Intra-Extra Dimensional Set Shift Research Articles

Impaired cognitive flexibility in schizophrenia: A systematic review of behavioral and neurobiological findings

Background and hypothesisImpaired cognitive flexibility in schizophrenia (SZ) is well documented and correlation with worse functional outcome indicates clinical relevance. Paradigms that assess cognitive flexibility include the Wisconsin Card Sorting Test (WCST) and the Cambridge Neuropsychological Test Automated Battery’s (CANTAB) Intra-Extra Dimensional Set Shift (IED). This systematic review provides an overview of the current state of research on cognitive flexibility in schizophrenia and points out relevant areas of non-consensus. MethodsTwo electronic databases (Embase and PubMed) were searched for records published from 1993 to 2024 on adult SZ patients that were assessed for cognitive flexibility/set-shifting ability using WCST and/or IED. Results38 studies were included in the review, most of which reported significantly worse performance of SZ patients in WCST and/or IED compared to healthy controls (HC). Most publications focused on the specific profile of cognitive inflexibility. Other aspects included progression of cognitive inflexibility over the course of the illness, neurobiological correlates, IQ as a possible confounder and whether cognitive inflexibility is a heritable trait. ConclusionIncluded studies show that cognitive inflexibility rather reflects a stable trait than a state, indicating a lasting prefrontal impairment in SZ. Further longitudinal studies are needed to clarify how these deficits evolve during progression of the disorder. Neither antipsychotic medication nor intelligence seem to explain impaired cognitive flexibility. However, a disease-specific cognitive phenotype has not yet been established and additional research on neuro-computational mechanisms is thus needed to identify possible targets for interventional studies.

Narrative production and executive functions in post-stroke agrammatic aphasia

ABSTRACT Background Narrative production has been widely characterized as providing an ecologically valid way to assess language skills in post-stroke aphasia. Although narrative tasks have been instrumental in delineating patterns of lexical and syntactic production in individuals with agrammatic aphasia, our knowledge of how narrative skills are affected in agrammatic aphasia is still limited. Aims The study’s aims were to (a) compare narrative performance between individuals with agrammatic aphasia and a language-unimpaired group, (b) investigate the contribution of lexical and syntactic skills in each group’s narrative organizational skills, and (c) explore the effects of executive functions on each group’s narrative performance. Methods & Procedures The study included 14 individuals with agrammatic aphasia and 14 age- and education-matched language unimpaired individuals as the control group. Both groups told the Cinderella story, and their narrative production was analyzed in terms of microstructure (lexical diversity, syntactic complexity, clause length) and macrostructure (story grammar, story structure complexity). Each group’s executive functions were evaluated through the One-Touch Stockings of Cambridge test that assesses working memory, and the Intra-Extra Dimensional Set Shift test that assesses cognitive flexibility. Outcomes & Results Regarding narrative microstructure, the individuals with agrammatism scored significantly lower than controls in syntactic complexity and clause length, but not in lexical diversity, but they performed lower than controls in both narrative macrostructural measurements. Also, the agrammatic group scored lower than controls in both executive function tasks. A series of linear regression models showed that microstructural skills significantly affected narrative macrostructural abilities in the cohort with agrammatic aphasia, while controls’ macrostructure was affected by both narrative microstructure and executive function skills. Conclusions The individuals with agrammatic aphasia exhibited impairment in both low-level language features of narrative production, such as syntactic complexity and narrative length, and global measures of narrative organization. Their macrostructural performance critically relied on their language resources, while controls’ narrative macrostructure seemed to also draw on domain-general cognitive skills. These findings suggest that both low-level language and high-level discourse organizational skills are vulnerable in narrative production in agrammatic aphasia, and that macrostructural skills are mainly related to the individuals’ microstructural skills.

Neuropsychological features of somatic symptom disorder and depression/anxiety in Taiwan: An analysis based on the comorbidity status

Individuals with somatic symptom disorder (SSD) often have comorbid depression or anxiety, but whether SSD is associated with specific neuropsychological functions has yet to be fully examined. We analyzed which neuropsychological features are more closely associated with SSD, anxiety, and depression. In this case-control study, we recruited 140 individuals with SSD, 104 individuals with affective disorders without SSD, and 159 healthy controls in Taiwan. We collected DSM-5 diagnoses, questionnaire scores, and performance on eight tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) for each participant. Several CANTAB tasks involving attention, executive function, and social cognition showed significant group differences. In the adjusted analysis, the tasks significantly associated with SSD were the Match to Sample Visual Search (MTS) and the Emotion Recognition Task (ERT). Among the questionnaires, the Cognitions about Body and Health Questionnaire showed the most significant associations with the tasks, specifically with Rapid Visual Information Processing, MTS, Paired Associates Learning, Spatial Working Memory, Intra-Extra Dimensional Set Shift, and ERT. We conclude that the MTS and ERT tasks show significant relationships with both SSD diagnosis and related questionnaires. These tasks primarily involve selective attention and negative emotion regulation.

Multimodal neuroimaging network associated with executive function in adolescent major depressive disorder patients via cognition-guided magnetic resonance imaging fusion.

Adolescents are high-risk population for major depressive disorder. Executive dysfunction emerges as a common feature of depression and exerts a significant influence on the social functionality of adolescents. This study aimed to identify the multimodal co-varying brain network related to executive function in adolescent with major depressive disorder. A total of 24 adolescent major depressive disorder patients and 43 healthy controls were included and completed the Intra-Extra Dimensional Set Shift Task. Multimodal neuroimaging data, including the amplitude of low-frequency fluctuations from resting-state functional magnetic resonance imaging and gray matter volume from structural magnetic resonance imaging, were combined with executive function using a supervised fusion method named multimodal canonical correlation analysis with reference plus joint independent component analysis. The major depressive disorder showed more total errors than the healthy controls in the Intra-Extra Dimensional Set Shift task. Their performance on the Intra-Extra Dimensional Set Shift Task was negatively related to the 14-item Hamilton Rating Scale for Anxiety score. We discovered an executive function-related multimodal fronto-occipito-temporal network with lower amplitude of low-frequency fluctuation and gray matter volume loadings in major depressive disorder. The gray matter component of the identified network was negatively related to errors made in Intra-Extra Dimensional Set Shift while positively related to stages completed. These findings may help to deepen our understanding of the pathophysiological mechanisms of cognitive dysfunction in adolescent depression.

Relationship between cognitive function and functional outcomes in remitted major depression

BackgroundFew studies have focused on functional impairment in depressed patients during symptomatic remission. The exact relationship between cognitive performance and functional outcomes of patients with Major depressive disorder (MDD) remains unclear.MethodsParticipants diagnosed with MDD were included and interviewed at both baseline and follow-up. Cognitive function was assessed during acute episodes using the Cambridge Neuropsychological Test Automated Battery (CANTAB), which targeted attention (Rapid Visual Processing - RVP), visual memory (Pattern Recognition Memory - PRM), and executive function (Intra-Extra Dimensional Set Shift - IED). The 17-item Hamilton Depression Scale (HAMD) was used for symptom assessment. Participants were divided into two groups based on their SDSS (Social Disability Screening Schedule) scores, and the differences between their demographic information, HAMD scores, and baseline CANTAB test results were compared. Logistic regression analysis was used to identify cognitive predictors of social function during symptomatic remission.ResultsAccording to the SDSS score at follow-up, 103 patients were divided into the normal social function group (n = 81,78.6%) and the poor social function group (n = 22, 21.4%) during clinical remission. Participants with poorer social function performed worse in the visual memory (PRM) and executive function tests (IED) at the baseline. Logistic regression analysis suggested that performance on the PRM (95%CI = 0.31–0.93, p = 0.030) and IED (95%CI = 1.01–1.13, p = 0.014) tests, instead of less severe symptoms, significantly contributed to functional outcomes.ConclusionBetter performance in visual memory and executive function during acute episodes may predict better social functional outcomes in individuals with MDD. A potential early intervention to improve social function in individuals with MDD could include the treatments for executive function and visual memory.

Clarifying the link between psychopathologies and heart rate variability, and the sex differences: Can neuropsychological features serve as mediators?

BackgroundPatients with common mental disorders (depression, anxiety, and somatic symptoms) often exhibit lower heart rate variability (HRV) than healthy individuals. Under the hypothesis that disorder status affects cognitive function, we examined whether neuropsychological features can be mediators between psychopathologies and HRV and possible sex differences. MethodsWe recruited 359 individuals (aged 42.47 ± 12.23) with and without common mental disorders. Questionnaires were used to measure their psychopathologies. Eight tests from the Cambridge Neuropsychological Test Automated Battery were selected to measure neuropsychological functions. Resting-state HRV measurements were obtained for 5 min. The associations among these constructs were analyzed using multiple linear regression analysis and structural equation modelling. ResultsAmong women, Reaction Time (RTI, a task of psychomotor speed) indicator mediated the relationship between depression and low-frequency power (LF); Emotion Recognition Task (ERT, a task of emotional regulation) indicator mediated the relationship between health anxiety and high-frequency power (HF). Among men, Intra-Extra Dimensional Set Shift (IED, a task of shifting) indicator mediated the relationship between depression and LF; Match to Sample Visual Search (MTS, a task of selective attention) indicator mediated the relationship between health cognition and HF. The depression-RTI-LF pathway in women tended to lower HRV; whereas health anxiety-ERT-HF in women, depression-IED-LF and health cognition-MTS-HF in men tended to increase HRV. LimitationsPossible medication effects; not directly measuring brain activity; only gathering resting-state HRV. ConclusionOur findings support the notion that neuropsychological features mediate the relationship between psychopathologies and HRV, and that sex differences exist.

Can computerized cognitive training enhance executive functions in healthy young adults? A preliminary study

Computerized cognitive training (CCT) is a computer-based intervention that targets cognitive functioning that has become increasingly popular in the recent decade. We examined the effectiveness of RehaCom as a standard computerized cognitive training on the executive functions of healthy adults in this preliminary study. The study was a quasi-experimental study using a pretest-posttest experimental design without a control group. The participants included 10 healthy adults. The participants were evaluated before and after the intervention using the Trail Making Test (TMT), Intra-Extra Dimensional Set Shift (IED), and Stockings of Cambridge (SOC) computerized tasks. The subjects trained by RehaCom software for 45 minutes per day, one day per week, for a total of four sessions over one month. Data were analyzed in the SPSS software (version 26) using the paired t-test test. Results show significant enhancement in participants’ central executive functioning (p < 0.01), shifting (p<0.05), and planning (p<0.05). A computerized cognitive training program can improve cognitive functions of healthy adults.

Relationship of insight to neurocognitive function and risk of recurrence in depression: A naturalistic follow-up study.

Major depressive disorder (MDD) is a highly recurrent mental illness accompanied by impairment of neurocognitive function. Lack of insight may affect patients' motivation to seek treatment, resulting in poor clinical outcomes. This study explores the relationship of insight to neurocognitive function and the risk of recurrence of depressive episodes in patients with MDD. Demographic, clinical variables, and neurocognitive function measured with Intra-Extra Dimensional Set Shift (IED) from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were collected from 277 patients with MDD. Among them, 141 participants completed a follow-up visit within 1-5 years. Insight was measured using the 17-item Hamilton Depression Rating Scale (HAM-D). To explore the factors associated with recurrence, binary logistic regression models were used. Patients with MDD, without insight, had significantly higher total and factor scores (anxiety/somatization, weight, retardation, and sleep) on the HAM-D and worse performance in the neurocognition task, compared to those with insight. Furthermore, binary logistic regression revealed that insight and retardation can predict recurrence. Lack of insight is associated with recurrence and impaired cognitive flexibility in patients with MDD.

A Randomized Trial Directly Comparing Ventral Capsule and Anteromedial Subthalamic Nucleus Stimulation in Obsessive-Compulsive Disorder: Clinical and Imaging Evidence for Dissociable Effects.

(Appeared originally in Biological Psychiatry 2019; 85:726-734) Reprinted under Creative Commons CC-BY license.

Neurocognitive Assessment of Adults with Sickle Cell Disease: A Descriptive Study

Introduction: Sickle cell disease (SCD) causes devastating complications that can affect any organ in the body. Particularly, SCD can present with neurological complications of overt strokes, silent infarcts and cognitive impairment. As patients are living longer with SCD, cognitive functioning is an important aspect of their disease as deficits can impact education, employment, or adherence to medications. Most of the studies assessing cognitive impairment in this population have been in children with limited data on adults. This study explored the results of cognitive testing in adult patients with SCD when compared to normative data. This study also sought to determine any association between psychological factors (baseline anxiety and depression) as well as biological factors (i.e. hemoglobin levels).Methods: This was a cross-sectional study conducted at the Sickle Cell Center of Southern Louisiana in New Orleans.The study included adults with a diagnosis of sickle cell disease regardless of subtype who were over the age of 18. Patients were excluded if they were not able to physically complete the tasks. Executive function, memory, psychomotor speed, and memory were assessed using the following tasks from standardized pencil-and-paper cognitive tasks from the Cambridge Neuropsychological Automated Battery (CANTAB) test: Stocking of Cambridge (SOC),Delayed Matching to Sample (DMS), Paired Associates Learning (PAL), Motor Screening Task (MOT), Intra-Extra Dimensional Set Shift (IED), Spatial Working Memory (SWM). The Hospital Anxiety and Depression Subscale (HADS) clinical assessment tool was used to screen for anxiety and depression at the time of testing. A HADS score >8 denotes significant anxiety or depression.Results: A total of 22 patients (59% females, mean age 29.6±2.1 years) were included in this study. Attention and psychomotor speed were relatively preserved cognitive domains with 59.1% of patients scoring greater than 75 thpercentile relative to normative mean. Conversely, executive functioning often appeared impaired with 72.7% and 77.3% of patients scoring below 25 thpercentile in outcome measures of IED and SWM, respectively. Similarly, a significant percentage of patients scored below 25 thpercentile in outcome measures of visual memory, PAL and DMS, 63.6% and 45.4%, respectively. Fifteen participants (68%) screened positive for anxiety while two screened positive for depression. Patients with anxiety tended to perform worse on most cognitive tasks, although the differences in scores did not reach statistical significance. Additional analyses of association of biologic factors and neurocognitive functioning are currently underway.Discussion and Conclusion: Our results support that adults with sickle cell disease often suffer from cognitive deficits, which was expected based on pediatric studies demonstrating cognitive impairment in children with SCD. Interestingly, we observed a predominance of poor executive function over changes in attention and psychomotor speed in this study. This is in contrast with what providers familiar with “mini mental assessment” for dementia may expect. Typical dementia patients develop attention and memory changes before executive function is affected. Therefore, it is possible that cognitive impairment in SCD may go by unnoticed without proper testing. Additionally, in this cohort, anxiety was frequent and tended to associate with worse performance. Since this is a cross-sectional study, it is unclear whether cognition is progressively impaired over the years. Prospective studies are required to help determine whether and how fast progression occurs and what risk factors are implicated in the development and progression of cognitive impairment. Such deficits have been demonstrated to be associated with difficulties around employment and adherence to medication, which ultimately jeopardizes long term outcomes. Overall, we recommend neurocognitive and psychological evaluations as part of the routine care for adult SCD patients since abnormal findings seem common and may not be obvious without adequate testing for different domains. Treatment of anxiety disorder and cognitive rehabilitation may prove helpful to improve cognition in SCD patients. DisclosuresFertrin: Sanofi Genzyme: Consultancy, Membership on an entity's Board of Directors or advisory committees; Agios Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Kruse-Jarres: Genentech/Roche: Speakers Bureau; Pfizer: Consultancy; CSL Behring: Consultancy; CRISPR: Consultancy; Biomarin: Consultancy; Genentech: Consultancy, Research Funding.

Did i do that? Cognitive flexibility and self-agency in patients with obsessivecompulsive disorder

Self-agency can be understood as the ability to infer causal relationships between actions and sensory events. Obsessive-Compulsive Disorder (OCD) patients with checking compulsions often report lack of “action-completion” sensations, possibly due to an altered sense of agency in these patients. The present study aimed to investigate whether self-agency was related to cognitive flexibility in OCD checkers. In 18 adult OCD checkers and 18 age- and gender-matched healthy controls, cognitive flexibility was assessed with the Intra-Extra Dimensional Set Shift Task (IED). Self-agency attribution was evaluated in two tasks that targeted the novel construct of “gaze-agency”, the capability of an observer to identify his or her own eye movements as the cause of a concurrent event (here, an auditory beep). This technique allows sensitive measurement of agency under subtly varying investigator-controlled conditions. OCD checkers manifested significantly inferior performance correctly ascribing the beeps to their own ocular saccades than controls, even when after a hint was provided. Although cognitive inflexibility (errors on the IED) did not differ significantly between the two groups, within the OCD sample there were positive correlations between errors in self-agency attribution and total and extra-dimensional shift errors. These findings show that cognitive inflexibility is related to self-agency in OCD.

The relationship between type 2 diabetes mellitus with cognitive functions

BackgroundType 2 diabetes mellitus (T2DM) has been associated with impairment of cognitive functions. Since the majority of patients with diabetes in the Saudi population are between the ages of 40 and 69 years, it is crucial to ascertain whether the control of blood glucose level negatively correlates with the level of cognitive function scores similar to the way it correlates in those who are not controlling their blood glucose level with medications. AimsTo assess cognitive functions in patients with T2DM and examine the effect of glycemic control on cognitive functions impairment in Saudi adults with T2DM. Methods and materialSeventy-nine patients with T2DM underwent cognitive assessment testing using the Cambridge neuropsychological test automated battery (CANTAB), Mini-Mental State Examination (MMSE), and Fatigue severity scale. Their cognitive function scores were then correlated with their blood glucose levels, duration of diabetes, and levels of education. Poor glycemic control was defined as glycated hemoglobin levels more than 7.5. We excluded patients with depression or neurocognitive disorders as well as those over 75 years of age. ResultsAttention switching task (AST) total latency (P = 0.003), AST congruent score (P = 0.002), AST incongruent score (P = 0.003), AST block 3 (p = 0.004), and AST Block 7 (p = 0.006) were significantly higher in poorly-controlled DM. The intra-extra dimensional set shift (IED) total errors were significantly higher in poorly-controlled patients (p = 0.023). The difference in IED stages completed (p = 0.716) and spatial span (SSP) (p = 0.782) were not significant between the two groups. The mini-mental state exam (p = 0.336) and the fatigue severity scale (P = 0.167) did not show any statistical significance between good and poor control of T2DM. There was a significant positive correlation between the duration of T2DM and AST latencies for AST total latency, AST congruent score, and AST incongruent score. ConclusionsPatients with T2DM have a statistically significant association between their cognitive functions and their glycemic control. Patients with uncontrolled T2DM showed decreased cognitive scores. Moreover, worsened cognitive scores were associated with longer disease duration.

Fronto-striatal circuits for cognitive flexibility in far from onset Huntington’s disease: evidence from the Young Adult Study

ObjectivesCognitive flexibility, which is key for adaptive decision-making, engages prefrontal cortex (PFC)-striatal circuitry and is impaired in both manifest and premanifest Huntington’s disease (pre-HD). The aim of this study was...

Resting-state brain oscillations predict cognitive function in psychiatric disorders: A transdiagnostic machine learning approach

BackgroundCognitive dysfunction is widespread in psychiatric disorders and can significantly impact quality of life. Deficits cut across traditional diagnostic boundaries, necessitating new approaches to understand how cognitive function relates to large-scale brain activity and psychiatric symptoms across the diagnostic spectrum. ObjectiveUsing random forest regression, we aimed to identify transdiagnostic patterns linking cognitive function to resting-state EEG oscillations. Methods216 participants recruited through an outpatient psychiatric clinic completed the Cambridge Neuropsychological Test Automated Battery and underwent a 5-minute eyes-closed resting state EEG recording. We built random forest regression models to predict performance on each cognitive test using the resting-state EEG power spectrum as input, and we compared model performance to a sampling distribution constructed with random permutations. For models that performed significantly better than chance, we used feature importance estimates to identify features of the EEG power spectrum that are predictive of cognitive functioning. ResultsRandom forest models successfully predicted performance on measures of episodic memory and associative learning (Paired Associates Learning, PAL), information processing speed (Choice Reaction Time, CRT), and attentional set-shifting and executive function (Intra-Extra Dimensional Set Shift, IED). Oscillatory power in the upper alpha range was associated with better performance on PAL and CRT, while low alpha power was associated with worse CRT performance. Beta power predicted poor performance on all three tests. Theta power was associated with good performance on PAL, and delta and theta oscillations were identified as predictors of good performance on IED. No differences in cognitive performance were found between diagnostic categories. ConclusionResting oscillations are predictive of certain dimensions of cognitive function across various psychiatric disorders. These findings may inform treatment development to improve cognition.

A specific dietary fibre supplementation improves cognitive performance-an exploratory randomised, placebo-controlled, crossover study.

The impact of the microbiota on the gut-brain axis is increasingly appreciated. A growing body of literature demonstrates that use of dietary fibre and prebiotics can manipulate the microbiota and affect host health. However, the influence on cognition and acute stress response is less well understood. The objective of this study was to investigate the efficacy of a dietary fibre, polydextrose (PDX), in improving cognitive performance and acute stress responses through manipulation of the gut microbiota in a healthy population. In this double-blind, randomised, placebo-controlled, crossover design study, 18 healthy female participants received 12.5 g Litesse®Ultra (> 90% PDX polymer) or maltodextrin for 4 weeks. Cognitive performance, mood, acute stress responses, microbiota composition, and inflammatory markers were assessed pre- and post-intervention. PDX improved cognitive flexibility as evidenced by the decrease in the number of errors made in the Intra-Extra Dimensional Set Shift (IED) task. A better performance in sustained attention was observed through higher number of correct responses and rejections in the Rapid Visual Information Processing (RVP) task. Although there was no change in microbial diversity, abundance of Ruminiclostridium 5 significantly increased after PDX supplementation compared with placebo. PDX supplementation attenuated the increase of adhesion receptor CD62L on classical monocytes observed in the placebo group. Supplementation with the PDX resulted in a modest improvement in cognitive performance. The results indicate that PDX could benefit gut-to-brain communication and modulate behavioural responses.

White matter correlates of cognitive flexibility in youth with bipolar disorder and typically developing children and adolescents

Prior studies using behavioral tasks and neuroimaging have shown that children and adolescents with bipolar disorder (BD) have deficits in cognitive flexibility (CF)—defined as adaptation to changing rewards and punishments. However, no study, to our knowledge, has examined the white matter microstructural correlates of CF in youth with BD. To address this gap, we examined the relationship between CF assessed with the Cambridge Neuropsychological Testing Automated Battery (CANTAB)’s Intra-Extra Dimensional Set Shift task (ID/ED) and diffusion tensor imaging analyzed with FSL's preprocessing tools and Tract-Based Spatial Statistics (TBSS). We found a significantly different relationship between microstructural integrity of multiple white matter regions and CF performance in BD (n=28) and age-matched typically developing control (TDC) youths (n=26). Evaluation of the slopes of linear regressions in BD vs. TDC (ID/ED Simple Reversal error rate vs. fractional anisotropy) revealed significantly different slopes across the groups, indicating an aberrant relationship between CF and underlying white matter microstructure in youth with BD. These results underscore the importance of examining specific CF-neuroimaging relationships in BD youth. Future longitudinal studies could seek to define the white matter microstructural trajectories in BD vs. TDC, and relative to CF deficits and BD illness course.

S235. COGNITION AND SOCIAL BEHAVIORS IN SPORTS FOR PATIENTS WITH SCHIZOPHRENIA ENGAGED IN SPORTS HABITS

BackgroundSeveral studies have reported that team sports are effective for maintaining and improving mental health among patients with schizophrenia. Social behavior, such as adjusting an individual’s motion while reading others’ intentions and predicting others’ motion in team sports, is considered to improve related cognitive characteristics. However, the quantitative evaluation of social behaviors during sports, and the cognitive characteristics of patients with schizophrenia engaging in team sports habits remain unclear. In this study, we aimed to clarify these behaviors and cognitions quantitatively.MethodsTwelve male patients with schizophrenia and 15 male healthy controls with experience playing football participated in this study. We used a 3-vs-1 ball possession task. Three-dimensional coordinates of the landmark points were acquired using a 3D optical motion capture system with 16 cameras (OptiTrack, USA). First, we evaluated group coordination in a previous study using three inner angles of the three attackers’ triangle. Second, we computed four variables for evaluating individual performance: pass-miss rate, pass angle, angular displacement, and additional distance. Third, we used a slalom dribble test to evaluate individual football skill. Meanwhile, we used three cognitive tasks: the Rey-Osterrieth Complex Figure test (ROCFT), Trail Making Test A and B (TMT), as well as RTI (reaction time), IED (intra-extra dimensional set shift) and SWM (spatial working memory) in the Cambridge Neuropsychological Test Automated Battery (CANTAB). For statistical analysis, we used the Mann-Whitney U-test to compare the variables between groups. We used Spearman’s rank correlation coefficient between the variables in 3-vs-1 and cognitive tasks. In addition, we conducted partial correlation analysis between these variables using recent football experience per month and duration of illness as covariates.ResultsIn group coordination during the 3-vs-1 task, the patient group exhibited a slightly wider distribution in the contour plots in the phase plane than the control group. Next, in individual performance in motor tasks, the angular displacement in patients with schizophrenia was significantly smaller than that in the control group (p = 0.043, r = −0.39). Meanwhile, there were no significant differences in the slalom test, pass-miss rate, pass angle, and additional distances (p > 0.05). For cognitive tasks, the reproduction scores of ROCFT after 3-min and 30-min in patients with schizophrenia were significantly smaller than those in the control group (p < 0.006, r < −0.53). Patients’ scores on the TMT (A and B) were significantly lower than those in the control group (p < 0.004, r < −0.56). In RTI on the CANTAB, five-choice reaction time and movement time in the patients were longer than those in the control group (p < 0.049, r > 0.37). Meanwhile, other characteristics were not significantly different between the two groups. In the correlation between 3-vs-1 variables and cognitive test performance, EDS errors in CANTAB IED and TMT A were negatively correlated with the pass angle (ρ = −0.62, p = 0.031 and ρ = −0.64, p = 0.026) in patients with schizophrenia. Additionally, the partial correlation in patients revealed that the negative partial correlation between EDS error in CANTAB IED and pass angle remained significant (ρ = −0.64, p = 0.046).DiscussionThe current results demonstrated that patients were not impaired in most domains of cognition and social behavior in the tasks. However, other types of cognition and social behavior for patients with schizophrenia and team sports habits were still likely to be impaired.

Assessment of fatigue severity and neurocognitive functions in the real setting of Ramadan in patients with type 2 diabetes mellitus

ObjectivesType 2 diabetes mellitus (T2DM) is linked with a risk of dementia and decline in neurocognitive function. The current observational case-control study was conducted to evaluate the effect of fasting during Ramadan on cognitive functions and fatigue severity in T2DM patients using the Cambridge Neuropsychological Test Automated Battery (CANTAB). MethodsThis research was conducted at King Saud University Medical city, on 82 subjects including 43 control and 39 T2DM patients of both genders. The standardized Fatigue Severity Scale (FSS) and tests from CANTAB, including the Motor Screening Task (MOT), Spatial Span (SSP) and Intra-Extra Dimensional Set Shift (IED) were recorded during 3rd week and 2–3 weeks after Ramadan under controlled environmental conditions. Neurocognitive functions were recorded through CANTAB. ResultsIED errors (24.43 vs 50.73, p = 0.007), MOT mean and median latency (1466.32 vs 1120.27, p = 0.002) were significantly higher in T2DM than controls. IED stages completed (7.43 vs 8.69, p = 0.003) and SSP Span length were significantly lower in T2DM than controls (4.13 vs 4.82, p = 0.059). The significant differences between T2DM patients and controls persisted in the post. T2DM patients made more errors and completed less IED stages than did the controls, indicating that a worsened flexibility of attention relative to controls. Moreover, T2DM patients exhibited longer latencies in MOT, indicating poor motor performance. A comparison of performances by T2DM patients on FSS and CANTAB during and after Ramadan showed that fasting substantially increased fatigue scales, motor performance, and working-memory capacity. ConclusionsPatients with T2DM have impaired cognitive functions including poor motor performance, low flexibility of attention, and poor working memory capacity compared to healthy control subjects during and also in post Ramadan period. However, there is no clear statistical evidence that the cognitive functions (except for SSP SL scores) and fatigue severity of T2DM subjects differ between Ramadan and after Ramadan in both T2DM and controls.

OSA and Neurocognitive Impairment in Children With Congenital Heart Disease

Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of OSA, which is associated with neurocognitive impairment in children without CHD. Is OSA is associated with neurocognitive impairment in children with CHD? Children aged 6 to 17 years with corrected moderate to complex CHD without syndromes that may affect neurocognition were recruited from the pediatric cardiology clinic. Participants underwent home sleep testing and neurocognitive testing, including a validated Intellectual Quotient (IQ) test as well as validated tests of memory (Paired Associates Learning test), executive function (Intra-Extra Dimensional set shift test), and attention (Simple Reaction Test) from the CANTAB neurocognitive testing battery. Complete results were available for 30 children. Seventeen children (57%) were found to have OSA. Total IQ was markedly lower in children with CHD and comorbid OSA compared with children with CHD without comorbid OSA (mean, 86 ± 12 vs98 ± 11; P= .01). Children with CHD and OSA did significantly worse on the Paired Associates Learning test, with a median of eight total errors (interquartile range [IQR], 2.25-15) compared with children with CHD without OSA (median total errors, 2, IQR, 1-8; P= .02). Children with CHD and comorbid OSA have impaired neurocognition compared with children with CHD without comorbid OSA. OSA may be a reversible cause of neurocognitive impairment in children with CHD. Further research is needed to evaluate the effects of OSA treatment on neurocognitive impairment in children with CHD.

The Relationship between Cognitive Impairment and Coronary Artery Disease in Middle-aged Adults.

BackgroundCognitive impairment is a phenomenon that appears late in many diseases. Many clinicians do not seriously consider cognitive impairment until there has been significant deterioration over time. Cognitive function can be assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB).MethodsUsing an observational case-control study design, we examined the relationship between coronary artery disease (CAD) and cognitive impairment. Participants (57 patients with CAD and 60 healthy controls; age: 30-60 years) were recruited and sampled using a non-probability quota sampling technique. Self-administered questionnaires were used to collect data about participants' demographic information. Blood chemistry samples were obtained to evaluate patients for CAD. Mini-Mental State Examination (MMSE) and CANTAB using three subsets including intra-extra dimensional set shift, spatial span (SSP), and pattern recognition memory (PRM) were used to assess participants' cognitive function.ResultsThe SSP and PRM were significantly lower in patients with CAD as compared with healthy controls. There were significant relationships of PRM with creatine kinase- muscle/brain, aspartate aminotransferase, and total cholesterol. On the other hand, SSP was found to have a significant relationship with triglycerides.ConclusionThere is cognitive impairment in CAD patients that needs to be assessed for early interventions to maintain cognitive functions.