Impaired Attention Research Articles

Cholinergic basal forebrain system degeneration underlies postural instability/gait difficulty and attention impairment in Parkinson's disease.

The specific pathophysiological mechanisms underlying postural instability/gait difficulty (PIGD) and cognitive function in Parkinson's disease (PD) remain unclear. Both postural and gait control, as well as cognitive function, are associated with the cholinergic basal forebrain (cBF) system. A total of 84 PD patients and 82 normal controls were enrolled. Each participant underwent motor and cognitive assessments. Diffusion tensor imaging was used to detect structural abnormalities in the cBF system. The cBF was segmented using FreeSurfer, and its fiber tract was traced using probabilistic tractography. To provide information on extracellular water accumulation, free-water fraction (FWf) was quantified. FWf in the cBF and its fiber tract, as well as cortical projection density, were extracted for statistical analyses. Patients had significantly higher FWf in the cBF (p < 0.001) and fiber tract (p = 0.021) than normal controls, as well as significantly lower cBF projection in the occipital (p < 0.001), parietal (p < 0.001) and prefrontal cortex (p = 0.005). In patients, a higher FWf in the cBF correlated with worse PIGD score (r = 0.306, p = 0.006) and longer Trail Making Test A time (r = 0.303, p = 0.007). Attentional function (Trail Making Test A) partially mediated the association between FWf in the cBF and PIGD score (indirect effect, a*b = 0.071; total effect, c = 0.256; p = 0.006). Our findings suggest that degeneration of the cBF system in PD, from the cBF to its fiber tract and cortical projection, plays an important role in cognitive-motor interaction.

Cross-Sectional Analysis of Periodontal Disease and Cognitive Impairment Conducted in a Memory Clinic: The Pearl Study.

Periodontal disease (PeD) is a risk factor of Alzheimer's disease and is associated with cognitive decline in older adults. However, the relationships between subitems of neuropsychological tests and PeD have not been fully clarified. To evaluate associations between PeD and subitems of neuropsychological tests. We performed a cross-sectional analysis of data of 183 participants (women: 50%, mean age: 79 years) from a clinical study. We enrolled patients who visited our memory clinic and assessed demographics, dementia-related risk factors, neuropsychological tests, brain magnetic resonance images, and a dental screening check. We evaluated the relationships between cognitive function and PeD using multivariable logistic regression analyses. Participants with dementia were less likely to make periodical visits to the dentist, had fewer teeth, had less frequent tooth brushing habits, and were more likely to have PeD. Impaired cognitive function was significantly associated with an increasing degree of PeD. In multivariable logistic regression analyses, impaired visuospatial function and attention were associated with twice the risk of moderate or severe PeD compared with individuals with preserved visuospatial function and attention (odds ratio: 2.11, 95% confidence interval: 1.04-4.29, p = 0.037). Impaired word recall and recognition and following commands were associated with increased risk of PeD (odds ratio: 2.80, 95% confidence interval: 1.41-5.32, p = 0.003). Cognitive decline, such as impaired visuospatial function, attention, word recall and recognition, and inability to follow commands were independently and strongly associated with PeD. These items can be assessed easily on a daily basis.

Recognition and Perception of Emotions in Juvenile Myoclonic Epilepsy.

Perception and recognition of emotions are fundamental prerequisites of human life. Patients with juvenile myoclonic epilepsy (JME) may have emotional and behavioral impairments which might influence socially desirable interactions. We aimed to investigate perception and recognition of emotions in patients with JME by means of neuropsychological tests and functional MRI (fMRI). Sixty-five patients with JME (median age 27 years, IQR 23-34) were prospectively recruited at the Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria. Patients were compared to 68 healthy controls (median age 24 years, IQR 21-31), matched for sex, age and education. All study participants underwent the Networks of Emotion Processing test battery (NEmo), an fMRI paradigm of "dynamic fearful faces", structured interview for psychiatric and personality disorders and comprehensive neuropsychological testing. JME patients versus healthy controls, demonstrated significant deficits in emotion recognition in facial and verbal tasks of all emotions, especially fear. fMRI revealed decreased amygdala activation in JME patients as compared to healthy controls. Patients were at a higher risk of experiencing psychiatric disorders as compared to healthy controls. Cognitive evaluation revealed impaired attentional and executive functioning, namely psychomotor speed, tonic alertness, divided attention, mental flexibility, and inhibition of automated reactions. Duration of epilepsy correlated negatively with parallel prosodic and facial emotion recognition in NEmo. Deficits in emotion recognition were not associated with psychiatric comorbidities, impaired attention and executive functions, types of seizures and treatment. This prospective study demonstrated that as compared to healthy subjects, patients with JME had significant deficits in recognition and perception of emotions as shown by neuropsychological tests and fMRI. The results of this study may have importance for psychological/psychotherapeutical interventions in the management of patients with JME.

Domain-specific cognitive impairment 6 months after stroke: The value of early cognitive screening.

Cognitive screening following stroke is widely recommended, yet few studies have considered the prognostic value of acute domain-specific function for longer-term cognitive outcome. Identifying which post-stroke cognitive impairments more commonly occur, recover, and persist, and which impairments hold prognostic value, could inform care planning, and resource allocation. This study aimed to determine the prevalence of domain-specific impairment acutely and at 6 months, assess the proportion of change in cognitive performance, and examine the prognostic value of acute domain-specific cognitive screening. A prospective stroke cohort completed the Oxford Cognitive Screen acutely (⩽2 weeks) and 6 months post-stroke. We determined the prevalence of acute and 6-month domain-specific impairment and proportion of change in performance from acute to 6 months. Hierarchical multivariable regression was used to predict global and domain-specific cognitive impairment at 6 months adjusted for demographic/vascular factors, stroke severity, and lesion volume. A total of 430 stroke survivors (mean/SD age 73.9/12.5 years, 46.5% female, median/interquartile range (IQR) National Institute of Health Stroke Scale (NIHSS) 5/2-10) completed 6-month follow-up. Acutely, domain-specific impairments were highly prevalent ranging from 26.7% (n = 112) in praxis to 46.8% (n = 183) in attention. At 6 months, the proportion of domain-specific recovery was highest in praxis (n = 73, 71%) and lowest in language (n = 89, 46%) and memory (n = 82, 48%). Severity of 6-month cognitive impairment was best predicted by the addition of acute cognitive impairment (adj R2 = 0.298, p < 0.0001) over demographic and clinical factors alone (adj R2 = 0.105, p < 0.0001). Acute cognitive function was the strongest predictor of 6-month cognitive performance (p < 0.0001). Acute domain-specific impairments in memory (p < 0.0001), language (p < 0.0001), and praxis (p < 0.0001) significantly predicted overall severity of cognitive impairment at 6 months. Post-stroke cognitive impairment is highly prevalent across all domains acutely, while impairments in language, memory, and attention predominate at 6 months. Early domain-specific screening can provide valuable prognostic information for longer-term cognitive outcomes.

Comparative the Diurnal changes in the Cognitive abilities of Patients with Parkinson's disease, from Morning to Afternoon

Introduction: Parkinson’s Diseases is primarily caused by damage of dopaminergic neurons in the nigrostriatal pathway and accumulation of aggregated a-snucleui in specific brain stem, spinal cord, and cortical region.The loss of dopamine is predominantly severe in the putamen, which explains the motor manifestations of the disease; other dopaminergic projections are also affected and contribute to the development of cognitive impairment. Cognitive dysfunction is common in Parkinson’s disease and predicts poor clinical outcomes. It is associated primarily with pathologic involvement of basal forebrain cholinergic and prefrontal dopaminergic systems. Impairments in executive functions, attention, and visuospatial abilities are its hallmark features with eventual involvement of memory and other domains. Aim: Compare the diurnal changes in cognitive abilities of patients with Parkinson's Disease over morning versus evening Methodology: Patients were selected for this study in the sample size of 30. The Mean age group of Parkinson’s patients lie in between 60- 70 year. Random sampling was done, Collection of Data from SAM global University, Bilkheriya. In the inclusion criteria MMSE Score is equal to 25, well understand the Hindi and English language, with having normal hearing capacity. In the exclusion criteria patient with wheel chair excluded and having Severe cognitive impairments or presence of any psychiatric impairments Result: Difference in cognition on the total score of PDCRS between Morning to Evening.(&lt;0.05).There was considerable cognitive decline seen as the day wears out Conclusions: Diurnal variation present in the subjects with Parkinson's disease seeing that there were significant variations in the scores of the patients on the cognitive rating scale from morning to evening.

B - 105 Long COVID: a Pediatric Neuropsychological Case Study.

A neuropsychological case review of Long COVID. Long COVID remains to be a controversial topic in terms of cognitive residuals from contracting the virus. This child was referred due to acute cognitive changes post-COVID-19 contraction. Active COVID-19 infection was generally unremarkable. Patient did not require hospitalization or medication intervention. This patient is a 14-year-old, Caucasian, right-handed male. A psychiatrist referred the patient due to emotional (anxiety and oppositionality), cognitive (attention, reduced processing, memory, "brain fog,"), and physical (disrupted sleep, fatigue) changes post-infection. The diagnostic question was to rule out ADHD and oppositionality prior to obtaining MRI results. MRI of the brain, 30days post-infection, revealed multiple subcortical white matter lesions, located in the cerebral hemispheres near the grey-white matter junction, particularly in the frontal and parietal lobes. Patient was administered the Meyers Neuropsychological Battery (MNB). Findings were consistent with diffuse neuropsychological deficits, that is, reduced processing speed, impaired attention, and below average immediate and delayed memory (spatial > verbal). Psychological findings were consistent with an ongoing anxiety disorder. Initial diagnostic impression of ADHD and oppositional defiance was ruled-out. MNB analysis revealed a pattern of findings consistent with diffuse neuropsychological deficits relating to an inflammatory condition such as Long COVID. Memory, attention, and processing speed were below the cut-off, a finding in agreement with previous research showing impaired results, especially for memory. Because memory, as well as fatigue, seems to be affected by COVID-19, future research should explore possible interactions with cognition and fatigue following COVID-19.

H - 69 Making Diagnostic Decisions Using Linguistically Congruent Neuropsychological Assessment in a Monolingual Low Education Latino: a Single Case.

As life expectancy and Latino populations increase in the United States, it is important to provide linguistically congruent neuropsychological assessments to assist in the treatment and diagnosis of neurodegenerative processes. This case used a linguistically congruent evaluation and appropriate norms in a 72-year-old Latin male with low education, to inform treatment recommendations. A 72-year-old Latin male with five years of education was referred by his neurologist in the context of cognitive, behavioral, and functional decline over the past several years. He was educated outside of the United States, in a Spanish-speaking country, and speaks limited English. Therefore, testing was administered in Spanish. All test data were compared to other Spanish-speaking clinical patients with low education levels from his country of origin when available (11 articles). Overall given the evidence, he was diagnosed with Mild Neurocognitive Disorder due to Multiple Etiologies, with behavioral disturbance. His profile revealed weaknesses in verbal learning and memory, attention, and psychomotor processing speed. However, when compared to non-corrected norms, he performed significantly different (at least 1 SD) across several measures. Using a linguistically congruent evaluation, in addition to a compilation of age and education-corrected norms, we came to a diagnostic conclusion of a Mild Neurocognitive Disorder. If the normative data not been corrected for age and education, his impairments in visuospatial abilities and attention would have been inflated. As the Latino population continues to age, it becomes increasingly important to develop ways to assess this population appropriately.

H - 38 Neuropsychological Evaluation and Cognitive Profile of Stiff Person Syndrome (SPS) in a Predominantly Spanish-Speaking Older Adult: Is Cognition Really Affected?

Stiff Person Syndrome (SPS) is a rare autoimmune disorder that affects approximately one in every million people. It is characterized by progressive muscle rigidity and intense, episodic muscle spasms triggered by environmental and psychosocial (i.e., emotional stress) factors. While original diagnostic criteria for classical SPS included the absence of frank cognitive impairment (aside from what would be expected from seizures), more recent literature suggests a number of neurocognitive difficulties potentially associated with reduced GABA levels. The following case study presents a 73-year-old, predominantly Spanish-speaking man with 14years of education. His medical history is notable for over 20years with diagnosed SPS, hypertension well managed with medications, and the absence of other medical conditions that may contribute to cerebrovascular burden. He completed a comprehensive neuropsychological evaluation in Spanish. Overall, his profile was notable for mild inefficiencies in frontal-subcortical functions, with a relative weakness in rote learning and retention. He performed remarkably well relative to his level of motor compromise. There was no evidence of either a mild or major neurocognitive disorder, and his clinical interview and behavioral inventories were suspicious for a personality disorder. Recent literature proposes SPS is related to impairment in verbal learning, retention, fluency, processing speed, and attention. The present case corroborated, at most, mild inefficiencies in these previously documented areas. Careful consideration should be used in the evaluation of studies on SPS and cognition, particularly in determining whether samples had high degrees of comorbid conditions (i.e., cerebrovascular burden) that could help explain positive findings related to cognition.

Effects of oral Δ9-tetrahydrocannabinol and cannabidiol combinations on a sustained attention task in rats.

A well-documented side effect of cannabis and Δ9-tetrahydrocannabinol (THC) acute administration is deficits in cognition and attention. Cannabidiol (CBD), a nonintoxicating constituent of cannabis, may modulate THC's impairing effects. A goal of this study was to determine the effects of THC and CBD, alone and in combination, on performance in the rodent Psychomotor Vigilance Test (rPVT), a translational paradigm used to quantify sustained attention. Outcome measures in the rPVT include motor speed, premature responding, and lapses in attention. Sprague Dawley rats were trained to perform the rPVT to the acquisition criteria and then received oral doses (mg/kg) of THC (1-17.6), CBD (1-100), and combinations of THC + CBD in sesame oil prior to rPVT sessions, administered in a within-subject randomized design. Blood was collected from rats receiving selected doses of THC alone or THC + CBD for analysis of THC and its metabolites. THC alone produced significant decreases in accuracy and increases in lapses in attention at higher doses (10 mg/kg; ps < .05). The coadministration of CBD (10 mg/kg) with THC (3 or 10 mg/kg) caused greater impairments to sustained attention compared with administration of THC alone (ps < .05). The rPVT is a translational platform sensitive to detect impairments in attention associated with THC and other cannabis constituents. Further work is necessary to determine the mechanism of THC and CBD interactions on impairments in sustained attention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The therapeutic effect of acupuncture on neurocognitive disorders under the concept of outcome based education

BackgroundThe neurocognitive disorder is a common neuropsychological disease characterized by impaired cognitive function, attention deficit, and memory loss. With the aging of the population and lifestyle changes, the prevalence of neurocognitive disorders is on the rise, seriously affecting patients’ quality of life. Acupuncture therapy, an essential part of traditional Chinese medicine, has shown potential therapeutic effects in treating neurocognitive disorders.Subjects and MethodsThe outcome based education concept was incorporated into acupuncture therapy to explore its therapeutic effect on neurocognitive disorders. The study included 50 neurocognitive-impaired patients, 25 of whom received acupuncture therapy under the outcome based education concept as an experimental group. The other 25 served as a control group and received traditional Chinese acupuncture treatment. The experiment lasted three months, and the 3-minute Delirium Diagnostic Scale (3D-CAM) was used to measure the level of consciousness, mental clarity, attention, and delirium characteristics.ResultsAfter receiving acupuncture therapy under the outcome based education concept, most of the patients in the experimental group had a lower risk of delirium, and their attention, thinking, and consciousness levels were significantly improved. Patients in the control group generally had a higher risk of delirium, difficulty concentrating, and memory loss.ConclusionsThe study proposed that the outcome based education concept in acupuncture therapy has a more noticeable effect on treating neurocognitive disorders. At the same time, this study’s results will help reveal the mechanism of acupuncture therapy in treating neurocognitive disorders and provide guidance for clinical practice.AcknowledgementThe research is supported by the Key R&amp;D project of Hainan Province (No.zdyf2019191).

Glioblastomas at the white matter of temporo-parietal junction cause a poor postoperative independence level.

Right cerebral hemispheric glioblastomas (GBMs) often decrease the Karnofsky performance status (KPS) score postoperatively, despite the patient having sufficient patient function while performing daily living. This study aimed to evaluate the factors that could cause poor KPS scores during the postoperative chronic phase in patients with right cerebral hemispheric GBMs. Data of 47 patients with newly diagnosed right cerebral hemispheric GBMs were analyzed. All patients were assessed preoperatively and 3 months postoperatively to determine KPS and brain function. To determine tumor location related to the postoperative KPS scores, we used voxel-based lesion symptom mapping (VLSM). The patients were divided into two groups (involvement and non-involvement groups) based on whether their lesion involved a significant region identified by VLSM. We then compared functional factors and prognosis between the groups using the chi-squared and log-rank tests, respectively. The KPS score significantly decreased after surgery compared to that preoperatively measured (p = 0.023). VLSM revealed that tumors in the white matter of temporo-parietal junction (WM-TPJ) caused a significant decline in the KPS score at three months postoperatively. The patients in the involvement group had a higher probability of impaired attention, visuospatial cognition, emotion recognition, and visual field than did those in the non-involvement group. In addition, tumor in the WM-TPJ were associated with shorter progression-free survival and overall survival (p = 0.039 and 0.023, respectively). GBMs involving the right WM-TPJ are more likely to result in poor postoperative KPS scores and prognoses. Impairments of several kinds of brain functions caused by tumor invasion to the WM-TPJ may be associated with lower KPS scores.

Clinical characteristics and cognitive function in bipolar disorder patients with different onset symptom.

In recent years, studies on the clinical features and cognitive impairment of patients with different first-episode types of bipolar disorder have received increasing attention. The patients with bipolar disorder may present with different symptoms at first onset. The aim of this study is to assess the cognitive functions of a patient's index episode of bipolar disorder, depression or mania, on risk factors of effecting on cognitive functions. One hundred sixty eight patients with bipolar disorder diagnosed for the first time were enrolled in the study. All patients were divided into two groups according to their index episode of bipolar disorder, either depression or mania. Seventy three patients of the cohort had an index episode mania and 95 patients had initial symptoms of depression. Demographic and clinical disease characteristic data of all enrolled patients were collected. Meanwhile, 75 healthy controls were included. Demographic data of controls were collected. The cognitive functions of all patients and controls were detected by continuous performance test (CPT), digital span test (DST) and Wisconsin card sorting test (WCST). The main cognitive functions data were compared among the mania group, depression group and control group. The relevant risk factors affecting cognitive function were analyzed. (1) Most patients with bipolar disorder had an index episode depression (56.55% vs. 43.45%). Compared with the depression group, the mania group had later age of onset [(24.01 ± 4.254) vs. (22.25 ± 6.472), t = 2. 122, p = 0.035]. The education level of patient groups was lower than control group (p < 0.001). (2) The healthy control group's DST, WCST and CPT scores were better than the patient groups (All p < 0.05). The mania group's DST (forward, reverse, sum), WCST (total responses, completed classifications, correct responses, incorrect responses, percentage of correct responses, completed the number of responses required for classification, the percentage of conceptualization level, the number of persistent responses, non-persistent errors), CPT (2 digit score, 3 digit score, 4 digit score) was better than the depression group (p < 0.05). (3) In mania group, correlation analysis showed that all CPT parameter, inverse digit span, and the sum of DST was negatively correlated with the education level (All p < 0.05). The CPT-4 digit score was negatively correlated with onset age (p < 0.05). In the WCST, the number of correct responses, the percentage of correct responses and the percentage of conceptualization level were positively correlated with the BRMS score (All p < 0.05). The number of false responses and persistent responses were negatively correlated with the BRMS score (All p < 0.05). The number of persistent errors and percentage of persistent errors was positively correlated with education years (All p < 0.05). In depression group, there was a positive correlation between inverse digit span and the education level (p < 0.05). In our study, there were cognitive impairments in attention, memory, and executive function of patients with different onset syndromes of bipolar disorder. Compared with the mania group, the degree of cognitive impairments in bipolar patients with the depressive episode was more severe. The risk factors affecting cognitive impairments included the age of onset, education level, number of hospitalizations and severity of illness.

EEG Microstates as Markers for Cognitive Impairments in Fragile X Syndrome.

Fragile X syndrome (FXS) is one of the most common inherited causes of intellectual disabilities. While there is currently no cure for FXS, EEG is considered an important method to investigate the pathophysiology and evaluate behavioral and cognitive treatments. We conducted EEG microstate analysis to investigate resting brain dynamics in FXS participants. Resting-state recordings from 70 FXS participants and 71 chronological age-matched typically developing control (TDC) participants were used to derive microstates via modified k-means clustering. The occurrence, mean global field power (GFP), and global explained variance (GEV) of microstate C were significantly higher in the FXS group compared to the TDC group. The mean GFP was significantly negatively correlated with non-verbal IQ (NVIQ) in the FXS group, where lower NVIQ scores were associated with greater GFP. In addition, the occurrence, mean duration, mean GFP, and GEV of microstate D were significantly greater in the FXS group than the TDC group. The mean GFP and occurrence of microstate D were also correlated with individual alpha frequencies in the FXS group, where lower IAF frequencies accompanied greater microstate GFP and occurrence. Alterations in microstates C and D may be related to the two well-established cognitive characteristics of FXS, intellectual disabilities and attention impairments, suggesting that microstate parameters could serve as markers to study cognitive impairments and evaluate treatment outcomes in this population. Slowing of the alpha peak frequency and its correlation to microstate D parameters may suggest changes in thalamocortical dynamics in FXS, which could be specifically related to attention control. (250 words).

Obstructive sleep apnea and attention deficits: A systematic review of magnetic resonance imaging biomarkers and neuropsychological assessments.

Obstructive sleep apnea (OSA) is a common sleep disorder that causes intermittent hypoxia and sleep fragmentation, leading to attention impairment and other cognitive deficits. Magnetic resonance imaging (MRI) is a powerful modality that can reveal the structural and functional brain alterations associated with attention impairment in OSA patients. The objective of this systematic review is to identify and synthesize the evidence on MRI biomarkers and neuropsychological assessments of attention deficits in OSA patients. We searched the Scopus and PubMed databases for studies that used MRI to measure biomarkers related to attention alteration in OSA patients and reported qualitative and quantitative data on the association between MRI biomarkers and attention outcomes. We also included studies that found an association between neuropsychological assessments and MRI findings in OSA patients with attention deficits. We included 19 studies that met our inclusion criteria and extracted the relevant data from each study. We categorized the studies into three groups based on the MRI modality and the cognitive domain they used: structural and diffusion tensor imaging MRI findings, functional, perfusion, and metabolic MRI findings, and neuropsychological assessment findings. We found that OSA is associated with structural, functional, and metabolic brain alterations in multiple regions and networks that are involved in attention processing. Treatment with continuous positive airway pressure can partially reverse some of the brain changes and improve cognitive function in some domains and in some studies. This review suggests that MRI techniques and neuropsychological assessments can be useful tools for monitoring the progression and response to treatment of OSA patients.

Cognitive impairment in 'non-user' first-degree relatives of persons with cannabis dependence syndrome: A pilot, endophenotype study.

Cannabis use disorders are global emerging problem nowadays, with high prevalence and morbidity. Cognitive impairments, and also corresponding genetic vulnerability, has been fairly replicated in individuals with cannabis dependence. However, there are few studies that assess cognitive functioning as an endophenotype or a trait marker for cannabis dependence. While the primary objective of this study was to assess the endophenotype pattern of cognitive dysfunction in cannabis dependence, assessing the association between the degree of cognitive functioning, and their socio-demographicand clinical variables in the cannabis dependence patients and their first-degree relatives was the secondary objective. We compared cognitive functioning across three groups- patients with cannabis dependence syndrome, their 'non-user' first-degree relatives and healthy controls, with 30 participants in each group. Five cognitive domains- attention and concentration, verbal fluency, memory, visuospatial ability and executive functions were assessed. We assessed for endophenotype pattern of statistical significance in pairwise analyses of Kruskal-Wallis test, which was corrected for multiple comparisons. Subsequently, correlation analysis to assess association of cognitive impairment with socio-demographic and clinical variables was conducted. Although impairment in attention and executive functions also was seen in patients with cannabis dependence, endophenotype pattern of statistical significance in pairwise analyses, with impairment in first-degree relatives too, was seen in all sub-scores of verbal fluency and verbal memory. None of the correlations were significant. 'Non-user' first-degree relatives of patients with cannabis dependence too show significant cognitive impairment. Verbal fluency and verbal memory are possible endophenotypes or trait markers for cannabis dependence syndrome.

Dyslexia Due to Visual Impairments.

Reading involves many different abilities that are necessary or sufficient conditions for fluent and flawless reading. The absence of one necessary or of all sufficient conditions is a cause of dyslexia. The present study investigates whether too short fixation times and an impaired ability to recognize a string of letters simultaneously are causes of dyslexia. The frequency and types of reading mistakes were investigated in a tachistoscopic pseudoword experiment with 100 children with dyslexia to test the impact of too short fixation times and the attempts of children with dyslexia to recognize more letters simultaneously than they can when reading pseudowords. The experiment demonstrates that all types of reading mistakes disappear when the fixation time increases and/or the number of letters that the children try to recognize simultaneously is reduced. The results cannot be interpreted as being due to altered visual crowding, impaired attention, or impaired phonological awareness, but can be regarded as an effect of impaired temporal summation and a dysfunction in the ventral stream of the visual system.

280 Prevalence of prescribing high anticholinergic scoring medications among over 65-year-old patients in primary care

Abstract Background The effects of anticholinergic drugs are widespread because acetylcholine is involved in regulating various bodily functions, both in the Central Nervous System (CNS) and the Peripheral Nervous System (PNS). By blocking the action of acetylcholine at CNS muscarinic receptors, anticholinergic drugs can lead to cognitive effects such as impaired attention, decreased learning ability, and memory difficulties. Blocking the PNS muscarinic receptors with anticholinergic drugs can lead to side effects such as urinary retention, constipation, and alterations in heart rate. Considering these issues, it is generally advisable to use anticholinergic drugs with caution in the elderly population as an anticholinergic score of 3 or more is associated with increased risk of confusion, falls and death. This audit seeks to determine the prevalence of the higher scoring Anticholinergic drugs (3) among the older population in a city centre GP Practice. Methods The website www.acbcalc.com provides a comprehensive list of medications with an Anticholinergic burden score of 3. Using this list of 48 commonly prescribed medicines, each one was searched on the practice clnical system individually and the number of patients currently prescribed each medicine documented. Results Approximately 5.45% of patients over 65 yrs (N = 2,770) are currently prescribed a medicine with an Anticholinergic score of 3. The most commonly prescribed are Amitriptyline (1.52%), Solifenacin (1.01%), Quetiapine (0.79%), Olanzapine (0.61%). Conclusion While anticholinergic medications can prove useful clinical interventions in certain patients, it is generally accepted that a burden score of 3 or more increases the patient’s risk of confusion, falls and death. Patients who have a high Anticholinergic score should have their medicines optimised through a shared decision making framework regularly, to ensure current therapy is beneficial and alternatives considered. An automated audit tool could be created within the primary care clinical system to score each patient’s anticholinergic burden and thus help target polypharmacy reviews.

The roles of apolipoprotein E ε4 on neuropathology and neuroinflammation in patients with Alzheimer's disease.

To explore the roles of apolipoprotein E (APOE) ε4 on the neuropathology and neuroinflammation in Alzheimer's disease (AD) patients. AD patients were divided into the APOE ε4 carrier and the APOE ε4 non-carrier groups according to APOE genotype. Demographic information, cognitive function, the levels of neuropathological proteins and neuroinflammatory factors in cerebrospinal fluid (CSF) were compared between the two groups, and their correlations were subsequently analyzed. β amyloid protein (Aβ)1-42 level from the APOE ε4 carrier group was significantly lower than that from the non-carrier group (p = 0.023), which was associated with worse cognitive function. The nitric oxide (NO) level was significantly elevated in the APOE ε4 carrier group compared to the non-carrier group (p = 0.016), which was significantly and positively correlated with the Trail Making Test (TMT)-A-time (r = 0.21, p = 0.026) and TMT-B-time (r = 0.38, p < 0.01). APOE ε4 is associated with poorer cognition, particularly the early symptoms of memory, language, and attention. APOE ε4 is associated with lower Aβ1-42 level, and the more numbers of APOE ε4 are carried, the lower level of Aβ1-42 is measured. APOE ε4 is associated with elevated NO level, which is linked to the impaired attention and executive function.

P01.08.B MENTAL FATIGUE IN PATIENTS WITH LOW-GRADE GLIOMA: ASSOCIATIONS WITH NEUROCOGNITIVE FUNCTIONING AND TUMOR CHARACTERISTICS

Abstract BACKGROUND Fatigue is a frequent consequence of low-grade glioma (LGG), but the causes are still barely understood. Specifically mental fatigue might be related to cognitive impairment such as mental slowness and decreased attention. Also, patients with greater tumor volumes or tumors in certain locations (such as the frontal cortex) might have more cognitive impairments and experience more fatigue. The aim of the present study was twofold: (1) to examine the relationship between mental fatigue and information processing speed and complex attention and (2) to investigate the associations between mental fatigue and tumor volume and location in patients with LGG. MATERIAL AND METHODS 124 patients with LGG (IDH mutated astrocytoma and oligodendroglioma grade 2 and 3) were included before the start of proton therapy. Different facets of fatigue, including mental fatigue, were measured after surgery, with a multidimensional fatigue scale, the Dutch Multifactor Fatigue Scale (DMFS). The Vienna Test System was used to examine simple information processing speed, response inhibition, and divided attention. Tumor location and tumor volume (radiation target volume) were scored on the pre-radiotherapy MRI scan. Descriptive statistics, Spearman’s correlations, and between group comparisons were performed. RESULTS 41% of patients with LGG reported severe mental fatigue. No significant differences were found in mean performance on simple information processing speed, response inhibition and divided attention between severely mental fatigued patients and non-severely mental fatigued patients. However, the percentage of patients with impaired divided attention was significantly higher in the severely mental fatigued group (39%) compared to the non-severely mental fatigued group (16.2%), χ2 = 7.6, p &amp;lt; 0.05. No significant relationships were found between mental fatigue and tumor volume and location. Also, tumor location was not related to neurocognitive functioning, but larger tumor volume was significantly associated with poorer performance on divided attention (r = -0.19, p &amp;lt; 0.05). CONCLUSION A high rate of mental fatigue was found in patients with LGG. Furthermore, a relationship between impaired divided attention and severe mental fatigue was found. This implies that patients may develop mental fatigue due to increased cognitive efforts to compensate for attentional deficits. This might be especially important in patients with larger tumors, considering the relationship between tumor volume and divided attention. The results stress the importance of neuropsychological assessment in this patient group before the start of adjuvant treatment, to timely offer individual rehabilitation.

P03.13.B RADIOTHERAPY-INDUCED COGNITIVE IMPAIRMENT IN CANCER PATIENTS: IS SENESCENCE INVOLVED?

Abstract BACKGROUND Patients with primary and metastatic brain tumors that survive may experience cognitive problems including progressive impairments in memory, attention, and executive function attributed to radiation-induced brain injury. Irradiation is known to bring tumor cells into senescence, a state of permanent proliferation arrest that is accompanied by metabolic changes and a secretory phenotype, which may cause inflammation. We hypothesize that senescence in the healthy brain, caused by whole brain radiotherapy (WBRT), plays an important role in cognitive problems. MATERIAL AND METHODS In this pilot experiment the effect of three different dosages (12, 30 and 60 Gy) of fractionated WBRT was assessed at different intervals after irradiation using male C57BL/6JRj mice. We performed senescence associated β-glucosidase (SA-β-gal) staining, cytokine ELISA assays, RT-qPCRs and immunohistochemistry to identify cellular senescence in the healthy brain. RESULTS Unexpectedly, no clear indications of induced cellular senescence in the brain could be observed by assessing SA-β-gal, cytokines and senescence markers on RNA and protein level. However, we found persistent DNA damage foci, microglial activation, a reduction in oligodendrocyte precursor cells and neurogenesis in the subvertricular zone. CONCLUSION No clear evidence for cellular senescence after WBRT was detected in the mouse brain, whereas profound effects were found on glia, neurogenesis and DNA damage. Difficulties in detecting cellular senescence might be explained by differences in presence of so-called markers for cellular senescence in the brain, or the rare nature of senescence in vivo. In future studies neurobiological changes will be assessed at later time points after WBRT, using a senescence reporter mouse and will be combined with behavioral studies.