Common Cognitive Deficits Research Articles

Diagnostic Challenges in Progressive Supranuclear Palsy: Early Identification and Mimics

AbstractBackgroundProgressive supranuclear palsy (PSP) is an often‐undiagnosed neurodegenerative disorder. There are often delays in diagnosing PSP.MethodRetrospective chart review of all newly diagnosed PSP patients referred to an outpatient clinic. We conducted a review of all initial/new PSP cases in our geriatric clinic. The most common preliminary diagnosis the patients had been given included was idiopathic Parkinson’s disease. Other common diagnoses were vascular Parkinson’s, frontal lobe dementia, psychotic depression and late life psychosis.Clinical records with the subjective accounts, cognitive assessments and brain imaging reports of 23 PSP patients were reviewed.ResultsThe most common cognitive deficits were visuospatial changes (100%), semantic fluency deficits (80.4%), dysexecutive function. Sleep disruption with insomnia with intermittent awakening was also commonly reported.A propensity for falls and multiple falls were also reported. The interval from the onset of symptoms and initial presentation to a clinical provider to diagnosis ranged from 1 ‐ 7 years.ConclusionA high index of suspicion and recognition that PSP might not be as uncommon as previously thought is needed. A timely diagnosis and recognition of the various cognitive and behavioral changes is important.

A comparative study of cognitive functions between schizophrenia and obsessive-compulsive disorder

BackgroundSchizophrenia (SZ) and obsessive-compulsive disorder (OCD) are closely linked, have a high comorbidity rate, and their differential diagnosis is challenging in clinic. Some studies have found common cognitive deficits in some domains between them. The goal of this research was to compare the cognitive functions of SZ and OCD in order to offer a clinical foundation for differential diagnosis and treatment of the two disorders. MethodsA control design was used in this study, which comprised 61 patients with SZ, 60 individuals with OCD, and 51 healthy controls (HC). We assessed patients' cognitive functions by testing six domains, including visual learning, reasoning and problem solving, verbal learning, attention/vigilance, speed of processing and working memory. ResultsThe results showed that patients with SZ had cognitive impairments in all areas except attention/vigilance, while patients with OCD only had cognitive impairment in reasoning and problem-solving. Overall, patients with SZ did not perform as well as patients with OCD in all domains. ConclusionsIn terms of neurocognition, both of SZ and OCD patients have defects in reasoning and problem solving. In addition to this, SZ patients also performed worse than HC in other areas such as speed of processing, working memory, verbal learning and visual learning. On the overall level, cognitive performance is better in OCD patients than in SZ patients. The field of reasoning and problem solving can be used as a new goal to study the relationship and treatment strategies between them in the future.

Predictors of dementia amongst newly diagnosed non-valvular atrial fibrillation patients

Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and dementia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst AF patients in India. This was a single-centre, prospective, observational study wherein recently diagnosed, treatment naïve, persistent non-valvular AF patients were enrolled. All patients were screened for dementia using the Mini-Mental state exam. Amongst a total of 108 patients enrolled, 40 (37%) had dementia. The most common cognitive deficits were in attention and calculation followed by memory deficits. Factors independently contributing to dementia were advanced age, female sex, presence of diabetes, elevated pulmonary artery pressures and a lower serum albumin.

The relationship between processing speed and verbal and non-verbal new learning and memory in progressive multiple sclerosis

Objective: Processing speed (PS) deficits are the most common cognitive deficits in multiple sclerosis (MS), followed by learning and memory deficits, and are often an early cognitive problem. It has been argued that impaired PS is a primary consequence of MS, which in turn decreases learning. The current analysis examined the association between PS and learning in a large cohort of individuals with progressive MS. Methods: Baseline data from a randomized clinical trial on rehabilitation taking place at 11 centers across North America and Europe were analyzed. Participants included 275 individuals with clinically definite progressive MS (primary, secondary) consented into the trial. Results: Symbol Digit Modalities Test (SDMT) significantly correlated with California Verbal Learning Test-II (CVLT-II) (r = 0.21, p = 0.0003) and Brief Visuospatial Memory Test–Revised (BVMT-R) (r = 0.516, p < 0.0001). Receiver operating characteristic (ROC) analysis of the SDMT z score to distinguish between impaired and non-impaired CVLT-II performance demonstrated an area under the curve (AUC) of 0.61 (95% confidence interval (CI): 0.55–0.68) and a threshold of −1.62. ROC analysis between SDMT and BVMT-R resulted in an AUC of 0.77 (95% CI: 0.71–0.83) and threshold of −1.75 for the SDMT z score to predict impaired BVMT-R. Conclusion: Results indicate little ability beyond chance to predict CVLT-II from SDMT (61%), albeit statistically significant. In contrast, there was a 77% chance that the model could distinguish between impaired and non-impaired BVMT-R. Several potential explanations are discussed.

Volume of hippocampal subfields and cognitive deficits in neuromyelitis optica spectrum disorders.

Aquaporin-4 (AQP4) water channel is involved in hippocampal plasticity and is the target of neuromyelitis optica spectrum disorders (NMOSD) autoimmunity. We measured volumes of hippocampal subfields and their association with cognitive performance in AQP4-seropositive NMOSD patients. Global and regional hippocampal volumes were derived from 28 AQP4-seropositive NMOSD patients and 101 healthy controls (HC) from 3D-T1-weighted images. Normalized brain volumes were also calculated. A neuropsychological evaluation, including the Brief Repeatable Battery of Neuropsychological Tests, was performed in patients. Based on HC data, we estimated mean z-scores of volumes in the whole NMOSD group and compared them according to the status of global and domain-selective cognitive impairment. Global cognitive impairment was detected in 46.4% of NMOSD patients, with attentive (60.7%) and executive (21.4%) domains being the most affected. NMOSD patients had left hippocampal atrophy at global (p=0.012) and regional level (fimbria, Cornu Ammonis [CA] 3, molecular layer, dentate gyrus [DG], and subicular complex, p values ranging between 0.033 and <0.001). On the right side the fimbria and hippocampal tail were atrophic (p=0.024 for both). Cognitively impaired patients showed atrophy in the left CA3 and CA4 (p=0.025-0.028), while patients presenting verbal and visual memory impairment had significant CA3 and DG atrophy. Those patients with attentive or executive impairment had preserved brain and hippocampal volumes. NMOSD patients showed hippocampal atrophy associated with verbal and visual memory impairment. Such damage did not explain attention and executive function alterations, which were the most common cognitive deficits in this population.

Cognitive functioning of children and youth with developmental language disorder

The article consists a literature review. It presents the results of research on the cognitive functioning of people with developmental language disorder, with particular emphasis on executive and linguistic functions. The discussion focused on terminological issues related to medical classifications of diseases. The most common cognitive deficits occurring in people with this disorder and their consequences for functioning are presented. The language profile is presented in detail, taking into account all language and language pragmatics.

White Matter Alterations Between Brain Network Hubs Underlie Processing Speed Impairment in Patients With Schizophrenia.

Processing speed (PS) impairment is one of the most severe and common cognitive deficits in schizophrenia. Previous studies have reported correlations between PS and white matter diffusion properties, including fractional anisotropy (FA), in several fiber bundles in schizophrenia, suggesting that white matter alterations could underpin decreased PS. In schizophrenia, white matter alterations are most prevalent within inter-hub connections of the rich club. However, the spatial and topological characteristics of this association between PS and FA have not been investigated in patients. In this context, we tested whether structural connections comprising the rich club network would underlie PS impairment in 298 patients with schizophrenia or schizoaffective disorder and 190 healthy controls from the Australian Schizophrenia Research Bank. PS, measured using the digit symbol coding task, was largely (Cohen’s d = 1.33) and significantly (P < .001) reduced in the patient group when compared with healthy controls. Significant associations between PS and FA were widespread in the patient group, involving all cerebral lobes. FA was not associated with other cognitive measures of phonological fluency and verbal working memory in patients, suggesting specificity to PS. A topological analysis revealed that despite being spatially widespread, associations between PS and FA were over-represented among connections forming the rich club network. These findings highlight the need to consider brain network topology when investigating high-order cognitive functions that may be spatially distributed among several brain regions. They also reinforce the evidence that brain hubs and their interconnections may be particularly vulnerable parts of the brain in schizophrenia.

Phonetic but not semantic verbal fluency impairment based on side-onset in Lewy body diseases

Objective: Verbal fluency impairment is the most common cognitive deficits in Parkinson's disease (PD) and it is a predictor of subsequent dementia. However, very little is known about the cognitive profile of PD patients based on side-onset of motor symptoms. The aim of this study was to determine the cognitive profile of Lewy body diseases (LBD) patients based on laterality of the onset of motor symptoms.

Cognition and gait in Parkinson's Disease

Introduction: As the Parkinson's disease progresses the common symptoms like cognitive and gait deficits usually get worse.Evaluating DT situations in Parkinson Disease

Insulin Resistance is Related with Cognition Impairment in Multiple Sclerosis Patients

Multiple sclerosis (MS) is a chronic and progressive autoimmune disease of the central nervous system (CNS). Slowed cognitive processing speed and episodic memory decline are the most common cognitive deficits in MS, with additional difficulties in executive function, verbal fluency, and visuospatial analysis. The aim of this study was to compare the cognitive status of MS patients with and non- insulin resistant. In a cross-sectional study, 74 patients with diagnosis of relapsing remitting MS were invited to collaborate. After obtaining informed consent and recording information including time of diagnosis, waist circumference, height and weight, 5 cc of fasting blood samples were taken from patients. And blood glucose and insulin levels were measured. Cognitive status of patients was assessed using Minimal Assessment of Cognitive Function in MS (MACFIMS) questionnaire. According to Homeostatic Model Assessment of Insulin Resistance (HOMA) index more than 2.5, patients were divided into two groups with (n=28) and non-insulin resistance (n=46), then cognitive status was compared in two groups. The mean of age, duration of disease and EDSS of all participants were 40.78 ± 5.2 years, 11.56± 4.56 years and 1.68 ± 1.12 respectively. In our study, the prevalence of insulin resistance was found 37.8%. The mean scores of CVLT, CVLT-DR, COWAT, JLO tests were significantly lower in the insulin resistance group comparing to non-insulin resistance group (P<0.05). Also, the score of the CVLT, CVLT-DR, COWAT, JLO, BVMT and DKEFS tests had reverse correlation with fasting insulin levels, which was meaningful for COWAT. MS patients with insulin resistance are more disturbed in the areas of verbal memory, verbal fluency, executive function and visuospatial processing and this disorder is exacerbated by an increase in fasting blood insulin levels.

Multi-domain neurocognitive classification of primary brain tumor patients prior to radiotherapy on a prospective clinical trial.

We investigated multi-domain baseline neurocognition of primary brain tumor patients prior to radiotherapy (RT), including clinical predictors of function and association between pre-RT and post-RT impairment on a prospective trial. A multi-domain neuropsychological battery (memory, executive functioning, language, attention, processing) was performed on 37 patients, pre-RT and 3-(n = 21), 6-(n = 22) and 12-(n = 14) months post-RT. Impairment rate was the proportion of patients with standardized T-scores ≤ 1.5 standard deviations below normative means. Per-patient impairment across all domains was calculated using a global deficit score (GDS; higher value indicates more impairment). Associations between baseline GDS and clinical variables were tested. Global GDS impairment rate at each time point was the fraction of patients with GDS scores > 0.5. Statistically significant baseline neurocognitive impairments were identified on 4 memory (all p ≤ 0.03) and 2 out of 3 (p = 0.01, p = 0.027) executive functioning tests. Per-patient baseline GDS was significantly associated with tumor volume (p = 0.048), tumor type (p = 0.043), seizure history (p = 0.007), and use of anti-epileptics (p = 0.009). The percentage of patients with the same impairment status at 3-, 6-, and 12-months as at baseline were 88%, 85%, and 85% respectively. Memory and executive functioning impairment were the most common cognitive deficits prior to RT. Patients with larger tumors, more aggressive histology, and use of anti-epileptics had higher baseline GDS values. GDS is a promising tool to encompass multi-domain neurocognitive function, and baseline GDS can identify those at risk of cognitive impairment.

Overlaps in brain dynamic functional connectivity between schizophrenia and autism spectrum disorder

Abstract Schizophrenia and autism share some genotipic and phenotypic aspects as connectome miswiring and common cognitive deficits. Currently, there are no medical tests available for either disorders, and diagnostics for both of them include direct reports of relatives and clinical evaluation by a psychiatrist. Despite several medical imaging biomarkers have been proposed in the past, novel effective biomarkers or improvements of the existing ones is still need. This work proposes a dynamic functional connectome analysis combined with machine learning techniques to complement the present diagnostic procedure. We used the moving window technique to locate a set of dynamic functional connectivity states, and then use them as features to classify subjects as autism/schizophrenia or control. Moreover, by using dynamic functional connectivity measures we investigate the question whether those two disorders overlap, namely whether schizophrenia is part of the autism spectrum and which brain region could be involved in both disorders. The results reveal that both static and dynamic functional connectivity can be used to classify subjects with schizophrenia or autism. Lastly, some brain regions show similar functional flexibility in both autism and schizophrenia cohorts giving further possible proofs of their overlaps.

Gastrodin Attenuates Bilateral Common Carotid Artery Occlusion-Induced Cognitive Deficits via Regulating Aβ-Related Proteins and Reducing Autophagy and Apoptosis in Rats.

Gastrodin (GAS), an active constituent extracted from Gastrodia elata Blume, is used to treat ischemic stroke, epilepsy, dizziness, and dementia for centuries in China. This study examined its effects on vascular dementia (VD) and the underlying molecular mechanisms. VD was established by ligation of bilateral common carotid artery occlusion (BCCAO). A total of 7 days after BCCAO surgery, GAS (15, 30, and 60 mg/kg) was orally administered for 28 consecutive days to evaluate therapeutic effects. Cognitive function was tested by the Morris water maze. The neuronal morphological changes were examined via Hematoxylin–Eosin staining. Flow cytometry was used for evaluating apoptosis in the hippocampi. The target protein expression was examined by Western blot. The results showed that BCCAO induced cognitive impairment, hippocampus CA1 and CA3 pyramidal neuron damage, beta-amyloid (Aβ) deposition, excessive autophagy, and apoptosis. GAS treatment significantly improved BCCAO-induced cognitive deficits and hippocampus neuron damage. Molecular analysis revealed that GAS exerted the protective effect via reducing the levels of Aβ1–40/42, APP, and β-site APP-cleaving enzyme 1 expression, and increasing Aβ-related protein, a disintegrin and metalloprotease 10, and insulin degrading enzyme expression. Meanwhile, GAS inhibited excessive autophagy via decreasing Beclin-1, LC3-II, and p62 levels. Furthermore, GAS inhibited apoptosis through the downregulation of Bax and upregulation of Bcl-2. Moreover, P38 MAPK signaling pathway was involved in the process. Our findings demonstrate that GAS was effective in the treatment of BCCAO-induced VD via targeting Aβ-related protein formation and inhibiting autophagy and apoptosis of hippocampus neurons.

Common transdiagnostic cognitive deficits among people with psychiatric disorders exposed to childhood maltreatment: a meta-analysis

ABSTRACTIntroduction: Previous meta-analyses have shown a moderate negative impact of maltreatment on the neuropsychological functioning of people with or without psychiatric disorders compared to healthy groups. The objectives of the present meta-analysis were to (1) investigate the impact of maltreatment on neuropsychological functioning of people with psychiatric disorders and to (2) evaluate the moderating effect of age, at the time of the cognitive assessment, on neuropsychological functioning.Methods: Seventeen studies published between 1970 and July 2017 were included.Results: The results showed a negative impact of maltreatment with a small effect size (g = −0.25) on the neuropsychological performances in the group with psychiatric disorders with a history of exposure to childhood maltreatment compared to the group with psychiatric disorders without a history of exposure to childhood maltreatment. Cognitive domains that are significantly affected by maltreatment are: working memory (g = −0.56), verbal episodic memory (g = −0.39), intelligence (g = −0.27) and processing speed (g = −0.21). The impact of childhood maltreatment on the cognitive profile is greater in adults than young people.Conclusions: Clinicians should consider these common cognitive deficits using a transdiagnostic approach in cognitive interventions.

Differences in atypical resting-state effective connectivity distinguish autism from schizophrenia.

Autism and schizophrenia share overlapping genetic etiology, common changes in brain structure and common cognitive deficits. A number of studies using resting state fMRI have shown that machine learning algorithms can distinguish between healthy controls and individuals diagnosed with either autism spectrum disorder or schizophrenia. However, it has not yet been determined whether machine learning algorithms can be used to distinguish between the two disorders. Using a linear support vector machine, we identify features that are most diagnostic for each disorder and successfully use them to classify an independent cohort of subjects. We find both common and divergent connectivity differences largely in the default mode network as well as in salience, and motor networks. Using divergent connectivity differences, we are able to distinguish autistic subjects from those with schizophrenia. Understanding the common and divergent connectivity changes associated with these disorders may provide a framework for understanding their shared cognitive deficits.

13 Attentional bias to facial emotion in individuals with dissociative seizures is not attributable to anxiety, depression or cognitive deficits

<h3>Objective</h3> The study sought to examine further the previously reported attentional bias for facial emotion in individuals diagnosed with dissociative (psychogenic non-epileptic) seizures (DS). Specifically, we assessed whether the attentional bias could be demonstrated whilst controlling for anxiety, depression and relevant cognitive abilities (i.e., facial perception, cognitive flexibility, intellectual abilities). <h3>Method</h3> Performance of DS patients (n=38) was compared to a healthy control group (n=43) on an emotional Stroop test, in which facial affect (anger, happiness, neutral) was presented subliminally. Individuals with diagnoses of clinical anxiety and depression were excluded from both groups. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression in those not excluded. Facial perception, intellectual abilities and cognitive flexibility were assessed with standardised cognitive tests (Benton Facial Recognition Test, Wechsler Abbreviated Scale of Intelligence, Stroop test). Groups were matched for age, gender and handedness. <h3>Results</h3> The DS group exhibited an elevated attentional bias for facial emotion (happy and angry faces), that was not attributable to differences in relevant cognitive abilities or the presence of symptoms of anxiety or depression. A positive relationship was observed between seizure frequency and attentional bias for happy faces in the DS group. <h3>Conclusion</h3> Individuals with DS automatically and disproportionately allocate attention to emotional faces relative to neutral faces. This attentional bias is not explained by the existence of more common psychopathological symptoms or cognitive deficits. Combined with recent findings of impaired overt recognition of facial emotion in this group, it seems that individuals with DS display hypervigilance for the presence of facial emotion, alongside misinterpretation of the nature of the emotion being displayed. Such abnormalities in social-emotional processing may contribute to significant distress and dysfunction in social encounters in daily life, possibly predisposing to the development of the disorder or contributing to the emotional distress hypothesised to trigger individual seizures. As such, these social-emotional processing impairments might represent an important target for psychological intervention.

MRI findings and cognitive functions in a small cohort of myotonic dystrophy type 1: Retrospective analyses.

Myotonic dystrophy type 1 (DM1) is a progressive multisystemic disease with common cognitive deficits and potential brain involvement in addition to the cardinal muscular and systemic symptoms. Impaired mental function associated with nonspecific pathological findings such as white-matter hyperintense lesions (WMHLs), ventricular enlargement and brain atrophy on brain MRI have been previously reported in DM1 patients. While some studies showed correlation of brain morphological changes with neuropsychological and clinical parameters including CTG repeat sizes and disease severity scales in DM1, others failed. The goal of this study was to retrospectively investigate cranial MR abnormalities, predominantly WMHLs, and their effects on clinical and cognitive deficits in a small, phenotypically or genotypically well-characterized cohort of DM1 patients.

ID 293 – Evaluation of cognitive functions, electrophysiological findings brain mr and in myotonic dystrophy type 1: Retrospective analyses

Objective Myotonic dystrophy type 1 (DM1) is a progressive multisystemic disease with common cognitive deficits and potential brain involvement beside the cardinal muscular symptoms. In this study, we evaluated the relationship between cognitive functions and cranial MRI findings in DM1 patients. Methods Clinical, electrophysiological and radiological data of 16 DM1 patients were evaluated. A comprehensive analysis of white-matter hyperintense lesions (WMHL) and brain atrophy detected by 3T MRI was performed. Cognitive impairment was assessed by an extensive neuropsychological battery. Results The age range of 16 (11M/5F) patients was 19-55 years. EMG showed myotonia and myopathic MUPs in all patients. Mild cognitive impairment was detected in 72% of the patients. WMHL was present in 55% and mild cognitive impairment was prominent in patients with temporal involvement. The severity of cognitive dysfunction was correlated by early onset of myotonia but not with clinical findings or sex. Conclusions The nature of CNS abnormalities revealed by MRI is still unclear: the ones located at the temporal poles seem to be characteristics of the disease, while small, diffuse WMHLs are similar to the age related alterations. Key message Our results indicate that the white matter abnormalities shown by neuroimaging might have implications for cognitive function.

Abnormal fronto-striatal functional connectivity in Parkinson’s disease

Parkinson’s disease (PD) is characterized by the relatively selective depletion of dopamine in the striatum, which consequently leads to dysfunctions in cortico–striatal–thalamic–cortical circuitries. It has been shown that the most common cognitive deficits in PD patients are related to the fronto-striatal circuits. In PD, most previous functional connectivity studies have been performed using seed-based methods to identify the brain regions that are abnormally connected to one or more seeds, but these cannot be used to quantify the interactions between one region and all other regions in a particular network. Functional connectivity degree, which is a measurement that can be used to quantify the functional or structural connectivity of a complex brain network, was adopted in this study to assess the interactions of the fronto-striatal network. Compared to healthy controls, PD patients had significantly decreased total functional connectivity degree for the left putamen and the right globus pallidum in fronto-striatal networks. Additionally, negative correlations between the fronto-pallial functional connectivity degree (i.e., the right globus pallidum with the left middle frontal gyrus, and with the right triangular part of inferior frontal gyrus) and disease duration were observed in PD patients. The results of this study demonstrate that fronto-striatal functional connectivity is abnormal in patients with PD and indicate that these deficits might be the result of motor and cognitive dysfunctions in PD patients.

Comparative neurocognitive effects of lithium and anticonvulsants in long-term stable bipolar patients

BackgroundThe aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized. MethodThree groups of BD patients were established according to their treatment: (i) lithium monotherapy (n=29); (ii) lithium together with one or more anticonvulsants (n=28); and (iii) one or more anticonvulsants (n=16). A group of healthy controls served as the control (n=25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Complex Figure Test, Stroop color-word test, Wisconsin Card Sorting Test, Tower of Hanoi, Frontal Assessment Battery, and Reading the Mind in the Eyes Test. ResultsRelative to healthy controls, BD patients showed the following: (i) those on lithium monotherapy, but not other BD groups, had preserved short-term auditory memory, long-term memory, and attention; (ii) those who took only anticonvulsants showed worse findings in short-term visual memory, working memory, and several executive functions; and (iii) all BD patients showed worse performance in processing speed, resistance to interference, and emotion recognition. LimitationsMedication alone cannot explain why all BD patients showed common cognitive deficits despite different pharmacological treatment. ConclusionThe impairment on some executive functions and emotion recognition is an inherent trait in BD patients, regardless of their pharmacological treatment. However, while memory, attention, and most of the executive functions are preserved in long-term stable BD patients, these cognitive functions are impaired in those who take anticonvulsants.