Abstract
Clinical assessment of brain function relies heavily on indirect behavior-based tests. Unfortunately, behavior-based assessments are subjective and therefore susceptible to several confounding factors. Event-related brain potentials (ERPs), derived from electroencephalography (EEG), are often used to provide objective, physiological measures of brain function. Historically, ERPs have been characterized extensively within research settings, with limited but growing clinical applications. Over the past 20 years, we have developed clinical ERP applications for the evaluation of functional status following serious injury and/or disease. This work has identified an important gap: the need for a clinically accessible framework to evaluate ERP measures. Crucially, this enables baseline measures before brain dysfunction occurs, and might enable the routine collection of brain function metrics in the future much like blood pressure measures today. Here, we propose such a framework for extracting specific ERPs as potential “brain vital signs.” This framework enabled the translation/transformation of complex ERP data into accessible metrics of brain function for wider clinical utilization. To formalize the framework, three essential ERPs were selected as initial indicators: (1) the auditory N100 (Auditory sensation); (2) the auditory oddball P300 (Basic attention); and (3) the auditory speech processing N400 (Cognitive processing). First step validation was conducted on healthy younger and older adults (age range: 22–82 years). Results confirmed specific ERPs at the individual level (86.81–98.96%), verified predictable age-related differences (P300 latency delays in older adults, p < 0.05), and demonstrated successful linear transformation into the proposed brain vital sign (BVS) framework (basic attention latency sub-component of BVS framework reflects delays in older adults, p < 0.05). The findings represent an initial critical step in developing, extracting, and characterizing ERPs as vital signs, critical for subsequent evaluation of dysfunction in conditions like concussion and/or dementia.
Highlights
Vital signs such as heart rate, pulse oxygenation, and blood pressure are essential to monitoring and managing the health of various body systems
The P300 was elicited during Basic attention to deviant tones (10.72 ± 2.66 μV)
Clinical evaluations of healthy brain functioning is moving from indirect subjective behavior-based tests, to objective, physiological measures of brain function, such as those derived from Event-related brain potentials (ERPs)
Summary
Vital signs such as heart rate, pulse oxygenation, and blood pressure are essential to monitoring and managing the health of various body systems. Current clinical assessments for screening brain functional status relies largely on subjective, behaviorbased measures, such as the Glasgow Coma Scale (GCS), to evaluate level of conscious awareness following brain injury Subjective behavior-based tests of this nature have been reported to have misdiagnosis rates as high as 43% These too are behavior-based measures, depending heavily on the patient’s capacity to produce voluntary, on-demand motor and/or verbal responses to stimuli Confounding factors, such as motoric and communicative limitations, often hamper greatly the clinical effectiveness for many of these measures
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