Publications by authors named "Elke Kalbe"

102 Publications

"The system has to be health literate, too" - perspectives among healthcare professionals on health literacy in transcultural treatment settings.

BMC Health Serv Res 2021 Jul 21;21(1):716. Epub 2021 Jul 21.

Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (CERES), University of Cologne and Research Unit Ethics, Faculty of Medicine and University Hospital Cologne, 50931, Cologne, Germany.

Background: Effective communication is a central aspect of organizational health literacy. Healthcare professionals are expected to ensure an effective and satisfactory flow of information and to support their patients in accessing, understanding, appraising, and applying health information. This qualitative study aimed to examine the health literacy-related challenges, needs, and applied solutions of healthcare professionals when engaging with persons with a migrant background. Based on the integrated model of health literacy (Sørensen et al., BMC Public Health 12:80, 2012), we focused on environmental, personal, and situational factors that shape health literacy in transcultural treatment settings.

Methods: We conducted five focus group discussions with healthcare professionals (N = 31) who are in regular contact with persons with a migrant background. Discussions were transcribed verbatim and analyzed using qualitative content analysis by applying a deductive-inductive categorization procedure. Deductive categories were derived from the integrated model of health literacy.

Results: Challenges included a mismatch in the provision and use of health services. Participants regarded easily accessible services and outreach counselling as helpful solutions. Further challenges were the migrant patients' distrust in healthcare professionals and the German healthcare system, the participants' uncertainty in dealing with patients' expectations and needs, and the patients' non-compliance with appointments. Environmental factors included systemic lack of time and economic pressure. Both were reported as impeding the flow of information in all treatment settings. Participants with a migrant background themselves (n = 16) regarded this personal factor as an opportunity that increased patients' trust in them. They also reported challenges such as high levels of responsibility felt when ad hoc interpreting for colleagues.

Conclusions: Known issues observed in the delivery of healthcare for the majority population (i.e., systemic lack of time, economic pressure) appear to be intensified in the context of migration. An increasingly diverse patient clientele indicates a growing need for culture-sensitive, health-literate healthcare organizations. A corresponding diversity of the health workforce is desirable and should be strengthened by national finance and educational programs. Healthcare professionals who interpret for colleagues should be given the necessary time. Further studies are needed to develop appropriate interventions for improving health literacy at individual and organizational levels. Funding for interpreting services should be expanded.
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http://dx.doi.org/10.1186/s12913-021-06614-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293586PMC
July 2021

The impact of subthalamic deep brain stimulation on belief revision and social validation.

Parkinsonism Relat Disord 2021 Jun 30;89:84-86. Epub 2021 Jun 30.

Department of Neurology, Faculty of Medicine, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany.

We investigated whether Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) influences social validation as measured by a Judge-Advisor task. In contrast to healthy controls and patients with their DBS OFF, patients with their stimulation switched on do not experience a gain of confidence after receiving competent advice.
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http://dx.doi.org/10.1016/j.parkreldis.2021.06.020DOI Listing
June 2021

Effects of Sociodemographic Variables and Depressive Symptoms on MoCA Test Performance in Native Germans and Turkish Migrants in Germany.

Int J Environ Res Public Health 2021 06 11;18(12). Epub 2021 Jun 11.

Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Department of Medical Psychology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany.

The validity of the Montreal Cognitive Assessment (MoCA) in migrants is questionable, as sociodemographic factors and the migration process may influence performance. Our aim was to evaluate possible predictors (age, education, sex, depression, and migration) of MoCA results in Turkish migrants and Germans living in Germany. Linear regression models were conducted with a German ( = 419), a Turkish ( = 133), and an overall sample. All predictor analyses reached statistical significance. For the German sample, age, sex, education, and depression were significant predictors, whereas education was the only predictor for Turkish migrants. For the overall sample, having no migration background and higher education were significant predictors. Migration background and education had an impact on MoCA performance in a sample of German and Turkish individuals living in Germany. Thus, culture-specific normative data for the MoCA are needed, and the development of culture-sensitive cognitive screening tools is encouraged.
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http://dx.doi.org/10.3390/ijerph18126335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296159PMC
June 2021

Prognostic Factors and Models for Changes in Cognitive Performance After Multi-Domain Cognitive Training in Healthy Older Adults: A Systematic Review.

Front Hum Neurosci 2021 27;15:636355. Epub 2021 Apr 27.

Department of Medical Psychology | Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany.

Cognitive Training (CT) may contribute to the maintenance and even enhancement of cognitive functions in healthy older adults. However, the question who benefits most from multi-domain CTs is still highly under-investigated. The goal is to investigate prognostic factors and models for changes in cognitive test performance in healthy older adults after a multi-domain CT. The data bases MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to July 2019. Studies investigating prognostic factors and/or models on cognitive outcomes (global cognition, memory, attention, executive functions, language, visuo-spatial abilities) after conducting a multi-domain CT in healthy older adults were included. Risk of Bias was assessed using the QUIPS and the PROBAST tool. 23 prognostic factor and model studies were included. Results indicate a high heterogeneity regarding the conducted multi-domain CTs, the investigated prognostic factors, the investigated outcomes, and the used statistical approaches. Age and neuropsychological performance at study entry were the most investigated predictors, yet they show inconsistent results. Data on prognostic factors and models of changes after multi-domain CT are still too rare and inconsistent to draw clear conclusions due to statistical shortcomings and low reporting quality. Approaches for future research are outlined. https://www.crd.york.ac.uk/prospero/, ID: CRD42020147531.
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http://dx.doi.org/10.3389/fnhum.2021.636355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110835PMC
April 2021

Assessment of Affective-Behavioral States in Parkinson's Disease Patients: Toward a New Screening Tool.

J Parkinsons Dis 2021 May 3. Epub 2021 May 3.

Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Background: Assessment of affective-behavioral states in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) is essential.

Objective: To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS.

Methods: Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach's alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed.

Results: The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach's alpha = 0.72-0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84-0.95). Sensitivities and specificities exceeded 0.7.

Conclusion: The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.
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http://dx.doi.org/10.3233/JPD-202375DOI Listing
May 2021

Psychosocial well-being and quality of life in siblings of children with congenital heart disease: A systematic review.

J Child Health Care 2021 Apr 29:13674935211012933. Epub 2021 Apr 29.

Department of Medical Psychology, Neuropsychology, Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, 27182University of Cologne, Germany.

Congenital heart disease (CHD) is a major global health problem. Until recently, the siblings of this group did not receive much attention. This review, conducted from November 2019 to October 2020, aims to summarize knowledge about psychosocial well-being and quality of life (QoL), associated factors, and interventions for siblings of children with CHD. Systematic searches were conducted in PubMed, PsycINFO, PsycARTICLES, Web of Science via EBSCOhost, and CENTRAL. Twelve articles were included. Results showed that psychosocial well-being was impaired in 14% to 40% of siblings. Negative impact of illness was highest for CHD siblings compared to siblings of children with cancer, cystic fibrosis, or diabetes. QoL was impaired in up to one-third. Siblings of children with CHD and cancer rated their QoL lower than those of siblings of children with cystic fibrosis or type-1 diabetes. Associated factors were sibling age, gender, socioeconomic status, miscarriage, previous sibling death, visibility of illness, and severity of condition. Only one of two interventions focused on siblings of CHD children. Although data are scarce and inhomogeneous, it indicates that siblings of CHD children suffer from lower psychosocial well-being and QoL than siblings of children with other chronic conditions. Interventions to improve their situation should be developed.
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http://dx.doi.org/10.1177/13674935211012933DOI Listing
April 2021

Memory enhancement by multidomain group cognitive training in patients with Parkinson's disease and mild cognitive impairment: long-term effects of a multicenter randomized controlled trial.

J Neurol 2021 Apr 27. Epub 2021 Apr 27.

Department of Neurology, University Oldenburg, Steinweg 13-17, 26122, Oldenburg, Germany.

Background: Meta-analyses indicate positive effects of cognitive training (CT) in patients with Parkinson's disease (PD), however, most previous studies had small sample sizes and did not evaluate long-term follow-up. Therefore, a multicenter randomized controlled, single-blinded trial (Train-ParC study) was conducted to examine CT effects in PD patients with mild cognitive impairment (PD-MCI). Immediately after CT, an enhancement of executive functions was demonstrated. Here, we present the long-term results 6 and 12 months after CT.

Methods: At baseline, 64 PD-MCI patients were randomized to a multidomain CT group (n = 33) or to a low-intensity physical activity training control group (PT) (n = 31). Both interventions included 90 min training sessions twice a week for 6 weeks. 54 patients completed the 6 months (CT: n = 28, PT: n = 26) and 49 patients the 12 months follow-up assessment (CT: n = 25, PT: n = 24). Primary study outcomes were memory and executive functioning composite scores. Mixed repeated measures ANOVAs, post-hoc t tests and multiple regression analyses were conducted.

Results: We found a significant time x group interaction effect for the memory composite score (p = 0.006, η = 0.214), but not for the executive composite score (p = 0.967, η = 0.002). Post-hoc t tests revealed significant verbal and nonverbal memory improvements from pre-intervention to 6 months, but not to 12 months follow-up assessment in the CT group. No significant predictors were found for predicting memory improvement after CT.

Conclusions: This study provides Class 1 evidence that multidomain CT enhances memory functioning in PD-MCI after 6 months but not after 12 months, whereas executive functioning did not change in the long-term.

Clinical Trial Registration: German Clinical Trials Register (ID: DRKS00010186), 21.3.2016 (The study registration is outlined as retrospective due to an administrative delay. The first patient was enrolled three months after the registration process was started. A formal confirmation of this process from the German Clinical Trials Register can be obtained from the authors.).
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http://dx.doi.org/10.1007/s00415-021-10568-9DOI Listing
April 2021

Screen Fast, Screen Faster: A Pilot Study to Screen for Depressive Symptoms Using the Beck Depression Inventory Fast Screen in Parkinson's Disease With Mild Cognitive Impairment.

Front Neurol 2021 8;12:640137. Epub 2021 Mar 8.

Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.

Depressive symptoms have a high prevalence in patients with Parkinson's disease (PD) and are associated with cognitive dysfunction. Especially in PD with mild cognitive impairment (MCI), a time-efficient and valid instrument for the assessment of depression primarily focusing on psychological symptoms and disregarding confounding somatic symptoms is needed. We performed an examination of the psychometric properties of the Beck Depression Inventory II (BDI-II) and the Beck Depression Inventory Fast Screen (BDI-FS). The sample consisted of 64 patients [22 females and 42 males, mean age: 67.27 years ( = 7.32)]. Depressive symptoms were measured in a cohort of PD patients with MCI. For the BDI-II and BDI-FS the psychometric concepts of internal consistency, convergent validity and diagnostic agreement were assessed. Patients gave higher ratings on test items addressing somatic symptoms than those addressing non-somatic ones. The correlation between the absolute total scores of the BDI-II and the BDI-FS was significant ( = 0.91, < 0.001), which indicated convergent validity. The Cronbach's alpha values indicated adequate internal consistencies for both measures (BDI-II: 0.84; BDI-FS: 0.78). There was a higher than chance level agreement of diagnoses of the two questionnaires, measured by Cohen's kappa (0.58, < 0.001). The agreements between previous diagnosis of depression and the diagnoses of the BDI-II/BDI-FS were also significantly higher than chance level (BDI-II: 0.34, = 0.007, BDI-FS: 0.39, = 0.002). Additional AUC analysis across different cutoffs showed that performance of BDI-FS was better than BDI-II, supporting the observation of an equivalent or better performance of BDI-FS than BDI-II. Importantly, AUC analysis confirmed that a cutoff = 4 for BDI-FS was suitable in the considered sample of patients with PD-MCI. In a cohort of PD-MCI, the BDI-FS demonstrates adequate psychometric properties in comparison to the BDI-II and can be used as a screening measure for assessing depression in cognitively impaired PD patients, focusing solely on psychological symptoms. Still, further research is needed to validate this instrument.
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http://dx.doi.org/10.3389/fneur.2021.640137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982682PMC
March 2021

[Guidelines for the Neuropsychological Assessment of Patients with Parkinson's Disease].

Fortschr Neurol Psychiatr 2021 Jul 9;89(7-08):363-373. Epub 2021 Feb 9.

Deutsches Zentrum für Neurodegenerative Erkrankungen, Bonn, Deutschland.

Background: Presence of mild cognitive impairment is currently the best predictor for the development of Parkinson's disease dementia. Diagnostic criteria for both Parkinson's with mild cognitive impairment and Parkinson's disease dementia have been suggested by the Movement Disorder Society. However, not all cognitive tests recommended are available in the German language with proper standard values.

Objectives: To define evidence-based guidelines for neuropsychological assessment of patients with Parkinson's disease in German.

Methods: Two systematic literature searches were conducted. First, articles that presented international guidelines (consensus papers or reviews) for the application of standardized neuropsychological assessments for the diagnosis of cognitive impairment in Parkinson's disease were selected. Of those, only neuropsychological assessments in German language with normative values referring either to a German, Austrian, or Swiss population were considered. Second, articles comparing test performances of healthy controls vs. Parkinson's disease and/or different cognitive Parkinson's disease subtypes (e.g. no cognitive impairment, Parkinson's with mild cognitive impairment, Parkinson's disease dementia) were selected. Effect sizes for group differentiation were calculated.

Results: Out of 127 full-text articles reviewed, 48 tests were identified during the first literature search. In the second search, 1716 articles were reviewed and 23 papers selected. The strongest effect sizes for group discrimination were revealed for tests assessing executive function, attention, and visuo-cognitive abilities. Based on the results of the two literature searches, consensus guidelines were defined by the authors, allowing for Level-II diagnosis for Parkinson's with mild cognitive impairment and Parkinson's disease dementia.

Conclusions: The presented guidelines may have the potential to standardize and improve the neuropsychological assessment of Parkinson's disease patients in German speaking countries.
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http://dx.doi.org/10.1055/a-1099-9332DOI Listing
July 2021

Predicting Working Memory Training Responsiveness in Parkinson's Disease: Both "System Hardware" and Room for Improvement Are Needed.

Neurorehabil Neural Repair 2021 02;35(2):117-130

University of Cologne, Cologne, Germany.

. Patients with Parkinson's disease (PD) are highly vulnerable to develop cognitive dysfunctions, and the mitigating potential of early cognitive training (CT) is increasingly recognized. Predictors of CT responsiveness, which could help to tailor interventions individually, have rarely been studied in PD. This study aimed to examine individual characteristics of patients with PD associated with responsiveness to targeted working memory training (WMT). . Data of 75 patients with PD (age: 63.99 ± 9.74 years, 93% Hoehn & Yahr stage 2) without cognitive dysfunctions from a randomized controlled trial were analyzed using structural equation modeling. Latent change score models with and without covariates were estimated and compared between the WMT group ( = 37), who participated in a 5-week adaptive WMT, and a waiting list control group ( = 38). . Latent change score models yielded adequate model fit (χ-test > .05, SRMR ≤ .08, CFI ≥ .95). For the near-transfer working memory composite, lower baseline performance, younger age, higher education, and higher fluid intelligence were found to significantly predict higher latent change scores in the WMT group, but not in the control group. For the far-transfer executive function composite, higher self-efficacy expectancy tended to significantly predict larger latent change scores. . The identified associations between individual characteristics and WMT responsiveness indicate that there has to be room for improvement (e.g., lower baseline performance) and also sufficient "hardware" (e.g., younger age, higher intelligence) to benefit in training-related cognitive plasticity. Our findings are discussed within the compensation versus magnification account. They need to be replicated by methodological high-quality research applying advanced statistical methods with larger samples.
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http://dx.doi.org/10.1177/1545968320981956DOI Listing
February 2021

Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study.

NeuroRehabilitation 2021 ;48(1):97-108

Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany.

Background: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking.

Objective: To evaluate the effects of combined CMT in early stroke rehabilitation.

Methods: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days.

Results: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed.

Conclusions: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.
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http://dx.doi.org/10.3233/NRE-201583DOI Listing
April 2021

Perception, Attitudes, and Experiences Regarding Mental Health Problems and Web Based Mental Health Information Amongst Young People with and without Migration Background in Germany. A Qualitative Study.

Int J Environ Res Public Health 2020 12 24;18(1). Epub 2020 Dec 24.

Medical Psychology, Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50923 Cologne, Germany.

Mental illnesses in adolescence and young adulthood are steadily increasing. Thus, mental disorders represent an individual and societal challenge and an enormous health economic burden, creating an urgent need for research and action. Mental health problems are omnipresent in the life of young people and the internet is the first resource, which helps them to understand their situation. Young people with migration background often have more difficulties accessing health care services. Digital technologies offer an ideal opportunity for a low-threshold platform that addresses the needs of young people. The current project "GeKo:mental" aims to design a multilingual website for Cologne-based adolescents and young adults that will enable them to obtain comprehensive information about mental illness and health, treatment options and first contact points. To design this website, this study aims to find out what kind of health information is needed and how it should best be presented. Nine focus group discussions with adolescents and young adults with and without migration background (N = 68) were conducted; the focus group discussions took place at schools, in an association for social youth work and in an cultural association, which is linked to a mosque in Cologne, Germany. A qualitative content analysis was conducted on the gathered material. The participants reported concrete challenges and needs. The results will form the basis for the development and design of a website.
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http://dx.doi.org/10.3390/ijerph18010081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7796242PMC
December 2020

Enhancement of Executive Functions but Not Memory by Multidomain Group Cognitive Training in Patients with Parkinson's Disease and Mild Cognitive Impairment: A Multicenter Randomized Controlled Trial.

Parkinsons Dis 2020 30;2020:4068706. Epub 2020 Nov 30.

German Center for Neurodegenerative Diseases (DZNE) and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tuebingen, Tuebingen, Germany.

Background: Meta-analyses have demonstrated cognitive training (CT) benefits in Parkinson's disease (PD) patients. However, the patients' cognitive status has only rarely been based on established criteria. Also, prediction analyses of CT success have only sparsely been conducted.

Objective: To determine CT effects in PD patients with mild cognitive impairment (PD-MCI) on cognitive and noncognitive outcomes compared to an active control group (CG) and to analyze CT success predictors.

Methods: Sixty-four PD-MCI patients (age: 67.61 ± 7.70; UPDRS-III: 26.58 ± 13.54; MoCA: 24.47 ± 2.78) were randomized to either a CT group or a low-intensity physical activity CG for six weeks (twice weekly, 90 minutes). Outcomes were assessed before and after training. MANOVAs with follow-up ANOVAs and multiple regression analyses were computed.

Results: Both interventions were highly feasible (participation, motivation, and evaluation); the overall dropout rate was 4.7%. Time × group interaction effects favoring CT were observed for phonemic fluency as a specific executive test (=0.018, =0.092) and a statistical trend for overall executive functions (=0.095, =0.132). A statistical trend for a time × group interaction effect favoring CG was shown for the digit span backward as a working memory test (=0.098, =0.043). Regression analyses revealed cognitive baseline levels, education, levodopa equivalent daily dose, motor scores, and ApoE status as significant predictors for CT success.

Conclusions: CT is a safe and feasible therapy option in PD-MCI, yielding executive functions improvement. Data indicate that vulnerable individuals may show the largest cognitive gains. Longitudinal studies are required to determine whether CT may also attenuate cognitive decline in the long term. This trial is registered with DRKS00010186.
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http://dx.doi.org/10.1155/2020/4068706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721510PMC
November 2020

A Systematic Review on Predictors of Working Memory Training Responsiveness in Healthy Older Adults: Methodological Challenges and Future Directions.

Front Aging Neurosci 2020 14;12:575804. Epub 2020 Oct 14.

Department of Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Research on predictors of working memory training responsiveness, which could help tailor cognitive interventions individually, is a timely topic in healthy aging. However, the findings are highly heterogeneous, reporting partly conflicting results following a broad spectrum of methodological approaches to answer the question "who benefits most" from working memory training. The present systematic review aimed to systematically investigate prognostic factors and models for working memory training responsiveness in healthy older adults. Four online databases were searched up to October 2019 (MEDLINE Ovid, Web of Science, CENTRAL, and PsycINFO). The inclusion criteria for full texts were publication in a peer-reviewed journal in English/German, inclusion of healthy older individuals aged ≥55 years without any neurological and/or psychiatric diseases including cognitive impairment, and the investigation of prognostic factors and/or models for training responsiveness after targeted working memory training in terms of direct training effects, near-transfer effects to verbal and visuospatial working memory as well as far-transfer effects to other cognitive domains and behavioral variables. The study design was not limited to randomized controlled trials. A total of 16 studies including = 675 healthy older individuals with a mean age of 63.0-86.8 years were included in this review. Within these studies, five prognostic model approaches and 18 factor finding approaches were reported. Risk of bias was assessed using the Quality in Prognosis Studies checklist, indicating that important information, especially regarding the domains study attrition, study confounding, and statistical analysis and reporting, was lacking throughout many of the investigated studies. Age, education, intelligence, and baseline performance in working memory or other cognitive domains were frequently investigated predictors across studies. Given the methodological shortcomings of the included studies, no clear conclusions can be drawn, and emerging patterns of prognostic effects will have to survive sound methodological replication in future attempts to promote precision medicine approaches in the context of working memory training. Methodological considerations are discussed, and our findings are embedded to the cognitive aging literature, considering, for example, the cognitive reserve framework and the compensation vs. magnification account. The need for personalized cognitive prevention and intervention methods to counteract cognitive decline in the aging population is high and the potential enormous. PROSPERO, ID CRD42019142750.
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http://dx.doi.org/10.3389/fnagi.2020.575804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591761PMC
October 2020

Feasibility of Music-Assisted Treadmill Training in Parkinson's Disease Patients With and Without Deep Brain Stimulation: Insights From an Ongoing Pilot Randomized Controlled Trial.

Front Neurol 2020 4;11:790. Epub 2020 Sep 4.

Medical Psychology | Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Music-assisted treadmill training (MATT) is a new therapeutic approach for Parkinson's disease (PD) patients, combining treadmill training with rhythmic auditory cueing and visual feedback. PD studies have shown larger positive effects on motor outcomes than usual treadmill training. However, effects on cognition, in contrast, are less clear. Existing studies provided intensive training protocols and included only stable medicated patients. Thus, a pilot randomized controlled trial was designed to analyze the feasibility of a shorter training protocol as well as preliminary effects on cognition, motor function, and patient-centered outcomes in a rehabilitation setting where PD patients with and without deep brain stimulation (DBS) undergo adaptation of medication and DBS settings. Here, we present the results from the feasibility analysis of the still ongoing trial. Non-demented PD patients with and without DBS were recruited during their inpatient rehabilitation and randomized to an experimental group (EG; 20 min MATT) or an active control group (CG; 20 min bike ergometer training). The trainings took place for 8 consecutive days and were added to the usual rehabilitation. Feasibility was assessed with the following parameters: patients' study protocol acceptance, study protocol transferability into clinical routine, training-induced adverse events, and patients' training perception. Thirty-two patients (EG: = 15; CG: = 17; 72% DBS) were included. The study protocol was well-accepted (inclusion rate: 84%). It was transferable into clinical routines; dropout rates of 40% (EG) and 18% (CG) were observed. However, an in-depth analysis of the dropout cohort did not reveal intervention-related dropout reasons. The MATT and the standard ergometer training showed no adverse events and were positively perceived by PD patients with and without DBS. MATT was shown to be a feasible, safe, and enjoyable treatment option in PD patients with and without DBS. Furthermore, the dropout cohort analysis revealed some exciting first insights into possible dropout reasons that go beyond the form of intervention. Therefore, research would benefit from a common practice of dropout analyses, as this would enhance our understanding of patients' therapy adherence and expectations.
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http://dx.doi.org/10.3389/fneur.2020.00790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498575PMC
September 2020

Predictors of changes after reasoning training in healthy adults.

Brain Behav 2020 12 27;10(12):e01861. Epub 2020 Sep 27.

Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.

Objectives: To investigate predictors of performance changes and their time course in healthy older adults.

Design: A post hoc analysis of a RCT investigating the effect of reasoning cognitive training (ReaCT) compared to an active control group (CG) during a time course.

Setting And Participants: An online, home-based RCT including n = 4,310 healthy participants (ReaCT: n = 2,557; CG: n = 1,753) aged 50 years and older.

Methods: Multiple regression analyses were conducted to investigate predictors (age, sex, education, severity of depression, number of training sessions the participants attended, and neuropsychological baseline values) of the outcome measures grammatical reasoning, working memory, digit vigilance, verbal short-term memory, and verbal learning at 6 weeks, 3, and 6 months.

Results: Being female and lower education predicted improvements in grammatical reasoning scores at 6 weeks and 3 months of training.

Conclusion And Implication: Identifying predictors for nonpharmacological interventions may help to set up a personalized medicine approach in order to prevent cognitive decline in healthy older adults.
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http://dx.doi.org/10.1002/brb3.1861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749593PMC
December 2020

Working memory training increases neural efficiency in Parkinson's disease: a randomized controlled trial.

Brain Commun 2020 27;2(2):fcaa115. Epub 2020 Aug 27.

Faculty of Medicine and University Hospital of Cologne, Department of Nuclear Medicine, University of Cologne, Cologne, Germany.

Impairment of working memory and executive functions is already frequently observed in early stages of Parkinson's disease. Improvements in working memory performance in this cohort could potentially be achieved via working memory training. However, the specific neural mechanisms underlying different working memory processes such as maintenance as opposed to manipulation are largely under-investigated in Parkinson's disease. Moreover, the plasticity of these correlates as a function of working memory training is currently unknown in this population. Thus, the working memory subprocesses of maintenance and manipulation were assessed in 41 cognitively healthy patients with Parkinson's disease using a newly developed working memory paradigm and functional MRI. Nineteen patients were randomized to a 5-week home-based digital working memory training intervention while the remaining patients entered a control, wait list condition. Working memory task-related activation patterns and context-dependent functional connectivity, as well as the change of these neural correlates as a function of training, were assessed. While both working memory processes activated an extended frontoparietal-cerebellar network, only the manipulation of items within working memory also recruited the anterior striatum. The intervention effect on the neural correlates was small, but decreased activation in areas relevant for working memory could be observed, with activation changes correlating with behavioural change. Moreover, training seemed to result in decreased functional connectivity when pure maintenance was required, and in a reorganization of functional connectivity when items had to be manipulated. In accordance with the neural efficacy hypothesis, training resulted in overall reduced activation and reorganized functional connectivity, with a differential effect on the different working memory processes under investigation. Now, larger trials including follow-up examinations are needed to further explore the long-term effects of such interventions on a neural level and to estimate the clinical relevance to potentially delay cognitive decline in cognitively healthy patients with Parkinson's disease.
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http://dx.doi.org/10.1093/braincomms/fcaa115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472906PMC
August 2020

Structured Care and Self-Management Education for Persons with Parkinson's Disease: Why the First Does Not Go without the Second-Systematic Review, Experiences and Implementation Concepts from Sweden and Germany.

J Clin Med 2020 Aug 28;9(9). Epub 2020 Aug 28.

Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany.

Integrated care is regarded as a key for care delivery to persons with chronic long-term conditions such as Parkinson's disease. For persons with Parkinson's disease, obtaining self-management support is a top priority in the context of integrated care. Self-management is regarded as a crucial competence in chronic diseases since the affected persons and their caregivers inevitably take up the main responsibility when it comes to day-to-day management. Formal self-management education programs with the focus on behavioral skills relevant to the induction and maintenance of behavioral change have been implemented as a standard in many chronic long-term conditions. However, besides the example of the Swedish National Parkinson School, the offers for persons with Parkinson's disease remain fragmented and limited in availability. Today, no such program is implemented as a nationwide standard in Germany. This paper provides (1) a systematic review on structured self-management education programs specifically designed or adopted for persons with Parkinson's disease, (2) presents the Swedish National Parkinson School as an example for a successfully implemented nationwide program and (3) presents a concept for the design, evaluation and long-term implementation of a future-orientated self-management education program for persons with Parkinson's disease in Germany.
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http://dx.doi.org/10.3390/jcm9092787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563525PMC
August 2020

Prognostic factors for change in memory test performance after memory training in healthy older adults: a systematic review and outline of statistical challenges.

Diagn Progn Res 2020 21;4. Epub 2020 May 21.

1Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 68, 50937 Cologne, Germany.

Background: The goal is to investigate prognostic factors for change in memory test performance in healthy older adults and to report and discuss the different statistical procedures used for investigating this topic in the literature.

Methods: Prognostic factors were here understood as any measures that were investigated to estimate change in memory test performance. MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to November 2019. Prognostic factor and prognostic factor finding studies investigating prognostic factors on verbal and non-verbal short- and long-term memory after conducting memory training in healthy older adults were included. Risk of bias was assessed using the QUIPS tool.

Results: Our search yielded 12,974 results. We included 29 studies that address prognostic factors of change in memory test performance, including sociodemographic, (neuro-)psychological, genetic, and biological parameters. Studies showed high variation and methodological shortcomings with regard to the assessment, statistical evaluation, and reporting of the investigated prognostic factors. Included studies used different types of dependent variables (change scores vs. post-test scores) when defining change in memory test performance leading to contradictory results. Age was the only variable investigated throughout most of the studies, showing that older adults benefit more from training when using the change score as the dependent variable.

Conclusion: Overall, there is a need for adequate reporting in studies of prognostic factors for change in memory test performance. Because of inconsistencies and methodological shortcomings in the literature, conclusions regarding prognostic factors remain uncertain. As a tentative conclusion, one may say that the higher the age of the participant, the more profound the improvement in memory test performance will be after memory training.

Trial Registration: CRD42019127479.
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http://dx.doi.org/10.1186/s41512-020-0071-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240921PMC
May 2020

Lower cognitive baseline scores predict cognitive training success after 6 months in healthy older adults: Results of an online RCT.

Int J Geriatr Psychiatry 2020 09 1;35(9):1000-1008. Epub 2020 Jun 1.

Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.

Background: Identifying predictors for general cognitive training (GCT) success in healthy older adults has many potential uses, including aiding intervention and improving individual dementia risk prediction, which are of high importance in health care. However, the factors that predict training improvements and the temporal course of predictors (eg, do the same prognostic factors predict training success after a short training period, such as 6 weeks, as well as after a longer training period, such as 6 months?) are largely unknown.

Methods: Data (N = 4,184 healthy older individuals) from two arms (GCT vs. control) of a three-arm randomized controlled trial were reanalyzed to investigate predictors of GCT success in five cognitive tasks (grammatical reasoning, spatial working memory, digit vigilance, paired association learning, and verbal learning) at three time points (after 6 weeks, 3 months, and 6 months of training). Possible investigated predictors were sociodemographic variables, depressive symptoms, number of training sessions, cognitive baseline values, and all interaction terms (group*predictor).

Results: Being female was predictive for improvement in grammatical reasoning at 6 weeks in the GCT group, and lower cognitive baseline scores were predictive for improvement in spatial working memory and verbal learning at 6 months.

Conclusion: Our data indicate that predictors seem to change over time; remarkably, lower baseline performance at study entry is only a significant predictor at 6 months training. Possible reasons for these results are discussed in relation to the compensation hypothesis. J Am Geriatr Soc 68:-, 2020.
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http://dx.doi.org/10.1002/gps.5322DOI Listing
September 2020

Gender-Specific Aspects of Health Literacy: Perceptions of Interactions with Migrants among Health Care Providers in Germany.

Int J Environ Res Public Health 2020 03 25;17(7). Epub 2020 Mar 25.

Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany.

Health literacy can be described as a complex process shaped by individual resources and preferences and by the nature and quality of health-related information people encounter. The main objective of this study was to explore the views of health care professionals on how gender as a personal determinant of health literacy affected their interactions with migrant patients. The interrelated challenges, needs and applied solutions were analyzed from a health literacy perspective. Five focus group discussions with health care professionals working with migrants ( = 31) were conducted in Cologne, Germany, audio recorded, transcribed and analyzed by qualitative content analysis. Gender-specific aspects, such as the gender of health care providers as a factor, were portrayed above all in relation to patients from Turkey and Arab countries regarding access to and understanding of health-related information. These statements exclusively represent the possibly biased or assumptions-based perspectives of health care professionals on their migrant patients and were made against the background of a systemic lack of time and the challenge of overcoming language barriers. Especially in this context, reducing time pressure and improving communication in the treatment setting may be to the benefit of all actors within healthcare.
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http://dx.doi.org/10.3390/ijerph17072189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177965PMC
March 2020

Concordance of Mini-Mental State Examination, Montreal Cognitive Assessment and Parkinson Neuropsychometric Dementia Assessment in the classification of cognitive performance in Parkinson's disease.

J Neurol Sci 2020 May 13;412:116735. Epub 2020 Feb 13.

Clinic and Polyclinic for Neurology, University Hospital Cologne, University of Cologne, Cologne, Germany.

Background: Cognitive impairment (CI) is frequently observed in Parkinson's disease (PD) and negatively influences the patient's and carer's quality of life. As a first step, assessment of CI is often accomplished by using screening instruments (level I diagnosis). Three commonly used instruments are the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Parkinson Neuropsychometric Dementia Assessment (PANDA). Because different preferences regarding test selection exist between clinics, this study aims to provide evidence about the concordance of these tests. It also converts total test scores of the three instruments to assist clinical practice.

Methods: Between January and December 2018, 96 patients with idiopathic PD were examined at the University Hospital of Cologne, Germany. Comparability of MMSE, MoCA, and PANDA scores was investigated by calculating correlations, classification agreements, and percentile ranks. Additionally, we converted test scores among the three screening instruments by implementing the equipercentile equating method and log-linear smoothing.

Results: The MMSE classified 26%, the PANDA 32.3% and the MoCA 54.2% of PD patients as having CI. The screening instruments' concordance in classifying cognition into normal cognition versus CI was 75% (AC1 = 0.62) for MMSE and PANDA, 63.5% (AC1 = 0.28) for MoCA and PANDA, and 57.3% (AC1 = 0.24) for MMSE and MoCA. The provided conversion table enables a quick and easy transformation of the three screening instruments within PD diagnostics.

Conclusion: These results contribute to a better understanding of the screenings' utility and concordance in a population of PD patients. Additionally, communication between clinics may be enhanced.
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http://dx.doi.org/10.1016/j.jns.2020.116735DOI Listing
May 2020

Effects of working memory training in patients with Parkinson's disease without cognitive impairment: A randomized controlled trial.

Parkinsonism Relat Disord 2020 03 11;72:13-22. Epub 2020 Feb 11.

Department of Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostic and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpenerstr. 62, 50937, Cologne, Germany. Electronic address:

Objective: To determine the feasibility and evaluate effects of a computerized working memory (WM) training (WMT) in patients with Parkinson's Disease (PD) on cognitive and clinical outcomes.

Methods: 76 patients with PD without cognitive impairment were randomized to either the WMT group (n = 37), who participated in a 5-week adaptive WMT, or a passive waiting-list control group (CG, n = 39). Patients underwent clinical and neuropsychological examination at baseline, after training, and at 3-months follow-up, with verbal WM and non-verbal WM as primary outcomes. Outcome assessors were blinded for group allocation.

Results: All WMT participants completed the training successfully and reported high levels of motivation for and satisfaction with the training. Repeated-measures, linear mixed-effects models revealed positive training effects for the WMT group compared to the CG in verbal working memory with a small relative effect size 0.39 [95%CI 0.05; 0.76] for the 3-months follow-up only. No other reliable training effects in cognitive and clinical variables were found for either point of time.

Conclusions: In this randomized controlled trial, WMT was feasible and yielded some evidence for 3-months follow-up training gains in patients with PD. WMT might be an effective intervention to prevent cognitive decline in this patient group, however, more longitudinal studies with longer follow-up periods and more sensitive assessment tools will have to proof this concept.

Trial Registration: German Clinical Trials Register (DRKS00009379).
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http://dx.doi.org/10.1016/j.parkreldis.2020.02.002DOI Listing
March 2020

Effects of Home-Based Working Memory Training on Visuo-Spatial Working Memory in Parkinson's Disease: A Randomized Controlled Trial.

J Cent Nerv Syst Dis 2020 16;12:1179573519899469. Epub 2020 Jan 16.

Multimodal Neuroimaging Group, Department of Nuclear Medicine, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Cologne, Germany.

Background: Cognitive impairment is a very frequent and severe nonmotor symptom of Parkinson's disease (PD). Early intervention in this at-risk group for cognitive decline may be crucial for long-term preservation of cognitive functions. Computerized working memory training (WMT) has been proven beneficial in non-PD patient populations, but such evidence is still needed for patients with PD.

Objective: This study aimed to evaluate the effect of WMT on visuo-spatial working memory (WM) in cognitively unimpaired patients with PD.

Methods: A single-blind randomized controlled trial encompassing 76 patients with PD but no cognitive impairment according to level II diagnostic criteria was conducted. Thirty-seven patients engaged in home-based adaptive WMT 5 times per week for a period of 5 weeks, whereas the remaining patients were in the waiting list arm of the study (control group [CG]). Working memory performance was evaluated using a computerized task before and after intervention and at 14-week follow-up, allowing to quantify the precision of WM on a continuous scale, ie, to test not only if an item was remembered but also how well the location of this item was retained.

Results: Coincidently, the WMT group showed slightly worse WM performance compared with the CG at baseline, which was ameliorated after WMT. This training-induced effect remained stable until follow-up.

Conclusion: Patients showing relatively low WM performance, despite not formally diagnosable as Parkinson's disease with mild cognitive impairment (PD-MCI), seem to benefit from home-based WMT. Thus, WMT could potentially be implemented in future trials as a time- and cost-efficient route to counteract subtle cognitive changes in early disease stages.

Trial Registration: German Clinical Trial Register (drks.de, DRKS00009379).
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http://dx.doi.org/10.1177/1179573519899469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966247PMC
January 2020

Prominence marking in parkinsonian speech and its correlation with motor performance and cognitive abilities.

Neuropsychologia 2020 02 16;137:107306. Epub 2019 Dec 16.

University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, 50937, Köln, Germany. Electronic address:

Objectives: Research suggests that people with Parkinson's disease (PwPD) do not only suffer from motor but also non-motor impairment. This interdisciplinary study investigated how prominence marking is influenced by problems on the motoric and cognitive level.

Materials And Methods: We collected speech production data from 38 native German speakers: 19 PwPD (under medication) with a mild to moderate motor impairment, 13 males and 6 females (mean 66.2 years old, SD = 7.7), and 19 healthy age- and gender-matched control participants (mean 65.4 years old, SD = 9.3). Target words were produced in an accented and unaccented condition within a speech production task. The data were analyzed for intensity, syllable duration, F0 and vowel production. Furthermore, we assessed motor impairment and cognitive functions, i.e. working memory, task-switching, attention control and speed of information processing.

Results: Both groups were able to mark prominence by increasing pitch, syllable duration and intensity and by adjusting their vowel production. Comparisons between PwPD and control participants revealed that the vowel space was smaller in PwPD even in mildly impaired speakers. Further, task-switching as an executive function, which was tested with the trail making test, was correlated with modulation of F0 and intensity in PwPD: the worse the task-switching performance, the stronger intensity and F0 were modulated (target overshoot). Moreover, motor impairment within the PwPD group was related to a decrease in the acoustic vowel space (target undershoot), which further resulted in a decrease in speech intelligibility and naturalness. This behaviour of target over- and undershoot indicates an inefficient way of prominence marking in PwPD with mildly affected speech.

Conclusion: PwPD with signs of mild dysarthria did not differ from the control speakers with respect to their strategies of prominence marking. However, only the PwPD overused F0 and intensity in prominent positions. Overmodulation of F0 and intensity was correlated with the patient's task-switching ability and reflected abnormalities in the regulatory mechanism for expressing prosodic prominence. This is the first study to report a link between cognitive skills and speech production at the phonetic level in PwPD.
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http://dx.doi.org/10.1016/j.neuropsychologia.2019.107306DOI Listing
February 2020

Longitudinal brain atrophy distribution in advanced Parkinson's disease: What makes the difference in "cognitive status" converters?

Hum Brain Mapp 2020 04 2;41(6):1416-1434. Epub 2019 Dec 2.

Department of Neurology, University of Ulm, Ulm, Germany.

We investigated the brain atrophy distribution pattern and rate of regional atrophy change in Parkinson's disease (PD) in association with the cognitive status to identify the morphological characteristics of conversion to mild cognitive impairment (MCI) and dementia (PDD). T1-weighted longitudinal 3T MRI data (up to four follow-up assessments) from neuropsychologically well-characterized advanced PD patients (n = 172, 8.9 years disease duration) and healthy elderly controls (n = 85) enrolled in the LANDSCAPE study were longitudinally analyzed using a linear mixed effect model and atlas-based volumetry and cortical thickness measures. At baseline, PD patients presented with cerebral atrophy and cortical thinning including striatum, temporoparietal regions, and primary/premotor cortex. The atrophy was already observed in "cognitively normal" PD patients (PD-N) and was considerably more pronounced in cognitively impaired PD patients. Linear mixed effect modeling revealed almost similar rates of atrophy change in PD and controls. The group comparison at baseline between those PD-N whose cognitive performance remained stable (n = 42) and those PD-N patients who converted to MCI/PDD ("converter" cPD-N, n = 26) indicated suggested cortical thinning in the anterior cingulate cortex in cPD-N patients which was correlated with cognitive performance. Our results suggest that cortical brain atrophy has been already expanded in advanced PD patients without overt cognitive deficits while atrophy progression in late disease did not differ from "normal" aging regardless of the cognitive status. It appears that cortical atrophy begins early and progresses already in the initial disease stages emphasizing the need for therapeutic interventions already at disease onset.
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http://dx.doi.org/10.1002/hbm.24884DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7267933PMC
April 2020

Fatigue and depression predict health-related quality of life in patients with pediatric-onset multiple sclerosis.

Mult Scler Relat Disord 2019 Nov 9;36:101368. Epub 2019 Aug 9.

Department of Pediatrics, Child and Adolescent Psychosomatics, Technische Universität München, Heigelhofstr. 63, 81377 Munich, Germany.

Background: Fatigue, depression and loss in health-related quality of life (HRQoL) have been reported to occur in a substantial amount of patients with pediatric-onset MS (POMS). This study aims to evaluate depression, fatigue and HRQoL and its relationship in a cohort of patients with POMS and matched healthy controls (HCs).

Methods: In a multicenter cross-sectional study, Beck Depression Inventory II, Depressionstest für Kinder, the Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core Scale and the PedsQL™ Multidimensional Fatique Scale were performed.

Results: In a cohort of 106 patients with POMS and 210 matched HCs, patients were significantly more often depressed (21.7% vs. 11.4%, p = 0.014) experienced greater fatigue (40.6% vs. 17.3%, p < 0.001) and a greater loss of HRQoL (43.4% vs. 15%, p < 0.001) than controls. Depression predicted 51.8% of variance of fatigue. Fatigue was also predicted by female gender. Loss of HRQoL was predicted by EDSS, depression and fatigue. Depression and fatigue together explained 67.7% of variance of HRQoL.

Conclusion: Patients with POMS are at a significant increased risk for depression, fatigue and loss of HRQoL. Furthermore, fatigue and depression significantly predict reduced HRQoL in POMS, suggesting that testing for these symptoms and early therapy is of utmost importance in all patients with POMS.
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http://dx.doi.org/10.1016/j.msard.2019.08.010DOI Listing
November 2019

[Development of "Cologne Culture ADL" for dementia diagnosis in individuals with Turkish migration background and in German patients].

Fortschr Neurol Psychiatr 2019 Sep 13;87(9):504-510. Epub 2019 Sep 13.

Uniklinik Köln, Medizinische Psychologie | Neuropsychologie und Gender Studies & Centrum für Neuropsychologische Diagnostik und Intervention (CeNDI).

Background:  Neuropsychological dementia diagnosis of migrants are limited regarding the testing of cognitive abilities as well as the recording of everyday activities (Activities of Daily Living, ADL) such as linguistic, educational, lifestyle and cultural-religious factors have not been taken into account in psychometric instruments.

Aim Of The Study:  We aimed to develop a culturally sensitive ADL scale, which is suitable for both German people and Turkish migrants that takes into consideration gender, cultural-religious and lifestyle aspects. A further aim was to determine the quality criteria for the newly proposed ADL scale.

Methods:  After the initial phase, including qualitative interviews (N = 15) with cognitively unimpaired German participants and Turkish migrants, a first version of the ADL instrument was developed. This version was then completed by cognitively unimpaired Germans (n = 197) and Turkish participants (n = 53) and the shortened ADL scale was generated based on an item analysis. It consisted of the three subscales 'cognition', 'Basic Activities of Daily Living (BADL)' and 'Instrumental Activities of Daily Living (IADL)'. For Turkish participants, questions about Islamic prayers were added. Montreal Cognitive Assessment (MoCA) and Geriatric Depression Scale (GDS) were applied to rule out cognitive impairment and depression. The 'Bayer-ADL' was used to measure the validity of the scale.

Results:  The everyday life of Germans and Turkish migrants differs in aspects of religious practice and in terms of sociocultural activities, which are taken into account in the CC-ADL. The reliability of the new ADL scale in terms of internal consistency (Cronbach's alpha) were regarding 'cognition' α = .43 for Germans and α = .80 for Turkish migrants; 'BADL' α = .55 for Germans and α = -.04 for Turkish migrants; 'IADL' α = .91 for Germans and α = .83 for Turkish migrants and α = .73 for Turkish migrants under the 'prayer items'. The correlation of the ADL total score with the Bayer ADL for Germans was ρ = .347 (p < .00) and for the Turkish sample ρ = .520 (p < .01).

Conclusion:  The development of a final version of the CC-ADL scale requires further data from healthy participants and patients (Mild Cognitive Impairment and dementia).
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http://dx.doi.org/10.1055/a-0877-6945DOI Listing
September 2019

Deficient allo-centric visuospatial processing contributes to apraxic deficits in sub-acute right hemisphere stroke.

J Neuropsychol 2020 06 17;14(2):242-259. Epub 2019 Jun 17.

Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany.

While visuospatial deficits are well-characterized cognitive sequelae of right hemisphere (RH) stroke, apraxic deficits in RH stroke remain poorly understood. Likewise, very little is known about the association between apraxic and visuospatial deficits in RH stroke or about the putative common or differential pathophysiology underlying these deficits. Therefore, we examined the behavioural and lesion patterns of apraxic deficits (pantomime of object use and bucco-facial imitation) and visuospatial deficits (line bisection and letter cancellation tasks) in 50 sub-acute RH stroke patients. Using principal component analysis (PCA), we characterized the relationship between the two deficits. We hypothesized that any interaction of these neuropsychological measures may be influenced by the demands of ego-centric/space-based and/or allo-centric/object-based processing. Contralesional visuospatial deficits were common in our clinically representative patient sample, affecting more than half of RH stroke patients. Furthermore, about one-third of all patients demonstrated apraxic deficits. PCA revealed that pantomiming and the imitation of bucco-facial gestures loaded clearly on a first component (PCA1), while letter cancellation loaded heavily on a second component (PCA2). For line bisection, overall mean deviation loaded on PCA1, while the difference between the mean deviations in contra- versus ipsilesional space loaded on PCA2. These results suggest that PCA1 represents allo-centric/object-based processing and PCA2 ego-centric/space-based processing. This interpretation was corroborated by the statistical lesion analyses with the component scores. Data suggest that disturbed allo-centric/object-based processing contributes to apraxic pantomime and imitation deficits in (sub-acute) RH stroke.
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http://dx.doi.org/10.1111/jnp.12191DOI Listing
June 2020

Structural brain signature of cognitive decline in Parkinson's disease: DTI-based evidence from the LANDSCAPE study.

Ther Adv Neurol Disord 2019 16;12:1756286419843447. Epub 2019 May 16.

Department of Neurology, University of Ulm, RKU, Oberer Eselsberg 45, Ulm 89081, Germany.

Background: The nonmotor symptom spectrum of Parkinson's disease (PD) includes progressive cognitive decline mainly in late stages of the disease. The aim of this study was to map the patterns of altered structural connectivity of patients with PD with different cognitive profiles ranging from cognitively unimpaired to PD-associated dementia.

Methods: Diffusion tensor imaging and neuropsychological data from the observational multicentre LANDSCAPE study were analyzed. A total of 134 patients with PD with normal cognitive function (56 PD-N), mild cognitive impairment (67 PD-MCI), and dementia (11 PD-D) as well as 72 healthy controls were subjected to whole-brain-based fractional anisotropy mapping and covariance analysis with cognitive performance measures.

Results: Structural data indicated subtle changes in the corpus callosum and thalamic radiation in PD-N, whereas severe white matter impairment was observed in both PD-MCI and PD-D patients including anterior and inferior fronto-occipital, uncinate, insular cortices, superior longitudinal fasciculi, corona radiata, and the body of the corpus callosum. These regional alterations were demonstrated for PD-MCI and were more pronounced in PD-D. The pattern of involved regions was significantly correlated with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) total score.

Conclusions: The findings in PD-N suggest impaired cross-hemispherical white matter connectivity that can apparently be compensated for. More pronounced involvement of the corpus callosum as demonstrated for PD-MCI together with affection of fronto-parieto-temporal structural connectivity seems to lead to gradual disruption of cognition-related cortico-cortical networks and to be associated with the onset of overt cognitive deficits. The increase of regional white matter damage appears to be associated with the development of PD-associated dementia.
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http://dx.doi.org/10.1177/1756286419843447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535714PMC
May 2019
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