Hendrik Niemann

Skala zur Erfassung von Aufmerksamkeitsdefiziten (SEA)

The objective of this study was to assess the psychometric properties of the Attention Deficits Questionnaire (ADQ), a new Rating scale for the assessment of attention deficits. Two-hundred and two patients with neurological disorders (e.g., traumatic brain injury, stroke) filled out the self rating version of ADQ (ADQ-S). The proxy rating version of the ADQ (ADQ-P) was provided from psychologists, occupational therapists or psychological technical assistants. Rasch analysis was applied and indicated that the ADQ measures a single dimension and demonstrated good person separation (ADQ-S: 2.86/ADQ-P: 3.40) and reliability (ADQ-S: .89/ADQ-P: .92) as well as a very good item separation (ADQ-S: 4.10/ADQ-P: 5.37) and reliability (ADQ-S: .94/ADQ-P: .97). However, as a whole the items of the ADQ were relatively easy for the included patients. In order to enhance the difficulty of the scale, so that it becomes more appropriate to assess a broader range of attention problems, new items have to be added. Intraclass correlation coefficient between self- and proxy- reports was low (ICC = .34). In summary, initial psychometric properties suggested that the ADQ is a promising rating scale for the assessment of attention deficits.

Convergent and predictive validity of two computerized attention tests in brain-damaged patients

Although computerized attention tests are used frequently, our knowledge about the convergent and predictive validity of these tests is limited. In the present study, 47 stroke and traumatic brain injury patients performed the Attention Network Test (ANT) and corresponding subtests of the Test for Attentional Performance (TAP). In addition, patients and staff completed the Attention Deficits Questionnaire (ADQ). Considering corresponding ANT and TAP subtests, significant correlations (r = .55 – .71) were found for alerting and orienting subtests and overall reaction time. Comparison of subtests of the two attention tests with staff reported deficits in the ADQ revealed moderate to high correlations for ANT (r = .62 – .70) and TAP (r = .36 – .86). The predictive validity of different subtests varies only sightly. The overall reaction time seems to be the best predictor of rated attention deficits. Findings support the convergent and predictive validity of both computerized attention tests.

Neurokognitive Funktionen und Fahreignung

The question of driving ability arises frequently in the treatment of brain-damaged patients. In the majority of patients, neuropsychological tests of psychophysical functions that are relevant for driving are necessary, in addition to the examination of medical risk-factors. In all cases of questionable driving ability, these examinations should be complemented by a comprehensive on-road driving test. The procedure recommended for the assessment and judgement of driving ability is detailed and illustrated by means of a flowchart. Furthermore, the results of an empirical study of driving ability in 196 brain-damaged patients are presented. All patients underwent a 90 min on-road driving test in public traffic, in addition to the medical and neuropsychological examination. Attempts to predict the outcome (pass/fail) of the driving test by discriminant analysis based on neuropsychological test results and clinical parameters were disappointing. Although 85% of the patients classified as “pass” actually passed the driving test (high positive predictive value), only 40% of those patients classified as “fail” actually failed the driving test (low negative predictive value). It is argued that the unsatisfying predictive value of the neuropsychological testing can be explained by the fact that the actual driving behavior is a rather complex skill that is essentially determined by strategic and tactic abilities and decisions and only in part by those operational skills reflected in the psychometric tests usually employed in traffic psychology. The results of a preliminary follow-up study with 21 patients support the notion that braindamaged subjects do not present a higher risk in driving.ZusammenfassungBei Patienten mit zerebralen Erkrankungen muss häufig die Frage der weiteren Fahreignung geklärt werden. Neben der Prüfung medizinischer Risikofaktoren ist meist auch eine neuropsychologische Untersuchung verkehrsrelevanter psychophysischer Leistungen vorzunehmen, die in Zweifelsfällen durch eine Fahrverhaltensprobe ergänzt werden muss. Der Prozess der Fahreignungsbeurteilung wird anhand eines Flussdiagramms dargestellt. Die theoretischen Erwägungen werden durch die Ergebnisse einer Fahreignungsprüfung bei 196 neurologischen Patienten ergänzt. Der Versuch, die Patienten mit bestandener und nichtbestandener Fahrprobe auf der Grundlage neuropsychologischer Testleistungen und klinischer Parameter zu unterscheiden, brachte kein befriedigendes Ergebnis. Gute Testleistungen machen zwar ein Bestehen der Fahrprobe sehr wahrscheinlich, jedoch bestehen auch mehr als die Hälfte der Patienten mit mangelhaften Testleistungen die Fahrprobe. Die geringe Übereinstimmung zwischen der praktischen Fahrfähigkeit und den Testleistungen wird anhand eines komplexen Modells des Fahrverhaltens erklärt. Die Resultate einer ersten Follow-up-Untersuchung bei 21 Patienten sprechen dafür, dass die Teilnahme hirngeschädigter Patienten am Straßenverkehr nicht mit einem erhöhten Risiko verbunden ist.

Störungen der Aufmerksamkeit

Dieses Kapitel beschaftigt sich mit Aufmerksamkeitsstorungen, die eine der haufigsten kognitiven Storungen nach einer Schadigung oder Erkrankung des Gehirns sind. Nach einer kurzen Ubersicht uber wichtige Aufmerksamkeitstheorien und aktuelle Erkenntnisse uber die neuronale Einbindung von Aufmerksamkeitsprozessen werden die zentralen Symptome einer Aufmerksamkeitsstorung beschrieben. Im Anschluss daran werden die Grundzuge der neuropsychologischen Diagnostik von Aufmerksamkeitsleistungen und therapeutische Ansatze zur Behandlung von Aufmerksamkeitsstorungen vorgestellt. Nicht berucksichtigt werden in diesem Kapitel der Neglect und Storungen der Aufmerksamkeit bei Kindern.