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PubMed2001

Computerised cognitive assessment of concussed Australian Rules footballers.

BACKGROUND: "Paper and pencil" neuropsychological tests play an important role in the management of sports related concussions. They provide objective information on the athlete's cognitive function and thus facilitate decisions on safe return to sport. It has been proposed that computerised cognitive tests have many advantages over such conventional tests, but their role in this domain is yet to be established. OBJECTIVES: To measure cognitive impairment after concussion in a case series of concussed Australian Rules footballers, using both computerised and paper and pencil neuropsychological tests. To investigate the role of computerised cognitive tests in the assessment and follow up of sports related concussions. METHODS: Baseline measures on the Digit Symbol Substitution Test (DSST), Trail Making Test-Part B (TMT), and a simple reaction time (SRT) test from a computerised cognitive test battery (CogState) were obtained in 240 players. Tests were repeated in players who had sustained a concussive injury. A group of non-injured players were used as matched controls. RESULTS: Six concussions were observed over a period of nine weeks. At the follow up, DSST and TMT scores did not significantly differ from baseline scores in both control and concussed groups. However, analysis of the SRT data showed an increase in response variability and latency after concussion in the injured athletes. This was in contrast with a decrease in response variability and no change in latency on follow up of the control players (p<0.02). CONCLUSION: Increased variability in response time may be an important cognitive deficit after concussion. This has implications for consistency of an athlete's performance after injury, as well as for tests used in clinical assessment and follow up of head injuries.

Adolescent↗
PubMed1991

Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance.

Most patients with asthma waken with nocturnal asthma from time to time. To assess morbidity in patients with nocturnal asthma nocturnal sleep quality, daytime sleepiness, and daytime cognitive performance were measured prospectively in 12 patients with nocturnal asthma (median age 43 years) and 12 age and intellect matched normal subjects. The median (range) percentage overnight fall in peak expiratory flow rate (PEF) was 22 (15 to 50) in the patients with nocturnal asthma and 4 (-4 to 7) in the normal subjects. The patients with asthma had poorer average scores for subjective sleep quality than the normal subjects (median paired difference 1.1 (95% confidence limits 0.1, 2.3)). Objective overnight sleep quality was also worse in the asthmatic patients, who spent more time awake at night (median difference 51 (95% CL 8.1, 74) minutes), had a longer sleep onset latency (12 (10, 30) minutes), and tended to have less stage 4 (deep) sleep (-33 (-58, 4) minutes). Daytime cognitive performance was worse in the patients with nocturnal asthma, who took a longer time to complete the trail making tests (median difference 62 (22, 75) seconds) and achieved a lower score on the paced serial addition tests (-10 (-24, -3)). Mean daytime sleep latency did not differ significantly between the two groups (2 (-3, 7) minutes). It is concluded that hospital outpatients with stable nocturnal asthma have impaired sleep quality and daytime cognitive performance even when having their usual maintenance asthma treatment.

Adult↗
PubMedDate not supplied

Relationship between cannabis use, schizotypal traits, and cognitive function in healthy subjects.

This research examined the relationship between cannabis use and schizotypal features. A sample of cannabis users (n = 20) was compared with a matched control group (n = 20). All participants were male students of the University of Hamburg. Subjects completed the Perceptual Aberration Scale and the Schizotypal Personality Questionnaire. A Negative Priming procedure and the Trail Making Test were carried out. A urine sample was obtained from each subject. Cannabis users exceeded controls in schizotypy scores and showed impaired neuropsychological parameters. Only within the cannabis group schizotypy scores correlated with neuropsychological parameters. Furthermore, cannabis users reported more often high-risk factors than controls. These findings indicate that among cannabis users there is an increased number of subjects with schizotypal features; schizotypal subjects seem to be more likely to use cannabis than the general population. Therefore, cannabis use may be a vulnerability indicator for schizophrenia.

Adult↗
PubMed1998

Hypertension is related to cognitive impairment: a 20-year follow-up of 999 men.

Recent findings of a linkage between high blood pressure (BP) and later development of dementia have given new prospects on cerebral target-organ damage in hypertension and have added substance to the concept of "preventable senility." The aim of this study was to analyze the impact of hypertension, circadian BP profile, and disturbed glucose metabolism on cognitive function. The study population consisted of 999 seventy-year-old men from a population-based cohort study in Uppsala, Sweden, followed with respect to cardiovascular risk factors since the age of 50 years. At the age of 70, 24-hour ambulatory BP was monitored together with measurements of insulin sensitivity, glucose tolerance, serum lipids, and lipoproteins. Cognitive function was assessed by the Mini-Mental State Examination and the Trail-Making Test. High diastolic BP at baseline predicted later impaired cognitive performance, even after excluding men with a previous stroke (n = 70). Cross-sectional measurements at age 70 showed that high 24-hour BP, nondipping, insulin resistance, and diabetes all were related to low cognitive function. The relationships between hypertension and cognitive impairment were strongest in untreated men. These data from a general population of healthy elderly men indicate that hypertension and associated metabolic disturbances might be susceptibility factors for cognitive disorders. The findings add support to possibilities of intervention in early stages in cognitive decline, ie, before manifest dementia.

Aged↗
PubMedDate not supplied

Neuropsychological performance one week after carotid endarterectomy reflects intra-operative ischemia.

Fourteen patients with severe bilateral carotid artery stenosis underwent carotid endarterectomy. Intra-operative ischemia was monitored by somatosensory evoked potentials (SSEP) bilaterally. Neuropsychological evaluations were completed within two days before operation and 4-9 days after operation. Complete loss of N1-P1 or P1-N2 components of the SSEP (seen in 4 patients) was associated with a worsening of neuropsychological abilities (p less than .01). Two of these patients subsequently had strokes (7 and 35 days after operation). No other patients in the series have had strokes. Patients whose N1-P1 or P1-N2 amplitudes decreased by 50% or more performed worse after operation than patients with less severe reductions in these amplitudes (p less than .02). Time since first ischemic symptoms, age, education, clamp time, pre-operative stroke, and interval from surgery to assessment were not statistically related to changes in neuropsychological abilities. Patients with ischemic events in the week prior to surgery tended to improve in neuropsychological abilities 4-9 days after operation (p less than .05). Recentness of ischemic episode, however, was not related to intra-operative SSEP change. Results suggest the potential utility of intra-operative SSEP monitoring and early post-operative neuropsychological assessments both for clinical and research purposes.

Aged↗
PubMed1998

Atrial fibrillation is an independent determinant of low cognitive function: a cross-sectional study in elderly men.

BACKGROUND AND PURPOSE: Cerebrovascular disease is increasingly recognized as a cause of dementia and cognitive decline. We have previously reported an association between hypertension and diabetes and low cognitive function in the elderly. Atrial fibrillation is another main risk factor for cerebrovascular disease. The aim of this study was to investigate whether atrial fibrillation is associated with low cognitive function in elderly men with and without previous manifest stroke. METHODS: This was a cross-sectional study based on a cohort of 952 community-living men, aged 69 to 75 years, in Uppsala, Sweden. Cognitive functions were assessed by the Mini-Mental State Examination and the Trail Making Tests, and a composite z score was calculated. The relation between atrial fibrillation and cognitive z score was analyzed, with stroke and other vascular risk factors taken into account. RESULTS: All analyses were adjusted for age, education, and occupational level. Men with atrial fibrillation (n=44) had lower mean adjusted cognitive z scores (-0.26+/-0.11) than men without atrial fibrillation (+0.14+/-0.03; P=0.0003). The exclusion of stroke patients did not alter this relationship; the mean cognitive z score was -0.24+/-0.12 in the 36 men with atrial fibrillation and +0.17+/-0.03 in those without atrial fibrillation (P=0.0004), corresponding to a difference of 0.4 SDs between groups. Adjustments for 24-hour diastolic blood pressure and heart rate, diabetes, and ejection fraction did not change this relationship. Men with atrial fibrillation who were treated with digoxin (n=27) performed markedly better (-0.05+/-0.21) than those without treatment (n=9; -1.14+/-0.34; adjusted P=0.0005). Previous myocardial infarction was not associated with impaired cognitive results. CONCLUSIONS: In these community-living elderly men, we found an association between atrial fibrillation and low cognitive function independent of stroke, high blood pressure, and diabetes. Interventional studies are needed to answer the question of whether optimal treatment of atrial fibrillation may prevent or postpone cognitive decline and dementia.

Aged↗
PubMed2001

Acute effects of exercise on cognition in patients with chronic obstructive pulmonary disease.

Prior data indicate positive effects of long-term exercise interventions for cognitive functioning among patients with chronic obstructive pulmonary disease (COPD), but no prior studies have examined acute effects of individual bouts of exercise among patients with COPD. This study evaluated acute effects of exercise on cognitive performance in a community-based sample of patients with COPD and a healthy control group, matched by age, sex, and education. Twenty-nine older adults with COPD (mean age = 67.8 yr [+/- 7.4]; range: 56-85; 17 women) and 29 matched healthy control subjects (mean age = 68.7 yr [+/- 6.0] ) were recruited from the community. All participants completed a 20-min exercise session in which they exercised to a peak level and a video control condition in which they were provided information about exercise and cholesterol. Conditions were separated by a 1-wk interval, and order of participation in conditions was randomly assigned. Assessments of cognitive performance (Trail Making Test, Digit Symbol, Verbal Fluency, Digit Span, Finger Tapping) were administered before and after each condition (exercise and video). Among patients with COPD, acute exercise was associated with improved performance on the Verbal Fluency test, a measure of verbal processing, suggesting that acute exercise may benefit aspects of cognitive performance among patients with COPD.

Aged↗
PubMed1996

Soft signs and neuropsychological performance in schizophrenia.

OBJECTIVE: Both neuropsychological impairment and neurological soft signs have been documented in at least a subset of patients with schizophrenia. The purpose of the present study was to examine the relationship between soft signs and neuropsychological performance in patients with schizophrenia in order to address the issue of whether soft signs are related to global or more selective cognitive impairment. METHOD: Patients with a DSM-III-R diagnosis of schizophrenia (N=176) were given a standardized neuropsychological battery and underwent a neurological examination. The study group was dichotomized on the basis of presence or absence of neurological soft signs. RESULTS: Patients with neurological soft signs (N=68) demonstrated significantly poorer performance on neuropsychological tasks that assessed timed motor speed and motor coordination (e.g., finger tapping, the Purdue Pegboard task, and part B of the Trail Making Test). These findings continued to be significant even after lifetime medication exposure, extrapyramidal symptoms, and abnormal involuntary movements were used as covariates. CONCLUSIONS: These findings support the notion that soft signs are a manifestation of a localizable behavioral deficit of the systems that are involved in motor speed, coordination, and sequencing and are not indicative of global cognitive impairment. The specific deficit in motor abilities is consistent with the types of neurological soft signs that are most frequently reported and suggests involvement of frontal/subcortical circuitry in schizophrenia.

Adolescent↗
PubMed2003

Increase in prefrontal cortex serotonin 2A receptors following estrogen treatment in postmenopausal women.

OBJECTIVE: This study investigated the effect of estrogen on brain serotonin 2A (5-HT(2A)) receptors in postmenopausal women and whether there was any correlation of receptor changes with cognition and mood. METHOD: Ten postmenopausal subjects underwent positron emission tomography measurements of 5-HT(2A) receptor binding with [(18)F]deuteroaltanserin before and after estrogen replacement therapy. RESULTS: 5-HT(2A) receptor binding was significantly increased after estrogen replacement therapy in the right prefrontal cortex (right precentral gyrus [Brodmann's area 9], inferior frontal gyrus [Brodmann's area 47], medial frontal gyrus [Brodmann's area 6, 10] and the anterior cingulate cortex [Brodmann's area 32]). In the inferior frontal gyrus [Brodmann's area 44]), receptor up-regulation was correlated with change in plasma estradiol. Verbal fluency and Trail Making Test performance, but not mood, were significantly improved by estrogen without correlation with receptor changes. CONCLUSIONS: Estrogen increases 5-HT(2A) receptor binding in human prefrontal regions.

Administration, Cutaneous↗
PubMed2004

Association between cognitive functioning and employment status of persons with bipolar disorder.

OBJECTIVE: The purpose of this study was to identify variables associated with employment status among persons with bipolar disorder, including cognitive functioning, severity of symptoms, demographic variables, and variables related to course of illness. METHODS: The authors assessed the current employment status of 117 persons with bipolar disorder. Study participants' cognitive functioning was evaluated with the Repeatable Battery for the Assessment of Neuropsychological Status, the information and letter-number sequencing subtests of the Wechsler Adult Intelligence Scale III, and part A of the Trail Making Test. Symptoms were rated by using the Brief Psychiatric Rating Scale, the Hamilton Depression Scale, and the Young Mania Rating Scale. A stepwise multivariate logistic regression analysis was used to predict employment status. RESULTS: Fifty-one percent of the study participants had no current work activity, 21 percent worked part-time or as volunteers, and 27 percent had full-time competitive employment. Current employment status was significantly associated with cognitive performance, especially immediate verbal memory, total symptom severity, history of psychiatric hospitalization, and maternal education. No association was found between employment status and history of psychotic symptoms, number of years of education, or age at onset of illness. CONCLUSIONS: Vocational programs for persons with bipolar disorder would benefit from inclusion of a formal cognitive assessment to better assess work potential and to study the predictors of work-related outcomes.

Adolescent↗
PubMed1989

Delirium: a subcortical phenomenon?

Evoked potentials of 23 patients with chronic liver disease and delirium were compared with those of matched controls without delirium. Delirious subjects had significantly worse scores on the Mini-Mental State Exam and Trail Making Tests. Mean peak activity from computerized spectral analysis of the EEG was lower in delirious subjects than in nondelirious subjects (7.5 +/- 3.8 cycles per second (cps) and 9.5 +/- 3.2 cps, respectively). Mean auditory brainstem evoked potentials were abnormal in both groups, with delirious subjects showing a bimodal distribution of latency values and a greater proportion of abnormal values. Somatosensory evoked potentials were abnormal for delirious patients and normal for controls, and the differences were significant. The data suggest that the underlying pathophysiology of delirium may lie, at least in part, at the subcortical level.

Adolescent↗
PubMed2000

A neuropsychological comparison of depressed suicide attempters and nonattempters.

The neuropsychological performance of 18 older inpatients with major depression who were admitted following a suicide attempt was compared with that of 29 older depressed inpatients who had never attempted suicide. There was an interactive effect of age and group on the Trail Making Test, part B, such that attempters showed greater performance declines with age. No other differences were detected between groups on a range of neuropsychological tasks. These findings are discussed in the context of the methodological limitations of previous studies and the need for future research to better elucidate the nature of the relationships between age, cognitive functioning, and suicidal behavior.

Age Factors↗
PubMed1992

Mental flexibility and planning skills in children and adolescents with learning disabilities.

Mental flexibility (skill with shifting response set) and visual planning skills were examined with a group of 60 children and adolescents with learning disabilities. The sample consisted of 44 boys and 16 girls with an age range of 9 to 15. Scores from the Trail Making Test and the Wisconsin Card Sorting Test were cluster-analyzed and subgroups were formulated. The results of the cluster analysis indicated a two-group solution to be most appropriate. One subtype was clearly dysfunctional on the classifying variables, while the other subgroup approached average levels. The two subtypes were compared on measures of intellectual functions, academic skills, auditory memory, visual memory, visual-motor integration, motor speed, and tactile integration. Significance was found on several different tests. The results are discussed in terms of potential cortical dysfunction evidenced by the subgroups.

Adolescent↗
PubMed2005

Apolipoprotein E epsilon4 and change in cognitive functioning in community-dwelling older adults.

The relationship between apolipoprotein E (APOE) epsilon4 and change in cognition was examined in older men (n = 247; age = 75.0 +/- 3.5 years) and women (n = 79; age = 70.8 +/- 4.9 years) free of history of stroke. Participants were examined again 4.0 +/- 0.5 years later. Exclusion criteria were (1) initial scores on the Mini-Mental State Examination of 23 or less or (2) the presence of the APOE 2/4 genotype. Men with epsilon4 showed greater decline in some measures of executive function and verbal memory compared to those without epsilon4; women with epsilon4 showed greater decline in Trail Making test performance relative to women without the allele. A significant gender x APOE epsilon4 interaction was seen for change in performance on short delay cued recall. These results suggest that APOE epsilon4 is associated with cognitive decline differently in older adult men and women.

Aged↗
PubMed2006

Cognitive impairment in bipolar II disorder.

BACKGROUND: Persistent impairments in neurocognitive function have been described in bipolar disorder. AIMS: To compare the cognitive performance of patients with bipolar II disorder with that of patients with bipolar I disorder and a healthy control group. METHOD: The study included 71 euthymic patients with bipolar disorder (38 bipolar I, 33 bipolar II), who were compared on clinical and neuropsychological variables (e.g. executive function, attention, verbal and visual memory) and contrasted with 35 healthy controls on cognitive performance. RESULTS: Compared with controls, both bipolar groups showed significant deficits in most cognitive tasks including working memory (DigitSpan Backwards, P=0.002) and attention (DigitSpan Forwards, P=0.005; Trail Making Test, P=0.001). Those with type II disorders had an intermediate level of performance between the bipolar I group and the control group in verbal memory (P<0.005) and executive functions (Stroop interference task, P=0.020). CONCLUSIONS: Cognitive impairment exists in both subtypes of bipolar disorder, although more so in the bipolar I group. The best predictors of poor psychosocial functioning in bipolar II disorder were subclinical depressive symptoms, early onset of illness and poor performance on a measure related to executive function.

Adult↗
PubMed2005

Sustained attention in mild Alzheimer's disease.

The vigilance decrement in perceptual sensitivity was examined in 10 patients with mild Alzheimer's disease (AD) and 20 age-matched controls. A visual high-event rate digit-discrimination task lasting 7.2 min. (six 1.2 min blocks) was presented at different levels of stimulus degradation. Previous studies have shown that sensitivity decrements (d') over time at high-stimulus degradation result from demands on effortful processing. For all degradation levels, the overall level of vigilance (d') was lower in AD patients than in controls. All participants showed sensitivity decrement over blocks, with greater decrement at higher degradation levels. AD patients exhibited greater sensitivity decrement over time at the highest degradation level they all could perform relative to control participants. There were no concomitant changes in either response bias (C) or response times. The results indicate that mild AD patients have overall lower levels of vigilance under conditions that require both automatic and effortful processing. Mild AD patients also exhibit a deficit in the maintenance of vigilance over time under effortful processing conditions. Although the sample of AD patients was small, results further suggest that both possible and probable AD patients had greater sensitivity decrement over time at the highest degradation level than did control participants, but only probable AD patients had lower overall levels of vigilance. In the possible AD patients as a group, the decrement in vigilance occurred in the absence of concurrent deficits on standard attentional tasks, such as the Stroop and Trail Making tests, suggesting that deficits in vigilance over time may appear earlier than deficits in selective attention.

Aged↗
PubMed2000

Bradykinesia in early Huntington's disease.

BACKGROUND: Huntington's disease (HD) is generally considered a hyperkinetic disorder, although hypokinetic features are part of the motor syndrome. Moreover, the striatum is considered to play a key role in initiating and executing motor programs and achieving optimal scheduling in response generation. Controversial results regarding the association between clinical features and markers of progression of the disease might be the result of inadequate restriction of clinical signs to the choreatic syndrome. OBJECTIVE: To determine the relationship of neurologic motor and cognitive indices in patients with HD with intrinsic neuronal loss in the striatum, as measured using raclopride C11 and PET. PATIENTS AND METHODS: A cross-sectional study was performed on 11 patients with mild HD (stages 0-2). Motor (Unified Huntington's Disease Rating Scale [UHDRS], saccadic and tapping speed) and cognitive (verbal fluency, Trail Making Test, Stroop Test, Symbol Digit Modalities Test, Conditioned Associative Learning Test, and silhouette identification and object decision of the Visual Object and Space Perception battery) scores were correlated with raclopride C11 binding. RESULTS: Bradykinesia (a summation of five items of the UHDRS motor scale) was the best predictor for stage, that is, functional capacity, and showed a highly significant relationship with putaminous D2 binding (r = -0.94) and with CAG expansion length x years of age (r = 0.96). The exclusion of two patients with a rigid-akinetic HD variant did not alter these coefficients. Chorea was less well correlated than bradykinesia with D2 binding in all striatal regions. Performance on different cognitive tests, especially in timed tasks, was highly correlated with raclopride C11 binding in caudate nucleus and ventral striatum. CONCLUSION: Loss of D2 binding in the striatum is highly correlated with the deficit in fast motor and cognitive processing in patients with early Huntington's Disease. Thus, impairment of rapid execution of adequate responses to environmental changes seems to be a common manifestation of striatal disorders.

Adult↗
PubMed1980

Alcohol misuse and neuropsychological deficits in men.

The 111 men alcoholics studied were of average intelligence or better and showed no gross memory deficit, but did show deficits on the Category, Tactual Performance and Trail Making Tests and the Impairment Index of the Halstead-Reitan neuropsychological test battery. Impairment of the fronto-limbic-diencephalic system may explain the findings.

Adult↗