EEG-neurofeedback as a tool to modulate cognition and behaviour: a review tutorial

Neurofeedback is attracting renewed interest as a method to self-regulate one’s own brain activity to directly alter the underlying neural mechanisms of cognition and behaviour. It promises new avenues as a method for cognitive enhancement in healthy subjects, but also as a therapeutic tool. In the current article, we present a review tutorial discussing key aspects relevant to the development of EEG neurofeedback studies. In addition, the putative mechanisms underlying neurofeedback learning are considered. We highlight both aspects relevant for the practical application of neurofeedback as well as rather theoretical considerations related to the development of new generation protocols. Important characteristics regarding the set-up of a neurofeedback protocol are outlined in a step-by-step way. All these practical and theoretical considerations are illustrated based on a protocol and results of a frontal-midline theta up-regulation training for the improvement of executive functions. Not least, assessment criteria for the validation of neurofeedback studies as well as general guidelines for the evaluation of training efficacy are discussed

Neurofeedback as a treatment intervention in ADHD:current evidence and practice

Purpose of Review Current traditional treatments for ADHD present serious limitations in terms of long-term maintenance of symptom remission and side effects. Here, we provide an overview of the rationale and scientific evidence of the efficacy of neurofeedback in regulating the brain functions in ADHD. We also review the institutional and professional regulation of clinical neurofeedback implementations. Recent Findings Based on meta-analyses and (large multicenter) randomized controlled trials, three standard neurofeedback training protocols, namely theta/beta (TBR), sensori-motor rhythm (SMR), and slow cortical potential (SCP), turn out to be efficacious and specific. However, the practical implementation of neurofeedback as a clinical treatment is currently not regulated. Summary We conclude that neurofeedback based on standard protocols in ADHD should be considered as a viable treatment alternative and suggest that further research is needed to understand how specific neurofeedback protocols work. Eventually, we emphasize the need for standard neurofeedback training for practitioners and binding standards for use in clinical practic

Literacy shapes thought: the case of event representation in different cultures

There has been a lively debate whether conceptual representations of actions or scenes follow a left-to-right spatial transient when participants depict such events or scenes. It was even suggested that conceptualizing the agent on the left side represents a universal. We review the current literature with an emphasis on event representation and on cross-cultural studies. While there is quite some evidence for spatial bias for representations of events and scenes in diverse cultures, their extent and direction depend on task demands, one‘s native language, and importantly, on reading and writing direction. Whether transients arise only in subject-verb-object languages, due to their linear sentential position of event participants, is still an open issue. We investigated a group of illiterate speakers of Yucatec Maya, a language with a predominant verb-object-subject structure. They were compared to illiterate native speakers of Spanish. Neither group displayed a spatial transient. Given the current literature, we argue that learning to read and write has a strong impact on representations of actions and scenes. Thus, while it is still under debate whether language shapes thought, there is firm evidence that literacy does

The temporal dynamics of attention:Thinking about oneself comes at a cost in sub‐clinical depression but not in healthy participants

Self-relevant stimuli seem to automatically draw attention, but it is unclear whether this comes at a cost for processing subsequent stimuli, and whether the effect is depending on one’s mental state (i.e. depression). To address this question, we performed two experiments. In Experiment 1, 45 participants were to report two words (T1 and T2) in an attentional blink (AB) paradigm. T1 was a personality characteristic varying in self-rated self-relevance, whereas T2 was a neutral word. A generalized linear mixed model (GLMM) was applied to compare the T1 and T2 accuracies when T1 was high or low self-relevant. A positive effect of self-relevance was found on T1, without observable carry-over effects on T2 performance. However, in Experiment 2, a GLMM applied on 93 participants showed that T1 self-relevance can affect T2, showing opposite effects depending on sub-clinical depression score. Our findings imply that people with low depression scores process self-relevant stimuli more efficiently, which is reflected in a reduced AB. In contrast, individuals with higher scores in depression demonstrated a difficulty to withdraw attention from self-relevant information, reflected in an increased AB. Our findings thus reveal that a processing advantage for highly self-relevant stimuli comes at either a subsequent cost or benefit in temporal attention depending on one’s mental disposition

Moderate effects of noninvasive brain stimulation of the frontal cortex for improving negative symptoms in schizophrenia:meta-analysis of controlled trials

Background: Negative symptoms in schizophrenia concern a clinically relevant reduction of goal-directed behavior that strongly and negatively impacts daily functioning. Existing treatments are of marginal effect and novel approaches are needed. Noninvasive neurostimulation by means of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are novel approaches that may hold promise. Objectives: To provide a quantitative integration of the published evidence regarding effects of rTMS and tDCS over the frontal cortex on negative symptoms, including an analysis of effects of sham stimulation. Methods: Meta-analysis was applied, using a random effects model, to calculate mean weighted effect sizes (Cohen's d). Heterogeneity was assessed by using Cochrans Q and I-2 tests. Results: For rTMS treatment, the mean weighted effect size compared to sham stimulation was 0.64 (0.32-0.96; k = 22, total N = 827). Studies with younger participants showed stronger effects as compared to studies with older participants. For tDCS studies a mean weighted effect size of 0.50 (-0.07 to 1.07; k = 5, total N = 134) was found. For all frontal noninvasive neurostimulation studies together (i.e., TMS and tDCS studies combined) active stimulation was superior to sham, the mean weighted effect size was 0.61 (24 studies, 27 comparisons, 95% confidence interval 0.33-0.89; total N = 961). Sham rTMS (baseline-posttreatment comparison) showed a significant improvement of negative symptoms, d = 0.31 (0.09-0.52; k = 16, total N = 333). Whereas previous meta-analyses were underpowered, our meta-analysis had a power of 0.87 to detect a small effect. Conclusions: The available evidence indicates that noninvasive prefrontal neurostimulation can improve negative symptoms. This finding suggests a causal role for the lateral frontal cortex in self-initiated goal-directed behavior. The evidence is stronger for rTMS than for tDCS, although this may be due to the small number of studies as yet with tDCS. More research is needed to establish moderator variables that may affect response to neurostimulation and to optimize treatment parameters in order to achieve stable and durable (and thus clinically relevant) effects

Neurofeedback Training of Fronto-medial Theta Oscillations as a Tool to Mitigate Engagement Issues While Flying

Flying is a multitasking and complex activity that requires high working memory, mental flexibility and inhibition abilities 1. It is now well admitted that stressors (eg. fatigue, psychological stress) can impair this executive functioning to an extent that pilots fail to face task demands and to adapt to external contingencies 1–[4]. Several solutions ranging from adaptive automation to the design of cognitive countermeasures have been successfully implemented [5]–[7]. A complementary approach is to consider the use of preventive approaches such as the neurofeedback technique. Indeed, neurofeedback allows displaying online cerebral activity using brain imaging techniques (e.g., EEG, fNIRS, fMRI) in order to teach self-regulation of brain functioning [8], [9]. Recent studies have highlighted that neurofeedback training is particularly relevant to improve performance in controlled settings [10], [11], but also in more ecological contexts [12], [13]. In addition, it has been shown that frontal-medial theta [4-8] Hz, which is regarded as the “working language” for neural communication of executive functioning can improve basic executive functions [14] . Consequently, we assume that training pilots in order to increase their theta activity in the fronto-medial cortex will help them perform better in tasks involving executive functions

Understanding the relationship between apathy, cognition and functional outcome in schizophrenia: The significance of an ecological assessment

In recent years there has been an increasing interest in understanding the role apathy plays in mediating the relationship between cognitive impairment and functional outcome. In general, most studies measure cognition with traditional cognitive tests that give explicit instructions and guide the participants toward generating a response. However, given that apathy is defined by a decrease in self-initiated behavior, it is crucial to evaluate cognition with ecological tasks that do not explicitly direct the patient´s motivation to generate behaviors to assess the actual effect. This study investigated whether an ecological cognitive assessment (the Jansari Executive Function Assessment, JEF©) would uniquely contribute to the relationship between cognition, apathy, and functional outcome in schizophrenia. The Apathy Evaluation Scale (AES), neuropsychological tests and the JEF© were administered to 20 patients with schizophrenia. Hierarchical multiple regression and mediation analysis were performed to test the associations between the variables of interest. Results showed that JEF© explained a significant portion of the variance in AES (25%). In addition, apathy explained 36% of the variance in functional outcome. However, AES did not mediate between cognition and functional outcome. Our results highlight the importance of assessing cognition with tasks that require integration of cognitive functions needed for real life demands

Anosognosia in Amnestic Mild Cognitive Impairment is Related to Diminished Hippocampal Volume Comparable to Alzheimer's Disease Dementia:Preliminary MRI Findings

Although the presence of anosognosia in amnestic mild cognitive impairment (aMCI) may be predictive of conversion to Alzheimer’s disease (AD), little is known about its neural correlates in AD and aMCI. Four different groups were compared using volumetric and diffusion magnetic resonance imaging metrics in regions of interest (hippocampus and cingulum cortex gray matter, cingulum bundle white matter): aMCI subjects with anosognosia (n = 6), aMCI subjects without anosognosia (n = 12), AD subjects with anosognosia (n = 6), and AD subjects without anosognosia (n = 9). aMCI subjects with anosognosia displayed a significantly lower gray matter density (GMD) in the bilateral hippocampus than aMCI subjects without anosognosia, which was accounted for by bilateral hippocampal differences. Furthermore, we identified that the mean hippocampal gray matter density of aMCI subjects with anosognosia was not statistically different than that of AD subjects. The groups of aMCI and AD subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex compared to subjects without anosognosia, but these differences were not statistically significant. No statistically significant differences were found in the fractional anisotropy or mean diffusivity of the hippocampus or cingulum between subjects with and without anosognosia in aMCI or AD groups. While these findings are derived from a small population of subjects and are in need of replication, they suggest that anosognosia in aMCI might be a useful clinical marker to suspect brain changes associated with AD neuropathology

A user-centred approach to unlock the potential of non-invasive BCIs: an unprecedented international translational effort

Non-invasive Mental Task-based Brain-Computer Interfaces (MT-BCIs) enable their users to interact with the environment through their brain activity alone (measured using electroencephalography for example), by performing mental tasks such as mental calculation or motor imagery. Current developments in technology hint at a wide range of possible applications, both in the clinical and non-clinical domains. MT-BCIs can be used to control (neuro)prostheses or interact with video games, among many other applications. They can also be used to restore cognitive and motor abilities for stroke rehabilitation, or even improve athletic performance.Nonetheless, the expected transfer of MT-BCIs from the lab to the marketplace will be greatly impeded if all resources are allocated to technological aspects alone. We cannot neglect the Human End-User that sits in the centre of the loop. Indeed, self-regulating one’s brain activity through mental tasks to interact is an acquired skill that requires appropriate training. Yet several studies have shown that current training procedures do not enable MT-BCI users to reach adequate levels of performance. Therefore, one significant challenge for the community is that of improving end-user training.To do so, another fundamental challenge must be taken into account: we need to understand the processes that underlie MT-BCI performance and user learning. It is currently estimated that 10 to 30% of people cannot control an MT-BCI. These people are often referred to as “BCI inefficient”. But the concept of “BCI inefficiency” is debated. Does it really exist? Or, are low performances due to insufficient training, training procedures that are unsuited to these users or is the BCI data processing not sensitive enough? The currently available literature does not allow for a definitive answer to these questions as most published studies either include a limited number of participants (i.e., 10 to 20 participants) and/or training sessions (i.e., 1 or 2). We still have very little insight into what the MT-BCI learning curve looks like, and into which factors (including both user-related and machine-related factors) influence this learning curve. Finding answers will require a large number of experiments, involving a large number of participants taking part in multiple training sessions. It is not feasible for one research lab or even a small consortium to undertake such experiments alone. Therefore, an unprecedented coordinated effort from the research community is necessary.We are convinced that combining forces will allow us to characterise in detail MT-BCI user learning, and thereby provide a mandatory step toward transferring BCIs “out of the lab”. This is why we gathered an international, interdisciplinary consortium of BCI researchers from more than 20 different labs across Europe and Japan, including pioneers in the field. This collaboration will enable us to collect considerable amounts of data (at least 100 participants for 20 training sessions each) and establish a large open database. Based on this precious resource, we could then lead sound analyses to answer the previously mentioned questions. Using this data, our consortium could offer solutions on how to improve MT-BCI training procedures using innovative approaches (e.g., personalisation using intelligent tutoring systems) and technologies (e.g., virtual reality). The CHIST-ERA programme represents a unique opportunity to conduct this ambitious project, which will foster innovation in our field and strengthen our community

Associative Vocabulary Learning: Development and Testing of Two Paradigms for the (Re-) Acquisition of Action- and Object-Related Words

Despite a growing number of studies, the neurophysiology of adult vocabulary acquisition is still poorly understood. One reason is that paradigms that can easily be combined with neuroscientfic methods are rare. Here, we tested the efficiency of two paradigms for vocabulary (re-) acquisition, and compared the learning of novel words for actions and objects. Cortical networks involved in adult native-language word processing are widespread, with differences postulated between words for objects and actions. Words and what they stand for are supposed to be grounded in perceptual and sensorimotor brain circuits depending on their meaning. If there are specific brain representations for different word categories, we hypothesized behavioural differences in the learning of action-related and object-related words. Paradigm A, with the learning of novel words for body-related actions spread out over a number of days, revealed fast learning of these new action words, and stable retention up to 4 weeks after training. The single-session Paradigm B employed objects and actions. Performance during acquisition did not differ between action-related and object-related words (time*word category: p = 0.01), but the translation rate was clearly better for object-related (79%) than for action-related words (53%, p = 0.002). Both paradigms yielded robust associative learning of novel action-related words, as previously demonstrated for object-related words. Translation success differed for action- and object-related words, which may indicate different neural mechanisms. The paradigms tested here are well suited to investigate such differences with neuroscientific means. Given the stable retention and minimal requirements for conscious effort, these learning paradigms are promising for vocabulary re-learning in brain-lesioned people. In combination with neuroimaging, neuro-stimulation or pharmacological intervention, they may well advance the understanding of language learning to optimize therapeutic strategies