated with one gender and subsequently asked participants to judge the gender of an ambiguous face. Results showed that participants are more likely to perceive an ambiguous face as male after being exposed to objects highly associated to females and vice versa. A gender adaptation aftereffect was obtained despite the adaptor and test stimuli being from different global categories (objects and faces respectively). These findings show that our perception of gender from faces is highly affected by our environment and recent experience. This suggests two possible mechanisms: (a) that perception of the gender associated with an object shares at least some brain areas with those responsible for gender perception of faces and (b) adaptation to gender, which is a high-level concept, can modulate brain areas that are involved in facial gender perception through top-down processes.