- About this project
- Der Beitrag der Neuropsychologie zum Problem der Differentialdiagnose Depression versus Demenz
- Diagnostik und Kognitive Neuropsychologie
- Arbeitsgruppe Klinische Neuropsychologie
- Publications - Klinische Psychologie - LMU München
On the basis of this data set, conditional expected values were calculated for each of the nine SKT subtests using multiple regressions taking into account age, gender and level of intelligence. Based on the deviations from the predicted performance, in a second step, norm scores of 0, 1 or 2 were defined depending on the size of the deviation of the actual performance from the predicted performance higher scores indicating greater cognitive impairment. The SKT total summary score ranging between 0 and 18 is obtained by adding the deviation scores i.
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It must be noted that the SKT total summary score can be reliably interpreted in case of a homogeneous test profile, i. In case of profile heterogeneity, the summary scores should be interpreted with caution and the severity of impairment should also be assessed separately for the two domains.
Furthermore, relatives rated the patient using the Bayer-ADL scale to stage functional capacities [ 32 ] and the Neuropsychiatric Interview [ 33 ] to assess behavioral disturbances occurring in dementia. The diagnostic classification of a given patient was made taking into account information from different sources anamnesis, medical examination, neuropsychology, everyday functioning, and neuroimaging or laboratory results.
From these, the subscores for memory and attention as well as the SKT total summary score were calculated by adding the corresponding subtest scores SKT subscores and total summary score are also included in the program printout. Using one-way analyses of variance, differences in the nine subtests, the two subscores and the SKT total summary score were checked for statistical significance between the three study groups.
Pairwise group comparisons were based on the Tukey test. A Bonferroni correction for multiple comparisons was not carried out, as the focus of the analyses presented here was on the comparative examination of test profiles and less on the detection of robust group differences. Comparisons of SKT profiles across the nine subtests and the memory and attention subscores were performed using multivariate analyses of variance for repeated measurements.
To assess the effect of depression on SKT scores, Pearson correlation coefficients were computed between depression scores [ 30 , 31 ] and the SKT summary score, the SKT memory and attention subscores and the norm scores of the nine SKT subtests. While we used two different depression scores, we calculated the mean of the transformed z-scores [ 30 , 31 ].
Furthermore, a receiver operator characteristics ROC analysis was employed to compute areas under the curve AUC for each of the three diagnostic groups using the SKT norming sample comprising non-demented community dwelling subjects aged between 60 and 91 as a reference group. The patients were distributed among the three diagnostic groups as follows: patients were diagnosed with MCI, patients were diagnosed with dementia F Diagnoses were based on ICD [ 10 ].
Sociodemographic data and SKT results subtests, subscores and SKT total score of the three study groups were compiled together with the results of the group comparisons in Table 2. The SKT test profiles of the three study samples are depicted in Figure 2. Furthermore, Figure 2 indicates less overall cognitive impairment in MCI and depressed subjects when compared to dementia patients.
SKT total summary scores for the MCI and depressed groups displayed values between 8 and 9 points; they do not differ statistically between both groups see Table 2. However, striking differences can be detected in their subtest profiles. The two remaining contrasts, MCI vs. However, when comparing only MCI vs. The remaining comparisons MCI vs. Accordingly, introducing depression as a covariate into the analyses of variance did not fundamentally change the outcome. Regarding significance, seven out of eight comparisons remained significant, even though less pronounced.
In the MCI and dementia conditions, the deficit patterns displayed their peaks for the delayed memory recall of objects. Since amnestic MCI isolated or in combination with other cognitive domains is considered to be the most frequent MCI subtype [ 24 , 26 ] and impaired episodic memory is a prerequisite for a dementia diagnosis according to the ICD criteria, this result is not really surprising.
However, it can be taken as an indication of the construct validity of the SKT as a tool to support diagnosis in organic mental disorders.
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It may be expected that the assessment of patients with other forms of dementia, e. Moreover, the slowing of speed of information processing, especially in tasks with a strong executive component, which could be observed in the depressed sample of the study has been described as a characteristic neuropsychological feature of depression [ 7 , 14 , 15 ].
To address a common misunderstanding, it must be pointed out that the SKT is not a test exclusively for the area of dementia. Originally, it was developed for usage with patients older than 17 years of age suffering from acute or chronic mental disorders irrespective of their aetiology. Therefore, there is ample experience with the SKT in the cross-sectional and longitudinal assessment of cognitive impairment resulting, e.
Der Beitrag der Neuropsychologie zum Problem der Differentialdiagnose Depression versus Demenz
The misclassification of the SKT as a dementia test was surely supported by the fact that the SKT has been used as an outcome measure in more than 50 studies investigating the efficacy of various nootropic compounds, cognition enhancers or antidementia drugs, in the past years with a clear focus on the efficacy of Ginkgo biloba [ 35 ].
In line with this shift of test usage towards dementing disorders starting in the s, all three test revisions of the SKT focused on older patients suffering from cognitive impairment. The first modification in aimed at making test materials more appealing [ 36 ]. The second revision suggested a finer classification of age norms beyond the age of 65 and included an option for separate assessment of memory and speed functions allowing for differential diagnostic considerations [ 37 ].
Finally, the new norming of [ 25 ] served the purpose of improving the sensitivity of the test for early recognition of dementia in persons aged 60 years or older. First data show the high sensitivity and specificity of the SKT for dementia being 0. The results of the ROC analyses reported in the present study support these findings.
Of special interest in the present investigation is the finding that the analysis of the SKT subscores for memory and attention revealed statistically significant differences between MCI and depressed patients. Other working groups, e. In the same way, Zihl et al. Nevertheless, they identified a significant reduction in speed of information processing for their depressed patients when comparing the results to cognitively normal older controls. This may be taken as a further indication that processing speed is a core domain affected by depression, which is in full accordance with the present results.
Accordingly, our ROC analyses for depression vs. Furthermore, the fact that the differences in SKT subscores for memory and speed performance outlasted a correction for self-rated depression may cautiously be considered as a hint of reduced speed of information processing as a trait marker for depression. Gehe zu: Forschungsprofile ; Zeitschriftenartikel ; Buchkapitel. Berger, T.
Internet-Interventionen in der Psychotherapie. PSYCH up2date , 13 5 , Journal of Clinical Psychology. Krieger, T. A randomized controlled trial comparing guided internet-based multi-component treatment and guided sleep restriction treatment to care as usual in insomnia.
Diagnostik und Kognitive Neuropsychologie
Sleep Medicine. Urech, A. A patient post-hoc perspective on advantages and disadvantages of blended cognitive-behavior therapy for depression: A qualitative content analysis. Psychotherapy Research. Wendt, L. Journal of Abnormal Psychology.
Preprint DOI: Psychotherapy Research , 29 1 , 30— DOI An Internet-based compassion-focused intervention for increased self-criticism: A Randomized Controlled Trial. Behavior Therapy, 50 2 , — Psychotherapy Research , 29 , 6, — Weisel, K. Efficacy and cost-effectiveness of guided and unguided internet- and mobile-based indicated transdiagnostic prevention of depression and anxiety ICare prevent : A three-armed randomized controlled trial in four European countries.
Internet Interventions, 16 , 52— Psychotherapie im Dialog , 19, 18— Journal of Affective Disorders, , — Journal of Psychopathology and Behavioral Assessment, 40 4 , — E-Mental Health: Chancen und Herausforderungen.
Arbeitsgruppe Klinische Neuropsychologie
Psychotherapie-Berufsentwicklung, 7 1 , 27— Psychopharmakotherapie, 25 , 2—8. Machmutow, K. Identifying relapse prevention elements during psychological treatment of depression: Development of an observer-based rating instrument. Stolz, T.
Publications - Klinische Psychologie - LMU München
A mobile app for social anxiety disorder: A three-arm randomized controlled trial comparing mobile and PC-based guided self-help interventions. Journal of Consulting and Clinical Psychology, 86 6 , — Transdiagnostic tailored internet-and mobile-based guided treatment for major depressive disorder and comorbid anxiety: Study protocol of a randomized controlled trial.
Frontiers in Psychiatry, 9 , Altenstein, D. To ensure its effectiveness, it is continuously updated based on participant feedback and rigorous research studies are conducted to examine outcomes. An overview of the training and our latest research results can be found here. Current MCT developments can be found on this page under the section "News". All materials for Metacognitive Training for patients with schizophrenia MCT and for patients with borderline B-MCT are available free of charge to interested mental health professionals e.
The effectiveness of both interventions has been successfully tested in randomized controlled trials. We find it critical that we can continue to offer our intervention programs and materials free of charge. Your donation will help us to achieve these goals! Show all 5 photos.