Consciousness level assessment in completely locked-in syndrome patients using soft-clustering

Brain-computer interfaces (BCIs) are very convenient tools to assess locked-in (LIS) and completely locked-in state (CLIS) patients' hidden states of consciousness. For the time being, there is no ground-truth data in respect to these states for above-mentioned patients. This lack of gold standard makes this problem particularly challenging. In addition to consciousness assessment, BCIs also provide them with a communication device that does not require the presence of motor responses, which they are lacking. Communication plays an important role in the patients' quality of life and prognosis. Significant progress have been made to provide them with EEG-based BCIs in particular. Nonetheless, the majority of existing studies directly dive into the communication part without assessing if the patient is even conscious. Additionally, the few studies that do essentially use evoked brain potentials, mostly the P300, that necessitates the patient's voluntary and active participation to be elicited. Patients are easily fatigued, and would consequently be less successful during the main communication task. Furthermore, when the consciousness states are determined using resting state data, only one or two features were used. In this thesis, different sets of EEG features are used to assess the consciousness level of CLIS patients using resting-state data. This is done as a preliminary step that needed to be succeeded in order to engage to the next step, communication with the patient. In other words, the 'conversation' is initiated only if the patient is sufficiently conscious. This variety of EEG features is utilised to increase the probability of correctly estimating the patients' consciousness states. Indeed, each of them captures a particular signal attribute, and combining them would allow the collection of different hidden characteristics that could have not been obtained from a single feature. Furthermore, the proposed method should allow to determine if communication shall be initiated at a specific time with the patient. The EEG features used are frequency-based, complexity related and connectivity metrics. Besides, instead of analysing results from individual channels or specific brain regions, the global activity of the brain is assessed. The estimated consciousness levels are then obtained by applying two different soft-clustering analysis methods, namely Fuzzy c-means (FCM) and Gaussian Mixture Models (GMM), to the individual features and ensembling their results using their average or their product. The proposed approach is first applied to EEG data recorded from patients with unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) (patients with disorders of consciousness (DoC)) to evaluate its performance. It is subsequently applied to data from one CLIS patient that is unique in its kind because it contains a time frame during which the experimenters affirmed that he was conscious. Finally, it is used to estimate the levels of consciousness of nine other CLIS patients. The obtained results revealed that the presented approach was able to take into account the variations of the different features and deduce a unique output taking into consideration the individual features contributions. Some of them performed better than others, which is not surprising since each person is different. It was also able to draw very accurate estimations of the level of consciousness under specific conditions. The approach presented in this thesis provides an additional tool for diagnosis to the medical staff. Furthermore, when implemented online, it would enable to determine the optimal time to engage in communication with CLIS patients. Moreover, it could possibly be used to predict patients' cognitive decline and/or death

Applications of multi-way analysis for characterizing paediatric electroencephalogram (EEG) recordings

This doctoral thesis outlines advances in multi-way analysis for characterizing electroencephalogram (EEG) recordings from a paediatric population, with the aim to describe new links between EEG data and changes in the brain. This entails establishing the validity of multi-way analysis as a framework for identifying developmental information at the individual and collective level. Multi-way analysis broadens matrix analysis to a multi-linear algebraic architecture to identify latent structural relationships in naturally occurring higher order (n-way) data, like EEG. We use the canonical polyadic decomposition (CPD) as a multi-way model to efficiently express the complex structures present in paediatric EEG recordings as unique combinations of low-rank matrices, offering new insights into child development. This multi-way CPD framework is explored for both typically developing (TD) children and children with potential developmental delays (DD), e.g. children who suffer from epilepsy or paediatric stroke. Resting-state EEG (rEEG) data serves as an intuitive starting point in analyzing paediatric EEG via multi-way analysis. Here, the CPD model probes the underlying relationships between the spatial, spectral and subject modes of several rEEG datasets. We demonstrate the CPD can reveal distinct population-level features in rEEG that reflect unique developmental traits in varying child populations. These development-affiliated profiles are evaluated with respect to capturing structures well-established in childhood EEG. The identified features are also interrogated for their predictive abilities in anticipating new subjects’ ages. Assessing simulations and real rEEG datasets of TD and DD children establishes the multi-way analysis framework as well suited for identifying developmental profiles from paediatric rEEG. We extend the multi-way analysis scheme to more complex EEG scenarios common in EEG rehabilitation technology, like brain-computer interfaces. We explore the feasibility of multi-way modelling for interventions where developmental changes often pose as barriers. The multi-way CPD model is expanded to include four modes- task, spatial, spectral and subject data, with non-negativity and orthogonality constraints imposed. We analyze a visual attention task that elucidates a steady-state visual evoked potential and present the advantages gained from the extended CPD model. Through direct multi-linear projection, we demonstrate that linear profiles of the CPD can be capitalized upon for rapid task classification sans individual subject classifier calibration. Incorporating concepts from the multi-way analysis scheme with child development measured by psychometric tests, we propose the Joint EEG Development Inference (JEDI) model for inferring development from paediatric EEG. We utilize a common EEG task (button-press) to establish a 4-way CPD model of paediatric EEG data. Structured data fusion of the CPD model and cognitive scores from psychometric evaluations then permits joint decomposition of the two datasets to identify common features associated with each representation of development. Use of grid search optimization and a fully cross-validated design supports the JEDI model as another technique for rapidly discerning the developmental status of a child via EEG. We then briefly turn our attention to associating child development as measured by psychometric tests to markers in the EEG using graph network properties. Using graph networks, we show how the functional connectivity can inform on potential developmental delays in very young epileptic children using routine, clinical rEEG measures. This establishes a potential tool complementary to the JEDI model for identifying and inferring links between the established psychometric evaluation of developing children and functional analysis of the EEG. Multi-way analysis of paediatric EEG data offers a new approach for handling the developmental status and profiles of children. The CPD model offers flexibility in terms of identifying development-related features, and can be integrated into EEG tasks common in rehabilitation paradigms. We aim for the multi-way framework and associated techniques pursued in this thesis to be integrated and adopted as a useful tool clinicians can use for characterizing paediatric development

Effects of Diversity and Neuropsychological Performance in an NFL Cohort

Objective: The aim of this study was to examine the effect of ethnicity on neuropsychological test performance by comparing scores of white and black former NFL athletes on each subtest of the WMS. Participants and Methods: Data was derived from a de-identified database in South Florida consisting of 63 former NFL white (n=28, 44.4%) and black (n=35, 55.6%) athletes (Mage= 50.38; SD= 11.57). Participants completed the following subtests of the WMS: Logical Memory I and II, Verbal Paired Associates I and II, and Visual Reproduction I and II. Results: A One-Way ANOVA yielded significant effect between ethnicity and performance on several subtests from the WMS-IV. Black athletes had significantly lower scores compared to white athletes on Logical Memory II: F(1,61) = 4.667, p= .035, Verbal Paired Associates I: F(1,61) = 4.536, p = .037, Verbal Paired Associates: II F(1,61) = 4.677, p = .034, and Visual Reproduction I: F(1,61) = 6.562, p = .013. Conclusions: Results suggest significant differences exist between white and black athletes on neuropsychological test performance, necessitating the need for proper normative samples for each ethnic group. It is possible the differences found can be explained by the psychometric properties of the assessment and possibility of a non-representative sample for minorities, or simply individual differences. Previous literature has found white individuals to outperform African-Americans on verbal and non-verbal cognitive tasks after controlling for socioeconomic and other demographic variables (Manly & Jacobs, 2002). This highlights the need for future investigators to identify cultural factors and evaluate how ethnicity specifically plays a role on neuropsychological test performance. Notably, differences between ethnic groups can have significant implications when evaluating a sample of former athletes for cognitive impairment, as these results suggest retired NFL minorities may be more impaired compared to retired NFL white athletes

Distinguishing Performance on Tests of Executive Functions Between Those with Depression and Anxiety

Objective: To see if there are differences in executive functions between those diagnosed with Major Depressive Disorder (MDD) and those with Generalized Anxiety Disorder (GAD).Participants and Methods: The data were chosen from a de-identified database at a neuropsychological clinic in South Florida. The sample used was adults diagnosed with MDD (n=75) and GAD (n=71) and who had taken the Halstead Category Test, Trail Making Test, Stroop Test, and the Wisconsin Card Sorting Test. Age (M=32.97, SD=11.75), gender (56.7% female), and race (52.7% White) did not differ between groups. IQ did not differ but education did (MDD=13.41 years, SD=2.45; GAD=15.11 years, SD=2.40), so it was ran as a covariate in the analyses. Six ANCOVAs were run separately with diagnosis being held as the fixed factor and executive function test scores held as dependent variables. Results: The MDD group only performed worse on the Category Test than the GAD group ([1,132]=4.022, p\u3c .05). Even though both WCST scores used were significantly different between the two groups, both analyses failed Levene’s test of Equality of Error Variances, so the data were not interpreted. Conclusions: Due to previous findings that those diagnosed with MDD perform worse on tests of executive function than normal controls (Veiel, 1997), this study wanted to compare executive function performance between those diagnosed with MDD and those with another common psychological disorder. The fact that these two groups only differed on the Category Test shows that there may not be much of a difference in executive function deficits between those with MDD and GAD. That being said, not being able to interpret the scores on the WCST test due to a lack of homogeneity of variance indicates that a larger sample size is needed to compare these two types of patients, as significant differences may be found. The results of this specific study, however, could mean that the Category Test could be used in assisting the diagnosis of a MDD patient

The Effect of Ethnicity on Neuropsychological Test Performance of Former NFL Athletes

Objective: To investigate the effect of ethnicity on neuropsychological test performance by specifically exploring differences between white and black former NFL athletes on subtests of the WAIS-IV. Participants and Methods: Data was derived from a de-identified database in Florida consisting of 63 former NFL athletes (Mage=50.38; SD=11.57); 28 white and 35 black. Participants completed the following subtests of the WAIS-IV: Block Design, Similarities, Digit Span, Matrix Reasoning, Arithmetic, Symbol Search, Visual Puzzles, Coding, and Cancellation. Results: One-Way ANOVA yielded a significant effect between ethnicity and performance on several subtests. Black athletes had significantly lower scaled scores than white athletes on Block Design F(1,61)=14.266, p\u3c.001, Similarities F(1,61)=5.904, p=.018, Digit Span F(1,61)=8.985, p=.004, Arithmetic F(1,61)=16.07, p\u3c.001 and Visual Puzzles F(1,61)=16.682, p\u3c .001. No effect of ethnicity was seen on performance of Matrix Reasoning F(1,61)=2.937, p=.092, Symbol Search F(1,61)=3.619, p=.062, Coding F(1,61)=3.032, p=.087 or Cancellation F(1,61)=2.289, p=.136. Conclusions: Results reveal significant differences between white and black athletes on all subtests of the WAIS-IV but those from the Processing Speed Scale and Matrix Reasoning. These findings align with previous literature that found white individuals to outperform African-Americans on verbal and non-verbal tasks after controlling for socioeconomic and demographic variables (Manly & Jacobs, 2002). These differences may also be a reflection of the WAIS-IV’s psychometric properties and it is significant to consider the normative sample used may not be appropriate for African-Americans. This study highlights the need for future research to identify how ethnicity specifically influences performance, sheds light on the importance of considering cultural factors when interpreting test results, and serves as a call to action to further understand how and why minorities may not be accurately represented in neuropsychological testing

Regional Cerebral Blood Flow Patterns in Children vs. Adults with ADHD Combined and Inattentive Types: A SPECT Study

Objective: The current study sought to determine whether ADHD Combined Type (ADHD-C) and ADHD Primarily Inattentive Type (ADHD-PI) showed differential regional cerebral blood flow (rCBF) patterns in children vs. adults. Participants and Methods: The overall sample (N=1484) was effectively split into four groups: adults with ADHD-PI (n=519), adults with ADHD-C (n=405), children with ADHD-PI (n=192), children with ADHD-C (n=368). All participants were void of bipolar, schizophrenia, autism, neurocognitive disorders, and TBI. The data were collected from a de-identified archival database of individuals who underwent SPECT scans at rest. Results: Using αConclusions: Overall, the current study suggested that children may show rCBF differences between different ADHD subtypes, but adults may not. The current study did not find significance in any of the 17 brain regions examined when comparing adults with ADHD-C to adults with ADHD-PI. All significant findings were attributed to the children with ADHD-C group showing aberrant blood flow rate than at least one other group. Previous research has supported that the differentiation of these subtypes as distinctive disorders is difficult to make in adults (Sobanski et al., 2006). Other research has indicated the potential of imaging techniques to differentiate the two in children (Al-Amin, Zinchenko, & Geyer, 2018). The current findings support nuanced ways in which rCBF patterns of ADHD-C and ADHD-PI differ between children and adults