Cognitive Impairment In Persons Research Articles

Getting clocked: screening for TBI-related cognitive impairment with the clock drawing test

ABSTRACTPrimary Objective: Undetected cognitive impairment resulting from Traumatic Brain Injuries (TBIs), particularly the 75–95% classified as mild (mTBI), poses a significant public health challenge as untreated symptoms, can persist and cause lasting disability. These cognitive deficits are often missed by standard screening tests, creating a need for alternative cognitive screening tools. The Clock Drawing Test (CDT), a popular, brief cognitive screening instrument, was used to evaluate cognition in persons with TBI.Design: The effectiveness of the CDT was assessed on its own and in tandem with a validated computerised screening battery, including the Stroop Test, Symbol Digit Modalities Test (SDMT), and Paced Visual Serial Addition Test 2-second trials (PVSAT-2).Methods and Procedures: The clock drawing component of the Montreal Cognitive Assessment (MoCA) of 223 subjects attending an outpatient TBI clinic was scored using two different methods.Main Outcomes and Results: The CDT screened for cognitive impairment most effectively when scored using the Clock Drawing Interpretation Scale (CDIS). Cognitive impairment was detected in 19.4% of the elusive cohort of persons with mTBI.Conclusions: The results of this study suggest that the CDT is effective at screening for cognitive impairment in persons with TBI. The CDT could be a valuable supplementary tool in TBI clinics as well as an effective cognitive screening instrument in busy primary care settings.

Effectiveness of Occupational Therapy Interventions for Adults With Systemic Lupus Erythematosus: A Systematic Review

Abstract Date Presented 3/31/2017 This session discusses the effectiveness of interventions within the scope of occupational therapy practice that address occupational performance, pain, fatigue, depression, and cognitive impairment in persons with systemic lupus erythematosus. Primary Author and Speaker: Janet Poole Additional Authors and Speakers: Joshua Bradford, Patricia Siegel

Social cognition according to cognitive impairment in different clinical phenotypes of multiple sclerosis

The objective of this study is to evaluate the relationship between social cognition (SC) and cognitive impairment in persons with multiple sclerosis (PwMS). A prospective study was conducted in 60 PwMS, 30 with relapsing-remitting MS (RRMS), 15 with secondary progressive MS (SPMS) and 15 with primary progressive MS (PPMS), and in healthy subjects (HS). All subjects were assessed by the Bordeaux Social Cognition Evaluation Protocol (PECS-B) (facial emotion recognition, theory of mind, emotional awareness and cognitive and affective alexithymia), by a large neuropsychological battery and by questionnaires (depression and anxiety). 43.3% of PwMS were impaired for at least one SC test. The proportion of PwMS with at least two impaired SC tests was similar in all three phenotypes (20%). Mean scores differed significantly between PwMS and HS only for the Reading the Mind in the Eyes Test, a test of Theory of Mind (ToM). ANOVA analyses showed an effect of phenotype on emotional awareness scores with lower scores in PPMS as compared to RRMS. ToM performance was significantly correlated (r 2=0.56) with executive functions, working memory and episodic memory scores. SC impairment was found in all phenotypes and was more prominent in cognitively impaired MS patients. Executive functions, and working and episodic memory performance accounts for approximately 50% of ToM performance. Emotional awareness is more impaired in progressive MS.

Developing easy to perform routine MRI measurements as potential surrogates for cognitive impairment in MS

ObjectivesOne of the most frequently disabling symptoms in Multiple Sclerosis (MS) is cognitive impairment which is often insidious in onset and therefore difficult to recognize in the early stages, for both persons with MS and clinicians. A biomarker that would help identify those at risk of cognitive impairment, or with only mild impairment, would be a useful tool for clinicians. Using MRI, already an integral tool in the diagnosis and monitoring of disease activity in MS, would be ideal. Thus, this study aimed to determine if simple measures on routine MRI could serve as potential biomarkers for cognitive impairment in MS. Patients and methodsWe retrospectively identified 51 persons with MS who had a cognitive assessment and MRI within six months of the MRI. Simple linear measurements of the hippocampi, bifrontral and third ventricular width, bicaudate width and the anterior, mid and posterior corpus callosum were made. Pearson’s correlations examined the relationship between these MRI measures and cognitive tests, and MRI measures were compared in persons with MS who were either normal or cognitively impaired on objective cognitive tests using Analysis of Covariance (ANCOVA). ResultsBicaudate span and third ventricular width were both negatively correlated, while corpus callosal measures were positive correlated with cognitive test performance. After controlling for potential confounders, bicaudate span was significant different on measures of immediate recall. Both anterior and posterior corpus collosal measure were significantly different on measures of verbal fluency, immediate recall and higher executive function; while the anterior corpus callosum was also significantly different on processing speed. The middle corpus collosal measure was significantly different on immediate recall and higher executive function. ConclusionThis study presents data demonstrating that simple to apply MRI measures of atrophy may serve as biomarkers for cognitive impairment in persons with MS. Further prospective studies are needed to validate these findings.

Related Factors and Predictors of Cognitive Dysfunction in Chronic Kidney Disease on Maintenance Hemodialysis in Nigeria.

Background:Previous studies suggest a high frequency of cognitive impairment (CI) in persons with chronic kidney disease (CKD); however, factors associated with CI and predictors of CI in persons with CKD remain largely unclear. The aim of this study was to determine the factors associated with CI and predictors of CI in CKD patients on maintenance hemodialysis.Materials and Methods:The first stage of the study included recruitment of 100 apparently healthy participants aimed at determining the reference values. The second stage of the study included eighty CKD patients on maintenance hemodialysis. The iron psychology (FEPSY) was used to assess the memory, psychomotor speed, concentration, and attention using simple auditory reaction time (ART) and visual reaction time (VRT) tasks, recognition memory tests (RMT), finger tapping task (FTT), and binary choice task (BCT).Results:Using normative values generated in this study, 41 (51.3%) and 43 (53.8%) CKD patients had abnormal scores on ART dominant (D) and nondominant (ND) sides, respectively. Forty (50%) and 42 (52.5%) patients had abnormal scores on VRT D and ND sides, respectively. Twenty-one (26.3%) and 68 (85%) had abnormal scores on BCT and computer-assisted visual scanning task, respectively. Sixty-four (80%) and 65 (81.3%) had abnormal scores on RMT (words) and RMT, respectively. Fifty-two (65%) and 48 (60%) patients had abnormal scores on D and ND sides of (FTT), respectively. Factors associated with psychomotor speed impairment were duration of CKD from diagnosis (P = 0.0001 and 0.043 in D and ND ART, respectively), duration on dialysis (P = 0.0001 across board in D and ND ART as well as in D and ND VRT, respectively), and plasma urea (PU) and plasma creatinine (PCr) (P < 0.05). Factors found to be associated with memory impairment included age (P = 0.045 and 0.025 on words and figures RMT, respectively), PU (P = 0.002 and 0.005 on words and figures RMT, respectively), and PCr (P = 0.012 and 0.040 on words and figures RMT, respectively). Duration on dialysis (P = 0.032) and PCr (P = 0.001) were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.Conclusion:Factors associated with psychomotor speed impairment were duration of CKD, duration on dialysis, and PU and PCr while age, PU, and PCr were associated with memory. Duration on dialysis and PCr were associated with attention and concentration. Only psychomotor speed was independently predicted by duration of CKD.

INFLUENCE OF LINGUISTIC AND ACCULTURATION CHARACTERISTICS ON TRADITIONAL AND COMPUTERISED NEUROPSYCHOLOGICAL TEST PERFORMANCES IN NON-NATIVE PROFICIENT ENGLISH SPEAKERS FROM THE SYDNEY MEMORY AND AGEING STUDY

Previous research has shown an effect of ethnicity on cognitive test performance and higher rates of Mild Cognitive Impairment in persons of non-English speaking background (NESB). This study examined differences in test performance between native English speakers and NESB on traditional and computerised neuropsychological measures; effects of demographic, linguistic and acculturation characteristics, and clinical and risk factors on performance, and whether these characteristics account for language group (English, NESB) performance differences.

Acute effects of varying intensities of treadmill walking exercise on inhibitory control in persons with multiple sclerosis: A pilot investigation

IntroductionExercise training represents a promising approach for managing cognitive impairment in persons with multiple sclerosis (MS). There is preliminary evidence that treadmill walking might be the modality of exercise that exerts the greatest beneficial effects on inhibitory control in fully-ambulatory persons with MS. However, the dose-dependent effects of varying intensities of treadmill walking exercise on this cognitive function are unknown. Such an investigation is critical for better delineating the optimal exercise stimulus (or stimuli) for improving inhibitory control in MS. MethodsThe present study compared the acute effects of light, moderate, and vigorous intensity treadmill walking exercise on inhibitory control (i.e., interference control) relative to quiet rest in 24 fully-ambulatory persons with MS, using a within-subjects, repeated-measures experimental design. Participants completed four experimental conditions that consisted of 20min of light, moderate, and vigorous intensity treadmill walking exercise, and quiet rest in a randomized, counterbalanced order. Participants underwent a modified flanker task as a measure of inhibitory control immediately prior to and following each condition. ResultsRepeated-measures ANOVAs indicated large, statistically significant reductions in the cost of interfering stimuli on reaction time, but not accuracy, on the modified flanker task for light, moderate, and vigorous intensity exercise compared with quiet rest (F(3,69)=4.27, p=.01, ηp2=.16). There were no differences in magnitude of reduction across the three exercise intensities. ConclusionsThe present results support light, moderate, and vigorous intensity treadmill walking as exercise stimuli that might particularly benefit interference control of reaction time. This represents the next step in delineating the optimal exercise stimuli for improving this cognitive function in fully-ambulatory persons with MS, and perhaps is important for informing a subsequent longitudinal exercise training intervention.

Does Alzheimer Disease Pathologic Change Underlie Subjective Cognitive Complaints?

HHS Public Access Author manuscript Author Manuscript Alzheimer Dis Assoc Disord. Author manuscript; available in PMC 2016 October 01. Published in final edited form as: Alzheimer Dis Assoc Disord. 2015 ; 29(4): 350–352. doi:10.1097/WAD.0000000000000092. Does Alzheimer’s disease pathologic change underlie subjective cognitive complaints? Joshua D. Grill, Ph.D. 1,* , Harry V. Vinters, M.D. 1,2 , and Sarah E. Monsell, M.S. 3 1 Mary Easton Center for Alzheimer’s Disease Research, Department of Neurology, UCLA, Los Angeles, CA Author Manuscript 2 Pathology 3 National and Laboratory Medicine (Neuropathology), UCLA, Los Angeles, CA Alzheimer’s Coordinating Center, University of Washington, Seattle, WA Keywords Alzheimer’s disease; subjective complaint; memory; neuropathology Introduction Author Manuscript Subjective memory complaints may serve as a harbinger of future cognitive impairment in persons who perform within the range of normal on objective testing of memory and other cognitive domains. The subsequent decline may ultimately meet diagnostic criteria for mild cognitive impairment or dementia, and risk of such progression may be increased among carriers of the apolipoprotein E (APOE) e4 allele 1 and those with biomarker evidence supporting the diagnosis of Alzheimer’s disease (AD). 2 Author Manuscript Cross-sectional studies suggest that persons with subjective complaints may be at increased risk to demonstrate abnormal AD biomarkers. 3 Relatively few studies have examined the relationship between subjective complaints and AD neuropathologic change. Neuropathology studies suggest that amyloid plaques, 1, 4 neurofibrillary tangles, 4 and fulfillment of diagnostic criteria for AD 5 are more frequent at autopsy among those with subjective complaints, compared to those lacking complaints. In this study, we tested the hypothesis that, among participants in the National Alzheimer’s Coordinating Center Uniform Data Set (NACC UDS), subjective memory complaints would be associated with AD pathologic change at autopsy. To test this hypothesis, we implemented criteria approximating the recent National Institute on Aging-Alzheimer’s Association (NIA-AA) criteria for pathological diagnosis for AD. 6 Methods We used data from the NACC UDS, a repository for longitudinal data collected from approximately 30 current or previously NIA-funded AD Centers nationwide that emphasize Corresponding author: Joshua D. Grill, PhD, UCLA Easton Alzheimer’s Center, 10911 Weyburn Ave, Suite 200. Los Angeles, CA 90095, USA. Tel.: (310) 794-2511; fax: (310) 794-3148. jgrill@mednet.ucla.edu.

Cardiorespiratory Fitness Is Positively Associated With Cognitive Function In Institutionalized Older Adults With Dementia

PURPOSE: Cognitive impairment is a highly prevalent, poorly managed, and disabling consequence of dementia. Exercise training that improves physical fitness can represent a promising approach for managing cognitive impairment in persons with dementia. This study aimed to exam the relationship between Cardiorespiratory Fitness with cognitive function in institutionalized older adults with dementia. METHODS: Fifty institutionalized older adults (mean age 79.1 ± 9.0 years old) clinically diagnosed with dementia (Alzheimer´s Disease, Lewy body dementia, Vascular dementia) were enrolled. The subjects participated in supervised in a multicomponent exercise program (including aerobic exercises, muscular resistance and strength training, flexibility and postural exercises) 45/55 minutes/session, twice a week, for six months.Cardiorespiratory Fitness (2-min step test) and Global Cognitive Function (MMSE) were assessed before (M1) and after 6-month (M2) exercise training. RESULTS: A paired sample test revealed a significant increase of CRF (2-min step test) (t= -2.702; p=0.09) and a significant increase in Global cognitive function (MMSE) (t= -2.594; p=0.012) from M1 to M2. Positive associations were observed between CRF and Global cognitive function at the baseline (M1) (r= 0.286; p=0.044) and after the intervention program (M2) (r= 0.383; p=0.006). CONCLUSIONS: The increase of CRF thru regular physical activity could represent an important and potent protective factor to preserve/improve global cognition function in institutionalized older adults with dementia.

Vascular cognitive impairments in chronic kidney disease

Objective : to study the specific features of development of cognitive impairments (CIs), the role of traditional cardiovascular risk factors and renal failure-induced factors in patients with Stages I–IV chronic kidney disease (CKD) and to assess an association of CIs with the signs of vascular wall remodeling in them. Patients and methods. Fifty-one patients aged 53±10 years with CKD were examined. Among them, there were 20 patients with Stages I–II CKD: a glomerular filtration rate (GFR) of і60 ml/min/1.73 m 2 , signs of renal lesion; 20 with Stages III CKD: a GFR of <60–30 ml/min/1.73 m 2 , and 11 with Stages VI CKD: a GFR of <30–15 ml/min/1.73 m 2 . Results and discussion. CIs were more common in the patients with Stages III–IV than in those with Stages I–II, as shown by the scores of the mini-mental state examination (p<0.001), the frontal assessment battery (p=0.001), and the regulatory function test (p<0.001). These tests showed that the magnitude of CIs increased with the higher stage of CKD. Stages III–IV CKD is an independent predictor of CIs in persons with predialysis-stage kidney lesion. CIs were found to be related to hyperhomocysteinemia, anemia, abdominal obesity, left ventricular hypertrophy, and patient age. The signs of atherosclerotic lesion of the common carotid arteries and the indicators of arterial stiffness were also associated with the incidence and magnitude of CIs in CKD. The detection of CIs in patients with early CKD allows one to timely initiate adequate therapy aimed particularly at improving cerebral circulation, eliminating the impact of risk factors, and slowing down the vascular remodeling. The management tactics for patients with CKD must involve the identification and correction of cardiovascular risk factors, and duplex scanning of the wall of the common carotid arteries may be used as a noninvasive method to assess the risk of the development and progression of CIs in predialysis CKD.

The Cardiovascular and Cerebrovascular Effects on Cognition in Persons with Parkinson’s Disease: A Systematic Review of the Literature

Purpose: The purpose of this systematic review of the literature is to examine the cerebrovascular and cardiovascular effects on cognition in persons with Parkinson’s disease. Relevance: Physical therapy treatment of persons with Parkinson’s disease (PD) has traditionally focused on lessening the impact of disease severity by improving quality of life and functional capacity. Research has shown that quality of life in persons with PD is not only significantly affected by motor symptoms, but also by the presence of defined non-motor symptoms such as cerebrovascular perfusion, cardiovascular dysfunction, and cognitive impairment. This study seeks to determine a causative effect among these non-motor symptoms with the intention to better manage cognitive impairment in persons with PD. Methods: A literature search was conducted utilizing the following databases: Scopus, PubMed, and CINAHL. After evaluating and grading studies using the Downs and Black Checklist, a total of seven studies remained for the final review. Results: Five common domains of cognition emerged throughout the seven studies: executive function, attention, verbal memory and fluency, visual memory, and working memory. Considering the articles reviewed, a relationship between cerebrovascular and cardiovascular deficiency and cognitive impairment in persons with PD was established. Conclusions: Persons with PD and certain cerebrovascular and cardiovascular risk factors, including orthostatic hypotension and systemic hypertension, should be referred to appropriate professionals for comprehensive neuropsychological testing secondary to an increased risk for more severe cognitive deficit.

Cognitive impairments in persons exposed to radiation during the period of prenatal development

To assess the cognitive status in persons exposed to ionizing radiation in prenatal period. The study included in-utero exposed people (n = 77), and the comparison group (n = 73), which consisted of people who lived in the territories of the Chelyabinsk Oblast that were not radioactive. The following methods were used: clinical, clinical-psychological (Mini-Mental State Examination (MMSE), the WAIS test, the proverb interpretation task, neurophysiological (EEG) methods, laboratory-based methods (cholesterol, high and low-density lipoproteins, triglycerides, cortisol, melatonin), and methods of statistical data processing. The number of people with non-psychotic mental disorders with the prevalence of organic mental disorders (cognitive and asthenic) was significantly higher among in-utero exposed subjects. A neurophysiological study revealed more severe changes in the bioelectric brain activity with the presence of pathological and theta-rhythms in exposed persons. The clinical-psychological study revealed a significant decrease in the analytic/synthetic ability in exposed people and significantly lower level of the general and verbal IQ. These changes were accompanied by higher levels of cortisol and melatonin which led to the activation and tension of the adaptation mechanisms in in-utero exposed subjects.

The MoCA and MMSE as screeners for cognitive impairment in a heart failure population: A study with comprehensive neuropsychological testing

ObjectiveTo examine the ability of the Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to detect cognitive impairment in persons with heart failure (HF). BackgroundAlthough the MMSE and MoCA are commonly used screeners in HF, no research team has validated their performance against neuropsychological testing. MethodsParticipants were 106 patients with HF (49.1% male, 68.13 ± 9.82 years) who completed the MoCA, MMSE, and a full neuropsychological battery. Sensitivity and specificity were examined. Discriminant function analyses tested whether the screeners correctly detected cognitive impairment. ResultsA MoCA score <25 and MMSE score of <28 yielded optimal sensitivity/specificity (.64/.66 and .70/.66, respectively). The MoCA correctly classified 65% of patients, Wilk's lambda = .91, χ2(1) = 9.89, p < .01, and the MMSE correctly classified 68%, Wilk's lambda = .87, χ2(1) = 14.26, p < .001. ConclusionsIn HF, both the MoCA and MMSE are useful in identifying the majority of patients with and without cognitive impairment. Both tests misclassified approximately one-third of patients, so continued monitoring and evaluation of patients is needed in conjunction with screening.

Association Between Physical Fitness and Cognitive Function in Multiple Sclerosis

Background. Cognitive impairment is a highly prevalent, poorly managed, and disabling consequence of multiple sclerosis (MS). Exercise training that improves physical fitness represents a promising approach for managing cognitive impairment in persons with MS. There is limited evidence that physical fitness is associated with multiple domains of cognitive dysfunction across levels of MS disability. Objective. This cross-sectional study examined the associations among aerobic capacity, lower limb muscle strength, and cognitive functions in persons with mild, moderate, and severe MS disability. Methods. The sample included 62 persons with mild (n = 20), moderate (n = 21), and severe (n = 21) MS disability. The participants underwent neuropsychological assessments of cognitive processing speed (CPS; Symbol Digit Modalities Test [SDMT]), verbal memory (California Verbal Learning Test-2 [CVLT-2]), and visual memory (Brief Visuospatial Memory Test–Revised [BVMT-R]). All participants further underwent testing for measuring aerobic capacity (ie, peak oxygen consumption) and muscular strength (ie, peak torque of knee flexors and extensors). Results. Aerobic capacity and muscular strength outcomes were associated with SDMT (r = .35-.41), but not CVLT-2 or BVMT-R (r < .19) scores in the overall sample. Aerobic capacity (r = .42) and knee flexor peak torque (r = .39) were associated with SDMT scores in persons with mild disability, but not in those with moderate (r < .06) and severe (r < .14) disability. Conclusions. These results support examining aerobic and resistance exercise training programs for improving CPS, particularly among persons with mild MS disability.

The 2-minute step test is independently associated with cognitive function in older adults with heart failure.

Cognitive impairment is common in persons with heart failure (HF), and measures like the 6-minute walk test (6MWT) are known to correspond to level of impairment. The 2- minute step test (2MST) has been suggested as a more practical alternative to the 6MWT, though no study has examined whether it is associated with cognitive impairment in persons with HF. This study examined whether the 2MST is associated with cognitive function in older adults with HF. Older adults with HF (n=145; 68.97±9.31 yrs) completed the 2MST and a neuropsychological test battery that assessed function in multiple cognitive domains. Consistent with past work, HF patients exhibited high rates of cognitive impairment. Hierarchical regression analyses adjusting for demographic and medical characteristics found that the 2MST accounted for unique variance in global cognitive function (ΔR²=0.09, p<0.001), executive function (ΔR²=0.03, p<0.05), and language (ΔR²=0.10, p<0.001). A trend emerged for attention (ΔR²=0.02, p=0.09). Follow-up tests indicated that better 2MST performance was significantly correlated with better global cognitive function, attention, executive, and language test performance. The current results indicate that the 2MST is associated with cognitive function in older adults with HF. Further work is needed to clarify underlying mechanisms for this association and the value of implementing the 2MST during routine visits.

HIV and Neurocognitive Dysfunction

The spectrum of HIV-associated neurocognitive disorder (HAND) has been dramatically altered in the setting of widely available effective antiretroviral therapy (ART). Once culminating in dementia in many individuals infected with HIV, HAND now typically manifests as more subtle, though still morbid, forms of cognitive impairment in persons surviving long-term with treated HIV infection. Despite the substantial improvement in severity of this disorder, the fact that neurologic injury persists despite ART remains a challenge to the community of patients, providers and investigators aiming to optimize quality of life for those living with HIV. Cognitive dysfunction in treated HIV may reflect early irreversible CNS injury accrued before ART is typically initiated, ongoing low-level CNS infection and progressive injury in the setting of ART, or comborbidities including effects of treatment which may confound the beneficial reduction in viral replication and immune activation effected by ART.

Both low birthweight and high birthweight are associated with cognitive impairment in persons with schizophrenia and their first-degree relatives

Both low birthweight and high birthweight have been associated with an increased risk for schizophrenia and cognitive impairments in the general population. We assessed the association between birthweight and cognitive performance in persons with schizophrenia and their unaffected first-degree relatives. We investigated a population-based family sample comprising persons with schizophrenia (n = 142) and their unaffected first-degree relatives (n = 277). Both patients and relatives were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV) and a comprehensive neuropsychological test battery was administered. Information on birthweight was obtained from obstetric records. We used generalized estimating equation (GEE) models to investigate the effect of birthweight, as a continuous variable, on cognitive functioning, adjusting for within-family correlation and relevant covariates. Both low birthweight and high birthweight were associated with lower performance in visuospatial reasoning, processing speed, set-shifting and verbal and visual working memory among persons with schizophrenia and their unaffected first-degree relatives compared to individuals with birthweight in the intermediate range. The group × birthweight interactions were non-significant. Both low birthweight and high birthweight are associated with deficits in cognition later in life. Schizophrenia does not seem to modify the relationship between birthweight and cognition in families with schizophrenia.

Pre-treatment compensation use is a stronger correlate of measures of activity limitations than cognitive impairment

Objectives: This study examined the relationship between baseline compensation use, activity limitations and cognitive impairment in persons who sustained moderate-to-severe acquired brain injury.Design: Randomized controlled clinical trial.Methods: A total of 22 individuals with medically documented brain injury and their family members completed a baseline assessment including measures of cognitive functioning (Repeatable Battery of Neuropsychological Assessment; RBANS), activity limitations (Neurobehavioural Functioning Inventory; NFI) and compensatory strategies use (Compensation Techniques Questionnaire; CTQ). There were no gender differences on measures of cognitive impairment, activity limitations or compensation use.Results: As predicted, cognitive impairment was not significantly associated with frequency of baseline compensation strategy use. Weaker word-list learning on RBANS was associated with greater family-reported memory problems on the NFI. Lower frequency of compensatory strategy use was correlated with greater patient-reported activity limitations on NFI, while it was not related to family ratings of activity limitations. After adjusting for history of depression and anxiety, baseline compensation use uniquely accounted for 16% of variance in predicting greater patient ratings of mood difficulties.Conclusions: Results indicate that, after acquired brain injury, baseline compensation use is more strongly associated with measures of activity limitations than is cognitive impairment.

Cognitive impairment in persons with rheumatoid arthritis

To explore the prevalence and possible predictors of cognitive impairment in persons with rheumatoid arthritis (RA). Individuals from a longitudinal cohort study of RA participated in a study visit that included a range of physical, psychosocial, and biologic metrics. Cognitive function was assessed using a battery of 12 standardized neuropsychological measures yielding 16 indices. Subjects were classified as "impaired" if they performed 1 SD below age-based population norms on at least 4 of 16 indices. Logistic regression analyses were conducted to identify which of the following were significant predictors of cognitive impairment: sex, race, income, education, depression, disease duration, disease severity, C-reactive protein (CRP) level, glucocorticoid use, and cardiovascular disease (CVD) risk factors. A total of 115 subjects with a mean ± SD age of 58.6 ± 10.8 years were included; 64% were women and 81% were white. The proportion of persons who were classified as cognitively impaired was 31%. Education, income, glucocorticoid use, and CVD risk factors independently predicted cognitive impairment, controlling for sex, race, disease duration, disease severity, CRP level, and depression. Individuals with cognitive impairment were more likely to have low education (odds ratio [OR] 6.18, 95% confidence interval [95% CI] 1.6-23.87), have low income (OR 7.12, 95% CI 1.35-37.51), use oral glucocorticoids (OR 2.92, 95% CI 1.05-8.12), and have increased CVD risk factors (OR 1.61, 95% CI 1.19-2.17 per risk factor). The findings of this study suggest that the burden of cognitive impairment in RA is significant, and future studies identifying specific etiologic contributors to cognitive impairment are warranted.

Cognitive profiles in heart failure: A cluster analytic approach

Cognitive impairment is common among individuals with heart failure (HF), but the exact nature of these impairments remains unclear. The current study examined 140 older adults with heart failure and sought to determine whether there are distinct cognitive profiles using a cluster analytic approach. Results indicated three unique profiles comprising individuals who were cognitively intact, memory impaired, and globally impaired. Clusters differed on several important demographic and clinical characteristics. These findings suggest that cognitive impairment in persons with HF is more heterogeneous than commonly believed and has important implications for treatment recommendations.