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PubMed2001

Impact of comorbid depressive symptoms on neuropsychological performance in obsessive-compulsive disorder.

There is indirect evidence from previous research that several executive disturbances in obsessive-compulsive disorder (OCD) are mediated by comorbid depressive symptoms. For the present study, the authors investigated whether OCD patients with elevated Hamilton Rating Scale for Depression (HRSD) scores would exhibit deficits in tasks sensitive to the medial and dorsolateral frontal cortex as well as other executive tasks. The 36 OCD patients were split along the median according to their HRSD scores and compared with matched control subjects. Patients with high HRSD scores performed significantly worse than control subjects and patients with low HRSD scores on the Wisconsin Card Sorting Test, the Trail-Making Test (TMT, Part B), and the TMT difference score. Moreover, patients with high HRSD scores exhibited deficits on a (creative) verbal fluency task. It is suggested that comorbid depressive symptoms may have artificially inflated some executive deficit scores in previous studies.

Adult↗
PubMed2006

Impact of catechol-O-methyltransferase on prefrontal brain functioning in schizophrenia spectrum disorders.

The enzyme catechol-O-methyltransferase (COMT) has attracted increasing interest regarding a genetic disposition towards schizophrenias and as a modulator of prefrontal brain function. A common SNP in the COMT gene causes a Val to Met transition at AA158/AA108 (Val158Met), resulting in reduced COMT activity in Met allele carriers. An impact of COMT genotype on cognition has been well established; however, the exact nature of this influence has yet to be elucidated. The aim of this study was to determine whether COMT genotype affects an electrophysiological marker of prefrontal activation and neuropsychological frontal lobe measures in schizophrenia. To this end, 56 acutely psychotic in-patients with schizophrenia spectrum disorders were investigated. Patients with the COMT 1947AA (Met/Met) genotype (n=13) were compared to a carefully matched sample of patients with a G1947A (Val/Met) genotype (n=15); matching criteria included patients' age, handedness, gender distribution, diagnosis, and medication status. A small group of six homozygous Val allele carriers was additionally included to allow an assessment of possible gene-dosage effects. P300 amplitudes and latencies, as well as an electrophysiological marker of prefrontal brain function (NoGo-Anteriorization/NGA) and neuropsychological measures (Stroop Test, Verbal Fluency, Trail Making Test) were regarded. Homozygous Met allele carriers had significantly increased NGA values and fronto-central Nogo amplitudes compared to patients with at least one Val allele. They also tended to perform better in the Stroop task, as compared to the matched group of Val/Met patients. These results indicate that COMT genotype exerts a strong impact on prefrontal functioning and executive control in schizophrenia spectrum disorders.

Adolescent↗
PubMed2000

Influence of demographic variables on neuropsychological test performance after traumatic brain injury.

The validity of correcting for demographic variables when considering neuropsychological test scores was evaluated in a sample of 136 patients with traumatic brain injury (TBI) who had been screened carefully for premorbid or comorbid confounding factors. When considered in concert with neurological variables, age and education accounted for a significant proportion of the variance in raw scores on the Category Test and the Trail Making Test in the complete sample. Gender did not affect level of test performance. Correcting neuropsychological test scores for demographic variables did not significantly alter their success in identifying patients with severe TBI, but did lead to greater accuracy when classifying individuals with mild-moderate TBI. This investigation concluded that norms that consider the demographic background of the individual are likely to reflect more accurately the neuropsychological status of patients with TBI than interpretations that are based exclusively on raw data.

Adult↗
PubMed2000

The association between low diastolic blood pressure in middle age and cognitive function in old age. A population-based study.

BACKGROUND: previous longitudinal studies have shown an inverse relation between blood pressure and cognitive function. OBJECTIVE: to determine the association between mid-life blood pressure and performance in different areas of cognitive function in late life. SUBJECTS AND METHODS: we recruited 502 men, aged 69-74 years, from a population-based cohort in Uppsala, Sweden. Blood pressure had been measured at age 50 and we examined performance in 13 psychometric tests about 20 years later. RESULTS: after the 39 men with a previous stroke had been excluded, there was an inverse relation between diastolic blood pressure at age 50 and performance 20 years later in the digit span test, the trail-making tests and in verbal fluency. The relationships were significant, independently of age, education and previous occupational level. Men within the lowest category of diastolic blood pressure (< or = 70 mmHg, n = 59) showed the best results. Baseline blood pressure levels were not linked to performance in tasks on vocabulary, verbal learning and memory or figure copying. CONCLUSIONS: low blood pressure in mid-life indicates a low long-term cerebrovascular risk and is associated with higher late-life performance in cognitive tests that mainly assess subcortico-frontal cognitive functions.

Aged↗
PubMed1999

Neuropsychological test performances of young depressed outpatient women. An examination of executive functions.

Thirty young, unmedicated, outpatient, depressed women were compared to an equal number of matching controls on a series of neuropsychological tests purported to be sensitive to the executive functions. Specifically, the measures included the Design Fluency Test, Hand Dynamometer tasks of grip strength, perseveration, and fatigue, the FAS Verbal Fluency Test, the Stroop Color and Word Test, and the Trail Making Test (Parts A and B). Despite past research which has indicated anterior hemispheric asymmetries and impaired neurocognitive performances in depressives, this research failed to identify any reliable differences between depressed and nondepressed women on any of the neuropsychological measures. These results argue against the frequently held stereotype that depressed individuals typically display impaired performances on neurocognitive tasks. Furthermore, since the profile of the depressed sample appeared to differ significantly from past studies, a discussion is provided as to how the characteristics of this group may have impacted the results. Implications of these findings for clinical practice and future research are also provided.

Journal Article↗
PubMed2006

Cognitive impairments in acute lacunar stroke.

BACKGROUND: The present study investigated the prevalence of cognitive deficits in acute lacunar stroke, validated the Mini Mental State Examination (MMSE) in detecting cognitive impairments in lacunar patients, and identified predictors of such deficits. METHODS: Seventy-one patients with lacunar stroke performed a comprehensive cognitive screening between day 2 and day 7 of their stay. The test battery included Trail Making Test A, Verbal Fluency, Object Learning Test, Ullevål Aphasia Screening, and Assessment of Stroke and other Brain Damage regarding motor apraxia, rational apraxia and visuospatial ability. RESULTS: Exactly 57.7% scored outside cutoff in at least one of the cognitive tests. Using a rigorous cutoff for MMSE (28/29 points) and the test battery as comparison, the sensitivity and specificity of MMSE were 0.69 and 0.67, respectively. Only male sex was significantly related to the presence of cognitive deficits (pathologic score on at least one of the tests--odds ratio 4.41, 95% confidence interval 1.45-13.43). CONCLUSION: Many lacunar stroke patients suffer cognitive problems. Male patients are at particular risk. MMSE failed to identify 30% of the patients diagnosed with cognitive deficits, and we suggest that lacunar stroke patients be offered a comprehensive cognitive screening, even when MMSE is normal.

Acute Disease↗
PubMed1987

Ventricular enlargement and neuropsychological testing in schizophrenia.

The Ventricular Brain Ratio was computed in a group of 42 young chronic schizophrenics (age range: 17-45). The patients also completed a battery of neuropsychological tests: four WAIS subscales, the Benton test and the Trail Making Test. Although patients as a whole showed the expected ventricular enlargement and neuropsychological impairment when compared to control groups, no correlation was found between the two measures. These results are inconsistent with previous work on the same topic that hypothesized the association of both parameters. Some tentative explanations for these conflicting results are given.

Adolescent↗
PubMedDate not supplied

Executive function in patients with remitted bipolar disorder and schizophrenia and its relationship with functional outcome.

BACKGROUND: Recent studies have reported that differences in cognitive performance between schizophrenic and bipolar patients seem to be smaller than expected. Patients with schizophrenia have consistently shown frontal executive dysfunctions, but studies regarding executive abilities in bipolar patients are scarce and discrepant. As executive function has been associated with psychosocial functioning in schizophrenia, we wanted to investigate if such a relationship is also present in bipolar disorder and the differences between the two groups. METHODS: Executive function was assessed in 49 euthymic (at least 6 months in remission, Hamilton Depression Rating Scale < or = 8 and Young Mania Rating Scale < or = 6) bipolar and in 49 schizophrenic, residual-type (with at least 1 year without acute exacerbation and predominant negative symptomatology) patients, by the Wisconsin Card Sorting Test (WCST), FAS Test (COWAT) and Trail Making Test. Baseline clinical and psychosocial variables were controlled and psychopathology evaluated by means of the Positive and Negative Syndrome Scale (PANSS). RESULTS: The two groups showed a similar pattern of cognitive deficits in tests of executive function, except for the number of categories achieved in the WCST, which was significantly lower in the schizophrenic group (F = 7.26; p = 0.009). Functional outcome was predicted by the negative syndrome (PANSSN) and perseverative errors (WCST) in schizophrenic patients, and general psychopathology (PANSSG) was the best predictor of functional outcome in the bipolar group. CONCLUSION: Executive function was a good predictor of functional outcome in the schizophrenic group, whereas clinical variables were more predictive of the bipolar one. Patterns of cognitive disturbances in tasks of executive function are similar in both groups but quantitatively more marked in schizophrenia.

Adult↗
PubMed2004

The frequency of executive cognitive impairment in elderly rehabilitation inpatients.

The aim of this study was to determine the frequency of executive cognitive dysfunction in a sample of elderly patients in 2 rehabilitation wards in Wellington, New Zealand. All patients in 2 wards over a 2-month period were approached and invited to complete a brief neuropsychological battery. Sixty-two patients volunteered, of whom 52 completed at least 3 of the 4 measures of executive functioning. The frequency of executive dysfunction in the resulting sample of 52 was determined. Impaired executive function was defined as impaired performance on at least 2 executive function tests. The authors administered the Hayling-Brixton tests, the verbal fluency test, the Trail-Making Test, the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale. Patients' behavior was rated for executive problems on the Dysexecutive Questionnaire by themselves and by a nurse. The frequency of executive impairment was high at 13 out of 52 patients (25%). Only 1 of these 13 patients with executive difficulties was impaired according to their MMSE score. Screening for executive impairment among older rehabilitation inpatients is a necessary part of their medical management and rehabilitation. This should involve more than just administering the MMSE at admission. Several brief methods for screening for executive impairment are now available.

Aged↗
PubMed1997

A Neuropsychological Study of Patients Exposed to Organic Solvents.

Sixty-seven male patients exposed to organic solvents were neurospychologically examined. Twenty-five subjects had possible causes of encephalopathy other than solvent exposure, leaving 42 patients for the study of the association between exposure and neuropsychological test results. The patients had been heavily exposed for, on average, 24.6 years (range 2-46). The main clinical findings were impairments of psychomotor function, short-term memory, and attention. The results suggest an association between impaired psychomotor speed and exposure duration (r = 0.41; p = 0.007), with moderate to severe impairment occurring after at least 15 years. Forty percent of the patients exposed for more than 30 years had moderate to severely impaired psychomotor speed. The results suggest declining test performance on Trail Making Test B related to exposure duration (r = -0.34; p = 0.03). Further, the individual age-adjusted score on the Digit Span task (WAIS) was reduced when compared with the individual age-adjusted score on the Picture Completion task (WAIS). This reduction was related to exposure duration (r = -0.48; p = 0.002).

Journal Article↗
PubMed1999

Does process-specific slowing account for cognitive deficits in Lyme disease?

Although several studies have suggested that cognitive slowing is a symptom in Lyme disease, it is not clear whether this slowing is general or relates to specific cognitive tasks. This study examined cognitive speed in 25 Lyme disease patients using a mental arithmetic task. These patients showed significant impairments when initiating the cognitive processes involved in counting, but performed as well as healthy participants (n = 23) when the number of counting increments increased. Lyme patients also performed a speeded perceptual-motor matching task as well as healthy participants. Lyme-related initiation speed deficits were significantly correlated with performance on standardized neuropsychological tests, including the Trail Making Test and the Digit Symbol Test, but not with self-reported depression. These results suggest that the cognitive deficits seen on speeded tasks are process specific in the Lyme patient group, and are not the result of generalized slowing.

Adult↗
PubMed2003

The neuropsychology of repeated 1- and 3-meter springboard diving among college athletes.

This study examined the neuropsychological effects of repeated springboard diving. It was hypothesized that the impact velocity, which can range from 20 to 30 mph, and accompanying deceleration in the water may lead to concussions and affect the diver's cognitive function. Six varsity National Collegiate Athletic Association Division 1 springboard divers participated in the study. Each diver performed a total of 50 practice dives from either the 1- or 3-m springboard. After each set of 10 dives, the participants were immediately evaluated at poolside using the Symbol Digit Modalities Test, the Stroop Color Word Test, and the Trail Making Test B. Baseline testing revealed, consistent with their athletic specialty, clear neurocognitive strengths among the divers on tests sensitive to proprioception, motor speed, and visual-spatial organization. Results from the serial assessments indicated no detectable neuropsychological deficits among competitive divers compared to baseline testing. Skilled diving at the collegiate level appears to be a safe sport and water appears to present the perfect medium for gradual deceleration. More studies, however, are warranted for 5-, 7.5-, and 10-m platform diving since the impact velocity of the diver from these heights is higher.

Adult↗
PubMed2004

Neuropsychological executive functions of adolescent sex offenders and nonsex offenders.

A growing body of research now suggests that a substantial number of criminal offenders display neuropsychological deficits, especially frontal-executive dysfunctions. The present study investigated the possibility of similar deficits by comparing the performance of 60 adolescent sex offenders court-ordered to a residential treatment facility with the performance of 60 nonsexual delinquent offenders matched on several pertinent sociodemographic characteristics and scores on four neuropsychological tests: (1) the Trail Making Test, (2) the Controlled Oral Word Association test of the Multilingual Aphasia Examination, (3) the Tower of London, and (4) the Wisconsin Card-sorting Test. Analysis indicated a pattern of frontal-executive dysfunction in a subset of both groups of offenders; this pattern has both theoretical and treatment implications.

Adolescent↗
PubMed2005

Impact of efavirenz on neuropsychological performance and symptoms in HIV-infected individuals.

BACKGROUND: Efavirenz is a commonly used antiretroviral drug that causes neurologic side effects in more than 50% of patients. OBJECTIVE: To characterize efavirenz-associated neurologic symptoms in a randomized, controlled study of initial antiretroviral treatment. DESIGN: Substudy of a randomized, double-blind, controlled trial of combination antiretroviral regimens (A5095) that was performed between March 2001 and January 2002. SETTING: Multicenter academic clinical trial units. PARTICIPANTS: HIV-infected patients who were initiating therapy in the context of a controlled trial. MEASUREMENTS: Neuropsychological performance measures, including the Digit Symbol Substitution Test and the Trail Making Test (Parts A and B); symptom questionnaires; standardized assessments of sleep quality, anxiety, and depression; and efavirenz plasma concentrations. RESULTS: Twenty of 303 (6.6%) enrolled participants prematurely discontinued the study. Neuropsychological performance improved in both groups over time without significant differences between patients who were receiving efavirenz and those who were not. The efavirenz group experienced more neurologic symptoms at week 1 (P < 0.001) but not at weeks 4, 12, or 24. A sleep index revealed that participants receiving efavirenz had more "bad dreams" during the first week of therapy (P = 0.038). No significant changes in anxiety or depressed mood were noted. Changes in efavirenz-associated neurologic symptoms were correlated to efavirenz plasma concentrations at week 1 but not at later time points. Twelve (6%) patients receiving efavirenz stopped taking the drug before the end of the study because of central nervous system symptoms. LIMITATIONS: Participant selection may have been biased in favor of patients with fewer psychiatric complications. The study design permitted substitution of a new drug in place of efavirenz in cases of treatment-limiting toxicity. CONCLUSIONS: In a large controlled trial, efavirenz use was associated with neurologic symptoms distinct from depression and anxiety that began early in therapy but resolved by week 4. Improvement in neuropsychological performance was comparable in patients who were receiving efavirenz and those who were not.

Adult↗
PubMed1999

Effects of a composite Indian herbal preparation on combat effectiveness in low-intensity-conflict operations.

The efficacy of a composite Indian herbal preparation (CIHP) in sustaining the mental performance of soldiers engaged in prolonged low-intensity-conflict operations has been evaluated. For this purpose, a cohort of 56 soldiers acted as volunteers in combat situations. After recording their initial responses to psychological tests such as the d2 test, the trail-making test, the serial addition test, the short-term memory test, and the Institute for Personality and Ability Testing Anxiety Scale, they were randomly given either CIHP or placebo in a double-blind fashion for 8 days while they performed their usual combat duties. The final 3 days of assignments included physically exhausting and life-threatening events. On day 8, they were withdrawn from combat duties and the psychological tests were readministered immediately. After 7 days of rest, the tests were repeated once again. The results indicate comparatively better performance immediately after the mission by the CIHP group. CIHP was effective at sustaining the mental abilities of soldiers in a low-intensity-conflict environment.

Adult↗
PubMedDate not supplied

[Executive function in Parkinson's disease].

Executive function declines in Parkinson's disease (PD). However, it has not been clearly shown at what stage in PD, this decline starts to occur. We here report a study aiming to answer this question. We conducted Wisconsin Card Sorting Test (WCST) and Trail Making Test A and B (TMT A, B) in three normal control groups (young, adult, and aged) and three PD patients groups (Hoehn & Yahr stage I, II, and III). We intend to analyze at what age or stage the decline in executive function would take place. The score of all the normal subjects and PD patients were 25 points or above by Mini-Mental State Examination. WCST in stage I PD patients (mean age 60.8, n = 9) was essentially same as those of young normal (mean age 23.1, n = 9) and adult normal (mean age 61.5, n = 10) subjects. Elderly normal subjects (mean age 75.8, n = 4) showed a significantly lower mean category achievement score (3.0 as the mean score) and higher numbers of errors and perseverations compared with those of young and adult normal subjects. Stage II (mean age 62.6, n = 8) and III PD (mean age 62.9, n = 8) patients showed significantly lower mean category achievement scores (2.4 and 2.1, respectively as the mean scores) and higher numbers of errors and perseverations compared with those of adult control subjects (5.4 as a mean score). TMT (B-A) in elderly normal subjects revealed significantly longer score (209 seconds as the mean score) compared with those of young and adult normal subjects (20 and 45 seconds, respectively as the mean scores). TMT (B-A) in stage III PD patients was significantly longer (219 seconds) compared with that of adult normal subjects (45 seconds as the mean), however TMT (B-A) in stage II PD patients (102 seconds as the mean) did not show prolongation. TMT (B/A) showed essentially similar results as TMT (B-A), however, stage II PD patients showed significant prolongation compared with that of normal adult subjects. Therefore, TMT (B/A) appears to be a more sensitive indicator of decline in executive function in PD. Between WCST and TMT, the former appeared to be a more sensitive indicator. Our results indicate that the decline in executive function takes place in normal ageing. In PD, this decline starts much earlier than the normal subjects. The onset in this decline coincides with the stage of PD, in which bilateral symptoms start to present. Anatomo-chemical subsrate of cognitive decline in PD is still to be debated, however, we believe that involvement of nigro-caudatal projection is at least in part responsible, as nigroputaminal pathway is mainly involved in motor functions. We also point out the importance of age factor in the evaluation of cognitive-executive function in PD, as this function is age-dependent in normal subjects.

Adult↗
PubMed1997

The Ray-Osterrieth Complex Figure Test as a neuropsychological measure in criminal offenders.

What does the Rey-Osterrieth Complex Figure Test (CFT) measure in criminal offenders? This study examined neuropsychological and personality test correlates of performance on the Complex Figure Test in a sample of 110 incarcerated criminal offenders. Three standard CFT scores-copy accuracy, memory recall accuracy, and organizational quality-did not discriminate between violent and nonviolent offenders, and were not correlated with either Psychopathy Checklist scores or self-reported anger using the Novaco Anger Scales. CFT performance was significantly correlated with two other standard neuropsychological measures, a short form of the Category Test and the Trail Making Test. As might be expected, CFT scores were positively correlated with WAIS-R Block Design, and to a lesser extent Vocabulary. Organizational quality scores were significantly correlated with the Barratt Impulsiveness Scale. Approximately 27 to 36% of the variance in CFT scores could be explained by the combination of minority status, measures of nonverbal cognitive performance, and self-reported impulsivity.

Journal Article↗
PubMedDate not supplied

[Personality dimensions and neuropsychological performance in first-degree relatives of patients with schizophrenia and by affective psychosis].

Several studies have found a significant increase in the prevalence of some personality disorders in the first-degree relatives of patients with schizophrenia; other studies have found subtle neuropsychological deficits in these relatives. However, little is known about the specificity of the personality traits reported or about the relationship between these traits and the neuropsychological deficits. One hundred first-degree relatives of patients with schizophrenia (AS) and 88 first-degree relatives of affective psychotic (APA) patients completed the Eysenck Personality Questionnaire which measures extraversion, neuroticism, psychoticism. They were also administered the National Adult Reading Test (NART), the Trail Making Test (TMT) and a Verbal Fluency Test (VFT). In the AS group, the male relatives scored significantly higher on the psychoticism scale than the male relatives in the APA group. There were no significant differences in personality between female relatives of the 2 patients groups. In the AS group, the NART scores were superior when the psychoticism scores were lower and the TMT performance was better when the extraversion scores were higher. These results seem to indicate some specificity as well as sex differences of the psychoticism dimension. Moreover, the relationship between the personality dimensions and the neuropsychological performance could indicate that psychoticism increases vulnerability to schizophrenia whereas extraversion decreases it.

Adult↗