@article{SeboldSchadNebeetal.2016,
  author    = {Sebold, Miriam and Schad, Daniel and Nebe, Stephan and Garbusow, Maria and Juenger, Elisabeth and Kroemer, Nils B. and Kathmann, Norbert and Zimmermann, Ulrich S. and Smolka, Michael N. and Rapp, Michael A. and Heinz, Andreas and Huys, Quentin J. M.},
  title     = {Pavlovian-to-Instrumental Transfer Effects Rely Less on Model-based Reinforcement Learning},
  series = {Journal of cognitive neuroscience},
  volume    = {28},
  journal   = {Journal of cognitive neuroscience},
  publisher = {MIT Press},
  address   = {Cambridge},
  issn      = {0898-929X},
  doi       = {10.1162/jocn_a_00945},
  pages     = {985 -- 995},
  year      = {2016},
  abstract  = {Behavioral choice can be characterized along two axes. One axis distinguishes reflexive, model-free systems that slowly accumulate values through experience and a model-based system that uses knowledge to reason prospectively. The second axis distinguishes Pavlovian valuation of stimuli from instrumental valuation of actions or stimulus-action pairs. This results in four values and many possible interactions between them, with important consequences for accounts of individual variation. We here explored whether individual variation along one axis was related to individual variation along the other. Specifically, we asked whether individuals' balance between model-based and model-free learning was related to their tendency to show Pavlovian interferences with instrumental decisions. In two independent samples with a total of 243 participants, Pavlovian-instrumental transfer effects were negatively correlated with the strength of model-based reasoning in a two-step task. This suggests a potential common underlying substrate predisposing individuals to both have strong Pavlovian interference and be less model-based and provides a framework within which to interpret the observation of both effects in addiction.},
  language  = {en}
}
@article{SeboldSpittaGleichetal.2019,
  author    = {Sebold, Miriam and Spitta, G. and Gleich, T. and Dembler-Stamm, T. and Butler, Oisin and Zacharias, Kristin and Aydin, S. and Garbusow, Maria and Rapp, Michael A. and Schubert, Florian and Buchert, Ralph and Gallinat, J{\"u}rgen and Heinz, A.},
  title     = {Stressful life events are associated with striatal dopamine receptor availability in alcohol dependence},
  series = {Journal of neural transmission},
  volume    = {126},
  journal   = {Journal of neural transmission},
  number    = {9},
  publisher = {Springer},
  address   = {Wien},
  issn      = {0300-9564},
  doi       = {10.1007/s00702-019-01985-2},
  pages     = {1127 -- 1134},
  year      = {2019},
  abstract  = {Stress plays a key role in modulating addictive behavior and can cause relapse following periods of abstinence. Common effects of stress and alcohol on the dopaminergic system have been suggested, although the precise mechanisms are unclear. Here, we investigated 20 detoxified alcohol-dependent patients and 19 matched healthy controls and assessed striatal D2/D3 availability using [F-18]-fallypride positron emission tomography and stressful life events. We found a strong association between striatal D2/D3 availability and stress in patients, but not in healthy controls. Interestingly, we found increased D2/D3 receptor availability in patients with higher stress levels. This mirrors complex interactions between stress and alcohol intake in animal studies and emphasizes the importance to investigate stress exposure in neurobiological studies of addiction.},
  language  = {en}
}
@article{StelzelBohleSchauenburgetal.2018,
  author    = {Stelzel, Christine and Bohle, Hannah and Schauenburg, Gesche and Walter, Henrik and Granacher, Urs and Rapp, Michael A. and Heinzel, Stephan},
  title     = {Contribution of the Lateral Prefrontal Cortex to Cognitive-Postural Multitasking},
  series = {Frontiers in psychologie},
  volume    = {9},
  journal   = {Frontiers in psychologie},
  publisher = {Frontiers},
  address   = {Lausanne},
  issn      = {1664-1078},
  doi       = {10.3389/fpsyg.2018.01075},
  pages     = {12},
  year      = {2018},
  abstract  = {There is evidence for cortical contribution to the regulation of human postural control. Interference from concurrently performed cognitive tasks supports this notion, and the lateral prefrontal cortex (lPFC) has been suggested to play a prominent role in the processing of purely cognitive as well as cognitive-postural dual tasks. The degree of cognitive-motor interference varies greatly between individuals, but it is unresolved whether individual differences in the recruitment of specific lPFC regions during cognitive dual tasking are associated with individual differences in cognitive-motor interference. Here, we investigated inter-individual variability in a cognitive-postural multitasking situation in healthy young adults (n = 29) in order to relate these to inter-individual variability in lPFC recruitment during cognitive multitasking. For this purpose, a oneback working memory task was performed either as single task or as dual task in order to vary cognitive load. Participants performed these cognitive single and dual tasks either during upright stance on a balance pad that was placed on top of a force plate or during fMRI measurement with little to no postural demands. We hypothesized dual one-back task performance to be associated with lPFC recruitment when compared to single one-back task performance. In addition, we expected individual variability in lPFC recruitment to be associated with postural performance costs during concurrent dual one-back performance. As expected, behavioral performance costs in postural sway during dual-one back performance largely varied between individuals and so did lPFC recruitment during dual one-back performance. Most importantly, individuals who recruited the right mid-lPFC to a larger degree during dual one-back performance also showed greater postural sway as measured by larger performance costs in total center of pressure displacements. This effect was selective to the high-load dual one-back task and suggests a crucial role of the right lPFC in allocating resources during cognitivemotor interference. Our study provides further insight into the mechanisms underlying cognitive-motor multitasking and its impairments.},
  language  = {en}
}
@article{StelzelSchauenburgRappetal.2017,
  author    = {Stelzel, Christine and Schauenburg, Gesche and Rapp, Michael A. and Heinzel, Stephan and Granacher, Urs},
  title     = {Age-Related Interference between the Selection of Input-Output Modality Mappings and Postural Control},
  series = {Frontiers in psychology},
  volume    = {8},
  journal   = {Frontiers in psychology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-1078},
  doi       = {10.3389/fpsyg.2017.00613},
  year      = {2017},
  abstract  = {Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19-30 and 66-84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input- and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks.},
  language  = {en}
}
@article{StelzelSchauenburgRappetal.2017,
  author    = {Stelzel, Christine and Schauenburg, Gesche and Rapp, Michael A. and Heinzel, Stephan and Granacher, Urs},
  title     = {Age-Related Interference between the Selection of Input-Output Modality Mappings and Postural Control-a Pilot Study},
  series = {Frontiers in psychology},
  volume    = {8},
  journal   = {Frontiers in psychology},
  publisher = {Frontiers Research Foundation},
  address   = {Lausanne},
  issn      = {1664-1078},
  doi       = {10.3389/fpsyg.2017.00613},
  pages     = {15},
  year      = {2017},
  abstract  = {Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19-30 and 66-84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input-and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks.},
  language  = {en}
}
@article{StroehleSchmidtSchultzetal.2015,
  author    = {Stroehle, Andreas and Schmidt, Dietlinde K. and Schultz, Florian and Fricke, Nina and Staden, Theresa and Hellweg, Rainer and Priller, Josef and Rapp, Michael A. and Rieckmann, Nina},
  title     = {Drug and Exercise Treatment of Alzheimer Disease and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Effects on Cognition in Randomized Controlled Trials},
  series = {The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry},
  volume    = {23},
  journal   = {The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry},
  number    = {12},
  publisher = {Elsevier},
  address   = {New York},
  issn      = {1064-7481},
  doi       = {10.1016/j.jagp.2015.07.007},
  pages     = {1234 -- 1249},
  year      = {2015},
  abstract  = {Objective: Demographic changes are increasing the pressure to improve therapeutic strategies against cognitive decline in Alzheimer disease (AD) and mild cognitive impairment (MCI). Besides drug treatment, physical activity seems to be a promising intervention target as epidemiological and clinical studies suggest beneficial effects of exercise training on cognition. Using comparable inclusion and exclusion criteria, we analyzed the efficacy of drug therapy (cholinesterase inhibitors, memantine, and Ginkgo biloba) and exercise interventions for improving cognition in AD and MCI populations. Methods: We searched The Cochrane Library, EBSCO, OVID, Web of Science, and U.S Food and Drug Administration data from inception through October 30, 2013. Randomized controlled trials in which at least one treatment arm consisted of an exercise or a pharmacological intervention for AD or MCI patients, and which had either a non-exposed control condition or a control condition that received another intervention. Treatment discontinuation rates and Standardized Mean Change score using Raw score standardization (SMCR) of cognitive performance were calculated. Results: Discontinuation rates varied substantially and ranged between 0\% and 49\% with a median of 18\%. Significantly increased discontinuation rates were found for galantamine and rivastigmine as compared to placebo in AD studies. Drug treatments resulted in a small pooled effect on cognition (SMCR: 0.23, 95\% CI: 0.20 to 0.25) in AD studies (N = 45, 18,434 patients) and no effect in any of the MCI studies (N = 5, 3,693 patients; SMCR: 0.03, 95\% CI: 0.00 to 0.005). Exercise interventions had a moderate to strong pooled effect size (SMCR: 0.83, 95\% CI: 0.59 to 1.07) in AD studies (N = 4, 119 patients), and a small effect size (SMCR: 0.20, 95\% CI: 0.11 to 0.28) in MCI (N = 6, 443 patients). Conclusions: Drug treatments have a small but significant impact on cognitive functioning in AD and exercise has the potential to improve cognition in AD and MCI. Head-to-head trials with sufficient statistical power are necessary to directly compare efficacy, safety, and acceptability. Combining these two approaches might further increase the efficacy of each individual intervention. Identifier: PROSPERO (2013:CRD42013003910).},
  language  = {en}
}
@article{SturmWildermuthStolzetal.2019,
  author    = {Sturm, Heidrun and Wildermuth, Ronja and Stolz, Regina and Bertram, L. and Eschweiler, G. W. and Thomas, C. and Rapp, Michael A. and Joos, S.},
  title     = {Diverging awareness of postoperative delirium and cognitive dysfunction in German Health Care Providers},
  series = {Clinical interventions in agins},
  volume    = {14},
  journal   = {Clinical interventions in agins},
  publisher = {DOVE Medical Press},
  address   = {Albany},
  issn      = {1178-1998},
  doi       = {10.2147/CIA.S230800},
  pages     = {2125 -- 2135},
  year      = {2019},
  abstract  = {Purpose: Postoperative cognitive dysfunction (POCD) appears in up to 30\% of patients suffering from postoperative delirium (POD). Both are associated with higher mortality and postoperative complications, prolonged hospital stays, and increased costs. Multi-modal models with pre-admission risk reduction counselling, perioperative monitoring, and training of multidisciplinary patient care providers have been shown to decrease the prevalence of both. The aim of our study is to understand how far those measures are known and implemented in routine care and to detect potential gaps in the current practice regarding risk communication and information flow between involved caregivers for patients at risk for POD/POCD. Patients and Methods: As part of a multicenter study, seven semi-structured focus group (FG) discussions with nurses and physicians from tertiary care hospitals (surgery, anesthesiology, and orthopedics, n=31) and general practitioners (GPs) in private practice (n=7) were performed. Transcribed discussions were analyzed using qualitative content analysis. Results: POD is present above all in the daily work of nurses, whereas physicians do not perceive it as a relevant problem. Physicians report that no regular risk assessment or risk communication was performed prior to elective surgery. Information about POD often gets lost during hand-offs and is not regularly reported in discharge letters. Thus, persisting cognitive dysfunction is often missed. The importance of standardized documentation and continuous education concerning risks, screening, and treatment was emphasized. The often-suggested pre-OP medication adjustment was seen as less important; in contrast, avoiding withdrawal was regarded as far more important. Conclusion: Altogether, it seems that standards and available best practice concepts are rarely implemented. In contrast to physicians, nurses are highly aware of delirium and ask for standardized procedures and more responsibility. Therefore, raising awareness regarding risks, screening tools, and effective preventive measures for POD/POCD seems an urgent goal. Nurses should have a central role in coordination and care of POD to prevent the risk for POCD.},
  language  = {en}
}
@article{SanchezThomasDeekenetal.2019,
  author    = {S{\´a}nchez, Alba and Thomas, Christine and Deeken, Friederike and Wagner, S{\"o}ren and Kl{\"o}ppel, Stefan and Kentischer, Felix and von Arnim, Chrstine A. F. and Denkinger, Michael and Conzelmann, Lars O. and Biermann-Stallwitz, Janine and Joos, Stefanie and Sturm, Heidrun and Metz, Brigitte and Auer, Ramona and Skrobik, Yoanna and Eschweiler, Gerhard W. and Rapp, Michael A.},
  title     = {Patient safety, cost-effectiveness, and quality of life},
  series = {Trials},
  volume    = {20},
  journal   = {Trials},
  number    = {71},
  publisher = {BioMed Central},
  address   = {London},
  issn      = {1468-6694},
  doi       = {10.1186/s13063-018-3148-8},
  pages     = {15},
  year      = {2019},
  abstract  = {Background Postoperative delirium is a common disorder in older adults that is associated with higher morbidity and mortality, prolonged cognitive impairment, development of dementia, higher institutionalization rates, and rising healthcare costs. The probability of delirium after surgery increases with patients' age, with pre-existing cognitive impairment, and with comorbidities, and its diagnosis and treatment is dependent on the knowledge of diagnostic criteria, risk factors, and treatment options of the medical staff. In this study, we will investigate whether a cross-sectoral and multimodal intervention for preventing delirium can reduce the prevalence of delirium and postoperative cognitive decline (POCD) in patients older than 70 years undergoing elective surgery. Additionally, we will analyze whether the intervention is cost-effective. Methods The study will be conducted at five medical centers (with two or three surgical departments each) in the southwest of Germany. The study employs a stepped-wedge design with cluster randomization of the medical centers. Measurements are performed at six consecutive points: preadmission, preoperative, and postoperative with daily delirium screening up to day 7 and POCD evaluations at 2, 6, and 12 months after surgery. Recruitment goals are to enroll 1500 patients older than 70 years undergoing elective operative procedures (cardiac, thoracic, vascular, proximal big joints and spine, genitourinary, gastrointestinal, and general elective surgery procedures. Discussion Results of the trial should form the basis of future standards for preventing delirium and POCD in surgical wards. Key aims are the improvement of patient safety and quality of life, as well as the reduction of the long-term risk of conversion to dementia. Furthermore, from an economic perspective, we expect benefits and decreased costs for hospitals, patients, and healthcare insurances. Trial registration German Clinical Trials Register, DRKS00013311. Registered on 10 November 2017.},
  language  = {en}
}
@article{TreuschMajicPageetal.2015,
  author    = {Treusch, Yvonne and Majic, Tomislav and Page, Julie and Gutzmann, Hans and Heinz, Andreas and Rapp, Michael A.},
  title     = {Apathy in nursing home residents with dementia: Results from a cluster-randomized controlled trial},
  series = {European psychiatry : the journal of the Association of European Psychiatrists},
  volume    = {30},
  journal   = {European psychiatry : the journal of the Association of European Psychiatrists},
  number    = {2},
  publisher = {Elsevier},
  address   = {Paris},
  issn      = {0924-9338},
  doi       = {10.1016/j.eurpsy.2014.02.004},
  pages     = {7},
  year      = {2015},
  abstract  = {Purpose: Here we evaluate an interdisciplinary occupational and sport therapy intervention for dementia patients suffering from apathy. Subjects and methods: A prospective, controlled, rater-blinded, clinical trial with two follow-ups was conducted as part of a larger cluster-randomized trial in 18 nursing homes in Berlin. n = 117 dementia patients with apathy, defined as a score of 40 or more on the apathy evaluation scale (AES) or presence of apathy on the Neuropsychiatric Inventory (NPI), were randomly assigned to intervention or control group. The intervention included 10 months of brief activities, provided once a week. The primary outcome measure was the total score on the AES scale measured directly after the intervention period and again after 12 months. Results: We found significant group differences with respect to apathy during the 10 month intervention period (F-2,F-82 = 7.79, P < 0.01), which reflected an increase in apathy in the control group, but not in the intervention group. Within one year after the intervention was ceased, the treatment group worsened and no longer differed significantly from the control group (P = 0.55). Conclusions: Our intervention was effective for the therapy of apathy in dementia, when applied, but not one year after cessation of therapy. (C) 2014 Elsevier Masson SAS. All rights reserved.},
  language  = {en}
}
@article{TschornSchulzeFoerstneretal.2022,
  author    = {Tschorn, Mira and Schulze, Susanne and F{\"o}rstner, Bernd Rainer and Holmberg, Christine and Spallek, Jacob and Heinz, Andreas and Rapp, Michael A.},
  title     = {Predictors and prevalence of hazardous alcohol use in middle-late to late adulthood in Europe},
  series = {Aging \& mental health},
  volume    = {27},
  journal   = {Aging \& mental health},
  number    = {5},
  publisher = {Routledge, Taylor \& Francis Group},
  address   = {Abingdon},
  issn      = {1360-7863},
  doi       = {10.1080/13607863.2022.2076208},
  pages     = {1001 -- 1010},
  year      = {2022},
  abstract  = {Objectives: Even low to moderate levels of alcohol consumption can have detrimental health consequences, especially in older adults (OA). Although many studies report an increase in the proportion of drinkers among OA, there are regional variations. Therefore, we examined alcohol consumption and the prevalence of hazardous alcohol use (HAU) among men and women aged 50+ years in four European regions and investigated predictors of HAU. Methods: We analyzed data of N = 35,042 participants of the European SHARE study. We investigated differences in alcohol consumption (units last week) according to gender, age and EU-region using ANOVAs. Furthermore, logistic regression models were used to examine the effect of income, education, marital status, history of a low-quality parent-child relationship and smoking on HAU, also stratified for gender and EU-region. HAU was operationalized as binge drinking or risky drinking (<12.5 units of 10 ml alcohol/week). Results: Overall, past week alcohol consumption was 5.0 units (+/- 7.8), prevalence of HAU was 25.4\% within our sample of European adults aged 50+ years. Male gender, younger age and living in Western Europe were linked to both higher alcohol consumption and higher risks of HAU. Income, education, smoking, a low-quality parent-child relationship, living in Northern and especially Eastern Europe were positively associated with HAU. Stratified analyses revealed differences by region and gender. Conclusions: HAU was highly prevalent within this European sample of OA. Alcohol consumption and determinants of HAU differed between EU-regions, hinting to a necessity of risk-stratified population-level strategies to prevent HAU and subsequent alcohol use disorders.},
  language  = {en}
}