[Treatment Options for Executive Dysfunction]. / Therapiemöglichkeiten bei exekutiver Dysfunktion.

The concept of executive function is a so-called umbrella concept, so that it includes many different and in some cases mutually contradictory higher-level organizational abilities such as planning, monitoring, inhibition and control of action. Typically, the cause of an executive dysfunction is an underlying lesion in the prefrontal cortex or subcortical regions. Deficits in executive functions appear in the fields of cognition as well as behavior. Diagnosis requires the use of a wide-ranging repertoire of tests and questionnaires making it a time-consuming process. Different therapeutic approaches addressing the diverse symptoms of executive dysfunction, both positive and negative, are available. These include modification and manipulation of the environment and practice of cognitive repetitive procedures. The former are implemented particularly in cases of severely impaired persons. The latter are used in persons in whom cognitive dysfunctions are the dominating symptoms of the disorder.The operational area of therapeutic approaches using paper and pencil as well as computer programs limits them to treatment of cognitive dysfunction. If behavioral disturbances dominate the clinical picture, other procedures should be used.The effectiveness of cognitive therapy of executive dysfunction is well demonstrated according to the criteria of evidence-based medicine (EBM).

[Living situation of mentally disabled people with dementia in institutions for the disabled: results of a questionnaire in Lower Saxony and Bremen]. / Die Lebenssituation von geistig behinderten Menschen mit Demenz in Einrichtungen der Behindertenhilfe : Ergebnisse einer Befragung in Niedersachsen und Bremen.

No empirical data about the topic "Mental Disability and Dementia" in Germany exist. The aim of this survey was to obtain current data about mentally disabled people with dementia. Therefore, the following questions need to be clarified: how many mentally disabled people are affected with dementia, which difficulties occur regarding the diagnosis of dementia and what challenges have to be solved in upcoming years. In all, 45 organisations for the mentally disabled took part in the survey, showing that dementia amongst people with mental disabilities appeared largely starting at the age of 50. Standardized diagnostics are seldom used by these organisations. Instead, observation of behaviour by care attendants plays a central role, due to the fact that speaking and introspection are not possible for a majority of the patients. In general, institutions for people with mental disabilities do not have specific offers for people with dementia, occasionally there are offers regarding their living situation and free time activities.

[Neuropsychology in occupational rehabilitation: a new field of intervention?]. / Neuropsychologie in der beruflichen Rehabilitation: ein neues Interventionsfeld?

The main goal of rehabilitation is social and vocational reintegration of handicapped people. Neuropsychological disorders prove to be particularly critical factors in this context. In many cases vocational retraining requiring good cognitive abilities and capacity is essential. Neuropsychological impairments can substantially diminish the chance of successful vocational rehabilitation. To assess the need for neuropsychological intervention within the scope of vocational rehabilitation programmes, 69 persons undergoing rehabilitation in the Berufsförderungswerk Sachsen-Anhalt, a non-profit organization devoted to vocational reintegration, were screened to identify individuals with cognitive deficits. Furthermore a brief multidimensional self-report inventory, the Symptom Checklist-90-R (SCL-90-R) was administered. In addition, the files of all participants were reviewed with regard to mental or neurological disorders. The study revealed cognitive deficits in a quarter to a third of the participants depending on the cognitive domain. Comparison of neuropsychological test performance of trainees with and without established diagnosis of pertinent diseases confirmed cognitive deficits in those with prior diagnosis of neurological disorder, as expected. Only for Divided Attention a significant correlation was found between neuropsychological deficits and psychiatric disorders as documented in the files. However, a considerable number of persons without corresponding medical-psychological pre-diagnosis were found to also perform poorly in particular tests. Furthermore it could be shown that subjectively experienced stress in trainees had a negative impact on reaction times in specific test procedures. These findings strongly suggest a need to supplement vocational rehabilitation by neuropsychological training programmes. When cognitive functional impairments are suspected, specific diagnostic assessments should be administered in order to select and implement appropriate interventions.

[Evidence based treatment of executive dysfunction]. / Evidenzbasierte Therapie bei exekutiver Dysfunktion.

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.

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.

[Cognitive dysfunction after abdominal surgery in elderly patients]. / Kognitive Dysfunktionen nach abdominal-chirurgischen Operationen bei älteren Patienten.

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.

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.

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.

[Analysis of the need for clinical neuropsychology in inpatient neurological rehabilitation (phases C and D)--an empirical study of 788 patients]. / Analyse des Bedarfs an klinischer Neuropsychologie in der stationären neurologischen Rehabilitation (Phase C und D)--eine empirische Studie an 788 Patienten.

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.