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PubMed2000

Differentiation of dementia of the Alzheimer's type from depression with cognitive impairment on the basis of a cortical versus subcortical pattern of cognitive deficit.

This study compared 15 "mildly" cognitively impaired participants with Dementia of the Alzheimer Type (DAT), 15 depressed cognitively impaired participants (DCI), and 15 normal participants. The participants were matched for age, and reading ability, and were tested on a series of cognitive instruments selected on the basis of their ability to distinguish a cortical versus subcortical pattern of deficit. The DAT group demonstrated impaired performances on tests of language, praxis and gnosis. Deficits in these areas were absent from DCI group. There were differences between all of the groups on the California Verbal Learning Test, but after this effect was controlled using an analysis of covariance procedure, the differences in tests of gnosis, praxis and language function between the DCI and the DAT participants still remained. These findings support the clinical usefulness of the cortical-subcortical distinction in differentiating DCI from DAT.

Journal Article↗
PubMed1988

Intercorrelation of clinical tests of verbal memory.

The Wechsler Memory Scale, Buschke Selective Reminding Test, and Rey Auditory Verbal Learning Test were administered to 25 patients with known or suspected cerebral dysfunction. Intercorrelation of subscales revealed generally modest relationships among measures, indicating that there may be considerable variability in an individual's performance across the three tasks. This finding has significant clinical and research implications.

Journal Article↗
PubMedDate not supplied

Clinical, electrophysiological and neuropsychological findings of twenty-two children with mesial temporal sclerosis.

Twenty-two patients, followed with the diagnosis of epilepsy between the ages of 8.5 and 19 years who were found to have mesial temporal sclerosis (MTS) on brain magnetic resonance imaging (MRI) were evaluated according to their clinical, electrophysiological and neuropsychological characteristics, and assessed for the significance of neuropsychological tests on lateralization. In both MTS groups, a remarkable number of patients had their intial seizure before one year of age (45.5% in the right MTS group, and 36.4% in the left MTS group). Half of the patients were seizure-free for a period of two months-9.5 years (average 3.9 years). The duration between the febrile seizure and first non-febrile seizure was 6.2 years. Eleven patients had MTS on the left temporal lobe. Interictal EEG was normal in five (22.5%) patients; 10 (45.5%) had temporal spike on the corresponding side with MTS. Six (27.3%) patients had paroxysmal activity and voltage asymmetry on cortical areas other than temporal region. The Wechsler Memory Scale (WMS), Visual Reproduction Subtest and Auditory Verbal Learning Test (AVLT) Delayed Recall and Retrieval Subtest performances were poor in the right MTS group.

Adolescent↗
PubMedDate not supplied

[Intelligence, memory and malingering: correlation between scales].

OBJECTIVES: To validate the test of memory malingering (TOMM), and to study the influence of intelligence and memory on its performance in brain injury patients. PATIENTS AND METHODS: A total of 30 patients with traumatic head injury were included in the study. All patients were assessed with the Complutense verbal learning test, the Visual Reproduction subtest of the Wechsler memory scale-revised, the Boston naming test, two fluency tests (FAS, and animals), the Wechsler adult intelligence test-III, and with the TOMM. Cognitive results below 1 standard deviation (SD) from normative data were considered 'abnormal'. A parametric correlation between TOMM scores and cognitive tests was used to detect whether memory and intelligence were affecting TOMM performance. Statistical significance was set up at p<0.05. RESULTS: Between 46.1% (Boston) and 81.4% (WAIS-III performance IQ) of the sample presented cognitive deficits. Up to 83.3% of the patients scored above the cutoff point suggestive of malingering in the TOMM (45/50). Significance correlations were found between TOMM scores and memory or intelligence indexes. DISCUSSION: The TOMM is a useful tool to detect malingering in head injured patients. Effects of low intelligence coefficients, as well as memory deficits should be considered in clinical practice when evaluating patients with TOMM scores suggestive of malingering.

Adolescent↗
PubMed2004

[Memory functions in children with attention deficit/hyperactivity disorder--the effects of methylphenidate on them].

The memory functions or capacities in attention-deficit/hyperactivity disorder (AD/HD) are still not clear, though it has been pointed that the working memory in AD/HD could be impaired due to difficulties of motor inhibition or self-regulation. We examined the Auditory Verbal Learning Test (AVLT) and the Rey-Osterrieth Complex Figure Test (RCFT) in addition to the memory tasks of ordinary intelligence tests (WISC-III and K-ABC) in children with AD/HD. Whether these results could be improved by methylphenidate administration or not was also evaluated. Over the half cases had normal results without medication. Some cases in whom methylphenidate were clinically effective showed improved memory functions, especially in the auditory long-term memory, after methylphenidate administration. In conclusion, memory capacities seem normal in AD/HD. Methylphenidate does not have an effect on the memory capacities, but may improve the strategies in which the short-term memory can be effectively transferred to the long-term memory.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Five years after traumatic brain injury: a study of individual outcomes and predictors of change in function.

OBJECTIVE: Study functional changes between one and five years after traumatic brain injury (TBI). DESIGN: Prospective cohort. SETTING AND PARTICIPANTS: TBI Model Systems National Database subjects using cohort with complete one and five year data (n = 301). MAIN OUTCOME MEASURES: Disability Rating Scale (DRS) Level of Functioning and Employability Items. RESULTS: On Level of Functioning, 53 (18%) individuals improved, 228 (76%) stayed the same, and 20 (7%) worsened by more than one point from Year 1 to Year 5. On Employability, 50 (17%) individuals improved, 237 (79%) stayed the same, and 14 (5%) worsened by greater than one point. Level of Functioning improvement was predicted by FIM-Motor, FIM-Cognitive, Rey Auditory Verbal Learning Test, Symbol Digit Modalities Test (written and oral), and Wechsler Adult Intelligence Scale-Revised Block Design, and worsening predicted by Symbol Digit Modalities Test (written and oral). Improvement in Employability was predicted by race, while Glasgow Coma Scale Eye Opening was predictive of worsening. CONCLUSIONS: Although the majority did not demonstrate meaningful change on the DRS items from year 1 to 5, some individuals made dramatic gains and a minority declined. There are demographic and functional indicators present at one-year post-injury that may be predictive of subsequent change.

Adolescent↗
PubMed2004

[Cognitive aspects in girls with fragile X syndrome].

INTRODUCTION AND AIMS: Fragile X syndrome (FXS) is the first cause of intellective dysfunction due to hereditary reasons, but above all it is a multisystemic pathology, in which the cognitive behavioural phenotype is going to mark the child's entire school and social life. An early diagnosis is fundamental for proper genetic counselling and for the pedagogical approach. In girls, this diagnosis is hindered by a poorer knowledge of the semiology and because of the variability of the symptoms. Recognising the most significant clinical signs that suggest a diagnosis during early childhood is fundamental. DEVELOPMENT: An analysis of the literature offered us very few reports of girls affected by FXS and most of them are to be found in publications about genetics. There is often no clear separation between adulthood and childhood or between permutation and complete mutation, and extreme shyness and low self esteem are the most commonly reported data. Intellective capacity is normal in 40% of those affected by complete mutation; the pragmatic aspects of language and difficulties at school that can take on symptoms of non verbal learning disorder are the most significant data at school age; the incidence that the number of CGG repetitions, the degree of methylation and the FMR protein rate can have on both the symptomatology and the intensity with which they appear do not offer any homogeneous data; the attitude of the school and familial environment is a factor that has recently been considered to be of great importance in the maintenance or improvement of behavioural aspects. CONCLUSIONS: Although the discovery of the FMR1 gene provided us with a greater understanding of the symptomatology of FXS in girls, the scarcer knowledge available about its manifestations means that we can find ourselves before the problem of possibly mistaking it for learning disorders. The greater variability of its clinical symptoms and the shortage of studies that have appeared in publications on paediatrics and neuropaediatrics may be the underlying reason behind this lack of knowledge. Spanish language publications practically ignore cases of girls with FXS.

Adult↗
PubMedDate not supplied

[Evaluating the simulation of memory problems within the legal and forensic fields].

The present article is a theoretic review of the techniques used to assess the malingering of memory problems in the forensic and legal context. The necessity of instruments to facilitate the detection of malingerers is confirmed. This phenomenon is more relevant in the memory pathology context because their exaggeration or false performance is very common. The reason of this preference is the ease of the simulation of these very well known symptoms. The consequences, economics primarily, of the confirmation of brain damage sequels have produced that malingerers are well informed about the characteristics of this syndrome. This review is focus on, both tests assessing different components of memory, such as the Wechsler Memory Scale III and the California Verbal Learning Test, and tests designed specifically to detect malingering. We also differentiate tests assessing explicit and implicit memory. Likewise, future lines of research are proposed in this important legal context.

Brain Injuries↗
PubMedDate not supplied

Relationship between clinical variables and cognitive performances in migraineurs with and without aura.

Conflicting data on cognitive defects in migraine could be explained by differences in the clinical variables of the populations studied. We investigated 21 patients with migraine with aura and 24 with migraine without aura, diagnosed according to the International Headache Society criteria. The patients were submitted to a comprehensive battery of neuropsychological tests and grouped according to attack frequency and side of pain. Attack frequency was not associated with significant differences in any of the tasks, while location of pain was found to be significantly related to poorer performance on both the immediate and delayed recall of Rey Complex Figure in migraineurs both with and without aura, and a significant relationship between side of pain and number of clusters in the second trial of California Verbal Learning Test was found only in migraine with aura patients. The finding of worse performances in patients with right-sided pain seems to support a right hemisphere dysfunction hypothesis.

Adult↗
PubMed2004

Self-reported memory symptoms with coronary artery disease: a prospective study of CABG patients and nonsurgical controls.

OBJECTIVE: Subjective memory complaints are common after coronary artery bypass grafting (CABG), but previous studies have concluded that such symptoms are more closely associated with depressed mood than objective cognitive dysfunction. We compared the incidence of self-reported memory symptoms at 3 and 12 months after CABG with that of a control group of patients with comparable risk factors for coronary artery disease but without surgery. METHODS: Patients undergoing CABG (n = 140) and a demographically similar nonsurgical control group with coronary artery disease (n = 92) were followed prospectively at 3 and 12 months. At each follow-up time, participants were asked about changes since the previous evaluation in areas of memory, calculations, reading, and personality. A Functional Status Questionnaire (FSQ) and self-report measure of symptoms of depression (CES-D) were also completed. RESULTS: The frequency of self-reported changes in memory, personality, and reading at 3 months was significantly higher among CABG patients than among nonsurgical controls. By contrast, there were no differences in the frequency of self-reported symptoms relating to calculations or overall rating of functional status. After adjustment for a measure of depression (CES-D rating score), the risk for self-reported memory changes remained nearly 5 times higher among the CABG patients than among control subjects. The relative risk of developing new self-reported memory symptoms between 3 and 12 months was 2.5 times higher among CABG patients than among nonsurgical controls (CI 1.24-5.02), and the overall prevalence of memory symptoms at 12 months was also higher among CABG patients (39%) than controls (14%). CONCLUSIONS: The frequency of self-reported memory symptoms 3 and 12 months after baseline is significantly higher among CABG patients than control patients with comparable risk factors for coronary and cerebrovascular disease. These differences could not be accounted for by symptoms of depression. The self-reported cognitive symptoms appear to be relatively specific for memory and may reflect aspects of memory functioning that are not captured by traditional measures of new verbal learning and memory. The etiology of these self-reported memory symptoms remains unclear, but our findings, as well as those of others, may implicate factors other than cardiopulmonary bypass itself.

Aged↗
PubMed2003

[A follow-up study on a randomized, single-blind control of King's Brain pills in treatment of memory disorder in elderly people with MCI in a Beijing community].

OBJECTIVE: To evaluate the effect of King's Brain pills (Compound Chinese ginseng extract from herbs) on the treatment and the delaying of memory decline in the elderly with mild cognitive impairment (MCI) in a community by a year follow-up of neuropsychology. METHOD: 75 patients with MCI were selected from Beixinqiao community of Beijing by a cutoff score of 0.0/0.5 on CDR and were randomly assigned into a treatment group (n = 30 cases), given 4 pills of a compound Chinese ginseng extract (King's Brain) with 2 placebo tablets, and a positive control group (n = 30 cases), given 2 tablets of Piracetam with 4 placebo tablets, as well as a placebo group (n = 15 cases), given a placebo of 4 tablets and 2 pills. All subjects took this medication 3 times a day for 3 months. Single-blind and double-moulding control were used in this study. At a baseline and a middlepoint (after 3 months), and a follow-up end (one year later) following a three months of medication therapeutics, all subjects were assessed using a battery consisting of MMSE and 5 memory items on BNPT battery. RESULT: In the treatment group, MMSE score 27.50 +/- 1.68 was increased to 28.27 +/- 1.70 after 3 months but decreased to 26.90 +/- 1.90 after one year of the treatment. However, the latter score was higher than that in a placebo group 26.33 +/- 1.03 (P < 0.05). Verbal Learning Test score was significantly increased from 68.73 +/- 28.74 at baseline to 87.33 +/- 29.78 at follow-up point in the treatment group, which was significantly higher than that in the placebo group (P < 0.01). The total score of memory items on BNPT battery was significantly increased from 78.23 +/- 28.98 at baseline to 93.53 +/- 35.56 at follow-up point in the treatment group, higher than that in Piracetam group (P < 0.05) and the placebo group (P < 0.01). CONCLUSION: Both King's Brain spills and piracetam tablets have protective effect on cognitive and memory decline in elderly with MCI.

Aged↗
PubMed1992

[Stage-independence and individual outcome of neuro-cognitive deficits in HIV. A follow-up study of 62 HIV-positive hemophilic patients].

62 of a series of 188 HIV-positive hemophiliacs, who had been neuropsychologically evaluated already in 1988 (T1), were re-examined 1 1/2 years later (T2). The aims of the study were to confirm the cross-sectional results of the 1988 study and to compare cross-sectional and longitudinal aspects of HIV infection and associated neurocognitive deficits. Patients were staged at T1 and T2 according to CDC classification criteria and retested using parallel tests of attention, verbal/nonverbal memory performance and depression. The following results were observed: (i) Data at T2 paralleled the findings from 1988, indicating increased deficits in attention and verbal learning and memory at an advanced stage of the disease. No association with the T4/T8 ratio was found. (ii) Between T1 and T2, 65% of the patients showed no change in stage, 27% changed one stage and only 8% showed a rapid progression through two stages. (iii) Only this latter group showed a significant cognitive deterioration over time. The remaining groups exhibited inconsistent performance changes which did not correlate with depression of changes of the T4/T8 ratio. Conclusively, the longitudinal data support the assumption of stage independent and individual different courses of the neurocognitive manifestations of HIV. A small minority of patients, however, manifested a rapid progression of the disease during the T1-T2 interval.

AIDS Dementia Complex↗
PubMed2005

The effects of benzodiazepines on cognition.

Initially thought to be virtually free of negative effects, benzodiazepines are now known to carry risks of dependence, withdrawal, and negative side effects. Among the most controversial of these side effects are cognitive effects. Long-term treatment with benzodiazepines has been described as causing impairment in several cognitive domains, such as visuospatial ability, speed of processing, and verbal learning. Conversely, long-term benzodiazepine use has also been described as causing no chronic cognitive impairment, with any cognitive dysfunction in patients ascribed to sedation or inattention or considered temporary and associated with peak plasma levels. Complicating the issue are whether anxiety disorders themselves are associated with cognitive deficits and the extent to which patients are aware of their own cognitive problems. In an attempt to settle this debate, meta-analyses of peer-reviewed studies were conducted and found that cognitive dysfunction did in fact occur in patients treated long term with benzodiazepines, and although cognitive dysfunction improved after benzodiazepines were withdrawn, patients did not return to levels of functioning that matched benzodiazepine-free controls. Neuroimaging studies have found transient changes in the brain after benzodiazepine administration but no brain abnormalities in patients treated long term with benzodiazepines. Such findings suggest that patients should be advised of potential cognitive effects when treated long term with benzodiazepines, although they should also be informed that the impact of such effects may be insignificant in the daily functioning of most patients.

Activities of Daily Living↗
PubMed1992

Epoetin and cognitive function.

The uremia of chronic renal failure (CRF) can alter brain electrophysiology and cognitive function, even in the well-dialyzed patient. The effect of uremia on brain function can be assessed by electrophysiologic techniques such as electroencephalogram (EEG), sensory-evoked potentials (EPs), and cognitive event-related potentials (ERPs), and through a series of neuropsychologic tests. Five tests have been used clinically to measure the speed and efficiency of cognitive functioning and include the following: Number Cancellation, Trailmaking Test, Symbol Digit Modalities Test, Rey Auditory Verbal Learning Test, and Controlled Oral Word Association Test. Test performance by patients with CRF is often below that of healthy controls. Auditory ERPs, a sensitive indicator of subtle changes in central nervous system (CNS) function in uremia, result in the generation of a P300 component wave that varies in amplitude and latency with patient variables such as attention and effort. Although dialysis tends to normalize P300 latencies, the waves remain somewhat prolonged in most patients. The anemia often observed in patients receiving chronic dialysis appears to aggravate uremic encephalopathy. This effect can be reversed when anemia is corrected following administration of recombinant human erythropoietin (epoetin). Improvement in P300 amplitudes, and, in some cases, decreases in P300 latencies correlated well with epoetin-induced increases in hematocrit levels. With the correction of anemia, that component of brain dysfunction not attributable to retention of uremic toxins can largely be reversed.

Anemia↗
PubMed2005

[The neuropsychological test battery for elderly people].

OBJECTIVE: To establish a Chinese T-score norm of neuropsychological test battery for the elderly (NTBE). METHODS: 903 normal elderly people over 60 years old from Shanghai, Beijing, Hebei, Jiangsu, Hubei, Hunan, Zhejiang, Shandong and Liaoning were evaluated by using NTBE which includes tests of auditory verbal learning, sorting, cancellation, language, motor, visual function, construction, trail making 1 and 2, etc. RESULTS: Age and education greatly affected the score of NTBE, but gender did not. Based on these facts, the 903 normal subjects were divided into 12 subgroups, according to the age and the years of education they had received. The raw scores of NTBE were transformed to standard score and normalized standard score, and then these scores were transformed to a total T score (Mean = 100, SD = 10). Using another normal elderly sample (n = 474) to analysis, the correlation between the raw scores and the total T score was significant. Using NTBE to diagnose 110 mild cognitive impairment (MCI) and 63 Alzheimer's disease (AD) patients, the sensitivity and specificity were 66% and 91% for MCI, and 79% and 96% for AD. CONCLUSION: The T norm of the NTBE is suitable for Chinese elderly, and can be a useful instrument for diagnosing mild cognitive impairment and Alzheimer's disease.

Aged↗
PubMed2006

The consequences of idiopathic partial epilepsies in relation to neuropsychological functioning: a closer look at the associated mathematical disability.

Although the seizure prognosis is mostly favorable in idiopathic partial epilepsies, there is some empirical evidence showing that subtle neuropsychological impairments, with a consequent risk of academic underachievement, are not rare. We investigated neuropsychological functioning including attention, memory, visuomotor ability, and executive functioning with a closer look at the associated mathematical ability in patients with idiopathic partial epilepsies. A battery of age-appropriate, neuropsychological and mathematics achievement tests was administered to 30 participants with idiopathic partial epilepsy [13 children with benign epilepsy with centrotemporal spikes (BECTS), 17 children with idiopathic childhood occipital epilepsies (ICOE)], and to 30 healthy participants matched for age, sex, handedness, and socioeconomic status. Results did not support any impairment in overall neuropsychological functioning in participants with idiopathic partial epilepsies, whereas, isolated deficits did exist. The mean performance of the IPE group was significantly lower than the control group in six out of 12, neuropsychological measures: drawing (p < 0.01), digit span (p < 0.05), verbal learning (p < 0.01), object assembly (p < 0.01), similarities (p < 0.05), and vocabulary (p < 0.001). Results suggested that one should be cautious regarding neuropsychological and academic prognosis in the so-called benign idiopathic partial epilepsies of childhood.

Adolescent↗
PubMed2006

Anti-NR2 glutamate receptor antibodies and cognitive function in systemic lupus erythematosus.

OBJECTIVE: To determine the prevalence of circulating anti-NR2 antibodies and their association with neuropsychiatric systemic lupus erythematosus (NP-SLE), particularly cognitive function, in women with SLE. METHODS: Cognitive function was assessed in 65 consecutive women with SLE from a single referral center using standardized neuropsychological tests. These were selected subtests of the Wechsler Adult Intelligence Scale-Revised, the Wechsler Memory Scale-Revised, and the California Verbal Learning Test, which provided information on 8 areas of cognitive function. After a mean followup of 64 (range 52-71) months, cognitive assessments were repeated. Global and domain-specific cognitive impairment was examined using predetermined decision rules, and the change in individual tests of cognitive performance over time was also examined. Overt NP-SLE was identified by clinical assessment and classified using the American College of Rheumatology nomenclature. Circulating IgG anti-NR2 and anti-dsDNA antibodies were determined by ELISA on up to 4 occasions over the study period. A positive result was defined as at least 3 standard deviations above the mean of healthy controls. RESULTS: At enrollment, 15/65 (23%) patients had cognitive impairment. This fell to 7/54 (13%) at followup. In addition 15/65 (23%) patients had a history of clinically overt NP-SLE. Twenty-three of 65 (35%) patients had anti-NR2 antibodies and 48/65 (74%) had anti-dsDNA antibodies. Anti-NR2 antibodies were present in 18/48 (38%) patients with anti-DNA antibodies, and 18/23 patients (78%) with anti-NR2 antibodies also had anti-dsDNA antibodies. There was no association between global cognitive impairment, domain-specific cognitive impairment, or a history of clinically overt NP-SLE and either the presence or amount of anti-NR2 or anti-dsDNA antibodies (p > 0.05). When change in cognitive performance or the occurrence of new NP-SLE events over the 5-year followup period was examined, there was no significant association with persistent elevation of either antibody (p > 0.05). Similarly there was no association between a rise in autoantibodies over time and the development of overt NP events or cognitive decline (p > 0.05). CONCLUSION: These results indicate that anti-NR2 antibodies occur in 35% of women with SLE and are infrequent in the absence of detectable anti-dsDNA antibodies. Their presence in the circulation is not associated with cognitive dysfunction at a single timepoint, and an increase in or persistently elevated antibody levels are not associated with a change in cognitive performance over time. There was no association with clinically overt NP-SLE. However, as our study did not examine cerebrospinal fluid samples, these results do not exclude a potential pathogenic role in selected patients for this group of autoantibodies should they penetrate the blood-brain barrier and thereby gain direct access to neuronal tissues.

Adult↗
PubMed2006

Reduced hippocampal volume correlates with executive dysfunctioning in major depression.

OBJECTIVE: Dysfunction of neuronal plasticity or remodelling seems to contribute to the pathopysiology of major depression and may cause the well-documented hippocampal changes in depression. We aimed to investigate whether reduced hippocampal volumes correlate with executive dysfunctioning or memory dysfunctioning or with depression severity. METHODS: We recruited 34 inpatients with a previous or current episode of major depression from the department of psychiatry at the Ludwig-Maximilians University of Munich, Germany. We examined the 34 patients and 34 healthy control subjects with structural high resolution MRI. We assessed cognitive functions with the Wisconsin Card Sorting Test (WCST) and the Rey Auditory Verbal Learning Test (RAVLT) and severity of depression with the Hamilton Depression Rating Scale. RESULTS: Hippocampal volumes and frontal lobe volumes were significantly smaller in patients, compared with healthy control subjects. Furthermore, lower hippocampal volumes were correlated with poorer performance in the WCST. No significant correlations were found between hippocampal volumes and RAVLT performance or severity of depression. CONCLUSIONS: The present findings emphasize that patients with reduced hippocampal volumes show more executive dysfunctions than their counterparts. Thus, the mechanisms resulting in reduced hippocampal volumes seem to be related to the development of major depression.

Adult↗

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