Abstract
Mismatch negativity (MMN) is suitable for studies of preattentive auditory discriminability and the auditory memory trace. Subjective cognitive decline (SCD) is an ideal target for early therapeutic intervention because SCD occurs at preclinical stages many years before the onset of Alzheimer’s disease (AD). According to a novel lifespan-based model of dementia risk, hearing loss is considered the greatest potentially modifiable risk factor of dementia among nine health and lifestyle factors, and hearing impairment is associated with cognitive decline. Therefore, we propose a neurofeedback training based on MMN, which is an objective index of auditory discriminability, to regulate sensory ability and memory as a non-pharmacological intervention (NPI) in SCD patients. Seventeen subjects meeting the standardized clinical evaluations for SCD received neurofeedback training. The auditory frequency discrimination test, the visual digital N-back (1-, 2-, and 3-back), auditory digital N-back (1-, 2-, and 3-back), and auditory tone N-back (1-, 2-, and 3-back) tasks were used pre- and post-training in all SCD patients. The intervention schedule comprised five 60-min training sessions over 2 weeks. The results indicate that the subjects who received neurofeedback training had successfully improved the amplitude of MMN at the parietal electrode (Pz). A slight decrease in the threshold of auditory frequency discrimination was observed after neurofeedback training. Notably, after neurofeedback training, the working memory (WM) performance was significantly enhanced in the auditory tone 3-back test. Moreover, improvements in the accuracy of all WM tests relative to the baseline were observed, although the changes were not significant. To the best of our knowledge, our preliminary study is the first to investigate the effects of MMN neurofeedback training on WM in SCD patients, and our results suggest that MMN neurofeedback may represent an effective treatment for intervention in SCD patients and the elderly with aging memory decline.
Highlights
Alzheimer’s disease (AD) is slow and progresses with a presymptomatic course over several years to decades (Sperling et al, 2011)
We evaluated the standard mismatch negativity (MMN) changes from event-related potential (ERP), auditory frequency threshold, and working memory (WM) ability by cognitive behavioral tests
Considering the differences in the educational levels and cognition between the participants, we have conducted three types of WM for cognitive assessment, and the auditory tone 3-back test performance was significantly improved in accuracy after the neurofeedback training
Summary
Alzheimer’s disease (AD) is slow and progresses with a presymptomatic course over several years to decades (Sperling et al, 2011). SCD may represent the first symptomatic manifestation of AD before mild cognitive impairment (MCI; Koppara et al, 2015; Bubbico et al, 2019). There is no consensus on the best intervention or treatment for SCD with regard to psychological, cognitive, lifestyle, and pharmacological interventions described in a recent systematic review and a meta-analysis (Williams and Tanabe, 2016; Bhome et al, 2018). Given the heterogeneity of etiology of SCD and considering individuals who have minimal manifestation of clinical symptoms, it is difficult to confirm a focal target of pharmacological intervention that does not cause an adverse reaction. Non-pharmacological intervention (NPI) may be a feasible method of treatment for patients with SCD (Smart et al, 2017; Bhome et al, 2018)
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