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PubMed2006

Neuropsychological functioning in adolescent children of mothers with a history of bipolar or major depressive disorders.

BACKGROUND: Growing evidence demonstrates an association of neuropsychological deficits with mood disorders, but it is not yet clear whether these deficits are risk factors or are concomitant with the symptoms. This study examines the neuropsychological functioning of a group of adolescent offspring who are at risk for a mood disorder by virtue of being raised by mothers who have been diagnosed with major depressive disorder (MDD) or bipolar disorder (BPD). METHODS: Adolescent offspring of mothers with BPD (n = 43) or MDD (n = 72) and of psychiatrically well parents (n = 50) completed a battery of neuropsychological tests to assess executive functioning, memory, and attention. RESULTS: Children of mothers with BPD showed deficits in executive functioning and selective deficits in spatial memory and attention, in comparison with children of well mothers. Deficits were not found for children of MDD mothers. CONCLUSIONS: Knowledge of these neurocognitive processes could aid ultimately in determining whether neurocognitive deficits precede BPD, whether unique profiles are associated with various types of mood disorders, and who may benefit from interventions.

Adolescent↗

PubMed2006

Brain perfusion effects of cholinesterase inhibitors in Parkinson's disease with dementia.

Several evidences suggest that cholinergic deficits may significantly contribute to dementia in Parkinson's disease (PDD) and acetylcholinesterase inhibitors (ChEIs) have been reported to improve cognitive symptoms in PDD, without worsening parkinsonism. Nineteen PDD patients underwent brain perfusion SPECT with (99m)Tc-ethyl cysteinate dimer after 6 months ChEIs treatment in order to evaluate the functional correlates of clinical improvement. A clear-cut cognitive improvement was reported in PDD patients with a significant improvement of ADAS-cog total score as well as of subscores exploring executive functions (p<0.01). MMSE total score did not significantly change after ChEIs but the subscore of attention significantly improved after therapy (p<0.01). No difference in motor performance as evaluated by UPDRS was reported. SPM analysis showed a significant increase of perfusion (p < 0.0001) in bilateral cingulate, and frontal regions after ChEIs. Our data confirm the efficacy of ChEIs in the treatment of dementia associated with PD mainly on attention and executive functions, and the functional findings indicate that this cognitive improvement could be associated with a sort of pharmacological frontal "re-afferentation".

Aged↗

PubMed2005

Evidence for sustained attention and working memory in schizophrenia sharing a common mechanism.

Sustained attention and working memory (WM) are closely related functions that may share common mechanisms. The authors assessed sustained attention in schizophrenia patients and healthy comparison subjects using visuomotor tracking tasks under varying distractor loads. The attentional effort expended to deal with distractors was lower in patients and showed significant association with WM, executive function and negative symptoms in that group. It is proposed that the anterior attention system of sustained attention models and the executive function of the WM model describe the same or a closely related mechanism that is located in the prefrontal cortex (PFC) and is impaired in schizophrenia.

Adult↗

PubMed2003

Neurocognitive function in HIV-infected patients with low weight and weight loss.

OBJECTIVE: To determine neurocognitive function in HIV-infected subjects with low weight and weight loss. DESIGN: Cross-sectional cohort. METHODS: Baseline data from male and female participants in longitudinal treatment studies of AIDS wasting were analyzed. Fifty-seven HIV-infected women (age: 38 +/- 5 years, education level: 12.3 +/- 2.3 years) and 24 HIV-infected men (age: 37 +/- 5 years, education level: 13.5 +/- 2.9 years) with weight <90% IBW or loss of >10% of preillness weight maximum underwent standardized neurocognitive testing to measure intellectual functioning, attention, memory, and fine motor dexterity. The z scores were determined using age- and gender-specific normative data. RESULTS: Among women, IQ (87 +/- 13, z score: -0.8 +/- 0.8 SD) and executive functioning scores (-0.7 +/- 1.2 SD) were below average but within normal limits. In contrast, performance (z scores) on measures of verbal learning (-2.5 +/- 1.5 SD), visuospatial abilities (-2.5 +/- 2.0 SD), and motor coordination (-2.3 +/- 3.3 SD) fell significantly below normal limits. Among men, IQ score was 96 +/- 13 SD (z score: -0.3 +/- 0.8 SD). Performance was below average on measures of verbal learning (-1.0 +/- 1.7 SD) and visual construction (-1.6 +/- 1.7 SD) but within normal limits on executive functioning (-0.1 +/- 1.0 SD). CONCLUSIONS: HIV-infected women at low weight demonstrate significantly reduced verbal learning, memory, and motor function, whereas HIV-infected men at low weight demonstrate more moderate impairment in verbal learning and other measures of neurocognitive function.

Adolescent↗

PubMed1997

Neuropsychological Dysfunction in HIV Infection:A Review.

FIfty-six studies which used neuropsychological tests to investigate areas of function affected by central nervous system dysfunction in HIV were reviewed. Only studies which compared the performance of HIV + subjects to HIV - controls using analysis of variance techniques were included. The results are examined in terms of broad neuropsychological function domains, and are examined separately for asymptomatic and symptomatic subjects. Studies which did and did not find significant differences between HIV + and HIV - subjects were compared in terms of various confounding factors such as risk groups, number of tests, sample size and subject characteristics. There was evidence for some dysfunction among subjects who are otherwise asymptomatic in the areas of verbal memory (27% of studies), executive function (43%), motor performance (20%) and information processing (44%). Studies of subjects with more advanced HIV infection showed consistent evidence of abnormal functioning in the areas of verbal (48% of studies) and visual memory (43%), executive functioning (71%), complex attention (62%), motor performance (37%) and information processing (69%). These deficits occurred prior to the onset of clinically apparent dementia. There were no consistent significant differences between studies which did and did not find significant differences between HIV + and HIV - subjects in terms of most of the confounding variables investigated, although studies of ASX subjects were more likely to find differences between HIV + subjects and controls with larger neuropsychological test battereies. However, much of the variation in results due to the neuropsychological tests used. In many cases, tests which relied on functions with a frontal lobe component were more likely to find significant results.

Attention↗

PubMed2003

Neurocognitive impairment in drug-free patients with major depressive disorder.

BACKGROUND: Although neurocognitive impairment has been widely reported in major depressive disorder (MDD), confounding factors, such as the effects of psychotropic medication, have rarely been controlled for. AIMS: To examine neurocognitive function in medication-free patients with MDD and healthy controls. METHOD: Forty-four patients meeting DSM-IV criteria for MDD, all psychotropic-medication-free for at least 6 weeks, and 44 demographically matched, healthy comparison subjects completed a comprehensive neurocognitive battery. RESULTS: Patients with depression were impaired significantly in a range of cognitive domains, including attention and executive function and visuospatial learning and memory, compared with controls. Motor and psychomotor functions were intact. Severity of depression correlated with learning and memory performance, but not executive function. CONCLUSIONS: Pronounced neurocognitive impairment was found in this sample of young adult out-patients with MDD. This is not attributable to the confounding effects of psychotropic medication and could therefore provide an objective marker of brain dysfunction in depression.

Adolescent↗

PubMed2005

Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex affects divided attention immediately after cessation of stimulation.

Transcranial magnetic stimulation has evolved into a powerful neuroscientific tool allowing to interfere transiently with specific brain functions. In addition, repetitive TMS (rTMS) has long-term effects (e.g. on mood), probably mediated by neurochemical alterations. While long-term safety of rTMS with regard to cognitive functioning is well established from trials exploring its therapeutic efficacy, little is known on whether rTMS can induce changes in cognitive functioning in a time window ranging from minutes to hours, a time in which neurochemical effects correlated with stimulation have been demonstrated. This study examined effects of rTMS on three measures of executive function in healthy subjects who received one single rTMS session (40 trains of 2 s duration 20 Hz stimuli) at the left dorsolateral prefrontal cortex (DLPFC). Compared to a sham condition one week apart, divided attention performance was significantly impaired about 30-60 min after rTMS, while Stroop-interference and performance in the Wisconsin Card Sorting Test was unaffected after rTMS. Repetitive TMS of the left DLPFC, at stimulation parameters used in therapeutic studies, does not lead to a clinically relevant impairment of executive function after stimulation. However, the significant effect on divided attention suggests that cognitive effects of rTMS are not limited to the of acute stimulation, and may possibly reflect known neurochemical alterations induced by rTMS. Sensitive cognitive measures may be useful to trace those short-term effects of rTMS non-invasively in humans.

Adult↗

PubMed2006

The neuropsychological correlates of borderline personality disorder and suicidal behaviour.

OBJECTIVE: In subjects with borderline personality disorder (BPD), compared with subjects who attempted suicide, to review neuropsychological (NP) function that may predispose to suicidal behaviour along a continuum of high and low lethality. METHOD: We undertook electronic searches of MEDLINE, PsycINFO, EMBASE, Biosos Reviews, and Cinhal. The searches were restricted to English-language publications from 1985 onward. The search terms borderline personality disorder, suicide, suicide attempt, self-harm behaviour, neuropsychological, executive function (EF), neurocognitive, and neuropsychological function produced 29 neuropsychology studies involving BPD and 7 neuropsychology studies of suicide attempters, regardless of psychiatric diagnosis. RESULTS: Of the BPD studies, 83% found NP impairment in one or more cognitive domains, irrespective of depression, involving specific or generalized deficits linked to the dorsolateral prefrontal and orbitofrontal regions. The functions most frequently reported (in 71% to 86% of BPD studies) are response-inhibitory processes affecting executive function performance that requires speeded attention and visuomotor skills. Decision making and visual memory impairment are also most frequently affected; 60% to 67% of BPD studies report attentional impairment, verbal memory impairment, and visuospatial organizational impairment. Least affected processes in BPD appear to involve spatial working memory, planning, and possibly, IQ. The similarities in NP deficits found in BPD and suicide-attempt studies involve decision making and Trails performances. BPD studies, however, reflect more frequent impairment on the Stroop Test and Wisconsin Card Sort Test performance than the suicide-attempt studies, whereas verbal fluency appears to be more frequently impaired in those attempting suicide. CONCLUSIONS: Impaired EF and disinhibitory processes, as indicated by verbal fluency, Trails, and Stroop performance, primarily associated with dorsolateral prefrontal cortical regions may represent a dominant executive pathway to suicide attempt. A primary motivational inhibitory pathway involving conflictual, affective, and reflexive decision-making processes associated with orbitofrontal brain regions, in combination with significant cognitive rigidity, may influence the repetitive expression of self-harm or low-lethality suicidal behaviour. The hypothesis of a specific trait-like cognitive vulnerability for suicidal behaviour involving dysregulatory, disinhibiting pathways awaits confirmation.

Attention↗

PubMed2005

Cognitive correlates of cerebral white matter lesions and water diffusion tensor parameters in community-dwelling older people.

BACKGROUND: The biological basis of cognitive ageing is unknown. One underlying process might be disruption of white matter tracts connecting cortical regions. White matter lesions (WML) seen on structural MRI may disrupt cortical connections, but diffusion tensor MRI (DT-MRI) parameters - mean diffusivity ( ) and fractional anisotropy (FA) - may reflect more subtle changes in white matter integrity. Here the relationships between WML load, DT-MRI parameters and cognition in a large cohort of elderly subjects with a very narrow age range were investigated. METHODS: 105 community-dwelling volunteers underwent MRI and neuropsychological assessment. Seventy-two (68.6%) were female, and their mean age was 78.4 (SD 1.5) years. Scans were rated for WML load. and FA were measured from regions of interest in normal-appearing frontal and occipital white matter, and centrum semiovale. RESULTS: and FA differed significantly among the three brain regions studied (p << 0.01). increased with age (r = 0.22 to 0.35, p < 0.03), and was negatively correlated with FA (r = -0.20 to -0.51, p < 0.05) in all three regions. There was a trend towards increased WML load correlating with poorer cognitive function, and this was statistically significant for the Mini-Mental State Examination (rho = -0.23, p = 0.02). was generally negatively correlated with cognitive test score, and FA was positively correlated. This pattern was more consistent for than for FA, and particularly for verbal fluency ( : r = -0.22 to -0.27, p < 0.03), which measures executive function. CONCLUSIONS: DT-MRI parameters, in particular , are sensitive to early ultrastructural changes underlying cognitive ageing. Executive function may be the cognitive domain most sensitive to age-related decline in white matter tract integrity.

Aged↗

PubMed2003

Comparative effects of risperidone and olanzapine on cognition in elderly patients with schizophrenia or schizoaffective disorder.

OBJECTIVE: To examine the effects of risperidone and olanzapine on cognitive functioning in elderly patients with schizophrenia or schizoaffective disorder. METHOD: One hundred seventy-six elderly inpatients and outpatients with schizophrenia or schizoaffective disorder were enrolled in this multicenter, double-blind trial. After their antipsychotic medications were tapered for 1 week, patients were randomly assigned to receive either risperidone 1 to 3 mg/day or olanzapine 5 to 20 mg/day for 8 weeks. Performance on the Continuous Performance Test (CPT), Serial Verbal Learning Test (SVLT), TMT (Trail Making Test) Parts A and B, Wisconsin Card Sorting Test (WCST), and Verbal Fluency Examinations (VFE) was assessed at baseline and at end point. RESULTS: Patients in the risperidone group had improved scores on at least one test of attention, memory, executive function, and verbal fluency, and those in the olanzapine group had improved scores on at least one test of attention and memory function. Scores on the TMT Part B, WCST total errors (executive function domain), and the VFE improved significantly from baseline in the risperidone group but not in the olanzapine group. No significant differences in change scores between the two groups were found. Higher baseline scores on each test predicted more improvement at endpoint. CONCLUSIONS: Low doses of risperidone and olanzapine improve cognitive function in elderly patients with schizophrenia or schizoaffective disorder. Consistent with research in younger populations, these improvements occur in aspects of cognitive functioning related to functional outcome.

Aged↗

PubMed2004

Cognitive dysfunction in Parkinson's disease: the role of frontostriatal circuitry.

It has been known for many years that the classic motor symptoms of Parkinson's disease are accompanied by deficits of executive function that resemble those seen after frontal lobe damage in humans. What is less clear is how different components of frontostriatal circuitry contribute to these impairments. Recently, improved methods of clinical assessment and classification, combined with novel technical approaches, such as functional neuroimaging, have led to great advances in our understanding of the fundamental mechanisms that drive frontostriatal circuitry. As a direct result, it has been possible to redefine impairments of executive function in Parkinson's disease more precisely in terms of the specific neuropsychological, neuroanatomical, and psychopharmacological mechanisms involved.

Animals↗

PubMed2004

Components of working memory and somatic markers in decision making.

According to Damasio's somatic marker hypothesis, affective reactions ordinarily guide and simplify decision making. In an earlier study, we used a modified version of the gambling task developed by Bechara and colleagues so that we could explore the relations among decision making, working memory (WM) load, and formation of somatic markers. This prior work found that an increased WM load produced by secondary tasks interfered with the development of somatic markers and led to poorer gambling task performance. In the present study, we tested whether secondary tasks affect the executive functions of WM, verbal buffering, or both. Our findings indicate that verbal buffering alone does not interfere with gambling task performance or the development of somatic markers. Interference with the executive functions of WM is necessary to disrupt gambling performance and somatic markers.

Adult↗

PubMed1997

The relationship between sexual abuse and mild traumatic brain injury.

It remains unclear why some individuals with mild traumatic brain injury (MTBI) complain of cognitive deficits many months after the injury. Given neuropathological changes associated with prolonged stress, such as occurs with repeated sexual abuse (SA), it seems possible that individuals who experienced SA might be predisposed to greater deficits after MTBI. Four groups of subjects were administered measures of cognitive and emotional functioning. These groups were those with MTBI (n = 10), those with a history of SA (n = 10), those with both MTBI and SA (n = 10), and normal control (NC) subjects (n = 10). Compared to the NC subjects, those with MTBI demonstrated deficits in working memory, those with SA demonstrated deficits in executive functioning, and those with both MTBI and SA demonstrated the greatest number of deficits which were in working memory, executive functioning and memory. Tests of anxiety, depression and post-traumatic stress disorder, while demonstrating significant symptoms in all clinical groups, did not correlate with the neuropsychological tests that differentiated the groups.

Adult↗

PubMed2005

Social reasoning, emotion and empathy in frontotemporal dementia.

INTRODUCTION: Social cognition is crucial for human interaction, and is markedly impaired in the frontal variant of frontotemporal dementia (fvFTD). The relationship of various aspects of social functioning, however, remains controversial in this group. METHODS: Patients with fvFTD (n = 18), and matched controls (n = 13), were tested using tasks designed to assess their Theory of Mind (ToM), moral reasoning, emotion recognition and executive function. Caregivers documented changes in empathy compared to premorbid functioning. RESULTS: We found marked impairments in the abilities of fvFTD patients, relative to controls, in ability to mentalise (ToM), which was evident on a cartoon test, but not on a story-based ToM task. Knowledge of social rules was intact, but moral reasoning was defective, and was due, in part, to an inability to rate the seriousness of moral and conventional transgressions appropriately. Executive function was impaired in this group, and compromised aspects of moral reasoning, but ToM performance was independent of this. Emotion recognition was globally impaired in fvFTD, but was particularly so for anger and disgust which may partly explain the difficulty these patients have with identifying social violations. Empathy, as rated by carers, was also shown to be abnormal. CONCLUSION: It appears that social reasoning is disrupted in a number of ways in fvFTD, and the findings provide a basis for the understanding and further study of abnormal behaviour in this disease. The results are discussed in light of neuroimaging findings in studies of social cognition and the locus of pathology in fvFTD.

Adult↗

PubMed2006

Response inhibition and everyday memory complaints in older adult women.

OBJECTIVE: To explore the association of executive functions to the everyday memory complaints of healthy older adults. METHODS: Ninety-nine community-dwelling women aged 60 and above were administered a battery that included neuropsychological tests of executive functions and memory, along with self-report measures of everyday memory complaints, depression, and anxiety. RESULTS: Multivariate regression analyses revealed that a measure of response inhibition (Stroop Color-Word) accounted for unique variance in predicting memory complaints above and beyond measures of episodic memory, depression, and anxiety. Depression, however, accounted for the largest variance in memory complaints. CONCLUSIONS: Higher frequency of everyday memory complaints among older adults was associated with decreased response inhibition independent of episodic memory and affective state. Further research is needed to understand the interrelationships among these and other predictors of everyday memory complaints.

Affect↗

PubMed1999

Executive dysfunction in Alzheimer's disease.

Executive functioning was examined in 20 patients with Alzheimer's disease (AD) and 20 normal elderly subjects. The results showed that AD patients present lower performance compared to control subjects in all executive tasks, confirming that some executive deficits may be present in the first stages of the disease. A factorial analysis suggested that these deficits can be related to two domains of the executive functions: the inhibition abilities and the capacity to co-ordinate simultaneously storage and processing of information. Moreover, the performance on these factors is correlated to different anterior and posterior cortical areas.

Aged↗

PubMed1998

Olfactory identification deficiency and WCST performance in men with schizophrenia.

Several studies using the University of Pennsylvania Smell Identification Test (UPSIT), which requires forced choice olfactory identifications, have reported olfactory identification deficits in patients with schizophrenia. This report examines the possible links between olfactory identification (usually attributed to the orbitofrontal cortex) and executive functions (usually attributed to dorsolateral prefrontal cortex) in 24 male patients with schizophrenia and 21 male comparison subjects. Olfactory performance was investigated under two conditions: spontaneous identification and forced choice identification. Executive function was assessed with the Wisconsin Card Sorting Test (WCST). Compared with controls, patients with schizophrenia exhibited a higher average number of cigarettes smoked per day, lower spontaneous identification scores on olfactory performance, and a higher percentage of perseverative errors on the WCST; there was a significant relationship between the two performance measures. Simpson-Angus scores, neuroleptic drug treatment levels, and scores on the Positive and Negative Syndrome Scale were not correlated with either olfactory measure. The lack of correlation between the forced choice olfactory identification score and the WCST score is consistent with findings in previous studies that used the UPSIT. By contrast, use of a spontaneous identification condition to assess olfactory performance did produce a significant association with WCST performance.

Adult↗

PubMed1999

Neuropsychological characteristics of adolescents with conduct disorder: association with attention-deficit-hyperactivity and aggression.

The purpose of this study was to determine whether an association exists between neuropsychological deficits and conduct disorder (CD) with and without concurrent attention-deficit-hyperactivity disorder (ADHD). In addition, we explored the differential neuropsychological performance of aggressive and nonaggressive CD adolescents and the combined effect of this behavioral status and ADHD on performance. Fifty-nine adolescents (mean age of 15.4 years) who met the criteria for CD were compared with 29 controls comparable in age, gender, and socioeconomic status. A neuropsychological battery of current tests measuring executive functions and a battery of language tests were used in the study. Multivariate analyses showed that, compared with controls, CD adolescents had significantly lower verbal skills but did not differ on executive function measures. However, the lower verbal performance of CD adolescents is not explained by the existence of a CD subgroup with concomitant ADHD or aggressiveness. The study confirms with a sample of CD adolescents the association between verbal deficits and antisocial behavior when socioeconomic status is controlled. Our results also demonstrate that CD per se can be a sufficient condition for such deficits.

Adolescent↗