The Current of Consciousness: Neural Correlates and Clinical Aspects

The Use of Event Related Potentials to Predict Amyloid PET Status Among Patients from a Memory Disorders Clinic

Background

Amyloid positron emission tomography (PET) scans provide in vivo evidence of Alzheimer's disease (AD); however, their high cost limits their use in standard clinical care. Event related potentials (ERPs) may represent an inexpensive and non-invasive additional method for detecting AD pathology.

Objective

We investigated whether ERPs, along with neuropsychological data, serve as predictors of amyloid PET status in patients with memory complaints.

Methods

Veterans aged 50-100 were recruited from a memory disorders clinic. Participants underwent a neuropsychological battery and an ERP auditory oddball protocol. Twenty-eight patients had a positive amyloid PET scan, and thirty-nine patients had a negative scan.

Results

ERP-P200 target amplitude and P200 standard latency were predictors of amyloid PET status. When submitting to ROC analysis, P200 standard latency exhibited the highest specificity and sensitivity in predicting amyloid PET positivity, correctly classifying the amyloid PET status for 86% of patients.

Conclusions

ERP-P200 measures are strong indicators of amyloid-β presence in patients from a memory disorder clinic. Increased P200 amplitude and decreased P200 latency in patients with a positive amyloid PET scan may be attributed to hyperactivation of perceptual bottom-up processes compensating for AD-related synaptic loss in the fronto-parietal networks.

Approaching the nature of consciousness through a phenomenal analysis of early vision. What is the explanandum?

Loorits (2014) identifies the solution to the hard problem of consciousness in the possibility of fully analyzing seemingly non-structural aspects of consciousness in structural terms. However, research on consciousness conducted in recent decades has failed to bridge the explanatory gap between the brain and conscious mind. One reason why the explanatory gap cannot be filled, and consequently the problem remains hard, is that experience and neural structure are too different or "distant" to be directly compatible. Conversely, structural aspects of consciousness can be found in phenomenal experience. One possible alternative, therefore, is to seek the structure of seemingly non-structural aspects of consciousness not in the neural substrate, but within consciousness itself, through a phenomenal analysis of the qualitative aspects of experience, starting from its simplest forms. An essential premise is to reformulate the explanandum of consciousness, which is usually attributed to qualia and what it is like to be in a certain state. However, these properties do not allow us to identify the fundamental aspects of phenomenal experience. Sensations such as the redness of red or the painfulness of pain are inseparable from the context of the experience to which they belong, making qualia appear as phenomenal artifacts. Furthermore, the simplest qualitative aspects can be found in early vision. They are involved in perceptual organization and necessarily have relational significance. The unitary set of qualities found in early vision-such as those related to being an object, background or detail-constitutes the explanandum of the simplest forms of consciousness and seems to imply a justifying structure. Although early vision is characterized by interdependent qualitative components that form a unitary whole, we cannot find in it the structure of seemingly non-structural aspects of consciousness. Phenomenal appearance alone does not seem sufficient to identify a unitary structure of consciousness. However, the closeness of these characteristics to a unitary structure prompts us to delve into less explored territory, using the components of experience also as possible explanans.

Implications of conscious AI in primary healthcare

The conversation about consciousness of artificial intelligence (AI) is an ongoing topic since 1950s. Despite the numerous applications of AI identified in healthcare and primary healthcare, little is known about how a conscious AI would reshape its use in this domain. While there is a wide range of ideas as to whether AI can or cannot possess consciousness, a prevailing theme in all arguments is uncertainty. Given this uncertainty and the high stakes associated with the use of AI in primary healthcare, it is imperative to be prepared for all scenarios including conscious AI systems being used for medical diagnosis, shared decision-making and resource management in the future. This commentary serves as an overview of some of the pertinent evidence supporting the use of AI in primary healthcare and proposes ideas as to how consciousnesses of AI can support or further complicate these applications. Given the scarcity of evidence on the association between consciousness of AI and its current state of use in primary healthcare, our commentary identifies some directions for future research in this area including assessing patients', healthcare workers' and policy-makers' attitudes towards consciousness of AI systems in primary healthcare settings.

Medicolegal issues and disorders of consciousness

BACKGROUND

The tasks and responsibilities that come with clinician involvement in medicolegal proceedings can be daunting and particularly so in challenging areas such as provision of medicolegal opinions in cases involving disorders of consciousness (DoC).

OBJECTIVE

The aim of this narrative review was to provide education and advice to healthcare practitioners who by choice or circumstance are asked and/or required to provide medicolegal opinions in cases involving patients with DoC.

METHODS

A literature search was conducted using PubMed Central and MedlinePlus for articles dealing with clinician involvement in medicolegal cases involving persons with DoC. The information provided also integrates the authors' nearly 40 years of clinical experience, brain injury medicine practice and "trials and tribulations" associated with medicolegal involvement in such cases.

RESULTS

The literature was found to be replete with articles on brain death and withdrawal/withholding of care (which are not the focus of this review). The extant medical literature in brain injury medicine on the other hand is currently lacking in practical information for clinicians working "in the trenches" regarding the challenges and caveats of medicolegal involvement in such cases.

CONCLUSION

This review provides the reader with a big picture overview of the most pertinent medicolegal topics inherent in clinical work with patients with DOC including pertinent nomenclature, caveats regarding forensic consultation including independent medical examinations, testimony tips, discussion of life expectancy/median survival concepts, prognostication in a medicolegal context, documentation and record keeping as well as some of the specific challenges pertinent to these types of brain injury cases that are not per se relevant in less severe injuries.