Papers by Cornelius Werner
Journal of Neurology, Neurosurgery & Psychiatry, 2010
Background: Huntington's disease (HD) is a rare triplet repeat (CAG) disorder. Advanced, multi-ce... more Background: Huntington's disease (HD) is a rare triplet repeat (CAG) disorder. Advanced, multi-centre, multinational research frameworks are needed to study simultaneously multiple complementary aspects of HD. This includes the natural history of HD, its management and the collection of clinical information and biosamples for research. Methods: We report on cross-sectional data of the first 1766 participants in REGISTRY, the European Huntington's Disease Network's (EHDN), multilingual , multinational prospective observational study of HD in Europe. Data collection (demographics, phenotype, genotype, medication, co-morbidities, biosamples) followed a standard protocol. Results: Phenotype, and the HD genotype, of manifest HD participants across different European regions was similar. Motor onset was most common (48%) with a non-motor onset in more than a third of participants. Motor signs increased, and cognitive abilities and functional capacity declined as the disease burden (CAGn-35.5) X age) increased. A lifetime history of behavioural symptoms was common, but the behavioural score was not related to disease burden. One fifth of participants had severe psychiatric problems, e.g. suicidal ideation and attempts, and/or irritability/aggression, with psychosis being less common. Participants on anti-dyskinetic medication had a higher motor and lower cognitive score, were older, and more prone to physical trauma. A higher motor and a lower cognitive score predicted more advanced disease. Conclusions: The unparalleled collection of clinical data and biomaterials within the EHDN's REGISTRY can expedite the search for disease modifiers (genetic and environmental) of age at onset and disease progression that could be harnessed for the development of novel treatments.
Journal of cachexia, sarcopenia and muscle, Jun 18, 2024
Journal of neurology, May 20, 2024
Background Aphasia is a devastating consequence after stroke, affecting millions of patients each... more Background Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large singlecenter cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting. Methods Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated. Results A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time postonset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response. Discussion Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.
Alzheimer's & Dementia, Nov 30, 2023
Pflege Zeitschrift, May 22, 2017
Beim Schlucken handelt es sich um einen komplexen, semireflektorischen Vorgang, an dem etwa 50 Mu... more Beim Schlucken handelt es sich um einen komplexen, semireflektorischen Vorgang, an dem etwa 50 Muskelpaare und sechs Hirnnerven beteiligt sind. Das Ziel eines jeden Schluckvorgangs ist es, Nahrung, Flüssigkeit oder Speichel und Sekret sicher über den Rachenraum und die Speiseröhre in den Magen zu befördern. Gelingt dies nicht mehr, drohen schwerwiegende gesundheitliche Konsequenzen.
Objective: Microstructural mapping indicates multiple sub-areas within Broca's region which c... more Objective: Microstructural mapping indicates multiple sub-areas within Broca's region which constitutes a core node in the language network. Connectivity based parcellations of white matter fiber tractograms have been shown to correlate with cytoarchitectonic mapping. More recently, navigated[for full text, please go to the a.m. URL]
Aphasia is an acquired language disorder resulting from damage to language related networks of th... more Aphasia is an acquired language disorder resulting from damage to language related networks of the brain, most often as a result of ischemic stroke or traumatic brain injury. Within the European Union, over 580 000 people are affected each year. Both assessment and treatment of aphasia require the analysis of language, in particular of spontaneous speech. Factoring in therapy and diagnosis sessions, which require the presence of a speech therapist and a physician, aphasia is a resource intensive condition: It has been estimated that in Germany alone, there are 70 000 new cases of stroke-related aphasia every year, 35 000 of which persist over more than six months-all of which should receive formal diagnostic testing at some point. Having an automatic system for the detection and evaluation of aphasic speech would be of great benefit for the medical domain by immensely speeding up diagnostic processes and thus freeing up valuable resources for, e.g., therapy. As a first step towards building such a system, it is necessary to identify the vocal biomarkers which characterize aphasic speech. Furthermore, a database is needed which maps from recordings of aphasic speech to the type and severity of the disorder. In this paper, we present the vocal biomarkers and a description of the existing Aachen Aphasia database containing recordings and transcriptions of therapy sessions. We outline how the biomarkers and the database could be used to construct a recognition system which automatically maps pathological speech to aphasia type and severity.
PubMed, 2019
Speaker attribution and labeling of single channel, multi speaker audio files is an area of activ... more Speaker attribution and labeling of single channel, multi speaker audio files is an area of active research, since the underlying problems have not been solved satisfactorily yet. This especially holds true for non-standard voices and speech, such as children and impaired speakers. Being able to perform speaker labelling of pathological speech would potentially enable the development of computer assisted diagnosis and treatment systems and is thus a desirable research goal. In this manuscript we investigate on the applicability of embeddings of audio signals, in the form of time and frequency-band based segments, into arbitrary vector spaces on diarization of pathological speech. We focus on modifying an existing embedding estimator such that it can be used for diarization. This is mainly done via clustering the time and frequency band dependant vectors and subsequently performing a majority vote procedure on all frequency dependent vectors of the same time segment to assign a speaker label. The result is evaluated on recordings of interviews of aphasia patients and language therapists. We demonstrate general applicability, with error rates that are close to what has been previously achieved in diarizing children's speech. Additionally, we propose to enhance the processing pipelines with smoothing and a more sophisticated, energy based, voting scheme.
Sprache-stimme-gehor, Dec 1, 2018
Zusammenfassung Hintergrund In der autobiografischen Narration, dem Erzählen über sich selbst, ka... more Zusammenfassung Hintergrund In der autobiografischen Narration, dem Erzählen über sich selbst, kann Identitätsarbeit gelingen. Personen mit Aphasie (PMA) benötigen aufgrund der hohen linguistischen Komplexität Unterstützungsmaßnahmen innerhalb von narrativen Texten, die Narration im sozialen Austausch erleichtern bzw. ermöglichen. Methode In einem ersten Pilotprojekt im Rahmen einer Masterarbeit wurde eine narrativ ausgerichtete Intervention konzipiert und erprobt, in der PMA in Erzählsituationen über persönlich relevante Themen sog. Visual-Scene-Displays (VSD) mit kontextreichen Fotos am Smartphone einsetzen. Die Machbarkeit der Intervention wurde mit 2 PMA erprobt und der Mehrwert des Medieneinsatzes u. a. für den kommunikativen Austausch zwischen PMA und Gesprächspartnern anhand einer qualitativen und quantitativen Gesprächsanalyse untersucht. Ergebnisse Zwischen den Bedingungen mit vs. ohne VSD-Dateien-Nutzung zeigten sich vielfältige Unterschiede im Gesprächsverhalten, sowohl bei den PMA als auch ihren KommunikationspartnerInnen (KP). Beide Patienten initiierten bis zu 18 % mehr Äußerungen und mussten bis zu 18 % weniger auf Fragen antworten. Sie erlebten die Kommunikation subjektiv als positiver. Die KP stellten bis zu 40 % weniger Verständnisfragen. Sie kommentierten dafür bis zu 19 % mehr und gaben bis zu 18 % mehr positive Bestätigung. Das Verständnis i. S.v. „content units“ war erhöht. Auch die KP waren mit der Kommunikation subjektiv zufriedener. Diskussion Die Studie liefert damit einen neuen Ansatz zur logopädischen Versorgung bei Aphasie mit einer personenzentrierten und ressourcenorientierten Ausrichtung. Erste Ergebnisse bestätigen die Machbarkeit der Intervention sowie verschiedene positive Auswirkungen des hier beschriebenen Medieneinsatzes auf den kommunikativen Austausch über persönliche Themen. Eine Replikation mit größeren Stichproben ist notwendig.
Lancet Neurology, Oct 1, 2018
European Journal of Neurology, Jun 24, 2021
This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmerc... more This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Age and Ageing, Jun 3, 2021
Introduction: Frailty is a disorder of multiple physiological systems impairing the capacity of t... more Introduction: Frailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST). Methods: We performed a retrospective study of patients with AIS of the anterior circulation submitted to EST between 2012 and 2017, based on a prospectively collected local registry of consecutive patients. The Hospital Frailty Risk Score (HFRS) at discharge was calculated for each patient. We compared groups of patients with and without favourable 3-month outcome after index AIS (modified Rankin Scale 0-2 and 3-6, respectively). A multivariable logistic regression model was used to identify variables independently associated with favourable 3-month outcome. Diagnostic test statistics were used to compare HFRS with other prognostic scores for AIS. Results: We included 489 patients with median age 75.6 years (interquartile range [IQR] = 65.3-82.3) and median NIHSS 15 (IQR = 11-19). About 29.7% presented a high frailty risk (HFRS >15 points). Patients with favourable 3-month outcome presented lower HFRS and lower prevalence of high frailty risk. High frailty risk was independently associated with decreased likelihood of favourable 3-month outcome (adjusted odds ratio = 0.48, 95% confidence interval = 0.26-0.89). Diagnostic performances of HFRS and other prognostic scores (THRIVE and PRE scores, SPAN-100 index) for outcome at 3-months were similar. Discussion: Frailty is an independent predictor of outcome in AIS patients submitted to EST.
Basal ganglia, May 1, 2017
Dysphagia, Sep 10, 2022
Oral stereognosis is the ability to recognize, discriminate and localize a bolus in the oral cavi... more Oral stereognosis is the ability to recognize, discriminate and localize a bolus in the oral cavity. Clinical observation indicates deficits in oral stereognosis in patients with vascular or neurodegenerative diseases particularly affecting the parietal lobes. However, the precise neural representation of oral stereognosis remains unclear whereas the neural network of manual stereognosis has already been identified. We hypothesize that oral and manual stereognosis share common neuronal substrates whilst also showing somatotopic distribution. Functional magnetic resonance images (fMRI; Siemens Prisma 3 T) from 20 healthy right-handed participants (11 female; mean age 25.7 years) using a cross-modal task of oral and manual spatial object manipulation were acquired. Data were analyzed using FSL software using a block design and standard analytical and statistical procedures. A conjunction analysis targeted the common neuronal substrate for stereognosis. Activations associated with manual and oral stereognosis were found in partially overlapping fronto-parietal networks in a somatotopic fashion, where oral stereognosis is located caudally from manual stereognosis. A significant overlap was seen in the left anterior intraparietal sulcus. Additionally, cerebellar activations were shown particularly for the oral condition. Spatial arrangement of shaped boli in the oral cavity is associated with neuronal activity in fronto-parietal networks and the cerebellum. These findings have significant implications for clinical diagnostics and management of patients with lesions or atrophy in parietal lobule (e.g. Alzheimer's disease, stroke). More studies are required to investigate the clinical effect of damage to these areas, such as loss of oral stereognosis or an impaired oral phase.
Mit der zunehmenden Digitalisierung des Gesundheitswesens und dem dadurch steigenden Einsatz von ... more Mit der zunehmenden Digitalisierung des Gesundheitswesens und dem dadurch steigenden Einsatz von Verfahren wie maschinellem Lernen und kunstlicher Intelligenz gehen komplexe Herausforderungen in samtlichen Bereichen des Informationsmanagements und damit verbundener Applikationen einher, die von der initialen Datenakquise bis zur interaktiven Visualisierung reichen: Wie lassen sich heterogene und verteilt vorliegende Datensatze automatisiert in einen konsolidierenden Datenbestand uberfuhren und fur Lernverfahren nutzbar zu machen? Wie mussen Entscheidungsunterstutzungssysteme gestaltet sein, um einen echten Mehrwert fur Nutzer in Diagnose und Therapie zu generieren? Welche Algorithmen ermoglichen eine hohe Transparenz fur medizinisches Fachpersonal, damit Pradiktionen nicht aus einer „Black Box“ kommen und die Nachvollziehbarkeit gewahrleistet ist? Der Informationsmanagementzyklus (IMZ) adressiert obige Herausforderungen bzw. Fragestellungen und stellt dabei stets den (medizinischen) Informationsnutzer (z. B. Patient, Arzt, Therapeut) und ein zu generierendes Informationsprodukt in das Zentrum der Betrachtung. Er ist in vier zyklisch miteinander verbundene und uberlappende Phasen unterteilt: Bedarfserhebung, Integration, Aufbereitung und Bereitstellung. In diesem Kapitel diskutieren wir sowohl das Informationsmanagement als auch den IMZ anhand eines praktischen Beispiels aus der medizinischen Diagnostik und stellen dabei sowohl Losungsansatze und Herausforderungen als auch Fallstricke in der tatsachlichen Implementierung vor.
Neurology, Jun 14, 2011
A rare cause of cardioembolic stroke in a 42-year-old patient A 42-year-old man presented with ac... more A rare cause of cardioembolic stroke in a 42-year-old patient A 42-year-old man presented with acute ataxia resulting from an embolic stroke without classic vascular risk factors but revealing a hitherto clinically asymptomatic aorto-ventricular tunnel, which is defined by a hereditary connection between the ascending aorta and one of the ventricles (figure). 1 We postulate that blood turbulences around the tortuous tunnel with a stenotic component and low flow areas caused cardiogenic cerebral emboli. Although no specific guidelines exist, we consider a surgical treatment approach as applied before by Nezafati and colleagues 2 as reasonable in the presence of ongoing, multifocal ischemic events.
Altered motor network activation and functional connectivity in adult Tourette's syndrome
Journal of Neurology
Introduction Mechanical thrombectomy (MT) is an established treatment approach in acute ischemic ... more Introduction Mechanical thrombectomy (MT) is an established treatment approach in acute ischemic stroke patients with large vessel occlusion (LVO). Recent studies suggest that the prevalence of dysphagia and pneumonia risk is increased in this patient population. The aim of this study was to systematically evaluate the prevalence, predictors, and influence of neurogenic dysphagia for 3-month outcome in a large population of patients receiving MT and to elucidate the relationship between dysphagia, stroke-associated pneumonia (SAP) and medium-term functional outcome. Materials and methods Data of a prospective collected registry of patients with LVO and MT between 2016 and 2019 were analyzed retrospectively. Binary logistic regression was carried out to determine predictors for dysphagia and 3-month outcome as measured by the modified Rankin Scale, respectively. A mediation analysis was performed to investigate the mediating influence of intercurrent SAP. Results A total of 567 patie...
PLOS ONE, Feb 5, 2014
Electroencephalography (EEG) frequencies have been linked to specific functions as an ''electroph... more Electroencephalography (EEG) frequencies have been linked to specific functions as an ''electrophysiological signature'' of a function. A combination of oscillatory rhythms has also been described for specific functions, with or without predominance of one specific frequency-band. In a simultaneous fMRI-EEG study at 3 T we studied the relationship between the default mode network (DMN) and the power of EEG frequency bands. As a methodological approach, we applied Multivariate Exploratory Linear Optimized Decomposition into Independent Components (MELODIC) and dual regression analysis for fMRI resting state data. EEG power for the alpha, beta, delta and theta-bands were extracted from the structures forming the DMN in a region-of-interest approach by applying Low Resolution Electromagnetic Tomography (LORETA). A strong link between the spontaneous BOLD response of the left parahippocampal gyrus and the delta-band extracted from the anterior cingulate cortex was found. A positive correlation between the beta-1 frequency power extracted from the posterior cingulate cortex (PCC) and the spontaneous BOLD response of the right supplementary motor cortex was also established. The beta-2 frequency power extracted from the PCC and the precuneus showed a positive correlation with the BOLD response of the right frontal cortex. Our results support the notion of beta-band activity governing the ''status quo'' in cognitive and motor setup. The highly significant correlation found between the delta power within the DMN and the parahippocampal gyrus is in line with the association of delta frequencies with memory processes. We assumed ''ongoing activity'' during ''resting state'' in bringing events from the past to the mind, in which the parahippocampal gyrus is a relevant structure. Our data demonstrate that spontaneous BOLD fluctuations within the DMN are associated with different EEG-bands and strengthen the conclusion that this network is characterized by a specific electrophysiological signature created by combination of different brain rhythms subserving different putative functions.
Journal of Neurology, Neurosurgery, and Psychiatry, Sep 1, 2016
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Papers by Cornelius Werner