Society for Applied Neuroscience May 5, 2011 – Thessaloniki, Greece

Validation of a global live z-score protocol:mechanism, within-subject results, and a randomized controlled study Society for Applied Neuroscience May 5, 2011 – Thessaloniki, Greece Thomas F. Collura, Ph.D., QEEG-D BrainMaster Technologies The Brain Enrichment Center Bedford, Ohio (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Acknowledgement • Elena Festa, Ph.D. • William Heindel, Ph.D. • Department of Cognitive, Linguistic, and Psychological Sciences • Brown University, Providence, Rhode Island • Alzheimer’s Association, USA (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Validation Principles • Controlled Conditions • Record physiological & behavioral variables • Demonstrate physiological change • Demonstrate behavioral change • Confirm principles of operation (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Validation Specifics • Metric based upon QEEG parameters • Live feedback of derived computations • Operant learning of brain • Demonstrable expected EEG changes • Demonstrable clinical / behavioral changes (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Live Z-Score Principles • Normalization of QEEG-based parameters • Resulting change in brain function • “Normal” reference database • Anatomy, Physiology, Logic • Activation AND Connectivity changes • “First Order” Changes – “expected” • Secondary / Compensating Changes (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Possible Changes – “Phenotypes” • Normalize aberrant process • Focal or Global abnormalities • Depression , Anxiety, Attention • Normalize coping/compensating mech. • Denial, Masking, Hyperconnection (injury) • PTST, chronic pain, chronic anxiety • Normalize “Peak performance” mechanism • “High” SMR, “Fast” Alpha • Hypercoherence, Hypocoherence (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Validation Stages • Single subject – Within Session • Single subject – Across Sessions • Across subjects – Within Session • Across subjects – Across Sessions • Physiological AND Behavioral observations (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Clinical Changes - Guan • Reduction of Anxiety • Reduction of Depression • Improved ability to study • Improved ability to return to work (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Clinical Changes - Lambos • ADHD / Defiant / Violent • Reduction in violent outbursts • Improved ability to pay attention • Increased compassion with others • Ability to transfer to regular class (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Controlled Study • Aging Population • Normal and Mild Alzheimer’s • N=79 • Real NF: 4-channels: Cz C4 P3 P4 • Percent Z Scores (PZOK): 248 Z-Scores • Cognitive / Behavioral Measures (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

NFT Study in AD and Aging • Train posterior sites to: • enhance cortical processing within posterior systems • relieve burden of anterior systems to moderate deteriorated posterior system • Investigate the short-term effects of NFT on neurocognitive measures of attention and sensory integration in healthy elderly and patients with early stage AD • Compare performance of true-NFT vs. mock-NFT subjects (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Experimental Design • Healthy elderly and AD patients assigned to either mock or true-NFT group • Each mock-NFT subject demographically matched to a true-NFT subject • 8 NFT sessions • 1-2 sessions/week over 4-6 weeks • Assessment battery pre & post NFT • Within 2 weeks of NFT sessions (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Healthy Elderly Participants MMSE: Mini-Mental State Examination RBANS: Repeatable Battery for the Assessment of Neuropsychological Status (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Methods • NFT sessions • Electrode sites: C3, C4, P3, P4 • 10 min. % z-score ok training • 5 min. baseline (eyes closed) pre & post • Brainwave activity recorded with Atlantis I (4+4) system (BrainMaster Technologies, Inc.) • Real-time z-score neurofeedback training provided by using the Z score DLL (Applied Neuroscience, Inc.) in conjunction with Brainmaster 3.21 software (BrainMaster Technologies, Inc.) (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Methods • Training Regimen • Sessions 1-4 • 75% of z-scores within 1 STD of normative range • Sessions 5-8 • 80% of z-scores within 1 STD of normative range • Audiovisual feedback provided through continuous modulation of the picture contrast of an IMAX nature movie and organ tones when reward criterion sustained for 500 ms • Mock-NFT subjects received feedback in each NFT session based on the recorded brainwave activity across each NFT session of the matched true-NFT subjects (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Methods • Assessment Battery • Several standardized neuropsychological tests of cognitive functions and emotional well-being (RBANS, CAD, GDS) • Resting brainwave activity 64-channel EEG recording (eyes closed) • Behavioral and EEG measures of neurocognitive tests assessing specific component attentional processes (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Neurocognitive Measures • Alerting, Orienting, & Executive Control • Spatial Orienting/Simon Interference task • Selective Attention & Sensory Integration • Visual Search task (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Results: Visual Search • Healthy Elderly • Real NFT decreased RTs for both sensory binding conditions • Mock NFT had no effect on RTs for either binding conditions • Mild AD • Real NFT had no effect on RTs for either binding conditions • Mock NFT had no effect on RTs for either binding conditions (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Results: Simon Interference • Healthy Elderly • Real NFT had no effect on RTs for either Congruent or Incongruent trials • Mock NFT increased RTs for both Congruent and Incongruent trials • Mild AD • Real NFT had no significant effect on RTs for either Congruent or Incongruent trials • Mock NFT had no significant effect on RTs for either Congruent or Incongruent trials (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Results: Spatial Orienting • Healthy Elderly • Real NFT reduced RTs for both Valid and Invalid Cue trials • Mock NFT increased RTs for both Valid and Invalid Cue trials • Mild AD • Real NFT selectively reduced RTs for Invalid Cue trials • Mock NFT had no effect on RTs for either Valid or Invalid Cue trials (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Results: Alerting • Healthy Elderly • Real NFT had no effect on RTs for either Double or No Cue trials • Mock NFT selectively increased RTs for No Cue Cue trials • Mild AD • Real NFT reduced RTs for both Double and No Cue Trials • Mock NFT increased RTs for both Double and No Cue Trials (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Summary: Real NFT • Healthy Elderly • No effect on cross-cortical sensory integration, but enhanced selective attention in the visual search task • Generalized enhancement of response times in spatial orienting • No effect on either alerting measures or response inhibition in Simon interference • Mild AD • No effect on either cross-cortical sensory integration or selective attention measures in the visual search task • Selective improvement in disengagement in spatial orienting • Enhanced phasic and tonic alerting • No effect on response inhibition in Simon interference (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Summary: Mock NFT • Healthy Elderly • No effect on cross-cortical sensory integration or selective attention in the visual search task • Generalized slowing of response times for spatial orienting, alerting and Simon interference measures • Mild AD • No effect on cross-cortical sensory integration or selective attention in the visual search task • No effect on response times for spatial orienting or Simon interference measures • Generalized slowing of response times for the alerting measures (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Non-Memory Impairments in AD • Attention • Cognitive operations involved in the detection and selection of sensory information • Automatic (stimulus-driven) • Voluntary (controlled, goal-directed) • Different attentional processes mediated by distinct neural subsystems • Sensory Integration • The “Binding Problem” • Moment-by-moment ability to combine distinct sensory inputs related to a single object into a coherent, unified representation • Dependent upon effective interactions across cortical areas (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Non-Memory Impairments in AD (and Aging) • Posterior Cortical Processing Systems • Alerting (cortical tonus) • Orienting • Sensory Integration • Inefficient cortical processing in Aging • Corticocortical disconnectivity in AD • Anterior Executive Control Processes • Changes in frontal cortex with age and AD results in less efficient controlled attentional processes • Greater demands placed on anterior executive processes to moderate deterioration in posterior attentional and sensory systems (C) 2011 Thomas F. Collura, Ph.D. &/or E. Festa, Brown University

Society for Applied Neuroscience May 5, 2011 – Thessaloniki, Greece