Abstract
Objective: To determine whether cognitive impairments in patients with Idiopathic Intracranial Hypertension (IIH) are correlated with changes in visual processing, weight, waist circumference, mood or headache, and whether they change over time.Methods: Twenty-two newly diagnosed IIH patients participated, with a subset assessed longitudinally at 3 and 6 months. Both conventional and novel ocular motor tests of cognition were included: Symbol Digit Modalities Test (SDMT), Stroop Colour and Word Test (SCWT), Digit Span, California Verbal Learning Test (CVLT), prosaccade (PS) task, antisaccade (AS) task, interleaved antisaccade-prosaccade (AS-PS) task. Patients also completed headache, mood, and visual functioning questionnaires.Results: IIH patients performed more poorly than controls on the SDMT (p< 0.001), SCWT (p = 0.021), Digit Span test (p< 0.001) and CVLT (p = 0.004) at baseline, and generated a higher proportion of AS errors in both the AS (p< 0.001) and AS-PS tasks (p = 0.007). Further, IIH patients exhibited prolonged latencies on the cognitively complex AS-PS task (p = 0.034). While weight, waist circumference, headache and mood did not predict performance on any experimental measure, increased retinal nerve fibre layer (RNFL) was associated with AS error rate on both the block [F(3, 19)=3.22, B = 0.30, p = 0.022] and AS-PS task [F(3, 20) = 2.65, B = 0.363, p = 0.013]. Unlike ocular motor changes, impairments revealed on conventional tests of cognition persisted up to 6 months.Conclusion: We found multi-domain cognitive impairments in IIH patients that were unrelated to clinical characteristics. Marked ocular motor inhibitory control deficits were predicted by RNFL thickness but remained distinct from other cognitive changes, underscoring the significance of visual processing changes in IIH.
Highlights
Idiopathic intracranial hypertension (IIH) is characterised by increased cerebrospinal fluid pressure with an unclear aetiology
We assessed cognitive changes in IIH using conventional neuropsychological measures and novel ocular motor tasks that examine visual processing changes associated with saccade generation [8]
Relationships were assessed between cognitive impairments and common co-morbid IIH features, such as headache, mood, weight, waist circumference and visual processing changes
Summary
Idiopathic intracranial hypertension (IIH) is characterised by increased cerebrospinal fluid pressure with an unclear aetiology. Whether cognitive changes are independent or a consequence of other features of the disorder, such as changes in visual processing, headache, mood disorders, weight and medication, is unknown. We assessed cognitive changes in IIH using conventional neuropsychological measures and novel ocular motor tasks that examine visual processing changes associated with saccade generation [8]. Ocular motor tasks were the simple prosaccade (PS) task, which requires a gaze shift toward a suddenlyappearing stimulus, reflecting simple sensorimotor processing, and the more complex antisaccade (AS) task that implicates cognitive networks required to inhibit a saccade toward a suddenly-appearing stimulus and move the eyes in the opposite direction [9]. Relationships were assessed between cognitive impairments and common co-morbid IIH features, such as headache, mood, weight, waist circumference and visual processing changes
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