Claudette Fortin

Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus.

Patients with type 2 diabetes often have impaired exercise capacity compared with nondiabetic subjects. Left ventricular (LV) diastolic dysfunction has been shown to limit exercise performance in nondiabetic subjects. Men with well-controlled type 2 diabetes were divided into 2 groups: normal LV diastolic function (group 1, n = 9) or LV diastolic dysfunction (group 2, n = 10) based on standard echocardiographic criteria using pulmonary veins and transmitral flow recordings. They were matched for age and had no evidence of systemic hypertension, macroalbuminuria, coronary artery disease, congestive heart failure, clinical diabetic complications, and thyroid disease. Good metabolic control was demonstrated by glycated hemoglobin levels of 6.7+/-1.6% and 6.6+/-2.5% (means +/- SD) in patients with LV diastolic dysfunction and in controls, respectively. Each subject performed a symptom-limited modified Bruce protocol treadmill exercise test. Maximal treadmill performance was higher in subjects with normal diastolic function compared with subjects with LV diastolic dysfunction when expressed in time (803+/-29 vs. 662+/-44 seconds, respectively, p<0.02) or in METs (11.4+/-1.2 vs. 9.5+/-1.9 METs, respectively, p<0.02). Moreover, there was a correlation between E/A ratio and exercise duration (r = 0.64, p = 0.004) or E/A ratio and METs (r = 0.658, p = 0.003). There were no significant differences in maximal heart rate, maximal systolic and diastolic blood pressure, or maximal rate-pressure product attained during the exercise test. In conclusion, this study demonstrated that LV diastolic dysfunction influences maximal treadmill performance and could explain lower maximal performance observed in patients with type 2 diabetes.

Time estimation and concurrent nontemporal processing: Specific interference from short-term-memory demands

Previous studies have shown that the effect of concurrent nontempcraLprocessmg on time astimation may vary depending on the level of difficulty of the nontemporal task. This is commonly interpreted within the context of so-called distraction/interruption models of temporal processing, which propose that as concurrent task difficulty or complexity is increased, temporal processing receives less attention. We hypothesize that the effect of nontemporal processing does not depend on the level of difficulty as such, but rather on the extent to which the concurrent nontemporal task specifically involves processing in short-term meraery. Four experiments were run in which the short-term memory requirements of concurrent tasks were systematically varied, although all of the tasks were of comparable levels of difficulty. In the first experiment, the effect of memory search on simultaneous temporal productions was proportional to the number of items to search. As with reaction time, produced intervals were shown to increase linearly with the number of items in the memorized set. In Experiment 2, a visual search involving some load on short-term memory interfered in the same way with time production, although to a lesser extent. The last two experiments showed that performing attention-demanding visual search tasks that did not involve short-term memory did not lengthen simultaneously produced time inter-vals. This suggests that interference of nontemporal processing on time processing may not be a matter of nonspecific general purpose attentional resources, but rather of concurrent short-term-memory processing demands.

Temporal interval production and processing in working memory

Short-term memory or working memory has been proposed as a cognitive structure contributing to time estimation. Thus, in a previous experiment, retrieving a stored item during a temporalinterval production lengthened the interval in proportion to the number of items in the memory set. In the present study, this issue was analyzed further by testing whether the proportional lengthening is induced by the load itself (i.e., the number of items) or by comparing the probe with memorized items. In a first experiment, a memory set was maintained during a temporal production, and the comparison of the probe with memorized items was postponed until the end of time production. Varying the number of items in the memory set had no effect on temporal intervals produced during its retention, suggesting that mental comparison was the source of the lengthening of time intervals. In succeeding experiments, tasks requiring processing in working memory but involving no memory load were combined with temporal production. In Experiment 2, increasing the number of syllables in a rhyme-judgment task proportionally lengthened temporal intervals that were produced simultaneously. In Experiment 3, increasing the amount of mental rotation in a task involving visuospatial processing also lengthened simultaneous temporal production. This interference between processing in working memory and time estimation suggests that working memory, defined as a work space for active processing of current information, contributes to time estimation.

Preclinical diabetic cardiomyopathy: relation of left ventricular diastolic dysfunction to cardiac autonomic neuropathy in men with uncomplicated well-controlled type 2 diabetes.

Diabetic cardiomyopathy is an ill-defined entity. This study was designed to explore the possible association between left ventricular diastolic dysfunction (LVDD) and cardiac autonomic neuropathy (CAN) independently from metabolic control. Three groups of 10 age-matched men each with well-controlled type 2 diabetes were studied: (1) subjects with normal diastolic function, (2) subjects with LVDD characterized by impaired LV relaxation, and (3) subjects with a more severe form of LVDD characterized by a pseudonormalized pattern of LV filling. No subject had evidence of clinical diabetic complications, coronary artery disease (CAD), hypertension, congestive heart failure, or thyroid or overt renal disease, and all had a negative maximal exercise test. LVDD was evaluated by Doppler echocardiographic and CAN was evaluated using spectral analysis of heart rate variability (HRV; time and frequency domains) from 24-hour Holter recordings. Findings showed that the high frequency power (HF: 0.15 to 0.4 Hz) tends to decrease with worsening diastolic function; 5.0 +/- 0.2 ms(2) (mean +/- SE) in group 1, 4.2 +/- 0.3 ms(2) in group 2, and 3.9 +/- 0.4 ms(2) (P =.03) in group 3, respectively, whereas the low frequency power (LF: 0.04 to 0.15 Hz) was similar between groups. In the time domain, the mean squared differences of the successive RR intervals (rMSDD) also showed the same pattern, ie, 31.0 +/- 2.8 ms, 23.8 +/- 1.6 ms, and 21.5 +/- 2.9 ms in groups 1, 2, and 3, respectively (P =.03). The E/A ratio correlated significantly with indices of parasympathetic modulation (HF; r = 0.448, P =.013; rMSDD: r = 0.457, P =.011; pNN50: r = 0.425, P =.019). LVDD and CAN are associated in patients with otherwise uncomplicated well-controlled type 2 diabetes. The parameters defining these 2 abnormalities may serve to better define diabetic cardiomyopathy as a distinct entity and could eventually become useful prognostic indicators as it has been shown in nondiabetic populations.

Order information in short-term memory and time estimation

In previous experiments, the amount of interference between time production and visual or memory search tasks was shown not to be related to the level of difficulty of the search task per se, but instead to the amount of processing in short-term memory required in the search task. The first experiment of the present study verified whether the amount of interference between time production and a short-term memory task may be related to the level of difficulty of the short-term memory task. Two versions of a memory task, with and without processing of order information, were combined with a temporal interval production task in a concurrent processing condition. As is shown in a control reaction time task, processing order information increased the level of difficulty of the memory search task. In the concurrent processing condition, the interference between short-term memory processing and time production was stronger when the level of difficulty of the short-term memory search task was increased by requiring that order information be processed. The results of Experiment 2 showed that the amount of interference between a similar short-term memory task and time production seems not to be related to the amount of order information that must be maintained during the time production task. This dissociation between the effects of processing and the maintenance of order information is compatible with a similar dissociation, observed in previous experiments, between the effects of processing and those of maintaining item information in short-term memory on concurrent time production.

Expectancy in humans in multisecond peak-interval timing with gaps

In two experiments, the peak-interval procedure was used with humans to test effects related to gaps in multisecond timing. In Experiment 1, peak times of response distributions were shorter when the gap occurred later during the encoding of the criterion time to be reproduced, suggesting that gap expectancy shortened perceived durations. Peak times were also positively related to objective target durations. Spreads of response distributions were generally related to estimated durations. In Experiment 2, peak times were shortest when gaps were expected but did not occur, confirming that the shortening effect of gap expectancy is independent of the gap occurrence. High positive start-stop correlations and moderate positive peak-time-spread correlations showed strong memory variability, whereas low and negative start-spread correlations suggest small response-threshold variability. Correlations seemed not to be influenced by expectancy. Overall, the peak-interval procedure with gaps provided relevant information on similarities and differences in timing in humans and other animals.

Attention Sharing during Timing: Modulation by Processing Demands of an Expected Stimulus

Varying the location of a nontemporal task during a time estimation task affects temporal estimates. Previous studies have also shown that manipulating the location of a stimulus to ignore may disturb timing similarly, suggesting that the effect might be independent of the processing requirements in the nontemporal task. In Experiment 1, the location of a tone varied during a 2-sec interval production; participants were asked either to ignore the tone or to discriminate its frequency. Productions were longer when the tone was presented later, but only when it was processed. In Experiment 2, short and long tones corresponding to more or less difficult discrimination tasks were used. The location effect was stronger and remained stronger throughout the experiment when participants were tested with the short tone in the first experimental session than when they were tested with the long tone first. These results suggest that timing is influenced by relatively stable attention-sharing strategies.

Age-Related Differences in Timing With Breaks

Two groups of participants differing in age were compared on a time production task during which timing was temporarily interrupted. Produced intervals lengthened with increasing delay before the break occurrence, and the effect was more pronounced in older than in younger adults. A reaction time response to the signal beginning the break period was required also. Older participants responded more slowly to this signal, but they benefited to a greater extent from a lengthening of the time preceding its presentation. These results suggest that performance of older participants is affected by attention sharing and preparation involved in timing with breaks.

Timing during interruptions in timing.

Duration and location of breaks in time interval production were manipulated in various conditions of stimulus presentation (Experiments 1-4). Produced intervals shortened and then stabilized as break duration lengthened, suggesting that participants used the break as a preparatory period to restart timing as quickly as possible at the end of the break. This interpretation was supported in Experiment 5, in which similar results were obtained with a reaction time response executed at the end of the break. In all experiments, produced intervals lengthened as the break occurred later during the interval. The authors conclude that varying break location and duration reveal, respectively, the influence of attentional time-sharing before the interruption and of preparatory processes taking place during the break.

Timing is affected by demands in memory search but not by task switching.

Recent studies suggest that timing and tasks involving executive control processes might require the same attentional resources. This should lead to interference when timing and executive tasks are executed concurrently. This study examined the interference between timing and task switching, an executive function. In 4 experiments, memory search and digit classification were performed successively in 4 conditions: search-search (search followed by search), search-digit, digit-search, and digit-digit. In a control reaction time (RT) condition, participants provided RT responses in each of the 2 tasks. In a time production condition, an RT response was provided to the first stimulus, but the response to the second stimulus, S2, was given only when participants judged that a previously presented target duration had elapsed. When responding to S2 required a switch, RTs to S2 were longer, but produced intervals were unaffected. These results show that memory search affects concurrent timing, but not task switching. Task switching seems therefore to be 1 executive function that does not interfer with timing.