Non-Invasive Detection and Preservation of Neurocognitive Signals in the Peri-Death Period Using Brain-Computer Interface and Artificial Intelligence

NCT07477028 — Not yet recruiting, 20 participants, Noah Tech, Corp.

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Feasibility of Non-Invasive Detection and Preservation of Neurocognitive Signals in the Peri-Death Period Using Brain-Computer Interface and Artificial Intelligence: A Prospective Observational Study (NeuroCogPresv)

RegistryNCT07477028, acronym NeuroCogPresv
StatusNot yet recruiting
Study typeObservational
Enrollment20 (Estimated)
SponsorNoah Tech, Corp. (Industry); collaborators: Columbia University, Massachusetts Institute of Technology, Stanford University, City of Hope Medical Center
ConditionsTerminal Illness, End-of-Life Care, Death, Brain Death, Death Anxiety, Consciousness, Electroencephalography, Gamma Oscillations, Near-Death Phenomena, Cognitive, Cognition, Memory, EEG, Severe Acute Trauma
Datesstart 2026-09-01 (estimated), primary completion 2030-09-30 (estimated), completion 2035-09-30 (estimated), first posted 2026-03-17, last updated 2026-03-17

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-Summary

Background: Recent electroencephalography (EEG) data indicate that the transition from clinical death to cellular death is marked by highly organized neurophysiological events, including significant surges in gamma-band power, cross-frequency coupling, and distinct spreading depolarization waves. This prospective, observational feasibility study utilizes rapid-deployment, high-density, noninvasive BCI hardware paired with proprietary AI analytics to detect, classify, and securely archive these terminal neurocognitive signals.

Objectives: (1) Quantify transient gamma-band activity and cross-frequency connectivity post-clinical death; (2) Validate the efficacy of machine learning models for real-time signal classification in high-noise clinical environments; (3) Establish a highly secure, encrypted bio-informational archive of peri-life EEG data.

Design: Prospective, open-label, multicenter, observational cohort (n>20).

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+Detailed description

This prospective observational feasibility study will use non-invasive high-density EEG combined with a wireless brain-computer interface (BCI) and artificial intelligence analytics to detect, characterize, and archive neurocognitive signals in adult patients during the peri-death period. The study includes individuals with terminal illness or severe acute trauma who have a do-not-resuscitate (DNR/DNI) order. Building on recent human findings of gamma oscillation surges and cross-frequency coupling (Vicente et al., 2022; Xu et al., 2023), the study aims to quantify these signals, test AI-driven real-time classification, and explore technical feasibility for future signal preservation and continuity research. No therapeutic intervention is performed. All monitoring is conducted with surrogate consent under strict ethical oversight.

+Arms and interventions

ArmTypeInterventionsDescription
Peri-Death CohortAdults (≥18 years) with terminal illness or severe acute trauma who have a do-not-resuscitate (DNR/DNI) order and for whom surrogate informed consent has been obtained. Participants undergo continuous non-invasive high-density EEG monitoring using a wireless brain-computer interface (BCI) headset. Monitoring begins prior to expected clinical death and continues for up to 6 hours after cardiac arrest. This single prospective cohort is followed to characterize neurocognitive signals during the transition from clinical death through brain death to cellular death. No study intervention is administered.

+Outcome measures

Primary outcomes

  • Detection of Neurocognitive Signals After Clinical Death Prior to Brain Death [0-120 minutes after clinical death]: Presence or absence of organized neurocognitive signals and measurable brain activity, as recorded by non-invasive high-density electroencephalography (EEG), in the human brain during the period immediately following clinical death (cessation of circulation) but prior to declaration of brain death. The primary outcome will be reported as the proportion of participants with detectable organized neural activity (yes/no) meeting predefined signal thresholds.

Secondary outcomes

  • Successful Capture and Preservation of Neurocognitive Signals [Up to 24 hours after clinical death]: Proportion of participants for whom real-time neurocognitive signals were successfully captured, recorded in high quality, and securely preserved for long-term storage using non-invasive high-density EEG and wireless brain-computer interface (BCI) technology. Reported as the number and percentage of participants with complete, artifact-free recordings suitable for analysis.
  • Spectral Power of Neurocognitive Signals [Up to 24 hours after clinical death]: Quantitative analysis of spectral power of captured neurocognitive signals, measured in microvolts squared per hertz (µV²/Hz), across standard EEG frequency bands (delta, theta, alpha, beta, gamma).
  • Functional Connectivity Patterns [Up to 24 hours after clinical death]: Quantitative analysis of functional connectivity patterns among brain regions, measured using coherence and phase-locking value (PLV) indices, reported on a scale from 0 (no connectivity) to 1 (perfect connectivity).
  • Cross-Frequency Coupling [Up to 24 hours after clinical death]: Quantitative analysis of cross-frequency coupling between EEG frequency bands, measured using the modulation index (MI), reported as a unitless value ranging from 0 (no coupling) to 1 (maximum coupling).
  • Temporal Dynamics of Neurocognitive Signals [Up to 24 hours after clinical death]: Quantitative analysis of the temporal dynamics of neurocognitive signals, including signal duration and onset latency, measured in seconds (s) from the time of clinical death.
  • Informational Content of Neurocognitive Signals [Up to 24 hours after clinical death]: Qualitative and quantitative analysis of the potential informational content of captured neurocognitive signals, measured using permutation entropy, reported as a unitless value on a scale from 0 (completely regular/predictable) to 1 (completely random).

+Eligibility

Sex: All, ages: 18 Years to any

Inclusion Criteria:

1. Adults ≥18 years with terminal illness or severe acute trauma
2. Do-not-resuscitate (DNR/DNI) order in place
3. Surrogate decision-maker available and willing to provide informed consent
4. Expected survival ≤7 days (physician estimate)

Exclusion Criteria:

1. Brain death already declared > 24 hours prior to enrollment
2. Contraindication to EEG/BCI headset placement (e.g., severe scalp injury)
3. Patient lacks a legally authorized representative

+Publications

  • Results publication: Zinn S, Dragovic SZ, Kloka JA, Willems LM, Harder S, Kratzer S, Zacharowski KD, Schneider G, Garcia PS, Kreuzer M. Parametrization of the dying brain: A case report from ICU bed-side EEG monitoring. Neuroimage. 2025 Jan;305:120980. doi: 10.1016/j.neuroimage.2024.120980. Epub 2024 Dec 17. PMID 39701335
  • Results publication: Blundon EG, Gallagher RE, Ward LM. Electrophysiological evidence of preserved hearing at the end of life. Sci Rep. 2020 Jun 25;10(1):10336. doi: 10.1038/s41598-020-67234-9. PMID 32587364
  • Results publication: Xu G, Mihaylova T, Li D, Tian F, Farrehi PM, Parent JM, Mashour GA, Wang MM, Borjigin J. Surge of neurophysiological coupling and connectivity of gamma oscillations in the dying human brain. Proc Natl Acad Sci U S A. 2023 May 9;120(19):e2216268120. doi: 10.1073/pnas.2216268120. Epub 2023 May 1. PMID 37126719
  • Results publication: Vicente R, Rizzuto M, Sarica C, Yamamoto K, Sadr M, Khajuria T, Fatehi M, Moien-Afshari F, Haw CS, Llinas RR, Lozano AM, Neimat JS, Zemmar A. Enhanced Interplay of Neuronal Coherence and Coupling in the Dying Human Brain. Front Aging Neurosci. 2022 Feb 22;14:813531. doi: 10.3389/fnagi.2022.813531. eCollection 2022. PMID 35273490