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  <front>
    <journal-meta />
    <article-meta>
      <title-group>
        <article-title>Huntington's disease and Scalar Expectancy Theory: A memory-based time perception deficit</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <string-name>Maria Pia Viggiano (mariapia.viggiano@unifi.it)</string-name>
          <email>silvia.piacentini@uni</email>
          <xref ref-type="aff" rid="aff0">0</xref>
          <xref ref-type="aff" rid="aff1">1</xref>
          <xref ref-type="aff" rid="aff2">2</xref>
          <xref ref-type="aff" rid="aff3">3</xref>
          <xref ref-type="aff" rid="aff4">4</xref>
        </contrib>
        <aff id="aff0">
          <label>0</label>
          <institution>Department of Neuroscience</institution>
          ,
          <addr-line>Psychology</addr-line>
          ,
          <institution>Drug Research and Child's Health - Sect.</institution>
          <addr-line>Psychology via di San Salvi 12, pad 26 - 50100 Firenze</addr-line>
          ,
          <country country="IT">ITALY</country>
        </aff>
        <aff id="aff1">
          <label>1</label>
          <institution>Giorgio Gronchi</institution>
        </aff>
        <aff id="aff2">
          <label>2</label>
          <institution>Marco Paganini</institution>
        </aff>
        <aff id="aff3">
          <label>3</label>
          <institution>Silvia Piacentini</institution>
        </aff>
        <aff id="aff4">
          <label>4</label>
          <institution>Stefania Righi</institution>
        </aff>
      </contrib-group>
      <fpage>379</fpage>
      <lpage>382</lpage>
      <abstract>
        <p>Huntington's disease (HD) damages the basal ganglia dopaminergic circuits which are fundamental neural correlates of the timekeeping mechanism. In this work we investigated whether HD may impair temporal processing and if any component of the Scalar Expectancy Theory (SET) might be responsible of the timing defect. To achieve this result we explored time perception in early symptomatic HD patients and controls for seconds and milliseconds. Data showed an impaired time processing in HD patients that overestimated shorter time intervals and underestimated the longer ones for both seconds and milliseconds. This defect, called migration effect, may suggest a specific deficit in the memory component of SET.</p>
      </abstract>
      <kwd-group>
        <kwd>neuropsychology</kwd>
        <kwd>Huntington's disease</kwd>
        <kwd>time perception</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <sec id="sec-1">
      <title>Introduction</title>
      <p>
        Huntington’s disease (HD) is an autosomal-dominant,
neurodegenerative disorder that typically produces a progressive
atrophy of subcortical structures, especially of caudatus and
putamen
        <xref ref-type="bibr" rid="ref3">(Lawrence, Sahakian, &amp; Robbins, 1998)</xref>
        . With
respect to basal ganglia and fronto-striatal circuits dysfunction,
HD patients exhibit typical movement disorders, psychiatric
symptoms and several neuropsychological deficits. An
increasing amount of evidences suggest the basal ganglia and
the fronto-striatal structures as a fundamental neural
correlates of timekeeping functions
        <xref ref-type="bibr" rid="ref8">(Meck &amp; Benson, 2002)</xref>
        .
      </p>
      <p>
        Despite this literature, timing deficits in HD has been
scarcely investigated. Furthermore, the very few studies
focused prevalently on time production processes exclusively
related to the motor performance
        <xref ref-type="bibr" rid="ref1 ref11">(Beste et al., 2007; Paulsen
et al., 2004)</xref>
        . Moreover, empirical results are seldom
interpreted in the light of time perception’s theoretical models.
      </p>
      <p>
        In this study, we take into account the Scalar Expectancy
Theory - SET
        <xref ref-type="bibr" rid="ref2">(Gibbon, 1991)</xref>
        - timekeeping model. It posits
three different subsequent stages of time processing. The first
one is the clock stage, in which an internal pacemaker,
attention mediated, counts time pulses stored by an accumulator
to reproduce a subjective time interval that correspond to the
real time elapsed. The two other stages translate clock
readings into behaviour: the memory stage stores the subjective
time interval as transient (working memory) and permanent
(reference memory) traces, to allow a suitable comparison
during the decision stage that leads to the identification of
an appropriate response. Changes in the internal clock speed
would produce a systematic error in all the timing
performance: Slowing down the internal clock pulses yields
underestimation of time intervals, whereas accelerating them
generates an overestimation of the elapsed time
        <xref ref-type="bibr" rid="ref7">(Meck, 1996)</xref>
        .
Defects in the memory components may produce the
migration effect
        <xref ref-type="bibr" rid="ref4">(Malapani, Deweer, &amp; Gibbon, 2002)</xref>
        which is the
tendency to overestimate the shorter intervals and
underestimate the longer ones.
      </p>
      <p>In sum, this paper aims to assess whether HD patients are
subject to an altered time perception and which stage of SET
is eventually responsible of this alteration.</p>
    </sec>
    <sec id="sec-2">
      <title>Experiment</title>
      <p>We investigated time perception in symptomatic HD patients
employing the temporal bisection task, which requires
subjects to compare temporal stimuli to durations held in
memory. In particular, we used two temporal-bisection tasks, one
in the second durations and the other in the millisecond
durations. The temporal bisection procedure has three advantages:
It has been specifically developed in the SET framework, it
does not place great demands on attentional processes and it
is suitable to highlight time-perception deficits.</p>
      <p>Method
Participants Eleven symptomatic HD patients (6 women)
were recruited at the Neurological Unit of the Hospital of
Careggi (Florence, Italy). Eleven healthy subjects matched
for age served as controls (7 women). UHDRS (Unified
Huntington’s Disease Rating Scale) motor scores were
assessed by an experienced neurologist. HD patients were all in
early clinical stages (range UHDRS 3-45). Disease severity
measures such as mean CAG-length, age of onset and
duration of the disease were collected and reported in Table 1. For
each subject, an Italian short version of Verbal IQ (VIQ) test
and MMSE were collected (see Table 1). The Ethics
Committee approved the study and all subjects gave written consent.
Stimuli and procedure Two separate bisection tasks were
employed for milliseconds (MS-task) and seconds (S-task). A
15 minutes interval divided the two tasks which were
administered in counterbalanced order across the participants. The
stimuli were tones at 700 Hz binaurally presented through a
wireless Karma R headset by using Presentation 0.50
software. Each task consisted of three phases: training session,
learning assessment and test phase. In the training session,
participants had to listen to 10 subsequent presentations of
the standard Short and Long durations, separated by random
intervals from 1000 to 1500 ms.</p>
      <p>In the learning assessment participants were requested to
recognize standard Long and Short tones which were
randomly presented 10 times. Feedback for incorrect responses
was given and the learning assessment was repeated until the
100% correct responses were achieved. Afterward, in the test
phase, participants were asked to say whether a randomly
presented tone from a set of nine test stimuli was more similar
to the standard Short or Long duration they had previously
learned. After the participant’s verbal response the
experimenter pressed the appropriate response key (Short=S; Long
=L) on the keyboard. The nine test stimuli presented were
the standard Short and Long together with seven intermediate
stimuli. Every bisection task consisted of 20 trials for each of
the nine stimuli. No feedback was given about the accuracy
of the responses during the test phase.</p>
      <p>In the millisecond-task (MS), the standard Short tone was
400 ms (T1) and the standard Long tone was 800 ms (T9).
The seven intermediate stimuli were: 450 ms (T2), 500 ms
(T3), 550 ms (T4), 600 ms (T5), 650 ms (T6), 700 ms (T7)
and 750 ms (T8).</p>
      <p>In the second-task (S), the standard Short tone was 1000 ms
(T1) and the standard Long tone was 2000 ms (T9). The seven
intermediate stimuli were: 1125 ms (T2), 1250 ms (T3), 1375
ms (T4), 1500 ms (T5), 1625 ms (T6), 1750 ms (T7) and 1875
ms (T8).</p>
      <p>Data Analysis A one- way ANOVA with Group at 2
levels (controls and HD) was used to compare HD and control
participants for age, VIQ and MMSE (see Table 1).</p>
      <p>Data from the Temporal Bisection tasks were separately
computed for each participant as proportion of Long
responses. These proportions were analysed with repeated
measures ANOVA with Group (HD patients and controls)
as between-subject variable, and Condition (MS- and
Sbisection task) and Stimulus duration (T1, T2, T3, T4, T5,
T6, T7, T8, and T9) as within-subject variables.</p>
    </sec>
    <sec id="sec-3">
      <title>Results</title>
      <p>The main effect of Stimulus duration (F(3,51) = 142.18,
p&lt;0.0001) indicated a progressive growth of the proportions
of Long responses as a function of the stimulus time-span
(T1, T2, T3, T4, T5, T6, T7, T8, T9). In addition, the
interaction Stimulus duration x Group was significant (F(3, 51) =
4.13, p=0.014), showing that HD patients significantly
overestimated short durations (T1: p&lt;0.011; T2: p&lt;0.03) and
underestimated the standard Long duration (T9: p&lt;0.015).
The main effect of Condition was not significant, suggesting
the same defect in second and millisecond durations. In
summary, HD patients were mainly impaired in judging the
extreme values of the psychophysical curve as shown in Figure
1.</p>
    </sec>
    <sec id="sec-4">
      <title>Discussion</title>
      <p>
        The aim of the present study was to explore the impaired
timing mechanisms in HD subjects taking into account the SET
model
        <xref ref-type="bibr" rid="ref2">(Gibbon, 1991)</xref>
        .
      </p>
      <p>Our main finding was that in a temporal bisection task HD
subjects, compared to controls, overestimated the Short
stimuli durations and underestimated the Long ones. This
temporal misrepresentation affected both millisecond and second
durations in the same way, suggesting that identical
mechanisms are involved in the processing of durations over and
under the second.</p>
      <p>
        This result may not be attributed to an internal clock
dysfunction, which would produce a unidirectional variation in
the curve (i.e. a rightward shift for all the stimuli if the
internal clock ran slowly). On the contrary, our findings
bear a strong resemblance to a deficit already observed in
Parkinson’s disease (PD) patients and called migration effect
        <xref ref-type="bibr" rid="ref4 ref5">(Malapani et al., 1998, 2002)</xref>
        .
      </p>
      <p>
        The study of
        <xref ref-type="bibr" rid="ref5">Malapani et al. (1998)</xref>
        employed a
peakinterval procedure in which PD subjects off-therapy were
trained to learn two target durations in the seconds range. The
patients tended to overestimate the shorter duration (8 s) and
underestimate the longer one (21 s). This effect arises from
the migration of the two peaks towards one another, so that
the two targets might more likely be coupled. The
migration effect may be attributed to memory retrieval difficulties
        <xref ref-type="bibr" rid="ref4">(Malapani et al., 2002)</xref>
        , suggesting an impairment in
memory representations. In a similar way, our HD results imply a
mutual attraction between the two time values (standard short
and long) when they are laid down in memory or retrieved and
compared to a current clock reading. The presence of deficits
in the time representation system of HD patients may be
related to the well documented difficulties in working memory
        <xref ref-type="bibr" rid="ref3">(Lawrence et al., 1998)</xref>
        and episodic memory
        <xref ref-type="bibr" rid="ref9">(Montoya et al.,
2006)</xref>
        . An open issue is whether the encoding, storage and/or
retrieval systems, are responsible for distortions in the timed
values to be estimated. Another concern is about what
neural substrates are underlying the time memory deficit in HD.
The temporal memory dysfunction might be associated to the
structural changes that affected striatum, prefrontal cortex (or
both) in the progression of the disease. HD occurs with a
typical dorsal-to-ventral progression of the cell death in which
the dorso-medial striatum is compromised earlier than ventral
striatum. This damage progression severely affects a
number of dopaminergic corticostriatal loops, primarily the
circuits with a close relationship with the dorso-medial striatum,
such as the dorsolateral prefrontal cortex (DLPC)
        <xref ref-type="bibr" rid="ref9">(Montoya
et al., 2006)</xref>
        . This area is suggested to be a specialized system
for the manipulation of information within working memory
        <xref ref-type="bibr" rid="ref10">(Mottaghy et al., 2000)</xref>
        as well as in some facets of long term
memory such as retrieval of novel material
        <xref ref-type="bibr" rid="ref14">(Sandrini et al.,
2003)</xref>
        and refreshing previously active representations
        <xref ref-type="bibr" rid="ref13">(Raye
et al., 2002)</xref>
        . Damage in DLPC might affect both storage
and retrieval processes of temporal memory in HD patients.
In addition, the time representation processing might also be
damaged by alterations in the dopaminergic cortico-striatal
loops. In a similar way, it has been suggested that temporal
memory storage is achieved by cortico-striatal circuits that
operate through dopamine-modulated long-term potentiation
processes
        <xref ref-type="bibr" rid="ref6">(Matell &amp; Meck, 2004)</xref>
        . The dopaminergic
deregulation might be responsible of temporal memory difficulties,
since several studies reported a significant reduction of
striatal D1 and D2 receptors in HD patients and a consequent
impairment in functioning of both cortico-striatal and
nigrostriatal loops
        <xref ref-type="bibr" rid="ref12">(Pavese et al., 2003)</xref>
        .
      </p>
      <p>In conclusion, our finding of a migration effect in HD
patients suggests a defective processing in the memory
component of the SET model. Further investigations are needed
to clarify whether the impairment involves storage and/or
retrieval processes of temporal memory. Moreover, another
open question is whether the mnestic deficit results from
striatal pathology deafferentating prefrontal areas or from early
cortical pathology per se.</p>
    </sec>
    <sec id="sec-5">
      <title>Acknowledgments</title>
      <p>This work was supported by the University of Florence and
Careggi Hospital. Many thanks to Luca Galli, Elisabetta
Bertini and Marco Raglianti for their useful input.</p>
    </sec>
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