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PubMed2006

Executive and visuospatial sketchpad resources in euthymic bipolar disorder: Implications for visuospatial working memory architecture.

Visuospatial working memory theory is used to interpret the cognitive impairment in euthymic bipolar disorder. Such patients show deficits in the Corsi Blocks Test (CBT) and executive control. To understand these deficits, 20 euthymic bipolar patients and controls were administered the CBT, Visual Patterns Test (VPT), and a new visual memory task designed to make minimal demands on executive resources. Initial analyses validated the visual memory task and implicated executive involvement in the CBT and VPT. Subsequent analyses on a number of tests confirmed CBT and executive deficits while performance was normal on the VPT and visual memory test. ANCOVA indicated that impaired executive function underpinned patients' CBT performance. Implications for the interface between executive and slave systems of working memory are discussed.

Adolescent↗

PubMed2004

Computer-mediated measurement and subjective ratings of white matter hyperintensities in vascular dementia: relationships to neuropsychological performance.

White matter hyperintensities (WMHs) are frequently found on MRI studies of vascular dementia (VaD) patients. As several studies have demonstrated that WMHs are often associated with severity of illness, cognitive impairment, and functional decline, the accurate and reliable measurement of WMHs on MRI is an important, yet often overlooked, prerequisite for accurate interpretation of neuroimaging studies. Using a sample of 39 VaD patients, we evaluated the reliability and validity of a visual ordinal rating scale and a computer-mediated thresholding technique to evaluate WMHs. Results indicated the computer-mediated technique had slightly stronger inter-rater reliability than the visual ordinal rating scale. Furthermore, the computer-mediated thresholding technique was correlated with measures of neuropsychological functioning believed to be compromised in VaD (i.e., psychomotor speed, executive functioning) while the visual rating scale was not. Results suggest that this computer-mediated thresholding technique is superior to visual ratings of WMHs.

Aged↗

PubMed2003

Assessment of social cognition in frail older adults and its association with social functioning in the nursing home.

PURPOSE: The aims of this study were to reliably assess a range of social-cognitive functioning in frail seniors and to examine the association between measures of social cognition and nurses' ratings of residents' social functioning in a nursing home. DESIGN AND METHODS: Forty nursing home residents with and without cognitive impairment completed 11 social cognition tasks on two occasions after assessment of their cognitive functioning with the Cambridge Cognitive Examination-Revised (CAMCOG), CAMCOG Executive Function, and two tests of working memory. Staff on the nursing units completed two measures of social behavior. RESULTS: Participants completed the social cognition protocol without difficulty. The measures demonstrated good internal (median alpha =.75) and test-retest reliability (median correlation =.70). Four of the social cognition measures were significantly associated with the measures of cognitive functioning; three additional measures showed significant positive associations with subsets of the cognitive tests. Regression analyses revealed that measures of social cognition were significantly and independently associated with nurses' ratings of residents' social functioning after age, gender, education, and the four measures of cognitive functioning were controlled for. One measure of social cognition that assessed interpersonal problem-solving accounted for 45% of the variance in nurses' ratings of participants' social functioning (F = 41.35; df = 1,17; p <.001). IMPLICATIONS: Measures of social cognition assess a domain of functioning that is not evaluated by traditional tests of cognitive status. These measures are informative about frail, older adults' ability to understand and respond to others and could be used to predict patterns of social functioning in nursing homes and other naturalistic settings.

Aged↗

PubMed2004

Quality of life compared during pharmacological treatments and clinical monitoring for non-localized prostate cancer: a randomized controlled trial.

OBJECTIVES: To investigate the effects of different management strategies for non-localized prostate cancer on men's quality of life and cognitive functioning. PATIENTS, SUBJECTS AND METHODS: Men with prostate cancer were randomly assigned to one of four treatment arms: leuprorelin, goserelin, cyproterone acetate (CPA), or close clinical monitoring. In a repeated-measures design, men were assessed before treatment (baseline) and after 6 and 12 months of treatment. A community comparison group of men of the same age with no prostate cancer participated for the same length of time. The men were recruited from public and private urology departments from university teaching hospitals. All those with prostate cancer who were eligible for hormonal therapy had no symptoms requiring immediate therapy. In all, 82 patients were randomized and 62 completed the 1-year study, and of the 20 community participants, 15 completed the study. The main outcome measures were obtained from questionnaires on emotional distress, existential satisfaction, physical function and symptoms, social and role function, subjective cognitive function, and sexual function, combined with standard neuropsychological tests of memory, attention, and executive functions. RESULTS: Sexual dysfunction increased for patients on androgen-suppressing therapies, and emotional distress increased in those assigned to CPA or close clinical monitoring. Compared with before treatment there was evidence of an adverse effect of leuprorelin, goserelin, and CPA on cognitive function. CONCLUSIONS: In deciding the timing of androgen suppression therapy for prostate cancer, consideration should be given to potential adverse effects on quality of life and cognitive function.

Aged↗

PubMed2001

Dementia as a complication of schizophrenia.

OBJECTIVES: Cognitive impairment is known to occur in schizophrenia, and may be marked in institutionalised patients. The aim of this study was to determine whether it ever warrants an additional diagnosis of dementia. METHODS: A population of chronic schizophrenic patients who were aged 65 or younger and showed no organic risk factors for dementia were screened for presence of disorientation. Any showing this underwent neuropsychological testing, physical investigations, and structural and functional neuroimaging. Information about day to day cognitive function was also obtained from carers. RESULTS: Eight patients aged 28 to 64 were identified who showed disorientation; in all cases this was accompanied by general intellectual impairment and objective evidence of a dementia syndrome. The patients' schizophrenic symptoms were unexceptional and did not seem sufficient to account for their cognitive impairment. Neuropsychological testing disclosed relative sparing of visual and visuospatial function and language syntax, but pervasive deficits in memory and executive function. Brain CT demonstrated only minor abnormalities but most of the patients showed frontal or temporal hypoperfusion on SPECT. CONCLUSIONS: Dementia in schizophrenia seems to be a real entity with a neuropsychological signature similar to that of frontotemporal dementia. Functional but not structural imaging abnormalities may also be characteristic.

Adult↗

PubMed2006

Cognitive assessment in Chinese patients with aneurysmal subarachnoid hemorrhage.

A subgroup of patients who survive aneurysmal subarachnoid hemorrhage (SAH) may have significant cognitive deficits. The aim of the current study was to determine the efficiency of cognitive tests and frequency of cognitive impairments associated with aneurysmal SAH in Chinese. A series of 116 patients with aneurysmal SAH were assessed before surgery. Only 37 patients have completed all tests. The other 79 patients had discontinued because of their clinical conditions, recurring severe headaches, refusing or misunderstanding due to low education. We found that one or more cognitive functions were impaired in 70.3% of the 37 patients, SAH patients were especially impaired in functions that are related to visual reproduction, verbal fluency, and executive functions. The results suggest that the patients have impressive cognitive deficits after aneurysmal SAH. A battery of appropriate cognitive tests should be developed for use by doctors and nurses.

Aged↗

PubMed2004

Cognitive impairments in cerebellar degeneration: a comparison with Huntington's disease.

To determine the specificity of cognitive impairments in patients with cerebellar degeneration (CD), the neuropsychological test performance of 31 CD patients was compared to that of 21 patients with Huntington's disease (HD) and 29 normal adults. The CD and HD groups did not differ in age, education, or duration of illness, and their overall severity on a quantified neurological examination was similar. Fifteen neuropsychological test variables were reduced to five underlying domains: motor, verbal, spatial, memory, and executive functioning. The CD patients had their greatest impairment in the executive domain and their least in the memory domain. In contrast, the HD patients had very substantial spatial deficits and significant memory impairment, in addition to executive dysfunction. The findings indicate that 1) the cognitive impairment in CD is not as severe as in HD, and 2) the pattern of deficits in CD, while consistent with a subcortical dementia, differs in important ways from that in HD. These differences may reflect the involvement of the cerebellar dentate nucleus and the striatal nuclei in separate "loops" or closed circuits, linking them with specific areas of cerebral neocortex.

Adult↗

PubMed2006

Radiographic predictors of neurocognitive functioning in pediatric Sickle Cell disease.

We compared magnetic resonance imaging (MRI), magnetic resonance angiography, and transcranial Doppler ultrasonography as predictors of specific neurocognitive functions in children with sickle cell disease. Participants were 27 children with sickle cell anemia (hemoglobin SS) who were participants in the Stroke Prevention Trial in Sickle Cell Anemia (STOP) and had no documented history of stroke. Children's MRIs were classified as normal or silent infarct, and their magnetic resonance angiograms were classified as normal or abnormal. The highest time-averaged mean flow velocity on transcranial Doppler ultrasonographic examination of the major cerebral arteries was analyzed. Age and hematocrit also were analyzed as predictor variables. The battery of neurocognitive tests included measures of intellectual functioning, academic achievement, attention, memory, visual-motor integration, and executive functions. MRI, magnetic resonance angiography, transcranial Doppler ultrasonography, age, and hematocrit were analyzed as predictors of participants' performance on the various measures of neurocognitive functioning. Age and hematocrit were robust predictors of a number of global and specific neurocognitive functions. When age and hematocrit were controlled, transcranial Doppler ultrasonography was a significantly unique predictor of verbal memory. We found an association between low hemoglobin and neurocognitive impairment. We also found that abnormalities on transcranial Doppler ultrasonography can herald subtle neurocognitive deficits. (J Child Neurol 2006;21:37-44).

Adolescent↗

PubMed2006

Effect of high-dose cortisol on memory functions.

Although research indicates that hightened glucocorticoid levels impair long-term memory functions and may inhibit traumatic memory retrieval in humans, the impact of acutely elevated glucocorticoid levels on learning and attentional functions is still unclear. Furthermore, the effect of glucocorticoids on executive functions as well as the recovery from long-term memory deficits is insufficiently studied. The present study examined memory functions in patients with acute exacerbation of neurological diseases (multiple sclerosis, acute optic neuritis), who were treated with a high dose of glucocorticoids. All patients demonstrated a reversible impairment of long-term memory functions, whereas measures of short-term memory, attentional functions, and alertness remained unaffected. These findings indicate a selective cognitive disturbance, providing further evidence that the memory deficits reflect a receptor-mediated effect of glucocorticoids on hippocampal function thereby supporting a potential association of stress-induced elevated cortisol levels and memory disturbances in trauma-related psychiatric disorders (psychogenic amnesia, PTSD).

Adult↗

PubMed2006

The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression.

Previous studies of neuropsychological performance in borderline personality disorder (BPD) have exhibited mixed results. The high rate of co-occurring major depressive disorder (MDD) in BPD makes it difficult to specify whether neuropsychological deficits in BPD predominantly reflect co-occurring MDD or unique aspects of their psychopathology. To address this issue, 22 participants with borderline personality disorder and concurrent major depressive disorder (BPD-MDD) and 33 participants with MDD and no concurrent personality disorder were compared on a neuropsychological battery that assessed seven domains of performance: general intellectual functioning, motor skill, psychomotor speed, attention, memory, working memory, and executive function. Neuropsychological performance did not differ between BPD-MDD and MDD. However, BPD-MDD participants reported higher levels of anger, anxiety, and of overall emotional distress compared to MDD. When levels of anxiety were controlled, BPD-MDD participants exhibited superior general intellectual performance, psychomotor speed, and attention. Deficits found in previous BPD samples may reflect their susceptibility to co-occurring MDD. The impact of anxiety on neuropsychological performance in BPD, though, indicates a need for future experimental studies of the effects of mood on cognitive function to determine whether mood dysregulation, rather than core depressive symptoms, underlie cognition impairments in BPD.

Adult↗

PubMed2006

Surgically restoring portal blood flow to the liver in children with primary extrahepatic portal vein thrombosis improves fluid neurocognitive ability.

OBJECTIVES: Children with primary extrahepatic portal vein thrombosis (EHPVT) have portal-systemic shunting, which may lead to disturbed neurocognitive function similar to portal-systemic encephalopathy (PSE) seen with chronic liver disease and cirrhosis. The functions most affected are those involving fluid cognitive ability, which comprise neurocognitive domains such as attention, processing speed, and short-term memory, that are particularly vulnerable to systemic illness or diffuse neurologic insult. We determined the fluid cognitive ability of children with EHPVT and whether surgically restoring portal blood flow by mesenteric left portal vein bypass (MLPVB) improved it. DESIGN: Twelve children with EHPVT and no overt PSE underwent comprehensive neurocognitive testing before and 1 year after undergoing surgery with intent to perform MLPVB. The evaluations sampled 4 functional domains at both time points: (1) neurobehavioral (behavior, emotional, executive functioning); (2) broad cognitive (intelligence, achievement); (3) fluid ability (attention, mental speed, working memory, memory encoding); and (4) visual motor (drawing, fine motor). Tasks in the fluid-ability and visual-motor domains were expected to be especially sensitive to adverse effects of EHPVT and to be most likely to show improvement with MLPVB. The test group consisted of 8 subjects who underwent successful MLPVB, and the comparison group was composed of 3 patients who received distal splenorenal shunts and one whose MLPVB failed. RESULTS: Both groups demonstrated similar fluid cognitive ability at initial evaluation. Successful MLPVB resulted in significantly improved fluid cognitive function: in the fluid cognitive domain, significant improvements were seen for the hit reaction time variability in the Conner's Continuous Performance Test, the attention scale of the Cognitive Assessment System, and immediate verbal memory in the Children's Memory Scale. In the visual-motor domain, z scores on the Grooved Pegboard Test improved. No improvement was observed in the comparison group. DISCUSSION: The results show that surgically restoring portal flow to the liver in children with primary EHPVT results in improved fluid cognitive ability. Subjects showed some neurocognitive abnormalities involving mainly fluid cognitive ability consistent with minimal PSE seen in adults with chronic liver disease. Cognitive defects in patients with minimal PSE seem to relate primarily to attention and fine motor skill, and although affected patients can function in everyday life, they are at risk for performance deficits in educational and vocational situations requiring the ability to pay close attention and react quickly (eg, driving, employment in manufacturing). The tests we administered in these domains are pediatric equivalents to measures used to detect minimal PSE in adults and should detect abnormalities in the same functional domains. Our results suggest that a narrow battery of tests could be used to detect minimal PSE in children in a manner similar to the 5-test battery used in adults, eliminating the need for the comprehensive and broad testing we performed. Our findings suggest that shunting of portal blood from the liver in primary EHPVT can result in PSE and question whether it is as benign a disease as previously thought. The importance of our findings is twofold. For understanding the pathophysiology of PSE, we have shown that restoring blood flow to the liver improves cognitive function in children with EHPVT. For therapy for EHPVT, it becomes clear that MLPVB is an excellent treatment option. It is effective for treating the complications of portal hypertension and provides effective portal blood flow that other medical and surgical therapies do not. The findings provide additional evidence that primary EHPVT should be considered curable by MLPVB. However, comparison of overall risks and benefits of MLPVB with those of other therapeutic options and longer-term outcome studies must be completed before MLPVB can be fully endorsed as the best treatment for EHPVT in children. CONCLUSIONS: Surgical restoration of portal venous flow to the liver in children with primary EHPVT by MLPVB improves fluid cognitive ability. MLPVB should be considered in treating primary EHPVT, because it corrects portal blood flow and could optimize learning potential.

Anastomosis, Surgical↗

PubMed2000

[Age-related cognitive decline: evaluation and prevention strategy].

The age-related decline of cognitive functions generally refers to a mild deterioration in memory performance, executive functions, and speed of cognitive processing. The terms "age-related cognitive decline" (ARCD) and "aging-associated cognitive decline" have been proposed recently to indicate an objective decline in cognitive functioning associated to the ageing process but within normal limits given the person's age. Whether ARCD is expression of a normal ageing process or represents a distinct clinical entity or, eventually, is a continuum with dementia is, at present, difficult to establish. The causes of ARCD are unknown, but some studies have suggested that it may be prevented. Avoidance of cardiovascular and other chronic diseases, high educational level, and maintenance of vision and hearing have been identified as protective factors from ARCD. On the contrary, hypertension, effects of altered metabolism of steroid hormones, smoking, low-complexity occupation, higher density of persons/bedroom in home, and low level of physical activity have been identified as risk factors for ARCD. Recent findings suggest a possible role of diet in the ARCD. In fact, in an elderly population of Southern Italy with a typical Mediterranean diet, high monounsaturated fatty acids energy intake appeared to be associated with a high protection against cognitive decline. Dietary antioxidants, specific macronutrients, estrogens, and anti-inflammatory drugs, may act synergistically with other protective factors, opening new therapeutic interventions for cognitive decline.

Age Factors↗

PubMed1992

Behavioral manifestations associated with multiple sclerosis.

The behavioral manifestations associated with MS include both cognitive and emotional disturbances. Overall intellect is slightly affected in about half of patients, and 20% to 33% demonstrate more severe impairments. Memory disturbances are particularly common, and retrieval function is especially affected. Difficulties with concept formation and other executive functions can be subtle yet have significant impact on daily living. Depression is frequent in MS, sometimes despite an outward euphoria that is more prevalent with advancing disease. Psychosis occurs rarely, but bipolar disorder is more frequent than in the general population. MS may be associated with a variety of personality changes, but it is impossible to generalize about this or to identify an "MS personality." Disturbances of emotional control are relatively frequent. Comprehensive management of these problems uses multiple modalities including good neurologic care, cognitive rehabilitation, counseling and support groups, and pharmacotherapy.

Cognition Disorders↗

PubMed2006

Cognitive deficit in schizophrenia: comparative analysis of positive and negative subtype and predictors of positive subtype.

OBJECTIVE: The objective of the study was to investigate the global cognitive deficit in schizophrenia and to compare cognitive dysfunction in the positive and negative subtypes of schizophrenia, and furthermore to examine the existence of predictors of the positive and negative subtypes of schizophrenia. METHOD: 56 patients with schizophrenia were evaluated with the Positive and Negative Syndrome Scale to classify them into the subtypes of schizophrenia, that is positive subtype (31 patients) and negative subtype (25 patients). All the patients were entering into remission. To examine the cognitive deficits in schizophrenia (global and selective) we compared scores on the Wechsler Individual Intelligence Test (VITI) for the positive and negative subtypes. RESULTS: The negative subtype of schizophrenia showed significantly higher cognitive dysfunction in comparison to the positive subtype, with reduced functioning in evolutionary higher cognitive functions like the selection of information, processing, planning, comprehension, realization (executive functions) as well as visual motor abilities. Verbal IQ predicts the positive subtype of schizophrenia.

Adult↗

PubMed1996

Intact and impaired memory functions in autism.

This study examined memory functions in individuals with autism. Based on previous evidence of executive function (EF) deficits, we hypothesized that subjects with autism would demonstrate a pattern of intact and impaired memory functions similar to that found in other groups with EF deficits, such as patients with frontal lobe pathology. We compared the performance of high-functioning children and adolescents with autism (n = 19) and clinical comparison subjects (n = 19) matched on sex, CA, and VIQ on measures of memory and EF. The group with autism performed significantly worse than comparison subjects on measures of temporal order memory, source memory, supraspan free recall, working memory, and EF, but not on short- and long-term recognition, cued recall, or new learning ability, consistent with the predictions of the EF theory. The cognitive measures were significantly more intercorrelated in the autism group than the comparison group, consistent with a limit in central cognition.

Adolescent↗

PubMed2005

Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort.

OBJECTIVES: To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent-living adults. DESIGN: Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial. SETTING: Six field sites in the United States. PARTICIPANTS: Two thousand eight hundred two independent-living subjects aged 65 to 94. MEASUREMENTS: Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form-36 (SF-36) Health Survey. RESULTS: After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal-lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF-36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline. CONCLUSION: Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent-living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.

Activities of Daily Living↗

PubMed2001

Impairments of memory and learning in older adults exposed to polychlorinated biphenyls via consumption of Great Lakes fish.

An association between in utero polychlorinated biphenyl (PCB) exposure and impaired childhood intellectual functioning has been reported, but the potential impact of PCB exposure during adulthood on intellectual functioning has received little attention. We assessed the impact of PCBs and other fish-borne contaminants on intellectual functioning in older adults. The subjects were 49- to 86-year-old Michigan residents recruited from an existing cohort. Fish eaters ate > 24 lb of sport-caught Lake Michigan fish per year and non-fish eaters ate < 6 lb of Lake Michigan fish per year. A battery of cognitive tests including tests of memory and learning, executive function, and visual-spatial function was administered to 180 subjects (101 fish eaters and 79 non-fish eaters). Blood samples were analyzed for PCBs and 10 other contaminants. We evaluated cognitive outcomes using multiple regression. PCBs and dichlorodiphenyl dichloroethene (DDE) were markedly elevated in fish eaters. After controlling for potential confounders PCB, but not DDE, exposure was associated with lower scores on several measures of memory and learning. These included the Weschler Memory Scale verbal delayed recall (p = 0.001), the semantic cluster ratio (p = 0.006), and list A, trial 1 (p = 0.037), from the California Verbal Learning Test. In contrast, executive and visual-spatial function were not impaired by exposure to either PCBs or DDE. In conclusion, PCB exposure during adulthood was associated with impairments in memory and learning, whereas executive and visual-spatial function were unaffected. These results are consistent with previous research showing an association between in utero PCB exposure and impairments of memory during infancy and childhood.

Aged↗

PubMed2001

Executive and cognitive functions in patients with extreme obsessive-compulsive disorder treated by capsulotomy.

All patients treated with thermocapsulotomy for obsessive-compulsive disorder (OCD) at Karolinska Hospital between 1978 and 1990 were examined at follow-up with a comprehensive neuropsychological test battery. For comparative reasons the same test battery was applied to current patients with OCD, approved for capsulotomy. Both groups performed within the normal to subnormal range on most tests. In a subgroup of operated patients who did not complete all categories on the Wisconsin Card Sorting Test (WCST), there was a significant positive correlation between time elapsed after capsulotomy and number of categories completed on the WCST. The results would indicate that neuropsychological performance, in general, remains intact after capsulotomy. In some patients executive function is affected, but restoration may take place over time.

Adult↗