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Hildebrandt H, Eling P. Comments on energy conservation treatments for MS-related fatigue and a new proposal. J Neurol Sci 2024; 461:123040. [PMID: 38735103 DOI: 10.1016/j.jns.2024.123040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
Psychological treatments of MS-related fatigue mostly depend on energy conservation programs. We argue that the evidence for energy conservation training is weak - in contrast to some reviews on this topic. The reasons for our concerns are the use of informed passive control groups allowing negative placebo effects, the lack of predefined primary outcome parameter, statistically rather than clinically significant effects, and the use of insensitive fatigue questionnaires. We propose to base psychological interventions not on a view of fatigue as a constant loss of mental energy but as a subjective representation ("feeling") of an inflammatory state, which draws away attentional capacity. This conceptualization allows to develop a three-step treatment approach: Getting short-term control on fatigue, extinction to reduce fatigue-related avoidance behavior, and a systematic increase of activities by pacing. Our proposal depends on the techniques, that can interrupt ongoing feelings of fatigue and can serve as a basis for extinction. We propose that Progressive Muscle Relaxation might be such a technique. The advantage of our model is that it shares similarities with well-established treatments for phobias and chronic pain and we discuss the shared set of assumptions. Hopefully, this will help to improve the treatment of fatigue in future.
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Affiliation(s)
- Helmut Hildebrandt
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany; Institute of Psychology, University of Oldenburg, Oldenburg, Germany.
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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2
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Garis G, Dettmers C, Hildebrandt A, Duning T, Hildebrandt H. Comparing two relaxation procedures to ease fatigue in multiple sclerosis: a single-blind randomized controlled trial. Neurol Sci 2023; 44:4087-4098. [PMID: 37698785 PMCID: PMC10570225 DOI: 10.1007/s10072-023-07042-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Various relaxation procedures have been proposed to reduce fatigue in multiple sclerosis (MS). However, it is unknown, which type of relaxation has the largest effect on fatigue reduction and on autonomic nervous system (ANS) activity. OBJECTIVE We aimed to compare two biofeedback-supported relaxation exercises: a deep breathing (DB) exercise and progressive muscle relaxation (PMR), which may ameliorate MS fatigue and alter ANS activity. METHODS We performed a single-blind randomized clinical trial, introducing MS patients (n = 34) to the DB or PMR exercise. We first tested cardiovagal integrity, reflected by changes in heart rate variability (HRV) in response to DB. Participants then performed a fatigue-inducing vigilance task, followed by the DB or PMR. State fatigue was recorded consecutively at baseline, after the vigilance task, and after the relaxation exercise, along with HRV reflecting ANS activity. RESULTS Only patients assigned to the PMR group experienced a significant drop in fatigue, whereas both relaxation exercises changed ANS activity. MS patients showed the expected autonomic response during the cardiovagal reflex test. The vigilance task elevated short-term feelings of fatigue and significantly reduced HRV parameters of parasympathetic activity. Trait fatigue was negatively correlated with HRV during the second half of the vigilance task. CONCLUSION PMR alleviates short-term feelings of fatigue in persons with MS. The vigilance task in combination with HRV measurements may be helpful for evaluating relaxation procedures as a treatment of fatigue. Hereby, future studies should ensure longer and more frequent relaxation exercises and focus on patients with weak to moderate fatigue. TRIAL REGISTRATION Trial Registry: DRKS00024358.
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Affiliation(s)
- Guadalupe Garis
- Department of Psychology, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.
- Department of Neurology, Klinikum Bremen-Ost, 28325, Bremen, Germany.
| | | | - Andrea Hildebrandt
- Department of Psychology, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Duning
- Department of Neurology, Klinikum Bremen-Ost, 28325, Bremen, Germany
| | - Helmut Hildebrandt
- Department of Psychology, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.
- Department of Neurology, Klinikum Bremen-Ost, 28325, Bremen, Germany.
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Schenke N, Diestel E, Kastrup A, Eling P, Hildebrandt H. Monocular eye patching modulates reorienting of covert attention in patients with unilateral middle cerebral artery stroke. Brain Cogn 2023; 169:106000. [PMID: 37253302 DOI: 10.1016/j.bandc.2023.106000] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
Unilateral brain lesions can lead to impaired contralesional attention and reduced ipsilesional and enhanced contralesional superior colliculus (SC) activity. We aimed to investigate whether modulation of SC activation via monocular eye patching can improve contralesional attention. Twenty left-hemispheric (LH) and 20 right-hemispheric (RH) patients with an acute or subacute middle cerebral artery (MCA) stroke completed an endogenous version of the Posner cueing task twice, while the left or right eye was covered with an eye patch. The LH and RH patients showed significantly slower reactions to contralesional than to ipsilesional stimuli. In addition, the eye patch modulated responses to invalidly but not those to validly cued stimuli. Post hoc analyses could not discriminate whether this effect pertained to a particular target side or eye patch position. However, exploratory analyses indicated that the observed eye patch effect might affect the RH group more than the LH group. As predicted 36 years ago, monocular eye patching modulates visuospatial attention, presumably due to differences in SC activation between the two eye patch conditions. However, this modulation seems too weak and unspecific, and therefore possibly not strong enough to be a treatment option for patients with visuospatial attention impairments.
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Affiliation(s)
- Nadine Schenke
- Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.
| | - Elfriede Diestel
- Department for Education and Human Development, Leibniz Institute for Research and Information in Education, Frankfurt/Main, Germany
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Helmut Hildebrandt
- Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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Schenke N, Hildebrandt H. P-93 Monocular eye patching modulates ipsilesional cueing in patients with small right-hemispheric media ischemia. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Hildebrandt H, Notbohm A, Duning T, Schweser I. Is recovery from left-sided neglect based on changes in automatic attention? An auditory event related potentials study. Appl Neuropsychol Adult 2023:1-11. [PMID: 36587828 DOI: 10.1080/23279095.2022.2163173] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
An automatic spatial attention deficit is the primary deficit in neglect. However, the cognitive processes enabling recovery from neglect have rarely been studied. We used event-related potentials (ERP) to analyze if recovery is based on changes in automatic attention components. Twelve sub-acute patients with left visuospatial neglect were included. They received 3 weeks of intensive treatment. ERPs were recorded using two auditory paradigms: either a tone was presented randomly to the right or left ear (ATP) or as a Posner paradigm (PP) with left to right and vice versa moving cue tones and validly and invalidly cued target tones. Patients improved significantly on neuropsychological tests and neurological scales. For the ATP, no differences were observed related to the side of stimulation, but the auditory PP showed characteristic results, that is, smaller amplitudes for left-sided targets and higher amplitudes for invalid trials. Both paradigms revealed a treatment effect, but no changes were found in the amplitudes for the two target sides, which would be expected if the treatment would affect the automatic attention bias. Recovery from neglect seems not to be associated with changes in the automatic spatial attention bias, arguing that recovery might be due to higher cognitive compensatory processes.
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Affiliation(s)
- Helmut Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Annika Notbohm
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Thomas Duning
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Insa Schweser
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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6
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Garis G, Haupts M, Duning T, Hildebrandt H. Heart rate variability and fatigue in MS: two parallel pathways representing disseminated inflammatory processes? Neurol Sci 2023; 44:83-98. [PMID: 36125573 PMCID: PMC9816295 DOI: 10.1007/s10072-022-06385-1] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Fatigue is a disabling symptom of multiple sclerosis. Its biological causes are still poorly understood. Several years ago, we proposed that fatigue might be the subjective representation of inflammatory processes. An important step for a straight-forward evaluation of our model would be to show that the level of fatigue is associated with vagal activation. The heart rate is under partial control of the vagus nerve. Using power spectrum analysis allows to separate, at least partly, sympathetic and parasympathetic impact on heart rate variability. METHODS This narrative review summarizes the evidence for heart rate variability changes in MS patients, their relationship with fatigue and disease course. To do this, we conducted a literature search, including 45 articles relevant to the topic treated in this review. RESULTS We illustrate that (1) inflammation leads to a change in cardiac behavior during acute and chronic phases, both in animals and in humans; (2) MS patients show changes of heart rate variability (HRV) that resemble those during acute and chronic inflammation due to multiple causes; (3) existing evidence favors a set of specific predictions about fatigue and parallel HRV changes; and (4) that MS-related brainstem lesions or neurological impairments do not completely explain HRV changes, leaving enough place for an explanatory relation between HRV and fatigue. DISCUSSION We discuss the results of this review in relation to our model of fatigue and propose several observational and experimental studies that could be conducted to gain a better insight into whether fatigue and HRV can be interpreted as a common pathway, both reflecting activated autoimmune processes in MS patients.
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Affiliation(s)
- Guadalupe Garis
- grid.5560.60000 0001 1009 3608Department of Psychology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany ,grid.419807.30000 0004 0636 7065Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Michael Haupts
- grid.411327.20000 0001 2176 9917Department of Neurology, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Thomas Duning
- grid.419807.30000 0004 0636 7065Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Helmut Hildebrandt
- grid.5560.60000 0001 1009 3608Department of Psychology, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany ,grid.419807.30000 0004 0636 7065Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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Hildebrandt H. Longley et al.: Non-pharmacological interventions for spatial neglect or inattention following stroke and other non-progressive brain injury. Cochrane Database of Systematic Reviews, 2021. Neuropsychol Rehabil 2022; 32:2673-2678. [PMID: 34402392 DOI: 10.1080/09602011.2021.1956977] [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: 12/30/2022]
Affiliation(s)
- Helmut Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.,Institute of Psychology, University of Oldenburg, Oldenburg, Germany
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Hartmann A, Hildebrandt H, Younan Z, Al-Nawas B, Kämmerer PW. Long-term results in three-dimensional, complex bone augmentation procedures with customized titanium meshes. Clin Oral Implants Res 2022; 33:1171-1181. [PMID: 36168748 DOI: 10.1111/clr.14000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 03/29/2022] [Revised: 08/18/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Complex, three-dimensional bony defects still represent challenging situations in routine implant dentistry. The aim of this study was to evaluate implant survival in customized bone regeneration using a patient-specific titanium mesh. MATERIAL AND METHODS Patients (n=21, implants 36) who had obtained an augmentation procedure with patient-specific titanium mesh were examined after 5.7 ± 0.38 years. Survival rate, clinical parameters for periimplantitis (bleeding on probing (BOP) and suppuration) and radiographic examination were evaluated. Peri-implant marginal bone loss (MBL) was calculated by using an image assessment program. Additionally, the influence of various factors on treatment outcome like periodontitis, smoking, professional maintenance, or diabetes was assessed as well as the impact on quality of life applying the Oral Health Impact Profile (OHIP). RESULTS The implant survival rate was 97%, with one implant loss in the lower jaw. At the end of the observation period MBL showed mesial 0.13±1.84mm and distal -0.13±1.73mm. The lower jaw showed significant more MBL mesial compared to the upper jaw (p=0.034, cluster-adjusted). Periodontitis was significantly associated with MBL mesial and distal (p<0.05). Positive BOP (four implants) was significantly associated with MBL mesial (p=0.0031) and distal (p=0.0018). MBL was significantly associated with suppuration mesial (p<0.0001) and distal (p<0.0001). CONCLUSIONS CBR® results in high implant survival rate and stabilized augmented marginal bone after follow-up of minimum 5 years. Periodontitis seems to play the mayor role for long-term stability indicated by BOP and suppuration.
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Affiliation(s)
- Amely Hartmann
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany.,Private Practice Dr. Seiler und Kollegen MVZ, Filderstadt, Germany
| | | | - Zina Younan
- Private Practice Am Mühlenviertel MVZ, Bremen, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, Mainz, Germany
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Böhm K, Quilling E, Hildebrandt H, Alayli A. MULTISEKTORALE ANSÄTZE DER GESUNDHEITSFÖRDERUNG: VON
KOOPERATIONEN ZU PARTNERSCHAFTEN. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753912] [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: 12/12/2022]
Affiliation(s)
- K Böhm
- HAGE – Hessische Arbeitsgemeinschaft für
Gesundheitsförderung e.V., Frankfurt, Deutschland
| | - E Quilling
- Hochschule für Gesundheit, Bochum, Deutschland
| | | | - A Alayli
- Universitätsklinikum Düsseldorf, Fachbereich
Versorgungsforschung im Kindes- und Jugendalter, Klinik für allgemeine
Pädiatrie, Neonatologie und pädiatrische Kardiologie,
Düsseldorf, Deutschland
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10
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Ertas-Spantgar F, Müller SV, Korabova S, Gabel A, Schiering I, Pape AE, Hildebrandt H. Errorless learning and assistive technology did not improve the negative prognosis for severe dressing impairment after stroke if persisting for two weeks: A randomized controlled trial. Appl Neuropsychol Adult 2022:1-9. [PMID: 35786077 DOI: 10.1080/23279095.2022.2090839] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following severe cerebrovascular accidents, patients are often unable to dress themselves. Little is known about the persistence and treatment of this impairment. Study 1 followed 23 patients who were (1) completely dependent on others for help with dressing (2) for two weeks continually until their discharge from the rehabilitation unit. Study 2, a randomized controlled trial of 24 patients, examined the effects of errorless learning and RehaGoal App-based dressing practice on recovery in dressing ability-impaired patients who also experienced visuospatial neglect and/or apraxia. The control and intervention groups both underwent a standard therapy in the rehab unit; the intervention group additionally received dressing training (seven sessions of 45 min). The primary outcome measure was the score on an adapted version of the Nottingham Stroke Dressing Assessment; secondary outcome measures were the Barthel Index and Functional Independence Measure. Less than one-third of the patients in Study1, showed improvement. In Study 2, the intervention produced no specific effect on patients' dressing ability. However, apraxia and neglect predicted improvement for both groups. If patients depend completely on assistance for dressing for two weeks, prospects for recovery are limited. Future studies should include additional intervention sessions and incorporate treatments for neglect or apraxia.
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Affiliation(s)
- Funda Ertas-Spantgar
- Faculty of Social Work, Ostfalia University of Applied Science, Wolfenbuttel, Germany
| | - Sandra Verena Müller
- Faculty of Social Work, Ostfalia University of Applied Science, Wolfenbuttel, Germany
| | - Sona Korabova
- Department of Geriatric, St.Bernward Krankenhaus, Hildesheim, Germany
| | - Alexander Gabel
- Faculty of Computer Science, Ostfalia University of Applied Science, Wolfenbuttel, Germany
| | - Ina Schiering
- Faculty of Computer Science, Ostfalia University of Applied Science, Wolfenbuttel, Germany
| | - Anna E Pape
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Helmut Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, Carl von Ossietzky, University of Oldenburg, Oldenburg, Germany
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Geraedts M, Bierbaum T, Gröne O, Härter M, Hildebrandt H, Hoffmann W, Klinkhammer-Schalke M, Köberlein-Neu J, Schmitt J. Methoden und Indikatorensets für die Evaluation regionaler
sektorverbindender Versorgungsmodelle. Gesundheitswesen 2022. [DOI: 10.1055/a-1824-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Scheffels JF, Lipinsky C, Korabova S, Eling P, Kastrup A, Hildebrandt H. The influence of clinical characteristics on prism adaptation training in visuospatial neglect: A post-hoc analysis of a randomized controlled trial. Appl Neuropsychol Adult 2022:1-11. [PMID: 35416101 DOI: 10.1080/23279095.2022.2061353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Previous studies indicate that the effect of prism adaptation training (PAT) on unilateral neglect may depend on clinical characteristics. In this explorative work, we re-analyzed data from a previously conducted randomized controlled trial (N = 23) to investigate whether age, etiology, severity of motor impairments, and visual field deficits affect the efficacy of PAT. Additionally, we reviewed PAT studies that reported lesion maps and distinguished responders from non-responders. We transferred these maps into a common standard brain and added data from 12 patients from our study. We found patients suffering from subarachnoid bleeding appeared to show stronger functional recovery than those with intracranial hemorrhage or cortical infarction. Furthermore, patients with visual field deficits and those with more severe contralateral motor impairments had larger after-effect sizes but did not differ in treatment effects. In addition, patients with parietal lesions showed reduced recovery, whereas patients with lesions in the basal ganglia recovered better. We conclude that PAT (in its current form) is effective when fronto-subcortical areas are involved but it may not be the best choice when parietal regions are affected. Overall, the present work adds to the understanding on the effects of clinical characteristics on PAT.
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Affiliation(s)
- J F Scheffels
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - C Lipinsky
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - S Korabova
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - P Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - A Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - H Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
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13
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Jansen WJ, Janssen O, Tijms BM, Vos SJB, Ossenkoppele R, Visser PJ, Aarsland D, Alcolea D, Altomare D, von Arnim C, Baiardi S, Baldeiras I, Barthel H, Bateman RJ, Van Berckel B, Binette AP, Blennow K, Boada M, Boecker H, Bottlaender M, den Braber A, Brooks DJ, Van Buchem MA, Camus V, Carill JM, Cerman J, Chen K, Chételat G, Chipi E, Cohen AD, Daniels A, Delarue M, Didic M, Drzezga A, Dubois B, Eckerström M, Ekblad LL, Engelborghs S, Epelbaum S, Fagan AM, Fan Y, Fladby T, Fleisher AS, Van der Flier WM, Förster S, Fortea J, Frederiksen KS, Freund-Levi Y, Frings L, Frisoni GB, Fröhlich L, Gabryelewicz T, Gertz HJ, Gill KD, Gkatzima O, Gómez-Tortosa E, Grimmer T, Guedj E, Habeck CG, Hampel H, Handels R, Hansson O, Hausner L, Hellwig S, Heneka MT, Herukka SK, Hildebrandt H, Hodges J, Hort J, Huang CC, Iriondo AJ, Itoh Y, Ivanoiu A, Jagust WJ, Jessen F, Johannsen P, Johnson KA, Kandimalla R, Kapaki EN, Kern S, Kilander L, Klimkowicz-Mrowiec A, Klunk WE, Koglin N, Kornhuber J, Kramberger MG, Kuo HC, Van Laere K, Landau SM, Landeau B, Lee DY, de Leon M, Leyton CE, Lin KJ, Lleó A, Löwenmark M, Madsen K, Maier W, Marcusson J, Marquié M, Martinez-Lage P, Maserejian N, Mattsson N, de Mendonça A, Meyer PT, Miller BL, Minatani S, Mintun MA, Mok VCT, Molinuevo JL, Morbelli SD, Morris JC, Mroczko B, Na DL, Newberg A, Nobili F, Nordberg A, Olde Rikkert MGM, de Oliveira CR, Olivieri P, Orellana A, Paraskevas G, Parchi P, Pardini M, Parnetti L, Peters O, Poirier J, Popp J, Prabhakar S, Rabinovici GD, Ramakers IH, Rami L, Reiman EM, Rinne JO, Rodrigue KM, Rodríguez-Rodriguez E, Roe CM, Rosa-Neto P, Rosen HJ, Rot U, Rowe CC, Rüther E, Ruiz A, Sabri O, Sakhardande J, Sánchez-Juan P, Sando SB, Santana I, Sarazin M, Scheltens P, Schröder J, Selnes P, Seo SW, Silva D, Skoog I, Snyder PJ, Soininen H, Sollberger M, Sperling RA, Spiru L, Stern Y, Stomrud E, Takeda A, Teichmann M, Teunissen CE, Thompson LI, Tomassen J, Tsolaki M, Vandenberghe R, Verbeek MM, Verhey FRJ, Villemagne V, Villeneuve S, Vogelgsang J, Waldemar G, Wallin A, Wallin ÅK, Wiltfang J, Wolk DA, Yen TC, Zboch M, Zetterberg H. Prevalence Estimates of Amyloid Abnormality Across the Alzheimer Disease Clinical Spectrum. JAMA Neurol 2022; 79:228-243. [PMID: 35099509 DOI: 10.1001/jamaneurol.2021.5216] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE One characteristic histopathological event in Alzheimer disease (AD) is cerebral amyloid aggregation, which can be detected by biomarkers in cerebrospinal fluid (CSF) and on positron emission tomography (PET) scans. Prevalence estimates of amyloid pathology are important for health care planning and clinical trial design. OBJECTIVE To estimate the prevalence of amyloid abnormality in persons with normal cognition, subjective cognitive decline, mild cognitive impairment, or clinical AD dementia and to examine the potential implications of cutoff methods, biomarker modality (CSF or PET), age, sex, APOE genotype, educational level, geographical region, and dementia severity for these estimates. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, individual-participant pooled study included participants from 85 Amyloid Biomarker Study cohorts. Data collection was performed from January 1, 2013, to December 31, 2020. Participants had normal cognition, subjective cognitive decline, mild cognitive impairment, or clinical AD dementia. Normal cognition and subjective cognitive decline were defined by normal scores on cognitive tests, with the presence of cognitive complaints defining subjective cognitive decline. Mild cognitive impairment and clinical AD dementia were diagnosed according to published criteria. EXPOSURES Alzheimer disease biomarkers detected on PET or in CSF. MAIN OUTCOMES AND MEASURES Amyloid measurements were dichotomized as normal or abnormal using cohort-provided cutoffs for CSF or PET or by visual reading for PET. Adjusted data-driven cutoffs for abnormal amyloid were calculated using gaussian mixture modeling. Prevalence of amyloid abnormality was estimated according to age, sex, cognitive status, biomarker modality, APOE carrier status, educational level, geographical location, and dementia severity using generalized estimating equations. RESULTS Among the 19 097 participants (mean [SD] age, 69.1 [9.8] years; 10 148 women [53.1%]) included, 10 139 (53.1%) underwent an amyloid PET scan and 8958 (46.9%) had an amyloid CSF measurement. Using cohort-provided cutoffs, amyloid abnormality prevalences were similar to 2015 estimates for individuals without dementia and were similar across PET- and CSF-based estimates (24%; 95% CI, 21%-28%) in participants with normal cognition, 27% (95% CI, 21%-33%) in participants with subjective cognitive decline, and 51% (95% CI, 46%-56%) in participants with mild cognitive impairment, whereas for clinical AD dementia the estimates were higher for PET than CSF (87% vs 79%; mean difference, 8%; 95% CI, 0%-16%; P = .04). Gaussian mixture modeling-based cutoffs for amyloid measures on PET scans were similar to cohort-provided cutoffs and were not adjusted. Adjusted CSF cutoffs resulted in a 10% higher amyloid abnormality prevalence than PET-based estimates in persons with normal cognition (mean difference, 9%; 95% CI, 3%-15%; P = .004), subjective cognitive decline (9%; 95% CI, 3%-15%; P = .005), and mild cognitive impairment (10%; 95% CI, 3%-17%; P = .004), whereas the estimates were comparable in persons with clinical AD dementia (mean difference, 4%; 95% CI, -2% to 9%; P = .18). CONCLUSIONS AND RELEVANCE This study found that CSF-based estimates using adjusted data-driven cutoffs were up to 10% higher than PET-based estimates in people without dementia, whereas the results were similar among people with dementia. This finding suggests that preclinical and prodromal AD may be more prevalent than previously estimated, which has important implications for clinical trial recruitment strategies and health care planning policies.
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Affiliation(s)
- Willemijn J Jansen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Banner Alzheimer's Institute, Phoenix, Arizona
| | - Olin Janssen
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Betty M Tijms
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands
| | - Stephanie J B Vos
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rik Ossenkoppele
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.,Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Pieter Jelle Visser
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, the Netherlands.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Dag Aarsland
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Daniel Alcolea
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Daniele Altomare
- Laboratory Alzheimer's Neuroimaging and Epidemiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fatebenefratelli, Brescia, Italy.,Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Christine von Arnim
- Division of Geriatrics, University of Goettingen Medical School, Goettingen, Germany.,Clinic for Neurogeriatrics and Neurological Rehabilitation, University and Rehabilitation Hospital Ulm, Ulm, Germany
| | - Simone Baiardi
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Spain
| | - Ines Baldeiras
- Center for Neuroscience and Cell Biology (CIBB), University of Coimbra, Coimbra, Portugal.,Neurology Department and Laboratory of Neurochemistry, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Randall J Bateman
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Bart Van Berckel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alexa Pichet Binette
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Department of Neuroscience and Physiology, Sahlgren's University Hospital, Mölndal, Sweden
| | - Merce Boada
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Henning Boecker
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Bonn, Germany
| | - Michel Bottlaender
- Université Paris-Saclay, Service Hospitalier Frédéric Joliot (CEA), French National Centre for Scientific Research (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), BioMaps, Service Hospitalier Frederic Joliot, Orsay, France
| | - Anouk den Braber
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - David J Brooks
- Translational and Clinical Research Institute, University of Newcastle upon Tyne, United Kingdom.,Department of Nuclear Medicine, Positron Emission Tomography Centre, Aarhus University, Aarhus, Denmark.,Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mark A Van Buchem
- Department of Neurology, University Hospital Leiden, Leiden, the Netherlands
| | - Vincent Camus
- Unite Mixte de Recherche, INSERM U930, French National Centre for Scientific Research (CNRS) ERL, Tours, France
| | - Jose Manuel Carill
- Nuclear Medicine Department, University Hospital Marqués de Valdecilla, Molecular Imaging, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), University of Cantabria, Santander, Spain
| | - Jiri Cerman
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, Arizona
| | - Gaël Chételat
- Normandie University, University of Caen Normandie (UNICAEN), INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Elena Chipi
- Centro Disturbi della Memoria, Laboratorio di Neurochimica Clinica, Clinica Neurologica, Università di Perugia, Perugia, Italy
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alisha Daniels
- Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Marion Delarue
- Normandie University, University of Caen Normandie (UNICAEN), INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Mira Didic
- Assistance Publique Hôpitaux de Marseille (AP-HM), Timone, Service de Neurologie et Neuropsychologie, Hôpital Timone Adultes, Marseille, France.,Aix Marseille Univ, INSERM, Institut de Neurosciences des Systèmes (INS), Marseille, France
| | - Alexander Drzezga
- Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE), Bonn, Germany.,Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Bruno Dubois
- Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer, Centre de Référence Démences Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | | | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium.,Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stéphane Epelbaum
- Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer, Centre de Référence Démences Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne M Fagan
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | | | - Wiesje M Van der Flier
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stefan Förster
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Nuclear Medicine, Klinikum Bayreuth, Bayreuth, Germany
| | - Juan Fortea
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kristian Steen Frederiksen
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yvonne Freund-Levi
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden.,Department of Old Age Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lars Frings
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Giovanni B Frisoni
- Memory Clinic, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Lutz Fröhlich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Tomasz Gabryelewicz
- Department of Neurodegenerative Disorders, Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland
| | - Hermann-Josef Gertz
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Kiran Dip Gill
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Olymbia Gkatzima
- Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
| | | | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany
| | - Eric Guedj
- Aix Marseille University, AP-HM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, Centre Européen de Recherche en Imagerie Médicale (CERIMED), Nuclear Medicine Department, Marseille, France
| | - Christian G Habeck
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, New York
| | - Harald Hampel
- Sorbonne University, Clinical Research Group no. 21, Alzheimer Precision Medicine, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Ron Handels
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Lucrezia Hausner
- Universität Heidelberg, Abteilung Gerontopsychiatrie, Zentralinstitut für Seelische Gesundheit Mannheim, Mannheim, Germany
| | - Sabine Hellwig
- Department of Psychiatry and Psychotherapy Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital of Bonn, Bonn, Germany.,Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine-Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, University of Oldenburg, Institute of Psychology, Oldenburg, Germany
| | - John Hodges
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jakub Hort
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | - Ane Juaristi Iriondo
- Center for Research and Advanced Therapies, Centro de Investigación y Ciencias Avanzadas-Alzheimer Foundation, Donostia-San Sebastian, Spain
| | - Yoshiaki Itoh
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Adrian Ivanoiu
- Department of Neurology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - William J Jagust
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley.,Division of Molecular Biophysics and Integrated Bioimaging, Lawrence Berkeley National Laboratory, Berkeley, California
| | - Frank Jessen
- Department of Psychiatry, Medical Faculty, University of Cologne, Cologne, Germany.,Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,DZNE, Bonn, Germany
| | - Peter Johannsen
- Memory Disorder Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Keith A Johnson
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Ramesh Kandimalla
- Department of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Radiation Oncology, Emory University, Atlanta, Georgia.,Applied Biology, Council of Scientific and Industrial Research (CSIR)-Indian Institute of Chemical Technology, Uppal Road, Tarnaka, Hyderabad, Telangana State, India.,Department of Biochemistry, Kakatiya Medical College/Mahatma Gandhi Memorial Hospital, Warangal, Telangana State, India
| | - Elisabeth N Kapaki
- National and Kapodistrian University of Athens, School of Medicine, 1st Department of Neurology, Eginition Hospital, Athens, Greece
| | - Silke Kern
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Aleksandra Klimkowicz-Mrowiec
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - William E Klunk
- Department of Psychiatry, Massachusetts General Hospital, Boston.,Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Milica G Kramberger
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Koen Van Laere
- Division of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium.,Department of Imaging and Pathology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susan M Landau
- Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley
| | - Brigitte Landeau
- Normandie University, University of Caen Normandie (UNICAEN), INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain at Caen-Normandie, Cyceron, Caen, France
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, South Korea
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Cristian E Leyton
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Kun-Ju Lin
- Healthy Aging Research Center and Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan
| | - Alberto Lleó
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Memory Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Malin Löwenmark
- Memory Clinic, Department of Geriatrics, Uppsala University Hospital, Uppsala, Sweden
| | - Karine Madsen
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Wolfgang Maier
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Jan Marcusson
- Acute Internal Medicine and Geriatrics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marta Marquié
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Pablo Martinez-Lage
- Center for Research and Advanced Therapies, CITA-Alzheimer Foundation, Donostia-San Sebastian, Spain
| | | | - Niklas Mattsson
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | | | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Shinobu Minatani
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Mark A Mintun
- Avid Radiopharmaceuticals, Philadelphia, Pennsylvania
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,BrainNow Research Institute, Guangdong Province, Shenzhen, China
| | - Jose Luis Molinuevo
- Alzheimer's Disease and Other Cognitive Disorders Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Clinic University Hospital, Barcelona, Spain
| | - Silvia Daniela Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - John C Morris
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.,Department of Biochemical Diagnostics, University Hospital of Białystok, Białystok, Poland
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania
| | - Flavio Nobili
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Agneta Nordberg
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.,Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Pauline Olivieri
- Department of Neurology of Memory and Language, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, F-75014, Paris, France.,Université de Paris, Paris, Université Paris-Saclay, BioMaps, CEA, CNRS, INSERM, Orsay, France
| | - Adela Orellana
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - George Paraskevas
- National and Kapodistrian University of Athens, School of Medicine, 1st Department of Neurology, Eginition Hospital, Athens, Greece
| | - Piero Parchi
- Istituto delle Scienze Neurologiche di Bologna, IRCCS, Bologna, Italy.,DIMES, University of Bologna, Bologna, Italy
| | | | - Lucilla Parnetti
- Centro Disturbi della Memoria, Laboratorio di Neurochimica Clinica, Clinica Neurologica, Università di Perugia, Perugia, Italy
| | - Oliver Peters
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin-CBF, Berlin, Deutschland
| | - Judes Poirier
- Studies on Prevention of Alzheimer's Disease (StOP-AD) Centre, Montreal, Quebec, Canada
| | - Julius Popp
- Department of Geriatric Psychiatry, University Hospital of Psychiatry Zürich and University of Zürich, Zürich, Switzerland.,Old Age Psychiatry, Department of Psychiatry, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Sudesh Prabhakar
- Department of Neurology, Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gil D Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Inez H Ramakers
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic of Barcelona, IDIBAPS, Barcelona, Spain
| | | | | | - Karen M Rodrigue
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas
| | | | - Catherine M Roe
- Department of Neurology and the Alzheimer's Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Pedro Rosa-Neto
- Studies on Prevention of Alzheimer's Disease (StOP-AD) Centre, Montreal, Quebec, Canada
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco
| | - Uros Rot
- Department of Neurology, Medical Center, Zaloska 7, Ljubljana, Slovenia
| | - Christopher C Rowe
- Department of Molecular Imaging, Austin Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience, University of Melbourne, Melbourne, Victoria, Australia
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University, Göttingen, Germany
| | - Agustín Ruiz
- Research Center and Memory Clinic of Fundació Alzheimer Centre Educacional, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III, Madrid, Spain
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Jayant Sakhardande
- Cognitive Neuroscience Division, Department of Neurology and the Taub Institute, Columbia University, New York, New York
| | - Pascual Sánchez-Juan
- Service of Neurology, University Hospital Marqués de Valdecilla-IDIVAL, CIBERNED, Santander, Spain
| | - Sigrid Botne Sando
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology, University Hospital of Trondheim, Trondheim, Norway
| | - Isabel Santana
- Center for Neuroscience and Cell Biology (CIBB), University of Coimbra, Coimbra, Portugal.,Neurology Department and Laboratory of Neurochemistry, Centro Hospitalar e Universitário de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Marie Sarazin
- Department of Neurology of Memory and Language, Groupe Hospitalier Universitaire Paris Psychiatry and Neurosciences, Hôpital Sainte Anne, F-75014, Paris, France.,Université de Paris, Paris, Université Paris-Saclay, BioMaps, CEA, CNRS, INSERM, Orsay, France
| | - Philip Scheltens
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Johannes Schröder
- Section for Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway
| | - Sang Won Seo
- Department of Neurology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Dina Silva
- Faculty of Medicine, University of Lisboa, Lisboa, Portugal
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Peter J Snyder
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, The University of Rhode Island, Kingston
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Marc Sollberger
- Memory Clinic, University Department of Geriatric Medicine, Felix Platter-Hospital, Basel, Switzerland.,Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Reisa A Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Harvard Aging Brain Study, Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Luisa Spiru
- Geriatrics, Gerontology and Old Age Psychiatry Clinical Department, Carol Davila University of Medicine and Pharmacy-Elias, Emergency Clinical Hospital, Bucharest, Romania.,Memory Clinic and Longevity Medicine, Ana Aslan International Foundation, Bucharest, Romania
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology and the Taub Institute, Columbia University, New York, New York
| | - Erik Stomrud
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Akitoshi Takeda
- Department of Neurology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Marc Teichmann
- Department of Neurology, Institut de la Mémoire et de la Maladie d'Alzheimer, Centre de Référence Démences Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Centre de Référence Démences Rares, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France
| | - Charlotte E Teunissen
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Louisa I Thompson
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jori Tomassen
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Magda Tsolaki
- Aristotle University of Thessaloniki, Memory and Dementia Center, 3rd Department of Neurology, George Papanicolau General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, University of Leuven, Leuven, Belgium.,Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Marcel M Verbeek
- Departments of Neurology and Laboratory Medicine, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Centre, Nijmegen, the Netherlands
| | - Frans R J Verhey
- Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Victor Villemagne
- Department of Molecular Imaging, Austin Health, Melbourne, Victoria, Australia.,Molecular Biomarkers in Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sylvia Villeneuve
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Jonathan Vogelgsang
- Translational Neuroscience Laboratory, McLean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Wallin
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Åsa K Wallin
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.,Center of Neurology, Department of Neurodegeneration and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - David A Wolk
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital, Guishan, Taoyuan, Taiwan.,Healthy Aging Research Center and Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Marzena Zboch
- Research-Scientific-Didactic Centre of Dementia-Related Diseases in Scinawa, Medical University of Wroclaw, Wroclaw, Poland
| | - Henrik Zetterberg
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, University College London (UCL) Queen Square Institute of Neurology, Queen Square, London, United Kingdom.,UK Dementia Research Institute, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
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14
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Scheffels JF, Korabova S, Eling P, Kastrup A, Hildebrandt H. The Effects of Continuous vs. Intermittent Prism Adaptation Protocols for Treating Visuospatial Neglect: A Randomized Controlled Trial. Front Neurol 2021; 12:742727. [PMID: 34867725 PMCID: PMC8639507 DOI: 10.3389/fneur.2021.742727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/16/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Visuospatial neglect may interfere with activities of daily living (ADL). Prism adaptation (PA) is one treatment option and may involve two components: recalibration (more strategic) and realignment (more implicit). We examined whether recalibration or realignment is the driving force in neglect rehabilitation using PA. In a randomized controlled trial with two recruitment series and a cross-over design, 24 neglect patients were allocated to a continuous (PA-c) or intermittent (PA-i) PA procedure. During the PA-c condition, goggles were worn without doffing. In the PA-i condition, patients donned goggles twice (first series of patients) or three times (second series) during training to induce more recalibrations. Primary outcome parameters were performance (omissions) on the Apples Cancellation Test and ADL scores. To assess the efficacy of the PA treatment, we compared effect sizes of the current study with those from three groups from previous studies at the same rehabilitation unit: (1) a passive treatment with a similar intensity, (2) a placebo treatment with a similar intensity, and (3) a PA treatment with fewer therapy sessions. Treatment conditions did not significantly predict scores on primary and most secondary outcome parameters. However, the spontaneous ipsilesional body orientation improved only in patients receiving the PA-i condition and this improvement also appeared in patients showing a strong after-effect (irrespective of condition). Effect sizes for the Apples Cancellation Test and the Functional Independence Measure were larger for both PA treatment protocols than the historical control groups. We conclude that more recalibrations during an intermittent PA treatment may have a beneficial effect on spontaneous body orientation but not on other aspects of neglect or on ADL performance. Clinical Trial Registration: German Clinical Trials Register, identifier: DRKS00018813, DRKS00021539.
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Affiliation(s)
- Jannik Florian Scheffels
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Sona Korabova
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Helmut Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
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15
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de la Piedra Walter M, Notbohm A, Eling P, Hildebrandt H. Audiospatial evoked potentials for the assessment of spatial attention deficits in patients with severe cerebrovascular accidents. J Clin Exp Neuropsychol 2021; 43:623-636. [PMID: 34592915 DOI: 10.1080/13803395.2021.1984397] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Neuropsychological assessment of spatial orientation in post-acute patients with large brain lesions is often limited due to additional cognitive disorders like aphasia, apraxia, or reduced responsiveness. METHODS To cope with these limitations, we developed a paradigm using passive audiospatial event-related potentials (pAERPs): Participants were requested to merely listen over headphones to horizontally moving tones followed by a short tone ("target"), presented either on the side to which the cue moved or on the opposite side. Two runs of 120 trials were presented and we registered AERPs with two electrodes, mounted at C3 and C4. Nine sub-acute patients with large left hemisphere (LH) or right hemisphere (RH) lesions and nine controls participated. RESULTS Patients had no problems completing the assessment. RH patients showed a reduced N100 for left-sided targets in all conditions. LH patients showed a diminished N100 for invalid trials and contralesional targets. CONCLUSION Measuring AERPs for moving auditory cues and with two electrodes allows investigating spatial attentional deficits in patients with large RH and LH lesions, who are often unable to perform clinical tests. Our procedure can be implemented easily in an acute and rehabilitation setting and might enable investigating spatial attentional processes even in patients with minimal conscious awareness.
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Affiliation(s)
| | - Annika Notbohm
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Helmut Hildebrandt
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.,Institute of Psychology, University of Oldenburg, Oldenburg, Germany
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16
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Kastrup A, Roth C, Politi M, Alexandrou M, Hildebrandt H, Schröter A, Papanagiotou P. Endovascular Therapy vs. Thrombolysis in Pre-stroke Dependent Patients With Large Vessel Occlusions Within the Anterior Circulation. Front Neurol 2021; 12:666596. [PMID: 34149598 PMCID: PMC8206778 DOI: 10.3389/fneur.2021.666596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/13/2021] [Indexed: 01/01/2023] Open
Abstract
Background: In the past few years, several randomized trials have clearly shown that endovascular treatment (ET) in addition to intravenous thrombolysis (IVT) is superior to IVT alone in patients with proximal cerebral arterial occlusions. However, the effectiveness of ET in pre-stroke dependent patients (modified Rankin Scale ≥3) is uncertain. Methods: Using our prospectively obtained stroke database, we analyzed the impact of pre-stroke dependence on the rates of poor outcome (discharge mRS 5-6), in-hospital death, infarct sizes, and symptomatic intracranial hemorrhage (SICH) in patients with distal intracranial carotid artery M1 and M2 occlusions during two time periods. Results: From 1/2008 to 10/2012, a total of 544 patients (455 without and 89 with dependence) were treated with IVT, and from 11/2012 to 12/2019 a total of 1,061 patients (919 without and 142 with dependence) received ET (with or without IVT). Irrespective of the treatment modality, the dependent patients had significantly higher rates of poor outcome (55 vs. 32%, p < 0.001), death (24 vs. 11%; p < 0.001), or SICH (8.2 vs. 3.6%, p < 0.01) than independent patients. In dependent patients, ET significantly reduced the rates of poor outcome (49 vs. 64%, p < 0.01) and led to smaller infarcts, whereas the rates of in-hospital death (25 vs. 22%; p = 0.6) or SICH (8.5 vs. 7.9%, p = 0.9) were comparable between both treatment modalities. Conclusions: Compared with IVT, ET avoids poor outcome and leads to smaller infarcts in dependent patients. However, the overall high rates of poor outcome in this patient population stress the importance to perform decisions based on a case-by-case basis.
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Affiliation(s)
- Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Christian Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Maria Politi
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Maria Alexandrou
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | | | | | - Panagiotis Papanagiotou
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany.,Department of Radiology, Aretaieion Hospital, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
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17
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Riemann JF, Teufel A, Ganslandt T, Hann A, Hildebrandt H, Jütte H, Meining A, Meyer H, Naumann A, Opitz O, Schilling D, Hüppe D. Digitale Kommunikationsstrategien in der Gastroenterologie. Z Gastroenterol 2021; 59:473-474. [PMID: 34224118 DOI: 10.1055/a-1458-6430] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Andreas Teufel
- II. Medizinische Klinik Sektionsleiter Hepatologie und Klinische Bioinformatik, Universitätsmedizin Mannheim
| | - Thomas Ganslandt
- Zentrum für Präventivmedizin und Digitale Gesundheit Baden-Württemberg, Medizinische Fakultät Mannheim der Universität Heidelberg
| | | | | | | | | | | | - Axel Naumann
- Praxiszentrum für Gastroenterologie und Endoskopie, Grevenbroich
| | - Oliver Opitz
- Medizinische Fakultät Mannheim der Ruprecht-Karls-Universität Heidelberg
| | - Dieter Schilling
- Diakonissenkrankenhaus, Theresienkrankenhaus, St. Hedwig-Klinik Mannheim
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18
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Turgut N, Jansen AL, Nielsen J, Heber I, Eling P, Hildebrandt H. Repeated application of the covert shift of attention task improves endogenous but not exogenous attention in patients with unilateral visuospatial inattention. Brain Cogn 2021; 151:105732. [PMID: 33895466 DOI: 10.1016/j.bandc.2021.105732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/27/2021] [Revised: 04/04/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Most neglect treatment studies focus on automatic re-orientation procedures, assuming a deficit in automatic processes. We compare an automatic- and a controlled procedure, using the endogenous and exogenous variants of Posner's covert shift of attention task. METHOD In two experiments, neglect patients and patients with a right hemispherical stroke without neglect performed three blocks of Posner's covert shift of attention task (Posner Task) on two days. In Study 1 we used endogenous cues, in Study 2, exogenous cues. RESULTS In the endogenous task, neglect patients improved significantly with valid left-sided cues between block 1 and 2 on Day 1, subsequently showing a plateauing. They also showed a gradual improvement on invalid trials on both days. In the exogenous condition, all participants responded only increasingly faster on trials with a long stimulus onset asynchrony. Practicing on both tasks led to fewer omissions for left-sided targets, minimally in the exogenous and clearly in the endogenous condition. CONCLUSION In line with prior neuroanatomical studies, our study shows that practicing an endogenous, but not an exogenous, visuospatial attention task leads to significant improvements in neglect patients, especially for invalid trials, suggesting that neglect treatments based on top-down strategies should be given more attention.
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Affiliation(s)
- Nergiz Turgut
- Instituto de Neurociencias, Universidad San Francisco de Quito, Quito, Ecuador
| | - Anna-Lena Jansen
- Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Jörn Nielsen
- Department of Cognitive Rehabilitation, Neurological Rehabilitation Centre Godeshöhe, Bonn, Germany; Department of Medical Psychology
- Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Ines Heber
- Department of Neurological Rehabilitation, Median Klinik Wilhelmshaven, Wilhelmshaven, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
| | - Helmut Hildebrandt
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany.
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Hildebrandt H, Stachowiak R, Heber I, Schlake HP, Eling P. Relation between cognitive fatigue and circadian or stress related cortisol levels in MS patients. Mult Scler Relat Disord 2020; 45:102440. [DOI: 10.1016/j.msard.2020.102440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
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20
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Sander C, Braun N, Modes F, Schlake HP, Eling P, Hildebrandt H. Can biofeedback-based training alleviate fatigue and vigilance performance in fatigued MS patients? Neuropsychol Rehabil 2020; 32:131-147. [PMID: 32851896 DOI: 10.1080/09602011.2020.1808023] [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] [Indexed: 10/23/2022]
Abstract
MS related fatigue might be related to autonomous nervous system (ANS) dysfunctions or to inflammation related vagal (hyper-) activation. Consequently, influencing ANS status may lead to relieve of fatigue. We used two opposite biofeedback interventions to either increase sympathetic ("self-alert training", SAT) or parasympathetic activation ("progressive muscle relaxation", PMR). We recorded fatigue status of patients before and after a challenging vigilance task, their behavioural performance on this task, their skin conductance response (SCR), and parameters indicating parasympathetic activity concerning heart rate variability (HRV). We repeated these recordings after the biofeedback training sessions. Patients of the SAT group were able to learn to increase their SCR voluntarily. Patients of the PMR group showed increasing parameters indicating parasympathetic modulation of the HRV. The vigilance task increased their feeling of fatigue. However, there was no effect of biofeedback training on either fatigue status or performance on the vigilance task. Our results show that MS patients can learn to change voluntarily their ANS activity using biofeedback instructions based on SCR and this can be used in future studies to test the postulated link between ANS and fatigue. However, in this experimental intervention we were unable to document a relation between ANS activity and fatigue.Trial registration: ClinicalTrials.gov identifier: NCT03268187.
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Affiliation(s)
- Carina Sander
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Median Klinik Wilhelmshaven, Wilhelmshaven, Germany
| | - Niclas Braun
- Department and Polyclinic for Psychiatry and Psychotherapy, Universitätsklinikum Bonn AöR, Bonn, Germany
| | - Fenja Modes
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany
| | | | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
| | - Helmut Hildebrandt
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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21
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Weicker J, Hudl N, Hildebrandt H, Obrig H, Schwarzer M, Villringer A, Thöne-Otto A. The effect of high vs. low intensity neuropsychological treatment on working memory in patients with acquired brain injury. Brain Inj 2020; 34:1051-1060. [PMID: 32511937 DOI: 10.1080/02699052.2020.1773536] [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] [Indexed: 10/24/2022]
Abstract
AIM To evaluate the combined effect of compensation therapy and functional training on working memory (WM) in patients with acquired injury and chronic cognitive deficits by investigating the dose-response relationship and specificity of transfer effects. RESEARCH DESIGN Double-blind randomized controlled trial. METHODS All patients underwent 4 weeks of compensation therapy in a day-care setting. In addition, they received either 20 sessions of computer-based WM training (n = 11) or attention training (n = 9). Transfer effects on cognition and their functional relevance in daily life were assessed before treatment, after 2 weeks (10 additional training sessions), and after 4 weeks (20 additional training sessions) of therapy. RESULTS The combined treatment led to significant improvements in WM performance, verbal memory, and self-reported changes in daily life. The amount of training was identified to modulate efficacy: Significant improvements showed only in the later training phase. We observed no differences between the two training schemes (WM vs. attentional training). CONCLUSIONS Even in the chronic phase after brain lesion WM performance can be enhanced by the combination of compensation therapy and computerized cognitive training when applied intensely; both a more general attention and a specific WM training regimen are effective.
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Affiliation(s)
- Juliane Weicker
- Clinic of Cognitive Neurology, University of Leipzig , Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany
| | - Nicole Hudl
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany.,Professorship of Sports Psychology, Chemnitz University of Technology , Chemnitz, Germany
| | - Helmut Hildebrandt
- Department of Psychology, Carl Von Ossietzky University of Oldenburg , Oldenburg, Germany
| | - Hellmuth Obrig
- Clinic of Cognitive Neurology, University of Leipzig , Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany
| | - Magdalena Schwarzer
- Department of Psychology, Carl Von Ossietzky University of Oldenburg , Oldenburg, Germany
| | - Arno Villringer
- Clinic of Cognitive Neurology, University of Leipzig , Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences , Leipzig, Germany
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22
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Schenke N, Franke R, Puschmann S, Turgut N, Kastrup A, Thiel CM, Hildebrandt H. Can auditory cues improve visuo-spatial neglect? Results of two pilot studies. Neuropsychol Rehabil 2020; 31:710-730. [PMID: 32102605 DOI: 10.1080/09602011.2020.1727931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although neglect is known to be a multimodal deficit, current interventions often address the visual modality only. Experimental studies, however, found that neglect patients can partially overcome their spatial inattention temporarily when being exposed to auditory cues that move towards the neglected side of space. Two pilot studies investigated the impact of dynamic auditory cueing on egocentric neglect severity in a clinical-therapeutic setting. In both studies, the patient groups received 15 sessions of intervention. Study 1, designed as double-blinded trial with a historical control group, targeted severely impaired early-acute patients who listened to music or audio books which were presented as moving dynamically from right to left. Results showed a reduction in egocentric neglect severity that persisted after therapy termination in the intervention but not in the historical control group. In study 2, based on the comparison with reported effect sizes of previous studies, dynamic meaningful auditory cues and optokinetic stimulation were combined in a computer-based training. Both studies found a significant reduction of neglect severity. Results provide evidence for the reduction of egocentric neglect severity after repetitive auditory cueing therapy in both severely and moderately impaired patients. Our promising findings should be verified thoroughly in randomized-controlled trials.
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Affiliation(s)
- N Schenke
- Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - R Franke
- Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - S Puschmann
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - N Turgut
- Institute of Neurosciences, University San Francisco de Quito, Quito, Ecuador
| | - A Kastrup
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - C M Thiel
- Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Cluster of Excellence "Hearing4all", Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - H Hildebrandt
- Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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23
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Scheunemann J, Gawęda Ł, Reininger KM, Jelinek L, Hildebrandt H, Moritz S. Advice weighting as a novel measure for belief flexibility in people with psychotic-like experiences. Schizophr Res 2020; 216:129-137. [PMID: 31924370 DOI: 10.1016/j.schres.2019.12.016] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/09/2019] [Accepted: 12/19/2019] [Indexed: 01/02/2023]
Abstract
Jumping to conclusions and bias against disconfirmatory evidence are two cognitive biases common in people with psychotic-like experiences and psychosis. However, many participants show comprehension problems doing traditional tasks; new paradigms with additional applied scenarios are thus needed. A large MTurk community sample (N = 1422) was recruited and subdivided into participants with high levels of psychotic-like experiences (at least 2 SD above the mean, n = 79) and participants with low levels of psychotic-like experiences (maximum 0.5 SD above the mean, n = 1110), based on the positive subscale of the Community Assessment of Psychic Experiences (CAPE). In the context of a judge-advisor system, participants made an initial estimate and then received advice that was either confirmatory or disconfirmatory. Participants then gave a new, possibly revised estimate and were allowed to seek additional advice. Participants with high levels of psychotic-like experiences gave their final assessment after receiving significantly less advice and were significantly more confident in their decision than participants with low psychotic-like experiences, in line with previous studies on jumping to conclusions and overconfidence. Contrary to the hypothesis and earlier studies, however, no deficit in belief revision was found. In fact, participants with high psychotic-like experiences weighted advice significantly higher in the condition with disconfirmatory advice, but only for the first advice they received. The increased weighting of a single piece of disconfirmatory advice can be explained by the hypersalience of evidence-hypothesis matches theory, according to which more weight is attached to the most recently available information.
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Affiliation(s)
- Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany.
| | - Łukasz Gawęda
- Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Klaus-Michael Reininger
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Helmut Hildebrandt
- Department of Psychology, University of Oldenburg, Ammerländer Heerstraße 114-118, 26129 Oldenburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Hanken K, Sander C, Schlake HP, Kastrup A, Eling P, Hildebrandt H. Fatigue in Multiple Sclerosis is related to relapses, autonomic dysfunctions and introversion: A quasi-experimental study. Mult Scler Relat Disord 2019; 36:101401. [PMID: 31563074 DOI: 10.1016/j.msard.2019.101401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/04/2019] [Revised: 07/31/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatigue in Multiple Sclerosis (MS) might be partially due to inflammatory processes. If so, relapses should increase the fatigue level. METHODS Two groups of MS patients participated in this study. One suffered from a relapse and was treated by Methylprednisolone. The other group experienced a deterioration of their neurological condition but no relapse and received neurological rehabilitation. We assessed fatigue before admission, at admission and after discharge (t1, t2, t3). Furthermore, autonomic dysfunctions, depressive mood, apathy and extraversion were assessed at admission. Changes in fatigue were analysed with ANCOVAs and fatigue levels were analysed with regression analyses using clinical data and scores for depressive mood, apathy, extraversion and autonomic dysfunctions. RESULTS Only patients suffering from a relapse showed a significant increment in fatigue from t1 to t2. Regression analyses revealed that autonomic dysfunctions and introversion best explained the fatigue level. CONCLUSIONS This study shows that a relapse is accompanied by an increase in MS-related fatigue. Moreover, autonomic dysfunctions and introversion, more than depression and apathy, play a major role in the explanation of MS-related fatigue. This finding represents additional evidence for the relationship between inflammation, vagal afferent signaling, autonomic dysfunctions, introversion and the feeling of MS-related fatigue.
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Affiliation(s)
- Katrin Hanken
- Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany.
| | - Carina Sander
- Median Klinik Wilhelmshaven, Department of Neurological Rehabilitation, Germany; Institute of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Hans-Peter Schlake
- Median Klinik Wilhelmshaven, Department of Neurological Rehabilitation, Germany
| | - Andreas Kastrup
- Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, the Netherlands
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany; Institute of Psychology, University of Oldenburg, Oldenburg, Germany
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25
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Sander C, Modes F, Schlake HP, Eling P, Hildebrandt H. Capturing fatigue parameters: The impact of vagal processing in multiple sclerosis related cognitive fatigue. Mult Scler Relat Disord 2019; 32:13-18. [PMID: 31005825 DOI: 10.1016/j.msard.2019.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/21/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Causes of fatigue in Multiple Sclerosis remain elusive. Recently, we developed a model linking cognitive fatigue to inflammatory processes based on a neuroinflammatory reflex-arc instantiated by the vagus nerve. The relation between experienced autonomic dysfunctions, based on vagal processing, and cognitive fatigue is well-known, but an examination of the association of objectively measured vagal activity and cognitive fatigue is missing. An attempt was made to collect behavioral and physiological evidence that can be associated with experienced autonomic dysfunctions and fatigue in Multiple Sclerosis patients. METHODS Behavioral performance (response bias) and autonomic functioning (Heart rate variability and Skin conductance level) during an acoustic vigilance task were investigated in 53 Multiple Sclerosis patients. We assessed trait fatigue (independent from task), and time-on-task related increase of fatigue. Regression analysis was used to predict the fatigue status with physiological and behavioral scores. RESULTS Response bias, indicating a reduced responsiveness, and high and very low frequency components of Heart rate variability, indicating an increased parasympathetic activity, contribute to the regression of trait fatigue. Reduced Heart rate variability (SDNN) and increased parasympathetic activity (pNN50) remained in the regression model predicting time-on-task fatigue. CONCLUSION Cognitive fatigue in MS is related to parasympathetic activity and reduced responsiveness, supporting our model representing fatigue as inflammatory processes in the brain. Standardized subjective and objective autonomous dysfunction measures might be considered as additional assessments in MS.
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Affiliation(s)
- Carina Sander
- Institute of Psychology, Carl von Ossietzy University of Oldenburg, Department VI - Medicine and Health Sciences, Ammerländer Heerstr. 114-11826129, Oldenburg, Germany; Median Klinik Wilhelmshaven, Department of Neurology, Bremer Straße 2, 26382 Wilhelmshaven, Germany.
| | - Fenja Modes
- Institute of Psychology, Carl von Ossietzy University of Oldenburg, Department VI - Medicine and Health Sciences, Ammerländer Heerstr. 114-11826129, Oldenburg, Germany.
| | - Hans-Peter Schlake
- Median Klinik Wilhelmshaven, Department of Neurology, Bremer Straße 2, 26382 Wilhelmshaven, Germany.
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Montessorilaan 3, 6525 HR, Nijmegen, Netherlands.
| | - Helmut Hildebrandt
- Institute of Psychology, Carl von Ossietzy University of Oldenburg, Department VI - Medicine and Health Sciences, Ammerländer Heerstr. 114-11826129, Oldenburg, Germany; Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany.
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26
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Turgut N, Möller L, Dengler K, Steinberg K, Sprenger A, Eling P, Kastrup A, Hildebrandt H. Adaptive Cueing Treatment of Neglect in Stroke Patients Leads to Improvements in Activities of Daily Living: A Randomized Controlled, Crossover Trial. Neurorehabil Neural Repair 2018; 32:988-998. [DOI: 10.1177/1545968318807054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nergiz Turgut
- Klinikum Bremen-Ost, Bremen, Germany
- Carl von Ossietzky Universität Oldenburg, Germany
| | | | | | | | - Andreas Sprenger
- University Hospital of Schleswig Holstein-Campus Lübeck, Germany
| | - Paul Eling
- Radboud University Nijmegen, Netherlands
| | | | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Bremen, Germany
- Carl von Ossietzky Universität Oldenburg, Germany
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Schill J, Kastrup A, Hildebrandt H. P75. A visual paired associative recognition task for the diagnosis of Alzheimer’s disease. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Hanken K, Sander C, Qaiser L, Schlake HP, Kastrup A, Haupts M, Eling P, Hildebrandt H. Salivary IL-1ß as an Objective Measure for Fatigue in Multiple Sclerosis? Front Neurol 2018; 9:574. [PMID: 30061859 PMCID: PMC6055002 DOI: 10.3389/fneur.2018.00574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 03/19/2018] [Accepted: 06/25/2018] [Indexed: 12/26/2022] Open
Abstract
Background: The causes of fatigue in multiple sclerosis (MS) and other inflammatory disorders are not well understood. One possible cause that might explain fatigue in inflammatory disorders appears to be the immunological process itself, triggering neural activity that is experienced as fatigue. Objectives: To investigate whether salivary IL-1ß concentration, associated with systemic inflammation, is related to subjective fatigue in MS. Methods: 116 MS patients (62 relapsing remitting MS, 54 secondary progressive MS) and 51 healthy controls participated in this study. Salivary concentration of IL-1ß was determined using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Fatigue was assessed using various fatigue scales. We compared IL-1ß concentration between groups and performed regression analyses to investigate which variables best predict fatigue scores. Results: We found that the IL-1ß concentration best predicts fatigue scores in relapsing remitting MS patients, even though the IL-1ß concentration did not differ significantly between relapsing remitting MS patients and healthy controls. Secondary progressive MS patients showed a somewhat elevated IL-1ß concentration compared to relapsing remitting MS patients and healthy controls. Furthermore, disease modifying treatment had a significant effect on the IL-1ß concentration, with treated patients showing a lower IL-1ß concentration than non-treated patients. Conclusions: The present study points to a significant relation between the proinflammatory cytokine IL-1ß and fatigue in relapsing remitting MS patients. It also suggests a potential effect of disease modifying treatment on the peripheral IL-1ß concentration.
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Affiliation(s)
- Katrin Hanken
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany
| | - Carina Sander
- Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.,Rehabilitationszentrum Oldenburg GmbH, Oldenburg, Germany
| | - Lara Qaiser
- Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | | | - Andreas Kastrup
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany
| | - Michael Haupts
- Augustahospital Anholt, Clinic for Neurology, Anholt, Germany.,Department of Neurology, Heinrich-Heine-Uni, Dusseldorf, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany.,Department of Psychology, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Kastrup A, Brunner F, Hildebrandt H, Roth C, Winterhalter M, Giessing C, Papanagiotou P. Endovascular Therapy versus Thrombolysis in Patients with Mild Strokes and Large Vessel Occlusions within the Anterior Circulation. Interv Neurol 2018; 7:431-438. [PMID: 30410521 DOI: 10.1159/000489708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 04/28/2018] [Indexed: 11/19/2022]
Abstract
Background In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, it is currently unclear if patients with mild strokes also benefit from ET. Methods We compared the discharge rates of good outcome (modified Rankin scale [mRS] ≤2), very good outcome (mRS 0-1), symptomatic intracranial hemorrhages (SICH), and infarct sizes in patients with mild strokes (admission National Institutes of Health Stroke Scale ≤10) and distal intracranial carotid artery, M1, and M2 occlusions during two time periods. Results From 1/2008 to 10/2012 160 patients (mean age: 72 ± 12 years) were treated with IVT, and from 11/2012 to 11/2016 145 patients (mean age: 71 ± 13 years,) received ET with or without IVT. The clinical results were comparable between both treatment groups (59% after ET vs. 56% after IVT, p = 0.5 for an mRS 0-2) and (38% after ET vs. 32% after IVT, p = 0.3 for an mRS 0-1). In the subgroup of patients with an mRS ≤6, the early outcome did not differ significantly between ET and IVT either. The rates of SICH as well as the infarct sizes were not significantly different after ET compared with IVT. Conclusion Compared with IVT, the routine use of ET did not significantly improve the early clinical or radiological outcome in patients with mild strokes and anterior circulation large vessel occlusions. Further randomized trials are urgently needed to determine the role of ET in this cohort.
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Affiliation(s)
- Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany.,Department of Neurology, University of Göttingen, Göttingen, Germany
| | | | | | - Christian Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | | | - Carsten Giessing
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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30
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Richter KM, Mödden C, Eling P, Hildebrandt H. Improving everyday memory performance after acquired brain injury: An RCT on recollection and working memory training. Neuropsychology 2018; 32:586-596. [PMID: 29697993 DOI: 10.1037/neu0000445] [Citation(s) in RCA: 5] [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] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To show the effectiveness of a combined recognition and working memory training on everyday memory performance in patients suffering from organic memory disorders. METHOD In this double-blind, randomized controlled Study 36 patients with organic memory impairments, mainly attributable to stroke, were assigned to either the experimental or the active control group. In the experimental group a working memory training was combined with a recollection training based on the repetition-lag procedure. Patients in the active control group received the memory therapy usually provided in the rehabilitation center. Both groups received nine hours of therapy. Prior (T0) and subsequent (T1) to the therapy, patients were evaluated on an everyday memory test (EMT) as well as on a neuropsychological test battery. Based on factor analysis of the neuropsychological test scores at T0 we calculated composite scores for working memory, verbal learning and word fluency. RESULTS After treatment, the intervention group showed a significantly greater improvement for WM performance compared with the active control group. More importantly, performance on the EMT also improved significantly in patients receiving the recollection and working memory training compared with patients with standard memory training. CONCLUSION Our results show that combining working memory and recollection training significantly improves performance on everyday memory tasks, demonstrating far transfer effects. The present study argues in favor of a process-based approach for treating memory impairments. (PsycINFO Database Record
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Affiliation(s)
| | | | - Paul Eling
- Donders Institute for Brain, Cognition, and Behavior, Radboud University of Nijmegen
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31
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Kastrup A, Brunner F, Hildebrandt H, Roth C, Winterhalter M, Papanagiotou P. Endovascular therapy versus thrombolysis in patients with large vessel occlusions within the anterior circulation aged ≥80 years. J Neurointerv Surg 2018; 10:1053-1056. [PMID: 29549121 DOI: 10.1136/neurintsurg-2017-013732] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND PURPOSE In patients with large vessel occlusions, endovascular treatment (ET) has been shown to be superior to intravenous thrombolysis (IVT) in recent trials. However, the effectiveness of ET in elderly patients is uncertain. METHODS Using our stroke database, we compared the rates of good outcome (modified Rankin scale (mRS) ≤2), excellent outcome (mRS 0-1), poor outcome (mRS 5-6) at discharge, in-hospital death, infarct size, and symptomatic intracranial hemorrhage (SICH) in patients aged ≥80 years with distal intracranial carotid artery, M1 and M2 occlusions during two time periods. RESULTS From January 2008 to October 2012, 217 patients were treated with IVT and, from November 2012 to October 2017, 209 patients received ET with stent retrievers (with or without IVT). Significantly more patients in the ET group than in the IVT group had a good outcome (25% vs 16%, P<0.05), as well as an excellent outcome (12% vs 4%, P<0.01). Significantly fewer patients in the ET group than in the IVT group died (14% vs 22%, P<0.05) or had a poor outcome (35% vs 52%, P<001). The SICH rates were lower after ET than after IVT (1% vs 6%, P<0.01), and the infarct sizes were smaller after ET than after IVT. CONCLUSIONS Compared with IVT, the routine use of ET significantly improved the early clinical and radiological outcome in patients with anterior circulation large vessel occlusions aged ≥80 years. Nevertheless, poor outcome rates were high so the role of ET needs to be defined further in this population.
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Affiliation(s)
- Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | - Freimuth Brunner
- Department of Neurology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
| | | | - Christian Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte gGmbH, Bremen, Germany
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32
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Hanken K, Francis Y, Kastrup A, Eling P, Klein J, Hildebrandt H. On the role of the amygdala for experiencing fatigue in patients with multiple sclerosis. Mult Scler Relat Disord 2018; 20:67-72. [DOI: 10.1016/j.msard.2017.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/14/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022]
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Jansen WJ, Ossenkoppele R, Tijms BM, Fagan AM, Hansson O, Klunk WE, van der Flier WM, Villemagne VL, Frisoni GB, Fleisher AS, Lleó A, Mintun MA, Wallin A, Engelborghs S, Na DL, Chételat G, Molinuevo JL, Landau SM, Mattsson N, Kornhuber J, Sabri O, Rowe CC, Parnetti L, Popp J, Fladby T, Jagust WJ, Aalten P, Lee DY, Vandenberghe R, Resende de Oliveira C, Kapaki E, Froelich L, Ivanoiu A, Gabryelewicz T, Verbeek MM, Sanchez-Juan P, Hildebrandt H, Camus V, Zboch M, Brooks DJ, Drzezga A, Rinne JO, Newberg A, de Mendonça A, Sarazin M, Rabinovici GD, Madsen K, Kramberger MG, Nordberg A, Mok V, Mroczko B, Wolk DA, Meyer PT, Tsolaki M, Scheltens P, Verhey FRJ, Visser PJ, Aarsland D, Alcolea D, Alexander M, Almdahl IS, Arnold SE, Baldeiras I, Barthel H, van Berckel BNM, Blennow K, van Buchem MA, Cavedo E, Chen K, Chipi E, Cohen AD, Förster S, Fortea J, Frederiksen KS, Freund-Levi Y, Gkatzima O, Gordon MF, Grimmer T, Hampel H, Hausner L, Hellwig S, Herukka SK, Johannsen P, Klimkowicz-Mrowiec A, Köhler S, Koglin N, van Laere K, de Leon M, Lisetti V, Maier W, Marcusson J, Meulenbroek O, Møllergård HM, Morris JC, Nordlund A, Novak GP, Paraskevas GP, Perera G, Peters O, Ramakers IHGB, Rami L, Rodríguez-Rodríguez E, Roe CM, Rot U, Rüther E, Santana I, Schröder J, Seo SW, Soininen H, Spiru L, Stomrud E, Struyfs H, Teunissen CE, Vos SJB, van Waalwijk van Doorn LJC, Waldemar G, Wallin ÅK, Wiltfang J, Zetterberg H. Association of Cerebral Amyloid-β Aggregation With Cognitive Functioning in Persons Without Dementia. JAMA Psychiatry 2018; 75:84-95. [PMID: 29188296 PMCID: PMC5786156 DOI: 10.1001/jamapsychiatry.2017.3391] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cerebral amyloid-β aggregation is an early event in Alzheimer disease (AD). Understanding the association between amyloid aggregation and cognitive manifestation in persons without dementia is important for a better understanding of the course of AD and for the design of prevention trials. OBJECTIVE To investigate whether amyloid-β aggregation is associated with cognitive functioning in persons without dementia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 2908 participants with normal cognition and 4133 with mild cognitive impairment (MCI) from 53 studies in the multicenter Amyloid Biomarker Study. Normal cognition was defined as having no cognitive concerns for which medical help was sought and scores within the normal range on cognitive tests. Mild cognitive impairment was diagnosed according to published criteria. Study inclusion began in 2013 and is ongoing. Data analysis was performed in January 2017. MAIN OUTCOMES AND MEASURES Global cognitive performance as assessed by the Mini-Mental State Examination (MMSE) and episodic memory performance as assessed by a verbal word learning test. Amyloid aggregation was measured with positron emission tomography or cerebrospinal fluid biomarkers and dichotomized as negative (normal) or positive (abnormal) according to study-specific cutoffs. Generalized estimating equations were used to examine the association between amyloid aggregation and low cognitive scores (MMSE score ≤27 or memory z score≤-1.28) and to assess whether this association was moderated by age, sex, educational level, or apolipoprotein E genotype. RESULTS Among 2908 persons with normal cognition (mean [SD] age, 67.4 [12.8] years), amyloid positivity was associated with low memory scores after age 70 years (mean difference in amyloid positive vs negative, 4% [95% CI, 0%-7%] at 72 years and 21% [95% CI, 10%-33%] at 90 years) but was not associated with low MMSE scores (mean difference, 3% [95% CI, -1% to 6%], P = .16). Among 4133 patients with MCI (mean [SD] age, 70.2 [8.5] years), amyloid positivity was associated with low memory (mean difference, 16% [95% CI, 12%-20%], P < .001) and low MMSE (mean difference, 14% [95% CI, 12%-17%], P < .001) scores, and this association decreased with age. Low cognitive scores had limited utility for screening of amyloid positivity in persons with normal cognition and those with MCI. In persons with normal cognition, the age-related increase in low memory score paralleled the age-related increase in amyloid positivity with an intervening period of 10 to 15 years. CONCLUSIONS AND RELEVANCE Although low memory scores are an early marker of amyloid positivity, their value as a screening measure for early AD among persons without dementia is limited.
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Affiliation(s)
- Willemijn J. Jansen
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands
| | - Rik Ossenkoppele
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands,Department of Radiology and Nuclear Medicine, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands,Department of Neurology, Memory and Aging Center,
University of California, San Francisco,Helen Wills Neuroscience Institute, University of
California, Berkeley
| | - Betty M. Tijms
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Anne M. Fagan
- Knight Alzheimer’s Disease Research Center,
Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Oskar Hansson
- Clinical Memory Research Unit, Clinical Sciences
Malmö, Lund University, Lund, Sweden
| | - William E. Klunk
- Department of Psychiatry, University of Pittsburgh
School of Medicine, Pittsburgh, Pennsylvania
| | - Wiesje M. van der Flier
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands,Department of Epidemiology and Biostatistics, VU
University Medical Center, Amsterdam, the Netherlands
| | - Victor L. Villemagne
- Department of Nuclear Medicine and Centre for PET,
Austin Health, Melbourne, Australia
| | - Giovanni B. Frisoni
- Laboratory of Alzheimer's Neuroimaging and
Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy,Memory Clinic and LANVIE–Laboratory of
Neuroimaging of Aging, University Hospitals, and University of Geneva, Geneva, Switzerland
| | - Adam S. Fleisher
- Banner Alzheimer’s Institute, Phoenix,
Arizona,Eli Lilly and Company, Indianapolis, Indiana,Department of Neurosciences, University of
California, San Diego
| | - Alberto Lleó
- Neurology Department, Hospital de Sant Pau,
Barcelona, Spain
| | | | - Anders Wallin
- Institute of Neuroscience and Physiology,
Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Sebastiaan Engelborghs
- Reference Center for Biological Markers of Dementia
(BIODEM), University of Antwerp, Antwerp, Belgium
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gäel Chételat
- Institut National de la Santé et de la
Recherche Médicale (INSERM), CHU de Caen, Caen, France
| | - José Luis Molinuevo
- Alzheimer’s Disease and Other Cognitive
Disorders Unit, IDIBAPS, Clinic University Hospital, Barcelona, Spain
| | - Susan M. Landau
- Helen Wills Neuroscience Institute, University of
California, Berkeley
| | - Niklas Mattsson
- Clinical Memory Research Unit, Clinical Sciences
Malmö, Lund University, Lund, Sweden
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy,
Friedrich-Alexander University of Erlangen–Nuremberg, Erlangen, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University of
Leipzig, Leipzig, Germany
| | - Christopher C. Rowe
- Knight Alzheimer’s Disease Research Center,
Department of Neurology, Washington University School of Medicine, St Louis, Missouri,Department of Nuclear Medicine and Centre for PET,
Austin Health, Melbourne, Australia
| | - Lucilla Parnetti
- Section of Neurology, Center for Memory
Disturbances, University of Perugia, Perugia, Italy
| | - Julius Popp
- Department of Psychiatry, Service of Old Age
Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Tormod Fladby
- Department of Neurology, Akershus University
Hospital, Lørenskog, Norway
| | - William J. Jagust
- Helen Wills Neuroscience Institute, University of
California, Berkeley
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National
University, College of Medicine, Seoul, South Korea
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology and Alzheimer
Research Centre KU Leuven, Catholic University Leuven, Leuven, Belgium
| | - Catarina Resende de Oliveira
- Center for Neuroscience and Cell Biology, Faculty of
Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Elisabeth Kapaki
- First Department of Neurology, Eginition Hospital,
Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Central
Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim,
Germany
| | - Adrian Ivanoiu
- Memory Clinic and Neurochemistry Laboratory, Saint
Luc University Hospital, Institute of Neuroscience, Université catholique de Louvain,
Brussels, Belgium
| | - Tomasz Gabryelewicz
- Department of Neurodegenerative Disorders,
Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Marcel M. Verbeek
- Departments of Neurology and Laboratory Medicine,
Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud
University Medical Center, Nijmegen, the Netherlands
| | - Páscual Sanchez-Juan
- Neurology Service, Universitary Hospital
Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Vincent Camus
- CHRU de Tours, CIC INSERM 1415, INSERM U930, and
Université François Rabelais de Tours, Tours, France
| | - Marzena Zboch
- Alzheimer Center, Wroclaw Medical University,
Scinawa, Poland
| | - David J. Brooks
- Division of Neuroscience, Medical Research Council
Clinical Sciences Centre, Imperial College London, London, England
| | - Alexander Drzezga
- Department of Nuclear Medicine, University of
Cologne, Cologne, Germany
| | - Juha O. Rinne
- Turku PET Centre and Division of Clinical
Neurosciences Turku, University of Turku and Turku University Hospital, Turku, Finland
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas
Jefferson University and Hospital, Philadelphia, Pennsylvania
| | - Alexandre de Mendonça
- Institute of Molecular Medicine and Faculty of
Medicine, University of Lisbon, Lisbon, Portugal
| | - Marie Sarazin
- Neurologie de la Mémoire et du Langage, Centre
Hospitalier Sainte-Anne, Université Paris 5, Paris, France
| | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center,
University of California, San Francisco
| | - Karine Madsen
- Neurobiology Research Unit, Copenhagen University
Hospital, Copenhagen, Denmark
| | - Milica G. Kramberger
- Center for Cognitive Impairments, University Medical
Centre Ljubljana, Ljubljana, Slovenia
| | - Agneta Nordberg
- Department NVS, Center for Alzheimer Research,
Translational Alzheimer Neurobiology, Karolinska Institutet, and Geriatric Medicine,
Karolinska University Hospital, Stockholm, Sweden
| | - Vincent Mok
- Lui Che Woo Institute of Innovative Medicine,
Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for
Prevention of Dementia, Hong Kong
| | - Barbara Mroczko
- Department of Neurodegeneration Diagnostics, Leading
National Research Centre in Białystok (KNOW), Medical University of Białystok,
Białystok, Poland
| | - David A. Wolk
- Department of Neurology, University of Pennsylvania,
Philadelphia
| | - Philipp T. Meyer
- Department of Nuclear Medicine, University Hospital
Freiburg, Freiburg, Germany
| | - Magda Tsolaki
- Third Department of Neurology, Aristotle University
of Thessaloniki, Thessaloniki, Greece
| | | | - Philip Scheltens
- Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School
for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University,
Maastricht, the Netherlands,Department of Neurology and Alzheimer Center, VU
University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Dag Aarsland
- Center for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Daniel Alcolea
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | | | - Ina S Almdahl
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Steven E Arnold
- Department of Neurology, University of Pennsylvania, Philadelphia
| | - Inês Baldeiras
- Center for Neuroscience and Cell Biology, Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Enrica Cavedo
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Département de Neurologie, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Hôpital Pitié-Stijmsalpêtrière, Boulevard de l'hôpital, F-75013, Paris, France.,AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, Arizona
| | - Elena Chipi
- Section of Neurology, Center for Memory Disturbances, University of Perugia, Perugia, Italy
| | - Ann D Cohen
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stefan Förster
- Department of Nuclear Medicine, Technische Universitaet München, Munich, Germany
| | - Juan Fortea
- Neurology Department, Hospital de Sant Pau, Barcelona, Spain
| | - Kristian S Frederiksen
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | - Yvonne Freund-Levi
- Department of Geriatrics, Karolinska University Hospital Huddinge, Section of Clinical Geriatrics, Institution of NVS, Karolinska Institutet, Stockholm, Sweden
| | - Olymbia Gkatzima
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universitaet München, Munich, Germany
| | - Harald Hampel
- Département de Neurologie, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Hôpital Pitié-Stijmsalpêtrière, Boulevard de l'hôpital, F-75013, Paris, France.,AXA Research Fund & UPMC Chair, Sorbonne Universités, Université Pierre et Marie Curie Paris 06, Inserm, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France.,Department of Psychiatry, Alzheimer Memorial Center and Geriatric Psychiatry Branch, Ludwig-Maximilian University, Munich, Germany
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sabine Hellwig
- Center of Geriatrics and Gerontology, University Hospital Freiburg, Freiburg, Germany
| | - Sanna-Kaisa Herukka
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Peter Johannsen
- Memory Clinic, Danish Dementia Research Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | | | - Koen van Laere
- Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - Mony de Leon
- School of Medicine, Center for Brain Health, New York University, New York
| | - Viviana Lisetti
- Section of Neurology, Center for Memory Disturbances, University of Perugia, Perugia, Italy
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Jan Marcusson
- Geriatric Medicine, Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Olga Meulenbroek
- Department of Geriatric Medicine, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanne M Møllergård
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - John C Morris
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Arto Nordlund
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - Gerald P Novak
- Janssen Research and Development, Titusville, New Jersey
| | - George P Paraskevas
- First Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gayan Perera
- Roche Products, Welwyn Garden City, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Kings College London, London, United Kingdom
| | - Oliver Peters
- Department of Psychiatry and Psychotherapy, Charité Berlin, German Center for Neurodegenrative Diseases (DZNE), Berlin, Germany
| | - Inez H G B Ramakers
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, IDIBAPS, Clinic University Hospital, Barcelona, Spain
| | | | - Catherine M Roe
- Knight Alzheimer's Disease Research Center, Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Uros Rot
- Center for Cognitive Impairments, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eckart Rüther
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University, Göttingen, Germany
| | - Isabel Santana
- Center for Neuroscience and Cell Biology, Faculty of Medicine, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Johannes Schröder
- Sektion Gerontopsychiatrie, Universität Heidelberg, Heidelberg, Germany
| | - Sang W Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hilkka Soininen
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Luiza Spiru
- Department of Geriatrics-Gerontology-Gerontopsychiatry, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Erik Stomrud
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Hanne Struyfs
- Reference Center for Biological Markers of Dementia (BIODEM), University of Antwerp, Antwerp, Belgium
| | - Charlotte E Teunissen
- Neurochemistry Laboratory and Biobank, Department of Clinical Chemistry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - Stephanie J B Vos
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, the Netherlands
| | - Linda J C van Waalwijk van Doorn
- Departments of Neurology and Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gunhild Waldemar
- Department of Nuclear Medicine, Technische Universitaet München, Munich, Germany
| | - Åsa K Wallin
- Clinical Memory Research Unit, Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University, Göttingen, Germany
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,UCL Institute of Neurology, Queen Square, London, United Kingdom
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Turgut N, Mödden C, Brumund T, Eling P, Hildebrandt H. A study on the independence of egocentric and allocentric neglect. Cortex 2017; 96:95-104. [PMID: 28988121 DOI: 10.1016/j.cortex.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/25/2017] [Revised: 06/13/2017] [Accepted: 09/06/2017] [Indexed: 11/28/2022]
Abstract
Currently there seems to be consensus that visuospatial neglect may involve egocentric and allocentric symptoms. However, the relation between the two is still discussed and models have been proposed based on the high correlation between allocentric and egocentric neglect symptoms. To analyze the relation between these two kinds of symptoms we developed a new paradigm. In contrast to previous paradigms, we varied the extension of the search field and we added centered reference targets to evaluate egocentric effects independent from allocentric effects. Patients with exclusively left-sided neglect (n = 15) and left-sided visual field deficit (VFD) (n = 9) were included. Right brain damaged patients (n = 15) and a healthy control (n = 15) acted as control groups. The results revealed egocentric inattention in VFD patients. Neglect patients suffered from egocentric and allocentric neglect, but we found no interaction between both kinds of impairments in the sense of a monotonous additive or multiplicative increase going from right to left in terms of egocentric and allocentric coordinates. On the contrary, at the outmost left allocentric and egocentric positions, the number of omissions did not increase, unlike in outmost right and centered positions. In conclusion, our experiment shows that egocentric and allocentric neglect can be clearly dissociated in neglect patients and do not interact. Inclusion of neglect patients with a VFD may lead to an artificial interaction between egocentric and allocentric symptoms and this may explain the differences with results of previous studies.
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Affiliation(s)
- Nergiz Turgut
- Klinikum Bremen-Ost, Department for Neurology, Bremen, Germany; Carl von Ossietzky Universität Oldenburg, Neurocognitive Psychology, Germany
| | - Claudia Mödden
- Klinikum Bremen-Ost, Department for Neurology, Bremen, Germany; Rehabilitation Hospital, Department for Neurology, Oldenburg, Germany
| | - Tanja Brumund
- Klinikum Bremen-Ost, Department for Neurology, Bremen, Germany; Rehabilitation Hospital, Department for Neurology, Oldenburg, Germany
| | - Paul Eling
- Radboud University Nijmegen, Donders Institute for Brain, Cognition, and Behaviour, The Netherlands
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Department for Neurology, Bremen, Germany; Carl von Ossietzky Universität Oldenburg, Neurocognitive Psychology, Germany.
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Sander C, Hildebrandt H, Schlake HP, Eling P, Hanken K. Subjective Cognitive Fatigue and Autonomic Abnormalities in Multiple Sclerosis Patients. Front Neurol 2017; 8:475. [PMID: 28955298 PMCID: PMC5601401 DOI: 10.3389/fneur.2017.00475] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/06/2017] [Accepted: 08/28/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cognitive fatigue and autonomic abnormalities are frequent symptoms in MS. Our model of MS-related fatigue assumes a shared neural network for cognitive fatigue and autonomic failures, i.e., aberrant vagus nerve activity induced by inflammatory processes. Therefore, they should occur in common. OBJECTIVE To explore the relationship between cognitive fatigue and autonomic symptoms in MS patients, using self-reported questionnaires. METHODS In 95 MS patients, cognitive fatigue was assessed with the Fatigue Scale for Motor and Cognitive Functions and autonomic abnormalities with the Composite Autonomic Symptom Scale-31 (COMPASS-31). We used exploratory correlational analyses and hierarchical regression analysis, controlling for age, depressive mood, disease status, and disease duration, to analyze the relation between autonomic abnormalities and cognitive fatigue. RESULTS The cognitive fatigue score strongly correlated with the COMPASS-31 score (r = 0.47, p < 0.001). Regression analysis revealed that a model, including the COMPASS-31 domains: pupillomotor, orthostatic intolerance, and bladder, best predict the level of cognitive fatigue (R2 = 0.47, p < 0.001) after forcing the covariates into the model. CONCLUSION In MS patients, cognitive fatigue and autonomic dysfunction share a proportion of variance. This supports our model assuming that fatigue might be explained at least partially by inflammation-induced vagus nerve activity.
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Affiliation(s)
- Carina Sander
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Rehabilitation Center Wilhelmshaven, Wilhelmshaven, Germany
| | - Helmut Hildebrandt
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany
| | | | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Katrin Hanken
- Institute of Psychology, University of Oldenburg, Oldenburg, Germany.,Klinikum Bremen-Ost, Department of Neurology, Bremen, Germany
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36
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Jahn K, Wieltsch C, Blumer N, Mehlich M, Pathak H, Khan AQ, Hildebrandt H, Frieling H. A cell culture model for investigation of synapse influenceability: epigenetics, expression and function of gene targets important for synapse formation and preservation in SH-SY5Y neuroblastoma cells differentiated by retinoic acid. J Neural Transm (Vienna) 2017; 124:1341-1367. [DOI: 10.1007/s00702-017-1769-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022]
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37
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El Chilali K, Patsalis P, Al-Rashid F, Hildebrandt H, Totzeck M, Lind A, Janosi R, Rassaf T, Kahlert P. P2616Impact of baseline left-ventricular ejection fraction on 30-day and 1-year outcome after transfemoral aortic valve implantation: Interaction with mean gradient across the aortic valve. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kastrup A, Brunner F, Hildebrandt H, Roth C, Winterhalter M, Gießing C, Papanagiotou P. THRIVE score predicts clinical and radiological outcome after endovascular therapy or thrombolysis in patients with anterior circulation stroke in everyday clinical practice. Eur J Neurol 2017; 24:1032-1039. [PMID: 28556351 DOI: 10.1111/ene.13328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Based on the data of several trials the Totaled Health Risks in Vascular Events (THRIVE) score has been shown to predict outcome after either intravenous thrombolysis (IVT) or endovascular therapy (ET) in acute stroke patients. It is unknown whether the THRIVE score can also predict outcome in everyday clinical practice. Using our prospectively obtained stroke database the utility of the THRIVE score to predict clinical and radiological outcome in everyday clinical practice was analysed. METHODS The relationships between THRIVE and good outcome (modified Rankin Scale ≤ 2 at discharge), poor outcome (modified Rankin Scale 5-6), in-hospital death, symptomatic intracranial haemorrhage (SICH) as well as infarct size were examined in patients with distal intracranial carotid artery, M1 and M2 occlusions after either IVT or ET. RESULTS From January 2008 to October 2016 a total of 546 patients were treated with IVT and 492 patients received ET with stent retrievers (with or without IVT). In both treatment groups the THRIVE score predicted clinical outcome (Mantel-Haenszel chi-squared tests for trend P < 0.001 for good outcome, P < 0.001 for poor outcome and P < 0.001 for in-hospital death). In the ET group the THRIVE score remained an independent predictor of outcome after controlling for recanalization. The THRIVE score was associated with the infarct size after IVT or ET, whereas it did not predict SICH rates in either treatment group. CONCLUSIONS In everyday clinical practice the THRIVE score strongly predicts clinical outcome and the extent of ischaemia after ET or IVT in patients with anterior circulation large vessel occlusions.
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Affiliation(s)
- A Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - F Brunner
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - H Hildebrandt
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - C Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - M Winterhalter
- Department of Anesthesiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - C Gießing
- Department of Psychology, European Medical School, University of Oldenburg, Oldenburg, Germany
| | - P Papanagiotou
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
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Gurevich P, Stuke H, Kastrup A, Stuke H, Hildebrandt H. Neuropsychological Testing and Machine Learning Distinguish Alzheimer's Disease from Other Causes for Cognitive Impairment. Front Aging Neurosci 2017; 9:114. [PMID: 28487650 PMCID: PMC5403832 DOI: 10.3389/fnagi.2017.00114] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/07/2017] [Indexed: 12/28/2022] Open
Abstract
With promising results in recent treatment trials for Alzheimer’s disease (AD), it becomes increasingly important to distinguish AD at early stages from other causes for cognitive impairment. However, existing diagnostic methods are either invasive (lumbar punctures, PET) or inaccurate Magnetic Resonance Imaging (MRI). This study investigates the potential of neuropsychological testing (NPT) to specifically identify those patients with possible AD among a sample of 158 patients with Mild Cognitive Impairment (MCI) or dementia for various causes. Patients were divided into an early stage and a late stage group according to their Mini Mental State Examination (MMSE) score and labeled as AD or non-AD patients based on a post-mortem validated threshold of the ratio between total tau and beta amyloid in the cerebrospinal fluid (CSF; Total tau/Aβ(1–42) ratio, TB ratio). All patients completed the established Consortium to Establish a Registry for Alzheimer’s Disease—Neuropsychological Assessment Battery (CERAD-NAB) test battery and two additional newly-developed neuropsychological tests (recollection and verbal comprehension) that aimed at carving out specific Alzheimer-typical deficits. Based on these test results, an underlying AD (pathologically increased TB ratio) was predicted with a machine learning algorithm. To this end, the algorithm was trained in each case on all patients except the one to predict (leave-one-out validation). In the total group, 82% of the patients could be correctly identified as AD or non-AD. In the early group with small general cognitive impairment, classification accuracy was increased to 89%. NPT thus seems to be capable of discriminating between AD patients and patients with cognitive impairment due to other neurodegenerative or vascular causes with a high accuracy, and may be used for screening in clinical routine and drug studies, especially in the early course of this disease.
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Affiliation(s)
- Pavel Gurevich
- Department of Mathematics, Free University of BerlinBerlin, Germany.,Faculty of Science, Peoples' Friendship University of RussiaMoscow, Russia
| | - Hannes Stuke
- Department of Mathematics, Free University of BerlinBerlin, Germany
| | - Andreas Kastrup
- Department of Neurology, Municipal Hospital of Bremen-OstBremen, Germany
| | - Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin BerlinBerlin, Germany
| | - Helmut Hildebrandt
- Department of Neurology, Municipal Hospital of Bremen-OstBremen, Germany.,Department of Psychology, University of OldenburgOldenburg, Germany
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40
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Turgut N, Miranda M, Kastrup A, Eling P, Hildebrandt H. P009 tDCS combined with optokinetic drift reduces egocentric neglect in severely impaired post-acute patients. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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41
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Stuke H, Hanken K, Hirsch J, Klein J, Wittig F, Kastrup A, Hildebrandt H. Cross-Sectional and Longitudinal Relationships between Depressive Symptoms and Brain Atrophy in MS Patients. Front Hum Neurosci 2016; 10:622. [PMID: 28018194 PMCID: PMC5159697 DOI: 10.3389/fnhum.2016.00622] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 07/30/2016] [Accepted: 11/22/2016] [Indexed: 01/12/2023] Open
Abstract
Introduction: Depressive symptoms are a frequent and distressing phenomenon in Multiple Sclerosis (MS) patients. Cross-sectional research links these symptoms to reduced brain gray matter volumes in parts of the prefrontal and temporal lobe as well as subcortical structures like the hippocampus, nucleus caudatus and globus pallidus. Nevertheless, prospective relationships between regional gray matter volume and the course of depressive symptoms are poorly understood. Methods: Forty-four patients with relapsing–remitting or secondary progressive MS participated in a prospective study with two assessments of depressive symptoms and high-resolution MRI with an inter-test-interval of 17 months. Relationships between baseline gray matter volume and baseline depressive symptoms, as well as prospective associations between the development of atrophy and depression were assessed using voxel-based morphometry (VBM). Results: Cross-sectional analyses revealed an association between depressive symptoms and gray matter loss in the left temporal lobe. Prospective analysis showed that gray matter losses in the right middle cingulate and middle frontal gyrus at baseline predicted increasing depressive symptoms during follow-up. Increase in depressive symptoms was related to a concomitant increase in atrophy in the left thalamus and right globus pallidus. Discussion: Our results fit well into the concept of a disturbed cortico–striatal–pallido–thalamic loop in depression. In this framework, progressive gray matter loss in limbic basal ganglia structures including globus pallidus and thalamus may lead to depression-typical deficits in hedonic motivation, whereas atrophy of the prefrontal cortex may contribute to maladaptive coping strategies, promoting an unfavorable development of depressive symptoms.
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Affiliation(s)
- Heiner Stuke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin Berlin, Germany
| | - Katrin Hanken
- Department of Psychology, University of OldenburgOldenburg, Germany; Department of Neurology, Klinikum Bremen-OstBremen, Germany
| | - Jochen Hirsch
- Fraunhofer MEVIS Institute for Medical Image Computing Bremen, Germany
| | - Jan Klein
- Fraunhofer MEVIS Institute for Medical Image Computing Bremen, Germany
| | - Fabian Wittig
- Department of Psychology, University of OldenburgOldenburg, Germany; Fraunhofer MEVIS Institute for Medical Image ComputingBremen, Germany
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost Bremen, Germany
| | - Helmut Hildebrandt
- Department of Psychology, University of OldenburgOldenburg, Germany; Department of Neurology, Klinikum Bremen-OstBremen, Germany
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Reinhart S, Schaadt A, Keller I, Hildebrandt H, Kerkhoff G, Utz K. Rotational coherent dot movement normalizes spatial disorientation of the subjective visual vertical in patients with rightsided stroke. Neuropsychologia 2016; 92:174-180. [DOI: 10.1016/j.neuropsychologia.2016.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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Hanken K, Bosse M, Möhrke K, Eling P, Kastrup A, Antal A, Hildebrandt H. Counteracting Fatigue in Multiple Sclerosis with Right Parietal Anodal Transcranial Direct Current Stimulation. Front Neurol 2016; 7:154. [PMID: 27708612 PMCID: PMC5030283 DOI: 10.3389/fneur.2016.00154] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 12/20/2022] Open
Abstract
Background Fatigue in multiple sclerosis (MS) patients appears to correlate with vigilance decrement as reflected in an increase in reaction time (RT) and errors with prolonged time-on-task. Objectives The aim of this study was to investigate whether anodal transcranial direct current stimulation (tDCS) over the right parietal or frontal cortex counteracts fatigue-associated vigilance decrement and subjective fatigue. Methods In study I, a randomized double-blind placebo-controlled study, anodal tDCS (1.5 mA) was delivered to the right parietal cortex or the right frontal cortex of 52 healthy participants during the first 20 min of a 40-min lasting visual vigilance task. Study II, also a randomized double-blind placebo-controlled study, investigated the effect of anodal tDCS (1.5 mA) over the right parietal cortex in 46 MS patients experiencing cognitive fatigue. tDCS was delivered for 20 min before patients performed a 20-min lasting visual vigilance task. Results Study I showed that right parietal stimulation, but not right frontal stimulation, counteracts the increase in RT associated with vigilance decrement. Hence, only right parietal stimulation was applied to the MS patients in study II. Stimulation had a significant effect on vigilance decrement in mildly to moderately cognitively fatigued MS patients. Vigilance testing significantly increased the feeling of fatigue independent of stimulation. Conclusion Anodal tDCS over the right parietal cortex can counteract the increase in RTs during vigilance performance, but not the increase in subjective fatigue. This finding is compatible with our model of fatigue in MS, suggesting a dissociation between the feeling and the behavioral characteristics of fatigue.
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Affiliation(s)
- Katrin Hanken
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Mona Bosse
- Department of Psychology, Carl von Ossietzky University Oldenburg , Oldenburg , Germany
| | - Kim Möhrke
- Department of Chemistry, Carl von Ossietzky University Oldenburg , Oldenburg , Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen , Nijmegen , Netherlands
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost , Bremen , Germany
| | - Andrea Antal
- University Medical Center, Georg-August University Göttingen , Göttingen , Germany
| | - Helmut Hildebrandt
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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Sander C, Eling P, Hanken K, Klein J, Kastrup A, Hildebrandt H. The Impact of MS-Related Cognitive Fatigue on Future Brain Parenchymal Loss and Relapse: A 17-Month Follow-up Study. Front Neurol 2016; 7:155. [PMID: 27708613 PMCID: PMC5030297 DOI: 10.3389/fneur.2016.00155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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: 05/31/2016] [Accepted: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Background Fatigue is a disabling syndrome in multiple sclerosis (MS), which may be associated with inflammation and faster disease progression. Objective To analyze the significance of cognitive fatigue for subsequent disease progression. Method We followed 46 MS patients and 14 healthy controls in a study over 17 months. At the beginning (t1) and at the end (t2) of the study participants scored their fatigue, performed the Multiple Sclerosis Functional Composite and received MRI scanning, encompassing MPR T1, FLAIR, and DTI sequences. At t1, MS patients were divided into those with and those without cognitive fatigue (cut-off score for moderate cognitive fatigue of the Fatigue Scale for Motor and Cognition). We calculated ANCOVAs for repeated measurement to analyze the relevance of cognitive fatigue status for the number of relapses and for MRI parameters. Results At t1, but not at t2, patients with cognitive fatigue showed increased axial and radial diffusivity of corpus callosum fibers. At t2, these patients showed significantly more loss of brain parenchyma and greater enlargement of lateral ventricles. Moreover, they developed more relapses, but there was no difference in lesion load or in performance deterioration. Additional analyses showed that only cognitive fatigue but not a more general score for fatigue (Fatigue Severity Scale) had an impact on the worsening of the disease status. Conclusion Patients with cognitive fatigue may develop more brain atrophy and relapses during the next 17 months than patients without cognitive fatigue. Hence, experiencing cognitive fatigue might indicate more aggressive inflammatory processes and subsequent neurodegeneration.
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Affiliation(s)
- Carina Sander
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Rehazentrum Wilhelmshaven, Wilhelmshaven, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University , Nijmegen , Netherlands
| | - Katrin Hanken
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Jan Klein
- Fraunhofer MEVIS Institute for Medical Image Computing , Bremen , Germany
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost , Bremen , Germany
| | - Helmut Hildebrandt
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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Schulte T, Kern E, Hildebrandt H. Implementierung der FORTA-Klassifikation zur Beurteilung der Arzneimitteltherapie-Sicherheit von Patienten ab 65 Jahren. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schulte T, Pimperl A, Fischer A, Dittmann B, Wendel P, Hildebrandt H. Ergebnisqualität Gesundes Kinzigtal – quantifiziert durch Mortalitätskennzahlen. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Voelter H, Hildebrandt H, Kastrup A. MS-assoziierte Fatigue – Welche Immuntherapie hilft? Akt Neurol 2016. [DOI: 10.1055/s-0042-114976] [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: 10/21/2022]
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Pimperl A, Schulte T, Mühlbacher A, Rosenmöller M, Busse R, Groene O, Rodriguez HP, Hildebrandt H. Evaluating the Impact of an Accountable Care Organization on Population Health: The Quasi-Experimental Design of the German Gesundes Kinzigtal. Popul Health Manag 2016; 20:239-248. [PMID: 27565005 DOI: 10.1089/pop.2016.0036] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A central goal of accountable care organizations (ACOs) is to improve the health of their accountable population. No evidence currently links ACO development to improved population health. A major challenge to establishing the evidence base for the impact of ACOs on population health is the absence of a theoretically grounded, robust, operationally feasible, and meaningful research design. The authors present an evaluation study design, provide an empirical example, and discuss considerations for generating the evidence base for ACO implementation. A quasi-experimental study design using propensity score matching in combination with small-scale exact matching is implemented. Outcome indicators based on claims data were constructed and analyzed. Population health is measured by using a range of mortality indicators: mortality ratio, age at time of death, years of potential life lost/gained, and survival time. The application is assessed using longitudinal data from Gesundes Kinzigtal, one of the leading population-based ACOs in Germany. The proposed matching approach resulted in a balanced control of observable differences between the intervention (ACO) and control groups. The mortality indicators used indicate positive results. For example, 635.6 fewer years of potential life lost (2005.8 vs. 2641.4; t-test: sig. P < 0.05*) in the ACO intervention group (n = 5411) attributable to the ACO, also after controlling for a potential (indirect) immortal time bias by excluding the first half year after enrollment from the outcome measurement. This empirical example of the impact of a German ACO on population health can be extended to the evaluation of ACOs and other integrated delivery models of care.
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Affiliation(s)
- Alexander Pimperl
- 1 Health Policy and Management, School of Public Health, University of California , Berkeley, Berkeley, California
| | - Timo Schulte
- 2 Department of Health, University of Witten/Herdecke , Witten, Germany .,3 OptiMedis AG , Hamburg, Germany
| | - Axel Mühlbacher
- 4 Institute for Health Economics and Health Care Management , Hochschule Neubrandenburg, Neubrandenburg, Germany
| | - Magdalena Rosenmöller
- 5 Centre for Research in Health Innovation Management, IESE Business School , Barcelona, Spain
| | - Reinhard Busse
- 6 Department of Health Care Management, Berlin University of Technology , Berlin, Germany
| | - Oliver Groene
- 3 OptiMedis AG , Hamburg, Germany .,7 Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine , London, United Kingdom
| | - Hector P Rodriguez
- 1 Health Policy and Management, School of Public Health, University of California , Berkeley, Berkeley, California
| | - Helmut Hildebrandt
- 3 OptiMedis AG , Hamburg, Germany .,8 Gesundes Kinzigtal GmbH , Haslach, Germany
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Abstract
Contemporary cognitive psychologists share methodological solipsism (MS) as a general research strategy. MS postulates that a complete explanatory level dealing exclusively with processes within an organism is the domain of psychology. The paper undertakes a critical review of MS. By reanalysing the debate between proponents of MS (cf. Fodor & Pylyshyn, 1981) and proponents of ecological realism (cf. Gibson, 1966, 1979), it will be shown that MS is theoretically unsound. As a second step, problems concerning the concept of transduction and invariance detection, using movement perception as a concrete example, are discussed. Existing findings do not support the principle of MS. The third step consists in discussing the status of MS in the theory of problemsolving developed by Newell and Simon (1972). The next section of the paper is devoted to the development of a model that fulfils the conditions stipulated by the critique of the principles of MS. The last part presents a summary of the differences of the developed model in relation to MS.
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Wasser K, Papanagiotou P, Brunner F, Hildebrandt H, Winterhalter M, Roth C, Kastrup A. Impact of ASPECTS on computed tomography angiography source images on outcome after thrombolysis or endovascular therapy in large vessel occlusions. Eur J Neurol 2016; 23:1599-1605. [PMID: 27414987 DOI: 10.1111/ene.13068] [Citation(s) in RCA: 14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy (ET) is superior to intravenous thrombolysis (IVT) in selected patients with anterior circulation large vessel occlusions. However, it is unclear if this positive effect also applies to patients with extensive early ischaemic changes. The aim of this study was to analyze the impact of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on the CT angiography source images (SI) on outcome after ET or IVT. METHODS Using our prospectively obtained stroke database and the admission SI-ASPECTS divided into three groups (0-5, 6-7 and 8-10), primarily the rates of good outcome [modified Rankin Scale (mRS) ≤2 at discharge] after either ET (n = 255) or IVT (n = 479) were compared. RESULTS A favorable SI-ASPECTS (8-10) was present in 501 patients, 132 patients had a moderately favorable SI-ASPECTS (6-7) and 101 patients had an unfavorable SI-ASPECTS (0-5). Irrespective of the treatment modality, no patient with an unfavorable SI-ASPECTS had a good outcome and 38% died during hospital stay. Whilst significantly more patients with a favorable SI-ASPECTS had a good outcome after ET than after IVT (51% vs. 35%, P < 0.01), there was only a non-significant trend towards a good outcome after ET than after IVT in patients with a moderately favorable ASPECTS (25% vs. 14%, P = 0.1). CONCLUSION Patients with extensive early ischaemic changes on CT scans (SI- ASPECTS ≤5) might not profit from ET. The impact of ET on outcome in patients with moderately favorable SI-ASPECTS should be addressed in further trials.
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Affiliation(s)
- K Wasser
- Department of Neurology, University of Göttingen, Göttingen, Germany
| | - P Papanagiotou
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - F Brunner
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - H Hildebrandt
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany
| | - M Winterhalter
- Department of Anesthesiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - C Roth
- Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany
| | - A Kastrup
- Department of Neurology, Klinikum Bremen-Mitte, Bremen, Germany.
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