Erwin Roy John

Decreased EEG synchronization in Alzheimer's disease and mild cognitive impairment.

The hypothesis of a functional disconnection of neuro-cognitive networks in patients with mild cognitive impairment (MCI) and Alzheimer Dementia was investigated using baseline resting EEG data. EEG databases from New York (264 subjects) and Stockholm (155 subjects), including healthy controls and patients with varying degrees of cognitive decline or Alzheimer Dementia were analyzed using Global Field Synchronization (GFS), a novel measure of global EEG synchronization. GFS reflects the global amount of phase-locked activity at a given frequency by a single number; it is independent of the recording reference and of implicit source models. Patients showed decreased GFS values in Alpha, Beta, and Gamma frequency bands, and increased GFS values in the Delta band, confirming the hypothesized disconnection syndrome. The results are discussed within the framework of current knowledge about the functional significance of the affected frequency bands.

Assessing interactions in the brain with exact low-resolution electromagnetic tomography

Scalp electric potentials (electroencephalogram; EEG) are contingent to the impressed current density unleashed by cortical pyramidal neurons undergoing post-synaptic processes. EEG neuroimaging consists of estimating the cortical current density from scalp recordings. We report a solution to this inverse problem that attains exact localization: exact low-resolution brain electromagnetic tomography (eLORETA). This non-invasive method yields high time-resolution intracranial signals that can be used for assessing functional dynamic connectivity in the brain, quantified by coherence and phase synchronization. However, these measures are non-physiologically high because of volume conduction and low spatial resolution. We present a new method to solve this problem by decomposing them into instantaneous and lagged components, with the lagged part having almost pure physiological origin.

Prediction of longitudinal cognitive decline in normal elderly with subjective complaints using electrophysiological imaging

An extensive literature reports changes in quantitative electroencephalogram (QEEG) with aging and a relationship between magnitude of changes and degree of clinical deterioration in progressive dementia. Longitudinal studies have demonstrated QEEG differences between mild cognitively impaired (MCI) elderly who go on to decline and those who do not. This study focuses on normal elderly with subjective cognitive complaints to assess the utility of QEEG in predicting future decline within 7 years. Forty-four normal elderly received extensive clinical, neurocognitive and QEEG examinations at baseline. All study subjects (N = 44) had only subjective complaints but no objective evidence of cognitive deficit (evaluated using the Global Deterioration Scale [GDS] score, GDS stage = 2) at baseline and were re-evaluated during 7-9 year follow-up. Baseline QEEGs of Decliners differed significantly (p < 0.0001, by MANOVA) from Non-Decliners, characterized by increases in theta power, slowing of mean frequency, and changes in covariance among regions, especially on the right hemisphere. Using logistic regression, an R2 of 0.93 (p < 0.001) was obtained between baseline QEEG features and probability of future decline, with an overall predictive accuracy of 90%. These data indicate high sensitivity and specificity for baseline QEEG as a differential predictor of future cognitive state in normal, subjectively impaired elderly.

Outcome Related Electrophysiological Subtypes of Cocaine Dependence

We previously described the existence of two quantitative EEG (QEEG) subtypes of cocaine dependent males, identified at baseline, displaying differential pronenessto relapse. The current study expands the population to include females and enhances the measure set to include both QEEG and somatosensory EP (SEP) features. Fifty-seven cocaine dependent adults (16 F, 41 M) were evaluated 5–14 days after last cocaine use, while in residence at a drug-free therapeutic community. The median length of stay in treatment (continued abstinence) was 25 weeks. Using a small subset of QEEG and SEP baseline features, three subtypes (CLUS) were identified. CLUS 2 (n=25) and CLUS 3 (n=23) replicated the published subtypes, while CLUS 1 (n=9) was previously undescribed. Cluster membership was significantly associated with length of stay in treatment (χ2=13.789, P<0.001), but not with length of exposure to crack cocaine or to any demographic or clinical features. Seventy-eight percent of CLUS 1 and 65% of CLUS 3 left treatment ≤ 25 weeks, whereas 80% of CLUS 2 remained in treatment > 25 weeks. The existence of outcome related subtypes may reflect: [1] differential neurophysiological vulnerability, “traits,” predisposing individuals to cocaine addiction; or [2] differential neurosensitivity, “states,” due to the effects of chronic cocaine exposure, and associated differences in treatment outcome. Using Variable Resolution Electrical Tomographic Analysis (VARETA), the mathematically most probable neuroanatomical source of the scalp recorded EEG data was localized. Computation of VARETA on the baseline Cluster profiles suggest significant differences in the underlying pathophysiology of these subtypes.

Electrophysiological subtypes of psychotic states

Objective:  This research sought neurobiological features common to psychotic states displayed by patients with different clinical diagnoses.

Neurometric Topographic Mapping of EEG and Evoked Potential Features: Application to Clinical Diagnosis and Cognitive Evaluation

There is widespread agreement that topographic maps of EEG measures are difficult to evaluate unless referred to a normative data base. This raises the difficult question of how “normal” should be defined. Because the particular target of our method, which we call “neurometries,” was cognitive dysfunctions and psychiatric disorders, the instruments used to evaluate our “normal” subjects included an extensive psychiatric and neuropsychological test battery, a psychiatric as well as neurological examination, achievement tests, and determination of eye, hand, and foot dominance. Medical and psychosocial histories, pre— and perinatal data, and current and past school or work records were also evaluated. The subset of instruments used varied with age. Subjects with significant abnormal findings or events in their history which placed them at risk were excluded. Additional exclusion criteria included current use of prescription drugs, a history of head injury or loss of consciousness, any previous EEG or neurological examination, and febrile convulsions.

Real-Time Intraoperative Monitoring during Neurosurgical and Neuroradiological Procedures

A real-time intraoperative evoked potential (EP) monitoring system is described and evaluated. Unique features include (1) online artifact rejection to reduce noise contamination, (2) optimum digital filtering to improve the signal-to-noise ratio of the EP signal, (3) statistically defined confidence intervals to determine significant EP peak latency deviations, and (4) sliding windows of EP subaverages of various sizes to minimize feedback time to the surgeon. The reliability and validity of this system were determined by comparison with conventional intraoperative EP averaging and by examining the correlation of EP parameter changes with concurrent surgical and radiological manipulations. This system was clearly superior to conventional averaging systems. Reliable EPs could be obtained from neuro-logically compromised patients within the electrically hostile operating room environment, in cases in which conventional averaging failed to extract a stable EP signal. EP update times of 10–20 s were quite common and allowed direct moment-to-moment correlations with surgical and radiological events. Case histories are presented that show the utility of this system for aiding in the prevention of neurological complications. This utility is examined for neurosurgical and neuroradiological procedures involving spinal cord, brainstem, midbrain, and cortical structures, and affecting the somatosensory, motor, auditory, and visual system pathways.

Electrophysiological analysis of the registration, storage and retrieval of information in delayed matching from samples.

Brain processes of registration, storage in working memory and retrieval of different kinds of information were studied by analysis of EEG and ERP activity recorded during two delayed matches from sample tasks: (1) matching the digits in two series of six numbers, and (2) matching the sums of the same two series of six numbers. each trial was composed of six intervals continuing six equally spaced visual stimuli: (1) control--observing a series of six fixation points, P1, on a computer monitor; (2) priming--viewing a series, S1, of six numbers; (3) delay--observing a second series of six fixation points, P2; (4) matching--viewing a second series, S2, of six numbers; (5) response selection--selecting the left button to press if S1 contained all the items in S2 or the right button if any item appeared only in S2, while observing six fixation points; (6) feedback--six color coded fixation points indicate correct or error. Each interval was 4 s in duration and 20 trials were presented in each task. During each interval the visual field flickered at a tracer frequency of 1.5/s, whether numbers or fixation points were on the monitor screen. Very narrow band power spectra (VNB), ERPs elicited by presentation of S1 or S2 information items, and non-contingent probes (NCP) elicited by presentation of fixation points were used to trace the processing of information by neural populations activated by the visual stimulation. Global field power maxima identified latencies at which functional landscapes were analyzed. VNB, ERP, NCP and landscape differences were found between digits and sums. However, though these differences were highly significant within each subject (p < 0.001), no consistency was found across individuals for the electrophysiological changes during the tasks. This suggests that utilization of brain resources in cognition varies greatly with individual cognitive styles and strategies.

Electroencephalographic mapping during routine clinical practice: cortical arousal during tracheal intubation?

We used quantitative analysis of the electroencephalogram (EEG) in 42 patients to assess the effect of tracheal intubation after induction of anesthesia with etomidate and sufentanil using standard clinical practice. The EEG was recorded from eight bipolar electrode derivations and Z-transformed relative to age expected normative data for relative power in the delta, theta, alpha, and beta frequency bands. Tracheal intubation resulted in classical cortical arousal, as indicated by acceleration of the EEG frequencies. Significant effects were seen in all frequency bands, most pronounced in the alpha frequency band, with the largest increase bilaterally in the fronto-temporal regions (F-values: Delta − 9.592, P < 0.001; theta − 1.691, P < 0.001; alpha − 18.439, P < 0.001; beta − 4.504, P < 0.001). Changes in alpha and delta power during induction of anesthesia were correlated with the dose of etomidate (P < 0.05). Changes in alpha after tracheal intubation were correlated at the parietooccipital brain regions to the dose of sufentanil (P < 0.05). Individual titration of the dose of etomidate and sufentanil, as during routine clinical practice, is not sufficient to block the strong noxious stimulation of tracheal intubation and results in cortical arousal. The clinical impact of this cortical wake-up phenomenon is undetermined.

Real-time monitoring of brainstem auditory evoked response (BAER) during cerebellopontine angle (CPA) surgery.

The signal-to-noise ratio of brainstem auditory evoked responses (BAER) can be greatly enhanced by use of optimal digital filtering before averaging. This permits accurate assessment of auditory nerve status every 5 to 10 seconds, making real-time intraoperative monitoring possible. The major advantages yielded by real-time monitoring—in our experience thus far—have been (1) identification of potentially adverse functional consequences of apparently uneventful surgical maneuvers, reducing postoperative dysfunction, (2) early indication of potential for improved clinical function, and (3) potential identification and localization of neural tissue in the face of absent surgical landmarks. Examples of these advantages will be provided from case studies, and the possibility that real-time monitoring may improve ability to preserve hearing will be discussed.