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The integrity of cortical motor networks and their descending effector-pathway (the corticospinal tract; CST) is a major determinant motor recovery after stroke. However, this view neglects the importance of ascending tracts and their modulatory effects on cortical physiology. Here, we explore the role of such a tract that connects dopaminergic ventral tegmental midbrain nuclei to motor cortex (the VTMC-tract) for post-stroke recovery.Lesion data and diffusivity parameters (fractional anisotropy) of the ipsi- and contralesional VTMC-tract and CST were obtained from 133 patients (63.9±13.4 years, 45 female) during acute and chronic stage after first-ever ischemic stroke in the middle cerebral artery territory. Degeneration of VTMC-tract and CST was quantified and related to clinical outcome parameters (National Institute of Health Stroke Scale [NIHSS] with motor and cortical-symptom subscores; modified Fugl-Meyer upper extremity score [mFMMS]; modified Ranking Scale [mRS]).A significant post-stroke degeneration occurred in both tracts, but only VTMC-degeneration was associated with lesion size. Using multiple regression models, we dissected the impact of particular tracts on recovery: Changes in VTMC-tract integrity were stronger associated with independence in daily activities (mRS), upper limb motor impairment (mFMMS) and cortical symptoms (aphasia, neglect) captured by NIHSS compared to CST. Changes in CST-integrity merely were associated with the degree of hemiparesis (NIHSS motor subscale).Post-stroke outcome is influenced by ascending (VTMC) and descending (CST) fiber tracts. Favourable outcome regarding independence (mRS), upper limb motor function (mFMMS) and cortical symptoms (aphasia, neglect) was stronger related to the ascending than descending tract. This article is protected by copyright. All rights reserved.

Conducting constitutes a well-structured system of signs anticipating information concerning the rhythm and dynamic of a musical piece. Conductors communicate the musical tempo to the orchestra, unifying the individual instrumental voices to form an expressive musical Gestalt. In an fMRI experiment, 12 professional conductors and 16 instrumentalists conducted real-time novel pieces with diverse complexity in orchestration and rhythm. For control, participants either listened to the stimuli or performed beat patterns, setting the time of a metronome or complex rhythms played by a drum. Activation of the left superior temporal gyrus (STG), supplementary and premotor cortex, and Broca's pars opercularis (F3op) was shared in both musician groups and separated conducting from the other conditions. Compared to instrumentalists, conductors activated Broca's pars triangularis (F3tri) and STG, which differentiated conducting from time beating and reflected the increase in complexity during conducting. In comparison to conductors, instrumentalists activated F3op and F3tri when distinguishing complex rhythm processing from simple rhythm processing. Fiber selection from a normative human connectome database, constructed using a global tractography approach, showed that F3op and STG are connected via the arcuate fasciculus, while F3tri and STG are connected via the extreme capsule. Like language, the anatomical framework characterizing conducting gestures is located in the left dorsal system centered on F3op. This system reflected the sensorimotor mapping for structuring gestures to musical tempo. The ventral system centered on F3Tri may reflect the art of conductors to set this musical tempo to the individual orchestra's voices in a global, holistic way.

Background Telemedicine has rapidly emerged as an important tool in emergency neurology. In particular, reliable biomarkers of large vessel occlusions (LVOs) are critically necessary in order to identify the need for in-hospital mechanical thrombectomy (MT). Based on pathophysiological factors, we propose that the presence of head and/or gaze deviation alone signifies cortical hypoperfusion and is therefore a highly sensitive marker for the presence of LVO. Methods We retrospectively analyzed a cohort of 160 patients, examined via telemedicine and suspected to have had an acute stroke; this included patients with ischemic or hemorrhagic stroke, transient ischemic attack, and stroke mimics. An assessment of head and gaze deviation and NIHSS score evaluation was performed. In a second analysis, patients who only had ischemia in the anterior circulation (n = 110) were evaluated. Results Head and/or gaze deviation alone was found to be a reliable marker of LVO (sensitivity: 0.66/specificity: 0.92), as well as a sound indicator for MT (0.82/0.91), in patients with suspected ischemic stroke. The performance of this indicator further improved when patients with ischemia in the anterior circulation only were assessed (LVO: 0.70/0.93; MT: 0.86/0.90). In both analyses, head and/or gaze deviation served as a better indicator for LVO or MT compared to the prevalence of motor deficits or aphasia. Of note, in patients who had ischemia in the anterior circulation, head and/or gaze deviation performed better than the NIHSS score as an indicator for MT. Conclusion These findings confirm that the presence of head and/or gaze deviation serves as a reliable biomarker in stroke-based telemedicine for the diagnosis of LVO, as well as a strong indicator for MT. Furthermore, this marker is just as reliable as the NIHSS score but easier to assess. We therefore suggest that any stroke patient who displays head and/or gaze deviation should immediately be scheduled for vessel imaging and subsequently transported to a MT-competent center.

Objectives The precise segmentation of atrophic structures remains challenging in neurodegenerative diseases. We determined the performance of a Deep Neural Patchwork (DNP) in comparison to established segmentation algorithms regarding the ability to delineate the putamen in multiple system atrophy (MSA), Parkinson’s disease (PD), and healthy controls. Methods We retrospectively included patients with MSA and PD as well as healthy controls. A DNP was trained on manual segmentations of the putamen as ground truth. For this, the cohort was randomly split into a training (N = 131) and test set (N = 120). The DNP’s performance was compared with putaminal segmentations as derived by Automatic Anatomic Labelling, Freesurfer and Fastsurfer. For validation, we assessed the diagnostic accuracy of the resulting segmentations in the delineation of MSA vs. PD and healthy controls. Results A total of 251 subjects (61 patients with MSA, 158 patients with PD, and 32 healthy controls; mean age of 61.5 ± 8.8 years) were included. Compared to the dice-coefficient of the DNP (0.96), we noted significantly weaker performance for AAL3 (0.72; p p p p = 0.02), 0.86 for Freesurfer (p = 0.048), and 0.85 for Fastsurfer (p = 0.04). Conclusion By utilization of a DNP, accurate segmentations of the putamen can be obtained even if substantial atrophy is present. This allows for more precise extraction of imaging parameters or shape features from the putamen in relevant patient cohorts. Clinical relevance statement Deep learning-based segmentation of the putamen was superior to currently available algorithms and is beneficial for the diagnosis of multiple system atrophy. Key Points • A Deep Neural Patchwork precisely delineates the putamen and performs equal to human labeling in multiple system atrophy, even when pronounced putaminal volume loss is present. • The Deep Neural Patchwork–based segmentation was more capable to differentiate between multiple system atrophy and Parkinson’s disease than the AAL3 atlas, Freesurfer, or Fastsurfer.

This scientific commentary refers to ‘Joint impact on attention, alertness and inhibition of lesions at a frontal white matter crossroad’ by Kaufmann et al. (https://doi.org/10.1093/brain/awac359).

The anatomical relationship between speech apraxia (SA) and oral apraxia (OA) is still unclear. To shed light on this matter we studied 137 patients with acute ischaemic left-hemisphere stroke and performed support vector regression-based, multivariate lesion–symptom mapping. Thirty-three patients presented with either SA or OA. These two symptoms mostly co-occurred (n = 28), except for few patients with isolated SA (n = 2) or OA (n = 3). All patient with either SA or OA presented with aphasia (p p

Background and ObjectivesTo compare a blended learning approach with traditional face-to-face instruction in terms of their individual effectiveness in imparting neurologic examination (NE) skills in medical students.MethodsWe conducted a prospective controlled study of 4th-year medical students (n = 163) who were pseudorandomly distributed into 2 groups. Group A (n = 87) was subjected to a traditional teaching method comprising 2 face-to-face sessions. Group B (n = 76) underwent blended learning, which consisted of an individual preparation period using a course handbook and videoclips, plus a single face-to-face session. NE skill acquisition was assessed by an objective structured clinical examination (OSCE). Questionnaires were used for evaluation.ResultsComparison of mean OSCE scores in groups A vs B revealed that NE skill acquisition was better in group B (blended learning), with a moderate effect size, a smaller OSCE score variance, and fewer students performing poorly than in group A (face-to-face instruction). Student evaluation revealed that both teaching approaches were well accepted, but a higher level of satisfaction was associated with the blended learning approach. This method also provided more time for practice and feedback.DiscussionThe blended learning approach is a highly efficacious and valued method for teaching NE skills. It offers instructors and faculty the advantage of successful skill acquisition in students despite the considerably reduced attendance time.

Apraxia is frequently described after left hemisphere stroke and results from lesions to a complex network for motor cognition with dorso-dorsal, ventro-dorsal and ventral processing streams. Apraxia also occurs after right hemisphere stroke, but lesion correlates and underlying mechanisms remain to be elucidated. To clarify the role of the right hemisphere in apraxic deficits and the influence of neglect, we prospectively examined apraxia (imitation of meaningless postures and pantomime of tool use) and neglect in 138 acute right hemisphere stroke patients with first-ever ischemic stroke in the middle cerebral artery territory and identified corresponding lesion correlates using voxel-based lesion-symptom mapping. Imitation of meaningless postures was impaired as frequently as after left hemisphere stroke (38.4%) and was significantly associated with neglect. Imitation of meaningless postures was related to temporal (middle temporal gyrus, temporoparietal junction, superior temporal gyrus and sulcus), parietal (angular gyrus, parieto-occpitpial sulcus), secondary sensorimotor cortex and (peri-)insular lesions. Presence of neglect dichotomized the results: a lesion correlate for isolated imitation without neglect was found in the right parieto-occipital cortex, while imitation deficits, when co-occurring with neglect, were related to lateral occipito-temporal, superior temporal sulcus and (peri-)insular lesions. Pantomime of tool use deficits, typical for apraxia after left hemisphere lesions, were found in only 5 cases (3.6%) and only in the context of neglect, and were associated with occipital lobe, ventral and anterior temporal lobe, and inferior frontal (areas 45/47) lesions. The syndrome of apraxia after right hemisphere stroke differs from apraxia after left hemisphere stroke. Imitation deficits are found in both hemispheres after dorso-dorsal stream lesions. Neglect also leads to and explains deficits in imitation and pantomime in patients with right ventral stream lesions. Therefore, in right hemisphere lesions, apraxia can either be explained as impaired visuomotor transformation or as a result of visuospatial deficits.

Der vorliegende Beitrag gibt eine Einfuhrung in die Neuropsychologie des menschlichen Gedachtnisses. Die Begriffe Kurzzeit‑, Arbeits-, episodisches Gedachtnis sowie semantisches und prozedurales Gedachtnis werden beschrieben, die anatomischen Korrelate der verschiedenen Gedachtnissysteme werden dargestellt. Zudem wird eine kurze Einfuhrung in die Methodik der neuropsychologischen Gedachtnisforschung gegeben, zusammen mit Hinweisen zur neuropsychologischen Diagnostik und Therapie.

Verbal short-term memory (vSTM) plays a crucial role in word learning, and patients with impaired vSTM have been demonstrated to fail on learning novel word forms. Word learning has exclusively been investigated with previously unknown or pseudowords. Several languages, however, make use of composition, i.e., combining morphemes into compounds. On the one hand, this is comparable to pseudoword learning because known elements are combined into novel representations, on the other hand compounds differ from pseudowords learning because they consist of previously known (lexical) elements. This may help to identify the role of vSTM in word learning. The present paper documents impaired word learning in a participant with impaired vSTM but also assessed, for the first time, the acquisition of novel noun-noun compounds. In two independent experiments, the participant was impaired in learning nonsense compounds (“ball door”) and the names of previously unknown tools (“nail puller”; “drill bit”). Control experiments revealed her impairment of word learning and novel compound noun learning to be selective: IS could acquire information about the novel tools' function and purpose and was unimpaired in several experiments on paired associate learning including different stimuli. The results suggest that vSTM is involved in variants of lexical learning such as compound noun acquisition. Implications for the modeling of the relationship between vSTM and word learning are discussed.

To improve clinical outcome, one longstanding goal in treating stroke patients has been an individual therapy based on functional and anatomical knowledge of the single patient. Therefore, in this study brain imaging of 36 chronic stroke patients was analyzed to identify parameters predicting clinical recovery. T1-weighted MRI was acquired to assess the lesion; functional MRI was used to visualize existing resources; DTI for the integrity of the corticospinal tract (CST) and long association tracts. These data were related to the clinical course. All patients were treated intensively with the mirror therapy (MT) only. After the training period, we analyzed which patient's feature would predict a beneficial course. Patients as a group improved after MT, but according to the fMRI activation of primary sensorimotor cortex (SMC), they could be divided in two groups with very diverging clinical outcome: those with ipsilesional SMC activation showed a noticeable increase of clinical scores, accompanied with ipsilesional activation in the frontal projection areas of the dorsal and ventral streams during action observation in fMRI. Those with contralesional SMC activation had lesions affecting both the dorsal and ventral stream and did not benefit from MT. The outcome for this therapy was not related to affection of CST. This study demonstrates that only in patients in which dorsal and ventral streams are not affected and therefore an interaction between these streams in post- and prerolandic regions is possible, MT can induce clinical improvement. Consequently, knowledge of the anatomical lesion can predict the beneficial course of MT.

The loss and recovery of language functions are still incompletely understood. This longitudinal functional MRI study investigated the neural mechanisms underlying language recovery in patients with post-stroke aphasia putting particular emphasis on the impact of lesion site. To identify patterns of language-related activation, an auditory functional MRI sentence comprehension paradigm was administered to patients with circumscribed lesions of either left frontal (n = 17) or temporo-parietal (n = 17) cortex. Patients were examined repeatedly during the acute (≤1 week, t1), subacute (1–2 weeks, t2) and chronic phase (>6 months, t3) post-stroke; healthy age-matched control subjects (n = 17) were tested once. The separation into two patient groups with circumscribed lesions allowed for a direct comparison of the contributions of distinct lesion-dependent network components to language reorganization between both groups. We hypothesized that activation of left hemisphere spared and perilesional cortex as well as lesion-homologue cortex in the right hemisphere varies between patient groups and across time. In addition, we expected that domain-general networks serving cognitive control independently contribute to language recovery. First, we found a global network disturbance in the acute phase that is characterized by reduced functional MRI language activation including areas distant to the lesion (i.e. diaschisis) and subsequent subacute network reactivation (i.e. resolution of diaschisis). These phenomena were driven by temporo-parietal lesions. Second, we identified a lesion-independent sequential activation pattern with increased activity of perilesional cortex and bilateral domain-general networks in the subacute phase followed by reorganization of left temporal language areas in the chronic phase. Third, we observed involvement of lesion-homologue cortex only in patients with frontal but not temporo-parietal lesions. Fourth, irrespective of lesion location, language reorganization predominantly occurred in pre-existing networks showing comparable activation in healthy controls. Finally, we detected different relationships of performance and activation in language and domain-general networks demonstrating the functional relevance for language recovery. Our findings highlight that the dynamics of language reorganization clearly depend on lesion location and hence open new perspectives for neurobiologically motivated strategies of language rehabilitation, such as individually-tailored targeted application of neuro-stimulation.

Contains fulltext : 246802.pdf (Publisher’s version ) (Open Access) Aphasia, the impairment to understand or produce language, is a frequent disorder after stroke with devastating effects. Conventional speech and language therapy includes each formal intervention for improving language and communication abilities. In the chronic stage after stroke, it is effective compared to no treatment, but its effect size is small. We present a new language training approach for the rehabilitation of patients with aphasia based on a brain-computer interface system. The approach exploits its capacity to provide feedback time-locked to a brain state. Thus, it implements the idea that reinforcing an appropriate language processing strategy may induce beneficial brain plasticity.In our approach, patients perform a simple auditory target word detection task while their EEG was recorded. The constant decoding of these signals by machine learning models generates an individual and immediate brain-state dependent feedback. It indicates to patients how well they accomplish the task during a training session, even if they are unable to speak.Results obtained from a proof-of-concept study with 10 stroke patients with mild to severe chronic aphasia (age range: 38–76 years) are remarkable. First, we found that the high intensity training (30 hours, four days per week) was feasible, despite a high word presentation speed and unfavorable stroke-induced EEG signal characteristics. Second, the training induced a sustained recovery of aphasia, which generalized to multiple language aspects beyond the trained task. Specifically, all tested language assessments (Aachen Aphasia Test, Snodgrass & Vanderwart, Communication Activity Log) showed significant medium to large improvements between pre- and post training, with a standardized mean difference of 0.63 obtained for the Aachen Aphasia Test, and five patients categorized as non-aphasic at post-training assessment. Third, our data shows that these language improvements were accompanied neither by significant changes in attention skills nor non-linguistic skills. Investigating possible modes of action of this brain-computer interface-based language training, neuroimaging data (EEG and resting-state functional MRI) indicates a training-induced faster word processing, a strengthened language network and a re-balancing between the language- and default mode networks. 19 p.

Mechanical thrombectomy (MT) improves early clinical outcome in patients with acute ischemic stroke but insights on determinants of long-term outcome after MT treatment are scarce. Data from stroke patients with anterior circulation large vessel occlusion of a prospective MT registry (01/2014–06/2017) of a large comprehensive stroke center were analyzed regarding clinical outcome between short- (3 months) and long-term (12 months) assessment reflected by a change of modified Rankin scores (∆mRS). Secondary endpoints included favorable long-term outcome (mRS 0–2). Multi-variable regression analysis was performed to identify determinants of outcome changes and favorable outcome at long term. Of 264 patients included, 42.0% showed a favorable long-term outcome. Longitudinal analysis found that some individuals still improved, but no overall mRS difference between short and long-term follow-up was detected [∆mRS − 0.004 (95% CI − 0.020; 0.013); p = 0.672]. Right hemispheric stroke [∆mRS 0.286 (0.011; 0.561); p = 0.043] and high NIHSS at discharge [∆mRS, 0.039 (0.004; 0.074); p = 0.029] were associated with a longitudinal mRS decline. Favorable long-term outcome was associated with successful recanalization (p

While neuropathological examinations in patients who died from COVID-19 revealed inflammatory changes in cerebral white matter, cerebral MRI frequently fails to detect abnormalities even in the presence of neurological symptoms. Application of multi-compartment diffusion microstructure imaging (DMI), that detects even small volume shifts between the compartments (intra-axonal, extra-axonal and free water/CSF) of a white matter model, is a promising approach to overcome this discrepancy. In this monocentric prospective study, a cohort of 20 COVID-19 inpatients (57.3 ± 17.1 years) with neurological symptoms (e.g. delirium, cranial nerve palsies) and cognitive impairments measured by the Montreal Cognitive Assessment (MoCA test; 22.4 ± 4.9; 70% below the cut-off value In summary, DMI in subacute COVID-19 patients revealed widespread volume shifts compatible with vasogenic oedema, affecting various supratentorial white matter tracts. These changes were associated with cognitive impairment and COVID-19 related changes in 18F-FDG PET imaging.

The brain hemispheres can be divided into an upper dorsal and a lower ventral system. Each system consists of distinct cortical regions connected via long association tracts. The tracts cross the central sulcus or the limen insulae to connect the frontal lobe with the posterior brain. The dorsal stream is associated with sensorimotor mapping. The ventral stream serves structural analysis and semantics in different domains, as visual, acoustic or space processing. How does the prefrontal cortex, regarded as the platform for the highest level of integration, incorporate information from these different domains? In the current view, the ventral pathway consists of several separate tracts, related to different modalities. Originally the assumption was that the ventral path is a continuum, covering all modalities. The latter would imply a very different anatomical basis for cognitive and clinical models of processing. To further define the ventral connections, we used cutting-edge in vivo global tractography on high-resolution diffusion tensor imaging (DTI) data from 100 normal subjects from the human connectome project and ex vivo preparation of fiber bundles in the extreme capsule of 8 humans using the Klingler technique. Our data showed that ventral stream tracts, traversing through the extreme capsule, form a continuous band of fibers that fan out anteriorly to the prefrontal cortex, and posteriorly to temporal, occipital and parietal cortical regions. Introduction of additional volumes of interest in temporal and occipital lobes differentiated between the inferior fronto-occipital fascicle (IFOF) and uncinate fascicle (UF). Unequivocally, in both experiments, in all subjects a connection between the inferior frontal and middle-to-posterior temporal cortical region, otherwise known as the temporo-frontal extreme capsule fascicle (ECF) from nonhuman primate brain-tracing experiments was identified. In the human brain, this tract connects the language domains of “Broca's area” and “Wernicke's area”. The differentiation in the three tracts, IFOF, UF and ECF seems arbitrary, all three pass through the extreme capsule. Our data show that the ventral pathway represents a continuum. The three tracts merge seamlessly and streamlines showed considerable overlap in their anterior and posterior course. Terminal maps identified prefrontal cortex in the frontal lobe and association cortex in temporal, occipital and parietal lobes as streamline endings. This anatomical substrate potentially facilitates the prefrontal cortex to integrate information across different domains and modalities.

During the Corona Virus Disease 2019 (COVID-19) pandemic, Long COVID-syndrome, which impairs patients through cognitive deficits, fatigue, and exhaustion, has become increasingly relevant. Its underlying pathophysiology, however, is unknown. In this study, we assessed cognitive profiles and regional cerebral glucose metabolism as a biomarker of neuronal function in outpatients suffering from long-term neurocognitive symptoms after COVID-19. Methods: Outpatients seeking neurological counseling with neurocognitive symptoms persisting for more than three months after polymerase chain reaction (PCR)-confirmed COVID-19 were included prospectively between June 16, 2020, and January 29, 2021. Patients (n = 31, 54±2.0 years) in the long-term phase after COVID-19 (202±58 days after positive PCR) were assessed with a neuropsychological test battery. Cerebral 18F-FDG PET imaging was performed in 14/31 patients. Results: Patients self-reported impaired attention, memory, and multitasking abilities (31/31), word-finding difficulties (27/31), and fatigue (24/31). Twelve of 31 patients could not return to the previous level of independence/employment. For all cognitive domains, average group results of the neuropsychological test-battery showed no impairment, but deficits (z-score

Cerebral amyloid angiopathy (CAA) might disturb the sensitive mechanism of cerebral pressure autoregulation. This study examines whether dynamic cerebral autoregulation (CA) is impaired in the posterior or anterior circulation of CAA patients. Fifteen patients with known CAA on magnetic resonance imaging (MRI) and 14 age-matched controls were examined with transcranial Doppler. Dynamic CA was assessed in the middle (MCA) and posterior cerebral artery (PCA) via transfer function phase and gain during respiratory-induced 0.1 Hz oscillations of arterial pressure. Within the patient group, 4 patients showed additional microbleeds in the basal ganglia on the MRI performed within the study (pure CAA vs mixed microbleeds). PCA phase was significantly lower in patients compared with controls (p = 0.018), particularly in patients with pure CAA (p = 0.0034). MCA values showed a similar but non-significant trend towards lower phase in patients with pure CAA. Poorer phase was associated with a higher number of microbleeds on MRI (MCA r = −0.57, p = 0.027; PCA r = −0.52, p = 0.098) and superficial cortical siderosis (PCA: p = 0.0025). In conclusion, dynamic cerebral autoregulation is impaired in patients with CAA. The degree of impairment is associated with the extent of cerebral microbleeds.

Retrograde blood flow from complex atheroma in the descending aorta (DAo) has only recently been described as a potential mechanism of stroke. However, prevalence of this mechanism in the general population and the exact factors influencing stroke risk are unclear. One hundred twenty-six consecutively recruited inhabitants of Freiburg, Germany, between 20 and 80 years of age prospectively underwent 3-T MRI. Aortic plaque location and thickness were determined by 3D T1 MRI (1 mm3). 4D flow MRI (spatial/temporal resolution 2 mm3/20 ms) and dedicated software were used to determine prevalence and extent of flow reversal and potential embolization from DAo plaques. Flow was correlated with baseline characteristics and echocardiographic and MRI parameters (aortic diameter, wall thickness, and pulse wave velocity). The maximum length of retrograde blood flow connecting the DAo with the left subclavian artery (LSA) increased from 16.1 ± 8.3 mm in 20–29-year-old to 24.7 ± 11.7 mm in 70–80-year-old subjects, correlated with age (r = 0.37; p

ZusammenfassungObwohl Aphasien nach ischämischen Schlaganfällen oder Hirnblutungen häufig auftreten, hat sich weder die medizinische Wissenschaft noch die obergerichtliche Rechtsprechung intensiver mit der praktisch bedeutsamen Frage beschäftigt, welche Auswirkungen diese Störung auf die Geschäftsfähigkeit hat.Mit Hilfe moderner Bildgebungsstudien ist eine differenzierte Betrachtung der unterliegenden Pathologien der erworbenen Sprachstörungen, der daraus resultierenden unterschiedlichen klinischen Bilder der Aphasie sowie dem Erholungsverlauf möglich. Auf der Basis dieser Befunde sowie dem Konzept der „Inneren Sprache“ wird untersucht, inwieweit Aphasien die Geschäftsfähigkeit beeinträchtigen könnten und ein Phasenmodell zur Beurteilung der Geschäftsfähigkeit bei Aphasie vorgeschlagen, welches die grundsätzlichen Möglichkeiten der Erholung im Rahmen neuronaler Reorganisation berücksichtigt.Die gutachtliche Beurteilung der Voraussetzungen zur Annahme einer Geschäftsfähigkeit oder -unfähigkeit bei Aphasie erfordert eine interdisziplinäre Zusammenarbeit von Neurologen, Psychiatern und Sprachtherapeuten. Da Gutachten zur Geschäftsunfähigkeit häufig ex-post erstellt werden müssen, ist der Gutachter auf eine detaillierte Befunddokumentation von Fähigkeiten und Defiziten bei Vorliegen einer Aphasie angewiesen. Um die bisherigen Limitationen in der Begutachtung der Geschäftsfähigkeit von Patienten mit Aphasien zu verbessern, wäre eine standardisierte Beschreibung der Aphasie und assoziierter neuropsychologischer Symptome als obligater Bestandteil eines Arztbriefes nach einer neurologischen Akut- und Rehabilitationsbehandlung wünschenswert.

Ziel/Aim Given the rapid spread of SARS-CoV-2 and emerging evidence of neurological symptoms particularly in hospitalized COVID-19 patients, we examined the impact of COVID-19 on the CNS in inpatients at the subacute stage by F-18-FDG PET. Methodik/Methods We assessed neurological and neuropsychological symptoms (MoCA) and F-18-FDG PET scans in 15 COVID-19 inpatients (once patients were no longer infectious). All scans were visually read using a 3-step rating scale (normal, mildly and severely abnormal). Principal components analysis (PCA;avoiding the need of a currently unknown reference region) was employed to explore whether a spatial covariance pattern exists in COVID-19 (compared to 45 control patients without somatic CNS disease). Exploratory, we assessed mean normalized F-18-FDG uptake (lean body weight- and plasma glucose-adjusted standardized uptake value, SUV) in 10 % voxels with highest covariance weights (positive and negative). Ergebnisse/Results Visual reads indicated pathological results in 10/15 patients (mainly frontotemporal hypometabolism). We detected a highly significant (p .39] in 10 % voxels with most negative and positive weights, respectively). Schlussfolgerungen/Conclusions Neocortical dysfunction accompanied by cognitive impairment was detected in two-thirds of inpatients with subacute COVID-19. A clear indication of regional hypermetabolism (suggesting inflammation) was not found. Follow-up studies are currently underway.

Cognitive impairment is a frequent complaint in coronavirus disease-19 (COVID-19) and can be related to cortical hypometabolism on 18F-FDG PET at the subacute stage. However, it is unclear if these changes are reversible. Methods: We prospectively assessed Montreal Cognitive Assessment (MoCA) and 18F-FDG PET scans in 8 COVID-19 patients at the subacute (as no longer infectious) and chronic stages (approximately six months after symptom onset). The expression of the previously established COVID-19-related covariance pattern was analyzed at both stages to examine the time course of post-COVID-19 cognitive impairment. For further validation, we also conducted a conventional group analysis. Results: Follow-up 18F-FDG PET revealed a significant reduction of initial frontoparietal and, to a lesser extent, temporal glucose hypometabolism that was accompanied by a significant improvement in cognition. The expression of the previously established COVID-19-related pattern was significantly lower at follow-up and correlated inversely with MoCA performance. However, both 18F-FDG PET and cognitive assessment suggest a residual impairment. Conclusions: Although a significant recovery of regional neuronal function and cognition can be clearly stated, residuals are still measurable in some patients six months after the manifestation of COVID-19. Given the current pandemic situation and tremendous uncertainty concerning the long-term effects of COVID-19, the present study provides novel insights of highest medical and socioeconomic relevance.