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PubMed2003

Reduced binocular depth inversion in regular cannabis users.

The binocular depth inversion illusion (BDII) has been shown to be a sensitive measure of impaired visual information processing under conditions including cannabinoid-intoxicated states, alcohol withdrawal, sleep deprivation, and in patients with positive symptoms of schizophrenia. This study assessed whether the BDII could detect subtle cognitive impairment due to regular cannabis use by comparing 10 regular cannabis users and 10 healthy controls from the same community sources, matched for age, sex, and premorbid IQ. Subjects were also compared on measures of executive functioning, memory, and personality. Regular cannabis users were found to have significantly higher BDII scores for inverted images. This was not due to a problem in the primary processing of visual information, as there was no significant difference between the groups for depth perception of normal images. There was no relationship between BDII scores for inverted images and time since last dose, suggesting that the measured impairment of BDII more closely reflected chronic than acute effects of regular cannabis use. There were no significant differences between the groups for other neuropsychological measures of memory or executive function. A positive relationship was found between EPQ-R-psychoticism and cannabis, tobacco, and alcohol use. Cannabis users also used significantly larger amounts of alcohol. However, no relationship was found between BDII scores and drug use other than cannabis or psychoticism. Compared to the other neuropsychological tests used, the BDII appears to be a more sensitive tool for the detection of subtle impairments in visual information processing related to chronic cannabis use.

Adult↗

PubMed2003

Neurocognitive effects of repetitive transcranial magnetic stimulation in severe major depression.

OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) is being investigated as a potential treatment for depression. Few studies have addressed the neurocognitive effects of a course of rTMS in severely depressed patients. We evaluated neurocognitive effects of a 1-4 week course (mean 3 weeks) of rTMS using an aggressive set of parameters, in 15 severely depressed subjects. METHODS: A battery of neurocognitive tests relevant to attention, working memory-executive function, objective memory and motor speed were administered to 15 subjects with treatment-resistant major depression (unipolar and bipolar), before and after a course of rTMS. Mean z scores were computed for each of 4 cognitive domains and analyzed using repeated measures multivariate analysis of covariance. Significant interactions were further clarified using univariate analysis of variance. RESULTS: There was no worsening of performance on any of the cognitive domains over the baseline-post rTMS period. On the contrary, evidence of modest but statistically significant improvement in performance was noted in working memory-executive function, objective memory and fine motor speed domains over the rTMS treatment period. CONCLUSIONS: There was no evidence of adverse neurocognitive changes over the baseline-post rTMS period in 15 treatment-resistant depressed subjects undergoing a 3 week (mean) trial of rTMS. Significant improvements in several domains observed over the rTMS treatment period could not be explained by improved mood. Practice effects as well as other factors potentially contributing to these findings are discussed. SIGNIFICANCE: rTMS is being increasingly studied as a neurophysiological probe as well as for its potential antidepressive effects. The effects on neuronal function raise appropriate questions of safety of its use at varying stimulus parameters and durations. This study contributes to the small body of evidence of the cognitive effects of rTMS in severely depressed patients.

Adult↗

PubMed2006

[Wiscosin card sorting task in patients with schizophrenia and thier siblings].

OBJECTIVE: This study's first objective was to confirm that patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function when compared to healthy control subjects. The second objective was to study the relation between Wisconsin card sorting task (WCST) performance and the persistence and severity of clinical symptoms, as well as different clinical dimensions. METHOD: Ninety subjects were involved in this study, divided in 3 groups of 30 each: one group of patients with schizophrenia, one group of their siblings, and a control group. Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS), and social functioning was measured by the Global functioning scale (GFS). The WCST was administered to all 3 groups. RESULTS: Patients with schizophrenia and their siblings had a significantly lower WCST performance than control subjects. Statistical analysis showed that the patient group had a significantly greater impaired WCST performance than the 2 other groups. Siblings also had a significantly lower performance than the control subjects. Furthermore, no significant relation was found between WCST performance and other variables, including age, gender, education, illness duration, treatment, and different PANSS and GFS scores. CONCLUSION: Patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function. These findings suggest that WCST performance can be considered a schizophrenia vulnerability marker in siblings of patients with schizophrenia.

Activities of Daily Living↗

PubMed2006

Trying to tell a tale: discourse impairments in progressive aphasia and frontotemporal dementia.

OBJECTIVE: To assess discourse in patients with frontotemporal dementia (FTD). METHODS: The authors asked patients with progressive nonfluent aphasia (PNFA), patients with semantic dementia (SemD), and nonaphasic patients with a disorder of social comportment and executive functioning (SOC/EXEC) to narrate the story of a wordless children's picture book. RESULTS: The authors found significant discourse impairments in all three groups of patients. Moreover, there were qualitatively important differences between the groups. Patients with PNFA had the sparsest output, producing narratives with the fewest words per minute. Patients with SemD had difficulty retrieving words needed to tell their narratives. Though not aphasic, patients with SOC/EXEC had profound difficulty organizing their narratives, and they could not effectively express the point of the story. This deficit correlated with poor performance on a measure of executive resources requiring an organized mental search. In addition, a correlation of narrative organization with cortical atrophy in patients with SOC/EXEC was significant in right frontal and anterior temporal brain regions. CONCLUSIONS: Impaired day-to-day communication in nonaphasic frontotemporal dementia patients with a disorder of social comportment and executive functioning is due in part to a striking deficit in discourse organization associated with right frontotemporal disease. Difficulty with discourse in progressive aphasia is due largely to the language impairments of these patients.

Aged↗

PubMed2003

Neuropsychological characteristics of young children from high-density alcoholism families: a three-year follow-up.

OBJECTIVE: We performed a follow-up study of a group of young children from high-density alcoholism families (HD children), who were first assessed about 3.5 years ago, with the aim of evaluating verbal span and visuospatial abilities (which differed significantly between HD and control [C] children at the first assessment), as well as other neuropsychological measures. METHOD: In this second assessment, 22 boys and girls were evaluated. They were comparable in family income and parents' level of education. The 12 HD children had an alcoholic father and at least two other alcoholic relatives, whereas the 10 C children had no family history of alcoholism in either the first or second generation. A neuropsychological battery was set up with standardized tasks to measure attention, memory, visuospatial and executive functions. RESULTS: Analysis revealed significant Group x Assessment interactions in the digit span subtest where high-density children increased their performance until it reached that of the control children, and in the Wisconsin Card Sorting Test (WCST) where high-density children did not show the same improvement as the C children with maturation. A main effect was also observed for group factor in perseverative responses of the WCST. CONCLUSIONS: High-density children attain the same level of performance as control children for verbal span, but differences between groups increase over time for executive functioning as measured by the WCST. These results are considered in the context of the developmental delay hypothesis. The small sample size, however, means further studies will be necessary to confirm our findings.

Adolescent↗

PubMed2000

Verbal self-regulation over time in preschool children at risk for attention and behavior problems.

This study is a prospective, longitudinal attempt to explore behavioral self-regulation, private speech, and speech-action coordination in a sample of behaviorally at-risk preschool children. Preschoolers (N = 72) were classified at age 3 years into a behaviorally at-risk group or a comparison group on the basis of preschool teacher behavioral ratings. Children were videotaped on four different occasions across the span of almost 2 years as they completed problem-solving tasks, and private speech, task performance, executive functioning, and speech-action coordination were analyzed. Children identified 2 years earlier as being hard to manage were at risk for continued behavior problems at elementary school entry. Behaviorally at-risk children consistently used more spontaneous private speech than comparison children across all observations. Both groups of children demonstrated a pattern of increasing silence with task success over time. No group differences were observed in children's speech-action coordination at age 5 years. Intraindividual developmental changes in private speech for both groups were associated with task performance, speech-action coordination, and executive functioning at age 5, but not with teacher- and parent-reported problem behavior.

Attention↗

PubMed2006

Visual function and execution of microsaccades related to reading skills, in cerebral palsied children.

This article investigates the ability of cerebral palsied (CP) children to execute microsaccades. One-hundred and five congenitally CP school aged children (6 to 15 years old), without severe mental retardation, were classified into three groups: those with spastic quadriplegi, spastic diplegics, and spastic hemiplegics on the basis of: (1) patient anamnesis, (2) IQ estimation, (3) evaluation of the microsaccadic skills with the Developmental Eye Movement test (DEM). Their performance in these tests was compared with a control group from the general pediatric population. IQ of the CP children ranged between 70 and 100; the microsaccadic skills were severely affected: only 19% of the CP children had normal function, 20.9% of the CP children appeared with a pure oculomotor problem, 32.4% of the CP children had a visual-perceptual problem, and 27.7% of the CP children had a combined oculomotor and visual perceptual problem. CP children, in the absence of severe mental retardation, have disturbed visual skills and visual perception that usually leads to reading difficulties. It is also suggested that microsaccadic skills of CP children is an identifiable factor compounding the adverse effects of mental retardation on reading skills.

Adolescent↗

PubMed1999

Cluster headaches: association with anxiety disorders and memory deficits.

OBJECTIVE: To estimate the frequency of mood and anxiety disorders and to assess memory and executive functions among a representative group of patients with episodic cluster headache (ECH) during the course of an acute episode. METHODS: We compared 21 patients with ECH with 21 patients with tension headache (TH) matched for age, sex, and educational level. Psychiatric diagnosis was made by a semi-structured interview and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. Quantitative measures of depression and anxiety were obtained using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HARS). In addition, all patients received a neuropsychological evaluation to assess basic memory and executive functions. RESULTS: Of the 21 patients with ECH, 5 (24%) met DSM-IV criteria for an anxiety disorder during the year before the episode. Panic disorder was diagnosed in two patients (10%). The remaining three patients (14%) met criteria for generalized anxiety disorder. Of the 21 patients with TH, 2 (10%) met diagnostic criteria for an adjustment disorder with depressed mood, and 1 (5%) met criteria for an adjustment disorder with mixed anxiety and depressed mood. HARS scores were higher among patients with ECH (Kruskal-Wallis, chi2 = 4.3, df = 1, p = 0.03). ECH patients also showed significantly lower Auditory Verbal Learning Test scores (Kruskal-Wallis, chi2 = 6.5, df = 1, p = 0.01). CONCLUSIONS: When compared with a group of patients with TH, ECH patients showed a higher frequency of anxiety disorders during the year before the onset of headaches and significantly greater HARS scores during the episode. In addition, patients with ECH were selectively impaired in verbal memory.

Adult↗

PubMed2006

Elevated impulsivity and impaired decision-making cognition in heavy users of MDMA ("Ecstasy").

RATIONALE: In animal studies, the common club drug 3,4-methylendioxymethamphetamine (MDMA, "Ecstasy") consistently caused a prolonged loss of presynaptic serotonergic neurons, and evidence suggests that MDMA consumption may also affect the human serotonergic system. Serotonin (5-HT) has been implicated in the regulation of impulsivity and such executive functions as decision-making cognition. In fact, MDMA users have shown elevated impulsivity in two studies, but little is known about decision making in drug-free MDMA consumers. OBJECTIVE: The aim of this study was to examine the cognitive neurotoxicity of MDMA with regard to behavioral impulsivity and decision-making cognition. METHODS: Nineteen male, abstinent, heavy MDMA users; 19 male, abstinent cannabis users; and 19 male, drug-naïve controls were examined with the Matching Familiar Figures Test (MFFT) as well as with a Go/No-Go Task (GNG) for impulsivity and with a Gambling Task (GT) for executive functioning. RESULTS: MDMA users showed significantly elevated impulsivity in the MFFT Impulsivity score (I-score), but not in commission errors of the GNG, compared with controls. Cannabis users did not yield altered impulsivity compared with controls. In the GT, MDMA users performed significantly worse than cannabis consumers and controls, whereas cannabis users exhibited the same decision-making capacity as controls. In addition, the I-score as well as the decision-making performance was correlated with measures of MDMA intake. The I-score and the decision-making performance were also correlated. CONCLUSION: These results suggest that heavy use of MDMA may elevate behavioral impulsivity and impair decision-making cognition possibly mediated by a selective impairment of the 5-HT system.

Adult↗

PubMed2001

Language facility and theory of mind development in deaf children.

Deaf children with signing parents, nonnative signing deaf children, children from a hearing impaired unit (HIU), and oral deaf children were tested on three first-order theory of mind (ToM) tasks--a subset was also given a second-order task (Perner & Wimmer, 1985). A British Sign Language (BSL) receptive language task (Herman, Holmes, & Woll, 1999) and four nonverbal executive function tasks were also administered. The new BSL task allowed, for the first time, the receptive language abilities of deaf children to be measured alongside ToM abilities. Hearing children acted as controls. These children were given the same tasks, except the British Picture Vocabulary Scale was substituted for the BSL task. Language ability correlated positively and significantly with ToM ability, and age was correlated with language ability for both the deaf and hearing children. Age, however, underpinned the relationship between ToM and language for deaf children with signing parents and hearing children but not for nonnative signing, HIU, or oral deaf children. Executive function performance in deaf children was not related to ToM ability. A subset of hearing children, matched on age and language standard scores with signing deaf children, passed significantly more ToM tasks than the deaf children did. The findings are discussed with respect to the hypotheses proposed by Peterson and Siegal (1995, 2000) and Courtin (2000).

Journal Article↗

PubMed2001

Patterns of verbal learning and memory in traumatic brain injury.

CVLT and WMS-R Digit Span variables were used to calculate indexes of seven specific short- and long-term memory processes: working memory span and central executive functions, and long-term memory encoding, consolidation, retention, retrieval, control abilities. Scores on these indexes were then cluster-analyzed to determine whether subtypes of memory performance exist that correspond to deficits in these theoretical memory constructs. Parallel analyses were conducted with two large samples (N = 150 and N = 151) of individuals who had sustained a traumatic brain injury (TBI). Findings showed that TBI results in subgroups of memory disorders with specific deficits in consolidation, retention, and retrieval processes. Control problems (keeping track of list versus non-list items) only appeared in conjunction with retrieval deficits. Working memory span and central executive functioning (i.e., the ability to manipulate information in working memory) do not appear to be deficits characteristic of TBI as no such clusters emerged in the analyses. By using specific indexes of memory processes, and in contrast to previous studies, patterns of memory dysfunction were found that correspond to deficits in theoretically meaningful memory constructs.

Adult↗

PubMed2003

Neurocognitive impairment in early adolescence following prenatal alcohol exposure of varying duration.

The aims of the study were, first, to perform a comprehensive assessment of neurocognitive status in early adolescence of children exposed to alcohol prenatally; and, second, to examine whether duration of exposure continues to be predictive of outcome at this age. Twenty-seven exposed 12-14-year-olds and 39 non-exposed 13-14-year-olds underwent neuropsychological assessments (WISC-III, NEPSY subtests) of attention and executive functions, language, visuomotor functions, and memory. The group of non-exposed children was used to develop preliminary test norms for the 13-14-year-old exposed children whereas published test norms could be used for the 12-year-olds. The results demonstrated neurocognitive impairment across all types of tasks. Impairment varied in degree according to the duration of alcohol exposure. Children exposed throughout pregnancy, most of who had diagnoses of Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE), performed well below the average range. It was concluded that the neurocognitive effects of alcohol exposure tend to be widespread and generalized. Attention and executive functions do not seem to be selectively affected. Further, the relationship between duration of prenatal alcohol exposure and neurocognitive development continues to be significant in early adolescence.

Adolescent↗

PubMed2004

Neuropsychological markers of dementia in patients with memory complaints.

OBJECTIVES: To identify neuropsychological markers able to predict evolution towards dementia, through the detection of differential neuropsychological characteristics in a group of subjects complaining of memory loss, in a longitudinal, two-year follow-up study. METHODS: Longitudinal and retrospective comparisons of neuropsychological performance in: (a) subjects complaining of memory loss who, after a two-year period, met neurological and clinical diagnostic criteria for probable AD, and (b) subjects from the same group who did not progress towards dementia. A sample of 43 subjects were administered a comprehensive neuropsychological battery evaluating orientation, logical-verbal and visuoperceptive reasoning, immediate and delayed verbal and visual memory, attention, learning, executive functions and semantic and phonemic verbal fluency. RESULTS: Of the 43 subjects evaluated and then re-evaluated two years later, ten (23%) progressed to dementia according to the NINCS-ADRDA criteria for probable Alzheimer's disease. The neuropsychological performance of the rest of the subjects (n=33) over the two examinations was stable. In the retrospective analysis the principal differences between the two groups were found in the intensity of the initial memory deficits (WMS-R) and in the impairment of other cognitive areas in the dementia group: formation of concepts, vocabulary and similarities (WAIS), learning (WMS-R) and several executive functions. CONCLUSIONS: The deficits in cognitive areas other than memory are significant in subjects with memory complaints who progress towards dementia within two years. Memory complaints represent a risk factor that is at least as important as actual memory loss. Recent proposals for adding descriptive labels to the diagnosis of Mild Cognitive Impairment (MCI) in order to reflect the neuropsychological functions impaired in addition to memory (Petersen, 2001a), may be decisive from the prognostic viewpoint.

Aged↗

PubMed2005

Deficits in inhibition and flexibility are associated with the APOE-E4 allele in nondemented older adults.

This prospective study of nondemented older adults at genetic risk for AD and other types of dementia (i.e., APOE e4 allele) utilized a new Stroop test that includes a dual executive-function condition requiring both response inhibition and cognitive switching. Results indicated that, relative to non-e4 subjects, the e4 group committed more errors, but only on the new Inhibition/Switching condition. In addition, error-rate variance on this task was more heterogeneous for the e4 compared to the non-e4 group, and errors rates correlated significantly with global cognitive status (i.e., DRS scores) for the e4 group but not for the non-e4 group. These findings suggest that vulnerability to errors in response inhibition and cognitive flexibility is present in persons at risk for AD and may signal early emergence of executive dysfunction in preclinical AD. The association between these subtle executive-function deficits and the overall cognitive functioning of at-risk individuals provides further evidence of their utility as a possible preclinical marker of AD.

Aged↗

PubMed1998

Executive deficits in major depression.

Clinically depressed patients and control subjects were examined by means of different tests to assess executive functions (the Wisconsin Card Sorting Test, the Stroop Color Word Test and a test of verbal fluency). The results indicate that the depressed patients were generally slower than the controls, as reflected by longer retrieval times for both words and colours. Furthermore, the depressed patients showed impairment with regard to altering behaviour appropriately in response to feedback. However, there were no depression-related increases in perseverative responses, and the ability to inhibit irrelevant information was unaffected by depression. No relationship was found between specific depressive symptoms or the severity of depression and cognitive performance. The overall pattern of results suggests that depression may affect various executive functions in a differentiated manner.

Analysis of Variance↗

PubMed2006

[Neuropsychological disorders in teenagers with attention deficit hyperactivity disorder].

AIMS: The aim of this study is to report on the neuropsychological aspects of teenage patients with attention deficit hyperactivity disorder (ADHD), namely disorders affecting attention, memory, the executive functions and language. We also discuss how to perform neuropsychological and functional evaluation of the systems involved in attention, by means of haemodynamic (functional magnetic resonance imaging) and neurophysiological (magnetoencephalography) techniques. The comorbidities that most frequently occur in teenage patients with ADHD are also described. DEVELOPMENT: The fundamental symptoms, that is to say, inattention, hyperactivity and impulsiveness, continue to be present in the teenager with ADHD, although with mild variations, and are probably dependent on each individual's own genetic load. The disorders most commonly associated with ADHD are oppositional defiant disorder (33%), conduct disorders (25%), anxiety (25%), learning disabilities (22%) and depression (22%). CONCLUSIONS: During adolescence, patients with ADHD usually suffer disorders that are secondary to their inability to process information efficiently due to the inadequate development of the executive functions. The lack of inhibitory control and a poor capacity to learn from their own mistakes facilitate the appearance of comorbid neuropsychiatric disorders.

Adolescent↗

PubMed1998

Neuropsychological correlates of duration of glances at secondary tasks while driving.

The aim of this study was to find out the neuropsychological measures correlating with overlong glances at secondary in-car tasks while driving. Fifteen. patients with brain damage (without clear neurological or neuropsychological restriction on driving a car) and 11 healthy participants drove a route of 126 km and performed a series of secondary tasks while driving on a highway in an instrumented compact car. Four videocameras allowed detailed analysis of glances during in-car tasks. Neuropsychological measures focused on executive functions, memory, visuospatial skills, and fine motor skills. Moreover, patients' emotional self-evaluation and relatives' evaluation of patients' competencies were included. The proportion of overlong glances away from the road during in-car tasks was greater among the patients than. the healthy drivers. The long glances of the patients correlated strongly with motor and visuospatial deficits, cognitive inflexibility, emotional symptoms, and relatives' evaluations of patients' impaired sensomotor abilities. The results suggest that the frequency of overlong glances was increased by 2 factors: (a) impaired motor and visuospatial skills that evidently caused difficulties in the manipulation of the equipment of the secondary tasks, and (b) impairments of executive functions that were likely to decrease the ability to control the risks related to long glances at the in-car tasks. The slowing of speed during secondary tasks was on the average rather slight and not significantly more pronounced among patients than control drivers, indicating that patients failed to reduce their speed and thus the risk related to prolonged glances at in-car tasks.

Journal Article↗

PubMed2005

An open trial of adjunctive donepezil in attention-deficit/hyperactivity disorder.

OBJECTIVE: Despite available pharmacotherapeutics, a number of youths with attentiondeficit/ hyperactivity disorder (ADHD) continue to experience residual symptoms and prominent executive function (EF) deficits resulting in impairment in multiple domains. We sought to determine if donepezil, used adjunctively to stimulant medication, would improve residual symptoms of ADHD and EF deficits. METHODS: In a 12-week open trial, we treated 7 children and 6 adults who had ADHD and evidence of further EF deficits with adjunctive donepezil. All subjects were stabilized on stimulants, at which time donepezil was initiated at 2.5 mg daily and increased to a maximum of 10 mg over the 12-week trial. RESULTS: Of 13 subjects receiving medication, 7 completed the trial. There was no clinically or statistically significant improvement in the ADHD Rating Scale and the Executive Function Checklist, our primary outcome measures. A majority of individuals experienced nonserious adverse events. CONCLUSIONS: Results of this small open study suggest that donepezil augmentation of stimulants is not well tolerated and does not appear useful for the treatment of residual ADHD and/or EF deficits.

Adolescent↗