Spectral perturbations of cortical dipoles during a dynamic visuo-spatial working memory task in schizophrenia

Altered neural oscillations during prestimulus-task conditions have been reported to be associated with aberrant information processing in schizophrenia. Spectral perturbations induced by visuo-spatial working memory (VSWM) task were investigated in patients and their first-degree relatives in order to study the biomarkers in schizophrenia. EEG was recorded using 128-channel during VSWM task in 28 patients, 27 first-degree relatives and 25 controls. After pre-processing and ICA, current dipole was estimated for each IC. Total of 1609 independent and localizable EEG components across all groups were used to compute ERSP during different events of task. Patients deactivated DMN, RSN, auditory cortex more compared to controls during search period to perform VSWM task. Relatives showed altered activation of right medial and inferior frontal gyri during different events and loads of task in lower frequencies compared to controls. Relatives also showed hyperactivity in right cingulate and parahippocampal gyri compared to controls. This is suggestive of genetic predisposition in schizophrenia and could act as vulnerability markers, further strengthened by no significant differences between patients and relatives. Altered processing of simultaneous ongoing events in patients and relatives can serve as state and trait-specific features of schizophrenia.

Multi-domain Cognitive Testing: A Biomarker for Classifying the Cognitive Status of Mild Cognitive Impairment and Alzheimer's Disease

CONTEXT

Cognition is impaired in Alzheimer's disease (AD) and patients with mild cognitive impairment (MCI) with varying levels of magnitude.

AIM

The present study aimed to identify a biomarker for classifying MCI and AD using multi-domain cognitive testing.

SETTINGS AND DESIGN

This was a cross-sectional study.

METHODS AND MATERIALS

26 AD patients, 28 MCI patients and 25 controls were recruited. Cognitive assessment of different domains was done using standard questionnaires and cognitive function tests.

STATISTICAL ANALYSIS USED

Cognitive task scores were compared between the groups using multivariate analysis of variance (MANOVA).

RESULTS

Patients with AD had significantly lower MMSE, CDR, cognitive task scores compared to controls and MCI. Cognitive scores of all tasks for MCI were significantly less than controls, except MMSE and digits forward score. ROC analysis showed that picture memory had 100% sensitivity, 91.6% specificity for AD and 88.4% sensitivity, 92.5% specificity for MCI. Word memory had 92.3% specificity, 100% specificity for AD and 80.7% specificity, 84.6% specificity for MCI.

CONCLUSIONS

The global cognitive tools are less specific in bringing out the differences especially between MCI and control. Limitation of MMSE, heterogeneity of MCI and differential impairment of various domains of cognition, demands the inclusion of multi-domain cognitive evaluation especially picture and word memory tasks with high sensitivity and specificity into the existing diagnostic protocol. ROC results also suggested the continuum of cognitive impairment and MCI as a transitional stage leaving more scope on the quantum of research required for intervention to halt the structural and functional decline.

An Integrated Dynamic Closed Loop Simulation Platform for Elbow Flexion Augmentation Using an Upper Limb Exosuit Model

Wearable robotic devices are designed to assist, enhance or restore human muscle performance. Understanding how a wearable robotic device changes human biomechanics through complex interaction is important to guide its proper design, parametric optimization and functional success. The present work develops a human-machine-interaction simulation platform for closed loop dynamic analysis with feedback control and to study the effect of soft-robotic wearables on human physiology. The proposed simulation platform incorporates Computed Muscle Control (CMC) algorithm and is implemented using the MATLAB -OpenSim interface. The framework is generic and will allow incorporation of any advanced control strategy for the wearable devices. As a demonstration, a Gravity Compensation (GC) controller has been implemented on the wearable device and the resulting decrease in the joint moments, muscle activations and metabolic costs during a simple repetitive load lifting task with two different speeds is investigated.

Reduced Resting-State Cortical Alpha Connectivity Reflects Distinct Functional Brain Dysconnectivity in Alzheimer's Disease and Mild Cognitive Impairment

Background: Emerging evidence suggests distinct abnormal activity patterns during resting state in intrinsic functional brain networks in patients with neurodegenerative diseases, including Alzheimer's disease (AD) and mild cognitive impairment (MCI). This study aimed to identify the changes in the resting-state intracortical lagged phase synchronization derived from dense array electroencephalography (EEG) in AD and MCI. Methods: Resting-state current source density (CSD) and lagged phase synchronization between 84 regions of interest defined by Brodmann areas (BAs) for seven EEG frequency bands were investigated between the study groups (AD, MCI, and age-matched controls) using 128-channel EEG. Results: Reduced CSD and connectivity (large effect size, Cohen's d > 0.8) were found in AD and MCI compared with controls at alpha frequency. However, a positive correlation (r = 0.433; p = 0.044) of mini-mental state examination scores was found with BA 32-33 connectivity values in AD only. Conclusion: Reduced resting-state alpha 1 source connectivity in patient groups and correlation between attenuation of resting-state alpha 1 connectivity with cognitive decline in AD could indicate the disruption of inhibitory function of alpha rhythm leading to tonic unselective cortical excitation that affects attention and controlled access to stored information.

Altered spontaneous cortical activity in mild glaucoma: A quantitative EEG study

Functional neuroimaging studies have reported alterations in cortical activity indicating glaucoma as a progressive neurodegenerative disease. Hence the current study aimed to assess the cortical activity using high-density EEG in patients with mild glaucoma during resting state. Treatment-naive 37 patients with primary open angle glaucoma (POAG), 34 patients with primary angle closure glaucoma (PACG), and 32 healthy controls were included in the study. Resting state EEG i.e., eyes closed (EC) and eyes open conditions (EO) were acquired using 128-channel for 3 min. After preprocessing, the current density of 6239 voxels of the data was estimated using sLORETA. In comparison to healthy controls, PACG had higher activity at cingulate gyri, medial and superior frontal gyri during EO only. POAG had significantly higher activity at precentral gyrus and middle frontal gyrus during EC, whereas at cingulate gyri, frontal gyri, precentral gyri, paracentral lobule, sub-gyral region, postcentral gyrus, and precuneus during EO. POAG had significantly higher activity at precuneus and cuneus compared to PACG during EO. Intraocular pressure and mean-deviation of visual fields had a positive correlation with cortical activity. Results of the study indicate physiological alterations not only at the level of retina but also at brain even in the early stages of the disease. These alterations in the cortical activity were more in POAG than PACG. Controlling the IOP alone might be insufficient in glaucoma because of widespread alterations in cortical activity. These findings might enhance the current understanding of cortical involvement in glaucoma.

IUPS Physiology Education Workshop series in India: organizational mechanics, outcomes, and lessons

Active learning promotes the capacity of problem solving and decision making among learners. Teachers who apply instructional processes toward active participation of learners help their students develop higher order thinking skills. Due to the recent paradigm shift toward adopting competency-based curricula in the education of healthcare professionals in India, there is an emergent need for physiology instructors to be trained in active-learning methodologies and to acquire abilities to promote these curriculum changes. To address these issues, a series of International Union of Physiological Sciences (IUPS) workshops on physiology education techniques in four apex centers in India was organized in November 2018 and November 2019. The "hands-on" workshops presented the methodologies of case-based learning, problem-based learning, and flipped classroom; the participants were teachers of basic sciences and human and veterinary medicine. The workshop series facilitated capacity building and creation of a national network of physiology instructors interested in promoting active-learning techniques. The workshops were followed by a brainstorming meeting held to assess the outcomes. The aim of this report is to provide a model for implementing a coordinated series of workshops to support national curriculum change and to identify the organizational elements essential for conducting an effective Physiology Education workshop. The essential elements include a highly motivated core organizing team, constant dialogue between core organizing and local organizing committees, a sufficient time frame for planning and execution of the event, and opportunities to engage students at host institutions in workshop activities.

Cingulate oscillatory activity reflects the quality of memory representations in visuospatial working memory

The human brain has the high likelihood for committing errors when confronted by a day-to-day situation that demands to process more than four integrated items in working memory, for example driving a car to a new destination in high traffic. However, neural mechanisms underlying the response outcome in working memory is still unclear. High temporal resolution and improved spatial resolution of dense array electroencephalogram (EEG) make it an ideal tool to investigate the dynamics of brain networks. In the present study, the brain activity of twenty healthy male volunteers was investigated during correct and error trials of visuospatial working memory task using dense array EEG. Independent brain components were identified using independent component analysis (ICA). Event-related spectral perturbations (ERSP) were computed for each independent component using Morlet wavelet transform for the frequency range of 3-70 Hz. ERSP of independent component clusters identified using K-means algorithm were statistically compared between correct and error trials. Delta and theta power increased in the component cluster located at cingulate gyrus before the error response of visuospatial working memory task. The current study findings suggest that cingulate oscillatory activity might reflect the quality of memory representation and intensity of target uncertainty during the visuospatial search.

Altered parahippocampal gyrus activation and its connectivity with resting-state network areas in schizophrenia: An EEG study

Synchronized and coherent activity in resting-networks during normal brain functioning could be altered in disconnection syndrome like schizophrenia. Study of neural oscillations as assessed by EEG appears to be a promising proposition to understand the pathophysiology of schizophrenia in patients and their first-degree relatives, where disturbances in neural oscillations point towards genetic predisposition. Therefore, present study aims at establishing EEG based biomarkers for early detection and management strategies. Thirty-two patients with schizophrenia, 28 first-degree relatives and 31 healthy controls (HC) participated in the study. Resting brain activity was recorded using 128-channel electroencephalography. After pre-processing and independent component analysis (ICA), an equivalent current dipole was estimated for each IC. Total of 1551 independent and localizable EEG components across all groups were used in subsequent analysis. Power spectral density and source coherence between IC clusters were computed. Patients and first-degree relatives displayed significantly higher power spectral density (PSD) than HC for all frequency bands in left parahippocampal gyrus (PHG) (-7, -26, 8; BA 27). Another region within left deep PHG (-4, -28, 1), however, distinguished patients from first-degree relatives and HC in terms of significantly lower PSD in higher frequency bands. Functional connectivity (FC) was found to be lower in patients and higher in relatives compared to HC between different resting-state network areas. In patients, connectivity was lower compared to first-degree relatives. Altered activity within left PHG and FC of primarily this with other areas in resting-state network can serve as state and trait markers of schizophrenia.

Microteaching enhances teaching skills of resident doctors in India: A pilot study

Background

The Medical Council of India has recommended microteaching for training medical graduates to improve their teaching efficiency. We assessed the effectiveness of microteaching on teaching skills of resident doctors through objective and subjective methods.

Methods

We obtained data from three microteaching sessions in which 10 resident doctors participated. Seven core teaching skills of the participants were compared between two training sessions using the paired t-test. Only 4 residents who had participated in the training sessions appeared for the semester examination. We compared the performance of the 'trained' residents (π = 4) with the 'naïve' residents (n = 6) who were getting exposed to microteaching for the first time during the semester examination using the Mann-Whitney test.

Results

Participants scored significantly high in the second training session compared to the first one. All the participants perceived the training sessions to have a positive effect on their teaching skills. In the semester examination, 'trained' residents performed significantly better than their 'naïve' counterparts.

Conclusions

Microteaching not only improved the teaching skills of the residents but also helped them perform well in their semester examination held 10 months later. Our results indicate that microteaching can be an effective teacher training technique for residents.

Planning, implementation, and evaluation of multicomponent, case-based learning for first-year Indian medical undergraduates

Didactic lecture is an effective method to quickly pass on a high volume of information to a large number of students. However, if not well designed, lectures can be monotonous and provide only passive learning, with little scope for higher order learning skills. To address this drawback of lectures, we supplemented it with case-based learning (CBL), which has been shown to promote self-learning. After giving an overview of gastrointestinal physiology through lectures, CBL on peptic ulcer disease was implemented for first-year Bachelor of Medicine, Bachelor of Surgery students. The present study aimed to evaluate the students' and teachers' opinions on the notion of supplementing lectures with CBL. In previous reports, discussion using clinical cases was primarily employed as the solitary component for conducting CBL. In the present study, three different but mutually exclusive components, such as case discussion, concept map, and critical thinking exercise on a specific topic in gastrointestinal pathophysiology, were integrated to form the multicomponent CBL (MC-CBL). Students reported that MC-CBL could promote application of the knowledge learned in lectures in a more appropriate context (92.42% positive response), enhance their learning efficiency (98.46% positive response), promote their active participation in the learning process (98.48% positive response), and help them in integrating physiological concepts with clinical science (98.46% positive response). Teachers observed that MC-CBL could promote active learning, analytic, and problem-solving skills of students. In conclusion, MC-CBL appeared to be an effective supplement for the lectures, providing an opportunity for the students to relate the knowledge learned during lectures.

Brain Networks Communicate Through Theta Oscillations to Encode High Load in a Visuospatial Working Memory Task: An EEG Connectivity Study

The encoding of visuospatial information is the foremost and indispensable step which determines the outcome in a visuospatial working memory (VSWM) task. It is considered to play a crucial role in limiting our ability to attend and process only 3-5 integrated items of information. Despite its importance in determining VSWM performance, the neural mechanisms underlying VSWM encoding have not been clearly differentiated from those involved during VSWM retention, manipulation and/or retrieval. The high temporal resolution of electroencephalography (EEG) and improved spatial resolution with dense array data acquisition makes it an ideal tool to study the dynamics in the functional brain connectivity during a cognitive task. In the present study, the changes in the functional brain connectivity due to memory load during VSWM encoding were studied using 128-channel EEG. Lagged linear coherence (LagR) was computed between 84 regions of interest (ROIs) defined according to the Brodmann areas for seven EEG frequency bands: delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), beta 2 (20-30 Hz), and gamma (30-45 Hz). Interestingly, out of seven EEG frequency bands investigated in the current study, LagR of only theta band varied significantly in 13 brain connections due to memory load during VSWM encoding. LagR of theta band increased significantly at high memory load when compared to low memory load in twelve brain connections with the maximum change observed between right cuneus and right middle temporal gyrus (Cohen's d = 0.836), indicating the integration of brain processes to confront the increase in memory demands. Theta LagR decreased significantly between left postcentral gyrus and right precentral gyrus at high memory load as compared to low memory load, which might have a role for sustaining attention during encoding. Change in the LagR values due to memory load between fusiform gyrus and lingual gyrus in the right hemisphere had a positive correlation (r = 0.464, p = 0.003) with the error rate, signifying the crucial role played by these two regions in predicting the performance. The current study has not only identified the neural connections that are responsible for the formation of working memory traces during VSWM encoding, but also support the notion that encoding is a rate-limiting process underlying our memory capacity limit.

Pre-trial and pre-response EEG microstates in schizophrenia: An endophenotypic marker

Cognitive deficits in Schizophrenia interfere with everyday functioning and social functioning. Strong familial associations in schizophrenia might serve to establish cognitive impairments as endophenotypic markers. Therefore, visuo-spatial working memory simulating day-to-day activities at high memory load was assessed in patients with schizophrenia, their first-degree relatives and healthy controls to explore pre-trial and pre-response EEG microstates and their intracranial generators. Twenty-eight patients with schizophrenia, first-degree relatives and matched healthy controls participated in the study. Brain activity during visuo-spatial working memory task was recorded using 128-channel electroencephalography. Pre-trial and pre-response microstate maps of correct and error trials were clustered across groups according to their topography. Microstate map parameters and underlying cortical sources were compared among groups. Pre-trial (correct) microstate Map 1 was significantly different between controls and patients which could qualify it as a state marker with its intracranial generator localized to right inferior frontal gyrus (rIFG). Pre-response (correct) microstate map was significantly different between controls and first-degree relatives which could be considered an endophenotypic marker for schizophrenia. No significant differences were observed for error trials between groups. rIFG which is involved in the execution of multi-component behaviour and selective inhibitory control could distinguish patients with schizophrenia from their first-degree relatives and healthy controls. Further, microstate based biomarkers have the potential to facilitate diagnosis of schizophrenia at a preclinical stage resulting in efficient diagnosis and better prognosis.

A novel method for assessing patients with schizophrenia and their first-degree relatives by increasing cognitive load of visuo-spatial working memory

INTRODUCTION

In patients with schizophrenia, social and functional outcome is determined by the cognitive impairment. Assessment of visuo-spatial working memory (VSWM) which can simulate the day-to-day activities by simultaneous involvement of various elements of working memory may reflect disorganized thinking and fragmentation of thoughts in schizophrenia.

METHODS

Thirty-six patients with schizophrenia, 29 first-degree relatives of patients, and 25 healthy controls performed a VSWM task with three memory loads (comprising three pairs, six pairs, and eight pairs of abstract pictures). They were administered Hindi version of the Mini Mental State Examination, Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms, and Edinburgh handedness inventory.

RESULTS

Patients (mean age 27.29(5.98) years) committed significantly higher number of errors than healthy controls (mean age 26.76(6.08) years) in load 3 (P = 0.012) and total errors (P = 0.018). Within all the groups, errors in load 3 were significantly higher than in load 2. Significant correlation was observed between years of education (r = -0.388, P = 0.021), treatment duration (r = -0.880, P < 0.001), negative symptoms scores (r = 0.345, P = 0.039), and the total errors committed by patients.

DISCUSSION

Visuo-spatial working memory was impaired in schizophrenia with increasing cognitive load with no difference in search time between the groups.

Hyperactivation of left inferior parietal lobule and left temporal gyri shortens resting EEG microstate in schizophrenia

OBJECTIVE

The momentary spatial configuration of the brain electric field at the scalp reflects quasi-stable "functional microstates" caused by activity of different intracranial generators. There is paucity in literature on the intracranial generators of resting state EEG microstate alterations in stable patients with schizophrenia. The present study aimed to investigate resting state microstate alterations and their neural generators in patients with schizophrenia and their first-degree relatives as compared to healthy controls in an attempt to establish state and trait marker.

METHOD

Thirty-four patients with schizophrenia (DSM-5 criteria), 29 first-degree relatives and 25 matched healthy controls participated in the study. Brain activity during eyes closed condition was recorded using 128 channel electroencephalography. Microstates were clustered into 5 maps across groups according to their topography. Microstate map parameters and their cortical sources were compared among groups.

RESULTS

Map 5 mean duration (χ²(2) = 7.617, p = 0.022) was significantly lower in patients compared to controls (U = 256, p = 0.010). Maximum activation was seen in left inferior parietal lobule (MNI coordinates: -65, -35, 25, Log-F_max = 0.748). Suprathreshold cortical voxels with increased activations were found localized at left temporal gyri.

CONCLUSION

Hyperactivation in left inferior parietal lobule and temporal gyri might have shortened Map 5 duration at rest in patients with schizophrenia. This could imply microstate alterations as the potential state marker of schizophrenia.