GridCORE (GRID COgnitive REhabilitation) is a project to support the diagnosis and research on neurodegenerative diseases.
The project uses a grid system to evaluate whether a rehabilitation, through a daily training of cognitive functions with a tablet (TABCOG training), is able to modulate the electroencephalographic rhythms in patients with neurodegenerative diseases.
GridCORE starts from the infrastructure built by the European project DECIDE, which focuses on patients with Alzheimer's disease and extends it to patients with Parkinson's disease.
In collaboration with
In recent years it has been widely demonstrated that the quantitative analysis of EEG rhythms in the resting condition (closed eyes), would provide a non-invasive, low-cost and easy to perform marker for the study of physiological and pathological aging. Interesting results have been obtained in the study of Alzheimer's and Parkinson's diseases.
In the case of the GridCORE project we rely, in particular, on the markers extracted from the EEG traces through the use of sophisticated algorithms. For the extraction and evaluation of these markers, GridCORE makes use of the infrastructure created by the FP7 DECIDE project, for which new functionalities have also been realized within GridCORE.
What is cognitive training
Cognitive training is a training practice aimed at improving cognitive functions both in patients with brain damage due to trauma or cerebrovascular diseases and in patients with neurodegenerative diseases such as Alzheimer's and Parkinson's.
Several studies have shown that cognitive training can slow the gradual decline in cognitive efficiency and reduce the relative risk of cognitive decline and dementia in healthy elderly subjects.
In recent years, several studies have shown the efficacy of this practice also for patients with Alzheimer's disease or with mild cognitive decline. People with Alzheimer's disease or mild cognitive impairment (MCI) undergoing cognitive training were characterized by an evident improvement in various aspects of cognitive function such as attention, memory, abstract reasoning, executive functions and information processing speed. Similar results were also observed for patients with Parkinson's who had a significant and stable improvement in verbal fluency, in memory and in executive functions after cognitive training.
GridCORE started from this evidence and carried out experimental tasks for the training of cognitive functions through the daily use of a tablet (TABCOG training) on the Android platform. The project has realized 8 different tasks (tasks) related to different functions (visuo-spatial, attention, categorization, memory, ...), whose complexity can be modulated according to the indications of the assistance staff in order to adapt to the type of user. For the various tests are calculated accuracy, reaction time and temporal variability of the correct answers
How it worksTask 1: Basic visuo-motor functions.
Objective: evaluation of basic motor sensory functions involved in the execution of cognitive tasks.
The user has at his disposal a "virtual table" on which cubes appear one at a time, which the subject must touch as quickly as possible.Task 2: Visual-spatial planning.
Objective: evaluation of frontal executive functions
In this task, on the virtual table appears a variable number of cubes in random order and a reference model with the cubes arranged in a certain spatial order (for example arranged in a tower or a triangle). The user must put the cubes in the same order as the model, which remains under his eyes.Task 3: Planning by categories.
Objective: evaluation of frontal executive functions.
In this test, on the virtual table appears a number of cubes of different colors in random order and a model with the same cubes arranged in horizontal line in a certain chromatic order. The task is to sort the cubes according to the indicated model, which remains under the user's eyes during the test.Task 4: Short-term memory.
Objective: assessment of cerebral functions for short-term episodic memory visuospatial.
At the center of the monitor appear a number of cubes of the same color in a certain spatial order (spatial model) for some time. After a few seconds, the model disappears from the virtual table. At the center of the table appear cubes of the same color in random order, which the user must put back in order according to the model shown above.Task 5: Short-term memory and categorization.
Objective: evaluation of brain functions for short-term episodic memory by categories.
At the center of the monitor appear a number of cubes of different colors in a certain chromatic order (color model) for a certain time. After a few seconds, the model disappears from the virtual table. At the center of the table appear cubes of the same color in random order, which the user must put back in order according to the model shown above.Task 6: Visual-spatial attention.
Objective: evaluation of brain functions for spatial visual attention.
An arrow pointing to the left or right side of the table appears at the center of the virtual table. After a certain number of seconds, a cube appears on the side indicated by the arrow (spatially congruent trial) or on the opposite side (spatially incongruent trial). The user must touch the cube as quickly as possible.Task 7: Attention to categories.
Objective: assessment of brain functions for attention by categories.
A number of cubes numbered in ascending order appears on the table in random order. The subject must pair the contiguous numbers (for example 1-2, 3-4, ...).Task 8: Attention to categories.
Objective: assessment of brain functions for attention by categories.
Some cubes appear randomly on the virtual table, one half of which is numbered in ascending order and the other half letters in alphabetical order. The user must create letter-number pairs in ascending order (for example 1-A, 2-B, ...).
The DECIDE project, active between 2010 and 2013 within the FP7 Program, has implemented a service to assist medical personnel in the early diagnosis of Alzheimer's.
Coordinated by GARR and supported by the Ministry of Health, the project has partnered with scientific bodies such as CNR and the European EADC (European Alzheimer Disease Consortium) network which includes 13 countries and includes some of the most important research centers on Alzheimer's, as the Center for the Study of Dementia of the IRCCS Fatebenefratelli of Brescia and the San Raffaele Vita-Salute University of Milan.
From a technological point of view, DECIDE is based on some high-level ingredients: a distributed infrastructure based on the resources of research networks and GÉANT, powerful computing resources, sophisticated algorithms for processing diagnostic images and access to large databases. clinical data worldwide.
The GridCORE project proposed to expand the functions of the infrastructure developed by the European project DECIDE (Diagnostic Enhancement of Confidence by an International Distributed Environment) to support the diagnosis and research on Alzheimer's disease (AD) to Parkinson's disease (PD). The infrastructure was used to evaluate the progression of the disease in patients and the effects of rehabilitation therapy through cognitive training on tablets (TABCOG) proposed by the project.
Specifically, GridCORE evaluated the "proof of the concept" that a training of cognitive functions through the daily use of a tablet application (TABCOG training for 15 days) was able to positively modify end points such as cortical delta sources , theta and alpha of EEG rhythms in the closed-eye condition in AD / ADMCI and PD / PDMCI patients.
The following objectives have been achieved:
- implementation of the experimental tasks for the training of cognitive functions (TABCOG training) through the daily use of a common tablet with an Android operating system;
- modification of the DECIDE infrastructure to allow the loading, archiving and display of behavioral data of the daily training sessions coming from the tablet;
- modification of the DECIDE infrastructure for loading, archiving, visualization and analysis of EEG data recorded in two experimental sessions (before and after cognitive training or execution of "sham" tasks, activities that are assigned to the patient but do not have no therapeutic value, such as viewing movies on the tablet) on subjects with Alzheimer's and Parkinson's;
- recruitment and collection of data in a population of 30 patients with Alzheimer's and 30 patients with Parkinson's divided into two subgroups, the first of which followed cognitive training and the second the SHAM procedure;
- analysis of clinical data, EEG and cognitive performance to the tasks performed on tablets in groups of subjects suffering from Alzheimer's and Parkinson's to evaluate the working hypothesis with appropriate statistical models.
GridCORE is based on the DECIDE infrastructure, a distributed ICT infrastructure able to offer support to neurologists and the different medical figures involved in the diagnosis and prognosis of neurodegenerative diseases.
In particular, DECIDE was created to provide effective tools to determine clinical markers for the early diagnosis of Alzheimer's disease. In fact, it allows, first of all, to store and share clinical and neuroimaging data of different modalities (magnetic resonance images, MRI: positron emission topography, PET, electroencephalography, EEG) in subjects suffering from Alzheimer's in the prodromal phase of mild cognitive decline and memory deficit (MCI) and initial dementia. In addition, it is possible to perform various analyzes on these MRI, PET and EEG data which, when combined, can provide brain markers of interest for the study of Alzheimer's and Parkinson's diseases.
The service offered by DECIDE has been designed to be compatible with the clinical routine, therefore with particular attention to ease of use, robustness and data processing in a reasonably short time, in line with those of other diagnostic tests. Particular attention was also dedicated to ethical and legal issues related to the management, processing and distribution of data.
Thanks to the work of GridCORE these tools have now been extended to Parkinson's.
- More information on DECIDE is available on: www.eu-decide.eu
Project results - summary
During the project the DECIDE (link) infrastructure for loading, archiving, visualization and analysis of electroencephalographic (EEG) data recorded in subsequent experimental sessions was modified for populations of patients with Alzheimer's disease (AD ) and Parkinson's disease (PD). In addition, the DECIDE infrastructure has been modified for the loading, archiving and display of daily performance obtained by patients performing TABCOG training on tablets. All information relating to a given patient remains available on the page dedicated to him on the DECIDE infrastructure.
Here are the main results:
- From the data acquired during the project, at the end of the training period with TABCOG, we observed an increase in execution accuracy and a reduction in response time, statistically significant, in the performance obtained in some of the 8 computerized tasks for training of cognitive functions, for both populations of subjects (AD and PD).
- Moreover, the TABCOG training decreased the activity of cortical sources delta of EEG rhythms in PD patients or in patients with mild cognitive impairment (MCI) due to PD (PDMCI), tending to mitigate the pathologic increase in amplitude of such cortical sources that are observed in this condition. This beneficial effect on cortical delta sources was far greater than that observed after control procedures. It should be noted that the TABCOG training did not produce any significant effect on the activity of cortical sources of EEG rhythms in AD patients or with MCI due to AD (ADMCI), suggesting a specific effect of this training on the brain function of PD and PDMCI patients. This specificity could be due to the well-known greater integrity of cholinergic systems in such patients compared to those with AD or ADMCI. It can be hypothesized that the TABCOG training stimulates a greater neuro-protective release of cortical acetylcholine by the still active neurons and that the effect is amplified in the case of a sufficient neuronal contingent, such as the one expected in patients with PD and PDMCI. Future cross-validation studies should verify the hypothesis that the beneficial effects of TABCOG training on PD and PDMCI patients are accompanied by an increase in cortical cholinergic activity reflectable by positron emission tomography recordings with radioactive receptor ligands, transporters or enzymes of acetylcholine degradation in the brain.
The results of the GRIDCORE project, therefore, provide a first important evidence of the positive effect of a training of cognitive functions through the daily use of a tablet application (TABCOG training), in PD and PDMCI. These results encourage a future cross-validation study before the clinical use of this procedure, free and non-invasive, to mitigate the deterioration of the oscillatory neurophysiological mechanisms underlying the fluctuations of cortical arousal and vigilance, due to this pathological condition.
Claudio Babiloni, Ph.D.
Associate Professor of Physiology
Dipartimento di Fisiologia e Farmacologia "V. Erspamer"
"La Sapienza" University of Rome
P.le A. Moro 5, 00185, Roma
tel/fax: +39 06 4991 0989/0917
Referrals of partner institutions
Dott. Fulvio Galeazzi
IRCCS San Raffaele Pisana di Roma
Prof. Claudio Babiloni
Università Cattolica del Sacro Cuore
Prof. Paolo Maria Rossini
Prof. Roberto Barbera
Contact person at "La Sapienza" University of Rome
Dipartimento di Fisiologia e Farmacologia "V. Erspamer"
Dott.ssa Roberta Lizio
Interview with Prof. C. Babiloni, Coordinator of the GridCORE project - in italian
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