Cognitive Test Data Research Articles

Cognitive Testing in Patients with CKD: The Problem of Missing Cases.

Cognitive testing is only valid in individuals with sufficient visual and motor skills and motivation to participate. Patients on dialysis usually suffer from limitations, such as impaired vision, motor difficulties, and depression. Hence, it is doubtful that the true value of cognitive functioning can be measured without bias. Consequently, many patients are excluded from cognitive testing. We focused on reasons for exclusion and analyzed characteristics of nontestable patients. Within the Choice of Renal Replacement Therapy Project (baseline survey: May 2014 to May 2015), n=767 patients on peritoneal dialysis (n=240) or hemodialysis (n=527) were tested with the Trail Making Test-B and the German d2-Revision Test and completed the Kidney Disease Quality of Life Short Form cognition subscale. We divided the sample into patients with missing cognitive testing data and patients with full cognitive testing data, analyzed reasons for nonfeasibility, and compared subsamples with regard to psychosocial and physical metrics. The exclusion categories were linked to patient characteristics potentially associated with missing data (age, comorbidity, depression, and education level) by calculation of λ-coefficient. The subsamples consisted of n=366 (48%) patients with missing data (peritoneal dialysis =62, hemodialysis =304) and n=401 patients with full cognitive testing data (peritoneal dialysis =178, hemodialysis =223). Patients were excluded due to visual impairment (49%), lack of motivation (31%), and motor impairment (13%). The remaining 8% did not follow instructions, suffered from medical incidents, or had language difficulties. Compared with patients with full cognitive testing data, they were more likely to have depression; be treated with hemodialysis; be older, nonworking, or more comorbid; and experience poorer shared decision making. Reasons for exclusion were not related to levels of age, comorbidity score, depression score, or education level. We excluded almost one half of eligible patients from cognitive testing due to visual, motivational, or motor difficulties. Our findings are consistent with exclusion categories reported from the literature. We should be aware that, because of disease-related limitations, conclusions about cognitive functioning in the CKD population may be biased. In the future, nonvisual and nonverbal cognitive testing can be a valuable resource.

Evaluation of Cognitive Deficits and Structural Hippocampal Damage in Encephalitis With Leucine-Rich, Glioma-Inactivated 1 Antibodies

Limbic encephalitis with leucine-rich, glioma-inactivated 1 (LGI1) antibodies is one of the most frequent variants of autoimmune encephalitis with antibodies targeting neuronal surface antigens. However, the neuroimaging pattern and long-term cognitive outcome are not well understood. To study cognitive outcome and structural magnetic resonance imaging (MRI) alterations in patients with anti-LGI1 encephalitis. A cross-sectional study was conducted at the Departments of Neurology at Charité-Universitätsmedizin Berlin and University Hospital Schleswig-Holstein, Kiel, Germany. Data on 30 patients with anti-LGI1 encephalitis and 27 healthy control individuals matched for age, sex, and educational level were collected from June 1, 2013, through February 28, 2015. Clinical assessment, cognitive testing, and high-resolution MRI data, including whole-brain, hippocampal and basal ganglia volumetry; white matter integrity (diffusion tensor imaging); gray matter density (voxel-based morphometry); and hippocampal microstructural integrity (mean diffusivity and fractional anisotropy). Of the 30 patients included in the study, 19 were male (63%); mean (SD) age was 65.7 (12.3) years. Patients with anti-LGI1 encephalitis had incomplete recovery with significant and persisting verbal (mean [SE] Rey Auditory Verbal Learning Test [RAVLT], delayed recall: patients, 6.52 [1.05]; controls, 11.78 [0.56], P < .001) and visuospatial (Rey-Osterrieth Complex Figure Test [ROCF], delayed recall: patients, 16.0 [1.96]; controls, 25.86 [1.24]; P < .001) memory deficits. These deficits were accompanied by pronounced hippocampal atrophy, including subfields cornu ammonis 2/3 (CA2/3) and CA4/dentate gyrus (DG), as well as impaired hippocampal microstructural integrity. Higher disease severity correlated with larger verbal memory deficits (RAVLT delayed recall, r = -0.40; P = .049), decreased volumes of left hippocampus (r = -0.47; P = .02) and left CA2/3 (r = -0.41; P = .04) and CA4/DG (r = -0.43; P = .03) subfields, and impaired left hippocampal microstructural integrity (r = 0.47; P = .01). In turn, decreased volume of the left CA2/3 subfield (RAVLT delayed recall, r = 0.40; P = .047) and impaired left hippocampal microstructural integrity (RAVLT recognition, r = -0.41; P = .04) correlated with verbal memory deficits. Basal ganglia MRI signal abnormalities were observed in only 1 patient, but a longer duration of faciobrachial dystonic seizures correlated with a reduction of pallidum volume (r = -0.71; P = .03). In contrast, no abnormalities of cortical gray matter or white matter were found. The latency between disease onset and initiation of immunotherapy was significantly correlated with verbal (RAVLT recall after interference, r = -0.48; P = .02) and visuospatial (ROCF delayed recall, r = -0.46; P = .03) memory deficits. Anti-LGI1 encephalitis is associated with cognitive deficits and disability as a result of structural damage to the hippocampal memory system. This damage might be prevented by early immunotherapy.

PRECiS (Patient Reported Evaluation of Cognitive State): psychometric evaluation of a new patient reported outcome measure of the impact of stroke

Objective: Determine the psychometric properties of PRECiS (Patient Reported Evaluation of Cognitive State): A new patient-centred, patient reported outcome measure for perceived impact of cognitive problems, developed through qualitative work, systematic review and service user consultation. Design: An observational study exploring acceptability, internal consistency, construct validity, inter-rater reliability and test-retest reliability, with opportunistic qualitative data on sensitivity to change. Setting: Home visits in the community. Participants: Stroke survivors with self-reported cognitive difficulties and informal carers. Measures: The 27 item PRECiS was self-completed with support, and proxy completed by informal carers. We collected descriptive cognitive screening test data, and measures of overall stroke impact, mood and activities of daily living to explore construct validity. Results: Data were collected from 159 (visit 1) and 66 (visit 2) stroke survivors and 86 informal carers. PRECiS showed good acceptability (no missing values or floor/ceiling effects, minimal skewness); high internal consistency (α = 0.94, indicative of potential redundancy); with moderate to strong construct correlations in the directions hypothesised (0.40 to 0.74). An intraclass correlation coefficient of 0.85 indicated good test-retest reliability. Where self-reported change had occurred from visit 1 to 2, PRECiS appeared sensitive. Using carers as proxy respondents is not supported by this analysis (inter-rater ICC = 0.43). Conclusions: PRECiS is a patient-centred, practical and reliable measure assessing perceived impact of cognitive problems from the unique perspective of stroke survivors.

Do Cognitive and Physical Functions Age in Concert from Age 70 to 76? Evidence from the Lothian Birth Cohort 1936.

The present study concerns the relation of mental and bodily characteristics to one another during ageing. The 'common cause' theory of ageing proposes that declines are shared across multiple, seemingly-disparate functions, including both physical and intellectual abilities. The concept of 'reserve' suggests that healthier cognitive (and perhaps bodily) functions from early in life are protective against the effects of senescence across multiple domains. In three waves of physical and cognitive testing data from the longitudinal Lothian Birth Cohort 1936 (n = 1,091 at age 70 years; n = 866 at 73; n = 697 at 76), we used multivariate growth curve modeling to test the 'common cause' and 'reserve' hypotheses. Support for both concepts was mixed: although levels of physical functions and cognitive functions were correlated with one another, physical functions did not decline together, and there was little evidence for shared declines in physical and mental functions. Early-life intelligence, a potential marker of system integrity, made a significant prediction of the levels, but not the slopes, of later life physical functions. These data suggest that common causes, which are likely present within cognitive functions, are not as far-reaching beyond the cognitive arena as has previously been suggested. They also imply that bodily reserve may be similar to cognitive reserve in that it affects the level, but not the slope, of ageing-related declines.

Cognitive-Behavioral Therapy for Adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder that regularly persists into adulthood and is associated with a number of maladaptive functional outcomes. Cognitive-behavioral therapy (CBT) is an empirically based treatment that has demonstrated effects on core ADHD symptoms and related impairments in adult samples. One manualized CBT in particular is proposed to target both core symptoms of ADHD and underlying executive functioning (EF) deficits. Targeting underlying dysfunction is important to ongoing treatment development efforts and may enhance efficacy. This manualized CBT was developed for groups. The aims of this case study were twofold. First, we adapted a manualized group-based CBT for adult ADHD for an individual format. Second, we discuss a case study to exemplify how clinicians can measure and track EF symptoms in a clinic setting using a multi-method approach. Self-report and collateral-report questionnaire data provided initial support for adaptation of Cognitive-Behavioral Therapy for Adult ADHD: Targeting Executive Dysfunction to an individual format. Outcome data were more limited with cognitive test scores. The discrepancy between questionnaire and cognitive test data along with the complications observed at 2-month follow up are discussed.

NCO-15PREDICTION OF SUBJECTIVE MEMORY ABILITY BEFORE RESECTION OF HIGH GRADE GLIOMA

OBJECTIVE: A significant relationship between subjective reports of cognitive function and objective neuropsychological test data is often absent in medical populations. Sociodemographic and clinical predictors of subjective memory ability are largely unknown in glioma patients. METHODS: Patients (n = 146) with high-grade glioma completed neuropsychological assessment preoperatively, including the Hopkins Verbal Learning Test-Revised (HVLT-R), the Functional Assessment of Cancer Therapy-Brain (FACT-Br), and the Beck Depression Inventory-Second Edition (BDI-II). Linear regression analyses were conducted with sociodemographic (age and sex), clinical (tumor location and lateralization), and neuropsychological variables (HVLT-R and BDI-II) as predictors of subjective memory ability (“I can remember new things”) from the FACT-Br. Three linear regression analyses were conducted to examine differences between the HVLT-R subtests (Immediate Recall, Delayed Recall, Delayed Recognition) in predicting subjective memory ability. RESULTS: FACT-Br subjective memory ability was significantly correlated with HVLT-R Immediate Recall, r(144) = .31, p < .001, Delayed Recall, r(136) = .26, p < .01, and Delayed Recognition, r(136) = .18, p < .05. Better subjective memory ability was predicted by a model (p < .001, R2 = .21) that included younger patient age (β = -.20; p = .018), better HVLT-R Immediate Recall (β = .19; p = .018), and less depressive symptomatology (β = -.24; p = .002). Separate models including HVLT-R Delayed Recall (p < .001, R2 = .20) and Delayed Recognition (p < .001, R2 = .20) did not find these subtests to be predictive of subjective memory ability; however, younger patient age (β = -.24; p = .006; and β = -.26; p = .002, respectively) and less depressive symptoms (β = -.25; p = .002; and β = -.26; p = .001, respectively) were predictive of better subjective memory ability. CONCLUSION: Subjective memory ability and objective memory test performance were modestly correlated in newly diagnosed patients with high-grade glioma. Multivariate analysis highlighted the additional importance of patient age and depressive symptoms in predicting subjective memory ability. Results underscore the importance of considering sociodemographic and clinical variables when patients self-report memory difficulties.

Abstract 04: Incident Heart Failure and Longitudinal Cognitive Trajectories in the Cardiovascular Health Study

OBJECTIVE: To determine whether older adults who develop incident heart failure (HF) experience faster cognitive decline than those without HF. METHODS: We analyzed longitudinal cognitive test data from the Cardiovascular Health Study, a community-based study of adults aged 65 years and older. Participants in this analysis did not have HF or history of stroke at baseline and were censored when they experienced incident clinical stroke. Incident HF was identified by self-report of physician-diagnosed HF and confirmed by adjudicated review of inpatient and outpatient medical records and medication use. Outcomes were mean score and rate of decline in mean score on the 100-point Modified Mini-Mental State Examination (3MSE), administered annually up to nine times from 1990 to 1998. A linear mixed effects model was used to model the relationship of cognitive decline with HF and age, adjusted for demographics, health behaviors, and comorbid conditions including hypertension and diabetes. RESULTS: Analyses included 5,211 participants with mean age 74 years at baseline, of whom 545 (10.5%) developed incident HF over a median follow-up of 7.8 years. Mean 3MSE score was lower at the time of HF diagnosis compared with no HF, and declined faster after incident HF compared with no HF. For example, at age 80, covariate-adjusted predicted mean 3MSE score was 88.6 points (95% CI: 88.3, 89.0) in participants without HF, but 87.6 points (95% CI: 87.3, 87.9) in those with newly diagnosed HF. Predicted five-year decline in mean 3MSE score from age 80 to age 85 was 5.9 points (95% CI: 5.7, 6.0) in participants without HF, but 10.0 points (95% CI: 8.6, 11.3) in those diagnosed with incident HF at age 80. Faster decline in 3MSE score after HF diagnosis was seen at all ages studied. The figure shows predicted mean 3MSE score trajectories without HF (solid line) and after HF diagnosed at ages 70, 75, 80, and 85 (dashed lines), with 95% CI shaded. CONCLUSIONS: Older adults diagnosed with incident HF experience faster average cognitive decline than those without HF.

Do statins impair cognition? A systematic review and meta-analysis of randomized controlled trials.

In 2012, the United States Food and Drug Administration (FDA) issued a warning regarding potential adverse effects of HMG-CoA reductase inhibitors (statins) on cognition, based on the Adverse Events Reporting System and a review of the medical literature. We aimed to synthesize randomized clinical trial (RCTs) evidence on the association between statin therapy and cognitive outcomes. We searched MEDLINE, EMBASE, and Cochrane CENTRAL through December 2012, and reviewed published systematic reviews of statin treatment. We sought RCTs that compared statin treatment versus placebo or standard care, and reported at least one cognitive outcome (frequency of adverse cognitive events or measurements using standard neuropsychological cognitive test scores). Studies reporting sufficient information to calculate effect sizes were included in meta-analyses. Standardized and unstandardized mean differences were calculated for continuous outcomes for global cognition and for pre-specified cognitive domains. The main outcome was change in cognition measured by neuropsychological tests; an outcome of secondary interest was the frequency of adverse cognitive events observed during follow-up. We identified 25 RCTs (all placebo-controlled) reporting cognitive outcomes in 46,836 subjects, of which 23 RCTs reported cognitive test results in 29,012 participants. Adverse cognitive outcomes attributable to statins were rarely reported in trials involving cognitively normal or impaired subjects. Furthermore, meta-analysis of cognitive test data (14 studies; 27,643 participants) failed to show significant adverse effects of statins on all tests of cognition in either cognitively normal subjects (standardized mean difference 0.01, 95% confidence interval, CI, -0.01 to 0.03, p = 0.42) or Alzheimer's disease subjects (standardized mean difference -0.05, 95% CI -0.19 to 0.10, p = 0.38). Statin therapy was not associated with cognitive impairment in RCTs. These results raise questions regarding the continued merit of the FDA warning about potential adverse effects of statins on cognition.

An evidence-based method for examining and reporting cognitive processes in nutrition research.

Cognitive outcomes are frequently implemented as endpoints in nutrition research. To reduce the number of statistical comparisons it is commonplace for nutrition researchers to combine cognitive test results into a smaller number of broad cognitive abilities. However, there is a clear lack of understanding and consensus as to how best execute this practice. The present paper reviews contemporary models of human cognition and proposes a standardised, evidence-based method for grouping cognitive test data into broader cognitive abilities. Both Carroll's model of human cognitive ability and the Cattell-Horn-Carroll (CHC) model of intelligence provide empirically based taxonomies of human cognition. These models provide a cognitive 'map' that can be used to guide the handling and analysis of cognitive outcomes in nutrition research. Making use of a valid cognitive nomenclature can provide the field of clinical nutrition with a common cognitive language enabling efficient comparisons of cognitive outcomes across studies. This will make it easier for researchers, policymakers and readers to interpret and compare cognitive outcomes for different interventions. Using an empirically derived cognitive nomenclature to guide the creation of cognitive composite scores will ensure that cognitive endpoints are theoretically valid and meaningful. This will increase the generalisability of trial results to the general population. The present review also discusses how the CHC model of cognition can also guide the synthesis of cognitive outcomes in systematic reviews and meta-analysis.

Altered resting state functional connectivity in young survivors of acute lymphoblastic leukemia

Chemotherapy treatment for pediatric acute lymphoblastic leukemia (ALL) has been associated with long-term cognitive impairments in some patients. However, the neurobiologic mechanisms underlying these impairments, particularly in young survivors, are not well understood. This study aimed to examine intrinsic functional brain connectivity in pediatric ALL and its relationship with cognitive status. We obtained resting state functional magnetic resonance imaging (rsfMRI) and cognitive testing data from 15 ALL survivors age 8-15 years and 14 matched healthy children. The ALL group had a history of intrathecal chemotherapy treatment but were off-therapy for at least 6 months at the time of enrollment. We used seed-based analyses to compare intrinsic functional brain network connectivity between the groups. We also explored correlations between connectivity and cognitive performance, demographic, medical, and treatment variables. We demonstrated significantly reduced connectivity between bilateral hippocampus, left inferior occipital, left lingual gyrus, bilateral calcarine sulcus, and right amygdala in the ALL group compared to controls. The ALL group also showed regions of functional hyperconnectivity including right lingual gyrus, precuneus, bilateral superior occipital lobe, and right inferior occipital lobe. Functional hypoconnectivity was associated with reduced cognitive function as well as younger age at diagnosis in the ALL group. This is the first study to demonstrate that intrinsic functional brain connectivity is disrupted in pediatric ALL following chemotherapy treatment. These results help explain cognitive dysfunction even when objective test performance is seemingly normal. Children diagnosed at a younger age may show increased vulnerability to altered functional brain connectivity.

Thalamic volume and thalamo-cortical white matter tracts correlate with motor and verbal memory performance

Cognitive testing and diffusion tensor imaging data from 121 normal subjects were combined to investigate the relationship between thalamic connectivity and cognitive performance. Thalamic regions were segmented based on their cortical connectivity, and regions for both ipsilateral and contralateral thalamocortical connections were identified. White matter tracts corresponding to these regions were identified and the mean fractional anisotropy, and axial and radial diffusivities within each tract were measured. Motor task performance correlated with radial diffusivity in the dominant thalamo-precentral tract. Verbal memory corresponded with the thalamic volume connected to the left temporal lobe. These data support the use of diffusion tractography to identify functionally important regions within the thalamus. Our findings provide the first robust correlation between thalamic volumes and tract characteristics with cognitive performance data in normal subjects.

A semiparametric approach to mixed outcome latent variable models: Estimating the association between cognition and regional brain volumes

Multivariate data that combine binary, categorical, count and continuous outcomes are common in the social and health sciences. We propose a semiparametric Bayesian latent variable model for multivariate data of arbitrary type that does not require specification of conditional distributions. Drawing on the extended rank likelihood method by Hoff [Ann. Appl. Stat. 1 (2007) 265-283], we develop a semiparametric approach for latent variable modeling with mixed outcomes and propose associated Markov chain Monte Carlo estimation methods. Motivated by cognitive testing data, we focus on bifactor models, a special case of factor analysis. We employ our semiparametric Bayesian latent variable model to investigate the association between cognitive outcomes and MRI-measured regional brain volumes.

Alzheimer's Disease Risk Assessment Using Large-Scale Machine Learning Methods

The goal of this work is to introduce new metrics to assess risk of Alzheimer's disease (AD) which we call AD Pattern Similarity (AD-PS) scores. These metrics are the conditional probabilities modeled by large-scale regularized logistic regression. The AD-PS scores derived from structural MRI and cognitive test data were tested across different situations using data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. The scores were computed across groups of participants stratified by cognitive status, age and functional status. Cox proportional hazards regression was used to evaluate associations with the distribution of conversion times from mild cognitive impairment to AD. The performances of classifiers developed using data from different types of brain tissue were systematically characterized across cognitive status groups. We also explored the performance of anatomical and cognitive-anatomical composite scores generated by combining the outputs of classifiers developed using different types of data. In addition, we provide the AD-PS scores performance relative to other metrics used in the field including the Spatial Pattern of Abnormalities for Recognition of Early AD (SPARE-AD) index and total hippocampal volume for the variables examined.

Spotlight on the October 22 Issue

The authors assessed the relationship between prerandomization red blood cell docosahexaenoic acid + eicosapentaenoic acid levels and cognitive function in 2,157 cognitively normal women. After adjustment for demographic, clinical, and behavioral characteristics, there were no cognitive differences at the time of the first annual cognitive battery or in the rate of cognitive change. See p. 1484 A quantitative lipidomic analysis was conducted on 524 longitudinal CSF samples. Subjects included HIV-infected individuals with longitudinal clinical and cognitive test data and cognitively normal HIV-negative healthy controls. HIV infection and combination antiretroviral therapy (cART) were …

A lipid storage–like disorder contributes to cognitive decline in HIV-infected subjects

In this multicenter cohort study, we sought to identify prognostic and associative metabolic indicators for HIV-associated neurocognitive disorders (HAND). A quantitative lipidomic analysis was conducted on 524 longitudinal CSF samples collected from 7 different performance sites across the mainland United States, Hawaii, and Puerto Rico. Subjects included HIV-infected individuals with longitudinal clinical and cognitive testing data and cognitively normal HIV-negative healthy controls. At baseline, HIV+ subjects could be differentiated from HIV- controls by reductions in a single ceramide species and increases in multiple forms of cholesterol. Perturbations in cholesterol metabolism and ceramide were influenced by combined antiretroviral therapy (cART) use. There were no cross-sectional baseline differences in any lipid metabolite when HIV+ subjects were grouped according to cognitive status. However, a single sphingolipid metabolite and reduced levels of esterified cholesterols were prognostic indicators of incident cognitive decline. Longitudinal patterns of these disturbances in sphingolipid and sterol metabolism suggest that a progressive disorder of lipid metabolism that is similar to disorders of lipid storage may contribute to the pathogenesis of HAND. These findings suggest that HIV infection and cART are independently associated with a CNS metabolic disturbance, identify surrogate markers that are prognostic for cognitive decline, and implicate a lipid storage-like disorder in the progression of HAND.

A snapshot of cognitive functioning: Deriving a tool for the efficient assessment of cognition in schizophrenia and other chronic psychiatric disorders in a real-world inpatient setting

Previous research has led to the development of short batteries of tests that efficiently measure the cognitive functioning of individuals with schizophrenia. To attempt to replicate previous findings, we applied an empirical test selection strategy to archival cognitive test data of two non-overlapping inpatient samples of individuals with schizophrenia or schizoaffective disorder (total N=110). We then extended previous findings by applying the empirical test selection strategy to the archival data of two non-overlapping inpatient samples of individuals with various psychiatric disorders (total N=149). For each sample, tests were selected by examining the relationships between individual test scores and averaged test scores representing global cognitive functioning while taking into account test administration times. Across patient samples, digit symbol coding tasks, verbal fluency tasks, and tests with a processing speed component (Trail Making Test Part A and Stroop) emerged as efficient and effective indicators of overall cognitive functioning. A brief cognitive assessment tool incorporating coding, fluency, and processing speed tasks would provide a valid and clinically useful snapshot of a patient's level of cognitive functioning if more comprehensive testing cannot be completed.

Prediction of patient contacts by cognition in schizophrenia

To investigate the correlations between cognitive function and clinical outcome variables. Patients diagnosed for the first time with schizophrenia between January 2004 and June 2010 were cognitively tested in conjunction with diagnostic procedures. Cognitive test data were connected to Danish healthcare registers and patients were followed in the registers from their first contact with psychiatric in- and outpatient care until October 2011. Patients had impaired attention, processing speed and executive function as measured by Trail Making Test part B; their executive functions, as measured by the Wisconsin Card Sorting Test (WCST), and working memory, as measured by Rigshospitalet's digit span test, were unaffected as compared to norms. The admission rate, from schizophrenia diagnosis to the end of the study, was predicted by Trail Making Test part A, Rey's Auditory Verbal Learning Test (RAVLT), RAVLT (total learning), RAVLT (memory), d2 Test of Attention (total) and d2 type 2 error (error of commission), independent of gender, age and schizophrenia subtype. The length of hospitalization after the schizophrenia diagnosis was mainly determined by the schizophrenia subtype (schizophrenia simplex: incidence rate ratio (IRR) 0.24; 95% confidence interval (CI) 0.15-0.40, p < 0.001). Diagnosis was secondarily determined by deficits in attention and executive function, Trail Making Test part B, d2 Test of Attention (total), d2 type 1 error (error of omission), d2 type 2 error, and also by age and substance use disorder. The outpatient contact rate from schizophrenia diagnosis to the end of the study was predicted by d2 Test of Attention, Trail Making Test part A, and d2 type 2 error. The annual rate of criminal conviction, institutionalization and social retirement pension was mainly predicted by substance misuse. Cognitive function only predicted hospitalization and outpatient contacts to a minor degree in a cohort of newly diagnosed patients with schizophrenia.

Iron deficiency, cognition, mental health and fatigue in women of childbearing age: a systematic review.

It is known that Fe deficiency has a negative impact on cognitive function in children by altering brain energy metabolism and neurotransmitter function. It is unclear whether Fe deficiency has detrimental effects on cognition, mental health and fatigue in women of childbearing age. Our aim was to systematically review the literature to determine whether Fe deficiency in women of childbearing age affects cognition, mental health and fatigue, and whether a change in Fe status results in improvements in cognition, mental health and fatigue. Studies using Fe supplement interventions were reviewed to examine the effect of Fe deficiency in women of childbearing age (13-45 years) on their cognition, mental health and fatigue. English-language articles ranging from the earliest record to the year 2011 were sourced. The quality of retrieved articles was assessed and the Fe pathology, cognitive, mental health and fatigue data were extracted. Means and standard deviations from cognitive test data were included in meta-analyses of combined effects. Of the 1348 studies identified, ten were included in the review. Three studies showed poorer cognition and mental health scores and increased fatigue with Fe deficiency at baseline. Seven studies reported an improvement in cognitive test scores after Fe treatment. Results of three of these studies were included in meta-analyses of the effect of Fe supplement intervention on cognition. The results of the meta-analyses showed a significant improvement in Arithmetic scores after treatment (P<0·01), but no effect on Digit Symbol, Digit Span or Block Design. While an improvement in cognition after Fe treatment was seen in seven out of ten studies, the evidence base is limited by poor study quality and heterogeneity across studies. Additional high-quality studies using consistent measures are warranted.

Post-exertion neurocognitive test failure among student-athletes following concussion

Objective: The purpose of the present study was to examine post-exertion (PE) neurocognitive performance among student-athletes following concussion who were asymptomatic and returned to baseline normal neurocognitive test levels at rest. This study examined the neurocognitive performance of a sub-set of student-athletes who ‘failed’ to perform at baseline levels of neurocognitive function, i.e. exhibited downward reliable change index (RCI) alterations following a moderate exertional protocol during recovery from concussion.Method: A retrospective records review was carried out of Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) and neuropsychological consultation data among athletes with sports-related concussion from a network of 22 schools and one junior hockey programme.Results: Fifty-four student-athletes met inclusion criteria and participated in the study. A total of 27.7% of concussed student-athletes who were symptom-free and returned to baseline on ImPACT at rest (i.e. no longer demonstrated performance deficits on neurocognitive tests) exhibited cognitive decline following moderate physical exertion. The PE cognitive changes were not simply general performance effects, but significant changes in memory ability in the presence of intact processing speed functions. The PE-Pass and PE-Fail groups did not, however, differ on post-concussive symptoms or concussion history.Conclusions: Clinicians’ return-to-play evaluation protocols should include post-exertional computerized neurocognitive testing.

VETSA: the Vietnam Era Twin Study of Aging.

The Vietnam Era Twin Study of Aging (VETSA) is a longitudinal behavioral genetic study with a primary focus on cognitive and brain aging in men. It comprises a subset of over 1,200 twins from the Vietnam Era Twin Registry. Like many other studies of aging, the VETSA includes many different phenotypes, but there are some key features that distinguish it from most other behavioral genetic aging studies. First, the initial assessment was conducted when all participants were middle-aged. Second, the age range of participants is narrow; all were in their 50s at the time of the initial recruitment. Third, the study includes an extensive and demanding neurocognitive test battery that was designed to provide good coverage of different cognitive abilities and avoid ceiling effects in middle-aged adults. Fourth, young adult cognitive test data (at an average age of 20 years) are available to provide a gauge of cognitive change. These features make the VETSA ideal for studying the heterogeneity of within-individual trajectories from midlife to old age, and for early detection of risk factors for cognitive decline.