Neuropsychological Impairment Research Articles

Prospective assessment of early developmental markers and their association with neuropsychological impairment

Children who experience adversities in the pre-perinatal period are at increased risk of developing impairment later in life, despite the absence of overt brain and neurological abnormalities. However, many of these children exhibit sequelae several years after a period of normal appearance. As a result, the need for reliable developmental assessments for the early detection of infants at high risk of adverse neurodevelopmental outcomes has emerged. The Griffiths Mental Developmental Scales have a promising but poorly explored prognostic ability. This longitudinal study evaluated the predictive power of the Griffiths Mental Developmental Scales at 12 and 24 months on the cognitive and neuropsychological profile at 6 years of age in a sample of 70 children with a history of prematurity or perinatal asphyxia but without brain and neurological abnormalities. We found that the Griffiths Mental Developmental Scales at 24 months had good predictive ability on the intelligence quotient at 6 years and the capacity to predict some neuropsychological performances. On the other hand, the Griffiths Mental Developmental Scale at 12 months was not associated with the performance at 6 years or 24 months. Conclusion: Data on brain development converge to indicate that the first two years of age represent a critical stage of development, particularly for children experiencing mild pre-perinatal adversities who are thought to exhibit white matter dysmaturity. For this reason, this age is crucial for identifying which children are at major risk, leaving enough time to intervene before overt deficits become apparent. Brain development in the first 2 years could explain the limited reliability of early neurodevelopmental testing.What is Known:• Pre-perinatal adversities increase the risk of developing neurodevelopmental disorders.• The predictive ability of the Griffith scale is poorly explored in low-grade conditions.What is New:• The predictive ability of the Griffith scale has been investigated in low-risk children.• A complete neuropsychological profile could offer a more accurate prediction than the intellectual quotient.

Neuropsychological side effects of anti-epileptic drugs in epilepsy patients: a cross sectional study

Background: Epilepsy is the fourth most common neurological disorder in world. Managing an epilepsy with anti-epileptic drugs (AEDs) either as monotherapy or polytherapy is necessary to reduce the deleterious effect of the disease and to provide neuroprotection. AEDs exert their negative effects on cognition by suppressing neuronal excitability or enhancing inhibitory neurotransmission. These neuropsychological side effects are found to be modest when the drug level is within the therapeutic concentration and used as monotherapy. Objectives were to assess the prevalence of neuropsychological side effects among epilepsy patients who were on antiepileptic drug therapy. Methods: An open label, cross-sectional, clinical study was conducted at a tertiary care hospital, 126 participants were recruited. Participants demographic data, detailed medical and seizure history followed by neuropsychological tests was performed. The prevalence was assessed based on the number of participants scoring <15th percentile in one or more tests. Results: Out of 126 participants who were recruited, 82 participants were on monotherapy and 44 participants were on polytherapy. Levetiracetam was the most commonly prescribed drug as monotherapy, followed by phenytoin, carbamazepine and valproate; whereas in polytherapy levetiracetam, clobazam followed by phenytoin were the commonly prescribed AED. The most common adverse effect was drowsiness, followed by headache, hypersensitivity reaction, giddiness, tremors, anxiety etc. The prevalence of neuropsychological side effects was 77.8%. The prevalence of impairment between monotherapy and polytherapy was statistically insignificant (p=0.727). Conclusions: In this study, levetiracetam was the most commonly prescribed drug and the most common adverse effect was drowsiness due to AEDs. The subgroup analyses between monotherapy and polytherapy did not show any statistically significant neuropsychological impairment when compared based on the gender, age groups, duration of epilepsy with medication and duration of current therapy.

Neuropsychological impairment in primary malignant brain tumor patients with awake craniotomy: a hospital-based registration study.

Neuroplasticity is an ability to maintain neural circuit function when facing damages. It is one of the reasons that making brain tumors notorious. Therefore, we evaluated the characteristics of patients with primary brain tumors, compared neuropsychological deficits between patients who had awake craniotomy with left- or right-sided tumors, and analyzed the association between white matter tracts and neuropsychological deficits in patients with right-sided tumors. Using the registration dataset of Chang Gung Memory Hospital between 2014 and 2020, this study included a total of 698 adult patients who received craniotomy for primary brain tumors (538 of conventional craniotomy; 160 of awake craniotomy). Neuropsychological assessments were arranged in patients as preoperative evaluation for awake craniotomies. A lower proportion of right-sided tumors was noted in patient who had awake craniotomy than those who had conventional craniotomy (33.8% and 51.5%, p < 0.001). In awake craniotomy, 88.7% of patients with left-sided tumors and 77.8% of patients with right-sided tumors had neuropsychological impairment. Patients with left-sided tumors had worse preoperative performance compared to those with right-sided tumors in global function (36.2% and 8.0%, p < 0.001), language domain (57.6% and 22.2%, p < 0.001), and attention (36.0% and 18.5%, p = 0.02). Furthermore, in those with right-sided low-grade gliomas, patients involving pathway of superior longitudinal fasciculus (SLF) I had a higher risk of deficits than those without involvement in verbal memory (p = 0.001, Odd ratio = 11.2, 95% CI = 1.8 ~ 71.4) and visual memory (p = 0.048, Odd ratio = 10.5, 95% CI = 1.0 ~ 111). In awake craniotomy, patients with left-sided brain tumors had worse cognitive function than those with right-sided tumors in terms of global function, language, and attention. 77% of patients with right-sided tumors had neuropsychological impairment. Therefore, a comprehensive neuropsychological evaluation and awake craniotomy are necessary for patients with brain tumors.

VRNPT: A Neuropsychological Test Tool for Diagnosing Mild Cognitive Impairment Using Virtual Reality and EEG Signals

Mild cognitive impairment is associated with many neurodegenerative diseases. It is essential to detect mild cognitive impairment on time to reduce the prevalence of such disorders. Nevertheless, present clinically employed test scales and biomarkers are time-consuming, user-unfriendly, and expensive. Hence, we developed a neuropsychological test system based on virtual reality in this study, the Virtual Reality Neuropsychological Mild Cognitive Impairment Test (VRNPT). The diagnosis and classification of MCI were achieved by effectively combining digital cognitive parameters and EEG signal features obtained during the VRNPT cognitive task. The VRNPT contains three head-mounted display-based cognitive tasks that assess participants’ attention, memory, spatial perception, working memory, and visuospatial executive ability across multiple cognitive domains of functioning. We investigated how to design and optimize these tasks. We conducted a field study by recruiting 80 participants (40 MCI patients and 40 normal older adults). The results showed that the classification accuracy of combining digitized cognitive parameters and EEG signals during VRNPT was 91.3%, higher than using only digitized parameters from VRNPT and applying EEG signals alone, demonstrating the validity and feasibility of this method for diagnosing MCI. The user satisfaction survey showed that the subjects were satisfied with VRNPT.

Improving Alzheimer's Disease Diagnosis with Artificial Intelligence and Neuropsychological Tests

Alzheimer's Disease (AD) is a type of progressive dementia that causes loss of memory and function. It affects over 5.8 million people sixty years of age and older in the United States alone. When an individual has AD, neurodegeneration ultimately leads to severe impairment and eventually death. Throughout the stages of the disease, symptoms can range from mild forgetfulness to loss of motor control and bodily functions. Unfortunately, the disease may go unnoticed during initial stages if not tested for and detected early. Signs of Alzheimer's may accidentally be overlooked by physicians, especially if they are subtle. Artificial intelligence (AI) and machine learning models (ML) can be used to improve the identification process of early signs of AD. Some neuropsychological impairments AD patients suffer from include memory loss, difficulty recalling words or phrases, changes in personality and behavior, and decline in bodily functions that affect day to day life. AI may be able to pick up certain details and data that human perception cannot. If trained with a proper data set, ML models would be helpful to physicians in this area of healthcare. In this systematic review, the different neuropsychological impairments visible in the early stages of AD will be discussed as they relate to ML, deep learning, and AI applications intended to aid the diagnosis of AD.

Emulsifiers during gestation: The risks of ultra-processed food revealed in mice.

Several dietary components disrupt the control of energy balance. A new study in PLOS Biology shows that, in mice, maternal consumption of emulsifiers induces a rewiring of the hypothalamic feeding circuits and causes neuropsychological impairment in the offspring.

Is Shadowing Behavior Caused by Body Representation Disorders and Apraxia?

Shadowing is a person-following behavior, commonly observed in dementia (e.g., Alzheimer's disease). It may be caused by neuropsychological impairments associated with posterior brain lesions, as Kudo et al. described it in a patient with posterior cortical atrophy and no frontal signs. These authors have suggested that shadowing may arise from the combination of visuospatial impairments, aphasia, apraxia, and prosopagnosia. However, how these symptoms may contribute to shadowing remains unclear. It is suggested that the combination of visuospatial impairments, body representation disorders, and apraxia, may result in complete loss of spatial representations and hence, shadowing behavior.

How fear of intimacy affects infertile men's neuropsychological functioning through mental toughness.

There is a significant need in Pakistan to investigate the psychological effects of infertility on the mental health of infertile men. The current study examined how fear of intimacy affects neuropsychological impairment and evaluated its relationship to other variables including quality of life and mental toughness. An analytical cross-sectional study was carried out on infertile male patients in various healthcare settings in Punjab, Pakistan. The participants were recruited using a non-probability (purposive) sampling strategy. The sample size was 120 infertile. SPSS 26 was used to analyze the data. Fear of intimacy was found significant impact on neuropsychological impairment (r = 0.40; ***p < 0.001), as well as fear of intimacy, significantly associated with emotional problems (r = 0.48; **p < 0.01), learning problems (r = 0.33; **p < 0.01), sensory and motor problem (r = 0.55; **p < 0.01), concentration problem (r = 0.21; **p < 0.01), mental & physical in coordination (r = 0.37; **p < 0.01) and depression (r = 0.22; **p < 0.01). Fear of intimacy has negative impact on QoL (r = -0.25; *p > 0.05). Similarly, neuropsychological impairment was found to be negatively associated with QoL (r = -0.52; **p > 0.01). The relationship between fear of intimacy and neuropsychological impairment was found to be significantly mediated by QoL. Furthermore, the findings revealed that mental toughness significantly moderated the relationship between fear of intimacy and neuropsychological impairment. Overall, infertile men in Pakistan had relatively high levels of fear of intimacy, which largely caused neuropsychological impairment. This study can help neuropsychological researchers, mental health professionals, as well as policymakers in improving clinical mental health practices for infertile patients.

Relationship between longitudinal changes in neuropsychological outcome and disease biomarkers in urea cycle disorders.

Urea cycle disorders (UCDs) cause impaired conversion of waste nitrogen to urea leading to rise in glutamine and ammonia. Elevated ammonia and glutamine have been implicated in brain injury. This study assessed relationships between biomarkers of metabolic control and long-term changes in neuropsychological test scores in participants of the longitudinal study of UCDs. The hypothesis was that elevated ammonia and glutamine are associated with neuropsychological impairment. Data from 146 participants who completed 2 neuropsychological assessments were analyzed. Neuropsychological tests that showed significant changes in scores over time were identified and associations between score change and interim metabolic biomarker levels were investigated. Participants showed a significant decrease in performance on visual motor integration (VMI) and verbal learning immediate-recall. A decrease in scores was associated with experiencing interim hyperammonemic events (HAE) and frequency of HAE. Outside of HAE there was a significant association between median ammonia levels ≥50µmol/L and impaired VMI. VMI and memory encoding are specifically affected in UCDs longitudinally, indicating that patients experience difficulties when required to integrate motor and visual functions and learn new information. Only ammonia biomarkers showed a significant association with impairment. Preventing HAE and controlling ammonia levels is key in UCD management. The Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery VMI) and List A Trial 5 of the California Verbal Learning Test (CVLT) may be good longitudinal biomarkers of treatment outcome in urea cycle disorders (UCD). This is the first report of longitudinal biomarkers for treatment outcome in UCD. These two biomarkers of outcome may be useful for clinical trials assessing new treatments for UCD. These results will also inform educators how to design interventions directed at improving learning in individuals with UCDs.

No evidence of neuronal/glial autoantibodies in febrile infection-related epilepsy syndrome (FIRES): a prospective clinic-serologic analysis.

The pediatric febrile infection-related epilepsy syndrome (FIRES) manifests with encephalopathy with super-refractory status epilepticus (SE) a few days after or accompanying a febrile illness. It often results in refractory epilepsy and cognitive dysfunction in previously healthy children and adolescents. The underlying pathomechanism is unknown, which is why causative neuronal and/or synaptic antibodies have been discussed. We report a prospective consecutive cohort of 14 children (10 male, four female) diagnosed with FIRES in the acute phase, whose serum and CSF were comprehensively screened for underlying synaptic/neuronal autoantibodies. The median age at onset was 6 years (range 4-9 years). None of the children had a medical history of epilepsy. Duration of SE varied from less than 1 week to 2.5 months (Median: 1 month, range < 1 week-2.5 months). Clinical response to treatment with antiseizure medications was poor as well as the outcome: one child died in the acute phase of SE, and two died in the long term. All surviving children showed neuropsychological impairments. No underlying synaptic or neuronal autoantibodies were identified in 13 of 14 children's sera or CSF. One child had currently uncharacterized neuronal autoantibodies in CSF, yet clinical presentation was atypical for FIRES. Based on our findings, the child was later diagnosed with autoimmune encephalitis (AE). We conclude that FIRES is not an autoantibody-mediated disease. However, a comprehensive screening for known and yet unknown antineuronal antibodies in serum and CSF is warranted to rule out AE mimicking FIRES.

A comparison of 2 doses of antenatal dexamethasone for the prevention of respiratory distress syndrome: an open-label, noninferiority, pragmatic randomized trial

Antenatal corticosteroids have been used for the prevention of respiratory complications, intraventricular hemorrhage, necrotizing enterocolitis, and other adverse neonatal outcomes for over 50 years, with limited evidence about their optimal doses. Higher steroid doses or frequencies of antenatal corticosteroids in preterm newborns pose adverse effects such as prolonged adrenal suppression, negative effects on fetal programming and metabolism, and increased risks of neurodevelopmental and neuropsychological impairments. Conversely, lower doses of antenatal corticosteroids may be an effective alternative to induce fetal lung maturation with less risk to the fetus. Late preterm births represent the largest population of all preterm neonates, with a respiratory distress syndrome risk of 8.83%. Therefore, determining the optimal antenatal corticosteroid dosage is of particular importance for this population. This study aimed to compare the efficacy of 5-mg and 6-mg dexamethasone in preventing neonatal respiratory distress syndrome in women with preterm births at 320 to 366 weeks of gestation. This was an open-label, randomized, controlled, noninferiority trial. Singleton pregnant women (n=370) at 320 to 366 weeks of gestation with spontaneous preterm labor or preterm premature rupture of membranes were enrolled. They were randomly assigned (1:1) to a 5-mg or 6-mg dexamethasone group. Dexamethasone was administered intramuscularly every 12 hours for 4 doses or until delivery. The primary outcome was the reduction in neonatal respiratory distress syndrome cases, whereas the secondary outcomes were any adverse maternal or neonatal events. Between December 2020 and April 2022, 370 eligible women, anticipating deliveries within the gestational range of 32 0/7 to 36 6/7 weeks, willingly participated in the study. They were evenly split, with 185 women assigned to the 5-mg group and 185 to the 6-mg group. The study revealed that the demographic profiles of the participants in the 2 groups were remarkably similar, with no statistically significant disparities (P>.05). It is noteworthy that most of these women gave birth after 34 weeks of gestation. Despite a substantial proportion not completing the full course of steroid treatment, the 5-mg dose exhibited noninferiority compared with the 6-mg dose of dexamethasone, as indicated by a modest proportional difference of 0.5% (95% confidence interval,-2.8 to 43.9). Neonatal respiratory distress syndrome occurred in a relatively low percentage of newborns in both groups, affecting 2.2% in the 5-mg group and 1.6% in the 6-mg group. Notably, the risk difference of 0.6% fell comfortably within the predefined noninferiority threshold of 10%. Our study suggests that a 5-mg dexamethasone dose is noninferior to a standard 6-mg dose in preventing neonatal respiratory distress syndrome in preterm births.

Arousal deregulation in the co-shaping of neuropsychological dysfunction in frontal and mesial temporal lobe epilepsy

ObjectiveOur work aims to investigate the role of physiological arousal in the expression of neuropsychological deficits in frontal lobe epilepsy (FLE) and mesial temporal lobe epilepsy (mTLE), by drawing on the Lurian theory of brain function. MethodsFor this study a total of 43 patients with focal onset epilepsy has been taken; twenty-four patients with FLE, 19 patients with mTLE and 26 healthy controls, all matched for age and education. Participants underwent a comprehensive neuropsychological assessment including various cognitive domains, such as attention, episodic memory, speed of information processing, response inhibition and mental flexibility, working memory, verbal fluency (phonological & semantic). ResultsThere were no significant differences between FLE and mTLE patients in terms of neuropsychological performance. However, both FLE and mTLE patients showed significantly worse performance in several cognitive domains than HCs. The results seem to support our hypothesis that aberrant physiological arousal, as reflected in patients’ worse performance in vigilance and attention, response inhibition, and processing speed, along with other disease-specific variables, may co-determine neuropsychological dysfunction and/or impairment in both FLE and mTLE. ConclusionIdentifying a differential arousal-related neuropsychological affection in FLE and mTLE, among the known deleterious effects of the functional deficit zone and other disease-related variables, may further our understanding of the underlying cognitive-pathophysiological mechanisms in focal epilepsy syndromes.

CLINICAL AND PSYCHOSOCIAL FACTORS DETERMINING THE QUALITY OF LIFE IN PATIENTS WITH ISCHEMIC STROKE

Acute cerebrovascular pathology, including common clinical forms such as ischemic stroke, remains the most important medical and socio-economic challenge, due to the severe consequences of the post-stroke period. Cognitive impairments are the most socially significant ones.&#x0D; The aim of the study is to assess the influence of psychosocial and clinical factors on the quality of life of patients with ischemic stroke.&#x0D; Materials and Methods. The authors examined 100 patients with ischemic stroke (54 men, 46 women). The age of patients ranged from 35–85; the average age of men was 59.6±11.0 years, the average age of women – 60.7±10.4 years. The authors interviewed the patients, conducted neurological examination, and neuropsychological testing using the HADS, MMSE scales, Personality Questionnaire of the Bekhterev Institute, SCL-90-R, and the SAGE test. Statistical processing was carried out using non-parametric (Mann–Whitney U test) and parametric (Student’s t-test) criteria.&#x0D; Results. The study establishes the main clinical and psychosocial factors of the acute period of ischemic stroke, which have the most significant impact on the patients’ quality of life. The most important are cognitive impairments associated with disorders of psycho-emotional background and autonomic regulation. They greatly reduce the adaptive abilities of a person. Despite neuropsychological and cognitive impairments, the motivation level for recovery remains high in all patients with ischemic stroke.&#x0D; Conclusions. While developing personalized rehabilitation programs, it is necessary to take into account personal characteristics of patients and to focus on the active restoration of their adaptive-compensatory capabilities.

Carotid Artery Stenting versus Carotid Endarterectomy in Terms of Neuroprotection DW-MRI Detected and Neuropsychological Assessment Impairment

Carotid artery stenting (CAS) versus carotid endarterectomy (CEA) is well issue known, but the purpose of this study is to compare CAS versus CEA in terms of asymptomatic Diffusion-weighted magnetic resonance imaging (DW-MRI) demonstrated microembolic scattering of infarction and neuropsychological assessment impairment. We performed a prospective, observational, cohort study on 211 consecutive carotid revascularizations at our institution. Patients were divided into 2 different cohorts: CEA was performed in n=116 patients (Group A); CAS was performed in n=95 (Group B). Adverse events were collected at 30days and 6months postoperative. Differences in terms of DW-MRI demonstrated microembolic scattering of infarction were analyzed and considered significative for P≤0.05. Secondary objectives were: major and minor stroke, neuropsychological assessment impairment, death, myocardial infarction (MI). CEA was associated with a significative decreased rate of asymptomatic DW-MRI demonstrated microembolic scattering of infarction (13.8% vs. 51%; P=0.0001) and of 6months neuropsychological assessments impairment (0.8 vs. 7.4) (P=0.04) in asymptomatic patients. There was no significant difference between 2 groups in terms of comorbidities. Stroke rates were similar at 30days (1.7% CEA vs. 4.1% CAS) and 6months (2.6% CEA vs. 5.3% CAS P=0.32). There were no differences in terms of central neurological events, death, transient ischemic attack, MI between the groups. The composite end point of stroke/death/MI at 6months postoperatively was 2.6% vs. 6.3% (P=0.19). According to these results, CEA achieved better outcomes compared to patients treated by CAS with distal filter in terms of asymptomatic microembolic event and impairment National Institutes of Health Stroke Scale scale and neuropsychological assessments. Limitations of the study lead to limited conclusions only in the specific population and not generalized. Further, comparative randomized studies are warranted.

New Insights into the Neuropsychological Profile and Intellectual Quotient Variability in Joubert Syndrome Compared to Other Congenital Cerebellar Malformations.

The neuropsychological characteristics of the cerebellar cognitive affective syndrome (CCAS) in congenital, non-progressive malformations of the cerebellum have been scarcely investigated, and even less is known for Joubert syndrome (JS), an inherited, non-progressive cerebellar ataxia characterized by the so-called molar tooth sign. The few studies on this topic reported inconsistent results about intellectual functioning and specific neuropsychological impairments. The aim of this research is to examine the neuropsychological profile of JS compared to other congenital cerebellar malformations (CM), considering individual variability of intellectual quotient (IQ) in the two groups. Fourteen patients with JS and 15 patients with CM aged 6-25 years were tested through a comprehensive, standardized neuropsychological battery. Their scores in the neuropsychological domains were inspected through descriptive analysis and compared by mean of MANOVA and ANOVA models, then replicated inserting IQ as covariate. The two groups showed a largely overlapping neuropsychological profile, consistent with CCAS. However, the JS group showed worse performance in visual-spatial memory compared to CM patients, although this difference was mitigated when considering IQ. These findings highlight a divergence between JS and other CM in visual-spatial memory, which might suggest a critical role of the cerebellum in recalling task-relevant memories and might inform rehabilitative interventions.

Probabilistic benefit-risk analysis of fish: Nutritional benefit versus methylmercury-contaminated risk

This paper carries out probabilistic approach to quantify the benefit-risk analysis for foods (BRAFO) of omega-3 polyunsaturated fatty acid and methylmercury (MeHg) for the people who eat the mercury-contaminated fish in Taiwan. We applied the hazard quotient (HQ) model to assess the risk of developmental neuropsychological impairment effect and the desirable dose index (DI) model to quantify the health benefits. Besides, we also applied the disability adjusted life years (DALY) model to assess the number of years lost by incidence of affected infants' intelligence quotient (IQ) and coronary heart disease (CHD) or Stroke for adult. The results of this study show that although the risk of cod and scad are higher, Taiwan residents do not need to reduce intake rate based on benefit considerations. Furthermore, according to the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), this study suggests that more intake of saury and salmon.

Efecto de los pesticidas sobre el rendimiento cognitivo y motor en habitantes de zonas rurales del Tolima

Organophosphate pesticides can cause cognitive impairment. However, the farmer uses different pesticides in all phases of the same crop. The aim of this study was to analyze the effect of serial pesticides on cognitive and motor performance in samples of exposed, indirectly exposed, and unexposed people. In the exploratory study with a cross-sectional design, a total of 135 small farmers from the informal sector participated. Mini-Mental, Trail Making, Rey-Osterrieth Complex Figure, Digit Retention, Hopkins Verbal Learning and the Grooved Pegboard tests were administered. The results show that the highest serial exposure occurs with Glyphosate, Lorsban, Furadan and Paraquat. The group with direct exposure to pesticides presented a lower performance in working memory, explicit verbal memory, constructive praxis and fine motor control of the right hand, than the indirectly exposed group and the unexposed group. In conclusion, direct and serial exposure to pesticides generates neuropsychological and motor impairment in informal sector farmers, it is recommended the development of public politics that promote healthy and safe practices, to minimize the risks due to the use of these substances

Neuropsychological Performance, Substance Misuse, and Recidivism in Intimate Partner Violence Perpetrators.

Previous research has pointed out the importance of neuropsychological impairments in intimate partner violence (IPV) perpetrators for reoffending/recidivism once treatment ends. However, less is known about whether substance misuse is associated with impairments or deficits, which facilitate recidivism. In this study, we first aimed to assess whether IPV perpetrators with (n = 104) and without (n = 120) substance misuse showed differences in specific neuropsychological variables in comparison with non-violent men (n = 82). Second, we examined whether there were differences in IPV perpetrators' recidivism and whether these differences were explained by neuropsychological performance. Our results revealed that IPV perpetrators with substance misuse showed worse cognitive performance than controls. Furthermore, we also found differences between IPV perpetrators without substance misuse and controls, but only in terms of executive functioning. There were no differences in neuropsychological performance between the two groups of IPV perpetrators, although those with substance misuse presented higher recidivism rates than those without substance misuse. Finally, cognitive flexibility, verbal fluency, and worse attention functioning were related to high recidivism in both groups of IPV perpetrators. This study underlies the importance of performing neuropsychological assessments during the initial stages of intervention programs for IPV perpetrators in order to design coadjutant neuropsychological/cognitive training to address not only the psychological needs (including substance misuse) of IPV perpetrators, but also their neuropsychological needs.

Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study.

Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.

Improve sleep in critically ill patients: Study protocol for a randomized controlled trial for a multi-component intervention of environment control in the ICU.

In critically ill patients, sleep and circadian rhythms are greatly altered. These disturbances have been associated with adverse consequences, including increased mortality. Factors associated with the ICU environment, such as exposure to inadequate light and noise levels during the day and night or inflexible schedules of daily care activities, have been described as playing an essential role in sleep disturbances. The main objective of this study is to evaluate the impact of the use of a multifaceted environmental control intervention in the ICU on the quantity and quality of sleep, delirium, and post-intensive care neuropsychological impairment in critically ill patients. This is a prospective, parallel-group, randomized trial in 56 critically ill patients once they are starting to recover from their acute illness. Patients will be randomized to receive a multifaceted intervention of environmental control in the ICU (dynamic light therapy, auditory masking, and rationalization of ICU nocturnal patient care activities) or standard care. The protocol will be applied from enrollment until ICU discharge. Baseline parameters, light and noise levels, polysomnography and actigraphy, daily oscillation of plasma concentrations of Melatonin and Cortisol, and questionnaires for the qualitative evaluation of sleep, will be assessed during the study. In addition, all patients will undergo standardized follow-up before hospital discharge and at 6 months to evaluate neuropsychological impairment. This study is the first randomized clinical trial in critically ill patients to evaluate the effect of a multicomponent, non-pharmacological environmental control intervention on sleep improvement in ICU patients. The results will provide data about the potential synergistic effects of a combined multi-component environmental intervention in ICU on outcomes in the ICU and long term, and the mechanism of action. ClinicalTrials.gov, NCT. Registered on January 10, 2023. Last updated on 24 Jan 2023.