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Weinhold SL, Lechinger J, Timm N, Hansen A, Ngo HVV, Göder R. Auditory stimulation in-phase with slow oscillations to enhance overnight memory consolidation in patients with schizophrenia? J Sleep Res 2022; 31:e13636. [PMID: 35686351 DOI: 10.1111/jsr.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Abstract
Sleep-dependent memory consolidation is disturbed in patients with schizophrenia, who furthermore show reductions in sleep spindles and probably also in delta power during sleep. The memory dysfunction in these patients is one of the strongest markers for worse long-term functional outcome. However, therapeutic interventions to normalise memory functions, e.g., with medication, still do not exist. Against this backdrop, we investigated to what extent a non-invasive approach enhancing sleep with real-time auditory stimulation in-phase with slow oscillations might affect overnight memory consolidation in patients with schizophrenia. To this end, we examined 18 patients with stably medicated schizophrenia in a double-blinded sham-controlled design. Memory performance was assessed by a verbal (word list) and a non-verbal (complex figure) declarative memory task. In comparison to a sham condition without auditory stimuli, we found that in patients with schizophrenia, auditory stimulation evokes an electrophysiological response similar to that in healthy participants leading to an increase in slow wave and temporally coupled sleep spindle activity during stimulation. Despite this finding, patients did not show any beneficial effect on the overnight change in memory performance by stimulation. Although the stimulation in our study did not improve the patient's memory, the electrophysiological response gives hope that auditory stimulation could enable us to provide better treatment for sleep-related detriments in these patients in the future.
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Affiliation(s)
- Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy (ZIP), University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Julia Lechinger
- Department of Psychiatry and Psychotherapy (ZIP), University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Nele Timm
- Department of Psychiatry and Psychotherapy (ZIP), University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Anja Hansen
- Department of Psychiatry and Psychotherapy (ZIP), University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
| | - Hong-Viet V Ngo
- Department of Psychology, University of Lübeck, Lübeck, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy (ZIP), University Hospital Schleswig-Holstein (UKSH), Kiel, Germany
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Weinhold SL, Lechinger J, Ittel J, Ritzenhoff R, Drews HJ, Junghanns K, Göder R. Dysfunctional Overnight Memory Consolidation in Patients with Schizophrenia in Comparison to Healthy Controls: Disturbed Slow-Wave Sleep as Contributing Factor? Neuropsychobiology 2022; 81:104-115. [PMID: 34433174 DOI: 10.1159/000517858] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Memory deficiency has been shown in schizophrenia patients, but results on the role of sleep parameters in overnight consolidation of associative verbal memory are still missing. Therefore, the aim of our study was to elucidate underlying processes of impaired sleep-related consolidation of associative word pairs in schizophrenia including standard sleep parameters as well as sleep spindle counts and spectral analysis. METHODS Eighteen stably medicated schizophrenia patients and 24 healthy age-matched controls performed an associative declarative memory task before and after polysomnographic recordings. Part of the participants expected verbal associative memory testing in the morning, while the others did not. Furthermore, participants filled in self-rating questionnaires of schizophrenia-typical experiences (Eppendorf Schizophrenia Inventory [ESI] and Psychotic Symptom Rating Scale). RESULTS Schizophrenia patients performed worse in verbal declarative memory in the evening as well as in overnight consolidation (morning compared to evening performance). While duration of slow-wave sleep was nearly comparable between groups, schizophrenia patients showed lower sleep spindle count, reduced delta power during slow-wave sleep, and reduced spindle power during the slow oscillation (SO) up-state. In healthy but not in schizophrenia patients, a linear relationship between overnight memory consolidation and slow-wave sleep duration as well as delta power was evident. No significant effect with respect to the expectation of memory retrieval was evident in our data. Additionally, we observed a negative linear relationship between total number of sleep spindles and ESI score in healthy participants. DISCUSSION/CONCLUSION As expected, schizophrenia patients showed deficient overnight verbal declarative memory consolidation as compared to healthy controls. Reduced sleep spindles, delta power, and spindle power during the SO up-state may link sleep and memory deficiency in schizophrenia. Additionally, the absence of a linear relationship between sleep-related memory consolidation and slow-wave sleep as well as delta power suggests further functional impairments in schizophrenia. Note that this conclusion is based on observational data. Future studies should investigate if stimulation of delta waves during sleep could improve memory performance and thereby quality of life in schizophrenia.
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Affiliation(s)
- Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Julia Lechinger
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Jasper Ittel
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Romina Ritzenhoff
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Henning Johannes Drews
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Klaus Junghanns
- Department of Psychiatry and Psychotherapy, Centre for Integrative Psychiatry (ZIP), University Lübeck, Lübeck, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Kiel, Germany
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Lechinger J, Koch J, Weinhold SL, Seeck-Hirschner M, Stingele K, Kropp-Näf C, Braun M, Drews HJ, Aldenhoff J, Huchzermeier C, Göder R. REM density is associated with treatment response in major depression: Antidepressant pharmacotherapy vs. psychotherapy. J Psychiatr Res 2021; 133:67-72. [PMID: 33310502 DOI: 10.1016/j.jpsychires.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 01/04/2023]
Abstract
Major depression is one of the most common psychiatric illnesses. Interestingly, a few studies have indicated the existence of depression subgroups, which respond differently to the available treatment options. Previously, sleep abnormalities have been suggested to indicate amenability to different treatment regimens. Thereby, especially REM-sleep parameters seem to play a prominent role, and REM-sleep dysregulation has been repeatedly discussed as a potential endophenotype of depression. With that said, estimating therapy outcome in order to choose the best line of treatment is of utmost importance to patients suffering from depression. The present study looks deeper into these clues by investigating the capability of polysomnographic sleep parameters to predict treatment response in depressed patients to either pharmacotherapy or psychotherapy. Moderately to severely depressed patients (n = 38) were randomly assigned to either psychotherapy (i.e. interpersonal psychotherapy) or pharmacotherapy (i.e., monotherapy with selective serotonin reuptake inhibitors, SSRI, or selective serotonin noradrenalin reuptake inhibitors, SSNRI). Prior to treatment, all patients underwent polysomnography in the sleep laboratory. After treatment, responders and non-responders of both treatment groups were compared regarding their baseline sleep parameters. Higher baseline REM density, i.e. the amount of rapid eye movements during REM sleep, predicted better response to antidepressant pharmacotherapy. In the psychotherapy group, the effect seemed reversed but was not statistically significant. No other sleep parameter predicted treatment response. Our findings support the notion that REM-sleep dysregulation is indeed indicative of a distinct endophenotype of depression and that pharmacotherapy with SSRI/SSNRI might be superior to psychotherapy in these patients.
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Affiliation(s)
- Julia Lechinger
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany.
| | - Jakob Koch
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Mareen Seeck-Hirschner
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Karoline Stingele
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Cornelia Kropp-Näf
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Milena Braun
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Henning Johannes Drews
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Josef Aldenhoff
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Christian Huchzermeier
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel.Niemannsweg 147, 24105, Kiel, Germany.
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Göder R, Bares S, Vogel C, Böttcher H, Drews HJ, Lechinger J, Jauch-Chara K, Weinhold S. Psychotic-like experiences in patients with insomnia or sleep apnea: associations with sleep parameters. Sleep Med 2020; 77:367-373. [PMID: 32819820 DOI: 10.1016/j.sleep.2020.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES There are strong links between sleep and psychotic-like experiences (PLE), such as magical ideations or persecutory ideas. Sleep disturbances seem to play an important role in the occurrence of such symptoms, but studies investigating PLE in patients with sleep disorders are lacking. METHODS We studied 24 subjects with insomnia disorder (41 ± 13 years) and 47 participants with obstructive sleep apnea (OSA, 47 ± 11 years) in the sleep laboratory and 33 healthy controls. Sleep in patients with sleep disorders was recorded and scored according to standard criteria of the American Academy of Sleep Medicine. PLE were measured by the Magical Ideation Scale (MIS, short form with 10 items) and by the Peters et al., Delusions Inventory (PDI, 21 items). Additionally, cognitive tests and further psychological self-rating tests such as the Beck Depression Inventory (BDI) and the Pittsburgh Sleep Quality Index (PSQI) were administered. RESULTS Patients with insomnia had significantly higher scores of magical and delusional ideations compared to healthy controls. Sleep apnea patients showed a tendency of a higher score of delusional beliefs in comparison to controls. Magical ideations in insomnia subjects were significantly negatively correlated with the number of sleep spindles. In a subgroup of insomnia patients without antidepressants, delusional beliefs were negatively associated with rapid eye movement (REM)-sleep. CONCLUSIONS As there are indications that diminutions of sleep spindles are a biomarker for dysfunctional thalamo-cortical circuits underlying the neuropathology of psychosis, we conclude that there might be a sub-group of insomnia patients with fewer sleep spindles which is more vulnerable to developing a psychotic disorder in the future.
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Affiliation(s)
- Robert Göder
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany.
| | - Sarah Bares
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Charlotte Vogel
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Heidi Böttcher
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Henning Johannes Drews
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Julia Lechinger
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kamila Jauch-Chara
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sara Weinhold
- Department of Psychiatry and Psychotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
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Drews HJ, Wallot S, Brysch P, Berger-Johannsen H, Weinhold SL, Mitkidis P, Baier PC, Lechinger J, Roepstorff A, Göder R. Bed-Sharing in Couples Is Associated With Increased and Stabilized REM Sleep and Sleep-Stage Synchronization. Front Psychiatry 2020; 11:583. [PMID: 32670111 PMCID: PMC7330166 DOI: 10.3389/fpsyt.2020.00583] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/OBJECTIVES Sharing the bed with a partner is common among adults and impacts sleep quality with potential implications for mental health. However, hitherto findings are contradictory and particularly polysomnographic data on co-sleeping couples are extremely rare. The present study aimed to investigate the effects of a bed partner's presence on individual and dyadic sleep neurophysiology. METHODS Young healthy heterosexual couples underwent sleep-lab-based polysomnography of two sleeping arrangements: individual sleep and co-sleep. Individual and dyadic sleep parameters (i.e., synchronization of sleep stages) were collected. The latter were assessed using cross-recurrence quantification analysis. Additionally, subjective sleep quality, relationship characteristics, and chronotype were monitored. Data were analyzed comparing co-sleep vs. individual sleep. Interaction effects of the sleeping arrangement with gender, chronotype, or relationship characteristics were moreover tested. RESULTS As compared to sleeping individually, co-sleeping was associated with about 10% more REM sleep, less fragmented REM sleep (p = 0.008), longer undisturbed REM fragments (p = 0.0006), and more limb movements (p = 0.007). None of the other sleep stages was significantly altered. Social support interacted with sleeping arrangement in a way that individuals with suboptimal social support showed the biggest impact of the sleeping arrangement on REM sleep. Sleep architectures were more synchronized between partners during co-sleep (p = 0.005) even if wake phases were excluded (p = 0.022). Moreover, sleep architectures are significantly coupled across a lag of ± 5min. Depth of relationship represented an additional significant main effect regarding synchronization, reflecting a positive association between the two. Neither REM sleep nor synchronization was influenced by gender, chronotype, or other relationship characteristics. CONCLUSION Depending on the sleeping arrangement, couple's sleep architecture and synchronization show alterations that are modified by relationship characteristics. We discuss that these alterations could be part of a self-enhancing feedback loop of REM sleep and sociality and a mechanism through which sociality prevents mental illness.
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Affiliation(s)
- Henning Johannes Drews
- Department of Psychiatry and Psychotherapy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Sebastian Wallot
- Department of Language and Literature, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
| | - Philip Brysch
- Department of Psychology, Christian-Albrechts University Kiel, Kiel, Germany
| | | | - Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Panagiotis Mitkidis
- Department of Management, Aarhus University, Aarhus, Denmark.,Center for Advanced Hindsight, Social Science Research Institute, Duke University, Durham, NC, United States
| | - Paul Christian Baier
- Department of Psychiatry and Psychotherapy, Christian-Albrechts University Kiel, Kiel, Germany
| | - Julia Lechinger
- Department of Psychiatry and Psychotherapy, Christian-Albrechts University Kiel, Kiel, Germany
| | | | - Robert Göder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts University Kiel, Kiel, Germany
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Wielek T, Lechinger J, Wislowska M, Blume C, Ott P, Wegenkittl S, del Giudice R, Heib DPJ, Mayer HA, Laureys S, Pichler G, Schabus M. Sleep in patients with disorders of consciousness characterized by means of machine learning. PLoS One 2018; 13:e0190458. [PMID: 29293607 PMCID: PMC5749793 DOI: 10.1371/journal.pone.0190458] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022] Open
Abstract
Sleep has been proposed to indicate preserved residual brain functioning in patients suffering from disorders of consciousness (DOC) after awakening from coma. However, a reliable characterization of sleep patterns in this clinical population continues to be challenging given severely altered brain oscillations, frequent and extended artifacts in clinical recordings and the absence of established staging criteria. In the present study, we try to address these issues and investigate the usefulness of a multivariate machine learning technique based on permutation entropy, a complexity measure. Specifically, we used long-term polysomnography (PSG), along with video recordings in day and night periods in a sample of 23 DOC; 12 patients were diagnosed as Unresponsive Wakefulness Syndrome (UWS) and 11 were diagnosed as Minimally Conscious State (MCS). Eight hour PSG recordings of healthy sleepers (N = 26) were additionally used for training and setting parameters of supervised and unsupervised model, respectively. In DOC, the supervised classification (wake, N1, N2, N3 or REM) was validated using simultaneous videos which identified periods with prolonged eye opening or eye closure.The supervised classification revealed that out of the 23 subjects, 11 patients (5 MCS and 6 UWS) yielded highly accurate classification with an average F1-score of 0.87 representing high overlap between the classifier predicting sleep (i.e. one of the 4 sleep stages) and closed eyes. Furthermore, the unsupervised approach revealed a more complex pattern of sleep-wake stages during the night period in the MCS group, as evidenced by the presence of several distinct clusters. In contrast, in UWS patients no such clustering was found. Altogether, we present a novel data-driven method, based on machine learning that can be used to gain new and unambiguous insights into sleep organization and residual brain functioning of patients with DOC.
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Affiliation(s)
- Tomasz Wielek
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Christine Blume
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Peter Ott
- ITS Informationstechnik & System-Management, Salzburg University of Applied Sciences, Salzburg, Austria
| | - Stefan Wegenkittl
- ITS Informationstechnik & System-Management, Salzburg University of Applied Sciences, Salzburg, Austria
| | - Renata del Giudice
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Dominik P. J. Heib
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Helmut A. Mayer
- Department of Computer Sciences, University of Salzburg, Salzburg, Austria
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Centre and Neurology Department, University and University Hospital of Liège, Liège, Belgium
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert Schweitzer Hospital Graz, Graz, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
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Benninghoven D, Hamann D, von Kodolitsch Y, Rybczynski M, Lechinger J, Schroeder F, Vogler M, Hoberg E. Inpatient rehabilitation for adult patients with Marfan syndrome: an observational pilot study. Orphanet J Rare Dis 2017; 12:127. [PMID: 28701211 PMCID: PMC5508759 DOI: 10.1186/s13023-017-0679-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/03/2017] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Advances in medical, interventional and surgical treatment have increased average life expectancy of patients with congenital heart defects. As a result a new group of adult patients with congenital cardiac defects requires medical rehabilitation. Patients with Marfan syndrome (MFS) are a relevant group among these patients. So far, no reports on the effectiveness of specialized rehabilitation programmes for MFS patients exist. We implemented an inpatient 3-week rehabilitation program for MFS patients at the Muehlenberg-Clinic for rehabilitation and assessed the medical safety as well as the impact of the program on physical fitness and psychological wellbeing of participants by means of an observational pilot study. The comprehensive multidisciplinary program included medical, physiotherapeutic, psychological and social issues. Two groups including 8 and 10 individuals with verified MFS attended the programme. Medically adverse events that occurred during the rehabilitation were registered. Adverse events were defined as: any new cardiac arrhythmias such as atrial fibrillation, ventricular tachycardia, cardiac syncope or any complications located at the aorta. Psychological assessment was performed using Short Form-36 (SF-36), hospital anxiety and depression scale and other psychometric questionnaires. Medical examinations included assessment of maximum power in bicycle ergometry. All assessments were performed at the beginning and at the end of the rehabilitation. Psychometric assessments were repeated 1 year after the end of the programme for both groups, respectively. RESULTS Patients were highly satisfied with the programme and improved in almost all psychological and physical fitness assessments. The pre-post-comparison resulted in significant positive changes for mental health (p < .001 for SF-36 Mental Health), fatigue (p < .05 for Fatigue Severity Scale), nociception (p < .05 for SF-36 Pain) and vitality (p < .05 for SF-36 Vitality). Physical fitness improved from admission to discharge (p < .001 for maximum power in bicycle ergometry, p < .05 for maximum nordic walking distance). Considerable improvements persisted through 1 year follow-up. Medical assessments excluded medical problems or adverse events caused by participation in the programme. CONCLUSIONS In our study, inpatient rehabilitation was both safe and helpful for MFS patients. They benefited in terms of physical fitness, health related quality of life and in terms of psychological wellbeing. An evaluation of the efficacy of the programme in a controlled design as well as further conceptual improvements of our current program is desirable.
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Affiliation(s)
- Dieter Benninghoven
- Muehlenberg-Clinic for Rehabilitation, Bad Malente-Gremsmühlen, Germany. .,Clinic of Psychosomatic Medicine and Psychotherapy, University of Luebeck, Lübeck, Germany.
| | - Denise Hamann
- Clinic of Cardiology at the University Heart Centre, University of Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Clinic of Cardiology at the University Heart Centre, University of Hamburg, Hamburg, Germany
| | - Meike Rybczynski
- Clinic of Cardiology at the University Heart Centre, University of Hamburg, Hamburg, Germany
| | - Julia Lechinger
- Muehlenberg-Clinic for Rehabilitation, Bad Malente-Gremsmühlen, Germany
| | | | - Marina Vogler
- Marfan Hilfe (Deutschland) e.V. (German Marfan Patient Organization), Eutin, Germany
| | - Eike Hoberg
- Muehlenberg-Clinic for Rehabilitation, Bad Malente-Gremsmühlen, Germany
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Blume C, Lechinger J, Santhi N, del Giudice R, Gnjezda MT, Pichler G, Scarpatetti M, Donis J, Michitsch G, Schabus M. Significance of circadian rhythms in severely brain-injured patients: A clue to consciousness? Neurology 2017; 88:1933-1941. [PMID: 28424270 PMCID: PMC5444311 DOI: 10.1212/wnl.0000000000003942] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/24/2017] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the relationship between the presence of a circadian body temperature rhythm and behaviorally assessed consciousness levels in patients with disorders of consciousness (DOC; i.e., vegetative state/unresponsive wakefulness syndrome or minimally conscious state). Methods: In a cross-sectional study, we investigated the presence of circadian temperature rhythms across 6 to 7 days using external skin temperature sensors in 18 patients with DOC. Beyond this, we examined the relationship between behaviorally assessed consciousness levels and circadian rhythmicity. Results: Analyses with Lomb-Scargle periodograms revealed significant circadian rhythmicity in all patients (range 23.5–26.3 hours). We found that especially scores on the arousal subscale of the Coma Recovery Scale–Revised were closely linked to the integrity of circadian variations in body temperature. Finally, we piloted whether bright light stimulation could boost circadian rhythmicity and found positive evidence in 2 out of 8 patients. Conclusion: The study provides evidence for an association between circadian body temperature rhythms and arousal as a necessary precondition for consciousness. Our findings also make a case for circadian rhythms as a target for treatment as well as the application of diagnostic and therapeutic means at times when cognitive performance is expected to peak.
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Affiliation(s)
- Christine Blume
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria.
| | - Julia Lechinger
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Nayantara Santhi
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Renata del Giudice
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Maria-Teresa Gnjezda
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Gerald Pichler
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Monika Scarpatetti
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Johann Donis
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Gabriele Michitsch
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
| | - Manuel Schabus
- From the Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology (C.B., J.L., R.d.G., M.-T.G., M. Schabus), and Centre for Cognitive Neuroscience Salzburg (CCNS) (C.B., J.L., R.d.G., M. Schabus), University of Salzburg, Austria; Surrey Sleep Research Centre (N.S.), Faculty of Health and Medical Sciences, University of Surrey, UK; Albert Schweitzer Clinic (G.P., M. Scarpatetti), Apallic Care Unit, Geriatric Health Centres of the City of Graz; and Neurologische Abteilung mit Wachkomabetreuung (J.D., G.M.), Pflegewohnhaus Donaustadt Wien, Vienna, Austria
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Blume C, Del Giudice R, Lechinger J, Wislowska M, Heib DPJ, Hoedlmoser K, Schabus M. Preferential processing of emotionally and self-relevant stimuli persists in unconscious N2 sleep. Brain Lang 2017; 167:72-82. [PMID: 27039169 DOI: 10.1016/j.bandl.2016.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 06/05/2023]
Abstract
Information processing has been suggested to depend on the current state of the brain as well as stimulus characteristics (e.g. salience). We compared processing of salient stimuli (subject's own names [SONs] and angry voice [AV] stimuli) to processing of unfamiliar names (UNs) and neutral voice (NV) stimuli across different vigilance stages (i.e. wakefulness as well as sleep stages N1 and N2) by means of event-related oscillatory responses during wakefulness and a subsequent afternoon nap. Our findings suggest that emotional prosody and self-relevance drew more attentional resources during wakefulness with specifically AV stimuli being processed more strongly. During N1, SONs were more arousing than UNs irrespective of prosody. Moreover, emotional and self-relevant stimuli evoked stronger responses also during N2 sleep suggesting a 'sentinel processing mode' of the brain during this state of naturally occurring unconsciousness. Finally, this initial preferential processing of salient stimuli during N2 sleep seems to be followed by an inhibitory sleep-protecting process, which is reflected by a K-complex-like response.
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Affiliation(s)
- Christine Blume
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Renata Del Giudice
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Julia Lechinger
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Malgorzata Wislowska
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Dominik P J Heib
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Kerstin Hoedlmoser
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Manuel Schabus
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
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Wislowska M, Del Giudice R, Lechinger J, Wielek T, Heib DPJ, Pitiot A, Pichler G, Michitsch G, Donis J, Schabus M. Night and day variations of sleep in patients with disorders of consciousness. Sci Rep 2017; 7:266. [PMID: 28325926 PMCID: PMC5428269 DOI: 10.1038/s41598-017-00323-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/21/2017] [Indexed: 02/01/2023] Open
Abstract
Brain injuries substantially change the entire landscape of oscillatory dynamics and render detection of typical sleep patterns difficult. Yet, sleep is characterized not only by specific EEG waveforms, but also by its circadian organization. In the present study we investigated whether brain dynamics of patients with disorders of consciousness systematically change between day and night. We recorded ~24 h EEG at the bedside of 18 patients diagnosed to be vigilant but unaware (Unresponsive Wakefulness Syndrome) and 17 patients revealing signs of fluctuating consciousness (Minimally Conscious State). The day-to-night changes in (i) spectral power, (ii) sleep-specific oscillatory patterns and (iii) signal complexity were analyzed and compared to 26 healthy control subjects. Surprisingly, the prevalence of sleep spindles and slow waves did not systematically vary between day and night in patients, whereas day-night changes in EEG power spectra and signal complexity were revealed in minimally conscious but not unaware patients.
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Affiliation(s)
- Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Renata Del Giudice
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Tomasz Wielek
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Dominik P J Heib
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria
| | - Alain Pitiot
- Laboratory of Image & Data Analysis, Ilixa Ltd., Nottingham, United Kingdom
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert-Schweitzer-Klinik, Graz, Austria
| | - Gabriele Michitsch
- Apallic Care Unit, Neurological Division, Pflegewohnhaus Donaustadt, Vienna, Austria
| | - Johann Donis
- Apallic Care Unit, Neurological Division, Pflegewohnhaus Donaustadt, Vienna, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness, & Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
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11
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Schabus M, Wislowska M, del Giudice R, Lechinger J, Chwala-Schlegel N, Pitiot A, Heib D, Chinchilla M, Machado C. Circadian fluctuations of EEG and graphoelements during sleep in patients with disorders of consciousness. Int J Psychophysiol 2016. [DOI: 10.1016/j.ijpsycho.2016.07.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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12
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Lechinger J, Wielek T, Blume C, Pichler G, Michitsch G, Donis J, Gruber W, Schabus M. Event-related EEG power modulations and phase connectivity indicate the focus of attention in an auditory own name paradigm. J Neurol 2016; 263:1530-43. [PMID: 27216625 PMCID: PMC4971049 DOI: 10.1007/s00415-016-8150-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/28/2022]
Abstract
Estimating cognitive abilities in patients suffering from Disorders of Consciousness remains challenging. One cognitive task to address this issue is the so-called own name paradigm, in which subjects are presented with first names including the own name. In the active condition, a specific target name has to be silently counted. We recorded EEG during this task in 24 healthy controls, 8 patients suffering from Unresponsive Wakefulness Syndrome (UWS) and 7 minimally conscious (MCS) patients. EEG was analysed with respect to amplitude as well as phase modulations and connectivity. Results showed that general reactivity in the delta, theta and alpha frequency (event-related de-synchronisation, ERS/ERD, and phase locking between trials and electrodes) toward auditory stimulation was higher in controls than in patients. In controls, delta ERS and lower alpha ERD indexed the focus of attention in both conditions, late theta ERS only in the active condition. Additionally, phase locking between trials and delta phase connectivity was highest for own names in the passive and targets in the active condition. In patients, clear stimulus-specific differences could not be detected. However, MCS patients could reliably be differentiated from UWS patients based on their general event-related delta and theta increase independent of the type of stimulus. In conclusion, the EEG signature of the active own name paradigm revealed instruction-following in healthy participants. On the other hand, DOC patients did not show clear stimulus-specific processing. General reactivity toward any auditory input, however, allowed for a reliable differentiation between MCS and UWS patients.
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Affiliation(s)
- Julia Lechinger
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria.
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria.
| | - Tomasz Wielek
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
| | - Christine Blume
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert-Schweitzer-Klinik, Graz, Austria
| | - Gabriele Michitsch
- Apallic Care Unit, Neurological Division, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
| | - Johann Donis
- Apallic Care Unit, Neurological Division, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna, Austria
| | - Walter Gruber
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep and Consciousness Research, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, 5020, Salzburg, Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg, Salzburg, Austria
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Thul A, Lechinger J, Donis J, Michitsch G, Pichler G, Kochs EF, Jordan D, Ilg R, Schabus M. EEG entropy measures indicate decrease of cortical information processing in Disorders of Consciousness. Clin Neurophysiol 2015; 127:1419-1427. [PMID: 26480834 DOI: 10.1016/j.clinph.2015.07.039] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinical assessments that rely on behavioral responses to differentiate Disorders of Consciousness are at times inapt because of some patients' motor disabilities. To objectify patients' conditions of reduced consciousness the present study evaluated the use of electroencephalography to measure residual brain activity. METHODS We analyzed entropy values of 18 scalp EEG channels of 15 severely brain-damaged patients with clinically diagnosed Minimally-Conscious-State (MCS) or Unresponsive-Wakefulness-Syndrome (UWS) and compared the results to a sample of 24 control subjects. Permutation entropy (PeEn) and symbolic transfer entropy (STEn), reflecting information processes in the EEG, were calculated for all subjects. Participants were tested on a modified active own-name paradigm to identify correlates of active instruction following. RESULTS PeEn showed reduced local information content in the EEG in patients, that was most pronounced in UWS. STEn analysis revealed altered directed information flow in the EEG of patients, indicating impaired feed-backward connectivity. Responses to auditory stimulation yielded differences in entropy measures, indicating reduced information processing in MCS and UWS. CONCLUSIONS Local EEG information content and information flow are affected in Disorders of Consciousness. This suggests local cortical information capacity and feedback information transfer as neural correlates of consciousness. SIGNIFICANCE The utilized EEG entropy analyses were able to relate to patient groups with different Disorders of Consciousness.
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Affiliation(s)
- Alexander Thul
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany; Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Germany.
| | - Julia Lechinger
- Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, University of Salzburg, Austria
| | - Johann Donis
- Apallic Care Unit, Neurological Division, Geriatriezentrum am Wienerwald, Vienna, Austria
| | - Gabriele Michitsch
- Apallic Care Unit, Neurological Division, Geriatriezentrum am Wienerwald, Vienna, Austria
| | - Gerald Pichler
- Apallic Care Unit, Neurological Division, Albert-Schweitzer-Klinik, Graz, Austria
| | - Eberhard F Kochs
- Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Denis Jordan
- Department of Anesthesiology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Rüdiger Ilg
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Manuel Schabus
- Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, University of Salzburg, Austria; Centre for Cognitive Neuroscience Salzburg (CCNS), Salzburg, Austria
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Lechinger J, Heib DPJ, Gruber W, Schabus M, Klimesch W. Heartbeat-related EEG amplitude and phase modulations from wakefulness to deep sleep: Interactions with sleep spindles and slow oscillations. Psychophysiology 2015; 52:1441-50. [DOI: 10.1111/psyp.12508] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/19/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Julia Lechinger
- Department of Psychology, Division of Physiological Psychology; University of Salzburg; Salzburg Austria
- Laboratory for Sleep and Consciousness Research; University of Salzburg; Salzburg Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg; Salzburg Austria
| | - Dominik Philip Johannes Heib
- Department of Psychology, Division of Physiological Psychology; University of Salzburg; Salzburg Austria
- Laboratory for Sleep and Consciousness Research; University of Salzburg; Salzburg Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg; Salzburg Austria
| | - Walter Gruber
- Department of Psychology, Division of Physiological Psychology; University of Salzburg; Salzburg Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg; Salzburg Austria
| | - Manuel Schabus
- Department of Psychology, Division of Physiological Psychology; University of Salzburg; Salzburg Austria
- Laboratory for Sleep and Consciousness Research; University of Salzburg; Salzburg Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg; Salzburg Austria
| | - Wolfgang Klimesch
- Department of Psychology, Division of Physiological Psychology; University of Salzburg; Salzburg Austria
- Centre for Cognitive Neuroscience (CCNS), University of Salzburg; Salzburg Austria
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15
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Blume C, Lechinger J, del Giudice R, Wislowska M, Heib DPJ, Schabus M. EEG oscillations reflect the complexity of social interactions in a non-verbal social cognition task using animated triangles. Neuropsychologia 2015; 75:330-40. [PMID: 26111488 DOI: 10.1016/j.neuropsychologia.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 05/28/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
The ability to attribute independent mental states (e.g. opinions, perceptions, beliefs) to oneself and others is termed Theory of Mind (ToM). Previous studies investigating ToM usually employed verbal paradigms and functional neuroimaging methods. Here, we studied oscillatory responses in the electroencephalogram (EEG) in a non-verbal social cognition task. The aim of this study was twofold: First, we wanted to investigate differences in oscillatory responses to animations differing with regard to the complexity of social "interactions". Secondly, we intended to evaluate the basic cognitive processes underlying social cognition. To this end, we analyzed theta, alpha, beta and gamma task-related de-/synchronization (TRD/TRS) during presentation of six non-verbal videos differing in the complexity of (social) "interactions" between two geometric shapes. Videos were adopted from Castelli et al. (2000)and belonged to three conditions: Videos designed to evoke attributions of mental states (ToM), interaction descriptions (goal-directed, GD) and videos in which the shapes moved randomly (R). Analyses revealed that only theta activity consistently varied as a function of social "interaction" complexity. Results suggest that ToM/GD videos attract more attention and working-memory resources and may have activated related memory contents. Alpha and beta results were less consistent. While alpha effects suggest that observation of social "interactions" may benefit from inhibition of self-centered processing, oscillatory responses in the beta range could be related to action observation. In summary, the results provide insight into basic cognitive processes involved in social cognition and render the paradigm attractive for the investigation of social cognitive processes in non-verbal populations.
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Affiliation(s)
- Christine Blume
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Julia Lechinger
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Renata del Giudice
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Malgorzata Wislowska
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria.
| | - Dominik P J Heib
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
| | - Manuel Schabus
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Austria; University of Salzburg, Centre for Cognitive Neuroscience Salzburg (CCNS), Austria.
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Himmelstoss NA, Brötzner CP, Zauner A, Kerschbaum HH, Gruber W, Lechinger J, Klimesch W. Prestimulus amplitudes modulate P1 latencies and evoked traveling alpha waves. Front Hum Neurosci 2015; 9:302. [PMID: 26074804 PMCID: PMC4445316 DOI: 10.3389/fnhum.2015.00302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 05/12/2015] [Indexed: 11/20/2022] Open
Abstract
Traveling waves have been well documented in the ongoing, and more recently also in the evoked EEG. In the present study we investigate what kind of physiological process might be responsible for inducing an evoked traveling wave. We used a semantic judgment task which already proved useful to study evoked traveling alpha waves that coincide with the appearance of the P1 component. We found that the P1 latency of the leading electrode is significantly correlated with prestimulus amplitude size and that this event is associated with a transient change in alpha frequency. We assume that cortical background excitability, as reflected by an increase in prestimulus amplitude, is responsible for the observed change in alpha frequency and the initiation of an evoked traveling trajectory.
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Affiliation(s)
- Nicole A. Himmelstoss
- Department of Psychology, University of SalzburgSalzburg, Austria
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
| | - Christina P. Brötzner
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
- Department of Cell Biology, University of SalzburgSalzburg, Austria
| | - Andrea Zauner
- Department of Psychology, University of SalzburgSalzburg, Austria
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
| | - Hubert H. Kerschbaum
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
- Department of Cell Biology, University of SalzburgSalzburg, Austria
| | - Walter Gruber
- Department of Psychology, University of SalzburgSalzburg, Austria
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
| | - Julia Lechinger
- Department of Psychology, University of SalzburgSalzburg, Austria
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
| | - Wolfgang Klimesch
- Department of Psychology, University of SalzburgSalzburg, Austria
- Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
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Blume C, Del Giudice R, Wislowska M, Lechinger J, Schabus M. Across the consciousness continuum-from unresponsive wakefulness to sleep. Front Hum Neurosci 2015; 9:105. [PMID: 25805982 PMCID: PMC4354375 DOI: 10.3389/fnhum.2015.00105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/12/2015] [Indexed: 11/13/2022] Open
Abstract
Advances in the development of new paradigms as well as in neuroimaging techniques nowadays enable us to make inferences about the level of consciousness patients with disorders of consciousness (DOC) retain. They, moreover, allow to predict their probable development. Today, we know that certain brain responses (e.g., event-related potentials or oscillatory changes) to stimulation, circadian rhythmicity, the presence or absence of sleep patterns as well as measures of resting state brain activity can serve the diagnostic and prognostic evaluation process. Still, the paradigms we are using nowadays do not allow to disentangle VS/UWS and minimally conscious state (MCS) patients with the desired reliability and validity. Furthermore, even rather well-established methods have, unfortunately, not found their way into clinical routine yet. We here review current literature as well as recent findings from our group and discuss how neuroimaging methods (fMRI, PET) and particularly electroencephalography (EEG) can be used to investigate cognition in DOC or even to assess the degree of residual awareness. We, moreover, propose that circadian rhythmicity and sleep in brain-injured patients are promising fields of research in this context.
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Affiliation(s)
- Christine Blume
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Renata Del Giudice
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Malgorzata Wislowska
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg Salzburg, Austria ; Centre for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg Salzburg, Austria
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18
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Gruber WR, Zauner A, Lechinger J, Schabus M, Kutil R, Klimesch W. Alpha phase, temporal attention, and the generation of early event related potentials. Neuroimage 2014; 103:119-129. [DOI: 10.1016/j.neuroimage.2014.08.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 08/18/2014] [Accepted: 08/31/2014] [Indexed: 11/17/2022] Open
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del Giudice R, Lechinger J, Wislowska M, Heib DPJ, Hoedlmoser K, Schabus M. Oscillatory brain responses to own names uttered by unfamiliar and familiar voices. Brain Res 2014; 1591:63-73. [PMID: 25307136 PMCID: PMC4235780 DOI: 10.1016/j.brainres.2014.09.074] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/26/2014] [Accepted: 09/30/2014] [Indexed: 11/05/2022]
Abstract
Among auditory stimuli, the own name is one of the most powerful and it is able to automatically capture attention and elicit a robust electrophysiological response. The subject’s own name (SON) is preferentially processed in the right hemisphere, mainly because of its self-relevance and emotional content, together with other personally relevant information such as the voice of a familiar person. Whether emotional and self-relevant information are able to attract attention and can be, in future, introduced in clinical studies remains unclear. In the present study we used EEG and asked participants to count a target name (active condition) or to just listen to the SON or other unfamiliar names uttered by a familiar or unfamiliar voice (passive condition). Data reveals that the target name elicits a strong alpha event related desynchronization with respect to non-target names and triggers in addition a left lateralized theta synchronization as well as delta synchronization. In the passive condition alpha desynchronization was observed for familiar voice and SON stimuli in the right hemisphere. Altogether we speculate that participants engage additional attentional resources when counting a target name or when listening to personally relevant stimuli which is indexed by alpha desynchronization whereas left lateralized theta synchronization may be related to verbal working memory load. After validating the present protocol in healthy volunteers it is suggested to move one step further and apply the protocol to patients with disorders of consciousness in which the degree of residual cognitive processing and self-awareness is still insufficiently understood. EEG during an active–passive task based on first names was time-frequency analyzed. The presented names were uttered either by an unfamiliar or a familiar voice. Counted names elicited alpha desynchronization and left theta synchronization. Own name and familiar voices enhanced strong right alpha desynchronization. Alpha desynchronization reflects attentional engagement and emotional processing.
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Affiliation(s)
- Renata del Giudice
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunnerstrasse 34, 5020 Salzburg, Austria.
| | - Julia Lechinger
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunnerstrasse 34, 5020 Salzburg, Austria.
| | - Malgorzata Wislowska
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunnerstrasse 34, 5020 Salzburg, Austria.
| | - Dominik P J Heib
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunnerstrasse 34, 5020 Salzburg, Austria.
| | - Kerstin Hoedlmoser
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunnerstrasse 34, 5020 Salzburg, Austria; Center for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria.
| | - Manuel Schabus
- University of Salzburg, Department of Psychology, Laboratory for Sleep, Cognition and Consciousness Research, Hellbrunnerstrasse 34, 5020 Salzburg, Austria; Center for Cognitive Neuroscience Salzburg (CCNS), University of Salzburg, Hellbrunnerstrasse 34, 5020 Salzburg, Austria.
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Zauner A, Gruber W, Himmelstoß NA, Lechinger J, Klimesch W. Lexical access and evoked traveling alpha waves. Neuroimage 2014; 91:252-61. [PMID: 24486978 PMCID: PMC3988926 DOI: 10.1016/j.neuroimage.2014.01.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 01/10/2014] [Accepted: 01/20/2014] [Indexed: 11/02/2022] Open
Abstract
Retrieval from semantic memory is usually considered within a time window around 300-600ms. Here we suggest that lexical access already occurs at around 100ms. This interpretation is based on the finding that semantically rich and frequent words exhibit a significantly shorter topographical latency difference between the site with the shortest P1 latency (leading site) and that with the longest P1 latency (trailing site). This latency difference can be described in terms of an evoked traveling alpha wave as was already shown in earlier studies.
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Affiliation(s)
- Andrea Zauner
- Department of Physiological Psychology, University of Salzburg, Austria
| | - Walter Gruber
- Department of Physiological Psychology, University of Salzburg, Austria
| | | | - Julia Lechinger
- Department of Physiological Psychology, University of Salzburg, Austria
| | - Wolfgang Klimesch
- Department of Physiological Psychology, University of Salzburg, Austria.
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Schabus M, Heib DP, Lechinger J, Griessenberger H, Klimesch W, Pawlizki A, Kunz AB, Sterman BM, Hoedlmoser K. Enhancing sleep quality and memory in insomnia using instrumental sensorimotor rhythm conditioning. Biol Psychol 2014; 95:126-34. [DOI: 10.1016/j.biopsycho.2013.02.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/05/2013] [Accepted: 02/20/2013] [Indexed: 12/16/2022]
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Schabus M, Griessenberger H, Heib D, Lechinger J, Hoedlmoser K. Non-pharmacological treatment of primary insomnia using sensorimotor-rhythm neurofeedback. Sleep Med 2013. [DOI: 10.1016/j.sleep.2013.11.634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Griessenberger H, Heib DPJ, Lechinger J, Luketina N, Petzka M, Moeckel T, Hoedlmoser K, Schabus M. Susceptibility to declarative memory interference is pronounced in primary insomnia. PLoS One 2013; 8:e57394. [PMID: 23451218 PMCID: PMC3581453 DOI: 10.1371/journal.pone.0057394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022] Open
Abstract
Sleep has been shown to stabilize memory traces and to protect against competing interference in both the procedural and declarative memory domain. Here, we focused on an interference learning paradigm by testing patients with primary insomnia (N = 27) and healthy control subjects (N = 21). In two separate experimental nights with full polysomnography it was revealed that after morning interference procedural memory performance (using a finger tapping task) was not impaired in insomnia patients while declarative memory (word pair association) was decreased following interference. More specifically, we demonstrate robust associations of central sleep spindles (in N3) with motor memory susceptibility to interference as well as (cortically more widespread) fast spindle associations with declarative memory susceptibility. In general the results suggest that insufficient sleep quality does not necessarily show up in worse overnight consolidation in insomnia but may only become evident (in the declarative memory domain) when interference is imposed.
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Affiliation(s)
- Hermann Griessenberger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Dominik P. J. Heib
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Julia Lechinger
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Nikolina Luketina
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Marit Petzka
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Tina Moeckel
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Kerstin Hoedlmoser
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, University of Salzburg, Salzburg, Austria
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Lechinger J, Chwala-Schlegel N, Fellinger R, Donis J, Michitsch G, Pichler G, Schabus M. Mirroring of a simple motor behavior in Disorders of Consciousness. Clin Neurophysiol 2013; 124:27-34. [PMID: 22721652 DOI: 10.1016/j.clinph.2012.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 10/28/2022]
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Griessenberger H, Hoedlmoser K, Heib DPJ, Lechinger J, Klimesch W, Schabus M. Consolidation of temporal order in episodic memories. Biol Psychol 2012; 91:150-5. [PMID: 22705480 PMCID: PMC3427018 DOI: 10.1016/j.biopsycho.2012.05.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Revised: 01/30/2012] [Accepted: 05/31/2012] [Indexed: 10/28/2022]
Abstract
Even though it is known that sleep benefits declarative memory consolidation, the role of sleep in the storage of temporal sequences has rarely been examined. Thus we explored the influence of sleep on temporal order in an episodic memory task followed by sleep or sleep deprivation. Thirty-four healthy subjects (17 men) aged between 19 and 28 years participated in the randomized, counterbalanced, between-subject design. Parameters of interests were NREM/REM cycles, spindle activity and spindle-related EEG power spectra. Participants of both groups (sleep group/sleep deprivation group) performed retrieval in the evening, morning and three days after the learning night. Results revealed that performance in temporal order memory significantly deteriorated over three days only in sleep deprived participants. Furthermore our data showed a positive relationship between the ratios of the (i) first NREM/REM cycle with more REM being associated with delayed temporal order recall. Most interestingly, data additionally indicated that (ii) memory enhancers in the sleep group show more fast spindle related alpha power at frontal electrode sites possibly indicating access to a yet to be consolidated memory trace. We suggest that distinct sleep mechanisms subserve different aspects of episodic memory and are jointly involved in sleep-dependent memory consolidation.
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Affiliation(s)
- H Griessenberger
- Laboratory for Sleep and Consciousness Research, University of Salzburg, Department of Psychology, Division of Physiological Psychology, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
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