1
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Luppi AI, Gellersen HM, Liu ZQ, Peattie ARD, Manktelow AE, Adapa R, Owen AM, Naci L, Menon DK, Dimitriadis SI, Stamatakis EA. Systematic evaluation of fMRI data-processing pipelines for consistent functional connectomics. Nat Commun 2024; 15:4745. [PMID: 38834553 PMCID: PMC11150439 DOI: 10.1038/s41467-024-48781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/10/2024] [Indexed: 06/06/2024] Open
Abstract
Functional interactions between brain regions can be viewed as a network, enabling neuroscientists to investigate brain function through network science. Here, we systematically evaluate 768 data-processing pipelines for network reconstruction from resting-state functional MRI, evaluating the effect of brain parcellation, connectivity definition, and global signal regression. Our criteria seek pipelines that minimise motion confounds and spurious test-retest discrepancies of network topology, while being sensitive to both inter-subject differences and experimental effects of interest. We reveal vast and systematic variability across pipelines' suitability for functional connectomics. Inappropriate choice of data-processing pipeline can produce results that are not only misleading, but systematically so, with the majority of pipelines failing at least one criterion. However, a set of optimal pipelines consistently satisfy all criteria across different datasets, spanning minutes, weeks, and months. We provide a full breakdown of each pipeline's performance across criteria and datasets, to inform future best practices in functional connectomics.
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Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia, University of Cambridge, Cambridge, UK.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- St John's College, University of Cambridge, Cambridge, UK.
- Montreal Neurological Institute, McGill University, Montreal, Canada.
| | - Helena M Gellersen
- German Center for Neurodegenerative Diseases, Magdeburg, Germany
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Zhen-Qi Liu
- Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Alexander R D Peattie
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Anne E Manktelow
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ram Adapa
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Adrian M Owen
- Department of Psychology, Western Institute for Neuroscience (WIN), Western University, London, ON, Canada
- Department of Physiology and Pharmacology, Western Institute for Neuroscience (WIN), Western University, London, ON, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Stavros I Dimitriadis
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Neuroinformatics Group, Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, College of Biomedical and Life Sciences, Cardiff, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK
- Neuroscience and Mental Health Research Institute, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, UK
- Integrative Neuroimaging Lab, Thessaloniki, Greece
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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2
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Lawn T, Martins D, O'Daly O, Williams S, Howard M, Dipasquale O. The effects of propofol anaesthesia on molecular-enriched networks during resting-state and naturalistic listening. Neuroimage 2023; 271:120018. [PMID: 36935083 PMCID: PMC10410200 DOI: 10.1016/j.neuroimage.2023.120018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Placing a patient in a state of anaesthesia is crucial for modern surgical practice. However, the mechanisms by which anaesthetic drugs, such as propofol, impart their effects on consciousness remain poorly understood. Propofol potentiates GABAergic transmission, which purportedly has direct actions on cortex as well as indirect actions via ascending neuromodulatory systems. Functional imaging studies to date have been limited in their ability to unravel how these effects on neurotransmission impact the system-level dynamics of the brain. Here, we leveraged advances in multi-modal imaging, Receptor-Enriched Analysis of functional Connectivity by Targets (REACT), to investigate how different levels of propofol-induced sedation alter neurotransmission-related functional connectivity (FC), both at rest and when individuals are exposed to naturalistic auditory stimulation. Propofol increased GABA-A- and noradrenaline transporter-enriched FC within occipital and somatosensory regions respectively. Additionally, during auditory stimulation, the network related to the dopamine transporter showed reduced FC within bilateral regions of temporal and mid/posterior cingulate cortices, with the right temporal cluster showing an interaction between auditory stimulation and level of consciousness. In bringing together these micro- and macro-scale systems, we provide support for both direct GABAergic and indirect noradrenergic and dopaminergic-related network changes under propofol sedation. Further, we delineate a cognition-related reconfiguration of the dopaminergic network, highlighting the utility of REACT to explore the molecular substrates of consciousness and cognition.
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Affiliation(s)
- Timothy Lawn
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK.
| | - Daniel Martins
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK
| | - Owen O'Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK
| | - Steve Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK
| | - Matthew Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK
| | - Ottavia Dipasquale
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's college London, London, UK
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3
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Deng F, Taylor N, Owen AM, Cusack R, Naci L. Responsiveness variability during anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks. Hum Brain Mapp 2023; 44:2142-2157. [PMID: 36617994 PMCID: PMC10028637 DOI: 10.1002/hbm.26199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/30/2022] [Accepted: 12/18/2022] [Indexed: 01/10/2023] Open
Abstract
Anaesthesia combined with functional neuroimaging provides a powerful approach for understanding the brain mechanisms of consciousness. Although propofol is used ubiquitously in clinical interventions that reversibly suppress consciousness, it shows large inter-individual variability, and the brain bases of this variability remain poorly understood. We asked whether three networks key to conscious cognition-the dorsal attention (DAN), executive control (ECN), and default mode (DMN)-underlie responsiveness variability under anaesthesia. Healthy participants (N = 17) were moderately anaesthetized during narrative understanding and resting-state conditions inside the Magnetic Resonance Imaging scanner. A target detection task measured behavioural responsiveness. An independent behavioural study (N = 25) qualified the attention demands of narrative understanding. Then, 30% of participants were unaffected in their response times, thus thwarting a key aim of anaesthesia-the suppression of behavioural responsiveness. Individuals with stronger functional connectivity within the DAN and ECN, between them, and to the DMN, and with larger grey matter volume in frontal regions were more resilient to anaesthesia. For the first time, we show that responsiveness variability during propofol anaesthesia relates to inherent differences in brain structure and function of the frontoparietal networks, which can be predicted prior to sedation. Results highlight novel markers for improving awareness monitoring during clinical anaesthesia.
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Affiliation(s)
- Feng Deng
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Nicola Taylor
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Adrian M Owen
- Brain and Mind Institute, Western University, London, Canada
- Department of Physiology and Pharmacology and Department of Psychology, Western University, London, Canada
| | - Rhodri Cusack
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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4
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Chamberlain TA, Rosenberg MD. Propofol selectively modulates functional connectivity signatures of sustained attention during rest and narrative listening. Cereb Cortex 2022; 32:5362-5375. [PMID: 35285485 DOI: 10.1093/cercor/bhac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 12/27/2022] Open
Abstract
Sustained attention is a critical cognitive function reflected in an individual's whole-brain pattern of functional magnetic resonance imaging functional connectivity. However, sustained attention is not a purely static trait. Rather, attention waxes and wanes over time. Do functional brain networks that underlie individual differences in sustained attention also underlie changes in attentional state? To investigate, we replicate the finding that a validated connectome-based model of individual differences in sustained attention tracks pharmacologically induced changes in attentional state. Specifically, preregistered analyses revealed that participants exhibited functional connectivity signatures of stronger attention when awake than when under deep sedation with the anesthetic agent propofol. Furthermore, this effect was relatively selective to the predefined sustained attention networks: propofol administration modulated strength of the sustained attention networks more than it modulated strength of canonical resting-state networks and a network defined to predict fluid intelligence, and the functional connections most affected by propofol sedation overlapped with the sustained attention networks. Thus, propofol modulates functional connectivity signatures of sustained attention within individuals. More broadly, these findings underscore the utility of pharmacological intervention in testing both the generalizability and specificity of network-based models of cognitive function.
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Affiliation(s)
- Taylor A Chamberlain
- Department of Psychology, The University of Chicago, 5848 S University Ave, IL 60637, Chicago
| | - Monica D Rosenberg
- Department of Psychology, The University of Chicago, 5848 S University Ave, IL 60637, Chicago.,Neuroscience Institute, The University of Chicago, 5812 South Ellis Ave., MC 0912, Suite P-400, IL 60637, Chicago
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5
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Coppola P, Allanson J, Naci L, Adapa R, Finoia P, Williams GB, Pickard JD, Owen AM, Menon DK, Stamatakis EA. The complexity of the stream of consciousness. Commun Biol 2022; 5:1173. [PMID: 36329176 PMCID: PMC9633704 DOI: 10.1038/s42003-022-04109-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Typical consciousness can be defined as an individual-specific stream of experiences. Modern consciousness research on dynamic functional connectivity uses clustering techniques to create common bases on which to compare different individuals. We propose an alternative approach by combining modern theories of consciousness and insights arising from phenomenology and dynamical systems theory. This approach enables a representation of an individual's connectivity dynamics in an intrinsically-defined, individual-specific landscape. Given the wealth of evidence relating functional connectivity to experiential states, we assume this landscape is a proxy measure of an individual's stream of consciousness. By investigating the properties of this landscape in individuals in different states of consciousness, we show that consciousness is associated with short term transitions that are less predictable, quicker, but, on average, more constant. We also show that temporally-specific connectivity states are less easily describable by network patterns that are distant in time, suggesting a richer space of possible states. We show that the cortex, cerebellum and subcortex all display consciousness-relevant dynamics and discuss the implication of our results in forming a point of contact between dynamical systems interpretations and phenomenology.
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Affiliation(s)
- Peter Coppola
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Judith Allanson
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Department of Neurosciences, Cambridge University Hospitals NHS Foundation, Addenbrooke's Hospital, Cambridge, UK
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Lloyd Building, Trinity College Dublin, Dublin, Ireland
| | - Ram Adapa
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Paola Finoia
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - John D Pickard
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Adrian M Owen
- The Brain and Mind Institute, Western Interdisciplinary Research Building, N6A 5B7 University of Western Ontario, London, ON, Canada
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
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6
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Chen K, Xie T, Ma L, Hudson AE, Ai Q, Liu Q. A Two-Stream Graph Convolutional Network Based on Brain Connectivity for Anesthetized States Analysis. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2077-2087. [PMID: 35862321 DOI: 10.1109/tnsre.2022.3193103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Investigating neural mechanisms of anesthesia process and developing efficient anesthetized state detection methods are especially on high demand for clinical consciousness monitoring. Traditional anesthesia monitoring methods are not involved with the topological changes between electrodes covering the prefrontal-parietal cortices, by investigating electrocorticography (ECoG). To fill this gap, a framework based on the two-stream graph convolutional network (GCN) was proposed, i.e., one stream for extracting topological structure features, and the other one for extracting node features. The two-stream graph convolutional network includes GCN Model 1 and GCN Model 2. For GCN Model 1, brain connectivity networks were constructed by using phase lag index (PLI), representing different structure features. A common adjacency matrix was founded through the dual-graph method, the structure features were expressed on nodes. Therefore, the traditional spectral graph convolutional network can be directly applied on the graphs with changing topological structures. On the other hand, the average of the absolute signal amplitudes was calculated as node features, then a fully connected matrix was constructed as the adjacency matrix of these node features, as the input of GCN Model 2. This method learns features of both topological structure and nodes of the graph, and uses a dual-graph approach to enhance the focus on topological structure features. Based on the ECoG signals of monkeys, results show that this method which can distinguish awake state, moderate sedation and deep sedation achieved an accuracy of 92.75% in group-level experiments and mean accuracy of 93.50% in subject-level experiments. Our work verifies the excellence of the graph convolutional network in anesthesia monitoring, the high recognition accuracy also shows that the brain network may carry neurological markers associated with anesthesia.
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7
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Naci L, Owen AM. Uncovering consciousness and revealing the preservation of mental life in unresponsive brain-injured patients. Semin Neurol 2022; 42:299-308. [PMID: 35790202 DOI: 10.1055/a-1892-1715] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Lorina Naci
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
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8
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Aubinet C, Schnakers C, Majerus S. Language Assessment in Patients with Disorders of Consciousness. Semin Neurol 2022; 42:273-282. [PMID: 36100226 DOI: 10.1055/s-0042-1755561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The assessment of residual language abilities in patients with disorders of consciousness (DoC) after severe brain injury is particularly challenging due to their limited behavioral repertoire. Moreover, associated language impairment such as receptive aphasia may lead to an underestimation of actual consciousness levels. In this review, we examine past research on the assessment of residual language processing in DoC patients, and we discuss currently available tools for identifying language-specific abilities and their prognostic value. We first highlight the need for validated and sensitive bedside behavioral assessment tools for residual language abilities in DoC patients. As regards neuroimaging and electrophysiological methods, the tasks involving higher level linguistic commands appear to be the most informative about level of consciousness and have the best prognostic value. Neuroimaging methods should be combined with the most appropriate behavioral tools in multimodal assessment protocols to assess receptive language abilities in DoC patients in the most complete and sensitive manner.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium.,Centre du Cerveau, University Hospital of Liège, Liège, Belgium.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Caroline Schnakers
- Research Institute, Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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9
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Luppi AI, Mediano PAM, Rosas FE, Allanson J, Pickard JD, Williams GB, Craig MM, Finoia P, Peattie ARD, Coppola P, Owen AM, Naci L, Menon DK, Bor D, Stamatakis EA. Whole-brain modelling identifies distinct but convergent paths to unconsciousness in anaesthesia and disorders of consciousness. Commun Biol 2022; 5:384. [PMID: 35444252 PMCID: PMC9021270 DOI: 10.1038/s42003-022-03330-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
The human brain entertains rich spatiotemporal dynamics, which are drastically reconfigured when consciousness is lost due to anaesthesia or disorders of consciousness (DOC). Here, we sought to identify the neurobiological mechanisms that explain how transient pharmacological intervention and chronic neuroanatomical injury can lead to common reconfigurations of neural activity. We developed and systematically perturbed a neurobiologically realistic model of whole-brain haemodynamic signals. By incorporating PET data about the cortical distribution of GABA receptors, our computational model reveals a key role of spatially-specific local inhibition for reproducing the functional MRI activity observed during anaesthesia with the GABA-ergic agent propofol. Additionally, incorporating diffusion MRI data obtained from DOC patients reveals that the dynamics that characterise loss of consciousness can also emerge from randomised neuroanatomical connectivity. Our results generalise between anaesthesia and DOC datasets, demonstrating how increased inhibition and connectome perturbation represent distinct neurobiological paths towards the characteristic activity of the unconscious brain. Perturbations in a large-scale whole-brain model suggest that anesthesia and injury may be imparting functionally similar effects in terms of brain dynamics.
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Affiliation(s)
- Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK. .,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. .,Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK. .,The Alan Turing Institute, London, UK.
| | - Pedro A M Mediano
- Department of Psychology, University of Cambridge, Cambridge, UK.,Department of Psychology, Queen Mary University of London, London, UK
| | - Fernando E Rosas
- Center for Psychedelic Research, Department of Brain Science, Imperial College London, London, UK.,Data Science Institute, Imperial College London, London, UK.,Centre for Complexity Science, Imperial College London, London, UK
| | - Judith Allanson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Neurosciences, Cambridge University Hospitals NHS Foundation, Addenbrooke's Hospital, Cambridge, UK
| | - John D Pickard
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Division of Neurosurgery, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Michael M Craig
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paola Finoia
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Alexander R D Peattie
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Peter Coppola
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Adrian M Owen
- The Brain and Mind Institute, University of Western Ontario, London, ON, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, UK
| | - Daniel Bor
- Department of Psychology, University of Cambridge, Cambridge, UK.,Department of Psychology, Queen Mary University of London, London, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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10
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While you were sleeping: Evidence for high-level executive processing of an auditory narrative during sleep. Conscious Cogn 2022; 100:103306. [DOI: 10.1016/j.concog.2022.103306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
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11
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Coppola P, Spindler LRB, Luppi AI, Adapa R, Naci L, Allanson J, Finoia P, Williams GB, Pickard JD, Owen AM, Menon DK, Stamatakis EA. Network dynamics scale with levels of awareness. Neuroimage 2022; 254:119128. [PMID: 35331869 DOI: 10.1016/j.neuroimage.2022.119128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/10/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023] Open
Abstract
Small world topologies are thought to provide a valuable insight into human brain organisation and consciousness. However, functional magnetic resonance imaging studies in consciousness have not yielded consistent results. Given the importance of dynamics for both consciousness and cognition, here we investigate how the diversity of small world dynamics (quantified by sample entropy; dSW-E1) scales with decreasing levels of awareness (i.e., sedation and disorders of consciousness). Paying particular attention to result reproducibility, we show that dSW-E is a consistent predictor of levels of awareness even when controlling for the underlying functional connectivity dynamics. We find that dSW-E of subcortical and cortical areas are predictive, with the former showing higher and more robust effect sizes across analyses. We find that the network dynamics of intermodular communication in the cerebellum also have unique predictive power for levels of awareness. Consequently, we propose that the dynamic reorganisation of the functional information architecture, in particular of the subcortex, is a characteristic that emerges with awareness and has explanatory power beyond that of the complexity of dynamic functional connectivity.
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Affiliation(s)
- Peter Coppola
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Lennart R B Spindler
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Andrea I Luppi
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Ram Adapa
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Division of Neurosurgery, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Lloyd Building, Dublin 2, Ireland
| | - Judith Allanson
- Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Neurosciences, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation, Hills Rd., Cambridge, CB2 0QQ, UK
| | - Paola Finoia
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Division of Neurosurgery, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK
| | - Guy B Williams
- Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, UK
| | - John D Pickard
- Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Division of Neurosurgery, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, UK
| | - Adrian M Owen
- The Brain and Mind Institute, Western Interdisciplinary Research Building, University of Western Ontario, London, ON N6A 5B7, Canada
| | - David K Menon
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge Biomedical Campus (Box 65), Cambridge CB2 0QQ, UK
| | - Emmanuel A Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK; Department of Clinical Neurosciences, School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Hills Rd., Cambridge CB2 0QQ, UK.
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12
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Hu H, Cusack R, Naci L. OUP accepted manuscript. Brain Commun 2022; 4:fcac071. [PMID: 35425900 PMCID: PMC9006044 DOI: 10.1093/braincomms/fcac071] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/29/2021] [Accepted: 03/16/2022] [Indexed: 11/12/2022] Open
Abstract
One of the great frontiers of consciousness science is understanding how early consciousness arises in the development of the human infant. The reciprocal relationship between the default mode network and fronto-parietal networks—the dorsal attention and executive control network—is thought to facilitate integration of information across the brain and its availability for a wide set of conscious mental operations. It remains unknown whether the brain mechanism of conscious awareness is instantiated in infants from birth. To address this gap, we investigated the development of the default mode and fronto-parietal networks and of their reciprocal relationship in neonates. To understand the effect of early neonate age on these networks, we also assessed neonates born prematurely or before term-equivalent age. We used the Developing Human Connectome Project, a unique Open Science dataset which provides a large sample of neonatal functional MRI data with high temporal and spatial resolution. Resting state functional MRI data for full-term neonates (n = 282, age 41.2 weeks ± 12 days) and preterm neonates scanned at term-equivalent age (n = 73, 40.9 weeks ± 14.5 days), or before term-equivalent age (n = 73, 34.6 weeks ± 13.4 days), were obtained from the Developing Human Connectome Project, and for a reference adult group (n = 176, 22–36 years), from the Human Connectome Project. For the first time, we show that the reciprocal relationship between the default mode and dorsal attention network was present at full-term birth or term-equivalent age. Although different from the adult networks, the default mode, dorsal attention and executive control networks were present as distinct networks at full-term birth or term-equivalent age, but premature birth was associated with network disruption. By contrast, neonates before term-equivalent age showed dramatic underdevelopment of high-order networks. Only the dorsal attention network was present as a distinct network and the reciprocal network relationship was not yet formed. Our results suggest that, at full-term birth or by term-equivalent age, infants possess key features of the neural circuitry that enables integration of information across diverse sensory and high-order functional modules, giving rise to conscious awareness. Conversely, they suggest that this brain infrastructure is not present before infants reach term-equivalent age. These findings improve understanding of the ontogeny of high-order network dynamics that support conscious awareness and of their disruption by premature birth.
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Affiliation(s)
- Huiqing Hu
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Rhodri Cusack
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Lorina Naci
- Trinity College Institute of Neuroscience, School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Correspondence to: Lorina Naci School of Psychology Trinity College Institute of Neuroscience Global Brain Health Institute Trinity College Dublin Dublin, Ireland E-mail:
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13
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Aubinet C, Chatelle C, Gosseries O, Carrière M, Laureys S, Majerus S. Residual implicit and explicit language abilities in patients with disorders of consciousness: A systematic review. Neurosci Biobehav Rev 2021; 132:391-409. [PMID: 34864003 DOI: 10.1016/j.neubiorev.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/13/2021] [Accepted: 12/01/2021] [Indexed: 01/14/2023]
Abstract
Language assessment in post-comatose patients is difficult due to their limited behavioral repertoire; yet associated language deficits might lead to an underestimation of consciousness levels in unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS; -/+) diagnoses. We present a systematic review of studies from 2002 assessing residual language abilities with neuroimaging, electrophysiological or behavioral measures in patients with severe brain injury. Eighty-five articles including a total of 2278 patients were assessed for quality. The median percentages of patients showing residual implicit language abilities (i.e., cortical responses to specific words/sentences) were 33 % for UWS, 50 % for MCS- and 78 % for MCS + patients, whereas explicit language abilities (i.e., command-following using brain-computer interfaces) were reported in 20 % of UWS, 33 % of MCS- and 50 % of MCS + patients. Cortical responses to verbal stimuli increased along with consciousness levels and the progressive recovery of consciousness after a coma was paralleled by the reappearance of both implicit and explicit language processing. This review highlights the importance of language assessment in patients with disorders of consciousness.
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Affiliation(s)
- Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium.
| | - Camille Chatelle
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Fund for Scientific Research, FNRS, Belgium
| | - Manon Carrière
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium; Centre du Cerveau, University Hospital of Liège, Belgium; Fund for Scientific Research, FNRS, Belgium
| | - Steve Majerus
- Fund for Scientific Research, FNRS, Belgium; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium.
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14
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Graham M. Residual Cognitive Capacities in Patients With Cognitive Motor Dissociation, and Their Implications for Well-Being. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2021; 46:729-757. [PMID: 34655220 PMCID: PMC8643594 DOI: 10.1093/jmp/jhab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Patients with severe disorders of consciousness are thought to be unaware of themselves or their environment. However, research suggests that a minority of patients diagnosed as having a disorder of consciousness remain aware. These patients, designated as having “cognitive motor dissociation” (CMD), can demonstrate awareness by imagining specific tasks, which generates brain activity detectable via functional neuroimaging. The discovery of consciousness in these patients raises difficult questions about their well-being, and it has been argued that it would be better for these patients if they were allowed to die. Conversely, I argue that CMD patients may have a much higher level of well-being than is generally acknowledged. It is far from clear that their lives are not worth living, because there are still significant gaps in our understanding of how these patients experience the world. I attempt to fill these gaps, by analyzing the neuroscientific research that has taken place with these patients to date. Having generated as comprehensive a picture as possible of the capacities of CMD patients, I examine this picture through the lens of traditional philosophical theories of well-being. I conclude that the presumption that CMD patients do not have lives worth living is not adequately supported.
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15
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Linke AC, Slušná D, Kohli JS, Álvarez-Linera Prado J, Müller RA, Hinzen W. Morphometry and functional connectivity of auditory cortex in school-age children with profound language disabilities: Five comparative case studies. Brain Cogn 2021; 155:105822. [PMID: 34837801 DOI: 10.1016/j.bandc.2021.105822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Many neurodevelopmental conditions imply absent or severely reduced language capacities at school age. Evidence from functional magnetic resonance imaging is highly limited. We selected a series of five cases scanned with the same fMRI paradigm and the aim of relating individual language profiles onto underlying patterns of functional connectivity (FC) across auditory language cortex: three with neurogenetic syndromes (Coffin-Siris, Landau-Kleffner, and Fragile-X), one with idiopathic intellectual disability, one with autism spectrum disorder (ASD). Compared to both a group with typical development (TD) and a verbal ASD group (total N = 110), they all showed interhemispheric FC below two standard deviations of the TD mean. Children with higher language scores showed higher intrahemispheric FC between Heschl's gyrus and other auditory language regions, as well as an increase of FC during language stimulation compared to rest. An increase of FC in forward vs. reversed speech in the posterior and middle temporal gyri was seen across all cases. The Coffin-Siris case, the most severe, also had the most anomalous FC patterns and showed reduced myelin content, while the Landau-Kleffner case showed reduced cortical thickness. These results suggest potential for neural markers and mechanisms of severe language processing deficits under highly heterogeneous etiological conditions.
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Affiliation(s)
- Annika Carola Linke
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - Dominika Slušná
- Department of Translation and Language Sciences, Campus Poblenou, Pompeu Fabra University, Barcelona 08018, Barcelona, Spain
| | - Jiwandeep Singh Kohli
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | - Ralph-Axel Müller
- Brain Development Imaging Laboratories, Department of Psychology, San Diego State University, San Diego, CA, USA; San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Wolfram Hinzen
- Department of Translation and Language Sciences, Campus Poblenou, Pompeu Fabra University, Barcelona 08018, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats, ICREA, 08010 Barcelona, Spain
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16
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Li F, Li Y, Zheng H, Jiang L, Gao D, Li C, Peng Y, Cao Z, Zhang Y, Yao D, Xu T, Yuan TF, Xu P. Identification of the General Anesthesia Induced Loss of Consciousness by Cross Fuzzy Entropy-Based Brain Network. IEEE Trans Neural Syst Rehabil Eng 2021; 29:2281-2291. [PMID: 34705652 DOI: 10.1109/tnsre.2021.3123696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although the spatiotemporal complexity and network connectivity are clarified to be disrupted during the general anesthesia (GA) induced unconsciousness, it remains to be difficult to exactly monitor the fluctuation of consciousness clinically. In this study, to track the loss of consciousness (LOC) induced by GA, we first developed the multi-channel cross fuzzy entropy method to construct the time-varying networks, whose temporal fluctuations were then explored and quantitatively evaluated. Thereafter, an algorithm was further proposed to detect the time onset at which patients lost their consciousness. The results clarified during the resting state, relatively stable fuzzy fluctuations in multi-channel network architectures and properties were found; by contrast, during the LOC period, the disrupted frontal-occipital connectivity occurred at the early stage, while at the later stage, the inner-frontal connectivity was identified. When specifically exploring the early LOC stage, the uphill of the clustering coefficients and the downhill of the characteristic path length were found, which might help resolve the propofol-induced consciousness fluctuation in patients. Moreover, the developed detection algorithm was validated to have great capacity in exactly capturing the time point (in seconds) at which patients lost consciousness. The findings demonstrated that the time-varying cross-fuzzy networks help decode the GA and are of great significance for developing anesthesia depth monitoring technology clinically.
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17
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Li Y, Li F, Zheng H, Jiang L, Peng Y, Zhang Y, Yao D, Xu T, Yuan T, Xu P. Recognition of general anesthesia-induced loss of consciousness based on the spatial pattern of the brain networks. J Neural Eng 2021; 18. [PMID: 34534980 DOI: 10.1088/1741-2552/ac27fc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022]
Abstract
Objective.Unconsciousness is a key feature related to general anesthesia (GA) but is difficult to be evaluated accurately by anesthesiologists clinically.Approach.To tracking the loss of consciousness (LOC) and recovery of consciousness (ROC) under GA, in this study, by investigating functional connectivity of the scalp electroencephalogram, we explore any potential difference in brain networks among anesthesia induction, anesthesia recovery, and the resting state.Main results.The results of this study demonstrated significant differences among the three periods, concerning the corresponding brain networks. In detail, the suppressed default mode network, as well as the prolonged characteristic path length and decreased clustering coefficient, during LOC was found in the alpha band, compared to the Resting and the ROC state. When to further identify the Resting and LOC states, the fused network topologies and properties achieved the highest accuracy of 95%, along with a sensitivity of 93.33% and a specificity of 96.67%.Significance.The findings of this study not only deepen our understanding of propofol-induced unconsciousness but also provide quantitative measurements subserving better anesthesia management.
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Affiliation(s)
- Yuqin Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Fali Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, People's Republic of China
| | - Lin Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Yueheng Peng
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Yangsong Zhang
- School of Computer Science and Technology, Southwest University of Science and Technology, Mianyang 621010, People's Republic of China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
| | - Tao Xu
- Department of Anesthesiology, Affiliated Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, People's Republic of China.,Department of Anesthesiology, Tongzhou People's Hospital, Nantong 226300, People's Republic of China
| | - Tifei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, People's Republic of China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, People's Republic of China
| | - Peng Xu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China.,School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, People's Republic of China
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18
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Manza P, Shokri-Kojori E, Volkow ND. Reduced Segregation Between Cognitive and Emotional Processes in Cannabis Dependence. Cereb Cortex 2021; 30:628-639. [PMID: 31211388 DOI: 10.1093/cercor/bhz113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 01/16/2023] Open
Abstract
Addiction is characterized by an erosion of cognitive control toward drug taking that is accentuated by negative emotional states. Here we tested the hypothesis that enhanced interference on cognitive control reflects a loss of segregation between cognition and emotion in addiction. We analyzed Human Connectome Project data from 1206 young adults, including 89 with cannabis dependence (CD). Two composite factors, one for cognition and one for emotion, were derived using principal component (PC) analyses. Component scores for these PCs were significantly associated in the CD group, such that negative emotionality correlated with poor cognition. However, the corresponding component scores were uncorrelated in matched controls and nondependent recreational cannabis users (n = 87). In CD, but not controls or recreational users, functional magnetic resonance imaging activations to emotional stimuli (angry/fearful faces > shapes) correlated with activations to cognitive demand (working memory; 2-back > 0-back). Canonical correlation analyses linked individual differences in cognitive and emotional component scores with brain activations. In CD, there was substantial overlap between cognitive and emotional brain-behavior associations, but in controls, associations were more restricted to the cognitive domain. These findings support our hypothesis of impaired segregation between cognitive and emotional processes in CD that might contribute to poor cognitive control under conditions of increased emotional demand.
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Affiliation(s)
- Peter Manza
- National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ehsan Shokri-Kojori
- National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nora D Volkow
- National Institute on Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, MD 20892, USA.,National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD 20892, USA
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19
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Houldin E, Fang Z, Ray LB, Stojanoski B, Owen AM, Fogel SM. Reversed and increased functional connectivity in non-REM sleep suggests an altered rather than reduced state of consciousness relative to wake. Sci Rep 2021; 11:11943. [PMID: 34099771 PMCID: PMC8184935 DOI: 10.1038/s41598-021-91211-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/18/2021] [Indexed: 12/02/2022] Open
Abstract
Sleep resting state network (RSN) functional connectivity (FC) is poorly understood, particularly for rapid eye movement (REM), and in non-sleep deprived subjects. REM and non-REM (NREM) sleep involve competing drives; towards hypersynchronous cortical oscillations in NREM; and towards wake-like desynchronized oscillations in REM. This study employed simultaneous electroencephalography-functional magnetic resonance imaging (EEG-fMRI) to explore whether sleep RSN FC reflects these opposing drives. As hypothesized, this was confirmed for the majority of functional connections modulated by sleep. Further, changes were directional: e.g., positive wake correlations trended towards negative correlations in NREM and back towards positive correlations in REM. Moreover, the majority did not merely reduce magnitude, but actually either reversed and strengthened in the opposite direction, or increased in magnitude during NREM. This finding supports the notion that NREM is best expressed as having altered, rather than reduced FC. Further, as many of these functional connections comprised “higher-order” RSNs (which have been previously linked to cognition and consciousness), such as the default mode network, this finding is suggestive of possibly concomitant alterations to cognition and consciousness.
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Affiliation(s)
- Evan Houldin
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,Department of Neuroscience, Western University, 1151 Richmond St. N., London, N6A 3K7, Canada.,Queensland Brain Institute, University of Queensland, Brisbane, 4072, Australia
| | - Zhuo Fang
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,University of Ottawa Brain and Mind Research Institute, 451 Smyth Rd, Ottawa, K1H 8M5, Canada
| | - Laura B Ray
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,The Royal's Institute for Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, K1Z 7K4, Canada
| | - Bobby Stojanoski
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada
| | - Adrian M Owen
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada.,Department of Psychology, Western University, London, N6A 5C2, Canada
| | - Stuart M Fogel
- Brain & Mind Institute, Western Interdisciplinary Research Building, Western University, London, N6A 5B7, Canada. .,University of Ottawa Brain and Mind Research Institute, 451 Smyth Rd, Ottawa, K1H 8M5, Canada. .,The Royal's Institute for Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, K1Z 7K4, Canada. .,Department of Psychology, Western University, London, N6A 5C2, Canada. .,School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, K1N 6N5, Canada.
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20
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Aubinet C, Chatelle C, Gillet S, Lejeune N, Thunus M, Hennen N, Cassol H, Laureys S, Majerus S. The Brief Evaluation of Receptive Aphasia test for the detection of language impairment in patients with severe brain injury. Brain Inj 2021; 35:705-717. [PMID: 33678094 DOI: 10.1080/02699052.2021.1894482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PRIMARY OBJECTIVE The assessment of language in patients post-comatose patients is limited by their reduced behavioral repertoire. We developed the Brief Evaluation of Receptive Aphasia (BERA) tool for assessing phonological, semantic and morphosyntactic abilities in patients with severe brain injury based on visual fixation responses. RESEARCH DESIGN Prospective cross-sectional study and case reports. METHODS AND PROCEDURE The BERA and Language Screening Test were first administered to 52 conscious patients with aphasia on two consecutive days in order to determine the validity and reliability of the BERA. Four post-comatose patients were further examined with the BERA, the Coma Recovery Scale-Revised (CRS-R), positron emission tomography and structural magnetic resonance imaging. MAIN OUTCOME AND RESULTS The BERA showed satisfactory intra- and inter-rater reliability, as well as internal and concurrent validity in patients with aphasia. The BERA scores indicated selective receptive difficulties for phonological, semantic and particularly morphosyntactic abilities in post-comatose patients. These results were in line with the cortical distribution of brain lesions. CONCLUSIONS The BERA may complement the widely used CRS-R for assessing and diagnosing patients with disorders of consciousness by providing a systematic and detailed characterization of residual language abilities.
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Affiliation(s)
- Charlène Aubinet
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Camille Chatelle
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Sophie Gillet
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
| | - Nicolas Lejeune
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium.,Centre Neurologique William Lennox, Ottignies-Louvain-la-Neuve, Belgium.,Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Margot Thunus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
| | - Noémie Hennen
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
| | - Helena Cassol
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Steven Laureys
- GIGA-Consciousness, GIGA Research Center (B34, +1), University of Liège, Liège, Belgium.,Centre Du Cerveau², University Hospital of Liège (B34, +1), Liège, Belgium
| | - Steve Majerus
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Quartier Agora (B33), Liège, Belgium
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21
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Lyons KM, Stevenson RA, Owen AM, Stojanoski B. Examining the relationship between measures of autistic traits and neural synchrony during movies in children with and without autism. NEUROIMAGE-CLINICAL 2021; 28:102477. [PMID: 33395970 PMCID: PMC7680702 DOI: 10.1016/j.nicl.2020.102477] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 01/18/2023]
Abstract
Neural synchrony during movie watching was measured in children with and without ASD. The ASD group had significantly less neural synchrony across the whole brain. The ASD group also had significantly less synchrony in the theory of mind network. Autistic traits did not predict neural synchrony in non-ASD children. These results suggest children with ASD process movies in a unique way.
Children who have been diagnosed with autism spectrum disorder (ASD) often show a marked deficit in measures of social cognition. In autistic adults, measures of social cognition have been shown to relate to differences in brain synchronization (as measured by fMRI) when individuals are processing naturalistic stimuli, such as movies. However, whether children who differ in their degree of autistic traits, with or without a diagnosis of ASD, differ in their neural responses to movies has not yet been investigated. In the current study, neural synchrony, measured using fMRI, was examined in three groups of children aged 7 to 12, who differed with respect to scores on a measure of autistic traits associated with social impairment and whether or not they had been diagnosed with ASD. While watching the movie ‘Despicable Me’, those diagnosed with ASD had significantly less neural synchrony in areas that have been previously shown to be associated with social cognition (e.g. areas related to ‘theory of mind’), and plot following (e.g. the lateral prefrontal cortex), than those who did not have an ASD diagnosis. In contrast, two groups who differed in their degree of autistic traits, but did not have a diagnosis of ASD, showed no significant differences in neural synchrony across the whole brain. These results shed some light on how autistic traits may contribute to an individual’s conscious experience of the world, and how, for children with ASD, that experience may differ markedly from that of those without ASD.
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Affiliation(s)
- K M Lyons
- The Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada; The Department of Psychology, Western University, London, ON N6A 5B7, Canada
| | - R A Stevenson
- The Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada; The Department of Psychology, Western University, London, ON N6A 5B7, Canada
| | - A M Owen
- The Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada; The Department of Psychology, Western University, London, ON N6A 5B7, Canada; The Department of Physiology and Pharmacology, Western University, London, ON N6A 5B7, Canada
| | - B Stojanoski
- The Brain and Mind Institute, Western University, London, ON N6A 5B7, Canada; The Department of Psychology, Western University, London, ON N6A 5B7, Canada.
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22
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Signature of consciousness in brain-wide synchronization patterns of monkey and human fMRI signals. Neuroimage 2020; 226:117470. [PMID: 33137478 DOI: 10.1016/j.neuroimage.2020.117470] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/07/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
During the sleep-wake cycle, the brain undergoes profound dynamical changes, which manifest subjectively as transitions between conscious experience and unconsciousness. Yet, neurophysiological signatures that can objectively distinguish different consciousness states based are scarce. Here, we show that differences in the level of brain-wide signals can reliably distinguish different stages of sleep and anesthesia from the awake state in human and monkey fMRI resting state data. Moreover, a whole-brain computational model can faithfully reproduce changes in global synchronization and other metrics such as functional connectivity, structure-function relationship, integration and segregation across vigilance states. We demonstrate that the awake brain is close to a Hopf bifurcation, which naturally coincides with the emergence of globally correlated fMRI signals. Furthermore, simulating lesions of individual brain areas highlights the importance of connectivity hubs in the posterior brain and subcortical nuclei for maintaining the model in the awake state, as predicted by graph-theoretical analyses of structural data.
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23
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Individualized assessment of residual cognition in patients with disorders of consciousness. NEUROIMAGE-CLINICAL 2020; 28:102472. [PMID: 33395966 PMCID: PMC7652775 DOI: 10.1016/j.nicl.2020.102472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 12/02/2022]
Abstract
Single-trial electrical recordings index higher-order cognitive processing of movie stimuli. Common patterns of neural activity associated with the brain’s executive network. The time course of common neural activity correlates with ratings of suspense. 38% of non-responsive patients correlate with controls during movie-watching tasks. 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.
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Kandeepan S, Rudas J, Gomez F, Stojanoski B, Valluri S, Owen AM, Naci L, Nichols ES, Soddu A. Modeling an auditory stimulated brain under altered states of consciousness using the generalized Ising model. Neuroimage 2020; 223:117367. [PMID: 32931944 DOI: 10.1016/j.neuroimage.2020.117367] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 08/08/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022] Open
Abstract
Propofol is a short-acting medication that results in decreased levels of consciousness and is used for general anesthesia. Although it is the most commonly used anesthetic in the world, much remains unknown about the mechanisms by which it induces a loss of consciousness. Characterizing anesthesia-induced alterations to brain network activity might provide a powerful framework for understanding the neural mechanisms of unconsciousness. The aim of this work was to model brain activity in healthy brains during various stages of consciousness, as induced by propofol, in the auditory paradigm. We used the generalized Ising model (GIM) to fit the empirical fMRI data of healthy subjects while they listened to an audio clip from a movie. The external stimulus (audio clip) is believed to be at least partially driving a synchronization process of the brain activity and provides a similar conscious experience in different subjects. In order to observe the common synchronization among the subjects, a novel technique called the inter subject correlation (ISC) was implemented. We showed that the GIM-modified to incorporate the naturalistic external field-was able to fit the empirical task fMRI data in the awake state, in mild sedation, in deep sedation, and in recovery, at a temperature T* which is well above the critical temperature. To our knowledge this is the first study that captures human brain activity in response to real-life external stimuli at different levels of conscious awareness using mathematical modeling. This study might be helpful in the future to assess the level of consciousness of patients with disorders of consciousness and help in regaining their consciousness.
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Affiliation(s)
- Sivayini Kandeepan
- Department of Physics and Astronomy and the Brain and Mind Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada; Department of Physics, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Jorge Rudas
- Department of Mathematics, Universidad Nacional de Colombia, Cra 45, Bogotá, Colombia
| | - Francisco Gomez
- Department of Mathematics, Universidad Nacional de Colombia, Cra 45, Bogotá, Colombia
| | - Bobby Stojanoski
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 3K7, Canada
| | - Sreeram Valluri
- Department of Physics and Astronomy and the Brain and Mind Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Adrian Mark Owen
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 3K7, Canada
| | - Lorina Naci
- Trinity College Institute of Neuroscience, Trinity College Dublin, College Green, Dublin 2, Ireland
| | - Emily Sophia Nichols
- Brain and Mind Institute, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 3K7, Canada
| | - Andrea Soddu
- Department of Physics and Astronomy and the Brain and Mind Institute, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
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Memory During the Presumed Vegetative State: Implications for Patient Quality of Life. Camb Q Healthc Ethics 2020; 29:501-510. [DOI: 10.1017/s0963180120000274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractA growing number of studies show that a significant proportion of patients, who meet the clinical criteria for the diagnosis of the vegetative state (VS), demonstrate evidence of covert awareness through successful performance of neuroimaging tasks. Despite these important advances, the day-to-day life experiences of any such patient remain unknown. This presents a major challenge for optimizing the patient’s standard of care and quality of life (QoL). We describe a patient who, following emergence from a state of complete behavioral unresponsiveness and a clinical diagnosis of VS, reported rich memories of his experience during this time. This case demonstrates the potential for a sophisticated mental life enabled by preserved memory in a proportion of patients who, similarly, are thought to be unconscious. Therefore, it presents an important opportunity to examine the implications for patient QoL and standard of care, both during the period of presumed unconsciousness and after recovery.
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Abstract
BACKGROUND Functional connectivity across the cortex has been posited to be important for consciousness and anesthesia, but functional connectivity patterns during the course of surgery and general anesthesia are unknown. The authors tested the hypothesis that disrupted cortical connectivity patterns would correlate with surgical anesthesia. METHODS Surgical patients (n = 53) were recruited for study participation. Whole-scalp (16-channel) wireless electroencephalographic data were prospectively collected throughout the perioperative period. Functional connectivity was assessed using weighted phase lag index. During anesthetic maintenance, the temporal dynamics of connectivity states were characterized via Markov chain analysis, and state transition probabilities were quantified. RESULTS Compared to baseline (weighted phase lag index, 0.163, ± 0.091), alpha frontal-parietal connectivity was not significantly different across the remaining anesthetic and perioperative epochs, ranging from 0.100 (± 0.041) to 0.218 (± 0.136) (P > 0.05 for all time periods). In contrast, there were significant increases in alpha prefrontal-frontal connectivity (peak = 0.201 [0.154, 0.248]; P < 0.001), theta prefrontal-frontal connectivity (peak = 0.137 [0.091, 0.182]; P < 0.001), and theta frontal-parietal connectivity (peak = 0.128 [0.084, 0.173]; P < 0.001) during anesthetic maintenance. Additionally, shifts occurred between states of high prefrontal-frontal connectivity (alpha, beta) with suppressed frontal-parietal connectivity, and high frontal-parietal connectivity (alpha, theta) with reduced prefrontal-frontal connectivity. These shifts occurred in a nonrandom manner (P < 0.05 compared to random transitions), suggesting structured transitions of connectivity during general anesthesia. CONCLUSIONS Functional connectivity patterns dynamically shift during surgery and general anesthesia but do so in a structured way. Thus, a single measure of functional connectivity will likely not be a reliable correlate of surgical anesthesia.
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Rudas J, Martínez D, Castellanos G, Demertzi A, Martial C, Carriére M, Aubinet C, Soddu A, Laureys S, Gómez F. Time-Delay Latency of Resting-State Blood Oxygen Level-Dependent Signal Related to the Level of Consciousness in Patients with Severe Consciousness Impairment. Brain Connect 2020; 10:83-94. [DOI: 10.1089/brain.2019.0716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jorge Rudas
- Institute of Biotechnology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Darwin Martínez
- Department of Computer Science, Universidad Nacional de Colombia, Bogotá, Colombia
- Department of Computer Science, Universidad Central de Colombia, Bogotá, Colombia
| | - Gabriel Castellanos
- Department of Physiological Sciences, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Athena Demertzi
- Physiology of Cognition Research Lab, GIGA-Consciousness, GIGA Institute, University of Liege, Liège, Belgium
| | - Charlotte Martial
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Manon Carriére
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Charlène Aubinet
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Andrea Soddu
- Department of Physics and Astronomy, University of Western Ontario, London, Ontario
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
| | - Francisco Gómez
- Department of Mathematics, Universidad Nacional de Colombia, Bogotá, Colombia
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Oh TK, Song IA, Jeon YT. Impact of Glasgow Coma Scale scores on unplanned intensive care unit readmissions among surgical patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:520. [PMID: 31807502 DOI: 10.21037/atm.2019.10.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Physiological instability at discharge from intensive care units (ICU) is known to increase readmission rates among critically ill patients. However, associations between consciousness levels at discharge and readmission rates remain unclear. This study aimed to investigate the association between the Glasgow Coma Scale (GCS) score at discharge and unplanned ICU readmissions in surgical patients. Methods This retrospective cohort study in a single tertiary academic hospital analyzed the electronic health records of adults aged 18 years or older, who were discharged from the ICU between January 2012 and December 2018. The primary endpoint was unplanned readmission within 48 hours after discharge. Multivariable logistic regression analysis was performed. Results Among 9,512 patients, unplanned readmissions occurred in 161 (1.7%). At discharge, GCS and verbal response scores of ≤13 (vs. ≥14) were associated with 2.28-fold higher unplanned readmissions within 48 hours [odds ratio (OR): 2.35, 95% confidence interval (CI): 1.51-3.65, P<0.001]. Sensitivity analysis showed that verbal response scores of ≤4 (vs. 5) at ICU discharge were associated with 2.21-fold higher unplanned readmissions within 48 hours (OR: 2.21, 95% CI: 1.49-3.29, P<0.001), whereas eye or motor responses at time of ICU discharge were not significantly associated with unplanned readmissions (P>0.05). Conclusions In this surgical ICU population cohort, GCS scores at ICU discharge were significantly associated with unplanned readmissions within 48 hours. This association was stronger with GCS scores of ≤13 and with verbal response scores of ≤4 at time of discharge. These findings suggest that surgical ICU patients with GCS scores of ≤13 or verbal response scores of ≤4 should be monitored carefully for discharge in order to avoid unplanned ICU readmissions.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Young-Tae Jeon
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea.,Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul, South Korea
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