Abstract
ObjectiveOur objective was to use episodic memory and executive function tests to determine whether or not Chiari Malformation Type I (CM) patients experience cognitive dysfunction.BackgroundCM is a neurological syndrome in which the cerebellum descends into the cervical spine causing neural compression, severe headaches, neck pain, and number of other physical symptoms. While primarily a disorder of the cervico-medullary junction, both clinicians and researchers have suspected deficits in higher-level cognitive function.Design and MethodsWe tested 24 CM patients who had undergone decompression neurosurgery and 24 age- and education-matched controls on measures of immediate and delayed episodic memory, as well as three measures of executive function.ResultsThe CM group showed performance decrements relative to the controls in response inhibition (Stroop interference), working memory computational speed (Ospan), and processing speed (automated digit symbol substitution task), but group differences in recall did not reach statistical significance. After statistical control for depression and anxiety scores, the group effects for working memory and processing speed were eliminated, but not for response inhibition. This response inhibition difference was not due to overall general slowing for the CM group, either, because when controls' data were transformed using the linear function fit to all of the reaction time tasks, the interaction with group remained statistically significant. Furthermore, there was a multivariate group effect for all of the response time measures and immediate and delayed recall after statistical control of depression and anxiety scores.ConclusionThese results suggest that CM patients with decompression surgery exhibit cognitive dysfunction compared to age- and education-matched controls. While some of these results may be related to anxiety and depression (likely proxies for chronic pain), response inhibition effects, in particular, as well as a general cognitive deficit persisted even after control for anxiety and decompression.
Highlights
Chiari Malformation Type I (CM), affecting approximately 300,000 individuals in the USA, is approximately as common as multiple sclerosis (MS).[1,2] CM is a clinical syndrome in which the cerebellar tonsils are displaced/descend by 5 mm or greater caudal to the foramen magnum[3,4] (Figure 1)
There was a multivariate group effect for all of the response time measures and immediate and delayed recall after statistical control of depression and anxiety scores. These results suggest that CM patients with decompression surgery exhibit cognitive dysfunction compared to age- and education-matched controls
While some of these results may be related to anxiety and depression, response inhibition effects, in particular, as well as a general cognitive deficit persisted even after control for anxiety and decompression
Summary
Chiari Malformation Type I (CM), affecting approximately 300,000 individuals in the USA, is approximately as common as multiple sclerosis (MS).[1,2] CM is a clinical syndrome in which the cerebellar tonsils are displaced/descend by 5 mm or greater caudal to the foramen magnum[3,4] (Figure 1). While headache and neck pain are the most common symptoms in CM [5], CM patients may show motoric and cognitive symptoms [3,6], studies using precise tests of these potential cognitive deficits are uncommon. Anxiety and depression were measured and used as covariates. Note that this argument does require certain assumptions. If we can show that anxiety and depression are significantly correlated with pain in CM patients, it seems reasonable to use this as a starting place for separating pain-related and other predictors of potential cognitive deficits in CM. CM is a neurological syndrome in which the cerebellum descends into the cervical spine causing neural compression, severe headaches, neck pain, and number of other physical symptoms. While primarily a disorder of the cervico-medullary junction, both clinicians and researchers have suspected deficits in higher-level cognitive function
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