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PubMed2006

Long-term cognitive impact of anticholinergic medications in older adults.

OBJECTIVE: The objective of this study was to determine whether chronic use of medications with anticholinergic (AC) properties impact older adults' cognitive functioning. METHODS: Six years of cognitive test data from two groups of older adults (AC and control) were examined retrospectively (N = 592). RESULTS: Declines over time were found for the AC group on parts A and B of the Trail Making Test. CONCLUSION: Physicians prescribing ACs to older adult patients should be aware of their potential effects on psychomotor speed and executive functioning. These cognitive effects may lead to impairments in daily functioning resulting in the need to reevaluate patient medications.

Aged↗
PubMed1999

Type-2 diabetes and cognitive function in a non-demented population.

OBJECTIVES: To study if type-2 (non-insulin-dependent) diabetes mellitus (NIDDM) is associated with cognitive dysfunction independently of clinically diagnosed dementia in an elderly population. MATERIAL AND METHODS: Cognitive function was investigated with a brief neuropsychological test battery in a non-demented elderly population consisting of 183 NIDDM (World Health Organization, 1985) patients and 732 non-diabetic subjects. RESULTS: Patients with NIDDM were impaired in the Trail-Making Test parts A and C, which may be a reflection of mildly affected frontal lobe/executive functions. Women with NIDDM performed better than non-diabetic subjects in the Mini-Mental State Examination. CONCLUSIONS: We conclude that NIDDM per se is not associated with impaired memory in the elderly, and the minor defects observed in tests of frontal lobe/executive functions are unlikely to affect daily living. In the non-demented population aged 69 78 years, NIDDM does not carry a significant risk of cognitive dysfunction, when compared to the non-diabetic subjects.

Activities of Daily Living↗
PubMed2006

Reading ability mediates the relationship between education and executive function tasks.

Neuropsychological test results are affected by multiple factors, but usually age and education are the only variables by which norms are stratified. Some authors have questioned whether these variables alone are sufficient (e.g., Marcopulos et al., 1997; Manly et al., 2002), since such norms have lead to problems, such as poor specificity for African Americans on dementia screening devices (Fillenbaum et al., 1990). Recent research has shown that reading ability, a measure of educational quality, attenuated racial differences in test performance (Manly et al., 2002). We specifically examined whether reading ability would account for a greater amount of variance than education in executive function tests in a population traditionally subject to poor educational quality. Results determined that reading ability accounted for a significantly greater amount of variance than years of education for Letter-Number Sequencing, Similarities, COWA, Trail Making Test, and Coloured Progressive Matrices. Reading ability was found to significantly mediate the relationship between each of these tests and education. Animal naming appears to be least affected by educational quality or quantity. These findings hold implications for the interpretation of neuropsychological test results, especially in those exposed to substandard educational quality, and for the way that test norms are constructed.

Achievement↗
PubMed1999

Association between executive attention and physical functional performance in community-dwelling older women.

OBJECTIVES: Executive functions supervise the contents of working memory, where information from long-term memory is integrated with information in the immediate present. This study examined whether executive attentional abilities were uniquely associated with the performance of complex, instrumental activities of daily living (IADLs) in cognitively intact and physically high-functioning older women. METHODS: Participants were 406 community-residing, older women aged 70-80 years in the Women's Health and Aging Study (WHAS) II, screened to be physically high functioning and cognitively intact using the Mini-Mental State Exam. Hierarchical regression models, adjusted for demographic and disease variables, were used to evaluate the association of cognitive domains, including executive attention, memory, psychomotor speed, and spatial ability with summary measures of IADL (e.g., looking up and dialing a telephone number) and mobility-based ADL (e.g., walking 4 meters) function. RESULTS: Tests of executive attention were associated with performance on IADLs (6.6%) and, to a lesser degree, mobility-based ADLs (1%), adjusting for demographic and disease variables. In particular, the mental flexibility component of the Trail Making Test accounted for the majority of attentional variance in IADL performance. Older age, lower education, and African American race were also associated with poorer physical test performances. DISCUSSION: Executive difficulties in flexibly planning and initiating a course of action were selectively associated with slower performance of higher-order IADL tests, relative to other domains of cognition, in a high-functioning, community-based older cohort. These results suggest that executive functions may be important in mediating the onset and progression of physical functional declines.

Activities of Daily Living↗
PubMed1970

Method for measuring cerebral dysfunction in patients with liver disease.

Objective tests of cerebral function were undertaken in 64 outpatients after portal decompression for intrahepatic portal hypertension. These involved scoring the errors in constructing a five-pointed star, and a simple modification of the Reitan trail making test. The first test was found to be less discriminating than the second. There was some correlation between the results and the presence or absence of overt encephalopathy, which-though generally mild-was present in 30 (47%) of the 64 patients.

Adult↗
PubMed1995

Recombinant erythropoietin improves cognitive function in patients maintained on chronic ambulatory peritoneal dialysis.

Psychometric performance was studied in 17 patients maintained on CAPD. Nine patients treated with rHuEpo performed a battery of psychometric tests before treatment (haemoglobin mean (SD) 6.8 (0.8) g/dl) and after partial correction of anaemia (haemoglobin 9.0 (1.0) g/dl). The same battery of psychometric tests was administered to eight patients (haemoglobin 7.7 (0.7) g/dl), matched with the treatment group for age, duration of dialysis and social class, who did not receive rHuEpo. The National Adult Reading Test was used in all patients to estimate the premorbid IQ (the peak cognitive level attained before any cognitive deterioration). In the rHuEpo-treated group current IQ, measured by a short form of the Wechsler Adult Intelligence Scale--Revised, improved by a mean of 7.2 points (P < 0.01) and approached estimated premorbid levels, while in the control group an improvement by 0.3 points was not significant. Concentration and speed of information processing were assessed by the Paced Auditory Serial Addition Task and also improved in the treatment group (P < 0.05). Memory, assessed by the Rey Auditory Verbal Learning Test, tended to improve in the treatment group with amelioration of anaemia, although only the improvement in delayed recall was significant. No overall change was seen in either group in the time taken to complete the Trail Making Test (part A). These results are consistent with our earlier findings in haemodialysis patients, indicating that anaemia makes a reversible contribution to uraemic cognitive dysfunction.

Adult↗
PubMed2005

EpiTrack: tracking cognitive side effects of medication on attention and executive functions in patients with epilepsy.

RATIONALE: Achievement of maximum seizure control with preservation or even improvement of patient's cognitive capabilities is the major aim of epilepsy therapy. EpiTrack is a brief screening tool for the tracking of cognitive side effects of antiepileptic drugs. Test selection was based on recent studies on the effects of topiramate on cognition and retrospective inspection of results from patients with antiepileptic drug (AED) side effects. METHODS: The 15-minute screening tool comprises six subtests: the Trail-Making Test (parts A and B), a test of response inhibition, digit span backward, written word fluency, and a maze test. These tests were standardized in 220 healthy subjects, 100 of whom were reevaluated after 5.3 months to obtain information on reliability and practice effects. Criterion validity was determined by correlation to other neuropsychological measures. For a first clinical evaluation, the impact of epilepsy (seizures) and medication on EpiTrack scores was evaluated cross-sectionally in 184 consecutive inpatients with chronic epilepsy. RESULTS: According to the normative data, we developed an easy scoring scheme assigning test scores on a 7-point scale. The EpiTrack is suitable for patients between 18 and 60 years of age. Age corrections were included for patients between 40 and 60 years. EpiTrack scores on subtests for both controls and patients were submitted to principal component analysis. VARIMAX rotation yielded a two-factor solution (verbal/visuo-spatial) that accounted for 63.8% of the total variance in controls. In the patient group, only one factor emerged accounting for 54.7% of variance. EpiTrack correlates with global scores of attention (r=0.85) and language (r=0.67) (P's<0.001). At a cutoff score of 25, only 2.7% of the controls were classified as impaired, while impairment was indicated in 48.4% of the patients. The score is sensitive to monthly frequency of complex partial seizures and to number of AEDs. It shows negative cognitive effects of valproate and topiramate given in mono/polytherapy. CONCLUSION: EpiTrack is a promising 15-minute screening tool for the detection and tracking of cognitive side effects of AEDs and adverse effects of seizures in patients with epilepsy. Future application will show its value in prospective follow-up studies on AED side effects.

Adolescent↗
PubMed1998

Validity of regression-based norms: an empirical test of the comprehensive norms with older adults.

This study empirically tested Fastenau and Adams' (1996) concerns about using regression-based norms (RBN) to statistically correct for demographic influences. A widely used RBN system (Heaton, Grant, & Matthews, 1991) was applied to scores from 63 healthy older adults for the Trail Making Test, Boston Naming Test, and Wisconsin Card Sorting Test (WCST). Age influences on all tests were virtually eliminated by the RBNs, whereas education influences were created by the RBN (better educated older adults penalized by the norms). Using RBNs from the Revised WCST Manual also created distortions, far overcorrecting for age. These findings cast considerable suspicion on norms that are generated by statistical regression when there are not adequate numbers of people supporting each demographic cell. Clinically, these norms can lead to higher rates of false negatives (or missed diagnoses) in older adults, especially those with less education and especially women in their 60s.

Adult↗
PubMed1998

Do antiarthritic drugs decrease the risk for cognitive decline? An analysis based on data from the MRC treatment trial of hypertension in older adults.

We ascertained nonsteroidal anti-inflammatory drug (NSAID) use in 2,651 participants in the UK MRC treatment trial of hypertension in older adults and measured change in cognitive function over the subsequent 54 months. There was a significant, although modest, association between change in the Paired Associate Learning Test score over time and NSAID use, which was modified by age. NSAID users showed less decline, with younger subjects seeming to benefit more than older. We found no relationship between NSAID use and time taken to complete the Trail Making Test and also no relationship between anti-indigestion drug use and either cognitive outcome. These analyses highlight the need for larger studies with prospective classification of NSAID use and adequate control of confounding, including exposure to other medications. A randomized controlled trial of NSAIDs, in those known to be at risk of cognitive decline or dementia, may be indicated in the future.

Adrenergic beta-Antagonists↗
PubMed1995

Construct validity of various verbal and visual memory tests.

Factor analysis was conducted on attention, information processing, verbal and visual memory scores of 112 patients. Factor structure did not vary as a function of age. The Expanded Paired Associates Test, Verbal Selective Reminding Test, Continuous Recognition Memory Test, and Continuous Visual Memory Test defined a general memory factor. The PASAT, WMS Mental Control, and WAIS-R Digit Span defined an attention/information processing factor. Immediate Visual Reproduction (VR) loaded primarily on visual/nonverbal intelligence, whereas delayed VR loaded primarily with the memory factor. The Trail Making Test, Part B was more closely associated with visual/nonverbal intelligence than with attention/information processing. Serial Digit Learning was more closely associated with attention/information processing than with general memory.

Adolescent↗
PubMed2005

Effects of mild traumatic brain injury cannot be differentiated from substance abuse.

PRIMARY OBJECTIVE: Patients involved in litigation relating to mild traumatic brain injury (MTBI) typically undergo a forensic neuropsychological evaluation. However, if cognitive problems are identified, it is difficult to know whether these are related to the MTBI or other factors such as pre- and/or post-injury substance abuse. The purpose of this study was to compare the neuropsychological test performances of 73 patients with acute, uncomplicated MTBIs to a sample of 73 patients from an inpatient substance abuse programme. METHODS AND PROCEDURES: Patients were perfectly matched on age, education and gender. Ten cognitive measures were used that included the Trail Making Test (TMT) and selected sub-tests from the Wechsler Memory Scale-Revised. MAIN OUTCOMES AND RESULTS: Patients with MTBI demonstrated poorer performances on Digits Backwards (p < 0.028) and TMTA (p < 0.032). There were no significant differences between the two groups on the remaining cognitive measures. The clinical usefulness of these measures to differentiate between the groups, using discriminant function analysis, was very poor. CONCLUSIONS: Patients with uncomplicated MTBIs could not be reliably differentiated from patients with substance abuse problems on these measures of concentration, memory and processing speed.

Adolescent↗
PubMed2004

Relationship between neuropsychological test performance and productivity at 1-year following traumatic brain injury.

While there has been strong evidence for the ability of neuropsychological performance at resolution of posttraumatic amnesia to predict later productivity, there has been less conclusive evidence for the relationship of neuropsychological test scores to concurrent productivity status. The purpose of the current study was to evaluate the relationship of neuropsychological test performance at 1 year post-injury to productivity assessed at the same time point. Participants were 518 persons with medically documented TBI who were enrolled in the TBI Model Systems Research and Demonstration Project. Stepwise logistic regression was utilized to determine the contributions of neuropsychological test scores to productivity after accounting for demographic characteristics, injury severity, and pre-injury productivity. Missing neuropsychological test scores were accounted for in the model. Variables that remained in the model and accounted for a significant proportion of the variance included age, duration of impaired consciousness, pre-injury productivity, and scores on measures of GOAT, Logical Memory II, and Trail Making Test, part B. The results indicate that neuropsychological test performance provides important information regarding the ability of persons with injury to return to productive activities. The results also indicate that inability to complete neuropsychological tests at 1 year post-injury is associated with non-productive activity.

Adolescent↗
PubMed2005

The Rey-Osterrieth Complex Figure as a measure of executive function in childhood.

In adults, the Rey-Osterrieth Complex Figure (ROCF) can be used for the assessment of not only visuoconstructional ability and visual memory, but also executive function in adults. We studied whether ROCF scores also correlated with executive function in childhood. The subjects consisted of 56 patients with various neurological diseases (5 years 7 months-14 years 11 months; mean: 8 years 8 months; M 42, F 14) whose full-scale IQs were 70 or higher (mean: 93.3). All subjects underwent the Wechsler Intelligence Scale for children third edition (WISC-III) and various psychological tests focusing on executive function. We evaluated the ROCF with the Boston Qualitative Scoring System (BQSS). We calculated the partial correlation coefficients between the BQSS Summary Scores and representative scores of other executive function tests, using age as the control variable. Among the scores of the various examinations, the Perseverative Errors of Nelson of the Wisconsin Card Sorting Test, the raw scores of the Mazes (WISC-III), the Digit Span (WISC-III), and the Block Design (WISC-III) were correlated significantly with two to four BQSS Summary Scores (P<0.05 or P<0.01). In contrast, the scores of the Trail Making Test, the Stroop Test, and the Commission Error of Continuous Performance Test-II did not show a significant correlation with any of the BQSS Summary Scores. The ROCF evaluated with the BQSS reflects not only visuoperceptual ability and visuoconstructional ability, but also executive function, especially planning and organization. However, a new BQSS Summary Score should be devised since no existing BQSS index specifically reflects executive functions with an outstandingly strong correlation.

Adolescent↗
PubMed1987

Neuropsychological test performance and CSF levels of monoamine metabolites in healthy volunteers and patients with Alzheimer's dementia.

Fifteen patients (51-78 yrs) with mild to moderately severe Alzheimer's dementia and 18 healthy subjects of the same age were examined by clinical rating scales and a battery of neuropsychological tests. Levels of the monoamine metabolites homovanillic acid (HVA), 3-methoxy-4-hydroxyphenyl glycol (MHPG) and 5-hydroxyindoleacetic acid (5-HIAA) were determined in the lumbar cerebrospinal fluid (CSF). Correlations between clinical, psychological and biochemical measures were calculated in order to elucidate whether monoaminergic mechanisms are of importance for the maintenance of cognitive abilities in normal and pathological aging. The patients' performance was severely impaired in all neuropsychological tests. The mean levels of monoamine metabolites, however, did not differ between patients and volunteers. The correlations between psychological test scores and CSF metabolite levels were generally low, but mostly negative, associating a poor performance to a high activity of brain monoaminergic neurons. Thus, among the volunteers high 5-HIAA and MHPG levels correlated with poor performance in the Picture completion and the Trail making tests--measures of visuo-perceptual and visuo-motor skills. In the demented patients poor performance in the memory tests was associated with high levels of HVA and 5-HIAA. The results indicate that monoamine neuron activity is not a primary determinant for cognitive abilities in healthy elderly subjects or in demented patients. The slight negative correlation between cognitive function and metabolite concentrations in the patients may reflect a disturbance in a dopaminergic-cholinergic balance due to degenerative changes of central cholinergic pathways.

Aged↗
PubMed2006

Neuropsychological normalization with long-term atypical antipsychotic treatment: results of a six-month randomized, double-blind comparison of ziprasidone vs. olanzapine.

The authors examined cognitive changes associated with treatment with ziprasidone and olanzapine over a 6-month double-blind clinical trial, using normative standards for the cognitive measures. Sixty-two schizophrenia patients entered the study on ziprasidone treatment (39 completers), and 71 patients entered while receiving treatment with olanzapine (33 completers). From a larger set of cognitive domains assessed in the acute treatment study, we selected verbal learning, executive functioning, and verbal fluency for further analysis due to their functional relevance and extensive normative data. Standard scores were developed based on previously published age- and education-corrected norms. Baseline performance was impaired across all tests on average. The proportion of patients impaired on each of the tests at baseline ranged from 36% (letter fluency) to 89%. Performance was significantly improved by ziprasidone and olanzapine treatment for all cognitive variables and for the composite measure. A number of subjects met the a priori criteria for normalization in performance, ranging from 10% for Trail Making Test Part B to 37% for Word List Total Learning. There were no significant differences across medications in extent of change or likelihood of inducing normalization. Statistically significant improvements in cognitive performance over 6 months of treatment with atypical antipsychotic medications are associated with performance increasing into the normal range of cognitive functioning in a proportion of previously impaired patients.

Adult↗
PubMed2001

Neuropsychological dysfunction in patients suffering from end-stage chronic obstructive pulmonary disease.

Few studies have examined the neuropsychological sequelae associated with end-stage pulmonary disease. Neuropsychological data are presented for 47 patients with end-stage chronic obstructive pulmonary disease (COPD) who were being evaluated as potential candidates for lung transplantation. Although patients exhibited a diversity of neurocognitive deficits, their highest frequencies of impairment were found on the Selective Reminding Test (SRT). Specifically, over 50% of the patients completing the SRT exhibited impaired immediate free recall and consistent long-term retrieval deficits, while more than 44% of these individuals displayed deficient long-term retrieval. Deficient SRT long-term storage strategies, cued recall, and delayed recall were exhibited by between 26% and 35% of these patients, while more than 32% of this sample displayed elevated numbers of intrusion errors. Over 31% of the patients completing the Wisconsin Card Sorting Test (WCST) failed to achieve the expected number of categories on this measure, while more than 23% of these individuals demonstrated elevated numbers of perseverative errors and total errors. Clinically notable frequencies of impairment (greater than 20% of the sample) were also found on the Trail Making Test (TMT): Part B and the Wechsler Memory Scale-R (WMS-R) Visual Reproduction II subtest. Minnesota Multiphasic Personality Inventory-2 (MMPI-2) personality assessments indicated that patients were experiencing a diversity of somatic complaints and that they may have been functioning at a reduced level of efficiency. These findings are discussed in light of patients' end-stage COPD and factors possibly contributing to their neuropsychological test performances. Implications for clinical practice and future research are also included.

Journal Article↗
PubMed2006

The relationship between menopausal status, phase of menstrual cycle, and replacement estrogen on cognition in healthy women without dementia.

The authors examined the effect of menopausal status on several aspects of cognition in 4 groups of women (young premenopausal women, middle-aged premenopausal women, naturally postmenopausal women not using hormone therapy, and postmenopausal women using hormone replacement therapy). Participants (N = 48) completed questionnaires designed to assess psychological and physical health. The authors administered a test battery consisting of 10 neuropsychological tests to assess cognitive functioning. Using multivariate analyses of covariance with age as the covariate, the authors found a significant main effect of menopausal status on attention and complex processing abilities. Postmenopausal women using hormone replacement therapy significantly outperformed postmenopausal women not using hormone therapy on the Trail Making Test, Part B of the Halstead-Reitan (R. M. Reitan, 1958). This effect was significant even when the authors controlled for the effects of age, vocabulary levels, and education. Results are consistent with previous findings and may provide further evidence for an ameliorative effect of estrogen replacement therapy on specific cognitive functions.

Adolescent↗
PubMedDate not supplied

Assessment of speed of processing after paediatric head trauma: need for better norms.

The neuropsychological test scores of 47 children with traumatic head injury (THI), aged 9-14 years, were evaluated to determine the relative contributions of severity of injury (length of coma) and age on performance. Stepwise regression analyses revealed that age consistently explained a statistically significant proportion of the variance on the Trail Making Test (TMT) and Finger Tapping Test (FTT), even after accounting for injury severity. However, logistic regression analyses indicated that currently available age-based norms for these tests did not improve classification of mild-moderate vs. severe injuries, as compared to a system based exclusively on raw scores. It is concluded that, whereas age is an important consideration when assessing children with THI, available age-based norms for some common paediatric neuropsychological tests do not appear to be sufficiently stratified or robust to fully capture these age effects. It is suggested that more comprehensive age-referenced norms, based on larger and more adequately stratified samples, are needed. In addition, some practical implications of these findings are discussed.

Adolescent↗