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Petersen M, Coenen M, DeCarli C, De Luca A, van der Lelij E, Barkhof F, Benke T, Chen CPLH, Dal-Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Fletcher EF, Franzmeier N, Hilal S, Hofer E, Koek HL, Maier AB, Maillard PM, McCreary CR, Papma JM, Pijnenburg YAL, Schmidt R, Smith EE, Steketee RME, van den Berg E, van der Flier WM, Venkatraghavan V, Venketasubramanian N, Vernooij MW, Wolters FJ, Xu X, Horn A, Patil KR, Eickhoff SB, Thomalla G, Biesbroek JM, Biessels GJ, Cheng B. Enhancing Cognitive Performance Prediction through White Matter Hyperintensity Connectivity Assessment: A Multicenter Lesion Network Mapping Analysis of 3,485 Memory Clinic Patients. medRxiv 2024:2024.03.28.24305007. [PMID: 38586023 PMCID: PMC10996741 DOI: 10.1101/2024.03.28.24305007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Introduction White matter hyperintensities of presumed vascular origin (WMH) are associated with cognitive impairment and are a key imaging marker in evaluating cognitive health. However, WMH volume alone does not fully account for the extent of cognitive deficits and the mechanisms linking WMH to these deficits remain unclear. We propose that lesion network mapping (LNM), enables to infer if brain networks are connected to lesions, and could be a promising technique for enhancing our understanding of the role of WMH in cognitive disorders. Our study employed this approach to test the following hypotheses: (1) LNM-informed markers surpass WMH volumes in predicting cognitive performance, and (2) WMH contributing to cognitive impairment map to specific brain networks. Methods & results We analyzed cross-sectional data of 3,485 patients from 10 memory clinic cohorts within the Meta VCI Map Consortium, using harmonized test results in 4 cognitive domains and WMH segmentations. WMH segmentations were registered to a standard space and mapped onto existing normative structural and functional brain connectome data. We employed LNM to quantify WMH connectivity across 480 atlas-based gray and white matter regions of interest (ROI), resulting in ROI-level structural and functional LNM scores. The capacity of total and regional WMH volumes and LNM scores in predicting cognitive function was compared using ridge regression models in a nested cross-validation. LNM scores predicted performance in three cognitive domains (attention and executive function, information processing speed, and verbal memory) significantly better than WMH volumes. LNM scores did not improve prediction for language functions. ROI-level analysis revealed that higher LNM scores, representing greater disruptive effects of WMH on regional connectivity, in gray and white matter regions of the dorsal and ventral attention networks were associated with lower cognitive performance. Conclusion Measures of WMH-related brain network connectivity significantly improve the prediction of current cognitive performance in memory clinic patients compared to WMH volume as a traditional imaging marker of cerebrovascular disease. This highlights the crucial role of network effects, particularly in attentionrelated brain regions, improving our understanding of vascular contributions to cognitive impairment. Moving forward, refining WMH information with connectivity data could contribute to patient-tailored therapeutic interventions and facilitate the identification of subgroups at risk of cognitive disorders.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirthe Coenen
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | | | - Alberto De Luca
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Image Sciences Institute, Division Imaging and Oncology, UMC Utrecht
| | | | | | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Christopher P. L. H. Chen
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
| | | | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Austria
- Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Lieza G. Exalto
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | | | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), LMU University Hospital, LMU Munich, Munich, Germany
| | - Saima Hilal
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Huiberdina L. Koek
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andrea B. Maier
- Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore
| | | | - Cheryl R. McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Janne M. Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yolande A. L. Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Eric E. Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca M. E. Steketee
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiesje M. van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Vikram Venkatraghavan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore
- Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W. Vernooij
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank J. Wolters
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xin Xu
- Memory, Aging and Cognition Center, National University Health System, Singapore
- School of Public Health and the Second Affiliated Hospital of School of Medicine, Zhejiang University, China
| | - Andreas Horn
- Charité - Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology with Experimental Neurology, 10117 Berlin, Germany
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Kaustubh R. Patil
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Simon B. Eickhoff
- Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J. Matthijs Biesbroek
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Geert Jan Biessels
- University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Coenen M, Biessels GJ, DeCarli C, Fletcher EF, Maillard PM, Barkhof F, Barnes J, Benke T, Boomsma JMF, P L H Chen C, Dal-Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Groeneveld O, Hilal S, Hofer E, Koek HL, Maier AB, McCreary CR, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Sudre CH, Steketee RME, van den Berg E, van der Flier WM, Venketasubramanian N, Vernooij MW, Wolters FJ, Xin X, Biesbroek JM, Kuijf HJ. Spatial distributions of white matter hyperintensities on brain MRI: A pooled analysis of individual participant data from 11 memory clinic cohorts. Neuroimage Clin 2023; 40:103547. [PMID: 38035457 PMCID: PMC10698002 DOI: 10.1016/j.nicl.2023.103547] [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: 08/27/2023] [Revised: 11/03/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The spatial distribution of white matter hyperintensities (WMH) on MRI is often considered in the diagnostic evaluation of patients with cognitive problems. In some patients, clinicians may classify WMH patterns as "unusual", but this is largely based on expert opinion, because detailed quantitative information about WMH distribution frequencies in a memory clinic setting is lacking. Here we report voxel wise 3D WMH distribution frequencies in a large multicenter dataset and also aimed to identify individuals with unusual WMH patterns. METHODS Individual participant data (N = 3525, including 777 participants with subjective cognitive decline, 1389 participants with mild cognitive impairment and 1359 patients with dementia) from eleven memory clinic cohorts, recruited through the Meta VCI Map Consortium, were used. WMH segmentations were provided by participating centers or performed in Utrecht and registered to the Montreal Neurological Institute (MNI)-152 brain template for spatial normalization. To determine WMH distribution frequencies, we calculated WMH probability maps at voxel level. To identify individuals with unusual WMH patterns, region-of-interest (ROI) based WMH probability maps, rule-based scores, and a machine learning method (Local Outlier Factor (LOF)), were implemented. RESULTS WMH occurred in 82% of voxels from the white matter template with large variation between subjects. Only a small proportion of the white matter (1.7%), mainly in the periventricular areas, was affected by WMH in at least 20% of participants. A large portion of the total white matter was affected infrequently. Nevertheless, 93.8% of individual participants had lesions in voxels that were affected in less than 2% of the population, mainly located in subcortical areas. Only the machine learning method effectively identified individuals with unusual patterns, in particular subjects with asymmetric WMH distribution or with WMH at relatively rarely affected locations despite common locations not being affected. DISCUSSION Aggregating data from several memory clinic cohorts, we provide a detailed 3D map of WMH lesion distribution frequencies, that informs on common as well as rare localizations. The use of data-driven analysis with LOF can be used to identify unusual patterns, which might serve as an alert that rare causes of WMH should be considered.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands.
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, USA
| | - Evan F Fletcher
- Department of Neurology, University of California at Davis, USA
| | | | - Frederik Barkhof
- Radiology & Nuclear Medicine, Amsterdam UMC, Location Vrije Universiteit, the Netherlands; UCL Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Austria
| | - Jooske M F Boomsma
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Christopher P L H Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | | | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Austria; Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Onno Groeneveld
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands; Department of Neurology, Isala, Meppel, the Netherlands
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria; Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Huiberdina L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andrea B Maier
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore; Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore; Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl R McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Janne M Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ross W Paterson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK; Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Rebecca M E Steketee
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore; Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W Vernooij
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore, Singapore; Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Utrecht, the Netherlands; Department of Neurology, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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Coenen M, Kuijf HJ, Huenges Wajer IMC, Duering M, Wolters FJ, Fletcher EF, Maillard PM, Barkhof F, Barnes J, Benke T, Boomsma JMF, Chen CPLH, Dal-Bianco P, Dewenter A, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Groeneveld O, Hilal S, Hofer E, Koek DL, Maier AB, McCreary CR, Padilla CS, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Steketee RME, Sudre CH, van den Berg E, van der Flier WM, Venketasubramanian N, Vernooij MW, Xin X, DeCarli C, Biessels GJ, Biesbroek JM. Strategic white matter hyperintensity locations for cognitive impairment: A multicenter lesion-symptom mapping study in 3525 memory clinic patients. Alzheimers Dement 2023; 19:2420-2432. [PMID: 36504357 DOI: 10.1002/alz.12827] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 04/19/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Impact of white matter hyperintensities (WMH) on cognition likely depends on lesion location, but a comprehensive map of strategic locations is lacking. We aimed to identify these locations in a large multicenter study. METHODS Individual patient data (n = 3525) from 11 memory clinic cohorts were harmonized. We determined the association of WMH location with attention and executive functioning, information processing speed, language, and verbal memory performance using voxel-based and region of interest tract-based analyses. RESULTS WMH in the left and right anterior thalamic radiation, forceps major, and left inferior fronto-occipital fasciculus were significantly related to domain-specific impairment, independent of total WMH volume and atrophy. A strategic WMH score based on these tracts inversely correlated with performance in all domains. DISCUSSION The data show that the impact of WMH on cognition is location-dependent, primarily involving four strategic white matter tracts. Evaluation of WMH location may support diagnosing vascular cognitive impairment. HIGHLIGHTS We analyzed white matter hyperintensities (WMH) in 3525 memory clinic patients from 11 cohorts The impact of WMH on cognition depends on location We identified four strategic white matter tracts A single strategic WMH score was derived from these four strategic tracts The strategic WMH score was an independent determinant of four cognitive domains.
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Affiliation(s)
- Mirthe Coenen
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
- Medical Image Analysis Center (MIAC) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frank J Wolters
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evan F Fletcher
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Pauline M Maillard
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Frederik Barkhof
- Radiology & Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands
- UCL Institute of Neurology, London, UK
| | - Josephine Barnes
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Thomas Benke
- Clinic of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Jooske M F Boomsma
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Christopher P L H Chen
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Peter Dal-Bianco
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Anna Dewenter
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Christian Enzinger
- Division of General Neurology, Department of Neurology, Medical University Graz, Graz, Austria
- Division of Neuroradiology, Interventional and Vascular Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Ewers
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Lieza G Exalto
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicolai Franzmeier
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Onno Groeneveld
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Department of Neurology, Isala MS Centre, Isala Hospital, Meppel, The Netherlands
| | - Saima Hilal
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Edith Hofer
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Dineke L Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea B Maier
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Department of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl R McCreary
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Catarina S Padilla
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - Janne M Papma
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ross W Paterson
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anna Rubinski
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Catherine F Slattery
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Eric E Smith
- Department of Clinical Neurosciences and Radiology and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rebecca M E Steketee
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Carole H Sudre
- MRC Unit for Lifelong Health and Ageing, the Centre for Medical Image Computing, UCL, London, UK
| | - Esther van den Berg
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Narayanaswamy Venketasubramanian
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
- Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Xu Xin
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Memory, Aging and Cognition Center, National University Health System, Singapore, Singapore
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, California, USA
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht, Brain Center, Utrecht, The Netherlands
- Department of Neurology, Diakonessenhuis Hospital, Utrecht, The Netherlands
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König T, Wurm R, Parvizi T, Silvaieh S, Hotzy C, Cetin H, Klotz S, Gelpi E, Bancher C, Benke T, Dal-Bianco P, Defrancesco M, Fischer P, Marksteiner J, Sutterlüty H, Ransmayr G, Schmidt R, Zimprich A, Stögmann E. C9orf72 repeat length might influence clinical sub-phenotypes in dementia patients. Neurobiol Dis 2022; 175:105927. [DOI: 10.1016/j.nbd.2022.105927] [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: 06/13/2022] [Revised: 10/27/2022] [Accepted: 11/11/2022] [Indexed: 11/15/2022] Open
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5
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Mosbacher JA, Waser M, Garn H, Seiler S, Coronel C, Dal-Bianco P, Benke T, Deistler M, Ransmayr G, Mayer F, Sanin G, Lechner A, Lackner HK, Schwingenschuh P, Grossegger D, Schmidt R. Functional (un-)Coupling: Impairment, Compensation, and Future Progression in Alzheimer's Disease. Clin EEG Neurosci 2021; 54:316-326. [PMID: 34658289 DOI: 10.1177/15500594211052208] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Functional (un-)coupling (task-related change of functional connectivity) between different sites of the brain is a mechanism of general importance for cognitive processes. In Alzheimer's disease (AD), prior research identified diminished cortical connectivity as a hallmark of the disease. However, little is known about the relation between the amount of functional (un-)coupling and cognitive performance and decline in AD. Method: Cognitive performance (based on CERAD-Plus scores) and electroencephalogram (EEG)-based functional (un-)coupling measures (connectivity changes from rest to a Face-Name-Encoding task) were assessed in 135 AD patients (age: M = 73.8 years; SD = 9.0). Of these, 68 patients (M = 73.9 years; SD = 8.9) participated in a follow-up assessment of their cognitive performance 1.5 years later. Results: The amounts of functional (un-)coupling in left anterior-posterior and homotopic interhemispheric connections in beta1-band were related to cognitive performance at baseline (β = .340; p < .001; β = .274; P = .001, respectively). For both markers, a higher amount of functional coupling was associated with better cognitive performance. Both markers also were significant predictors for cognitive decline. However, while patients with greater functional coupling in left anterior-posterior connections declined less in cognitive performance (β = .329; P = .035) those with greater functional coupling in interhemispheric connections declined more (β = -.402; P = .010). Conclusion: These findings suggest an important role of functional coupling mechanisms in left anterior-posterior and interhemispheric connections in AD. Especially the complex relationship with cognitive decline in AD patients might be an interesting aspect for future studies.
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Affiliation(s)
| | - Markus Waser
- Center for Digital Safety and Security, AIT Austrian Institute of Technology, Vienna, Austria
| | - Heinrich Garn
- Center for Digital Safety and Security, AIT Austrian Institute of Technology, Vienna, Austria
| | - Stephan Seiler
- Department of Neurology, 31475Medical University of Graz, Graz, Austria
| | - Carmina Coronel
- Center for Digital Safety and Security, AIT Austrian Institute of Technology, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, 27271Medical University of Vienna, Vienna, Austria
| | - Thomas Benke
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria
| | - Manfred Deistler
- Institute of Statistics and Mathematical Methods in Economics, 27259Vienna University of Technology, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, 31197Kepler University Hospital Linz, Med Campus III, Linz, Austria
| | - Florian Mayer
- Department of Neurology, 27271Medical University of Vienna, Vienna, Austria
| | - Guenter Sanin
- Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria
| | - Anita Lechner
- Department of Neurology, 31475Medical University of Graz, Graz, Austria
| | - Helmut K Lackner
- Division of Physiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | | | | | - Reinhold Schmidt
- Department of Neurology, 31475Medical University of Graz, Graz, Austria
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Defrancesco M, Bancher C, Dal-Bianco P, Hinterhuber H, Schmidt R, Struhal W, Ransmayr G, Stögmann E, Marksteiner J. [Position paper of the Austrian Alzheimer Association (Österreichische Alzheimer Gesellschaft, ÖAG) : Effects of the COVID-19 pandemic in Austria on people with dementia and their care environment-problem areas, recommendations, and strategies]. Neuropsychiatr 2021; 35:35-47. [PMID: 33123943 PMCID: PMC7594989 DOI: 10.1007/s40211-020-00363-9] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/06/2020] [Indexed: 01/10/2023]
Abstract
Older adults are particularly affected by the current COVID-19 (SARS-CoV-2) pandemic. The risk of dying from COVID-19 increases with age and is often associated with pre-existing health conditions. Globally, more than 50 million-in Austria currently approximately 140,000 people-suffer from dementia. The co-occurrence of dementia as a "pandemic of old age" together with the COVID-19 pandemic has a double impact on persons living with dementia and their caregivers. The COVID-19 pandemic poses major challenges for individuals with dementia and their caregivers: (1) People with dementia have limited access to information on COVID-19, may have difficulties with protective measures such as wearing masks and in remembering safety regulations. (2) People with dementia live alone or with their family, or are institutionalized. To reduce the chance of infection among older people in nursing homes, Austrian local authorities have banned visitors to nursing homes and long-term care facilities and implemented strict social-distancing measures. As a result, older people lost face-to-face contact with their family members, became isolated and social activities stopped. Consequently, anxiety, stress and serious concerns about infections among staff in nursing homes increased and they developed signs of exhaustion and burnout during the full lockdown of the facilities. Thus, due to the emerging COVID-19 crisis, the Austrian Alzheimer Association (Österreichische Alzheimer Gesellschaft, ÖAG) and international societies developed recommendations to support people living with dementia and their caregivers on various issues of physical and mental health.
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Affiliation(s)
- Michaela Defrancesco
- Universitätsklinik für Psychiatrie I, Department Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Christian Bancher
- Abteilung für Neurologie/neurologische Rehabilitation, Landesklinikum Horn-Allentsteig, Horn, Österreich
| | - Peter Dal-Bianco
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Hartmann Hinterhuber
- Universitätsklinik für Psychiatrie I, Department Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Reinhold Schmidt
- Universitätsklinik für Neurologie, Klinische Abteilung für Neurogeriatrie, Medizinische Universität Graz, Graz, Österreich
| | - Walter Struhal
- Abteilung für Neurologie, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Standort Tulln, Tulln, Österreich
| | - Gerhard Ransmayr
- Abteilung für Neurologie, Kepler Universitätsklinikum, Linz, Österreich
| | - Elisabeth Stögmann
- Universitätsklinik für Neurologie, Medizinische Universität Wien, Wien, Österreich
| | - Josef Marksteiner
- Department für Psychiatrie und Psychotherapie A, Landeskrankenhaus Hall, Hall, Österreich
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7
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Rabensteiner J, Hofer E, Fauler G, Fritz-Petrin E, Benke T, Dal-Bianco P, Ransmayr G, Schmidt R, Herrmann M. The impact of folate and vitamin B12 status on cognitive function and brain atrophy in healthy elderly and demented Austrians, a retrospective cohort study. Aging (Albany NY) 2020; 12:15478-15491. [PMID: 32706338 PMCID: PMC7467363 DOI: 10.18632/aging.103714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Dementia, and in particular Alzheimer's disease (AD), is a debilitating progressive disease with high prevalence in our society. Vitamin B12 and folate deficiency are potential modifiable risk factors. However, previous studies reported inconsistent results. RESULTS The average concentrations of all biochemical markers were within the respective reference ranges. Cross-sectional and longitudinal analyses did not reveal significant associations between biochemical markers and cognitive function, global or regional brain volume, cortical thickness or cortical surface area, neither in controls nor in AD patients. CONCLUSIONS Variations of direct and indirect markers of B12 and folate status are not associated with cognitive dysfunction and brain atrophy. METHODS This retrospective study explored the association between biochemical markers of B12 and folate status, cognitive function and MRI-based brain atrophy in cognitive normal elderly (controls) and AD patients. Folate, total and active vitamin B12 and MMA were measured in blood samples from 378 controls and 217 AD patients. Neuropsychiatric tests capturing memory, executive function and visuopractical skills were performed in all participants. Brain atrophy was assessed by MRI in 155 controls and 217 AD patients. In a subset of participants cognitive testing (n=234) and MRI (n=182) was repeated after an average median between 1.25 and 6.25 years.
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Affiliation(s)
- Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Edith Hofer
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Günter Fauler
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Eva Fritz-Petrin
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Faculty of Medicine, Johannes Kepler University, Kepler University Hospital, Linz, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Austria
| | - Markus Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
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8
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Defrancesco M, Marksteiner J, Kemmler G, Dal-Bianco P, Ransmayr G, Benke T, Mosbacher J, Höller Y, Schmidt R. Specific Neuropsychiatric Symptoms Are Associated with Faster Progression in Alzheimer’s Disease: Results of the Prospective Dementia Registry (PRODEM-Austria). J Alzheimers Dis 2020; 73:125-133. [DOI: 10.3233/jad-190662] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Michaela Defrancesco
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, General Hospital, Hall, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology 2, Kepler University Hospital, Med Campus III, Linz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jochen Mosbacher
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Yvonne Höller
- Department of Psychology, University of Akureyri, Akureyri, Iceland
| | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
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9
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Wagner F, Duering M, Gesierich BG, Enzinger C, Ropele S, Dal-Bianco P, Mayer F, Schmidt R, Koini M. Gray Matter Covariance Networks as Classifiers and Predictors of Cognitive Function in Alzheimer's Disease. Front Psychiatry 2020; 11:360. [PMID: 32431629 PMCID: PMC7214682 DOI: 10.3389/fpsyt.2020.00360] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/09/2020] [Indexed: 11/19/2022] Open
Abstract
The study of shared variation in gray matter morphology may define neurodegenerative diseases beyond what can be detected from the isolated assessment of regional brain volumes. We, therefore, aimed to (1) identify SCNs (structural covariance networks) that discriminate between Alzheimer's disease (AD) patients and healthy controls (HC), (2) investigate their diagnostic accuracy in comparison and above established markers, and (3) determine if they are associated with cognitive abilities. We applied a random forest algorithm to identify discriminating networks from a set of 20 SCNs. The algorithm was trained on a main sample of 104 AD patients and 104 age-matched HC and was then validated in an independent sample of 28 AD patients and 28 controls from another center. Only two of the 20 SCNs contributed significantly to the discrimination between AD and controls. These were a temporal and a secondary somatosensory SCN. Their diagnostic accuracy was 74% in the original cohort and 80% in the independent samples. The diagnostic accuracy of SCNs was comparable with that of conventional volumetric MRI markers including whole brain volume and hippocampal volume. SCN did not significantly increase diagnostic accuracy beyond that of conventional MRI markers. We found the temporal SCN to be associated with verbal memory at baseline. No other associations with cognitive functions were seen. SCNs failed to predict the course of cognitive decline over an average of 18 months. We conclude that SCNs have diagnostic potential, but the diagnostic information gain beyond conventional MRI markers is limited.
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Affiliation(s)
- Fabian Wagner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Benno G Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | | | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Florian Mayer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Marisa Koini
- Department of Neurology, Medical University of Graz, Graz, Austria
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10
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Pirker-Kees A, Dal-Bianco P, Schmidt R. Effects of Psychotropic Medication on Cognition, Caregiver Burden, and Neuropsychiatric Symptoms in Alzheimer’s Disease over 12 Months: Results from a Prospective Registry of Dementia in Austria (PRODEM). J Alzheimers Dis 2019; 71:623-630. [DOI: 10.3233/jad-181102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Agnes Pirker-Kees
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics and Division of General Neurology, Department of Neurology, Medical University Graz, Graz, Austria
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11
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Fruehwirt W, Dorffner G, Roberts S, Gerstgrasser M, Grossegger D, Schmidt R, Dal-Bianco P, Ransmayr G, Garn H, Waser M, Benke T. Associations of event-related brain potentials and Alzheimer's disease severity: A longitudinal study. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:31-38. [PMID: 30582941 DOI: 10.1016/j.pnpbp.2018.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/16/2018] [Accepted: 12/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND So far, no cost-efficient, widely-used biomarkers have been established to facilitate the objectivization of Alzheimer's disease (AD) diagnosis and monitoring. Research suggests that event-related potentials (ERPs) reflect neurodegenerative processes in AD and might qualify as neurophysiological AD markers. OBJECTIVES First, to examine which ERP component correlates the most with AD severity, as measured by the Mini-Mental State Examination (MMSE). Then, to analyze the temporal change of this component as AD progresses. METHODS Sixty-three subjects (31 with possible, 32 with probable AD diagnosis) were recruited as part of the cohort study Prospective Dementia Registry Austria (PRODEM). For a maximum of 18 months patients revisited every 6 months for follow-up assessments. ERPs were elicited using an auditory oddball paradigm. P300 and N200 latency was determined with regard to target as well as difference wave ERPs, whereas P50 amplitude was measured from standard stimuli waveforms. RESULTS P300 latency exhibited the strongest association with AD severity (e.g., r = -0.512, p < 0.01 at Pz for target stimuli in probable AD subjects). Further, there were significant Pearson correlations for N200 latency (e.g., r = -0.407, p = 0.026 at Cz for difference waves in probable AD subjects). P50 amplitude, as measured by different detection methods and at various scalp sites, did not significantly correlate with disease severity - neither in probable AD, possible AD, nor in both subgroups of patients combined. ERP markers for the group of possible AD patients did not show any significant correlations with MMSE scores. Post-hoc pairwise comparisons between baseline and 18-months follow-up assessment revealed significant P300 latency differences (e.g., p < 0.001 at Cz for difference waves in probable AD subjects). However, there were no significant correlations between the change rates of P300 latency and MMSE score. CONCLUSIONS P300 and N200 latency significantly correlated with disease severity in probable AD, whereas P50 amplitude did not. P300 latency, which showed the highest correlation coefficients with MMSE, significantly increased over the course of the 18 months study period in probable AD patients. The magnitude of the observed prolongation is in line with other longitudinal AD studies and substantially higher than in normal ageing, as reported in previous trials (no healthy controls were included in our study).
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Affiliation(s)
- Wolfgang Fruehwirt
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria; University of Oxford, Department of Engineering Science, Oxford, UK.
| | - Georg Dorffner
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - Stephen Roberts
- University of Oxford, Department of Engineering Science, Oxford, UK
| | | | | | - Reinhold Schmidt
- Medical University of Graz, Department of Neurology, Graz, Austria
| | - Peter Dal-Bianco
- Medical University of Vienna, Department of Neurology, Vienna, Austria
| | - Gerhard Ransmayr
- Kepler University Hospital, Department of Neurology 2, Linz, Austria
| | - Heinrich Garn
- AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Markus Waser
- AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Thomas Benke
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
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Damulina A, Pirpamer L, Seiler S, Benke T, Dal-Bianco P, Ransmayr G, Struhal W, Hofer E, Langkammer C, Duering M, Fazekas F, Schmidt R. White Matter Hyperintensities in Alzheimer’s Disease: A Lesion Probability Mapping Study. J Alzheimers Dis 2019; 68:789-796. [DOI: 10.3233/jad-180982] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Anna Damulina
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology and Center for Neurosciences, Imaging of Dementia and Aging Laboratory, University of California at Davis, CA, USA
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology, Kepler University Hospital, Linz, Austria
| | - Walter Struhal
- Department of Neurology, Kepler University Hospital, Linz, Austria
- Department of Neurology, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Edith Hofer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
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13
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Novak P, Schmidt R, Kontsekova E, Kovacech B, Smolek T, Katina S, Fialova L, Prcina M, Parrak V, Dal-Bianco P, Brunner M, Staffen W, Rainer M, Ondrus M, Ropele S, Smisek M, Sivak R, Zilka N, Winblad B, Novak M. FUNDAMANT: an interventional 72-week phase 1 follow-up study of AADvac1, an active immunotherapy against tau protein pathology in Alzheimer's disease. Alzheimers Res Ther 2018; 10:108. [PMID: 30355322 PMCID: PMC6201586 DOI: 10.1186/s13195-018-0436-1] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
Background Neurofibrillary pathology composed of tau protein is closely correlated with severity and phenotype of cognitive impairment in patients with Alzheimer’s disease and non-Alzheimer’s tauopathies. Targeting pathological tau proteins via immunotherapy is a promising strategy for disease-modifying treatment of Alzheimer’s disease. Previously, we reported a 24-week phase 1 trial on the active vaccine AADvac1 against pathological tau protein; here, we present the results of a further 72 weeks of follow-up on those patients. Methods We did a phase 1, 72-week, open-label study of AADvac1 in patients with mild to moderate Alzheimer’s disease who had completed the preceding phase 1 study. Patients who were previously treated with six doses of AADvac1 at monthly intervals received two booster doses at 24-week intervals. Patients who were previously treated with only three doses received another three doses at monthly intervals, and subsequently two boosters at 24-week intervals. The primary objective was the assessment of long-term safety of AADvac1 treatment. Secondary objectives included assessment of antibody titres, antibody isotype profile, capacity of the antibodies to bind to AD tau and AADvac1, development of titres of AADvac1-induced antibodies over time, and effect of booster doses; cognitive assessment via 11-item Alzheimer’s Disease Assessment Scale cognitive assessment (ADAS-Cog), Category Fluency Test and Controlled Oral Word Association Test; assessment of brain atrophy via magnetic resonance imaging (MRI) volumetry; and assessment of lymphocyte populations via flow cytometry. Results The study was conducted between 18 March 2014 and 10 August 2016. Twenty-six patients who completed the previous study were enrolled. Five patients withdrew because of adverse events. One patient was withdrawn owing to noncompliance. The most common adverse events were injection site reactions (reported in 13 [50%] of vaccinated patients). No cases of meningoencephalitis or vasogenic oedema were observed. New micro-haemorrhages were observed only in one ApoE4 homozygote. All responders retained an immunoglobulin G (IgG) antibody response against the tau peptide component of AADvac1 over 6 months without administration, with titres regressing to a median 15.8% of titres attained after the initial six-dose vaccination regimen. Booster doses restored previous IgG levels. Hippocampal atrophy rate was lower in patients with high IgG levels; a similar relationship was observed in cognitive assessment. Conclusions AADvac1 displayed a benign safety profile. The evolution of IgG titres over vaccination-free periods warrants a more frequent booster dose regimen. The tendency towards slower atrophy in MRI evaluation and less of a decline in cognitive assessment in patients with high titres is encouraging. Further trials are required to expand the safety database and to establish proof of clinical efficacy of AADvac1. Trial registration The studies are registered with the EU Clinical Trials Register and ClinicalTrials.gov: the preceding first-in-human study under EudraCT 2012-003916-29 and NCT01850238 (registered on 9 May 2013) and the follow-up study under EudraCT 2013-004499-36 and NCT02031198 (registered 9 Jan 2014), respectively. Electronic supplementary material The online version of this article (10.1186/s13195-018-0436-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Petr Novak
- Axon Neuroscience CRM Services SE, Dvorakovo nabrezie 11, 811 02, Bratislava, Slovakia.
| | - Reinhold Schmidt
- Clinical Division of Neurogeriatrics and Division of General Neurology, Department of Neurology, Medical University Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Eva Kontsekova
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Branislav Kovacech
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Tomas Smolek
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Stanislav Katina
- Axon Neuroscience CRM Services SE, Dvorakovo nabrezie 11, 811 02, Bratislava, Slovakia
| | - Lubica Fialova
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Michal Prcina
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Vojtech Parrak
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Peter Dal-Bianco
- University Clinic of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Martin Brunner
- University Clinic of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Wolfgang Staffen
- University Clinic of Neurology, Christian-Doppler-Clinic, Ignaz-Harrer-Straße 79, 5020, Salzburg, Austria
| | - Michael Rainer
- Social and Medical Centre East, Danube Hospital, Karl Landsteiner Institute for Memory and Alzheimer Research, Langobardenstraße 122, 1220, Vienna, Austria
| | - Matej Ondrus
- Axon Neuroscience CRM Services SE, Dvorakovo nabrezie 11, 811 02, Bratislava, Slovakia
| | - Stefan Ropele
- Clinical Division of Neurogeriatrics and Division of General Neurology, Department of Neurology, Medical University Graz, Auenbruggerplatz 2, 8036, Graz, Austria
| | - Miroslav Smisek
- Axon Neuroscience CRM Services SE, Dvorakovo nabrezie 11, 811 02, Bratislava, Slovakia
| | - Roman Sivak
- Axon Neuroscience CRM Services SE, Dvorakovo nabrezie 11, 811 02, Bratislava, Slovakia
| | - Norbert Zilka
- Axon Neuroscience R&D Services SE, Dvorakovo nabrezie 10, 811 02, Bratislava, Slovakia
| | - Bengt Winblad
- Division of Neurogeriatrics, Department NVS Clinical Trial Unit, Karolinska Institute Alzheimer Disease Research Centre, Geriatric Clinic, Karolinska University Hospital, Hälsovägen 7, S-14157, Huddinge, Sweden
| | - Michal Novak
- Axon Neuroscience SE, 4, Arch. Makariou & Kalogreon, Nicolaides Sea View City, 5th floor, office 506, 6016, Larnaca, Cyprus
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Waser M, Garn H, Benke T, Dal-Bianco P, Ransmayr G, Schmidt R, Jennum PJ, Sorensen HBD. A flexible method for the automated offline-detection of artifacts in multi-channel electroencephalogram recordings. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2017:3793-3796. [PMID: 29060724 DOI: 10.1109/embc.2017.8037683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Electroencephalogram (EEG) signal quality is often compromised by artifacts that corrupt quantitative EEG measurements used in clinical applications and EEG-related studies. Techniques such as filtering, regression analysis and blind source separation are often used to remove these artifacts. However, these preprocessing steps do not allow for complete artifact correction. We propose a method for the automated offline-detection of remaining artifacts after preprocessing in multi-channel EEG recordings. In contrast to existing methods it requires neither adaptive parameters varying between recordings nor a topography template. It is suited for short EEG segments and is flexible with regard to target applications. The algorithm was developed and tested on 60 clinical EEG samples of 20 seconds each that were recorded both in resting state and during cognitive activation to gain a realistic artifact set. Five EEG features were used to quantify temporal and spatial signal variations. Two distance measures for the single-channel and multi-channel variations of these features were defined. The global thresholds were determined by three-fold cross-validation and Youden's J statistic in conjunction with receiver operating characteristics (ROC curves). We observed high sensitivity of 95.5%±4.8 and specificity of 88.8%±2.1. The method has thus shown great potential and is promising as a possible tool for both EEG-based clinical applications and EEG-related research.
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Ransmayr G, Hermann P, Sallinger K, Benke T, Seiler S, Dal-Bianco P, Marksteiner J, Defrancesco M, Sanin G, Struhal W, Guger M, Vosko M, Hagenauer K, Lehner R, Futschik A, Schmidt R. Caregiving and Caregiver Burden in Dementia Home Care: Results from the Prospective Dementia Registry (PRODEM) of the Austrian Alzheimer Society. J Alzheimers Dis 2018; 63:103-114. [DOI: 10.3233/jad-170657] [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] [Indexed: 12/31/2022]
Affiliation(s)
- Gerhard Ransmayr
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Philipp Hermann
- Department of Applied Statistics, Johannes Kepler University Linz, Austria
| | | | - Thomas Benke
- Department of Neurology, Medical University Innsbruck, Austria
| | - Stephan Seiler
- Department of Neurology, Section of Neurogeriatrics, Medical University Graz, Austria
| | | | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall, Austria
| | - Michaela Defrancesco
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Austria
| | - Günter Sanin
- Department of Neurology, Medical University Innsbruck, Austria
| | - Walter Struhal
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Michael Guger
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Milan Vosko
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Karin Hagenauer
- Department for Clinical and Health Psychology, Med Campus III, Kepler University Hospital, Linz, Austria
| | - Riccarda Lehner
- Department of Neurology 2, Med Campus III, Kepler University Hospital, Faculty of Medicine, Johannes Kepler University Linz, Austria
| | - Andreas Futschik
- Department of Applied Statistics, Johannes Kepler University Linz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Section of Neurogeriatrics, Medical University Graz, Austria
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16
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Reyes-Coronel C, Waser M, Garn H, Deistler M, Dal-Bianco P, Benke T, Ransmayr G, Grossegger D, Schmidt R. Predicting rapid cognitive decline in Alzheimer's disease patients using quantitative EEG markers and neuropsychological test scores. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:6078-6081. [PMID: 28269639 DOI: 10.1109/embc.2016.7592115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Alzheimer's Disease (AD) can take different courses: some patients remain relatively stable while others decline rapidly within a given period of time. Losing more than 3 Mini-Mental State Examination (MMSE) points in one year is classified as rapid cognitive decline (RCD). This study used neuropsychological test scores and quantitative EEG (QEEG) markers obtained at a baseline examination to identify if an AD patient will be suffering from RCD. Data from 68 AD patients of the multi-centric cohort study PRODEM-Austria were applied. 15 of the patients were classified into the RCD group. RCD versus non-RCD support vector machine (SVM) classifiers using QEEG markers as predictors obtained 72.1% and 77.9% accuracy ratings based on leave-one-out validation. Adding neuropsychological test scores of Boston Naming Test improved the classifier to 80.9% accuracy, 80% sensitivity, and 81.1% specificity. These results indicate that QEEG markers together with neuropsychological test scores can be used as RCD predictors.
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17
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Stogmann E, Moser D, Klug S, Gleiss A, Auff E, Dal-Bianco P, Pusswald G, Lehrner J. Activities of Daily Living and Depressive Symptoms in Patients with Subjective Cognitive Decline, Mild Cognitive Impairment, and Alzheimer's Disease. J Alzheimers Dis 2016; 49:1043-50. [PMID: 26577522 DOI: 10.3233/jad-150785] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Subjective cognitive decline (SCD) may be an early indicator for an increased risk of dementia. The exact definition of SCD remains unclear and has recently become a major research interest. OBJECTIVES To determine impairments in activities of daily living (ADL) and depressive symptoms in elderly individuals with SCD, mild cognitive impairment (MCI), and Alzheimer's disease (AD). METHODS We included 752 consecutive patients suffering from SCD, non-amnestic (naMCI) or amnestic MCI (aMCI), AD, and 343 healthy controls into this prospective cohort study. A neuropsychological test battery, B-ADL and BDI-II was performed. RESULTS SCD patients showed a decreased performance in ADL compared to controls. Performance in ADL declined concurrently with cognitive abilities along the controls-SCD-naMCI-aMCI-AD continuum. Individuals with cognitive complains, no matter if SCD, MCI, or AD patients, reported more often depressive symptoms compared to healthy controls without complaints. Within all five cognitive subgroups, patients with depressive symptoms reported more difficulties in ADL in comparison to patients without depressive symptoms. Adjusting for depressive symptoms, there was no significant group difference between the control versus the SCD group (OR 1.1, CI 0.6-1.7). CONCLUSIONS SCD is a heterogeneous clinical condition. Specific features such as slightly impaired ADL and depressive symptoms are associated with SCD. Clinical markers may serve as an indicator for preclinical AD and in combination with biomarkers guide to an early diagnosis of a progressive neurodegenerative disease.
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Affiliation(s)
- Elisabeth Stogmann
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - Doris Moser
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefanie Klug
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Eduard Auff
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - Gisela Pusswald
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
| | - Johann Lehrner
- Department of Clinical Neurology, Medical University of Vienna, Vienna, Austria
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18
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Pusswald G, Tropper E, Kryspin-Exner I, Moser D, Klug S, Auff E, Dal-Bianco P, Lehrner J. Health-Related Quality of Life in Patients with Subjective Cognitive Decline and Mild Cognitive Impairment and its Relation to Activities of Daily Living. J Alzheimers Dis 2016; 47:479-86. [PMID: 26401569 DOI: 10.3233/jad-150284] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Health related quality of life (HRQOL) is an important issue in the context of dementia care. OBJECTIVES The purpose of this study was to investigate HRQOL in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and its relation to Activity of Daily Living (ADL). METHODS In this cross sectional study, four experimental groups (each n = 98), controls, SCD, naMCI and aMCI, were compared. For data collection, neuropsychological methods (NTBV) and psychological questionnaires (SF-36 and B-ADL) were used. Multivariate analysis of variance was calculated to detect differences in HRQOL between groups. Correlations between HRQOL and ADL were explored. RESULTS The dimensions of HRQOL showed mainly consistent differences between the control and the SCD group and MCI subgroups. In almost every dimension of HRQOL, the control group scored higher than subjects with SCD, naMCI, or aMCI. The controls showed low to moderate negative correlations between HQROL and B-ADL in some dimensions of the HRQOL. In the SCD group, low negative correlations with ADL were observed in some HRQOL scales. Low to moderate correlations were found between each scale of the SF-36 and the B-ADL in both MCI subtypes. We found gender differences in HRQOL. CONCLUSION In conclusion, we could demonstrate that patients with SCD report reduced quality of life. This knowledge is important to get a better understanding of the individuals with SCD and may pave the way for the development of early intervention.
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Affiliation(s)
- Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Elisa Tropper
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Doris Moser
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefanie Klug
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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19
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Silva MR, Moser D, Pflüger M, Pusswald G, Stögmann E, Dal-Bianco P, Auff E, Lehrner J. Self-reported and informant-reported memory functioning and awareness in patients with mild cognitive impairment and Alzheimer´s disease. Neuropsychiatr 2016; 30:103-12. [PMID: 27294268 PMCID: PMC4917599 DOI: 10.1007/s40211-016-0185-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/05/2016] [Indexed: 11/29/2022]
Abstract
Background Awareness of subjective memory is an important factor for adequate treatment of patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). This study served to find out whether awareness of subjective memory complies with objective performance, if differences in awareness are observed longitudinally and whether decrease of awareness can serve as a predictor of AD in MCI patients. Methods Thirty-four patients with MCI seeking help in a memory outpatient clinic were included. All participants underwent thorough neuropsychological examination. Awareness of subjective memory was obtained by calculating difference scores between patient and informant ratings on a 16-item questionnaire concerning complaints about loss of memory in every-day life. Retesting was performed after a mean follow-up period of 24 months. Results Whole group analyses showed that awareness remained relatively stable across time. Self-reported memory complaints correlated with episodic memory at baseline and with performance on a language task at follow-up. Retests displayed decrease of awareness. At group level differences in awareness between both times of assessment were not significant for MCI and MCI patients converting to mild AD at follow-up. The predictive value of awareness was low. Conclusions Awareness of subjective memory deficit is linked to episodic memory function and decreases with decline of cognitive ability. Further studies evaluating predictive power of awareness of subjective memory should include a larger patient sample.
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Affiliation(s)
| | - Doris Moser
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Melanie Pflüger
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Elisabeth Stögmann
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria.
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20
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Lehrner J, Bodendorfer B, Lamm C, Moser D, Dal-Bianco P, Auff E, Pusswald G. Subjective Memory Complaints and Conversion to Dementia in Patients with Subjective Cognitive Decline and Patients with Mild Cognitive Impairment. Zeitschrift für Neuropsychologie 2016. [DOI: 10.1024/1016-264x/a000175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract. Background: Subjective cognitive complaints and their clinical significance are discussed controversially. Objectives: To determine the clinical validity of subjective cognitive complaints among subjects with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). Design: Longitudinal study with one follow up examination at a University based out-patient memory clinic. Participants: A clinical sample of patietns with SCD and MCI (n = 141), aged 50 and older, who came to the memory outpatient clinic. Results: No significant differences between converters and non converters regarding subjective cognitive complaints were detected. MCI patients had a higher risk than the patients with SCD developing AD (OR = 7.3 [CI 0.9 to 61.2]. Verbal memory testing using the Verbal Selektive Reminding Test (VSRT) showed better diagnostic validity than subjective cognitive complaints using the Forgetfulness Assessment Inventory (FAI) in predicting conversion to dementia. Conclusion: Verbal memory testing was superior in predicting conversion to dementia compared to subjective cognitive complaints.
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Affiliation(s)
- Johann Lehrner
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Claus Lamm
- Faculty of Psychology, University of Vienna, Austria
| | - Doris Moser
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Austria
| | - Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Austria
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21
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Waser M, Garn H, Schmidt R, Benke T, Dal-Bianco P, Ransmayr G, Schmidt H, Seiler S, Sanin G, Mayer F, Caravias G, Grossegger D, Frühwirt W, Deistler M. Quantifying synchrony patterns in the EEG of Alzheimer's patients with linear and non-linear connectivity markers. J Neural Transm (Vienna) 2016; 123:297-316. [PMID: 26411482 PMCID: PMC4766239 DOI: 10.1007/s00702-015-1461-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/11/2015] [Indexed: 11/25/2022]
Abstract
We analyzed the relation of several synchrony markers in the electroencephalogram (EEG) and Alzheimer's disease (AD) severity as measured by Mini-Mental State Examination (MMSE) scores. The study sample consisted of 79 subjects diagnosed with probable AD. All subjects were participants in the PRODEM-Austria study. Following a homogeneous protocol, the EEG was recorded both in resting state and during a cognitive task. We employed quadratic least squares regression to describe the relation between MMSE and the EEG markers. Factor analysis was used for estimating a potentially lower number of unobserved synchrony factors. These common factors were then related to MMSE scores as well. Most markers displayed an initial increase of EEG synchrony with MMSE scores from 26 to 21 or 20, and a decrease below. This effect was most prominent during the cognitive task and may be owed to cerebral compensatory mechanisms. Factor analysis provided interesting insights in the synchrony structures and the first common factors were related to MMSE scores with coefficients of determination up to 0.433. We conclude that several of the proposed EEG markers are related to AD severity for the overall sample with a wide dispersion for individual subjects. Part of these fluctuations may be owed to fluctuations and day-to-day variability associated with MMSE measurements. Our study provides a systematic analysis of EEG synchrony based on a large and homogeneous sample. The results indicate that the individual markers capture different aspects of EEG synchrony and may reflect cerebral compensatory mechanisms in the early stages of AD.
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Affiliation(s)
- Markus Waser
- AIT Austrian Institute of Technology GmbH, Vienna, Austria.
| | - Heinrich Garn
- AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Reinhold Schmidt
- Department of Neurology, Clinical Section of Neurogeriatrics, Graz Medical University, Graz, Austria
| | - Thomas Benke
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Vienna Medical University, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology and Psychiatry, Linz General Hospital, Linz, Austria
| | - Helena Schmidt
- Institute of Molecular Biology and Biochemistry, Graz Medical University, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Clinical Section of Neurogeriatrics, Graz Medical University, Graz, Austria
| | - Günter Sanin
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Florian Mayer
- Department of Neurology, Vienna Medical University, Vienna, Austria
| | - Georg Caravias
- Department of Neurology and Psychiatry, Linz General Hospital, Linz, Austria
| | | | | | - Manfred Deistler
- Institute for Mathematical Methods in Economics, Vienna University of Technology, Vienna, Austria
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22
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Haslacher H, Michlmayr M, Batmyagmar D, Perkmann T, Ponocny-Seliger E, Scheichenberger V, Pilger A, Dal-Bianco P, Lehrner J, Pezawas L, Wagner O, Winker R. Physical exercise counteracts genetic susceptibility to depression. Neuropsychobiology 2016; 71:168-75. [PMID: 25998702 DOI: 10.1159/000381350] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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] [Received: 04/11/2014] [Accepted: 02/27/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Depression is a highly prevalent disorder in elderly individuals. A genetic variant (rs6265) of the brain-derived neurotrophic factor (BDNF) impacting on emotion processing is known to increase the risk for depression. We aim to investigate whether intensive endurance sports might attenuate this genetic susceptibility in a cohort of elderly marathon athletes. METHODS Fifty-five athletes and 58 controls were included. rs6265 of the BDNF gene was genotyped by the TaqMan method. Depressive symptoms were assessed by standardized self-rating tests (BDI = Beck Depression Inventory, GDS = Geriatric Depression Scale). RESULTS In multivariable analysis of BDI and GDS scores, the interaction between group (athletes vs. controls) and genotypes ([C];[C] vs. [C];[T] + [T];[T]) was found to be statistically significant (BDI: p = 0.027, GDS: p = 0.013). Among [C];[C] carriers, merely controls had an increased relative risk of 3.537 (95% CI = 1.276-9.802) of achieving a subclinical depression score ≥10 on the BDI. There was no such effect in carriers of the [T] allele. In a multivariable binary logistic regression, genetic information, group (athletes/controls), but no information on rs6265 allele carrier status presented as a significant predictor of BDI scores ≥10. CONCLUSION Physical exercise positively affects BDNF effects on mood. Since 66Met BDNF secretion is impaired, this effect seems to be much stronger in [C];[C] homozygous individuals expressing the 66Val variant. This confirms that genetic susceptibility to depressive symptoms can indeed be influenced by endurance sports in elderly people.
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Affiliation(s)
- Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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23
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Haslacher H, Michlmayr M, Batmyagmar D, Perkmann T, Ponocny-Seliger E, Scheichenberger V, Scherzer TM, Nistler S, Pilger A, Dal-Bianco P, Lehrner J, Pezawas L, Wagner OF, Winker R. rs6295 [C]-Allele Protects Against Depressive Mood in Elderly Endurance Athletes. J Sport Exerc Psychol 2015; 37:637-645. [PMID: 26866771 DOI: 10.1123/jsep.2015-0111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A single nucleotide variant within the promoter of the 5-hydroxytryptamine1A (5HT1A) receptor, rs6295, is part of a binding site for the transcription factor. We aimed to ascertain whether the rs6295 mediates the effect of exercise on depressive mood in elderly endurance athletes. We prospectively enrolled 55 elderly athletes (marathon runners/bicyclists) and 58 controls. In a controlled, univariate model, an interaction between the [C]-allele and physical activity indicated that only among athletes, the variant resulting in an imperfect NUDR binding site was associated with a lower depression score. Hence, athletes presented with a significantly lower relative risk of achieving a suspicious depression score among carriers of at least one [C]-allele. Our results suggest that the positive effect of physical exercise on depressive mood might be mediated by the 5HT1A receptor and the extent of this protective effect seems to be enhanced by the [C]-allele of the rs6295 variant.
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Affiliation(s)
- Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
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24
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Waser M, Garn H, Deistler M, Benke T, Dal-Bianco P, Ransmayr G, Schmidt H, Sanin G, Santer P, Caravias G, Seiler S, Grossegger D, Fruehwirt W, Schmidt R. Using static and dynamic canonical correlation coefficients as quantitative EEG markers for Alzheimer's disease severity. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2014:2801-4. [PMID: 25570573 DOI: 10.1109/embc.2014.6944205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We analyzed the relation between Alzheimer's disease (AD) severity as measured by Mini-Mental State Examination (MMSE) scores and quantitative electroencephalographic (qEEG) markers that were derived from canonical correlation analysis. This allowed an investigation of EEG synchrony between groups of EEG channels. In this study, we applied the data from 79 participants in the multi-centric cohort study PRODEM-Austria with probable AD. Following a homogeneous protocol, the EEG was recorded both in resting state and during a cognitive task. A quadratic regression model was used to describe the relation between MMSE and the qEEG synchrony markers. This relation was most significant in the δ and θ frequency bands in resting state, and between left-hemispheric central, temporal and parietal channel groups during the cognitive task. Here, the MMSE explained up to 40% of the qEEG marker's variation. QEEG markers showed an ambiguous trend, i.e. an increase of EEG synchrony in the initial stage of AD (MMSE>20) and a decrease in later stages. This effect could be caused by compensatory brain mechanisms. We conclude that the proposed qEEG markers are closely related to AD severity. Despite the ambiguous trend and the resulting diagnostic ambiguity, the qEEG markers could provide aid in the diagnostics of early-stage AD.
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25
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Pusswald G, Lehrner J, Hagmann M, Dal-Bianco P, Benke T, Marisa Loitfelder, Marksteiner J, Mosbacher J, Ransmayr G, Sanin G, Schmidt R. Gender-Specific Differences in Cognitive Profiles of Patients with Alzheimer’s Disease: Results of the Prospective Dementia Registry Austria (PRODEM-Austria). J Alzheimers Dis 2015; 46:631-7. [DOI: 10.3233/jad-150188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Austria
| | - Michael Hagmann
- Department of Medical Statistics and Informatics, Medical University of Vienna, Austria
| | | | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Marisa Loitfelder
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall in Tirol, Austria
| | - Jochen Mosbacher
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Austria
| | | | - Guenter Sanin
- Department of Neurology, Medical University of Innsbruck, Austria
| | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Austria
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26
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Seidel S, Dal-Bianco P, Pablik E, Müller N, Schadenhofer C, Lamm C, Klösch G, Moser D, Klug S, Pusswald G, Auff E, Lehrner J. Depressive Symptoms are the Main Predictor for Subjective Sleep Quality in Patients with Mild Cognitive Impairment--A Controlled Study. PLoS One 2015; 10:e0128139. [PMID: 26090659 PMCID: PMC4474695 DOI: 10.1371/journal.pone.0128139] [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: 12/30/2014] [Accepted: 04/22/2015] [Indexed: 01/09/2023] Open
Abstract
Objective Controlled data on predictors of subjective sleep quality in patients with memory complaints are sparse. To improve the amount of comprehensive data on this topic, we assessed factors associated with subjective sleep quality in patients from our memory clinic and healthy individuals. Methods Between February 2012 and August 2014 patients with mild cognitive impairment (MCI) and subjective cognitive decline (SCD) from our memory clinic and healthy controls were recruited. Apart from a detailed neuropsychological assessment, the subjective sleep quality, daytime sleepiness and depressive symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and the Beck Depression Inventory (BDI-II). Results One hundred fifty eight consecutive patients (132 (84%) MCI patients and 26 (16%) SCD patients) and 75 healthy controls were included in the study. Pairwise comparison of PSQI scores showed that non-amnestic MCI (naMCI) patients (5.4±3.5) had significantly higher PSQI scores than controls (4.3±2.8, p = .003) Pairwise comparison of PSQI subscores showed that naMCI patients (1.1±0.4) had significantly more “sleep disturbances” than controls (0.9±0.5, p=.003). Amnestic MCI (aMCI) (0.8±1.2, p = .006) and naMCI patients (0.7±1.2, p = .002) used “sleep medication” significantly more often than controls (0.1±0.6) Both, aMCI (11.5±8.6, p<.001) and naMCI (11.5±8.6, p<.001) patients showed significantly higher BDI-II scores than healthy controls (6.1±5.3). Linear regression analysis showed that the subjective sleep quality was predicted by depressive symptoms in aMCI (p<.0001) and naMCI (p<.0001) patients as well as controls (p<.0001). This means, that more depressive symptoms worsened subjective sleep quality. In aMCI patients we also found a significant interaction between depressive symptoms and global cognitive function (p = .002) Discussion Depressive symptoms were the main predictor of subjective sleep quality in MCI patients and controls, but not in SCD patients. Better global cognitive function ameliorated the negative effect of depressive symptoms on the subjective sleep quality in aMCI patients.
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Affiliation(s)
- Stefan Seidel
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eleonore Pablik
- Department of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Nina Müller
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Claus Lamm
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Gerhard Klösch
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Doris Moser
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefanie Klug
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Johann Lehrner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Lehrner J, Krakhofer H, Lamm C, Macher S, Moser D, Klug S, Dal-Bianco P, Pirker W, Auff E, Pusswald G. Visuo-constructional functions in patients with mild cognitive impairment, Alzheimer's disease, and Parkinson's disease. Neuropsychiatr 2015; 29:112-9. [PMID: 25861769 DOI: 10.1007/s40211-015-0141-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/27/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several recently proposed criteria for assessing cognitive disorder require measuring the cognitive domain of visuo-constructional function. The aims of the present study were to develop a new test (Vienna Visuo-constructional Test-VVT) measuring visuo-constructional functions and to determine the reliability and validity of the VVT in patients with mild cognitive impairment (MCI), Parkinson's disease (PD), and Alzheimer's disease (AD). We further examined age and sex effects and the psychometric quality of the VVT. METHODS The study included 76 healthy controls and 103 patients who were referred to the Department of Neurology, Medical University of Vienna for neurocognitive assessment. An administering and scoring system for the VVT was developed. RESULTS Internal consistency (Cronbach's alpha) was found to range from 0.82 for the healthy control group to 0.93 for the total patient group. There was no sex effect, but age had a negative effect on VVT performance. The VVT successfully differentiated healthy controls from MCI patients, AD patients, and PD patients, respectively. CONCLUSION The VVT shows satisfactory validity and reliability and can be administered easily in clinical practice. It constitutes a new measure that can successfully be used to identify visuo-constructional problems in patients with cognitive dysfunction.
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Affiliation(s)
- Johann Lehrner
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1097, Vienna, Austria.
| | | | - Claus Lamm
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Doris Moser
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefanie Klug
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Walter Pirker
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Eduard Auff
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gisela Pusswald
- Department of Neurology, Medical University of Vienna, Vienna, Austria
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Benke T, Sanin G, Lechner A, Dal-Bianco P, Ransmayr G, Uranüs M, Marksteiner J, Gaudig M, Schmidt R. Predictors of patient dependence in mild-to-moderate Alzheimer's disease. J Alzheimers Dis 2014; 43:443-9. [PMID: 25096619 DOI: 10.3233/jad-140099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patient dependence has rarely been studied in mild-to-moderate Alzheimer's disease (AD). OBJECTIVE To identify factors which predict patient dependence in mild-to-moderate AD. METHODS We studied 398 non-institutionalized AD patients (234 females) of the ongoing Prospective Registry on Dementia (PRODEM) in Austria. The Dependence Scale (DS) was used to assess patient dependence. Patient assessment comprised functional abilities, neuropsychiatric symptoms and cognitive functions. A multiple linear regression analysis was performed to identify predictors of patient dependence. RESULTS AD patients were mildly-to-moderately impaired (mean scores and SDs were: CDR 0.84 ± 0.43; DAD 74.4 ± 23.3, MMSE = 22.5 ± 3.6). Psychopathology and caregiver burden were in the low range (mean NPI score 13.2, range 0 to 98; mean ZBI score 18, range 0-64). Seventy five percent of patients were classified as having a mild level of patient dependence (DS sum score 0 to 6). Patient dependence correlated significantly and positively with age, functional measures, psychopathology and depression, disease duration, and caregiver burden. Significant negative, but low correlations were found between patient dependence, cognitive variables, and global cognition. Activities of daily living, patient age, and disease severity accounted for 63% of variance in patient dependence, whereas cognitive variables accounted for only 11%. CONCLUSION Dependence in this cohort was mainly related to age and functional impairment, and less so to cognitive and neuropsychiatric variables. This differs from studies investigating patients in more advanced disease stages which found abnormal behavior and impairments of cognition as main predictors of patient dependence.
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Affiliation(s)
- Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Sanin
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anita Lechner
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerhard Ransmayr
- Department of Neurology and Psychiatry, General Hospital Linz, Linz, Austria
| | | | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Maren Gaudig
- Janssen Alzheimer Immunotherapy, Health Economics & Market Access, Dublin, Ireland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
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Garn H, Waser M, Deistler M, Benke T, Dal-Bianco P, Ransmayr G, Schmidt H, Sanin G, Santer P, Caravias G, Seiler S, Grossegger D, Fruehwirt W, Schmidt R. Quantitative EEG markers relate to Alzheimer's disease severity in the Prospective Dementia Registry Austria (PRODEM). Clin Neurophysiol 2014; 126:505-13. [PMID: 25091343 DOI: 10.1016/j.clinph.2014.07.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/26/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate which single quantitative electro-encephalographic (QEEG) marker or which combination of markers correlates best with Alzheimer's disease (AD) severity as measured by the Mini-Mental State Examination (MMSE). METHODS We compared quantitative EEG markers for slowing (relative band powers), synchrony (coherence, canonical correlation, Granger causality) and complexity (auto-mutual information, Shannon/Tsallis entropy) in 118 AD patients from the multi-centric study PRODEM Austria. Signal spectra were determined using an indirect spectral estimator. Analyses were adjusted for age, sex, duration of dementia, and level of education. RESULTS For the whole group (39 possible, 79 probable AD cases) MMSE scores explained 33% of the variations in relative theta power during face encoding, and 31% of auto-mutual information in resting state with eyes closed. MMSE scores explained also 25% of the overall QEEG factor. This factor was thus subordinate to individual markers. In probable AD, QEEG coefficients of determination were always higher than in the whole group, where MMSE scores explained 51% of the variations in relative theta power. CONCLUSIONS Selected QEEG markers show strong associations with AD severity. Both cognitive and resting state should be used for QEEG assessments. SIGNIFICANCE Our data indicate theta power measured during face-name encoding to be most closely related to AD severity.
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Affiliation(s)
- Heinrich Garn
- AIT Austrian Institute of Technology GmbH, Vienna, Austria.
| | - Markus Waser
- AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | | | - Thomas Benke
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Vienna Medical University, Vienna, Austria
| | | | - Helena Schmidt
- Department of Neurology, Graz Medical University, Graz, Austria
| | - Guenter Sanin
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Peter Santer
- Department of Neurology, Vienna Medical University, Vienna, Austria
| | - Georg Caravias
- Department of Neurology, Linz General Hospital, Linz, Austria
| | - Stephan Seiler
- Department of Neurology, Graz Medical University, Graz, Austria
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Garn H, Waser M, Benke T, Dal-Bianco P, Ransmayr G, Deistler M, Grossegger D, Schmidt R. Using cognitive qEEG to characterize disease severity in the prospective dementia registry Austria (PRODEM). J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1159] [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: 11/26/2022]
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Benke T, Delazer M, Sanin G, Schmidt H, Seiler S, Ransmayr G, Dal-Bianco P, Uranüs M, Marksteiner J, Leblhuber F, Kapeller P, Bancher C, Schmidt R. Cognition, Gender, and Functional Abilities in Alzheimer's Disease: How are They Related? ACTA ACUST UNITED AC 2013; 35:247-52. [DOI: 10.3233/jad-122383] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas Benke
- Department of Neurology, Medical University, Innsbruck, Austria
| | | | - Günter Sanin
- Department of Neurology, Medical University, Innsbruck, Austria
| | - Helena Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Wien, Austria
| | - Margarete Uranüs
- Department of Geriatric Psychiatry, Landesnervenklinik Sigmund Freud, Graz, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital, Hall in Tirol, Austria
| | - Friedrich Leblhuber
- Department of Neurology and Geriatric Psychiatry, Nervenklinik Wagner-Jauregg, Linz, Austria
| | - Peter Kapeller
- Department of Neurology and Psychosomatic Medicine, Regional Hospital, Villach, Austria
| | | | - Reinhold Schmidt
- Division of Neurogeriatrics, Department of Neurology, Medical University of Graz, Graz, Austria
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Seiler S, Schmidt H, Lechner A, Benke T, Sanin G, Ransmayr G, Lehner R, Dal-Bianco P, Santer P, Linortner P, Eggers C, Haider B, Uranues M, Marksteiner J, Leblhuber F, Kapeller P, Bancher C, Schmidt R. Driving cessation and dementia: results of the prospective registry on dementia in Austria (PRODEM). PLoS One 2012; 7:e52710. [PMID: 23300746 PMCID: PMC3530518 DOI: 10.1371/journal.pone.0052710] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [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: 08/24/2012] [Accepted: 11/20/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the influence of cognitive, functional and behavioral factors, co-morbidities as well as caregiver characteristics on driving cessation in dementia patients. METHODS The study cohort consists of those 240 dementia cases of the ongoing prospective registry on dementia in Austria (PRODEM) who were former or current car-drivers (mean age 74.2 (±8.8) years, 39.6% females, 80.8% Alzheimer's disease). Reasons for driving cessation were assessed with the patients' caregivers. Standardized questionnaires were used to evaluate patient- and caregiver characteristics. Cognitive functioning was determined by Mini-Mental State Examination (MMSE), the CERAD neuropsychological test battery and Clinical Dementia Rating (CDR), activities of daily living (ADL) by the Disability Assessment for Dementia, behavior by the Neuropsychiatric Inventory (NPI) and caregiver burden by the Zarit burden scale. RESULTS Among subjects who had ceased driving, 136 (93.8%) did so because of "Unacceptable risk" according to caregiver's judgment. Car accidents and revocation of the driving license were responsible in 8 (5.5%) and 1(0.7%) participant, respectively. Female gender (OR 5.057; 95%CI 1.803-14.180; p = 0.002), constructional abilities (OR 0.611; 95%CI 0.445-0.839; p = 0.002) and impairment in Activities of Daily Living (OR 0.941; 95%CI 0.911-0.973; p<0.001) were the only significant and independent associates of driving cessation. In multivariate analysis none of the currently proposed screening tools for assessment of fitness to drive in elderly subjects including the MMSE and CDR were significantly associated with driving cessation. CONCLUSION The risk-estimate of caregivers, but not car accidents or revocation of the driving license determines if dementia patients cease driving. Female gender and increasing impairment in constructional abilities and ADL raise the probability for driving cessation. If any of these factors also relates to undesired traffic situations needs to be determined before recommendations for their inclusion into practice parameters for the assessment of driving abilities in the elderly can be derived from our data.
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Affiliation(s)
- Stephan Seiler
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Helena Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
- Institute of Molecular Biology and Biochemistry, Centre for Molecular Medicine, Medical University of Graz, Graz, Austria
| | - Anita Lechner
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Guenter Sanin
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Riccarda Lehner
- Department of Neurology, General Hospital Linz, Linz, Austria
| | - Peter Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Peter Santer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Patricia Linortner
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
| | - Christian Eggers
- Department of Neurology, Konventhospital der Barmherzigen Brüder Linz, Linz, Austria
| | - Bernhard Haider
- Department of Neurology, Konventhospital der Barmherzigen Brüder Linz, Linz, Austria
| | - Margarete Uranues
- Department of Geriatric Psychiatry, Landesnervenklinik Sigmund Freud Graz, Graz, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy, Regional Hospital Hall in Tirol, Hall in Tirol, Austria
| | - Friedrich Leblhuber
- Department of Neurology and Geriatric Psychiatry, Nervenklinik Wagner-Jauregg Linz, Linz, Austria
| | - Peter Kapeller
- Department of Neurology and Psychosomatic Medicine, Regional Hospital Villach, Villach, Austria
| | | | - Reinhold Schmidt
- Department of Neurology, Division of Neurogeriatrics, Medical University of Graz, Graz, Austria
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Walla P, Duregger C, Deecke L, Dal-Bianco P. Dysfunctional Incidental Olfaction in Mild Cognitive Impairment (MCI): An Electroencephalography (EEG) Study. Brain Sci 2011; 1:3-15. [PMID: 24962612 PMCID: PMC4061781 DOI: 10.3390/brainsci1010003] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/27/2011] [Accepted: 10/18/2011] [Indexed: 10/31/2022] Open
Abstract
Our study provides evidence that Mild Cognitive Impairment (MCI) is associated with olfactory dysfunction on both conscious and non-conscious levels. MCI patients and age-matched controls underwent a face processing task during which sympathy decisions had to be made via button presses. Incidentally, some of the faces were associated with a simultaneously presented odour. Although attention was paid to faces, brain activities were analysed with respect to odour versus no-odour conditions. Behavioural differences were found related to overall face recognition performance, but these were not statistically significant. However, odour-related neurophysiology differed between both groups. Normal controls demonstrated brain activity differences between odour and no-odour conditions that resemble difference activity patterns in healthy young participants as described in a previous magnetoencephalography (MEG) study [1]. They showed odour-related activity patterns between about 160 ms and 320 ms after stimulus onset and between about 640 ms and 720 ms. On the other hand, the patient group did not show any such difference activities. Based on previous research we interpret the early odour-related brain activity pattern in controls as being associated with subliminal olfaction and the later activity pattern with conscious olfaction. None of these were found in MCI patients, although it has to be emphasised that our sample size was rather small. We confirm previous findings about olfactory related dysfunction in patients with MCI and conclude from our findings that even subliminal odour-related information processing is impaired.
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Affiliation(s)
- Peter Walla
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Callaghan 2308 NSW, Australia.
| | - Cornelia Duregger
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, Callaghan 2308 NSW, Australia.
| | - Lüder Deecke
- Department of Clinical Neurology, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Peter Dal-Bianco
- Department of Clinical Neurology, Medical University Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Winker R, Lukas I, Perkmann T, Haslacher H, Ponocny E, Lehrner J, Tscholakoff D, Dal-Bianco P. Cognitive function in elderly marathon runners: cross-sectional data from the marathon trial (APSOEM). Wien Klin Wochenschr 2010; 122:704-16. [PMID: 21072603 DOI: 10.1007/s00508-010-1485-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 09/22/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cognitive impairment of the elderly contributes to morbidity, loss of quality of life, and impairment of work ability in aging western societies. Thus strategies to maintain cognitive function at an advanced age imply a great challenge to Occupational Medicine. AIM To study whether intensive endurance exercise training is associated with better cognitive performance and increases brain-derived neurotrophic factor (BDNF) and insulin-like growth factor (IGF). METHODS Active elderly marathon runners or bicyclists older than 60 years were recruited and matched with an inactive control group according to age, sex, and education years. After exclusion of various diseases according to the study protocol 56 athletes and 58 controls could be selected for follow-up studies. The influence of endurance training on cognitive function was assessed by the use of the Vienna Neuropsychological Test Battery and the CERAD test battery. Other relevant outcomes were the levels of BDNF, IGF-1, Apo e4 carrier state, and self-ratings. RESULTS The elderly marathon group performed better only in one specific cognitive task (the Five Point Test, p = 0.04) and almost significantly better in one additional test (the NAI Stroop Test, p = 0.08). Neither BDNF nor IGF-1 was related to the duration of daily exercise and no differences in the basal levels of these humoral growth factors in the exercise and the control cohort were found. Interestingly, we also found significantly decreased BDNF levels in subjects with Alzheimer's disease in the family in spite of the maintained normal cognitive performance (p = 0.01). CONCLUSION These results suggest that extensive endurance exercise training might be beneficial for maintaining cognitive function in elderly persons. Our data demonstrate that beneficial endurance training effects are not linked to the upregulation of the examined neurotrophins. Since we found reduced BDNF-levels in subjects with a positive family history of Alzheimer's disease, we speculate that BDNF-reduction might precede cognitive impairment.
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Affiliation(s)
- Robert Winker
- Unit of Occupational Medicine, Medical University of Vienna, Vienna, Austria.
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Pirker A, Assem-Hilger E, Schmied M, Dal-Bianco P. P1‐307: Upregulation of T‐helper subtype 17 lymphocytes in cultured peripheral blood mononuclear cells of patients with Alzheimer's disease. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schmidt R, Marksteiner M, Dal-Bianco P, Ransmayr G, Bancher C, Benke T, Wancata J, Fischer P, Leblhuber CF, Psota G, Ackerl M, Alf C, Berek K, Croy A, Delazer M, Fasching P, Frühwald T, Fruhwürth G, Fuchs-Nieder B, Gatterer G, Grossmann J, Hinterhuber H, Iglseder B, Imarhiagbe D, Jagsch C, Jellinger K, Kalousek M, Kapeller P, Ladurner G, Lampl C, Lechner A, Lingg A, Nakajima T, Rainer M, Reisecker F, Spatt J, Walch T, Uranüs M, Walter A. [Consensus statement "Dementia 2010" of the Austrian Alzheimer Society]. Neuropsychiatr 2010; 24:67-87. [PMID: 20605003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.
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Affiliation(s)
- Reinhold Schmidt
- Universitätsklinik für Neurologie, Medizinische Universität Graz,
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Schmidt R, Bach M, Dal-Bianco P, Holzer P, Pluta-Fuerst A, Assem-Hilger E, Lechner A, Cavalieri M, Haider B, Schmidt H, Pinter G, Pipam W, Stögmann E, Lampl C, Likar R. [Dementia and pain]. Neuropsychiatr 2010; 24:1-13. [PMID: 20146915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Dementia has been associated with disturbed pain processing and an impaired ability to provide self-reported ratings on pain. Patients with cognitive impairment have been shown to receive pain treatment less frequently than cognitively unimpaired individuals. Comorbidity is common in patients with dementia and a major factor contributing to pain. This demonstrates that a structured evaluation and categorisation of pain is mandatory for the treatment of older patients and that care should be taken to note indirect signs of pain. The appropriate scales are available and we propagate their application. Multimodal pain therapy is superior to one-dimensional approaches. A discussion of the effects and interactions of the analgesics presently available for geriatric care forms an integral part of this review.
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Affiliation(s)
- Reinhold Schmidt
- Universitätsklinik für Neurologie, Medizinische Universität Graz.
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Lehrner J, Pusswald G, Gleiss A, Auff E, Dal-Bianco P. Odor Identification and Self-reported Olfactory Functioning in Patients with Subtypes of Mild Cognitive Impairment. Clin Neuropsychol 2009; 23:818-30. [DOI: 10.1080/13854040802585030] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [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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Schmidt R, Alf C, Bancher C, Benke T, Berek K, Dal-Bianco P, Führwürth G, Imarhiagbe D, Jagsch C, Lechner A, Rainer M, Reisecker F, Rotaru J, Uranüs M, Walter A, Winkler A, Wuschitz A. [Transdermal rivastigmine patch in outpatient services in Austria: a naturalistic study in 103 patients with Alzheimer dementia]. Neuropsychiatr 2009; 23:58-63. [PMID: 19272293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We performed a 6-month open-label study on the use of the transdermal rivastigmine patch in clinical routine in 103 patients with Alzheimer's disease from 25 outpatient services in Austria. After baseline, safety and tolerability of the 10 cm2--rivastigmine patch was assessed at week 4, 12 and 24 in all patients. A Mini Mental State Examination was done at baseline and at week 12 and 24. Skin adherence of the patch was very good or good in 85% of study participants. Only 2.9% of patients had gastrointestinal adverse events. Local skin reactions occurred in 23% of individuals. Skin alteration were mostly mild in severity. In only 6.8% of subjects did they result in termination of treatment. At the earliest skin reactions were observed after 3 months of treatment. Cognitive functioning of patients improved comparable to the controlled trial which led to approval of the rivastigmine patch. In daily routine the safety profile of the rivastigmine patch is favourable, as is the response to treatment. Local, mostly mild skin reactions affect approximately every fifth patient, and they occur relatively late in the course of therapy. Patients and their caregivers should receive detailed information about skin reactions to omit unnecessary drop outs to treatment.
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Affiliation(s)
- Reinhold Schmidt
- Universitätsklinik für Neurologie, Medizinische Universität Graz.
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Mamoli B, Dal-Bianco P, Dorda W. Der Einfluß der Körpergröße, der Armlänge, des Geschlechtes und der Temperatur auf die SSEP-Latenzen. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dal-Bianco P, Mamoli B, Dorda W. Identifikationshäufigkeit und Konfigurationsvarianten der NSEP-Signal in Abhängigkeit vom Ableitort und Meßzeitpunkt. KLIN NEUROPHYSIOL 2008. [DOI: 10.1055/s-2008-1060984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Goldenberg G, Reisner T, Dal-Bianco P. Der Beitrag von Angiographie und Computertomographie zur Beurteilung der Pathogenese und des Verlaufs zerebraler Durchblutungsstörungen. Akt Neurol 2008. [DOI: 10.1055/s-2007-1020949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schmidt R, Kienbacher E, Benke T, Dal-Bianco P, Delazer M, Ladurner G, Jellinger K, Marksteiner J, Ransmayr G, Schmidt H, Stögmann E, Friedrich J, Wehringer C. [Sex differences in Alzheimer's disease]. Neuropsychiatr 2008; 22:1-15. [PMID: 18381051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The prevalence of Alzheimer disease is higher in women than in men. In the age group 65-69 years 0.7% of women and 0.6% of men suffer from the disease with increasing frequencies of 14.2% and 8.8% in individuals aged 85-89 years. The incidence is also higher in demented women. In Austria 74.1% of Alzheimer patients older than 60 years are women. Several studies report more pronounced language, mnestic, semantic and orientation deficits in women, but methodological shortcomings might be responsible for this finding. The validity of results reporting a more rapid cognitive decline in women can also be questioned. Women have a broader spectrum of dementiarelated behavioural symptoms with a predominance of depression, while aggression is more frequent in men than in women. Biological explanations for gender-specific differences in the phenotype of Alzheimer s disease include different brain morphology and function with higher susceptibility for pathological lesions in women and greater cognitive reserve in men. Sex differences were also reported for expression of antioxidative enzymes and post-menopausal hormonal changes. Interactions between gender nd response to treatment, if any, are subtle and have large intra-individual variability. In Austria, two thirds of patients receiving attendance allowance are women. Care takes place in 80% by the families and is provided by women in 78%. The rate of female care-givers in partly institutionalized care units in 91% in nursing homes it is 84%.
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Schmidt R, Neff F, Lampl C, Benke T, Anditsch M, Bancher C, Dal-Bianco P, Reisecker F, Marksteiner J, Rainer M, Kapeller P, Dodel R. [Therapy of Alzheimer's disease: current status and future development]. Neuropsychiatr 2008; 22:153-171. [PMID: 18826870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cholinesterase inhibitors and memantine can slow the course of Alzheimer's disease. In Austria the frequency of treatment is in the upper third among countries of the EU. Yet, the majority of Alzheimer patients does not receive adequate medication. Compliance to treatment is low. Studies on cholinesterase inhibitors show that only one third and one fifth of patients adhere to medication after 3 months and 12 months, respectively. Causes for low compliance are only partly patient-related, many factors are system-inherent. Knowledge of these factors is a pre-requisite for the treating physician to improve current unfavourable situation. Present treatment strategies are symptomatic, causal disease-modifying therapies are urgently needed. Research activity in the field is high and dominated by the amyloid hypothesis. We here review the basis and recent studies on secretase-inhibitors, immunization, aggregation of Abeta, statins and PPARgamma-agonists. Research towards strategies against tau-pathology is less dominant and focuses on inhibition of kinases and increase of activity of phosphatases. Causal therapies would have great effects on a population basis even if efficacy is only moderate. A disease-modifying therapy which delays the onset of Alzheimer disease by 5 years, will probably reduce the number of patients by nearly 50% during the next 50 years.
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Affiliation(s)
- Reinhold Schmidt
- Universitätsklinik für Neurologie, Medizinische Universität Graz.
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Ransmayr G, Katzenschlager R, Dal-Bianco P, Wenning G, Bancher C, Jellinger K, Schmidt R, Poewe W. [Dementia with Lewy Bodies and its differentiation from Alzheimer's disease]. Neuropsychiatr 2007; 21:63-74. [PMID: 17640492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Dementia with Lewy Bodies (DLB) accounts for approximately 20 % of all autopsy-confirmed dementias in the elderly. Presumably, DLB is underdiagnosed in patients without or with only mild Parkinsonian symptoms in the daily routine of memory clinics. This motivated the Austrian Alzheimer Society and the Austrian Parkinson Society to inform about core features, suggestive features and supportive clinical findings of DLB and to provide information on diagnostic possibilities leading to better differential diagnosis. We also guide in the management of DLB as pharmacological treatment can pose difficult dilemmas for the treating clinician.
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Affiliation(s)
- Gerhard Ransmayr
- Neurologische Universitätsklinik Graz, Medizinische Universität Graz.
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Bauer M, Langer O, Dal-Bianco P, Karch R, Brunner M, Abrahim A, Lanzenberger R, Hofmann A, Joukhadar C, Carminati P, Ghirardi O, Piovesan P, Forloni G, Corrado ME, Lods N, Dudczak R, Auff E, Kletter K, Müller M. A positron emission tomography microdosing study with a potential antiamyloid drug in healthy volunteers and patients with Alzheimer’s disease. Clin Pharmacol Ther 2006; 80:216-27. [PMID: 16952488 DOI: 10.1016/j.clpt.2006.05.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [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: 02/16/2006] [Accepted: 05/03/2006] [Indexed: 11/18/2022]
Abstract
This work describes a microdosing study with an investigational, carbon 11-labeled antiamyloid drug, 1,1'-methylene-di-(2-naphthol) (ST1859), and positron emission tomography (PET) in healthy volunteers (n = 3) and patients with Alzheimer's disease (n = 6). The study aimed to assess the distribution and local tissue pharmacokinetics of the study drug in its target organ, the human brain. Before PET studies were performed in humans, the toxicologic characteristics of ST1859 were investigated by an extended single-dose toxicity study according to guidelines of the Food and Drug Administration and European Medicines Agency, which are relevant for clinical trials with a single microdose. After intravenous bolus injection of 341 +/- 21 MBq [(11)C]ST1859 (containing <11.4 nmol of unlabeled ST1859), peripheral metabolism was rapid, with less than 20% of total plasma radioactivity being in the form of unchanged parent drug at 10 minutes after administration. In both the control and patient groups, uptake of radioactivity into the brain was relatively fast (time to reach maximum concentration, 9-17 minutes) and pronounced (maximum concentration [standardized uptake value], 1.3-2.2). In both healthy volunteers and patients, there was a rather uniform distribution of radioactivity in the brain, including both amyloid-beta-rich and -poor regions, with slow washout of radioactivity (half-life, 82-185 minutes). In conclusion, these data provide important information on the blood-brain barrier penetration and metabolism of an investigational antiamyloid drug and suggest that the PET microdosing approach is a useful method to describe the target-organ pharmacokinetics of radiolabeled drugs in humans.
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Affiliation(s)
- Martin Bauer
- Department of Clinical Pharmacology, Division of Clinical Pharmacokinetics, University of Vienna, Vienna, Austria
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Lehrner J, Gufler R, Guttmann G, Maly J, Gleiss A, Auff E, Dal-Bianco P. Annual conversion to alzheimer disease among patients with memory complaints attending an outpatient memory clinic: the influence of amnestic mild cognitive impairment and the predictive value of neuropsychological testing. Wien Klin Wochenschr 2006; 117:629-35. [PMID: 16416345 DOI: 10.1007/s00508-005-0428-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [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: 01/31/2005] [Accepted: 05/30/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goals of this study were to determine the annual conversion rate to Alzheimer disease (AD) among patients reporting memory problems, including a subgroup with amnestic mild cognitive impairment (aMCI), and to investigate the predictive value of neurocognitive testing for future dementia. METHODS A prospective study was carried out in an outpatient memory clinic. One hundred and seven patients underwent a clinical examination and completed a battery of standard cognitive tests at study entry and two years later. The conversion rate to clinically manifested AD two years later was investigated and sensitivity, specificity, receiver operating characteristics (AUC), positive predictive value and negative predictive value for each neuropsychological test were determined. RESULTS We found an annual rate of conversion to AD of 6.5% among patients reporting memory decline in the setting of our clinic. Specifically, patients with aMCI had an annual conversion rate of approximately 20%. The annual conversion rate for patients reporting memory problems but showing no memory deficit at memory testing was approximately 3%. Receiver operating characteristics (AUC) of the neuropsychological tests ranged from 0.60 to 0.94. CONCLUSIONS Patients with aMCI have 8.6-fold higher odds of developing AD compared with patients without evident memory impairment on neuropsychological testing. Although the risk of developing AD among patients without objective memory decline is small, some patients in this group still convert to AD and therefore close clinical monitoring of patients is necessary.
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Affiliation(s)
- Johann Lehrner
- University Clinic of Neurology, Medical University of Vienna, Vienna, Austria.
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Abstract
We recorded changes of brain activity from 10 MCI patients and 10 controls related to shallow (nonsemantic) and deep (semantic) word encoding using a whole-head MEG. During the following recognition tasks, all participants had to recognize the previously encoded words, which were presented again together with new words. In both groups recognition performance significantly varied as a function of depth of processing. No significant differences were found between the groups. Reaction times related to correctly classified new words (correct rejections) and incorrectly classified repetitions (misses) of MCI patients showed a strong tendency toward prolongation compared to controls, although no statistically significant differences occurred. Strikingly, in patients the neurophysiological data associated with nonsemantic and semantic word encoding differed significantly between 250 and 450 ms after stimulus onset mainly over left frontal and left temporal sensors. They showed higher electrophysiological activation during shallow encoding as compared to deep encoding. No such significant differences were found in controls. The present results might reflect a dysfunction with respect to shallow encoding of visually presented verbal information. It is interpreted that additional neural activation is needed to compensate for neurodegeneration. This finding is suggested to be an additional tool for MCI diagnosis.
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Affiliation(s)
- E Püregger
- Department of Clinical Neurology, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Abstract
Owing to the progress of individual life expectancy, the number of demented people will clearly increase in the next decades. Cognitive impairment refers not only to dementia, but also to mild cognitive impairment (MCI), associated with reduced complex daily activity and decreased quality of live. It may, in many cases (10-15% per year) progress to permanent dementia. The most frequent aetiologies of dementia syndromes are the Alzheimer's Disease (AD), vascular Dementia (VD), the combination of both and Lewy-Body-Disease. Primarily neuro-psychiatric and internal medical reasons for cognitive decline have also to be taken into account for rational treatment.
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Affiliation(s)
- P Dal-Bianco
- Universitätsklinik für Neurologie, Währinger Gürtel 18-20, A-1090 Wien.
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Kropiunigg U, Sebek K, Leonhardsberger A, Schemper M, Dal-Bianco P. [Psychosocial risk factors for Alzheimer's disease]. Psychother Psychosom Med Psychol 1999; 49:153-9. [PMID: 10396132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Psychosocial stress has been shown to contribute to neurodegenerative changes and has been discussed as a pathogenic element in Alzheimer's disease (AD). However, studies investigating this aspect are rare. We performed a case-control study on 50 clinically diagnosed probable AD patients and 90 controls consisting of surgical patients. Interviews were performed by trained personnel, using a questionnaire, a semi-structured interview, and a psychosocial risk list protocol. Findings are presented as marginal and partial odds ratio from linear logistic regressions. Adapting to an active but unproductive working style as well as living with a dominant spouse is associated with significant risk for AD. Protective factors are high self-esteem and working in one's desired job. Our results indicate psychosocial factors as a possible agent in the latent development of AD and may shift the focus from more traditional risk factors to hitherto almost neglected psychosocial factors in a disease of still unknown etiology.
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Affiliation(s)
- U Kropiunigg
- Institut für Medizinische Psychologie, Universität Wien.
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