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PubMed2001

Pregnancy and post partum: changes in cognition and mood.

Steroidal hormones are increasingly recognized as highly relevant in multiple aspects of brain functioning. While basic science has actively worked to advance understanding of fundamental steroid mechanisms within the brain, investigation of the neurobehavioral outcomes of reproductive hormone actions on the human brain has received less attention. We argue that the dramatic steroidal hormone changes seen in human reproduction must be systematically studied and may provide novel explanations of cognitive and mood disorders associated with reproductive events. This chapter provides a review of current literature establishing a role for a variety of steroids on neuroactivity, and evidence from a variety of observational and experimental paradigms linking hormones and clinical aspects of cognition and mood in humans. The specific hormonal changes of pregnancy are described and discussed in relation to concomitant alterations in cognition and mood across the peri-natal period. A review of studies that have systematically observed cognitive and affective changes both during pregnancy and the post-partum period is presented, as well as new data that follow a small cohort of women for an extended period of time after delivery. We conclude that women may show specific areas of cognitive changes during and after pregnancy, notably deficits in verbal learning and memory. Mood appears to be impacted as well. While steroidal hormones show a pattern of associations with mood during and after pregnancy, no such pattern is evident for cognition. The embryonic state of our knowledge regarding reproductive hormones and neurobehavioral functioning is evident, as are the scientific and public health reasons to redress this lacuna.

Affect↗
PubMed2000

Effect of apomorphine on motor and cognitive function in melancholic patients: a preliminary report.

Given the many clinical parallels between melancholia and disorders associated with impaired dopaminergic function such as Parkinson's Disease (PD), it has been hypothesised that major depressive disorder, and in particular the psychomotor features of melancholic depression, may also be associated with a hypodopaminergic state. If this is the case, then the use of a dopamine agonist might lead to reversal of both the cognitive and motor impairments seen in these patients. A double-blind, placebo-controlled cross-over design was used to test the effect of apomorphine on motor and cognitive function in seven melancholic subjects (as defined by the CORE instrument) and five control subjects. The testing battery included the following items: finger tapping, rapid alternating movements, verbal fluency, Rey Auditory Verbal Learning Task, digit symbol substitution task and simple and complex reaction times. The independent t-test, after covarying for age, revealed significant impairment in melancholic subjects for the walking task and digit symbol substitution at baseline. Results of the ANCOVA revealed no impact of time or drug condition, either alone or in combination, upon task performance in either group whether assessed separately or jointly. Results of a MANCOVA revealed that apomorphine impaired performance on some cognitive tasks, and that this was seen to a lesser extent in melancholics than control subjects. There was no evidence that the dopamine agonist apomorphine improved cognitive or motor function in subjects with strictly defined melancholia, suggesting that psychomotor retardation is not associated with a hypodopaminergic state. Our conclusions, however, were limited by small sample size; minimal baseline task impairment in depressed compared to control subjects; mild sedation in many subjects during task performance; and lack of serum apomorphine levels.

Aged↗
PubMed2002

Visual processing and neuropsychological function in schizophrenia and schizoaffective disorder.

Persons with schizophrenia and schizoaffective disorder exhibit deficits in both visual processing and neuropsychological tasks. Little is known, however, about whether these deficits are related to one another. We administered psychophysical tests of visual discrimination and recognition, and neuropsychological tests of abstract flexibility, verbal learning, visual memory, working memory and attention to 42 outpatients with stable but chronic schizophrenia or schizoaffective disorder. Multiple regression analyses were performed to determine the relationship between these measures of neuropsychological function and visual psychophysical performance. Results indicated that motion perception was associated with working memory, and that the addition of a memory component to motion perception (motion recognition) was associated with both working memory and visual memory. Visual performance was not associated with symptom severity as measured by the PANSS. These results suggest that psychophysical tests of visual processing may contribute to deficits on neuropsychological tests of visual cognition, and may also reflect cross-modal disturbances of working memory function.

Adult↗
PubMed2002

Schizophrenia and memory impairment: evidence for a neurocognitive subtype.

Evidence is presented that verbal memory impairment distinguishes a subgroup of patients with schizophrenia who also differ in symptom profile and illness adjustment. On the basis of the California Verbal Learning Test (CVLT), a sample of patients was partitioned into memory-impaired (n=16) and memory-unimpaired groups (n=16). Groups were matched for age, sex, IQ, and anti-psychotic medication. These groups were then compared using the Brief Psychiatric Rating Scale (BPRS) and the Sickness Impact Profile (SIP). Results indicate that memory-impaired schizophrenia patients experience significantly more positive symptoms and a poorer quality of life than their memory-unimpaired counterparts. This finding supports the idea that neurocognitive measures are a valuable way of organizing the heterogeneous disease states of schizophrenia.

Adolescent↗
PubMed2003

Effects of Attention Process Training on cognitive functioning of schizophrenic patients.

The goal of this study was to investigate the impact of Attention Process Training (APT) on cognitive functioning in schizophrenia. Twenty-four patients with schizophrenia were randomly assigned to one of the two following conditions: training by means of APT or no training. The dependent variables included measures of attention, memory and executive functions derived from a cancellation task, dichotic listening, dual task, Trail Making Test, Paced Auditory Serial Addition Task, Everyday Attention Questionnaire, Spain-Complutense Verbal Learning Test and Wisconsin Card Sorting Test (WCST). All participants were also rated on measures of positive and negative symptoms. The tasks were administrated to all participants at baseline. Participants in the training group received individual intensive APT twice a week, whereas the control group did not receive training. All participants were subsequently retested on the same tests. Although, contrary to expectations, neither group improved on clinical and information-processing measures of attention and memory, patients in the trained group had a significantly higher performance on executive function (as measured by the WCST) than did the control group. We conclude that it is feasible to use practice in attention to remediate executive function deficits in schizophrenia.

Adult↗
PubMed2003

Neurological soft signs and neuropsychological performance in patients with first episode schizophrenia.

Neurological soft signs and neuropsychological (NP) impairments are prevalent in schizophrenic patients. However, the relationship of these deficits is rarely studied, and it remains controversial in what way soft signs influence NP performance. The Neurological Evaluation Scale (NES) and a comprehensive neuropsychological test battery were used to assess soft signs and cognitive functions in 61 first-episode schizophrenic patients. The NP test battery included tests such as the California Verbal Learning Test, the Continuous Performance Test, the Span of Apprehension Test, the Stroop Color-Word Test, the Trail-Making Test and the Wisconsin Card Sorting Test. The NP tests were also administered to 87 healthy controls. The first-episode schizophrenic patients were split along the median of their NES total score (SS- vs. SS+). The level of NP performance and the differences in relative performance (shape of the NP profile) on NP functions between the two groups were assessed. The two groups (SS- vs. SS+) did not differ in any demographic or clinical variable. However, they differed in the level of their NP performance (profile mean) but did not show differential deficits in NP performance (profile shape). Neurologic soft signs influence NP performance and are correlated to a generalized NP deficit rather than to any specific NP functions.

Adult↗
PubMed1999

Non-linear time series analysis of intracranial EEG recordings in patients with epilepsy--an overview.

Deterministic chaos offers a striking explanation for apparently irregular behavior, a characteristic feature of brain electrical activity. The framework of the theory of non-linear dynamics provides new concepts and powerful algorithms to analyze such time series. However, different influencing factors render the use of non-linear measures in a strict sense problematic. Nevertheless, if interpreted with care, particularly the correlation dimension or the Lyapunov-exponents provide a means to reliably characterize different states of normal and pathological brain function. This overview summarizes recent findings applying this concept in the field of epileptology that promise to be important for clinical practice. Non-linear measures extracted from the intra-cranially recorded EEG allow (a) localization of epileptogenic areas in different cerebral regions even during seizure-free intervals, (b) investigation of the influence of anticonvulsive drugs and (c) detection of features predictive of imminent seizure activity. Moreover, particularly the dimensional complexity proves a valuable parameter reflecting spatially distributed neuronal activity during verbal learning and memory processes. Specific changes in time of this non-linear measure allow the prediction of memory performance and, in addition, represent an estimate of the recruitment potency in the anterior mesial temporal lobes. Thus, the application of non-linear time series analysis to brain electrical activity offers new information about the dynamics of the underlying neuronal networks.

Electroencephalography↗
PubMed2004

Neuropsychological impairment in borderline personality disorder.

In spite of accumulating evidence from neurological, neuroimaging, neuropsychological, and, more recently, developmental studies, borderline personality disorder (BPD) is not considered routinely a neurocognitive disorder. A review of the neuropsychological literature shows that the preponderance of BPD studies failed to examine a broad range of cognitive domains and, in particular, have not adequately evaluated attention. Nevertheless, most neuropsychological studies suggest that these patients' cognitive skills are compromised. The authors administered a neuropsychological battery designed to evaluate nine cognitive domains in twelve female inpatients diagnosed with BPD. Relative to a healthy normative group, inpatients with BPD were impaired in seven cognitive domains, with attention-vigilance and verbal learning and memory most pronounced. Neuropsychological performance was significantly related to degree of psychopathology. The authors recommend that clinicians routinely screen BPD patients for cognitive dysfunction and highlight the roles that this important knowledge can have in treatment.

Adolescent↗
PubMedDate not supplied

Does aspirin or other NSAIDs reduce the risk of cognitive decline in elderly persons? Results from a population-based study.

OBJECTIVE: To investigate the protective effect of NSAIDs and aspirin separately on cognitive decline in elderly subjects, controlling for consistent use of these agents over a prolonged period of time. METHODS: The study sample consisted of 1007 subjects, drawn from a population-based random sample of elderly individuals, 62-85 years old, who participated in a 3-year follow-up study. From this sample subjects were selected, who did use NSAIDs and completed all cognitive tests at both measurements (n=137), and subjects who did not use NSAIDs and completed all cognitive tests (n=475). Cognitive tests included the Mini-Mental State Examination (MMSE), tests for episodic memory (Auditory Verbal Learning Test) and information processing speed (coding task). Cognitive decline was computed using Edwards-Nunnally method. Multiple logistic regression analyses were performed to examine the association between NSAID (with and without aspirin) and decline in cognitive performance. Besides, the interaction of NSAIDs with age on cognitive decline was determined. RESULTS: The relative risk estimates of decline in episodic memory (immediate recall) adjusted for age, gender, education, baseline MMSE, vascular diseases, diabetes mellitus and (rheumatoid) arthritis for aspirin users only was more than three times reduced (OR: 0.30, 95% CI: 0.09-0.82). The odds ratio for decline in memory of NSAID use without aspirin, adjusted for age, gender, education, baseline MMSE, vascular diseases, diabetes mellitus and (rheumatoid) arthritis was not significant (OR: 1.00, 95% CI: 0.39-2.93). The effect of aspirin was significant only in persons of 75 years and over (OR: 0.10, 95% CI: 0.01-0.81), not in subjects younger than 75 years (OR: 0.52, 95% CI: 0.14-1.96). NSAIDs did not have benefit on information processing speed. In 92% of aspirin users a low dose of 100mg daily or less was used. CONCLUSION: Low-dose aspirin might be protective for decline in memory in individuals of 75 years and over. The benefit of a low-dose aspirin does not support an anti-inflammatory effect, but suggests an antiplatelet effect. Therefore, a possible protective effect of low-dose aspirin on cognitive decline is likely only in subjects with aspirin use over a prolonged period of time.

Aged↗
PubMed1988

Relationship of dialysis modality and other factors to cognitive function in chronic dialysis patients.

To determine if dialysis modality may be an independent factor in the level of cognitive function in chronic dialysis patients, cognitive function was studied in 17 pairs of continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) subjects matched for sex, age, diabetic status, and interval since dialysis onset. Data on current metabolic, medical, psychological, and vocational function status were obtained. Neuropsychological (NP) measures included the Number Cancellation Protocol (NCP), Trailmaking test forms A and B (TMT A, TMT B), Symbol Digit Modalities (SDM), and the Rey Auditory Verbal Learning Test (RAVLT). The CAPD subject group had consistently more efficient cognitive function than the CHD subject group. Regardless of modality, the groups of subjects under age 51 and those who were vocationally active had significantly better NP performance. No cognitive function differences were found in groups categorized by sex or duration of dialysis. Creatinine levels were more highly correlated with NP scores than were BUN levels, with higher creatinine levels associated with better cognitive function. Serum calcium, CO2, total protein, albumin, and SGOT levels also were correlated with NP scores. CAPD may be more effective than HD in reversing uremic encephalopathy by mechanisms mostly unrelated to serum creatinine and BUN levels. Longitudinal studies will be needed to determine if dialysis modality is an independent factor in the degree of reversal of uremic encephalopathy.

Adult↗
PubMed2003

Open-label nefazodone in patients with a major depressive episode and alcohol dependence.

PURPOSE: Major depressive disorder (MDD) and alcohol dependence (AD) frequently occur together. However, MDD clinical trials generally exclude patients with alcohol-related disorders. GENERAL METHODS: A 12-week, open-label trial of nefazodone in a group of people (n=13) with both a current major depressive episode and current AD was conducted to examine the effect of this antidepressant on depressive symptoms, alcohol use, and cognition. FINDINGS: Scores on the Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA) significantly decreased from baseline to exit. In addition, significant reduction in alcohol craving, drinks/week, and days of alcohol use/week was found. Scores on the Rey Auditory Verbal Learning Test (RAVLT) did not significantly improve during the study. Changes in mood/anxiety and memory did not correlate with changes in alcohol use. CONCLUSIONS: Thus, nefazodone therapy was associated with improvement in mood/anxiety and alcohol use, which seem to be independent of each other in this patient sample. However, declarative memory, which was low average at baseline, did not show statistically significant improvement during the 12 weeks of the study.

Adult↗
PubMed2000

Effects of apolipoprotein E phenotypes on the neuropsychological functions of community-dwelling elderly individuals without dementia.

Studies have demonstrated that different apolipoprotein E (APOE) phenotypes appear to modulate the effects of cognitive aging in Caucasian elderly populations. Few studies have investigated the effects of the common APOE alleles on the neuropsychological functioning in other ethnic elderly populations. We examined the different effects of APOE polymorphism on the neuropsychological functions of 213 community-dwelling Korean elderly individuals without dementia. Individuals with APOE epsilon4 allele performed poorly on memory measures, Recency of the Elderly Verbal Learning Test, Immediate and Delayed Reproductions of the Simplified Rey Figure Test (SRFT), the Primary Memory Index, and the Secondary Memory Index. They also performed worse on the sub-scale assessing executive function on the Korean-Dementia Rating Scale (K-DRS). Subjects with APOE epsilon2 allele performed better on visuo-spatial measures, the Construction sub-scale of the K-DRS, and the Copy and Immediate Reproductions of the SRFT.

Aged↗
PubMed2004

Free recall of pleasant words from recency positions is especially sensitive to acute administration of cortisol.

In a recent study we investigated the acute effects of cortisol administration in healthy male volunteers on free recall of pleasant, unpleasant, and neutral nouns using a between-subjects double-blind placebo-controlled design. The volunteers were administered 10 mg of hydrocortisone or placebo between 9:00 and 10:30. Two hours after administration of cortisol a decline in recall of neutral and pleasant words was found, while recall of unpleasant words did not change. These results are consistent with a possible inhibitory influence of cortisol on a prefrontal dopaminergic mechanism involved in approach and positivity bias. In this paper we first explain why this interpretation would predict recall of pleasant words from recency positions to be especially sensitive to cortisol administration. Comparing primacy and recency recall of pleasant and unpleasant words, there proved to be a selective decline in recall of pleasant recency words. These results did not appear to stem from differences in recall strategies between our groups of volunteers.

Adolescent↗
PubMed2003

Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors.

PURPOSE: To identify the characteristics of adult patients with newly diagnosed primary brain tumors associated with identifiable deficits in neuropsychologic function to target interventions to improve function and quality of life (QOL). MATERIALS AND METHODS: Adult patients with newly diagnosed primary brain tumors and their caregivers were enrolled and underwent a battery of standardized neuropsychologic tests, allowing for qualitative and quantitative assessment and sensitive to the effects of the brain tumor, QOL, or caregiver stress. RESULTS: We enrolled 68 patients with no prior radiotherapy. Patients with left hemisphere tumors reported significantly more memory problems and depressive symptoms. They also exhibited poorer attention and were more distractible, with poorer verbal fluency and poorer verbal learning. Patients with glioblastoma multiforme demonstrated poorer psychomotor speed and visual tracking than patients with non-glioblastoma multiforme histologic features. Patients and caregivers perceived QOL in a similar fashion, with significant correlation between patient and caregiver on hope testing and general QOL on the Linear Analog Self-Assessment Scale. CONCLUSIONS: Patients with left hemisphere tumors and glioblastoma multiforme histologic features demonstrated testable differences in neuropsychologic function and QOL that may be amenable to improvement with medical therapy or tailored rehabilitation programs. Caregiver assessments can predict patient QOL, which may be useful in patients with declining status.

Activities of Daily Living↗
PubMed1998

Assessment of neuropsychological changes in patients with arteriovenous malformation (AVM) after radiosurgery.

PURPOSE: The purpose of this study was to investigate neuropsychological effects of radiosurgery in patients with cerebral arteriovenous malformation (AVM), with special focus on attention and memory. This report describes the study setup and presents the first results during a follow-up of up to 1 year. MATERIALS AND METHODS: Seventy-nine patients were studied before, acutely after radiosurgery, and during the regular follow-up (subacute phase: Weeks 6-12, chronic phase: Months 6-12). Radiosurgery was performed using a modified linear accelerator (minimum doses to the target volume: 15-22 Gy, median 20 Gy). Estimated whole brain dose was 0.5 to 2 Gy. Neuropsychological testing included assessment of general intelligence (Wechsler Adult Intelligence Scale), attention (modified Trail-Making Test A, Digit Symbol Test, D2 Test, Wiener Determination Machine) and memory (Rey Auditory Verbal Learning Test, Benton Visual Retention Test). During follow-up, alternate test versions were used. Neuropsychological deficits were defined as a test score of at least one standard deviation (SD) below the mean of the normal distribution. RESULTS: The pretherapeutic evaluation revealed marked deviations from the normal population; 24% had deficits in intelligence (range 23-31% in different subtests), attention (35%, 23-59%) and memory (48%, 31-61%). The overall percentage of aberrant results was reduced by 12% (memory) to 14% (attention) in the chronic phase up to 12 months after therapy. The improvement in test scores was significant (p < 0.05) in 3 of 4 subtests of attention functions. CONCLUSIONS: The acute tolerance of radiosurgery seems to be very good in these patients, showing no relevant increase in number of patients with neuropsychological deficits. Although the long-term follow-up needs to be further increased, our data indicate a tendency to slight improvement in the overall neuropsychological performance of AVM patients in the chronic phase after radiosurgery.

Adult↗
PubMed1998

Cognitive improvement despite minimal arachnoid cyst decompression.

There are relatively few reports that evaluate the cognitive functions of patients with arachnoid cysts. Presumably, these 'silent cysts' are regarded as incidental findings with no functional significance. Although postoperative clinical improvement is well documented in patients with significant reduction in cystic volume, the current report describes a patient who underwent cystoperitoneal shunting due to mass effect, with minimal postoperative decompression. Neuropsychological testing indicated significant cognitive improvement in verbal learning, memory, visual-perceptual abilities, constructional skills, conceptual shifting, and psychomotor speed after shunt placement, despite marginal evidence of decompression. These findings suggest that (1) significant cognitive changes can occur in these patients, despite minimal postoperative regression of the lesion, (2) cognitive measures may provide an alternative, functional index of outcome efficacy, and (3) reliance on traditional outcome measures (i.e. anatomical decompression or resolution of clinical symptoms) may underestimate the efficacy of surgical intervention for these patients.

Adult↗
PubMed2003

Cognitive performance in patients after carotid endarterectomy.

OBJECTIVE: Research investigating the benefits of carotid endarterectomy (CEA) on cognitive functioning remains inconclusive. This study sought to determine what patient characteristics affect cognitive functioning and whether changes in cognitive functioning occur following surgery after controlling for these characteristics. METHODS: In a prospective longitudinal study, 39 patients scheduled for CEA surgery underwent neuropsychological testing in the week prior to their surgery. Two patients had a stroke following surgery, leaving 37 patients who were tested again at 7 days and 3 months following surgery. The surgery was performed under a locoregional anesthetic. RESULTS: Patient characteristics associated with cognitive functioning were age, education, and IQ. In addition, differences in cognitive performance on a number of tests were related to presenting symptoms. Stroke patients (n = 6) differed significantly from symptom-free patients (n = 18) and patients with symptoms (n = 13) on measures of verbal fluency, visual search and mental flexibility, and verbal learning. When differences in patient characteristics were controlled for, no significant changes in cognitive functioning were found that could be attributed to the effects of surgery. CONCLUSIONS: No changes in cognitive functioning were associated with CEA. Differences in cognitive functioning, however, were associated with patient characteristics, including differences in presenting symptoms.

Age Factors↗
PubMed1991

Adolescents with ADHD: patterns of behavioral adjustment, academic functioning, and treatment utilization.

Adolescents with attention deficit hyperactivity disorder (ADHD) were compared with a control group on a comprehensive assessment battery. More ADHD teenagers had oppositional defiant disorder (68%) and conduct disorder (39%) and were rated as more impaired in social competence, behavioral and emotional adjustment, and school performance by parents and teachers than control teens. The ADHD youths, however, rated themselves as better adjusted than did their parents and teachers, differing only from controls in depressive symptoms and antisocial acts. Poorer performances in verbal learning and vigilance and greater ADHD behaviors during a math task also distinguished the ADHD from control teenagers.

Achievement↗