Detailed Neuropsychological Assessment Research Articles

Cognitive Sex Differences: Evidence from Indian Young Adults

In the present study, we examined the effect of sex on cognitive abilities among young adults. Our total sample was comprised of 64 participants (33 females). Males and females were matched with respect to age and years of education. Each participant underwent a detailed neuropsychological assessment, including assessment of attention, executive functions, fluency, verbal and visuospatial memory. Results revealed that females exhibited superior performance in verbal domain such as learning, immediate memory, and fruit fluency. Additionally, a noteworthy trend was observed indicating females’ enhanced performance on verbal delayed recall, animal and vegetable fluency. Contrastingly, no discernible gender-based effects were identified in relation to executive functions, working memory, or visuospatial ability. It is pertinent to note that our findings did not conclusively support male superiority in the visuospatial or verbal domains. In conclusion, the present study provides valuable insights into sex-related differences in cognitive abilities among young adults. Nonetheless, further investigations employing larger sample sizes across diverse age groups are imperative to validate and extend these findings.

Clinical value of Alzheimer's disease biomarker testing.

In the Investigating the Impact of Alzheimer's Disease Diagnostics in British Columbia (IMPACT-AD BC) study, we aimed to understand how Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarker testing-used in medical care-impacted medical decision-making (medical utility), personal decision-making (personal utility), and health system economics. The study was designed as an observational, longitudinal cohort study. A total of 149 patients were enrolled between February 2019 and July 2021. Patients referred to memory clinics were approached to participate if their dementia specialist ordered AD CSF biomarker testing as part of their routine medical care, and the clinical scenario met the appropriate use criteria for lumbar puncture and AD CSF biomarker testing. For the medical utility pillar, detailed clinical management plans were collected via physician questionnaires pre- and post-biomarker disclosure. Patients with completed management questionnaires (n = 142) had a median age of 64 (interquartile range: 59-69) years, 48% were female, and 60% had CSF biomarker profiles on the AD continuum. Clinical management changed in 89.4% of cases. AD biomarker testing was associated with decreased need for other diagnostic procedures, including brain imaging (-52.0%) and detailed neuropsychological assessments (-63.2%), increased referrals and counseling (57.0%), and guided AD-related drug prescriptions (+88.4% and -50.0% in biomarker-positive and -negative cases, respectively). AD biomarker testing was associated with significant and positive changes in clinical management, including decreased health care resource use, therapy optimization, and increased patient and family member counseling. While certain changes in management were linked to the AD biomarker profile (e.g., referral to clinical trials), the majority of changes were independent of baseline clinical presentation and level of cognitive impairment, demonstrating a broad value for AD biomarker testing in individuals meeting the appropriate use criteria for testing.

Parkinson's disease CA2-CA3 hippocampal atrophy is accompanied by increased cholinergic innervation in patients with normal cognition but not in patients with mild cognitive impairment.

Although brain cholinergic denervation has been largely associated with cognitive decline in patients with Parkinson's disease (PD), new evidence suggests that cholinergic upregulation occurs in the hippocampus of PD patients without cognitive deficits. The specific hippocampal sectors and potential mechanisms of this cholinergic compensatory process have been further studied here, using MRI volumetry and morphometry coupled with molecular imaging using the PET radiotracer [18F]-Fluoroethoxybenzovesamicol ([18F]-FEOBV). Following a thorough screening procedure, 18 participants were selected and evenly distributed in three groups, including cognitively normal PD patients (PD-CN), PD patients with mild cognitive impairment (PD-MCI), and healthy volunteers (HV). Participants underwent a detailed neuropsychological assessment, structural MRI, and PET imaging with [18F]-FEOBV. Basal forebrain Ch1-Ch2 volumes were measured using stereotaxic mapping. Hippocampal subfields were automatically defined using the MAGeT-Brain segmentation algorithm. Cholinergic innervation density was quantified using [18F]-FEOBV uptake. Compared with HV, both PD-CN and PD-MCI displayed significantly reduced volumes in CA2-CA3 bilaterally. We found no other hippocampal subfield nor Ch1-Ch2 volume differences between the three groups. PET imaging revealed higher [18F]-FEOBV uptake in CA2-CA3 of the PD-CN compared with HV or PD-MCI. A positive correlation was observed between cognitive performances and [18F]-FEOBV uptake in the right CA2-CA3 subfield. Reduced volume, together with increased [18F]-FEOBV uptake, were observed specifically in the CA2-CA3 hippocampal subfields. However, while the volume change was observed in both PD-CN and PD-MCI, increased [18F]-FEOBV uptake was present only in the PD-CN group. This suggests that a cholinergic compensatory process takes place in the atrophied CA2-CA3 hippocampal subfields and might underlie normal cognition in PD.

Effect of multivitamin-mineral supplementation versus placebo on cognitive function: results from the clinic subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS) randomized clinical trial and meta-analysis of 3 cognitive studies within COSMOS

BackgroundLonger effects of multivitamin-mineral (MVM) supplementation on late-life cognitive function remain untested using in-person, detailed neuropsychological assessments. Furthermore, insufficient evidence exists for healthcare providers to recommend daily MVM supplements to prevent cognitive decline. ObjectivesThis study aimed to test MVM effects on cognitive change using in-person, detailed neuropsychological assessments and conduct a meta-analysis within COSMOS (COcoa Supplement and Multivitamin Outcomes Study) cognitive substudies for a robust evaluation of MVM effects on cognition. MethodsCOSMOS is a 2 × 2 factorial trial of cocoa extract (500 mg flavanols/d) and/or a daily MVM supplement for cardiovascular disease and cancer prevention among 21,442 United States adults aged ≥60 y. There were 573 participants in the clinic subcohort of COSMOS (that is, COSMOS-Clinic) who completed all cognitive tests administered at baseline. For the meta-analysis, we included nonoverlapping participants across 3 COSMOS cognitive substudies: COSMOS-Clinic (n = 573); COSMOS-Mind (n = 2158); COSMOS-Web (n = 2472). ResultsIn COSMOS-Clinic, we observed a modest benefit of MVM compared with placebo on global cognition over 2 y {mean difference [95% confidence interval (CI)] = 0.06 SD units (SU) (−0.003, 0.13)}, with a significantly more favorable change in episodic memory [mean difference (95% CI) = 0.12 SU (0.002, 0.23)] but not in executive function or attention [mean difference (95% CI) = 0.04 SU (−0.04, 0.11)]. The meta-analysis of COSMOS substudies showed clear evidence of MVM benefits on global cognition [mean difference (95% CI) = 0.07 SU (0.03, 0.11); P = 0.0009] and episodic memory [mean difference (95% CI) = 0.06 SU (0.03, 0.10); P = 0.0007]; the magnitude of effect on global cognition was equivalent to reducing cognitive aging by 2 y. ConclusionsIn COSMOS-Clinic, daily MVM supplementation leads to a significantly more favorable 2-y change in episodic memory. The meta-analysis within COSMOS cognitive substudies indicates that daily MVM significantly benefits both global cognition and episodic memory. These findings within the COSMOS trial support the benefits of a daily MVM in preventing cognitive decline among older adults.This trial was registered at COSMOS—clinicaltrials.gov as NCT02422745, at COSMOS-Mind—clinicaltrials.gov as NCT03035201, and at COSMOS-Web—clinicaltrials.gov as NCT04582617.

Development and Validation of a Screening Questionnaire for Dementia With Lewy Bodies (DLB): the DLB Screening Questionnaire (DLBSQ).

Although dementia with Lewy bodies (DLB) is the second most common cause of neurodegenerative dementia, its clinical prevalence is low. We developed a short and easy-to-complete DLB screening questionnaire (DLBSQ) to raise diagnostic sensitivity in routine clinical settings. A total of 501 participants were retrospectively enrolled, including 71 controls, 184 patients without DLB, and 246 patients with probable DLB. All patients underwent clinical evaluation, including core features of DLB, the DLBSQ, brain magnetic resonance imaging, and detailed neuropsychological assessments. The diagnostic performance of the DLBSQ for probable DLB was investigated using a receiver operating characteristic curve analysis. Total DLBSQ score was associated with visuospatial and frontal/executive dysfunction and the diagnosis of probable DLB. The area under the receiver operating characteristic curve for total DLBSQ score was 0.727. Youden's method revealed an optimal cutoff value of 3. The sensitivity and specificity of the DLBSQ were 68.7% and 62.4%, respectively. Its discriminating performance improved when cognitive test profiles were additionally considered (area under the curve: 0.822, sensitivity: 80.6%, and specificity: 70.4%). The DLBSQ might be a useful screening tool for DLB in routine clinical practice with good sensitivity and specificity.

Executive Functions, Processing Speed, and Memory Performance: Untangling the Age-related Effects

Abstract Context: Age-related decline in memory function is a universal phenomenon. However, several factors are known to affect memory decline associated with aging. Aim: The present research aimed to study the differences between young adults and older adults in neurocognitive functions. It also aimed to examine the relative contribution of aging and executive functions to memory performance. Subjects and Methods: The sample consisted of two groups: 43 young adults and 40 older adults. Participants were selected from the community using purposive sampling. Each participant underwent screening using the Edinburgh Handedness Inventory, Modified Mini Screen, and Global Cognitive Screen. A detailed neuropsychological assessment was individually conducted using standardized measures of executive functions, processing speed, episodic memory, and semantic memory. We examined group differences between younger and older participants using the Mann Whitney U test. Additionally, we investigated the contributions of age, processing speed, and executive function to memory through stepwise multiple regression analysis. Results: Analysis of the results suggests significantly worse performance by older participants compared to younger participants on learning and memory (p<.001), semantic memory (p<.001), processing speed (p<.001), and executive functions (p<.001). Our results further indicate that age, processing speed, and executive functions were associated with better performance in learning and memory. However, age emerged as the strongest predictor, followed by processing speed and working memory. Conclusion: Our study demonstrates that aging plays the most significant role in predicting the decline of learning and memory, as well as semantic memory. However, executive functions and processing speed can differentially influence age-associated memory decline. Future studies are warranted on larger populations and more diverse age groups to better comprehend the differential roles of speed, executive functions, and aging on memory performance. We recommend developing age- and education-based normative data for neuropsychological tools specifically tailored to the Indian population.

Effect of cocoa extract supplementation on cognitive function: results from the clinic subcohort of the COSMOS trial

BackgroundSome prior randomized clinical trials (RCTs) that tested the effects of cocoa extract (CE), a source of flavanols, on late-life cognition have yielded promising findings. A long-term RCT using in-person neuropsychological tests covering multiple cognitive domains may clarify the cognitive effects of CE. ObjectivesTo test whether daily supplementation with CE, compared with placebo, produces better cognitive change over 2 y. MethodsThe COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a 2 × 2 factorial RCT of CE [500 mg flavanols/d, including 80 mg (–)-epicatechin] and/or a daily multivitamin-mineral supplement for cardiovascular disease and cancer prevention among 21,442 United States adults aged ≥60 y. There were 573 participants in the clinic subcohort of COSMOS (that is, COSMOS-Clinic) who completed all cognitive tests at baseline; of these, 492 completed 2-y follow-up assessments. The primary outcome was global cognition (averaging z-scores across 11 tests). Secondary outcomes were episodic memory and executive function/attention. Repeated measures models were used to compare randomized groups. ResultsParticipants' mean age (standard deviation) was 69.6 (5.3); 49.2% were females. Daily supplementation with CE, compared with placebo, had no significant effect on 2-y change in global cognition {mean difference [95% confidence interval (CI)]: −0.01 (−0.08, 0.05) standard deviation units (SU)}. CE, compared with placebo, had no significant effects on 2-y change in episodic memory [mean difference (95% CI): −0.01 (−0.13, 0.10) SU] or executive function/attention [mean difference (95% CI): 0.003 (−0.07, 0.08) SU]. Subgroup analyses uncorrected for multiple-testing suggested cognitive benefits of CE supplementation, compared with placebo among those with poorer baseline diet quality. ConclusionsAmong 573 older adults who underwent repeat in-person, detailed neuropsychological assessments over 2 y, daily CE supplementation, compared with placebo, showed no overall benefits for global or domain-specific cognitive function. Possible cognitive benefits of CE among those with poorer diet quality warrant further study. Trial registrationThis trial was registered at clinicaltrials.gov with identifier – NCT02422745.

Functional connectome‐based prediction of individual clinical and cognitive scores in midlife population with risk of dementia

AbstractBackgroundIt is well acknowledged that Alzheimer’s Disease (AD) neuropathology start decades before clinical manifestations, but the brain mechanism of sporadic AD in midlife remains unclear. Resting‐state functional connectivity (FC) is increasingly used to understand early brain changes in Alzheimer’s disease (AD) (Sperling, 2011; van den Heuvel & Sporns, 2019). We asked whether risk for late‐life dementia impacts functional connectivity in cognitively healthy middle‐aged individuals.MethodFunctional Magnetic Resonance Imaging and detailed neuropsychological assessments were obtained for 585 (207/378 female/male) cognitively healthy individuals, aged 40‐59 years (mean = 50.9), from the PREVENT‐Dementia study. Dementia risk was calculated with the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score. A novel connectome‐based predictive method called NBS‐Predict was used to investigate the association between FC and CAIDE score and its role in cognition.ResultFC significantly predicted CAIDE scores across the whole cohort (r = 0.207, p < 0.001). FC within and between the cingulo‐opercular network (CON) and sensorimotor network (SMN), as well as between CON and fronto‐parietal network (FPN), and between SMN with default mode network (DMN), and FPN contributed the most (Figure 1). Furthermore, we found that, in the high dementia risk group (CAIDE > 6) only, FC, mainly in DMN‐SMN and DMN‐CON (Figure 2), significantly predicted multisensory processing cognitive score (r = 0.114, p<0.05).ConclusionOur results show that FC can be used to detect early brain changes associated with risk of future dementia in cognitively healthy individuals. This method has implications of the early detection of dementia in preclinical populations.

Protocol for the Tallaght University Hospital Institute for Memory and Cognition-Biobank for Research in Ageing and Neurodegeneration

IntroductionAlzheimer’s disease and other dementias affect >50 million individuals globally and are characterised by broad clinical and biological heterogeneity. Cohort and biobank studies have played a critical role in advancing...

APOE E4 as a moderator for gait speed and executive function

AbstractBackgroundGait speed has been found to be associated with cognitive function (Liu, 2022) with slower walking speed related to poorer cognition (Hoogendijik, 2020). Slower gait speed was found to be associated with poorer global cognitive function, verbal memory and executive function (Watson, 2010). Additionally, APOE E4 carriers with slow gait speed have been found to perform worse on the MMSE than APOE E4 carriers without slow gait and APOE E4 non‐carriers with slow gait (Sakurai, 2017).We aim to evaluate the moderating effects of APOE E4 status on gait speed and cognition in a pre‐dementia community population in Singapore.MethodWe recruited 534 participants from the community who completed a detailed neuropsychological assessment and APOE genotyping. To test for the moderating effects of APOE E4 with gait speed and cognition, we performed a multiple generalized linear model controlling for covariates of age, sex and education.ResultThe cohort included 186 subjects with subjective cognitive decline and 348 mild cognitive impairment subjects from Dementia Research Centre (Singapore). Mean age of the cohort was 62.55, SD = 9.55, mean education years was 13.97, SD = 3.45 and majority were women (57.1%). The presence of slow gait speed among our cohort was 4.7% and there were 12.6% APOE E4 carriers. There were no significant differences in walking gait between APOE E4 carriers and non‐carriers (p = 0.235). APOE E4 moderated the effect of slow gait speed on executive function. APOE E4 non‐carrier interacted with slow gait speed, resulting in worse performance on the trail making task B (β = 71.97, p = 0.003), digit span backwards (β = ‐2.23, p = 0.037), and colour trails 2 (β = 64.01, p<0.001).ConclusionAPOE E4 status moderates the effect of slow gait speed on executive function. APOE E4 non‐carriers with slow gait speed are at risk for poorer executive function.

The detrimental effects of apathy on cognition, frailty and quality of life

AbstractBackgroundApathy is defined as the lack of motivation and has been found to be associated with incident dementia in western populations (Dalen, 2018). Little is known about the impact of apathy in Asians. Apathy is a prevalent behavioural symptom of pre dementia and current literature shows that apathy increases the risk of dementia (Bock, 2020). Apathy is also linked to an increased risk of frailty(Ayers, 2018) and found to impair executive function and processing speed(Lohner, 2017). We aim to evaluate the association of apathy with cognitive function, frailty and lifestyle factors in a pre‐dementia community population in Singapore.MethodWe recruited 534 participants from the community who completed a detailed neuropsychological assessment. Apathy was measured using the mild behavioural impairment checklist (MBI‐C). To test for the association of apathy with the different variables, we performed a multiple generalized linear model controlling for covariates age, sex and education.ResultThe study population included 186 participants with subjective cognitive decline and 348 mild cognitive impairment participants from Dementia Research Centre (Singapore). Mean age of the cohort was 62.55, SD = 9.55, mean education years was 13.97, SD = 3.45 and majority were women (57.1%). The prevalence of apathy among our cohort was 23.5%. Compared to participants without apathy, those with apathy had poorer cognitive scores in processing speed (test of coding) (β = ‐4.60, p<0.001), executive function (colour trails 2) (β = 9.71, p = 0.020), episodic memory on the RAVLT Delayed (β = ‐0.738, p = 0.026), RCFT Delayed (β = ‐1.941, p = 0.009) and FCSRT delayed (β = ‐0.616, p = 0.030). Participants with apathy were also more frail (β = 0.316, p<0.001) on the Fried Phenotype frailty assessment test and had poorer quality of life (β = ‐12.49, p<0.001), had lower levels of physical activity (β = 0.163, p = 0.017), and had poorer sleep (β = 2.25, p<0.001).ConclusionApathy is associated with worse cognitive performance, higher frailty, lower physical performance and poorer sleep in an Asian pre‐dementia community cohort. Screening for apathy and appropriate early intervention could reduce incidence of dementia and frailty.

Usefulness of the Visual Cognitive Assessment Test (VCAT) in detecting mild cognitive impairment in the community

AbstractBackgroundA delay in the detection of Mild Cognitive Impairment (MCI) in the community delays the opportunity for early intervention. Accurate tools to detect MCI in the community are lacking. The Visual Cognitive Assessment Test (VCAT) is a visual based cognitive test useful for multilingual populations without the need for translation. Here, we evaluate the usefulness of VCAT in detecting MCI in a community population in Singapore.MethodWe recruited 469 participants from the community who completed a detailed neuropsychological assessment and 261 of them completed a 3T Magnetic Resonance Imaging (MRI) brain scan. We performed a ROC analysis to test the diagnostic performance of VCAT compared to MoCA in distinguishing mild cognitive impairment (MCI) from cognitively normal (CN) by measuring area under the curve (AUC). To test for the association of VCAT with structural MRI, we performed a Pearson’s correlation analysis for VCAT and MRI variables.ResultWe recruited 39 CN, 168 subjective cognitive decline and 262 MCI participants from Dementia Research Centre (Singapore). Mean age of the cohort was 62.77, SD = 9.57, mean education years was 13.97, SD = 3.41 and majority were women (57.8%). VCAT was effective in detecting MCI from CN with an AUC of 0.794 (95% CI 0.723‐0.865) which was slightly higher than MOCA 0.699 (95% CI 0.621‐0.777). Among subjects with MCI, VCAT was associated with medial temporal lobe atrophy (MTA) (ρ = ‐0.265, p = 0.001).ConclusionThe VCAT is useful in detecting MCI in the community in Singapore and may be an effective measure of neurodegeneration.

Sleep Quality and Cognitive Decline Across the Adult Age Range: Findings from the Maastricht Aging Study (MAAS).

Sleep disturbances have been linked with cognitive decline and a higher risk of dementia. However, there is a lack of studies with sufficient follow-up duration, a detailed neuropsychological assessment and adequate control of main confounders. To investigate the relation between self-reported sleep quality and cognitive decline over 12 years in cognitively healthy individuals from the general population. We used data from the Maastricht Aging Study (MAAS), a Dutch population-based prospective cohort study of 1,823 community-dwelling adults aged 24 to 82 years at baseline. Cognitive performance was measured at baseline, 6 and 12 years on verbal memory, executive functions, and information processing speed. Sleep quality was assessed at baseline using the sleep subscale score of the 90-item Symptom Checklist (SCL-90). Additional modifiable dementia risk factors were summarized in the LIfestyle for BRAin health (LIBRA) risk score. Weighted linear mixed models tested the association between continuous scores and tertiles of subjective sleep quality and change in cognitive performances over time. Models were adjusted for age, gender, educational level, LIBRA, and use of hypnotic (sleep) medication. Worse sleep quality was associated with faster decline in processing speed. At older age (≥65 years), it was also associated with faster decline in verbal memory. Association were independent of other modifiable dementia risk factors and use of hypnotic medication. Directionally similar but non-significant associations were found between worse sleep quality and executive functions. In this population-based study across the adult age range, poor self-reported sleep was associated with accelerated cognitive decline.

Case report: Neuropsychological assessment in a patient with 4H leukodystrophy

Objective: POLR3-HLD or 4H leukodystrophy is an autosomal recessive disorder characterized by hypomyelination, hypodontia, and hypogonadotropic hypogonadism, and caused by variants in POLR3A, POLR3B, POLR1C, or POLR3K genes. Neurological and non-neurological clinical features and disease severity vary. While previous studies reference variable cognition, this is the first report of 4H detailing a comprehensive neuropsychological assessment. Method: The current study presents a 20-year-old, English-speaking, right-handed, non-Hispanic White female with 12 years of education with genetically confirmed 4H POLR3B-related leukodystrophy without hormonal replacement treatment. Results: At age 4, developmental delays, ataxia, hearing loss, and abnormal dentition were present. Imaging, endocrinology, and neurologic examinations revealed hypomyelination, reduced cerebellar volume, delayed bone age density, osteopenia, and evidence of adrenarche without signs of true puberty. Neuropsychological assessment at age 20 revealed global cognitive impairment with intellectual, attention, verbal memory retrieval, construction, executive (e.g. processing speed, sustained attention) and math computation deficits, along with behavioral dysregulation. Conclusion: We present the first detailed neuropsychological assessment of a patient with 4H leukodystrophy. The neuropsychological assessment revealed cognitive and behavioral dysexecutive deficits aligning with hypomyelination observed on imaging. Further longitudinal studies are needed to shed light on the neurobehavioral presentation associated with this disorder to assist care providers, patients, and their families.

Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study

Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43–74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36–0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.

A prospective 5-year longitudinal study detects neurocognitive and imaging correlates of seizure remission in self-limiting Rolandic epilepsy

ObjectiveSelf-limiting Rolandic epilepsy (RE) is the most common epilepsy in school-age children. Seizures are generally infrequent, but cognitive, language, and motor coordination problems can significantly impact the child’s life. To better understand brain structure and function changes in RE, we longitudinally assessed neurocognition, cortical thickness, and subcortical volumes. MethodsAt baseline, we recruited 30 participants diagnosed with RE and 24-healthy controls and followed up for 4.94 ± 0.8 years when the participants with RE were in seizure remission. Measures included were as follows: T1-weighted magnetic resonance brain imaging (MRI) with FreeSurfer analysis and detailed neuropsychological assessments. MRI and neuropsychological data were compared between baseline and follow-up in seizure remission. ResultsLongitudinal MRI revealed excess cortical thinning in the left-orbitofrontal (p = 0.0001) and pre-central gyrus (p = 0.044).There is a significant association (p = 0.003) between a reduction in cortical thickness in the left-orbitofrontal cluster and improved processing of filtered words.Longitudinal neuropsychology revealed significant improvements in the symptoms of developmental coordination disorder (DCD, p = 0.005) in seizure remission. ConclusionsThere is evidence for altered development of neocortical regions between active seizure state and seizure remission in RE within two clusters maximal in the left-orbitofrontal and pre-central gyrus. There is significant evidence for improvement in motor coordination between active seizures and seizure remission and suggestive evidence for a decline in fluid intelligence and gains in auditory processing.

The effect of vitamin D on neurocognitive functions in older vitamin D deficient adults: a pilot longitudinal interventional study.

The relationship between vitamin D and cognitive status remains controversial. We aimed to evaluate the effect of vitamin D replacement on cognitive functions in healthy and cognitively intact vitamin D deficient older females. This study was designed as a prospective interventional study. A total of 30 female adults aged ≥60 with a serum 25 (OH) vitamin D level of <10 ng/ml were included. Participants were administered 50 000 IU vitamin D3 weekly for 8 weeks followed by a maintenance therapy of 1000 U/day. Detailed neuropsychological assessment was performed prior to vitamin D replacement and repeated at 6 months by the same psychologist. Mean age was 63 ± 6.7 years and baseline vitamin D level was 7.8 ± 2.0 (range: 3.5-10.3) ng/ml. At 6 months, vitamin D level was 32.5 ± 3.4 (32.2-55) ng/ml. The Judgement of Line Orientation Test (P = 0.04), inaccurate word memorizing of the Verbal Memory Processes Test (P = 0.02), perseveration scores of the Verbal Memory Processes Test (P = 0.005), topographical accuracy of the Warrington Recognition Memory Test (P = 0.002), and the spontaneous self-correction of an error in the Boston Naming Test (P = 0.003) scores increased significantly, while the delayed recall score in the Verbal Memory Processes Test (P = 0.03), incorrect naming of words in the Boston Naming Test (P = 0.04), interference time of the Stroop Test (P = 0.05), and spontaneous corrections of the Stroop Test (P = 0.02) scores decreased significantly from baseline. Vitamin D replacement has a positive effect on cognitive domains related to visuospatial, executive, and memory processing functions.

The effects of carotid artery stiffness on cerebral small vessel disease and cognition

AbstractBackgroundCarotid artery stiffness is associated with cognitive impairment and dementia, however, the underlying mechanism remains unknown. We examined the association of carotid artery stiffness with cerebral small vessel disease (CSVD) markers, cognitive impairment, dementia with its subtypes, as well as cognitive performance.MethodIn this case‐control study, 272 subjects from a memory clinic underwent physical and medical evaluation along with carotid ultrasonography, 3T brain magnetic resonance imaging and detailed neuropsychological assessment. Carotid ultrasonography was conducted to assess arterial compliance (AC), pressure‐strain elastic modulus (Ep), β‐index, augmentation index (AI), and pulse wave velocity‐β (PWV‐β). Brain MRIs were graded for white matter hyperintensities (WMH), lacunes, and cerebral microbleeds (CMBs). Participants were classified as no cognitive impairment, cognitive impairment no dementia, as well as dementia and its subtypes; Alzheimer’s disease (AD) and vascular dementia (VaD). Cognition was assessed using NINDS–Canadian Stroke Network harmonization neuropsychological battery.ResultIncreased carotid β‐index (β = 0.73, P&lt;0.001), Ep (β = 0.86, P&lt;0.001), and PWV‐β (β = 0.83, P&lt;0.001) were independently associated with WMH. Ep (OR = 1.42, 95%CI = 1.05–1.93), and PWV‐β (OR = 1.43, 95%CI = 1.05–1.94) were associated with presence of lacunes. Ep was associated with AD (OR = 1.59, 95%CI = 1.01‐2.73) and VaD (OR = 2.23, 95%CI = 1.04‐5.94). Additionally, PWV‐β was associated with VaD (OR = 2.24, 95%CI = 1.07–5.62). All carotid artery stiffness measurements, except AI, were associated with worse performance in global cognition, visuomotor speed and memory after adjusting for age, sex, education, hypertension, diabetes, hyperlipidaemia, cardiovascular disease, and smoking. These associations became attenuated but remained significant with global cognition after adjusting for CSVD markers (β‐index; β = ‐0.27, P = 0.04), Ep; β = ‐0.30, P = 0.03), and PWV‐β; β = ‐0.32, P = 0.02).ConclusionCarotid artery stiffening is associated with WMH, lacunes, and etiologic subtypes of dementia. Carotid artery stiffening is also associated with global cognition independent of CSVD. Elevated carotid artery stiffness may help identify patients at risk for developing CSVD and dementia.

ADVANCE-TBI study protocol: traumatic brain injury outcomes in UK military personnel serving in Afghanistan between 2003 and 2014 – a longitudinal cohort study

IntroductionOutcomes of traumatic brain injury (TBI) are highly variable, with cognitive and psychiatric problems often present in survivors, including an increased dementia risk in the long term. Military personnel are...

Post-operative cognitive dysfunction in patients following gastrointestinal endoscopic treatment

We aimed to explore the changes in post-operative cognitive dysfunction (POCD) after gastrointestinal endoscopic treatment using detailed neuropsychological assessments. Patients hospitalized for gastrointestinal endoscopic polypectomy were recruited for neuropsychological evaluations, which included the Chinese version of the Mini-Mental State Examination (MMSE), Auditory-Verbal Learning Test, Digit Span Test (DST), Trail Making Task (TMT), Verbal Fluency Test, Clock Drawing Test, and Stroop test. Cognitive assessments were performed twice: one day before and 24 h after treatment. Healthy control subjects participated in the neuropsychological assessment during the same intervals. Detailed cognitive assessments were performed for 40 patients and 60 control subjects. Based on the Z scores, the incidence of POCD 24 h after gastrointestinal endoscopic treatment was 20%. Patients with POCD had significant impairment in the post-operative MMSE, forward DST, TMT, and Stroop interference effect correct count tests (all p < 0.05). Our preliminary results showed that patients were not fully recovered, and 20% had impairment in multiple cognitive assessments 24 h after a gastrointestinal endoscopy. As attention was affected, safety while discharging those patients should be a concern.