ERP based decision fusion for AD diagnosis across cohorts

Decision fusion in healthcare and medicine: a narrative review

OBJECTIVE

To provide an overview of the decision fusion (DF) technique and describe the applications of the technique in healthcare and medicine at prevention, diagnosis, treatment and administrative levels.

BACKGROUND

The rapid development of technology over the past 20 years has led to an explosion in data growth in various industries, like healthcare. Big data analysis within the healthcare systems is essential for arriving to a value-based decision over a period of time. Diversity and uncertainty in big data analytics have made it impossible to analyze data by using conventional data mining techniques and thus alternative solutions are required. DF is a form of data fusion techniques that could increase the accuracy of diagnosis and facilitate interpretation, summarization and sharing of information.

METHODS

We conducted a review of articles published between January 1980 and December 2020 from various databases such as Google Scholar, IEEE, PubMed, Science Direct, Scopus and web of science using the keywords decision fusion (DF), information fusion, healthcare, medicine and big data. A total of 141 articles were included in this narrative review.

CONCLUSIONS

Given the importance of big data analysis in reducing costs and improving the quality of healthcare; along with the potential role of DF in big data analysis, it is recommended to know the full potential of this technique including the advantages, challenges and applications of the technique before its use. Future studies should focus on describing the methodology and types of data used for its applications within the healthcare sector.

Enhanced Feedback-Related Negativity in Alzheimer's Disease

Alzheimer’s disease (AD), the most common cause of dementia in the elderly, results in the impairment of executive function, including that of performance monitoring. Feedback-related negativity (FRN) is an electrophysiological measure reflecting the activity of this monitoring system via feedback signals, and is generated from the anterior cingulate cortex. However, there have been no reports on FRN in AD. Based on prior aging studies, we hypothesized that FRN would decrease in AD patients. To assess this, FRN was measured in healthy individuals and those with AD during a simple gambling task involving positive and negative feedback stimuli. Contrary to our hypothesis, FRN amplitude increased in AD patients, compared with the healthy elderly. We speculate that this may reflect the existence of a compensatory mechanism against the decline in executive function. Also, there was a significant association between FRN amplitude and depression scores in AD, and the FRN amplitude tended to increase insomuch as the Self-rating Depression Scale (SDS) was higher. This result suggests the existence of a negative bias in the affective state in AD. Thus, the impaired functioning monitoring system in AD is a more complex phenomenon than we thought.

Evoked potentials and neuropsychological tests validate Positron Emission Topography (PET) brain metabolism in cognitively impaired patients

Fluorodeoxyglucose (FDG) Positron Emission Topography (PET) brain hypometabolism (HM) correlates with diminished cognitive capacity and risk of developing dementia. However, because clinical utility of PET is limited by cost, we sought to determine whether a less costly electrophysiological measure, the P300 evoked potential, in combination with neuropsychological test performance, would validate PET HM in neuropsychiatric patients. We found that patients with amnestic and non-amnestic cognitive impairment and HM (n = 43) evidenced significantly reduced P300 amplitudes, delayed latencies, and neuropsychological deficits, compared to patients with normal brain metabolism (NM; n = 187). Data from patients with missing cognitive test scores (n = 57) were removed from the final sample, and logistic regression modeling was performed on the modified sample (n = 173, p = .000004). The logistic regression modeling, based on P300 and neuropsychological measures, was used to validate membership in the HM vs. NM groups. It showed classification validation in 13/25 HM subjects (52.0%) and in 125/148 NM subjects (84.5%), correlating with total classification accuracy of 79.8%. In this paper, abnormal P300 evoked potentials coupled with cognitive test impairment validates brain metabolism and mild/moderate cognitive impairment (MCI). To this end, we cautiously propose incorporating electrophysiological and neuropsychological assessments as cost-effective brain metabolism and MCI indicators in primary care. Final interpretation of these results must await required additional studies confirming these interesting results.

Analysis of complexity based EEG features for the diagnosis of Alzheimer's disease

As life expectancy increases, particularly in the developed world, so does the prevalence of Alzheimer's Disease (AD). AD is a neurodegenerative disorder characterized by neurofibrillary plaques and tangles in the brain that leads to neuronal death and dementia. Early diagnosis of AD is still a major unresolved health concern: several biomarkers are being investigated, among which the electroencephalogram (EEG) provides the only option for an electrophysiological information. In this study, EEG signals obtained from 161 subjects--79 with AD, and 82 age-matched controls (CN)--are analyzed using several nonlinear signal complexity measures. These measures include: Higuchi fractal dimension (HFD), spectral entropy (SE), spectral centroid (SC), spectral roll-off (SR), and zero-crossing rate (ZCR). HFD is a quantitative measure of time series complexity derived from fractal theory. Among spectral measures, SE measures the level of disorder in the spectrum, SC is a measure of spectral shape, and SR is frequency sample below which a specified percent of the spectral magnitude distribution is contained. Lastly, ZCR is simply the rate at which the signal changes signs. A t-test was first applied to determine those features that provide significant differences between the groups. Those features were then used to train a neural network. The classification accuracies ranged from 60-66%, suggesting they contain some discriminatory information; however, not enough to be clinically useful alone. Combining these features and training a support vector machine (SVM) resulted in a diagnostic accuracy of 78%, indicating that these feature carry complementary information.

Real-time decision fusion for multimodal neural prosthetic devices

BACKGROUND

The field of neural prosthetics aims to develop prosthetic limbs with a brain-computer interface (BCI) through which neural activity is decoded into movements. A natural extension of current research is the incorporation of neural activity from multiple modalities to more accurately estimate the user's intent. The challenge remains how to appropriately combine this information in real-time for a neural prosthetic device.

METHODOLOGY/PRINCIPAL FINDINGS

Here we propose a framework based on decision fusion, i.e., fusing predictions from several single-modality decoders to produce a more accurate device state estimate. We examine two algorithms for continuous variable decision fusion: the Kalman filter and artificial neural networks (ANNs). Using simulated cortical neural spike signals, we implemented several successful individual neural decoding algorithms, and tested the capabilities of each fusion method in the context of decoding 2-dimensional endpoint trajectories of a neural prosthetic arm. Extensively testing these methods on random trajectories, we find that on average both the Kalman filter and ANNs successfully fuse the individual decoder estimates to produce more accurate predictions.

CONCLUSIONS

Our results reveal that a fusion-based approach has the potential to improve prediction accuracy over individual decoders of varying quality, and we hope that this work will encourage multimodal neural prosthetics experiments in the future.