The Effect of Transcranial Temporal Interference Stimulation (tTIS) on Pavlovian Bias

In life, humans often approach the outcomes deemed valuable and avoid those that are harmful. This is known as the Pavlovian system. This default system is often adaptive, but it can also interfere with the more flexible instrumental system in pursuit of a goal. Research has indicated that the dorsal anterior cingulate cortex (dACC) plays a role in the arbitration process between these two systems. Due to the location of the dACC it has been difficult to focally stimulate it. Recently, transcranial temporal interference stimulation (tTIS) has been proposed as a new non-invasive brain stimulation technique to focally stimulate areas deeper in the cortex. In a preregistered, repeated measures, double-blinded study, we tested the effect of tTIS on the dACC. The participants (N = 21) completed a value-based Go/NoGo task designed to induce a conflict between the Pavlovian and instrumental system. We found no statistically significant results, leading us to speculate on whether this was due to tTIS not having its proposed effect or the dACC not responding to stimulation the way we hypothesized. These findings might have implications for better understanding the role of the dACC in decision making and for the future feasibility of tTIS

White Matter Integrity as a Biomarker for Stroke Recovery: Implications for TMS Treatment

White matter consists of myelinated axons which integrate information across remote brain regions. Following stroke white matter integrity is often compromised leading to functional impairment and disability. Despite its prevalence among stroke patients the role of white matter in development of post-stroke rehabilitation has been largely ignored. Rehabilitation interventions like repetitive transcranial magnetic stimulation (rTMS) are promising but reports on its efficacy have been conflicting. By understanding the role of white matter integrity in post-stroke motor recovery, brain reorganization and TMS efficacy we may be able to improve the development of future interventions. In this dissertation we set out answer these questions by investigating the relationship between white matter integrity and 1) bimanual motor performance following stroke, 2) cortical laterality following stroke and 3) TMS signal propagation (in a group of cocaine users without stroke). We identified white matter integrity of the corpus callosum as a key structure influencing bimanual performance using kinematic measures of hand symmetry (Chapter 2). Second, we found that reduced white matter integrity of corpus callosum was correlated with loss of functional laterality of the primary motor cortex during movement of the affected hand (Chapter 3). Lastly, we found that reduced white matter tract integrity from the site of stimulation to a downstream subcortical target, was correlated to the ability to modulate that target (Chapter 4). Taken together these studies support white matter integrity as a valuable biomarker for future rTMS trials in stroke. To emphasize the implications of these findings, we provide an example of how to incorporate white matter integrity at multiple levels of rTMS study design

Towards clinical assessment of cerebral blood flow regulation using ultrasonography : model applicability in clinical studies

For preservation of its vital functions, the brain is largely dependent of a sufficient delivery of oxygen and nutrients. Blood flow to the brain is essentially regulated by 2 control mechanisms i.e. neurovascular coupling and cerebral autoregulation. Cerebral autoregulation aims for constant adequate blood supply by compensating for blood pressure variations by dilatation or narrowing of the cerebral microvasculature. Neurovascular coupling adjusts blood supply to the local metabolic need. Cerebral perfusion and blood flow regulation are compromised in several pathological conditions. Clinical examination of cerebral blood flow and its regulation may therefore provide helpful diagnostic, predictive and therapeutic information. The work in this thesis was aimed at putting a step forward towards development of reliable and clinically usable parameters for cerebral blood flow regulation assessment using ultrasonography. Regarding early diagnostics, screening and monitoring of cerebral blood flow and its regulation, ultrasonography has major advantages over other imaging tools because of its noninvasiveness, cost-effectiveness, easy usability and its good time resolution. It allows examination of blood flow velocities at multiple locations throughout the extra- and intracranial circulation and evaluation of both control mechanisms by transfer function analysis. For evaluation of cerebral autoregulation, transcranial Doppler blood flow velocities in the large middle cerebral arteries have been recorded simultaneously with plethysmographic (finger) blood pressure. Gain and phase of the pressure-flow transfer function have been determined to obtain quantitative measures for cerebral autoregulation. Neurovascular coupling has been assessed by presenting a visual block stimulus to a subject and simultaneous measurement of the blood flow velocity in the artery exclusively supplying the visual cortex. The obtained visually-evoked blood flow response (VEFR) has been considered as the step response of a linear second order control system model providing patient-specific parameters such as gain and damping as quantitative measures for neurovascular coupling . In chapter 2, a clinical study has been described in which extra- and intracranial blood flow velocities (BFVs), measured at multiple sites in the circulation, have been compared between Alzheimer patients (AD), patients with mild cognitive impairment (MCI) and healthy aging controls (HC). BFVs of AD were significantly lowered at proximal sites but preserved at distal sites for the internal carotid artery and middle and posterior cerebral arteries as compared to those of MCI or HC. This specific pattern can presumably be ascribed to reduced distal diameters resulting from AD pathology. MCI BFV were similar to HC BFV in the extracranial and intracranial posterior circulation, whereas they were intermediate between AD and HC in the intracranial anterior circulation. This suggests that intracranial anterior vessels are most suitable for early detection of pathological alterations resulting from AD. The study findings further indicate that extensive ultrasonographic screening of intra- and extracranial arteries is useful for monitoring BFV decline in the MCI stage. Future follow-up of MCI patients may reveal the predictive value of location-specific BFV for conversion to AD. In the same study cohort, dynamic cerebral autoregulation has been studied as discussed in chapter 3. Cerebral autoregulatory gain and phase values were similar for AD, MCI and HC which implies that the cerebral autoregulatory mechanism is preserved in AD. However, the cerebrovascular resistance index i.e. the ratio between absolute time-averaged blood pressure and flow velocity, was significantly higher in AD as compared to MCI and HC indicating that vessel stiffness is increased in AD. Indeed, it appeared to be a potential biomarker for AD development of MCI. The cerebrovascular resistance increase in AD was furthermore confirmed by windkessel model findings of a significantly elevated peripheral resistance in AD. Arterial resistance and peripheral compliance were equal for all groups. From chapter 4, the focus was shifted to assessment of local blood flow regulation. Visuallyevoked blood flow responses (VEFRs) of formerly (pre-)eclamptic patients and healthy controls have been examined to evaluate neurovascular coupling first in a relative young study population. The aim of the study was to investigate whether possible local (pre)eclampsia-induced endothelial damage was reversible or not. The measured VEFRs have been fitted with the step response of a 2nd order control system model. Although inter-group differences in model parameters were not found, a trend was observed that critical damping (z>1) occurred more frequently in former patients than in controls. Critical damping reflects an atypical VEFR, which is either uncompensated (sluggish, z>1; Tv <20) or compensated by a rise in rate time (intermediate, z>1; Tv > 20). Since these abnormal VEFRs were mainly found in former patients (but not exclusively), these response types were hypothesized to result from pathological disturbances. A revised VEFR analysis procedure to account for reliability and blood pressure dynamics has been proposed in chapter 5. This revised procedure consists of the introduction of a reliability measure for model parameters and of a model extension to consider possible blood pressure contribution to the measured VEFR. The effects of these adjustments on study outcomes have been evaluated by applying both the standard VEFR analysis procedure (applied in chapter 4) and the revised procedure to the AD study cohort. Reliability consideration resulted in about 40% VEFR exclusion, mainly due to the models’ inability to fit critically damped responses. Reliability consideration reduced parameter variability substantially. Regarding the influence of blood pressure variation, a significantly increased damping was found in AD for the standard but not for the revised model. This reversed the study conclusion from altered to normal neurovascular coupling in AD. Considering their influence on obtained parameters, both aspects i.e. reliability and blood pressure variation should be included in VEFR-analysis. Regarding clinical study outcomes, neurovascular coupling seems to be unaffected in AD since the finding of an increased damping may be ascribed to ignorance of blood pressure contribution to VEFR. Study conclusions of earlier chapters (4 and 5) emphasize the need for a model incorporating physiological features. In chapter 6, preliminary results have been reported of the application of a newly developed lumped parameter model of the visual cortex vasculature to the 3 different VEFR types. In the new model, regulatory processes i.e. neurogenic, metabolic, myogenic and shear stress mechanisms, act on smooth muscle tone which inherently leads to adjustment of microcirculatory resistance and compliance. This allows the study of effects of pathological changes on the VEFR. It may be concluded that the model provides an improved link between VEFR and physiology. Preliminary results show that the physiology-based model can describe VEFR type representatives reasonably well obtaining physiologically plausible parameter values. Thus, from a clinical perspective it may be concluded that (Duplex) ultrasonography has great potential as a standard screening tool for MCI patients. It seems worthwhile to examine all future MCI patients on extra- and intracranial blood flow velocity and to determine their cerebrovascular resistance index by simultaneous blood pressure recording. Follow-up of MCI patients will reveal the predictive value of these parameters for future AD development. Furthermore, from a methodological perspective, it can be concluded that the current standard of control system analysis to assess local cerebral blood flow regulation has limitations regarding parameter reliability and VEFR interpretation. Both reliability and interpretation may be improved by optimization and control of data acquisition quality and by use of physiology-based models. Physiological mechanisms influencing VEFR establishment should be incorporated in such a model to possibly explain part of its variance. Efforts should be directed to development and validation of physiology-based models aimed at reliable description of VEFRs by physiologically meaningful parameters

Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee

As the field of noninvasive brain stimulation (NIBS) expands, there is a growing need for comprehensive guidelines on training practitioners in the safe and effective administration of NIBS techniques in their various research and clinical applications. This article provides recommendations on the structure and content of this training. Three different types of practitioners are considered (Technicians, Clinicians, and Scientists), to attempt to cover the range of education and responsibilities of practitioners in NIBS from the laboratory to the clinic. Basic or core competencies and more advanced knowledge and skills are discussed, and recommendations offered regarding didactic and practical curricular components. We encourage individual licensing and governing bodies to implement these guidelines

Motor learning and neuroplasticity in humans

The central nervous system is plastic, in that the number and strength of synaptic connections changes over time. In the adult the most important driver of such changes is experience, in the form of learning and memory. There are thought to be a number of rules, operating relatively local to each synapse that govern changes in strength and organisation. Some of these such as Hebbian plasticity or plasticity following repeated activation of a connection have been studied in detail in animal preparations. However, recent work with non-invasive methods of transcranial stimulation in human, such as transcranial magnetic stimulation, has opened the opportunity to study similar effects in the conscious human brain. In this thesis I use these methods to explore some of the presumed changes in synaptic connectivity in the motor cortex during different forms of motor learning. The experiments only concern learning in the healthy brain; however it seems likely that the same processes will be relevant to neurorehabilitation and disease of the nervous system. This thesis explores the link between neuroplasticity and motor learning in humans using non-invasive brain stimulation, pharmacological agents and psychomotor testing in 6 related studies. 1) Chapter 3 reports initial pharmacological investigations to confirm the idea that some of the long term effects of TMS are likely to involve LTP-like mechanisms. The study shows that NMDA agonism can affect the response to a repetitive form of TMS known as theta burst stimulation (TBS) 2) Following up on the initial evidence for the role of NMDA receptors in the long term effects of TBS, Chapter 4 explores the possible modulatory effects of dopaminergic drugs on TBS. 3) Chapter 5 takes the investigations to normal behaviours by examining how the NMDA dependent plasticity produced by TBS interacts with learning a simple motor task of rapid thumb abduction. The unexpected results force a careful examination of the possible mechanisms of motor learning in this task. 4) Chapter 6 expands on these effects by employing a battery of TMS methods as well as drug agents to examine the role of different intracortical circuits in ballistic motor learning. 5) Chapter 7 studies the plasticity of intracortical circuits involved in transcallosal inhibition. 6) Chapter 8 studies the interaction between synaptic plasticity invoked by TBS and sequence learning. The studies described in the thesis contribute to understanding of how motor learning and neuroplasticity interact, and possible strategies to enhance these phenomena for clinical application

The role of limbic structures in financial abilities of mild cognitive impairment patients

Mild Cognitive Impairment (MCI) patients experience problems in financial abilities that affect everyday functioning. To date, the neural correlates of decline in this domain are unclear. This study aims at examining the correlation between the pattern of brain atrophy of MCI patients and performance on financial abilities. Forty-four MCI patients and thirty-seven healthy controls underwent structural magnetic resonance imaging, and assessment of financial abilitiesby means of the Numerical Activities of Daily Living Financial battery (NADL-F). As compared to healthy controls, MCI patients showed impaired performance in three out of the seven domains assessed by NADL-F: Item purchase, percentage, and financial concepts. The patients\u2019 performance in the NADL-F correlated with memory, language, visuo-spatial, and abstract reasoning composite scores. The analysis also revealed that volumetric differences in the limbic structures significantly correlated with financial abilities in MCI. Specifically, the patients\u2019 performance in the NADL-F was correlated with atrophy in the left medial and lateral amygdala and the right anterior thalamic radiation. These findings suggest that completing daily financial tasks involves sub-cortical regions in MCI and presumably also the motivational and emotional processes associated to them. Involvement of altered limbic structures in MCI patients suggests that impairment in financial abilities may be related to emotional and reflexive processing deficits

Manipulating neuronal communication by using low-intensity repetitive transcranial magnetic stimulation combined with electroencephalogram

Repetitive transcranial magnetic stimulation (rTMS) modulates ongoing brain rhythms by activating neuronal structures and evolving different neuronal mechanisms. In the current work, the role of stimulation strength and frequency for brain rhythms was studied. We hypothesized that a weak oscillating electric field induced by low-intensity rTMS could induce entrainment effects in the brain. To test the hypothesis, we conducted three separate experiments, in which we stimulated healthy human participants with rTMS. We individualized stimulation parameters using computational modeling of induced electric fields in the targets and individual frequency estimated by electroencephalography (EEG). We demonstrated the immediately induced entrainment of occipito-parietal and sensorimotor mu-alpha rhythm by low-intensity rTMS that resulted in phase and amplitude changes measured by EEG. Additionally, we found long-lasting corticospinal excitability changes in the motor cortex measured by motor evoked potentials from the corresponding musle.2021-11-2

The strategy and motivational influences on the beneficial effect of neurostimulation: a tDCS and fNIRS study

The use and public knowledge of noninvasive neurostimulation is rapidly increasing. Transcranial direct current stimulation (tDCS) is a noninvasive technique in which small amounts of current are passed through the cortex in order to change the resting state of underlying neurons. This technique has wide use in rehabilitation and research settings. Here we studied the use of tDCS in healthy younger adults. Our previous findings demonstrated that tDCS can improve working memory (WM) performance in some individuals. We learned that individual differences in education level and WM capacity modulate tDCS effects. In Experiment 1 and 2 we investigated why low WM capacity participants do not benefit or have reduced performance after tDCS. We also explored how tDCS affects cortical blood flow using functional near infrared spectroscopy (fNIRS). In Experiment 1 we examined how strategy use influences tDCS effects. The results demonstrated that active strategy use does not facilitate tDCS effects in low WM capacity participants. Conversely, the high WM capacity participants continued to improve. Furthermore, we found that only the high WM capacity participants had an increase in oxygenated blood flow following anodal tDCS regardless of strategy use. In Experiment 2 we investigated how motivation level modified tDCS effects. We found that motivation level promoted enhanced performance across tDCS conditions for both WM capacity groups. Interestingly, only the low WM capacity participants had an increase in oxygenated blood flow across all motivation and tDCS conditions. The results from all four experiences have important implications for future successful use of neurostimulation in both clinical and healthy populations

Investigating the Cortical, Metabolic and Behavioral Effects of Transcranial Direct Current Stimulation in Preparation for Combined Rehabilitation

The goal of this thesis was to determine the cortical reorganization that occurs in patients with cervical spondylotic myelopathy (CSM) after surgical decompression and to implement this knowledge into a new rehabilitation strategy. Transcranial direct current stimulation (tDCS) is a non-invasive technique to modulate human behavior. Due to the novel electrode montage used, it was first pertinent that we determine how tDCS would modulate cortical, metabolic and motor behavior in healthy individuals. We observed the longitudinal functional adaptations that occur in patients with CSM using functional MRI. Enhanced excitation of supplementary motor area (SMA) was observed following surgical decompression and associated with increased function following surgery. This novel finding of enhanced excitation of motivated us to use a bihemispheric tDCS protocol, exciting bilateral motor areas to provide optimal motor enhancement. This novel tDCS electrode montage, targeting the SMA and primary motor cortex (M1) was implemented in healthy older adults to determine its effects on enhancing manual dexterity. Furthermore, to determine the frequency with which to apply tDCS, a single and tri session protocol was used. We observed a differential pattern of action with anti-phase and in-phase motor tasks during multisession tDCS. We used ultra-high field (7T) MRI to examined the metabolic changes that occur following tDCS. After the stimulation period we observed no significant metabolite modulation. A trend towards an increase in the NAA/tCr ratio, with a concomitant decrease in the absolute concentration of tCr was observed. Finally, we examined the functional connectivity before, during and after tDCS with the use of resting-state fMRI at 7T. We observed enhanced connectivity within right sensorimotor area after stimulation compared to during stimulation. This result confirmed that cortical modulations differ during versus after tDCS, signifying that optimal modulation of behaviour may be after the stimulation period. Furthermore, we observed an enhanced correlation between motor regions and the caudate, both during and after stimulation. In conclusion, we observed novel cortical adaptations in CSM patients after surgical decompression, which led us to believe that bihemispheric tDCS of M1-SMA network would result in optimal motor enhancement and warrants further investigation in CSM and other neurological disorders

The effect of EEG and fNIRS in the digital assessment and digital therapy of Alzheimer’s disease: a systematic review

In the context of population aging, the growing problem of Alzheimer’s disease (AD) poses a great challenge to mankind. Although there has been considerable progress in exploring the etiology of AD, i.e., the important role of amyloid plaques and neurofibrillary tangles in the progression of AD has been widely accepted by the scientific community, traditional treatment and monitoring modalities have significant limitations. Therefore novel evaluation and treatment modalities for Alzheimer’s disease are called for emergence. In this research, we sought to review the effectiveness of digital treatment based on monitoring using functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG). This work searched four electronic databases using a keyword approach and focused on journals focusing on AD and geriatric cognition. Finally, 21 articles were included. The progress of digital therapy and outcome monitoring in AD was reviewed, including digital therapy approaches on different platforms and different neuromonitoring techniques. Because biomarkers such as theta coherence, alpha and beta rhythms, and oxyhemoglobin are effective in monitoring the cognitive level of AD patients, and thus the efficacy of digital therapies, this review particularly focuses on the biomarker validation results of digital therapies. The results show that digital treatment based on biomarker monitoring has good effectiveness. And the effectiveness is reflected in the numerical changes of biomarker indicators monitored by EEG and fNIRS before and after digital treatment. Increases or decreases in the values of these indicators collectively point to improvements in cognitive function (mostly moderate to large effect sizes). The study is the first to examine the state of digital therapy in AD from the perspective of multimodal monitoring, which broadens the research perspective on the effectiveness of AD and gives clinical therapists a “reference list” of treatment options. They can select a specific protocol from this “reference list” in order to tailor digital therapy to the needs of individual patients