Integrated Development Environment for EEG-Driven Cognitive-Neuropsychological Research

Advanced Dementia: Brain-State Characteristics and Clinical Indicators of Early Mortality

There is an urgent need in advanced dementia for evidence-based clinical prognostic predictors that could positively influence ethical decisions allowing health provider and family preparation for early mortality. Accordingly, the authors review and discuss the prognostic utility of clinical assessments and objective measures of pathological brain states in advanced dementia patients associated with accelerated mortality. Overall, due to the paucity of brain-activity and clinical-comorbidity predictors of survival in advanced dementia, authors outline the potential prognostic value of brain-state electroencephalography (EEG) measures and reliable clinical indicators for forecasting early mortality in advanced dementia patients. In conclusion, two consistent risk-factors for predicting accelerated mortality in terminal-stage patients with advanced dementia were identified: pressure ulcers and paroxysmal slow-wave EEG parameters associated with cognitive impairment severity and organic disease progression. In parallel, immobility, malnutrition, and co-morbid systemic diseases are highly associated with the risk for early mortality in advanced dementia patients. Importantly, the authors' conclusions suggest utilizing reliable quantitative-parameters of disease progression for estimating accelerated mortality in dementia patients entering the terminal disease-stages characterized by severe intellectual deficits and functional disability.

Left-prefrontal alpha-dynamics predict executive working-memory functioning in elderly people

Recent findings suggest that electroencephalography (EEG) oscillations in the theta and alpha frequency-bands reflect synchronized interregional neuronal activity and are considered to reflect cognitive-control, and executive working memory mechanisms in humans. Above the age of 50 years, hypothesized pronounced alterations in alpha and theta-band power at resting or across different WM-functioning brain states may well be due to pre-dementia cognitive impairments, or increasing severity of age-related neurological disorders. Executive working memory (EWM) functioning was assessed in older-adult participants (54 to 83 years old) by obtaining their WM-related EEG oscillations and WM performance scores. WM performance and WM brain-state EEG were recorded during online-WM periods as well as during specific online WM events within EWM periods, and during resting offline-WM periods that preceded online-WM periods. Left-prefrontal alpha-power was enhanced during offline-WM periods versus online-WM periods and was significantly related to WM accuracy. Left-prefrontal alpha power and left prefrontal-parietal theta power anterior-posterior difference-gradient during online WM activity were related to reaction times (RT's). Importantly, during active-storage events, WM-offset offline-periods, and preparatory pre-retrieval events, excessive left-prefrontal alpha activity was related to poor EWM performance. The potential for developing targeted noninvasive cognition-enhancing interventions and developing clinical-monitoring EEG-based biomarkers of pathological cognitive-decline in elderly people is discussed.

Neural reactivity parameters of awareness predetermine one-year survival in patients with disorders of consciousness

Objective: The current investigation evaluated the sensitivity of neural-reactivity markers of awareness versus standard clinical assessments in predicting 1-year survival in nonresponsive-awake patients with disorders of consciousness (DOC).Methods: Pre-attentive auditory mismatch-negativity (MMN) event-related potentials (ERP's), globally induced electroencephalography (EEG) spectral power following verbal command, and clinical parameters were assessed. The study included 10 patients with DOC with mixed etiology and 10 healthy controls (HC) at baseline. The clinical status of patients with DOC was reassessed after 1 year.Results: Unlike baseline clinical assessment scores, baseline MMN amplitudes of non-survivors and induced theta-power following verbal-command clearly distinguished the non-surviving patients versus surviving patients. Baseline MMN peak-amplitude latencies in survivors with DOC were significantly related to clinical outcome over a 1-year period.Conclusion: Current findings underscore the increased sensitivity of EEG-reactivity markers of awareness versus standard clinical scores in predicting 1-year clinical outcome and survival in patients with DOC. Further longitudinal research in larger DOC samples is needed to confirm the prognostic-reliability, and validity of neural reactivity parameters of awareness in patients with DOC. Current finding may have implications for clinical care and medical-legal decisions in unresponsive-awake patients, and could assist clinicians to predict their survival up to 1 year from admission.