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PubMed2006

Cardiorespiratory fitness as a predictor of successful cognitive ageing.

This study examined whether cardiorespiratory fitness influences cognitive ageing and whether this influence is domain specific. A cross-sectional design comprising 25 young (18-30 years), 25 young-old (65-74 years), 25 middle-old (75-84 years) and 25 old-old adults (85-92 years) compared the relationship between cardiorespiratory fitness (VO(2max)) and measures of processing resources (attention, working memory, speed) and higher-order cognitive functions (executive function, memory). Fitness was a strong predictor of cognition and accounted for more variance in processing resources than in higher-order functions. This suggests that cardiorespiratory fitness may have a selective protective effect against age-associated cognitive decline.

Adolescent↗

PubMed2005

Developmental, cognitive, and neuropsychological functioning in preschool-aged foster children: associations with prior maltreatment and placement history.

Although young children in foster care are at high risk for developmental delays and subsequent academic, social, and behavioral difficulties, many do not receive services for delays. We sought to explicate the types of developmental delays observed in young children (ages 3-6 years) in foster care and how placement and maltreatment experiences for these children were associated with such delays. Physical growth, neuropsychological functioning, executive functioning, language, and general cognitive functioning were compared for a sample of 99 foster children and 54 nonmaltreated, same-aged children from comparable socioeconomic status backgrounds. The foster children showed developmental lags on measures of height, head circumference, visuospatial functioning, language, and general cognitive functioning. A history of neglect was negatively associated with functioning in a number of domains; surprisingly, the number of maltreatment types experienced was positively associated with functioning. Placement history was generally not associated with scores in the various developmental domains. We discuss the need to screen and evaluate preschoolers and possible methods for doing so.

Child↗

PubMed2004

Spontaneous improvement in severe, chronic schizophrenia and its neuropsychological correlates.

Cognitive impairment is well established in schizophrenia but its relationship to the course of the illness remains incompletely understood. Here we document two patients with schizophrenia who underwent neuropsychological testing while chronically unwell, and this was repeated after improvement took place. Both patients showed significant recovery of general intellectual function, accompanied by improvements in some but not all areas of neuropsychological function: executive function remained particularly impaired.

Adult↗

PubMed2004

Subthalamic nucleus stimulation induces deficits in decoding emotional facial expressions in Parkinson's disease.

BACKGROUND: Bilateral subthalamic nucleus (STN) stimulation is recognised as a treatment for parkinsonian patients with severe levodopa related motor complications. Although adverse effects are infrequent, some behavioural disturbances have been reported. OBJECTIVE: To investigate the consequences of STN stimulation on emotional information processing in Parkinson's disease by assessing the performance of an emotional facial expression (EFE) decoding task in a group of patients before and after surgery. METHODS: 12 non-demented patients with Parkinson's disease were studied. They were assessed one month before surgery and three months after. Their ability to decode EFEs was assessed using a standardised quantitative task. Overall cognitive function, executive function, visuospatial perception, depression, and anxiety were also measured. Twelve healthy controls were matched for age, sex, and duration of education. RESULTS: Before surgery, the patients showed no impairment in EFE decoding compared with the controls. Their overall cognitive status was preserved but they had a moderate dysexecutive syndrome. Three months after surgery, they had significant impairment of EFE decoding. This was not related to their overall cognitive status or to depression/anxiety scores. Visuospatial perception was not impaired. There was no change in the extent of the dysexecutive syndrome except for a reduction in phonemic word fluency. CONCLUSIONS: Bilateral STN stimulation disturbs negative emotional information processing in Parkinson's disease. The impairment appears specific and unrelated to certain secondary variables. This behavioural complication of STN may have implications for the patient's social life.

Affect↗

PubMed2001

Evaluation of attention problems in children with autism and children with a specific language disorder.

Children with autism and children with a specific language disorder show additional attention deficits. The literature on the neuropsychological investigation of attention in both groups of children suggests that the nature of their attention problems might be different. The purpose of this study is to examine the attention test profiles in these two groups of children with developmental disorders. Nineteen children and adolescents with autism, 17 subjects with a specific language disorder and 19 control subjects participated in the study. Non-verbal intelligence was normal for all subjects. The "Testbatterie zur Aufmerksamkeitsprüfung" was administered to all subjects. This instrument provides the possibility to examine a wide range of attention functions and executive functions. The results showed that the autistic individuals had deficits in executive functions, whereas the language impaired children had deficits in auditory sustained attention, in auditory selective attention, and in the domain of executive functions. It is concluded that although both groups of developmentally impaired subjects showed attention problems, the deficits are not the same in both groups. The different neuropsychological profiles probably reflect different mechanisms in the pathogenesis of the attention deficits in both types of developmental disorders.

Adolescent↗

PubMed2002

The neuropsychological and emotional consequences of living with intractable temporal lobe epilepsy: implications for clinical management.

PURPOSE: To investigate and document the neuropsychological and emotional effects of epilepsy in people with intractable temporal lobe epilepsy (TLE). METHODS: 273 patients with a diagnosis of TLE underwent a complete neuropsychological and psychological examination as a routine part of their investigation for epilepsy surgery. Neuropsychological assessment included measures of intellect, memory, language functioning, higher executive functioning, emotional well-being and the psychosocial impact of epilepsy and its treatment. RESULTS: The sample comprised 135 females and 138 males with a clearly lateralised epileptogenic focus. Patients were mildly anxious but not depressed, although many reported that epilepsy and its treatment had a marked effect on their daily lives. Current reading ability was in the average range; the mean obtained full scale IQ was 88 (low average range). Verbal memory functioning was within the borderline impaired range with visual memory functioning within the average range. Mean language performance was between the 5-10th percentile. Higher executive functioning results were in the normal range. Multiple univariate analyses were performed according to onset laterality. There were no significant differences between the groups on measures of psychological or emotional functioning. Participants with left TLE scored significantly lower than those in the right temporal group on measures of verbal intelligence, general intelligence, attention span and expressive language functioning. CONCLUSIONS: Patients with intractable epilepsy suffer significant neuropsychological difficulties in terms of their intellect, memory and language. Higher executive functioning appears unaffected. In addition, there is also evidence of emotional distress. These all impact upon their day-to-day functioning, which can be improved by the application of various psychological therapies and interventions.

Adult↗

PubMed2000

Functional neuroanatomy of executive processes involved in dual-task performance.

The subjective experience of allocating one's attentional resources among competing tasks is nearly universal, and most current models of cognition include a mechanism that performs this allocation; examples include the central executive system and the supervisory attentional system. Yet, the exact form that an executive system might take and even its necessity for cognition are controversial. Dual-task paradigms have commonly been used to investigate executive function. The few neuroimaging studies of these paradigms have yielded contradictory findings. Using functional MRI, we imaged brain function during two dual-task paradigms, each with a common auditory component task (NOUN task) but varying with respect to a visual component task (SPACE or FACE tasks). In each of the two dual-task paradigms, the results showed that the activated areas varied with the component tasks, that all of the areas activated during dual task performance were also activated during the component tasks, and that surplus activation within activated areas during DUAL conditions was parsimoniously accounted for by the addition of the second task. These findings suggest that executive processes may be mediated by interactions between anatomically and functionally distinct systems engaged in performance of component tasks, as opposed to an area or areas dedicated to a generic executive system.

Brain↗

PubMed2005

Neuropsychiatric symptoms, functional impairment and executive ability in Thai patients with Alzheimer's disease.

BACKGROUND: Instrumental activities of daily living (IADL) depend on executive planning and procedural memory mediated by the frontal lobes. Planning and judgment are involved in clock drawing. Neuropsychiatric symptoms are also mediated by frontal lobes, and a relationship between ADL, clock drawing and neuropsychiatric symptoms was hypothesized. OBJECTIVE: To investigate the relationship between behavioral disturbances, ADL, and executive function. METHODS: Seventy-three Thai patients with Alzheimer's disease (AD) were evaluated. Neuropsychiatric symptoms and behaviors were assessed with the Nevropsychiatric Inventory (NPI). The Thai version of the Mini-mental State Examination (TMSE) was utilized as a global cognitive assessment. A clock-drawing test (CDT) and both category (animals) and letter (ko, so in Thai) verbal fluency were used as executive measures. Thai ADL scale, Barthel Index (BI), and Functional Assessment Questionnaire (FAQ) were ADL measures used in this study. RESULTS: There were statistically significant correlations between CDT and the frontally-mediated behaviors of agitation (r = -0.367), apathy (r = -0.273) and disinhibition (r = -0.247). Verbal fluency correlated with agitation (r = -0.341). There were significant correlations between Thai ADL scores and agitation (r = 0.350), apathy (r = 0.441), and disinhibition (r = 0.417). FAQ correlated with the same three behaviors. After controlling for TMSE, a significant correlation remained between Thai ADL scores and agitation (r = 0.291) and apathy (r = 0.342). CONCLUSIONS: We demonstrated correlations between ADL and behavioral changes in Thai elderly with AD. Our results emphasize the important relationships among behavioral changes and impaired ADL.

Aged↗

PubMedDate not supplied

Influence of elderly executive cognitive function on attention in the lower visual field during step initiation.

BACKGROUND: There is a well-established relationship between poor executive cognitive abilities and elderly fall risk, but the precise mechanism underlying this relationship is unknown. Older persons frequently fall or trip on objects below eye level, and it was hypothesized that the pathological mechanism linking low executive function and fall risk is a selective impairment in the resolution of visual attention in the lower visual fields. OBJECTIVE: To determine if normally sighted older persons living in the community with deficits in executive cognitive abilities have a reduced resolution of visual attention in the lower visual fields compared to elderly and younger subjects with high executive abilities. METHODS: Eye and head angulations were monitored as subjects fixated on a point rear-projected at eye level at the end of a 3- meter walkway. Visual stimuli were briefly presented (<300 ms) in the peripheral visual field (with and without distractors) to directly cue the selection of the right or left foot to lead a step over a foam obstacle resting at the subject's feet. No saccades were allowed until the stimulus was extinguished, at which time a down-saccade-step sequence moved the foot over the obstacle. The resolution of visual attention (tested with gratings) and the influence of target eccentricity in the upper and lower visual fields were evaluated. The primary outcome measures were step error and obstacle contact rate, saccade occurrence after extinguished stimulus and the log of cue-saccade latency (limb-independent reaction time). RESULTS: All groups experienced greater stepping errors than expected by chance when stimuli were presented in the lower versus upper visual field and with increasing eccentricity. However, the obstacle contact rate was greater, cue-saccade latency was prolonged, and fewer down-saccades were generated in the elderly group with poor executive abilities compared to those with high executive function and younger subjects. CONCLUSIONS: Loss of visual attention in the lower visual fields was not unique to elderly subjects with poor executive function. However, slowed processing time and reduction in the frequency of down-saccades associated with a low level of executive function potentially account for the mechanism linking executive abilities and fall risk.

Accidental Falls↗

PubMed2003

Working memory deficit as a core neuropsychological dysfunction in schizophrenia.

OBJECTIVE: This study tested the hypothesis that impaired working memory is a core deficit underlying multiple neuropsychological deficits in schizophrenia patients. METHOD: The subjects were 27 men with stable chronic schizophrenia treated with atypical antipsychotics and 38 normal participants. They were assessed with a battery of neuropsychological tests. Verbal working memory was measured with the WAIS digit span tests, and the Dot Test was used to test spatial working memory. RESULTS: In the patients, verbal working memory showed significant correlations with visual retention, visual orientation, simple motor function, visuomotor coordination, and executive function but not with memory for objects, memory for faces, recognition of facial emotions, or attention. Spatial working memory showed significant correlations with visual retention, visual orientation, memory for objects, memory for faces, and simple motor function but not attention, executive function, or visuomotor coordination. In the comparison group, no correlations between working memory and other neuropsychological functions were found. CONCLUSIONS: These findings support the hypothesis that working memory is a core deficit in schizophrenia. The authors postulate that the lower capacity for verbal and spatial "on-line storage" is rate limiting in the performance of other cognitive functions. Executive functions rely critically on the phonetic loop, complex visual functions such as object and face memory rely on the spatial on-line storage system (visuospatial scratch pad), while other functions such as visual orientation depend critically on both capacities.

Adult↗

PubMed2007

The effect of a single aerobic training session on cognitive flexibility in late middle-aged adults.

Research has shown that aerobic exercise enhances cognitive function, specifically executive functions. This study examines the effect of acute aerobic exercise on cognitive flexibility - an executive function - in late middle-aged individuals. Fourteen men and 45 women aged 50 - 64, were randomly assigned to moderate exercise (60 % of heart rate reserve), moderately-intense (70 % of heart rate reserve) exercise, and movie-watching control groups after a maximal exercise test. Prior to and following the exercise or control sessions participants performed two cognitive tasks: the Alternate Uses assessing cognitive flexibility and the Digit Span Forward subtest from the Wechsler Adult Intelligence Scale - Revised assessing attention span. Results indicated significant improvement in Alternate Uses in the exercise groups but not in the control group. No group differences were indicated on the Digit Span. These results provide partial support for the benefit of acute aerobic exercise on cognitive flexibility.

Analysis of Variance↗

PubMed2006

Functional cognitive assessment scale (FUCAS): a new scale to assess executive cognitive function in daily life activities in patients with dementia and mild cognitive impairment.

BACKGROUND: Several tests have been developed to examine performance of demented patients in daily life activities. However, most of them are based either on the subjective evaluation of performance by the patient him/herself, or on the reports of relatives. Functional Cognitive Assessment Scale (FUCAS) is a new reliable (alpha > 0.89 - 0.92) cognitive-behavioral scale that assesses executive function in daily life activities directly in patients with dementia. AIMS: This study aimed at testing FUCAS' internal consistency of items, criterion-related validity, interrater reliability, discriminative ability, and effect of age, sex, and education on FUCAS scores. RESULTS: Criterion-related validity was supported by significant correlations between FUCAS, CAMCOG, MMSE, and FRSSD. The interrater reliability of FUCAS' total score for two raters was r 0.997 and we found no significant effect of age, sex, or education on FUCAS' total performance. Discriminant analysis has identified that FUCAS was able to sufficiently discriminate the patients with MCI from those with moderate-severe dementia. CONCLUSION: FUCAS is a useful and reliable diagnostic tool for MCI. Cognitive-behavioral assessment such as that provided by FUCAS can provide objective information that can serve to enhance the quality of clinical decision-making.

Activities of Daily Living↗

PubMedDate not supplied

[Neuropsychological evaluation in a case of multiple sclerosis].

INTRODUCTION: The neuropsychological assessment of patients with multiple sclerosis (MS) may be diagnostically useful to provide a patient's cognitive profile, to observe the spread of the deficit and to identify the peculiar areas that are more or less affected, in order to plan a long-term management and treatment. CLINICAL CASE: In this article, we present a case of cognitive dysfunction associated with a progressive MS in a 54 years woman, which was diagnosed six years ago. The magnetic resonance imaging showed demyelinating lesions at the periventricular region, with left predominance, and in the protuberance with signs of cortico-subcortical atrophy. We performed neuropsychological assessment of the main cognitive areas: orientation, attention, information processing, memory, general intelligence functioning, language, arithmetic, visual-spatial functioning, motor, executive functioning and personality. CONCLUSIONS: The results obtained point out serious alterations in the information speed processing, long term memory, motor, executive functioning and personality. This results go in a concordant way with the results reported in the consulted bibliography. Likewise, it is commented the resemblance of the cognitive deficit related to a pattern of subcortical dementia.

Affect↗

PubMed2000

Neuropsychological and Behavioral Correlates of Obstructive Sleep Apnea Syndrome in Children: A Preliminary Study.

STUDY OBJECTIVES: The purpose of this pilot study was to evaluate a group of children with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) for baseline neurocognitive deficits and behavioral dysfunction. A subset of the sample were also reassessed, using the same test battery, after treatment with adenotonsillectomy. DESIGN: Baseline and post-treatment neuropsychological and behavioral assessment. SETTING: Pediatric sleep disorders clinic at a children's teaching hospital. PATIENTS: 18 children (12 males, 6 females, mean age 7.3 years plus minus 2.0) meeting polysomnographic criteria for OSAS underwent baseline assessment; 8 children (6 males, 2 females, mean age 8.4 years plus minus 2.6) also completed the post-treatment assessment phase. MEASUREMENTS: An age appropriate neuropsychological battery including measures of global cognitive functioning, language, executive functioning and attention, memory, visual perception/visual motor skills and motor skills; two parent rating scales of behavior. RESULTS: Modest impairments, largely in executive functioning/attention and motor skills, were found at baseline. Parents endorsed a variety of behavioral problems, especially somatic complaints and problems with learning. There appeared to be relatively little association between impairment and disease severity, although there was a trend for the children with less severe disease, who were also older, to have relatively more behavioral problems. Post treatment, there were modest improvements in executive functioning/attention and motor skills, as well as in parent-reported internalizing and externalizing behaviors. CONCLUSIONS: The preliminary results with a small sample suggest mild deficits in executive functions and motor skills in children with mild to moderate OSAS, with modest improvements in the same neuropsychological domains post-treatment. A variety of parent-reported behavioral problems were found at baseline, again with modest improvement post-adenotonsillectomy.

Journal Article↗

PubMed2006

Frontal functions in young patients with essential tremor: a case comparison study.

Essential tremor (ET) is classified as a pure motor system disease. It has been previously reported that impairments in cognitive functions can be associated with ET. The authors assessed cognitive functions in a relatively young patient group with ET and comparison subjects. Correlations between tremor severity and regional cerebral blood flow (rCBF) and neuropsychological test performances of ET patients and comparison subjects were investigated. Sixteen patients with ET and 16 comparison subjects were assessed by a comprehensive neuropsychological test battery designed to assess global attention, language, memory, visuospatial functions, and executive functions. In 11 of 16 patients and in nine of 16 comparison subjects, rCBF was measured by technetium-99m-hexamethyl propylene amine oxime single photon emission computed tomography (technetium-99m-HMPAO SPECT). The tremor severity was quantified using the Clinical Rating Scale for Tremor (CRST). Findings revealed that ET patients differed significantly from comparison subjects on tests assessing visuospatial functions and verbal memory, whereas differences in other tests did not reach statistical significance. There was no significant difference between the rCBF of ET patients and comparison subjects. There were statistically significant inverse correlations between tremor severity and executive functions. Tremor severity was inversely correlated with bilateral frontal blood flow by technetium-99m-HMPAO SPECT. Conclusions suggest that the subclinical cognitive deficits characterized by visuospatial and verbal memory impairments and executive dysfunction may be a clinical feature of ET, and the cerebello-thalamo-frontal network may play a role in the pathophysiology of this disorder.

Adolescent↗

PubMed2000

Pattern of motor and cognitive deficits in detoxified alcoholic men.

BACKGROUND: Chronic excessive consumption of alcohol produces marked deficits in cognitive and motor abilities, although not all functions are affected to the same extent. Furthermore, although the occurrence of neuropsychological deficits in recently detoxified alcoholics is firmly established, the relative severity of these deficits, the specific neural systems that underlie the deficits, and their relationship to age and alcohol consumption variables either are less established or have proven elusive altogether. METHODS: We administered an extensive battery of neuropsychological tests, chosen for their known sensitivity to brain lesions in specific locations, to 71 recently (1 month) detoxified alcoholic men and 74 healthy controls who spanned the adult age range. Test scores were standardized to the controls for age and grouped a priori into composites that reflected performance in six functional domains: executive functions, short-term memory, upper limb motor ability, declarative memory, visuospatial abilities, and gait and balance. Analogous verbal and nonverbal materials and left- and right-hand upper limb motor tasks were used to test whether alcohol-related deficits were greater for left or right hemisphere. RESULTS: Compared with controls, the alcoholics were impaired on executive functions, visuospatial abilities, and gait and balance even after we accounted for group differences in estimated premorbid IQ and education. Within the alcoholic group, the most salient deficits were in gait and balance and visuospatial abilities. No consistent lateralized deficit was observed across the four domains tested. Unlike the cognitive composites, the upper limb motor ability and gait and balance composites both showed increasing vulnerability to age, with an independent contribution to the gait and balance dysfunction from the amount of alcohol consumed over a lifetime. CONCLUSIONS: The pattern of functional deficits implicates at least two principal neural systems: the cerebellar-frontal system and the corticocortical system between the prefrontal and parietal cortices. In addition, age and amount of alcohol consumption were better predictors of motor than cognitive impairments.

Adult↗

PubMed2026

Pilot randomized trial of intermittent theta-burst stimulation versus H-Coil transcranial magnetic stimulation for treatment-resistant depression.

BACKGROUND: Intermittent theta burst stimulation (figure-8-coil iTBS) and H7-coil repetitive transcranial magnetic stimulation (rTMS) are FDA-cleared treatments for major depression; yet their comparative effectiveness in treatment-resistant depression (TRD) has not been evaluated in randomized trials. This pilot randomized trial was designed to obtain preliminary comparative estimates and to explore whether baseline cognitive functioning relates to early remission. METHODS: Twenty-eight adults with TRD were randomized to six weeks of figure-8-coil iTBS delivered to the dorsolateral prefrontal cortex (DLPFC) (n = 15) or H7-coil rTMS delivered to the dorsomedial prefrontal cortex (DMPFC) (n = 13). The primary outcome was change in 17-item Hamilton Depression Rating Scale (HRSD-17) score from baseline to week 6, analyzed with ANCOVA. Additional outcomes included response, remission, and symptom trajectories through week 18. Exploratory analyses examined the association between baseline cognitive functioning, such as executive functions and memory, and remission. RESULTS: Twenty-five participants completed all 30 sessions. Adjusted week-6 HRSD-17 scores did not differ between groups (mean difference -0.40, 95% CI -5.23 to 4.43; p=.865). Response rates were 40.0% for figure-8-coil iTBS and 50.0% for H7-coil rTMS (p>.60), and remission rates were identical across groups (20.0%). Remitters showed higher baseline executive functioning than non-remitters in exploratory analyses, although these associations were not confirmed in adjusted models. CONCLUSION: In this pilot trial, figure-8-coil iTBS and H7-coil rTMS showed symptom improvement, with no clear between-group differences. Exploratory findings suggest a potential signal involving executive functioning that warrants further investigation. These results inform the feasibility and design of larger comparative trials. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05902312).

Adult↗

PubMed2001

Cortisol levels predict cognitive impairment induced by electroconvulsive therapy.

BACKGROUND: Elevated glucocorticoids may increase the vulnerability of the brain to the adverse effects of repeated seizures. This study tested the hypothesis that higher ambient cortisol levels would predict increased cognitive impairment in depressed patients subsequent to receiving electroconvulsive therapy (ECT) for major depression. METHODS: Sixteen subjects provided three samples of saliva the day before receiving unilateral nondominant ECT. Measures of mood, global cognitive functioning, attention, executive function, verbal and visuospatial memory, and visuospatial processing speed were obtained 1 day before the first ECT and 1 day after the sixth ECT treatment. The relationship between basal salivary cortisol obtained before the first ECT treatment and the change score of each cognitive measure after the sixth ECT treatment was examined and tested with Pearson correlation coefficients. RESULTS: Electroconvulsive therapy treatments delivered over 2 weeks resulted in a significant improvement in mood and a decline in most measures of cognitive performance. Elevated basal cortisol was associated with a greater decline in performance of executive function, visuospatial processing speed, and verbal memory. CONCLUSIONS: Although this study is limited by the small number of subjects and the high number of comparisons, all significant correlations were consistent with the hypothesis that elevated cortisol predicts a greater degree of ECT-induced cognitive impairment.

Adult↗