Comparison of Model-Based Indices of Cerebral Autoregulation and Vasomotor Reactivity Using Transcranial Doppler versus Near-Infrared Spectroscopy in Patients with Amnestic Mild Cognitive Impairment

We recently introduced model-based "physiomarkers" of dynamic cerebral autoregulation and CO2 vasomotor reactivity as an aid for diagnosis of early-stage Alzheimer's disease (AD) [1], where significant impairment of dynamic vasomotor reactivity (DVR) was observed in early-stage AD patients relative to age-matched controls. Milder impairment of DVR was shown in patients with amnestic mild cognitive impairment (MCI) using the same approach in a subsequent study [2]. The advocated approach utilizes subject-specific data-based models of cerebral hemodynamics to quantify the dynamic effects of resting-state changes in arterial blood pressure and end-tidal CO2 (the putative inputs) upon cerebral blood flow velocity (the putative output) measured at the middle cerebral artery via transcranial Doppler (TCD). The obtained input-output models are then used to compute model-based indices of DCA and DVR from model-predicted responses to an input pressure pulse or an input CO2 pulse, respectively. In this paper, we compare these model-based indices of DVR and DCA in 46 amnestic MCI patients, relative to 20 age-matched controls, using TCD measurements with their counterparts using Near-Infrared Spectroscopy (NIRS) measurements of blood oxygenation at the lateral prefrontal cortex in 43 patients and 22 age-matched controls. The goal of the study is to assess whether NIRS measurements can be used instead of TCD measurements to obtain model-based physiomarkers with comparable diagnostic utility. The results corroborate this view in terms of the ability of either output to yield model-based physiomarkers that can differentiate the group of aMCI patients from age-matched healthy controls.

Sparse Large-Scale Nonlinear Dynamical Modeling of Human Hippocampus for Memory Prostheses

In order to build hippocampal prostheses for restoring memory functions, we build sparse multi-input, multi-output (MIMO) nonlinear dynamical models of the human hippocampus. Spike trains are recorded from hippocampal CA3 and CA1 regions of epileptic patients performing a variety of memory-dependent delayed match-to-sample (DMS) tasks. Using CA3 and CA1 spike trains as inputs and outputs respectively, sparse generalized Laguerre-Volterra models are estimated with group lasso and local coordinate descent methods to capture the nonlinear dynamics underlying the CA3-CA1 spike train transformations. These models can accurately predict the CA1 spike trains based on the ongoing CA3 spike trains during multiple memory events, e.g., sample presentation, sample response, match presentation and match response, of the DMS task, and thus will serve as the computational basis of human hippocampal memory prostheses.

A cognitive prosthesis for memory facilitation by closed-loop functional ensemble stimulation of hippocampal neurons in primate brain

Very productive collaborative investigations characterized how multineuron hippocampal ensembles recorded in nonhuman primates (NHPs) encode short-term memory necessary for successful performance in a delayed match to sample (DMS) task and utilized that information to devise a unique nonlinear multi-input multi-output (MIMO) memory prosthesis device to enhance short-term memory in real-time during task performance. Investigations have characterized how the hippocampus in primate brain encodes information in a multi-item, rule-controlled, delayed match to sample (DMS) task. The MIMO model was applied via closed loop feedback micro-current stimulation during the task via conformal electrode arrays and enhanced performance of the complex memory requirements. These findings clearly indicate detection of a means by which the hippocampus encodes information and transmits this information to other brain regions involved in memory processing. By employing the nonlinear dynamic multi-input/multi-output (MIMO) model, developed and adapted to hippocampal neural ensemble firing patterns derived from simultaneous recorded multi-neuron CA1 and CA3 activity, it was possible to extract information encoded in the Sample phase of DMS trials that was necessary for successful performance in the subsequent Match phase of the task. The extension of this MIMO model to online delivery of electrical stimulation patterns to the same recording loci that exhibited successful CA1 firing in the DMS Sample Phase provided the means to increase task performance on a trial-by-trial basis. Increased utility of the MIMO model as a memory prosthesis was exhibited by the demonstration of cumulative increases in DMS task performance with repeated MIMO stimulation over many sessions. These results, reported below in this article, provide the necessary demonstrations to further the feasibility of the MIMO model as a memory prosthesis to recover and/or enhance encoding of cognitive information in humans with memory disruptions resulting from brain injury, disease or aging.

Multiple-input nonlinear modelling of cerebral haemodynamics using spontaneous arterial blood pressure, end-tidal CO2 and heart rate measurements

In order to examine the effect of changes in heart rate (HR) upon cerebral perfusion and autoregulation, we include the HR signal recorded from 18 control subjects as a third input in a two-input model of cerebral haemodynamics that has been used previously to quantify the dynamic effects of changes in arterial blood pressure and end-tidal CO2upon cerebral blood flow velocity (CBFV) measured at the middle cerebral arteries via transcranial Doppler ultrasound. It is shown that the inclusion of HR as a third input reduces the output prediction error in a statistically significant manner, which implies that there is a functional connection between HR changes and CBFV. The inclusion of nonlinearities in the model causes further statistically significant reduction of the output prediction error. To achieve this task, we employ the concept of principal dynamic modes (PDMs) that yields dynamic nonlinear models of multi-input systems using relatively short data records. The obtained PDMs suggest model-driven quantitative hypotheses for the role of sympathetic and parasympathetic activity (corresponding to distinct PDMs) in the underlying physiological mechanisms by virtue of their relative contributions to the model output. These relative PDM contributions are subject-specific and, therefore, may be used to assess personalized characteristics for diagnostic purposes.

Understanding spike-triggered covariance using Wiener theory for receptive field identification

Receptive field identification is a vital problem in sensory neurophysiology and vision. Much research has been done in identifying the receptive fields of nonlinear neurons whose firing rate is determined by the nonlinear interactions of a small number of linear filters. Despite more advanced methods that have been proposed, spike-triggered covariance (STC) continues to be the most widely used method in such situations due to its simplicity and intuitiveness. Although the connection between STC and Wiener/Volterra kernels has often been mentioned in the literature, this relationship has never been explicitly derived. Here we derive this relationship and show that the STC matrix is actually a modified version of the second-order Wiener kernel, which incorporates the input autocorrelation and mixes first- and second-order dynamics. It is then shown how, with little modification of the STC method, the Wiener kernels may be obtained and, from them, the principal dynamic modes, a set of compact and efficient linear filters that essentially combine the spike-triggered average and STC matrix and generalize to systems with both continuous and point-process outputs. Finally, using Wiener theory, we show how these obtained filters may be corrected when they were estimated using correlated inputs. Our correction technique is shown to be superior to those commonly used in the literature for both correlated Gaussian images and natural images.

Distinguishing cognitive state with multifractal complexity of hippocampal interspike interval sequences

Fractality, represented as self-similar repeating patterns, is ubiquitous in nature and the brain. Dynamic patterns of hippocampal spike trains are known to exhibit multifractal properties during working memory processing; however, it is unclear whether the multifractal properties inherent to hippocampal spike trains reflect active cognitive processing. To examine this possibility, hippocampal neuronal ensembles were recorded from rats before, during and after a spatial working memory task following administration of tetrahydrocannabinol (THC), a memory-impairing component of cannabis. Multifractal detrended fluctuation analysis was performed on hippocampal interspike interval sequences to determine characteristics of monofractal long-range temporal correlations (LRTCs), quantified by the Hurst exponent, and the degree/magnitude of multifractal complexity, quantified by the width of the singularity spectrum. Our results demonstrate that multifractal firing patterns of hippocampal spike trains are a marker of functional memory processing, as they are more complex during the working memory task and significantly reduced following administration of memory impairing THC doses. Conversely, LRTCs are largest during resting state recordings, therefore reflecting different information compared to multifractality. In order to deepen conceptual understanding of multifractal complexity and LRTCs, these measures were compared to classical methods using hippocampal frequency content and firing variability measures. These results showed that LRTCs, multifractality, and theta rhythm represent independent processes, while delta rhythm correlated with multifractality. Taken together, these results provide a novel perspective on memory function by demonstrating that the multifractal nature of spike trains reflects hippocampal microcircuit activity that can be used to detect and quantify cognitive, physiological, and pathological states.

Hippocampal closed-loop modeling and implications for seizure stimulation design

OBJECTIVE

Traditional hippocampal modeling has focused on the series of feedforward synapses known as the trisynaptic pathway. However, feedback connections from CA1 back to the hippocampus through the entorhinal cortex (EC) actually make the hippocampus a closed-loop system. By constructing a functional closed-loop model of the hippocampus, one may learn how both physiological and epileptic oscillations emerge and design efficient neurostimulation patterns to abate such oscillations.

APPROACH

Point process input-output models where estimated from recorded rodent hippocampal data to describe the nonlinear dynamical transformation from CA3 → CA1, via the schaffer-collateral synapse, and CA1 → CA3 via the EC. Each Volterra-like subsystem was composed of linear dynamics (principal dynamic modes) followed by static nonlinearities. The two subsystems were then wired together to produce the full closed-loop model of the hippocampus.

MAIN RESULTS

Closed-loop connectivity was found to be necessary for the emergence of theta resonances as seen in recorded data, thus validating the model. The model was then used to identify frequency parameters for the design of neurostimulation patterns to abate seizures.

SIGNIFICANCE

Deep-brain stimulation (DBS) is a new and promising therapy for intractable seizures. Currently, there is no efficient way to determine optimal frequency parameters for DBS, or even whether periodic or broadband stimuli are optimal. Data-based computational models have the potential to be used as a testbed for designing optimal DBS patterns for individual patients. However, in order for these models to be successful they must incorporate the complex closed-loop structure of the seizure focus. This study serves as a proof-of-concept of using such models to design efficient personalized DBS patterns for epilepsy.

Sparse generalized volterra model of human hippocampal spike train transformation for memory prostheses

In order to build hippocampal prostheses for restoring memory functions, we build multi-input, multi-output (MIMO) nonlinear dynamical models of the human hippocampus. Spike trains are recorded from the hippocampal CA3 and CA1 regions of epileptic patients performing a memory-dependent delayed match-to-sample task. Using CA3 and CA1 spike trains as inputs and outputs respectively, second-order sparse generalized Laguerre-Volterra models are estimated with group lasso and local coordinate descent methods to capture the nonlinear dynamics underlying the spike train transformations. These models can accurately predict the CA1 spike trains based on the ongoing CA3 spike trains and thus will serve as the computational basis of the hippocampal memory prosthesis.

System identification of point-process neural systems using probability based Volterra kernels

BACKGROUND

Neural information processing involves a series of nonlinear dynamical input/output transformations between the spike trains of neurons/neuronal ensembles. Understanding and quantifying these transformations is critical both for understanding neural physiology such as short-term potentiation and for developing cognitive neural prosthetics.

NEW METHOD

A novel method for estimating Volterra kernels for systems with point-process inputs and outputs is developed based on elementary probability theory. These Probability Based Volterra (PBV) kernels essentially describe the probability of an output spike given q input spikes at various lags t1, t2, …, tq.

RESULTS

The PBV kernels are used to estimate both synthetic systems where ground truth is available and data from the CA3 and CA1 regions rodent hippocampus. The PBV kernels give excellent predictive results in both cases. Furthermore, they are shown to be quite robust to noise and to have good convergence and overfitting properties. Through a slight modification, the PBV kernels are shown to also deal well with correlated point-process inputs.

COMPARISON WITH EXISTING METHODS

The PBV kernels were compared with kernels estimated through least squares estimation (LSE) and through the Laguerre expansion technique (LET). The LSE kernels were shown to fair very poorly with real data due to the large amount of input noise. Although the LET kernels gave the best predictive results in all cases, they require prior parameter estimation. It was shown how the PBV and LET methods can be combined synergistically to maximize performance.

CONCLUSIONS

The PBV kernels provide a novel and intuitive method of characterizing point-process input-output nonlinear systems.

Principal dynamic mode analysis of the Hodgkin-Huxley equations

We develop an autoregressive model framework based on the concept of Principal Dynamic Modes (PDMs) for the process of action potential (AP) generation in the excitable neuronal membrane described by the Hodgkin-Huxley (H-H) equations. The model's exogenous input is injected current, and whenever the membrane potential output exceeds a specified threshold, it is fed back as a second input. The PDMs are estimated from the previously developed Nonlinear Autoregressive Volterra (NARV) model, and represent an efficient functional basis for Volterra kernel expansion. The PDM-based model admits a modular representation, consisting of the forward and feedback PDM bases as linear filterbanks for the exogenous and autoregressive inputs, respectively, whose outputs are then fed to a static nonlinearity composed of polynomials operating on the PDM outputs and cross-terms of pair-products of PDM outputs. A two-step procedure for model reduction is performed: first, influential subsets of the forward and feedback PDM bases are identified and selected as the reduced PDM bases. Second, the terms of the static nonlinearity are pruned. The first step reduces model complexity from a total of 65 coefficients to 27, while the second further reduces the model coefficients to only eight. It is demonstrated that the performance cost of model reduction in terms of out-of-sample prediction accuracy is minimal. Unlike the full model, the eight coefficient pruned model can be easily visualized to reveal the essential system components, and thus the data-derived PDM model can yield insight into the underlying system structure and function.

Identification of functional synaptic plasticity from spiking activities using nonlinear dynamical modeling

This paper presents a systems identification approach for studying the long-term synaptic plasticity using natural spiking activities. This approach consists of three modeling steps. First, a multi-input, single-output (MISO), nonlinear dynamical spiking neuron model is formulated to estimate and represent the synaptic strength in means of functional connectivity between input and output neurons. Second, this MISO model is extended to a nonstationary form to track the time-varying properties of the synaptic strength. Finally, a Volterra modeling method is used to extract the synaptic learning rule, e.g., spike-timing-dependent plasticity, for the explanation of the input-output nonstationarity as the consequence of the past input-output spiking patterns. This framework is developed to study the underlying mechanisms of learning and memory formation in behaving animals, and may serve as the computational basis for building the next-generation adaptive cortical prostheses.

Model-based asessment of an in-vivo predictive relationship from CA1 to CA3 in the rodent hippocampus

Although an anatomical connection from CA1 to CA3 via the Entorhinal Cortex (EC) and through backprojecting interneurons has long been known it exist, it has never been examined quantitatively on the single neuron level, in the in-vivo nonpatholgical, nonperturbed brain. Here, single spike activity was recorded using a multi-electrode array from the CA3 and CA1 areas of the rodent hippocampus (N = 7) during a behavioral task. The predictive power from CA3→CA1 and CA1→CA3 was examined by constructing Multivariate Autoregressive (MVAR) models from recorded neurons in both directions. All nonsignificant inputs and models were identified and removed by means of Monte Carlo simulation methods. It was found that 121/166 (73 %) CA3→CA1 models and 96/145 (66 %) CA1→CA3 models had significant predictive power, thus confirming a predictive 'Granger' causal relationship from CA1 to CA3. This relationship is thought to be caused by a combination of truly causal connections such as the CA1→EC→CA3 pathway and common inputs such as those from the Septum. All MVAR models were then examined in the frequency domain and it was found that CA3 kernels had significantly more power in the theta and beta range than those of CA1, confirming CA3's role as an endogenous hippocampal pacemaker.

Extraction and restoration of hippocampal spatial memories with non-linear dynamical modeling

To build a cognitive prosthesis that can replace the memory function of the hippocampus, it is essential to model the input-output function of the damaged hippocampal region, so the prosthetic device can stimulate the downstream hippocampal region, e.g., CA1, with the output signal, e.g., CA1 spike trains, predicted from the ongoing input signal, e.g., CA3 spike trains, and the identified input-output function, e.g., CA3-CA1 model. In order for the downstream region to form appropriate long-term memories based on the restored output signal, furthermore, the output signal should contain sufficient information about the memories that the animal has formed. In this study, we verify this premise by applying regression and classification modelings of the spatio-temporal patterns of spike trains to the hippocampal CA3 and CA1 data recorded from rats performing a memory-dependent delayed non-match-to-sample (DNMS) task. The regression model is essentially the multiple-input, multiple-output (MIMO) non-linear dynamical model of spike train transformation. It predicts the output spike trains based on the input spike trains and thus restores the output signal. In addition, the classification model interprets the signal by relating the spatio-temporal patterns to the memory events. We have found that: (1) both hippocampal CA3 and CA1 spike trains contain sufficient information for predicting the locations of the sample responses (i.e., left and right memories) during the DNMS task; and more importantly (2) the CA1 spike trains predicted from the CA3 spike trains by the MIMO model also are sufficient for predicting the locations on a single-trial basis. These results show quantitatively that, with a moderate number of unitary recordings from the hippocampus, the MIMO non-linear dynamical model is able to extract and restore spatial memory information for the formation of long-term memories and thus can serve as the computational basis of the hippocampal memory prosthesis.

Model-based physiomarkers of cerebral hemodynamics in patients with mild cognitive impairment

In our previous studies, we have introduced model-based "functional biomarkers" or "physiomarkers" of cerebral hemodynamics that hold promise for improved diagnosis of early-stage Alzheimer's disease (AD). The advocated methodology utilizes subject-specific data-based dynamic nonlinear models of cerebral hemodynamics to compute indices (serving as possible diagnostic physiomarkers) that quantify the state of cerebral blood flow autoregulation to pressure-changes (CFAP) and cerebral CO2 vasomotor reactivity (CVMR) in each subject. The model is estimated from beat-to-beat measurements of mean arterial blood pressure, mean cerebral blood flow velocity and end-tidal CO2, which can be made reliably and non-invasively under resting conditions. In a previous study, it was found that a CVMR index quantifying the impairment in CO2 vasomotor reactivity correlates with clinical indications of early AD, offering the prospect of a potentially useful diagnostic tool. In this paper, we explore the use of the same model-based indices for patients with amnestic Mild Cognitive Impairment (MCI), a preclinical stage of AD, relative to a control subjects and clinical cognitive assessments. It was found that the model-based CVMR values were lower for MCI patients relative to the control subjects.

Donor/recipient enhancement of memory in rat hippocampus

The critical role of the mammalian hippocampus in the formation, translation and retrieval of memory has been documented over many decades. There are many theories of how the hippocampus operates to encode events and a precise mechanism was recently identified in rats performing a short-term memory task which demonstrated that successful information encoding was promoted via specific patterns of activity generated within ensembles of hippocampal neurons. In the study presented here, these “representations” were extracted via a customized non-linear multi-input multi-output (MIMO) mathematical model which allowed prediction of successful performance on specific trials within the testing session. A unique feature of this characterization was demonstrated when successful information encoding patterns were derived online from well-trained “donor” animals during difficult long-delay trials and delivered via online electrical stimulation to synchronously tested naïve “recipient” animals never before exposed to the delay feature of the task. By transferring such model-derived trained (donor) animal hippocampal firing patterns via stimulation to coupled naïve recipient animals, their task performance was facilitated in a direct “donor-recipient” manner. This provides the basis for utilizing extracted appropriate neural information from one brain to induce, recover, or enhance memory related processing in the brain of another subject.

Facilitation of memory encoding in primate hippocampus by a neuroprosthesis that promotes task-specific neural firing

OBJECTIVE

Memory accuracy is a major problem in human disease and is the primary factor that defines Alzheimer's, ageing and dementia resulting from impaired hippocampal function in the medial temporal lobe. Development of a hippocampal memory neuroprosthesis that facilitates normal memory encoding in nonhuman primates (NHPs) could provide the basis for improving memory in human disease states.

APPROACH

NHPs trained to perform a short-term delayed match-to-sample (DMS) memory task were examined with multi-neuron recordings from synaptically connected hippocampal cell fields, CA1 and CA3. Recordings were analyzed utilizing a previously developed nonlinear multi-input multi-output (MIMO) neuroprosthetic model, capable of extracting CA3-to-CA1 spatiotemporal firing patterns during DMS performance.

MAIN RESULTS

The MIMO model verified that specific CA3-to-CA1 firing patterns were critical for the successful encoding of sample phase information on more difficult DMS trials. This was validated by the delivery of successful MIMO-derived encoding patterns via electrical stimulation to the same CA1 recording locations during the sample phase which facilitated task performance in the subsequent, delayed match phase, on difficult trials that required more precise encoding of sample information.

SIGNIFICANCE

These findings provide the first successful application of a neuroprosthesis designed to enhance and/or repair memory encoding in primate brain.

Model-based quantification of cerebral hemodynamics as a physiomarker for Alzheimer's disease?

Previous studies have found that Alzheimer's disease (AD) impairs cerebral vascular function, even at early stages of the disease. This offers the prospect of a useful diagnostic method for AD, if cerebral vascular dysfunction can be quantified reliably within practical clinical constraints. We present a recently developed methodology that utilizes a data-based dynamic nonlinear closed-loop model of cerebral hemodynamics to compute "physiomarkers" quantifying the state of cerebral flow autoregulation to pressure-changes (CA) and cerebral CO2 vasomotor reactivity (CVMR) in each subject. This model is estimated from beat-to-beat measurements of mean arterial blood pressure, mean cerebral blood flow velocity and end-tidal CO2, which can be made reliably and non-invasively under resting conditions. This model may also take an open-loop form and comparisons are made with the closed-loop counterpart. The proposed model-based physiomarkers take the form of two indices that quantify the gain of the CA and CVMR processes in each subject. It was found in an initial set of clinical data that the CVMR index delineates AD patients from control subjects and, therefore, may prove useful in the improved diagnosis of early-stage AD.

Time-varying modeling of cerebral hemodynamics

The scientific and clinical importance of cerebral hemodynamics has generated considerable interest in their quantitative understanding via computational modeling. In particular, two aspects of cerebral hemodynamics, cerebral flow autoregulation (CFA) and CO2 vasomotor reactivity (CVR), have attracted much attention because they are implicated in many important clinical conditions and pathologies (orthostatic intolerance, syncope, hypertension, stroke, vascular dementia, mild cognitive impairment, Alzheimer's disease, and other neurodegenerative diseases with cerebrovascular components). Both CFA and CVR are dynamic physiological processes by which cerebral blood flow is regulated in response to fluctuations in cerebral perfusion pressure and blood CO2 tension. Several modeling studies to date have analyzed beat-to-beat hemodynamic data in order to advance our quantitative understanding of CFA-CVR dynamics. A confounding factor in these studies is the fact that the dynamics of the CFA-CVR processes appear to vary with time (i.e., changes in cerebrovascular characteristics) due to neural, endocrine, and metabolic effects. This paper seeks to address this issue by tracking the changes in linear time-invariant models obtained from short successive segments of data from ten healthy human subjects. The results suggest that systemic variations exist but have stationary statistics and, therefore, the use of time-invariant modeling yields "time-averaged models" of physiological and clinical utility.

Conformal ceramic electrodes that record glutamate release and corresponding neural activity in primate prefrontal cortex

Conformal ceramic electrodes utilized in prior recordings of nonhuman primate prefrontal cortical layer 2/3 and layer 5 neurons were used in this study to record tonic glutamate concentration and transient release in layer 2/3 PFC. Tonic glutamate concentration increased in the Match (decision) phase of a visual delayed-match-to-sample (DMS) task, while increased transient glutamate release occurred in the Sample (encoding) phase of the task. Further, spatial vs. object-oriented DMS trials evoked differential changes in glutamate concentration. Thus the same conformal recording electrodes were capable of electrophysiological and electrochemical recording, and revealed similar evidence of neural processing in layers 2/3 and layer 5 during cognitive processing in a behavioral task.

On parsing the neural code in the prefrontal cortex of primates using principal dynamic modes

Nonlinear modeling of multi-input multi-output (MIMO) neuronal systems using Principal Dynamic Modes (PDMs) provides a novel method for analyzing the functional connectivity between neuronal groups. This paper presents the PDM-based modeling methodology and initial results from actual multi-unit recordings in the prefrontal cortex of non-human primates. We used the PDMs to analyze the dynamic transformations of spike train activity from Layer 2 (input) to Layer 5 (output) of the prefrontal cortex in primates performing a Delayed-Match-to-Sample task. The PDM-based models reduce the complexity of representing large-scale neural MIMO systems that involve large numbers of neurons, and also offer the prospect of improved biological/physiological interpretation of the obtained models. PDM analysis of neuronal connectivity in this system revealed "input-output channels of communication" corresponding to specific bands of neural rhythms that quantify the relative importance of these frequency-specific PDMs across a variety of different tasks. We found that behavioral performance during the Delayed-Match-to-Sample task (correct vs. incorrect outcome) was associated with differential activation of frequency-specific PDMs in the prefrontal cortex.

Analysis of intravenous glucose tolerance test data using parametric and nonparametric modeling: application to a population at risk for diabetes

BACKGROUND

Modeling studies of the insulin-glucose relationship have mainly utilized parametric models, most notably the minimal model (MM) of glucose disappearance. This article presents results from the comparative analysis of the parametric MM and a nonparametric Laguerre based Volterra Model (LVM) applied to the analysis of insulin modified (IM) intravenous glucose tolerance test (IVGTT) data from a clinical study of gestational diabetes mellitus (GDM).

METHODS

An IM IVGTT study was performed 8 to 10 weeks postpartum in 125 women who were diagnosed with GDM during their pregnancy [population at risk of developing diabetes (PRD)] and in 39 control women with normal pregnancies (control subjects). The measured plasma glucose and insulin from the IM IVGTT in each group were analyzed via a population analysis approach to estimate the insulin sensitivity parameter of the parametric MM. In the nonparametric LVM analysis, the glucose and insulin data were used to calculate the first-order kernel, from which a diagnostic scalar index representing the integrated effect of insulin on glucose was derived.

RESULTS

Both the parametric MM and nonparametric LVM describe the glucose concentration data in each group with good fidelity, with an improved measured versus predicted r² value for the LVM of 0.99 versus 0.97 for the MM analysis in the PRD. However, application of the respective diagnostic indices of the two methods does result in a different classification of 20% of the individuals in the PRD.

CONCLUSIONS

It was found that the data based nonparametric LVM revealed additional insights about the manner in which infused insulin affects blood glucose concentration.

Closed-loop dynamic modeling of cerebral hemodynamics

The dynamics of cerebral hemodynamics have been studied extensively because of their fundamental physiological and clinical importance. In particular, the dynamic processes of cerebral flow autoregulation (CFA) and CO2 vasomotor reactivity have attracted broad attention because of their involvement in a host of pathologies and clinical conditions (e.g., hypertension, syncope, stroke, traumatic brain injury, vascular dementia, Alzheimer's disease, mild cognitive impairment etc.). This raises the prospect of useful diagnostic methods being developed on the basis of quantitative models of cerebral hemodynamics, if cerebral vascular dysfunction can be quantified reliably from data collected within practical clinical constraints. This paper presents a modeling method that utilizes beat-to-beat measurements of mean arterial blood pressure, cerebral blood flow velocity and end-tidal CO2 (collected non-invasively under resting conditions) to quantify the dynamics of CFA and cerebral vasomotor reactivity (CVMR). The unique and novel aspect of this dynamic model is that it is nonlinear and operates in a closed-loop configuration.