Measures Of Intellectual Functioning Research Articles

Normative Magnetic Resonance Imaging Data Increase the Sensitivity to Brain Volume Abnormalities in the Classification of Fetal Alcohol Spectrum Disorder

ObjectiveTo evaluate the use of a large MRI normative dataset to quantify structural brain anomalies that may improve diagnostic sensitivity for atypical brain volume in youth with fetal alcohol spectrum disorder (FASD). Study DesignParticipants included 48 children with prenatal alcohol exposure (PAE) and 43 controls, ages 8-17 years, from the longitudinal Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Recently published lifespan brain charts were used to quantify participants’ (per)centile for brain volumes (cortical and subcortical gray matter and cortical white matter), providing an index of (dis)similarity to typically developing individuals of the same age and sex. ResultsParticipants with PAE demonstrated lower mean centile scores compared with controls. Participants with PAE and scores ≤ 10th centile on at least one brain volume metric demonstrated significantly lower performance on measures of intellectual function and aspects of executive functioning compared with participants with PAE and “typical” volumes (>10th centile). Brain volume centiles explained a greater amount of variance in IQ and improved sensitivity to brain volume anomalies in FASD compared with the most commonly used diagnostic criterion of occipitofrontal circumference (OFC) ≤ 10th. ConclusionAge- and sex-adjusted brain volumes based on a large normative dataset may be useful predictors of functional outcomes and may identify a greater number of individuals with FASD than the currently used criterion of OFC.

16 Superior Verbal Learning and Memory in Pediatric Brain Tumor Survivors Treated with Proton Versus Photon Radiotherapy

Objective:Radiotherapy for pediatric brain tumor has been associated with late cognitive effects. Compared to conventional photon radiotherapy (XRT), proton radiotherapy (PRT) delivers less radiation to healthy brain tissue. PRT has been associated with improved long term cognitive outcomes compared to XRT. However, there is limited research comparing the effects of XRT and PRT on verbal memory outcomes.Participants and Methods:Survivors of pediatric brain tumor treated with either XRT (n = 29) or PRT (n = 51) completed neuropsychological testing > 1 year following radiotherapy. XRT and PRT groups were similar with respect to sex, handedness, race, age at diagnosis, age at evaluation, tumor characteristics, and treatment history (i.e., craniospinal irradiation, craniotomy, shunting, chemotherapy, radiation dose). Verbal learning and memory were assessed using the age-appropriate version of the California Verbal Learning Test (CVLT-II/CVLT-C). Measures of intellectual functioning, executive functioning, attention and adaptive behavior were also collected. Performance on neuropsychological measures was compared between treatment groups (XRT vs. PRT) using analysis of covariance (ANCOVA). On the CVLT, each participant was classified as having an encoding deficit profile (i.e., impaired learning, recall, and recognition), retrieval deficit profile (i.e., impaired recall but intact recognition), intact profile, or other profile. Chi-squared tests of independence were used to compare the probability of each memory profile between treatment groups. Pearson correlation was used to examine associations between memory performance and strategy use, intellectual functioning, adaptive behavior, attention, and executive functioning.Results:Overall, patients receiving PRT demonstrated superior verbal learning (CVLT Trials 1-5; t(76) = 2.61, p = .011), recall (CVLT Long Delay Free; t(76) = 3.57, p = .001) and strategy use (CVLT Semantic Clustering; t(76) = 2.29, p = .025) compared to those treated with XRT. Intact performance was more likely in the PRT group than the XRT group (71% PRT, 38% XRT; X2 = 8.14, p = .004). Encoding and retrieval deficits were both more common in the XRT group, with encoding problems being most prevalent (Encoding Deficits: 31% XRT, 12% PRT, X2 = 4.51, p = .034; Retrieval Deficits: 17% XRT, 4% PRT, X2 = 4.11, p = .043). Across all participants, semantic clustering predicted better encoding (r = .28, p = .011) and retrieval (r = .26, p = .022). Better encoding predicted higher intellectual (r = .56, p < .001) and adaptive functioning (r = .30, p = .011), and fewer parent-reported concerns about day-today attention (r = -.36, p = .002), and cognitive regulation (r = -.35, p = .002).Conclusions:Results suggest that PRT is associated with superior verbal memory outcomes compared to XRT, which may be driven by encoding skills and use of learning strategies. Moreover, encoding ability predicted general intellectual ability and day-to-day functioning. Future work may help to clarify underlying neural mechanisms associated with verbal memory decline following radiotherapy, which will better inform treatment approaches for survivors of pediatric brain tumor.

Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings

ABSTRACT Introduction This study aimed to provide a preliminary assessment of objective and subjective neurocognitive functioning in individuals with functional motor symptoms (FMS) and/or functional seizures (FS). We tested the hypotheses that the FMS/FS group would display poorer objective attentional and executive functioning, altered social cognition, and reduced metacognitive accuracy. Method Individuals with FMS/FS (n = 16) and healthy controls (HCs, n = 17) completed an abbreviated CANTAB battery, and measures of intellectual functioning, subjective cognitive complaints, performance validity, and comorbid symptoms. Subjective performance ratings were obtained to assess local metacognitive accuracy. Results The groups were comparable in age (p = 0.45), sex (p = 0.62), IQ (p = 0.57), and performance validity (p-values = 0.10–0.91). We observed no impairment on any CANTAB test in this FMS/FS sample compared to HCs, although the FMS/FS group displayed shorter reaction times on the Emotional Bias task (anger) (p = 0.01, np2 = 0.20). The groups did not differ in subjective performance ratings (p-values 0.15). Whilst CANTAB attentional set-shifting performance (total trials/errors) correlated with subjective performance ratings in HCs (p-values<0.005, rs = −0.85), these correlations were non-significant in the FMS/FS sample (p-values = 0.10–0.13, rs-values = −0.46–0.50). The FMS/FS group reported more daily cognitive complaints than HCs (p = 0.006, g = 0.92), which were associated with subjective performance ratings on CANTAB sustained attention (p = 0.001, rs = −0.74) and working memory tests (p < 0.001, rs = −0.75), and with depression (p = 0.003, rs = 0.70), and somatoform (p = 0.003, rs = 0.70) and psychological dissociation (p-values<0.005, rs-values = 0.67–0.85). Conclusions These results suggest a discordance between objective and subjective neurocognitive functioning in this FMS/FS sample, reflecting intact test performance alongside poorer subjective cognitive functioning. Further investigation of neurocognitive functioning in FND subgroups is necessary.

Scoping review of dual-task interference in individuals with intellectual disability.

Dual-task paradigms can provide insights on the structures and mechanisms underlying information processing and hold diagnostic, prognostic, and rehabilitative value for populations with cognitive deficits such as in individuals with intellectual disability (ID). In this paradigm, two tasks are performed separately (single-task context) and concurrently (dual-task context). The change in performance from single- to dual-task context represents dual-task interference. Findings from dual-task studies have been largely inconsistent on whether individuals with ID present with dual-task-specific deficits. The current review aimed to map the published literature on dual-task methods and pattern of dual-task interference in individuals with ID. A scoping review based on Arksey and O'Malley's five-stage methodological framework was performed. Seventeen electronic databases and registries were searched to identify relevant studies, including gray literature. Charted data from included studies were analyzed quantitatively and qualitatively. PRISMA guidelines informed the reporting of this review. Twenty-two studies involving 1,102 participants (656 with ID and 446 without ID) met the review's inclusion criteria. Participants in the included studies were heterogeneous in sex, age (range 3-59 years), etiology and ID severity. Included studies characterized their ID-sample in different ways, most commonly using intelligence quotient (IQ) scores. Other measures of intellectual function (e.g., mental age, ID severity, verbal and/or visuospatial ability scores) were also used, either solely or in combination with IQ. Methods of dual-task testing varied across studies, particularly in relation to dual-task combinations, equation of single-task performance between groups, measurement and reporting of dual-task performance for each single-task, and task priority instructions. Thematic content of the included studies were: (1) structural interference to dual-tasking; (2) etiology-based differences in dual-tasking; (3) gait and balance dual-task performance; (4) testing executive function using dual-task paradigms; and (5) training effect on dual-task performance. Although the evidence consistently supported the intact dual-tasking ability of individuals with ID, the pattern of dual-task interference was inconsistent. Likewise, the evidence was inconclusive regarding dual-task deficit specific to individuals with ID because of heterogeneity in dual-task study designs among included studies.

Prefrontal cortex and putamen grey matter alterations in cannabis and tobacco users.

Previous magnetic resonance imaging studies in regular cannabis users report altered grey matter volume (GMV) in brain regions, including the prefrontal cortex (PFC), putamen and hippocampus. However, most studies have tended to recruit recreational users with high levels of cannabis use, and have not controlled for the possible confounding effects of tobacco use. We attempt to address these limitations in the present study. We acquired volumetric images in sex, age and IQ-matched groups of (1) regular Cannabis users who also smoke Tobacco cigarettes ('CT'; n = 33), (2) non-cannabis-using Tobacco cigarette smokers ('T'; n = 19) and (3) non-cannabis/tobacco-using Controls ('C'; n = 35). GMV in bilateral PFC, putamen and hippocampal regions was compared across groups. We also examined the associations between GMV differences and levels of cannabis and tobacco use, measures of intellectual function, and of depression, anxiety and stress. Relative to controls, both CT and T groups showed lower GMV in the left inferior frontal gyrus, and greater GMV in the putamen. In addition, lower GMV in the right frontal pole in the CT group (but not the T group) was associated with lifetime cannabis use, but not with cigarette use. Regular cannabis users who also smoked tobacco cigarettes showed altered GMV patterns relative to controls. However, a similar pattern of GMV differences was also seen between regular tobacco users that did not use cannabis. Further research is needed to disentangle the effects of cannabis and tobacco use on brain structure.

Interpersonal negotiation skills in ADHD

ABSTRACT Social interaction difficulties are amongst the most prevalent and pervasive adverse outcomes for children and adolescents with ADHD. Problem-solving strategies are impaired in affected individuals, according to the literature. This study aimed to investigate the social problem-solving skills of children and adolescents with and without ADHD, using objective quantitative measures provided by the Interpersonal Negotiation Strategies Interview (INSI). Since verbal communication skills and working memory may be impaired in ADHD, we investigated their contribution to the performance. Forty-three children and adolescents with ADHD and 27 clinical controls with clinical diagnoses other than ADHD completed the INSI along with measures of verbal communication skills (Verbal Comprehension Index [VCI]): Similarities, Vocabulary and Comprehension subtests from the Wechsler Battery, visual (Corsi Blocks) and verbal (Digit Span) working memory tasks. Groups performed similarly on measures of intellectual functioning, working memory, and verbal communication. For the entire sample, VCI scores were positively correlated with INSI performance scores. The ADHD group performed worse on the INSI than the clinical control group. Linear regression analysis showed that inattention and hyperactivity/impulsivity levels and Similarities predicted INSI’s performance. Our findings indicate that interpersonal negotiation difficulties in ADHD are related to DSM-5 defining symptoms of the disorder.

Neurocognitive functioning in preschool children with sickle cell disease.

Children with sickle cell disease (SCD) experience neurodevelopmental delays; however, there is limited research with preschool-age children. This study examined neurocognitive risk and protective factors in preschoolers with SCD. Sixty-two patients with SCD (60% HbSS/HbSβ0 -thalassemia; 40% HbSC/HbSβ+ -thalassemia) between the ages of 3 and 6years (mean = 4.77years) received a neuropsychological evaluation as routine systematic surveillance. Patients were not selected for disease severity, prior central nervous system findings, or existing cognitive concerns. Thirty-four patients (82% HbSS/HbSβ0 -thalassemia) were prescribed hydroxyurea (HU) at the time of their neuropsychological evaluation. On average, these patients had been prescribed HU at 2.15 (standard deviation = 1.45)years of age. The average dose was 28.8mg/kg/day. Besides genotype, there were no group differences in medical or demographic factors based on HU treatment status. Patients with HbSS/HbSβ0 -thalassemia scored below normative expectations on measures of intelligence, verbal comprehension, and school readiness (false discovery rate-adjusted p-value [pFDR ]<.05). Age, sickle genotype, and HU treatment exposure were not associated with measured neurocognitive outcomes (pFDR >.05). Greater social vulnerability at the community level was associated with poorer performance on measures of intellectual functioning, verbal comprehension, visuomotor control, and school readiness, as well as parent report of executive dysfunction (pFDR <.05). Greater household socioeconomic status was positively associated with academic readiness. Preschoolers with severe SCD (HbSS/HbSβ0 -thalassemia) perform below age expectations on measures of intelligence and academic readiness. Sociodemographic factors were stronger drivers of neurocognitive performance than disease severity or disease-modifying treatment. Neurodevelopmental interventions targeting the home and broader community environment are needed.

Apathy in Parkinson's Disease: A Retrospective Study of Its Prevalence and Relationship With Mood, Anxiety, and Cognitive Function.

Apathy is thought to be an important clinical feature of Parkinson’s disease (PD). However, its prevalence ranges greatly across studies because of differing definitions, assessment tools, and patient inclusion criteria. Furthermore, it remains unclear how the presentation of apathy in PD is related to mood disorder and/or cognitive impairment. This study sought to examine the prevalence of a pure apathy syndrome in PD, distinct from both depression and anxiety, and reveal its associated cognitive profile. A retrospective study was performed on 177 PD patients who had completed measures of apathy [Apathy Evaluation Scale (AES)] and mood functioning [Hospital Anxiety and Depression Scale (HADS)] and had undergone extensive neuropsychological assessment, using measures of intellectual functioning, memory, executive function, attention, language, visual processing, and cognitive speed; 14.7% of the sample indicated clinically significant levels of apathy, but this nearly always co-presented with depression and/or anxiety, with cases of “pure” apathy very rare (2.8%). On extensive cognitive assessment, patients with mood disorder performed worse on a measure of non-verbal intellectual functioning, but patients with additional apathy or apathy only demonstrated no further losses. The syndrome of apathy in PD greatly overlaps with that of depression and anxiety, suggesting that apathy in PD may be in large an epiphenomenon of mood disorder, with no specific neuropsychological features.

Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery.

Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities.Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment.Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%.Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.

A-26 ADHD and Neurocognitive Functioning Following Late or Moderate Preterm Birth

Abstract Objective This study sought to broaden the findings of the current research on the relationship between late and moderate preterm (LAMP) birth and long-term neurocognitive outcomes, specifically those related to Attention Deficit Hyperactivity Disorder (ADHD). LAMP children were compared to term-born children on rates of ADHD prevalence and neurocognitive functioning. Method This cross-sectional study included 169 patients, ages 8–12 years, who completed neuropsychological evaluation; 30.2% were female, 37.87% identified with a non-White racial group, 36.7% were Medicaid, 18.34% had in-utero exposure to substances, 40.8% were LAMP, 9.47% were born following pre-eclampsia, 21.3% required intensive care at birth, and 51.5% had ADHD family history. Measures of intellectual functioning (IQ), attention, working memory (WM), executive functioning (EF), and processing speed were derived from the Wechsler Intelligence Scale for Children, Fifth Edition, Conners Continuous Performance Test, Second and Third Editions (CPT-2/CPT-3), Delis-Kaplan Executive Function System, and NEPSY, Second Edition. Results ADHD prevalence was similar between LAMP (79.7%) and term-born children (75%), as were neurocognitive outcomes. Interestingly, no significant differences in performance-based WM or EF were observed between those with and without ADHD; inattention (CPT-2/CPT-3 Omissions) was the only performance-based measure that was significantly higher among those with ADHD (M = 61.93, SD = 15.35) than those without (M = 54.31, SD = 11.27), t(165) = −3.38, p &amp;lt; 0.01, 95% CI [−12.11, −3.13]. Conclusion(s) Prevalence of ADHD and measured neurocognitive outcomes were not significantly different between LAMP and term-born children. This affirms the multifactorial etiological pathways to ADHD and supports ADHD as a heterogenous neurocognitive presentation.

Neuropsychological outcomes in children and adolescents following anti-NMDA receptor encephalitis

ABSTRACT Anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE) is a neurologic disorder that is becoming more recognized in children and adolescents. Early studies suggested that patients typically recover well, but more recent data suggests that children may experience persistent cognitive deficits, especially in verbal memory and executive functioning. The aims of this study are to evaluate areas of impairment and to characterize neuropsychological outcomes in pediatric patients with ANMDARE. This was a multi-centered retrospective chart review. We identified 23 pediatric patients who were, on average, 18.5 months from diagnosis. Patients underwent comprehensive neuropsychological assessment, including measures of intellectual functioning, memory, reading, verbal fluency, visuomotor skills, attention, and working memory. Caregiver ratings and information regarding resource utilization were also collected (e.g., formal school services, outpatient rehabilitation, psychological support). Neuropsychological impairment index (NPI) scores were calculated for each patient. Neuropsychological outcomes highlighted variability across individuals. Memory and fine motor dexterity were particularly impacted. Almost 90% of caregivers reported more concerns than average on at least one measure of emotional-behavioral, adaptive, or executive functioning. More than two-thirds of the sample were considered impaired based on NPI scores on performance measures. More than three quarters of the sample received outpatient intervention, most often consisting of school-based services. Our findings provide additional quantitative evidence that pediatric patients recovering from ANMDARE demonstrate ongoing cognitive concerns. While most patients experience remarkable recoveries following appropriate diagnosis and treatment, ongoing monitoring and support is recommended over time for these patients.

Recognizing children's emotions in child abuse and neglect.

Past research has suggested that parents' ability to recognize their children's emotions is associated with an enhanced quality of parent-child interactions and appropriateness of parental caregiving behavior. Although this association has also been examined in abusive and neglectful parents, the results are mixed and do not adequately address child neglect. Based on the Social Information Processing model of child abuse and neglect, we examined the association between mothers' ability to recognize children's emotions and self- and professionals-reported child abuse and neglect. The ability to recognize children's emotions was assessed with an implicit valence classification task and an emotion labeling task. A convenience sample of 166 mothers (78 with at least one child referred to Child Protection Services) completed the tasks. Child abuse and neglect were measured with self-report and professionals-report instruments. The moderating role of mothers' intellectual functioning and socioeconomic status were also examined. Results revealed that abusive mothers performed more poorly on the negative emotions recognition task, while neglectful mothers demonstrated a lower overall ability in recognizing children's emotions. When classifying the valence of emotions, mothers who obtained higher scores on child neglect presented a higher positivity bias particularly when their scores in measures of intellectual functioning were low. There was no moderation effect for socioeconomic status. Moreover, the results for child abuse were mainly observed with self-report measures, while for child neglect, they predominantly emerged with professionals-report. Our findings highlight the important contribution of the social information processing model in the context of child maltreatment, with implications for prevention and intervention addressed.

161-LB: Neurodevelopmental Outcomes of Infancy-Onset Diabetes

Background: Infancy-onset diabetes is largely monogenic before 6 months of age, whereas autoimmune type 1 diabetes is more likely from 6-12 months of age. As the most common neonatal diabetes, patients with KATP channel mutations exhibit a spectrum of neurodevelopmental disability that is largely related to brain expression of mutated channels. It is not known how glycemic dysregulation of any type of early-onset diabetes may affect brain development. Methods: Subjects included from UChicago Monogenic Diabetes Registry with diabetes diagnosed under a year of age currently aged 4-20 years and unaffected sibling controls. Known KATP channel mutations or other rare causes affecting brain development were excluded. Measures of intellectual function (IF), executive function (EF), visual motor integration (VMI) and academic achievement (AA) were utilized (Table 1). A two-sample t-test was conducted comparing each group assuming unequal variance. Results: Comprehensive testing was completed for those with infancy-onset diabetes and siblings (Table 1). There were no significant differences on any measure, though mean scores trended lower in the affected group. Conclusion: Our findings show no difference in IF, EF, VMI, AA in children diagnosed with diabetes in infancy compared to their unaffected siblings. Our conclusions are limited due to a small sample size; differences may be subtle and require a larger sample size to be identified. Disclosure M. McCauley: None. A.M. Denson: None. L.R. Letourneau-Freiberg: None. M.N. Scott: None. S.W. Greeley: None. Funding American Diabetes Association (1-17-JDF-008 to S.A.W.G.); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK104942, P30DK0205950); National Center for Advancing Translational Sciences (UL1TR002389)

Learning disability and challenges in male prisons: programme screening evaluation

Purpose The purpose of this paper is to validate the learning screening tool (LST) and the adapted functioning checklist-revised (AFC-R) as screening tools to aid programme allocation, and to investigate whether programme decision makers were using the tools as per the guidance provided by HMPPS Interventions Services. Design/methodology/approach LST and AFC-R data were gathered for 555 men who had been assessed for programmes between 2015 and 2018 across eight prisons and one probation area. WAIS-IV IQ data were also gathered if completed. Findings The findings provide support for the use of the LST, and AFC-R in helping to make decisions about programme allocation. The LST and AFC-R correlate well with each other, and a measure of intellectual functioning (WAIS-IV). Those who were allocated to learning disability or challenges (LDC) programmes scored higher on the LST (greater problems) and lower on the AFC-R (lower functioning) compared to those allocated to mainstream programmes. The LST had adequate predictive validity. In the majority of cases, the correct procedures were followed in terms of using the tools for programme allocation. Research limitations/implications The sample size for examining the relationships between all three tools was limited. The research was also unable to take into consideration the clinical decision making involved in how the tools were interpreted. Originality/value This research contributes to the growing evidence about the effective use of LDC screening tools in forensic settings.

Unraveling the Association between Pediatric Traumatic Brain Injury and Social Dysfunction: The Mediating Role of Self-Regulation.

Social dysfunction is a common and disabling outcome of childhood traumatic brain injury (TBI); however, the mechanisms that link early brain injury to impaired social behavior are unclear. This longitudinal prospective study involved 129 children, including 86 children with TBI (53 mild, 33 moderate-severe TBI) and 43 age-matched typically developing control (TDC) children. Children with TBI were recruited via consecutive admissions to the emergency department of the Royal Children's Hospital, Melbourne Australia. At 6 months post-injury, all participants were assessed on measures of intellectual functioning, and parents provided ratings of children's self-regulation skills using gold standard measures of everyday executive function. At 12-month follow up, parents rated children's social adjustment using standardized measures of social skills, communication, and behavior. As expected, children with moderate-severe TBI were rated by parents as having greater self-regulation problems, worse social skills, and poorer communication than the mild TBI and TDC groups. In mediation models, greater self-regulation problems at 6 months post-injury were predictive of poorer social skills and worse overall social adjustment at 12-month follow-up. Moreover, self-regulation skills mediated the effect of moderate-severe TBI, but not mild TBI, on social skills and overall social adjustment. Our findings show that, while impaired social adjustment is common at 12 months following moderate-severe child TBI, the impact of TBI on these outcomes is likely mediated by its effect on self-regulation skills. Evidence for robust prospective associations between self-regulation deficits and later social adjustment difficulties have implications for early identification of children at high risk for chronic social problems.

Investigating the natural history and prognostic factors of ASD in children: the multicEntric Longitudinal study of childrEN with ASD - the ELENA study protocol

IntroductionThere is global concern about the increasing prevalence of autism spectrum disorders (ASDs), which are early-onset and long-lasting disorders. Although ASDs are considered to comprise a unique syndrome, their clinical...

Frontal lobe dysfunction as a predictor of depression and anxiety following temporal lobe epilepsy surgery

ObjectivePredictors of psychiatric outcome following TLE surgery have proved elusive and represent a current challenge in the practice of TLE surgery. This prospective study investigated whether frontal lobe dysfunction is predictive of poorer psychiatric outcomes. MethodsForty-nine unilateral TLE surgical patients were assessed using the Beck Depression Inventory–Fast Screen (BDI-FS) and Beck Anxiety Inventory (BAI) preoperatively and 6 and 12 months postoperatively. Measures of intellectual function, semantic knowledge, memory and executive function were completed preoperatively, at 6 and 12 months following surgery. ResultsPreoperatively, 33 (67%) patients had minimal depressive symptoms, 8 (16%) were mildly depressed, 2 (4%) were moderately depressed, and 6 (12%) reported severe depressive morbidity. Twenty-three (47%) patients reported minimal anxiety, 18 (37%) were mildly anxious, 6 (12%) were moderately anxious and 2 (4%) patients reported severe anxiety symptoms. A mixed-model repeated-measures analysis was performed on the BDI-FS and BAI scores, adjusting for pertinent covariates identified in univariable analyses. At a year following TLE surgery, anxiety symptoms significantly improved but depressive morbidity did not. Indicators of frontal lobe dysfunction moderated the magnitude and direction of mood change. Specifically, pre-surgical cognitive measures of frontal lobe dysfunction predicted increased depression and anxiety symptoms following surgery. There was no relationship between preoperative BDI-FS or BAI scores and seizure outcome at 12 months or change in affective morbidity and seizure outcome. SignificanceThis is the first longitudinal study to provide evidence that specific pre-surgical cognitive and behavioural indices of frontal dysfunction are predictive of poorer psychiatric outcome following TLE surgery. In addition, our findings highlight the potential utility of a dysexecutive behavioural rating scale (DEX) as an assessment tool in epilepsy. Examination of executive functioning in pre-surgical evaluations may lead to an increase in the power of prognostic models used to predict the psychiatric outcome of TLE surgery.

Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology

ABSTRACTBackground: Adolescent cannabis use is associated with increased risk for psychological problems, with evidence for more severe problems among youth who use cannabis in combination with other substances (i.e., polysubstance use). Juvenile offenders engage in both cannabis use and polysubstance use at higher rates than the general adolescent population. Yet, limited research has examined the relationship between cannabis poly-use (e.g., cannabis and alcohol use) and functional or psychological problems among juvenile offenders.Objectives: The current study addresses this gap by examining the association of polysubstance use of cannabis compared to cannabis only use with cognitive functioning, psychological distress, and substance-related problems among juvenile detainees.Methods: Participants were 238 detained youth ages 12–18 (80.4 % male, 77.3% non-White) who completed assessments of substance use, intellectual functioning, psychological symptoms, and substance-related problems. Youth were also assessed by a clinical psychologist for substance use disorder.Results: Four cannabis-use typologies were identified; cannabis and alcohol use was the largest class, followed by cannabis only use, cannabis, alcohol and other drug use, then cannabis and other drug use. Polysubstance use was associated with lower scores on measures of intellectual functioning, more externalizing and internalizing symptomology, and more substance-related problems relative to cannabis only use. However, the relationship between polysubstance use and problems varied by typology.Conclusions: Findings suggest that justice-involved youth engaged in polysubstance use may be at greater need for concurrent academic, affective, and behavioral support in their rehabilitation and transition back to the community.

Intellectual Functioning and Autism Spectrum Disorder: Can Profiles Inform Identification of Subpopulations?

Profiles of scores on measures of intellectual functioning may aid in understanding etiology and developing targeted intervention in autism spectrum disorder (ASD) by providing details about specific phenotypes or subpopulations of ASD. Research investigating the relationship between ASD symptoms and intellectual functioning suggests that scores on the factors comprising global measures of intellectual functioning may be related to ASD symptoms (e.g., Joseph et al. J Child Psychol Psychiatry 43:807–821, 2002). Research has been limited by methodological problems, such as defining samples using unreliable subtypes of ASD and an overreliance on variable-centered methodological strategies. In the current paper, the authors provide a summary of existing research related to ASD symptoms and measures of intellectual functioning, review recent research identifying subpopulations in ASD, and provide goals for future areas of research in this area.

Preliminary evidence concerning the pattern and magnitude of cognitive dysfunction in major depressive disorder using cogstate measures

BackgroundCognitive deficits are common in individuals with major depressive disorder (MDD), and are associated with treatment non-responsiveness and poorer functional outcomes. Characterization of the nature and magnitude of deficits in this population has been limited in part by lack of brief, practical, and well-validated assessment measures. The goal of this study was to use a brief, practical, and repeatable computerized cognitive test battery from Cogstate to examine differences in cognitive functioning between individuals with MDD and healthy controls. MethodsForty participants (22 healthy controls (HCs), 18 with MDD) completed a battery of six cognitive measures, as well as measures of intellectual functioning (intellect) and depressive symptom severity. A multivariate analysis of covariance (MANCOVA) was conducted to compare cognitive test performance across groups while controlling for intellect. ResultsIndividuals with MDD had lower full-scale IQ scores on average, and performed worse on measures of visual attention (d=1.04), verbal learning (d=1.22) and memory (d=1.22), and visuospatial problem solving (d=0.80) than HCs after adjustment for differences in intellect. Psychomotor speed, visual memory, and working memory did not differ between groups. ConclusionsCogstate measures appear to be sensitive in assessing deficits in attention, verbal learning and memory, and executive function in individuals with MDD. Further research will be useful in establishing the utility of Cogstate measures for standard use in research and clinical practice.