Attention Subtests Research Articles

QOL-07. EFFICIENT NEUROPSYCHOLOGICAL ASSESSMENT IN PATIENTS WITH BRAIN TUMORS AND ACUTE LYMPHOBLASTIC LEUKEMIA

Abstract BACKGROUND Children treated for cancer may experience a decline in performance for a variety of reasons, one of which is the impact of treatment. Children treated for leukemias and brain tumours are at the highest risk of developing neurocognitive sequale (Daly and Brown, 2015). METHODS In our study we used Bayesian regression to identify assessment tools that would best predict the sequale of brain tumors (BT) and acute lymphoblastic leukemia (ALL) in children and adolescents. Using data from 15 patients with BT, 15 patients with (ALL) and 9 siblings controls we compared the predictive validity of the Wechsler Intelligence Scales for Children (WISC-V), Delis-Kaplan Executive Function System (D-KEFS), Continuous Performance Test (CPT-3), the Developmental Neuropsychological Assessment (NEPSY-II) and the parent and teacher report forms of the Achenbach Assessment System (ASEBA). RESULTS We found that the best predictors of ALL were d’ scores on the CPT (BF = 20.69, pd =.05) and CPT ommission scores (BF = 17.50, pd =.05), while the best predictor a BT was the WISC-IV Coding subtest (BF = 21.17, pd =.05) in addition to CPT omission scores (BF = 12.00, pd =.08) and HRT SD scores (BF = 11.91, pd =.08). CPT d’s scores were also predictive of Methotrexate treatment (MTX) (BF = 32.61, pd = 0.03), as were WISC-V Symbol Search scores (BF = 32.61, pd = 0.03) and the NEPSY-II Auditory Attention subtest (BF = 26.06, pd = 0.04). We also noted differential sensitivity of the ASEBA teacher report form for detecting deficits identified during the neuropsychological assessment. CONCLUSIONS We feel our findings will, together with previous meta-analyses, contribute to more efficient neuropsychological assessment in patients with BT and ALL. Neuropsychological asseessment is vital for identifying potential sequale of disease and treament in pediatric oncology.

Association between ApoE ε4 genotype and attentional function in non-demented, middle-aged, and older adults from rural India.

Several genetic factors have been associated with cognitive decline in aging. Apolipoprotein E (ApoE) ε4 has been widely studied in the risk for pathological cognitive decline, including dementia. However, the association between ApoE ε4 and cognitive functioning in the healthy aging Indian population has been understudied, and the results are ambiguous. This study aims to examine the role of the ApoE genotype with attentional function in aging adults (≥45 years) in a rural Indian population. Cross-sectional (baseline) data (n = 2100) was utilized from an ongoing longitudinal cohort study on aging (Srinivaspura Aging, Neurosenescence, and Cognition study). Participants hailed from villages of Srinivaspura in Karnataka, southern India. Participants were categorized based on ApoE-ε4 status into three categories: No ε4, heterozygous ε4, and homozygous ε4. Attentional function was assessed using the auditory and visual attention subtests from a computerized neurocognitive test battery. Linear regression was performed adjusting for age, gender, and education. In model 1 (unadjusted), we did not find an association between ApoE and attention function. In the partially adjusted model 2 (adjusting for age), ApoE ε4 with age was significantly associated with the attention function. Further, with increasing age, there was a decline in attention among homozygous ε4 individuals. Model 3 (model 2 + gender) found that ApoE ε4, age, and gender explained a significant variance in attention function. In addition, with increasing age, males had poor attention in the homozygous as compared to heterozygous group. Model 4 (model 3+ education) explained a significant variance in attention and also revealed that with increasing age, attention declined in the illiterate and low literacy groups in both homozygous and heterozygous groups among both genders. Although ApoE ε4 alone was not associated, it interacted with age, gender, and education to affect attention function in this rural Indian population. Longitudinal cognitive monitoring will yield insights into understanding whether the ApoE ε4 genotype influences the rate of cognitive decline in this rural, aging population.

16 The Multicultural Neuropsychological Scale (MUNS): The New Attention Subtest, Preliminary Cross-Cultural Data

Objective:The MUNS is a screening scale developed in Cordoba, Argentina (2018). It is devised with multicultural stimuli that are easily translated into different languages. The scale consists of seven subtests evaluating five cognitive domains: attention, memory, executive functioning, constructional praxis, and language. Previous cross-cultural studies with this scale found significant differences in performance on the attention subtest. The authors have developed a new attention subtest called “Arrows Cancellation”, a short cancellation test designed to overcome its predecessor’s shortcomings. The minimum score of this subtest is 0, and the maximum score is 160. It takes between 3 to 5 minutes to administer. A pilot study of this subtest was performed in Argentina in 2021 (n=62, M=105.61 ± 15.06). The aim of this study is to present the first cross-cultural comparison for the Arrows Cancellation subtest of the MUNS.Participants and Methods:Argentinian (n=25, 84% female) and U.S.A. (n=39, 87% female) samples were administered the Arrows Cancellation subtest. In both cases, individuals gave their consent to participate voluntarily in this study. Participants’ health backgrounds, explored through a set of questions, determined their inclusion in the study. Participants with any of the following diagnoses were excluded from this sample: stroke, loss of consciousness (at least 20 minutes), traumatic head injury, central nervous system disease, chronic renal insufficiency, hepatic encephalopathy, non-treated thyroid disease, epilepsy, non-treated high blood pressure, severe cardiac failure, severe sleep disorders, coma, diagnosed psychiatric disease, or illegal drug consumption. Argentinians were given the instructions in Spanish whilst Americans were instructed in English. The mean age for the Argentinian sample was 21.24 ± 2.44, and for the American sample it was 20.18 ± 1.89. The mean years of education was 13.44 ± 0.96 for the Argentinian group and 13.6 ± 1.55 for the American group. A t-test showed that there were no significant differences in age (p=.06), years of schooling (p=.67) between both samples.Results:The mean score of the Arrows Cancellation subtest for the Argentinian sample was 107.30 ± 14.51 and 108.95 ± 14.12 for the American sample. A t-test did not show significant differences in the Arrows Cancellation subtest score between samples (p=.65). In addition, there were no significant differences between males and females (p=.43).Conclusions:The results of this study show that the new attention subtest of the MUNS did not show significant differences between two different cultural samples. Further studies are needed to confirm its utility in other cultural settings. Among the limitations of this study are the sample sizes and the restricted ranges of age and years of schooling.

71 Feasibility of Virtual Useful Field of View Assessment and Equivalence with In-Person Administration Among Youth Clinically Recovered from Concussion and Uninjured Controls

Objective:Youth athletes with concussion are at an increased risk of sustaining new concussions and orthopedic injuries after clearance for return-to-play. There are training programs, extensively studied in other patient populations, which can improve performance in cognitive domains that have been implicated in sport-related injury and re-injury after concussion (i.e., visual attention/processing speed). The Useful Field of View (UFOV) is one such training program, accompanied by a computerized adaptive assessment for evaluating response to training and maintenance in clinical trials. Remote UFOV assessment administration may help improve adherence, particularly in assessing long-term training effects. The current study explores the feasibility of virtual UFOV assessment and equivalence with in-person administration in youth clinically recovered from concussion and healthy controls.Participants and Methods:Participants included youth ages 10-18 enrolled in a longitudinal study examining neural recovery following medical clearance from concussion. UFOV was attempted in 61 participants (Mage=15.06; SD=2.00; n=19 in-person; n=42). Of these, 7 virtual administrations were discontinued due to computer limitations, and 1 in-person administration was excluded due to overall performance validity concerns. This resulted in a total sample of 53 participants (Mage=15.02, SD=2.00, 58.5% male; n=14 concussion, Mdays_since_injury=272.64, SD=185.35; n=39 controls). UFOV was administered either in-person (n=18) using manual guidelines or virtually (n=35) on the participant’s computer using video-conference screen-share and a secondary device for an additional view of the participant and their keyboard/mouse. For virtual visits, the examiner recorded concerns about the remote testing environment (e.g., screen glare, viewing distance not measured appropriately), and analyses were conducted with and without cases with concerns. Between-group (in-person vs virtual administration) demographic differences were examined using chi-square tests/t-tests. Mann-Whitney U tests were used to examine for differences in UFOV scores (ms; higher scores are worse) by administration context (in-person vs. virtual) given threats to normality.Results:For virtual administrations, the most commonly reported concerns about the remote testing environment were related to lighting (n=12) and viewing distance (n=3). There were no significant differences in age, sex, concussion history, sport participation history, or IQ by administration context (in-person vs. virtual). UFOV performance did not vary significantly by administration context for processing speed or divided attention subtests, but performance on the selective attention subtest was significantly better in the virtual administration group (Median in-person =93.33; Medianvirtual=63.33; U=203.00, p=0.035). This trend persisted after removing an outlier (>2SD; p=0.065) and after removing cases where lighting (p=0.060) and screen-viewing distance (p=0.085) were not adequately controlled.Conclusions:Though preliminary, results suggest that UFOV can be administered virtually, in youth with and without a history of concussion, but that those assessed virtually using their home computer may have an advantage, particularly for the selective attention subtest. This may be due to comfort level within the home environment or subtle differences in viewing distance that were not appreciated by the examiner remotely. Importantly, not all participants were able to complete the assessment virtually due to computer limitations. Future work with larger samples size should examine the extent to which completers vary from non-completers in terms of sociodemographic variables.

5 Normative Data Collection for the Multicultural Neuropsychological Scale (MUNS)

Objective:Despite the array of neuropsychological tests available, these assessments are largely made and developed for use in WEIRD (western, educated, industrialized, rich, democratic) societies (Fernandez, 2019; Ponsford, 2017). The Multicultural Neuropsychological Scale (MUNS) was developed with underrepresented groups in mind as a universally valid neuropsychological assessment which can be used across cultures and adapted to different languages. To assist with the validation of the MUNS as a cross-cultural instrument, investigators administered the MUNS to a cognitively 'healthy’ college-aged population in the United States as a means of collecting normative data. Results were compared to samples taken from an Argentine university, Universidad Catelica de Cerdoba, and combined with another American university, Marymount Loyola University. The goal of this comparison was to provide evidence supporting the validity of the MUNS as a universal, cross-cultural neuropsychological assessment battery.Participants and Methods:Students from James Madison University (JMU) in Harrisonburg, Virginia (N = 24, Age = 20.083 1.93, Female = 87.5%) were recruited via a campus-wide email. Students who met inclusionary criteria were selected for MUNS administration. Students completed a background questionnaire and effort measure (REY-15; Rey, 1964) before completing the MUNS battery, consisting of eight subtests with four delayed trials. Descriptive statistics of the group were assessed, and one-way ANOVAs were conducted on the various subtests to determine whether differences exist between the American and Argentine samples.Results:No significant difference between groups was found for seven subtests. A difference existed on the Attention subtest between the American (f (1, 106) = 45.409, p < .001).Conclusions:The results show support for the cross-cultural validity of the MUNS. The only significant difference was found in the Arrows (Old) subtest. This is in alignment with previous administrations of the MUNS (Fernandez et al., 2018). Further studies are needed to assess potential bias within this subtest, as well as to pursue comparison studies for the New Arrows subtest administered within this USA sample. The present findings provide further evidence that the MUNS can be applied as a neuropsychological assessment across a variety of populations.

Dissociation of Arousal Index Between REM and NREM Sleep in Elderly Adults with Cognitive Impairment, No Dementia: A Pilot Study.

Sleep disruption in elderly has been associated with an increased risk of cognitive impairment and its transition into Alzheimer's disease (AD). High arousal indices (AIs) during sleep may serve as an early-stage biomarker of cognitive impairment non-dementia (CIND). Using full-night polysomnography (PSG), we investigated whether CIND is related to different AIs between NREM and REM sleep stages. Fourteen older adults voluntarily participated in this population-based study that included Mini-Mental State Examination, Neuropsi battery, Katz Index of Independence in Activities of Daily Living, and single-night PSG. Subjects were divided into two groups (n = 7 each) according to their results in Neuropsi memory and attention subtests: cognitively unimpaired (CU), with normal results; and CIND, with -2.5 standard deviations in memory and/or attention subtests. AIs per hour of sleep during N1, N2, N3, and REM stages were obtained and correlated with Neuropsi total score (NTS). AI(REM) was significantly higher in CU group than in CIND group. For the total sample, a positive correlation between AI(REM) and NTS was found (r = 0.68, p = 0.006), which remained significant when controlling for the effect of age and education. In CIND group, the AI(N2) was significantly higher than the AI(REM). In CIND older adults, this attenuation of normal arousal mechanisms in REM sleep are dissociated from the relative excess of arousals observed in stage N2. We propose as probable etiology an early hypoactivity at the locus coeruleus noradrenergic system, associated to its early pathological damage, present in the AD continuum.

Long-term neurodevelopment in children with resected congenital lung abnormalities.

To determine whether children who underwent resection of a congenital lung abnormality (CLA) are at higher risk for neurodevelopmental impairments than peers in the general population. The study population consisted of children born between 1999-2018 who underwent resection of a symptomatic CLA. Neurocognitive development (intelligence, memory, attention, visuospatial processing, executive functioning) and motor function of this population are monitored through our structured, prospective longitudinal follow-up program at the ages of 30months, 5, 8, and 12years. We compared study population scores with Dutch norm values using one-sample t-tests and one-sample binominal proportion tests. Forty-seven children were analyzed. The 8-year-olds showed significant impairments in sustained attention through the Dot Cancellation Test (mean z-scores -2.4; [-4.1; -0.8], p = 0.006 and -7.1; [-12.8; -1.4], p = 0.02 for execution speed and fluctuations respectively). Visuospatial memory was impaired at 8years, though only in 1 out of 3 assessment tools (Rey Complex Figure Test z-scores (-1.0; [-1.5; -0.5], p < 0.001). Further neurocognitive outcomes were unimpaired at all tested ages. Regarding motor function outcomes, mean z-scores of total motor functioning were unimpaired across assessed ages. However, at 8years, significantly more children than expected had definite motor problems (18% vs 5%, 95% CI [0.052; 0.403], p = 0.022). Conclusion: This evaluation reveals impairment in some subtests of sustained attention, visuospatial memory and motor development. However, globally, normal neurodevelopmental outcomes were found throughout childhood. We recommend testing for neurodevelopmental impairments in children who underwent surgery for CLA only if associated morbidities are present or if caregivers express doubts about their daily functioning. What is Known: • In general, surgically managed CLA cases seldom suffer from long-term surgery-related morbidity and show favorable lung function. What is New: • Long-term neurocognitive and motor function outcome appear unimpaired within surgically managed CLA cases. We recommend testing for neurodevelopmental impairments in children who underwent surgery for CLA only if associated morbidities are present or if caregivers express doubts about their daily functioning.

Remote cognitive evaluation in aging adults: A new software implementation during COVID‐19

AbstractBackgroundRemote cognitive testing is a convenient and efficient method to evaluate older adults especially because of the sanitary restrictions due to COVID 19. Our aim was to test the psychometric properties of newly developed versions of two visuospatial attention subtests, Hidden Patterns and Identical Pictures, administered by remote cognitive evaluation platform developed by Neurobehavioral Systems, Inc. We conducted testing and analysis in a sample of healthy aging adults.MethodsParticipants were recruited in East‐Bay, California; 184 aging adults completed the computerized hidden patterns test, and 160 older adults answered the identical picture test. The mean age was 70.11 years old with a range of 60 to 85 years old. Most of the participants were female (59.60%), and dementia symptoms were not reported. Participants were evaluated twice in one year at home, the software created by Neurobehavioral Systems, Inc allowed a synchronous interaction with the remote evaluator, which helped to monitor and answer any question before, during or after the evaluation.ResultDifficulty and discrimination analysis (classical test theory) was performed in R (version 4.1.0),. We estimated a Bayesian 1PL Item Response Model (IRT) for each test along with DIF testing by gender. The IRT models were calculated with the package rstan (Stan Development Team, 2020)ConclusionThe IRT models showed group differences at the items’ difficulty. The estimated reliability showed to be adequate (α &gt; .75), and test – retest correlations were medium to high (r &gt; .50). Correlations with age ranged from r = ‐.33 to r = .25.

Influence of blood phenylalanine level variations on the development of executive functions and social cognition in children with phenylketonuria

ObjectiveTo investigate the performance of 27 children with phenylketonuria (PKU) in tests of Executive Functions (EF) and Social Cognition (SC), and their associations with metabolic control inferred by phenylalanine (Phe) levels. MethodsThe PKU group was dichotomized according to baseline Phe-levels into; "classical PKU"(n = 14), with Phe-levels above 1200 μmol/L (> 20 mg/dL); and "mild PKU" (n = 13) with Phe-between 360 and 1200 μmol/L (6–20 mg/dL). The neuropsychological assessment focused on the EF and SC subtests of the NEPSY-II battery and intellectual performance. Children were compared to age-matched healthy participants. ResultsParticipants with PKU presented significantly lower Intellectual Quotient (IQ) compared to controls (p = 0.001). Regarding EF analysis adjusted by age and IQ, significant differences between groups were observed only in the executive attention subtests (p = 0.029). The SC set of variables was significantly different between groups (p = 0.003), as in the affective recognition task (p < 0.001). In the PKU group, the relative variation of Phe-achieved 32.1 ± 21.0%. Relative Phe-variation was correlated only with measures of Working Memory (p < 0.001), Verbal Fluency (p = 0.004), Inhibitory Control (p = 0.035) and Theory of Mind (p = 0.003). ConclusionsPhonological Verbal Fluency, Working Memory, Inhibitory Control, and Theory of Mind were shown to be most vulnerable when there is non-ideal metabolic control. Variations in the level of Phe-may have a selective negative effect on Executive Functions and Social Cognition, but not on intellectual performance.

Feasibility and Tolerability of Useful Field of View Assessment in Youth with Concussion

<h3>Research Objectives</h3> To investigate the feasibility and tolerability of the Useful Field of View (UFOV) assessment, a computerized adaptive measure, in youth with mild traumatic brain injury (mTBI). <h3>Design</h3> Retrospective chart review. <h3>Setting</h3> Interdisciplinary pediatric concussion clinic. <h3>Participants</h3> Eight symptomatic patients with mTBI (M age=15.16, SD=2.67) were administered the UFOV assessment during their initial clinic visit. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Total UFOV administration time and report of symptoms prior to and following UFOV administration. <h3>Results</h3> All patients were able to understand and complete the UFOV assessment in less than 15 minutes (M=8.51, SD=2.35). The evaluation was well-tolerated (no patient experienced symptom exacerbation greater than 2 points on a scale from 0 to 10). Although all participants performed within normal limits on UFOV using manual cutoffs, three participants (all with prior mTBIs) performed below expectations relative to peers using published pre-commercialization normative data. On the divided attention subtest (Subtest 2), those with prior history of mTBI (n=3; M=64.33, SD=5.13) performed significantly worse than those without such history (n=5; M=32.97, SD=4.94), (t (6) = 8.58, p< .001). <h3>Conclusions</h3> The UFOV assessment has been well-studied in older adults and is predictive of driving performance in young adults and those with moderate to severe TBI. Useful field of view can be trained in older adults which may have implications for younger populations and those with acquired brain injury. Data suggest that UFOV assessment is both feasible and well-tolerated among youth with mTBI presenting to an interdisciplinary concussion clinic. Future research should seek to better understand the relationship between UFOV performance and risk of and recovery from mTBI in youth. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

A FEASIBILITY STUDY EXPLORING THE EFFICACY OF COGNITIVE REHABILITATION THERAPY FOR PAEDIATRIC HIV IN RURAL SOUTH AFRICA: A FOCUS ON SUSTAINED ATTENTION

Despite advances in combination antiretroviral therapy (cARTs), children in Sub-Saharan Africa continue to experience neurocognitive deficits due to the virus crossing the blood-brain barrier (BBB). Based on the principles of neuroplasticity, our study sought to investigate the feasibility of introducing a pencil and paper cognitive rehabilitation tool called Brainwave-R, to ameliorate the effects of HIV neurocognition amongst children from a low socioeconomic background in rural South Africa. Five HIV positive and six HIV negative children were assigned to either an experimental or control group. The experimental group underwent two months of cognitive rehabilitation therapy to remediate sustained attention, using Brainwave-R, whereas the noncontact control group took part in placebo activities. Sustained attention measures were taken before and after the intervention training sessions, using a sustained attention subtest. The control group later received cognitive intervention three months following the conclusion of the research study. A Mann Whitney U Test revealed that the experimental group (Mdn=38.50) did not differ significantly from the control group (Mdn=37.00) after the cognitive rehabilitation intervention, U= 12.00, z= -.55, p= 0.66, r= -0.17. A Wilcoxon Signed Rank Test found that there was a significant improvement from pretest scores (Mdn=31.00) to post test scores (Mdn=38.00) following the rehabilitation for HIV positive participants in the sample, T=15.00, z = -2.02, p= 0.04, r= -0.90. The findings of our study raise the feasibility of a pencil and paper cognitive rehabilitation method to supplement antiretroviral (ARV) therapy in paediatric HIV.

Linking aberrant pauses during object naming to letter and word decoding speed in elderly with attention complaints

Attention deficit and reading difficulty are often comorbid in neuropsychiatric disorders of childhood and adolescence. Although recent research has shown how these two domains may interact in children, knowledge about such interaction in elderly is lacking. The present study tested whether this association is also present in healthy elderly with undiagnosed attention problems. Thirty-two subjects (65+ years) with life-long complaints of attention and with a Mini Mental (MMSE) cutoff of 27 points were tested with MapCog Spectra (MCS), with a word recognition test (Word Chains test) and CANTAB subtests of attention. All tests were presented on a tablet, except for the Word Chains test. The participants mean MMSE score was 29 points and their mean age was 71.5 years. Strong correlations were seen between the Word Chains test and the MCS, suggesting that a high number of aberrantly long pauses during serial naming was associated with fewer identifications of letters, words and sentences. The number of aberrant pauses was also associated with slower Reaction Time and a lower score on the Attention Shifting task of the CANTAB. The results were not associated with either gender or general intelligence. This study shows that attention is linked to decoding speed irrespective of intelligence and gender. We therefore suggest that a clinical assessment of attention deficit should also include an assessment of decoding ability, and vice versa, as these cognitive functions are strongly interdependent.

CRP and its relation to cognitive performance in schizophrenia patients: a cross-sectional study

Background Schizophrenia (SZ) is one of the most severe and chronic forms of mental illness. It involves cognition, emotion, perception, and behavior. There is an obvious role of neuroinflammation and immunogenetics in SZ. There is a relation between the severity of cognitive deficits and enhanced levels of inflammatory markers in schizophrenic patients, including C-reactive protein (CRP). Also, a relation between CRP and the negative-symptom subscale of Positive and Negative Syndrome Scale (PANSS) was observed.Aims To study the relation between CRP level with different cognitive domains in patients with SZ and its relation to the psychopathology of SZ.Methods A cross-sectional study was applied on 40 SZ patients and 40 healthy controls, serum CRP was measured, and they were cognitively assessed using Arabic version of Montreal Cognitive Assessment Basic (MoCA-B).Results SZ patients showed worse cognitive performance on all subtests (except orientation), MOCA-B, and the total score when compared with normal controls. A negative correlation between executive functions, calculation, abstraction, memory, naming, and attention subtests of MoCA-B and its total score with the serum CRP was found. A positive correlation between CRP and the negative subscale and total score of PANSS was found.Conclusions Serum CRP level was elevated in patients with SZ when compared with healthy controls and significantly negatively correlated with cognitive functions, and positively correlated with negative symptoms in SZ patients, which seconds the neuroinflammatory etiology of SZ.

Cognitive Measures and the Acceptable Noise Level.

The aim of this study was to determine the relation between the acceptable noise level (ANL) and cognitive measures of auditory attention and working memory. Young adults were administered the following tests: the ANL, the Digit Span and Letter-Number Sequencing subtests of the Wechsler Adult Intelligence Scale-Fourth Edition, the Auditory Attention subtest from the Woodcock-Johnson Tests of Cognitive Abilities, the Hearing in Noise Test (HINT), and the operation span (OSPAN) test. A correlation matrix was constructed using Pearson coefficients. Twenty-four young adults aged 20-29 years with normal hearing participated in the study. No significant relationships were found among the ANL and the different cognitive tasks, nor was there a significant relation found between the ANL and the HINT. However, significant relationships were found between individual cognitive tasks. There was a significant relation found between selective attention and the most comfortable level of presentation of a story. Selective attention may be a key cognitive function in acceptance of background noise.

Translation and Cross-cultural Adaptation of the Aphasia Check List in Persian Speakers With Aphasia.

Introduction:The Aphasia Check List (ACL) is a comprehensive, time-saving tool for language evaluation in aphasia, including a cognitive assessment part. This cross-sectional study aimed to translate ACL into Persian and analyze the psychometric features of the translated version. The original version of the ACL was translated and adapted from German; its psychometric features were then determined.Methods:Twenty People With Aphasia (PWA) and 50 age- and education-matched, cognitively healthy controls participated in this research. Possible floor and ceiling effects, discriminant validity, test-retest reliability, and internal consistency of the test were analyzed in addition to the evaluation of internal correlations between the test parts (language & cognition).Results:Regarding the performance of PWAs in the language section and the cognitive subtests assessing attention, memory, and reasoning, there were no floor and ceiling effects. Adequate discriminant validities for the language section of the test [i.e., total score: (Mann-Whitney U= 6.000, P<0.001); diagnostic subtests scores: (Mann-Whitney U= 3.000, P<0.001), and each subtest individually. Besides, the attention subtest of the cognition section (Mann-Whitney U= 16.500, P<0.001) was also observed. There was no difference between the control and patient groups in the subtests of memory (Mann-Whitney U= 497.500, P=0.973) and reasoning (Mann-Whitney U= 3.000, P= 308). The test-retest reliability was acceptable in all subtests (ICC agreement= 0.573–0.984). The ACL-P suggested appropriate internal consistency (Cronbach’s alpha coefficient= 0.761 for test & retest scores). There were also significant correlations between language and cognition in the control and patient groups.Conclusion:The ACL-P test indicated sufficient reliability and validity for the evaluation of Persian-speaking PWAs and is suggested to be used in studies on this population.

A-054 Deficit in Custained Attention in Children Born with Hypoxic-ischaemic Encephalopathy

Abstract Objective There are evidences that children, born with Hypoxic-ischaemic Encephalopathy (HIE), have a delay in the development of neurocognitive functions, specifically they have a deficit in executive abilities. Do they have global or specific deficit in executive abilities? The goal of this research was to examine the hypothesis that children, born with HIE, have a deficit in sustained attention. Methods The experimental group included 20 children aged 5-6 years (mean age = 5.7). They were born full-term with perinatal Hypoxic-ischaemic Encephalopathy. The control group included 20 typically developing children. The children from experimental and control group were matched for gender and age. Children from both groups were assessed with 4 subtests from NEPSY (Tower, Auditory Attention and Response Set, Visual Attention, Statue) which are designed to assess the executive abilities in children. Results One-way ANOVA has revealed group differences (p &amp;lt; .05) in two subtests from NEPSY. Children with perinatal HIE have shown the weaknesses in performing Auditory Attention and Response Set and Visual Attention subtest. We did not reveal the significant differences (p &amp;lt; .05) in performing Tower and Statue subtest. Conclusion In view of the obtained results it can be assumed that the Hypoxic-ischaemic Encephalopathy has a specific (not global) negative effect on the development of executive abilities, particularly children with perinatal HIE have a deficit in sustained attention at the age of 5-6 years.

The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment.

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI++D+), severe OSA nondesaturators (AHI++D−), and moderate OSA nondesaturators (AHI+D−). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients.

Hemispheric lateralization of depression and attention deficit

Objective: There is a complex interaction among to the ischemic cerebrovascular diseases, cognition and depression. The aim of present study is to investigate the relationship between lesion side and depression and attention deficit in patients with Middle Cerebral Artery (MCA) infarction.&#x0D; Methods: This study was conducted on 41 patients with right and left MCA infarction. Beck Depression Inventory (BDI) was used for determination of depression severity of patients and Montreal Cognitive Assessment (MoCA) scoring was used for evaluation of cognitive status. Attention sub-test of MoCA score was also examined.&#x0D; Results: 20 patients had right MCS. The mean age of the patients was 72.21 years. 51.2% of the patients were male. BDI mean score was found to be 11.25 in patients with right MCA infarction and 16.9 in patients with left MCA infarction (p:0.04). The total MoCA scores between two groups were similar (right/left MCA infarction: 20.8/21.3). It was seen to be lower attention sub-score in patients with right hemisphere effects compared to patients with left hemispheric lesion (3.1/5.9; p:0.00).&#x0D; Conclusion: According to our findings, it is understood that attention of patients with right MCA infarction is more affected and patients with left MCA infarction is more depressed. In future studies, depression and attention affects which are at risk of developing after MCA infarctions should be evaluated in detail and should be put emphasis to rehabilitation of these areas.

Changes in attention variables in those who treated with anticholinergic agents for nonmonosymptomatic enuresis.

PurposeBrain dysfunction related to areas regarding attention and arousal may occur not only in patients with attention-deficit/hyperactivity disorder (ADHD) but also in patients with enuresis and daytime symptoms. This study aimed to investigate changes in computerized comprehensive attention tests (CATs), a psychometric test for ADHD when patients with nonmonosymptomatic enuresis (NME) were treated with anticholinergic agents.Materials and MethodsThirty patients with NME featuring overactive bladder were prospectively enrolled. They were treated with 5 mg of solifenacin to control daytime symptoms. Using CATs, patients were evaluated during 12 weeks of treatment. Four subtests of attention (visual and auditory selective attention, sustained attention, and flanker tests) were measured. For each subtest, four domains (omission error, commission error, response time [RT], and standard deviation of RT) were assessed.ResultsOnly one domain of the flanker test was in the deficient range at baseline. The presence of urge incontinence affected follow-up results on the sustained attention tests. Treatment with anticholinergic agents did not significantly affect attention variables but changes in several variables were correlated with bladder symptoms and enuresis.ConclusionsMinimal baseline defects in attention function were seen in patients with NME. Follow-up results for some attention variables were affected by daytime symptoms and enuresis. These results suggest that altered brain function in enuretic patients influences improvement in both attention and bladder function.

The Newly Normed SKT Reveals Differences in Neuropsychological Profiles of Patients with MCI, Mild Dementia and Depression.

The SKT (Syndrom-Kurztest) is a short cognitive performance test assessing deficits of memory and attention in the sense of speed of information processing. The new standardization of the SKT (2015) aimed at improving its sensitivity for early cognitive decline due to dementia in subjects aged 60 or older. The goal of this article is to demonstrate how the neuropsychological test profile of the SKT can be used to provide valuable information for a differential diagnosis between MCI (mild cognitive impairment), dementia and depression. n = 549 patients attending a memory clinic (Nuremberg, Germany) were diagnosed according to ICD-10 and tested with the SKT. The SKT consists of nine subtests, three for the assessment of memory and six for measuring attention in the sense of speed of information processing. The result of the SKT test procedure is a total score, which indicates the severity of overall cognitive impairment. Besides the summary score, two subscores for memory and attention can be interpreted. Using the level of depression as a covariate, statistical comparisons of SKT test profiles between the three patient groups revealed that depressed patients showed more pronounced deficits than MCI patients in all six attention subtests. On the other hand, MCI patients displayed significantly greater mnestic impairment than the depressed group, which was indicated by significant differences in the memory subscore. MCI and dementia patients showed similar deficit patterns dominated by impairment of memory (delayed recall) with MCI patients demonstrating less overall impairment. In sum, the SKT neuropsychological test profiles provided indicators for a differential diagnosis between MCI and beginning dementia vs. depression.