We present the first evidence of altered long-range neuromagnetic synchronization in very preterm children, indicative of altered functional connectivity during visual STM retention. We demonstrate that alterations in long-range synchronization are concentrated within the alpha frequency range, suggesting that alpha oscillations may play a critical role in altered cortical network function in children born very preterm. These results show that differences in long-range alpha synchronization during cognition are evident in very preterm children with broadly normal intelligence and without major sensory or motor impairment. This indicates that children born very preterm, even when their intellectual ability is considered within the normal range, express markedly different cortical network dynamics to support cognitive processing. Research using fcMRI has indicated that children and adolescents born very prematurely recruit different patterns of cortical connectivity to support cognitive processing (
Gozzo et al., 2009;
Schafer et al., 2009). These findings suggest functional reorganization during the cortical development of very preterm children, and/or the use of compensatory strategies. This outlook is supported by MEG findings that a larger number of dipoles are required to account for brain activity within several cortical areas in adolescents born very preterm during the performance of a cognitive task (
Frye et al., 2010). This indicates that very preterm adolescents recruit more diffuse brain areas during cognition. The findings of the present study expand our emerging understanding of cortical network function in very preterm children by demonstrating that oscillatory mechanisms mediating functional connectivity during cognition exhibit frequency-specific deviation from patterns of phase locking observed in children born full-term and healthy. As we focused our analysis of group differences on correct trials, our results demonstrate that even when very preterm children successfully recruit functional network connectivity to support visual STM retention, they do so using a different set of oscillatory networks and mechanisms than are observed in full-term children and adults. Analysis of correct trials also ensured that observed group differences were due to altered cortical processing during STM retention, rather than differences between successful and unsuccessful processing, as very preterm children performed less accurately than full-term controls. Alterations in long-range oscillatory synchronization during successful cognition in children born very preterm may be related to altered development of structural connectivity due to selective vulnerabilities in the developing brain during the neonatal period corresponding to premature birth, white matter injury (see
Miller and Ferriero, 2009), and/or functional reorganization and compensation related to recovery from adverse effects on brain development experienced by this vulnerable population during the perinatal period (i.e.
Schafer et al., 2009).
In the present study, we reproduce and extend findings from our previous work (
Doesburg et al., 2010a) indicating that STM retention in healthy children at age 6 to 10 years born full-term entails long-range synchronization in a number of frequency ranges including the theta, alpha and beta-bands. This result is consistent with research on adult humans which has demonstrated increased inter-regional synchronization during visual STM and working memory retention using electroencephalography (EEG) (
Sarnthein et al., 1998;
Payne and Kounios, 2009;
Sauseng et al., 2005), MEG (
Palva et al., 2005;
Palva et al., 2010a;
Palva et al., 2010b;
Doesburg et al., 2010a) and implanted electrodes (
Tallon-Baudry et al., 2001). Such synchronization has been interpreted as functional connectivity within a distributed cell assembly recruited to maintain the memory trace. Very preterm children, relative to controls, exhibited reduced long-range synchronization during STM retention in the alpha frequency range. Strikingly, this was manifest as task-dependent long-range alpha-band
desynchronization in children born very preterm, whereas task-dependent synchronization was observed in full-term controls. Very preterm children, however, expressed a pattern of long-range synchronization more similar to that observed in controls in other frequency ranges. The significance of alpha synchronization to the development perceptual and cognitive function is evidenced by observation of age-related changes in event-related long-range alpha-band synchronization throughout childhood and adolescence during visual perception (
Uhlhaas et al., 2009b), as well as age-related changes in alpha oscillatory responses during cognition throughout childhood (
Krause et al., 2001;
Yordanova and Kolev, 1996,
1997). The functional role of alpha oscillations in visual STM retention is demonstrated by findings that individual differences in visual STM span can be predicted from the parameters of alpha oscillations (
Maltseva and Maslobev, 1997) and long-range alpha-band synchronization (
Palva et al., 2010a).
Inspection of group differences in the spectral density of global-long range synchronization reveals that children born very preterm express a second peak in the high theta range (6 Hz), which is distinct from the low-theta peak observed in both preterm and full-term children. In the PLV spectrum of interhemispheric long-range synchronization, a topography in which group differences in long-range alpha synchronization were concentrated, this group difference was more pronounced and statistically significant. The presence of an additional peak within the slower theta frequency range suggests that alpha oscillatory mechanisms mediating functional connectivity during visual STM retention are not entirely absent in very preterm children, but rather are expressed at a slower frequency, indicating reorganized and/or compensatory cortical network dynamics. Reduced interhemispheric synchronization in very preterm children may relate to anatomical brain development as structural alterations of corpus collosum have been reported in children born preterm and are related to functional outcome in this group (see
Hart et al., 2008 for review), and resting interhemispheric alpha-band EEG coherence has been related to corpus collosum structure in ageing adults with and without mild cognitive impairment (
Teipel et al., 2009). It has also been shown that extremely low birth weight (ELBW) infants measured at term equivalent age express reduced interhemispheric EEG coherence in the 1 – 12 Hz frequency range during sleep (
Grieve et al., 2008), and that young adults who were born ELBW expressed greater short-distance, and reduced long-distance, alpha-band resting EEG coherence over the right hemisphere (
Miskovic et al., 2009). Such results suggest that alterations in long-range alpha-band synchrony in very preterm children may emerge very early in life and persist into adulthood. A limitation of the present study is that MRI was not implemented to screen or evaluate white matter structure in our cohort of very preterm children, but rather relied on neonatal ultrasound for detection of structural brain abnormalities. Accordingly, it is possible that subtle white matter abnormalities detectable using conventional MRI may have been present in some subjects. Future research will be required to explore the potential relationship between white matter damage, microstructural white matter abnormalities, and altered inter-regional synchronization among cortical and sub-cortical brain areas in very preterm children.
Investigations of resting spectral power lend precedent to the notion that alpha oscillatory mechanisms may be slowed toward the theta frequency range in very preterm children, as it is well known that brain development is characterized by a progressive shift from lower to higher frequencies, a trend that begins in the perinatal period (Okamura et al., 2006) and continues throughout childhood (
Clarke et al., 2001) and into early adulthood (
Fehr et al., 2002). Children born very preterm express relatively more low-frequency activity during the neonatal period (Okamura et al., 2006), and this tendency persists into school age as evidenced by a greater ratio of low-to-high frequency resting EEG activity (
Miskovic et al., 2009) and a slowing of the alpha peak towards the theta frequency range in spontaneous MEG recordings (see
Doesburg et al., 2010b). Slowing of alpha oscillations toward the theta-band has been attributed to disordered interaction between cortex and thalamus (
Llinás et al., 1999;
Hughes and Crunelli, 2005), and very preterm children show altered development of thalamocortical systems (i.e.
Anjari et al., 2007;
Giménez et al., 2006;
Srinivasan et al., 2007). The relationship between altered electromagnetic oscillations and structural brain development in very preterm children represents a promising direction for future study, as recent research indicates that parameters of the alpha rhythms are related to white matter architecture (
Valdés-Hernández et al., 2010).
Analysis of long-range synchronization within the group of 34 very preterm children confirmed that observed alterations in long-range synchronization were also present in a larger group of very preterm children, and also provided sufficient sample size to investigate the potential relationship of altered long-range alpha-band synchronization with performance on the visual STM task and measures of cognitive ability. Within the group of 34 very preterm children global alpha-band synchronization was correlated with accuracy on the visual STM task and with a visual perception task that did not have memory demands, but importantly was not a function of full-scale IQ. This indicates that altered long-range alpha synchronization may be a mechanism underlying selective difficulties in very preterm children, as this population is known to commonly express problems in visual perceptual function, even when intelligence is broadly normal and in the absence of neurological, sensory or motor impairment (see
Grunau et al., 2002). Alternatively stated, the degree to which very preterm children express altered long-range alpha-band synchronization during successful visual STM maintenance is correlated with the extent of reduced visual-perceptual function. As global alpha synchronization was not correlated with gestational age in very preterm children, and because alpha desynchronization was observed in preterm children near the upper limit of gestational ages included in the present study, the altered cortical dynamics reported presently appear to affect children born across the entire range of gestational ages investigated (≤32 weeks). Critically, children born full-term and healthy did not exhibit the same pattern of correlations between long-range alpha synchronization, accuracy on the STM task, and visual-perceptual function, indicating that altered long-range alpha synchronization in very preterm children is relevant to specific issues surrounding neurocognitive development within this vulnerable population, rather than variation within the population of school age children more generally. Although the relatively small sample size of full-term controls in the present study was not sufficient for a proper statistical evaluation of the correlation between alpha-band synchronization and visual-perceptual ability, it was sufficient to establish the direction of correlation (see
Cohen, 1992). Observation that this correlation was in the opposite direction than was observed for the very preterm children indicates that the relationship between long-range synchronization and cognitive function was not similar across full-term and preterm groups. These differential relationships are unlikely to have arisen because of differences in variance across the groups, as variability on these measures were roughly similar in both populations, and neither group trended toward greater variability for all relevant measures (alpha PLV, STM accuracy, and Beery visual perception subscore). Global alpha amplitude did not exhibit a similar, or statistically significant, relationship to STM performance or visual-perceptual function, indicating that alterations of alpha-mediated mechanisms underlying functional connectivity, rather than local activation, were of particular relevance to perceptual function in school age children born very preterm. Confirmation of observed group differences in long-range synchronization comparing 12 controls and 34 very preterm children also indicates that these effects could not have arisen due to signal-to-noise ratio imbalances in our primary analysis (i.e. more correct trials for the full term controls), as greater signal-to-noise ratio would be present for the very preterm group in this secondary analysis.
As with any study investigating synchronization between sensors or electrodes arrayed over the surface of the head, the potential influence of volume conducted neural synchrony is an important consideration. There are several reasons, however, that the effects reported in the present study are not attributable to the influence of volume conduction. As in
Doesburg et al., (2010a), we found that global long-range alpha-band synchronization was increased in full-term children, whereas global alpha-band amplitude was decreased, demonstrating that these PLV and instantaneous amplitude measures were sensitive to very distinct aspects of brain activity and indicating that the observed normative pattern of long-range alpha synchronization during STM retention could not arise through volume conduction. The view that PLV values represent neural processes distinct from local amplitude changes is further buttressed by the finding that although global long-range alpha-band synchronization showed opposite directionality between the groups and differed significantly, both preterm and full-term children showed global alpha amplitude reductions during STM retention and did not differ statistically on this measure. Moreover, long-range alpha phase locking showed correlations with accuracy on the visual STM task and with visual perceptual function within the very preterm group which were not observed for global alpha amplitude. Furthermore, increased long-range alpha synchronization was observed in controls between posterior sensors showing reduced alpha amplitude, and relative desynchronization in very preterm children was observed between frontal sensors expressing relative increases alpha amplitude. Due to the distributed lead fields of the axial gradiometers, however, a limitation of the present study is that it is not possible to infer the putative engagement of specific cortical regions in large-scale network connectivity. Future research combining source localization and long-range synchronization analysis methods will be required to precisely map altered connectivity and communication between specific brain regions underlying selective cognitive difficulties in children born very preterm.