A cerebral blood flow evaluation during cognitive tasks following a cervical spinal cord injury: a case study using transcranial Doppler recordings

Cerebral Autoregulation during Postural Change in Patients with Cervical Spinal Cord Injury-A Carotid Duplex Ultrasonography Study

Patients with a spinal cord injury (SCI) frequently experience sudden falls in blood pressure during postural change. Few studies have investigated whether the measurement of blood flow velocity within vessels can reflect brain perfusion during postural change. By performing carotid duplex ultrasonography (CDU), we investigated changes in cerebral blood flow (CBF) during postural changes in patients with a cervical SCI, determined the correlation of CBF change with presyncopal symptoms, and investigated factors affecting cerebral autoregulation. We reviewed the medical records of 100 patients with a cervical SCI who underwent CDU. The differences between the systolic blood pressure, diastolic blood pressure, and CBF volume in the supine posture and after 5 min at 50° tilt were evaluated. Presyncopal symptoms occurred when the blood flow volume of the internal carotid artery decreased by ≥21% after tilt. In the group that had orthostatic hypotension and severe CBF decrease during tilt, the body mass index and physical and functional scores were lower than in other groups, and the proportion of patients with a severe SCI was high. The higher the SCI severity and the lower the functional score, the higher the possibility of cerebral autoregulation failure. CBF should be assessed by conducting CDU in patients with a high-level SCI.

Multidimensional review of cognitive impairment after spinal cord injury

Cognitive impairment is highly prevalent in the population with spinal cord injury (SCI) and exerts a significant impact on functional independence and quality of life in this population. A number of neuroscientists have conducted preliminary investigations of cognitive deficits after SCI, but achieved marginally contradictory results due to some limitations such as the heterogeneity in the sample population, sample size, types of tests utilized, study design, and time since SCI. Therefore, this review mainly focuses on the characteristics, assessments, potential causality and treatment of cognitive impairment for better understanding such deficits in the SCI population.

Evaluating Peripersonal Space through the Functional Transcranial Doppler: Are We Paving the Way for Early Detecting Mild Cognitive Impairment to Dementia Conversion?

BACKGROUND

Identifying the patients with mild cognitive impairment (MCI) who may develop dementia (MDC) is challenging. The study of peripersonal space (PPS) by using functional transcranial Doppler (fTCD) could be used for this purpose.

OBJECTIVE

To identify changes in cerebral blood flow (CBF) during motor tasks targeting PPS, which can predict MDC.

METHODS

We evaluated the changes in CBF in 22 patients with MCI and 23 with dementia [Alzheimer's disease (AD) and vascular dementia (VaD)] during a motor task (passive mobilization, motor imagery, and movement observation) in which the hand of the subject moved forward and backward the face.

RESULTS

CBF increased when the hand approached the face and decreased when the hand moved from the face in the healthy controls (HCs). CBF changed were detectable only in patients with MCI but not in those with the AD and those who were MDC after 8-month follow-up. On the other hand, the patients with VaD presented a paradoxical response to the motor task (i.e., a decrease of CBF rather than an increase, as observed in HCs and MCI). Therefore, we found a modulation of PPS-related CBF only in HCs and patients with stable MCI (at the 8-month follow-up).

CONCLUSIONS

fTCD may allow preliminarily differentiating and following-up the patients with MCI and MDC, thus allowing the physician to plan beforehand more individualized cognitive rehabilitative training.

Hemispheric asymmetry non-linear analysis of EEG during emotional responses from idiopathic Parkinson's disease patients

Recent studies show right hemisphere has a unique contribution to emotion processing. The present study investigated EEG using non-linear measures during emotional processing in PD patients with respect to motor symptom asymmetry (i.e., most affected body side). We recorded 14-channel wireless EEGs from 20 PD patients and 10 healthy age-matched controls (HC) by eliciting emotions such as happiness, sadness, fear, anger, surprise and disgust. PD patients were divided into two groups, based on most affected body side and unilateral motor symptom severity: left side-affected (LPD, n = 10) or right side-affected PD patients (RPD, n = 10). Nonlinear analysis of these emotional EEGs were performed by using approximate entropy, correlation dimension, detrended fluctuation analysis, fractal dimension, higher order spectra, hurst exponent (HE), largest Lyapunov exponent and sample entropy. The extracted features were ranked using analysis of variance based on F value. The ranked features were then fed into classifiers namely fuzzy K-nearest neighbor and support vector machine to obtain optimal performance using minimum number of features. From the experimental results, we found that (a) classification performance across all frequency bands performed well in recognizing emotional states of LPD, RPD, and HC; (b) the emotion-specific features were mainly related to higher frequency bands; and (c) predominantly LPD patients (inferred right-hemisphere pathology) were more impaired in emotion processing compared to RPD, as showed by a poorer classification performance. The results suggest that asymmetric neuronal degeneration in PD patients may contribute to the impairment of emotional communication.