Altersabhängigkeit Der Impliziten, Sequentiellen Lern- Und Gedächtnisleistung Bei Gesunden Probanden

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Altersabhängigkeit Der Impliziten, Sequentiellen Lern- Und Gedächtnisleistung Bei Gesunden Probanden Aus der Klinik für Neurologie Direktor: Professor Dr. med. L. Timmermann Fachbereich Medizin der Philipps-Universität Marburg in Zusammenarbeit mit dem Universitätsklinikum Gießen und Marburg GmbH Standort Marburg Altersabhängigkeit der impliziten, sequentiellen Lern- und Gedächtnisleistung bei gesunden Probanden Implementierung eines standardisierten Normkollektivs für den seriellen Reaktionszeittest Inaugural-Dissertation Zur Erlangung des Doktorgrades der gesamten Humanmedizin dem Fachbereich Medizin der Philipps-Universität Marburg vorgelegt von Moritz Philipp Böhringer aus Saarbrücken Marburg, 2020 Angenommen vom Fachbereich Medizin der Philipps-Universität Marburg am 27.11.2020 Gedruckt mit Genehmigung des Fachbereichs. Dekan: i.V. der Prodekan Prof. Dr. R. Müller Referent: Prof. Dr. F. Rosenow Korreferent: PD Dr. D. Leube Altersabhängigkeit der impliziten, sequentiellen Lern- und Gedächtnisleistung bei gesunden Probanden Abkürzungsverzeichnis ................................................................................................. 6 1. Einleitung .................................................................................................................. 8 1.1. Lernen und Gedächtnis ...................................................................................... 8 1.2. Einteilung des Gedächtnisses ............................................................................ 8 1.2.1. Explizites und implizites Gedächtnis .............................................................. 11 1.2.2. Erfassen des impliziten Gedächtnisses ......................................................... 13 1.2.3. Neuroanatomische Zuordnung des sequentiellen Lernens ............................ 15 1.2.4 Rolle des Striatums ........................................................................................ 17 1.2.5. Rolle des Hippocampus ................................................................................. 18 1.2.5.1. Dissoziation ................................................................................................ 19 1.2.5.2. Interaktion................................................................................................... 19 1.2.5.3. Konkurrenz ................................................................................................. 20 1.2.5.4. Hippokampektomie ..................................................................................... 20 1.2.5. Aktuelle Studienlage ...................................................................................... 21 1.3. Stichproben und Normkollektiv ......................................................................... 22 1.3.1. Problematik geeigneter Vergleichsgruppen ................................................... 22 1.3.2. Parallelisierte Stichproben ............................................................................. 22 1.3.3. Unabhängige Gruppe .................................................................................... 23 1.3.4. Normstichproben ........................................................................................... 24 1.4. Fragestellung und Hypothesen ......................................................................... 24 2. Methoden ................................................................................................................ 25 2.1. Probanden ........................................................................................................ 26 2.2. Ausschlusskriterien .......................................................................................... 27 2.3. Aufklärung und Anonymisierung ....................................................................... 28 2.4. Ablauf der Studie .............................................................................................. 29 2.5. Standardisierte SRTT-Version dieser Studie .................................................... 29 2.5.1. Technische Details und Durchführung des SRTT .......................................... 30 2.5.1.2. Auswertung des SRTT................................................................................ 32 2.5.1.3. Bestimmung der impliziten Lernleistung ..................................................... 32 2.5.2. Generation Task (GT) .................................................................................... 34 2.6 Verbaler Lern und Merkfähigkeitstest (VLMT) ................................................... 34 2.7 Edinburgh Handedness Inventory (EHI) ............................................................ 35 2.8 Strukturiertes Interview ...................................................................................... 36 2.9 Archivierung ...................................................................................................... 37 3. Statistik ................................................................................................................... 37 4. Ergebnis ................................................................................................................. 39 3 Altersabhängigkeit der impliziten, sequentiellen Lern- und Gedächtnisleistung bei gesunden Probanden 4.1 Probandencharakteristik .................................................................................... 39 4.1.1 Altersverteilung ............................................................................................... 39 4.1.2. Geschlechterverteilung .................................................................................. 39 4.1.3. Bildungsniveau .............................................................................................. 39 4.1.4. Händigkeit ..................................................................................................... 40 4.1.5. Neuropsychiatrische Familienanamnese ....................................................... 40 4.2. Messung des expliziten verbalen Lernens ........................................................ 41 4.3.1. Implizites Lernen beim SRTT ........................................................................ 44 4.3.1.1. Reaktionszeit der Gesamtgruppe ............................................................... 44 4.3.1.1. Fehlerrate der Gesamtgruppe..................................................................... 46 4.3.1.2. Verlauf der Reaktionszeit pro Altersgruppe................................................. 46 4.3.1.2.1. Erste Altersgruppe (18-30 Jahre) ............................................................. 46 4.3.1.2.2. Zweite Altersgruppe (31-40 Jahre)........................................................... 47 4.3.1.2.3. Dritte Altersgruppe (41-50 Jahre) ............................................................ 49 4.3.1.2.4. Vierte Altersgruppe (51-60 Jahre) ............................................................ 49 4.3.1.2.5. Fünfte Altersgruppe (61-75 Jahre) ........................................................... 51 4.3.2.1. Vergleich der RZ pro Block und Altersgruppe ............................................. 51 4.3.2.2. Altersabhängigkeit ...................................................................................... 52 4.3.2.3. Post-hoc-Analyse in Bezug auf den Faktor Altersgruppe ............................ 53 4.3.3. Analyse der Fehlerraten ................................................................................ 54 4.3.3.1. Verlauf der Fehlerrate pro Altersgruppe ...................................................... 54 4.3.3.1.1. Erste Altersgruppe (18-30 Jahre) ............................................................. 54 4.3.3.1.2. Zweite Altersgruppe (31-40 Jahre)........................................................... 55 4.3.1.2.3. Dritte Altersgruppe (41-50 Jahre) ............................................................ 55 4.3.1.2.4. Vierte Altersgruppe 51-60 Jahre) ............................................................. 56 4.3.1.2.5. Fünfte Altersgruppe (61-75 Jahre) ........................................................... 56 4.3.1.3. Vergleich anhand der Fehlerrate ................................................................ 57 4.4 Bestimmung des impliziten Lernens .................................................................. 58 4.4.1. Reaktionszeitanalyse relevanter Blöcke 5,6,7 ................................................ 58 4.4.2.1 Implizites Lernen anhand der Reaktionszeit ................................................ 60 4.4.2.2 Implizites Lernen anhand der Fehlerrate ..................................................... 61 4.5. Einflussfaktoren auf das implizite Lernen .......................................................... 63 4.5.1 Händigkeit ...................................................................................................... 63 4.5.2 Computeraktivität ........................................................................................... 63 4.5.3. Instrumentale Fähigkeit ................................................................................. 63 4.5.4. Medikamenteneinnahme ............................................................................... 63 4 Altersabhängigkeit der impliziten, sequentiellen Lern- und Gedächtnisleistung bei gesunden Probanden 4.6. Korrelation explizites Lernen (VLMT) und implizites Lernen (SRTT) ................. 64 4.7. Generation task (GT) ........................................................................................ 66 4.8. Subjektive Einschätzung der Lernleistung ........................................................ 67 4.9 Verwendung des Normkollektivs
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