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Cognitive functioning after subarachnoid haemorrhage of unknown origin.

Twenty patients, who had sustained a proven subarachnoid haemorrhage (SAH) and in whom cerebral panangiography had failed to reveal any source of the bleeding (SAH-NUD), were subjected to a neuropsychological examination involving memory functions, spatial perceptual organization, visuoconstructive abilities, reasoning, perceptual speed and accuracy, and concept formation. Cognitive functioning in SAH-NUD patients was compared with normal reference values and also related to the cognitive performance of neurologically intact patients having sustained an aneurysmal bleeding (SAH-AN). SAH-NUD patients showed significant reduction of verbal learning and retention, and of abilities involving abstract attitude and concept formation, i.e., functions related to frontotemporal structures. In all other respects the performance of these patients approached normality. Unexpectedly, there were no significant differences in mean test scores separating SAH-NUD from aneurysmal SAH patients. Collapsing the patient groups produced an increased number of significant deviations from normality, which was interpreted as the effect of the contribution of a greater number of relatively more impaired SAH-AN patients. This was supported by the finding that the ratio of impaired individuals to total number of subjects differed in the groups; the proportion of individuals showing cognitive sequelae was larger among SAH-AN patients throughout all comparisons but one. Although SAH of unknown aetiology represents much less of a catastrophe as compared with haemorrhage of aneurysmal origin, it does not preclude cognitive disturbances. Thus, the presence of blood per se anywhere in the subarachnoid spaces appears to affect higher brain function(s).

Adolescent↗

Course of attention and memory after common whiplash: a two-years prospective study with age, education and gender pair-matched patients.

Attentional functioning and memory of common whiplash patients were evaluated during the first two years after experiencing injury. The study was based on a non-selected sample of 117 whiplash patients referred from primary care and recruited according to a strict injury definition. All patients had a similar socioeconomic background, all being injured in automobile accidents and fully covered by insurance plans. Two years following initial trauma, 21 patients remained symptomatic. For each of these 21 patients, a counterpart matched by age, educational attainment and gender was selected from the group of patients who had fully recovered during the follow-up period. Symptomatic patients and matched controls were compared with regard to baseline, six-months and two-years findings. Examinations included testing of different aspects of attention (i.e. Digit Span, Corsi Block-Tapping Test, Trail Making Test, Number Connection Test, Paced Auditory Serial Addition Task) and memory functioning (California Verbal Learning Test). Cognitive functioning was assessed in conjunction with self-ratings of cognitive abilities (Cognitive Failures Questionnaire), well-being (Well-being Scale), headache and neckpain intensity, utilized medication and subjective complaints. Results show no impairment of memory in symptomatic patients. In attentional functioning, different levels of improvement were found for symptomatic patients and matched counterparts, with the former showing difficulty at follow-up with tasks of divided attention. Utilized medication and pain intensity could not explain this difference in recovery of attentional functioning between the groups. These findings suggest problems in selective aspects of attentional functioning after common whiplash, which under real life circumstances may explain these patients' cognitive complaints and cause adaptational problems in daily life.

Accidents, Traffic↗

Comparison of current levels of performance and scores based on change as diagnostic discriminators among the elderly.

Elderly in residential care were classified as probably 'normal' and probably 'organic' by a community screening questionnaire. Performance on a test of verbal learning was assessed at baseline and after two years. The initial and follow-up scores on this test, the changes shown during follow-up and the discrepancies between follow-up score and predicted follow-up performance (estimated from baseline score) were related to this classification. Against expectation, scores based on change did not discriminate better than current levels of performance at baseline or follow-up.

Aged↗

Immediate memory in the orally trained deaf: effects of 'lipreadability' in the recall of written syllables.

Immediate recall of written lists was compared in strictly orally trained born-deaf teenagers and in hearing controls. The lists were of syllables of CV form (e.g. SHA NA ZA DA). The deaf subjects showed a significant effect of consonant 'lipreadability'. Syllable lists containing consonants like D, SH and Z whose place of articulation is not visibly distinctive and which are therefore hard to lipread are less well recalled than (phonetically and orthographically matched) syllable lists containing consonants like F, TH and B which are produced with the tongue, teeth and lips in visible configuration. We conclude that for these deaf youngsters the phonological representation of written consonants is less secure for speech sounds that are hard, rather than easy, to lipread. The oral training of these youngsters has had an effect on their internal representation of written speech. Hearing subjects showed no 'lipreadability' effect in their recall of these lists. Reading-age matched controls (aged 8-10 years) showed significantly shorter span for both list types than the deaf group. Older hearing controls (14-16 years) matched the deaf group in span and tended to recall most accurately written syllables which are not easily lipread. We discuss these comparisons and conclude that while this group of deaf subjects is using a phonological code in the recall of written syllables, it is qualitatively different from that used by hearing subjects in this task. In particular, not only hard-to-lipread consonants but also vowels may be less strongly represented in these deaf readers' 'inner voice'.

Adolescent↗

Memory processes in depressed geriatric patients with and without subcortical hyperintensities on MRI.

In this study, 12 patients over age 60 with depression with moderate to severe subcortical hyperintensities (SH) localized to the periventricular white matter were identified by quantitative MRI. Using the California Verbal Learning Test, they were compared with 12 age-, education-, and severity-matched patients with depression with minimal white matter changes on specific aspects of memory performance. Patients with cortical lesions, neurologic or systemic illness affecting cognition, and history of substance abuse were excluded. Patients in the group with high SH showed reduced use of semantic encoding strategies (p < 0.05), reduced learning efficiency (p < 0.05), and a greater discrepancy between free recall and recognition discriminability (p < 0.05) than their low SH counterparts. This pattern of performance on memory tasks is similar to that found in previous studies to be associated with subcortical degenerative disorders such as Huntington's and Parkinson's diseases. Geriatric patients with depression with SH may represent a subgroup with greater subcortical involvement, with associated cognitive and functional decline.

Aged↗

Methylphenidate does not improve cognitive function in healthy sleep-deprived young adults.

BACKGROUND: Abuse of methylphenidate, a treatment of attention-deficit/hyperactivity disorder, is reported to be increasing among students for the purpose of improving cognition. METHODS: A single capsule, containing methylphenidate (20 mg) or placebo, was administered to healthy young adults orally following 24 hours of sleep deprivation. Measurements included percent change in score from sleep-deprived baseline on four standardized tests of cognitive function: Hopkins Verbal Learning, Digit Span, Modified Stroop, and Trail Making tests. Measurements also included percent changes in blood pressure and heart rate from sleep-deprived baseline and plasma methylphenidate concentration. RESULTS: Differences in cognitive test performance were not observed between intervention groups. In subjects receiving methylphenidate, mean percent changes from baseline for systolic blood pressure and heart rate were increased relative to placebo between 90 and 210 minutes following capsule administration (maximum increases of 9.45% and 11.03%, respectively). The timing of peak differences in physiologic measures did not correlate with peak serum methylphenidate concentrations. Exit questionnaire ratings of "capsule effect" and perceived performance on the postcapsule administration of the most challenging cognitive test were both higher (p = .044 and p = .009, respectively) for the methylphenidate group than for the placebo group. CONCLUSIONS: Cognitive improvement among sleep-deprived young adults was not observed following methylphenidate administration. Benefits perceived by abusers may relate to increased confidence and sense of well-being, as well as to sympathetic nervous system stimulation. Moreover, methylphenidate administration results in physiologic effects that could be harmful to certain individuals.

Adult↗

Deficient saccadic inhibition in Asperger's disorder and the social-emotional processing disorder.

BACKGROUND: Both Asperger's disorder and the social-emotional processing disorder (SEPD), a form of non-verbal learning disability, are associated with executive function deficits. SEPD has been shown to be associated with deficient saccadic inhibition. OBJECTIVE: To study two executive functions in Asperger's disorder and SEPD, inhibition and task switching, using a single saccadic paradigm. METHODS: 22 control subjects and 27 subjects with developmental social processing disorders-SEPD, Asperger's disorder, or both syndromes-performed random sequences of prosaccades and antisaccades. This design resulted in four trial types, prosaccades and antisaccades, that were either repeated or switched. The design allowed the performance costs of inhibition and task switching to be isolated. RESULTS: Subjects with both Asperger's disorder and SEPD showed deficient inhibition, as indicated by increased antisaccade errors and a disproportionate increase in latency for antisaccades relative to prosaccades. In contrast, task switching error and latency costs were normal and unrelated to the costs of inhibition. CONCLUSIONS: This study replicates the finding of deficient saccadic inhibition in SEPD, extends it to Asperger's disorder, and implicates prefrontal cortex dysfunction in these syndromes. The finding of intact task switching shows that executive function deficits in Asperger's disorder and SEPD are selective and suggests that inhibition and task switching are mediated by distinct neural networks.

Adult↗

Pallidal stimulation in dystonia: effects on cognition, mood, and quality of life.

Bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) alleviates symptoms in patients with dystonia but its effects on cognition, neuropsychiatric status, and quality of life have not been examined. This is a case series report of 15 consecutive patients with different forms of dystonia who underwent bilateral implantation of DBS electrodes in the GPi. The patients were evaluated preoperatively and after 3-12 months of DBS with tests of cognition (Mattis Dementia Rating Scale, Stroop Test, Trail Making Test, Phonemic and Category Word Fluency, Digit Span, Rey Auditory Verbal Learning Test, Tonic and Phasic Alertness), neuropsychiatric status (Beck Depression and Anxiety Inventories, Montgomery Asberg Depression Rating Scale, Snaith-Hamilton Pleasure Scale, Brief Psychiatric Rating Scale), quality of life, and motor functions. GPi DBS significantly improved dystonic symptoms, functional abilities, and quality of life allowing for a significant reduction of antidystonic medications. No deterioration was observed in cognitive scores and neuropsychiatric measures. The present case series report thus provides preliminary evidence for the safety of GPi DBS regarding cognitive and neuropsychiatric functions in patients with dystonia.

Adolescent↗

Discriminative and predictive power of an informant report in mild cognitive impairment.

BACKGROUND: The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) requires caregivers to rate decline in patients' cognitive and functional performance and has never been used for mild cognitive impairment (MCI). METHODS: We contrasted the discriminative and predictive power of the IQCODE with that of the Mini Mental State Examination (MMSE) and a verbal episodic memory measure, the Rey's Auditory Verbal Learning Test (RAVLT), in 45 patients with MCI (mean (SD) age at baseline: 71.6 (4.7) years) and 30 outpatients with dementia (70.5 (6.3) years) attending the Neuropsychology Service, St Gerardo Hospital, and compared them with 55 cognitively intact elderly people (70.7 (7.1) years). Patients with MCI were followed up for at least 2 years or until conversion to dementia. RESULTS: In total, 24 patients with MCI (53.3%) had converted to dementia at follow up (mean (SD) duration of follow up 17.0 (7.3) months for converters and 35.0 (7.1) months for non-converters). At baseline, the ability to differentiate patients with MCI from healthy controls was similar for the IQCODE (area under the curve (AUC) 0.86) and the MMSE (AUC 0.84; z = 0.53, not significant). As predictors of conversion to dementia, a trend favouring the IQCODE (AUC 0.86) with respect to immediate (AUC 0.74) and delayed (AUC 0.75) recall on the RAVLT was apparent (z = 1.36, p = 0.087 versus immediate recall, z = 1.51, p = 0.064 versus delayed recall). The independent predictive ability of IQCODE and memory scores was evaluated through logistic regression, and the questionnaire alone yielded the best correct classification of 81%. CONCLUSIONS: The IQCODE is an informant based measure of cognitive decline that may provide a relevant contribution to the diagnostic and prognostic investigation of patients with MCI.

Adult↗

Influence of APOE polymorphism on cognitive and behavioural outcome in moderate and severe traumatic brain injury.

AIM: To analyse the influence of apolipoprotein (APOE) epsilon4 status on the cognitive and behavioural functions usually impaired after moderate and severe traumatic brain injury (TBI). METHODS: In all, 77 patients with TBI selected from 140 consecutive admissions were genotyped for APOE. Each patient was subjected to neuropsychological and neurobehavioural assessment at least 6 months after injury. RESULTS: Performance of participants carrying the epsilon4 allele was notably worse on verbal memory (Auditory Verbal Learning Test), motor speed, fine motor coordination, visual scanning, attention and mental flexibility (Grooved Pegboard, Symbol Digit Modalities Test and part B of the Trail Making Test) and showed considerably more neurobehavioural disturbances (Neurobehavioral Rating Scale-Revised) than the group without the epsilon4 allele. CONCLUSIONS: In particular, performance on neuropsychological tasks that are presumed to be related to temporal lobe, frontal lobe and white matter integrity is worse in patients with the APOE epsilon4 allele than in those without it. More neurobehavioural disturbances are observed in APOE epsilon4 carriers than in APOE epsilon2 and epsilon3 carriers.

Apolipoprotein E4↗

Assessment of anomalous sentences repetition test.

Use of Anomalous Sentences Repetition Test (ASRT) in 16 patients with diagnosis of dementia of Alzheimer's type, 16 normal elderly and 18 patients with depression revealed no difference in the age adjusted scores between the three groups, suggesting that it is not a good test for diagnosing dementia or differentiating dementia from depression.

Aged↗

Neuropsychological pattern of striatonigral degeneration: comparison with Parkinson's disease and progressive supranuclear palsy.

To study the neuropsychological pattern of striatonigral degeneration (SND), 14 consecutive patients with probable SND were submitted to an extensive battery of neuropsychological tests. Compared with controls the performance of patients with SND was impaired on category and phonemic fluency, frontal behaviours, trail making test A and B, and free recall of the Grober and Buschke test, but normal on the revised WAIS verbal scale, Raven 47 coloured progressive matrices, Wechsler memory scale, California verbal learning test, Wisconsin card sorting test, and the Stroop interference condition. The performance of patients with SND was also compared with that of 14 patients with Parkinson's disease and 14 patients with progressive supranuclear palsy (PSP) matched for age at onset, duration of disease, severity of intellectual deterioration, and depression. The results showed that the dysexecutive syndrome of SND is similar to that of Parkinson's disease and less severe than in PSP.

Analysis of Variance↗

Memory disorders in probable Alzheimer's disease: the role of hippocampal atrophy as shown with MRI.

Magnetic resonance based volumetric measures of hippocampal formation, amygdala (A), caudate nucleus (CN), normalised for total intracranial volume (TIV), were analysed in relation to measures of cognitive deterioration and specific features of memory functions in 18 patients with probable Alzheimer's disease. Neuropsychological examination included the mini mental state examination (MMSE), the Mattis dementia rating scale (DRS), tests of executive functions, assessment of language abilities and praxis, the Wechsler memory scale (WMS), the California verbal learning test (CVLT) and the Grober and Buschke test. The volume of the hippocampal formation (HF/TIV) was correlated with specific memory variables: memory quotient and paired associates of the WMS; intrusions and discriminability at recognition for the Grober and Buschke test. By contrast, except for intrusions, no correlations were found between memory variables and the volume of amygdala (A/TIV). No correlations were found between the volume of caudate nuclei (CN/TIV) and any neuropsychological score. The volume of the hippocampal formation was therefore selectively related to quantitative and qualitative aspects of memory performance in patients with probable Alzheimer's disease.

Aged↗

Autism and visual agnosia in a child with right occipital lobectomy.

OBJECTIVES: Autistic disorder is a developmental handicap with an unknown neurological basis. Current neuropsychological models for autism suggest an abnormal construction of visual perceptual representation or a deficit in executive functions. These models predict cerebral lesions in the temporo-occipital or frontal regions of autistic patients. The present study aimed at studying the presence of symptoms of autism and visual agnosia in a 13 year old girl who had a right temporo-occipital cortical dysplasia that was surgically removed at the age of 7. METHODS: Neuropsychological evaluation included Wechsler and Kaufman intelligence scales, a test of word fluency, digit span, Corsi block, California verbal learning, Trail making, Benton facial recognition, Snoodgrass object recognition tests, Rivermead face learning subtest, and developmental test of visual perception. The ADI-R was used to show current and retrospective diagnosis of autistic disorder. Neuroimagery included brain MRI, single photon emission computed tomography (SPECT), and PET. RESULTS: Brain MRI showed a right occipital defect and an abnormal hyperintensity of the right temporal cortex. PET and SPECT disclosed a left frontal hypometabolism together with the right occipital defect. Neuropsychological testing showed a visual apperceptive agnosia and executive function deficits. Psychiatric study confirmed the diagnosis of autistic disorder. CONCLUSIONS: Although the possibility that autism and visual agnosia were dissociable factors in this patient cannot be excluded, the finding of both deficits supports the possibility that occipito-temporal lesions can predispose to the development of autism.

Adolescent↗