Neurocognitive Rehabilitation Research Articles

Neuropsychological profile in patients with early stage of Parkinson's disease in Taiwan

Given the importance of early detection and intervention for disease management, determining the vulnerable neuropsychological function in patients with early-stage Parkinson's disease (PD) is a priority. Here, we describe the neuropsychological pattern in early-stage PD patients with mild cognitive impairment (PD-MCI) and dementia (PDD) in Taiwanese population. The neuropsychological performance of 94 patients with PD was compared with that of 84 healthy controls (HCs) and available normative data, using a comprehensive neuropsychological assessment including tests of executive, memory, psychomotor speed, attention, visuospatial, and language functions. Our results showed that PD patients performed significantly worse on executive function (i.e., category of card sorting) and psychomotor speed (i.e., processing speed index). Up to 46.8% were classified as PD-MCI and the majority of those having single-domain impairment (68.2%); 9.6% met the consensus diagnostic criteria for PDD. Accordingly, we suggest that early-stage PD patients have cognitive dysfunction predominately in the anterior brain. Further follow-up study to determine how many percent of PD-MCI develop PDD is important. The effect of neurocognitive rehabilitation on executive function is also valuable in the subsequence study.

Hypnosis meets neuropsychology: Simulating visuospatial neglect in healthy participants

Neglect patients are not aware of stimuli in the contralesional space. We aimed to simulate neglect-like behaviour in healthy participants, by asking them to orient their visuospatial attention in two conditions: non-hypnotic suggestion and post-hypnotic suggestion. Results showed that directing visuospatial attention to one side of space caused neglect of stimuli in the opposite side of space, but only when participants were under post-hypnotic suggestion. Furthermore, directing visuospatial attention to the right side of space caused more neglect of left-sided stimuli than directing visuospatial attention to the left side of space did for right-sided stimuli. We propose that post-hypnotic suggestion can be a useful tool for (de)activating neurocognitive mechanisms underlying visuospatial awareness, a function that is fundamental for our survival. The use of post-hypnotic suggestion could be applied to the study of many domains of cognitive neurosciences (e.g., neurocognitive rehabilitation).

The horse with stripes: a case of anti-NMDA receptor encephalitis.

The horse with stripes: a case of anti-NMDA receptor encephalitis.

The Horse With Stripes

The Horse With Stripes

A Weak And Painful Shoulder In A Professional Volleyball Player

HISTORY: A 29-year old professional volleyball player, without history of recent trauma, surgical procedures, infections, complained of a dull ache in the right lateral base of the neck, exacerbated by digital pressure on the region and associated with episodes of vagal reaction (asthenia, dizziness, nausea) after training sessions and cold air exposure. After 3 days, the athlete exhibited deficiency of right scapula adduction, mild limitation of scapula elevation, right shoulder weakness, mild pain in the right lateral base of the neck, radiated to the right shoulder, without sensitivity deficits. PHYSICAL EXAMINATION: Physical exam revealed an asymmetrical neckline with drooping of the affected shoulder, lateral displacement and minimal winging of the right scapula, that was displaced laterally, rotating downward and outward. Winging disappeared during forward flexion of the arm. A moderate pain on the right neck base persisted for about 20 days. Both deep reflexes and strength of upper right limb were normal, and no contractures were present. The athlete complained of weakness in abduction of right arm and inability of scapula adduction, but he could shrug the shoulders, elevate forward the right arm and move the neck in any direction. After 1 week hypotrophy of superior trapezius was evident. DIFFERENTIAL DIAGNOSIS: -paralysis of the rhomboid and serratus anterior muscles; -herniated nucleus pulposus of cervical disks; -progressive neuromuscular disease; -scapular osteochondroma; -herpes zoster infection; -thoracic outlet syndrome; -suprascapular nerve injury. TEST AND RESULTS: Magnetic resonance imaging of cervical spine and shoulder: - no signs of mass lesions nor disk disease; - signs of infraspinatus chronic tendinopathy and acromioclavicular arthrosis. EMG right upper limb: -denervation in the upper, middle and lower components of the right trapezius muscle, due to axonotmesis of spinal accessory nerve. Blood tests: - protein profile and complete blood count were normal; Varicella-Zoster and Herpes virus IgM antibodies were negative. FINAL/WORKING DIAGNOSIS: Idiopathic spinal accessory nerve palsy. TREATMENT AND OUTCOMES: - Rest from playing volleyball for 3 months - Formal physical therapy. - Neurocognitive Rehabilitation - Transition to sport specific movements and return to play

Treatment of fatigue in multiple sclerosis patients: a neurocognitive approach.

The objective of the study was to treat fatigue in patients with multiple sclerosis (MS) by a neurocognitive rehabilitation program aimed at improving motor planning by using motor imagery (MI). Twenty patients with clinically definite MS complaining of fatigue were treated for five weeks with exercises of neurocognitive rehabilitation twice a week. Patients were evaluated by Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), MSQoL54, Expanded Disability Status Scale (EDSS), and MS Functional Composite (MSFC). After treatment, a decrease in fatigue was detected with both FSS (P = 0.0001) and MFIS (P = 0.0001). MSFC (P = 0.035) and MSQoL54 (P = 0.002) scores improved compared to baseline. At six-month followup, the improvement was confirmed for fatigue (FSS, P = 0.0001; MFIS P = 0.01) and for the physical subscale of MSQoL54 (P = 0.049). No differences in disability scales were found. These results show that neurocognitive rehabilitation, based on MI, could be a strategy to treat fatigue in MS patients.

The Author Response: The Supernumerary Phantom Limb and Phantom Limb Pain in Stroke: Localization and Management Concerns

The supernumerary phantom limb is the problem of perception of body scheme (1), and phantom limb pain is one type of central pain, defined as central neuropathic pain caused by lesions or dysfunction in the central nervous system (brain, brainstem, and spinal cord) (2). Central pain is a neurological disorder that is rather common although difficult to treat, causing unrelenting suffering and disability (3). Diagnosis of central pain that may occur following stroke is complicated by cognitive and speech limitations as well as by depression, anxiety and sleep disturbances. Localized brain lesions causing central pain and their management have not been established clearly. Kiefer et al. (4) reported that the phantom limb pain is difficult to treat compared to conventional pain, and repetitive transcranial magnetic stimulation (rTMS) have shown to respond to drug resistant neurogenic pain (3, 5). The mechanism of cortical stimulation for the relief of pain is based on the excitability modification of neuronal activity intimately involved in the neural circuits responsible for perception and pain processing. Lefaucheur et al. (5) studied whether neurogenic pain relief by rTMS depended on the origin or the site of pain. The most favorable conditions were trigeminal nerve lesion, facial pain, and absence of severe sensory loss within the painful zone. The worst conditions were brainstem stroke, limb pain, and severe sensory loss. Basbaum et al. (6) described various descending modulatory pathways in the brainstem acting on pain transmission. Patients with brainstem stroke could have damage on these structures, leading to the inefficacy of corticothalamic descending control triggered by rTMS. The patients in our case report had the supernumerary phantom limb and phantom limb pain after brainstem stroke (7). We chose multimodal sensory neurocognitive rehabilitation and anticonvulsants (pregabalin) instead of rTMS (1). The purported age difference between poststroke patients, who developed central poststroke pain and those who did not, is a subject of some debate in the literature. Anderson et al. (8) found no disparity in age between the patients that went on to develop central poststroke pain (n = 87) versus those that did not (n = 120). Bowsher (9) found a significant difference in age of stroke onset between 130 central pain patients (median age 57 yr) and the whole stroke population (median age 75 yr). No studies on the relationship of demographic characteristics and phantom limb pain have been published. Both patients in our case report are middle-aged, highly educated, and have median socioeconomic status. In addition, the patients did not have psychotic symptoms (hallucination, delusion), therefore psychiatric consultation about supernumerary phantom limb was thought to be unnecessary. Subsequent larger and randomized studies are needed to examine the relationship between demographic characteristics (age, sex, education level), personality characteristics and central pain including phantom limb pain. We really appreciate the comments by Dr. Das, and further evaluation is needed for the brain localization of body scheme and the management of central pain.

Neurocognitive deficits in children with sickle cell disease: a comprehensive profile

Sickle cell disease (SCD) can lead to profound cerebral damage, associated with neurocognitive deficits. The aim of the current study was to evaluate a broad range of neurocognitive functions in children with SCD compared to a SES-matched control group, in order to gain more insight into the specific deficits of these patients. Forty-one children with homozygous SCD (HbSS or HbS-β0-thalassemia) and 38 controls were assessed on a comprehensive set of well-defined and validated measures of neurocognitive functioning. Besides general intelligence, we evaluated executive functioning extensively (including response inhibition, sustained attention, planning, visuo-spatial working memory, and verbal working memory) as well as visuo-motor functioning. SCD was clearly associated with lower IQ scores. More than one in three children with SCD had a Full-scale IQ below 75. Furthermore, children with SCD showed deficits in visuo-motor functioning. Some evidence was found for executive dysfunction: Children with SCD displayed poor visuo-spatial working memory, as well as subtle deficits in sustained attention and planning. No significant differences were found between children with SCD and controls in terms of response inhibition and verbal working memory. Children with SCD are at increased risk of lower intelligence, visuo-motor impairments, and executive dysfunction. These neurocognitive deficits may underlie high rates of scholastic impairments in these children. The present findings further illuminate the importance of regular neurocognitive evaluations and future neurocognitive rehabilitation programs for children with SCD.

P03-107 - Clinical remission, cognitive functions and functional outcome in schizophrenia

ObjectivesAn impairment of several cognitive domains has been largely documented in patients with schizophrenia. The present study aimed to investigate the relationships between cognitive functioning, symptomatic remission and functional outcome in schizophrenia.MethodsThe performance on the neuropsychological battery “Brief Assessment of Cognition in Schizophrenia (BACS)” has been investigated in clinically remitted (R) and non-remitted (NR) schizophrenic patients. The associations of neuropsychological performance with psychopathological dimensions derived from PANSS and indices of social functioning (as assessed by the Global Assessment of Functioning scale, the Personal and Social Performance scale, the Quality of Life Scale, the UCSD Performance-Based Skills Assessment-Brief Version and the Psychosocial Remission in Schizophrenia scale) were also explored by means of multiple regression (MR) analyses.ResultsCompared with NR, R patients showed a better performance on tests exploring executive functions, processing speed and verbal fluency. Residual negative symptoms and processing speed were independent predictors of functional outcome, while remission status did not enter the MR function.ConclusionsOur findings suggest that cognitive abilities, in particular processing speed and executive functions, are preserved in patients who are able to reach clinical remission. Independently from the remission state or residual negative symptomatology, processing speed also predicts functional outcome in schizophrenia. Our findings support the view that cognitive dysfunctions in schizophrenia should be targeted by specific treatment intervention, such as neurocognitive rehabilitation.

Neurocognitive training in patients with high-grade glioma: a pilot study

Although their neurocognitive performance is one of the major concerns of patients with high-grade gliomas (HGG) and although neurocognitive deficits have been described to be associated with negative outcome, neurocognitive rehabilitation is usually not integrated into the routine care of patients with malignant gliomas. In this pilot trial, a weekly group training session for attention, verbal, and memory skills was offered to patients with HGG with pre and post-training evaluation. Eleven patients, six with glioblastoma multiforme and five with WHO grade III gliomas, median age 50 years, with a Karnofsky performance score of 80-100 participated in ten group training sessions of 90 min. For evaluation at baseline and after the training by a neuropsychologist not involved in care or training of the patients, Trail Making Tests A and B (TMTA and TMTB), Hopkins Verbal Learning Test (HVLT), and the Controlled Oral Word Association Test (COWA) were used. Comparison of mean group differences between baseline and at post-training evaluation after 12 weeks revealed improvement across all neurocognitive variables. The patients showed a great diversity in their performances, with worsening, improvement, and stabilization. However, a significant group difference was detected only for the HVLT (score 19.6 +/- 8.9 at baseline, 23.6 +/- 8.8 after 12 weeks, P = 0.04). This pilot study shows that neurocognitive training in patients with HGG is feasible as group training with weekly sessions and might be able to induce improvements in attention and memory skills.

Pathogenesis and Neuropsychological Sequelae in Cysticercosis: A Case Study

Cysticercosis is a disease that occurs via the dissemination of the larvae form of the pork tapeworm Taenia solium to various organ systems, including the central nervous system. Sequelae may include seizures and neuropsychological impairment. The present case study involves a 45-year-old Caucasian female executive diagnosed with neurocysticercosis. Evaluation methods consisted of neuropsychological and electrophysiological assessment. Both neuropsychological evaluation and electrophysiological testing suggested right temporal and right parietal lobe dysfunction. Comparison of neuropsychological and quantitative electroencephalogram (QEEG) test results yielded high agreement in terms of site of lesion as documented by magnetic resonance imaging (MRI) and computed tomography scan (CT scan) findings. Neuropsychological findings are described in detail, as well as a description of subsequent neurocognitive rehabilitation. Serial assessment is delineated and compared with the baseline evaluation. This case study serves to underscore the clinical utility of neuropsychological assessment and neurocognitive rehabilitation in infectious disease consultations, specifically in neurocysticercosis.

Potentiel d’apprentissage et revalidation cognitive dans la schizophrénie

Many studies have stressed the importance of neurocognitive deficits in schizophrenia that represent a core feature of the pathology. Cognitive dysfunctions are present in 80% of schizophrenic patients, including deficits in attention, memory, speed processing and executive functioning, with well-known functional consequences on daily life, social functioning and rehabilitation outcome. Recent studies have stressed that cognitive deficits, rather than the positive or negative symptoms of schizophrenia, predict poor performance in basic activities of daily living. If it is possible to reduce psychotic symptoms and to prevent relapses with antipsychotic medication, it is not yet possible to have the same convincing impact on cognitive or functional impairments. Cognitive remediation is a new psychological treatment which has proved its efficacy in reducing cognitive deficits. A growing literature on cognitive rehabilitation suggests possibilities that in schizophrenia, specific techniques are able to enhance an individual's cognitive functioning.Presently, two distinct and complementary cognitive remediation methods have been developed: the compensatory and the restorative approaches: (A) restorative approaches attempt to improve function by recruiting relatively intact cognitive processes to fill the role of those impaired, or by using prosthetic aids to compensate for the loss of function; (B) in contrast, in the restorative approach cognitive deficits are targeted directly through repeated practice training. However, results concerning cognitive remediation remain inconsistent. It is clear that not all individuals with schizophrenia display cognitive impairment, and even among those who do, the specific pattern of cognitive functioning varies. Moreover, traditional neurocognitive assessment, with a single or static administration of cognitive measures, provides moderately good prediction of skills acquisition in schizophrenia. Among other factors such as motivation, awareness of having a disease and acuteness of symptomatology, some studies have exposed that a cognitive variable, learning potential could mediate in part the effectiveness of cognitive remediation.The concept of learning potential is used to explain some of the observed variability in cognitive functioning. Learning potential is the ability to attain and utilize cognitive skills after cognitive training: it is assessed by individual variation in performance across three consecutive administrations of the Wisconsin Card Sorting Test (WCST): a pretest with standard instruction procedures, a training phase with expanded instruction and a post test with only standard instruction. Three learner subtypes can be identified: "learners" who perform poorly at the pretest but improve performance during the post-test, "non-retainers" who perform poorly at pre-test and do not improve at post-testing and "high achievers" who perform well in the initial pretest and maintain their good performance across the other two administrations. The assessment of learning potential could predict, with other psychological measures such as insight and motivation, the most effective neurocognitive rehabilitation program for an individual patient, and could help the clinician to optimize patient outcome through appropriate individual management.Indeed, learning potential could represent a good cognitive predictor and indicator for rehabilitation in schizophrenia for clinicians and should be used in cognitive assessment practice. However, the individuals most likely to benefit from cognitive remediation, and whether changes in cognitive function translate into functional improvements, are as yet unclear.

P03-143 Early treatment of schizophrenia: Links between insight and cognitive disorders

In the early treatment of schizophrenia, insight and cognitive disorders are key components in the observance and the functional prognosis of patients.This study aims to evaluate the impact of neurocognitive rehabilitation and psycho information programs on the quality of insight in a population of 20 schizophrenic patients.Results show a correlation between the extent of cognitive disorders and the quality of insight as well as with the efficiency of specific treatment programs.The study emphasizes close links between improvement of cognitive skills and the quality of insight in this population.

Estimulación magnética transcraneal. Aplicaciones en neurociencia cognitiva

In this review we trace some of the mayor developments in the use of transcranial magnetic stimulation (TMS) as a technique for the investigation of cognitive neuroscience. Technical aspects of the magnetic stimulation are also reviewed. Among the many methods now available for studying activity of the human brain, magnetic stimulation is the only technique that allows us to interfere actively with human brain function. At the same time it provides a high degree of spatial and temporal resolution. Standard TMS applications (central motor conduction time, threshold and amplitude of motor evoked potentials) allow the evaluation of the motor conduction in the central nervous system and more complex TMS applications (paired pulse stimulation, silent period) permit study the mechanisms of diseases causing changes in the excitability of cortical areas. These techniques also allow investigation into motor disorder, epilepsy, cognitive function and psychiatric disorders. Transcranial magnetic stimulation applications have an important place among the investigative tools to study cognitive functions and neurological and psychiatric disorders. Even so, despite the many published research and clinical studies, a systematic study about the possible diagnostic value and role in neurocognitive rehabilitation of TMS testing need to be realized to offer new possibilities of future applications.

Neurocognitive rehabilitation for schizophrenia

A critical review of randomized, controlled trials of extended programs of neurocognitive rehabilitation for the cognitive deficits characteristic of schizophrenia conducted between the years 2000 to 2002 was completed. Over the past several years, two models of cognitive rehabilitation have emerged. In one model, labeled "cognitive remediation," cognitive deficits are treated directly through repeated practice and acquisition of compensatory strategies on cognitive exercises designed to engage underfunctioning brain systems. In a second model, labeled "cognitive adaptation," neurocognitive deficits are addressed through modification of the patients' environment to allow patients to bypass their deficits. Results revealed that a range of cognitive remediation strategies varying widely along dimensions of duration, intensity, method, target of behavioral intervention, and clinical status of participants produced improvements on measures of working memory, emotion perception, and executive function distinct from those trained during remediation. No effects were evident in secondary verbal or nonverbal memory. Results of two pilot studies using functional magnetic resonance imaging to assess changes in task-evoked brain activation have revealed that these interventions may produce changes in several functionally relevant neural systems in a subset of patients. Results from studies of standardized cognitive adaptation interventions have indicated that these treatments can produce improvements in symptoms, psychosocial status, and relapse rates. A variety of approaches for future research are also discussed.

Shaping attention span: an operant conditioning procedure to improve neurocognition and functioning in schizophrenia.

The high prevalence of neurocognitive deficits in schizophrenia, and their association with poorer outcomes, has created interest in treatments that can improve neurocognitive functioning in this illness. While a variety of rehabilitation interventions have been developed, many are not appropriate for the most severely ill patients, whose attention spans are so short that they cannot attend to the material being presented. For this population, the only neurocognitive rehabilitation methods with demonstrated effectiveness are those that involve the operant conditioning technique known as shaping. In this article, we review the rationale for the use of shaping-based methods as neurocognitive retraining techniques for treatment-refractory schizophrenia patients, review published reports using this intervention, and offer suggestions for the future development of this method from both clinical and research perspectives.

Effects of methylphenidate on functional MRI blood oxygen level dependent (BOLD) contrast

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What are we changing with neurocognitive rehabilitation?: Illustrations from two single cases of changes in neuropsychological performance and brain systems as measured by SPECT

If cognitive remediation is to be developed further, there have to be not only large-scale randomized trials but also detailed analysis of the strategies used to produce improved performance. In this study the strategies adopted by two people who took part in a remediation program are investigated, with their results on neuropsychological tasks and with concomitant brain image data gathered via SPECT while the participant was performing a Verbal Fluency task. After remediation there were improvements in many of the neuropsychological tests, and changes in the scan data. The changes in strategies and brain activation were different for both individuals. One person increased his verbal output but without close monitoring, so also increased his errors. The other participant decreased his output but monitored it more closely, and so decreased the errors. These strategies were reflected in the changes in activation between scans, i.e. increases in temporal areas for the increased output and bilateral decreases in the anterior cingulate and left pre-motor areas for the decreased output case. Together these results imply that the participants continue to use individual strategies which for many of the neuropsychological tasks produced gains. Further investigation of whether it is possible to change idiosyncratic strategy use is needed if we are to develop the efficacy of this remediation technique.

Neurocognitive rehabilitation guidelines for therapists.

Establishing and implementing cognitive rehabilitation (CR) plans requ i re the efforts of al I rehabilitation staff members. In addition to clear expectations about therapists' roles and responsibilities, there are other issues that need to be considered when creating CR protocols. Specifically, the patient's insight into his or her deficits is a crucial consideration when establishing a CR plan. Other factors also need to be examined, such as the role of the family, the method of establishing goals and monitoring progress, and the necessity of providing feedback to the patient. This article addresses these issues and provides guidelines for rehabilitation teams to establish CR plans.

Neurocognitive rehabilitation of patients with chronic schizophrenia: Three case studies

Neurocognitive rehabilitation of patients with chronic schizophrenia: Three case studies