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EEG-Neurofeedback as a Potential Therapeutic Approach for Cognitive Deficits in Patients with Dementia, Multiple Sclerosis, Stroke and Traumatic Brain Injury
2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Life 2023, 13(2), 365; https://doi.org/10.3390/life13020365
Received: 15 December 2022
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Revised: 21 January 2023
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Accepted: 25 January 2023
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Published: 29 January 2023
(This article belongs to the Special Issue Applications of EEG in Neural Rehabilitation)
Abstract
Memory deficits are common in patients with
dementia, such as Alzheimer’s disease, but also in patients with other
neurological and psychiatric disorders, such as brain injury, multiple
sclerosis, ischemic stroke and schizophrenia. Memory loss affects
patients’ functionality and, by extension, their quality of life.
Non-invasive brain training methods, such as EEG neurofeedback, are used
to address cognitive deficits and behavioral changes in dementia and
other neurological disorders by training patients to alter their brain
activity via operant activity. In this review paper, we analyze various
protocols of EEG neurofeedback in memory rehabilitation in patients with
dementia, multiple sclerosis, strokes and traumatic brain injury. The
results from the studies show the effectiveness of the ΕΕG-NFB method in
improving at least one cognitive domain, regardless of the number of
sessions or the type of protocol applied. In future research, it is
important to address methodological weaknesses in the application of the
method, its long-term effects as well as ethical issues.
1. Introduction
Cognitive
deficits, such as memory loss and attention disorders, are very common
nowadays because of the aging world population and the numerous
neurodegenerative diseases that lead to cognitive impairment. Until
recently, the treatment of cognitive deficits was based exclusively on
the administration of appropriate medication. However, a deeper
understanding of the nature of cognitive deficits combined with advances
in technology has led to the development of methods and techniques
aimed at improving both cognitive deficits and non-cognitive conditions,
in order to improve the quality of life not only for the patients but
also for their families.
A popular method is
cognitive rehabilitation. Cognitive rehabilitation is a behavioral
approach that aims to improve patients’ cognitive deficits, but also to
provide assistance to both patients and their families in order to
improve their daily lives. It can be carried out with paper and pencil
exercises, but also with electronic programs, through which the patient
practices various cognitive tasks [1].
Another
method is neurofeedback (NFB). NFB is a biofeedback technique for
training patients with neurological and psychiatric disorders to change
brain activity through operant conditioning [2].
Through this method, the individual learns to enhance and inhibit
specific electrophysiological parameters through the process of
learning. Modification of the individual’s behavioral response is made
possible through feedback and positive reinforcement [3].
EEG-NFB is investigated in patients with depression, post-traumatic
stress, schizophrenia, addictions, attention deficit hyperactivity
disorder, autism and learning disabilities, and it is correlated with
short- or long-term symptom relief.
Neurophysiological
factors for NFB training are not clearly defined. It is considered that
two types of neuroplasticity are involved: Hebbian plasticity and
homeostatic plasticity. Reformation of the neural membrane and synaptic
potentiation because of EEG amplitude are characteristics of Hebbian
neuroplasticity, while homeostatic plasticity plays the opposite role,
in order to stabilize the neuronal activity and limit the expression of
the Hebbian type. In any case, the neuronal mechanisms have not been
clearly investigated until now [4,5].
There
are three types of EEG-NFB: 1. slow cortical potentials; 2. coherence
training; and 3. frequency training. The third type of training is the
most commonly used and is aimed at modifying the power ratio of
frequency bands. The frequency bands are divided into 1. delta, 2.
theta, 3. alpha, 4. beta and 5. gamma [6].
These frequencies are used to classify brain oscillations [7].
They are created by the coordinated activity of cells and thus make it
possible to communicate between different brain regions in a way that
allows the brain to utilize the information it receives and then
synthesize it [3].
Additionally, brain oscillations are connected with specific cognitive
functions. Theta oscillations are connected with encoding retrieval,
while alpha bands are connected with attention. Alpha and gamma
oscillations are capable of suppressing factors that can reduce
concentration [8].
The
most commonly used EEG-NFB protocols for the therapeutic management of
cognitive deficits are: 1.EEG-theta/beta ratio; 2. Sensorimotor Rhythm
(SMR) (12–15 Hz) [9].
In the first protocol, theta band power (ranging between 4 and 7 Hz)
divided by beta band ratio (ranging between 13 and 30 Hz) shows cortical
and sub-cortical brain interactions [10].
The second protocol, SMR, includes rhythm with a mean frequency of 10
Hz, and it is recorded over sensorimotor cortices in C3 and C4 [11].
The
effectiveness of EEG-NFB in cognitive rehabilitation is still under
investigation and is mainly evaluated through comparisons of patients’
cognitive performance before and after their training in various EEG
protocols. A review of studies using EEG-NFB as a therapeutic tool for
treating cognitive deficits in patients with Alzheimer’s dementia (AD),
mild cognitive disorder (MCI), stroke, multiple sclerosis (MS) and
traumatic brain injury (TBI) is analyzed below. The novelty of our
review lies in gathering findings on the effectiveness of EEG
neurofeedback as a therapeutic method in the aforementioned four
neurological disorders. Recent studies demonstrating the effectiveness
of the method, regardless of whether EEG-NFB is used as a clinical tool
or a wearable device, are reviewed.
Contribution of Our Review
- Review of recent EEG-NFB studies in dementia, multiple sclerosis, strokes and TBI.
- Therapeutic effectiveness of EEG-NFB regardless of how it is applied (clinical use of EEG or wearable device).More at link.
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