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PubMed2001

Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases.

The literature on chronic diseases recognizes the role of illness cognition as a mediator between stress and illness. Few conceptualizations and instruments, however, give an indication of both unfavorable and favorable ways of adjusting to an uncontrollable long-term stressor, such as a chronic disease. The authors propose 3 generic illness cognitions that reflect different ways of reevaluating the inherently aversive character of a chronic condition: helplessness as a way of emphasizing the aversive meaning of the disease, acceptance as a way to diminish the aversive meaning, and perceived benefits as a way of adding a positive meaning to the disease. A self-report instrument, the Illness Cognition Questionnaire, was developed to assess these cognitions across different chronic diseases. The results support the reliable and valid assessment of these illness cognitions in patients with rheumatoid arthritis and multiple sclerosis and indicate the maladaptive function of helplessness and the adaptive function of acceptance and perceived benefits for the long-term physical and psychological health of patients with a chronic disease.

Adolescent↗

PubMedDate not supplied

[The action of memantine on the cognitive disorders of patients with dementia: reflections following two years' experience in Spain].

AIMS: To review the literature on the effectiveness of memantine in cognitive disorders, and to discuss data from our own personal experience. DEVELOPMENT: In moderately advanced or advanced stages of Alzheimer's disease (AD), use of memantine for cognitive disorders and functional independence is significantly effective, regardless of whether anticholinesterases are taken or not. Effectiveness lasts at least 1 year (open trial). The NNT (number needed to treat) of 7 means it has a value that is similar to that of anticholinesterases for the treatment of the early or moderate phases and the magnitude effect of 0.47 can be graded as intermediate. In incipient or moderate AD its effectiveness on the cognitive functions is lower. In early or moderate vascular dementia, memantine has favourable effects with regard to cognition, especially in dementia due to 'small-vessel' disease, although this is not reflected in functional independence, probably because it is also affected by other neurological and systemic factors. A retrospective analysis of 43 of our own cases (AD at GDS 6-7) showed a percentage of 'not worse' between successive visits (mean interval of 6 months) of 40-70%, the best result being obtained by those who take anticholinesterase. CONCLUSIONS: The effectiveness of memantine on cognitive impairment is significant in moderately advanced and advanced stages of AD, although we need to know physicians' impressions in order to determine the extent to which the first expectations from clinical trials are confirmed. This effect is less pronounced in the early and intermediate stages and in vascular dementia.

Alzheimer Disease↗

PubMed1980

A cognitive perspective applied to emancipation problems.

A cognitive theoretical perspective toward emotional distress and behavior disorders is described and then applied to developing both a classification of emancipation problems and a plan for intervention. Problems described include over-dependency, vacillation about dependency, and resistance to authority. The plan for intervention minimizes complications that a vigorously confrontive method often intensifies with adolescents. Instead, it entails accurate reflection of cognitions and thereby capitalizes on anti-expectation.

Adolescent↗

PubMed2004

[Convergence of psychotherapeutic and neurobiological outcome measure in a patient with OCD].

We used psychotherapeutic measures and functional magnetic resonance imaging (fMRI) to assess the effect of a combined psychodynamic and cognitive behavioral treatment of a patient suffering from a severe obsessive compulsive disorder (OCD). The clinical outcome was controlled by a detailed case description and psychometric test instruments. Intensive exploration of the patient made possible the creation of an idiosyncratic imagination paradigm suitable for fMRI. The patient shows at the end of treatment a decrease in symptoms as assessed by clinical as well as psychometric instruments. Especially recapitulation and cleaning obsessions decreased, but the cognitive avoidance strategies remained almost unchanged. fMRI showed no orbito-fronto-striatothalamic activation corresponding to obsessive compulsive symptoms, but an increased activation of the medial prefrontal (MFC) and anterior cingulate cortex (ACC). The lack of activation of the orbito-fronto-striatothalamic circuits and at the same time the occurrence of the increased activation of the MFC and ACC reflects the cognitive avoidance strategies still triggered by the symptom provoking stimulus.

Adult↗

PubMed1991

Event-related potentials related to recognition memory. Effects of unilateral temporal lobectomy and temporal lobe epilepsy.

Event-related potentials (ERPs) were recorded during a continuous recognition memory task for visually presented words, with a 6 item lag between the first and second presentation of each word. The subjects consisted of: (i) a control group of patients with primary generalized epilepsy; (ii) patients who had undergone either a left or a right anterior temporal lobectomy; (iii) unoperated patients with either left or right unilateral temporal lobe epilepsy. In the controls, ERPs to detected 'old' words were reliably more positive-going in the interval 300 to 600 ms post-stimulus than were ERPs to 'new' items. In both left and right lobectomy patients, 'old/new' ERP differences in the same latency range were significantly smaller than in the controls, and did not differ significantly from zero. At midline electrodes, old/new effects in the temporal lobe epilepsy patients were of similar magnitude to those of the controls. In contrast to the control data, the old/new effects in the temporal lobe epilepsy patients were asymmetric, in that they were smaller over the hemisphere ipsilateral to the seizure focus than over the contralateral hemisphere. No relationship was found across subjects between the magnitude of old/new ERP effects and verbal memory performance. In a second task, occasional non-words had to be discriminated against a background of sequentially presented words, some of which were repetitions of the immediately preceding item. ERPs evoked by repeated words were more positive-going than were those to first presentations; this effect was reliable, and of equivalent size, in all patient groups. It is concluded that in the recognition task, old/new ERP effects are dependent on temporal lobe functioning, but that the anterior temporal lobe is not the principal locus of the generators of these effects. The cognitive processes reflected by these effects do not appear to be strongly lateralized to one hemisphere, and neither do they seem to be necessary for normal verbal memory.

Adolescent↗

PubMed1990

Social cognition and impaired social interaction in people with severe learning difficulties.

Social skills training has focused on 'performance' or overt behaviour, rather than on the other components of successful social functioning: motivation and goals, analysis of social information, and performance feedback, Some basic aspects of this 'analysis' or 'social cognition' component were compared in a preliminary study of 25 teenagers and young adults with severe learning difficulties, whose social interaction was categorized as either 'impaired' or 'appropriate'. As predicted from the literature on autistic children, there were no differences between the groups on tasks involving recognition of the visual aspects of the concept of self or perceptual role-taking. It is suggested that social impairments do not reflect social cognitive abilities which are 'lower level' (i.e. can be solved on the basis of information available to the senses). Contrary to expectations, on the four individual tasks of affective role-taking, which is 'higher level', since it requires inferences to be made about the inner emotional state of another person, the differences between the groups were not significant. However, the results were in the predicted direction, and when scores on the tasks were combined, the overall performance of the socially impaired group was significantly poorer (P less than 0.05). It is suggested that the results from this aspect of social cognition might be attributed either to methodological difficulties or to differences between autistic children and the present sample. The clinical implications of the findings of the study are discussed.

Adolescent↗

PubMed1999

Insight in dementia: when does it occur? Evidence for a nonlinear relationship between insight and cognitive status.

Lack of insight or impaired awareness of deficits in patients with dementia is a relatively neglected area of study. The aim of this study was to evaluate insight in a group of demented patients with two assessment scales and to assess their relationship with the cognitive level of disease severity. Sixty-nine consecutive patients affected by Alzheimer's disease (n = 37) and vascular dementia (n = 32) with a wide range of cognitive impairment (MMSE = 17.0 +/- 6.4) were recruited. Insight was evaluated with the Guidelines for the Rating of Awareness Deficits (GRAD)--specifically targeted to memory deficits--and the Clinical Insight Rating scale (CIR), evaluating a broader spectrum of insight (reason for the visit, cognitive deficits, functional deficits, and perception of the progression of the disease). In the whole sample, GRAD and CIR were significantly associated with MMSE (Spearman's coefficient = .51, p < .001; and r = -.55, p < .001) and with Clinical Dementia Rating scale (-.57, p < .001; and r = .57, p < .001) respectively. The shape of the relationship of MMSE with CIR and GRAD scales was assessed with spline smoothers suggesting that the relationship follows a trilinear pattern and is similar for both scales. Insight was uniformly high for MMSE scores > or = 24, showed a linear decrease between MMSE scores of 23 and 13, and was uniformly low for MMSE scores < or = 12. The trilinear model of the association between insight and cognitive status reflects more closely the observable decline of insight and can provide estimates of when the decline of insight begins and ends.

Activities of Daily Living↗

PubMed2006

The conviction of delusional beliefs scale: reliability and validity.

This study reports on the development of a new measure of delusional belief conviction, the Conviction of Delusional Beliefs Scale (CDBS). Most of the current scales in use assess belief conviction with a single item and primarily reflect the cognitive aspects of conviction. The CDBS represents an improvement over existing scales in that it contains a larger number of test items that can be subjected to psychometric examination. In addition, the CDBS also broadens the concept of belief conviction by incorporating cognitive, emotional, and behavioral items. In the present study, fifty participants with delusions completed the CDBS along with measures of delusional ideation, psychiatric symptomatology, insight, and reading ability. The CDBS showed very good levels of internal consistency and test-retest stability over a six-week period. All of the CDBS items loaded highly on a unitary factor of belief conviction. The CDBS positively correlated with four measures of belief conviction thereby reflecting the convergent validity of the scale. The CDBS was unrelated to other dimensions of delusional ideation, psychiatric symptomatology, insight, and reading ability, which supported the discriminant validity of the scale. The CDBS appears to be a reliable and valid measure of delusional belief conviction that could be used in clinical and research settings.

Adult↗

PubMed1998

Subconscious detection of threat as reflected by an enhanced response bias.

Neurobiological and cognitive models of unconscious information processing suggest that subconscious threat detection can lead to cognitive misinterpretations and false alarms, while conscious processing is assumed to be perceptually and conceptually accurate and unambiguous. Furthermore, clinical theories suggest that pathological anxiety results from a crude preattentive warning system predominating over more sophisticated and controlled modes of processing. We investigated the hypothesis that subconscious detection of threat in a cognitive task is reflected by enhanced "false signal" detection rather than by selectively enhanced discrimination of threat items in 30 patients with panic disorder and 30 healthy controls. We presented a tachistoscopic word-nonword discrimination task and a subsequent recognition task and analyzed the data by means of process-dissociation procedures. In line with our expectations, subjects of both groups showed more false signal detection to threat than to neutral stimuli as indicated by an enhanced response bias, whereas indices of discriminative sensitivity did not show this effect. In addition, patients with panic disorder showed a generally enhanced response bias in comparison to healthy controls. They also seemed to have processed the stimuli less elaborately and less differentially. Results are consistent with the assumption that subconscious threat detection can lead to misrepresentations of stimulus significance and that pathological anxiety is characterized by a hyperactive preattentive alarm system that is insufficiently controlled by higher cognitive processes.

Adult↗

PubMed1993

Pauses in the narratives produced by autistic, mentally retarded, and normal children as an index of cognitive demand.

This study investigated the production of different types of speech pauses and repairs in the story narratives produced by autistic, mentally retarded, and normal children, matched on verbal mental age. Ten children in each group were asked to tell the story depicted in a wordless picture book. The narratives were analyzed for frequency of grammatical (between phrase) and nongrammatical (within phrase) pauses, and for several measures of story length and complexity. The main results were that children with autism produced significantly fewer nongrammatical pauses, and that their nongrammatical pausing was correlated with measures of story length and complexity. These findings suggest that the stories told by the autistic children reflect reduced cognitive and communicative demand. The implications of this study for future research on the use of a variety of prosodic characteristics as measures of social cognitive deficit in autism are discussed.

Attention↗

PubMed2005

Cognitive function in bulbar- and spinal-onset amyotrophic lateral sclerosis. A longitudinal study in 52 patients.

We performed a longitudinal study of frontal and temporal lobe functions in patients with amyotrophic lateral sclerosis (ALS) and compared the evolution of cognitive performance with that of motor deficits in patients with spinal and bulbar-onset of the disease. Fifty two patients suffering from sporadic ALS according to the El Escorial criteria were examined; 37 patients had a spinal, 15 a bulbar onset of the disease. The data profile included examinations at entry (E1), every four months at follow-up (E2, E3, E4) and after 18 months (E5), if possible. Neuropsychological testing covered the domains of executive functions, memory and attentional control. ALS patients showed executive dysfunctions that were most prominently represented by deficits of non-verbal and verbal fluency and concept formation. Memory-related deficits were also present but less expressed. The same held true for phasic and tonic alertness and divided attention. In contrast to motor functions declining concomitantly with disease progression, cognitive deficits appeared in early disease, were essentially present at initial testing and did not substantially decline on follow-up. A subgroup analysis revealed that bulbar-onset ALS patients performed consistently poorer in many cognitive tests than spinal-onset ones with special reference to verbal and non-verbal fluency and interference control. This subgroup difference persisted or even increased throughout follow-up. We conclude that there is a fronto-temporal pattern of cognitive dysfunction in ALS expressing itself early in the course of the disease and mainly with bulbar forms. The cognitive deficits do not progress in synchrony with motor decline, but distinctly more slowly. We suggest that cognitive dysfunctions reflect functional and possibly morphological deficits outside the primary motor system that is specific for the nature and evolution of the disease and might also give clues to etiopathogenesis.

Aged↗

PubMed2002

Are essentialist beliefs associated with prejudice?

Gordon Allport (1954) proposed that belief in group essences is one aspect of the prejudiced personality, alongside a rigid, dichotomous and ambiguity-intolerant cognitive style. We examined whether essentialist beliefs-beliefs that a social category has a fixed, inherent, identity-defining nature-are indeed associated in this fashion with prejudice towards black people, women and gay men. Allport's claim, which is mirrored by many contemporary social theorists, received partial support but had to be qualified in important respects. Essence-related beliefs were associated strongly with anti-gay attitudes but only weakly with sexism and racism, and they did not reflect a cognitive style that was consistent across stigmatized categories. When associations with prejudice were obtained, only a few specific beliefs were involved, and some anti-essentialist beliefs were associated with anti-gay attitudes. Nevertheless, the powerful association that essence-related beliefs had with anti-gay attitudes was independent of established prejudice-related traits, indicating that they have a significant role to play in the psychology of prejudice.

Adult↗

PubMed2000

Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer's disease.

OBJECTIVE/BACKGROUND: To determine whether difficulty in the early differentiation between frontotemporal dementia (FTD) and AD may arise from a failure to discriminate between the temporal and frontal variants of FTD. METHODS: Neuropsychological profiles of patients with early dementia of Alzheimer type (DAT; n = 10), the temporal variant of FTD (tv-FTD or semantic dementia; n = 5), and the frontal variant of FTD (fv-FTD; n = 10) were compared to each other and normal controls (n = 10). Structural MRI demonstrated temporal lobe atrophy in the tv-FTD patients and frontal lobe atrophy in the fv-FTD group. RESULTS: Subjects with tv-FTD showed severe deficits in semantic memory with preservation of attention and executive function. Subjects with fv-FTD showed the reverse pattern. Attention and executive function impairment separated the fv-FTD patients from the early DAT subjects, who were densely amnesic. CONCLUSION: The double dissociation in performance on semantic memory and attention/executive function clearly separated the temporal and frontal variants of FTD and aids the early differentiation of FTD from AD. The characteristic cognitive profiles reflect the distribution of pathology within each syndrome and support the putative role of the inferolateral temporal neocortex in semantic memory, the medial temporal lobe structures of the hippocampal complex in episodic memory, and the frontal lobes in executive function.

Acoustic Stimulation↗

PubMed1996

Dissimilar age influences on two ERP waveforms (LPC and N400) reflecting semantic context effect.

Age-related changes in semantic context effects were examined using late event-related brain potentials (ERPs). Auditory ERPs to semantically congruous and incongruous final words in spoken sentences were recorded in 16 children (aged 5-11 years) and 16 adults. Previous findings concerning age-related effects on N400 were replicated: the N400 effect was significantly larger in children than in adults. The main new finding was that a late positive component (LPC) following N400 and modulated by semantic context in adults was not found in children. Thus, the common generalization that semantic context effects decline with age holds only for ERP components occurring in the N400 time window or earlier. The cognitive function reflected by the semantic LPC we observed is not clear, but it seems to have a role different from that of the N400, although in adults the components often co-exist as an N400-LPC complex.

Aging↗

PubMed2004

The severe combined immunodeficient (SCID) mouse model of human immunodeficiency virus encephalitis: deficits in cognitive function.

The severe combined immunodeficient (SCID) mouse model of human immunodeficiency virus (HIV) encephalitis exhibits many of the histopathological and pathophysiological features of human HIV-associated dementia (HAD). Although deficits that may resemble HAD in humans have been reported for HIV-infected SCID mice, the cognitive deficit aspect of the model has very limited empirical support. Here, the authors report that HIV-infected SCID mice display cognitive deficits on a task requiring the animal to learn and remember the spatial relationship of cues in its environment in order to locate a submerged platform in a Morris water maze. The cognitive deficits manifest as longer latencies to locate the platform on the last day of the maze acquisition period and during a retention test 8 days later. Control experiments indicated that the poor performance by HIV-infected mice in comparison to controls was not due to impaired motor function or swimming ability, impaired visual acuity, or increased susceptibility to fatigue. Thus, the increased times required for HIV-infected mice to locate the submerged platform during the acquisition and memory tests likely reflect a cognitive deficit, rather than sensorimotor or emotional abnormalities. These behavioral deficits are associated with significant increases in astrogliosis and microgliosis in the HIV-infected mice. The results of this study strengthen the SCID mouse model of HIV encephalitis by definitively establishing cognitive deficits for the model in addition to its previously reported neuropathological features.

AIDS Dementia Complex↗

PubMed1991

Longitudinal prediction of specific cognitive abilities from infant novelty preference.

A test of visual novelty preference, the Fagan Test of Infant Intelligence, was administered to a group of 113 full-term infants from the Colorado Adoption Project at 5 and 7 months of age. The infants were followed longitudinally and the Bayley scales were administered at 12 and 24 months, the Sequenced Inventory of Communication Development at 24 and 36 months, and the Stanford-Binet and the Colorado Specific Cognitive Abilities Test at 36 months. 1 novelty preference score was obtained for each infant by averaging across the 2 test ages. Novelty preference correlated significantly with 36-month Binet IQ, the first unrotated principle component from the cognitive battery, and the 24-month Bayley MDI score. Novelty preference was also compared to specific abilities at all 3 follow-up ages; all of the specific abilities were significantly related to novelty preference, with the exceptions of 12- and 24-month Imitation and 36-month Perceptual Speed. Partial correlations suggest that novelty preference predicts language and memory independent of IQ. Overall, the results indicate that novelty preference during the first year of life not only predicts later IQ but may also reflect specific cognitive processes.

Attention↗

PubMed2000

Prediction of sexual, emotional, and physical maltreatment and mental health outcomes in a longitudinal cohort of 290 adolescent women.

A longitudinal study of 290 Canadian females measured factors at ages 3, 6, 9, and 13 that predicted emotional, physical, and sexual maltreatment occurring up to the age of 16. Significant factors predicting maltreatment were early neurological status and difficult temperament, cognitive status, maternal stress, chronic poverty, negative family climate, weak bonding, and family disruption. There was complex interplay between these factors in predicting both maltreatment status and poor mental health at age 17. Sexual abuse retained a significant link with emotional (but not conduct) problems when effects of physical and emotional abuse were controlled for. Adolescents with a combination of prolonged rather than brief sexual abuse combined with other types of abuse, with a background of family disruption and poverty, and child's impaired coping skills (reflecting poorer cognitive capacity and central nervous system problems) were most likely to have markedly impaired emotional functioning at age 17.

Adolescent↗

PubMed1999

Perfectionism and depression symptom severity in major depressive disorder.

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [Frost, R.O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.

Adult↗