Event-related potential repetition effect in alzheimer's patients: Multiple repetition priming with pictures

A systematic review of cognitive event-related potentials in mild cognitive impairment and Alzheimer's disease

This systematic review examined whether event-related potentials (ERPs) during higher cognitive processing can detect subtle, early signs of neurodegenerative disease. Original, empirical studies retrieved from PsycINFO and PubMed were reviewed if they analyzed patterns in cognitive ERPs (≥150 ms post-stimulus) differentiating mild cognitive impairment (MCI), Alzheimer's disease (AD), or cognitively intact elders who carry AD risk through the Apolipoprotein-E ε4 allele (ε4+) from healthy older adult controls (HC). The 100 studies meeting inclusion criteria (MCI = 47; AD = 47; ε4+ = 6) analyzed N200, P300, N400, and occasionally, later components. While there was variability across studies, patterns of reduced amplitude and delayed latency were apparent in pathological aging, consistent with AD-related brain atrophy and cognitive impairment. These effects were particularly evident in advanced disease progression (i.e., AD > MCI) and in later ERP components measured during complex tasks. Although ERP studies in intact ε4+ elders are thus far scarce, a similar pattern of delayed latency was notable, along with a contrasting pattern of increased amplitude, consistent with compensatory neural activation. This limited work suggests ERPs might be able to index early neural changes indicative of future cognitive decline in otherwise healthy elders. As ERPs are also accessible and affordable relative to other neuroimaging methods, their addition to cognitive assessment might substantively enhance early identification and characterization of neural dysfunction, allowing opportunity for earlier differential diagnosis and targeting of intervention. To evaluate this possibility there is urgent need for well-powered studies assessing late cognitive ERPs during complex tasks, particularly in healthy elders at risk for cognitive decline.

Remembering perceptual features unequally bound in object and episodic tokens: Neural mechanisms and their electrophysiological correlates

We present a neurocognitive model of long-term object memory. We propose that perceptual priming and episodic recognition are phenomena based on three distinct kinds of representations. We label these representations types and tokens. Types are prototypical representations needed for object identification. The network of non-arbitrary features necessary for object categorization is sharpened in the course of repeated identification, an effect that we call type trace and which causes perceptual priming. Tokens, on the other hand, support episodic recognition. Perirhinal structures are proposed to bind intrinsic within-object features into an object token that can be thought of as a consolidated perceptual object file. Hippocampal structures integrate object- with contextual information in an episodic token. The reinstatement of an object token is assumed to generate a feeling of familiarity, whereas recollection occurs when the reinstatement of an episodic token occurs. Retrieval mode and retrieval orientation dynamically modulate access to these representations. In this review, we apply the model to recent empirical research (behavioral, fMRI, and ERP data) including a series of studies from our own lab. We put specific emphasis on the effects that sensory features and their study-test match have on familiarity. The type-token approach fits the data and additionally provides a framework for the analysis of concepts like unitization and associative reinstatement.

Clinical applications of cognitive event-related potentials in Alzheimer's disease

This article has reviewed several abnormalities in the cognitive ERPs of AD patients. These abnormalities are prominent from latencies of approximately 200 msec and later. In contrast, sensory-dependent evoked potentials, such as N100, are generally normal in AD. This finding is as one familiar with the neuropathology of AD would predict. Predilection sites in early AD include the medial temporal lobe, other limbic areas, and multimodal association cortices with sparing of primary sensory areas. Unimodal association cortex is involved in AD, but not as heavily as multimodal cortex. Particular advantages of studying a given ERP paradigm or component depend largely on the specific application or hypothesis being tested. A P300 paradigm can be useful in detecting a disorder of attention or in quantifying the effects of drugs that improve attention, such as the cholinesterase inhibitors. For the early diagnosis of AD or other memory disorders, a word-repetition paradigm with an explicit recognition task or one that fosters associative learning would be recommended. This article has discussed potential use of N400 in tracking disease progression. ERPs provide a flexible and powerful technique, with superb temporal resolution, which can be used as a probe into subtle "subclinical" abnormalities of cognitive processes. Despite being applied to AD for about 25 years since the early P300 studies, the full potential of ERPs in helping diagnose and treat AD patients has yet to be realized. In this era of rapidly evolving brain-imaging techniques, electrophysiologic data are important in advancing understanding of cognition. Brain-mapping techniques that can inform where and when key cognitive processes occur are finally emerging. A final example of potential clinical application of cognitive ERPs is in the development of rational combinational treatment of cognitive enhancing drugs. Along these lines, P300 investigations in epilepsy proved helpful in ranking the cognitive side effects of anticonvulsant drugs. Drug studies that use 2 x 2 combinational designs, which compare the effects of drug A, drug B, with A + B, are currently prohibitively expensive for full-scale clinical trials in AD. It is likely that precise ERP measures could hasten drug development in several ways. Smaller samples could be used, at lower cost, to test the cognitive effects of each specific drug combination. Optimal doses of combinational therapy perhaps could be identified by repeated within-subject ERP measures. Longitudinal changes in the ERP hold promise as a marker of individual responsivity to a particular agent, which could have diagnostic utility (eg, testing response to cholinergic or dopaminergic therapy). This horizon and many others remain wide open for well-planned explorations.

Event-related brain potential evidence of spared knowledge in Alzheimer's disease

The authors recorded event-related brain potentials (ERPs) to picture primes and word targets (picture-name verification task) in patients with Alzheimer's disease (AD) and in elderly and young participants. N400 was more negative to words that did not match pictures than to words that did match pictures in all groups: In the young, this effect was significant at all scalp sites; in the elderly, it was only at central-parietal sites; and in AD patients, it was limited to right central-parietal sites. Among AD patients pretested with a confrontation-naming task to identify pictures they could not name, neither the N400 priming effect nor its scalp distribution was affected by ability to name pictures correctly. This ERP evidence of spared knowledge of these items was complemented by 80% performance accuracy. Thus, although the name of an item may be inaccessible in confrontation naming, N400 shows that knowledge is intact enough to prime cortical responses.

An overview of age-related changes in the scalp distribution of P3b

In this overview of 7 studies, the scalp distribution of the P3b component (i.e. the P3 or P300) of the event-related potential elicited by target events in young and older adults was assessed. The target P3b data were recorded in either auditory oddball paradigms or in visual study tasks in which orienting activity was manipulated (as a within-subjects variable) in investigations of indirect memory. Some of the studies required choice reaction time responses, whereas others required responses only to the target stimuli. Motor response requirements had a profound effect on the P3b scalp distribution of older but not of younger subjects. The presence of a frontally oriented scalp focus in the topographies of the older adults in most of the tasks described here is consistent with older adults continuing to use prefrontal processes for stimuli that should have already been well encoded and/or categorized. However, although older subjects generally had different P3b scalp distributions than younger subjects, their scalp distributions were modulated similarly by task requirements. These data suggest that similar mechanisms modulate the scalp distribution of P3b in older compared to younger adults. However, in the older adult, these scalp distribution changes in response to task demands are superimposed on a frontally oriented scalp focus due to a putative frontal lobe contribution to target P3b topography.

Mismatch negativity during attend and ignore conditions in Alzheimer's disease

Mismatch negativities (MMNs) of the event-related potential to deviant tones and environmental sounds were recorded during active and ignore oddball sequences in young and elderly controls and patients with probable Alzheimer's disease (PAD). MMNs were smaller in the PAD waveforms compared to those of the controls, suggesting a degraded sensory memory trace in these subjects; however, under ignore conditions, environmental sounds elicited robust MMNs in the PAD group along with N2b and novelty P3 components in similar fashion to controls. As N2b and P3 are usually elicited by attended stimuli, these data suggest that in the PAD subjects, the highly deviant events involuntarily captured attention, perhaps reflecting the activation of an attentional switching mechanism. Because this passive switching is thought to reflect activation of a mechanism located in the frontal lobes, the data suggest that this putative frontal lobe mechanism is relatively intact in the early stages of the disease.

Old/new differences in direct and indirect memory tests using pictures and words in within- and cross-form conditions: event-related potential and behavioral measures

Indirect measures of repetition priming are more sensitive to changes in surface features than are direct measures of memory. This dissociation may reflect differences in the extent to which the two tasks rely on form-specific processes, or on the activation of different memory systems. To assess this, subjects at study made semantic discriminations to a mixed list of pictures and words. At test, half the concepts were repeated in the surface form presented at study while half were repeated in the other surface form. Subjects in the indirect test continued making the same discrimination, whereas those in the direct test performed a yes/no recognition task. For both tasks, significant old/new within-form differences were found for event-related potential (ERP) and reaction time (RT) measures. Cross-form old/new differences were reliable only for the word-picture condition in the direct task and only for the ERP indices. These data suggest that both direct and indirect memory tasks are influenced by form-specific as well as form-non-specific processing, and that neither the transfer-appropriate processing nor memory systems approaches can completely account for this pattern of results.