Strukturbereich Kognitionswissenschaften
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- Strukturbereich Kognitionswissenschaften (216) (remove)
Background: Interoceptive awareness, the awareness of stimuli originating inside the body, plays an important role in human emotions and psychopathology. The insula is particularly involved in neural processes underlying iA. However, iA-related neural activity in the insula during the acute state of major depressive disorder (MDD) and in remission from depression has not been explored.
Methods: A well-established fMRI paradigm for studying interoceptive awareness (iA; heartbeat counting) and exteroceptive awareness (eA; tone counting) was used. Study participants formed three independent groups: patients suffering from MDD, patients in remission from MDD or healthy controls. Task-induced neural activity in three functional subdivisions of the insula was compared between these groups.
Results: Depressed participants showed neural hypo-responses during iA in anterior insula regions, as compared to both healthy and remitted participants. The right dorsal anterior insula showed the strongest response to iA across all participant groups. In depressed participants there was no differentiation between different stimuli types in this region (i.e., between iA, eA and noTask). Healthy and remitted participants in contrast showed clear activity differences.
Conclusions: This is the first study comparing iA and eA-related activity in the insula in depressed participants to that in healthy and remitted individuals. The preliminary results suggest that these groups differ in there being hypo-responses across insula regions in the depressed participants, whilst healthy participants and patients in remission from MDD show the same neural activity during iA in insula subregions implying a possible state marker for MDD. The lack of activity differences between different stimulus types in the depressed group may account for their symptoms of altered external and internal focus.
The processing of nonverbal auditory stimuli has not yet been sufficiently investigated in patients with aphasia. On the basis of a duration discrimination task, we examined whether patients with left-sided cerebrovascular lesions were able to perceive time differences in the scale of approximately 150ms. Further linguistic and memory-related tasks were used to characterize more exactly the relationships in the performances between auditory nonverbal task and selective linguistic or mnemonic disturbances. All examined conduction aphasics showed increased thresholds in the duration discrimination task. The low thresholds on this task were in a strong correlative relation to the reduced performances in repetition and working memory task. This was interpreted as an indication of a pronounced disturbance in integrating auditory verbal information into a long-term window (sampling disturbance) resulting in an additional load of working memory. In order to determine the lesion topography of patients with sampling disturbances, the anatomical and psychophysical data were correlated on the basis of a voxelwise statistical approach. It was found that tissue damage extending through the insula, the posterior superior temporal gyrus, and the supramarginal gyrus causes impairments in sequencing of time-sensitive information.
Finger-based numerical representations have gained increasing research interest. However, their description and assessment often refer to different numerical principles of ordinality, cardinality and 1-to-1 correspondence. Our aim was to investigate similarities and differences between these principles in finger-based numerical representations. Sixty-eight healthy adults performed ordinal finger counting, cardinal finger montring (showing the number of gestures) and finger-to-number mapping with twisted arms and fingers. We found that counting gestures and montring postures were identical for Number 10 but differed to varying degrees for other numbers. Interestingly, there was no systematic relation between finger-to-number mapping and ordinal finger counting habits. These data question the assumption of a unitary embodied finger-based numerical representation, but suggest that different finger-based representations co-exist and can be recruited flexibly depending on the numerical aspects to be conveyed.
Number processing evokes spatial biases, both when dealing with single digits and in more complex mental calculations. Here we investigated whether these two biases have a common origin, by examining their flexibility. Participants pointed to the locations of arithmetic results on a visually presented line with an inverted, right-to-left number arrangement. We found directionally opposite spatial biases for mental arithmetic and for a parity task administered both before and after the arithmetic task. We discuss implications of this dissociation in our results for the task-dependent cognitive representation of numbers.
Objective. We evaluated the long-term effect of a smoking intervention embedded in an adherence program in patients with an increased risk for cardiovascular disease.
Method. Secondary analysis of a randomized controlled trial: In 2002-2004,8108 patients with hypercholesterolemia were enrolled from general practices in Germany. Patients received a 12-month adherence program and statin medication (intervention) or statin medication only (control). The program aimed to improve adherence to medication and lifestyle by educational material, mailings, and phone calls. Smoking was self-reported at baseline and every 6 months during the 3-year follow-up.
Results. In total, 7640 patients were analyzed. At baseline, smoking prevalence was 21.7% in the intervention and 21.5% in the control group. Prevalence decreased in both groups to 16.6% vs. 19.5%, 153% vs. 16.8%, and 14.2% vs. 15.6% at the 12-, 24-, and 36-month follow-up. The intervention had a beneficial effect on smoking differing over time (group x time: P = 0.005). The effect was largest after 6 and 12 months [odds ratios (95% confidence intervals): 0.67 (0.54-0.82) and 0.63 (0.51-0.78)]. The effect decreased until the 18-month follow-up [0.72 (0.58-0.90)] and was not significant after 24 months.
Conclusion. A low-intensity smoking intervention embedded in an adherence program can contribute to smoking cessation although the intervention effect diminished over time. (C) 2015 Elsevier Inc. All rights reserved.
Various behavioural studies show that semantic typicality (TYP) and age of acquisition (AOA) of a specific word influence processing time and accuracy during the performance of lexical-semantic tasks. This study examines the influence of TYP and AOA on semantic processing at behavioural (response times and accuracy data) and electrophysiological levels using an auditory category-member-verification task. Reaction time data reveal independent TYP and AOA effects, while in the accuracy data and the event-related potentials predominantly effects of TYP can be found. The present study thus confirms previous findings and extends evidence found in the visual modality to the auditory modality. A modality-independent influence on semantic word processing is manifested. However, with regard to the influence of AOA, the diverging results raise questions on the origin of AOA effects as well as on the interpretation of offline and online data. Hence, results will be discussed against the background of recent theories on N400 correlates in semantic processing. In addition, an argument in favour of a complementary use of research techniques will be made. (C) 2015 Elsevier Ltd. All rights reserved.
Continuous treatment with antidementia drugs in Germany 2003-2013: a retrospective database analysis
(2015)
Background: Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics.
Methods: Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan-Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status.
Results: After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82-0.95) and memantine (HR: 0.85; 0.79-0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41-0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline.
Conclusions: Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.
Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 +/- 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) 40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% +/- 9.3%. The mean left ventricular mass index (LVMI) was 52.1 +/- 21.2 g/m(2.7) and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%-12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.
Background: Evidence that home telemonitoring for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage.
Methods: Between January 2010 and June 2013, patients with a confirmed diagnosis of CHF were enrolled and randomly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system (Motiva (R)). The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow-up of 12 months.
Results: A total of 621 predominantly male patients were enrolled, whereof 302 patients were assigned to the intervention group and 319 to the control group. Ischemic cardiomyopathy was the leading cause of heart failure. Despite randomization, subjects of the control group were more often in NYHA functional class III-IV, and exhibited peripheral edema and renal dysfunction more often. Additionally, the control and intervention groups differed in heart rhythm disorders. No differences existed regarding risk factor profile, comorbidities, echocardiographic parameters, especially left ventricular and diastolic diameter and ejection fraction, as well as functional test results, medication and quality of life. While the observed baseline differences may well be a play of chance, they are of clinical relevance. Therefore, the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances.
Conclusions: CardioBBEAT provides prospective outcome data on both, clinical and health economic impact of home telemonitoring in CHF. The study differs by the use of a high evidence level randomized controlled trial (RCT) design along with actual cost data obtained from health insurance companies. Its results are conducive to informed political and economic decision-making with regard to home telemonitoring solutions as an option for health care. Overall, it contributes to developing advanced health economic evaluation instruments to be deployed within the specific context of the German Health Care System.
Accentual preferences and predictability: An acceptability study on split intransitivity in German
(2015)
The difference in the default prosodic realization of simple sentences with unergative vs. unaccusative/passive verbs (assigning early nuclear accent with unaccusative/passive verbs but late nuclear accent with unergative verbs) is often related to the syntactic distinction of their nominative arguments as starting off in different hierarchical positions. Alternative accounts try to trace this prosodic variation back to asymmetries in the semantic or pragmatic contribution of the verb to an utterance. The present article investigates the interaction of the assignment of default nuclear accent with the predictability of the verb. In an experimental study testing the acceptability of nuclear accent assignment, we confirmed that the predictability of the verb influences accentual preferences (such that highly predictable verbs are preferably not accented). However, the experiment also reveals that the unaccusativity distinction cannot be accounted for by means of pragmatic phenomena of this type: the two verb classes are associated with distinct accentual patterns in the baseline condition, that is, without the predictability manipulation. (C) 2014 Elsevier B.V. All rights reserved.