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[Neurophysiologic correlations of cognitive dysfunction in depressed patients with syndrome of juvenile asthenic deficiency].

Peculiarities of cognitive process were studied in 34 right-handed endogenously depressed patients with "juvenile asthenic deficiency" ("endogener juveniler Versagensyndrome" according to J. Glatzel and G Huber, 1968) by means of visual evoked potentials (EP) in the emotional recognition task. Two control groups consisted of 19 healthy individuals and 20 patients with other types of depressions. The main and control groups were matched for age, sex, handedness and education level. Compared to controls the patients with "juvenile asthenic deficiency" demonstrated highly significant alterations in indices of EP late negative wave in anterior areas of the left hemisphere which related to neither the nosology of "juvenile asthenic deficiency" (cyclothymia, schizophrenia) nor the types of dominant cognitive disorders. Dependence on both nosology and clinical subtype of asthenic deficiency was found only for separate characteristics of earlier EP waves. The results suggest the disturbance of the final stages of information processing and the decision making specific for "juvenile asthenic deficiency".

Adolescent↗

Is cardiopulmonary bypass still the cause of cognitive dysfunction after cardiac operations?

OBJECTIVE: The purpose of this study was to determine whether cognitive impairment is related to cardiopulmonary bypass. METHODS: Twenty-five patients undergoing coronary artery bypass grafting without cardiopulmonary bypass were matched with 50 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. All patients received the same anesthetic regimen, and one surgeon performed all the operations. A battery of 10 standard tests of neuropsychologic function were performed before, at discharge, and 3 months after the operation. A comprehensive multidimensional measure of subjective health status was used as the primary clinical measure of functional outcome. RESULTS: The groups were similar with respect to age, sex, and ventricular function and differed only in the need for a circumflex artery graft. Both groups showed significant improvement in the comprehensive multidimensional measure of subjective health status at 3 months. At discharge most neuropsychologic tests had deteriorated in both groups (the same 4 tests had deteriorated significantly in both groups, and an additional test had deteriorated significantly in the cardiopulmonary bypass group). At 3 months all but one test in the cardiopulmonary bypass group had returned to or exceeded baseline performance. The same 2 tests had improved significantly in both groups, and a further test had improved significantly in the group without cardiopulmonary bypass. At no specific time point was there a significant difference between the absolute or change scores between the groups on any of the tests. CONCLUSIONS: The similar pattern of early decline and late recovery of cognitive function in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass suggests that cardiopulmonary bypass is not the major cause of postoperative cognitive impairment. This merits consideration in deciding optimal treatment strategies in coronary revascularization.

Cardiopulmonary Bypass↗

Can music alleviate cognitive dysfunction in schizophrenia?

It has recently been reported that students performed relatively better on cognitive tasks after listening to music. Conceivably, music might reduce the level of arousal in subjects who are tense, thereby improving their performance. A test case would be schizophrenic subjects, noted for poor performance on tasks demanding attention, who have been characterized as suffering from hyperarousal, which mediates these attentional deficits. We investigated whether cognitive task performance could be facilitated by music in schizophrenics and report a beneficial effect.

Adult↗

Visuo-cognitive dysfunctions in Parkinson's disease.

Loss of will, decreased activity, and poverty of behavior are among the common symptoms observed in Parkinson's disease (PD). In line with these clinical observations, PD patients display prominent deficit in neuropsychological tests, requiring self-generated and effort-demanding operations. However, recent evidence suggests that this impairment is not generalized: visuo-spatial working memory and attentional set-shifting seem to be selectively impaired in the early stages of the disease. Electrophysiological studies also demonstrate the dysfunction of higher-level visual information processing. In this article, we discuss some current results to show the connection between clinical symptoms and neuropsychological deficits. We also consider dysfunction in underlying neural mechanisms, with particular emphasis on the dysregulation of fronto-striatal circuits. However, it is conceivable that visuo-cognitive impairment in PD reflects dysfunction of neural assemblies, involving basal ganglia, dorsal visual stream, and frontal-prefrontal circuits.

Attention↗

Cognitive dysfunction in schizophrenia: comparison of treatment with atypical antipsychotic agents and conventional neuroleptic drugs.

Impaired cognitive function is both a feature of schizophrenia and a side effect of conventional neuroleptics. Maze tests were used to determine the effects on cognition of conventional dopamine antagonist neuroleptics (haloperidol and fluphenazine) and the newer serotonin-dopamine antagonist antipsychotics (risperidone and clozapine). Patients on clozapine or risperidone showed better performance on the maze tasks than untreated patients or patients taking conventional neuroleptics. In particular, patients treated with risperidone or clozapine were better able to maintain motor coordination while they focused on the more complex "frontal" maze tasks which required sequencing and planning. In view of the restrictions on the use of clozapine, it is suggested that risperidone should be more widely used in schizophrenia because it preserves cognitive function better than conventional neuroleptics and is therefore likely to allow patients to have better insight into their illness and to have better long-term quality of life expectations.

Clozapine↗

P2 flash visual evoked response delay may be a marker of cognitive dysfunction in healthy elderly volunteers.

In an earlier study, 31 healthy elderly volunteers had normal cognitive function as measured by the Mini-Mental State Examination. Twenty-seven returned for further memory testing using the Wechsler Memory Scale-Revised (WMS-R). The P2 latency of the flash visual evoked response was positively correlated with age (p = .0008), but was not significantly related to gender. Nine of these 27 putatively healthy subjects had a delayed P2, suggestive of dementia. Although unaware of any memory deficits, 5 of the 27 had WMS-R Visual Memory Span percentile scores 1 or more standard deviations less than age-matched controls. Four of the five also had a significantly delayed P2 component. This positive correlation, adjusted for age, between poor Visual Memory Span performance and a delayed P2 was statistically significant (p < .025). These findings suggest that a delayed P2 in putatively healthy subjects is indicative of a visuospatial deficit which might be a precursor of dementia later.

Aged↗

Cognitive dysfunctions and white matter lesions in patients with bipolar disorder in remission.

OBJECTIVE: To compare cognitive functioning in relation to white matter lesions in bipolar disorder in remission and schizophrenia. METHOD: Cognitive performance and the occurrence of white matter lesions on MRI images of the brain were assessed in 22 patients with bipolar disorder in remission, 22 patients with schizophrenia and 22 healthy volunteers. RESULTS: Performance of tests of memory, speed and cognitive flexibility was significantly impaired in both patient groups. The frequency of white matter lesions did not differ significantly between the three groups. No differences in cognitive performance were found between patients with white matter lesions and patients without such lesions. CONCLUSION: White matter lesions apparently do not underlie cognitive deficits that are found in patients with bipolar disorder in remission and in patients with schizophrenia.

Bipolar Disorder↗

Cognitive dysfunction and impaired organization of complex motility in degenerative parkinsonian syndromes.

BACKGROUND: A frontostriatal pattern of cognitive decline, consisting of a frontal lobe-like syndrome without genuine cortical defects such as amnesia, apraxia, aphasia, or agnosia, is well established in basal ganglial diseases. Recent pathological investigations, however, have again noted cortical damage in progressive supranuclear palsy (PSP), suggesting that cortical defects could be present. OBJECTIVES: To delineate the pattern of cognitive impairment and to detect higher-order motor impairments (including ideomotor apraxia) in parkinsonian syndromes. PATIENTS AND METHODS: We assessed ideomotor apraxia, and simple and sequential tapping in patients with Parkinson disease, multiple system atrophy, and PSP with similar disease severity, age range, and education. We also administered a comprehensive battery of neuropsychological tests to examine general intelligence, memory, executive functions, attention, and visuospatial orientation. The results were compared between groups and with a matched normal control group. RESULTS: Sequential tapping and the imitation of sequences of gestures were impaired in all patient groups, with patients with PSP performing worse than the other groups. Based on ideomotor apraxia scores and a qualitative analysis of errors, 3 patients with PSP and 2 with multiple system atrophy were considered apraxic. General intelligence and executive functions were compromised in all patient groups. The impairment of patients with PSP was more pervasive than that of the other groups, and included compromise of visuospatial functions, attention, and memory. Discriminant analysis of all cognitive and motor tests showed that the tapping and ideomotor apraxia tests best identified the patients vs control subjects. CONCLUSIONS: The presence of cortical as well as subcortical damage in patients with PSP and those with multiple system atrophy is indicated by the presence of pervasive cognitive and motor disturbances in the former, substantial motor disorganization in the latter, and the finding of ideomotor apraxia in some patients with these diseases. Furthermore, the discovery that tests of motor and gesture best identified all patients vs control subjects is consistent with the existence of a common motor disorganization in these parkinsonian syndromes, in agreement with the known damage to the corticostriatal pathways in these conditions.

Aged↗

Carbohydrate-deficient glycoprotein syndrome type 1a: a variant phenotype with borderline cognitive dysfunction, cerebellar hypoplasia, and coagulation disturbances.

An 8-year-old boy is described with borderline cognitive impairment, cerebellar hypoplasia, a stroke-like episode, and venous thrombosis of the left leg after a period of immobilization. The pattern of multiple abnormalities in blood coagulation suggested carbohydrate-deficient glycoprotein syndrome type 1a. Isoelectric focusing of serum transferrin was abnormal. The activity of phosphomannomutase in leukocytes and fibroblasts was decreased. Mutation analysis of the PMM2 gene revealed the R141H/E151G genotype. These results confirm the presence of carbohydrate-deficient glycoprotein syndrome type 1a without severe psychomotor retardation.

Blood Coagulation Disorders↗

MRI correlates of cognitive dysfunction in multiple sclerosis patients.

Studies with conventional magnetic resonance imaging (MRI) support the hypothesis that cognitive impairment in multiple sclerosis (MS) patients is related with the lesion burden. Patterns of frontal lobe cognitive decline were also found to be related with the corresponding regional lesion load, although the total lesion load on T2-weighted MRI scans of the brain seems to be more relevant in determining frontal lobe deficits. Other non-conventional MRI techniques with a higher specificity to the heterogeneous substrates of MS pathology, such as the assessment of hypointense lesion load on T1-weighted scans and the histogram analysis of magnetisation transfer ratio (MTR) maps, have recently been applied to MS cognitive studies. Results from these studies suggest that three factors play a role in the pathogenesis of MS dementia: the burden of MS lesions, the severity of the pathological damage within individual lesions and that of the normal-appearing white matter.

Cognition Disorders↗

[Disseminated sclerosis: organic basis for mental disorders and cognitive dysfunction].

The MRI-(magnetic resonance imaging) scanner has improved the knowledge of the organic basis of cognitive defects in multiple sclerosis. Recent studies demonstrated a correlation of MRI-verified single lesions, atrophy of the corpus callosum and cognitive defects; but failed to demonstrate the convincing correlation between psychic symptoms and MRI-verified lesions.

Atrophy↗

Delayed hypoxic encephalopathy without cognitive dysfunction.

Three days after an episode of hypoxia, a 20-year-old man developed profound motor deficit in the absence of behavioral or cognitive disturbance. Previous reviews of delayed hypoxic encephalopathy have stressed behavioral and cognitive disturbances as the initial symptoms. This patient's pyramidal tract dysfunction in the absence of higher cortical dysfunction serves to illustrate that delayed hypoxic encephalopathy is predominantly a white matter rather than a gray matter disorder.

Adult↗

The value of Luria's Neuropsychological Investigation for the assessment of cognitive dysfunction in Alzheimer-type dementia.

Items from Luria's Neuropsychological Investigation (LNI) were used to assess cognitive functioning in three groups: patients with Alzheimer-type dementia (ATD), with alcoholic Korsakoff syndrome (KS) and control subjects of comparable age. The LNI was shown to be a sensitive assessment in that it distinguished differences within the ATD group and among the three groups. The validity and usefulness of the LNI in Alzheimer-type dementia are discussed.

Aged↗