The impact of aerobic endurance training on cognitive performance in schizophrenic inpatients in a clinical routine setting.

The primary aim of this study was to investigate the impact of aerobic endurance training in schizophrenic inpatients on cognitive performance in a clinical routine setting. Of secondary interest was the influence on psychopathological symptoms. A total of 31 schizophrenic inpatients were randomly assigned to receive either controlled endurance training or occupational therapy. The experimental group underwent endurance training of 20-30 min each, 3 times per week for a total of up to 22 training sessions. The control group received about 90 min of occupational therapy, 2-3 times per week for up to 22 sessions. Cognitive performance was assessed via an extensive neuropsychological examination before randomization and prior to discharge. Significant improvements in cognitive functions and psychopathology could be shown in both groups. For verbal memory functions (short-term memory, working memory, and learning performance), there was a significant advantage for the aerobic endurance training group. Physical exercise is a feasible, easy-to-implement add-on therapy for schizophrenic patients in a clinical routine setting with positive effects on verbal memory functions. Besides, it seems important to fill the gap between inpatient and outpatient health care, providing physical training supply for this patient group.

Protocol for the conceptualization and evaluation of a screening-tool for fitness-to-drive assessment in older people with cognitive impairment.

INTRODUCTION: Due to aging and health status people may be subjected to a decrease of cognitive ability and subsequently also a decline of driving safety. On the other hand there is a lack of valid and economically applicable instruments to assess driving performance. OBJECTIVE: The study is designed to develop a valid screening-tool for fitness-to-drive assessment in older people with cognitive impairment externally validated on the basis of on-road driving performance. METHODS: In a single-centre, non-randomized cross-sectional trial cognitive functioning and on-road-driving-behavior of older drivers will be assessed. Forty participants with cognitive impairment of different etiology and 40 healthy controls will undergo an extensive neuropsychological assessment. Additionally, an on-road driving assessment for external validation of fitness to drive will be carried out. Primary outcome measures will be performance in attention, executive functions and visuospatial tasks that will be validated with respect to performance on the on-road-driving-test. Secondary outcome measures will be sociodemographic, clinical- and driving characteristics to systematically examine their influence on the prediction of driving behavior. DISCUSSION: In clinical practice counselling patients with respect to driving safety is of great relevance. Thus, having valid, reliable, time economical and easily interpretable screening-tools on hand to counsel patients is of great relevance for practitioners. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee at the Ludwig-Maximilians-University Munich. The trial results will be disseminated through peer-reviewed publications and various conferences. TRIAL REGISTRATION: 18-640. Trial registration: German Clinical Trials Register. Registration number: DRKS00023549.

Driving Performance Under Treatment of Most Frequently Prescribed Drugs for Mental Disorders: A Systematic Review of Patient Studies.

BACKGROUND: Mobility is important for daily life functioning, with particular challenges regarding road safety under pharmacological treatment in patients with a psychiatric disease. METHODS: According to PRISMA guidelines, a systematic literature search on PubMed database (January 1970 to December 2020) was performed. Primary endpoints were driving performance in on-road tests, driving simulator performance, or psychomotor and visual perception functions assessed to estimate fitness to drive according to legal regulations in patient studies. RESULTS: Forty studies were identified (1533 patients, 38% female, median age 45 years), of which more than 60% were cross-sectional and open-label trials. Under steady-state medication, 31% (range 27%-42.5%) of schizophrenic or schizoaffective patients under antipsychotics and 18% (range 16%-20%) of unipolar and bipolar patients under antidepressants showed severe impairment in skills relevant for driving. Data point to an advantage of second-generation antipsychotics compared with first-generation antipsychotics as well as modern antidepressants over tricyclic antidepressants with respect to driving. Most patients significantly improved or stabilized in driving skills within 2-4 weeks of treatment with non-sedative or sedative antidepressants. Diazepam significantly worsened driving the first 3 weeks after treatment initiation, whereas medazepam (low dose), temazepam, and zolpidem did not impair driving. In long-term users of sedating antidepressants or benzodiazepines, impairments in on-road tests were not evident. CONCLUSION: The available evidence suggests that psychopharmacologic medicines improve or at least stabilize driving performance of patients under long-term treatment when given on clinical considerations. To enhance treatment compliance, existing classification systems of medicinal drugs concerning impact on driving performance should also incorporate information about effects of long-term-treatment.

Boosting Learning Efficacy with Noninvasive Brain Stimulation in Intact and Brain-Damaged Humans.

Numerous behavioral studies have shown that visual function can improve with training, although perceptual refinements generally require weeks to months of training to attain. This, along with questions about long-term retention of learning, limits practical and clinical applications of many such paradigms. Here, we show for the first time in female and male human participants that just 10 d of visual training coupled with transcranial random noise stimulation (tRNS) over visual areas causes dramatic improvements in visual motion perception. Relative to control conditions and anodal stimulation, tRNS-enhanced learning was at least twice as fast, and, crucially, it persisted for 6 months after the end of training and stimulation. Notably, tRNS also boosted learning in patients with chronic cortical blindness, leading to recovery of motion processing in the blind field after just 10 d of training, a period too short to elicit enhancements with training alone. In sum, our results reveal a remarkable enhancement of the capacity for long-lasting plastic and restorative changes when a neuromodulatory intervention is coupled with visual training.SIGNIFICANCE STATEMENT Our work demonstrates that visual training coupled with brain stimulation can dramatically reduce the training period from months to weeks, and lead to fast improvement in neurotypical subjects and chronic cortically blind patients, indicating the potential of our procedure to help restore damaged visual abilities for currently untreatable visual dysfunctions. Together, these results indicate the critical role of early visual areas in perceptual learning and reveal its capacity for long-lasting plastic changes promoted by neuromodulatory intervention.

Prolonged Neuromodulation of Cortical Networks Following Low-Frequency rTMS and Its Potential for Clinical Interventions.

Non-invasive brain stimulation safely induces persistent large-scale neural modulation in functionally connected brain circuits. Interruption models of repetitive transcranial magnetic stimulation (rTMS) capitalize on the acute impact of brain stimulation, which decays over minutes. However, rTMS also induces longer-lasting impact on cortical functions, evident by the use of multi-session rTMS in clinical population for therapeutic purposes. Defining the persistent cortical dynamics induced by rTMS is complicated by the complex balance of excitation and inhibition among functionally connected networks. Nonetheless, it is these neuronal dynamic responses that are essential for the development of new neuromodulatory protocols for translational applications. We will review evidence of prolonged changes of cortical response, tens of minutes following one session of low frequency rTMS over the cortex. We will focus on the different methods which resulted in prolonged behavioral and brain changes, such as the combination of brain stimulation techniques, and individually tailored stimulation protocols. We will also highlight studies which apply these methods in multi-session stimulation practices to extend stimulation impact into weeks and months. Our data and others' indicate that delayed cortical dynamics may persist much longer than previously thought and have potential as an extended temporal window during which cortical plasticity may be enhanced.

Modulating the excitability of the visual cortex using a stimulation priming paradigm.

BACKGROUND: Transcranial random noise stimulation (tRNS) can cause long term increase of corticospinal excitability when used to prime the motor cortex, before measuring the motor response in the hand muscles with TMS (Terney et al., 2008). In cognitive studies, tRNS has been used to improve visual attention and mathematical skills, an enhancement effect that might suggest sustained cortical plasticity changes (Cappelletti et al., 2013; Snowball et al., 2013). However, while the behavioral evidence of increased performance is becoming substantiated by empirical data, it still remains unclear whether tRNS over visual areas causes an increase in cortical excitability similar to what has been found in the motor cortex, and if that increase could be a potential physiological explanation for behavioral improvements found in visual tasks. OBJECTIVE/HYPOTHESIS: In the present study, we aimed to investigate whether priming the visual cortex with tRNS leads to increased and sustained excitability as measured with visual phosphenes. METHODS: We measured phosphene thresholds (PTs) using an objective staircase method to quantify the magnitude of cortical excitability changes. Single-pulse TMS was used to elicit phosphenes before, immediately after, and every 10 min up to one hour after the end of 20 min tRNS, anodal tDCS (a-tDCS) or sham. RESULTS: Results showed that phosphene thresholds were significantly reduced up to 60 min post stimulation relative to baseline after tRNS, a behavioral marker of increased excitability of the visual cortex, while a-tDCS had no effect. This result is very similar in magnitude and duration to what has been found in the motor cortex. CONCLUSIONS: Our findings demonstrate promising potential of tRNS as a tool to increase and sustain cortical excitability to promote improvement of cognitive functions.

Contralesional rTMS relieves visual extinction in chronic stroke.

Patients affected by right parietal lobe lesion can be severely impaired in sustained attention tasks, particularly in the left visual field. For example, patients with right parietal stroke are commonly limited in their ability to attentionally track multiple moving objects in their left visual field when competing stimuli are simultaneously presented in the right, ipsilesional visual field. This is a hallmark of visual extinction, a failure to respond to contralesional visual stimuli, when competing stimuli are presented in the good hemifield. It has been hypothesized that post-stroke hyperactivity of the undamaged left hemisphere leads to excessive cross-hemispheric inhibition of the damaged right hemisphere, thus exacerbating the attentional deficits. However, there has been no direct physiological demonstration of this hypothesis, as most of the studies are conducted using unilateral tasks, a condition not sufficient to drive inter-hemispheric competition. The inter-hemispheric inhibition hypothesis also raises the possibility that if hyperactivity of the healthy hemisphere were reduced, this could relieve inter-hemispheric inhibition, disinhibiting the damaged hemisphere and potentially restoring some function. To test this hypothesis, and to examine whether we could relieve deficits in sustained attention in right parietal patients, we used repetitive transcranial magnetic stimulation (rTMS) to reduce the activity of the left, healthy hemisphere. Six patients suffering from visual extinction underwent two counterbalanced sessions: low frequency rTMS over the left parietal lobe and sham control stimulation. The patients' performance in an attentional tracking task significantly improved in the contralesional visual field immediately after rTMS, but not after sham. Performance remained unaltered in the ipsilesional field. We hypothesize that rTMS temporarily releases the damaged right hemisphere from excessive cross-hemispheric inhibition by the hyperactive healthy hemisphere, leading to some cognitive recovery after cortical lesion.