The neural correlate of consciousness

The prefrontal cortex: from monkey to man

The prefrontal cortex is so important to human beings that, if deprived of it, our behaviour is reduced to action-reactions and automatisms, with no ability to make deliberate decisions. Why does the prefrontal cortex hold such importance in humans? In answer, this review draws on the proximity between humans and other primates, which enables us, through comparative anatomical-functional analysis, to understand the cognitive functions we have in common and specify those that distinguish humans from their closest cousins. First, a focus on the lateral region of the prefrontal cortex illustrates the existence of a continuum between rhesus monkeys (the most studied primates in neuroscience) and humans for most of the major cognitive functions in which this region of the brain plays a central role. This continuum involves the presence of elementary mental operations in the rhesus monkey (e.g. working memory or response inhibition) that are constitutive of 'macro-functions' such as planning, problem-solving and even language production. Second, the human prefrontal cortex has developed dramatically compared to that of other primates. This increase seems to concern the most anterior part (the frontopolar cortex). In humans, the development of the most anterior prefrontal cortex is associated with three major and interrelated cognitive changes: (i) a greater working memory capacity, allowing for greater integration of past experiences and prospective futures; (ii) a greater capacity to link discontinuous or distant data, whether temporal or semantic; and (iii) a greater capacity for abstraction, allowing humans to classify knowledge in different ways, to engage in analogical reasoning or to acquire abstract values that give rise to our beliefs and morals. Together, these new skills enable us, among other things, to develop highly sophisticated social interactions based on language, enabling us to conceive beliefs and moral judgements and to conceptualize, create and extend our vision of our environment beyond what we can physically grasp. Finally, a model of the transition of prefrontal functions between humans and non-human primates concludes this review.

A protocol for a multicenter randomized and personalized controlled trial using rTMS in patients with disorders of consciousness

Background

Improving the functional recovery of patients with DoC remains one of the greatest challenges of the field. Different theories exist about the role of the anterior (prefrontal areas) versus posterior (parietal areas) parts of the brain as hotspots for the recovery of consciousness. Repetitive transcranial magnetic stimulation (rTMS) is a powerful non-invasive brain stimulation technique for the treatment of DoC. However, a direct comparison of the effect of TMS treatment on the front versus the back of the brain has yet to be performed. In this study, we aim to assess the short- and long-term effects of frontal and parietal rTMS on DoC recovery and characterize responders phenotypically.

Methods/design

Ninety patients with subacute and prolonged DoC will be included in a two-part multicenter prospective study. In the first phase (randomized controlled trial, RCT), patients will undergo four rTMS sessions in a crossover design over 10 days, targeting (i) the left dorsolateral prefrontal cortex (DLPFC) and (ii) the left angular gyrus (AG), as well as (iii & iv) their sham alternatives. In the second phase (longitudinal personalized trial), patients will receive personalized stimulations for 20 working days targeting the brain area that showed the best results in the RCT and will be randomly assigned to either active or sham intervention. The effects of rTMS on neurobehavioral and neurophysiological functioning in patients with DoC will be evaluated using clinical biomarkers of responsiveness (i.e., the Coma Recovery Scale-Revised; CRS-R), and electrophysiological biomarkers (e.g., power spectra, functional and effective connectivity, perturbational complexity index before and after intervention). Functional long-term outcomes will be assessed at 3 and 6 months post-intervention. Adverse events will be recorded during the treatment phase.

Discussion

This study seeks to identify which brain region (front or back) is best to stimulate for the treatment of patients with DoC using rTMS, and to characterize the neural correlates of its action regarding recovery of consciousness and functional outcome. In addition, we will define the responders' profile based on patients' characteristics and functional impairments; and develop biomarkers of responsiveness using EEG analysis according to the clinical responsiveness to the treatment.

Clinical Trial Registration

https://clinicaltrials.gov/ct2/show/NCT04401319, Clinicaltrials.gov, n° NCT04401319.

Propofol anesthesia-induced spatiotemporal changes in cortical activity with loss of external and internal awareness: An electrocorticography study

OBJECTIVE

To understand the underlying mechanism of consciousness, investigating spatiotemporal changes in the cortical activity during the induction phase of unconsciousness is important. Loss of consciousness induced by general anesthesia is not necessarily accompanied by a uniform inhibition of all cortical activities. We hypothesized that cortical regions involved in internal awareness would be suppressed after disruption of cortical regions involved in external awareness. Thus, we investigated temporal changes in cortex during induction of unconsciousness.

METHODS

We recorded electrocorticography data of 16 epilepsy patients and investigated power spectral changes during induction phase from awake state to unconsciousness. Temporal changes were assessed at 1) the start point and 2) the interval of normalized time between start and end of power change (Δ t^normalized).

RESULTS

We found that the power increased at frequencies < 46 Hz, and decreased in range of 62-150 Hz, in global channels. In temporal changes of power change, superior parietal lobule and dorsolateral prefrontal cortex started to change early, but the changes were completed over a prolonged interval, whereas angular gyrus and associative visual cortex showed a delayed change and rapid completion.

CONCLUSIONS

Loss of consciousness induced by general anesthesia results first from disrupted communication between self and external world, followed by disrupted communication within self, with decreased activities of superior parietal lobule and dorsolateral prefrontal cortex, and later, attenuated activities of angular gyrus.

SIGNIFICANCE

Our findings provided neurophysiological evidence for the temporal changes in consciousness components induced by general anesthesia.

Methodological aspects of studying the mechanisms of consciousness

There are at least two approaches to the definition of consciousness. In the first case, certain aspects of consciousness, called qualia, are considered inaccessible for research from a third person and can only be described through subjective experience. This approach is inextricably linked with the so-called "hard problem of consciousness", that is, the question of why consciousness has qualia or how any physical changes in the environment can generate subjective experience. With this approach, some aspects of consciousness, by definition, cannot be explained on the basis of external observations and, therefore, are outside the scope of scientific research. In the second case, a priori constraints do not constrain the field of scientific investigation, and the best explanation of the experience in the first person is included as a possible subject of empirical research. Historically, in the study of cause-and-effect relationships in biology, it was customary to distinguish between proximate causation and ultimate causation existing in biological systems. Immediate causes are based on the immediate influencing factors [1]. Proximate causation has evolutionary explanations. When studying biological systems themselves, such an approach is undoubtedly justified, but it often seems insufficient when studying the interaction of consciousness and the brain [2,3]. Current scientific communities proceed from the assumption that the physical substrate for the generation of consciousness is a neural network that unites various types of neurons located in various brain structures. Many neuroscientists attach a key role in this process to the cortical and thalamocortical neural networks. This question is directly related to experimental and clinical research in the field of disorder of consciousness. Progress in this area of medicine depends on advances in neuroscience in this area and is also a powerful source of empirical information. In this area of consciousness research, a large amount of experimental data has been accumulated, and in this review an attempt was made to generalize and systematize.

Functional Relevance of Endocannabinoid-Dependent Synaptic Plasticity in the Central Nervous System

The endocannabinoid (eCB) signaling system plays a key role in short-term and long-term synaptic plasticity in brain regions involved in various neural functions ranging from action selection to appetite control. This review will explore the role of eCBs in shaping neural circuit function to regulate behaviors. In particular, we will discuss the behavioral consequences of eCB mediated long-term synaptic plasticity in different brain regions. This review brings together evidence from in vitro and ex vivo studies and points out the need for more in vivo studies.

Building a pipeline to discover and validate novel therapeutic targets and lead compounds for Alzheimer's disease

Cognitive decline, Alzheimer's disease (AD) and other causes are major public health problems worldwide. With changing demographics, the number of persons with dementia will increase rapidly. The treatment and prevention of AD and other dementias, therefore, is an urgent unmet need. There have been considerable advances in understanding the biology of many age-related disorders that cause dementia. Gains in understanding AD have led to the development of ante-mortem biomarkers of traditional neuropathology and the conduct of several phase III interventions in the amyloid-β cascade early in the disease process. Many other intervention strategies are in various stages of development. However, efforts to date have met with limited success. A recent National Institute on Aging Research Summit led to a number of requests for applications. One was to establish multi-disciplinary teams of investigators who use systems biology approaches and stem cell technology to identify a new generation of AD targets. We were recently awarded one of three such grants to build a pipeline that integrates epidemiology, systems biology, and stem cell technology to discover and validate novel therapeutic targets and lead compounds for AD treatment and prevention. Here we describe the two cohorts that provide the data and biospecimens being exploited for our pipeline and describe the available unique datasets. Second, we present evidence in support of a chronic disease model of AD that informs our choice of phenotypes as the target outcome. Third, we provide an overview of our approach. Finally, we present the details of our planned drug discovery pipeline.

Molecular concentration of deoxyHb in human prefrontal cortex predicts the emergence and suppression of consciousness

This is the first study to use fNIRS to explore anaesthetic depth and awakening during surgery with general anaesthesia. A 16 channel continuous wave (CW) functional near-infrared system (fNIRS) was used to monitor PFC activity. These outcomes were compared to BIS measures. The results indicate that deoxyHb concentration in the PFC varies during the suppression and emergence of consciousness. During suppression, deoxyHb levels increase, signalling the deactivation of the PFC, while during emergence, deoxyHb concentration drops, initiating PFC activation and the recovery of consciousness. Furthermore, BIS and deoxyHb concentrations in the PFC display a high negative correlation throughout the different anaesthetic phases. These findings suggest that deoxyHb could be a reliable marker for monitoring anaesthetic depth, and that the PFC intervenes in the suppression and emergence of consciousness.

A thalamic reticular networking model of consciousness

[BACKGROUND]: It is reasonable to consider the thalamus a primary candidate for the location of consciousness, given that the thalamus has been referred to as the gateway of nearly all sensory inputs to the corresponding cortical areas. Interestingly, in an early stage of brain development, communicative innervations between the dorsal thalamus and telencephalon must pass through the ventral thalamus, the major derivative of which is the thalamic reticular nucleus (TRN). The TRN occupies a striking control position in the brain, sending inhibitory axons back to the thalamus, roughly to the same region where they receive afferents. [HYPOTHESES]: The present study hypothesizes that the TRN plays a pivotal role in dynamic attention by controlling thalamocortical synchronization. The TRN is thus viewed as a functional networking filter to regulate conscious perception, which is possibly embedded in thalamocortical networks. Based on the anatomical structures and connections, modality-specific sectors of the TRN and the thalamus appear to be responsible for modality-specific perceptual representation. Furthermore, the coarsely overlapped topographic maps of the TRN appear to be associated with cross-modal or unitary conscious awareness. Throughout the latticework structure of the TRN, conscious perception could be accomplished and elaborated through accumulating intercommunicative processing across the first-order input signal and the higher-order signals from its functionally associated cortices. As the higher-order relay signals run cumulatively through the relevant thalamocortical loops, conscious awareness becomes more refined and sophisticated. [CONCLUSIONS]: I propose that the thalamocortical integrative communication across first- and higher-order information circuits and repeated feedback looping may account for our conscious awareness. This TRN-modulation hypothesis for conscious awareness provides a comprehensive rationale regarding previously reported psychological phenomena and neurological symptoms such as blindsight, neglect, the priming effect, the threshold/duration problem, and TRN-impairment resembling coma. This hypothesis can be tested by neurosurgical investigations of thalamocortical loops via the TRN, while simultaneously evaluating the degree to which conscious perception depends on the severity of impairment in a TRN-modulated network.