Neuropsychological Impairment In Patients Research Articles

The association between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health related quality of life in newly diagnosed ovarian cancer patients

ObjectiveTo assess cognitive function in patients newly diagnosed with ovarian cancer (OC) before treatment and explore the relationship between neuropsychological impairment, self-perceived cognitive deficit, symptoms, and health-related quality of life in them. MethodsFrom May 2021 to February 2022, 105 women newly diagnosed with OC were enrolled in the Cancer Center of Fudan University, Shanghai, China. Objective and subjective cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) scale and Perceptual Deficits Questionnaire (PDQ). Symptoms and quality of life were evaluated using the Memorial Symptom Assessment Scale (MSAS) and Functional Assessment of Cancer Therapy-Ovarian Cancer (FACT-O), respectively. ResultsThis study included 105 newly diagnosed OC patients, with an average age of 49.73 (±8.48) years. Of these, 72.38% had impaired neuropsychological test scores, especially in delayed recall, abstraction, and visuospatial/executive function. Retrospective, and prospective memory were the most serious perceived deficits. The results of the MoCA test were not associated with PDQ (Rs = -0.180, P = 0.067) and significantly correlated with the distress index, physiological and total scores of the MSAS, and emotional well- being of the FACT-O. The PDQ positively correlated with all MSAS dimensions but not with the FACT-O. ConclusionThe incidence of neuropsychological impairment in patients newly diagnosed with OC was high, with no association with self-perceived cognitive deficits. It is recommended that healthcare providers include cognitive impairment in symptom management in this population, who may benefit from early assessment, prevention, and intervention.

17 Comparing Cognitive Patient-Reported Outcomes with Neuropsychological Impairment in Patients with Diffuse Glioma.

Objective:Cognitive difficulties among diffuse glioma survivors are common in survivorship due to cancer treatment effects (i.e., surgery, chemotherapy, and/or radiation therapy), which can diminish quality of life. Routine monitoring of cognitive symptoms in survivorship is recommended and can help address patient needs and inform clinical interventions (e.g., cognitive rehabilitation). While several patient-reported outcome (PRO) measures have been used in brain tumor populations, there has been few studies comparing the performance of these PROs in patients with diffuse glioma. In order to better understand the value of different PROs, we conducted preliminary analyses associating cognitive PROs with neuropsychological impairment in a well-characterized sample of patients with diffuse glioma.Participants and Methods:23 glioma patients (mean aged 44.26 ± 12.24), six or more months after completing cancer treatment, underwent comprehensive psychosocial and neuropsychological assessments. The neuropsychological battery included the Hopkins Verbal Learning Test - Revised, Brief Visuospatial Memory Test - Revised, Wechsler Adult Intelligence Scale-IV tests of Coding and Digit Span, Trail-Making Test, Stroop Test, FAS, Animals, Boston Naming Test, and Rey-Osterrieth Complex Figure (copy). Completed cognitive PROs included the Functional Assessment of Cancer - Cognitive Function and Brain questionnaires (FACT-Cog; FACT-Br), the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire for Brain Neoplasms (EORTC QLQ-BN20), and the Multidimensional Fatigue Symptom Inventory, short form (MFSI-SF) Mental subscale. Based on published norms, we divided the sample into cognitively impaired and non-impaired groups (two or more primary neuropsychological test scores <= -2 z-score). We compared PRO scores between impaired and non-impaired groups using Mann-Whitney U tests. Higher medians equate to better cognitive functioning for all PROs, except for the MSFI-SF.Results:We found significantly worse scores in the impaired group compared to non-impaired group on the FACT-Cog subscales of perceived cognitive ability (PCA), [Non-Impaired (Mdn = 21, n = 11), Impaired (Mdn = 10, n = 12), U = 22.5, z = -2.68, = 0.007], perceived cognitive impairment (PCI), [Non-Impaired (Mdn = 59, n = 11), Impaired (Mdn = 44, n = 12), U = 32.5, z = -2.06, p=0.039]. The impaired group also trended towards worse scores on the FACT-Br additional concerns subscale [Non-Impaired (Mdn = 79.5, n = 10), Impaired (Mdn = 61, n = 12), U = 32.5, z = -1.81, p=0.07]. Group differences were not observed on the MSFI-SF [Non-Impaired (Mdn = 5, n = 11), Impaired (Mdn = 7, n = 12), U = 40.5, z = -1.57, p=0.12], or EORTC Cognitive Functioning subscale [Non-Impaired (Mdn = 83.33, n = 10), Impaired (Mdn = 75, n = 12), U = 42, z = -1.23, p=0.218].Conclusions:The preliminary findings suggest that the FACT-Cog, especially the PCA and PCI correspond with neuropsychological impairment among diffuse glioma survivors better than other cognitive PROs. The FACT-Br subscale was somewhat effective. The MFSI-SF Mental and EORTC Cognitive Functioning subscales did not correspond to impairment status. The FACT-Cog is a promising instrument and future work is needed to better determine relative utility of cognitive PROs in this population.

Virtual reality working memory training improves cognitive performance of acute and remitted patients with major depressive disorder

BackgroundCognitive training is effective in treating neuropsychological impairment in patients with major depressive disorder (MDD), and virtual reality (VR) is a promising tool to provide such training. However, studies using VR-based working memory (WM) training in treating depressed patients' cognitive impairment are extremely scarce and how it affects cognitive performance remains unclear. Therefore, we aimed to determine the efficacy of VR-WM training in acute and remitted depressed patients and try to investigate its potential mechanisms. MethodsForty-two patients with MDD (22 acute patients and 20 remitted patients) received 20-session VR-WM training, while 22 healthy controls (HC) received no intervention. WM and other cognitive domains' performance were assessed by the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) and the MATRICS Consensus Cognitive Battery (MCCB) before and after the intervention. Depressive symptoms were assessed by the 24-item Hamilton Depression Rating Scale (24-HDRS) at the same time points. ResultsAcute and remitted MDD patients both exhibited significant improvements from pre- to post-training in WM, processing speed, visual learning, reasoning and problem-solving, and total cognition (all p < 0.05). Significant groups-by-time interactions were observed for the 24-HDRS score (p < 0.05). Mediation analysis showed that 24-HDRS score partially mediated the association between the effect of VR-WM training on WM and total cognition performance in total depressive samples. ConclusionsVR-WM training effectively improved WM and other cognitive domains' performance in both acute and remitted MDD patients. Besides, VR-WM training improves WM and total cognition performance in MDD patients partially via the enhancement of depressive symptoms.

Spatial Patterns of Amyloid Deposition in Patients with Chronic Focal or Diffuse Traumatic Brain Injury Using 18F-FPYBF-2 PET.

AimAmyloid-β (Aβ) accumulation, accelerated by traumatic brain injury (TBI), may play a crucial role in neurodegeneration in chronic-stage TBI. The injury type could influence Aβ dynamics because of TBI’s complex, heterogeneous nature. We, therefore, investigated spatial patterns of amyloid deposition according to injury type after TBI using 5-(5-(2-(2-(2-[F]-fluoroethoxy)ethoxy)ethoxy)benzofuran-2-yl)-N-methylpyridin-2-amine (18F-FPYBF-2) positron emission tomography (PET).MethodsAltogether, 20 patients with chronic TBI [12 with focal injury, 8 with diffuse axonal injury (DAI)] underwent 18F-FPYBF-2 PET, structural magnetic resonance imaging (MRI), and neuropsychological examination. Additionally, 50 healthy controls underwent either 18F-FPYBF-2 PET (n=30) or structural MRI (n=20).ResultsStandardized uptake value ratio (SUVR) on PET images and regional brain volumes were measured in four cortical (frontal, parietal, occipital, temporal) and subcortical (combined caudate, putamen, pallidum, thalamus) regions. Patients with DAI showed significantly increased (compared with controls) SUVR in occipital and temporal cortices and decreased brain volume in occipital cortex (corrected p < 0.05). Although patients with focal injury showed decreased SUVR in all regions except occipital cortex, there were no significant differences (compared with controls) in the SUVR in any regions. There were no significant correlations between increased SUVR and neuropsychological impairments in patients with DAI.ConclusionVarying spatial patterns of amyloid deposition suggest amyloid pathology diversity depending on the injury type in chronic-TBI patients.

Effects of mood episodes and comorbid anxiety on neuropsychological impairment in patients with bipolar spectrum disorder.

ObjectivesCases of patients with bipolar disorder (BD) having neuropsychological impairment have been reported, although inconsistently. The possibility of comorbidity with anxiety disorder (AD) has been suggested. The association between mood episodes and AD comorbidity on neuropsychological performance is unclear and thus was investigated in the current study.MethodsAll participants were informed about and agreed to participate in this study. Patients with BD were recruited from outpatient and inpatient settings, and healthy controls (HCs) were recruited as a comparison group. Six hundred and twenty‐eight participants (175 HCs and 453 BD—56 BDI and 397 BDII) were studied based on their current mood episode, namely, depressive (BDd), manic/hypomanic (BDm), mixed (BDmix), and euthymic (BDeu), compared with/without AD comorbidity (164 with AD).ResultsCompared to HCs, all BD groups had significantly more impaired neuropsychological profiles, but the BDeu group was found to have less impairment in memory and executive function than the episodic BD groups. The percentage of AD comorbidity in BDd, BDm, BDmix, and BDeu was 33.9%, 40.3%, 33.0%, and 35.6%, respectively (χ 2 = 1.61, p > .05). The results show that AD plays a different role in neuropsychological impairment across various mood episodes in BD.ConclusionMemory impairment and executive dysfunction may be state‐like cognitive phenotypes and are affected by AD comorbidity during mixed and depressive episodes in BD, while sustained attention deficiencies are more like trait markers, regardless of mood episodes, and persist beyond the course of the illness. The AD comorbidity effect on attentional deficit is greater when suffering from a manic episode.

Executive functions and bone health: a focus on cognitive impulsivity and bone mineral density

Background : It is known that cognitive impairment is associated with low bone mineral density (BMD) and that low BMD is also observed in elderly people with neurodegenerative diseases, in which executive functions (EF) could be decreased. A limited number of studies investigated the association between EF with BMD and fracture risk in elderly women. Aims : The aim of this study was to explore the association between cognitive impulsivity, BMD and fall risk in a sample of postmenopausal women evaluated for osteoporosis. Methods : We consecutively recruited women who obtained a score ≥ 24 at the Mini Mental State Examination (MMSE). Cognitive impulsivity was evaluated by the Stroop Colour and Word Test (SCWT). BMD was detected by dual-energy X-ray absorptiometry at lumbar spine and femoral neck. Results: Cognitive impulsivity, as evidenced by the greater number of errors at the SCWT, was significantly related with BMD values at lumbar spine and femoral neck (r= -0.39, p= 0.01 and r= -0.43, p= 0.008; respectively), suggesting a neuropsychological impairment in patients assessed for osteoporosis. Moreover, interference effect on response time was significantly associated with higher prevalence of falls (r= 0.342; p= 0.031). Discussion and Conclusions : Our findings suggested a potential involvement of cognitive impulsivity on BMD and risk of fall. This is a relevant issue in clinical practice for both clinical psychologists and physicians who evaluate postmenopausal women, to eventually predict risk of fracture.

Neuropsychological impairment in patients with idiopathic generalized epilepsy (IGE)

Background: Idiopathic Generalized Epilepsy (IGE) is a group of genetically determined epileptic syndromes including generalized epilepsy with generalized tonicclonic seizures (IGEGTCS), juvenile myoclonic epilepsy (JME), childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE). Given the neuropsychological deficits in many patients, IGE should not be considered entirely “benign”.

Neuropsychological Outcomes in Patients with Complicated Versus Uncomplicated Mild Traumatic Brain Injury: 6-Month Follow-Up

To compare the extent of persistent neuropsychological impairment in patients with complicated mild traumatic brain injury (mTBI) and those with uncomplicated mTBI. Sixty-one patients with mTBI (Glasgow Coma Scale score 13-15) were recruited prospectively, categorized according to baseline computed tomography findings, and subjected to neuropsychological assessment at initial admission (n= 61) as well as at a 6-month follow-up (n= 30). The paired t test, Cohen's d effect size calculation, and repeated-measures analysis of variance were used to establish the differences between the 2 groups in terms of neuropsychological performance. A trend toward poorer neuropsychological performance among the patients with complicated mTBI was observed during admission; however, performance in this group improved over time. In contrast, the uncomplicated mTBI group showed slower recovery, especially in tasks of memory, visuospatial processing, and executive functions, at follow-up. Our findings suggest that despite the broad umbrella designation of mTBI, the current classification schemes of injury severity for mild neurotrauma should be revisited. They also raise questions about the clinical relevance of both traumatic focal lesions and the absence of visible traumatic lesions on brain imaging studies in patients with milder forms of head trauma.

The relationship between self-reported and objective neuropsychological impairments in patients with hoarding disorder

Although hoarding disorder (HD) is characterized by self- and clinician-reported difficulties with cognitive functioning, studies of neuropsychological performance have yielded little evidence of consistent, clinical-level cognitive impairments. The aim of this study was to quantify this inconsistency and to examine whether this pattern is unique to HD. Fifty-three adults (20 with HD, 19 with obsessive compulsive disorder (OCD) and minimal hoarding symptoms, and 14 with OCD and a high degree of hoarding symptoms (OCD-H)) completed self-report and objective neuropsychological tests of inhibition, attention, and memory. The three groups differed significantly on self-reported attention and memory deficits, with the HD group reporting greater difficulties. However, the groups performed comparably on objective neuropsychological tests of inhibition, attention, immediate and delayed nonverbal memory, and immediate verbal memory. The OCD-H group demonstrated a greater rate of impairment on a test of delayed verbal memory. The HD group was characterized by lower concordance rates between self-report and objective memory impairment. The groups did not differ significantly in concordance rates for self-report and objective measures of attention and inhibition. Understanding the discrepancy between self-report and objective neuropsychological measures may help to better characterize the role of cognitive processes in HD.

Obsessive-compulsive disorder: an integrative genetic and neurobiological perspective.

Obsessive-compulsive disorder (OCD) is characterized by repetitive thoughts and behaviours that are experienced as unwanted. Family and twin studies have demonstrated that OCD is a multifactorial familial condition that involves both polygenic and environmental risk factors. Neuroimaging studies have implicated the cortico-striato-thalamo-cortical circuit in the pathophysiology of the disorder, which is supported by the observation of specific neuropsychological impairments in patients with OCD, mainly in executive functions. Genetic studies indicate that genes affecting the serotonergic, dopaminergic and glutamatergic systems, and the interaction between them, play a crucial part in the functioning of this circuit. Environmental factors such as adverse perinatal events, psychological trauma and neurological trauma may modify the expression of risk genes and, hence, trigger the manifestation of obsessive-compulsive behaviours.

Cognitive dysfunction and depression in Fabry disease: a systematic review

Fabry disease, an X-linked lysosomal storage disorder, leads to multi-organ dysfunction, including cerebrovascular disease and psychological disorders. However, the prevalence and pattern of associated cognitive dysfunction is not well understood. To investigate whether there is reliable evidence for neuropsychological impairment in patients with Fabry disease and which cognitive domains are affected. To estimate the prevalence of and factors associated with depression in patients with Fabry disease. Qualitative systematic review of the literature of studies conducting neuropsychological assessment or measuring the prevalence of depression in adults with Fabry disease using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines where appropriate. There is some evidence for neuropsychological impairment in Fabry disease in executive functioning, information processing speed and attention, with preservation of: general intellectual functioning, memory, naming, perceptual functioning and global cognitive functioning. Prevalence rates of depression in Fabry disease ranged from 15% to 62%, with the largest study to date reporting a prevalence rate of 46%. The most common factor associated with depression was neuropathic pain, both directly and indirectly by affecting social and adaptive functioning. Our review suggests that Fabry disease may be associated with a characteristic pattern of cognitive deficits and a high prevalence of psychological disorders such as depression but highlights the limited available data. Exploring the nature of cognitive impairment in Fabry disease using standardised neuropsychological assessment, brain imaging and measures of depression is an important task for future research.

Neuropsychological Parameters as Potential Biomarkers for Alzheimer’s Disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disease. It is of great importance that we find efficient preclinical markers that can be used in clinics. The neuropathological features associated with AD brain include the progressive formation of insoluble amyloid plaques and vascular deposits consisting of the amyloid β peptide in the brain and neuron loss that innervates regions such as the hippocampus and the cortex. These lesions are considered to cause the abnormal sensory information processing and brain dysfunction of AD patients. Combined cognitive and sensory as well as neuroimaging approaches have advantages to find the altered cognitive symptoms and brain dysfunction in the early stage in AD involved mild memory or planning problems. This review provides an overview of the neuropsychological impairments in patients with AD, which may be used as potential biomarkers for early diagnosis of AD.

Initial neuropsychological impairments in patients with the E46K mutation of the α-synuclein gene (PARK 1)

IntroductionIn 2004 we described the mutation E46K of the α-Synuclein (SNCA). These patients show Parkinson's disease with early cognitive impairment, sleep disorders and autonomic dysfunction. ObjectiveThe main objective is to identify early neuropsychological impairments in patients with the E46K mutation. MethodsThis is a longitudinal neuropsychological study of 4 of the 5 surviving patients with E46K mutation by semi-structured interviews and the following scales: Mattis Dementia Rating Scale (MDRS), semantic and phonemic verbal fluency tests (VFT), Benton Visual Retention Test (BVRT), Stroop Test (STROOP), Clock drawing test (CLOCK), WAIS III Letter and Number sequencing (WAIS III LN), Rey Auditory Verbal Learning Test (RAVLT) and Benton Judgement of Line Orientation Test (BJLOT). Motor status was assessed by UPDRS III. ResultsMotor status: Patients 1, 2 and 3 present mild to moderate Parkinson disease of 7, 8 and 3years of evolution respectively, patient 4 is asymptomatic.Cognitive status: Patient 2 and 3 both refer cognitive decline while patient 1 presents no cognitive complaints, however they all show a progressive cognitive decline across various tasks. Tests of frontal function showed the first alterations in all patients but fluctuate. The first cognitive complaints coincide with deterioration of tasks of posterior cortical basis. Patient 4 presents a normal performance on all tests. Patient 1, 2 and 3 have all presented visual hallucinations. ConclusionsA fluctuating frontal impairment is observed at early stages. Prominent visuospatial alterations and visual hallucinations suggest that posterior cortical dysfunction might be a distinct early feature of the cognitive impairment observed in patients with this mutation.

Specifying the Neuropsychology of Affective Disorders: Clinical, Demographic and Neurobiological Factors

Neuropsychological research in patients with affective disorders shows heterogeneous results with regard to the severity and profile of cognitive impairments. In this paper we hypothesize that the investigation of clinical (subtypes, comorbidity, traumatization, personality, severity, diurnal swings, course, duration, age of onset, biased processing, rumination, motivation, experience of failure, sleep, suicidal tendencies, computer attitudes), demographic (age, education, gender) and neurobiological factors (structural and functional brain changes, glucocorticoids, medication, ECT) that are related to cognitive performance has specified the understanding of severity and profile of neuropsychological impairments. We reviewed the literature pertaining to clinical, demographic and neurobiological factors following Pubmed and PsychInfo databases using different combinations of general key-terms including "Affective Disorder," "Depression," "Mania," "Neuropsychological," "Neurobiological," "Moderator," and "Review" as well as more specific demographic, clinical and neurobiological search terms. Findings from the literature show that the consideration of these factors has improved knowledge about the severity of neuropsychological impairments in patients with affective disorders whereas the neuropsychological profile is still poorly understood. Despite limited understanding, however, the existent results provide promising suggestions for the development of treatment programs.

Topiramate dose effects on cognition

Topiramate (TPM), a broad-spectrum antiepileptic drug, has been associated with neuropsychological impairment in patients with epilepsy and in healthy volunteers. To establish whether TPM-induced neuropsychological impairment emerges in a dose-dependent fashion and whether early cognitive response (6-week) predicts later performance (24-week). Computerized neuropsychological assessment was performed on 188 cognitively normal adults who completed a double-blind, placebo-controlled, parallel-group, 24-week, dose-ranging study which was designed primarily to assess TPM effects on weight. Target doses were 64, 96, 192, or 384 mg per day. The Computerized Neuropsychological Test Battery was administered at baseline and 6, 12, and 24 weeks. Individual cognitive change was established using reliable change index (RCI) analysis. Neuropsychological effects emerged in a dose-dependent fashion in group analyses (p < 0.0001). RCI analyses showed a dose-related effect that emerged only at the higher dosing, with 12% (64 mg), 8% (96 mg), 15% (192 mg), and 35% (384 mg) of subjects demonstrating neuropsychological decline relative to 5% declining in the placebo group. Neuropsychological change assessed at 6 weeks significantly predicted individual RCI outcome at 24 weeks. Neuropsychological impairment associated with TPM emerges in a dose-dependent fashion. Subjects more likely to demonstrate cognitive impairment after 24 weeks of treatment can be identified early on during treatment (i.e., within 6 weeks). RCI analysis provides a valuable approach to quantify individual neuropsychological risk.

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.

Resuscitating the heart but losing the brain

Many survivors of cardiac arrest are left with considerable long-term impairments due to a transient ischemic state of the brain. Neuropsychologists identified a wide range of neuropsychological deficits in these patients besides the well-known amnesic syndrome. To date, there is no complete and unbiased documentation of the affected brain areas in vivo. We aimed to identify the brain tissue atrophy underlying the observed neuropsychological deficits in a case-control study. We measured gray matter loss by voxel-based morphometry of 3-T structural magnetic resonance images in a sample of 12 patients who had had cardiac arrest with successful subsequent resuscitation in comparison with 12 individually age- and sex-matched control subjects. Such data are rare because many of these patients wear cardiac pacemakers. We found extensive reductions of gray matter volumes in the anterior, medial, and posterior cingulate cortex, the precuneus, the insular cortex, the posterior hippocampus, and the dorsomedial thalamus in tight correlation with neuropsychological impairments, namely, amnestic deficits and apathy. The identified neuroanatomical pattern of brain tissue loss substantiates the reports of wide-ranging neuropsychological impairments in patients after cardiac arrest.

Prevalence and Predictors of Self-Reported Neuropsychological Impairment in Patients Undergoing Hematopoietic Cell Transplantation (HCT) - Impact On Return to Work After HCT.

Abstract 808The growing population of HCT survivors may be at risk for neuropsychological impairment due to exposure to neurotoxic agents. HCT survivors frequently report problems with memory and attention (Cancer 2002;95:183-192), and even though the patients are acutely aware of neuropsychological declines, these changes do not correlate well with impairment on standardized neuropsychological assessments (Bone Marrow Transplant 2005;36:695-702). This discrepancy suggests that the tests may not be sensitive enough to detect subtle changes that could nonetheless impact patients' societal reintegration, highlighting the importance of self-report instruments. The present study aims to assess the longitudinal trajectory of self-reported neuropsychological impairment in patients from pre-HCT to 1 year post-HCT; to evaluate the impact of demographic and clinical factors on self-reported neuropsychological impairment; to examine the relationship between self-reported neuropsychological impairment data and objective data collected using standardized assessments; and to understand the relationship between self-reported impairment and return to work. Participants were 182 adult patients undergoing HCT for hematological malignancies. Mean age at HCT was 50 years (range, 18-73); 60% were males; 68% were non-Hispanic whites; 62% received autologous HCT. Patients completed a 2-hour battery of standardized neuropsychological tests (domains: processing speed; immediate, general, and working memory; cognitive reserve; executive function) and a self-reported Neuropsychological Impairment Scale (NIS – scales: Global Measure of Impairment [GMI, an overall summary score], Cognitive Efficiency [COG], Attention [ATT], Memory [MEM], Learning-Verbal [L-V], Academic Skills [ACD]). Self-reported information on return to work was obtained at 6 months and 1 year after HCT. Demographic (sex, age, race/ethnicity, education, income, marital status) and clinical data (diagnosis, donor source, risk of relapse, conditioning exposures) were collected. Raw scores were converted to t-scores using normative data; individuals with t-scores above 1 SD of the normative distribution were classified as impaired. Generalized estimating equations were used to examine longitudinal trends. The prevalence of domain-specific impairment at specified time points is shown in the Table. After adjusting for significant covariates, GMI worsened at 6 months and plateaued thereafter (p=0.04) and ATT worsened at 6 months but returned to baseline at 1 year (p=0.006) (Figure). Multivariate analyses revealed the following risk factors: at pre-HCT: female gender and less than high school education (higher MEM impairment, p=0.03, p=0.05, respectively); at both 6 months and 1 year post-HCT: annual household income less than $20,000 (higher GMI impairment, p=0.02); exposure to total body irradiation (TBI: higher COG impairment, p=0.006, and higher ATT impairment, p=0.05); female gender (p=0.05) and 4-year college education (p=0.058) (higher MEM impairment). Correlations between NIS scores and standardized assessments were weak (range, r= -0.3 to 0.09). At 6 months, 57% of the patients had not returned to work. Patients with COG impairment were less likely to return to work (p=0.05), while patients with higher cognitive reserve were more likely to return to work (p=0.03). These results suggest that a significant proportion of patients undergoing HCT report neuropsychological impairment that may not be readily captured by standardized assessments. The present study identifies low household income, TBI, female gender, and college education as risk factors and describes the impact of self-reported neuropsychological impairment on the ability to return to work. This study therefore helps characterize a vulnerable population that needs to be followed closely for appropriate intervention to ensure appropriate societal reintegration after HCT.TablePrevalence of neuropsychological impairment (t>60) by time pointGMICOGATTMEML-VACDPre-HCT29%33%25%25%24%22%6 months (n=94)32%40%32%27%33%22%1 year (n=69)32%29%23%29%25%23% [Display omitted] Disclosures:Forman:City of Hope: Employment.

Diagnostic validity of a neuropsychological test battery for Hispanic patients with epilepsy

The Neuropsychological Screening Battery for Hispanics (NeSBHIS) was developed to address the growing need for linguistically appropriate Spanish-language assessment measures. Despite the potential benefits to clinical practice, no prior study has assessed its diagnostic validity in populations with epilepsy. One hundred and fifteen patients with confirmed epilepsy were evaluated via the NeSBHIS; these data were standardized according to age- and education-based norms. Performance decrements were observed in more than 40% of participants on measures of processing speed and naming. Deficits in verbal and visual recall were also exhibited by 29 and 26% of the sample, respectively. No significant differences in test performance emerged between patients with VEEG evidence of left ( N = 48) versus right ( N = 24) temporal lobe epilepsy. Although the NeSBHIS is sensitive to the cognitive impairments commonly observed in populations with epilepsy, there are limitations to its ability to identify lateralized neuropsychological impairment in patients with temporal lobe epilepsy.

Neuropsychological impairment in patients with schizophrenia and evidence of hyponatremia and polydipsia.

Patients with schizophrenia and water imbalance may represent a subset of patients with distinct pathophysiological abnormalities and susceptibility to cognitive impairment. Specifically, patients with polydipsia and hyponatremia have been shown to have smaller anterior hippocampal volumes, which are also associated with various impairments in neuroendocrine function. To determine whether abnormalities in patients with water imbalance extend to the cognitive realm, the present study evaluated neuropsychological functioning in three groups of patients with schizophrenia: polydipsic hyponatremic, polydipsic normonatremic, and nonpolydipsic normonatremic. Participants were administered cognitive tests assessing intelligence, attention, learning/memory (verbal, nonverbal, emotional), and facial discrimination. Hyponatremic patients showed poorer overall neuropsychological functioning relative to all other patients, and polydipsic normonatremic patients performed intermediate to the other two groups. Results indicate that patients with schizophrenia and polydipsia, and particularly those with hyponatremia, show prominent cognitive deficits relative to patients without water imbalance. The clinical, neuroendocrine, and cognitive abnormalities in these patients may arise from pathology within the anterior hippocampus and associated prefrontal/limbic brain regions.