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Lin L, Cheng Y, Huang P, Zhang J, Zheng J, Pan X. Synchronous monitoring of brain-heart electrophysiology using heart rate variability coupled with rapid quantitative electroencephalography in orthostatic hypotension patients with α-synucleinopathies: Rapid prediction of orthostatic hypotension and preliminary exploration of brain stimulation therapy. CNS Neurosci Ther 2024; 30:e14571. [PMID: 38421092 PMCID: PMC10850923 DOI: 10.1111/cns.14571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND In α-synucleinopathies, the dysfunction of the autonomic nervous system which typically manifests as orthostatic hypotension (OH) often leads to severe consequences and poses therapeutic challenges. This study aims to discover the brain-cardiac electrophysiological changes in OH patients with α-synucleinopathies using the rapid quantitative electroencephalography (qEEG) coupled with heart rate variability (HRV) technique to identify rapid, noninvasive biomarkers for early warning and diagnosis, as well as shed new light on complementary treatment approaches such as brain stimulation targets. METHODS In this study, 26 subjects of α-synucleinopathies with OH (α-OH group), 21 subjects of α-synucleinopathies without OH (α-NOH group), and 34 healthy controls (control group) were included from September 2021 to August 2023 (NCT05527067). The heart rate-blood pressure variations in supine and standing positions were monitored, and synchronization parameters of seated resting-state HRV coupled with qEEG were collected. Time-domain and frequency-domain of HRV measures as well as peak frequency and power of the brainwaves were extracted. Differences between these three groups were compared, and correlations between brain-heart parameters were analyzed. RESULTS The research results showed that the time-domain parameters such as MxDMn, pNN50, RMSSD, and SDSD of seated resting-state HRV exhibited a significant decrease only in the α-OH group compared to the healthy control group (p < 0.05), while there was no significant difference between the α-NOH group and the healthy control group. Several time-domain and frequency-domain parameters of seated resting-state HRV were found to be correlated with the blood pressure changes within the first 5 min of transitioning from supine to standing position (p < 0.05). Differences were observed in the power of beta1 waves (F4 and Fp2) and beta2 waves (Fp2 and F4) in the seated resting-state qEEG between the α-OH and α-NOH groups (p < 0.05). The peak frequency of theta waves in the Cz region also showed a difference (p < 0.05). The power of beta2 waves in the Fp2 and F4 brain regions correlated with frequency-domain parameters of HRV (p < 0.05). Additionally, abnormal electrical activity in the alpha, theta, and beta1 waves was associated with changes in heart rate and blood pressure within the first 5 min of transitioning from supine to standing position (p < 0.05). CONCLUSION Rapid resting-state HRV with certain time-domain parameters below normal levels may serve as a predictive indicator for the occurrence of orthostatic hypotension (OH) in patients with α-synucleinopathies. Additionally, the deterioration of HRV parameters correlates with synchronous abnormal qEEG patterns, which can provide insights into the brain stimulation target areas for OH in α-synucleinopathy patients.
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Affiliation(s)
- Lin Lin
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Yingzhe Cheng
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Peilin Huang
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Jiejun Zhang
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
- Center for GeriatricsHainan General HospitalHaikou CityHainan ProvinceChina
| | - Jiahao Zheng
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
| | - Xiaodong Pan
- Department of Neurology, Center for Cognitive NeurologyFujian Medical University Union HospitalFuzhou CityChina
- Fujian Institute of GeriatricsFujian Medical University Union HospitalFuzhou CityChina
- Institute of Clinical NeurologyFujian Medical UniversityFuzhou CityChina
- Fujian Key Laboratory of Molecular NeurologyFujian Medical UniversityFuzhou CityChina
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Anjum MF, Espinoza AI, Cole RC, Singh A, May P, Uc EY, Dasgupta S, Narayanan NS. Resting-state EEG measures cognitive impairment in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:6. [PMID: 38172519 PMCID: PMC10764756 DOI: 10.1038/s41531-023-00602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/14/2023] [Indexed: 01/05/2024] Open
Abstract
Cognitive dysfunction is common in Parkinson's disease (PD). We developed and evaluated an EEG-based biomarker to index cognitive functions in PD from a few minutes of resting-state EEG. We hypothesized that synchronous changes in EEG across the power spectrum can measure cognition. We optimized a data-driven algorithm to efficiently capture these changes and index cognitive function in 100 PD and 49 control participants. We compared our EEG-based cognitive index with the Montreal cognitive assessment (MoCA) and cognitive tests across different domains from National Institutes of Health (NIH) Toolbox using cross-validations, regression models, and randomization tests. Finally, we externally validated our approach on 32 PD participants. We observed cognition-related changes in EEG over multiple spectral rhythms. Utilizing only 8 best-performing electrodes, our proposed index strongly correlated with cognition (MoCA: rho = 0.68, p value < 0.001; NIH-Toolbox cognitive tests: rho ≥ 0.56, p value < 0.001) outperforming traditional spectral markers (rho = -0.30-0.37). The index showed a strong fit in regression models (R2 = 0.46) with MoCA, yielded 80% accuracy in detecting cognitive impairment, and was effective in both PD and control participants. Notably, our approach was equally effective (rho = 0.68, p value < 0.001; MoCA) in out-of-sample testing. In summary, we introduced a computationally efficient data-driven approach for cross-domain cognition indexing using fewer than 10 EEG electrodes, potentially compatible with dynamic therapies like closed-loop neurostimulation. These results will inform next-generation neurophysiological biomarkers for monitoring cognition in PD and other neurological diseases.
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Affiliation(s)
- Md Fahim Anjum
- Department of Neurology, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Arturo I Espinoza
- Department of Neurology, The University of Iowa, Iowa city, IA, 52240, USA
| | - Rachel C Cole
- Department of Neurology, The University of Iowa, Iowa city, IA, 52240, USA
| | - Arun Singh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South Dakota, South Dakota, SD, 57069, USA
| | - Patrick May
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa city, IA, 52240, USA
| | - Ergun Y Uc
- Department of Neurology, The University of Iowa, Iowa city, IA, 52240, USA
- Neurology Service, Iowa City VA Medical Center, Iowa city, IA, 52240, USA
| | - Soura Dasgupta
- Department of Electrical and Computer Engineering, The University of Iowa, Iowa city, IA, 52240, USA
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Anjum MF, Espinoza A, Cole R, Singh A, May P, Uc E, Dasgupta S, Narayanan N. Resting-state EEG measures cognitive impairment in Parkinson's disease. RESEARCH SQUARE 2023:rs.3.rs-2666578. [PMID: 36993450 PMCID: PMC10055637 DOI: 10.21203/rs.3.rs-2666578/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background Cognitive dysfunction is common in Parkinson's disease (PD) and is diagnosed by complex, time-consuming psychometric tests which are affected by language and education, subject to learning effects, and not suitable for continuous monitoring of cognition. Objectives We developed and evaluated an EEG-based biomarker to index cognitive functions in PD from a few minutes of resting-state EEG. Methods We hypothesized that synchronous changes in EEG across the power spectrum can measure cognition. We optimized a data-driven algorithm to efficiently capture these changes and index cognitive function in 100 PD and 49 control participants. We compared our EEG-based cognitive index with the Montreal cognitive assessment (MoCA) and cognitive tests across different domains from the National Institutes of Health (NIH) Toolbox using cross-validation schemes, regression models, and randomization tests. Results We observed cognition-related changes in EEG activities over multiple spectral rhythms. Utilizing only 8 best-performing EEG electrodes, our proposed index strongly correlated with cognition (rho = 0.68, p value < 0.001 with MoCA; rho ≥ 0.56, p value < 0.001 with cognitive tests from the NIH Toolbox) outperforming traditional spectral markers (rho = -0.30 - 0.37). The index showed a strong fit in regression models (R2 = 0.46) with MoCA, yielded 80% accuracy in detecting cognitive impairment, and was effective in both PD and control participants. Conclusions Our approach is computationally efficient for real-time indexing of cognition across domains, implementable even in hardware with limited computing capabilities, making it potentially compatible with dynamic therapies such as closed-loop neurostimulation, and will inform next-generation neurophysiological biomarkers for monitoring cognition in PD and other neurological diseases.
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The Increase of Theta Power and Decrease of Alpha/Theta Ratio as a Manifestation of Cognitive Impairment in Parkinson's Disease. J Clin Med 2023; 12:jcm12041569. [PMID: 36836103 PMCID: PMC9965386 DOI: 10.3390/jcm12041569] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/06/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
In this study, we aim to assess and examine cognitive functions in Parkinson's Disease patients using EEG recordings, with a central focus on characteristics associated with a cognitive decline. Based on neuropsychological evaluation using Mini-Mental State Examination, Montreal Cognitive Assessment, and Addenbrooke's Cognitive Examination-III, 98 participants were divided into three cognitive groups. All the particpants of the study underwent EEG recordings with spectral analysis. The results revealed an increase in the absolute theta power in patients with Parkinson's disease dementia (PD-D) compared to cognitively normal status (PD-CogN, p=0.00997) and a decrease in global relative beta power in PD-D compared to PD-CogN (p=0.0413). An increase in theta relative power in the left temporal region (p=0.0262), left occipital region (p=0.0109), and right occipital region (p=0.0221) were observed in PD-D compared to PD-N. The global alpha/theta ratio and global power spectral ratio significantly decreased in PD-D compared to PD-N (p = 0.001). In conclusion, the increase in relative theta power and the decrease in relative beta power are characteristic changes in EEG recordings in PD patients with cognitive impairment. Identifying these changes can be a useful biomarker and a complementary tool in the neuropsychological diagnosis of cognitive impairment in Parkinson's Disease.
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Liu H, Huang Z, Deng B, Chang Z, Yang X, Guo X, Yuan F, Yang Q, Wang L, Zou H, Li M, Zhu Z, Jin K, Wang Q. QEEG Signatures are Associated with Nonmotor Dysfunctions in Parkinson's Disease and Atypical Parkinsonism: An Integrative Analysis. Aging Dis 2023; 14:204-218. [PMID: 36818554 PMCID: PMC9937709 DOI: 10.14336/ad.2022.0514] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Parkinson's disease (PD) and atypical parkinsonism (AP), including progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), share similar nonmotor symptoms. Quantitative electroencephalography (QEEG) can be used to examine the nonmotor symptoms. This study aimed to characterize the patterns of QEEG and functional connectivity (FC) that differentiate PD from PSP or MSA, and explore the correlation between the differential QEEG indices and nonmotor dysfunctions in PD and AP. We enrolled 52 patients with PD, 31 with MSA, 22 with PSP, and 50 age-matched health controls to compare QEEG indices among specific brain regions. One-way analysis of variance was applied to assess QEEG indices between groups; Spearman's correlations were used to examine the relationship between QEEG indices and nonmotor symptoms scale (NMSS) and mini-mental state examination (MMSE). FCs using weighted phase lag index were compared between patients with PD and those with MSA/PSP. Patients with PSP revealed higher scores on the NMSS and lower MMSE scores than those with PD and MSA, with similar disease duration. The delta and theta powers revealed a significant increase in PSP, followed by PD and MSA. Patients with PD presented a significantly lower slow-to-fast ratio than those with PSP in the frontal region, while patients with PD presented significantly higher EEG-slowing indices than patients with MSA. The frontal slow-to-fast ratio showed a negative correlation with MMSE scores in patients with PD and PSP, and a positive correlation with NMSS in the perception and mood domain in patients with PSP but not in those with PD. Compared to PD, MSA presented enhanced FC in theta and delta bands in the posterior region, while PSP revealed decreased FC in the delta band within the frontal-temporal cortex. These findings suggest that QEEG might be a useful tool for evaluating the nonmotor dysfunctions in PD and AP. Our QEEG results suggested that with similar disease duration, the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by those with PD, and lastly in patients with MSA.
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Affiliation(s)
- Hailing Liu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Zifeng Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Zihan Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Xingfang Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Feilan Yuan
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Qin Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Liming Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Haiqiang Zou
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangdong, China.
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Zhaohua Zhu
- Clinical Research Centre, Orthopedic Centre, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Correspondence should be addressed to: Dr. Qing Wang, Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. .
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Brak IV, Filimonova E, Zakhariya O, Khasanov R, Stepanyan I. Transcranial Current Stimulation as a Tool of Neuromodulation of Cognitive Functions in Parkinson’s Disease. Front Neurosci 2022; 16:781488. [PMID: 35903808 PMCID: PMC9314857 DOI: 10.3389/fnins.2022.781488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
Decrease in cognitive function is one of the most common causes of poor life quality and early disability in patients with Parkinson’s disease (PD). Existing methods of treatment are aimed at both correction of motor and non-motor symptoms. Methods of adjuvant therapy (or complementary therapy) for maintaining cognitive functions in patients with PD are of interest. A promising subject of research in this regard is the method of transcranial electric current stimulation (tES). Here we reviewed the current understanding of the pathogenesis of cognitive impairment in PD and of the effects of transcranial direct current stimulation and transcranial alternating current stimulation on the cognitive function of patients with PD-MCI (Parkinson’s Disease–Mild Cognitive Impairment).
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Affiliation(s)
- Ivan V. Brak
- Laboratory of Comprehensive Problems of Risk Assessment to Population and Workers’ Health, Federal State Budgetary Scientific Institution “Izmerov Research Institute of Occupational Health”, Moscow, Russia
- “Engiwiki” Scientific and Engineering Projects Laboratory, Department of Information Technologies, Novosibirsk State University, Novosibirsk, Russia
- *Correspondence: Ivan V. Brak,
| | | | - Oleg Zakhariya
- Faculty of Philosophy, Lomonosov Moscow State University, Moscow, Russia
| | - Rustam Khasanov
- Faculty of Philosophy, Lomonosov Moscow State University, Moscow, Russia
- Independent Researcher, Novosibirsk, Russia
| | - Ivan Stepanyan
- Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia
- Mechanical Engineering Research Institute of the Russian Academy of Sciences, Moscow, Russia
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Wagner JR, Schaper M, Hamel W, Westphal M, Gerloff C, Engel AK, Moll CKE, Gulberti A, Pötter-Nerger M. Combined Subthalamic and Nigral Stimulation Modulates Temporal Gait Coordination and Cortical Gait-Network Activity in Parkinson’s Disease. Front Hum Neurosci 2022; 16:812954. [PMID: 35295883 PMCID: PMC8919031 DOI: 10.3389/fnhum.2022.812954] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/27/2022] [Indexed: 01/10/2023] Open
Abstract
Background Freezing of gait (FoG) is a disabling burden for Parkinson’s disease (PD) patients with poor response to conventional therapies. Combined deep brain stimulation of the subthalamic nucleus and substantia nigra (STN+SN DBS) moved into focus as a potential therapeutic option to treat the parkinsonian gait disorder and refractory FoG. The mechanisms of action of DBS within the cortical-subcortical-basal ganglia network on gait, particularly at the cortical level, remain unclear. Methods Twelve patients with idiopathic PD and chronically-implanted DBS electrodes were assessed on their regular dopaminergic medication in a standardized stepping in place paradigm. Patients executed the task with DBS switched off (STIM OFF), conventional STN DBS and combined STN+SN DBS and were compared to healthy matched controls. Simultaneous high-density EEG and kinematic measurements were recorded during resting-state, effective stepping, and freezing episodes. Results Clinically, STN+SN DBS was superior to conventional STN DBS in improving temporal stepping variability of the more affected leg. During resting-state and effective stepping, the cortical activity of PD patients in STIM OFF was characterized by excessive over-synchronization in the theta (4–8 Hz), alpha (9–13 Hz), and high-beta (21–30 Hz) band compared to healthy controls. Both active DBS settings similarly decreased resting-state alpha power and reduced pathologically enhanced high-beta activity during resting-state and effective stepping compared to STIM OFF. Freezing episodes during STN DBS and STN+SN DBS showed spectrally and spatially distinct cortical activity patterns when compared to effective stepping. During STN DBS, FoG was associated with an increase in cortical alpha and low-beta activity over central cortical areas, while with STN+SN DBS, an increase in high-beta was prominent over more frontal areas. Conclusions STN+SN DBS improved temporal aspects of parkinsonian gait impairment compared to conventional STN DBS and differentially affected cortical oscillatory patterns during regular locomotion and freezing suggesting a potential modulatory effect on dysfunctional cortical-subcortical communication in PD.
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Affiliation(s)
- Jonas R. Wagner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas K. Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K. E. Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Monika Pötter-Nerger
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Polverino P, Ajčević M, Catalan M, Mazzon G, Bertolotti C, Manganotti P. Brain oscillatory patterns in mild cognitive impairment due to Alzheimer’s and Parkinson’s disease: an exploratory high-density EEG study. Clin Neurophysiol 2022; 138:1-8. [DOI: 10.1016/j.clinph.2022.01.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/08/2021] [Accepted: 01/31/2022] [Indexed: 01/06/2023]
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Hassin-Baer S, Cohen OS, Israeli-Korn S, Yahalom G, Benizri S, Sand D, Issachar G, Geva AB, Shani-Hershkovich R, Peremen Z. Identification of an early-stage Parkinson's disease neuromarker using event-related potentials, brain network analytics and machine-learning. PLoS One 2022; 17:e0261947. [PMID: 34995285 PMCID: PMC8741046 DOI: 10.1371/journal.pone.0261947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of this study is to explore the possibility of developing a biomarker that can discriminate early-stage Parkinson's disease from healthy brain function using electroencephalography (EEG) event-related potentials (ERPs) in combination with Brain Network Analytics (BNA) technology and machine learning (ML) algorithms. BACKGROUND Currently, diagnosis of PD depends mainly on motor signs and symptoms. However, there is need for biomarkers that detect PD at an earlier stage to allow intervention and monitoring of potential disease-modifying therapies. Cognitive impairment may appear before motor symptoms, and it tends to worsen with disease progression. While ERPs obtained during cognitive tasks performance represent processing stages of cognitive brain functions, they have not yet been established as sensitive or specific markers for early-stage PD. METHODS Nineteen PD patients (disease duration of ≤2 years) and 30 healthy controls (HC) underwent EEG recording while performing visual Go/No-Go and auditory Oddball cognitive tasks. ERPs were analyzed by the BNA technology, and a ML algorithm identified a combination of features that distinguish early PD from HC. We used a logistic regression classifier with a 10-fold cross-validation. RESULTS The ML algorithm identified a neuromarker comprising 15 BNA features that discriminated early PD patients from HC. The area-under-the-curve of the receiver-operating characteristic curve was 0.79. Sensitivity and specificity were 0.74 and 0.73, respectively. The five most important features could be classified into three cognitive functions: early sensory processing (P50 amplitude, N100 latency), filtering of information (P200 amplitude and topographic similarity), and response-locked activity (P-200 topographic similarity preceding the motor response in the visual Go/No-Go task). CONCLUSIONS This pilot study found that BNA can identify patients with early PD using an advanced analysis of ERPs. These results need to be validated in a larger PD patient sample and assessed for people with premotor phase of PD.
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Affiliation(s)
- Sharon Hassin-Baer
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren S. Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Simon Israeli-Korn
- Movement Disorders Institute and Department of Neurology, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gilad Yahalom
- Department of Neurology and Movement Disorders Clinic, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sandra Benizri
- Movement Disorders Unit, Functional Neurosurgery Center, Assuta Ramat Ha Hayal Hospital, Tel Aviv, Israel
| | - Daniel Sand
- elminda Ltd., Herzliya, Israel
- Faculty of Medicine, Department of Medical Neurobiology, The Hebrew University of Jerusalem, Ein Kerem, Jerusalem, Israel
| | | | - Amir B. Geva
- elminda Ltd., Herzliya, Israel
- Department of Electrical and Computer Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hamburg S, Bush D, Strydom A, Startin CM. Comparison of resting-state EEG between adults with Down syndrome and typically developing controls. J Neurodev Disord 2021; 13:48. [PMID: 34649497 PMCID: PMC8518326 DOI: 10.1186/s11689-021-09392-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022] Open
Abstract
Background Down syndrome (DS) is the most common genetic cause of intellectual disability (ID) worldwide. Understanding electrophysiological characteristics associated with DS provides potential mechanistic insights into ID, helping inform biomarkers and targets for intervention. Currently, electrophysiological characteristics associated with DS remain unclear due to methodological differences between studies and inadequate controls for cognitive decline as a potential cofounder. Methods Eyes-closed resting-state EEG measures (specifically delta, theta, alpha, and beta absolute and relative powers, and alpha peak amplitude, frequency and frequency variance) in occipital and frontal regions were compared between adults with DS (with no diagnosis of dementia or evidence of cognitive decline) and typically developing (TD) matched controls (n = 25 per group). Results We report an overall ‘slower’ EEG spectrum, characterised by higher delta and theta power, and lower alpha and beta power, for both regions in people with DS. Alpha activity in particular showed strong group differences, including lower power, lower peak amplitude and greater peak frequency variance in people with DS. Conclusions Such EEG ‘slowing’ has previously been associated with cognitive decline in both DS and TD populations. These findings indicate the potential existence of a universal EEG signature of cognitive impairment, regardless of origin (neurodevelopmental or neurodegenerative), warranting further exploration. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-021-09392-z.
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Affiliation(s)
- Sarah Hamburg
- The London Down Syndrome Consortium (LonDownS), London, UK.
| | - Daniel Bush
- Institute of Cognitive Neuroscience, University College London, London, UK.,Queen Square Institute of Neurology, University College London, London, UK
| | - Andre Strydom
- The London Down Syndrome Consortium (LonDownS), London, UK.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Carla M Startin
- The London Down Syndrome Consortium (LonDownS), London, UK.,Department of Psychology, University of Roehampton, London, UK
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Maggioni E, Arienti F, Minella S, Mameli F, Borellini L, Nigro M, Cogiamanian F, Bianchi AM, Cerutti S, Barbieri S, Brambilla P, Ardolino G. Effective Connectivity During Rest and Music Listening: An EEG Study on Parkinson's Disease. Front Aging Neurosci 2021; 13:657221. [PMID: 33994997 PMCID: PMC8113619 DOI: 10.3389/fnagi.2021.657221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Music-based interventions seem to enhance motor, sensory and cognitive functions in Parkinson’s disease (PD), but the underlying action mechanisms are still largely unknown. This electroencephalography (EEG) study aimed to investigate the effective connectivity patterns characterizing PD in the resting state and during music listening. EEG recordings were obtained from fourteen non-demented PD patients and 12 healthy controls, at rest and while listening to three music tracks. Theta- and alpha-band power spectral density and multivariate partial directed coherence were computed. Power and connectivity measures were compared between patients and controls in the four conditions and in music vs. rest. Compared to controls, patients showed enhanced theta-band power and slightly enhanced alpha-band power, but markedly reduced theta- and alpha-band interactions among EEG channels, especially concerning the information received by the right central channel. EEG power differences were partially reduced by music listening, which induced power increases in controls but not in patients. Connectivity differences were slightly compensated by music, whose effects largely depended on the track. In PD, music enhanced the frontotemporal inter-hemispheric communication. Our findings suggest that PD is characterized by enhanced activity but reduced information flow within the EEG network, being only partially normalized by music. Nevertheless, music capability to facilitate inter-hemispheric communication might underlie its beneficial effects on PD pathophysiology and should be further investigated.
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Affiliation(s)
- Eleonora Maggioni
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Arienti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stella Minella
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Mameli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Linda Borellini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Nigro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Cogiamanian
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sergio Cerutti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Sergio Barbieri
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Gianluca Ardolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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12
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A Comprehensive Meta-analysis on Short-term and Working Memory Dysfunction in Parkinson's Disease. Neuropsychol Rev 2021; 31:288-311. [PMID: 33523408 DOI: 10.1007/s11065-021-09480-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/05/2021] [Indexed: 12/29/2022]
Abstract
A previous meta-analysis demonstrated short-term memory (STM) and working memory (WM) dysfunction in patients with Parkinson's disease (PD). However, considerable research on the topic that calls into question the extent of such impairments in PD has since been published. The aim of the present quantitative review was to provide the largest statistical overview on STM and WM dysfunction in Parkinson's disease (PD), while simultaneously providing novel insights on moderating factors of effect size heterogeneity in PD. The systematic literature search in PubMed, PsycINFO, PsycArticles, Scopus and Web of Science databases allowed us to estimate 350 effect sizes from 145 empirical studies that reported STM and WM scores for patients with PD against healthy controls. The outcomes indicated general dysfunction in the visuospatial domain and poor verbal WM in PD. Subgroup analyses suggested that mild cognitive impairment is associated with STM and WM difficulties in PD. Furthermore, meta-regression analyses revealed that disease duration accounted for more than 80% of the visuospatial STM effect size variance (β = 0.136, p < .001, R2 = .8272), larger daily levodopa equivalent dose was associated with WM dysfunction (verbal: β = -0.001, p = .016, R2 = .1812; visuospatial: β = 0.003, p = .069, R2 = .2340), and years of education partially explained the verbal STM effect size variance (β = -0.027, p = .040, R2 = .1171). Collectively, these findings advance our understanding of underlying factors that influence STM and WM functioning in PD, while at the same time providing novel directions for future research.
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Yılmaz NH, Çalışoğlu P, Güntekin B, Hanoğlu L. Correlation between alpha activity and neuropsychometric tests in Parkinson's disease. Neurosci Lett 2020; 738:135346. [PMID: 32911456 DOI: 10.1016/j.neulet.2020.135346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/16/2020] [Accepted: 08/27/2020] [Indexed: 12/22/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that leads to memory impairment and executive and visuospatial dysfunction as the disease progresses. Alpha activity on EEG has been related to cognition in previous studies. We aimed to investigate the correlation between alpha activity and neuropsychometric tests (NPTs) in PD patients. Fifty-five idiopathic PD patients and 20 healthy controls were included. The Standardized Mini-Mental Test (SMMT), Verbal Learning Memory Test (VLMT), Wechsler Memory Scale (WMS), Stroop Color-Word Test, Categorical Verbal Fluency Test (CVFT), Benton's Face Recognition Test (BFR), and Benton Line Judgment Orientation Test (BLOT) were administered to all participants. Patients were separated into four groups according to NPT results: healthy controls (HC); PD patients with normal cognition (PDNC); PD patients with MCI (PDMCI); and PD patients with dementia (PDD). Analysis of the EEG data showed that HC had the highest alpha activity, and PDD had the lowest. High SMMT scores were correlated with high alpha activity at posterior electrode locations in all PD groups. VLMT and WMS test scores were associated with alpha activity at the parietal sites in PDMCI. VLMT, WMS, and CVFT test scores were correlated with alpha activity at parietooccipital sites in PDD. Verbal and visuospatial memory dysfunction related to low alpha activity was evident in both PDMCI and PDD, whereas executive dysfunction was more strongly associated with low alpha activity in PDD. Analysis of alpha activity could help clinicians predict the progression of cognitive dysfunction in PD patients.
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Affiliation(s)
- Nesrin Helvacı Yılmaz
- Istanbul Medipol University, Faculty of Medicine, Department of Neurology, TEM Avrupa Otoyolu Göztepe ÇıkışıNo:1 Bağcılar, 34214, Istanbul, Turkey.
| | - Pervin Çalışoğlu
- Istanbul Medipol University, Graduate School of Health Science, Department of Neuroscience, Göztepe Mahallesi, Atatürk Caddesi No: 40/16 Kavacık, Beykoz, Istanbul, Turkey.
| | - Bahar Güntekin
- Istanbul Medipol University, International School of Medicine, Department of Biophysics, Program Director-Göztepe Mahallesi, Atatürk Caddesi No: 40/16 Kavacık, Beykoz, Istanbul, Turkey.
| | - Lütfü Hanoğlu
- Istanbul Medipol University, Faculty of Medicine, Department of Neurology, TEM Avrupa Otoyolu Göztepe ÇıkışıNo:1 Bağcılar, 34214, Istanbul, Turkey.
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14
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Lanza G, Aricò D, Lanuzza B, Cosentino FII, Tripodi M, Giardina F, Bella R, Puligheddu M, Pennisi G, Ferri R, Pennisi M. Facilitatory/inhibitory intracortical imbalance in REM sleep behavior disorder: early electrophysiological marker of neurodegeneration? Sleep 2020; 43:5584903. [PMID: 31599326 DOI: 10.1093/sleep/zsz242] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES Previous studies found an early impairment of the short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) to transcranial magnetic stimulation (TMS) in Parkinson's disease. However, very little is known on the TMS correlates of rapid eye movement (REM) sleep behavior disorder (RBD), which can precede the onset of a α-synucleinopathy. METHODS The following TMS measures were obtained from 14 de novo patients with isolated RBD and 14 age-matched healthy controls: resting motor threshold, cortical silent period, latency and amplitude of the motor evoked potentials, SICI, and ICF. A cognitive screening and a quantification of subjective sleepiness (Epworth Sleepiness Scale [ESS]) and depressive symptoms were also performed. RESULTS Neurological examination, global cognitive functioning, and mood status were normal in all participants. ESS score was higher in patients, although not suggestive of diurnal sleepiness. Compared to controls, patients exhibited a significant decrease of ICF (median 0.8, range 0.5-1.4 vs. 1.9, range 1.4-2.3; p < 0.01) and a clear trend, though not significant, towards a reduction of SICI (median 0.55, range 0.1-1.4 vs. 0.25, range 0.1-0.3), with a large effect size (Cohen's d: -0.848). REM Sleep Atonia Index significantly correlated with SICI. CONCLUSIONS In still asymptomatic patients for a parkinsonian syndrome or neurodegenerative disorder, changes of ICF and, to a lesser extent, SICI (which are largely mediated by glutamatergic and GABAergic transmission, respectively) might precede the onset of a future neurodegeneration. SICI was correlated with the muscle tone alteration, possibly supporting the proposed RBD model of retrograde influence on the cortex from the brainstem.
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Affiliation(s)
- Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Debora Aricò
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Bartolo Lanuzza
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | | | - Mariangela Tripodi
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Floriana Giardina
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Science and Advanced Technologies, University of Catania, Catania, Italy
| | - Monica Puligheddu
- Sleep Disorder Research Center, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Raffaele Ferri
- Sleep Research Center, Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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High cortical delta power correlates with aggravated allodynia by activating anterior cingulate cortex GABAergic neurons in neuropathic pain mice. Pain 2019; 161:288-299. [DOI: 10.1097/j.pain.0000000000001725] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Andrade AQ, Roughead EE. Consumer‐directed technologies to improve medication management and safety. Med J Aust 2019; 210 Suppl 6:S24-S27. [DOI: 10.5694/mja2.50029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Geraedts VJ, Boon LI, Marinus J, Gouw AA, van Hilten JJ, Stam CJ, Tannemaat MR, Contarino MF. Clinical correlates of quantitative EEG in Parkinson disease: A systematic review. Neurology 2018; 91:871-883. [PMID: 30291182 DOI: 10.1212/wnl.0000000000006473] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the relevance of quantitative EEG (qEEG) measures as outcomes of disease severity and progression in Parkinson disease (PD). METHODS Main databases were systematically searched (January 2018) for studies of sufficient methodologic quality that examined correlations between clinical symptoms of idiopathic PD and cortical (surface) qEEG metrics. RESULTS Thirty-six out of 605 identified studied were included. Results were classified into 4 domains: cognition (23 studies), motor function (13 studies), responsiveness to interventions (7 studies), and other (10 studies). In cross-sectional studies, EEG slowing correlated with global cognitive impairment and with diffuse deterioration in other domains. In longitudinal studies, decreased dominant frequency and increased θ power, reflecting EEG slowing, were biomarkers of cognitive deterioration at an individual level. Results on motor dysfunction and treatment yielded contrasting findings. Studies on functional connectivity at an individual level and longitudinal studies on other domains or on connectivity measures were lacking. CONCLUSION qEEG measures reflecting EEG slowing, particularly decreased dominant frequency and increased θ power, correlate with cognitive impairment and predict future cognitive deterioration. qEEG could provide reliable and widely available biomarkers for nonmotor disease severity and progression in PD, potentially promoting early diagnosis of nonmotor symptoms and an objective monitoring of progression. More studies are needed to clarify the role of functional connectivity and network analyses.
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Affiliation(s)
- Victor J Geraedts
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
| | - Lennard I Boon
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
| | - Johan Marinus
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
| | - Alida A Gouw
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
| | - Jacobus J van Hilten
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
| | - Cornelis J Stam
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
| | - Martijn R Tannemaat
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands.
| | - Maria Fiorella Contarino
- From the Department of Neurology (V.J.G., J.M., J.J.v.H., M.R.T., M.F.C.), Leiden University Medical Center; Department of Clinical Neurophysiology and MEG Center (V.J.G., L.I.B., A.A.G., C.J.S.) and Alzheimer Center, Department of Neurology (A.A.G.), VU University Medical Center, Amsterdam; and Department of Neurology (M.F.C.), Haga Teaching Hospital, The Hague, the Netherlands
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