a-v-p300 response control 8-11-13

Response Control in Neuropsychiatric Patients: Advantage of Combined Auditory and Visual Processing

Zimmerman, E. M.,1 Klein, L.,2 Konopka, C. J.,3 Epstein, P. S.4 & Konopka, L. M.2,3 1The Chicago School of Professional Psychology, Chicago, IL 2Yellowbrick, Evanston, IL 3Loyola University, Chicago, IL 4Advanced Neurodiagnostics and Clinical Neuroscience, Wheeling, IL

Purpose

Patients with similar amplitudes in auditory and visual P300 will have better performance on IVA+Plus measures of response control.

Sample: •  N= 72 patients selected (total sample, n = 92)

•  Community-based outpatient clinic •  Self-referred for a broad range of psychiatric presentations:

mood and anxiety disorders, attention and behavioral difficulties, memory impairment

•  Patients removed: n=17 without clearly identifiable P300 amplitudes; n=3 with invalid IVA+Plus scores on multiple domains

Auditory and Visual P300: •  Digital EEG recorded from 19 cephalic silver silver-

chloride electrodes placed according to the international 10/20 system with non-cephalic electrodes monitoring eye movement and EKG. Impendence was <5 kOhms at all electrodes, acquisition sampling rate was 500 Hz with filter settings at 0.1 and 70 Hz.

•  P300 amplitude and latency were measured at Cz and Pz electrodes and averaged with Neuroscan software over two repeat 5-minute standard oddball auditory and visual paradigms.

Procedure

Patients were categorized into three groups based on 25% differences between auditory and visual P300 amplitudes at Cz, Pz, or both electrode sites.

IVA+Plus Continuous Performance Test The Integrated Visual and Auditory (IVA) Continuous Performance Test (CPT; Sandford & Turner, 2000) is a computerized measure of attention and response control for auditory and visual modalities. The IVA yields a full scale response control quotient (RCQ) based on a combination of auditory and visual response control involving Prudence (impulsive errors of commission), Consistency (response time variability), and Stamina (mean reaction times of correct responses). Statistical Analysis One-way between-subject ANOVAs were utilized to compare mean IVA+Plus scores in measures of response control. Chi-squared analyses were run to compare group demographics in terms of gender, handedness, and age distribution.

Hypothesis

Patients groups were similar in gender, handedness, and age distribution. Significant differences in IVA+Plus scores were identified between dominant modality types on measures of response control. Figure 2. Gender, Handedness, Age Distribution

Figure 3. Full Scale Response Control Scores by Dominant Modality (ANOVA, F(2,69)=3.846, p = .026)

Figure 4. Auditory Response Control Scores by Dominant Modality (ANOVA, F(2,69)=4.188, p = .019)

Figure 5. Auditory Prudence Scores by Dominant Modality (ANOVA, F(2,69)=4.188, p = .019)

FULL SCALE RESPONSE CONTROL (RCQ)

AUDITORY RESPONSE CONTROL VISUAL RESPONSE CONTROL Prudence Prudence Consistency Consistency Stamina Stamina

References

AUDITORY (N=31) VISUAL (N=10) NO DOMINANCE (N=31) GENDER (Pearson Chi-Square, p = .078) Male 19 Male 2 Male 16 Female 12 Female 8 Female 15 HANDEDNESS (Pearson Chi-Square, p = .317) Left 0 Left 2 Left 3 Right 30 Right 8 Right 27 Mixed 1 Mixed 0 Mixed 1 AGE (ANOVA F(2,69)=1.484, p = .234) Mean = 36.55, SD = 13.93 Mean = 32.60, SD = 17.50 Mean = 29.68, SD = 16.81

No Dominance M=104.13, SD=13.58

Auditory Dominance M=91.29, SD=25.66

Visual Dominance M=89.40, SD=18.14







P300 and IVA+Plus may offer predictive patterns of behavior for psychiatric patients with difficulties in executive functions, often marked by impaired ability to inhibit immediate reactions and effectively control responses to the external environment. Electrophysiological methods that capture event-related potentials (ERP) such as P300 have been used to measure the brain’s response to tasks that require attention and decision-making, providing useful information about the patient’s ability to discriminate between and response to target and non-target auditory and visual stimuli. Behavioral measures such as IVA+Plus can be useful in measuring inhibition and response control by requiring the patient to identify and respond to target information while inhibiting responses to non-target information in both auditory and visual modalities. This study examined auditory and visual response control in a group of neuropsychiatric patients by comparing visual and auditory P300 with behavioral performance on the Integrated Visual and Auditory Continuous Performance Task (IVA+Plus). Patients with comparable electrophysiological responses in both sensory modalities may have greater distribution of resources to recruit for effective response control.

Results

Figure 1. International 10-20 Electrode System, Cz and Pz electrodes circled

NO DOMINANCE

Less than 25% difference between Auditory and

Visual Amplitude

AUDITORY DOMINANCE

Auditory > (25%) Visual

VISUAL DOMINANCE

Visual > (25%) Auditory

N=31

N=10

N=31

Cardin, V., Orfanidou, E., Ronnberg, J., Capek, C. M., Rudner, M., & Woll, B. (2013). Dissociating cognitive and sensory neural plasticity in human superior temporal cortex. Nature Communications, 4(1473), 1-5. Frank, Y., Seiden, J. A, & Napolitano, B. (1994). Event-related potentials to an “oddball” auditory paradigm in children with learning disabilities with or without attention deficit hyperactivity disorder. Clinical Electroencephalography, 25(4), 136-141. Freitas, A. L., Azizian, A., Leung, H. C., & Squires, N. K. (2007). Resisting recently acted-on cues: Compatibility of Go/NoGo responses to response history modulates (frontal P3) event-related potentials. Psychophysiology, 44(1), 2-10. Halgren, E., Marinkovic, K., & Chauvel, P. (1998). Generators of the late cognitive potentials in auditory and visual oddball tasks. Electroencephalography and Clinical Neurophysiology, 106(2), 156-164. Johnson, R. (1989). Auditory and visual P300s in temporal lobectomy patients: evidence for modality-dependent generators. Journal of Psychophysiology, 26(6), 633-650. Kiehl, K. A., Laurens, K. R., Duty, T. L., Forster, B. B., & Liddle, P. F. (2001). An event-related fMRI study of visual and auditory oddball tasks. Journal of Psychophysiology, 15, 221-240. Linden, D. E. J. (2005). The P300: Where in the brain is it produced and what does it tell us? The Neuroscientist, 11(6), 563-576. Linden, D. E. J., Prvolovic, D., Formisano, E., Vollinger, M., Zanella, F. E., Goebel, R., & Dierks, T. (1999). The functional neuroanatomy of target detection: an fMRI study of visual and auditory oddball tasks. Cerebral Cortex, 9(8), 815-823. Sandford, J. A., & Turner, A. (2000). Integrated visual and auditory continuous performance task. Richmond, VA: Brain Train.

Conclusions This study provides a unique link between auditory and visual P300 amplitude and behavioral measures of response control. This link is supported by previous literature showing relationships between P300 amplitude, cognitive performance, and impulse control. P300 amplitudes have been shown to correlate with performance outcomes (Frank, Seiden, & Napolitano, 1994), and have also been shown to correspond to engagement of inhibitory processing in response control (Freitas, Azizian, Leung, & Squires, 2007). Previous studies have demonstrated that auditory and visual P300 generators are both separate and overlapping. Varying auditory and visual P300 amplitudes can imply bioelectrical sources are modality specific. Electrophysiological studies have confirmed that auditory and visual modalities function independently of each other (Johnson, 1989), and utilize different neuroanatomical pathways (Kiehl, Laurens, Duty, Forster, & Liddle, 2001; Linden et al., 1999). Modality-specific P300 generators suggest that preference for auditory or visual processing may translate to modality-specific utilization of cognitive resources without full engagement of additional pathways. Limited recruitment of other resources may imply underutilization of broader networks including those involved in behavioral response to stimuli. Our study supports this hypothesis in that patients with dominance in either the auditory or visual P300 had impaired response control. At the same time, data also suggest involvement of common pathways, including shared, widespread anatomical regions activated by both auditory and visual tasks (see Halgren, Marinkovic, & Chauvel, 1998 and Linden, 2005 for reviews). Studies have demonstrated shared visual and auditory P300 generators include regions such as the inferior parietal lobule, cingulate cortex, dorsolateral prefrontal cortex, and superior parietal lobule (Halgren et al., 1998; Linden, 2005). These areas are involved in tasks of executive function including motor planning and response inhibition. Preference for one modality may suggest limited or sensory-specific activation of these cortical regions instead of full engagement of inhibitory networks. This study demonstrates that patients with similar cortical processing of auditory and visual stimuli have better response control than those with preference for one sensory modality. In light of current understanding of brain plasticity in sensory processing (Cardin, 2013), neuropsychiatric patients with a deficit in a particular sensory modality may benefit from a multimodality approach in treatment. Future studies may consider comparing amplitude differences in patients with a modality-specific preference as well as explore in greater detail the role played by auditory and visual processing in aspects of behavioral performance such as attention and impulsivity.

a-v-p300 response control 8-11-13

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