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PubMed1990

Neuropsychological aspects of Parkinson's disease.

The neuropsychological effects of Parkinson's disease have gained wide recognition in recent literature. Effects have been documented in almost all areas of cognitive functioning, including general intellectual functioning, visual-spatial functioning, executive functions, attention and memory functions, language functions, and affective processes. Visual-spatial functions, memory functions, and executive functions have received particular interest. This review of the literature is an attempt to tie together the large number of studies in these cognitive areas and to present a suggestion for a comprehensive neuropsychological battery tailored to the patient with Parkinson's disease. Throughout the review, factors relevant to Parkinson's disease, e.g., dementia, motor symptoms, and hemiparkinsonism, are considered.

Alzheimer Disease↗

PubMed2005

The behavioural neurology assessment.

BACKGROUND: We present information regarding the standardization, reliability and clinical validity of two versions of the Behavioural Neurology Assessment (BNA). The BNA-Long Form consists of 24 subtests within separate domains: Attention, Memory, Language, Visuospatial Function, Executive Function, and Praxis. The BNA-Short Form consists of 13 subtests within the domains of Attention, Memory, Naming, Visuospatial Function and Executive Function. In addition to individual domain indices, a Grand Total score was calculated for both BNA versions. OBJECTIVE: To standardize the administration and scoring and validate the BNA for detection of dementia. METHODS: Standardized normative data were obtained on 115 healthy subjects ranging in age from 50 to 95. Test-retest stability was obtained on 19 subjects and clinical validity was investigated by administering the BNA and Mini-Mental Status Examination (MMSE) to 29 patients with dementia and 29 age-matched healthy subjects (controls). RESULTS: Age had a significant effect on all but the Visuospatial and Praxis indices of the BNA-Long Form and an effect on Naming and Grand Total score of the Short-Form. Internal consistency (Cronbach's coefficient alpha) was .87 and .67 for the Long and Short Forms (.95 and .96 for dementia and control groups combined). Test-retest stability was acceptable. Grand Total indices of both BNA versions showed significant, positive correlations with the MMSE. Both BNA versions had superior sensitivity to dementia relative to the MMSE (.93 versus .79). Specificity was equivalent to the MMSE (.93 versus .97). CONCLUSIONS: Positive predictive values of the BNA and MMSE are equivalent but the BNA provides superior negative predictive value.

Age Factors↗

PubMed2000

Neuropsychological change in young people at high risk for schizophrenia: results from the first two neuropsychological assessments of the Edinburgh High Risk Study.

BACKGROUND: Studies of groups of individuals who have a genetically high risk of developing schizophrenia, have found neuropsychological impairments that highlight likely trait markers of the schizophrenic genotype. This paper describes the change in neuropsychological function and associations with psychiatric state of high risk participants during the first two assessments of the Edinburgh High Risk Study. METHODS: Seventy-eight high risk participants and 22 normal controls, age and sex matched completed two neuropsychological assessments 18 months to 2 years apart. The areas of function assessed include intellectual function, executive function, learning and memory, and verbal ability and language. RESULTS: The high risk participants performed significantly worse on particular tests of verbal memory and executive function over the two assessments than matched controls. Those high risk participants who experienced psychotic symptoms were found to exhibit a decline in IQ and perform worse on tests of verbal memory and executive function than those without symptoms. An increase in psychotic symptoms between the two assessments in the high risk group was found to be associated with an apparent decline in IQ and memory. CONCLUSIONS: The results suggest that the development of psychotic symptoms is preceded by a decline in IQ and memory. This may reflect a general and a more specific disease process respectively.

Adolescent↗

PubMed2002

Conceptual issues in behavioral teratology and their application in determining long-term sequelae of prenatal marihuana exposure.

BACKGROUND: Behavioral teratology, particularly as it is applied to the evaluation of cognition and behavior of children beyond the toddler stage, has become an area of burgeoning activity. In the area of drug abuse, children exposed in utero are often at developmental peril because of non-drug pre- and postnatal risk factors that make a causal association between the drug of interest and a behavioral teratogenic outcome increasingly problematic as the child gets older. METHODS: In the first portion of this review, the strategies that behavioral teratologists have undertaken to investigate the putative consequences of in utero exposure are discussed in terms of research design, statistical methods and interpretative approaches. In the second part of the paper, the relatively limited literature dealing with the behavioral teratological consequences of prenatal marihuana exposure, particularly in school age offspring, is reviewed. RESULTS: An emergent theme arising from primarily two longitudinal investigations is that in utero cannabis exposure does not impact upon standardized derived IQ scores but is negatively associated with attentional behavior and visual analysis/hypothesis testing. These findings are interpreted as supporting the hypothesis that, among offspring beyond the toddler stage, prenatal marihuana exposure has a negative influence on aspects of executive function. Executive function is a 'top-down', multifaceted cognitive construct involved in organizing and integrating specific cognitive and output processes over a interval of time and is largely mediated by the late developing, prefrontal region of the brain. CONCLUSIONS: The results and the interpretation of the prenatal marihuana findings are discussed in terms of the behavioral teratogenic effects (or lack of effects) during the various developmental stages of the offspring, the non-unitary nature of executive function, cannabis receptors, and the consequences of chronic marihuana use in the non-pregnant population.

Adolescent↗

PubMed1996

[Neuropsychological evaluation of a case of organic personality disorder due to penetrating brain injury].

In this paper, an organic personality disorder case by penetrating brain injury, predominantly localized in the right frontal lobe, is presented. Neuropsychological and neuroimaging (CT scan studies) were performed. We assessed the main cognitive aspect: orientation, attention, memory, intelligence, language, visual-spatial functioning, motor functioning, executive functioning and personality. The results obtained, point out disorders in the patient's behavior and in the executive functions. Likewise, other cognitive functions as: attention, memory, language and visual-spatial functioning, show specific deficits.

Frontal Lobe↗

PubMed2004

A neuropsychological investigation of male premutation carriers of fragile X syndrome.

It is currently thought that fragile X syndrome (FraX; the most common inherited form of learning disability) results from having more than 200 cytosine-guanine-guanine (CGG) trinucleotide repeats, with consequent methylation of the fragile X mental retardation (FMR1) gene and loss of FMR1 protein (FMRP). It was also considered that premutation carriers (with 55-200 CGG repeats) are unaffected, although a tremor/ataxia syndrome has recently been described in older adult male carriers. We reported that premutation expansion of CGG trinucleotide repeats affects brain anatomy, which, together with other studies, indicates that the molecular model for FraX needs modification. However, there are few studies on the cognitive ability of adult male premutation carriers. Thus, we selected 20 male premutation carriers on the basis of their genetic phenotype, and compared them to 20 male controls matched on age, IQ and handedness. We investigated intellectual functioning, executive function, memory, attention, visual and spatial perception, and language and pragmatics. The premutation carriers had significant impairments on tests of executive function (Verbal Fluency, Trail Making Test and Tower of London) and memory (Names sub-test of the Doors and People, Verbal Paired Associates Immediate Recall and Visual Paired Associates Delayed Recall sub-tests of the WMS-R, and Category Fluency Test for natural kinds). We therefore suggest that CGG trinucleotide repeats in the premutation range affect specific neuronal circuits that are concordant with specific neuropsychological deficits; and that these deficits reflect an emerging neuropsychological phenotype of premutation FraX.

Adult↗

PubMed2006

The neurocognitive effects of aripiprazole: an open-label comparison with olanzapine.

RATIONALE: Cognitive deficits are a core feature of schizophrenia. As a target of intervention, improvements in cognition may lead to improvements in functional outcome. OBJECTIVES: The present paper is the first report, to our knowledge, on the neurocognitive effects of aripiprazole. Unlike other second-generation antipsychotics, aripiprazole is a D(2) and D(3) receptor partial agonist. It is unknown what effects this unusual pharmacological profile may yield on neurocognition. MATERIALS AND METHODS: The present open-label study included data on 169 patients with schizophrenia or schizoaffective disorder who were randomly treated with aripiprazole or olanzapine. Subjects received a neurocognitive battery at baseline, week 8, and 26. RESULTS: The aripiprazole group had a significantly greater dropout rate than the olanzapine group. Neurocognitive data were reduced through a principal components analysis that yielded a three-factor solution. The factors were general cognitive functioning, executive functioning, and verbal learning. For general cognitive functioning, both groups improved from baseline and the effects were relatively stable over the 26-week protocol. There were no differential treatment effects. For executive functioning, neither group improved significantly from baseline. For verbal learning, the aripiprazole group improved significantly from baseline to the 8th and 26th week of assessment, and there was a between-group effect favoring aripiprazole over olanzapine that was largely attributable to the differences in performance within the 8th week. Separate analyses were conducted for a measure of sustained attention (Continuous Performance Test-Identical Pairs). There were no differential treatment effects on this measure. CONCLUSIONS: The findings from this open-label study suggest that the neurocognitive effects of aripiprazole are at least as good as those of olanzapine.

Adult↗

PubMed2006

Neurocognitive aspects of medication adherence in HIV-positive injecting drug users.

Cognitive deficits are associated with nonadherence to HIV medications. HIV-positive injecting drug users (IDUs) are at particular risk for nonadherence and cognitive barriers to adherence specific to this population should therefore be identified. The present study assessed the relation of three domains of cognitive functioning, executive functions, memory, and psychomotor speed, to self-reported antiretroviral adherence in a sample of HIV-positive IDUs. Depression, use of alcohol, heroin, cocaine/crack, or marijuana in the last week were also included in the models. Logistic regression analyses showed that only psychomotor slowing was significantly associated with nonadherence. Executive functions, memory, depression, and active alcohol and substance use were unrelated to adherence. No other studies to date have exclusively linked psychomotor slowing to nonadherence in HIV infection. Psychomotor slowing among our study sample was severe and suggests that when evident, such slowing may be a valuable determinant for antiretroviral adherence among IDUs.

Adult↗

PubMed2005

A neuropsychological investigation into violence and mental illness.

Previous research has reported cognitive impairment in patients with schizophrenia and antisocial personality disorder (APD), the two psychiatric illnesses most implicated in violent behaviour. Previous studies have focused on either group exclusively, and have been criticized for procedural inadequacies and sample heterogeneity. The authors investigated and compared neuropsychological profiles of individuals with APD and violent and nonviolent individuals with schizophrenia in a single investigation. The study involved four groups of subjects: (i) individuals with a history of serious violence and a diagnosis of APD, (ii) individuals with a history of violence and schizophrenia, (iii) individuals with schizophrenia without a history of violent behaviour and (iv) healthy control subjects. All study groups were compared on a neuropsychological battery designed to assess general intellectual function, executive function, attention, and processing speed. Cognitive deficits were more widespread among individuals with schizophrenia regardless of history of violence, compared with those with APD. Significant impairment in patients with APD was limited to processing speed. Violent individuals with schizophrenia demonstrated poorer performance than their nonviolent schizophrenia peers on a measure of executive function. Different cognitive impairments are manifested by individuals with APD and schizophrenia with violent behaviours, suggesting differences in underlying pathology. Furthermore, cognitive impairment appears to be more a feature of schizophrenia than of violent behaviour, although there is evidence that a combination of schizophrenia and violent behaviour is associated with greater cognitive deficits.

Adolescent↗

PubMed2000

Neurodevelopmental and psychosocial aspects of Turner syndrome.

Turner syndrome (TS) is the complex phenotype of human females with complete or partial absence of the second sex chromosome, or monosomy X. A characteristic neurocognitive and psychosocial profile has also been described in TS females. Typically, specific deficits in visual-spatial/perceptual abilities, nonverbal memory function, motor function, executive function, and attentional abilities occur in TS children and adults of varying races and socioeconomic status. TS-associated psychosocial difficulties occur in the areas of maturity and social skills. We hypothesize that a subset of the neurocognitive deficits (visual-spatial/perceptual abilities) are genetically determined and result from abnormal expression of one or more X chromosome genes. In addition, a different subset of these neurocognitive deficits (memory, reaction time, and speeded motor function) result from estrogen deficiency and are at least somewhat reversible with estrogen treatment. The TS-associated psychosocial problems are most likely linked to these core neurocognitive deficits and do not reflect a separate and independent component of the syndrome. Turner syndrome research has progressed significantly over the last decade. The field has moved from descriptive reports based on single individuals or small clinical samples to the use of experimental designs with larger, more diverse and representative samples. This degree of variability among individuals with Turner syndrome in all domains (karyotype or genetic constitution, physical attributes, neurocognitive and social functioning) suggests the need to identify risk and protective factors contributing to the heterogeneity in the phenotype. Active education about TS and participation in patient advocacy groups such as the Turner Syndrome Society of the United States (http://www. turner-syndrome-us.org/) has provided new information for TS adults and families as well as a supportive peer group. MRDD Research Reviews 2000;6:135-141.

Adaptation, Psychological↗

PubMed2004

The occurrence of inattention, hyperactivity, impulsivity and coexisting symptoms in a population study of 471 6-8-year old children based on the FTF (Five to Fifteen) questionnaire.

OBJECTIVE: To study the usefulness of a new parent questionnaire and to evaluate the prevalence of inattention, hyperactivity, impulsivity and co-existing problems in a group of 6-8-year-old children. METHOD: A questionnaire comprising 179 three-score-items including the DSM-IV diagnostic symptom criteria on AD/HD and questions on motor function, executive functions, perception, memory, language and speech, learning, social skills and psychiatric problems was used (5-15 questionnaire, FTF). The answers given by parents of 6-8-year-old children in a community in Finland are presented. RESULTS: The answers for 471 children, 230 boys and 241 girls, revealed a significantly higher rate of problems for boys than for girls in all developmental domains. The number of children with scores exceeding the mean +2 SD for inattention and/or hyperactivity-impulsivity subdomains were 42. About an half of these children had many coexisting problems, when the 90(th) percentile score for each domain was used as a measurement. Of the 42 children 11 fulfilled the DSM-IV symptom list criteria (6/9 for inattention and/or hyperactivity-impulsivity) for AD/HD and 9 children for subthreshold (5/9) AD/HD. CONCLUSION: A community-based study revealed that 2.3% of 6-8-year-old children had the full symptom list criteria (6/9) of AD/HD according to DSM-IV, and another 1.9 % fulfilled the symptom criteria (5/9) for subthreshold AD/HD. Coexisting problems were common. The severity of symptoms of inattentiveness and hyperactivity-impulsivity correlated significantly with the severity of coexisting problems.

Attention Deficit Disorder with Hyperactivity↗

PubMed2005

Unawareness of deficits in Alzheimer's disease and other dementias: operational definitions and empirical findings.

Individuals with dementia frequently demonstrate decreased awareness of their cognitive difficulties. Empirical research examining this phenomenon has addressed a number of aspects of unawareness in Alzheimer's disease and other dementias, including occurrence in various disorders; possible neuroanatomical substrates; relationship to general cognitive functioning, executive functioning, and psychiatric symptomatology; and progression over time and across cognitive domains. Limitations of the current research literature are discussed, particularly issues surrounding operational definitions of unawareness and the current limited understanding of the role of the frontal lobes. A number of conclusions regarding unawareness that appear to be supported by the current body of empirical research and possible future directions are discussed.

Alzheimer Disease↗

PubMed2006

C-reactive protein, but not homocysteine, is related to cognitive dysfunction in older adults with cardiovascular disease.

Cardiovascular disease (CVD) is a risk factor for cognitive impairment and dementia. Recent studies implicate homocysteine (HCY) and C-reactive protein (CRP) in this increased risk, as both are associated with cognitive dysfunction in demented and non-demented patients. However, it remains unclear whether they confer added risk in older adults with CVD. A total of 126 older CVD patients underwent blood and neuropsychological evaluation as part of a prospective examination of the neurocognitive consequences of CVD. A subset of these participants (n=37) also underwent neuroimaging to quantify the degree of white matter disease. After adjusting for demographic and medical factors, no significant relationship emerged between HCY and cognitive performance. In contrast, CRP showed significant independent relationships to test performance, including global cognitive performance, attention/psychomotor function, executive function, memory, and visuospatial abilities. Neither HCY nor CRP was related to extent of white matter disease or whole brain volume on magnetic resonance imaging. Further study is needed to identify mechanisms by which inflammatory processes impact on cognitive function and to determine whether reducing circulating levels of inflammatory markers results in improved cognition.

Aged↗

PubMed2001

Are some memory deficits unique to lesions of the mammillary bodies?

The role of the mammillary bodies in human memory is still in debate. A recent model of human amnesia proposes similar functions for the mammillary bodies and the hippocampus. But the main evidence for this model comes from animal studies using the delayed non-matching to sample paradigm. We describe a patient who developed a severe memory impairment after surgical removal of a germinoma. Postsurgical high resolution MRI revealed bilaterally shrunken mammillary bodies and an infarct of the left mammillary body. There were no other relevant lesions. Neuropsychological testing showed mildly impaired frontal lobe functions (executive functions, working memory and word fluency), almost intact learning and recognition, but severely impaired free and delayed recall. Experimental investigations revealed a reduced but preserved release of proactive interference and a pronounced impairment of recency and source judgments. We conclude that the mammillary bodies do play a prominent role in human memory, although the role differs slightly from that of the hippocampus.

Adult↗

PubMed2003

Cognitive estimation and affective judgments in alcoholic Korsakoff patients.

Alcoholic Korsakoff patients have their most marked deficits in memory, but may exhibit problems in further cognitive and behavioral domains, particularly in so-called frontal lobe functions and on the emotional level. Cognitive estimation is among the frontal lobe-associated functions; nevertheless, the underlying processes of estimation and estimation deficits are still unknown. Additionally, though affective judgments were found to be disturbed in Korsakoff patients one can question whether this result is due to a deficiency in emotional processing itself, or whether deteriorated basic processes underlying all kinds of judgment tasks result in affective judgment errors. In this study, possible relations and underlying cognitive processes of affective and nonaffective judgments (cognitive estimates) were analyzed in a large sample of 39 Korsakoff patients. A neuropsychological test battery was administered together with a new test for cognitive estimation consisting of four dimensions ('size,' 'weight,' 'quantity,' and 'time') and an affective judgment task comprising negative, neutral, and positive words. The Korsakoff patients' results showed marked deficits concerning both, cognitive estimation and affective judgments. These deficits were highly intercorrelated and performance in both tasks was related to basic (e.g., information processing speed) and higher cognitive functions (executive functions and memory), suggesting a common basis in cognitive estimation and in affective judgments in Korsakoff syndrome.

Aged↗

PubMed2003

Neurocognitive functioning is associated with employment status: a quantitative review.

Neurocognitive assessment is frequently used as a basis for making determinations regarding a person's ability to work; yet, to our knowledge, a review of the association between neurocognition and employment status has not been conducted. For this review, we utilized meta-analysis to quantify objectively the association between eight neurocognitive domains and employment status. The meta-analysis revealed that performance in each domain was significantly associated with employment status, and that the associations were greatest for the following domains: intellectual functioning, executive functioning, and memory. These findings support the ecological validity of neurocognitive assessment.

Attention↗

PubMed2003

Emotional adjustment following cognitive recovery from 'persistent vegetative state': psychological and personal perspectives.

Previously, the cognitive recovery of a 26 year old woman, Kate, who developed a severe encephalomyelopathy and was in a 'minimally conscious/persistent vegetative state' for 6 months was reported. After 6 months, Kate began to respond to her environment and, at 2 years post-illness, neuropsychological assessment indicated that Kate was functioning within the normal range on tests of general intellectual functioning, executive functioning and most memory functions (with the exception of visual recognition memory). Although Kate has a severe dysarthria necessitating the use of a communication board and severe physical disabilities that require her to use a wheelchair, she has demonstrated an almost complete cognitive recovery and is among a tiny percentage of minimally conscious patients to do so. This single case report describes the emotional factors central to Kate's rehabilitation. Using a newly developed model of cognitive rehabilitation as a framework, the pivotal role that emotional and psychological factors played in Kate's adjustment to the consequences of her illness and the role of psychotherapeutic intervention in facilitating this adjustment are discussed.

Adaptation, Psychological↗

PubMed2006

Who benefits? Outcome following a coping skills group intervention for traumatically brain injured individuals.

PRIMARY OBJECTIVE: To investigate the variables associated with positive psychological outcome following a group intervention for 33 individuals with traumatic brain injury. RESEARCH DESIGN: Evaluation study which used multiple regression analysis to examine the variables associated with change in psychological adjustment following a 10-session cognitive behaviour therapy-based group. METHODS AND PROCEDURES: The predictor variables were age at injury, time since injury, injury severity, self-awareness, pre-morbid intellectual function, memory function, executive function and level of depression and anxiety prior to intervention. MAIN OUTCOMES AND RESULTS: The predictor variables contributed a significant proportion of the variance in percentage change in depression. The major finding was that better outcomes following intervention were associated with greater self-awareness of injury-related deficits. CONCLUSIONS: The present study identified a number of variables that were associated with improvement in depression following psychological intervention and may assist future treatment resources to be directed most effectively.

Adaptation, Psychological↗