Impact of generalized anxiety disorder (GAD) on prehospital delay of acute myocardial infarction patients. Findings from the multicenter MEDEA study.

BACKGROUND: Anxiety has been identified as a cardiac risk factor. However, less is known about the impact of generalized anxiety disorder (GAD) on prehospital delay during an acute myocardial infarction (AMI). This study assessed the impact of GAD on prehospital delay and delay related cognition and behavior. METHODS: Data were from the cross-sectional Munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study with a total of 619 ST-elevated myocardial infarction (STEMI) patients. Data on socio-demographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed with the Generalized Anxiety Disorder scale (GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety disorder. RESULTS: A total of 11.47% (n = 71) MI patients suffered from GAD. GAD was associated with decreased odds of delay compared to patients without GAD (OR 0.58, 95% CI 0.35-0.96), which was more significant in women (112 vs. 238 min, p = 0.02) than in men (150 vs. 198 min, p = 0.38). GAD was highly correlated with acute anxiety (p = 0.004) and fear of death (p = 0.005). Nevertheless, the effect remained significant after controlling for these two covariates. GAD patients were more likely to perceive a higher cardiovascular risk (OR 2.56, 95% CI 1.37-4.76) in 6 months before MI, which leads to the higher likelihood of making self-decision to go to the hospital (OR 2.68, 95% CI 1.48-4.85) in the acute phase. However, GAD was also highly associated with impaired psychological well-being, stress and fatigue (p < 0.0001). CONCLUSIONS: In AMI patients, GAD was independently associated with less prehospital delay, but led to an impaired psychological state.

Intranasal oxytocin reduces provoked symptoms in female patients with posttraumatic stress disorder despite exerting sympathomimetic and positive chronotropic effects in a randomized controlled trial.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a severe psychiatric disease accompanied by neuroendocrine changes such as adrenergic overdrive and hence an elevated cardiovascular morbidity. Current pharmacotherapeutic options for PTSD are less than suboptimal, necessitating the development of PTSD-specific drugs. Although the neuropeptide oxytocin has been repeatedly suggested to be effective in PTSD treatment, there are, to our knowledge, only three studies that have assessed its efficacy on the intensity of PTSD symptoms in PTSD patients - among them one symptom provocation study in male veterans. METHODS: To evaluate for the first time how oxytocin influences the intensity of provoked PTSD symptoms and, furthermore, cardiac control in female PTSD patients, we assessed their psychic and cardiac response to trauma-script exposure with and without oxytocin pretreatment in a double-blind randomized placebo-controlled study. We used a within-subject design to study 35 female PTSD patients who received oxytocin and placebo in a 2-week interval. Furthermore, we performed a small pilot study to get an idea of the relation of the stress-modulated endogenous oxytocin levels and heart rate - we correlated oxytocin serum levels with the heart rate of 10 healthy individuals before and after exposure to the Trier Social Stress Test (TSST). RESULTS: Intranasal oxytocin treatment was followed by a reduction of provoked total PTSD symptoms, in particular of avoidance, and by an elevation in baseline and maximum heart rate together with a drop in the pre-ejection period, a marker for sympathetic cardiac control. Furthermore, we found a positive correlation between endogenous oxytocin levels and heart rate both before and after TSST challenge in healthy control subjects. CONCLUSIONS: This study provides the first evidence that oxytocin treatment reduces the intensity of provoked PTSD symptoms in female PTSD patients. The small size of both samples and the heterogeneity of the patient sample restrict the generalizability of our findings. Future studies have to explore the gender dependency and the tolerability of the oxytocin-mediated increase in heart rate. This randomized controlled trial was retrospectively registered at the German Trials Register (DRKS00009399) on the 02 October 2015.

A common variant in myosin-18B contributes to mathematical abilities in children with dyslexia and intraparietal sulcus variability in adults.

The ability to perform mathematical tasks is required in everyday life. Although heritability estimates suggest a genetic contribution, no previous study has conclusively identified a genetic risk variant for mathematical performance. Research has shown that the prevalence of mathematical disabilities is increased in children with dyslexia. We therefore correlated genome-wide data of 200 German children with spelling disability, with available quantitative data on mathematic ability. Replication of the top findings in additional dyslexia samples revealed that rs133885 was a genome-wide significant marker for mathematical abilities (P(comb) = 7.71 × 10(-10), n = 699), with an effect size of 4.87%. This association was also found in a sample from the general population (P = 0.048, n = 1080), albeit with a lower effect size. The identified variant encodes an amino-acid substitution in MYO18B, a protein with as yet unknown functions in the brain. As areas of the parietal cortex, in particular the intraparietal sulcus (IPS), are involved in numerical processing in humans, we investigated whether rs133885 was associated with IPS morphology using structural magnetic resonance imaging data from 79 neuropsychiatrically healthy adults. Carriers of the MYO18B risk-genotype displayed a significantly lower depth of the right IPS. This validates the identified association between rs133885 and mathematical disability at the level of a specific intermediate phenotype.

[Restless legs syndrome and cardiovascular risk]. / Restless-legs-Syndrom und kardiovaskuläres Risiko.

Large epidemiological studies have repeatedly suggested a possible association between restless legs syndrome (RLS) and common cardiovascular diseases and cardiovascular risk factors. Patients complaining of symptoms of RLS were also more likely to suffer from coronary artery disease, stroke, or, in some instances, hypertension. The underlying pathogenesis of the disease association depicted above has not been elucidated conclusively. Increased activation of the sympathetic nervous system - due to the RLS itself and the frequently accompanying periodic limb movements - has been linked to increased cardiovascular stress in patients with RLS.

Macroscopic brain architecture changes and white matter pathology in acromegaly: a clinicoradiological study.

Although long-term exposure of the brain to increased GH/IGF-1 likely influences cerebral functions, no in vivo studies have been directed towards changes of the brain structure in acromegaly. Here, we used high resolution magnetic resonance images to compare volumes of gray matter (GM), white matter (WM) and cerebrospinal fluid (CSF) of forty-four patients with acromegaly to an age and gender matched, healthy control group (n = 44). In addition, white matter lesions (WMLs) were quantified and graded. Patients exhibited larger GM (+3.7% compared with controls, P = 0.018) and WM volumes (+5.1%, P = 0.035) at the expense of CSF. Differences of WML counts between patients and controls were subtle, however, showing more patients in the 21-40 lesions category (P = 0.044). In conclusion, this MRI study provides first evidence that acromegalic patients exhibit disturbances of the macroscopic brain tissue architecture. Furthermore, acromegalic patients may have an increased risk of neurovascular pathology, likely due to secondary metabolic and vascular comorbidities.

Building episodic connections: changes in episodic priming with age and dementia.

Previous studies of associative encoding that used explicit retrieval tasks have shown both age- and dementia of the Alzheimer type (DAT)-related declines, but such results may be biased by group differences in explicit retrieval. In the present experiment, the authors assessed implicit associative encoding for 25 younger adults (ages 18-25), 73 healthy older adults (ages 59-91), and 65 adults with DAT (ages 59-91) during a speeded word-naming task using an episodic priming measure. Episodic priming refers to the facilitation in responding to a target word after repetition of both words in a prime-target pair, in comparison with simple repetition of the target word with a new prime on each presentation. In contrast with other studies of implicit associative encoding that did not use an implicit episodic priming measure, the present study found both age- and DAT-related declines in associative encoding under conditions of massed learning trials.

Factors influencing word naming in younger and older adults.

The present study examined age differences in the influence of 3 factors that previous research has shown to influence word-naming performance. The influence of word frequency, orthographic length, and orthographic neighborhood measures was examined using large-scale regression analyses on the naming latencies for 2,820 words. Thirty-one younger adults and 29 older adults named all of these words, and age differences in the influence of these factors were examined. The results revealed that all 3 factors predicted reliable amounts of variance in word-naming latencies for both groups. However, older adults showed a larger influence of word frequency and reduced influences of orthographic length and orthographic neighborhood density compared with younger adults. Overall, these results suggest that lexical level factors increase in influence in older adults whereas sublexical factors decrease in influence.

Levels of selective attention revealed through analyses of response time distributions.

The present research examines the nature of the interference effects in a number of selective attention tasks. All of these tasks result in interference in performance by presenting information that is irrelevant to task performance but competes for selection. The interference from this competing information slows the response time (RT) of participants relative to a condition where the competition is minimized. The authors use a convolution of an exponential and a Gaussian (ex-Gaussian) distribution to examine the influence of interference on the characteristics of RT distributions. Consistent with previous research, the authors show that interference in the Stroop task is reflected by both the Gaussian and exponential portions of the ex-Gaussian. In contrast, in 4 experiments they show that several other interference tasks evidence interference that is reflected only in the Gaussian portion of the ex-Gaussian distribution. The authors suggest that these differences reflect the operation of different selection mechanisms, and they examine how sequential sampling models accommodate these effects.

Explicitly modeling the effects of aging on response time.

Research into the effects of aging on response time has focused on Brinley plots. Brinley plots are constructed by plotting mean response times for older subjects against those for young subjects for a set of experimental conditions. The typical result is a straight line with a slope greater than 1 and a negative intercept. This linear function has been interpreted as showing that aging leads to a general slowing of cognitive processes. In this article, we show that the slope of the Brinley plot is actually a measure of the relative standard deviations of older versus young subjects' response times; it is not a measure of general slowing. We examine current models of the effects of aging on mean response time and show how they might be reinterpreted. We also show how a more comprehensive model, Ratcliff's diffusion model (1978), can account for Brinley plot regularities and, at the same time, provide an account of accuracy rates, the shapes of response time distributions, and the relative speeds of error and correct response times, aspects of the data about which models designed to account for Brinley plots are mute. We conclude by endorsing a research approach that applies explicit models to response time data in aging in order to use the parameters of the model to interpret the effects of aging.

Individual differences in information-processing rate and amount: implications for group differences in response latency.

Research on group differences in response latency often has as its goal the detection of Group x Treatment interactions. However, accumulating evidence suggests that response latencies for different groups are often linearly related, leading to an increased likelihood of finding spurious overadditive interactions in which the slower group produces a larger treatment effect. The authors propose a rate-amount model that predicts linear relationships between individuals and that includes global processing parameters based on large-scale group differences in information processing. These global processing parameters may be used to linearly transform response latencies from different individuals to a common information-processing scale so that small-scale group differences in information processing may be isolated. The authors recommend linear regression and z-score transformations that may be used to augment traditional analyses of raw response latencies.

Word frequency, repetition, and lexicality effects in word recognition tasks: beyond measures of central tendency.

Response time (RT) distributions obtained from 3 word recognition experiments were analyzed by fitting an ex-Gaussian function to the empirical data to determine the main effects and interactive influences of word frequency, repetition, and lexicality on the nature of the underlying distributions. The ex-Gaussian analysis allows one to determine if a manipulation simply shifts the response time (RT) distribution, produces a skewing of the RT distribution, or both. In contrast to naming performance, the lexical decision results indicated that the main effects and interactions of word frequency, repetition, and lexicality primarily reflect increased skewing of the RT distributions, as opposed to simple shifts of the RT distributions. The implications of the results were interpreted within a hybrid 2-stage model of lexical decision performance.

Explorations of Cohen, Dunbar, and McClelland's (1990) connectionist model of Stroop performance.

The J. D. Cohen, K. Dunbar, and J. L. McClelland (1990) model of Stroop task performance is used to model data from a study by D. H. Spielder, D. A. Balota, and M. E. Faust (1996). The results indicate that the model fails to capture overall differences between word reading and color naming latencies when set size is increased beyond 2 response alternatives. Further empirical evidence is presented that suggests that the influence of increasing response set size in Stroop task performance is to increase the difference between overall color naming and word reading, which is in direct opposition to the decrease produced by the Cohen et al. architecture. Although the Cohen et al. model provides a useful description of meaning-level interference effects, the qualitative differences between word reading and color naming preclude a model that uses identical architectures for each process, such as that of Cohen et al., to fully capture performance in the Stroop task.

Characteristics of associative learning in younger and older adults: evidence from an episodic priming paradigm.

Two experiments investigated age differences in the encoding of associative information during a speeded naming task. In both experiments, semantically unrelated prime-target word pairs were presented 4 times, in either massed or spaced fashion, during the learning phase. An immediate or delayed test trial was presented following the fourth presentation. In Experiment 1, participants named both the primes and the targets. Younger and older adults showed similar benefits when naming targets that were part of a consistent prime-target pairing compared with targets presented with different primes at each presentation. In Experiment 2, participants named only the target word. Younger adults showed a benefit for consistently paired words, whereas older adults showed no benefit for consistently paired words. The results of the test trials showed a greater benefit for massed repeated words than for spaced repeated words at the immediate test and a reversed pattern at the delayed test. This spacing by test delay interaction was evident in response latency in Experiment 1 and in cued recall performance in Experiment 2.

Stroop performance in healthy younger and older adults and in individuals with dementia of the Alzheimer's type.

Components of the Stroop task were examined to investigate the role that inhibitory processes play in cognitive changes in healthy older adults and in individuals with dementia of the Alzheimer's type (DAT). Inhibitory breakdowns should result in an increase in Stroop interference. The results indicate that older adults show a disproportionate increase in interference compared with younger adults. DAT individuals show interference proportionate to older adults but a disproportionate increase in facilitation for congruent color-word trials, and an increased intrusion of word naming on incongruent color naming trials. An ex-Gaussian analysis of response time distributions indicated that the increased interference observed in older adults was due to an increase in the tail of the distribution. Application of the process dissociation analysis of the Stroop task (D.S. Lindsay & L.L. Jacoby, 1994) indicated that older adults showed increased word process estimates, whereas DAT individuals showed differences in both color and word process estimates. Taken together, the results are consistent with an inhibitory breakdown in normal aging and an accelerated breakdown in inhibition in DAT individuals.

Mental model organization.

Previous research (Radvansky & Zacks, 1991) has shown that the fan effect is mediated not by the number of nominal associations paired with a concept but by the number of mental models into which related concepts are organized. Specifically, newly learned "facts" about different objects in one location are integrated into a single mental model and no fan effect is produced, whereas facts about one object in different locations are not integrated and a fan effect is produced. In 6 experiments we investigated several factors' influence on location-based organization preferences. We found no impact of either article type (definite or indefinite) or object transportability. However, animate sentence subjects (people) reduced preference for location-based organizations. A clear person-based organization emerged by using locations that typically contain only a single person (e.g., phone booth) to make location-based situations less plausible.