TY - JOUR A1 - Rapp, Michael Armin A1 - Mell, Thomas A1 - Majic, Tomislav A1 - Treusch, Yvonne A1 - Nordheim, Johanna A1 - Niemann-Mirmehdi, Mechthild A1 - Gutzmann, Hans A1 - Heinz, Andreas T1 - Agitation in Nursing Home Residents With Dementia (VIDEANT Trial) - Effects of a Cluster-Randomized, Controlled, Guideline Implementation Trial JF - Journal of the American Medical Directors Association N2 - Objective: To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions. Design, Setting, Participants: Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients. Intervention: Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual. Measurements: Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs). Results: Of 326 patients screened, 304 (93.3%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95% CI 2.03-14.14; P = .009; Cohen's d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05). Conclusion: Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy. KW - Dementia KW - agitation KW - nursing home KW - guideline KW - trial Y1 - 2013 U6 - https://doi.org/10.1016/j.jamda.2013.05.017 SN - 1525-8610 VL - 14 IS - 9 SP - 690 EP - 695 PB - Elsevier CY - New York ER - TY - JOUR A1 - Majic, Tomislav A1 - Gutzmann, Hans A1 - Heinz, Andreas A1 - Lang, Undine E. A1 - Rapp, Michael Armin T1 - Animal-assisted therapy and agitation and depression in nursing home residents with dementia - a matched case-control trial JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry N2 - Objectives: To investigate the efficacy of animal-assisted therapy (AAT) on symptoms of agitation/aggression and depression in nursing home residents with dementia in a randomized controlled trial. Previous studies have indicated that AAT has beneficial effects on neuropsychiatric symptoms in various psychiatric disorders but few studies have investigated the efficacy of AAT in patients suffering from dementia. Methods: Of 65 nursing home residents with dementia (mean [standard deviation] age: 81.8 [9.2] years; mean Mini-Mental State Examination score: 7.1 [0.7]), 27 matched pairs (N = 54) were randomly assigned to either treatment as usual or treatment as usual combined with AAT, administered over 10 weekly sessions. Blinded raters assessed cognitive impairment with the Mini-Mental State Examination, presence of agitation/aggression with the Cohen-Mansfield Agitation Inventory, and depression with the Dementia Mood Assessment Scale at baseline and during a period of 4 weeks after AAT intervention. Results: In the control group, symptoms of agitation/aggression and depression significantly increased over 10 weeks; in the intervention group, patients receiving combined treatment displayed constant frequency and severity of symptoms of agitation/aggression (F-1,F-48 = 6.43; p <0.05) and depression (F-1,F-48 = 26.54; p <0.001). Symptom amelioration did not occur in either group. Conclusions: AAT is a promising option for the treatment of agitation/aggression and depression in patients with dementia. Our results suggest that AAT may delay progression of neuropsychiatric symptoms in demented nursing home residents. Further research is needed to determine its long-time effects. KW - AAT KW - Alzheimer disease KW - agitation KW - animal-assisted therapy KW - BPSD KW - depression KW - dog-assisted therapy KW - nursing home Y1 - 2013 U6 - https://doi.org/10.1016/j.jagp.2013.03.004 SN - 1064-7481 SN - 1545-7214 VL - 21 IS - 11 SP - 1052 EP - 1059 PB - Lippincott Williams & Wilkins CY - Philadelphia ER - TY - JOUR A1 - Heinzel, Stephan A1 - Riemer, Thomas G. A1 - Schulte, Stefanie A1 - Onken, Johanna A1 - Heinz, Andreas A1 - Rapp, Michael Armin T1 - Catechol-O-methyltransferase (COMT) genotype affects age-related changes in plasticity in working memory: a pilot study JF - BioMed research international N2 - Objectives. Recent work suggests that a genetic variation associated with increased dopamine metabolism in the prefrontal cortex (catechol-O-methyltransferase Val158Met; COMT) amplifies age-related changes in working memory performance. Research on younger adults indicates that the influence of dopamine-related genetic polymorphisms on working memory performance increases when testing the cognitive limits through training. To date, this has not been studied in older adults. Method. Here we investigate the effect of COMT genotype on plasticity in working memory in a sample of 14 younger (aged 24-30 years) and 25 older (aged 60-75 years) healthy adults. Participants underwent adaptive training in the n-back working memory task over 12 sessions under increasing difficulty conditions. Results. Both younger and older adults exhibited sizeable behavioral plasticity through training (P < .001), which was larger in younger as compared to older adults (P < .001). Age-related differences were qualified by an interaction with COMT genotype (P < .001), and this interaction was due to decreased behavioral plasticity in older adults carrying the Val/Val genotype, while there was no effect of genotype in younger adults. Discussion. Our findings indicate that age-related changes in plasticity in working memory are critically affected by genetic variation in prefrontal dopamine metabolism. Y1 - 2014 U6 - https://doi.org/10.1155/2014/414351 SN - 2314-6133 SN - 2314-6141 PB - Hindawi Publishing Corp. CY - New York ER - TY - JOUR A1 - Zaytseva, Yuliya A1 - Korsakova, Natalya A1 - Gurovich, Isaac Ya A1 - Heinz, Andreas A1 - Rapp, Michael Armin T1 - Luria revisited: Complex motor phenomena in first episode schizophrenia and schizophrenia spectrum disorders JF - Psychiatry research : the official publication of the International Society for Neuroimaging in Psychiatry KW - Luria KW - Fist-Edge-Palm test KW - Bimanual probe KW - Error monitoring KW - First psychotic episode KW - Schizophrenia KW - Schizophrenia spectrum disorders Y1 - 2014 U6 - https://doi.org/10.1016/j.psychres.2014.08.009 SN - 0165-1781 VL - 220 IS - 1-2 SP - 145 EP - 151 PB - Elsevier CY - Clare ER - TY - JOUR A1 - Heinzel, Stephan A1 - Lorenz, Robert C. A1 - Brockhaus, Wolf-Ruediger A1 - Wuestenberg, Torsten A1 - Kathmann, Norbert A1 - Heinz, Andreas A1 - Rapp, Michael Armin T1 - Working memory load-dependent brain response predicts behavioral training gains in older adults JF - The journal of neuroscience N2 - In the domain of working memory (WM), a sigmoid-shaped relationship between WM load and brain activation patterns has been demonstrated in younger adults. It has been suggested that age-related alterations of this pattern are associated with changes in neural efficiency and capacity. At the same time, WM training studies have shown that some older adults are able to increase their WM performance through training. In this study, functional magnetic resonance imaging during an n-back WM task at different WM load levels was applied to compare blood oxygen level-dependent (BOLD) responses between younger and older participants and to predict gains in WM performance after a subsequent 12-session WM training procedure in older adults. We show that increased neural efficiency and capacity, as reflected by more "youth-like" brain response patterns in regions of interest of the frontoparietal WM network, were associated with better behavioral training outcome beyond the effects of age, sex, education, gray matter volume, and baseline WM performance. Furthermore, at low difficulty levels, decreases in BOLD response were found after WM training. Results indicate that both neural efficiency (i. e., decreased activation at comparable performance levels) and capacity (i. e., increasing activation with increasing WM load) of a WM-related network predict plasticity of the WM system, whereas WM training may specifically increase neural efficiency in older adults. KW - aging KW - fMRI KW - neuroimaging KW - plasticity KW - training KW - working memory Y1 - 2014 U6 - https://doi.org/10.1523/JNEUROSCI.2463-13.2014 SN - 0270-6474 VL - 34 IS - 4 SP - 1224 EP - 1233 PB - Society for Neuroscience CY - Washington ER - TY - JOUR A1 - Garbusow, Maria A1 - Schad, Daniel A1 - Sommer, Christian A1 - Juenger, Elisabeth A1 - Sebold, Miriam Hannah A1 - Friedel, Eva A1 - Wendt, Jean A1 - Kathmann, Norbert A1 - Schlagenhauf, Florian A1 - Zimmermann, Ulrich S. A1 - Heinz, Andreas A1 - Huys, Quentin J. M. A1 - Rapp, Michael Armin T1 - Pavlovian-to-instrumental transfer in alcohol dependence: a pilot study JF - Neuropsychobiology : international journal of experimental and clinical research in biological psychiatry, pharmacopsychiatry, Biological Psychology/Pharmacopsychology and Pharmacoelectroencephalography N2 - Background: Pavlovian processes are thought to play an important role in the development, maintenance and relapse of alcohol dependence, possibly by influencing and usurping ongoing thought and behavior. The influence of pavlovian stimuli on ongoing behavior is paradigmatically measured by pavlovian-to-instrumental transfer (PIT) tasks. These involve multiple stages and are complex. Whether increased PIT is involved in human alcohol dependence is uncertain. We therefore aimed to establish and validate a modified PIT paradigm that would be robust, consistent and tolerated by healthy controls as well as by patients suffering from alcohol dependence, and to explore whether alcohol dependence is associated with enhanced PIT. Methods: Thirty-two recently detoxified alcohol-dependent patients and 32 age- and gender-matched healthy controls performed a PIT task with instrumental go/no-go approach behaviors. The task involved both pavlovian stimuli associated with monetary rewards and losses, and images of drinks. Results: Both patients and healthy controls showed a robust and temporally stable PIT effect. Strengths of PIT effects to drug-related and monetary conditioned stimuli were highly correlated. Patients more frequently showed a PIT effect, and the effect was stronger in response to aversively conditioned CSs (conditioned suppression), but there was no group difference in response to appetitive CSs. Conclusion: The implementation of PIT has favorably robust properties in chronic alcohol-dependent patients and in healthy controls. It shows internal consistency between monetary and drug-related cues. The findings support an association of alcohol dependence with an increased propensity towards PIT. KW - Pavlovian-to-instrumental transfer KW - Alcohol dependence KW - Human Y1 - 2014 U6 - https://doi.org/10.1159/000363507 SN - 0302-282X SN - 1423-0224 VL - 70 IS - 2 SP - 111 EP - 121 PB - Karger CY - Basel ER - TY - JOUR A1 - Lorenz, Robert C. A1 - Gleich, Tobias A1 - Beck, Anne A1 - Poehland, Lydia A1 - Raufelder, Diana A1 - Sommer, Werner A1 - Rapp, Michael Armin A1 - Kuehn, Simone A1 - Gallinat, Jürgen T1 - Reward anticipation in the adolescent and aging brain JF - Human brain mapping : a journal devoted to functional neuroanatomy and neuroimaging N2 - Processing of reward is the basis of adaptive behavior of the human being. Neural correlates of reward processing seem to be influenced by developmental changes from adolescence to late adulthood. The aim of this study is to uncover these neural correlates during a slot machine gambling task across the lifespan. Therefore, we used functional magnetic resonance imaging to investigate 102 volunteers in three different age groups: 34 adolescents, 34 younger adults, and 34 older adults. We focused on the core reward areas ventral striatum (VS) and ventromedial prefrontal cortex (VMPFC), the valence processing associated areas, anterior cingulate cortex (ACC) and insula, as well as information integration associated areas, dorsolateral prefrontal cortex (DLPFC), and inferior parietal lobule (IPL). Results showed that VS and VMPFC were characterized by a hyperactivation in adolescents compared with younger adults. Furthermore, the ACC and insula were characterized by a U-shape pattern (hypoactivation in younger adults compared with adolescents and older adults), whereas the DLPFC and IPL were characterized by a J-shaped form (hyperactivation in older adults compared with younger groups). Furthermore, a functional connectivity analysis revealed an elevated negative functional coupling between the inhibition-related area rIFG and VS in younger adults compared with adolescents. Results indicate that lifespan-related changes during reward anticipation are characterized by different trajectories in different reward network modules and support the hypothesis of an imbalance in maturation of striatal and prefrontal cortex in adolescents. Furthermore, these results suggest compensatory age-specific effects in fronto-parietal regions. Hum Brain Mapp 35:5153-5165, 2014. (c) 2014 Wiley Periodicals, Inc. KW - reward anticipation KW - lifespan KW - aging KW - adolescence KW - fMRI KW - connectivity Y1 - 2014 U6 - https://doi.org/10.1002/hbm.22540 SN - 1065-9471 SN - 1097-0193 VL - 35 IS - 10 SP - 5153 EP - 5165 PB - Wiley-Blackwell CY - Hoboken ER - TY - JOUR A1 - Schad, Daniel A1 - Juenger, Elisabeth A1 - Sebold, Miriam Hannah A1 - Garbusow, Maria A1 - Bernhardt, Nadine A1 - Javadi, Amir-Homayoun A1 - Zimmermann, Ulrich S. A1 - Smolka, Michael N. A1 - Heinz, Andreas A1 - Rapp, Michael Armin A1 - Huys, Quentin J. M. T1 - Processing speed enhances model-based over model-free reinforcement learning in the presence of high working memory functioning JF - Frontiers in psychology N2 - Theories of decision-making and its neural substrates have long assumed the existence of two distinct and competing valuation systems, variously described as goal-directed vs. habitual, or, more recently and based on statistical arguments, as model-free vs. model-based reinforcement-learning. Though both have been shown to control choices, the cognitive abilities associated with these systems are under ongoing investigation. Here we examine the link to cognitive abilities, and find that individual differences in processing speed covary with a shift from model-free to model-based choice control in the presence of above-average working memory function. This suggests shared cognitive and neural processes; provides a bridge between literatures on intelligence and valuation; and may guide the development of process models of different valuation components. Furthermore, it provides a rationale for individual differences in the tendency to deploy valuation systems, which may be important for understanding the manifold neuropsychiatric diseases associated with malfunctions of valuation. KW - decision-making KW - reward KW - cognitive abilities KW - model-based and model-free learning KW - fluid intelligence KW - habitual and goal-directed system Y1 - 2014 U6 - https://doi.org/10.3389/fpsyg.2014.01450 SN - 1664-1078 VL - 5 PB - Frontiers Research Foundation CY - Lausanne ER - TY - JOUR A1 - Sebold, Miriam Hannah A1 - Deserno, Lorenz A1 - Nebe, Stefan A1 - Schad, Daniel A1 - Garbusow, Maria A1 - Haegele, Claudia A1 - Keller, Juergen A1 - Juenger, Elisabeth A1 - Kathmann, Norbert A1 - Smolka, Michael N. A1 - Rapp, Michael Armin A1 - Schlagenhauf, Florian A1 - Heinz, Andreas A1 - Huys, Quentin J. M. T1 - Model-based and model-free decisions in alcohol dependence JF - Neuropsychobiology : international journal of experimental and clinical research in biological psychiatry, pharmacopsychiatry, Biological Psychology/Pharmacopsychology and Pharmacoelectroencephalography N2 - Background: Human and animal work suggests a shift from goal-directed to habitual decision-making in addiction. However, the evidence for this in human alcohol dependence is as yet inconclusive. Methods: Twenty-six healthy controls and 26 recently detoxified alcohol-dependent patients underwent behavioral testing with a 2-step task designed to disentangle goal-directed and habitual response patterns. Results: Alcohol-dependent patients showed less evidence of goal-directed choices than healthy controls, particularly after losses. There was no difference in the strength of the habitual component. The group differences did not survive controlling for performance on the Digit Symbol Substitution Task. Conclusion: Chronic alcohol use appears to selectively impair goal-directed function, rather than promoting habitual responding. It appears to do so particularly after nonrewards, and this may be mediated by the effects of alcohol on more general cognitive functions subserved by the prefrontal cortex. KW - Alcohol dependence KW - Decision-making KW - Reinforcement learning KW - Dopamine KW - Computational psychiatry Y1 - 2014 U6 - https://doi.org/10.1159/000362840 SN - 0302-282X SN - 1423-0224 VL - 70 IS - 2 SP - 122 EP - 131 PB - Karger CY - Basel ER - TY - JOUR A1 - Haegele, Claudia A1 - Schlagenhauf, Florian A1 - Rapp, Michael Armin A1 - Sterzer, Philipp A1 - Beck, Anne A1 - Bermpohl, Felix A1 - Stoy, Meline A1 - Stroehle, Andreas A1 - Wittchen, Hans-Ulrich A1 - Dolan, Raymond J. A1 - Heinz, Andreas T1 - Dimensional psychiatry: reward dysfunction and depressive mood across psychiatric disorders JF - Psychopharmacology N2 - A dimensional approach in psychiatry aims to identify core mechanisms of mental disorders across nosological boundaries. We compared anticipation of reward between major psychiatric disorders, and investigated whether reward anticipation is impaired in several mental disorders and whether there is a common psychopathological correlate (negative mood) of such an impairment. During reward anticipation, we observed significant group differences in ventral striatal (VS) activation: patients with schizophrenia, alcohol dependence, and major depression showed significantly less ventral striatal activation compared to healthy controls. Depressive symptoms correlated with dysfunction in reward anticipation regardless of diagnostic entity. There was no significant correlation between anxiety symptoms and VS functional activation. Our findings demonstrate a neurobiological dysfunction related to reward prediction that transcended disorder categories and was related to measures of depressed mood. The findings underline the potential of a dimensional approach in psychiatry and strengthen the hypothesis that neurobiological research in psychiatric disorders can be targeted at core mechanisms that are likely to be implicated in a range of clinical entities. KW - Dimensional KW - fMRI KW - Reward system KW - Ventral striatum KW - Monetary incentive delay task KW - Depressive symptoms Y1 - 2015 U6 - https://doi.org/10.1007/s00213-014-3662-7 SN - 0033-3158 SN - 1432-2072 VL - 232 IS - 2 SP - 331 EP - 341 PB - Springer CY - New York ER -