Mind and Brain Health
Transcript of Mind and Brain Health
Matthew Rizzo, MD, FAANFrances and Edgar Reynolds Professor & Chair
Department of Neurological Sciences
Clinical Program Leader, Neurosciences
Director, Great Plains IDeA CTR
Supported by
U.S. NIA, NINDS, NHLBI,, NIDA, CDC, Nissan,
Toyota CSRC & State of Nebraska
Mind and Brain Health
MS&V for Predictive Leadership and Decision-
Making
September 25, 2018
Overview
• Neuroergonomics
• Simulation
• Linking Physiology and Behavior
• Brain-in-the-Wild
• Drinking from a Firehose
• Conclusions
IDeA-CTRs
Center for Research Capacity Building, National Institute of General Medical Sciences,
National Institute of Health. (2016) IDeA-CTR Principal Investigator Directory 2016.
Retrieved from https://www.nigms.nih.gov/Research/CRCB/IDeA/documents/2016IDeA-CTR_Directory.pdf
Neuroergonomics
Key Issues and Approaches•Cognitive Readiness
•Decision Making and Stress
•Lessons from Brain Damage
•Bridging the gap between lab
and real world
•Simulation
•Experience Sampling
•Triangulating on Behavior
Effects of fatigue, drugs, brain injury, disease, aging
Information processing and the brain
• Analyze individual operators’visual perceptual and attentional, memory, executive and motor functions, and emotions.
• Assess performance with simulations, in the field and past performance records
• Evaluate which cognitive profiles impairments underlie specific operator errors and adverse outcomes.
• Develop training and task related countermeasures.
Lessons from brain injury
Inouye, 1905
*FDA here!
Localizing functional errors
•Emotion execution sites include hypothalamus, basal forebrain, and brain stem (tegmental nuclei).
Emotion comprises visceral, and endocrine and somatomotor responses (not shown).
Visceral sensations reach anterior insular cortex via the brain stem.
Feelings result from re-representing visceral changes in relation to the object or event that incited them. The anterior cingulate cortex is a site of this secondary mapping.
•Information on emotionally
salient objects is represented
in brain sensory systems.
•This information can be
derived from the environment or recalled.
•It is made available to trigger
sites for emotion: amygdala &
orbitofrontal cortex.
•There are feedback connections: Do you run
away because you are
frightened or vice versa?
The Frontal Lobes
• Comprise about 30% of the entire cortical surface
• Can be grossly divided into dorsolateral, medial, orbital and polar regions.
• These regions are organized into networks that include, cortical, subcortical, and limbic.
• They are damaged in a wide variety of conditions
• Are critically important to decision-making in real-life, including in military decisions.
Traumatic Brain Injury (TBI)
• Arises from projectile wounds, blunt trauma and acceleration-deceleration forces (e.g,
vehicle crashes, falls, blast injuries.
• TBI is associated with
– diffuse axonal shearing of white matter
– cerebral contusions, lacerations and hemorrhages
» petechial
» subdural
» intraparenchymal)
» often involving frontal and anterior temporal lobes
Neuropsychological Tests
• Tests of vision and cognition
• Standardized
• Easy to use
• Widely available
Benton Visual Retention Test (VRT)
Trail-making test, Part B
•The TMT is a widely used and reliable measure of executive functions. •On Part B, the subject must learn to simultaneously track two types of information, which requires cognitive flexibility, planning, and executive switching of attention between tasks. •The TMT is well standardized, easy to administer and score, and time-efficient.
RED
GREEN
Stroop: Name the color of the ink
Participants see names of colors written in colored ink
Must name the color of the ink instead of reading the name of the color.
Provides a measure of behavioral control and resistance to interference.
Awareness
• The Awareness Interview assesses discrepancy between a patient's self-reported cognitive problems
and measurement of those abilities with standardized neuropsychological measures (Anderson and Tranel, 1989).
• Lack of awareness of self-impairment is a common problem neurological disorders, fatigue and stress.
• These individuals are more likely to place themselves
in harm’s way despite being less able to perform
Value of Simulation
• Assessment
• Training
Simulators -Advantages
• Provide the best means to replicate exactly
the experimental task conditions under which
operator decisions are made
• Simulations are safe, without the injury risks
of the real world.
• Can be used to quantify performance profiles
in context in at risk situations /cohorts.
– eg, hostage situations (ARL), driving simulation in
risky drivers (teen, neurological disease, drugs)
The Holodeck: Introduced in the first episode of
Star Trek: The Next Generation (1987-1994)
•VR tools range
from surrealistic
gaming
platforms to
caves to fully
immersive
HMDs.
•These computer
based synthetic
environments
are used for
training, treating
and augmenting
human
performance
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RIGHT - LATERAL LEFT - LATERAL
LEFT - MEDIAL RIGHT - MEDIAL654321123456
Subject
Oncoming Vehicles
HonkingVehicle
5 S
4 S
3 S
3
4
5
6
7
8
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vmPFC BDC NC
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DECISION-MAKING
Siz
e o
f gap for 50%
accepta
nce
CONTROL
SOCIALPRESSURE
Susceptibility to social pressure following VMPF damage Chen, Rusch, Dawson, Rizzo, & Anderson, Social
Cognitive & Affective Neuroscience, 2015
• vmPFC damage more likely to select smaller & potentially unsafe gaps under social pressure
• Comparison group gap selection did not change under pressure. • vmPFC damage showed prolonged elevated SCR under pressure. • Comparisonsshowed similar initial elevated SCR which then declined prior to left-turn decisions
SENSEI
Simulator for Ergonomics Neuroscience, Safety
Engineering & Innovation
Simulation Infrastructure
• Advanced data collection
capabilities
• Full integration with a network of
• Scenario authoring tools
• Software to allow real-time
monitoring of human behavior
• Channels for real-time graphic
rendering
• Servers to support data
analysis and storage
SENSEI
Linking Physiology and Behavior
Potential Physiologic Measures
•Body temperature
•Blood Pressure
•Heart rate
•Respiratory rate
•Galvanic skin response
•Electroencephalographic activity
•Electromyography activity
•Gastric activity (Electrogastrogram, EGG)
•Eyelid closure (an index of alertness and arousal)
•Eye movements and other motor control measures
•Oximetry (blood oxygenation- earlobe or fingertip)
•Transcranial doppler sonography
•fNIRS
•Blood/serum measures of metabolites or drugs
•Cerebral metabolic activity (PET, fMRI)
•Combination with human brain lesion method
Drowsy Operators
Head Nod
Microsleep before head nod
5 sec Microsleep
Simulation differs from the real-world
Behavior in the wild
Measuring behavior and
physiology in the field, in
naturalistic settings
Sensors and Power
Experience Sampling Method (ESM)
• Attempts to provide valid tools to describe variations
in self-reports of mental processes & behavior
• Provides data on frequency, patterns and intensity of
– daily activity, social interaction, and movement;
– psychological (emotional, cognitive) and conative
dimensions (mental processes or experiences geared
toward action, e.g., impulse, desire, volition, and striving).
– thoughts, including quality and intensity of thought
disturbance.
• Can be applied to study a range of issues in normal
and clinical populations, including in military settings.
Experience Sampling Method (ESM)
• ESM measures correlate with
• physiological measures
• baseline psychological tests
• behavioral indices
• Csikszentmihalyi & Larson (1987). Validity and
reliability of the Experience-Sampling Method J
Nerv Ment Dis, 175, 526-536.
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• Subjects respond to queries when alerted
– researcher not present
– alerted several times per day
– business as usual until alerted
– duration often 1-3 weeks
• Need tools for
– alerting participant (random, timed, event
based/user-driven)
– delivering queries
– capturing participant responses
Experience Sampling Method (ESM)
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What a participant might carry
Tools for capturing responses include: paper booklets,
PDAs, Phones, audio recorders, cameras.
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Video validation of report
photos - of interest to the participant or that document
what the participant was experiencing or doing
Brain in the WildDiagnosis, Treatment, and Monitoring Outside
Hospitals and Clinics • Ubiquitous embedded sensors (in
devices, vehicles, buildings, clothing and
people) monitor behavioral and
physiological data continuously, over
extended time frames
• Data from this IoT together with ecological
momentary assessment and self-report
allow unprecedented observation of the
brain in the wild.
• We can discern heretofore unknown
behavior phenotypes linked to acute and
chronic dysfunction in neural systems.
• Results show novel relationships
between brain, behavior, mobility, and
health.
• Connect to EMR, advance CTR (NIH, etc.) Internet of Things (IoT)
• Driver with our Black Box System brakes rapidly to avoid
hitting a child who ran in front of her car (left panel).
• GPS data (middle panel) locates the car as the child runs
into its path.
• Sensor data capture the rapid vehicle deceleration (right
panel, speed).
• Longitudinal g force negative spike as vehicle brakes (right
panel, acceleration).
Predictions of Driver Safety in Advancing Age (NIA R01 AG17177)
LINKING GLUCOSE AND DRIVING
SAFETY
Unsafe Driving EventSeverely hypoglycemic
Drinking from a Fire Hose
• Naturalistic data sets can be
huge
• Putting it all together-
synchronizing data streams
• “Drinking from a firehose”
– Data Analysis Strategies:
Data mining/machine
learning, pattern
recognition, SAX, Principal
Component Analyses, etc.
– Data storage and
confidentiality (HIPPA, etc.)
• Combine methods to study a phenomen. (Denzin, 1978)
• Multiple viewpoints increase accuracy.
• Metaphor from geometry, navigation and military strategy using multiple referents to pinpoint targets.
• Behavior research can improve accuracy of findings by considering multiple sources of data on human performance and safety.
Triangulation
Simulation
Instrumented Vehicle
Black Box/Naturalistic
“truth"
Four triangulation
types
1. Data: data are
collected across
different times, people,
situations, etc.
2. Investigator: multiple
researchers gather and
interpret data
3. Theoretical: multiple
theoretical frameworks
are used to interpret
data
4. Methodological
multiple methods are
used to collect data.
Triangulation in mind and brain research
Telehealth: diagnosis, treatment and monitoring outside hospitals and clinics
/Analytics
• Symbolists: Focus on inverse deduction. Instead of the classical model of
starting with a premise and looking for conclusions, inverse deduction starts
with a set of premises and conclusions and works backward to fill gaps.
• Connectionists: Focus on re-engineering the brain. Key example is Deep
Learning”. Approach is based on connecting artificial neurons in a neural
network. Connectionist techniques are efficient in areas such as image
recognition or machine translation.
• Evolutionaries: Focus on applying the idea of genomes and DNA in the
evolutionary process to data processing. Evolutionary algorithms will evolve
and adapt to unknown conditions and processes.
• Bayesians: Focus on handling uncertainty using probabilistic inference. Bayesians will take a hypothesis, apply “a priori” thinking believing some
outcomes are more likely, then update a hypothesis as they see more data.
Vision learning and spam filtering are problems tackled by the approach.
• Analogizers: Focus on techniques to match bits of data to each other. Key model is “nearest neighbor” algorithm which can give results to neural network
models.
Machine Learning Technologies
Combine Five Tribes
Domingos, 2015
“One Algorithm to rule them all,
One algorithm to find them,
One Algorithm to bring them all
and in the darkness bind them,
In the Land of Learning where
the Data lies”
Pedro Domingos, 2015
• Advances in the past 30
years have improved
methods to judge “causes”
(or intervention effects) in
non-experimental/
observational settings.
• Applicable to medical and
driving studies – where
difficult or unethical to do
RCT
Finding causality in observational settings
Analytic Methods for
Observational Data
• Propensity score methods
• Marginal structural models
• Use of multiple control
groups
• Instrumental variables
• Regression discontinuity
• Interrupted time series
• Sensitivity Analyses
Computer Vision Object/Lane Detection
Detection Incursion
The Book of Why: The New Science
of Cause and Effect- Pearl and
Mackenzie
The Ladder of Causation, with
representative organisms at each level. Most animals and present-day learning
machines are on the first rung, learning
from association. Tool users, such as
early humans, are on the second rung,
if they act by planning and not merely by imitation. We can also use
experiments to learn the effects of
interventions, and presumably this is
how babies acquire much of their
causal knowledge. On the top rung, counterfactual
learners can imagine worlds that do not
exist and infer reasons for observed
phenomena.
• Simulation allows safe testing of at risk situations and scenarios
• People may act differently in simulation than in the real world because
rewards and benefits of behavior are different
• Differences may be marked in individuals with executive dysfunction.
• Direct evidence of human behavior in naturalistic settings is needed.
• Experience sampling is one way of assessing mental processes and
behavior in the real world.
• Modern technology also allows development of systems combining
accelerometers, GPS, video, other sensors (e.g., of cerebral activity,
eye movement, HR, temperature) to make naturalistic observations of
human movement, physiology and behavior over extended time
frames.
• These systems can assess physiology and behavior from different
vantages (outside looking inside, inside d outside) to evaluate
behavior of people who are seeing, feeling, attending, deciding, erring,
and self-correcting during key activities of daily life.
Conclusions