Analysis of the alpha activity envelope in electroencephalography in relation to the ratio of excitatory to inhibitory neural activity.

Alpha waves, one of the major components of resting and awake cortical activity in human electroencephalography (EEG), are known to show waxing and waning, but this phenomenon has rarely been analyzed. In the present study, we analyzed this phenomenon from the viewpoint of excitation and inhibition. The alpha wave envelope was subjected to secondary differentiation. This gave the positive (acceleration positive, Ap) and negative (acceleration negative, An) values of acceleration and their ratio (Ap-An ratio) at each sampling point of the envelope signals for 60 seconds. This analysis was performed on 36 participants with Alzheimer's disease (AD), 23 with frontotemporal dementia (FTD) and 29 age-matched healthy participants (NC) whose data were provided as open datasets. The mean values of the Ap-An ratio for 60 seconds at each EEG electrode were compared between the NC and AD/FTD groups. The AD (1.41 ±0.01 (SD)) and FTD (1.40 ±0.02) groups showed a larger Ap-An ratio than the NC group (1.38 ±0.02, p<0.05). A significant correlation between the envelope amplitude of alpha activity and the Ap-An ratio was observed at most electrodes in the NC group (Pearson's correlation coefficient, r = -0.92 ±0.15, mean for all electrodes), whereas the correlation was disrupted in AD (-0.09 ±0.21, p<0.05) and disrupted in the frontal region in the FTD group. The present method analyzed the envelope of alpha waves from a new perspective, that of excitation and inhibition, and it could detect properties of the EEG, Ap-An ratio, that have not been revealed by existing methods. The present study proposed a new method to analyze the alpha activity envelope in electroencephalography, which could be related to excitatory and inhibitory neural activity.

Pandemic-Induced Occupational Disruption and Association With Health in Japanese Community-Dwelling Older Adults.

The COVID-19 pandemic caused occupational disruption and adverse health outcomes in community-dwelling older adults. This study aimed to investigate the extent of occupational disruption in older adults and its relationship to health-related quality of life (QOL), depression, and frailty. In this cross-sectional study, retention rates in four activity domains and relationships with health outcomes were examined in Japanese older adults aged ≥65 years (n=163) using canonical correlation analysis (CCA) and mixed linear models. More than 25% of activities were restricted compared with the pre-pandemic period. CCA demonstrated correlations between four retention rates and health outcomes (canonical correlation = .42, p = .0003). Retention in instrumental and social activities independently predicted QOL and depression (p < .05). This study highlights that different activities may have different effects on health outcomes and can provide community occupational therapy practitioners with a perspective to assess occupational disruption and identify activities for intervention.

Pandemic-Induced Changes of Daily Routine and Its Association with Health for Japanese Older AdultsWe investigated the changes in daily activity due to the COVID-19 pandemic among community-dwelling older adults in Japan and examined their association with health outcomes. The results showed that more than 25% of activity was reduced due to the pandemic. There was a moderate association between changes in activity and physical, mental, and subjective health. Especially, instrumental and social activities were strongly associated with mental and subjective health. This study highlights the possibility that different types of activities may have different effects on health. Our study can provide occupational therapy practitioners supporting community-dwelling older adults with a perspective to assess changes in daily activities due to the pandemic and identify activities to target for future intervention. As this study was conducted at a single point in time, future studies should be conducted at multiple points in time.

Changes in Community-Dwelling Elderly's Activity and Participation Affecting Depression during COVID-19 Pandemic: A Cross-Sectional Study.

We determined the changes in the activity or participation of the community-dwelling elderly in Japan during the COVID-19 pandemic and identified the activities leading to depression. This will allow us to evaluate rehabilitation interventions that can be used to minimize or eliminate the negative impact of COVID-19 on today's community-dwelling elderly. Herein, demographics, activity or participation (Activity Card Sort-Japan version: ACS-JPN), the number of social networks (Lubben Social Network Scale: LSNS), and depression (Geriatric Depression Scale: GDS) were examined in 74 community-dwelling elderly in Japan from August to October 2020. A statistical analysis was conducted to determine the effect of demographics on GDS, LSNS, and ACS-JPN, to compare the activity retention rates of the four domains using ACS-JPN, and to extract the activities that might affect depression using a generalized linear model. The results show that the retention of leisure activity with a high physical demand (H-leisure) and sociocultural activities was significantly lower than instrumental activities of daily living and leisure activity with a low physical demand (L-leisure). L-leisure and the number of social networks were possible risk factors for depression during the pandemic. This study highlighted the importance of maintaining the number of L-leisure and social networks at home to prevent depression in community-dwelling elderly when they could not perform outdoor activities and direct interpersonal interaction.

Identification of Subgroups of Activity Participation in Group of Community-Dwelling Older Adults.

Occupational therapy in public health is advancing for groups of older adults, but few studies have focused on measuring population-based activity engagement. This study aimed to identify subgroups based on the daily activity pattern of community-dwelling older adults. Japanese older adults aged ≥65 years responded to a 128-activity-item questionnaire. Sparse principal component analysis was applied to summarize the activities, and k-means clustering was used to identify subgroups. Respondents were divided into three subgroups (subgroup 1: n = 39, high instrumental/leisure and social/cognitive activity; subgroup 2: n = 51, high instrumental/leisure and low social/cognitive activity; subgroup 3: n = 44, low instrumental/leisure and social/cognitive activity). The three subgroups were associated with sociodemographics (sex, area, education, and activity level) (p < .05). This study highlighted the activity-based subgroups of older adults and provided a novel viewpoint regarding occupation-based community assessments in addition to previous community occupational therapy practice.

Gender differences in psychosocial factors related to severe stress in a construction company in Japan.

BACKGROUND: In Japan, women's participation in the workforce has been increasing. However, there are few studies about gender differences in stress factors in the workplace. OBJECTIVES: We aimed to clarify gender differences in psychosocial factors in the workplace related to severe stress. METHODS: In total, 930 male and 339 female employees working in a construction company in Japan participated in this study. We used individual responses to the Brief Job Stress Questionnaire (BJSQ) conducted by their company for the most recent year between 2016 and 2019. Data were categorized by gender, and we extracted the factors contributing to severe stress using logistic regression. RESULTS: We identified 142 men and 32 women who had severe stress. Logistic regression analysis showed that six factors ("Qualitative job overload", "Job control", "Interpersonal conflict", "Poor physical environment", "Supervisor's support", and "Job satisfaction and life satisfaction") were significantly associated with the presence of severe stress in men. In women, five factors ("Qualitative job overload", "Job control", "Interpersonal conflict", "Suitable work", and "Job satisfaction and life satisfaction") showed a significant association with severe stress. CONCLUSION: Factors associated with severe stress were "Poor physical environment" and "Supervisor's support" in men, and "Suitable work" in women.

Pre-stimulus alpha oscillation and post-stimulus cortical activity differ in localization between consciously perceived and missed near-threshold somatosensory stimuli.

Conscious perception of a near-threshold (NT) stimulus is characterized by the pre- and post-stimulus brain state. However, the power of pre-stimulus neural oscillations and strength of post-stimulus cortical activity that lead to conscious perception have rarely been examined in individual cortical areas. This is because most previous electro- and magnetoencephalography (EEG and MEG, respectively) studies involved scalp- and sensor-level analyses. Therefore, we recorded MEG during a continuous NT somatosensory stimulus detection task and applied the reconstructed source data in order to identify cortical areas where the post-stimulus cortical activity and pre-stimulus alpha oscillation predict the conscious perception of NT somatosensory stimuli. We found that the somatosensory hierarchical processing areas, prefrontal areas and cortical areas belonging to the default mode network showed stronger cortical activity for consciously perceived trials in the post-stimulus period, but the cortical activity in primary somatosensory area (SI) is independent of conscious perception during the early stage of NT stimulus processing. In addition, we revealed that the pre-stimulus alpha oscillation only in SI is predictive of conscious perception. These findings suggest that the bottom-up stream of somatosensory information flow following SI and pre-stimulus alpha activity fluctuation in SI as a top-down modulation are crucial constituents of conscious perception.

Chronic pain-related cortical neural activity in patients with complex regional pain syndrome.

Quantitative objective measurement of chronic pain is important. We elucidated chronic pain-related cortical neural activity and neural connectivity among pain-related brain regions in complex regional pain syndrome (CRPS). Resting-state magnetoencephalography recordings were performed. Cortical current density and neural connectivity, revealed by amplitude envelope correlation (AEC), were estimated on standardized brain magnetic resonance imaging. Intra-experiment pain was assessed subjectively using a visual analogue scale (VAS). The correlation between current density and VAS scores was calculated for the occipital areas and pain-related cortices. Current density in the primary (SI) and secondary (SII) somatosensory cortex and precuneus in both hemispheres was negatively correlated with the pain VAS score. The AEC and VAS values were significantly correlated for the SII and the precuneus and for the SII and insular cortex in the alpha frequency band in the right hemisphere. In the theta frequency band, the AEC and VAS values correlated for the SII and posterior cingulate cortex in the right hemisphere. Our results suggested that disruption of pain processes and functions in the default mode network occurs in CRPS. Our method targeting the neural mechanism of pain has the potential to offer a clinically objective means of evaluating it.

[Nonconvulsive Status Epilepticus Associated with Theophylline: A Case Report].

An 87-year-old woman was admitted to our hospital because of speech disturbance and right facio-pharyngo-glosso-masticatory diplegia. She had bronchial asthma, was previously diagnosed with cerebral infarction, had experienced two events of convulsive status epilepticus, and was undergoing treatment with theophylline, levetiracetam, and clopidogrel. Head diffusion-weighted magnetic resonance imaging revealed a high-signal area in the left crus posterior capsula interna. For this, we administered cilostazol along with her regular medicines. On day 14, she had tonic-clonic convulsions, extending from the right upper and lower limbs to the whole body. Subsequently, cilostazol was discontinued, and the dose of levetiracetam was increased. However, she developed severe tonic-clonic seizures with right sensory aphasia and right hemiplegia, for which an increased dose of lacosamide was added. When theophylline was discontinued 5 days after the onset of convulsions, the blood concentration of theophylline was 9.7µg/mL. After theophylline was discontinued, tonic-clonic convulsions improved. The disturbance of consciousness and right hemiparesis were improved after one week, while the disturbance of sensory aphasia was improved after one month. We suspect that cerebral infarction may have aggravated the central nervous system damage caused by theophylline, thereby resulting in aminophylline-related non-convulsive status epilepticus. (Received 20 July 2020; Accepted 27 October 2020; Published 1 March 2021).

C-reactive Protein is A Predictor of Deterioration of Acute Internal Carotid Artery M1 Qcclusion Following Recanalization.

INTRODUCTION: Administration of intravenous recombinant tissue plasminogen activator (rt-PA) and mechanical thrombectomy (MT) have become standard therapeutic approaches for acute internal carotid artery and middle cerebral artery M1 segment occlusion (ICA/M1O). However, clinical deterioration of the condition is still observed in some cases. OBJECTIVE: We aimed to identify patients' factors associated with exacerbation. This was a single-center, retrospective study of 35 consecutive patients with acute ICA/M1O who underwent rt-PA/rt-PA and MT at our hospital between January 2016 and September 2019. We divided patients into two groups based on the total NIHSS score at discharge: the "improvement" and "exacerbation" groups. Clinical characteristics, laboratory data, and imaging findings were compared between the groups. RESULTS: The improvement group (13 patients [37%]) had a lower mean age (70 vs. 81 years, p = 0.02), National Institutes of Health Stroke Scale score (NIHSS, 13 vs. 19, p = 0.02), and C-reactive protein (CRP) levels (0.24 vs. 0.92 mg/dl, p < 0.01) than the exacerbation group (22 patients [63%]). Receiver operating characteristic curve analysis revealed the cut-off age to be 79 (sensitivity 76.9%, specificity 72.7%), NIHSS score to be 20 (sensitivity 92.3%, specificity 63.6%), and CRP to be 0.14 mg/dl (sensitivity 69.2%, specificity 81.8%). Multivariate analysis confirmed a CRP level of >0.14 mg/dl (odds ratio, 10.16; 95% confidence interval 1.38-75.13; p = 0.01) to be independently associated with clinical deterioration at discharge. CONCLUSIONS: A CRP level of >0.14 mg/dl is a strong predictor of clinical deterioration at discharge in patients with acute ICA/M1O undergoing recanalization therapy.

Items Selection for the Japanese Version of the Preschool Activity Card Sort.

Preschool Activity Card Sort (PACS) is a valid measure of preschoolers' participation and is a useful and unique tool for focusing on the extent and frequency of their participation. However, given the cultural differences between Japan and other countries, researchers should consider these differences when adapting the PACS for use with children in Japan. The purpose of this study was to select culturally suitable activity items to develop the Japanese version of PACS (PACS-JPN). A two-round survey of parents (who had typically developing children aged between 3 and 6 years) was conducted. The final version of the PACS-JPN included 98 activity items. The PACS-JPN reflects Japanese sociocultural background and allows occupational therapists to assess preschoolers' actual participation by assessing multiple aspects of children's community life. The psychometric properties, including the validity and reliability of the PACS-JPN should be examined in future research.

Spontaneous Dissection of Both Vertebral Arteries Diagnosed with Three-Dimensional T1-Weighted Image.

A 48-year-old woman spontaneously developed occipital pain, without any other neurological deficit. A brain magnetic resonance angiography showed narrowing, irregular dilatation, and aneurysmal formation in both the vertebral arteries (VA). According to these findings and the clinical course, we diagnosed the patient with spontaneous VA dissection. There was no finding suggesting cerebral infarction or subarachnoid hemorrhage. Three-dimensional T1-weighted magnetic resonance imaging performed 27 days after first onset of headache revealed a crescent-shaped high-intensity lesion in both the VA walls. These findings indicated that the lesions in both VAs were equally in the subacute phase. Follow-up three-dimensional T1-weighted imaging indicated that the high-intensity signals in both VAs disappeared at almost the same time. This case report presents imaging evidence showing that spontaneous dissection occurred simultaneously in both the VAs.

Selection of Activity Items for Development of the Activity Card Sort-Japan Version.

The Activity Card Sort (ACS) can both record the clients' participation and any changes, which is a useful tool for practitioners to establish tailored occupation-focused goals. However, there is a limitation to apply the ACS to Japanese older adults as it consists of culturally relevant activities in the United States. The aim of this study was to select activity items reflecting Japanese older adults' lifestyles and opinions to develop the Activity Card Sort-Japan Version (ACS-JPN). In the item selection process, a two-round questionnaire survey was conducted for community-dwelling Japanese older adults (Round 1: n = 177, M age = 69.9 years; Round 2: n = 178, M age = 74.9 years). Seventy-two activity items were finally included in the ACS-JPN and were classified into four domains. The ACS-JPN has some unique features compared with other ACS versions. This study only selected activity items. Further work on psychometric properties is needed.

Impact of D-dimer levels for short-term or long-term outcomes in cryptogenic stroke patients.

BACKGROUND: D-dimer levels are used in several clinical settings, such as in predicting venous thrombosis, cardioembolic stroke and cancer status. In the present study, we investigated the associations between plasma D-dimer levels at admission, clinical characteristics and mortality at discharge in cryptogenic stroke patients. We also investigated whether D-dimer levels can predict long-term outcomes in those patients, including those with and without right-to-left shunt (RLS). METHODS: Acute cryptogenic stroke patients (n = 295, 72 ± 13 years old) were consecutively enrolled and retrospectively analyzed. We defined the cryptogenic stroke as an undetermined etiology according to the Trial of Org 10172 in Acute Stroke Treatment criteria. Plasma D-dimer levels at admission were evaluated. Assessments for RLS were performed using saline contrast-transcranial Doppler ultrasonography or contrast-transesophageal echography. Survivors (at discharge) underwent follow-up for up to 3 years after stroke onset. RESULTS: Of the total enrolled cohort, 17 patients died at discharge. D-dimer levels correlated with initial National Institutes of Health Stroke Scale (NIHSS) score (r = 0.391, P < 0.001) and were associated with mortality at discharge [odds ratio 1.04; 95% confidence interval (CI) 1.00-1.08, P = 0.049] after adjusting for age, sex and initial NIHSS score. Of the 278 survivors at discharge, 266 patients were evaluated to assess RLS during hospitalization, and 62 patients (23.3%) exhibited RLS. According to the median plasma D-dimer levels at admission (0.7 µg/ml), the patients were divided into a low D-dimer group (n = 136, < median) and a high D-dimer group (n = 130, ≥ median). Patients in the high D-dimer group were older, more frequently female, had a lower BMI, had a higher prevalence of cancer and had greater initial neurological severity compared to the patients in the low D-dimer group. During the follow-up period (median, 1093 days), 31 patients developed recurrent stroke and 33 patients died. High D-dimer levels at admission were independently associated with recurrent stroke and all-cause mortality [hazard ratio (HR) 3.76; 95% CI 1.21-14.1, P = 0.021) in patients with RLS, but not in those without RLS (HR 1.35; 95% CI 0.74-2.50, P = 0.335). CONCLUSIONS: Increased D-dimer levels at admission were associated with mortality at discharge in cryptogenic stroke patients. In addition, high D-dimer levels were also associated with long-term outcomes in cryptogenic stroke patients with RLS.

Association between changes in visual evoked magnetic fields and non-motor features in Parkinson's disease.

Visual dysfunction can be caused by several abnormalities, including dysfunctions in the visual cortex and retina. Our aim was to investigate changes in visual evoked brain responses in the primary visual cortex associated with Parkinson's disease (PD). Sixteen healthy control subjects and ten patients with PD participated in this study. We assessed the visual evoked magnetic field (VEF) using magnetoencephalography (MEG). Checkerboard pattern reversal (CPR) and monotonous grating pattern (MGP) stimulations were used. Magnetic resonance imaging (MRI) was performed to analyze brain volume and generate a tractogram. Cognitive and olfactory function, and Unified Parkinson's Disease Rating Scale (UPDRS) scores were evaluated in patients with PD. Four components of the VEF (1M, 2M, 3M, 4M) were observed following stimulation. For both stimuli, results from the 1M and 2M components were significantly greater and the latency of the 1M component was increased markedly in the PD group compared with the healthy control group. In the PD group, 1M latency correlated with the UPDRS score of 1 for both stimuli, and a correlation was observed between olfactory function and the UPDRS score of 3 for the CPR stimulation alone. We suggest that the conduction delay observed following visual stimulation occurs peripherally rather than in the primary visual cortex. Degeneration of selective elements of the visual system in the retina, possibly midget cells, may be involved.

[A Case of Takayasu Arteritis with Acute Bilateral Occlusion of the Internal Carotid Arteries].

A 38-year-old woman developed disturbance of consciousness and quadriplegia. Magnetic resonance images showed scattered acute infarcts in both hemispheres and bilateral occlusion of the intracranial artery (ICA). Immediate mechanical thrombectomy restored the patency of the ICA. Contrast-enhanced computed tomography revealed bilateral wall thickening of the abdominal aorta and the iliac arteries. This finding and an elevated erythrocyte sedimentation rate supported the diagnosis of Takayasu arteritis. Here, we thus report a rare case of Takayasu arteritis with acute bilateral occlusion of the internal carotid arteries.

Functional inter-cortical connectivity among motor-related cortices during motor imagery: A magnetoencephalographic study.

Neural connectivity was measured during motor imagery (MI) and motor execution (ME) using magnetoencephalography in nine healthy subjects, MI, and at rest. Lower coherence values during ME and MI between sensorimotor areas than at rest, and lower values during MI between the left supplementary motor area and inferior frontal gyrus than ME suggested the sensorimotor network of MI functioned with similar connectivity to ME and that the inhibitory activity functioned continuously during MI, respectively.

The temporal stability and variability across frequency bands in neural synchrony between primary and secondary somatosensory areas following somatosensory stimulation.

OBJECTIVES: To examine the temporal stability and variability of neuronal synchronization among the contralateral primary somatosensory cortex (cSI) and contralateral (cSII) and ipsilateral secondary somatosensory cortex (iSII) in response to median nerve stimulation. METHODS: Both the spontaneous magnetoencephalography (MEG) signals as the pre-stimulus condition and somatosensory evoked magnetic-fields (SEF) were recorded in eleven healthy subjects. We calculated a phase-locking value (PLV) between two areas among cSI, cSII, and iSII in five frequency bands (theta: 5-7 Hz, alpha: 8-12 Hz, beta: 15-29 Hz, gamma-1: 30-59 Hz, and gamma-2: 60-90 Hz), and compared the PLV among in pre-stimulus and stimulus conditions. RESULTS: The PLV between cSI and cSII for the theta band activity varied within 2 s from the stimulus onset. On the other hand, the PLV between cSI and iSII for the alpha band did not vary within 2 s. CONCLUSION: The fluctuation of neuronal synchrony among sensory-related cortices in response to median nerve stimulation depends on the induced frequency band and inter-region. SIGNIFICANCE: This study is the first to report the temporal characteristic of stimulus-driven neural synchrony following somatosensory stimulation.