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PubMed1983

Integrating cognitive strategies into the physical therapy setting.

Effectively integrating cognitive management concepts into the physical therapy setting is dependent upon an adequate understanding of the cognitive and behavioral consequences of head injury and the appropriate use of diagnostic and prognostic cognitive data as a basis for program design. The intent of this article is to provide a framework for simultaneously addressing the physical and cognitive consequences of head injury. Behavioral manifestations of cognitive dysfunction and a means of clinically observing and assessing patient performance are provided as a basis for program design. Specific examples of treatment strategies applicable to various phases of cognitive recovery are described.

Behavior↗

PubMed2000

Cognitive function in HIV-1-infected drug users.

Loss of cognitive ability, the most common neuropsychological complication in HIV-1 disease, may influence compliance with treatment and has been associated with decreased functional capacity, as well as an increased risk of mortality. In HIV-1-infected drug users, cognitive impairment affecting attention, memory, planning of complex tasks, information processing, and motor processes, has been reported, similar to findings in predominantly HIV-1-infected nondrug-using cohorts. The issue of whether early signs of cognitive dysfunction can be identified in asymptomatic HIV-1-infected drug users remains controversial. Evaluation of potential confounding factors, such as drug abuse, age, education, nutritional status, which may influence cognitive function, is essential for determining the dominant cause of neuropsychological abnormalities. There is evidence for a time-limited, protective effect against the development of AIDS dementia with zidovudine therapy. The potential ability of other therapies (e.g., antioxidants, B-complex vitamins) to prevent neuronal damage and protect the brain remains to be determined.

AIDS Dementia Complex↗

PubMedDate not supplied

[Neuropsychological findings in patients with middle temporal lobe epilepsy].

INTRODUCTION: Cognitive dysfunction in mesial temporal lobe epilepsy (MTLE) is still a controversial subject. Since refractory MTLE is considered a surgically remediable syndrome, the neuropsychological assessment to establish the presence of cognitive impairment in the surgical candidate became an important issue, given its possible relevance in predicting outcome after surgery. OBJECTIVE: Our aim was to study the cognitive profile of MTLE patients and to correlate the cognitive status with the presence or absence of hippocampal sclerosis. PATIENTS AND METHODS: Fifty patients with MTLE and 20 control subjects were matched by age and educational level. All subjects were studied with EEG, MRI scan, SPECT, and a comprehensive neuropsychological battery that included measures of language (naming and verbal fluency), visuospatial function (Block Design Test), memory (Signoret Battery), attention (Digit Span and Trail Making Test A) and executive abilities (Trail Making Test B and Wisconsin Card Sorting Test). RESULTS: MTLE patients, particularly those with hippocampal sclerosis, were found to have a considerable lower performance in learning (p < 0.01), naming (p < 0.05), attention (p < 0.05) and executive functions (p < 0.001). Among the MTLE patients a considerable number of subjects showed results within the normal range (n = 27) while others evidenced laterality specific cognitive impairments (n = 13). Material specific memory effects were seen in some patients but not all. CONCLUSIONS: Our results showed the neuropsychological heterogeneity of temporal lobe epilepsy, thus ruling out the existence of a single specific cognitive pattern of impairment in all MTLE patients, and suggesting the need of a thorough pre-surgical neuropsychological evaluation to be used with post-surgical prognosis purposes.

Adult↗

PubMed1989

Evidence for task-dependent memory dysfunction in the aged monkey.

Experimentally naive adult (9-11 years old) and aged (approximately 22-26 years old) female rhesus monkeys were evaluated on 3 neuropsychological tests of memory function. Aged monkeys were impaired in a delayed response test of visuospatial memory when the retention interval of the task was increased from 0 to 10 sec. These animals performed as well as younger subjects, however, at very short delays (0 and 1 sec), when the memory demands of the task were minimal. The same subjects were then trained in a delayed nonmatching to sample (DNMS) test of visual object recognition memory. Although they required significantly more training than the younger subjects to learn the nonmatching principle of the task, aged animals were only minimally impaired when recognition memory was tested at retention intervals ranging from 10 sec to 22 hr. In contrast to their relatively intact performance on the object recognition task, aged monkeys were dramatically impaired in a second version of DNMS that required subjects to remember the temporal order in which objects were presented. These findings support the view that certain memory functions are differentially susceptible to age-dependent deterioration. Since neuropsychological studies in young subjects demonstrate that different brain regions make relatively specific contributions to learning and memory, the task-dependent deficits observed in the aged monkey are important for determining which neural structures mediate age-dependent cognitive dysfunction. According to this perspective, aged monkeys were impaired on tasks known to be sensitive to prefrontal cortical damage, but the same animals performed well on a DNMS procedure that subjects with medial temporal lobe damage fail. These results suggest that prefrontal cortical dysfunction may mediate prominent aspects of age-dependent cognitive impairment in the monkey.

Aging↗

PubMed2005

Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits.

A number of studies have demonstrated an increased rate of histories of childhood maltreatment among adults with serious mental illness. The present investigation documented the presence of childhood maltreatment in a sample of 40 psychiatric inpatients with schizophrenia spectrum disorders. The type (neglect, physical abuse, sexual abuse), duration, and severity of childhood maltreatment was examined along with measures of premorbid functioning, current symptomatology, and cognitive functioning. Participants with histories of maltreatment were significantly more likely to have poorer peer relationships in childhood, more difficulty in school, an earlier age at first hospitalization, more previous hospitalizations, elevated symptoms of anxiety, depression, and suicidality on the Brief Psychiatric Rating Scale (BPRS), and more impaired performance on a task of visual-perceptual organization. Severity and frequency of childhood maltreatment were both positively correlated with hallucinations and delusions on the BPRS. Linear trend analysis indicated a pattern of more severe impairment as the number of types of maltreatment increased. No relationships were found between maltreatment and measures of executive functioning, verbal fluency, or verbal processing speed. A history of childhood maltreatment appears to be a significant determinant of premorbid functioning, illness-related symptom expression, and specific forms of cognitive dysfunction.

Adult↗

PubMed2003

Type 2 diabetes mellitus and cognition: an understudied issue in women's health.

INTRODUCTION: Diabetes is a common chronic illness, affecting approximately 16 million Americans, and is slightly more common in women than men. Data from population studies demonstrate that women with diabetes are at greater risk for cardiovascular disease, the leading cause of death among women and an independent risk factor for cognitive decline. Longitudinal epidemiologic studies report an association between diabetes mellitus and vascular dementia, but conflicting data on the association between diabetes and Alzheimer's dementia. Whether type 2 diabetes has an effect on cognitive function, independent of dementia, has received much attention since the 1980s, but the question remains unresolved. METHOD: The literature was rigorously reviewed for studies in which cognitive functioning was measured with neuropsychological (NP) tests in participants with type 2 diabetes and a control/comparison group without diabetes. RESULTS: Of 32 studies that reported the effects of type 2 diabetes on cognition in nondemented middle-aged and older adults, 30 included women in their samples, and two focused exclusively on women. Of studies that included women, 20 (67%) reported that participants with type 2 diabetes performed more poorly than those without diabetics on one or more NP tests, leading the authors to conclude that diabetes is positively associated with cognitive dysfunction. CONCLUSIONS: Owing to the small number of studies with adequate numbers of women to report findings by gender, little is known about the effect of type 2 diabetes on cognition in women. It is critical that studies on type 2 diabetes and cognitive functioning be designed to include women in numbers adequate for examination of gender effects. The discussion addresses issues specific to women that warrant further research.

Cognition↗

PubMed2002

Cognitive epilepsy: ADHD related to focal EEG discharges.

This study was undertaken to determine the effect of antiepileptic treatment on a child with attention-deficit-hyperactivity disorder and subclinical electroencephalographic discharges without seizures. We performed a longitudinal follow-up study correlating clinical, neuropsychologic, and electroencephalographic features with antiepileptic drug therapy. The results revealed a temporal relation between subclinical epileptiform discharges and cognitive dysfunction and a significant effectiveness of antiepileptic drugs on attention-deficit-hyperactivity disorder and electroencephalographic discharges. The practice of monitoring antiepileptic treatment limited to seizure control should be revised; cognitive impairments also need to be taken into account even without occurrence of seizure. The classical principle of treating only seizures needs to be reconsidered.

Antiemetics↗

PubMed2000

The longitudinal relationship of clinical symptoms, cognitive functioning, and adaptive life in geriatric schizophrenia.

Cognitive dysfunction is increasingly being recognized as a major contributor to the adaptive impairment seen in most patients with schizophrenia. Reported here is a prospective longitudinal evaluation of the relationship between cognitive and adaptive functioning in elderly patients with schizophrenia. It was hypothesized that baseline cognitive and negative, but not positive symptoms, would be predictive of cross-sectional impairment and longitudinal outcome. Subjects were 168 elderly patients with schizophrenia, free of major neurological disorders, who were residents of a long-term psychiatric facility. Subjects were assessed at baseline and again an average of 15months later. The PANSS was used to assess the severity of symptoms of schizophrenia. Cognitive symptoms were assessed using the components of the CERAD cognitive battery. Social and adaptive functioning was assessed using the SAFE scale. Spearman correlations were determined among clinical variables, and the rank ordering of prediction of SAFE scale scores at follow-up was determined using a stepwise regression procedure. At follow-up, adaptive life skills correlated with cognitive performance and negative symptoms (Spearman rho values 0. 41-0.57, all p values <0.0001), but not positive symptoms (r=0.09, n. s.). Among cognitive tasks, verbal learning and memory were most highly correlated with adaptive skills at follow-up. These results confirm and extend previous studies that indicate that cognitive impairments are predictive, both cross-sectionally and longitudinally, of adaptive life skills in persons with schizophrenia. Negative symptoms, but not positive symptoms, were correlated with impaired adaptive skills. Taken together, these results underscore the need to develop more effective treatments for cognitive and negative symptoms in schizophrenia.

Activities of Daily Living↗

PubMed2005

Integrating cognitive function screening and assessment into the routine care of multiple sclerosis patients.

Cognitive dysfunction, a common feature of multiple sclerosis (MS), frequently leads to impaired activities of daily living, social skills deficits, diminished social support, and unemployment. There is growing evidence indicating that cognitive impairment is amenable to the effects of medication and behavioral counseling. Unfortunately, routine neuropsychological testing is rare in MS clinics because screening is ineffective and testing strategies are often too cumbersome or expensive. Recent research supports the reliability of a brief screening test called the Multiple Sclerosis Neuropsychological Screening Questionnaire as well as a minimal neuropsychological battery called the Minimal Assessment of Cognitive Function in Multiple Sclerosis. Data indicate that the Multiple Sclerosis Neuropsychological Screening Questionnaire has excellent split-half and test-retest reliability, and that it predicts neuropsychological deficiency with good sensitivity and specificity. Recently acquired data also show that the Minimal Assessment of Cognitive Function in Multiple Sclerosis tests have good test-retest reliability, discriminate MS patients from normal controls, and predict unemployment in MS patients. Thus, these or similar methods should be employed for the routine monitoring of cognitive functioning of MS patients.

Adult↗

PubMedDate not supplied

Constraint-based therapies as a proposed model for cognitive rehabilitation.

This article proposes that constraint-induced therapy represents a theoretical model of rehabilitation emerging from basic research with implications for cognitive remediation attempts. It provides an overview of current work on constraint-induced therapies with a focus on the most widely used of these techniques, constraint-induced movement therapy (CIMT). An example from recent research in the cognitive sciences demonstrates how underlying principles of the CIMT could be used to guide rehabilitative efforts for cognitive dysfunction. Limitations and obstacles of applying such an approach are discussed.

Animals↗

PubMed2005

Homocysteine and cognitive function in a population-based study of older adults.

OBJECTIVES: To assess the relations between homocysteine levels and neurobehavioral test scores representing a broad range of cognitive domains in a population-based study of older adults. DESIGN: Cross-sectional analysis of first-visit data of subjects in the Baltimore Memory Study, a longitudinal study. SETTING: Specific neighborhoods in Baltimore. PARTICIPANTS: Participants were 1,140 randomly selected residents aged 50 to 70 with a mean age+/-standard deviation of 59.3+/-5.9; 65.9% were female, and 54.2% were white and 41.1% African-American. MEASUREMENTS: Twenty neurobehavioral test scores in eight cognitive domains. RESULTS: Linear regression models revealed that homocysteine was consistently and strongly associated with worse neurobehavioral test performance, in crude analysis and after control for a large set of important covariates. Associations were observed in all eight cognitive domains assessed but were strongest and most consistent in the domains of simple motor and psychomotor speed, eye-hand coordination/manual dexterity, and verbal memory and learning. On average, an increase in homocysteine levels from the 25th to the 75th percentile, all in the generally accepted normal range, was equivalent in its association with neurobehavioral test scores to an increase of 4.2 years of age. Logistic regression models revealed that, on average, for the neurobehavioral tests associated with homocysteine, subjects in the highest quartile of homocysteine levels were more than two times as likely to be in the lowest quartile of neurobehavioral test scores as those in the lowest quartile. CONCLUSION: Higher homocysteine levels were associated with worse function across a broad range of cognitive domains, and the magnitude of the associations was large. The data suggest that homocysteine may be a potentially important modifiable cause of cognitive dysfunction.

Aged↗

PubMed1995

Neuropsychological characteristics of Huntington's disease carriers: a double blind study.

A cohort of 33 people at risk for Huntington's disease (HD), applying for genetic testing, were tested with a battery of neuropsychological tests covering attentional, visuospatial, learning, memory, and planning functions. A psychiatric rating scale, SCL-90R, was also applied, mainly as a control, since cognitive dysfunction could be ascribed to functional disorders as well as neurodegenerative processes. Self-rating did not indicate any psychiatric symptoms in carriers or non-carriers. However, significantly inferior cognitive functioning in the gene carriers was disclosed by the neuropsychological tests. Primarily, attentional, learning, and planning functions were affected. It is concluded that premorbid cognitive decline occurs in HD.

Adolescent↗

PubMedDate not supplied

Predicting long-term outcome in group treatment of atopic dermatitis.

BACKGROUND: Psychological group treatments are effective adjuncts to dermatological treatments in improving dermatological symptoms and quality of life. However, no data are available on variables that may predict which patients benefit from such group treatments. METHODS: On the basis of data from the Marburg group treatment study, we explored which variables are associated with successful treatment. Treatment outcome was defined by a marked reduction of dermatological symptoms at 1-year follow-up. RESULTS: Regardless of the treatment condition, a high pretreatment level of scratching, a low serum IgE level, low scores on the internal Health Locus of Control Scale and a high frequency of coping-related cognitions regarding itching predicted good outcome at 1 year. Logistic regression analyses indicated that the predictive power of locus of control and itch-related cognitions differed between different treatment conditions. CONCLUSION: In patients with atopic dermatitis, indication for psychological treatment may be based on the assessment of psychological target problems including excessive scratching and dysfunctional cognitions.

Adult↗

PubMed1994

Self-assessed cognitive function in snorers and sleep apneics. An epidemiological study of 1,504 females and males aged 30-60 years: the Dan-MONICA II Study.

The objective of the study was to evaluate the relation between every-night (habitual) snoring, sleep apnea and cognitive complaints (concentration and memory problems) in an adult population-based sample. In the Dan-MONICA (MONItoring trends in CArdiovascular diseases) 1,504 males and females aged 30, 40, 50 and 60 years were classified according to their snoring habits. Nocturnal respiration was measured in 748 participants. The following measures were regarded as potential confounders: age, gender, unintended sleepiness, insomnia, depression, hypnotic use, alcohol and tobacco consumption by questionnaire, body mass index (BMI) and blood pressure. Concentration and memory problems were both related to depression, insomnia and unintended sleepiness. Snoring and sleep apnea (defined as a respiratory distress index - RDI > or = 5), were associated with concentration problems and unintended sleepiness. The odds ratios (95% confidence intervals) between snoring, concentration and memory problems, calculated by logistic regression analysis after adjustments of the above confounders, were 1.90 (1.23-2.91, p < 0.01) and 1.38 (0.97-1.99, NS). For those with sleep apnea, the odds ratios were 3.53 (1.42-8.73, p < 0.001) and 1.51 (0.81-2.14, NS) for concentration and memory problems, respectively. The main conclusion drawn from this study is that cognitive complaints show a high correlation to mood, insomnia, and hypersomnia. Habitual snoring and sleep apnea show a correlation to concentration problems, but not to memory complaints. This suggests that part of the association between snoring, sleep apnea and cognitive dysfunction is related to the presence of sleep disturbances and daytime sleepiness.

Adult↗

PubMed1997

Cognitive screening instruments in neuropsychiatry: a report of the Committee on Research of the American Neuropsychiatric Association.

A 1994 survey by the Research Committee of the American Neuropsychiatric Association revealed that 58% of respondents employed formal assessment of cognitive status; the Mini-Mental State Examination (MMSE) and neuropsychological testing were the commonest techniques. Literature review on common cognitive screening instruments found that the MMSE has widespread popularity, ease of use, and a large body of research demonstrating its sensitivity to common neuropsychiatric disorders. The Committee recommends that clinicians who employ the MMSE 1) use it as a minimum screening for cognitive dysfunction; 2) employ age- and education-normative corrections; and 3) supplement it with specific measures of spatial functions, delayed memory, and executive abilities. The Modified MMSE and the Neurobehavioral Cognitive Status Examination also show promise as screening tools.

Adolescent↗

PubMed1999

The effects of clozapine on cognitive functioning in schizophrenia.

Cognitive function may be markedly impaired in patients with schizophrenia; however, it has only recently been recognized as an important factor in determining patient outcome. Research has shown that improvements in cognitive functioning occur independently of improvements in positive or negative clinical symptoms, and whereas typical antipsychotics may improve clinical symptoms, they have little or no efficacy in improving cognitive dysfunction. However, there is evidence that the atypical antipsychotic clozapine may improve this core deficit of schizophrenia. This review summarizes 12 published studies that assessed the effect of clozapine on cognitive functioning. As a group, these studies suggest that psychomotor speed, verbal fluency, and verbal learning and memory may be improved by treatment with clozapine. Such cognitive improvements with clozapine treatment may offer an advantage to patients with schizophrenia by enhancing the possibility of better vocational functioning and quality of life.

Antipsychotic Agents↗

PubMed1997

Pattern of neuropsychologic dysfunction in inactive systemic lupus erythematosus.

The pattern of neuropsychological dysfunction in patients with inactive systemic lupus erythematosus (SLE) was examined. Fifty-eight subjects with inactive SLE and 47 healthy controls were administered a standardized neuropsychological test battery. Summary scores reflecting 18 different cognitive processes were derived. Subjects were designated cognitively impaired if three or more summary scores differed significantly from premorbid estimates of cognitive functioning. Cognitive impairment was identified in 43% of subjects with inactive SLE and 19% of healthy controls. Subjects with inactive SLE, as a group, performed significantly worse than healthy controls on measures of auditory verbal memory, visual spatial memory, psychomotor speed, and motor functioning. A significantly greater proportion of subjects with inactive SLE than healthy controls was impaired only on a measure of visual spatial memory. Cognitive impairment in subjects with inactive SLE was associated with increasing age. There were no associations between cognitive impairment and current depressive symptoms or current corticosteroid use. These findings suggest that cognitive dysfunction occurs frequently in inactive SLE. The variability of performance of subjects with inactive SLE is consistent with the heterogeneity of CNS involvement in the disease.

Adult↗

PubMed1998

Cognitive and behavioral correlates of depression in learning-disabled and nonlearning-disabled adult students.

Cognitive and behavioral correlates of depression were examined in 33 learning-disabled (LD) and 99 nonlearning-disabled (NLD) adult students. Self-reported depressive symptomatology was significantly correlated with dysfunctional cognitions and reinforcement level in LD students. LD students reported engaging in significantly more unpleasant activities and experiencing significantly less pleasure than NLD students. There was a nonsignificant trend for LD students to report more depression than NLD students. These results are discussed in the context of cognitive and behavioral theories of depression.

Adolescent↗