Cognitive Impairment in Parkinson's Disease Is Reflected with Gradual Decrease of EEG Delta Responses during Auditory Discrimination

Optimized FFNN with multichannel CSP-ICA framework of EEG signal for BCI

The electroencephalogram (EEG) of the patient is used to identify their motor intention, which is then converted into a control signal through a brain-computer interface (BCI) based on motor imagery. Whenever gathering features from EEG signals, making a BCI is difficult in part because of the enormous dimensionality of the data. Three stages make up the suggested methodology: pre-processing, extraction of features, selection, and categorization. To remove unwanted artifacts, the EEG signals are filtered by a fifth-order Butterworth multichannel band-pass filter. This decreases execution time and memory use, both of which improve system performance. Then a novel multichannel optimized CSP-ICA feature extraction technique is used to separate and eliminate non-discriminative information from discriminative information in the EEG channels. Furthermore, CSP uses the concept of an Artificial Bee Colony (ABC) algorithm to automatically identify the simultaneous global ideal frequency band and time interval combination for the extraction and classification of common spatial pattern characteristics. Finally, a Tunable optimized feed-forward neural network (FFNN) classifier is utilized to extract and categorize the temporal and frequency domain features, which employs an FFNN classifier with Tunable-Q wavelet transform. The proposed framework, therefore optimizes signal processing, enabling enhanced EEG signal classification for BCI applications. The result shows that the models that use Tunable optimized FFNN produce higher classification accuracy of more than 20% when compared to the existing models.

Electrophysiological and Cognitive Changes in Hard Coal Miners Associated with Working Underground

Miners working underground face some risk factors that affect the nervous system-such as high noise, dark environment, chronic stress, and exposure to toxic gases. However, it is not known whether these risk factors affect the cognition of miners. In this study, the cognitive changes of miners were examined through event-related oscillations via electroencephalogram (EEG). Twenty underground miners and control groups, equal to each other in age, education level, and working duration, participated in this study. Neuropsychological tests were applied to all participants to examine their cognitive characteristics. Then, 20-channel EEG was recorded for electrophysiological changes during visual oddball paradigm. Event-related power spectrum and phase locking were analyzed in delta (0.5-3.5), theta (4-7), and alpha (8-13 Hz) frequency bands. It was determined that the delta responses that emerged during the target stimulus differed between the two groups in terms of phase locking (p < 0.05). Considering event-related alpha responses, a statistical difference was found regarding power spectrum and phase locking (p < 0.05). Moreover, the alpha power spectrum in the miners was found to be negatively statistically correlated with working duration (p < 0.05). This study determined that the event-related electrophysiological responses of the miners were negatively affected depending on the working conditions. In addition, neuropsychological assessment determined miners had deficiencies in learning and memory skills and many other cognitive functions such as attention, behavioral inhibition, and visual perception.

Lower oddball event-related EEG delta and theta responses in patients with dementia due to Parkinson's and Lewy body than Alzheimer's disease

Oddball task-related EEG delta and theta responses are associated with frontal executive functions, which are significantly impaired in patients with dementia due to Parkinson's disease (PDD) and Lewy bodies (DLB). The present study investigated the oddball task-related EEG delta and theta responses in patients with PDD, DLB, and Alzheimer's disease dementia (ADD). During visual and auditory oddball paradigms, EEG activity was recorded in 20 ADD, 17 DLB, 20 PDD, and 20 healthy (HC) older adults. Event-related EEG power spectrum and phase-locking analysis were performed at the delta (1-4 Hz) and theta (4-7 Hz) frequency bands for target and nontarget stimuli. Compared to the HC persons, dementia groups showed lower frontal and central delta and theta power and phase-locking associated with task performance and neuropsychological test scores. Notably, this effect was more significant in the PDD and DLB than in the ADD. In conclusion, oddball task-related frontal and central EEG delta and theta responses may reflect frontal supramodal executive dysfunctions in PDD and DLB patients.

Aberrations in temporal dynamics of cognitive processing induced by Parkinson's disease and Levodopa

The motor symptoms of Parkinson's disease (PD) have been shown to significantly improve by Levodopa. However, despite the widespread adoption of Levodopa as a standard pharmaceutical drug for the treatment of PD, cognitive impairments linked to PD do not show visible improvement with Levodopa treatment. Furthermore, the neuronal and network mechanisms behind the PD-induced cognitive impairments are not clearly understood. In this work, we aim to explain these cognitive impairments, as well as the ones exacerbated by Levodopa, through examining the differential dynamic patterns of the phase-amplitude coupling (PAC) during cognitive functions. EEG data recorded in an auditory oddball task performed by a cohort consisting of controls and a group of PD patients during both on and off periods of Levodopa treatment were analyzed to derive the temporal dynamics of the PAC across the brain. We observed distinguishing patterns in the PAC dynamics, as an indicator of information binding, which can explain the slower cognitive processing associated with PD in the form of a latency in the PAC peak time. Thus, considering the high-level connections between the hippocampus, the posterior and prefrontal cortices established through the dorsal and ventral striatum acting as a modulatory system, we posit that the primary issue with cognitive impairments of PD, as well as Levodopa's cognitive deficit side effects, can be attributed to the changes in temporal dynamics of dopamine release influencing the modulatory function of the striatum.

Innovations in Neurophysiology and Their Use in Neuropsychiatry

Many structural and functional tests are used to explore the nature of neurodevelopmental and neurodegenerative diseases. Cognitive involvement has become more and more remarkable in many neurological and psychiatric diseases. This condition evoked a paradigm shift, and today disorders are addressed from a neuroscientific perspective, including silent symptoms. The spatial resolution of structural studies is lacking and is combined with the unique temporal resolution of EEG methods. In our current clinical practice, EEG does not have definitive diagnostic value in psychiatric disorders, but it helps to make a correct diagnosis by excluding other neurological diseases. However, the use of EEG for research purposes is promising in both groups. In this review; there is up-to-date information on the use of electrophysiological examinations in neurological diseases, especially Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and psychiatric disorders such as schizophrenia, mood disorders, attention deficit and hyperactivity disorder, and obsessive-compulsive disorder, to define the point we have reached in our journey to understand these disorders.

Abnormal Cross Frequency Coupling of Brain Electroencephalographic Oscillations Related to Visual Oddball Task in Parkinson's Disease with Mild Cognitive Impairment

Parkinson's disease (PD) is a movement disorder caused by degeneration in dopaminergic neurons. During the disease course, most of PD patients develop mild cognitive impairment (PDMCI) and dementia, especially affecting frontal executive functions. In this study, we tested the hypothesis that PDMCI patients may be characterized by abnormal neurophysiological oscillatory mechanisms coupling frontal and posterior cortical areas during cognitive information processing. To test this hypothesis, event-related EEG oscillations (EROs) during counting visual target (rare) stimuli in an oddball task were recorded in healthy controls (HC; N = 51), cognitively unimpaired PD patients (N = 48), and PDMCI patients (N = 53). Hilbert transform served to estimate instantaneous phase and amplitude of EROs from delta to gamma frequency bands, while modulation index computed ERO phase-amplitude coupling (PAC) at electrode pairs. As compared to the HC and PD groups, the PDMCI group was characterized by (1) more posterior topography of the delta-theta PAC and (2) reversed delta-low frequency alpha PAC direction, ie, posterior-to-anterior rather than anterior-to-posterior. These results suggest that during cognitive demands, PDMCI patients are characterized by abnormal neurophysiological oscillatory mechanisms mainly led by delta frequencies underpinning functional connectivity from frontal to parietal cortical areas.

A Systematic Survey of Research Trends in Technology Usage for Parkinson's Disease

Parkinson's disease (PD) is a neurological disorder with complicated and disabling motor and non-motor symptoms. The complexity of PD pathology is amplified due to its dependency on patient diaries and the neurologist's subjective assessment of clinical scales. A significant amount of recent research has explored new cost-effective and subjective assessment methods pertaining to PD symptoms to address this challenge. This article analyzes the application areas and use of mobile and wearable technology in PD research using the PRISMA methodology. Based on the published papers, we identify four significant fields of research: diagnosis, prognosis and monitoring, predicting response to treatment, and rehabilitation. Between January 2008 and December 2021, 31,718 articles were published in four databases: PubMed Central, Science Direct, IEEE Xplore, and MDPI. After removing unrelated articles, duplicate entries, non-English publications, and other articles that did not fulfill the selection criteria, we manually investigated 1559 articles in this review. Most of the articles (45%) were published during a recent four-year stretch (2018-2021), and 19% of the articles were published in 2021 alone. This trend reflects the research community's growing interest in assessing PD with wearable devices, particularly in the last four years of the period under study. We conclude that there is a substantial and steady growth in the use of mobile technology in the PD contexts. We share our automated script and the detailed results with the public, making the review reproducible for future publications.

Treatment effects on event-related EEG potentials and oscillations in Alzheimer's disease

Alzheimer's disease dementia (ADD) is the most diffuse neurodegenerative disorder belonging to mild cognitive impairment (MCI) and dementia in old persons. This disease is provoked by an abnormal accumulation of amyloid-beta and tauopathy proteins in the brain. Very recently, the first disease-modifying drug has been licensed with reserve (i.e., Aducanumab). Therefore, there is a need to identify and use biomarkers probing the neurophysiological underpinnings of human cognitive functions to test the clinical efficacy of that drug. In this regard, event-related electroencephalographic potentials (ERPs) and oscillations (EROs) are promising candidates. Here, an Expert Panel from the Electrophysiology Professional Interest Area of the Alzheimer's Association and Global Brain Consortium reviewed the field literature on the effects of the most used symptomatic drug against ADD (i.e., Acetylcholinesterase inhibitors) on ERPs and EROs in ADD patients with MCI and dementia at the group level. The most convincing results were found in ADD patients. In those patients, Acetylcholinesterase inhibitors partially normalized ERP P300 peak latency and amplitude in oddball paradigms using visual stimuli. In these same paradigms, those drugs partially normalize ERO phase-locking at the theta band (4-7 Hz) and spectral coherence between electrode pairs at the gamma (around 40 Hz) band. These results are of great interest and may motivate multicentric, double-blind, randomized, and placebo-controlled clinical trials in MCI and ADD patients for final cross-validation.

Are there consistent abnormalities in event-related EEG oscillations in patients with Alzheimer's disease compared to other diseases belonging to dementia?

Cerebrospinal and structural-molecular neuroimaging in-vivo biomarkers are recommended for diagnostic purposes in Alzheimer's disease (AD) and other dementias; however, they do not explain the effects of AD neuropathology on neurophysiological mechanisms underpinning cognitive processes. Here, an Expert Panel from the Electrophysiology Professional Interest Area of the Alzheimer's Association reviewed the field literature and reached consensus on the event-related electroencephalographic oscillations (EROs) that show consistent abnormalities in patients with significant cognitive deficits due to Alzheimer's, Parkinson's (PD), Lewy body (LBD), and cerebrovascular diseases. Converging evidence from oddball paradigms showed that, as compared to cognitively unimpaired (CU) older adults, AD patients had lower amplitude in widespread delta (>4 Hz) and theta (4-7 Hz) phase-locked EROs as a function of disease severity. Similar effects were also observed in PD, LBD, and/or cerebrovascular cognitive impairment patients. Non-phase-locked alpha (8-12 Hz) and beta (13-30 Hz) oscillations were abnormally reduced (event-related desynchronization, ERD) in AD patients relative to CU. However, studies on patients with other dementias remain lacking. Delta and theta phase-locked EROs during oddball tasks may be useful neurophysiological biomarkers of cognitive systems at work in heuristic and intervention clinical trials performed in AD patients, but more research is needed regarding their potential role for other dementias.

Event-related oscillations differentiate between cognitive, motor and visual impairments

BACKGROUND

Parkinson's disease (PD) and dementia with Lewy bodies (DLB) share pathological and clinical similarities while differing in the timing and severity of motor cognitive and visual impairment. Previous EEG studies found abnormal neural oscillations in PD, mild cognitive impairment (MCI) and Alzheimer's disease, however, the electrophysiological signature of clinical symptoms is still unclear. We assessed the specificity of event-related oscillations in distinguishing between cognitive, motor and visual involvement in patients with neurodegenerative conditions.

METHODS

EEG was recorded during a visual oddball task in 30 PD, 28 DLB, 30 MCI patients and 32 age-matched healthy controls. Target and non-target event-related power were examined in the time-frequency domain using complex Morlet wavelet convolution and compared within and between the study groups.

RESULTS

MCI (z = - 1.8, p = 0.04, Cohen's d = - 0.5) and DLB (z = - 3.1, p < 0.001, d = - 1.0) patients showed decreased delta-band target event-related synchronization compared to participants with normal cognition. PD (z = 1.6, p = 0.05, d = 0.5) and DLB (z = 2.7, p < 0.01, d = 0.9) patients showed decreased beta suppression compared to MCI patients and controls. DLB patients with visual hallucinations (VH) showed decreased early-alpha suppression (z = 2.08, p = 0.019, d = 3.19, AUC = 1.0 ± 0.0) compared to DLB-VH^-.

CONCLUSIONS

Decreased event-related delta-band synchronization, reflecting a decline in information processing ability, was characteristic of cognitive impairment due to any cause. Decreased event-related beta suppression, reflecting impaired execution of motor action, was specific to PD and DLB. Decreased event-related early-alpha suppression was characteristic of the presence of VH in DLB. These findings show that specific oscillations may reflect specific clinical symptoms, being a marker of network dysfunction.

Meta-Analysis of Cognition in Parkinson's Disease Mild Cognitive Impairment and Dementia Progression

Mild cognitive changes, including executive dysfunction, are seen in Parkinson's Disease (PD). Approximately 30% of individuals with PD develop Parkinson's disease dementia (PDD). Mild cognitive impairment (MCI) has been identified as a transitional state between normal cognition and dementia. Although PD-MCI and its cognitive correlates have been increasingly studied as a risk indicator for development of PDD, investigations into the PD-MCI construct have yielded heterogeneous findings. Thus, a typical PD-MCI cognitive profile remains undefined. The present meta-analysis examined published cross-sectional studies of PD-MCI and cognitively normal PD (PD-CN) groups to provide aggregated effect sizes of group test performance by cognitive domain. Subsequently, longitudinal studies examining PD-MCI to PDD progression were meta-analyzed. Ninety-two cross-sectional articles of PD-MCI vs. PD-CN were included; 5 longitudinal studies of PD-MCI conversion to PDD were included. Random effects meta-analytic models were constructed resulting in effect sizes (Hedges' g) for cognitive domains. Overall performance across all measures produced a large effect size (g = 0.83, 95% CI [0.79, 0.86], t² = 0.18) in cross-sectional analyses, with cognitive screeners producing the largest effect (g = 1.09, 95% CI [1.00, 1.17], t² = 0.19). Longitudinally, overall measures produced a moderate effect (g = 0.47, 95% CI [0.40, 0.53], t² = 0.01), with measures of executive functioning exhibiting the largest effect (g = 0.70, 95% CI [0.51, 0.89], t² = 0.01). Longitudinal effects were made more robust by low heterogeneity. This report provides the first comprehensive meta-analysis of PD-MCI cognitive outcomes and predictors in PD-MCI conversion to PDD. Limitations include heterogeneity of cross-sectional effect sizes and the potential impact of small-study effects. Areas for continued research include visuospatial skills and visual memory in PD-MCI and longitudinal examination of executive dysfunction in PD-MCI.

Neurophysiological investigation of auditory intensity dependence in patients with Parkinson's disease

There is accumulating evidence for auditory dysfunctions in patients with Parkinson's disease (PD). Moreover, a possible relationship has been suggested between altered auditory intensity processing and the hypophonic speech characteristics in PD. Nonetheless, further insight into the neurophysiological correlates of auditory intensity processing in patients with PD is needed primarily. In the present study, high-density EEG recordings were used to investigate intensity dependence of auditory evoked potentials (IDAEPs) in 14 patients with PD and 14 age- and gender-matched healthy control participants (HCs). Patients with PD were evaluated in both the on- and off-medication states. HCs were also evaluated twice. Significantly increased IDAEP of the N1/P2 was demonstrated in patients with PD evaluated in the on-medication state compared to HCs. Distinctive results were found for the N1 and P2 component. Regarding the N1 component, no differences in latency or amplitude were shown between patients with PD and HCs regardless of the medication state. In contrast, increased P2 amplitude was demonstrated in patients with PD evaluated in the on-medication state compared to the off-medication state and HCs. In addition to a dopaminergic deficiency, deficits in serotonergic neurotransmission in PD were shown based on increased IDAEP. Due to specific alterations of the N1-P2 complex, the current results suggest deficiencies in early-attentive inhibitory processing of auditory input in PD. This interpretation is consistent with the involvement of the basal ganglia and the role of dopaminergic and serotonergic neurotransmission in auditory gating.

Special Report on the Impact of the COVID-19 Pandemic on Clinical EEG and Research and Consensus Recommendations for the Safe Use of EEG

INTRODUCTION

The global COVID-19 pandemic has affected the economy, daily life, and mental/physical health. The latter includes the use of electroencephalography (EEG) in clinical practice and research. We report a survey of the impact of COVID-19 on the use of clinical EEG in practice and research in several countries, and the recommendations of an international panel of experts for the safe application of EEG during and after this pandemic.

METHODS

Fifteen clinicians from 8 different countries and 25 researchers from 13 different countries reported the impact of COVID-19 on their EEG activities, the procedures implemented in response to the COVID-19 pandemic, and precautions planned or already implemented during the reopening of EEG activities.

RESULTS

Of the 15 clinical centers responding, 11 reported a total stoppage of all EEG activities, while 4 reduced the number of tests per day. In research settings, all 25 laboratories reported a complete stoppage of activity, with 7 laboratories reopening to some extent since initial closure. In both settings, recommended precautions for restarting or continuing EEG recording included strict hygienic rules, social distance, and assessment for infection symptoms among staff and patients/participants.

CONCLUSIONS

The COVID-19 pandemic interfered with the use of EEG recordings in clinical practice and even more in clinical research. We suggest updated best practices to allow safe EEG recordings in both research and clinical settings. The continued use of EEG is important in those with psychiatric diseases, particularly in times of social alarm such as the COVID-19 pandemic.

Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review

BACKGROUND

Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed.

OBJECTIVE

To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs.

METHODS

Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O'Malley's scoping review and appraisal process was followed.

RESULTS

There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs.

CONCLUSION

Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.

Tunable Q wavelet transform based emotion classification in Parkinson's disease using Electroencephalography

Parkinson's disease (PD) is a severe incurable neurological disorder. It is mostly characterized by non-motor symptoms like fatigue, dementia, anxiety, speech and communication problems, depression, and so on. Electroencephalography (EEG) play a key role in the detection of the true emotional state of a person. Various studies have been proposed for the detection of emotional impairment in PD using filtering, Fourier transforms, wavelet transforms, and non-linear methods. However, these methods require a selection of basis and are confined in terms of accuracy. In this paper, tunable Q wavelet transform (TQWT) is proposed for the classification of emotions in PD and normal controls (NC). EEG signals of six emotional states namely happiness, sadness, fear, anger, surprise, and disgust are studied. Power, entropy, and statistical moments based features are elicited from the highpass and lowpass sub-bands of TQWT. Six features selected by statistical analysis are classified with a k-nearest neighbor, probabilistic neural network, random forest, decision tree, and extreme learning machine. Three performance measures are obtained, maximum mean accuracy, sensitivity, and specificity of 96.16%, 97.59%, and 88.51% for NC and 93.88%, 96.33%, and 81.67% for PD are achieved with a probabilistic neural network. The proposed method proved to be very effective such that it classifies emotions in PD and could be used as a potential tool for diagnosing emotional impairment in hospitals.

Alpha Power and Functional Connectivity in Cognitive Decline: A Systematic Review and Meta-Analysis

Background:

Mild cognitive impairment (MCI) is a stage between expected age-related cognitive decline and dementia. Dementias have been associated with changes in neural oscillations across the frequency spectrum, including the alpha range. Alpha is the most prominent rhythm in human EEG and is best detected during awake resting state (RS). Though several studies measured alpha power and synchronization in MCI, findings have not yet been integrated.

Objective:

To consolidate findings on power and synchronization of alpha oscillations across stages of cognitive decline.

Methods:

We included studies published until January 2020 that compared power or functional connectivity between 1) people with MCI and cognitively healthy older adults (OA) or people with a neurodegenerative dementia, and 2) people with progressive and stable MCI. Random-effects meta-analyses were performed when enough data was available.

Results:

Sixty-eight studies were included in the review. Global RS alpha power was lower in AD than in MCI (ES = –0.30; 95% CI = –0.51, –0.10; k = 6), and in MCI than in OA (ES = –1.49; 95% CI = –2.69, –0.29; k = 5). However, the latter meta-analysis should be interpreted cautiously due to high heterogeneity. The review showed lower RS alpha power in progressive than in stable MCI, and lower task-related alpha reactivity in MCI than in OA. People with MCI had both lower and higher functional connectivity than OA. Publications lacked consistency in MCI diagnosis and EEG measures.

Conclusion:

Research indicates that RS alpha power decreases with increasing impairment, and could—combined with measures from other frequency bands—become a biomarker of early cognitive decline.

The theoretical mechanism of Parkinson's oscillation frequency bands: a computational model study

Excessive synchronous oscillation activities appear in the brain is a key pathological feature of Parkinson's disease, the mechanism of which is still unclear. Although some previous studies indicated that β oscillation (13-30 Hz) may directly originate in the network composed of the subthalamic nucleus (STN) and external globus pallidus (GPe) neurons, specific onset mechanisms of which are unclear, especially theoretical evidences in numerical simulation are still little. In this paper, we employ a STN-GPe mean-field model to explore the onset mechanism of Parkinson's oscillation. In addition to β oscillation, we find that some other common oscillation frequency bands can appear in this network, such as the α oscillation band (8-12 Hz), the θ oscillation band (4-7 Hz) and δ oscillation band (1-3 Hz). In addition to the coupling weight between the STN and GPe, the delay is also a critical factor to affect oscillatory activities, which can not be neglected compared to other parameters. Through simulation and analysis, we propose two possible theories may induce the system to transfer from the stable state to the oscillatory state in this model: (1). The oscillation activity can be induced when the firing activation level of the population increases to large enough; (2). In some special cases, the population may stay in the high firing rate stable state and the mean discharge rate of which is too large to induce oscillations, then oscillation activities may be induced as the MD decreases to moderate value. In most situations, the change trends of the MD and oscillation dominant frequency are contrary, which may be an important physiological phenomenon shown in this model. The delays and firing rates were obtained by simulating, which may be verified in the experiment in the future.

Differential changes in visual and auditory event-related oscillations in dementia with Lewy bodies

OBJECTIVE

Aside from the cognitive impairment, patients with dementia with Lewy bodies (DLB) have a high frequency of visual hallucinations and a number of other vision-related symptoms, whereas auditory hallucinations are less frequent. To better understand the differential dysfunction of the visual network in DLB, we compared auditory and visual event-related potentials and oscillations in patients with DLB.

METHODS

Event-related potentials elicited by visual and auditory oddball tasks were recorded in 23 patients with DLB and 22 healthy controls and analyzed in time and time-frequency domain.

RESULTS

DLB patients had decreased theta band activity related to both early sensory and later cognitive processing in the visual, but not in the auditory task. Patients had lower delta and higher alpha and beta bands power related to later cognitive processing in both auditory and visual tasks.

CONCLUSIONS

In DLB visual event-related oscillations are characterized by a decrease in theta and lack of inhibition in alpha bands.

SIGNIFICANCE

Decreased theta and a lack of inhibition in alpha band power might be an oscillatory underpinning of some classical DLB symptoms such as fluctuations in attention and high-level visual disturbances and a potential marker of dysfunction of the visual system in DLB.

Abnormalities in auditory and visual cognitive processes are differentiated with theta responses in patients with Parkinson's disease with and without dementia

The research on the abnormalities of event-related oscillations in Parkinson's disease (PD) was mostly studied with cognitively normal patients. The present study aims to show the adverse effects of cognitive decline in PD patients via the EEG-Brain Oscillations approach by comparing the electrophysiological responses in two modalities, i.e. auditory, and visual in which PD group show deficit. We conducted a study in which we analyzed event-related theta power and phase-locking during auditory and visual oddball paradigm. Cognitively normal PD (PDCN) patients (N = 15), PD with mild cognitive impairment (PDMCI) patients (N = 22), PD dementia (PDD) patients (N = 11) and healthy controls (HC) (N = 17) were included in the study. Neuropsychological assessments were applied to all participants. There was a gradual decrease in scores of neuropsychological tests (HC, PDCN, PDMCI, PDD, respectively). Most of the neuropsychological test scores of the participants were highly correlated with the theta power and theta phase locking values, especially over frontal-central areas. HC had higher theta phase-locking and power in comparison to PDMCI and PDD. The differentiation between HC and PDCN was specific to frontal-central areas. Theta power and theta phase-locking were decreased overall locations in PDMCI and PDD both during visual and auditory oddball paradigms compared with PDCN. The results indicate that theta responses in PD patients decreased gradually as the cognitive decline increased. We can conclude that complex abnormalities in their neurotransmitter and neuronal signal systems that occur with the progression of the disease could be responsible for these results.

Auditory Dysfunction in Parkinson's Disease

PD is a progressive and complex neurological disorder with heterogeneous symptomatology. PD is characterized by classical motor features of parkinsonism and nonmotor symptoms and involves extensive regions of the nervous system, various neurotransmitters, and protein aggregates. Extensive evidence supports auditory dysfunction as an additional nonmotor feature of PD. Studies indicate a broad range of auditory impairments in PD, from the peripheral hearing system to the auditory brainstem and cortical areas. For instance, research demonstrates a higher occurrence of hearing loss in early-onset PD and evidence of abnormal auditory evoked potentials, event-related potentials, and habituation to novel stimuli. Electrophysiological data, such as auditory P3a, also is suggested as a sensitive measure of illness duration and severity. Improvement in auditory responses following dopaminergic therapies also indicates the presence of similar neurotransmitters (i.e., glutamate and dopamine) in the auditory system and basal ganglia. Nonetheless, hearing impairments in PD have received little attention in clinical practice so far. This review summarizes evidence of peripheral and central auditory impairments in PD and provides conclusions and directions for future empirical and clinical research. © 2020 International Parkinson and Movement Disorder Society.

Translational Informatics for Parkinson's Disease: from Big Biomedical Data to Small Actionable Alterations

Parkinson's disease (PD) is a common neurological disease in elderly people, and its morbidity and mortality are increasing with the advent of global ageing. The traditional paradigm of moving from small data to big data in biomedical research is shifting toward big data-based identification of small actionable alterations. To highlight the use of big data for precision PD medicine, we review PD big data and informatics for the translation of basic PD research to clinical applications. We emphasize some key findings in clinically actionable changes, such as susceptibility genetic variations for PD risk population screening, biomarkers for the diagnosis and stratification of PD patients, risk factors for PD, and lifestyles for the prevention of PD. The challenges associated with the collection, storage, and modelling of diverse big data for PD precision medicine and healthcare are also summarized. Future perspectives on systems modelling and intelligent medicine for PD monitoring, diagnosis, treatment, and healthcare are discussed in the end.

Oscillatory Activity in the Cortex, Motor Thalamus and Nucleus Reticularis Thalami in Acute TTX and Chronic 6-OHDA Dopamine-Depleted Animals

The motor thalamus (MTh) and the nucleus reticularis thalami (NRT) have been largely neglected in Parkinson's disease (PD) research, despite their key role as interface between basal ganglia (BG) and cortex (Cx). In the present study, we investigated the oscillatory activity within the Cx, MTh, and NRT, in normal and different dopamine (DA)-deficient states. We performed our experiments in both acute and chronic DA-denervated rats by injecting into the medial forebrain bundle (MFB) tetrodotoxin (TTX) or 6-hydroxydopamine (6-OHDA), respectively. Interestingly, almost all the electroencephalogram (EEG) frequency bands changed in acute and/or chronic DA depletion, suggesting alteration of all oscillatory activities and not of a specific band. Overall, δ (2-4 Hz) and θ (4-8 Hz) band decreased in NRT and Cx in acute and chronic state, whilst, α (8-13 Hz) band decreased in acute and chronic states in the MTh and NRT but not in the Cx. The β (13-40 Hz) and γ (60-90 Hz) bands were enhanced in the Cx. In the NRT the β bands decreased, except for high-β (Hβ, 25-30 Hz) that increased in acute state. In the MTh, Lβ and Hβ decreased in acute DA depletion state and γ decreased in both TTX and 6-OHDA-treated animals. These results confirm that abnormal cortical β band are present in the established DA deficiency and it might be considered a hallmark of PD. The abnormal oscillatory activity in frequency interval of other bands, in particular the dampening of low frequencies in thalamic stations, in both states of DA depletion might also underlie PD motor and non-motor symptoms. Our data highlighted the effects of acute depletion of DA and the strict interplay in the oscillatory activity between the MTh and NRT in both acute and chronic stage of DA depletion. Moreover, our findings emphasize early alterations in the NRT, a crucial station for thalamic information processing.