Caffeine improves left hemisphere processing of positive words

Caffeine, Postoperative Delirium And Change In Outcomes after Surgery (CAPACHINOS)-2: protocol for a randomised controlled trial

INTRODUCTION

Delirium is a major public health issue for surgical patients and their families because it is associated with increased mortality, cognitive and functional decline, prolonged hospital admission and increased healthcare expenditures. Based on preliminary data, this trial tests the hypothesis that intravenous caffeine, given postoperatively, will reduce the incidence of delirium in older adults after major non-cardiac surgery.

METHODS AND ANALYSIS

The CAffeine, Postoperative Delirium And CHange In Outcomes after Surgery-2 (CAPACHINOS-2) Trial is a single-centre, placebo-controlled, randomised clinical trial that will be conducted at Michigan Medicine. The trial will be quadruple-blinded, with clinicians, researchers, participants and analysts all masked to the intervention. The goal is to enrol 250 patients with a 1:1:1: allocation ratio: dextrose 5% in water placebo, caffeine 1.5 mg/kg and caffeine 3 mg/kg as a caffeine citrate infusion. The study drug will be administered intravenously during surgical closure and on the first two postoperative mornings. The primary outcome will be delirium, assessed via long-form Confusion Assessment Method. Secondary outcomes will include delirium severity, delirium duration, patient-reported outcomes and opioid consumption patterns. A substudy analysis will also be conducted with high-density electroencephalography (72-channel system) to identify neural abnormalities associated with delirium and Mild Cognitive Impairment at preoperative baseline.

ETHICS AND DISSEMINATION

This study was approved by the University of Michigan Medical School Institutional Review Board (HUM00218290). An independent data and safety monitoring board has also been empanelled and has approved the clinical trial protocol and related documents. Trial methodology and results will be disseminated via clinical and scientific journals along with social and news media.

TRIAL REGISTRATION NUMBER

NCT05574400.

Delirium, Caffeine, and Perioperative Cortical Dynamics

Delirium is a major public health issue associated with considerable morbidity and mortality, particularly after surgery. While the neurobiology of delirium remains incompletely understood, emerging evidence suggests that cognition requires close proximity to a system state called criticality, which reflects a point of dynamic instability that allows for flexible access to a wide range of brain states. Deviations from criticality are associated with neurocognitive disorders, though the relationship between criticality and delirium has not been formally tested. This study tested the primary hypothesis that delirium in the postanesthesia care unit would be associated with deviations from criticality, based on surrogate electroencephalographic measures. As a secondary objective, the impact of caffeine was also tested on delirium incidence and criticality. To address these aims, we conducted a secondary analysis of a randomized clinical trial that tested the effects of intraoperative caffeine on postoperative recovery in adults undergoing major surgery. In this substudy, whole-scalp (16-channel) electroencephalographic data were analyzed from a subset of trial participants (n = 55) to determine whether surrogate measures of neural criticality – (1) autocorrelation function of global alpha oscillations and (2) topography of phase relationships via phase lag entropy – were associated with delirium. These measures were analyzed in participants experiencing delirium in the postanesthesia care unit (compared to those without delirium) and in participants randomized to caffeine compared to placebo. Results demonstrated that autocorrelation function in the alpha band was significantly reduced in delirious participants, which is important given that alpha rhythms are postulated to play a vital role in consciousness. Moreover, participants randomized to caffeine demonstrated increased alpha autocorrelation function concurrent with reduced delirium incidence. Lastly, the anterior-posterior topography of phase relationships appeared most preserved in non-delirious participants and in those receiving caffeine. These data suggest that early postoperative delirium may reflect deviations from neural criticality, and caffeine may reduce delirium risk by shifting cortical dynamics toward criticality.

EEG based emotion recognition using minimum spanning tree

Emotion is a fundamental factor that influences human cognition, motivation, decision making and social interactions. This psychological state arises spontaneously and goes with physiological changes that can be recognized by computational methods. In this study, changes in minimum spanning tree (MST) structure of brain functional connectome were used for emotion classification based on EEG data and the obtained results were employed for interpretation about the most informative frequency content of emotional states. For estimation of interaction between different brain regions, several connectivity metrics were applied and interactions were calculated in different frequency bands. Subsequently, the MST graph was extracted from the functional connectivity matrix and its features were used for emotion recognition. The results showed that the accuracy of the proposed method for separating emotions with different arousal levels was 88.28%, while for different valence levels it was 81.25%. Interestingly, the system performance for binary classification of emotions based on quadrants of arousal-valence space was also higher than 80%. The MST approach allowed us to study the change of brain complexity and dynamics in various emotional states. This capability provided us enough knowledge to claim lower-alpha and gamma bands contain the main information for discrimination of emotional states.

10 years of BAWLing into affective and aesthetic processes in reading: what are the echoes?

Reading is not only "cold" information processing, but involves affective and aesthetic processes that go far beyond what current models of word recognition, sentence processing, or text comprehension can explain. To investigate such "hot" reading processes, standardized instruments that quantify both psycholinguistic and emotional variables at the sublexical, lexical, inter-, and supralexical levels (e.g., phonological iconicity, word valence, arousal-span, or passage suspense) are necessary. One such instrument, the Berlin Affective Word List (BAWL) has been used in over 50 published studies demonstrating effects of lexical emotional variables on all relevant processing levels (experiential, behavioral, neuronal). In this paper, we first present new data from several BAWL studies. Together, these studies examine various views on affective effects in reading arising from dimensional (e.g., valence) and discrete emotion features (e.g., happiness), or embodied cognition features like smelling. Second, we extend our investigation of the complex issue of affective word processing to words characterized by a mixture of affects. These words entail positive and negative valence, and/or features making them beautiful or ugly. Finally, we discuss tentative neurocognitive models of affective word processing in the light of the present results, raising new issues for future studies.

Neural correlates of an early attentional capture by positive distractor words

Exogenous or automatic attention to emotional distractors has been observed for emotional scenes and faces. In the language domain, however, automatic attention capture by emotional words has been scarcely investigated. In the current event-related potentials study we explored distractor effects elicited by positive, negative and neutral words in a concurrent but distinct target distractor paradigm. Specifically, participants performed a digit categorization task in which task-irrelevant words were flanked by numbers. The results of both temporo-spatial principal component and source location analyses revealed the existence of early distractor effects that were specifically triggered by positive words. At the scalp level, task-irrelevant positive compared to neutral and negative words elicited larger amplitudes in an anterior negative component that peaked around 120 ms. Also, at the voxel level, positive distractor words increased activity in orbitofrontal regions compared to negative words. These results suggest that positive distractor words quickly and automatically capture attentional resources diverting them from the task where attention was voluntarily directed.

A familiar font drives early emotional effects in word recognition

The emotional connotation of a word is known to shift the process of word recognition. Using the electroencephalographic event-related potentials (ERPs) approach it has been documented that early attentional processing of high-arousing negative words is shifted at a stage of processing where a presented word cannot have been fully identified. Contextual learning has been discussed to contribute to these effects. The present study shows that a manipulation of the familiarity with a word's shape interferes with these earliest emotional ERP effects. Presenting high-arousing negative and neutral words in a familiar or an unfamiliar font results in very early emotion differences only in case of familiar shapes, whereas later processing stages reveal similar emotional effects in both font conditions. Because these early emotion-related differences predict later behavioral differences, it is suggested that contextual learning of emotional valence comprises more visual features than previously expected to guide early visual-sensory processing.

Caffeine promotes global spatial processing in habitual and non-habitual caffeine consumers

Information processing is generally biased toward global cues, often at the expense of local information. Equivocal extant data suggests that arousal states may accentuate either a local or global processing bias, at least partially dependent on the nature of the manipulation, task, and stimuli. To further differentiate the conditions responsible for such equivocal results we varied caffeine doses to alter physiological arousal states and measured their effect on tasks requiring the retrieval of local versus global spatial knowledge. In a double-blind, repeated-measures design, non-habitual (Experiment 1; N = 36, M = 42.5 ± 28.7 mg/day caffeine) and habitual (Experiment 2; N = 34, M = 579.5 ± 311.5 mg/day caffeine) caffeine consumers completed four test sessions corresponding to each of four caffeine doses (0, 100, 200, 400 mg). During each test session, participants consumed a capsule containing one of the three doses of caffeine or placebo, waited 60 min, and then completed two spatial tasks, one involving memorizing maps and one spatial descriptions. A spatial statement verification task tested local versus global spatial knowledge by differentially probing memory for proximal versus distal landmark relationships. On the map learning task, results indicated that caffeine enhanced memory for distal (i.e., global) compared to proximal (i.e., local) comparisons at 100 (marginal), 200, and 400 mg caffeine in non-habitual consumers, and marginally beginning at 200 mg caffeine in habitual consumers. On the spatial descriptions task, caffeine enhanced memory for distal compared to proximal comparisons beginning at 100 mg in non-habitual but not habitual consumers. We thus provide evidence that caffeine-induced physiological arousal amplifies global spatial processing biases, and these effects are at least partially driven by habitual caffeine consumption.