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The Event-Related Potentials Mismatch Negativity, P300, and N400: Effects of Attentional Modulation and Application in Patients with Disorders of Consciousness

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The event-related potentials Mismatch Negativity, P300, and N400: Effects of attentional modulation and application in patients with disorders of consciousness Inaugural-Dissertation zur Erlangung der Doktorwürde Der Humanwissenschaftlichen Fakultät Der Julius-Maximilians-Universität Würzburg Vorgelegt von Helena Erlbeck aus Dresden Würzburg 2015 Erstgutachter: Professor Dr. Andrea Kübler Zweitgutachter: Professor Dr. Johannes Hewig Tag des Kolloquiums: 15.09.2015 Danksagung Ich möchte mich an dieser Stelle bei meiner Betreuerin Frau Prof. Dr. Kübler für die motivierende Begleitung in den letzten Jahren, die zahlreichen fachlichen Anregungen und Diskussionen und das in mich gesetzte Vertrauen bedanken. Ich danke weiterhin meiner Men- torin Dr. Veser und Herrn Prof. Dr. Kotchoubey für die Inspiration für und die Unterstützung bei der vorliegenden Arbeit. Danke auch Herrn Prof. Dr. Hewig für die Begutachtung und an Dr. Tobias Kaufmann für das erste Gegenlesen. Besonders erwähnen möchte ich die studenti- schen Mitarbeiter Janine Nolden, David Wenzel und Mona Körber. Danke für euer unermüd- liches Engagement. Weiterhin bedanke ich mich bei meinen Kollegen Ruben Real, Dr. Sonja Kleih und Teresa Sollfrank für die fachliche, aber auch zwischenmenschliche Unterstützung. Danke an die Patienten und deren Familien, die sich für die Teilnahme an den Studien bereit erklärt haben. Ihre Geschichten bleiben mir in Erinnerung und unvergessen. Danke auch an die Belegschaft der Intensivpflegeklinik Schwaig und Hersbruck für die freundliche Unterstützung in der Arbeit mit den Patienten. Mein besonderer Dank gilt außerdem meiner Familie, meinem Freund Vincent und mei- nem fantastischen Freundeskreis, in dem ich bei unzähligen Gelegenheiten den perfekten Ausgleich zur Arbeit fand. Bei euch habe ich Kraft getankt. i Content Content ....................................................................................................................................... ii List of Figures ............................................................................................................................ v List of Tables ............................................................................................................................. vi 1 Graphical Abstract .............................................................................................................. 1 2 Abstract .............................................................................................................................. 2 3 Zusammenfassung .............................................................................................................. 3 4 Introduction ........................................................................................................................ 4 4.1 The concept of attention .............................................................................................. 5 4.2 Electroencephalography and event-related potentials ................................................. 7 4.2.1 The Mismatch Negativity (MMN) ....................................................................... 7 4.2.2 The P300 ............................................................................................................ 10 4.2.3 The N400 ............................................................................................................ 12 4.3 Disorders of consciousness ........................................................................................ 14 4.3.1 Hierarchical approach ........................................................................................ 16 4.4 Event-related potentials in patients with disorders of consciousness ........................ 17 4.4.1 Event-related potentials in diagnostic application.............................................. 17 4.4.2 Event-related potentials in communication applications.................................... 19 4.4.3 Challenges .......................................................................................................... 20 4.5 Motivation and general hypotheses ........................................................................... 21 5 Study 1 – Interviews with practitioners ............................................................................ 23 5.1 Study aims ................................................................................................................. 23 5.2 Method ....................................................................................................................... 24 5.3 Results ....................................................................................................................... 24 5.3.1 Current diagnostic procedures ............................................................................ 25 5.3.2 Weaknesses in the current procedures................................................................ 25 5.3.3 Requirements and expectations .......................................................................... 26 5.4 Discussion and summary ........................................................................................... 26 6 Study 2 – Event-related potentials in non-responsive patients......................................... 28 6.1 Study aims ................................................................................................................. 28 6.2 Methods ..................................................................................................................... 28 6.2.1 Participants ......................................................................................................... 28 6.2.2 Experimental procedure and stimuli .................................................................. 30 6.2.3 Material and data acquisition ............................................................................. 31 6.2.4 Data pre-processing and analysis ....................................................................... 32 6.3 Results ....................................................................................................................... 33 6.3.1 MMN Duration ................................................................................................... 33 ii 6.3.2 P300 .................................................................................................................... 36 6.3.3 N400 Words ....................................................................................................... 41 6.3.4 N400 Sentences .................................................................................................. 43 6.3.5 CRS and ERPs .................................................................................................... 46 6.3.6 Summary ............................................................................................................ 46 6.4 Discussion and summary ........................................................................................... 47 6.4.1 Hierarchical approach ........................................................................................ 48 6.4.2 Focused and passive tasks .................................................................................. 49 6.4.3 Behavioral assessment and ERPs ....................................................................... 50 6.4.4 Altered ERPs in patients .................................................................................... 50 6.4.5 Significance of the results .................................................................................. 51 6.4.6 Limitations ......................................................................................................... 52 6.4.7 Conclusion .......................................................................................................... 53 7 Study 3 – Attention effects on MMN and N400 .............................................................. 55 7.1 Study aims ................................................................................................................. 55 7.2 Method ....................................................................................................................... 56 7.2.1 Participants ......................................................................................................... 56 7.2.2 Experimental procedure and stimuli .................................................................. 57 7.2.3 Material and data acquisition ............................................................................. 58 7.2.4 Data preprocessing and analysis ........................................................................ 58 7.3 Results ....................................................................................................................... 60 7.3.1 MMN Duration ................................................................................................... 60 7.3.2 N400 Words ....................................................................................................... 62 7.3.3 N400 Sentences .................................................................................................. 64 7.3.4 Comparison of N400 Sentences and N400 Words ............................................. 65 7.3.5 Subjective effort and performance ..................................................................... 66 7.4 Discussion and summary ........................................................................................... 68 7.4.1 Attentional effects on MMN
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