**3. Measurement of conscious-state transition capacity under euthanatic administration**

The thalamocortical pathway is central to cortical network information processing during conscious-state transition behavior [58] including auditory and visual sensory information response with emotion-based learning and recall networks. It is influenced by bioperception related retinal vibrations received via the suprachiasmatic nucleus and retinohyptothalamic tract, along with influence from genetic signaling (e.g., CLOCK, BMAL1 and others) governing overall homeostasis [59–61]. The networks include the primary and secondary association area networks of the brain neocortex, as well as networks involving the orbitomedial prefrontal cortex (OMPC, areas 11 & 12) as part of the region described by the limbic cortex and septal nuclei (including the amygdala) on behalf of patient mood regulation monitoring, the hippocampus, the thalamus and basal ganglia which are directly involved in sleep/wake environmental awareness-states [62]. The disruption of these networks occurs from circadian desynchronization and the persistence of neuroinflammation [63]. Images of such disruption and the resulting network changes from neurodegeneration can be seen in detail from fMRI image repositories provided by the Human Connectome Project [52], the Alzheimer's Disease Connectome [64], and similar collections. In fact, a future generation Connectome project might include the complementary circadian-calibrated XR-based data collected from dementia patients across multiple demographics, for key times of day, pre-dawn, mid-day and pre-dusk to dusk. A schematic for a

*The Need for XR-Measurement of Decision-Making Decline and Conscious-State Transition… DOI: http://dx.doi.org/10.5772/intechopen.97384*

potential model of selected networks with the Human Connectome is shown in **Figure 2**, below.

Currently, no tool exists to measure consciousness or self-consciousness objectively by any machine [65]. In non-communicative patients, its estimation requires the interpretation of motor responsiveness [66]. This response represents active brain processing events in the Primary Motor Cortex (MI, area 4) in the precentral gyrus and the corticospinal tract which has its own relationship to somatotopic organization for specific movement coordination, in general with other sensory processing information via a major thalamic motor nucleus, including its ventral

#### **Figure 2.**

4.Bioperceptive capacity versus retinal limitations that reduce visual motion-

6.Heart-rate variation monitoring that is reliable throughout each XR-test

8.Real-world time of day consistency of the XR-session for both scotopic and

9. Statistical evenness in game scenes without the use of biased cultural asset-

10.Geotimestamped coordinates of player position and any testing-related assets

11.Alignment of player data with existing patient psyhiatric evaluations and

12.Appropriate asset-labeling, tagging, data-reporting standards and patient

The reader is encouraged to review a detailed description of how these features may be presented in a Supplementary Materials section titled, *Example XR-setup for*

**3. Measurement of conscious-state transition capacity under euthanatic**

The thalamocortical pathway is central to cortical network information processing during conscious-state transition behavior [58] including auditory and visual sensory information response with emotion-based learning and recall networks. It is influenced by bioperception related retinal vibrations received via the suprachiasmatic nucleus and retinohyptothalamic tract, along with influence from genetic signaling (e.g., CLOCK, BMAL1 and others) governing overall homeostasis [59–61]. The networks include the primary and secondary association area networks of the brain neocortex, as well as networks involving the orbitomedial prefrontal cortex (OMPC, areas 11 & 12) as part of the region described by the limbic cortex and septal nuclei (including the amygdala) on behalf of patient mood regulation monitoring, the hippocampus, the thalamus and basal ganglia which are directly involved in sleep/wake environmental awareness-states [62]. The disruption of these networks occurs from circadian desynchronization and the persistence of neuroinflammation [63]. Images of such disruption and the resulting network changes from neurodegeneration can be seen in detail from fMRI image repositories provided by the Human Connectome Project [52], the Alzheimer's Disease Connectome [64], and similar collections. In fact, a future generation Connectome project might include the complementary circadian-calibrated XR-based data collected from dementia patients across multiple demographics, for key times of day, pre-dawn, mid-day and pre-dusk to dusk. A schematic for a

detection and circadian synchronization;

photopic illumination intensity calibrations;

clinical epidemiological research; plus,

*Decision-making Decline Monitoring of Dementia Patients.*

objects in the environment;

session;

and events;

**administration**

**270**

privacy integrations.

5.Headturning rates, restrictions and sensorimotor ease;

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

7.Saccadic "blink" synchronization with behavioral sampling;

*Schematic example of a selected nucleic-network XR model using the human connectome project (HCP). HCP hosts detailed neuromorphological fMRI datasets combining networks from dementia and related human and animal pathology treatment records. An assembly of virtual reality (XR) monitoring programmes can be organized to support integration with HCP data collections for dementia patients, focusing on any range of selected neuronal-nucleic networks.*

lateral nucleus (VL) and Ventral anterior nucleus (VA), and in the presence of dementia-related inflammation [67, 68].

In the Supplementary Materials, a list of some of the parameters are explained so that optogenetic waveform signals are consistent within the virtual reality scene as they are in the natural environment that activates synaptic relays between the intralaminar nucleus of the thalamus and the sensory-information processing cortical networks. These are the same brain regions associated with awareness of self, in relationship to the environment.

Testing in XR can be used to evaluate the degree of this circadian desynchronization in dementia patients, as long as phototopic and scotopic illumination settings are maintained for real-world time-of-day concurrently. γ-Amino-Butyric-Acid (GABA) is necessary for refinement of the circadian firing rhythm that maintains healthy conscious-state transition processes throughout every brain region via the suprachiasmatic nucleus [69] and connecting intergeniculate leaflet (IGL) and retinohypothalamic tract to thalamocortical and related nuclei (**Figure 3**) is responsible for healthy circadian integration of environmental-information throughout multiple cellular oscillations [13] in observable brainwaves.

Circadian daylight regulation [70] via the suprachiasmatic nucleus is also crucial to the production of anti-inflammatory melatonin and so, it would be questionable to find XR-circadian related prosthetics lacking in palliative care for dementia patients.

Melatonin, secreted by the pineal gland, protects neuronal cells with its antioxidant and anti-amyloid properties, and helps to limit or reduce formation of amyloid fibrils involved in Alzheimer-like tau hyperphosphorylation [71, 72]. In neuroinflammatory dementia patients, phase shifts of daylight into dusk trigger agitation, aggression, and delirium during the late afternoon and early evening hours [73], a behavioral regulatory challenge known as *sundowning* [74]. Medically, it is vital to incorporate this condition as a risk of additional suffering during euthanization administration, particularly where euthanatic neurotoxic delivery does not reach the brain and the patient is already conscious-state transition severely impaired (see **Figure 4**).

The XR-tests in conscious-state transition offer an opportunity to evaluate retinal-support as part of psychiatric comfort targets [75] or, to evaluate potential pharmaceutical risk of overdosing a dementia patients.

**4. Summary**

**Figure 4.**

**273**

In this chapter, an XR-based method for evaluating decision-making competence is presented. in reaction to a recent dutch law that suggests decisionmaking incompetence is sufficient grounds for non-voluntary euthanization of dementia patients. Instead, this chapter proposes that decision-making needs to be measured precisely along with conscious-state transition using XR. This is because majority of dementia patients cannot transition from alert or rest state to death state instantly, and that this predisposes them to high risk of brain aware and awake state, including for the duration of the euthanatic product half-life, and despite cardiac arrest. And so, the dutch law which currently only describes patient-disease irreversibility and social dignity loss, appears to overlook the need to evaluate disease conditions and patient conditions for which euthanization is not medically safe and non-

*Relationship of melatonin absence and elevated risk of dementia alert/awake or risk of convulsion.*

*The Need for XR-Measurement of Decision-Making Decline and Conscious-State Transition…*

*DOI: http://dx.doi.org/10.5772/intechopen.97384*

XR-based tests are described as short-instance virtual environmentallyinteractive tests, provided in diurnal sessions that have been calibrated to the circadian optogenetic settings of neuronal-nucleic brain thalamocortical networks. The tests provide opportunity to demonstrate neuroinflammation progression and the impact of high expression of anti-somnogenic cytokines, the loss of antiinflammatory neuroprotective melatonin and circadian desynchronization to the patient. This makes XR-based monitoring in palliative patient caregiving generally

voluntary euthanization of such patients is cruelty.

valuable as well as key to evaluation of euthanization-readiness.

#### **Figure 3.**

*A simplistic schematic of the bioperception circadian excitatory (yellow) and inhibitory (green) response neuronal-nucleic network relationships, for XR-calibration development purposes.*

*The Need for XR-Measurement of Decision-Making Decline and Conscious-State Transition… DOI: http://dx.doi.org/10.5772/intechopen.97384*

#### **4. Summary**

lateral nucleus (VL) and Ventral anterior nucleus (VA), and in the presence of

*Suggestions for Addressing Clinical and Non-Clinical Issues in Palliative Care*

In the Supplementary Materials, a list of some of the parameters are explained so that optogenetic waveform signals are consistent within the virtual reality scene as they are in the natural environment that activates synaptic relays between the intralaminar nucleus of the thalamus and the sensory-information processing cortical networks. These are the same brain regions associated with awareness of self, in

Testing in XR can be used to evaluate the degree of this circadian desynchronization in dementia patients, as long as phototopic and scotopic illumination settings are maintained for real-world time-of-day concurrently. γ-Amino-Butyric-Acid (GABA) is necessary for refinement of the circadian firing rhythm that maintains healthy conscious-state transition processes throughout every brain region via the suprachiasmatic nucleus [69] and connecting intergeniculate leaflet (IGL) and retinohypothalamic tract to thalamocortical and related nuclei (**Figure 3**) is responsible for healthy circadian integration of environmental-information throughout multiple cellular oscillations [13] in observable brainwaves.

Circadian daylight regulation [70] via the suprachiasmatic nucleus is also crucial to the production of anti-inflammatory melatonin and so, it would be questionable to find XR-circadian related prosthetics lacking in palliative care for dementia

Melatonin, secreted by the pineal gland, protects neuronal cells with its antioxidant and anti-amyloid properties, and helps to limit or reduce formation of amyloid fibrils involved in Alzheimer-like tau hyperphosphorylation [71, 72]. In neuroinflammatory dementia patients, phase shifts of daylight into dusk trigger agitation, aggression, and delirium during the late afternoon and early evening hours [73], a behavioral regulatory challenge known as *sundowning* [74]. Medically, it is vital to incorporate this condition as a risk of additional suffering during euthanization administration, particularly where euthanatic neurotoxic delivery does not reach the brain and the patient is already conscious-state transition

The XR-tests in conscious-state transition offer an opportunity to evaluate retinal-support as part of psychiatric comfort targets [75] or, to evaluate potential

*A simplistic schematic of the bioperception circadian excitatory (yellow) and inhibitory (green) response*

*neuronal-nucleic network relationships, for XR-calibration development purposes.*

dementia-related inflammation [67, 68].

relationship to the environment.

severely impaired (see **Figure 4**).

pharmaceutical risk of overdosing a dementia patients.

patients.

**Figure 3.**

**272**

In this chapter, an XR-based method for evaluating decision-making competence is presented. in reaction to a recent dutch law that suggests decisionmaking incompetence is sufficient grounds for non-voluntary euthanization of dementia patients. Instead, this chapter proposes that decision-making needs to be measured precisely along with conscious-state transition using XR. This is because majority of dementia patients cannot transition from alert or rest state to death state instantly, and that this predisposes them to high risk of brain aware and awake state, including for the duration of the euthanatic product half-life, and despite cardiac arrest. And so, the dutch law which currently only describes patient-disease irreversibility and social dignity loss, appears to overlook the need to evaluate disease conditions and patient conditions for which euthanization is not medically safe and nonvoluntary euthanization of such patients is cruelty.

XR-based tests are described as short-instance virtual environmentallyinteractive tests, provided in diurnal sessions that have been calibrated to the circadian optogenetic settings of neuronal-nucleic brain thalamocortical networks. The tests provide opportunity to demonstrate neuroinflammation progression and the impact of high expression of anti-somnogenic cytokines, the loss of antiinflammatory neuroprotective melatonin and circadian desynchronization to the patient. This makes XR-based monitoring in palliative patient caregiving generally valuable as well as key to evaluation of euthanization-readiness.
