Brandenburg Klinik

Bernau bei Berlin, Germany

Brandenburg Klinik

Bernau bei Berlin, Germany
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Dementia is a collective term for a lot of different reversible and irreversible diseases with various cognitive disturbances. Language functions are affected especially in degenerative cortical dementias such as Primary Progressive Aphasia (PPA), Semantic Dementia (SD) and Logopenic Progressive Aphasia (LPA). In other forms as in degenerative subcortical or vascular dementias executive, attentional and mnemonic dysfunctions lower the efficiency of language processing. The following paper presents a general view of classification and symptoms of different forms of dementia and related language disorders. It will give helpful information for establishing a differential diagnosis among language dementias and in comparison with aphasias. In addition the article gives relevant links about treatment: patients with non-degenerative dementias can benefit from symptom-oriented training, whereas in patients with degenerative dementias an inverse symptom-oriented training is indicated. © Georg Thieme Verlag KG Stuttgart - New York.


PubMed | Helios Inc., Neurologisches Rehabilitationszentrum, Institute For Neurorehabilitative Forschung Information Der Bdh Klinik Hessisch Oldendorf Ggmbh, Asklepios Kliniken Schildautal and 13 more.
Type: Journal Article | Journal: Der Nervenarzt | Year: 2016

In Germany, neurological-neurosurgical early rehabilitation is well established in the treatment of severe neurological diseases. To develop quality standards, knowledge of the current rehabilitation course is required.Aretrospective analysis was performed on the course of rehabilitation from patients in anearly neurological/neurosurgical rehabilitation program in 16centers from 10German states. The odds for agood or poor outcome were investigated using amultivariate logistic regression model.Seven hundred and fifty-four patients were included in the study. The average age of the patients was 68 15years. Of the patients studied, 26% were on mechanical ventilation commencing their neurological rehabilitation. The average duration of stay was 56 51days. Weaning rate from mechanical ventilation was 65% and the rate of weaning from tracheal cannula was 54%. Mean improvement in the Barthel Index of 17 points, significant reduction of dysphagia (from 62 to 30%) and depended walking (from 99 to 82%), and the achievement of phaseC (the next stage of rehabilitation) in 38% can still be counted as signs of successful rehabilitation. During their course of stay, near 10% of the patients died. Of these, 67% received solely palliative care. In the multivariate logistic models, the absence of the factor necessity for mechanical ventilation on admission (odds ratio 0.61; 95% confidence interval (CI): 0.420.89) increased the chance for good outcome and the presence of this factor the risk of dying with an odds ratio of 8.07 (95% CI: 4.54-14.34).In spite of the severity of neurological deficits, significant functional progress has been made. These results could be interpret as positive proof of the efficacy of neurological/neurosurgical early rehabilitation programs.


A sepsis has wide-ranging neurological consequences. It can affect peripheral nerves (critical illness polyneuropathy), peripheral muscles (critical illness myopathy) or the brain (septic encephalopathy). Critical illness polyneuropathy and -myopathy have a negative impact on the rate of weaning from mechanical ventilation and from the tracheostomy tube as well as on oral feeding. Septic encephalopathy causes cognitive dysphasia. Especially disturbed executive, attentional and mnestic functions decrease the efficacy of language processing. Yet there are no specific curative treatment options (except treatment of the systemic inflammation itself). So the therapeutic approach is not distinct from that for seriously ill neurological patients. However numerous comorbidities and acute medical complications have to be taken adequately into account. © Georg Thieme Verlag KGStuttgart New York.


Nasogastric tubes are often used in acute stroke patients for enteral nutrition, but they can lead to various complications, including delayed deglutition processes, a pathogenic oral and gastric flora, gastro-esophageal reflux disease, a deprivation of cough and swallowing reflex, chronic sinusitis or ulcerations of the post cricoid region. Tubes anaesthetize the apposed mucosa and therefore influence directly cortical swallowing areas which are responsible for volitional aspects of deglutition. If a nasogastric tube is well-placed it seems to be a satisfactory option for intermittent enteral feeding in the first 14 days after acute stroke to prevent malnutrition. If enteral nutrition is expected to take longer than 28 days an (always individual) decision concerning a PEG has to be reached. © Hippocampus Verlag 2015.


Ungerer O.,Brandenburg Klinik | Deter H.-C.,Charité - Medical University of Berlin | Fikentscher E.,Martin Luther University of Halle Wittenberg | Konzag T.A.,Brandenburg Klinik
PPmP Psychotherapie Psychosomatik Medizinische Psychologie | Year: 2010

The study examines the effectiveness of applying the Life-Stressor Checklist (LSC-R) in diagnosing trauma-related disease. The validity of a quantitative analysis of the checklist is evaluated in consideration of the dose-response effect between the number of different traumatic stressor expositions and the degree of trauma-related symptoms. The trauma checklist LSC-R was applied to 130 patients. Data on psychological symptoms was collected with the help of IES-R (PTSD symptoms) and SCL90-R, the relevance of traumatic experiences for the genesis of disorders was assessed by expert evaluation. The dose effect replicated clearly with r=0.714 and a cut-off of ≥ 6 yielded a 75% agreement with the expert evaluation. The total value of the trauma checklist showed a differentiation within high-risk groups and also agreement with the severity of the traumatization. The quantitative analysis of the trauma checklist permits an effective screening for identifying trauma-related disease. © Georg Thieme Verlag KG Stuttgart • New York.


Delirium Syndromes are no specific cerebral diseases, but reflect an "acute brain failure" including deficits at the highest level of Cognition. Causes are multifactorially and comprise physical as well as non-physical factors. Core symptoms of delirium are above all attentional deficits which lead to various impairments in language and speech motor functions. In the hypoactive subtype patients display logopenia, hypophonia and a diminished acuity of articulation as a result of reduced attentional intensity. In the hyperactive subtype of delirium patients show incoherence, hyperphonia and raised speech rate due to disturbed attentional selection. A Screening of language functions (particularly of spontaneous speech and writing, naming and language comprehension) as well as a Screening of speech motor functions (changes in oral fluency, phonation, prosody and articulation accuracy) could reinforce the delirium diagnosis.


Micrographia is an acquired disturbance of writing, which is characterized by consistent or progressive diminution of letter size. Micrographia is mainly caused by left parietal lesions and degenerative changes or focal lesions of the basal ganglia and striato-frontal circuits. Therefore, micrographia is a common symptom in Parkinson's disease or in ACM infarction. Writing samples show that micrographia in patients with right ACM infarction is embedded in numerous cognitive and perceptual deficits. Due to severe spatial impairments handwriting is neographic in spite of normal language structures. In the diagnosis of micrographia premorbid samples of writing are essential, however a patient's copy of letters and figures is more significant than free writing. Effective treatments are interventions which focus the patient's attention on the writing process or give compensatory assistance. Severe impairments in selective attention decrease therapeutic effectiveness. © Schattauer 2010.


Progressive supranuclear palsy (PSP) is a neurodegenerative disease of the basal ganglia, which was first described precisely by Steele, Richardson and Olszewski in 1964. Main features of PSP are psychomotorical deceleration and disturbed executive functions, which lead to fronto-subcortical dementia within a few years. Relevant symptoms of PSP for speech therapy are cognitive dysphasias of dysexecutive origin, mixed hypokinetic-spastic dysarthrias, neurogenic dysphagias with difficulties in oral and pharyngeal stage and impaired deglutition based on executive dysfunctions. Due to the progression of cognitive dysphasia, dysarthrophonia and dysphagia, patients with PSP should receive obligatory speech therapy besides physical and occupational therapy. In the early stage of the disease an assessment of executive function disorder is important (e. g. by use of the brief Frontal Assessment Battery) as well as a symptomatic treatment of these deficits. In the middle stage of the disease an inverse-symptomatic treatment of executive, speech motor and phagic functions is essential to stabilise still available skills as long as possible.


Cognitive dysphasias are brain damage-related, non-aphasic language disorders caused by attentional, mnemonic and executive disturbances. Such language processing disorders are until now relatively unspecifically termed as "non-aphasic" and include a large number of heterogeneous symptoms such as tangentiality, incoherence, pragmatic disturbances, hyperverbalizations, confabulations or a reduced speech drive. A few of these non-aphasic language disorders are well described - for example language impairments after right hemisphere damage, after traumatic brain injury or within exogenic psychosis. However, until this day there is no superordinated classification and therefore no superordinated therapeutic approach for such language disorders. The term "Cognitive dysphasias" is supposed to replace the common denotation "non-aphasic central language disorders" and should integrate central language disturbances (such as those within dementias or hypoxias), which have been neglected so far in a broad classification system. This system could be the basis of a cognitive-oriented language therapy, which includes options of treatment for those cognitive impairments that most affect the patients' communication ability in everyday life. © Hippocampus Verlag 2010.


Volz M.,Humboldt University of Berlin | Mobus J.,Brandenburg Klinik | Letsch C.,Segeberger Kliniken | Werheid K.,Humboldt University of Berlin
Journal of Affective Disorders | Year: 2016

Background Post-stroke depression (PSD) is the most frequent mental disorder after stroke, affecting about 30% of stroke survivors. Despite extensive research, little is known about the influence of general self-efficacy (GSE) on PSD. We investigated the effect of GSE on depression six months post-stroke while controlling for established risk factors. Methods Eighty-eight patients from two rehabilitation centers with first-ever ischemic stroke were assessed around 8 weeks and 6 months after stroke. Baseline assessment included demographic variables, GSE scale, physical disability (Barthel-Index), stroke severity (modified NIH Scale), pre-stroke mental illness, cognitive status (Mini-Mental-State-Test), social support (F-SozU Questionnaire) and depressiveness (Geriatric Depression Scale, GDS). Follow-up assessment included DSM-IV depression, GDS and GSE. The influence of each risk factor on PSD was analyzed by binary hierarchical regression. Results Baseline depressiveness (OR=1.41, p<.01) and social support (OR=.95, p=.03) predicted PSD. Decreasing GSE was associated with high baseline GSE (r=.51, p<.01) and influenced later PSD (OR=1.39, p<.01). Limitations Patients’ range of impairment may have been limited as sufficient speech comprehension and capacity for interview participation were required. Causal relationship between decreasing GSE and increasing GDS cannot be assumed based on correlations. Discussion Decreasing GSE was linked to PSD, especially in patients with high baseline GSE. This effect may be due to dissatisfaction with recovery following high expectations. Early depressive symptoms and low social support predicted PSD. Early screening for depressive symptoms and focusing on self-efficacy might help to prevent later depression. © 2016 Elsevier B.V.

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