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PubMed2006

Evidence of cognitive compensation associated with educational level in early relapsing-remitting multiple sclerosis.

BACKGROUND: Cognitive compensatory mechanisms may limit the cognitive dysfunction due to cerebral tissue destruction in multiple sclerosis (MS). OBJECTIVE: To explore the effect of educational status on cognitive performances in early relapsing-remitting (RR) MS. METHODS: 43 RRMS patients were individually matched for age, sex and educational level with 43 healthy controls. Each patient underwent neuropsychological tests, clinical assessment and magnetic resonance imaging (MRI). Cognitive scores of MS patients were compared to those of their paired controls according to educational level. RESULTS: Less educated patients had low performances on all but two neuropsychological tests, while more educated patients had low scores only for three tests. Cognitive performances of more educated patients but not those of less educated ones were strongly correlated with MRI parameters and decreased with the severity of cerebral tissue destruction. CONCLUSION: These different cognitive patterns suggest the existence of a cognitive compensation in more educated patients which is limited by the accumulation of tissue damage.

Adult↗

PubMed2001

Neuropsychiatric aspects of HIV infection among older adults.

Treatment advances such as the advent of highly active antiretroviral therapy (HAART) have translated into greater life expectancy for HIV-infected individuals, which will ultimately result in a "graying" of the HIV/AIDS epidemic. In addition, older individuals are engaging in a higher rate of high risk behaviors than had been previously expected. As such, study of older HIV-infected patients, including study of the psychiatric and neurocognitive aspects of the disease, appears highly indicated. Epidemiological studies have demonstrated that HIV infection is associated with higher rates of several psychological/psychiatric disorders when compared to general population base rates. There is also a rich literature that has documented the adverse neurocognitive effects of HIV infection, ranging from subtle cognitive complaints to frank dementia, among younger adults. Although it has been hypothesized that older age may potentiate the deleterious effects of HIV infection, little is actually known, however, regarding the incidence, prevalence, course, and clinical features of HIV-associated psychiatric and cognitive dysfunction among older adults. This article provides an overview of the epidemiology and clinical manifestations of HIV-associated cognitive and psychiatric disorder across the age spectrum, with particular focus on what is known regarding the interaction of advancing age and HIV infection. Future directions for research are suggested, including basic epidemiologic study of incidence and prevalence rates of neurodisease among older HIV-infected adults as well as investigations designed to determine whether the nature, severity, course, or treatment of such disorders differs among older versus younger patients.

Age Factors↗

PubMed1989

Cerebrospinal fluid somatostatin in delirium.

Cerebrospinal fluid somatostatin-like immunoreactivity (CSF SLI) was determined for 67 elderly patients who met the DSM-III criteria for delirium and for 19 age-matched controls. As a group, and also when subdivided according to the type of delirium, severity of cognitive decline or the type of central nervous system disease, the delirious patients showed significant reductions of SLI compared with the controls, together with a declining trend associated with increasing cognitive dysfunction. These findings are in accordance with previous observations that reduced CSF SLI is associated with diseases in which cognitive function is disturbed and they extend this finding to delirium.

Aged↗

PubMed2006

Acute, transient hemorrhagic hypotension does not aggravate structural damage or neurologic motor deficits but delays the long-term cognitive recovery following mild to moderate traumatic brain injury.

OBJECTIVES: Posttraumatic hypotension is believed to increase morbidity and mortality in traumatically brain-injured patients. Using a clinically relevant model of combined traumatic brain injury with superimposed hemorrhagic hypotension in rats, the present study evaluated whether a reduction in mean arterial blood pressure aggravates regional brain edema formation, regional cell death, and neurologic motor/cognitive deficits associated with traumatic brain injury. DESIGN: Experimental prospective, randomized study in rodents. SETTING: Experimental laboratory at a university hospital. SUBJECTS: One hundred nineteen male Sprague-Dawley rats weighing 350-385 g. INTERVENTIONS: Experimental traumatic brain injury of mild to moderate severity was induced using the lateral fluid percussion brain injury model in anesthetized rats (n = 89). Following traumatic brain injury, in surviving animals one group of animals was subjected to pressure-controlled hemorrhagic hypotension, maintaining the mean arterial blood pressure at 50-60 mm Hg for 30 mins (n = 47). The animals were subsequently either resuscitated with lactated Ringer's solution (three times shed blood volume, n = 18) or left uncompensated (n = 29). Other groups of animals included those with isolated traumatic brain injury (n = 34), those with isolated hemorrhagic hypotension (n = 8), and sham-injured control animals receiving anesthesia and surgery alone (n = 22). MEASUREMENTS AND MAIN RESULTS: The withdrawal of 6-7 mL of arterial blood significantly reduced mean arterial blood pressure by 50% without decreasing arterial oxygen saturation or Pao2. Brain injury induced significant cerebral edema (p < .001) in vulnerable brain regions and cortical tissue loss (p < .01) compared with sham-injured animals. Neither regional brain edema formation at 24 hrs postinjury nor the extent of cortical tissue loss assessed at 7 days postinjury was significantly aggravated by superimposed hemorrhagic hypotension. Brain injury-induced neurologic deficits persisted up to 20 wks after injury and were also not aggravated by the hemorrhagic hypotension. Cognitive dysfunction persisted for up to 16 wks postinjury. The superimposition of hemorrhagic hypotension significantly delayed the time course of cognitive recovery. CONCLUSIONS: A single, acute hypotensive event lasting 30 mins did not aggravate the short- and long-term structural and motor deficits but delayed the speed of recovery of cognitive function associated with experimental traumatic brain injury.

Animals↗

PubMed1984

Lithium antagonizes ethanol intoxication in alcoholics.

Thirty-five detoxified alcoholics given lithium in a placebo-controlled, double-blind study reported less intoxication, a decrease in the desire to continue drinking, and less cognitive dysfunction when challenged by standardized doses of ethanol. Lithium also appeared to antagonize the ethanol-induced decrement in cognitive and perceptual motor performance. No differential lithium effect was noted when alcoholics were divided by diagnoses of affective disorder versus no affective disorder. The authors suggest that, in addition to mood normalization, lithium's capacity to directly affect ethanol intoxication may help explain its potential therapeutic efficacy in alcoholism, providing further confirmatory evidence that lithium may be useful in the treatment of alcoholism.

Adult↗

PubMed1986

[Some linguistic aspects of thought disorder in non-acute schizophrenia].

Seventy texts, which had been produced spontaneously but in standardized contexts by (non-acute) schizophrenic patients and by non-schizophrenic subjects, were analysed linguistically in order to investigate the various strategies that speakers may use to join different sentences together to form a unified structure by semantic and lexicogrammatical ties. For this purpose we used Halliday's and Hasan's classification of so-called "cohesive ties". This theoretical framework makes it possible to describe the inner coherence of linguistic texts in a quantitative way. In the "schizophrenic texts" the sentences contained significantly fewer such cohesive ties than in those texts produced by normal speakers. An additional longitudinal analysis revealed an increase in the number of cohesive ties per sentence, when the same schizophrenic speakers were asked to produce a second text (in a similar context) after participating in a 3-month psychotherapy programme. The central goal of psychotherapy was to improve the patients' cognitive ability to face and cope with social stress situations. The results of several textual and statistical procedures are discussed, mainly under the aspect of cognitive dysfunctions during periods of non-acute schizophrenia.

Adult↗

PubMed2001

Butyrylcholinesterase and cognitive function.

Butyrylcholinesterase (BuChE) is expressed in brain structures involved in cognition, but the effect of selective BuChE inhibitors on human cognitive function is unknown. We report a patient whose cognitive function deteriorated following a reduction and improved following reinstitution of ethopropazine, a selective BuChE inhibitor. We suggest that, because neurons expressing BuChE may be involved in cognition, there is merit to further evaluation of selective BuChE inhibitors in treating cognitive dysfunction.

Adult↗

PubMed2006

Neurologic complications in noncardiac surgery.

In this article, the incidence of nervous system injuries associated with noncardiac surgery is reviewed briefly. In general, these can be divided into injuries that are clinically apparent (eg, stroke or peripheral nerve damage), which may generally be detectable on clinical examination, and more subtle forms of brain injury (eg, personality changes and postoperative cognitive dysfunction), injuries that are primarily detected by neuropsychological testing.

Anesthesia↗

PubMed1991

Effects of hyperbaric environment on the P300 component of event-related potentials.

Hyperbaric chamber dives at 19 ATA with helium-oxygen were performed at the Japan Marine Science Technology Center, Yokosuka, from January 31 to February 2 in 1990. During simulated underwater experiments, event-related potentials were recorded in 2 divers for assessment of the cognitive function. Although the P300 amplitude of the potentials did not show any significant change, its latency was clearly prolongated and this prolongation continued to when the decompression reached to 70 m below sea level. These findings indicated that the hyperbaric environment corresponding to 180 m below sea level or less must cause some cognitive dysfunctions and that P300 is useful for early detection of those dysfunctions or HPNS.

Cognition↗

PubMed1995

Recombinant erythropoietin improves cognitive function in patients maintained on chronic ambulatory peritoneal dialysis.

Psychometric performance was studied in 17 patients maintained on CAPD. Nine patients treated with rHuEpo performed a battery of psychometric tests before treatment (haemoglobin mean (SD) 6.8 (0.8) g/dl) and after partial correction of anaemia (haemoglobin 9.0 (1.0) g/dl). The same battery of psychometric tests was administered to eight patients (haemoglobin 7.7 (0.7) g/dl), matched with the treatment group for age, duration of dialysis and social class, who did not receive rHuEpo. The National Adult Reading Test was used in all patients to estimate the premorbid IQ (the peak cognitive level attained before any cognitive deterioration). In the rHuEpo-treated group current IQ, measured by a short form of the Wechsler Adult Intelligence Scale--Revised, improved by a mean of 7.2 points (P < 0.01) and approached estimated premorbid levels, while in the control group an improvement by 0.3 points was not significant. Concentration and speed of information processing were assessed by the Paced Auditory Serial Addition Task and also improved in the treatment group (P < 0.05). Memory, assessed by the Rey Auditory Verbal Learning Test, tended to improve in the treatment group with amelioration of anaemia, although only the improvement in delayed recall was significant. No overall change was seen in either group in the time taken to complete the Trail Making Test (part A). These results are consistent with our earlier findings in haemodialysis patients, indicating that anaemia makes a reversible contribution to uraemic cognitive dysfunction.

Adult↗

PubMed1985

Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation.

The mortality rate has recently been reduced to only a small percentage of patients selected for early aneurysm surgery. Despite recovery without neurological deficits, however, a diffuse encephalopathy may remain, with emotional and psychological sequelae that will interfere with rehabilitation and social reintegration. The present study evaluates quality of life, degree of cognitive dysfunction, and adjustment of patients with a satisfactory neurological recovery after aneurysm operation in the acute stage following a major subarachnoid hemorrhage (SAH). Of 118 patients with a good neurological recovery, 40 patients were randomly sampled for a cross-sectional study and subjected to a questionnaire relating to their symptoms, a clinical interview, and a comprehensive neuropsychological investigation. The time interval between SAH and assessment varied between 14 months and 7 years, averaging 3 1/2 years. By means of standardized psychometric testing of intellectual capacity, memory functions, visuo-spatial abilities, perceptual speed and accuracy, and concept formation, degrees of cognitive impairment ranging from slight to severe dysfunction were identified. The results suggest that these disturbances may be permanent. The degree of impairment appeared to correlate with the patients' age. Interview data revealed substantial post-hemorrhagic maladjustment with respect to vitality, social management, self-assertion, emotional control, temperament, mood, and cognitive abilities. These findings were considerably at variance with the symptoms reported. It is stressed that, in the absence of gross neurological deficits, vital information on post-hemorrhage adjustment and impairment may easily be overlooked due to psychological defensive measures. It remains an open question whether post-SAH encephalopathy is enhanced by surgery performed in the acute stage.

Activities of Daily Living↗

PubMed2005

Apolipoprotein E variants and cognition in healthy individuals: a critical opinion.

The epsilon4 allele of apolipoprotein E (ApoE) is a well-established risk factor for late onset Alzheimer's disease (AD). This knowledge has generated interest in the role of ApoE variants in normal cognition. Varying degrees of cognitive dysfunction have been described in non-demented individuals with one or two epsilon4 alleles leading to suggestions that the gene plays a role in normal cognition or helps calibrate the aging process. In this paper, these hypotheses are critically evaluated. It is argued that ApoE variants play no role in cognitive development. Given the differential neurocognitive sequelae of normal aging and AD, we also suggest that accelerated aging is unlikely to account for the pattern of deficits observed in non-demented epsilon4 allele carriers. We conclude that the neuropsychological dysfunction reported in non-demented epsilon4 carriers is most likely to be the result of incipient AD.

Apolipoproteins E↗

PubMed1989

Relationship of body-image distortion to sex-role identifications, irrational cognitions, and body weight in eating-disordered females.

Thirty-one eating-disordered (ED) women and 11 normal women completed tests of sex-role identity, dysfunctional cognitions, and body image. Anorexics, not bulimics, exhibited body-image distortion. All EDs (distorters and nondistorters) showed "hyperfeminine" identifications. Maladaptive cognitions were present in all EDs, but more marked in "overestimators." Body weight predicted BID better than other measures of eating pathology, which suggests important effects of weight per se in producing BID.

Adult↗

PubMed1993

Poor cognitive task performance of insulin-dependent diabetic children (6-12 years) in India.

UNLABELLED: Cognitive function was assessed in 22 diabetic and 39 healthy children, all in the age group of 6-12 years. Wechsler's coding, digit span test and Raven's colored progressive matrices were included in the battery of tests. The diabetic children underscored on all these tasks compared to the healthy children. The raw scores (mean +/- S.D.), of the diabetic and healthy children were: Wechsler's coding: 17.4 +/- 6.48, 37.4 +/- 9.33; digit span: 22.0 +/- 8.8, 44.1 +/- 7.67 and on Raven's A+AB+B: 16.2 +/- 3.5. 24.1 +/- 6.26; P < 0.001 in each instance, respectively. Duration of diabetes did not correlate with any of the test scores. No significant differences were noted between the early onset (IDDM starting before the age of 5 years) and late onset (IDDM starting after 5 years) diabetic children in their performance. We attribute the very low scores in our diabetic children to the psycho-social factors in addition to the metabolic control. CONCLUSIONS: (1) specific cognitive dysfunction is present in children with IDDM compared to the healthy children; (2) duration of diabetes did not correlate with cognitive function scores; (3) IDDM manifesting after the age of 5 years also had hitherto unknown detrimental effects on the cognitive process.

Age of Onset↗

PubMed2006

Cognitive changes in early MS: a call for a common framework.

Cognitive dysfunction is among the main symptoms of multiple sclerosis (MS) and adversely affects patients' quality of life. The occurrence of cognitive impairment early in the disease process raises crucial issues related to definition of the impairment and its magnitude as well as to the tools applied to the assessment. To date there is little evidence concerning the reliability and validity of cognitive measures in early MS and their predictive long-term role. As MS is a complex disease, multidimensional approaches should be further developed and validated to study the cognitive sphere in the early stages of the disease. Considering that none of the available tests performed in isolation is able to provide a complete picture of the cognitive impairment in early MS, this calls for the definition of phase duration, impairment and tools appropriate for use by clinicians and researches. The present review proposes a framework aimed to help neurologists in approaching cognitive impairment in early MS and stimulate discussions and evaluations of the suggested recommendations.

Age of Onset↗

PubMed2007

Association between IL-8 cytokine and cognitive performance in an elderly general population--the MEMO-Study.

OBJECTIVES: To investigate the associations between circulating cytokines and specific neuropsychological domains of cognitive functioning (memory, processing speed and motor function) and general cognitive function (MMSE) in healthy elderly individuals. METHODS: In a cross-sectional study of 369 community dwelling elderly subjects, we examined the relationship between serum IL-1beta, sIL-4R, IL-6, IL-8, IL-10, IL-12 and TNF-alpha concentrations and cognitive performance using an extensive standardized and validated cognitive test battery assessing memory, word fluency, perceptual/cognitive speed, attention and executive functioning, and motor speed. RESULTS: Multivariate analysis adjusted for various confounders and Bonferroni correction for multiple comparisons demonstrated that increased serum concentrations of IL-8 were associated with poor performance in the memory and speed domains and in motor function. No significant associations were found between the remaining cytokines and domains of cognitive functioning. Global cognitive functioning, as measured with MMSE, was not associated with any cytokine. CONCLUSIONS: This study suggests an association between circulating IL-8 concentrations and cognitive dysfunction in the elderly. An interaction between this cytokine and glial cells may help explain the pathophysiological mechanisms leading to cognitive impairment in our study group.

Aged↗

PubMed2004

The role of catecholamines in memory impairment in chicks following reduced gas exchange in ovo.

We have shown previously that reducing gas exchange to chick embryos by half wrapping eggs with an impermeable membrane from either days 14-18 (W14-18) or days 10-18 (W10-18) of the 21 day incubation results in post-hatch memory deficits. In the W10-18 chicks, short-term memory following training is impaired, whereas in the W14-18 chicks, memory is intact for 30 min but does not consolidate into long-term storage. The reduction in gas exchange caused by half wrapping eggs resulted in alterations in hematocrit, O2 and CO2 tensions suggesting that the embryos are hypoxic and hypercapnic. Our aim was to test the hypothesis that increases in circulating levels of catecholamines in ovo, as a result of hypoxia, lead to a disturbance of the central noradrenergic pathways resulting in cognitive impairment. Noradrenaline is critical for memory consolidation and a disturbance during development could compromise cognitive ability. In the present study, plasma noradrenaline levels were significantly elevated compared with control levels 2 days after hatch in W14-18 chicks. There was also a decrease in tissue noradrenaline concentration in the anterior forebrain in both W14-18 and W10-18 chicks. The differential ability of centrally administered beta2- and beta3-adrenoceptor agonists to overcome the memory deficit post-training, suggests altered responsiveness of central beta2-adrenoceptors to noradrenaline in W14-18 chicks. By comparing the W10-18 and W14-18 chicks with those from eggs wrapped from W10-14 we show that it is the timing of the prenatal hypoxia, rather than its duration, that determines the nature of cognitive dysfunction. We conclude that prenatal hypoxia induced by restriction of gas exchange can disrupt or alter central noradrenergic transmission causing cognitive impairment.

Adrenergic beta-2 Receptor Agonists↗

PubMed2001

Neurocognitive development of children with congenital unilateral brain lesion and epilepsy.

The aim of this study was to specify the neuropsychological deficits characteristic of children with unilateral non-progressive brain lesion. In order to assess these specific functions, we used a comprehensive model of congenital hemiparesis with partial epilepsy and newly diagnosed partial epilepsy without hemiparesis. The neuropsychological examination was performed using the NEPSY test battery on 44 children aged from 4 to 9 years. The children were divided into three groups: 18 children suffering from congenital hemiparesis with chronic partial epilepsy, 12 children with newly diagnosed partial epilepsy prior to anti-epileptic treatment, and 14 healthy controls matched by sex, age, and socioeconomic status. Children with congenital hemiparesis and epilepsy had a more clearly expressed cognitive dysfunction, especially in language, visuo-perceptual and memory tasks, than children with newly diagnosed partial epilepsy. The profile of cognitive weakness appears to be diffuse and quite similar in both groups, and it did not demonstrate a clear effect of lateralization, according to the side of epileptic electroencephalogram discharges. Children within both groups are likely to have a high risk of developing attention, phonological, visuo-perceptual, and memory deficits in their life. Especially interesting and surprising was the fact that the newly diagnosed epilepsy group demonstrated impairment not only in attention, visuo-perceptual and short-term memory skills, but also in auditory perception, lexical function, and the comprehension of speech. Therefore, it is recommended that children with epilepsy would undergo neuropsychological examination in order to assess their cognitive abilities.

Attention Deficit Disorder with Hyperactivity↗