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PubMed1984

Performance and its measurement.

Performance involves numerous sub-functions, and cannot be treated as a unit. Several attempts have been made to separate functions impaired by different classes of drug: for example, high (monitoring) vs lower (performing) levels of function, early (perceptual) vs later (motor) functions, and strategic vs executive functions. The practical implications are that one cannot predict effects of a drug from a single performance test. One must either simulate the practical situation exactly, or use a battery of analytical tests to form a profile of effects. The latter is the policy urged in this paper.

Amphetamine↗
PubMed2004

Medial temporal lobe atrophy and memory deficits in elderly stroke patients.

Medial temporal lobe atrophy (MTA) and its role in memory deficits have been studied extensively in patients with various dementias and non-degenerative neurologic diseases. In stroke patients MTA is a significant risk factor for dementia. However, its role in memory decline in non-demented stroke patients is not yet known. Our aim was to evaluate the relationship between MTA and cognitive functions in a large cohort of elderly patients, who underwent a comprehensive neuropsychologic examination and magnetic resonance imaging 3 months after an ischemic stroke. The study sample (n = 260) was divided into three groups according to the severity of MTA. After adjusting for age, volume of infarcts and cortical atrophy, we found that patients with moderate to severe MTA performed significantly worse in tests of learning, story recall, visual reproduction, block design and mental speed. In contrast, the groups did not differ in tests of digit span, flexibility, verbal fluency and conceptualization. Our conclusion is that in aged stroke patients, MTA is associated with poor performance in specific cognitive domains. The most vulnerable domains are memory and visuospatial functions, whereas verbal and executive functions seem to be unrelated to MTA.

Aged↗
PubMed2003

No evidence of a homogeneous frontal neuropsychological profile in a sample of schizophrenic subjects.

The authors obtained a frontal functions profile for 81 schizophrenic patients using six neuropsychological tests that evaluate the dorsolateral prefrontal cortex functions, i.e., working memory, executive functions, and strategic performance. They then analyzed the test performances with a cluster analysis, which produced a four-cluster solution. The results support the hypothesis that neuropsychological dysfunctions in schizophrenia are heterogeneous. The performances on many of the neuropsychological tests were also strongly correlated with verbal and nonverbal IQ, as measured by the Wechsler Adult Intelligence Scale-Revised.

Adult↗
PubMedDate not supplied

Neuropsychological assessment of an aging population of Great Lakes fisheaters.

Because of the decline in central nervous system function that occurs with age, older people may be at greater risk of neurological dysfunction following exposure to neurotoxic contaminants in the environment. This study was designed to assess the neuropsychological functioning of a group of 50-90-year-old fisheaters exposed to polychlorinated biphenyls (PCBs) through Great Lakes fish consumption, and a group of age- and sex-matched nonfisheaters selected from the Michigan Department of Public Health's established cohort of fisheaters and nonfisheaters. A neuropsychological assessment battery, demographic interview, and fish consumption questionnaire were developed and piloted on similarly aged men and women in the Lansing and Detroit, Michigan, areas. The assessment battery included tests of motor function, memory and learning, executive functions, and visual-spatial functions, and took approximately two hours to administer. Most of the tests included in the battery have been shown to be sensitive to subtle, age-related declines in cognitive and motor function. The demographic questionnaire included questions on a number of important control variables that could influence the neuropsychological end points that were assessed in the study. These included demographic background, alcohol consumption, tobacco use, prescription and nonprescription drug use, medical history (including psychiatric illnesses), employment history, and activity level. The fish consumption questionnaire asked about historical and current consumption of specific fish species from each of the Great Lakes and its tributaries and was based on the fish consumption advisories published in the 1992 Michigan Fishing Guide. The questionnaire also asked about consumption of wild game, fish preparation and cooking methods, serving size, and changes in fish consumption patterns over time. After each subject completed the neuropsychological assessment, demographic interview, and fish consumption questionnaire, a blood sample was collected for analysis of PCBs, dichloro diphenyl dichloroethene (DDE), and ten other contaminants frequently detected in Great Lakes fish. Subject recruitment for the study began in July 1993 and was completed in November 1995. The data will be analyzed in two steps: first, to assess differences in confounding variables between fisheaters and nonfisheaters; and secondly, to determine the independent effects of Great Lakes fish consumption, as well as serum PCB and DDE levels, on cognitive and motor function after controlling for all identified covariates. Three indices of PCB exposure-total PCBs, total ortho-substituted PCBs and total coplanar PCBs-will be assessed. These studies should shed light on three questions: 1) Does consumption of contaminated fish from the Great Lakes exacerbate or accelerate the normal age-related decline in cognitive and motor function? 2) Do serum PCB or DDE concentrations predict the degree of behavioral dysfunction? and 3) If PCB exposure is related to behavioral outcomes, which class of PCB congeners, ortho-substituted or coplanar, are responsible for the cognitive and motor deficits?

Aged↗
PubMed2006

Insight dimensions and cognitive function in psychosis: a longitudinal study.

BACKGROUND: It has been reported that lack of insight is significantly associated with cognitive disturbance in schizophrenia. This study examines the longitudinal relationships between insight dimensions and cognitive performance in psychosis. METHODS: Participants were 75 consecutively admitted inpatients with schizophrenia, affective disorder with psychotic symptoms or schizoaffective disorder. Assessments were conducted at two time points during the study: at the time of hospital discharge after an acute psychotic episode and at a follow-up time that occurred more than 6 months after discharge. A multidimensional approach of insight was chosen and three instruments for its assessment were used: the Scale to Assess Unawareness of Mental Disorder (SUMD), three items concerning insight on the Assessment and Documentation in Psychopathology (AMDP) system and the Insight and Treatment Attitudes Questionnaire. The neuropsychological battery included a wide range of tests that assessed global cognitive function, attention, memory, and executive functions. RESULTS: After conducting adequate statistical correction to avoid Type I bias, insight dimensions and cognitive performance were not found to be significantly associated at cross-sectional and longitudinal assessments. In addition, baseline cognitive performance did not explain changes in insight dimensions at follow-up. Similar results were found in the subset of patients with schizophrenia (n = 37). The possibility of a Type II error might have increased due to sample attrition at follow-up. CONCLUSION: These results suggest that lack of insight dimensions and cognitive functioning may be unrelated phenomena in psychosis.

Adult↗
PubMed2000

Unilateral pallidotomy in PD: a controlled study of cognitive and behavioral effects. The Netherlands Pallidotomy Study (NEPAS) group.

OBJECTIVE: To investigate whether unilateral pallidotomy affects cognitive and behavioral functioning. METHODS: At baseline and after 6 months we assessed neuropsychological functioning in 35 patients with advanced PD. After baseline examination, patients were randomized to pallidotomy within 1 month (6 left-sided, 13 right-sided) or to pallidotomy after follow-up assessment 6 months later (n = 16; control group). We performed neuropsychological tests of language, visuospatial function, memory, attention, and executive functions. Self ratings and proxy ratings of memory problems and dysexecutive symptoms were also collected. RESULTS: No significant differences over time were found between pallidotomy and control groups, with the exception of a decrease of verbal fluency in the left-sided pallidotomy group. CONCLUSIONS: Unilateral pallidotomy is relatively safe with respect to cognition and behavior. Left-sided pallidotomy may lead to minor deterioration in verbal fluency. The sample size of this study is too small, however, to rule out the possibility of infrequent but clinically important side effects.

Aged↗
PubMed2001

MRI predictors of cognition in subcortical ischemic vascular disease and Alzheimer's disease.

BACKGROUND: Causes of cognitive impairment in subcortical ischemic vascular disease (SIVD) are less well understood than in AD, but have been thought to result from direct effects of subcortical lacunes and white matter lesions, perhaps related to disruption of important cortical-subcortical pathways. OBJECTIVE: To examine the relation between cognitive abilities and quantitative MRI measures of subcortical cerebrovascular disease and cortical and hippocampal atrophy. METHODS: Subjects were 157 participants in a multicenter study of SIVD and AD who included cognitively normal, cognitively impaired, and demented individuals with and without subcortical lacunar infarcts. Dependent variables were neuropsychological tests of global cognitive function, memory, language, and executive function. Independent variables were quantitative MRI measures of volume of lacunar infarcts in specific subcortical structures, volume of white matter lesion (WML), volume of cortical gray matter (cGM), and total hippocampal volume (HV). Multiple regression analyses were used to identify MRI predictors of cognition. RESULTS: Subcortical lacunes were not related to cognitive measures independent of effects of other MRI variables. WML was independently related to selected, timed measures. HV and cGM were strong and independent predictors of cognitive variables, with effects that did not differ in subjects with and without subcortical lacunes. CONCLUSIONS: Results suggest that cognitive impairment associated with subcortical ischemic vascular disease is primarily a result of associated hippocampal and cortical changes.

Aged↗
PubMed2006

The cognitive, emotional, and social sequelae of stroke: psychological and ethical concerns in post-stroke adaptation.

In the clinical domain, ethical analyses involve examination of complex individual responses, psychological processes, and social context. Psychological aspects of stroke adaptation include the risk for depression and anxiety, changes in identity and personality processes, and potential for social isolation. Depression and anxiety are heterogeneous constructs and can affect individuals' emotional functioning and cognitive abilities. Executive function, self-agency, and volition may be affected. Alterations in identity and personality may also result from the interaction of fluctuating emotional, cognitive, and physical abilities as well as from changes in social context and family dynamics. Social isolation, or lack of access to social contact or resources, can be a consequence of difficulties in cognitive and emotional function that influence interpersonal relationships, changes in social roles, communication difficulties, and challenges in transportation and employment. Social stigma and marginalization also contribute to isolation. The authors describe these psychological phenomena in the context of brain damage and recovery and raise ethical concerns including impact on decision-making capacity, pre- and postinjury selves and interests, and the social milieu in which strokes are experienced.

Ethics, Clinical↗
PubMed2003

Multivariate modeling of two associated cognitive outcomes in a longitudinal study.

Longitudinal studies of Alzheimer's disease provide information about cognitive decline and predictors of this decline. However, overall cognitive function is comprised of many underlying processes, each of which may respond differently over time and may be affected by different predictors. In addition to studying how these processes decline independently, one might also be interested in how the processes decline together. Multivariate growth models, an extension and modification of random effects models, provide a means of dealing with these issues and enable assessing the association between the processes of interest. This technique allows for separate random effects and predictors for each process in the same model, thereby providing simultaneous estimates of the model parameters and variability for each process. We can then determine if factors associated with decline in one process are also associated with decline in another process and the extent to which the processes differ. We provide data that include information on two underlying processes of cognitive function, namely memory and executive function, to illustrate this methodology.

Aged↗
PubMed1999

A tailless fas-FADD death-effector domain chimera is sufficient to execute Fas function in T cells but not B cells of MRL-lpr/lpr mice.

The Fas receptor delivers signals crucial for lymphocyte apoptosis through its cytoplasmic death domain. Several Fas cytoplasmic-associated proteins have been reported and studied in cell lines. So far, only Fas-associated death domain protein (FADD), another death domain-containing molecule has been shown to be essential for Fas signals in vivo. FADD is thought to function by recruiting caspase-8 through its death-effector domain. To test whether FADD is sufficient to deliver Fas signals, we generated transgenic mice expressing a chimera comprised of the Fas extracellular domain and FADD death-effector domain. Expression of this protein in lymphocytes of Fas-deficient MRL-lpr/lpr mice completely diminishes their T cell but not their B cell abnormalities. These results suggest that FADD alone is sufficient for initiation of Fas signaling in primary T cells, but other pathways may operate in B cells.

Adaptor Proteins, Signal Transducing↗
PubMedDate not supplied

[Neuropsychological aspects of obsessive compulsive disorder].

INTRODUCTION AND OBJECTIVE: Neuropsychological performance in obsessive compulsive disorder (OCD) and its association with disfunctions in neuroanatomic structures and clinical symptoms of disorder has been reviewed. DEVELOPMENT: OCD symptoms and different aspects between children and adult psychopatology are presented. Briefly neurobiologic studies related with the etiology and patophisiology of OCD has been revised. This article summarizes some last studies about OCD cognitive functioning and its impairment. CONCLUSION: The more impaired cognitive functions in OCD are executive functions and visual abilities, specially non verbal memory. In addition, other studies have identified verbal memory deficits. These deficits are consistent with neurodevelopmental models, which hypothesizes that abnormalities of ventral prefrontal striatal and thalamic circuits may be involved in the etiology and patophisiology of OCD. The cognitive deficits could be functioning as a intermediate variable between neurobiological abnormalities and OCD symptoms. More studies are needed to analize the OCD cognitive impairment.

Adult↗
PubMed1997

[Fragile X syndrome and mental retardation].

INTRODUCTION: Fragile-X syndrome is characterized by the presence of a fragile site (gap) on Xq 27.3 and the transcriptional inhibition of a mRNA protein-binding gene called FMR-1. Neuropsychological features include cognitive impairment, attention deficit disorder with and without hyperactivity, and impairment of visuospatial functions, language and frontal executive functions. In the present paper, other cytogenetic and phenotype characteristics, associate disorders, neurological and neuroimaging studies are revised. CLINICAL CASES: We describe two siblings that illustrate the pattern of neurocognitive and behavioural trends of the Fragile X syndrome, and sex differences. DISCUSSION AND CONCLUSIONS: These two cases emphasize the need for performing a cytogenetic diagnostic in patients with mental retardation, of unknown etiology, and with a familiar history of mental retardation.

Adult↗
PubMed2001

Spatial working memory deficits in schizophrenia: relationship with tardive dyskinesia and negative symptoms.

OBJECTIVE: This study examined the interrelationship between negative symptoms, orofacial tardive dyskinesia, and specific neurocognitive processes, particularly those involved in memory and executive function, in patients with schizophrenia. METHOD: A set of computerized neurocognitive tasks, the Cambridge Neuropsychological Test Automated Battery, was used to assess executive and memory function in 54 hospitalized patients with chronic schizophrenia. Analysis of covariance was used to examine differences between groups with or without the topographical syndromes of orofacial tardive dyskinesia and between groups with high or low negative symptom scores. Principal-components and path analyses were used to examine further the influence of negative symptoms and orofacial tardive dyskinesia on performance on tests of memory and executive function. RESULTS: Both orofacial tardive dyskinesia and negative symptoms were significantly and independently associated with deficits on measures of spatial working memory span derived from principal-components analysis, but only orofacial tardive dyskinesia was associated with deficits on measures of spatial working memory strategy. Both were also associated with impairment on the delayed-matching-to-sample task, a test of memory. These associations were not explained by deficits in global intellectual function. Path analysis suggested that the relationships between the clinical symptoms and performance on the delayed-matching-to-sample task were mediated entirely through their relationship with the spatial working memory measures. CONCLUSIONS: In schizophrenia, orofacial tardive dyskinesia and evident negative symptoms are relatively independent markers of compromise of the cerebral systems that mediate spatial working memory. Candidate neural circuits include the frontal-striatal-thalamic systems, particularly those involving the dorsolateral prefrontal cortex.

Adult↗
PubMed2005

Decision-making and impulse control after frontal lobe injuries.

PURPOSE OF REVIEW: For a long time, the prefrontal cortex has been considered a 'nonfunctional' brain area, and understanding its function has lagged behind other areas. This is no longer true since appreciation of the vital role that this brain region plays in adaptive behaviors, and especially decision-making, is now evident more than ever. The present review highlights recent progress made in this area of research. RECENT FINDINGS: Decision-making is a term often referred to in the psychological literature as one of the 'executive functions' that play a role in managing (like an executive) other cognitive functions, such as memory, attention, and language. Considerable research efforts have been directed towards differentiating various processes of executive functions, but much of this effort in the past has focused on the dorsolateral prefrontal cortex sector. Here we will review findings that address decision-making and its link to the ventromedial prefrontal cortex. SUMMARY: Decision-making impairments as encountered in neurological and psychiatric patients are costly in terms of individual human suffering and in financial terms. In addition to its obvious value in advancing fundamental knowledge in neuroscience, understanding the neural mechanisms of decision-making is likely to have important practical consequences, including the understanding and management of neuropsychiatric disorders such as addiction, as well as the management of a considerable number of elderly people suffering from a decline in cognitive functions critical for decision-making, in spite of relatively intact memory and general intellect, which impact real-life matters that are important to themselves and their family.

Brain Injuries↗
PubMed2002

Frontal Systems Behavior Scale in schizophrenia: relationships with psychiatric symptomatology, cognition and adaptive function.

Schizophrenia patients often exhibit impairments in executive functioning on formal testing and exhibit behaviors consistent with executive/frontal impairment in daily life. The Frontal Systems Behavior Scale (FrSBe) assesses behaviors associated with frontal lobe damage including executive dysfunction, apathy and disinhibition. We examined the reliability and validity of the FrSBe in 131 schizophrenia outpatients. Subjects were rated on the FrSBe and received symptom, cognitive and functional assessments. Statistical tests were corrected for multiple comparisons. The FrSBe was found to have good internal consistency and test-retest reliability. All three dimensions of the FrSBe (i.e. executive dysfunction, apathy and disinhibition) were significantly correlated with poor adaptive functioning as measured by the Social and Occupational Functioning Scale and the Functional Needs Assessment. In addition, differential relationships were found for apathy and disinhibition with symptoms as rated from the Brief Psychiatric Rating Scale and with cognitive variables including Trails B and verbal fluency scores. A multivariate analysis of variance examined differences on the FrSBe between patients and a group of 51 education-matched controls. Patients had significantly greater impairment on the FrSBe than controls. These differences were found for all FrSBe subscales. Results support the use of the FrSBe to characterize goal-directed behavior in schizophrenia patients.

Adaptation, Psychological↗
PubMed2003

The effect of housing interventions on neuropsychological functioning among homeless persons with mental illness.

The authors tested the hypotheses that neuropsychological functioning would improve after homeless persons with severe and persistent mental illness were provided with housing and that executive functioning would improve more among those placed in group homes than among those placed in independent apartments. A total of 114 persons with serious and persistent mental illness who were stable residents of homeless shelters completed neuropsychological testing and were randomly assigned to group homes or independent apartments; 91 participants (52 assigned to group homes and 39 assigned to independent apartments) were retested after 18 months. Overall neuropsychological functioning improved significantly across the full study sample. Executive performance, measured by the Wisconsin Card Sorting Test, decreased significantly among persons assigned to independent apartments and increased, but not significantly, among those assigned to group homes. The findings suggest that providing housing for persons who have severe and persistent mental illness improves cognitive functioning but that independent living may diminish executive functioning.

Activities of Daily Living↗