Cognitive deficits associated with neurological disorders such as schizophrenia (SCZ) and mild cognitive impairment (MCI) present a significant challenge to both individuals and healthcare systems. Despite advancements in medical technology, treatment options for cognitive symptoms or conditions like MCI and Alzheimer’s disease (AD) remain limited, leaving over 23 million people in the United States affected by early-stage cognitive decline without effective interventions. For SCZ and MCI patients, working memory (WM) deficit is a common symptom, linked to impaired frontal gamma activity for both patient groups. Gamma oscillations, particularly in the frontal cortex, are essential for cognitive functions such as attention and working memory, making them a critical target for therapeutic intervention. Yet, restoring or modulating these oscillations through conventional methods remains challenging, emphasizing the need for novel approaches to enhance cognitive function in these populations.This dissertation explores clinical gamma neuromodulation as a promising therapeutic approach, focusing on the mechanisms of gamma activity modulation, identifying neurophysiological predictors of effective training, and applying brain-computer interface (BCI) technology to facilitate this modulation in SCZ and MCI patients. Through EEG-based neurofeedback (NFB), patients are trained to increase frontal gamma coherence, a neural signature associated with cognitive performance.
In SCZ patients, a 12-week BCI-based gamma-NFB training protocol resulted in significant improvements in frontal gamma coherence and enhanced EEG markers of working memory, such as increased frontal P3 amplitude. This novel BCI system, developed using MATLAB/EEGLAB, converts real-time gamma coherence into reinforcement signals, enabling patients to modulate their brain activity directly. The double-blind, placebo-controlled randomized clinical trial (RCT) of SCZ patients demonstrated that those undergoing active NFB training achieved significant increases in F3-F4 gamma coherence and WM, demonstrating the potential of BCI technology to offer an adaptive, non-invasive intervention for cognitive deficits.
Similarly, in MCI patients, a small sub-sample from the ongoing placebo-controlled RCT showed that active gamma-NFB training significantly increased frontal gamma coherence compared to a placebo group, with baseline gamma power at electrode F4 predicting the degree of training-related improvement. These findings suggest that gamma-NFB can enhance cognitive function in MCI patients, providing a tailored and scalable therapeutic option.
By identifying neurophysiological predictors of training success and demonstrating the effectiveness of BCI-driven neuromodulation in clinical populations, this dissertation contributes to developing personalized, brain feature targeted interventions for cognitive impairments. These findings support the potential of gamma neuromodulation as a viable therapeutic approach for improving memory and cognitive function in both SCZ and MCI patients, paving the way for future research into long-term benefits and broader clinical applications.