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In this study the correlation between executive functions and intelligence as assessed by the BRIEF-P and WNV, respectively will be examined.A sample of 447 children at the 4;0-5;11 year age group was assessed with the WNV. Additionally, parents answered a questionnaire on executive functions (BRIEF-P) and a second questionnaire concerning family background. Partial correlations were calculated on the subtest and scale level and linear regression models were tested.The primary scale Working Memory (BRIEF-P) contributes to an explanation of cognitive functions (WNV), as does the maternal educational level. WM an the Emergent Metacognition Index, which is incorporated the WM scale, shows significant correlation with subtests and with both of the higher order IQ scales of the WNV.Already at the preschool age, executive functions play an important role in intelligence. Deficits in EF are related to ADHD and to negative school careers. Early programs for prevention or intervention should be implemented to improve conditions for academic learning.

Zusammenfassung Achtsamkeit wird verstanden als eine auf Körpersignale, Sinneseindrücke, Gedanken und Gefühle gerichtete nicht bewertende Aufmerksamkeit im Moment, deren Training die Eigenwahrnehmung, die Aufmerksamkeitslenkung und die Emotionsregulation verbessert. Durch den akzeptierenden Umgang mit allen Empfindungen und Gedanken verringert sich das Stresserleben, sodass belastende Situationen einfacher bewältigt werden können. Regelmäßige Ausführungen der Achtsamkeitsübungen sprechen neurobiologische Mechanismen an, die insgesamt zu einer Verbesserung der exekutiven Funktionen wie auch der psychischen Gesundheit beitragen können. Metaanalysen weisen auf kleine Wirkungen von Achtsamkeitsinterventionen in der Schule sowohl für den kognitiven Bereich (exekutive Funktionen, Konzentration, Gedächtnis) als auch für den emotionalen Bereich (Angst, Depressivität, Wohlbefinden) hin. Im Mittelpunkt dieses Überblicks stehen daher deutsche und englischsprachige Achtsamkeitsprogramme für Kinder und Jugendliche in Schulen, zu denen bereits erste Evaluationsstudien durchgeführt wurden. Vorgestellt werden die Programme Paws b, Mind Up und Mehr Ruhe für Kinder, sowie .b, Mind Up, AISCHU und 8sam für Jugendliche samt ihren Evaluationsergebnissen. Abschließend werden offene Fragen konzeptueller und methodischer Art diskutiert.

The present review focuses on cognitive and participation impairments after aneurysmal subarachnoidal hemorrhage (aSAH). Such impairments may be present even in cases without evidence of damage in the neuropsychologically expected brain area. Neuroinflammation and oxidative stress may be responsible for this finding. Most frequently, cognitive impairment can be found in the verbal memory domain, visuospatial skills and memory domain, attention and working memory domain, executive functions (planning, central control, problem solving, attention, decision making), psychomotor speed and language domain. The presence of cognitive deficits is a major risk factor not to return to work again. Together with cognitive impairment, psychiatric symptoms like anxiety, depression and fatigue may be observed. Psychiatric disturbances result in impairments of social and vocational participation and - consecutively - worsening of quality of life.Das vorliegende Review beschäftigt sich mit kognitiven Störungen und Teilhabebeeinträchtigungen nach aneurysmatischen Subarachnoidalblutungen (aSAB). Diese können auch ohne den Nachweis einer substanziellen Hirnschädigung in der neuropsychologisch zu erwartenden Region auftreten. Als Ursache für diese Diskrepanz gelten neuroinflammatorische Prozesse und oxidativer Stress. Am häufigsten sind das verbale Gedächtnis, visuell-räumliche Fähigkeiten, das Gedächtnis für visuelle Inhalte, Aufmerksamkeit, Arbeitsgedächtnis, Exekutivfunktionen (Planung, Kontrolle, Problemlösung, Aufmerksamkeit, Entscheidungsfindung), die allgemeine kognitive Verarbeitungsgeschwindigkeit und die sprachliche Domäne betroffen. Es zeigt sich, dass das Vorhandensein kognitiver Beeinträchtigungen einen wesentlichen Risikofaktor darstellt, nicht mehr beruflich reintegriert werden zu können. Zusätzlich zu den kognitiven Symptomen treten nach einer aSAB auch gehäuft psychiatrische Symptome wie Angst, Depression und Fatigue auf. Diese wirken sich zusätzlich zu den körperlichen und kognitiven Beeinträchtigungen negativ auf die Teilhabe am beruflichen und sozialen Leben aus, was wiederum zu einer schlechteren Lebensqualität beiträgt.

Children with congenital heart disease (CHD) are at significant risk of psychomotor and cognitive developmental disorders, with negative effects on psychosocial and academic performance and quality of life. Innate characteristics such as genetic abnormalities, type and severity of CHD and socioeconomic factors are the most important risk factors. Prenatally, hypoperfusion or hypoxia can cause developmental and maturation disorders of the brain, thus promoting postpartum lesions of the more vulnerable brain substance and neurodevelopmental disorders. The high-risk group includes primarily infants requiring open heart surgery. Specific phenotypic characteristics of development emerge at different ages: in early childhood motor and linguistic articulation deficits; at school age impaired speech and language, attention, memory, visual-spatial, executive, and motor skills, often associated with academic deficits, and emotional or social issues; in adolescence executive, psychosocial and psychiatric disorders and impaired quality of life; in adulthood, neurocognitive, psychosocial and problems of self-management and professional perspective. Physical and social functioning, psychomotor development and mental health are key factors for quality of life. The German Society of Pediatric Cardiology demands detailed serial neuropsychological examinations at the age of 2 and 5 years, before puberty and before adulthood, for the high-risk group of children with CHD operated on in infant age in order to detect and to treat partial performance disorders at an early stage.Kinder mit angeborenem Herzfehler (AHF) haben ein signifikantes Risiko für psychomotorische und kognitive Entwicklungsstörungen mit negativen Auswirkungen auf die psychosoziale Situation, akademische Leistung und Lebensqualität. Wichtigste Risikofaktoren sind angeborene Merkmale wie genetische Anomalien, Art und Schweregrad des AHF und sozioökonomische Faktoren. Pränatal können durch Hypoperfusion oder Hypoxie Reifungs- und Entwicklungsstörungen des Gehirns entstehen mit der Folge postnataler Läsionen der vermehrt vulnerablen Hirnsubstanz und neurologischer Entwicklungsstörungen. Die Hochrisiko-Gruppe umfasst vor allem Säuglinge, bei denen eine Operation am offenen Herzen erforderlich ist. Es bestehen spezifische phänotypische Merkmale der Entwicklung in verschiedenen Lebensaltern: in der frühen Kindheit motorische Defizite und sprachliche Artikulationsprobleme; bei Schulkindern eine Beeinträchtigung von Sprache, Aufmerksamkeit, Gedächtnis, visuell-räumlichen Fähigkeiten, exekutiven Funktionen und motorischen Fähigkeiten, oft in Verbindung mit akademischen Defiziten sowie emotionalen oder sozialen Problemen; im Jugendalter exekutive, psychosoziale sowie psychiatrische Störungen und eine eingeschränkte Lebensqualität; im Erwachsenenalter neurokognitive, psychosoziale sowie Probleme des Selbstmanagements und der beruflichen Perspektive. Körperliche und soziale Funktionsfähigkeit, psychomotorische Entwicklung und psychisches Befinden erweisen sich als Schlüsselfaktoren für die Lebensqualität. Die Deutsche Gesellschaft für Pädiatrische Kardiologie fordert für die Hochrisikogruppe der im Säuglingsalter operierten Kinder mit AHF ausführliche serielle neuropsychologische Untersuchungen im Alter von 2 und 5 Jahren, vor Pubertät und vor Beginn des Erwachsenenalters, um frühzeitig Teilleistungsstörungen erkennen und behandeln zu können.

Neuropsychological assessment should be an integral component of clinical psychiatric diagnostics. Yet, the commonly used tests have not been investigated adequately for this population so far. The current study evaluated a clinically approved neuropsychological test battery by analyzing data on 226 mentally ill patients using factor and regression analyses. The extraction of three factors (Speed, Memory, and Executive Functions) proved to be adequate as the tests could be allocated properly. Regression analysis revealed an economical basis assessment consisting of three tests (TAP Alertness, VLMT, and Matrices Test). Based on acceptance, economy, and factorial structure aspects, we recommend the investigated test battery for neuropsychological assessment of psychiatric and psychosomatic patients.Neuropsychologische Untersuchungen sollten ein integraler Bestandteil der klinisch-psychiatrischen Diagnostik sein. Die gängigen Testverfahren wurden bisher jedoch nicht ausreichend an dieser Klientel untersucht. In der vorliegenden Untersuchung wurde eine im klinischen Alltag bewährte neuropsychologische Testbatterie evaluiert. Hierzu wurden Daten von 226 psychisch kranken Patienten anhand von Faktoren- und Regressionsanalysen ausgewertet. Es erwies sich als sinnvoll, drei Faktoren zu extrahieren (Speed, Gedächtnis, Exekutivfunktionen), zu denen sich die Einzeltests plausibel zuordnen ließen. Anhand regressionsanalytischer Berechnungen konnte zudem ein zeitökonomisches Basisassessment aus drei Einzeltests (TAP Alertness, VLMT und Matrizentest) ermittelt werden. Zusammenfassend kann vor dem Hintergrund der Akzeptanz, Ökonomie und faktoriellen Struktur die evaluierte Testbatterie für den Einsatz bei psychiatrischen und psychosomatischen Patienten empfohlen werden.

Executive functions, visuo-spatial processing and control of behaviour are pertinent for safe driving. In patients with mild cognitive impairment and dementia, these abilities can be impaired, in addition to age-related impairments, and driving ability can be compromised at an early stage. Neurologists and psychiatrists play an important role in the examination, counseling and, if required, the issuing of a medical driving ban. Mistakes in this process may ensue forensic sequelae for the involved physicians. The present article presents the relevant conditions and associated cognitive impairments, and gives some recommendations on the neuropsychological workup and on the communication with patients and relatives concerning driving.Exekutive Leistungen, visuell-räumliches Denken und Verhaltenskontrolle sind für das sichere Autofahren wesentliche geistige Leistungen. Bei Demenz und Leichter Kognitiver Störung treten Defizite dieser Leistungen auf, die sich zu altersbedingten Defiziten addieren. Sie können durch eine angepasste Fahrweise nicht immer ausreichend kompensiert werden und führen ggf. schon im frühen Stadium zur Aufhebung der Fahrtauglichkeit. Neurologen und Psychiater kommt eine wichtige Rolle bei der Untersuchung, Aufklärung und ggf. Aussprache eines ärztlichen Fahrverbotes zu. Fehler und Unterlassungen können hier unter Umständen juristische Konsequenzen nach sich ziehen. Der vorliegende Beitrag stellt die relevanten Erkrankungen und die mit ihnen assoziierten kognitiven Störungen dar, gibt Empfehlungen für die neuropsychologische Untersuchung und die Kommunikation mit Patienten und Angehörigen.

The concept of executive function is a so-called umbrella concept, so that it includes many different and in some cases mutually contradictory higher-level organizational abilities such as planning, monitoring, inhibition and control of action. Typically, the cause of an executive dysfunction is an underlying lesion in the prefrontal cortex or subcortical regions. Deficits in executive functions appear in the fields of cognition as well as behavior. Diagnosis requires the use of a wide-ranging repertoire of tests and questionnaires making it a time-consuming process. Different therapeutic approaches addressing the diverse symptoms of executive dysfunction, both positive and negative, are available. These include modification and manipulation of the environment and practice of cognitive repetitive procedures. The former are implemented particularly in cases of severely impaired persons. The latter are used in persons in whom cognitive dysfunctions are the dominating symptoms of the disorder.The operational area of therapeutic approaches using paper and pencil as well as computer programs limits them to treatment of cognitive dysfunction. If behavioral disturbances dominate the clinical picture, other procedures should be used.The effectiveness of cognitive therapy of executive dysfunction is well demonstrated according to the criteria of evidence-based medicine (EBM).

Parkinson's disease (PD) is the second most prevalent chronic neurodegenerative disorder worldwide, following Alzheimer's disease. Along with the characteristic motor symptoms of the disorder, especially bradykinesia, cognitive deficits can often be found prior to the onset of the disorder. These mainly concern executive functioning. To detect cognitive deficits at an early stage, initial screening procedures are recommended. The new cognitive rapid test Paarassoziationslernen-5 ("PAL-5") has been developed to detect the most prevalent cognitive symptoms - namely executive impairments - of PD patients. It consists of a direct recall of five incompatible and newly jointed word pairs (capitals vs. countries), an intermediate formal lexical word fluency task ("FAS-Test") and a delayed recall. Thereby, the three major executive functioning processes are tested: cognitive flexibility, inhibition and memory. In the department of neurology of the University Clinic of Cologne, the PAL-5 was completed by 154 PD patients, 115 participants with cognitive deficits without a PD diagnosis and 115 controls (N = 384) between 2014 and 2016. For purposes of retest reliability determination, another 42 controls were examined from February to July 2017, with a four-month time interval between the initial and second test. Highly significant group differences have been found. PD patients and cognitive impaired participants scored significantly lower than the control group. A comparison of PD patients and cognitively impaired participants did not reveal significant group differences. Additionally, a moderate to high correlation between PAL-5 and MMST as well as PAL-5 and PANDA was found (respectively p .001). An ROC analysis of the PAL-5 total score of PD patients with a score lower than 11 showed an AUC of .91. Therefore, a cut-off of ≤ 10 seems to be practicable to detect cognitive deficits - especially executive functioning deficits and memory impairments - in PD patients. It has been shown that cognitive flexibility, inhibition and memory is a short useful combination for a screening procedure of PD patients.Morbus Parkinson ist nach der Demenz vom Alzheimer-Typ die zweithäufigste chronische neurodegenerative Erkrankung weltweit. Neben den charakteristischen motorischen Symptomen der Krankheit, insbesondere der Bradykinese, treten häufig bereits vor Beginn der Erkrankung leichte kognitive Beeinträchtigungen (PD-MCI) auf, die vor allem die Exekutivfunktionen betreffen. Um solche kognitiven Beeinträchtigungen frühzeitig zu erkennen, ist initial die Durchführung eines Screenings wünschenswert. Der neu entwickelte kognitive Schnelltest Paarassoziationslernen-5 („PAL-5“) wurde konzipiert, um die Leitsymptomatik kognitiver Störungen – nämlich exekutive Beeinträchtigungen – bei Parkinson-Patienten zu erkennen. Dieser besteht aus einem unmittelbaren Abruf von fünf inkompatiblen und neu zusammengefügten Wortpaaren (Hauptstädte vs. Länder), einer intermediären formallexikalischen Wortflüssigkeitsaufgabe („FAS-Test“) und einem anschließenden verzögerten Abruf. Damit werden die drei Kernprozesse exekutiver Funktionen getestet: kognitive Flexibilität, Inhibition und Gedächtnis. An der Klinik und Poliklinik für Neurologie der Universitätsklinik Köln wurde der PAL-5 in den Jahren von 2014 bis 2016 insgesamt an 154 Parkinson-Patienten, 115 kognitiv Beeinträchtigten ohne Parkinson-Diagnose und 115 Kontrollprobanden durchgeführt (N = 384). Für eine Retest-Reliabilitätsbestimmung wurden außerdem weitere 42 Kontrollprobanden herangezogen, die im Zeitraum von Februar bis Juli 2017, in einem Abstand von jeweils vier Monaten zwischen der ersten und zweiten Testung, untersucht wurden. Es stellten sich hochsignifikante Gruppenunterschiede in den Subtests des PAL-5 heraus. Parkinson-Patienten sowie kognitiv Beeinträchtigte schnitten signifikant schlechter ab als die Kontrollprobanden. Zwischen den Parkinson-Patienten und kognitiv Beeinträchtigten gab es keine signifikanten Gruppenunterschiede in den Testscores. Außerdem zeigten sich mittelhohe bis hohe Korrelationen zwischen PAL-5 und MMST sowie PAL-5 und PANDA (jeweils p 0,001). In der ROC-Analyse für den PAL-5-Gesamtwert bei Parkinson-Patienten mit einem Score von weniger als 11 Punkten zeigte sich eine AUC von 0,91. Ein Summenscore von ≤ 10 scheint daher praktikabel zu sein, um kognitive Defizite – vor allem exekutive Funktionsstörungen und Gedächtnisbeeinträchtigungen – bei Parkinsonerkrankten zu erkennen. Es hat sich gezeigt, dass die Kombination von kognitiver Flexibilität, Inhibition und Gedächtnis eine kurze sinnvolle Zusammenstellung für ein Screeningverfahren von Parkinson-Patienten ist.

Patients with lesions of the prefrontal cortex as a result of frontal brain tumors (intra- and extra-axial) can show impairments of executive functions 1 2 3 4. Although there are a large number of psychological tests, the detection of impairments of relevant everyday executive functions in these patients is still extremely difficult. In 30 patients with lesions of the prefrontal cortex, the executive functions were tested with the Behavioral Assessment of Dysexecutive Syndrome (BADS) and 21 patients were also followed up postoperatively. Additionally, if possible, the Wisconsin Card Sorting Test (WCST), a widely used executive function test, and the Wechsler Adult Intelligence Scale (WAIS) for general cognitive performance were conducted. Pre- and postoperatively, a total of 16 patients were followed up with all three tests. The aim was to investigate the neuropsychological assessment pre- and postoperatively, to evaluate it in terms of deficits and changes in performance and to ensure that no new relevant everyday cognitive deficits arose. Preoperatively, only one patient, who could not be tested post-surgery, showed a reduced overall profile value in the BADS. In all tested patients, there was no evidence of deterioration of cognitive status 8 - 12 weeks postoperatively. Further investigations using fMRI should be used to clarify whether the results obtained should be interpreted as neuroplastic adaptations of prefrontal cognitive functions or as a failure to detect deficits due to a lack of sensitivity of the tests used.

In the context of neurological assessment, neuropsychological deficits, in particular of attention and memory functions, usually require additional neuropsychological evaluation. Clinical neuropsychology also has at its disposal an inventory of validated and standardized tests for assessing symptom validity. Procedure, test selection, quality criteria and limitations of neuropsychological expert medical evaluations are presented. Independent expert evaluations should be conducted by a qualified clinical neuropsychologist.

Investigate whether treatment response in people at clinical high risk of psychosis (CHR) is predicted by their cognitive performance.128 CHR outpatients were randomized into two treatment groups, one receiving integrated psychological intervention (IPI), including psychoeducation, the other receiving supportive counselling (SC) for 12 months. Multiple regression analysis was used to identify neurocognitive predictors of treatment response in a subgroup of n = 105, measured by symptomatic and functional improvement at 1-year follow-up.In the IPI, treatment response was associated with performance of executive control and processing speed (R² = 0.27, p = 0.002). In both treatment groups, performance of working memory/attention was a significant predictor (IPI: R² = 0.15, p = 0.039, SC: R² = 0.19, p = 0.012).Cognitive performance is associated with treatment response in CHR people. The enhancement of cognitive performance is a useful target of early intervention.

Dementia influences at an early stage the driving aptitude of motor vehicle steering persons. Every year in Switzerland, around 16'000 driving permit holders suffer newly from dementia; therefore the driving aptitude is questioned, especially because of possibly limited executive functions. Individuals with early-stage dementia often may show a dangerous driving stile. However, a mild dementia does not a priori exclude the driving aptitude, and less than half of these drivers can continue driving for another 1 - 3 years. In contrast, there is no further driving aptitude in presence of moderate dementia. In the assessment of driving aptitude, the underlying cause of dementia is always taken into account. Cognitive short tests such as the Mini-Mental Status Exam, Clock Drawing Test and Trail-Making Test are not suitable to make reliable statements about the aptitude to drive, but these tests are very important for the initial diagnosis of dementia in primary care practice and can lead the way for further examination concerning driving aptitude. The legally prescribed regular check-up for motorists aged over 70 years in Switzerland provides an ideal opportunity for early detection of incipient dementia. The practical procedure for the assessment of aptitude to drive in the primary care practice is presented. The physician-guided on-road driving test represents a meaningful, practical and relatively cost-effective tool for the evaluation of driving aptitude in cases of doubt.Demenz-Erkrankungen beeinflussen bereits in einem frühen Stadium die Fahreignung von Motorfahrzeuglenkenden. In der Schweiz erkranken jährlich rund 16'000 Ausweisinhaber neu an Demenz, dabei ist die Fahreignung vor allem aufgrund der eingeschränkten Exekutivfunktionen in Frage gestellt. Personen mit beginnender Demenz zeigen häufig ein gefährliches Fahrverhalten. Eine leichte Demenz schließt jedoch die Fahreignung nicht von vornherein aus, weniger als die Hälfte der betroffenenen Personen können noch 1 – 3 Jahre weiterfahren. Demgegenüber ist die Fahreignung bei Vorliegen einer mittelschweren Demenz nicht mehr gegeben. Bei der Beurteilung der Fahreignung ist immer auch die zugrunde liegende Demenzursache zu berücksichtigen. Kognitive Kurztests wie Mini-Mental-Status, Uhrentest und Trail-Making-Test Kurztests sind nicht geeignet, zuverlässige Aussagen über die Fahreignung zu machen, sie sind aber sehr wichtig für die Erst-Diagnostik in der Grundversorgerpraxis und können wegweisend sein für das weitere Vorgehen bezüglich Fahreignungsabklärung. Die in der Schweiz vorgeschriebene verkehrsmedizinische Kontrolluntersuchung bildet eine ideale Möglichkeit zur Früherfassung einer beginnenden Demenz-Erkrankung. Das praktische Vorgehen für die Fahreignungsbeurteilung in der Grundversorger-Praxis wird vorgestellt. Die ärztlich begleitete Kontrollfahrt stellt in Zweifelsfällen ein aussagekräftiges, praxisnahes und vergleichsweise kostengünstiges Untersuchungsinstrument bei der Fahreignungsabklärung dar.

The role of the cerebellum in motor control and motor learning is well-recognised. Patients with cerebellar disease consult a doctor because of their motor dysfunction (ataxia). For nearly three decades intense research has been addressing the question to what extent the cerebellum may support cognitive functions. Neuroanatomic findings support the notion that posterolateral parts of the cerebellum contribute to cognition. Although there is a huge number of neuropsychological studies in patients with cerebellar disease, interpretation of findings is frequently hampered by the accompanying motor disorders and extracerebellar lesions. This review summarises the anatomic findings and attempts to give a critical evaluation of findings in human lesion studies. There are good reasons to believe that cerebellar disorders, both cerebellar degeneration and focal cerebellar lesions, may lead to certain cognitive dysfunctions. Disorders in executive function, in particular working memory, and certain higher language tasks are best documented. However, disorders in adults with chronic diseases tend to be mild. Dysfunction appears to be more prominent in patients with acute disease.

Through cortico-subcortico-cortical loop systems, the dopaminergic modulation influences not only motor, but also other executive functions. Neuropsychological findings in Parkinson's disease are reviewed and physiologically interpreted. The theory of a "supervisory attentional system" according to Norman and Shallice (1986) seems to be an adequate model of the interaction of cortex and basal ganglia in executive function and control.

We investigated the moderating influence of apathy, depression and transient mood changes on executive functions under best medical treatment and under postoperative stimulation-on and -off conditions in a sample of 33 patients with Parkinson's disease (PD) after deep brain stimulation of the subthalamic nucleus (STN), 33 PD patients with pharmacological treatment only and 34 healthy controls. In comparison to clinical and healthy control groups, DBS patients showed worse executive task performance and also more severe symptoms of depression and apathy. Apathy accounted for differences in stroop interference between groups. The effects of DBS on stroop interference were explained by increased state anxiety in the -off, so that DBS STN had no significant influence on test performance. Consideration of neuropsychiatric symptoms and acute mood changes is an important aspect when evaluating neuropsychological deficits in DBS patients.

Psychiatric disorders in childhood and adolescence, in particular attention deficit disorder or specific learning disorders like developmental dyslexia and developmental dyscalculia, affect academic performance and learning at school. Recent advances in neuroscientific research have incited an intensive debate both in the general public and in the field of educational and instructional science as well as to whether and to what extent these new findings in the field of neuroscience might be of importance for school-related learning and instruction. In this review, we first summarize neuroscientific findings related to the development of attention, working memory and executive functions in typically developing children and then evaluate their relevance for school-related learning. We present an overview of neuroimaging studies of specific learning disabilities such as developmental dyslexia and developmental dyscalculia, and critically discuss their practical implications for educational and teaching practice, teacher training, early diagnosis as well as prevention and disorder-specific therapy. We conclude that the new interdisciplinary field of neuroeducation cannot be expected to provide direct innovative educational applications (e.g., teaching methods). Rather, the future potential of neuroscience lies in creating a deeper understanding of the underlying cognitive mechanisms and pathomechanisms of learning processes and learning disorders.Psychische Störungen im Kindes- und Jugendalter, vor allem Störungen der Aufmerksamkeit, Lese-Rechtschreibstörungen (LRS) und Rechenstörungen, betreffen in ihrem Auftreten und ihren Auswirkungen ganz besonders die Schule und das schulische Lernen. In jüngster Zeit entfachten neurowissenschaftliche Befunde sowohl in der Öffentlichkeit als auch in der Lehr- und Lernforschung eine rege Diskussion, ob und inwieweit neue Erkenntnisse zur Funktionsweise des Gehirns auch relevant für das Lernen und Lehren in der Schule sein können. Der vorliegende Übersichtsartikel fasst neurowissenschaftliche Befunde zur regelhaften kindlichen Entwicklung von Aufmerksamkeits-, Arbeitsgedächtnis- und Exekutivfunktionen zusammen und diskutiert kritisch deren Relevanz für schulisches Lernen. Des Weiteren werden Bildgebungsbefunde zu spezifischen Teilleistungsstörungen wie LRS und Dyskalkulie dargestellt und mögliche praktische Implikationen für Unterrichtspraxis, Lehrerausbildung, Frühdiagnostik und Prävention sowie störungsspezifische Therapie zusammengefasst. Insgesamt sind es wohl weniger neue Anwendungen (wie z. B. Lehrmethoden), die von einer Neurodidaktik als interdisziplinärem Forschungsfeld zu erwarten sind; vielmehr können die Neurowissenschaften Argumentationsgrundlagen für bestimmte Theorien und Modelle liefern, welche ein tieferes Verständnis zugrundeliegender kognitiver Mechanismen und Pathomechanismen von Lernprozessen und –störungen ermöglichen.

The legal framework and the essentials in traffic and transport psychology and statistics were described in part 1. Safe driving depends on different sensory and mental processes interacting in a complicated manner. Physiological changes and--even more importantly--a variety of diseases result in impaired performance in these functional areas. Moderate to severe dementia certainly means that the person is no longer fit to drive, whereas driving ability may be maintained in mild dementia for some time. There are different approaches and assessment tools, but a single test that could, on its own, answer the question whether a patient with mild dementia is fit to drive does not exist. Driving ability is not only determined by cognitive function. Further assessment of possible risk factors and overall functioning is necessary. If dementia is diagnosed, then the question of fitness to drive must be promptly discussed with the patient because during the course of dementia driving ability will inevitably be lost. The conclusion of the assessment of driving ability must not be pronounced like a verdict, the physician should rather counsel and support the patient and his family on the difficult road towards driving cessation.

Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions.The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN.The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.Fragestellung: Erwachsene mit Anorexia nervosa (AN) zeigen vor und nach Gewichtsrehabilitation Beeinträchtigungen kognitiver Funktionen. Im Bereich der kindlichen und früh-adoleszenten AN besteht ein großer Bedarf an strukturierten Untersuchungen der kognitiven Funktionen. Bisherige Studien weisen methodische Inkonsistenzen bezüglich der Testauswahl und der Operationalisierung kognitiver Funktionen auf, die die Interpretierbarkeit und Vergleichbarkeit der Befunde deutlich einschränken. Um diese Inkonsistenzen zu verringern, wurde eine neuropsychologische Testbatterie, das sogenannte „Ravello Profil“ entwickelt, das bisher jedoch nicht für den deutschen Sprachraum zur Verfügung steht. Die vorliegende Arbeit stellt daher eine für den deutschen Sprachraum adaptierte Version des Ravello Profils vor und überprüft dessen Anwendbarkeit im Kindes- und Jugendalter. Methodik: Das Ravello Profil wurde für den deutschen Sprachraum adaptiert. Anhand von drei Fallbeispielen wurde die Durchführbarkeit des Ravello Profils bei Kindern und Jugendlichen mit AN überprüft. Ergebnisse und Schlussfolgerungen: Die Fallbeispiele verdeutlichen die Anwendbarkeit des adaptierten Ravello Profils bei Kindern und Jugendlichen mit AN. Das Ravello Profil ermöglicht somit auch im deutschen Sprachraum methodisch konsistente Untersuchungen kognitiver Funktionen bei Kindern, Jugendlichen und Erwachsenen mit AN. Mithilfe des Ravello Profils kann die Rolle kognitiver Funktionen bei der Entstehung einer AN über eine umfassende Altersspanne systematisch untersucht werden.

Multiple sclerosis (MS) is the most common chronic immune-mediated disease which goes along with serious somatic and psychic symptoms. Whereas recent research rather focussed on the neurological symptoms of MS, there is nowadays an increasing interest among researchers in psychological symptoms of the disease. It is known that about half of the MS patients suffer from cognitive deficits, and that cognitive decline has a disadvantageous impact on lifestyle and quality of life in affected persons. So far, cognitive deficits in subjects with MS have been described as rather isolated, specific cognitive disturbances with otherwise intact intellectual abilities, while global deterioration of mental skills in terms of dementia is considered as being rather rare. In the present article, we describe cognitive domains which are typically impaired in subjects with MS and reflect on the question if the diagnosis of dementia might be underrepresented in MS patients due to several reasons (e.g., progression of cognitive deficits in the course of the disorder, adhering very closely to memory deficits as cardinal symptom of dementia, lack of longitudinal studies of cognitive performance levels). Furthermore, we recommend a multistage neuropsychological diagnostic procedure for clinical practice which aims at diagnosing cognitive deficits already in early stages of the illness. In so doing, practitioners may be able to offer adequate therapies to affected persons in all stages of the disorder in order to improve psychosocial functional levels.

Recent advances achieved in the field of clinical neuro(bio-)psychology have been varied and impressive. Together with the related social and psychosocial aspects, they contribute to and enrich the development of new options in diagnosis and psychotherapy. Important research results are discussed here based on the examples of depression, Alzheimer's disease and self-injury, which profit greatly from neuropsychological research, especially through early detection of symptoms and prevention.

As part of inclusive efforts more and more deaf and hard-of-hearing (D/HH) children are attending general schools. This makes it important to consider significant developmental prerequisites necessary for this step. This study analyzed the socioemotional problems of hearing-impaired children from general schools with respect to their executive functioning and communicative competence.The executive functions of a sample of 69 hearing-impaired students were assessed by their teachers with a German version of the Behavior Rating Inventory of Executive Functions (BRIEF). In addition, a questionnaire measuring communicative competence as well as a German version of the Strengths and Difficulties Questionnaire were administered. The data were compared with those from a hearing normative sample, and further correlation and regression analyses were performed. The relationships between executive functioning and sociodemographic variables were also analyzed.There was a significantly higher rate of problems in executive functions for the group of D/HH students than for a hearing normative sample on nearly all scales, with the prevalence rate for executive dysfunctions being on average about three times higher. In addition to the children's sex, the BRIEF index for behavior regulation proved best for predicting socioemotional problems.The consequences for practical work are discussed. The results from the study suggest that D/HH students at general schools benefit in their psychosocial development from educational concepts that, in addition to promoting language and communicative competences, explicitly include strengthening self-efficacy and self-control.Fragestellung: Da im Zuge inklusiver Bestrebungen immer mehr hörgeschädigte Kinder eine allgemeine Schule besuchen werden, gilt es, relevante entwicklungspsychologische Voraussetzungen hierfür genauer zu betrachten. In einer Studie wurden deshalb sozial-emotionale Probleme hörgeschädigter Kinder an allgemeinen Schulen im Zusammenhang mit möglichen Problemen in der Entwicklung exekutiver Funktionen und der kommunikativen Kompetenz diskutiert. Methodik: Eine Stichprobe von 69 Schülern wurde mit einer deutschen Version des «Behavior Rating Inventory of Executive Functions (BRIEF)», einer Kurzskala zur Erfassung der kommunikativen Kompetenz sowie dem Strengths and Difficulties Questionnaire untersucht. Die Daten wurden mit einer Normierungsstichprobe verglichen, weiter wurden korrelative und regressionsanalytische Zusammenhänge der Variablen berechnet. Ebenso wurden Zusammenhänge der exekutiven Funktionen mit soziodemographischen Variablen analysiert. Ergebnisse: Die Ergebnisse zeigen, dass in fast allen Bereichen exekutiver Funktionen die hörgeschädigten Kinder mehr Probleme aufweisen als die Kinder der hörenden Normierungsstichprobe und die Prävalenzrate durchschnittlich ca. dreimal höher ist. Der Index für verhaltensregulierende exekutive Funktionen erweist sich neben dem Geschlecht am besten zur Vorhersage sozial-emotionaler Probleme. Schlussfolgerungen: Für die pädagogische Praxis ergibt sich, dass hörgeschädigte Schüler an allgemeinen Schulen in Bezug auf ihre psychosoziale Entwicklung von einem pädagogischen Konzept profitieren, das neben der Förderung sprachkommunikativer Kompetenzen auch auf die Stärkung von Selbstkontrolle und Selbstwirksamkeit der Kinder fokussiert.

Several studies have revealed impairments in cognitive functions among patients with affective disorders (AD). However, to date there are few neuropsychological studies on cognitive flexibility among adolescent patients with AD, especially on gender differences in AD. Here, we investigate cognitive functions, especially cognitive flexibility, in adolescent patients with unipolar AD (UAD) compared to a healthy control group (CG).The study population consists of 17 male patients (Minfage/inf= 15.4 ± 1.3) and 22 female patients with UAD (Minfage/inf= 15.6 ± 1.4) as well as 20 male (Minfage/inf= 16.0 ± 1.0) and 30 female (Minfage/inf= 15.7 ± 0.9) healthy adolescents. A neuropsychological test battery was conducted, and depressive symptoms, psychological stress, and intelligence were also assessed.The analyses revealed no significant group differences regarding cognitive flexibility or visual processing speed, albeit slight better performance in motor processing speed for the CG. Furthermore, no gender differences were observed regarding cognitive flexibility, though female subjects general displayed better performance in processing speed.Overall, there are no indications for serious deficits and specific gender differences in cognitive flexibility or processing speed in adolescent patients with UAD. Independent of psychological distress, female subjects seem to have some advantages in processing speed.Fragestellung: Verschiedene Studien verweisen auf Einschränkungen in der kognitiven Flexibilität bei Patienten mit Affektiven Störungen (AS). Derzeit herrscht jedoch ein Forschungsmangel hinsichtlich neuropsychologischer Untersuchungen bei jugendlichen Patienten mit AS sowie der Erforschung geschlechtsbezogener Unterschiede. Ziel der vorliegenden Studie ist daher die Erfassung kognitiver Funktionen, insbesondere kognitiver Flexibilität, bei jugendlichen Patienten mit unipolaren Affektiven Störungen (UAS) im Vergleich zu einer gesunden Kontrollgruppe (KG). Methodik: In die Stichprobe wurden 17 männliche (MinfAlter/inf= 15.4 ± 1.3) und 22 weibliche (MinfAlter/inf= 15.6 ± 1.4) Patienten mit UAS sowie 20 männliche (MinfAlter/inf= 16.0 ± 1.0) und 30 weibliche (MinfAlter/inf= 15.7 ± 0.9) gesunde Kontrollprobanden einbezogen. Neben dem Einsatz einer neuropsychologische Testbatterie erfolgte die Erfassung depressiver Symptome, psychischer Belastung sowie Intelligenz. Ergebnisse: Die Ergebnisse zeigen keine signifikanten Gruppenunterschiede bezüglich kognitiver Flexibilität oder visueller Verarbeitungsgeschwindigkeit und lediglich tendenzielle Unterschiede hinsichtlich der motorischen Verarbeitungsgeschwindigkeit mit einer besseren Leistung bei der KG. Zudem ergeben sich keine geschlechtsbezogenen Unterschiede in der kognitiven Flexibilität, jedoch bessere Leistungen in der Verarbeitungsgeschwindigkeit bei weiblichen Probanden. Schlussfolgerung: Insgesamt betrachtet offenbaren sich keine Hinweise für gravierende Einschränkungen in der kognitiven Flexibilität und Verarbeitungsgeschwindigkeit oder diesbezügliche spezifische geschlechtsbezogene Unterschiede bei jugendlichen Patienten mit UAS. Mädchen scheinen, unabhängig von einer psychischen Beeinträchtigung, Vorteile in Bezug auf die Verarbeitungsgeschwindigkeit aufzuweisen.

Mental activities have been suggested to influence the risk and course of dementia. This study was performed in order to assess the association of various mental activities with diagnosis and cognitive functions in an elderly population.A total of 191 memory clinic patients (mean age 71.7 ± 10.7 years) were included in this study. Participants completed a standardized neuropsychological test battery, a clinical interview, and a semistructured interview to assess mental activities.Of the 191 patients, 39 were diagnosed as cognitively intact, 72 had mild cognitive impairment, and 80 mild Alzheimer's disease. Group comparisons of mental activity scores revealed differences for the variables art, culture, media consumption, travelling, and cognitive activities. Correlation analysis showed a significant association of culture, media consumption, travelling, and cognitive activities with cognitive functions.Our results suggest that mental activities may influence the extent of cognitive impairment and possibly the risk for Alzheimer's disease.

Previous studies could show a complex relationship between alcohol consumption and cognition but also with processes of ageing both social and biological. Acute effects of alcohol during intoxication include clinical signs such as excitation and reduced inhibition, slurred speech, and increased reaction time but also cognitive dysfunction, especially deficits in memory functions. However, these cognitive deficits during alcohol intoxication are reversible while patients with alcohol addiction and chronic alcohol intake show severe impairments of cognitive functions especially deficits in executive functions. Frontal executive impairments in these patients include deficits in problem solving, abstraction, planning, organizing, and working memory.Additionally, gender specific deficits are relevant for the course of the disease and its concomitant health problems with female alcoholics showing a higher vulnerability for cognitive dysfunction and brain atrophy at earlier stages of alcoholism history.

High-functioning autism (HFA) and Aspergers syndrome (AS) are autism spectrum disorders (ASD) characterised by disturbances in social interaction, both verbal and non-verbal communication and repetitive and/or restrictive behaviour since early childhood. Symptoms appear generally during early childhood and adolescence. The increasing need to clarify diagnostic queries in advanced age led to the constitution of specialised outpatient clinics for adults involving a growing amount of HFA/AS subjects diagnosed late in life. However, thus far neuropsychological data about this group are scarce.We present a subgroup of 39 patients with HFA/AS (mean age at diagnosis 31.1 ± 8.9 years) who were consecutively diagnosed at the autism outpatient clinic at the Department of Psychiatry at the University Hospital Cologne. Autistic symptoms (autism spectrum quotient; AQ), depressive symptoms (Beck depression inventory; BDI), general intelligence (HAWIE-R), social cognition ("theory of mind", ToM) and executive functioning (COWAT) were systematically studied in comparison to a control group matched for age, education, gender and intelligence (n = 39).HFA/AS subjects presented higher AQ scores (40.4 ± 5.2) as opposed to the healthy controls (13.5 ± 4.8). Neuropsychologically, patients showed deficits in social cognition, executive functions and in subtests of HAWIE-R related to verbal comprehension and perceptual organisation as opposed to the healthy control group.The diagnosis of autistic disorders in adulthood basically relies on the clinical assessment of autistic core symptoms which were corroborated by high AQ values. The self-rating instrument AQ was found to be highly discriminative between the HFA/AS group and the healthy control group. The neuropsychological profile of adult HFA/AS patients diagnosed late in life is compatible with that of previously investigated HFA/AS populations. These findings show that such basic autism-associated deficits persist until adulthood, although patients are able to learn social rules.

In the past two decades, an increasing number of functional and structural brain imaging studies has provided insights into the neurobiological basis of autism spectrum disorders (ASD). This article summarizes pertinent functional brain imaging studies addressing the neuronal underpinnings of ASD symptomatology (impairments in social interaction and communication, repetitive and restrictive behavior) and associated neuropsychological deficits (theory of mind, executive functions, central coherence), complemented by relevant structural imaging findings. The results of these studies show that although cognitive functions in ASD are generally mediated by the same brain regions as in typically developed individuals, the degree and especially the patterns of brain activation often differ. Therefore, a hypothesis of aberrant network connectivity has increasingly been favored over one of focal brain dysfunction.

To review neuropsychological models of theory of mind (ToM), executive functions (EF), and central coherence (CC) as framework for cognitive abnormalities in autism spectrum disorders (ASD).Behavioral and functional imaging studies are described that assess social-cognitive, emotional, and executive functions as well as locally oriented perception in ASD.Impairments in ToM and EF as well as alterations in CC are frequently replicated phenomena in ASD. Especially problems concerning social perception and ToM have high explanatory value for clinical symptomatology. Brain activation patterns differ between individuals with and without ASD for ToM, EF, und CC functions. An approach focussing on reduced cortical connectivity seems to be increasingly favored over explanations focussing on single affected brain sites.A better understanding of the complexities of ASD in future research demands the integration of clinical, neuropsychological, functional imaging, and molecular genetics evidence. Weaknesses in ToM and EF as well as strengths in detail-focussed perception should be used for individual intervention planning.

Cognitive decline is a common disorder in idiopathic Parkinson's syndrome, the risk for the development of a dementia is four- to six-fold higher for Parkinsonian patients. The cognitive profile in Parkinson's disease dementia (PDD) differs from that of Alzheimer-type dementias. The affected cognitive functions include attention, executive functions, visual-spatial functions and recall. The main differential diagnosis for PDD is the Lewy body dementia (LBD), which can be differentiated through the temporal development of motor and cognitive symptoms. Cognitive symptoms in Parkinsonian syndromes have a relevant negative impact on quality of life, on the burden for the care-givers, on the prognosis of the disease and on the possible referral to a nursing home. Dementias in Parkinsonian syndromes (PDD and LBD) need a confirmatory diagnosis at an early stage in order to initiate further therapeutic steps with, e. g., acetylcholine esterase inhibitors or, perspectively, neuropsychological training methods.

In order to understand cognitive impairment associated with epilepsy, it is essential to appreciate that independent static and dynamic factors affect brain function in this disease. Whereas morphological lesions or structural changes are associated with more or less irreversible deficits, epileptic activity, seizures, and the treatment of epilepsy can cause dynamic and principally reversible impairment. The relative contribution of these factors differs depending on the type of epilepsy, the age at lesion/epilepsy onset, the localization and lateralization of epilepsy and individual demographic patient characteristics. Altered brain structure and function can result in epilepsy, but epilepsy can also alter the functional cerebral organization of the brain. Thus epilepsy-related cognitive impairment must be integrated within a developmental neuropsychological framework. The aetiology of epilepsy is strongly related to the age of onset. From a neuropsychological point of view, it makes a big difference for cognitive outcome as to whether epilepsy hits the maturing versus mature or aging brain. Dependent on this, epilepsy can result in retardation, loss of acquired functions, or accelerated mental decline. It will be demonstrated that cognitive impairments in epilepsy mostly exist from the beginning of epilepsy, that early onset lesions/epilepsy interfere with mental development, and that a progressive aetiology, severe seizures, and lesions secondary to epilepsy may accelerate mental decline. It will furthermore be discussed that uncontrolled epilepsy and epileptic activity may reversibly and irreversibly contribute to cognitive impairment. The same is demonstrated with regard to the pharmacological treatment of epilepsy. Finally, the cognitive risks and benefits of epilepsy surgery and the advantages of selective surgery will be addressed. The consequences for the neuropsychological assessment are discussed in part two of this review.

The increasing aging demographics never seen before is associated with the enormous challenge of dementia epidemics which urgently needs a paradigm shift in the approach to cognitive functions in health and disease. If on one hand the achievement or maintenance of a healthy lifestyle should be a medical priority, the early recognition of cognitive disturbances is mandatory. Cognitive impairment is not only associated with disability and lack of compliance and adherence, but also with dangerous geriatric syndromes such as instability, falls, and delirium. The evaluation of cognitive performance, particularly in older patients and especially in those hospitalized for other reasons, should be performed in all cases. While the National Institute of Aging and Alzheimer Association established new criteria for the diagnosis of Alzheimer's disease, the large majority of dementia cases are assigned to a multifactorial syndrome presenting as a long-lasting continuum from organ/function integrity to dementia. While the monoclonal antibody aducanumab is under careful evaluation for release on the market as the first curative drug, current anti-Alzheimer medication strategies remain symptomatic. In spite of the previous distinction between neurodegenerative and vascular forms of dementia, it is now accepted that control of vascular risk factors and comorbidities strongly affects the prevention of all types of cognitive impairment. The WHO has published in May 2019 an official guideline document for reducing dementia risk. The guidelines provide recommendations on the major modifiable lifestyle factors and chronic diseases. The best way to prevent cognitive impairment and its worsening include vascular risk control and a healthy diet including a balanced natural nutrition (without nutritional supplements for which scientific evidence is lacking), physical exercise (preferably aerobic), enough social participation, interaction and conviviality as well as cognitive exercise (focusing on general cognitive function, executive function and working memory) While the activation of all domains of lifestyle are critical for the achievement of the best preventive effects, these should be implemented 1) in a personalized, goal-oriented fashion (the so called tailored interventions) and 2) with the ultimate goal of maintaining the care of personal interests and functions along with quality of life and wellbeing.For an effective prevention of cognitive decline, resources from all domains of lifestyle (nutrition, exercise, rest, social participation, cognitive activity) should be used, however in a personalized way. The Comprehensive Geriatric Assessment (CGA), evaluating the physical, psychosocial and functional aspects of young-old, old-old and oldest-old persons, can be used to detect early cognitive impairment and factors associated with its course in order to modulate them.PRäVENTION DES KOGNITIVEN ABBAUS: Maßnahmen zur Früherkennung und zur Prävention des kognitiven Abbaus stehen im Vordergrund der Therapie. Im Gegensatz zur früheren Trennung zwischen neurodegenerativen und vaskulären Formen der Demenz wird aktuell die konsequente Therapie und Einstellung von kardiovaskulären Risikofaktoren angestrebt, um das Fortschreiten von möglicherweise allen Demenzformen zu verlangsamen. Die im Mai dieses Jahres von der Weltgesundheitsorganisation veröffentlichten Leitlinien geben Anhaltspunkte, wie dem Nachlassen der kognitiven Funktion mit zunehmendem Alter begegnet werden kann. Zu den Säulen der Prävention gehören eine ausgewogene Ernährung (für die Substitution einzelner, künstlicher Nährstoffe gibt es keine Evidenz), körperliche Aktivität (vor allem aerobes Training), ausreichender Schlaf, Konvivialität und soziale Interaktion (sensorische Störungen, gerade eine Beeinträchtigung des Hörens, dürfen nicht unterschätzt werden) sowie kognitive Aktivitäten und Übungen, die die allgemeinen, exekutiven und logischen Funktionen, die Denkgeschwindigkeit und das Arbeitsgedächtnis unterstützen. KONSEQUENZ FüR DEN KLINISCHEN ALLTAG: Obwohl alle o. g. Bereiche des Lebensstils für die Prävention des kognitiven Abbaus wichtig sind, sind multidimensionale Interventionen nur dann für den Erhalt der Funktionen wirksam, wenn diese · auf die Bedürfnisse jedes einzelnen Patienten zugeschnitten werden (die sogenannten personalized tailored interventions) und. · mit persönlichem Interesse, guter Lebensqualität und adäquatem Wohlbefinden verbunden sind..

This article reviews research on neurocognitive deficits in adult patients with malignant brain tumors, i. e. high-grade primary brain tumors and brain metastases. Brain tumor patients experience significant neurocognitive deficits, mainly in the domains of attention, memory, executive function and psychomotor function. Neurosurgical, radiotherapeutic or radiochemotherapeutic treatment regimens are often associated with a decline in cognitive functioning. However, such empirical observations are often confounded with the neurocognitive effects of tumor progression. Few studies investigated associations among neurocognitive deficits and distress. These studies revealed contradictory results. Similarly, research on neurocognitive deficits and health-related quality of life has resulted in equivocal evidence. Furthermore, convincing empirical evidence for the effectiveness of neurocognitive training in patients with high-grade brain tumors is lacking.

Based on functional relations between the central autonomic network and cortical areas involved in motivational, attentional, affective, and executive function, autonomic regulation can mediate cognitive performance as well as cardiovascular and psychosomatic diseases. Our objective was to test the predictive value of resting heart rate variability (HRV), a measure of sympatho-vagal balance, with regard to the type and intensity of cardiovascular responses to mental challenge.A total of 248 healthy subjects (85 females, aged 47.3+/-7.6 years; 163 males, aged 47.5+/-6.7 years) were included in the study. All participants underwent standardized psychometric testing (e.g., Stroop's color-word-conflict test).First, we found significant increases of heart rate and sympatho-vagal balance (low frequency/high frequency) and significant decreases of absolute LF- and HF-power in response to mental tasks. Second, there were significant differences in cardiovascular response to mental challenge when clustering our population on the basis of sympatho-vagal balance at rest.We conclude that short-term recordings of HRV can provide health-related information of cardio-vascular response to mental challenge. However, there is no association between sympatho-vagal balance at rest and classical cardiovascular risk factors.

As the levels of care within long-term nursing care regulations are defined according to limitations in performing fundamental activities of daily living, the extent to which medically diagnosed cognitive, emotional and behavioral dementia symptoms are taken into account in the grading, should be investigated.390 patients with mild to moderate dementia from the Mid-Franconia region, were included into the IDA ("Initiative Demenzversorgung in Allgemeinmedizin") study by specially trained general practitioners. The GPs had diagnosed dementia and noted the accompanying signs at baseline. In an interview with the caregiver, the Barthel Index was used to measure the level of help required with fundamental daily tasks. Predictors for grading were set down using logistic regression analysis.Where one accompanying sign is present, about half the patients had not been assigned a grade. Besides the Barthel Index, the presence of agitation and agnosia and the absence of depression are the only independent predictors for grading. All other symptoms, impairment of the executive function, loss of orientation, aphasia, anxiety, sleeplessness, aggressiveness and tendency to wander, have no significant predictive value.In the future development of nursing care insurance, the need for nursing care should be redefined using symptoms associated with dementia, particularly sleeplessness, aggressiveness and the tendency to wander as inclusion criteria. This is a prerequisite of improving the care available to dementia patients in the long term and also of expanding relief measures for family caregiver.

Cognitive deficits are among the core symptoms of patients with Huntington's disease (HD). While impaired attention, visuospatial processing, and memory can be observed during early stages of the illness, HD patients exhibit deficits in executive function on tests requiring planning, problem solving, and cognitive flexibility with progression of the disease. Cognitive dysfunction is already present in individuals who carry the HD gene mutation but remain presymptomatic for motor and cognitive disturbances. This review provides an overview and a discussion of functional neuroimaging findings on cognitive dysfunction in patients with HD and presymptomatic HD gene mutation carriers. In HD patients, currently available evidence suggests a functional deficit of multiple cortical and subcortical regions extending beyond volumetric abnormalities. Early dysfunction of lateral prefrontal and cingulate regions has been shown in individuals with presymptomatic HD, while compensatory responses of posterior brain regions may occur closer to the onset of manifest clinical symptoms. While functional neuroimaging techniques may substantially contribute to defining neurodegenerative disease phenotypes and to identifying neural biomarkers in presymptomatic individuals, the extant data on cognitive function in HD patients and HD gene carriers however is sparse and has to be expanded through further studies.

The early assessment of prevalent disability and functional decline is of increasing importance for prevention issues and for the evaluation of change in clinical studies. The assessment of common daily tasks and resulting disability is essential for a complete impression of a patient's capabilities. There are plenty of instruments that cover basic and instrumental activities of daily living by assessing the person's dependence at a specific functional task. However, the early stages of everyday life limitations and functional decline are usually not being captured. In this article we have examined psychometric properties of the German adaptation of the abbreviated "late life function and disability instrument", a promising tool that is capable of capturing early aspects of functional decline and disability.Older Caucasian men and women (Median=82 years) with a wide range of functional status (Short Physical Performance Battery: Median=6, Min.=0, Max.=12) completed the abbreviated version of the LLFDI once (n=173). A subgroup was assessed twice to examine interrater (n=13) and intrarater (n=10) reliability. Cognitive and functional status was assessed at baseline.Internal consistency (Cronbach's ) was acceptable for the personal role and social role of the frequency items of the disability component (0.55 to 0.62) and very good for all other parts of the instrument (0.78 to 0.89) without a significant difference when compared for overall cognitive performance or executive function. Test-retest reliability was very good (0.81 to 0.96) and interrater reliability was acceptable to very good (0.62 to 0.96) with only acceptable results for the limitation items of the disability component. The total scores of the two components did not demonstrate significant floor or ceiling effects and the interview lasted on average 17 minutes (range 8 to 35 min).The German adaptation of the abbreviated version of the "Late Life Function and Disability Instrument" has minimal ceiling and floor effects, acceptable to good internal consistency and interrater reliability, and very good test-retest reliability. Hence, it constitutes an excellent alternative to common self-rating instruments for the assessment of functional capacities in everyday activities.

The attention-deficit-/hyperactivity disorders (ADHD) are the most common psychiatric disorders in children and adolescents. ADHD persists in 30 - 50 % into the adulthood. Attention problems were found to be more persistent than hyperactivity and impulsivity. Many of the symptoms classified as ADHD symptoms of inattention are actually symptoms of executive function impairments. Assessment and differential diagnosis of adult ADD/ADHD may be difficult, because of a high rate of comorbidity. This article gives an overview about the impairments caused by attention-deficits, the clinical picture, the problems of diagnosis, the pharmacotherapy, the psychotherapy and comorbidity of ADHD in adults.

OBJECTIVE: The aim of this study was to evaluate the effects of atypical antipsychotics on cognitive function in schizophrenic patients under clinical routine conditions. METHOD: Schizophrenic patients (n = 78) were evaluated on neuropsychological tests of attention, short-term- and working memory, learning, long-term memory (retention) and executive function. Data were analyzed according to medication, severity of illness and age. RESULTS: We observed that treatment with atypical antipsychotics compared to conventional neuroleptics was significantly associated with a more favorable effect on cognitive function. Especially in short-term memory and retention a clear advantage of atypical antipsychotics could be seen. CONCLUSION: Results from this study suggest that even under clinical routine conditions atypical antipsychotics have an advantage on cognitive function when compared with conventional neuroleptics.

The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine, or MDMA, and some analogues) causes selective and persistent neurotoxic damage of the central serotonergic system in laboratory animals. Serotonin plays a role in numerous functional systems in the CNS. Consequently, various abnormalities including psychiatric, vegetative, neuroendocrine, and cognitive disorders might be expected in humans following damage of the central serotonergic system. In recent years, the questions of possible functional disorders following ecstasy-induced neurotoxicity were addressed in several cross-sectional studies with drug users. In this review we summarize and evaluate the quality of design of these studies. Despite large methodological problems, evidence accumulates in favor of persisting brain damage in ecstasy users resulting in subtle cognitive deterioration. Findings of relatively low memory performance associated with heavy ecstasy use are highly consistent across different studies and user populations. In addition, low performance in tests of higher executive function were reported in some but not all studies. The important questions about progression, persistence, or reversibility of damage after long periods of abstinence have to be addressed in future studies with longitudinal design.

Cerebrovascular disorders are the second most frequent cause of dementia in late life next to Alzheimer's disease. A recent community-based autopsy study has demonstrated that relevant cerebrovascular changes are much more prevalent in individuals aged 70+ years than previously assumed. Furthermore, the combination between cerebrovascular lesions and Alzheimer-type pathology is the most common neuropathological finding in elderly patients with dementia. There is still some uncertainty about which types of cerebrovascular changes are most likely to cause cognitive impairment including dementia and which pathogenetic mechanisms are involved. Without doubt, however, the vascular dementias are a heterogeneous group of diseases in terms of etiology, histopathology, and clinical appearance. According to the vessel calibres and perfusion territories that are preferentially affected a distinction is commonly made between the frequent subcortical small-vessel disease and the rare cortical large-vessel disease. With these morphological subtypes three major clinical variants are associated: dementia due to subcortical lacunes and white matter changes including Binswanger's disease, multi-infarct-dementia, and dementia due to singular strategic infarcts. In most cases of dementia of cerebrovascular origin the pattern of intellectual impairment is frontal or subcortical, in contrast to the typical cortical presentation of Alzheimer's disease. Deterioration of executive function and attention as well as changes in personality, rather than memory loss, are the predominant symptoms. Therefore the current diagnostic criteria for dementia are poorly suited for the detection of vascular dementias. None of the criteria that have been specifically proposed for the diagnosis of vascular dementias provide clear guidelines for evaluating the causal relationship between cerebrovascular lesions and psychopathological findings. Further research will reveal whether clinical diagnosis can be improved by taking into account the heterogeneity of cerebrovascular diseases. A large proportion of dementias of cerebrovascular origin may be preventable by treating the risk-factors for stroke. Once significant cognitive impairment has occurred, however, there is no established pharmacological treatment for the vascular dementias to date. Only recently results of placebo-controlled clinical trials have become available showing that cholinergic treatment strategies are effective in vascular dementia and in dementia due to combined vascular and neurodegenerative pathologies.

A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group setting.