A P300-based cognitive assessment battery

Bariatric surgery and its impact on depressive symptoms, cognition, brain and inflammation

Background

Obesity has been associated with depressive symptoms and impaired cognition, but the mechanisms underlying these relationships are not well understood. It is also not clear whether reducing adiposity reverses these behavioral outcomes. The current study tested the impact of bariatric surgery on depressive symptoms, cognition, and the brain; using a mediation model, we also examined whether the relationship between changes in adiposity after the surgery and those in regional thickness of the cerebral cortex are mediated by changes in low-grade inflammation (as indexed by C-reactive protein; CRP).

Methods

A total of 18 bariatric patients completed 3 visits, including one baseline before the surgery and two post-surgery measurements acquired at 6- and 12-months post-surgery. Each visit consisted of a collection of fasting blood sample, magnetic resonance imaging of the brain and abdomen, and assessment of depressive symptoms and cognition.

Results

After surgery, we observed reductions of both visceral fat (p< 0.001) and subcutaneous fat (p< 0.001), less depressive symptoms (p< 0.001), improved verbal reasoning (p< 0.001), and reduced CRP (p< 0.001). Mediation analyses revealed that the relationships between the surgery-related changes in visceral fat and cortical thickness in depression-related regions are mediated by changes in CRP (ab=-.027, SE=.012, 95% CI [-.054, -,006]).

Conclusion

These findings suggest that some of the beneficial effects of bariatric surgery on brain function and structure are due to a reduction of adiposity-related low-grade systemic inflammation.

Modulation of theta and gamma oscillations during familiarization with previously unknown music

Repeated listening to unknown music leads to gradual familiarization with musical sequences. Passively listening to musical sequences could involve an array of dynamic neural responses in reaching familiarization with the musical excerpts. This study elucidates the dynamic brain response and its variation over time by investigating the electrophysiological changes during the familiarization with initially unknown music. Twenty subjects were asked to familiarize themselves with previously unknown 10 s classical music excerpts over three repetitions while their electroencephalogram was recorded. Dynamic spectral changes in neural oscillations are monitored by time-frequency analyses for all frequency bands (theta: 5-9 Hz, alpha: 9-13 Hz, low-beta: 13-21 Hz, high beta: 21-32 Hz, and gamma: 32-50 Hz). Time-frequency analyses reveal sustained theta event-related desynchronization (ERD) in the frontal-midline and the left pre-frontal electrodes which decreased gradually from 1st to 3rd time repetition of the same excerpts (frontal-midline: 57.90 %, left-prefrontal: 75.93 %). Similarly, sustained gamma ERD decreased in the frontal-midline and bilaterally frontal/temporal areas (frontal-midline: 61.47 %, left-frontal: 90.88 %, right-frontal: 87.74 %). During familiarization, the decrease of theta ERD is superior in the first part (1-5 s) whereas the decrease of gamma ERD is superior in the second part (5-9 s) of music excerpts. The results suggest that decreased theta ERD is associated with successfully identifying familiar sequences, whereas decreased gamma ERD is related to forming unfamiliar sequences.

ImGo: A Novel Tool for Behavioral Impulsivity Assessment Based on Go/NoGo Tasks

This manuscript aims to present a novel behavioral impulsivity test ImGo, which is suitable for impulsivity assessment in the general population. A series of three studies was conducted to validate its psychometric qualities. In Study 1 we describe the principles of ImGo and verify its test-retest and split-half reliability and its convergent validity with an impulsivity self-report scale and Stop Signal test. In Study 2 we re-analyze the convergent validity of ImGo with a Stop Signal test and examine the potential relationship between ImGo and oculomotor inhibition measured by an Anti-Saccades test. In Study 3 we present a robust research with a large sample size and investigate the discriminant validity of ImGo with tests of other related cognitive and executive processes. Backed by our findings from these studies we can safely claim ImGo is a powerful tool with a good level of reliability (both test-retest and split-half) and validity (convergent and discriminant). Its potential lies in its use in diagnostic and research practice of experts from various countries as the test has already been translated to 9 languages so far. The open-source Hypothesis platform, on which the ImGo test is running, provides the option of both individual and group testing in laboratory conditions as well as remotely through an internet browser.

Chemo-brain: An activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies

Adults with non-central nervous system (CNS) cancers frequently report problems in attention, memory and executive function during or after chemotherapy, referred to as cancer-related cognitive dysfunction (CRCD). Despite numerous studies investigating CRCD, there is no consensus regarding the brain areas implicated. We sought to determine if there are brain areas that consistently show either hyper- or hypo-activation in people treated with chemotherapy for non-CNS cancer (Chemo+). Using activation likelihood estimation on brain coordinates from 14 fMRI studies yielding 25 contrasts from 375 Chemo+ and 429 chemotherapy-naive controls while they performed cognitive tasks, the meta-analysis yielded two significant clusters which are part of the frontoparietal attention network, both showing lower activation in Chemo+. One cluster peaked in the left superior parietal cortex, extending into precuneus, inferior parietal lobule, and angular gyrus. The other peaked in the right superior prefrontal areas, extending into inferior prefrontal cortex. We propose that these observed lower activations reflect a dysfunction in mobilizing and/or sustaining attention due to depletion of cognitive resources. This could explain higher level of mental fatigue reported by Chemo+ and why cancer survivors report problems in a wide variety of cognitive domains.

Individualized assessment of residual cognition in patients with disorders of consciousness

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Single-trial electrical recordings index higher-order cognitive processing of movie stimuli.

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Common patterns of neural activity associated with the brain’s executive network.

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The time course of common neural activity correlates with ratings of suspense.

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38% of non-responsive patients correlate with controls during movie-watching tasks.

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Novel bedside assessment of complex cognition in behaviourally non-responsive patients.

Patients diagnosed with disorders of consciousness show minimal or inconsistent behavioural evidence of conscious awareness. However, using functional neuroimaging, recent research in clinical neuroscience has identified a subpopulation of these patients who reliably produce neural markers indicative of awareness. In this study, we recorded electroencephalograms during a response-free movie task to assess narrative processing in patients with disorders of consciousness. Thirteen patients diagnosed with a disorder of consciousness and 28 healthy controls participated in this study. We designed a movie-watching/listening paradigm involving two suspenseful movie clips, one audiovisual and one audio-only, and used electroencephalography to extract patterns of brain activity that were maximally correlated between subjects. These activity patterns served as electrophysiological indices of narrative processing, which were compared to the neural responses of patients during the same movies. Our analysis revealed two patterns of neural activity, one for each movie condition, that were significantly and reliably correlated between healthy participants. Of the twelve patients who watched the audiovisual movie, 25% produced a pattern of activity that was significantly correlated with the healthy group, while of the ten who listened to the audio narrative, 30% produced electrophysiological patterns similar to controls (one patient responded appropriately to both). The method presented here allows for rapid bedside assessment of higher-order cognitive processing in patients with disorders of consciousness. By leveraging the common neural response to movie stimuli, we were able to identify comparable patterns of brain activity in individual, behaviourally non-responsive patients, reflecting a capacity for narrative processing.

Applied potential of task-free event-related paradigms for assessing neurocognitive functions in disorders of consciousness

Diagnosing patients with disorders of consciousness is immensely difficult and often results in misdiagnoses, which can have fatal consequences. Despite the severity of this well-known issue, a reliable assessment tool has not yet been developed and implemented in the clinic. The main aim of this focused review is to evaluate the various event-related potential paradigms, recorded using EEG, which may be used to improve the assessment of patients with disorders of consciousness; we also provide a brief comparison of these paradigms with other measures. Notably, most event-related potential studies on the topic have focused on testing a small set of components, or even just a single component. However, to be of practical use, we argue that an assessment should probe a range of cognitive and linguistic functions at once. We suggest a novel approach that combines a set of well-tested auditory event-related potential components: N100, mismatch negativity, P3a, N400, early left anterior negativity and lexical response enhancement. Combining these components in a single, task-free design will provide a multidimensional assessment of cognitive and linguistic processes, which may help physicians make a more precise diagnosis.

Electrophysiological markers of poor versus superior math abilities in healthy individuals

Interindividual differences in the numerical ability of healthy adults have been previously demonstrated, mainly with tasks involving mental number line or size representation. However, electrophysiological correlates of superior versus poor arithmetic ability (in the healthy population) have been scarcely investigated. We correlated electric potentials with math performance in 13 skilled and 13 poor calculators selected from a sample of 41 graduate students on the basis of their poor or superior math abilities assessed through a timed test. EEG was recorded from 128 channels while participants solved 352 arithmetical operations (additions, subtractions, multiplications, divisions) and decided whether the provided solution was correct or incorrect. Overall skilled individuals correctly solved a higher number of operations than poor calculators and had faster response times. Consistently, the latency of fronto-central P300 component of event-related potentials (ERPs) peaked earlier in the skilled than poor group. The P300 was larger in amplitude to correct than incorrect solutions, but just in the skilled group, with a tendency found in poor calculators. Spearman's ρ correlation coefficient analyses showed that the larger P300 response was to correct arithmetic solutions, the better the performance; conversely, the larger the P300 amplitude was to incorrect solutions, the worse the performance. The results suggest that poor calculators had a less clear representation of arithmetic solutions and difficulty in quickly accessing it. This study provides a standard method for directly investigating math abilities throughout ERP recordings that could be useful for assessing acalculia/dyscalculia in the clinical population (children, elderly, brain-damaged patients).

Assessment of Statistically Significant Command-Following in Pediatric Patients with Disorders of Consciousness, Based on Visual, Auditory and Tactile Event-Related Potentials

Disorders of consciousness (DOC) are among the major challenges of contemporary medicine, mostly due to the high rates of misdiagnoses in clinical assessment, based on behavioral scales. This turns our attention to potentially objective neuroimaging methods. Paradigms based on electroencephalography (EEG) are most suited for bedside applications, but sensitive to artifacts. These problems are especially pronounced in pediatric patients. We present the first study on the assessment of pediatric DOC patients by means of command-following procedures and involving long-latency cognitive event-related potentials. To deal with the above mentioned challenges, we construct a specialized signal processing scheme including artifact correction and rejection, parametrization, classification and final assessment of the statistical significance. To compensate for the possible bias of the tests involved in the final diagnosis, we propose the Monte Carlo evaluation of the processing pipeline. To compensate for possible sensory impairments of DOC patients, for each subject we check command-following responses to the stimuli in the major modalities: visual, tactile, and audio (words and sounds). We test the scheme on 20 healthy volunteers and present results for 15 patients from a hospital for children with severe brain damage, in relation to their behavioral diagnosis on the Coma Recovery Scale-Revised (CRS-R).

Reduced delta-band modulation underlies the loss of P300 responses in disorders of consciousness

OBJECTIVE

The P300 component of a sensory event-related potential is one of the major electrophysiological markers used to explore remnants of cognitive function in patients with disorders of consciousness (DoC). However, measuring the P300 in patients is complicated by significant inter-trial variability commonly observed in levels of arousal and awareness. To overcome this limitation, we analyzed single-trial modulation of power in the delta and theta frequency bands, which underlie the P300.

METHODS

In a preliminary cross-sectional study using a 24-channel EEG and a passive own-name oddball paradigm, we analyzed event-related synchronization (ERS) across trials in the delta and theta bands in a sample of 10 control and 12 DoC subjects.

RESULTS

In comparison to controls, DoC subjects presented a low percentage of trials where delta ERS was observed. In particular, coordinated modulation between delta and theta in response to the stimulus was absent, with a high percentage of trials where only theta ERS was observed. Further, we found a positive correlation between the percentage of epochs with delta ERS and the strength of the P300.

CONCLUSIONS

Reduced modulation of spectral activity in the delta band in response to stimuli indicates a dissociation in the activity of the neural networks that oscillate in delta and theta ranges and contribute to the generation of the P300.

SIGNIFICANCE

The reduction in spectral modulation observed in DoC provides a deeper understanding of neurophysiological dysfunction and the means to develop a more fine-grained marker of residual cognitive function in individual patients.

The Effect of Apolipoprotein E ε4 (APOE ε4) on Visuospatial Working Memory in Healthy Elderly and Amnestic Mild Cognitive Impairment Patients: An Event-Related Potentials Study

Background: Apolipoprotein E (APOE) ε4 is the only established risk gene for late-onset, sporadic Alzheimer’s disease (AD). Previous studies have provided inconsistent evidence for the effect of APOE ε4 status on the visuospatial working memory (VSWM).

Objective: The aim was to investigate the effect of APOE ε4 on VSWM with an event-related potential (ERP) study in healthy controls (HC) and amnestic mild cognitive impairment (aMCI) patients.

Methods: The study recorded 39 aMCI patients (27 APOE ε4 non-carriers and 12 APOE ε4 carriers) and their 43 matched controls (25 APOE ε4 non-carriers and 18 APOE ε4 carriers) with an 64-channel electroencephalogram. Participants performed an N-back task, a VSWM paradigm that manipulated the number of items to be stored in memory.

Results: The present study detected reduced accuracy and delayed mean correct response time (RT) in aMCI patients compared to HC. P300, a positive component that peaks between 300 and 500 ms, was elicited by the VSWM task. In addition, aMCI patients showed decreased P300 amplitude at the central–parietal (CP1, CPz, and CP2) and parietal (P1, Pz, and P2) electrodes in 0- and 1-back task compared to HC. In both HC and aMCI patients, APOE ε4 carriers showed reduced P300 amplitude with respect to non-carriers, whereas no significant differences in accuracy or RT were detected between APOE ε4 carriers and non-carriers. Additionally, standardized low-resolution brain electromagnetic tomography analysis (s-LORETA) showed enhanced brain activation in the right parahippocampal gyrus (PHG) during P300 time range in APOE ε4 carriers with respect to non-carriers in aMCI patients.

Conclusion: It demonstrated that P300 amplitude could predict VSWM deficits in aMCI patients and contribute to early detection of VSWM deficits in APOE ε4 carriers.

Brain-computer interfaces for patients with disorders of consciousness

The disorders of consciousness refer to clinical conditions that follow a severe head injury. Patients diagnosed as in a vegetative state lack awareness, while patients diagnosed as in a minimally conscious state retain fluctuating awareness. However, it is a challenge to accurately diagnose these disorders with clinical assessments of behavior. To improve diagnostic accuracy, neuroimaging-based approaches have been developed to detect the presence or absence of awareness in patients who lack overt responsiveness. For the small subset of patients who retain awareness, brain-computer interfaces could serve as tools for communication and environmental control. Here we review the existing literature concerning the sensory and cognitive abilities of patients with disorders of consciousness with respect to existing brain-computer interface designs. We highlight the challenges of device development for this special population and address some of the most promising approaches for future investigations.

Retrieval Deficiency in Brain Activity of Working Memory in Amnesic Mild Cognitive Impairment Patients: A Brain Event-Related Potentials Study

In the early stage of Alzheimer disease (AD) or mild cognitive impairment (MCI), working memory (WM) deficiency is prominent and could be attributed to failure in encoding, maintenance or retrieval of information. However, evidence for a retention or retrieval deficit remains equivocal. It is also unclear what cognitive mechanism in WM is impaired in MCI or early AD. We enrolled 46 subjects from our Memory Clinics and community, with 24 amnesic MCI patients and 22 normal subjects. After neurological and cognitive assessments, they performed a classic delayed match to sample (DMS) task with simultaneous event-related potential (ERP) recorded. The ERPs in encoding and retrieval epoch during WM were analyzed separately. The latency and amplitude of every ERP component were compared between two groups, and then analyzed to explore their relationship with neuropsychological performance. Finally, the locations of maximal difference in cortex were calculated by standard low-resolution tomographic analysis. A total of five components were found: P1, N1, P2, N2, and P300. The amplitude of P2 and P300 was larger in normal subjects than in MCI patients only during retrieval, not encoding epoch, while the latency did not show statistical difference. The latency and amplitude of P1 and N1 were similar in two groups. P2 amplitude in the retrieval epoch positively correlated with memory test (auditory verbal learning test) and visual spatial score of Chinese Addenbrooke's Cognitive Examination-Revised (ACE-R), while P300 amplitude correlated with ACE-R. The activation difference in P2 time range was maximal at medial frontal gyrus. However, the difference in cortex activation during P300 time range did not show significance. The amplitude of P2 indicated deficiency in memory retrieval process, potentially due to dysfunction of central executive in WM model. Regarding the location of P2 during WM task, medial frontal plays important role in memory retrieval. The findings in the present study suggested that MCI patients have retrieval deficit, probably due to central executive based on medial frontal gyrus. Thus, it may provide new biomarker for early detection and intervention for aMCI.