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Biomedical subjects

S V Müller

Publications and source records attributed to S V Müller.

6 recordsLinked to original sources

[Evidence based treatment of executive dysfunction].

The therapy of executive functions plays an essential role for the functional outcome and the social reintegration. Nevertheless there is a lack of cognitive oriented and evidence-based therapy programs. The purpose of our review is the classification of the present evaluation studies with regard of the principles of evidence based medicine (EbM) and of the content. Besides the EbM criteria the number of participants, the kind and number of interventions, the types of etiology and the standardisation and quality of the outcome parameters are measured. By that, an assessment should be possible, which interventions are successful for what types of dysexecutive syndrome. The present studies belong to three different types of therapy: at first, a therapy form focussing on manipulation and modification of the environment, second, a therapy form using behaviour management and a third form, which is based on practise and cognitive interventions. The heterogeneity of the therapy forms makes different types of evaluation necessary. The evaluation studies reach different classes of evidence. While the cognitive therapy forms reach comparable high evidence classes, the evaluation studies about behaviour management--mostly present as single case studies with individual outcome parameter--reach only low evidence classes. Final, we discuss, which therapy forms are effective using the strong evaluation criteria and at which point further conceptual task and further research is useful.

Cognitive Behavioral Therapy↗

Brain potentials related to self-generated and external information used for performance monitoring.

OBJECTIVE: Humans need to supervise and adjust their own behavior by means of an error detection and correction system as well as by using externally available information. The purpose of the present study was to compare the electrophysiological effects related to self-generated internal and to external (feedback) information used for performance monitoring. METHODS: Fourteen young normal subjects learned to associate each of several line-drawings with either a left-hand or right-hand response. In the experiment proper multi-channel ERPs were obtained time-locked to (a) the line-drawings, (b) the button-press, and (c) subsequent feedback stimuli. Feedback was either affirmative, negative, or equivocal. Event-related potentials were quantified and statistically evaluated using standard methodology. RESULTS: Response-locked ERPs showed a typical error-related negativity (ERN) for erroneous responses. ERPs to negative and equivocal feedback stimuli contained a negativity with a more posterior distribution than that of the ERN, which occurred earlier and had a higher peak amplitude in the equivocal condition. Dipole modeling suggests that this feedback-related negativity is generated by medial prefrontal and posterior cingulate cortex areas. CONCLUSIONS: Different brain systems support the use of internal and external information necessary for performance monitoring and modification. SIGNIFICANCE: The flexible use of internal and external information for performance control is a core executive function. The delineation of the corresponding brain correlates will further our understanding of executive dysfunction in neurological disorders.

Adult↗

[Cognitive dysfunction after abdominal surgery in elderly patients].

Elderly patients often suffer from postoperative cognitive deficits (POCD) after serious surgical operations. The reasons for this are not well understood. We investigated the influence of the invasiveness of the operation and the duration of the operation as well as the patient's preoperative physical status on measures of cognitive dysfunction. In a prospective study 59 elderly patients (mean age 69.2 years) were subjected to a neuropsychological test battery and a questionnaire following an abdominal surgical operation. The postoperative recovery with a focus on memory function was assessed using the Wechsler Memory Scale (WMS) seven days after the operation. Self-reported cognitive deficits were studied using the a questionnaire of experienced attention deficits (FEDA) three months after the operation. Postoperative psychological and self-reported test results varied as a function of the invasiveness and the duration of the operation. After more invasive operations patients reported a stronger deficit in activities of daily living and a reduction in drive than after less invasive operations. In addition, the duration of anesthesia influenced the experienced deficits. The self-reported deficits were more strongly influenced by the features of the operation than the psychological test data. The physical status of the patients according to the American Society of Anesthesiologists (ASA) along with the duration of anesthesia as covariate was identified as a good predictor for the cognitive recovery post operation.

Abdomen↗

Selective loss of timbre perception for keyboard and percussion instruments following a right temporal lesion.

We report the case of a 65-year-old man WDK, who experienced selective loss of timbre perception for keyboard and percussion instruments following a right temporal stroke comprising the anterior superior and medial gyrus and parts of the insular region. Formerly an avid listener to music, the sound of an orchestra appeared to be "flat" to him. WDK and a matched control subject underwent a detailed neuropsychological test battery covering basic auditory function (audiometry and just notable difference for pitch shifts), specific auditory function (recognition of environmental sounds), specific musical functions like discrimination of pitch, interval, contour, rhythm and metre, recognition of familiar melodies, emotional responsiveness, perception of timbre and auditory spectral analysis. While WDK displayed no deficits in primary auditory function, the test battery revealed a selective impairment in the perception of timbre of keyboard and percussion instruments which could be traced to a deficit in discriminating rapid changes of the spectral composition of a tone. Hence, these findings demonstrate the existence of highly specific neural networks underlying isolated aspects of timbre perception in the right anterior temporal lobe.

Acoustic Stimulation↗

Central effects of sildenafil (Viagra) on auditory selective attention and verbal recognition memory in humans: a study with event-related brain potentials.

The purpose of this study was to assess possible central side-effects of sildenafil (Viagra) on attention and memory functions. Sildenafil and placebo were administered in young male subjects in a double-blind balanced cross-over design. Behavioral patterns and event-related brain potentials (ERP) were recorded in a spatial auditory attention and a visual word recognition task. While behavioral patterns did not reveal any overt effects of sildenafil, auditory ERPs were indicative of an enhanced ability to focus attention (amplitude enhancement of Nd-effect) and to select relevant target stimuli in the sildenafil condition (P3 component). In the memory task, CNS-effects of sildenafil were evident in a reduction of a negativity in the 150-250 ms range. No overt effects on behavior were observed. Nevertheless, the data reveal CNS-effects of sildenafil necessitating further studies.

Adult↗

[Analysis of the need for clinical neuropsychology in inpatient neurological rehabilitation (phases C and D)--an empirical study of 788 patients].

Recently, several studies concerning the need for neuropsychologists in early or in out-patient rehabilitation settings have been submitted; however, an analysis of classical in-patient neurological rehabilitation which is most important by virtue of its numerical impact has not yet been performed. An empirical study focussing on the need for neuropsychologists during in-patient rehabilitation (phases C and D) is discussed. The two-year study records deficits observed among all patients with damage to the central nervous system (n = 788) admitted to a neurological rehabilitation clinic in north-western Germany. The deficits were divided into the following groups: memory, visual-constructional, deficits involving the planning process, attention deficits and emotional disturbances. Depending on the deficits displayed, patients were prescribed either individual or group therapy, or a combination of both. An empirical pattern of job distribution for neuropsychologists is calculated for the first time based upon findings of the study, which concern the time required for neuropsychological diagnostics, neuropsychological therapy, consultation of relatives and a fixed time-budget established for team supervision and documentation.

Adult↗