Behavioral Syndrome Research Articles

COMORBIDITY OF NON-PSYCHOTIC MENTAL DISORDERS AND NEUROLOGIC SYMPTOMS AMONG YOUNG PEOPLE

The aim: to determine occurrence and structure of non-psychotic mental disorders associated with chronic pain among young people. Materials and methods: The results of examination of 1235 students were analyzed. The following methods were applied: clinical, clinical-psychopathological, clinical-epidemiological, clinical-anamnestic, experimental-psychological and statistical. Results: Students with neurotic disorders associated with stress and somatoform disorders were found to prevail in the main group (F40-48.1) 187 (58,99%), affective mood disorders were on the second position (F30-34.1) - 79 (24,92%) individuals, followed by disorders of a mature personality and behavior of adults (F60-60.7) diagnosed in 31 (9,78%) students, and at last, behavioral syndromes associated with physiological disorders and physical factors (F50-51.4) - 20 (6,30%) respectively. Chronic pain syndrome was diagnosed in 113 (35,65%) students with NMD including 43 (38,05%) men and 70 (61,95%) women. The majority of young people (86 individuals - 76,11%) observed severe pain, and 27 (23,89%) of them - moderate pain. A clear correlation was found between a depressive episode and CPS (γ<0,02). Conclusions: The findings obtained should be considered in development of screening systems concerning diagnostics, prevention of nonpsychotic mental disorders associated with chronic pain syndrome.

Новый тест для изучения поведения мухоловки-пеструшки Ficedula hypoleuca (Pallas, 1764)

An original test to study the behavior of the pied flycatcher has been developed. The experimental arena can be used in field and laboratory study. It looks like a plus maze with a darkened central compartment, simulating an empty nesting box, and four entrances to the illuminated peripheral compartments of the arena. Birds demonstrate individual behavioral variability. They stay in the central compartment or leave it; make a different number of transitions between compartments and try to escape from the peripheral compartments through the transparent cover. Bird activity may depend on a number of factors, including the level of research activity and anxiety of individuals. This allows you to use this test to study the behavioral syndrome of the pied flycatcher.

Experimental evidence for a role of dopamine in avian personality traits.

There is increasing interest in the genetic and physiological bases of behavioural differences among individuals, namely animal personality. One particular dopamine (DA) receptor gene (the dopamine receptor D4 gene) has been used as candidate gene to explain personality differences, but with mixed results. Here, we used an alternative approach, exogenously manipulating the dopaminergic system and testing for effects on personality assays in a social bird species, the common waxbill (Estrilda astrild). We treated birds with agonists and antagonists for DA receptors of both D1 and D2 receptor pathways (the latter includes the D4 receptor) and found that short-term manipulation of DA signalling had an immediate effect on personality-related behaviours. In an assay of social responses (mirror test), manipulation of D2 receptor pathways reduced time spent looking at the social stimulus (mirror image). Blocking D2 receptors reduced motor activity in this social assay, while treatment with a D2 receptor agonist augmented activity in this social assay but reduced activity in a non-social behavioural assay. Also, in the non-social assay, treatment with the D1 receptor antagonist markedly increased time spent at the feeder. These results show distinct and context-specific effects of the dopaminergic pathways on waxbill personality traits. Our results also suggest that experimental manipulation of DA signalling can disrupt a behavioural correlation (more active individuals being less attentive to mirror image) that is habitually observed as part of a behavioural syndrome in waxbills. We discuss our results in the context of animal personality, and the role of the DA system in reward and social behaviour.

Variation in neophobia among cliff swallows at different colonies.

Animal groups often represent nonrandom subsets of individuals, and increasing evidence indicates that individuals may sort among groups based on their personalities. The size of a group can predict its personality composition in some species due to differential suitability of a personality for groups of certain sizes, and the group itself may function more effectively if particular personality types are present. We quantified cliff swallow (Petrochelidon pyrrhonota) behavioral measures using linear and generalized linear mixed models to identify whether they: (1) varied among individuals within colonies and among colonies, (2) were related to reproductive success, and (3) predicted levels of parental care. Significant among-individual and among-colony site variation in a cliff swallow’s latency to enter its nest when presented with a novel stimulus was revealed. We also found significant among-individual variation in the number of attacks directed toward a novel stimulus at the nest and in the response to broadcast of a cliff swallow alarm call recording, but among site variation in these measures was not significant. We did not find evidence for behavioral syndromes linking the personalities measured. Differences among individuals in latency to enter the nest and the number of attacks were not significantly related to reproductive success or to the extent to which birds fed their nestlings. However, extent of nestling feeding was significantly predicted by the number of mist net captures. The limited evidence in general of systematic variation in the behavior we measured among cliff swallow colonies may reflect the different and sometimes opposing selection pressures on behavior in different social environments. Future work should perhaps examine variation in other behavioral traits, such as foraging, in cliff swallow colonies of different sizes.

41 Age Modifies the Association between Apathy ANND Recurrent Falling in Dutch Ambulant Older Persons with a High Fall Risk

Abstract Apathy, a common and disabling behavioural syndrome in older persons, has been associated with impaired physical performance and executive dysfunction. Both are fall risk factors and they share pathophysiological pathway. We cross-sectionally examined the association between apathy and recurrent falling (≥2 falls in the past 12 months) and number of falls in the past 12 months in 243 outpatients aged ≥ 65 years with ≥3 fall risk-factors visiting a fall-clinic after a fall. We calculated Odds Ratio’s (ORs), Incidence Rate Ratio’s (IRRs) and their 95% Confidential Intervals (CI95) using multivariable regression and negative binomial regression analyses. We adjusted for cognitive functioning, depression, the use of fall risk increasing drugs, visual impairment, urine incontinence, comorbidity, smoking, use of alcohol, body mass index (BMI), and the number of months between assessment of fall risk and of apathy. We assessed effect modification by age and gender. In our study, apathy was independently associated with recurrent falling in patients aged 65-75 years: OR 2.8 (CI95 1.0-7.7). Overall, patients with apathy experienced 1.46 times as many falls in the past 12 months compared to patients without apathy (IRR 1.46 (CI95 1.0-2.1). To conclude, in high fall-risk older outpatients, apathy was cross-sectionally associated with recurrent falling in patients aged 65-75 years and the number of falls. Apathy appeared to be especially relevant in relation to falling in this age group. Whether apathy predicts recurrent falling is yet to be determined.

Maternal diet affects juvenile Carpetan rock lizard performance and personality.

Differences in both stable and labile state variables are known to affect the emergence and maintenance of consistent interindividual behavioral variation (animal personality or behavioral syndrome), especially when experienced early in life. Variation in environmental conditions experienced by gestating mothers (viz. nongenetic maternal effects) is known to have significant impact on offspring condition and behavior; yet, their effect on behavioral consistency is not clear. Here, by applying an orthogonal experimental design, we aimed to study whether increased vitamin D3 content in maternal diet during gestation (vitamin‐supplemented vs. vitamin control treatments) combined with corticosterone treatment (corticosterone‐treated vs. corticosterone control treatments) applied on freshly hatched juveniles had an effect on individual state and behavioral consistency of juvenile Carpetan rock lizards (Iberolacerta cyreni). We tested the effect of our treatments on (a) climbing speed and the following levels of behavioral variation, (b) strength of animal personality (behavioral repeatability), (c) behavioral type (individual mean behavior), and (d) behavioral predictability (within‐individual behavioral variation unrelated to environmental change). We found higher locomotor performance of juveniles from the vitamin‐supplemented group (42.4% increase), irrespective of corticosterone treatment. While activity personality was present in all treatments, shelter use personality was present only in the vitamin‐supplemented × corticosterone‐treated treatment and risk‐taking personality was present in corticosterone control treatments. Contrary to our expectations, behavioral type was not affected by our treatments, indicating that individual quality can affect behavioral strategies without affecting group‐level mean behavior. Behavioral predictability decreased in individuals with low climbing speed, which could be interpreted as a form of antipredator strategy. Our results clearly demonstrate that maternal diet and corticosterone treatment have the potential to induce or hamper between‐individual variation in different components of boldness, often in interactions.

STUDENTS’ BEHAVIOUR OF INDISCIPLINE SYNDROME IN TEACHING AND LEARNING PROCESS

This study reported the discovery and identification of behavioral syndrome of students’ indiscipline in teaching and learning process. For this purpose, researcher used qualitative approach of phenomenology. The study involved 9 subjects determined by purposive sampling for the phenomenon of indiscipline were more dominated by those subjects. Four techniques have been used to collect the data: participation-observation, in-depth interviews, field notes, and documentation. The results indicated that the behavioral syndrome of indiscipline is influenced by premature (imature) self-concept, determination of multidimensional environment, keeping and building a societal relationship in communities, as well as teachers’ attitude and behavior as a direct model. Therefore, teachers should give the exemplary cognition, affection, psychomotor, as well as should be truthful and orderly socially so that the students’ behaviour of indiscipline can be reduced to a good quality of learning.

Are personalities genetically determined? Inferences from subsocial spiders

BackgroundRecent research has revealed that polymorphic behavioral strategies shape intra-and interspecific interactions and contribute to fitness in many animal species. A better understanding of the proximate mechanisms underlying these behavioral syndromes will enhance our grasp this phenomenon. Spiders in the genus Anelosimus exhibit inter-individual behavioral variation on several axes: individuals have consistent responses to stimuli (e.g. bold vs. shy individuals) and they are subsocial (exhibiting extended maternal care and sibling cooperation) across most of their range, but they sometimes form permanent social groups in northern temperate regions. Here, we seek genetic variants associated with boldness and with social structure in a socially polymorphic population of the spider Anelosimus studiosus. We also develop preliminary genomic resources, including a genome assembly and linkage map, that support this and future genomic research on this group.ResultsRemarkably, we identify a small genomic scaffold (~ 1200 bp) that harbors seven single nucleotide polymorphisms (SNPs) associated with boldness. Moreover, heterozygotes are less common than expected based on Hardy-Weinberg equilibrium, suggesting that either assortative mating or selection against heterozygotes may be occurring in this system. We find no loci significantly associated with social organization. Our draft genome assembly allows us to localize SNPs of interest in this study and to carry out genetic comparisons with other published genomes, although it remains highly fragmented.ConclusionsBy identifying a locus associated with a well-studied animal personality trait, this study opens up avenues for future research to link behavioral studies of animal personality with genotype and fitness.

Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions.

Autism spectrum disorder (ASD) is a complex behavioral syndrome that is characterized by speech and language disorders, intellectual impairment, learning and motor dysfunctions. Several genetic and environmental factors are suspected to affect the ASD phenotype including air pollution, exposure to pesticides, maternal infections, inflammatory conditions, dietary factors or consumption of antibiotics during pregnancy. Many children with ASD shows abnormalities in gastrointestinal (GI) physiology, including increased intestinal permeability, overall microbiota alterations, and gut infection. Moreover, they are “picky eaters” and the existence of specific sensory patterns in ASD patients could represent one of the main aspects in hampering feeding. GI disorders are associated with an altered composition of the gut microbiota. Gut microbiome is able to communicate with brain activities through microbiota-derived signaling molecules, immune mediators, gut hormones as well as vagal and spinal afferent neurons. Since the diet induces changes in the intestinal microbiota and in the production of molecules, such as the SCFA, we wanted to investigate the role that nutritional intervention can have on GI microbiota composition and thus on its influence on behavior, GI symptoms and microbiota composition and report which are the beneficial effect on ASD conditions.

Screen time and problem behaviors in children: exploring the mediating role of sleep duration

BackgroundPrevious research examining the relationship between screen time (ST) and psychological health outcomes have primarily focused on one type of ST (i.e., television), while little research has considered other types of screens (e.g., videos, movies, social media), screen content (e.g., violent video games), or potential mediating variables. Therefore, the purpose of the present study was to assess ST types and content and their association with problem behaviors, and to determine whether these relationships were mediated by sleep duration.MethodsParents and children provided cross-sectional baseline data (2016–18) as part of the Adolescent Brain Cognitive Development study, a broadly US representative sample of 11,875 children aged 9 to 10 years. Parents self-reported their children’s emotional and behavioral syndromes via the Child Behavior Checklist and sleep duration using one item from the Parent Sleep Disturbance Scale. Children self-reported their ST behavior, which comprised ST types (television/movies, videos, video games, and social media) and content (mature-rated video games and R-rated movies).ResultsTime spent in various ST types was positively associated with problem behaviors: watching television/movies was associated with a 5.9% increase in rule-breaking behavior (incidence rate ratio [IRR] = 1.059), 5% increase in social problems (IRR = 1.050), 4% increase in aggressive behavior (IRR = 1.040), and 3.7% increase in thought problems (IRR = 1.037). Greater time spent playing mature-rated video games was associated with greater somatic complaints (IRR = 1.041), aggressive behavior (IRR = 1.039), and reduced sleep duration (IRR = .938). Sleep duration mediated the relationship between ST (type and content) and problem behaviors, albeit the effect sizes were small. The largest effects were observed between sleep duration and all problem behaviors, with greater sleep duration predicting an 8.8–16.6% decrease in problem behaviors (IRRs ranging from .834 to .905).ConclusionGreater time spent in ST behavior was associated with greater problem behaviors among children. There was strong evidence that longer sleep duration was associated with reduced problem behaviors. While sleep duration mediated the effects of ST on problem behaviors, other potential mediating variables need to be investigated in future research.

Intermediate turbidity elicits the greatest antipredator response and generates repeatable behaviour in mosquitofish

Increased turbidity, a common human-induced aquatic disturbance, can potentially have major impacts on predator–prey interactions via effects on key foraging and antipredator behaviours, on the repeatability of these behaviours (i.e. on animal personalities) and on behavioural syndromes (correlations among behaviours). Here, we repeatedly assayed individual western mosquitofish, Gambusia affinis, across a range of turbidity levels (low, intermediate, high) to test the degree to which a suite of behaviours (activity, exploration, sociality, responses to olfactory predator cues) scaled with increasing turbidity. In particular, we tested the a priori hypothesis, based on previous work, that fish show stronger behavioural repeatability and behavioural correlations when perceived predation risk is high. While individuals in all treatments responded to predator cues by reducing activity and exploration, those assayed in intermediate turbidity exhibited the strongest antipredator responses. Consistent with our prediction that repeatability should be greatest in high risk, significant behavioural repeatability was only detected in antipredator behaviours at intermediate turbidity. Significant correlations among behavioural traits were detected in all turbidity treatments but primarily under threat of predation – not when predator cues were absent (with one exception). This study demonstrates that levels of human-induced environmental change may interact with predation risk to shape both mean behavioural responses as well as patterns of behavioural correlations within and among individuals.

Home-cage monitoring ascertains signatures of ictal and interictal behavior in mouse models of generalized seizures.

Epilepsy is a significant contributor to worldwide disability. In epilepsy, disability can be broadly divided into two components: ictal (pertaining to the burden of unpredictable seizures and associated medical complications including death) and interictal (pertaining to more pervasive debilitating changes in cognitive and emotional behavior). In this study, we objectively and noninvasively appraise aspects of ictal and interictal behavior in mice using instrumented home-cage chambers designed to assay kinematic and appetitive behavioral measures. Through daily intraperitoneal injections of the chemoconvulsant pentylenetetrazole (PTZ) applied to C57BL/6J mice, we coordinately measure how “behavioral severity” (complex dynamic changes in movement and sheltering behavior) and convulsive severity (latency and occurrence of convulsive seizures) evolve or kindle with repeated injections. By closely studying long epochs between PTZ injections, we identify an interictal syndrome of nocturnal hypoactivity and increased sheltering behavior which remits with the cessation of seizure induction. We observe elements of this interictal behavioral syndrome in seizure-prone DBA/2J mice and in mice with a pathogenic Scn1a mutation (modeling Dravet syndrome). Through analyzing their responses to PTZ, we illustrate how convulsive severity and “behavioral” severity are distinct and independent aspects of the overall severity of a PTZ-induced seizure. Our results illustrate the utility of an ethologically centered automated approach to quantitatively appraise murine expressions of disability in mouse models of seizures and epilepsy. In doing so, this study highlights the very unique psychopharmacological profile of PTZ.

Stigma Towards Mental Illness Among Tanta University Students, Egypt.

A "mental disorder" can be defined as a "behavioral or psychological syndrome that occurs in an individual. It represents about 13% of the global disease burden which is expected increase to 15% by 2020. Moreover, by 2020, depression is expected to be second to ischemic heart disease as a contributor in the global disease burden. This study aimed to assessment of stigmatizing beliefs towards mental illness among students, in Tanta University, Egypt. The study was conducted on medical, pharmaceutical and science faculties, Tanta University, Egypt during October and November 2018. The methods were a self administered questionnaire consisted of two parts sociodemographic factors and Belief about Mental Illness Scale. The results were: the pharmaceutical students have more negative beliefs towards mental illness than other students. The study concluded that: science students showing a more positive belief towards mental illness followed by medical then pharmaceutical students.

Male guppies differ in daily frequency but not diel pattern of display under daily light changes

Sexually signalling animals must trade off the benefits of attracting mates with the consequences of attracting predators. For male guppies, predation risk depends on their behaviour, colouration, environmental conditions and changing intensity of predation throughout the day. Theoretically, this drives diel patterns of display behaviour in native Trinidadian populations, where males display more under low-light conditions when their most dangerous predator is less active. Here, we observed Australian guppies in a laboratory setting to investigate their diel display pattern, and if this pattern is controlled by ambient light intensity. We also quantified individual variation in both the daily frequency and diel pattern of displays, and if such variation relates to body size, colouration and a non-sexual behaviour. Under a typical daily light regime, male guppies displayed mostly in the first hour of observation. Extending the duration of dawn-like lighting, however, resulted in an extended period of high display, demonstrating that light intensity per se is an important cue for this behaviour. These findings mirror those obtained for Trinidadian populations, suggesting that male courtship timing is likely shaped by broad, potentially generalizable features of guppy ecology. The effect of acclimation to captive conditions on male behaviour is also discussed. Whereas the temporal pattern of display appeared consistent, individuals varied in their daily display frequency, and this was correlated with variation in colour phenotype and a measure of non-sexual risk acceptance behaviour. Such relationships pose promising avenues for integrating behavioural and sensory ecology with contemporary work on behavioural syndromes and animal personality. To limit the costs of their conspicuous colour patterns, male guppies should alter their behaviour to avoid predation. However, our understanding of how different individuals deal with this problem is lacking. Following individuals in the laboratory, we demonstrated individual variation in the daily frequency of male displays, and this was correlated with variation in colour phenotypes and non-sexual behaviour. However, all male guppies displayed more in the early hours of the day and extending the period of low lighting also extended this period of elevated display. These findings replicate and expand experiments on native populations, suggesting that male courtship timing is likely shaped by broad, potentially generalizable features of guppy ecology.

Dispersal decisions and personality in a freshwater fish

Historically, the differences in dispersal behaviour between individuals within a species has largely been ignored. Instead, we tend to assume all individuals within a population express similar phenotypes. However, evidence is growing for the importance of intraspecific variability in dispersal propensity and how this variability may influence population dynamics, as well as the role of environmental context in driving this behaviour. Individuals that are more likely to disperse can have other traits, such as being bolder or more aggressive, that collectively form behavioural syndromes. We tested for a behavioural syndrome in carp gudgeons (Hypseleotris spp.) species' complex, a type of small fish found in intermittent streams in southeastern Australia. Intermittent streams are an environment where selection may favour the evolution of different dispersal phenotypes, given the variable and unpredictable nature of flows. During dry periods, fish become isolated in refuge pools that vary in quality and persistence, and then can disperse when flow resumes. Dispersal can have costs (e.g. the risk of not finding another habitat) but also benefits (e.g. opportunity to find better habitat), meaning that different strategies (i.e. dispersing versus staying) may both be advantageous and thus evolve. Through a series of experiments that assessed these fish's latency to emergence into a novel environment and tendency to shoal, as well as movement behaviour in artificial streams, we found that (1) flow is not likely to be a movement cue, and (2) boldness, sociability and dispersal distance were repeatable, consistent with the notion that carp gudgeons exhibit personalities. To our knowledge, this is the first demonstration of a behavioural syndrome in a freshwater fish that inhabits intermittent streams. This finding contributes to our understanding of how carp gudgeons move through intermittent streams and the potential dynamics that allow these fish to persist in such harsh, hydrologically variable habitats.

Physical activity, sedentary behavior, and restless legs syndrome in persons with multiple sclerosis

The present study examined the relationships among parameters (i.e., volume and pattern) of physical activity and sedentary behavior with the presence and severity of restless legs syndrome(RLS) in adults with multiple sclerosis(MS). Participants with MS (N = 253) wore an accelerometer for a 7-day period and completed the Cambridge-Hopkins Restless Legs Syndrome Questionnaire, the International Restless Legs Syndrome Study Group Scale (IRLS), and the Patient Determined Disease Steps scale. Sixty-six (26%) persons with MS had RLS (MS + RLS). There were no differences between the MS + RLS and MS group for parameters of physical activity or sedentary behavior. Among participants with IRLS scores in the mild range (n = 26), more time spent in light physical activity (rs = 0.39), fewer sedentary bouts per day (rs = 0.55), less time in sedentary bouts per day (rs = 0.51), and fewer breaks in sedentary time per day (rs = 0.57) were associated with lower RLS severity. This study represents the first step toward recognizing a relationship between physical activity, patterns of sedentary behavior, and RLS severity in MS and these results suggest that light physical activity and the pattern of sedentary behavior may be important targets for prospective behavioral interventions that target the management of RLS in persons with MS who have mild RLS severity.

An Evolutionary Ecological Framework for Understanding Human Behavioral Syndromes: Commentary on Lukaszewski et al. 2017

In their recent paper, Lukaszewski et al. proposed a socioecological hypothesis for analyzing the covariations between the Big Five personality traits. The hypothesis states that the shared variance between the personality traits is higher in less complex societies marked by lower economic development, urbanization, and niche diversity. We welcome this hypothesis and add an additional framework for understanding the covariation between the traits—behavioral syndromes. We state that behavioral syndromes and their effects on fitness should be the primary target for the evolutionary ecological analysis of the relations between human personality traits on a population level. Behavioral syndromes are extensively studied in animal behavioral ecology which provides an opportunity for the comparative study of personality. We point to the behavioral syndromes in Lukaszewski et al. data, especially to the agreeableness–conscientiousness correlation, which roughly corresponds to the aggressiveness–impulsiveness behavioral syndrome in animals. We point to other potentially problematic issues and provide recommendations for future research.

Toward Integration of the Niche Diversity Hypothesis With Other Explanations for Personality Covariation: Reply to Međedović's (2019) Commentary on Lukaszewski et al. (2017)

The hypothesis of a human-universal personality structure is undermined by cross-cultural studies in small-scale societies. To explain cross-population differences in patterns of behavioral covariance, we proposed the niche diversity hypothesis, which holds that the degree of behavioral covariation within a population is inversely related to the number and diversity of niches within its socioecology. This hypothesis is formalized as a computational model, and its predictions have been supported empirically. Herein, we respond to several important issues regarding this line of research that were raised in a recent commentary: (1) the study of specific behavioral syndromes should be integrated into the niche diversity model; (2) environmental harshness might alternatively explain our cross-cultural findings regarding effects of niche diversity; and (3) better definitions of behavioral traits are needed for future research. We conclude that the niche diversity hypothesis can be integrated with other explanations for cross-cultural differences in personality covariation.

The influence of the invasive process on behaviours in an intentionally introduced hybrid, Xiphophorus helleri–maculatus

Both intentionally and unintentionally introduced populations vary greatly in their ability to succeed as invasive species. What causes this extreme variability in success largely remains controversial. Understanding the extent to which these differences are due to aspects of the invasive process could lead to better mitigation of invasive species. We investigated the effect of the invasive process in selecting for individual behaviours and behavioural syndromes in the Xiphophorus helleri–maculatus hybrid, an intentionally introduced fish species. We measured three behaviours (boldness, aggression and exploration) known to play a role in invasive success across three populations representing different stages of invasion: fish from commercial breeding pools, from pet stores and from an established invasive population in Hawaii. We detected significant differences in boldness across populations, with a significant decrease from the breeding pool to the pet store and a significant increase from the pet store to the established invasive population. In addition, we detected behavioural syndromes between either two or all three behaviours that were significantly different across populations. Overall variation in behaviours was similar between breeding pool and pet store fish but appeared to decrease in the invasive population when compared to the pet store population, potentially leading to a more defined behavioural syndrome between exploration and aggression. Our results suggest that while aspects of the invasive process influenced boldness and behavioural syndromes, the increased variation, produced either through hybridization or relaxed selection in the pet trade, is at least partly responsible for the success of X. helleri–maculatus as an invasive species. Additional studies are needed to examine the source of the variation in the pet trade and its influence on the formation of behavioural syndromes in invasive populations.

P08.05 Cognitive impairment in patients with newly-diagnosed high-grade gliomas

Abstract BACKGROUND Cognitive dysfunction is frequent in patients with primary brain tumor, impairing attention, memory and executive function. It compromises functional independence, decision making capacity and psycho-social well-being. Cognitive functioning is highly correlated to disease progression and quality of survival, thus cognitive follow-up is essential in the management of the disease. Cognitive screening tools are often used, since a comprehensive battery may be time consuming and challenging for patients. The objective of this study was to identify a pattern of cognitive dysfunction in patients with newly-diagnosed high-grade gliomas and evaluate the sensitivity and specificity of the MoCA (Montreal Cognitive Assessment) as a cognitive screening tool in the clinical practice. MATERIAL AND METHODS We compared performances in tests of memory, action speed, visuospatial ability and executive function of 156 patients with newly-diagnosed WHO Grade III and IV gliomas, after surgery and prior to radiochemotherapy, to those of a group of healthy controls (n=1003). Relatives assessed behavior through a questionnaire of behavioral dysexecutive syndrome. A stepwise logistic regression was performed to select cognitive domains better discriminating patients from healthy controls and we tested the sensitivity and specificity of the MOCA using ROC curve analysis. RESULTS The stepwise logistic regression analysis identified the 3 following factors better discriminating patients from controls: TMT-B completion time (OR: 0.673; 95% CI: 0.511–0.886; p=0.0005), a verbal memory index (OR:0.507; 95% CI: 0.358–0.718; p=0.0001) and a behavioral dysexecutive score (OR:0.616; 95% CI: 0.468–0.812, p=0.001). Prevalence of cognitive-behavioral impairment was of 35.94%; 95% CI: 28.3 - 43.5. The ROC curve analysis for the assessment of the MoCA sensitivity and specificity in detecting impairment yielded 0.795 (95%CI: 0.714–0.875) for the MoCA raw score, and 0.804 (95%CI: 0.727 - 0.881) for the adjusted z score. The optimal discrimination was obtained for a raw score ≤ 25 (sensitivity of 0.526; specificity of 0.832). For the adjusted score, optimal discrimination value was observed with a -0.603 z score (sensitivity of 0.716; specificity of 0.768). CONCLUSION Cognitive impairment and behavioral dysexecutive syndrome is frequent in patients with newly-diagnosed high-grade glioma. The MoCA lacks sensitivity in screening cognitive impairment to discriminate patients from healthy controls in this setting, and a comprehensive neuropsychological assessment is still recommended.