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Quantitative Electroencephalography and Low Resolution Electromagnetic Tomography Imaging of Alzheimer’S Disease

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Quantitative Electroencephalography and Low Resolution Electromagnetic Tomography Imaging of Alzheimer’S Disease SPECIAL ATRICLE CASE REPORT pKISEPp 0ORIGINAL ARTICLE0 Psychiatry Investig 2007;4:31-37 ISSN 1738-3684 Quantitative Electroencephalography and Low Resolution Electromagnetic Tomography Imaging of Alzheimer’s Disease Hyung-Tae Jung, MD, ObjectiveㅋThe EEG abnormalities of Alzheimer’s disease (AD) patients are characterized by Seung-Hwan Lee, MD, PhD, increased slow wave activities and reduced asymmetry between the two hemispheres. We at- tempted to find the specific spatio-temporal EEG pattern of AD through quantitative EEG Jong-Nam Kim, PhD, (qEEG) and the source localization of specific frequency bands. Kang-Joon Lee, MD, PhD, MethodsㅋThe AD group consisted of 22 patients who fulfilled the DSM-IV criteria of AD with Young-Cho Chung, MD, PhD no space occupying lesions confirmed by brain CT or MRI. The normal control (NC) group Department of Psychiatry, consisted of 27 subjects with no personal history of psychiatric or neurological abnormalities. Inje University College of Medicine, We performed qEEG, compared the hemispheric asymmetry between the AD and NC groups, Ilsan Paik Hospital, Goyang, Korea and tried to obtain source imaging of each frequency band using low resolution electromagnetic tomography (LORETA). ResultsㅋCompared with the NC group, the AD patients had significantly increased slow wave activities of the theta (4-7 Hz) and delta waves (1-3 Hz) over all of the electrodes. There was no statistically significant asymmetric difference between the AD and NC groups. The slow waves of the AD patients were dominant in the right hemisphere compared to the NC subjects. Increased theta wave activity was observed, especially in Brodmann area 40 (inferior parietal lobule) in the AD patients compared with the NC subjects. Increased delta wave activity was observed especially in Brodmann area 7 (postcentral gyrus) in the AD patients compared with the NC subjects. The MMSE score had a significant negative correlation with the theta waves and a positive correlation with the alpha waves in the AD patients. There was a positive corre- lation between the duration of illness and the theta waves in the AD patients. ConclusionsㅋOur results showed that AD patients had increased theta and delta wave ac- tivity in the right parietal areas, which reflect their decreased brain function in these regions. Our results suggest that qEEG and LORETA imaging are useful tools for detecting and evaluating AD. KEY WORDS: Quantitative electroencephalography, Brain mapping, Low-resolution brain electromagnetic tomography, Alzheimer’s disease. Psychiatry Investig 2007;4:31-37 Introduction Correspondence Alzheimer’s disease (AD) represents the most frequent cause of senile dementia. Seung-Hwan Lee, MD, PhD This disease has a slow onset and gradual progression, so its diagnosis is very im- Department of Psychiatry, portant. Over the past few years, considerable importance has been attributed to the Inje University College of Medicine, Ilsan Paik Hospital, diagnostic techniques of brain imaging, which are able to provide morphological and 2240 Daehwa-dong, Ilsan-seo-gu, functional images. EEG mapping is one of the most widely used methods. In this Goyang 411-706, Korea study, we used qEEG and LORETA1-3 to perform EEG mapping. Tel +82-31-910-7262 qEEG can compare the statistical values of the voltage and frequency that quali- Fax +82-31-910-7268 E-mail [email protected] tative EEG cannot. Therefore, it can draw a topographic map representing focal brain E-mail [email protected] function. LORETA can make a three dimensional and functional brain map by calcu- ⓒ 2007 Official Journal of Korean Neuropsychiatric Association www.psychiatryinvestigation.org 31 qEEG and LORETA Imaging of Alzheimer’s Disease lating the brain waves of the scalp surface. Although this and functional brain imaging of AD through qEEG and method has a low resolution power, it can give us im- LORETA.1-3 Also, we analyzed the relations between the portant information about brain functioning. mini mental status exam (MMSE) score and the power The EEG patterns of AD patients have consistency. of each frequency value. They are characterized by a slowed mean frequency and reduced asymmetry between the two hemispheres.4 qEEG Methods has also shown that there is a decrease in the mean fre- quency along with an increase in the delta and theta power Subjects and a parallel decrease in the alpha and beta power in AD The AD group consisted of 22 patients (19 female and patients compared with the corresponding results for nor- 3 male) who fulfilled the DSM-IV criteria of dementia mal elderly subjects.5-11 It is generally thought that the of Alzheimer’s type. Their mean age was 73.8±7.6 years earliest changes are an increase in the theta activity and with a mean duration of AD 22.4±19 months. Patients a decrease in the beta activity, which are followed later with other medical conditions known to cause dementia by a decrease in the alpha activity. The delta activity in- were excluded by means of neurological, serological and creases at a later period of the disease course. Patients imagery tests, including computed tomographic imaging with severe dementia exhibit a decrease in alpha and an scan (CT-scan) and magnetic resonance imaging (MRI). increase in delta activity.12-16 The symptom severity of AD was assessed by MMSE. There have been many equivocal reports about the to- The mean MMSE score was 19.2±3.6. The control group pographic findings in AD patients. However, Go et al.17 consisted of 27 subjects (13 female and 14 male) with no reported there was a pathophysiologic location especi- personal history of psychiatric or neurological abnorma- ally in the left parietotemporal areas in AD patients com- lities. Their mean age was 66.5±4.7 years and their mean pared to the NC group. Moreover, they reported that these MMSE score was 27.37±1.1 (Table 1). findings were comparable with the PET or SPECT fin- dings.18,19 Duffy et al.20 reported that the areas of maxi- EEG Recording and analysis mal group differences in slow waves between the senile The 18 EEG channels of the international 10-20 cri- AD patient group and their controls involved the mid- teria were used. The right ear was used as a reference frontal and anterior frontal lobes, bilaterally. Elmstahl et electrode. The measurements were performed with the al.21 reported that the delta wave activity was most mar- subjects laying down in a resting position. Their brain ked over the posterior regions of the brain in AD patients. waves were recorded about 15 minutes using a Nicolete Prichep et al.22 reported that there was no localized or system (Nicolete biomedical, Madison, WI, WSA) with a lateralized findings, but only diffuse increased theta waves sampling rate of 250 Hz/channel, a sensitivity of 7μV, a over all brain regions. Schreiter-Gasser et al.23 reported lower filter of 1 Hz, a higher filter of 70 Hz, and a time that there were increased slow waves in the total brain constant of 0.3. Five epochs (eye closed state) were taken area, but there were localized decreased fast waves in per subject over the whole record. The length of an epoch the left parietotemporal area. was 4.5 seconds, and eye movement and blinking and arti- Generally, the asymmetry of the cerebrum is a rather fact data were visually screened and rejected. In the analy- natural phenomenon. However, the asymmetry of the EEG sis of the qEEG, the delta range was 1-3 Hz, the theta pattern of AD patients is more significant than that of NC range 4-7 Hz, the alpha range 8-12 Hz, and the beta ran- subjects.17 Celsis et al.24 reported that there were lateral ge 13-25 Hz. asymmetries of the cognitive functions, SPECT and EEG findings in AD patients, but not in controls. Montplaisir Statistical analysis et al.25 reported that the degrees of interhemispheric asy- The independent t-test and bivariate correlation were mmetry calculated by both qEEG and single photon emis- TABLE 1. Demographic data of AD and NC subjects sion computerized tomography (SPECT) were concordant AD NC p-value 26 for the parieto-occipital region. Breslau et al. reported Numbers of patients 22 27 that AD patients were characterized by a marked delta Sex Male 03 14 asymmetry in the temporal regions, which was not seen Female 19 13 in the NC groups. Age (year) 073.8±07.6 66.50±04.7 <0.001 Thus, the measurement of qEEG or asymmetry of brain Symptom duration (month) 22.4±19. waves may be a useful device for the early detection of MMSE 019.2±03.6 27.37±01.1 <0.001 AD. Therefore, in this study, we attempted to find the Values are mean±standard deviation. MMSE: mini mental sta- specific EEG pattern, hemispheric asymmetry findings tus exam, AD: Alzheimer’s disease, NC: normal control 32 Psychiatry Investig 2007;4:31-37 HT Jung et al. used to analyze the EEG relative values, including the the alpha waves in the AD patients. There was a posi- spectral power and asymmetry. tive correlation between the duration of illness and theta To analyze the asymmetry, we used the lateral asymme- waves in the AD patients (Table 5). try index (LAI).27 The LAI was determined by comparing the corresponding frequency band percentages for the left TABLE 2. Mean transformed relative power of electrodes for theta frequency band (4-7 Hz) in the resting EEG of AD patients and right hemispheres. The LAI was computed by divi- and NC subjects ding the differences between the two hemispheres by their Location AD (N=22) NC (N=27) t p sum, A=(Pleft-Pright)/(Pleft+Pright), where Pleft and Fp1 0.088 0.067 2.785 0.006† Pright are the relative powers of the corresponding fre- Fp2 0.096 0.078 2.140 0.033* quency band in the appropriate brain region.
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