Cognitive Deficits In Patients Research Articles

Aberrant Default Mode Network Underlying the Cognitive Deficits in the Patients With Late-Onset Depression.

Late-onset depression (LOD) is regarded as a risk factor or a prodrome of Alzheimer’s disease (AD). Moreover, LOD patients with cognitive deficits have the higher risk of subsequent AD. Thus, it is necessary to understand the neural underpinnings of cognitive deficits and its pathological implications in LOD. Consistent findings show that the default mode network (DMN) is an important and potentially useful brain network for the cognitive deficits in LOD patients. In recent years, genetics has been actively researched as a possible risk factor in the pathogenesis of LOD. So, in this review, we discuss the current research progress on the cognitive deficits and DMN in LOD through a combined view of brain network and genetics. We find that different structural and functional impairments of the DMN might be involved in the etiological mechanisms of different cognitive impairments in LOD patients.

P01.161 Neurocognitive evaluation in elderly Glioma patients

Glioblastoma (GBM) is the most common primary brain tumor in adults, with an increasing incidence in patients aged 75 through 85. Prognosis in these patients is particularly dismal due to more aggressive tumor biology, lower functional reserve and high prevalence of comorbidities. Many studies report cognitive impairment in GBM patients, ranging from 29 to 90%. This study was aimed at evaluating neurocognitive status and comorbidities of an elderly population with high grade glioma and the correlation with clinical and demographical variables. patients underwent an extended neuropsychological evaluation with a battery of standardized tests on 8 cognitive domains: global function (GF); verbal learning (VL); short and long-term memory (STM); executive functions (EF); abstract reasoning (AR); attention (ATT) and visuo-constructional abilities (CA). Moreover, the Cumulative Illness Rating Scale was administered to each patient for comorbidities evaluation. We assessed 69 patients with median age at diagnosis of 74 years (range 65–85). 43 patients (62%) presented multi-domain cognitive impairment, and only 8 (12%) showed no cognitive impairment. Neuropsychological deficit mainly affected executive functions (n=42), short term memory (n=28), long term memory and attention (n=22). Patients with AR deficit had a poorer PFS and OS (p<0. 001%). At the follow up, 7 out of 12 patients showed cognitive improvement, 4 resulted furtherly deteriorated and 1 patient was stable. Attention was the most affected function at follow up, while verbal learning was the most improved one. Our results highlight the high prevalence of cognitive deficits in patients with Glioma. Moreover, this study underlines the need to include cognitive functioning and comorbidities evaluation in the assessment of elderly neuro-oncological patients.

Characteristics of cognitive functions in patients of different age with dyscirculatory encephalopathy and metabolic syndrome

Objective — to establish the characteristics of cognitive changes in patients of different age subgroups with metabolic syndrome (MetS).Methods and subjects. 503 patients aged 45 to 89 years with dyscirculatory encephalopathy (DE) of mixed etiology were examined. Patients were divided into two groups: 1 — without MetS (n = 198), 2 — with MetS (n = 305). Patients in both clinical groups were also divided into 3 age subgroups: 45 — 59 — middle age, 60 — 74 years — elderly, 75 — 89 years old — senile age. The general‑clinical, neurological, neuropsychological, laboratory and instrumental examinations were conducted.Results. The patients with DE and MetS had worse indicators of cognitive functions, compared to the patients without MetS (the speed of sensory motor responses, mental performance, the volume of active attention, the efficacy of information processing, lower rates on the clock drawing test and the Frontal Assessment Battery). The severity of cognitive decline in patients of both clinical groups accrued with aging. The most pronounced negative effect of MetS on cognitive functions was observed in the subgroup of middle‑aged patients, which was depicted in significantly lower overall MMSE score. According to the MMSE subtest profile, patients with DE and MetS of all age subgroups had significantly worse, comparing with patients without MetS, parameters of the short‑term memory and reproduction of verbal material. It should be noted that in the middle and elderly age, changes in the cognitive profile are similar, whereas in the senile age subgroup it varies due to an increase in deterioration in time orientation subtest paramters.Conclusions. Patients with DE with MetS had more severe impairment of cognitive functions. Significant influence of age on the severity of cognitive impairment was found: the severity of cognitive deficits in patients of both clinical groups increased in aging.

Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment.

The objective of the present study was to assess the presence of cognitive deficits in patients with chronic migraine, and to assess the main factors that trigger cognitive disorders, such as comorbidities or the use of medications. Chronic migraine and control groups were interviewed in a case-control study. The frequency and intensity of the headache, medication used and associated comorbidities were determined. All patients were submitted to an extended neuropsychological assessment. The chronic migraine group (n = 30) had a worse performance in the Montreal Cognitive Assessment Test (p = 0.00), Verbal Fluency (p = 0.00), Stroop (p = 0.00), Clock Drawing Test (p = 0.00), Digit Span (p = 0.00) and Matrix Reasoning (p = 0.01). After statistical adjustment by linear regression, migraine continued to be the only relevant factor in the poorer performance in the Montreal Cognitive Assessment, Verbal Fluency, Clock Drawing and Stroop tests. Patients with chronic migraine have cognitive deficits in multiple tasks, regardless of the presence of comorbidities or the use of medications.

Superior cognitive goal maintenance in carriers of genetic markers linked to reduced striatal D2 receptor density (C957T and DRD2/ANKK1-TaqIA)

Maintaining goal representations is a critical component of cognitive control and is required for successful performance in many daily activities. This is particularly important when goal-relevant information needs to be maintained in working memory (WM), updated in response to changing task demands or internal goal states, and protected from interference by inhibiting counter-goal behaviors. Modulation of fronto-striatal dopamine is critical for updating and maintaining goals and representations. Here we test the hypothesis that a genetic predisposition (C957T T+ and DRD2/ANKK1-TaqIA A+) for reduced striatal D2 receptor availability would facilitate goal maintenance using the AX-continuous performance task (AX-CPT), on a sample of 196 adults (25–67 y). We demonstrate that carriers of two polymorphisms that have been linked to reduced striatal D2 receptor density show increased performance on context-dependent (BX) trials, and that the effect of these polymorphisms was only significant for long ISI trials where the demand for goal maintenance is high. The current results add further knowledge to the role of D2 receptor functioning in cognitive stability and flexibility, and could have implications for understanding cognitive deficits in patients characterized by altered dopamine functioning.

Cerebral Evoked Potentials in Patients at an Early Stage of Schizophrenia

Visual and auditory EPs (with special attention to their cognitive components) were examined in 33 patients with newly diagnosed schizophrenia (a group of patients, Pat; all subjects obtained supporting pharmacotherapy) and 30 mentally healthy subjects (a control group, Contr). Reversive chess patterns with the squares of 60 or 120 ang. sec were used as stimuli in the case of visual EPs, while tones of different frequencies, 1.0 and 4.0 kHz, were used for initiation of auditory EPs. The odd-ball paradigm was used; the probabilities of significant stimuli (i.e., signals) at each sensory modality were 20 or 50%. The amplitudes and latencies of generally differentiated EP components, with special attention to the P1, N1, P2, N2, P3 (P300), and N4 waves, were measured; in addition, the latencies (times) of sensorimotor reactions (SMRs) to presentation of the signal stimuli (pushing the button) were recorded. The averaged latencies of visual N1, P2, N2, P300, and N4 (at the 50% probability) and of N2, P300, and N4 (20% probability) in patients with schizophrenia were significantly longer than those in the control. Besides, the amplitudes of visual P2 and N2 (50% probability) and of P2, P300, and N4 (20% probability) were significantly lower than in the control. At auditory stimulation, the latencies of nearly all EP components in the Pat group at both 50 and 20% probabilities of significant stimuli were longer that in the norm, but the differences did not reach the significance level. The amplitudes of components P1–N2 in auditory EPs at the 50% probability were significantly lower than in the control. Significantly longer latencies (times) of the SMRs were observed in the Pat group at both auditory and visual stimulation and at both probabilities of significant stimuli. It is concluded that the cognitive deficit in patients with schizophrenia is probably more clearly reflected in the parameters of visual EPs, while changes in the positive symptoms of this disease are more reflected in the parameters of auditory EPs.

Inhibition of Phosphodiesterase-4 Reverses Aβ-Induced Memory Impairment by Regulation of HPA Axis Related cAMP Signaling.

Beta amyloid peptides (Aβ) are found to be associated with dysfunction of hypothalamic-pituitary-adrenal axis (HPA axis) that leads to memory and cognitive deficits in patients with Alzheimer's disease (AD). Phosphodiesterase 4 (PDE4) inhibitors increase the intracellular cAMP activities, which may ameliorate cognitive deficits associated with AD. However, it remains unclear whether PDE4-mediated reversal of cognitive impairment in mouse model of AD is related to HPA axis and downstream cAMP-dependent pathway. The present study investigated the effects of PDE4 inhibitor rolipram on Aβ1-42-induced cognitive dysfunction and its underlying mechanisms. The step-down passive avoidance (PA) and Morris water-maze (MWM) tests were conducted 1 week (1 W), 2 months (2 M), and 6 months (6 M) after intracerebroventricular microjection (i.c.v.) of Aβ1-42. The results suggested that memory impairment emerged as early as 1 W, peaked at 2 M, and lasted until 6 M after injection. Chronic treatment with rolipram (0.1, 0.5, 1.0 mg/kg/d, i.p.) for 2 weeks (i.e., treatment started at 1.5 months after Aβ1-42 microinjection) dose-dependently improved memory performance in both MWM and PA tests. Moreover, rolipram reversed the Aβ-induced increases in serum corticosterone (CORT), corticotropin-releasing factor, and glucocorticoid receptors (CRF-R and GR) levels, whereas it decreases in brain-derived neurotropic factor (BDNF) and the ratio of pCREB to CREB expression. These effects of rolipram were prevented by pre-treatment with PKA inhibitor H89. The findings indicated that the protective effects of rolipram against Aβ1-42-induced memory deficits might involve HPA axis and cAMP-CREB-BDNF signaling.

Memory and attention deficit in chronic migraine

Background. Memory and attention deficits are prevalent in the chronic pain population. There are multiple common mechanisms in chronic pain and cognitive impairment. However, the presence, prevalence and clinical burden of such impairment are frequently underestimated.Objective: to evaluate subjective and objective cognitive deficits in patients with chronic migraine (CM).Materials and methods. We recruited 53 subjects with CM and 22 genderand age-matched controls with low-frequency episodic migraine (a maximum of 4 headache days per month) aged 18–59. All patients filled in the HADS (Hospital Anxiety and Depression Scale) anxiety and depression scale and Pittsburg Sleep Quality Inventory (PSQI). Cognitive function was assessed with Montreal Cognitive Assessment (MoCA), Digital Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT) and the Perceived Deficits Questionnaire (PDQ-20).Results. 56 % of patients with CM complained of memory problems. Decreased cognitive function was also observed during self-assessment using the PDQ-20 questionnaire. Objectively, we found a significant decrease in 90-second DSST results and RAVLT total recall and learning rates. 44 % of subjects with CM scored lower than 26 points on MoCA. Most frequently we found impairments in attention (75 %), memory/delayed recall (50 %), language (50 %) and executive function (37 %). Depression and sleep quality correlated with only several parameters of cognitive tests.Conclusion. Subjective and objective cognitive deficits are prevalent in the CM population. Most often memory and attention are impaired. Cognitive complaints need to be carefully assessed, and treatment of such impairment may improve quality of life and decrease disability in CM.

Transcranial direct current stimulation combined with cognitive training for the treatment of Parkinson Disease: A randomized, placebo-controlled study

BackgroundA number of non-motor symptoms occurs in Parkinson Disease (PD), cognitive decline and mood disturbances representing the most prevalent.Recent studies reported that cognitive training could potentially help to attenuate cognitive deficits in patients with PD and several researches demonstrated a beneficial effect of active transcranial Direct Current Stimulation (tDCS) over the left dorsolateral prefrontal cortex (anode over left dorsolateral prefrontal cortex, cathode over right supraorbital area) on cognitive deficits and mood disturbances. ObjectiveTo investigate the effects of active tDCS combined with computerized cognitive training on cognition and mood disturbances in PD patients. MethodsTwenty-two patients with PD were assigned to either active tDCS plus computerized cognitive training (CCT) or sham tDCS plus CCT groups. Each patient underwent two weeks' treatment of daily application of tDCS for 25 minutes during CCT focalized on functions related with prefrontal cortex. Each patient was evaluated at baseline, after treatment and at 3-month follow-up. ResultsA significant reduction of depressive symptoms was observed in the active tDCS group from baseline to post-treatment assessment and from baseline to 3-month follow-up. An improvement in cognitive performances, referring more specifically to language, attentional and executive functions, was observed in both groups post-treatment and at follow-up. However, phonemic verbal fluency showed significant greater changes from baseline in the active tDCS group. ConclusionsWe concluded that cognitive training along with active tDCS is a useful combined approach in the management of mood and cognitive dysfunctions in PD.

Cognitive deficits in patients with β-thalassemia major

Cognitive deficits in patients with β-thalassemia major

Topological Reorganization of the Default Mode Network in Severe Male Obstructive Sleep Apnea

Impaired spontaneous regional activity and altered topology of the brain network have been observed in obstructive sleep apnea (OSA). However, the mechanisms of disrupted functional connectivity (FC) and topological reorganization of the default mode network (DMN) in patients with OSA remain largely unknown. We explored whether the FC is altered within the DMN and examined topological changes occur in the DMN in patients with OSA using a graph theory analysis of resting-state functional magnetic resonance imaging data and evaluated the relationship between neuroimaging measures and clinical variables. Resting-state data were obtained from 46 male patients with untreated severe OSA and 46 male good sleepers (GSs). We specifically selected 20 DMN subregions to construct the DMN architecture. The disrupted FC and topological properties of the DMN in patients with OSA were characterized using graph theory. The OSA group showed significantly decreased FC of the anterior–posterior DMN and within the posterior DMN, and also showed increased FC within the DMN. The DMN exhibited small-world topology in both OSA and GS groups. Compared to GSs, patients with OSA showed a decreased clustering coefficient (Cp) and local efficiency, and decreased nodal centralities in the left posterior cingulate cortex and dorsal medial prefrontal cortex, and increased nodal centralities in the ventral medial prefrontal cortex and the right parahippocampal cortex. Finally, the abnormal DMN FC was significantly related to Cp, path length, global efficiency, and Montreal cognitive assessment score. OSA showed disrupted FC within the DMN, which may have contributed to the observed topological reorganization. These findings may provide further evidence of cognitive deficits in patients with OSA.

Changes in language white matter tract microarchitecture associated with cognitive deficits in patients with presumed low-grade glioma.

The authors conducted a study to determine whether cognitive functioning of patients with presumed low-grade glioma is associated with white matter (WM) tract changes. The authors included 77 patients with presumed low-grade glioma who underwent awake surgery between 2005 and 2013. Diffusion tensor imaging with deterministic tractography was performed preoperatively to identify the arcuate, inferior frontooccipital, and uncinate fasciculi and to obtain the mean fractional anisotropy (FA) and mean diffusivity per tract. All patients were evaluated preoperatively using an extensive neuropsychological protocol that included assessments of the language, memory, and attention/executive function domains. Linear regression models were used to analyze each cognitive domain and each diffusion tensor imaging metric of the 3 WM tracts. Significant correlations (corrected for multiple testing) were found between FA of the arcuate fasciculus and results of the repetition test for the language domain (β = 0.59, p < 0.0001) and between FA of the inferior frontooccipital fasciculus and results of the imprinting test for the memory domain (β = -0.55, p = 0.002) and the attention test for the attention and executive function domain (β = -0.62, p = 0.006). In patients with glioma, language deficits in repetition of speech, imprinting, and attention deficits are associated with changes in the microarchitecture of the arcuate and inferior frontooccipital fasciculi.

Cognitive Deficits in Patients With Depression

Cognitive impairment in patients with depression is often overlooked because cognitive deficits and symptoms of depression often overlap. Understanding the neurobiological aspects of cognitive deficits is important, because cognition evolves as a therapeutic target in treating depression. Cognitive symptoms can precede or linger after symptoms of depression, such as sleep, appetite, and affective symptoms, improve. Emerging literature on medications targeting cognition in patients with depression should be considered when clinical decisions are made. Residual cognitive symptoms have been identified as a predictor of poor outcomes when treating depression. Referral to psychiatry should be considered in patients with residual symptoms where diagnosis is unclear.

Intraventricular extension of an aneurysmal subarachnoid hemorrhage is an independent predictor of a worse functional outcome

ObjectiveThe objective of this study is to determine the impact of intraventricular hemorrhage (IVH) on the cognitive prognosis of subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm, independent of the presence of intraparenchymal hemorrhage, hydrocephalus or vasospasm. Patient and MethodsA Retrospective review of a prospectively collected database of patients with aneurysmal SAH from July 2009 to November 2016 was performed. Patients were included if they had a saccular aneurysm with a Hunt-Hess grade (HHG) 1–3. Those who underwent craniectomy/clipping and those with vasospasm were excluded. Patients with IVH were grouped into 5 groups depending on the blood distribution in the ventricles. Functional outcomes studied were modified Rankin score (mRS) 0–2, cognitive impairment and memory impairment, and the presence of amnesia to the event. A univariate followed by a multivariate analysis ware performed. ResultsA total of 443 patients were identified and 124 patients met the criterion. There were no significant differences in the proportion of patients with mRS of 0–2 between patients with IVH and those without IVH but with EVD (external ventricular drain). There was a higher proportion of cognitive deficits in patients with IVH (71.95%), compared to those without (31.58%; p = 0.01). Patients with IVH had a higher rate of anterograde amnesia (100% vs. 4.3% p < 0.0001), lower rate of mRS 0–2 (78% vs 100% p < 0.001), and higher rate of cognitive impairment (71.9% vs. 13% p < 0.0001) compared with those who did not require an EVD. Grade 3 and grade 4 were shown to have lower rate of patients with mRS 0–2 and a higher rate of cognitive impairment.In multivariate analysis, independent predictors of cognitive and memory impairment were increasing HHG (OR = 155.33; P < 0.01), ACOM/A1/ACA/anterior choroidal aneurysms, (OR = 5.24; P = 0.04), increasing Fischer scale (OR = 6.93; P = 0.01), and increasing IVH grade (OR = 6.9; P = 0.01). Only worse HHG (OR = 2704.22; P = 0.01) and IVH grade 2–4 were associated (perfect predictor, OR cannot be extracted) with anterograde amnesia. ConclusionIVH is an independent prognosticator of SAH cognitive outcomes. The effect of IVH drainage and other intraventricular therapies on SAH course is an attractive topic for further investigation.

Altered functional connectivity strength and its correlations with cognitive function in subjects with ultra-high risk for psychosis at rest.

Evidence of altered structural and functional connectivity in the frontal-occipital network is associated with cognitive deficits in patients with schizophrenia. However, the altered patterns of functional connectivity strength (FCS) in individuals with ultra-high risk (UHR) for psychosis remain unknown. In this study, whole-brain FCS was assessed to examine the altered patterns of FCS in UHR subjects. A total of 34 UHR subjects and 37 age- and sex-matched healthy controls were enrolled to undergo resting-state functional magnetic resonance imaging. The imaging data were analyzed using the graph theory method. Compared with healthy controls, UHR subjects showed significantly decreased FCS in the left middle frontal gyrus and significantly increased FCS in the left calcarine cortex. The FCS values in the left middle frontal gyrus were positively correlated to the scores of the Brief Assessments of Cognitionin Schizophrenia Symbol Coding Test (r=0.366, P=0.033) in the UHR subjects. A negative correlation was found between the FCS values in the left calcarine cortex and the scores of the Stroop color-naming test (r=-0.475, P=0.016) in the UHR subjects. A combination of the FCS values in the 2 brain areas showed an accuracy of 87.32%, a sensitivity of 73.53%, and a specificity of 100% for distinguishing UHR subjects from healthy controls. Significantly altered FCS in the frontal-occipital network is observed in the UHR subjects. Furthermore, decreased FCS in the left middle frontal gyrus and increased FCS in the left calcarine have significant correlations with the cognitive measures of the UHR subjects and thus improve our understanding of the underlying pathophysiological mechanisms of schizophrenia. Moreover, a combination of the FCS values in the 2 brain areas can serve as a potential image marker to distinguish UHR subjects from healthy controls.

Circadian rhythm resynchronization improved isoflurane-induced cognitive dysfunction in aged mice

Postoperative cognitive dysfunction (POCD) is a common clinical phenomenon characterized by cognitive deficits in patients after anesthesia and surgery. Advanced age is a significant independent risk factor for POCD. We previously reported that in young mice, sleep–wake rhythm is involved in the isoflurane-induced memory impairment. In present study, we sought to determine whether advanced age increased the risk of POCD through aggravated and prolonged post-anesthetic circadian disruption in the elderly. We constructed POCD model by submitting the mice to 5-h 1.3% isoflurane anesthesia from Zeitgeber Time (ZT) 14 to ZT19. Under novel object recognition assay (NOR) and Morris water maze (MWM) test, We found 5-h isoflurane anesthesia impaired the cognition of young mice for early 3 days after anesthesia but damaged the aged for at least 1 week. With Mini-Mitter continuously monitoring, a 3.22 ± 0.75 h gross motor activity acrophase delay was manifested in young mice on D1, while in the aged mice, the gross motor activity phase shift lasted for 3 days, consistent with the body temperature rhythm trends of change. Melatonin has been considered as an effective remedy for circadian rhythm shift. In aged mice, melatonin was pretreated intragastrically at the dose of 10 mg/kg daily for 7 consecutive days before anesthesia. We found that melatonin prevented isoflurane-induced cognitive impairments by restoring the locomotor activity and temperature circadian rhythm via clock gene resynchronization. Overall, these results indicated that Long-term isoflurane anesthesia induced more aggravated and prolonged memory deficits and circadian rhythms disruption in aged mice. Melatonin could prevent isoflurane-induced cognitive impairments by circadian rhythm resynchronization.

T43. TRANSCRANIAL DIRECT-CURRENT STIMULATION (TDCS) IN PATIENTS WITH ULTRA-TREATMENT-REFRACTORY AUDITORY HALLUCINATIONS

BackgroundTranscranial direct-current stimulation (tDCS), a noninvasive neurostimulation treatment, has been reported to show improvements in treatment-resistant auditory hallucinations in patients with schizophrenia. tDCS administered over a limited number of sessions effectively produced lasting attenuation of auditory hallucinations in otherwise stable outpatients. It has also been shown that tDCS may be a useful intervention for ameliorating cognitive deficits in patients with chronic schizophrenia. The purpose of this study was to test tDCS for auditory hallucinations in ultra-treatment resistant schizophrenia to assess if this form of neurostimulation can alleviate treatment-refractory auditory hallucination symptoms up to 4 weeks after the final treatment. In addition, we also wanted to examine the effects of tDCS on cognitive functions.Methods28 inpatients with DSM-V schizophrenia and long-standing treatment resistance and persistent auditory verbal hallucinations were recruited. Each individual participated in behavioral assessments at baseline, endpoint and follow-up [PANSS and Auditory Hallucinations Rating Scale (AHRS) and MCCB cognitive battery] and were randomized to receive active vs. sham tDCS treatments. For active treatment, patients had the inhibitory (cathodal) tDCS electrode placed over left auditory cortex relative to an excitatory (anodal) electrode placed over frontal cortex on the right side. tDCS treatments took place for 20 min twice daily for 5 consecutive days. Assessment batteries were repeated following the 4 weeks of treatment. The Chattanooga, dual channel CHA-1335 stimulator with two 7 × 5 cm (35 cm2) sponge electrodes soaked in a saline solution (0.9% NaCl) was used for the delivery of 2 mA current.ResultsA total of 28 subjects were enrolled (tDCS, n = 13; Control, n = 15). 20 subjects completed the trial. 3 subjects dropped out of the active tDCS treatment group, while 4 subjects did not complete the control treatment due to early discharge from the hospital. Most subjects were male (tDCS n = 10, 76.9%; Control n = 6, 40.0%). Length of present psychiatric admission ranged from 1–25 months, with a mode of 2 months (n = 12) and average of 2.9 months. Participating inpatients were on clozapine, haloperidol, paliperidone depot, fluphenazine decanoate, paliperidone, olanzapine, and risperidone as primary medications. Repeated Measures ANOVA showed a significant difference for the auditory hallucination total score, frequency and number of voices over time (p < 0.05) with greater reduction in scores observed for the tDCS group. Improvements were maintained after 4 weeks. There was no significant change over time observed for the PANSS positive symptoms or total score, or for the PANSS Hallucinatory Behavior item score. When assessing cognitive functioning, only Working Memory change was significant (p = 0.048) between the tDCS and the Control group with the tDCS group showing significant improvement in T-Score as compared to the Control group.DiscussionSubjects who received tDCS treatment showed a significant reduction in the frequency, number of voices, and total scores of their auditory hallucination. Additionally, subjects in the tDCS group showed significant improvement in the Working Memory. Our results indicate that patients who have been ultra-resistant to antipsychotic treatments and who received tDCS treatment presented with robust diminution of their auditory hallucinations. We conclude that tDCS seems to be effective not only for ambulatory, higher functioning patients, but also for much lower functioning patients with medication-refractory auditory verbal hallucinations.

Cognitive Impairment in Patients With Neuropsychiatric and Non-neuropsychiatric Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. Its most prevalent manifestation is neuropsychiatric SLE (NP-SLE), which is characterized by increased involvement of the nervous system, with relevant symptoms, such as marked cognitive deficits, which are directly involved in subsequent functional disability. The objective of this study is to identify and compare the profile of cognitive deficits in patients with NP-SLE and patients with non-neuropsychiatric SLE (nonNP-SLE) by means of a systematic review and meta-analysis. We performed a systematic literature search based on the key words "cogn* OR neurocogn* AND lupus AND neuropsychiatry*" and included articles published between April 1999 and December 2016. A total of 244 articles were retrieved. We excluded reviews and meta-analyses, experiments not performed in humans, and single case reports. We included studies that used standardized cognitive measures and had included at least the subgroups NP-SLE and non NP-SLE. The meta-analysis was finally based on six studies, and 10 neuropsychological variables were examined. Significant differences were observed between the groups for six variables. In the remaining four variables, we observed marked heterogeneity between the groups or a low number of studies. The data obtained indicate greater cognitive impairment among NP-SLE patients than among nonNP-SLE patients, at least for the cognitive domains of visuomotor coordination, attention, executive function, visual learning and memory, and phonetic fluency. The identification and definition of cognitive deficits in SLE patients is necessary to develop adequate cognitive remediation programs to improve functional outcomes. (JINS, 2018, 24, 629-639).

Evaluation of cognitive impairment in patients with episodic migraine

ABSTRACT BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the presence of cognitive deficits in patients with episodic migraine and control group, and to compare with the results previously described in the literature. METHODS: Patients with episodic migraine were included according to the International Headache Society criteria, and a control group was selected, matched by sex, age, and schooling. Patients were asked about the frequency and intensity of headaches, medications used, and comorbidities. Afterwards, a neuropsychological assessment was applied using the Montreal Cognitive Assessment, the clock drawing test, the verbal fluency test, and the Stroop test. The main variables influencing cognitive dysfunctions were analyzed (depressive disorder, anxiety disorder, sleep disorder, use of medication). RESULTS: Thirty patients with episodic migraine and 30 controls were evaluated. Patients with episodic migraine had a performance in the Montreal Cognitive Assessment test (p=0.53), the clock drawing test (p=0.80), the verbal fluency test (p=0.44) and the Stroop test (p=0.97) similar to the control group. Patients with chronic migraine (30 patients and 30 controls) performed a Montreal Cognitive Assessment test (p=0.00), verbal fluency test (p=0.00) and Stroop test (p=0.00) lower than the group control. The main variables influencing cognitive disorders were studied by linear regression, and none of these variables was an influencing factor in the Montreal Cognitive Assessment test. CONCLUSION: Patients with episodic migraine did not present cognitive deficits compared to a control group.

Intellectual disability in patients with epilepsy with eyelid myoclonias

We describe here the clinical outcome of four women with epilepsy with eyelid myoclonia (aged 21–53 years). All patients had an uneventful early history, normal physical growth and appearance and no comorbid sensory or motor disability and normal brain magnetic resonance imaging finding. Two women were moderately and one mildly intellectually disabled and one showed a low-average intelligence. The overall well-being of the patients was hampered by psychiatric or various somatic comorbidities and related psychosocial problems. The three women with an intellectual disability had been treated with narrow-spectrum antiepileptic drugs and one also with vigabatrin during childhood and adolescence. The patient with a low-average intelligence had been on broad-spectrum antiepileptic medication (i.e. valproate and ethosuximide) since the epilepsy diagnosis but she has had compliance problems. Based on these cases, the cognitive deficits in patients with epilepsy with eyelid myoclonia may occur more commonly than what has been thought hitherto. We discuss the role of narrow-spectrum antiepileptic drugs as a contributing factor to poor seizure control and an impaired intelligence.