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PubMed2003

A 9-year controlled prospective neuropsychologic assessment of amateur boxing.

OBJECTIVE: To test the hypothesis that there is an association between amateur boxing and chronic traumatic encephalopathy using neuropsychologic assessments. DESIGN: A prospective, controlled, blinded, observational, neuropsychologic study. SETTING: Amateur boxing clubs in Dublin, Ireland, March 1992 to April 2001. PARTICIPANTS: Twenty randomly selected, actively competing, male amateur boxers and 20 age-matched, socio-economic controls. INTERVENTIONS: The boxers participated in amateur competition and sparring. MAIN OUTCOME MEASURES: Raw scores and changes in scores over time were recorded in the following neuropsychologic tests: Trail Making Tests A and B, Digit Symbol, Finger Tapping (dominant and nondominant hands), modified versions of the Finger Tapping Tests, Paired-Associate Learning, Digit Span, Rey-Osterrieth Complex Figure Tests A and B, and Serial Addition. Raw scores and changes in scores for the two groups were compared, and a regression analysis was performed to detect any association between these values and exposure to boxing. RESULTS: The boxers showed superior performance in the Trail Making Tests A and B at all time points and an inferior performance in both standard Finger Tapping Tests at all time points except baseline for the dominant hand. This inferior performance was not found in the modified versions of the tests. The controls showed significant deterioration in their performance in the Rey-Osterrieth Complex Figure Tests A and B. CONCLUSIONS: In this small controlled, prospective study of competitive amateur boxers, there was no evidence of neuropsychologic deterioration over 9 years. The amateur boxers demonstrated relative preservation and/or improvement of some neuropsychologic skills relative to the socioeconomic controls.

Adolescent↗
PubMed2000

A comparison of sideline versus clinical cognitive test performance in collegiate athletes.

OBJECTIVE: To test whether performance on 5 cognitive tests administered in a controlled clinical environment differed compared with administration in an uncontrolled sideline environment. Additionally, we investigated the effect of testing environment order on the learning effect for each cognitive test. DESIGN AND SETTING: Athletes were assessed on 2 test occasions (8 +/- 2 days apart), once in a sports medicine research laboratory and once on a lacrosse practice field site. SUBJECTS: A total of 59 Division I collegiate student-athletes participated in this study. MEASUREMENTS: Normative data were collected on 5 cognitive tests (Stroop Test, Trail-Making Test part A, Trail-Making Test part B, Wechsler Digit-Span Forward Test, and Digit-Span Backward Test). RESULTS: An independent-samples t test for environment difference on test day 1 revealed no significant differences between tests performed in the controlled environment and those performed in the uncontrolled environment. A repeated- measures analysis of variance test revealed a significant learning effect for all 5 tests, as subjects tended to improve approximately 11 points on the Stroop Test, 3 seconds on the Trail-Making A Test, 7 seconds on the Trail-Making B Test, and 1 point each on the Wechsler Digit Span Forward and Backward Tests. A paired-samples t test using delta scores (first test minus second test), sorted by order of testing environment, revealed a significant difference for the Stroop Test, but not for the remaining cognitive tests. CONCLUSIONS: There appears to be no difference in cognitive testing performance completed in a controlled clinical environment versus that performed in an uncontrolled sideline environment. This finding suggests that clinicians can administer cognitive tests to athletes with mild head injuries in uncontrolled sideline environments and expect valid results. Thus, clinicians can more thoroughly evaluate mildly head-injured athletes during the most crucial period after injury so that a safe return-to-play decision can be based on quantifiable, objective data.

Journal Article↗
PubMed2000

Comparison of the Trail Making and Color Trails Tests in a Chinese context: a preliminary report.

The Color Trails Test developed as a culturally fair analogue of the Trail Making Test, was used to examine the relationship between the two tests with 35 undergraduate Chinese in Hong Kong recruited as the subjects. The scores on these two tests of the 12 men and 23 women were significantly correlated .71. The equivalence of the Trail Making and Color Trails Tests when applied to Chinese in Hong Kong was discussed.

Adult↗
PubMed2000

Are trail making and color trails tests of equivalent constructs?

The Color Trails Test (CTT) was developed as a culturally fair analogue of the Trail Making Test (TMT). This study examined the equivalence of these two tests for Chinese individuals in Hong Kong. One hundred and eight Chinese people volunteered for this study, and were classified into four groups according to their age and level of education. Their performance on these two tests was compared. The findings suggested that age and level of education indeed played significant roles in their performance on these two tests. Strong correlations (r = 0.72) were only observed between scores on Part B of the TMT and Part 2 of the CTT when the participants were older and had higher levels of education. This suggests that the equivalent construct of the Trail Making and Color Trails Tests can only be examined and established within specific age and education parameters.

Adolescent↗
PubMed1986

Classification rates obtained with "standard" cut-off scores on selected neuropsychological measures.

Examined in a normal sample (N = 365) the number of subjects was classified as impaired on several commonly used neuropsychological tests (Seashore Rhythm Test, Trail Making Test, Finger Tapping Test, and Grooved Pegboard Test) in reference to conventional cut-off scores. The sample was stratified on the basis of age, sex, and education. For the sample as a whole, the percentage of subjects classified as impaired ranged from 15.6 to 80. In some subgroups on some tests, the percentage so classified was 100. The data were discussed in relation to the need to adjust conventional cut-off scores for the influence of subject variables. In addition, cross-cultural differences on some tests suggested the need for local or national normative studies.

Adolescent↗
PubMed2002

Quality of life on randomized treatment for isolated systolic hypertension: results from the Syst-Eur Trial.

OBJECTIVE: To compare quality of life in elderly patients with isolated systolic hypertension allocated randomly to groups to receive placebo or active treatment in the Systolic Hypertension in the Elderly Trial. DESIGN: Double-blind randomized controlled trial. METHODS: Patients aged 60 years were allocated randomly to groups to receive first-line treatment with nitrendipine (with second- and third-line enalapril and hydrochlorothiazide) or placebo. Trained interviewers administered trail-making tests (Trail A and B), Brief Assessment Index (a measure of depressed mood) and four subscales from the Sickness Impact Profile (Ambulation, Social Interaction, Sleep and Rest, and Home work). RESULTS: Six hundred and ten patients completed a baseline and at least one follow-up questionnaire. Trail-making scores were slower in actively treated patients, especially in the first 6 months of follow-up when the between-group effect sizes were 0.25 [95% confidence interval (CI) 0.07 to 0.43] for Trail-making A and 0.13 (95% CI -0.05 to 0.31) for Trail-making B. Across the 4 years of follow-up, patients receiving active treatment were more likely to report problems on the Social Interaction scale than were placebo-treated patients (odds ratio 1.32, 95% CI 1.02 to 1.69), equivalent to a 7% difference. There were no significant differences between active and placebo treatment in the other Sickness Impact Profile dimensions or in the measure of depression. CONCLUSIONS: Active treatment in the Systolic Hypertension in Europe trial was associated with some small adverse impacts on quality of life.

Aged↗
PubMed2003

Effects of past noninjection drug abuse upon executive function and working memory in HIV infection.

Interactive effects of past noninjection drug abuse/dependence and HIV disease status upon measures of executive function were assessed in a group of 294 homosexual men. Participants were stratified according to HIV status and substance use diagnoses, thereby yielding a 4 (seronegative, asymptomatic seropositive, symptomatic seropositive, and AIDS defining illness) x 2 (never abused drugs, previous substance use disorder) design. Significant main effects of HIV status were found on the Wisconsin Card Sorting Test, Ruff Figural Fluency Test, Trail Making Test B, and total number of impaired performances. Analyses revealed that men with AIDS defining illness performed worse than the other three groups. Drug use history had no significant effect upon neurobehavioral function, and effect sizes for drug abuse history were small. The data suggest that prior drug use yields little if any residual cognitive impairment in HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Dietary protein, carbohydrate, and fat enhance memory performance in the healthy elderly.

BACKGROUND: Dietary carbohydrates can improve memory. Whether these effects are related to elevations in blood glucose or to energy ingestion is unknown. OBJECTIVES: Our objectives were to determine 1) the influence of isoenergetic protein-, carbohydrate-, and fat-containing drinks on cognitive performance and 2) whether the time period after ingestion affects cognition. DESIGN: After fasting overnight, 11 men and 11 women aged 61-79 y consumed either a 300-mL drink containing 774 kJ as pure protein (whey), carbohydrate (glucose), or fat (safflower oil) or a nonenergy placebo on 4 separate mornings. Cognitive tests were administered 15 and 60 min after ingestion of the drinks. Plasma glucose and serum insulin concentrations were measured. RESULTS: Only the carbohydrate drink increased blood glucose (P < 0.0001). Compared with the placebo, all 3 macronutrients improved delayed paragraph recall (PR) (P < 0.001) and improved or tended to improve immediate PR (P < 0.04) 15 min after ingestion. Beneficial effects on other cognitive tests were confined to one or more of the macronutrients: carbohydrate improved Trail Making Test (Trails) performance at 60 min (P = 0.02) and tended to improve Trails at 15 min (P = 0.04) and PR at 60 min in men, carbohydrate and fat improved or tended to improve performance on Trails at 15 and 60 min in subjects with poor baseline scores (r > -0.41, P < 0.03), fat tended to improve attention at 60 min (P < 0.05), and protein reduced the rate of forgetting on the PR at 15 min (P = 0.002). CONCLUSIONS: Energy intake from protein, carbohydrate, or fat can enhance memory independently of elevations in blood glucose. Each macronutrient may also exert unique effects on cognition.

Aged↗
PubMed2004

The development of a trial making test in young children: the TRAILS-P.

Preschool children have a more limited verbal repertoire, less proficient manual skills, and more variable attention spans relative to those of school age, with comparatively few neuropsychological tasks available for use in this age range. A prototypic neuropsychological test, the Trail Making Test, was adapted for use with young children, the TRAILS-P, using a developmentally salient storybook format with colorful stimuli in differing conditions with varying executive demands. The TRAILS-P was administered to 103 normally developing preschoolers between 2 and 6 years of age; 30 of these children were retested within one month to determine test reliability. Correlations among latencies to complete each condition and condition errors generally were moderate to high, suggesting coherence in test content. There also was evidence for good test-retest reliability. Latency to complete the TRAILS-P conditions differed as a function of the interaction of condition type and age group. Although the youngest children generally took more time to complete all TRAILS-P conditions, 3-year-old children were disproportionately slow to complete the condition that required shifting between stamping stimuli of two classes, with distraction by the additional presence of irrelevant stimuli. In contrast, the number of errors differed only in the 5-year-olds relative to younger children. These findings suggest that executive abilities can be assessed adequately in young children when tasks are designed to take advantage of the developmentally unique features of the preschool period.

Age Factors↗
PubMed2006

Impaired working speed and executive functions as frontal lobe dysfunctions in young first-degree relatives of schizophrenic patients.

The aim of the investigation was to detect neuropsychological markers, such as sustained and selective attention and executive functions, which contribute to the vulnerability to schizophrenia especially in young persons. Performance was assessed in 32 siblings and children of schizophrenic patients and 32 matched controls using Wisconsin Card Sorting Test, Colour-Word-Interference-Test, Trail Making Test, and d2-Concentration-Test. The first-degree relatives showed certain impairments on all four tests, in particular, slower times on all time-limited tests. These results suggest the need for more time when completing neuropsychological tasks involving selected and focused attention, as well as cognitive flexibility, as a possible indicator of genetic vulnerability to schizophrenia.

Adolescent↗
PubMed1982

Correlations between psychopathology, psychological test results and computerized tomography changes in senile dementia.

This study is an investigation of the relationship between morphological, neuropsychological, and clinical measurements, all presumably contributing to an expert's diagnosis of senile dementia. Morphological assessment was carried out by linear measurements taken from the photographs of the CT scanners display. The battery of tests comprised instruments able to evaluate performance (WAIS, Benton test, d2 test, Trail Making test) as well as personality (FPI) from a quantitative point of view. For clinical assessment the Assessment Scale for Gerontopsychiatry (AGP) was used. A group of 39 patients suffering from mild to severe dementia was studied. The results show strong correlations between some sub-tests of the WAIS and certain CT measurements but fail to show comparable features in using the full scale IQ. The other cognitive tests did not work as well in detecting brain atrophy. Surprisingly, the personality inventory (FPI) showed some correlations with brain atrophy. A number of correlations between morphological and clinical variables were found as well, consistent with well-known clinical experience. Topographical features will be discussed supporting the view that cerebral lesions in the progress of senile dementia take the form of distinct patterns.

Affect↗
PubMed1995

[Effect of modafinil in narcoleptic patients. Electrophysiologic and psychometric studies].

Clinical efficiency of Modafinil was clearly demonstrated in narcoleptic patients but only a few electrophysiological studies were carried out to confirm these observations. Since Modafinil did not change the propensy to fall asleep, the aim of this work was to study maintenance of wakefulness and performance levels in treated narcoleptic patients. Of the 16 treated patients, 12 responded as expected to Modafinil. These 12 patients were studied. After a one night polysomnography, electrophysiological tests included: baseline spectral analysis, maintenance of wakefulness tests carried out respectively eyes open in diffused light and eyes closed in darkness during which sleep latency, duration of test and changes in the theta/alpha ratio were measured. Psychometric performances were evaluated using verbal or non verbal tests: visual and auditory reaction time tests. Trail Making Test, Stroop, verbal Fluency and WAIS-R. Modafinil improved the ability of narcoleptic patients to remain awake only when the situation or the environmental conditions were favorable. Some psychometric performances also trended towards on improvement.

Adult↗
PubMed2006

A dopamine agonist, pramipexole, and cognitive functions in Parkinson's disease.

The cognitive performance of 55 non-demented idiopathic Parkinson's disease (PD) patients treated with levodopa alone or receiving dopamine agonist pramipexole as add-on therapy to levodopa was evaluated in the present study during 6 months of treatment. Neuropsychological tests were administered two times. In the first assessment to differentiate test sensitive to cognitive changes typical for PD control group was also assessed. After 6 months of treatment PD patients were retested only with tests that differentiate them from control group. Compared to controls PD patients showed inferior performance on Stroop Interference test, Trail Making test, letter fluency and Hooper Visual Organization Test. No statistically significant differences between two groups and first and second neuropsychological assessment were found. Present findings indicate that pramipexole as add-on therapy to levodopa is safe in non-demented PD patients in terms of the effect on cognitive performance.

Adult↗
PubMed2006

The differential impact of executive attention dysfunction on episodic memory in obsessive-compulsive disorder patients with checking symptoms vs. those with washing symptoms.

Neuropsychological studies of obsessive-compulsive disorder (OCD) have pointed to memory and attention deficits among its sufferers, but these reports have largely ignored the possibility that cognitive disturbances may vary across OCD clinical subtypes, or that their interactions may differ between subtypes. The purpose of the present study was to determine whether "checkers" and "washers" demonstrate differences in their memory and executive attention function. Fifty-three outpatients with primary DSM-IV diagnosis of OCD with typical checking (n=27) or washing (n=26) rituals participated in the study. Patients were administered the Wechsler Memory Scale-Revised and a comprehensive neuropsychological battery to assess executive attention function. Various neuropsychological tests were then subjected to factor analysis. Neuropsychological test results and obtained factor scores were compared between "washers" and "checkers". Effects of these factor scores on memory by OCD subtypes were examined. No significant difference in terms of demographic and clinical variables was found between the two groups. Checkers displayed performance deficits on Stroop test, Trail Making Test, GO/NO GO test (commission errors) and category fluency. Three factors, inhibition, cognitive flexibility, and multi-tasking, were obtained. Statistically significant differences were observed between the two groups on the inhibition and the cognitive flexibility scores, but not on the general memory or the multi-tasking score. There was a statistically significant interaction between groups and the inhibition score. Only among "checkers", a significant correlation was noted between the inhibition factor and the general memory, while no such correlation was observed among "washers". Among "checkers", poor general memory was related to inhibition deficits.

Adolescent↗
PubMed2004

Effects of quetiapine on cognitive functions in schizophrenia.

OBJECTIVE: All atypical antipsychotic drugs with complex pharmacology have been shown to improve some, but not all, domains of cognitive function, including quetiapine, i.e., the agent with the most rapid dissociation from dopamine receptors and a relatively weak serotonin antagonism. The present study was to evaluate which, if any, areas of cognition improve in patients with schizophrenia, following a brief treatment with quetiapine. METHODS: Effects of quetiapine on cognition were investigated in a group of patients with schizophrenia (n=14). Neuropsychological tests in cognitive areas previously shown as impaired in schizophrenia were administered at baseline and after 8 weeks of treatment with quetiapine. Administered at these two times were also the Positive and Negative Syndrome Scale, Hamilton Depression Rating Scale, and scales to assess motor side effects (Abnormal Involuntary Movement Scale, Simpson-Angus Scale, and Barnes Akathisia Scale). RESULTS: Wilcoxon Signed Ranks Test indicated a statistically significant improvement in scores on Digit Span Test, Trail Making Test, Stroop Test, Finger Tapping Test, and on the Positive and Negative Syndrome Scale. No significant change was noted in motor side effects. CONCLUSION: The patients improved in their attentional, motor, and visuo-motor skills, and in executive functions as well as with respect to psychopathology, without an increase in motor side effects.

Adult↗
PubMed2005

Dermatoglyphic anomalies and neurocognitive deficits in sibling pairs discordant for schizophrenia spectrum disorders.

The neurodevelopmental hypothesis of schizophrenia suggests that adverse genetic loading in conjunction with environmental factors early in fetal life causes a disruption of neural development, decades before the symptomatic manifestation of the disease. Neurocognitive deficits have been observed early on the course of schizophrenia, and their association with an early developmental brain lesion has been postulated. Dermatoglyphics have been analyzed in schizophrenia as markers of prenatal brain injury because of their early fetal ontogenesis and susceptibility to the same environmental factors that can also affect cerebral development. The aim of our study was to conduct a comparative examination of neurocognitive functions and dermatoglyphic variables in 89 sibling pairs discordant for schizophrenia spectrum disorders. Therefore, we investigated the association between these two markers to explore the prenatal origin of cognitive deficits in schizophrenia. The affected siblings were significantly impaired on all the cognitive variables assessed (Wisconsin Card Sorting Test, Trail Making Test and Continuous Performance Test) and had a greater number of dermatoglyphic anomalies. These results suggest the influence of intrauterine environmental factors in the siblings affected with schizophrenia. However, we did not detect a significant association between these two vulnerability markers in the schizophrenic patients, suggesting the role of genetic or late environmental factors in the origin of the neurocognitive deficits found in these patients.

Adult↗
PubMed2001

Cardiopulmonary bypass affects cognitive brain function after coronary artery bypass grafting.

BACKGROUND: The causes for cognitive impairment after coronary artery bypass grafting (CABG) have long been a topic for debate. METHODS: We prospectively followed 308 consecutive, unselected survivors of CABG at our institution. In addition to determination of clinical measurements, cognitive brain function was measured objectively by P300 auditory-evoked potentials before CABG, at 7-day and at 4-month follow-up. Standard psychometric tests (Trail Making Test A, Mini Mental State Examination) were also performed. RESULTS: At 7-day follow-up cognitive P300 auditory-evoked potentials were significantly impaired compared with preoperative levels (peak latencies: 376 +/- 40 ms versus 366 +/- 37 ms, p = 0.0001). P300 measurements were almost normalized at 4-month follow-up (peak latencies: 369 +/- 33 ms, p = NS versus preoperative). Standard psychometric tests failed to detect this subclinical cognitive impairment. Multiple regression analysis revealed that use of cardiopulmonary bypass was the only independent predictor of impaired cognitive brain function at 7-day (p < 0.0001) and 4-month follow-up (p = 0.0008). The presence of diabetes mellitus (p = 0.0135) or concomitant repair of significant carotid artery stenosis (p = 0.0049) was predictive of late improvement of cognitive brain function at 4-month follow-up. CONCLUSIONS: Objective cognitive P300 auditory-evoked potential measurements demonstrate that the use of cardiopulmonary bypass is the only predictor of short- and long-term cognitive brain dysfunction after CABG. Interestingly, the presence of diabetes mellitus and concomitant repair of a significant carotid artery stenosis were predictive for long-term cognitive benefit.

Aged↗
PubMed1996

Relationship between pharmacodynamic activity and cognitive effects of eptastigmine in patients with Alzheimer's disease. Eptastigmine Study Group.

OBJECTIVE: To assess the safety, tolerability, pharmacodynamics, and preliminary efficacy of eptastigmine, a new long-acting cholinesterase inhibitor, in patients with probable Alzheimer's disease. METHODS: This was a double-blind, randomized, placebo-controlled, unbalanced parallel-group study. One-hundred and three patients (83 in the eptastigmine group and 20 in the placebo group) were recruited by 10 centers. Patients received 20 mg eptastigmine or placebo for 4 weeks with twice-a-day or three-times-a-day regimens, depending on body weight (< or = 65 kg or > 65 kg, respectively). Patient performance on the Logical Memory Test, Semantic Word Fluency Test, Trail Making Test, Index of Independence in Activities of Daily Living, Instrumental Activities of Daily Living Scales (IADL), and the Physician and Caregiver Clinical Global Impression of Change (CGIC) was assessed at baseline and at the end of treatment. RESULTS: Nine patients, all from the eptastigmine group, did not complete treatment because of uncooperativeness (n = 3), adverse events (n = 3), protocol violations (n = 2), and clinical decline (n = 1). Twenty-five patients receiving eptastigmine (34%) reported adverse events mainly of the cholinergic type. Cholinergic side effects were generally associated with peak red blood cell cholinesterase inhibition exceeding 50% after the first dose, or 70% at steady state. At steady state, average daily acetylcholinesterase inhibition ranged from 13% to 54%. Overall, 34% of patients receiving eptastigmine versus 0% receiving placebo (p = 0.006) improved on the Physician CGIC. This percentage increased to 46% in the subgroup of patients with average daily acetylcholinesterase inhibition ranging from 30% to 35%. Patient performance on the IADL also improved significantly compared with the placebo group (p = 0.019). In the eptastigmine group, performances on all tests and scales improved with an inverted U-shaped relation to average daily acetylcholinesterase inhibition. CONCLUSIONS: This study shows that doses of 40 to 60 mg per day of eptastigmine are relatively safe and well tolerated and that moderate acetylcholinesterase inhibition is associated with maximal cognitive efficacy.

Aged↗