Areas Of Cognitive Functioning Research Articles

The Minimum Data Set 2.0: a functional assessment to predict mortality in nursing home residents.

Measures of functional assessment, such as the Karnofsky Scale, the Modified ADL Scale, and the Descriptive Scale, have been used to predict appropriateness for hospice care. A tool is needed to assess functional status across all treatment settings, including acute care, long-term care, and hospice. The objective of this paper is to determine whether the Minimum Data Set, when utilized in conjunction with physical assessment tools to determine prognosis, is accurate in predicting short-term mortality in nursing home residents. The paper has been designed as a retrospective study of residents in 24 Minnesota nursing homes who were referred to a hospice program. The study included 199 patients from 30 to 107 years of age. Functional variables, as triggered by the Minimum Data Set, have a direct correlation to patient mortality within three months of the documented observation of the triggered variable, and are the main outcome measure. Of a total of 199 patients, 147 patients (74 percent) died within 15 days of a documented significant decline in the Minimum Data Set in areas of cognitive function, communication, activities of daily living, incontinence, and nutrition. Age, gender, diagnosis, and significant medical data received from the nursing home staff at the time of referral to hospice were applied to the Karnofsky Scale, the Modified ADL Scale, the Descriptive Scale, and the Minimum Data Set to determine if a resident assessment protocol (RAP) would be triggered by these data. The data were then analyzed to determine whether there existed a correlation between a significant change, as documented on the Minimum Data Set, and subsequent death of the patient. If there existed a correlation, the data were further studied to determine consistency in the categories of change that might demonstrate predictors of short-term mortality in nursing home residents. A decline in functional status, as documented on the Minimum Data Set 2.0 in the areas of cognitive functioning, communication, activities of daily living, incontinence, and nutrition, are strong predictors of short-term mortality in nursing home residents, independent of age, gender, and diagnosis.

The Mini-Mental State Examination (MMSE).

BEST TOOL: The Mini Mental State Examination (MMSE) is a tool that can be used to systematically and thoroughly assess mental status. It is an 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language. The maximum score is 30. A score of 23 or lower is indicative of cognitive impairment. The MMSE takes only 5-10 minutes to administer and is therefore practical to use repeatedly and routinely. TARGET POPULATION: The MMSE is effective as a screening tool for cognitive impairment with older, community dwelling, hospitalized and institutionalized adults. Assessment of an older adult’s cognitive function is best achieved when it is done routinely, systematically and thoroughly. VALIDITY/RELIABILITY: Since its creation in 1975, the MMSE has been validated and extensively used in both clinical practice and research.

Neuropsychological function in obstructive sleep apnoea.

Patients with obstructive sleep apnoea (OSA) experience neuropsychological deficits falling broadly into the four areas of daytime sleepiness, cognitive deficits, reduced driving competence and impaired psychosocial well-being. Case-control studies of daytime function in OSA patients generally indicate moderate to severe daytime sleepiness using polysomnographic or self-rating assessments. Cognitive performance on tests of attention and concentration ability, visuomotor and constructional skills, verbal fluency, planning and problem-solving, memory and executive function may be mildly to moderately impaired. These two symptoms may contribute to a road traffic accident rate in OSA between two and seven times higher than that of normals, and to the high prevalence of minor psychiatric morbidity, and reductions in functional and health status, among patients. The daytime impairments associated with OSA are improved by continuous positive airway pressure (CPAP) therapy, although a lack of complete normalization has been suggested for objective sleepiness and some areas of cognitive function. The severity of sleepiness and cognitive impairments show weak and moderate correlations with frequency of sleep-disordered breathing in clinical and epidemiological studies. Experimental and clinical evidence supports a role for nocturnal physiological events of OSA, arousals and hypoxaemia, in directly or indirectly producing neuropsychological deficits, particularly those of sleepiness and cognitive deterioration.

Anxiety, depression, psychotropic drug use and cognitive impairment.

Numerous studies have shown that anxiety and depression are related to cognitive impairment, but the concomitant association between anxious symptoms, depressive symptoms and cognitive function has not been investigated, and, most studies have not considered psychotropic drug use as a possible confounding factor. We assessed the independent association between depression, anxiety, psychotropic drug use and cognitive performance in 457 men and 659 women, aged 59-71 years living in the community. Data on demographic background, occupation, medical history, drug use and personal habits were obtained using a standardized questionnaire. The Spielberger Inventory Trait and the Center for Epidemiologic Study-Depression (CES-D) scales were used to evaluate anxious and depressive symptomatology respectively. Cognitive assessment included six traditional tests covering the main areas of cognitive functioning. In men, anxious and depressive symptomatologies had independent significant associations with most cognitive abilities, independent of psychotropic drug use. In women, the association between anxiety or depression and cognitive functioning was less strong and disappeared after adjustment for psychotropic drug use. Psychotropic drug use was associated with lower cognitive scores in both sexes. In men with high CES-D scores, we found positive correlations between anxiety level and cognitive scores. The study showed that anxiety, depression and psychotropic drug use were significantly and independently associated with cognitive functioning in elderly men. The high prevalence of psychotropic drug use in women with or without psychological disorders may explain its major effect in women. Results suggested that anxiety may partly compensate for some negative effects of depression on cognitive functioning.

Neuropsychological function and cerebral glucose utilization in isolated memory impairment and Alzheimers disease

We hypothesized that 20 patients with isolated memory impairment (IMI) would demonstrate [ 18 F]-2-fluoro-2-deoxy- d-glucose utilization and a progression of neuropsychological symptoms consistent with Alzheimers disease (AD). IMI subjects performed similarly to AD in recall and verbal fluency, but comparable to normal subjects in other areas of cognitive functioning. A positron emission tomography (PET) diagnostic index based on parietal Z-scores categorized IMI patients into normal and abnormal metabolic patterns. Ten of the original 20 IMI patients (50%) reflected PET AD abnormalities. Clinical information was available for IMI patients at three-year follow-up. Ten (50%) had converted to AD, three were found to have pseudodementia and the seven remained IMI. Of the 10 IMI patients with an originally normal PET index, three (30%) were diagnosed with AD at three years. Of the 10 with an abnormal index originally, seven (70%) converted to AD. The finding that memory deficit in IMI was as pronounced as that in AD patients is consistent with the notion that memory is an initial symptom of AD. A substantial number of the IMI patients reflected regional hypometabolism similar to AD, suggesting that IMI is likely an early stage in progressive dementia. A large percentage of IMI patients converted clinically to AD within three years of initial study, though we observed impaired memory functioning well before a clinical diagnosis of AD could be made. In addition to potential clinical utility, IMI and PET represent an opportunity to study dementia in relation to brain chemistry at a time when brain pathology is in the process of development.

Blood alcohol level and early cognitive status after traumatic brain injury

Statement of Purpose: This archival study sought to clarify the relationship between admission blood alcohol level (BAL) after traumatic brain injury (TBI) and subsequent neuropsychological functioning. It was hypothesized that BAL would be positively correlated with impairment on basic neuropsychological tests and that this relation would weaken as time since TBI increased.Methods: Fifty-eight patients were tested within 60 days of their TBI. Correlational analyses were used to test the relation between neuropsychological performance and admission BAL.Results: As expected, BAL was unrelated to demographic variables or lag time between TBI and time of testing. Bivariate correlations showed that higher BAL predicted poorer performance on a broad range of neuropsychological tests. Patients tested less than 30 days after their TBI showed the strongest effects.Conclusions: Neuropsychological impairments detected 1-2 months after TBI may be affected by BAL at the time of hospital admission. The influence of BAL seems greatest during the first month postinjury, but may persist beyond 30 days in some areas of cognitive function. Blood alcohol at the time of injury may have a direct effect on cognitive functioning or may be a proxy for the effects of chronic alcohol use or abuse. Clinical implications are discussed.

Identity processes and perceptions of physical functioning in adults: Theoretical and clinical implications.

The present research explores the relationship between identity and changes in physical functioning over the adult years. Adults from 40-95 years of age (N = 242) rated themselves in 20 areas of normative functioning and identity processes. The findings indicate that adults as young as 40 are sensitive to age-related changes. Those 65 and older exhibited greater sensitivity to changes in competence. Identity assimilation was used most by adults under 65, particularly in the area of cognitive functioning. For individuals in both age groups, identity assimilation was positively related to self-esteem. The findings suggest that individuals may make behavioral adjustments without ruminating or becoming preoccupied, a strategy that may promote healthy adaptation to the aging process. Clinical implications of these findings are examined. The construct of identity is used in the area of adult development and aging to refer to the

Sex differences in the association between alcohol consumption and cognitive performance. EVA Study Group. Epidemiology of Vascular Aging.

Heavy alcohol drinking is associated with cognitive impairment, but little is known concerning the cognitive effect of moderate alcohol consumption. The Epidemiology of Vascular Aging (EVA) Study is a longitudinal study of cognitive and vascular aging. Between June 1991 and June 1993, 1,389 subjects aged 59-71 years (574 men and 815 women) who had been recruited from the electoral rolls of Nantes, France, were examined. Trained psychologists administered a battery of 10 neuropsychological tests assessing most areas of cognitive functioning. Detailed information on alcohol intake was collected during a structured interview. A multiple linear regression model was used to examine the relations between test scores and alcohol consumption at baseline in men and women separately, controlling for age, education, income, depressive symptoms, and smoking status. Odds ratios for being a high cognitive performer (i.e., being in the top 10% of the distribution of summary scores from the neuropsychological battery) were calculated. Among men, neuropsychological test scores were not associated with alcohol consumption in either univariate or multivariate analysis; nor did the proportion of high cognitive performers vary by alcohol consumption. In contrast, among women, significant positive associations between alcohol consumption and cognitive performance were observed for most tests in multivariate analysis. For example, for the Mini-Mental State Examination, the adjusted mean score for female nondrinkers was 27.5 and that for the heaviest drinkers 28.2 (p < 0.001). The odds ratio for being a high cognitive performer was 2.5 (95% confidence interval 1.1-5.7) for women who usually consumed two or more drinks per day in comparison with nondrinkers. These findings suggest that, among women, moderate alcohol consumption may have a beneficial effect on cognitive function.

Uncoupling learning from initial recall: the relationship between speed and memory deficits in old age.

Nettelbeck & Rabbitt (1992) found that measures of speed of performance with low knowledge requirements (four-choice reaction time, inspection time and coding-substitution) accounted substantially for age-related changes among 104 persons aged from 54 to 85 years in a number of more complex cognitive measures reflecting general fluid ability. However, the numbers of words recalled from a list after either a single brief viewing of each word, or following a cumulative learning procedure across four trials, provided an exception to this general trend, leading to the conclusion that some aspects of memory may be independent of mental speed. A follow-up of 82 of the same people 18-20 months later was designed to partition performance in a similar cumulative learning procedure into an initial first recall component and a subsequent learning component. This was accomplished by fitting individual cumulative learning data with a hyperbolic power function which met the theoretical requirement of defining separate initial recall and learning parameters. These parameters were found to be independent and it was concluded that learning involved rehearsal, whereas first recall did not. The hyperbolic power function provided a good account for 92 per cent of individual cases. Analyses which combined Nettelbeck & Rabbitt's (1992) data with new measures confirmed the reliability of these authors' results. Furthermore, it was found that first recall, but not learning, was mediated by processing speed. Learning was relatively unaffected by age-related slowing in mental speed, suggesting that Nettelbeck & Rabbitt's results were the consequence of a strong rehearsal component in their memory tasks. Thus, while mental slowing is clearly one important aspect of cognitive decline during old age, it does not constitute a sufficient explanation for changes in all areas of cognitive functioning. Specifically, age-decline in rate of learning with rehearsal appeared to be independent of slowing in speed of information processing.

Cognitive effects of vigabatrin

Studies were reviewed in which patients who received vigabatrin underwent cognitive testing. The overall results were categorized into five areas of cognitive function: reception, attention, intellectual function, memory, and psychomotor function. Overall, the studies showed either no detrimental effects or, in some cases, slightly improved function. It is speculated that a relationship exists between GABA and the results of these studies because vigabatrin enhances the GABAergic mechanism in the CNS.

Psychometric characteristics of the Mini-Mental State Examination in a community population? A grade of membership analysis: Part I

The Mini-Mental State Examination (MMSE), a brief, widely used measure of cognitive status, was designed to assess functioning in five areas (orientation, registration, attention and calculation, recall and language). Using a grade of membership analysis, which does not rely on a multivariate normal distribution or assume an underlying continuum for dichotomously scored variables, we examined data from a sample of 1317 community residents 18 years of age and older who made two or more errors on the MMSE. Our findings suggest that for these primarily cognitively intact persons, the items of the MMSE varied in level of difficulty; multiple distinct areas of cognitive functioning were not identified. The results of confirmatory testing using clinic populations with cognitive deficit are given in the accompanying article.

Does education level determine the course of cognitive decline?

Many studies have implicated low education as a risk factor for cognitive impairment in elderly people. Findings are, however, inconsistent and the mechanism by which education level may intervene in senescent cognitive change is uncertain. The present study examines cognitive change over a 1-year period in 283 elderly persons manifesting recent subclinical deterioration in at least one area of cognitive functioning. The results suggest that the impact of both education level and young adult IQ on the degree of cognitive change over the year is greater in the older age groups. Secondary memory and language functions were found to be more resistant to decline in the high-education group, while attention, implicit memory and visuospatial skills are found to decline irrespective of education level.

Gender-related differences in spatial ability and the k factor of general spatial ability in a population of academically talented students

Spatial ability is an area of cognitive functioning in which evidence of gender-related differences in performance tends to emerge relatively often. Previous research has found, however, that different types of spatial tasks differ in their amounts of gender-sensitivity. Mental rotation tasks, for instance, have often shown large gender-related differences in favour of males, whereas there are small differences or advantages for females on visual memory tasks. Therefore, the present study examined the profile of differences across a wide array of types of spatial tasks. Two forms of a spatial test battery containing 14 types of items each were administered to academically talented middle and high school students. Factor analysis yielded a strong general factor (termed “ k factor”) underlying performance in both forms. The gender-sensitivity of the item types depended to a considerable extent on the loadings of the subtests on the k factor. When the k factor was partialled out of the variances of the tests, gender-related differences on the various types of items were reduced, often to insignificance, and some tests that had initially exhibited little gender-related variance showed advantages for females. Mental rotation and visualization of perspectives, however, consistently showed substantial gender-related variance beyond the variation explained by the k factor.

A comparison of characteristics of patients with completed stroke: those who achieve continence and those who do not.

The purpose of this retrospective study was to compare the demographic, neurologic, and cognitive characteristics of patients with completed stroke who participated in a behavioral management program for urinary incontinence. The study sought to determine the differences between those patients who achieved continence by the time of discharge from the program and those who did not. A retrospective chart review that used the Functional Independence Measure (FIM) scores identified 75 subjects with urinary incontinence at the time of admission. Forty-two study subjects achieved continence after participating in a rehabilitation and bladder management program. Thirty-three study subjects remained incontinent despite participation in a rehabilitation and bladder management program. Incontinent subjects had more difficulty with orientation to time, memory, and problem solving. These areas of cognitive function appear to have a direct impact on the ability of the person with stroke to achieve continence.

NEUROPSYCHOLOGICAL DIFFERENCES BETWEEN SONS OF ACTIVE ALCOHOLIC AND NON-ALCOHOLIC FATHERS

Ten- to fourteen-year-old sons of active alcoholic fathers (n = 59) with a positive family history of alcoholism (AFH+) and sons of social drinker fathers (n = 58) with a negative family history of alcoholism (NFH-) were administered a battery of neuropsychological tasks. Areas of cognitive function which were assessed were memory, visuospatial and attentional abilities and, in addition, motor skills and general intellectual functioning. MANOVAs conducted on these measures showed that sons of active alcoholic fathers' performance on the more difficult visuospatial and memory tasks as well as on an attentional test was reduced relative to sons of non-alcoholic fathers.

Neuropsychologic effects of cranial irradiation, intrathecal methotrexate, and systemic methotrexate in childhood cancer.

To investigate the neuropsychologic effects of cranial irradiation (CRT), intrathecal methotrexate (IT-MTX), and systemic methotrexate (SYS-MTX) in a cohort of pediatric patients with cancer who had either received no, moderate, or high doses of these treatments alone or in various combinations. Data were collected on 120 pediatric cancer patients from a large variety of diagnostic groups. Patients completed a comprehensive neuropsychologic test battery designed to assess most areas of cognitive functioning. In analyzing cancer treatment effects, the following variables were statistically controlled: (1) age, (2) socioeconomic status (SES), (3) age at diagnosis, (4) months since both onset and cessation of CNS treatments, (5) time missed from schooling, and (6) presence/type of CNS cancer. CRT, largely in combination with IT-MTX, was significantly associated with deficits in several, primarily nondominant, hemispheric neuropsychologic functions, even after control and other treatment variables were addressed. This relationship was somewhat, but not highly, dose-dependent at CRT doses greater than approximately 18 Gy, at least over the first several years posttreatment. While there was statistically significant evidence for cognitive impairment, absence from school during treatment and age at diagnosis were more predictive of reading and spelling academic achievement than having received CRT. IT-MTX and SYS-MTX alone were not associated with significant degrees of neuropsychologic involvement. CRT, especially when administered with IT-MTX, at currently used dosages was associated with significant neuropsychologic impairment in children. These impairments are most likely to be reflected in nonverbal intelligence, perceptual abilities, and susceptibility to distraction. IT-MTX and SYS-MTX did not result in a consistent pattern of cognitive deficit.

Genoptræning af personer med arbejdsbetingede hjerneskader efter opløsningsmiddel-eksponering

This study examines the effects of an intensive therapeutic and cognitive retraining program for brain impaired patients. The subjects consisted of 20 patients with chronic brain damage due to solvent exposure. Before the treatment all subjects completed an extensive neuropsychological evaluation. The patients were re-evaluated after three months of intensive treatment, and again three months and one year after the rehabilitation. The results of the intensive therapeutic and cognitive retraining showed significant improvement in some areas of cognitive functioning as determined by comparison of post-treatment neuropsychological data with initial evaluation results. The result of intensive treatment shows improvement in psychomotor speed and categorization. There was only minor change in personality function measured by MMPI, but a clear reduction in stress reaction.

The ability of the Dementia Rating Scale to predict everyday functioning

The Dementia Rating Scale (DRS) is a brief neuropsychological assessment battery designed to assess five areas of cognitive functioning in the elderly. The relationship between DRS performance and everyday functioning was examined for 50 psychogeriatric patients. Everyday functioning was assessed with a standardized performance measure examining self-care, safety, money management, cooking, medication administration, and community utilization. Regression analyses were conducted for each of the six functional domains. In addition, correlations between the DRS subscales and the functional areas were computed. Results revealed significant predictive relationships (p <.01) between performance on the DRS and most functional domains. The multiple Rs ranged from .52–.70, accounting for 27% to 49% of the variance. The Initiation/Perseveration subscale was most heavily weighted in each analysis. Significant correlations were obtained between subdomains of cognition and most functional areas. The findings provide evidence of relationships between DRS performance and functional ability.

Abnormal cranial magnetic resonance imaging scans in sickle-cell disease. Neurological correlates and clinical implications.

Eight asymptomatic patients with sickle-cell disease (SCD) with magnetic resonance imaging (MRI) abnormalities consistent with cerebral infarcts (group 1) and eight asymptomatic patients with SCD with normal MRI scans (group 2) were followed up to assess the neurological correlates and the clinical outcome. Patients in the two cohorts underwent clinical evaluations and xenon 133 regional cerebral blood flow (rCBF) studies within 1 month of the entry MRI. This study sequence was repeated up to 5 years later. Neuropsychological studies also were performed in six group 1 patients and eight group 2 patients at the end of the study. The patients were recruited from the Comprehensive Sickle Cell Center at Columbia University, New York, NY. All patients had SCD, hemoglobin SS, and normal findings on clinical evaluation at entry. The group 1 cohort had clinically silent MRI abnormalities consistent with cerebral infarction. The group 2 cohort was age matched to group 1 and had normal MRI studies. None. The natural history of MRI abnormalities and the neurological correlates were assessed to determine the predictive value of subclinical MRI lesions as a risk factor for clinically apparent stroke. The mean duration of MRI follow-up was 3.7 years. In group 1, four patients (50%) demonstrated progressive MRI abnormalities and three patients (38%) became clinically symptomatic. In group 2, findings for all patients remained normal on clinical and radiological examination. Both groups had markedly elevated rCBF values. Individual rCBF differences correlated with the specific MRI abnormalities. The psychometric study results were similar in the two cohorts. Eighty-three percent of group 1 and 88% of group 2 patients had defective scores in one or more areas of cognitive functioning. Three patients met cognitive criteria for dementia. Cranial MRI abnormalities have important prognostic implications even when detected in clinically asymptomatic patients. Cognitive abnormalities exist in patients with SCD even in the absence of MRI abnormalities or clinical stroke.

Validity and reliability of the revised neuropsychological impairment scale (NIS)

The revised Neuropsychological Impairment Scale (NIS) is a 95-item, self-reporting screening measure of neuropsychological symptoms. The present report examines the concurrent validity and test-retest stability of the NIS with a neurologically stable sample. The validation study found higher than chance correlations between the NIS and the validity battery and higher correlations with tests that are more sensitive to cognitive impairment. Results also suggest that patients may have more accurate awareness of certain areas of cognitive functioning (academic skills, speech/language functioning) than others (memory, attention, higher level problem-solving). High stability correlations over 2 to 3 months suggest that the NIS measures persisting characteristics rather than temporary states.