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PubMed2003

Indications for neuropsychological assessment.

A neuropsychological evaluation can help in narrowing the differential diagnosis of cognitive dysfunction, choosing treatments, and evaluating the efficacy of an intervention on an ongoing basis. In patients with documented neurologic disorders, information from neuropsychological assessment can define the patient's functional limitations or residual cognitive strengths. Proper use of neuropsychological assessment can improve the quality of care.

Cognition Disorders↗

PubMed2001

Current management of opioid-related side effects.

The optimal management of opioid-related side effects is hampered by a lack of comparative studies of management strategies. The prevalence of such side effects is influenced by the extent of disease, the patient's age, the presence of coexistent renal and hepatic disease, pulmonary disease, and cognitive dysfunction, a prior opioid history, use of polypharmacy, dose of opioid drug being administered, and the route of administration. The most common opioid-related side effects are constipation, sedation, nausea, vomiting, and cognitive disturbance. Less frequent side effects include urinary retention, perceptual distortion, respiratory depression, and myoclonus. In an era emphasizing quality of life in cancer care, clinicians need to be aware of (1) factors that influence the prevalence of opioid-related side effects, (2) effective management strategies, and (3) how to recognize when symptoms are opioid related as opposed to caused by other etiologies, such as the patient's disease process or treatment approaches. The use of validated instruments and repeated assessment enhances such an evaluation and subsequent treatment. This article delineates the current optimal management of opioid-related nausea and vomiting, constipation, cognitive side effects, myoclonus, and respiratory depression.

Analgesics, Opioid↗

PubMed2004

Language, ageing and neurodegenerative disease.

UNLABELLED: Until recently brain-behavior relationships in healthy ageing and neurodegenerative disease were based on studies of the state of the brain after its final outcome, death. Direct in vivo imaging of dynamic cognitive systems at different disease stages offers an unprecedented opportunity to gain insight into evolving cognitive dysfunctions and changing brain systems. In this talk we will present new data on how this semantic system is affected by healthy ageing, lesions and neurodegenerative disease. 1. Age: One of the principal cognitive consequences of normal ageing is a decline of episodic memory while semantic memory is preserved. Despite the fact that semantic task performance remains at equal levels, the underlying semantic brain network shows clear alterations: The gradient between left and right prefrontal cortex is significantly decreased, principally due to a decrease of left prefrontal activation. 2. Focal brain lesions: In a patient who suffered from an ischemic lesion that is confined to the right anterior fusiform gyrus, associative semantics were still performed at a high level while drawing from memory and pseudo-object decision task were severely impaired. The right anterior fusiform group activation coincided with the lesion. In this patient the mirror left fusiform region was significantly more active during picture semantics than under normal circumstances. A case with a lesion in the mirror left fusiform region will also be discussed. 3. Neurodegenerative disease: We will contrast two patient groups: Patients with a progressive word finding and semantic memory deficit (primary progressive aphasia, most often due to frontotemporal degeneration) and patients with an isolated episodic memory deficit (incipient Alzheimer's disease, mild cognitive impairment). In patients with primary progressive aphasia different components of the semantic network, i.e. inferior frontal sulcus, superior temporal sulcus and anterior temporal pole, show less activity than in healthy controls. The activity levels correlate with performance on off-line picture naming tasks. Interestingly, the right medial temporal lobe, classically implicated in episodic memory functions, shows higher activity in primary progressive aphasics than in healthy controls, suggesting that patients make use of non-verbal episodic memory strategies to compensate for their semantic deficit. In contrast, patients with mild cognitive impairment clinically have only an isolated episodic memory deficit and perform within the normal range on semantic tasks. Despite normal performance the semantic system for words and pictures show profound alterations, including among other differences decreased activity in Wernicke's area (posterior middle temporal gyrus) on the left compared to age-matched controls. CONCLUSION: cognitive brain systems for semantic memory change with increasing age. These changes are qualitatively different from those found in incipient Alzheimer's disease or in primary progressive aphasia. The degree to which brain systems adapt in a plastic way to pathogenetic processes at multiple levels, is a determinant of disease manifestation and an important target for current and future therapies.

Aging↗

PubMed1996

[Mental dysfunction in Parkinson's disease].

In Parkinson's disease, mental disturbances frequently accompany the typical motor disorder. Subcortical dementia develops in 10 to 20% of patients. Contrary to the dementia of Alzheimer's type, the apraxia-aphasia-amnesia syndrome is uncommon. Depression and specific impairment of speech, visuospatial functions, and memory are present in an important proportion of patients. As a principal feature of cognitive disorder, deficit of executive functions can be characterised by decreased mental flexibility and inability to cope with changing external conditions. Further, psychiatric complications of pharmacological treatment of Parkinson's disease are briefly described. Finally, presumed pathophysiological mechanisms of cognitive dysfunction are characterized involving dopaminergic and non-dopaminergic changes and complex interactions on the subcortico-cortical level.

Cognition Disorders↗

PubMed2001

Gender, aging, health and society.

There are more women than men at any elderly age group. Depression and osteoporosis are the commonest problems in elderly subjects. Some problems specific to males are hypogonadism, erectile dysfunction and enlargement of prostrate and to females are post-menopausal disturbances, urinary incontinence and breast and lung cancer. However, problems of special concern in both male and female elderly are malnutrition, falls and cognitive dysfunction. Men and women in general suffer from the same sorts of health problems but the frequency of these problems as well as the speed of the onset of death distinguishes them. Infact cultural and social forces act to separate the sexes in their personal health ethos and their sick propensity. The impact of old age on women is different from that of men because of differences in their status and role in society. This is specially so because proportion of widows in 60+ age group is considerably higher than that of widowers. Sexuality is often overlooked as a health status particularly in elderly women. Clinicians should recognise the importance of sexual functions to the overall health of older persons particularly women. Religious participation and involvement are associated with positive mental and physical health. Family life is the key to the health of elders specially older men. Lack of social support increases the risk of mortality and supportive relationships are associated with lower illness rates, faster recovery rates and higher levels of health care behavior.

Accidental Falls↗

PubMedDate not supplied

[Is age at onset associated with executive dysfunction in obsessive-compulsive disorder?].

In obsessive-compulsive disorder (OCD), clinical, neurobiological and genetic differences have been reported according to age at onset (AAO). Given the importance of identifying homogeneous subtypes in complex hete-rogeneous disorders such as OCD, it would be particularly useful to identify a specific cognitive profile associated with early-onset OCD. Although impaired cognition has repea-tedly been demonstrated in OCD patients, discrepancies between studies have hampered the identification of a precise cognitive dysfunction. Executive dysfunction has often been reported, but findings have not always been replicated. The aim of this study was to assess executive functions in 30 patients according to their AAO. The sample consisted of 15 early-onset and 15 late-onset OCD patients and 22 normal controls, matched for age, sex and socio-economic status. Various aspects of executive function were assessed with five neuropsychological tests: Tower of London, Trail Making Test, Verbal Fluency, Design Fluency and Association Fluen-cy. The 30 OCD patients obtained lower total scores than the controls in the Tower of London test and association fluen-cy task (p<0.05 and p<0.001, respectively). Impairments were more marked for the early-onset group, with no effect of gender or age at interview. Deficits in specific aspects of frontal lobe function were found in the OCD group and were particularly pronounced within the early-onset group. These findings confirm clinical data suggesting that OCD patients can be subtyped according to age at onset and that OCD patients present unusual cognitive characteristics. They also support the hypothesis that early-onset OCD might be a rele-vant subgroup characterised both by a particular clinical profile and by specific cognitive characteristics.

Adolescent↗

PubMed2002

Measures of cognitive function in persons with varying degrees of sleep-disordered breathing: the Sleep Heart Health Study.

Epidemiologic literature suggests that persons with clinically diagnosed sleep apnoea frequently have impaired cognitive function, but whether milder degrees of sleep-disordered breathing (SDB) are associated with cognitive dysfunction in the general population is largely unknown. Approximately 1700 subjects free of clinically diagnosed SDB underwent at-home polysomnography (PSG) as part of the Sleep Heart Health Study (SHHS) and completed three cognitive function tests within 1-2 years of their PSG: the Delayed Word Recall Test (DWR), the WAIS-R Digit Symbol Subtest (DSS), and the Word Fluency test (WF). A respiratory disturbance index (RDI) was calculated as the number of apnoeas and hypopnoeas per hour of sleep. After adjustment for age, education, occupation, field centre, diabetes, hypertension, body-mass index, use of CNS medications, and alcohol drinking status, there was no consistent association between the RDI and any of the three cognitive function measures. There was no evidence of a dose-response relation between the RDI and cognitive function scores and the adjusted mean scores by quartiles of RDI never differed from one another by more than 5% for any of the tests. In this sample of free-living individuals with mostly mild to moderate levels of SDB, the degree of SDB appeared to be unrelated to three measures of cognitive performance.

Aged↗

PubMed2006

Repeat mild traumatic brain injury: how to adjust return to play guidelines.

Determining when it is safe for an athlete to return to play (RTP) after concussion is one of the most difficult decisions facing the team physician. There is significant variability in the evaluation and management of mild traumatic brain injury (mTBI). In the past decade, a tremendous amount of sport-specific research has improved our understanding of mTBI. The advent of neuro-psychologic (NP) testing batteries designed to assess concussive injury has improved the assessment of cognitive dysfunction that occurs in the absence of structural brain abnormalities. The severity of injury is determined by the nature, burden, and duration of symptoms. Athletes must be asymptomatic and have a normal neurologic and cognitive evaluation prior to RTP. Several factors aid in making the RTP decision, including age, the severity of injury, and history of prior mTBIs. Given the potential complications of mTBI, the RTP decision must be made using a thoughtful, individualized process.

Age Factors↗

PubMed1999

Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia.

OBJECTIVE: The primary purpose of this article was to determine if cognitive abilities decline, remain unchanged, or modestly improve throughout the course of schizophrenic illness. METHOD: Forty-two patients with a first hospitalization for schizophrenia or schizophreniform disorder and 16 normal comparison subjects had a battery of neuropsychological tests and a magnetic resonance imaging (MRI) brain scan at approximate yearly intervals for the first 2 to 5 years of illness. Summary rating scales for language, executive, memory, processing speed, and sensory-perceptual functions were constructed. RESULTS: Patients with schizophrenia scored 1 to 2 standard deviations below normal comparison subjects on neuropsychological test measures during the course of the study. Patients exhibited less improvement than comparison subjects on measures of verbal memory. In general, improvement in positive symptoms over the time interval was associated with improvement in cognition. No changes in regional brain measurements were correlated with cognitive change in the patient group. CONCLUSIONS: Patients with schizophrenia have considerable cognitive dysfunction in the first 4 to 5 years of illness, which is stable at a level of 1 to 2 standard deviations below that of comparison subjects. There is little evidence for deterioration of cognitive abilities over the first few years of illness, with the exception of verbal memory, which shows significantly less improvement in patients over time relative to that of comparison subjects.

Adult↗

PubMed1997

Insulin and cognitive function in an elderly population. The Rotterdam Study.

OBJECTIVE: To examine the association between insulin and cognitive function in the population-based Rotterdam Study. RESEARCH DESIGN AND METHODS: Serum insulin was measured 2 h after an oral glucose load, while global cognitive function was assessed by the Mini Mental State Examination in 5,510 subjects, aged 55 years and over. RESULTS: An increase in postload insulin only in women was associated with a decrease in cognitive function (age-adjusted regression coefficient -0.10 per 50 mU/l insulin; 95% CI -0.16 to -0.04). The association between insulin resistance, assessed by the ratio of postload insulin over glucose, and cognitive function was not statistically significant. Further adjustment for the individual risk factors of serum glucose, BMI, HDL, systolic blood pressure, smoking, or use of estrogen did not change the results. The association was present in women with and without cardiovascular disease and present after excluding subjects with diabetes. Women with dementia, the extreme of cognitive dysfunction, had increased age-adjusted insulin levels (76.3 +/- 4.9 vs. 66.8 +/- 1.0 mU/l [means +/- SE], P = 0.06). CONCLUSIONS: The results of this study suggest that increased serum insulin may be associated with decreased cognitive function and dementia in women. These findings are more compatible with a direct effect of insulin on the brain than with an effect through an increase in cardiovascular risk factors.

Aged↗

PubMed2004

[Cognitive function in patients with endometrial and colorectal cancer: connection with hormonal and metabolic status].

Cognitive dysfunction may be associated with the presence of an array of hormono-metabolic factors of risk for certain basic noninfectious diseases, supposedly, including cancer. The investigation was concerned with an appraisal of such cognitive functions as verbal and eye memory and ability to concentrate in endometrial and colorectal cancer patients versus hormonometabolic status and relevant parameters in menopausal women. The indices of short-term memory and concentration in endometrial carcinoma were significantly higher than both in colorectal cancer and osteoporotic patients. However, they were not among healthy women of the same age. A whole range of relationships between said indices and glucose- and estradiol levels in blood serum of patients was studied. No link was established between blood-serum cholesterol, b-lipoproteide and insulin concentration in patients, on the one hand, and cognitive function, on the other. Further research is expected to disclose the ties of the latter with other hormono-metabolic factors as well as tumor-related stress.

Aged↗

PubMed2003

Cognitive decline over time following electrical injury.

Electrical injury (EI) is on the rise in the US, with more than 2400 injuries occurring annually. Consequences of EI often include diffuse neurological damage and a myriad of emotional and behavioural sequelae. While delayed onset of cognitive dysfunction is frequently alluded to in the literature, few cases have been published that document the progressive neuropsychological manifestations of EI over time. This paper offers a case study of a 49 year-old female who suffered a high voltage EI and who underwent neuropsychological evaluations at 6 and 56 months post-injury. Comparison of test results suggested a progressive pattern of global decline in cognitive functioning, with particular impairment in memory, verbal learning, abstract reasoning and sensory-motor functions. This case study illustrates the delayed onset and progression of neuropsychological dysfunction that may occur following EI, as well as the importance of long-term follow-up with patients after high voltage EI.

Adult↗

PubMed1994

Cognitive function after open-heart surgery: are postoperative neuropsychological deficits caused by cardiopulmonary bypass?

Despite the many technological developments in arterial perfusion and cardiac surgical procedures, open-heart surgery is still believed to pose a significant risk for cerebral injury. There are several potential causes of brain damage during open-heart surgery, including prolonged or severe arterial hypotension, as well as emboli emanating from the cardiopulmonary bypass circuit or the operative field. This article reviews the available neuropsychological studies of outcome following cardiac valve replacement and coronary artery bypass grafting. Because both procedures are life-saving operations, the research in this area has been quasi-experimental and fraught with methodological problems. Nonetheless, the findings converge to suggest that cognitive dysfunction occurs after open-heart surgery, and that the deficits are attributable, at least in part, to factors specific to the operation or to the patient being maintained on cardiopulmonary bypass. Preliminary findings suggest that embolization is the primary cause of perioperative deficits in uncomplicated operations. Studies have also consistently found preoperative deficits in this population, suggesting that neuropsychological dysfunction is caused by severe chronic cardiac disease as well as open-heart surgery.

Aged↗

PubMed1993

Brain magnetic resonance imaging correlates of cognitive impairment in multiple sclerosis.

We evaluated the correlations between cognitive impairment, clinical and brain magnetic resonance imaging (MRI) findings in 100 patients with multiple sclerosis (MS). The performance on one or more neuropsychological tests was abnormal in 47% of the 64 patients who completed the entire neuropsychological battery; the cognitive impairment was mild in 14 (22%) and severe in 16 (25%). Performance on any single neuropsychological test was unrelated to clinical parameters (age, duration of the disease, disability). The neuropsychological performance of relapsing-remitting patients was better than in patients with a chronic-progressive disease. The mean scores for almost all the neuropsychological tests were significantly lower in patients with severe ventricular dilatation and corpus callosum atrophy than in patients in whom these structures were little affected. Mean scores for WMS, performance Intelligence Quotient (IQ), total IQ and Token Test (TT) were also significantly correlated with the widening of cortical sulci and total lesional scores. Our data support the contention that the involvement of pathways that are critical for a given cognitive process as well as the progression of the axonal degeneration and sclerosis seem to play important roles in the pathophysiology of cognitive dysfunction in MS.

Adult↗

PubMed1996

Relationship between cognitive impairments, event-related potentials, and motor disability scores in patients with Parkinson's disease: 2-year follow-up study.

We studied event-related potentials and the cognitive state for 2 years in 29 patients with Parkinson's disease (PD). Of those patients, 11 were at stage II and 18 were at stage III at initial assessment, as measured on the Hoehn and Yahr scale. The peak latency of P300 in patients at stage III was significantly prolonged, as compared with that in age-matched normal controls or PD patients at stage II. There was no significant change in P300 latency among patients whose motor ability remained unchanged at stage II or stage III during follow-up period. The mean P300 latency prolonged significantly in patients whose motor ability worsened from stage III to stage IV. The cognitive state in the patients with PD was characterized by impairment in the categories of orientation, recall and constructional ability. The degree of impairment of these items increased as the motor disability increased. These results suggest that cognitive dysfunctions and abnormality of P300 latency increased as the motor disabilities progressed.

Aged↗

PubMed1990

Cholinergic-dopaminergic interactions in cognitive performance.

Both acetylcholinergic (ACh) and dopaminergic (DA) systems have been found to be crucial for the maintenance of accurate cognitive performance. In a series of studies examining those aspects of cognitive function revealed by the radial-arm maze, we have found that these two neurotransmitter systems interact in a complex fashion. Choice accuracy deficits in the radial-arm maze can be induced by blockade of either muscarinic- or nicotinic-ACh receptors. The choice accuracy deficit induced by blockade of muscarinic receptors with scopolamine can be reversed by the DA receptor blocker, haloperidol. The specific DA D1 blocker SCH 23390 also has this effect, whereas the specific D2 blocker raclopride does not, implying that it is D1 blockade that is critical for reversing the scopolamine effect. On the other hand, the choice accuracy deficit induced by nicotinic blockade with mecamylamine is potentiated by haloperidol. This effect is also seen with the D2 antagonist raclopride, but not with the D1 antagonist SCH 23390, implying that it is the D2 receptor which is important for the potentiation of the mecamylamine effect. The relevance of the D2 receptor for nicotinic actions on cognitive function is emphasized by the finding that the selective D2 agonist LY 171555 reverses the choice accuracy deficit caused by mecamylamine. Nicotinic and muscarinic blockade are synergistic in the deficit they produce. Antagonist doses subthreshold when given alone produce a pronounced impairment when given together. This latter deficit can be reversed by the D2 agonist LY 171555. These studies have outlined the complex nature of ACh-DA interactions with regard to cognitive function. Possible neural circuits for these interactions are discussed. The effectiveness of these selective DA treatments in reversing cognitive deficits due to ACh underactivation suggests a novel approach to treating cognitive dysfunction in syndromes such as Alzheimer's disease.

Acetylcholine↗

PubMed1989

Neuropsychological performance in HIV-1 immunocompromised patients: a preliminary report.

This study examined the pattern of neuropsychologic abnormalities in three groups of subjects: 20 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS); 14 patients diagnosed with AIDS Related Complex (ARC); and 13 seronegative controls. Subjects with past history of chronic substance abuse, neurologic disease, or focal findings on MRI or CT were excluded. All subjects were administered a comprehensive neuropsychological battery. Results revealed a pattern of preserved attention and concentration, language skills, and most visuospatial construction abilities in the presence of more notable deficits in nonverbal memory and speeded psychomotor tasks. Practical implications for the early detection of HIV-1 related cognitive dysfunction are addressed.

AIDS-Related Complex↗

PubMed2005

Cognitive functioning in community dwelling older adults with chronic partial epilepsy.

PURPOSE: To examine cognitive functioning in community-dwelling older adults with chronic partial epilepsy and demographically matched healthy older adults. METHODS: Standardized measures of neurocognitive function were collected as part of an ongoing study investigating health-related quality-of-life issues in older adults with epilepsy. Cognitive tests consisted of the Mattis Dementia Rating Scale (subscales include attention, initiation/perseveration, construction, conceptualization, memory), Logical Memory subtest from the WMS-III (immediate and delayed recall scores), and word fluency. Mood was measured with the Geriatric Depression Scale. Older adults with epilepsy (n=25) and healthy older adults (n=27) completed testing. All participants were at least 60 years old, living independently in the community, and had no history of drug/alcohol abuse or life-threatening medical conditions. All older adults with epilepsy had been diagnosed as having medically intractable partial complex seizures, including those with histories of secondary generalization. RESULTS: Older adults with epilepsy demonstrated impairments across all cognitive measures compared with the healthy controls. Seizure onset (age) and seizure duration (years) were not statistically associated with neurocognitive function or self-reported mood. Older adults with epilepsy who were receiving antiepileptic drug (AED) polytherapy (n=11) displayed worse performance on the attention, initiation/perseveration, and memory subscales of the DRS and Logical Memory delayed recall score compared with those older adults with epilepsy receiving monotherapy (n=14). The number of AEDs taken was not associated with seizure frequency. CONCLUSIONS: Negative effects on cognitive function are experienced by older adults with chronic partial epilepsy. AED polytherapy may increase the risk for negative cognitive dysfunction.

Affect↗