Event-Related Potential (ERP) Components in Clinical Diagnosis

Study Overview
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Brief Summary
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In this study, the investigators will use a novel electroencephalogram (EEG) system that participants will wear during a single in-person research session to investigate whether ERPs are now ready for validation as a tool clinicians can easily implement to increase diagnostic accuracy and confidence. This EEG will not be used to treat, cure, mitigate or diagnosis any disease and there will be no safety or efficacy data collected about the machine for any purpose including support of FDA submission. The investigators will compare the ERP data to that of neuropsychological testing in order to determine the degree of correlation between these two measures. Questionnaires on cognition, mood, and fluency will be administered prior to the EEG to establish a baseline. ERP data from the EEG session will be compared with the results of the neuropsychological battery in order to determine whether the implementation of ERPs in the existing workflow of clinicians can aid in diagnostic accuracy, thus altering clinical management.

Detailed Description
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A cross sectional cohort study design with four groups will be implemented to determine how ERPs can provide diagnostic information and alter clinical management beyond that of neuropsychological testing alone in patients with Alzheimer's disease (AD) or Mild Cognitive Impairment (MCI). Secondary Objectives: To determine the impact of ERP testing (using cognitive health assessment reports) on change in research grade clinical diagnosis To determine the degree of correlation between quantitative ERP measures with neuropsychological testing performance using a standardized neuropsychological battery. 75 mild AD dementia and 75 MCI due to any etiology, 25 Older Adults (OA) and 25 Younger Adults (YA) will be enrolled over the course of two years. Each subject will participate in the study for 1 visit. The in person 50-60-minute testing session consists of a neuropsychological battery, and an EEG session with computer tasks including the Auditory Oddball paradigm, a Continuous Visual Memory Test, Auditory Evoked Potentials, Visual Evoked Potentials, the Erikson Flanker Task, and the Hayling Task.

Official Title
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The Clinical Utility of ERPs in the Diagnosis of Cognitive Impairment

Conditions
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Alzheimer Disease, Dementia, Mild, Mild Cognitive Impairment

Intervention / Treatment
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* Device: Electroencephalogram (EEG) system
* Behavioral: Standard Neuropsychological Testing
* Behavioral: Additional neuropsychological tests


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: For Mild Alzheimer Disease (AD) dementia Meets probable AD dementia National Institute on Aging and Alzheimer's Association (NIA-AA) criteria 50-90 years old Mini-Mental State Examination (MMSE) 20-27 Performance on delayed recall and recognition memory worse than 1.5 standard deviation (SD) for age and education Performance on delayed recall and recognition memory worse than 1.5 SD for age & education in at least one other cognitive domain (e.g., language, executive functioning) based on other tests in our neuropsychological test battery. Dr. Turk and Dr. Budson will confirm all mild AD dementia diagnoses For Mild cognitive impairment (MCI) MCI due to any etiology 50-90 years old MMSE > 23 Performance on delayed recall and recognition memory worse than 1.0 SD for age & education adjusted norms Dr. Turk and Dr. Budson will confirm all MCI diagnoses For Healthy older adults 50-90 years old Functioning normally in occupation determined by self-report For Healthy younger adults 20-50 years old Functioning normally in occupation determined by self-report Exclusion Criteria: A clinically significant problem of any of the following conditions: depression heavy alcohol or drug use cerebrovascular disease a different degenerative disease (e.g., fronto-temporal dementia, Parkinson's disease) any medical condition whose severity could significantly impair cognition (e.g., organ failure) on any antipsychotic or epilepsy medication Unable to understand the consent form

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 75 Mild AD<br>75 patients diagnosed with Mild Alzheimer's disease. | Device: Electroencephalogram (EEG) system<br>* An FDA 510(k) approved EEG/ERP device designed by G-Tec ™ intended for the acquisition, display, analysis, storage, reporting and management of EEG and auditory evoked potentials (AEP) information and uses Bluetooth technology to securely transmit EEG signals to a computer. The device is patient-friendly, and no serious adverse events have occurred to-date in any research or clinical study or in clinical use.<br>* Other names: g.Nautilus PRO (G-Tec ™);Behavioral: Standard Neuropsychological Testing<br>* Prior to the EEG session, neuropsychological testing will be done to establish a baseline measurement. We administer a full standard neuropsychological battery (45 mins) for all participants which includes the following tests: MOCA (only for older participants), MMSE, CERAD, Phonemic Test and the Category Fluency test, Trails Making Test A and B, BNT, BAI, BDI, PANAS, Ishihara Color Blindness test, and the Snellen Eye Chart.<br>* Other names: Neuropsychological Battery;|
| 75 MCI due to any etiology<br>75 patients diagnosed with Mild Cognitive Impairment due to any etiology. | Device: Electroencephalogram (EEG) system<br>* An FDA 510(k) approved EEG/ERP device designed by G-Tec ™ intended for the acquisition, display, analysis, storage, reporting and management of EEG and auditory evoked potentials (AEP) information and uses Bluetooth technology to securely transmit EEG signals to a computer. The device is patient-friendly, and no serious adverse events have occurred to-date in any research or clinical study or in clinical use.<br>* Other names: g.Nautilus PRO (G-Tec ™);Behavioral: Standard Neuropsychological Testing<br>* Prior to the EEG session, neuropsychological testing will be done to establish a baseline measurement. We administer a full standard neuropsychological battery (45 mins) for all participants which includes the following tests: MOCA (only for older participants), MMSE, CERAD, Phonemic Test and the Category Fluency test, Trails Making Test A and B, BNT, BAI, BDI, PANAS, Ishihara Color Blindness test, and the Snellen Eye Chart.<br>* Other names: Neuropsychological Battery;|
| 25 Healthy Older Adults<br>25 Healthy older adults age: 50-90 (control). | Device: Electroencephalogram (EEG) system<br>* An FDA 510(k) approved EEG/ERP device designed by G-Tec ™ intended for the acquisition, display, analysis, storage, reporting and management of EEG and auditory evoked potentials (AEP) information and uses Bluetooth technology to securely transmit EEG signals to a computer. The device is patient-friendly, and no serious adverse events have occurred to-date in any research or clinical study or in clinical use.<br>* Other names: g.Nautilus PRO (G-Tec ™);Behavioral: Standard Neuropsychological Testing<br>* Prior to the EEG session, neuropsychological testing will be done to establish a baseline measurement. We administer a full standard neuropsychological battery (45 mins) for all participants which includes the following tests: MOCA (only for older participants), MMSE, CERAD, Phonemic Test and the Category Fluency test, Trails Making Test A and B, BNT, BAI, BDI, PANAS, Ishihara Color Blindness test, and the Snellen Eye Chart.<br>* Other names: Neuropsychological Battery;|
| 25 Healthy Younger Adults<br>25 Healthy younger adults age: 20-50 (control). | Device: Electroencephalogram (EEG) system<br>* An FDA 510(k) approved EEG/ERP device designed by G-Tec ™ intended for the acquisition, display, analysis, storage, reporting and management of EEG and auditory evoked potentials (AEP) information and uses Bluetooth technology to securely transmit EEG signals to a computer. The device is patient-friendly, and no serious adverse events have occurred to-date in any research or clinical study or in clinical use.<br>* Other names: g.Nautilus PRO (G-Tec ™);Behavioral: Standard Neuropsychological Testing<br>* Prior to the EEG session, neuropsychological testing will be done to establish a baseline measurement. We administer a full standard neuropsychological battery (45 mins) for all participants which includes the following tests: MOCA (only for older participants), MMSE, CERAD, Phonemic Test and the Category Fluency test, Trails Making Test A and B, BNT, BAI, BDI, PANAS, Ishihara Color Blindness test, and the Snellen Eye Chart.<br>* Other names: Neuropsychological Battery;Behavioral: Additional neuropsychological tests<br>* Younger participants will receive additional testing along with the standard neuropsychological battery including Pittsburgh Sleep Quality Index (PSQI) [37] for sleep quality measures, the Test of Memory Malingering (TOMM) for effort measure, Ohio State Traumatic Brain Injury Identification Method questionnaire (OSU-TBI) [38] to gather lifetime TBI history, and the Neurobehavioral Symptom Inventory (NBSI) [39] for post-concussive symptoms. These additional tests will add an extra fifteen minutes, making the total time for neuropsychological questionnaires 1 hour in younger participants.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Electroencephalogram (EEG) memory diagnosis | The EEG memory diagnosis will be arrived through the blinded review of the EEG data | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Montreal Cognitive Assessment (MoCA) performance | This neuropsychological test will be used for cognitive screening. The scores on this test ranges from 0 to 30, and lower scores indicate decreased cognitive ability. | baseline | 
| Mini Mental State Examination (MMSE) | This neuropsychological test will be used to assess cognitive functioning. MMSE scores range from 0 to 30 with lower scores indicating decreased cognitive ability. | baseline | 
| Consortium to Establish a Registry in Alzheimer's disease Word List Test (CERAD) | The CERAD evaluates the immediate recall of a list of words (up to 30 correct recall on 3 individual recall trials), delayed recall (up to 10 correct recall after a 5 minute delay), and on yes-no recognition memory (up to 10 correct recognition) | baseline | 
| Verbal Fluency test: Phonemic Test and the Category Fluency test | Phonemic word fluency and categoric word fluency will be assessed using the Verbal Fluency: Phonemic Test and the Category Fluency test. For letter fluency, individuals name as many words as possible in one minute that start with the letters F, A, and S. For category fluency, individuals name as many words as possible in one minute that are within the Animals, Vegetables, and Fruits categories. | baseline | 
| Trails Making Test A and B | The Trail Making Test Part A consists of connecting a series a numbers with a line in ascending order as quickly as possible (performance is timed, and the score is the time to complete the task). The Trail Making Test Part B consists of connecting a series of letters and numbers, alternating back and forth between them, as quickly as possible in ascending order (performance is timed, and the score is the time to complete).This test will be used to assess the central executive functioning. | baseline | 
| Boston Naming Test | This test consists of 15 line drawings, with a maximum score of 15 correct. It will be used to assess naming skills in speakers of multiple languages | baseline | 
| EEG amplitude | EEG amplitudes will be measured from the EEG data | baseline | 
| EEG latency | EEG latency will be measured from the EEG data | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Memory Strategies, EEG headgear, Event-Related Potentials