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Hamilton CA, Gallagher P, Ciafone J, Barnett N, Barker SAH, Donaghy PC, O'Brien JT, Taylor JP, Thomas AJ. Sustained attention in mild cognitive impairment with Lewy bodies and Alzheimer's disease. J Int Neuropsychol Soc 2024; 30:421-427. [PMID: 38017617 DOI: 10.1017/s1355617723000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Attentional impairments are common in dementia with Lewy bodies and its prodromal stage of mild cognitive impairment (MCI) with Lewy bodies (MCI-LB). People with MCI may be capable of compensating for subtle attentional deficits in most circumstances, and so these may present as occasional lapses of attention. We aimed to assess the utility of a continuous performance task (CPT), which requires sustained attention for several minutes, for measuring attentional performance in MCI-LB in comparison to Alzheimer's disease (MCI-AD), and any performance deficits which emerged with sustained effort. METHOD We included longitudinal data on a CPT sustained attention task for 89 participants with MCI-LB or MCI-AD and 31 healthy controls, estimating ex-Gaussian response time parameters, omission and commission errors. Performance trajectories were estimated both cross-sectionally (intra-task progress from start to end) and longitudinally (change in performance over years). RESULTS While response times in successful trials were broadly similar, with slight slowing associated with clinical parkinsonism, those with MCI-LB made considerably more errors. Omission errors were more common throughout the task in MCI-LB than MCI-AD (OR 2.3, 95% CI: 1.1-4.7), while commission errors became more common after several minutes of sustained attention. Within MCI-LB, omission errors were more common in those with clinical parkinsonism (OR 1.9, 95% CI: 1.3-2.9) or cognitive fluctuations (OR 4.3, 95% CI: 2.2-8.8). CONCLUSIONS Sustained attention deficits in MCI-LB may emerge in the form of attentional lapses leading to omissions, and a breakdown in inhibitory control leading to commission errors.
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Affiliation(s)
- Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joanna Ciafone
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sally A H Barker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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2
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Olğun Y, Aksoy Poyraz C, Bozluolçay M, Poyraz BÇ. Quantitative EEG in the Differential Diagnosis of Dementia Subtypes. J Geriatr Psychiatry Neurol 2024:8919887241227410. [PMID: 38217438 DOI: 10.1177/08919887241227410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Most neurodegenerative dementias present with substantial overlap in clinical features. Therefore, differential diagnosis is often a challenging task necessitating costly and sometimes invasive diagnostic procedures. A promising, non-invasive and cost-effective method is the widely available electroencephalography (EEG). METHODS Twenty-three subjects with Alzheimer's disease (AD), 28 subjects with dementia with Lewy bodies (DLB), 15 subjects with frontotemporal dementias (FTDs), and 22 healthy controls (HC) were enrolled. Nineteen channel computerized EEG recordings were acquired. Mean relative powers were calculated using the standard frequency bands. Theta/alpha ratio (TAR), theta/beta ratio (TBR), a spectral index of (alpha + beta)/(theta + delta) and an alpha reactivity index (alpha in eyes-open condition/alpha in eyes-closed condition) were also calculated. Receiver operating characteristic (ROC) analyses were performed to assess diagnostic accuracy. RESULTS For the comparison of EEG measures across groups, we performed a multivariate ANOVA followed by univariate ANOVAs controlling for the effects of age, with post hoc tests. Theta power and TBR were increased in DLB compared to other groups. Alpha power was decreased in DLB compared to HC and FTD; and in AD compared to FTD. Beta power was decreased in DLB compared to AD and HC. Furthermore, regional analyses demonstrated a unique pattern of theta power increase in DLB; affecting frontal, central, parietal, occipital, and temporal regions. In AD, theta power increased compared to HC in parietal, occipital, and right temporal regions. TAR was increased in DLB compared to other groups; and in AD compared to HC. Finally, alpha reactivity index was higher in DLB compared to HC and FTD. In AD, EEG slowing was associated with cognitive impairment, while in DLB, this was associated with higher DLB characteristics. In the ROC analyses to distinguish DLB from FTD and AD, measures of EEG slowing yielded high area under curve values, with good specificities. Also, decreased alpha reactivity could distinguish DLB from FTD with good specificity. EEG slowing in DLB showed a diffuse pattern compared to AD, where a posterior and temporal slowing predominated. CONCLUSION We showed that EEG slowing was satisfactory in distinguishing DLB patients from AD and FTD patients. Notably, this slowing was a characteristic finding in DLB patients, even at early stages, while it paralleled disease progression in AD. Furthermore, EEG slowing in DLB showed a diffuse pattern compared to AD, where a posterior and temporal slowing predominated. These findings align with the previous evidence of the diencephalic dysfunction in DLB.
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Affiliation(s)
- Yeşim Olğun
- Department of Psychiatry, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Melda Bozluolçay
- Department of Neurology, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burç Çağrı Poyraz
- Department of Psychiatry, Cerrahpaşa Medical School, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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3
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Bejia I, Labidi J, Warniez A, Bayot M, Bourriez JL, Derambure P, Lebouvier T, Pasquier F, Delval A, Betrouni N. Multi-approach comparative study of EEG patterns associated with the most common forms of dementia. Neurobiol Aging 2023; 130:30-39. [PMID: 37433259 DOI: 10.1016/j.neurobiolaging.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/30/2023] [Accepted: 06/10/2023] [Indexed: 07/13/2023]
Abstract
Electroencephalography's (EEG) sensitivity in discriminating dementia syndromes remains unclear. This study aimed to investigate EEG markers in patients with major cognitive disorders. The studied population included 4 groups of patients: Alzheimer's disease with associated vascular lesions, Alzheimer's disease without vascular lesions (AD-V), Lewy body disease and vascular dementia (VaD); and completed by a control group composed by cognitively unimpaired patients. EEGs were analysed quantitatively using spectral analysis, functional connectivity and micro-states. By comparison to the controls, expected slowing and alterations of functional connectivity were detected in patients with dementia. Among these patients, an overall increase in power in the alpha band was observed in the VaD group, mainly when compared to the 2 AD groups, while the Alzheimer's disease without vascular lesions group exhibited increased power in the beta-2 band and higher functional connectivity in the same frequency band. Micro-state analyses revealed differences in temporal dynamics for the VaD group. A number of EEG modifications reported as markers of some syndromes were found, but others were not reproduced.
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Affiliation(s)
- Ines Bejia
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Jordan Labidi
- CHU Lille, Clinical Neurophysiology Department, F-59000 Lille, France
| | - Aude Warniez
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Madli Bayot
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; CHU Lille, Clinical Neurophysiology Department, F-59000 Lille, France
| | | | - Philippe Derambure
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; CHU Lille, Clinical Neurophysiology Department, F-59000 Lille, France
| | - Thibaut Lebouvier
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; CHU Lille, Centre Mémoire de Ressources et de Recherche (CMRR), F-59000 Lille, France
| | - Florence Pasquier
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; CHU Lille, Centre Mémoire de Ressources et de Recherche (CMRR), F-59000 Lille, France
| | - Arnaud Delval
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; CHU Lille, Clinical Neurophysiology Department, F-59000 Lille, France
| | - Nacim Betrouni
- Univ. Lille, INSERM, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France.
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Jaramillo-Jimenez A, Tovar-Rios DA, Ospina JA, Mantilla-Ramos YJ, Loaiza-López D, Henao Isaza V, Zapata Saldarriaga LM, Cadavid Castro V, Suarez-Revelo JX, Bocanegra Y, Lopera F, Pineda-Salazar DA, Tobón Quintero CA, Ochoa-Gomez JF, Borda MG, Aarsland D, Bonanni L, Brønnick K. Spectral features of resting-state EEG in Parkinson's Disease: A multicenter study using functional data analysis. Clin Neurophysiol 2023; 151:28-40. [PMID: 37146531 DOI: 10.1016/j.clinph.2023.03.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE This study aims 1) To analyse differences in resting-state electroencephalogram (rs-EEG) spectral features of Parkinson's Disease (PD) and healthy subjects (non-PD) using Functional Data Analysis (FDA) and 2) To explore, in four independent cohorts, the external validity and reproducibility of the findings using both epoch-to-epoch FDA and averaged-epochs approach. METHODS We included 169 subjects (85 non-PD; 84 PD) from four centres. Rs-EEG signals were preprocessed with a combination of automated pipelines. Sensor-level relative power spectral density (PSD), dominant frequency (DF), and DF variability (DFV) features were extracted. Differences in each feature were compared between PD and non-PD on averaged epochs and using FDA to model the epoch-to-epoch change of each feature. RESULTS For averaged epochs, significantly higher theta relative PSD in PD was found across all datasets. Also, higher pre-alpha relative PSD was observed in three of four datasets in PD patients. For FDA, similar findings were achieved in theta, but all datasets showed consistently significant posterior pre-alpha differences across multiple epochs. CONCLUSIONS Increased generalised theta, with posterior pre-alpha relative PSD, was the most reproducible finding in PD. SIGNIFICANCE Rs-EEG theta and pre-alpha findings are generalisable in PD. FDA constitutes a reliable and powerful tool to analyse epoch-to-epoch the rs-EEG.
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Affiliation(s)
- Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway; Faculty of Health Sciences, University of Stavanger. Stavanger, Norway; Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación SINAPSIS, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación NeuroCo, Universidad de Antioquia, School of Medicine & School of Engenieering. Medellín, Colombia.
| | - Diego A Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway; Faculty of Health Sciences, University of Stavanger. Stavanger, Norway; Universidad del Valle, Grupo de Investigación en Estadística Aplicada - INFERIR, Faculty of Engineering, Santiago de Cali, Colombia; Universidad del Valle, Prevención y Control de la Enfermedad Crónica - PRECEC, Faculty of Health, Santiago de Cali, Colombia
| | - Johann Alexis Ospina
- Facultad de Ciencias Básicas, Universidad Autónoma de Occidente, Santiago de Cali, Colombia
| | - Yorguin-Jose Mantilla-Ramos
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación NeuroCo, Universidad de Antioquia, School of Medicine & School of Engenieering. Medellín, Colombia
| | - Daniel Loaiza-López
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación NeuroCo, Universidad de Antioquia, School of Medicine & School of Engenieering. Medellín, Colombia
| | - Verónica Henao Isaza
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación NeuroCo, Universidad de Antioquia, School of Medicine & School of Engenieering. Medellín, Colombia
| | - Luisa María Zapata Saldarriaga
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación NeuroCo, Universidad de Antioquia, School of Medicine & School of Engenieering. Medellín, Colombia
| | - Valeria Cadavid Castro
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Semillero de Investigación NeuroCo, Universidad de Antioquia, School of Medicine & School of Engenieering. Medellín, Colombia
| | - Jazmin Ximena Suarez-Revelo
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia
| | - Yamile Bocanegra
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine. Medellín, Colombia
| | - David Antonio Pineda-Salazar
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia
| | - Carlos Andrés Tobón Quintero
- Grupo de Neurociencias de Antioquia, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia; Área Investigación e Innovación, Hospital Alma Mater de Antioquia. Medellín, Colombia
| | - John Fredy Ochoa-Gomez
- Grupo Neuropsicología y Conducta, Universidad de Antioquia, School of Medicine. Medellín, Colombia
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway; Faculty of Health Sciences, University of Stavanger. Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Pontificia Universidad Javeriana, Ageing Institute, Medical School. Bogotá, Colombia
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway; Faculty of Health Sciences, University of Stavanger. Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London. London, UK
| | - Laura Bonanni
- Department of Medicine and Aging Sciences, G. d'Annunzio University. Chieti, Italy
| | - Kolbjørn Brønnick
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital. Stavanger, Norway; Faculty of Health Sciences, University of Stavanger. Stavanger, Norway
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5
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Liu H, Huang Z, Deng B, Chang Z, Yang X, Guo X, Yuan F, Yang Q, Wang L, Zou H, Li M, Zhu Z, Jin K, Wang Q. QEEG Signatures are Associated with Nonmotor Dysfunctions in Parkinson's Disease and Atypical Parkinsonism: An Integrative Analysis. Aging Dis 2023; 14:204-218. [PMID: 36818554 PMCID: PMC9937709 DOI: 10.14336/ad.2022.0514] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
Parkinson's disease (PD) and atypical parkinsonism (AP), including progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), share similar nonmotor symptoms. Quantitative electroencephalography (QEEG) can be used to examine the nonmotor symptoms. This study aimed to characterize the patterns of QEEG and functional connectivity (FC) that differentiate PD from PSP or MSA, and explore the correlation between the differential QEEG indices and nonmotor dysfunctions in PD and AP. We enrolled 52 patients with PD, 31 with MSA, 22 with PSP, and 50 age-matched health controls to compare QEEG indices among specific brain regions. One-way analysis of variance was applied to assess QEEG indices between groups; Spearman's correlations were used to examine the relationship between QEEG indices and nonmotor symptoms scale (NMSS) and mini-mental state examination (MMSE). FCs using weighted phase lag index were compared between patients with PD and those with MSA/PSP. Patients with PSP revealed higher scores on the NMSS and lower MMSE scores than those with PD and MSA, with similar disease duration. The delta and theta powers revealed a significant increase in PSP, followed by PD and MSA. Patients with PD presented a significantly lower slow-to-fast ratio than those with PSP in the frontal region, while patients with PD presented significantly higher EEG-slowing indices than patients with MSA. The frontal slow-to-fast ratio showed a negative correlation with MMSE scores in patients with PD and PSP, and a positive correlation with NMSS in the perception and mood domain in patients with PSP but not in those with PD. Compared to PD, MSA presented enhanced FC in theta and delta bands in the posterior region, while PSP revealed decreased FC in the delta band within the frontal-temporal cortex. These findings suggest that QEEG might be a useful tool for evaluating the nonmotor dysfunctions in PD and AP. Our QEEG results suggested that with similar disease duration, the cortical neurodegenerative process was likely exacerbated in patients with PSP, followed by those with PD, and lastly in patients with MSA.
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Affiliation(s)
- Hailing Liu
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Department of Neurology, Maoming People's Hospital, Maoming, Guangdong, China.
| | - Zifeng Huang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Bin Deng
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Zihan Chang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Xiaohua Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Xingfang Guo
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Feilan Yuan
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Qin Yang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Liming Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Haiqiang Zou
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangdong, China.
| | - Mengyan Li
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Zhaohua Zhu
- Clinical Research Centre, Orthopedic Centre, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.
| | - Kunlin Jin
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China.,Correspondence should be addressed to: Dr. Qing Wang, Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510282, China. .
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Jin L, Nawaz H, Ono K, Nowell J, Haley E, Berman BD, Mukhopadhyay ND, Barrett MJ. One Minute of EEG Data Provides Sufficient and Reliable Data for Identifying Lewy Body Dementia. Alzheimer Dis Assoc Disord 2023; 37:66-72. [PMID: 36413637 PMCID: PMC9974530 DOI: 10.1097/wad.0000000000000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the minimum duration of electroencephalography (EEG) data necessary to differentiate EEG features of Lewy body dementia (LBD), that is, dementia with Lewy bodies and Parkinson disease dementia, from non-LBD patients, that is, Alzheimer disease and Parkinson disease. METHODS We performed quantitative EEG analysis for 16 LBD and 14 non-LBD patients. After artifact removal, a fast Fourier transform was performed on 90, 60, and thirty 2-second epochs to derive dominant frequency; dominant frequency variability; and dominant frequency prevalence. RESULTS In LBD patients, there were no significant differences in EEG features derived from 90, 60, and thirty 2-second epochs (all P >0.05). There were no significant differences in EEG features derived from 3 different groups of thirty 2-second epochs (all P >0.05). When analyzing EEG features derived from ninety 2-second epochs, we found that LBD had significantly reduced dominant frequency, reduced dominant frequency variability, and reduced dominant frequency prevalence alpha compared with the non-LBD group (all P <0.05). These same differences were observed between the LBD and non-LBD groups when analyzing thirty 2-second epochs. CONCLUSIONS There were no differences in EEG features derived from 1 minute versus 3 minutes of EEG data, and both durations of EEG data equally differentiated LBD from non-LBD.
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Affiliation(s)
- Lucy Jin
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Huma Nawaz
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kenichiro Ono
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
- U.S. Dept. of Veterans Affairs – Central Virginia Healthcare System, Richmond, VA, USA
| | - Justin Nowell
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Erik Haley
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Brian D. Berman
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Nitai D. Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Matthew J. Barrett
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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7
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Iannaccone S, Houdayer E, Spina A, Nocera G, Alemanno F. Quantitative EEG for early differential diagnosis of dementia with Lewy bodies. Front Psychol 2023; 14:1150540. [PMID: 37151310 PMCID: PMC10157484 DOI: 10.3389/fpsyg.2023.1150540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Differentiating between the two most common forms of dementia, Alzheimer's dementia and dementia with Lewy bodies (DLB) remains difficult and requires the use of invasive, expensive, and resource-intensive techniques. We aimed to investigate the sensitivity and specificity of electroencephalography quantified using the statistical pattern recognition method (qEEG-SPR) for identifying dementia and DLB. Methods Thirty-two outpatients and 16 controls underwent clinical assessment (by two blinded neurologists), EEG recording, and a 6-month follow-up clinical assessment. EEG data were processed using a qEEG-SPR protocol to derive a Dementia Index (positive or negative) and DLB index (positive or negative) for each participant which was compared against the diagnosis given at clinical assessment. Confusion matrices were used to calculate sensitivity, specificity, and predictive values for identifying dementia and DLB specifically. Results Clinical assessment identified 30 cases of dementia, 2 of which were diagnosed clinically with possible DLB, 14 with probable DLB and DLB was excluded in 14 patients. qEEG-SPR confirmed the dementia diagnosis in 26 out of the 32 patients and led to 6.3% of false positives (FP) and 9.4% of false negatives (FN). qEEG-SPR was used to provide a DLB diagnosis among patients who received a positive or inconclusive result of Dementia index and led to 13.6% of FP and 13.6% of FN. Confusion matrices indicated a sensitivity of 80%, a specificity of 89%, a positive predictive value of 92%, a negative predictive value of 72%, and an accuracy of 83% to diagnose dementia. The DLB index showed a sensitivity of 60%, a specificity of 90%, a positive predictive value of 75%, a negative predictive value of 81%, and an accuracy of 75%. Neuropsychological scores did not differ significantly between DLB and non- DLB patients. Head trauma or story of stroke were identified as possible causes of FP results for DLB diagnosis. Conclusion qEEG-SPR is a sensitive and specific tool for diagnosing dementia and differentiating DLB from other forms of dementia in the initial state. This non-invasive, low-cost, and environmentally friendly method is a promising diagnostic tool for dementia diagnosis which could be implemented in local care settings.
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Affiliation(s)
- Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elise Houdayer
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- *Correspondence: Elise Houdayer,
| | - Alfio Spina
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gianluca Nocera
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Alemanno
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
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8
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Zinno L, Negrotti A, Falzoi C, Messa G, Goldoni M, Calzetti S. Generalized Rhythmic Delta Activity Frontally Predominant Differentiates Dementia with Lewy Bodies From Alzheimer's Disease and Parkinson's Disease Dementia: A Conventional Electroencephalography Visual Analysis. Clin EEG Neurosci 2022; 53:426-434. [PMID: 33843293 DOI: 10.1177/1550059421997147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. An easily accessible and inexpensive neurophysiological technique such as conventional electroencephalography may provide an accurate and generally applicable biomarker capable of differentiating dementia with Lewy bodies (DLB) from Alzheimer's disease (AD) and Parkinson's disease-associated dementia (PDD). Method. We carried out a retrospective visual analysis of resting-state electroencephalography (EEG) recording of 22 patients with a clinical diagnosis of 19 probable and 3 possible DLB, 22 patients with probable AD and 21 with PDD, matched for age, duration, and severity of cognitive impairment. Results. By using the grand total EEG scoring method, the total score and generalized rhythmic delta activity frontally predominant (GRDAfp) alone or, even better, coupled with a slowing of frequency of background activity (FBA) and its reduced reactivity differentiated DLB from AD at an individual level with an high accuracy similar to that obtained with quantitative EEG (qEEG). GRDAfp alone could also differentiate DLB from PDD with a similar level of diagnostic accuracy. AD differed from PDD only for a slowing of FBA. The duration and severity of cognitive impairment did not differ between DLB patients with and without GRDAfp, indicating that this abnormal EEG pattern should not be regarded as a disease progression marker. Conclusions. The findings of this investigation revalorize the role of conventional EEG in the diagnostic workup of degenerative dementias suggesting the potential inclusion of GRDAfp alone or better coupled with the slowing of FBA and its reduced reactivity, in the list of supportive diagnostic biomarkers of DLB.
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Affiliation(s)
- Lucia Zinno
- Neurology Unit, 18630Azienda Ospedaliero-Universitaria of Parma, Parma, Emilia-Romagna, Italy
| | - Anna Negrotti
- Neurology Unit, 18630Azienda Ospedaliero-Universitaria of Parma, Parma, Emilia-Romagna, Italy
| | - Chiara Falzoi
- Center for Cognitive Disorders, AUSL of Parma, Parma, Emilia-Romagna, Italy
| | - Giovanni Messa
- Center for Cognitive Disorders, AUSL of Parma, Parma, Emilia-Romagna, Italy
| | | | - Stefano Calzetti
- Neurology Unit, 18630Azienda Ospedaliero-Universitaria of Parma, Parma, Emilia-Romagna, Italy
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9
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Jennings JL, Peraza LR, Baker M, Alter K, Taylor JP, Bauer R. Investigating the power of eyes open resting state EEG for assisting in dementia diagnosis. Alzheimers Res Ther 2022; 14:109. [PMID: 35932060 PMCID: PMC9354304 DOI: 10.1186/s13195-022-01046-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/13/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The differentiation of Lewy body dementia from other common dementia types clinically is difficult, with a considerable number of cases only being found post-mortem. Consequently, there is a clear need for inexpensive and accurate diagnostic approaches for clinical use. Electroencephalography (EEG) is one potential candidate due to its relatively low cost and non-invasive nature. Previous studies examining the use of EEG as a dementia diagnostic have focussed on the eyes closed (EC) resting state; however, eyes open (EO) EEG may also be a useful adjunct to quantitative analysis due to clinical availability. METHODS We extracted spectral properties from EEG signals recorded under research study protocols (1024 Hz sampling rate, 10:5 EEG layout). The data stems from a total of 40 dementia patients with an average age of 74.42, 75.81 and 73.88 years for Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), respectively, and 15 healthy controls (HC) with an average age of 76.93 years. We utilised k-nearest neighbour, support vector machine and logistic regression machine learning to differentiate between groups utilising spectral data from the delta, theta, high theta, alpha and beta EEG bands. RESULTS We found that the combination of EC and EO resting state EEG data significantly increased inter-group classification accuracy compared to methods not using EO data. Secondly, we observed a distinct increase in the dominant frequency variance for HC between the EO and EC state, which was not observed within any dementia subgroup. For inter-group classification, we achieved a specificity of 0.87 and sensitivity of 0.92 for HC vs dementia classification and 0.75 specificity and 0.91 sensitivity for AD vs DLB classification, with a k-nearest neighbour machine learning model which outperformed other machine learning methods. CONCLUSIONS The findings of our study indicate that the combination of both EC and EO quantitative EEG features improves overall classification accuracy when classifying dementia types in older age adults. In addition, we demonstrate that healthy controls display a definite change in dominant frequency variance between the EC and EO state. In future, a validation cohort should be utilised to further solidify these findings.
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Affiliation(s)
- Jack L Jennings
- School of Computing, Newcastle University, Newcastle upon Tyne, UK.
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | | | - Mark Baker
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus of Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne, NE1 4LP, UK
| | - Kai Alter
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus of Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Roman Bauer
- Department of Computer Science, University of Surrey, Guildford, GU2 7XH, UK
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10
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Rodriguez-Porcel F, Wyman-Chick KA, Abdelnour Ruiz C, Toledo JB, Ferreira D, Urwyler P, Weil RS, Kane J, Pilotto A, Rongve A, Boeve B, Taylor JP, McKeith I, Aarsland D, Lewis SJG. Clinical outcome measures in dementia with Lewy bodies trials: critique and recommendations. Transl Neurodegener 2022; 11:24. [PMID: 35491418 PMCID: PMC9059356 DOI: 10.1186/s40035-022-00299-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/31/2022] [Indexed: 12/28/2022] Open
Abstract
The selection of appropriate outcome measures is fundamental to the design of any successful clinical trial. Although dementia with Lewy bodies (DLB) is one of the most common neurodegenerative conditions, assessment of therapeutic benefit in clinical trials often relies on tools developed for other conditions, such as Alzheimer's or Parkinson's disease. These may not be sufficiently valid or sensitive to treatment changes in DLB, decreasing their utility. In this review, we discuss the limitations and strengths of selected available tools used to measure DLB-associated outcomes in clinical trials and highlight the potential roles for more specific objective measures. We emphasize that the existing outcome measures require validation in the DLB population and that DLB-specific outcomes need to be developed. Finally, we highlight how the selection of outcome measures may vary between symptomatic and disease-modifying therapy trials.
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Affiliation(s)
- Federico Rodriguez-Porcel
- Department of Neurology, Medical University of South Carolina, 208b Rutledge Av., Charleston, SC, 29403, USA.
| | - Kathryn A. Wyman-Chick
- grid.280625.b0000 0004 0461 4886Department of Neurology, Center for Memory and Aging, HealthPartners, Saint Paul, MN USA
| | - Carla Abdelnour Ruiz
- grid.7080.f0000 0001 2296 0625Autonomous University of Barcelona, Barcelona, Spain
| | - Jon B. Toledo
- grid.15276.370000 0004 1936 8091Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL USA
| | - Daniel Ferreira
- grid.4714.60000 0004 1937 0626Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Center for Alzheimer’s Research, Karolinska Institutet, Stockholm, Sweden ,grid.66875.3a0000 0004 0459 167XDepartment of Radiology, Mayo Clinic, Rochester, MN USA
| | - Prabitha Urwyler
- grid.5734.50000 0001 0726 5157ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Rimona S. Weil
- grid.83440.3b0000000121901201Dementia Research Centre, University College London, London, UK
| | - Joseph Kane
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University, Belfast, UK
| | - Andrea Pilotto
- grid.7637.50000000417571846Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arvid Rongve
- grid.413782.bDepartment of Research and Innovation, Helse Fonna, Haugesund Hospital, Haugesund, Norway ,grid.7914.b0000 0004 1936 7443Institute of Clinical Medicine (K1), The University of Bergen, Bergen, Norway
| | - Bradley Boeve
- grid.66875.3a0000 0004 0459 167XDepartment of Neurology, Center for Sleep Medicine, Mayo Clinic, Rochester, MN USA
| | - John-Paul Taylor
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- grid.1006.70000 0001 0462 7212Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dag Aarsland
- grid.13097.3c0000 0001 2322 6764Department of Old Age Psychiatry Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Simon J. G. Lewis
- grid.1013.30000 0004 1936 834XForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, 100 Mallett Street, Camperdown, NSW 2050 Australia
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11
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Fonseca E, Quintana M, Seijo‐Raposo I, Ortiz de Zárate Z, Abraira L, Santamarina E, Álvarez‐Sabin J, Toledo M. Interictal brain activity changes in temporal lobe epilepsy: A quantitative electroencephalogram analysis. Acta Neurol Scand 2022; 145:239-248. [PMID: 34687043 DOI: 10.1111/ane.13543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the usefulness of quantitative electroencephalography (qEEG) in the analysis of baseline activity in patients with temporal lobe epilepsy (TLE) and identify measures potentially associated with disease duration and drug resistance. MATERIALS AND METHODS Cross-sectional study of adult patients with TLE and controls who underwent video-EEG monitoring. Representative artifact-free resting wakefulness baseline EEG segments were selected for quantitative analysis. The fast Fourier transform (FFT) approach was used for the power spectral analysis, with computation of FFT power ratios and alpha-delta and alpha-theta ratios for both hemispheres. The resulting measures were compared between TLE patients and controls and their values as predictors of epilepsy duration and drug resistance analyzed. RESULTS Thirty-nine TLE patients and 23 controls were included. The TLE patients had a lower alpha-delta ratio in the posterior quadrant ipsilateral to the epileptic focus and a lower alpha-theta ratio in the ipsilateral anterior/posterior quadrants and temporal region. A younger age at onset and longer epilepsy duration correlated with a higher theta power ratio in the contralateral anterior and posterior quadrants and temporal region. No qEEG measures predicted drug resistance. CONCLUSIONS Quantitative electroencephalography background activity may contribute to the diagnosis of TLE and provide useful information on disease duration. A lower alpha-delta and alpha-theta ratio may be reliable baseline qEEG measures for identifying patients with TLE. A higher contralateral theta power ratio may be indicative of longer epilepsy duration.
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Affiliation(s)
- Elena Fonseca
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Manuel Quintana
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Iván Seijo‐Raposo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Zuriñe Ortiz de Zárate
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Department of Pediatric Neurology Vall d'Hebron University Hospital Barcelona Spain
| | - Laura Abraira
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - Estevo Santamarina
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
| | - José Álvarez‐Sabin
- Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Medicine Department Universitat Autònoma de Barcelona Barcelona Spain
| | - Manuel Toledo
- Epilepsy Unit Neurology Department Vall d'Hebron University Hospital Barcelona Spain
- Research Group on Status Epilepticus and Acute Seizures Vall d'Hebron Research Institute (VHIR) Vall d'Hebron University Hospital Barcelona Spain
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Ouchani M, Gharibzadeh S, Jamshidi M, Amini M. A Review of Methods of Diagnosis and Complexity Analysis of Alzheimer's Disease Using EEG Signals. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5425569. [PMID: 34746303 PMCID: PMC8566072 DOI: 10.1155/2021/5425569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/20/2021] [Accepted: 10/18/2021] [Indexed: 01/27/2023]
Abstract
This study will concentrate on recent research on EEG signals for Alzheimer's diagnosis, identifying and comparing key steps of EEG-based Alzheimer's disease (AD) detection, such as EEG signal acquisition, preprocessing function extraction, and classification methods. Furthermore, highlighting general approaches, variations, and agreement in the use of EEG identified shortcomings and guidelines for multiple experimental stages ranging from demographic characteristics to outcomes monitoring for future research. Two main targets have been defined based on the article's purpose: (1) discriminative (or detection), i.e., look for differences in EEG-based features across groups, such as MCI, moderate Alzheimer's disease, extreme Alzheimer's disease, other forms of dementia, and stable normal elderly controls; and (2) progression determination, i.e., look for correlations between EEG-based features and clinical markers linked to MCI-to-AD conversion and Alzheimer's disease intensity progression. Limitations mentioned in the reviewed papers were also gathered and explored in this study, with the goal of gaining a better understanding of the problems that need to be addressed in order to advance the use of EEG in Alzheimer's disease science.
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Affiliation(s)
- Mahshad Ouchani
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Shahriar Gharibzadeh
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Mahdieh Jamshidi
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran, Iran
| | - Morteza Amini
- Shahid Beheshti University, Tehran, Iran
- Institute for Cognitive Science Studies (ICSS), Tehran, Iran
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13
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Milán-Tomás Á, Fernández-Matarrubia M, Rodríguez-Oroz MC. Lewy Body Dementias: A Coin with Two Sides? Behav Sci (Basel) 2021; 11:94. [PMID: 34206456 PMCID: PMC8301188 DOI: 10.3390/bs11070094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
Lewy body dementias (LBDs) consist of dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), which are clinically similar syndromes that share neuropathological findings with widespread cortical Lewy body deposition, often with a variable degree of concomitant Alzheimer pathology. The objective of this article is to provide an overview of the neuropathological and clinical features, current diagnostic criteria, biomarkers, and management of LBD. Literature research was performed using the PubMed database, and the most pertinent articles were read and are discussed in this paper. The diagnostic criteria for DLB have recently been updated, with the addition of indicative and supportive biomarker information. The time interval of dementia onset relative to parkinsonism remains the major distinction between DLB and PDD, underpinning controversy about whether they are the same illness in a different spectrum of the disease or two separate neurodegenerative disorders. The treatment for LBD is only symptomatic, but the expected progression and prognosis differ between the two entities. Diagnosis in prodromal stages should be of the utmost importance, because implementing early treatment might change the course of the illness if disease-modifying therapies are developed in the future. Thus, the identification of novel biomarkers constitutes an area of active research, with a special focus on α-synuclein markers.
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Affiliation(s)
- Ángela Milán-Tomás
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
| | - Marta Fernández-Matarrubia
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - María Cruz Rodríguez-Oroz
- Department of Neurology, Clínica Universidad de Navarra, 28027 Madrid, Spain;
- Department of Neurology, Clínica Universidad de Navarra, 31008 Pamplona, Spain;
- IdiSNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
- CIMA, Center of Applied Medical Research, Universidad de Navarra, Neurosciences Program, 31008 Pamplona, Spain
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14
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Chatzikonstantinou S, McKenna J, Karantali E, Petridis F, Kazis D, Mavroudis I. Electroencephalogram in dementia with Lewy bodies: a systematic review. Aging Clin Exp Res 2021; 33:1197-1208. [PMID: 32383032 DOI: 10.1007/s40520-020-01576-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/21/2020] [Indexed: 01/26/2023]
Abstract
Dementia with Lewy bodies (DLB) belongs to the spectrum of Lewy body dementia (LBD) that also encompasses Parkinson's disease dementia (PDD). It is a common neurodegenerative disorder characterized by memory decline, cognitive fluctuations, visual hallucinations, autonomic nervous system disturbance, REM sleep behavior disorder, and parkinsonism. Definite diagnosis can be established only through neuropathological confirmation of Lewy bodies' presence in brain tissue. Probable or possible diagnosis relies upon clinical features, imaging, polysomnography, and electroencephalogram (EEG) findings. Potential neurophysiological biomarkers for the diagnosis, management, and evaluation of treatment-response in DLB should be affordable and widely available outside academic centers. Increasing evidence supports the use of quantitative EEG (qEEG) as a potential DLB biomarker, with promising results in discriminating DLB from other dementias and in identifying subjects who are on the trajectory to develop DLB. Several studies evaluated the diagnostic value of EEG in DLB. Visual analysis and qEEG techniques have been implemented, showing a superiority of the last in terms of sensitivity and objectivity. In this systematic review, we attempt to provide a general synthesis of the current knowledge on EEG application in DLB. We review the findings from original studies and address the issues remaining to be further clarified.
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Affiliation(s)
- Simela Chatzikonstantinou
- Third Department of Neurology, Aristotle University of Thessaloniki, 3 Arsaki Street, Pefka, 57010, Thessaloníki, Greece.
| | | | - Eleni Karantali
- Third Department of Neurology, Aristotle University of Thessaloniki, 3 Arsaki Street, Pefka, 57010, Thessaloníki, Greece
| | - Fivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 3 Arsaki Street, Pefka, 57010, Thessaloníki, Greece
| | - Dimitrios Kazis
- Third Department of Neurology, Aristotle University of Thessaloniki, 3 Arsaki Street, Pefka, 57010, Thessaloníki, Greece
| | - Ioannis Mavroudis
- Leeds Teaching Hospitals, Leeds, UK
- Medical School, Cyprus University, Nicosia, Cyprus
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15
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Koberda JL. QEEG as a Useful Tool for the Evaluation of Early Cognitive Changes in Dementia and Traumatic Brain Injury. Clin EEG Neurosci 2021; 52:119-125. [PMID: 32391721 DOI: 10.1177/1550059420914816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Quantitative electroencephalography (QEEG)-electrical neuroimaging has been underutilized in general neurology practice. Recent advances in computer technology have made this electrophysiological testing relatively inexpensive as well as precise in identifying brain areas with electrical dysfunction related to either traumatic injury or neurodegenerative process. In this article, the author presents 2 cases that can be frequently encountered in every general neurological practice: case of early dementia and traumatic brain injury. The clinical usefulness of QEEG is demonstrated by showing evidence of electrical abnormalities and networks dysfunctions (including an elevation of frontal/temporal delta and theta powers as well as abnormalities in functional connectivity). In addition, the correlation of QEEG and findings from structural imaging technique-magnetic resonance imaging diffusion tensor imaging and another functional imaging-positron emission tomography is presented.
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Affiliation(s)
- J Lucas Koberda
- Neurology, PL/Brain Enhancement Inc, TNBC, Tallahassee, FL, USA
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16
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Chávez-Fumagalli MA, Shrivastava P, Aguilar-Pineda JA, Nieto-Montesinos R, Del-Carpio GD, Peralta-Mestas A, Caracela-Zeballos C, Valdez-Lazo G, Fernandez-Macedo V, Pino-Figueroa A, Vera-Lopez KJ, Lino Cardenas CL. Diagnosis of Alzheimer's Disease in Developed and Developing Countries: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy. J Alzheimers Dis Rep 2021; 5:15-30. [PMID: 33681713 PMCID: PMC7902992 DOI: 10.3233/adr-200263] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The present systematic review and meta-analysis of diagnostic test accuracy summarizes the last three decades in advances on diagnosis of Alzheimer's disease (AD) in developed and developing countries. OBJECTIVE To determine the accuracy of biomarkers in diagnostic tools in AD, for example, cerebrospinal fluid, positron emission tomography (PET), and magnetic resonance imaging (MRI), etc. METHODS The authors searched PubMed for published studies from 1990 to April 2020 on AD diagnostic biomarkers. 84 published studies were pooled and analyzed in this meta-analysis and diagnostic accuracy was compared by summary receiver operating characteristic statistics. RESULTS Overall, 84 studies met the criteria and were included in a meta-analysis. For EEG, the sensitivity ranged from 67 to 98%, with a median of 80%, 95% CI [75, 91], tau-PET diagnosis sensitivity ranged from 76 to 97%, with a median of 94%, 95% CI [76, 97]; and MRI sensitivity ranged from 41 to 99%, with a median of 84%, 95% CI [81, 87]. Our results showed that tau-PET diagnosis had higher performance as compared to other diagnostic methods in this meta-analysis. CONCLUSION Our findings showed an important discrepancy in diagnostic data for AD between developed and developing countries, which can impact global prevalence estimation and management of AD. Also, our analysis found a better performance for the tau-PET diagnostic over other methods to diagnose AD patients, but the expense of tau-PET scan seems to be the limiting factor in the diagnosis of AD in developing countries such as those found in Asia, Africa, and Latin America.
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Affiliation(s)
- Miguel A. Chávez-Fumagalli
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
| | - Pallavi Shrivastava
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
| | - Jorge A. Aguilar-Pineda
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
| | - Rita Nieto-Montesinos
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
| | - Gonzalo Davila Del-Carpio
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
| | - Antero Peralta-Mestas
- Division of Neurology, Psychiatry and Radiology of the National Hospital ESSALUD-HNCASE, Arequipa, Peru
| | - Claudia Caracela-Zeballos
- Division of Neurology, Psychiatry and Radiology of the National Hospital ESSALUD-HNCASE, Arequipa, Peru
| | - Guillermo Valdez-Lazo
- Division of Neurology, Psychiatry and Radiology of the National Hospital ESSALUD-HNCASE, Arequipa, Peru
| | - Victor Fernandez-Macedo
- Division of Neurology, Psychiatry and Radiology of the National Hospital ESSALUD-HNCASE, Arequipa, Peru
| | - Alejandro Pino-Figueroa
- Department of Pharmaceutical Sciences, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Karin J. Vera-Lopez
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
| | - Christian L. Lino Cardenas
- Laboratory of Genomics and Neurovascular Diseases, Vicerrectorado de investigación, Universidad Católica de Santa Maria, Arequipa, Peru
- Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
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17
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Fontanillo Lopez CA, Li G, Zhang D. Beyond Technologies of Electroencephalography-Based Brain-Computer Interfaces: A Systematic Review From Commercial and Ethical Aspects. Front Neurosci 2020; 14:611130. [PMID: 33390892 PMCID: PMC7773904 DOI: 10.3389/fnins.2020.611130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/13/2020] [Indexed: 01/22/2023] Open
Abstract
The deployment of electroencephalographic techniques for commercial applications has undergone a rapid growth in recent decades. As they continue to expand in the consumer markets as suitable techniques for monitoring the brain activity, their transformative potential necessitates equally significant ethical inquiries. One of the main questions, which arises then when evaluating these kinds of applications, is whether they should be aligned or not with the main ethical concerns reported by scholars and experts. Thus, the present work attempts to unify these disciplines of knowledge by performing a comprehensive scan of the major electroencephalographic market applications as well as their most relevant ethical concerns arising from the existing literature. In this literature review, different databases were consulted, which presented conceptual and empirical discussions and findings about commercial and ethical aspects of electroencephalography. Subsequently, the content was extracted from the articles and the main conclusions were presented. Finally, an external assessment of the outcomes was conducted in consultation with an expert panel in some of the topic areas such as biomedical engineering, biomechatronics, and neuroscience. The ultimate purpose of this review is to provide a genuine insight into the cutting-edge practical attempts at electroencephalography. By the same token, it seeks to highlight the overlap between the market needs and the ethical standards that should govern the deployment of electroencephalographic consumer-grade solutions, providing a practical approach that overcomes the engineering myopia of certain ethical discussions.
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Affiliation(s)
| | - Guangye Li
- The Robotics Institute, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dingguo Zhang
- The Department of Electronic and Electrical Engineering, University of Bath, Bath, United Kingdom
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18
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Pascarelli MT, Del Percio C, De Pandis MF, Ferri R, Lizio R, Noce G, Lopez S, Rizzo M, Soricelli A, Nobili F, Arnaldi D, Famà F, Orzi F, Buttinelli C, Giubilei F, Salvetti M, Cipollini V, Franciotti R, Onofri M, Fuhr P, Gschwandtner U, Ransmayr G, Aarsland D, Parnetti L, Farotti L, Marizzoni M, D'Antonio F, De Lena C, Güntekin B, Hanoğlu L, Yener G, Emek-Savaş DD, Triggiani AI, Paul Taylor J, McKeith I, Stocchi F, Vacca L, Hampel H, Frisoni GB, Bonanni L, Babiloni C. Abnormalities of resting-state EEG in patients with prodromal and overt dementia with Lewy bodies: Relation to clinical symptoms. Clin Neurophysiol 2020; 131:2716-2731. [PMID: 33039748 DOI: 10.1016/j.clinph.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 06/29/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Here we tested if cortical sources of resting state electroencephalographic (rsEEG) rhythms may differ in sub-groups of patients with prodromal and overt dementia with Lewy bodies (DLB) as a function of relevant clinical symptoms. METHODS We extracted clinical, demographic and rsEEG datasets in matched DLB patients (N = 60) and control Alzheimer's disease (AD, N = 60) and healthy elderly (Nold, N = 60) seniors from our international database. The eLORETA freeware was used to estimate cortical rsEEG sources. RESULTS As compared to the Nold group, the DLB and AD groups generally exhibited greater spatially distributed delta source activities (DLB > AD) and lower alpha source activities posteriorly (AD > DLB). As compared to the DLB "controls", the DLB patients with (1) rapid eye movement (REM) sleep behavior disorders showed lower central alpha source activities (p < 0.005); (2) greater cognitive deficits exhibited higher parietal and central theta source activities as well as higher central, parietal, and occipital alpha source activities (p < 0.01); (3) visual hallucinations pointed to greater parietal delta source activities (p < 0.005). CONCLUSIONS Relevant clinical features were associated with abnormalities in spatial and frequency features of rsEEG source activities in DLB patients. SIGNIFICANCE Those features may be used as neurophysiological surrogate endpoints of clinical symptoms in DLB patients in future cross-validation prospective studies.
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Affiliation(s)
| | - Claudio Del Percio
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | | | | | | | | | - Susanna Lopez
- Department of Emergency and Organ Transplantation - Nephrology, Dialysis and Transplantation Unit, Aldo Moro University of Bari, Bari, Italy
| | - Marco Rizzo
- Oasi Research Institute - IRCCS, Troina, Italy
| | - Andrea Soricelli
- IRCCS SDN, Napoli, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | - Flavio Nobili
- Clinica neurologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI), Università di Genova, Italy
| | - Dario Arnaldi
- Clinica neurologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI), Università di Genova, Italy
| | - Francesco Famà
- Dipartimento di Neuroscienze, Oftalmologia, Genetica, Riabilitazione e Scienze Materno-infantili (DiNOGMI), Università di Genova, Italy
| | - Francesco Orzi
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Carla Buttinelli
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Franco Giubilei
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Salvetti
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy; Neuromed: IRCCS Istituto Neurologico Mediterraneo (INM) Neuromed, 86077 Pozzilli, IS, Italy
| | - Virginia Cipollini
- Department of Neuroscience, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Raffaella Franciotti
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Marco Onofri
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Peter Fuhr
- Universitätsspital Basel, Abteilung Neurophysiologie, Petersgraben 4, 4031 Basel, Switzerland
| | - Ute Gschwandtner
- Universitätsspital Basel, Abteilung Neurophysiologie, Petersgraben 4, 4031 Basel, Switzerland
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Faculty of Medicine, Johannes Kepler University, Kepler University Hospital, Krankenhausstr. 9, A-4020 Linz, Austria
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College University, London, UK
| | - Lucilla Parnetti
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Lucia Farotti
- Centre for Memory Disturbances, Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Moira Marizzoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | | | - Carlo De Lena
- Department of Human Neurosciences, Sapienza University of Rome, Italy
| | - Bahar Güntekin
- Department of Biophysics, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Lutfu Hanoğlu
- Department of Neurology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Görsev Yener
- Izmir Biomedicine and Genome Center, Dokuz Eylul University Health Campus, Izmir, Turkey; Department of Neurosciences, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Derya Durusu Emek-Savaş
- Department of Psychology and Department of Neurosciences, Dokuz Eylül University, Izmir, Turkey
| | | | | | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Fabrizio Stocchi
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Laura Vacca
- Institute for Research and Medical Care, IRCCS San Raffaele Pisana, Rome, Italy
| | - Harald Hampel
- Department of Neurology, Institute of Memory and Alzheimer's Disease (IM2A), Brain and Spine Institute (ICM), François Lhermitte Building, France
| | - Giovanni B Frisoni
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy; Memory Clinic and LANVIE - Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences and CESI, University G d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Claudio Babiloni
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy; San Raffaele of Cassino, Cassino, FR, Italy.
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Stylianou M, Zaaimi B, Thomas A, Taylor JP, LeBeau FEN. Early Disruption of Cortical Sleep-Related Oscillations in a Mouse Model of Dementia With Lewy Bodies (DLB) Expressing Human Mutant (A30P) Alpha-Synuclein. Front Neurosci 2020; 14:579867. [PMID: 33041770 PMCID: PMC7527476 DOI: 10.3389/fnins.2020.579867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023] Open
Abstract
Changes in sleep behavior and sleep-related cortical activity have been reported in conditions associated with abnormal alpha-synuclein (α-syn) expression, in particular Parkinson’s disease (PD) and dementia with Lewy bodies (DLB). Notably, changes can occur in patients years before the onset of cognitive decline. Sleep-related network oscillations play a key role in memory function, but how abnormal α-syn impacts the generation of such activity is currently unclear. To determine whether early changes in sleep-related network activity could also be observed, prior to any previously reported cognitive dysfunction, we used mice that over-express human mutant α-syn (A30P). Recordings in vivo were performed under urethane anesthesia in the medial prefrontal cortex (mPFC) and CA1 region of the hippocampus in young male (2.5 – 4 months old) A30P and age-matched wild type (WT) mice. We found that the slow oscillation (SO) < 1 Hz frequency was significantly faster in both the mPFC and hippocampus in A30P mice, and Up-state-associated fast oscillations at beta (20 – 30 Hz) and gamma (30 – 80 Hz) frequencies were delayed relative to the onset of the Up-state. Spindle (8 – 15 Hz) activity in the mPFC was also altered in A30P mice, as spindles were shorter in duration and had reduced density compared to WT. These changes demonstrate that dysregulation of sleep-related oscillations occurs in young A30P mice long before the onset of cognitive dysfunction. Our data suggest that, as seen in patients, changes in sleep-related oscillations are an early consequence of abnormal α-syn aggregation in A30P mice.
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Affiliation(s)
- Myrto Stylianou
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Boubker Zaaimi
- School of Life & Health Sciences, Aston University, Birmingham, United Kingdom
| | - Alan Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona E N LeBeau
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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20
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The Role of EEG in the Diagnosis, Prognosis and Clinical Correlations of Dementia with Lewy Bodies-A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10090616. [PMID: 32825520 PMCID: PMC7555753 DOI: 10.3390/diagnostics10090616] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 12/31/2022] Open
Abstract
Despite improvements in diagnostic criteria for dementia with Lewy bodies (DLB), the ability to discriminate DLB from Alzheimer’s disease (AD) and other dementias remains suboptimal. Electroencephalography (EEG) is currently a supportive biomarker in the diagnosis of DLB. We performed a systematic review to better clarify the diagnostic and prognostic role of EEG in DLB and define the clinical correlates of various EEG features described in DLB. MEDLINE, EMBASE, and PsycINFO were searched using search strategies for relevant articles up to 6 August 2020. We included 43 studies comparing EEG in DLB with other diagnoses, 42 of them included a comparison of DLB with AD, 10 studies compared DLB with Parkinson’s disease dementia, and 6 studies compared DLB with other dementias. The studies were visual EEG assessment (6), quantitative EEG (35) and event-related potential studies (2). The most consistent observation was the slowing of the dominant EEG rhythm (<8 Hz) assessed visually or through quantitative EEG, which was observed in ~90% of patients with DLB and only ~10% of patients with AD. Other findings based on qualitative rating, spectral power analyses, connectivity, microstate and machine learning algorithms were largely heterogenous due to differences in study design, EEG acquisition, preprocessing and analysis. EEG protocols should be standardized to allow replication and validation of promising EEG features as potential biomarkers in DLB.
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21
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Schumacher J, Taylor JP, Hamilton CA, Firbank M, Cromarty RA, Donaghy PC, Roberts G, Allan L, Lloyd J, Durcan R, Barnett N, O'Brien JT, Thomas AJ. Quantitative EEG as a biomarker in mild cognitive impairment with Lewy bodies. ALZHEIMERS RESEARCH & THERAPY 2020; 12:82. [PMID: 32641111 PMCID: PMC7346501 DOI: 10.1186/s13195-020-00650-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
Objectives To investigate using quantitative EEG the (1) differences between patients with mild cognitive impairment with Lewy bodies (MCI-LB) and MCI with Alzheimer’s disease (MCI-AD) and (2) its utility as a potential biomarker for early differential diagnosis. Methods We analyzed eyes-closed, resting-state, high-density EEG data from highly phenotyped participants (39 MCI-LB, 36 MCI-AD, and 31 healthy controls). EEG measures included spectral power in different frequency bands (delta, theta, pre-alpha, alpha, and beta), theta/alpha ratio, dominant frequency, and dominant frequency variability. Receiver operating characteristic (ROC) analyses were performed to assess diagnostic accuracy. Results There was a shift in power from beta and alpha frequency bands towards slower frequencies in the pre-alpha and theta range in MCI-LB compared to healthy controls. Additionally, the dominant frequency was slower in MCI-LB compared to controls. We found significantly increased pre-alpha power, decreased beta power, and slower dominant frequency in MCI-LB compared to MCI-AD. EEG abnormalities were more apparent in MCI-LB cases with more diagnostic features. There were no significant differences between MCI-AD and controls. In the ROC analysis to distinguish MCI-LB from MCI-AD, beta power and dominant frequency showed the highest area under the curve values of 0.71 and 0.70, respectively. While specificity was high for some measures (up to 0.97 for alpha power and 0.94 for theta/alpha ratio), sensitivity was generally much lower. Conclusions Early EEG slowing is a specific feature of MCI-LB compared to MCI-AD. However, there is an overlap between the two MCI groups which makes it difficult to distinguish between them based on EEG alone.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.,Institute of Health Research, University of Exeter, Exeter, UK
| | - Jim Lloyd
- Nuclear Medicine Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rory Durcan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, CB2 0SP, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building 3rd floor, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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22
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van der Zande JJ, Gouw AA, van Steenoven I, van de Beek M, Scheltens P, Stam CJ, Lemstra AW. Diagnostic and prognostic value of EEG in prodromal dementia with Lewy bodies. Neurology 2020; 95:e662-e670. [PMID: 32636325 DOI: 10.1212/wnl.0000000000009977] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/27/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Early biomarkers for dementia with Lewy bodies (DLB) are lacking. To determine whether EEG differentiates the prodromal phase of DLB from other causes of mild cognitive impairment (MCI) and whether EEG is predictive for time to conversion from MCI to DLB, we compared EEGs and clinical follow-up of patients with MCI due to DLB with those of patients with MCI due to Alzheimer disease (MCI-AD). METHODS We compared 37 patients with MCI who developed DLB during follow-up or had an abnormal 123I-PF-CIT SPECT scan (MCI-DLB) with 67 age-matched patients with MCI-AD. EEGs were assessed visually with a score of increasing abnormality (range 1-5). We performed fast Fourier transform to analyze the power spectrum. With survival analyses, EEG characteristics were related to time to progression to dementia. RESULTS The visual EEG score was higher in MCI-DLB (score >2 in 60%) compared to MCI-AD (score >2 in 8%, p < 0.001). We found frontal intermittent delta activity in 22% of MCI-DLB, not in MCI-AD. Patients with MCI-DLB had a lower peak frequency (7.5 [6.0-9.9] Hz vs 8.8 [6.8-10.2] in MCI-AD, p < 0.001) and more slow-wave activity. Several individual EEG measures showed good performance to discriminate MCI-DLB from MCI-AD (areas under the curve up to 0.94). In MCI-DLB, high visual EEG score, diffuse abnormalities, and low α2 power were related to time to progression to dementia (hazard ratios 4.1, 9.9, 5.1, respectively). CONCLUSIONS Profound EEG abnormalities are already present in the prodromal stage of DLB and have diagnostic and prognostic value. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that EEG abnormalities are more common in MCI-DLB than MCI-AD.
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Affiliation(s)
- Jessica Joanne van der Zande
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands.
| | - Alida A Gouw
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Inger van Steenoven
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Marleen van de Beek
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Philip Scheltens
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Cornelis Jan Stam
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Afina Willemina Lemstra
- From the Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience (J.J.v.d.Z., A.A.G., I.v.S., M.v.d.B., P.S., A.W.L.), and Department of Clinical Neurophysiology (A.A.G., C.J.S.), Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
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23
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O'Dowd S, Schumacher J, Burn DJ, Bonanni L, Onofrj M, Thomas A, Taylor JP. Fluctuating cognition in the Lewy body dementias. Brain 2020; 142:3338-3350. [PMID: 31411317 DOI: 10.1093/brain/awz235] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023] Open
Abstract
Fluctuating cognition is a core diagnostic feature of dementia with Lewy bodies and is also a key clinical feature of Parkinson's disease dementia. These dementias share common pathological features and are referred to as Lewy body dementias. Whilst highly prevalent in Lewy body dementia, with up to 90% of patients experiencing the symptom at some point in the disease trajectory, clinical identification of fluctuating cognition is often challenging. Furthermore, its underlying pathophysiological processes remain unclear. However, neuroimaging and neurophysiological techniques have recently provided insight into potential drivers of the phenomenon. In this update, we review data pertaining to clinical features and underlying mechanisms of fluctuating cognition in Lewy body dementia. We collate evidence for different proposed aetiologies: fluctuating cognition as an attentional disorder, as a consequence of loss of cholinergic drive, as a manifestation of failure in neuronal efficiency and synchrony, and as a disorder of sleep/arousal. We also review data relating to putative mechanisms that have received less attention to date. Increased understanding of fluctuating cognition may help to illuminate pathophysiological mechanisms in cognitive processing in Lewy body dementia, guide future research, and facilitate the design of targeted therapeutic approaches.
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Affiliation(s)
- Seán O'Dowd
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Department of Neurology, Tallaght University Hospital, Dublin 24, Ireland; Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - David J Burn
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science and Aging Research Centre, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Alan Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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24
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Schumacher J, Thomas AJ, Peraza LR, Firbank M, Cromarty R, Hamilton CA, Donaghy PC, O'Brien JT, Taylor JP. EEG alpha reactivity and cholinergic system integrity in Lewy body dementia and Alzheimer's disease. Alzheimers Res Ther 2020; 12:46. [PMID: 32321573 PMCID: PMC7178985 DOI: 10.1186/s13195-020-00613-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/02/2020] [Indexed: 11/14/2023]
Abstract
BACKGROUND Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), is characterised by marked deficits within the cholinergic system which are more severe than in Alzheimer's disease (AD) and are mainly caused by degeneration of the nucleus basalis of Meynert (NBM) whose widespread cholinergic projections provide the main source of cortical cholinergic innervation. EEG alpha reactivity, which refers to the reduction in alpha power over occipital electrodes upon opening the eyes, has been suggested as a potential marker of cholinergic system integrity. METHODS Eyes-open and eyes-closed resting state EEG data were recorded from 41 LBD patients (including 24 patients with DLB and 17 with PDD), 21 patients with AD, and 40 age-matched healthy controls. Alpha reactivity was calculated as the relative reduction in alpha power over occipital electrodes when opening the eyes. Structural MRI data were used to assess volumetric changes within the NBM using a probabilistic anatomical map. RESULTS Alpha reactivity was reduced in AD and LBD patients compared to controls with a significantly greater reduction in LBD compared to AD. Reduced alpha reactivity was associated with smaller volumes of the NBM across all groups (ρ = 0.42, pFDR = 0.0001) and in the PDD group specifically (ρ = 0.66, pFDR = 0.01). CONCLUSIONS We demonstrate that LBD patients show an impairment in alpha reactivity upon opening the eyes which distinguishes this form of dementia from AD. Furthermore, our results suggest that reduced alpha reactivity might be related to a loss of cholinergic drive from the NBM, specifically in PDD.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK.
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | | | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - Ruth Cromarty
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
| | - John T O'Brien
- Department of Psychiatry, School of Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Biomedical Research Building 3rd floor, Newcastle upon Tyne, NE4 5PL, UK
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25
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Chabran E, Noblet V, Loureiro de Sousa P, Demuynck C, Philippi N, Mutter C, Anthony P, Martin-Hunyadi C, Cretin B, Blanc F. Changes in gray matter volume and functional connectivity in dementia with Lewy bodies compared to Alzheimer's disease and normal aging: implications for fluctuations. Alzheimers Res Ther 2020; 12:9. [PMID: 31907068 PMCID: PMC6945518 DOI: 10.1186/s13195-019-0575-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/23/2019] [Indexed: 12/02/2022]
Abstract
BACKGROUND Fluctuations are one of the core clinical features characterizing dementia with Lewy bodies (DLB). They represent a determining factor for its diagnosis and strongly impact the quality of life of patients and their caregivers. However, the neural correlates of this complex symptom remain poorly understood. This study aimed to investigate the structural and functional changes in DLB patients, compared to Alzheimer's disease (AD) patients and healthy elderly subjects, and their potential links with fluctuations. METHODS Structural and resting-state functional MRI data were collected from 92 DLB patients, 70 AD patients, and 22 control subjects, who also underwent a detailed clinical examination including the Mayo Clinic Fluctuation Scale. Gray matter volume changes were analyzed using whole-brain voxel-based morphometry, and resting-state functional connectivity was investigated using a seed-based analysis, with regions of interest corresponding to the main nodes of the salience network (SN), frontoparietal network (FPN), dorsal attention network (DAN), and default mode network (DMN). RESULTS At the structural level, fluctuation scores in DLB patients did not relate to the atrophy of insular, temporal, and frontal regions typically found in this pathology, but instead showed a weak correlation with more subtle volume reductions in different regions of the cholinergic system. At the functional level, the DLB group was characterized by a decreased connectivity within the SN and attentional networks, while the AD group showed decreases within the SN and DMN. In addition, higher fluctuation scores in DLB patients were correlated to a greater connectivity of the SN with the DAN and left thalamus, along with a decreased connectivity between the SN and DMN, and between the right thalamus and both the FPN and DMN. CONCLUSIONS Functional connectivity changes, rather than significant gray matter loss, could play an important role in the emergence of fluctuations in DLB. Notably, fluctuations in DLB patients appeared to be related to a disturbed external functional connectivity of the SN, which may lead to less relevant transitions between different cognitive states in response to internal and environmental stimuli. Our results also suggest that the thalamus could be a key region for the occurrence of this symptom.
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Affiliation(s)
- Eléna Chabran
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Vincent Noblet
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Paulo Loureiro de Sousa
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
| | - Catherine Demuynck
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Nathalie Philippi
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Catherine Mutter
- INSERM Centre d’Investigation Clinique 1434, University Hospitals of Strasbourg, Strasbourg, France
| | - Pierre Anthony
- General Hospital Centre, Geriatrics Department, CM2R, Geriatric Day Hospital, Colmar, France
| | - Catherine Martin-Hunyadi
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Benjamin Cretin
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
| | - Frédéric Blanc
- ICube Laboratory UMR 7357 and FMTS (Fédération de Médecine Translationnelle de Strasbourg), Team IMIS, University of Strasbourg and CNRS, Strasbourg, France
- CM2R (Research and Resources Memory Centre), Geriatrics Department, University Hospitals of Strasbourg, Geriatric Day Hospital and Neuropsychology Unit, Strasbourg, France
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26
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Mehraram R, Kaiser M, Cromarty R, Graziadio S, O'Brien JT, Killen A, Taylor JP, Peraza LR. Weighted network measures reveal differences between dementia types: An EEG study. Hum Brain Mapp 2019; 41:1573-1590. [PMID: 31816147 PMCID: PMC7267959 DOI: 10.1002/hbm.24896] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/03/2019] [Accepted: 11/29/2019] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of dementia with Lewy bodies (DLB) versus Alzheimer's disease (AD) can be difficult especially early in the disease process. However, one inexpensive and non‐invasive biomarker which could help is electroencephalography (EEG). Previous studies have shown that the brain network architecture assessed by EEG is altered in AD patients compared with age‐matched healthy control people (HC). However, similar studies in Lewy body diseases, that is, DLB and Parkinson's disease dementia (PDD) are still lacking. In this work, we (a) compared brain network connectivity patterns across conditions, AD, DLB and PDD, in order to infer EEG network biomarkers that differentiate between these conditions, and (b) tested whether opting for weighted matrices led to more reliable results by better preserving the topology of the network. Our results indicate that dementia groups present with reduced connectivity in the EEG α band, whereas DLB shows weaker posterior–anterior patterns within the β‐band and greater network segregation within the θ‐band compared with AD. Weighted network measures were more consistent across global thresholding levels, and the network properties reflected reduction in connectivity strength in the dementia groups. In conclusion, β‐ and θ‐band network measures may be suitable as biomarkers for discriminating DLB from AD, whereas the α‐band network is similarly affected in DLB and PDD compared with HC. These variations may reflect the impairment of attentional networks in Parkinsonian diseases such as DLB and PDD.
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Affiliation(s)
- Ramtin Mehraram
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK.,Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruth Cromarty
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Newcastle in vitro Diagnostics Co-operative, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alison Killen
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,IXICO Plc, London, UK
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27
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Abstract
Currently established and employed biomarkers of Alzheimer's disease (AD) predominantly mirror AD-associated molecular and structural brain changes. While they are necessary for identifying disease-specific neuropathology, they lack a clear and robust relationship with the clinical presentation of dementia; they can be altered in healthy individuals, while they often inadequately mirror the degree of cognitive and functional deficits in affected subjects. There is growing evidence that synaptic loss and dysfunction are early events during the trajectory of AD pathogenesis that best correlate with the clinical symptoms, suggesting measures of brain functional deficits as candidate early markers of AD. Resting-state electroencephalography (EEG) is a widely available and noninvasive diagnostic method that provides direct insight into brain synaptic activity in real time. Quantitative EEG (qEEG) analysis additionally provides information on physiologically meaningful frequency components, dynamic alterations and topography of EEG signal generators, i.e. neuronal signaling. Numerous studies have shown that qEEG measures can detect disruptions in activity, topographical distribution and synchronization of neuronal (synaptic) activity such as generalized EEG slowing, reduced global synchronization and anteriorization of neuronal generators of fast-frequency resting-state EEG activity in patients along the AD continuum. Moreover, qEEG measures appear to correlate well with surrogate markers of AD neuropathology and discriminate between different types of dementia, making them promising low-cost and noninvasive markers of AD. Future large-scale longitudinal clinical studies are needed to elucidate the diagnostic and prognostic potential of qEEG measures as early functional markers of AD on an individual subject level.
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Affiliation(s)
- Una Smailovic
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Vesna Jelic
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Clinic for Cognitive Disorders, Theme Aging, Karolinska University Hospital, Huddinge, Sweden
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28
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Matar E, Shine JM, Halliday GM, Lewis SJG. Cognitive fluctuations in Lewy body dementia: towards a pathophysiological framework. Brain 2019; 143:31-46. [DOI: 10.1093/brain/awz311] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/21/2019] [Accepted: 08/16/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Fluctuating cognition is a complex and disabling symptom that is seen most frequently in the context of Lewy body dementias encompassing dementia with Lewy bodies and Parkinson’s disease dementia. In fact, since their description over three decades ago, cognitive fluctuations have remained a core diagnostic feature of dementia with Lewy bodies, the second most common dementia in the elderly. In the absence of reliable biomarkers for Lewy body pathology, the inclusion of such patients in therapeutic trials depends on the accurate identification of such core clinical features. Yet despite their diagnostic relevance, cognitive fluctuations remain poorly understood, in part due to the lack of a cohesive clinical and scientific explanation of the phenomenon itself. Motivated by this challenge, the present review examines the history, clinical phenomenology and assessment of cognitive fluctuations in the Lewy body dementias. Based on these data, the key neuropsychological, neurophysiological and neuroimaging correlates of cognitive fluctuations are described and integrated into a novel testable heuristic framework from which new insights may be gained.
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Affiliation(s)
- Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - James M Shine
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Glenda M Halliday
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
| | - Simon J G Lewis
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, NSW Australia
- Parkinson’s Disease Research Clinic, Brain and Mind Centre, University of Sydney, NSW, Australia
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29
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Schumacher J, Peraza LR, Firbank M, Thomas AJ, Kaiser M, Gallagher P, O’Brien JT, Blamire AM, Taylor JP. Dysfunctional brain dynamics and their origin in Lewy body dementia. Brain 2019; 142:1767-1782. [PMID: 30938426 PMCID: PMC6536851 DOI: 10.1093/brain/awz069] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 01/06/2019] [Accepted: 01/27/2019] [Indexed: 01/08/2023] Open
Abstract
Lewy body dementia includes dementia with Lewy bodies and Parkinson's disease dementia and is characterized by transient clinical symptoms such as fluctuating cognition, which might be driven by dysfunction of the intrinsic dynamic properties of the brain. In this context we investigated whole-brain dynamics on a subsecond timescale in 42 Lewy body dementia compared to 27 Alzheimer's disease patients and 18 healthy controls using an EEG microstate analysis in a cross-sectional design. Microstates are transiently stable brain topographies whose temporal characteristics provide insight into the brain's dynamic repertoire. Our additional aim was to explore what processes in the brain drive microstate dynamics. We therefore studied associations between microstate dynamics and temporal aspects of large-scale cortical-basal ganglia-thalamic interactions using dynamic functional MRI measures given the putative role of these subcortical areas in modulating widespread cortical function and their known vulnerability to Lewy body pathology. Microstate duration was increased in Lewy body dementia for all microstate classes compared to Alzheimer's disease (P < 0.001) and healthy controls (P < 0.001), while microstate dynamics in Alzheimer's disease were largely comparable to healthy control levels, albeit with altered microstate topographies. Correspondingly, the number of distinct microstates per second was reduced in Lewy body dementia compared to healthy controls (P < 0.001) and Alzheimer's disease (P < 0.001). In the dementia with Lewy bodies group, mean microstate duration was related to the severity of cognitive fluctuations (ρ = 0.56, PFDR = 0.038). Additionally, mean microstate duration was negatively correlated with dynamic functional connectivity between the basal ganglia (r = - 0.53, P = 0.003) and thalamic networks (r = - 0.38, P = 0.04) and large-scale cortical networks such as visual and motor networks in Lewy body dementia. The results indicate a slowing of microstate dynamics and disturbances to the precise timing of microstate sequences in Lewy body dementia, which might lead to a breakdown of the intricate dynamic properties of the brain, thereby causing loss of flexibility and adaptability that is crucial for healthy brain functioning. When contrasted with the largely intact microstate dynamics in Alzheimer's disease, the alterations in dynamic properties in Lewy body dementia indicate a brain state that is less responsive to environmental demands and might give rise to the apparent slowing in thinking and intermittent confusion which typify Lewy body dementia. By using Lewy body dementia as a probe pathology we demonstrate a potential link between dynamic functional MRI fluctuations and microstate dynamics, suggesting that dynamic interactions within the cortical-basal ganglia-thalamic loop might play a role in the modulation of EEG dynamics.
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Affiliation(s)
- Julia Schumacher
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Luis R Peraza
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Firbank
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Alan J Thomas
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, UK
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, The Henry Wellcome Building, Newcastle upon Tyne, UK
| | - John T O’Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Andrew M Blamire
- Institute of Cellular Medicine and Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
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30
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Outeiro TF, Koss DJ, Erskine D, Walker L, Kurzawa-Akanbi M, Burn D, Donaghy P, Morris C, Taylor JP, Thomas A, Attems J, McKeith I. Dementia with Lewy bodies: an update and outlook. Mol Neurodegener 2019; 14:5. [PMID: 30665447 PMCID: PMC6341685 DOI: 10.1186/s13024-019-0306-8] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/08/2019] [Indexed: 01/17/2023] Open
Abstract
Dementia with Lewy bodies (DLB) is an age-associated neurodegenerative disorder producing progressive cognitive decline that interferes with normal life and daily activities. Neuropathologically, DLB is characterised by the accumulation of aggregated α-synuclein protein in Lewy bodies and Lewy neurites, similar to Parkinson’s disease (PD). Extrapyramidal motor features characteristic of PD, are common in DLB patients, but are not essential for the clinical diagnosis of DLB. Since many PD patients develop dementia as disease progresses, there has been controversy about the separation of DLB from PD dementia (PDD) and consensus reports have put forward guidelines to assist clinicians in the identification and management of both syndromes. Here, we present basic concepts and definitions, based on our current understanding, that should guide the community to address open questions that will, hopefully, lead us towards improved diagnosis and novel therapeutic strategies for DLB and other synucleinopathies.
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Affiliation(s)
- Tiago Fleming Outeiro
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK. .,Department of Experimental Neurodegeneration, Center for Nanoscale Microscopy and Molecular Physiology of the Brain, Center for Biostructural Imaging of Neurodegeneration, University Medical Center Göttingen, Göttingen, Germany. .,Max Planck Institute for Experimental Medicine, Göttingen, Germany.
| | - David J Koss
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Daniel Erskine
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Lauren Walker
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Marzena Kurzawa-Akanbi
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - David Burn
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Paul Donaghy
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Christopher Morris
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - John-Paul Taylor
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Alan Thomas
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Johannes Attems
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK
| | - Ian McKeith
- Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle Upon Tyne, NE2 4HH, UK.
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31
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Influence of Stainless Needle Electrodes and Silver Disk Electrodes over the Interhemispheric Cerebral Coherence Value in Vigil Dogs. SENSORS 2018; 18:s18113990. [PMID: 30453513 PMCID: PMC6264086 DOI: 10.3390/s18113990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022]
Abstract
Electroencephalography (EEG) is an objective diagnostic tool in the evaluation of cerebral functionality, both in human and veterinary medicine. For EEG acquisition, different types of electrodes are used, as long as they have no impact on the recorded background activity. However, to date, the influence of electrode type on quantitative EEG and cerebral coherence has not been investigated. Twenty EEG traces (ten with needle electrodes and ten with disk electrodes) were recorded from ten mesocephalic vigil dogs in a monopolar montage. Values for interhemispheric coherence for each frequency band were compared between stainless needle and silver disk electrodes traces. Our results show that the values of interhemispheric coherence in vigil dogs are depending of the type of electrodes used in EEG recordings. In the frontal (FP) channel, for delta and theta frequency bands, the registered coherence is significantly higher when stainless needle electrodes are used. Our results might have important consequences in the field of canine neurology and applied neuroscience, as the frontal channel analysis is preferred in aging and behavior studies.
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32
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Goldstein E, Ertekin-Taner N, Stephens A, Carrasquillo M, Boeve B, Tatum W, Feyissa A. Electroencephalogram findings in patients with posterior cortical atrophy. Neurol Neurochir Pol 2018; 52:690-694. [DOI: 10.1016/j.pjnns.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 09/22/2018] [Accepted: 09/22/2018] [Indexed: 11/15/2022]
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