Neurocognitive Findings Research Articles

EPA-1360 – Hashimoto's encephalopathy presenting with neuropsychiatric symptoms

Introduction Hashimoto's encephalopathy is a rare neurological disorder of unknown cause associated with thyroid autoimmunity. The disease may present in two types - a sudden vasculitic type or a progressive subacute type associated to cognitive impairment and psychiatric symptoms. Objectives Report a case of a patient with Hashimoto's encephalopathy presenting with neuropsychiatric symptoms. Aims Highlight the diagnostic difficulties of medical disorder presenting with clinical features overlapping psychiatric syndromes. Methods Review of the scientific literature and patient's clinical notes. Results A 61-year old female without previous psychiatric history was referred to psychiatry consultation for depressive symptomatology in the last year. She was prescribed with antidepressants with some initial overall improvement, but gradually developed, during the next nine months, cognitive impairment with loss of skills to be independent and increasing tremor of the extremities. Neurological evaluation was requested which revealed frontal functions impairment. Blood workup only found increased titers of anti-thyroid antibody. EEG showed mild bitemporal slowing, brain MRI was normal and brain SPECT scan revealed fronto-temporo-parietal hypoperfusion. Hashimoto encephalopathy was presumed and corticoids were started with significant improvement of neuropsycological symptoms and tremor. After one year she remains assymptomatic. Conclusions Hashimoto's encephalopathy is a diagnosis of exclusion and clinical suspicion is essential for its identification. This unusual disorder is often unrecognized for a long time because of the multiple and protracted neurocognitive manifestations and normal findings in several different examinations. This case also highlights the importance for close collaboration between psychiatrists and neurologists.

Clinical, Haematological, and Neurocognitive Findings in Lead-Exposed Workers of a Battery Plant in Iran

The aim of this comparative cross-sectional study was to assess neurocognitive impairment, haematological findings, and clinical symptoms of lead exposure among 316 male battery plant workers aged between 20 and 61 years. Compared to 123 matched controls (matching in age and years of work), the exposed workers showed significantly higher mean blood lead level (BLL) and lower haematocrit, haemoglobin, and red blood cell count. Mean BLL significantly correlated with clinical symptoms such as nocturia, increased urination frequency, oedema, drop in deep tendon reflex, concentration impairment, agitation, headache, depression, abdominal pain, palpitation, fatigue, and diminished sex drive. Workers with clinical disorders had higher BLL and lower haematological parameters. These findings warn that silent toxicological problems caused by lead might go unnoticed by health professionals.

Posterior Fossa Syndrome After Cerebellar Stroke

Posterior fossa syndrome (PFS) due to vascular etiology is rare in children and adults. To the best of our knowledge, PFS due to cerebellar stroke has only been reported in patients who also underwent surgical treatment of the underlying vascular cause. We report longitudinal clinical, neurocognitive and neuroradiological findings in a 71-year-old right-handed patient who developed PFS following a right cerebellar haemorrhage that was not surgically evacuated. During follow-up, functional neuroimaging was conducted by means of quantified Tc-99m-ECD SPECT studies. After a 10-day period of akinetic mutism, the clinical picture developed into cerebellar cognitive affective syndrome (CCAS) with reversion to a previously learnt accent, consistent with neurogenic foreign accent syndrome (FAS). No psychometric evidence for dementia was found. Quantified Tc-99m-ECD SPECT studies consistently disclosed perfusional deficits in the anatomoclinically suspected but structurally intact bilateral prefrontal brain regions. Since no surgical treatment of the cerebellar haematoma was performed, this case report is presumably the first description of pure, "non-surgical vascular PFS". In addition, reversion to a previously learnt accent which represents a subtype of FAS has never been reported after cerebellar damage. The combination of this unique constellation of poststroke neurobehavioural changes reflected on SPECT shows that the cerebellum is crucially implicated in the modulation of neurocognitive and affective processes. A decrease of excitatory impulses from the lesioned cerebellum to the structurally intact supratentorial network subserving cognitive, behavioural and affective processes constitutes the likely pathophysiological mechanism underlying PFS and CCAS in this patient.

Goal Commitments and the content of thoughts and dreams: basic principles

A few empirically supported principles can account for much of the thematic content of waking thought, including rumination, and dreams. (1) An individual’s commitments to particular goals sensitize the individual to respond to cues associated with those goals. The cues may be external or internal in the person’s own mental activity. The responses may take the form of noticing the cues, storing them in memory, having thoughts or dream segments related to them, and/or taking action. Noticing may be conscious or not. Goals may be any desired endpoint of a behavioral sequence, including finding out more about something, i.e., exploring possible goals, such as job possibilities or personal relationships. (2) Such responses are accompanied and perhaps preceded by protoemotional activity or full emotional arousal, the amplitude of which determines the likelihood of response and is related to the value placed on the goal. (3) When the individual is in a situation conducive to making progress toward attaining the goal, the response to goal cues takes the form of actions or operant mental acts that advance the goal pursuit. (4) When circumstances are unfavorable for goal-directed operant behavior, the response remains purely mental, as in mind-wandering and dreaming, but still reflects the content of the goal pursuit or associated content. (5) Respondent responses such as mind-wandering are more likely when the individual is mentally unoccupied with ongoing tasks and less likely the more that is at stake in the ongoing task. The probability of respondent thought is highest during relaxed periods, when the brain’s default-mode network dominates, or during sleep. The article briefly summarizes neurocognitive findings that relate to mind-wandering and evidence regarding adverse effects of mind-wandering on task performance as well as evidence suggesting adaptive functions in regard to creative problem-solving, planning, resisting delay discounting, and memory consolidation.

Neurotoxic Effects of Alcohol in Adolescence

This review examines neuroimaging and neurocognitive findings on alcohol-related toxicity in adolescents. Teens who meet criteria for alcohol use disorders, as well as those who engage in subdiagnostic binge drinking behaviors, often show poorer neurocognitive performance, alterations in gray and white matter brain structure, and discrepant functional brain activation patterns when compared to nonusing and demographically matched controls. Abnormalities are also observed in teens with a family history of alcoholism, and such differences in neuromaturation may leave youths at increased risk for the development of an alcohol use disorder or increased substance use severity. More prospective investigations are needed, and future work should focus on disentangling preexisting differences from dose-dependent effects of alcohol on neurodevelopment. Intervention strategies that utilize neuroimaging findings (e.g., identified weaknesses in particular neural substrates and behavioral correlates) may be helpful in both prevention and intervention campaigns for teens both pre- and postinitiation of alcohol use.

White matter abnormalities in skin picking disorder: a diffusion tensor imaging study.

Skin picking disorder (SPD) is characterized by the repetitive and compulsive picking of skin, resulting in tissue damage. Neurocognitive findings in SPD implicate difficulty with response inhibition (suppression of pre-potent motor responses). This function is dependent on the integrity of the right frontal gyrus and the anterior cingulate cortices, and white-matter tracts connecting such neural nodes. It was hypothesized that SPD would be associated with reduced fractional anisotropy in regions implicated in top-down response suppression, particularly white-matter tracts in proximity of the bilateral anterior cingulate and right frontal (especially orbitofrontal and inferior frontal) cortices. 13-subjects meeting proposed SPD criteria for DSM-5 free from other current psychiatric comorbidities, and 12 healthy comparison subjects underwent MRI with a 3-T system. Between-group comparisons of imaging data underwent voxelwise analysis with permutation modeling and cluster correction. Fractional anisotropy (measured using diffusion tensor imaging) was the primary outcome measure. Subjects with SPD exhibited significantly reduced fractional anisotropy in tracts distributed bilaterally, which included the anterior cingulate cortices. Fractional anisotropy did not correlate significantly with SPD disease severity, or depressive or anxiety scores. These findings implicate disorganization of white-matter tracts involved in motor generation and suppression in the pathophysiology of SPD, findings remarkably similar to those previously reported in trichotillomania. This study adds considerable support to the notion that-in addition to the phenomenological and comorbid overlap between SPD and trichotillomania-these disorders likely share overlapping neurobiology.

Errorless and errorful learning of face-name associations: An electrophysiological study

The advantage of errorless learning over errorful learning is associated with the avoidance of errors during learning. Errorful learning challenges the executive control system as erroneous items compete with correct items during retrieval. In an event-related potential (ERP) study, face-name associations learned in errorless or errorful mode were contrasted during retrieval. Learning mode was manipulated by the number of distracters. This modulation resulted in best performances after errorless learning followed by medium and high conflict errorful learning but lost its advantage over time. Within stimulus-locked ERPs, the N250 and the N400f components were associated with successful retrieval. The N250 was also driven by learning mode. Within response-locked ERPs, the error-related negativity (ERN) was modulated by correctness. The error-positivity (Pe) to erroneous responses was modulated by learning mode. The study reveals an initial advantage of errorless over errorful learning, which diminishes over time. The neurocognitive findings are discussed in light of conflict and error-likelihood models.

Cognitive aspects of fetal alcohol spectrum disorder.

Nearly four decades have passed since a link was first established between alcohol consumption during pregnancy and a particular pattern of birth defects. Since then, autopsy, longitudinal, structural imaging, and functional imaging studies have revealed a great deal about the teratogenic effects of alcohol. This paper provides a comprehensive summary of the findings from the neurocognitive and behavioral literature on fetal alcohol spectrum disorder (FASD) and outlines the unique profile of cognitive deficits associated with it. We describe diagnostic issues as well as factors contributing to the heterogeneity of the FASD cognitive presentation. Next, we review research on the impact of prenatal alcohol exposure on intellectual functioning, attention, executive functioning, learning and memory, language, quantitative reasoning, and social cognition. In our opinion, future research can now begin to focus on FASD-specific interventions directly informed by the rich body of neurocognitive findings accumulated thus far. WIREs Cogn Sci 2013, 4:81-92. doi: 10.1002/wcs.1202 For further resources related to this article, please visit the WIREs website.

Timing deficits in attention-deficit/hyperactivity disorder (ADHD): Evidence from neurocognitive and neuroimaging studies

Relatively recently, neurocognitive and neuroimaging studies have indicated that individuals with attention-deficit/hyperactivity disorder (ADHD) may have deficits in a range of timing functions and their underlying neural networks. Despite this evidence, timing deficits in ADHD are still somewhat neglected in the literature and mostly omitted from reviews on ADHD. There is therefore a lack of integrative reviews on the up-to-date evidence on neurocognitive and neurofunctional deficits of timing in ADHD and their significance with respect to other behavioural and cognitive deficits. The present review provides a synthetic overview of the evidence for neurocognitive and neurofunctional deficits in ADHD in timing functions, and integrates this evidence with the cognitive neuroscience literature of the neural substrates of timing. The review demonstrates that ADHD patients are consistently impaired in three major timing domains, in motor timing, perceptual timing and temporal foresight, comprising several timeframes spanning milliseconds, seconds, minutes and longer intervals up to years. The most consistent impairments in ADHD are found in sensorimotor synchronisation, duration discrimination, reproduction and delay discounting. These neurocognitive findings of timing deficits in ADHD are furthermore supported by functional neuroimaging studies that show dysfunctions in the key inferior fronto-striato-cerebellar and fronto-parietal networks that mediate the timing functions. Although there is evidence that these timing functions are inter-correlated with other executive functions that are well established to be impaired in the disorder, in particular working memory, attention, and to a lesser degree inhibitory control, the key timing deficits appear to survive when these functions are controlled for, suggesting independent cognitive deficits in the temporal domain. There is furthermore strong evidence for an association between timing deficits and behavioural measures of impulsiveness and inattention, suggesting that timing problems are key to the clinical behavioural profile of ADHD. Emerging evidence shows that the most common treatment of ADHD with the dopamine agonist and psychostimulant Methylphenidate attenuates most timing deficits in ADHD and normalises the abnormally blunted recruitment of the underlying fronto-striato-cerebellar networks. Timing function deficits in ADHD, therefore, next to executive function deficits, form an independent impairment domain, and should receive more attention in neuropsychological, neuroimaging, and pharmacological basic research as well as in translational research aimed to develop pharmacological or non-pharmacological treatment of abnormal timing behaviour and cognition in ADHD.

Neurocognition in the Psychosis Risk Syndrome: A Quantitative and Qualitative Review

Cognitive dysfunction is a hallmark feature of schizophrenia and is evident across all phases of the illness. While prior meta-analyses have elucidated the level and pattern of cognitive deficits in the premorbid and post-onset periods of psychosis, no meta-analyses of studies of the putative prodromal period have been published. Our primary aim is to provide a meta-analysis of neurocognitive findings from 14 studies of psychosis risk syndrome (PRS) individuals published through February 2011, and compare the resulting profile with that synthesized by meta-analyses from other periods of the disorder. Meta-analysis of 1215 PRS individuals with a mean age of 19.2 (± 3.3) and 851 healthy control subjects yielded small-to-medium impairments across nine of 10 neurocognitive domains (Cohen's d = -0.26 to -0.67). Seven studies reported on PRS individuals who later developed psychosis (n = 175) and their baseline performance level generally yielded moderate-to-large ESs (d = -0.35 to -0.84). Mild cognitive deficits are reliably and broadly present in PRS individuals, falling at a level that is intermediate between healthy individuals and those diagnosed with schizophrenia, and at a level that is comparable to those at familial ("genetic") risk and with premorbid data. Moreover, baseline neurocognition in PRS individuals who converted to psychosis showed more severe deficits than non-converters in nearly all domains. However, considerable heterogeneity of ESs across studies in many domains underscores variability in phenotypic expression and/or measurement sensitivity, and a critical need for improved reporting of sample characteristics to support moderator variable analyses.

An Unusual Developmental Profile of Salla Disease in a Patient with the SallaFIN Mutation

Salla disease (SD) is a disorder caused by defective storage of free sialic acid and results from mutations in the SLC17A5 gene. Early developmental delay of motor functions, and later cognitive skills, is typical. We describe a developmental profile of an unusual homozygous patient, who harboured the SallaFIN (p.R39C) mutation gene. The study involved neurological examination, neuropsychological investigation, and brain imaging. The neurocognitive findings were atypical in comparison with other patients with the SallaFIN mutation. Interestingly, there was no deterioration in the patient's neurological condition during adulthood. Her neurocognitive skills were remarkably higher than those of other patients with a conventional phenotype of SD. Our results suggest that the phenotype of SD is broad. Unidentified genetic or environmental variation might explain the unique SD type of this case.

Long-term Neurocognitive and Neuroimaging Outcomes in Posterior Reversible Encephalopathy Syndrome: Two Case Reports and Implications

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic and neurometabolic state associated with a distinct appearance on computed tomography and magnetic resonance imaging, as well as particular clinical features. While PRES is defined as a reversible condition, instances of irreversible or persisting cytotoxic edema have been reported and appear to be associated with poor outcomes. Studies addressing the post-acute neurocognitive findings in persisting/irreversible PRES are lacking. We report two cases of persisting PRES with associated neurocognitive deficits and functional limitations following acute presentation. Neuroimaging revealed abnormalities within the posterior parietal lobes, along with bilateral involvement of the occipital and frontal lobes. The results from the neuropsychological examination revealed a pattern of impairment generally affecting spatial-perceptual and related functions and aspects of executive function. These cases document instances of irreversible/persisting PRES with associated neurocognitive deficits and functional limitations generally corresponding with the areas implicated on neuroimaging. Studies addressing the post-acute neurocognitive presentation and functional outcomes of PRES are needed.

NEUROCOGNITION IN FIRST-EPISODE SCHIZOPHRENIA: A META-ANALYTIC REVIEW

Compromised neurocognition is a core feature of schizophrenia. Following Heinrichs and Zakzanis's (1998) seminal meta-analysis of middle-aged and predominantly chronic schizophrenia samples, the aim of this study is to provide a meta-analysis of neurocognitive findings from 47 studies of first-episode (FE) schizophrenia published through October 2007. The meta-analysis uses 43 separate samples of 2,204 FE patients with a mean age of 25.5 and 2,775 largely age- and gender-matched control participants. FE samples demonstrated medium-to-large impairments across 10 neurocognitive domains (mean effect sizes from -0.64 to -1.20). Findings indicate that impairments are reliably and broadly present by the FE, approach or match the degree of deficit shown in well-established illness, and are maximal in immediate verbal memory and processing speed. Larger IQ impairments in the FE compared to the premorbid period, but comparable to later phases of illness suggests deterioration between premorbid and FE phases followed by deficit stability at the group level. Considerable heterogeneity of effect sizes across studies, however, underscores variability in manifestations of the illness and a need for improved reporting of sample characteristics to support moderator variable analyses.

Psychopathologies of pervasive developmental disorder in the perspective of neurocognitive findings

Psychopathologies of pervasive developmental disorder in the perspective of neurocognitive findings

Case report: Long-term cognitive sequelae of sarin exposure

The long-term sequelae of acute sarin exposure are not well understood. The largest clinical cohort resulted from the 1994 and 1995 attacks in Japan. Observers noted mostly psychiatric sequelae, with a high prevalence of post-traumatic stress disorder (PTSD). We describe neurocognitive findings that may represent sequelae of low-level sarin exposure in Iraq.

Neurocognitive dysfunction in adult moyamoya disease

We wanted to determine the neurocognitive profile of adult patients with moyamoya disease prior to neurosurgical intervention. The experience of three United States medical centers, Columbia University, University of Illinois at Chicago, and the University of Texas Southwestern Medical Center at Dallas, were combined. Clinical data from adult patients (N = 29) referred for neuropsychological evaluation from 1996 to 2008 were reviewed. Neurocognitive functioning was assessed using standardized neuropsychological tests and all data were converted to z-scores. Memory, attention, processing speed, verbal memory, visuo-spatial, language, and executive functions were examined. Cognitive dysfunction was defined as performance in two or more cognitive domains 1.5 standard deviations below age-corrected normative means OR one or more cognitive domains two standard deviations below age-corrected normative means. Manual strength and dexterity, as well as depressive symptoms, were also assessed. Two-thirds of patients demonstrated neurocognitive dysfunction. A large proportion of patients were found to have pronounced cognitive dysfunction (>2 SD below the mean) on tests of processing speed (29%), verbal memory (31%), verbal fluency (26%) and executive function (25%). Manual strength and dexterity were also affected in many patients, with impairment found in 36-58% of patients. Twenty-eight percent of patients reported moderate to severe depression, but depressive symptoms did not correlate with neurocognitive findings. A large proportion of adults with moyamoya disease demonstrate disruption of neurocognition in a broad range of functions, particularly those mediated by subcortical and frontal regions. The pattern of deficits suggests a mechanism of diffuse small vessel disease possibly caused by chronic hypoperfusion.

Indices of orbitofrontal and prefrontal function in Cluster B and Cluster C personality disorders

Neuropsychological studies implicate disruption of frontal systems in personality disorders. Few studies have examined the performance of Cluster B and Cluster C personality disorder patients on tests of orbitofrontal (OFC) and prefrontal (PFC) cortex function. Patients carrying diagnoses of either Cluster B ( n = 56) or Cluster C ( n = 19) personality disorders were compared with healthy control subjects ( n = 61) on the Iowa Gambling Task and University of Pennsylvania Smell Identification Test. They also completed the Wechsler Abbreviated Scale of Intelligence as a control for general intellectual ability. On the gambling task, Cluster B and Cluster C patients made more disadvantageous decisions during certain portions of the task but overall did not differ from healthy controls. Whereas no appreciable differences in olfactory identification performances were detected between patient and healthy control groups, IQ was higher for controls and was related to Cluster B patients' lower educational levels. Overall, there was limited evidence for neurocognitive inefficiency for personality disorder groups on tests sensitive to OFC and PFC function. The present study is among the first to report neurocognitive findings for the full range of Cluster B personality disorders and any Cluster C personality disorder.

Transient psychosis in anorexia nervosa: Review and case report

Psychotic symptoms are a key feature in eating disorders. Restrictive-type anorectics are more prone to suffer them, coherent with recent neurocognitive findings reporting attentional and processing deficits in restrictive anorexia partially common to schizophrenia. Psychotic crises urge psychiatrists to make an accurate differential diagnosis with endogenous psychoses and carefully judge treatment options. If attentively attended, such crises can give us clues to understand the patient s functioning and consider new strategies. We report two transient psychotic episodes in restrictive-type anorectic female patients, one with a previous experience. Onset of psychotic symptoms was related to severe malnutrition only in one of them (body mass index <15). We discuss risk factors, clinical presentation and treatment, focusing on the emotional disturbances maintained after recovery. Causes for psychotic features in these patients are reviewed and treatment individually tailored. An integrative understanding of eating disorders as a unique meeting point between psychosis and neurosis is encouraged.

Neurocognition in first-episode schizophrenia: A meta-analytic review.

Compromised neurocognition is a core feature of schizophrenia. Following Heinrichs and Zakzanis's (1998) seminal meta-analysis of middle-aged and predominantly chronic schizophrenia samples, the aim of this study is to provide a meta-analysis of neurocognitive findings from 47 studies of first-episode (FE) schizophrenia published through October 2007. The meta-analysis uses 43 separate samples of 2,204 FE patients with a mean age of 25.5 and 2,775 largely age- and gender-matched control participants. FE samples demonstrated medium-to-large impairments across 10 neurocognitive domains (mean effect sizes from -0.64 to -1.20). Findings indicate that impairments are reliably and broadly present by the FE, approach or match the degree of deficit shown in well-established illness, and are maximal in immediate verbal memory and processing speed. Larger IQ impairments in the FE compared to the premorbid period, but comparable to later phases of illness suggests deterioration between premorbid and FE phases followed by deficit stability at the group level. Considerable heterogeneity of effect sizes across studies, however, underscores variability in manifestations of the illness and a need for improved reporting of sample characteristics to support moderator variable analyses.

The Role of Prominence Information in the Real‐Time Comprehension of Transitive Constructions: A Cross‐Linguistic Approach

AbstractApproaches to language processing have traditionally been formulated with reference to general cognitive concepts (e.g. working memory limitations) or have based their representational assumptions on concepts from generative linguistic theory (e.g. structure determines interpretation). Thus, many well‐established generalisations about language that have emerged from cross‐linguistic/typological research have not as yet had a major influence in shaping ideas about online processing. Here, we examine the viability of using typologically motivated concepts to account for phenomena in online language comprehension. In particular, we focus on the comprehension of simple transitive sentences (i.e. sentences involving two arguments/event participants) and cross‐linguistic similarities and differences in how they are processed. We argue that incremental argument interpretation in these structures is best explained with reference to a range of cross‐linguistically motivated, hierarchically ordered information types termed ‘prominence scales’ (e.g. animacy, definiteness/specificity, case marking and linear order). We show that the assumption of prominence‐based argument processing can capture a wide range of recent neurocognitive findings, as well as deriving well‐known behavioural results.