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Purrer V, Pohl E, Borger V, Weiland H, Boecker H, Schmeel FC, Wüllner U. Motor and non-motor outcome in tremor dominant Parkinson's disease after MR-guided focused ultrasound thalamotomy. J Neurol 2024:10.1007/s00415-024-12469-z. [PMID: 38822147 DOI: 10.1007/s00415-024-12469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is an emerging technique for the treatment of severe, medication-refractory tremor syndromes. We here report motor and non-motor outcomes 6 and 12 months after unilateral MRgFUS thalamotomy in tremor-dominant Parkinson's disease (tdPD). METHODS 25 patients with tdPD underwent neuropsychological evaluation including standardized questionnaires of disability, quality of life (QoL), mood, anxiety, apathy, sleep disturbances, and cognition at baseline, 6 and 12 months after MRgFUS. Motor outcome was evaluated using the Clinical Rating Scale for Tremor (CRST) and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). In addition, side effects and QoL of family caregivers were assessed. RESULTS 12 months after MRgFUS significant improvements were evident in the tremor subscores. Patients with concomitant rest and postural tremor showed better tremor outcomes compared to patients with predominant rest tremor. There were no differences in the non-motor assessments. No cognitive decline was observed. Side effects were mostly transient (54%) and classified as mild (62%). No changes in the caregivers' QoL could be observed. CONCLUSION We found no changes in mood, anxiety, apathy, sleep, cognition or persistent worsening of gait disturbances after unilateral MRgFUS thalamotomy in tdPD. Concomitant postural tremors responded better to treatment than predominant rest tremors.
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Affiliation(s)
- Veronika Purrer
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- German Centre of Neurodegenerative Diseases (DZNE), Bonn, Bonn, Germany.
| | - Emily Pohl
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hannah Weiland
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Henning Boecker
- German Centre of Neurodegenerative Diseases (DZNE), Bonn, Bonn, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Frederic Carsten Schmeel
- German Centre of Neurodegenerative Diseases (DZNE), Bonn, Bonn, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Ullrich Wüllner
- Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- German Centre of Neurodegenerative Diseases (DZNE), Bonn, Bonn, Germany
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Erfanian Abdoust M, Knecht S, Husain M, Le Heron C, Jocham G, Studer B. Effort-based decision making and motivational deficits in stroke patients. Brain Cogn 2024; 175:106123. [PMID: 38183905 DOI: 10.1016/j.bandc.2023.106123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024]
Abstract
Motivational deficits in patients recovering from stroke are common and can reduce active participation in rehabilitation and thereby impede functional recovery. We investigated whether stroke patients with clinically reduced drive, initiation, and endurance during functional rehabilitative training (n = 30) display systematic alterations in effort-based decision making compared to age, sex, and severity-matched stroke patients (n = 30) whose drive appeared unaffected. Notably, the two groups did not differ in self-reported ratings of apathy and depression. However, on an effort-based decision-making task, stroke patients with clinically apparent drive impairment showed intact willingness to accept effort for reward, but were more likely to fail to execute the required effort compared to patients without apparent drive impairments. In other words, the decision behavioural assessment revealed that stroke patients that displayed reduced drive, initiation, and endurance during inpatient neurorehabilitation failed to persist in goal-directed effort production, even over very short periods. These findings indicate that reduced drive during rehabilitative therapy in post-stroke patients is not due to a diminished motivation to invest physical effort, but instead is related to a reduced persistence with effortful behaviour.
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Affiliation(s)
- Mani Erfanian Abdoust
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK; Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Campbell Le Heron
- Department of Medicine, University of Otago (Christchurch), New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Gerhard Jocham
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany
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3
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Bastgen T, Evers J, Oedekoven C, Weide C, Herzog L, Ashton N, Zetterberg H, Blennow K, Albus A, Vidovic N, Kraff O, Deuschl C, Dodel R, Ross JA. Repetitive head injuries in German American football players do not change blood-based biomarker candidates for CTE during a single season. Neurol Res Pract 2024; 6:13. [PMID: 38419110 PMCID: PMC10903054 DOI: 10.1186/s42466-024-00307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/28/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Repetitive traumatic brain injuries in American football players (AFPs) can lead to the neurodegenerative disease chronic traumatic encephalopathy (CTE). Clinical symptoms of CTE range from mood and behavioral changes to cognitive impairment, depression, and suicidality. So far, CTE cannot be diagnosed in vivo and thus specific diagnostic parameters for CTE need to be found, to observe and treat exposed athletes as early as possible. Promising blood-based biomarkers for CTE include total tau (tTau), hyperphosphorylated tau (pTau), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), amyloid-β40 (Aβ40), amyloid-β42 (Aβ42) and calcium-binding protein B (S100-B). Previous studies have found elevated levels of these biomarkers in subjects exposed to TBIs, whereas cerebrospinal fluid (CSF) levels of Aβ40 and Aβ42 were decreased in CTE subjects. Here, we investigated whether young AFPs already exhibit changes of these biomarker candidates during the course of a single active season. METHODS Blood samples were drawn from n = 18 American Football Players before and after a full season and n = 18 male age-matched control subjects. The plasma titers of tTau, pTau, NF-L, GFAP, Aβ40, Aβ42 and S100-B were determined. Additionally, Apathy, Depression, and Health status as well as the concussion history and medical care were assessed and analyzed for correlations. RESULTS Here we show, that the selected biomarker candidates for CTE do not change significantly during the seven-month period of a single active season of American Football in blood samples of AFPs compared to healthy controls. But interestingly, they exhibit generally elevated pTau titers. Furthermore, we found correlations of depression, quality-of-life, career length, training participation and training continuation with headache after concussion with various titers. CONCLUSION Our data indicates, that changes of CTE marker candidates either occur slowly over several active seasons of American Football or are exclusively found in CSF. Nevertheless, our results underline the importance of a long-term assessment of these biomarker candidates, which might be possible through repeated blood biomarker monitoring in exposed athletes in the future.
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Affiliation(s)
- Theres Bastgen
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
| | - Janis Evers
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
- Institute for Health Services Research and Clinical Epidemiology (IVE), Philipps-University, Marburg, Germany
| | - Christiane Oedekoven
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
| | - Caroline Weide
- Department of Radiology, University Hospital Essen, Essen, Germany
| | - Lars Herzog
- Department of Radiology, University Hospital Essen, Essen, Germany
| | - Nicholas Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience Maurice Wohl Institute Clinical Neuroscience Institute, King's College London, London, UK
- NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin-Madison, Madison, WI, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Alexandra Albus
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany
| | - Natasha Vidovic
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany
| | - Oliver Kraff
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany
| | | | - Richard Dodel
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany.
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany.
| | - J Alexander Ross
- Department of Geriatric Medicine and Center for Translational and Behavioral Neuroscience, University Duisburg-Essen, Essen, Germany
- Therapy Research in Neurogeriatrics, Chair of Geriatric Medicine, University Duisburg-Essen, Virchowstrasse 171, 45174, Essen, Germany
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Yassine S, Almarouk S, Gschwandtner U, Auffret M, Fuhr P, Verin M, Hassan M. Electrophysiological signatures of anxiety in Parkinson's disease. Transl Psychiatry 2024; 14:66. [PMID: 38280864 PMCID: PMC10821912 DOI: 10.1038/s41398-024-02745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 01/29/2024] Open
Abstract
Anxiety is a common non-motor symptom in Parkinson's disease (PD) occurring in up to 31% of the patients and affecting their quality of life. Despite the high prevalence, anxiety symptoms in PD are often underdiagnosed and, therefore, undertreated. To date, functional and structural neuroimaging studies have contributed to our understanding of the motor and cognitive symptomatology of PD. Yet, the underlying pathophysiology of anxiety symptoms in PD remains largely unknown and studies on their neural correlates are missing. Here, we used resting-state electroencephalography (RS-EEG) of 68 non-demented PD patients with or without clinically-defined anxiety and 25 healthy controls (HC) to assess spectral and functional connectivity fingerprints characterizing the PD-related anxiety. When comparing the brain activity of the PD anxious group (PD-A, N = 18) to both PD non-anxious (PD-NA, N = 50) and HC groups (N = 25) at baseline, our results showed increased fronto-parietal delta power and decreased frontal beta power depicting the PD-A group. Results also revealed hyper-connectivity networks predominating in delta, theta and gamma bands against prominent hypo-connectivity networks in alpha and beta bands as network signatures of anxiety in PD where the frontal, temporal, limbic and insular lobes exhibited the majority of significant connections. Moreover, the revealed EEG-based electrophysiological signatures were strongly associated with the clinical scores of anxiety and followed their progression trend over the course of the disease. We believe that the identification of the electrophysiological correlates of anxiety in PD using EEG is conducive toward more accurate prognosis and can ultimately support personalized psychiatric follow-up and the development of new therapeutic strategies.
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Affiliation(s)
- Sahar Yassine
- MRC Brain Dynamic Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
- University of Rennes, LTSI - U1099, F-35000, Rennes, France.
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France.
| | - Sourour Almarouk
- University of Rennes, LTSI - U1099, F-35000, Rennes, France
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- Neuroscience Research Centre, Lebanese University, Faculty of Medicine, Beirut, Lebanon
| | - Ute Gschwandtner
- Dept. of Neurology, Hospitals of the University of Basel, Basel, Switzerland
| | - Manon Auffret
- University of Rennes, LTSI - U1099, F-35000, Rennes, France
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- France Développement Electronique, Monswiller, France
| | - Peter Fuhr
- Dept. of Neurology, Hospitals of the University of Basel, Basel, Switzerland
| | - Marc Verin
- University of Rennes, LTSI - U1099, F-35000, Rennes, France
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- Institut des Neurosciences Cliniques de Rennes (INCR), Rennes, France
- Movement Disorders Unit, Neurology Department, Pontchaillou University Hospital, Rennes, France
| | - Mahmoud Hassan
- Behavior & Basal Ganglia, CIC1414, CIC-IT, CHU Rennes, Rennes, France
- School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
- MINDIG, F-35000, Rennes, France
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5
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Toloraia K, Meyer A, Beltrani S, Fuhr P, Lieb R, Gschwandtner U. Anxiety, Depression, and Apathy as Predictors of Cognitive Decline in Patients With Parkinson's Disease-A Three-Year Follow-Up Study. Front Neurol 2022; 13:792830. [PMID: 35211081 PMCID: PMC8860828 DOI: 10.3389/fneur.2022.792830] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/10/2022] [Indexed: 12/31/2022] Open
Abstract
Objective Anxiety, depression, and apathy are the most common neuropsychiatric symptoms in Parkinson's disease (PD) patients. They impair cognitive functioning and have a profound impact on quality of life. This follow-up study aims to investigate the predictive value of anxiety, depression, and apathy on the development of Mild Cognitive Impairment (MCI) in PD patients. Methods Twenty-nine cognitively unimpaired PD patients (mean age 68.2 SD ± 7.12 years; 13 women) participated in this study. At Baseline (BL) levels of apathy (Apathy Evaluation Scale, AES), depression (Beck Depression Inventory, BDI-II), and anxiety (Beck Anxiety Inventory, BAI), were assessed. Cognitive status was reassessed three years later according to MCI/non-MCI status. For statistics, we used binary logistic regression and receiver operating characteristic curve (ROC) analysis to examine anxiety, apathy, and depression at BL as a predictor of MCI status three years later. Results Eight of the 29 patients developed MCI. Anxiety level at BL was found to predict MCI status at three-year follow-up (OR = 1.20, CI = 1.02–1.41, p = 0.02), while depression (OR = 1.16, CI = 0.93–1.47, p = 0.20) and apathy (OR = 1.06, CI = 0.92–1.23, p = 0.40) did not predict MCI status. The area under the ROC curve (AUC) of BAI for discriminating PD-non-MCI from PD-MCI was 0.79 (CI = 0.61–0.98). The optimal classification threshold yielded a sensitivity of 75.0 % and a specificity of 76.2 %. Neither apathy nor depression at BL discriminated between PD-non-MCI patients from PD-MCI three years later. Conclusions This study shows an association between anxiety and the development of MCI in PD patients, although the association between apathy, depression, and MCI did not reach a significant level.
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Affiliation(s)
- Ketevan Toloraia
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Selina Beltrani
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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6
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Renz KE, Pillny M, Lincoln TM. Increasing motivation in effort-based decision-making tasks: effects of salience and reward expectancy manipulations. Cogn Neuropsychiatry 2022; 27:20-34. [PMID: 34812121 DOI: 10.1080/13546805.2021.2007068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND A significant proportion of patients with affective and psychotic disorders show a marked reduction in goal-directed behaviour, which is also reflected in the behavioural outcomes of effort-based decision-making paradigms. The factors underlying this reduction are not yet fully understood. Reward salience and reward expectancy have been discussed as factors that potentially influence approach behaviour. The aim of this study was thus to test their effects on behaviour in an effort-based decision-making paradigm. METHODS In two studies with community samples we applied a modified version of the Balloon Task. In study 1, we manipulated reward salience in a within-subject design (N = 32) by highlighting the monetary rewards. In study 2, we manipulated reward expectancy in a between-subject design (N = 72) by adding five practice trials with either positive or negative feedback prior to the task. RESULTS The salience of rewards manipulation significantly increased effort expenditure and the allocation of effort to the level of rewards whereas the reward expectancy manipulation did not. CONCLUSIONS The finding that increasing the salience of rewards increases motivated behaviour in an effort-based decision-making paradigm offers promising possibilities for intervention in disorders characterised by motivational deficits, such asaffective and psychotic disorders.
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Affiliation(s)
- Katharina E Renz
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Matthias Pillny
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
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7
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Nitsch FJ, Strenger H, Knecht S, Studer B. Lesion Evidence for a Causal Role of the Insula in Aversion to Social Inequity. Soc Cogn Affect Neurosci 2021; 17:nsab098. [PMID: 34355245 PMCID: PMC8881633 DOI: 10.1093/scan/nsab098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/20/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Humans resist unequal distributions of goods in their social interactions, even if it requires foregoing personal gains. Functional neuroimaging studies implicate the insula in this aversion to social inequity and in fairness-related decisions, but a causal contribution has not yet been established. We compared the responses of 30 patients with lesions to the insula on a multiple-trial version of the one-shot Ultimatum Game, a neuroeconomic social exchange paradigm where a sum of money is split between two players, to those of 30 matched patients with brain injuries sparing the insula. Insula lesion patients accepted offers of an unequal disadvantageous split significantly more often than comparison lesion patients. Computational modeling confirmed that this difference in choice behavior was due to decreased aversion to disadvantageous inequity following insula damage, rather than due to increased decision noise or non-consideration of inequity. Our results provide novel evidence that the insula is causally involved in aversion to inequity and in value-based choices in the context of social interactions.
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Affiliation(s)
- Felix Jan Nitsch
- Comparative Psychology, Institute of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Germany
| | | | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany
- Mauritius Hospital Meerbusch, Meerbusch, Germany
| | - Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Germany
- Mauritius Hospital Meerbusch, Meerbusch, Germany
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8
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Schedlich-Teufer C, Jost ST, Krack P, Witt K, Weintraub D, Baldermann JC, Sommerauer M, Amstutz D, van Eimeren T, Dafsari HS, Kalbe E, Visser-Vandewalle V, Fink GR, Kessler J, Barbe MT. Assessment of Affective-Behavioral States in Parkinson's Disease Patients: Towards a New Screening Tool. JOURNAL OF PARKINSONS DISEASE 2021; 11:1417-1430. [PMID: 33967055 DOI: 10.3233/jpd-202375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of affective-behavioral states in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) is essential. OBJECTIVE To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS. METHODS Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach's alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed. RESULTS The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach's alpha = 0.72-0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84-0.95). Sensitivities and specificities exceeded 0.7. CONCLUSION The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.
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Affiliation(s)
- Charlotte Schedlich-Teufer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Sommerauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Deborah Amstutz
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thilo van Eimeren
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Josef Kessler
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Neurological soft signs and cognition in the late course of chronic schizophrenia: a longitudinal study. Eur Arch Psychiatry Clin Neurosci 2021; 271:1465-1473. [PMID: 32417958 PMCID: PMC8563630 DOI: 10.1007/s00406-020-01138-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/04/2020] [Indexed: 02/07/2023]
Abstract
Neurological soft signs (NSS) are minor ('soft') neurological abnormalities in sensory and motor performances, which are frequently reported in patients with schizophrenia at any stage of their illness. It has been demonstrated that NSS vary in the clinical course of the disorder: longitudinally NSS decrease in parallel with remission of psychopathological symptoms, an effect which mainly applies to patients with a remitting course. These findings are primarily based on patients with a first episode of the disorder, while the course of NSS in patients with chronic schizophrenia and persisting symptoms is rather unknown. Therefore, we investigated NSS twice in 21 patients with chronic schizophrenia (initial mean duration of illness: 23 ± 11 years) with a mean follow-up interval of 7 years. NSS were evaluated by the Heidelberg Scale, established instruments were used to rate neuropsychological performance and psychopathological symptoms. NSS showed significant increases on the subscales "motor coordination" and "integrative functions", while positive and negative symptoms, including apathy, showed only minor, non-significant changes. Verbal memory, verbal fluency, and cognitive flexibility along with severity of global cognitive deficits demonstrated a significant deterioration. Regression analyses identified executive dysfunction (cognitive flexibility and verbal fluency) at baseline as significant predictors of NSS increase at follow-up. Our findings indicate that NSS deteriorate in the long-term course of chronic schizophrenia. This effect may be accounted for by a decrease of executive functions and logical memory, which can be attributed to premature brain aging.
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Lee B, Gleason C, Umucu E. Clinical utility and psychometric properties of the Apathy Evaluation Scale. Rehabil Psychol 2020; 65:311-312. [PMID: 32804534 DOI: 10.1037/rep0000356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Apathy Evaluation Scale (AES) is a tool utilized with individuals with brain injury, neurocognitive disorders, and other mixed populations to quantify and characterize apathy in adults. The scale "treats apathy as a psychological dimension defined by simultaneous deficits in the overt behavioral, cognitive, and emotional concomitants of goal-directed behavior." It has three versions: self-rated (AES-S), clinician-rated (AES-C), and informant-rated (AES-I). Using factor analysis, Marin and colleagues identified three factors for the scale, including general apathy, disinterest or amotivation, and lack of concern. The psychometric properties of the AES have been examined in various clinical cohorts, including individuals with Alzheimer's disease (AD), traumatic brain injury (TBI), acquired brain injury, multiple sclerosis, severe mental illness, and cognitively healthy middle-aged cohort who are at risk for AD. The AES is a useful, reliable, and valid instrument to quantify and measure severity of apathy symptoms in adults. It is important to note that the AES-C and AES-S were able to discriminate apathy from depression and anxiety better than the AES-I did. It has been translated into Japanese, Portuguese, German, and Turkish. As a neuropsychiatric symptom, apathy should be measured in examining problems of relevance to psychology, psychiatry, and neurology, which may aid in understanding motivation, prognosis, and differential diagnosis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Bientzle M, Kimmerle J, Eggeling M, Cebi I, Weiss D, Gharabaghi A. Evidence-Based Decision Aid for Patients With Parkinson Disease: Protocol for Interview Study, Online Survey, and Two Randomized Controlled Trials. JMIR Res Protoc 2020; 9:e17482. [PMID: 32673261 PMCID: PMC7388050 DOI: 10.2196/17482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Shared decision making is particularly important in situations with different treatment alternatives. For the treatment of idiopathic Parkinson disease, both pharmacological and surgical approaches can be applied. OBJECTIVE In this research project, a series of studies will be conducted to investigate how decision aids for patients with idiopathic Parkinson disease should be designed in order to support the decision-making process. METHODS In Study 1a, qualitative interviews will be conducted to determine which needs frequently occur for patients with idiopathic Parkinson disease. In Study 1b, the identified needs will then be rated for personal relevance by an independent group of patients in an online survey. In Study 2, a randomized controlled trial will be used to pretest different decision aids in a sample group of people who do not have a medical background and who do not have Parkinson disease. In Study 3, a randomized controlled trial will be used to investigate the effect of the decision aids that had been evaluated as positive in Study 2 with patients who have idiopathic Parkinson disease. RESULTS This series of studies received ethical approval in January 2020. As of June 2020, data collection for Study 1a has started, and it is estimated that Studies 1a, 1b, 2, and 3 will take approximately 4, 4, 6, and 6 months to complete, respectively. It is planned to present the results and analyses at international conferences and to submit the results to peer-reviewed journals for publication, once the studies have been completed. The findings will also be shared with clinicians and patients through presentations at information events. CONCLUSIONS This series of studies is intended to result in an evidence-based decision aid for patients with idiopathic Parkinson disease in order to support the informed and reflected shared decision-making process. We further intend to contribute to a deeper understanding of the individual preferences of patients with idiopathic Parkinson disease and the impact of those preferences on treatment decisions.
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Affiliation(s)
| | - Joachim Kimmerle
- Leibniz-Institut für Wissensmedien, Tübingen, Germany
- Department of Psychology, University of Tübingen, Tübingen, Germany
| | | | - Idil Cebi
- Division of Functional and Restorative Neurosurgery and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
| | - Daniel Weiss
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Centre of Neurodegenerative Diseases, Tübingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
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Hartelt E, Scherbaum R, Kinkel M, Gold R, Muhlack S, Tönges L. Parkinson's Disease Multimodal Complex Treatment (PD-MCT): Analysis of Therapeutic Effects and Predictors for Improvement. J Clin Med 2020; 9:jcm9061874. [PMID: 32560079 PMCID: PMC7356837 DOI: 10.3390/jcm9061874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
Parkinson’s disease Multimodal Complex Treatment (PD-MCT) is a multidisciplinary inpatient treatment approach that has been demonstrated to improve motor function and quality of life in patients with Parkinson’s disease (PD). In this study, we assessed the efficacy of PD-MCT and calculated predictors for improvement. We performed a prospective analysis in a non-randomized, open-label observational patient cohort. Study examinations were done at baseline (BL), at discharge after two-weeks of inpatient treatment (DC) and at a six-week follow-up examination (FU). Besides Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III as a primary outcome, motor performance was measured by the Timed Up-and-Go (TUG), the Berg Balance Scale (BBS) and the Perdue Pegboard Test (PPT). Until DC, motor performance improved significantly in several parameters and was largely maintained until FU (MDS-UPDRS III BL-to-DC: −4.7 ± 1.2 (SE) p = 0.0012, BL-to-FU: −6.1 ± 1.3 p = 0.0001; TUG BL-to-DC: −2.5 ± 0.9 p = 0.015, BL-to-FU: 2.4 ± 0.9 p = 0.027; BBS BL-to-DC: 2.4 ± 0.7 p = 0.003, BL-to-FU: 1.3 ± 0.7 p = 0.176, PPT BL-to-DC: 3.0 ± 0.5 p = 0.000004, BL-to-FU: 1.7 ± 0.7 p = 0.059). Overall, nontremor items were more therapy responsive than tremor items. Motor complications evaluated with MDS-UPDRS IV occurred significantly less frequent at DC (−1.8 ± 0.5 p = 0.002). Predictor analyses revealed an influence of initial motor impairment and disease severity on the treatment response in different motor aspects. In summary, we demonstrate a significant positive treatment effect of PD-MCT on motor function of PD patients which can be maintained in several parameters for an extended time period of six weeks and identify predictors for an improvement of motor function.
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Affiliation(s)
- Elke Hartelt
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (E.H.); (R.S.); (R.G.); (S.M.)
| | - Raphael Scherbaum
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (E.H.); (R.S.); (R.G.); (S.M.)
| | - Manuel Kinkel
- Psychiatrisches Gutachtenbüro, 44795 Bochum, Germany;
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (E.H.); (R.S.); (R.G.); (S.M.)
- Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr-University Bochum, 44801 Bochum, Germany
| | - Siegfried Muhlack
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (E.H.); (R.S.); (R.G.); (S.M.)
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany; (E.H.); (R.S.); (R.G.); (S.M.)
- Neurodegeneration Research, Protein Research Unit Ruhr (PURE), Ruhr-University Bochum, 44801 Bochum, Germany
- Correspondence:
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Maier F, Spottke A, Bach JP, Bartels C, Buerger K, Dodel R, Fellgiebel A, Fliessbach K, Frölich L, Hausner L, Hellmich M, Klöppel S, Klostermann A, Kornhuber J, Laske C, Peters O, Priller J, Richter-Schmidinger T, Schneider A, Shah-Hosseini K, Teipel S, von Arnim CAF, Wiltfang J, Jessen F. Bupropion for the Treatment of Apathy in Alzheimer Disease: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206027. [PMID: 32463470 PMCID: PMC7256670 DOI: 10.1001/jamanetworkopen.2020.6027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Apathy is a frequent neuropsychiatric symptom in dementia of Alzheimer type and negatively affects the disease course and patients' and caregivers' quality of life. Effective treatment options are needed. OBJECTIVE To examine the efficacy and safety of the dopamine and noradrenaline reuptake inhibitor bupropion in the treatment of apathy in patients with dementia of Alzheimer type. DESIGN, SETTING, AND PARTICIPANTS This 12-week, multicenter, double-blind, placebo-controlled, randomized clinical trial was conducted in a psychiatric and neurological outpatient setting between July 2010 and July 2014 in Germany. Patients with mild-to-moderate dementia of Alzheimer type and clinically relevant apathy were included. Patients with additional clinically relevant depressed mood were excluded. Data analyses were performed between August 2018 and August 2019. INTERVENTIONS Patients received either bupropion or placebo (150 mg for 4 weeks plus 300 mg for 8 weeks). In case of intolerability of 300 mg, patients continued to receive 150 mg throughout the study. MAIN OUTCOMES AND MEASURES Change on the Apathy Evaluation Scale-Clinician Version (AES-C) (score range, 18-72 points) between baseline and week 12 was the primary outcome parameter. Secondary outcome parameters included measures of neuropsychiatric symptoms, cognition, activities of daily living, and quality of life. Outcome measures were assessed at baseline and at 4, 8, and 12 weeks. RESULTS A total of 108 patients (mean [SD] age, 74.8 [5.9] years; 67 men [62%]) were included in the intention-to-treat analysis, with 54 randomized to receive bupropion and 54 randomized to receive placebo. The baseline AES-C score was comparable between the bupropion group and the placebo group (mean [SD], 52.2 [8.7] vs 50.4 [8.2]). After controlling for the baseline AES-C score, site, and comedication with donepezil or galantamine, the mean change in the AES-C score between the bupropion and placebo groups was not statistically significant (mean change, 2.22; 95% CI, -0.47 to 4.91; P = .11). Results on secondary outcomes showed statistically significant differences between bupropion and placebo in terms of total neuropsychiatric symptoms (mean change, 5.52; 95% CI, 2.00 to 9.04; P = .003) and health-related quality of life (uncorrected for multiple comparisons; mean change, -1.66; 95% CI, -3.01 to -0.31; P = .02) with greater improvement in the placebo group. No statistically significant changes between groups were found for activities of daily living (mean change, -2.92; 95% CI, -5.89 to 0.06; P = .05) and cognition (mean change, -0.27; 95% CI, -3.26 to 2.73; P = .86). The numbers of adverse events (bupropion group, 39 patients [72.2%]; placebo group, 33 patients [61.1%]) and serious adverse events (bupropion group, 5 patients [9.3%]; placebo group, 2 patients [3.7%]) were comparable between groups. CONCLUSIONS AND RELEVANCE Although it is safe, bupropion was not superior to placebo for the treatment of apathy in patients with dementia of Alzheimer type in the absence of clinically relevant depressed mood. TRIAL REGISTRATION EU Clinical Trials Register Identifier: 2007-005352-17.
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Affiliation(s)
- Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Jan-Philipp Bach
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
| | - Katharina Buerger
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | | | | | - Lutz Frölich
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Zentralinstitut für Seelische Gesundheit Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
| | - Arne Klostermann
- German Center for Neurodegenerative Diseases, Berlin, Germany
- Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Laske
- German Center for Neurodegenerative Diseases, Tübingen, Germany
- Section for Dementia Research, Hertie Institute for Clinical Brain Research, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases, Berlin, Germany
- Department of Psychiatry, Charité Berlin, Berlin, Germany
| | - Josef Priller
- German Center for Neurodegenerative Diseases, Berlin, Germany
- Department of Neuropsychiatry, Berlin Institute of Health, Charité Berlin, Berlin, Germany
| | - Tanja Richter-Schmidinger
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, University of Bonn, Bonn, Germany
| | - Kija Shah-Hosseini
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases, Rostock, Germany
- Department of Psychosomatic Medicine, University Hospital of Rostock, Rostock, Germany
| | | | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Georg-August-University, Goettingen, Germany
- German Center for Neurodegenerative Diseases, Goettingen, Germany
| | - Frank Jessen
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
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Herold CJ, Essig M, Schröder J. Neurological soft signs (NSS) and brain morphology in patients with chronic schizophrenia and healthy controls. PLoS One 2020; 15:e0231669. [PMID: 32320431 PMCID: PMC7176089 DOI: 10.1371/journal.pone.0231669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/28/2020] [Indexed: 01/06/2023] Open
Abstract
Subtle abnormalities in sensory integration, motor coordination and sequencing of complex motor acts or neurological soft signs (NSS) are characteristic phenomena in patients with schizophrenia at any stage of the illness. Previous MRI studies in schizophrenia found NSS to be associated with cortical, thalamic and cerebellar changes. Since these studies mainly focused on first-episode or recent onset schizophrenia, the cerebral correlates of NSS in chronic schizophrenia remained rather unclear. 49 middle-aged patients with chronic schizophrenia with a mean duration of illness of 20.3 ± 14.0 years and 29 healthy subjects matched for age and sex were included. NSS were examined on the Heidelberg Scale and correlated to grey matter (GM) by using whole brain high resolution magnetic resonance imaging (3 Tesla) with SPM12/CAT12 analyses. As expected, NSS in patients were significantly (p≤0.001) elevated in contrast to healthy controls, a finding, which not only applied to NSS total score, but also to the respective subscales "motor coordination", "sensory integration", "complex motor tasks", "right/left and spatial orientation" and "hard signs". Within the patient group NSS total scores were significantly correlated to reduced GM in right lingual gyrus, left parahippocampal gyrus, left superior temporal gyrus, left thalamus (medial dorsal nucleus) and left posterior lobe of the cerebellum (declive). Respective negative associations could also be revealed for the subscales "motor coordination", "complex motor tasks" and "right/left and spatial orientation". These findings remained significant after FWE-correction for multiple comparisons and were confirmed when years of education, chlorpromazine-equivalents or variables indicating the severity of psychopathology were introduced as additional covariates. According to our results lingual, parahippocampal, superior temporal, inferior and middle frontal gyri, thalamus and cerebellum have to be considered as important sites of NSS in chronic schizophrenia. That these findings only applied for patients but not healthy controls may indicate a different pathogenesis of NSS.
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Affiliation(s)
- Christina J. Herold
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marco Essig
- Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - Johannes Schröder
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
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15
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Treusch Y, Majic T, Page J, Gutzmann H, Heinz A, Rapp M. Apathy in Nursing Home Residents with Dementia: Results From A Cluster-Randomized Controlled Trial. Eur Psychiatry 2020; 30:251-7. [DOI: 10.1016/j.eurpsy.2014.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/30/2014] [Accepted: 02/08/2014] [Indexed: 11/25/2022] Open
Abstract
AbstractPurpose:Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy.Subjects and methods:A prospective, controlled, rater-blinded, clinical trial with two follow-ups was conducted as part of a larger cluster-randomized trial in 18 nursing homes in Berlin. n = 117 dementia patients with apathy, defined as a score of 40 or more on the apathy evaluation scale (AES) or presence of apathy on the Neuropsychiatric Inventory (NPI), were randomly assigned to intervention or control group. The intervention included 10 months of brief activities, provided once a week. The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months.Results:We found significant group differences with respect to apathy during the 10 month intervention period (F2,82 = 7.79, P < 0.01), which reflected an increase in apathy in the control group, but not in the intervention group. Within one year after the intervention was ceased, the treatment group worsened and no longer differed significantly from the control group (P = 0.55).Conclusions:Our intervention was effective for the therapy of apathy in dementia, when applied, but not one year after cessation of therapy.
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16
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Geritz J, Maetzold S, Steffen M, Pilotto A, Corrà MF, Moscovich M, Rizzetti MC, Borroni B, Padovani A, Alpes A, Bang C, Barcellos I, Baron R, Bartsch T, Becktepe JS, Berg D, Bergeest LM, Bergmann P, Bouça-Machado R, Drey M, Elshehabi M, Farahmandi S, Ferreira JJ, Franke A, Friederich A, Geisler C, Hüllemann P, Gierthmühlen J, Granert O, Heinzel S, Heller MK, Hobert MA, Hofmann M, Jemlich B, Kerkmann L, Knüpfer S, Krause K, Kress M, Krupp S, Kudelka J, Kuhlenbäumer G, Kurth R, Leypoldt F, Maetzler C, Maia LF, Moewius A, Neumann P, Niemann K, Ortlieb CT, Paschen S, Pham MH, Puehler T, Radloff F, Riedel C, Rogalski M, Sablowsky S, Schanz EM, Schebesta L, Schicketmüller A, Studt S, Thieves M, Tönges L, Ullrich S, Urban PP, Vila-Chã N, Wiegard A, Warmerdam E, Warnecke T, Weiss M, Welzel J, Hansen C, Maetzler W. Motor, cognitive and mobility deficits in 1000 geriatric patients: protocol of a quantitative observational study before and after routine clinical geriatric treatment - the ComOn-study. BMC Geriatr 2020; 20:45. [PMID: 32028945 PMCID: PMC7006407 DOI: 10.1186/s12877-020-1445-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Motor and cognitive deficits and consequently mobility problems are common in geriatric patients. The currently available methods for diagnosis and for the evaluation of treatment in this vulnerable cohort are limited. The aims of the ComOn (COgnitive and Motor interactions in the Older populatioN) study are (i) to define quantitative markers with clinical relevance for motor and cognitive deficits, (ii) to investigate the interaction between both motor and cognitive deficits and (iii) to assess health status as well as treatment outcome of 1000 geriatric inpatients in hospitals of Kiel (Germany), Brescia (Italy), Porto (Portugal), Curitiba (Brazil) and Bochum (Germany). METHODS This is a prospective, explorative observational multi-center study. In addition to the comprehensive geriatric assessment, quantitative measures of reduced mobility and motor and cognitive deficits are performed before and after a two week's inpatient stay. Components of the assessment are mobile technology-based assessments of gait, balance and transfer performance, neuropsychological tests, frailty, sarcopenia, autonomic dysfunction and sensation, and questionnaires to assess behavioral deficits, activities of daily living, quality of life, fear of falling and dysphagia. Structural MRI and an unsupervised 24/7 home assessment of mobility are performed in a subgroup of participants. The study will also investigate the minimal clinically relevant change of the investigated parameters. DISCUSSION This study will help form a better understanding of symptoms and their complex interactions and treatment effects in a large geriatric cohort.
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Affiliation(s)
- Johanna Geritz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sara Maetzold
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Maren Steffen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Marta F. Corrà
- Neurology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Mariana Moscovich
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Maria C. Rizzetti
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Annekathrin Alpes
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Corinna Bang
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Igor Barcellos
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Ralf Baron
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thorsten Bartsch
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jos S. Becktepe
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Lu M. Bergeest
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philipp Bergmann
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular, Lisbon, Portugal. CNS-Campus Neurológico Sénior, Torres Vedras, Portugal. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Michael Drey
- Medical Clinic and Policlinic IV, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Morad Elshehabi
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Susan Farahmandi
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Joaquim J. Ferreira
- Instituto de Medicina Molecular, Lisbon, Portugal. CNS-Campus Neurológico Sénior, Torres Vedras, Portugal. Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja Friederich
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Corinna Geisler
- Institute of Human nutrition, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philipp Hüllemann
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Janne Gierthmühlen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Oliver Granert
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Maren K. Heller
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Markus A. Hobert
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Björn Jemlich
- Third Medical Clinic for Gastroenterology/Rheumatology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Laura Kerkmann
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Stephanie Knüpfer
- Department of Urology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Katharina Krause
- Department of Internal Medicine I, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Maximilian Kress
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sonja Krupp
- Research Group Geriatrics Lübeck, Red Cross Hospital Geriatric Centre, Lübeck, Germany
| | - Jennifer Kudelka
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Roland Kurth
- Department of Psychiatry and Psychotherapy, ZIP, Centre for Integrative Psychiatry, Kiel, Germany
| | - Frank Leypoldt
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Corina Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Luis F. Maia
- Neurology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Andreas Moewius
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Patricia Neumann
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Katharina Niemann
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Steffen Paschen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Minh H. Pham
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Digital Signal Processing and System Theory, Faculty of Engineering, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Franziska Radloff
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christian Riedel
- Department of Radiology and Neuroradiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Marten Rogalski
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Simone Sablowsky
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Elena M. Schanz
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Linda Schebesta
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Department of Cardiac and Vascular Surgery, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany
| | | | - Simone Studt
- Department of Psychiatry and Psychotherapy, ZIP, Centre for Integrative Psychiatry, Kiel, Germany
| | - Martina Thieves
- Geriatric Clinic, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Lars Tönges
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Sebastian Ullrich
- Third Medical Clinic for Gastroenterology/Rheumatology, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - Peter P. Urban
- Department of Neurology, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Nuno Vila-Chã
- Neurology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Anna Wiegard
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Elke Warmerdam
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Digital Signal Processing and System Theory, Faculty of Engineering, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Muenster, Germany
| | - Michael Weiss
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Julius Welzel
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Clint Hansen
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Christian-Albrechts-University of Kiel, Kiel, Germany
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Schüssler S, Zuschnegg J, Paletta L, Fellner M, Lodron G, Steiner J, Pansy-Resch S, Lammer L, Prodromou D, Brunsch S, Holter M, Carnevale L, Russegger S. Effects of a Humanoid Socially Assistive Robot Versus Tablet Training on Psychosocial and Physical Outcomes of Persons With Dementia: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e14927. [PMID: 32022697 PMCID: PMC7055795 DOI: 10.2196/14927] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/12/2019] [Accepted: 09/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background New technologies, like socially assistive robots (SARs), may have the potential to support caregivers at home. Still, the evidence for people with dementia in home care is unclear because a lot of studies are performed in a laboratory or institutional setting, and mainly use robots in prototype stages. Objective This study aims to explore the effects of the refined, commercially-available, humanoid SAR Pepper combined with a tablet PC–based dementia training program (Coach Pepper) versus an exclusively tablet PC–based dementia training program on psychosocial and physical outcomes of people with dementia living at home, including caregivers and dementia trainers. We hypothesize that Coach Pepper has a more positive effect on the primary outcome motivation (stable or decreased apathy) of people with dementia. Methods A mixed methods study will be performed, including a randomized controlled, parallel, 2-arm study with a complementary qualitative part. This sample includes 40 PWD living at home and 40 relatives, each complemented with five professional caregivers and dementia trainers. The intervention group will receive Coach Pepper (a SAR connected with a tablet PC–based dementia training program), and the control group will receive exclusively tablet PC–based training without the SAR. The duration of the intervention will be three weeks per household. Data will be collected at baseline and during and after the intervention by standardized questionnaires, sensor data of the robot, and tablet PC, as well as semistructured interviews, focus groups, and observation. Results To date, no results are available for this study protocol. The study intervention started in May 2019 and will end in Spring 2020. Conclusions The intervention of this study can be seen as a nonpharmacological intervention, including cognitive and physical training by a robot. This study will help to further refine SAR for the specific needs of people with dementia living at home. International Registered Report Identifier (IRRID) DERR1-10.2196/14927
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Affiliation(s)
- Sandra Schüssler
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Julia Zuschnegg
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Lucas Paletta
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Maria Fellner
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Gerald Lodron
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Josef Steiner
- Sozialverein Deutschlandsberg, Deutschlandsberg, Austria
| | | | - Lara Lammer
- Humanizing Technologies GmbH, Vienna, Austria
| | | | | | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Silvia Russegger
- Institut Digital, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
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18
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Spirgi S, Meyer A, Calabrese P, Gschwandtner U, Fuhr P. Effects of Cognitive Performance and Affective Status on Fatigue in Parkinson's Disease. Dement Geriatr Cogn Dis Extra 2019; 9:344-351. [PMID: 31616458 PMCID: PMC6792463 DOI: 10.1159/000498883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/12/2019] [Indexed: 12/16/2022] Open
Abstract
Background Fatigue is a common non-motor symptom in Parkinson's disease (PD) and is typically assessed via self-reported questionnaires such as the Parkinson's Fatigue Scale (PFS). The PFS captures the presence of subjective experience of physical fatigue as well as its impact on daily functioning. Objectives We aimed to investigate whether different variables (cognition, neuropsychiatric symptoms, disease-related measures) are associated with the experience of physical fatigue in comparison to fatigue affecting daily functioning. Method Sixty-two non-demented PD patients were evaluated through questionnaires assessing fatigue, daytime sleepiness, apathy, depression, anxiety, and cognition. Items of fatigue were classified and summarized into two index variables measuring either the subjective experience of physical fatigue or the impact of fatigue on daily functioning. Linear regression with a stepwise elimination procedure was conducted to select the significant predictors for each index variable separately. Results Subjective experience of physical fatigue (Model 1; r2 = 0.46; p <0.01) was significantly associated with higher levels of depression (b =0.07; p <0.01), anxiety (b =0.03; p <0.05), and lower performances in verbal episodic memory (b =-0.16; p <0.05). Fatigue affecting daily functioning (Model 2; r2 = 0.44; p <0.05) was significantly related to higher levels of depression (b = 0.07; p < 0.01), anxiety (b = 0.03; p > 0.05), and lower motor functioning (b = 0.01; p = 0.05). Conclusions In conclusion, our work supports associations between fatigue and other neuropsychiatric symptoms in PD and extends prior work suggesting that motor disturbances are specifically linked to fatigue-related impairment of daily functioning, but not to the subjective experience of physical fatigue.
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Affiliation(s)
- Susan Spirgi
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | | | - Ute Gschwandtner
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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19
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Ullrich P, Eckert T, Bongartz M, Werner C, Kiss R, Bauer JM, Hauer K. Life-space mobility in older persons with cognitive impairment after discharge from geriatric rehabilitation. Arch Gerontol Geriatr 2018; 81:192-200. [PMID: 30605862 DOI: 10.1016/j.archger.2018.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/11/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation. METHODS A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17-26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI). Bivariate analyses and multivariate regression analyses were used to investigate associations between LSM and physical, cognitive, psychosocial, environmental, financial and demographic characteristics, and physical activity behavior. RESULTS LSM in 118 older, multimorbid participants (age: 82.3 ± 6.0 years) with cognitive impairment (MMSE score: 23.3 ± 2.4 points) was substantially limited, depending on availability of personal support and equipment. More than 30% of participants were confined to the neighborhood and half of all patients could not leave the bedroom without equipment or assistance. Motor performance, social activities, physical activity, and gender were identified as independent determinants of LSM and explained 42.4% (adjusted R²) of the LSA-CI variance in the regression model. CONCLUSION The study documents the highly restricted LSM in older persons with CI following geriatric rehabilitation. The identified modifiable determinants of LSM show potential for future interventions to increase LSM in such a vulnerable population at high risk for restrictions in LSM by targeting motor performance, social activities, and physical activity. A gender-specific approach may help to address more advanced restrictions in women.
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Affiliation(s)
- Phoebe Ullrich
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Tobias Eckert
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Martin Bongartz
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany
| | - Christian Werner
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Rainer Kiss
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Rohrbacher Str. 149, 69126 Heidelberg, Germany; Department of Health and Social Affairs, FHM Bielefeld, University of Applied Science, Ravensberger Str. 10G, 33602 Bielefeld, Germany
| | - Jürgen M Bauer
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Klaus Hauer
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany.
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20
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Herold CJ, Duval CZ, Lässer MM, Schröder J. Neurological soft signs (NSS) and cognitive impairment in chronic schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 16:17-24. [PMID: 30671351 PMCID: PMC6305804 DOI: 10.1016/j.scog.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/16/2023]
Abstract
Recent studies indicate that neurological soft signs (NSS) in schizophrenia are associated with generalized cognitive impairments rather than changes in specific neuropsychological domains. However, the majority of studies solely included first-episode patients or patients with a remitting course and did not consider age, course, education or severity of global cognitive deficits as potential confounding variables. Therefore, we examined NSS with respect to cognitive deficits in chronic schizophrenia, i.e. patients who are particularly vulnerable to both, NSS and cognitive impairments. Eighty patients with chronic schizophrenia (43.36 ± 15a) and 60 healthy controls (47.52 ± 14.8a) matched for age, sex and years of education were examined on the Heidelberg NSS scale and a broad neuropsychological battery including short term, working, logical and autobiographic memory (AM), theory of mind (ToM), psychomotor speed and cognitive flexibility. When contrasted with the controls, patients showed significantly higher NSS scores and impairments in all neuropsychological domains but short-term memory. NSS were significantly associated with all neuropsychological domains considered but short-term memory and semantic AM. Except for episodic AM (which was significantly correlated with NSS in patients only) these correlations applied to both groups and were confirmed when age, years of education and severity of global cognitive deficits (Mini Mental State Examination) were controlled for. Results demonstrate that NSS reflect a rather wide range of cognitive impairments in schizophrenia, which also involves episodic AM and ToM. These associations were not accounted for by age, education or severity of global cognitive deficits and facilitate the clinical usage of NSS as a screening instrument.
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Affiliation(s)
- Christina J Herold
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Céline Z Duval
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc M Lässer
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Section of Geriatric Psychiatry, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
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21
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Stankevich Y, Lueken U, Balzer-Geldsetzer M, Dodel R, Gräber-Sultan S, Berg D, Liepelt-Scarfone I, Hilker-Roggendorf R, Kalbe E, Kaut O, Mollenhauer B, Reetz K, Schäffer E, Schmidt N, Schulz JB, Spottke A, Witt K, Linse K, Storch A, Riedel O. Psychometric Properties of an Abbreviated Version of the Apathy Evaluation Scale for Parkinson Disease (AES-12PD). Am J Geriatr Psychiatry 2018; 26:1079-1090. [PMID: 30082208 DOI: 10.1016/j.jagp.2018.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Apathy is a frequent symptom in Parkinson's disease (PD), substantially aggravating the course of PD. Regarding the accumulating evidence of the key role of apathy in PD, time-efficient assessments are useful for fostering progress in research and treatment. The Apathy Evaluation Scale (AES) is widely used for the assessment of apathy across different nosologies. OBJECTIVE To facilitate the application of the AES in PD, we reduced the AES to two-thirds its length and validated this abbreviated version. DESIGN Data sets of 339 PD patients of the DEMPARK/LANDSCAPE study without dementia and depression were randomly split into two samples. Data of sample 1 were used to develop a brief version of the AES (AES-12PD). A cross-validation was conducted in sample 2 and in a subsample of 42 PD patients with comorbid dementia and depressive symptomatology. Receiver operating characteristic analysis was applied to determine the optimal cutoff of the AES-12PD as an indicator of apathy. RESULTS The AES-12PD featured high internal consistency that was better compared to the AES. The abbreviated scale was well differentiated from motor impairment and cognitive deficits. The AES-12PD cutoff of 27/28 was the optimal cutoff for apathy in PD patients without dementia and depression. The cutoff of 25/26 indicated apathy in PD patients with comorbid dementia and depression. CONCLUSION Results confirm a high internal consistency and good discriminant validity of the AES-12PD. The AES-12PD represents a reliable tool for the efficient assessment of apathy that can be applied in PD patients with and without dementia and depression.
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Affiliation(s)
- Yuliya Stankevich
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany.
| | - Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany; Department of Psychology, Humboldt-Universität zu Berlin, Berlin
| | - Monika Balzer-Geldsetzer
- Department of Neurology, Phillips University Marburg, Marburg, Germany; Chair of Geriatrics, University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Essen, Germany
| | - Richard Dodel
- Department of Neurology, Phillips University Marburg, Marburg, Germany; Chair of Geriatrics, University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Essen, Germany
| | - Susanne Gräber-Sultan
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Universität Tübingen, and German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Campus Kiel, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, Universität Tübingen, and German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Elke Kalbe
- Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne
| | - Oliver Kaut
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Brit Mollenhauer
- Paracelsus-Elena-Klinik, Kassel, Germany; Klinik für Neurologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Eva Schäffer
- Department of Neurology, University Hospital Campus Kiel, Kiel, Germany
| | - Nele Schmidt
- Department of Neurology, University Hospital Campus Kiel, Kiel, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Annika Spottke
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Karsten Witt
- Department of Neurology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Linse
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Department of Neurology, University of Rostock, and German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Oliver Riedel
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany; Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
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22
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Self- and informant-rated apathy in patients with childhood-onset craniopharyngioma. J Neurooncol 2018; 140:27-35. [DOI: 10.1007/s11060-018-2936-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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23
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Psychometric evaluation of the Temporal Experience of Pleasure Scale (TEPS) in a German sample. Psychiatry Res 2018; 260:138-143. [PMID: 29195165 DOI: 10.1016/j.psychres.2017.11.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 10/12/2017] [Accepted: 11/18/2017] [Indexed: 11/20/2022]
Abstract
Anhedonia, or the inability to experience pleasure, is commonly observed in schizophrenia. It has been suggested that patients with schizophrenia are unable to predict future pleasurable events, but show intact experience of in-the-moment pleasure. Therefore, the Temporal Experience of Pleasure Scale (TEPS), a self-report measure allowing the assessment of anticipatory and consummatory pleasure, has been developed. To validate the German version of the TEPS, we recruited 59 healthy control participants and 51 patients with schizophrenia or schizoaffective disorder who completed the TEPS as well as a battery of psychometric tests to assess psychopathology, in particular self-rated anhedonia and clinician-rated apathy as well as overall measures of negative symptoms. We found acceptable to good internal consistency and a factor structure comparable to the original version. Scores of the TEPS were related to measures of anhedonia and apathy, but not with other measures of psychopathology. The present results suggest that the German version of the TEPS shows adequate reliability and validity to assess the construct of anhedonia. However, differential aspects of anticipatory and consummatory pleasure should be further investigated in clinical samples.
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24
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Herold CJ, Lässer MM, Seidl UW, Hirjak D, Thomann PA, Schröder J. Neurological Soft Signs and Psychopathology in Chronic Schizophrenia: A Cross-Sectional Study in Three Age Groups. Front Psychiatry 2018; 9:98. [PMID: 29632500 PMCID: PMC5879443 DOI: 10.3389/fpsyt.2018.00098] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 03/09/2018] [Indexed: 11/19/2022] Open
Abstract
As established in a wealth of studies subtle motor and sensory neurological abnormalities or neurological soft signs (NSS) are frequently found in patients with schizophrenia at any stage of their illness. However, the potential impact of chronicity and age on NSS was scarcely investigated. Therefore, we assessed NSS in 90 patients with subchronic (n = 22) or chronic (n = 68) schizophrenia and in 60 healthy controls who were assigned to three age groups (18-29, 30-49, and +50 years). NSS were measured on the Heidelberg Scale, psychopathological symptoms including apathy were rated on established instruments. As demonstrated by analysis of variance, NSS scores in patients were significantly (p < 0.05) increased relative to healthy controls. Significant age effects arose in all NSS subscores, with older subjects scoring well above the younger ones. These age effects were more pronounced in patients than controls, indicating that NSS in chronic schizophrenia exceed age-associated changes. Moreover, the NSS scores in patients were significantly associated with duration of illness, thought disturbance, positive symptoms, and apathy. These results were confirmed after age/duration of illness and years of education were partialed out and via regression analyses. Our findings conform to the hypothesis that NSS are associated with chronicity of the disorder as indicated by the correlations of NSS with both, duration of illness and apathy. The correlations between NSS and positive symptoms/thought disturbance correspond to the fluctuation of positive symptoms during the course of the disorder. The significantly more pronounced age effects on NSS in patients may either point to ongoing cerebral changes or to a greater susceptibility of patients toward physiological age effects, which may be mediated among other factors by a lower cognitive reserve.
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Affiliation(s)
- Christina J Herold
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Marc M Lässer
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | | | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp A Thomann
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Johannes Schröder
- Department of General Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
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25
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Lueken U, Evens R, Balzer-Geldsetzer M, Baudrexel S, Dodel R, Gräber-Sultan S, Hilker-Roggendorf R, Kalbe E, Kaut O, Mollenhauer B, Reetz K, Schäffer E, Schmidt N, Schulz JB, Spottke A, Witt K, Linse K, Storch A, Riedel O. Psychometric properties of the apathy evaluation scale in patients with Parkinson's disease. Int J Methods Psychiatr Res 2017; 26:e1564. [PMID: 28418163 PMCID: PMC6877280 DOI: 10.1002/mpr.1564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 11/06/2022] Open
Abstract
Parkinson's disease (PD) frequently entails non-motor symptoms, worsening the course of the disease. Apathy is one of the core neuropsychiatric symptoms that has been investigated in recent years; research is however hampered by the limited availability of well-evaluated apathy scales for these patients. We evaluated the psychometric properties of the Apathy Evaluation Scale (AES) in a sample of PD patients. Psychometric properties, convergent and discriminant validity and sensitivity/specificity were evaluated in patients with (n = 582) or without dementia/depression (n = 339). Internal consistency was high in the entire sample as well as in patients without dementia/depression. Correlations were moderate for convergent validity (UPDRS I item 4: motivation). While apathy could be differentiated from cognitive decline, it was related to depression (Geriatric Depression Scale, GDS-15). The overall classification accuracy based on the UPDRS I item 4 was comparable for AES and GDS scores. The AES exhibits good psychometric properties in PD patients with and without dementia and/or depression. Commonly used screenings on the presence of apathy had low detection rates compared to the AES and reflected both apathetic and depressive symptoms. Psychometric evaluation of available instruments will support further research on the clinical relevance of apathy for disease progression and treatment approaches in PD patients.
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Affiliation(s)
- Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Würzburg, Würzburg, Germany.,Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Ricarda Evens
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Simon Baudrexel
- Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Richard Dodel
- Department of Neurology, Phillips University Marburg, Marburg, Germany
| | - Susanne Gräber-Sultan
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE), University Tübingen, Tübingen, Germany
| | | | - Elke Kalbe
- Department of Medical Psychology: Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Cologne, Germany
| | - Oliver Kaut
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Aachen, (Germany).,JARA - Translational Brain Medicine, Jülich and Aachen, Aachen, Germany.,Institute of Neuroscience and Medicine (INM 11), Research Center Jülich GmbH, Jülich, Germany
| | - Eva Schäffer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research and German Center for Neurodegenerative Diseases (DZNE), University Tübingen, Tübingen, Germany
| | - Nele Schmidt
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, (Germany).,JARA - Translational Brain Medicine, Jülich and Aachen, Aachen, Germany.,Institute of Neuroscience and Medicine (INM 11), Research Center Jülich GmbH, Jülich, Germany
| | - Annika Spottke
- Department of Neurology, University Hospital Bonn, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Karsten Witt
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | - Katharina Linse
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Alexander Storch
- Division of Neurodegenerative Diseases, Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Department of Neurology, University of Rostock, Rostock, Germany
| | - Oliver Riedel
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Dresden, Germany.,Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
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Hatz F, Meyer A, Zimmermann R, Gschwandtner U, Fuhr P. Apathy in Patients with Parkinson's Disease Correlates with Alteration of Left Fronto-Polar Electroencephalographic Connectivity. Front Aging Neurosci 2017; 9:262. [PMID: 28860987 PMCID: PMC5559507 DOI: 10.3389/fnagi.2017.00262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/24/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction: Quantitative electroencephalography (QEEG) brain frequency and network analyses are known to differentiate between disease stages in Parkinson's disease (PD) and are possible biomarkers. They correlate with cognitive decline. Little is known about changes in brain networks in relation to apathy. Objective/Aims: To analyze changes in brain network connectivities related to apathy. Methods: 40 PD patients (14 PD with mild cognitive deficits and 26 PD with normal cognition) were included. All patients had extensive neuropsychological testing; apathy was evaluated using the apathy evaluation score (AES, median 24.5, range 18–39). Resting state EEG was recorded with 256 electrodes and analyzed using fully automated Matlab® code (TAPEEG). For estimation of the connectivities between brain regions, PLI (phase lag index) was used, enhanced by a microstates segmentation. Results: After correction for multiple comparisons, significant correlations were found for single alpha2-band connectivities with the AES (p-values < 0.05). Lower connectivities, mainly involving the left fronto-polar region, were related to higher apathy scores. Conclusions: In our sample of patients with PD, apathy correlates with a network alteration mainly involving the left fronto-polar region. This might be due to dysfunction of the cortico-basal loop, modulating motivation.
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Affiliation(s)
- Florian Hatz
- Department of Neurology, Hospitals of University of BaselBasel, Switzerland
| | - Antonia Meyer
- Department of Neurology, Hospitals of University of BaselBasel, Switzerland
| | - Ronan Zimmermann
- Department of Neurology, Hospitals of University of BaselBasel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, Hospitals of University of BaselBasel, Switzerland
| | - Peter Fuhr
- Department of Neurology, Hospitals of University of BaselBasel, Switzerland
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Johansson M, Johansson P, Stomrud E, Hagell P, Hansson O. Psychometric testing of a Swedish version of the Apathy Evaluation Scale. Nord J Psychiatry 2017. [PMID: 28632431 DOI: 10.1080/08039488.2017.1334820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Apathy, a prevalent and clinically relevant symptom in neurodegenerative disease, is often evaluated by the instrument Apathy Evaluation Scale (AES). However, this instrument has not been translated into Swedish, halting clinical and research efforts. Furthermore, previous studies lack analyses of some basic properties, such as the legitimacy of a total score, or have analysed dimensionality by questionable methods. AIM To translate and psychometrically evaluate a Swedish version of the AES. METHOD The AES was translated, and its psychometric properties were tested in the Swedish BioFINDER study, including cognitively well elderly, and subjects with mild cognitive or parkinsonian symptoms. Psychometric analyses were conducted according to classical test theory (CTT) and aimed to resemble those performed in the English original study by Marin et al. in 1991. Dimensionality was additionally analysed on a matrix of polychoric correlations and parallel analyses. RESULTS Data indicate that the Swedish AES performs satisfactorily regarding data completeness, scaling assumptions, targeting, and reliability. Principal component analyses (with parallel analysis) of polychoric correlation matrices identified a single component. Convergent and discriminative validity correlations accorded with a priori expectations. CONCLUSIONS The study provides initial support that this Swedish AES performs similarly to the English original, and exhibits acceptable psychometric properties according to CTT, including supported unidimensionality, and may be adopted for use in clinical and research settings.
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Affiliation(s)
- Maurits Johansson
- a Clinical Memory Research Unit, Clinical Sciences Malmö , Lund University , Malmö , Sweden.,b Clinical Sciences Lund/Helsingborg , Lund University , Helsingborg , Sweden
| | - Per Johansson
- b Clinical Sciences Lund/Helsingborg , Lund University , Helsingborg , Sweden.,c Department of Internal Medicine , Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
| | - Erik Stomrud
- a Clinical Memory Research Unit, Clinical Sciences Malmö , Lund University , Malmö , Sweden.,d Memory Clinic , Skåne University Hospital , Malmö , Sweden
| | - Peter Hagell
- e The PRO-CARE Group, School of Health and Society , Kristianstad University , Kristianstad , Sweden
| | - Oskar Hansson
- a Clinical Memory Research Unit, Clinical Sciences Malmö , Lund University , Malmö , Sweden.,d Memory Clinic , Skåne University Hospital , Malmö , Sweden
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Lincoln TM, Dollfus S, Lyne J. Current developments and challenges in the assessment of negative symptoms. Schizophr Res 2017; 186:8-18. [PMID: 26960948 DOI: 10.1016/j.schres.2016.02.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/18/2016] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
Reliable and valid assessment of negative symptoms is crucial to further develop etiological models and improve treatments. Our understanding of the concept of negative symptoms has undergone significant advances since the introduction of quantitative assessments of negative symptoms in the 1980s. These include the conceptualization of cognitive dysfunction as separate from negative symptoms and the distinction of two main negative symptom factors (avolition and diminished expression). In this review we provide an overview of existing negative symptom scales, focusing on both observer-rated and self-rated measurement of negative symptoms. We also distinguish between measures that assess negative symptoms as part of a broader assessment of schizophrenia symptoms, those specifically developed for negative symptoms and those that assess specific domains of negative symptoms within and beyond the context of psychotic disorders. We critically discuss strengths and limitations of these measures in the light of some existing challenges, i.e. observed and subjective symptom experiences, the challenge of distinguishing between primary and secondary negative symptoms, and the overlap between negative symptoms and related factors (e.g. personality traits and premorbid functioning). This review is aimed to inform the ongoing development of negative symptom scales.
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Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, University of Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Sonia Dollfus
- CHU de Caen, Service universitaire de Psychiatrie, Centre Esquirol, Avenue Côte de Nacre, Caen F-14000, France; UNICAEN, UFR Médecine, F-14074 Caen, France
| | - John Lyne
- Royal College of Surgeons in Ireland, North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland; Dublin and East Treatment and Early Care Team, Avila House, Blackrock Business Park, Blackrock, Co. Dublin, Ireland
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Pfeifer L, Horn AB, Maercker A, Forstmeier S. Caregiver perception of apathy in persons with mild cognitive impairment or Alzheimer's disease: a longitudinal study. Aging Ment Health 2017; 21:494-500. [PMID: 26666575 DOI: 10.1080/13607863.2015.1118678] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Discrepancy between self- and caregiver apathy ratings was examined longitudinally for persons with mild cognitive impairment or Alzheimer's disease. Particular focus was on the distinction between the positive and negative caregiver bias and its predictive value for a clinical diagnosis of apathy. METHOD Apathy rating discrepancy was based on the apathy evaluation scale. Dyads were categorized depending on whether the caregiver reported fewer deficits (positive caregiver bias) or more deficits (negative caregiver bias) than the cognitively impaired person did. RESULTS Caregiver ratings and rating discrepancy showed a significant increase from baseline to follow-up. By contrast, self- and clinician ratings showed no change across the two time points. Ratings with a negative caregiver bias remained stable, while those with a positive caregiver bias showed a significant increase in the caregiver ratings but also a significant decrease in the self-ratings. A negative caregiver bias at baseline was significantly related to greater likelihood of having clinical apathy at follow-up, adjusted for an array of control variables. CONCLUSION Positive and negative caregiver bias should be distinguished, as they seem to reflect distinct dyadic processes and are relevant for clinical outcome. Furthermore, negative rating discrepancies can be considered a risk factor for developing apathy.
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Affiliation(s)
- Livia Pfeifer
- a Department of Psychology Division Psychopathology and Clinical Intervention , University of Zurich , Zurich , Switzerland
| | - Andrea B Horn
- a Department of Psychology Division Psychopathology and Clinical Intervention , University of Zurich , Zurich , Switzerland
| | - Andreas Maercker
- a Department of Psychology Division Psychopathology and Clinical Intervention , University of Zurich , Zurich , Switzerland
| | - Simon Forstmeier
- a Department of Psychology Division Psychopathology and Clinical Intervention , University of Zurich , Zurich , Switzerland
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Gelderblom H, Wüstenberg T, McLean T, Mütze L, Fischer W, Saft C, Hoffmann R, Süssmuth S, Schlattmann P, van Duijn E, Landwehrmeyer B, Priller J. Bupropion for the treatment of apathy in Huntington's disease: A multicenter, randomised, double-blind, placebo-controlled, prospective crossover trial. PLoS One 2017; 12:e0173872. [PMID: 28323838 PMCID: PMC5360242 DOI: 10.1371/journal.pone.0173872] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/28/2017] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of bupropion in the treatment of apathy in Huntington's disease (HD). METHODS In this phase 2b multicentre, double-blind, placebo-controlled crossover trial, individuals with HD and clinical signs of apathy according to the Structured Clinical Interview for Apathy-Dementia (SCIA-D), but not depression (n = 40) were randomized to receive either bupropion 150/300mg or placebo daily for 10 weeks. The primary outcome parameter was a significant change of the Apathy Evaluation Scale (AES) score after ten weeks of treatment as judged by an informant (AES-I) living in close proximity with the study participant. The secondary outcome parameters included changes of 1. AES scores determined by the patient (AES-S) or the clinical investigator (AES-C), 2. psychiatric symptoms (NPI, HADS-SIS, UHDRS-Behavior), 3. cognitive performance (SDMT, Stroop, VFT, MMSE), 4. motor symptoms (UHDRS-Motor), 5. activities of daily function (TFC, UHDRS-Function), and 6. caregiver distress (NPI-D). In addition, we investigated the effect of bupropion on brain structure as well as brain responses and functional connectivity during reward processing in a gambling task using magnetic resonance imaging (MRI). RESULTS At baseline, there were no significant treatment group differences in the clinical primary and secondary outcome parameters. At endpoint, there was no statistically significant difference between treatment groups for all clinical primary and secondary outcome variables. Study participation, irrespective of the intervention, lessened symptoms of apathy according to the informant and the clinical investigator. CONCLUSION Bupropion does not alleviate apathy in HD. However, study participation/placebo effects were observed, which document the need for carefully controlled trials when investigating therapeutic interventions for the neuropsychiatric symptoms of HD. TRIAL REGISTRATION ClinicalTrials.gov 01914965.
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Affiliation(s)
- Harald Gelderblom
- Department of Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tim McLean
- European Huntington’s Disease Network, Ulm, Germany
| | | | | | - Carsten Saft
- Department of Neurology, Huntington-Center NRW, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Rainer Hoffmann
- Department of Neurology, Huntington-Center NRW, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | | | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena Universityhospital, Jena, Germany
| | - Erik van Duijn
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Bernhard Landwehrmeyer
- European Huntington’s Disease Network, Ulm, Germany
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Josef Priller
- Department of Neuropsychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence NeuroCure, DZNE and BIH, Berlin, Germany
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Life-space and movement behavior in nursing home residents: results of a new sensor-based assessment and associated factors. BMC Geriatr 2017; 17:36. [PMID: 28129741 PMCID: PMC5273820 DOI: 10.1186/s12877-017-0430-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 01/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Studies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons. The purpose of this study was to provide an advanced descriptive analysis of LS in nursing home residents and to identify associated factors based on an established theoretical framework, using an objective, sensor-based assessment with a high spatiotemporal resolution. Methods Cross-sectional study in two nursing homes in Heidelberg, Germany (n = 65; mean age: 82.9 years; 2/3 female). Changes of location in the nursing home (Transits) as well as time spent away from the private room (TAFR) were assessed using a wireless sensor network. Measures of physical, psychosocial, cognitive, socio-demographic, and environmental factors were assessed via established motor performance tests, interviews, and proxy-reports. Results LS of residents was largely restricted to the private room and the surrounding living unit (90%); 10% of daytime was spent outside the living unit and/or the facility. On average, TAFR was 5.1 h per day (±2.3; Range: 0–8); seven Transits (6.9 ± 3.2; Range: 0–18) were performed per day. Linear regression analyses revealed being male, lower gait speed, higher cognitive status, and lower apathy to be associated with more Transits; higher gait speed, lower cognitive status, and less depressive symptoms were associated with more TAFR. LS was significantly increased during institutional routines (mealtimes) as compared to the rest of the day. Conclusions The sensor-based LS assessment provided new, objective insights into LS of institutionalized persons living in nursing homes. It revealed that residents’ LS was severely limited to private rooms and adjacent living units, and that in institutional settings, daily routines such as meal times seem to be the major determinant of LS utilization. Gait speed, apathy, and depressive symptoms as well as institutional meal routines were the only modifiable predictors of Transits and/or TAFR, and thus have greatest potential to lead to an enhancement of LS when targeted with interventions. Trial registration Current Controlled Trials ISRCTN96090441 (retrospectively registered).
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Hadinia A, Meyer A, Bruegger V, Hatz F, Nowak K, Taub E, Nyberg E, Stieglitz RD, Fuhr P, Gschwandtner U. Cognitive Behavioral Group Therapy Reduces Stress and Improves the Quality of Life in Patients with Parkinson's Disease. Front Psychol 2017; 7:1975. [PMID: 28101066 PMCID: PMC5209356 DOI: 10.3389/fpsyg.2016.01975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022] Open
Abstract
Objective: The aim of this study is to compare a cognitive behavioral group therapy (CBT) with a health enhancement program (HEP) for stress reduction and the impact on quality of life (QoL) in patients with Parkinson’s disease (PD). Method: Thirty patients with PD participated in the study: 16 received CBT including stress-reducing elements and 14 took part in a HEP. The two groups did not differ significantly in their baseline demographic characteristics. The patients in both groups underwent weekly sessions of 2 h duration for 9 weeks. The Parkinson’s Disease Questionnaire with 39 items (PDQ-39), the Burden Questionnaire for Parkinson’s Disease (translated from the original German: Belastungsfragebogen für Parkinsonpatienten (BELA) and the Disease-Related Questionnaire [Fragebogen zur krankheitsbezogenen Kommunikation (FKK)] were used for assessment. Ratings were completed at baseline and after 9 weeks (immediately after the last treatment session). Results: The patients in the CBT group achieved significantly better BELA, FKK and PDQ-39 scores (p < 0.05). Subscale analysis revealed that the scores on the BELA subscales “emotional well-being” and “somatic motor function” contributed significantly to stress reduction (p < 0.05). The FKK revealed significant improvement in social skills in the CBT group (p < 0.05). Conclusion: Cognitive Behavioral Group Therapy appears to be an effective way for patients with PD to lessen stress and improve their quality of life.
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Affiliation(s)
- Anousha Hadinia
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Antonia Meyer
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Viviane Bruegger
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Florian Hatz
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Karolina Nowak
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Ethan Taub
- Department of Neurosurgery, University Hospital of Basel Basel, Switzerland
| | - Elisabeth Nyberg
- Department of Psychiatry, University Hospital of Basel Basel, Switzerland
| | - Rolf-Dieter Stieglitz
- Department of Psychiatry, University Hospital of BaselBasel, Switzerland; Department of Psychology, University of BaselBasel, Switzerland
| | - Peter Fuhr
- Department of Neurology, University Hospital of Basel Basel, Switzerland
| | - Ute Gschwandtner
- Department of Neurology, University Hospital of Basel Basel, Switzerland
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Köller L, Knebel M, Haberstroh J, Krause K, Sahlender S, Jakob M, Schoch J, Ehret S, Schmitt E, Kruse A, Schröder J, Pantel J. Apathy in Dementia Care. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2016. [DOI: 10.1024/1662-9647/a000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract. Apathy is a diminished goal-directed behavior stemming from a lack of motivation. It is one of the most common symptoms in dementia. While the Apathy Evaluation Scale (AES) has proved to be a psychometrically robust measure for assessing apathy, the German version (AESD) requires further validation. Associations of apathy with important variables in dementia care, such as cognitive impairment or caregiver burden, were repeatedly found, though contradictory findings have also been reported. The present study assessed apathy in 100 community-dwelling persons with dementia. Their informal and formal caregivers used the German informant version of the Apathy Evaluation Scale (AESD-I) to investigate the severity of dementia and cognitive deficits as measured with the Mini-Mental State Examination (MMSE) and Global Deterioration Scale (GDS), respectively. A reliability analysis was performed to estimate the internal consistency of the AESD-I, and the data were tested for potential correlations with results from a shortened version of the AESD-I (AESD16-I). Cronbach’s α was .880 for the AESD-I and .904 for the AESD16-I. The prevalence of apathy was 77%, its severity was on average moderate to high. Significant (p < .05) negative correlations were shown between the AESD16-I, the Barthel Index (BI), and the Quality of Life-Alzheimer’s Disease (QOL-AD). Correlations between the AESD16-I, GDS, and Zarit Burden Interview were positive. After Bonferroni correction, the only correlations that remained significant were between the AESD16-I and BI and QOL-AD. The present study underlines the favorable psychometric properties of the AESD-I and confirms the high prevalence of apathy with considerable severity in the sample of community-dwelling persons with dementia. In addition, it contributes to the diversity of evidence on clinical correlates of apathy which require further clarification.
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Affiliation(s)
- Lena Köller
- Department of Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Germany
- Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine, Kreisklinikum Siegen, Germany
| | - Maren Knebel
- Department of Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Germany
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Julia Haberstroh
- Interdisciplinary Ageing Research, Faculty of Educational Sciences, Johann Wolfgang Goethe University, Frankfurt, Germany
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Katharina Krause
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Sandra Sahlender
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Marion Jakob
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Judith Schoch
- Institute of Gerontology, University of Heidelberg, Germany
| | - Sonja Ehret
- Institute of Gerontology, University of Heidelberg, Germany
| | - Eric Schmitt
- Institute of Gerontology, University of Heidelberg, Germany
| | - Andreas Kruse
- Institute of Gerontology, University of Heidelberg, Germany
| | - Johannes Schröder
- Department of Psychiatry, Section of Geriatric Psychiatry, University of Heidelberg, Germany
- Institute of Gerontology, University of Heidelberg, Germany
| | - Johannes Pantel
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt, Germany
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Musacchio T, Purrer V, Papagianni A, Fleischer A, Mackenrodt D, Malsch C, Gelbrich G, Steigerwald F, Volkmann J, Klebe S. Non-Motor Symptoms of Essential Tremor Are Independent of Tremor Severity and Have an Impact on Quality of Life. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2016; 6:361. [PMID: 26989573 PMCID: PMC4790197 DOI: 10.7916/d8542nch] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/19/2016] [Indexed: 12/01/2022]
Abstract
Background Several publications have focused on accompanying non-motor symptoms (NMS) in essential tremor (ET) patients; however, it remains unclear if NMS are an intrinsic part of the disease or secondary phenomena. We present the results of several neuropsychiatric tests and their impact on quality of life (QoL) in community-dwelling patients with ET. Methods Participants were recruited via a newspaper article about ET published in the local media and on the internet. All participants completed several standard neuropsychiatric tests, including those that assess QoL. To compare differences between cases and controls, Student’s t-tests with Bonferroni-Holm post hoc tests were performed. Spearman’s correlation coefficients were also calculated. Results We enrolled 110 patients with definite or probable ET. Highly significant changes were observed for apathy, anxiety, and cognition and negatively impacted QoL. Most aberrations were independent of tremor severity and duration. Discussion The significant neuropsychiatric deficits and reduced QoL demonstrate a degree of illness that appears to be a non-motor phenotype rather than a secondary effect of ET. In the future, NMS should carefully be explored in ET patients as they may have an impact on QoL and treatment.
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Affiliation(s)
- Thomas Musacchio
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Veronika Purrer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | | | - Anna Fleischer
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Daniel Mackenrodt
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Carolin Malsch
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Clinical Trial Center, University Hospital of Würzburg, Würzburg, Germany
| | - Frank Steigerwald
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Stephan Klebe
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany; Department of Neurology, University Hospital of Freiburg, Freiburg, Germany
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Simon JJ, Cordeiro SA, Weber MA, Friederich HC, Wolf RC, Weisbrod M, Kaiser S. Reward System Dysfunction as a Neural Substrate of Symptom Expression Across the General Population and Patients With Schizophrenia. Schizophr Bull 2015; 41:1370-8. [PMID: 26006262 PMCID: PMC4601714 DOI: 10.1093/schbul/sbv067] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Dysfunctional patterns of activation in brain reward networks have been suggested as a core element in the pathophysiology of schizophrenia. However, it remains unclear whether this dysfunction is specific to schizophrenia or can be continuously observed across persons with different levels of nonclinical and clinical symptom expression. Therefore, we sought to investigate whether the pattern of reward system dysfunction is consistent with a dimensional or categorical model of psychosis-like symptom expression. 23 patients with schizophrenia and 37 healthy control participants with varying levels of psychosis-like symptoms, separated into 3 groups of low, medium, and high symptom expression underwent event-related functional magnetic resonance imaging while performing a Cued Reinforcement Reaction Time task. We observed lower activation in the ventral striatum during the expectation of high vs no reward to be associated with higher symptom expression across all participants. No significant difference between patients with schizophrenia and healthy participants with high symptom expression was found. However, connectivity between the ventral striatum and the medial orbitofrontal cortex was specifically reduced in patients with schizophrenia. Dysfunctional local activation of the ventral striatum depends less on diagnostic category than on the degree of symptom expression, therefore showing a pattern consistent with a psychosis continuum. In contrast, aberrant connectivity in the reward system is specific to patients with schizophrenia, thereby supporting a categorical view. Thus, the results of the present study provide evidence for both continuous and discontinuous neural substrates of symptom expression across patients with schizophrenia and the general population.
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Affiliation(s)
- Joe J. Simon
- Section of Experimental Psychopathology and Neurophysiology, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg, Germany;,Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, Heidelberg, Germany;,*To whom correspondence should be addressed; Centre for Psychosocial Medicine, General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany; tel: +49 (0)6221 56-38667, fax: +49 (0)6221 56-5988, e-mail:
| | - Sheila A. Cordeiro
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, Heidelberg, Germany;,LVR-Klinikum Essen, Department of Psychosomatic Medicine and Psychotherapy, Essen, Germany
| | - Robert C. Wolf
- Department of General Adult Psychiatry, Centre for Psychosocial Medicine, Heidelberg, Germany;,Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Homburg, Germany
| | - Matthias Weisbrod
- Section of Experimental Psychopathology and Neurophysiology, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, Heidelberg, Germany;,Department of General Adult Psychiatry, Centre for Psychosocial Medicine, Heidelberg, Germany;,SRH Klinikum, Karlsbad-Langensteinbach, Germany
| | - Stefan Kaiser
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
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Meyer A, Zimmermann R, Gschwandtner U, Hatz F, Bousleiman H, Schwarz N, Fuhr P. Apathy in Parkinson's disease is related to executive function, gender and age but not to depression. Front Aging Neurosci 2015; 6:350. [PMID: 25642187 PMCID: PMC4295432 DOI: 10.3389/fnagi.2014.00350] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/28/2014] [Indexed: 01/24/2023] Open
Abstract
Deficits in executive functions occur in up to 93% of patients with Parkinson's disease (PD). Apathy, a reduction of motivation and goal-directed behavior is an important part of the syndrome; affecting both the patients as well as their social environment. Executive functions can be subdivided into three different processes: initiation, shifting and inhibition. We examined the hypotheses, (1) that apathy in patients with Parkinson's disease is only related to initiation and not to shifting and inhibition, and (2) that depression and severity of motor signs correlate with apathy. Fifty-one non-demented patients (19 = female) with PD were evaluated for apathy, depression and executive functions. Executive function variables were summarized with an index variable according to the defined executive processes. Linear regression with stepwise elimination procedure was used to select significant predictors. The significant model (R2 = 0.41; p < 0.01) revealed influences of initiation (b = −0.79; p < 0.01), gender (b = −7.75; p < 0.01), age (b = −0.07; p < 0.05) and an age by gender interaction (b = 0.12; p < 0.01) on apathy in Parkinson's disease. Motor signs, depression and level of education did not influence the relation. These results support an association of apathy and deficits of executive function in PD. Initiation strongly correlates with apathy, whereas depression does not. We conclude, that initiation dysfunction in a patient with Parkinson's disease heralds apathy. Apathy and depression can be dissociated. Additionally, apathy is influenced by age and gender: older age correlates with apathy in men, whereas in women it seems to protect against it.
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Affiliation(s)
- Antonia Meyer
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Ronan Zimmermann
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Ute Gschwandtner
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Florian Hatz
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Habib Bousleiman
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland ; Epidemiology and Public Health, Swiss Tropical and Public Health Institute, University of Basel Basel, Switzerland
| | - Nadine Schwarz
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland
| | - Peter Fuhr
- Clinical Neurophysiology, Department of Neurology, Hospital of the University of Basel Basel, Switzerland
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Lewis CJ, Maier F, Horstkötter N, Zywczok A, Witt K, Eggers C, Meyer TD, Dembek TA, Maarouf M, Moro E, Zurowski M, Woopen C, Kuhn J, Timmermann L. Subjectively perceived personality and mood changes associated with subthalamic stimulation in patients with Parkinson's disease. Psychol Med 2015; 45:73-85. [PMID: 25066623 DOI: 10.1017/s0033291714001081] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Clinical and ethical implications of personality and mood changes in Parkinson's disease (PD) patients treated with subthalamic deep brain stimulation (STN-DBS) are under debate. Although subjectively perceived personality changes are often mentioned by patients and caregivers, few empirical studies concerning these changes exist. Therefore, we analysed subjectively perceived personality and mood changes in STN-DBS PD patients. METHOD In this prospective study of the ELSA-DBS group, 27 PD patients were assessed preoperatively and 1 year after STN-DBS surgery. Two categories, personality and mood changes, were analysed with semi-structured interviews. Patients were grouped into personality change yes/no, as well as positive/negative mood change groups. Caregivers were additionally interviewed about patients' personality changes. Characteristics of each group were assessed with standard neurological and psychiatric measurements. Predictors for changes were analysed. RESULTS Personality changes were perceived by six of 27 (22%) patients and by 10 of 23 caregivers (44%). The preoperative hypomania trait was a significant predictor for personality change perceived by patients. Of 21 patients, 12 (57%) perceived mood as positively changed. Higher apathy and anxiety ratings were found in the negative change group. CONCLUSIONS Our results show that a high proportion of PD patients and caregivers perceived personality changes under STN-DBS, emphasizing the relevance of this topic. Mood changed in positive and negative directions. Standard measurement scales failed to adequately reflect personality or mood changes subjectively perceived by patients. A more individualized preoperative screening and preparation for patients and caregivers, as well as postoperative support, could therefore be useful.
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Affiliation(s)
- C J Lewis
- Department of Neurology,University of Cologne,Cologne,Germany
| | - F Maier
- Department of Neurology,University of Cologne,Cologne,Germany
| | - N Horstkötter
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - A Zywczok
- Department of Neurology,University of Cologne,Cologne,Germany
| | - K Witt
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - C Eggers
- Department of Neurology,University of Cologne,Cologne,Germany
| | - T D Meyer
- Institute of Neuroscience,Newcastle University,Newcastle upon Tyne,UK
| | - T A Dembek
- Department of Neurology,University of Cologne,Cologne,Germany
| | - M Maarouf
- Department of Stereotaxy and Functional Neurosurgery,University of Cologne,Cologne,Germany
| | - E Moro
- Movement Disorders Unit, Department of Psychiatry and Neurology,University Hospital Center (CHU) of Grenoble,Grenoble,France
| | - M Zurowski
- Department of Psychiatry,University of Toronto, University Health Network,Toronto,Canada
| | - C Woopen
- Research Unit Ethics, Institute for the History of Medicine and Medical Ethics,University of Cologne,Cologne,Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy,University of Cologne,Cologne,Germany
| | - L Timmermann
- Department of Neurology,University of Cologne,Cologne,Germany
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Jansen CP, Claßen K, Hauer K, Diegelmann M, Wahl HW. Assessing the effect of a physical activity intervention in a nursing home ecology: a natural lab approach. BMC Geriatr 2014; 14:117. [PMID: 25407431 PMCID: PMC4273428 DOI: 10.1186/1471-2318-14-117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/31/2014] [Indexed: 11/05/2022] Open
Abstract
Background Physical activity (PA) is not only an important marker of physical impairment, but also a pathway to improve quality of life and enhance cognitive and social functioning of old individuals. Yet, making interventional use of PA training as a means for prevention and enhancement of quality of life of nursing home residents has found very limited attention worldwide so far. That said, the project ‘Long-term Care in Motion’ (LTCMo) as a part of the INNOVAGE consortium (funded by the European Commission) has the following aims: Overall: Install and assess a socially innovative intervention in the nursing home ecology. Concrete: (a) Conceptualization of a multidimensional intervention program (resident and staff oriented) with the potential to promote PA in nursing home residents; (b) Mixed-methods assessment of the program based on automated recording as well as questionnaire data. Methods/Design LTCMo’s PA-related intervention has several components which are applied in parallel manner: (1) Residents are engaged in a physical exercise program that is based on multiple approaches: supervised group sessions, a serious games approach, and specific training in severely impaired persons; (2) Staff members will receive a competence training with a focus on PA motivation and facilitation of residents’ PA engagement. Primary outcome assessment (movement-related behavior of residents) is completely conducted by means of automated data collection strategies (accelerometer-based activity recording, sensor-based life space recording). This is enriched by a broad range of secondary outcomes (e.g., cognitive performance, depression of residents; behavioral and attitudinal components of staff). Pre-, post- and 3-month follow-up assessment will take place in the target intervention setting as well as in a waiting control condition in which we will also replicate the training and its assessment in a later step. Discussion Although we are faced with methodological challenges (e.g., rather small sample size; no randomized control trial), we believe that our approach has something to offer and indeed has some unique characteristics that may have the potential to contribute to the enhancement of nursing home residents’ quality of life and at the same time further PA-related research with vulnerable populations at large. Trial registration Current Controlled Trials ISRCTN96090441. Registered 31 July 2014.
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Affiliation(s)
- Carl-Philipp Jansen
- Institute of Psychology, Department of Psychological Aging Research, Heidelberg University, Bergheimer Str, 20, 69115 Heidelberg, Germany.
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Wettstein M, Seidl U, Wahl HW, Shoval N, Heinik J. Behavioral Competence and Emotional Well-Being of Older Adults with Mild Cognitive Impairment. GEROPSYCH 2014. [DOI: 10.1024/1662-9647/a000107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We examined whether older individuals with mild cognitive impairment (MCI) differed from healthy controls (HC) and persons with dementia (AD) in objective and perceived behavioral competence as well as in emotional well-being. We used a merged sample of 257 older adults aged 59 to 91 years (M = 72.9; SD = 6.4) stemming from Israel and Germany. Objective behavioral competence (assessed based on global positioning system (GPS)-based tracking data and a structured questionnaire) of MCI individuals was mostly similar to the HC group. Regarding perceived behavioral competence and emotional well-being, MCI individuals were more similar to the AD group and below the HC group’s mean levels. Findings suggest that a differentiated view of MCI individual’s competence and emotional well-being is in place.
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Affiliation(s)
- Markus Wettstein
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Ulrich Seidl
- Center for Mental Health, Klinikum Stuttgart, Germany
| | - Hans-Werner Wahl
- Department of Psychological Aging Research, Heidelberg University, Germany
| | - Noam Shoval
- Geography Department, Hebrew University Jerusalem, Israel
| | - Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital and Sackler Faculty of Medicine, Tel Aviv University, Israel
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Seidl U, Lueken U, Thomann PA, Kruse A, Schröder J. Facial expression in Alzheimer's disease: impact of cognitive deficits and neuropsychiatric symptoms. Am J Alzheimers Dis Other Demen 2012; 27:100-6. [PMID: 22495337 PMCID: PMC10697354 DOI: 10.1177/1533317512440495] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In Alzheimer's disease (AD), nonverbal aspects of communication become increasingly important in caregiver-patient interactions when the ability to communicate verbally is fading with progression of the disease. We therefore investigated the impact of cognitive deficits and neuropsychiatric symptoms, particularly apathy, on facial expression in AD. While overall neuropsychiatric symptoms were not associated with facial expression, apathy exhibited substantial correlations, even after controlling for cognitive deficits. Moreover, apathy appeared to moderate the influence of cognitive deficits: without considering apathy, cognitive deficits were associated with less specific facial expressions. After controlling for apathy, cognitive decline was related to increased facial expressiveness. In conclusion, apathetic symptoms appear to be specifically associated with facial expression in AD and thus could contribute to a disregard for patients' needs in everyday life.
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Affiliation(s)
- Ulrich Seidl
- Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany.
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Actigraphic Daytime Activity is Reduced in Patients With Cognitive Impairment and Apathy. Eur Psychiatry 2011; 28:94-7. [DOI: 10.1016/j.eurpsy.2011.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 04/08/2011] [Accepted: 04/18/2011] [Indexed: 11/19/2022] Open
Abstract
AbstractObjectivesApathy is a neuropsychiatric symptom in mild cognitive impairment (MCI) and dementia. This study examines correlations between Apathy Evaluation Scale (AES) ratings and actigraphic measures of daytime activity. The aim of this study is to determine the value of ambulatory actigraphy in the assessment of locomotor deficits as a correlate of apathy in geriatric patients with cognitive impairment.Patients and methodsIn this cross-sectional study a total of 82 participants were recruited, 32 patients with dementia, 21 patients with MCI and 23 elderly controls. Rating scales for apathy (AES) and depression (Beck Depression Inventory, BDI) were completed. To measure daytime activity a wrist-worn actigraph and an established protocol were used. A single measure of mean daytime activity per participant was calculated for further statistical analysis.ResultsIn the two groups of patients with MCI and dementia, apathy is associated with reduced daytime activity, independent of diagnosis (no group by apathy interaction). AES scores correlate significantly with daytime activity. Cognitive impairment reduces daytime activity (effect greater in dementia than in MCI). Daytime activity is negatively correlated with memory deficits.ConclusionAmbulatory actigraphy is a promising method to evaluate self-initiated action as a correlate of apathy in patients with cognitive impairment.
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Anosognosia in Alzheimer's disease: the role of impairment levels in assessment of insight across domains. J Int Neuropsychol Soc 2010; 16:463-73. [PMID: 20188013 DOI: 10.1017/s1355617710000056] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Impaired insight for deficits (anosognosia) is common in Alzheimer's disease (AD). However, it has not yet been determined clearly (a) whether different methods for assessing insight are comparable, and (b) whether anosognosia affects different domains to different degrees (domain-specificity). Impaired insight was investigated in 32 patients with AD, who were each accompanied by a caregiver. Anosognosia was assessed by a global clinical rating, questionnaire discrepancies (patient vs. caregiver) covering different domains, and performance discrepancies (self-assessment vs. performance) based on four neuropsychological tests which were compared with those of a healthy control sample. The results of clinical rating and questionnaire discrepancies were closely correlated, but performance discrepancies showed no association with the other methods. Anosognosia was present in the majority of the sample, and occurred across domains. The domains corresponding to core deficits in AD (recent memory, activities of daily living) appeared especially prone to anosognosia. However, results do not suggest that anosognosia itself is domain-specific. Rather, it appears that insight may be invariant, while differences in patient-caregiver discrepancies arise largely from different degrees of deficit across domains.
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Neural correlates of reward processing in schizophrenia--relationship to apathy and depression. Schizophr Res 2010; 118:154-61. [PMID: 20005675 DOI: 10.1016/j.schres.2009.11.007] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/03/2009] [Accepted: 11/15/2009] [Indexed: 11/22/2022]
Abstract
The present study employs a new framework to categorise the heterogeneous findings on the relationship between impaired reward processing and negative and affective symptoms of schizophrenia. Based on previous behavioural and neuroimaging studies we postulate that "wanting" (i.e. anticipation) of a reward is specifically related to apathy, whereas "liking" (i.e. hedonic impact) is related to anhedonia and depression--symptoms commonly observed in schizophrenia. Fifteen patients with schizophrenia or schizoaffective disorder treated with atypical antipsychotic drugs and fifteen healthy controls performed a probabilistic monetary incentive delay task while undergoing functional magnetic resonance imaging. At the group level we found no significant differences between patients and controls in neural activation during anticipation or receipt of a reward. However, in patients with schizophrenia specific relationships between ventral-striatal activation and symptoms were observed. Ventral-striatal activation during reward anticipation was negatively correlated with apathy, while activation during receipt of reward was negatively correlated with severity of depressive symptoms. These results suggest that the link between negative symptoms and reward anticipation might specifically relate to apathy, i.e. a lack of motivation and drive. Impaired hedonic reward processing might contribute to the development of depressive symptoms in patients with schizophrenia, but it is not directly associated with self-rated anhedonia. These results indicate the necessity of more specifically differentiating negative and affective symptoms in schizophrenia in order to understand the role of the reward system in their pathogenesis.
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Berg A, Sadowski K, Beyrodt M, Hanns S, Zimmermann M, Langer G, Becker C, Lautenschläger C, Behrens J. Snoezelen, structured reminiscence therapy and 10-minutes activation in long term care residents with dementia (WISDE): study protocol of a cluster randomized controlled trial. BMC Geriatr 2010; 10:5. [PMID: 20113526 PMCID: PMC2843691 DOI: 10.1186/1471-2318-10-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 01/31/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with dementia are often inapproachable due to symptoms of their illness. Therefore nurses should establish relationships with dementia patients via their remaining resources and facilitate communication. In order to achieve this, different targeted non-pharmacological interventions are recommended and practiced. However there is no sufficient evidence about the efficacy of most of these interventions. A number of publications highlight the urgent need for methodological sound studies so that more robust conclusions may be drawn. METHODS/DESIGN The trial is designed as a cluster randomized controlled trial with 20 nursing homes in Saxony and Saxony-Anhalt (Germany) as the units of randomization. Nursing homes will be randomly allocated into 4 study groups consisting of 5 clusters and 90 residents: snoezelen, structured reminiscence therapy, 10-minutes activation or unstructured verbal communication (control group). The purpose is to determine whether the interventions are effective to reduce apathy in long-term care residents with dementia (N = 360) as the main outcome measure. Assessments will be done at baseline, 3, 6 and 12 months after beginning of the interventions. DISCUSSION This trial will particularly contribute to the evidence on efficacy of non-pharmacological interventions in dementia care. TRIAL REGISTRATION ClinicalTrials.gov NCT00653731.
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Affiliation(s)
- Almuth Berg
- Institute for Health Care and Nursing Studies, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Germany.
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Lueken U, Leisse M, Mattes K, Naumann D, Wittling W, Schweiger E. Altered tonic and phasic cortisol secretion following unilateral stroke. Psychoneuroendocrinology 2009; 34:402-12. [PMID: 18996647 DOI: 10.1016/j.psyneuen.2008.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 09/25/2008] [Accepted: 10/01/2008] [Indexed: 11/28/2022]
Abstract
Evidence is accumulating that cerebral laterality appears to be an important feature in the regulation of the stress response with the right hemisphere being closely linked to stress-regulatory systems, including the hypothalamic-pituitary-adrenal (HPA) axis. Although some animal and human data support this hypothesis, studies on brain damaged patients yet failed to substantiate laterality effects on cortisol secretion. The aim of this study was to examine whether unilateral stroke differentially affects tonic and phasic response characteristics of the HPA axis, and to evaluate the impact of intrahemispheric lesion location. Basal morning cortisol levels and phasic responses towards a mentally challenging task were examined in 32 stroke patients with left-sided (LH; n=18) or right-sided (RH; n=14) infarctions and 30 healthy controls matched for age and gender. Only LH, but not RH patients displayed increased morning cortisol levels when compared to controls. In contrast, phasic reactions were blunted in the combined patient group with RH patients showing the most distinct decline. More anterior located lesions were associated with reduced phasic, but not tonic cortisol measures. This relationship appeared to be particularly pronounced in RH patients. Results support the conclusion that the central regulation of cortisol secretion is under excitatory control of the right hemisphere and can be interpreted within a framework of asymmetrical regulation of the stress response. Left- and right-sided strokes may differentially affect response patterns of the HPA axis, a stress-regulatory system that is associated with effective protection against disease and external challenges.
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Affiliation(s)
- Ulrike Lueken
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Strasse 46, D-01187 Dresden, Germany.
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Lueken U, Schwarz M, Hertel F, Schweiger E, Wittling W. Impaired performance on the Wisconsin Card Sorting Test under left- when compared to right-sided deep brain stimulation of the subthalamic nucleus in patients with Parkinson’s disease. J Neurol 2009; 255:1940-8. [DOI: 10.1007/s00415-009-0040-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 11/27/2007] [Accepted: 06/27/2008] [Indexed: 11/25/2022]
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Rapp MA, Decker A, Klein U, Duch T, Treusch Y, Majic T, Petermann A, Hildebrand C, Heinz A, Gutzmann H. Verhaltenssymptome bei Demenz in Pflegeeinrichtungen. ACTA ACUST UNITED AC 2008. [DOI: 10.1024/1011-6877.21.3.205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In fortgeschrittenen Stadien von Demenzerkrankungen treten neben Depression vermehrt Verhaltenssymptome auf, zu denen Unruhe, Aggressivität und Halluzinationen zählen. In Pflegeeinrichtungen betrifft dies bis zu drei Viertel aller Bewohner. Diese Symptome sind für Pflegende belastend, ziehen erhöhte Versorgungskosten, eine vermehrte Verschreibung von Psychopharmaka, sowie häufigere Krankenhausaufenthalte nach sich. Im Jahr 2003 haben die Amerikanischen Gesellschaften für Gerontopsychiatrie und Geriatrie Leitlinien zur Behandlung von Depressionen und Verhaltenssymptomen in Pflegeeinrichtungen vorgestellt. Vergleichbare Leitlinien der deutschen Fachgesellschaften liegen bislang nicht vor. Die amerikanischen Leitlinien geben neben einem standardisierten Assessment Therapiealgorhythmen vor. In unserem Projekt werden diese Leitlinien in acht Pflegeinrichtungen in Berlin eingeführt und die Ausprägung von Verhaltenssymptomen, die Verschreibung von Psychopharmaka, die Anzahl der Krankenhauseinweisungen und die Belastung der Pflegenden mit einer Kontrollstichprobe von acht vergleichbaren Pflegeeinrichtungen ohne Leitlinienbehandlung über einen Zeitraum von 12 Monaten verglichen. Wir erwarten eine Verminderung der Ausprägung von Verhaltenssymptomen, sowie der Psychopharmakaverschreibungen, der Hospitalisierungsrate und der subjektiven Belastung für Pflegende.
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Affiliation(s)
- Michael A. Rapp
- Klinik für Psychiatrie und Psychotherapie, Charite Campus Mitte, Berlin
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | - A. Decker
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | | | - T. Duch
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | - Y. Treusch
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | - T. Majic
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
| | | | | | - A. Heinz
- Klinik für Psychiatrie und Psychotherapie, Charite Campus Mitte, Berlin
- Gerontopsychiatrisches Zentrum, Psychiatrische Universitätsklinik der Charite im St. Hedwig Krankenhaus, Berlin
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Lueken U, Seidl U, Völker L, Schweiger E, Kruse A, Schröder J. Development of a short version of the Apathy Evaluation Scale specifically adapted for demented nursing home residents. Am J Geriatr Psychiatry 2007; 15:376-85. [PMID: 17463188 DOI: 10.1097/jgp.0b013e3180437db3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Apathy is among the most frequent neuropsychiatric symptoms in dementia, particularly Alzheimer disease. The Apathy Evaluation Scale (AES) has been widely employed for assessing apathy in different patient groups. To further facilitate the usage of the AES, an abbreviated version was constructed. METHOD On basis of a sample of 356 nursing home residents, a cross-validation procedure was carried out to develop a brief version of the AES. According to a thorough clinical examination, 85% of the residents were demented, 8% presented with mild cognitive impairment, whereas 7% did not present any cognitive deficits. After subdividing the patient group into two matched samples, the first subsample was used to identify problematic items due to defined psychometric and content-related criteria. The original 18-item scale was thus reduced to 10 items. Psychometric properties of the shortened version were subsequently reassessed in the second subsample. RESULTS The short version demonstrated favorable psychometric properties that could be confirmed by cross-validation with the second sample. Correlations with the original full-length version were high (r = 0.97 for both subsamples); the shortened scale yielded no substantial losses regarding internal consistency or construct validity (correlations with the respective subscales of the Neuropsychiatric Inventory). CONCLUSION The frequency of apathetic symptoms in the nursing home residents included confirms the clinical importance of apathy for understanding dementia. Given this specific patient population, setting, and mode of data collection, the short-version AES seems to be a valuable and time-efficient instrument for assessing apathy.
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Affiliation(s)
- Ulrike Lueken
- Section of Geriatric Psychiatry, University of Heidelberg, Germany
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