Neuropsychological Performance In Patients Research Articles

Neuropsychological Functioning in Patients With Alcohol-Related Liver Disease Before and After Liver Transplantation

Cognitive dysfunction is common in both end-stage liver disease and chronic alcohol misuse. The impact of orthotopic liver transplantation (OLT) on neuropsychological function is poorly documented. This prospective study examined changes in cognitive function pre- and post-OLT in patients with alcohol-related liver disease (ALD). Comprehensive neuropsychological assessment was conducted with 92 abstinent patients with ALD scheduled for OLT. Forty-two patients were available for reassessment 12 months post-OLT. Posttransplantation, cognitive performance on all measures fell within normal limits. Greatest improvement occurred in visuomotor speed, complex visual attention processes, and the ability to solve visually presented problems. Performance on memory assessment tasks also improved posttransplantation. Applying a more robust assessment of change (Reliable Change Index), approximately half improved reliably on overall cognitive function. One quarter improved in memory performance. With the exception of the Full-Scale Intelligence Quotient scales, discriminant analysis was unable to successfully predict which patients reliably improved. Overall improvement in cognitive function occurs after liver transplantation in ALD. It was not possible to identify which patient characteristics were associated with reliable change.

P41 Cognitive dysfunction in hospitalised patients prior to discharge following acute exacerbation of COPD

RationaleCognitive impairment is one of the least well-studied COPD comorbidities. It occurs in a proportion of hypoxemic patients, but its presence during acute exacerbation has not been established. We assessed...

Neuropsychological function in patients who have had epilepsy surgery: A long-term follow-up

We examined the relationship between seizure outcomes and long-term changes in memory and intellectual function in 70 patients who had undergone temporal lobe resection for medically intractable epilepsy. Patients were assessed on four occasions: preoperatively (T1), 3months postoperatively (T2), 1year postoperatively (T3), and more than 5years postoperatively (T4). The majority of patients had stable memory function across the assessments. However, many were functioning below the 15th percentile on the test norms preoperatively, with little capacity for further decline. All patients who demonstrated a progressive decline in verbal or visual learning were female and continued to experience seizures postoperatively. Progressive postoperative declines in memory function are associated with poor postoperative seizure control. These patterns can be obscured in group analyses that do not take into account baseline levels of function. Neuropsychological scores must be set in the context of the norms of the test and the associated capacity for further significant change over time to maximize the clinical relevance of long-term surgical follow-up studies.

Early-onset Alzheimer's disease is associated with a distinct neuropsychological profile

Alzheimer's disease (AD) mostly occurs in the elderly. Nevertheless, AD also occurs in younger patients (i.e. ≤ 65 years old) and often has a different clinical manifestation. This study examined whether neuropsychological performance in patients with early onset AD differed from patients with late onset AD. In 172 Patients with AD (81 early onset and 91 late onset) cognition was assessed using a battery of neuropsychological tests. These tests were combined into five cognitive domains (memory, language, attention, executive functioning and visuo-spatial functioning). Global cognitive functioning was assessed using Mini-Mental State Examination (MMSE) and Cambridge Cognitive Examination (CAMCOG). Univariate analyses of variance were performed with age of onset as between-subjects factor, and sex and education as covariates. In patients with early onset AD age (mean±SD) was 60±4 years, 54% were female. In patients with late onset AD age was 72±5 years, 52% were female. Global cognition did not differ between early (MMSE:20±5, CAMCOG:69±15) and late onset AD (MMSE:21±5, CAMCOG:70±15) (p = 0.2 and p = 0.25). Patients with early onset AD performed worse on tasks demanding attention (p < 0.001), executive functioning (p < 0.001) and visuo-spatial functioning (p < 0.001) than patients with late onset AD. Patients with late onset AD performed worse on memory than patients with early onset AD, but this was not significant (p = 0.11). We found no differences in language (p = 0.21). Patients with early onset AD presented with a different profile of cognitive impairment than patients with late onset AD. In patients with early onset AD visuo-spatial functioning, attention and executive functioning were more severely impaired, while memory was relatively spared.

Neuropsychological correlates of apathy in mild cognitive impairment and Alzheimer's disease: the role of executive functioning

Apathy is a common and important behavioral syndrome in various neuropsychiatric diseases, such as mild cognitive impairment (MCI) and Alzheimer's disease (AD). So far, only few studies have compared the neuropsychological correlates of apathy in patients with MCI and dementia. The aim of the current study was to examine the association between apathy and neuropsychological functioning in patients with MCI and AD. Two-hundred-and-sixty AD patients and 178 MCI patients visiting the Memory Clinic of the Maastricht University Medical Centre participated in the study. Linear regression analysis, corrected for age, gender, level of education and depression, was performed to reveal cross-sectional associations between apathy and scores on neuropsychological tests of memory, attention, psychomotor speed and executive functioning. In patients with MCI, apathy was characterized by decreased verbal fluency and psychomotor tracking. In AD, patients with apathy differed from non-apathetic patients only on a verbal fluency task. Apathy is related to executive dysfunction in the early phases of cognitive decline. In particular, in the prodromal phase of AD, apathy seems to be characterized by poor initiating. In the more advanced stages of cognitive deterioration, associations between apathy and specific neuropsychological correlates may be obscured by the more severe neuropathology. Awareness of apathy in the early phase of cognitive impairment may help in early diagnosis of AD.

Neuropsychological performance in patients with schizophrenia and controls as a function of cigarette smoking status

Schizophrenia is associated with many neurocognitive deficits, some of which are improved by nicotine and cigarette smoking. To better understand the relationship between smoking and cognitive function in schizophrenia, cross-sectional assessment of neuropsychological performance as a function of smoking status (smoker or non-smoker) and smoking history (current, former or never-smoker) in clinically stable outpatients with schizophrenia and controls was evaluated. Subjects (n=140) were divided into subgroups on the basis of self-report and biochemical verification of smoking history. Current smokers with schizophrenia (n=38), former smokers with schizophrenia (n=17), never-smokers with schizophrenia (n=12), control smokers (n=31), control former smokers (n=16), and control never-smokers (n=26) were administered a comprehensive neuropsychological battery. Smokers were studied under non-deprivation conditions. Comparison of neuropsychological performance in schizophrenia and control subjects revealed significant main effects of diagnosis. Analysis of the data as a function of smoking history demonstrated that never-smokers with schizophrenia performed the poorest on measures of sustained attention, processing speed and response inhibition, when compared to the other schizophrenia subgroups. Cigarette smoking did not alter neuropsychological performance in controls. Our findings suggest that smoking status and history differentially alters neuropsychological outcomes in schizophrenia compared to non-psychiatric controls, and that never-smokers may present with more severe neurocognitive impairments.

P12.7 Intraoperative neurophysiological monitoring improves postoperative neuropsychological performance in patients with brain tumor

P12.7 Intraoperative neurophysiological monitoring improves postoperative neuropsychological performance in patients with brain tumor

P01-248-Theory of mind, moral judgments and neuropsychological functioning in patients with bipolar disorders

IntroductionSeveral studies revealed that cognitive functioning in BPD are impaired not only in the acute phase but over time (Mur et al., 2008). On Theory of Mind (ToM) recent studies found a impairment of this ability in remitted patients, supporting the theory that ToM deficits are trait-dependent (Bora et al., 2009) in contrast with another study that suggest a partially dependence(Wolf et al. 2010).ObjectivesWe explored: a) ToM in BPD investigating two cognitive processes: emotional recognition, second order beliefs attribution; b) Moral judgments in BPD; c) possible effects of neuropsychological functioning on ToM task and moral dilemmas.AimsThe principal aim is to investigate the domain specificity of ToM and Moral sense, studying selective impairments.MethodA total of 20 patients with bipolar I disorder were tested and 20 healthy controls. We use a complete neuropsychological assessment, two ToM tasks (Eyes test, Sullivan's stories) and we added two moral dilemmas to asses moral judgment Results: We found ToM deficits in BDP, with a multiple correlation between ToM and neuropsychological functioning. Also we found for the first time a impairment on personal moral dilemma, with a correlation between emotional recognition and moral judgments.ConclusionPatients with BPD are impaired in ToM partially independent of other cognitive dysfunctions and in moral reasoning.

A Meta-Analysis of Neuropsychological Functioning in Patients with Early Onset Schizophrenia and Pediatric Bipolar Disorder

Despite the nosological distinction between bipolar disorder and schizophrenia, there is increasing evidence that these conditions share phenomenological characteristics. To examine the similarities in their patterns of cognitive impairment, we conducted a meta-analysis from 12 studies of Early Onset Schizophrenia (EOS) and 12 studies of Pediatric Bipolar Disorder (PBD). We found that individuals with PBD suffer from cognitive deficits (e.g., verbal learning and memory, processing speed, or executive control) that are milder but similar in nature to those of patients with EOS. Qualitative similarities between the neuropsychological profiles produced by these groups of patients might represent a “continuum of psychosis” or reflect some degree of genetic biological overlap.

Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis.

This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (beta = .36, p < .001 and beta = .61, p < .001, respectively). Changes in depression and fatigue were not significantly related to changes in objective neuropsychological performance. Improvements in depression and fatigue also predicted improved accuracy in perceiving cognitive abilities from pre- to posttreatment (OR = .77, p < .001 and OR = .90, p < .001, respectively). The results of this study suggest that improvements in depression and fatigue through treatment do not influence objective neuropsychological performance in MS patients, but do relate to changes in subjective impairment. Furthermore, these changes improve patients' abilities to accurately perceive their cognitive functioning.

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

Nonclinical Obsessive-Compulsive Symptoms and Executive Functions in Schizophrenia

The relation between level of depression and neuropsychological functioning in patients with Alzheimer's disease

The relation between level of depression and neuropsychological functioning in patients with Alzheimer's disease

Functional cooking skills and neuropsychological functioning in patients with stroke: An ecological validity study

Efforts to relate neuropsychological performance to real-world task functioning have predominantly yielded lackluster results, typically with neuropsychological performance accounting for modest amounts of variance in function. Nonetheless, the ecological validity of neuropsychological measures for predicting functional abilities remains a strong research interest and clinical necessity. This study relates neuropsychological performance to performance on a standardised cooking task (Rabideau Kitchen Evaluation – Revised; RKE-R) in persons with stroke. Results showed that while the composite score of mean neuropsychological performance had the largest association with meal preparation, several neuropsychological measures were significantly related to the RKE-R. Groups of left and right hemisphere stroke patients were not significantly different in terms of RKE-R performance. These results suggest that functional cooking task performance is related to intact cognitive abilities in delayed verbal memory, simple auditory attention, and visuospatial skills, as well as overall cognitive performance. Implications for neuropsychologists are discussed.

Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder

Neurocognitive dysfunction in schizophrenia (SZ), bipolar (BD) and related disorders represents a core feature of these illnesses, possibly a marker of underlying pathophysiology. Substantial overlap in domains of neuropsychological deficits has been reported among these disorders after illness onset. However, it is unclear whether deficits follow the same longitudinal pre- and post-morbid course across diagnoses. We examine evidence for neurocognitive dysfunction as a core feature of all idiopathic psychotic illnesses, and trace its evolution from pre-morbid and prodromal states through the emergence of overt psychosis and into chronic illness in patients with SZ, BD and related disorders. Articles reporting on neuropsychological functioning in patients with SZ, BD and related disorders before and after illness onset were reviewed. Given the vast literature on these topics and the present focus on cross-diagnostic comparisons, priority was given to primary data papers that assessed cross-diagnostic samples and recent meta-analyses. Patients with SZ exhibit dysfunction preceding the onset of illness, which becomes more pronounced in the prodrome and early years following diagnosis, then settles into a stable pattern. Patients with BD generally exhibit typical cognitive development pre-morbidly, but demonstrate deficits by first episode that are amplified with worsening symptoms and exacerbations. Neuropsychological deficits represent a core feature of SZ and BD; however, their onset and progression differ between diagnostic groups. A lifetime perspective on the evolution of neurocognitive deficits in SZ and BD reveals distinct patterns, and may provide a useful guide to the examination of the pathophysiological processes underpinning these functions across disorders.

Lithium Treatment Effects on the Neuropsychological Functioning of Patients With Bipolar I Disorder

To determine if medication plays a major role in cognitive impairment in bipolar disorder and if regular treatment with lithium influences the cognitive performance of a group of euthymic patients with bipolar I disorder. Cognitive performance was assessed using neuropsychological tests of attention, memory, and executive function on 60 subjects: 20 euthymic bipolar I patients with no medication intake, 20 euthymic bipolar I patients who were following regular treatment with lithium carbonate monotherapy, and a third group of 20 control healthy subjects. The subjects were evaluated from January 2005 to October 2006. Patients were diagnosed using DSM-IV criteria for bipolar disorder. Compared to the healthy group, bipolar I patients had significantly lower performance on episodic verbal and visual-verbal memory regardless of their medication status. No significant cognitive performance differences were found between the two groups of patients with bipolar disorder, suggesting that lithium therapy had no deleterious effects on cognition. Patients with bipolar I disorder have verbal memory deficits that are not explained by medication or by lithium monotherapy, but by the condition itself.

Neuropsychological function in patients with a single gene mutation associated with autosomal dominant nocturnal frontal lobe epilepsy

Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a nonlesional condition associated with mutation of the gene coding for the α4 nicotinic acetylcholine receptor (nAChR). The nAChR modulates aspects of memory and attention. We examined the neuropsychological phenotype of ADNFLE, with a particular emphasis on understanding the impact on frontal lobe functions. We used standard clinical tests as well as focused measures of frontal lobe function in a well-defined group of patients with ADNFLE. Their performance was compared with that of a group of age-, sex-, and education-matched control participants. Patients with ADNFLE showed impairments on tasks requiring cognitive flexibility against a background of well-preserved intellectual abilities. In accord with existing research, verbal memory impairments were identified in the patient group; the level of impairment on these tasks correlated with disease-related factors. In our study of ADNFLE associated with one mutation, cognitive flexibility appears to be the core cognitive deficit.

P02-301 - Cognitive and psycopathological dimentions of eating disorders

ObjectivesSeveral studies have examined the neuropsychological functioning in patients with Eating Disorders (ED) suggesting that they could be related to an impairment in several areas. We investigate such cognitive functions especially decision making and visual-spatial memory in an independent sample of patients suffering from ED and to evaluate possible differences between patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) as well as between ED subjects and healthy controls.MethodsTrial Making Test (TMT), Iowa Gambling Task (IGT) and Gambling Task (GT) were administered to 15 AN patients 12 BN patients and 19 healthy subjects.ResultsWe observed that 80% of AN and the 75% of BN subjects performed poorly in the IGT compared to the healthy subjects (36,8%). Similarly, ED patients committed more mistakes and employed more time to complete TMT compared to healthy controls. However, no significant difference was found between ED groups and healthy subjects with respect to GT. Further, no significant difference was observed between AN and BN subjects with respect to IGT and GT.ConclusionOur results suggested that patients with ED could have a significant deficit in visual-spatial attention. As a consequence they need more time to complete the task and make more mistakes. Furthermore ED patient had a deficit in decision making tasks as well. This could reflect deficits in planning long term strategies to approach problems, possibly leading to improper behaviors for the control of their weight.

Changes in neuropsychological functioning following temporal lobectomy in patients with temporal lobe epilepsy

Purpose: This study was conducted to evaluate the changes in neuropsychological functioning in patients with temporal lobe epilepsy (TLE) after temporal lobe resection.Methods: Fifty-four TLE patients were evaluated before and after surgery using comprehensive neuropsychological tests to assess general intelligence, executive functioning, language, verbal and visual memory, working memory, visuo-spatial ability, attention and motor function.Results: The patients with left TLE showed no impairment of neuropsychological functioning after surgery, with the exception of auditory immediate memory. Furthermore, they showed significant improvement in performance IQ, executive function, working memory, visual memory, attention and psychomotor speed. The patients with right TLE did not show any significant impairment in post-operative neuropsychological functioning. They showed improvements in intellectual and executive functions, language, visual memory, visuo-spatial ability, attention and motor function post-operatively. The patients with hippocampal sclerosis showed greater post-operative improvements than the patients without hippocampal sclerosis regardless of the side. Patients with better pre-operative neuropsychological function had a higher chance of successfully discontinuing all seizure medications after surgery.Discussion: The results of this study suggest that temporal lobectomy does not harm the neuropsychological functioning of patients with intractable TLE and that it improves cognitive functions of the contralateral hemisphere.

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

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

Impairment of Driving Ability and Neuropsychological Function in Patients with MHE Disease

Minimal hepatitis encephalopathy (MHE) is a liver cirrhosis complication that does not show symptoms of overt hepatitis encephalopathy (OHE) but can be detected using specific complementary neuropsychological and neurophysiological evaluations. Patients with MHE show abnormalities in cognitive functions, which can increase the risk of automobile accidents. The aim of this study was to compare the cognitive functioning of patients with MHE to patients with other liver disease and to compare their driving abilities, using a driving simulator and the Stim(2) software. Thirty-eight participants, who were not diagnosed with OHE but were diagnosed with chronic hepatitis and liver cirrhosis, took part in the study. The results indicate that patients with MHE show reduced level of cognitive functioning, which may affect their ability to drive safely. We cautiously predict that any future guidelines based on this knowledge may help reduce the incidence of traffic accidents caused by drivers with decreased with driving abilities.