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Fradera A, McLaren J, Gadon L, Cullen B, Evans J. Does the presence of chronic pain affect scores on cognitive screening tests/brief cognitive measures for dementia? A systematic review and meta-analysis. Clin Neuropsychol 2024:1-24. [PMID: 38369508 DOI: 10.1080/13854046.2024.2315739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Cognitive screening tests can identify potential dementia by indicating a concerning level of cognitive impairment. The older populations for whom this is most relevant are more likely to experience chronic pain, which also impairs cognitive function, but pain's impact on cognitive screening tests specifically remains unknown. METHOD We conducted a systematic review and meta-analysis (SR/MA) following PRISMA guidelines evaluating cognitive screening scores in studies involving participants with chronic pain compared with a pain-free control group. Our question was whether the presence of chronic pain (self-reported or based on diagnosis) was associated with poorer performance on these screens, and to identify the heterogeneity across groups and screens. RESULTS The 51 studies identified yielded 62 effect size estimates. The pooled g was 0.76 (95% confidence interval 0.57 to 0.95). Heterogeneity was high for the full model (= 93.16%) with some reductions in sub-analyses. Around half of the studies were identified as being at a low risk of bias. There was no evidence of publication bias. CONCLUSIONS As a whole, this analysis suggests medium to large effect sizes on cognitive screen performance when people are living with chronic pain. We suggest that clinicians should consider the effect of chronic pain when cognitive screens are employed to investigate dementia. Further research could clarify the effect pain has on different screen sub-domains to aid their effective use with these populations.
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Affiliation(s)
- Alex Fradera
- School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Lisa Gadon
- NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Breda Cullen
- School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jonathan Evans
- School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Abdulhussein MA, An X, Alsakaa AA, Ming D. Lack of habituation in migraine patients and Evoked Potential types: Analysis study from EEG signals. JOURNAL OF INFORMATION & OPTIMIZATION SCIENCES 2022. [DOI: 10.1080/02522667.2022.2095958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Msallam Abbas Abdulhussein
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
- Faculty of Computer Science and Mathematics, Kufa University, Najaf, Iraq
| | - Xingwei An
- Tianjin International Joint Research Centre for Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin 300072, China
| | - Akeel A. Alsakaa
- Department of Computer Science, University of Kerbala, Karbala, Iraq
| | - Dong Ming
- Department of Biomedical Engineering, College of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin 300072, China
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Zhang X, Gao R, Zhang C, Chen H, Wang R, Zhao Q, Zhu T, Chen C. Evidence for Cognitive Decline in Chronic Pain: A Systematic Review and Meta-Analysis. Front Neurosci 2021; 15:737874. [PMID: 34630023 PMCID: PMC8492915 DOI: 10.3389/fnins.2021.737874] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023] Open
Abstract
Background: People with chronic pain (CP) sometimes report impaired cognitive function, including a deficit of attention, memory, executive planning, and information processing. However, the association between CP and cognitive decline was still not clear. Our study aimed to assess the association of CP as a risk factor with cognitive decline among adults. Methods: We included data from clinical studies. Publications were identified using a systematic search strategy from PubMed, Embase, and Cochrane Library databases from inception to October 10, 2020. We used the mean cognitive outcome data and the standard deviations from each group. The standardized mean difference (SMD) or odds ratio (OR), and 95% confidence intervals (CI) were performed for each cognitive decline outcome. I 2-values were assessed to quantify the heterogeneities. Results: We included 37 studies with a total of 52,373 patients with CP and 80,434 healthy control participants. Because these studies used different evaluative methods, we analyzed these studies. The results showed CP was associated with cognitive decline when the short-form 36 health survey questionnaire (SF-36) mental component summary (SMD = -1.50, 95% CI = -2.19 to -0.81), the Montreal cognitive assessment (SMD = -1.11, 95% CI = -1.60 to -0.61), performance validity testing (SMD = 3.05, 95% CI = 1.74 to 4.37), or operation span (SMD = -1.83, 95% CI = -2.98 to -0.68) were used. However, we got opposite results when the studies using International Classification of Diseases and Related Health Problems classification (OR = 1.58, 95% CI = 0.97 to 2.56), the Mini-Mental State Examination (SMD = -0.42, 95% CI = -0.94 to 0.10; OR = 1.14, 95% CI = 0.91 to 1.42), and Repeatable Battery for the Assessment of Neuropsychological Status memory component (SMD = -0.06, 95% CI = -0.37 to 0.25). Conclusion: There may be an association between CP and the incidence of cognitive decline when some cognitive, evaluative methods were used, such as short-form 36 health survey questionnaire, Montreal cognitive assessment, performance validity testing, and operation span.
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Affiliation(s)
- Xueying Zhang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Gao
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Changteng Zhang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Chen
- Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruiqun Wang
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Zhao
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chan Chen
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
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Terassi M, Ottaviani AC, Souza ÉND, Fraga FJ, Montoya P, Pavarini SCI, Hortense P. Cognition and chronic pain: an analysis on community-dwelling elderly caregivers and non-caregivers. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:201-208. [PMID: 33886793 DOI: 10.1590/0004-282x-anp-2019-0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In recent years there has been an increasing number of elderly people who care for another elderly person in the same household. These elderly people are more susceptible to overload and the presence of chronic pain, while pain can negatively influence cognitive variables. OBJECTIVE To compare the performance and cognitive processing of elderly caregivers and non-caregivers with and without chronic pain. METHODS This was a cross-sectional study carried out among 149 elderly people divided into four groups that were matched according to sex, age and schooling. The tests used were a numerical pain assessment scale, the Brief Cognitive Screening Battery (BCSB), Addenbrooke's Cognitive Examination (ACER-R) and cognitive processing through event-related potentials (P300). RESULTS Statistically significant differences between participants with and without chronic pain were found with regard to attention/orientation (p=0.045) and visual-spatial skills (p=0.017), and in the total score (p=0.033). In the pain-free group, the caregivers showed better results than the non-caregivers. There were no effects between subjects or interactions (caregiving and pain factors) either on P300 amplitude or on P300 latency. CONCLUSION In general, it was observed that pain-free individuals presented better performance. No relationship was observed between the factors care and pain regarding cognitive performance.
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Affiliation(s)
- Marielli Terassi
- Universidade Federal de São Carlos, Departamento de Enfermagem, São Carlos SP, Brazil
| | | | - Érica Nestor de Souza
- Universidade Federal de São Carlos, Departamento de Enfermagem, São Carlos SP, Brazil
| | - Francisco José Fraga
- Universidade Federal do ABC, Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Santo André SP, Brazil
| | - Pedro Montoya
- University of Balearic Islands, Research Institute of Health Sciences, Palma, Spain
| | | | - Priscilla Hortense
- Universidade Federal de São Carlos, Departamento de Enfermagem, São Carlos SP, Brazil
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5
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Chen WT, Hsiao FJ, Wang SJ. Brain Excitability in Tension-Type Headache: a Separate Entity from Migraine? Curr Pain Headache Rep 2021; 24:82. [PMID: 33415543 DOI: 10.1007/s11916-020-00916-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Tension-type headache is often regarded as the "normal" headache due to its high prevalence and mild disability in contrast with migraine. Clinically, both headaches are common comorbidities to each other. To date there has been many studies linked migraine to a brain excitability disorder. This review summarized earlier studies on brain excitability of TTH and discuss if TTH is a separate clinical entity from migraine as suggested by the diagnostic criteria. RECENT FINDINGS A recent magnetoencephalographic study from our group enrolled patients with "strict-criteria" TTH (i.e., absence of any migraine characteristics and associated symptoms) to compare the somatosensory excitability with patients with migraine and controls. This study provided evidence that TTH and migraine differ in excitability profiles and the measurement of preactivation excitability was able to discriminate TTH from migraine. Earlier studies on brain excitability of TTH yielded negative findings or a common change shared with migraine. Future studies using strict diagnostic criteria to avoid the unwanted interference from migraine comorbidity may help decipher the "true" pathophysiology of TTH, which may pave the way to a TTH-specific brain signature and treatment.
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Affiliation(s)
- Wei-Ta Chen
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.
| | - Fu-Jung Hsiao
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan
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6
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Pu L, Lion KM, Todorovic M, Moyle W. Portable EEG monitoring for older adults with dementia and chronic pain - A feasibility study. Geriatr Nurs 2021; 42:124-128. [PMID: 33385771 DOI: 10.1016/j.gerinurse.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/02/2023]
Abstract
Given the reduced ability of people with dementia to self-report pain, this study examined the feasibility of using a portable electroencephalography (EEG) headband (MUSE 2) as a pain measurement tool for long-term care residents with dementia. Ten minutes of resting-state EEG was acquired by MUSE 2 from people with dementia experiencing ongoing pain (n = 3) and without current pain (n = 1) over three days. The MUSE 2 was acceptable and feasible for use in people with dementia while challenges regarding software, data collection and analysis in using this device are reported. Compared to the resident not experiencing pain, EEG signals of residents with ongoing pain showed different EEG patterns, and this could be a potential biomarker to support pain measurement in people with dementia. Further research with larger sample size is warranted to verify study results.
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Affiliation(s)
- Lihui Pu
- School of Nursing and Midwifery, Griffith University, QLD, Australia; Menzies Health Institute Queensland, Griffith University, 2.10 Health Sciences (N48), 170 Kessel Rd, Nathan, Brisbane, QLD 4111, Australia
| | - Katarzyna Malgorzata Lion
- Menzies Health Institute Queensland, Griffith University, 2.10 Health Sciences (N48), 170 Kessel Rd, Nathan, Brisbane, QLD 4111, Australia
| | - Michael Todorovic
- School of Nursing and Midwifery, Griffith University, QLD, Australia; Menzies Health Institute Queensland, Griffith University, 2.10 Health Sciences (N48), 170 Kessel Rd, Nathan, Brisbane, QLD 4111, Australia
| | - Wendy Moyle
- School of Nursing and Midwifery, Griffith University, QLD, Australia; Menzies Health Institute Queensland, Griffith University, 2.10 Health Sciences (N48), 170 Kessel Rd, Nathan, Brisbane, QLD 4111, Australia.
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Steiner GZ, Barry RJ, Wassink K, De Blasio FM, Fogarty JS, Cave AE, Love S, Armour M. Neuronal Correlates of Cognitive Control Are Altered in Women With Endometriosis and Chronic Pelvic Pain. Front Syst Neurosci 2020; 14:593581. [PMID: 33390910 PMCID: PMC7772245 DOI: 10.3389/fnsys.2020.593581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022] Open
Abstract
Endometriosis is a debilitating women's health condition and is the most common cause of chronic pelvic pain. Impaired cognitive control is common in chronic pain conditions, however, it has not yet been investigated in endometriosis. The aim of this study was to explore the neuronal correlates of cognitive control in women with endometriosis. Using a cross-sectional study design with data collected at a single time-point, event-related potentials were elicited during a cued continuous performance test from 20 women with endometriosis (mean age = 28.5 ± 5.2 years) and 20 age- and gender-matched controls (mean age = 28.5 ± 5.2 years). Event-related potential components were extracted and P3 component amplitudes were derived with temporal principal components analysis. Behavioral and ERP outcomes were compared between groups and subjective pain severity was correlated with ERP component amplitudes. No significant behavioral differences were seen in task performance between the groups (all p > 0.094). Target P3b (all p < 0.034) and SW (all p < 0.040), and non-target early P3a (eP3a; all p < 0.023) and late P3a (lP3a; all p < 0.035) amplitudes were smaller for the endometriosis compared to the healthy control group. Lower non-target eP3a (p < 0.001), lP3a (p = 0.013), and SW (p = 0.019) amplitudes were correlated with higher pain severity scores. Findings suggest that endometriosis-associated chronic pelvic pain is linked to alterations in stimulus-response processing and inhibitory control networks, but not impaired behavioral performance, due to compensatory neuroplastic changes in overlapping cognitive control and pain networks.
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Affiliation(s)
- Genevieve Z Steiner
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia.,Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Robert J Barry
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Katherine Wassink
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Frances M De Blasio
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Jack S Fogarty
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Adele E Cave
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Sapphire Love
- Brain & Behaviour Research Institute and School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute and Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
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Schouppe S, Van Oosterwijck S, Danneels L, Van Damme S, Van Oosterwijck J. Are Functional Brain Alterations Present in Low Back Pain? A Systematic Review of EEG Studies. THE JOURNAL OF PAIN 2019; 21:25-43. [PMID: 31260806 DOI: 10.1016/j.jpain.2019.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/31/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Abstract
This systematic review analyzed available literature on functional brain alterations in low back pain (LBP) measured with electroencephalography (EEG), as until now evidence thereof was unclear. Four electronic databases were systematically searched the 10th of March 2018, resulting in 12 included studies. Studies showed a risk of bias of 37.5 to 75% using the Newcastle-Ottawa Scale for case-control studies. Limited evidence reported higher amplitudes of balance-related potentials and early components of somatosensory evoked potentials (SEP) to noxious stimuli, and altered feedback-related negativity and P300 potentials during decision-making in chronic LBP (CLBP). These findings suggest postural strategies requiring a higher cortical attention-demand, increased sensory-discriminative processing of noxious input, and altered decision-making in CLBP. However, further research is warranted as these inferences were based on single studies. Moderate evidence for unaltered amplitude of late-phase SEPs to noxious stimuli and auditory evoked potentials in LBP implies that the affective-emotional processing of stimuli might be unaffected in LBP. Furthermore, moderate evidence indicated disturbed habituation of somatosensory stimuli in LBP. Most studies examined nonspecific or mixed CLBP populations, hence EEG-quantified brain activity in (sub)acute or recurrent LBP still needs to be explored. PERSPECTIVE: This review presents an overview of the current understanding of the functional LBP brain measured with EEG. The limited evidence in current research suggests altered cortical function regarding balance control, somatosensory processing, and decision making in LBP, and highlights opportunities for future EEG-research.
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Affiliation(s)
- Stijn Schouppe
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Pain in Motion International Research Group, Belgium, www.paininmotion.be
| | - Sophie Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Stefaan Van Damme
- Department of Experimental - Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jessica Van Oosterwijck
- SPINE Research Unit Ghent, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Pain in Motion International Research Group, Belgium, www.paininmotion.be; Research Foundation - Flanders (FWO), Brussels, Belgium
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Altered Neurocognitive Processing of Tactile Stimuli in Patients with Complex Regional Pain Syndrome. THE JOURNAL OF PAIN 2018; 19:395-409. [DOI: 10.1016/j.jpain.2017.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/06/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022]
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10
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Comparison of somatosensory cortex excitability between migraine and “strict-criteria” tension-type headache: a magnetoencephalographic study. Pain 2018; 159:793-803. [DOI: 10.1097/j.pain.0000000000001151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Electroencephalographic Evidence of Altered Top–Down Attentional Modulation in Fibromyalgia Patients During a Working Memory Task. Brain Topogr 2017; 30:539-547. [DOI: 10.1007/s10548-017-0561-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
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Chen W, Shen X, Liu X, Luo B, Liu Y, Yu R, Sun G, Shen M, Wang W. Passive Paradigm Single-Tone Elicited ERPs in Tension-Type Headaches and Migraine. Cephalalgia 2016; 27:139-44. [PMID: 17257234 DOI: 10.1111/j.1468-2982.2006.01256.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The active 'oddball' event-related potential (ERP) P3 is elongated or reduced in migraine and tension-type headaches, indicating a deficit of active attention in these primary headaches. It is then reasonable to study the passive attention function in these headaches through the technology of passive paradigm singletone elicited ERPs. We invited 32 patients suffering from chronic tension-type headache (CTTH), 17 from frequent episodic tension-type headache (FETH) and 32 from interictal migraine without aura, as well as 28 healthy subjects to undergo passive paradigm single-tone ERPs. There were no statistically significant differences when the mean latencies and amplitudes of N1, P2, N2 or the mean latencies of P3 of the four groups were considered. In contrast, the P3 amplitudes were significantly reduced in the patient groups when compared with healthy controls. However, no further significant difference was found between patient groups when considering P3 amplitude. Our study demonstrated a deficit of passive attention in CTTH, FETH and migraine, but could not separate these headache types in this regard. The reduced P3 in patients might be due to the head pain experienced.
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Affiliation(s)
- W Chen
- Department of Clinical Psychology and Psychiatry, Zhejiang University, Hangzhou, China
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Tomasevic-Todorovic S, Boskovic K, Filipovic D, Milekic B, Grajic M, Hanna F. Auditory Event-Related P300 Potentials in Rheumatoid Arthritis Patients. NEUROPHYSIOLOGY+ 2015. [DOI: 10.1007/s11062-015-9510-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Magis D, Vigano A, Sava S, d'Elia TS, Schoenen J, Coppola G. Pearls and pitfalls: electrophysiology for primary headaches. Cephalalgia 2014; 33:526-39. [PMID: 23671250 DOI: 10.1177/0333102413477739] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Primary headaches are functional neurological diseases characterized by a dynamic cyclic pattern over time (ictal/pre-/interictal). Electrophysiological recordings can non-invasively assess the activity of an underlying nervous structure or measure its response to various stimuli, and are therefore particularly appropriate for the study of primary headaches. Their interest, however, is chiefly pathophysiological, as interindividual, and to some extent intraindividual, variations preclude their use as diagnostic tools. AIM OF THE WORK This article will review the most important findings of electrophysiological studies in primary headache pathophysiology, especially migraine on which numerous studies have been published. RESULTS In migraine, the most reproducible hallmark is the interictal lack of neuronal habituation to the repetition of various types of sensory stimulations. The mechanism subtending this phenomenon remains uncertain, but it could be the consequence of a thalamocortical dysrythmia that results in a reduced cortical preactivation level. In tension-type headache as well as in cluster headache, there seems to be an impairment of central pain-controlling mechanisms but the studies are scarce and their outcomes are contradictory. The discrepancies between studies might be as a result of methodological differences as well as patients' dissimilarities, which are also discussed. CONCLUSIONS AND PERSPECTIVES Electrophysiology is complementary to functional neuroimaging and will undoubtedly remain an important tool in headache research. One of its upcoming applications is to help select neurostimulation techniques and protocols that correct best the functional abnormalities detectable in certain headache disorders.
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Affiliation(s)
- Delphine Magis
- Headache Research Unit, University Department of Neurology, CHR Citadelle, Liege 4000, Belgium.
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Berryman C, Stanton TR, Bowering JK, Tabor A, McFarlane A, Moseley LG. Evidence for working memory deficits in chronic pain: A systematic review and meta-analysis. Pain 2013; 154:1181-96. [DOI: 10.1016/j.pain.2013.03.002] [Citation(s) in RCA: 211] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/05/2013] [Accepted: 03/01/2013] [Indexed: 12/19/2022]
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Coppola G, Di Lorenzo C, Schoenen J, Pierelli F. Habituation and sensitization in primary headaches. J Headache Pain 2013; 14:65. [PMID: 23899115 PMCID: PMC3733593 DOI: 10.1186/1129-2377-14-65] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/21/2013] [Indexed: 11/20/2022] Open
Abstract
The phenomena of habituation and sensitization are considered most useful for studying the neuronal substrates of information processing in the CNS. Both were studied in primary headaches, that are functional disorders of the brain characterized by an abnormal responsivity to any kind of incoming innocuous or painful stimuli and it's cycling pattern over time (interictal, pre-ictal, ictal). The present review summarizes available data on stimulus responsivity in primary headaches obtained with clinical neurophysiology. In migraine, the majority of electrophysiological studies between attacks have shown that, for a number of different sensory modalities, the brain is characterised by a lack of habituation of evoked responses to repeated stimuli. This abnormal processing of the incoming information reaches its maximum a few days before the beginning of an attack, and normalizes during the attack, at a time when sensitization may also manifest itself. An abnormal rhythmic activity between thalamus and cortex, namely thalamocortical dysrhythmia, may be the pathophysiological mechanism subtending abnormal information processing in migraine. In tension-type headache (TTH), only few signs of deficient habituation were observed only in subgroups of patients. By contrast, using grand-average responses indirect evidence for sensitization has been found in chronic TTH with increased nociceptive specific reflexes and evoked potentials. Generalized increased sensitivity to pain (lower thresholds and increased pain rating) and a dysfunction in supraspinal descending pain control systems may contribute to the development and/or maintenance of central sensitization in chronic TTH. Cluster headache patients are characterized during the bout and on the headache side by a pronounced lack of habituation of the brainstem blink reflex and a general sensitization of pain processing. A better insight into the nature of these ictal/interictal electrophysiological dysfunctions in primary headaches paves the way for novel therapeutic targets and may allow a better understanding of the mode of action of available therapies.
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Affiliation(s)
- Gianluca Coppola
- Department of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation IRCCS, Via Livenza 3, 00198, Rome, Italy
| | | | - Jean Schoenen
- Headache Research Unit, University Department of Neurology & GIGA-Neurosciences, Liège University, Liège, Belgium
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The contribution of clinical neurophysiology to the comprehension of the tension-type headache mechanisms. Clin Neurophysiol 2011; 122:1075-85. [DOI: 10.1016/j.clinph.2010.12.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 11/16/2022]
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Korostenskaja M, Pardos M, Kujala T, Rose DF, Brown D, Horn P, Wang Y, Fujiwara H, Xiang J, Kabbouche MA, Powers SW, Hershey AD. Impaired Auditory Information Processing During Acute Migraine: A Magnetoencephalography Study. Int J Neurosci 2011; 121:355-65. [PMID: 21425948 DOI: 10.3109/00207454.2011.560312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Milena Korostenskaja
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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19
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Stankewitz A, May A. Understanding the migraineous brain: an exclusive focus on habituation may be misleading. Pain 2010. [DOI: 10.1016/j.pain.2010.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Sandrini G, Rossi P. The clinical neurophysiology of tension-type headache. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:367-376. [PMID: 20816436 DOI: 10.1016/s0072-9752(10)97030-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Despite being widely investigated, the pathogenesis of tension-type headache (TTH) continues to be debated. Among the different approaches used to explore the mechanisms underlying TTH, clinical neurophysiology plays an important role. Studies to date have focused mainly on two areas: (1) evaluation of peripheral factors (i.e., by electromyography (EMG)); and (2) exploration of the role of the pain control system. In the second of these areas, a large number of studies have explored trigeminal pathways, in particular using reflexes (e.g., the trigeminofacial reflex, trigeminotrigeminal reflexes). More recently, the descending inhibitory system, known to modulate both the trigeminal and the spinal system, has also been investigated. In addition, several studies have sought to establish whether there are neurophysiological parameters that could be markers of this condition, but the results of these were inconclusive, since some abnormalities could frequently be observed in migraine too. This chapter critically reviews the clinical neurophysiology of TTH. It concludes that the majority of neurophysiological studies on TTH present serious methodological flaws that will have to be overcome to allow further understanding of the mechanisms of TTH.
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Affiliation(s)
- Giorgio Sandrini
- University Center for Adaptive Disorders and Headache (UCADH) and Department of Neurological Sciences, IRCCS "C. Mondino Institute of Neurology" Foundation, Pavia, Italy.
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21
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Abstract
Pain is a highly complex and subjective experience that is not linearly related to the nociceptive input. What is clear from anecdotal reports over the centuries and more recently from animal and human experimentation is that nociceptive information processing and consequent pain perception is subject to significant pro- and anti-nociceptive modulations. These modulations can be initiated reflexively or by contextual manipulations of the pain experience including cognitive and emotional factors. This provides a necessary survival function since it allows the pain experience to be altered according to the situation rather than having pain always dominate. The so-called descending pain modulatory network involving predominantly medial and frontal cortical areas, in combination with specific subcortical and brain stem nuclei appears to be one key system for the endogenous modulation of pain. Furthermore, recent findings from functional and anatomical neuroimaging support the notion that an altered interaction of pro- and anti-nociceptive mechanisms may contribute to the development or maintenance of chronic pain states. Research on the involved circuitry and implemented mechanisms is a major focus of contemporary neuroscientific research in the field of pain and should provide new insights to prevent and treat chronic pain states.
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Affiliation(s)
- Ulrike Bingel
- Department of Neurology, NeuroImage Nord, University Medical Center Hamburg-Eppendorf, Germany; and
- Department of Clinical Neurology, Oxford Centre for Functional MRI on the Brain, Nuffield Department of Anaesthetics, Oxford University, John Radcliffe Hospital, Oxford, United Kingdom,
| | - Irene Tracey
- Department of Clinical Neurology, Oxford Centre for Functional MRI on the Brain, Nuffield Department of Anaesthetics, Oxford University, John Radcliffe Hospital, Oxford, United Kingdom,
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22
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Raieli V, Puma D, Brighina F. Role of neurophysiology in the clinical practice of primary pediatric headaches. Drug Dev Res 2008. [DOI: 10.1002/ddr.20205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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23
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Abstract
PURPOSE OF REVIEW In this review, we discuss recent advances in pain imaging research. We focus on the involvement of endogenous pain control mechanisms in the healthy central nervous system and the potential contribution of failure within this system for chronic pain states. RECENT FINDINGS Nociceptive information processing and related pain perception is subject to substantial pro and antinociceptive modulation. Recent studies demonstrate that this modulation can take place at any stage of ascending information processing. A network of cortical, predominantly mesial and frontal areas, in combination with specific brainstem nuclei, appear to be the key players in the context of endogenous pain modulation. Recent findings from functional and anatomical neuroimaging support the notion that an altered interaction of pro and antinociceptive mechanisms may contribute to the development or maintenance of chronic pain states. The additional use of pharmacological intervention in pain imaging research provides an alternative tool for investigating mechanisms of pain modulation. SUMMARY Top-down pain modulation relies on both cortical and subcortical structures. Research on the involved circuitry, including the implemented mechanisms, is a major focus of contemporary neuroscientific research in the field of pain and will provide new insights into the prevention and treatment of chronic pain states.
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Affiliation(s)
- Ulrike Bingel
- NeuroImage Nord, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany.
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Bingel U, Schoell E, Herken W, Büchel C, May A. Habituation to painful stimulation involves the antinociceptive system. Pain 2007; 131:21-30. [PMID: 17258858 DOI: 10.1016/j.pain.2006.12.005] [Citation(s) in RCA: 208] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 11/15/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
Abstract
The perception of pain results from an interaction between nociceptive and antinociceptive mechanisms. A better understanding of the neural circuitry underlying these physiological interactions provides an important opportunity to develop better treatment strategies for and ultimately even prevent pain. Here, we investigated how repeated painful stimulation over several days is processed, perceived and finally modulated in the healthy human brain. Twenty healthy subjects were stimulated daily with a 20min pain paradigm for 8 consecutive days, and functional MRI performed on days 1, 8 and 22. Repeated painful stimulation over several days resulted in substantially decreased pain ratings to identical painful stimuli. The decreased perception of pain over time is reflected in decreased BOLD responses to nociceptive stimuli in classical pain areas, including thalamus, insula, SII and the putamen. In contrast to this finding, we found that pain-related responses in the rACC, specifically the subgenual anterior cingulate cortex (sgACC), significantly increased over time. Given this area's predominant role in endogenous pain control, this response pattern suggests that habituation to pain is at least in part mediated by increased antinociceptive activity.
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Affiliation(s)
- U Bingel
- Department of Neurology, University of Hamburg (UKE), Germany.
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25
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Stensdotter AK, Hodges P, Ohberg F, Häger-Ross C. Quadriceps EMG in Open and Closed Kinetic Chain Tasks in Women With Patellofemoral Pain. J Mot Behav 2007; 39:194-202. [PMID: 17550871 DOI: 10.3200/jmbr.39.3.194-202] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors investigated whether the discrepancy noted in the literature regarding delayed and decreased activity in vastus medialis obliquus (VMO) in people with patellofemoral pain (PFP) depends on the nature of the open kinetic chain (OKC) and the closed kinetic chain (CKC) in the experimental task. They hypothesized that activity in VMO would be more delayed and decreased in CKC tasks than in OKC tasks. Women with PFP (n = 17) and healthy controls (n = 17) performed isometric quadriceps contractions in CKC and OKC tasks. The authors manipulated only the application of resistance. Electromyographs (EMGs) showed that participants with PFP reacted later and activated the quadriceps more in the CKC task but had intramuscular quadriceps coordination similar to that of controls. The nature of the OKC task or the CKC task does not seem to explain contradictory findings regarding VMO activation.
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26
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Ozkul Y, Ay H. Habituation of sympathetic skin response in migraine and tension type headache. Auton Neurosci 2007; 134:81-4. [PMID: 17395550 DOI: 10.1016/j.autneu.2007.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 01/28/2007] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
This study aimed to investigate the changes of habituations in the autonomic function of patients suffering from migraine or tension type headache through sympathetic skin responses. Patients with migraine without aura (n=26), with episodic tension type headache without migraine (n=28) and 30 healthy controls were studied. During continuous stimulation, four blocks of 20 responses were sequentially recorded. Mean amplitude changes in the second, third and fourth blocks are expressed as the percentages of the first block. In both headache groups, there was a lack of habituation compared to the control group.
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Affiliation(s)
- Yasar Ozkul
- Harran University, Faculty of Medicine, Department of Neurology, Turkey.
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Abstract
Migraine is associated with structural and functional CNS changes, for example, ictal hyperalgesia and allodynia and interictal neural excitation. Structural abnormalities, most notably white matter changes, occur in greater prevalence in migraineurs (16 - 40%). Several studies have examined the neuropsychological correlates of migraine and/or white matter abnormalities. These studies suggest mild, interictal dysfunction in migraineurs. More research is needed to correlate migraine severity, frequency and/or treatment with neuropsychological testing. Additional studies should: identify interictal cognitive changes; clarify the contribution to long-term cognitive changes from migraine genotype, sequelae of repeated pain episodes or their treatment and the consequences of co-morbid vascular disease; and include cognitive measures as secondary end points in clinical trials.
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Affiliation(s)
- Dawn A Marcus
- Pain Evaluation & Treatment Institute, 5750 Centre Avenue, Pittsburgh, PA 15206, USA.
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28
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Karl A, Diers M, Flor H. P300-amplitudes in upper limb amputees with and without phantom limb pain in a visual oddball paradigm. Pain 2004; 110:40-8. [PMID: 15275750 DOI: 10.1016/j.pain.2004.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Revised: 02/11/2004] [Accepted: 03/01/2004] [Indexed: 01/12/2023]
Abstract
The aim of the study was to investigate to what extent cortical hyper-reactivity to visual stimuli is present in upper limb amputees. Five amputees with phantom limb pain (PLP), five amputees without PLP (Non-PLP) and 10 healthy controls (HC) were investigated using a visual oddball paradigm. Two hundred visual stimuli were presented with target stimuli occurring at a probability of 25% and standard stimuli at a probability of 75%. Event-related potentials were recorded from nine scalp positions (F3, F4, Fz, C3, C4, Cz, P3, P4, Pz). The PLP-patients had significantly higher P300-amplitudes to both types of stimuli compared to the non-PLP-patients. The HC were not significantly different from both amputee groups. P300-amplitude to targets at frontal sites in the hemisphere contralateral to the amputation was higher in the PLP patients. P300-latencies to target stimuli differed only at frontal sites with PLP-patients showing significantly longer latencies than non-PLP-patients. To standard stimuli, however, they showed significantly shorter latencies at central and parietal scalp positions. The HC had significantly shorter latencies than both amputee groups. The size of the P300-amplitude was positively correlated with the intensity of PLP. These findings suggest a higher magnitude of non-specific cortical excitability in amputees with PLP and a reduced excitability in amputees without PLP. This extends previous findings of differences in cortical excitability in PLP and non-PLP patients in the sensorimotor domain.
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Affiliation(s)
- Anke Karl
- Biopsychology, University of Technology Dresden, Zellescher Weg 17, D-01062 Dresden, Germany.
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Alanoğlu E, Ulaş UH, Ozdağ F, Odabaşi Z, Cakçi A, Vural O. Auditory event-related brain potentials in fibromyalgia syndrome. Rheumatol Int 2004; 25:345-9. [PMID: 14986061 DOI: 10.1007/s00296-004-0443-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2003] [Accepted: 12/31/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to investigate cognitive functions using auditory event-related brain potentials (ERP) in fibromyalgia syndrome (FMS). METHODS The P300 component of ERP was studied in 36 female FMS patients and 22 control subjects. The short form 36 (SF-36) medical outcome study was used to determine quality of life. Number of tender points and disease duration were noted. Cognitive functions were evaluated with P300. RESULTS The symptoms were discrepant in FMS (P<0.001). The scores of the eight SF-36 subgroups in FMS patients were significantly lower than in the control group (P<0.001). Fibromyalgia syndrome patients had prolonged latency and reduced amplitude of P300 (P<0.001). No correlation was found between the subgroups of SF-36, tender point count, disease duration, and P300. CONCLUSION The results of our study reveal that FMS affects quality of life and dysfunction in cognitive abilities can be determined by brain event-related potentials.
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Affiliation(s)
- Ece Alanoğlu
- Physical Therapy and Rehabilitation Department, Social Security Hospital of Ankara, Dişkapi, Ankara, Turkey.
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