Postoperative Outcomes in Elderly Patients Undergoing Cardiac Surgery With Preoperative Cognitive Impairment: A Systematic Review and Meta-Analysis

BACKGROUND

Older patients with preoperative cognitive impairment are at risk for increased postoperative complications after noncardiac surgery. This systematic review and meta-analysis aimed to determine the association between preoperative cognitive impairment and dementia and postoperative outcomes in older surgical patients after cardiac surgery.

METHODS

Eight electronic databases were searched from inception to January 4, 2022. Inclusion criteria were cardiac surgery patients ≥60 years of age; preoperative cognitive impairment; ≥1 postoperative complication reported; comparator group with no preoperative cognitive impairment; and written in English. Using a random-effects model, we calculated effect sizes as odds ratio (OR) and standardized mean differences (SMDs). Risk of random error was assessed by applying trial sequential analysis.

RESULTS

Sixteen studies (62,179 patients) were included. Preoperative cognitive impairment was associated with increased risk of delirium in older patients after cardiac surgery (70.0% vs 20.5%; OR, 8.35; 95% confidence interval [CI], 4.25-16.38; I2, 0%; P < .00001). Cognitive impairment was associated with increased hospital length of stay (LOS; SMD, 0.36; 95% CI, 0.20-0.51; I2, 22%; P < .00001) and intensive care unit (ICU) LOS (SMD, 0.39; 95% CI, 0.09-0.68; I2, 70%; P = .01). No significant association was seen for 30-day mortality (1.7% vs 1.1%; OR, 2.58; 95% CI, 0.64-10.44; I2, 55%; P = .18).

CONCLUSIONS

In older patients undergoing cardiac surgery, cognitive impairment was associated with an 8-fold increased risk of delirium, a 5% increase in absolute risk of major postoperative bleeding, and an increase in hospital and ICU LOS by approximately 0.4 days. Further research on the feasibility of implementing routine neurocognitive testing is warranted.

EEG Resting-State Functional Networks in Amnestic Mild Cognitive Impairment

Background. Alzheimer's cognitive-behavioral syndrome is the result of impaired connectivity between nerve cells, due to misfolded proteins, which accumulate and disrupt specific brain networks. Electroencephalography, because of its excellent temporal resolution, is an optimal approach for assessing the communication between functionally related brain regions. Objective. To detect and compare EEG resting-state networks (RSNs) in patients with amnesic mild cognitive impairment (aMCI), and healthy elderly (HE). Methods. We recruited 125 aMCI patients and 70 healthy elderly subjects. One hundred and twenty seconds of artifact-free EEG data were selected and compared between patients with aMCI and HE. We applied standard low-resolution brain electromagnetic tomography (sLORETA)-independent component analysis (ICA) to assess resting-state networks. Each network consisted of a set of images, one for each frequency (delta, theta, alpha1/2, beta1/2). Results. The functional ICA analysis revealed 17 networks common to groups. The statistical procedure demonstrated that aMCI used some networks differently than HE. The most relevant findings were as follows. Amnesic-MCI had: i) increased delta/beta activity in the superior frontal gyrus and decreased alpha1 activity in the paracentral lobule (ie, default mode network); ii) greater delta/theta/alpha/beta in the superior frontal gyrus (i.e, attention network); iii) lower alpha in the left superior parietal lobe, as well as a lower delta/theta and beta, respectively in post-central, and in superior frontal gyrus(ie, attention network). Conclusions. Our study confirms sLORETA-ICA method is effective in detecting functional resting-state networks, as well as between-groups connectivity differences. The findings provide support to the Alzheimer's network disconnection hypothesis.

Neural signaling of methamphetamine craving and seeking intensified by bupropion in the ventral tegmental area-cortico-accumbens circuitry in mice

Previously, bupropion (BUP), a norepinephrine (NE)/dopamine (DA) transporter blocker and nicotinic acetylcholine receptors (nAChRs) antagonist, was found to intensify methamphetamine (METH) craving behaviours in mice. Intense craving causes relapse in drug dependence. This study characterized local field potential (LFP) patterns in the brain regions associated with METH-conditioned place preference (CPP) enhanced by BUP. Male Swiss albino ICR mice were implanted with LFP electrodes to the ventral tegmental area (VTA), medial prefrontal cortex (mPFC) and the nucleus accumbens core (NAcc). Animals received sessions to learn the association between injection effects (1 mg/kg METH and normal saline) with contextual environments (METH- and saline-paired compartments) during the conditioning phase. A total of 20 mg/kg BUP was given to animals before LFP, and behaviour recording in the CPP apparatus during the post-conditioning phase. The results showed that increased CPP scores and % number of entries to the METH-paired zone, as well as changes in VTA, mPFC and NAcc spectral powers and coherence among these areas, were associated with METH-CPP. Treatment with BUP increased VTA delta and gamma I, decreased mPFC alpha, increased NAcc gamma I and decreased gamma II powers. Coherence analyses revealed that BUP decreased gamma II VTA-mPFC and increased beta and gamma I VTA-NAcc connectivity. Altogether, BUP produced additional effects to that of METH-CPP alone. These findings demonstrated changes in neural circuit activities associated with METH-CPP intensified by BUP. Moreover, modulation of NE/DA systems and/or nAChRs actions in the VTA-cortico-accumbens loop might underlie METH craving and dependence.

Functional Brain Networks in Mild Cognitive Impairment Based on Resting Electroencephalography Signals

The oscillatory patterns of electroencephalography (EEG), during resting states, are informative and helpful in understanding the functional states of brain network and their contribution to behavioral performances. The aim of this study is to characterize the functional brain network alterations in patients with amnestic mild cognitive impairment (aMCI). To this end, rsEEG signals were recorded before and after a cognitive task. Functional connectivity metrics were calculated using debiased weighted phase lag index (DWPLI). Topological features of the functional connectivity network were analyzed using both the classical graph approach and minimum spanning tree (MST) algorithm. Subsequently, the network and connectivity values together with Mini-Mental State Examination cognitive test were used as features to classify the participants. Results showed that: (1) across the pre-task condition, in the theta band, the aMCI group had a significantly lower global mean DWPLI than the control group; the functional connectivity patterns were different in the left hemisphere between two groups; the aMCI group showed significantly higher average clustering coefficient and the remarkably lower global efficiency than the control. (2) Analysis of graph measures under post-task resting state, unveiled that for the percentage change of post-task vs. pre-task in beta EEG, a significant increase in tree hierarchy was observed in aMCI group (2.41%) than in normal control (-3.89%); (3) Furthermore, the classification analysis of combined measures of functional connectivity, brain topology, and MMSE test showed improved accuracy compared to the single method, for which the connectivity patterns and graph metrics were used as separate inputs. The classification accuracy obtained for the case of post-task resting state was 87.2%, while the one achieved under pre-task resting state was found to be 77.7%. Therefore, the functional network alterations in aMCI patients were more prominent during the post-task resting state. This study suggests that the disintegration observed in MCI functional network during the resting states, preceding and following a task, might be possible biomarkers of cognitive dysfunction in aMCI patients.

Generating diagnostic profiles of cognitive decline and dementia using magnetoencephalography

Accurate identification of the underlying cause(s) of cognitive decline and dementia is challenging due to significant symptomatic overlap between subtypes. This study presents a multi-class classification framework for subjects with subjective cognitive decline, mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies, fronto-temporal dementia and cognitive decline due to psychiatric illness, trained on source-localized resting-state magnetoencephalography data. Diagnostic profiles, describing probability estimates for each of the 6 diagnoses, were assigned to individual subjects. A balanced accuracy rate of 41% and multi-class area under the curve value of 0.75 were obtained for 6-class classification. Classification primarily depended on posterior relative delta, theta and beta power and amplitude-based functional connectivity in the beta and gamma frequency band. Dementia with Lewy bodies (sensitivity: 100%, precision: 20%) and Alzheimer's disease subjects (sensitivity: 51%, precision: 90%) could be classified most accurately. Fronto-temporal dementia subjects (sensitivity: 11%, precision: 3%) were most frequently misclassified. Magnetoencephalography biomarkers hold promise to increase diagnostic accuracy in a noninvasive manner. Diagnostic profiles could provide an intuitive tool to clinicians and may facilitate implementation of the classifier in the memory clinic.

On the characterization of cognitive tasks using activity-specific short-lived synchronization between electroencephalography channels

Accurate characterization of brain activity during a cognitive task is challenging due to the dynamically changing and the complex nature of the brain. The majority of the proposed approaches assume stationarity in brain activity and disregard the systematic timing organization among brain regions during cognitive tasks. In this study, we propose a novel cognitive activity recognition method that captures the activity-specific timing parameters from training data that elicits maximal average short-lived pairwise synchronization between electroencephalography signals. We evaluated the characterization power of the activity-specific timing parameter triplets in a motor imagery activity recognition framework. The activity-specific timing parameter triplets consist of latency of the maximally synchronized signal segments from activity onset Δt, the time lag between maximally synchronized signal segments τ, and the duration of the maximally synchronized signal segments w. We used cosine-based similarity, wavelet bi-coherence, phase-locking value, phase coherence value, linearized mutual information, and cross-correntropy to calculate the channel synchronizations at the specific timing parameters. Recognition performances as well as statistical analyses on both BCI Competition-III dataset IVa and PhysioNet Motor Movement/Imagery dataset, indicate that the inter-channel short-lived synchronization calculated using activity-specific timing parameter triplets elicit significantly distinct synchronization profiles for different motor imagery tasks and can thus reliably be used for cognitive task recognition purposes.

A Graph Gaussian Embedding Method for Predicting Alzheimer's Disease Progression With MEG Brain Networks

Characterizing the subtle changes of functional brain networks associated with the pathological cascade of Alzheimer's disease (AD) is important for early diagnosis and prediction of disease progression prior to clinical symptoms. We developed a new deep learning method, termed multiple graph Gaussian embedding model (MG2G), which can learn highly informative network features by mapping high-dimensional resting-state brain networks into a low-dimensional latent space. These latent distribution-based embeddings enable a quantitative characterization of subtle and heterogeneous brain connectivity patterns at different regions, and can be used as input to traditional classifiers for various downstream graph analytic tasks, such as AD early stage prediction, and statistical evaluation of between-group significant alterations across brain regions. We used MG2G to detect the intrinsic latent dimensionality of MEG brain networks, predict the progression of patients with mild cognitive impairment (MCI) to AD, and identify brain regions with network alterations related to MCI.

No Evidence That Cognitive and Physical Activities Are Related to Changes in EEG Markers of Cognition in Older Adults at Risk of Dementia

An active lifestyle as well as cognitive and physical training (PT) may benefit cognition by increasing cognitive reserve, but the underlying neurobiological mechanisms of this reserve capacity are not well understood. To investigate these mechanisms of cognitive reserve, we focused on electrophysiological correlates of cognitive performance, namely on an event-related measure of auditory memory and on a measure of global coherence. Both measures have shown to be sensitive markers for cognition and might therefore be suitable to investigate potential training- and lifestyle-related changes. Here, we report on the results of an electrophysiological sub-study that correspond to previously published behavioral findings. Altogether, 65 older adults with subjective or objective cognitive impairment and aged 60-88 years were assigned to a 10-week cognitive (n = 19) or a 10-week PT (n = 21) or to a passive control group (n = 25). In addition, self-reported lifestyle was assessed at baseline. We did not find an effect of both training groups on electroencephalography (EEG) measures of auditory memory decay or global coherence (ps ≥ 0.29) and a more active lifestyle was not associated with improved global coherence (p = 0.38). Results suggest that a 10-week unimodal cognitive or PT and an active lifestyle in older adults at risk for dementia are not strongly related to improvements in electrophysiological correlates of cognition.

Cognition in Vascular Aging and Mild Cognitive Impairment

Cardiovascular health declines with age, due to vascular risk factors, and this leads to an increasing risk of cognitive decline. Mild cognitive impairment (MCI) is defined as the negative cognitive changes beyond what is expected in normal aging. The purpose of the study was to compare older adults with vascular risk factors (VRF), MCI patients, and healthy controls (HC) in main dimensions of cognitive control. The sample comprised a total of 109 adults, aged 50 to 85 (M = 66.09, S.D. = 9.02). They were divided into three groups: 1) older adults with VRF, 2) MCI patients, and 3) healthy controls (HC). VRF and MCI did not differ significantly in age, educational level, or gender as was the case with HC. The tests used mainly examine inhibition, cognitive flexibility, and working memory processing. Results showed that the VRF group had more Set Loss Errors in drawing designs indicating deficits in establishing cognitive set and in cognitive shifting. MCI patients displayed lower performance in processing. Hence, different types of specific impairments emerge in vascular aging and MCI, and this may imply that discrete underlying pathologies may play a role in the development of somewhat different profiles of cognitive decline.

Genetic Association Between Alzheimer's Disease Risk Variant of the PICALM Gene and EEG Functional Connectivity in Non-demented Adults

Genome wide association studies (GWAS) have identified and validated the association of the PICALM genotype with Alzheimer's disease (AD). The PICALM rs3851179 A allele is thought to have a protective effect, whereas the G allele appears to confer risk for AD. The influence of the PICALM genotype on brain functional connectivity in non-demented subjects remains largely unknown. We examined the association of the PICALM rs3851179 genotype with the characteristics of lagged linear connectivity (LLC) of resting EEG sources in 104 non-demented adults younger than 60 years of age. The EEG analysis was performed using exact low-resolution brain electromagnetic tomography (eLORETA) freeware (Pascual-Marqui et al., 2011). We found that the carriers of the A PICALM allele (PICALM AA and AG genotypes) had higher widespread interhemispheric LLC of alpha sources compared to the carriers of the GG PICALM allele. An exploratory correlation analysis showed a moderate positive association between the alpha LLC interhemispheric characteristics and the corpus callosum size and between the alpha interhemispheric LLC characteristics and the Luria word memory scores. These results suggest that the PICALM rs3851179 A allele provides protection against cognitive decline by facilitating neurophysiological reserve capacities in non-demented adults. In contrast, lower functional connectivity in carriers of the AD risk variant, PICALM GG, suggests early functional alterations in alpha rhythm networks.

Effective differentiation of mild cognitive impairment by functional brain graph analysis and computerized testing

Community-dwelling African American elders are twice as likely to develop mild cognitive impairment (MCI) or Alzheimer’s disease and related dementias than older white Americans and therefore represent a significant at-risk group in need of early monitoring. More extensive imaging or cerebrospinal fluid studies represent significant barriers due to cost and burden. We combined functional connectivity and graph theoretical measures, derived from resting-state electroencephalography (EEG) recordings, with computerized cognitive testing to identify differences between persons with MCI and healthy controls based on a sample of community-dwelling African American elders. We found a significant decrease in functional connectivity and a less integrated graph topology in persons with MCI. A combination of functional connectivity, topological and cognition measurements is powerful for prediction of MCI and combined measures are clearly more effective for prediction than using a single approach. Specifically, by combining cognition features with functional connectivity and topological features the prediction improved compared with the classification using features from single cognitive or EEG domains, with an accuracy of 86.5%, compared with the accuracy of 77.5% of the best single approach. Community-dwelling African American elders find EEG and computerized testing acceptable and results are promising in terms of differentiating between healthy controls and persons with MCI living in the community.

Characterization of the dynamic behavior of neural activity in Alzheimer's disease: exploring the non-stationarity and recurrence structure of EEG resting-state activity

OBJECTIVE

Mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) have been shown to induce perturbations to normal neuronal behavior and disrupt neuronal networks. Recent work suggests that the dynamic properties of resting-state neuronal activity could be affected by MCI and AD-induced neurodegeneration. The aim of the study was to characterize these properties from different perspectives: (i) using the Kullback-Leibler divergence (KLD), a measure of non-stationarity derived from the continuous wavelet transform; and (ii) using the entropy of the recurrence point density ([Formula: see text]) and the median of the recurrence point density ([Formula: see text]), two novel metrics based on recurrence quantification analysis.

APPROACH

KLD, [Formula: see text] and [Formula: see text] were computed for 49 patients with dementia due to AD, 66 patients with MCI due to AD and 43 cognitively healthy controls from 60 s electroencephalographic (EEG) recordings with a 10 s sliding window with no overlap. Afterwards, we tested whether the measures reflected alterations to normal neuronal activity induced by MCI and AD.

MAIN RESULTS

Our results showed that frequency-dependent alterations to normal dynamic behavior can be found in patients with MCI and AD, both in non-stationarity and recurrence structure. Patients with MCI showed signs of patterns of abnormal state recurrence in the theta (4-8 Hz) and beta (13-30 Hz) frequency bands that became more marked in AD. Moreover, abnormal non-stationarity patterns were found in MCI patients, but not in patients with AD in delta (1-4 Hz), alpha (8-13 Hz), and gamma (30-70 Hz).

SIGNIFICANCE

The alterations in normal levels of non-stationarity in patients with MCI suggest an initial increase in cortical activity during the development of AD. This increase could possibly be due to an impairment in neuronal inhibition that is not present during later stages. MCI and AD induce alterations to the recurrence structure of cortical activity, suggesting that normal state switching during rest may be affected by these pathologies.

Modeling the Switching Behavior of Functional Connectivity Microstates (FCμstates) as a Novel Biomarker for Mild Cognitive Impairment

The need for designing and validating novel biomarkers for the detection of mild cognitive impairment (MCI) is evident. MCI patients have a high risk of developing Alzheimer's disease (AD), and for that reason the introduction of novel and reliable biomarkers is of significant clinical importance. Motivated by recent findings on the rich information of dynamic functional connectivity graphs (DFCGs) about brain (dys) function, we introduced a novel approach of identifying MCI based on magnetoencephalographic (MEG) resting state recordings. The activity of different brain rhythms {δ, 𝜃, α1, α2, β1, β2, γ1, γ2} was first beamformed with linear constrained minimum norm variance in the MEG data to determine 90 anatomical regions of interest (ROIs). A DFCG was then estimated using the imaginary part of phase lag value (iPLV) for both intra-frequency coupling (8) and cross-frequency coupling pairs (28). We analyzed DFCG profiles of neuromagnetic resting state recordings of 18 MCI patients and 22 healthy controls. We followed our model of identifying the dominant intrinsic coupling mode (DICM) across MEG sources and temporal segments, which further leads to the construction of an integrated DFCG (iDFCG). We then filtered statistically and topologically every snapshot of the iDFCG with data-driven approaches. An estimation of the normalized Laplacian transformation for every temporal segment of the iDFCG and the related eigenvalues created a 2D map based on the network metric time series of the eigenvalues (NMTSeigs). The NMTSeigs preserves the non-stationarity of the fluctuated synchronizability of iDCFG for each subject. Employing the initial set of 20 healthy elders and 20 MCI patients, as training set, we built an overcomplete dictionary set of network microstates (n μstates). Afterward, we tested the whole procedure in an extra blind set of 20 subjects for external validation. We succeeded in gaining a high classification accuracy on the blind dataset (85%), which further supports the proposed Markovian modeling of the evolution of brain states. The adaptation of appropriate neuroinformatic tools that combine advanced signal processing and network neuroscience tools could properly manipulate the non-stationarity of time-resolved FC patterns revealing a robust biomarker for MCI.

Magnetoencephalography applied to the study of Alzheimer's disease

Magnetoencephalography (MEG) is a relatively modern neuroimaging technique able to study normal and pathological brain functioning with temporal resolution in the order of milliseconds and adequate spatial resolution. Although its clinical applications are still relatively limited, great advances have been made in recent years in the field of dementia and Alzheimer's disease (AD) in particular. In this chapter, we briefly describe the physiological phenomena underlying MEG brain signals and the different metrics that can be computed from these data in order to study the alterations disrupting brain activity not only in demented patients, but also in the preclinical and prodromal stages of the disease. Changes in non-linear brain dynamics, power spectral properties, functional connectivity and network topological changes observed in AD are narratively summarized in the context of the pathophysiology of the disease. Furthermore, the potential of MEG as a potential biomarker to identify AD pathology before dementia onset is discussed in the light of current knowledge and the relationship between potential MEG biomarkers and current established hallmarks of the disease is also reviewed. To this aim, findings from different approaches such as resting state or during the performance of different cognitive paradigms are discussed.Lastly, there is an increasing interest in current scientific literature in promoting interventions aimed at modifying certain lifestyles, such as nutrition or physical activity among others, thought to reduce or delay AD risk. We discuss the utility of MEG as a potential marker of the success of such interventions from the available literature.

Brain network disintegration as a final common pathway for delirium: a systematic review and qualitative meta-analysis

Delirium is an acute neuropsychiatric syndrome characterized by altered levels of attention and awareness with cognitive deficits. It is most prevalent in elderly hospitalized patients and related to poor outcomes. Predisposing risk factors, such as older age, determine the baseline vulnerability for delirium, while precipitating factors, such as use of sedatives, trigger the syndrome. Risk factors are heterogeneous and the underlying biological mechanisms leading to vulnerability for delirium are poorly understood. We tested the hypothesis that delirium and its risk factors are associated with consistent brain network changes. We performed a systematic review and qualitative meta-analysis and included 126 brain network publications on delirium and its risk factors. Findings were evaluated after an assessment of methodological quality, providing N=99 studies of good or excellent quality on predisposing risk factors, N=10 on precipitation risk factors and N=7 on delirium. Delirium was consistently associated with functional network disruptions, including lower EEG connectivity strength and decreased fMRI network integration. Risk factors for delirium were associated with lower structural connectivity strength and less efficient structural network organization. Decreased connectivity strength and efficiency appear to characterize structural brain networks of patients at risk for delirium, possibly impairing the functional network, while functional network disintegration seems to be a final common pathway for the syndrome.

•

Delirium is consistently associated with functional network impairments.

•

Risk factors are associated with lower structural connectivity strength.

•

Risk factors are associated with a less efficient structural network organization.

•

Structural impairments make the functional network more vulnerable to deterioration.

•

Functional network disintegration seems to be a final common pathway for delirium.

M/EEG-Based Bio-Markers to Predict the MCI and Alzheimer's Disease: A Review From the ML Perspective

This paper reviews the state-of-the-art neuromarkers development for the prognosis of Alzheimer's disease (AD) and mild cognitive impairment (MCI). The first part of this paper is devoted to reviewing the recently emerged machine learning (ML) algorithms based on electroencephalography (EEG) and magnetoencephalography (MEG) modalities. In particular, the methods are categorized by different types of neuromarkers. The second part of the review is dedicated to a series of investigations that further highlight the differences between these two modalities. First, several source reconstruction methods are reviewed and their source-level performances explored, followed by an objective comparison between EEG and MEG from multiple perspectives. Finally, a number of the most recent reports on classification of MCI/AD during resting state using EEG/MEG are documented to show the up-to-date performance for this well-recognized data collecting scenario. It is noticed that the MEG modality may be particularly effective in distinguishing between subjects with MCI and healthy controls, a high classification accuracy of more than 98% was reported recently; whereas the EEG seems to be performing well in classifying AD and healthy subjects, which also reached around 98% of the accuracy. A number of influential factors have also been raised and suggested for careful considerations while evaluating the ML-based diagnosis systems in the real-world scenarios.

Relationship between Cortical Thickness and Neuropsychological Performance in Normal Older Adults and Those with Mild Cognitive Impairment

Mild cognitive impairment (MCI) has been extensively investigated in recent decades to identify groups with a high risk of dementia and to establish effective prevention methods during this period. Neuropsychological performance and cortical thickness are two important biomarkers used to predict progression from MCI to dementia. This study compares the cortical thickness and neuropsychological performance in people with MCI and cognitively healthy older adults. We further focus on the relationship between cortical thickness and neuropsychological performance in these two groups. Forty-nine participants with MCI and 40 cognitively healthy older adults were recruited. Cortical thickness was analysed with semiautomatic software, Freesurfer. The analysis reveals that the cortical thickness in the left caudal anterior cingulate (p=0.041), lateral occipital (p=0.009) and right superior temporal (p=0.047) areas were significantly thinner in the MCI group after adjustment for age and education. Almost all neuropsychological test results (with the exception of forward digit span) were significantly correlated to cortical thickness in the MCI group after adjustment for age, gender and education. In contrast, only the score on the Category Verbal Fluency Test and the forward digit span were found to have significant inverse correlations to cortical thickness in the control group of cognitively healthy older adults. The study results suggest that cortical thinning in the temporal region reflects the global change in cognition in subjects with MCI and may be useful to predict progression of MCI to Alzheimer’s disease. The different pattern in the correlation of cortical thickness to the neuropsychological performance of patients with MCI from the healthy control subjects may be explained by the hypothesis of MCI as a disconnection syndrome.

Assessment of EEG Connectivity Patterns in Mild Cognitive Impairment Using Phase Slope Index

Mild cognitive impairment (MCI) is a pathology characterized by an abnormal cognitive state. MCI patients are considered to be at high risk for developing dementia. The aim of this study is to characterize the changes that MCI causes in the patterns of brain information flow. For this purpose, spontaneous EEG activity from 41 MCI patients and 37 healthy controls was analyzed by means of an effective connectivity measure: the phase slope index (PSl). Our results showed statistically significant decreases in PSI values mainly at delta and alpha frequency bands for MCI patients, compared to the control group. These abnormal patterns may be due to the structural changes in the brain suffered by patients: decreased hippocampal volume, atrophy of the medial temporal lobe, or loss of gray matter volume. This study suggests the usefulness of PSI to provide further insights into the underlying brain dynamics associated with MCI.

The Role of Magnetoencephalography in the Early Stages of Alzheimer's Disease

The ever increasing proportion of aged people in modern societies is leading to a substantial increase in the number of people affected by dementia, and Alzheimer’s Disease (AD) in particular, which is the most common cause for dementia. Throughout the course of the last decades several different compounds have been tested to stop or slow disease progression with limited success, which is giving rise to a strong interest toward the early stages of the disease. Alzheimer’s disease has an extended an insidious preclinical stage in which brain pathology accumulates slowly until clinical symptoms are observable in prodromal stages and in dementia. For this reason, the scientific community is focusing into investigating early signs of AD which could lead to the development of validated biomarkers. While some CSF and PET biomarkers have already been introduced in the clinical practice, the use of non-invasive measures of brain function as early biomarkers is still under investigation. However, the electrophysiological mechanisms and the early functional alterations underlying preclinical Alzheimer’s Disease is still scarcely studied. This work aims to briefly review the most relevant findings in the field of electrophysiological brain changes as measured by magnetoencephalography (MEG). MEG has proven its utility in some clinical areas. However, although its clinical relevance in dementia is still limited, a growing number of studies highlighted its sensitivity in these preclinical stages. Studies focusing on different analytical approaches will be reviewed. Furthermore, their potential applications to establish early diagnosis and determine subsequent progression to dementia are discussed.

How to Build a Functional Connectomic Biomarker for Mild Cognitive Impairment From Source Reconstructed MEG Resting-State Activity: The Combination of ROI Representation and Connectivity Estimator Matters

Our work aimed to demonstrate the combination of machine learning and graph theory for the designing of a connectomic biomarker for mild cognitive impairment (MCI) subjects using eyes-closed neuromagnetic recordings. The whole analysis based on source-reconstructed neuromagnetic activity. As ROI representation, we employed the principal component analysis (PCA) and centroid approaches. As representative bi-variate connectivity estimators for the estimation of intra and cross-frequency interactions, we adopted the phase locking value (PLV), the imaginary part (iPLV) and the correlation of the envelope (CorrEnv). Both intra and cross-frequency interactions (CFC) have been estimated with the three connectivity estimators within the seven frequency bands (intra-frequency) and in pairs (CFC), correspondingly. We demonstrated how different versions of functional connectivity graphs single-layer (SL-FCG) and multi-layer (ML-FCG) can give us a different view of the functional interactions across the brain areas. Finally, we applied machine learning techniques with main scope to build a reliable connectomic biomarker by analyzing both SL-FCG and ML-FCG in two different options: as a whole unit using a tensorial extraction algorithm and as single pair-wise coupling estimations. We concluded that edge-weighed feature selection strategy outperformed the tensorial treatment of SL-FCG and ML-FCG. The highest classification performance was obtained with the centroid ROI representation and edge-weighted analysis of the SL-FCG reaching the 98% for the CorrEnv in α1:α2 and 94% for the iPLV in α2. Classification performance based on the multi-layer participation coefficient, a multiplexity index reached 52% for iPLV and 52% for CorrEnv. Selected functional connections that build the multivariate connectomic biomarker in the edge-weighted scenario are located in default-mode, fronto-parietal, and cingulo-opercular network. Our analysis supports the notion of analyzing FCG simultaneously in intra and cross-frequency whole brain interactions with various connectivity estimators in beamformed recordings.

Alterations of Effective Connectivity Patterns in Mild Cognitive Impairment: An MEG Study

Neuroimaging techniques have demonstrated over the years their ability to characterize the brain abnormalities associated with different neurodegenerative diseases. Among all these techniques, magnetoencephalography (MEG) stands out by its high temporal resolution and noninvasiveness. The aim of the present study is to explore the coupling patterns of resting-state MEG activity in subjects with mild cognitive impairment (MCI). To achieve this goal, five minutes of spontaneous MEG activity were acquired with a 148-channel whole-head magnetometer from 18 MCI patients and 26 healthy controls. Inter-channel relationships were investigated by means of two complementary coupling measures: coherence and Granger causality. Coherence is a classical method of functional connectivity, while Granger causality quantifies effective (or causal) connectivity. Both measures were calculated in the five conventional frequency bands: delta (δ, 1-4 Hz), theta (θ, 4-8 Hz), alpha (α, 8-13 Hz), beta (β, 13-30 Hz), and gamma (γ, 30-45 Hz). Our results showed that connectivity values were lower for MCI patients than for controls in all frequency bands. However, only Granger causality revealed statistically significant differences between groups (p-values < 0.05, FDR corrected Mann-Whitney U-test), mainly in the beta band. Our results support the role of MCI as a disconnection syndrome, which elicits early alterations in effective connectivity patterns. These findings can be helpful to identify the neural substrates involved in prodromal stages of dementia.

MEG Beamformer-Based Reconstructions of Functional Networks in Mild Cognitive Impairment

Subjects with mild cognitive impairment (MCI) have an increased risk of developing Alzheimer’s disease (AD), and their functional brain networks are presumably already altered. To test this hypothesis, we compared magnetoencephalography (MEG) eyes-closed resting-state recordings from 29 MCI subjects and 29 healthy elderly subjects in the present exploratory study. Functional connectivity in different frequency bands was assessed with the phase lag index (PLI) in source space. Normalized weighted clustering coefficient (normalized Cw) and path length (normalized Lw), as well as network measures derived from the minimum spanning tree [MST; i.e., betweenness centrality (BC) and node degree], were calculated. First, we found altered PLI values in the lower and upper alpha bands in MCI patients compared to controls. Thereafter, we explored network differences in these frequency bands. Normalized Cw and Lw did not differ between the groups, whereas BC and node degree of the MST differed, although these differences did not survive correction for multiple testing using the False Discovery Rate (FDR). As an exploratory study, we may conclude that: (1) the increases and decreases observed in PLI values in lower and upper alpha bands in MCI patients may be interpreted as a dual pattern of disconnection and aberrant functioning; (2) network measures are in line with connectivity findings, indicating a lower efficiency of the brain networks in MCI patients; (3) the MST centrality measures are more sensitive to detect subtle differences in the functional brain networks in MCI than traditional graph theoretical metrics.

Attention and Working Memory-Related EEG Markers of Subtle Cognitive Deterioration in Healthy Elderly Individuals

Future treatments of Alzheimer's disease need the identification of cases at high risk at the preclinical stage of the disease before the development of irreversible structural damage. We investigated here whether subtle cognitive deterioration in a population of healthy elderly individuals could be predicted by EEG signals at baseline under cognitive activation. Continuous EEG was recorded in 97 elderly control subjects and 45 age-matched mild cognitive impairment (MCI) cases during a simple attentional and a 2-back working memory task. Upon 18-month neuropsychological follow-up, the final sample included 55 stable (sCON) and 42 deteriorated (dCON) controls. We examined the P1, N1, P3, and PNwm event-related components as well as the oscillatory activities in the theta (4-7 Hz), alpha (8-13 Hz), and beta (14-25 Hz) frequency ranges (ERD/ERS: event-related desynchronization/synchronization, and ITC: inter-trial coherence). Behavioral performance, P1, and N1 components were comparable in all groups. The P3, PNwm, and all oscillatory activity indices were altered in MCI cases compared to controls. Only three EEG indices distinguished the two control groups: alpha and beta ERD (dCON >  sCON) and beta ITC (dCON <  sCON). These findings show that subtle cognitive deterioration has no impact on EEG indices associated with perception, discrimination, and working memory processes but mostly affects attention, resulting in an enhanced recruitment of attentional resources. In addition, cognitive decline alters neural firing synchronization at high frequencies (14-25 Hz) at early stages, and possibly affects lower frequencies (4-13 Hz) only at more severe stages.

Beta-Band Functional Connectivity is Reorganized in Mild Cognitive Impairment after Combined Computerized Physical and Cognitive Training

Physical and cognitive idleness constitute significant risk factors for the clinical manifestation of age-related neurodegenerative diseases. In contrast, a physically and cognitively active lifestyle may restructure age-declined neuronal networks enhancing neuroplasticity. The present study, investigated the changes of brain's functional network in a group of elderly individuals at risk for dementia that were induced by a combined cognitive and physical intervention scheme. Fifty seniors meeting Petersen's criteria of Mild Cognitive Impairment were equally divided into an experimental (LLM), and an active control (AC) group. Resting state electroencephalogram (EEG) was measured before and after the intervention. Functional networks were estimated by computing the magnitude square coherence between the time series of all available cortical sources as computed by standardized low resolution brain electromagnetic tomography (sLORETA). A statistical model was used to form groups' characteristic weighted graphs. The introduced modulation was assessed by networks' density and nodes' strength. Results focused on the beta band (12-30 Hz) in which the difference of the two networks' density is maximum, indicating that the structure of the LLM cortical network changes significantly due to the intervention, in contrast to the network of AC. The node strength of LLM participants in the beta band presents a higher number of bilateral connections in the occipital, parietal, temporal and prefrontal regions after the intervention. Our results show that the combined training scheme reorganizes the beta-band functional connectivity of MCI patients. ClinicalTrials.gov Identifier: NCT02313935 https://clinicaltrials.gov/ct2/show/NCT02313935.

Complex network analysis of resting state EEG in amnestic mild cognitive impairment patients with type 2 diabetes

Purpose: Diabetes is a great risk factor for dementia and mild cognitive impairment (MCI). This study investigates whether complex network-derived features in resting state EEG (rsEEG) could be applied as a biomarker to distinguish amnestic mild cognitive impairment (aMCI) from normal cognitive function in subjects with type 2 diabetes (T2D).

Method: In this study, EEG was recorded in 28 patients with T2D (16 aMCI patients and 12 controls) during a no-task eyes-closed resting state. Pair-wise synchronization of rsEEG signals were assessed in six frequency bands (delta, theta, lower alpha, upper alpha, beta, and gamma) using phase lag index (PLI) and grouped into long distance (intra- and inter-hemispheric) and short distance interactions. PLI-weighted connectivity networks were also constructed, and characterized by mean clustering coefficient and path length. The correlation of these features and Montreal Cognitive Assessment (MoCA) scores was assessed.

Results: Main findings of this study were as follows: (1) In comparison with controls, patients with aMCI had a significant decrease of global mean PLI in lower alpha, upper alpha, and beta bands. Lower functional connection at short and long intra-hemispheric distance mainly appeared on the left hemisphere. (2) In the lower alpha band, clustering coefficient was significantly lower in aMCI group, and the path length significantly increased. (3) Cognitive status measured by MoCA had a significant positive correlation with cluster coefficient and negative correlation with path length in lower alpha band.

Conclusions: The brain network of aMCI patients displayed a disconnection syndrome and a loss of small-world architecture. The correlation between cognitive states and network characteristics suggested that the more in deterioration of the diabetes patients' cognitive state, the less optimal the network organization become. Hence, the complex network-derived biomarkers based on EEG could be employed to track cognitive function of diabetic patients and provide a new diagnosis tool for aMCI.

Resting state fMRI feature-based cerebral glioma grading by support vector machine

PURPOSE : Tumor grading plays an essential role in the optimal selection of solid tumor treatment. Noninvasive methods are needed for clinical grading of tumors. This study aimed to extract parameters of resting state blood oxygenation level-dependent functional magnetic resonance imaging (RS-fMRI) in the region of glioma and use the extracted features for tumor grading. METHODS : Tumor segmentation was performed with both conventional MRI and RS-fMRI. Four typical parameters, signal intensity difference ratio, signal intensity correlation (SIC), fractional amplitude of low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), were defined to analyze tumor regions. Mann-Whitney [Formula: see text] test was employed to identify statistical difference of these four parameters between low-grade glioma (LGG) and high-grade glioma (HGG), respectively. Support vector machine (SVM) was employed to assess the diagnostic contributions of these parameters. RESULTS : Compared with LGG, HGG had more complex anatomical morphology and BOLD-fMRI features in the tumor region. SIC [Formula: see text], fALFF ([Formula: see text]) and ReHo ([Formula: see text]) were selected as features for classification according to the test [Formula: see text] value. The accuracy, sensitivity and specificity of SVM classification were better than 80, where SIC had the best classification accuracy (89). CONCLUSION : Parameters of RS-fMRI are effective to classify the tumor grade in glioma cases. The results indicate that this technique has clinical potential to serve as a complementary diagnostic tool.

Synchronization during an internally directed cognitive state in healthy aging and mild cognitive impairment: a MEG study

Mild cognitive impairment (MCI) is a stage between healthy aging and dementia. It is known that in this condition the connectivity patterns are altered in the resting state and during cognitive tasks, where an extra effort seems to be necessary to overcome cognitive decline. We aimed to determine the functional connectivity pattern required to deal with an internally directed cognitive state (IDICS) in healthy aging and MCI. This task differs from the most commonly employed ones in neurophysiology, since inhibition from external stimuli is needed, allowing the study of this control mechanism. To this end, magnetoencephalographic (MEG) signals were acquired from 32 healthy individuals and 38 MCI patients, both in resting state and while performing a subtraction task of two levels of difficulty. Functional connectivity was assessed with phase locking value (PLV) in five frequency bands. Compared to controls, MCIs showed higher PLV values in delta, theta, and gamma bands and an opposite pattern in alpha, beta, and gamma bands in resting state. These changes were associated with poorer neuropsychological performance. During the task, this group exhibited a hypersynchronization in delta, theta, beta, and gamma bands, which was also related to a lower cognitive performance, suggesting an abnormal functioning in this group. Contrary to controls, MCIs presented a lack of synchronization in the alpha band which may denote an inhibition deficit. Additionally, the magnitude of connectivity changes rose with the task difficulty in controls but not in MCIs, in line with the compensation-related utilization of neural circuits hypothesis (CRUNCH) model.

Recognizing mild cognitive impairment based on network connectivity analysis of resting EEG with zero reference

The diagnosis of mild cognitive impairment (MCI) is very helpful for early therapeutic interventions of Alzheimer's disease (AD). MCI has been proven to be correlated with disorders in multiple brain areas. In this paper, we used information from resting brain networks at different EEG frequency bands to reliably recognize MCI. Because EEG network analysis is influenced by the reference that is used, we also evaluate the effect of the reference choices on the resting scalp EEG network-based MCI differentiation. The conducted study reveals two aspects: (1) the network-based MCI differentiation is superior to the previously reported classification that uses coherence in the EEG; and (2) the used EEG reference influences the differentiation performance, and the zero approximation technique (reference electrode standardization technique, REST) can construct a more accurate scalp EEG network, which results in a higher differentiation accuracy for MCI. This study indicates that the resting scalp EEG-based network analysis could be valuable for MCI recognition in the future.

Analysis of neural dynamics in mild cognitive impairment and Alzheimer's disease using wavelet turbulence

OBJECTIVE

Current diagnostic guidelines encourage further research for the development of novel Alzheimer's disease (AD) biomarkers, especially in its prodromal form (i.e. mild cognitive impairment, MCI). Magnetoencephalography (MEG) can provide essential information about AD brain dynamics; however, only a few studies have addressed the characterization of MEG in incipient AD.

APPROACH

We analyzed MEG rhythms from 36 AD patients, 18 MCI subjects and 27 controls, introducing a new wavelet-based parameter to quantify their dynamical properties: the wavelet turbulence.

MAIN RESULTS

Our results suggest that AD progression elicits statistically significant regional-dependent patterns of abnormalities in the neural activity (p < 0.05), including a progressive loss of irregularity, variability, symmetry and Gaussianity. Furthermore, the highest accuracies to discriminate AD and MCI subjects from controls were 79.4% and 68.9%, whereas, in the three-class setting, the accuracy reached 67.9%.

SIGNIFICANCE

Our findings provide an original description of several dynamical properties of neural activity in early AD and offer preliminary evidence that the proposed methodology is a promising tool for assessing brain changes at different stages of dementia.

Relative power and coherence of EEG series are related to amnestic mild cognitive impairment in diabetes

OBJECTIVE

Diabetes is a risk factor for dementia and mild cognitive impairment. The aim of this study was to investigate whether some features of resting-state EEG (rsEEG) could be applied as a biomarker to distinguish the subjects with amnestic mild cognitive impairment (aMCI) from normal cognitive function in type 2 diabetes.

MATERIALS AND METHODS

In this study, 28 patients with type 2 diabetes (16 aMCI patients and 12 controls) were investigated. Recording of the rsEEG series and neuropsychological assessments were performed. The rsEEG signal was first decomposed into delta, theta, alpha, beta, gamma frequency bands. The relative power of each given band/sum of power and the coherence of waves from different brain areas were calculated. The extracted features from rsEEG and neuropsychological assessments were analyzed as well.

RESULTS

The main findings of this study were that: (1) compared with the control group, the ratios of power in theta band [P(theta)] vs. power in alpha band [P(alpha)] [P(theta)/P(alpha)] in the frontal region and left temporal region were significantly higher for aMCI, and (2) for aMCI, the alpha coherences in posterior, fronto-right temporal, fronto-posterior, right temporo-posterior were decreased; the theta coherences in left central-right central (LC-RC) and left posterior-right posterior (LP-RP) regions were also decreased; but the delta coherences in left temporal-right temporal (LT-RT) region were increased.

CONCLUSION

The proposed indexes from rsEEG recordings could be employed to track cognitive function of diabetic patients and also to help in the diagnosis of those who develop aMCI.

Relative power and coherence of EEG series are related to amnestic mild cognitive impairment in diabetes

Objective: Diabetes is a risk factor for dementia and mild cognitive impairment. The aim of this study was to investigate whether some features of resting-state EEG (rsEEG) could be applied as a biomarker to distinguish the subjects with amnestic mild cognitive impairment (aMCI) from normal cognitive function in type 2 diabetes.

Materials and Methods: In this study, 28 patients with type 2 diabetes (16 aMCI patients and 12 controls) were investigated. Recording of the rsEEG series and neuropsychological assessments were performed. The rsEEG signal was first decomposed into delta, theta, alpha, beta, gamma frequency bands. The relative power of each given band/sum of power and the coherence of waves from different brain areas were calculated. The extracted features from rsEEG and neuropsychological assessments were analyzed as well.

Results: The main findings of this study were that: (1) compared with the control group, the ratios of power in theta band [P(theta)] vs. power in alpha band [P(alpha)] [P(theta)/P(alpha)] in the frontal region and left temporal region were significantly higher for aMCI, and (2) for aMCI, the alpha coherences in posterior, fronto-right temporal, fronto-posterior, right temporo-posterior were decreased; the theta coherences in left central-right central (LC-RC) and left posterior-right posterior (LP-RP) regions were also decreased; but the delta coherences in left temporal-right temporal (LT-RT) region were increased.

Conclusion: The proposed indexes from rsEEG recordings could be employed to track cognitive function of diabetic patients and also to help in the diagnosis of those who develop aMCI.

Spectral changes in spontaneous MEG activity across the lifespan

OBJECTIVE

The aim of this study is to explore the spectral patterns of spontaneous magnetoencephalography (MEG) activity across the lifespan.

APPROACH

Relative power (RP) in six frequency bands (delta, theta, alpha, beta-1, beta-2 and gamma) was calculated in a sample of 220 healthy subjects with ages ranging from 7 to 84 years.

MAIN RESULTS

A significant RP decrease in low-frequency bands (i.e. delta and theta) and a significant increase in high bands (mainly beta-1 and beta-2) were found from childhood to adolescence. This trend was observed until the sixth decade of life, though only slight changes were found. Additionally, healthy aging was characterized by a power increase in low-frequency bands. Our results show that spectral changes across the lifespan may follow a quadratic relationship in delta, theta, alpha, beta-2 and gamma bands with peak ages being reached around the fifth or sixth decade of life.

SIGNIFICANCE

Our findings provide original insights into the definition of the 'normal' behavior of age-related MEG spectral patterns. Furthermore, our study can be useful for the forthcoming MEG research focused on the description of the abnormalities of different brain diseases in comparison to cognitive decline in normal aging.

Alcohol affects the brain's resting-state network in social drinkers

Acute alcohol intake is known to enhance inhibition through facilitation of GABA(A) receptors, which are present in 40% of the synapses all over the brain. Evidence suggests that enhanced GABAergic transmission leads to increased large-scale brain connectivity. Our hypothesis is that acute alcohol intake would increase the functional connectivity of the human brain resting-state network (RSN). To test our hypothesis, electroencephalographic (EEG) measurements were recorded from healthy social drinkers at rest, during eyes-open and eyes-closed sessions, after administering to them an alcoholic beverage or placebo respectively. Salivary alcohol and cortisol served to measure the inebriation and stress levels. By calculating Magnitude Square Coherence (MSC) on standardized Low Resolution Electromagnetic Tomography (sLORETA) solutions, we formed cortical networks over several frequency bands, which were then analyzed in the context of functional connectivity and graph theory. MSC was increased (p<0.05, corrected with False Discovery Rate, FDR corrected) in alpha, beta (eyes-open) and theta bands (eyes-closed) following acute alcohol intake. Graph parameters were accordingly altered in these bands quantifying the effect of alcohol on the structure of brain networks; global efficiency and density were higher and path length was lower during alcohol (vs. placebo, p<0.05). Salivary alcohol concentration was positively correlated with the density of the network in beta band. The degree of specific nodes was elevated following alcohol (vs. placebo). Our findings support the hypothesis that short-term inebriation considerably increases large-scale connectivity in the RSN. The increased baseline functional connectivity can -at least partially- be attributed to the alcohol-induced disruption of the delicate balance between inhibitory and excitatory neurotransmission in favor of inhibitory influences. Thus, it is suggested that short-term inebriation is associated, as expected, to increased GABA transmission and functional connectivity, while long-term alcohol consumption may be linked to exactly the opposite effect.

Modifications of default-mode network connectivity in patients with cerebral glioma

Purpose

The aim of the study was to evaluate connectivity modifications in the Default Mode Network (DMN) in patients with cerebral glioma, and to correlate these modifications to tumor characteristics.

Methods

Twenty-four patients with a left-hemisphere cerebral tumor (14 grade II and 10 grade IV gliomas) and 14 healthy age-matched right-hand volunteers were enrolled in the study. Subjects underwent fMRI while performing language tasks for presurgical mapping. Data was analyzed with independent component analysis in order to identify the DMN. DMN group maps were produced by random-effect analysis (p<0.001, FDR-corrected). An analysis of variance across the three groups (p<0.05) and post-hoc t-test contrasts between pairs of groups were calculated (p<0.05, FDR-corrected).

Results

All three groups showed typical DMN areas. However, reduced DMN connectivity was detected in tumor patients with respect to controls. A significantly increased and reduced integration of DMN areas was observed in the hippocampal and prefrontal regions, respectively. Modifications were closely related to tumor grading. Moreover, the DMN lateralized to the hemisphere contralateral to tumor in the low-grade, but not in the high-grade tumor patients.

Conclusion

Modifications of DMN connectivity were induced by gliomas and differed for high and low grade tumors.

Analysis of spontaneous MEG activity in mild cognitive impairment and Alzheimer's disease using spectral entropies and statistical complexity measures

Alzheimer's disease (AD) is the most common cause of dementia. Over the last few years, a considerable effort has been devoted to exploring new biomarkers. Nevertheless, a better understanding of brain dynamics is still required to optimize therapeutic strategies. In this regard, the characterization of mild cognitive impairment (MCI) is crucial, due to the high conversion rate from MCI to AD. However, only a few studies have focused on the analysis of magnetoencephalographic (MEG) rhythms to characterize AD and MCI. In this study, we assess the ability of several parameters derived from information theory to describe spontaneous MEG activity from 36 AD patients, 18 MCI subjects and 26 controls. Three entropies (Shannon, Tsallis and Rényi entropies), one disequilibrium measure (based on Euclidean distance ED) and three statistical complexities (based on Lopez Ruiz-Mancini-Calbet complexity LMC) were used to estimate the irregularity and statistical complexity of MEG activity. Statistically significant differences between AD patients and controls were obtained with all parameters (p < 0.01). In addition, statistically significant differences between MCI subjects and controls were achieved by ED and LMC (p < 0.05). In order to assess the diagnostic ability of the parameters, a linear discriminant analysis with a leave-one-out cross-validation procedure was applied. The accuracies reached 83.9% and 65.9% to discriminate AD and MCI subjects from controls, respectively. Our findings suggest that MCI subjects exhibit an intermediate pattern of abnormalities between normal aging and AD. Furthermore, the proposed parameters provide a new description of brain dynamics in AD and MCI.

Analysis of spontaneous MEG activity in mild cognitive impairment using spectral entropies and disequilibrium measures

The aim of this study was to explore the ability of several spectral entropies and disequilibrium measures to discriminate between spontaneous magnetoencephalographic (MEG) oscillations from 18 mild cognitive impairment (MCI) patients and 24 controls. The Shannon spectral entropy (SSE), Tsallis spectral entropy (TSE), and Rényi spectral entropy (RSE) were calculated from the normalized power spectral density to evaluate the irregularity patterns. In addition, the Euclidean (ED) and Wootters (WD) distances were computed as disequilibrium measures. Results revealed statistically significant lower SSE and TSE(2) values for MCI patients than for controls (p < 0.05) in the right lateral region of the brain. ED also obtained statistically significant lower values for MCI patients than for controls using the (p < 0.05) in the right lateral region of the brain. These findings suggest that MCI is associated with a significant decrease in irregularity of MEG activity. In addition, the highest accuracy of 64.3% was achieved by the SSE. We conclude that measures from information theory can be useful to both characterize abnormal brain dynamics and help in MCI detection.

MEG connectivity analysis in patients with Alzheimer's disease using cross mutual information and spectral coherence

Alzheimer's disease (AD) is an irreversible brain disorder which represents the most common form of dementia in western countries. An early and accurate diagnosis of AD would enable to develop new strategies for managing the disease; however, nowadays there is no single test that can accurately predict the development of AD. In this sense, only a few studies have focused on the magnetoencephalographic (MEG) AD connectivity patterns. This study compares brain connectivity in terms of linear and nonlinear couplings by means of spectral coherence and cross mutual information function (CMIF), respectively. The variables defined from these functions provide statistically significant differences (p < 0.05) between AD patients and control subjects, especially the variables obtained from CMIF. The results suggest that AD is characterized by both decreases and increases of functional couplings in different frequency bands as well as by an increase in regularity, that is, more evident statistical deterministic relationships in AD patients' MEG connectivity. The significant differences obtained indicate that AD could disturb brain interactions causing abnormal brain connectivity and operation. Furthermore, the combination of coherence and CMIF features to perform a diagnostic test based on logistic regression improved the tests based on individual variables for its robustness.

Magnetoencephalography in neuropsychiatry: ready for application?

PURPOSE OF REVIEW

Magnetoencephalography (MEG) has been available for over 30 years, but the past 10 years have seen serious investigation of its use as a clinical tool. It is therefore an opportune time to review how MEG is able to contribute to neuropsychiatric research and practice.

RECENT FINDINGS

We limit this review to the areas of dementia, schizophrenia, depression and autism. MEG can achieve correct classification of individuals with mild cognitive impairment versus Alzheimer's disease, may identify a marker of early disease in schizophrenia, can distinguish bipolar from major depressive disorder, and has been used to study cognitive and other deficits in autism. It provides a valuable tool to study cognitive dysfunction.

SUMMARY

The most important aspect of MEG is the ability to record neural activity with millisecond precision, allowing coherence analysis of neural data to examine how brain areas are synchronized. Such synchrony is thought to underlie cognitive processes. As cognitive dysfunction is a common marker of neuropsychiatric disorders, MEG is emerging as an important investigatory tool in neuropsychiatry. It may also be useful clinically for early or differential diagnosis of some neuropsychiatric disorders, or for the prediction of drug effects, but more research is necessary before this becomes a clinical reality.

Relating structural and functional anomalous connectivity in the aging brain via neural mass modeling

The structural changes that arise as the brain ages influence its functionality. In many cases, the anatomical degradation simply leads to normal aging. In others, the neurodegeneration is large enough to cause neurological disorders (e.g. Alzheimer's disease). Structure and function can be both currently measured using noninvasive techniques, such as magnetic resonance imaging (MRI) and electroencephalography (EEG) respectively. However, a full theoretical scheme linking structural and functional degradation is still lacking. Here we present a neural mass model that aims to bridge both levels of description and that reproduces experimentally observed multichannel EEG recordings of alpha rhythm in young subjects, healthy elderly subjects, and patients with mild cognitive impairment. We focus our attention in the dominant frequency of the signals at different electrodes and in the correlation between specific electrode pairs, measured via the phase-lag index. Our model allows us to study the influence of different structural connectivity pathways, independently of each other, on the normal and aberrantly aging brain. In particular, we study in detail the effect of the thalamic input on specific cortical regions, the long-range connectivity between cortical regions, and the short-range coupling within the same cortical area. Once the influence of each type of connectivity is determined, we characterize the regions of parameter space compatible with the EEG recordings of the populations under study. Our results show that the different types of connectivity must be fine-tuned to maintain the brain in a healthy functioning state independently of its age and brain condition.