Assessment Of Neuropsychological Testing Research Articles

Cognitive profile of kidney transplant patients and impact of deceased vs. living donor transplantation.

It is important to learn more about the prevalence, severity and characteristics (i.e., which cognitive abilities are especially affected) of cognitive impairment in kidney transplant patients. Furthermore, the impact of living vs. deceased donor renal transplantation on cognitive outcome in this patient groupneeds further studies. Fifty-nine patients (43 men, age 55 ± 13years) who received a deceased donor or living donor kidney transplant, completed a comprehensive neuropsychological test assessment. Neuropsychological tests explored the cognitive domains of verbal and visual memory, attention, and executive functions. Fifteenpercent of the patients had mild, 25% moderate, and 15% severe cognitive impairment. The level of domain-specific cognitive deficit differed between verbal memory, attention, and executive functions (χ2(2) = 7.11, p = 0.029). On average, patients showed the highest deficit in executive functions, and the lowest deficit in verbal memory. Patients who received a kidney graft from a deceased donor were more likely to have a cognitive impairment than those who received a kidney graft from a living donor (OR = 3.03, 95% CI [0.99,9.32], Wald χ2(1) = 3.74, p = 0.053). This effect was independent of time on dialysis as well as of creatinine levels, or creatinine clearance. Our results show that in kidney transplant patients with cognitive impairment, the cognitive domain of executive functions is the most affected one. This might be detrimental for quality of life. The fact that patients who received living donor kidneys seem to do better in terms of cognition than patients with deceased donor kidneys deserves more attention in future research.

Risk Polymorphisms of FNDC5, BDNF, and NTRK2 and Poor Education Interact and Aggravate Age-Related Cognitive Decline.

Cognitive abilities tend to decline with aging, with variation between individuals, and many studies seek to identify genetic biomarkers that more accurately anticipate risks related to pathological aging. We investigated the influence of BDNF, NTRK2, and FNDC5 single nucleotide polymorphisms (SNPs) on the cognitive performance of young and older adults with contrasting educational backgrounds. We addressed three questions: (1) Is education associated with reduced age-related cognitive decline? (2) Does the presence of SNPs explain the variation in cognitive performance observed late in life? (3) Is education differentially associated with cognition based on the presence of BDNF, NTRK2, or FNDC5 polymorphisms? We measured the cognitive functions of young and older participants, with lower and higher education, using specific and sensitive tests of the Cambridge Automated Neuropsychological Test Assessment Battery. A three-way ANOVA revealed that SNPs were associated with differential performances in executive functions, episodic memory, sustained attention, mental and motor response speed, and visual recognition memory and that higher educational levels improved the affected cognitive functions. The results revealed that distinct SNPs affect cognition late in life differentially, suggesting their utility as potential biomarkers and emphasizing the importance of cognitive stimulation that advanced education early in life provides.

Everyday memory in patients with depression: An explorative pilot study using an ecological assessment paradigm

Background People with major depressive disorder (MDD) often experience significant memory problems in their daily lives, which, however, frequently do not correspond to standardized memory test (SMT) results. The present pilot study aimed to examine the everyday memory performance of people with MDD by means of an ecological assessment paradigm (EAP). Methods Participants were unexpectedly called one week after their neuropsychological test assessment and asked about their memories of specific details of the former test situation. Associations of this EAP with SMT, subjective everyday memory problems, and symptom coping were exploratively analyzed. Results The study involved 22 MDD inpatients (M = 42.5 years, 64% female) and 22 comparable healthy control persons. MDD patients showed a significantly reduced performance in the EAP as well as in the SMT and they reported more memory problems in their daily lives. However, the EAP was not related to SMT results assessed a week before. Moreover, only the EAP was significantly associated with subjective daily memory problems and (distraction) coping style in the MDD group. Conclusions The EAP appears to better reflect the everyday memory problems of persons with depression than standardized test procedures. However, the findings need to be validated by further research with larger samples.

Association of Subjective Memory Complaints With White Matter Hyperintensities and Cognitive Decline Among Older Adults in Chicago, Illinois

ImportanceSubjective memory complaints (SMCs) are associated with a faster cognitive decline; whether this association is also associated with structural brain alterations, such as white matter hyperintensity (WMH) volumes, requires investigation.ObjectiveTo evaluate the association of SMCs with WMH volumes and cognitive decline and investigate the role of WMH volumes in the association between SMCs and cognitive decline.Design, Setting, and ParticipantsThe Chicago Health and Aging Project, a population-based cohort study, enrolled adults aged 65 years or older. Data collection occurred in 3-year cycles from 1993 until 2012. Our study comprised 975 participants with magnetic resonance imaging assessments, of which 900 participants had data on SMCs and covariates, and 713 participants provided 2 or more cognitive assessments during the follow-up. Statistical analyses were conducted from May to October 2021.ExposuresSMCs were obtained from self-reported questionnaire data during clinical evaluations, and the cycle, when reported, constituted the baseline of our study. Based on the frequency and severity of concerns, we categorized participants into 3 groups, (1) no concerns, (2) moderate concerns, and (3) very worried.Main Outcomes and MeasuresVolumetric magnetic resonance imaging measures of WMH volume and neuropsychological testing assessments of global cognition. Linear regression analysis was used to investigate the association between SMCs and WMH volumes in a multivariable model adjusted for age, sex, race and ethnicity, education, APOE4 status, and total intracranial volume. The association of SMCs with cognitive decline was investigated using linear mixed-effects models for age, sex, race and ethnicity, education, APOE4 status, follow-up time, and each variable in interaction with time to estimate the annual longitudinal change in cognitive function.ResultsOf the 900 participants with data on SMCs, covariates, and WMH volumes, 553 (61.4%) were women, 539 (59.9%) were African American, and the mean (SD) age was 79.5 (6.2) years. SMCs were associated with a larger WMH volume and faster cognitive decline. Compared with participants with no concerns, participants who were very worried had higher WMH volumes (β = 0.833; 95% CI, 0.203-1.463) and 174% faster cognitive decline (β = −0.049; 95% CI, −0.076 to −0.022). The association between SMCs and cognitive decline remained statistically significant among individuals with large WMH volumes (ie, within the fourth quartile). Within the fourth quartile of WMH volumes, participants who were very worried had 428% faster cognitive decline (β = −0.077; 95% CI, −0.144 to −0.011) compared with participants with no concerns.Conclusions and RelevanceThis cohort study suggests that SMCs, frequently reported by older individuals, are an important sign of cognitive impairment, especially among people with abnormalities in brain structure, such as larger WMH volumes.

Executive function, attention, and memory deficits in antisocial personality disorder and psychopathy

Antisocial personality disorder (ASPD) and psychopathy attempt to represent individuals demonstrating callousness and disregard for others. ASPD has been criticized for capturing a heterogeneous population whilst missing the essence of the diagnosis by neglecting interpersonal/affective deficits which measures of psychopathy include. This heterogeneity in operationalizations has led to diverse findings without clear understanding of what characterizes this broader population. This study sought to clarify the neuropsychological profiles of ASPD and psychopathy. The Cambridge Neuropsychological Test Assessment Battery was administered to 85 adult male offenders in a personality disorder secure service and to 20 healthy controls. Of patients with ASPD, 46% met criteria for psychopathy. Of those with psychopathy, 89% met criteria for ASPD. There were two sets of comparisons: ASPD versus other personality disorders versus controls and psychopathy versus other personality disorders versus controls. ASPD showed deficits across executive functions, visual short-term and working memory, and attention (compared with controls). Psychopathy showed deficits limited to attention, complex planning, inhibitory control, and response reversal. Response reversal and visual search deficits appeared specific to ASPD and psychopathy versus other personality disorders and may underpin antisocial traits. Additional deficits in inhibitory control and working memory appeared to distinguish ASPD from other personality disorders.

Lifestyle factors associated with cognitive functioning in breast cancer survivors

Weight, physical activity, and sleep are modifiable lifestyle factors that impact cognitive functioning in noncancer populations but have yet to be examined in cancer survivors. The aim of the study was to assess the relationship of obesity, physical activity, and sleep, with cognitive functioning among breast cancer survivors. Participants were 136 early-stage postmenopausal breast cancer survivors who completed an assessment of neuropsychological testing, height, weight, physical activity, and sleep. Linear regression models examined the associations of the seven neuropsychological domains with obesity, physical activity, and sleep. Logistic regression models examined odd of impairment in each domain. All models controlled for breast cancer treatment variables and relevant demographic and clinical variables. Obese participants had significantly worse performance (β = -5.04, standard error (SE) = 2.53) and were almost three times more likely to be impaired (odds ratio (OR) = 2.87; 95% CI: 1.02-8.10) on the Information processing domain. The highest tertile of physical activity was significantly related to better performance on the executive functioning domain (β = 5.13, SE = 2.42) and attention domain (β = 4.26, SE = 2.07). The middle tertile of physical activity was significantly related to better performance (β = 9.00, SE = 3.09) and decreased odds of impairment (OR = 0.89, 95% CI: 0.07-0.91) on the visual-spatial domain. More hours of sleep per night was significantly associated with better performance (β = 2.69, SE = 0.98) and decreased odds of impairment (OR = 0.52; 95% CI: 0.33-0.82) on the verbal functioning domain. These findings suggest that obesity, physical activity, and sleep are related to cognitive functioning among breast cancer survivors and have potential to be intervention targets to improve cognitive functioning.

Omega-6 to omega-3 fatty acid ratio and higher-order cognitive functions in 7- to 9-y-olds: a cross-sectional study

Biochemical and behavioral evidence has suggested that the ratio of n-6 (omega-6) to n-3 (omega-3) could be an important predictor of executive function abilities in children. We determined the relation between the ratio of n-6 to n-3 and cognitive function in children. We hypothesized that children with lower ratios of n-6 to n-3 fatty acids would perform better on tests of planning and working memory. Seventy 7- to 9-y-old children completed three 24-h diet recalls and a subset of the Cambridge Neuropsychological Test Assessment Battery. Parents provided information on their demographics and children's diet histories. Mean n-3 and mean n-6 intakes were related to the mean time spent on each action taken in the planning problem. The ratio of n-6 to n-3 significantly predicted performance on the working memory and planning problems. There was a significant interaction between the ratio and fatty acid intake; when children had high ratios, a higher intake of n-3 fatty acids predicted a better performance on the planning task than when children had lower n-3 intakes. When children had low ratios, a lower intake of n-3 and lower intake of n-6 predicted better performance than when intakes were higher. The relation between cognitive abilities and the ratio of n-6 to n-3 may be mediated by an enzymatic affinity for n-3 fatty acids. The ratio of n-6 to n-3 should be considered an important factor in the study of fatty acids and cognitive development. This trial was registered at clinicaltrials.gov as NCT01823419.

Cognitive and behavioural predictors of survival in Alzheimer disease: results from a sample of treated patients in a tertiary‐referral memory clinic

This study examined the influence of cognitive and non-cognitive factors at the time of diagnosis on the survival of patients with treated probable Alzheimer Disease (AD). Consecutive patients seen at a regional, tertiary-referral clinic completed a battery of cognitive tests and assessments of activities of daily living and neuropsychiatric symptoms. These clinic data were linked with death certificate data for all individuals and survival from diagnosis was calculated. Cox regression models were constructed using the baseline covariates. The sample comprised 653 patients (459 women), mean age 77.1 years (SD 7.6, range 48-94 years), diagnosed with probable AD and treated with a cholinesterase inhibitor. In the survival analysis, age was a consistently significant predictor of survival with a gender-adjusted hazard ratio of 1.35 (95% CI 1.23, 1.48) for one standard deviation increase in age. Men were at greater risk of death than women (age-adjusted HR 1.44, 95% CI 1.19, 1.73). In a model adjusted for all study variables, Paired-Associate Learning (Cambridge Automated Neuropsychological Test Assessment Battery) and the psychotic factor of the Neuropsychiatric Inventory were significant predictors of survival. At diagnosis, in addition to the anticipated impact of age and gender, the presence of psychotic symptoms and poor performance on paired-associate learning are also indicators of poor prognosis.

The Association of Magnetic Resonance Imaging Measures With Cognitive Function in a Biracial Population Sample

White matter hyperintensity volume (WMHV), cerebral infarcts, and total brain volume (TBV) are associated with cognitive function, but few studies have examined these associations in the general population or whether they differ by race. To examine the association of WMHV, cerebral infarcts, and TBV with global cognition and cognition in 5 separate domains in a biracial population sample. A biracial community population of Chicago, Illinois. Cross-sectional population study. The study population comprised 575 participants from the Chicago Health and Aging Project (CHAP). Volumetric magnetic resonance imaging (MRI) measures of WMHV, TBV, and cerebral infarcts and detailed neuropsychological testing assessments of global cognition and 5 cognitive domains. Overall and among those without dementia, cognition was inversely associated with WMHV and number of infarcts but was positively associated with TBV. When all 3 measures were simultaneously added to the model, the association of global cognition with WMHV and TBV remained significant and unchanged but was no longer significant with infarcts. Among subjects without dementia, all 3 MRI measures were associated with performance in multiple cognitive domains, specifically perceptual speed. However, among subjects with dementia, only TBV was associated with cognition and performance in multiple cognitive systems. Race did not significantly modify any of these associations. In this biracial general population sample, the associations of MRI measures with cognition differed according to clinical status of subjects (stronger among subjects without dementia) and were not modified by race. These associations did not affect all cognitive domains equally but were more consistent with impairments in perceptual speed.

Assessment of neuropsychological testing

Response from the Panel: We thank the neuropsychologists who wrote in response to Assessment: Neuropsychological testing of adults. Considerations for The correspondence indicates that this is an important area of dialogue between neurologists and neuropsychologists, and we are pleased that the Assessment stimulated this exchange of ideas as well as provided guidance to neurologists regarding neuropsychological evaluations. It was not our intention to undermine relationships between neurologists and neuropsychologists as suggested in several of the letters; we regard the collaboration of these two specialties as so integral that it can easily withstand critical examination. The dialogue is also timely because consulting relationships are being affected by an increasing emphasis on evidence-based medicine, the importance of outcome assessments as a means of guiding health services delivery, decreasing use of specialty services, and the need for cost containment. In this response, we reiterate the purpose and development of the Assessment and respond to the letters received. The purpose of the Assessment is to aid neurologists who consult neuropsychologists in the course of caring for patients with known or suspected brain disorders. The Assessment described both the role and the limitations of neuropsychological testing in neurologic practice based on the available evidence. We did not address the many valuable contributions that neuropsychology has made to understanding the effects of brain disease on behavior. These contributions are impressive but are of limited importance in determining whether a neuropsychological consultation is needed and in aiding a neurologist in caring for the patient. The neuropsychological assessment was initiated by the Therapeutics and Technology Assessment (TTA) Subcommittee of the American Academy of Neurology(AAN) because neuropsychological assessment is a common consultation made by neurologists and one for which re-examination might improve its utility for neurologists. The panel facilitator (Dr. Cummings) identified an expert panel to develop the …

A prospective evaluation of changes in neuropsychological and liver function tests following transjugular intrahepatic portosystemic stent-shunt

Background/Aims: This study was designed to assess changes in: (a) neuropsychological tests, measures of memory, quality of life and scores for anxiety and depression; (b) liver function tests; and (c) the relationship between these following transjugular intrahepatic portosystemic stent-shunt. Methods: Twenty-nine patients undergoing transjugular intrahepatic portosystemic stent-shunt for recurrent variceal haemorrhage, 12 matched patients with cirrhosis and variceal haemorrhage manage with variceal band ligation and 16 normal controls were studied. Patients in any of the groups who were clinically encephalopathic were excluded from the study. Serial changes in the conventional liver function tests and Indocyanine green clearance, and psychometric function (Hospital Anxiety Depression Scale, Rivermead Behavioral Memory Test, Quality of Life and the memory and reaction sub-tests of the Cambridge Automated Neuropsychological Test Assessment Battery) were measured prior to and 1, 3, 9 and 15 months following transjugular intrahepatic portosystemic stent-shunt. Results: Over a mean follow up of 9.1 months in the transjugular intrahepatic portosystemic stent-shunt group (range 3–28), one patient (3%) developed clinically detectable encephalopathy. Sixty-seven percent of patients with cirrhosis showed evidence of subclinical encephalopathy as compared with the control population. Significant deterioration occurred in the reaction sub-tests of the Cambridge Automated neuropsychological Test Assessment Battery in patients, both in the transjugular intrahepatic portosystemic stent-shunt group and the controls with cirrhosis, during follow up. Transjugular intrahepatic portosystemic stent-shunt was followed by significant deterioration in levels of anxiety and psychological component of the quality of life. The Rivermead Behavioural Memory Test and the memory sub-test of the Cambridge Automated Neurpsychological Test Assessment Battery did, however, improve significantly at 1 and 15 months after transjugular intrahepatic portosystemic stent-shunt, respectively. Serum alanine aminotransferase, bilirubin and indocyanine green clearance deteriorated significantly following transjugular intrahepatic portosystemic stent-shunt ( p<0.001, p<0.001 and p<0.0001, respectively). Significant correlation was observed between changes in the indocyanine green clearance and changes in the complex and simple reaction time subtests of the Cambridge Automated Neuropsychological Test Assessment Battery ( r=0.6 and r=0.66, respectively). Conclusions: The results of this study showed that about 67% of patients with cirrhosis were subclinically encephalopathic and that temporary deterioration occurred in the Cambridge Automated Neuropsychological Test Assessment Battery during follow up, both in patients having transjugular intrahepatic portosystemic stent-shunt and in the controls with cirrhosis. These parallel the changes in the liver function tests and indocyanine green clearance. Temporary deterioration was also observed in the Quality of Life and Hospital Anxiety Depression Scale in the transjugular intrahepatic portosystemic stent-shunt group, although the measures of memory improved. Further studies should address the biochemical mechanisms of these changes and the role of prophylactic measures.

Univariate Vs. Multivariate Analysis in Neuropsychological Test Assessment of Lateralized Brain Damage

This study compared univariate with multivariate statistical procedures in regard to accuracy of prediction of lateralization of brain lesions. Utilizing measures derived from the Halstead Neuropsychological Test Battery, the Wechsler Adult Intelligence Scale, and other neuropsychological tests, discrimination was attempted through single test score t test analysis, utilization of factor scores, and discriminant function analysis. Subjects consisted of 26 patients with left hemisphere and 22 patients with right hemisphere lesions. It was found that while the single variable and factor score methods did not differ substantially from each other in predictive power, the discriminant analysis method was clearly superior. The conclusion was reached that cerebral lateralization is a complex phenomenon that is best approached by multivariate methods rather than by attempting to conceptualize it through some single test or principle.