Test-retest reliability and reliable change index of the Philips IntelliSpace Cognition digital test battery.

OBJECTIVE: This article provides the test-retest reliability and Reliable Change Indices (RCIs) of the Philips IntelliSpace Cognition (ISC) platform, which contains digitized versions of well-established neuropsychological tests. METHOD: 147 participants (ages 19 to 88) completed a digital cognitive test battery on the ISC platform or paper-pencil versions of the same test battery during two separate visits. Intraclass correlation coefficients (ICC) were calculated separately for the ISC and analog test versions to compare reliabilities between administration modalities. RCIs were calculated for the digital tests using the practice-adjusted RCI and standardized regression-based (SRB) method. RESULTS: Test-retest reliabilities for the ISC tests ranged from moderate to excellent and were comparable to the test-retest reliabilities for the paper-pencil tests. Baseline test performance, retest interval, age, and education predicted test performance at visit 2 with baseline test performance being the strongest predictor for all outcome measures. For most outcome measures, both methods for the calculation of RCIs show agreement on whether or not a reliable change was observed. CONCLUSIONS: RCIs for the digital tests enable clinicians to determine whether a measured change between assessments is due to real improvement or decline. Together, this contributes to the growing evidence for the clinical utility of the ISC platform.

Conversion of a medical implant into a versatile computer-brain interface.

BACKGROUND: Information transmission into the human nervous system is the basis for a variety of prosthetic applications. Spinal cord stimulation (SCS) systems are widely available, have a well documented safety record, can be implanted minimally invasively, and are known to stimulate afferent pathways. Nonetheless, SCS devices are not yet used for computer-brain-interfacing applications. OBJECTIVE: Here we aimed to establish computer-to-brain communication via medical SCS implants in a group of 20 individuals who had been operated for the treatment of chronic neuropathic pain. METHODS: In the initial phase, we conducted interface calibration with the aim of determining personalized stimulation settings that yielded distinct and reproducible sensations. These settings were subsequently utilized to generate inputs for a range of behavioral tasks. We evaluated the required calibration time, task training duration, and the subsequent performance in each task. RESULTS: We could establish a stable spinal computer-brain interface in 18 of the 20 participants. Each of the 18 then performed one or more of the following tasks: A rhythm-discrimination task (n = 13), a Morse-decoding task (n = 3), and/or two different balance/body-posture tasks (n = 18; n = 5). The median calibration time was 79 min. The median training time for learning to use the interface in a subsequent task was 1:40 min. In each task, every participant demonstrated successful performance, surpassing chance levels. CONCLUSION: The results constitute the first proof-of-concept of a general purpose computer-brain interface paradigm that could be deployed on present-day medical SCS platforms.

Philips IntelliSpace Cognition digital test battery: Equivalence and measurement invariance compared to traditional analog test versions.

Objective: To collect evidence of validity for a selection of digital tests on the Philips IntelliSpace Cognition (ISC) platform.Method: A total of 200 healthy participants (age 50-80) completed both the ISC battery and an analog version of the battery during separate visits. The battery included the following screeners and cognitive tests: Mini-Mental State Examination (2nd edition), Clock Drawing Test, Trail-Making Test (TMT), Rey Auditory Verbal Learning Test (RAVLT), Rey-Osterrieth Complex Figure Test (ROCFT), Letter Fluency, Star Cancellation Test, and Digit Span Test. The ISC tests were administered on an iPad Pro and were automatically scored using designated algorithms. The analog tests were administered in line with existing guidelines and scored by trained neuropsychologists. Criterion validity was established through relative agreement coefficients and raw score equivalence tests. In addition,measurement invariance analysis was used to compare the factor structures of both versions. Finally, we explored effects of demographics and experience with digital devices on performance.Results: We found fair to excellent relative agreement between test versions. Absolute equivalence was found for RAVLT, Letter Fluency, Star Cancellation Test, and Digit Span Test. Importantly, we demonstrated equal loadings of the digital and analog test versions on the same set of underlying cognitive domains. Demographic effects were mostly comparable between modalities, and people's experience with digital devices was found to only influence performance on TMT B.Conclusions: This study provides several sources of evidence for the validity of the ISC test battery, offering an important step in validating ISC for clinical use.Supplemental data for this article is available online at https://doi.org/10.1080/13854046.2021.1974565.

Corticospinal beta-band synchronization entails rhythmic gain modulation.

Rhythmic synchronization of neurons in the beta or gamma band occurs almost ubiquitously, and this synchronization has been linked to numerous nervous system functions. Many respective studies make the implicit assumption that neuronal synchronization affects neuronal interactions. Indeed, when neurons synchronize, their output spikes reach postsynaptic neurons together, trigger coincidence detection mechanisms, and therefore have an enhanced impact. There is ample experimental evidence demonstrating this consequence of neuronal synchronization, but beyond this, beta/gamma-band synchronization within a group of neurons might also modulate the impact of synaptic input to that synchronized group. This would constitute a separate mechanism through which synchronization affects neuronal interactions, but direct in vivo evidence for this putative mechanism is lacking. Here, we demonstrate that synchronized beta-band activity of a neuronal group modulates the efficacy of synaptic input to that group in-phase with the beta rhythm. This response modulation was not an addition of rhythmic activity onto the average response but a rhythmic modulation of multiplicative input gain. Our results demonstrate that beta-rhythmic activity of a neuronal target group multiplexes input gain along the rhythm cycle. The actual gain of an input then depends on the precision and the phase of its rhythmic synchronization to this target, providing one mechanistic explanation for why synchronization modulates interactions.

Prospective, blind study of the triple stimulation technique in the diagnosis of ALS.

OBJECTIVE: To evaluate the diagnostic yield of magnetic cortical stimulation with the triple stimulation technique (TST) to identify upper motor neuron (UMN) involvement in patients suspected of having ALS. METHODS: Fifty-nine patients were recruited to undergo TST in addition to the standard work-up for suspected motor neuron disease. TST combines transcranial magnetic stimulation of the motor cortex with collision studies, which results in a higher sensitivity in detecting UMN involvement. Primary outcome was the number of abnormal TST results in patients with possible ALS. The positivity rate was converted to the number needed to test with TST (NN-TST) for one extra diagnosis of ALS. RESULTS: Fifty patients underwent TST. In the total group (n=59), 18 patients had a motor neuron disorder but did not fulfil criteria for 'probable' or 'definite' ALS. In four of these patients TST was abnormal (NN-TST, 4.5). One TST was erroneously interpreted as abnormal. TST findings were normal in inclusion body myositis and peripheral nerve disorders. CONCLUSION: This prospective and blind study confirms open studies of TST in the evaluation of ALS. We suggest that TST can be used to arrive at a diagnosis of 'probable' or 'definite' ALS in patients lacking UMN signs in the upper extremities.

Evidence of Validity for a Newly Developed Digital Cognitive Test Battery.

Clinical practice still relies heavily on traditional paper-and-pencil testing to assess a patient's cognitive functions. Digital technology has the potential to be an efficient and powerful alternative, but for many of the existing digital tests and test batteries the psychometric properties have not been properly established. We validated a newly developed digital test battery consisting of digitized versions of conventional neuropsychological tests. Two confirmatory factor analysis models were specified: a model based on traditional neuropsychological theory and expert consensus and one based on the Cattell-Horn-Carroll (CHC) taxonomy. For both models, the outcome measures of the digital tests loaded on the cognitive domains in the same way as established in the neuropsychological literature. Interestingly, no clear distinction could be made between the CHC model and traditional neuropsychological model in terms of model fit. Taken together, these findings provide preliminary evidence for the structural validity of the digital cognitive test battery.

Changes in corticospinal excitability and the direction of evoked movements during motor preparation: a TMS study.

BACKGROUND: Preparation of the direction of a forthcoming movement has a particularly strong influence on both reaction times and neuronal activity in the primate motor cortex. Here, we aimed to find direct neurophysiologic evidence for the preparation of movement direction in humans. We used single-pulse transcranial magnetic stimulation (TMS) to evoke isolated thumb-movements, of which the direction can be modulated experimentally, for example by training or by motor tasks. Sixteen healthy subjects performed brisk concentric voluntary thumb movements during a reaction time task in which the required movement direction was precued. We assessed whether preparation for the thumb movement lead to changes in the direction of TMS-evoked movements and to changes in amplitudes of motor-evoked potentials (MEPs) from the hand muscles. RESULTS: When the required movement direction was precued early in the preparatory interval, reaction times were 50 ms faster than when precued at the end of the preparatory interval. Over time, the direction of the TMS-evoked thumb movements became increasingly variable, but it did not turn towards the precued direction. MEPs from the thumb muscle (agonist) were differentially modulated by the direction of the precue, but only in the late phase of the preparatory interval and thereafter. MEPs from the index finger muscle did not depend on the precued direction and progressively decreased during the preparatory interval. CONCLUSION: Our data show that the human corticospinal movement representation undergoes progressive changes during motor preparation. These changes are accompanied by inhibitory changes in corticospinal excitability, which are muscle specific and depend on the prepared movement direction. This inhibition might indicate a corticospinal braking mechanism that counteracts any preparatory motor activation.

The inferior frontal cortex in artificial syntax processing: an rTMS study.

The human capacity to implicitly acquire knowledge of structured sequences has recently been investigated in artificial grammar learning using functional magnetic resonance imaging. It was found that the left inferior frontal cortex (IFC; Brodmann's area (BA) 44/45) was related to classification performance. The objective of this study was to investigate whether the IFC (BA 44/45) is causally related to classification of artificial syntactic structures by means of an off-line repetitive transcranial magnetic stimulation (rTMS) paradigm. We manipulated the stimulus material in a 2 x 2 factorial design with grammaticality status and local substring familiarity as factors. The participants showed a reliable effect of grammaticality on classification of novel items after 5 days of exposure to grammatical exemplars without performance feedback in an implicit acquisition task. The results show that rTMS of BA 44/45 improves syntactic classification performance by increasing the rejection rate of non-grammatical items and by shortening reaction times of correct rejections specifically after left-sided stimulation. A similar pattern of results is observed in FMRI experiments on artificial syntactic classification. These results suggest that activity in the inferior frontal region is causally related to artificial syntax processing.

Muscle imaging: mapping responses to transcranial magnetic stimulation with high-density surface electromyography.

Representations of different body parts or muscles in the human primary motor cortex overlap extensively. At the effector level, most muscles are surrounded by and overlap with several neighbours as well. This hampers the assessment of excitability in individual muscles with transcranial magnetic stimulation (TMS), even if so-called "focal" stimulating coils are used. Here we used a novel mapping paradigm based on high-density surface electromyography (HD-sEMG) to investigate the spatial selectivity of TMS in the forearm musculature. In addition, we tested the hypothesis that selective stimulation can be improved by a voluntary background contraction of the target muscle. We mapped and compared the topographies of motor evoked potential (MEP) amplitudes during rest and during background contractions of two forearm muscles (extensor carpi radialis and extensor digitorum communis). The MEP topographies were also compared to the amplitude topography of voluntary EMG. The results indicate that under many conditions a large proportion of the MEP activity recorded at the surface originated from the target muscle's neighbours. There was a systematic relationship between TMS intensity and the topographic distribution of MEP responses during voluntary contraction. With increasing stimulus intensity, the MEP topography deviated increasingly more from the topography of voluntary EMG. We conclude that when standard EMG montages are used, the recorded MEPs are not necessarily evoked in the target muscle alone. Stimulation during a voluntary background contraction of the target muscle may enhance the selectivity of TMS. It however remains essential to use stimulus intensities as low as possible, to minimize the contribution of surrounding non-target muscles to the MEP.

Understanding communicative actions: a repetitive TMS study.

Despite the ambiguity inherent in human communication, people are remarkably efficient in establishing mutual understanding. Studying how people communicate in novel settings provides a window into the mechanisms supporting the human competence to rapidly generate and understand novel shared symbols, a fundamental property of human communication. Previous work indicates that the right posterior superior temporal sulcus (pSTS) is involved when people understand the intended meaning of novel communicative actions. Here, we set out to test whether normal functioning of this cerebral structure is required for understanding novel communicative actions using inhibitory low-frequency repetitive transcranial magnetic stimulation (rTMS). A factorial experimental design contrasted two tightly matched stimulation sites (right pSTS vs left MT+, i.e., a contiguous homotopic task-relevant region) and tasks (a communicative task vs a visual tracking task that used the same sequences of stimuli). Overall task performance was not affected by rTMS, whereas changes in task performance over time were disrupted according to TMS site and task combinations. Namely, rTMS over pSTS led to a diminished ability to improve action understanding on the basis of recent communicative history, while rTMS over MT+ perturbed improvement in visual tracking over trials. These findings qualify the contributions of the right pSTS to human communicative abilities, showing that this region might be necessary for incorporating previous knowledge, accumulated during interactions with a communicative partner, to constrain the inferential process that leads to action understanding.

Working memory load attenuates emotional enhancement in recognition memory.

Emotionally arousing stimuli are perceived and remembered better than neutral stimuli. Under threat, this negativity bias is further increased. We investigated whether working memory (WM) load can attenuate incidental memory for emotional images. Two groups of participants performed the N-back task with two WM load levels. In one group, we induced anxiety using a threat of shock paradigm to increase attentional processing of negative information. During task performance we incidentally and briefly flashed emotional distracter images which prolonged response times in both load conditions. A subsequent unannounced immediate recognition memory test revealed that when load at exposure had been low, recognition was better for negative items in both participant groups. This enhancement, however, was attenuated under high load, leaving performance on neutral items unchanged regardless of the threat of shock manipulation. We conclude that both in threat and in normal states WM load at exposure can attenuate immediate emotional memory enhancement.

Intervention to lower anxiety of 18F-FDG PET/CT patients by use of audiovisual imagery during the uptake phase before imaging.

UNLABELLED: Many patients referred for PET suffer from anxiety, possibly affecting the workflow and patient experience. In addition, patient anxiety may affect image quality through uptake of (18)F-FDG in muscles or brown adipose tissue (BAT).This study investigated the effects of a nonpharmacologic intervention-the use of audiovisual imagery in the PET uptake room-on patient anxiety and false-positive uptake of (18)F-FDG (in muscles and BAT). METHODS: A 2-stage study was conducted on 101 patients. The cohort undergoing the intervention included 51 patients. The first stage (n = 35) included physiologic measurements (cardiovascular activity, muscular activity, skin conductance, and cortisol), a state anxiety questionnaire, and visual evaluation of (18)F-FDG uptake in muscles and BAT; the second stage (n = 66) included only the state anxiety questionnaire and the (18)F-FDG uptake evaluation. RESULTS: Throughout the stay in the uptake room, a significant decrease in overall anxiety was found, together with several other significant changes in patient physiology. In the cohort with audiovisual intervention, however, the decrease in patient anxiety was significantly larger. The cohort with intervention also showed significantly lower (18)F-FDG uptake in BAT but not in muscles. CONCLUSION: The investigated audiovisual intervention helps to lower patient anxiety in the PET uptake room and can lower false-positive (18)F-FDG uptake in BAT.

The alpha-motoneuron pool as transmitter of rhythmicities in cortical motor drive.

OBJECTIVE: Investigate the effectiveness and frequency dependence of central drive transmission via the alpha-motoneuron pool to the muscle. METHODS: We describe a model for the simulation of alpha-motoneuron firing and the EMG signal as response to central drive input. The transfer in the frequency domain is investigated. Coherence between stochastical central input and EMG is also evaluated. RESULTS: The transmission of central rhythmicities to the EMG signal relates to the spectral content of the latter. Coherence between central input to the alpha-motoneuron pool and the EMG signal is significant whereby the coupling strength hardly depends on the frequency in a range from 1 to 100 Hz. Common central input to pairs of alpha-motoneurons strongly increases the coherence levels. The often-used rectification of the EMG signal introduces a clear frequency dependence. CONCLUSIONS: Oscillatory phenomena are strongly transmitted via the alpha-motoneuron pool. The motoneuron firing frequencies do play a role in the transmission gain, but do not influence the coherence levels. Rectification of the EMG signal enhances the transmission gain, but lowers coherence and introduces a strong frequency dependency. We think that it should be avoided. SIGNIFICANCE: Our findings show that rhythmicities are translated into alpha-motoneuron activity without strong non-linearities.

Virtual Lesions of the IFG Abolish Response Facilitation for Biological and Non-Biological Cues.

Humans are faster to perform a given action following observation of that same action. Converging evidence suggests that the human mirror neuron system (MNS) plays an important role in this phenomenon. However, the specificity of the neural mechanisms governing this effect remain controversial. Specialist theories of imitation suggest that biological cues are maximally capable of eliciting imitative facilitation. Generalist models, on the other hand, posit a broader role for the MNS in linking visual stimuli with appropriate responses. In the present study, we investigated the validity of these two theoretical approaches by disrupting the left and right inferior frontal gyrus (IFG) during the preparation of congruent (imitative) and incongruent (complementary) actions cued by either biological (hand) or non-biological (static dot) stimuli. Delivery of TMS over IFG abolished imitative response facilitation. Critically, this effect was identical whether actions were cued by biological or non-biological stimuli. This finding argues against theories of imitation in which biological stimuli are treated preferentially and stresses the notion of the IFG as a vital center of general perception-action coupling in the human brain.

Stimulus-response characteristics of motor evoked potentials and silent periods in proximal and distal upper-extremity muscles.

OBJECTIVE: To compare stimulus-response characteristics of both motor evoked potentials (MEP) and silent periods (SP) induced by transcranial magnetic stimulation (TMS) in proximal and distal upper-extremity muscles. METHODS: Stimulus-response curves of MEPs and SPs were obtained from the biceps brachii (BB) and abductor digiti minimi (ADM) muscles in 15 healthy participants. A nonlinear mixed model was used to fit the stimulus-response curves to a sigmoid Boltzmann function. RESULTS: Small residuals of the function were found for MEPs and SPs in both muscles. Higher maximal MEP amplitudes were found for the BB compared to the ADM (p<0.01). The active motor threshold to obtain a SP was less for the ADM compared to the BB (p<0.01). The slope parameter of the function of the SP duration was steeper and more variable in the ADM than in the BB (p<0.01). For the MEP amplitude no difference in active motor threshold and slope of the function was found between both muscles. CONCLUSIONS: Excitatory (MEP) and inhibitory (SP) effects of TMS differ between proximal arm and distal hand muscles in healthy participants. The adequate fit of our model suggests that this model can be used to study between and within subject changes in future studies.

Modeling transcranial DC stimulation.

A method to estimate the potential and current density distribution during transcranial DC stimulation (tDCS) is introduced. The volume conductor model consists of a realistic head model (concerning shape as well as conductivity), obtained from TI-, PD- and DT-MR images. The model includes five compartments with different conductivities. For the skull and the white matter compartments, the conductivities are anisotropic. Using this model, the potentials inside the head that are generated by tDCS electrodes positioned on the scalp were computed by using the Finite Element Method. The results show that this is a promising method for the study of the effects of tDCS.

Expectancy induces dynamic modulation of corticospinal excitability.

Behavioral studies using motor preparation paradigms have revealed that increased expectancy of a response signal shortens reaction times (RTs). Neurophysiological data suggest that in such paradigms, not only RT but also neuronal activity in the motor structures involved is modulated by expectancy of behaviorally relevant events. Here, we directly tested whether expectancy of a response signal modulates excitability of the corticospinal system used in the subsequent movement. We combined single- and paired-pulse transcranial magnetic stimulation (TMS) over the primary motor cortex with a simple RT task with variable preparatory delays. We found that, in line with typical behavioral observations, the subjects' RTs decreased with increasing response signal expectancy. TMS results revealed a modulation of corticospinal excitability in correspondence with response signal expectancy. Besides an increased excitability over the time-course of the preparatory delay, corticospinal excitability transiently increased whenever a response signal was expected. Paired-pulse TMS showed that this modulation is unlikely to be mediated by excitability changes in interneuronal inhibitory or facilitatory networks in the primary motor cortex. Changes in corticospinal synchronization or other mechanisms involving spinal circuits are candidates mediating the modulation of corticospinal excitability by expectancy.

Online maintenance of sensory and motor representations: effects on corticospinal excitability.

Flexible behavior requires the ability to delay a response until it is appropriate. This can be achieved by holding either a sensory or a motor representation online. Here we assess whether maintenance of sensory or motor material drives the motor system to different functional states, as indexed by alterations of corticospinal excitability. We used single-pulse TMS to measure corticospinal excitability evoked during the delay period of a novel paradigm in which task contingencies, rather than explicit verbal instructions, induced participants to use either sensory or motor codes to solve a delay-nonmatch-to-sample (DNMS) task. This approach allowed us to probe the state of the motor system while the participants were retaining either sensory or motor codes to cross the delay period, rather than the control of short-term storage driven by verbal instructions. When participants could prepare the movement in advance (preparation trials), the excitability of the motor cortex contralateral to the moving hand increased, whereas the excitability of the ipsilateral motor cortex decreased. The increase in excitability was confined to the prime mover, whereas the decrease in excitability extended to cortical territories controlling muscles unrelated to the response. Crucially, these changes in excitability were evoked only during preparation trials and not during trials in which subjects needed to maintain sensory items online (memory trials). We infer that short-term storage of sensory information and preparation of motor responses have differential and specific access to the output stage of the motor system.