Color Trails Test Research Articles

A normative study of the Color Trails Test in the adult Indian population

The Color Trails Test (CTT) is a neuropsychological measure assessing for frontal and executive functioning, while also minimizing the cultural and language barriers inherent in similar measures such as the Trail Making Test (TMT). This study establishes convergent validity for the CTT in the Indian population by comparing participant performance on the CTT and TMT. It also generates culturally appropriate normative data for CTT-Form A among the Indian adult population. Six-hundred and sixty-nine cognitively healthy, community-dwelling individuals between ages 18 and 69 participated in the study and were stratified based on age, gender, and educational attainment. Participant performance on the CTT and TMT were correlated to establish convergent validity. Strong correlation was found between TMT-A and CTT-1 (r = 0.61) and between TMT-B and CTT-2 (r = 0.66). An analysis of variance test was used to determine the mean and standard deviation for each stratified participant group. Further analysis found that age and educational attainment significantly impact participant performance on CTT-1 [F(4, 649) = 4.395, p = 0.002], whereas gender, age, and educational attainment significantly impact participant performance on CTT-2 [F(4,649) = 2.446, p = 0.045]. Normative data generated from this study has important clinical implications and contributes to the growing body of culturally appropriate normative data available for the Indian population.

Long-term Cognitive Outcomes in Tuberculous Meningitis.

Data on cognitive changes in patients with tuberculous meningitis (TBM) are sparse. We aimed to study the cognitive profiles of patients with grade I TBM and correlate them with the cytokine values. Prospectively, 60 patients (M:F-31:29) with grade I TBM were recruited. Clinical details were collected; CSF estimation of cytokines, neuropsychological assessment, and correlation were performed. Mean age at presentation was 32.2 years (32.2 ± 10.1), and the duration of symptoms was 29.9 days (29.9 ± 25.9), respectively. Definitive evidence of mycobacterial infection was observed in 28.3% of the patients. Mean levels of tumor necrosis factor-α (TNF-α), interferon (IFN-γ), and interleukin-6 (IL-6) were 11.57 ± 30.35, 197.02 ± 186.64, and 127.03 ± 88.71 pg/mL, respectively. TNF-α levels were significantly elevated in definitive TBM (p = 0.044). Neuropsychological tests revealed an impaired auditory verbal learning test (88.3%), followed by complex figure test (50%), spatial span test (50%), clock drawing test (48.3%), digit span test (35%), color trail tests 1 and 2 (30% and 33.3%, respectively), and animal naming test (28.3%). Elevated levels of IFN-γ and IL-6 in TBM directly correlated with the number of impaired neuropsychological tests. During follow-up, significant improvement was noticed in animal naming test (p = 0.005), clock drawing test (p = 0.003), color trail test 2 (0.02), spatial span test (p = 0.012), and digit span test (0.035). Verbal learning did not show any significant change. Overall, the neuropsychological tests showed better recovery of attention, working memory, and category fluency and showed minimal recovery of verbal learning. There is subclinical evidence of cognitive impairment in patients with TBM, and this correlated with elevated cytokines. Both the frontal and temporal lobes showed varying degrees of cognitive impairment.

Effects of a Cognitive-Functional Intervention Method on Improving Executive Function and Self-Directed Learning in School-Aged Children with Attention Deficit Hyperactivity Disorder: A Single-Subject Design Study.

Background School-aged children with attention deficit hyperactivity disorder (ADHD) face many difficulties with self-directed learning because of their poor executive function. This leads to secondary problems such as learning disabilities and depression, so the role of intervention to improve executive function in school-aged children with ADHD is important. Objective The present study is aimed to investigate how cognitive-functional (Cog-Fun) intervention affected executive function of school-aged children with ADHD and the sustainability of these effects. To investigate the effects of changes in the executive function of school-aged children with ADHD through Cog-Fun intervention in self-directed learning. Method A single-subject A-B-A research design was employed in this study. Three children aged 9-10 years who were diagnosed with ADHD were selected. A total of 17 experimental sessions were conducted. The Cog-Fun intervention program was implemented during the intervention phase. To measure dependent variables, Behavior Rating Inventory of Executive Function (BRIEF) and Homework Problems Checklist (HPC) were used. Significant changes in executive function assessed by the Children's Color Trails Test (CCTT) and Stroop test were analyzed through two-standard deviation band analysis. Additionally, video clips of task performance were analyzed to examine qualitative performance changes in self-directed learning. Result All three participants presented statistically significant changes with a number of near-misses of CCTT and color words score of Stroop test during the intervention. T-scores of the Global Executive Composite (GEC) decreased after the intervention, indicating improvement in executive function. The follow-up period revealed retention of the improved executive function. Additionally, self-directed learning improved in all participants after the implementation Cog-Fun intervention. Conclusion The study supports the effectiveness of Cog-Fun intervention in improving executive function in school-aged children with ADHD and confirmed that the improvement of executive function ultimately leads to the improvement of self-directed learning performance.

Factors affecting cognition and emotion in patients with traumatic brain injury.

BACKGROUND:Cognitive and emotional disturbances are common serious issues in patients with traumatic brain injury (TBI). However, predictors associated with neuropsychological functions were not consistent.OBJECTIVE:To investigate factors affecting cognition and emotion in patients with TBI, we evaluated executive function, memory, and emotion based on injury severity and lesion location.METHODS:Neuropsychological outcomes of 80 TBI patients were evaluated via Wisconsin Card Sorting Test (WCST), Color Trail Test (CTT), Controlled Oral Word Association Test (COWAT), Everyday Memory Questionnaire (EMQ), Geriatric Depression Scale (GDS), State-Trait Anxiety Inventory (STAI), and Agitated Behavior Scale (ABS). WCST, CTT, and COWAT assessed executive function; EMQ assessed everyday memory; and GDS, STAI, and ABS assessed emotion. Patients were categorized according to lateralization of lesion and existence of frontal lobe injury.RESULTS:Patients with longer duration of loss of consciousness (LOC) showed more severe deficits in everyday memory and agitated behaviors. The frontal lesion group showed poorer performance in executive function and higher agitation than the non-frontal lesion group. Patients with bilateral frontal lesion showed greater deficits in executive function and were more depressed than unilateral frontal lesion groups. Especially in those unilateral frontal lesion groups, right side frontal lesion group was worse on executive function than left side frontal lesion group.CONCLUSIONS:Duration of LOC and lesion location are main parameters affecting executive function, everyday memory, and emotion in neuropsychological outcomes following TBI, suggesting that these parameters need to be considered for cognitive rehabilitation interventions.

The relationship between cingulum bundle integrity and different aspects of executive functions in chronic schizophrenia

BackgroundEvidence suggests that disruption in the cingulum bundle (CB) may influence executive dysfunctions in schizophrenia, but findings are still inconsistent. Using diffusion tensor imaging tractography, we investigated the differences in fiber integrity between schizophrenia patients and healthy controls together with the association between fiber integrity and executive functions. MethodsThirty-two patients with chronic schizophrenia and 24 healthy controls took part in the study. Both groups were matched for age, sex, and years of education. Assessment of cognitive functions was performed using the Berg Card Sorting Test (BCST), the Color Trail Test (CTT), and the Stroop Color-Word Test (SCWT). ResultsResults showed group differences, bilaterally (left and right) in fractional anisotropy (FA) of the CB, where patients showed less anisotropy than controls. Moreover, normal asymmetry (left FA > right FA) in the CB in schizophrenia was found. There were no group differences in mean diffusivity (MD). Patients had a similar but reduced profile of executive functions compared to healthy controls. However, when premorbid IQ was controlled for, the differences were no longer statistically significant. In schizophrenia patients, a negative correlation was found between FA of the left CB and perseverative errors in the BCST. ConclusionsThese findings provide evidence that CB disruption appears in schizophrenia patients and might account for impairments of executive processes, including concept formation.

Capacity of cognitive control in patients with cerebral small vessel disease

Objective To evaluate the capacity of cognitive control(CCC) in patients with cerebral small vessel disease(CSVD) and explore the relationship between CCC and cognitive function in CSVD, and to assess the predict value of CCC on the occurrence of CSVD. Methods Twenty-two patients with CSVD and twenty-three healthy controls were enrolled.All of them completed the majority function task-masked (MFT-M) and a set of neuropsychological tests.Neuropsychological test was performed by Montreal cognitive assessment (MoCA), verbal fluency test (VFT), Chinese auditory learning test (CAVLT), symbol digit modalities test (SDMT), digital span (DS), Stroop color word test (SCWT), color trail test (CTT) and Modified Boston naming test (Modified BNT). The predict value of CCC for the occurrence of CSVD was assessed with logistic regression analysis. Results CCC of patients with CSVD was lower than that of healthy control ((2.97±0.72)bps vs (3.53±0.62)bps, t=-2.704, P=0.01). Between patients with CSVD and healthy control, there were significant differences in MoCA ((22.24±4.58 vs (24.86±2.42), t=-2.334, P=0.026), VFT-animal (12(6) vs 15(6), Z=-2.965, P=0.003), VFT-vegetables and fruits ((13.79±3.81) vs (18.27±4.13), t=-3.592, P=0.001), CAVLT-immediate ((7.45±2.18) vs (9.11±2.08), t=-2.502, P=0.017), CAVLT-short term delay ((7.20±3.32) vs (10.76±3.08), t=-3.564, P=0.001), CAVLT-long term delay ((7.30±3.16) vs (10.29±3.18), t=-3.012, P=0.005), SDMT ((15.95±5.49) vs (23.41±12.73), t=-2.513, P=0.018), CTT-A (85.17(42.60) vs 55.50(52.65), Z=-2.965, P=0.003), CTT-B ((200.69±71.35) vs (132.44±53.66), t=3.556, P=0.001), and CTT-B-A ((104.13±53.31) vs (65.20±35.98), t=2.819, P=0.007). But there was no significant difference in VFT-word begin with Chinese characterwater((3.68±2.63) vs (5.44±2.71), t=-1.940, P=0.061), CAVLT-recognition (14(3) vs 14(4), Z=-0.524, P=0.601), DS-forward (7.0(3.0) vs 5.5(2.0), Z=-0.152, P=0.880), DS-backward (4(1) vs 4(2), Z=-1.044, P=0.297), SCWT ((9.50±9.28) vs (5.94±10.47), t=1.123, P=0.268), Modified BNT (14.0(3.0) vs 13.5(3.0), Z=-0.727, P=0.467) between CSVD patients and healthy controls.In patients with CSVD, CCC was positively correlated with scores of MoCA (r=0.551, P=0.010) and also with DS-forward (r=0.532, P=0.013) and SCWT (r=-0.487, P=0.040). Logistic regression analysis showed that CCC was an important variable in predicting the possibility of CSVD (B=-1.318, P=0.019, OR=0.268, 95%CI (0.089-0.808)). Conclusion Compared with the healthy control, CCC in patients with CSVD decreases significantly and CCC is related to the cognitive impairment.CCC can predict the possibility of CSVD. Key words: Cognitive control capacity; Cerebral small vessel disease; Cognitive function

Neurocognitive Functions and Brain Volume in Patients with Endogenous Cushing's Syndrome Before and After Curative Surgery.

Introduction:Cushing's syndrome (CS) leads to various neuropsychiatric manifestations due to structural and functional changes of the brain and contributes significantly in the impairment of health-related quality of life.Aim and Objective:This study is conducted with aims to evaluate neurocognitive functions and brain volume in patients with endogenous Cushing's syndrome before and after curative surgery.Methods:The diagnosis of CS was made by clinical features, abnormal cortisol dynamics, ACTH levels, and imaging studies. Neuropsychiatric tests (Beck depression Index, Spatial span test, PGI memory scale, Color trail test, Verbal fluency test), and Brain volume (Bi-caudate and third ventricular diameter) were done before and after curative surgery.Results:Fifteen patients of CS were included for the study; all patients underwent curative surgery, neuropsychiatric assessment, and brain volume measurements. Nine patients were followed successfully till remission and repeat evaluation of these patients was done. Depression was the most common neuropsychiatric illness. Severity of depression positively correlated with 0800 h plasma cortisol and ACTH. Patients with higher severity of depression had maximum improvement after curative surgery. Significant decrease in the third ventricular, as well as bicaudate diameter, was observed after curative surgery (P < 0.01).Conclusion:Neuropsychiatric functions and structural brain changes reverse after curative surgery in patients with endogenous CS, however, long term follow-up is required to know whether these changes reverse completely or not.

Influência da caminhada na cognição e composição corporal de mulheres idosas

O objetivo deste estudo foi verificar a influência da caminhada em variáveis cognitivas e antropométricas de mulheres idosas. Foram recrutadas 30 mulheres destreinadas, sem doenças neurodegenerativas, com média de idade de 64,40 ± 3,71 anos, divididas por conveniência em grupo de intervenção (n = 16) e controle (n = 14). O grupo de intervenção foi submetido à prática de jogos desportivos, caminhada e alongamento, em ambientes abertos, durante três meses, duas vezes por semana. O grupo controle não participou de nenhum programa de atividade física. Antes e após a intervenção, todas as idosas foram submetidas aos testes Códigos WAIS-III, Color Trail Test (CTT-A e CTT-B), e medidas de massa corporal e estatura (determinação do índice de massa corporal – IMC), circunferência da cintura e do quadril (razão cintura-quadril – RCQ). O grupo de intervenção melhorou o desempenho no teste Códigos WAIS-III (Δ = 8,68; IC95%: 6,7; 10,7) e reduziu os tempos de execução dos testes CTT-A (Δ = -7,94; IC95%: -13,1; -2,8) e CTT-B (Δ = -18,59; IC95%: -31,4; -5,8). As modificações do grupo controle não foram estatisticamente significativas (p &gt; 0,05). Conclui-se que a prática de caminhada pode melhorar habilidades cognitivas de mulheres idosas destreinadas.

Children’s Color Trail Test for Objective Assessment of Attention in Children with Attention Deficit Hyperactivity Disorder: A Diagnostic Accuracy Study

To compare the Children's Color Trail Test scores in children with and without Attention Deficit Hyperactivity Disorder to assess its diagnostic performance in assessing attention-deficit. 50 children with Attention Deficit Hyperactivity Disorder (diagnosed as per Diagnostic and Statistical Manual, 5th edition) and 50 age- and sex-matched children underwent Test 1 and Test 2 of the Children's Color Trail Test. A Receiver Operating Characteristics curve was constructed for the diagnostic accuracy of Children's Color Trail Test in Attention Deficit Hyperactivity Disorder. The Receiver Operating Characteristics curve showed a score ≤32 for Children's Color Trail Test 1 [AUC: 0.8 (0.71 to 0.87); P<0.001] and score ≤40 for Children's Color Trail Test 2 [AUC: 0.85 (0.77 to 0.92); P<0.001] as the best cut-off for diagnosing Attention Deficit Hyperactivity Disorder. Children's Color Trail Test is a promising tool for diagnosing attention deficit, and could be used in settings where parent or teacher reports are not available.

Trajectory Analysis of Cognitive Outcomes in Children With Perinatal HIV.

Children with perinatal HIV (pHIV) may display distinct long-term cognitive phenotypes. We used group-based trajectory modeling to identify clusters of children with pHIV after similar developmental trajectories and predictors of belonging to select cognitive trajectory groups. Participants included children, 4-17 years of age, with pHIV in Thailand and Cambodia. Cognitive measures included translated versions of Intelligence Quotient tests, Color Trails Tests and Beery-Buktenica Developmental Test of Visual-Motor Integration conducted semiannually over 3-6 years. The best fit of trajectory groups was determined using maximum likelihood estimation. Multivariate logistic regression identified baseline factors associated with belonging to the lowest scoring trajectory group. Group-based trajectory analyses revealed a 3-cluster classification for each cognitive test, labeled as high, medium and low scoring groups. Most trajectory group scores remained stable across age. Verbal IQ declined in all 3 trajectory groups and the high scoring group for Children's Color Trails Test 1 and 2 showed an increase in scores across age. Children in the lowest scoring trajectory group were more likely to present at an older age and report lower household income. Group-based trajectory modeling succinctly classifies cohort heterogeneity in cognitive outcomes in pHIV. Most trajectories remained stable across age suggesting that cognitive potential is likely determined at an early age with the exception of a small subgroup of children who displayed developmental gains in select cognitive domains and may represent those with better cognitive reserve. Poverty and longer duration of untreated HIV may predispose children with pHIV to suboptimal cognitive development.

Development of a Delayed Cerebral Infarction Load Scoring System (DCI Score).

Delayed cerebral infarction (DCI) is related to unfavorable outcome after aneurysmal subarachnoid hemorrhage (SAH). There lacks a clear understanding how the DCI load affects cognitive function after SAH. We conducted a literature review on the clinical classification systems on brain hemorrhages and cerebral infarction and devised a Delayed Cerebral Infarction Load Scoring System (DCI Score). DCI Score significantly correlated with Symbol Digit Modalities Test (-0.334, p=0.032), Color Trail Test (-0.310, p=0.032), Hong Kong List Learning Test (-0.318, p=0.036), Verbal Digit Span Forward (-0.382, p=0.017), and Visual Digit Span Backward (-0.425, p=0.012). In conclusion, higher DCI load impacted significantly on memory and executive function. DCI Score is a useful system for clinical quantification of DCI load and clinical research.

Panayiotopoulos syndrome and Gastaut syndrome are distinct entities in terms of neuropsychological findings

BackgroundAlthough the courses of self-limited focal epilepsies of childhood are considered as benign, a handful of studies suggested that these children may suffer from cognitive problems. Implementing tailor-made educational strategies would aid these children to reach their full potentials. Therefore, it is crucial to understand and differentiate the complete neuropsychological and behavioral profiles of these rather common syndromes. We aimed to examine the distinct cognitive and behavioral profiles of the Panayiotopoulos syndrome (PS) and the Gastaut syndrome (GS), comparatively. MethodTwenty patients with PS, 20 patients with GS, and 20 healthy controls have been recruited. The testing protocol included Wechsler Intelligence Scale for Children-Revised, Conner's Continuous Performance Test, Verbal Fluency Test, Stroop Color and Word Test, Color Trails Test, Tower of London Test, Symbol Digit Modalities Test, California Verbal Learning Test-Children's Version, Rey Complex Figure Test, Benton Face Recognition Test, Benton Judgment of Line Orientation, Peabody Picture Vocabulary Test, Reading and Writing Test, Child Behavior Checklist, Conner's Parent Rating Scale-48, and Behavior Rating Inventory of Executive Function. Demographical, clinical, electrophysiological data, and imaging findings have also been evaluated. ResultsWith regard to intelligence, the patients with PS scored less in all scales compared to the healthy controls. However, only the performance IQ (intelligence quotient) scores differed significantly between the patient groups, with the patients with PS scoring lower than the patients with GS. Verbal memory problems were eminent in both of the patient groups; whereas, visual memory was impaired only in the group with PS. Psychomotor speed was affected in both groups. Reading problems were prominent only in the patients with PS. Writing and arithmetic skills were defective in both patient groups. There were no noteworthy behavioral problems in comparison to healthy subjects. ConclusionUsing neuropsychological profiles, this study demonstrated that the GS and the PS are two distinct entities. Cognitive dysfunction is a more prominent and widespread feature of the patients with PS; whereas, the patients with GS suffer only from milder and isolated cognitive problems.

Culturally Sensitive Normative Data for the Color Trails Test in the Indian Population

Abstract Objective The Color Trails Test (CTT) is a neuropsychological measure tapping into frontal and executive functioning, while at the same time minimizing the cultural and language barriers inherent in similar neurocognitive measures such as the Trail Making Test (TMT). This study generates culturally-appropriate normative data for the CTT in an adult Indian population. Method Six-hundred and sixty-nine cognitively healthy, community dwelling Indian individuals between ages 18 and 69 participated in the study. Eligible participants were stratified on the basis of age, gender, and educational attainment. Participant performance on the CTT and TMT were correlated to establish concurrent validity. Results Significant correlations were found between TMT-part A and CTT-part 1 (r = .61) and between TMT-part B and CTT-part 2 (r = .66). In addition to generating culturally-appropriate normative data, the current study found that age and educational attainment significantly impacted participant performance on CTT-Part 1 [F(4, 649) = 4.395, p = .002], whereas gender, along with age, and educational attainment significantly impacted performance on CTT-Part 2 [F(4,649) = 2.446, p = .045]. In general, younger participants with more educational attainment performed better on both parts of the CTT. Interestingly, older female participants with lower educational attainment performed better than their younger counterparts on CTT-Part 2, whereas no such findings were noted for male participants. Conclusions Age, gender, and educational attainment are important factors to consider when interpreting CTT completion times in the Indian population. Normative data generated from this study has important clinical implications and contributes to the growing body of culturally-appropriate normative data available for the Indian population.

The Validity of the Montreal Cognitive Assessment for Moderate to Severe Traumatic Brain Injury Patients: A Pilot Study.

The aim of the study was to pilot the use of Montreal Cognitive Assessment as a quick clinical screen for cognitive assessment in traumatic brain injury patients. The study recruited 61 participants with moderate to severe traumatic brain injury presenting to a tertiary rehabilitation center under the Brain Injury Program. A Montreal Cognitive Assessment questionnaire and neuropsychological battery (Repeatable Battery for the Assessment of Neuropsychological Status and Color Trails Test) were administered to participants who had completed inpatient rehabilitation. Receiver operating characteristic analysis for the Montreal Cognitive Assessment revealed an optimal balance of sensitivity and specificity at 24/25 to discriminate participants who were classified as less than 5th centile on the Total Scale Index on the Repeatable Battery for the Assessment of Neuropsychological Status. This achieved a sensitivity, specificity, PPV, and NPV of 73.9%, 86.5%, 77.3%, and 84.2%, respectively. Receiver operating characteristic analysis for the trail making subtest of the Montreal Cognitive Assessment achieved a sensitivity, specificity, PPV, and NPV of 79.4%, 74.1%, 79.4%, and 74.1% in identifying patients classified as less than 5th centile on Color Trail Test part 2. The use of Montreal Cognitive Assessment displayed good validity in identifying patients with clinically significant impairment on a standard neuropsychological assessment battery in the study population. However, it may lack sensitivity for estimating mild levels of impairment.

Early Trauma and Cognitive Functions of Patients With Schizophrenia.

Aim: The following work aims to investigate the putative correlation between early trauma and cognitive functions, as well as psychotic symptoms and cognitive functions, in individuals diagnosed with schizophrenia. Methods: A quantitative assessment was performed with 20 individuals diagnosed with schizophrenia according to the 5th edition of the Diagnostic and Statistical Manual (DSM-5) criteria and who were in ongoing outpatient treatment in Psychosocial Care Centres in Brazil. Clinical measurements comprised a semistructured clinical interview, a screening questionnaire for common mental disorders, the Positive and Negative Syndrome Scale (PANSS), and the Early Trauma Inventory Self-Report—Short Form (ETISR-SF). Cognitive assessment included Beta III test, Concentrated Attention (CA) test, Color Trails Test (CTT), and Visual Face Memory (VFM) test. Results: Age-adjusted analysis showed a negative correlation between early trauma and visual memory performance (r = −0.585, p = 0.007) and negative symptoms and attention performance (r = −0.715, p = 0.000). Conclusion: Although a cause–effect relationship cannot be firmly stated, an association between early trauma experience and cognitive impairment such as visual memory, as well as a relationship between negative symptoms and attention domains, is suggested by our preliminary findings. Future studies with larger sample sizes and prospective design will clarify the long-term effects of early exposure to trauma and its clinical meaning in terms of developing psychotic-related illness.

Montreal Cognitive Assessment in a Greek sample of patients with multiple sclerosis: A validation study

The Montreal Cognitive Assessment (MoCA) is a brief cognitive instrument for the measurement of dementia. The aim of the present study was to measure the sensitivity of this test in a group of Greek speaking participants diagnosed with multiple sclerosis. 40 MS participants complaining for cognitive dysfunction were matched in age and education to 490 healthy participants. The MoCA test and a neuropsychological test battery were administered to both groups. The MoCA test was found to differentiate the MS from the controls (U = 3761.00, p < .001) and it was correlated with all neuropsychological tests (digit span: r = 0.454, p < .0001; phonemic verbal fluency: r = 0.390, p < .0001; semantic verbal fluency: r = 0.319, p < .0001; Color Trails Test 1 (CTT1): r = −.256, p < .0001; Color Trails Test 2 (CTT2): r = −.321, p < .0001). Multiple regression analysis showed that 10.3% of the variation in the MoCA score was accounted for by the Expanded Disability Status Scale (EDSS) total score. Also, the test showed high discriminant validity (optimal screening cut off point 25, sensitivity 0.68, specificity 0.89). MoCA is a sensitive test to differentiate cognitive impairment in Greek speaking MS participants from healthy controls. Further research is needed to use it in larger clinical samples and in different subtypes of the disease.

Impact of Immunosuppression on Executive Functioning After Pediatric Liver Transplantation

Children after liver transplantation show increased rates of impaired cognitive functioning. We aimed to assess the potential effects of immunosuppressive therapy on executive functioning measured by the Children's Color Trail Test and the cognitive functioning module of the PedsQL (cogPedsQL) in liver transplanted children to explore potential targets for intervention to improve executive functioning. We performed a cross-sectional study in 155 children (78 girls) aged 10.4 (2-18) years at 5.0 (0.1-17) years after liver transplantation, with follow-up at 6 months in n = 114. Executive functioning was assessed by Children's Color Trail Test (ages 8-16) and by patients and parent-proxy cogPedsQL (ages 5-18/2-18, respectively). Results were correlated with clinical parameters. Stability of results over time was compared between n = 23 patients who for clinical reasons switched from twice daily calcineurin inhibitor (CNI) to once-daily slow-release tacrolimus (Tac) during the study period, and patients with unchanged CNI. Worse executive functioning was associated with longer stay in the intensive care unit and longer time elapsed since transplantation. No difference was found between users of cyclosporine and Tac. Children on once-daily slow-release Tac performed better than children on twice-daily Tac. In children who switched from twice-daily CNI to once-daily Tac, parent-proxy cogPedsQL improved significantly compared to stable results in the nonswitch group. In addition to a strong impact of disease burden around transplantation, executive functioning appears to deteriorate over time. Although there is no clear-cut advantage of any CNI, once-daily Tac appears to be advantageous compared to twice-daily Tac.

Attentional Bias, "Cool" and "Hot" Executive Functions in Obese Patients: Roles of Body Mass Index, Binge Eating, and Eating Style.

Obesity is recognized as an important risk factor for many chronic diseases and is a major health issue. The current study examined attentional bias to food and the "cool" (inhibitory control and mental flexibility) and "hot" (affective decision making) executive functions (EFs) in obese patients preparing for bariatric surgery. In addition to body mass index (BMI), this study examined the impact of the binge-eating tendency and eating styles. The study population comprised 21 morbidly obese patients preparing to undergo bariatric surgery (BMI ≥30 kg/m) and 21 normal-weight controls (24 kg/m > BMI ≥ 18.5 kg/m). The Visual Probe Task was adopted to examine attentional bias toward food-related cues. The Stop-Signal Task and the Color Trails Test were used to assess inhibitory control and mental flexibility, respectively. The Iowa Gambling Task was administered to assess the affective decision making. (1) The obese patients showed poorer performances on cool EFs (for Color Trails Test, P = 0.016, ηp = 0.136; for Stop-Signal Task, P = 0.049, ηp = 0.093) and hot EF (for Iowa Gambling Task, normal controls showed progressed performance, P = 0.012, ηp = 0.077, but obese patients did not show this progress, P = 0.111, ηp = 0.089) compared with the normal controls; (2) participants with low binge-eating tendency had larger attentional biases at 2000 milliseconds than at 200 milliseconds on food-related cues (P = 0.003, ηp = 0.363); and (3) low-restrained participants exhibited attentional bias toward the low-calorie food cues, compared with the high-restrained group (P = 0.009, ηp = 0.158). The current study contributes to the development of a different therapeutic focus on obese patients and binge eaters.

The Clinical Utility of the TYM and RBANS in a One-Stop Memory Clinic in Singapore: A Pilot Study

We aimed to examine the discriminant validity of a brief self-administered cognitive screening test, the Test Your Memory (TYM) and a brief neuropsychological test, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), supplemented with executive and language tests (Color Trail Test [CTT] and modified Boston Naming Test [mBNT], respectively), in detecting cognitive impairment (CI) in a one-stop memory clinic in Singapore. Ninety patients ≥50 years old with a diagnosis of no cognitive impairment, mild cognitive impairment, and mild Alzheimer disease were recruited from memory clinic. They received the TYM, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), RBANS, CTT, mBNT, and a gold-standard formal neuropsychological test battery. The TYM had a significantly larger area under the curve (AUC) than MMSE (0.96 vs 0.88, P = .03) and was equivalent to MoCA in detecting CI (0.96 vs 0.95, P = .80). At the optimal cutoff points, the TYM (<38) was significantly more sensitive than the MMSE (<24) and MoCA (<20; P < .001). The RBANS had an AUC equivalent to the RBANS supplemented with CTT and mBNT (0.92 vs 0.86, P = .22) in detecting CI. The RBANS supplemented with CTT and mBNT was more sensitive than RBANS alone in detecting CI (sensitivity: 0.98 vs 0.93, P = .016) among patients screened negative using TYM. The self-administered TYM is superior to MMSE and equivalent to MoCA in detecting CI and could be implemented routinely. The RBANS supplemented with CTT and mBNT is more sensitive in detecting CI than RBANS alone therefore could be used for diagnostic purposes.

Neuropsychological rehabilitation of patients with symptoms of depression after ischemic stroke

Introduction Depression significantly affects the effects of rehabilitation, quality of life, as well as patients’ mortality. The estimated prevalence of post-stroke depression is approximately 25%–70%. Aim To examine when neuropsychological rehabilitation after stroke affects the cognitive functions of people suffering from depression. Material and methods 42 persons after ischemic stroke suffering from depression took part in the study. The participants were in 3 weeks daily neurological rehabilitation care. Mood disorders were measured by Beck depression inventory. Cognitive functions were examined using verbal fluency test and following psychological tests: mini mental state examination, color trail test and Benton visual retention test. Results and discussion Mood disorders were diagnosed in 70% of patients. The neuropsychological diagnosis revealed existing memory disorders, low resistance to distractors (30.9% participants), impaired visuospatial function (78.7%), impaired ability to recognize visual stimuli with preserved normal vision, weakened executive functions, in particular planning, initiating and sustaining activities (85.6%), rigid thinking, slackening, difficulty with focusing on the task, problems with selective attention and increased levels of anxiety. Verbal fluency deficits was diagnosed in 92.9% of patients. Significant improvements were observed for all cognitive domains after neuropsychological rehabilitation. The biggest improvement was noted in the attentional domain (73.8%), the least – in the visuo-spatial functions (21.4%). Conclusions Depression is a frequent and important problem among patients with stroke, as a post-stroke depression is present in at least 30% of survivors from stroke. Psychological complications such as emotional, behavioral and cognitive disorders, can have a negative effects on the social functioning and the overall quality of life of stroke survivors.