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PubMed2001

Neuropsychological test performance in a cognitively intact sample of older Japanese American adults.

The purpose of this paper was to present population-based data showing the effects of age on cognitive test performance in a sample of older Japanese American adults. In addition, the relative effects of education, gender, and primary spoken language were compared to effects that have been reported in the literature for majority culture older adults. Subjects included 201 non-demented Japanese American adults age 70 and older currently enrolled in the Kame Project, a prospective study of aging and dementia in King County, WA. Cognitive tests included the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological assessment battery, WAIS-R Digit Span and Digit Symbol subtests, Trail Making Test, Purdue Pegboard, and Finger Tapping. Older age was associated with significantly (p<0.05) lower scores on all tests; less than high school education was associated with lower scores on all tests except Digit Span, Finger Tapping, and the Purdue Pegboard. Women and English-speaking participants scored higher than men and Japanese speakers on various tests of memory, attention, and visuomotor ability. These data reinforce the importance of using appropriately corrected norms when interpreting results of cognitive screening tests with minority culture older adults.

Journal Article↗
PubMed1988

Neuropsychological and neuroradiological correlates in Huntington's disease.

Measurements of cortical and subcortical atrophy were made on CT scans of 34 patients with Huntington's disease. Significant correlations were found between the bicaudate ratio (BCR) and an eye movement scale (r = 0.44, p less than 0.01), and activities of daily living scale (r = 0.57, p less than 0.001) and the Mini-Mental State Exam (r = 0.49, p less than 0.01). No correlations were found between BCR values and severity of chorea or voluntary motor impairment. A detailed neuropsychological evaluation of 18 Huntington's disease patients showed significant correlations between the BCR and Symbol Digit Modalities test (r = 0.65, p less than 0.01), and parts A (r = 0.72, p less than 0.001) and B (r = 0.80, p less than 0.0001) of the Trail Making Test. These data support work in primates that demonstrates the role of the caudate nucleus in cognitive and oculomotor functions, but not in motor control (which is governed by putamino-subthalamic systems). The specific cognitive skills correlated with caudate atrophy in Huntington's disease are those reported in primate work to be served by the frontal-caudate loop system: eye movements, conceptual tracking, set shifting and psychomotor speed.

Adolescent↗
PubMed1993

Neuropsychologic correlates of MRI white matter hyperintensities: a study of 150 normal volunteers.

To determine the effects of MRI white matter hyperintensities (WMH) on cognitive functioning, we used neuropsychologic tests and MRI to study 150 elderly volunteers free of neuropsychiatric or general disease. There were 76 (50.3%) individuals without and 74 (49.7%) with WMH. The latter subset was older (61.3 +/- 6.6 years versus 58.5 +/- 5.8 years, p = 0.005), had a higher mean arterial blood pressure (103.7 +/- 11.4 mm Hg versus 99.9 +/- 10.3 mm Hg, p = 0.03), and a larger ventricular-to-intracranial-cavity ratio (6.3 +/- 5.6% versus 4.7 +/- 1.6%, p = 0.02). Individuals with WMH performed worse than their counterparts without such abnormalities on all tests administered. After adjusting for the group differences in age, arterial blood pressure, and ventricular size, we noted statistically significant results on form B of the Trail Making Test (121.8 +/- 37.8 msec versus 100.3 +/- 47.9 msec, p = 0.04), a complex reaction time task (680.8 +/- 104.9 msec versus 607.1 +/- 93.9 msec, p = 0.001), and the assembly procedure of the Purdue Peg-board Test (27.5 +/- 5.8 versus 30.6 +/- 5.9, p = 0.02). Partial correlations did not reveal any relationship between test scores and the semiautomatically assessed total area of WMH. Our data suggest that the presence of WMH exerts a subtle effect on neuropsychologic performance of normal elderly individuals, which becomes particularly evident on tasks measuring the speed of more complex mental processing.

Adult↗
PubMed2005

Prolonged effects of concussion in high school athletes.

OBJECTIVE: To identify enduring prolonged neuropsychological effects of cerebral concussion in high school youth athletes. METHODS: High school athletes (n = 223) underwent baseline neuropsychological evaluation between 1999 and 2000, assigned to independent groups on the basis of concussion history: athletes with no concussion history or present medical and/or neuropsychological complaints (n = 82), symptom-free athletes who experienced one (n = 56) or two or more (n = 45) concussions (not in the prior 6 mo), and those who experienced a concussion 1 week before testing (n = 40). Main outcome measures included a structured clinical interview, demographic form, symptom checklist, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Trail Making Tests A and B. Analyses of variance were used to determine between-group differences. RESULTS: Athletes with recent concussions performed significantly worse on measures of attention and concentration than youth athletes with no concussion history. Symptom-free athletes with a history of two or more concussions performed similar on testing to youth athletes who had just experienced a recent concussion. Similarly, cumulative academic grade point averages were significantly lower not only for youth athletes with two or more previous concussion groups, but for youth athletes who experienced recent concussions, suggesting that athletes with lower grade point averages may be more prone to concussion. CONCLUSION: There seem to be subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.

Adolescent↗
PubMed2003

Significant improvement in frontal lobe associated neuropsychological functions after withdrawal of topiramate in epilepsy patients.

RATIONALE: Topiramate (TPM) is a highly effective anticonvulsant drug, but a comparably high rate of cognitive adverse effects have been reported. In this study, we investigated changes in frontal lobe associated cognitive measures after TPM withdrawal in epilepsy patients hospitalized for presurgical evaluation. METHODS: Twenty epilepsy patients were administered a brief neuropsychological test battery before and after withdrawal of TPM. Neuropsychological evaluation included a verbal fluency task, verbal (Wechsler's digits) and spatial spans (Corsi block-tapping) and Trail Making Test (TMT, parts A and B). Median baseline dosage of TPM was 237.5mg/d, the median retest-interval was 8 days. Results were compared to a matched group of patients, who had been tested and retested before and after reduction of AEDs other than TPM at comparable time intervals. RESULTS: After TPM withdrawal, group performance appeared significantly improved in five of six tests administered. The scores of the control patients remained largely unchanged after drug reduction. After withdrawal, the scores of the TPM group did not differ significantly from the results of the control group whereas pronounced differences had been observed before. Individual improvement became apparent in the majority of patients. Cognitive performance was not correlated to current daily dosages/current blood serum levels of TPM. CONCLUSION: Withdrawal of TPM causes significant improvement in frontal lobe associated measures like verbal fluency and working memory. As withdrawal was part of the preoperative work-up, and not initiated because of patients' complaints or hints of intoxication, cognitive impairment due to TPM appears to be easily overlooked and underestimated.

Adult↗
PubMed2006

Population-based case-control study of cognitive function in essential tremor.

OBJECTIVES: To determine whether patients with essential tremor (ET) have cognitive deficits when compared with controls and whether the types of cognitive deficits reported previously are also found in this large sampling of patients with ET. METHODS: A total of 232 patients with ET and 696 matched controls age 65 years or older (median 75 years) living in central Spain (the Neurologic Diseases in Central Spain study) underwent a neuropsychological assessment, including tests of global cognitive performance, frontal executive function, verbal fluency, and memory. Subjects also were asked whether they had forgetfulness. RESULTS: Fifty-six patients with ET were previously undiagnosed; only 14 (6%) were taking medication for tremor. Adjusted for age, gender, education, premorbid intelligence, medications, and depressive symptoms, cases performed less well on most neuropsychological tests and especially tests of global cognitive performance (37-item Mini-Mental State Examination = 27.0 +/- 6.7 in cases vs 28.9 +/- 5.9 in controls, p < 0.001) and frontal executive function (Trail Making Test number of errors = 8.7 +/- 11.0 in cases vs 3.8 +/- 7.6 in controls, p < 0.001). Forgetfulness was reported in 117 (50.4%) patients with ET vs 300 (43.1%) controls (p = 0.05). CONCLUSIONS: In a population-based sample of largely untreated patients with essential tremor, cases performed more poorly on formal neuropsychological testing than did their counterparts without tremor. A complaint of forgetfulness was also marginally more common in patients with essential tremor.

Age Factors↗
PubMed2004

The Adjusting-Paced Serial Addition Test (Adjusting-PSAT): thresholds for speed of information processing as a function of stimulus modality and problem complexity.

A modified computer version of the PASAT (Adjusting-PSAT; ) is described that measures speed of information processing and working memory by means of a temporal threshold rather than number of correct responses. This is accomplished by making the duration of the interval between numbers depend on the correctness of responding-a correct response decreases the interval between digits and an incorrect response increases the interval. Modality of presentation (visual and auditory) was factorially combined with problem difficulty (answers between 2-10 or 2-18). Performance of 60 healthy student volunteers on the Adjusting-PSAT was compared to that obtained on several traditional neuropsychological measures (Digit Span, Trail Making Test, and Symbol Digit Modality Test) and on a test of basic addition skills. The visual version of the test produced a lower threshold than did the auditory version, but problem difficulty did not produce a significant effect. Of the neuropsychological tests, Trails-B (TMT-B) was most highly correlated with thresholds. However, regression analyses revealed that math ability accounted for more variance than did TMT-B. The clinical implications of these finding are discussed.

Acoustic Stimulation↗
PubMed1992

Cognitive function in major depression.

Forty patients with a major depressive episode were divided into equal endogenous and neurotic sub-groups using the Newcastle scale. They were all rated on the 17-item Hamilton scale and with a variety of neuropsychological tests. They were compared with 20 age- and education-matched control subjects. Both endogenous and neurotic groups had impaired memory function on the auditory verbal learning test; recall and recognition were equally impaired suggesting that effort was not a major determinant of performance. The endogenous group was more impaired on digit symbol substitution and the Trail making test (A and B). Impairment was correlated with symptom scores on the Hamilton and Newcastle scales, even after allowing for the effect of age. It is concluded that the conventional distinction between organic and functional impairment breaks down in severe depressive illness. The implications of this for clinical neuropsychological testing and the anatomy of the brain dysfunction in depressive illness are discussed.

Adult↗
PubMed2005

Impairments of executive/attentional functions in schizophrenia with primary and secondary negative symptoms.

Frontal cognitive inabilities have been amply described in schizophrenic patients with negative symptoms, but findings are controversial. These discrepancies could be due to the fact that negative symptoms are heterogeneous, composed of primary and secondary negative symptoms. The hypothesis tested was that executive/attentional dysfunctions would be significantly more impaired in patients with primary than in patients with secondary negative symptoms independently of IQ, the severity of negative or positive symptoms, treatments and side effects. Fifty-six DSM-IV schizophrenic patients characterized either by primary or secondary negative symptoms and 56 controls matched on age, sex and level of education were assessed with executive/attentional cognitive tests. The categories score of the Modified Card Sorting Test (MCST) and the Verbal Fluency Test, which reflect solving and organizing skills, were significantly more impaired in the primary negative subtype than in the secondary negative subtype. In contrast, scores on the MCST (perseveration), the Trail Making Test and the Stroop Color Word Test, which test the ability to inhibit an automatic response, did not differ between the two subtypes. In conclusion, this study supports the view that primary and secondary negative symptoms could be associated with different levels of executive/attentional dysfunctions.

Adolescent↗
PubMed2000

Neuropsychological functioning among heart transplant candidates: a case control study.

Neuropsychological performance was examined among a group of patients with end-stage heart disease undergoing routine evaluation for transplantation using a matched case-control design. Heart transplant candidates and controls were matched case by case for gender, race, education and age range. In order to match all 44 controls, a clinical series of 303 heart transplant candidates evaluated between October 1995 through March 1998 were considered. Although not specifically matched on variables of estimated IQ and socioeconomic status, statistical analysis showed no group differences on these variables. A separate analysis of variance on each neuropsychological test indicated that the heart transplant candidates performed significantly worse than controls on tasks of fine motor speed and dexterity (i.e., Grooved Peg Board), psychomotor speed and mental flexibility (i.e., Trail Making Test, Part B), and abstract reasoning and problem solving ability (i.e., Shipley Institute of Living Scale-Abstraction subtest). Implications of the results and future directions are discussed.

Adult↗
PubMedDate not supplied

Neuropsychological findings in adult attention deficit disorder: a pilot study.

Relatively little is known about neuropsychological deficits in adults with Attention Deficit Disorder (ADD). This paper presents data for a consecutive series of 11 adults diagnosed as having adult ADD. The sample had a mean age of 33 4 years (range=22-56) and mean education of 15 years (range=8-19) and included 5 women and 6 men All were Caucasians. A neuropsychological test battery was administered. The results suggested few neuropsychological deficits except in the initial acquisition of verbal information on the Logical Memory Subtest, the Wechsler Memory Scale, and the Category Test. When a subsample was examined using age-, education-and gender-corrected norms, there appeared to be a tendency to obtain borderline scores on part B of the Trail Making Test and Category Test, but normal scores on the Rhythm Test, Speech Sounds Perception Test and Finger Tapping Test. These findings argue for the neuropsychological evaluation of adults suspected of having ADD.

Journal Article↗
PubMedDate not supplied

Cognitive test performance and presence of subclinical cardiovascular disease in the cardiovascular health study.

The purpose of the present study was to investigate the relationship between performance on a comprehensive battery of neuropsychological tests and the presence of clinical, subclinical or no cardiovascular disease in an elderly community-dwelling population. The results confirm previous reports of significant associations of age, education and gender with test performance. When performance was examined controlling for these variables, significant associations of disease group were seen with five measures emphasizing speed of performance; Parts A and B of the Trail Making Test, the WAIS-R Digit Symbol and Block Design subtests and category verbal fluency. These results add to the evidence that, in addition to other health implications, cardiovascular disease is related to cognitive functioning in the elderly even at subclinical levels.

Aged↗
PubMed2005

Hypertension and cognitive decline: impact on executive function.

Hypertension is a risk factor for mild cognitive deterioration and vascular dementia. Cognitive deterioration attributable to normal aging was distinguished from cognitive deterioration related to hypertension by means of neuropsychologic tests. Sixty hypertensive patients, aged 65-80 years, were compared with 30 normotensive individuals. Patients with a history of stroke and/or transient ischemic attacks, diabetes, atrial fibrillation, hypercholesterolemia, or bypass surgery, and those diagnosed with dementia, depression, or anxiety, were excluded. Neither gender differences, duration of hypertension (10.2+/-8.2 years), nor prescribed antihypertensive drug treatment had an influence on study results. Immediate recall was impaired in both groups. The hypertensive patients evinced impairment in all tests vs. the normotensive subjects. Mean deferred recall scores +/- SD were 5.68+/-2.6 vs. 7.13+/-2.4; p<0.01. Deficits in attention speed and executive function, as measured by nonperformance on the Trail Making Test Part B, were present in 46% of hypertensive patients vs. 13% of normotensive patients (p<0.005), with more errors made by the hypertensive patients (1.15+/-1.54 vs. 0.46+/-0.9; p<0.02). Scores on the Stroop Color and Word Test also revealed deficits in the hypertensive patients (24.7+/-7.6 vs. 32+/-10.7; p<0.005). Compared with the control group, the hypertensive participants revealed more deficits in skills involving delayed recall and prefrontal-region skills. The relevant neuropsychologic tests were sufficiently sensitive and proved easy to use in clinical practice.

Adrenergic beta-Antagonists↗
PubMed2000

Evaluation of the supervisory system in elderly subjects with and without disinhibition.

UNLABELLED: Disinhibition and irritability, defined as loss of behavioral and emotional control, are frequent in the elderly. The working hypothesis for this study was that these disorders are associated with a cognitive alteration of control processes that manifests as non-routine behavior because of the dysfunction of a general executive component known as the supervisory attentional system (SAS). METHODS: A total of 28 elderly subjects with mild cognitive impairment were recruited and divided into two groups using the Neuropsychiatric Inventory. Fourteen subjects were allocated to the disinhibited group and 14 subjects matched for age, sex and educational level formed a disinhibition-free control group. The neuropsychological battery included the following tests: Mini Mental Score Evaluation, Boston Naming test, Token test, Trail Making and Verbal Fluency. Two tasks were specifically designed to stress the SAS: 1) A specific verbal sentence arrangement task in which subjects had to use sequential reasoning with verbal material. Each test sequence consisted of a series of words shown in jumbled order. The construction of some sequences had to be done by using familiar routine associations (valid conditions). In contrast, other sequences required the overriding selection of familiar routine associations, which were inappropriate within the general context of the task (invalid conditions). 2) Using the Continuous Performance Test, four aspects were evaluated: sustained, selective, preparation and suppressive attention. RESULTS: The only group differences in neuropsychological test results were the following: 1) the sentence arrangement task. In comparison with the control group, the disinhibited group was impaired in invalid conditions and the calculated difference between the number of correct responses in invalid conditions minus that in valid conditions was significantly higher; and 2) the CPT. Disinhibited subjects had a significantly lower number of hits, exclusively in the 'suppressive attention' paradigm. These results suggest that subjects with disinhibition have impaired supervisory system function.

Aged↗
PubMed2003

Neuropsychological correlates of P300 abnormalities in patients with schizophrenia and obsessive-compulsive disorder.

The cognitive significance of P300 abnormalities in schizophrenia and obsessive-compulsive disorder (OCD) was investigated. P300 was measured by an auditory oddball paradigm, in which a series of standard tones (1000 Hz) and target tones (1500 Hz) were presented. The subject's task was to count the number of the presented target tones. Cognitive functions were evaluated by neuropsychological tests, which were chosen to be sensitive to frontal and temporal dysfunction. Twenty-two schizophrenic patients, 19 OCD patients and 21 healthy controls participated. Event-related potentials measured at 15 electrode sites, which consisted of five levels on the left-right dimension and three levels on the anterior-posterior dimension, were included in the statistical analysis. P300 amplitudes on all 15 electrode sites were significantly smaller in schizophrenic and OCD patients than in the controls. Schizophrenic patients performed poorly on almost all neuropsychological tests, while OCD patients showed impaired performance on the Rey-Osterrieth Complex Figure Test and on a controlled oral word association test. In schizophrenic patients, P300 amplitude was associated with performance on verbal memory and learning by the Luria-Nebraska Neuropsychological Battery, while for OCD patients, P300 amplitude was related to the Trail Making Test, Part B response time. These results indicate that schizophrenic patients have generalized cognitive impairments, which are substrated by a wide range of cortical dysfunctions. The major cognitive deficits observed in OCD patients were impairments of controlled attention and self-guided, flexible behavior, which are mediated by the fronto-striatal system. The neurophysiological mechanisms underlying P300 abnormalities observed in schizophrenic and OCD patients are discussed.

Acoustic Stimulation↗
PubMed1997

Neuropsychological prediction of psychosocial outcome after traumatic brain injury.

The ability of neuropsychological tests to predict later psychosocial outcome on the Community Integration Questionnaire (CIQ; WiIler, Rosenthal, Kreutzer, Gordon, & Rempel, 1993) was examined. A previous investigation by Millis, Rosenthal, and Lourie (1994) found that the Trail Making Test (TMT; Lezak, 1995) and the Rey Auditory Verbal Learning Test (RAVLT; Lezak, 1995) were related to performance on the CIQ at 1 year postinjury. The RAVLT and the TMT Parts A and B (TMT-A, TMT-B) in conjunction with age at time of injury significantly predicted psychosocial outcome as measured by individual self-report. When self-reported functioning was examined by domain, these variables significantly predicted home and social adaptation. These variables were applied to significant others' reports of community integration, where age and the TMT remained significant predictors of psychosocial outcome. These results underscore the utility of neuropsychological measures in the prediction of later community integration after traumatic brain injury.

Journal Article↗
PubMedDate not supplied

Driving evaluation practices of clinicians working in the United States and Canada.

OBJECTIVE: To determine off-road and on-road driving evaluation practices of clinicians in the United States and Canada who assess individuals with disabilities for fitness to drive. PARTICIPANTS: Participants were 114 clinician attendees at the 2003 annual Association of Driver Educators for the Disabled with driving assessment experience ranging from 1 month to 25 years. MEASURES: Information was elicited regarding the clinician, clientele, referral practices, and off-road and on-road driving evaluation practices and retraining practices using a self-administered questionnaire. RESULTS: Participants were largely occupational therapists (68%) who worked in 42 different states and provinces. The most prevalent clientele were persons with traumatic brain injury (97%) and stroke (96%). Testing times greater than 60 min were common for both the off-road (61%) and on-road (49%) evaluations. Commonly performed off-road assessments included the Brake Reaction Timer; Trail Making Test, Parts A and B; and the Motor Free Visual Perception Test, used by 73%, 72%, and 66%, respectively; comprehensive computer-based driving evaluation was rare. Sixty-one percent indicated that all clients underwent on-road evaluation regardless of the off-road results. Finally, 78% used a standard driving route, whereas 24% used a scoring system to evaluate on-road driving. CONCLUSION: Driving assessment in Canada and the United States is multidimensional and time-intensive. Although the domains being assessed are similar across clincians, specific off-road and on-road assessment practices vary greatly. The majority use nonstandardized on-road assessments.

Automobile Driver Examination↗
PubMedDate not supplied

[Psychometric procedures and questionnaires in geronto-psychological research].

This paper presents the Nuremberg-Geriatric Inventory (NAI), a test and questionnaire battery for geronto-psychological and pharmacological problems. This inventory consists of three modified subtests of the Wechsler-Adult-Intelligence-Scale (WAIS), a maze-pathway, a modified Trail Making test (ZVT), a psychological rating scale, a rating scale for activities-of-daily-living, a self-rating and a questionnaire, containing problems of growing old. The objectivity, reliability and validity of all tests and scales are described, as well as some norms for different groups of patients. First experiences and results using this inventory in longitudinal studies and pharmacological investigations are reported.

Aged↗