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PubMed2006

Executive dysfunctions and depression in Behçet's disease without explicit neurological involvement.

This study aims to assess the executive functions and depression status in patients with Behçet's disease without explicit neurological involvement and to evaluate cognitive functions in this group of patients independent of accompanying depression. In the present study, 30 patients with Behçet's disease in the non-active phase of their illness and 30 healthy volunteers were included. In the evaluation of depression levels, Beck Depression Inventory was employed. The executive functions of the patients were evaluated by Wisconsin Card Sorting Test (WCST) and Stroop Test (ST). Beck Depression Inventory scores measured in the Behçet's disease group, in which no clinically serious depression was observed, were higher than the control group. Then, it was observed that the scores of neuropsychological tests of the Behçet's disease group were found to be significantly lower, especially in WCST, while significant relations were revealed between Beck Depression Inventory scores and WCST, ST scores. The authors' findings suggest that there may be factors other than depression causing executive impairment in patients with Behçet's disease without explicit neurological symptoms. Executive dysfunctions may occur in association with mild depressive states due to chronic disease stress or silent and/or future neurological involvement of Behçet's disease, especially in the frontal lobes.

Adult↗

PubMed2005

Emotion-based learning and central executive resources: an investigation of intuition and the Iowa Gambling Task.

The role of emotion in complex decision-making can be assessed on the Iowa Gambling Task (IGT), a widely used neuropsychological measure that may tap a different aspect of executive function than that assessed by conventional measures. Most notably, the 'feeling' about which decks are good or bad, often described in relation to IGT performance, seems reminiscent of decision-making based on intuition-linked to a long history of research in decision-making contrasting the 'intuition' versus 'reasoning' styles of problem solving. To test the claim that the performance on the IGT relies more on emotion-based learning than conventional executive resources for normal performance, a group of participants completed the IGT simultaneously with one of two secondary-tasks, one of which (random number generation) is known to load executive resources. A third group performed the IGT with no secondary-task. If performance on the IGT requires the properties associated with intuitive operations, then participants should either show no disruption when completing a secondary-task, or at least show no selective disruption on a secondary-task that loads for executive function. The rate of learning in the three groups was not significantly different. This suggests that the sorts of cognitive resources loaded by traditional executive tasks such as random number generation do not overlap, in the cognitive architecture, with the emotion-based learning skills that are required for Iowa Gambling Task performance. The findings of the present study are also consistent with a previous claim of the Iowa group that emotion-based learning and working memory resources are doubly dissociable.

Cognition↗

PubMed2004

The relationship between brain structure and neurocognition in schizophrenia: a selective review.

Both Kraepelin [1919. Dementia Praecox and Paraphrenia, Livingston, Edinburgh.] and Bleuler [1911. Dementia Praecox or the Group of Schizophrenias. Reprinted 1950 (trans. and ed. J. Zinkin). New York: International Univ. Press.] proposed that cognitive disturbances in schizophrenia are manifestations of brain abnormality. With the advent of magnetic resonance imaging (MRI) methodology, a number of studies have attempted to determine the relationship between brain structure and neurocognition in schizophrenia. We performed a review (1991-to date) of such studies with the aim of identifying the most consistent and compelling findings. The review revealed that whole brain volume tends to correlate with the measures of general intelligence as well as with a range of specific cognitive functions in normal controls and female schizophrenia patients, but this relationship is disrupted in male patients. The enlargement of the third ventricle, relative to the whole brain volume, is associated with deficient abstraction/flexibility, language, and attention/concentration in patients, whereas disproportionally larger lateral ventricles are associated with poorer psychomotor speed and attention/concentration in women, but not in men, with schizophrenia. Archicortical, but not paleocortical, prefrontal cortex tends to associate with the measures of executive function in both sexes regardless of diagnosis. Temporal lobe, hippocampus and parahippocampal gyrus correlate with cognitive abilities such as performance speed and accuracy, memory and executive function, verbal endowment and abstraction/categorization, respectively. Some of these medial temporal lobe/neurocognition relationships appear to be specific to schizophrenia (i.e. not seen in controls). Striatal size is positively associated with goal-directed behavior, but not perseveration, in schizophrenia. Larger cerebellum is associated with higher IQ in normal controls and affected women, but this association is disrupted in affected men. Increased white matter of the vermis is associated with poorer language and immediate verbal memory in schizophrenia. Finally, the methodological limitations of the reviewed studies are discussed and suggestions for future research are offered.

Attention↗

PubMed2005

Infant motor development and adult cognitive functions in schizophrenia.

BACKGROUND: Childhood neuromotor dysfunction is a risk factor for schizophrenia, a disorder in which cognitive deficits are prominent. The relationship between early neurodevelopment and adult cognition in schizophrenia remains unclear. METHODS: We examined the associations between infant motor development and adult cognitive functions in schizophrenia (n = 61) and the general population (n = 104) in a sample drawn from the The Northern Finland 1966 Birth Cohort. Data on ages of learning to stand and walk with or without support were obtained at age 12 months by health visitor assessment. Neurocognitive measures at age 33-35 included executive function, verbal and visual episodic memory, and visuo-spatial working memory. RESULTS: The schizophrenia group achieved neuromotor milestones later and performed significantly worse than the control group on all measures of cognition. In pooled analyses there were associations between infant motor development and adult cognition in the domains of executive function, verbal learning and visuospatial working memory, but not in visual object learning. The pattern of associations between development and cognition was similar in schizophrenia and the general population. CONCLUSIONS: These findings are consistent with the hypothesis that in schizophrenia mild infant motor developmental delay and adult cognitive deficits (at least in some domains) are age dependent manifestations of the same underlying neural process. Thus, they may be better considered as part of a single longitudinal syndrome.

Adult↗

PubMed1998

Does the sedation resulting from sleep deprivation and lorazepam cause similar cognitive deficits?

It is notoriously difficult to assess the contribution of the sedative effects of benzodiazepines to the cognitive impairments that they produce. The purpose of the present experiment was to determine whether a similar pattern of cognitive impairment would be seen in conditions when subjects felt equally sleepy as the result of sleep deprivation. The effects of a sedative dose of lorazepam (2.5 mg) in healthy volunteers was therefore compared with the effects of acute sleep deprivation (a night on-call) in a group of junior doctors and the effects of chronically disturbed sleep due to snoring. Lorazepam, acute sleep deprivation, and chronic sleep disturbance all significantly increased subjective sedation. In addition, lorazepam significantly impaired performance in two tests of psychomotor speed and caused significant anterograde amnesia. Semantic and short-term memory were not impaired by lorazepam, nor was there any impairment in executive function. The only deficit found following acute sleep deprivation was in a test of semantic memory, generating examples from a difficult category. The only significant deficit in the group suffering from chronically disturbed sleep, compared with age-matched controls, was in executive function, and there was a nearly significant impairment in sustained attention. These results suggest that, despite the common factor of increased subjective sedation, the profile of cognitive impairment in the two sleep deprivation groups are neither similar to each other nor to that seen following an acute dose of lorazepam.

Adult↗

PubMed2003

Profile of cognitive progression in early Huntington's disease.

OBJECTIVE: To examine the pattern of cognitive decline in early Huntington's disease (HD). METHODS: The authors studied 61 patients with mild to moderate HD who had at least three annual neuropsychological assessments using the Core Assessment Program for Intracerebral Transplantation in Huntington's Disease short battery. A subset of 34 patients had additional neuropsychological tests, and another subset of 21 patients was assessed annually on the Cambridge Neuropsychological Test Automated Battery. Neuropsychological measures that changed significantly over time were submitted to a multiple analysis of covariance to explore associations with demographic and neurologic indices. RESULTS: Patients showed a progressive impairment in attention, executive function, and immediate memory, with timed tests of psychomotor skill being particularly sensitive to decline. In contrast, general cognition, semantic memory, and delayed recall memory were relatively unaffected. CONCLUSION: The profile of cognitive performance shows selective and progressive dysfunction of attention and executive function in patients with mild to moderate HD, consistent with frontostriatal pathology at this stage of disease.

Adult↗

PubMed2006

Long-term clinical and neuropsychological outcomes of West Nile virus infection.

BACKGROUND: Since its introduction in 1999, West Nile virus has rapidly become the most common arboviral infection in North America. Little is known about the long-term clinical sequelae of West Nile virus infection. METHODS: A total of 49 patients with laboratory-confirmed West Nile virus infection were identified through state-based surveillance. Stratification for disease severity was based on hospitalization during the infection episode. Assessment occurred a mean of 13 months after diagnosis. Medical records were reviewed, and a complete neurologic examination was performed. Standardized surveys for quality of life, functional ability, fatigue, and depression were performed for all subjects. An extensive battery of neuropsychological tests was performed to assess cognitive function. RESULTS: Self-reported fatigue, memory problems, extremity weakness, word-finding difficulty, and headache were common complaints. Standardized survey data confirmed an overall sense of poor physical health, fatigue, depression, and moderate-to-severe disability in 24 (49%), 24 (49%), 12 (24%), and 4 (8%) patients, respectively. New tremor was seen or reported for 10 (20%) of the patients. Neuropsychological testing showed abnormalities of motor skills, attention, and executive functions. Univariate analysis of multiple risk factors did not identify any predictors of adverse outcomes. CONCLUSIONS: Multiple somatic complaints, tremor, and abnormalities in motor skills and executive functions are common long-term problems among patients who have had West Nile virus infection. Patients with milder illness are just as likely as patients with more-severe illness to experience adverse outcomes.

Aged↗

PubMed2004

Development of cognitive functions in children with rolandic epilepsy.

An initial investigation of cognitive functions in 32 children, aged 7 to 15 years, with rolandic epilepsy (RE), using an extensive test battery, was followed 2.5 to 3 years later by a second assessment of 26 of these children, using the same technique. The initial investigation reported cognitive deficits in memory and learning of auditory-verbal material together with executive functions compared with controls. At the second assessment, the ability for immediate memory, memory and learning of visuospatial as well as auditory-verbal material and delayed recall was the same in the RE group as in the control group. On one of the tests measuring executive functions, Verbal Fluency, the RE group scored significantly lower than controls. With respect to reading and writing ability, the children with RE had some difficulty with word comprehension. Nonverbal reasoning was the same in the two groups, as was general IQ. In conclusion, the children with RE did not present any major cognitive difficulties when a mean of approximately 5 years had passed since onset of the typical syndrome, and at a time when most of them were seizure-free. Maturational factors apparently are of importance to the course of RE.

Adolescent↗

PubMed2006

[Early detection of cognitive impairment in relapsing-remitting multiple sclerosis: functional-anatomical correlations and longitudinal follow-up].

INTRODUCTION: Cognitive impairment is frequent in relapsing remitting Multiple Sclerosis and is often diagnosed after disruption of occupational and social relations. METHODS: We studied at baseline a homogeneous population of 32 RRMS patients, diagnosed for less than 5 years, with spontaneous memory complaints, and 20 controls. Sixteen patients were followed for 2 years, combining physical examination, neuropsychological tests, and brain MRI. Neuropsychological tests used evaluated memory capacities, attentional capacities, executive functions, language, and visuo-constructive praxis. Lesion load on brain MRI was measured with semi-automatic segmentation procedures and manual control. RESULTS: Eighty percent of patients presented cognitive impairment, and this proportion was higher than that found in the literature. These disorders were more marked for verbal episodic memory, attention, and executive functions. Patients with brain MRI that initially fulfilled the Barkhof criteria and those with callous lesions had more memory disorders. No link between global T1 and T2 lesion loads and neuropsychological scores was found. A statistical link between posterior fossa lesions and attentional disorders was shown. In the longitudinal follow-up, patients had better performances in memory and attentional domains, and a lower number of cognitive domains with dysfunction for each patient. This improvement on neuropsychological tests, whereas EDSS levels were stable, underlined a possible test-retest effect. CONCLUSION: During the initial phase of the disease, most of the relapsing remitting patients present a mild cognitive impairment. Early detection, therapeutic propositions, and recognition of disorders are necessary.

Adult↗

PubMed2006

Cognitive and psychosocial correlates of alexithymia following traumatic brain injury.

Changes in emotional and social behaviour are considered to be amongst the most common and debilitating consequences of traumatic brain injury (TBI). Little is known of the effects of TBI on alexithymia, which refers to impairment in aspects of understanding emotions. In the current study TBI patients (N=28) were compared with demographically matched healthy controls (N=31) on the Toronto Alexithymia Scale-20 (TAS-20), a measure that taps three distinct characteristics of the alexithymia concept; difficulty in identifying emotions, difficulty in describing emotions and externally oriented thinking. Patients and controls also completed measures of anxiety, depression, quality of life, and measures of fluency to assess executive function. Patients showed greater levels of alexithymia, in terms of difficulty identifying emotions and reduced introspection. Difficulty in identifying emotions was associated with poorer quality of life, even when depression and anxiety were controlled. Difficulty in identifying emotions was also uniquely associated with executive function deficits. Thus, although studies typically focus on aspects of cognitive change following head injury, these results lend support to Becerra et al.'s (Becerra, R., Amos, A., & Jongenelis, S. (2002). Organic alexithymia: a study of acquired emotional blindness. Brain Injury, 16, 633-645.) notion of an 'organic alexithymia', and suggest that more attention should be focused upon assessment of emotional change post-head injury.

Adolescent↗

PubMed2006

Comorbid substance abuse and neurocognitive function in recent-onset schizophrenia.

Despite the high prevalence of comorbid substance use disorder (SUD) up to 65% in schizophrenia there is still few knowledge about the influence of substance abuse on neurocognitive function. In a prospective design we recruited 68 patients (aged 18-40 years) diagnosed as recent-onset schizophrenia or schizoaffective disorder consecutively admitted to hospital. The patients received standardized psychopathological evaluation of schizophrenic symptoms [Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS)], depressive symptoms [Montgomery Asberg Depression Rating Scale, (MADRS)] and global ratings [Clinical Global Impressions Scale (CGI), Global Assessment of Functioning Scale (GAF)]. Out of this sample 44 subjects underwent after stabilization (4-6 weeks after admission) neuropsychological investigation focusing on early information processing (Trail-Making-Test A, Digit Span), visuo-spatial ability (Corsi Block Tapping), verbal fluency (Verbal Fluency Test, semantic and letter category), and executive functioning and cognitive flexibility [Trail-Making-Test B, Wisconsin Card Sorting Test (WCST)]. About 36% of patients reported drug abuse [European Addiction Severity Index (EuropASI)] with a high prevalence for cannabis. Compared with nonabusers the sample of substance abusers was younger, predominantly male and had lower socioeconomic status. Attentional impairment according to the SANS subscale was less in abusers than in nonabusers on admission, no other psychopathological differences could be detected. Schizophrenic patients without substance abuse demonstrated significantly better performance only in a few neurocognitive tasks (Verbal Fluency, letter category and at trend level Digit Span, backwards), while there tended to be an advantage for substance abusers in executive functioning (WCST, not significant). These results are consistent with other studies of first-episode patients. The lack of higher cognitive disturbance in young schizophrenic patients with comorbid substance abuse may encourage clinicians to develop integrated treatment programmes using cognitive strategies of drug therapy.

Adult↗

PubMed2003

Subtle cognitive impairment but no dementia in patients with spastin mutations.

BACKGROUND: The most frequent form of autosomal dominant hereditary spastic paraparesis is associated with the SPG4 locus, described originally as a pure form of the disease. Mutations of the SPG4 gene have been increasingly associated with reports of cognitive impairment. OBJECTIVE: To investigate cognitive function in 10 families with hereditary spastic paraparesis due to mutations in the SPG4 gene, using intrafamilial control subjects. PATIENTS AND METHODS: Neuropsychological examinations, including the Cambridge Cognitive Evaluation, were conducted in 29 carriers with identified SPG4 mutations and 29 intrafamilial controls. RESULTS: Carriers were not demented but had a subclinical cognitive impairment primarily affecting executive functions. The dysfunction was more severe in those carriers older than 50 years, but was correlated with the progression of the disease, not with age. Disease progression and cognitive impairment appeared to be more severe in the carriers of missense mutations than in those with truncating mutations. CONCLUSION: Asymptomatic cognitive impairment mostly affecting executive functions is present in SPG4 mutation carriers and is more frequent in those with missense mutations.

Adenosine Triphosphatases↗

PubMed2006

The relationship between working memory and episodic memory disorders in transient global amnesia.

In a previous study, we investigated the relationship between the disorders of both episodic memory and working memory in the acute phase of transient global amnesia (TGA). Since executive functions were spared, another dysfunction may be responsible for the binding and maintenance of multimodal informations and contribute to the encoding disorders observed in some patients [Quinette, P., Guillery, B., Desgranges, B., de la Sayette, V., Viader, F., & Eustache, F. (2003). Working memory and executive functions in transient global amnesia. Brain, 126, 1917-1934.]. The aim of this present study was to assess the functions of binding and maintenance of multimodal information during TGA and explore their involvement in episodic memory disorders. We therefore conducted a more thorough investigation of working memory in 16 new patients during the acute phase of TGA using two tasks designed to assess the binding process and both dimensions of the maintenance, namely the active storage and the memory load ability. We also investigated the nature of the episodic memory impairment in distinguishing between the performance of patients with preferential encoding deficits and those of patients with preferential storage disorders on the episodic memory task. This distinction was closely related to the severity of amnesia, i.e. an encoding disorder was observed rather in the early phase of TGA. The results showed that while the functions of binding and maintenance of multimodal information were intact in patients with storage disorders, they were impaired in the case of encoding deficits. These results are interpreted in the recent framework of episodic buffer proposed by Baddeley [Baddeley, A. D. (2000). The episodic buffer: A new component of working memory? Trends in Cognitive Sciences, 4, 417-423] that represents an interface between working memory and episodic memory.

Aged↗

PubMed2000

Card sorting performance and ADHD symptomatology in children and adolescents with tourette syndrome.

Children and adolescents with Tourette Syndrome (TS) do not have a characteristic neuropsychological profile. Performance on complex cognitive tasks, particularly those associated with executive functioning (EF), has been variable and sometimes contradictory. The high rate of comorbidity of TS with disorders, especially Attention Deficit Hyperactivity Disorder (ADHD), may account for such variability. A group of 57 individuals with TS, aged 8 - 16, was examined on a component of executive functioning in relation to comorbid symptomatology of ADHD. Each participant was evaluated using two EF measures, the Wisconsin Card Sorting Test (WCST) and the California Card Sorting Test (CCST). Using factor analytic procedures for purposes of data reduction, WCST and CCST measures loaded on different factors. Individuals with TS who had a high rate of ADHD symptomatology did not differ from those with a lower rate of ADHD symptomatology on any measure of card sorting performance.

Adolescent↗

PubMed2006

Correlations of functional capacity and neuropsychological performance in older patients with schizophrenia: evidence for specificity of relationships?

BACKGROUND: Neuropsychological (NP) performance is a consistent correlate of everyday functioning in schizophrenia, but it is unclear whether relationships between individual NP ability areas and domains of everyday functioning are general or specific. Assessments of real-world everyday functioning may be influenced by environmental and social factors (e.g., social security, disability status, opportunities and restrictions in living situations). This study examined the specificity of the relationships between different NP abilities and performance-based measures of social and living skills. METHODS: 181 ambulatory older (age>50) patients with schizophrenia were examined with NP tests measuring episodic and working memory, executive functioning, verbal fluency, and processing speed. All subjects performed tasks examining social (Social Skills Performance Assessment: SSPA) and everyday living (UCSD Performance Based Skills Assessment: UPSA) skills. RESULTS: Using canonical analysis, the NP variables were used to predict the functional capacity measures. The analysis found that 37% of the variance in the functional capacity and NP measures was shared, X(2) (54)=106.29, p<.001. Two canonical roots described the cognitive variables and the roots were differentially associated with everyday living and social skills. The root loading on processing speed, episodic memory, and executive functions were associated with UPSA scores, while the root loading on working and episodic memory and verbal fluency were associated most strongly with social competence. IMPLICATIONS: Social and everyday living skills deficits in patients with schizophrenia may reflect generally independent domains of functional outcome, linked through cognitive performance. The data suggest that somewhat different cognitive processes are associated with these two domains of functional capacity, although there appears to be some overlap, which may be due to the nature of the NP tests employed.

Activities of Daily Living↗

PubMed1999

Functional anatomy of neuropsychological deficits after severe traumatic brain injury.

BACKGROUND: Neurobehavioral disorders after severe traumatic brain injury (TBI) are poorly correlated with focal lesions detected by structural neuroimaging techniques such as CT scan or MRI. OBJECTIVE: To explore the relationships between regional cerebral glucose metabolism at rest, as measured by PET, and neurobehavioral status after severe TBI at the subacute stage. METHODS: Thirteen patients without focal structural lesion on MRI were studied. Neuropsychological assessment included tests of memory, attention and speed of information processing, and executive functions, and a global neurobehavioral assessment. Regional cerebral glucose metabolism at rest was measured with (18F)-fluorodeoxyglucose and PET. RESULTS: A close link was found between cognitive and behavioral disorders and decreased cortical metabolism in prefrontal and cingulate cortex. Tests of memory and executive functions significantly correlated with regional metabolism in the mesial and lateral prefrontal cortex and the cingulate gyrus. Behavioral disorders correlated significantly with mesial prefrontal and cingulate metabolisms. CONCLUSION: These results suggest a predominant role of prefrontal and cingulate dysfunction in cognitive and behavioral disorders of patients with severe traumatic brain injury, even in the absence of focal structural lesion of the brain. Further cognitive functional activation research using PET or functional MRI might help clarify the relative contributions of both areas to dysfunction.

Adolescent↗

PubMed2006

Preservation of cognitive function in dystonia treated by pallidal stimulation.

OBJECTIVE: To assess the effects of bilateral pallidal deep brain stimulation (DBS) on mood and cognitive performance in patients with dystonia before surgery (at baseline, while patients received their usual treatment) and 12 months postoperatively (while patients received neurostimulation and their medications) in a multicenter prospective study. METHODS: Twenty-two patients with primary generalized dystonia were evaluated with tests focused on executive functions. The authors considered the patients' severe disability and selected the following tests: Raven Progressive Matrices 38, Similarities and Arithmetic subtests of the Wechsler Adult Intelligence Scale-R, Grober and Buschke, Wisconsin Card Sorting Test (WCST), verbal fluency, Trail Making Test, and the Beck Depression Inventory. Median age at surgery was 30 years (range = 14 to 54 years), median duration of disease was 18.5 years (range = 4 to 37 years). RESULTS: Before surgery, no patients showed cognitive decline or depression. The surgical procedure appeared to be benign cognitively. One year after surgery, free recall improved. There was a significant reduction in the number of errors in the WCST. No behavioral or mood changes were found. CONCLUSIONS: Bilateral pallidal stimulation has a good benefit-to-risk ratio as it did not negatively affect cognitive performance and mood in primary dystonia, while a significant motor improvement was obtained. Moreover, a significant mild improvement in executive functions was observed, which may have been related either to the surgical treatment or to the marked decrease in anticholinergic drugs.

Adolescent↗

PubMed2003

Selectivity of verbal memory deficit in schizophrenic patients and their relatives.

Some of the relatives of people with schizophrenia show impairments of memory and executive function. It is not known, however, whether within these domains there is a class of processes that is especially impaired. Seventy schizophrenic or schizoaffective patients, 115 of their relatives and 66 normal controls underwent a series of assessments evaluating modality specific recall/learning, and aspects of executive functioning, including, planning ability, spatial working memory, strategy formation and rapid mental flexibility. The pattern of performance across cognitive processes was assessed using z-scores that allow direct comparison between tests with different raw score metrics. Selectivity of deficit was evaluated by subtracting the z-score of each cognitive process from the mean of the z-scores of those remaining. Patients performed out worse than controls on most measures, with verbal immediate recall and visual memory/learning the most impaired. Their relatives showed lower scores than controls on verbal and visual memory/learning and strategy formation; verbal memory and strategy formation remained impaired after eliminating those relatives with a psychiatric diagnosis. Consistent with the findings in their schizophrenic kin, healthy relatives also showed disproportionate impairments in verbal immediate recall. Our finding of a selective deficit in verbal memory among relatives suggests that such impairment constitutes a familial, probably genetic, risk factor for schizophrenia.

Adolescent↗