Zusammenfassung: Die jüngsten Revisionen der Krankheitsklassifikationssysteme DSM-5 und ICD-11 stärken die Rolle der Neuropsychologie bei der Diagnose neurokognitiver Störungen. Zugleich ist eine gewisse Stagnation der neuropsychologischen Methodenentwicklung auf dem Gebiet der Demenzdiagnostik zu verzeichnen. Vor diesem Hintergrund wurde im Rahmen des computergestützten Wiener Testsystems (WTS) das portable Test-Set Cognitive Functions Dementia (CFD) entwickelt und anhand der hier berichteten multizentrischen Beobachtungsstudie im klinischen Einsatz evaluiert. Bei guter Akzeptanz zeigten sich keine besonderen Anwendungsprobleme. Die 14 Hauptvariablen und 6 Indizes des CFD unterscheiden Demenz-Erkrankte ( n = 131) deutlich von Gesunden ( n = 407) sowie Personen mit Depression (n = 145), leichter kognitiver Störung (n = 57) und Morbus Parkinson ( n = 52). Im Vergleich zum Mini-Mental Status Test (MMST) ist das CFD sensitiver für diskrete Beeinträchtigungen neurokognitiver Funktionen. Die Ergebnisse belegen die Eignung des Test-Sets für die Demenz-Früherkennung und Differenzialdiagnostik Demenz vs. Depression.
Mit Einführung der 11. Revision der Internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme der World Health Organization (ICD-11) wurden strukturelle und inhaltliche Anpassungen der diagnostischen Richtlinien für Angststörungen vorgenommen, die in diesem Übersichtsartikel dargestellt werden. Die bisher in der Gruppe „Neurotische, Belastungs- und somatoforme Störungen“ verorteten „Phobischen Störungen“ bzw. „Anderen Angststörungen“ werden in der ICD-11 als „Angst- oder furchtbezogene Störungen“ in einer eigenen Gruppe zusammengefasst. Dabei wird an den zentralen Diagnosen Agoraphobie, soziale Angststörung, spezifische Phobie, Panikstörung und generalisierte Angststörung festgehalten, wobei Agoraphobie und Panikstörung nun getrennt voneinander und komorbid vergeben werden können. Im Rahmen der Lebensspannenperspektive wurden zudem die Störung mit Trennungsangst und der selektive Mutismus in die Gruppe der „Angst- oder furchtbezogenen Störungen“ aufgenommen. Die Diagnose „Angst und depressive Störung, gemischt“ wird nun als „Gemischte depressive Störung und Angststörung“ der Gruppe der „Affektiven Störungen“ zugeordnet. Analog der 5. Ausgabe des Diagnostic and Statistical Manual of Mental Disorders (DSM‑5) besteht die Möglichkeit, isolierte Panikattacken zusätzlich zu anderen psychischen oder somatischen Erkrankungen zu kodieren. Insgesamt folgt damit die ICD-11 im Bereich der Angst- oder furchtbezogenen Störungen in vielen Punkten der Klassifikation des DSM‑5. Darüber hinaus stellt der Verzicht auf Subkategorisierungen und eine exakte Mindestanzahl von Symptomen eine Vereinfachung der Diagnostik dar. Zukünftige Studien werden sich Fragen zur diagnostischen Genauigkeit, klinischen Praktikabilität und weiteren Operationalisierung der ICD-11 Diagnosekriterien für Angst- oder furchtbezogene Störungen widmen müssen.
Frontotemporal dementia (FTD) with right anterior temporal lobe (RATL) predominant atrophy is an emerging area of interest. Recent findings by the International Working Group (IWG) have identified this subtype as having a distinct clinical profile within the FTD spectrum (Ulugut et al., 2024, A&D). However, its genetic and pathological underpinnings remain unexplored in large, multicultural cohorts. Retrospective analyses encompassing clinical, genetic, pathological, and neuroimaging data from 23 IWG sites across 13 countries in Asia, Middle East, Europe, North and South America were conducted. The study included 444 patients with FTD exhibiting predominant RATL atrophy. Genetic screening was performed on 51% ( n = 225) of the cohort for at least the major frontotemporal lobar degeneration (FTLD) mutations including microtubule-associated protein tau ( MAPT ), progranulin ( GRN ), and chromosome 9 open reading frame 72 ( C9orf72 ), or dementia panels encompassing extended sets of genes. Of these, 81% were sporadic, showing negative results for the screened genes and a modified Goldman Score of ≥ 3, indicating a negative family history for dementia. The MAPT mutation was the most common genetic variant, identified in 7% of the screened cases (Figure 1). Pathological confirmation was available for 63 patients. Among the sporadic cases, transactive response DNA-binding protein 43 type C (TDP-C) pathology was most prevalent (60%, n = 32), while tau-MAPT pathology was most common in the genetic cases (38%, n = 16). Fifteen cases did not fit neatly into genetic or sporadic categories, displaying heterogeneous pathologies (Figure 2). At the initial visit, compared to genetic cases, patients with TDP-C pathology were older, and more frequently exhibited semantic deficits, with less frequent attention difficulties and executive dysfunction. No differences were observed in sex distribution, symptom duration or disease severity between genetic and sporadic TDP-C cases. However, left handedness was more common in TDP-C cases (14%) compared to genetic cases (5%). While FTD with RATL atrophy primarily appears sporadic, a significant proportion of cases exhibit genetic variants. These sporadic and genetic subtypes display distinct neuropathological features and clinical manifestations. Given the implications for therapeutic strategies, precise clinical and molecular subtyping is critical for enhancing patient management and ensuring appropriate enrollment in clinical trials.
Sex-linked differences in sporadic behavioral variant frontotemporal dementia (s-bvFTD) are increasingly recognized. Research suggests that females with bvFTD exhibit greater atrophy in affected brain regions than males, despite similar clinical severity. Given that brain atrophy correlates with elevated markers of neurodegeneration, such as neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), we hypothesized that these biomarkers differ between sexes. Serum NfL and GFAP levels were measured using Simoa in 357 participants (275 with s-bvFTD, 82 with primary psychiatric disorders (PPD)). Biomarker levels were compared between sexes, followed by linear regression analyses stratified by diagnostic group. In a subset of s-bvFTD participants (47 females, 105 males) with available Z-scored cognitive composite scores (including global cognition, executive function, attention and working memory), we performed linear regression using a residuals approach (with age at blood sample (AAS), education, and Z-scored NfL or GFAP as predictor) to assess cognitive reserve. Females with s-bvFTD had significantly higher NfL and GFAP levels than males (both p <0.05), whereas no sex differences were observed in the PPD group. Within s-bvFTD, higher AAS (β=0.015, 95% CI [0.006-0.023]) and female sex (β=0.223, 95% CI [0.071-0.375]) were associated with higher logNfL. In PPD, higher AAS (β=0.030, 95% CI [0.019-0.042]) correlated with higher logNfL, but no sex effect was observed (β=-0.092, 95% CI [-0.265-0.082]). For GFAP, higher AAS (β=0.030, 95% CI [0.023-0.037]) and female sex (β=0.305, 95% CI [0.183-0.427]) were associated with higher logGFAP in s-bvFTD. In PPD, only AAS (β=0.026, 95% CI [0.012-0.040]) was significant, without a sex effect (β=0.033, 95% CI [-0.177-0.243]). Composite scores were lower in females (female=-0.24 vs. male=0.003), though not significantly ( p >0.05). Residuals of linear regression did not differ by sex for both GFAP and NfL ( p >0.05). However, NfL (but not GFAP) predicted a steeper cognitive decline in males (β=-0.15, p <0.05) than in females (β=-0.12, p >0.05). Females with s-bvFTD exhibited significantly higher NfL and GFAP levels. This sex difference is not explained by differences in cognitive reserve. Given that NfL plateaus as disease progresses, these findings suggest that females with s-bvFTD may present at a more advanced disease stage upon clinical presentation.
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.
