School-age effects of the newborn individualized developmental care and assessment program for preterm infants with intrauterine growth restriction: preliminary findings

Background: The experience in the newborn intensive care nursery results in premature infants’ neurobehavioral and neurophysiological dysfunction and poorer brain structure. Preterms with severe intrauterine growth restriction are doubly jeopardized given their compromised brains. The Newborn Individualized Developmental Care and Assessment Program improved outcome at early school-age for preterms with appropriate intrauterine growth. It also showed effectiveness to nine months for preterms with intrauterine growth restriction. The current study tested effectiveness into school-age for preterms with intrauterine growth restriction regarding executive function (EF), electrophysiology (EEG) and neurostructure (MRI). Methods: Twenty-three 9-year-old former growth-restricted preterms, randomized at birth to standard care (14 controls) or to the Newborn Individualized Developmental Care and Assessment Program (9 experimentals) were assessed with standardized measures of cognition, achievement, executive function, electroencephalography, and magnetic resonance imaging. The participating children were comparable to those lost to follow-up, and the controls to the experimentals, in terms of newborn background health and demographics. All outcome measures were corrected for mother’s intelligence. Analysis techniques included two-group analysis of variance and stepwise discriminate analysis for the outcome measures, Wilks’ lambda and jackknifed classification to ascertain two-group classification success per and across domains; canonical correlation analysis to explore relationships among neuropsychological, electrophysiological and neurostructural domains at school-age, and from the newborn period to school-age. Results: Controls and experimentals were comparable in age at testing, anthropometric and health parameters, and in cognitive and achievement scores. Experimentals scored better in executive function, spectral coherence, and cerebellar volumes. Furthermore, executive function, spectral coherence and brain structural measures discriminated controls from experimentals. Executive function correlated with coherence and brain structure measures, and with newborn-period neurobehavioral assessment. Conclusion: The intervention in the intensive care nursery improved executive function as well as spectral coherence between occipital and frontal as well as parietal regions. The experimentals’ cerebella were significantly larger than the controls’. These results, while preliminary, point to the possibility of long-term brain improvement even of intrauterine growth compromised preterms if individualized intervention begins with admission to the NICU and extends throughout transition home. Larger sample replications are required in order to confirm these results

Learning from Complex Neuroimaging Datasets

Advancements in Magnetic Resonance Imaging (MRI) allowed for the early diagnosis of neurodevelopmental disorders and neurodegenerative diseases. Neuroanatomical abnormalities in the cerebral cortex are often investigated by examining group-level differences of brain morphometric measures extracted from highly-sampled cortical surfaces. However, group-level differences do not allow for individual-level outcome prediction critical for the application to clinical practice. Despite the success of MRI-based deep learning frameworks, critical issues have been identified: (1) extracting accurate and reliable local features from the cortical surface, (2) determining a parsimonious subset of cortical features for correct disease diagnosis, (3) learning directly from a non-Euclidean high-dimensional feature space, (4) improving the robustness of multi-task multi-modal models, and (5) identifying anomalies in imbalanced and heterogeneous settings. This dissertation describes novel methodological contributions to tackle the challenges above. First, I introduce a Laplacian-based method for quantifying local Extra-Axial Cerebrospinal Fluid (EA-CSF) from structural MRI. Next, I describe a deep learning approach for combining local EA-CSF with other morphometric cortical measures for early disease detection. Then, I propose a data-driven approach for extending convolutional learning to non-Euclidean manifolds such as cortical surfaces. I also present a unified framework for robust multi-task learning from imaging and non-imaging information. Finally, I propose a semi-supervised generative approach for the detection of samples from untrained classes in imbalanced and heterogeneous developmental datasets. The proposed methodological contributions are evaluated by applying them to the early detection of Autism Spectrum Disorder (ASD) in the first year of the infant’s life. Also, the aging human brain is examined in the context of studying different stages of Alzheimer’s Disease (AD).Doctor of Philosoph

Advancing the Study of Functional Connectome Development

A better understanding of functional changes in the brain across childhood offers the potential to better support neurodevelopmental and learning challenges. However, neuroimaging tools such as functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) are vulnerable to head motion and other artifacts, and studies have had limited reproducibility. To accomplish research goals, we need to understand the reliability and validity of data collection, processing, and analysis strategies. Neuroimaging datasets contain individually unique information, but identifiability is reduced by noise or lack of signal, suggesting it can be a measure of validity. The goal of this thesis was to use identifiability to benchmark different methodologies, and describe how identifiability associates with age across early childhood. I first compared several different fMRI preprocessing pipelines for data collected from young children. Preprocessing techniques are often controversial due to specific drawbacks and have typically been assessed with adult datasets, which have much less head motion. I found benefits to the use of global signal regression and temporal censoring, but overly strict censoring can impact identifiability, suggesting noise removed must be balanced against signal retained. I also compared several different EEG measures of functional connectivity (FC). EEG can be vulnerable to volume conduction artifacts that can be mitigated by only considering shared information with a time delay between signals. However, I found that mitigation strategies result in lower identifiability, suggesting that while removing confounding noise they also discard substantial signal of interest. Individual experiences may shape development in an individually unique way, which is supported by evidence that adults have more individually identifiable patterns of FC than children. I found that across 4 to 8 years of age, identifiability increased via increased self-stability, but without changes in similarity-to-others. In the absence of ground truth, it is difficult to argue for or against analysis decisions based solely on a theoretical framework and need to also be validated. My work highlights the importance of not thinking about techniques in a valid-invalid dichotomy; certain methods may be sub-optimal while still being preferable to alternatives if they better manage the trade off between noise removed and signal retained

Univariate and multivariate pattern analysis of preterm subjects: a multimodal neuroimaging study

Background: Widespread lasting functional connectivity (FC) and brain volume changes in cortices and subcortices after premature birth have been researched in recent studies. However, the relationship remains unclear between spontaneously slow blood oxygen dependent level (BOLD) fluctuations and gray matter volume (GMV) changes in specific brain areas, such as temporal insular cortices, and whether classification methods based on MRI could be successfully applied to the identification of preterm individuals. In this thesis I hypothesized that in prematurely born adults 1. Ongoing neural excitability and brain activity, as estimated by regional functional connectivity of resting state functional MRI (rs-fMRI) is accompanied with altered low-frequency fluctuations and neonatal complications; 2. Altered regional functional connectivity is connected with superimposed cerebral structural reductions; and 3. multivariate neuroanatomical and functional brain patterns could be treated as features to identify preterm subjects from term subjects individually. Methods: To investigate these hypotheses, the principal results of structural alterations were measured with voxel-based morphometry (VBM), while rs-fMRI outcomes were estimated with amplitude of low-frequency fluctuations (ALFF) in analysis with ninety-four very preterm/very low birth weight (VP/VLBW) and ninety-two full-term (FT) born young adults. Results: The results of the thesis support the hypotheses by showing that, in univariate results, first in VP/VLBW grownups, ALFF was decreased in the left lateral temporal cortices no matter with global signal regression, and this reduction was closely associated with neonatal complications and cognitive variables. Second overlapped brain regions were found between reduced ALFF and reduced brain volumes in the left temporal cortices, and positively associated with each other, demonstrating a potential relationship between VBM and ALFF in this brain area. In multimodal multivariate pattern recognition analysis (MVPA), the gray matter volume (GMV) classifier displayed a higher accuracy (80.7%) contrast with the ALFF classifier (77.4%). The late fusion of GMV and ALFF did not outperform single GMV modality classification by reaching 80.4% accuracy. Moderator analysis from both rs-fMRI and structural MRI (sMRI) uncovered that the neuro-prematurity performance was predominantly determined by neonatal complications. Conclusions: In conclusion, these outcomes exhibit the long term effects of premature labour on lateral temporal cortices, which changed in both ongoing BOLD fluctuations and decreased cerebral structural volumes. This thesis further provided evidence that multivariate pattern analysis such as support vector machine (SVM) may identify imaging-based biomarkers and reliably detect signatures of preterm birth

Children at high-familial risk for Eating Disorders: study of psychopathology, neuropsychology and neuroimaging

Evidence suggest that a diagnosis of an eating disorder (ED) is associated with differential neurocognitive functioning and neural mechanisms. However, whether differences are present prior to the onset of the disorder (‘trait’), possibly affecting risk status for development of an ED; or whether differences are a consequence of secondary features of the disorder such as low nutritional intake (‘state’), is not clear. Family studies have established that first-degree relatives of individuals with ED are at higher risk of developing an ED than the general population, therefore, children of mothers with an ED (current or history) are the perfect group to study risk pathways to developing ED. This is the first study to explore neural alterations as well as neurocognitive functioning in girls at high-familial risk of developing an ED, in comparison to children who are not. High risk status of girls were defined using a maternal clinical interview to confirm lifetime ED diagnosis. Intelligence, social cognition, reward responsiveness, neuropsychological function and brain imaging were investigated in girls at high-familial risk. Girls at high familial risk demonstrated difficulties in set-shifting (cognitive flexibility) and increased reward responsiveness when compared to girls at low risk. Girls at risk also had overall increased Gray matter (GM) volume, and specifically increased GM in amygdala, caudate, hippocampus and orbitofrontal cortex when compared to girls at low risk. There were no differences in white matter (WM) connectivity from amygdala to areas of the cortex in girls at risk compared to girls at low risk. Results suggest that differences observed may constitute putative intermediate phenotypes for ED, although this requires further study with larger samples. Findings are important as they support hypothesis of altered set-shifting as an endophenotype for ED. They also provide evidence of alterations in ventral (limbic) neurcircuit that includes the amygdala and caudate, both of which are of importance for identifying emotional stimuli and generation of affective response to these as well as playing a role in reward processes and behaviour regulation

ENIGMA and global neuroscience: A decade of large-scale studies of the brain in health and disease across more than 40 countries

This review summarizes the last decade of work by the ENIGMA (Enhancing NeuroImaging Genetics through Meta Analysis) Consortium, a global alliance of over 1400 scientists across 43 countries, studying the human brain in health and disease. Building on large-scale genetic studies that discovered the first robustly replicated genetic loci associated with brain metrics, ENIGMA has diversified into over 50 working groups (WGs), pooling worldwide data and expertise to answer fundamental questions in neuroscience, psychiatry, neurology, and genetics. Most ENIGMA WGs focus on specific psychiatric and neurological conditions, other WGs study normal variation due to sex and gender differences, or development and aging; still other WGs develop methodological pipelines and tools to facilitate harmonized analyses of "big data" (i.e., genetic and epigenetic data, multimodal MRI, and electroencephalography data). These international efforts have yielded the largest neuroimaging studies to date in schizophrenia, bipolar disorder, major depressive disorder, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, attention-deficit/hyperactivity disorder, autism spectrum disorders, epilepsy, and 22q11.2 deletion syndrome. More recent ENIGMA WGs have formed to study anxiety disorders, suicidal thoughts and behavior, sleep and insomnia, eating disorders, irritability, brain injury, antisocial personality and conduct disorder, and dissociative identity disorder. Here, we summarize the first decade of ENIGMA's activities and ongoing projects, and describe the successes and challenges encountered along the way. We highlight the advantages of collaborative large-scale coordinated data analyses for testing reproducibility and robustness of findings, offering the opportunity to identify brain systems involved in clinical syndromes across diverse samples and associated genetic, environmental, demographic, cognitive, and psychosocial factors