Disentangling conscious from unconscious cognitive processing with event-related EEG potentials

A study on EEG differences between active counting and focused breathing tasks for more sensitive detection of consciousness

Introduction

In studies on consciousness detection for patients with disorders of consciousness, difference comparison of EEG responses based on active and passive task modes is difficult to sensitively detect patients' consciousness, while a single potential analysis of EEG responses cannot comprehensively and accurately determine patients' consciousness status. Therefore, in this paper, we designed a new consciousness detection paradigm based on a multi-stage cognitive task that could induce a series of event-related potentials and ERD/ERS phenomena reflecting different consciousness contents. A simple and direct task of paying attention to breathing was designed, and a comprehensive evaluation of consciousness level was conducted using multi-feature joint analysis.

Methods

We recorded the EEG responses of 20 healthy subjects in three modes and reported the consciousness-related mean event-related potential amplitude, ERD/ERS phenomena, and the classification accuracy, sensitivity, and specificity of the EEG responses under different conditions.

Results

The results showed that the EEG responses of the subjects under different conditions were significantly different in the time domain and time-frequency domain. Compared with the passive mode, the amplitudes of the event-related potentials in the breathing mode were further reduced, and the theta-ERS and alpha-ERD phenomena in the frontal region were further weakened. The breathing mode showed greater distinguishability from the active mode in machine learning-based classification.

Discussion

By analyzing multiple features of EEG responses in different modes and stimuli, it is expected to achieve more sensitive and accurate consciousness detection. This study can provide a new idea for the design of consciousness detection methods.

Why art? The role of arts in arts and health

This article is an answer to a report called "What is the evidence on the role of the arts in improving health and well-being?" The authors conclude that the arts have an impact on mental and physical health. Yet, the question of the role of the arts remains unanswered. What is and what is not an art effect? Recently, embodied theory has inspired articles on the perception of art. These articles have not yet received attention in the field of Arts and Health. Scholars in psychosomatic medicine have argued for an approach based on recent work in enactive embodied theory to investigate the connection between the body and the mind. The present article examines how key concepts in this theory relate to art. This leads to a discussion of art in terms of empathy-the relation between the internal state of the artist and the internal state of the beholder. I exemplify with a conceptual framework of musical empathy. Implications for health are addressed.

Implicit auditory perception of local and global irregularities in passive listening condition

The auditory system detects differences in sounds at an implicit level, but data on this difference might not be sufficient to make explicit discrimination. The biomarkers of implicit auditory memory of ambiguous stimuli could shed light on unconscious auditory processing and implicit auditory learning. Mismatch negativity (MMN) and P3a, components of event-related potentials (ERPs) reflecting stimuli discrimination without direct attention, were previously detected in response to the local (short-term) irregularity in the auditory sequence even in an unconscious state. At the same time, P3b was elicited only in case of direct attention in response to the global (long-term) irregularity. In this study, we applied the local-global auditory paradigm to obtain possible electrophysiological signatures of implicit detection of hardly distinguishable auditory stimuli. ERPs were recorded from 20 healthy volunteers during active discrimination of deviant sounds in the old-ball sequence and passive listening of the same sounds in the sequence with local-global irregularity. The discrimination task consisted of two blocks with different deviant sounds targeted to respond. The sound discrimination accuracy was at an average of 40%, implying the difficulty of explicit sound recognition. Comparing ERPs to standard and deviant sounds, we found posterior negativity in ERP around 450-600 ms in response to targeted deviant sounds. MMN was significant only in response to non-target deviants. In the passive local-global paradigm, we observed an anterior positivity (284-412 ms), compatible with P3a, in response to a violation of local regularity. Violation of global regularity elicited an anterior negative response (228-586 ms), resembling the N400 component of ERPs. Importantly, the other indexes of auditory discrimination, such as MMN and P3b, were insignificant in ERPs to both regularity violations. The observed P3a and N400 components of ERPs may reflect prediction error signals in the implicit perception of sound patterns even if behavioral recognition was poor.

Apical amplification-a cellular mechanism of conscious perception?

We present a theoretical view of the cellular foundations for network-level processes involved in producing our conscious experience. Inputs to apical synapses in layer 1 of a large subset of neocortical cells are summed at an integration zone near the top of their apical trunk. These inputs come from diverse sources and provide a context within which the transmission of information abstracted from sensory input to their basal and perisomatic synapses can be amplified when relevant. We argue that apical amplification enables conscious perceptual experience and makes it more flexible, and thus more adaptive, by being sensitive to context. Apical amplification provides a possible mechanism for recurrent processing theory that avoids strong loops. It makes the broadcasting hypothesized by global neuronal workspace theories feasible while preserving the distinct contributions of the individual cells receiving the broadcast. It also provides mechanisms that contribute to the holistic aspects of integrated information theory. As apical amplification is highly dependent on cholinergic, aminergic, and other neuromodulators, it relates the specific contents of conscious experience to global mental states and to fluctuations in arousal when awake. We conclude that apical dendrites provide a cellular mechanism for the context-sensitive selective amplification that is a cardinal prerequisite of conscious perception.

Hierarchical Decoding Model of Upper Limb Movement Intention From EEG Signals Based on Attention State Estimation

Decoding the motion intention of the human upper limb from electroencephalography (EEG) signals has important practical values. However, existing decoding models are built under the attended state while subjects perform motion tasks. In practice, people are often distracted by other tasks or environmental factors, which may impair decoding performance. To address this problem, in this paper, we propose a hierarchical decoding model of human upper limb motion intention from EEG signals based on attention state estimation. The proposed decoding model includes two components. First, the attention state detection (ASD) component estimates the attention state during the upper limb movement. Next, the motion intention recognition (MIR) component decodes the motion intention by using the decoding models built under the attended and distracted states. The experimental results show that the proposed hierarchical decoding model performs well under the attended and distracted states. This work can advance the application of human movement intention decoding and provides new insights into the study of brain-machine interfaces.

Unconscious processing of subliminal stimuli in panic disorder: A systematic review and meta-analysis

Attentional biases to threat exist in panic disorder (PD), probably related to altered subliminal processing. We systematically reviewed studies investigating subliminal processing in PD. Studies were retrieved from MEDLINE and Scopus®. We meta-analytically compared PD (n = 167) and healthy controls (HC, n = 165) for processing of masked panic-related and neutral words. We also compared subliminal and supraliminal presentations of panic-related words relative to neutral words within PD subjects and HC. We found a significantly enhanced Stroop interference to masked panic-related words in PD vs HC (Hedges' g = 0.60, p = 0.03; Q = 14.83, I² = 66.3 %, p = 0.01). While both PD subjects and HC tended to be slower to respond to supraliminal threat words than to neutral words, PD subjects only showed a marginally significant slower response to subliminal panic-related words vs neutral words. Findings remain inconclusive regarding comparison to other mental disorders, neural correlates, and the effect of psychotherapy. Even if possibly flawed by methodological weaknesses, our findings support the existence of a sensitivity to subliminal threat cues in PD, which could be targeted to improve treatment.

Temporal Fluctuation of Mood in Gaming Task Modulates Feedback Negativity: EEG Study With Virtual Reality

Feedback outcomes are generally classified into positive and negative feedback. People often predict a feedback outcome with information that is based on both objective facts and uncertain subjective information, such as a mood. For example, if an action leads to good results consecutively, people performing the action overestimate the behavioral result of the next action. In electroencephalogram measurements, negative feedback evokes negative potential, called feedback negativity, and positive feedback evokes positive potential, called reward positivity. The present study investigated the relationship between the degree of the mood caused by the feedback outcome and the error-related brain potentials. We measured the electroencephalogram activity while the participants played a virtual reality shooting game. The experimental task was to shoot down a cannonball flying toward the player using a handgun. The task difficulty was determined from the size and curve of the flying cannonball. These gaming parameters affected the outcome probability of shooting the target in the game. We also implemented configurations in the game, such as the player’s life points and play times. These configurations affected the outcome magnitude of shooting the target in the game. Moreover, we used the temporal accuracy of shooting in the game as the parameter of the mood. We investigated the relationship between these experimental features and the event-related potentials using the single-trial-based linear mixed-effects model analysis. The feedback negativity was observed at an error trial, and its amplitude was modulated with the outcome probability and the mood. Conversely, reward positivity was observed at hit trials, but its amplitude was modulated with the outcome probability and outcome magnitude. This result suggests that feedback negativity is enhanced according to not only the feedback probability but also the mood that was changed depending on the temporal gaming outcome.

Neurophysiological aspects of the completely locked-in syndrome in patients with advanced amyotrophic lateral sclerosis

OBJECTIVE

Amyotrophic lateral sclerosis (ALS) patients in completely locked-in syndrome (CLIS) are incapable of expressing themselves, and their state of consciousness and awareness is difficult to evaluate. Due to the complete paralysis included paralysis of eye muscles, any assessment of the perceptual and psychophysiological state can only be implemented in passive experimental paradigms with neurophysiological recordings.

METHODS

Four patients in CLIS were investigated in several experiments including resting state, visual stimulation (eyes open vs eyes closed), auditory stimulation (modified local-global paradigm), somatosensory stimulation (electrical stimulation of the median nerve), and during sleep.

RESULTS

All patients showed altered neurophysiological metrics, but a unique and common pattern could not be found between patients. However, slowing of the electroencephalography (EEG) and attenuation or absence of alpha wave activity was common in all patients. In two of the four patients, a slow dominant frequency emerged at 4 Hz with synchronized EEG at all channels. In the other two patients slowing of EEG appears less synchronized. EEGs between eyes open and eyes closed were significantly different in all patients. The dominant slow frequency during the day changes during slow-wave sleep (supposedly sleep stage 3) to even slower frequencies below 2 Hz. Somatosensory evoked potentials (SEPs) were absent or significantly altered in comparison to healthy subjects, similarly for auditory evoked potentials (AEPs).

CONCLUSIONS

The heterogeneity of the results underscores the fact that no single neurophysiological index is available to assess psychophysiological states in unresponsive ALS patients in CLIS. This caveat may also be valid for the assessment of cognitive processes; a functioning BCI can be the solution.

SIGNIFICANCE

Most of the studies of the neurophysiology of ALS patients focused on the early stage of the disease, and there are very few studies on the late stage when patients are completely paralyzed with no means of communication (i.e., CLIS). This study provides quantitative metrics of different neurophysiological aspects of these patients.

Assessing the state of consciousness for individual patients using complex, statistical stimuli

Patients with prolonged disorders of consciousness (PDOC) are often unable to communicate their state of consciousness. Determining the latter is essential for the patient's care and prospects of recovery. Auditory stimulation in combination with neural recordings is a promising technique towards an objective assessment of conscious awareness. Here, we investigated the potential of complex, acoustic stimuli to elicit EEG responses suitable for classifying multiple subject groups, from unconscious to responding. We presented naturalistic auditory textures with unexpectedly changing statistics to human listeners. Awake, active listeners were asked to indicate the change by button press, while all other groups (awake passive, asleep, minimally conscious state (MCS), and unresponsive wakefulness syndrome (UWS)) listened passively. We quantified the evoked potential at stimulus onset and change in stimulus statistics, as well as the complexity of neural response during the change of stimulus statistics. On the group level, onset and change potentials classified patients and healthy controls successfully but failed to differentiate between the UWS and MCS groups. Conversely, the Lempel-Ziv complexity of the scalp-level potential allowed reliable differentiation between UWS and MCS even for individual subjects, when compared with the clinical assessment aligned to the EEG measurements. The accuracy appears to improve further when taking the latest available clinical diagnosis into account. In summary, EEG signal complexity during onset and changes in complex acoustic stimuli provides an objective criterion for distinguishing states of consciousness in clinical patients. These results suggest EEG-recordings as a cost-effective tool to choose appropriate treatments for non-responsive PDOC patients.

Towards New Diagnostic Approaches in Disorders of Consciousness: A Proof of Concept Study on the Promising Use of Imagery Visuomotor Task

Background: advanced paraclinical approaches using functional neuroimaging and electroencephalography (EEG) allow identifying patients who are covertly aware despite being diagnosed as unresponsive wakefulness syndrome (UWS). Bedside detection of covert awareness employing motor imagery tasks (MI), which is a universally accepted clinical indicator of awareness in the absence of overt behavior, may miss some of these patients, as they could still have a certain level of awareness. We aimed at assessing covert awareness in patients with UWS using a visuomotor-guided motor imagery task (VMI) during EEG recording. Methods: nine patients in a minimally conscious state (MCS), 11 patients in a UWS, and 15 healthy individuals (control group—CG) were provided with an VMI (imagine dancing while watching a group dance video to command), a simple-MI (imagine squeezing their right hand to command), and an advanced-MI (imagine dancing without watching a group dance video to command) to detect command-following. We analyzed the command-specific EEG responses (event-related synchronization/desynchronization—ERS/ERD) of each patient, assessing whether these responses were appropriate, consistent, and statistically similar to those elicited in the CG, as reliable markers of motor imagery. Results: All patients in MCS, all healthy individuals and one patient in UWS repeatedly and reliably generated appropriate EEG responses to distinct commands of motor imagery with a classification accuracy of 60–80%. Conclusions: VMI outperformed significantly MI tasks. Therefore, patients in UWS may be still misdiagnosed despite a rigorous clinical assessment and an appropriate MI assessment. It is thus possible to suggest that motor imagery tasks should be delivered to patients with chronic disorders of consciousness in visuomotor-aided modality (also in the rehabilitation setting) to greatly entrain patient’s participation. In this regard, the EEG approach we described has the clear advantage of being cheap, portable, widely available, and objective. It may be thus considered as, at least, a screening tool to identify the patients who deserve further, advanced paraclinical approaches.

A N400 ERP Study in letter recognition after passive tactile stimulation training in blind children and sighted controls

BACKGROUND

We previously demonstrated that using a sensory substitution device (SSD) for one week, tactile stimulation results in faster activation of lateral occipital complex in blind children than in seeing controls.

OBJECTIVE

We used long-term haptic tactile stimulation training with an SSD to test if it results in stable cross-modal reassignment of visual pathways after six months, to provide high level processing of tactile semantic content.

METHODS

We enrolled 12 blind and 12 sighted children. The SSD transforms images to a stimulation matrix in contact with the dominant hand. Subjects underwent twice-daily training sessions, 5 days/week for six months. Children were asked to describe line orientation, name letters, and read words. ERP sessions were performed at baseline and 6 months to analyze the N400 ERP component and reaction times (RT). N400 sources were estimated with Low Resolution Electromagnetic Tomography (LORETA). SPM8 was used to make population-level inferences.

RESULTS

We found no group differences in RTs, accuracy of identifications, N400 latencies or distributions with the line task at 1 week or at 6 months. RTs on the letter recognition task were also similar. After 6 months, behavioral training increased accurate letter identification in both seeing and blind children (Chi 2 = 11906.934, p = 0.000), but the increase was larger in blind children (Chi 2 = 8.272, p = 0.004). Behavioral training shifted peak N400 amplitude to left occipital and bilateral parietal cortices in blind children, but to left precentral and postcentral and bilateral occipital cortices in sighted controls.

CONCLUSIONS

Blind children learn to recognize SSD-delivered letters better than seeing controls and had greater N400 amplitude in the occipital region. To the best of our knowledge, our results provide the first published example of standard letter recognition (not Braille) by children with blindness using a tactile delivery system.

Low- and medium-rate auditory steady-state responses in patients with prolonged disorders of consciousness correlate with Coma Recovery Scale - Revised score

Diagnosis of consciousness in patients with prolonged disorders of consciousness (PDOC) remains challenging since their responsiveness is often very impaired, while their assessment depends on observable behavior. The aim of this proof-of-concept study was to evaluate whether low- and medium-rate amplitude-modulated (AM) auditory steady-state responses (ASSRs) can be sensitive to the state of PDOC patients and may thus serve as a diagnostic tool which does not explicitly depend on a patient's cooperation. EEG was recorded from nine unresponsive wakefulness syndrome/vegetative state (UWS/VS) and eight minimally conscious state (MCS)/emergence from MCS patients during stimulation with two-minute trains of simple tones, amplitude modulated (AM) by 4 Hz, 6 Hz, 8 Hz, 12 Hz, 20 Hz, 40 Hz. The obtained ASSRs were then related to the Coma Recovery Scale - Revised (CRS-R) diagnosis and its total score. We observed significant correlations between mean inter-trial phase coherence (PC) (averaged across all stimulation frequencies) and total CRS-R score, as well as between 40 Hz relative power (RP) and total CRS-R score. Moreover, both parameters significantly differed between the patient groups. Our preliminary results suggest that a passive auditory stimulation protocol consisting of low- and medium-rate ASSRs might be used as an objective estimate of the level of neural dysfunction in PDOC patients. Consequently, the integrity of the auditory system appears to be an important predictor of the actual state of consciousness in PDOC patients.

Uncovering Consciousness in Unresponsive ICU Patients: Technical, Medical and Ethical Considerations

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

Neural correlates of automatic beliefs about gender stereotypes: Males are more prejudicial

Aim of this study was to investigate the neural bases of stereotype representation, including the presence of gender bias. EEG was recorded from 128 sites in 38 Italian participants. While looking for rare animal words, participants read 240 sentences, half of which expressed notions congruent with gender stereotypes, and the other half did not (e.g., "Prepared the tomato sauce and then SHAVED", "The engineer stained HER SKIRT"). Event-related potentials (ERPs) were time-locked to critical words. Findings showed enhanced anterior N400 and occipito-parietal P600 responses to items that violated gender stereotypes, mostly in men. The swLORETA analysis applied to N400 potentials in response to incongruent phrases showed that the most activated areas during stereotype processing were the right medial temporal and medial frontal gyri, as well as the TPJ. The data hint at a gender difference in stereotyping, with men being more prejudicial especially when the depicted character is a male.