PartnerCARE-a psycho-oncological online intervention for partners of patients with cancer: study protocol for a randomised controlled feasibility trial

INTRODUCTION

Cancer burdens not only the patient but also the partner to a comparable extent. Partners of patients with cancer are highly involved in the caring process and therefore often experience distress and report a low quality of life. Interventions for supporting partners are scarce. Existing ones are rarely used by partners because they are often time-consuming per se and offer only limited flexibility with regard to schedule and location. The online intervention PartnerCARE has been developed on the basis of caregiver needs and consists of six consecutive sessions and four optional sessions, which are all guided by an e-coach. The study aims to evaluate feasibility and acceptance of the online intervention PartnerCARE and the related trial process. In addition, first insights of the putative efficacy of PartnerCARE should be gained.

METHODS AND ANALYSIS

A two-arm parallel-group randomised controlled trial will be conducted to compare the PartnerCARE online intervention with a waitlist control group. The study aims to recruit in total n=60 partners of patients with any type of cancer across different access paths (eg, university medical centres, support groups, social media). Congruent with feasibility study objectives, the primary outcome comprises recruitment process, study procedure, acceptance and satisfaction with the intervention (Client Satisfaction Questionnaire adapted to Internet-based interventions), possible negative effects (Inventory of Negative Effects in Psychotherapy) and dropout rates. Secondary outcomes include quality of life, distress, depression, anxiety, caregiver burden, fear of progression, social support, self-efficacy, coping and loneliness. Online measurements will be performed by self-assessment at three time points (baseline/pre-randomisation, 2 months and 4 months after randomisation). Data analyses will be based on intention-to-treat principle.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Ethics Committee of the University of Ulm (No 390/18). Results from this study will be disseminated to relevant healthcare communities, in peer-reviewed journals and at scientific and clinical conferences.

TRIAL REGISTRATION NUMBER

DRKS00017019.

INPART - a psycho-oncological intervention for partners of patients with haemato-oncological disease – study protocol

Background

Suffering from cancer confronts both the patient and their partner with a number of psychosocial challenges in various aspects of their life. These challenges may differentially impact on quality of life, coping ability and compliance to treatment. This especially holds true for haemato-oncological diseases. To date, psychological interventions have predominantly been developed for oncological patients however specific interventions for partners of haemato-oncological patients are rare. In this study we aim to conduct a psycho-oncological group-intervention for partners of patients with haemato-oncological diseases. The aim of the intervention is to significantly reduce symptoms of depression and anxiety in the partners and the patient, as well as enhancing dyadic coping.

Methods

The design of the INPART-study is an unblinded, randomised controlled trial with 2 treatment conditions (experimental and control) and assessments at baseline, 3 and 6 months. It will be conducted at three study centres: the university medical centre’s in Leipzig, Hannover and Ulm. The outcome criteria will be a reduction in depressive and anxiety symptoms as well as an improvement of dyadic coping.

Discussion

This trial shall provide information regarding the efficiency of a psycho-oncological intervention for partners of patients with haemato-oncological diseases and give references to the possible outcome in terms of dyadic coping and the reduction of mental strain.

The study was supported by a grant from the German José Carreras Leukaemia Foundation.

Trial registration

ISRCTN16085028; 20/03/2019.

Mindfulness in Follow-Up Care After Breast Cancer: Can It Prevent Recurrence?

This review focuses on the question whether mindfulness in follow-up care can contribute to the prevention of breast cancer (BC) recurrence. We first introduce behavioral risk and protective factors in follow-up care by presenting current research outcomes modulating individual risk for recurrence. We argue that although increased self-awareness is undoubtedly beneficial for BC survivors, it may also trigger adverse effects in vulnerable individuals such as overarousal and impaired emotional regulation. Indeed, research shows that many BC survivors are often confronted with clinical levels of fear of recurrence and anxiety and depressive symptoms. Research on awareness about the impact of behavior on health and fear of recurrence also offers interesting insights which can help to better understand non-compliant responses of BC survivors to medical recommendations regarding lifestyle or screening in follow-up care. Given the high rate of clinically relevant symptoms such as fear of recurrence and anxiety that may be related to dysfunctional levels of self-monitoring, we review the effects of a therapeutic intervention called Mindfulness-Based Stress Reduction (MBSR) that appears promising in reintegrating self-observation with patient well-being.

Semantic Ambiguity Resolution in Patients With Bipolar Disorder-An Event-Related Potential Study

Deficits in inhibitory function are assumed to underlie psychopathology in bipolar disorder (BD), especially in states of mania. A subdomain of inhibition, semantic inhibition (SI), referring to the suppression of irrelevant word meanings, may underlie formal thought disorder, such as flights of ideas. In the present study, we investigated SI in patients with BD during semantic ambiguity resolution using behavioral and event-related potential (ERP) measures. We presented 14 patients with BD with current manic, hypomanic, or mixed clinical states and 28 healthy controls sequentially with word triplets containing either a homonym (e.g., “organ”) or a comparable unambiguous word (e.g., “piano”). Participants were instructed to make a decision whether or not the target word was related to the meaning field of the first two words. The inappropriate homonym meaning had to be inhibited to correctly perform the target decision. In addition to reaction times (RT) and error rates (ER), the N400 ERP component to the target, an electrophysiological index of semantic processing, was analyzed as measure of the amount of SI that had taken place. Analyses of the behavioral data revealed that BD patients exhibited an overall worse performance in terms of RT and ER. In the ERP data, we found differences in N400 amplitude to ambiguous and unambiguous conditions over the right hemisphere in patients with BD depending on target congruence: In incongruent trials, N400 amplitude was smaller in ambiguous than in unambiguous words. In congruent trials, in contrast, N400 amplitude was larger in ambiguous than in unambiguous words. Such ERP differences between ambiguous and unambiguous words were absent in controls. We conclude that N400 amplitude differences in the ambiguous and unambiguous conditions of the BD group may reflect insufficient suppression of irrelevant homonym meanings in the right hemisphere. Disturbed SI processes might contribute to formal thought disorder in BD.

Brain Activation during Masked and Unmasked Semantic Priming: Commonalities and Differences

Using fMRI during a lexical decision task, we investigated the neural correlates of semantic priming under masked and unmasked prime presentation conditions in a repeated measurement design of the same group of 24 participants (14 women). The task was to discriminate between pseudowords and words. Masked and unmasked prime words differed in their degree of semantic relatedness with target stimuli. Neural correlates of priming were defined as significantly different neural activations upon semantically unrelated minus related trials. Left fusiform gyrus, left posterior inferior frontal gyrus, and bilateral pre-SMA showed priming effects independent of the masking condition. By contrast, bilateral superior temporal gyri, superior parietal lobules, and the SMA proper demonstrated greater neural priming in the unmasked compared with the masked condition. The inverted contrast (masked priming minus unmasked priming) did not show significant differences even at lowered thresholds of significance. The conjoint effects of priming in the left fusiform gyrus suggest its involvement as a direct consequence of the neural organization of semantic memory. Activity in brain regions showing significantly more neural priming in the unmasked condition possibly reflected participants' evaluation of the prime–target relationship, presumably in the context of semantic matching. The present results therefore indicate that masked and unmasked semantic priming partially depend on dissociable mechanisms at the neural and most likely also at the functional level.

Sustained incentive value of heroin-related cues in short- and long-term abstinent heroin users

Models of addiction and addiction memory propose that drug-associated cues elicit incentive effects in drug users, which play an important role in maintenance of drug use and relapse. Incentive effects have been demonstrated for smoking and alcohol-related cues but evidence for heroin-related cues has been inconclusive. Furthermore, it is unknown whether appetitive effects of heroin-related cues persist after prolonged abstinence, although heroin addiction is known to have high relapse rates. Therefore, we investigated implicit and explicit valence of heroin-related cues in dependent users at different stages of abstinence using affective startle modulation. In Study I, 15 current heroin users were measured before and after detoxification. Correspondingly, 15 healthy control participants were tested twice at an interval of 14 days. In Study II, 14 long-term abstinent heroin users were additionally measured in a single session. Implicit processing of drug-related stimuli was assessed using affective startle modulation by pictures of heroin and smoking scenes. Explicit reactions were measured using ratings of valence and craving. In contrast to controls, heroin-dependent participants showed a clear reduction of startle response during heroin-related pictures (p<0.05). Detoxification did not significantly change their startle responses to heroin-cues. No difference between non-detoxified current and long-term abstinent heroin users was found in implicit reactions to heroin-cues, whereas explicit measures differed between both groups (all p<0.05). After detoxification and even after prolonged abstinence, heroin cues still exert implicit appetitive effects in heroin users. This implies that drug-induced adaptations of reward circuits are long-lasting, resulting in a highly stable addiction memory.

Dissociating the representation of action- and sound-related concepts in middle temporal cortex

Modality-specific models of conceptual memory propose close links between concepts and the sensory-motor systems. Neuroimaging studies found, in different subject groups, that action-related and sound-related concepts activated different parts of posterior middle temporal gyrus (pMTG), suggesting a modality-specific representation of conceptual features. However, as these different parts of pMTG are close to each other, it is possible that the observed anatomical difference is merely related to interindividual variability. In the present functional magnetic resonance imaging study, we now investigated within the same participant group a possible conceptual feature-specific organization in pMTG. Participants performed lexical decisions on sound-related (e.g., telephone) and action-related (hammer) words. Sound words elicited higher activity in anterior pMTG adjacent to auditory association cortex, but action-related words did so in posterior pMTG close to motion sensitive areas. These results confirm distinct conceptual representations of sound and action in pMTG, just adjacent to the respective modality-specific cortices.

Mechanisms underlying flexible adaptation of cognitive control: behavioral and neuroimaging evidence in a flanker task

Cognitive control can be adapted flexibly according to the conflict level in a given situation. In the Eriksen flanker task, interference evoked by flankers is larger in conditions with a higher, rather than a lower proportion of compatible trials. Such compatibility ratio effects also occur for stimuli presented at two spatial locations suggesting that different cognitive control settings can be simultaneously maintained. However, the conditions and the neural correlates of this flexible adaptation of cognitive control are only poorly understood. In the present study, we further elucidated the mechanisms underlying the simultaneous maintenance of two cognitive control settings. In behavioral experiments, stimuli were presented centrally above and below fixation and hence processed by both hemispheres or lateralized to stimulate hemispheres differentially. The different compatibility ratio at two stimulus locations had a differential influence on the flanker effect in both experiments. In an fMRI experiment, blocks with an identical compatibility ratio at two central spatial locations elicited stronger activity in a network of prefrontal and parietal brain areas, which are known to be involved in conflict resolution and cognitive control, as compared with blocks with a different compatibility ratio at the same spatial locations. This demonstrates that the simultaneous maintenance of two conflicting control settings vs. one single setting does not recruit additional neural circuits suggesting the involvement of one single cognitive control system. Instead a crosstalk between multiple control settings renders adaptation of cognitive control more efficient when only one uniform rather than two different control settings has to be simultaneously maintained.

Neuroplasticity of semantic representations for musical instruments in professional musicians

Professional musicians constitute a model par excellence for understanding experience-dependent plasticity in the human brain, particularly in the auditory domain. Their intensive sensorimotor experience with musical instruments has been shown to entail plastic brain alterations in cortical perceptual and motor maps. It remains an important question whether this neuroplasticity might extend beyond basic perceptual and motor functions and even shape higher-level conceptualizations by which we conceive our physical and social world. Here we show using functional magnetic resonance imaging (fMRI) that conceptual processing of visually presented musical instruments activates auditory association cortex encompassing right posterior superior temporal gyrus, as well as adjacent areas in the superior temporal sulcus and the upper part of middle temporal gyrus (pSTG/MTG) only in musicians, but not in musical laypersons. These areas in and adjacent to auditory association cortex were not only recruited by conceptual processing of musical instruments during visual object recognition, but also by auditory perception of real sounds. Hence, the unique intensive experience of musicians with musical instruments establishes a link between auditory perceptual and conceptual brain systems. Experience-driven neuroplasticity in musicians is thus not confined to alterations of perceptual and motor maps, but even leads to the establishment of higher-level semantic representations for musical instruments in and adjacent to auditory association cortex. These findings highlight the eminent importance of sensory and motor experience for acquiring rich concepts.

Speaking in multiple languages: neural correlates of language proficiency in multilingual word production

The human brain has the fascinating ability to represent and to process several languages. Although the first and further languages activate partially different brain networks, the linguistic factors underlying these differences in language processing have to be further specified. We investigated the neural correlates of language proficiency in a homogeneous sample of multilingual native Ladin speakers from a mountain valley in South Tyrol, Italy, who speak Italian as second language at a high level, and English at an intermediate level. In a constrained word production task under functional magnetic resonance imaging (fMRI), participants had to name pictures of objects in Ladin, Italian and English in separate blocks. Overall, multilingual word production activated a common set of brain areas dedicated to known subcomponents of picture naming. In comparison to English, the fluently spoken languages Ladin and Italian were associated with enhanced right prefrontal activity. In addition, the MR signal in right prefrontal cortex correlated with naming accuracy as a measure of language proficiency. Our results demonstrate the significance of right prefrontal areas for language proficiency. Based on the role of these areas for cognitive control, our findings suggest that right prefrontal cortex supports language proficiency by effectively supervising word retrieval.

Conceptual Flexibility in the Human Brain: Dynamic Recruitment of Semantic Maps from Visual, Motor, and Motion-related Areas

Traditionally, concepts are assumed to be situational invariant mental knowledge entities (conceptual stability), which are represented in a unitary brain system distinct from sensory and motor areas (amodality). However, accumulating evidence suggests that concepts are embodied in perception and action in that their conceptual features are stored within modality-specific semantic maps in the sensory and motor cortex. Nonetheless, the first traditional assumption of conceptual stability largely remains unquestioned. Here, we tested the notion of flexible concepts using functional magnetic resonance imaging and event-related potentials (ERPs) during the verification of two attribute types (visual, action-related) for words denoting artifactual and natural objects. Functional imaging predominantly revealed crossover interactions between category and attribute type in visual, motor, and motion-related brain areas, indicating that access to conceptual knowledge is strongly modulated by attribute type: Activity in these areas was highest when nondominant conceptual attributes had to be verified. ERPs indicated that these category-attribute interactions emerged as early as 116 msec after stimulus onset, suggesting that they reflect rapid access to conceptual features rather than postconceptual processing. Our results suggest that concepts are situational-dependent mental entities. They are composed of semantic features which are flexibly recruited from distributed, yet localized, semantic maps in modality-specific brain regions depending on contextual constraints.

Impaired prepulse inhibition of acoustic startle in obsessive-compulsive disorder

BACKGROUND

Animal and clinical studies suggest that impaired sensorimotor gating, as assessed with the prepulse inhibition (PPI) paradigm, may result from dysfunctional frontostriatal brain circuits and from neurochemical alterations which are also implied in the pathophysiology of obsessive-compulsive disorder (OCD). However, there is only preliminary evidence about impaired PPI in OCD so far.

METHODS

Acoustic PPI was measured in 30 OCD patients and 30 matched healthy controls with a paradigm using different prepulse intensities. Psychopathology assessment included ratings for obsessions, compulsions, and depression.

RESULTS

PPI was reduced in OCD patients, and this deficit was most pronounced for most intense (16 dB(A)) prepulses, where mean PPI was 39.6% in unmedicated patients (n = 4), 45.8% in medicated patients, and 58.9% in controls. No group differences were observed with regard to the habituation of acoustic startle magnitude. Startle measures were generally not associated with clinical measures, although such associations may have been obscured by medication effects.

CONCLUSIONS

The present study confirms deficient central inhibitory functioning in patients with OCD and supports the model of deficient frontostriatal circuits in OCD. The relationship of PPI deficits to pharmacological and behavioral treatment and to possible subtypes of OCD merits further study.

Functional 3.0-T MR Assessment of Higher Cognitive Function: Are There Advantages over 1.5-T Imaging?

PURPOSE

To compare cortical activation patterns associated with manual motor decision tasks at 1.5- and 3.0-T functional magnetic resonance (MR) imaging.

MATERIALS AND METHODS

The local ethics committee approved this study, and informed written consent was obtained. Ten right-handed healthy volunteers (eight men and two women; mean age, 35 years +/- 7 [standard deviation]) underwent functional MR imaging twice, once at 1.5 T and once at 3.0 T, while performing cognitive tasks that demanded manual motor decisions (letter-finger matching and lexical and semantic decisions). While stimulus presentation was blocked, an event-related model was employed to analyze subjects' individual responses. A group analysis of functional data was performed with a t test of 1.5- and 3.0-T results in the 10 subjects.

RESULTS

Manual motor decisions activated a widespread network of motor- (primary motor, posterior parietal) and decision-related areas (superior frontal cortex or anterior cingulate) at both field strengths (P <.05, corrected). Moreover, additional functional activation was detected in medial (supplementary motor area) and dorsal premotor regions (P <.05, corrected) at 3.0-T functional MR imaging, which was not detectable with corresponding 1.5-T imaging. The mean t value for peak voxels in activated areas detectable with both systems was 1.3 times larger at 3.0 T than that at 1.5 T.

CONCLUSION

Functional 3.0-T MR imaging allows detection of additional activation in cortical areas involved in higher executive motor functions compared with functional 1.5-T MR imaging.

Mediotemporal contributions to semantic processing: fMRI evidence from ambiguity processing during semantic context verification

The medial temporal lobe (MTL) is well known to be crucial for various types of memory; however, controversy remains as to which of its substructures contribute to semantic processing and, if so, to what extent. The current study addresses the issue of MTL contributions to semantic processing during lexico-semantic ambiguity processing by using functional magnetic resonance imaging (fMRI) in combination with a context verification task (CVT). The CVT required decisions on the semantic fit of congruent and incongruent target words to the overall meaning of preceding sentential contexts with and without semantic ambiguity. In two of the four experimental conditions (congruent homographic, incongruent homographic), target decisions were critically dependent on the successful processing of prior sentence-final lexico-semantic ambiguity. Semantic context verification per se evidenced bilateral activations of the hippocampus that were part of a functional network including inferior prefrontal and superior parietal cortices. Commonalities in activation differences pertaining to the specific cognitive component of lexico-semantic ambiguity processing were found in a left temporal lobe network that comprised activation foci in the temporal pole, the parahippocampal and fusiform gyri. The present results suggest that the hippocampus may well contribute to semantic processing, namely by a mnemonic function that serves to link the target meaning representation with the meaning of a prior sentence context. Contrary to previous reports from human lesion studies, the present findings further suggest, that the specific cognitive component of lexico-semantic ambiguity processing is neither dependent on the hippocampus nor exclusively subserved by the temporal pole, but also recruits an associative semantic memory function from the parahippocampal gyrus as well as a more general (bottom-up) semantic function from the fusiform gyrus.

Effects of serotonergic and noradrenergic antidepressants on auditory startle response in patients with major depression

RATIONALE

Amplitude, habituation and prepulse inhibition (PPI) of the acoustic startle response (ASR) in rodents and humans are sensitive to psychotropic drugs. Studies with rodents suggest that an increase or decrease in serotonin level in the brain alters several modalities of the ASR. So far, little is known about serotonergic and noradrenergic startle modulation in humans.

OBJECTIVE

This study was designed to investigate the effects of the selective serotonin uptake inhibitor sertraline versus the selective noradrenalin uptake inhibitor reboxetine on magnitude, habituation and PPI of ASR in patients with major depression.

METHODS

We studied ASR in 23 patients with the diagnosis of major depression according to DSM-IV who were randomly treated either with sertraline or with reboxetine. Initially, ASR assessment was carried out when patients were drug-free for at least 2 weeks and again after 14 days of treatment.

RESULTS

The habituation of ASR was strongly attenuated by sertraline and not significantly altered by reboxetine. None of the substances altered the startle reactivity. In addition, PPI was not altered by sertraline, but reboxetine tended to decrease PPI. The startle reactivity at baseline was correlated with improvement of depressive symptoms at the end of the study.

CONCLUSION

These results provide the first evidence for different effects of noradrenergic and serotonergic antidepressants on the startle response in depressed patients.

Prepulse inhibition and habituation of acoustic startle response in male MDMA ('ecstasy') users, cannabis users, and healthy controls

Chronic administration of 3,4-methylenedioxymethamphetamine (MDMA) is associated with long-term depletion of serotonin (5-HT) and loss of 5-HT axons in the brains of rodents and nonhuman primates. Despite the broad database concerning the selective serotonergic neurotoxicity of recreational MDMA consumption by humans, controversy still exists with respect to the question of whether the well-known functional consequences of these neurotoxic effects, such as memory impairment, were caused by chronic 5-HT deficiency. Habituation and prepulse inhibition (PPI) of the acoustic startle response (ASR) can be used as a marker of central serotonergic functioning in rodents and humans. Thus, we investigated the functional status of the central serotonergic system in chronic but abstinent MDMA users by measuring PPI and habituation of ASR. PPI and habituation of ASR were measured in three groups. The first group (MDMA group) included 20 male drug-free chronic users of MDMA; the second group (cannabis group) consisted of 20 male drug-free chronic users of cannabis; and the third group (healthy controls) comprised 20 male participants with no history of illicit drug use. Analysis revealed significantly increased PPI of MDMA users compared to those of cannabis users and healthy controls. Cannabis users and healthy controls showed comparable patterns of PPI. There were no differences in habituation among the three groups. These results suggest that the functional consequences of chronic MDMA use may be explained by 5-HT receptor changes rather than by a chronic 5-HT deficiency condition. Use of cannabis does not lead to alterations of amplitude, habituation, or PPI of ASR.

Curved-surface projection: an alternative method for visualizing functional MR imaging results

Curved-surface projection (CSP) is a new technique for visualizing functional MR imaging data. This technique helps in identifying anatomic structures by demonstrating the whole gyral and sulcal pattern of the brain at once. Compared with other techniques, CSP preserves the spatial relation of eloquent areas to lesions. Especially in neurosurgical patients with space-occupying lesions, CSP helps in assigning the anatomy to its function.

Different negative priming impairments in schizophrenia and subgroups of obsessive-compulsive disorder

BACKGROUND

Inhibitory functioning is assumed to be deficient in some psychiatric disorders, most notably in patients with schizophrenia and obsessive-compulsive disorder (OCD). In order to investigate inhibitory functioning, priming tasks are commonly used. The present paradigm offers the opportunity to isolate specific distractor features (identity, location) for independent examination.

METHODS

Negative priming (NP) for stimulus identity and location was examined in patients with schizophrenia (N = 16), patients with OCD (N = 15) and matched controls (N = 16). All groups performed a referent size-selection task in which they were instructed successively to select the larger one of two cardinal numbers. The deeper processing of both stimuli was expected to yield large NP effects that allow the detection of subtle group differences.

RESULTS

Large NP effects were found for stimulus identity in all three groups. Schizophrenic patients differed from normal controls with respect to the amount of incidental location priming. Subgroup analyses of OCD patients showed NP impairments for checkers when the response-stimulus interval (RSI) was short, but large identity NP when the RSI was long. OCD non-checkers showed normal NP patterns with short RSI, but reduced identity NP with longer RSI.

CONCLUSIONS

Schizophrenic patients do not show the ability to use spatial selective attention in order to guide their actions as shown by normal controls. Information processing was differentially impaired in OCD subgroups (checkers and non-checkers) dependent on RSI variation. This result supports those studies that found reduced NP in OCD patients and points to the necessity of differential subgroup studies.

Amplitude reduction of the mismatch negativity in first-degree relatives of patients with schizophrenia

First-degree relatives of schizophrenic patients display alterations in various cognitive domains and their electrophysiological counterparts similar to schizophrenic subjects. The mismatch negativity (MMN) is an event-related potential that reflects sensory memory in the pre-attentive stage of auditory processing. An amplitude reduction of the MMN has been reported in schizophrenia. The present study investigated the MMN in patients with schizophrenia, first-degree relatives and control subjects. The MMN amplitude was reduced in relatives compared to controls. The MMN amplitude reduction in schizophrenic patients compared to controls, however, did not reach significance in the present study. These results provide first evidence for disturbed sensory memory in relatives of patients with schizophrenia.

Sensory gating deficit expressed by a disturbed suppression of the P50 event-related potential in patients with Alzheimer's disease

OBJECTIVE

Disturbed sensory gating has been related to attention deficit and greater distractibility in patients with schizophrenia, and dysfunction of the alpha-7 subunit of the cholinergic nicotinic receptor has been discussed as its biological basis. Alzheimer's disease is characterized by a cholinergic deficit, and postmortem studies have reported alpha-7 receptor loss in patients with Alzheimer's disease. In this study, the authors tested whether sensory gating is disturbed in patients with Alzheimer's disease.

METHOD

Suppression of the P50 event-related potential following the second click of a double-click paradigm, a measure of sensory gating, was assessed in 17 Alzheimer's disease patients and 17 comparison subjects.

RESULTS

Alzheimer's disease patients showed less P50 suppression following the second click relative to the comparison subjects.

CONCLUSIONS

Disturbed sensory gating might result from cholinergic dysfunction and possibly from alpha-7 nicotinic receptor loss in patients with Alzheimer's disease. Prospective studies should investigate the relationship between sensory gating deficit and behavioral disturbances in Alzheimer's disease patients.