Wiener klinische Wochenschrift / Assessment of individual cognitive changes after deep brain stimulation surgery in Parkinsons disease using the Neuropsychological Test Battery Vienna short version

Long-term therapy of Parkinsons disease with LDOPA is associated with a high risk of developing motor fluctuations and dyskinesia. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can improve these motor complications. Although the positive effect on motor symptoms has been proven, postoperative cognitive decline has been documented. To tackle the impact of DBS on cognition, 18 DBS patients were compared to 25 best medically treated Parkinsons patients, 24 patients with mild cognitive impairment (MCI) and 12 healthy controls using the Neuropsychological Test Battery Vienna short version (NTBV-short) for cognitive outcome 12 months after the first examination. Reliable change index methodology was used. Roughly 10% of DBS patients showed cognitive decline mainly affecting the domains attention and executive functioning (phonemic fluency). Further research is needed to identify the mechanisms that lead to improvement or deterioration of cognitive functions in individual cases.(VLID)355129

Self-reported and informant-reported memory functioning and awareness in patients with mild cognitive impairment and Alzheimers disease

Grundlagen Die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ist ein wichtiger Faktor für eine angemessene Behandlung von Patienten mit leichter kognitiver Beeinträchtigung (MCI) und Alzheimer-Krankheit (AD). Ziel der vorliegenden Studie war herauszufinden (i) ob subjektive Gedächtnisleistung und objektive Gedächtnisleistung assoziiert sind, (ii) ob sich die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung mit der Zeit verändert und (iii) ob die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ein Prädiktor für die Entwicklung einer Demenz ist. Methodik Vierunddreißig Patienten mit MCI, die Hilfe in einer universitären Gedächtnisambulanz suchten, wurden in die Studie eingeschlossen. Alle Teilnehmer wurden einer ausführlichen neuropsychologischen Untersuchung unterzogen. Die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung wurde durch Berechnung der Differenzwerte zwischen Patient und Informant Bewertung auf einem 16-Punkt-Fragebogen hinsichtlich Gedächtnisbeschwerden im täglichen Leben erhalten. Eine Kontrolluntersuchung wurde nach einer mittleren Nachbeobachtungszeit von 24 Monaten durchgeführt. Ergebnisse Die Analyse zeigte, dass die Einsicht (Awareness) hinsichtlich der Erinnerungsleistung relativ stabil über die Zeit blieb. Selbst berichtete Gedächtnisbeschwerden korrelierten mit der episodischen Gedächtnisleistung zu Beginn der Studie und mit der Leistung bei einer Sprachaufgabe bei der Nachuntersuchung. Wiederholungsprüfungen angezeigt Rückgang des Bewusstseins. Der prädiktive Wert der Einsicht (Awareness) hinsichtlich der Erinnerungsleistung in Bezug auf die Demenzentwicklung war gering. Schlussfolgerungen Einsicht (Awareness) hinsichtlich der Erinnerungsleistung ist mit episodischer Gedächtnis-Funktion verknüpft und nimmt mit Abnahme der kognitiven Fähigkeiten ab. Weitere Studien zur Vorhersagekraft der Einsicht (Awareness) hinsichtlich der Erinnerungsleistung sollten eine größere Patientenstichprobe umfassen.Awareness of subjective memory is an important factor for adequate treatment of patients with mild cognitive impairment (MCI) and Alzheimers 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.(VLID)347208

Best logistic regression models for the sleep status for each subgroup.

<p>aMCI = amnestic MCI, naMCI = non-amnestic MCI, SCD = subjective cognitive decline, MMSE = Mini Mental State Examination, BDI-II = Beck Depression Inventory</p><p>Best logistic regression models for the sleep status for each subgroup.</p

Relative frequency of good (black) and bad (white) sleepers in each group of patients with similar BDI scores.

<p>The number of patients is shown above the bars and the range of BDI score for each subgroup is shown below the bars.</p

Pairwise comparison of MMSE, BDI and PSQI (sub-)scores between aMCI-, naMCI-, SCD patients and controls.

<p>aMCI = amnestic MCI, naMCI = non-amnestic MCI, SCD = subjective cognitive decline, MMSE = Mini Mental State Examination, BDI-II = Beck Depression Inventory, PSQI = Pittsburgh Sleep Quality Index, p adj Tukey HSD = adjusted p-values for post-hoc Tukey’s HSD, CI = 95% confidence interval.</p><p>Pairwise comparison of MMSE, BDI and PSQI (sub-)scores between aMCI-, naMCI-, SCD patients and controls.</p

Best logistic regression model for the sleep status among the whole sample.

<p>BDI-II = Beck Depression Inventory</p><p>Best logistic regression model for the sleep status among the whole sample.</p

Spearman correlation coefficients for the whole sample between PSQI total scores and neuropsychological subdomains.

<p>Cc = correlation coefficient; AKT = Alters-Konzentrations-Test; WAIS-R = Wechsler Adult Intelligence Scale—Revised; TMTA = Trail Making Test Version A; TMTB = Trail Making Test Version B; NAI = Nürnberger Alters Inventar; C.I. = Cerebral Insufficiency Test; VSRT = Verbal Selective Reminding Test; mBNT = modified Boston Naming Test.</p><p>Spearman correlation coefficients for the whole sample between PSQI total scores and neuropsychological subdomains.</p

Best linear regression model for PSQI score among the whole sample.

<p>MMSE = Mini Mental State Examination, BDI-II = Beck Depression Inventory</p><p>Best linear regression model for PSQI score among the whole sample.</p

Best linear regression models for PSQI score for each subgroup.

<p>aMCI = amnestic MCI, naMCI = non-amnestic MCI, SCD = subjective cognitive decline, MMSE = Mini Mental State Examination, BDI-II = Beck Depression Inventory</p><p>Best linear regression models for PSQI score for each subgroup.</p