Da die Lebenserwartung in den westlichen industrialisierten Landern stetig steigt, steigt die Anz... more Da die Lebenserwartung in den westlichen industrialisierten Landern stetig steigt, steigt die Anzahl der alteren Mitburger unserer Gesellschaft. Hierdurch erhoht sich auch progressiv das Auftreten der haufigsten psychiatrischen Erkrankungen im Alter, wie z. B. der degenerativen und vaskularen Demenzen. Da eine therapeutische Hilfe bei der Demenz vom Alzheimer Typ (DAT) wahrscheinlich nur in fruhen Stadien der Erkrankung Erfolgsaussichten hat, ist eine rechtzeitige Diagnose im Fruhstadium von groser Bedeutung [10]. Trotz intensiver Bemuhungen ist es nicht gelungen, einen fruhen und zuverlassigen Marker fur DAT zu finden.
Die Digitalisierung erfasst heute alle Facetten des Alltags und hat auch im Gesundheitswesen Einz... more Die Digitalisierung erfasst heute alle Facetten des Alltags und hat auch im Gesundheitswesen Einzug gehalten. Die Pflege hat gezeigt, dass sie sich auf neue Entwicklungen einstellen kann. Digitale Innovationen wie Monitorsysteme und Service-Roboter schaffen Entlastung – gerade im Hinblick auf eine immer älter werdende Gesellschaft. Eine Technik, die sowohl Pflegebedürftigen als auch Pflegenden viel Sicherheit und Mobilität bieten kann, ist der GPS-Tracker. Doch es gibt nicht nur Vorteile beim Einsatz dieses Systems.
As a means of obtaining information on the CNS action of psychotropic drugs, we studied the topog... more As a means of obtaining information on the CNS action of psychotropic drugs, we studied the topographic distribution of brain electrical activity before and after administration of phosphatidylserine in normal volunteers
As early as 1936 Lemere published reports of EEG changes in schizophrenic patients which showed a... more As early as 1936 Lemere published reports of EEG changes in schizophrenic patients which showed a reduction of alpha rhythm. This was 1 year before Berger himself described an EEG recording of a 17-year-old schizophrenic patient who exhibited prominent beta activity. Berger interpreted beta waves as “material concomitant of cognitive processes”. The large number of reports about EEG alterations, which cannot be reviewed in detail here, described more or less similar peculiarities in schizophrenics, such as “disorganized EEG’s dominated by choppy activity” (Ellingson 1954). Attempts to quantify EEG data go back to 1932, when Dietsch described a Fourier analysis of human EEG, and 1939, when Gibbs used an analogue frequency analyzer to investigate cortical frequency spectra of schizophrenic individuals. The quantitative procedure was able to verify the former descriptive and qualitative EEG findings. The development of small digital computers and the fast Fourier transform algorithm (Cooley and Tukey 1965) have made real quantitative frequency analysis of the EEG technically feasible. Worthy of mention in this context are the frequency profiles of schizophrenic patients made by Itil etal. (1972), who confirmed an appearance of excessive fast activity along with some slow waves and the lack of alpha activity. The more recent quantitative studies have been reviewed by Itil (1978).
EEG segmentation can be used to measure altered brain function in aging and diseases of the brain... more EEG segmentation can be used to measure altered brain function in aging and diseases of the brain. The parameter ‘number of different segments’ makes clear how many different potential fields are involved in brain activity during a given period of time. It should represent effects of aging and disease. To prove this assumption, 11 young and 10 aged controls, 12 patients with mild dementia of the Alzheimer type (DAT), 10 young and 12 aged patients with endogenous depression were included in the study. The number of different segments in the beta frequency band between 16 and 19.75 Hz was measured according to the theory of Lehmann et al. [Clinical Neurophysiology 1987;67:271–288], and the segments were classified by their location on the scalp. The Mann-Whitney U test was used for statistical comparison. Aged controls had more different segments than young controls (n = 21, U = 14, p < 0.0038). Patients with DAT had less different segments than healthy aged controls (n = 22, U = 18.5, p < 0.0061). Aged patients with endogenous depression had more different segments than patients with mild DAT (n = 24, U = 32, p < 0.021). The reduction of the number of different segments in DAT compared to controls and patients suffering from depression may be helpful for differential diagnosis. The higher number of different segments in aged versus young controls could be interpreted as a sign of increased complexity in the aged brain.
Previous studies suggested that EGb 761® may be more effective when dementia is associated with n... more Previous studies suggested that EGb 761® may be more effective when dementia is associated with neuropsychiatric features. To find out whether treatment effects correlate with neuropsychiatric symptom burden at baseline, retrospective analyses of data from a 24-week randomized, placebo-controlled, double-blind clinical trial of EGb 761® (240 mg once daily) were performed. 410 outpatients with mild to moderate AD, VaD or AD with cerebrovascular disease, each associated with neuropsychiatric features, were enrolled. Patients scored 5 or above on the NPI, with at least one item score being ≥3, and between 9 and 23 on the SKT cognitive test battery. Correlations between the NPI composite score at baseline and other efficacy variables were calculated. Regression analyses with the NPI composite score as regressor and efficacy variables as dependent variables were performed. Correlations between changes from baseline and NPI baseline scores were weak to modest, but conspicuously different between active drug and placebo groups. The slopes of the regression lines for the EGb 761® and the placebo groups showed qualitative and statistically significant differences: With increasing NPI baseline scores there was faster deterioration in the placebo group and thus more net benefit from treatment for the EGb 761® group.
The event-related potential P300 probably reflects the encoding of information into short-term me... more The event-related potential P300 probably reflects the encoding of information into short-term memory. Anatomical structures of the limbic system are involved in this process. Since the same structures are involved in the generation of the event-related potential P300, P300 is thus well suited to assess pharmacological influence on memory functions and cognitive processes, for example, by changing the availability of neurotransmitters like acetylcholine at their respective receptors.
Since Berger described the human EEG in 1929 (Berger 1929) clinicians as well as researchers have... more Since Berger described the human EEG in 1929 (Berger 1929) clinicians as well as researchers have attempted to conceptualize electrical activity of the brain as a reflection of mental processes. Due to recent advances in computer software and hardware it is now possible to sample more electrical information from the brain and make the concept of the EEG as an electrical brain mirror tangible. However, the increasing amount of data make a sensible interpretation of the data difficult. One way to reduce data in a reasonable way is to calculate equivalent dipoles, which describe the electrical activity of the brain as one or more dipoles generating the electrical field over the surface of the scalp. The calculation of dipoles have mostly been accomplished in the time domain, for example, epileptic discharges or evoked potentials. For the investigation of psychiatric diseases, however, the analysis of frequency bands is of higher interest than an analysis of the time domain.
Physostigmine, an inhibitor of acetylcholine esterase activates brain function by an increase in ... more Physostigmine, an inhibitor of acetylcholine esterase activates brain function by an increase in acetylcholine. Brofaromine, a selective reversible MAO-A inhibitor activates by reducing the turnover of catecholamines like norepinephrine. Because these substances act selectively via two different neurotransmitter pathways, distinct alterations in electrical brain activity might be induced. In the present experiment, relative amount of power in EEG was investigated. 6 young male students agreed to participate in this double blind study with three substances (placebo, 1 mg physostigmine, 50mg brofaromine) in a latin square design. 0.5 mg glycopyrrulate blocked peripheral side effects of physostigmine. The interval between each measurement was one week. Electrical brain activity was measured with 19 electrodes placed according to the 10-20 system before, 30, 60, 90, and 120 min after application of the drugs. After Fourier transformation, percentage of power was calculated for six four Hz steps between 0 and 23.5 Hz. Only alpha power was used for statistical analysis with Friedman test. The maximum of alterations was seen between 30 and 60 min after application of the drugs. The percentage of alpha power differed significantly under the three treatments (N = 6, k= 3, chi-square--9.33, p =0.0055). Highest values for alpha power were found under brofaromine treatment (Fig. 1). An increase of alpha power was not seen after physostigmine compared to placebo.
The P300 wave undergoes alterations during physiological aging showing lower amplitudes and longe... more The P300 wave undergoes alterations during physiological aging showing lower amplitudes and longer latencies in geriatric controls. By means of topographical display of P300-data it could be shown that the topography with maximal positivity at parietal sites is maintained in aging. In patients, however, suffering from senile dementia of Alzheimer's type signs of a frontal elevation and a parietal decrement of P300 amplitudes could be observed. The findings can be interpreted firstly as an indication that the frontal lobe is less effected. On the other side if a hippocampal dipole is assumed a neuronal lesion could lead to a turn of this dipole with the result of a now frontally located positivity.
was 20 points. The control group consisted of 21 people (6 males and 15 females, average age of 7... more was 20 points. The control group consisted of 21 people (6 males and 15 females, average age of 74.1, average MMSE score was 28). We measured the psychological symptoms using the Japanese version of Neuropsychiatric Inventory-Nursing Home Version (NPI). We used 3.0T magnetic resonance imaging and voxel-based morphometry to analyze the relationship between the psychological symptoms and the atrophy of the brain. Results: The most frequent symptoms in the NPI subscores were apathy, depression, anxiety, sleep disturbance, irritability/lability, and agitation/aggression. More than half of the subjects from the AD group with anxiety or irritability/lability or apathy had multiple BPSD.The psychological symptoms related with the amygdala atrophy were anxiety (left and right amygdala, right hippocampus, right and left uncus, right parahippocampal gyrus), irritability/lability (right amygdala, right hippocampus, left and right parahippocampal gyrus) and apathy(left amygdala, right hippocampus, left parahippocampal gyrus, right uncus). Conclusions: It is possible that the atrophy of the amygdala may influence the role of the amygdala in the emotion and BPSD of the patients with AD, such as anxiety, irritability/lability and apathy. From these results, we must establish the effective care to BPSD, considering the disability of the brain.
Da die Lebenserwartung in den westlichen industrialisierten Landern stetig steigt, steigt die Anz... more Da die Lebenserwartung in den westlichen industrialisierten Landern stetig steigt, steigt die Anzahl der alteren Mitburger unserer Gesellschaft. Hierdurch erhoht sich auch progressiv das Auftreten der haufigsten psychiatrischen Erkrankungen im Alter, wie z. B. der degenerativen und vaskularen Demenzen. Da eine therapeutische Hilfe bei der Demenz vom Alzheimer Typ (DAT) wahrscheinlich nur in fruhen Stadien der Erkrankung Erfolgsaussichten hat, ist eine rechtzeitige Diagnose im Fruhstadium von groser Bedeutung [10]. Trotz intensiver Bemuhungen ist es nicht gelungen, einen fruhen und zuverlassigen Marker fur DAT zu finden.
Die Digitalisierung erfasst heute alle Facetten des Alltags und hat auch im Gesundheitswesen Einz... more Die Digitalisierung erfasst heute alle Facetten des Alltags und hat auch im Gesundheitswesen Einzug gehalten. Die Pflege hat gezeigt, dass sie sich auf neue Entwicklungen einstellen kann. Digitale Innovationen wie Monitorsysteme und Service-Roboter schaffen Entlastung – gerade im Hinblick auf eine immer älter werdende Gesellschaft. Eine Technik, die sowohl Pflegebedürftigen als auch Pflegenden viel Sicherheit und Mobilität bieten kann, ist der GPS-Tracker. Doch es gibt nicht nur Vorteile beim Einsatz dieses Systems.
As a means of obtaining information on the CNS action of psychotropic drugs, we studied the topog... more As a means of obtaining information on the CNS action of psychotropic drugs, we studied the topographic distribution of brain electrical activity before and after administration of phosphatidylserine in normal volunteers
As early as 1936 Lemere published reports of EEG changes in schizophrenic patients which showed a... more As early as 1936 Lemere published reports of EEG changes in schizophrenic patients which showed a reduction of alpha rhythm. This was 1 year before Berger himself described an EEG recording of a 17-year-old schizophrenic patient who exhibited prominent beta activity. Berger interpreted beta waves as “material concomitant of cognitive processes”. The large number of reports about EEG alterations, which cannot be reviewed in detail here, described more or less similar peculiarities in schizophrenics, such as “disorganized EEG’s dominated by choppy activity” (Ellingson 1954). Attempts to quantify EEG data go back to 1932, when Dietsch described a Fourier analysis of human EEG, and 1939, when Gibbs used an analogue frequency analyzer to investigate cortical frequency spectra of schizophrenic individuals. The quantitative procedure was able to verify the former descriptive and qualitative EEG findings. The development of small digital computers and the fast Fourier transform algorithm (Cooley and Tukey 1965) have made real quantitative frequency analysis of the EEG technically feasible. Worthy of mention in this context are the frequency profiles of schizophrenic patients made by Itil etal. (1972), who confirmed an appearance of excessive fast activity along with some slow waves and the lack of alpha activity. The more recent quantitative studies have been reviewed by Itil (1978).
EEG segmentation can be used to measure altered brain function in aging and diseases of the brain... more EEG segmentation can be used to measure altered brain function in aging and diseases of the brain. The parameter ‘number of different segments’ makes clear how many different potential fields are involved in brain activity during a given period of time. It should represent effects of aging and disease. To prove this assumption, 11 young and 10 aged controls, 12 patients with mild dementia of the Alzheimer type (DAT), 10 young and 12 aged patients with endogenous depression were included in the study. The number of different segments in the beta frequency band between 16 and 19.75 Hz was measured according to the theory of Lehmann et al. [Clinical Neurophysiology 1987;67:271–288], and the segments were classified by their location on the scalp. The Mann-Whitney U test was used for statistical comparison. Aged controls had more different segments than young controls (n = 21, U = 14, p < 0.0038). Patients with DAT had less different segments than healthy aged controls (n = 22, U = 18.5, p < 0.0061). Aged patients with endogenous depression had more different segments than patients with mild DAT (n = 24, U = 32, p < 0.021). The reduction of the number of different segments in DAT compared to controls and patients suffering from depression may be helpful for differential diagnosis. The higher number of different segments in aged versus young controls could be interpreted as a sign of increased complexity in the aged brain.
Previous studies suggested that EGb 761® may be more effective when dementia is associated with n... more Previous studies suggested that EGb 761® may be more effective when dementia is associated with neuropsychiatric features. To find out whether treatment effects correlate with neuropsychiatric symptom burden at baseline, retrospective analyses of data from a 24-week randomized, placebo-controlled, double-blind clinical trial of EGb 761® (240 mg once daily) were performed. 410 outpatients with mild to moderate AD, VaD or AD with cerebrovascular disease, each associated with neuropsychiatric features, were enrolled. Patients scored 5 or above on the NPI, with at least one item score being ≥3, and between 9 and 23 on the SKT cognitive test battery. Correlations between the NPI composite score at baseline and other efficacy variables were calculated. Regression analyses with the NPI composite score as regressor and efficacy variables as dependent variables were performed. Correlations between changes from baseline and NPI baseline scores were weak to modest, but conspicuously different between active drug and placebo groups. The slopes of the regression lines for the EGb 761® and the placebo groups showed qualitative and statistically significant differences: With increasing NPI baseline scores there was faster deterioration in the placebo group and thus more net benefit from treatment for the EGb 761® group.
The event-related potential P300 probably reflects the encoding of information into short-term me... more The event-related potential P300 probably reflects the encoding of information into short-term memory. Anatomical structures of the limbic system are involved in this process. Since the same structures are involved in the generation of the event-related potential P300, P300 is thus well suited to assess pharmacological influence on memory functions and cognitive processes, for example, by changing the availability of neurotransmitters like acetylcholine at their respective receptors.
Since Berger described the human EEG in 1929 (Berger 1929) clinicians as well as researchers have... more Since Berger described the human EEG in 1929 (Berger 1929) clinicians as well as researchers have attempted to conceptualize electrical activity of the brain as a reflection of mental processes. Due to recent advances in computer software and hardware it is now possible to sample more electrical information from the brain and make the concept of the EEG as an electrical brain mirror tangible. However, the increasing amount of data make a sensible interpretation of the data difficult. One way to reduce data in a reasonable way is to calculate equivalent dipoles, which describe the electrical activity of the brain as one or more dipoles generating the electrical field over the surface of the scalp. The calculation of dipoles have mostly been accomplished in the time domain, for example, epileptic discharges or evoked potentials. For the investigation of psychiatric diseases, however, the analysis of frequency bands is of higher interest than an analysis of the time domain.
Physostigmine, an inhibitor of acetylcholine esterase activates brain function by an increase in ... more Physostigmine, an inhibitor of acetylcholine esterase activates brain function by an increase in acetylcholine. Brofaromine, a selective reversible MAO-A inhibitor activates by reducing the turnover of catecholamines like norepinephrine. Because these substances act selectively via two different neurotransmitter pathways, distinct alterations in electrical brain activity might be induced. In the present experiment, relative amount of power in EEG was investigated. 6 young male students agreed to participate in this double blind study with three substances (placebo, 1 mg physostigmine, 50mg brofaromine) in a latin square design. 0.5 mg glycopyrrulate blocked peripheral side effects of physostigmine. The interval between each measurement was one week. Electrical brain activity was measured with 19 electrodes placed according to the 10-20 system before, 30, 60, 90, and 120 min after application of the drugs. After Fourier transformation, percentage of power was calculated for six four Hz steps between 0 and 23.5 Hz. Only alpha power was used for statistical analysis with Friedman test. The maximum of alterations was seen between 30 and 60 min after application of the drugs. The percentage of alpha power differed significantly under the three treatments (N = 6, k= 3, chi-square--9.33, p =0.0055). Highest values for alpha power were found under brofaromine treatment (Fig. 1). An increase of alpha power was not seen after physostigmine compared to placebo.
The P300 wave undergoes alterations during physiological aging showing lower amplitudes and longe... more The P300 wave undergoes alterations during physiological aging showing lower amplitudes and longer latencies in geriatric controls. By means of topographical display of P300-data it could be shown that the topography with maximal positivity at parietal sites is maintained in aging. In patients, however, suffering from senile dementia of Alzheimer's type signs of a frontal elevation and a parietal decrement of P300 amplitudes could be observed. The findings can be interpreted firstly as an indication that the frontal lobe is less effected. On the other side if a hippocampal dipole is assumed a neuronal lesion could lead to a turn of this dipole with the result of a now frontally located positivity.
was 20 points. The control group consisted of 21 people (6 males and 15 females, average age of 7... more was 20 points. The control group consisted of 21 people (6 males and 15 females, average age of 74.1, average MMSE score was 28). We measured the psychological symptoms using the Japanese version of Neuropsychiatric Inventory-Nursing Home Version (NPI). We used 3.0T magnetic resonance imaging and voxel-based morphometry to analyze the relationship between the psychological symptoms and the atrophy of the brain. Results: The most frequent symptoms in the NPI subscores were apathy, depression, anxiety, sleep disturbance, irritability/lability, and agitation/aggression. More than half of the subjects from the AD group with anxiety or irritability/lability or apathy had multiple BPSD.The psychological symptoms related with the amygdala atrophy were anxiety (left and right amygdala, right hippocampus, right and left uncus, right parahippocampal gyrus), irritability/lability (right amygdala, right hippocampus, left and right parahippocampal gyrus) and apathy(left amygdala, right hippocampus, left parahippocampal gyrus, right uncus). Conclusions: It is possible that the atrophy of the amygdala may influence the role of the amygdala in the emotion and BPSD of the patients with AD, such as anxiety, irritability/lability and apathy. From these results, we must establish the effective care to BPSD, considering the disability of the brain.
Uploads