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PubMed2006

Is there any correlation between severity of epilepsy and cognitive abilities in patients with temporal lobe epilepsy?

Frequent refractory seizures may cause cognitive deterioration when they present at an early age, especially in infants. The findings of previous studies designed to examine the impact of repetitive seizures on cognition in adolescents and adults, however, have shown wide variation. We analyzed the data of neuropsychological evaluations of patients before they underwent temporal lobe resection because of refractory seizure disorder in our institution from 1998 to 2001. Forty-four consecutive patients aged 12-48 years underwent a comprehensive neuropsychological evaluation that included a battery of selected visual and verbal memory tests. Statistical analysis revealed no significant correlation between disease-related parameters, such as age of onset, duration of active disease, estimated cumulative number of complex partial seizures and secondarily generalized seizures, and the results of neuropsychological tests. These findings support the hypothesis that factors other than repetitive seizures are responsible for cognitive dysfunction among adolescents and adults.

Adolescent↗

PubMed2002

Effects of depression and Parkinson's disease on cognitive functioning.

This study compared the performance of Parkinson's disease (PD) patients with and without depression, patients with depression alone, and normal control subjects on a cognitive screening instrument, the Mattis Dementia Rating Scale (DRS) to evaluate the influences of depression and Parkinson's disease on cognition. PD affects overall level of cognitive functioning and, to a lesser extent, DRS Initiation/Perseveration, Construction, and Attention. Diminished memory was primarily related to depression. Treatment of depression may ameliorate aspects of cognitive dysfunction in the PD patient with depression.

Aged↗

PubMed2005

Internal fixation versus hemiarthroplasty for displaced fractures of the femoral neck in elderly patients with severe cognitive impairment.

We studied 60 patients with an acute displaced fracture of the femoral neck and with a mean age of 84 years. They were randomly allocated to treatment by either internal fixation with cannulated screws or hemiarthroplasty using an uncemented Austin Moore prosthesis. All patients had severe cognitive impairment, but all were able to walk independently before the fracture. They were reviewed at four, 12 and 24 months after surgery. Outcome assessments included complications, revision surgery, the status of activities of daily living (ADL), hip function according to the Charnley score and the health-related quality of life (HRQOL) according to the Euroqol (EQ-5D) (proxy report). General complications and the rate of mortality at two years (42%) did not differ between the groups. The rate of hip complications was 30% in the internal fixation group and 23% in the hemiarthroplasty group; this was not significant. There was a trend towards an increased number of re-operated patients in the internal fixation group compared with the hemiarthroplasty group, 33% and 13%, respectively (p = 0.067), but the total number of surgical procedures which were required did not differ between the groups. Of the survivors at two years, 54% were totally dependent in ADL functions and 60% were bedridden or wheelchair-bound regardless of the surgical procedure. There was a trend towards decreased mobility in the hemiarthroplasty group (p = 0.066). All patients had a very low HRQOL even before the fracture. The EQ-5D(index) score was significantly worse in the hemiarthroplasty group compared with the internal fixation group at the final follow-up (p < 0.001). In our opinion, there is little to recommend hemiarthroplasty with an uncemented Austin Moore prosthesis compared with internal fixation, in patients with severe cognitive dysfunction.

Activities of Daily Living↗

PubMed2004

Homocysteine and cognitive function in elderly people.

Dementia is highly prevalent among elderly people, and projections show that the number of people affected might triple over the next 50 years, mainly because of a large increase in the oldest-old segment of the population. Because of this and the disease's devastating effects, measures for the prevention and early detection of dementia are crucial. Age and years of education are among the most relevant risk factors for dementia, but in recent years the role of homocysteine has also been investigated. Homocysteine is an amino acid produced in the metabolism of methionine, a process dependent on the B vitamins cobalamin, vitamin B6 and folic acid. There is evidence that increased serum homocysteine levels are associated with declining cognitive function and dementia. We review this evidence in addition to the potential mechanisms through which homocysteine acts on the brain to cause cognitive dysfunction, the metabolism of homocysteine and factors associated with alteration of the normal metabolism.

Aged↗

PubMed1997

Impaired neuropsychological performance in euthymic patients with recurring mood disorders.

BACKGROUND: Both patients suffering from schizophrenia and patients suffering from recurring mood disorder show cognitive impairments as established by a variety of neuropsychological tests. The aim of the present study was to investigate the neuropsychological performance of euthymic patients who had recurring mood disorder and the possible relationship between episodes of hospitalization and cognitive impairments. METHOD: Twenty-six euthymic patients with a DSM-III-R recurring mood disorder diagnosis were investigated by using the Synonym Reasoning and Block-Test Battery and a part of the Halstead-Reitan Test Battery. RESULTS: An overall lowered performance in the test results was found. There was a significant positive relationship between four different tests and the number of hospitalization episodes; the patients with impaired cognitive functioning had significantly more hospitalization episodes than patients with normal cognitive functioning. CONCLUSION: The results suggest that a subgroup of patients with recurring mood disorder are defined by more relapses and episodes of hospitalization and show cognitive dysfunctions even when euthymic.

Adult↗

PubMed1991

The treatment of cognitive impairment in Alzheimer's disease: beyond the cholinergic approach.

Despite the well-founded rationale for the use of cholinomimetic and monoaminergic agents in the treatment of Alzheimer's disease, thus far, these strategies have only led to modest results. None of the drugs assessed to date have been shown to improve cognitive function to a clinically significant degree in patients with Alzheimer's disease. Some agents have produced mild improvements on specific tests, whereas others seem to slow down the progression of the disease. This article provides a brief overview of the current trends in the treatment of cognitive dysfunction in Alzheimer's disease.

Alzheimer Disease↗

PubMed2005

Does negative symptom change relate to neurocognitive change in schizophrenia? Implications for targeted treatments.

Negative symptoms and cognitive dysfunction are among the most challenging obstacles in the treatment of schizophrenia. It is unknown to what extent they are overlapping or independent disease processes. In the search for targeted treatments of negative symptoms and cognitive impairments, it is imperative to determine their longitudinal relationship. 267 stable outpatients with schizophrenia in a work and cognitive rehabilitation program were evaluated using symptom measures and a comprehensive neuropsychological test battery at baseline and at the conclusion of rehabilitation, 6 months later. Baseline negative symptom, neuropsychological variables and change scores from intake to follow-up on these variables were correlated. These analyses were repeated with a subsample (n = 161) who had clinically significant negative symptoms at baseline. ANCOVA's were performed to compare patients whose negative symptoms improved by 5 points or more (n = 69) with those whose negative symptoms got worse by 5 points or more (n = 26) on their neurocognitive performance at follow-up. Intake negative symptoms were significantly associated with theory of mind and visuomotor processing. Results failed to support a lawful relationship between change in negative symptoms and neurocognition. These findings suggest that negative symptoms and neurocognition should be viewed as relatively independent targets for intervention.

Adult↗

PubMed2006

Diabetes mellitus in older men.

Most persons with diabetes mellitus are over the age of 60 years. Males develop diabetes more commonly than females. Older diabetics tend to have both impaired insulin release as well as insulin resistance. In older persons diabetes mellitus is associated with decreased functional status and cognitive dysfunction. In general, older persons with diabetes are inclined to be underdiagnosed and undertreated. Managing diabetes in older persons requires special considerations because of their differences in pathophysiology of diabetes and strong association with functional, cognitive impairments and comorbidities. The use of strict therapeutic diets is not recommended in older persons. Treatment of hypertension and hyperglycemia can improve outcomes in older persons. The interdisciplinary team approach is important for care of older diabetic persons.

Aged↗

PubMed1995

Predictors of skilled nursing placement in a multilevel long-term-care facility.

OBJECTIVE: To determine if cognitive and functional data gathered before admission to residential care (i.e., board and care) placement can predict nursing home placement. DESIGN: Retrospective study using Cox proportional hazards analysis and pairwise assessment of adjusted relative risk factors to determine which independent variables predicted skilled nursing placement. Subjects were followed for an average of 23.7 months (SD = 18.6 months). SETTING: Multilevel 1,735-bed long-term care facility, Jewish Home for the Aging, Reseda, California. PARTICIPANTS: Of the 248 consecutive residential care admissions studied, 80% were women. Subject's mean age was 84.8 years (SD = 5.0); 67% had no significant cognitive impairment. INDEPENDENT VARIABLES: Categorical variables were classifications with respect to dementia status, incontinence, hearing, and ambulation. Interval variables were number of medications, Katz ADL, and five neuropsychological tests. Demographic variables were gender, age, language of origin, and education. OUTCOME VARIABLE: Time between preadmission testing and the move up to skilled nursing placement. RESULTS: Pairwise assessment of adjusted potential risk factors indicated that cognitive dysfunction, less than perfect Katz ADL performance, and hearing loss were the most important independent risk factors for nursing placement. CONCLUSIONS: The findings remind us to pay careful attention to residents exhibiting even relatively mild cognitive deficits upon admission because these residents are likely to need increased environmental support.

Aged↗

PubMed1986

Organic brain syndrome associated with marginal hypothyroidism.

The authors report organic brain dysfunction in two psychiatric patients with grade 2 hypothyroidism; one was depressed and one had a paranoid psychosis with depressive features. The depression and psychosis responded to psychotropic medication and L-thyroxine, but the cognitive dysfunction improved only partially.

Aged↗

PubMedDate not supplied

[Diagnostic decision tree for the correct use of neuropsychological evaluation in head injury].

INTRODUCTION AND OBJECTIVE: We present a diagnostic decision tree for the correct use of neuropsychological evaluation techniques in head injury. Our aim is to avoid extensive, intensive use of unnecessary tests and measurements or lapses into diagnostic error which often accompany cognitive dysfunction when 'superficial' 'undirected' studies are done. DEVELOPMENT: It is essential to select the neuropsychological, neuroconductal and psychosocial evaluation tests which are most suitable in each case and establish a reliable diagnosis of the functional, cognitive, emotional and psychosocial conditions of the patient. The decision tree for neuropsychological evaluation is a guide to assist professionals so that they may adequately examine the functional changes which can occur as a consequence of traumatic brain damage, adapted to each point in its evolution and taking into account factors which may influence neuropsychological evaluation. CONCLUSION: The evaluation of consequences of trauma includes evaluation of the gravity of the head injury, and the neuropsychological, neuroconductal and functional evaluation of the patient.

Activities of Daily Living↗

PubMed2001

[Cognitive restraint in obesity. History of ideas, clinical description].

AN EXPLANATION OF DISAPPOINTING RESULTS: Handling obesity and moderate overweight with dietary prescriptions or cognitive and behavioral therapies gives unsatisfying results. For some, such treatments even have the drawback of aggravating eating behavioral patterns, not to mention other psychopathological disorders. We believe, on the contrary, that such disappointing results and troubles may be explained by the cognitive restraint theory. COGNITIVE RESTRAINT THEORY: After the radical questioning of a psycho-genic origin to obesity, the efforts made to lose weight have gradually been held responsible for the psychopathological troubles observed in the cases of overweight patients. Herman and Polivy thus consider that slimming diets bring about a state of cognitive restraint, i.e. a way of eating ruled by beliefs of all kinds in the various consequences on the patients' weight of alimentary habits and choices, as opposed to inner criteria of hunger and satiety. DIFFERENT STATES: A person in a state of cognitive restraint can either experience inhibition without loss of control, or a loss both of inhibition and of control. In the former case, one can distinguish: a) a voluntarist stage in which the individual deliberately chooses not to heed his hunger and satiety sensations in order to privilege rules that are supposed to allow him/her to control his/her weight; b) an unconscious stage during which physiological sensations are blurred, and eating habits ruled by unconscious cognitive processes and emotions. The individual thus ends up organising his eating behaviour around his/her fear of lacking, the frustration/guilt doublet and troubles in the comforting pattern. Such a state of inhibition is frequently interspersed with losses of control, described as hyperphagic or bulimic bouts and compulsive eating. THERAPEUTIC STRATEGIES: Certain authors, facing the necessity to bring down their patients' weight, tend nevertheless to advocate restrictive methods, or seem to consider that in spite of the above-mentioned drawbacks, cognitive restraint remains the only extant method to lose weight. An alternative therapeutic strategy is definitely worth exploring: one that consists precisely in helping the overweight patient to deliver him/herself from cognitive restraint. The first target could thus be to restore eating habits in conformity with personal tastes and with the patient's own personal hunger and satiety physiological regulation systems. This implies a questioning of dysfunctioning cognitive processes, and a thorough investigation of upholding factors such as self-esteem or emotional and relational troubles.

Cognition↗

PubMed2001

Quantitative and qualitative interpretation of neuropsychological data in the assessment of temporal lobectomy candidates.

Neuropsychologists who serve as members of an epilepsy surgery team are often asked to provide information regarding localized cerebral dysfunction that may relate to the seizure focus in patients with intractable temporal lobe epilepsy (TLE). However, the rate at which neuropsychological (NP) assessment results correspond with the side of seizure focus (i.e., left vs. right) in TLE patients is unknown. The majority of literature in this area has focused on the ability of single NP tests to detect lateralized cognitive dysfunction in groups of TLE patients, with mixed findings and few consistent replications. The primary purpose of this study was to examine the rate at which qualitative clinician interpretations of NP profiles agree with seizure lateralization as determined by a multidisciplinary surgery team in temporal lobectomy candidates. Quantitative analyses of single NP test scores and groups of test scores (i.e., cognitive domain composite scores) were also conducted to examine their effectiveness in discriminating left from right TLE groups. Only four of the 19 NP test variables and three of the nine composite cognitive domain scores significantly differed between the groups. However, clinician interpretation of NP profiles agreed with the surgery conference team's determination of seizure laterality in two-thirds of cases. These findings suggest that qualitative aspects of NP performance play an important role in identifying lateralized cerebral dysfunction in TLE patients, and provide additional support for the use of NP assessment results in the selection of temporal lobectomy candidates.

Adult↗

PubMed2006

Neurocognitive sequelae of a giant arachnoid cyst: case study.

We conducted a comprehensive neuropsychological evaluation of a normally functioning man with a giant arachnoid cyst encompassing much of the space normally occupied by the left hemisphere. Although of solidly average intellectual ability, the patient demonstrated neurocognitive deficits only revealed upon neuropsychological assessment. Despite the remarkable left hemisphere lesion, the pattern of cognitive dysfunction suggested right hemisphere pathology. We review the arachnoid cyst literature and discuss the possibility of a crowding phenomenon by which language function relocates to the more viable hemisphere. This case illustrates striking preservation of higher cognition in the presence of substantial structural abnormality.

Adult↗

PubMed2002

Effect of interferon-beta-1b on cognitive functions in multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is recognised as a central nervous system disease also affecting cognition. The rate of cognitive dysfunction in MS is in the range of 45-65% and adversely affect the quality of life. OBJECTIVE: To evaluate the effect of 1 year of treatment with interferon-beta-1b (IFNbeta-1b) on cognitive functions in patients suffering from relapsing-remitting MS. METHODS: A battery of cognitive tests was used to assess verbal learning, delayed recall, visual learning and recall, complex attention, concentration and verbal fluency at baseline and after 1 year of treatment with IFNbeta-1b. A group of 23 relapsing-remitting MS patients matched for neurological disability served as controls. RESULTS: Eighteen of 23 patients treated with IFNbeta-1b (74%) completed the study. In the IFNbeta-1b-treated group, complex attention, concentration as well as visual learning and recall improved significantly (p = 0.024, p = 0.006 and p = 0.005, respectively), while no deterioration was observed in the other dimensions. In the control group, complex attention, verbal fluency, as well as visual learning and recall deteriorated significantly (p = 0.02, p = 0.004 and p = 0.01, respectively), while no deterioration was observed in the other dimensions. CONCLUSION: Immunomodulating drugs that reduce the relapse rate and slow the disease progression also inhibit cognitive deterioration in patients with MS.

Adjuvants, Immunologic↗

PubMed2004

A prospective controlled study of cognitive function during an amateur boxing tournament.

BACKGROUND: Few studies have reported acute postbout cognitive function in amateur boxers, and none have documented the effects of repeated boxing bouts within a short time frame. OBJECTIVE: To determine whether participation in a 7-day amateur boxing tournament is associated with acute deterioration in cognitive test performance. METHODS: A prospective study was done of 82 collegiate amateur boxers participating in a 7-day single elimination tournament and a group of 30 matched nonboxing control participants. No participants had a history of recent concussion or past history of brain injury. For boxers, cognitive assessment using a computerized test battery was performed before the tournament and within 2 hours of completing each bout. Tests of simple and choice reaction time, working memory, and learning were administered. Analysis of variance was conducted to compare the serial performance of control participants with that of boxers participating in one, two, and three bouts. RESULTS: The 82 boxers fought 159 times. Cognitive testing was performed after 142 of these bouts. On simple reaction time, choice reaction time, and working memory tasks, the serial performance of boxers participating in three bouts (n = 22) was equivalent to that of boxers participating in two bouts (n = 22) and one bout (n = 32) and to nonboxing control participants (n = 30). An improvement in performance was observed on the learning task in boxers participating in three bouts. Boxers whose bout was stopped by the referee (n = 7) displayed significant slowing in simple and choice reaction time. CONCLUSIONS: With the exception of boxers whose contest is stopped by the referee, amateur boxers participating in multiple bouts during a 7-day tournament display no evidence of cognitive dysfunction in the immediate postbout period.

Adult↗

PubMed2006

The effects of clozapine on cognitive function and regional cerebral blood flow in the negative symptom profile schizophrenia.

OBJECTIVE: Cognitive function and regional cerebral blood flow (rCBF) were studied in negative symptom profile schizophrenic patients by using WCST and SPECT. METHODS: Twenty-one schizophrenic patients who matched the criteria of Andreason's negative symptom profile received SPECT and WCST, and then were treated with clozapine for 8 consecutive weeks. There were 28 and 12 normal subjects as the control groups of WCST and SPECT, respectively. RESULTS: Compared with controls, significantly poorer performance on total trials of category (TT), persevering errors (PE), and non-persevering errors (NPE) of WCST were found in schizophrenia (p < 0.05). The total score of the scale for assessment negative symptoms (SANS) was significantly related with poor TT (r = 0.45, p < 0.01) and PE performance (r = 0.45, p < 0.01). The poor TT, PE, and NPE tasks of WCST and SANS scores in the negative schizophrenic patients were significantly improved through clozapine treatment (p < 0.05). The schizophrenic patients had a significantly lower rCBF in bilateral frontal and temporal lobes and lower change rate of rCBF in bilateral frontal lobes during WCST compared to normal controls (p < 0.05). CONCLUSIONS: Negative symptom profile schizophrenia has cognitive deficits and lower rCBF in bilateral frontal and temporal lobes, which suggests that negative symptom profile schizophrenic patients have hypofrontality. Clozapine can improve negative symptoms and improve cognitive dysfunction, although it cannot improve reduced rCBF in the frontal lobes.

Adult↗

PubMed2004

Neurologic sequela of hydrogen sulfide poisoning.

A 25-year-old man, a field operator in a petroleum refinery was found unconscious. He was exposed to hydrogen sulfide and presented with Glasgow Coma Score of 5, severe hypoxemia on arterial blood gas analysis, normal chest radiography, and normal blood pressure. On hospital day 7, his mental state became clear, and neurologic examination showed quadriparesis, profound spasticity, increased tendon reflexes, abnormal Babinski response, and bradykinesia. He was also found to have decreased memory, attention deficits and blunted affect, which suggested general cognitive dysfunction, but which improved soon. MRI scan showed abnormal signals in both basal ganglia and motor cortex, compatible with clinical findings of motor dysfunction.

Adult↗