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Results for “Cognitive Dysfunction”

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PubMed2005

Cognitive versus behavioral treatment of concurrent alcohol dependence and agoraphobia: a pilot study.

With the growing awareness of the prevalence of anxiety disorders among alcohol abusers there is a need for effective cognitive--behavioral treatments (CBTs). This study is a pilot investigation comparing two treatments for concurrent alcohol dependence and panic disorder with agoraphobia. A 10-session behavioral treatment (BT), consisting of five sessions treating alcohol dependence and five sessions treating panic disorder with agoraphobia, was compared to a 10-session cognitive treatment (CT) that addressed the dysfunctional cognitions mediating the alcohol problem and anxiety symptoms. There were no group differences in frequency or quantity of alcohol consumption or in anxiety symptoms posttreatment or at a 1-year follow-up in a sample of 14 subjects who completed the study. Both groups showed within-group improvements on measures of both alcohol and anxiety symptomatology. Approximately one-third of the subjects made clinically relevant gains on both alcohol and anxiety symptoms. A brief BT for concurrent alcohol dependence and agoraphobia appears encouraging.

Adult↗

PubMed2003

Cerebrospinal fluid markers for prediction of Alzheimer's disease.

A major diagnostic challenge when people seek advice for cognitive dysfunction is to differentiate between mild cognitive impairment (MCI) and incipient Alzheimer's disease (AD). We show that a combination of three cerebrospinal fluid biochemical markers, total-tau, phospho-tau and beta-amyloid(1-42), can detect incipient AD among patients fulfilling the criteria for MCI with a sensitivity of 68% (95% CI 45-86%) and a specificity of 97% (95% CI 83-100%). The usefulness of these markers is further emphasized by the finding of a positive predictive value of 94% and a negative predictive value of 81%.

Aged↗

PubMed2006

Set shifting deficit in anorexia nervosa.

Anorexia nervosa (AN) is a severe mental illness characterized in part by rigid thinking and ritualized behaviors involving eating and weight. Cognitive rigidity may play a role in the perpetuation of symptoms, and may provide information as to important brain-based abnormalities. Neuropsychological studies of patients with AN have shown cognitive dysfunction, but few have focused on cognitive flexibility. This study assessed set shifting in patients with AN, as a measure of cognitive flexibility. In this study, 15 patients with AN were compared with 11 healthy controls using a neuropsychological battery including the Wisconsin Card Sort Test (WCST). While patients with AN did not differ from controls on 5 measures of neuropsychological function, they made significantly more perseverative errors on the WCST, indicating a problem in set shifting. This finding suggests that patients with AN have a specific neurocognitive abnormality that may play a role in the development and persistence of this disorder.

Adult↗

PubMedDate not supplied

Psychological treatment of patients with chronic toxic encephalopathy: lessons from studies of chronic fatigue and whiplash.

BACKGROUND: Chronic toxic encephalopathy (CTE), which can result from long-term exposure to organic solvents, is characterized by problems of attention and memory, fatigue and affective symptoms. There is little experience with (neuro)psychological treatment in this patient group. We reviewed treatment outcome studies of CTE and comparable syndromes, namely, chronic whiplash-associated disorder (WAD) and chronic fatigue syndrome (CFS), with a view to providing recommendations for the psychological treatment of patients with CTE. METHODS: PubMed and PsychLIT were systematically searched and reference lists of retrieved articles were studied. The articles were classified according to study design and level of evidence. RESULTS: The studies of CFS provided high-level evidence for the effectiveness of cognitive-behavior therapy (CBT) in challenging dysfunctional cognitions regarding the effectiveness of rest and in stimulating graded activity. The studies of WAD were methodologically weaker, and most evaluated a combination of CBT and graded activity training. There was some evidence that changing fatigue- or pain-related behaviors may result in cognitive improvement. Two uncontrolled studies of CTE evaluated cognitive rehabilitation techniques but yielded inconsistent findings. CONCLUSIONS: CBT techniques focusing on changing illness attributions and on stimulating graded activity might be useful for patients with CTE, diminishing fatigue-related problems of concentration and memory. Future studies should evaluate whether cognitive deficits of CTE patients as a result of neurotoxic effects of exposure should be treated by cognitive rehabilitation.

Chronic Disease↗

PubMed1997

A neuropsychological perspective on three schizophrenic patients with midline structural defects.

BACKGROUND: The relationship between midline structural defects and schizophrenia remains unclear, although a number of neuroradiological studies have reported an association between schizophrenia and a range of anomalies. METHOD: Three patients are reported, each diagnosed with schizophrenia and neuroradiological evidence of midline structural anomalies. MRI scans are reported in conjunction with performance over a range of neuropsychological tests designed to assess frontal and lateralised cognitive functions. RESULTS: Evidence of anterior dysfunction was present in all three cases, while on an individual basis patients displayed varying patterns of preserved and dysfunctional cognitive processing. CONCLUSION: The reported findings raise a number of interesting issues regarding the nature of hemispheric involvement in schizophrenia.

Adult↗

PubMed2006

Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients?

UNLABELLED: There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. RESULTS: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior.

Adult↗

PubMed2025

GHSR suppression in neurons protects against aging-associated metabolic and cognitive impairments.

Aging is accompanied by progressive declines in metabolic and cognitive functions. Growth hormone secretagogue receptor (GHSR), a receptor for the gut hormone ghrelin, is highly expressed in neurons and plays a crucial role in metabolic regulation. We previously reported that aged global GHSR-ablated mice are lean and insulin-sensitive, and that neuronal GHSR-deleted mice (Syn1-cre;Ghsrf/f) completely prevent diet-induced obesity. However, the role of neuronal GHSR in metabolic and cognitive aging has not been elucidated. The current study aims to determine the roles of neuronal GHSR in aging metabolism and cognitive dysfunction. Syn1-cre;Ghsrf/f mice were subjected to cold stress, glucose- and insulin-tolerance tests, behavioral tests, and tissue analysis. Aging is accompanied by glycemic dysregulation and insulin resistance; old Syn1-cre;Ghsrf/f mice showed improved glucose tolerance and insulin sensitivity. Aging is associated with thermogenic impairment and cognitive decline; old Syn1-cre;Ghsrf/f mice showed better cold resistance and retained better recognition memory. Noticeably, there were increased expression of thermogenic makers (PGC1α and UCP1) and elevated sympathetic innervation markers (tyrosine hydroxylase and synaptophysin) in brown adipose tissue of old Syn1-cre;Ghsrf/f mice. Lastly, old Syn1-cre;Ghsrf/f mice exhibited decreased pro-inflammatory cytokines and increased neural plasticity-related markers (brain-derived neurotrophic factor, synaptophysin, and tyrosine hydroxylase) in metabolic and cognitive-relevant brain regions such as hypothalamus, cortex, and hippocampus. In conclusion, neuronal inhibition of GHSR promotes a healthy aging phenotype showing improved energy metabolism and cognitive function, which is likely contributed to the improved thermogenesis and insulin sensitivity, reduced inflammation, and restored neuronal plasticity.

Animals↗

PubMed2004

How does dysfunctional thinking decrease during recovery from major depression?

Decreased dysfunctional thinking in recovering depressed patents could reflect predominantly (a). reduced access to dysfunctional schemas or (b). increased metacognitive monitoring of dysfunctional schematic products. Twenty acutely depressed patients, 20 partially remitted depressed patients, and 20 controls were compared on tasks primarily reflecting one or the other of these processes. On both tasks, acutely depressed patients differed significantly from controls. Partially remitted patients resembled acutely depressed patients on the task assessing dysfunctional schema access but resembled controls on the metacognitive monitoring task. Results suggest that reduced dysfunctional thinking associated with partial remission is mediated primarily by increased metacognitive monitoring of dysfunctional cognitive products rather than reduced access to dysfunctional schemas.

Adolescent↗

PubMed2026

Acute COVID-19 severity and impaired cognitive function up to 32 months after diagnosis: an observational study.

BACKGROUND: Cognitive dysfunction ("brain fog") is a commonly reported post-COVID-19 symptom. Leveraging data from five general population cohorts across four European countries (Estonia, Iceland, Norway, and Sweden), we assessed long-term prevalence of impaired subjective cognitive function among individuals diagnosed with COVID-19 by acute illness severity. METHODS: The included cohorts consisted of adult participants recruited from March 2020 and followed with self-report measures of cognitive function and past COVID-19 infection (except one cohort consisting of clinically confirmed COVID-19 cases) through February 2023. In a cross-sectional analysis we contrasted the prevalence of impaired cognitive function among individuals with and without a COVID-19 diagnosis, overall and by illness severity up to 32 months post-diagnosis. We adjusted for age, gender, education, relationship status, binge drinking, body mass index, previous psychiatric diagnosis, number of chronic medical conditions, and response period. In a longitudinal analysis, we assessed potential changes in cognitive function scores before and after COVID-19 diagnosis. RESULTS: The study population consisted of 153,841 participants (71% women), with 31,359 (20.4%) reporting a positive COVID-19 test. Overall, a COVID-19 diagnosis was not statistically significantly associated with increased prevalence ratio (PR) of impaired cognitive function (PR 1.30 [95% CI: 0.98-1.71]). Individuals bedridden due to COVID-19 for 1-6 days (PR 1.38 [95% CI 0.96-1.99]) or ≥ 7 days (2.59 [1.55-4.33]) had higher prevalence of impaired cognitive function compared to those never diagnosed, while individuals never bedridden had a lower prevalence to those never diagnosed with COVID-19 (0.89 [0.80-1.00]). These findings were corroborated in the longitudinal analysis where a pre- to post diagnosis decline in cognitive function was observed among individuals bedridden due to COVID-19 (p < 0.0001). CONCLUSIONS: The data indicates that a severe COVID-19 acute illness course is associated with impaired cognitive function up to 18-32 months after COVID-19 diagnosis.

Adult↗

PubMed2005

Computerized cognitive testing in patients with type I Gaucher disease: effects of enzyme replacement and substrate reduction.

PURPOSE: Because of concern for drug-induced cognitive dysfunction during clinical trials using substrate reduction therapy (miglustat) in type 1 Gaucher disease and because it has been suggested that some patients with type 1 Gaucher disease may develop neurocognitive impairment as part of the natural history, two different batteries of neuropsychological tests were devised to examine these issues. Using these tests, cognitive function was assessed in patients treated with miglustat, in patients receiving enzyme replacement (standard care for symptomatic patients), and in untreated (milder) patients. METHODS: For this study, 55/60 patients exposed to miglustat in Israel participated in psychologist-administered testing; 36/55 participated in computerized testing. Of these, 31 enzyme-treated patients and 22 untreated patients participated in the psychologist-administered testing, and 15 enzyme-treated patients and 18 untreated patients participated in computerized testing. The psychologist-administered battery consisted of 18 standard neuropsychological subtests specific to executive and visuospatial functioning. The computerized battery (Mindstreams, NeuroTrax Corp., New York, NY) consisted of 10 subtests tapping multiple cognitive domains. Between-group analyses for each modality compared cognitive performance. RESULTS: In the psychologist-administered testing, patients exposed to miglustat performed significantly less well than the other groups in 5/18 subtests. On the computerized tests, all patients performed comparably to normal controls. Scores in patients exposed to miglustat were higher than in untreated patients, particularly in visuospatial function, whereas enzyme-treated patients performed less well. However, with the exception of visuospatial function, these results were not statistically significant. CONCLUSIONS: It is unclear why different testing methods yielded discordant results. Any dysfunction suggested by the current study is apparently subtle and of doubtful clinical relevance given that cognitive status did not interfere with patients' daily intellectual function. The computerized battery has methodological advantages (e.g., language options, objectivity, brevity, and ease of use) that make it well-suited for longitudinal studies, for long-term surveillance of substrate reduction therapy as well as for comparisons with other lysosomal storage disorders and other chronic diseases. These preliminary findings should allay fears of cognitive dysfunction due to short-term miglustat therapy.

1-Deoxynojirimycin↗

PubMed1998

Validation of the screening instrument for neuropsychological impairment in stroke.

BACKGROUND AND PURPOSE: Full neuropsychological assessment is time-consuming and exhausting for the patient in the early phase of stroke. The screening instrument for neuropsychological impairment in stroke (SINS) is a brief, bedside-applicable instrument designed to screen perceptual and cognitive dysfunction related to functional activities in stroke. It has been developed by physiotherapists to be incorporated in the general assessment of the patient. This study evaluates the validity of the method against a more extensive reference method assessing cognitive function. METHODS AND RESULTS: An unselected group of hospitalized stroke patients (N = 87) was assessed 10 days and 12 months after stroke. Factor analyses (52% explained variance), identified three factors: 'aphasia', 'apraxia' and 'visuocognitive dysfunction'. Receiver operating characteristics (ROC) curves demonstrated that for all factors, high specificity was maintained at the high sensitivity needed for a screening method. Kendall rank correlation coefficients between the scorings on the new instrument and the reference method were high. Effect size analysis showed that the ability of the new instrument to detect change in cognitive functioning during the first year was of the same magnitude as the reference method. CONCLUSIONS: SINS has a high sensitivity regarding cognitive dysfunction, as diagnosed by the more comprehensive and time-consuming reference method. The instrument would be useful as an initial step in the assessment of neuropsychological impairment in stroke patients.

Aged↗

PubMed1999

Cognitive performance after cardiac operation: implications of regression toward the mean.

OBJECTIVE: The purpose of this study was to assess the influence of regression toward the mean on different definitions of cognitive dysfunction after coronary artery bypass graft operation. METHODS: A total of 120 patients who underwent nonemergency coronary bypass operation and who were involved in a randomized trial of an anti-inflammatory agent were assessed prospectively with a battery of 10 psychometric tests covering a variety of cognitive domains. The battery was administered before the operation and 5 days and 3 months after the operation. Data from 2 representative tests, the Rey Auditory Verbal Learning Test and the Trail Making Test (part A), were used. The influence of regression toward the mean on 3 commonly used single-case definitions of cognitive impairment (1 SD method; one-half SD method; 20% method) was analyzed. RESULTS: Group mean performance deteriorated on the Rey Auditory Verbal Learning Test at the discharge assessment (P <.001) and remained below baseline at 3 months (P =.03). Mean performance on the Trail Making Test (part A) showed a near-significant decline at discharge (P =. 06), followed by improvement at 3 months (P <.01). Regression toward the mean was demonstrated on both tests by classifying the preoperative scores into low, moderate, and high-performance categories. Applying the different definitions of dysfunction resulted in substantially larger numbers of patients in the high-performance group being classified as impaired. CONCLUSION: Single-case definitions of cognitive dysfunction are influenced strongly by regression toward the mean. Disproportionate numbers of high-baseline performers are classified as impaired, thereby questioning the validity of established definitions. Group mean analysis with controls is potentially the most reliable method for detecting real change or differences.

Cognition↗

PubMed2004

Spatial memory deficits induced by perinatal treatment of rats with PCP and reversal effect of D-serine.

It has been suggested that perinatal treatment with the noncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist phencyclidine (PCP) induces transient neurodegeneration in the limbic and cortical structures of rats. Since dysfunction of these structures is associated with cognitive deficits in patients with schizophrenia, we studied the effects of subchronic treatment with PCP in perinatal rats with respect to spatial reference, reversal, and spatial working memories using the Morris water maze task in adulthood. In addition, we investigated the effect of D-serine, which has clinical relevance for the treatment of cognitive deficits in patients with schizophrenia. Our goal was to develop a neurodevelopmental model with predictive validity for the cognitive dysfunction described in patients with schizophrenia. Male and female Sprague-Dawley rats were treated with either saline or PCP (8.7 mg/kg s.c.) on days 7, 9, and 11, postnatal, and the long-term behavioral effects were investigated in adulthood. Male PCP-treated rats were slightly impaired during the spatial reference memory task, but strongly impaired during the reversal and spatial working memory tasks. Female rats were not significantly affected by this treatment. This cognitive deficit was reversed by chronic treatment with D-serine. We suggest that this model mimics some of the cognitive deficits of patients with schizophrenia and might be appropriate for the screening of putative antipsychotic agents for the treatment of these cognitive deficits.

Animals↗

PubMed1993

Dissociation of benzodiazepine-induced amnesia from sedation by flumazenil pretreatment.

The human amnestic syndrome associated with lesions of the hippocampus and amygdala is characterized by a selective impairment of recent (explicit, episodic) memory. Benzodiazepine (BZ) treated normal subjects demonstrate similar, marked impairments in episodic memory, but in addition, BZ also induces sedation and inattention. Thus, the amnestic effects of BZ may be secondary to drug-induced sedation. However, when subjects were pretreated with the specific BZ receptor antagonist, flumazenil, the sedative and attentional effects of diazepam were blocked, but a marked impairment in episodic memory still occurred. This demonstrates that, using neuropharmacological methods, it is possible to produce a dissociation of memory impairment from inattention and sedation. Such distinct patterns of cognitive dysfunction may serve as models for clinical cognitive syndromes.

Adult↗

PubMed2005

Validation of distinct amnesic and executive type memory deficit in a psychiatric sample based on retrieval performance.

Studies of localized brain dysfunctions have revealed connections between patterns of cognitive dysfunction and specific profiles of memory impairment. The amnesic type of memory impairment is defined by deficits in both free recall and recognition memory, whereas the dysexecutive memory impairment is characterized by retrieval deficits, i.e. a disproportional impairment in free recall relative to recognition memory. The present study tests whether classifications of psychiatric patients into recall impaired only (= RO group) and Recall and Recognition impaired (= RR group) correspond to the executive type and amnesic type of memory impairment. The alternative hypothesis is that the two groups merely differ in degree of neuropsychological and psychiatric disturbance. Forty-four subjects impaired on California Verbal Learning Test (CVLT) were selected from a larger database of 103 impaired and non-impaired subjects with schizophrenia or recurrent major depression. Subjects were classified into RO and RR groups and compared on measures of memory strategy (recency effect and interference on CVLT), overall neuropsychological function (Stroop Test and WAIS-R similarity) and psychiatric symptom load (positive and negative symptoms). Repeated measures ANOVA showed no effects of group, i.e. the RR group did not perform consistently below the RO group with regard to memory strategy, neuropsychological function or psychiatric symptom load. Two out of three analyses showed group x test interaction, supporting the dissociation of distinct executive and amnesic profiles among psychiatric patients. The RO group was more susceptible to interference but had better recency score than the RR group. The RO had higher negative symptoms while the RR group had higher positive symptoms.

Amnesia↗

PubMed1992

Developmental manual dyspraxia: a lesson in mind and brain.

For decades, pediatricians assiduously documented "soft neurologic signs" in children referred for school learning difficulties, although pediatric neurologists, including Charles F. Barlow, pointed out the dissociation between most neuropsychological abnormalities and the motor findings in question. Later, large epidemiologic studies confirmed the independence of soft signs from other neuropsychological defects. We used a standardized dyspraxia battery to study 164 schoolchildren 5 to 12 years old. We found that in the group as a whole there was a positive correlation between motor performance in the dyspraxia battery and IQ on the Wechsler Intelligence Scale for Children--revised (Full-Scale, Verbal, and Performance). In terms of dyspraxia subscales, we found that Performance IQ and Full-Scale IQ correlated with imitation of nonsense gestures and use of actual objects, whereas Verbal IQ correlated positively only with pantomime on command. In contrast, for the group of 24 subjects whose scores on the battery designated them as dyspraxic, there was no correlation between dyspraxia scores and IQ. Together with the existence of specific, dramatically different, types of dyspraxia among the 24 dyspraxic subjects, present findings uphold the earlier neurologic opinion that "motor soft signs" are not evidence for fixed "brain damage" or even for other types of motor dysfunction, and that dissociation of different specific cognitive dysfunctions is the rule within individual patients.

Achievement↗

PubMed1996

The effectiveness of cognitive therapy in the treatment of non-psychotic morbid jealousy.

BACKGROUND: Although a cognitive-behavioural formulation of morbid jealousy has been described there is little empirical research into the practical usefulness of this model. This study evaluated the effectiveness of treating non-psychotic morbid jealousy using a cognitive approach. METHOD: Cognitive-behavioural and emotional measures of jealousy were calibrated by comparison with 40 non-jealous normal controls. These instruments were used as measures of change to assess the effectiveness of cognitive therapy in altering cognitive errors in 30 morbidly jealous out-patient referrals, divided into delayed and immediate treatment subgroups to assess the stability of the condition. Both groups completed all measures immediately before and after treatment, and at follow-up. RESULTS: The instruments demonstrated significant differences between jealous and non-jealous subjects on cognitive-behavioural and emotional aspects of jealousy. The delayed treatment group showed no significant alteration in scores on any of the instruments after 12 weeks on the waiting list, confirming the stability of the condition. In the majority of cases cognitive therapy aimed at the modification of dysfunctional cognitive processes resulted in a significant improvement on all jealousy measures, immediately after treatment and at follow-up. The improvement reported by patients was supported by the partner's ratings. CONCLUSION: The results support the postulation of the cognitive model that modification of cognitive schema by a schema-focused treatment package results in a significant reduction in disturbance in all aspects of the jealousy syndrome.

Adolescent↗

PubMed2006

A review of evidence-based psychosocial interventions for bipolar disorder.

Various forms of psychosocial intervention have been found efficacious as adjunctive treatments for bipolar disorder, including family-focused therapy, interpersonal and social rhythm therapy, cognitive-behavioral therapy, and individual or group psychoeducation. When used in conjunction with pharmacotherapy, these interventions may prolong time to relapse, reduce symptom severity, and increase medication adherence. Family-focused therapy seeks to reduce the high levels of stress and conflict in the families of bipolar patients, thereby improving the patient's illness course. Interpersonal and social rhythm therapy focuses on stabilizing the daily and nightly routines of bipolar patients and resolving key interpersonal problems. Cognitive-behavioral therapy assists patients in modifying dysfunctional cognitions and behaviors that may aggravate the course of bipolar disorder. Group psychoeducation provides a supportive, interactive setting in which patients learn about their disorder and how to cope with it. This article discusses each of these interventions and summarizes the evidence for their efficacy in randomized trials. Recommendations for implementing psychosocial interventions in clinical practice are also given.

Bipolar Disorder↗