The Late Positive Complex (LPC) is an Event-Related Potential (ERP) consistently observed in recognition-memory paradigms. In the present study, we investigated whether the LPC tracks the strength of multiple types of memory signals, and whether it does so in a decision dependent manner. For this purpose, we employed judgements of cumulative lifetime exposure to object concepts, and judgements of cumulative recent exposure (i.e., frequency judgements) in a study-test paradigm. A comparison of ERP signatures in relation to degree of prior exposure across the two memory tasks and the study phase revealed that the LPC tracks both types of memory signals, but only when they are relevant to the decision at hand. Another ERP component previously implicated in recognition memory, the FN400, showed a distinct pattern of activity across conditions that differed from the LPC; it tracked only recent exposure in a decision-dependent manner. Another similar ERP component typically linked to conceptual processing in past work, the N400, was sensitive to degree of recent and lifetime exposure, but it did not track them in a decision dependent manner. Finally, source localization analyses pointed to a potential source of the LPC in left ventral lateral parietal cortex, which also showed the decision-dependent effect. The current findings highlight the role of decision making in ERP markers of prior exposure in tasks other than those typically used in studies of recognition memory, and provides an initial link between the LPC and the previously suggested role of ventral lateral parietal cortex in memory judgements.

Establishing when cerebral cortical activity stops relative to circulatory arrest during the dying process will enhance trust in donation after circulatory determination of death. We used continuous electroencephalography and arterial blood pressure monitoring prior to withdrawal of life sustaining measures and for 30 min following circulatory arrest to explore the temporal relationship between cessation of cerebral cortical activity and circulatory arrest. Qualitative and quantitative EEG analyses were completed. Among 140 screened patients, 52 were eligible, 15 were enrolled, 11 completed the full study, and 8 (3 female, median age 68 years) were included in the analysis. Across participants, EEG activity stopped at a median of 78 (Q1 = −387, Q3 = 111) seconds before circulatory arrest. Following withdrawal of life sustaining measures there was a progressive reduction in electroencephalographic amplitude (p = .002), spectral power (p = .008), and coherence (p = .003). Prospective recording of cerebral cortical activity in imminently dying patients is feasible. Our results from this small cohort suggest that cerebral cortical activity does not persist after circulatory arrest. Confirmation of these findings in a larger multicenter study are needed to help promote stakeholder trust in donation after circulatory determination of death.

Non-therapeutic research with imminently dying patients in intensive care presents complex ethical issues. The vulnerabilities of the imminently dying, together with societal disquiet around death and dying, contribute to an intuition that such research is beyond the legitimate scope of scientific inquiry. Yet excluding imminently dying patients from research hinders the advancement of medical science to the detriment of future patients. Building on existing ethical guidelines for research, we propose a framework for the ethical design and conduct of research involving the imminently dying. To enable rapid translation to practice, we frame the approach in the form of eight ethical questions that researchers and research ethics committees ought to answer prior to conducting any research with this patient population. (1) Does the study hypothesis require the inclusion of imminently dying patients? (2) Are non-therapeutic risks and burdens minimised consistent with sound scientific design? (3) Are the risks of these procedures no more than minimal risk? (4) Are these non-therapeutic risks justified insofar as they are reasonable in relation to the anticipated benefits of the study? (5) Will valid informed consent be obtained from an authorised surrogate decision maker? (6) How will incidental findings be handled? (7) What additional steps are in place to protect families and significant others of research participants? (8) What additional steps are in place to protect clinical staff and researchers? Several ethical challenges hinder research with imminently dying patients. Nonetheless, provided adequate protections are in place, non-therapeutic research with imminently dying patients is ethically justifiable. Applying our framework to an ongoing study, we demonstrate how our question-driven approach is well suited to guiding investigators and research ethics committees.

Highlights Single-trial electrical recordings index higher-order cognitive processing of movie stimuli. Common patterns of neural activity associated with the brain’s executive network. The time course of common neural activity correlates with ratings of suspense. 38% of non-responsive patients correlate with controls during movie-watching tasks. Novel bedside assessment of complex cognition in behaviourally non-responsive patients.

Fourteen patients with severe brain injuries and chronic disorders of consciousness underwent polysomnographic recordings for a 24-h period. Their electrophysiological data were scored using a modified sleep staging system employed in a previous study of similar patients (J Head Trauma Rehabil 30:334-346, 2015). In addition to sleep scoring, the patients' data were compared with a sample of approximately age-matched healthy volunteers in the spectral domain. All patients demonstrated some form of a sleep-wake cycle; however, the integrity of normal sleep features was remarkably heterogenous across individuals, and in some cases, sleep was significantly impoverished. In three patients, these cycles were biphasic and comprised of only alternating periods of wakefulness and sleep-like electrophysiological activity. Two patients demonstrated a sleepwake cycle that included all sleep stages aside from non-REM stage 3, and another two patients demonstrated a sleep-wake cycle that included all sleep stages aside from REM sleep. The remaining seven patients, which included patients diagnosed as being in a minimally conscious state and patients diagnosed as being in a vegetative state (unresponsive wakefulness syndrome), demonstrated full sleep architecture, including k-complexes, REMs, and slow wave sleep. However, three of the patients with full sleep architecture did not generate sleep spindles. Altogether, these findings highlight the heterogeneity of brain function among patients with disorders of consciousness, regardless of their diagnostic category. Polysomnography is a useful tool to complement other behavioural and physiological assessments that characterize the abilities of each patient.