Measures Of Psychomotor Speed Research Articles

Neurocognitive Impairments and Their Relationship With Psychosocial Functioning in Euthymic Bipolar II Disorder

The aim of this study was to compare neurocognitive functioning between euthymic patients with bipolar I disorder (BDI), bipolar II disorder (BDII), and healthy controls. An additional aim was to estimate the relationship between neurocognitive impairments and psychosocial functioning. Eighty-seven patients with BDI (n = 48) or BDII (n = 39) and 39 healthy controls were included. All subjects completed an extensive neurocognitive battery. Psychosocial functioning was assessed using the General Assessment of Functioning. Patients with BDII performed more poorly than did the controls in measures of psychomotor speed, verbal memory, and executive functioning. Patient groups did not show differences in any of the cognitive measures assessed. The performance in trail-making test B was the only independent predictor of psychosocial functioning in both patient groups. Patients with BDII have cognitive impairments, and this has a negative influence on their functional outcome. Our results bring additional support to the notion that BDII disorder is not a merely mild type of BDI.

High alcohol consumption in middle-aged adults is associated with poorer cognitive performance only in the low socio-economic group. Results from the GAZEL cohort study

To examine the association of alcohol consumption over 10 years with cognitive performance in different socio-economic groups. Prospective cohort study, the French GAZEL study. France. Employees of France's national electricity and gas company. Alcohol intake was assessed annually, beginning in 1992, using questions on frequency and quantity of alcoholic beverages consumed in a week; used to define mean consumption and trajectory of alcohol intake over 10 years. Cognitive performance among participants aged ≥ 55 years (n = 4073) was assessed in 2002-04 using the Digit Symbol Substitution Test (DSST), a measure of psychomotor speed, attention and reasoning. Occupational position at age 35 and education were used as the markers of socio-economic position. All analyses were stratified by socio-economic position. In the low occupational group, participants consuming a mean of more than 21 drinks per week had 2.1 points lower (95% CI: -3.9, -0.3) DSST score compared to those consuming four to 14 drinks per week. In participants with primary school education, the corresponding difference was 3.6 points (95% CI: -7.1, -0.0). No association between alcohol consumption and cognitive performance was observed in the intermediate and high socio-economic groups, defined using either occupation or education. Analysis of trajectories of alcohol consumption showed that in the low socio-economic groups large increase or decrease in alcohol consumption was associated with lower cognitive scores compared to stable consumption. Our results suggest that high alcohol consumption is associated with poorer cognitive performance only in the low socio-economic group, due possibly to greater cognitive reserve in the higher socio-economic groups.

Neuropsychological function in unmedicated recurrent brief depression

BackgroundRecurrent brief depression (RBD) is a mood disorder characterized by mild to severe depressive episodes lasting less than 2weeks and occurring approximately once a month with complete recovery between episodes. The aim of this study was to describe neuropsychological impairments associated with RBD, relating cognitive performance to clinical features and comorbidity. MethodsForty-six ICD-10 defined RBD patients (mean age 33.8) and 24 matched controls were assessed on working memory/attention tasks, executive functions, verbal/visual memory, and psychomotor speed. ResultsPatients were significantly impaired across all domains of cognition except for verbal learning and non-semantic verbal fluency. Neuropsychological performance was not related to depression severity, duration of depressive episodes, interval duration, psychiatric or somatic comorbidity, or attributable to a general reduction in processing speed or effort. Patients reporting previous major depressive episodes were impaired on one measure of psychomotor speed. Previous episodes of hypomania were not related to neuropsychological performance. LimitationsThe relatively high number of self-referrals, high female-to-male ratio in the patient sample, and the relatively high level of education and intellectual capacity among participants may limit the possibility to generalize our results to the RBD population in general. ConclusionsUnmedicated RBD patients demonstrate significant neuropsychological impairment that also may persist into euthymic states. Examining cognitive functions might be equally important in RBD as in major depression with consequences for functional diagnostics and treatment strategies.

Poster 27: Characterizing Psychomotor Declines in Prodromal Huntington Disease with the Trail Making Test

Objective Individuals who have the Huntington disease (HD) gene-expansion but do not yet meet clinical criteria for HD (prHD) demonstrate detectable psychomotor declines long before diagnosis. The aim of this study is to assess performance on the Trail Making Test (TMT), a well known neuropsychological measure of psychomotor speed and aspects of attention and executive functioning in prHD. A secondary aim is to determine which aspects of preclinical motor decline affect TMT performance. Method A total of 984 prHD participants and non-gene expanded controls from the PREDICT-HD study were assessed with the TMT and the motor rating scale within the Unified Huntington's Disease Rating Scale (UHDRS). The TMT consists of 2 parts: TMT-A, a measure of psychomotor speed and attention, and TMT-B, which adds a cognitive set-shifting component. Index scores were seconds to complete TMT-A and TMT-B, as well as the difference between the two parts. The UHDRS motor scale was analyzed using the 5 motor factors (i.e., oculomotor, dystonia, rigidity, bradykinesia, and chorea) identified by Marder et al. (2000). PrHD participants were grouped based on estimated proximity to diagnosis (NEAR, 15 years) according to CAG repeat length and age, using Langbehn et al.'s (2004) formula. Results Linear modeling and post-hoc comparisons revealed differences between all prognostic groups, with the NEAR group performing worst on all three TMT measures (p Conclusion PrHD participants ≤15 years to diagnosis are different from controls on all TMT measures, which indicates that TMT might be a sensitive outcome measure in preventative clinical trials. Bradykinesia was most consistently associated with poorer performance, suggesting that slowed performance, rather than oculomotor changes or chorea, are most related to TMT performance.

Cognitive performance before and after kidney transplantation: A prospective controlled study of adequately dialyzed patients with end-stage renal disease

Patients with end-stage renal disease (ESRD) who receive dialysis have been shown to have impaired neuropsychological performance. It remains unclear, however, whether cognitive deficits associated with ESRD and/or dialysis are reversible after successful kidney transplantation. Thus, the main purpose of this study was to longitudinally compare the cognitive performance of adequately dialyzed patients with ESRD before and shortly after kidney transplantation. Twenty-two dialyzed patients with ESRD who subsequently received a kidney transplant, 20 dialyzed patients who were medically qualified and awaiting kidney transplant but did not receive it, and 30 matched controls were the participants for this study. Overall, our results demonstrate that a successful kidney transplant is associated with improved neuropsychological performance in patients with ESRD. Specifically, a significant improvement was seen on measures of psychomotor speed, visual planning, retrieval of learnt material, and abstract thinking. Additionally, the degree of cognitive improvement following kidney transplant was significantly associated with some pre-, intra-, and postoperative factors (e.g., age, duration of chronic kidney disease, postoperative graft function). The results of this study also show that the cognitive performance of adequately dialyzed patients without a kidney transplant, although often below that of matched controls, remains relatively stable over time.

Cognitive decline in Parkinson’s disease: A prospective longitudinal study

This controlled prospective study examined the evolution and predictors of cognitive decline in Parkinson's disease (PD). Consecutive patients diagnosed at baseline with PD (n = 89), established PD (EPD) patients (n = 52) with a mean disease duration of 6.5 years, and healthy control subjects (n = 64) underwent extensive neuropsychological assessment twice, approximately 3 years apart. A standardized regression-based method, normative data, and multivariate normative comparisons were used to assess the cognitive course of PD. Cognitive performance of newly diagnosed patients decreased significantly over time, particularly on measures of psychomotor speed and attention and to a lesser extent on tests of memory, visuospatial skills, and executive functions. About 50% of the patients showed cognitive decline and 9% developed dementia. Similar results were observed in EPD patients. None of the baseline features predicted cognitive change in newly diagnosed patients, whereas age at disease onset and axial impairment (postural and gait disorders) contributed to decline in established patients. We conclude that within few years after diagnosis, PD patients show faster rate of cognitive decline than matched healthy subjects, particularly in domains of attention and psychomotor speed. Selection bias probably led to underestimation of the true extent of cognitive decline in established patients.

Executive Decline and Dysfunction Precedes Declines in Memory: The Women's Health and Aging Study II

Understanding preclinical transitions to impairment in cognitive abilities associated with risks for functional difficulty and dementia. This study characterized in the Women's Health and Aging Study (WHAS) II 9-year declines and transitions to impairment across domains of cognition. The WHAS II is an observational study of initially high-functioning, community-dwelling women aged 70-80 years at baseline. Random-effects models jointly compared rates of decline, and discrete-time Cox models estimated hierarchies of incident clinical impairment on measures of psychomotor speed and executive function (EF) using the Trail Making Test and in immediate and delayed verbal recall using the Hopkins Verbal Learning Test. Patterns of transition were related to incidence of global cognitive impairment on the Mini-Mental State Exam (MMSE). Mean decline and impairment occurred first in EF and preceded declines in memory by about 3 years. Thereafter, memory decline was equivalent to that for EF. Over 9 years, 49% developed domain-specific impairments. Risk of incident EF impairment occurred in 37% of the sample and was often the first impairment observed (23.7%), at triple the rate for psychomotor speed (p < .01). Risk of immediate and delayed recall impairments was nearly double that for psychomotor speed (p values <.01). Incident impairment in EF and delayed recall was associated with greater risk for MMSE impairment. Executive dysfunction developed first among nearly one quarter of older women and was associated with elevated risk for global cognitive impairment. Because EF declines preceded memory declines and are important to efficient storage and retrieval EF represents an important target for interventions to prevent declines in memory and MMSE both of which are associated with progression to dementia.

The generalizability of neurocognitive test/retest data derived from a nonclinical sample for detecting change among two HIV+ cohorts

Objective methods for determining clinically relevant neurocognitive change are useful for clinicians and researchers, but the utility of such methods requires validation studies in order to assess their accuracy among target populations. We examined the generalizability of regression equations and reliable change indexes (RCI) derived from a healthy sample to two HIV-infected samples, one similar in demographic makeup to the normative group and the other dissimilar. Measures administered at baseline and follow-up included the Trail Making Test, Controlled Oral Word Association Test (COWAT), Grooved Pegboard, and Digit Span. Frequencies of decline, improvement, or stability were determined for each measure. Among the demographically similar clinical cohort, elevated rates of decline among more immunologically impaired participants were indicated by simple regression method on measures of psychomotor speed and attention, while RCI addressing practice effects (RCI-PE) indicated improvement on most measures regardless of immunostatus. Conversely, among the demographically dissimilar cohort, simple regression indicated high rates of decline across all measures, while RCI-PE indicated elevated rates of decline on psychomotor and attention measures. Thus, the accuracy of the two methods examined for determining clinically significant change among HIV+ cohorts differs depending upon their similarity with the normative sample.

Efficient Allocation of Attentional Resources in Patients With ADHD

Background: It has been proposed that ADHD is an executive control disorder. Little is known however about the maturation of executive control in ADHD. Method: A cross-sectional study of ADHD patients compared to normal controls tested on a computerized neurocognitive test battery. Participants: 175 patients with ADHD, age 10 to 29, compared to 175 age-matched normal controls. Results: In every age group, ADHD patients were impaired in measures of psychomotor speed, reaction time, cognitive flexibility, and attention. Participants in both groups improved with age. In tests of executive control, normals improved their performance with shorter reaction times. ADHD patients improved their performance but by adopting a less efficient strategy: Their reaction times increased with age. Conclusions: These data support executive control as a “core deficit” in ADHD. In the Stroop and the shifting attention tests, ADHD patients proved to be inefficient in allocating their attentional resources.

A Meta-Analytic Review of Verbal Fluency Performance in Patients With Traumatic Brain Injury.

A meta-analysis of 30 studies with 1,269 participants was conducted to investigate the sensitivity of tests of verbal fluency to the presence of traumatic brain injury (TBI). As has been found for patients with focal frontal lobe injuries (but not for patients with focal temporal lobe lesions), TBI patients were comparably impaired on tests of phonemic and semantic fluency. The phonemic fluency deficit could not be accounted for by patients' level of premorbid or current verbal IQ and was also substantially (although not significantly) in excess of the deficit on a measure of psychomotor speed. Phonemic fluency was also significantly more sensitive to the presence of TBI than was the Wisconsin Card Sorting Test.

Randomized placebo‐controlled trial of donepezil in cognitive impairment in Parkinson's disease

To evaluate the efficacy and safety of donepezil, an acetylcholinesterase inhibitor, as a treatment for cognitive impairment and dementia in patients with Parkinson' s disease (PD). Using a randomized, double-blind, placebo-controlled design, nine patients received placebo and seven patients received donepezil (2.5-10 mg/day) for a mean (SD) duration of 15.2 (3.4) weeks. The primary efficacy outcomes were derived from a neuropsychological battery that assessed global cognitive status as well as memory, attention, psychomotor speed, and visuospatial and executive functions. Secondary efficacy outcomes were psychiatric symptom and activities of daily living ratings. Primary safety measures were motor signs and assessments of adverse effects. Patients on donepezil showed selective and significant (p<0.05) improvement on the memory subscale of the Dementia Rating Scale. There was also a trend toward improvement on a measure of psychomotor speed and attention. There were no group differences in psychiatric status, motor function, or activities of daily living as measured at baseline or end-point. Adverse effects resulted in premature withdrawal of four patients on donepezil, two for peripheral cholinergic effects and one for increased parkinsonism. Side effects were associated with dosage increases. Donepezil has a beneficial effect on memory and may improve other cognitive deficits in patients with PD and cognitive impairment. However, variable tolerability in our sample underscores the need for careful monitoring when prescribing donepezil to patients with PD, especially with dosage increases.

Response to systemic HIV viral load suppression correlates with psychomotor speed performance.

The authors evaluated the association of a virologic response to highly active antiretroviral therapy, or a subsequent rebound, with performance on two measures of psychomotor speed in HIV-positive subjects. Virologic suppression was associated with improved performance on measures of psychomotor speed, and virologic rebound was associated with psychomotor speed performance decline. Changes in plasma HIV viral load in HIV-positive individuals with cognitive slowing correlate with performance on tests of psychomotor speed.

Central Nervous System Correlates of Behavioral Deficits Following Simian Immunodeficiency Virus Infection

Despite the high incidence of cognitive and motor impairment in acquired immunodeficiency syndrome (AIDS) patients, the mechanisms of AIDS-related central nervous system (CNS) pathology are not completely understood. Infection with simian immunodeficiency virus (SIV) in macaques provides an excellent model of AIDS, including human immunodeficiency virus (HIV)-induced CNS pathology and cognitive/behavioral impairment. Co-inoculation with two SIV strains, SIV/17E-Fr and SIV/DeltaB670, accelerates SIV CNS disease, producing SIV encephalitis in over 90% of pig-tailed macaques within 3 months. In the present study, this SIV model was employed to identify cellular and viral correlates of behavioral impairment following SIV infection. Measures of psychomotor speed (simple reaction time), fine motor control (bimanual motor task), and general motor activity (home cage movement) were all adversely affected by SIV disease. Prior to euthanasia, performance was significantly impaired in both a simple reaction time task in 6 of 12 monkeys and a bimanual motor task in 5 of 6 monkeys. All monkeys evaluated (11 of 11) showed significant reductions in spontaneous motor activity. Significant correlations were found between impaired performance on the bimanual motor test and axonal damage (accumulation of beta-amyloid precursor protein in the corpus callosum) as well as increased microglial activation and macrophage infiltration (levels of CD68 and Ham56 immunostaining). These results suggest that axonal damage is related to the behavioral impairment induced by infection with SIV. The axonal damage may result from neuroimmune responses, including microglial and macrophage activation. Therefore, axonal damage may be a morphologic manifestation of neuronal dysfunction that underlies development of behavioral impairment in HIV/SIV CNS infection.

Effects of temazepam on memory and psychomotor performance: a dose-response study.

In a randomised, three-period crossover study, psychomotor performance and memory were tested and mood assessed for 3 h after single doses of placebo (PL), 20 mg temazepam (T20) or 30 mg temazepam (T30) were given to six healthy females aged 21-23. A composite measure of psychomotor speed showed a dose-dependent slowing (Page's L trend test: p < 0.001; sign test PL vs T20 and T30 vs T20: p < 0.05). The number of errors in the performance of tasks was increased, significantly in the case of some measures. Explicit memory (Buschke Selective Reminding Task) showed significant impairment of long-term but not short-term memory (Page's L trend test: p < 0.05). The form of the dose-response curve was positively accelerating, with the difference in performance between T20 and T30 at least as great as that between PL and T20. Visual Analogue Scales showed a decrease in a factor representing functional integrity (Page's L trend test: p < 0.05;) sign test (PL vs T20: p < 0.05), but no changes in mood. These results show that 30 mg is a useful extension of the dose range of temazepam, being well tolerated and that it produces a substantially greater impairment of performance than 20 mg. Copyright 2001 John Wiley & Sons, Ltd.

Neuropsychological performance as a function of cardiac status among heart transplant candidates: a replication.

This study examined the relationship between cardiac function and cognitive test performance among candidates for heart transplant. Participants were 26 individuals undergoing heart catheterization within one day of completing a battery of cognitive tests. Partial correlation analyses controlling for age and education were used to examine the relationship between cardiac function and cognitive performance. Results replicate previous findings in that increasing hemodynamic pressure variables, e.g., pulmonary artery systolic pressure, were associated with decreased cognitive performance on a measure of psychomotor speed and attention (Trail Making Test-Part A: r=.53). In contrast, cardiac output and cardiac index appeared to be not significantly related to cognitive performance. Taken together, poor performance on cognitive tests among heart transplant candidates appears to be attentionally mediated.

NEUROPSYCHOLOGICAL PERFORMANCE AS A FUNCTION OF CARDIAC STATUS AMONG HEART TRANSPLANT CANDIDATES: A REPLICATION

This study examined the relationship between cardiac function and cognitive test performance among candidates for heart transplant. Participants were 26 individuals undergoing heart catheterization within one day of completing a battery of cognitive tests. Partial correlation analyses controlling for age and education were used to examine the relationship between cardiac function and cognitive performance. Results replicate previous findings in that increasing hemodynamic pressure variables, e.g., pulmonary artery systolic pressure, were associated with decreased cognitive performance on a measure of psychomotor speed and attention (Trail Making Test–Part A; r = .53). In contrast, cardiac output and cardiac index appeared to be not significantly related to cognitive performance. Taken together, poor performance on cognitive tests among heart transplant candidates appears to be attentionally mediated.

Effects of ethanol and temazepam on episodic and semantic memory: a dose-response comparison

Drug-induced memory impairment is most apparent for long-term memory, but it is unclear whether this effect is restricted to episodic memory with no effect on semantic memory. Here we compare how the formation of new semantic and episodic memories are affected by ethanol and temazepam. Eighteen subjects (12 male, 6 female; age 19–43 years; weight 52–104 kg) took part in five sessions in which they received by mouth, in random order: (E2) ethanol, 0.8 g/kg, maximum 60 g males, 50 g females; (E1) ethanol, 75 per cent of the dose for E1; (T2) temazepam 20 mg; (T1) temazepam 15 mg; (P) placebo. They carried out a series of tests including learning of invented ‘facts, a measure of the acquisition of new semantic memory; the Buschke test, a measure of short- and long-term learning of words; Digit–Symbol substitution, a measure of psychomotor speed; and Visual Analogue Scales. Both acquisition of new semantic memory and the long-term measure from the Buschke were impaired by both drugs. The effects of ethanol were more marked than those of temazepam for the memory tests at the doses used here, particularly for the Buschke. Psychomotor impairment as assessed by Digit–Symbol substitution speed was equally affected by both drugs. Subjects rated themselves more drunk on ethanol than on temazepam, but drowsiness was similar for the two drugs. These results show that both drugs impair the acquisition of new semantic memory as well as new episodic memory, and suggest that it is new long-term memory formation that is impaired by these drugs and not the formation of a specific type of memory, such as episodic memory. Copyright © 1999 John Wiley & Sons, Ltd.

Behavioural toxicity of antianxiety and antidepressant agents

Standard measures of psychomotor speed and central nervous system arousal were used to assess the behavioural toxicity of several antianxiety and antidepressant agents. The results indicate that, for the agents evaluated, there is a wide variation in the effects on cognitive function. As pharmacoeconomic factors become increasingly important, the cost of accidents due to the behavioural toxicity of these drugs must be taken into account when determining the true treatment costs. Copyright © 1999 John Wiley & Sons, Ltd.

Outcome of Chronic Opioid Therapy for Non-Cancer Pain

Potential iatrogenic mood and cognitive declines associated with long-acting opioid therapy were examined in 19 patients receiving long-acting oral opioid medications and compared to ten patients receiving usual care. Pain, mood, and cognitive function were measured before and after achieving stable doses. In addition to reducing pain, long-acting opioid medication reduced anxiety and hostility. No declines in cognitive function were associated with the long-acting opioid medications, and the group receiving long-acting opioid medications showed significant improvement on a measure of psychomotor speed and sustained attention. Both patient groups reported significant reductions in perceived impairment in daily activities due to pain. Treatment responders taking long-acting opioid medications (63%) were taking a significantly lower dose at follow-up than the treatment non-responder group. These findings suggest that long-acting opioid medications can improve mood and do not impair cognitive functioning in patients with chronic non-cancer pain.

Clinical and neuropsychological comparison of psychotic depression with nonpsychotic depression and schizophrenia.

This study compared the clinical and neuropsychological characteristics of patients with psychotic depression to those of patients with nonpsychotic depression and patients with schizophrenia. Two hundred eighteen patients over the age of 45, including 30 who met the DSM-III-R criteria for unipolar major depression with psychotic features, 28 with nonpsychotic unipolar major depression, and 160 with schizophrenia, were examined. Subjects were evaluated on several clinical measures as well as on neuropsychological tests of attention, learning, memory (retention), psychomotor speed, and motor skills. The three groups were comparable in age and education. The severity of depressive symptoms in the depressed patients with and without psychosis was similar. The patients with psychotic depression were comparable to those with schizophrenia on the neuropsychological measures; they were more impaired than the patients with nonpsychotic depression on the measures of psychomotor speed, motor skills, attention, and learning. The cognitive deficits seemed to be trait-related. The findings provide additional support for the validity of psychotic depression as a diagnostic category distinct from nonpsychotic depression.