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25 Delayed Cerebrovascular Response in Parkinson's Disease
- Sephira G. Ryman, Stephanie Nitschke, Nicholas Shaff, Kayla Julio, Christopher Wertz, Andrew R. Mayer, Andrei A. Vakhtin, Gerson Suarez Cedeno, Amanda Deligtisch, Sarah Pirio Richardson
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 541-542
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Objective:
Cardiovascular risk factors and white matter hyperintensities predict the progression and severity of cognitive symptoms in PD. While controversial, emerging evidence suggests that cerebrovascular dysfunction is an etiological driver of protein aggregation in neurodegenerative conditions, highlighting a need to understand how cerebrovascular function impacts cognitive function in PD. MRI cerebrovascular reactivity (CVR) paradigms provide an opportunity to measure the ability of the cerebral vessels to dilate or constrict in response to challenges. The current study evaluates whether whole brain CVR measures, degree of response (fit) and delay differ in PD with normal cognition (PD-NC) and PD with mild cognitive impairment (PD-MCI) relative to healthy controls (HC). Additionally, we evaluate if these metrics are associated with cognitive performance.
Participants and Methods:8 PD-NC, 11 PD-MCI and 11 age and sex-matched healthy controls (HC) participated in the study. PD participants were diagnosed with MCI based on the Movement Disorders Society Task force, Level II assessment (comprehensive assessment). Participants were asked to inhale gas enriched in CO2 to elicit a vasodilatory response while undergoing bold oxygen level-dependent magnetic resonance image (MRI). Whole brain fit to an end-tidal CO2 regressor and delay were used to quantify CVR in each participant. An analysis of covariance (ANCOVA) was used to evaluate group differences between HC, PD-NC, and PD-MCI in the whole brain fit and delay CVR measures accounting for age, sex, and education. Multiple regressions were conducted for each cognitive variable with whole brain fit and delay as the dependent variables adjusting for age, sex, and education.
Results:A significant main effect of group was observed for whole brain CVR latency (F(2, 23) = 4.227; p = 0.027). Post hoc tests were not significant, though indicated a trend that PD-NC (18.14 ±1.94) and PD-MCI (18.15 ± 1.55) patients exhibited longer delays relative to HC (15.84 ± 2.37). Regression results indicated limited relationships between CVR measures and cognitive functioning.
Conclusions:PD patients (PD-NC and PD-MCI) exhibited longer CVR delays relative to HC, suggesting a delayed vasodilatory response in PD. Examination of the association between CVR metrics and cognition were not significant, though these results should be interpreted with caution given the small sample size.
5 Midbrain Degeneration and Cognition in Parkinson’s Disease
- Kayla R Julio, Stephanie R Nitschke, Nicholas Shaff, Christopher Wertz, Andrew Mayer, Andrei Vakhtin, Gerson Suarez Cedeno, Amanda Deligtisch, Sarah Pirio Richardson, Sephira G Ryman
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 414-415
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Objective:
Neuromelanin imaging is an emerging biomarker for PD as it captures degeneration of the midbrain, a process which is associated with the motor symptoms of the disease. Currently, it is unknown whether this degeneration also contributes to cognitive dysfunction in PD beyond dysfunction associated with fronto-subcortical systems, as quantitative examination of substantia nigra (SN) degeneration could not be studied until recently.
In the current study, we examine whether neuromelanin signal is associated with broader cognitive dysfunction in PD patients with varying degrees of cognitive impairment: PD with normal cognition (PD-NC), PD with mild cognitive impairment (PD-MCI), and healthy controls (HC).
Participants and Methods:11 PD-NC, 16 PD-MCI and 14 age and sex-matched healthy controls (HC) participated in the study. PD participants were diagnosed with MCI based on the Movement Disorders Society Task force, Level II assessment (comprehensive assessment). In addition, all participants underwent an MRI scan that included a T1-weighted sequence and a neuromelanin-sensitive (NM-MRI) sequence. Contrast-to-noise-ratio of the substantia nigra pars compacta (SNc) was calculated and a distribution-corrected z-score was used to identify the number of extrema voxels for each individual, suggestive of the number of voxels that have exhibited significant degeneration (extrema_count). An analysis of covariance (ANCOVA) was used to evaluate group differences between HC, PD-NC, and PD-MCI in the extrema_count accounting for age, sex, and education. A multiple regression for each cognitive variable with extrema_count as the dependent variable adjusting for age, sex, and education were conducted.
Results:A significant main effect of group (F(2, 33) = 33.548 ; p < 0.001) indicated that PD-NC (21.55 ± 12.57) and PD-MCI (43.64 ± 32.84) patients exhibited significantly greater extrema_counts relative to HC (3.36 ± 3.61; both p < 0.001). Regression results indicated that higher extrema_counts were associated with worse cognitive performance across cognitive domains, including working memory (Digit Span Backward; R2 = .357, F(1,20) = 5.295, p = .032), (Hopkins Verbal Learning Test - Revised, Trials 1 to 3; R2 = .432, F(1,20) = 5.819, p = .026).
Conclusions:PD patients (PD-NC and PD-MCI) exhibited decreased neuromelanin in the SNc relative to healthy controls, confirming the ability of the NM-MRI sequence to differentiate PD from HC. There was no significant difference in SNc neuromelanin levels between PD-NC patients and PD-MCI patients, however, this is likely due to the small sample size. In addition, significant SNc degeneration was associated with worse cognitive performances in tasks associated with working memory and executive functioning. These results warrant further examination of the role of SN in PD patients with differing levels of cognitive impairment.
4 Compensatory Functional Activation During Motion Discrimination in Parkinson’s Disease
- Stephanie R Nitschke, Nicholas Shaff, Chris Wertz, David Stone, Andrei Vakhtin, Andrew Mayer, Elena K. Festa, William C. Heindel, David P. Salmon, Gerson Suarez Cedeno, Amanda Deligtisch, Sarah Pirio Richardson, Sephira G. Ryman
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 413-414
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Objective:
PD patients commonly exhibit executive dysfunction early in the disease course which may or may not predict further cognitive decline over time. Early emergence of visuospatial and memory impairments, in contrast, are more consistent predictors of an evolving dementia syndrome. Most prior studies using fMRI have focused on mechanisms of executive dysfunction and have demonstrated that PD patients exhibit hyperactivation that is dependent on the degree of cognitive impairment, suggestive of compensatory strategies. No study has evaluated whether PD patients with normal cognition (PD-NC) and PD patients with Mild Cognitive Impairment (PD-MCI) exhibit compensatory activation patterns during visuospatial task performance.
Participants and Methods:10 PD-NC, 12 PD-MCI, and 14 age and sex-matched healthy controls (HC) participated in the study. PD participants were diagnosed with MCI based on the Movement Disorders Society Task Force, Level II assessment (comprehensive assessment). Functional magnetic resonance imaging (fMRI) was performed during a motion discrimination task that required participants to identify the direction of horizontal global coherent motion embedded within dynamic visual noise under Low and High coherence conditions. Behavioral accuracy and functional activation were evaluated using 3 * 2 analyses of covariance (ANCOVAs) (group [HC, PD-NC, PD-MCI] * Coherence [High vs. Low]) accounting for age, sex, and education. Analyses were performed in R (v4.1.2(Team, 2013)).
Results:PD-MCI (0.702± 0.269) patients exhibited significantly lower accuracy on the motion discrimination task than HC (0.853 ± 0.241; p = 0.033) and PD-NC (0.880 ± 0.208; p =0.039). A Group * Coherence interaction was identified in which several regions, including orbitofrontal, posterior parietal and occipital cortex, showed increased activation during High relative to Low coherence trials in the PD patient groups but not in the HC group. HC showed default mode deactivation and frontal-parietal activation during Low relative to High coherence trials that was not evident in the patient groups.
Conclusions:PD-MCI patients exhibited worse visuospatial performance on a motion discrimination task than PD-NC and HC participants and exhibited hyperactivation of the posterior parietal and occipital regions during motion discrimination, suggesting possible compensatory activation.
Racial Classification, Slavery, and Human Rights: The Impacts of the Transatlantic Order in Eighteenth-Century Germany
- Edited by Patricia Anne Simpson, University of Nebraska, Lincoln, Birgit Tautz, Bowdoin College, Maine
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- Book:
- Goethe Yearbook 30
- Published by:
- Boydell & Brewer
- Published online:
- 20 December 2023
- Print publication:
- 13 June 2023, pp 135-136
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Summary
THE PANEL OF the DGEJ (Deutsche Gesellschaft zur Erforschung des 18. Jahrhunderts) at the 2022 ASECS convention in Baltimore was organized by Sigrid G. Köhler and Claudia Nitschke. Based on recent historical studies that have demonstrated how the Germans participated in the transatlantic slave trade (whether directly or indirectly) and the slave plantation system, the aim of the panel was to examine more closely the extent to which German-speaking authors knew of these connections, how this knowledge came to bear on their writing as well as political and theoretical thinking, and, finally, how impactful these considerations ultimately were. The panel not only placed an emphasis on the normative frameworks of (anti)slavery in the eighteenth century but also on the media and strategies of representation that were employed in the discussions revolving around these topics.
In his paper There are Slaves in the Past and Nowadays: Slavery in German Natural Law, Frank Grunert examined the justification given by natural law in the seventeenth and eighteenth centuries to legitimize or delegitimize slavery. I n the Latin nomenclature of natural law, borrowed from Roman law, the terms servus and servitus stood for different forms of economic and legal dependence, of which slavery is an extreme version. A ccording to Grunert, in Samuel von Pufendorf's philosophy of natural law, slavery is a systematic part of natural law, which Pufendorf saw as justified by an assumed voluntary agreement. However, and this accounts for the ambivalence of his argument, Pufendorf emphatically advocated for the difference between the possession of a person and a thing. A t the beginning of the eighteenth century, authors such as Johann Gottlieb Heineccius still argued in keeping with Pufendorf's ideas, even if they already posed the question of legal protection against extreme violence by the lord or owner. I n the middle of the eighteenth century, however, the institution of slavery could no longer be justified under natural law because, as Gottfried Achenwall and Johann Stephan Püttner argued in their Elementa Iuris Naturae, people could not be property. S uch power over people would be despotism, and voluntary consent would not be a declaration of will, but simply madness.
(P2-6) Evaluation of Air Rescue Missions Using a Helicopter — Analysis from a German Helicopter Base
- M.D. Frank, U. Aschenbrenner, G. Nitschke, J. Braun
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- Journal:
- Prehospital and Disaster Medicine / Volume 26 / Issue S1 / May 2011
- Published online by Cambridge University Press:
- 25 May 2011, p. s137
- Print publication:
- May 2011
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Introduction
In Germany, emergency medical care is provided by ambulances. Emergency physicians also are used in the German rescue system to ensure primary care. Additionally, rescue helicopters are insertable. The rescue helicopter in Dresden covers the city of Dresden and its surrounding areas, with 517,000 inhabitants and distances up to 70 km. The goal of this study was to evaluate emergency cases in helicopter rescue missions according to primary diagnoses and severity of the mission on the basis of NACA Score.
MethodsData from all emergencies using the German Air Rescue (DRF-Luftrettung) Helicopter Base Dresden were recorded on a standardized protocol and transferred to a central computer database (MEDAT®). Data from all emergency cases between January 2006 and July 2010 were analyzed.
ResultsThere was a total of 6,310 emergencies during the study period, with a significant increase over time. The helicopter was on-scene within 10.9 minutes. In total, 54% of the patients were male. The rate of female patients > 80 years of age was 64.5%. A total of 63.4% of patients suffered life-threatening injuries or dysfunctions and a NACA score ≥ 4. A total of 7.6% of patients were classified in NACA 6 or 7. The most common cause for rescue missions was an acute coronary syndrome (20.4%). Other frequent diagnoses included brain injury (13.3%), unconsciousness (12.5%), stroke (12.9%), general cerebral convulsion (7.9%), polytrauma (6.4%), and cardiac arrest (5.0%). The rate of prehospital endotracheal intubation was 15.1%. In 1.1% of patients, a thoracic drainage was established.
ConclusionsIn recent years the number of helicopter rescue missions increased, along with injury severity. The total number of patients with NACA 6 and 7 was extremely high, and demonstrates the need for an efficient emergency medical rescue system that includes helicopters.
Contributors
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- By Nicholas B. Allen, Stephanie Assuras, Robert M. Bilder, Joan C. Borod, John L. Bradshaw, Warrick J. Brewer, Ariel Brown, Nik Brown, Tyrone Cannon, Audrey Carstensen, Cameron S. Carter, Luke Clark, Phyllis Chua, Thilo Deckersbach, Richard A. Depue, Tali Ditman, Aleksey Dumer, David E. Fleck, Lara Foland-Ross, Judith M. Ford, Nelson Freimer, Paolo Fusar-Poli, Nathan A. Gates, Terry E. Goldberg, George Graham, Igor Grant, Melissa J. Green, Michelle M. Halfacre, Wendy Heller, John D. Herrington, Garry D. Honey, Jennifer E. Iudicello, Henry J. Jackson, J. David Jentsch, Donald Kalar, Paul Keedwell, Ester Klimkeit, Nancy S. Koven, Donna A. Kreher, Gina R. Kuperberg, Edythe London, Dan I. Lubman, Daniel H. Mathalon, Patrick D. McGorry, Philip McGuire, George R. Mangun, Gregory A. Miller, Albert Newen, Jack B. Nitschke, Jaak Panksepp, Christos Pantelis, Mary Philips, Russell A. Poldrack, Scott L. Rauch, Susan M. Ravizza, Steven Paul Reise, Nicole Rinehart, Angela Rizk-Jackson, Trevor W. Robbins, Tamara A. Russell, Fred W. Sabb, Cary R. Savage, Kimberley R. Savage, J. Cobb Scott, Marc L. Seal, Larry J. Seidman, Paula K. Shear, Marisa M. Silveri, Nadia Solowij, Laura Southgate, G. Lynn Stephens, D. Stott Parker, Stephen M. Strakowski, Simon A. Surguladze, Kate Tchanturia, René Testa, Janet Treasure, Eve M. Valera, Kai Vogeley, Anthony P. Weiss, Sarah Whittle, Stephen J. Wood, Steven Paul Woods, Murat Yücel, Deborah A. Yurgelun-Todd
- Edited by Stephen J. Wood, University of Melbourne, Nicholas B. Allen, University of Melbourne, Christos Pantelis, University of Melbourne
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- Book:
- The Neuropsychology of Mental Illness
- Published online:
- 10 May 2010
- Print publication:
- 01 October 2009, pp xv-xx
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