Twelve-month follow-up effects of cognitive training after heart valve surgery on cognitive functions and health-related quality of life: a randomised clinical trial.

OBJECTIVES: Postoperative cognitive decline (POCD) or decreased health-related quality of life (HQL) have been reported after cardiac surgery. A previous investigation showed beneficial effects of postoperative cognitive training on POCD and HQL 3 months after heart surgery. Here, we present the 12-month follow-up results. METHODS: This bicentric, 1:1 randomised and treatment-as-usual controlled trial included elderly patients scheduled for elective heart valve surgery. The training consisted of paper-and-pencil-based exercises practising multiple cognitive functions for 36 min/day 6 days/week over a period of 3 weeks. Neuropsychological tests and questionnaires assessing HQL (36-Item Short Form Health Survey (SF-36)) and cognitive failures in daily living (Cognitive Failures Questionnaire) were performed presurgery and 12 months after training. RESULTS: Twelve months post training, the training group (n=30) showed improvements in HQL compared with the control group (n=28), especially in role limitations due to physical health (U=-2.447, p=0.015, η2=0.109), role limitations due to emotional problems (U=-2.245, p=0.025, η2=0.092), pain (U=-1.979, p=0.049, η2=0.068), average of all SF-36 factors (U=-3.237, p<0.001, η2=0.181), health change from the past year to the present time (U=-2.091, p=0.037, η2=0.075), physical component summary (U=-2.803, p=0.005, η2=0.138), and mental component summary (U=-2.350, p=0.018, η2=0.095). Furthermore, the training group (n=19) showed an improvement compared with the control group (n=27) in visual recognition memory (U=-2.137, p=0.034, η2=0.099). POCD frequency was 22% (n=6) in the control group and 11% (n=2) in the training group (χ²(1) =1.06, p=0.440; OR=2.43, 95% CI 0.43 to 13.61). CONCLUSION: In conclusion, postoperative cognitive training shows enhancing effects on HQL in cardiac surgery patients after 12 months.

Functional connectivity in a monetary and social incentive delay task in medicated patients with schizophrenia.

Introduction: Numerous studies indicate impaired reward-related learning in individuals with schizophrenia, with various factors such as illness duration, medication, disease severity, and level of analysis (behavioral or neurophysiological data) potentially confounding the results. Patients with schizophrenia who are treated with second-generation antipsychotics have been found to have a less affected reward system. However, this finding does not explain the neural dysfunctions observed in previous studies. This study aimed to address the open question of whether the less impaired reward-related behavior is associated with unimpaired task-related functional connectivity or altered task-related functional connectivity. Methods: The study included 23 participants diagnosed within the schizophrenia spectrum and 23 control participants matched in terms of age, sex, and education. Participants underwent an MRI while performing a monetary incentive delay task and a social incentive delay task. The collected data were analyzed in terms of behavior and functional connectivity. Results: Both groups exhibited a main effect of reward type on behavioral performance, indicating faster reaction times in the social incentive delay task, but no main effect of reward level. Altered functional connectivity was observed in predictable brain regions within the patient group, depending on the chosen paradigm, but not when compared to healthy individuals. Discussion: In addition to expected slower response times, patients with schizophrenia demonstrated similar response patterns to control participants at the behavioral level. The similarities in behavioral data may underlie different connectivity patterns. Our findings suggest that perturbations in reward processing do not necessarily imply disturbances in underlying connectivities. Consequently, we were able to demonstrate that patients with schizophrenia are indeed capable of exhibiting goal-directed, reward-responsive behavior, although there are differences depending on the type of reward.

The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls.

Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.

The impact of postoperative cognitive training on health-related quality of life and cognitive failures in daily living after heart valve surgery: A randomized clinical trial.

BACKGROUND: Heart surgery is a risk factor for objectively and subjectively assessable postoperative cognitive decline (POCD), which is relevant for everyday life. The aim of this study was to investigate whether early postoperative cognitive training has an impact on health-related quality of life and cognitive failures in daily living after cardiac surgery. METHODS: The study was a two-arm, randomized, controlled, outcome-blinded trial involving older patients undergoing elective heart valve surgery with extracorporeal circulation (ECC). Recruitment took place at the Departments of Cardiac Surgery of the Kerckhoff Clinic in Bad Nauheim (Germany) and the University Hospital in Giessen (Germany). The patients were randomized (1:1 ratio) to either a paper-and-pencil-based cognitive training group or a control group. We applied the Short Form Health Survey (SF-36) and the Cognitive Failures Questionnaire (CFQ) prior to surgery and 3 months after the cognitive training. Data were analyzed in a per-protocol fashion. RESULTS: Three months after discharge from rehabilitation, the training group (n = 31) showed improvement in health-related quality of life compared to the control group (n = 29), especially in role limitations due to emotional problems (U = -2.649, p = .008, η2  = 0.121), energy and fatigue (F[2.55] = 5.72, p = .020, η2  = 0.062), social functioning (U = -2.137, p = .033, η2  = 0.076), the average of all SF-36 factors (U = -2.374, p = .018, η2  = 0.094), health change from the past year to the present time (U = -2.378, p = .017, η2  = 0.094), and the mental component summary (U = -2.470, p = .013, η2  = 0.102). CONCLUSION: As our cognitive training has shown beneficial effects, this intervention could be a promising method to enhance health-related quality of life after cardiac surgery.

Increasing preoperative cognitive reserve to prevent postoperative delirium and postoperative cognitive decline in cardiac surgical patients (INCORE): Study protocol for a randomized clinical trial on cognitive training.

Introduction: Postoperative delirium (POD) and postoperative cognitive decline (POCD) can be observed after cardiosurgical interventions. Taken together, these postoperative neurocognitive disorders (PNCDs) contribute to increased morbidity and mortality. Preoperative risk factors of PNCD, such as decreased neuropsychometric performance or decreased cognitive daily activities, can be interpreted as reduced cognitive reserve. This study aims to build up cognitive reserves to protect against the development of PNCD through preoperative, home-based, cognitive training. Methods: The planned research project is a monocentric, two-arm randomized controlled intervention study involving 100 patients undergoing elective cardiac surgery with extracorporeal circulation. Patients will be assigned to a training group or control group. The intervention involves a standardized, paper-and-pencil-based cognitive training that will be performed by the patients at home for ~40 min per day over a preoperative period of 2-3 weeks. The control group will receive neither cognitive training nor a placebo intervention. A detailed assessment of psychological functions will be performed ~2-3 weeks before the start of training, at the end of the training, during hospitalization, at discharge from the acute clinic, and 3 months after surgery. The primary objective of this study is to investigate the interventional effect of preoperative cognitive training on the incidence of POD during the stay in the acute clinic, the incidence of POCD at the time of discharge from the acute clinic, and 3 months after surgery. Secondary objectives are to determine the training effect on objective cognitive functions before the surgery and subjective cognitive functions, as well as health-related quality of life 3 months after surgery. Discussion: Should it become evident that the use of our cognitive training can both reduce the incidence of POCD and POD and improve health-related quality of life, this intervention may be integrated into a standardized prehabilitation program.

Constant installation of present orientation and safety (CIPOS) - subjective and physiological effects of an ultrashort-term intervention combining both stabilizing and confrontational elements.

Objectives: Constant Installation of Present Orientation and Safety (CIPOS) is a Eye Movements Desensitization and Reprocessing (EMDR)-derived technique, which is often used to prepare for the treatment of post-traumatic stress disorder (PTSD). It differs from the latter by involving cyclically recurring exercises in reorientation to the present, interspersed between brief periods of exposure to the traumatic material.While EMDR is well established as a therapeutic method, the efficacy and mechanisms of action of CIPOS have not been investigated so far. In this pilot study, an experimental setting was used to record the subjective and physiological effects of the CIPOS intervention compared to a control condition with pure mental exposition. Methods: The study was performed on 30 healthy volunteers aged from 20 to 30 years. Distress was induced using audio files of subjectively stressful situations. Subjective distress was measured via the Subjective Units of Distress Scale (SUD), while physiological indicators (noise-induced startle reflex, skin conductance level) were used as measures for objective stress. For each condition, pre- and post-intervention comparisons were calculated. Results: In both groups, startle reflex potentiation and mean skin conductance level significantly decreased. In the group with CIPOS intervention, but not in the control group, a significant decrease in the SUD value was found. Conclusion and significance: The results show that the CIPOS technique is as effective as pure mental exposition in reducing physiological stress. In addition, a superiority in reducing subjective distress (indicating a simplified reassessment of the stressful material) was found compared to pure mental exposition. Possible explanations of these effects are discussed.

Fractional anisotropy and peripheral cytokine concentrations in outpatients with depressive episode: a diffusion tensor imaging observational study.

Over the past few years, evidence of a positive relationship between inflammation and depression has grown steadily. The aim of the current study was to investigate whether such depression-related inflammation could also be associated with altered microstructural changes in the white matter. FA and serum cytokines (IL-1ß, IL-6, TNF-α, and IFN-γ) were measured in 25 patients with depression (DE) and 24 healthy controls (HC). Diffusion tensor imaging was performed. Fractional anisotropy (FA) was calculated using the FSL pipeline for Tract-Based Spatial Statistics (TBSS). Both voxelwise and mean whole-brain FA were analyzed using general linear models (GLM). Higher concentrations of IL-1ß were associated with lower whole-brain fractional anisotropy, particularly in people with depression (ρ = - 0.67; p < 0.001). TNF-α shared some variance with IL-1ß and also showed a negative relationship between TNF-α concentrations and FA in depression (F1,46 = 11.13, p = 0.002, η2p = 0.21). In detail, the voxelwise analysis showed that the regression slopes of IL-1ß on FA were more negative in the DE group than in the HC group, mainly in the corpus callosum (cluster statistics: genu corpus callosum, p = 0.022; splenium of corpus callosum, p = 0.047). Similar effects were not found for the other remaining cytokines. This study clearly demonstrated an association between peripherally measured IL-1ß and white matter integrity in depression as assessed by DTI. The results suggest that microstructural changes in the corpus callosum are associated with increased peripheral IL-1ß concentrations in depression.

Multimodal speech-gesture training in patients with schizophrenia spectrum disorder: Effects on quality of life and neural processing.

Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia spectrum disorder (SSD) that severely affects quality of life. Interpreting abstract speech and integrating nonverbal information is particularly affected. Considering the difficulty to treat communication dysfunctions with usual intervention, we investigated the possibility to apply a multimodal speech-gesture (MSG) training. In the MSG training, we offered 8 sessions (60 min each) including perceptive and expressive tasks as well as meta-learning elements and transfer exercises to 29 patients with SSD. In a within-group crossover design, patients were randomized to a TAU-first (treatment as usual first, then MSG training) group (N = 20) or a MSG-first (MSG training first, then TAU only) group (N = 9), and were compared to healthy controls (N = 17). Outcomes were quality of life and related changes in the neural processing of abstract speech-gesture information, which were measured pre-post training through standardized psychological questionnaires and functional Magnetic Resonance Imaging, respectively. Pre-training, patients showed reduced quality of life as compared to controls but improved significantly during the training. Strikingly, this improvement was correlated with neural activation changes in the middle temporal gyrus for the processing of abstract multimodal content. Improvement during training, self-report measures and ratings of relatives confirmed the MSG-related changes. Together, we provide first promising results of a novel multimodal speech-gesture training for patients with schizophrenia. We could link training induced changes in speech-gesture processing to changes in quality of life, demonstrating the relevance of intact communication skills and gesture processing for well-being.

Effects of postoperative cognitive training on neurocognitive decline after heart surgery: a randomized clinical trial.

OBJECTIVES: Following cardiac surgery, postoperative cognitive decline (POCD) is a common complication that can impair the quality of life and increase mortality. The aim of this study was to investigate whether early postoperative cognitive training can decrease POCD after cardiac surgery. METHODS: The study was a multi-centred, two-arm, randomized (1:1 ratio), controlled trial involving older patients undergoing elective heart valve surgery with extracorporeal circulation. Recruitment took place at the Department of Cardiac Surgery of the Kerckhoff-Clinic in Bad Nauheim (Germany) and the University-Hospital in Giessen (Germany). The patients were randomized to either a paper-and-pencil-based cognitive training group or a standard rehabilitation care control group. The cognitive training started 1 week after surgery and lasted about 3 weeks until discharge from rehabilitation. To detect POCD, neuropsychological functions were assessed prior to surgery, upon discharge from rehabilitation (primary outcome), and 3 months after discharge (secondary outcome). Data were primarily analysed in a per-protocol fashion. RESULTS: The frequency of POCD at discharge from rehabilitation (training group, n = 37; control group, n = 44) was 50% in the control group and 19% in the training group (χ2[1] = 8.45, P = 0.004; odds ratio = 4.29, 95% confidence interval [1.56-11.80]). Three months after the cognitive training (training group, n = 33; control group, n = 34), POCD frequency was 29% in the control group and 6% in the training group (χ2[1] = 6.21, P = 0.013; odds ratio = 6.46, 95% confidence interval [1.29-32.28]). CONCLUSIONS: Since our cognitive training showed beneficial effects, it could be a promising method to prevent POCD.

Is There Reduced Hemodynamic Brain Activation in Multiple Sclerosis Even with Undisturbed Cognition?

Cognitive impairments related to changes in deep gray matter and other brain regions occur in up to 70% of people with multiple sclerosis. But do such brain changes also occur in patients without significant cognitive impairment? Eighteen participants with relapsing-remitting multiple sclerosis (RRMS) and fifteen healthy controls participated in this study. Cognitive status, depression, and fatigue were assessed using the Multiple Sclerosis Inventory of Cognition (MUSIC), Beck's Depression Inventory (BDI-II), and the Fatigue Severity Scale (FSS). fMRI was recorded while a participant performed the modified attention network test (ANT). The effects of ANT executive attention network on hemodynamic activation of a priori defined regions of interest, including the hippocampus, anterior cingulate cortex (ACC), thalamus, caudate nucleus, pallidum, and putamen were studied. The individual lesion load was estimated. For fMRI data analysis a general linear model with randomization statistics including threshold-free cluster enhancement as implemented in the FSL software was used. Participants with RRMS showed reduced activation of the executive attention network in the hippocampus, pallidum, and ACC. The thalamus was involved in both group activations but did not differ between groups. In summary, functional changes in the brain can also be demonstrated in RRMS patients without cognitive deficits. The affected brain regions can best be assigned to the attention network for executive control. This association could likely serve as a biological indicator of susceptibility to imminent cognitive impairment in MS.

Differing Time Courses of Reward-Related Attentional Processing: An EEG Source-Space Analysis.

Since our environment typically contains more information than can be processed at any one time due to the limited capacity of our visual system, we are bound to differentiate between relevant and irrelevant information. This process, termed attentional selection, is usually categorized into bottom-up and top-down processes. However, recent research suggests reward might also be an important factor in guiding attention. Monetary reward can bias attentional selection in favor of task-relevant targets and reduce the efficiency of visual search when a reward-associated, but task-irrelevant distractor is present. This study is the first to investigate reward-related target and distractor processing in an additional singleton task using neurophysiological measures and source space analysis. Based on previous studies, we hypothesized that source space analysis would find enhanced neural activity in regions of the value-based attention network, such as the visual cortex and the anterior cingulate. Additionally, we went further and explored the time courses of the underlying attentional mechanisms. Our neurophysiological results showed that rewarding distractors led to a stronger attentional capture. In line with this, we found that reward-associated distractors (compared with reward-associated targets) enhanced activation in frontal regions, indicating the involvement of top-down control processes. As hypothesized, source space analysis demonstrated that reward-related targets and reward-related distractors elicited activation in regions of the value-based attention network. However, these activations showed time-dependent differences, indicating that the neural mechanisms underlying reward biasing might be different for task-relevant and task-irrelevant stimuli.

Modality-specific dysfunctional neural processing of social-abstract and non-social-concrete information in schizophrenia.

Schizophrenia is characterized by marked communication dysfunctions encompassing potential impairments in the processing of social-abstract and non-social-concrete information, especially in everyday situations where multiple modalities are present in the form of speech and gesture. To date, the neurobiological basis of these deficits remains elusive. In a functional magnetic resonance imaging (fMRI) study, 17 patients with schizophrenia or schizoaffective disorder, and 18 matched controls watched videos of an actor speaking, gesturing (unimodal), and both speaking and gesturing (bimodal) about social or non-social events in a naturalistic way. Participants were asked to judge whether each video contains person-related (social) or object-related (non-social) information. When processing social-abstract content, patients showed reduced activation in the medial prefrontal cortex (mPFC) only in the gesture but not in the speech condition. For non-social-concrete content, remarkably, reduced neural activation for patients in the left postcentral gyrus and the right insula was observed only in the speech condition. Moreover, in the bimodal conditions, patients displayed improved task performance and comparable activation to controls in both social and non-social content. To conclude, patients with schizophrenia displayed modality-specific aberrant neural processing of social and non-social information, which is not present for the bimodal conditions. This finding provides novel insights into dysfunctional multimodal communication in schizophrenia, and may have potential therapeutic implications.

The Stroop Negative Priming Matching Task: A New Task for the Direct Comparison of Interference Control and Inhibition.

Inhibition processing is an inherent part of cognitive and behavioral control. The aim of the present study was to develop and investigate psychometric criteria of an experimental paradigm that combines Stroop interference and negative priming, both of which involve inhibitory processes. We adopted a Stroop matching paradigm assessing interference control and implemented a negative priming condition. A nonclinical community sample of 94 volunteers performed this Stroop Negative Priming Matching paradigm. Since timing plays a role in priming, the interval between the prime and the probe has been varied in length (500 ms, 800 ms, and 3000 ms). The main results showed both, effects of Stroop interference and negative priming, as indicated by reaction times and incorrect responses. Reduced time pressure showed an effect on response speed and accuracy, but no interaction with interference and priming effects occurred. Reliability computed as internal consistency was generally high and did not differ between Stroop interference and negative priming scales. Retest-reliability was best for the prime-probe interval of 3000 ms. Concluding, the Stroop negative priming matching task provides reliable and directly comparable assessment of Stroop interference and negative priming effects.

Pro-inflammatory markers and fatigue in patients with depression: A case-control study.

The aim of this work was to investigate differences between depressed subjects (PG) and non-depressed healthy control participants (HCG) with regard to fatigue dimensions and inflammation. For this purpose, 43 participants in the PG and 51 participants in the HCG were included in the study. IL-6, IL-1ß, TNF-α, IFN-γ, and CRP were assessed in venous blood samples. Fatigue and depression were assessed using the FIS-D and BDI-FS questionnaires. Main results showed higher BDI-FS values in PG. Moreover, PG showed mean differences for fatigue dimensions when compared to the HCG. For the pro-inflammatory markers, a moderate group effect was found between PG and HCG which was mainly caused by IL-6. Correlations between TNF-α and BDI-FS, TNF-α and cognitive fatigue, TNF-α and psychosocial fatigue were found within the PG. In the HCG, correlations were found between IL-6, TNF-α and somatic fatigue, as well as IL-6 and cognitive fatigue. Significant correlations were found between the psychological variables in both groups. All results were controlled for the confounding variables gender, age, BMI and multiple comparisons. These results suggest the presence of inflammation in both depression and fatigue. However, each correlates with different pro-inflammatory parameters, suggesting a biological heterogeneity.

A Multimodal Speech-Gesture Training Intervention for Patients With Schizophrenia and Its Neural Underpinnings - the Study Protocol of a Randomized Controlled Pilot Trial.

Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia that also affects quality of life. Interpreting abstract speech and integrating nonverbal modalities is particularly affected. Considering the impact of communication on social life but failure to treat communication dysfunctions with usual treatment, we will investigate the possibility to improve verbal and non-verbal communication in schizophrenia by applying a multimodal speech-gesture training (MSG training). Here we describe the newly developed MSG training program and the study design for the first clinical investigation. The intervention contains perceptive rating (match/mismatch of sentence and gesture) and memory tasks (n-back tasks), imitation and productive tasks (e.g., SG fluency-similar to verbal fluency where words are accompanied by gesture). In addition, we offer information about gesture as meta-learning element as well as homework for reasons of transfer to everyday life as part of every session. In the MSG training intervention, we offer eight sessions (60 min each) of training. The first pilot study is currently conducted as a single-center, randomized controlled trial of speech-gesture intervention versus wait-list control with a follow-up. Outcomes are measured through pre-post-fMRI and standardized psychological questionnaires comparing two subject groups (30 patients with schizophrenia and 30 healthy controls). Patients and healthy controls are randomized in two intervention groups (with 20 being in the wait-training group and 10 in the training-follow-up group). With our study design we will be able to demonstrate the beneficial effect of the MSG training intervention on behavioral and neural levels. CLINICAL TRIAL REGISTRATION: DRKS.de, identifier DRKS00015118.

Symbol Comprehension in Patients With Alzheimer Disease Dementia, Mild Cognitive Impairment, and Major Depressive Disorder.

INTRODUCTION: Previous research suggests that specific symbol features attenuate symbol comprehension deficits in seniors suffering from Alzheimer disease dementia (ADD). However, it remains unclear whether these findings also apply to other disorders associated with cognitive dysfunctions. METHODS: Ninety healthy controls, 30 patients with major depressive disorder (MDD), 35 patients with mild cognitive impairment (MCI), and 55 patients with ADD performed a Symbol Processing Task with 4 different symbol categories. Nonparametric between×within subjects analyses were conducted to examine the impact of different symbol categories on performance accuracy in all experimental groups. RESULTS: Analyses revealed a higher symbol comprehension accuracy in healthy seniors than in MDD, MCI, and ADD patients, with the lowest accuracy rates shown by ADD patients. Although the type of symbol hardly affected performance accuracy in healthy seniors and MDD patients, different symbol categories influenced the performance of MCI and ADD patients significantly. CONCLUSIONS: Our findings indicate that symbols with distracting features impede symbol comprehension in ADD and MCI. Symbols with visual cues, by contrast, facilitate symbol comprehension in ADD and may even be advantageous over standardized symbols used in public life.

Decreasing postoperative cognitive deficits after heart surgery: protocol for a randomized controlled trial on cognitive training.

BACKGROUND: The occurrence of postoperative cognitive deficits, especially after heart surgery, has been demonstrated in several studies. These deficits can clearly be noticed by the patients and by their close relatives in daily life. Furthermore, postoperative cognitive deficits can decrease quality of life in social functioning and earning capacity. The aim of this study is to investigate whether early postoperative cognitive training can reduce subjective and objective postoperative cognitive deficits. METHODS: The proposed study is a multicenter, two-arm, randomized controlled trial involving 144 elderly patients undergoing elective heart-valve surgery with extracorporeal circulation. Patients will be assigned to either a training group or a control group. The intervention involves paper-and-pencil-based cognitive training, which is conducted for 36 min over a period of 18 days. The training starts about 1 week after surgery and is carried out during the hospitalized rehabilitation phase. The control group will not receive cognitive training or a placebo intervention. A detailed assessment of psychological functions and health-related quality of life prior to surgery at discharge from rehabilitation and 3 and 12 months after discharge will be performed. The primary outcome of this trial is the training effect on objective cognitive functions at discharge from rehabilitation. Secondary outcomes are the training effect on objective and subjective cognitive functions (3 and 12 months after discharge), depression, health-related quality of life, and the impact of perioperative cerebral ischemia on the training effect. Perioperative cerebral ischemia will be measured with postoperative magnetic resonance imaging including diffusion-weighted sequences. DISCUSSION: Should it be shown that our cognitive training can improve postoperative cognitive deficits and quality of life, one possibility could be to integrate this intervention into early rehabilitation. Furthermore, we hope that the investigation of perioperative ischemia by diffusion-weighted magnetic resonance imaging will improve our understanding of neurobiological factors influencing the course of postoperative cognitive plasticity. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00015512. Retrospectively registered on 21 September 2018.

Performance Level and Cortical Atrophy Modulate the Neural Response to Increasing Working Memory Load in Younger and Older Adults.

There is evidence that the neural response to increasing working memory (WM) load is modulated by age and performance level. For a valid interpretation of these effects, however, it is important to understand, whether and how they are related to gray matter atrophy. In the current work, we therefore used functional magnetic resonance imaging (fMRI) and voxel-based morphometry (VBM) to examine the association between age, performance level, spatial WM load-related brain activation and gray matter volume in 18 younger high-performers (YHP), 17 younger low-performers (YLP), 17 older high-performers (OHP), and 18 older low-performers (OLP). In multiple sub regions of the prefrontal cortex (PFC), load-related activation followed a linear trend with increasing activation at increasing load in all experimental groups. Results did not reveal differences between the sub groups. Older adults additionally showed a pattern of increasing activation from low to medium load but stable or even decreasing activation from medium to high load in other sub regions of the PFC (quadratic trend). Quadratic trend related brain activation was higher in older than in younger adults and in OLP compared to OHP. In OLP, quadratic trend related brain activation was negatively correlated with both performance accuracy and prefrontal gray matter volume. The results suggest an efficient upregulation of multiple PFC areas as response to increasing WM load in younger and older adults. Older adults and particularly OLP additionally show dysfunctional response patterns (i.e., enhanced quadratic trend related brain activation compared to younger adults and OHP, respectively) in other PFC clusters being associated with gray matter atrophy.

Spatial-temporal dynamics of gesture-speech integration: a simultaneous EEG-fMRI study.

The semantic integration between gesture and speech (GSI) is mediated by the left posterior temporal sulcus/middle temporal gyrus (pSTS/MTG) and the left inferior frontal gyrus (IFG). Evidence from electroencephalography (EEG) suggests that oscillations in the alpha and beta bands may support processes at different stages of GSI. In the present study, we investigated the relationship between electrophysiological oscillations and blood-oxygen-level-dependent (BOLD) activity during GSI. In a simultaneous EEG-fMRI study, German participants (n = 19) were presented with videos of an actor either performing meaningful gestures in the context of a comprehensible German (GG) or incomprehensible Russian sentence (GR), or just speaking a German sentence (SG). EEG results revealed reduced alpha and beta power for the GG vs. SG conditions, while fMRI analyses showed BOLD increase in the left pSTS/MTG for GG > GR ∩ GG > SG. In time-window-based EEG-informed fMRI analyses, we further found a positive correlation between single-trial alpha power and BOLD signal in the left pSTS/MTG, the left IFG, and several sub-cortical regions. Moreover, the alpha-pSTS/MTG correlation was observed in an earlier time window in comparison to the alpha-IFG correlation, thus supporting a two-stage processing model of GSI. Our study shows that EEG-informed fMRI implies multiple roles of alpha oscillations during GSI, and that the method is a best candidate for multidimensional investigations on complex cognitive functions such as GSI.

Action-Related Speech Modulates Beta Oscillations During Observation of Tool-Use Gestures.

Language and action have been thought of as closely related. Comprehending words or phrases that are related to actions commonly activates motor and premotor areas, and this comprehension process interacts with action preparation and/or execution. However, it remains unclear whether comprehending action-related language interacts with action observation. In the current study, we examined whether the observation of tool-use gesture subjects to interaction with language. In an electroencephalography (EEG) study (n = 20), participants were presented with video clips of an actor performing tool-use (TU, e.g., hammering with a fist) and emblematic (EM, e.g., the thumb up sign for 'good job') gestures accompanied by either comprehensible German (G) or incomprehensible Russian sentences (R). Participants performed a semantic judging task, evaluating whether the co-speech gestures were object- or socially-related. Behavioral results from the semantic task showed faster response for the TU versus EM gestures only in the German condition. For EEG, we found that TU elicited beta power decrease (~ 20 Hz) when compared to EM gestures, however this effect was reduced when gestures were accompanied by German instead of Russian sentences. We concluded that the processing of action-related sentences might facilitate gesture observation, in the sense that motor simulation required for TU gestures, as indexed by reduced beta power, was modulated when accompanied by comprehensible German speech. Our results corroborate the functional role of the beta oscillations during perception of hand gestures, and provide novel evidence concerning language-motor interaction.