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PubMed1982

[Postoperative syndromes after portacaval shunt in patients with cirrhosis of the liver (author's transl)].

Postoperative care of patients with a portacaval shunt is identical with the perioperative care performed to avoid the dangerous complications of cirrhosis of the liver. Clinical symptoms (edema, ascites, skin changes) and clinical chemistry (prothrombin time, bilirubin, albumin) will allow, to survey liver function appropriately. Neurological examination and simple psychosomatic tests (test of writing, trail making test) will allow to recognize early the occurrence of hepatoportal encephalopathy. EEG examinations done every 4 to 6 months are helpful in diagnosis. X-ray or endoscopic examinations should be done, if gastric ulcers are suspected. A definite warning must be pronounced against using high ceiling diuretics of unnecessarily; diuretics should be given only for short periods of time and in low dosage. Regular measurements of serum electrolytes are mandatory. The patient must be informed about the rationale of the diet restricted in proteins and abstinence from alcohol.

Alcohol Drinking↗
PubMed1996

Neuropsychological functioning and recovery after mild head injury in collegiate athletes.

OBJECTIVE: This study prospectively examined neuropsychological functioning in 2300 collegiate football players from 10 National Collegiate Athletic Association Division A universities. The study was designed to determine the presence and duration of neuropsychological symptoms after mild head injury. METHODS: A nonequivalent repeated measures control group design was used to compare the neuropsychological test scores and symptoms of injured players (n = 183) with those of gender, age, and education matched controls. A number of neuropsychological tests, including the Paced Auditory Serial Addition Test, the Digit Symbol Test, and the Trail Making Test, as well as a symptom checklist were used. TECHNIQUE: Players and controls were assessed before engaging in game activity and 24 hours, 5 days, and 10 days after injury, using the standardized test battery and symptom checklist. RESULTS: Players with head injuries displayed impaired performance and increased symptoms in comparison to controls, but this impairment resolved within 5 days in most players. Players with head injuries showed significant improvement between 24 hours and 5 days, as well as between 5 and 10 days. CONCLUSION: Although single, uncomplicated mild head injuries do cause limited neuropsychological impairment, injured players generally experience rapid resolution of symptoms with minimal prolonged sequelae.

Adolescent↗
PubMed1980

Alcoholics' recovery from cerebral impairment as a function of duration of abstinence.

There is clear evidence in the literature for permanent cerebral impairment due to prolonged alcohol abuse. Observation also suggests that there is a component of this cerebral impairment that is found immediately subsequent to heavy drinking and that is reversible. This study examined the time-course of recovery from this temporary impairment and delineated more specifically the neuropsychological functions that participate in the recovery. Four groups (N = 87) of hospitalized male alcoholics were tested after 6, 15, 21, and 110 days of abstinence using the Raven Progressive Matrices, the Trail-Making Test, the Memory for Designs, and the following subscales of the WAIS: Arithmetic, Digit Span, Block Design, Similarities, and Digit Symbol. The results indicated that significant improvement occurred during the third week of abstinence (between 15 and 21 days) on the Digit Span, Block Design, Similarities, Memory for Designs, Raven, and Trail-Making tests, but not on the Arithmetic and Digit Symbol tests. These results suggest that treatment programs that use a preliminary "drying-out" period should consider lengthening this period to 3 weeks to insure that patients are maximally responsive to psychotherapy.

Alcohol Drinking↗
PubMed2001

Neuropsychological evaluation of higher functioning homeless persons: a comparison of an abbreviated test battery to the mini-mental state exam.

This study examined neuropsychological functioning in a heterogeneous population of persons who were homeless (N = 60) and compared the value of the Abbreviated Halstead-Reitan Test Battery with the Mini-Mental State Exam (MMSE). A high incidence of neuropsychological dysfunction was evident with 80% of patients showing impaired test battery performance and 35% showing an impaired MMSE. Performance on the Trail Making Test, Part B was especially impaired. Patients impaired on Trails B more often showed impaired test battery performance, suggesting it may be a better screening tool than the MMSE. Neuropsychological performance was not significantly affected by the patients' gender, age, diagnosis, or past psychiatric and medical history. Regression analysis suggested that 29% of the variance in test battery performance was accounted for by the patients' education. Results support previous findings that large numbers of people who are homeless are neuropsychologically impaired; this should be considered when planning treatment and rehabilitation.

Adult↗
PubMed1998

Order effects within the Trail Making and Stroop tests in patients with neurologic disorders.

Effects of order of presentation within the Trail Making and Stroop tests were investigated by comparing 50 consecutive patients receiving detailed neuropsychological assessment given the components of each test in standard order with 50 given them in reverse. Groups were well matched on a wide range of demographic and neuropsychological variables. The only significant group difference in mean scores for the test components and derived ratios and differences, a higher Trail Making Test Part B/Part A ratio in the 'reverse' group than in the 'standard' group, was most easily explained in terms of a slight effect of practice in visual scanning. Greater variance in the Stroop Test Part C score and its derivatives in the standard group may have been attributable to factors other than order of presentation. Performance of these tests in patients with neurological disorders is not crucially dependent upon accumulation of proactive interference from simpler to more complex parts; the latter can reasonably be used in isolation.

Adolescent↗
PubMed2001

Performance feedback deficit in geriatric depression.

BACKGROUND: The orbital frontal cortex is involved with processing of performance feedback. This study tests the hypothesis that older depressed subjects, compared with elderly control subjects, commit more subsequent errors after receiving feedback from an initial error. METHODS: We administered 116 older depressed patients and 139 control subjects the Trail Making Test Part B (TRAILS-B). Subjects who committed an error on TRAILS-B were immediately given feedback on performance. We then measured the frequency of making an error on the subsequent three tries. The likelihood of making any subsequent error was examined. RESULTS: After controlling for the overall initial error rate, more depressed patients than control subjects made subsequent errors. This association remained significant in later regression models. When the depressed group was examined in additional models, severity of depression was not associated with increased subsequent errors. CONCLUSIONS: These results extend previous findings suggesting a performance feedback deficit in geriatric depression. The findings support previous studies linking the orbital frontal cortex and depression.

Aged↗
PubMed2000

Cognitive tests that best discriminate between presymptomatic AD and those who remain nondemented.

OBJECTIVE: To identify the most accurate cognitive measures in discriminating between individuals with presymptomatic AD and individuals who remained nondemented. METHODS: During a 10-year prospective community study, 120 nondemented subjects completed a battery of standard cognitive tests and clinically manifested AD 1.5 years later. Performance on each of 16 cognitive tests was compared between these 120 presymptomatic cases and 483 controls who remained nondemented over the 10-year follow-up period. The area under the receiver operating characteristic (AUC) curve for each test was used to measure its accuracy of discrimination between cases and controls. RESULTS: Among the 16 neuropsychological tests, Word List Delayed Recall discriminated best between cases and controls (AUC = 0.806), followed by the Word List 3rd Learning Trial (0.787), Word List 1st Learning Trial (0.774), and Trail-making Test B (0.773), compared to the Mini-Mental State Examination (MMSE) (0.726). Both Word List Delayed Recall and Word List 3rd Learning Trial were significantly more accurate than the MMSE. The combination of Word List Delayed Recall and Trail-making Test B comprised the optimal set of cognitive measures, with the highest AUC (0.852). CONCLUSION: Measures of delayed recall and executive functions were the best discriminators between those who would manifest AD 1.5 years later and those who would remain nondemented. These findings are relevant for the early detection of AD and, therefore, for prevention and early intervention trials. Executive dysfunction may be a subtle manifestation of incipient AD, along with memory dysfunction.

Aged↗
PubMed1996

Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients with congestive heart failure.

OBJECTIVES: The aim of this study was to determine the impact of nasal nocturnal oxygen therapy on respiration, sleep, exercise capacity, cognitive function and daytime symptoms in patients with congestive heart failure and Cheyne-Stokes respiration. BACKGROUND: Cheyne-Stokes respiration is common in patients with congestive heart failure and is associated with significant nocturnal oxygen desaturation and sleep disruption with arousals. Oxygen desaturations and arousals cause an increase in pulmonary artery pressure and sympathoneural activity and therefore may reduce exercise capacity. Oxygen is an effective treatment of Cheyne-Stokes respiration and should improve exercise capacity in these patients. METHODS: The study was designed as a randomized crossover, double-blind, placebo-controlled trial: 22 patients were assigned to 1 week each of nocturnal oxygen and room air. After each week, polysomnography, maximal bicycle exercise with expiratory gas analysis and trail-making test were performed, and a health assessment chart was completed. RESULTS: Nocturnal oxygen significantly reduced the duration of Cheyne-Stokes respiration (162 +/- 142 vs. 88 +/- 105 min [mean +/- SD]; p < 0.005). Sleep improved as evidenced by less stage 1 sleep and fewer arousals (20 +/- 13 vs. 15 +/- 9/h total sleep time; p < 0.05) as well as more stage 2 and slow-wave sleep; nocturnal oxygen saturation also improved. Peak oxygen consumption during exercise testing increased after oxygen treatment (835 +/- 395 vs. 960 +/- 389 ml/min; p < 0.05). Cognitive function evaluated by the trail-making test improved, but daytime symptoms in the health assessment chart did not improve significantly. CONCLUSIONS: Successful treatment of Cheyne-Stokes respiration with nocturnal nasal oxygen improves not only sleep, but also exercise tolerance and cognitive function in patients with congestive heart failure.

Adult↗
PubMed2003

Tracking cognitive functioning over time: ten-year longitudinal data from a community-based study.

Over 10 years, a community-based sample age 65> or = years, with a starting cohort size of 1,206, was assessed biennially with the Mini-Mental State Exam; the Consortium to Establish a Registry for Alzheimer's Disease battery; Immediate and Delayed Recall of a Story; Verbal Fluency for P and S, Fruits and Animals; Clock Drawing; Temporal Orientation; and Trail Making tests. We report distributions of scores over time, at each wave, in (a) all individuals who were assessed at that wave, whether or not they participated in all waves, and (b) the Survivor subgroup of 425 participants who completed all tests at all 5 waves. Scores and factor structures remained remarkably stable over the study period. The most marked decline over time was seen on the Trail Making tests. As the survivors are de facto a largely healthy and motivated group, their data can be considered population-based healthy norms and may serve as a reference for other studies conducting repeated evaluations using the same tests.

Aged↗
PubMed1995

Cognitive function and biological correlates of cognitive performance in schizotypal personality disorder.

There is evidence that some schizophrenic patients have deficits on tests of cognitive function, particularly tests of executive function, including the Wisconsin Card Sorting Test (WCST) and the Trail-making Test, Part B. This study was conducted to determine the generalizability of these findings across the schizophrenia spectrum to schizotypal personality disorder (SPD). Forty DSM-III SPD patients, 56 nonschizophrenia-related other personality disorder (OPD) patients, and 32 normal volunteers from two medical centers performed tests of executive function such as the WCST, Trail-making Part B, Stroop Word-Color Test, and Verbal Fluency, as well as tests of more general intellectual functioning such as the Wechsler Intelligence Scale-Revised Vocabulary and Block Design subtests, and Trail-making Part A. SPD patients performed more poorly on the WCST and on Trail-making Part B than did OPD patients or normal subjects; the groups did not differ on tests of general intellectual functioning. SPD patients may share some of the cognitive deficits observed in schizophrenia.

Adult↗
PubMed1989

The effects of varying cigarette deprivation duration on cognitive and performance tasks.

The effects of varying times of cigarette deprivation on cognitive and performance tasks were examined. This study employed a between-subjects design in which five groups of smokers (9-10 subjects in each group) were compared on a vigilance task and cognitive measures as a function of length of deprivation (0, 2, 4, 8, or 24 hours). Each subject was tested during baseline ad-lib smoking and at one of the deprivation durations. Difference scores were compared between the 0-hour group and the 2-, 4-, 8-, and 24-hour groups. The results showed that there were no significant withdrawal effects on the measures at 2, 4, and 8 hours after cigarette deprivation with the exception of poorer performance on the Trail Making Test (B) at 4 hours, However, there were significant withdrawal effects at 24-hours deprivation. These included increased mean reaction time, increased variability in reaction time, and increased errors of commission on the vigilance task. There were near significant changes at 24-hours deprivation on the Trail Making Test (B) and Symbol Digits Modalities.

Adolescent↗
PubMed2003

Abnormal CNV in chronic heavy drinkers.

OBJECTIVE: We used the contingent negative variation (CNV), a slow negative shift in the human electroencephalogram, to investigate the effects of heavy chronic alcohol use on frontal lobe function. METHODS: Event-related potentials (ERPs) were recorded from 30 heavy drinkers (HD) and 30 age-, sex-, and education-matched light or non-drinkers (LD), using a classical two-stimulus reaction time (RT) paradigm. Structural magnetic resonance images and neuropsychological tests were also administered. RESULTS: The amplitude of the late CNV was significantly reduced in HD relative to light drinkers. Moreover, diminished CNV amplitudes in HD appear to be closely related to the amount of recent alcohol consumption. There were no significant differences in neuropsychological measures of frontal lobe function and frontal lobe volume between light and HD. However, in HD, reduced late CNV amplitudes were associated with decreased frontal lobe gray matter volume and poor performance on the Trail Making Test B. In LD but not in HD, late CNV amplitude correlated positively with RT, suggesting that the late CNV reflects some aspect of motor and cognitive preparation. CONCLUSIONS: The inverse relationships between frontal lobe gray matter volume, performance on the Trail Making Test B, and late CNV amplitude in HD suggest that the ERP abnormalities observed in the current study may be indices of alcohol-related damage to the frontal lobe. The lack of a significant relationship between CNV amplitude and RT in HD suggests that chronic heavy alcohol use may disrupt response preparation.

Adult↗
PubMed2003

Corpus callosum atrophy, white matter lesions, and frontal executive dysfunction in normal aging and Alzheimer's disease. A community-based study: the Tajiri Project.

BACKGROUND AND OBJECTIVES: Cerebral MRIs of normal aging and Alzheimer's disease (AD) frequently reveal corpus callosum (CC) atrophy, white matter hyperintensity (WMH), and hippocampal atrophy. However, their relationship or the relationship between these findings and cognitive function has not been fully studied. We investigated the relationship between CC atrophy, WMH, and hippocampal atrophy, together with frontal executive dysfunction in both normal aging and AD. METHOD: We examined 170 randomly selected residents from a designated community: 99 Clinical Dementia Rating (CDR) 0 (healthy, control group, HC) participants, 54 CDR 0.5 (very mild AD) patients, and 17 CDR 1 & 2 (probable AD) patients. By means of MRI, WMH and CC atrophy were visually rated. Four portions of the CC and the hippocampal width were measured. A Mini-Mental State Examination and Cognitive Abilities Screening Instrument (CASI) were performed to assess global function. For the frontal function, the CASI subitems of attention and word fluency, letter-based fluency, the Digit Symbol test of the WAIS-R, and Trail Making Tests were performed. RESULTS: Those patients with CDR 1 & 2 had both hippocampal and CC atrophy, whereas the CDR 0.5 patients had only hippocampal atrophy. Frontal executive dysfunction was associated with CC atrophy in both the HC and AD groups. Significant Spearman correlations were noted between CC atrophy and WMH in both groups. The combined effect of CC atrophy and WMH was noted only in the verbal fluency test in the HC group. CONCLUSION: In both groups, CC atrophy was associated with frontal executive dysfunction. The combined effect of CC atrophy and WMH in normal aging was probably due to subclinical ischemic conditions.

Aged↗
PubMed1994

Improvement by picoTesla range magnetic fields of perceptual-motor performance and visual memory in a patient with chronic progressive multiple sclerosis.

The occurrence of cognitive deficits in multiple sclerosis (MS) has been recognized since 1877 when Charcot first observed "enfeeblement of memory." It is now recognized that visuoperceptive and visuomotor deficits commonly occur in MS patients particularly in those with a chronic progressive course of the disease. Using various drawing tests as markers of constructional performance, we reported recently that treatment with picoTesla range magnetic fields (MF) rapidly improved visuoperceptive and constructional abilities in patients with MS. We now report a 58 year old man with a 37 year history of chronic progressive MS in whom external application of MF in the picoTesla range produced rapid improvement of neurologic symptoms including walking, balance, sensory symptoms, and bladder functions. The patient's recovery was associated with a significant improvement in perceptual-motor functions as demonstrated on the Rey-Osterrieth Complex Figure and the Trail Making tests. Specifically, the patient demonstrated a 41% improvement over pretest values on copying the Complex figure and a 72% improvement in recall of the figure immediately after MF treatment. A further 4% improvement on copying the figure and a 27% improvement on recall was demonstrated 24 hours later. On the Trail Making test the patient demonstrated an overall improvement of 39% in Part A of the test and a 24% improvement in Part B of the test 24 hours after application of MF. These findings confirm the beneficial effects of picoTesla range MF in the treatment of MS and demonstrate the unique efficacy of this treatment modality in improving some of the cognitive deficits of the disease.

Chronic Disease↗
PubMed2005

Interpretation of a complex picture and its sensitivity to frontal damage: a reappraisal.

A. R. Luria introduced the interpretation of a meaningful picture as a tool for assessing pre-frontal impairment. We gave this test to 196 normal adults, who were asked to communicate what was happening in the portrayed scene (a boy chases a mouse hidden under a cupboard, while three frightened girls assist). The same subjects were given two other frontal tests (verbal fluency on phonemic cue and Trail Making Test (TMT)) and Raven's Matrices. Twenty-three normal subjects (12%) failed to correctly interpret the picture. We also examined 20 patients whose brain lesion encroached upon pre-frontal areas, in order to check if this version of the test could be easily administered to this type of patient, and if its difficulty level was appropriate for avoiding ceiling and floor effects. Twelve patients were unable to interpret the picture (60%). A similar failure rate was observed with the same subjects on verbal fluency and TMT, while Raven's Matrices were less impaired (35%). Some dissociation was found between Picture Interpretation and the TMT. The Italian version of the Picture Interpretation Test is suitable for the examination of pre-frontal patients.

Adult↗
PubMed1998

The validity of psychometric instruments for detection of dementia in the elderly general population.

OBJECTIVE: To compare the validity of different instruments for screening and diagnosis of dementia and to provide threshold scores for these purposes, ie screening focusing on a high sensitivity and diagnosis focusing on a high specificity. SETTING: 287 subjects from a general population sample who had completed more than one of these psychometric tests. METHODS: The performances of the Structured Interview for the Diagnosis of Dementia of the Alzheimer Type, Multi-Infarct Dementia and Dementias of Other Aetiology according to ICD-10 and DSM-III-R, the Mini-Mental State Examination, the Blessed Dementia Rating Scale, the Global Deterioration Scale, the Verbal Fluency Test, the Word list Learning Task, the Trail Making Test and the Labyrinth Test were compared using receiver operating characteristics analysis. RESULTS: The validity of composite instruments for the discrimination of dementia and cognitive health was higher than the validity of individual tests. However, some cognitive tests, ie verbal fluency and immediate recall of words, reached a high validity, making them useful and short screening instruments for dementia. CONCLUSION: There is no perfect instrument for screening and diagnosis of dementia. Different threshold scores for different purposes were provided in the present study. Recommendations for improving the validity of the Delayed Word List Learning Task for discriminating dementia and cognitive health include the expansion of list length and shortening of delay.

Aged↗
PubMed2003

Short-term, delayed, and working memory are impaired during hypoglycemia in individuals with type 1 diabetes.

OBJECTIVE: To examine the effects of acute insulin-induced hypoglycemia on short-term, delayed, and working memory in individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS: A hyperinsulinemic glucose clamp was used to maintain arterialized blood glucose level at either 4.5 mmol/l (euglycemia) or 2.5 mmol/l (hypoglycemia) on two separate occasions in 16 adults with type 1 diabetes. The participants completed tests of immediate and delayed verbal memory, immediate and delayed visual memory, and working memory during each experimental condition. Two other mental tests, the Trail Making B Test and the Digit Symbol Test, were also administered. RESULTS: Performance in tests of immediate verbal and immediate visual memory was significantly impaired during hypoglycemia. The effect of hypoglycemia on working memory and delayed memory was more profound. Performance in the nonmemory tests, the Trail Making B Test, and the Digit Symbol Test also deteriorated during hypoglycemia. CONCLUSIONS: All of the memory systems examined in the present study were affected significantly by acute hypoglycemia, particularly working memory and delayed memory. Mild (self-treated) hypoglycemia is common in individuals with insulin-treated diabetes; therefore, these observed effects of hypoglycemia on memory are of potential clinical importance because they could interfere with many everyday activities.

Acute Disease↗
PubMed1982

Neuropsychological dysfunction following elective cardiac operation. I. Early assessment.

Two neuropsychological tests were administered to 227 men and women, ages 25 to 69 years, before and after coronary bypass and cardiac valve operations to provide current information regarding the incidence of postoperative decrements in neuropsychological dysfunction and the factors associated with them. Biographical, psychological, and medical-surgical data were studied together with changes in scores on the Trail Making Tests and the Visual Reproduction (VR) Test of the Wechsler Memory Scale (WMS). Postoperative decrements greater than one standard deviation were observed in each of the four scores derived from these testings for 11% to 17% of the patients. Yet 70% of all patients remained within one standard deviation of original performance on all four scores. Among the preoperative correlates of significantly reduced test performance were age greater than 60 years, end-diastolic pressure greater than 30 mm Hg, moderate to severely enlarged heart size on preoperative x-ray film, and use of propranolol or chlordiazepoxide hydrochloride. Significant perioperative correlates included measure of duration of operation (such as total time of operation greater than 7 hours, time on the pump greater than 2 hours, and aortic cross-clamp time greater than 2 hours), total estimate of blood loss greater than 2,000 ml, hypotension, difficult intubation, and insertion of an intra-aortic balloon. Postoperative factors significantly associated with declines in test scores included electrolyte (Na+, K+, Cl-) abnormalities, longer stay in the intensive care unit, bizarre behavior or disorientation, and depression score. These findings suggest that those patients with more precarious heart function, a more protracted operation, and/or increased metabolic disturbances are especially prone to neuropsychological dysfunction following cardiac operations.

Adult↗