TY - THES A1 - Schneider, Anja T1 - Einfluss der clear-cornea-Phakoemulsifikation auf den Augeninnendruck bei Glaukompatienten - eine pro- und retrospektive Analyse T1 - Influence of clear cornea phacoemulsification on intraocular pressure of patients with glaucoma - pro- and retrospective analysis N2 - Anhand dieser Untersuchung sollte geklärt werden, welchen Einfluss eine extrakapsuläre Kataraktoperation mit clear-cornealer Schnitt-Technik, Phakoemulsifikation und Implantation einer Hinterkammerlinse auf den Augeninnendruck bei Patienten mit Offenwinkelglaukom hat. Dabei wurden sowohl retrospektiv die Daten von 76 Patienten als auch prospektiv die Daten von 49 Patienten aus der Universitätsaugenklinik Würzburg verglichen. Alle Patienten wiesen entweder ein Primäres Offenwinkelglaukom oder ein Pseudoexfoliationsglaukom auf und erhielten eine Kataraktoperation, die anhand einer clear-cornea-Phakoemulsifikation durchgeführt wurde. Keiner der Patienten hatte eine vorangegangene filtrierende Glaukomoperation. Für die retrospektive Analyse wurden IOD und Anzahl an antiglaukomatöser Medikation vor und durchschnittlich 12,9 Monate nach der Operation bestimmt. Hierbei konnte eine Redukion des IOD von 18,3 ± 3,7 mmHg präoperativ auf 16,7 ± 3,3 mmHg postoperativ beobachtet werden (p=0,011*). Die durchschnittliche Anzahl an Medikamenten verringerte sich von 1.4 ± 0.9 präoperativ auf 1.0 ± 0.9 postoperativ (p=0,0004***). Während der prospektiven Untersuchung wurden Augeninnendruck, Anzahl der Medikamente und zusätzlich der Visus jeweils am Tag vor der Kataraktoperation sowie postoperativ am Tag vor Entlassung, nach sechs und nach zwölf Monaten bestimmt. Der IOD sank von durchschnittlichen 17,6 ± 3,8 mmHg präoperativ auf 14,2 ± 3,1 mmHg postoperativ (p=0,0003***), 15,8 ± 2,1 mmHg nach sechs Monaten (p=0,0021**) und 15,4 ± 3,2 mmHg nach zwölf Monaten (p=0,0085**). Die Medikamentenzahl konnte von durchschnittlich 1,6 ± 1,0 präoperativ auf 1,2 ± 1,0 postoperativ (p=0,0098**), 1,1 ± 1,0 nach sechs Monaten (p=0,0019**) und auf 1,1 ± 1,0 nach zwölf Monaten (p=0,0056**) reduziert werden. Der Visus verbesserte sich von durchschnittlich 0,3 ± 0,2 auf 0,63 ± 0,3. Somit ist die clear-cornea-Phakoemulsifikation eine sichere Alternative bei Koexistenz von Offenwinkelglaukom und Katarakt, wenn bestimmte Voraussetzungen erfüllt sind. Sie eignet sich vor allem bei Patienten mit noch nicht zu stark ausgeprägten Glaukomschäden, einer guten Medikamentencompliance und einer nicht zu großen Anzahl an Medikamenten. Dann kann eine gute Visusverbesserung erzielt und gleichzeitig eine Verbesserung oder Stabilisierung der Glaukomkontrolle erreicht werden. Nur bei einer geringen Anzahl von Patienten ist mit einer Verschlechterung zu rechnen. Außerdem lässt dieser operative Zugang die Möglichkeit offen, im weiteren Verlauf noch eine filtrierende Operation durchzuführen. N2 - The issue of this examination was to evaluate changes in intraocular pressure following phacoemulsification cataract extraction with IOL-implantation on patients with glaucoma. We retrospectively reviewed the data of 76 patients and prospectively compared the data of 49 patients. All patients had primary open angle glaucoma (POWG)or pseudoexfoliation glaucoma (PEX)and the IOL was implanted through clear corneal incision. None of the patients had prior filtration surgery. In the retrospective review the mean preoperative IOP was 18,3 ± 3,7 mmHg and 16,7 ± 3,3 mmHg after one year (p=0,011*). The average number of medicaments was reduced from 1,4 ± 0,9 to 1,0 ± 0,9 after one year (p=0,0004***). During the prospective study the mean IOP, number of medicaments and visual acuity were examined the day before operation, some days later, six months and one year after operation. The mean preoperative IOP was 17,6 ± 3,8 mmHg in comparision to 14,2 ± 3,1 mmHg postoperative (p=0003***), after six months it reached a mean IOP of 15,8 ± 2,1 mmHg (p=0,0021**) and 15,4 ± 3,2 mmHg after 12 months (p=0,0085**). The mean number of medications decreased from 1,6 ± 1,0 preoperative to 1,2 ± 1,0 postoperative (p=0.0098**), to 1,1 ± 1,0 after six months and to 1,1 ± 1,0 after one year. The visual acuity improved from 0,3 ± 0,2 to 0,63 ± 0,3. In the management of co-existing cataract and glaucoma the phacoemulsification cataract extraction through clear corneal incision with IOL- implantation is a safe alternative associated with significant decrease in IOP with less medication. KW - Glaukom KW - Katarakt KW - Clear-cornea KW - Phakoemulsifikation KW - Augeninnendruck KW - IOD KW - glaucoma KW - cataract KW - clear corneal incision KW - phacoemulsification KW - intraocular pressure KW - IOP Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-30453 ER - TY - JOUR A1 - Semler, Elisa A1 - Anderl-Straub, Sarah A1 - Uttner, Ingo A1 - Diehl-Schmid, Janine A1 - Danek, Adrian A1 - Einsiedler, Beate A1 - Fassbender, Klaus A1 - Fliessbach, Klaus A1 - Huppertz, Hans-Jürgen A1 - Jahn, Holger A1 - Kornhuber, Johannes A1 - Landwehrmeyer, Bernhard A1 - Lauer, Martin A1 - Muche, Rainer A1 - Prudlo, Johannes A1 - Schneider, Anja A1 - Schroeter, Matthias L. A1 - Ludolph, Albert C. A1 - Otto, Markus T1 - A language-based sum score for the course and therapeutic intervention in primary progressive aphasia JF - Alzheimer's Research & Therapy N2 - Background With upcoming therapeutic interventions for patients with primary progressive aphasia (PPA), instruments for the follow-up of patients are needed to describe disease progression and to evaluate potential therapeutic effects. So far, volumetric brain changes have been proposed as clinical endpoints in the literature, but cognitive scores are still lacking. This study followed disease progression predominantly in language-based performance within 1 year and defined a PPA sum score which can be used in therapeutic interventions. Methods We assessed 28 patients with nonfluent variant PPA, 17 with semantic variant PPA, 13 with logopenic variant PPA, and 28 healthy controls in detail for 1 year. The most informative neuropsychological assessments were combined to a sum score, and associations between brain atrophy were investigated followed by a sample size calculation for clinical trials. Results Significant absolute changes up to 20% in cognitive tests were found after 1 year. Semantic and phonemic word fluency, Boston Naming Test, Digit Span, Token Test, AAT Written language, and Cookie Test were identified as the best markers for disease progression. These tasks provide the basis of a new PPA sum score. Assuming a therapeutic effect of 50% reduction in cognitive decline for sample size calculations, a number of 56 cases is needed to find a significant treatment effect. Correlations between cognitive decline and atrophy showed a correlation up to r = 0.7 between the sum score and frontal structures, namely the superior and inferior frontal gyrus, as well as with left-sided subcortical structures. Conclusion Our findings support the high performance of the proposed sum score in the follow-up of PPA and recommend it as an outcome measure in intervention studies. KW - frontotemporal dementia KW - cognitive neuropsychology in dementia KW - assessment of cognitive disorders/dementia KW - volumetric MRI KW - aphasia Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-236277 VL - 10 ER - TY - JOUR A1 - Albrecht, Franziska A1 - Mueller, Karsten A1 - Ballarini, Tommaso A1 - Lampe, Leonie A1 - Diehl-Schmid, Janine A1 - Fassbender, Klaus A1 - Fliessbach, Klaus A1 - Jahn, Holger A1 - Jech, Robert A1 - Kassubek, Jan A1 - Kornhuber, Johannes A1 - Landwehrmeyer, Bernhard A1 - Lauer, Martin A1 - Ludolph, Albert C. A1 - Lyros, Epameinondas A1 - Prudlo, Johannes A1 - Schneider, Anja A1 - Synofzik, Matthis A1 - Wiltfang, Jens A1 - Danek, Adrian A1 - Otto, Markus A1 - Schroeter, Matthias L. T1 - Unraveling corticobasal syndrome and alien limb syndrome with structural brain imaging JF - Cortex N2 - Alien limb phenomenon is a rare syndrome associated with a feeling of non-belonging and disowning toward one's limb. In contrast, anarchic limb phenomenon leads to involuntary but goal-directed movements. Alien/anarchic limb phenomena are frequent in corticobasal syndrome (CBS), an atypical parkinsonian syndrome characterized by rigidity, akinesia, dystonia, cortical sensory deficit, and apraxia. The structure function relationship of alien/anarchic limb was investigated in multi centric structural magnetic resonance imaging (MRI) data. Whole-group and single subject comparisons were made in 25 CBS and eight CBS-alien/anarchic limb patients versus controls. Support vector machine was used to see if CBS with and without alien/anarchic limb could be distinguished by structural MRI patterns. Whole-group comparison of CBS versus controls revealed asymmetric frontotemporal atrophy. CBS with alien/anarchic limb syndrome versus controls showed frontoparietal atrophy including the supplementary motor area contralateral to the side of the affected limb. Exploratory analysis identified frontotemporal regions encompassing the pre-/and postcentral gyrus as compromised in CBS with alien limb syndrome. Classification of CBS patients yielded accuracies of 79%. CBS-alien/anarchic limb syndrome was differentiated from CBS patients with an accuracy of 81%. Predictive differences were found in the cingulate gyrus spreading to frontomedian cortex, postcentral gyrus, and temporoparietoocipital regions. We present the first MRI-based group analysis on CBS-alien/anarchic limb. Results pave the way for individual clinical syndrome prediction and allow understanding the underlying neurocognitive architecture. (C) 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). KW - Alien limb syndrome KW - Anarchic limb syndrome KW - Corticobasal syndrome KW - Diagnosis prediction KW - Support vector machine Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-221040 VL - 117 ER - TY - JOUR A1 - Lombardi, Jolina A1 - Mayer, Benjamin A1 - Semler, Elisa A1 - Anderl‐Straub, Sarah A1 - Uttner, Ingo A1 - Kassubek, Jan A1 - Diehl‐Schmid, Janine A1 - Danek, Adrian A1 - Levin, Johannes A1 - Fassbender, Klaus A1 - Fliessbach, Klaus A1 - Schneider, Anja A1 - Huppertz, Hans‐Jürgen A1 - Jahn, Holger A1 - Volk, Alexander A1 - Kornhuber, Johannes A1 - Landwehrmeyer, Bernhard A1 - Lauer, Martin A1 - Prudlo, Johannes A1 - Wiltfang, Jens A1 - Schroeter, Matthias L. A1 - Ludolph, Albert A1 - Otto, Markus T1 - Quantifying progression in primary progressive aphasia with structural neuroimaging JF - Alzheimer's & Dementia N2 - Introduction The term primary progressive aphasia (PPA) sums up the non‐fluent (nfv), the semantic (sv), and the logopenic (lv) variant. Up to now, there is only limited data available concerning magnetic resonance imaging volumetry to monitor disease progression. Methods Structural brain imaging and an extensive assessment were applied at baseline and up to 4‐year(s) follow‐up in 269 participants. With automated atlas‐based volumetry 56 brain regions were assessed. Atrophy progression served to calculate sample sizes for therapeutic trials. Results At baseline highest atrophy appeared in parts of the left frontal lobe for nfvPPA (–17%) and of the left temporal lobe for svPPA (–34%) and lvPPA (–24%). Severest progression within 1‐year follow‐up occurred in the basal ganglia in nfvPPA (–7%), in the hippocampus/amygdala in svPPA (–9%), and in (medial) temporal regions in lvPPA (–6%). Conclusion PPA presents as a left‐dominant, mostly gray matter sensitive disease with considerable atrophy at baseline that proceeds variant‐specific. KW - atlas‐based volumetry KW - disease progression KW - frontotemporal dementia KW - longitudinal magnetic resonance imaging KW - primary progressive aphasia KW - sample size calculation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262605 VL - 17 IS - 10 SP - 1595 EP - 1609 ER -