The differential risk of oral contraceptives: the impact of full exposure history*

Previous discussions have indicated that the small increases of risk of venous thromboembolism (VTE) associated with newer combined oral contraceptives (third generation, containing desogestrel and gestodene) may be attributed to bias due to cohort effects. In a case-control analysis, this may produce an overestimate of risk of newer preparations. In 10 centres in Germany and the UK, the Transnational Study analysed data from 502 women aged 16-44 years with VTE, and from 1864 controls matched for 5-year age group and region. Information on lifetime exposure history from all subjects was added to the dataset used in previous analyses and entered into a Cox regression model with time-dependent covariates. Based on 17 622 continuous exposure episodes comprising 47 914 person-years of observation, the adjusted hazard ratio (equivalent to odds ratio, OR) of VTE for the comparison of current users of third-generation versus current users of second-generation (primarily levonorgestrel compounds) combined oral contraceptives was 0.8 (0.5 to 1.3). The OR obtained in standard case-control analysis had been 1.5 (1.1 to 2.1). Adjustment for past exposures includes more information and appears more valid than the standard cross-sectional analysis. Using this approach, the Transnational Study data show no evidence for an increased risk of VTE with third- compared with second-generation combined oral contraceptive

Altern und Demenz

Werheid K. Altern und Demenz. In: Schellig D, Heinemann D, Schächtele B, Sturm W, eds. Handbuch neuropsychologischer Testverfahren, Band 4. 1st ed. Göttingen: Hogrefe; 2023: 1003-1327

Impaired performance on the rapid visual information processing task (RVIP) could be an endophenotype of schizophrenia

The aim of the present study was to investigate whether healthy first-degree relatives of schizophrenia patients show reduced sensitivity performance, higher intra-individual variability (IIV) in reaction time (RT), and a steeper decline in sensitivity over time in a sustained attention task. Healthy first-degree relatives of schizophrenia patients (n=23) and healthy control subjects (n=46) without a family history of schizophrenia performed a demanding version of the Rapid Visual Information Processing task (RVIP). RTs, hits, false alarms, and the sensitivity index A' were assessed. The relatives were significantly less sensitive, tended to have higher IIV in RT, but sustained the impaired level of sensitivity over time. Impaired performance on the RVIP is a possible endophenotype for schizophrenia. Higher IIV in RT, apparently caused by impaired context representations, might result in fluctuations in control and lead to more frequent attentional lapses

Darstellung und Bewertung neuropsychologischer Therapieverfahren am Beispiel PC-gestützter Trainingsprogramme – ein Projekt des Arbeitskreises Aufmerksamkeit und Gedächtnis der GNP

Die Mehrzahl PC-gestützter Trainingsprogramme erhebt den Anspruch einer theoriegeleiteten Konzeption und weckt entsprechend hohe Erwartungen. Wissenschaftliche Wirksamkeitsnachweise existieren nur für wenige Verfahren. Der Arbeitskreis Aufmerksamkeit & Gedächtnis der GNP präsentiert hier die Struktur einer Programmrezension, die eine übersichtliche Zusammenfassung und transparente Bewertung von Trainingsprogrammen unter Bezug auf insgesamt 20 neuropsychologische, technische und pragmatische Kriterien erlaubt. Schließlich beschreiben wir den Aufbau eines Manuals, das für alle Kriterien die qualitäts-bestimmenden Programmeigenschaften spezifiziert und durch die Erstellung einer Rezension führt; das komplette Manual ist in diesem Heft abgedruckt. Die mit dieser Zeitschrift begonnene Veröffentlichung von Beispielrezensionen wird in loser Folge fortgesetzt

Hemispheric asymmetry in visuospatial attention assessed with transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) was used to study visuospatial attention processing in ten healthy volunteers. In a forced choice recognition task the subjects were confronted with two symbols simultaneously presented during 120 ms at random positions, one in the left and the other in the right visual field. The subject had to identify the presented pattern out of four possible combinations and to press the corresponding response key within 2 s. Double-pulse TMS (dTMS) with a 100-ms interstimulus interval (ISI) and an intensity of 80% of the stimulator output (corresponding to 110-120% of the motor threshold) was applied by a non-focal coil over the right or left posterior parietal cortex (PPC, corresponding to P3/P4 of the international 10-20 system) at different time intervals after onset of the visual stimulus (starting at 120 ms, 270 ms and 520 ms). Double-pulse TMS over the right PPC starting at 270 ms led to a significant increase in percentage of errors in the contralateral, left visual field (median: 23% with TMS vs 13% without TMS, P=0.0025). TMS applied earlier or later showed no effect. Furthermore, no significant increase in contra- or ipsilateral percentage of errors was found when the left parietal cortex was stimulated with the same timing. These data indicate that: (1) parietal influence on visuospatial attention is mainly controlled by the right lobe since the same stimulation over the left parietal cortex had no significant effect, and (2) there is a vulnerable time window to disturb this cortical process, since dTMS had a significant effect on the percentage of errors in the contralateral visual hemifield only when applied 270 ms after visual stimulus presentation

Determination of Language Dominance: Wada Test and fMRI Compared Using a Novel Sentence Task

This study aimed to develop a new linguistic based functional magnetic resonance imaging (fMRI)-sentence decision task that reliably detects hemispheric language dominance

Residual oculomotor and exploratory deficits in patients with recovered hemineglect

Several studies on hemineglect have reported that patients recover remarkably well when assessed with neuropsychological screening tests, however, they show deficits on novel or complex tasks. We investigated whether such deficits can be revealed with eye movement analysis, applying two basic oculomotor tasks as well as two exploratory tasks. Eye movements were recorded in eight hemineglect patients at least eleven months after right-hemisphere brain damage had occurred. Sixteen healthy volunteers participated in the control group. Regarding the basic oculomotor tasks, only the overlap task revealed residual deficits in patients, suggesting that a directional deficit in disengaging attention persisted during recovery. Further residual deficits were evident in the exploratory tasks. When everyday scenes were explored, patients showed a bias in early orienting towards the ipsilateral hemispace. In a search task, they demonstrated the same orienting bias as well as a non-directional deficit concerning search times. Moreover, patients preferentially fixated in the contralateral hemispace, but did not benefit from this asymmetry in terms of search times, i.e. they did not detect contralateral targets faster than ipsilateral ones. This suggests a dissociation between oculomotor processes and attentional ones. In conclusion, we have identified behavioural aspects that seem to recover slower than others. A disengagement deficit and biases in early orienting have been the most pronounced residual oculomotor deficits