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Studer M, Guggisberg AG, Gyger N, Gutbrod K, Henke K, Heinemann D. Accelerated long-term forgetting in patients with acquired brain injury. Brain Inj 2024; 38:377-389. [PMID: 38385560 DOI: 10.1080/02699052.2024.2311349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE Recent research suggests that patients with neurological disorders without overt seizures may also experience accelerated long-term forgetting (ALF). This term describes unimpaired learning and memory performance after standard retention intervals, but an excessive rate of forgetting over delays of days or weeks. The objective of this retrospective study was to investigate ALF in patients with an acquired brain injury (ABI) and to associate memory performance with executive functions. METHODS Verbal memory performance (short-term recall, 30-min recall, 1-week recall) was assessed in 34 adult patients with ABI and compared to a healthy control group (n = 54) using an auditory word learning and memory test. RESULTS Repeated measure analysis showed significant effects of time and group as well as interaction effects between time and group regarding recall and recognition performance. Patients with ABI had a significantly impaired 1-week recall and recognition performance compared to the healthy control group. Correlations between recall performance and executive functions were nonsignificant. DISCUSSION Our results demonstrate that non-epileptic patients with ABI, especially patients with frontal and fronto-temporal lesions, are prone to ALF. Additionally, our data support the assumption that ALF results from a consolidation impairment since verbal recall and recognition were impaired in patients with ABI.
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Affiliation(s)
- M Studer
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Basel (UKBB), Basel, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - A G Guggisberg
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - N Gyger
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - K Gutbrod
- Neurozentrum Bern, Bern, Switzerland
| | - K Henke
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - D Heinemann
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
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2
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Mock N, Balzer C, Gutbrod K, Jäncke L, Wandel J, Bonati L, Trost W. Nonverbal memory tests revisited: Neuroanatomical correlates and differential influence of biasing cognitive functions. Cortex 2023; 164:63-76. [PMID: 37201378 DOI: 10.1016/j.cortex.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/01/2023] [Accepted: 03/31/2023] [Indexed: 05/20/2023]
Abstract
The detection of right temporal lobe dysfunction with nonverbal memory tests has remained difficult in the past. Reasons for this might be the potential influence of other biasing cognitive functions such as executive functions or the verbalisability of nonverbal material. The aim of this study was to investigate three classic nonverbal memory tests by identifying their neuroanatomical correlates with lesion-symptom mapping (LSM) and by probing their independence from verbal encoding abilities and executive functions. In a cohort of 119 patients with first-time cerebrovascular accident, memory performance was assessed in the Nonverbal Learning and Memory Test for Routes (NLMTR), the Rey Complex Figure Test (RCFT), and the Visual Design Learning Test (VDLT). Calculating multivariate LSM, we identified crucial brain structures for these three nonverbal memory tests. Behavioural analyses were performed to assess the impact of executive functions and verbal encoding abilities with regression analyses and likelihood-ratio tests. LSM revealed for the RCFT mainly right-hemispheric frontal, insular, subcortical, and white matter structures and for the NLMTR right-hemispheric temporal (hippocampus), insular, subcortical, and white matter structures. The VDLT did not reach significance in LSM analyses. Behavioural results showed that amongst the three nonverbal memory tests the impact of executive functions was most pronounced for RCFT, and the impact of verbal encoding abilities was most important in VDLT. Likelihood-ratio tests confirmed that only for NLMTR did the goodness of fit not significantly improve by adding executive functions or verbal encoding abilities. These results suggest that amongst the three nonverbal memory tests the NLMTR, as a spatial navigation test, could serve as the most suitable marker of right-hemispheric temporal lobe functioning, with the right hippocampus being involved only in this test. In addition, the behavioural results propose that only NLMTR seems mostly unaffected by executive functions and verbal encoding abilities.
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Affiliation(s)
- Nadia Mock
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland; Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Neurology, Zurich University Hospital, Zurich, Switzerland.
| | | | - Klemens Gutbrod
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Neurozentrum Bern, Switzerland
| | - Lutz Jäncke
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jasmin Wandel
- Institute for Optimisation and Data Analysis, Bern University of Applied Sciences, Switzerland
| | - Leo Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland; Department of Neurology, Department of Clinical Research, Basel University Hospital, Switzerland
| | - Wiebke Trost
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
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El-Garci A, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Zeitlberger A, Velz J, Sebök M, Eggenberger N, May A, Bijlenga P, Guerra-Lopez U, Maduri R, Beaud V, Starnoni D, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Gutbrod K, Maldaner N, Früh S, Schwind M, Bozinov O, Neidert MC, Brugger P, Keller E, Germans MR, Regli L, Hostettler IC, Stienen MN. Successful weaning versus permanent cerebrospinal fluid diversion after aneurysmal subarachnoid hemorrhage: post hoc analysis of a Swiss multicenter study. Neurosurg Focus 2023; 54:E3. [PMID: 37004134 DOI: 10.3171/2023.1.focus22638] [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: 09/25/2022] [Accepted: 01/17/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Acute hydrocephalus is a frequent complication after aneurysmal subarachnoid hemorrhage (aSAH). Among patients needing CSF diversion, some cannot be weaned. Little is known about the comparative neurological, neuropsychological, and health-related quality-of-life (HRQOL) outcomes in patients with successful and unsuccessful CSF weaning. The authors aimed to assess outcomes of patients by comparing those with successful and unsuccessful CSF weaning; the latter was defined as occurring in patients with permanent CSF diversion at 3 months post-aSAH. METHODS The authors included prospectively recruited alert (i.e., Glasgow Coma Scale score 13-15) patients with aSAH in this retrospective study from six Swiss neurovascular centers. Patients underwent serial neurological (National Institutes of Health Stroke Scale), neuropsychological (Montreal Cognitive Assessment), disability (modified Rankin Scale), and HRQOL (EuroQol-5D) examinations at < 72 hours, 14-28 days, and 3 months post-aSAH. RESULTS Of 126 included patients, 54 (42.9%) developed acute hydrocephalus needing CSF diversion, of whom 37 (68.5%) could be successfully weaned and 17 (31.5%) required permanent CSF diversion. Patients with unsuccessful weaning were older (64.5 vs 50.8 years, p = 0.003) and had a higher rate of intraventricular hemorrhage (52.9% vs 24.3%, p = 0.04). Patients who succeed in restoration of physiological CSF dynamics improve on average by 2 points on the Montreal Cognitive Assessment between 48-72 hours and 14-28 days, whereas those in whom weaning fails worsen by 4 points (adjusted coefficient 6.80, 95% CI 1.57-12.04, p = 0.01). They show better neuropsychological recovery between 48-72 hours and 3 months, compared to patients in whom weaning fails (adjusted coefficient 7.60, 95% CI 3.09-12.11, p = 0.02). Patients who receive permanent CSF diversion (ventriculoperitoneal shunt) show significant neuropsychological improvement thereafter, catching up the delay in neuropsychological improvement between 14-28 days and 3 months post-aSAH. Neurological, disability, and HRQOL outcomes at 3 months were similar. CONCLUSIONS These results show a temporary but clinically meaningful cognitive benefit in the first weeks after aSAH in successfully weaned patients. The resolution of this difference over time may be due to the positive effects of permanent CSF diversion and underlines its importance. Patients who do not show progressive neuropsychological improvement after weaning should be considered for repeat CT imaging to rule out chronic (untreated) hydrocephalus.
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Affiliation(s)
- Ahmed El-Garci
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
| | | | - Noemi Dannecker
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | | | - Julia Velz
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 5Department of Neurosurgery, University Hospital Geneva
| | | | | | | | - Valérie Beaud
- 8Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | | | - Alessio Chiappini
- 10Department of Neurosurgery, Cantonal Hospital Lugano
- 11Department of Neurosurgery, University Hospital Basel
| | - Stefania Rossi
- 12Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 10Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Johannes Goldberg
- 13Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 13Department of Neurosurgery, University Hospital Berne, Switzerland
- 14Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 13Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Klemens Gutbrod
- 15Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Nicolai Maldaner
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Severin Früh
- 16Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen; and
| | - Marc Schwind
- 16Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen; and
| | - Oliver Bozinov
- 1Department of Neurosurgery, Cantonal Hospital St. Gallen
| | | | - Peter Brugger
- 2Neuropsychology Unit, Department of Neurology, University Hospital Zurich
- 17Neuropsychology Unit, Rehabilitation Clinic Valens, Switzerland
| | - Emanuela Keller
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Menno R Germans
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
| | - Luca Regli
- 3Department of Neurosurgery, University Hospital Zurich
- 4Clinical Neuroscience Center, University of Zurich
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4
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Fasnacht JS, Wueest AS, Berres M, Thomann AE, Krumm S, Gutbrod K, Steiner LA, Goettel N, Monsch AU. Conversion between the Montreal Cognitive Assessment and the Mini-Mental Status Examination. J Am Geriatr Soc 2023; 71:869-879. [PMID: 36346002 DOI: 10.1111/jgs.18124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/20/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Early and accurate detection of cognitive changes using simple tools is essential for an appropriate referral to a more detailed neurocognitive assessment and for the implementation of therapeutic strategies. The Mini-Mental Status Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are two commonly used psychometric tests for cognitive screening. Both tests have different strengths and weaknesses. Preferences regarding test selection may therefore differ among clinicians. The aim of this retrospective observational cohort study was to define corresponding scores for the MMSE and the MoCA. METHODS We examined the relationship between the cognitive screening tests in 803 German-speaking Memory Clinic outpatients, encompassing a wide range of neurocognitive disorders. We produced a conversion table using the equipercentile equating method with log-linear smoothing. In addition, we conducted a systematic review of existing MMSE-MoCA conversions to create a table allowing for the conversion of MoCA scores into MMSE scores and vice versa using the weighted mean method. RESULTS The Memory Clinic sample showed that the prediction of MMSE to MoCA was overall less accurate compared to the conversion from MoCA to MMSE. The 19 studies included after thorough literature search showed that MoCA scores were consistently lower than MMSE scores. Eleven of 19 conversion studies had addressed the conversion of the MoCA to the MMSE, while two studies converted MMSE to MoCA scores. Another six studies applied bi-directional conversions. We provide an easy-to-use table covering the entire range of scores and taking into account all currently existing conversion formulas. CONCLUSION The comprehensive MMSE-MoCA conversion table enables a direct comparison of cognitive test scores at screening examinations and over the course of disease in patients with neurocognitive disorders.
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Affiliation(s)
- Jael S Fasnacht
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Alexandra S Wueest
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Department of Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Germany
| | - Alessandra E Thomann
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Department of Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Sabine Krumm
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Klemens Gutbrod
- Neurozentrum Bern and Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Luzius A Steiner
- Department of Anesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Nicolai Goettel
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andreas U Monsch
- From the Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Faculty of Psychology, University of Basel, Basel, Switzerland
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5
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Mock N, Balzer C, Gutbrod K, De Haan B, Jäncke L, Ettlin T, Trost W. Lesion-symptom mapping corroborates lateralization of verbal and nonverbal memory processes and identifies distributed brain networks responsible for memory dysfunction. Cortex 2022; 153:178-193. [DOI: 10.1016/j.cortex.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/10/2021] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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6
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Stienen MN, Germans MR, Zindel-Geisseler O, Dannecker N, Rothacher Y, Schlosser L, Velz J, Sebök M, Eggenberger N, May A, Haemmerli J, Bijlenga P, Schaller K, Guerra-Lopez U, Maduri R, Beaud V, Al-Taha K, Daniel RT, Chiappini A, Rossi S, Robert T, Bonasia S, Goldberg J, Fung C, Bervini D, Maradan-Gachet ME, Gutbrod K, Maldaner N, Neidert MC, Früh S, Schwind M, Bozinov O, Brugger P, Keller E, Marr A, Roux S, Regli L. Longitudinal neuropsychological assessment after aneurysmal subarachnoid hemorrhage and its relationship with delayed cerebral ischemia: a prospective Swiss multicenter study. J Neurosurg 2022; 137:1742-1750. [PMID: 35535839 DOI: 10.3171/2022.2.jns212595] [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: 11/10/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While prior retrospective studies have suggested that delayed cerebral ischemia (DCI) is a predictor of neuropsychological deficits after aneurysmal subarachnoid hemorrhage (aSAH), all studies to date have shown a high risk of bias. This study was designed to determine the impact of DCI on the longitudinal neuropsychological outcome after aSAH, and importantly, it includes a baseline examination after aSAH but before DCI onset to reduce the risk of bias. METHODS In a prospective, multicenter study (8 Swiss centers), 112 consecutive alert patients underwent serial neuropsychological assessments (Montreal Cognitive Assessment [MoCA]) before and after the DCI period (first assessment, < 72 hours after aSAH; second, 14 days after aSAH; third, 3 months after aSAH). The authors compared standardized MoCA scores and determined the likelihood for a clinically meaningful decline of ≥ 2 points from baseline in patients with DCI versus those without. RESULTS The authors screened 519 patients, enrolled 128, and obtained complete data in 112 (87.5%; mean [± SD] age 53.9 ± 13.9 years; 66.1% female; 73% World Federation of Neurosurgical Societies [WFNS] grade I, 17% WFNS grade II, 10% WFNS grades III-V), of whom 30 (26.8%) developed DCI. MoCA z-scores were worse in the DCI group at baseline (-2.6 vs -1.4, p = 0.013) and 14 days (-3.4 vs -0.9, p < 0.001), and 3 months (-0.8 vs 0.0, p = 0.037) after aSAH. Patients with DCI were more likely to experience a decline of ≥ 2 points in MoCA score at 14 days after aSAH (adjusted OR [aOR] 3.02, 95% CI 1.07-8.54; p = 0.037), but the likelihood was similar to that in patients without DCI at 3 months after aSAH (aOR 1.58, 95% CI 0.28-8.89; p = 0.606). CONCLUSIONS Aneurysmal SAH patients experiencing DCI have worse neuropsychological function before and until 3 months after the DCI period. DCI itself is responsible for a temporary and clinically meaningful decline in neuropsychological function, but its effect on the MoCA score could not be measured at the time of the 3-month follow-up in patients with low-grade aSAH with little or no impairment of consciousness. Whether these findings can be extrapolated to patients with high-grade aSAH remains unclear. Clinical trial registration no.: NCT03032471 (ClinicalTrials.gov).
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Affiliation(s)
- Martin N Stienen
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | - Menno R Germans
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | | | - Noemi Dannecker
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Yannick Rothacher
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Ladina Schlosser
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Julia Velz
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Martina Sebök
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Noemi Eggenberger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich
| | - Adrien May
- 4Department of Neurosurgery, University Hospital Geneva
| | | | | | - Karl Schaller
- 4Department of Neurosurgery, University Hospital Geneva
| | | | - Rodolfo Maduri
- 6Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier
| | - Valérie Beaud
- 7Neuropsychology Unit, Department of Neurology, University Hospital Lausanne
| | - Khalid Al-Taha
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | - Roy Thomas Daniel
- 8Department of Clinical Neurosciences, Service of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne
| | | | - Stefania Rossi
- 10Neuropsychology Unit, Department of Neurology, Cantonal Hospital Lugano
| | - Thomas Robert
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Sara Bonasia
- 9Department of Neurosurgery, Cantonal Hospital Lugano
| | - Johannes Goldberg
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | - Christian Fung
- 11Department of Neurosurgery, University Hospital Berne, Switzerland.,12Department of Neurosurgery, University Hospital Freiburg, Germany
| | - David Bervini
- 11Department of Neurosurgery, University Hospital Berne, Switzerland
| | | | - Klemens Gutbrod
- 13Neuropsychology Unit, Department of Neurology, University Hospital Berne
| | | | | | - Severin Früh
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Marc Schwind
- 15Neuropsychology Unit, Department of Neurology, Cantonal Hospital St. Gallen
| | - Oliver Bozinov
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich.,14Department of Neurosurgery, Cantonal Hospital St. Gallen
| | - Peter Brugger
- 3Neuropsychology Unit, Department of Neurology, University Hospital Zurich.,16Neuropsychology Unit, Rehabilitation Clinic Valens; and
| | - Emanuela Keller
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
| | - Angelina Marr
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Sébastien Roux
- 17Global Clinical Development, Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland
| | - Luca Regli
- 1Department of Neurosurgery, University Hospital Zurich.,2Clinical Neuroscience Center, University of Zurich
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7
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Darling KEA, Locatelli I, Benghalem N, Nadin I, Calmy A, Gutbrod K, Hauser C, Brugger P, Hasse B, Kovari H, Kunze U, Stoeckle M, Fux C, Rossi S, Di Benedetto C, Früh S, Schmid P, Tarr PE, Daeppen JB, Du Pasquier R, Cavassini M. Alcohol consumption and neurocognitive deficits in people with well-treated HIV in Switzerland. PLoS One 2021; 16:e0246579. [PMID: 33651794 PMCID: PMC7924787 DOI: 10.1371/journal.pone.0246579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively. Results Most participants (96.2%) had undetectable viral loads and 64% were aged >50 years old. Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%. While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary (odds ratio, OR ≥2.0, P <0.05) and continuous (mean z-score difference -0.2 to -0.4, P ≤0.01) outcomes. A significant U-shaped distribution of AUDIT-C score was also observed for motor skills and overall neurocognitive function. Conclusions In this cohort of PWH with well-controlled HIV infection, NCI was associated with the practice of binge drinking rather than alcohol consumption frequency or quantity. Longitudinal analysis of alcohol consumption and NCI in this population is currently underway.
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Affiliation(s)
| | - Isabella Locatelli
- Division of Biostatistics and Quantitative Methods, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nadia Benghalem
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Isaure Nadin
- Department of Clinical Neurosciences, Laboratory of Neuroimmunology, Research Centre of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandra Calmy
- HIV Unit, Infectious Diseases Division, Medicine Specialties Department, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland
| | - Christoph Hauser
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Brugger
- Department of Neuropsychology, Neurology Clinic, University Hospital Zürich, Zürich, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Helen Kovari
- Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Ursi Kunze
- Memory Clinic, Felix Platter Hospital, University Centre for Medicine of Aging, Basel, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christophe Fux
- Infectious Diseases and Hospital Epidemiology Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Stefania Rossi
- Neuropsychology Unit, Lugano Regional Hospital, Lugano, Switzerland
| | | | - Severin Früh
- Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Philip E. Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - Jean-Bernard Daeppen
- Service of Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Service of Neurology, Department of clinical neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
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8
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Santos G, Locatelli I, Métral M, Berney A, Nadin I, Calmy A, Tarr P, Gutbrod K, Hauser C, Brugger P, Kovari H, Kunze U, Stoeckle M, Früh S, Schmid P, Rossi S, Di Benedetto C, Du Pasquier R, Darling K, Cavassini M. The association between depressive symptoms and neurocognitive impairment in people with well-treated HIV in Switzerland. Int J STD AIDS 2021; 32:729-739. [PMID: 33629882 DOI: 10.1177/0956462420987434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Depression may contribute to neurocognitive impairment (NCI) in people with HIV (PWH). Attributing NCI to depression rather than to HIV is complicated as depression may be both a causal factor and an effect of NCI. This study aimed to determine the association between depressive symptoms and NCI among PWH with well-controlled infection. METHODS The Neurocognitive Assessment in the Metabolic and Ageing Cohort study is an ongoing, prospective, longitudinal study of PWH aged ≥45 years old nested within the Swiss HIV Cohort Study. Neurocognitive Assessment in the Metabolic and Ageing Cohort study participants underwent neurocognitive assessment and grading of depressive symptoms using the Centre for Epidemiological Studies Depression Scale. Neurocognitive impairment categories were defined using Frascati criteria. Participants with NCI related to neurological or psychiatric confounders other than depression were excluded. The cross-sectional association between the Centre for Epidemiological Studies Depression score and neurocognitive impairment was examined taking Centre for Epidemiological Studies Depression score as a continuous variable and then as a binary variable using two score thresholds, 16 and 27. RESULTS Excluding 79 participants with confounding factors, 902 participants were studied: 81% were men; 96% had plasma viral loads <50 copies/ml; 35% had neurocognitive impairment; 28% had Centre for Epidemiological Studies Depression scores ≥16. Higher Centre for Epidemiological Studies Depression scores were associated with female sex (p = 0.0003), non-Caucasian origin (p = 0.011) and current/past intravenous drug use (p = 0.002). Whilst neurocognitive impairment was associated with higher Centre for Epidemiological Studies Depression scores, the Centre for Epidemiological Studies Depression score was a poor predictor of having neurocognitive impairment (area under the ROC curve 0.604). Applying a Centre for Epidemiological Studies Depression score threshold of 16 predicted the presence of neurocognitive impairment with a sensitivity of 38.3% (specificity 77.2%), increasing the threshold to 27 lowered sensitivity to 15.4% (specificity 93.6%). CONCLUSION In this large cohort of PWH in Switzerland, we did not observe a Centre for Epidemiological Studies Depression score threshold that was sensitive in predicting neurocognitive impairment. As neurocognitive impairment was however associated with higher Centre for Epidemiological Studies Depression scores, the data support the screening for and treatment of depression among PWH diagnosed with neurocognitive impairment.
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Affiliation(s)
- Galia Santos
- Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland
| | - Isabella Locatelli
- Division of biostatistics and quantitative methods, Institute of Social and Preventive Medicine, 30640Lausanne University Hospital, Lausanne, Switzerland
| | - Mélanie Métral
- Laboratory of neuroimmunology, Research Centre of clinical neurosciences, Department of clinical neurosciences, 419233Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Isaure Nadin
- Laboratory of neuroimmunology, Research Centre of clinical neurosciences, Department of clinical neurosciences, 419233Lausanne University Hospital, Lausanne, Switzerland.,Department of Neurology, 27230Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Alexandra Calmy
- HIV unit, Infectious Diseases Division, Medicine Specialties Department, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Philip Tarr
- University Department of Medicine, Kantonsspital Bruderholz, 27209University of Basel, Bruderholz, Basel, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland
| | - Christoph Hauser
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Brugger
- Department of Neuropsychology, Neurology Clinic, 27243University Hospital Zürich, Zürich, Switzerland
| | - Helen Kovari
- Department of Infectious Diseases and Hospital Epidemiology, Universitätsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Ursi Kunze
- Memory Clinic, University Centre for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, 30262University Hospital Basel, University of Basel, Basel, Switzerland
| | - Severin Früh
- Department of Neurology, Neuropsychology Unit, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefania Rossi
- Neuropsychology Unit, 30721Lugano Regional Hospital, Lugano, Switzerland
| | | | - Renaud Du Pasquier
- Service of Neurology, Department of clinical neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Katharine Darling
- Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, 30635Lausanne University Hospital, Lausanne, Switzerland
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9
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Schmidt N, Gerber SM, Zante B, Gawliczek T, Chesham A, Gutbrod K, Müri RM, Nef T, Schefold JC, Jeitziner MM. Effects of intensive care unit ambient sounds on healthcare professionals: results of an online survey and noise exposure in an experimental setting. Intensive Care Med Exp 2020; 8:34. [PMID: 32705428 PMCID: PMC7376325 DOI: 10.1186/s40635-020-00321-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 01/11/2020] [Accepted: 07/03/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Noise levels on intensive care units (ICUs) are typically elevated. While many studies reported negative effects of ICU ambient sounds on patients, only few investigated noise as a factor to influence well-being or performance in healthcare professionals. METHODS An online survey in the German-speaking part of Switzerland was conducted to assess how ICU soundscapes are subjectively perceived by healthcare professionals. The questionnaire was answered by 348 participants. Additionally, effects of noise on working memory performance were evaluated in an experimental noise exposure setting. Twenty-six healthcare professionals and 27 healthy controls performed a 2-back object-location task while being exposed to either ICU or pink noise. RESULTS Survey results demonstrate that a majority of participants was aware of heightened noise levels. Participants reported that mostly well-being, performance, and attention could be reduced, along with subjective annoyance and fatigue by ICU ambient sounds. Although no significant effects of noise exposure on working memory performance was observed, self-assessments revealed significantly higher stress levels, increased annoyance and distraction ratings as well as decreased confidence in performance after ICU-noise exposure. CONCLUSION Subjective assessments indicate that heightened noise levels on ICUs induce annoyance, with heightened stress levels, impaired well-being, and reduced performance being potential consequences. Empirical evidence with objective and physiological measures is warranted.
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Affiliation(s)
- Nadine Schmidt
- Gerontechnology & Rehabilitation Group, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland
| | - Stephan M Gerber
- Gerontechnology & Rehabilitation Group, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland
| | - Björn Zante
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, CH-3010, Bern, Switzerland
| | - Tom Gawliczek
- Hearing Research Laboratory, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland
| | - Alvin Chesham
- Gerontechnology & Rehabilitation Group, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland
| | - Klemens Gutbrod
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - René M Müri
- Gerontechnology & Rehabilitation Group, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Freiburgstrasse, CH-3010, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation Group, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland.
- ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, CH-3010, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, University Hospital Bern (Inselspital), University of Bern, CH-3010, Bern, Switzerland
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10
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Stienen MN, Fung C, Bijlenga P, Zumofen DW, Maduri R, Robert T, Seule MA, Marbacher S, Geisseler O, Brugger P, Gutbrod K, Chicherio C, Monsch AU, Beaud V, Rossi S, Früh S, Schmid N, Smoll NR, Keller E, Regli L. Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage-Protocol of a Swiss Nationwide Observational Study (MoCA-DCI Study). Neurosurgery 2020; 84:1124-1132. [PMID: 29762759 DOI: 10.1093/neuros/nyy155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/27/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The exact relationship between delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) and neuropsychological impairment remains unknown, as previous studies lacked a baseline examination after aneurysm occlusion but before the DCI-period. Neuropsychological evaluation of acutely ill patients is often applied in a busy intensive care unit (ICU), where distraction represents a bias to the obtained results. OBJECTIVE To evaluate the relationship between DCI and neuropsychological outcome after aSAH by comparing the Montreal Cognitive Assessment (MoCA) results in aSAH patients with and without DCI at 3 mo with a baseline examination before the DCI-period (part 1). To determine the reliability of the MoCA, when applied in an ICU setting (part 2). METHODS Prospective, multicenter, and observational study performed at all Swiss neurovascular centers. For part 1, n = 240 consecutive aSAH patients and for part 2, n = 50 patients with acute brain injury are recruited. EXPECTED OUTCOMES Part 1: Effect size of the relationship between DCI and neuropsychological outcome (MoCA). Part 2: Reliability measures for the MoCA. DISCUSSION The institutional review boards approved this study on July 4, 2017 under case number BASEC 2017-00103. After completion, the results will be offered to an international scientific journal for peer-reviewed publication. This study determines the exact impact of DCI on the neuropsychological outcome after aSAH, unbiased by confounding factors such as early brain injury or patient-specific characteristics. The study provides unique insights in the neuropsychological state of patients in the early period after aSAH.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Christian Fung
- Department of Neurosurgery, University Hospital Berne, Berne, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Rodolfo Maduri
- Department of Neurosurgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Thomas Robert
- Department of Neurosurgery, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Olivia Geisseler
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Klemens Gutbrod
- Neuropsychology Unit, Department of Neurology, University Hospital Berne, Berne, Switzerland
| | - Christian Chicherio
- Neuropsychology Unit, Department of Neurology, University Hospital Geneva, Geneva, Switzerland
| | - Andreas U Monsch
- Neuropsychology Unit, Department of Neurology, Memory Clinic Basel, Basel, Switzerland
| | - Valérie Beaud
- Neuropsychology Unit, Department of Neurology, University Hospital Lausanne, Lausanne, Switzerland
| | - Stefania Rossi
- Neuropsychology Unit, Department of Neurology, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Severin Früh
- Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nicole Schmid
- Neuropsychology Unit, Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicolas R Smoll
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Emanuela Keller
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Clinical Neuroscience Center, University of Zurich, Switzerland
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11
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Rohner A, Gutbrod K, Kohler B, Lidzba K, Fischer U, Goeggel-Simonetti B, Regenyi M, Steinlin M, Bigi S. Health-Related Quality of Life in Young Adults Following Pediatric Arterial Ischemic Stroke. Stroke 2020; 51:952-957. [DOI: 10.1161/strokeaha.119.027622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose—
Pediatric arterial ischemic stroke (AIS) is a rare disease leading to long-lasting neurological sequelae. Little is known about the long-term health-related quality of life (HRQoL) of these patients. The study aims to compare HRQoL in young adults who have had pediatric AIS with a healthy control group.
Methods—
A cross-sectional study compared self-rated HRQoL, depression, fatigability, and behavior in pediatric stroke survivors to healthy controls. Patients with a confirmed diagnosis of pediatric AIS who were ≥18 years at the time of recruitment and ≥2 years after acute AIS, as well as healthy controls ≥18 years matched for age, sex, and socioeconomic status were included. Primary outcome was HRQoL measured with the Short Form Health Survey.
Results—
Thirty-three patients (median [interquartile range] aged 22 years [20–26]; 22 males, 67%) and 71 controls (median [interquartile range] aged 23 years [21–25]; 41 males, 58%) were included. Overall, HRQoL, depression, or fatigability did not differ between the patients and the control group. Patients rated themselves lower on the disinhibition scale (
P
=0.049) and tended to rate themselves lower on the executive dysfunction scale (
P
=0.076). Patients with a poor outcome 24 months after AIS showed a clear trend toward impairment of executive functioning (
P
=0.056) and work/productivity in the stroke-specific QoL (
P
=0.05).
Conclusions—
Self-rated HRQoL, depression, and fatigability in adult pediatric stroke survivors are comparable to healthy adult peers. A poor outcome 24 months after acute stroke might affect work performance and executive functioning in adulthood.
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Affiliation(s)
- Aline Rohner
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Klemens Gutbrod
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (K.G., U.F., B.G.-S.)
| | - Barbara Kohler
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Karen Lidzba
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (K.G., U.F., B.G.-S.)
| | - Barbara Goeggel-Simonetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (K.G., U.F., B.G.-S.)
- Division of Child Neurology, Istituto Pediatrico della Svizzera Italiana, Bellinzona, Switzerland (B.G.-S.)
| | - Maria Regenyi
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Maja Steinlin
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Sandra Bigi
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
- Swiss Epilepsy Clinic, Klinik Lengg, Zürich, Switzerland (S.B.)
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12
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Metral M, Nadin I, Locatelli I, Tarr PE, Calmy A, Kovari H, Brugger P, Cusini A, Gutbrod K, Schmid P, Schwind M, Kunze U, Di Benedetto C, Pignatti R, Du Pasquier R, Darling K, Cavassini M. How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well-treated HIV-positive population? HIV Med 2019; 21:342-348. [PMID: 31883203 PMCID: PMC7216878 DOI: 10.1111/hiv.12828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 12/30/2022]
Abstract
Objectives Diagnosing neurocognitive impairment (NCI) in HIV infection requires time‐consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI. Methods The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self‐report forms [Center for Epidemiologic Studies Depression Scale (CES‐D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated. Results Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV‐associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV‐associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001). Conclusions The EACS screening questions had an NPV of 0.7 for excluding patients with HIV‐associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.
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Affiliation(s)
- M Metral
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - I Nadin
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland.,Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - I Locatelli
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - P E Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - A Calmy
- HIV Unit, Infectious Diseases Division, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - H Kovari
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - P Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - A Cusini
- Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K Gutbrod
- Division of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St Gallen, St Gallen, Switzerland
| | - M Schwind
- Neurology Clinic, St. Gallen, Switzerland
| | - U Kunze
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - C Di Benedetto
- Infectious Diseases Unit, Lugano Regional Hospital, Lugano, Switzerland
| | - R Pignatti
- Department of Neurology, Neurocentre of Southern Switzerland, Lugano Regional Hospital, Lugano, Switzerland
| | - R Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne, Switzerland
| | - Kea Darling
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
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13
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Métral M, Darling K, Locatelli I, Nadin I, Santos G, Brugger P, Kovari H, Cusini A, Gutbrod K, Tarr PE, Calmy A, Lecompte TD, Assal F, Monsch A, Kunze U, Stoeckle M, Schwind M, Schmid P, Pignatti R, Di Benedetto C, Du Pasquier R, Cavassini M. The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study: baseline participant profile. HIV Med 2019; 21:30-42. [PMID: 31589807 PMCID: PMC6916574 DOI: 10.1111/hiv.12795] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
Objectives The aim of the study was to examine baseline neurocognitive impairment (NCI) prevalence and factors associated with NCI among patients enrolled in the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study. Methods The NAMACO study is an ongoing, prospective, longitudinal, multicentre and multilingual (German, French and Italian) study within the Swiss HIV Cohort Study. Between 1 May 2013 and 30 November 2016, 981 patients ≥ 45 years old were enrolled in the study. All underwent standardized neuropsychological (NP) assessment by neuropsychologists. NCI was diagnosed using Frascati criteria and classified as HIV‐associated or as related to other factors. Dichotomized analysis (NCI versus no NCI) and continuous analyses (based on NP test z‐score means) were performed. Results Most patients (942; 96.2%) had viral loads < 50 HIV‐1 RNA copies/mL. NCI was identified in 390 patients (39.8%): 263 patients (26.8%) had HIV‐associated NCI [249 patients (25.4%) had asymptomatic neurocognitive impairment (ANI)] and 127 patients (13%) had NCI attributable to other factors, mainly psychiatric disorders. There was good correlation between dichotomized and continuous analyses, with NCI associated with older age, non‐Caucasian ethnicity, shorter duration of education, unemployment and longer antiretroviral therapy duration. Conclusions In this large sample of aging people living with HIV with well‐controlled infection in Switzerland, baseline HIV‐associated NCI prevalence, as diagnosed after formal NP assessment, was 26.8%, with most cases being ANI. The NAMACO study data will enable longitudinal analyses within this population to examine factors affecting NCI development and course.
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Affiliation(s)
- M Métral
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Kea Darling
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - I Locatelli
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - I Nadin
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland.,Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - G Santos
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - P Brugger
- Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - H Kovari
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - A Cusini
- Department of Infectious Diseases and Hospital Epidemiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - K Gutbrod
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - P E Tarr
- University Department of Medicine, Kantonsspital Bruderholz, University of Basel, Bruderholz, Switzerland
| | - A Calmy
- HIV Unit, Infectious Diseases Division, Medicine Department, University Hospital of Geneva, Geneva, Switzerland
| | - T D Lecompte
- HIV Unit, Infectious Diseases Division, Medicine Department, University Hospital of Geneva, Geneva, Switzerland
| | - F Assal
- Service of Neurology, University Hospital of Geneva, Geneva, Switzerland
| | - A Monsch
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - U Kunze
- Memory Clinic, Felix Platter Hospital, University Center for Medicine of Aging, Basel, Switzerland
| | - M Stoeckle
- Infectious Diseases Unit, Basel, Switzerland
| | - M Schwind
- Neurology Clinic, St Gallen, Switzerland
| | - P Schmid
- Infectious Diseases and Hospital Epidemiology Division, Kantonsspital St Gallen, St Gallen, Switzerland
| | - R Pignatti
- Department of Neurology, Neurocentre of Southern Switzerland, Lugano Regional Hospital, Lugano, Switzerland
| | - C Di Benedetto
- Infectious Diseases Unit, Lugano Regional Hospital, Lugano, Switzerland
| | - R Du Pasquier
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - M Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
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14
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Zietzer A, Jahnel AL, Hosen MH, Gutbrod K, Doermann P, Nickenig G, Werner N, Jansen F. P2584Extracellular vesicles are relevant transporters of C16 ceramide and induce apoptosis in endothelial vesicle recipient cells. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Extracellular vesicles (EVs) have recently been identified as important intercellular transporters of biologically active molecules. Besides microRNAs, which have been shown to mediate an important part of the EV function, various sphingolipids have been shown to be exported into EVs. Among these sphingolipids, ceramides have been gained interest in the cardiovascular context, because elevated plasma levels of d18:1–16:0 Ceramide (C16) have been shown to correlate with an increased risk for cardiovascular events. How ceramides are enriched in endothelial cell derived-EVs and if they are transferred to EV recipient cells to exert specific biological functions is currently unknown.
Methods and results
Endothelial cell derived large EVs were isolated from human coronary artery endothelial cells (HCAECs) via differential centrifugation of the culture supernatant (1 x 1500 g / 15 min + 2 x 20,000 g / 40 min). EVs were characterized by immunoblotting, electron microscopy and nanoparticle tracking analysis (Size: 252±24 nm). Sphingolipids were extracted from HCAECs and EVs (with and without glycemic injury by 30mmol/L glucose for 72 h) by solid phase extraction and analysed via Q-TOF MS/MS mass spectrometry. Lipidomic analysis revealed an enrichment of all sphingolipid classes in EVs, including C16, which was most abundantly present in EVs. As a next step, we tested if ceramides can be transferred between HCAECs by EVs. Therefore, HCAECs were incubated with NBD-labeled ceramide. NBD-Ceramide uptake into HCAECs and vesicular transfer to native HCAECs were confirmed by fluorescence microscopic imaging. Importantly, the transfer of NBD-Ceramide was abrogated if the vesicles were degraded in Triton-X 1% before incubation with EV recipient cells, which confirms that the transfer is vesicle dependent. Additionally, uptake of C16 into HCAECs and release into EVs was confirmed via mass spectrometry. Viability of C16 treated HCAECs was significantly reduced at concentrations above 5 μM of C16 in an MTT-based assay. In order to assess if the increased vesicular packing and transfer of Ceramides also reduces viability of EV recipient cells, native HCAECs were incubated with EVs from HCAECs which were treated with 2 μM and 20 μM C16. Treatment with C16 enriched vesicles lead to a significant reduction of EV recipient cell viability in a dose dependant manner.
Conclusion
In the present study, we found that C16 is enriched in EVs and that C16 is transferred through EVs among HCAECs. Depending on the amount of transferred C16, this process reduces the viability of native EV recipient HCAECs. Furthermore, vesicular C16 export is increased after glycemic injury. In comparison to the amounts of free C16, which are necessary to induce a similar reduction in HCAEC viability, the amount of EV transferred C16 is negliable. Hence, vesicular packaging results in a high bioavailability of ceramides leading to a relevant regulation of endothelial cell death.
Acknowledgement/Funding
BONFOR Progamm University Bonn
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Affiliation(s)
- A Zietzer
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - A L Jahnel
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - M H Hosen
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - K Gutbrod
- University of Bonn, Institute of Molecular Physiology and Biotechnology of Plants, Bonn, Germany
| | - P Doermann
- University of Bonn, Institute of Molecular Physiology and Biotechnology of Plants, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - F Jansen
- University Hospital Bonn, Medical Department II, Bonn, Germany
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15
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Chesham A, Gerber SM, Schütz N, Saner H, Gutbrod K, Müri RM, Nef T, Urwyler P. Search and Match Task: Development of a Taskified Match-3 Puzzle Game to Assess and Practice Visual Search. JMIR Serious Games 2019; 7:e13620. [PMID: 31094325 PMCID: PMC6532342 DOI: 10.2196/13620] [Citation(s) in RCA: 12] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/04/2019] [Accepted: 04/21/2019] [Indexed: 11/17/2022] Open
Abstract
Background Visual search declines with aging, dementia, and brain injury and is linked to limitations in everyday activities. Recent studies suggest that visual search can be improved with practice using computerized visual search tasks and puzzle video games. For practical use, it is important that visual search ability can be assessed and practiced in a controlled and adaptive way. However, commercial puzzle video games make it hard to control task difficulty, and there are little means to collect performance data. Objective The aim of this study was to develop and initially validate the search and match task (SMT) that combines an enjoyable tile-matching match-3 puzzle video game with features of the visual search paradigm (taskified game). The SMT was designed as a single-target visual search task that allows control over task difficulty variables and collection of performance data. Methods The SMT is played on a grid-based (width × height) puzzle board, filled with different types of colored polygons. A wide range of difficulty levels was generated by combinations of 3 task variables over a range from 4 to 8 including height and width of the puzzle board (set size) and the numbers of tile types (distractor heterogeneity). For each difficulty level, large numbers of playable trials were pregenerated using Python. Each trial consists of 4 consecutive puzzle boards, where the goal of the task is to find a target tile configuration (search) on the puzzle board and swap 2 adjacent tiles to create a line of 3 identical tiles (match). For each puzzle board, there is exactly 1 possible match (single target search). In a user study with 28 young adults (aged 18 to 31 years), 13 older (aged 64 to 79 years) and 11 oldest (aged 86 to 98 years) adults played the long (young and older adults) or short version (oldest adults) of the difficulty levels of the SMT. Participants rated their perception and the usability of the task and completed neuropsychological tests that measure cognitive domains engaged by the puzzle game. Results Results from the user study indicate that the target search time is associated with set size, distractor heterogeneity, and age. Results further indicate that search performance is associated with general cognitive ability, selective and divided attention, visual search, and visuospatial and pattern recognition ability. Conclusions Overall, this study shows that an everyday puzzle game–based task can be experimentally controlled, is enjoyable and user-friendly, and permits data collection to assess visual search and cognitive abilities. Further research is needed to evaluate the potential of the SMT game to assess and practice visual search ability in an enjoyable and adaptive way. A PsychoPy version of the SMT is freely available for researchers.
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Affiliation(s)
- Alvin Chesham
- Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland
| | | | - Narayan Schütz
- Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland
| | - Hugo Saner
- Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland.,Department of Cardiology, University Hospital (Inselspital), Bern, Switzerland
| | - Klemens Gutbrod
- Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - René Martin Müri
- Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland.,Artificial Organ Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Prabitha Urwyler
- Gerontechnology & Rehabilitation, University of Bern, Bern, Switzerland.,Artificial Organ Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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16
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Rodriguez B, Zimmermann R, Gutbrod K, Heinemann D, Z'Graggen WJ. Orthostatic Cognitive Dysfunction in Postural Tachycardia Syndrome After Rapid Water Drinking. Front Neurosci 2019; 13:327. [PMID: 31024242 PMCID: PMC6465605 DOI: 10.3389/fnins.2019.00327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/21/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Postural tachycardia syndrome (POTS) is a form of autonomic dysregulation and is characterized by an excessive heart rate (HR) increment upon the upright body position while blood pressure is maintained. Patients experience typical symptoms of orthostatic intolerance such as dizziness, nausea and cognitive impairments. The present study assessed position-dependent attentional and cognitive functioning in POTS patients compared to healthy subjects and tested the response of cognitive performance to acute water intake. Methods: Data was obtained from eight patients with neuropathic POTS and eight healthy subjects of similar age and gender. All participants completed questionnaires that assessed health-related quality of life and depression and underwent four rounds of neuropsychological testing overall, each before and after the intake of 500 ml still mineral water and both in the supine and in the upright posture. Results: Postural tachycardia syndrome patients showed deficits in working memory (WM) exclusively in the upright position compared to healthy subjects, but no position-dependent impairments in alertness or divided attention. Rapid water ingestion had a beneficial effect on WM in the upright posture, lead to a decrease in HR increment and to an improvement of subjective symptom experience. Conclusion: The results provide support for the occurrence of purely orthostatic cognitive deficits in POTS, especially when increased executive control and cognitive resources are required and document a favorable effect of water intake on cognitive performance. These findings have important implications for the management of cognitive symptoms in POTS as high water intake is an easy and accessible strategy.
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Affiliation(s)
- Belén Rodriguez
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raya Zimmermann
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klemens Gutbrod
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Doerthe Heinemann
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner J Z'Graggen
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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17
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Chesham A, Gerber SM, Schütz N, Wyss P, Urwyler P, Gutbrod K, Müri R, Nef T. P1‐046: PUZZLING THE MIND: EVALUATING THE DIFFICULTY OF GENERATED PUZZLE GAME LEVELS FOR A PUZZLE GAME INTERVENTION — PRELIMINARY RESULTS. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | | | - Prabitha Urwyler
- University of BernARTORG Center for Biomedical Engineering ResearchBernSwitzerland
| | - Klemens Gutbrod
- Inselspital, Bern University HospitalUniversity of BernBernSwitzerland
| | - René Müri
- Bern University Hospital InselspitalDepartment of Cognitive and Restorative NeurologyBernSwitzerland
| | - Tobias Nef
- University of BernARTORG Center for Biomedical Engineering ResearchBernSwitzerland
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18
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Preisig BC, Eggenberger N, Cazzoli D, Nyffeler T, Gutbrod K, Annoni JM, Meichtry JR, Nef T, Müri RM. Multimodal Communication in Aphasia: Perception and Production of Co-speech Gestures During Face-to-Face Conversation. Front Hum Neurosci 2018; 12:200. [PMID: 29962942 PMCID: PMC6010555 DOI: 10.3389/fnhum.2018.00200] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/30/2018] [Indexed: 11/24/2022] Open
Abstract
The role of nonverbal communication in patients with post-stroke language impairment (aphasia) is not yet fully understood. This study investigated how aphasic patients perceive and produce co-speech gestures during face-to-face interaction, and whether distinct brain lesions would predict the frequency of spontaneous co-speech gesturing. For this purpose, we recorded samples of conversations in patients with aphasia and healthy participants. Gesture perception was assessed by means of a head-mounted eye-tracking system, and the produced co-speech gestures were coded according to a linguistic classification system. The main results are that meaning-laden gestures (e.g., iconic gestures representing object shapes) are more likely to attract visual attention than meaningless hand movements, and that patients with aphasia are more likely to fixate co-speech gestures overall than healthy participants. This implies that patients with aphasia may benefit from the multimodal information provided by co-speech gestures. On the level of co-speech gesture production, we found that patients with damage to the anterior part of the arcuate fasciculus showed a higher frequency of meaning-laden gestures. This area lies in close vicinity to the premotor cortex and is considered to be important for speech production. This may suggest that the use of meaning-laden gestures depends on the integrity of patients’ speech production abilities.
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Affiliation(s)
- Basil C Preisig
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University of Bern Inselspital, Bern, Switzerland.,Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Noëmi Eggenberger
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University of Bern Inselspital, Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University of Bern Inselspital, Bern, Switzerland.,Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Luzern, Switzerland
| | - Klemens Gutbrod
- University Neurorehabilitation Clinics, Department of Neurology, University of Bern Inselspital, Bern, Switzerland
| | - Jean-Marie Annoni
- Neurology Unit, Laboratory for Cognitive and Neurological Sciences, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland
| | - Jurka R Meichtry
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University of Bern Inselspital, Bern, Switzerland.,University Neurorehabilitation Clinics, Department of Neurology, University of Bern Inselspital, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René M Müri
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University of Bern Inselspital, Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,University Neurorehabilitation Clinics, Department of Neurology, University of Bern Inselspital, Bern, Switzerland
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19
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Abstract
OBJECTIVE To investigate, in two separate studies, whether amnesic patients with a severe memory impairment can learn to perform a habitual prospective memory task when they receive immediate feedback on prospective memory failures (Study 1) and whether amnesic patients are able to benefit from previous habitual prospective memory performance after a 24-h retention interval. METHOD A prospective memory task was embedded in a lexical decision task (Study 1) and in a perceptual discrimination task (Study 2). Performance was compared across test halves. Participants received immediate performance feedback on prospective memory failures that served as a reminder for the prospective memory task. A retest was performed after 24 h in Study 2, but without immediate feedback in the first test half. RESULTS In Study 1, amnesic patients performed at a lower level than the control group, but they improved significantly across the experiment. In Study 2, the results of the first session replicated this pattern. The results of the second session showed a performance breakdown in amnesic patients. However, one single reminder was enough to boost performance again on the level of the second part of day one. CONCLUSIONS This indicates that amnesic patients have residual prospective memory capacities and that providing immediate feedback is a promising strategy to draw on these capacities.
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Affiliation(s)
- Beat Meier
- a Institute of Psychology , University of Bern , Bern , Switzerland
| | - Severin Fanger
- a Institute of Psychology , University of Bern , Bern , Switzerland
| | - Giannina Toller
- a Institute of Psychology , University of Bern , Bern , Switzerland
| | - Sibylle Matter
- a Institute of Psychology , University of Bern , Bern , Switzerland
| | - René Müri
- b Department of Neurology , University of Bern , Bern , Switzerland.,c Department of Cognitive and Restorative Neurology , Bern University Hospital , Bern , Switzerland
| | - Klemens Gutbrod
- b Department of Neurology , University of Bern , Bern , Switzerland.,c Department of Cognitive and Restorative Neurology , Bern University Hospital , Bern , Switzerland
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20
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Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D’Alonzo D, Marbacher S, Maduri R, Hostettler IC, Schatlo B, Schneider MM, Seule MA, Schöni D, Goldberg J, Fung C, Arrighi M, Valsecchi D, Bijlenga P, Schaller K, Bozinov O, Regli L, Burkhardt JK, Fandino J, Marbacher S, D'Alonzo D, Coluccia D, Schmid N, Zumofen D, Roethlisberger M, Mariani L, Guzman R, Monsch AU, Bläsi S, Fung C, Bervini D, Beck J, Raabe A, Goldberg J, Schöni D, Gralla J, Zweifel-Zehnder A, Gutbrod K, Müri R, Maduri R, Thomas Daniel R, Starnoni D, Messerer M, Levivier M, Beaud V, Valsecchi D, Arrighi M, Venier A, Reinert M, Kuhlen DE, Robert T, Rossi S, Sacco L, Bijlenga P, Corniola M, Schaller K, Chicherio C, Seule MA, Ferrari A, Weyerbrock A, Hlavica M, Fournier JY, Früh S, Schatlo B, Burkhardt JK, Stienen MN, Keller E, Regli L, Bozinov O, Maldaner N, Finkenstädt S, Neidert MC, Brugger P, Mondadori C. The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS). Neurosurgery 2018; 83:1286-1293. [DOI: 10.1093/neuros/nyx609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marian Christoph Neidert
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolai Maldaner
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Nikolaus Stienen
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michel Roethlisberger
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel W Zumofen
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Donato D’Alonzo
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Serge Marbacher
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Rodolfo Maduri
- Department Clinical Neurosciences, Service Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | - Bawarjan Schatlo
- Department of Neurosurgery, University Hospital Göttingen, Göttingen, Germany
| | - Michel M Schneider
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Martin A Seule
- Department of Neurosurgery, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Daniel Schöni
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | | | - Christian Fung
- Department of Neurosurgery, Inselspital Bern, Bern, Switzerland
| | - Marta Arrighi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Daniele Valsecchi
- Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Philippe Bijlenga
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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21
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Wüst M, Gutbrod K, Mathis J, Nirkko A. Internet sleep medicine: comparison of assisted vs. non-assisted online health screening from 67446 completed questionnaires. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Gutbrod K, Heinemann D, Müri R. Neurorehabilitation kognitiver Störungen. Therapeutische Umschau 2017; 74:503-509. [DOI: 10.1024/0040-5930/a000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Eine erworbene Hirnschädigung ist die häufigste Ursache für eine chronische Behinderung im Erwachsenenalter. Trotz neurologischer Erholung können neuropsychologische Störungen persistieren und die Lebensqualität des Patienten einschränken. Aus diesem Grund ist die kognitive Rehabilitation eine wichtige Komponente der Neurorehabilitation. Kognitive Störungen nach einer Hirnschädigung finden sich am häufigsten in den Bereichen Gedächtnis, Aufmerksamkeit, exekutive Funktionen und Neglect. Für jeden dieser Bereiche werden in dieser Überblicksarbeit die verschiedenen Therapiemöglichkeiten beschrieben. Für alle diese kognitiven Domänen existieren evidenzbasierte Studien zur spezifischen Therapiewirksamkeit, welche eine Empfehlung eines Standards für die klinische Praxis erlauben.
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Affiliation(s)
- Klemens Gutbrod
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, Bern
| | - Dörthe Heinemann
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, Bern
| | - René Müri
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, Bern
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23
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Heldner MR, Kaufmann-Ezra S, Gutbrod K, Bernasconi C, Bigi S, Blatter V, Mattle HP, Müri RM, Verma RK, Kamm CP. Behavioral Changes in Patients with Multiple Sclerosis. Front Neurol 2017; 8:437. [PMID: 28894432 PMCID: PMC5581390 DOI: 10.3389/fneur.2017.00437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 08/10/2017] [Indexed: 11/18/2022] Open
Abstract
Background Behavioral changes are common in patients with multiple sclerosis (MS), however not as readily recognized as cognitive impairments. Objective The aim of this study was to analyze behavioral changes and its relation to disease characteristics, disability, and cognitive impairments in patients with MS. Method This is a single-center cross-sectional study. A detailed neuropsychological examination, including the Frontal Systems Behavior Scale (FrSBe), the Beck depression inventory (BDI), and the Wuerzburg Fatigue Inventory for Multiple Sclerosis (WEIMuS) test, was performed. FrSBe results were correlated with disease characteristics, disability, and cognitive assessments. Results 66 patients were enrolled (mean age: 43.4 years; disease duration: 9.3 years; Expanded Disability Status Scale: 3.0). Up to one third of patients showed behavioral changes in at least one domain or the total score of the FrSBe. Patients were mildly affected with regard to cognitive functioning. Consistent correlation was found between behavioral changes and fatigue (WEIMuS) and depressive symptoms (BDI), but not with disease characteristics, disability, or cognitive functions. There was an increase of behavioral changes on all FrSBe scales in the current status compared to the retrospectively rated status before disease onset. Self- and family ratings with regard to current behavioral changes were similar. Conclusion Behavioral changes are common in otherwise mildly affected MS patients with up to one third being affected. In this patient cohort, behavioral changes occur largely independent of disease characteristics, physical disability, and cognitive functioning but correlate with both fatigue and depressive symptoms. Therefore, they should be tested specifically.
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Affiliation(s)
- Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sigal Kaufmann-Ezra
- University Neurorehabilitation, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klemens Gutbrod
- University Neurorehabilitation, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Corrado Bernasconi
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sandra Bigi
- Department of Neuropediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Verena Blatter
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - René M Müri
- University Neurorehabilitation, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rajeev K Verma
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian P Kamm
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
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Kamal S, Locatelli I, Wandeler G, Sehhat A, Bugnon O, Metral M, Du Pasquier R, Gutbrod K, Cavassini M, Schneider MP. The Presence of Human Immunodeficiency Virus-Associated Neurocognitive Disorders Is Associated With a Lower Adherence to Combined Antiretroviral Treatment. Open Forum Infect Dis 2017; 4:ofx070. [PMID: 28584853 PMCID: PMC5450901 DOI: 10.1093/ofid/ofx070] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-associated neurocognitive disorders (HAND) are defined according to their diagnostic degrees as follows: asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia. Because high adherence to combined antiretroviral therapy (cART) is required to maintain viral suppression among HIV-infected patients, it is important to investigate the impact of HAND on medication adherence. Our study hypothesis was that patients with HAND had a lower medication adherence than patients who did not have HAND. METHODS This was an observational, exploratory, 2-center pilot study of patients who had a state-of-the-art neurocognitive assessment performed between January 2011 and June 2015 while also being followed at their respective adherence clinics. Adherence was measured with electronic monitors. Patients' sociodemographic characteristics, HIV viral load, and CD4 counts were retrieved from the Swiss HIV Cohort Study database. At each time t, adherence was computed as the proportion of patients taking medication as prescribed at that time. RESULTS We included 59 patients, with a median (Q1, Q3) age of 53 years (47-58) and 39 (66%) were male participants. Twenty-two patients (35%) had no neurocognitive deficits, 16 (27%) patients had HAND, and 21 (35%) patients had non-HAND (mostly depression). Implementation over 3 years showed a significant decline (50%) in medication adherence among patients diagnosed with HAND in comparison with patients who had a normal neuropsychological status or a non-HIV-related cognitive deficit (implementation stayed 90% during follow-up). CONCLUSIONS Our findings support the hypothesis that HAND is associated with reduced cART adherence.
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Affiliation(s)
- Susan Kamal
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Isabella Locatelli
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Department of Social and Preventive Medicine, University of Lausanne, Switzerland
| | - Gilles Wandeler
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Asemaneh Sehhat
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | | | | | - Klemens Gutbrod
- Department of Neuropsychology, University Hospital and University of Bern, Switzerland; and
| | - Matthias Cavassini
- Infectious Disease Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marie P Schneider
- Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Switzerland.,Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
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25
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Meichtry JR, Cazzoli D, Chaves S, von Arx S, Pflugshaupt T, Kalla R, Bassetti CL, Gutbrod K, Müri RM. Pure optic ataxia and visual hemiagnosia - extending the dual visual hypothesis. J Neuropsychol 2017; 12:271-290. [PMID: 28258660 DOI: 10.1111/jnp.12119] [Citation(s) in RCA: 5] [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: 08/30/2016] [Revised: 02/01/2017] [Indexed: 11/28/2022]
Abstract
Goodale and Milner's two visual system hypothesis is an influential model for the understanding of the primate visual system. Lesions of either the ventral (occipito-temporal) or the dorsal (occipito-parietal) stream produce distinct and dissociated syndromes in humans: visual agnosia is typical for ventral damage, whereas optic ataxia (OA) for dorsal damage. We studied the case of a 59-year-old left-handed woman with a circumscribed lesion around the left posterior occipital sulcus, extending to the underlying white matter. Initially, she presented with a central visual field OA, which regressed to an OA to the right visual hemifield during the 3 months observation period. In addition, tachistoscopic experiments showed visual hemiagnosia to the right visual hemifield. In line with the findings of the neuropsychological experiments, the analysis of the structural MR data by means of a trackwise hodologic probabilistic approach revealed damage to the left superior longitudinal fasciculus and to the left inferior longitudinal fasciculus, indicating an impairment of both the dorsal and the ventral stream. The combination of OA and visual hemiagnosia in the same patient has never been previously described. The present case study thus provides further insights for the understanding of visual processing.
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Affiliation(s)
- Jurka R Meichtry
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland.,Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - Dario Cazzoli
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, University of Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Silvia Chaves
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland
| | - Sebastian von Arx
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland
| | - Tobias Pflugshaupt
- Center of Neurology and Neurorehabilitation, State Hospital Luzern, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland
| | - Claudio L Bassetti
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland
| | - Klemens Gutbrod
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland.,Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, University of Bern, Switzerland
| | - René M Müri
- Department of Neurology, Inselspital, University Hospital Bern, Switzerland.,Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, University of Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
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26
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de Jong D, Kaufmann-Ezra S, Meichtry JR, von Arx S, Cazzoli D, Gutbrod K, Müri RM. The influence of reading direction on hemianopic reading disorders. J Clin Exp Neuropsychol 2016; 38:1077-83. [PMID: 27350288 DOI: 10.1080/13803395.2016.1189884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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27
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Preisig BC, Eggenberger N, Zito G, Vanbellingen T, Schumacher R, Hopfner S, Gutbrod K, Nyffeler T, Cazzoli D, Annoni JM, Bohlhalter S, Müri RM. Eye Gaze Behavior at Turn Transition: How Aphasic Patients Process Speakers' Turns during Video Observation. J Cogn Neurosci 2016; 28:1613-24. [PMID: 27243612 DOI: 10.1162/jocn_a_00983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The human turn-taking system regulates the smooth and precise exchange of speaking turns during face-to-face interaction. Recent studies investigated the processing of ongoing turns during conversation by measuring the eye movements of noninvolved observers. The findings suggest that humans shift their gaze in anticipation to the next speaker before the start of the next turn. Moreover, there is evidence that the ability to timely detect turn transitions mainly relies on the lexico-syntactic content provided by the conversation. Consequently, patients with aphasia, who often experience deficits in both semantic and syntactic processing, might encounter difficulties to detect and timely shift their gaze at turn transitions. To test this assumption, we presented video vignettes of natural conversations to aphasic patients and healthy controls, while their eye movements were measured. The frequency and latency of event-related gaze shifts, with respect to the end of the current turn in the videos, were compared between the two groups. Our results suggest that, compared with healthy controls, aphasic patients have a reduced probability to shift their gaze at turn transitions but do not show significantly increased gaze shift latencies. In healthy controls, but not in aphasic patients, the probability to shift the gaze at turn transition was increased when the video content of the current turn had a higher lexico-syntactic complexity. Furthermore, the results from voxel-based lesion symptom mapping indicate that the association between lexico-syntactic complexity and gaze shift latency in aphasic patients is predicted by brain lesions located in the posterior branch of the left arcuate fasciculus. Higher lexico-syntactic processing demands seem to lead to a reduced gaze shift probability in aphasic patients. This finding may represent missed opportunities for patients to place their contributions during everyday conversation.
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Affiliation(s)
| | | | | | | | | | - Simone Hopfner
- University Hospital Inselspital Bern.,University of Bern
| | | | | | | | | | | | - René M Müri
- University Hospital Inselspital Bern.,University of Bern
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28
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Béguelin C, Vázquez M, Bertschi M, Yerly S, de Jong D, Gutbrod K, Rauch A, Cusini A. Viral Escape in the Central Nervous System with Multidrug-Resistant Human Immunodeficiency Virus-1. Open Forum Infect Dis 2015; 3:ofv210. [PMID: 26885540 PMCID: PMC4753349 DOI: 10.1093/ofid/ofv210] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/19/2015] [Indexed: 11/12/2022] Open
Abstract
In this study, we report the case of a patient infected with human immunodeficiency virus (HIV)-1 who developed ataxia and neurocognitive impairment due to viral escape within the central nervous system (CNS) with a multidrug-resistant HIV-1 despite long-term viral suppression in plasma. Antiretroviral therapy optimization with drugs with high CNS penetration led to viral suppression in the CSF, regression of ataxia, and improvement of neurocognitive symptoms.
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Affiliation(s)
- C Béguelin
- Department of Infectious Diseases , Inselspital, Bern University Hospital, University of Bern
| | - M Vázquez
- Department of Infectious Diseases , Inselspital, Bern University Hospital, University of Bern
| | - M Bertschi
- Department of Neurology , Bern University Hospital and University of Bern
| | - S Yerly
- Laboratory of Virology , Geneva University Hospital
| | - D de Jong
- Department of Neurology , Bern University Hospital and University of Bern
| | - K Gutbrod
- Department of Neurology , Bern University Hospital and University of Bern
| | - A Rauch
- Department of Infectious Diseases , Inselspital, Bern University Hospital, University of Bern
| | - A Cusini
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern; Infectious Diseases Unit, Cantonal Hospital, Chur, Switzerland
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29
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Schumacher R, Cazzoli D, Eggenberger N, Preisig B, Nef T, Nyffeler T, Gutbrod K, Annoni JM, Müri RM. Cue Recognition and Integration - Eye Tracking Evidence of Processing Differences in Sentence Comprehension in Aphasia. PLoS One 2015; 10:e0142853. [PMID: 26562795 PMCID: PMC4642964 DOI: 10.1371/journal.pone.0142853] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose We aimed at further elucidating whether aphasic patients’ difficulties in understanding non-canonical sentence structures, such as Passive or Object-Verb-Subject sentences, can be attributed to impaired morphosyntactic cue recognition, and to problems in integrating competing interpretations. Methods A sentence-picture matching task with canonical and non-canonical spoken sentences was performed using concurrent eye tracking. Accuracy, reaction time, and eye tracking data (fixations) of 50 healthy subjects and 12 aphasic patients were analysed. Results Patients showed increased error rates and reaction times, as well as delayed fixation preferences for target pictures in non-canonical sentences. Patients’ fixation patterns differed from healthy controls and revealed deficits in recognizing and immediately integrating morphosyntactic cues. Conclusion Our study corroborates the notion that difficulties in understanding syntactically complex sentences are attributable to a processing deficit encompassing delayed and therefore impaired recognition and integration of cues, as well as increased competition between interpretations.
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Affiliation(s)
- Rahel Schumacher
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Noëmi Eggenberger
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
| | - Basil Preisig
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jean-Marie Annoni
- Neurology Unit, Laboratory for Cognitive and Neurological Sciences, Department of Medicine, Faculty of Science, University of Fribourg, Fribourg, Switzerland
| | - René M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, and University of Bern, Bern, Switzerland
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
- * E-mail:
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30
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Stienen M, Zweifel-Zehnder A, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier J, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel R, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch A. Call for Uniform Psychosocial Assessment after Aneurysmal Subarachnoid Hemorrhage: Swiss Recommendations. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Zweifel-Zehnder AE, Stienen MN, Chicherio C, Studerus-Germann A, Bläsi S, Rossi S, Gutbrod K, Schmid N, Beaud V, Mondadori C, Brugger P, Sacco L, Müri R, Hildebrandt G, Fournier JY, Keller E, Regli L, Fandino J, Mariani L, Raabe A, Daniel RT, Reinert M, Robert T, Schatlo B, Bijlenga P, Schaller K, Monsch AU. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir (Wien) 2015; 157:1449-58. [PMID: 26179382 DOI: 10.1007/s00701-015-2480-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines. METHODS To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized. RESULTS We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed. CONCLUSIONS This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.
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Affiliation(s)
- Antoinette E Zweifel-Zehnder
- Division of Neuropaediatrics, Development, and Rehabilitation, Department of Paediatrics, Inselspital Bern, Bern, Switzerland
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32
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Nowacki A, Seidel K, Schucht P, Schindler K, Abela E, Heinemann D, Gutbrod K, Wiest R, Raabe A, Pollo C. Induction of Fear by Intraoperative Stimulation During Awake Craniotomy: Case Presentation and Systematic Review of the Literature. World Neurosurg 2015; 84:470-4. [DOI: 10.1016/j.wneu.2015.03.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/24/2022]
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33
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Hopfner S, Kesselring S, Cazzoli D, Gutbrod K, Laube-Rosenpflanzer A, Chechlacz M, Nef T, Mosimann U, Bohlhalter S, Müri RM, Nyffeler T. Neglect and Motion Stimuli--Insights from a Touchscreen-Based Cancellation Task. PLoS One 2015; 10:e0132025. [PMID: 26158619 PMCID: PMC4497636 DOI: 10.1371/journal.pone.0132025] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose In stroke patients, neglect diagnostic is often performed by means of paper-pencil cancellation tasks. These tasks entail static stimuli, and provide no information concerning possible changes in the severity of neglect symptoms when patients are confronted with motion. We therefore aimed to directly contrast the cancellation behaviour of neglect patients under static and dynamic conditions. Since visual field deficits often occur in neglect patients, we analysed whether the integrity of the optic radiation would influence cancellation behaviour. Methods Twenty-five patients with left spatial neglect after right-hemispheric stroke were tested with a touchscreen cancellation task, once when the evenly distributed targets were stationary, and once when the identic targets moved with constant speed on a random path. The integrity of the right optic radiation was analysed by means of a hodologic probabilistic approach. Results Motion influenced the cancellation behaviour of neglect patients, and the direction of this influence (i.e., an increase or decrease of neglect severity) was modulated by the integrity of the right optic radiation. In patients with an intact optic radiation, the severity of neglect significantly decreased in the dynamic condition. Conversely, in patients with damage to the optic radiation, the severity of neglect significantly increased in the dynamic condition. Conclusion Motion may influence neglect in stroke patients. The integrity of the optic radiation may be a predictor of whether motion increases or decreases the severity of neglect symptoms.
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Affiliation(s)
- Simone Hopfner
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Sonja Kesselring
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Annett Laube-Rosenpflanzer
- Division of Computer Science, Institute for ICT-Based Management, Bern University of Applied Sciences, Biel, Switzerland
| | - Magdalena Chechlacz
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Tobias Nef
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Urs Mosimann
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Luzern, Switzerland
| | - René M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital, Luzern, Switzerland
- * E-mail:
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34
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Vanbellingen T, Schumacher R, Eggenberger N, Hopfner S, Cazzoli D, Preisig BC, Bertschi M, Nyffeler T, Gutbrod K, Bassetti CL, Bohlhalter S, Müri RM. Different visual exploration of tool-related gestures in left hemisphere brain damaged patients is associated with poor gestural imitation. Neuropsychologia 2015; 71:158-64. [PMID: 25841335 DOI: 10.1016/j.neuropsychologia.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/09/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
According to the direct matching hypothesis, perceived movements automatically activate existing motor components through matching of the perceived gesture and its execution. The aim of the present study was to test the direct matching hypothesis by assessing whether visual exploration behavior correlate with deficits in gestural imitation in left hemisphere damaged (LHD) patients. Eighteen LHD patients and twenty healthy control subjects took part in the study. Gesture imitation performance was measured by the test for upper limb apraxia (TULIA). Visual exploration behavior was measured by an infrared eye-tracking system. Short videos including forty gestures (20 meaningless and 20 communicative gestures) were presented. Cumulative fixation duration was measured in different regions of interest (ROIs), namely the face, the gesturing hand, the body, and the surrounding environment. Compared to healthy subjects, patients fixated significantly less the ROIs comprising the face and the gesturing hand during the exploration of emblematic and tool-related gestures. Moreover, visual exploration of tool-related gestures significantly correlated with tool-related imitation as measured by TULIA in LHD patients. Patients and controls did not differ in the visual exploration of meaningless gestures, and no significant relationships were found between visual exploration behavior and the imitation of emblematic and meaningless gestures in TULIA. The present study thus suggests that altered visual exploration may lead to disturbed imitation of tool related gestures, however not of emblematic and meaningless gestures. Consequently, our findings partially support the direct matching hypothesis.
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Affiliation(s)
- Tim Vanbellingen
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Rahel Schumacher
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Noëmi Eggenberger
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Simone Hopfner
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Dario Cazzoli
- Nuffield Department of Clinical Neurosciences, Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Basil C Preisig
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Manuel Bertschi
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - Klemens Gutbrod
- Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
| | - Claudio L Bassetti
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland
| | - Stephan Bohlhalter
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Switzerland
| | - René M Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, Inselspital, University Hospital Bern, Switzerland; Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland; Center for Cognition, Learning and Memory, University of Bern, Bern, Switzerland.
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35
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Tanner-Eggen C, Balzer C, Perrig WJ, Gutbrod K. The Neuropsychological Assessment of Cognitive Deficits Considering Measures of Performance Variability. Arch Clin Neuropsychol 2015; 30:217-27. [DOI: 10.1093/arclin/acv008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 11/14/2022] Open
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36
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Eggen C, Huber O, Bär A, Huber OW, Perrig WJ, Müri R, Gutbrod K. Impairments in an early stage of the decision-making process in patients with ventromedial prefrontal damage: preliminary results. Neurocase 2015; 21:509-19. [PMID: 25080839 DOI: 10.1080/13554794.2014.944545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lesions of the ventromedial prefrontal cortex can result in a deficient decision-making behavior. So far, most experimental results in the neuropsychological decision-making research have been obtained with gambling tasks. Due to their high complexity, it is difficult to evaluate the underlying processes of the decision-making deficits. The aim of this study was to assess if patients with ventromedial prefrontal damage compared to patients with dorsolateral prefrontal damage and controls show a deficit in an early stage of the decision-making process. Nine patients with ventromedial prefrontal damage, three with dorsolateral prefrontal damage, and eleven healthy controls were tested with a newly developed decision task in which they had to search actively for the information they needed for their decisions. Our results show that patients with ventromedial prefrontal damage compared to the brain-lesioned dorsolateral prefrontal control group and healthy controls searched less for information with regard to risk defusing operators or consequences of their decisions indicating impairment already in the early stage of the decision-making process.
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Affiliation(s)
- Céline Eggen
- a Neurological Rehabilitation Centre, Reha Rheinfelden , Rheinfelden Switzerland
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37
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Beck J, Gralla J, Fung C, Ulrich CT, Schucht P, Fichtner J, Andereggen L, Gosau M, Hattingen E, Gutbrod K, Z'Graggen WJ, Reinert M, Hüsler J, Ozdoba C, Raabe A. Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients. J Neurosurg 2014; 121:1380-7. [DOI: 10.3171/2014.6.jns14550] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH.
Methods
All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: MRI of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT. Spinal pathologies were classified according to direct proof of CSF outflow from the intrathecal to the extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was proof of a CSF leak.
Results
Twenty-seven patients, with a mean age of 49.6 ± 9.2 years, underwent operations for CSDH. Hematomas were unilateral in 20 patients and bilateral in 7 patients. In 7 (25.9%) of 27 patients, spinal CSF leakage was proven, in 9 patients (33.3%) spinal meningeal cysts in the cervicothoracic region were found, and 3 patients (11.1%) had spinal cysts in the sacral region. The remaining 8 patients (29.6%) showed no pathological findings.
Conclusions
The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of nongeriatric CSDH.
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Affiliation(s)
| | | | | | | | | | | | | | - Martin Gosau
- 4Department of Cranio-Maxillo-Facial Surgery, University Medical Center, Regensburg, Germany
| | - Elke Hattingen
- 5Institute of Neuroradiology, University of Frankfurt, Frankfurt/Main, Germany
| | | | - Werner J. Z'Graggen
- 1Departments of Neurosurgery,
- 3Neurology, Bern University Hospital, Bern, Switzerland
| | - Michael Reinert
- 1Departments of Neurosurgery,
- 6Department of Neurosurgery, Ospedale Cantonale di Lugano, Switzerland; and
| | - Jürg Hüsler
- 7Institute of Mathematical Statistics and Actuarial Science, University of Bern, Switzerland
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Abstract
Largely based on findings from functional neuroimaging studies, the medial parietal lobe is known to contribute to internally directed cognitive processes such as visual imagery or episodic memory. Here, we present 2 patients with behavioral impairments that extend this view. Both had chronic unilateral lesions of nearly the entire medial parietal lobe, but in opposite hemispheres. Routine neuropsychological examination conducted >4 years after the onset of brain damage showed little deficits of minor severity. In contrast, both patients reported persistent unusual visual impairment. A comprehensive series of tachistoscopic experiments with lateralized stimulus presentation and comparison with healthy participants revealed partial visual hemiagnosia for stimuli presented to their contralesional hemifield, applying inferential single-case statistics to evaluate deficits and dissociations. Double dissociations were found in 4 experiments during which participants had to integrate more than one visual element, either through comparison or formation of a global gestalt. Against the background of recent neuroimaging findings, we conclude that of all medial parietal structures, the precuneus is the most likely candidate for a crucial involvement in such bottom-up visual integration.
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Affiliation(s)
- Tobias Pflugshaupt
- Department of Neurology.,Center of Neurology and Neurorehabilitation, State Hospital Luzern, Luzern, Switzerland
| | | | - Klemens Gutbrod
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Konrad P Weber
- Department of Neurology.,Department of Ophthalmology, University Hospital Zürich, Zürich, Switzerland
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Abstract
See Mayes (doi:10.1093/brain/awu284) for a scientific commentary on this article. The hippocampus is thought to support only conscious memory, while neocortex supports both conscious and unconscious memory. Duss et al. show that amnesic patients with damage to the hippocampal–anterior thalamic axis exhibit a diminished form of unconscious encoding and retrieval, suggesting that certain forms of unconscious memory are hippocampus-dependent. Textbooks divide between human memory systems based on consciousness. Hippocampus is thought to support only conscious encoding, while neocortex supports both conscious and unconscious encoding. We tested whether processing modes, not consciousness, divide between memory systems in three neuroimaging experiments with 11 amnesic patients (mean age = 45.55 years, standard deviation = 8.74, range = 23–60) and 11 matched healthy control subjects. Examined processing modes were single item versus relational encoding with only relational encoding hypothesized to depend on hippocampus. Participants encoded and later retrieved either single words or new relations between words. Consciousness of encoding was excluded by subliminal (invisible) word presentation. Amnesic patients and controls performed equally well on the single item task activating prefrontal cortex. But only the controls succeeded on the relational task activating the hippocampus, while amnesic patients failed as a group. Hence, unconscious relational encoding, but not unconscious single item encoding, depended on hippocampus. Yet, three patients performed normally on unconscious relational encoding in spite of amnesia capitalizing on spared hippocampal tissue and connections to language cortex. This pattern of results suggests that processing modes divide between memory systems, while consciousness divides between levels of function within a memory system.
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Affiliation(s)
- Simone B Duss
- 1 Division of Experimental Psychology and Neuropsychology, Department of Psychology, University of Bern, Bern, Switzerland 2 Centre for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Thomas P Reber
- 1 Division of Experimental Psychology and Neuropsychology, Department of Psychology, University of Bern, Bern, Switzerland 2 Centre for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
| | - Jürgen Hänggi
- 3 Division Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Simon Schwab
- 2 Centre for Cognition, Learning and Memory, University of Bern, Bern, Switzerland 4 Department of Psychiatric Neurophysiology, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Roland Wiest
- 5 Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - René M Müri
- 2 Centre for Cognition, Learning and Memory, University of Bern, Bern, Switzerland 6 Division of Cognitive and Restorative Neurology, Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Peter Brugger
- 7 Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Klemens Gutbrod
- 2 Centre for Cognition, Learning and Memory, University of Bern, Bern, Switzerland 6 Division of Cognitive and Restorative Neurology, Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Katharina Henke
- 1 Division of Experimental Psychology and Neuropsychology, Department of Psychology, University of Bern, Bern, Switzerland 2 Centre for Cognition, Learning and Memory, University of Bern, Bern, Switzerland
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Lüthi M, Henke K, Gutbrod K, Nyffeler T, Chaves S, Müri RM. In your eyes only: deficits in executive functioning after frontal TMS reflect in eye movements. Front Behav Neurosci 2014; 8:7. [PMID: 24478654 PMCID: PMC3902210 DOI: 10.3389/fnbeh.2014.00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 01/06/2014] [Indexed: 11/13/2022] Open
Abstract
This study investigated the roles of the right and left dorsolateral prefrontal (rDLPFC, lDLPFC) and the medial frontal cortex (MFC) in executive functioning using a theta burst transcranial magnetic stimulation (TMS) approach. Healthy subjects solved two visual search tasks: a number search task with low cognitive demands, and a number and letter search task with high cognitive demands. To observe how subjects solved the tasks, we assessed their behavior with and without TMS using eye movements when subjects were confronted with specific executive demands. To observe executive functions, we were particularly interested in TMS-induced changes in visual exploration strategies found to be associated with good or bad performance in a control condition without TMS stimulation. TMS left processing time unchanged in both tasks. Inhibition of the rDLPFC resulted in a decrease in anticipatory fixations in the number search task, i.e., a decrease in a good strategy in this low demand task. This was paired with a decrease in stimulus fixations. Together, these results point to a role of the rDLPFC in planning and response selection. Inhibition of the lDLPFC and the MFC resulted in an increase in anticipatory fixations in the number and letter search task, i.e., an increase in the application of a good strategy in this task. We interpret these results as a compensatory strategy to account for TMS-induced deficits in attentional switching when faced with high switching demands. After inhibition of the lDLPFC, an increase in regressive fixations was found in the number and letter search task. In the context of high working memory demands, this strategy appears to support TMS-induced working memory deficits. Combining an experimental TMS approach with the recording of eye movements proved sensitive to discrete decrements of executive functions and allows pinpointing the functional organization of the frontal lobes.
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Affiliation(s)
- Mathias Lüthi
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University Hospital Bern Inselspital Bern, Switzerland ; Center for Cognition, Learning, and Memory, University of Bern Bern, Switzerland
| | - Katharina Henke
- Center for Cognition, Learning, and Memory, University of Bern Bern, Switzerland ; Division of Experimental Psychology and Neuropsychology, Department of Psychology, University of Bern Bern, Switzerland
| | - Klemens Gutbrod
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University Hospital Bern Inselspital Bern, Switzerland ; Center for Cognition, Learning, and Memory, University of Bern Bern, Switzerland
| | - Thomas Nyffeler
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University Hospital Bern Inselspital Bern, Switzerland ; Center for Cognition, Learning, and Memory, University of Bern Bern, Switzerland ; Center of Neurology and Neurorehabilitation, Luzerner Kantonsspital Luzern, Switzerland
| | - Silvia Chaves
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University Hospital Bern Inselspital Bern, Switzerland ; Center for Cognition, Learning, and Memory, University of Bern Bern, Switzerland
| | - René M Müri
- Perception and Eye Movement Laboratory, Department of Neurology and Clinical Research, University Hospital Bern Inselspital Bern, Switzerland ; Center for Cognition, Learning, and Memory, University of Bern Bern, Switzerland
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Meier B, Weiermann B, Gutbrod K, Stephan MA, Cock J, Müri RM, Kaelin-Lang A. Implicit task sequence learning in patients with Parkinson's disease, frontal lesions and amnesia: The critical role of fronto–striatal loops. Neuropsychologia 2013. [DOI: 10.1016/j.neuropsychologia.2013.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Meier B, Weiermann B, Gutbrod K, Stephan MA, Cock J, Mür RM, Kaelin-Lang A. Implicit task sequence learning in patients with Parkinson's disease, frontal lesions and amnesia: the critical role of fronto–striatal loops. Neuropsychologia 2013; 51:3014-3024. [PMID: 24436969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to investigate the role of the fronto–striatal system for implicit task sequence learning. We tested performance of patients with compromised functioning of the fronto–striatal loops, that is, patients with Parkinson's disease and patients with lesions in the ventromedial or dorsolateral prefrontal cortex. We also tested amnesic patients with lesions either to the basal forebrain/orbitofrontal cortex or to thalamic/medio-temporal regions. We used a task sequence learning paradigm involving the presentation of a sequence of categorical binary-choice decision tasks. After several blocks of training, the sequence, hidden in the order of tasks, was replaced by a pseudo-random sequence. Learning (i.e., sensitivity to the ordering) was assessed by measuring whether this change disrupted performance. Although all the patients were able to perform the decision tasks quite easily, those with lesions to the fronto–striatal loops (i.e., patients with Parkinson's disease, with lesions in the ventromedial or dorsolateral prefrontal cortex and those amnesic patients with lesions to the basal forebrain/orbitofrontal cortex) did not show any evidence of implicit task sequence learning. In contrast, those amnesic patients with lesions to thalamic/medio-temporal regions showed intact sequence learning. Together, these results indicate that the integrity of the fronto–striatal system is a prerequisite for implicit task sequence learning.
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Stienen MN, Weisshaupt R, Fandino J, Fung C, Keller E, Hildebrandt G, Studerus-Germann A, Müri R, Gutbrod K, Bläsi S, Monsch AU, Brugger P, Mondadori C, Sailer M, Bijlenga P, Schaller K, Schatlo B. Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 2013; 155:2045-51. [PMID: 23887856 DOI: 10.1007/s00701-013-1823-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/10/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies. METHODS A MEDLINE analysis was performed using the search term "subarachnoid haemorrhage outcome". The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed. RESULTS A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used. CONCLUSION Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland,
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Kipfer S, Jung S, Lemke JR, Kipfer-Kauer A, Howell JP, Kaelin-Lang A, Nyffeler T, Gutbrod K, Abicht A, Müri RM. Novel CACNA1A mutation(s) associated with slow saccade velocities. J Neurol 2013; 260:3010-4. [DOI: 10.1007/s00415-013-7099-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 08/23/2013] [Accepted: 09/06/2013] [Indexed: 01/11/2023]
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45
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Hofer H, Frigerio S, Frischknecht E, Gassmann D, Gutbrod K, Müri RM. Diagnosis and treatment of an obsessive-compulsive disorder following traumatic brain injury: a single case and review of the literature. Neurocase 2013; 19:390-400. [PMID: 22784309 DOI: 10.1080/13554794.2012.690423] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 27-year-old patient with traumatic brain injury and neuropsychiatric symptoms fitting the obsessive-compulsive disorder was investigated. Brain CT-scan revealed left temporal and bilateral fronto-basal parenchymal contusions. Main Outcome Measure was the Yale-Brown Obsessive Compulsive Scale at pre- and post-treatment and at 6 months follow-up. The combination of pharmacotherapy and psychotherapy resulted in lower intensity and frequency of symptoms. Our case illustrates the importance of a detailed diagnostic procedure in order to provide appropriate therapeutic interventions. Further studies are needed to guide the clinician in determining which patients are likely to benefit from a psychotherapeutic intervention in combination with pharmacotherapy.
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Affiliation(s)
- Helene Hofer
- Department of Neurology, University Hospital, Bern, Switzerland.
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46
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Meier B, Rey-Mermet A, Woodward TS, Müri R, Gutbrod K. Episodic context binding in task switching: Evidence from amnesia. Neuropsychologia 2013; 51:886-92. [DOI: 10.1016/j.neuropsychologia.2013.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 01/18/2013] [Accepted: 01/20/2013] [Indexed: 11/29/2022]
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47
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Cazzoli D, Muri RM, Schumacher R, von Arx S, Chaves S, Gutbrod K, Bohlhalter S, Bauer D, Vanbellingen T, Bertschi M, Kipfer S, Rosenthal CR, Kennard C, Bassetti CL, Nyffeler T. Theta burst stimulation reduces disability during the activities of daily living in spatial neglect. Brain 2012; 135:3426-39. [DOI: 10.1093/brain/aws182] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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48
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Gutbrod K, Spring D, Degonda N, Heinemann D, Nirkko A, Hauf M, Ozdoba C, Schnider A, Schroth G, Wiest R. Determination of language dominance: Wada test and fMRI compared using a novel sentence task. J Neuroimaging 2011; 22:266-74. [PMID: 21883628 DOI: 10.1111/j.1552-6569.2011.00646.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE This study aimed to develop a new linguistic based functional magnetic resonance imaging (fMRI)-sentence decision task that reliably detects hemispheric language dominance. METHODS FMRI was performed in 13 healthy right-handed controls and 20 patients at 1.5 T prior to neurosurgery. The main components of language were assessed with different paradigms (rhyme, synonym, and sentence). In controls, activations were quantified by a volume of interest analysis. Four neuroimagers tested a visual rating score in the patients group. Interrater agreement and concordance between fMRI and Wada test were calculated. RESULTS In healthy controls, the frontal language area was activated by the sentence and synonym task in 100% and in 73% by the rhyme task. The temporal language area was activated in 100% by the sentence-, in 64% by the synonym, and in 55% by the rhyme task. In the patients group, interrater agreement was .90 for activations in the inferior frontal and .97 in the superior temporal gyrus. Correlation between the WADA test and fMRI was .86 for the sentence, and .89 for the synonym task. CONCLUSIONS The sentence task provides robust activations in putative essential language areas and can be used for visual analysis of predefined areas to facilitate interpretation of clinical fMRI.
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Affiliation(s)
- Klemens Gutbrod
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland
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49
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Baas U, de Haan B, Grässli T, Karnath HO, Mueri R, Perrig WJ, Wurtz P, Gutbrod K. Personal neglect—A disorder of body representation? Neuropsychologia 2011; 49:898-905. [DOI: 10.1016/j.neuropsychologia.2011.01.043] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 01/28/2011] [Accepted: 01/28/2011] [Indexed: 11/29/2022]
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50
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Briellmann RS, Ozdoba C, Donati F, Gutbrod K, Hess CW, Schroth G. Onset-age dependent MRI based hippocampal volume asymmetries in intractable partial complex temporal lobe epilepsy. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1997.tb00384.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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