Cambridge Neuropsychological Test Automated Battery Research Articles

A Study Protocol to Determine Heat-Related Health Impacts among Primary Schoolchildren in South Africa.

Climate models predict that the global average temperature of Earth will rise in the future. Studies show that high classroom temperatures can affect the ability of the student to learn and function. It is important to understand the impact that heat will have on the health, wellbeing, and academic performance of learners, as they spend a significant amount of time in classrooms compared to any other environment. A follow-up panel study among 20 public primary schools in the Gauteng province (South Africa) will be carried out, in which Grade 4 learners will be selected to complete an hourly heat-health symptom questionnaire. A Cambridge Neuropsychological Test Automated Battery (CANTAB) test will be used to determine their memory and attention span. A nursing practitioner will measure body weight, height, and temperature. Lascar data loggers will be used to measure indoor classroom temperature. School principals will complete a questionnaire on existing school coping mechanisms and policies in place that help deal with hot weather conditions. This is the first study to quantitatively assess the effects of heat on learners’ health, well-being and school performance in South Africa. The outcomes of this study will enable policymakers and public officials to develop appropriate school heat adaptation and mitigation measures and will assist in channeling their resources where it is most needed.

Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery.

Background: Measuring cognitive functioning is common in traumatic brain injury (TBI) research, but no universally accepted method for combining several neuropsychological test scores into composite, or summary, scores exists. This study examined several possible composite scores for the test battery used in the large-scale study Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI).Methods: Participants with mild traumatic brain injury (MTBI; n = 140), orthopedic trauma (n = 72), and healthy community controls (n = 70) from the Trondheim MTBI follow-up study completed the CENTER-TBI test battery at 2 weeks after injury, which includes both traditional paper-and-pencil tests and tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Seven composite scores were calculated for the paper and pencil tests, the CANTAB tests, and all tests combined (i.e., 21 composites): the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); and the number of scores ≤5th percentile, ≤16th percentile, or <50th percentile.Results: The OTBM and the number of scores <50th percentile composites had distributional characteristics approaching a normal distribution. The other composites were in general highly skewed and zero-inflated. When the MTBI group, the trauma control group, and the community control group were compared, effect sizes were negligible to small for all composites. Subgroups with vs. without loss of consciousness at the time of injury did not differ on the composite scores and neither did subgroups with complicated vs. uncomplicated MTBIs. Intercorrelations were high within the paper-and-pencil composites, the CANTAB composites, and the combined composites and lower between the paper-and-pencil composites and the CANTAB composites.Conclusion: None of the composites revealed significant differences between participants with MTBI and the two control groups. Some of the composite scores were highly correlated and may be redundant. Additional research on patients with moderate to severe TBIs is needed to determine which scores are most appropriate for TBI clinical trials.

Predictors of Disease Progression in Early-Onset Alzheimer's Dementia: A Retrospective Cohort Study

ObjectivesEarly-onset Alzheimer's disease (EOAD), defined as onset of AD before the age of 65 years, is less common than the late-onset type, and little is known about the factors affecting disease progression. The aim of the study was to investigate factors influencing disease progression in people with EOAD. DesignRetrospective cohort study. Setting and ParticipantsPeople with EOAD who were assessed and attended the specialist memory service at a university teaching hospital in a European setting, between 2000 and 2010. MeasuresSociodemographic details and clinical and cognitive assessments at initial assessment were used as potential predictors of change in clinical status and outcome at final follow-up within the memory service. ResultsOf the 101 people diagnosed with EOAD during this period, 96 patients were followed up (53 women; aged 59 ± 4.9 years; mean follow-up 36.3 ± 29.12 months). Patients were classified as Stable (n = 25) if continued within the memory service or discharged to primary care, and those transferred to other specialist services (n = 66) for further inputs, institutional care (n = 4), or died (n = 1) were classified as Worseners (n = 71). Lower education (P = .008), lower Cambridge Cognition Examination scores (P = .049), and presence of family history of dementia [P = .012, χ2 (1) = 8.84] was associated with worse change in clinical status. Furthermore, cognitive deficits such as lower scores on comprehension, recent memory, and executive functions were found to predict a worse clinical outcome. Conclusions and ImplicationsIdentification of predictors of faster disease progression has significant clinical benefit, allowing clinicians to estimate prognosis and plan patient care accordingly.

Role of Single Low Pulse Intensity of Transcranial Magnetic Stimulation Over the Frontal Cortex for Cognitive Function.

Background: The principal aim of this study was to measure the effect of online single-pulse transcranial magnetic stimulation (TMS) over the right dorsolateral prefrontal cortex (DLPFC) on cognition via the Cambridge Neuropsychological Test Automated Battery (CANTAB) in healthy individuals.Methods: In a single-blind, sham-controlled study, we assessed both 50% and 60% of the resting motor threshold (RMT) over the right DLPFC in healthy right-handed (n = 42) adults using cognitive function, such as attention and memory, as a measure via CANTAB.Results: We observed an improvement in the cognitive function level during the use of online low intensities of 50% and 60% RMT active stimulation of the DLPFC compared to the sham stimulation.Conclusions: The results showed that low-intensity TMS can indeed effectively modulate cognitive function in DLPFC. Future research is, however, necessary to investigate the potential effects of low-intensity TMS on different brain areas to increase confidence in the observed results.

Impaired neuropsychological functioning in patients with hypopituitarism.

BackgroundTreatment of pituitary pathology mostly does not result in complete recovery of impairment in cognitive functioning. The primary aim of the current study was to assess cognitive impairment in patients with stable replacement therapy for hypopituitarism during the last 6 months prior to inclusion. It was expected that patients showed subjective and objective subnormal scores on neuropsychological functioning.MethodsForty‐two patients (40% men, 49 ± 15 years) treated for hypopituitarism conducted a neuropsychological test battery, including the Cognitive Failures Questionnaire (CFQ), 15‐Word test (15‐WT), Cambridge Neuropsychological Test Automated Battery (CANTAB) Motor Screening Task (MOT), Spatial Working Memory (SWM) and Affective Go/No‐go (AGN). Results were compared to reference values of healthy norm groups.ResultsMale and female participants scored significantly worse on the CFQ (P < .01, d = 0.91‐4.09) and AGN mean correct latency (P < .01, d = 1.66 and 1.29, respectively). Female participants scored significantly worse on 15‐WT direct recall (P = .01, d = 0.66), 15‐WT delayed recall (P = .01, d = 0.79), SWM total errors (P = .05, d = 0.41), SWM strategy (P = .04, d = 0.43), AGN errors of commission (P = .02, d = 0.56) and omission (P = .04, d = 0.41).ConclusionThis study shows that subjective cognitive functioning is worse in patients treated for hypopituitarism compared to reference data. Also, female participants treated for hypopituitarism score worse on objective aspects of memory and executive functioning compared to reference data. Besides worse focus attention, this objective cognitive impairment was not found in male participants. It is recommended to conduct additional research, which focuses on the design and evaluation of a cognitive remediation therapy, aimed at compensation of impairments in different aspects of memory and executive functioning.

Neurological soft signs (NSS) and cognitive deficits in HIV associated neurocognitive disorder

Neurological soft signs (NSS) are frequently found in severe mental disorders, such as Alzheimer's disease, schizophrenia or HIV associated neurocognitive disorder (HAND) which includes asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia. To characterize NSS in patients with HIV we examined them with respect to neuropsychological deficits typically found in the disorder.67 HIV + patients without a history of head trauma, opportunistic infections, severe psychiatric disorders or acute confounding comorbidities of the Central nervous system (CNS) were recruited. NSS and neuropsychological deficits were examined on the Heidelberg scale and the Cambridge Neuropsychological Test Automated Battery (CANTAB), respectively. Semantic and phonemic verbal fluency were additionally established.According to NIMH and NINDS criteria, 18 patients were diagnosed with ANI and 21 with MND, 28 showed no cognitive deficits. NSS total scores were significantly correlated with several cognitive domains and NSS subscales. These correlations were confirmed when motor performance was entered as a covariate.According to our findings, NSS in HIV positive patients are significantly correlated with deficits in a broad range of neuropsychological domains. Similar findings were reported in schizophrenia, emphasizing the transdiagnostic character of NSS and supporting NSS examination in screening HIV patients for HAND.

Subacute and chronic neuropsychological sequalae of acute organophosphate pesticide self-poisoning: a prospective cohort study from Sri Lanka

Context Some epidemiological evidence implicates acute organophosphate (OP) pesticide poisoning in long-term neurocognitive deficits. However, no study has prospectively followed up poisoned patients long-term from the time of intoxication. We aimed to determine whether clinically significant acute OP self-poisoning leads to subacute and chronic neurocognitive deficits, in a prospective follow up study. Methods Employing Mini Mental State Examination, Digit Span and Cambridge Neuropsychological Test Automated Battery (CANTAB), we compared multiple cognitive functions in 222 patients hospitalized with acute OP pesticide self-poisoning with a control group of 52 patients hospitalized with paracetamol overdose, at three time points: on discharge following clinical recovery, 6 weeks and 6 months post-ingestion. Intergroup comparisons at each time point were done in multiple regression models, adjusting for sex, age, education and psychiatric comorbidities. OP within-group analysis was done to determine a dose–response relationship. Results After adjusting for covariates, the OP poisoned group had significantly poorer working memory (Digit Span) and episodic memory (CANTAB Paired Associates Learning); impaired spatial planning (CANTAB Stocking of Cambridge); and slower response speed in the sustained attention task (CANTAB Rapid Visual Information Processing), in the post-discharge assessment. Only working memory and episodic memory measures were impaired in the OP group at 6 weeks, whereas no significant intergroup differences were observed at 6 months. The OP subgroup who had complete red cell acetylcholinesterase inhibition on admission had poorer episodic memory when tested post-discharge than those who had partial inhibition, but no significant subgroup differences were observed at 6 weeks or 6 months. Discussion Acute OP pesticide poisoning may cause neuropsychological impairment that outlasts the cholinergic phase on a subacute time scale; but does not cause measurable chronic neuropsychological deficits.

The pharmacokinetics, efficacy, and safety of a novel selective-dose cannabis inhaler in patients with chronic pain: A randomized, double-blinded, placebo-controlled trial.

BackgroundPrecise cannabis treatment dosing remains a major challenge, leading to physicians’ reluctance to prescribe medical cannabis.ObjectiveTo test the pharmacokinetics, analgesic effect, cognitive performance and safety effects of an innovative medical device that enables the delivery of inhaled therapeutic doses of Δ9‐Tetrahydrocannabinol (THC) in patients with chronic pain.MethodsIn a randomized, three‐arms, double‐blinded, placebo‐controlled, cross‐over trial, 27 patients received a single inhalation of Δ9‐THC: 0.5mg, 1mg, or a placebo.Δ9‐THC plasma levels were measured at baseline and up to 150‐min post‐inhalation. Pain intensity and safety parameters were recorded on a 10‐cm visual analogue scale (VAS) at pre‐defined time points. The cognitive performance was evaluated using the selective sub‐tests of the Cambridge Neuropsychological Test Automated Battery (CANTAB).ResultsFollowing inhalation of 0.5 mg or 1mg, Δ9‐THC plasma C max ± SD were 14.3 ± 7.7 and 33.8 ± 25.7 ng/ml. T max ± SD were 3.7 ± 1.4 and 4.4 ± 2.1 min, and AUC0 → infinity±SD were 300 ± 144 and 769 ± 331 ng*min/ml, respectively. Both doses, but not the placebo, demonstrated a significant reduction in pain intensity compared with baseline and remained stable for 150‐min. The 1‐mg dose showed a significant pain decrease compared to the placebo. Adverse events were mostly mild and resolved spontaneously. There was no evidence of consistent impairments in cognitive performance.ConclusionThis feasibility trial demonstrated that a metered‐dose cannabis inhaler delivered precise and low THC doses, produced a dose‐dependent and safe analgesic effect in patients with neuropathic pain/ complex‐regional pain syndrome (CRPS). Thus, it enables individualization of medical cannabis regimens that can be evaluated pharmacokinetically and pharmacodynamically by accepted pharmaceutical models.SignificanceEvidence suggests that cannabis‐based medicines are an effective treatment for chronic pain in adults. The pharmacokinetics of THC varies as a function of its route of administration. Pulmonary assimilation of inhaled THC causes rapid onset of analgesia. However, currently used routes of cannabinoids delivery provide unknown doses, making it impossible to implement a pharmaceutical standard treatment plan. A novel selective‐dose cannabis inhaler delivers significantly low and precise doses of THC, thus allowing the administration of inhaled cannabis‐based medicines according to high pharmaceutical standards. These low doses of THC can produce safe and effective analgesia in patients with chronic pain.

Behavioral shaping of rhesus macaques using the Cambridge neuropsychological automated testing battery

BackgroundThe Cambridge neuropsychological test automated battery (CANTAB) is a set of computerized visuospatial tests used to probe cognition in humans. The non-human primate (NHP) version of the battery is a valuable translational research tool to quantify cognitive changes in NHP models of disease by allowing direct comparison with performance data from human patient populations. One limitation is the long training times required for NHPs to reach appropriate levels of task performance, which is prohibitive for high throughput experimental designs. New methodWe report a new training regimen to teach NHPs a subset of CANTAB cognitive tasks using a method of successive approximations (shaping), where rewarded behaviors progressively approximate the goal behavior, and sequential task learning is used to build upon previously learned rules. Using this refined method, we taught 9 adult rhesus macaques to perform three tasks: the self-ordered spatial search (SOSS), delayed match-to-sample (DMTS), and paired associative learning (PAL) tasks. Results and comparison with existing methodsNHPs learned all three cognitive tasks in approximately 130 training sessions, roughly 200 sessions faster than previously published training times. NHPs were able to perform each task to a stable level of performance (>80 % correct) enabling their use in future cognitive experiments. ConclusionsOur approach of behavioral shaping reduced the time to train NHPs to performance criteria on SOSS, DMTS, and PAL tasks. This allows efficient use of the NHP-adapted CANTAB to compare cognitive changes in NHP models of neurological disease with those observed in human patient populations.

Shift-work-related sleep disruption and the risk of decline in cognitive function: The CRUISE Study.

Acute total sleep deprivation and partial sleep deprivation have negative impacts on cognitive performance. Studies in subjects who regularly experience sleep loss, however, are rare and often restricted to examination of internal sleeping disorders. To address this issue, we set up a pilot study to explore the effects of a week characterized by sleep disruption on cognitive functioning, using a case–control setting in a maritime pilot group with chronic exposure to intermittent extrinsic, work‐related sleep disruption. Twenty maritime pilots (aged 30–50 years) were compared to sex‐ and education‐matched controls with normal sleep behaviour, from the same age range. We assessed subjective and objective cognitive function, including attention, psychomotor speed, memory and executive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). Although we were able to confirm poorer sleep in maritime pilots and subjective complaints in some cognitive domains, we did not find objective cognitive deficits in the maritime pilot group compared to controls without sleep disruption. This could suggest that in this group of healthy, young maritime pilots, exposure to sleep disruption resulted in some subjective cognitive complaints, but objective deficits of cognitive function were not detected in comparison with a non‐pilot control group. However, given the small sample size, the absence of an effect does not exclude the possibility that sleep disruption could result in cognitive deficits in general. Therefore, our findings have to be confirmed in future prospective studies with a larger sample size and matched controls, regarding age, education and work history.

Circulating Insulin-Like Growth Factor-1 Is Positively Associated with Growth and Cognition in 6- to 9-Year-Old Schoolchildren from Ghana

Milk intake stimulates linear growth and improves cognition in children from low-income countries. These effects may be mediated through insulin-like growth factor-1 (IGF-1). The objective was to assess the effect of milk supplement on circulating IGF-1 and to assess IGF-1 as a correlate of growth and cognition in children. Secondary data on blood spot IGF-1 from a randomized, double-blind, controlled trial in 6-9-y-old children from rural Ghana were analyzed. Intervention groups received porridge with non-energy-balanced supplements: 8.8g milk protein/d, 100kcal/d (Milk8); 4.4g milk and 4.4g rice protein/d, 100kcal/d (Milk/rice); 4.4g milk protein/d, 48kcal/d (Milk4); or a control (no protein, 10kcal/d). IGF-1, length, body composition, and Cambridge Neuropsychological Test Automated Battery (CANTAB) were measured at 3.5 or 8.5 mo. Linear regressions were used to assess the effect of milk interventions on IGF-1 and IGF-1 as a correlate of growth and cognition. The increase in IGF-1 was 15.3 (95% CI: 3.3, 27.3) ng/mL higher in children receiving Milk8 compared with the control. The IGF-1 increases in the isonitrogenous, isoenergetic Milk/rice or the Milk4 groups were not different from the control (P≥0.49). The increase in IGF-1 was associated with improvements in 4 out of 5 CANTAB domains. The strongest associations included reductions in "mean correct latency" from Pattern Recognition Memory and "pre-extradimensional (pre-ED) shift errors" from Intra/Extradimensional Set Shift (P≤0.005). In addition, change in IGF-1 was positively associated with changes in height, weight, and fat-free mass (P≤0.001). Intake of skimmed milk powder corresponding to one, but not half a glass of milk on school days stimulates IGF-1 in 6-9-y-old Ghanian children. IGF-1 seems to mediate the effect of milk intake on growth and cognition. The association between IGF-1 and cognition in relation to milk intake is novel and opens possibilities for dietary interventions to improve cognition.

Clinical and biomarker changes of Alzheimer's disease in adults with Down syndrome: a cross-sectional study

SummaryBackgroundAlzheimer's disease and its complications are the leading cause of death in adults with Down syndrome. Studies have assessed Alzheimer's disease in individuals with Down syndrome, but the natural history of biomarker changes in Down syndrome has not been established. We characterised the order and timing of changes in biomarkers of Alzheimer's disease in a population of adults with Down syndrome.MethodsWe did a dual-centre cross-sectional study of adults with Down syndrome recruited through a population-based health plan in Barcelona (Spain) and through services for people with intellectual disabilities in Cambridge (UK). Cognitive impairment in participants with Down syndrome was classified with the Cambridge Cognitive Examination for Older Adults with Down Syndrome (CAMCOG-DS). Only participants with mild or moderate disability were included who had at least one of the following Alzheimer's disease measures: apolipoprotein E allele carrier status; plasma concentrations of amyloid β peptides 1–42 and 1–40 and their ratio (Aβ1–42/1–40), total tau protein, and neurofilament light chain (NFL); tau phosphorylated at threonine 181 (p-tau), and NFL in cerebrospinal fluid (CSF); and one or more of PET with 18F-fluorodeoxyglucose, PET with amyloid tracers, and MRI. Cognitively healthy euploid controls aged up to 75 years who had no biomarker abnormalities were recruited from the Sant Pau Initiative on Neurodegeneration. We used a first-order locally estimated scatterplot smoothing curve to determine the order and age at onset of the biomarker changes, and the lowest ages at the divergence with 95% CIs are also reported where appropriate.FindingsBetween Feb 1, 2013, and June 28, 2019 (Barcelona), and between June 1, 2009, and Dec 31, 2014 (Cambridge), we included 388 participants with Down syndrome (257 [66%] asymptomatic, 48 [12%] with prodromal Alzheimer's disease, and 83 [21%] with Alzheimer's disease dementia) and 242 euploid controls. CSF Aβ1–42/1–40 and plasma NFL values changed in individuals with Down syndrome as early as the third decade of life, and amyloid PET uptake changed in the fourth decade. 18F-fluorodeoxyglucose PET and CSF p-tau changes occurred later in the fourth decade of life, followed by hippocampal atrophy and changes in cognition in the fifth decade of life. Prodromal Alzheimer's disease was diagnosed at a median age of 50·2 years (IQR 47·5–54·1), and Alzheimer's disease dementia at 53·7 years (49·5–57·2). Symptomatic Alzheimer's disease prevalence increased with age in individuals with Down syndrome, reaching 90–100% in the seventh decade of life.InterpretationAlzheimer's disease in individuals with Down syndrome has a long preclinical phase in which biomarkers follow a predictable order of changes over more than two decades. The similarities with sporadic and autosomal dominant Alzheimer's disease and the prevalence of Down syndrome make this population a suitable target for Alzheimer's disease preventive treatments.FundingInstituto de Salud Carlos III, Fundació Bancaria La Caixa, Fundació La Marató de TV3, Medical Research Council, and National Institutes of Health.

The chemo-brain effect in colorectal cancer patients.

e24095 Background: The chemo-brain effect associated with systemic chemotherapy results in cognitive disturbances impacting the capacity to engage in tasks and quality of life (QOL). Patients with colorectal cancer (CRC) who receive adjuvant chemotherapy generally have long survival times. The long-term effect of chemotherapy on cognition is uncertain. We aimed to ascertain the frequency of long-term cognitive impairment using neuropsychological assessments and correlating with neuroimaging. Methods: In this prospective pilot study, patients (n=22) with stage II to III CRC between 45 to 75 years old, who were planned to receive adjuvant chemotherapy, were recruited. 3 visits were scheduled for each subject – pre-chemotherapy (V1), at 1 month post chemotherapy (V2), and at 6 months post chemotherapy (V3). Serial tests were performed – the Cambridge Neuropsychological Test Automated Battery (CANTAB), QOL questionnaires (Hospital Anxiety and Depression Scale (HADS), Perceived Deficits Questionnaire (PDQ), EORTC QLQ-C30, FACT-ES), 3 item pocket smell test, functional PET/MRI brain imaging, and blood biomarker studies. Results: 18/22 subjects (13 male, 5 female) had completed tests at all 3 visits; the median age was 62 years (range 51 – 69). 9/18 had an initial decline (median -0.033) of Rapid Visual Information processing (RVP) at V2; 3/9 showed improvement to baseline at V3. 8/18 had a persistent decline in RVP scores at V3 (median -0.054). This was associated with increased HADS depression scores (mean 3.63 at V2 vs 4.63 at V1), worsening attention scores (mean 4.38 at V3 and 3.63 at V1), prospective memory scores (mean 3.75 at V3 vs 3.38 at V1), and total scores (mean 14.63 at V3 vs 13.75 at V1) on the PDQ. 7/18 had an increase in Paired Associates Learning (PAL) errors (median +6) at V2. 3/7 improved to baseline at V3, while 4/7 continued to have a persistent decline. PAL scores were not associated with worsening retrospective or prospective PDQ memory scores, changes in HADS depression or EORTC QLQ-C30 scores. There was no difference in baseline CANTAB scores for patients reporting declining vs stable QLQ-C30 scores. Conclusions: Only half of patients with initial RVP A and PAL decline improved at 6 months post chemotherapy. Further efforts should be placed to identify those at risk of poor recovery, and develop strategies to manage the chemo-brain effect. The correlation of cognitive decline with neuroimaging will be presented in the final analysis.

S235. COGNITION AND SOCIAL BEHAVIORS IN SPORTS FOR PATIENTS WITH SCHIZOPHRENIA ENGAGED IN SPORTS HABITS

BackgroundSeveral studies have reported that team sports are effective for maintaining and improving mental health among patients with schizophrenia. Social behavior, such as adjusting an individual’s motion while reading others’ intentions and predicting others’ motion in team sports, is considered to improve related cognitive characteristics. However, the quantitative evaluation of social behaviors during sports, and the cognitive characteristics of patients with schizophrenia engaging in team sports habits remain unclear. In this study, we aimed to clarify these behaviors and cognitions quantitatively.MethodsTwelve male patients with schizophrenia and 15 male healthy controls with experience playing football participated in this study. We used a 3-vs-1 ball possession task. Three-dimensional coordinates of the landmark points were acquired using a 3D optical motion capture system with 16 cameras (OptiTrack, USA). First, we evaluated group coordination in a previous study using three inner angles of the three attackers’ triangle. Second, we computed four variables for evaluating individual performance: pass-miss rate, pass angle, angular displacement, and additional distance. Third, we used a slalom dribble test to evaluate individual football skill. Meanwhile, we used three cognitive tasks: the Rey-Osterrieth Complex Figure test (ROCFT), Trail Making Test A and B (TMT), as well as RTI (reaction time), IED (intra-extra dimensional set shift) and SWM (spatial working memory) in the Cambridge Neuropsychological Test Automated Battery (CANTAB). For statistical analysis, we used the Mann-Whitney U-test to compare the variables between groups. We used Spearman’s rank correlation coefficient between the variables in 3-vs-1 and cognitive tasks. In addition, we conducted partial correlation analysis between these variables using recent football experience per month and duration of illness as covariates.ResultsIn group coordination during the 3-vs-1 task, the patient group exhibited a slightly wider distribution in the contour plots in the phase plane than the control group. Next, in individual performance in motor tasks, the angular displacement in patients with schizophrenia was significantly smaller than that in the control group (p = 0.043, r = −0.39). Meanwhile, there were no significant differences in the slalom test, pass-miss rate, pass angle, and additional distances (p > 0.05). For cognitive tasks, the reproduction scores of ROCFT after 3-min and 30-min in patients with schizophrenia were significantly smaller than those in the control group (p < 0.006, r < −0.53). Patients’ scores on the TMT (A and B) were significantly lower than those in the control group (p < 0.004, r < −0.56). In RTI on the CANTAB, five-choice reaction time and movement time in the patients were longer than those in the control group (p < 0.049, r > 0.37). Meanwhile, other characteristics were not significantly different between the two groups. In the correlation between 3-vs-1 variables and cognitive test performance, EDS errors in CANTAB IED and TMT A were negatively correlated with the pass angle (ρ = −0.62, p = 0.031 and ρ = −0.64, p = 0.026) in patients with schizophrenia. Additionally, the partial correlation in patients revealed that the negative partial correlation between EDS error in CANTAB IED and pass angle remained significant (ρ = −0.64, p = 0.046).DiscussionThe current results demonstrated that patients were not impaired in most domains of cognition and social behavior in the tasks. However, other types of cognition and social behavior for patients with schizophrenia and team sports habits were still likely to be impaired.

M4. CHILDHOOD TRAUMA, BRAIN STRUCTURE AND EMOTION RECOGNITION IN SCHIZOPHRENIA AND HEALTHY ADULTS: A MODERATED MEDIATION ANALYSIS

BackgroundWhile traumatic childhood experiences have been frequently associated with adverse effects on social cognitive abilities, specifically emotion recognition, in individuals with schizophrenia (SZ) and to some degree in healthy adults also (Rokita et al., 2018), the neural mechanisms for this association remain unclear. Therefore, the main aim of this study was to explore the impact of childhood trauma on brain structures that are particularly sensitive to stress and are involved in emotion recognition processes (i.e. amygdala, hippocampus, anterior cingulate cortex (ACC)) (Cancel et al., 2019). We also investigated whether volumetric changes in these brain regions mediate the association between childhood trauma and performance on an emotion recognition task.MethodsWe investigated 46 patients with SZ (mean age=43.74; SD=10.94; 12 females and 34 males) and 112 healthy adults (mean age=40.13; SD=12.46; 31 females and 81 males). All participants underwent an MRI scan and completed the Childhood Trauma Questionnaire (CTQ) (Bernstein et al., 2003), which assesses the experience of trauma in childhood, including emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. Emotion recognition was measured with the total score on the Emotion Recognition Task (ERT) implemented in the Cambridge Neuropsychological Test Automated Battery (CANTAB) (Robbins et al., 1994). Mediation analyses were conducted to explore the direct and indirect effects of childhood trauma on emotion recognition via volumetric changes in the amygdala, hippocampus and the ACC as mediators.ResultsWe found that patients with SZ had significantly higher scores on physical neglect (PN; p=.018) and cumulative childhood trauma (p=.049) compared to healthy participants. Patients also had significantly smaller hippocampus (p=.001), but not amygdala (p=.453) or ACC (p=.893), and performed worse on the ERT task (p<.001), compared to the healthy group. PN was significantly negatively associated with the total score on the ERT task (r=-.321, p<.001) and a smaller volume of the left ACC (r=-.161, p=.046) in all participants. Reduced volumes of the left and entire ACC appeared to mediate the association between PN and ERT task in healthy adults (β=-1.183, SE=.687, 95% [-2.701: -.079]; β=-1.176, SE=.738, 95% [-2.872: -.0162], respectively). In the patient group, only the direct association between PN and the ERT score was significant (β= -11.657, SE=3.843, 95% CI [-19.251: -4.064], p=.003).DiscussionOur findings provide further evidence for the detrimental impact of childhood trauma, specifically physical neglect, on volumetric changes in the ACC region in both patients with SZ and healthy adults. Moreover, to the best of our knowledge, this is the first study to show that the ACC region may be a potential neural mediator in the association between physical neglect and the ability to recognise emotions. These findings highlight the need to develop early interventions (e.g. parenting programs) in order to minimise the occurrence of childhood adversities, hence preventing from their detrimental effects on brain structure and function in both clinical and non-clinical populations.

The Cambridge Neuropsychological Test Automated Battery (CANTAB) Versus the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) for the Assessment of Cognitive Function in Patients with Multiple Sclerosis

BackgroundWe determined how the Cambridge Neuropsychological Test Automated Battery (CANTAB) compared to the Minimal Assessment of Cognitive Function in multiple sclerosis (MACFIMS) in terms of sensitivity, specificity, and predictive values in detecting cognitive impairment in multiple sclerosis (MS) patients. MethodsSixty MS patients were recruited, 2 of whom were lost to follow-up. On the first day of the neuropsychological examination, the standard MACFIMS battery and the day after, the CANTAB (paired-associate learning (PAL), reaction time (RTI), rapid visual information processing (RVP), and spatial working memory tasks (SWM)) were completed by the patients. The sensitivity, specificity, and predictive values of the CANTAB in the differentiation of cognitively impaired (CI) patients from not cognitively impaired (NCI) ones were compared with those of the MACFIMS battery using appropriate statistical tests. ResultsFifty-eight patients were categorized into two groups of CI (n=16 (27.58%)) and NCI (n=42 (72.41%)) based on the MACFIMS battery standard criteria. The best reporter indices and their cut-off scores for differentiation of CI from NCI patients in each task of the CANTAB were “total errors=13” for PAL, “between errors=26” for SWM, “five-choice reaction time=368.57” for RTI, and “mean latency=522.14” for RVP. The optimal cut-off point for distinguishing CI from NCI in the CANTAB was found to be an impaired function in 3 or more tasks [(AUC (95% CI): 0.97 (0.94–1.00); p<0.001)]. Accordingly, 36.20% of the patients were CI based on the CANTAB criteria. The inter-test agreement (CANTAB and MACFIMS batteries) was found to be the highest (Cohen's κ (95% CI): 0.80 (0.64–0.96)). ConclusionResults confirm that the CANTAB can discriminate CI from NCI MS patients with high accuracy, and its results are comparable to those of the MACFIMS battery; thus, they might be interchangeably used in the clinical practice.

Hydrolyzed Chicken Extract (ProBeptigen®) on Cognitive Function in Healthy Middle-Aged People: A Randomized Double-Blind Trial.

Cognitive decline is an important issue of global public health. Cognitive aging might begin at middle adulthood, the period particularly vulnerable to stress in lifespan. Essence of chicken (EOC) has consistently demonstrated its beneficial effects on various cognitive domains as nutritional supplementation. This study primarily aimed to examine the cognitive enhancement effects of ProBeptigen® (previously named CMI-168), hydrolyzed peptides extracted from EOC, in healthy middle-aged people under mild stress. Ninety healthy subjects were randomly assigned into the ProBeptigen® or placebo group for eight weeks. Neurocognitive assessment, event-related potentials (ERPs), and blood tests were conducted before, during, and after the treatment. The ProBeptigen® group outperformed placebo group on Logical Memory subtests of Wechsler Memory Scale-third edition (WMS-III) and Spatial Working Memory task in the Cambridge Neuropsychological Test Automated Battery (CANTAB). The anti-inflammatory effects of ProBeptigen® in humans were also confirmed, with progressively declining high-sensitivity C-reactive protein (hs-CRP) levels. Regular dietary supplementation of ProBeptigen® is suggested to improve verbal short- and long-term memory as well as spatial working memory, and reduce inflammation in middle-aged healthy individuals with stress. The effects of ProBeptigen® on cognition warrant further investigation. (NCT03612752)

Cognitive impairment, endothelial biomarkers and mortality in maintenance haemodialysis patients: a prospective cohort study

Haemodialysis (HD) patients have a high prevalence of cardiovascular disease risk factors as well as cognitive impairment. The objective of the present study was to evaluate the interrelationship between cognitive impairment, endothelium-related biomarkers and cardiovascular/non-cardiovascular mortality. A total of 216 outpatients were recruited from three centres in a dialysis network in Brazil between June 2016 and June 2019. Sociodemographic and clinical data were obtained by applying a patient questionnaire, reviewing medical records data and conducting patient interviews. Cognitive function was assessed using the Cambridge Cognitive Examination. Plasma endothelium-related biomarkers [syndecan-1, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1) and angiopoietin-2 (AGPT2)] were measured. Patients were followed for 30 months. Cox proportional hazards regression models were used to assess the associations of the cognitive function scores and each endothelium-related biomarker with cardiovascular/non-cardiovascular mortality. Cognitive function was associated with cardiovascular mortality {each standard deviation [SD] better cognitive score was associated with a 69% lower risk for cardiovascular mortality [hazard ratio (HR) 0.31 [95% confidence interval (CI) 0.17-0.58]} but not with non-cardiovascular mortality. Moreover, cognitive function was also correlated with all endothelial-related biomarkers, except VCAM-1. ICAM-1, AGPT2 and syndecan-1 were also associated with cardiovascular mortality. The association between cognitive function and cardiovascular mortality remained significant with no HR value attenuation [fully adjusted HR 0.32 (95% CI 0.16-0.59)] after individually including each endothelial-related biomarker in the Cox model. In conclusion, cognitive impairment was associated with several endothelium-related biomarkers. Moreover, cognitive impairment was associated with cardiovascular mortality but not with non-cardiovascular mortality, and the association between cognitive impairment and cardiovascular mortality in HD patients was not explained by any of the endothelial-related biomarkers.

Assessment of fatigue severity and neurocognitive functions in the real setting of Ramadan in patients with type 2 diabetes mellitus

ObjectivesType 2 diabetes mellitus (T2DM) is linked with a risk of dementia and decline in neurocognitive function. The current observational case-control study was conducted to evaluate the effect of fasting during Ramadan on cognitive functions and fatigue severity in T2DM patients using the Cambridge Neuropsychological Test Automated Battery (CANTAB). MethodsThis research was conducted at King Saud University Medical city, on 82 subjects including 43 control and 39 T2DM patients of both genders. The standardized Fatigue Severity Scale (FSS) and tests from CANTAB, including the Motor Screening Task (MOT), Spatial Span (SSP) and Intra-Extra Dimensional Set Shift (IED) were recorded during 3rd week and 2–3 weeks after Ramadan under controlled environmental conditions. Neurocognitive functions were recorded through CANTAB. ResultsIED errors (24.43 vs 50.73, p = 0.007), MOT mean and median latency (1466.32 vs 1120.27, p = 0.002) were significantly higher in T2DM than controls. IED stages completed (7.43 vs 8.69, p = 0.003) and SSP Span length were significantly lower in T2DM than controls (4.13 vs 4.82, p = 0.059). The significant differences between T2DM patients and controls persisted in the post. T2DM patients made more errors and completed less IED stages than did the controls, indicating that a worsened flexibility of attention relative to controls. Moreover, T2DM patients exhibited longer latencies in MOT, indicating poor motor performance. A comparison of performances by T2DM patients on FSS and CANTAB during and after Ramadan showed that fasting substantially increased fatigue scales, motor performance, and working-memory capacity. ConclusionsPatients with T2DM have impaired cognitive functions including poor motor performance, low flexibility of attention, and poor working memory capacity compared to healthy control subjects during and also in post Ramadan period. However, there is no clear statistical evidence that the cognitive functions (except for SSP SL scores) and fatigue severity of T2DM subjects differ between Ramadan and after Ramadan in both T2DM and controls.

Effects of transcranial direct current stimulation over frontal, parietal and cerebellar cortex for cognitive function during fasting in healthy adults

BackgroundTranscranial direct current stimulation (tDCS) is a neuromodulation tool used to modify the cognitive function in subjects. There is a paucity of data on tDCS’ effect on cognitive function during Ramadan fasting. This paper aims to assess the effect of tDCS of three brain areas, including the right dorsolateral prefrontal cortex (DLPFC), posterior parietal cortex (PPC), and cerebellum on cognitive function, and obtain safety data in healthy adults during Ramadan fasting. Methods and materialA total of 42 healthy, right-handed participants were randomly assigned to one of the 6 stimulation groups: active (anodal)-tDCS of right DLPFC, PPC, and cerebellum; or sham for DLPFC, PPC, and cerebellum after 8 h of fasting for Ramadan. Safety data and cognitive function, such as attention-switching tasks (AST), were obtained by employing the Cambridge Neuropsychological Test Automated Battery (CANTAB) before and after each tDCS session. The cognitive function outcome variables were the response time and the percentage of correct answers in AST. For sham stimulation, the placement of the electrodes was the same as for the active stimulation. ResultsAn improvement in performance time in attention tasks was observed; however, it did not reach a significant level after anodal stimulation of the DLPFC, PPC, and cerebellum. Overall, there were no statistically significant differences between the active and sham tDCS groups in cognitive function. There were no significant side effects of tDCS during fasting for any group. ConclusionsOur data suggest that there are variable effects of tDCS on attention tasks during Ramadan fasting. TDCS appears to be safe, well-tolerated and adhered to the international standard of safety in the local population during Ramadan fasting. Further large sample size studies should be conducted to validate the current study findings and reach better conclusions.