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Reflective thinking and mental imagery: a perspective on the development of posttraumatic stress disorder.

Reflective thinking occurs when information stored in long-term memory (LTM) is not sufficient to allow one to respond "automatically" to an object or event. Instead, stored information must be entered into working memory and a novel response or solution produced. In this article I argue that mental imagery plays a central role in this process, and that over the course of normal cognitive development the process of reflective thinking "programs" LTM so that an increasingly large number of tasks can be performed without reflective thinking. Normal cognitive development thus results in a decreasing reliance on imagery. However, if highly emotional images are formed, additional retrieval cues can be entered into LTM, making such images more likely to occur in the future. Such images induce arousal, similar to that induced by the actual event. This line of thinking leads to a novel perspective on the neurocognitive deficits that underlie the development of posttraumatic stress disorder, and may also help to explain some symptoms seen in hyperactivity, impulsiveness, and difficulties in self-control.

Brain↗

Subjective Side Effects Acutely Following ECT: Associations with Treatment Modality and Clinical Response.

Patient reports of systemic side effects and cognitive impairment were obtained the afternoon of each treatment during the electroconvulsive therapy (ECT) course. Side effects were grouped a priori as reflecting physical complaints, perceived cognitive impairment, and as mood-related. Patients randomly assigned to bilateral ECT reported more cognitive impairment than patients who received right unilateral ECT. There were indications that the unilateral ECT group had greater physical/somatic complaints. Patients who responded to ECT differed from nonresponders only on the more explicitly mood-related items. Generally, the findings supported the desirability of extending studies of patient reports of ECT adverse effects to include subjective systemic side effects in addition to subjective cognitive impairment.

Journal Article↗

Auditory event-related potentials in Parkinson's disease in relation to cognitive ability.

Auditory event-related potentials were evaluated in 45 nondemented patients with mild to moderate Parkinson's disease and 40 matched normal controls. All patients were neuropsychologically assessed by means of the Raven Colored Progressive Matrices, four subtests of the Wechsler Memory Scale (Digit Span Forward, Logical Memory, Visual Memory, Associate Learning), and the Wisconsin Card-sorting Test. The P300 component of the auditory event-related potentials was significantly prolonged in the patients with Parkinson's disease. Correlations between P300 latency and neuropsychological measures showed significant associations with lower performance on the Raven Colored Progressive Matrices and the Wisconsin Card-sorting Test. Our results indicate that for patients with mild to moderate Parkinson's disease subtle changes in cognitive abilities may be reflected as P300 prolongation.

Adult↗

Cerebral metabolic correlates of four dementia scales in Alzheimer's disease.

Different scales can be used to evaluate dementia severity in Alzheimer's disease (AD). They do assess different cognitive or functional abilities, but their global scores are frequently in mutual correlation. Functional imaging provides an objective method for the staging of dementia severity. Positron emission tomography was used to assess the relationship between brain metabolism and four dementia scales that reflect a patient's global cognitive abilities (mini mental state), caregiver's evaluation of cognitive impairment (newly designed scale), daily living functioning (instrumental activities of daily living) and global dementia (clinical dementia rating). We wondered whether different clinical dementia scales would be related to severity of metabolic impairment in the same brain regions, and might reflect impairment of common cognitive processes. 225 patients with probable AD were recruited in a prospective multicentre European study. All clinical scales were related to brain metabolism in associative temporal, parietal or frontal areas. A factorial analysis demonstrated that all scales could be classified in a single factor. That factor was highly correlated to decrease of cerebral activity in bilateral parietal and temporal cortices, precuneus, and left middle frontal gyrus. This finding suggests that global scores for all scales provided similar information on the neural substrate of dementia severity. Capitalizing on the neuroimaging literature, dementia severity reflected by reduced metabolism in posterior and frontal associative areas in AD might be related to a decrease of controlled processes.

Activities of Daily Living↗

Explaining math: gesturing lightens the load.

Why is it that people cannot keep their hands still when they talk? One reason may be that gesturing actually lightens cognitive load while a person is thinking of what to say. We asked adults and children to remember a list of letters or words while explaining how they solved a math problem. Both groups remembered significantly more items when they gestured during their math explanations than when they did not gesture. Gesturing appeared to save the speakers' cognitive resources on the explanation task, permitting the speakers to allocate more resources to the memory task. It is widely accepted that gesturing reflects a speaker's cognitive state, but our observations suggest that, by reducing cognitive load, gesturing may also play a role in shaping that state.

Adult↗

[The cytochemical indices of the sensorimotor cortex neurons in rats differing in their trainability in a food-acquiring habit].

Comparative study of protein metabolism in neurons of layers III and V of the sensorimotor cortex was carried out in two groups of Wistar rats, which differed in learning results: "bad" (60% of population) and "good" learners (40%). It was found out that the associative neurons (layer III) were most sensitive to cognitive load. In "bad" learners, an increase in nuclear and cytoplasmic dimensions and rise in protein concentration and content took place in these neurons, while in the efferent neurons (layer V) the protein content increased only in the cytoplasm. In "good" learners, the cognitive load led to a decrease in all the cytochemical parameters in neurons of the layer III while in the neurons of the layer V the content and concentration of proteins increased both in nuclei and cytoplasm. It is suggested that the character of protein metabolism changes produced by information load can be considered as a reflection of individual peculiarities of cognitive activity, and the extent of cytochemical changes as a reflection of complicity of a cognitive task.

Animals↗

Is there a relationship between serum S-100beta protein and neuropsychologic dysfunction after cardiopulmonary bypass?

OBJECTIVES: Over the past decade, the glial protein S-100beta has been used to detect cerebral injury in a number of clinical settings including cardiac surgery. Previous investigations suggest that S-100beta is capable of identifying patients with cerebral dysfunction after cardiopulmonary bypass. Whether detection of elevated levels S-100beta reflects long-term cognitive impairment remains to be shown. The present study evaluated whether perioperative release of S-100beta after coronary artery operations with cardiopulmonary bypass could predict early or late neuropsychologic impairment. METHODS: A total of 100 patients undergoing elective coronary bypass without a previous history of neurologic events were prospectively studied. To exclude noncerebral sources of S-100beta, we did not use cardiotomy suction or retransfusion of shed mediastinal blood. Serial perioperative measurements of S-100beta were performed with the use of a new sensitive immunoluminometric assay up to 8 hours after the operation. Patients underwent cognitive testing on a battery of 11 tests before the operation, before discharge from the hospital, and 3 months later. RESULTS: No significant correlation was found between S-100beta release and neuropsychologic measures either 5 days or 3 months after the operation. CONCLUSION: Despite using a sensitive immunoluminometric assay of S-100beta, we found no evidence to support the suggestion that early release of S-100beta may reflect long-term neurologic injury capable of producing cognitive impairment.

Anesthesia, General↗

The effects of memory load on event-related EEG desynchronization and synchronization.

OBJECTIVES: To examine the effects of working memory load on the event-related desynchronization (ERD) and synchronization (ERS) of several narrow EEG frequency bands. METHODS: ERD/ERS responses of the 4-6, 6-8, 8-10 and 10-12 Hz EEG frequency bands were studied in 24 normal subjects performing a visual sequential letter task (so-called n-back task) in which memory load was varied from 0 to 2. RESULTS: In the 4-6 Hz theta frequency band, a long-lasting synchronization was observed in the anterior electrodes, especially after the presentation of targets. In the 6-8 and 8-10 Hz frequency bands, anterior ERS was elicited especially in the 2-back condition (highest memory load). In contrast to the responses of the 8-10 Hz frequency band, in the 10-12 Hz frequency band the 2-back experimental condition elicited the greatest ERD. CONCLUSIONS: In the highest memory load (2-back) experimental condition the attentional capacities were most probably exceeded, resulting in 6-8 and 8-10 Hz ERS. This might reflect an inhibition of such brain areas (frontal cortices) no longer involved in task completion when alternative strategies are needed and utilized. These more 'cognitive' strategies were then reflected as an increase in 10-12 Hz ERD. Additionally, our results support the assumption that the simultaneously recorded ERD/ERS responses of different narrow EEG frequency bands differ and reflect distinct aspects of information processing.

Adult↗

Pupillary dilatation test and Fourier analysis of pupillary oscillations in patients with multiple sclerosis.

Recently we investigated 29 patients aged between 31 and 60 years with multiple sclerosis by means of two new techniques. The first technique was based on pupillary dilatation response to the topical application of the cholinergic antagonist tropicamide. The second technique was the Fourier analysis of pupillary oscillations for measurement of central activation, carried out without and under the influence of a cognitive task. The multiple sclerosis group had a pupillary dilatation of 31.9% after 40 min. Under the influence of a cognitive task the patient group revealed lower amplitudes of pupillary oscillations reflecting a decreased capacity for cognitive activation.

Adult↗

Proto-professionalism and the dissecting laboratory.

This essay argues for medical students' dissection of cadavers because this activity offers medical students opportunities to have certain experiences and reflect on them in ways facilitating their development of mature medical professionalism at the time they enter clinical practice. Issues central to professionalism as we envision it are (1) cognitive abilities identified as reflective judgment and principled ethical reasoning as they are exercised in four practice domains and (2) learning to learn in medical settings. We argue further that a key feature of such setting is practitioners' having to deal with ill-structured problems, and so we identify their features and relate their management to the sophisticated cognitive and learning abilities required of medical professionals.

Anatomy↗

Conversion from cognitive health to mild cognitive impairment and Alzheimer's disease: prediction by plasma amyloid beta 42, medial temporal lobe atrophy and homocysteine.

The changes of plasma amyloid beta (Abeta42) protein, homocysteine and medial temporal lobe atrophy (MTA) were studied by the transition from cognitive health to mild cognitive impairment (MCI) and to Alzheimer's disease (AD) in a prospective cohort of individuals aged 75 years. MTA but not plasma Abeta42 measured at baseline predicted which persons remained cognitively healthy (CH) and who developed AD 2.5 years later. The increase of plasma Abeta42 over time significantly distinguished between persons who remained CH on the one hand and MCI converters and AD converters out of cognitive health on the other (CH-to-MCI and CH-to-AD converters). Although both groups showed similar increase of Abeta42 levels, CH-to-AD converters had a higher increase of homocysteine compared to CH-to-MCI converters or to persons remaining CH. In comparison to all cognitive subgroups, the AD converters from MCI at baseline showed the smallest increase of Abeta42 levels and rather no increase of homocysteine. In logistic regression analysis, the increase of plasma Abeta42 but not change of MTA significantly predicted the conversion from CH to MCI, and changes of MTA and homocysteine but not of plasma Abeta42 predicted the conversion from CH to AD. The increase of plasma Abeta42 correctly allocated CH-to-MCI and CH-to-AD converters with low (63%) specificity (for both) and low (60%) sensitivity (54% for AD group). These results indicate that (1) plasma Abeta42 alone is not suitable as a biomarker for AD, (2) in the course of cognitive deterioration of the AD-type the increase of plasma Abeta42 seems to be an initial event, (3) similar to cerebrospinal fluid, changes of plasma Abeta42 may reflect the transition from cognitive health to AD, and (4) whether persons with MCI develop AD may depend on an accumulation of further toxic metabolites such as homocysteine.

Aged↗

The cognitive effects of opioids.

Successful opioid therapy often depends on achieving a balance between analgesic effectiveness and side effects. The risk of opioid-induced cognitive impairment often hinders clinicians and patients from initiating or optimizing opioid therapy. Despite subjective experiences of mental dullness and sedation, objective tests of cognitive functioning do not always demonstrate marked changes following opioid administration. To guide clinical practice, as well as patient and family teaching, pain management nurses should be familiar with literature regarding this topic. The purpose of this article is to review the empiric literature on opioids and cognitive functioning, including the relationships among pain, cognition, delirium, and opioids. In general, research reflects minimal to no significant impairments in cognitive functioning. If impairment does occur, it is most often associated with parenteral opioids administered to opioid-naive individuals. Some evidence suggests that opioids may actually enhance cognitive function and decrease delirium in some patient populations. This article describes this research and explores the clinical implications of the research in this area.

Analgesics, Opioid↗

Cocaine craving and attentional bias in cocaine-dependent schizophrenic patients.

Cocaine craving has been implicated as a major factor underlying addiction and drug relapse. From a cognitive viewpoint, craving may reflect, in part, attentional processing biased in favor of drug-related cues and stimuli. Schizophrenic individuals (SZ), however, abuse cocaine in high numbers but typically manifest baseline cognitive deficits that impair their ability to selectively allocate their attentional resources. In this study, we examined the relationship between attentional bias and craving in patients with cocaine dependence (COC; n=20), schizophrenic patients comorbid for cocaine dependence (COC+SZ; n=23), as well as two other comparison groups using a modified version of the Stroop test to include cocaine-relevant words. Results revealed that only the COC patients demonstrated Stroop interference on the cocaine-related words. Moreover, COC patients' attentional processing biases were significantly associated with their cocaine craving severity ratings. COC+SZ patients, in contrast, did not demonstrate Stroop interference and manifested significantly fewer craving symptoms than their COC counterparts. These results suggest that COC+SZ patients' inability to selectively encode their drug-use experience may limit and shape their subjective experience of craving cocaine and motivation for cocaine use.

Adult↗

Thalassemic children's understanding of illness: a study of cognitive and emotional factors.

A study that explored children's understanding of the body and illness was conducted with 23 thalassemic outpatients and 27 healthy controls. The findings were supportive of a developmental progression in children's understanding that is reflective of their underlying cognitive maturity. Behavioral compliance was related to psychiatric adjustment. There was a trend toward poorer psychiatric adjustment in children with impaired understanding of their illness. These findings hold implications for both educational and psychiatric intervention with this group. Optimal health care of chronically ill children requires knowledge of the developmental course and interplay of children's cognition and their familial and personal adjustment.

Adaptation, Psychological↗

Working memory and processing speed deficits in systemic lupus erythematosus as measured by the paced auditory serial addition test.

As many as 66% of systemic lupus erythematosus (SLE) patients have been reported to have cognitive deficits. These deficits are often associated with information processing speed and working memory. Similarly, processing speed and working memory impairments are the hallmark of cognitive dysfunction in multiple sclerosis (MS). The Paced Auditory Serial Addition Test (PASAT) places high demands on processing speed and working memory. Fisk and Archibald, however, demonstrated that the total score of the PASAT does not accurately reflect impairments in these cognitive processes. They found that MS patients used a chunking strategy to obtain correct responses and reduce the cognitive demands of the task. In the present study, PASAT performance was examined for 45 SLE patients and 27 controls using alternative scoring procedures. Although the total number of correct responses did not differ between SLE and controls at the 2.4 or 2.0 s presentation rates, SLE patients had fewer dyads (correct consecutive responses) than controls at the faster rate, and more chunking responses than controls at both rates. Disease activity, disease duration, depression, fatigue, and corticosteroids could not account for these differences. The findings suggest that SLE patients, like MS patients, chunk responses more often than controls, and that this scoring procedure may better reflect the working memory and processing speed deficits present in SLE.

Acoustic Stimulation↗

Cognitive abilities of patients with Lesch-Nyhan disease.

Parents of 42 patients with Lesch-Nyhan disease completed a questionnaire systematizing caregiver observations of the subject's behavior during a wide variety of daily events. Responses were grouped in nine categories reflecting different aspects of cognitive skills. Only 1 boy appears to have any significant generalized cognitive impairment. The patients' memory for both recent and past events is excellent, their emotional life has a normal range of reactions and is appropriate; they have good concentration, are capable of abstract reasoning, have good self-awareness, and are highly social. However, they are behind in academic ability, with only 15% at grade level for math and reading. Implications for designing educational activities, parenting or caregiver strategies, and research methodology are discussed.

Achievement↗

Protective effect of practice on cognition during aging: implications for predictive characteristics of performance and efficacy of practice.

In the present study, the effect of previous experience on spatial memory, which required the retention of information either over long intervals or within a single session, was longitudinally tested in the water maze in male F-344 rats that were from 6 to 24 months of age. Performance in these tasks was found to be age-dependent (Markowska, 1999). Other behavioral tasks in the straight alley and with a visible platform in the water maze controlled the noncognitive components of performance. For all tasks, performance was significantly correlated between 12-month-old and 18-month-old rats, indicating that cognitive performance at the early, but not advanced, stage of aging could be predicted from performance at a younger age if the novelty of the first exposure to the task was eliminated. The protective effect of experience was more robust in the reference memory task as compared to the working memory task and was modified by age when training was initiated. Behavior during the probe trials was more sensitive to the effect of aging and more resistant to the beneficial effect of practice as compared to the performance in the platform trials. The speed of swimming of experienced rats progressively decreased with age only when tested in the cognitive tasks but not in the straight alley. This indicates that speed of swimming during cognitive tasks does not exclusively reflect the ability to swim, but might be also affected by the cognitive demands of the task. Protective effect of experience on cognition was not modified by restriction in diet.

Aging↗

Intracerebral potentials to rare target and distractor auditory and visual stimuli. I. Superior temporal plane and parietal lobe.

Event-related potentials were recorded from 537 sites in the superior temporal plane and parietal lobe of 41 patients. Depth electrodes were implanted to localize seizure origin prior to surgical treatment. Subjects received an auditory discrimination task with target and non-target rare stimuli ("standard oddball paradigm"). In some cases, the target, distracting and frequent tones were completely balanced across blocks for pitch and volume. Variants included an analogous visual discrimination task, or auditory tasks where the rare target event was the omission of a tone, or the repetition of a tone within a series of alternating tones. In some subjects, the same auditory stimuli were delivered but the patient ignored them while reading. Three general response patterns could be distinguished on the basis of their wave forms, latencies and task correlates. First, potentials apparently related to rarity per se, as opposed to differences in sensory characteristics, or in habituation, were observed in the posterior superior temporal plane, beginning with a large positivity superimposed on early components. This positivity peaked at 150 msec after stimulus onset and inverted in sites superior to the Sylvian fissure. Subsequent components could be large, focal and/or inverting in polarity, and usually included a positivity at 230 msec and a negativity at 330 msec. All components in this area were specific to the auditory modality. Second, in the posterior cingulate and supramarginal gyri, a sharp triphasic negative-positive-negative wave form with peaks at about 210-300-400 msec was observed. This wave form was of relatively small amplitude and diffuse, and seldom inverted in polarity. It was multimodal but most prominent to auditory stimuli, appeared to remain when the stimuli were ignored, and was not apparent to repeated words and faces. Third, a broad, often monophasic, wave form peaking at about 380 msec was observed in the superior parietal lobe, similar to that which has been recorded in the hippocampus. This wave form could be of large amplitude, often highly focal, and could invert over short distances. It was equal to visual and auditory stimuli and was also evoked by repeating words and faces. The early endogenous activity in auditory cortex may embody activity that is antecedent to the other patterns in multimodal association cortex. The "triphasic" pattern may embody a diffuse non-specific orienting response that is also reflected in the scalp P3a. The later broad pattern may embody the cognitive closure that is also reflected in the scalp P3b or late positive component.

Acoustic Stimulation↗