An objective model for diagnosing comorbid cognitive impairment in patients with epilepsy based on the clinical-EEG functional connectivity features

Abstract

ObjectiveCognitive impairment (CI) is a common disorder in patients with epilepsy (PWEs). Objective assessment method for diagnosing CI in PWEs would be beneficial in reality. This study proposed to construct a diagnostic model for CI in PWEs using the clinical and the phase locking value (PLV) functional connectivity features of the electroencephalogram (EEG).MethodsPWEs who met the inclusion and exclusion criteria were divided into a cognitively normal (CON) group (n = 55) and a CI group (n = 76). The 23 clinical features and 684 PLVEEG features at the time of patient visit were screened and ranked using the Fisher score. Adaptive Boosting (AdaBoost) and Gradient Boosting Decision Tree (GBDT) were used as algorithms to construct diagnostic models of CI in PWEs either with pure clinical features, pure PLVEEG features, or combined clinical and PLVEEG features. The performance of these models was assessed using a five-fold cross-validation method.ResultsGBDT-built model with combined clinical and PLVEEG features performed the best with accuracy, precision, recall, F1-score, and an area under the curve (AUC) of 90.11, 93.40, 89.50, 91.39, and 0.95%. The top 5 features found to influence the model performance based on the Fisher scores were the magnetic resonance imaging (MRI) findings of the head for abnormalities, educational attainment, PLVEEG in the beta (β)-band C3-F4, seizure frequency, and PLVEEG in theta (θ)-band Fp1-Fz. A total of 12 of the top 5% of features exhibited statistically different PLVEEG features, while eight of which were PLVEEG features in the θ band.ConclusionThe model constructed from the combined clinical and PLVEEG features could effectively identify CI in PWEs and possess the potential as a useful objective evaluation method. The PLVEEG in the θ band could be a potential biomarker for the complementary diagnosis of CI comorbid with epilepsy.

Investigating the Impact of Epilepsy on Cognitive Function: A Narrative Review

“…Cognitive impairment (CI) is a more prevalent comorbidity that affects 70-80% of patients with epilepsy [34].…”

“…Cognitive impairment (CI) is a more prevalent comorbidity that affects 70-80% of patients with epilepsy [ 34 ]. Early detection and treatment can help to improve the patient's quality of life.…”

“…Even though it can have a negative impact on the patient's life, it is not well-addressed and researched [ 35 ]. The Montreal Cognitive Assessment (MOCA) and the Mini-Mental State Examination (MMSE) are two frequently used screening measures for diagnosing cognitive impairment in epileptic patients [ 34 ]. MOCA consists of a 30-point questionnaire that assesses several neurocognitive domains.…”

The potential of the Lempel–Ziv complexity of the EEG in diagnosing cognitive impairment in patients with temporal lobe epilepsy

“…Quantitative electroencephalogram refers to the extraction of meaningful features from the EEG signals to delineate local and/or global changes in brain dynamics. [7][8][9] It is believed that each person exhibits a unique signal pattern on EEG, like a fingerprint of the brain. Besides, the EEG network is relatively stable for each adult individual and may correspond to the genetic makeup, disease-associated functional alterations, and treatment outcomes.…”

“…Quantitative electroencephalogram refers to the extraction of meaningful features from the EEG signals to delineate local and/or global changes in brain dynamics 7–9 . It is believed that each person exhibits a unique signal pattern on EEG, like a fingerprint of the brain.…”