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PubMed2006

Predictors of stress in parents of children with fetal alcohol spectrum disorders.

This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the child"s executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.

Child↗

PubMedDate not supplied

Estrogen therapy selectively enhances prefrontal cognitive processes: a randomized, double-blind, placebo-controlled study with functional magnetic resonance imaging in perimenopausal and recently postmenopausal women.

OBJECTIVE: Estrogen therapy (ET) seems to differentially effect cognitive processes in younger versus older postmenopausal women, suggesting a window of opportunity when ET is most beneficial. Cognitive improvement in younger postmenopausal women has been attributed to ET's influence on hot flushes and sleep, but empiric examination of the mediating role of menopause symptoms versus direct effects of ET on the brain is limited. DESIGN: In a double-blind trial, 52 women were randomly assigned to estradiol 0.05 mg/day (n = 26) or placebo transdermal patches (n = 26) for 12 weeks. Women completed tests of memory, learning, and executive functioning, and hot flush and sleep assessments at baseline and study end. A subset of women (five ET treated, six placebo treated) also underwent blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) studies. RESULTS: Nondepressed perimenopausal and postmenopausal women were studied. The majority had hot flushes and sleep impairment. Compared with placebo, ET selectively reduced errors of perseveration during verbal recall (P = 0.03), a frontal system-mediated function, but did not influence other cognitive processes. Women with baseline hot flushes had greater cognitive benefit with ET (P < 0.05). Cognitive benefit was not associated with sleep problems or its improvement. Measures of fMRI BOLD activation during tests of verbal and spatial working memory showed significant increases in frontal system activity with ET (P < 0.001). CONCLUSIONS: Estrogen therapy selectively improves executive functioning as demonstrated by reduced perseverative errors and prefrontal cortex activation during verbal recall tasks. Cognitive improvement with ET is associated with hot flushes, but not with sleep, suggesting that ET has a direct central nervous system effect, rather than an indirect effect mediated through improvement of sleep.

Administration, Cutaneous↗

PubMed2004

Neuropsychological functioning in first-break, never-medicated adolescents with psychosis.

The purpose of the current study was to examine neuropsychological functioning in a group of never-medicated first-break adolescents with psychosis. It is the first report of cognition in a sample of adolescents with psychosis in which all patients were drug-naive. Twenty-nine adolescent patients (mean age = 16.07; SD = 2.00; 15 male and 14 female patients) experiencing their first psychotic episode and 17 age-matched and sex-matched normal volunteers (mean age = 16.88; SD = 2.39; 9 male and 8 female subjects) were recruited and assessed with a neuropsychological battery. Measures of attention, memory, language, executive functioning, perceptual motor processing, and motor speed were obtained. Psychiatric symptomatology, estimated verbal IQ, and parental socioeconomic status were also determined. Patients with psychosis were significantly more impaired than normal volunteers; effect sizes were greatest in the areas of executive functioning, attention, and memory, and significantly smaller in areas of language, perceptual motor processing, and motor speed. The pattern was not altered when differences in verbal IQ and parental socioeconomic status were controlled. Sex and age interactions indicated that younger male patients were particularly impaired. The findings demonstrate neuropsychological deficits in adolescents with psychosis and suggest that cognitive deficits are core symptoms in psychotic disorders.

Adolescent↗

PubMed2005

Cognitive correlates of cortical cholinergic denervation in Parkinson's disease and parkinsonian dementia.

We recently reported findings that loss of cortical acetylcholinesterase (AChE) activity is greater in parkinsonian dementia than in Alzheimer's disease (AD). In this study we determined cognitive correlates of in vivo cortical AChE activity in patients with parkinsonian dementia (PDem, n = 11), Parkinson's disease without dementia (PD, n = 13), and in normal controls (NC, n = 14) using N-[(11)C]methyl-piperidin-4-yl propionate ([(11)C]PMP) AChE positron emission tomography (PET). Cortical AChE activity was significantly reduced in the PDem (-20.9%) and PD (-12.7 %) subjects (P < 0.001) when compared with the control subjects. Analysis of the cognitive data within the patient groups demonstrated that scores on the WAIS-III Digit Span, a test of working memory and attention, had most robust correlation with cortical AChE activity (R = 0.61, p < 0.005). There were also significant correlations between cortical AChE activity and other tests of attentional and executive functions, such as the Trail Making and Stroop Color Word tests. There was no significant correlation between cortical AChE activity and duration of motor disease (R = -0.01, ns) or severity of parkinsonian motor symptoms (R = 0.14, ns). We conclude that cortical cholinergic denervation in PD and parkinsonian dementia is associated with decreased performance on tests of attentional and executive functioning.

Acetylcholinesterase↗

PubMed2000

The CyberCruiser: an investigation of development of prospective memory in children.

Prospective memory can be defined as the timely execution of a previously formed intention, and is critical in daily life because of its inherent involvement in goal-directed behavior. Cognitive systems involved in prospective memory have been hypothesized as involving the frontal cortex, and in adults, associated with working memory and executive functions. This study introduces a new computerized measure of prospective memory designed for children. In this study prospective memory is examined in a driving game task called the CyberCruiser. In a sample of 80 children ages 6-12 years, variables from this task demonstrated a significant age effect and were significantly correlated with other well known measures of executive function, even after controlling for chronological age. Performance on this task also demonstrated the anticipated pattern of strategic monitoring that has been demonstrated in other studies of prospective memory.

Age Factors↗

PubMed2006

Objective neuropsychological test performance of professional divers reporting a subjective complaint of "forgetfulness or loss of concentration".

OBJECTIVE: This study attempted to determine whether the higher prevalence of reported "forgetfulness or loss of concentration" among professional divers can be confirmed using objective neuropsychological tests. Secondary aims were to qualify the functional nature of the complaints and to ascertain whether reduced performance was linked to diving history. METHODS: In a case-control study, the neuropsychological test performance of divers complaining of moderate or severe "forgetfulness or loss of concentration" was compared with two age-matched control groups reporting no or slight "forgetfulness or loss of concentration" ("nonforgetful" divers and "nonforgetful" nondivers). The group differences were analyzed using a multivariate analysis of co-variance, followed by canonical discriminant function analysis. Altogether 102 divers with a complaint, 100 nonforgetful divers, and 100 nonforgetful nondivers completed the study. RESULTS: The overall neuropsychological performance differed significantly between the groups [Pillai's trace: F(24,484)=2.04, P=0.003]. Verbal memory (Logical Memory and the California Verbal Learning Test), current intelligence (Wechsler Abbreviated Scale of Intelligence), and sustained attention (rapid visual processing) were poorer among the divers with a complaint than among the nonforgetful divers or the nonforgetful nondivers. The tests of memory, but not those of executive function, differentiated the divers with complaints from the two control groups. Mixed gas bounce diving and surface oxygen decompression diving, but not other techniques, were negatively associated with memory performance. CONCLUSIONS: A cognitive complaint of divers was confirmed using objective tests of neuropsychological performance. Memory, rather than executive function, was affected at the group level, but only to a mild degree. The relationships between diving experience and neuropsychological test performance were small and only seen with diving techniques used in the offshore oil and gas industry.

Adult↗

PubMed2005

Cognitive structure of executive deficits in patients with frontal lesions performing activities of daily living.

OBJECTIVE: Executive function in activities of daily living (ADL) were investigated in 10 patients with excised frontal lobe tumours. METHOD: The patients with frontal lesions were compared to 10 normal controls with a neuropsychological test battery, a script generation task and a realistic implementation of complex multi-task ADL (planning and preparing a meal). RESULTS: The patients manifested numerous basic executive deficits on the paper-pencil tests, were unimpaired on the script generation task despite an aberrant semantic structure and manifested marked anomalies in the meal preparation task. CONCLUSION: Frontal lobe deficits in lengthy complex multi-task ADL can be explained by impairment of several executive functions, generalized slowness of performance and paucity of behaviour.

Activities of Daily Living↗

PubMedDate not supplied

Therapeutic effects of an acetylcholinesterase inhibitor (donepezil) on memory in Wernicke-Korsakoff's disease.

Wernicke-Korsakoff's disease (WKD) is cognitively an amnestic state resulting from strategic lesions in the limbic system subserving the episodic memory network and resulting from thiamine deficiency. Neurochemical deficits have been implicated in the pathophysiology of amnesia based on the pathologic observations that various brainstem and basal forebrain nuclei are also affected. Previous treatment attempts with serotoninergic, noradrenergic, and cholinergic drugs have given controversial results. The objective of this study was to assess the effects of a cholinesterase inhibitor, donepezil, on memory, attention, and executive functions in patients with nonalcoholic WKD. Seven patients who developed WKD after a hunger strike were included in this single, blind, placebo-controlled, one-way, crossover study. The patients were administered donepezil during the first 30 days, and were administered placebo during the following 30 days. Neuropsychological tests to evaluate verbal and visual memory, and attention and executive function were performed on days 0, 31, and 61. All patients completed both phases of the study. There were no statistically significant differences between the three evaluations, except for a difference between active treatment and the placebo phase during recall of the Rey-Osterrieth complex figure, which was in favor of the placebo phase. There were no significant changes in favor of the active treatment. Cholinergic treatment with the cholinesterase inhibitor donepezil does not seem to provide marked beneficial effects in patients with WKD in this small, descriptive study. This may be because pathways mediating channel and state-dependent functions are impaired in this disease, and enhancement of state-dependent cholinergic transmission may not be sufficient. Subtle benefits, however, cannot be excluded because of the small sample size and the relatively short duration of the treatment.

Adult↗

PubMed1987

Planning disorder after closed head injury: a case study.

Disturbances of executive functioning after traumatic brain injury represent significant obstacles to social and vocational recovery and may require specific remedial intervention. We report the treatment of a client with impaired planning ability and poor self-control after closed head injury. Intervention consisted of a self-instructional procedure that required him to verbalize a plan of behavior before and during execution of the training task and gradually faded overt verbalization. There was systematic reduction of off-task behaviors and problem-solving errors over the eight weeks of training. Pre- and postmeasures showed significant changes consistent with increased planning ability. Self-control ratings of everyday behaviors improved with explicit training to promote generalization. Training of plan-ahead and self-verbalization strategies appears effective for remediation of executive functioning after traumatic brain injury. Generalization to real-life situations can be observed with extended training.

Adult↗

PubMed2005

One-year treatment of Alzheimer's disease with acetylcholinesterase inhibitors: improvement on ADAS-cog and TMT A, no change or worsening on other tests.

The aim of this study was to assess cognitive functioning measured by selected psychometric and neuropsychological tools in patients with Alzheimer's disease (AD) after 1-year treatment with acetylcholinesterase inhibitors. Seventy-six patients (22 male and 54 female) with a mild to moderate stage of AD, aged 56-86 (mean 68) years, were treated. Forty-seven received donepezil (mean dose 9.3 mg/d) and 29 rivastigmine (mean dose 8.5 mg/d). Cognitive measurements included: the mini mental state examination (MMSE), the Alzheimer disease assessment scale-cognitive (ADAS- cog), the trail making test (TMT) and the Stroop color word interference test. The assessments were made before and after 3, 6 and 12 months of treatment. A significant improvement in ADAS-cog (p < 0.001, 83% of patients improved) and a worsening in MMSE (84% of patients worsened, p < 0.01 after 6 and 12 months) was noted after the 1 year treatment. A majority of patients (57%) improved in the TMT-A (p < 0.001), measuring psychomotor speed and worsened in the TMT-B (p < 0.01, after 12 months), and Stroop B test (p < 0.001), measuring working memory and executive functions, 53% and 61%, respectively. Most patients (83%) did not change their performance in the Stroop A (improvement after 3 months, p < 0.001, worsening after 6 and 12 months p < 0.01) test measuring verbal abilities, after 1 year treatment. The results obtained suggest that the treatment with cholinergic drugs may improve global cognitive functioning (ADAS-cog) and psychomotor speed (TMT A), however, such treatment is unable to prevent the deterioration of working memory and executive functions.

Aged↗

PubMed2006

Neurocognition in depression: patients on and off medication versus healthy comparison subjects.

Patients with depression have neuropsychological deficits in attention, memory, psychomotor speed, processing speed, and executive function. It is not clear, however, whether neurocognition in depression is impaired in a global or nonspecific way or if specific cognitive domains are selectively impaired. This naturalistic cross-sectional study employed a computerized neurocognitive screening battery to evaluate 38 depressed, drug-free patients, compared to 31 patients who responded to antidepressant monotherapy and to 69 healthy comparison subjects. There was evidence for global neuropsychological impairment in untreated depressed patients. In patients who had been successfully treated, performance was improved but not normalized. There was also evidence for specific depression-related deficits in executive function and processing speed but not in memory, psychomotor speed, or reaction time. Although depressed patients have global neurocognitive impairments, deficits in certain cognitive domains are more important than in others. In particular, impairments are noted in tests of executive control and in tests that demand effortful attention. Information processing speed is also impaired but not reaction time. Computerized testing in the clinic setting demonstrates a range of neurocognitive problems in patients with depression. These problems may have a bearing on treatment and outcome.

Adolescent↗

PubMed1994

Neurobehavioral characteristics of CGG amplification status in fragile X females.

Neurobehavioral correlates of CGG amplification were studied in 17 nonretarded adult female carriers of fragile X syndrome. The results revealed a significant relationship between IQ and the number of CGG repeats in the 5' untranslated region of the FMR1 gene. Women with a full mutation (> 200 CGG repeats) scored below average in IQ, visual-spatial perception, visual-spatial organization, and executive function. There were no differences in fine motor dexterity or memory as a function of CGG amplification status. A history of major depressive disorder was identified in 71% of the sample, but incidence of depression was not associated with the degree of CGG amplification. Schizotypal features were noted in 18%. No intellectual or neuropsychological deficit was found in women with a premutation (< 200 CGG repeats). Decrements in IQ, visual-spatial perception, and executive function appear to arise as a consequence of the CGG amplification.

Adult↗

PubMed2004

Inhibition and shifting in children with learning deficits in arithmetic and reading.

The executive functions of inhibition and shifting were studied in arithmetic-disabled children, reading-disabled children, reading plus arithmetic-disabled children, and controls (N = 74). Measures involved the rapid naming of objects, digits, letters, or quantities with or without additional task requirements that reflected inhibition or shifting. Also, the Making Trails task, reflecting shifting, was administered. For tasks without executive demands, arithmetic-disabled children were slower in the naming of digits and quantities, whereas reading-disabled children were slower in the naming of digits and letters. For the executive tasks, arithmetic-disabled children as well as reading plus arithmetic-disabled children were impaired on the Making Trails task and on an object naming task that required both inhibition and shifting. Reading-disabled children exhibited no problems in executive functioning. Furthermore, it was shown that reading plus arithmetic-disabled children experienced the combination of problems that characterize children with a single learning deficit.

Child↗

PubMed2006

Dysexecutive agraphia: a major executive dysfunction sign.

Different types of writing disorders associated with brain pathology have been described. Limited mention the writing disturbances associated with prefrontal pathology, however, is found. Clinical observations of patients not only with focal prefrontal pathology but also with other conditions affecting the frontal system (e.g., traumatic head injury, dementia) confirm the assumption that these patients present an overt decrease in the ability to express ideas in writing. It is proposed that complex aspects of writing, such as planning, narrative coherence, and maintained attention, are significantly disturbed in cases of impairments of executive functions. Frontal lobe patients not only have difficulties in keeping the effort required for writing, but also to organize the ideas in the written texts. The term dysexecutive agraphia is proposed to refer to this writing disorder. Three illustrative cases are presented. It is finally suggested that questions regarding the ability to write should be included in dementia questionnaires and executive functioning testing.

Adult↗

PubMed1996

Neuropsychological profiles of three sisters homozygous for the fragile X premutation.

Fragile X syndrome (fraX) is associated with an amplification of a CGG repeat within the fraX mental retardation (FMR-1) gene. We describe an exceptional family in which 3 adult sisters are homozygous for the FMR-1 premutation. Each sister inherited 2 premutation alleles (ca. 80 CGG repeats) from their biologically unrelated parents. The 3 sisters were administered measures of executive function, visual spatial, memory, and verbal skills. Deficiencies in the first 2 of these domains have been reported among females with the full mutation. The sisters' performances were compared with available normative data and with published group means for females affected by fraX. These women did not appear to have verbal or memory difficulties. None of the women demonstrated a global executive function deficit, and none had global deficits in spatial ability. The profiles of these sisters are consistent with reports that the fragile X premutation does not affect cognitive performance.

Adult↗

PubMed2005

Hypothermia-induced platelet aggregation and cognitive decline in coronary artery bypass surgery: a pilot study.

Hypothermia-induced platelet aggregation (HIPA) was previously reported in whole blood exposed to synthetic surfaces at 24 degrees-32 degrees C in one-third of normal subjects tested. Cardiopulmonary bypass, conducted with hypothermia, may lead to such aggregation, resulting in microvascular occlusion contributing to cognitive impairment. This pilot study was conducted to explore the relationship between HIPA and cognitive outcome at hospital discharge in patients undergoing coronary artery bypass graft (CABG) surgery as a first step toward a longer-term study. Patients (n = 45) undergoing mild to moderate hypothermia (32 degrees-28 degrees C) during CABG surgery underwent cognitive testing preoperatively and prior to hospital discharge. Tests included: visual and verbal memory, mental processing speed, executive function, language, and intellectual function. HIPA was identified using an in vitro assay in which blood flowing in polyvinychloride tubing was subjected to hypothermia, and platelet aggregates were detected using microscopy and passing the exiting blood through a 20-microm pore filter. Forty-four percent of patients exhibited HIPA. The entire cohort exhibited significant postoperative cognitive decline in verbal memory, mental processing speed and executive function. There was greater cognitive decline in the group with HIPA compared with the group not exhibiting this phenomenon. The patients with HIPA showed significant decline in four of five cognitive measures whereas patients not exhibiting this phenomenon declined in only two of five cognitive measures. HIPA appears to be associated with an added risk of cognitive decline immediately following CABG surgery employing mild to moderate hypothermia. The findings of our study suggest the long-term cognitive effects of hypothermia-induced platelet aggregation need to be explored.

Aged↗

PubMed1998

Ecological validity of neuropsychological tests: focus on the California Verbal Learning Test and the Wisconsin Card Sorting Test.

To date, few studies have assessed the ecological validity of current measures of memory and executive functioning, particularly the California Verbal Learning Test (CVLT) and the Wisconsin Card Sorting Test (WCST). A battery of tests, including the CVLT and the WCST, was administered to 28 severely head-injured adults who were 1 year or more postinjury. Hierarchical linear regression was performed to assess the relationship between these cognitive tests and work functioning while statistically controlling for physical disability, emotional distress, and memory compensation strategies utilized by the participants. Results suggest that the CVLT was best at predicting performance on the job; however, the CVLT and the WCST were about equally predictive of the type of position held by a participant. Hence, this study demonstrates the ecological validity of measures of memory and executive functioning for predicting work-related skills.

Journal Article↗

PubMed2004

Trajectories of adolescent emotional and cognitive development: effects of sex and risk for drug use.

Adolescence has been widely accepted as a time for notable alterations in brain functioning. The objective of this longitudinal study was to compare trajectories of emotional and cognitive development in adolescent girls and boys with low- versus high-risk for future drug use. Nineteen healthy adolescents (aged 13.9 +/- 2.0 years; 10 girls), stratified into low- and high-risk groups based on family history of drug abuse, were examined at baseline and after one year. Emotional intelligence was assessed using the Bar-On Emotional Quotient Inventory, the Multidimensional Anxiety Scale for Children, and the Perceived Stress Scale. The neurocognitive test battery was designed to evaluate academic achievement, executive function, verbal memory and learning, and included the Wide Range Achievement Test, Stroop Color-Word Interference Test, Rey Auditory Verbal Learning Test, and Digit Span and Digit Symbol subtests of the Wechsler Adult Intelligence Scale-Revised. Improvements in academic achievement, executive function, and working memory were observed at the one-year follow-up. Notable sex differences also were evident in emotional intelligence, academic achievement, and memory. Interestingly, these sex-related differences interacted with risk status; improvement in cognitive performance in boys and low-risk girls was generally superior to high-risk girls, who tended to show modest, if any, improvement at the one-year follow-up. These preliminary findings provide evidence of sex differences in emotion intelligence and cognitive function. Furthermore, these data also suggest that history of familial drug abuse may have a more pronounced impact on emotional and cognitive development in adolescent girls than boys.

Adolescent↗