@article{SalzwedelHeidlerMengetal.2020,
  author    = {Salzwedel, Annett and Heidler, Maria-Dorothea and Meng, Karin and Schikora, Martin and Wegscheider, Karl and Reibis, Rona Katharina and V{\"o}ller, Heinz},
  title     = {Impact of cognitive performance on disease-related knowledge six months after multi-component rehabilitation in patients after an acute cardiac event},
  series = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology},
  volume    = {26},
  journal   = {European journal of preventive cardiology : the official ESC journal for primary \& secondary cardiovascular prevention, rehabilitation and sports cardiology},
  number    = {1},
  publisher = {Sage Publ.},
  address   = {London},
  issn      = {2047-4873},
  doi       = {10.1177/2047487318791609},
  pages     = {46 -- 55},
  year      = {2020},
  abstract  = {Background Although associations between cardiovascular diseases and cognitive impairment are well known, the impact of cognitive performance on the success of patient education as a core component of cardiac rehabilitation remains insufficiently investigated so far. Design Prospective observational study in two inpatient cardiac rehabilitation centres between September 2014 and August 2015 with a follow-up six months after cardiac rehabilitation. Method At admission to and discharge from cardiac rehabilitation, the cognitive performance of 401 patients (54.5 ± 6.3 years, 80\% men) following an acute coronary syndrome and/or coronary artery bypass graft was tested using the Montreal Cognitive Assessment. Patients' disease-related knowledge was determined using a quiz (22 items for medical knowledge and 12 items for healthy lifestyle and behaviour) at both times and at follow-up. The change in knowledge after cardiac rehabilitation was analysed in multivariable regression models. Potentially influencing parameters (e.g. level of education, medication, cardiovascular risk factors, coronary artery bypass graft, comorbidities, exercise capacity) were considered. Results During cardiac rehabilitation, disease-related knowledge was significantly enhanced in both scales. At follow-up, the average level of medical knowledge was significantly reduced, while lifestyle knowledge remained at a stable level. The maintenance of knowledge after cardiac rehabilitation was predominantly predicted by prior knowledge, cognitive performance at discharge from cardiac rehabilitation and, in the case of medical knowledge, by coronary artery bypass graft. Conclusion Patient education in cardiac rehabilitation led to enhanced disease-related knowledge, but the maintenance of this essentially depended on patients' cognitive performance, especially after coronary artery bypass graft. Therefore, patient education concepts in cardiac rehabilitation should be reconsidered and adjusted as needed.},
  language  = {en}
}
@article{SalzwedelReibisHeidleretal.2019,
  author    = {Salzwedel, Annett and Reibis, Rona Katharina and Heidler, Maria-Dorothea and Wegscheider, Karl and V{\"o}ller, Heinz},
  title     = {Determinants of Return to Work After Multicomponent Cardiac Rehabilitation},
  series = {Archives of Physical Medicine and Rehabilitation},
  volume    = {100},
  journal   = {Archives of Physical Medicine and Rehabilitation},
  number    = {12},
  publisher = {Elsevier},
  address   = {Philadelphia},
  issn      = {0003-9993},
  doi       = {10.1016/j.apmr.2019.04.003},
  pages     = {2399 -- 2402},
  year      = {2019},
  abstract  = {Objectives: To explore predictors of return to work in patients after acute coronary syndrome and coronary artery bypass grafting, taking into account cognitive performance, depression, physical capacity, and self-assessment of the occupational prognosis. Design: Observational, prospective, bicentric. Setting: Postacute 3-week inpatient cardiac rehabilitation (CR). Participants: Patients (N=401) <65 years of age (mean 54.5 +/- 6.3y), 80\% men. Interventions: Not applicable. Main Outcome Measures: Status of return to work (RTW) 6 months after discharge from CR. Results: The regression model for RTW showed negative associations for depression (odds ratio 0.52 per SD, 95\% confidence interval 0.36-0.76, P=.001), age (odds ratio 0.72, 95\% confidence interval 0.52-1.00, P=.047), and in particular for a negative subjective occupational prognosis (expected incapacity for work odds ratio 0.19, 95\% confidence interval 0.06-0.59, P=.004; unemployment odds ratio 0.08, 95\% confidence interval 0.01-0.72, P=.024; retirement odds ratio 0.07, 95\% confidence interval 0.01-0.067, P=.021). Positive predictors were employment before the cardiac event (odds ratio 9.66, 95\% confidence interval 3.10-30.12, P<.001), capacity to work (fit vs unfit) at discharge from CR (odds ratio 3.15, 95\% confidence interval 1.35-7.35, P=.008), and maximum exercise capacity (odds ratio 1.49, 95\% confidence interval 1.06-2.11, P=.022). Cognitive performance had no effect.},
  language  = {en}
}
@article{Heidler2019,
  author    = {Heidler, Maria-Dorothea},
  title     = {Dysphagie bei tracheotomierten Patienten nach Langzeitbeatmung},
  series = {An{\"a}sthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : ains ; Organ der Deutschen Gesellschaft f{\"u}r An{\"a}sthesiologie und Intensivmedizin},
  volume    = {54},
  journal   = {An{\"a}sthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : ains ; Organ der Deutschen Gesellschaft f{\"u}r An{\"a}sthesiologie und Intensivmedizin},
  number    = {3},
  publisher = {Thieme},
  address   = {Stuttgart},
  issn      = {0939-2661},
  doi       = {10.1055/a-0769-6551},
  pages     = {218 -- 222},
  year      = {2019},
  abstract  = {Unabh{\"a}ngig von der Art der kritischen Erkrankung haben tracheotomierte Patienten ein hohes Risiko, eine Schluckst{\"o}rung zu entwickeln. Diese ist potenziell lebensbedrohlich, da sie zu Aspiration und Pneumonie f{\"u}hren kann. Vor einer oralen Nahrungsgabe sollte daher unbedingt eine Schluckdiagnostik mittels Bolusf{\"a}rbetest und/oder FEES durchgef{\"u}hrt werden. Da ein physiologischer Luftstrom durch den Larynx und ein ad{\"a}quater subglottischer Druck Schl{\"u}sselkomponenten eines effektiven Schluckaktes sind, sollte eine Oralisierung bei geblockter Trachealkan{\"u}le m{\"o}glichst vermieden werden. Dysphagien sind eine h{\"a}ufige und potenziell lebensbedrohliche Komplikation bei langzeitbeatmeten tracheotomierten Patienten. Denn sie k{\"o}nnen zu Aspiration (Eindringen von Speichel und Nahrung in die Luftwege) und einer sich daraus entwickelnden Pneumonie f{\"u}hren [1]. Bevor diese Patienten auf orale Ern{\"a}hrung umgestellt und mit einem Sprechventil versehen werden, muss daher unbedingt die Schluckf{\"a}higkeit gepr{\"u}ft werden.},
  language  = {de}
}
@article{HeidlerSalzwedelJoebgesetal.2018,
  author    = {Heidler, Maria-Dorothea and Salzwedel, Annett and J{\"o}bges, Michael and L{\"u}ck, Olaf and Dohle, Christian and Seifert, Michael and von Helden, Andrea and Hollweg, Wibke and V{\"o}ller, Heinz},
  title     = {Decannulation of tracheotomized patients after long-term mechanical ventilation - results of a prospective multicentric study in German neurological early rehabilitation hospitals},
  series = {BMC Anesthesiology},
  volume    = {18},
  journal   = {BMC Anesthesiology},
  publisher = {BMC},
  address   = {London},
  issn      = {1471-2253},
  doi       = {10.1186/s12871-018-0527-3},
  pages     = {7},
  year      = {2018},
  abstract  = {Background: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation. Methods: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 +/- 12.9 years, 68\% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e.g. relevant neurological and internistic diseases, duration of mechanical ventilation, tracheotomy technique, and nutrition) as well as functional assessments (Coma Recovery Scale-Revised (CRS-R), Early Rehabilitation Barthel Index, Bogenhausener Dysphagia Score) were collected. Complications and the success of the decannulation procedure were documented at discharge. Results: Four hundred seventy patients (57\%) were decannulated. The probability of decannulation was significantly negatively associated with increasing age (OR 0.68 per SD = 12.9 years, p < 0.001), prolonged duration of mechanical ventilation (OR 0.57 per 33.2 days, p < 0.001) and complications. An oral diet (OR 3.80; p < 0.001) and a higher alertness at admission (OR 3.07 per 7.18 CRS-R points; p < 0.001) were positively associated. Conclusions: This study identified practically measurable predictors of decannulation, which in the future can be used for a decannulation prognosis and supply optimization at admission in the neurological early rehabilitation clinic.},
  language  = {en}
}
@article{SalzwedelHeidlerHauboldetal.2017,
  author    = {Salzwedel, Annett and Heidler, Maria-Dorothea and Haubold, Kathrin and Schikora, Martin and Reibis, Rona Katharina and Wegscheider, Karl and J{\"o}bgens, Michael and V{\"o}ller, Heinz},
  title     = {Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation},
  series = {Vascular Health and Risk Management},
  volume    = {13},
  journal   = {Vascular Health and Risk Management},
  publisher = {Dove Medical Press Ltd},
  address   = {Albany, Auckland},
  issn      = {1176-6344},
  doi       = {10.2147/VHRM.S121086},
  pages     = {55 -- 60},
  year      = {2017},
  abstract  = {Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8\% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7\%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7\%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8\%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5\%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95\% confidence interval 1.07-2.79; P = 0.03) and heavy workloads (OR 2.18, 95\% confidence interval 1.42-3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.},
  language  = {en}
}
@article{HeidlerBiduVoelleretal.2017,
  author    = {Heidler, Maria-Dorothea and Bidu, Laura and V{\"o}ller, Heinz and Salzwedel, Annett},
  title     = {Pr{\"a}diktoren des kognitiven Outcomes beatmeter Fr{\"u}hrehabilitationspatienten},
  series = {Der Nervenarzt : Organ der Deutschen Gesellschaft f{\"u}r Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft f{\"u}r Neurologie},
  volume    = {88},
  journal   = {Der Nervenarzt : Organ der Deutschen Gesellschaft f{\"u}r Psychiatrie, Psychotherapie und Nervenheilkunde ; Mitteilungsblatt der Deutschen Gesellschaft f{\"u}r Neurologie},
  publisher = {Springer},
  address   = {New York},
  issn      = {0028-2804},
  doi       = {10.1007/s00115-017-0311-5},
  pages     = {905 -- 910},
  year      = {2017},
  abstract  = {Hintergrund Patienten, die nach gescheitertem Weaning von der Intensivstation in die Fr{\"u}hrehabilitation (FR) verlegt werden, weisen neben motorischen Einschr{\"a}nkungen oft auch Defizite in ihrer kognitiven Leistungsf{\"a}higkeit auf. Welche patientenseitigen Faktoren das kognitive Outcome am Ende der FR beeinflussen, ist noch unzureichend untersucht. Zielstellung Ermittlung von Pr{\"a}diktoren auf das kognitive Leistungsverm{\"o}gen initial beatmeter FR-Patienten. Methode Zwischen 01/2014 und 12/2015 wurden 301 Patienten (68,3 ± 11,4 Jahre, 67 \% m{\"a}nnlich) einer neurologischen Phase-B-Weaningstation konsekutiv in eine prospektive Beobachtungsstudie eingeschlossen. Zur Ermittlung m{\"o}glicher Einflussfaktoren auf das kognitive Outcome (operationalisiert mittels Neuromentalindex [NMI]) wurden soziodemografische Daten, kritische Erkrankung, Komorbidit{\"a}ten, Parameter zu Weaning und Dekan{\"u}lierung sowie diverse Scores zur Ermittlung funktionaler Parameter erhoben und mittels ANCOVA multivariat ausgewertet. Ergebnisse Insgesamt 248 Patienten (82 \%) konnten erfolgreich geweant werden, 155 (52 \%) dekan{\"u}liert, 75 Patienten (25 \%) verstarben, davon 39 (13 \%) unter Palliativtherapie. F{\"u}r die {\"u}berlebenden Patienten (n = 226) konnten im finalen geschlechts- und altersadjustierten statistischen Modell unabh{\"a}ngige Pr{\"a}diktoren des NMI bei Entlassung aus der FR ermittelt werden: Wachheit und erfolgreiche Dekan{\"u}lierung waren positiv mit dem NMI assoziiert, w{\"a}hrend als kritische Erkrankungen hypoxische Hirnsch{\"a}digungen, Hirninfarkte und Sch{\"a}del-Hirn-Traumata einen negativen Einfluss auf die kognitive Leistungsf{\"a}higkeit hatten. Das berechnete Modell begr{\"u}ndet 57 \% der Varianz des NMI (R2 = 0,568) und weist damit eine hohe Erkl{\"a}rungsqualit{\"a}t auf. Schlussfolgerung Aufgrund des erh{\"o}hten Risikos f{\"u}r eine verminderte kognitive Leistungsf{\"a}higkeit zum Ende der FR sollten vor allem Patienten nach Hypoxie, Hirninfarkt und Sch{\"a}del-Hirn-Trauma intensiv neuropsychologisch betreut werden. Da weiterhin eine erfolgreiche Dekan{\"u}lierung mit verbesserten kognitiven Leistungen assoziiert ist, sollte - vor allem bei wachen Patienten - zudem ein z{\"u}giges Trachealkan{\"u}lenmanagement im therapeutischen Fokus stehen.},
  language  = {de}
}
@article{Heidler2017,
  author    = {Heidler, Maria-Dorothea},
  title     = {Kognitive St{\"o}rungen bei Patienten mit Herzerkrankungen},
  series = {Zeitschrift f{\"u}r Neuropsychologie},
  volume    = {28},
  journal   = {Zeitschrift f{\"u}r Neuropsychologie},
  number    = {1},
  publisher = {Hogrefe},
  address   = {Bern},
  issn      = {1016-264X},
  doi       = {10.1024/1016-264X/a000193},
  pages     = {33 -- 44},
  year      = {2017},
  abstract  = {Patienten mit Herzerkrankung leiden unter zahlreichen kognitiven Defiziten, die mit steigendem Alter und der Schwere der kardialen Erkrankung zunehmen. Die Genese kognitiver Defizite und ihre Wechselwirkung mit Herzerkrankungen ist multifaktoriell, potenziell sind sie jedoch durch eine ad{\"a}quate medizinische Behandlung der Herzerkrankung modifizierbar. Oft haben neuropsychologische St{\"o}rungen wie beeintr{\"a}chtigte Aufmerksamkeits-, Ged{\"a}chtnis- oder Exekutivfunktionen nachhaltige Auswirkungen auf die Lebensqualit{\"a}t und auf das Outcome kardiologischer Rehabilitationsmaßnahmen und k{\"o}nnen Herzerkrankungen verschlimmern (bspw. durch die Aufrechterhaltung eines ungesunden Lebensstils oder unzureichende Medikamentenadh{\"a}renz). Ein routinem{\"a}ßig angewandtes neuropsychologisches Screening k{\"o}nnte helfen, kognitiv beeintr{\"a}chtigte Patienten zu identifizieren, um medizinische und rehabilitative Maßnahmen optimieren zu k{\"o}nnen.},
  language  = {de}
}
@misc{SalzwedelHeidlerHauboldetal.2016,
  author    = {Salzwedel, Annett and Heidler, Maria-Dorothea and Haubold, Kathrin and Schikora, Martin and Reibis, Rona Katharina and Wegscheider, Karl and J{\"o}bgens, Michael and V{\"o}ller, Heinz},
  title     = {Prevalence of mild cognitive impairment in employable patients after acute coronary event in cardiac rehabilitation},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-104113},
  pages     = {55 -- 60},
  year      = {2016},
  abstract  = {Introduction: Adequate cognitive function in patients is a prerequisite for successful implementation of patient education and lifestyle coping in comprehensive cardiac rehabilitation (CR) programs. Although the association between cardiovascular diseases and cognitive impairments (CIs) is well known, the prevalence particularly of mild CI in CR and the characteristics of affected patients have been insufficiently investigated so far. Methods: In this prospective observational study, 496 patients (54.5 ± 6.2 years, 79.8\% men) with coronary artery disease following an acute coronary event (ACE) were analyzed. Patients were enrolled within 14 days of discharge from the hospital in a 3-week inpatient CR program. Patients were tested for CI using the Montreal Cognitive Assessment (MoCA) upon admission to and discharge from CR. Additionally, sociodemographic, clinical, and physiological variables were documented. The data were analyzed descriptively and in a multivariate stepwise backward elimination regression model with respect to CI. Results: At admission to CR, the CI (MoCA score < 26) was determined in 182 patients (36.7\%). Significant differences between CI and no CI groups were identified, and CI group was associated with high prevalence of smoking (65.9 vs 56.7\%, P = 0.046), heavy (physically demanding) workloads (26.4 vs 17.8\%, P < 0.001), sick leave longer than 1 month prior to CR (28.6 vs 18.5\%, P = 0.026), reduced exercise capacity (102.5 vs 118.8 W, P = 0.006), and a shorter 6-min walking distance (401.7 vs 421.3 m, P = 0.021) compared to no CI group. The age- and education-adjusted model showed positive associations with CI only for sick leave more than 1 month prior to ACE (odds ratio [OR] 1.673, 95\% confidence interval 1.07-2.79; P = 0.03) and heavy workloads (OR 2.18, 95\% confidence interval 1.42-3.36; P < 0.01). Conclusion: The prevalence of CI in CR was considerably high, affecting more than one-third of cardiac patients. Besides age and education level, CI was associated with heavy workloads and a longer sick leave before ACE.},
  language  = {en}
}
@misc{VoellerHeidlerRiecketal.2016,
  author    = {V{\"o}ller, Heinz and Heidler, Maria-Dorothea and Rieck, Angelika and Schikora, Martin and Haubold, Kathrin and Joebges, Michael and Salzwedel, Annett},
  title     = {Prevalence of mild cognitive impairment in patients after an acute coronary syndrome in cardiac rehabilitation},
  series = {European heart journal},
  volume    = {37},
  journal   = {European heart journal},
  publisher = {Oxford Univ. Press},
  address   = {Oxford},
  issn      = {0195-668X},
  pages     = {543 -- 543},
  year      = {2016},
  language  = {en}
}
@article{HeidlerBiduFriedrichetal.2015,
  author    = {Heidler, Maria-Dorothea and Bidu, Laura and Friedrich, Nele and V{\"o}ller, Heinz},
  title     = {Oral feeding of long-term ventilated patients with a tracheotomy tube. Underestimated danger of dysphagia},
  series = {Medizinische Klinik, Intensivmedizin und Notfallmedizin},
  volume    = {110},
  journal   = {Medizinische Klinik, Intensivmedizin und Notfallmedizin},
  number    = {1},
  publisher = {Springer},
  address   = {New York},
  issn      = {2193-6218},
  doi       = {10.1007/s00063-014-0397-5},
  pages     = {55 -- 60},
  year      = {2015},
  abstract  = {In long-term mechanically ventilated patients, dysphagia is a common and potentially life-threatening complication, which can lead to aspiration and pneumonia. Nevertheless, many intensive care unit (ICU) patients are fed by mouth without evaluation of their deglutition capability. The goal of this work was to evaluate the prevalence of aspiration due to swallowing disorders in long-term ventilated patients who were fed orally in the ICU while having a blocked tracheotomy tube. In all, 43 patients participated-each underwent a fiberoptic investigation of deglutition on the day of admission to the rehabilitation clinic. A total of 65 \% of the patients aspirated, 71 \% of these silently. There were no associations between aspiration and any of the following: gender, indication for mechanical ventilation (underlying disease) or the duration of intubation and ventilation by tracheotomy tube. However, the association between aspiration and age was statistically significant (p = 0.041). Aspirating patients were older (arithmetic mean = 70 years, median = 74 years) than patients who did not aspirate (arithmetic mean = 66 years, median = 67 years). Intubation and add-on tracheotomies can lead to potentially life-threatening swallowing disorders that cause aspiration, independent of the underlying disease. Before feeding long-term mechanically ventilated patients by mouth, their ability to swallow needs to be investigated using fiberoptic endoscopic evaluation of swallowing (FEES) or a saliva dye test, if a cuff deflation and the use of a speaking valve are possible during spontaneous respiration.},
  language  = {de}
}
@misc{Heidler2012,
  author    = {Heidler, Maria-Dorothea},
  title     = {Clock test in patients with severe aphasia},
  series = {Nervenheilkunde : Zeitschrift f{\"u}r interdisziplin{\"a}re Fortbildung},
  volume    = {31},
  journal   = {Nervenheilkunde : Zeitschrift f{\"u}r interdisziplin{\"a}re Fortbildung},
  number    = {11},
  publisher = {Schattauer},
  address   = {Stuttgart},
  issn      = {0722-1541},
  pages     = {837 -- 843},
  year      = {2012},
  abstract  = {Objective: How do patients with severe aphasia perform in the clock test? Methods:Ten patients with severe aphasia performed the clock test in two modes: copy a given clock (copy condition) and set a clock by drawing the clock hands, where a given digital display (11:10) should be transformed into an analogue display (time setting condition). Results: Not a single patient with severe aphasia was able to master any mode of the clock test. Both copy and time conditions were severely impaired by executive, conceptual, motoric visuospatial and apraxic disorders - impairments of language system were only one of numerous influencing factors. Conclusions and clinical relevance:The clock test measures and requires for its execution so many different cognitive, motoric and perceptual functions that it cannot adequately differentiate between patients with severe aphasia and other severe brain damage.},
  language  = {de}
}