Impairment of oculomotor functions in patients with early to advanced amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) can result into an incomplete locked in state (iLIS), in which communication depends on eye tracking computer devices. Oculomotor function impairments in ALS have been reported, but there is little research, particularly with respect to patients in iLIS. In the present study, we compared reflexive and executive oculomotor function by means of an eye tracking test battery between three groups: advanced ALS patients in iLIS (n = 22), patients in early to middle ALS stages (n = 44) and healthy subjects (n = 32). Patients with ALS showed significant deteriorations in oculomotor functions, with stronger impairments in iLIS. More specifically, ALS patients produced visually guided prosaccades with longer latencies and more frequent hypometria compared to healthy subjects. Longest latencies were obtained in iLIS patients, with a stronger prolongation for vertical than for horizontal prosaccades. ALS patients made more antisaccade errors and generated antisaccades with longer latencies. Smooth pursuit was also impaired in ALS. In the earlier ALS stages, bulbar onset patients presented stronger antisaccade and smooth pursuit deficits than spinal onset patients. Our findings reveal a relevant deterioration of important oculomotor functions in ALS, which increases in iLIS. It includes impairments of reflexive eye movements to loss of executive inhibitory control, indicating a progressing pathological involvement of prefrontal, midbrain and brainstem areas. The assessment of oculomotor functions may therefore provide clinically relevant bio- and progression marker, particularly in advanced ALS.

Ion transport mechanism in anhydrous lithium thiocyanate LiSCN Part I: ionic conductivity and defect chemistry.

This work reports on the ion transport properties and defect chemistry in anhydrous lithium thiocyanate Li(SCN), which is a pseudo-halide Li+ cation conductor. An extensive doping study was conducted, employing magnesium, zinc and cobalt thiocyanate as donor dopants to systematically vary the conductivity and derive a defect model. The investigations are based on impedance measurements and supported by other analytical techniques such as X-ray powder diffraction (XRPD), infrared (IR) spectroscopy, and density functional theory (DFT) calculations. The material was identified as Schottky disordered with lithium vacancies being the majority mobile charge carriers. In the case of Mg2+ as dopant, defect association with lithium vacancies was observed at low temperatures. Despite a comparably low Schottky defect formation enthalpy of (0.6 ± 0.3) eV, the unexpectedly high lithium vacancy migration enthalpy of (0.89 ± 0.08) eV distinguishes Li(SCN) from the chemically related lithium halides. A detailed defect model of Li(SCN) is presented and respective thermodynamic and kinetic data are given. The thiocyanate anion (SCN)- has a significant impact on ion mobility due to its anisotropic structure and bifunctionality in forming both Li-N and Li-S bonds. More details about the impact on ion dynamics at local and global scale, and on the defect chemical analysis of the premelting regime at high temperatures are given in separate publications (Part II and Part III).

Ion transport mechanism in anhydrous lithium thiocyanate LiSCN part III: charge carrier interactions in the premelting regime.

In lithium thiocyanate Li(SCN), the temperature regime below the melting point (274 °C) is characterized by excess conductivities over the usual Arrhenius behavior (premelting regime). Here, the Schottky defect pair concentration is high, and the point defect chemistry can no longer be considered as dilute. Coulomb interactions of Schottky pairs are expected to occur lowering the formation energy of new carriers and hence leading avalanche-like to a transition into a fully defective superionic state. The respective non-linear behavior is investigated using the cube-root law approach characterized by a defect interaction parameter J, which is a measure of the effective defect-lattice energy. In the case of Li(SCN), the rather pronounced volume expansion is to be included in the model. A literature comparison with other materials emphasizes to what degree defect formation as well as defect interactions depend not only on the dominant mobile defect, but also on the respective sublattice. Overall, a quantitative description of the defect chemistry of Li(SCN) in the premelting regime is derived.

Ion transport mechanism in anhydrous lithium thiocyanate LiSCN part II: frequency dependence and slow jump relaxation.

Specific aspects of the Li+ cation conductivity of anhydrous Li(SCN) are investigated, in particular the high migration enthalpy of lithium vacancies. Close inspection of impedance spectra and conductivity data reveals two bulk relaxation processes, with comparatively fast ion transport at high frequencies and slow ion migration at low frequencies. The impedance results are supported by solid state nuclear magnetic resonance (ssNMR), and pair distribution function (PDF) analysis. This behavior reflects a frequency dependent conductivity, which is related to the extremely slow thiocyanate (SCN)- anion lattice relaxation that occurs when a Li+ cation jumps to the next available site. Two possible migration models are proposed: the first model considers an asymmetric energy landscape for Li+ cation hopping, while the second model is connected to the jump relaxation model and allows for 180° rotational disorder of the (SCN)- anion. A complete kinetic analysis for the hopping of Li+ cations is presented, which reveals new fundamental insights into the ion transport mechanism of materials with complex anions.

Quality of life and mental health in the locked-in-state-differences between patients with amyotrophic lateral sclerosis and their next of kin.

For both patients with amyotrophic lateral sclerosis (ALS) and their next of kin (NOK), the maintenance of quality of life (QoL) and mental health is particularly important. First studies suggest significant discrepancies between QoL reports by patients and NOK, but little is known for advanced ALS stages. To address this issue, we screened 52 ALS patients in incomplete locked-in state (iLIS). Final results were obtained for 15 couples of iLIS patients and NOK. We assessed patients' and NOK's subjective QoL, depression and anxiety and NOK's caregiver burden. Gaze controlled questionnaires allowed direct assessment of patients. Patients and NOK self-reported comparable, mostly moderate to high levels of QoL. Of note, NOK indicated stronger anxiety symptoms. Higher anxiety levels in NOK were associated with stronger caregiver burden and reduced QoL. No significant misjudgment of patient's QoL by the NOK was evident, while patients overestimated NOK's global QoL. However, NOK with severe caregiver burden and depression symptoms gave poorer estimations of patients' QoL. This relationship is relevant, considering NOK's impact on life critical treatment decisions. While the daily time NOK and patient spend together was positively correlated with NOK's QoL and mental health, this was not reversely found for the patients. Our results suggest that NOK adapt less successfully to the disease and concomitant experience of loss and point to an urgent need for specialized psychosocial support. The findings emphasize the importance of direct psychological wellbeing assessment of both patients and NOK in clinical practice, enabled by eye-tracking technology for patients in iLIS.

Motor-Independent Cognitive Testing in Motor Degenerative Diseases.

Cognitive function is tested through speech- or writing-based neuropsychological instruments. The application and validity of those tests is impeded for patients with diseases that affect speech and hand motor skills. We therefore developed a "motor-free" gaze-controlled version of the Trail Making Test (TMT), including a calibration task to assess gaze accuracy, for completion by means of an eye-tracking computer system (ETCS). This electronic TMT version (eTMT) was evaluated for two paradigmatic "motor-neurodegenerative" diseases, Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS). We screened 146 subjects, of whom 44 were excluded, e.g., because of vision deficits. Patients were dichotomized into subgroups with less (ALS-, PD-) or severe motor affection (ALS+, PD+). All 66 patients and all 36 healthy controls (HC) completed the eTMT. Patients with sufficient hand motor control (ALS-, PD-, PD+) and all HC additionally completed the original paper-pencil-based version of the TMT. Sufficient and comparable gaze fixation accuracy across all groups and the correlations of the eTMT results with the TMT results supported the reliability and validity of the eTMT. PD+ patients made significantly more errors than HC in the eTMT-B. We hereby proved the good applicability of a motor-free cognitive test. Error rates could be a particularly sensitive marker of executive dysfunction.

Conductivity Mechanism in Ionic 2D Carbon Nitrides: From Hydrated Ion Motion to Enhanced Photocatalysis.

Carbon nitrides are among the most studied materials for photocatalysis; however, limitations arise from inefficient charge separation and transport within the material. Here, this aspect is addressed in the 2D carbon nitride poly(heptazine imide) (PHI) by investigating the influence of various counterions, such as M = Li+ , Na+ , K+ , Cs+ , Ba2+ , NH4 + , and tetramethyl ammonium, on the material's conductivity and photocatalytic activity. These ions in the PHI pores affect the stacking of the 2D layers, which further influences the predominantly ionic conductivity in M-PHI. Na-containing PHI outperforms the other M-PHIs in various relative humidity (RH) environments (0-42%RH) in terms of conductivity, likely due to pore-channel geometry and size of the (hydrated) ion. With increasing RH, the ionic conductivity increases by 4-5 orders of magnitude (for Na-PHI up to 10-5 S cm-1 at 42%RH). At the same time, the highest photocatalytic hydrogen evolution rate is observed for Na-PHI, which is mirrored by increased photogenerated charge-carrier lifetimes, pointing to efficient charge-carrier stabilization by, e.g., mobile ions. These results indicate that also ionic conductivity is an important parameter that can influence the photocatalytic activity. Besides, RH-dependent ionic conductivity is of high interest for separators, membranes, or sensors.

Synthesis and characterisation of two lithium-thiocyanate solvates with tetrahydrofuran: Li[SCN]·THF and Li[SCN]·2THF.

Li[SCN]·THF and Li[SCN]·2THF can be obtained from solutions of anhydrous Li[SCN] in tetrahydrofuran (C4H8O, THF). Both compounds are very hygroscopic and slowly decompose even at room temperature. At ambient conditions Li[SCN]·THF crystallizes in the monoclinic space group P21/c with the lattice parameters a = 574.41(2), b = 1643.11(6), c = 830.15(3) pm and ß = 99.009(1)° for Z = 4 as determined by laboratory X-ray powder diffraction. Its crystal structure contains Li+ cations surrounded by one THF molecule and three thiocyanate anions [SCN]- forming {Li[NCS]2[SCN](OC4H8)}2- tetrahedra, which join together as pairs via shared N⋯N edges. CHNS combustion analysis and vibrational spectroscopy confirmed its composition, whereas differential scanning calorimetry and thermogravimetric analysis coupled with a mass spectrometer were applied to record its thermal behaviour. Li[SCN]·2THF crystallises in a primitive monoclinic lattice as well, but in the space group P21/n with the lattice parameters a = 1132.73(3), b = 1637.98(3), c = 1264.88(2) pm and ß = 94.393(2)° for Z = 8 as determined from single-crystal X-ray diffraction data at 100 K. Its structure contains two crystallographically independent Li+-centred tetrahedra {Li[NCS]2(OC4H8)2}-, which form dimers {(C4H8O)2Li[µ2-NCS]2Li(OC4H8)2} via shared N⋯N edges. They are merely stabilised by weak agostic H⋯S interactions between some CH2-groups of the C4H8O molecules and the [NCS]- ligands.

Synthesis, characterization and thermal behaviour of solid phases in the quasi-ternary system Mg(SCN)2-H2O-THF.

Mg(SCN)2·4H2O can be converted into previously unknown compounds Mg(SCN)2·(4 - x) H2O·xTHF with x = 0, 2 and 4 by multiple recrystallization in tetrahydrofuran (THF). The phases were characterized by infrared spectroscopy (IR), thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC), and their crystal structures were solved from X-ray powder diffraction (XRPD) data. In the crystal structures isolated Mg(NCS)2(H2O)4-x(THF)x units form layered motifs. The thermal behavior of Mg(SCN)2·4H2O and Mg(SCN)2·4THF was investigated by temperature dependent in situ XRPD, where Mg(SCN)2·4THF was found to acquire a room temperature (α-form) and high temperature modification (ß-form). The phase transformation is associated with an order-disorder transition of the THF molecules and with a reversion of the stacking order of the layered motifs. Further heating eventually leads to the formation of Mg(SCN)2·2THF. There thiocyanate related sulfur atoms fill the voids in the coordination sphere of magnesium, which leads to the formation of one dimensional electroneutral ∞[Mg(NCS)2/2(SCN)2/2(THF)2] chains. All investigated Mg(SCN)2·(4 - x) H2O·xTHF phases exhibit a remarkable anisotropic thermal expansion, and Mg(SCN)2·4H2O and Mg(SCN)2·2THF were found to show both positive and negative thermal expansion coefficients.

Communication Matters-Pitfalls and Promise of Hightech Communication Devices in Palliative Care of Severely Physically Disabled Patients With Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease, leading to progressive paralysis, dysarthria, dysphagia, and respiratory disabilities. Therapy is mostly focused on palliative interventions. During the course of the disease, verbal as well as nonverbal communicative abilities become more and more impaired. In this light, communication has been argued to be "the essence of human life" and crucial for patients' quality of life. High-tech augmentative and alternative communication (HT-AAC) technologies such as eyetracking based computer devices and brain-computer-interfaces provide the possibility to maintain caregiver-independent communication and environmental control even in the advanced disease state of ALS. Thus, they enable patients to preserve social participation and to independently communicate end-of-life-decisions. In accordance with these functions of HT-AAC, their use is reported to strengthen self-determination, increase patients' quality of life and reduce caregiver burden. Therefore, HT-AAC should be considered as standard of (palliative) care for people with ALS. On the other hand, the supply with individually tailored HT-AAC technologies is limited by external and patient-inherent variables. This review aims to provide an overview of the possibilities and limitations of HT-AAC technologies and discuss their role in the palliative care for patients with ALS.

Spark Plasma Sintering (SPS)-Assisted Synthesis and Thermoelectric Characterization of Magnéli Phase V6O11.

The Magnéli phase V6O11 was synthesized in gram amounts from a powder mixture of V6O11/V7O13 and vanadium metal, using the spark plasma sintering (SPS) technique. Its structure was determined with synchrotron X-ray powder diffraction data from a phase-pure sample synthesized by conventional solid-state synthesis. A special feature of Magnéli-type oxides is a combination of crystallographic shear and intrinsic disorder that leads to relatively low lattice thermal conductivities. SPS prepared V6O11 has a relatively low thermal conductivity of κ = 2.72 ± 0.06 W (m K)-1 while being a n-type conductor with an electrical conductivity of σ = 0.039 ± 0.005 (µΩ m)-1, a Seebeck coefficient of α = -(35 ± 2) µV K-1, which leads to a power factor of PF = 4.9 ± 0.8 × 10-5W (m K2)-1 at ∼600 K. Advances in the application of Magnéli phases are mostly hindered by synthetic and processing challenges, especially when metastable and nanostructured materials such as V6O11 are involved. This study gives insight into the complications of SPS-assisted synthesis of complex oxide materials, provides new information about the thermal and electrical properties of vanadium oxides at high temperatures, and supports the concept of reducing the thermal conductivity of materials with structural building blocks such as crystallographic shear (CS) planes.

Usability of eyetracking computer systems and impact on psychological wellbeing in patients with advanced amyotrophic lateral sclerosis.

Restrictions in communicative abilities are well known in patients with amyotrophic lateral sclerosis (ALS), but only few approaches in terms of evaluation of supportive technologies have been made. We aimed to assess the use and perceived usability of eye-tracking computer devices (ETCS) of severely impacted patients with ALS in an independent, direct manner and relate it to psychological well-being. ETCS enable active communication and social participation in the quadriplegic and anarthric disease state. Therefore, ETCS-based versions of widely used psychosocial questionnaires (ADI-12, SeiQoL-DW, WHO-5) as well as structured questions on communicative functioning and ETCS usage were developed to assess ALS patients, their next of kin and professional caregivers. Eleven patients (ALSFRS-R: 5.3 ± 5.9; ALS duration: 6.5 ± 3.8 years, range 1‒12; 82% invasively ventilated), nine next of kin and 10 professional caregivers could be assessed. Patients reported a mean use of their personal ETCS of 9.1 h per d (range 0.5‒16), with a high user satisfaction, preservation of communicative abilities and subjective indispensability of the ETCS. ETCS use was associated with higher psychological well-being. Next of kin and professional caregivers also nominated some critical aspect, which remains to be clarified. Our results strengthen the evidence that preserved mental autonomy influences psychological well-being in ALS and might even modify disease course and end-of-life-decisions in ALS.

Eye-tracking-based assessment suggests preserved well-being in locked-in patients.

We assessed quality of life (QoL) and psychological well-being in patients with amyotrophic lateral sclerosis-induced locked-in state and their next of kin in a fully unbiased manner using eye-tracking computer systems. Eleven of 30 screened patients and 9 next of kin completed study procedures. Patients reported good QoL, which appeared to be at the cost of the QoL of their next of kin. Next of kin rated their own or patients' QoL similarly, but they identified different areas as important as compared with patients. Our results are of importance for the discussion of end-of-life decisions and the evaluation of patients' presumed wishes as well as for psychosocial interventions. Ann Neurol 2017;81:310-315.