Deficits In Processing Speed Research Articles

Cognitive Impairment in Primary and Secondary Headache Disorders.

Purpose of ReviewTo critically evaluate the recent literature on cognitive impairment and headache.Recent FindingsNeurocognitive symptoms are prevalent, debilitating, and occur often with both primary and secondary headache disorders.SummaryThis is a “narrative review of the current literature in PubMed on cognitive function and headache.” Migraine is associated with cognitive impairment years before a migraine diagnosis. In young and middle-aged adults, migraine is associated with deficits in attention, executive function, processing speed, and memory. It is unlikely that migraine is associated with dementia. Although methodologically difficult to assess, there does not seem to be an association between tension-type headache and cognitive dysfunction. In early to midlife, cluster headache seems to be associated with executive dysfunction. Several secondary headache syndromes relevant to clinicians managing headache disorders are associated with poorer cognitive performance or distinctive cognitive patterns, including those attributed to chronic cerebral or systemic vascular disorders, trauma, and derangements of intracranial pressure and volume, including frontotemporal brain sagging syndrome.

The efficacy of speed of processing training for improving processing speed in individuals with multiple sclerosis: a randomized clinical trial.

The current study examines the efficacy of speed of processing training (SOPT) to improve processing speed (PS) in individuals with multiple sclerosis (MS). Outcomes included changes in the useful field of view (UFOV) and neuropsychological evaluation (NPE). This double-blind, placebo-controlled randomized clinical trial included 84 participants with clinically definite MS and impaired PS, 43 in the treatment group and 41 in the placebo control group. Participants completed a baseline NPE and a repeat NPE post-treatment. The treatment group was randomized to booster sessions or no contact. Long-term follow-up assessments were completed 6months after treatment. A significant effect of SOPT was observed on both the UFOV (large effect) and pattern comparison with a similar pattern of results noted on letter comparison, albeit at a trend level. The treatment effect was maintained 6months later. The impact of booster sessions was not significant. Correlations between degree of improvement on the UFOV and the number of levels completed within each training task were significant for both speed and divided attention indicating that completion of more levels of training correlated with greater benefit. SOPT is effective for treating PS deficits in MS with benefit documented on both the UFOV and a neuropsychological measure of PS. Less benefit was observed as the outcome measures became more distinct in cognitive demands from the treatment. Long-term maintenance was observed. The number of training levels completed within the 10-sessions exerted a significant impact on treatment benefit, with more levels completed resulting in greater benefit.

Dynamic and Static Cognitive Deficits in Schizophrenia and Bipolar Disorder After the First Episode.

Few studies have comprehensively examined the profile of cognitive functioning in first episode psychosis patients throughout the lifespan, and from first episode to chronic stage. We assessed functioning in general and specific cognitive functions, comparing both schizophrenia (N = 64) and bipolar I (N = 19) patients to controls (N = 103). Participants were from a population-based, case-control study of first episode psychosis patients, who were followed prospectively up to 10 years post first admission. A cognitive battery was administered at baseline and follow-up. By combining longitudinal and cross-sectional data, we were able to examine the cognitive profile of patients and controls throughout the entire age range of our sample (16–65). Schizophrenia patients exhibited widespread declines in IQ, executive function, visual memory, language ability, and verbal knowledge. However, the ages at which these declines occurred differed between functions. Deficits in verbal memory, working memory, processing speed, and visuospatial ability, on the other hand, were present at the first episode, and remained relatively static thereafter. Bipolar I patients also showed declines in IQ, verbal knowledge, and language ability, albeit at different ages to schizophrenia patients and only in verbal functions. Deficits on measures of verbal memory, processing speed, and executive function remained relatively static. Thus, both schizophrenia and bipolar I patients experienced cognitive decline in general and specific functions after the first episode, but the age at which these declines occurred differed between disorder and function. Cognitive remediation efforts may be most fruitful when targeting individual functions during specific time periods throughout adulthood.

Evaluating the diagnostic validity of the cerebellar cognitive affective syndrome (CCAS) in pediatric posterior fossa tumor patients.

BackgroundThe aim of this case-control study was to investigate the severity of the cerebellar cognitive affective syndrome (CCAS) in patients treated for pediatric posterior fossa tumors (PFT) and evaluate its diagnostic validity and predictive value for long-term effects.MethodsUsing neuropsychological test data from 56 patients with PFT (average age: 14 years), the severity of deficits in the CCAS core areas (executive functions, verbal functions, visuospatial abilities and emotions/behaviour) was examined. Neuropsychological and academic long-term outcomes of patients with CCAS were compared to two control groups of PFT patients (treated with either surgery or surgery followed by radio-/chemotherapy) without the syndrome. Risk factors associated with various deficits were considered.ResultsAll but one PFT patient suffered from slight to severe impairments in at least one CCAS domain, while complete CCAS occurred in 35.7%. Seven years after tumor diagnosis CCAS patients performed worse in information processing, logical reasoning, verbal functions, visuospatial skills, and executive functioning and required more special educational support compared to the control groups. CCAS patients performed equally poor as patients treated with chemo-/radiotherapy in tasks measuring information processing speed. Risk factors were significantly associated with deficits in information processing speed but not CCAS emergence.ConclusionsDeficits in the core CCAS domains are commonly found in PFT patients, but varying in severity, which suggests the syndrome to be continuous rather than dichotomous. However, the validity of CCAS diagnosis was low and unspecific. The exclusion of relevant functions typically impaired in PFT patients (eg, information processing) resulted in difficulties being overlooked.

Comparison of white matter hyperintensity abnormalities and cognitive performance in individuals with low and high cardiovascular risk: Data from the Diabetes and Dementia (D2) study

AbstractBackgroundType 2 diabetes Mellitus (T2DM) is recognised as a major contributor to cognitive decline. People with T2DM demonstrate increased white matter hyperintensity (WMH) abnormalities on MRI compared to control individuals. We investigated associations between a validated vascular risk score: The Framingham Risk Score (FRS), WMH volumes and cognitive function in the Diabetes‐and‐Dementia (D2) study, a longitudinal cohort study of community dwelling people with T2DM.MethodOne hundred and twenty‐three non‐demented participants with T2DM (age 66.7±6.8 years, range 50‐80, 68M/55F) completed neuropsychological assessments, health questionnaires to allow FRS calculation, 24‐hour ambulatory blood pressure monitoring, and a 3T‐MRI scan. WMH were calculated using the functionality "run‐samseg" in FreeSurfer 7. Quality control on the traced lesions was performed using an in‐house semi‐automated MATLAB tool. Periventricular and deep WMH volumes were estimated based on the edited lesion traces. We divided participants into low (n=61) and high (n=62) FRS groups based on the median score (x=48.7). Differences in WMH volumes were compared between the FRS groups after correcting for sex and age. We compared cognitive performance between low/high FRS individuals across five composite cognitive domains: memory, language, visuospatial skills, executive function, and attention‐and‐processing‐speed. The composite score for each domain was the normalised z‐scores average for the respective tests.ResultParticipants with high FRS (implicating greater vascular risk) were significantly older (age F(1, 122)=14.97; p<0.001), were less likely to be female (sex χ2=16.73, p<0.001), and tend to have less than 12 years of education (χ2= 3.69, p = 0.041). Relative to individuals with low FRS, those with high FRS showed significantly higher WMH volumes (F(1, 121)=6.11; p=0.015). Significant differences were also identified for periventricular (F(1, 121)=6.16; p=0.014) and deep (F(1, 121)=4.25; p=0.042) WMH volumes. When the cognitive data were analysed, the low FRS group performed signifcantly better than the high FRS group only on the attention‐and‐processing‐speed factor (F(1,115)=5.17; p=0.025).ConclusionHigh cardiovascular risk, defined as a high FRS, in participants with T2DM was associated with greater WMH volume, a marker of white matter dysfunction, and with deficits in processing speed and attention. Subclinical cognitive deficits were common in our community dwelling cohort without known or preceding cognitive dysfunction.

The impact of pandemic-related worry on cognitive functioning and risk-taking.

Here, we sought to quantify the effects of experienced fear and worry, engendered by the COVID-19 pandemic, on both cognitive abilities-speed of information processing, task-set shifting, and proactive control-as well as economic risk-taking. Leveraging a repeated-measures cross-sectional design, we examined the performance of 1517 participants, collected during the early phase of the pandemic in the US (April-June 2020), finding that self-reported pandemic-related worry predicted deficits in information processing speed and maintenance of goal-related contextual information. In a classic economic risk-taking task, we observed that worried individuals' choices were more sensitive to the described outcome probabilities of risky actions. Overall, these results elucidate the cognitive consequences of a large-scale, unpredictable, and uncontrollable stressor, which may in turn play an important role in individuals' understanding of, and adherence to safety directives both in the current crisis and future public health emergencies.

Cognitive Profile of Adults with Sickle Cell Disease - Cluster Analysis

Background: Published literature on cognitive functioning in adults with sickle cell disease (SCD) is sparse when compared to children. A few reports describe deficits in processing speed and executive functioning. Some studies suggest that these deficits are more severe in patients with silent cerebral infarcts (SCI). Even in the absence of radiological evidence of ischemic injury, some cognitive deficits have been depicted in adults . We hypothesize that in SCD adults, the cognitive profile varies with the presence of ischemic injury (SCI or overt stroke). The aims of this study were 1) to describe the neuropsychological profiles of SCD adults, and 2) to characterize clusters of patients with similar cognitive profiles.Methods: We conducted a retrospective analysis of all consecutive SCD adults who underwent comprehensive neuropsychological assessment during routine care at the UMGGR clinic at Henri Mondor Hospital, Créteil (France), between January 2017 and April 2021. The Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) were used for cognitive disorder, anxiety and depression screening, respectively. The cognitive battery combined standardized neuropsychological tests with established clinical utility and validity. Educational attainment was scored based on the number of years of schooling for the highest completed diploma. Principal component analysis was performed. ANOVA was used to compare patients' characteristics between clusters.Results: 80 patients, median age 36.5 [range 19-63] years were included. 40 (50.0%) were male. Genotype distribution was 62 patients (77.5%) with SS/Sbeta 0, 12 (15.0%) with SC and 6 (7.5%) with Sbeta +. On Principal Component Analysis, a 5-factor model presented the best fit (Bartlett's sphericity test (χ²(171)=1174; p<0.001)), explaining 71.8% of the variance in neuropsychological scores. The first factor encompassed tests specifically assessing visual attention/visual organization (right hemisphere). The second included tests for mental/cognitive control (frontal lobe), the third tests of selective inhibition/attention (fronto-parietal), the fourth tests for language/memory (left temporal lobe) and the last referred to shifting skill (sub-cortical loop). On hierarchical classification, 3 different clusters emerged: 32 patients in cluster 1, 32 in cluster 2 and 16 in cluster 3. Cluster 1 had a lower mean educational level (F(2,77) = 15,65; p<0,001). Cluster 1 showed the lowest mean MoCA score (20.0/30.0), relative to cluster 2 and 3 (24.6 and 26.4; p<0.001 and p<0.001, respectively). Cluster 1 patients presented deficits on all five factors. Cluster 2 patients compared to cluster 3 were altered in 4 factors (factors 1-4), but to a lesser extent than cluster 1. Processing speed was slower and some frontal-executive deficits were present in cluster 2 compared to cluster 3. There was no statistical difference between clusters in terms of ethnic origins. There was a trend for the presence of more cerebral vasculopathy in cluster 1 (chi2; p=0.06). Regarding stroke, 70% occurred during childhood in cluster 1, whereas 70% during adulthood in cluster 2, and 100% during adulthood in cluster 3.Conclusions: Overall, these results suggest at least three different cognitive profiles in adults with SCD: 1) few or no cognitive deficits (cluster 3), 2) some cognitive impairment with a sub-cortical cognitive profile (cluster 2) and 3) more global cognitive impairment with cortical/sub-cortical profile and specific deficits of memory, language and constructional praxis, depending on the location of prior overt neurological events (cluster 1). To reduce the long-term cognitive morbidity of SCD, patients can be identified by their distinct cognitive profiles and neurorehabilitation tailored to their unique profile should be applied. The large proportion of childhood stroke in patients with global cognitive impairment in contrast with majority of those with milder to no cognitive impairment having had their stroke in adulthood emphasize the crucial importance of preventing early childhood stroke and implementing early neurorehabilitation. DisclosuresForté: Canadian Hematology Society: Research Funding; Pfizer: Research Funding; Novartis: Honoraria. Kuo: Pfizer: Consultancy, Research Funding; Bluebird Bio: Consultancy; Novartis: Consultancy, Honoraria; Apellis: Consultancy; Alexion: Consultancy, Honoraria; Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy; Bioverativ: Membership on an entity's Board of Directors or advisory committees. Bartolucci: Jazz Pharma: Other: Lecture fees; AGIOS: Consultancy; Emmaus: Consultancy; GBT: Consultancy; F. Hoffmann-La Roche Ltd: Consultancy; Hemanext: Consultancy; INNOVHEM: Other: Co-founder; Bluebird: Consultancy, Research Funding; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: Lecture fees, Steering committee, Research Funding; Fabre Foundation: Research Funding; Addmedica: Consultancy, Other: Lecture fees, Research Funding.

Comprehensive Assessment of Cognitive Function in Patients with Sickle Cell Disease Reveals Deficits in Memory and Processing Speed

Cognitive impairment (CI) is a serious complication of sickle cell disease (SCD) and can cause significant functional and social limitations. To date, there are only a few studies characterizing CI in adults with SCD. In this study, we comprehensively assessed cognitive function in a cross-sectional sample of patients with SCD compared to healthy controls across ten memory and processing speed domains.Patients with SCD (HbSS, HbSC and HbS/beta thalassemia) ages 18 years and older were recruited from the University of Pittsburgh Medical Center Adult Sickle Cell Program, and sex- and age-matched controls were recruited from the community and by SCD patient referral. Unlike previous studies, we did not restrict participation to patients with HbSS only and we included all SCD comorbidities. All participants underwent neurocognitive assessments using measures that are validated and accurate in discriminating CI from dementia and normal cognition. We conducted linear regression analyses to estimate the difference in each cognitive domain score between patients and controls. We also contrasted pairwise comparisons between controls and patients with and without stroke, with and without chronic blood transfusions, and classified by disease severity based on genotype.Among 86 SCD patients and 66 controls, 43% were male and the average age was 36.2 years. SCD patients had fewer years of education on average (13.3 vs. 14.2) and a higher percent had a history of smoking (46% vs. 29%). Additionally, 45% of patients had milder disease (HbSC or HbSb +-thalassemia) with the rest having severe disease (HbSS or HbSb 0-thalassemia)), 14% had a history of stroke, and 20% were receiving chronic exchange transfusions.Patients with SCD had significantly lower scores on five out of ten cognitive domains: language (b=-5.88, P=0.014), attention/processing (b=-14.47, P<0.001), RBANS total score (b=-7.55, P<0.001), executive function (b=-1.60, P<0.001), and DSST scaled score (b=-2.08, P<0.001). Adjusting for pre-morbid verbal IQ (VIQ), hemoglobin level, and smoking history, attention/processing (b=-10.70, P=0.001), RBANS total (b=-7.27, P=0.003), and DSST scaled scores (b=-1.54, P=0.019) were significantly lower among patients compared to controls.In adjusted models, there were no significant differences in cognitive domain scores between patients with mild disease compared to patients with severe disease; both mild and severe disease subgroups had lower attention/processing scores compared to controls (both P<0.05). Patients with SCD and a history of stroke had significantly lower attention/processing, executive function, RBANS total, and DSST scaled scores (all P<0.01) compared to controls, and SCD patients who did not have a history of stroke had lower attention/processing and RBANS total scores than controls (both P<0.05). Patients with a history of stroke had significantly lower executive function (b=-1.65, P=0.012), RBANS total (b=-8.64, P=0.020), and DSST scaled scores (b=-2.43, P=0.015) than patients without a history of stroke. There were no significant differences in cognitive domain scores between patients receiving chronic transfusions and those not receiving transfusions.To our knowledge, this is the most inclusive real-life study of adult patients with SCD to investigate cognition to date, further characterizing CI among this patient population. Many of the disparities in cognitive function between patients and controls are not explained by pre-morbid VIQ, hemoglobin levels or smoking, indicating further research is needed to understand the pathogenesis of CI in SCD. [Display omitted] DisclosuresNovelli: Novartis Pharmaceuticals: Consultancy.

Silent Cerebral Infarction on Brain MRI Is Associated with Cognitive Impairment in Ittp Survivors in Hematological Remission

▪BACKGROUND: Individuals with immune mediated thrombotic thrombocytopenic purpura (iTTP) frequently exhibit cognitive impairment and are at higher risk of stroke than matched controls. However, the etiology of cognitive impairment in these individuals has not been established. We conducted this prospective study to examine the patterns of cognitive impairment and to test the hypothesis that cognitive impairment in iTTP survivors is associated with silent cerebral infarction (SCI, ischemic lesions on brain MRI without corresponding overt neurodeficits), which are also a risk factor for future stroke.METHODS: We prospectively enrolled adult (age ≥ 18 years) patients with iTTP and age- and sex-matched controls without prior iTTP or stroke. iTTP was diagnosed based on ADAMTS13 activity <10% during an acute episode. All study assessments were performed after achieving hematological remission (platelet count >150x10 9/L for at least 30 days after stopping plasma exchange and/or caplacizumab). Participants undergo annual study visits including the following study measures: 1) NIH stroke scale to rule out acute stroke, 2) NIH ToolBox Cognition battery, a comprehensive iPad based neurobehavioral tool that has been validated across multiple populations and for which normative control data are available. The NIH ToolBox Cognition Battery tests multiple cognitive domains (Figure 1) including executive function (dimensional change card sort test, flanker inhibitory control and attention test), processing speed (pattern comparison test), episodic memory (picture sequence memory test), working memory (list sort working memory test), language (oral reading recognition, picture vocabulary test). We used T scores adjusted for age, sex, race and educational attainment where the normative mean T score is 50 with standard deviation (SD) of 10. Mild and major cognitive impairment are defined as a T scores that are 1-2 SD below mean and > 2SD below mean for any domain, respectively; 2) Brain MRI: SCI is defined as a infarct-like lesion (punctate T2 and FLAIR hyperintensity) without corresponding neurodeficits. The Chi-squared test and Mann Whitney test were used to compare categorical and continuous variables across groups, respectively.RESULTS: Between September 2020 and June 2021, we enrolled 34 participants including 28 iTTP patients and 6 controls. Demographics and clinical characteristics of patients and controls are summarized in Table 1. NIH Stroke Scale score was 0 in all controls and all but one iTTP patient (score = 1). Among iTTP patients, 28.6% (8/28) had prior stroke (including during acute episodes).(i) iTTP survivors demonstrate cognitive deficits affecting executive function and processing speed: Among iTTP patients, 46.4% had cognitive impairment in at least one domain including 25% (7/28) with major cognitive impairment and 21.4% (6/28) with mild cognitive impairment (> 1 SD below mean T score). Among controls, 0% had major cognitive impairment and 16.6% (1/6) had mild cognitive impairment. Figure 1 shows detailed cognitive testing results for iTTP patients and controls. iTTP patients most commonly had deficits (T score < 40) in executive function (flanker inhibition test, dimensional change card sort test) and processing speed (pattern comparison test) (Table 1).(ii) Silent cerebral infarction is associated with major cognitive impairment: MRI was completed in 24 iTTP patients and all controls. SCI was present in 50% (12/24) of iTTP patients (representative image, figure 2A) and 16.6% (1/6) controls. Another 29.1% (7/24) had evidence of prior stroke. Rate of SCI was 35.7% in patients without cognitive deficits, 50% in those with minor cognitive deficits and 83.3% in those with major cognitive deficits. SCI was present in 83.3% (5/6) with major cognitive impairment versus 38.9% (7/18) without major cognitive impairment (P = 0.05) (Figure 2B).CONCLUSIONS: Cognitive deficits in iTTP survivors primarily affect executive function and processing speed and are associated with SCI suggesting ischemic etiology. Whether SCI occur during acute episodes or during remission (with remission ADAMTS13 as a risk factor) is being studied prospectively with serial MRI and cognitive assessment. iTTP patients may benefit from neurocognitive testing and referral to neuropsychological therapy, where appropriate, and aggressive measures to address risk factors for cerebrovascular disease. [Display omitted] DisclosuresNaik: Rigel: Research Funding. Lanzkron: GBT: Research Funding; Pfizer: Current holder of individual stocks in a privately-held company; Teva: Current holder of individual stocks in a privately-held company; Novartis: Research Funding; Novo Nordisk: Consultancy; Imara: Research Funding; CSL Behring: Research Funding; Shire: Research Funding; Bluebird Bio: Consultancy. Chaturvedi: Sanofi Genzyme: Other: Advisory board member; Argenx: Other: Advisory board member; UCB: Other: Advisory board participation; Dova: Other: Advisory board member; Alexion: Other: Advisory board member.

Older age, male sex, and cerebral microbleeds predict white matter loss after traumatic brain injury.

Little is known on how mild traumatic brain injury affects white matter based on age at injury, sex, cerebral microbleeds, and time since injury. Here, we study the fractional anisotropy of white matter to study these effects in 109 participants aged 18-77 (46 females, age μ ± σ = 40 ± 17years) imaged within [Formula: see text] 1week and [Formula: see text] 6months post-injury. Age is found to be linearly associated with white matter degradation, likely due not only to injury but also to cumulative effects of other pathologies and to their interactions with injury. Age is associated with mean anisotropy decreases in the corpus callosum, middle longitudinal fasciculi, inferior longitudinal and occipitofrontal fasciculi, and superficial frontal and temporal fasciculi. Over [Formula: see text] 6months, the mean anisotropies of the corpus callosum, left superficial frontal fasciculi, and left corticospinal tract decrease significantly. Independently of other predictors, age and cerebral microbleeds contribute to anisotropy decrease in the callosal genu. Chronically, the white matter of commissural tracts, left superficial frontal fasciculi, and left corticospinal tract degrade appreciably, independently of other predictors. Our findings suggest that large commissural and intra-hemispheric structures are at high risk for post-traumatic degradation. This study identifies detailed neuroanatomic substrates consistent with brain injury patients' age-dependent deficits in information processing speed, interhemispheric communication, motor coordination, visual acuity, sensory integration, reading speed/comprehension, executive function, personality, and memory. We also identify neuroanatomic features underlying white matter degradation whose severity is associated with the male sex. Future studies should compare our findings to functional measures and other neurodegenerative processes.

Neurodevelopmental Outcomes in Children With Inherited Liver Disease and Native Liver.

ABSTRACTObjective:To evaluate neurodevelopmental status among children with inherited cholestatic liver diseases with native liver and variables predictive of impairment.Methods:Participants with Alagille syndrome (ALGS), progressive familial intrahepatic cholestasis (PFIC), and alpha 1 antitrypsin deficiency (A1AT) enrolled in a longitudinal, multicenter study and completed the Wechsler Preschool and Primary Scale of Intelligence-III or Intelligence Scale for Children-IV. Full Scale Intelligence Quotient (FSIQ) was analyzed continuously and categorically (>100, 85–99, 70–84, <70). Univariate linear regression was performed to study association between FSIQ and risk factors, stratified by disease.Results:Two hundred and fifteen completed testing (ALGS n = 70, PFIC n = 43, A1AT n = 102); median age was 7.6 years (3.0–16.9). Mean FSIQ in ALGS was lower than A1AT (94 vs 101, P = 0.01). Frequency of FSIQ < 85 (>1 standard deviation [SD] below average) was highest in ALGS (29%) versus 18.6% in PFIC and 12.8% in A1AT, and was greater than expected in ALGS based on normal distribution (29% vs 15.9%, P = 0.003). ALGS scored significantly lower than test norms in almost all Wechsler composites; A1AT scored lower on Working Memory and Processing Speed; PFIC was not different from test norms. Total bilirubin, alkaline phosphatase, albumin, hemoglobin, and parental education were significantly associated with FSIQ.Conclusions:Patients with ALGS are at increased risk of lower FSIQ, whereas our data suggest A1AT and PFIC are not. A1AT and ALGS appear vulnerable to working memory and processing speed deficits suggestive of attention/executive function impairment. Malnutrition, liver disease severity, and sociodemographic factors appear related to FSIQ deficits, potentially identifying targets for early interventions.

Impact of Visual Discomfort Symptoms On SDMT Performance Among Persons With Multiple Sclerosis

<h3>Research Objectives</h3> To examine how visual discomfort symptoms affect performance on the symbol digit modalities test (SDMT), a visually mediated information processing speed task which is considered a gold standard measure for cognition in multiple sclerosis (MS) research. <h3>Design</h3> Observational, cross-sectional study. <h3>Setting</h3> General community. <h3>Participants</h3> Eighty-seven persons with MS and 30 healthy controls (HCs). <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Visual discomfort questionnaire (VDQ) and SDMT. <h3>Results</h3> Persons with MS reported significantly more severe visual discomfort symptoms on the VDQ than HCs (W = 424, p < 0.001). More severe visual discomfort symptoms was significantly associated with worse SDMT performance (ρ = -0.24, p = 0.011). Specifically, reports of symptoms such as text moving or fading while reading (p = 0.038), blurriness and diplopia (p = 0.055), having to re-read texts (p = 0.076), and slow reading (p = 0.008) were significantly related to SDMT performance, while symptoms related to headache and eye soreness (p = 0.824) and glare (p = 0.961) were not linked to SDMT performance. <h3>Conclusions</h3> Visual discomfort symptoms may impact/interfere with SDMT performance in persons with MS. When determining information processing speed deficits using the SDMT, visual discomfort symptoms need to be considered. <h3>Author(s) Disclosures</h3> Authors declare no conflicts of interest.

What is a processing speed weakness? Importance of cognitive ability when defining processing speed in a child psychiatric population

ABSTRACT There is growing evidence that processing speed (PS) deficits in youth with neuropsychiatric conditions are associated with functional difficulties. However, there is no consistent definition of slower PS; specifically, whether slower PS should be defined as a discrepancy from same-aged peers (normative weakness) or as an intrapersonal deficit relative to overall cognitive ability (relative weakness). In a sample of clinically-referred youth, we calculated slower PS both ways and examined the impact on adaptive, academic, and psychopathology outcomes in relation to different levels of cognitive ability. Significant PS x cognitive ability interactions were found on adaptive and academic outcomes. A norm-based weakness in PS (PSI Standard Score <85) was associated with lower adaptive skills and lower academic skills regardless of cognitive ability. In the above average cognitive ability group, relatively lower PS (PSI >15 point difference from VCI) was associated with significantly lower academic performance. No significant associations were found for general psychopathology. Results suggest a normative weakness in PS impacts functional outcomes interactively and differently with level of general cognitive ability. Data suggest that higher cognitive ability may be somewhat protective from the impact of normatively weak PS on adaptive outcomes; however, youth across all abilities with normatively weak PS showed weaker academic performance. Second, children with high cognitive abilities and relatively weak PS showed discrepant performance compared to comparison group. Implications and areas for future research are discussed.

Let’s lower the floor: Clinical utility of the D-KEFS TMT with a forensic psychiatric inpatient population

Trail-making tests are widely used as part of neuropsychological assessments, although the prevalence of processing speed deficits in schizophrenia spectrum disorders may limit their utility when administered to this population. In response, our study sought to explore D-KEFS TMT performance among a forensic-oriented schizophrenia spectrum sample, with the goal of generating normative data to enhance the utility of the TMT with this population. Archival data was collected from a sample of patients admitted to a forensic maximum-security psychiatric facility. Analyses revealed a large percentage of individuals achieved an “impaired” result across D-KEFS TMT trials, ranging from 20% to more than 60%. The most noteworthy finding was for Number-Letter Switching, in which approximately 48% of participants performed at the floor level. Following reclassification of performance, 36% of our sample were identified as “below average,” while greater than 60% of individuals were captured as average to above average. The current analyses revealed a problematic skew in TMT performance among schizophrenia spectrum patients, in turn complicating interpretation of cognitive status as well as the ability to compare performance between patients and over time. The present adjustments account for this skew and yield more variability in standardized scoring.

The Role of Cognitive Impairment on Physical Therapy Attendance and Outcomes in Multiple Sclerosis.

Many persons with multiple sclerosis (PwMS) experience cognitive impairments, which may affect their ability to engage in physical therapy. There is limited information on how cognitive impairments are associated with PwMS' ability to participate and improve their functional outcomes. This study aimed to assess the relationship between cognitive functioning and PwMS' attendance, total goal attainment, and functional improvement following physical therapy intervention. Participants (n = 45) were PwMS who participated in a larger self-management study and enrolled in physical therapy within the past 2 years. Objective cognitive functioning was examined using tests of prospective memory, retrospective memory, working memory, and processing speed, along with a self-report measure. Bivariate analyses were conducted to examine the relationship between cognitive functioning and each physical therapy outcome (session attendance, attaining goals, and changes in functional outcome measures), followed by logistic regressions with age, education, gender, and disability level as covariates. Difficulty learning new verbal information was associated with a greater likelihood of "no showing" one or more of their physical therapy sessions. Reductions in working memory and processing speed were associated with PwMS not meeting all their rehabilitation goals. Despite deficits in new learning, memory, and processing speed, 85.2% of those with pre-/postscores showed improvements in at least one functional outcome measure following physical therapy intervention. These findings demonstrate the ability for PwMS to make functional motor gains despite the presence of cognitive impairments and highlight the potential contributions of cognitive functioning on attendance and goal attainment of physical therapy intervention.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A362, which includes background, methods, results, and discussion in the authors' own voices).

Evaluation and Psychoeducational Intervention of Learning Disabilities: A Case Study

Learning Disabilities are one of the most frequent deficits in the teaching and learning process, present between 5 and 15% of the students. Various definitions have been made, such as DSM 5, ICD-11, or other more psychoeducational definitions. The main problem is the unexpected difficulties in learning how to read or write despite having a medium intellectual capacity. Deficits can be found in: cognitive variables, visual perceptual processing, phonological processing, semantic processing, and morphosyntactic processing. The purpose of this paper is to identify the reading and writing learning disabilities of a Spanish-speaking subject. The methodology is a single case study, which is examined of a 7-year-old boy enrolled in the second year of Primary Education at a grant-maintained school in the city of Malaga (Spain). A psychoeducational evaluation proposal is described with different qualitative and quantitative techniques. The results indicate that the subject presents difficulties in his acquisition of Reading and Writing skills, showing signs of cognitive deficits in memory, attention, processing speed, visual and phonological processing, and difficulties in reading and writing. Finally, a proposal for psychoeducational intervention is described, which would be useful in promoting learning and improving the pupil's academic performance. The research shows the relevance of the global evaluation of cognitive and psycho-linguistic variables and the need to establish an early diagnosis. It is also necessary to highlight the relevance of early intervention and the establishment of clear educational guidelines towards the teacher and the family. The main limitations are determined from the single case study and the possible limitations of validity and generalizability of this study to other languages.

A-142 A Correlation between Reading Fluency and Processing Speed in a Child Population

Abstract Objective The aim of this study was to determine whether a correlation exists between reading fluency in the WJ-IV ACH and processing speed in the WISC-V. Method The data for this study was derived from a large de-identified database. Participants (n = 90) included individuals who completed the Wechsler Intelligence Scale for Children Fifth Edition (WISC-V), which measures intellectual ability, and the Woodcock Johnson IV Tests of Achievement (WJ-IV ACH), which tests for reading, writing, and mathematic achievement. The participants consisted of 36.7% White, 20% Black, 31.1% Hispanic, and 12.2% Other. From the sample, 66.7% were male and 32.3% were female. All the participants were administered the WISC-V and WJ-IV ACH (mean age = 10.53, SD = 2.50; mean education = 4.6, SD = 2.47). Vocabulary was controlled for. Results The results indicated a significant correlation between the WJ-IV ACH Reading Fluency and the WISC-V Processing Speed Index r(87) = 0.326, p = 0.002. Conclusions Previous research has found that deficits in processing speed affect reading efficiency. Cognitive processes are affected even in children with ADHD who are able to decode words accurately. Processing speed, specifically Coding in the WISC-IV, was found to be significantly associated with verbal span and measures of working memory. Moreover, processing speed and working memory have been found to be significant predictors of oral reading fluency (Jacobson et al., 2011). The current findings confirm a correlation between processing speed and reading fluency in updated versions of the forementioned assessments. Future research should investigate the role of comorbid diagnosis found in the functioning of both processing speed and reading fluency.

A-158 Case Study: Cognitive Deficits Associated with Postoperative Intracranial Hemorrhage Following Meningioma Resection

Abstract Objective Postoperative intracranial hemorrhages (PIH) are an infrequent complication following cranial tumor resection and associated with prolonged hospitalization as well as long-term neurologic deficits. There is limited research examining the neuropsychological deficits resulting from PIH following meningioma resection, especially with neuropsychological data. Here, we present the neurocognitive profile of a patient who underwent a meningioma resection surgery and subsequently suffered a PIH within the resection cavity. Method Mr. Doe is a bilingual male in his late 40s who developed right-side vision loss and an isolated incidence of disorientation, resulting in discovery of a left anterior clinoid meningioma. He underwent a left frontotemporal craniotomy for gross total resection of the mass a month after discovery. Postoperative neuroimaging the following day revealed the appearance of a hematoma and intracranial hemorrhage within the resection cavity, resulting in right hemiplegia, aphasia, and ophthalmoplegia. He underwent neuropsychological evaluation 15 months post-resection, to assess residual cognitive deficits following his hospitalization and subsequent inpatient rehabilitation. Results In the context of average premorbid intellectual functioning, Mr. Doe’s neurocognitive profile was notable for deficits in processing speed, receptive and expressive language, and executive functioning associated with speed/verbally mediated tasks. Testing revealed lateralized deficits indicative of left (language-dominant) hemisphere dysfunction secondary to meningioma resection and subsequent PIH within the resection cavity. Conclusion The current poster aims to contribute to the limited body of literature examining residual neuropsychological deficits resulting from PIH following intracranial resection of meningioma. This is especially crucial given that long-term cognitive deficits can negatively impact patients’ quality of life over time.

Network analysis of cognitive deficit in patients with schizophrenia spectrum disorders

BackgroundCognitive impairments are found in 80% of patients with schizophrenia. The severity of these impairments significantly affects the recovery of patients in terms of social functioning.Network analysis is the most suitable approach for studying complex relationships among cognitive functions. AimTo build a network model of neurocognitive functions for identifying both the severity of impairments in individual functions and the vertices central to the whole model. MethodsThe study included 115 patients with schizophrenia and schizophrenia spectrum disorders and a comparison group, comprising 99 healthy subjects. The severity of clinical symptoms was assessed using the PANSS, CDSS and YMRS, and the SAS and BARS for extrapyramidal symptoms and akathisia. Subjects from the comparison group completed screening questionnaires QIDS-SR and PQ-16. Neurocognitive functions were assessed using the BACS. ResultsThe patients performed worse than the healthy subjects on all tests. In the cognitive network models of healthy subjects, fewer connections were revealed and the central place was occupied by working memory, the functioning of which depends upon everyday functioning in the community. In the cognitive models of patients there was a greater connectedness of neurocognitive functions. Furthermore, the central place of the networks in patients is occupied by the processing speed, evaluated primarily using the Symbol Coding test, which reflects the dependence of patient activity on lower-order functions. ConclusionThe processing speed deficit is key to schizophrenia and it may be considered a potential endophenotype of the disease.

A Dissociation of Attention, Executive Function and Reaction to Difficulty: Development of the MindPulse Test, a Novel Digital Neuropsychological Test for Precise Quantification of Perceptual-Motor Decision-Making Processes.

Traditionally, neuropsychological testing has assessed processing speed and precision, closely related to the ability to perform high-order cognitive tasks. An individual making a decision under time pressure must constantly rebalance its speed to action in order to account for possible errors. A deficit in processing speed appears to be afrequent disorder caused by cerebral damage — but it can be hard to pinpoint the exact cause of the slowdown. It is therefore important to separate the perceptual-motor component of processing speed from the decision-time component. We present a technique to isolate Reaction Times (RTs): a short digital test to assess the decision-making abilities of individuals by gauging their ability to balance between speed and precision. Our hypothesis is that some subjects willaccelerate, and others slow down in the face of the difficulty. This pilot study, conducted on 83 neurotypical adult volunteers, used images stimuli. The test was designed to measure RTs and correctness. After learning release gesture, the subjects were presented with three tasks: a simple Reaction Time task, a Go/No-Go, and a complex Go/No-Go with 2 simultaneous Choices. All three tasks have in common a perceptual component and a motor response. By measuring the 3 reference points requiring attentional and executive processing, while progressively increasing the conceptual complexity of the task, we were able to compare the processing times for different tasks — thus calculating the deceleration specific to the reaction time linked to difficulty. We defined the difficulty coefficient of a task as being the ratio of the group average time of this task minus the base time/average time of the unit task minus the base time. We found that RTs can be broken down into three elementary, uncorrelated components: Reaction Time, Executive Speed, and Reaction to Difficulty (RD). We hypothesized that RD reflects how the subject reacts to difficulty by accelerating (RD < 0) or decelerating (RD > 0). Thus we provide here a first proof of concept: the ability to measure four axes of the speed-precision trade-off inherent in a subject’s fundamental decision making: perceptual-motor speed, executive speed, subject accuracy, and reaction to difficulty.