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PubMed2004

The effect of acute stress on subsequent neuropsychological test performance (2003).

Acute mental stressors have been implicated as variables that may deleteriously affect neuropsychological test performance by increasing distractibility and decreasing working memory function. This study examined 25 subjects with no known neurological or psychiatric impairment on a brief battery of neuropsychological measures on alternate days following either rest or induced mental stress in a counterbalanced design. The test battery consisted of the Rey Auditory-Verbal Learning Test, the Rey Complex Figure, and three Wechsler Memory Scale-III subtests (Logical Memory, Digit Span, and Visual Memory Span). The Ss average age was 24.8 years (S.D. = 10.1) and average education was 15.0 years (S.D. = 1.6). The mental stressor employed was a videotaped public-speaking exercise that has been shown in previous work to induce negative mood, cardiovascular reactivity, and perceived mental stress. Ss demonstrated statistically significant (P < .05) increases in negative mood, heart rate, diastolic blood pressure, and systolic blood pressure as well as elevated cortisol concentration following induced stress, suggesting substantially increased adrenocortical reactivity and cardiovascular stress response. There were, however, no statistically significant differences in any of the neuropsychological measures when stress versus rest days were compared. The results suggest that acute mental stressors may have no measurable effect on subsequent performance on selected neuropsychological tests in a normal population. Further work is suggested to determine whether pre-existing anxiety-related psychopathology or pre-existing neurological compromise might interact with induced mental stress to cause decrements in neuropsychological test performance.

Adolescent↗
PubMed2005

Assessment practices of clinical neuropsychologists in the United States and Canada: a survey of INS, NAN, and APA Division 40 members.

The present study surveyed assessment practices and test usage patterns among clinical neuropsychologists. Respondents were 747 North American, doctorate-level psychologists (40% usable response rate) affiliated with Division 40 of the American Psychological Association (APA), the National Academy of Neuropsychology (NAN), or the International Neuropsychological Society (INS). Respondents first provided basic demographic and practice-related information and reported their most frequently utilized instruments. Overall, the Wechsler Adult Intelligence Scales and Wechsler Memory Scales were most frequently used, followed by the Trail Making Test, California Verbal Learning Test, and Wechsler Intelligence Scale for Children. Respondents also reviewed a vignette about a traumatic brain injury patient, and then reported the instruments they would use to assess this patient's specific cognitive symptomatology, general cognitive ability, and capacity to return to work. Particular attention was paid to the areas of memory, attention, and executive functioning. The current study represents the largest and most comprehensive test usage survey conducted to date within the field of clinical neuropsychology. Survey results update and greatly expand knowledge about neuropsychologists' assessment practices. Following a review of findings, results are compared to those obtained in prior surveys and implications for the field of neuropsychology are discussed.

Adult↗
PubMed2005

A retrospective review of the neuropsychological test performance of physicians referred for medical infractions.

Physician-related errors are rising, resulting in an increase in disciplinary actions by licensing medical authorities. It has been previously reported that cognitive impairment may be responsible for 63% of all physician-related medical adverse events. In this paper we examine neuropsychological testing results from 148 physicians referred for assessment by the California Medical Board (CMB) for various infractions. The neuropsychological test performance of the physicians was compared to normative reference samples. Overall, they performed in the average range on most measures; however, they demonstrated relative deficits on tests of sequential processing, attention, logical analysis, eye-hand coordination, verbal and non-verbal learning. These findings reveal that this cohort of physicians is performing lower than expected on tests of intellectual and neuropsychological functioning. Applying a neuropsychological framework to the assessment of physicians may uncover potential cognitive factors that contribute to medical practice errors.

Adult↗
PubMed2006

Linear measures of temporal lobe atrophy on brain magnetic resonance imaging (MRI) but not visual rating of white matter changes can help discrimination of mild cognitive impairment (MCI) and Alzheimer's disease (AD).

Clinical discrimination of the early stages of AD and MCI is challenging. MRI indices which are simple enough to be applied by non-radiologists on hard copies would be of practical importance in the discrimination. We studied 45 consecutive patients (17 with MCI, 25 with AD, 3 with normal cognitive findings) with at least one white matter lesion (WML) on axial fluid-attenuated inversion recovery (FLAIR) MRI sequences. WML load was evaluated by Fazekas' scoring system; temporal lobe atrophy by interuncal distance (IUD) measurement. WML pattern had no significant discriminative value of AD and MCI. No significant correlation between periventricular/subcortical WML scores and neuropsychological test results was observed. The mean IUD was significantly smaller in patients with MCI compared to those with AD. The cut-off value of IUD was 28.3 mm with receiver operating curve (ROC) analysis. Area under the curve was 0.925 (95% CI: 0.800-0.983). A significant negative correlation between IUD and the mini mental state examination (MMSE), verbal fluency, clock drawing, and Rey Auditory verbal learning test (AVLT) was noted. The results indicate that measurement of IUD is a clinically useful test in discrimination of AD and MCI patients with WML(s) on brain MRI. However, severity of these lesions is not useful for distinctions.

Aged↗
PubMed2026

Post-intervention effectiveness of a computerized personalized cognitive stimulation program adapted according to cognitive reserve in older adults without cognitive impairment in Primary Care: A randomized clinical trial.

BACKGROUND: Cognitive reserve may influence responsiveness to cognitive interventions, yet it is rarely used to tailor computerized stimulation. OBJECTIVE: To evaluate the effectiveness of a computerized cognitive stimulation program personalized according to cognitive reserve on cognition, reserve-related activities, and digital competence in community-dwelling older adults without cognitive impairment in Primary Care. METHODS: In this randomized clinical trial, 102 adults aged &#x2265;65 years with normal cognitive performance were recruited from three primary care centers in Zaragoza, Spain, and stratified by cognitive reserve level before random allocation to intervention or control. The intervention comprised digital literacy sessions followed by 8 weeks of home-based computerized cognitive stimulation tailored to participants' cognitive reserve profiles and life history. Controls received a single group-based health education session focused on maintaining everyday cognitive activity. Outcomes were assessed at baseline and post-intervention using global cognition (MEC-35), the Cognitive Reserve Questionnaire, the Mobile Device Proficiency Questionnaire-16, and domain-specific neuropsychological tests. A total of 100 participants completed the final evaluation and were included in complete-case analyses. RESULTS: Compared with controls, the intervention group showed greater adjusted post-intervention improvements in global cognition (MEC-35 between-group difference: 1.8 points) and several cognitive measures, including temporal orientation, calculation, attention, praxis, verbal fluency, processing speed, executive functions, and verbal learning. CRQ scores and digital competence also improved, with small-to-large effect sizes. CONCLUSIONS: A computerized cognitive stimulation program adapted according to cognitive reserve appears feasible in Primary Care and may improve cognition, engagement in reserve-related activities, and digital competence in older adults without cognitive impairment.

Humans↗
PubMed2006

Memory dysfunction in caudate infarction caused by Heubner's recurring artery occlusion.

We report five cases with caudate infarction due to Heubner's recurring artery occlusion, in which we conducted detailed memory examinations in terms of explicit memory and implicit memory. We performed the auditory verbal learning test as explicit memory tasks, and motor and cognitive procedural memory tasks, developed by Komori, as implicit memory tasks. Comparing normal control subjects with patients with left caudate infarction due to Heubner's recurring artery occlusion demonstrated lower scores on both declarative and motor procedural memory tasks. These results suggest that the left caudate nucleus may be related with both declarative memory and procedural memory.

Adult↗
PubMed2005

Sequential processing in hemispheric word recognition: the impact of initial letter discriminability on the OUP naming effect.

The cerebral hemispheres have been proposed to engage different word recognition strategies: the left hemisphere implementing a parallel, and the right hemisphere, a sequential, analysis. To investigate this notion, we asked participants to name words with an early or late orthographic uniqueness point (OUP), presented horizontally to their left (LVF), right (RVF), or both fields of vision (BVF). Consistent with past foveal research, Experiment 1 produced a robust facilitatory effect of early OUP for RVF/BVF presentations, indicating the presence of sequential processes in lexical retrieval. The effect was absent for LVF trials, which we argue results from the disadvantaged position of initial letters of words presented in the LVF. To test this proposition, Experiment 2 assessed the discriminability of various letter positions in the visual fields using a bar-probe task. The obtained error functions highlighted the poor discriminability of initial letters in the LVF and latter letters in the RVF. To confirm that this asymmetry in initial letter acuity was responsible for the absent OUP effect for LVF presentations, Experiment 3 replicated Experiment 1 using vertical stimulus presentations. Results indicated a marked facilitatory effect of early OUP across visual fields, supporting our contention that the lack of OUP effect for LVF presentations in Experiment 1 resulted from poor discriminability of the initial letters. These findings confirm the presence of sequential processes in both left and right hemisphere word recognition, casting doubt on parallel models of word processing.

Adult↗
PubMed2004

Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria.

To stimulate the development of new drugs for the cognitive deficits of schizophrenia, the National Institute of Mental Health (NIMH) established the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. This article presents an overview of decisions from the first MATRICS consensus conference. The goals of the meeting were to 1) identify the cognitive domains that should be represented in a consensus cognitive battery and 2) prioritize key criteria for selection of tests for the battery. Seven cognitive domains were selected based on a review of the literature and input from experts: working memory, attention/vigilance, verbal learning and memory, visual learning and memory, reasoning and problem solving, speed of processing, and social cognition. Based on discussions at this meeting, five criteria were considered essential for test selection: good test-retest reliability, high utility as a repeated measure, relationship to functional outcome, potential response to pharmacologic agents, and practicality/tolerability. The results from this meeting constitute the initial steps for reaching a consensus cognitive battery for clinical trials in schizophrenia.

Clinical Trials as Topic↗
PubMed2006

Toward constructing an endophenotype strategy for bipolar disorders.

Research aimed at elucidating the underlying neurobiology and genetics of bipolar disorder, and factors associated with treatment response, have been limited by a heterogeneous clinical phenotype and lack of knowledge about its underlying diathesis. We used a survey of clinical, epidemiological, neurobiological, and genetic studies to select and evaluate candidate endophenotypes for bipolar disorder. Numerous findings regarding brain function, brain structure, and response to pharmacological challenge in bipolar patients and their relatives deserve further investigation. Candidate brain function endophenotypes include attention deficits, deficits in verbal learning and memory, cognitive deficits after tryptophan depletion, circadian rhythm instability, and dysmodulation of motivation and reward. We selected reduced anterior cingulate volume and early-onset white matter abnormalities as candidate brain structure endophenotypes. Symptom provocation endophenotypes might be based on bipolar patients' sensitivity to sleep deprivation, psychostimulants, and cholinergic drugs. Phenotypic heterogeneity is a major impediment to the elucidation of the neurobiology and genetics of bipolar disorder. We present a strategy constructed to improve the phenotypic definition of bipolar disorder by elucidating candidate endophenotypes. Studies to evaluate candidate endophenotypes with respect to specificity, heritability, temporal stability, and prevalence in unaffected relatives are encouraged.

Bipolar Disorder↗
PubMedDate not supplied

Demographic, clinical, and neurocognitive predictors of quality of life in schizophrenia patients receiving conventional neuroleptics.

We sought to evaluate demographic, clinical, and neurocognitive predictors of self-rated life quality and hospitalization in schizophrenia patients without the potentially cognition-enhancing influence of newer generation neuroleptic medication. A sample of 55 atypical neuroleptic-naive schizophrenia patients was assessed at index and 3 years later. Index neurocognitive measures included general intellectual ability (IQ), executive ability (Wisconsin Card Sorting Test [WCST]), verbal memory (California Verbal Learning Test [CVLT]), and manual dexterity (Purdue Pegboard). These measures, along with demographic (age, sex, education) and clinical (symptoms, prior hospitalizations) variables, were entered into regression equations to predict life quality (Sickness Impact Profile [SIP]) at follow-up, as well as rehospitalization during the 3-year period. Stability data were also analyzed. Demographic and cognitive data predicted subjective quality of life, but not rehospitalization. Changes in memory over time rather than performance levels related to life quality at follow-up. Rehospitalization was related only to demographic data and previous hospital admissions. The findings support the predictive value of selected aspects of neurocognition in relation to a subjective outcome domain in schizophrenia.

Adolescent↗
PubMedDate not supplied

Insight into illness in schizophrenia.

Lack of insight of patients with schizophrenia into various aspects of their illness and treatment is an important clinical issue. Poor insight has been reported to be associated with neurocognitive deficits, particularly in the frontal and parietal functions. The aim of this study was to examine relationships between insight and cognitive and emotional function in patients with schizophrenia. Thirty-five male forensic patients suffering from chronic schizophrenia participated. The Scale for the Assessment of Unawareness of Mental Disorder was used to assess insight. Neuropsychological function was assessed with a comprehensive battery of tests. Clinical state was also assessed. Of 35 patients, 18 (51%) believed that they had a mental disorder. A similar proportion reported awareness of a need for medication and correctly attributed symptoms to illness. Measures of insight showed significant associations with visual object learning, verbal working memory, and identification of facial emotions but not with measures of frontal lobe function. Poorer insight was associated with a higher occurrence of violent events. Our findings support an association between poor insight and cognitive impairment in patients with chronic schizophrenia but suggest that the relationship may not specifically involve frontal lobe dysfunction.

Adult↗
PubMed2003

Auditory and action semantic features activate sensory-specific perceptual brain regions.

Traditionally, concepts were considered propositional, amodal, and verbal in nature (for review, see ). Recent findings, however, suggest that conceptual knowledge is divisible into different types (L. Wu and L.W. Barsalou, personal communication, ) and that each type may be linked to specific sensory and motor processes. This implies that sensory processing regions of the brain may also process concepts. In fact, there is some neuroimaging evidence that conceptual information does activate perceptual brain regions and that there is a correspondence between knowledge type and the region being activated. In the following experiment, using a training technique developed in previous studies, participants verbally learned associations between novel objects and conceptual features. The objective was to create objects that were associated with features from only one knowledge type, something that does not occur with common objects. During a visual task that did not require retrieval of learned associations, the superior temporal gyrus, which responds well to sounds, was preferentially activated by objects associated with auditory features (e.g., buzzes). Likewise, the posterior superior temporal sulcus, which responds well to motion, was preferentially activated by objects associated with "action" features (e.g., hops). These findings support the theory that knowledge is grounded in perception.

Acoustic Stimulation↗
PubMed2006

Cognitive function after on or off pump coronary artery bypass grafting.

OBJECTIVE: To investigate cognitive outcome after on and off pump coronary artery bypass grafting. METHODS: Seventy patients between 50 and 80 years with stable angina pectoris, ejection fraction >30%, serum creatinine <150 micromol/l, and lack of tight main stem stenosis were randomized to on or off pump coronary artery bypass grafting. Standardized neuropsychological tests evaluated attention, verbal and visuo-spatial short-term and working memory, verbal learning, delayed recall, visuo-motor speed, and aspects of executive functions. Levels of anxiety and depression were also investigated. Testing was performed before and at 1 week, 1 and 6 months after surgery. RESULTS: There was no difference in cognitive impairment (defined as a 20% reduction in at least 20% of the tests) between groups. The incidence at 1 week post-operatively was 57% in the on pump group and 58% in the off pump group, after 1 month 30% and 12% and after 6 months 19% and 15%, respectively (p for interaction=0.19). There was no difference between groups in anxiety (p=0.18) or depression (p=0.48). CONCLUSIONS: This prospective, randomized study showed no differences in post-operative cognitive function after on pump compared to off pump coronary artery bypass grafting in low risk patients.

Aged↗
PubMed2006

Cognitive impairment in patients with chronic hepatitis treated with interferon alpha (IFNalpha): results from a prospective study.

BACKGROUND: Treatment with low-dose interferon alpha (IFN-alpha) is often associated with neuropsychiatric side effects. In addition to depression and anxiety, IFN-alpha associated cognitive impairment significantly affects patient's mental health and quality of life. AIMS OF THE STUDY: To measure possible effects of low-dose IFN-alpha on cognitive functioning and its relationship to the development of depression and anxiety. METHOD: We prospectively followed 38 patients with a chronic hepatitis B or C by neuropsychological tests and psychiatric self-rating scales during 12 weeks of low-dose treatment with IFN-alpha. RESULTS: Before IFN-alpha treatment, neuropsychological tests as well as self-ratings in the Beck's Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS) and the Self-Report Symptom Inventory 90 Items-Revised (SCL-90-R) were within the normal range. Following 12 weeks of treatment with IFN-alpha resulted in a slight, but significant increase in depression scores. Neuropsychological assessment after 12 weeks of IFN-alpha treatment showed a significant decrease of the immediate recall in the Auditory-Verbal Learning Test (AVLT) and a significant reduction of words recited in the Controlled Oral Word Association Test (COWA). Cognitive impairment did not significantly correlate with depressive symptoms or anxiety. CONCLUSION: Our results indicate that even low-dose IFN-alpha induces cognitive impairment independent from depressive symptoms, which might be related to functional disturbances in the prefrontal cortex and the hippocampus. We suggest close monitoring of cognitive function during IFN-alpha treatment of chronic hepatitis.

Adult↗
PubMed2006

Using assessment of higher brain functions of children with GJB2-associated deafness and cochlear implants as a procedure to evaluate language development.

OBJECTIVE: While investigators have reported that patients with GJB2-associated deafness and cochlear implants have preferable language development, the mechanisms of this phenomenon remains unknown. The goal of the present study was to assess higher brain functions of patients with GJB2-related and GJB2-unrelated deafness as a method of evaluating language development. METHODS: Eight children with cochlear implants were subjected to genetic testing for GJB2 and underwent the Raven colored progressive matrices test, Rey's auditory verbal learning test, Rey's complex figure test, the standardized language test for aphasia, the picture vocabulary test, and the standardized comprehension test for abstract words. RESULTS: Three children were diagnosed with GJB2-related deafness, and five children were diagnosed with GJB2-unrelated deafness. All three GJB2-related cases demonstrated normal range higher brain functions and fair language development. By contrast, one GJB2-unrelated case showed a semantic disorder, another demonstrated a visual cognitive disorder with dyslexia, and another had attention deficit-hyperactivity disorder. CONCLUSIONS: Children with GJB2-unrelated deafness showed a high frequency of heterogeneous disorders that can affect proper language development. This difference between children with GJB2-related and GJB2-unrelated deafness may account for the improved language development in children with GJB2-related deafness and cochlear implants. Further, genetic diagnosis of the non-syndromic hearing loss represents a useful tool for the preoperative prediction of outcomes following a cochlear implant procedure.

Audiometry↗
PubMed2006

Intellectual efficiency of children with unilateral hearing loss.

OBJECTIVE: The aim of our study was to observe the consequences of unilateral hearing loss with regard to intellectual functioning and development of children. METHODS: The studies were conducted on the group of 64 children (42 boys and 22 girls) aged 6-16 years with left- or right-sided hearing loss using D. Wechsler Intelligence Scale for Children (WISC). RESULTS: Children with right-sided hearing loss had a limited range of concepts, lower capability of learning verbal material and logical reasoning, abstract thinking and classifying. Left-sided hearing loss caused deterioration of intellectual abilities within non-verbal intelligence. Such a children had poorer abilities for analyzing, synthesizing and visual memory, worse spatial imagination and visual coordination. CONCLUSIONS: The examined children with unilateral hearing loss achieved the intelligence quotient on the average level in D. Wechsler Intelligence Scale. The side of hearing loss has a significant influence on the development of individual intellectual functions.

Adolescent↗
PubMed2004

Evidence for continuing neuropsychological impairments in depression.

BACKGROUND: Neuropsychological deficits have been reported in patients with major depressive disorder (MDD) during an acute episode of MDD. Little is known whether these abnormalities persist when patients are remitted. The purpose of the present study was to describe the neuropsychological functioning of fully remitted, unmedicated patients with a history of MDD by focusing on tasks related to prefrontal cortex functioning. METHODS: Twenty-eight young to middle-aged, unmedicated, fully remitted patients with MDD were compared to 23 healthy control subjects on tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) and the California Verbal Learning Test (CVLT). RESULTS: Patients with remitted MDD relative to controls were impaired on tasks of rapid visual information processing (RVIP), psychomotor performance and spatial working memory (SWM). After correction for residual depressive symptoms, deficits in sustained attention remained significant. LIMITATIONS: CANTAB tasks are not equated for difficulty, and difficulty differences between the CANTAB tasks and the CVLT are not known. CONCLUSIONS: These findings suggest deficits in sustained attention as vulnerability marker for MDD. The functional importance of this finding and the neuronal networks involved remain to be elucidated.

Adult↗
PubMed2006

Effects of donepezil on memory and cognition in multiple sclerosis.

Acetylcholinesterase inhibitors are used to treat dementia associated with Alzheimer's disease, but their cognitive benefits may extend to additional disorders such as multiple sclerosis (MS). A single-center double-blind placebo-controlled randomized clinical trial evaluated the effectiveness of donepezil in a sample of 69 MS persons selected for initial memory difficulties. Subjects received neuropsychological assessment at baseline and after 24 weeks of treatment. The primary outcome was change in total recall on the Selective Reminding Test, a measure of verbal learning and memory. Secondary outcomes included other neuropsychological tests from the Brief Repeatable Battery, patient-reported change in memory, and physician-reported impression of cognitive change. Donepezil improved memory performance on the SRT compared to placebo. This benefit remained significant after controlling for various covariates including Expanded Disability Status Scale (EDSS), MS subtype, interferon beta use, treatment group beliefs, gender, baseline selected reminding test (SRT) score, and reading ability. Subjects on donepezil were more likely to report memory improvement (65.7%) than those on placebo (32.4%). The clinician also reported cognitive improvement in more donepezil (54.3%) than placebo (29.4%) subjects. No serious adverse events related to study medication occurred. However, more donepezil (34.3%) than placebo (8.8%) subjects reported unusual/abnormal dreams. Donepezil improved learning and memory in MS patients with initial cognitive difficulties in a single-center clinical trial. Replication of results in a larger multi-center investigation is warranted in order to more definitively assess the efficacy of this intervention.

Adult↗