Central Nervous System Vital Signs Research Articles

Assessment of Neurocognitive Functions in Children and Adolescents with Obesity

ABSTRACTObesity is linked to adverse neurocognitive outcomes including reduced cognitive functioning. We aimed to investigate the differences in neuropsychological test performance of Turkish children and adolescents with obesity and healthy peers. Study includes 147 children and adolescents ranging in age from 8 to 16 years: 92 with obesity and 55 with healthy controls. After the participants were administered the Children's Depression Inventory (CDI) and the Screen for Child Anxiety Related Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor speed, Processing speed, Reaction time, Complex attention, Executive Function, Cognitive flexibility), and a summary score (Neurocognition Index [NCI]). There was a statistically significant difference between the obesity and control groups on all cognitive domains. The mean NCI score of the obesity group was 81.3 ± 10.24 compared to 97.29 ± 4.97 for the control group. The mean NCI score in the obesity group was significantly lower than that of the control group (p < 0.001). The mean scores of other domains of obese patients were also found to be significantly lower than those of the control participants (p < 0.001). The mean SCARED scores of the participants with obesity were found to be significantly higher than those of the control participants (p < 0.05). However, no statistically significant relationship was found between the SCARED and the CNSVS scores. Cognitive dysfunction in children and adolescents with obesity should be taken into consideration when assessing and managing this population.

Interaction between C-reactive protein and cognitive functions according to APOE gene polymorphism in post-menopausal women.

IntroductionA potential factor increasing the risk of the development of cognitive impairment with age is apolipoprotein E (APOE) ε4 carrier status. A subsequent factor which may increase the risk of development of cognitive impairment at an older age is the concentration of C-reactive protein (CRP). The objective of the study was to examine the relationship between cognitive functions and the concentration of CRP in post-menopausal women who were carriers of particular apolipoprotein E gene (APOE) polymorphisms.Material and methodsA group of 402 women was recruited to the study. The inclusion criteria were: minimum two years after the last menstruation, follicle-stimulating hormone (FSH) concentration 30 U/ml, no dementi signs on Montreal Cognitive Assessment (MoCA). The computerized battery of the Central Nervous System Vital Signs (CNS VS) test was used to diagnose cognitive functions. APOE genotyping was performed by multiplex PCR. The blood plasma CRP levels were determined. Statistical analysis was performed using Statistica software.ResultsThe level of neurocognitive index (NCI) and cognitive functions in post-menopausal women depends on apolipoprotein E gene polymorphism (p < 0.001) and the concentration of CRP (p < 0.05). A negative correlation was found between CRP and NCI (p = 0.018), and the reaction time (p = 0.008) of women with APOE ε2/ε3. A positive correlation was observed between CRP and visual memory (p = 0.025) in women with APOE ε3/ε3, and verbal memory (p = 0.023) in women with APOE ε3/ε4 or ε4/ε4.ConclusionsApolipoprotein E gene polymorphism may modify the relationship between CRP concentration and cognitive functions in post-menopausal women.

Evaluation of executive functions in children and adolescents with familial Mediterranean fever

ABSTRACTThe aim of the present study was to investigate neuropsychological test performance in children and adolescents with familial Mediterranean fever (FMF). A total of 88 children and adolescents aged 8 to 17 years were included, 52 with FMF and 36 healthy controls. After the participants were administered the Children Depression Inventory (CDI) and the Screen for Child Anxiety Related Emotional Disorders (SCARED), they completed the battery tests of the Central Nervous System Vital Signs (CNSVS), a neurocognitive test battery, via computer. The battery calculates seven domain scores (Memory, Psychomotor Speed, Processing Speed, Reaction Time, Complex Attention, Executive Function, and Cognitive Flexibility) and a summary score (Neurocognition Index [NCI]). A statistically significant difference between the FMF and control groups was found in six out of seven domains, where the scores of the participants with FMF were found to be significantly lower than those of the control participants (p < .05). Although the mean Reaction Time score of the participants with FMF was found to be lower than that of the control participants, the finding was not statistically significant (p > .05). The mean CDI and SCARED scores of the participants with FMF were found to be significantly higher than those of the control participants (p < .05). Low scores in the Processing Speed and Psychomotor Speed domains of the CNSVS were significantly correlated with higher SCARED scores (r = −.37, p = .01). Impaired cognitive functions should be taken into consideration in children and adolescents with FMF when assessing and managing this population.

Thalamic atrophy predicts cognitive impairment in relapsing remitting multiple sclerosis. Effect on instrumental activities of daily living and employment status

IntroductionCognitive impairment is an important predictor of quality of life at all stages of MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. ObjectiveThe aim of the study was to designate the MRI marker that predicts cognitive decline and explore its effect on every day activities and employment status. Methods50 RRMS patients and 31 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Everyday activities were evaluated with the instrumental activities of daily living (IADL) scale and employment status. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, corpus callosum and thalamic atrophy. ResultsThe frequency of cognitive dysfunction for our RRMS patients was 38%. RRMS patients differed significantly from controls on the TMTA, TMTB, phonological verbal fluency task, memory, psychomotor speed, reaction time and cognitive flexibility. Neuropsychological measures had a strong correlation with all MRI atrophy measures and a weak or moderate correlation with lesion volume. Psychomotor speed was the most sensitive marker for IADL, while memory and TMTB for employment status. Thalamic area was the most sensitive MRI marker for memory, psychomotor speed and TMTB.. ConclusionThalamic atrophy predicts the clinically meaningful cognitive decline in our RRMS patients.

Cognitive functions, lipid profile, and Apolipoprotein E gene polymorphism in postmenopausal women.

The objective of the study was investigation of the relationship between cognitive functions and lipid profile, BMI and change of body weight in postmenopausal women carriers of Apolipoprotein E gene polymorphisms (APOE). A group of 170 women was recruited to the study. The inclusion criteria were: minimum of two years after the last menstruation, FSH concentration 30 U/ml and no signs of dementia on the Montreal Cognitive Assessment (MoCA). A computerized battery of Central Nervous System Vital Signs (CNS VS) was used for diagnostic cognitive functions. APOE genotype was performed by multiplex PCR. In blood plasma were determined: triglycerides, total cholesterol and its fractions: HDL cholesterol and LDL cholesterol. Statistical analysis was performed using two-way analysis of variance in STATISTICA software. In the postmenopausal women examined, the carrier state of APOE gene polymorphism was associated with the level of triglycerides, and results concerning three cognitive functions: executive functions, psychomotor speed, and cognitive flexibility. Loss of body weight in postmenopausal women was related with lower results in neurocognitive index and the majority of cognitive functions. The results concerning cognitive functions in postmenopausal women in the study were not significantly related with lipid profile. Significant differences were observed according to APOE gene polymorphism in correlations between LDL/HDL and CHOL/HDL ratios, and results in the processing speed and reaction time, as well as between the BMI and results in processing speed in the postmenopausal women examined.

Homocysteine and cognitive disorders of postmenopausal women measured by a battery of computer tests--central nervous system vital signs.

The purpose of the study was the analysis of cognitive functions in postmenopausal women having different status of homocysteine levels by a battery of computer tests-central nervous system vital signs (CNS-VS). We examined whether homocysteine increases the risk of cognitive decline and which cognitive domains are more affected. We showed that the considerably better neurocognitive index was obtained by women with low homocysteine levels in comparison with those with hyperhomocysteinemia (p = 0.0017). Similarly, results were obtained in the field of executive functioning (p = 0.0011), complex attention (p = 0.0106), cognitive flexibility (p = 0.0016), and memory (p = 0.0145). Verbal memory and visual memory did not differ considerably among the studied groups. Also, we demonstrated that ε4/ε4 genotype was the most common (15.5%) in women with hyperhomocysteinemia than in groups of patients with low (0%) or normal (1.9%) homocysteine levels. In summary, hyperhomocysteinemia was related with increased risk of decline in executive functioning, complex attention, cognitive flexibility, and memory in postmenopausal women.

Are cognitive functions in post-menopausal women related with the contents of macro- and micro-components in the diet?

The objective of the study was an evaluation of the relationship between the level of cognitive functions and contents of micro- and macro-components in the diet of postmenopausal women. A group of 402 women was recruited to the study. The inclusion criteria were: minimum two years after the last menstruation, FSH concentration 30 U/ml and no dementia signs on the Montreal Cognitive Assessment (MoCA). A computerized battery of the Central Nervous System Vital Signs (CNS VS) test was used to diagnose cognitive functions. The dietary questionnaire was evaluated based on observation of a seven-day diet. The data obtained were introduced into the database and analyzed using computer software DIETICIAN. Statistical analysis was performed using statistical software STATISTICA. The results of the study concerning diet unequivocally indicate a very poor quality of diet in the group of postmenopausal women examined. The daily diet had a too high energetic value. The women consumed an excessive amount of total fat, including definitely too much monounsaturated fatty acids, and insufficient polyunsaturated fatty acids. The dietary intake of sodium and phosphorus was too high, whereas deficiencies were observed in the consumption of iron, copper, potassium, calcium, magnesium and zinc. No significant correlations were found in the analysis of cognitive functions according to the energetic value of daily diet and contents of macro- and micro-components. The results concerning verbal memory significantly depended on the daily intake of polyunsaturated fatty acids. Women who consumed polyunsaturated fatty acids below the daily normal or normal level obtained significantly higher results in verbal memory.

Physiotherapy Management of Comobidity of Post Knee Arthroscopy and Mental Disorder: Case Study

Mrs M.A was referred to physiotherapy for the rehabilitation of function post Right (R) Knee Arthroscopy. The referring surgeon described her over the phone as a difficult patient and that her case was of great concern to the company she works for. A 39 years old professional with frayed lateral and medial meniscus; lateral meniscial tears with medial femoral condral defect. She was also referred to a psychiatrist 10 days before surgery who managed her for 3 days as Spectral Analysis (Neurofeedback and Central nervous system vital signs assessment) was indicative of anxiety and/or depression. She regretted going in for surgery and lacked confidence in her work environment. Outcomes: By the 18th therapy session of Physiotherapy at the end of week 6, Pain reduced from Score 10 to Score (4) VAS, Muscles' strength increased from Grade 2/2+ to 4/4+ Oxford muscle grading, Range of motion increased from 00 -1000 to 00 -1200 which is the normal; Function improved from non weight bearing crutch walking wearing 0.5 inch sandal to normal gait wearing inch foot wears. Built confidence and settled at work with team members such that she could work outstation; Life events scale score reduced from 549 to 289. However at week 10 she reported back with exacerbation of pain, score (10) as a result of handling a household emergency. Conclusion: The occurrence together of musculoskeletal conditions and mental disorders in the same person often complicates treatment and management plans. Clinical management of people with comorbid conditions can be more complex and time consuming than for those with single conditions. Mental health status of patients should be assessed prior to surgery, and physiotherapists irrespective of specialty areas of practice should take cognisance of the fact that anyone referred for rehabilitation should be managed with holistic and biopsychosocial approaches in the context of the WHO International Classification of Functioning, Disability and Health.

Functional status of thyroid and cognitive functions after menopause.

BackgroundThyroid activity plays a role in cognition. However, the relation between the functional state of thyroid and neuropsychiatric changes proceeding with age among people without clinical symptoms of thyroid dysfunction is still unknown. The aim of this study was analysis of cognitive function levels in reference to thyroid examination: thyroid-stimulating hormone (TSH), total thyroxin (TT4), triiodothyronine (TT3), free thyroxin (FT4), free triiodothyronine (FT3), thyroperoxidase antibodies (TPO-AB), and thyroglobulin antibodies (Tg-AB), TSH receptor antibodies (AB-TSHR) in women after menopause.Material/MethodsA group of 383 women was recruited for the study. The inclusion criteria were: minimum two years after the last menstruation and no dementia signs on Montreal Cognitive Assessment (MoCA). Computerized battery of Central Nervous System Vital Signs (CNS VS) test was used to diagnostic cognitive functions. The blood plasma values were determined: TSH, FT3, FT4, TT3, TT4, TPO-AB, Tg-AB, and AB-TSHR. Statistical analysis was performed using Pearson’s correlation coefficient and analysis of variance in STATISTICA software.ResultsIn women after menopause, TSH was negatively correlated with NCI results, executive functions, complex attention, and cognitive flexibility. FT4 was positively correlated with results of psychomotor speed. TT3 and TT4 were negatively correlated with results of memory and verbal memory. Furthermore, TT4 was negatively correlated with NCI, executive functions, and cognitive flexibility. TPO-AB was negatively correlated with results of memory, verbal memory, and psychomotor speed. Tg-AB was positively correlated with results of reaction time. AB-TSHR was negatively correlated with NCI results, memory, executive functions, psychomotor speed, complex attention, and cognitive flexibility.ConclusionsOur study supports the importance of thyroid functionality in cognitive functioning in a group of women after menopause. The values of TSH, TT3, TT4, TPO-AB, and AB-TSHR were higher and FT4 was lower in examined women. The results were poorer in examination of cognitive functions measured with a battery of CNS-VS tests.

The Selective Glycine Uptake Inhibitor Org 25935 as an Adjunctive Treatment to Atypical Antipsychotics in Predominant Persistent Negative Symptoms of Schizophrenia

Using a selective glycine uptake inhibitor as adjunctive to second-generation antipsychotic (SGA) was hypothesized to ameliorate negative and/or cognitive symptoms in subjects with schizophrenia. Subjects with predominant persistent negative symptoms (previously stabilized ≥3 months on an SGA) were enrolled in a randomized, placebo-controlled trial to investigate adjunctive treatment with Org 25935, a selective inhibitor of type 1 glycine transporter, over 12 weeks in a flexible dose design. Org 25935 was tested at 4 to 8 mg twice daily and 12 to 16 mg twice daily versus placebo. Primary efficacy outcome was mean change from baseline in Scale for Assessment of Negative Symptoms composite score. Secondary efficacy end points were Positive and Negative Syndrome Scale total and subscale scores, depressive symptoms (Calgary Depression Scale for Schizophrenia), global functioning (Global Assessment of Functioning scale), and cognitive measures using a computerized battery (Central Nervous System Vital Signs). Responder rates were assessed post hoc. A total of 215 subjects were randomized, of which 187 (87%) completed the trial. Both dose groups of Org 25935 did not differ significantly from placebo on Scale for Assessment of Negative Symptoms, Positive and Negative Syndrome Scale (total or subscale scores), Global Assessment of Functioning, or the majority of tested cognitive domains. Org 25935 was generally well tolerated within the tested dose range, with no meaningful effects on extrapyramidal symptoms and some reports of reversible visual adverse effects. Org 25935 did not differ significantly from placebo in reducing negative symptoms or improving cognitive functioning when administered as adjunctive treatment to SGA. In our study population, Org 25935 appeared to be well tolerated in the tested dose ranges.

Effects of Omega-3 Fatty Acid Supplementation on Neurocognitive Functioning and Mood in Deployed U.S. Soldiers: A Pilot Study

Omega-3 fatty acids (FAs) may have neuroprotective properties for psychological health and cognition. The objective of this study was to evaluate the effectiveness of omega-3 FAs (eicosapentaenoic + docosahexaenoic; Harris-Schacky [HS]-Omega-3 Index) on neuropsychological functioning among U.S. Soldiers deployed to Iraq. This randomized, double-blind, placebo-controlled trial included Soldiers between the ages of 18 and 55 years who were randomly assigned to either the active treatment group (n = 44) or placebo group (n = 34). Active treatment was 2.5 g per day of eicosapentaenoic + docosahexaenoic (Lovaza; GlaxoSmithKline, Research Triangle Park, North Carolina). The placebo was corn oil ethyl esters. HS-Omega-3 Index, a neurocognitive battery (Central Nervous System-Vital Signs, Morrisville, North Carolina), and psychological health scales were assessed at baseline and after 60 days of treatment. Although the results revealed that omega-3 FAs significantly increased the HS-Omega-3 Index (p = 0.001), there were no significant effects on indices psychological health and neurocognitive functioning by treatment group. Nevertheless, there was a significant inverse correlation between the changes in the HS-Omega-3 Index and daytime sleepiness (r = 0.30, p = 0.009). Short-term treatment with 2.5 g of omega-3 FAs did not alter measures of neurocognition or psychological health, but there was evidence of a relationship between omega-3 levels and daytime sleepiness.

Cognitive impairment in relapsing remitting and secondary progressive multiple sclerosis patients: efficacy of a computerized cognitive screening battery.

Objective. To investigate the pattern of cognitive impairment in relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients using a computerized battery. Methods. RRMS patients (N = 50), SPMS patients (N = 30), and controls (N = 31) were assessed by Central Nervous System Vital Signs (CNS VS) computerized battery, Trail Making Tests (TMT) A and B, and semantic and phonological verbal fluency tasks. Results. The overall prevalence of cognitive dysfunction was 53.75% (RRMS 38%, SPMS 80%). RRMS patients differed from controls with large effect size on reaction time, medium effect size on TMT A and small on TMT B, phonological verbal fluency, composite memory, psychomotor speed, and cognitive flexibility. SPMS patients differed from controls in all neuropsychological measures (except complex attention) with large effect sizes on TMT A and B, phonological verbal fluency, composite memory, psychomotor speed, reaction time, and cognitive flexibility. Between patient groups, medium effect sizes were present on TMT B and psychomotor speed, while small effect sizes were present on composite memory and processing speed. Conclusion. CNS VS is sensitive in detecting cognitive impairment in RRMS and SPMS patients. Significant impairment in episodic memory, executive function, and processing speed were identified, with gradual increment of the frequency as disease progresses.

Standards for thyroid laboratory testing, and cognitive functions after menopause.

IntroductionThe aim of the study is to analyze the relationship between normative and non-normative thyroid tests (TSH, TT4, TT3, FT3, FT4, anti-TPO, anti-Tg, AB-TSHR) and the level of cognitive functions in postmenopausal women.Material and methodsThe study group consisted of 383 women from south-eastern Poland, aged 50-65 years. The cognitive functions were evaluated using a diagnostic instrument – Central Nervous System – Vital Signs (CNS-VS). Blood was collected for determination of the following parameters: TSH, TT4, TT3, FT3, FT4, anti-TPO, anti-Tg, AB-TSHR.ResultsThere were significant differences in NCI, executive functions, psychomotor speed, reaction time, complex attention and cognitive flexibility, depending on the normative and non-normative level of TSH. Women whose level of FT3 was at the lower limit of the normal range obtained poorer results in psychomotor speed, while subjects with levels of FT4 below the standard achieved significantly lower scores for this function. The relationship between NCI and cognitive functions, and the normative and non-normative anti-TPO results, showed significant differences in verbal memory, visual memory, processing speed and reaction time. The level of AB-TSHR reported as normal or above the norm significantly differentiated from the results of NCI, processing speed, executive functions, psychomotor speed, complex attention and cognitive flexibility.ConclusionsConcentrations of laboratory parameters assessing the thyroid function located within the upper limits of the normal range showed a different relationship with the cognitive performance than concentrations located within the lower limits of the standard.

Relationship between exercise behavior, cardiorespiratory fitness, and cognitive function in early breast cancer patients treated with doxorubicin-containing chemotherapy: a pilot study.

The purpose of this study was to examine the relationship between self-reported exercise behavior, cardiorespiratory fitness (CRF), and cognitive function in early breast cancer patients. Thirty-seven breast cancer patients following completion of chemotherapy (median 16 months) and 14 controls were studied. Cognitive function was assessed using the Central Nervous System (CNS) Vital Signs software (CNS Vital Signs, LLC, Morrisville, N.C., USA), a computerized test battery consisting of 9 cognitive subtests. Exercise behavior was evaluated using the Godin Leisure Time Exercise Questionnaire, and CRF was assessed via a cardiopulmonary exercise test to assess peak oxygen consumption. Patients' mean total exercise was 184 ± 141 min·week(-1) compared with 442 ± 315 min·week(-1) in controls (p < 0.001). Significantly fewer patients (32%) were meeting exercise guidelines (i.e., ≥150 min of moderate-intensity or vigorous exercise per week) compared with 57% of controls (p = 0.014). Patients' peak oxygen consumption averaged 23.5 ± 6.3 mL·kg(-1)·min(-1) compared with 30.6 ± 7.0 mL·kg(-1)·min(-1) in controls (p < 0.01). Scores on the cognitive subdomains were generally lower in patients compared with controls, although only the difference in verbal memory was significant (unadjusted p = 0.041). In patients, weak to moderate correlations were indicated between exercise, peak oxygen consumption, and the majority of cognitive subdomain scores; however, there was a significant positive correlation between exercise and visual memory (r = 0.47, p = 0.004). In conclusion, breast cancer patients following the completion of primary adjuvant chemotherapy exhibit, in general, worse cognitive performance than healthy women from the general population, and such performance may be related to their level of exercise behavior.

Cognitive performance is impaired in euthymic Chinese patients with Bipolar 1 Disorder

BackgroundData from euthymic patients with Bipolar Disorder (BD) has shown cognitive impairment and the notion that sufferers of BD achieve full recovery between illness episodes is questionable. These findings have not been replicated in a Chinese population. The present study examined the cognitive profile of euthymic Chinese patients with Bipolar 1 Disorder (BD-1) and matched healthy control participants. MethodsEuthymic patients with BD-1 and matched controls (n=104 in total) completed serial measures to assess mood and also completed an IQ test and the Central Nervous System Vital Signs (CNSVS) computerized battery assessing memory (verbal and visual), executive functions, attention, psychomotor and processing speed. ResultsPatients with BD-1 performed worse than controls on all cognitive domains. When using 2 or more scores below the 5th percentile as a cutoff for neurocognitive impairment, 46.2% of the patients with BD-1 and none of the control sample scored in this range (p<.001). Correlational analysis among the illness variables in BD-1 revealed that cognitive performance was inversely correlated with the number of manic episodes and duration of illness. LimitationsIt was not possible to determine the causal relationship between associated illness and performance. The effect of medication on cognitive performance requires further study. ConclusionsEuthymic Chinese patients with BD-1 demonstrate marked cognitive impairments and these correlated with illness parameters. Cognitive impairment in BD may be independent of language and culture.

Huntington's Disease: Two-Year Observational Follow-Up of Executive Function Evaluation with CNS Vital Signs Test in an Adult Patient

Huntington's disease (HD) is a genetic, degenerative, and progressive central nervous system disease. It is characterized by motor abnormalities and cognitive and psychiatric symptoms. Objective. To describe the precise degree of clinical severity of patients with HD through a new neurocognitive assessment. Methods. Unprecedented battery of computerized tests, CNSVS (Central Nervous System Vital Signs), was applied at three different moments in 2008, 2009, and 2010. The accurate and reliable CNSVS objectively provided the cognitive state of patients and allowed for the evaluation of disease progression. Case Report. P., 26, female, without any medication, with normal psychomotor development is a parent carrier of HD. In 2008, she was diagnosed with HD in accordance with the Medical Genetics Laboratories. Conclusion. The tests may be useful to reveal the exact measure of the current evolutionary stage of HD patients, allowing for more efficient planning of treatment and future procedures, such as the medication, therapy, and physical activity to be administered.

Identifying Cognitive Problems in Children and Adolescents with Depression Using Computerized Neuropsychological Testing

Depression in children and adolescents can negatively impact cognitive functioning, social development, and academic performance. The purpose of this study was to determine whether a computerized battery of neuropsychological tests could detect neurocognitive difficulties in children and adolescents with depression. Participants included 30 children and adolescents between the ages of 9 and 17 years (M = 14.6, SD = 2.1) with a clinical diagnosis of depression. Healthy control participants were individually matched on age, education, sex, race, primary language, handedness, and self-reported computer familiarity. All participants completed the Central Nervous System Vital Signs computerized battery. This battery of seven tests yields 23 test scores and 5 domain scores (Memory, Psychomotor Speed, Reaction Time, Complex Attention, and Cognitive Flexibility). Children and adolescents with depression performed worse on the Memory (Cohen's d = .43) and Complex Attention domains (d = .58) than matched controls. On the individual test scores, children and adolescents with depression performed worse on delayed verbal memory (d = .63), delayed visual memory (d = .34), measures of reaction time (d = .34–.53), and accuracy/inhibition on complex attention tasks (d = .49–.65). When considering the five domain scores simultaneously, children and adolescents with depression were more likely to have two or more scores at or below the 5th percentile (p = .05). Children and adolescents with depression have problems with reduced processing speed, memory for verbal information, and executive functioning on this computerized battery of tests, which represents a feasible method for neuropsychological screening.

Identifying Neurocognitive Impairment in Depression Using Computerized Testing

There is considerable interest in the identification of neurocognitive impairment in patients with depression. The purpose of this study is to illustrate a methodology for identifying frank neurocognitive impairment in clinical practice and research using a computerized battery of neuropsychological tests. Participants were 100 adult patients with depression who were not on antidepressants. They were carefully matched on age, education, gender, and ethnicity to 100 healthy adult control subjects. All participants completed the Central Nervous System Vital Signs (CNS-VS) computerized assessment battery, which takes approximately 30–40 minutes to administer. Patients with depression performed more poorly than controls on all five domain scores (Cohen's d ranged from d = .37 to .72). When using two or more scores below the 5th percentile as the cutoff for frank neurocognitive impairment, 31.0% of the depressed sample and only 5.0% of the control sample scored in this range. In this study, patients with depression were 8.5 times more likely to have two or more index scores that were below the 5th percentile. Computerized testing, using the interpretive methodology presented, represents an efficient methodology for identifying cognitive problems in patients who present with untreated depression.

Rapid Computerized Assessment of Neurocognitive Deficits in Bipolar Disorder

The purpose of this study is to illustrate the clinical usefulness of a computerized neuropsychological battery for identifying neurocognitive deficits in adults with bipolar disorder. Participants were 47 outpatients with bipolar disorder who were individually matched on age, education, sex, and ethnicity to 47 control subjects from the Central Nervous System (CNS) Vital Signs normative database. CNS Vital Signs is comprised of seven common neuropsychological measures, and it generates 15 primary scores that are used to calculate five domain scores (Memory, Psychomotor Speed, Reaction Time, Cognitive Flexibility, and Complex Attention). There was a significant multivariate effect and statistically significantly worse scores for those in the bipolar group on all five domain scores (medium to large effect sizes). When using two or more scores below the fifth percentile as a cutoff for neurocognitive impairment, 42.6% of the bipolar sample and only 6.4% of the control sample scored in this range. A subset of outpatients with bipolar disorder has frank neurocognitive impairments identifiable with this 30–40-minute computerized assessment battery.

Quantitative monitoring of brain function, vital signs, and hormonal response during acute insulin-induced hypoglycemia

Acute insulin-induced hypoglycemia provokes changes in central nervous system activity and release of counterregulatory hormones. The clinical relationship between central nervous system activity, hormone secretion, and vital signs has not to our knowledge been previously reported. We used computerized electroencephalographic (CEEG) analysis to monitor 5 nondiabetic subjects during acute insulin-induced hypoglycemia (0.75 U/kg intravenous push). Their glucose nadir was 38 +/- 6 mg/dl (mean +/- 1 SD). A three-phase pattern of change in CEEG power in response to hypoglycemia was observed: phase 1 was characterized by an increase in total CEEG power (natural log of activity = 9.1 +/- 1.3 microV2) over baseline (8.7 +/- 1.2 microV2) in the theta, delta, and beta frequency bands. This phase preceded and coincided with the glucose nadir. During phase 2, power in all frequency bands fell significantly below baseline. A nadir in CEEG power (8.0 +/- 1.6 microV2) occurred 40 to 55 minutes after insulin injection as glucose levels were rising. During phase 3 there was a return to baseline in CEEG power and frequency spectra. Heart rate increase just before phase 1; peak heart rate (91 +/- 8 beats/min) coincided with peak CEEG power and was significantly higher than basal rate (71 +/- 11, P less than 0.05). A significant increase in respiratory rate occurred during phase 1 of the CEEG and persisted through phase 2. A significant decrease in mean blood pressure (nadir = 73 +/- 6 mm Hg) below preinsulin blood pressure (81 +/- 8 mm Hg, P less than 0.05) coincided with the nadir of CEEG power in phase 2.(ABSTRACT TRUNCATED AT 250 WORDS)