Julia Lechinger

Consolidation of temporal order in episodic memories.

Highlights ► Performance in temporal order memory deteriorates with sleep deprivation. ► REM early in the night is associated with delayed temporal order recall. ► Participants who improve during sleep overnight show more fast spindle activity. ► Spindle-related alpha power at frontal locations may indicate “offline” memory access. ► Distinct sleep mechanisms subserve different aspects of episodic memory consolidation.

Heartbeat-related EEG amplitude and phase modulations from wakefulness to deep sleep: Interactions with sleep spindles and slow oscillations.

Based on physiological models of neurovisceral integration, different studies have shown how cognitive processes modulate heart rate and how the heartbeat, on the other hand, modulates brain activity. We tried to further determine interactions between cardiac and electrical brain activity by means of EEG. We investigated how the heartbeat modulates EEG in 23 healthy controls from wakefulness to deep sleep and showed that frontocentral heartbeat evoked EEG amplitude and phase locking (as measured by intertrial phase locking), at about 300-400 ms after the R peak, decreased with increasing sleep depth with a renewed increase during REM sleep, which underpins the assumption that the heartbeat evoked positivity constitutes an active frontocortical response to the heartbeat. Additionally, we found that individual heart rate was correlated with the frequency of the EEGs spectral peak (i.e., alpha peak frequency during wakefulness). This correlation was strongest during wakefulness and declined linearly with increasing sleep depth. Furthermore, we show that the QRS complex modulates spindle phase possibly related to the correspondence between the frequency of the QRS complex and the spindle frequency of about 12-15 Hz. Finally, during deep sleep stages, a loose temporal coupling between heartbeats and slow oscillation (0.8 Hz) could be observed. These findings indicate that cardiac activity such as heart rate or individual heartbeats can modulate or be modulated by ongoing oscillatory brain activity.

Across the consciousness continuum—from unresponsive wakefulness to sleep

Advances in the development of new paradigms as well as in neuroimaging techniques nowadays enable us to make inferences about the level of consciousness patients with disorders of consciousness (DOC) retain. They, moreover, allow to predict their probable development. Today, we know that certain brain responses (e.g., event-related potentials or oscillatory changes) to stimulation, circadian rhythmicity, the presence or absence of sleep patterns as well as measures of resting state brain activity can serve the diagnostic and prognostic evaluation process. Still, the paradigms we are using nowadays do not allow to disentangle VS/UWS and minimally conscious state (MCS) patients with the desired reliability and validity. Furthermore, even rather well-established methods have, unfortunately, not found their way into clinical routine yet. We here review current literature as well as recent findings from our group and discuss how neuroimaging methods (fMRI, PET) and particularly electroencephalography (EEG) can be used to investigate cognition in DOC or even to assess the degree of residual awareness. We, moreover, propose that circadian rhythmicity and sleep in brain-injured patients are promising fields of research in this context.

Susceptibility to declarative memory interference is pronounced in primary insomnia.

Sleep has been shown to stabilize memory traces and to protect against competing interference in both the procedural and declarative memory domain. Here, we focused on an interference learning paradigm by testing patients with primary insomnia (N = 27) and healthy control subjects (N = 21). In two separate experimental nights with full polysomnography it was revealed that after morning interference procedural memory performance (using a finger tapping task) was not impaired in insomnia patients while declarative memory (word pair association) was decreased following interference. More specifically, we demonstrate robust associations of central sleep spindles (in N3) with motor memory susceptibility to interference as well as (cortically more widespread) fast spindle associations with declarative memory susceptibility. In general the results suggest that insufficient sleep quality does not necessarily show up in worse overnight consolidation in insomnia but may only become evident (in the declarative memory domain) when interference is imposed.

Oscillatory brain responses to own names uttered by unfamiliar and familiar voices

Among auditory stimuli, the own name is one of the most powerful and it is able to automatically capture attention and elicit a robust electrophysiological response. The subject’s own name (SON) is preferentially processed in the right hemisphere, mainly because of its self-relevance and emotional content, together with other personally relevant information such as the voice of a familiar person. Whether emotional and self-relevant information are able to attract attention and can be, in future, introduced in clinical studies remains unclear. In the present study we used EEG and asked participants to count a target name (active condition) or to just listen to the SON or other unfamiliar names uttered by a familiar or unfamiliar voice (passive condition). Data reveals that the target name elicits a strong alpha event related desynchronization with respect to non-target names and triggers in addition a left lateralized theta synchronization as well as delta synchronization. In the passive condition alpha desynchronization was observed for familiar voice and SON stimuli in the right hemisphere. Altogether we speculate that participants engage additional attentional resources when counting a target name or when listening to personally relevant stimuli which is indexed by alpha desynchronization whereas left lateralized theta synchronization may be related to verbal working memory load. After validating the present protocol in healthy volunteers it is suggested to move one step further and apply the protocol to patients with disorders of consciousness in which the degree of residual cognitive processing and self-awareness is still insufficiently understood.

Night and day variations of sleep in patients with disorders of consciousness

Brain injuries substantially change the entire landscape of oscillatory dynamics and render detection of typical sleep patterns difficult. Yet, sleep is characterized not only by specific EEG waveforms, but also by its circadian organization. In the present study we investigated whether brain dynamics of patients with disorders of consciousness systematically change between day and night. We recorded ~24 h EEG at the bedside of 18 patients diagnosed to be vigilant but unaware (Unresponsive Wakefulness Syndrome) and 17 patients revealing signs of fluctuating consciousness (Minimally Conscious State). The day-to-night changes in (i) spectral power, (ii) sleep-specific oscillatory patterns and (iii) signal complexity were analyzed and compared to 26 healthy control subjects. Surprisingly, the prevalence of sleep spindles and slow waves did not systematically vary between day and night in patients, whereas day-night changes in EEG power spectra and signal complexity were revealed in minimally conscious but not unaware patients.

Significance of circadian rhythms in severely brain-injured patients A clue to consciousness?

Objective: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviorally assessed consciousness levels in patients with disorders of consciousness (DOC; i.e., vegetative state/unresponsive wakefulness syndrome or minimally conscious state). Methods: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across 6 to 7 days using external skin temperature sensors in 18 patients with DOC. Beyond this, we examined the relationship between behaviorally assessed consciousness levels and circadian rhythmicity. Results: Analyses with Lomb-Scargle periodograms revealed significant circadian rhythmicity in all patients (range 23.5–26.3 hours). We found that especially scores on the arousal subscale of the Coma Recovery Scale–Revised were closely linked to the integrity of circadian variations in body temperature. Finally, we piloted whether bright light stimulation could boost circadian rhythmicity and found positive evidence in 2 out of 8 patients. Conclusion: The study provides evidence for an association between circadian body temperature rhythms and arousal as a necessary precondition for consciousness. Our findings also make a case for circadian rhythms as a target for treatment as well as the application of diagnostic and therapeutic means at times when cognitive performance is expected to peak.

Preferential processing of emotionally and self-relevant stimuli persists in unconscious N2 sleep

HighlightsOwn names (SONs) and angry voice (AV) stimuli are salient during wakefulness.Intriguingly, SONs and AV stimuli remain salient during unconscious N2 sleep.Results suggest a ‘sentinel processing mode’ of the brain during unconscious sleep.A K‐complex‐like response indicates preferential processing of salient stimuli.Presumably, delta, theta and sigma ERS reflect the subsequent sleep‐protecting mechanism. Abstract Information processing has been suggested to depend on the current state of the brain as well as stimulus characteristics (e.g. salience). We compared processing of salient stimuli (subject’s own names [SONs] and angry voice [AV] stimuli) to processing of unfamiliar names (UNs) and neutral voice (NV) stimuli across different vigilance stages (i.e. wakefulness as well as sleep stages N1 and N2) by means of event‐related oscillatory responses during wakefulness and a subsequent afternoon nap. Our findings suggest that emotional prosody and self‐relevance drew more attentional resources during wakefulness with specifically AV stimuli being processed more strongly. During N1, SONs were more arousing than UNs irrespective of prosody. Moreover, emotional and self‐relevant stimuli evoked stronger responses also during N2 sleep suggesting a ‘sentinel processing mode’ of the brain during this state of naturally occurring unconsciousness. Finally, this initial preferential processing of salient stimuli during N2 sleep seems to be followed by an inhibitory sleep‐protecting process, which is reflected by a K‐complex‐like response.

Can self-relevant stimuli help assessing patients with disorders of consciousness?

Emotional and self-relevant stimuli are able to automatically attract attention and their use in patients suffering from disorders of consciousness (DOC) might help detecting otherwise hidden signs of cognition. We here recorded EEG in three Locked-in syndrome (LIS) and four Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS) patients while they listened to the voice of a family member or an unfamiliar voice during a passive. Data indicate that, in a passive listening condition, the familiar voice induces stronger alpha desynchronization than the unfamiliar one. In an active condition, the target evoked stronger alpha desynchronization in controls, two LIS patients and one VS/UWS patient. Results suggest that self-relevant familiar voice stimuli can engage additional attentional resources and might allow the detection of otherwise hidden signs of instruction-following and thus residual awareness. Further studies are necessary to find sensitive paradigms that are suited to find subtle signs of cognition and awareness in DOC patients.

Prestimulus amplitudes modulate P1 latencies and evoked traveling alpha waves.

Traveling waves have been well documented in the ongoing, and more recently also in the evoked EEG. In the present study we investigate what kind of physiological process might be responsible for inducing an evoked traveling wave. We used a semantic judgment task which already proved useful to study evoked traveling alpha waves that coincide with the appearance of the P1 component. We found that the P1 latency of the leading electrode is significantly correlated with prestimulus amplitude size and that this event is associated with a transient change in alpha frequency. We assume that cortical background excitability, as reflected by an increase in prestimulus amplitude, is responsible for the observed change in alpha frequency and the initiation of an evoked traveling trajectory.