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Prefrontal N-acetylaspartate is strongly associated with memory performance in (abstinent) ecstasy users: preliminary report.

BACKGROUND: 3,4-methylenedioxymethamphetamine (MDMA or "Ecstasy") is known to damage brain serotonin neurons in animals and possibly humans. Because serotonergic damage may adversely affect memory, we compared verbal memory function between MDMA users and MDMA-naïve control subjects and evaluated the relationship between verbal memory function and neuronal dysfunction in the MDMA users. METHODS: An auditory verbal memory task (Rey Auditory Verbal Learning Test) was used to study eight abstinent MDMA users and seven control subjects. In addition 1H-MRS was used in different brain regions of all MDMA users to measure N-acetylaspartate/creatine (NAA/Cr) ratios, a marker for neuronal viability. RESULTS: The MDMA users recalled significantly fewer words than control subjects on delayed (p =.03) but not immediate recall (p =.08). In MDMA users, delayed memory function was strongly associated with NAA/Cr only in the prefrontal cortex (R(2) =.76, p =.01). CONCLUSIONS: Greater decrements in memory function predicted lower NAA/Cr levels-and by inference greater neuronal dysfunction-in the prefrontal cortex of MDMA users.

Adult↗

Delayed-onset deficits in verbal encoding strategies among patients with mild traumatic brain injury.

Knowledge obtained from longitudinal animal models was used to predict the course of verbal memory deficits in 19 concussed patients and 19 control patients who were given versions of the Hopkins Verbal Learning Test--Revised at 2 hr, 48 hr, and 1 week postconcussion. The physiological literature suggests that concussed patients should exhibit a decline in performance from 2 hr to 48 hr postconcussion on a measure of complex memory strategies. Consistent with this hypothesis, mixed-factor analysis of covariance revealed that concussed patients used less semantic clustering strategies than control patients at 48 hr postconcussion, whereas minimal differences were found at 2 hr postinjury. Furthermore, a chi-square analysis showed that a significant number of concussed patients experienced a decline in the number of semantic clusters they used from 2 hr to 48 hr. No differences were found between the groups at the 1-week testing session.

Adult↗

Interaction between effects of caffeine and lorazepam in performance tests and self-ratings.

In 18 normal volunteers, lorazepam (2.5 mg) compared with placebo significantly impaired performance in a verbal learning task, in the digit-symbol substitution test, and in symbol copying and number cancellation tasks. These impairments were found equally in subjects with high and low state anxiety and in subjects with high and low trait anxiety. Caffeine citrate (125 to 500 mg) significantly improved performance on the digit-symbol substitution test when given alone and reduced the lorazepam impairment. In the symbol copying test caffeine counteracted the lorazepam impairment. Lorazepam produced a significant loss of appetite and made the subjects feel significantly more dizzy, physically and mentally tired, withdrawn and tranquil, and significantly less anxious. Caffeine citrate (500 mg) counteracted the lorazepam effect of reducing anxiety and making the subjects feel more relaxed.

Adult↗

Greater vulnerability to the amnestic effects of ketamine in males.

RATIONALE: Gender differences both in response to ketamine in animals and general cognitive functioning in humans have been observed and suggested to be related to modulatory effects of sex hormones on N-methyl-D: -aspartate receptor (NMDA-R) functioning. OBJECTIVES: The current study aimed to determine whether there were gender differences in response to ketamine in humans. METHODS: Behavioral data including positive and negative symptoms (Brief Psychiatric Rating Scale), perceptual alterations (Clinician-Administered Dissociative States Scale, CADSS), and "high" and "anxiety" states (Visual Analog Scale) from 295 subjects who participated in a total of 11 placebo-controlled ketamine studies were analyzed. In a subset of subjects, memory (Hopkins Verbal Learning Task: HVLT, n=108) and attention (continuous performance task, n=177) data were also analyzed. RESULTS: Male participants showed a greater performance decrement on the HVLT after ketamine administration compared to women. Men also reported a greater subjective sense of memory impairment on a CADSS subscale. No other gender differences in behavioral or cognitive measures were observed. CONCLUSIONS: Men showed a greater vulnerability to the amnestic effects of ketamine than women. Possible explanations of these findings are neuroanatomical and cognitive differences in processing of words in men and women and interactions between sex hormones and NMDA-R function.

Adult↗

Early patterns of verbal memory impairment in children treated for medulloblastoma.

Children treated for medulloblastoma demonstrate a variety of cognitive deficits in addition to white matter and hippocampal neuropathology. This study examined 40 children treated for medulloblastoma as compared with 40 demographically matched controls on the California Verbal Learning Test-Children's Version (D. C. Delis, J. H. Kramer, E. Kaplan, & B. A. Ober, 1994). Results revealed significantly poorer performance on indices of word recall in the patient group as compared with the controls in addition to milder but still significantly poorer recognition memory. These findings suggest that children treated for medulloblastoma demonstrate a mixed profile of memory impairment consisting of both retrieval and recognition deficits. Implications of these findings for understanding neurobehavioral sequelae within pediatric medulloblastoma populations and for designing educational and remediation strategies to be used with these children are discussed.

Adolescent↗

Metabolic disconnection between the mediodorsal nucleus of the thalamus and cortical Brodmann's areas of the left hemisphere in schizophrenia.

OBJECTIVE: The authors' goal was to examine interregional correlations of thalamocortical metabolic activity during a verbal learning task in schizophrenia. METHOD: They used [18F]fluorodeoxyglucose positron emission tomography in 41 unmedicated patients with schizophrenia and 59 normal comparison subjects. RESULTS: A metabolic disconnection was observed in patients with schizophrenia in the left hemisphere between the mediodorsal nucleus and widespread frontotemporal cortical regions, and stronger-than-normal intercorrelations were found between the pulvinar and superior temporal, selected parietal, posterior cingulate, and occipital areas. CONCLUSIONS: Deficits in the functional interrelationships between the left frontotemporal cortices and the left mediodorsal nucleus of the thalamus complement inferences from postmortem and magnetic resonance imaging volumetric studies identifying a thalamic diathesis in schizophrenia.

Adolescent↗

Memory in patients with subcortical infarction--an auditory event-related potential study.

Event-related potentials (ERPs) were recorded from 21 patients with subcortical infarction (mean age, 62.1 years) and 14 normal control subjects (mean age, 62.7 years) as they listened to lists of words or pronounceable non-words. Some words were repeated immediately after initial presentation (lag 0), while others were repeated after five intervening words (lag 5), or after 2 to 4 min (lag 11-77). The subjects were asked to push a button upon hearing the occasional non-words. The Auditory-Verbal Learning Test (AVLT) also was administered to the patients to examine explicit memory. The mean N400 amplitude, appearing between 300 and 800 ms after the stimulus, was smaller in patients with subcortical infarction than in control subjects. The N400 in response to repeated words at lags 0, 5 and 11-77 was attenuated for both the patient and control groups. On the AVLT the total number of recalled words and number of words after interference were significantly decreased in patients relative to controls, while recognition was relatively preserved. The results suggest that lexical processing and retrieval mechanism of explicit memory are disturbed in patients with subcortical infarction, but implicit memory measured by this N400 paradigm is relatively preserved.

Acoustic Stimulation↗

Response bias and aging on a recognition memory task.

UNLABELLED: Response bias reflects the decision rule an individual uses when faced with uncertainty on recognition memory tasks. Recent studies indicate frontal regions may mediate response bias performance. One theory of aging also implicates frontal lobe contributions in age-related cognitive changes. This suggests that frontal lobe changes may mediate response bias in older adults. Consistent with this frontal aging hypothesis, we predicted that response bias would become more liberal with age. METHODS: Participants were 181 younger (30-49) and 112 older normal adults (75+) that were part of the California Verbal Learning Test-second edition (CVLT-2) normative sample (total n = 1078). We used parametric measures of discriminability and response bias provided by the CVLT-2 scoring program. Groups were similar in IQ and education. Multi-level regression models were created to examine the effects of moderating variables. The interaction between age and age group significantly predicted response bias. Post hoc analysis indicated that increasing age was associated with more liberal bias in the older but not in the younger group. In the light of reported relationships between frontal regions and both aging and response bias, we hypothesize that frontal changes may be the underlying mechanism explaining the increase in liberal response bias with age.

Adult↗

Is verbal recognition memory really different in Huntington's and Alzheimer's disease.

Verbal recall and recognition were examined in Huntington's disease (HD) and Alzheimer's disease (AD) patients. Subgroups of HD and AD patients were matched for overall severity of dementia. Subjects were administered the Hopkins Verbal Learning Test, a list-learning task with three free-recall trials followed immediately by one yes/no recognition trial with semantically related and unrelated distractors. The matched AD and HD groups did not differ in the number of words recalled, although the HD patients showed slightly greater improvement over trials. Recognition performance was evaluated with measures of accuracy and response bias that are independent of each other. The matched groups did not differ in overall recognition accuracy, but the AD patients tended to have a more liberal ("yea-saying") response bias than did the HD patients. In addition, only the AD patients were differentially enticed to false-positive responding by semantically related distractors. The results suggest that the rule for making decisions when uncertain, rather than memory strength per se, distinguishes the recognition memory performance of AD and HD patients.

Alzheimer Disease↗

Source memory and encoding strategy in normal aging.

Of the memory deficits associated with aging, elders are most impaired at attributing the source to remembered information. Additionally, aging is marked by a decrease in the use of encoding strategies that are thought to enhance the acquisition and retention of information. We examined how manipulating the encoding strategy during acquisition affected item and source memory in 32 young and 68 elderly participants. Elderly participants were dichotomized into young-old and old-old based upon the median age (74 years). Memory was assessed using Word List A from the California Verbal Learning Test (CVLT) and its alternate form. Encoding strategy was manipulated by semantic clustering. For the Blocked List, words were presented grouped into their semantic categories, whereas for the Unblocked List categories were intermixed within the list. Item and source memory judgments were made 20 minutes after the final CVLT recall trial and again one week later. Results revealed a disproportionate decline in source, compared to item memory in the two older groups. Semantic blocking enhanced item memory for the elders, but not for the young. The amount of semantic clustering performed by the elders showed a decline with age and was positively related to source performance. Results also suggest that subtle age-related changes in semantic knowledge may be related to declines in semantic clustering and memory performance.

Adult↗

The effects of adjunctive topiramate on cognitive function in patients with epilepsy.

PURPOSE: We investigated possible cognitive effects of topiramate (TPM) in polypharmacy on patients with intractable epilepsy. METHODS: Study 1 evaluated 22 consecutively admitted patients whose antiepileptic drugs (AEDs) on admission to the Montreal Neurological Hospital included TPM. Performance on neuropsychological tests administered on and subsequently off TPM was analyzed. Four patients also were tested before taking TPM, allowing comparisons off, then on, and then off the drug again. Measures included intellectual function, verbal and nonverbal memory, language, word and design fluency, somatosensory sensitivity, and motor skills. In Study 2, 16 patients at the Minnesota Epilepsy Group were tested first off, then on TPM with nine cognitive tasks that measured concentration, verbal fluency, language, and psychomotor speed. RESULTS: In Study 1, significant (p < or = 0.01) improvements were observed off TPM on 13 measures including verbal and nonverbal fluency and certain verbal and perceptual tasks. Notably, verbal learning and memory were unaffected; a limited effect was observed on nonverbal memory. Patients tested 3 times scored better in both tests off TPM compared with on this drug. In Study 2, declines on TPM were observed on all measures, significantly (p < or = 0.05) for tests of fluency, sustained concentration, and visual motor processing speed. CONCLUSIONS: TPM was associated with declines in fluency, attention/concentration, processing speed, language skills, and perception; working memory but not retention was affected. As the two studies used an opposite order of testing on versus off TPM, our results clearly show a performance decrement while patients are taking TPM, without respect to which condition is tested first.

Adolescent↗

Early assessment of post-stroke patients entering acute inpatient rehabilitation: utility of the WASI and HVLT-R.

OBJECTIVE: To examine the clinical utility of two brief assessment tools, the Wechsler Abbreviated Scale of Intelligence (WASI) and the Hopkins Verbal Learning Test-Revised (HVLT-R). We hypothesized that these measures would predict continued need for supervision and functional outcome at discharge. DESIGN: In this retrospective review, 44 patients with stroke who were admitted for acute inpatient rehabilitation were measured on five variables: WASI, HVLT-R, length of stay, FIM discharge scores, and need for supervision on discharge. RESULTS: Performance on the HVLT-R and WASI matrix reasoning subtest of the WASI was predictive of cognitive discharge scores on the FIM and need for supervision on discharge. The WASI similarities subtest was not associated with outcome. CONCLUSIONS: WASI matrix reasoning and HVLT-R are brief neuropsychological measures that are predictive of need for supervision and functional outcome in the acute stroke rehabilitation setting.

Aged↗

Neuropsychological assessment and telemedicine: a preliminary study examining the reliability of neuropsychology services performed via telecommunication.

Within the last decade, various applications of two-way audio-visual telecommunication have been implemented in the Norwegian health care system to facilitate the delivery of medical services to patients located in rural areas away from the hospitals. This technology may also be useful to extend neuropsychological services to underserved areas and thereby reduce the patients' travel time and costs. In the current study, a total of 12 visual, verbal and performance tests were administered face-to-face and via videophones to 32 volunteer participants to examine the consistency and stability of test-scores when delivered via different formats. The obtained reliability coefficients ranged from .37 to .86 with a median value of .74. When testing for mean differences, the measures on verbal learning (WMS-Logical Memory I) and auditory attention (Seashore Rhythm Test) differed significantly due to administration format (t = 2.34, p = .024 and t = 2.37, p = .025, respectively). The findings imply that administration format does not appear to affect the reliability of measurement but neuropsychological test performance is significantly higher for the measures of attention and memory when delivered via videophone. Additional research on these cognitive domains is required, and if the observed differences due to testing format persist, separate normative data via telecommunication will be required before assessments are carried out. Also, since only normal participants were included in this study, the findings may have external validity for normal populations, but similar controlled trials with patients need to be completed before remote assessments can be implemented in regular clinical practice.

Adolescent↗

Predictive validity of the Q16 questionnaire: a comparison between reported symptoms and neurobehavioral tests.

The correspondence between the answers to the Q16 questions regarding memory and attention-concentration and relevant neurobehavioral performance test scores has been evaluated. The sensitivity, specificity and diagnostic validity of Q16 have been assessed, taking the relevant neurobehavioral test score as a reference diagnostic criterion, the lower quartile of performance being considered as a poor response. The group under study consisted of 74 volunteers (24 females), aged 40 years on average (SD:7.5) and recruited among styrene-exposed workers and healthy controls. The test battery included the logical memory (short- and long-term) and the verbal learning (short- and long-term) tests of the Wechsler Adult Intelligence Scale (WAIS). The answers to the Q16 questions were poorly related to the performance: self-perceived forgetfulness showed a limited agreement with the long-term logical memory test (r=-0.23, p<0.05). The number of false negatives (no symptom but low test scores) was generally high, giving rise to a very low sensitivity of the questionnaire, despite a relatively high specificity. Accordingly, the positive diagnostic validity was low (<30%), whereas the negative diagnostic validity was high (>80%). Different methods used to investigate subtle neurological changes give rise to inconsistencies between self-perceived disturbances and objective measurements of relevant functions. Owing to its low sensitivity and positive diagnostic value, the Q16 cannot be recommended as a screening tool among workers occupationally exposed to neurotoxic chemicals.

Adult↗

Discrimination of normal from demented elderly on a Spanish version of the verbal Selective Reminding Test.

The verbal Selective Reminding Test (vSRT) is a frequently used test for evaluating verbal learning and memory. In the present study we investigated the construct validity of a Spanish version of the vSRT by determining its ability to distinguish between a group of healthy elderly subjects and a group of patients with dementia of the Alzheimer type (DAT). Further validation of the test was assessed by comparing the pattern of memory deficits found in the group of patients with DAT with findings from previous neuropsychological research concerning with memory impairments in English-speaking patients with Alzheimer's disease. Analyses revealed that the test was able to differentiate normal individuals from patients with DAT. In addition the pattern of memory functioning found in the group of patients with DAT was consistent with findings of previous experimental and clinical reports. These results support the construct validity of the Spanish version of the vSRT.

Aged↗

How low is too low, revisited: sentence repetition and AVLT-recognition in the detection of malingering.

Sentence Repetition (SR) and Rey Auditory Verbal Learning Test-Recognition Task (AVLT-R) scores of 5 groups of examinees (severe traumatic brain injury [TBI], mild TBI nonlitigants, normal controls, mild TBI litigants, and actors) were compared with the intent of determining cutoffs for the detection of malingering. Cutoff scores were set below the minimum of the severe TBI group, resulting in a specificity of 100% for both tests. At this level of specificity, the AVLT-R detected 10 of the 20 known actors (50% sensitivity), whereas SR correctly identified 14 of the 20 actors (70% sensitivity). Among litigants with mild injury, 12.24% were identified by the AVLT-R and 6.12% by SR as malingerers. These findings are similar to those found utilizing a variety of other common neuropsychological instruments. Employing commonly used neuropsychological tests as measures of motivation is both practical and clinically useful.

Accidents, Traffic↗

Effect of phenytoin on mood and declarative memory during prescription corticosteroid therapy.

BACKGROUND: In humans and animals, corticosteroid excess is associated with impairment in declarative memory and changes in hippocampal structure. In animals, phenytoin pretreatment blocks the effects of stress on memory and hippocampal histology, although no studies have examined the use of phenytoin to prevent corticosteroid-associated memory changes in humans. Mood changes are also common with corticosteroids, but few treatment data are available. This report examines whether phenytoin can prevent mood or declarative memory changes secondary to bursts of prescription corticosteroids. METHODS: Thirty-nine patients with allergies or pulmonary or rheumatologic illnesses and given systemic corticosteroid therapy were randomized to receive either phenytoin (300 mg/day) or placebo concurrently with the corticosteroids. Mood was assessed with the Hamilton Rating Scale for Depression, Young Mania Rating Scale, and Activation (ACT) subscale of the Internal State Scale; declarative memory was assessed with the Rey Auditory Verbal Learning Test (RAVLT) at baseline and after approximately 7 days of corticosteroid plus phenytoin or placebo therapy. RESULTS: The two groups were similar in age, gender, education, and corticosteroid dose. The phenytoin-treated group showed significantly smaller increases on the ACT, a mania self-report scale, than the placebo-treated group. Groups did not differ significantly on RAVLT change scores. CONCLUSIONS: This is the first placebo-controlled study to examine whether a medication can prevent mood and memory changes secondary to corticosteroids. Phenytoin blocked the hypomanic effects of prescription corticosteroids; however, phenytoin did not block the declarative memory effects of corticosteroids.

Adrenal Cortex Hormones↗

Evidence for impaired encoding and retrieval memory profiles in Parkinson disease.

OBJECTIVE: The purpose of the study was to determine whether patients with Parkinson disease (PD) demonstrate different memory profiles. Specifically, we sought to ascertain whether the memory performance of PD patients can be categorized as fitting an unimpaired, an impaired retrieval, or an impaired encoding memory profile. BACKGROUND: Cognitive impairment in PD is usually described as subcortical-frontal in nature. However, neuropathophysiological changes consistent with diffuse cortical disease are also reported. Establishing memory subtypes in PD could potentially assist in reducing the observed heterogeneity of disease presentation, establishing prognosis, making clinical decisions, and defining endpoints in clinical trials. METHODS: : A sample of 63 PD patients was evaluated with the Hopkins Verbal Learning Test-Revised (HVLT-R). Cluster analysis was used to classify patients into three memory subgroups based on performance on free recall, intrusion errors, and recall enhancement with recognition. Subgroup comparisons were made for demographic and clinical characteristics. RESULTS: An "unimpaired" group (n = 30) demonstrated intact free recall and few intrusion errors. "Impaired retrieval" (n = 22) and "impaired encoding" (n = 11) subgroups with similar impairment on free recall were also identified, but the impaired retrieval group demonstrated greater memory improvement with recognition (P < 0.001) and had fewer intrusion errors (P < 0.001) than the impaired encoding group. CONCLUSIONS: A majority of PD patients demonstrate memory impairment, which can be categorized as either a primary retrieval or a primary encoding deficit. Further research is needed to confirm memory subtypes in PD and determine their diagnostic, prognostic, and therapeutic significance.

Adult↗