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At least 289 records · Page 16Linked to original sources

PubMed2003

Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: the Fremantle Cognition in Diabetes Study.

OBJECTIVE: To determine whether the prevalence of dementia, depression and/or disability in older diabetic subjects warrants an active screening approach by diabetes health care workers. PATIENTS AND METHODS: The initial 223 members of a cohort of 529 eligible diabetic subjects, aged 70 years or over, were screened for cognitive impairment (using the Mini-Mental State Examination (MMSE) and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE)), physical impairments and depressive symptoms. RESULTS: Virtually all subjects were community-dwelling (99%) and mobile (86%) and relatively few had moderate or severe deficits in activities of daily living (ADL) (17.5%). The prevalences of cognitive impairment and probable dementia estimated from the screening tests were high (range 10.8-17.5%) compared with population studies. Any deficit with ADL was reported by 53% of the subjects and common problems included urinary and faecal incontinence. Scores consistent with clinical depression were reported by 14.2% of the sample but 50.2% of the remainder reported one or more depressive symptoms below the cut-off point for clinical depression. Only 36% of the study subjects were free of deficits in any domain. CONCLUSIONS: Community-living older diabetic subjects have high rates of cognitive impairment, deficits in physical function and depressive symptomatology suggesting that screening programs for functional impairments and depression may be beneficial in health care systems that manage older diabetic patients.

Activities of Daily Living↗

PubMed1997

Safety and tolerability of the antioxidant OPC-14117 in HIV-associated cognitive impairment. The Dana Consortium on the Therapy of HIV Dementia and Related Cognitive Disorders.

Cognitive impairment is a common and disabling complication of advanced HIV infection. Antiretroviral agents are the only proven therapies currently used for the treatment of HIV dementia, but the response to these agents is frequently unsatisfactory, short-lived, or complicated by intolerable side effects. We hypothesized that OPC-14117, a lipophilic antioxidant that acts to scavenge superoxide anion radicals, might ameliorate the toxic interactions between HIV infected macrophages and neurons. We conducted a double-blind, placebo-controlled, randomized clinical trial to assess the safety and tolerability of OPC-14117 240 mg per day. All 30 patients enrolled (15 per group) had cognitive impairment based on performance on neuropsychological tests. The primary outcome was tolerability of the study drug as measured by the proportion of subjects able to complete the study on their assigned dosage of experimental medication. Overall OPC-14117 was as well tolerated as placebo. Five subjects withdrew because of adverse experiences (two placebo, three OPC-14117). The OPC-14117-treated group had better scores on a clinical global impression scale, compared with the placebo group. There were trends toward improvement in the cognitive test scores; however, these changes were not statistically significant. These results demonstrate that this antioxidant intervention is well tolerated in cognitively impaired patients with advanced HIV infection, and suggest that a larger efficacy trial to assess the impact of OPC-14117 on cognitive performance is warranted.

AIDS Dementia Complex↗

PubMed2001

Clinical trials in HIV-associated cognitive impairment: cognitive and functional outcomes.

Cognitive and functional outcomes are of primary interest in the design of efficacy trials in HIV-associated cognitive impairment. In a longitudinal cohort study, weak associations were found between measures of cognitive performance and commonly used measures of daily functioning (mostly self-report measures) in HIV-infected individuals. Modifications of current functional scales or new functional instruments are needed to assess the clinical relevance of cognitive changes in clinical trials of HIV-associated cognitive impairment.

AIDS Dementia Complex↗

PubMed1998

Tinnitus Cognitions Questionnaire: Development and Psychometric Properties of a Measure of Dysfunctional Cognitions Associated with Tinnitus.

The development of the Tinnitus Cognitions Questionnaire (TCQ), a scale designed to assess positive and negative cognitions associated with tinnitus, is described. Psychometric analyses of the TCQ are examined, with a total of 189 subjects from three separate samples. The results indicate good test-retest reliability (r = 0.88) and internal consistency (Cronbach's alpha = 0.91). Factor analysis revealed two factors that were interpreted as positive cognitions and negative cognitions. TCQ negative items and positive items were found to be unrelated (r = 0.09). Correlations between the TCQ and other self-report indices of depression, automatic negative thoughts, and tinnitus-specific symptomatology are reported. The TCQ may provide a useful index of the cognitive responses of tinnitus sufferers and may be employed as a measure of change in outcome research on psychological management of tinnitus.

Journal Article↗

PubMed2006

The proposal of measurement of RNs at acute care setting cognitive process when they make cognitive error.

This paper presents the proposal for the design of a measurement of cognitive process of nurses at acute care setting when they make cognitive error. nurses especially at acute care setting perform their numerous nursing tasks simultaneously in time-stressed, information-rich situation. To cope with these severe cognitive demands expertise nurses develop simplification strategies not to consume their mental resources so much. However medical errors happen, regardless of nurses' experience. The resource allocation theory of Norman and Bobrow suggests that inappropriate selection of simplification strategy when the task is needed more attention induce the cognitive error. In this paper too much mental workload is presumed one of the reasons to make inappropriate selection. And the study design to measure cognitive process under the different mental workload situation by talk aloud protocol and psycho-physiological response is proposed.

Communication↗

PubMed1997

Cognitive assessment of obsessive-compulsive disorder. Obsessive Compulsive Cognitions Working Group.

Recent theories of obsessive-compulsive disorder (OCD) emphasize the importance of cognitive contents (beliefs and appraisals) and cognitive processes in the etiology and maintenance of OCD. In order to evaluate these theories and to assess the mechanisms of treatment-related change, it is necessary to develop measures of the relevant cognitive contents and processes. Several scales have been developed, although many are unpublished and there is a great deal of overlap among measures. The purpose of the present article is to describe the progress of an international group of investigators who have commenced a coordinated effort to develop a standardized set of cognitive measures. This article describes the theoretical bases and clinical importance of such an endeavor, and the proceedings of the working group meetings are summarized. Several methods of assessment are reviewed, including idiographic methods, information processing paradigms, and self-report measures. The working group is currently developing and evaluating self-report measures of appraisals about intrusions, and self-report measures of OC-related beliefs. Consensus ratings indicated that 6 belief domains are likely to be important in OCD. These are beliefs pertaining to: (1) inflated responsibility; (2) overimportance of thoughts; (3) excessive concern about the importance of controlling one's thoughts; (4) overestimation of threat; (5) intolerance of uncertainty; and (6) perfectionism.

Cognition↗

PubMed2002

A theory of cognitive control, aging cognition, and neuromodulation.

A theory is described which links cognitive changes observed in normal aging to an underlying decline in the function of the dopamine (DA) system projection to prefrontal cortex (PFC). The theory postulates that this neural mechanism is integral to the representation, maintenance and updating of context information, and as such impacts cognitive control across a wide range of cognitive domains, including working memory, attention, and inhibition. Behavioral and brain imaging data in support of the theory are discussed, which demonstrate selective impairments in context processing among healthy older adults associated with abnormal PFC activation. These findings highlight the utility of a computational approach to cognitive aging. Current directions for further refinement and validation of the model are outlined.

Aging↗

PubMed1997

Cognitive enhancers in theory and practice: studies of the cholinergic hypothesis of cognitive deficits in Alzheimer's disease.

The current status of the cholinergic hypothesis of cognitive dysfunction in Alzheimer's disease is reviewed in the context of recent attempts to alleviate specific cognitive impairments produced in rats by excitotoxic lesions of basal forebrain neurons by treatment with cholinergic agents. AMPA-induced lesions of the nucleus basalis region in rats produce profound and relatively specific reductions in neocortical markers of cholinergic function but fail to affect performance in many tests of memory and learning in rats. However, such lesions produce specific deficits in responding accurately in a test of visual attentional performance, which are reversed dose-dependently by treatment with systemic physostigmine or nicotine. Analogous improvements have been reported in a clinical trial of the anticholinesterase tacrine in patients with Alzheimer's disease. By contrast, AMPA-induced lesions of the medial septum produce profound reductions in hippocampal acetylcholine and accompanying delay-dependent deficits in a delayed non-matching-to-position procedure which measures spatial working memory in rats. This impairment is shown to be reversed to some extent by treatment with low doses of physostigmine. The results are discussed in terms of the multivariate nature of the neurochemical pathology of Alzheimer's disease and attendant limitations in the use of the cholinergic strategy. The cognitive costs, as well as benefits, of cognitive enhancers are discussed, as well as the need to broaden our therapeutic approach to other neurotransmitter systems and other neurodegenerative disorders.

Alzheimer Disease↗

PubMed1997

Response to cognitive-behavioral therapy in depression: effects of pretreatment cognitive dysfunction and life stress.

Response to cognitive-behavioral therapy (CBT) for depression is variable and the factors that account for differences in response are not yet well established. Level of cognitive dysfunction and the occurrence of negative life stress have been theorized as patient variables, which may account for differences in response to CBT. The relationship between response to CBT and the interaction of cognitive dysfunction with negative life events was examined in a sample of 53 depressed outpatients. Overall, there was little support for the prediction of a difference in acute outcome between patients with or without pretreatment cognitive dysfunction and negative stressors.

Adult↗

PubMed1998

Cognitive skill learning and schizophrenia: implications for cognitive remediation.

The ability to acquire a motor and cognitive skill was investigated in 26 patients with schizophrenia and 26 normal participants using repeated testing on the Tower of Toronto puzzle. Seven patients with defective performance were retested using additional trials and immediate feedback designed to facilitate problem solving. A component analysis of performance was used based on J. R. Anderson's (1987) model of cognitive skill learning. Patients exhibited a performance deficit on both motor and cognitive skills. However, their acquisition rate was similar to that of normal participants on most parameters, indicating that skill learning suffered little or no impairment. Performance deficit was accounted for by poor problem-solving ability, explicit memory, and general intellectual capacities. It was remediable in some, but not all, patients. Remediation failure was also related to severe defects of cognitive functions.

Adult↗

PubMed2006

Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms.

Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

Affect↗

PubMed1989

Prospective cognitive assessment of stroke patients before inpatient rehabilitation. The relationship of the Neurobehavioral Cognitive Status Examination to functional improvement.

Prospective studies establish cognitive status as an important determinant of post-stroke rehabilitation success. The Neurobehavioral Cognitive Status Examination (NCSE) briefly assesses cognition in the ability areas of language, constructions, memory, calculation and reasoning. The NCSE, as well as the commonly used Mini-Mental State Examination and Albert's Test, were administered to 38 stroke patients before inpatient rehabilitation to determine the extent to which they predict rehabilitation outcome. Rehabilitation outcome was measured as the difference between initial and discharge Barthel Index score. The NCSE was shown to be a more sensitive indicator of impairment than the Mini-Mental State Examination and Albert's Test, especially in subsections of orientation and memory (X2 = 8.690, df = 1, P less than 0.005; X2 = 13.348, df = 1, P less than 0.001, respectively). Stepwise multiple regression revealed that attention, calculations and judgement were in association the best predictors of improvement in the Barthel Index scores. Therefore, the NCSE provides both a rapid and sensitive measure of cognitive function and it appears to predict functional status change as a result of inpatient stroke rehabilitation.

Aged↗

PubMed2006

Weaving the fabric of social interaction: articulating developmental psychology and cognitive neuroscience in the domain of motor cognition.

In this article, we bring together recent findings from developmental science and cognitive neuroscience to argue that perception-action coupling constitutes the fundamental mechanism of motor cognition. A variety of empirical evidence suggests that observed and executed actions are coded in a common cognitive and neural framework, enabling individuals to construct shared representations of self and other actions. We review work to suggest that such shared representations support action anticipation, organization, and imitation. These processes, along with additional computational mechanisms for determining a sense of agency and behavioral regulation, form the fabric of socialinteraction. In addition, humans possess the capacity to move beyond these basic aspects of action analysis to interpret behavior at a deeper level, an ability that may be outside the scope of the mirror system. Understanding the nature of shared representations from the vantage point of developmental and cognitive science and neuroscience has the potential to inform a range of motor and social processes. This perspective also elucidates intriguing new directions and research questions and generates specific hypotheses regarding the impact of early disorders (e.g., developmental movement disorders) on subsequent action processing.

Awareness↗

PubMed1993

[Modification of cognitive disorders in schizophrenic and schizoaffective psychoses using cognitive therapy in comparison with sociotherapy].

In this study, 24 patients with subacute schizophrenic or schizoaffective psychoses were treated with "Integrated Psychological Therapy for Schizophrenic Patients" (IPT, Roder et al. 1988) and compared with 21 subacute schizophrenic or schizoaffective patients treated with sociotherapy, in respect of cognitive changes. Each therapy was administered at 8 sessions weekly for a period of 6 weeks. Advantages of the cognitively oriented therapy (IPT) appeared significantly greater with regard to interference and short-time memory improvement, and tendentially in respect to overinclusion. Neither type of therapy seems to affect schizophrenic concretism. Cognitive disorders, as reported by the patients themselves, show some remission with both forms of therapy. At 6 and 12 weeks after completion of therapy, differences between the two groups on these measures became insignificant. The findings suggest a quicker reduction of cognitive disorders by IPT in comparison with sociotherapy.

Attention↗

PubMed2002

Systemic lupus erythematosus in three ethnic groups. X. Measuring cognitive impairment with the cognitive symptoms inventory.

OBJECTIVE: To determine the factor structure of the Cognitive Symptoms Inventory (CSI) in patients with systemic lupus erythematosus (SLE) participating in a multiethnic longitudinal study of outcome, the Lupus in Minority populations, Nature versus nurture (LUMINA) study. METHODS: LUMINA patients of Hispanic (n = 48), African American (n = 64), and Caucasian (n = 44) ethnicity who had a study visit (enrollment or followup) between January 1 and September 30, 2000 were included. Patients completed the CSI, a 21-item self-report measure of cognitive function. Sociodemographic, clinical, immunologic, psychosocial, and behavioral variables were ascertained per protocol and as previously described. Data were analyzed with SPSS. The factor structure of the CSI was determined using the principal axis method with oblique rotation as decided by Gorsuch. All factors having an Eigenvalue greater than 1 were considered. A 4-factor solution was derived that accounted for 42.6% of the common variance. The correlations between patient factor scale scores and variables from the demographic, clinical, psychosocial, and behavioral domains were then examined. RESULTS: The four factors and their respective variance are, Attention/Concentration (28.8%), Pattern Recognition/Activity Management (5.7%), Intermediate Memory (4.7%), and Initiation of Executive Functions (3.4%); each factor correlated with the total CSI score. Overall, patients' factor scale scores were positively and significantly correlated with other measures of cognitive dysfunction such as the Systemic Lupus Activity Measure (neuromotor domain) or the Systemic Lupus International Collaborating Clinics Damage Index (neurocognitive impairment), as well as with measures of fatigue, maladaptive coping skills, poor mental functioning, poor social support, and helplessness. They were, however, not correlated with sociodemographic or clinical variables. CONCLUSIONS: In addition to demonstrating that the CSI can be used to measure cognitive impairment in patients with SLE in the research setting, we have determined a 4-factor solution for the CSI that appears to have adequate metric properties. At present, the CSI may best be used as a screen for difficulties in daily activities involving intermediate memory, concentration, attention, and executive function. Nevertheless, further work with the CSI items and factor scales is necessary to establish internal and test-retest reliability of the factor scales; and provide additional evidence of the convergent and predictive validity of these scales in larger samples of patients from each ethnic subgroup.

Adult↗

PubMed2005

Degree of discrepancy between self and other-reported everyday functioning by cognitive status: dementia, mild cognitive impairment, and healthy elders.

BACKGROUND: Previous studies show individuals with dementia overestimate their cognitive and functional abilities compared to reports from caregivers. Few studies have examined whether individuals with Mild Cognitive Impairment (MCI) also tend to underestimate their deficits. In this study we examined whether degree of discrepancy between patient and informant-reported everyday functioning was associated with cognitive status. METHODS: The sample consisted of 111 ethnically diverse community-dwelling older adults (46 Caucasians and 65 Hispanic individuals), which was divided into four diagnostic categories: cognitively normal, MCI-memory impaired, MCI-nonmemory impaired, and demented. Everyday functional abilities were measured using both a self-report and informant-report version of the Daily Function Questionnaire (DFQ). A Difference Score was calculated by subtracting patients' DFQ score from their informants' score. RESULTS: DFQ Difference Scores were significantly higher in the demented group compared to normals and both of the MCI groups. However, the Difference Scores for the MCI groups were not significantly different than the normals. Further, while patient reported everyday functioning did not differ among the four diagnostic groups, informant reported functional status was significantly different across all diagnostic groups except MCI-nonmemory impaired vs normals. Performance on objective memory testing was associated with informant-rated but not patient-rated functional status. Demographic characteristics of the patients and informants, including ethnicity, had no association with the degree of discrepancy between raters. CONCLUSIONS: Although there may be some mild functional changes associated particularly with the MCI-memory impaired subtype, individuals with MCI do not appear to under-report their functional status as can often been seen in persons with dementia.

Activities of Daily Living↗

PubMed1979

Detection of cognitive deficits by a brief mental status examination: the Cognitive Capacity Screening Examination, a reappraisal and a review.

Results of a brief mental status questionnaire, the Cognitive Capacity Screening Examination (CCSE), were compared with the clinical evaluations of 59 patients on a neurology service. In 71% of the cases, the CCSE scores correctly indicated a cognitive deficit (true-positive) or the absence of one (true-negative); false-negative results were observed in 15% and questionable negative results were found in 10%. Abnormal neurologic physical signs were present in 90% of all patients with cognitive deficits. In this population, although positive CCSE scores were reliable, negative scores were often misleading. Mild diffuse intellectual dysfunction (dementia) and some discrete intellectual deficits (aphasia and anosognosia) went undetected. Cognitive deficits associated with major cerebral disease were unappreciated in nine patients. Caution is recommended in interpreting negative CCSE scores. Abbreviated screening devices are only a preliminary approach to mental status evaluation; this test requires further refinement.

Aged↗

PubMed1984

Cognitive impairments in Parkinson's disease: distinguishing between effort-demanding and automatic cognitive processes.

The study was designed to define some of the elements of cognitive impairments evident in unmedicated Parkinson's disease (PD) patients. Unlike patients with progressive dementias such as Alzheimer's disease, untreated, mildly to moderately affected PD patients are efficient at accessing previously acquired knowledge. They also can learn and remember information that can be processed "automatically," using operations requiring little cognitive capacity. However, PD patients demonstrate relatively specific cognitive impairments for effort-demanding processes. These findings are clinically useful, but also help define the boundaries of psychobiologically distinct cognitive (memory-learning) processes.

Aged↗