Midazolam-induced amnesia reduces memory for details and affects the ERP correlates of recollection and familiarity

Using temporo-spatial principal component analysis as tool to dissociate latent ERP components of episodic memory retrieval: Objectifying time-window selection for overlapping ERP components

This report details how principal component analysis (PCA) can be used as a valuable tool to dissociate latent ERP components, even when considerable temporal and spatial overlap makes it difficult to discern ERP effects in standard time windows. We illustrate our methodological approach in a data set from a recognition memory paradigm, in which event-related potential (ERP) correlates of familiarity, recollection and the late parietal negativity (LPN) were partially overlapping. By adapting standard time windows based on the results of a temporo-spatial PCA, small yet reliable ERP correlates reflecting familiarity and recollection for identical items and late recollection for changed items were identified, complementing the result pattern observed in behavioral performance. Due to similar temporo-spatial characteristics and opposing polarities in late parietal ERP correlates associated with memory retrieval, component overlap is often observed in this field of research. Hence, the complex interplay of several processes underlying higher cognitive functions such as memory retrieval may interfere with standard ERP assessment. In such instances, PCA can provide promising ways to objectively assess time window selection for subsequent ERP analyses.

Immediate retrograde amnesia induced by midazolam: A prospective, non-randomised cohort study

BACKGROUND

Midazolam, a short-acting benzodiazepine, has sedative, anxiolytic, amnestic and anticonvulsant effects. Given its advantages of rapid onset, short duration and low toxicity, midazolam is optimal for any procedural sedation. Midazolam is known to cause anterograde amnesia; however, the possibility of retrograde amnesia has also been raised. This prospective cohort, non-randomised study evaluated the presence and extent of retrograde amnesia induced by midazolam during caesarean delivery.

METHODS

One hundred parturients scheduled for elective caesarean delivery under spinal anaesthesia were enrolled. As soon as giving birth, six picture cards were shown to the patients in 1-min intervals, and then midazolam (0.1 mg/kg) was given or not according to the patients' preference. This overall retrograde recall rate of six cards was the primary outcome of our study, which was asked by a blinded investigator.

RESULTS

The overall retrograde card recall rate was lower in the midazolam group compared with the control group (77.0 ± 13.4 vs. 87.7 ± 3.9%, P < .001), especially at 1 minute before midazolam administration (58% vs. 88%, P < .001). Decreased memory trend was observed as time progressed towards midazolam administration in the midazolam group (P = .035). More patients answered 'yes' to the factitious event in the midazolam group than in the control group (26% vs. 4%, P = .004).

CONCLUSION

Intravenous midazolam could cause a brief-period retrograde amnesia in visual and event memory. Moreover, there were more spurious reports of intraoperative factitious events in the midazolam group, implying that episodic memories were also affected by midazolam.

The Effect of Light Sedation with Midazolam on Functional Connectivity of the Dorsal Attention Network

Altered connectivity within and between the resting-state networks (RSNs) brought about by anesthetics that induce altered consciousness remains incompletely understood. It is known that the dorsal attention network (DAN) and its anticorrelations with other RSNs have been implicated in consciousness. However, the role of DAN-related functional patterns in drug-induced sedative effects is less clear. In the current study, we investigated altered functional connectivity of the DAN during midazolam-induced light sedation. In a placebo-controlled and within-subjects experimental study, fourteen healthy volunteers received midazolam or saline with a 1-week interval. Resting-state fMRI data were acquired before and after intravenous drug administration. A multiple region of interest-driven analysis was employed to investigate connectivity within and between RSNs. It was found that functional connectivity was significantly decreased by midazolam injection in two regions located in the left inferior parietal lobule and the left middle temporal area within the DAN as compared with the saline condition. We also identified three clusters in anticorrelation between the DAN and other RSNs for the interaction effect, which included the left medial prefrontal cortex, the right superior temporal gyrus, and the right superior frontal gyrus. Connectivity between all regions and DAN was significantly decreased by midazolam injection. The sensorimotor network was minimally affected. Midazolam decreased functional connectivity of the dorsal attention network. These findings advance the understanding of the neural mechanism of sedation, and such functional patterns might have clinical implications in other medical conditions related to patients with cognitive impairment.

Alcohol and pharmacologically similar sedatives impair encoding and facilitate consolidation of both recollection and familiarity in episodic memory

Alcohol and other pharmacologically similar sedatives (i.e., GABA_A positive allosteric modulators or PAMs) impair the encoding of new episodic memories but retroactively facilitate the consolidation of recently encoded memories. These effects are consistent for recollection (i.e., the retrieval of details) but some mixed results have been reported for familiarity (i.e., a feeling of knowing a stimulus was presented). Here, with dual-process models, we reanalyzed prior work testing the effects of GABA_A PAMs at encoding or consolidation. Contrary to previous conclusions, we show that GABA_A PAMs at encoding consistently impair both recollection and familiarity when an independence correction is applied to familiarity-based responses. These findings were further confirmed and extended in a dual-process signal detection analysis of a recent study on the effects of alcohol during encoding or consolidation: Alcohol at encoding impaired both recollection and familiarity, whereas alcohol at consolidation enhanced both recollection and familiarity. These findings speak to the ability of alcohol and other GABA_A PAMs to induce 'blackouts,' highlighting the importance of dual-process approaches when analyzing drug manipulations at different phases of episodic memory.

Decreased Cerebral Blood Flow in Mesial Thalamus and Precuneus/PCC during Midazolam Induced Sedation Assessed with ASL

While some previous work suggests that midazolam-induced light sedation results from the functional disconnection within resting state network, little is known about the underlying alterations of cerebral blood flow (CBF) associated with its effects. A randomized, double-blind, within-subject, cross-over design was adopted, while 12 healthy young volunteers were scanned with arterial spin-labeling (ASL) perfusion MRI both before and after an injection of either saline or midazolam. The contrast of MRI signal before and after midazolam administration revealed the CBF decrease in the bilateral mesial thalamus and precuneus/posterior cingulate cortex (PCC). These effects were confirmed after controlling for any effect of injection as well as head motions. These findings provide new evidences that midazolam-induced light sedation is related to the disruption of cortical functional integration, and have new implications to the neural basis of consciousness.

Is propofol injection pain really important to patients?

Background

Propofol injection pain (PIP) has been adequately studied during the past decades. However, patients’ opinion on this problem and the incidence of patients’ recall of this brief discomfort are still unknown. Thus, we conducted this study to know the patients’ perspectives on PIP and provide useful information about the incidence of recall of PIP under our routine general anesthesia.

Methods

Five hundred preoperative questionnaires were distributed to patients who were scheduled for elective open thyroidectomy under general anesthesia from May 2016 to July 2016. They were asked to rank ten possible adverse effects associated with general anesthesia from their most undesirable to their least undesirable effect. Patients who completed the preoperative questionnaires were asked whether they could recall PIP and to grade the severity of PIP on the first postoperative day.

Results

A total of 448 preoperative questionnaires were returned and analyzed with an efficient rate of 89.6%. Incisional pain was ranked as most undesirable, followed (in order) by vomiting, gagging on the tracheal tube, nausea, sore throat, propofol injection pain, shivering, intravenous puncture pain, and anxiety. The majority (91.5%) of surveyed patients could not recall any discomfort or pain during anesthetics injection. Of those who could recall PIP, 89.5% grade it as mild pain, 7.9% moderate pain, and 2.6% severe pain.

Conclusions

Most of patients undergoing elective open thyroidectomy in our hospital viewed PIP as a relatively minor problem. The incidence of recall of PIP was low and the majority of those who recalled regarded it as mild, temporary and acceptable pain. However, further investigations into propofol injection pain may be warranted as patients’ perspectives on propofol injection pain and its severity may differ between patient populations.

FN400 and LPC memory effects for concrete and abstract words

According to dual-process models, recognition memory depends on two neurocognitive mechanisms: familiarity, which has been linked to the frontal N400 (FN400) effect in studies using ERPs, and recollection, which is reflected by changes in the late positive complex (LPC). Recently, there has been some debate over the relationship between FN400 familiarity effects and N400 semantic effects. According to one view, these effects are one and the same. Proponents of this view have suggested that the frontal distribution of the FN400 could be due to stimulus concreteness: recognition memory experiments commonly use highly imageable or concrete words (or pictures), which elicit semantic ERPs with a frontal distribution. In the present study, we tested this claim using a recognition memory paradigm in which subjects memorized concrete and abstract nouns; half of the words changed font color between study and test. FN400 and LPC old/new effects were observed for abstract as well as concrete words, and were stronger over right hemisphere electrodes for concrete words. However, there was no difference in anteriority of the FN400 effect for the two word types. These findings challenge the notion that the frontal distribution of the FN400 old/new effect is fully explained by stimulus concreteness.

Disruption of cortical integration during midazolam-induced light sedation

This work examines the effect of midazolam‐induced light sedation on intrinsic functional connectivity of human brain, using a randomized, double‐blind, placebo‐controlled, cross‐over, within‐subject design. Fourteen healthy young subjects were enrolled and midazolam (0.03 mg/kg of the participant's body mass, to a maximum of 2.5 mg) or saline were administrated with an interval of one week. Resting‐state fMRI was conducted before and after administration for each subject. We focus on two types of networks: sensory related lower‐level functional networks and higher‐order functions related ones. Independent component analysis (ICA) was used to identify these resting‐state functional networks. We hypothesize that the sensory (visual, auditory, and sensorimotor) related networks will be intact under midazolam‐induced light sedation while the higher‐order (default mode, executive control, salience networks, etc.) networks will be functionally disconnected. It was found that the functional integrity of the lower‐level networks was maintained, while that of the higher‐level networks was significantly disrupted by light sedation. The within‐network connectivity of the two types of networks was differently affected in terms of direction and extent. These findings provide direct evidence that higher‐order cognitive functions including memory, attention, executive function, and language were impaired prior to lower‐level sensory responses during sedation. Our result also lends support to the information integration model of consciousness. Hum Brain Mapp 36:4247–4261, 2015. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Sometimes we have to intentionally focus on the details: Incidental encoding and perceptual change decrease recognition memory performance and the ERP correlate of recollection

Prior studies suggest that memory retrieval is based on two independent processes: Recollection and familiarity. Here, we investigated the role of incidental and intentional encoding, and specifically whether perceptual changes between study and test affects behavioral and electrophysiological correlates of both retrieval processes. During retrieval, participants distinguished between identical and changed exemplars as well as novel distractors. Following incidental encoding, participants had difficulty identifying changed exemplars; item and feature recognition increased after intentional encoding, in particular for changed exemplars. Reflecting this increase in memory performance, the ERP correlate of recollection was larger after intentional encoding and for identical item repetitions, whereas the ERP correlate for familiarity was largely unaffected. Pre-response old/new effects corresponding to later aspects of recollection (700-1000 ms relative to stimulus onset) were larger in response-compared to stimulus-locked averages, but also of similar magnitude for identical and changed exemplars. These results corroborate previous findings suggesting that the electrophysiological signature of recollection is modulated as a function of memory performance. The role of task characteristics and material retrieved from memory for modulations in familiarity-based retrieval processes is discussed.

The time course of episodic associative retrieval: electrophysiological correlates of cued recall of unimodal and crossmodal pair-associate learning

Little is known about the time course of processes supporting episodic cued recall. To examine these processes, we recorded event-related scalp electrical potentials during episodic cued recall following pair-associate learning of unimodal object-picture pairs and crossmodal object-picture and sound pairs. Successful cued recall of unimodal associates was characterized by markedly early scalp potential differences over frontal areas, while cued recall of both unimodal and crossmodal associates were reflected by subsequent differences recorded over frontal and parietal areas. Notably, unimodal cued recall success divergences over frontal areas were apparent in a time window generally assumed to reflect the operation of familiarity but not recollection processes, raising the possibility that retrieval success effects in that temporal window may reflect additional mnemonic processes beyond familiarity. Furthermore, parietal scalp potential recall success differences, which did not distinguish between crossmodal and unimodal tasks, seemingly support attentional or buffer accounts of posterior parietal mnemonic function but appear to constrain signal accumulation, expectation, or representational accounts.

A within-subject ERP and fMRI investigation of orientation-specific recognition memory for pictures

Despite a large body of recognition memory research, its temporal, measured with ERPs, and spatial, measured with fMRI, substrates have never been investigated in the same subjects. In the present study, we obtained this information in parallel sessions, in which subjects studied and recognized images of visual objects and their orientation. The results showed that ERP-familiarity processes between 240 and 440 ms temporally preceded recollection processes and were structurally associated with prefrontal brain regions. Recollection processes were most prominent from 440 to 600 ms and correlated with activation in temporal, parietal, and occipital brain regions. Post-retrieval monitoring, which occurred in the ERP between 600 and 1000 ms as a long-lasting slow-wave over frontal channel groups, showed correlations with activation in the prefrontal and parietal cortex. These ERP/fMRI relationships showed some correspondences to source localizations of the investigated ERP memory effects.

Familiarity in source memory

Familiarity and recollection are thought to be separate processes underlying recognition memory. Event-related potentials (ERPs) dissociate these processes, with an early (approximately 300-500ms) frontal effect relating to familiarity (the FN400) and a later (500-800ms) parietal old/new effect relating to recollection. It has been debated whether source information for a studied item (i.e., contextual associations from when the item was previously encountered) is only accessible through recollection, or whether familiarity can contribute to successful source recognition. It has been shown that familiarity can assist in perceptual source monitoring when the source attribute is an intrinsic property of the item (e.g., an object's surface color), but few studies have examined its contribution to recognizing extrinsic source associations. Extrinsic source associations were examined in three experiments involving memory judgments for pictures of common objects. In Experiment 1, source information was spatial and results suggested that familiarity contributed to accurate source recognition: the FN400 ERP component showed a source accuracy effect, and source accuracy was above chance for items judged to only feel familiar. Source information in Experiment 2 was an extrinsic color association; source accuracy was at chance for familiar items and the FN400 did not differ between correct and incorrect source judgments. Experiment 3 replicated the results using a within-subjects manipulation of spatial vs. color source. Overall, the results suggest that familiarity's contribution to extrinsic source monitoring depends on the type of source information being remembered.