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Saleh C, Ilia TS, Schöpfer R, Seidl U, Deraita J, Todua-Lennigk S, Lieb J, Budincevic H, Trzcinska M, Hovhannisyan K, Boviatsis KA, Saleh FM. Atherosclerosis and depression: is carotid intima-media thicker in patients with depression compared to matched control individuals? A systematic review and meta-analysis. J Psychiatr Res 2024; 173:216-224. [PMID: 38552331 DOI: 10.1016/j.jpsychires.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To investigate if there is an association between atherosclerosis and depression by using as imaging biomarker the carotid intima media thickness (cIMT), a surrogate marker for atherosclerosis. METHODS PubMed/Medline, Embase and Cochrane databases were comprehensively searched to identify studies investigating the association between cIMT and depression. The results were pooled using a random-effects statistical model, appropriate for the expected high heterogeneity. Sensitivity and subgroup analyses were conducted where data was available. RESULTS Overall, 22 and 13 studies met inclusion criteria for the qualitative and the quantitative synthesis, respectively, with a total of 4466 patients and 21,635 control participants. Results showed that cIMT is significantly higher in the depression, compared to the control groups with an overall mean difference of 0.07 mm (95% CI 0.04-0.10, p < 0.01). Subgroup analysis showed that diabetes could present as a confounding factor in patients with depression and an increased cIMT. CONCLUSIONS This study confirms a significantly increased cIMT in patients with depression, compared with controls and suggests a possible bidirectional link between atherosclerosis and depression. An early screening of cardiovascular disease in individuals suffering with depression should be considered.
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Affiliation(s)
| | - Tatiani Soultana Ilia
- Child and Adolescent Psychiatric Clinic, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | | | - Ulrich Seidl
- Department of Psychiatry, Clinic for Psychiatry, Psychotherapy and Psychosomatics, SHG-Kliniken Sonnenberg, Saarbrücken, Germany
| | - Jasmine Deraita
- Department of Forensics, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Salome Todua-Lennigk
- Department of Forensics, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Johanna Lieb
- Division of Neuroradiology, Clinic of Radiology & Nuclear Medicine, Department of Theragnostics, University Hospital of Basel, Basel, Switzerland
| | - Hrvoje Budincevic
- Stroke and Intensive Care Unit, Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia; Faculty of Medicine, Department of Neurology and Neurosurgery, J.J. Strossmayer University of Osijek, Osijek, Croatia
| | - Maria Trzcinska
- Division of Substance Use Disorders, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
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Seidl U, Bohne AS, Kaeding M, Bauer L, Weichenthal M, Wehkamp U, Hutloff A, Schwarz T, Gerdes S, Heine G. Angiolymphoid hyperplasia with eosinophilia infiltrated by GATA3+ Th2 cells responding to dupilumab. J Eur Acad Dermatol Venereol 2023. [PMID: 37060261 DOI: 10.1111/jdv.19116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Affiliation(s)
- U Seidl
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A S Bohne
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Kaeding
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - L Bauer
- Institute of Immunology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Weichenthal
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - U Wehkamp
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - A Hutloff
- Institute of Immunology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - T Schwarz
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - S Gerdes
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - G Heine
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
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3
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Seidl U, Heine G. [Principles of allergy diagnostics]. Z Rheumatol 2023; 82:298-306. [PMID: 37017761 DOI: 10.1007/s00393-023-01343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Allergies are frequent and approximately 30% of the general population in Germany are affected. The specific sensitization against an allergen is asymptomatic. On renewed allergen contact the symptoms are indicative of the underlying pathomechanism. A variety of different test procedures are available to identify allergic reactions. OBJECTIVE AND AIM In this review article the typical clinical symptoms of allergic reactions are assigned to mechanisms and possible test methods are presented and discussed. Current developments in recombinant serum diagnostics and cellular testing methods are presented.
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Affiliation(s)
- Ulrich Seidl
- Klinik für Dermatologie, Venerologie und Allergologie, am Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Guido Heine
- Klinik für Dermatologie, Venerologie und Allergologie, am Universitätsklinikum Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
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4
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Gerdes S, Lenz D, Seidl U, Weidinger S, Mrowietz U, von Spreckelsen R. Entwicklung eines Fragebogens zur Evaluation des Kratzverhaltens bei Patienten mit Psoriasis und atopischer Dermatitis. J Dtsch Dermatol Ges 2022; 20:1011-1015. [PMID: 35881095 DOI: 10.1111/ddg.14775_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sascha Gerdes
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Darya Lenz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Ulrich Seidl
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | | | - Ulrich Mrowietz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
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5
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Gerdes S, Lenz D, Seidl U, Weidinger S, Mrowietz U, von Spreckelsen R. Development of a questionnaire to evaluate scratching behavior in patients with psoriasis and atopic dermatitis. J Dtsch Dermatol Ges 2022; 20:1011-1015. [PMID: 35701100 DOI: 10.1111/ddg.14775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sascha Gerdes
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Darya Lenz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | - Ulrich Seidl
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
| | | | - Ulrich Mrowietz
- Klinik für Dermatologie, Venerologie und Allergologie am UKSH Kiel
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6
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Saleh C, Seidl U, Hutter G, Hund-Georgiadis M. The need for neuroimaging in first manifestations of psychiatric symptoms. Surg Neurol Int 2021; 12:441. [PMID: 34777905 PMCID: PMC8586871 DOI: 10.25259/sni_754_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background Brain imaging in psychiatry, especially by first-episode psychiatric symptoms, is unfortunately not a standard procedure in psychiatric clinics and is recommended only if indicated by history or if associated with neurological findings. As a result, the most serious diagnoses can be delayed or missed. Case Description We describe a patient who presented with psychiatric symptoms admitted initially to a psychiatric clinic. Thanks to routine imaging the diagnosis of a brain tumor could be made with prompt transfer to neurosurgery. Conclusion Brain imaging should be a mandatory procedure upon admission to a psychiatric clinic also in patients who present with exclusive psychiatric symptoms.
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Affiliation(s)
- Christian Saleh
- Department of Neurology, Center for Neurorehabilitation and Paraplegiology, REHAB Basel
| | - Ulrich Seidl
- Department of Psychiatry, Clinic for Psychiatry, Psychotherapy and Psychosomatics, SHG-Kliniken Sonnenberg, Saarbrücken, Germany
| | - Gregor Hutter
- Department of Neurosurgery, University Hospital Basel, Baselland, Switzerland
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7
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Seidl U, Pinter A, Wilsmann-Theis D, Poortinga S, Morrison K, Mrowietz U, Gerdes S. Absolute Psoriasis Area and Severity Index as a valuable marker to determine initial treatment response in psoriasis patients treated with guselkumab in routine clinical care. Dermatol Ther 2021; 35:e15193. [PMID: 34741783 DOI: 10.1111/dth.15193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/17/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
Guselkumab is an anti-interleukin-23p19 monoclonal antibody approved as a first-line medication in patients with moderate-to-severe plaque-type psoriasis and second-line in active psoriatic arthritis. In the clinic, patients who have shown a lack of previous treatment efficacy and/or tolerability are often prescribed guselkumab. These patients generally have less severe psoriasis compared to clinical trial cohorts, reflected in lower Psoriasis Area and Severity Index (PASI). To evaluate treatment response in a real-world setting, we conducted a multicenter-retrospective chart review in three specialized dermatological centers. Seventy-four patients who received guselkumab treatment were included in the study and baseline characteristics were described. The mean PASI at baseline was 13.0 (± 6.7). After 12 weeks of treatment 40 patients could be followed up at the participating centers and efficacy was assessed: 72.5% of these patients achieved an absolute PASI ≤5 (55.0% ≤3; 42.5% ≤2) whereas only 57.5% of patients were able to gain a delta PASI reduction of at least 75%. Using the absolute PASI as a treatment goal rather than response rate revealed that guselkumab was highly effective in this real-world setting. In conclusion, the absolute PASI proved to be a more valuable tool to measure treatment outcome.
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Affiliation(s)
- Ulrich Seidl
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Sietske Poortinga
- Department of Dermatology and Allergy, University Bonn, Bonn, Germany
| | - Kirsten Morrison
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Sascha Gerdes
- Psoriasis-Center at the Department of Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
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8
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Saleh C, Seidl U, Stegentritt K, Schumacher F, Fehrenbach RA. [Posterior cortical atrophy-plus syndrome. A case report]. Fortschr Neurol Psychiatr 2020; 88:528-531. [PMID: 32634845 DOI: 10.1055/a-1149-2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Posterior cortical atrophy (PCA) is a rare neurodegenerative disease, which manifests with complex visual disturbances. PCA can present in isolation ('PCA-pure') or in association with other neurodegenerative disorders ('PCA-plus'). Diagnosis is nevertheless frequently delayed, as PCA is a less known disease entity and initially a primary ocular disease is taken into consideration.
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Affiliation(s)
| | - Ulrich Seidl
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, SHG-Kliniken Sonnenberg
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9
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Schmitgen MM, Kubera KM, Depping MS, Nolte HM, Hirjak D, Hofer S, Hasenkamp JH, Seidl U, Stieltjes B, Maier-Hein KH, Sambataro F, Sartorius A, Thomann PA, Wolf RC. Exploring cortical predictors of clinical response to electroconvulsive therapy in major depression. Eur Arch Psychiatry Clin Neurosci 2020; 270:253-261. [PMID: 31278421 DOI: 10.1007/s00406-019-01033-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/15/2019] [Indexed: 12/11/2022]
Abstract
Electroconvulsive therapy (ECT) is a rapid and highly effective treatment option for treatment-resistant major depressive disorder (TRD). The neural mechanisms underlying such beneficial effects are poorly understood. Exploring associations between changes of brain structure and clinical response is crucial for understanding ECT mechanisms of action and relevant for the validation of potential biomarkers that can facilitate the prediction of ECT efficacy. The aim of this explorative study was to identify cortical predictors of clinical response in TRD patients treated with ECT. We longitudinally investigated 12 TRD patients before and after ECT. Twelve matched healthy controls were studied cross sectionally. Demographical, clinical, and structural magnetic resonance imaging data at 3 T and multiple cortical markers derived from surface-based morphometry (SBM) analyses were considered. Multiple regression models were computed to identify predictors of clinical response to ECT, as reflected by Hamilton Depression Rating Scale (HAMD) score changes. Symptom severity differences pre-post-ECT were predicted by models including demographic data, clinical data and SBM of frontal, cingulate, and entorhinal structures. Using all-subsets regression, a model comprising HAMD score at baseline and cortical thickness of the left rostral anterior cingulate gyrus explained most variance in the data (multiple R2 = 0.82). The data suggest that SBM provides powerful measures for identifying biomarkers for ECT response in TRD. Rostral anterior cingulate thickness and HAMD score at baseline showed the greatest predictive power of clinical response, in contrast to cortical complexity, cortical gyrification, or demographical data.
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Affiliation(s)
- Mike M Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Malte S Depping
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Henrike M Nolte
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan Hofer
- Department of Anesthesiology, Westpfalz-Klinikum GmbH, Kaiserslautern, Germany
| | - Julia H Hasenkamp
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
| | - Ulrich Seidl
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
- Department of Psychiatry and Psychotherapy, SHG-Kliniken, Saarbrücken, Germany
| | - Bram Stieltjes
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Klaus H Maier-Hein
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fabio Sambataro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp A Thomann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany
- Center for Mental Health, Odenwald District Healthcare Center, Erbach, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Vosstrasse 4, 69115, Heidelberg, Germany.
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10
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Hekler A, Utikal JS, Enk AH, Hauschild A, Weichenthal M, Maron RC, Berking C, Haferkamp S, Klode J, Schadendorf D, Schilling B, Holland-Letz T, Izar B, von Kalle C, Fröhling S, Brinker TJ, Schmitt L, Peitsch WK, Hoffmann F, Becker JC, Drusio C, Jansen P, Klode J, Lodde G, Sammet S, Schadendorf D, Sondermann W, Ugurel S, Zader J, Enk A, Salzmann M, Schäfer S, Schäkel K, Winkler J, Wölbing P, Asper H, Bohne AS, Brown V, Burba B, Deffaa S, Dietrich C, Dietrich M, Drerup KA, Egberts F, Erkens AS, Greven S, Harde V, Jost M, Kaeding M, Kosova K, Lischner S, Maagk M, Messinger AL, Metzner M, Motamedi R, Rosenthal AC, Seidl U, Stemmermann J, Torz K, Velez JG, Haiduk J, Alter M, Bär C, Bergenthal P, Gerlach A, Holtorf C, Karoglan A, Kindermann S, Kraas L, Felcht M, Gaiser MR, Klemke CD, Kurzen H, Leibing T, Müller V, Reinhard RR, Utikal J, Winter F, Berking C, Eicher L, Hartmann D, Heppt M, Kilian K, Krammer S, Lill D, Niesert AC, Oppel E, Sattler E, Senner S, Wallmichrath J, Wolff H, Gesierich A, Giner T, Glutsch V, Kerstan A, Presser D, Schrüfer P, Schummer P, Stolze I, Weber J, Drexler K, Haferkamp S, Mickler M, Stauner CT, Thiem A. Superior skin cancer classification by the combination of human and artificial intelligence. Eur J Cancer 2019; 120:114-121. [DOI: 10.1016/j.ejca.2019.07.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
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11
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Maron RC, Weichenthal M, Utikal JS, Hekler A, Berking C, Hauschild A, Enk AH, Haferkamp S, Klode J, Schadendorf D, Jansen P, Holland-Letz T, Schilling B, von Kalle C, Fröhling S, Gaiser MR, Hartmann D, Gesierich A, Kähler KC, Wehkamp U, Karoglan A, Bär C, Brinker TJ, Schmitt L, Peitsch WK, Hoffmann F, Becker JC, Drusio C, Jansen P, Klode J, Lodde G, Sammet S, Schadendorf D, Sondermann W, Ugurel S, Zader J, Enk A, Salzmann M, Schäfer S, Schäkel K, Winkler J, Wölbing P, Asper H, Bohne AS, Brown V, Burba B, Deffaa S, Dietrich C, Dietrich M, Drerup KA, Egberts F, Erkens AS, Greven S, Harde V, Jost M, Kaeding M, Kosova K, Lischner S, Maagk M, Messinger AL, Metzner M, Motamedi R, Rosenthal AC, Seidl U, Stemmermann J, Torz K, Velez JG, Haiduk J, Alter M, Bär C, Bergenthal P, Gerlach A, Holtorf C, Karoglan A, Kindermann S, Kraas L, Felcht M, Gaiser MR, Klemke CD, Kurzen H, Leibing T, Müller V, Reinhard RR, Utikal J, Winter F, Berking C, Eicher L, Hartmann D, Heppt M, Kilian K, Krammer S, Lill D, Niesert AC, Oppel E, Sattler E, Senner S, Wallmichrath J, Wolff H, Giner T, Glutsch V, Kerstan A, Presser D, Schrüfer P, Schummer P, Stolze I, Weber J, Drexler K, Haferkamp S, Mickler M, Stauner CT, Thiem A. Systematic outperformance of 112 dermatologists in multiclass skin cancer image classification by convolutional neural networks. Eur J Cancer 2019; 119:57-65. [DOI: 10.1016/j.ejca.2019.06.013] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/07/2023]
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Sambataro F, Thomann PA, Nolte HM, Hasenkamp JH, Hirjak D, Kubera KM, Hofer S, Seidl U, Depping MS, Stieltjes B, Maier-Hein K, Wolf RC. Transdiagnostic modulation of brain networks by electroconvulsive therapy in schizophrenia and major depression. Eur Neuropsychopharmacol 2019; 29:925-935. [PMID: 31279591 DOI: 10.1016/j.euroneuro.2019.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/14/2019] [Accepted: 06/10/2019] [Indexed: 12/30/2022]
Abstract
Major depressive disorder (MDD) and schizophrenia (SCZ) share neurobiological and clinical commonalities. Altered functional connectivity of large-scale brain networks has been associated with both disorders. Electroconvulsive therapy (ECT) has proven to be an effective treatment in severe forms of MDD and SCZ. However, the role of ECT on the modulation of the dynamics of brain networks is still unknown. In this study, we used resting state functional magnetic resonance imaging (rs-fMRI) to investigate functional connectivity in 16 pharmacoresistant patients with SCZ or MDD and a matched group of normal controls. Patients were scanned before and after right-sided unilateral ECT. Group spatial independent component analysis was carried out with a multiple analysis of covariance (MANCOVA) approach to estimate the effects of ECT treatment on intrinsic components (INs). Functional network connectivity (FNC) was calculated between pairs of INs. Patients had reduced connectivity within a striato-thalamic network in the thalamus as well as increased low frequency oscillations in a striatal network. ECT reduced low frequency oscillations (LFOs) on a striatal network along with increasing functional connectivity in the medial prefrontal cortex within the DMN. Following ECT treatment, the FNC of the executive network was reduced with the DMN and increased with the salience network, respectively. Our findings suggest transnosological effects of ECT on the connectivity of large-scale networks as well as at the level of their interplay. Furthermore, they support a transnosological approach for the investigation not only of the neural correlates of the disease but also of the brain mechanism of treatment of mental disorders.
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Affiliation(s)
- Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy.
| | - Philipp Arthur Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany; Center for Mental Health, Odenwald District Healthcare Center, Erbach, Germany
| | - Henrike Maria Nolte
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany
| | - J H Hasenkamp
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, 68159 Mannheim, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany
| | - Stefan Hofer
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany; Department of Anaesthesiology, Westpfalz-Klinikum GmbH, 67655 Kaiserslautern, Germany
| | - Ulrich Seidl
- Department of Anaesthesiology, Westpfalz-Klinikum GmbH, 67655 Kaiserslautern, Germany
| | - Malte Sebastian Depping
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany
| | - Bram Stieltjes
- Department of Radiology, Section Quantitative Imaging Based Disease Characterization, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Klaus Maier-Hein
- Medical Image Computing Group, Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, 69115 Heidelberg, Germany.
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13
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Hirjak D, Sambataro F, Remmele B, Kubera KM, Schröder J, Seidl U, Thomann AK, Maier-Hein KH, Wolf RC, Thomann PA. The relevance of hippocampal subfield integrity and clock drawing test performance for the diagnosis of Alzheimer's disease and mild cognitive impairment. World J Biol Psychiatry 2019; 20:197-208. [PMID: 28721741 DOI: 10.1080/15622975.2017.1355474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The clock drawing test (CDT) is one of the worldwide most used screening tests for Alzheimer's disease (AD). MRI studies have identified temporo-parietal regions being involved in CDT impairment. However, the contributions of specific hippocampal subfields and adjacent extrahippocampal structures to CDT performance in AD and mild cognitive impairment (MCI) have not been investigated so far. It is unclear whether morphological alterations or CDT score, or a combination of both, are able to predict AD. METHODS 38 AD patients, 38 MCI individuals and 31 healthy controls underwent neuropsychological assessment and MRI at 3 Tesla. FreeSurfer 5.3 was used to perform hippocampal parcellation. We used a collection of statistical methods to better understand the relationship between CDT and hippocampal formation. We also tested the clinical feasibility of this relationship when predicting AD. RESULTS Impaired CDT performance in AD was associated with widespread atrophy of the cornu ammonis, presubiculum, and subiculum, whereas MCI subjects showed CDT-related alterations of the CA4-dentate gyrus and subiculum. CDT correlates in AD and MCI showed regional and quantitative overlap. Importantly, CDT score was the best predictor of AD. CONCLUSIONS Our findings lend support for an involvement of different hippocampal subfields in impaired CDT performance in AD and MCI. CDT seems to be more efficient than subfield imaging for predicting AD.
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Affiliation(s)
- Dusan Hirjak
- a Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim , Heidelberg University , Mannheim , Germany.,c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Fabio Sambataro
- b Department of Medicine (DAME) , Udine University , Udine , Italy
| | - Barbara Remmele
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Katharina M Kubera
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Johannes Schröder
- d Section of Geriatric Psychiatry , Heidelberg University , Mannheim , Germany
| | - Ulrich Seidl
- e Department of Psychiatry , Center for Mental Health , Stuttgart , Germany
| | - Anne K Thomann
- f Department of Internal Medicine II, Medical Faculty Mannheim , Heidelberg University , Mannheim , Germany
| | - Klaus H Maier-Hein
- g Medical Image Computing Group, Div. Medical and Biological Informatics , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Robert C Wolf
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Philipp A Thomann
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany.,h Center for Mental Health , Odenwald District Healthcare Center , Erbach , Germany
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14
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Hirjak D, Wolf RC, Pfeifer B, Kubera KM, Thomann AK, Seidl U, Maier-Hein KH, Schröder J, Thomann PA. Cortical signature of clock drawing performance in Alzheimer's disease and mild cognitive impairment. J Psychiatr Res 2017; 90:133-142. [PMID: 28284155 DOI: 10.1016/j.jpsychires.2017.02.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 12/24/2022]
Abstract
It is unclear whether clock drawing test (CDT) performance relies on a widely distributed cortical network, or whether this test predominantly taps into parietal cortex function. So far, associations between cortical integrity and CDT impairment in Alzheimer's disease (AD) and mild cognitive impairment (MCI) largely stem from cortical volume analyses. Given that volume is a product of thickness and surface area, investigation of the relationship between CDT and these two cortical measures might contribute to better understanding of this cognitive screening tool for AD. 38 patients with AD, 38 individuals with MCI and 31 healthy controls (HC) underwent CDT assessment and MRI at 3 Tesla. The surface-based analysis via Freesurfer enabled calculation of cortical thickness and surface area. CDT was scored according to the method proposed by Shulman and related to the two distinct cortical measurements. Higher CDT scores across the entire sample were associated with cortical thickness in bilateral temporal gyrus, the right supramarginal gyrus, and the bilateral parietal gyrus, respectively (p < 0.001 CWP corr.). Significant associations between CDT and cortical thickness reduction in the parietal lobe remained significant when analyses were restricted to AD individuals. There was no statistically significant association between CDT scores and surface area (p < 0.001 CWP corr.). In conclusion, CDT performance may be driven by cortical thickness alterations in regions previously identified as "AD vulnerable", i.e. regions predominantly including temporal and parietal lobes. Our results suggest that cortical features of distinct evolutionary and genetic origin differently contribute to CDT performance.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany; Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany.
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
| | - Barbara Pfeifer
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
| | - Anne K Thomann
- Department of Internal Medicine II, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Department of Psychiatry, Prießnitzweg 24, Stuttgart 70374, Germany
| | - Klaus H Maier-Hein
- Medical Image Computing Group, German Cancer Research Center (DKFZ), Germany
| | | | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany; Center for Mental Health, Odenwald District Healthcare Center, Albert-Schweitzer-Straße 10-20, 64711 Erbach, Germany
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15
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Thomann PA, Wolf RC, Nolte HM, Hirjak D, Hofer S, Seidl U, Depping MS, Stieltjes B, Maier-Hein K, Sambataro F, Wüstenberg T. Neuromodulation in response to electroconvulsive therapy in schizophrenia and major depression. Brain Stimul 2017; 10:637-644. [DOI: 10.1016/j.brs.2017.01.578] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 01/10/2017] [Accepted: 01/13/2017] [Indexed: 01/18/2023] Open
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Hirjak D, Wolf RC, Remmele B, Seidl U, Thomann AK, Kubera KM, Schröder J, Maier-Hein KH, Thomann PA. Hippocampal formation alterations differently contribute to autobiographic memory deficits in mild cognitive impairment and Alzheimer's disease. Hippocampus 2017; 27:702-715. [PMID: 28281317 DOI: 10.1002/hipo.22726] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 12/17/2022]
Abstract
Autobiographical memory (AM) is part of declarative memory and includes both semantic and episodic aspects. AM deficits are among the major complaints of patients with Alzheimer's disease (AD) even in early or preclinical stages. Previous MRI studies in AD patients have showed that deficits in semantic and episodic AM are associated with hippocampal alterations. However, the question which specific hippocampal subfields and adjacent extrahippocampal structures contribute to deficits of AM in individuals with mild cognitive impairment (MCI) and AD patients has not been investigated so far. Hundred and seven participants (38 AD patients, 38 MCI individuals and 31 healthy controls [HC]) underwent MRI at 3 Tesla. AM was assessed with a semi-structured interview (E-AGI). FreeSurfer 5.3 was used for hippocampal parcellation. Semantic and episodic AM scores were related to the volume of 5 hippocampal subfields and cortical thickness in the parahippocampal and entorhinal cortex. Both semantic and episodic AM deficits were associated with bilateral hippocampal alterations. These associations referred mainly to CA1, CA2-3, presubiculum, and subiculum atrophy. Episodic, but not semantic AM loss was associated with cortical thickness reduction of the bilateral parahippocampal and enthorinal cortex. In MCI individuals, episodic, but not semantic AM deficits were associated with alterations of the CA1, presubiculum and subiculum. Our findings support the crucial role of CA1, presubiculum, and subiculum in episodic memory. The present results implicate that in MCI individuals, semantic and episodic AM deficits are subserved by distinct neuronal systems.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Germany
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Robert C Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Barbara Remmele
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | - Ulrich Seidl
- Department of Psychiatry, Center for Mental Health, Stuttgart, Germany
| | - Anne K Thomann
- Department of Internal Medicine II, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
| | | | - Klaus H Maier-Hein
- Medical Image Computing Group, Division Medical and Biological Informatics, German Cancer Research Center (DKFZ), Germany
| | - Philipp A Thomann
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Germany
- Center for Mental Health, Odenwald District Healthcare Center, Albert-Schweitzer-Straße 10-20, Erbach, 64711, Germany
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Herold CJ, Schmid LA, Lässer MM, Seidl U, Schröder J. Cognitive Performance in Patients with Chronic Schizophrenia Across the Lifespan. GeroPsych 2017. [DOI: 10.1024/1662-9647/a000164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Chronic schizophrenia involves neuropsychological deficits that primarily strike executive functions and episodic memory. Our study investigated these deficits throughout the lifespan in patients with chronic schizophrenia and in healthy controls. Important neuropsychological functions were tested in 94 patients and 66 healthy controls, who were assigned to three age groups. Compared with the healthy controls, patients performed significantly poorer on all tests applied. Significant age effects occurred on all tests except the digit span forward, with older subjects scoring well below the younger ones. With respect to cognitive flexibility, age effects were more pronounced in the patients. These findings underline the importance of cognitive deficits in chronic schizophrenia and indicate that diminished cognitive flexibility shows age-associated differences.
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Affiliation(s)
- Christina Josefa Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Lena Anna Schmid
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc Montgomery Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany
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18
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Wolf RC, Nolte HM, Hirjak D, Hofer S, Seidl U, Depping MS, Stieltjes B, Maier-Hein K, Sambataro F, Thomann PA. Structural network changes in patients with major depression and schizophrenia treated with electroconvulsive therapy. Eur Neuropsychopharmacol 2016; 26:1465-1474. [PMID: 27424799 DOI: 10.1016/j.euroneuro.2016.06.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/06/2016] [Accepted: 06/18/2016] [Indexed: 02/06/2023]
Abstract
Electroconvulsive therapy (ECT) is one of the most effective treatments in severe and treatment-resistant major depressive disorder (MDD). In schizophrenia (SZ), ECT is frequently considered in drug-resistant cases, as an augmentation of antipsychotic treatment or in cases when rapid symptom relief is indicated. Accumulating neuroimaging evidence suggests modulation of medial temporal lobe and prefrontal cortical regions in MDD by ECT. In SZ, ECT-effects on brain structure have not been systematically investigated so far. In this study, we investigated brain volume in 21 ECT-naïve patients (12 with MDD, 9 with SZ) who received right-sided unilateral ECT. Twenty-one healthy controls were included. Structural magnetic resonance imaging data were acquired before and after ECT. Healthy participants were scanned once. Source-based morphometry was used to investigate modulation of structural networks pre/post ECT. ECT had an impact on distinct structural networks in MDD and SZ. In both MDD and SZ SBM revealed a medial temporal lobe (MTL) network (including hippocampus and parahippocampal cortex) which showed a significant increase after ECT. The increase in MTL network strength was not associated with clinical improvement in either MDD or SZ. In SZ a lateral prefrontal/cingulate cortical network showed a volume increase after ECT, and this effect was accompanied by clinical improvement. These findings provide preliminary evidence for structural network change in response to ECT in MDD and SZ. The data suggest both diagnosis-specific and transdiagnostic ECT-effects on brain volume. In contrast to SZ, in MDD structural network modulation by ECT was not associated with clinical improvement.
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Affiliation(s)
- Robert Christian Wolf
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Kirrberger Str. 1, 66421 Homburg, Germany.
| | - Henrike Maria Nolte
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
| | - Dusan Hirjak
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, 70374 Stuttgart, Germany
| | - Malte Sebastian Depping
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Klaus Maier-Hein
- Medical Image Computing Group, Division of Medical and Biological Informatics, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Fabio Sambataro
- Department of Experimental and Clinical Medical Sciences (DISM), University of Udine, Udine, Italy
| | - Philipp Arthur Thomann
- Center for Psychosocial Medicine, Department of Psychiatry, University of Heidelberg, 69115 Heidelberg, Germany
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Hirjak D, Kubera KM, Wolf RC, Thomann AK, Hell SK, Seidl U, Thomann PA. Local brain gyrification as a marker of neurological soft signs in schizophrenia. Behav Brain Res 2015; 292:19-25. [DOI: 10.1016/j.bbr.2015.05.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 01/28/2023]
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Herold CJ, Lässer MM, Schmid LA, Seidl U, Kong L, Fellhauer I, Thomann PA, Essig M, Schröder J. Neuropsychology, autobiographical memory, and hippocampal volume in "younger" and "older" patients with chronic schizophrenia. Front Psychiatry 2015; 6:53. [PMID: 25954208 PMCID: PMC4404739 DOI: 10.3389/fpsyt.2015.00053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/28/2015] [Indexed: 01/17/2023] Open
Abstract
Despite a wide range of studies on neuropsychology in schizophrenia, autobiographical memory (AM) has been scarcely investigated in these patients. Hence, less is known about AM in older patients and hippocampal contribution to autobiographical memories of varying remoteness. Therefore, we investigated hippocampal volume and AM along with important neuropsychological domains in patients with chronic schizophrenia and the respective relationships between these parameters. We compared 25 older patients with chronic schizophrenia to 23 younger patients and an older healthy control group (N = 21) with respect to AM, additional neuropsychological parameters, and hippocampal volume. Personal episodic and semantic memory was investigated using a semi-structured interview. Additional neuropsychological parameters were assessed by using a battery of standard neuropsychological tests. Structural magnetic resonance imaging data were analyzed with an automated region-of-interest procedure. While hippocampal volume reduction and neuropsychological impairment were more pronounced in the older than in the younger patients, both groups showed equivalent reduced AM performance for recent personal episodes. In the patient group, significant correlations between left hippocampal volume and recent autobiographical episodes as well as personal semantic memories arose. Verbal memory and working memory were significantly correlated with right hippocampal volume; executive functions, however, were associated with bilateral hippocampal volumes. These findings underline the complexity of AM and its impairments in the course of schizophrenia in comparison to rather progressive neuropsychological deficits and address the importance of hippocampal contribution.
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Affiliation(s)
- Christina Josefa Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Marc Montgomery Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Lena Anna Schmid
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart , Stuttgart , Germany
| | - Li Kong
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Iven Fellhauer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg , Heidelberg , Germany
| | - Philipp Arthur Thomann
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg , Heidelberg , Germany
| | - Marco Essig
- German Cancer Research Center , Heidelberg , Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg , Heidelberg , Germany ; Institute of Gerontology, University of Heidelberg , Heidelberg , Germany
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21
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Hirjak D, Wolf RC, Stieltjes B, Hauser T, Seidl U, Thiemann U, Schröder J, Thomann PA. Neurological soft signs and brainstem morphology in first-episode schizophrenia. Neuropsychobiology 2014; 68:91-9. [PMID: 23881157 DOI: 10.1159/000350999] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/24/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Minor motor and sensory deficits or neurological soft signs (NSS) have frequently been reported in patients with schizophrenia at any stage of their illness. NSS have been demonstrated to correlate with neuroanatomical abnormalities in various brain regions. Despite its important role in the integration and coordination of automatic motor actions, the brainstem has so far rather been ignored in previous neuroimaging studies on NSS in schizophrenia. METHOD We investigated 21 right-handed first-episode schizophrenia patients using high-resolution magnetic resonance imaging at 3 T. The severity of NSS was measured with the Heidelberg Scale. Associations between NSS and both brainstem volume and shape changes were examined. RESULTS Higher NSS scores were significantly associated with structural alterations in the brainstem. According to volume measurements higher NSS scores correlated with global changes of the brainstem. Using shape analyses these associations referred to regionally specific morphometric alterations predominantly in the midbrain and pons. CONCLUSION The findings suggest that brainstem morphometric alterations are associated with the severity of NSS in patients with first-episode schizophrenia. They further indicate the involvement of the brainstem in the pathogenesis of schizophrenia.
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Affiliation(s)
- Dusan Hirjak
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany. dusan.hirjak @ med.uni-heidelberg.de
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Wettstein M, Seidl U, Wahl HW, Shoval N, Heinik J. Behavioral Competence and Emotional Well-Being of Older Adults with Mild Cognitive Impairment. GeroPsych 2014. [DOI: 10.1024/1662-9647/a000107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We examined whether older individuals with mild cognitive impairment (MCI) differed from healthy controls (HC) and persons with dementia (AD) in objective and perceived behavioral competence as well as in emotional well-being. We used a merged sample of 257 older adults aged 59 to 91 years (M = 72.9; SD = 6.4) stemming from Israel and Germany. Objective behavioral competence (assessed based on global positioning system (GPS)-based tracking data and a structured questionnaire) of MCI individuals was mostly similar to the HC group. Regarding perceived behavioral competence and emotional well-being, MCI individuals were more similar to the AD group and below the HC group’s mean levels. Findings suggest that a differentiated view of MCI individual’s competence and emotional well-being is in place.
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Affiliation(s)
- Markus Wettstein
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Germany
| | - Hans-Werner Wahl
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Noam Shoval
- Geography Department, Hebrew University Jerusalem, Israel
| | - Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital and Sackler Faculty of Medicine, Tel Aviv University, Israel
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23
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Herold CJ, Lässer MM, Schmid LA, Seidl U, Kong L, Fellhauer I, Thomann PA, Essig M, Schröder J. Hippocampal volume reduction and autobiographical memory deficits in chronic schizophrenia. Psychiatry Res 2013; 211:189-94. [PMID: 23158776 DOI: 10.1016/j.pscychresns.2012.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 03/12/2012] [Accepted: 04/05/2012] [Indexed: 12/16/2022]
Abstract
Although autobiographical memory (AM) deficits and hippocampal changes are frequently found in schizophrenia, their actual association remained yet to be established. AM performance and hippocampal volume were examined in 33 older, chronic schizophrenic patients and 21 healthy volunteers matched for age, gender and education. Psychopathological symptoms and additional neuropsychological parameters were assessed by using appropriate rating scales; magnetic resonance imaging (MRI) 3-T data were analyzed via an automated region-of-interest procedure. When compared with the control subjects, patients showed significantly decreased left anterior and posterior hippocampal volumes. Episodic but not semantic AM performance was significantly lower in the patients than in the healthy controls. Both episodic and semantic AM deficits were significantly correlated with volume of the left hippocampus in the patient group. In contrast, deficits in verbal memory, working memory and remote semantic memory observed in the patients did not relate to hippocampal volume. Our findings indicate that AM deficits in chronic schizophrenia are associated with hippocampal volume reductions and underline the importance of this pathology in schizophrenia.
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Affiliation(s)
- Christina Josefa Herold
- Section of Geriatric Psychiatry, University of Heidelberg, Voßstr. 4, 69115 Heidelberg, Germany
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24
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Berna F, Schönknecht P, Seidl U, Toro P, Schröder J. Episodic autobiographical memory in normal aging and mild cognitive impairment: a population-based study. Psychiatry Res 2012; 200:807-12. [PMID: 22520853 DOI: 10.1016/j.psychres.2012.03.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 02/17/2012] [Accepted: 03/17/2012] [Indexed: 11/20/2022]
Abstract
While episodic memory impairment has been extensively studied in normal and pathological aging, studies investigating age-related episodic autobiographical memory among representative samples are scarce. We therefore investigated episodic autobiographical memory in a sample of 395 participants of a population-based prospective study of aging. Three groups were compared, consisting of 194 middle-aged participants, 138 healthy old-aged participants and 63 patients with mild cognitive impairment (MCI). Results showed a significant impairment of episodic autobiographical memory performance associated with MCI, but not with normal aging. These deficits were significantly correlated with verbal memory performances, but not with measures of executive functions.
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Affiliation(s)
- Fabrice Berna
- Section of Geriatric Psychiatry, Institute of Gerontology, University of Heidelberg, Voss Strasse 4, 69115 Heidelberg, Germany
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25
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Wettstein M, Wahl HW, Shoval N, Oswald F, Voss E, Seidl U, Frölich L, Auslander G, Heinik J, Landau R. Out-of-home behavior and cognitive impairment in older adults: findings of the SenTra Project. J Appl Gerontol 2012; 34:3-25. [PMID: 25548086 DOI: 10.1177/0733464812459373] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study explores differences in the out-of-home behavior of community-dwelling older adults with different cognitive impairment. Three levels of complexity of out-of-home behavior were distinguished: (a) mostly automatized walking behavior (low complexity), (b) global out-of-home mobility (medium complexity), and (c) defined units of concrete out-of-home activities, particularly cognitively demanding activities (high complexity). A sample of 257 older adults aged 59 to 91 years (M = 72.9 years, SD = 6.4 years) included 35 persons with early-stage Alzheimer's disease (AD), 76 persons with mild cognitive impairment (MCI), and 146 cognitively healthy persons (CH). Mobility data were gathered by using a GPS tracking device as well as by questionnaire. Predicting cognitive impairment status by out-of-home behavior and a range of confounders by means of multinomial logistic regression revealed that only cognitively demanding activities showed at least a marginally significant difference between MCI and CH and were highly significant between AD and CH.
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Affiliation(s)
| | | | | | | | - Elke Voss
- Central Institute of Mental Health, Mannheim, Germany
| | - Ulrich Seidl
- Klinikum Stuttgart, Department of Psychiatry, Stuttgart, Germany
| | - Lutz Frölich
- Central Institute of Mental Health, Mannheim, Germany
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Thomann PA, Seidl U, Brinkmann J, Hirjak D, Traeger T, Wolf RC, Essig M, Schroder J. Hippocampal morphology and autobiographic memory in mild cognitive impairment and Alzheimer's disease. Curr Alzheimer Res 2012; 9:507-15. [PMID: 22372439 DOI: 10.2174/156720512800492558] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 12/19/2011] [Accepted: 01/18/2012] [Indexed: 11/22/2022]
Abstract
Autobiographical memory (AM) comprises memories of one's own past that are characterized by a sense of subjective time and autonoetic awareness. AM deficits are among the major complaints of patients with Alzheimer's disease (AD) even in early or preclinical stages. However, little is known on the association between cerebral alterations and AM in mild cognitive impairment (MCI) and AD. In the current study, patients with AD or MCI and healthy controls underwent high-resolution magnetic resonance imaging (MRI) and neuropsychological testing including semi-structured assessment of semantic and episodic AM of distinct lifetime periods. In MRI analysis, FSL-FIRST was used to automatically ascertain volume and shape of the hippocampal formation. Episodic, but not semantic AM loss was associated with morphological changes of the hippocampus, primarily involving the left hemisphere. According to shape analyses, these associations referred to regionally specific rather than global atrophy of the hippocampus. Our study demonstrates that loss of episodic AM early in the course of AD is associated with regionally confined hippocampal atrophy, thus supporting the multiple trace theory for the role of the hippocampus in episodic AM. Our findings are not only relevant for the understanding of memory function, but may also contribute to facilitating the early diagnosis of AD.
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Affiliation(s)
- Philipp A Thomann
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany.
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Abstract
Autobiographical memory comprises memories of one's own past that are characterized by a sense of subjective time and autonoetic awareness. Although autobiographical memory deficits are among the major complaints of patients with dementia, they have rarely been systematically assessed in mild cognitive impairment and Alzheimer's disease. We therefore investigated semantic and episodic aspects of autobiographical memory for remote and recent life periods in a sample of 239 nursing home residents (165 in different stages of Alzheimer's disease, 33 with mild cognitive impairment, and 41 cognitively unimpaired) with respect to potential confounders. Episodic autobiographical memories, especially the richness of details, were impaired early in the course of Alzheimer's disease or even in the preclinical phase, while semantic memories were spared until moderate stages, indicating a dissociation between both memory systems. The examination of autobiographic memory loss can facilitate the clinical diagnosis of Alzheimer's disease.
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Affiliation(s)
- Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany.
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Kong L, Herold C, Stieltjes B, Essig M, Seidl U, Wolf RC, Wüstenberg T, Lässer MM, Schmid LA, Schnell K, Hirjak D, Thomann PA. Reduced gray to white matter tissue intensity contrast in schizophrenia. PLoS One 2012; 7:e37016. [PMID: 22615876 PMCID: PMC3352852 DOI: 10.1371/journal.pone.0037016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 04/12/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While numerous structural magnetic resonance imaging (MRI) studies revealed changes of brain volume or density, cortical thickness and fibre integrity in schizophrenia, the effect of tissue alterations on the contrast properties of neural structures has so far remained mostly unexplored. METHODS Whole brain high-resolution MRI at 3 Tesla was used to investigate tissue contrast and cortical thickness in patients with schizophrenia and healthy controls. RESULTS Patients showed significantly decreased gray to white matter contrast in large portions throughout the cortical mantle with preponderance in inferior, middle, superior and medial temporal areas as well as in lateral and medial frontal regions. The extent of these intensity contrast changes exceeded the extent of cortical thinning. Further, contrast changes remained significant after controlling for cortical thickness measurements. CONCLUSIONS Our findings clearly emphasize the presence of schizophrenia related brain tissue changes that alter the imaging properties of brain structures. Intensity contrast measurements might not only serve as a highly sensitive metric but also as a potential indicator of a distinct pathological process that might be independent from volume or thickness alterations.
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Affiliation(s)
- Li Kong
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christina Herold
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | | | - Marco Essig
- German Cancer Research Center, Heidelberg, Germany
| | - Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center for Mental Health, Klinikum Stuttgart, Stuttgart, Germany
| | - Robert Christian Wolf
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | | | - Lena Anna Schmid
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Knut Schnell
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Dusan Hirjak
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Philipp Arthur Thomann
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
- Center of Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
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Hirjak D, Wolf RC, Stieltjes B, Seidl U, Schröder J, Thomann PA. Neurological soft signs and subcortical brain morphology in recent onset schizophrenia. J Psychiatr Res 2012; 46:533-9. [PMID: 22316638 DOI: 10.1016/j.jpsychires.2012.01.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 01/06/2012] [Accepted: 01/09/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Minor motor and sensory deficits or neurological soft signs (NSS) are frequently found in patients with schizophrenia at any stage of their illness. The thalamus and basal ganglia are accepted as being important for both motor control and integration of sensory input. However, whether NSS are related to alterations of these brain regions remains controversial. METHOD Twenty patients with recent onset schizophrenia were investigated using high-resolution magnetic resonance imaging (MRI) at 3 Tesla. NSS were examined on the Heidelberg Scale after remission of acute symptoms and related to both volumetric and shape measurements of thalamus, caudate nucleus, putamen, and globus pallidus, respectively. Age, education, medication and duration of illness were considered as potential confounders. RESULTS NSS were associated with structural alterations predominantly in the thalamus, the left caudate nucleus, and in the right globus pallidus. According to shape analyses these associations referred to regionally specific morphometric alterations rather than to global atrophy of the respective structures. CONCLUSION Our findings provide new insights into the association of NSS with brain morphometric alterations and lend further support to an involvement of multiple subcortical regions in schizophrenia.
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Affiliation(s)
- Dusan Hirjak
- Structural Neuroimaging Group, Department of General Psychiatry, University of Heidelberg, Germany.
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Seidl U, Lueken U, Thomann PA, Kruse A, Schröder J. Facial expression in Alzheimer's disease: impact of cognitive deficits and neuropsychiatric symptoms. Am J Alzheimers Dis Other Demen 2012; 27:100-6. [PMID: 22495337 PMCID: PMC10697354 DOI: 10.1177/1533317512440495] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Alzheimer's disease (AD), nonverbal aspects of communication become increasingly important in caregiver-patient interactions when the ability to communicate verbally is fading with progression of the disease. We therefore investigated the impact of cognitive deficits and neuropsychiatric symptoms, particularly apathy, on facial expression in AD. While overall neuropsychiatric symptoms were not associated with facial expression, apathy exhibited substantial correlations, even after controlling for cognitive deficits. Moreover, apathy appeared to moderate the influence of cognitive deficits: without considering apathy, cognitive deficits were associated with less specific facial expressions. After controlling for apathy, cognitive decline was related to increased facial expressiveness. In conclusion, apathetic symptoms appear to be specifically associated with facial expression in AD and thus could contribute to a disregard for patients' needs in everyday life.
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Affiliation(s)
- Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany.
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31
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Seidl U, Traeger TV, Hirjak D, Remmele B, Wolf RC, Kaiser E, Stieltjes B, Essig M, Schröder J, Thomann PA. Subcortical morphological correlates of impaired clock drawing performance. Neurosci Lett 2012; 512:28-32. [PMID: 22322075 DOI: 10.1016/j.neulet.2012.01.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/16/2011] [Accepted: 01/24/2012] [Indexed: 11/24/2022]
Abstract
The objective of this study was to investigate the associations between clock drawing test (CDT) performance and subcortical brain morphology. Fifty-four participants (21 patients with Alzheimer's disease, 23 with mild cognitive impairment and 10 healthy controls) underwent neuropsychological assessment and high-resolution magnetic resonance imaging at 3T. CDT performance was related to volume and shape measurements of amygdala, caudate nucleus, hippocampus, nucleus accumbens, pallidum, putamen, and thalamus, respectively. Impaired CDT performance was correlated with alterations predominantly in the hippocampus bilaterally and in the right globus pallidus. These associations referred to regionally specific morphometric alterations rather than to global atrophy of the respective structures. Our findings support an involvement of subcortical brain regions in CDT performance.
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Affiliation(s)
- Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Voss-Str. 4, 69115 Heidelberg, Germany
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Schreml S, Meier R, Albert M, Seidl U, Zeller V, Behm B, Landthaler M, Abels C, Babilas P. The Impact of 10% α-Hydroxy Acid Emulsion on Skin pH. Skin Pharmacol Physiol 2012; 25:34-8. [DOI: 10.1159/000331204] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 07/19/2011] [Indexed: 01/23/2023]
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Dos Santos V, Thomann PA, Wüstenberg T, Seidl U, Essig M, Schröder J. Morphological cerebral correlates of CERAD test performance in mild cognitive impairment and Alzheimer's disease. J Alzheimers Dis 2011; 23:411-20. [PMID: 21116054 DOI: 10.3233/jad-2010-100156] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the association between structural cerebral changes and neuropsychological deficits in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Sixty patients with MCI, 34 patients with mild to moderate AD, and 32 healthy controls underwent both extensive neuropsychological assessment (CERAD test battery) and high-resolution structural magnetic resonance imaging. We used optimized voxel based morphometry to investigate (i) differences in gray matter density between the three aforementioned groups and (ii) the putative relations of CERAD test performance with atrophic brain changes. When compared to the healthy controls, the AD patients and, to a lesser extent, patients with MCI showed significant density losses predominantly in the medial temporal lobe. Deficits in verbal fluency and word finding were significantly correlated with left fronto-temporal and left temporal (including hippocampal) changes, respectively. Decreased scores in immediate and delayed recall and in delayed recognition were associated with several cortical and subcortical sites including the parahippocampal and posterior cinguli gyri, the right thalamus, and the right hippocampus, whereas deficits in constructional praxis and constructional praxis recall referred to sites in the left thalamus and cerebellum, and the temporal cortices (bilaterally), respectively. Our findings lend further support for medial temporal lobe degeneration in MCI and AD and demonstrate that cognitive deficits as assessed on the CERAD do not simply refer to specific changes in discrete cerebral sites but rather reflect morphological alterations in widespread networks.
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Affiliation(s)
- Vasco Dos Santos
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
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Giesel FL, Mehndiratta A, Hohmann N, Seidl U, Essig M, Schr Ouml der J. WITHDRAWN: Stability of cerebral activation patterns in patients with first-episode schizophrenia and a healthy control group using functional MRI. Eur J Radiol 2011:S0720-048X(11)00544-4. [PMID: 21741193 DOI: 10.1016/j.ejrad.2011.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/01/2011] [Indexed: 11/23/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Frederik Lars Giesel
- German Cancer Research Center, Radiology, INF 280, 69120 Heidelberg, Germany; Department of Nuclear Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
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Seidl U, Thomann P, Schröder J. P3‐391: Apathy in Alzheimer's disease. Alzheimers Dement 2011. [DOI: 10.1016/j.jalz.2011.05.1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Philipp Thomann
- Department of PsychiatrySection of Geriatric PsychiatryHeidelbergGermany
| | - Johannes Schröder
- Department of PsychiatrySection of Geriatric PsychiatryHeidelbergGermany
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Hirjak D, Stieltjes B, Fritzsche K, Wüstenberg T, Seidl U, Essig M, Schröder J, Thomann P. FC07-03 - Neurological soft signs and morphological changes of basal ganglia and thalamus in patients with first-episode psychosis. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
ObjectivesMinor motor and sensory deficits or neurological soft signs (NSS) are frequently found in individuals suffering from schizophrenia at any stage of their illness. The basal ganglia and the thalamus are accepted as being important for both motor control and integration of sensory input. However, whether NSS are related to structural alterations of these brain regions remains controversial.Method20 patients with a first-episode psychosis were investigated using high-resolution magnetic resonance imaging (MRI) at 3 Tesla. NSS were examined on the Heidelberg Scale after remission of acute symptoms and correlated with volume and shape of striatum, pallidum and thalamus by using sophisticated MRI analyses, namely VBM-DARTEL (volume) and FSL-FIRST (shape).Results NSS scores in patients with schizophrenia were significantly associated with volumetric changes and surface alterations in all investigated areas. Associations remained significant when controlling for age, gender, education, medication and intracranial volume.ConclusionOur findings lend further support for an involvement of the basal ganglia and the thalamus in NSS.
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Affiliation(s)
- Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Philipp A. Thomann
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
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Kaiser E, Thomann PA, Seidl U, Schröder J. CSF-concentrations of tau-protein, phospho-tau-protein (181) and amyloid-beta (1–42) in patients with stable and non-stable MCI. Pharmacopsychiatry 2009. [DOI: 10.1055/s-0029-1240143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Thomann PA, Dos Santos V, Seidl U, Toro P, Essig M, Schröder J. MRI-derived atrophy of the olfactory bulb and tract in mild cognitive impairment and Alzheimer's disease. J Alzheimers Dis 2009; 17:213-21. [PMID: 19494444 DOI: 10.3233/jad-2009-1036] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
There is increasing histopathological evidence that the olfactory bulb and tract (OBT) is a primary focus of neurodegenerative changes in Alzheimer's disease (AD). Correspondingly, high-resolution magnetic resonance imaging revealed significant atrophy of the OBT in manifest AD. Whether these alterations are already present in mild cognitive impairment, the assumed preclinical stage of AD, has not been investigated yet. OBT volumes were assessed by manual tracing in 29 patients with mild cognitive impairment, 27 patients with probable AD, and 30 healthy controls. In a second step, voxel based morphometry was used to investigate the potential association between OBT atrophy and morphological changes in other brain regions. Patients had significantly lower OBT volumes when compared to controls, with atrophy being most prominent in the AD group. In addition, OBT atrophy was associated with a decreased medial temporal lobe (MTL) gray matter density bilaterally. Our findings indicate that neurodegeneration in OBT and MTL regions is linked and suggest that OBT volume might be a surrogate marker in AD.
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Affiliation(s)
- Philipp A Thomann
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany.
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Thomann PA, Schläfer C, Seidl U, Santos VD, Essig M, Schröder J. The cerebellum in mild cognitive impairment and Alzheimer's disease - a structural MRI study. J Psychiatr Res 2008; 42:1198-202. [PMID: 18215400 DOI: 10.1016/j.jpsychires.2007.12.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 11/20/2007] [Accepted: 12/05/2007] [Indexed: 01/11/2023]
Abstract
Neuropathological research consistently revealed the cerebellum to undergo degenerative changes in Alzheimer's disease (AD). Whether these alterations affect cerebellar morphology in vivo has not yet been investigated in a comprehensive way. Magnetic resonance imaging was performed in 20 patients with AD, 20 with mild cognitive impairment (MCI), and 20 healthy controls. By manual tracing the cerebellum was divided in four substructures (anterior lobe, superior posterior lobe, inferior posterior lobe and corpus medullare, respectively) on each hemisphere. Posterior cerebellar lobes were significantly smaller in AD patients when compared to healthy controls. In the AD group, atrophy of the posterior cerebellar regions was associated with poorer cognitive performance. Our findings lend further support for cerebellar involvement in AD.
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Affiliation(s)
- Philipp A Thomann
- Section of Geriatric Psychiatry, University of Heidelberg, Vossstr. 4, 69115 Heidelberg, Germany.
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Gousetis S, Rommel F, Parzer P, Seidl U, Schreiner R, Kopitz J, Bergemann N. Olanzapine Concentrations in Plasma and CSF. Pharmacopsychiatry 2008. [DOI: 10.1055/s-0028-1088246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Seidl U, Lueken U, Toro P, Schröder J. P3‐178: Apathy and facial expressions in demented nursing home residents. Alzheimers Dement 2008. [DOI: 10.1016/j.jalz.2008.05.1744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Pablo Toro
- University Clinic HeidelbergHeidelbergGermany
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43
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Thomas C, vom Berg I, Rupp A, Seidl U, Schröder J, Roesch-Ely D, Kreisel SH, Mundt C, Weisbrod M. P50 gating deficit in Alzheimer dementia correlates to frontal neuropsychological function. Neurobiol Aging 2008; 31:416-24. [PMID: 18562045 DOI: 10.1016/j.neurobiolaging.2008.05.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/21/2008] [Accepted: 05/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cognitive inhibition processes were found to be deficient early in the clinical course of Alzheimer's disease (AD). The inhibition of redundant information is a precondition for efficient cognitive processing and presumably modulated by prefrontal attentional networks. Deficits in the suppression of the evoked potential P50 response to paired clicks are well known in schizophrenic patients and undergo cholinergic modulation. In this study, we aimed to investigate inhibitory gating deficits of P50 in AD and their relation to neuropsychological measures. METHOD P50 suppression was assessed in 19 AD-patients in comparison to a young and elderly control group (n=17 each) and related to MMSE and specific neuropsychological assessments. RESULTS Patients showed reduced sensory gating compared to healthy elderly (p<0.021) and exhibited significantly higher N40-P50-amplitudes. There were no age or gender effects in controls. Frontal neuropsychological tests (TMT-B, verbal fluency) and working memory requiring inhibition, but not declarative memory functions, were significantly correlated with inhibitory gating and test amplitude in both, AD-patients and controls. CONCLUSIONS The results support an early inhibitory deficit interfering with executive functions and working memory in AD independent from physiological aging. P50 gating might be applicable as a marker for inhibition deficits and thereby be important for prognosis estimation.
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Affiliation(s)
- Christine Thomas
- Centre for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Vossstr. 2, 69115 Heidelberg, Germany.
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Shoval N, Auslander GK, Freytag T, Landau R, Oswald F, Seidl U, Wahl HW, Werner S, Heinik J. The use of advanced tracking technologies for the analysis of mobility in Alzheimer's disease and related cognitive diseases. BMC Geriatr 2008; 8:7. [PMID: 18366748 PMCID: PMC2291469 DOI: 10.1186/1471-2318-8-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Accepted: 03/26/2008] [Indexed: 11/20/2022] Open
Abstract
Background One of the more common behavioral manifestations of dementia-related disorders is severe problems with out-of-home mobility. Various efforts have been attempted to attain a better understanding of mobility behavior, but most studies are based on institutionalized patients and the assessment usually relies on reports of caregivers and institutional staff, using observational approaches, activity monitoring, or behavioral checklists. The current manuscript describes the research protocol of a project that measures mobility in Alzheimer's disease and related cognitive disorders in an innovative way, by taking advantage of advanced tracking technologies. Methods/design Participants are 360 demented persons, mildly cognitively impaired persons, and unimpaired controls aged ≥ 65 in Israel and Germany. Data regarding space-time activities will be collected via a GPS tracking kit for a period of 4 weeks in 3 waves (one year apart) with the same participants (using a repeated measures design). Participants will be interviewed by use of a battery of instruments prior to and following GPS data collection. Further, a family member will complete a questionnaire both before and after data tracking. Statistical analyses will strive to explain differences in mobility based on a wide range of socio-structural, clinical, affect-related and environmental variables. We will also assess the impact of the use of advanced tracking technology on the quality of life of dementia patients and care givers, as well as its potential as a diagnostic tool. Systematic assessment of ethical issues involved in the use of tracking technology will be an integral component of the project. Discussion This project will be able to make a substantial contribution to basic as well as applied and clinical aspects in the area of mobility and cognitive impairment research. The innovative technologies applied in this study will allow for assessing a range of dimensions of out-of-home mobility, and provide better quality data.
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Affiliation(s)
- Noam Shoval
- Department of Geography, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel.
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Ahlsdorf E, Seidl U, Markowitsch HJ, Schröder J. Autobiographical Memory and Cognitive Disorders. Pharmacopsychiatry 2007. [DOI: 10.1055/s-2007-1002799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hunt A, Schönknecht P, Henze M, Seidl U, Haberkorn U, Schröder J. Reduced cerebral glucose metabolism in patients at risk for Alzheimer's disease. Psychiatry Res 2007; 155:147-54. [PMID: 17524628 DOI: 10.1016/j.pscychresns.2006.12.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Revised: 04/10/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
While significantly reduced glucose metabolism in fronto-temporo-parietal and cingulate cortices has been demonstrated in Alzheimer's disease (AD) compared with controls, cerebral glucose metabolism in patients with mild cognitive impairment who subsequently develop AD is less well-defined. In the present study we measured cerebral glucose metabolism by positron emission tomography (PET) with (18)F-2-fluoro-2-deoxy-D-glucose in 14 patients with aging-associated cognitive decline (AACD), 44 patients with AD, and 14 healthy control subjects at baseline. The AACD patients were clinically followed up, and conversion to AD was determined. Compared with controls, AACD patients had significantly reduced glucose metabolism in the right precuneus, posterior cingulate, right angular gyrus, and bilateral middle temporal cortices, while the respective deficits were more pronounced in AD patients and also involved the frontal cortices. AACD patients who subsequently converted to AD (AACD-converters) showed more extended metabolic changes which also involved the frontal and temporal cortices, right cingulate gyrus, right thalamus, and bilateral precuneus.
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Affiliation(s)
- Aoife Hunt
- Section for Geriatric Psychiatry, Ruprecht-Karls-University Heidelberg, Voss-Strasse 4, D-69115 Heidelberg, Germany
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Lueken U, Seidl U, Völker L, Schweiger E, Kruse A, Schröder J. Development of a short version of the Apathy Evaluation Scale specifically adapted for demented nursing home residents. Am J Geriatr Psychiatry 2007; 15:376-85. [PMID: 17463188 DOI: 10.1097/jgp.0b013e3180437db3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Apathy is among the most frequent neuropsychiatric symptoms in dementia, particularly Alzheimer disease. The Apathy Evaluation Scale (AES) has been widely employed for assessing apathy in different patient groups. To further facilitate the usage of the AES, an abbreviated version was constructed. METHOD On basis of a sample of 356 nursing home residents, a cross-validation procedure was carried out to develop a brief version of the AES. According to a thorough clinical examination, 85% of the residents were demented, 8% presented with mild cognitive impairment, whereas 7% did not present any cognitive deficits. After subdividing the patient group into two matched samples, the first subsample was used to identify problematic items due to defined psychometric and content-related criteria. The original 18-item scale was thus reduced to 10 items. Psychometric properties of the shortened version were subsequently reassessed in the second subsample. RESULTS The short version demonstrated favorable psychometric properties that could be confirmed by cross-validation with the second sample. Correlations with the original full-length version were high (r = 0.97 for both subsamples); the shortened scale yielded no substantial losses regarding internal consistency or construct validity (correlations with the respective subscales of the Neuropsychiatric Inventory). CONCLUSION The frequency of apathetic symptoms in the nursing home residents included confirms the clinical importance of apathy for understanding dementia. Given this specific patient population, setting, and mode of data collection, the short-version AES seems to be a valuable and time-efficient instrument for assessing apathy.
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Affiliation(s)
- Ulrike Lueken
- Section of Geriatric Psychiatry, University of Heidelberg, Germany
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Seidl U, Lueken U, Völker L, Re S, Becker S, Kruse A, Schröder J. [Non-cognitive symptoms and psychopharmacological treatment in demented nursing home residents]. Fortschr Neurol Psychiatr 2007; 75:720-7. [PMID: 17464898 DOI: 10.1055/s-2007-959211] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dementias, in particular Alzheimer's disease (AD), are the main reason for availing of nursing home care. In the course of the illness, the clinical picture is affected by cognitive decline and by other psychopathological, "non-cognitive" symptoms such as apathy, depression, delusions or agitation. Little attention has been paid to these symptoms, although they lead to an increase in strain on the patients and their relatives as well as complications in nursing care. Psychopathological symptoms were evaluated by using the Neuropsychiatric Inventory in 145 nursing home residents (age: 85 +/- 7 years, duration of stay: 35 +/- 48 months); the majority of them with moderate to severe dementia (GDS: 5 +/- 2; MMSE: 11 +/- 9). In addition, the Apathy Evaluation Scale was applied. To meet potential regional effects, residents were recruited in nursing homes in the areas around Heidelberg as well as Munster. 87% of the participants showed psychopathological symptoms of an at least moderate degree, depressive mood (52%), apathy (41%) and agitation (38%) being most frequent. General condition, nutritional status and care status were evaluated as 'good', likewise general health care. In contrast, only 27% were treated by psychiatrists. 70% received psychopharmacological treatment, mostly sedatives (44%), while antidementive drugs were used only in 11%. The findings underline the need of further information and advanced training.
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Affiliation(s)
- U Seidl
- Sektion Gerontopsychiatrie, Psychiatrische Universitätsklinik Heidelberg
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Abstract
Zusammenfassung: Störungen der Gedächtnisfunktionen bilden das Achsensymptom demenzieller Erkrankungen, insbesondere der Alzheimer-Demenz (AD) als ihrer häufigsten Form. Gerade Defizite des autobiographischen Gedächtnisses entstehen schon in den Anfangsstadien der Erkrankung und betreffen primär Erinnerungen an selbst Erfahrenes einschließlich prägender Lebensereignisse, während äußere Lebensdaten noch lange abrufbar bleiben. Autobiographische Gedächtnisdefizite wurden nur selten untersucht, vor allem da derartige Studien besondere methodische Anforderungen stellen, die sich aus der Individualität des erinnerten Materials und dem Charakter demenzieller Erkrankungen ergeben. Wir haben deshalb autobiographische Gedächtnisdefizite differenziert nach semantischen und episodischen Qualitäten mit dem “Bielefelder Autobiographischen Gedächtnisinventar” (BAGI) in einer modifizierten Version bei 230 Heimbewohnern (24 kognitiv Gesunde; 28 mit leichter kognitiver Beeinträchtigung; 178 mit manifester AD) untersucht. Eine nachhaltige Beeinträchtigung des autobiographischen Gedächtnisses zeigte sich dabei schon in frühen Phasen der AD. Bereits Bewohner mit leichter kognitiver Beeinträchtigung wiesen ausgeprägte Defizite des episodischen Gedächtnisses auf, die bei mittelgradiger oder schwerer AD fortbestanden. Demgegenüber gingen semantische autobiographische Gedächtnisinhalte graduell verloren, sodass weitreichende Defizite erst bei stark Eingeschränkten entstanden. Die Kenntnis dieser Zusammenhänge vertieft nicht nur unser Verständnis der Alzheimer- Demenz, sondern erweitert auch das verfügbare diagnostische Instrumentarium.
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Affiliation(s)
- Ulrich Seidl
- Sektion Gerontopsychiatrie, Universitätsklinik Heidelberg
| | - Elke Ahlsdorf
- Sektion Gerontopsychiatrie, Universitätsklinik Heidelberg
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Lueken U, Seidl U, Schwarz M, Völker L, Naumann D, Mattes K, Schröder J, Schweiger E. Die Apathy Evaluation Scale: Erste Ergebnisse zu den psychometrischen Eigenschaften einer deutschsprachigen Übersetzung der Skala. Fortschr Neurol Psychiatr 2006; 74:714-22. [PMID: 17167730 DOI: 10.1055/s-2006-932164] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Apathy is a common feature of a variety of different psychiatric, neurological, and medical disorders. It can be defined as lack of motivation affecting cognitive, emotional, and overt behavioural aspects. Despite being associated with other clinical disorders, apathy can also occur as an independent syndrome (e. g., after brain injuries), now depicting a primary loss of motivation. However, apathy is predominantly assessed within the scope of superordinate psychiatric disorders. As a syndrome-independent scale, the Apathy Evaluation Scale (AES) claims to assess levels of apathy in different disorders. The aim of the present study is to provide German speaking researchers with an authorized German translation of the AES (AES (D)). The scale was evaluated in a sample of 217 subjects, consisting of patients suffering from dementia (n=120), remission-phase schizophrenia (n=20), Parkinson's disease (n=12), stroke (n=28), as well as elderly healthy controls (n=37). Preliminary results concerning the factorial structure, item characteristics, reliability, and construct validity demonstrate favourable statistical properties and suggest that the AESD is comparable to its original. The scale seems well-suited to detect apathy in different clinical groups. Differences between informant sources (clinician interview, self-, and informant ratings) seem to be related to the severity of symptoms or expert practice.
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Affiliation(s)
- U Lueken
- Zentrum für Neuropsychologische Forschung, Universität Trier, Germany.
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