Alpha desynchronization during Stroop test unmasks cognitively healthy individuals with abnormal CSF Amyloid/Tau

Diagnostic utility of electrophysiological markers for early and differential diagnosis of Alzheimer's, Frontotemporal, and Lewy Body dementias: A systematic review

BACKGROUND

An early and accurate diagnosis is crucial to provide optimal patient care in neurodegenerative diseases. Although an EEG shows advantages in availability and cost compared to the current diagnostic tools, it is not routinely used in clinical practice. Previous reviews have either focused on single disease populations and/or solely on resting-state EEG. To evaluate the utility of EEG for early diagnosis and differential diagnosis, we conducted a systematic review across Alzheimer's disease (AD), Frontotemporal Dementia (FTD) and Lewy Body Dementia (DLB).

METHODS

We searched databases Pubmed, Cochrane, Web of Science, and Scopus for articles published from 2000 to 2023 investigating resting-state and task-based EEG-markers in biomarker-proven AD, FTD and DLB.

RESULTS

Our search yielded a total of 12010 studies, of which 70 papers were eligible: 34 on AD, 18 on DLB, 9 on FTD, and 9 studies combining disease populations. Slowing of the frequency spectrum was a common observation across diseases, achieving excellent sensitivity in AD and DLB. Research on FTD was limited and with varying results in the discrimination from healthy controls, although connectivity analysis and microstates are promising avenues. In differential diagnosis, both spectral and connectivity metrics show encouraging results. Task-based EEG emerges as a promising tool in early AD.

CONCLUSION

EEG shows promise as a cost-effective, non-invasive tool for early detection and differential diagnosis. Future research should aim to collect standardized data from multicentric cohorts, across multiple diseases and stages, and explore the neural underpinnings of these diseases, to improve interpretability of the findings.

Temporal dynamics analysis reveals that concurrent working memory load eliminates the Stroop effect through disrupting stimulus-response mapping

Concurrent verbal working memory task can eliminate the color-word Stroop effect. Previous research, based on specific and limited resources, suggested that the disappearance of the conflict effect was due to the memory information preempting the resources for distractors. However, it remains unclear which particular stage of Stroop conflict processing is influenced by working memory loads. In this study, electroencephalography (EEG) recordings with event-related potential (ERP) analyses, time-frequency analyses, multivariate pattern analyses (MVPAs), and representational similarity analyses (RSAs) were applied to provide an in-depth investigation of the aforementioned issue. Subjects were required to complete the single task (the classical manual color-word Stroop task) and the dual task (the Sternberg working memory task combined with the Stroop task), respectively. Behaviorally, the results indicated that the Stroop effect was eliminated in the dual-task condition. The EEG results showed that the concurrent working memory task did not modulate the P1, N450, and alpha bands. However, it modulated the sustained potential (SP), late theta (740-820 ms), and beta (920-1040 ms) power, showing no difference between congruent and incongruent trials in the dual-task condition but significant difference in the single-task condition. Importantly, the RSA results revealed that the neural activation pattern of the late theta was similar to the response interaction pattern. Together, these findings implied that the concurrent working memory task eliminated the Stroop effect through disrupting stimulus-response mapping.

Executive control from healthy ageing to cognitive impairment: A systematic review of stroop and simon effects using psychophysiological and imaging techniques

BACKGROUND

The prevalence of cognitive impairment and dementia in the ageing population emphasises the need for strategies to mitigate cognitive decline. While research on Alzheimer's Disease (AD) has focused on early risk factors, less attention has been paid to protective factors such as cognitive reserve (CR) and cognitive control (CC).

METHODS

This review examines age-related changes in the prefrontal cortex (PFC) in healthy ageing and cognitive impairment. We analysed studies using Stroop and Simon tasks in conjunction with EEG, EEG/ERP, fNIRS and fMRI.

RESULTS

Of the 1411 articles reviewed, 49 studies met our criteria. The results suggest that the Stroop and Simon effects are essential for distinguishing between healthy ageing and cognitive impairment. Increased activity of the PFC supports task performance, especially in cognitive ageing. However, when compensatory mechanisms fail, deficits in Stroop and Simon effects may indicate cognitive impairment and reduced activation of the PFC.

CONCLUSION

This review emphasises the critical role of CR in attenuating age-related cognitive decline and highlights the importance of the PFC in maintaining CC.

Analysis of individual alpha frequency in a large cohort from a tertiary memory center

BACKGROUND AND PURPOSE

Precise and timely diagnosis is crucial for the optimal use of emerging disease-modifying treatments for Alzheimer disease (AD). Electroencephalography (EEG), which is noninvasive and cost-effective, can capture neural abnormalities linked to various dementias. This study explores the use of individual alpha frequency (IAF) derived from EEG as a diagnostic and prognostic tool in cognitively impaired patients.

METHODS

This retrospective study included 375 patients from the tertiary Memory Clinic of IRCCS San Raffaele Hospital, Milan, Italy. Participants underwent clinical and neuropsychological assessments, brain imaging, cerebrospinal fluid biomarker analysis, and resting-state EEG. Patients were categorized by amyloid status, the AT(N) classification system, clinical diagnosis, and mild cognitive impairment (MCI) progression to AD dementia. IAF was calculated and compared among study groups. Receiver operating characteristic (ROC) analysis was used to calculate its discriminative performance.

RESULTS

IAF was higher in amyloid-negative subjects and varied significantly across AT(N) groups. ROC analysis confirmed IAF's ability to distinguish A-T-N- from the A+T+N+ and A+T-N+ groups. IAF was lower in AD and Lewy body dementia patients compared to MCI and other dementia types, with moderate discriminatory capability. Among A+ MCI patients, IAF was significantly lower in those who converted to AD within 2 years compared to stable MCI patients and predicted time to conversion (p < 0.001, R = 0.38).

CONCLUSIONS

IAF is a valuable tool for dementia diagnosis and prognosis, correlating with amyloid status and neurodegeneration. It effectively predicts MCI progression to AD, supporting its use in early, targeted interventions in the context of disease-modifying treatments.

Associations of Plasma Glutamatergic Metabolites with Alpha Desynchronization during Cognitive Interference and Working Memory Tasks in Asymptomatic Alzheimer's Disease

Electroencephalogram (EEG) studies have suggested compensatory brain overactivation in cognitively healthy (CH) older adults with pathological beta-amyloid(Aβ42)/tau ratios during working memory and interference processing. However, the association between glutamatergic metabolites and brain activation proxied by EEG signals has not been thoroughly investigated. We aim to determine the involvement of these metabolites in EEG signaling. We focused on CH older adults classified under (1) normal CSF Aβ42/tau ratios (CH-NATs) and (2) pathological Aβ42/tau ratios (CH-PATs). We measured plasma glutamine, glutamate, pyroglutamate, and γ-aminobutyric acid concentrations using tandem mass spectrometry and conducted a correlational analysis with alpha frequency event-related desynchronization (ERD). Under the N-back working memory paradigm, CH-NATs presented negative correlations (r = ~-0.74--0.96, p = 0.0001-0.0414) between pyroglutamate and alpha ERD but positive correlations (r = ~0.82-0.95, p = 0.0003-0.0119) between glutamine and alpha ERD. Under Stroop interference testing, CH-NATs generated negative correlations between glutamine and left temporal alpha ERD (r = -0.96, p = 0.037 and r = -0.97, p = 0.027). Our study demonstrated that glutamine and pyroglutamate levels were associated with EEG activity only in CH-NATs. These results suggest cognitively healthy adults with amyloid/tau pathology experience subtle metabolic dysfunction that may influence EEG signaling during cognitive challenge. A longitudinal follow-up study with a larger sample size is needed to validate these pilot studies.

Practice makes imperfect: stronger implicit interference with practice in individuals at high risk of developing Alzheimer's disease

Early screening to determine patient risk of developing Alzheimer's will allow better interventions and planning but necessitates accessible methods such as behavioral biomarkers. Previously, we showed that cognitively healthy older individuals whose cerebrospinal fluid amyloid/tau ratio indicates high risk of cognitive decline experienced implicit interference during a high-effort task, signaling early changes in attention. To further investigate attention's effect on implicit interference, we analyzed two experiments completed sequentially by the same high- and low-risk individuals. We hypothesized that if attention modulates interference, practice would affect the influence of implicit distractors. Indeed, while both groups experienced a strong practice effect, the association between practice and interference effects diverged between groups: stronger practice effects correlated with more implicit interference in high-risk participants, but less interference in low-risk individuals. Furthermore, low-risk individuals showed a positive correlation between implicit interference and EEG low-range alpha event-related desynchronization when switching from high- to low-load tasks. This suggests that lower attention on the task was correlated with stronger interference, a typical phenomenon in the younger population. These results demonstrate how attention impacts implicit interference and highlight early differences in perception between high- and low-risk individuals.

Resting heart rate (variability) and cognition relationships reveal cognitively healthy individuals with pathological amyloid/tau ratio

Introduction

Resting heart rate (HR) and heart rate variability (HRV) have been linked with cognition in the general population and in older individuals. The knowledge of this aspect of heart-brain relationship is relatively absent in older individuals with early Alzheimer's disease (AD) pathology. This study explores relationships of the HR, HRV, and cognition in cognitively healthy individuals with pathological amyloid/tau ratio (CH-PATs) in cerebral spinal fluid (CSF) compared to those with normal ratio (CH-NATs).

Methods

We examined therelationshipsbetween1) resting HR and Mini-Mental State Examination (MMSE); 2) resting HR and brain processing during Stroop interference; and 3) resting vagally mediated HRV (vmHRV) and task switching performance.

Results

Our studies showed that compared to CH-NATs, those CH-PATs with higher resting HR presented with lower MMSE, and less brain activation during interference processing. In addition, resting vmHRV was significantly correlated with task switching accuracy in CH-NATs, but not in CH-PATs.

Discussion

Thesethreedifferenttestsindicatedysfunctionalheart-brainconnections in CH-PATs, suggesting a potential cardio-cerebral dysfunctional integration.

Practice makes imperfect: stronger implicit interference with practice in individuals at high risk of developing Alzheimer's disease

Early screening to determine patient risk of developing Alzheimer's will allow better interventions and planning but necessitates accessible methods such as behavioral biomarkers. Previously, we showed that cognitively healthy older individuals whose cerebrospinal fluid amyloid / tau ratio indicates high risk of cognitive decline experienced implicit interference during a high-effort task, signaling early changes in attention. To further investigate attention's effect on implicit interference, we analyzed two experiments completed sequentially by the same high- and low-risk individuals. We hypothesized that if attention modulates interference, practice would affect the influence of implicit distractors. Indeed, while both groups experienced a strong practice effect, the association between practice and interference effects diverged between groups: stronger practice effects correlated with more implicit interference in high-risk participants, but less interference in low-risk individuals. Furthermore, low-risk individuals showed a positive correlation between implicit interference and EEG low-range alpha event-related desynchronization when switching from high- to low-load tasks. These results demonstrate how attention impacts implicit interference and highlight early differences in cognition between high- and low-risk individuals.

Stroop in motion: Neurodynamic modulation underlying interference control while sitting, standing, and walking

There is conflicting evidence about how interference control in healthy adults is affected by walking as compared to standing or sitting. Although the Stroop paradigm is one of the best-studied paradigms to investigate interference control, the neurodynamics associated with the Stroop task during walking have never been studied. We investigated three Stroop tasks using variants with increasing interference levels - word-reading, ink-naming, and the switching of the two tasks, combined in a systematic dual-tasking fashion with three motor conditions - sitting, standing, and treadmill walking. Neurodynamics underlying interference control were recorded using the electroencephalogram. Worsened performance was observed for the incongruent compared to congruent trials and for the switching Stroop compared to the other two variants. The early frontocentral event-related potentials (ERPs) associated with executive functions (P2, N2) differentially signaled posture-related workloads, while the later stages of information processing indexed faster interference suppression and response selection in walking compared to static conditions. The early P2 and N2 components as well as frontocentral Theta and parietal Alpha power were sensitive to increasing workloads on the motor and cognitive systems. The distinction between the type of load (motor and cognitive) became evident only in the later posterior ERP components in which the amplitude non-uniformly reflected the relative attentional demand of a task. Our data suggest that walking might facilitate selective attention and interference control in healthy adults. Existing interpretations of ERP components recorded in stationary settings should be considered with care as they might not be directly transferable to mobile settings.

Short-term PM2.5 exposure and cognitive function: Association and neurophysiological mechanisms

BACKGROUND

Although converging evidence has demonstrated that exposure to fine particulate matter (PM_2.5) caused adverse effects on brain structure and cognitive function, the association between the short-term exposure to PM_2.5 and cognition dysfunction remained underexplored, especially possible neurophysiological mechanisms.

METHODS

We conducted a longitudinal observational study with four repeated measurement sessions among 90 young adults from September 2020 to June 2021. During each measurement session, we measured participants' personal-level air pollution exposure for one week with portable monitors, followed by executive function assessment and electrophysiological signal recording at an assessment center. Standard Stroop color-word test was used accompanied with electroencephalogram (EEG) recording to assess performance on executive function. We used linear mixed-effect model with lagged values of PM_2.5 levels to analyze the association between PM_2.5 exposure and changes in executive function, and mediation analysis to investigate mediation effect by EEG signal.

RESULTS

Adjusted mixed-effect models demonstrated that elevated PM_2.5 exposure three days prior to cognitive assessment (lag-3) was associated with (1) declined performance in both congruent and incongruent tasks in Stroop test, (2) reduced lower and upper alpha event-related desynchronization (ERD) during 500-1000 ms after stimuli, both indicating impaired executive control. Lower and upper alpha ERD also mediated observed associations between short-term PM_2.5 exposure and executive function. No significant associations were found between short-term PM_2.5 exposure or aperiodic exponents in tonic and phasic states, or periodic alpha oscillations in tonic state.

CONCLUSION

Our results provided evidence that short-term PM_2.5 exposure was associated with executive dysfunction. Reduced alpha ERD was likely to be the underlying pathway through which PM_2.5 induced adverse effects on neuron activities during cognitive tasks.

Stronger implicit interference in cognitively healthy older participants with higher risk of Alzheimer's disease

Introduction

Abnormal cerebrospinal fluid amyloid beta (Aβ)42 and tau levels have been revealed decades before symptoms onset in Alzheimer's disease (AD); however, the examination is usually invasive and inaccessible to most people. We thus aimed to develop a non-invasive behavioral test that targets early potential cognitive changes to gauge cognitive decline. Specifically, we hypothesized that older cognitive healthy participants would exhibit comparable performance when the task was explicit and relied on conscious cognition. However, when the task was implicit, the performance of participants at high and low risks for AD would bifurcate. That is, early changes in unconscious cognition could be linked to cognitive health.

Methods

We measured implicit interference elicited by an imperceptible distractor in cognitively healthy elderly participants with normal (low risk) and pathological (high risk) Aβ42/total tau ratio. Participants were required to perform a Stroop task (word-naming or color-naming on an ink-semantics inconsistent word) with a visually masked distractor presented prior to the target task.

Results

We found that, under a high-effort task (i.e., color-naming in the Stroop task), high-risk participants suffered interference when the imperceptible distractor and the subsequent target were incongruent in the responses they triggered. Their reaction times were slowed down by approximately 4%. This implicit interference was not found in the low-risk participants.

Discussion

These findings indicate that weakened inhibition of distracting implicit information can be a potential behavioral biomarker of early identification of AD pathology. Our study thus offers a new experimental paradigm to reveal early pathological aging by assessing how individuals respond to subperceptual threshold visual stimuli.