Brain signal complexity in adults with Down syndrome: Potential application in the detection of mild cognitive impairment

Background

Down syndrome (DS) is considered the most frequent cause of early-onset Alzheimer’s disease (AD), and the typical pathophysiological signs are present in almost all individuals with DS by the age of 40. Despite of this evidence, the investigation on the pre-dementia stages in DS is scarce. In the present study we analyzed the complexity of brain oscillatory patterns and neuropsychological performance for the characterization of mild cognitive impairment (MCI) in DS.

Materials and methods

Lempel-Ziv complexity (LZC) values from resting-state magnetoencephalography recordings and the neuropsychological performance in 28 patients with DS [control DS group (CN-DS) (n = 14), MCI group (MCI-DS) (n = 14)] and 14 individuals with typical neurodevelopment (CN-no-DS) were analyzed.

Results

Lempel-Ziv complexity was lowest in the frontal region within the MCI-DS group, while the CN-DS group showed reduced values in parietal areas when compared with the CN-no-DS group. Also, the CN-no-DS group exhibited the expected pattern of significant increase of LZC as a function of age, while MCI-DS cases showed a decrease. The combination of reduced LZC values and a divergent trajectory of complexity evolution with age, allowed the discrimination of CN-DS vs. MCI-DS patients with a 92.9% of sensitivity and 85.7% of specificity. Finally, a pattern of mnestic and praxic impairment was significantly associated in MCI-DS cases with the significant reduction of LZC values in frontal and parietal regions (p = 0.01).

Conclusion

Brain signal complexity measured with LZC is reduced in DS and its development with age is also disrupted. The combination of both features might assist in the detection of MCI within this population.

Fuzzy Entropy Analysis of the Electroencephalogram in Patients with Alzheimer's Disease: Is the Method Superior to Sample Entropy?

Alzheimer’s disease (AD) is the most prevalent form of dementia in the world, which is characterised by the loss of neurones and the build-up of plaques in the brain, causing progressive symptoms of memory loss and confusion. Although definite diagnosis is only possible by necropsy, differential diagnosis with other types of dementia is still needed. An electroencephalogram (EEG) is a cheap, portable, non-invasive method to record brain signals. Previous studies with non-linear signal processing methods have shown changes in the EEG due to AD, which is characterised reduced complexity and increased regularity. EEGs from 11 AD patients and 11 age-matched control subjects were analysed with Fuzzy Entropy (FuzzyEn), a non-linear method that was introduced as an improvement over the frequently used Approximate Entropy (ApEn) and Sample Entropy (SampEn) algorithms. AD patients had significantly lower FuzzyEn values than control subjects (p < 0.01) at electrodes T6, P3, P4, O1, and O2. Furthermore, when diagnostic accuracy was calculated using Receiver Operating Characteristic (ROC) curves, FuzzyEn outperformed both ApEn and SampEn, reaching a maximum accuracy of 86.36%. These results suggest that FuzzyEn could increase the insight into brain dysfunction in AD, providing potentially useful diagnostic information. However, results depend heavily on the input parameters that are used to compute FuzzyEn.

Characterisation of the complexity of intracranial pressure signals measured from idiopathic and secondary normal pressure hydrocephalus patients

Hydrocephalus is a condition characterised by enlarged cerebral ventricles, which in turn affects intracranial pressure (ICP); however, the mechanisms regulating ICP are not fully understood. A nonlinear signal processing approach was applied to ICP signals measured during infusion studies from patients with two forms of hydrocephalus, in a bid to compare the differences. This is the first study of its kind. The two forms of hydrocephalus were idiopathic normal pressure hydrocephalus (iNPH) and secondary normal pressure hydrocephalus (SH). Following infusion tests, the Lempel-Ziv (LZ) complexity was calculated from the iNPH and SH ICP signals. The LZ complexity values were averaged for the baseline, infusion, plateau and recovery stages of the tests. It was found that as the ICP increased from basal levels, the LZ complexities decreased, reaching their lowest during the plateau stage. However, the complexities computed from the SH ICP signals decreased to a lesser extent when compared with the iNPH ICP signals. Furthermore, statistically significant differences were found between the plateau and recovery stage complexities when comparing the iNPH and SH results (p = 0.05). This Letter suggests that advanced signal processing of ICP signals with LZ complexity can help characterise different types of hydrocephalus in more detail.

Intracranial pressure for the characterization of different types of hydrocephalus: A Permutation Entropy study

Hydrocephalus is a condition characterized by altered cerebrospinal fluid (CSF) dynamics and chronic rises in intracranial pressure (ICP). However, the reason why hydrocephalic physiologies fail to inhibit dangerously high ICP levels is not known. Infusion studies are used to raise ICP and evaluate CSF circulation disorders. In this pilot study, ICP signals recorded during infusion tests from 33 patients with normal pressure hydrocephalus and 36 patients having developed a secondary form of normal pressure hydrocephalus were characterized using Permutation Entropy (PE), a symbolic non-linear method to quantify complexity. Each ICP signal was divided into four epochs--baseline (before infusion begins), infusion, plateau, and recovery (after infusion has stopped)--and the mean PE was calculated for each epoch. Statistically significant differences were found between PE for most epochs (p<;0.00833, Bonferroni-corrected Wilcoxon tests), with a significant decrease in the plateau phase. However, differences between PE for normal pressure and secondary hydrocephalus were not significant. Results suggest that the increase in ICP during infusion studies is associated with a significant decrease in PE. PE analysis of ICP signals could be useful for increasing our understanding of CSF dynamics in normal pressure hydrocephalus.

Alteration of the P-wave non-linear dynamics near the onset of paroxysmal atrial fibrillation

The analysis of P-wave variability from the electrocardiogram (ECG) has been suggested as an early predictor of the onset of paroxysmal atrial fibrillation (PAF). Hence, a preventive treatment could be used to avoid the loss of normal sinus rhythm, thus minimising health risks and improving the patient's quality of life. In these previous studies the variability of different temporal and morphological P-wave features has been only analysed in a linear fashion. However, the electrophysiological alteration occurring in the atria before the onset of PAF has to be considered as an inherently complex, chaotic and non-stationary process. This work analyses the presence of non-linear dynamics in the P-wave progression before the onset of PAF through the application of the central tendency measure (CTM), which is a non-linear metric summarising the degree of variability in a time series. Two hour-length ECG intervals just before the arrhythmia onset belonging to 46 different PAF patients were analysed. In agreement with the invasively observed inhomogeneous atrial conduction preceding the onset of PAF, CTM for all the considered P-wave features showed higher variability when the arrhythmia was closer to its onset. A diagnostic accuracy around 80% to discern between ECG segments far from PAF and close to PAF was obtained with the CTM of the metrics considered. This result was similar to previous P-wave variability methods based on linear approaches. However, the combination of linear and non-linear methods with a decision tree improved considerably their discriminant ability up to 90%, thus suggesting that both dynamics could coexist at the same time in the fragmented depolarisation of the atria preceding the arrhythmia.

Lempel-Ziv complexity of cortical activity during sleep and waking in rats

Understanding the dynamics of brain activity manifested in the EEG, local field potentials (LFP), and neuronal spiking is essential for explaining their underlying mechanisms and physiological significance. Much has been learned about sleep regulation using conventional EEG power spectrum, coherence, and period-amplitude analyses, which focus primarily on frequency and amplitude characteristics of the signals and on their spatio-temporal synchronicity. However, little is known about the effects of ongoing brain state or preceding sleep-wake history on the nonlinear dynamics of brain activity. Recent advances in developing novel mathematical approaches for investigating temporal structure of brain activity based on such measures, as Lempel-Ziv complexity (LZC) can provide insights that go beyond those obtained with conventional techniques of signal analysis. Here, we used extensive data sets obtained in spontaneously awake and sleeping adult male laboratory rats, as well as during and after sleep deprivation, to perform a detailed analysis of cortical LFP and neuronal activity with LZC approach. We found that activated brain states—waking and rapid eye movement (REM) sleep are characterized by higher LZC compared with non-rapid eye movement (NREM) sleep. Notably, LZC values derived from the LFP were especially low during early NREM sleep after sleep deprivation and toward the middle of individual NREM sleep episodes. We conclude that LZC is an important and yet largely unexplored measure with a high potential for investigating neurophysiological mechanisms of brain activity in health and disease.

Analysis of intracranial pressure signals recorded during infusion studies using the spectral entropy

Hydrocephalus includes a range of disorders characterized by clinical symptoms, abnormal brain imaging and altered cerebrospinal fluid (CSF) dynamics. Infusion tests can be used to study CSF circulation in patients with hydrocephalus. In them, intracranial pressure (ICP) is deliberately raised and CSF circulation disorders evaluated through measurements of the resulting ICP. In this study, we analyzed 77 ICP signals recorded during infusion tests using the spectral entropy (SE). Each signal was divided into four artifact-free epochs. The mean SE, <SE>, and the standard deviation of SE, SD[SE], were calculated for each epoch. Statistically significant differences were found between phases of the infusion test using <SE> and SD[SE] (p<1.7 · 10(-3), Bonferroni-corrected Wilcoxon tests). Furthermore, we found significantly lower <SE> and SD[SE] values in the plateau phase than in the basal phase. These findings suggest that the increase in ICP during infusion studies is associated with a significant decrease in irregularity and variability of the spectral content of ICP signals, measured in terms of SE. We conclude that the spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus.

Spectral analysis of intracranial pressure signals recorded during infusion studies in patients with hydrocephalus

Hydrocephalus includes a number of disorders characterised by clinical symptoms, enlarged ventricles (observable using neuroimaging techniques) and altered cerebrospinal fluid (CSF) dynamics. Infusion tests are one of the available procedures to study CSF circulation in patients with clinical and radiological features of hydrocephalus. In them, intracranial pressure (ICP) is deliberately raised and CSF circulation disorders evaluated through measurements of the resulting ICP. In this study, we analysed seventy-seven ICP signals recorded during infusion tests using four spectral-based parameters: median frequency (MF) and relative power (RP) in three frequency bands. These measures provide a novel perspective for the analysis of ICP signals in the frequency domain. Each signal was divided into four artefact-free epochs (corresponding to the basal, early infusion, plateau and recovery phases of the infusion study). The four spectral parameters were calculated for each epoch. We analysed differences between epochs of the infusion test and correlations between these epochs and patient data. Statistically significant differences (p < 1.7 × 10(-3), Bonferroni-corrected Wilcoxon signed-rank tests) were found between epochs of the infusion test using MF and RP. Furthermore, some spectral parameters (MF in the basal phase, RP for the first frequency band and in the early infusion phase, RP for the second frequency band and in all phases of the infusion study and RP in the third frequency band and in the basal phase) revealed significant correlations (p < 0.01) between epochs of the infusion test and signal amplitude in the basal and plateau phases. Our results suggest that spectral analysis of ICP signals could be useful for understanding CSF dynamics in hydrocephalus.

Quantitative evaluation of artifact removal in real magnetoencephalogram signals with blind source separation

The magnetoencephalogram (MEG) is contaminated with undesired signals, which are called artifacts. Some of the most important ones are the cardiac and the ocular artifacts (CA and OA, respectively), and the power line noise (PLN). Blind source separation (BSS) has been used to reduce the influence of the artifacts in the data. There is a plethora of BSS-based artifact removal approaches, but few comparative analyses. In this study, MEG background activity from 26 subjects was processed with five widespread BSS (AMUSE, SOBI, JADE, extended Infomax, and FastICA) and one constrained BSS (cBSS) techniques. Then, the ability of several combinations of BSS algorithm, epoch length, and artifact detection metric to automatically reduce the CA, OA, and PLN were quantified with objective criteria. The results pinpointed to cBSS as a very suitable approach to remove the CA. Additionally, a combination of AMUSE or SOBI and artifact detection metrics based on entropy or power criteria decreased the OA. Finally, the PLN was reduced by means of a spectral metric. These findings confirm the utility of BSS to help in the artifact removal for MEG background activity.

Complexity analysis of the cerebrospinal fluid pulse waveform during infusion studies

PURPOSE

Nonlinear dynamics has enhanced the diagnostic abilities of some physiological signals. Recent studies have shown that the complexity of the intracranial pressure waveform decreases during periods of intracranial hypertension in paediatric patients with acute brain injury. We wanted to assess changes in the complexity of the cerebrospinal fluid (CSF) pressure signal over the large range covered during the study of CSF circulation with infusion studies.

METHODS

We performed 37 infusion studies in patients with hydrocephalus of various types and origin (median age 71 years; interquartile range 60-77 years). After 5 min of baseline measurement, infusion was started at a rate of 1.5 ml/min until a plateau was reached. Once the infusion finished, CSF pressure was recorded until it returned to baseline. We analysed CSF pressure signals using the Lempel-Ziv (LZ) complexity measure. To characterise more accurately the behaviour of LZ complexity, the study was segmented into four periods: basal, early infusion, plateau and recovery.

RESULTS

The LZ complexity of the CSF pressure decreased in the plateau of the infusion study compared to the basal complexity (p=0.0018). This indicates loss of complexity of the CSF pulse waveform with intracranial hypertension. We also noted that the level of complexity begins to increase when the infusion is interrupted and CSF pressure drops towards the initial values.

CONCLUSIONS

The LZ complexity decreases when CSF pressure reaches the range of intracranial hypertension during infusion studies. This finding provides further evidence of a phenomenon of decomplexification in the pulsatile component of the pressure signal during intracranial hypertension.

Optimal parameters study for sample entropy-based atrial fibrillation organization analysis

Sample entropy (SampEn) is a nonlinear regularity index that requires the a priori selection of three parameters: the length of the sequences to be compared, m, the patterns similarity tolerance, r, and the number of samples under analysis, N. Appropriate values for m, r and N have been recommended and widely used in the literature for the application of SampEn to some physiological time series, such as heart rate, hormonal data, etc. However, no guidelines exist for the selection of that values in other cases. Therefore, an optimal parameters study should be required for the application of SampEn to not previously analyzed biomedical signals. In the present work, a thorough analysis on the optimal values for m, r and N is presented within the context of atrial fibrillation (AF) organization estimation, computed from surface electrocardiogram recordings. Recently, the evaluation of AF organization through SampEn, has revealed clinically useful information that could be used for a better treatment of this arrhythmia. The present study analyzed optimal SampEn parameter values within two different scenarios of AF organization estimation, such as the prediction of paroxysmal AF termination and the electrical cardioversion outcome in persistent AF. As a result, interesting recommendations about the selection of m, r and N, together with the relationship between N and the sampling rate (f(s)) were obtained. More precisely, (i) the proportion between N and f(s) should be higher than 1s and f(s)>or=256 Hz, (ii) overlapping between adjacent N-length windows does not improve AF organization estimation with respect to the analysis of non-overlapping windows, and (iii) values of m and r maximizing successful classification for the analyzed AF databases should be considered within a range wider than the proposed in the literature for heart rate analysis, i.e. m=1 and m=2 and r between 0.1 and 0.25 times the standard deviation of the data.

Blind source separation to enhance spectral and non-linear features of magnetoencephalogram recordings. Application to Alzheimer's disease

This work studied whether a blind source separation (BSS) and component selection procedure could increase the differences between Alzheimer's disease (AD) patients and control subjects' spectral and non-linear features of magnetoencephalogram (MEG) recordings. MEGs were acquired with a 148-channel whole-head magnetometer from 62 subjects (36 AD patients and 26 controls), who were divided randomly into training and test sets. MEGs were decomposed using the algorithm for multiple unknown signals extraction (AMUSE). The extracted AMUSE components were characterised with two spectral--median frequency and spectral entropy (SpecEn)--and two non-linear features: Lempel-Ziv complexity (LZC) and sample entropy (SampEn). One-way analysis of variance with age as a covariate was applied to the training set to decide which components had the most significant differences between groups. Then, partial reconstructions of the MEGs were computed with these significant components. In the test set, the accuracy and area under the ROC curve (AUC) associated with each partial reconstruction of the MEGs were compared with the case where no BSS-preprocessing was applied. This preprocessing increased the AUCs between 0.013 and 0.227, while the accuracy for SpecEn, LZC and SampEn rose between 6.4% and 22.6%, improving the separation between AD patients and control subjects.

Nonlinear analysis of electroencephalogram and magnetoencephalogram recordings in patients with Alzheimer's disease

The aim of the present study is to show the usefulness of nonlinear methods to analyse the electroencephalogram (EEG) and magnetoencephalogram (MEG) in patients with Alzheimer's disease (AD). The following nonlinear methods have been applied to study the EEG and MEG background activity in AD patients and control subjects: approximate entropy, sample entropy, multiscale entropy, auto-mutual information and Lempel-Ziv complexity. We discuss why these nonlinear methods are appropriate to analyse the EEG and MEG. Furthermore, the performance of all these methods has been compared when applied to the same databases of EEG and MEG recordings. Our results show that EEG and MEG background activities in AD patients are less complex and more regular than in healthy control subjects. In line with previous studies, our work suggests that nonlinear analysis techniques could be useful in AD diagnosis.

Interpretation of the auto-mutual information rate of decrease in the context of biomedical signal analysis. Application to electroencephalogram recordings

The mutual information (MI) is a measure of both linear and nonlinear dependences. It can be applied to a time series and a time-delayed version of the same sequence to compute the auto-mutual information function (AMIF). Moreover, the AMIF rate of decrease (AMIFRD) with increasing time delay in a signal is correlated with its entropy and has been used to characterize biomedical data. In this paper, we aimed at gaining insight into the dependence of the AMIFRD on several signal processing concepts and at illustrating its application to biomedical time series analysis. Thus, we have analysed a set of synthetic sequences with the AMIFRD. The results show that the AMIF decreases more quickly as bandwidth increases and that the AMIFRD becomes more negative as there is more white noise contaminating the time series. Additionally, this metric detected changes in the nonlinear dynamics of a signal. Finally, in order to illustrate the analysis of real biomedical signals with the AMIFRD, this metric was applied to electroencephalogram (EEG) signals acquired with eyes open and closed and to ictal and non-ictal intracranial EEG recordings.

Neural network based detection of hard exudates in retinal images

Diabetic retinopathy (DR) is an important cause of visual impairment in developed countries. Automatic recognition of DR lesions in fundus images can contribute to the diagnosis of the disease. The aim of this study is to automatically detect one of these lesions, hard exudates (EXs), in order to help ophthalmologists in the diagnosis and follow-up of the disease. We propose an algorithm which includes a neural network (NN) classifier for this task. Three NN classifiers were investigated: multilayer perceptron (MLP), radial basis function (RBF) and support vector machine (SVM). Our database was composed of 117 images with variable colour, brightness, and quality. 50 of them (from DR patients) were used to train the NN classifiers and 67 (40 from DR patients and 27 from healthy retinas) to test the method. Using a lesion-based criterion, we achieved a mean sensitivity (SE(l)) of 88.14% and a mean positive predictive value (PPV(l)) of 80.72% for MLP. With RBF we obtained SE(l)=88.49% and PPV(l)=77.41%, while we reached SE(l)=87.61% and PPV(l)=83.51% using SVM. With an image-based criterion, a mean sensitivity (SE(i)) of 100%, a mean specificity (SP(i)) of 92.59% and a mean accuracy (AC(i)) of 97.01% were obtained with MLP. Using RBF we achieved SE(i)=100%, SP(i)=81.48% and AC(i)=92.54%. With SVM the image-based results were SE(i)=100%, SP(i)=77.78% and AC(i)=91.04%.

A study on the possible usefulness of detrended fluctuation analysis of the electroencephalogram background activity in Alzheimer's disease

We studied the EEG background activity of Alzheimer's disease (AD) patients with detrended fluctuation analysis (DFA). DFA provides an estimation of the scaling information and long-range correlations in time series. We recorded the EEG in 11 AD patients and 11 age-matched controls. Our results showed two scaling regions in all subjects' channels (for limited time scales from 0.01 to 0.04 s and from 0.08 to 0.43 s, respectively), with a clear bend when their corresponding slopes (alpha(1) and alpha(2)) were different. No significant differences between groups were found with alpha(1). However, alpha(2) values were significantly lower in control subjects at electrodes T5, T6, and O1 (p < 0.01, Student's t-test). These findings suggest that the scaling behavior of the EEG is sensitive to AD. Although alpha(2) values allowed us to separate AD patients and controls, accuracies were lower than with spectral analysis. However, a forward stepwise linear discriminant analysis with a leave-one-out cross-validation procedure showed that the combined use of DFA and spectral analysis could improve the diagnostic accuracy of each individual technique. Thus, although spectral analysis outperforms DFA, the combined use of both techniques may increase the insight into brain dysfunction in AD.

Evaluation of spectral ratio measures from spontaneous MEG recordings in patients with Alzheimer's disease

Alzheimer's disease (AD) is the most frequent form of dementia in western countries. The rise in life expectancy will likely increase its prevalence, since ageing is the greatest known risk factor. Although an early and accurate identification is critical, low diagnostic accuracy is currently reached. Hence, the aim of the present study was to analyse the spontaneous magnetoencephalographic (MEG) activity from 148 channels in 20 AD patients and 21 healthy controls to extract discriminating spectral features. Relative power (RP) was calculated in conventional frequency bands and several ratios were defined to emphasise the differences in its distribution. Both RP values and spectral ratios were transformed with a principal component analysis to summarise information with minimal loss of variability. AD patients showed a significant increase of RP(delta) and RP(theta), along with a decrease of RP(beta) and RP(gamma). The most significant differences were reached by spectral ratios using the beta band. Specifically, we obtained 75.0% sensitivity, 90.5% specificity and 82.9% accuracy (linear discriminant analysis with a leave-one-out cross-validation procedure), together with a p-value lower than 0.001 (one-way analysis of variance with age as a covariate) using the [RP(alpha)+RP(beta(1))+RP(beta(2))+RP(gamma)]/[RP(delta)+RP(theta)] ratio. The spectral ratios also showed a higher correlation with the severity of dementia than individual relative power measures. Our results suggest that the spectral ratios could be useful descriptors to help in the AD diagnosis, since they effectively summarise the slowing of the AD patients' MEG rhythms in individual indexes and correlate significantly with the severity of dementia.

A novel automatic image processing algorithm for detection of hard exudates based on retinal image analysis

We present an automatic image processing algorithm to detect hard exudates. Automatic detection of hard exudates from retinal images is an important problem since hard exudates are associated with diabetic retinopathy and have been found to be one of the most prevalent earliest signs of retinopathy. The algorithm is based on Fisher's linear discriminant analysis and makes use of colour information to perform the classification of retinal exudates. We prospectively assessed the algorithm performance using a database containing 58 retinal images with variable colour, brightness, and quality. Our proposed algorithm obtained a sensitivity of 88% with a mean number of 4.83+/-4.64 false positives per image using the lesion-based performance evaluation criterion, and achieved an image-based classification accuracy of 100% (sensitivity of 100% and specificity of 100%).

Space-time ICA versus Ensemble ICA for ictal EEG analysis with component differentiation via Lempel-Ziv complexity

In this proof-of-principle study we analyzed intracranial electroencephalogram recordings in patients with intractable focal epilepsy. We contrast two implementations of Independent Component Analysis (ICA) - Ensemble (or spatial) ICA (E-ICA) and Space-Time ICA (ST-ICA) in separating out the ictal components underlying the measurements. In each case we assess the outputs of the ICA algorithms by means of a non-linear method known as the Lempel-Ziv (LZ) complexity. LZ complexity quantifies the complexity of a time series and is well suited to the analysis of non-stationary biomedical signals of short length. Our results show that for small numbers of intracranial recordings, standard E-ICA results in marginal improvements in the separation as measured by the LZ complexity changes. ST-ICA using just 2 recording channels both near and far from the epileptic focus result in more distinct ictal components--although at this stage there is a subjective element to the separation process for ST-ICA. Our results are promising showing that it is possible to extract meaningful information from just 2 recording electrodes through ST-ICA, even if they are not directly over the seizure focus. This work is being further expanded for seizure onset analysis.

Electroencephalogram background activity characterization with approximate entropy and auto mutual information in Alzheimer's disease patients

The aim of this study was to analyze the electroencephalogram (EEG) background activity in Alzheimer's disease (AD) with two non-linear methods: Approximate Entropy (ApEn) and Auto Mutual Information (AMI). ApEn quantifies the regularity in data, while AMI detects linear and non-linear dependencies in time series. EEGs were recorded from the 19 scalp loci of the international 10-20 system in 11 AD patients and 11 age-matched controls. ApEn was significantly lower in AD patients at electrodes O1, O2, P3 and P4 (p<0.01). The AMI of the AD patients decreased significantly more slowly with time delays than the AMI of normal controls at electrodes T5, T6, O1, O2, P3 and P4 (p<0.01). Furthermore, we observed a strong correlation between the results obtained with both non-linear methods, suggesting that the AMI rate of decrease can be used to estimate the regularity in time series. The decreased irregularity found in AD patients suggests that EEG analysis with ApEn and AMI could help to increase our insight into brain dysfunction in AD.

Analysis of MEG recordings from Alzheimer's disease patients with sample and multiscale entropies

Alzheimer's disease (AD) is one of the most prominent neurodegenerative disorders. The aim of this study is to analyze the magnetoencephalogram (MEG) background activity in AD patients using sample entropy (SampEn) and multiscale entropy (MSE). The former quantifies the signal regularity, while the latter is a complexity measure. These concepts, irregularity and complexity, are linked although the relationship is not straightforward. Five minutes of recording were acquired with a 148-channel whole-head magnetometer in 20 patients with probable AD and 21 control subjects. Our results show that MEG recordings are less complex and more regular in AD patients than in control subjects. Significant differences between both groups were found in some MEG channels with both methods (p<0.01, Student's t-test with Bonferroni's correction). Using receiver operating characteristic curves, accuracies of 75.6% with SampEn and of 87.8% with MSE were reached. Our findings show the usefulness of these entropy measures to increase our insight into AD.

Analysis of spontaneous MEG activity in patients with Alzheimer's disease using spectral entropies

The aim of this study was to explore the ability of several spectral entropies to discriminate between spontaneous magnetoencephalographic (MEG) oscillations from 20 Alzheimer's disease (AD) patients and 21 controls. Hence, the relative spectral power (RSP) in classical frequency bands was calculated from the averaged power spectral density. Given the fact that the RSP can be viewed as a probability distribution function, the Shannon spectral entropy, Tsallis spectral entropy, generalized escort-Tsallis spectral entropy and Rényi spectral entropy were calculated from the RSP. Significant differences for each parameter were assessed with Mann-Whitney U test, whereas classification performance was studied using binary logistic regression. Results revealed an increase in the RSP of control subjects at beta and gamma bands, while AD patients showed an increase in the RSP values at delta and theta bands. Entropies obtained statistically significant lower values for AD patients than for controls. This issue suggests a significant decrease in irregularity of AD patients' MEG activity.

Artifact removal in magnetoencephalogram background activity with independent component analysis

The aim of this study was to assess whether independent component analysis (ICA) could be valuable to remove power line noise, cardiac, and ocular artifacts from magnetoencephalogram (MEG) background activity. The MEGs were recorded from 11 subjects with a 148-channel whole-head magnetometer. We used a statistical criterion to estimate the number of independent components. Then, a robust ICA algorithm decomposed the MEG epochs and several methods were applied to detect those artifacts. The whole process had been previously tested on synthetic data. We found that the line noise components could be easily detected by their frequency spectrum. In addition, the ocular artifacts could be identified by their frequency characteristics and scalp topography. Moreover, the cardiac artifact was better recognized by its skewness value than by its kurtosis one. Finally, the MEG signals were compared before and after artifact rejection to evaluate our method.

Extraction of spectral based measures from MEG background oscillations in Alzheimer's disease

In this study, we explored the ability of several spectral based measures to summarize the information of the power spectral density (PSD) function from spontaneous magnetoencephalographic (MEG) activity in Alzheimer's disease (AD). The MEGs of 20 AD patients and 21 elderly controls were recorded with eyes closed at rest during 5 min from 148 channels. Five spectral parameters were estimated from PSD: mean frequency (MF), individual alpha frequency (IAF), transition frequency (TF), 95% spectral edge frequency (SEF95) and spectral entropy (SE). To reduce the dimensionality of the problem, we applied a principal component analysis. According to our results, MF was the best discriminating index between both groups (85.00% sensitivity, 85.71% specificity) indicating a shift to the left of the power spectrum in AD. A significant MEG slowing was also observed using both IAF (p < 0.001) and TF (p < 0.01). The lowest classification statistics (65% sensitivity, 66.67% specificity) were obtained with SEF95. However, these results were also significant (p < 0.05). This fact points out that there is a variation in the spectral content at high frequencies of AD patients and controls. Finally, a significant decrease of irregularity in the AD group was observed with SE, with results close to those obtained with MF (90.00% sensitivity, 76.19% specificity). In conclusion, a complete description of PSD can help to increase our insight into brain dysfunction in AD and to extract spectral patterns specific to the disease.

Analysis of the magnetoencephalogram background activity in Alzheimer's disease patients with auto-mutual information

The aim of the present study was to analyse the magnetoencephalogram (MEG) background activity in patients with Alzheimer's disease (AD), one of the most frequent disorders among elderly population. For this pilot study, we recorded the MEGs with a 148-channel whole-head magnetometer in 20 patients with probable AD and 21 age-matched control subjects. Artefact-free epochs of 3392 samples were analysed with auto-mutual information (AMI). Average AMI decline rates were lower for the AD patients' recordings than for control subjects' ones. Statistically significant differences were found using a Student's t-test (p<0.01) in 144 channels. Mean AMI values were analysed with a receiver operating characteristic curve. Sensitivity, specificity and accuracy values of 75%, 90.5% and 82.9% were obtained. Our results show that AMI estimations of the magnetic brain activity are different in both groups, hence indicating an abnormal type of dynamics associated with AD. This study suggests that AMI might help medical doctors in the diagnosis of the disease.

Predicting survival in critical patients by use of body temperature regularity measurement based on approximate entropy

Body temperature is a classical diagnostic tool for a number of diseases. However, it is usually employed as a plain binary classification function (febrile or not febrile), and therefore its diagnostic power has not been fully developed. In this paper, we describe how body temperature regularity can be used for diagnosis. Our proposed methodology is based on obtaining accurate long-term temperature recordings at high sampling frequencies and analyzing the temperature signal using a regularity metric (approximate entropy). In this study, we assessed our methodology using temperature registers acquired from patients with multiple organ failure admitted to an intensive care unit. Our results indicate there is a correlation between the patient's condition and the regularity of the body temperature. This finding enabled us to design a classifier for two outcomes (survival or death) and test it on a dataset including 36 subjects. The classifier achieved an accuracy of 72%.

Analysis of intracranial pressure during acute intracranial hypertension using Lempel-Ziv complexity: further evidence

We analyzed intracranial pressure (ICP) signals during periods of acute intracranial hypertension (ICH) using the Lempel-Ziv (LZ) complexity measure. Our results indicate the LZ complexity of ICP decreases during periods of ICH. The mean LZ complexity before ICH was 0.20+/-0.04, while the mean LZ complexity during ICH was 0.16+/-0.03 (p<0.05). The mean decrease of the LZ complexity values during the ICH episodes was 19.5%. Additionally, we present preliminary evidence suggesting that periods of ICH may be detectable from non-invasive signals coupled with ICP, such as pulse oximetry (SpO2).

Heart rate regularity analysis obtained from pulse oximetric recordings in the diagnosis of obstructive sleep apnea

Approximate entropy (ApEn) is a technique that can be used to quantify the irregularity or variability of time series. We prospectively evaluated the validity of ApEn of heart rate data obtained from pulse oximetric recordings as a diagnostic test for obstructive sleep apnea (OSA) in patients clinically suspected of suffering this disease. A sample of 187 referred outpatients (147 men and 40 women), with a mean age of 57.9+/-12.8 years and a body mass index of 29.5+/-5.5 kg/m(2), clinically suspected of having OSA were studied using nocturnal pulse oximetric recording performed simultaneously with complete polysomnography. A diagnosis of OSA was confirmed in 111 (59.3%). Patients with OSA presented significantly higher ApEn levels than those without OSA (1.334+/-0.189 vs 1.167+/-0.182). Chronic obstructive pulmonary disease (COPD) was diagnosed for 42 patients. Among these patients, 22 (52.4%) were diagnosed with OSA. COPD patients with OSA showed significantly higher ApEn levels than COPD patients without OSA (1.337+/-0.193 vs 1.184+/-0.173; p=0.01). ApEn correlated significantly with apnea-hypopnea index (r=0.38; p=0.000). There was no significant correlation between ApEn and either age or body mass index. No significant changes were observed in ApEn throughout the night in OSA patients. Using receiver operating characteristic curve analysis, we obtained a diagnostic sensitivity of 71.2%, specificity of 78.9%, positive predictive value of 81.3%, and negative predictive value of 66% at a threshold of 1.272. We conclude that ApEn analysis of heart rate data obtained from pulse oximetric recordings could be a useful tool in the study of OSA.

Magnetoencephalogram blind source separation and component selection procedure to improve the diagnosis of Alzheimer's disease patients

The aim of this study was to improve the diagnosis of Alzheimer's disease (AD) patients applying a blind source separation (BSS) and component selection procedure to their magnetoencephalogram (MEG) recordings. MEGs from 18 AD patients and 18 control subjects were decomposed with the algorithm for multiple unknown signals extraction. MEG channels and components were characterized by their mean frequency, spectral entropy, approximate entropy, and Lempel-Ziv complexity. Using Student's t-test, the components which accounted for the most significant differences between groups were selected. Then, these relevant components were used to partially reconstruct the MEG channels. By means of a linear discriminant analysis, we found that the BSS-preprocessed MEGs classified the subjects with an accuracy of 80.6%, whereas 72.2% accuracy was obtained without the BSS and component selection procedure.

Utility of Approximate Entropy From Overnight Pulse Oximetry Data in the Diagnosis of the Obstructive Sleep Apnea Syndrome

Approximate entropy (ApEn) is a family of statistics introduced as a quantification of regularity in time series without any a priori knowledge about the system generating them. The aim of this preliminary study was to assess whether a time series analysis of arterial oxygen saturation (SaO2) signals from overnight pulse oximetry by means of ApEn could yield essential information on the diagnosis of obstructive sleep apnea (OSA) syndrome. We analyzed SaO2 signals from 187 subjects: 111 with a positive diagnosis of OSA and 76 with a negative diagnosis of OSA. We divided our data in a training set (44 patients with OSA Positive and 30 patients with OSA Negative) and a test set (67 patients with OSA Positive and 46 patients with OSA Negative). The training set was used for algorithm development and optimum threshold selection. Results showed that recurrence of apnea events in patients with OSA determined a significant increase in ApEn values. This method was assessed prospectively using the test dataset, where we obtained 82.09% sensitivity and 86.96% specificity. We conclude that ApEn analysis of SaO2 from pulse oximetric recording could be useful in the study of OSA.

Interpretation of the Lempel-Ziv complexity measure in the context of biomedical signal analysis

Lempel-Ziv complexity (LZ) and derived LZ algorithms have been extensively used to solve information theoretic problems such as coding and lossless data compression. In recent years, LZ has been widely used in biomedical applications to estimate the complexity of discrete-time signals. Despite its popularity as a complexity measure for biosignal analysis, the question of LZ interpretability and its relationship to other signal parameters and to other metrics has not been previously addressed. We have carried out an investigation aimed at gaining a better understanding of the LZ complexity itself, especially regarding its interpretability as a biomedical signal analysis technique. Our results indicate that LZ is particularly useful as a scalar metric to estimate the bandwidth of random processes and the harmonic variability in quasi-periodic signals.

Analysis of electroencephalograms in Alzheimer's disease patients with multiscale entropy

The aim of this study was to analyse the electroencephalogram (EEG) background activity of Alzheimer's disease (AD) patients using multiscale entropy (MSE). MSE is a recently developed method that quantifies the regularity of a signal on different time scales. These time scales are inspected by means of several coarse-grained sequences formed from the analysed signals. We recorded the EEGs from 19 scalp electrodes in 11 AD patients and 11 age-matched controls and estimated the MSE profile for each epoch of the EEG recordings. The shape of the MSE profiles reveals the EEG complexity, and it suggests that the EEG contains information in deeper scales than the smallest one. Moreover, the results showed that the EEG background activity is less complex in AD patients than control subjects. We found significant differences between both subject groups at electrodes F3, F7, Fp1, Fp2, T5, T6, P3, P4, O1 and O2 (p-value < 0.01, Student's t-test). These findings indicate that the EEG complexity analysis performed on deeper time scales by MSE may be a useful tool in order to increase our knowledge of AD.

Analysis of EEG background activity in Alzheimer's disease patients with Lempel–Ziv complexity and central tendency measure

In this study we have investigated the electroencephalogram (EEG) background activity in patients with Alzheimer's disease (AD) using non-linear analysis methods. We calculated the Lempel-Ziv (LZ) complexity - applying two different sequence conversion methods - and the central tendency measure (CTM) of the EEG in 11 AD patients and 11 age-matched control subjects. CTM quantifies the degree of variability, while LZ complexity reflects the arising rate of new patterns along with the EEG time series. We did not find significant differences between AD patients and control subjects' EEGs with CTM. On the other hand, AD patients had significantly lower LZ complexity values (p<0.01) at electrodes P3 and O1 with a two-symbol sequence conversion, and P3, P4, O1 and T5 using three symbols. Our results show a decreased complexity of EEG patterns in AD patients. In addition, we obtained 90.9% sensitivity and 72.7% specificity at O1, and 72.7% sensitivity and 90.9% specificity at P3 and P4. These findings suggest that LZ complexity may contribute to increase the insight into brain dysfunction in AD in ways which are not possible with more classical and conventional statistical methods.

Nonlinear characteristics of blood oxygen saturation from nocturnal oximetry for obstructive sleep apnoea detection

Nocturnal oximetry is an attractive option for the diagnosis of obstructive sleep apnoea (OSA) syndrome because of its simplicity and low cost compared to polysomnography (PSG). The present study assesses nonlinear analysis of blood oxygen saturation (SaO(2)) from nocturnal oximetry as a diagnostic test to discriminate between OSA positive and OSA negative patients. A sample of 187 referred outpatients, clinically suspected of having OSA, was studied using nocturnal oximetry performed simultaneously with complete PSG. A positive OSA diagnosis was found for 111 cases, while the remaining 76 cases were classified as OSA negative. The following oximetric indices were obtained: cumulative time spent below a saturation of 90% (CT90), oxygen desaturation indices of 4% (ODI4), 3% (ODI3) and 2% (ODI2) and the delta index (Delta index). SaO(2) records were subsequently processed applying two nonlinear methods: central tendency measure (CTM) and Lempel-Ziv (LZ) complexity. Significant differences (p < 0.01) were found between OSA positive and OSA negative patients. Using CTM we obtained a sensitivity of 90.1% and a specificity of 82.9%, while with LZ the sensitivity was 86.5% and the specificity was 77.6%. CTM and LZ accuracies were higher than those provided by ODI4, ODI3, ODI2 and CT90. The results suggest that nonlinear analysis of SaO(2) signals from nocturnal oximetry could yield useful information in OSA diagnosis.

Complexity analysis of the magnetoencephalogram background activity in Alzheimer's disease patients

The aim of the present study was to analyse the magnetoencephalogram (MEG) background activity in patients with Alzheimer's disease (AD) using the Lempel-Ziv (LZ) complexity. This non-linear method measures the complexity of finite sequences and is related to the number of distinct substrings and the rate of their occurrence along the sequence. The MEGs were recorded with a 148-channel whole-head magnetometer (MAGNES 2500 WH, 4D Neuroimaging) in 21 patients with AD and in 21 age-matched control subjects. Artefact-free epochs were selected for complexity analysis. Results showed that MEG signals from AD patients had lower complexity than control subjects' MEGs and the differences were statistically significant (p<0.01). In order to reduce the dimension of the LZ complexity results, a principal components analysis (PCA) was applied, and only the first principal component was retained. The first component score from PCA was graphically analysed using a box plot and a receiver-operating characteristic (ROC) curve. A specificity of 85.71%, a sensitivity of 80.95% and an area under the ROC curve of 0.9002 were obtained. These preliminary results suggest that cognitive dysfunction in AD is associated with a decreased LZ complexity in the MEG signals.

Variability, Regularity, and Complexity of Time Series Generated by Schizophrenic Patients and Control Subjects

We analyzed time series generated by 20 schizophrenic patients and 20 sex- and age-matched control subjects using three nonlinear methods of time series analysis as test statistics: central tendency measure (CTM) from the scatter plots of first differences of data, approximate entropy (ApEn), and Lempel-Ziv (LZ) complexity. We divided our data into a training set (10 patients and 10 control subjects) and a test set (10 patients and 10 control subjects). The training set was used for algorithm development and optimum threshold selection. Each method was assessed prospectively using the test dataset. We obtained 80% sensitivity and 90% specificity with LZ complexity, 90% sensitivity, and 60% specificity with ApEn, and 70% sensitivity and 70% specificity with CTM. Our results indicate that there exist differences in the ability to generate random time series between schizophrenic subjects and controls, as estimated by the CTM, ApEn, and LZ. This finding agrees with most previous results showing that schizophrenic patients are characterized by less complex neurobehavioral and neuropsychologic measurements.

Entropy analysis of the EEG background activity in Alzheimer's disease patients

Alzheimer's disease (AD) is the most common neurodegenerative disorder. Although a definite diagnosis is only possible by necropsy, a differential diagnosis with other types of dementia and with major depression should be attempted. The aim of this study was to analyse the electroencephalogram (EEG) background activity of AD patients to test the hypothesis that the regularity of the AD patients' EEG is higher than that of age-matched controls. We recorded the EEG from 19 scalp electrodes in 11 AD patients and 11 age-matched controls. Two different methods were used to estimate the regularity of the EEG background activity: spectral entropy (SpecEn) and sample entropy (SampEn). We did not find significant differences between AD patients and control subjects' EEGs with SpecEn. On the other hand, AD patients had significantly lower SampEn values than control subjects (p < 0.01) at electrodes P3, P4, O1 and O2. Our results show an increase of EEG regularity in AD patients. These findings suggest that nonlinear analysis of the EEG with SampEn could yield essential information and may contribute to increasing the insight into brain dysfunction in AD in ways which are not possible with more classical and conventional statistical methods.

Rejection of artifact sources in magnetoencephalogram background activity using independent component analysis

The aim of this pilot study was to assess the usefulness of independent component analysis (ICA) to detect cardiac artifacts and power line interferences in magnetoencephalogram (MEG) recordings. We recorded MEG signals from six subjects with a 148-channel whole-head magnetometer (MAGNES 2500 WH, 4D Neuroimaging). Epochs of 50 s with power line noise, cardiac, and ocular artifacts were selected for analysis. We applied a statistical criterion to determine the number of sources, and a robust ICA algorithm to decompose the MEG epochs. Skewness, kurtosis, and a spectral metric were used to mark the studied artifacts. We found that the power line interference could be easily detected by its frequency characteristics. Moreover, skewness outperformed kurtosis when identifying the cardiac artifact.

Interpretation of approximate entropy: analysis of intracranial pressure approximate entropy during acute intracranial hypertension

We studied changes in intracranial pressure (ICP) complexity, estimated by the approximate entropy (ApEn) of the ICP signal, as subjects progressed from a state of normal ICP (< 20-25 mmHg) to acutely elevated ICP (an ICP "spike" defined as ICP > 25 mmHg for < or = 5 min). We hypothesized that the measures of intracranial pressure (ICP) complexity and irregularity would decrease during acute elevations in ICP. To test this hypothesis we studied ICP spikes in pediatric subjects with severe traumatic brain injury (TBI). We conclude that decreased complexity of ICP coincides with episodes of intracranial hypertension (ICH) in TBI. This suggests that the complex regulatory mechanisms that govern intracranial pressure are disrupted during acute rises in ICP. Furthermore, we carried out a series of experiments where ApEn was used to analyze synthetic signals of different characteristics with the objective of gaining a better understanding of ApEn itself, especially its interpretation in biomedical signal analysis.

Analysis of regularity in the EEG background activity of Alzheimer's disease patients with Approximate Entropy

OBJECTIVE

The aim of this study was to analyse the regularity of the EEG background activity of Alzheimer's disease (AD) patients to test the hypothesis that the irregularity of the AD patients' EEG is lower than that of age-matched controls.

METHODS

We recorded the EEG from 19 scalp electrodes in 10 AD patients and 8 age-matched controls and estimated the Approximate Entropy (ApEn). ApEn is a non-linear statistic that can be used to quantify the irregularity of a time series. Larger values correspond to more complexity or irregularity. A spectral analysis was also performed.

RESULTS

ApEn was significantly lower in the AD patients at electrodes P3 and P4 (P < 0.01), indicating a decrease of irregularity. We obtained 70% sensitivity and 100% specificity at P3, and 80% sensitivity and 75% specificity at P4. Results seemed to be complementary to spectral analysis.

CONCLUSIONS

The decreased irregularity found in the EEG of AD patients in the parietal region leads us to think that EEG analysis with ApEn could be a useful tool to increase our insight into brain dysfunction in AD. However, caution should be applied due to the small sample size.

SIGNIFICANCE

This article represents a first step in demonstrating the feasibility of ApEn for recognition of EEG changes in AD.