Da die Lebenserwartung in den westlichen industrialisierten Landern stetig steigt, steigt die Anzahl der alteren Mitburger unserer Gesellschaft. Hierdurch erhoht sich auch progressiv das Auftreten der haufigsten psychiatrischen... more
Da die Lebenserwartung in den westlichen industrialisierten Landern stetig steigt, steigt die Anzahl der alteren Mitburger unserer Gesellschaft. Hierdurch erhoht sich auch progressiv das Auftreten der haufigsten psychiatrischen Erkrankungen im Alter, wie z. B. der degenerativen und vaskularen Demenzen. Da eine therapeutische Hilfe bei der Demenz vom Alzheimer Typ (DAT) wahrscheinlich nur in fruhen Stadien der Erkrankung Erfolgsaussichten hat, ist eine rechtzeitige Diagnose im Fruhstadium von groser Bedeutung [10]. Trotz intensiver Bemuhungen ist es nicht gelungen, einen fruhen und zuverlassigen Marker fur DAT zu finden.
Research Interests: Medicine and Gynecology
Die Digitalisierung erfasst heute alle Facetten des Alltags und hat auch im Gesundheitswesen Einzug gehalten. Die Pflege hat gezeigt, dass sie sich auf neue Entwicklungen einstellen kann. Digitale Innovationen wie Monitorsysteme und... more
Die Digitalisierung erfasst heute alle Facetten des Alltags und hat auch im Gesundheitswesen Einzug gehalten. Die Pflege hat gezeigt, dass sie sich auf neue Entwicklungen einstellen kann. Digitale Innovationen wie Monitorsysteme und Service-Roboter schaffen Entlastung – gerade im Hinblick auf eine immer älter werdende Gesellschaft. Eine Technik, die sowohl Pflegebedürftigen als auch Pflegenden viel Sicherheit und Mobilität bieten kann, ist der GPS-Tracker. Doch es gibt nicht nur Vorteile beim Einsatz dieses Systems.
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As a means of obtaining information on the CNS action of psychotropic drugs, we studied the topographic distribution of brain electrical activity before and after administration of phosphatidylserine in normal volunteers
Research Interests: Neuroscience, Cartography, Psychiatry, Treatment, Electroencephalography, and 15 moreMedicine, Brain Mapping, Evoked Potentials, Humans, Cerebral Cortex, Female, Brainstem, Male, Adult, Topographic Map, Action (Physics), Phosphatidylserine, Membrane Fluidity, Psychology and Cognitive Sciences, and Medical and Health Sciences
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As early as 1936 Lemere published reports of EEG changes in schizophrenic patients which showed a reduction of alpha rhythm. This was 1 year before Berger himself described an EEG recording of a 17-year-old schizophrenic patient who... more
As early as 1936 Lemere published reports of EEG changes in schizophrenic patients which showed a reduction of alpha rhythm. This was 1 year before Berger himself described an EEG recording of a 17-year-old schizophrenic patient who exhibited prominent beta activity. Berger interpreted beta waves as “material concomitant of cognitive processes”. The large number of reports about EEG alterations, which cannot be reviewed in detail here, described more or less similar peculiarities in schizophrenics, such as “disorganized EEG’s dominated by choppy activity” (Ellingson 1954). Attempts to quantify EEG data go back to 1932, when Dietsch described a Fourier analysis of human EEG, and 1939, when Gibbs used an analogue frequency analyzer to investigate cortical frequency spectra of schizophrenic individuals. The quantitative procedure was able to verify the former descriptive and qualitative EEG findings. The development of small digital computers and the fast Fourier transform algorithm (Cooley and Tukey 1965) have made real quantitative frequency analysis of the EEG technically feasible. Worthy of mention in this context are the frequency profiles of schizophrenic patients made by Itil etal. (1972), who confirmed an appearance of excessive fast activity along with some slow waves and the lack of alpha activity. The more recent quantitative studies have been reviewed by Itil (1978).
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EEG segmentation can be used to measure altered brain function in aging and diseases of the brain. The parameter ‘number of different segments’ makes clear how many different potential fields are involved in brain activity during a given... more
EEG segmentation can be used to measure altered brain function in aging and diseases of the brain. The parameter ‘number of different segments’ makes clear how many different potential fields are involved in brain activity during a given period of time. It should represent effects of aging and disease. To prove this assumption, 11 young and 10 aged controls, 12 patients with mild dementia of the Alzheimer type (DAT), 10 young and 12 aged patients with endogenous depression were included in the study. The number of different segments in the beta frequency band between 16 and 19.75 Hz was measured according to the theory of Lehmann et al. [Clinical Neurophysiology 1987;67:271–288], and the segments were classified by their location on the scalp. The Mann-Whitney U test was used for statistical comparison. Aged controls had more different segments than young controls (n = 21, U = 14, p < 0.0038). Patients with DAT had less different segments than healthy aged controls (n = 22, U = 18.5, p < 0.0061). Aged patients with endogenous depression had more different segments than patients with mild DAT (n = 24, U = 32, p < 0.021). The reduction of the number of different segments in DAT compared to controls and patients suffering from depression may be helpful for differential diagnosis. The higher number of different segments in aged versus young controls could be interpreted as a sign of increased complexity in the aged brain.
Research Interests: Psychology, Cognitive Science, Dementia, Aging, Electroencephalography, and 14 moreMedicine, Humans, Female, Male, Depressive Disorder, Differential Diagnosis, Clinical Sciences, Aged, Adult, Degenerative Neurological Disease, Alzheimer Disease, Neurosciences, Scalp, and Psychiatric Status Rating Scales
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Previous studies suggested that EGb 761® may be more effective when dementia is associated with neuropsychiatric features. To find out whether treatment effects correlate with neuropsychiatric symptom burden at baseline, retrospective... more
Previous studies suggested that EGb 761® may be more effective when dementia is associated with neuropsychiatric features. To find out whether treatment effects correlate with neuropsychiatric symptom burden at baseline, retrospective analyses of data from a 24-week randomized, placebo-controlled, double-blind clinical trial of EGb 761® (240 mg once daily) were performed. 410 outpatients with mild to moderate AD, VaD or AD with cerebrovascular disease, each associated with neuropsychiatric features, were enrolled. Patients scored 5 or above on the NPI, with at least one item score being ≥3, and between 9 and 23 on the SKT cognitive test battery. Correlations between the NPI composite score at baseline and other efficacy variables were calculated. Regression analyses with the NPI composite score as regressor and efficacy variables as dependent variables were performed. Correlations between changes from baseline and NPI baseline scores were weak to modest, but conspicuously different between active drug and placebo groups. The slopes of the regression lines for the EGb 761® and the placebo groups showed qualitative and statistically significant differences: With increasing NPI baseline scores there was faster deterioration in the placebo group and thus more net benefit from treatment for the EGb 761® group.
Research Interests: Dementia, Clinical Trial, Treatment Outcome, Medicine, Phytotherapy, and 15 moreHumans, Internal Medicine, Placebo, Cerebrovascular Disease, Female, Male, Regression Analysis, Statistical Significance, Clinical Sciences, Plant extracts, Randomized Controlled Trial, Ginkgo Biloba, Neurosciences, Treatment Effect, and Neuropsychological Tests
The event-related potential P300 probably reflects the encoding of information into short-term memory. Anatomical structures of the limbic system are involved in this process. Since the same structures are involved in the generation of... more
The event-related potential P300 probably reflects the encoding of information into short-term memory. Anatomical structures of the limbic system are involved in this process. Since the same structures are involved in the generation of the event-related potential P300, P300 is thus well suited to assess pharmacological influence on memory functions and cognitive processes, for example, by changing the availability of neurotransmitters like acetylcholine at their respective receptors.
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Since Berger described the human EEG in 1929 (Berger 1929) clinicians as well as researchers have attempted to conceptualize electrical activity of the brain as a reflection of mental processes. Due to recent advances in computer software... more
Since Berger described the human EEG in 1929 (Berger 1929) clinicians as well as researchers have attempted to conceptualize electrical activity of the brain as a reflection of mental processes. Due to recent advances in computer software and hardware it is now possible to sample more electrical information from the brain and make the concept of the EEG as an electrical brain mirror tangible. However, the increasing amount of data make a sensible interpretation of the data difficult. One way to reduce data in a reasonable way is to calculate equivalent dipoles, which describe the electrical activity of the brain as one or more dipoles generating the electrical field over the surface of the scalp. The calculation of dipoles have mostly been accomplished in the time domain, for example, epileptic discharges or evoked potentials. For the investigation of psychiatric diseases, however, the analysis of frequency bands is of higher interest than an analysis of the time domain.
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Physostigmine, an inhibitor of acetylcholine esterase activates brain function by an increase in acetylcholine. Brofaromine, a selective reversible MAO-A inhibitor activates by reducing the turnover of catecholamines like norepinephrine.... more
Physostigmine, an inhibitor of acetylcholine esterase activates brain function by an increase in acetylcholine. Brofaromine, a selective reversible MAO-A inhibitor activates by reducing the turnover of catecholamines like norepinephrine. Because these substances act selectively via two different neurotransmitter pathways, distinct alterations in electrical brain activity might be induced. In the present experiment, relative amount of power in EEG was investigated. 6 young male students agreed to participate in this double blind study with three substances (placebo, 1 mg physostigmine, 50mg brofaromine) in a latin square design. 0.5 mg glycopyrrulate blocked peripheral side effects of physostigmine. The interval between each measurement was one week. Electrical brain activity was measured with 19 electrodes placed according to the 10-20 system before, 30, 60, 90, and 120 min after application of the drugs. After Fourier transformation, percentage of power was calculated for six four Hz steps between 0 and 23.5 Hz. Only alpha power was used for statistical analysis with Friedman test. The maximum of alterations was seen between 30 and 60 min after application of the drugs. The percentage of alpha power differed significantly under the three treatments (N = 6, k= 3, chi-square--9.33, p =0.0055). Highest values for alpha power were found under brofaromine treatment (Fig. 1). An increase of alpha power was not seen after physostigmine compared to placebo.
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The P300 wave undergoes alterations during physiological aging showing lower amplitudes and longer latencies in geriatric controls. By means of topographical display of P300-data it could be shown that the topography with maximal... more
The P300 wave undergoes alterations during physiological aging showing lower amplitudes and longer latencies in geriatric controls. By means of topographical display of P300-data it could be shown that the topography with maximal positivity at parietal sites is maintained in aging. In patients, however, suffering from senile dementia of Alzheimer's type signs of a frontal elevation and a parietal decrement of P300 amplitudes could be observed. The findings can be interpreted firstly as an indication that the frontal lobe is less effected. On the other side if a hippocampal dipole is assumed a neuronal lesion could lead to a turn of this dipole with the result of a now frontally located positivity.
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was 20 points. The control group consisted of 21 people (6 males and 15 females, average age of 74.1, average MMSE score was 28). We measured the psychological symptoms using the Japanese version of Neuropsychiatric Inventory-Nursing Home... more
was 20 points. The control group consisted of 21 people (6 males and 15 females, average age of 74.1, average MMSE score was 28). We measured the psychological symptoms using the Japanese version of Neuropsychiatric Inventory-Nursing Home Version (NPI). We used 3.0T magnetic resonance imaging and voxel-based morphometry to analyze the relationship between the psychological symptoms and the atrophy of the brain. Results: The most frequent symptoms in the NPI subscores were apathy, depression, anxiety, sleep disturbance, irritability/lability, and agitation/aggression. More than half of the subjects from the AD group with anxiety or irritability/lability or apathy had multiple BPSD.The psychological symptoms related with the amygdala atrophy were anxiety (left and right amygdala, right hippocampus, right and left uncus, right parahippocampal gyrus), irritability/lability (right amygdala, right hippocampus, left and right parahippocampal gyrus) and apathy(left amygdala, right hippocampus, left parahippocampal gyrus, right uncus). Conclusions: It is possible that the atrophy of the amygdala may influence the role of the amygdala in the emotion and BPSD of the patients with AD, such as anxiety, irritability/lability and apathy. From these results, we must establish the effective care to BPSD, considering the disability of the brain.
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Research Interests: Psychology, Assessment, Dementia, Behavior, Psychopathology, and 15 moreMedicine, Phytotherapy, Humans, Placebo, Female, Male, Psychogeriatrics, Aged, Middle Aged, Plant extracts, Psychiatric Status Rating Scales, Neuropsychological Tests, Randomized Controlled Trials as Topic, Psychology and Cognitive Sciences, and Medical and Health Sciences
Regional alterations in the distribution of beta activity over the scalp have not been investigated. Regional cerebral blood flow measured by HMPAO-SPECT is also able to detect DAT-related flow reductions in parietotemproal regions. Both... more
Regional alterations in the distribution of beta activity over the scalp have not been investigated. Regional cerebral blood flow measured by HMPAO-SPECT is also able to detect DAT-related flow reductions in parietotemproal regions. Both measures were investigated to uncover regional effects of DAT
Research Interests: Psychiatry, Dementia, Electroencephalography, Medicine, Brain Mapping, and 10 moreHumans, Cerebral Cortex, Aged, Single Photon Emission Computed Tomography, Cerebral Blood Flow, Alzheimer Disease, Beta Rhythm, Neuropsychological Tests, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Research Interests: Dementia, Global Health, Medicine, Biological Psychiatry, Humans, and 15 moreDisease, NPS, Psychological Intervention, Biological, Psychosocial, Cholinesterase inhibitors, Guidelines, Clinical Sciences, Neuropsychiatric Symptoms, Alzheimer Disease, Alzheimer, Neurosciences, GuideLine, Neuroprotective Agents, and Tolerability
: Beside senile dementia of Alzheimer's type (SDAT) there are also dementive syndromes due to a disturbance in metabolism. In a case with a disturbance of copper metabolism (Wilson's disease) a similar P300-pattern was found as... more
: Beside senile dementia of Alzheimer's type (SDAT) there are also dementive syndromes due to a disturbance in metabolism. In a case with a disturbance of copper metabolism (Wilson's disease) a similar P300-pattern was found as described in SDAT with signs of a frontal amplitude elevation. Under therapy with d-penicillamine the frontal P300-positivity moved from frontal to parietal structures. Combined with this migration was an amelioration in cognitive function. This single-case study underlines the significance of P300-topography in the evaluation of therapy effects in dementive disorders.
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Functional brain imaging of symptomatic psychoses might contribute to the understanding of the pathophysiology of schizophrenia
Research Interests: Neuroscience, Psychology, Psychiatry, Psychosis, Schizophrenia, and 14 moreElectroencephalography, Medicine, Brain Mapping, Temporal Lobe, Humans, Cerebral Cortex, Male, Adult, Auditory evoked Potentials, Arachnoid, Arachnoid Cyst, Psychology and Cognitive Sciences, Medical and Health Sciences, and Cysts
Research Interests: Psychology, Dementia, Cognition, Medicine, Activities of Daily Living, and 15 morePhytotherapy, Humans, Placebo, Memantine, Donepezil, Psychogeriatrics, Plant extracts, Cognitive Function, Combination drug therapy, Ginkgo Biloba, Galantamine, Piperidines, Indans, Psychology and Cognitive Sciences, and Medical and Health Sciences
The electroencephalogram (EEG) and evoked potentials (EP) show changes in electrical brain activity both in physiological aging and in senile dementia of the Alzheimer type (SDAT). In physiological aging there is slowing of the main alpha... more
The electroencephalogram (EEG) and evoked potentials (EP) show changes in electrical brain activity both in physiological aging and in senile dementia of the Alzheimer type (SDAT). In physiological aging there is slowing of the main alpha frequency in the order of 0.5–1 Hz (Visser 1985). In addition, an increase of beta activity from 12% in young adults to 24% in aged persons and an increase of slow activity from 7% to 15% can be observed. In SDAT the slowing of the alpha rhythm can be in the range of 1–3 Hz, so that an alpha frequency of 8 Hz and less is achieved. The amount of theta and delta activity can rise considerably (Gordon and Sim 1967). Focal lesions are not common in SDAT but are frequent findings in dementia due to multiple infarction (MID).
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The Test for the Early Detection of Dementia with Discrimination from Depression (TE4D) was developed as a screening instrument for mild dementia. We investigated the convergent validity of the TE4D to EEG and other psychometric tests in... more
The Test for the Early Detection of Dementia with Discrimination from Depression (TE4D) was developed as a screening instrument for mild dementia. We investigated the convergent validity of the TE4D to EEG and other psychometric tests in patients suffering from dementia and depression. In 47 patients suffering from Alzheimer's disease (ICD-10 F.00) and 16 patients with affective disorders (F30-F39) the tests TE4D, ADAS-cog, SKT, BCRS, MMSE were performed and an EEG recorded. Group differences were compared by t-tests and a regression analysis was calculated. The inter-test-correlations varied between rs = 0.77 and rs = 0.91. Significant differences between the diagnostic groups were found for all tests as well as for the frequency bands alpha and beta. For the qEEG, significant positive correlations were found between TE4D (Dementia subscore) and the mean frequency (r = 0.47), the peak frequency (r = 0.42), the frequency bands alpha (r = 0.59) and beta (r = 0.56) as well as negative correlations in the frequency bands delta (r = -0.23) and theta (r = -0.42). The mean frequency and the activity in the frequency bands alpha, beta2, delta and theta contributed to the regression equation. The correlation between regression equation and the TE4D was rs = 0.87. The other tests also correlated with the TE4D: ADAS rs = -0.75, MMST rs = 0.82, SKT rs = -0.74, BCRS rs = -0.83. The TE4D showed convergent validity with the EEG parameters. Both the TE4D-score and the EEG-alterations correlated significantly with the degree of severity of Alzheimer's disease. This result underlines the assumption that the TE4D will be a useful instrument for the diagnostic process in dementia.
Research Interests: Psychology, Cognitive Science, Psychometrics, Depression, Dementia, and 15 moreAudiology, Electroencephalography, Medicine, Linear models, Humans, Correlation, Female, Male, Differential Diagnosis, Clinical Sciences, Geriatric Psychiatry, Aged, Psychological Tests, Alzheimer Disease, and Predictive value of tests
Research Interests: Emotion, Electrophysiology, Audiology, Cognition, Electroencephalography, and 15 moreFace, Categorization, Facial expression, Comparative Study, Affect, Evoked Potentials, Humans, Female, Male, Event Related Potentials, Emotional Expression, Adult, Blurred vision, Electrooculography, and Medical and Health Sciences
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... References Jacoby, R. and Oppenheimer, C. (Eds.) (2002) Psychiatry in the Elderly. 3rd Edition. ... The Clinical Management of Elder Abuse Editor: GEORGINA J. ANETZBERGER The Haworth Press, New York, 2004, US $24.95 Paperback, pp.... more
... References Jacoby, R. and Oppenheimer, C. (Eds.) (2002) Psychiatry in the Elderly. 3rd Edition. ... The Clinical Management of Elder Abuse Editor: GEORGINA J. ANETZBERGER The Haworth Press, New York, 2004, US $24.95 Paperback, pp. 180, ISBN 0 7890 1947 7 ...
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IntroductionIn developed nations more than 20% of the population are older than 65 years. Around 8% of this group are estimated to suffer from dementia. For Europe, this means 12–15 million patients and at least the same number of... more
IntroductionIn developed nations more than 20% of the population are older than 65 years. Around 8% of this group are estimated to suffer from dementia. For Europe, this means 12–15 million patients and at least the same number of relatives are confronted with dementia. Thus, dementia must be a priority theme in science.ObjectivesCauses, diagnostics, therapy and services in dementia.AimTo give an update.MethodsFor new developments in dementia research, guidelines and recent research articles were screened. Resulting facts were grouped in the areas causes, diagnostics, therapy and services.ResultsIn research on causes no breaking news could be detected. For diagnostics, new attempts were proposed. Recent treatment guidelines were developed (for example of the WFSBP). In comparison of nations and even within nations service structures are heterogeneous.ConclusionsIn the field of dementia the lack of breaking news demonstrates how necessary research will be. Some nations have developed national dementia action plans. A European dementia action plan might improve our knowledge on dementia and, moreover, improve the actual situation of patients and care givers.
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Research Interests: Psychology and Philosophy
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The clinical diagnosis of dementia of Alzheimer type (DAT) relies on the identification of a dementia syndrome in the absence of other known etiologies, which results in a diagnostic validity of approximately 90 percent. Thus, the... more
The clinical diagnosis of dementia of Alzheimer type (DAT) relies on the identification of a dementia syndrome in the absence of other known etiologies, which results in a diagnostic validity of approximately 90 percent. Thus, the identification of a biological ante-mortem marker of DAT would be of great help. Investigations on post-mortem tissue have established several cascades of cell biological events in the affected brain, e.g. cholinergic degeneration, free oxygen radical toxicity, impairment of glucose metabolism, which we used as a rationale for testing the diagnosis utility of related parameters in DAT patients. Acetylcholine (ACh) and choline, and vitamin E in the CSF as well as neuroendocrine changes after a GHRH/CRH challenge and hormonal changes after an oral glucose tolerance in DAT patients were measured. For ACh concentration in CSF and neuroendocrine changes after GHRH as well as insulin release after OGTT, there were subtle changes from controls. The potential use of these parameters as diagnostic markers of Alzheimer’s disease in the alive patient is discussed.
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Becoming older in Germany often leads to admission into a nursing home. The aim of this study was to investigate if a complete support network (CSN) can contribute to preventing admission into a nursing home. Organizational and financial... more
Becoming older in Germany often leads to admission into a nursing home. The aim of this study was to investigate if a complete support network (CSN) can contribute to preventing admission into a nursing home. Organizational and financial prerequisites of a CSN were documented. In this study 32 patients with psychiatric disorders diagnosed according to the International Classification of Diseases 10 (ICD 10, 16 as F00 dementia in Alzheimer disease and 16 as F31-33 bipolar affective disorder, depressive episode and recurrent depressive disorder) were observed over a period of 2 years. The intervention consisted of participation in a defined CSN, which was developed by the Alexian Research Centre in Krefeld (ARCK). A cooperation of all persons and institutions involved in the care of elderly patients with psychiatric disorders was initiated. An individualized help plan was compiled for each patient. The primary outcome was admittance to a nursing home or remaining at home. The duration of staying at home was measured in days. User satisfaction was assessed with a 5‑step Likert scale questionnaire. The steering process and the financial efforts necessary to run the CSN were descriptively evaluated. At the end of the observation period 28 out of 32 patients were not admitted to a nursing home. During the observational period one patient dropped out, one died and two were admitted to a nursing home. User satisfaction achieved a median score of 5 (very satisfied). No additional funding was necessary to run the CSN. The CSN can prevent admission to a nursing home without needing additional funding and the whole process can be guided by the patient.
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The time course of information processing and parts of cognitive functioning can be measured objectively by means of exogenous and endogenous evoked potentials. The aim of the present investigation was to find out whether pyritinol,... more
The time course of information processing and parts of cognitive functioning can be measured objectively by means of exogenous and endogenous evoked potentials. The aim of the present investigation was to find out whether pyritinol, suggested in some experiments to enhance cognitive activity, has an effect upon allocortical functioning measured by means of P300 maps
Research Interests: Psychology, Cognitive Psychology, Psychiatry, Electrophysiology, Audiology, and 14 moreCognition, Attention, Electroencephalography, Medicine, Information Processing, Brain, Evoked Potentials, Humans, Aged, Arousal, Pyridines, Clinical Trials as Topic, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Abstract Objective. To define a practice guideline for biological treatment of dementias for general practitioners in primary care. Methods. TThis paper is a short and practical summary of the World Federation of Biological Psychiatry... more
Abstract Objective. To define a practice guideline for biological treatment of dementias for general practitioners in primary care. Methods. TThis paper is a short and practical summary of the World Federation of Biological Psychiatry (WFSBP) guidelines for the Biological treatment of Alzheimer's disease and other dementias for treatment in primary care ( Ihl et al. 2011 ). The recommendations were developed by a task force of international experts in the field and are based on randomized controlled studies. Results. Anti-dementia medications neither cure, nor arrest, or alter the course of the disease. The type of dementia, the individual symptom constellation and the tolerability and evidence for efficacy should determine what medications should be used. In treating neuropsychiatric symptoms, psychosocial intervention should be the treatment of first choice. For neuropsychiatric symptoms, medications should only be considered when psychosocial interventions are not adequate and after cautious risk-benefit analysis. Conclusions. Depending on the diagnostic entity and clinical presentation different anti-dementia drugs can be recommended. These guidelines provide a practical approach for general practitioners managing dementias.
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Research Interests: Dementia, Audiology, Electroencephalography, Medicine, Biological Sciences, and 15 moreBiological Psychiatry, Brain Mapping, Fourier Analysis, Humans, Cerebral Cortex, Female, Male, Electroencephalogram, Aged, Middle Aged, Alzheimer Disease, MAXIMA, Beta Rhythm, Neuropsychological Tests, and Medical and Health Sciences
We review four randomised, controlled trials investigating the efficacy of Ginkgo biloba extract EGb 761(®) in elderly patients with Alzheimer or vascular dementia with neuropsychiatric features. Patients with a total score of 9-23 in the... more
We review four randomised, controlled trials investigating the efficacy of Ginkgo biloba extract EGb 761(®) in elderly patients with Alzheimer or vascular dementia with neuropsychiatric features. Patients with a total score of 9-23 in the Syndrom-Kurz test (SKT) cognitive test battery (cognitive domain) and with a composite score 6 and greater in the Neuropsychiatric Inventory (NPI; behavioural domain) were included. Three trials compared 2 × 120 mg/day or 1 × 240 mg/day EGb 761(®) to placebo while one used donepezil as an active control. The duration of randomised treatment was 22 or 24 weeks. One thousand, two hundred and ninety-four patients were analysed for efficacy. Patients treated with EGb 761(®) showed improvements of cognitive performance and behavioural symptoms that were associated with advances in activities of daily living and a reduced burden to caregivers. Placebo-treated patients, on the other hand, showed only minimal improvements or signs of progression. In each placebo-controlled trial, EGb 761(®) was significantly superior in all mentioned domains (p < 0.01). In the actively controlled trial, EGb 761(®) and donezepil as well as a combination of both drugs had similar effects. The review supports the efficacy of EGb 761(®) in age-related dementia with neuropsychiatric features. The drug was safe and well-tolerated.
Research Interests: Psychology, Dementia, Cognition, Medicine, Activities of Daily Living, and 15 morePhytotherapy, Humans, Placebo, Placebos, Donepezil, Clinical Sciences, Plant extracts, Randomized Controlled Trial, Ginkgo Biloba, Neuroprotective Agents, Severity of Illness Index, Neuropsychological Tests, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, and Outcome assessment (Health care)
In Alzheimer's disease (AD) olfactory deficits are common and depression is a difficult differential diagnosis. We therefore investigated the usefulness of an odor identification test to... more
In Alzheimer's disease (AD) olfactory deficits are common and depression is a difficult differential diagnosis. We therefore investigated the usefulness of an odor identification test to differentiate both conditions. Twenty patients with probable Alzheimer's disease (AD), twenty elderly patients with a depressive disorder, and thirty healthy elderly subjects performed a German odor identification test. AD patients had significantly lower odor identification scores, compared with both depressive patients and control subjects (F=121.96, df=2, 67, p<0.001). With a cut-off score of 10/11, the sensitivity of the identification test to differentiate AD patients from depressive patients was 100%, and specificity was 95%. The odor identification test used in this study is able to reveal olfactory deficits in AD. It also seems to be a useful instrument to differentiate AD from depression.
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... Electrophysiological correlates of emotional and structural face processing in humans. ... first task dependent differences in neuromagnetic responses to identical faces (emotion recognition vs. object identification) in a recent... more
... Electrophysiological correlates of emotional and structural face processing in humans. ... first task dependent differences in neuromagnetic responses to identical faces (emotion recognition vs. object identification) in a recent magnetoencephalograph (MEG) study [14] within this ...
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This randomised, double-blind exploratory trial was undertaken to compare treatment effects and tolerability of EGb 761(R), donepezil and combined treatment in patients with AD and neuropsychiatric features. We enrolled 96 outpatients,... more
This randomised, double-blind exploratory trial was undertaken to compare treatment effects and tolerability of EGb 761(R), donepezil and combined treatment in patients with AD and neuropsychiatric features. We enrolled 96 outpatients, aged 50 years or above, who met the NINCDS/ADRDA criteria for probable AD, scored below 36 on the TE4D, a screening test for dementia, below 6 on the Clock-Drawing Test (CDT) and between 9 and 23 on the SKT, a cross-culturally validated cognitive test battery. They scored at least five on the 12-item Neuropsychiatric Inventory (NPI). EGb 761(R) (240 mg per day), donepezil (initially 5 mg, after 4 weeks 10 mg per day) or EGb 761(R) and donepezil combined (same doses) were administered for 22 weeks. Changes from baseline to week 22 and response rates were similar for all three treatment groups with respect to all outcome measures (SKT, NPI, total score and activities-of-daily-living sub-score of the Gottfries-Bråne-Steen Scale, Hamilton Rating Scale for Depression, CDT and Verbal Fluency Test). An apparent tendency in favour of combination treatment warrants further scrutiny. Compared to donepezil mono-therapy, the adverse event rate was lower under EGb 761(R) treatment and even under the combination treatment. These exploratory findings helped to develop three hypotheses that will have to be proven in further studies: (1) there is no significant difference in the efficiency between EGb 761(R) and donepezil, (2) a combination therapy will be superior to a mono-therapy with one of both substances and (3) there will be less side effects under a combination therapy than under mono-therapy with donepezil.