Controlled Oral Word Association Test Research Articles

Hepatitis C Virus (HCV) Infection and Neurocognitive Impairment in Subjects with Mild Liver Disease.

Hepatitis C virus (HCV) infection is a leading cause of liver cirrhosis, hepatocellular carcinoma, and liver-related deaths. It is estimated that 40-74% of patients with hepatitis C will experience at least one extrahepatic manifestation within their lifetime. The finding of HCV-RNA sequences in post-mortem brain tissue raises the possibility that HCV infection may affect the central nervous system and be the source of subtle neuropsychological symptoms, even in non-cirrhotic. Our investigation aimed to evaluate whether asymptomatic, HCV-infected subjects showed cognitive dysfunctions. Twenty-eight untreated asymptomatic HCV subjects and 18 healthy controls were tested using three neuropsychological instruments in a random sequence: Symbol Digit Modalities Test (SDMT), Controlled Oral Word Association Test (COWAT), and Continuous Visual Attention Test (CVAT). We performed depression screening, liver fibrosis assessment, blood tests, genotyping, and HCV-RNA viral load. A MANCOVA and univariate ANCOVAS were performed to examine group differences (HCV vs. healthy controls) in four scores of the CVAT (omission errors, commission errors, reaction time-RT, and variability of RT-VRT), and the scores derived from the SDMT, and the COWAT. A discriminant analysis was performed to identify which test variables effectively discriminate HCV-infected subjects from healthy controls. There were no group differences in the scores of the COWAT, SDMT, and in two variables of the CVAT (omission and commission errors). In contrast, the performance of the HCV group was poorer than the controls in RT (p = 0.047) and VRT (p = 0.046). The discriminant analysis further indicated that the RT was the most reliable variable to discriminate the two groups with an accuracy of 71.7%. The higher RT exhibited by the HCV group may reflect deficits in the intrinsic-alertness attention subdomain. As the RT variable was found to be the best discriminator between HCV patients and controls, we suggest that intrinsic-alertness deficits in HCV patients may affect the stability of response times increasing VRT and leading to significant lapses in attention. In conclusion, HCV subjects with mild disease showed deficits in RT and intraindividual VRT as compared to healthy controls.

Sleep-disordered breathing and neurocognitive function in multiple sclerosis: Differential associations across cognitive domains

Background: Sleep disorders are common in people with multiple sclerosis (PwMS) and could contribute to cognitive dysfunction. However, effects of pathological sleep on cognitive domains are insufficiently characterized. Objective: To evaluate associations between cognitive performance and polysomnographic (PSG)-based sleep disturbances in PwMS. Methods: PwMS with known/suspected untreated obstructive sleep apnea (OSA, N = 131) underwent PSG and cognitive tests: Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), California Verbal Learning Test-II (CVLT-II), Brief Visuospatial Memory Test-Revised (BVMT-R Total and Delayed), Judgment of Line Orientation (JLO), Controlled Oral Word Association Test (COWAT), Trail Making Test, Go/No-Go, and Nine-Hole Peg Test (NHPT). Results: Apnea severity measures were associated with worse processing speed, attention, and working memory (SDMT); immediate and delayed visual memory (BVMT-R Total and Delayed); attention, psychomotor speed, and cognitive flexibility (Trails); and manual dexterity and visuomotor coordination (NHPT) (ps ⩽ 0.011). Sleep macrostructure measures showed stronger associations with verbal memory and response inhibition (CVLT-II Total Recognition Discriminability Index), and immediate visual memory (BVMT-R Total) (ps ⩽ 0.011). Conclusions: Pathological sleep, including hypoxia, sleep fragmentation, and disturbances in sleep/wake states, are differentially associated with worse cognitive performance in PwMS. These findings could inform future personalized approaches to cognitive impairment in PwMS with sleep disorders. Trial registration: ClinicalTrials.gov identifier: NCT02544373 (https://clinicaltrials.gov/ct2/show/NCT02544373).

Large-Scale Network Connectivity and Cognitive Function Changes After Exercise Training in Older Adults with Intact Cognition and Mild Cognitive Impairment.

Despite growing evidence regarding the association between exercise training (ET) and functional brain network connectivity, little is known about the effects of ET on large-scale within- and between-network functional connectivity (FC) of core brain networks. We investigated the effects of ET on within- and between-network functional connectivity of the default mode network (DMN), frontoparietal network (FPN), and salience network (SAL) in older adults with intact cognition (CN) and older adults diagnosed with mild cognitive impairment (MCI). The association between ET-induced changes in FC and cognitive performance was examined. 33 older adults (78.0±7.0 years; 16 MCI and 17 CN) participated in this study. Before and after a 12-week walking ET intervention, participants underwent a graded exercise test, Controlled Oral Word Association Test (COWAT), Rey Auditory Verbal Learning Test (RAVLT), a narrative memory test (logical memory; LM), and a resting-state fMRI scan. We examined the within (W) and between (B) network connectivity of the DMN, FPN, and SAL. We used linear regression to examine associations between ET-related changes in network connectivity and cognitive function. There were significant improvements in cardiorespiratory fitness, COWAT, RAVLT, and LM after ET across participants. Significant increases in DMNW and SALW, and DMN-FPNB, DMN-SALB, and FPN-SALB were observed after ET. Greater SALW and FPN-SALB were associated with enhanced LM immediate recall performance after ET in both groups. Increased within- and between-network connectivity following ET may subserve improvements in memory performance in older individuals with intact cognition and with MCI due to Alzheimer's disease.

Longitudinal assessment of neurocognitive function in people with relapsing multiple sclerosis initiating alemtuzumab in routine clinical practice: LEM-COG study results.

Alemtuzumab is effective in reducing relapse rate and disability, but limited data exist on its effect on cognitive function in relapsing multiple sclerosis (RMS). The present study assessed neurocognitive function and safety associated with alemtuzumab treatment in RMS. This longitudinal, single-arm, prospective study included people with RMS (aged 25-55 years) who were treated with alemtuzumab in clinical practice in the United States of America and Canada. The first participant was enrolled in December 2016. The primary endpoint was the change from baseline to post-baseline (month [M] 12/24) in MS-COGnitive (MS-COG) composite score. Secondary endpoints included Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Brief Visuospatial Memory Test-Revised (BVMT-R), Selective Reminding Test (SRT), Controlled Oral Word Association Test (COWAT), and Automated Neuropsychological Assessment Metrics (ANAM) scores. Depression and fatigue were assessed using Hamilton Rating Scale-Depression (HAM-D) and Fatigue Severity Scale (FSS)/Modified Fatigue Impact Scale (MFIS), respectively. Magnetic resonance imaging (MRI) parameters were assessed when available. Safety was assessed throughout the study. Descriptive statistics were used for the pre-specified statistical analyses. Since the study was terminated early (November 2019) because of operational and resource difficulties, post hoc analyses for statistical inference were performed among participants who had a baseline value and at least one complete post-baseline assessment for cognitive parameters, fatigue, or depression. Of the 112 participants enrolled, 39 were considered as the primary analysis population at M12. At M12, a mean change of 0.25 (95% confidence interval [CI]: 0.04, 0.45; p=0.0049; effect size [ES]: 0.39) was observed in the MS-COG composite score. Improvements were observed in processing speed (based on PASAT and SDMT; p < 0.0001; ES: 0.62), as well as in individual PASAT, SDMT and COWAT scores. An improvement was also noted in HAM-D (p=0.0054; ES: -0.44), but not in fatigue scores. Among MRI parameters, decreases in burden of disease volume (BDV; ES: -0.12), new gadolinium-enhancing lesions (ES: -0.41) and newly active lesions (ES: -0.07) were observed at M12. About 92% of participants showed stable or improved cognitive status at M12. There were no new safety signals reported in the study. The most common adverse events (≥10% of participants) were headache, fatigue, nausea, insomnia, urinary tract infection, pain in extremity, chest discomfort, anxiety, dizziness, arthralgia, flushing, and rash. Hypothyroidism (3.7%) was the most frequent adverse event of special interest. The findings from this study suggest that alemtuzumab has a positive impact on cognitive function with significant improvements in processing speed and depression in people with RMS over a period of 12 months. The safety profile of alemtuzumab was consistent with previous studies.

An examination of the clinical utility of phonemic fluency in healthy adults and adults with mild cognitive impairment

The Controlled Oral Word Association Test (COWAT) is a widely utilized measure of phonemic fluency. However, two issues remain: (1) whether demographic, cognitive variables, or version of test administered predict performance; (2) if the test is predictive of Mild Cognitive Impairment (MCI). Recent studies report that item-level analyses such as lexical frequency may be more sensitive to early cognitive change. The purpose of this study was to examine the clinical utility of the COWAT, considering both total correct words and the lexical frequency. Sixty-seven healthy adults and thirty-seven adults with MCI completed neuropsychological testing. Mann–Whitney U tests were used to determine if there was a difference in COWAT performance between groups. Elastic net regression models were used to assess whether variance in total scores/lexical frequencies can be predicted by demographics, test version, or diagnosis; which cognitive tests explained the variance in performance; and how total scores and lexical frequencies compared with other cognitive tests in predicting diagnosis. Overall, individuals with MCI produced fewer and higher frequency words. The variance in total correct words or lexical frequency was not explained by demographics, test version, or diagnosis. Total correct words was a more important predictor of diagnosis than lexical frequency.

Could thalamic biochemical changes correlate to cognitive impairment in idiopathic generalized epilepsy?

BackgroundThe thalamus is crucial in the development of idiopathic generalized epilepsy (IGE), which could lead to cognitive dysfunctions, according to data from neuropsychology and advanced neuroimaging investigations. This research aimed to measure the metabolic changes in the thalamus and to assess if could be contributed to cognitive impairment in IGE patients. Thirty IGE patients and thirty healthy volunteers with matched ages, genders, and educational levels participated in this cross-sectional case–control research. The IGE patients and controls were evaluated neuropsychologically using Intelligence Quotient (IQ) to assess general cognitive ability, Digit span for attention, Wechsler memory scale (WMS) for verbal memory, cube drawing test for visuospatial memory, Trail making test for executive functions, and Controlled Oral Word Association test (COWAT) for verbal fluency and quantitative multi-voxel MR spectroscopy (MRS) measurements of N-acetyl aspartate (NAA), choline (Cho), creatine (Cr), NAA/Cr, NAA/Cho and Cho/Cr ratios at 1.5 T scanner. The voxels were located over the right and left thalamus.ResultsThe IGE patients showed worse cognitive performance in IQ, attention, executive function, and verbal and visuospatial memory domains compared to the controls. The IGE patients exhibited a significantly decrease NAA in the right thalamus (p = 0.004) and a lower NAA/Cr ratio in the left thalamus (p = 0.01). the mean thalamus NAA level exhibited a positive correlation with CDT (r = 0.45, p = P = 0.01), and WMS-R (r = 0.39, p = 0.03) and a negative correlation with trail-making A test (r = 0.42, P = 0.01).Conclusionsit was concluded that IGE patients exhibited poor cognition which could be attributed to thalamic neurometabolic changes due to impaired thalamic cortical circuits.

The Role of The Predominant Polarity on Neurocognitive and Social Cognitive Dysfunctions in Patients with Bipolar Disorder

IntroductionBipolar disorder (BD) is characterized by significant inter-individual variation in terms of course and outcome. The most important factors associated with the outcome are subsyndromal depression and cognitive disability. Predominant polarity (PP), which is a proposed course specifier for BD, can be associated with various clinical differences such as psychotic feature, suicidality, hospitalization, while it is thought to be associated with the severity of cognitive impairment.ObjectivesTo elucidate the role of the predominant polarity on cognitive dysfunction in patients with BD.MethodsPatients with BD in remission (n=84) and healthy control volunteers (HC, n=27) participated in the study. Patients were divided into 3 subgroups according to their PP characteristics: manic (MPP, n=31), depressive (DPP, n=25), and undetermined (UPP, n=28). Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5/CV), WAIS-R-Vocabulary Subtest, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Young Mania Rating Scale, Rey’s Auditory Verbal Learning Test (RAVLT), Trail Making Test (TMT), Stroop Test (ST), WMS-R Visual Reproduction Subtest, Controlled Oral Word Association Test (COWAT), Auditory Consonant Trigrams Test (ACT), Reading the Mind in the Eyes Test (RMET), Hinting Test (HT), Wisconsin Card Sorting Test (WCST), and Conners Continuous Performance Test (CCPT) were administered. Scores that do not show normal distribution were transformed using the two-step normalization method. Principal component analysis (PCA) with direct oblimin rotation was applied as a dimension reduction technique to identify different neurocognitive domains. Single-factorial PCA was also applied to calculate global cognition scores.ResultsIn MPP group compared to HC, worse performance was observed in ACT (d=1.24), COWAT (d=1.16), RMET (d=1.03), HT (d=1.78), WCST correct answers (d=0.99), CCPT correct target section (d=0.99) and a prolongation in TMT-A (d=1.00). Compared to DPP, MPP had a weak performance in COWAT (d=0.89), RMET (d=0.86) and HT (d=1.00). MPP (d=1.18) and UPP (d=1.03) groups showed deterioration in processing speed compared to HC. MPP group showed impairment in working memory (d=1.17) and attention (d=0.70) compared to HC. In problem-solving and reasoning, deterioration was found in MPP compared to HC (d=1.16) and UPP (d=0.67), also in DPP compared to HC (d=0.74).ConclusionsThe MPP group yielded more severe cognitive impairment in verbal fluency and social cognition tests compared to DPP. Predominant polarity may also be related to cognitive impairment patterns seen in BD.Disclosure of InterestNone Declared

Comparison of Word Production Ability of Young and Middle-Aged Adults Using Word-Chain Tasks

Purpose: The purpose of the present study was to investigate the performance on a word-chain task across two age groups (youth: 20~39 years and middle-aged groups: 40~64 years).Methods: In the word-chain task, we analyzed the number of correct responses and reaction times (time from the final consonant/vowel of the previous word to the initial consonant/vowel of the second syllable of the next word). The correlation between the ability of word-chain task and Controlled Oral Word Association Test (COWAT), Korean-Mini Mental State Examination, Short form-Korean-Boston Naming Test, Korean-Trail Making Test-Elderly (K-TMT-E) (A,B) &amp; Digit Symbol Coding (DSC) were analyzed.Results: The following results were obtained: (i) with increasing age, the number of the correct responses in the word-chain task’s (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and that of COWAT (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) gradually declined; (ii) with increasing age, the number of DSC produced gradually declined (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and response time of K-TMT-E (A,B) also gradually increased; (iii) in both groups, the total number of correct responses of the word-chain task correlated with the number of correct responses of COWAT; (iv) the middle-aged group showed a correlation between the word-chain task and DSC.Conclusion: The ability on the word-chain task might reflect aging and cognitive changes in normal adults.

Intraindividual Change in Cognitive Function Among Adults With Systemic Lupus Erythematosus: A Markov Analysis Over 7 Years.

Cognitive impairment is prevalent in systemic lupus erythematosus (SLE). There remain gaps in understanding cognition and SLE longitudinally. We studied intraindividual change in cognition in SLE over time. Data were from the University of California, San Francisco Lupus Outcome Study, which included 1281 adults with SLE. The Hopkins Verbal Learning Test-Revised (HVLT-R) and the Controlled Oral Word Association Test (COWAT) were administered annually over 7 years. A two-state Markov analysis was used to model transition intensities for probabilities of change in cognition. Logistic regression examined the association between clinical variables and cognitive change. Minimal transition between cognitive states was observed in the Markov analysis. Using the COWAT, higher levels of self-reported depression were associated with decreased likelihood of cognitive improvement (Relative Risk [RR]: 0.98; 95% confidence interval [CI]: 0.96-0.99), and higher self-reported disease severity was associated with cognitive decline (RR: 1.05; 95% CI: 1.02-1.09). Using the HVLT-R, increasing age (RR: 1.02; 95% CI: 1.01-1.03) and higher education level (RR: 1.82; 95% CI: 1.28-2.58) were associated with cognitive improvement, and higher self-reported disease severity (RR: 1.02; 95% CI: 1.01-1.03) and depression (RR: 1.05; 95% CI: 1.03-1.07) were associated with cognitive decline. Most individuals with SLE did not transition between states of high (Z score ≥ -1.5) or low (Z score < -1.5) cognition in a Markov analysis over a 7-year assessment period, highlighting a degree of relative stability in cognition over time. Increasing age and higher education levels were associated with greater likelihood of cognitive improvement. Greater self-reported SLE disease severity and depression were associated with cognitive decline.

Effect of interactive multitouch game-based cognitive intervention on cognitive function in older adults: A randomized controlled trial.

This study investigated the effects of an interactive multitouch game-based cognitive intervention (ICI) on cognitive function in community-dwelling older adults. Thirty-two older adults (19 women) between 65 and 84 years of age (mean age, 74.47 ± 4.30 years) without a history of neurological disease participated. They were randomized into two groups: intervention and control. The intervention group took part in ICI sessions using HAPPYTABLE® (Spring Soft Co. Ltd, Seoul, Korea) (ICI group), and the control group underwent a traditional paper-and-pencil-based cognitive intervention (TCI group). Both groups completed 10 intervention sessions over four consecutive weeks. Cognitive function was assessed before (pre-intervention) and after (post-intervention) intervention. Executive function was evaluated through the Color-Word Stroop Test (CWST) and Controlled Oral Word Association Test (COWAT). Memory was assessed through the Verbal Learning Test (VLT) and Rey Complex FigureTest (RCFT). The ICI and TCI groups showed significant improvements in some cognitive functions after the intervention. Both groups showed substantial improvements in VLT and RCFT (P < 0.05), reflecting memory function. Regarding the executive role, the ICI group showed significant post-intervention improvements in the conditions of the CWST incongruent (ICI 76.31 ± 23.82; P = 0.004) compared to the pre-intervention scores. ANCOVA with pre-intervention scores and gender as covariates revealed improved results in the ICI group compared with the VLT delayed (ICI 9.18 ± 1.68, TCI 7.56 ± 2.13; P = 0.015) and VLT recognition task (ICI 22.81 ± 1.22, TCI 21.38 ± 1.09; P = 0.035). These findings revealed that both ICI and TCI helped increase cognitive performance in community-dwelling older persons; nevertheless, ICI showed better improvement in memory function than TCI. Thus, the ICI can be used to improve cognitive performance among older adults living in the community.

Effect of the Interactive Multitouch Game-based Cognitive Remediation on Cognitive Function in Community-Dwelling Elderly

<h3>Research Objectives</h3> To investigate effect of the interactive multitouch game-based cognitive remediation (ICR) on cognitive function in community-dwelling elderly. <h3>Design</h3> Randomized controlled trial. <h3>Setting</h3> Clinical experimental study. <h3>Participants</h3> Thirty-two healthy adults (19 females; mean aged 74.47±4.30 years) who were aged between 65 to 84 years without history of neurological diseases. <h3>Interventions</h3> All participants were randomized into two groups; intervention and control. The intervention group received ICR sessions using Happy Table® (Spring Soft Co. Ltd., Seoul, Korea), while the control group received traditional paper-and-pencil-based cognitive remediation (TCR). Both groups had ten 40-minute intervention sessions for four weeks. <h3>Main Outcome Measures</h3> Executive function was assessed by the Color-word Stroop Test (CWST), Controlled Oral Word Association Test (COWAT), GO no GO and Trail Making Test (TMT). Memory was assessed by the Verbal Learning Test (VLT) and Rey Complex Figure Test (RCFT). The assessments were done before and after the intervention. <h3>Results</h3> Both cognitive remediation methods showed significant improvements in within-group analysis. For executive functions, the ICR showed significant improvements in CSWT incongruent, COWAT phonemic (P < 0.05). The TCR group showed improvements in GO no GO and TMT (P < 0.05). For memory function, both groups showed significant improvements in VLT and RCFT (P < 0.05). In between group comparisons, the ICR group showed better improvements in VLT (delayed and recognition) and RCFT (recognition) than TCR group (P < 0.05, pre-intervention value as a covariate). <h3>Conclusions</h3> Both ICR and TCR were effective in enhancing executive and memory functions. However, the ICR showed better outcome especially for the long-term memory function. The ICR can be used for the purpose of improving memory and executive functions for community-dwelling elderly. <h3>Author(s) Disclosures</h3> 1. Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, SAIHST, Seoul, Republic of Korea 2. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 3. Department of Health Sciences and Technology, Department of Digital Health, Sungkyunkwan University, SAIHST, Seoul, Republic of Korea

The effect of home-based transcranial direct current stimulation in cognitive performance in fibromyalgia: A randomized, double-blind sham-controlled trial.

Transcranial Direct Current Stimulation (tDCS) is a promising approach to improving fibromyalgia (FM) symptoms, including cognitive impairment. So, we evaluated the efficacy and safety of home-based tDCS in treating cognitive impairment. Besides, we explored if the severity of dysfunction of the Descendant Pain Modulation System (DPMS) predicts the tDCS effect and if its effect is linked to changes in neuroplasticity as measured by the brain-derived neurotrophic factor (BDNF). This randomized, double-blind, parallel, sham-controlled clinical trial, single-center, included 36 women with FM, aged from 30 to 65 years old, assigned 2:1 to receive a-tDCS (n = 24) and s-tDCS (n = 12). The primary outcome was the Trail Making Test's assessment of executive attention, divided attention, working memory (WM), and cognitive flexibility (TMT-B-A). The secondary outcomes were the Controlled Oral Word Association Test (COWAT), the WM by Digits subtest from the Wechsler Adult Intelligence Scale (WAIS-III), and quality of life. Twenty-minute daily sessions of home-based tDCS for 4 weeks (total of 20 sessions), 2 mA anodal-left (F3) and cathodal-right (F4) prefrontal stimulation with 35 cm2 carbon electrodes. GLM showed a main effect for treatment in the TMT-B-A [Wald χ2 = 6.176; Df = 1; P = 0.03]. The a-tDCS improved cognitive performance. The effect size estimated by Cohen's d at treatment end in the TMT-B-A scores was large [-1.48, confidence interval (CI) 95% = -2.07 to-0.90]. Likewise, the a-tDCS effects compared to s-tDCS improved performance in the WM, verbal and phonemic fluency, and quality-of-life scale. The impact of a-tDCS on the cognitive tests was positively correlated with the reduction in serum BDNF from baseline to treatment end. Besides, the decrease in the serum BDNF was positively associated with improving the quality of life due to FM symptoms. These findings revealed that daily treatment with a home-based tDCS device over l-DLPFC compared to sham stimulation over 4 weeks improved the cognitive impairment in FM. The a-tDCS at home was well-tolerated, underlining its potential as an alternative treatment for cognitive dysfunction. Besides, the a-tDCS effect is related to the severity of DPMS dysfunction and changes in neuroplasticity state. [www.ClinicalTrials.gov], identifier [NCT03843203].

Preservation of language function by mapping the arcuate fasciculus using intraoperative corticocortical evoked potential under general anesthesia in glioma surgery.

Intraoperative language mapping under general anesthesia is imperative for brain tumor surgery because awake surgery is not always feasible. Monitoring corticocortical evoked potential (CCEP) is known to be a useful method for tracking neuronal connectivity and localizing functional areas. The authors evaluated the clinical benefit of intraoperative CCEP monitoring for language function preservation in patients undergoing glioma surgery. Between January 2019 and June 2021, the authors performed a total of 29 consecutive glioma surgeries using CCEP monitoring under general anesthesia because of a risk of speech impairment; these were analyzed. Language area mapping was implemented by the anterior language area to posterior language area CCEP method for arcuate fasciculus mapping, and tumor resection was performed while avoiding the localized language areas. Language function before and after surgery was evaluated by the Controlled Oral Word Association Test (COWAT). Intraoperative CCEP was successfully monitored in 25 patients (86.2%), and a valid signal was undetectable in the other 4 patients. Language function evaluation was possible before and after surgery in a total of 20 patients. Overall, the preservation rate of language function was 65.0%, and the deterioration rate was 35.0% after tumor resection with CCEP monitoring. Among those 8 patients with preoperative COWAT scores ≥ 18, 5 patients (62.5%) successfully preserved their language function, with COWAT scores > 18 after tumor resection. Among the 12 patients with preoperative deteriorated language function (COWAT score < 18), 8 patients (66.7%) showed improvement or preserved language function after surgery. Intraoperative CCEP monitoring of the arcuate fasciculus is an acceptable technology for the preservation of language function under general anesthesia in glioma surgery in patients in whom awake surgery is not feasible.

O propunere de adaptare pentru limba română a unei probe de fluență verbală fonematică (testul de asociere orală controlată a cuvintelor – COWAT)

Verbal fluency is an indicator of good cognitive functioning. The Controlled Oral Word Association Test (COWAT) is part of the examination tools in neuropsychology. For English there are stratified standards by age and background (Tombaugh, Kozak, &amp; Rees, 1999). The phonemic combinations used are F-A-S, C-T-L or P-R-W. These combinations are not specific to the Romanian language. This study proposes a way to identify phonemes that could be specific to the Romanian language for an adapted version of the COWAT test.

Depression, diabetes and change in cognitive functioning: results from the Canadian Longitudinal study on Aging

Abstract Background Individuals who ultimately receive a diagnosis of dementia typically have an observable accelerated cognitive decline (ACD) many years prior to diagnosis. Depression in combination with diabetes is an emerging risk factor that is associated with cognitive problems. Using data from the Canadian Longitudinal Study on Aging, the objective of the present study was to investigate the longitudinal association between depression, diabetes, and cognitive decline in an elderly cohort. Methods Baseline and follow-up data from a population-based study in Canada were used. The sample consisted of 18161 adults between 45 and 85 years of age without diabetes. Cognitive functioning was assessed at baseline and after 4 years using six measures: the Rey Auditory Verbal Learning Test (RAVLT), the Mental Alternation Test (MAT), the Animal Fluency Test (AF), the Controlled Oral Word Association Test (COWAT), the Stroop Test, and the Prospective Memory Test. Depression was assessed using the CES-D10. Regression analysis was conducted to evaluate interactions between depression, diabetes and cognitive decline. Results The mean age of participants was 61 years. Participants with a comorbidity of depression and diabetes had an accelerated cognitive decline (g-factor) compared to those with depression without diabetes and those with diabetes without depression (regression coefficients ß=-0.145 (0.036), ß=-0.076 (0.011), and ß=-0.053 (0.021), respectively). Conclusions This study suggests that depression and diabetes might increase the risk of cognitive decline in a synergistic way.

Association between descending pain modulatory system and cognitive impairment in fibromyalgia: A cross-sectional exploratory study.

BackgroundThe successful regulation of sensory input to the central nervous system depends on the descending pain modulatory system (DPMS). For the effective regulation of sensory input to the central nervous system and behavioral responses to pain, the DPMS is required. Its connection to fibromyalgia (FM)-related cognitive dysfunction has not yet been investigated. Therefore, this study tested whether measures of verbal fluency, sustained attention, and short-term and working memory could distinguish FM patients from healthy controls (HC). Additionally, it investigated, using a standardized paradigm, the link between cognitive ability and the function of the DPMS in responders and non-responders to the conditioned pain modulation test (CPM-test).Materials and methodsWe enrolled 21 HC women and 69 FM patients, all of whom ranged in age from 30 to 65. We employed scores from the Trail Making Test (TMTB-A) (sustained and divided attention), the Controlled Oral Word Association Test (COWAT) (orthographic and semantic fluency), and the Digits subtest of the Wechsler Adult Intelligence Scale (WAIS-III) as dependent variables.ResultsA generalized linear model (GLM) adjusted by educational level revealed significantly lower scores in FM than HC on the Span digits forward, COWAT-orthographic, and TMTB-A. For FM patients, multilevel MANCOVA revealed that the cognitive performance of non-responders compared to responders to CPM-test showed lower adjusted scores in Span digits forward (Partial-η2 = 0.358, P = 0.001), Span digits backward (Partial-η2 = 0.358, P = 0.001), COWAT-orthographic (Partial-η2 = 0.551, P = 0.001), COWAR-semantic (Partial-η2 = 0.355, P = 0.001), and TMTB-A (Partial-η2 = 0.360, P = 0.001). The association between the cognitive tests and the DPMS is moderated by the serum level of brain-derived neurotrophic factor (BDNF). Additionally, these cognitive assessments had a positive correlation with antidepressant use and pain threshold. The cognitive assessments, on the other hand, were conversely associated with a life of quality.ConclusionBased on these findings, it can be shown that HC performed substantially better on cognitive exams than FM did. They demonstrated a link between clinical complaints about attention and memory and decreased DPMS effectiveness. Additionally, they demonstrated that the BDNF is a moderating element in a potential relationship between the severity of cognitive impairment and DPMS dysfunction.

The association between body mass index, demographic and clinical characteristics with cognitive performance in patients with neuromyelitis optica spectrum disorder.

Background: Cognitive dysfunction is one of the problems that patients with neuromyelitis optica spectrum disorder (NMOSD) suffer from. We aimed to assess the association between demographic and clinical features as well as body mass index (BMI) and cognitive function in patients with NMOSD. Methods: A cross-sectional study was performed on 41 patients with definite diagnosis of NMOSD. Serum status of neuromyelitis optica immunoglobulin G (NMO-IgG) was determined using enzyme-linked immunosorbent assay (ELISA) method. Cognitive function was assessed by Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery which is validated for Persian people before and North American Adult Reading Test (NAART). Results: The mean score of NAART test was higher in participants with normal weight compared with overweight patients (40.47 ± 3.51 vs. 36.00 ± 5.74, P = 0.02). Current age was negatively correlated with Delis-Kaplan Executive Function System (D-KEFS)-Sorting (P = 0.05, r = -0.30). The correlation of duration of disease and cognitive performance was not significant (P > 0.05). Higher physical disability based on Expanded Disability Status Scale (EDSS) was correlated with lower results in Brief Visuospatial Memory Test-Revised (BVMT-R) (P < 0.01, r = -0.50), California Verbal Learning Test-second edition (CVLT-II)-Delayed Recall (P = 0.02, r = -0.35), and Symbol Digit Modalities Test (SDMT) (P = 0.03, r = -0.33) subtests of MACFIMS. Annual relapse rate was indirectly correlated with CVLT-II (P = 0.03, r = -0.34) and CVLT-II-Delayed Recall (P = 0.01, r = -0.38). Male participants obtained better scores in Paced Auditory Serial Addition Test (PASAT) subtest (P = 0.05). NMO-IgG seropositive patients had poorer performance in terms of CVLT-II-Delayed Recall, Controlled Oral Word Association Test (COWAT), and D-KEFS-Descriptive (P < 0.05). Participants with bachelor and master education degrees showed significantly better results compared to those with high school degree (P < 0.05). Conclusion: Investigating the clinical and demographic factors affecting cognitive impairment can increase the awareness of health care providers for early diagnosis of cognitive impairment in patients with NMOSD and increase the quality of health services.

A-200 “It’s on the Tip of My Tongue!” – Base Rates and Neuroanatomical Correlates of Confrontation Naming Deficits in Patients with Multiple Sclerosis

Abstract Objective: Word-finding difficulty is a commonly reported complaint in patients with multiple sclerosis (pwMS), though it is often under evaluated in clinical care. This study sought to identify base rates of confrontation naming impairments relative to other language tasks and examine its neuroanatomical correlates in pwMS. Method: Of 372 pwMS referred for neuropsychological assessment, 185 (MAge=48.8±11.23; MEd=14.5±2.4; 83% White; 73% women) met inclusion criteria for the final sample (i.e., estimated premorbid IQ ≥70, English-speaking, valid data on performance validity indices). Norm-based T scores for the following tests were of interest: Boston Naming Test (BNT); Controlled Oral Word Association Test (COWAT); and Animal Fluency (AF). A subset of 50 patients underwent recent quantitative MRI variables for whole brain fraction (WBF) and white matter lesion burden (T2LV). Results: PwMS showed greater impairment (≤1.5 SD) on the BNT (27.6%) as compared to AF (18.4%; p=.002), but not COWAT (24.3%; p=.304) based on binomial tests. Controlling for age and sex, significant partial correlations (ps&amp;lt;.05) were identified between BNT and both WBF (r=.32) and T2LV (r=-.30) and between AF and T2LV (r = -.30). COWAT did not correlate significantly with WBF (r=.08) or T2LV (r=-.09). Conclusions: Confrontation naming is relatively frequently impaired in pwMS, and correlates with both cerebral volume and lesion burden. Semantic fluency correlated only with lesion burden, and phonemic fluency did not correlate with neuroimaging. Future research should continue to investigate the clinical presentation and neuroanatomical underpinnings of language dysfunction, particularly naming/word-finding difficulties, in pwMS.

A-145 Much Ado About Norming: Ethnic Differences Across Three Normative Systems for COWAT/FAS Performance

Abstract Objective: Demographic correction of cognitive data is being increasingly scrutinized. We compared phonemic fluency for African Americans and Caucasians using three normative systems. Methods: Controlled Oral Word Association Test (COWAT)/FAS raw scores for 321 African Americans (56.4% female, mean age 50 years, mean education 13 years) and a matched sample of 330 Caucasians (53.6% female, mean age 47, mean education 13.5 years) were converted to T-scores using three normative systems (Heaton et al., 2004; Mitrushina et al., 1999; Schretlen et al., 2010). ANOVA was used to compare differences for the overall sample as well as for education level (15 years) and age range (18-35, 36-50, 51-65, and &amp;gt;65 years old). Results: Normative outcomes were significantly different between African American and Caucasian participants [Heaton (F (1,516) = 6.77, p=.01; Mitrushina F (1,509) = 10.32, p=.001; Shretlen F (1,516) = 14.15, p=.001]. Heaton norms were significantly different for ethnicity for all education levels except &amp;gt;15 years of education. Mitrushina meta-norms and CNNS (Schretlen et al., 2010) were significantly different for ethnicity on FAS scores only for &amp;gt;15 years of education. Heaton norms were significantly different for ethnicity for the ranges of 18-35 years old and 51-65 years old. Mitrushina meta-norms and CNNS were significantly different for ethnicity only for the 36-50 years range. None of the norming systems were significantly different for &amp;gt;65 years. Conclusions: The interpretation of FAS performance for African Americans and Caucasians differed by the normative system utilized with different effects for age and education noted between normative approaches.

Trail Making Test Could Predict Impairment in Cognitive Domains in Patients with Multiple Sclerosis: A Study of Diagnostic Accuracy.

Cognitive impairment (CI) and executive dysfunction (ED) are prevalent in patients with multiple sclerosis (PwMS). The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is the gold standard neuropsychological battery (NPB) for detecting CI. Delis-Kaplan Executive Function System (DKEFS) NPB evaluates ED. We aimed to find practical test(s) from DKEFS with acceptable diagnostic utility for early detection of impairment in cognitive and executive domains. Cognitive and executive tasks, physical disability, and depression scores of 30 PwMS were assessed (17 women, age: 38.1). Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Controlled Oral Word Association Test (COWAT) from MACFIMS and Trail Making Test (TMT), Design Fluency Test (DFT), and Verbal Fluency Test (VFT) from DKEFS were selected. The association between patients' characteristics and performance in tests, and diagnostic accuracy of DKEFS tests in detecting impairment in cognitive tasks were evaluated, using Pearson correlation and receiver operator characteristic curve analyses, respectively. A significant correlation was found between disease duration and SDMT and TMT subtests. Expanded Disability Status Scale was significantly related to SDMT, VFT-switching, and TMT subtests. Beck Depression Inventory was significantly related to DFT. TMT-switching detected abnormalities in SDMT and PASAT with 100% sensitivity, 93.3% (for SDMT), and 85.7% specificity (for PASAT). TMT-letter showed 100% sensitivity and 90% specificity in identifying abnormalities in COWAT. TMT, particularly the switching condition, is a practical paper-based test that could predict impairment in cognitive tasks. Clinicians may use TMT as a screening tool among PwMS.