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PubMed1986

Outcome evaluation following subarachnoid hemorrhage.

Seventy-eight individuals among a population of 1.46 million suffered aneurysmal subarachnoid hemorrhage (SAH) during 1983. Within 24 hours after the bleed, 32 of the 78 patients were in Hunt and Hess neurological Grades I to II, 13 were in Grade III, 21 were in Grades IV to V, and 12 were dead on admission to a hospital or forensic department. When the amount of blood visualized on computerized tomography (CT) scanning was integrated with the Hunt and Hess neurological classification in order to improve prediction of prognosis, only 16 patients were considered to have a good prognosis (CT-modified Grades I to II), 21 had a less favorable prognosis (CT-modified Grade III), and 29 had a poor prognosis (CT-modified Grades IV to V). Assessment at 1 year revealed that only 32 patients (41%) had a good physical recovery. The physical morbidity rate was 22%, and the overall mortality rate was 37%. Twenty-six individuals with a good neurological outcome and five with a fair outcome also underwent reexamination 1 year or more post-SAH, which included a comprehensive evaluation of the quality of life, assessment of cognitive dysfunction, and determination of general adjustment. Five of the patients with a good neurological outcome and all five with a fair outcome (four of whom had had a poor prognosis in the acute stage) showed severe psychosocial and cognitive incapacitation. When functional morbidity, based upon persistent severe cognitive and psychosocial impairment, was included in the outcome assessment, only 33% of the total series was considered to have a favorable outcome. Approximately 60% of the initially good-risk patients (Grades I and II) showed a good physical outcome without concomitant indications of severe cognitive dysfunction and/or psychosocial impairment. Among the good-risk patients with a CT-modified grade, the figure was 70%. It is suggested that in any outcome grading system, persistent cognitive and psychosocial disturbances be taken into account.

Cognition Disorders↗

PubMed1999

Treatment-resistant schizophrenia and staff rejection.

This study examined the relationship between characteristics of patients suffering from treatment-refractory schizophrenia and staff rejection and criticism. Subjects were 30 inpatients with treatment-resistant schizophrenia and the 29 staff members treating them. Measures included assessment of the patients' symptoms and aggression risk profile using the Positive and Negative Syndrome Scale (PANSS) and assessment of staff attitudes toward these patients using the Patient Rejection Scale (PRS). Nursing staff completed the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). PRS ratings did not correlate with patients' demographic and treatment characteristics. Significant correlations existed, however, between increased staff rejection and higher scores for PANSS cognitive factor and NOSIE manifest psychosis factor. Negative symptoms, although preponderant in the patient sample, were not significant predictors of staff rejection on the PRS. Older nursing staff tended to view patients as more irritable and manifestly psychotic. These findings suggest that disorganized behavior and impaired cognition dysfunction areas are more likely to be associated with high levels of rejection among staff working with treatment-resistant schizophrenia patients. Incorporation of the relatively new concepts of cognitive dysfunction and treatment resistance in staff training programs and multidisciplinary team reviews may greatly benefit schizophrenia patients and the staff treating them.

Adult↗

PubMed2002

Impact on cognition of the use of antipsychotics.

Cognitive dysfunction is recognised as one of the more enduring deficits in schizophrenia. The syndrome is associated with impairment of the temporal and frontal regions of the brain that are concerned with cognitve function, as well as subcortical regions that are closely interconnected with them. Cognitive dysfunction may underpin some of the psychopathology of schizophrenia, as well as contribute to the patient's impaired social and vocational functioning. Cognitive deficits are relatively independent of psychotic symptoms in schizophrenia, and are probably central and enduring features of the disorder. It must also be considered that cognitive disability may be rate-limiting to the schizophrenic patient's rehabilitation and impairs quality of life. Although there is a general consensus that neuroleptic drugs are able to improve the psychopathology of schizophrenia, there is continued debate concerning their impact on cognitve function. Chronic treatment with classical neuroleptics has been reported to produce only minimal improvement in, and may actually impair, cognitive function in schizophrenia. In contrast, novel antipsychotics seem to cause less cognitive impairment than classical antipsychotic medication and may improve cognitive function. Whilst in the past research focused on the development of clinically effective antipsychotic drugs with a reduced propensity to cause extrapyramidal symptoms (EPS), it is now being recognised that maintaining and enhancing cognitive function and improving quality of life should be the goal in the treatment of schizophrenia.

Antipsychotic Agents↗

PubMed1995

Prevalence of cognitive and functional impairment in an elderly Puerto Rican population.

Data from the Gurabo census of the elderly, 1987-1988 (n = 1890) were analyzed to determine the prevalence rates for cognitive and functional impairment in that population. Besides socio-demographic questions, the census questionnaire included the Short Portable Mental Status Questionnaire to determine cognitive dysfunction, and the modified Katz Scale to detect functional impairment. The overall prevalence rates were 18.5% and 18.4% for cognitive and functional dysfunction respectively. After multiple logistic regression analysis, cognitive impairment was found to be associated with poor education (OR = 4.0, CI = 2.31-6.93), older age (OR = 2.67, C.I. = 2.00-3.58), functional decline (OR = 2.44, C.I. = 1.83-3.25), female sex (OR = 1.82, C.I. = 1.39-2.40) and low income (OR = 1.49, C.I. = 113-1.98). Functional impairment was found to be associated with cognitive dysfunction (OR = 2.45, C.I. = 1.84-3.27) and older age (OR = 2.08, C.I.-1.59 = 2,72). These findings suggest that a substantial proportion of the elderly in Puerto Rico may require assistance to deal with the consequences of these impairments.

Activities of Daily Living↗

PubMed2006

Cognitive deficit in schizophrenia: comparative analysis of positive and negative subtype and predictors of positive subtype.

OBJECTIVE: The objective of the study was to investigate the global cognitive deficit in schizophrenia and to compare cognitive dysfunction in the positive and negative subtypes of schizophrenia, and furthermore to examine the existence of predictors of the positive and negative subtypes of schizophrenia. METHOD: 56 patients with schizophrenia were evaluated with the Positive and Negative Syndrome Scale to classify them into the subtypes of schizophrenia, that is positive subtype (31 patients) and negative subtype (25 patients). All the patients were entering into remission. To examine the cognitive deficits in schizophrenia (global and selective) we compared scores on the Wechsler Individual Intelligence Test (VITI) for the positive and negative subtypes. RESULTS: The negative subtype of schizophrenia showed significantly higher cognitive dysfunction in comparison to the positive subtype, with reduced functioning in evolutionary higher cognitive functions like the selection of information, processing, planning, comprehension, realization (executive functions) as well as visual motor abilities. Verbal IQ predicts the positive subtype of schizophrenia.

Adult↗

PubMedDate not supplied

[Cognitive impairment in multiple sclerosis patients].

In addition to neurological symptoms, multiple sclerosis is characterized by cognitive function impairment. Disturbances of memory, recall, information processing, visual-spacial perception, attention, and executive function, in less extent of speech, are present in about 60% of patients. They are similar to disorders in other subcortical dementias. Once they appear, they rarely recede. Conventional, and especially nonconventional magnetic resonance imaging evaluates more precisely the tissue substrate--diffuse neuroaxonal lesion of the entire brain parenchyma--than clinical findings, already in the early stage of the disease. Alterations in the brain imaging are manifested by T2 hyperintensive and T1 hypointensive lesions, decreased neuronal marker N-acetyl-aspartate in magnetic spectroscopy, decreased magnetization transfer ratio, and increased diffusivity with reduced anisotropy in diffusion-weighted imaging. Total volume of brain lesion, corpus callosum diameter, and relation of measures of brain chambers and the rest of the brain, are best indices of cognitive dysfunction in multiple sclerosis. Their diagnosis in the very beginning of the disease allows early application of therapeutic procedures. Symptomatic treatment of these disorders is not efficient, and immunomodulation, particularly the use of biologic versions of interferon-beta, shows disputable effects. Cognitive dysfunctions affect relationships and working ability of patients.

Attention Deficit Disorder with Hyperactivity↗

PubMed1994

White matter lesions and cognitive deficits: relevance of lesion pattern?

Magnetic resonance imaging (MRI) permits efficient visualization of white matter lesions (WML). A growing body of literature deals with the correlation of WML and cognitive dysfunction with conflicting results. We studied the influence of lesion pattern as well as size by analyzing MRI and psychometric test performance in 2 patient collectives with different WML patterns. 22 patients with myotonic dystrophy (MD) and mainly subcortical WML were compared with 39 patients with multiple sclerosis (MS) and mainly periventricular lesions. 73% of MD patients had WML, the extent of which correlated with cognitive deficits. Severely impaired patients had psychometric findings compatible with "subcortical" dementia. In MS the extent of WML alone did not correlate significantly with cognitive deficits. Significant cognitive dysfunction was observed with extension of WML to areas of white matter immediately underlying cortex, but not with exclusively periventricular lesions. Cerebral atrophy had less impact. Comparison of MD and MS indicates that WML immediately subjacent to cortex are likely to cause significant cognitive deficits, whereas extensive periventricular demyelination may cause no major dysfunction. This may relate to early disturbance of associative fibers by subcortical lesions. Our results emphasize the significance of pattern as well as total extent of WML. Myotonic dystrophy is a useful model to study the effect of subcortical lesions, due to a typical lesion pattern unusual in other conditions.

Adolescent↗

PubMed1999

Hormones and cognition: current concepts and issues in neuropsychology.

This article provides an extensive and comprehensive review of the effects of hormones on cognition. Studies detailing specific neurocognitive functions affected by variation in hormone levels across the life span are presented. Dysregulation of hormone levels is considered from models of both normal and diseased functioning. Patterns of cognitive dysfunction are described for a range of syndromes involving the neuroendocrine system, and evidence of specific neurophysiological mechanisms that can account for these findings is outlined. This review includes discussion of treatment outcomes and the permanency of endocrine-related cognitive dysfunction. The authors present a set of guidelines for clinical neuropsychologists to use for assessment of patients with neuroendocrine system dysfunction. Clinical and methodological issues in research and treatment settings are discussed.

Cognition Disorders↗

PubMed1998

Previous episodes of hypoglycemic coma are not associated with permanent cognitive brain dysfunction in IDDM patients on intensive insulin treatment.

Intensive insulin treatment of IDDM is associated with increased frequency of hypoglycemic coma. The extent of possible cerebral sequelae after recovery is still unknown. We studied the impact of previous hypoglycemic coma on neurophysiological measures of cognitive brain function in 108 patients with adult-onset IDDM receiving intensive insulin treatment. In the study, 55 IDDM patients (age 38 +/- 14 years, mean +/- SD) who had a history of > or =1 (median 3, range 1-35) comatose hypoglycemic event were compared with 53 IDDM patients (age 34 +/- 12 years) with no history of hypoglycemic events using P300 event-related potentials and psychometric tests (the Mini-Mental State Exam and trailmaking test, part A). Findings on these patients were compared with those from 108 matched healthy control subjects. No difference was observed in P300 latencies and psychometric tests between patients with and without a history of hypoglycemic coma (P300 latency, 346 vs. 342 ms; trailmaking test, 31 vs. 30 s; Mini-Mental State Exam, 29.5 vs. 29.6; NS). In diabetic patients, however, P300 latencies were delayed compared with those of healthy control subjects (344 vs. 332 ms; P < 0.001) and were correlated to diabetes duration but not to total hypoglycemic episodes. Scores on the Mini-Mental State Exam (29.5 vs. 29.6; P = 0.59) and trailmaking test (31 vs. 28 s; P = 0.10) were not different between patients and control subjects. In conclusion, previous episodes of hypoglycemic coma are not associated with permanent impairment of cognitive brain function in patients with adult-onset IDDM receiving intensive insulin treatment compared with patients without such episodes. Cognitive brain function, however, is subclinically impaired in relation to duration of diabetes.

Adult↗

PubMed1993

Assessment of cognitive function in patients with systemic lupus erythematosus.

The spectrum of central nervous system manifestations of systemic lupus erythematosus (SLE) is very broad and has been found to include subtle subclinical cognitive dysfunction which may be detected only by the lengthy process of detailed neuropsychological evaluation. This study reports the value of estimating premorbid intelligence as a simple yet effective means of screening for subclinical cognitive dysfunction. Twenty one female patients with clinically quiescent SLE underwent neuropsychological examination at entry to the study. In all patients, this examination included measurement of full-scale intelligence quotient (IQ), verbal and performance IQ as well as verbal and visual memories. In addition, premorbid intelligence was estimated using the Schonell graded word reading test. Nine patients (43%) gave a history of neuropsychiatric (NP) disease. No difference was identified between the results of the neuropsychological evaluation in these 9 patients and in either the other SLE patients or in age and sex matched control patients. Sixteen patients were re-evaluated 1 year later. A comparison of measured full-scale IQ with the estimated premorbid intelligence identified a subgroup of 3 patients who demonstrated a significant reduction in intelligence. Unlike the other 13 patients, these 3 patients had multiple (3 or more) other features of cognitive impairment.

Cognition Disorders↗

PubMed1998

The cognitive efficacy of atypical antipsychotics in schizophrenia.

Cognitive dysfunction, a symptom of schizophrenia, has been recently identified as an important measure of outcome in the treatment of this disorder. Drug-mediated symptom improvement, the traditional measure of treatment success for schizophrenia, typically fails to associate with modifications of cognitive dysfunction, resulting in a failure of the patient to reintegrate into society. A paradigm shift is now required in the conceptualization of treatment success away from symptom decrement and towards treatments that improve cognitive function. Clozapine treatment has been shown to provide a significantly greater improvement in several domains of cognitive function, especially attention and verbal fluency, compared with conventional neuroleptics, whereas risperidone appears to have a beneficial effect on working memory. These results may be because of the normalization of dopamine function by clozapine and antagonism of 5HT2 receptors.

Antipsychotic Agents↗

PubMed1995

Cognitive performance in patients recovering from depression.

Investigations into the development of cognitive impairment in 30 hospitalized depressive patients have suggested that such disturbances encompass two dichotomous entities: a core entity of long-persisting, therapy-resistant impairment and an entity of reversible impairment with a prompt onset of improvement. The course of improvement turned out to evolve largely independently with respect to psychopathology: about one half of patients displayed severe cognitive dysfunctions which remained virtually unchanged until hospital discharge, while 80% significantly improved within the first 12 days with respect to their depressive symptoms, and 53.3% displayed a clear response to treatment at the time of hospital discharge. In particular, a considerable number of patients with a significant reduction of depressive symptomatology at hospital discharge still suffered from severe cognitive dysfunctions. Neither antidepressant or antipsychotic medication nor acute side effects due to medication explained the development of cognitive impairment. Accordingly, cognitive impairment seems to represent an essentially independent syndrome complex comparable to 'deficits' or 'negative symptoms' in schizophrenia. On the other hand, single case correlation analysis revealed a somewhat closer relationship of cognitive impairment with speech behavior and voice sound characteristics. Two thirds of patients displayed significant correlations between cognitive performance scores and second-order constructs like speech flow, dynamics or intonation. However, the respective subgroups defined by significant correlations with single speech parameters were relatively small (< or = 35% of cases), thus indicating that there exist large interindividual differences as to how cognitive impairment affects the patients' speech.

Adjustment Disorders↗

PubMedDate not supplied

Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine.

Cognitive dysfunction is common in older persons suffering from a major depression. However, the degree to which this dysfunction is reversible with successful treatment of the depression remains uncertain. The present study examined the effects that treatment (randomized double-blind design) with either an SSRI (paroxetine) or a tricyclic antidepressant (nortriptyline) had on cognition in older depressed patients. The patients' performance was compared to that of a group of normal controls of similar age and education. Patients and controls were administered measures of working memory, information-processing speed, episodic memory and attention five times over the course of a 12 week trial. At baseline, the patients performed more poorly than the elderly controls on all cognitive measures. While the patients' performance did improve over the course of their treatment, the magnitude of this improvement did not exceed that produced in the elderly controls by practice alone. The same pattern of results was evident in both intent-to-treat and responder analyses. Thus, there was no evidence that the depressed patients' cognitive performance normalized after response to antidepressant therapy. Neither the patients' age at onset nor their baseline level of cognitive functioning influenced the amount by which their performance improved over the 12 week trial. There was no difference between paroxetine and nortriptyline in the amount of cognitive change associated with treatment. The present results suggest that cognitive dysfunction persists in older depressed patients even after their mood disorder has responded to antidepressant medications.

Aged↗

PubMed2000

Primary central nervous system lymphoma: a clinicopathological study of 28 cases.

A group of 28 consecutive patients (mean age 59 years) with primary central nervous system lymphoma (PCNSL) was treated with different regimens, including steroids only, radiotherapy (RT), chemotherapy or combinations of all. Lymphoma was classified as high grade malignant B-cell non-Hodgkin's lymphoma of the diffuse large cell type in each of these cases. RT alone led to tumour remission in more than 70 per cent, survival could be prolonged with additional chemotherapy. Thirteen patients were treated with chemotherapy alone; nine of them received a novel combined intraventricular and systemic polychemotherapy protocol based on high dose methotrexate (MTX) and high dose cytarabine (ara-C). The response rate was 90 per cent with 80 per cent complete responses. Neurotoxicity, i.e. white matter lesions associated with severe cognitive dysfunction affected both patients surviving RT more than a year and patients treated with combination RT/chemotherapy. Confluent white matter hyperintense lesions were detectable on MRI in three out of 13 patients treated with chemotherapy alone, however, cognitive dysfunction has not been detected in these patients.

Adult↗

PubMed1991

[Mirror-writing in the aged].

Mirror-writing is script that runs in the direction opposite to normal, with the individual letters also reversed. Although mirror-writing is well recognized as occurring in the presence of central nervous system damage, and is especially seen in association with hemiplegia, its mechanism has not yet been elucidated. The purpose of the present study is to document a high incidence of mirror-writing among patients aged 65 years or more, and to investigate the relationship of mirror-writing with brain damage and the degree of cognitive dysfunction. The subjects analyzed in this study were 112 patients (44 males and 68 females) and their average age was 73.8 years. Hasegawa's Dementia Scale (HDS) was used to evaluate their cognitive function. We could find no cases of mirror-writing with the right hand. A high incidence of mirror-writing was found in patients who could use their left hand. Mirror-writing was seen in 67% of patients with cerebral lesions on CT scan. However, we could not observe any relationship between the incidence of mirror-writing and damage to a given circumscribed area of the brain. More than 90% of demented patients, whose HDS scores were less than 20, showed mirror-writing with their left hand. The mean score on the HDS for those with a high incidence of mirror-writing was significantly lower than the score for those without mirror-writing. These results indicate that a high incidence of mirror-writing among aged patients is related to cerebral damage and cognitive dysfunction.

Aged↗

PubMed2006

Cognitive and magnetic resonance imaging brain morphometric correlates of brain-derived neurotrophic factor Val66Met gene polymorphism in patients with schizophrenia and healthy volunteers.

CONTEXT: Relatively little is known about genetic determinants of cognitive dysfunction in schizophrenia. Recent studies suggest that a brain-derived neurotrophic factor (BDNF) prodomain single nucleotide polymorphism resulting in a valine (Val)-to-methionine (Met) substitution is associated with impaired declarative memory in healthy volunteers and patients with schizophrenia. These studies indicate that the BDNF(Met) variant may mediate hippocampal cognitive functions by modulating intracellular trafficking and activity-dependent BDNF release. To our knowledge, the way in which this functional single nucleotide polymorphism affects other neurocognitive measures has not been examined. Its role in determining cognitive deficits in schizophrenia has also not been systematically studied. OBJECTIVES: To characterize the neurocognitive and brain morphometric phenotypic correlates of the BDNF Val66Met polymorphism and to test the specificity of the BDNF(Met) variant on cognitive dysfunction in schizophrenia. DESIGN, SETTING, AND PARTICIPANTS: A comprehensive battery of standardized neuropsychological tests was administered to 144 healthy volunteers and 293 patients with schizophrenia spectrum disorder at a tertiary care university hospital. Approximately two thirds of the sample also underwent high-resolution magnetic resonance imaging brain scans. MAIN OUTCOME MEASURES: Genotype effects (in Met allele carriers vs Val homozygotes) on 5 cognitive domain z scores and magnetic resonance imaging gray matter brain volume measures (Talairach atlas-based cerebral lobes and optimized voxel-based morphometry) were examined using general linear models. RESULTS: On verbal memory, there was a significant genotype effect but no genotype x diagnosis effects. In both patients with schizophrenia and healthy volunteers, Met allele carriers had poorer verbal memory performance than their Val-homozygous counterparts. On visuospatial abilities, there were significant genotype and genotype x diagnosis effects. Met allele-associated visuospatial impairment was specific to patients with schizophrenia but not healthy volunteers. There were significant genotype effects on gray matter volumes within brain regions known to subserve these 2 cognitive domains, with Met allele carriers having smaller temporal and occipital lobar gray matter volumes. Optimized voxel-based morphometry further suggests that parietal heteromodal cortical gray matter deficits may underlie visuospatial impairment in patients with schizophrenia carrying the Met allele. CONCLUSIONS: We replicated the association between the BDNF(Met) variant and poor medial temporal lobe-related memory performance. The consonance of our cognitive and brain morphology findings further suggests that the BDNF(Met) variant may have a specific role in conferring visuospatial dysfunction in schizophrenia.

Adult↗

PubMed2003

Natural history of cognitive deficits and their relationship to MRI T2-hyperintensities in NF1.

BACKGROUND: Cognitive impairment is the most common complication of neurofibromatosis type 1 (NF1) in childhood. Current research suggests a strong relationship between cognitive deficits and brain T2-hyperintensities. The majority of these lesions disappear as the child ages. Cross-sectional data suggest that there also are improvements in intellect. OBJECTIVE: To determine the natural history of cognitive functioning and MRI T2-hyperintensities from childhood into adulthood, and whether changes in MRI T2-hyperintensities over time are predictive of changes in cognitive functioning. METHODS: The authors conducted a prospective longitudinal study of a cohort of 32 patients with NF1 and 11 unaffected sibling controls. All patients underwent neuropsychological assessments and 27 children underwent MRI examinations. The patients were then reassessed after an 8-year period. RESULTS: and CONCLUSIONS: There was no improvement in cognitive ability as the children with NF1 developed into adulthood compared with controls. Despite significant decreases in the number, size, and intensity of the T2-hyperintensities over the 8-year period, these changes were not associated with changes in cognitive ability. T2-hyperintensities in the cortex or subcortical or deep white matter are more frequent with age and these lesions are likely to have a different pathology than basal ganglia lesions. The best predictor of cognitive dysfunction in adulthood was the presence of T2-hyperintensities in childhood, rather than current lesion status. There is a limited time window (<18 years) in which the presence of T2-hyperintensities can be used as biologic markers of cognitive dysfunction.

Adolescent↗

PubMed1990

Neuropsychological features of benign partial epilepsy in children.

Rolandic paroxysmal epilepsy (RPE) is a useful model for investigating the complex links between epilepsy and cognitive dysfunction. 44 children with RPE who met the following (among other) criteria: negative CT scan, freedom from drug treatment, and IQ greater than or equal to 80, were assigned to three subgroups by side of EEG focus: left, right and bilateral. A neuropsychological battery elicited small differences in cognitive performance between the whole group and the controls and among the subgroups, only partially correlated with EEG side. A follow-up assessment showed that the short falls had disappeared along with the seizures and EEG anomalies, thus confirming the benign nature of RPE. Our findings suggest too that the mere presence of paroxysmal cortical activity is enough to trigger cognitive dysfunction.

Child↗