Neuropsychological Measures Research Articles

Beyond neuropsychological tests: AI speech analysis in PKU.

Phenylketonuria (PKU) is a rare inherited metabolic disorder characterized by toxic phenylalanine (Phe) concentrations in blood and brain. State-of-the-art analyses of speech detected a dimension of verbal discourse providing insights that extend beyond those captured by existing paradigms to measure performance associated with biochemical markers in PKU. The Cookie Theft Picture Task provided a standardized stimulus for eliciting spontaneous speech from 42 adults with PKU and 41 adults without PKU. Subtests measuring language and memory from the Wechsler Adult Intelligence Scale-Fourth Edition showed no differences between the groups and no correlations with biomarkers in PKU. In contrast, AI analyses of responses to the Cookie Theft Task revealed significant differences between the PKU and non-PKU groups on 23 linguistic features. Using multidimensional scaling (MDS), these features were aggregated into a single quantifiable Dimension 1 that significantly correlated with biomarkers. When extreme examples of Dimension 1 were presented to chatGPT, the differences noted reflected attention to detail, clarity in word choice, expression cohesion, contextual awareness and emotion recognition. We subsequently defined Dimension 1 as Proficiency in Verbal Discourse. This novel measure elucidated discourse styles possibly associated with suboptimal achievement and learning disabilities, often reported in PKU. In summary, AI captured a characteristic associated with metabolic status undetectable through traditional neuropsychological measures. Future studies will expand upon this novel paradigm, leveraging speech AI to quantify meaningful aspects of everyday functioning and possibly provide information for management decisions. Once validated, this measure holds promise for extension to other rare diseases and incorporation into clinical trials.

Serial Paediatrics Omics Tracking in Myalgic Encephalomyelitis (SPOT-ME): protocol paper for a multidisciplinary, observational study of clinical and biological markers of paediatric myalgic encephalomyelitis/chronic fatigue syndrome in Australian adolescents aged 12–19 years

IntroductionMyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling condition that can affect adolescents during a vulnerable period of development. The underlying biological mechanisms for ME/CFS remain unclear and have rarely...

Neuropsychological Outcomes After Stereo-EEG Radiofrequency Thermocoagulation.

Stereo-EEG-guided radiofrequency thermocoagulation (RFTHC) has been proposed as relatively safe from a cognitive perspective; however, there is a lack of evidence based on neuropsychological assessments supporting this. This study is the first prospective evaluation of neuropsychological outcomes associated with stereo-EEG-guided RFTHC in patients with focal drug-resistant epilepsy. This cohort study involved prospective recruitment of consecutive patients undergoing stereo-EEG from 2 Australian centers. A comprehensive neuropsychological assessment was administered before implantation and 3 months after RFTHC (M = 104.51 days, SD = 29.25). Outcomes across cognitive domains were assessed at a group level with repeated measures t tests. Factorial repeated measures analyses of variance compared memory and language outcomes according to whether dominant mesial temporal lobe (mTL) structures were coagulated. Reliable change indices (RCIs) were computed to explore psychometrically reliable changes at an individual level. The sample comprised 39 patients who underwent stereo-EEG (M = 37.08 ± 9.67 years, range = 17-56 years, 54% female). Nineteen (49%) had a language dominant epileptogenic zone (EZ), 16 (41%) a nondominant EZ, and 4 (10%) a bilateral EZ. All patients underwent RFTHC with a mean of 11.87 (SD = 6.82, range = 2-29) coagulation sites. Ten patients (26%) had RFTHC within the dominant mTL. At a group level, RFTHC was not associated with a significant decline on any neuropsychological measures (all comparisons p > 0.05). Subgroup analyses revealed a decline in delayed verbal recall after RFTHC of dominant mTL structures (F(1,37) = 4.46, p = 0.04, ηp2 = 0.11, 95% CI [0-0.30]; medium to large effect), although it did not remain statistically significant after correction for false discovery rate. No statistically significant group differences were observed on visual memory or language measures post-RFTHC (all comparisons p > 0.05). RCI revealed that after RFTHC within the dominant mTL, 20% of patients experienced a decline in verbal memory and 10% in visual memory. By contrast, 7% declined in verbal memory and 10% in visual memory post-RFTHC outside the dominant mTL. While these findings support the current view that RFTHC is cognitively benign for most cases, the results raise the question of a verbal memory decline after coagulation of the dominant mTL. Individualized neuropsychological counseling before stereo-EEG is essential to avoid unanticipated deficits.

Receptive vocabulary is superior to education level to account for Black and White neuropsychological performance discrepancies.

To evaluate the impact of receptive vocabulary versus years of education on neuropsychological performance of Black and White older adults. A community-based prospectively enrolled cohort (n = 1,007; 130 Black, 877 White) in the Emory Healthy Brain Study were administered the NIH Toolbox Picture Vocabulary Test and neuropsychological measures. Group differences were evaluated with age, sex, and education or age, sex, and Toolbox Vocabulary scores as covariates to determine whether performance differences between Black versus White participants were attenuated or eliminated. With vocabulary as a covariate, the main effect of race was no longer significant for the MoCA, Phonemic Fluency, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test immediate and delayed recall. Although still significantly different between groups, the effect sizes for Animal Fluency, Trails B-A, Symbol Digit Modalities Test, and Rey Copy were attenuated, with the greatest reductions occurring for the Multilingual Naming Test and Judgment of Line Orientation. Findings support the value of using receptive vocabulary as a proxy for premorbid ability level when comparing the cognitive performance of Black and White older adults. The results extend investigations using measures of single word reading to encompass measures assessing word meaning.

Negative memory bias predicts change in psychiatric problems in a naturalistic psychiatric patient sample

Self-referential negative memory bias contributes to depression and other psychiatric disorders. Co-morbidity between these disorders is highly common in clinical practice, but transdiagnostic predictors like negative memory bias are not well understood yet. Therefore, the present study aimed to investigate the predictive value of negative memory bias for long-term change in broad psychiatric problems. In a naturalistic psychiatric patient sample (N = 202), using a prospective design, we examined the predictive value of negative memory bias (Self-Referent Encoding Task, SRET) for change in psychiatric problems (Outcome Questionnaire-45, OQ-45) after one, two, three, and four years. More negative memory bias predicted more psychiatric problems three and four years later, even when controlling for baseline psychiatric problems and depression. Memory bias might be a transdiagnostic predictor of change in psychiatric problems. Including such neuropsychological measures in diagnostics and symptom course prediction may improve psychological interventions.

Effects of one-to-one music therapy in older adults with cognitive impairment: A randomized controlled trial.

This study investigated the effects of music therapy (MT), a nonpharmacological therapy, on cognitive, behavioral, and physiological outcomes in older adults with mild-to-moderate cognitive decline residing in care home settings. A randomized controlled trial design was employed, with 42 care home residents (Mage = 86.25 years) randomly assigned to either a one-to-one 16-week MT intervention or an active control group receiving storytelling. Experimental and control activities were matched on key aspects, and groups were equivalent at baseline concerning demographic factors, general health, cognitive-behavioral characteristics, and cognitive reserve levels. Pre/postintervention neuropsychological and behavioral measures were collected, alongside saliva samples for cortisol/dehydroepiandrosterone ratio and respiratory sinus arrhythmia analysis as indicators of overall stress and autonomic regulation. The MT group exhibited benefits in cognitive, behavioral, and physiological domains, suggesting potential advantages in maintaining cognitive functioning and reducing neuropsychiatric symptoms. Biomarkers indicated possible mechanisms underlying the effectiveness of MT. The 16 one-to-one interactive MT sessions-delivered over 5 months-had a positive impact on older adults with mild-to-moderate cognitive decline living in care home settings. The implications of these findings for healthy aging and suggestions for future research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Dietary inflammatory index scores and cognitive aging: results from the Framingham heart Study offspring cohort.

Nutritional factors can abet or protect against systemic chronic inflammation, which plays an important role in the development and progression of dementia. We evaluated whether higher (i.e. pro-inflammatory) Dietary Inflammatory Index (DII) scores were associated with cognitive decline in the community-based Offspring Framingham Heart Study (FHS). 1,614 older adults (mean age 61 years [standard deviation (SD)], 9;55% women]) completed validated 126-item Food Frequency Questionnaires (FFQ), administered at FHS examination cycle 7 (1998-2001) and examination cycle 5 (1991-1995) and/or 6 (1995-1998). We created a DII score (based on the published method by Shivappa et al. 2014) for each available exam; a cumulative DII score was calculated by averaging exam-specific scores across the two or three exams. Cognitive testing was completed at call back sessions following examination cycles 7 and 8 (2005-2008). Exam 7 was considered as study baseline and participants were followed over a mean time of seven years (SD 1). We excluded participants with prevalent dementia at baseline and those with no cognitive testing data at either/or exams 7 and 8. We examined associations between the cumulative DII score and cognitive test scores over time using annualized change adjusting for age, sex, education (model 1) and additionally for exam 7 measures of body mass index, total energy intake, total cholesterol: high-density lipoprotein ratio, smoking and anti-cholesterol medication (model 2). Higher DII scores were significantly associated with (less) decline in performance on Similarities (verbal comprehension/reasoning) and Global cognition, following adjustments for model 1 covariates (Model 1:β and SE, 0.017, 0.008,p=0.03; 0.004,0.002,p=0.02, respectively). The effect sizes remained similar after additional adjustment for Model 2 covariates (0.018, 0.009,p=0.06; 0.004, 0.002,p=0.03, respectively). Additionally, we found that higher DII scores associated with accelerated decline in performance on Trail Making B-A (processing speed and executive function) (Model 2: -0.010, 0.004,p=0.03). We observed no relationships between higher DII scores and other neuropsychological tests. Further, stratified analyses revealed a linear relationship between higher DII scores and (less) decline in performance on Hooper visual organization among men, but not women (Model 2: 0.022, 0.010,p=0.02; -0.011, 0.009,p=0.23, respectively). Higher DII scores were associated with (less) cognitive decline. We take our unexpected findings with caution as we previous have seen a relationship between higher DII scores and increased risk for dementia. To date, such studies have been very limited, most studies that found a relationship were cross-sectional and have used less sensitive testing. Future longitudinal studies with sensitive neuropsychological test measures are encouraged to elucidate whether a longitudinal relationship between higher DII scores and age-related cognitive decline exists.

Home-based, computer-assisted cognitive rehabilitation for attention in pediatric onset multiple sclerosis: a randomized, multicenter pilot study.

Cognitive impairment affects approximately 30% of pediatric onset Multiple Sclerosis (POMS) patients with a negative impact on everyday life. The aim of this study was to evaluate the feasibility and effectiveness of a home-based, computer-assisted training of attention in patients with POMS. This was a randomized double-blind study. Subjects were randomized to specific training (ST) or non-specific training (n-ST), delivered through a customized module based on attention exercises (COGNI-TRAcK2). The main feature of the ST is the implementation of working load algorithms and procedures for intensiveness regulation. The effectiveness of the ST on attention was primarily assessed on the Symbol Digit Modalities Test (SDMT), using the Wilcoxon signed-rank test. Secondary objectives included effectiveness on other cognitive tests. The evaluations were performed at baseline, end of training and 3-month follow-up. 22 relapsing-remitting patients were included: data of 8 subjects in n-ST and 5 subjects in ST were available. As for the primary outcome, SDMT score improved in the ST group (from 31.2 at baseline to 42.4 after 3 months, p = 0.043).There was no benefit in other neuropsychological measures. These preliminary findings point to a potential benefit of a home-based, computer-assisted training of attention in patients with POMS.

Quick-reference criteria for identifying multivariate cognitive change in older adults with mild cognitive impairment and dementia: An ADNI study.

To establish quick-reference criteria regarding the frequency of statistically rare changes in seven neuropsychological measures administered to older adults. Data from 935 older adults examined over a two-year interval were obtained from the Alzheimer's Disease Neuroimaging Initiative. The sample included 401 cognitively normal older adults whose scores were used to determine the natural distribution of change scores for seven cognitive measures and to set change score thresholds corresponding to the 5th percentile. The number of test scores that exceeded these thresholds were counted for the cognitively normal group, as well as 381 individuals with mild cognitive impairment (MCI) and 153 individuals with dementia. Regression analyses examined whether the number of change scores predicted diagnostic group membership beyond demographic covariates. Only 4.2% of cognitively normal participants obtained two or more change scores that fell below the 5th percentile of change scores, compared to 10.6% of the stable MCI participants and 38.6% of those who converted to dementia. After adjusting for age, gender, race/ethnicity, and premorbid estimates, the number of change scores below the 5th percentile significantly predicted diagnostic group membership. It was uncommon for older adults to have two or more change scores fall below the 5th percentile thresholds in a seven-test battery. Higher change counts may identify those showing atypical cognitive decline.

Forensic Neuropsychological Foundations in Competency to Stand Trial Evaluations.

Neuropsychological assessment can play a vital role in competency to stand trial (CST) evaluations. This article provides an overview of the brain and behavior-based conditions that may impact an individual's ability to participate in their legal proceedings, as well as the relevant legal parameters that guide these types of forensic mental health evaluations. Circumstances that may warrant the involvement of a neuropsychologist in these evaluations are reviewed. For example, neuropsychologists' expertise with validity testing, as well as their specialized knowledge of cognition, is useful from the onset of the evaluation through the end, where involved parties often want to know about restoration interventions and feasibility. Select neuropsychological testing measures and cultural considerations are also addressed. The article concludes with illustrative case examples that demonstrate the real-world application of neuropsychological involvement in this specific forensic context. Given the expanding opportunities for neuropsychologists to assist triers of fact, this work contributes to the necessary and developing education base for neuropsychologists who wish to provide informed, effective, and culturally sensitive CST evaluations or related consultation to the legal system.

The spectrum effect: Convergence of clinical and neuropsychological characteristics in adults referred for autism assessment

Clinical and neuropsychological profiles of adults referred for autism assessment are not thoroughly understood, and information derived from studies comparing autistic adults to neurotypical controls might not be accurate to infer on individuals in a real-world, clinical setting. 263 adults (aged 18–65 years, 70 % males) referred to our clinic with a suspected diagnosis of autism were clinically explored and administered neuropsychological investigations. The suspected diagnosis was either confirmed or rejected. We conducted multivariate and post-hoc univariate analyses of covariance (MANCOVA; ANCOVA), controlling for possible confounders, to evaluate differences between autistic and non-autistic participants and further associations. Effect sizes (partial η²) were calculated for significant results. There were no significant differences in age means and sex ratios. Both groups showed high Autism Questionnaire (AQ) scores, high schizoid, avoidant, and obsessive-compulsive scores, and mild depressive symptoms, without significant difference between groups. The effect sizes of differences ranged from negligible to small for measures of nonsocial cognition, but were large for a measure of social cognition, the emotion recognition 40 (ER40). Autistic and non-autistic participants present converging features across multiple measures. In this diagnostic setting, psychiatric and neuropsychological measures are helpful in identifying individual difficulties and strengths. However, most of them, including the AQ, are poor indicators of autism. Our results mostly aligned with previous research and showed that information derived from comparisons to neurotypical controls cannot be directly transferred to a real-world setting. Detected impairments in emotion recognition were fairly specific to autism, expanding on previous findings.

Retelling of Stories with Common Phrasal Expressions by High-Proficiency Learners: Implications for Learning and High-Stakes Testing

The goal of this research was to investigate how well L2 English speakers of different proficiency levels were able to perform on a test of auditory memory like that used in the Wechsler Memory Scale (WMS). In this test, participants must retell heard stories. While the validity of elicited imitation tests is well established in second-language acquisition research, the effectiveness of using retelling as a neuropsychological measurement when a language other than the test taker’s L1 is used is unclear. Further, due to their importance in memory function, this study also analyzed the role of common phrasal expressions in how well participants retold stories in three groups of different proficiency. The results indicated that the increase in scores in the retelling of stories aligned with the proficiency level of the non-native participants. Higher-proficiency NNSs were also able to use more of the commonly used spoken phrases in their retelling. Further, there was no difference in this measure between the higher-proficiency Second-Language English and First-Language English participants. While the effectiveness of this test method as a neuropsychological tool when a language other than the test taker’s L1 is used is unclear, these results indicate significant progress by the higher-proficiency participants. Nevertheless, given that this test is often used in this context with immigrants and minority language patients, doubts remain about its suitability for less proficient individuals.

Neurocognitive Intraindividual Variability in Veterans with Mild Traumatic Brain Injury History and Posttraumatic Stress Disorder.

Veterans with a history of blast-related mild traumatic brain injury (mTBI) and posttraumatic stress disorder (PTSD) may be at risk for greater cognitive concerns and worse functional outcomes compared to those with either condition in isolation. However, traditional neuropsychological assessment approaches have yielded equivocal results in these populations. The present study examined an alternative method for detecting subtle cognitive inefficiencies: neurocognitive intraindividual variability (IIV), a measure of within-person performance consistency. Participants were 79 male Veterans with a history of blast-related mTBI and current PTSD (mTBI/PTSD group; n = 54) or neither diagnosis (controls; n = 25). Mean T-scores and IIV scores were calculated from neuropsychological measures of attention and speed of information processing (A/SoP) as well as executive functioning (EF). Global IIV was significantly higher in the mTBI/PTSD group compared to controls (p = .047, Cohen's d = 0.49). At the domain level, larger effect sizes were observed for EF IIV (Cohen's d = 0.46) compared to A/SoP IIV (d = 0.32), although neither were statistically significant. Within the mTBI/PTSD group, higher Global IIV was associated with worse self-reported executive dysfunction, psychological quality of life, and cognitive post-concussive symptoms; at the domain level, these clinical outcomes were generally associated with greater A/SoP IIV (but not EF IIV). Findings extend previous investigations of neurocognitive IIV in individuals with a history of mTBI across PTSD status. Among Veterans with a history of mTBI and comorbid PTSD, neurocognitive variability may be a better indicator of self-reported cognitive inefficiencies and Veteran experience of daily cognitive functioning than mean neuropsychological performances.

Psychometrics of drift-diffusion model parameters derived from the Eriksen flanker task: Reliability and validity in two independent samples.

The flanker task is a widely used measure of cognitive control abilities. Drift-diffusion modeling of flanker task behavior can yield separable parameters of cognitive control-related subprocesses, but the parameters' psychometrics are not well-established. We examined the reliability and validity of four behavioral measures: (1) raw accuracy, (2) reaction time (RT) interference, (3) NIH Toolbox flanker score, and (4) two drift-diffusion model (DDM) parameters-drift rate and boundary separation-capturing evidence accumulation efficiency and speed-accuracy trade-off, respectively. Participants from two independent studies - one cross-sectional (N = 381) and one with three timepoints (N = 83) - completed the flanker task while electroencephalography data were collected. Across both studies, drift rate and boundary separation demonstrated comparable split-half and test-retest reliability to accuracy, RT interference, and NIH Toolbox flanker score, but better incremental convergent validity with psychophysiological measures (i.e., the error-related negativity; ERN) and neuropsychological measures of cognitive control than the other behavioral indices. Greater drift rate (i.e., faster and more accurate responses) to congruent and incongruent stimuli, and smaller boundary separation to incongruent stimuli were related to 1) larger ERN amplitudes (in both studies) and 2) faster and more accurate inhibition and set-shifting over and above raw accuracy, reaction time, and NIH Toolbox flanker scores (in Study 1). Computational models, such as DDM, can parse behavioral performance into subprocesses that exhibit comparable reliability to other scoring approaches, but more meaningful relationships with other measures of cognitive control. The application of these computational models may be applied to existing data and enhance the identification of cognitive control deficits in psychiatric disorders.

Amyloid deposition and its association with depressive symptoms and cognitive functions in late-life depression: a longitudinal study using amyloid-β PET images and neuropsychological measurements

BackgroundAlthough depression is linked to an increased risk of dementia, the association between late-onset depression (LOD) and amyloid burden remains unclear. This study aimed to determine amyloid deposition in patients with LOD compared to healthy controls (HC) using amyloid-beta (Aβ) positron emission tomography (PET) images and neuropsychological assessments.MethodsForty patients first diagnosed with major depressive disorder after the age of 60 (LOD) and twenty-one healthy volunteers (HC) were enrolled. Depression and anxiety were evaluated using the 17-item Hamilton Depression Scale, Hamilton Anxiety Rating Scale, and Clinical Global Impression Scale. Cognitive function was assessed using the Korean versions of the Mini-Mental Status Examination, Montreal Cognitive Assessment, and Seoul Neuropsychological Screening Battery at baseline and 3-month follow-up. 18F-florbetapir PET images were co-registered with T1-weighted magnetic resonance images.ResultsThere was no significant difference in Aβ deposition between LOD and HC groups. No significant correlation between Aβ burden and depressive symptom severity was found in LOD patients. Higher somatic anxiety was correlated with lower Aβ burden in multiple brain regions, including the left inferior frontal lobe (p = 0.009), right anterior cingulate (p = 0.003), and right superior frontal lobe (p = 0.009). Despite cognitive recovery in areas such as attention (Digit Span Forward, p = 0.026), memory (Auditory Verbal Learning Test Recall Total, p = 0.010; Rey Complex Figure Test Delayed Recall, p = 0.039), and frontal executive function (Contrasting Program, p = 0.033) after three months of antidepressant treatment, cognitive improvement showed no association with amyloid deposition.ConclusionsThese findings suggest distinct mechanisms may underlie amyloid deposition in neurodegenerative changes associated with depression. While amyloid burden in specific brain regions negatively correlated with somatic anxiety, it showed no significant correlation with the severity of depression or overall cognitive function.

The Moderating Role of Genetics on the Effectiveness of the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) Program on Cognitive Impairment.

Genetics may influence symptoms experienced by breast cancer survivors (BCS) by moderating the effects of stress-reducing interventions, including the Mindfulness-Based Stress Reduction (MBSR(BC)) program, to reduce symptom severity. As part of a larger clinical trial, the aim of this study was to evaluate genetic variants as moderators of MBSR(BC) on improvements among BCS in cognitive functioning and symptoms. BCS (n = 128) were randomized to MBSR(BC) or the Breast Cancer Education Support Program. Objective neuropsychological and subjective measures of cognitive performance, and psychological and physical symptoms were collected at baseline, 6, 12, and 26 weeks. Linear mixed models were implemented to identify MBSR(BC)'s effects over time. A total of 22 single nucleotide polymorphisms (SNPs) from 20 genes known to be related to these symptoms were investigated using genomic DNA. These SNPs were tested as moderators of MBSR(BC) program effects. Results showed MBSR(BC) participants experienced significantly greater benefits in cognitive functioning, however, the level of benefit varied based on one's genetic profile. Effects sizes, consistency across similar measures were investigated. Among 22 candidate SNPs, rs4680 in COMT, rs1800497 in ANKK1, and rs6277 in DRD2 demonstrated the strongest, most consistent positive effects in moderating MBSR(BC)'s impact on cognitive outcomes. Although the effects were small, this translational research may potentially identify BCS with genotypes that would be most influenced by the MBSR(BC) program. These results may be used to develop personalized intervention programs tailored to the genetic profile of each breast cancer survivor who received chemotherapy or chemotherapy and radiation. ClinicalTrials.gov, https://www.ClinicalTrials.gov Registration Number: NCT02786797.

Assessing the Effectiveness of Audio-Visual vs. Visual Neurofeedback for Attention Enhancement: A Pilot Study with Neurological, Behavioural, and Neuropsychological Measures.

Electroencephalogram (EEG) based Neurofeedback training has gained traction as a practical method for enhancing executive functions, particularly attention, among healthy individuals. The neurofeedback protocols based on EEG channel locations, frequency bands, or EEG features has been tested. However, the improvement in attention was not measured by comparing different feedback stimulus types. We believe that multisensory nature feedback even with few training sessions may induce strong effect. Therefore, this study compares the effect of audio-visual and visual feedback stimuli for attention enhancement utilizing neurophysiological, behavioural and neuropsychological measures. Total 21 subjects were recruited, undergoing six alternate days of neurofeedback training sessions to upregulate EEG beta power of frontocentral (FC5). Dwell time, fractional occupancy and transition probability were also estimated from the EEG beta power. Audiovisual group (G1) as compared to visual group (G2) demonstrate a significant increase of global EEG beta activity alongside improved dwell time (t = 2.76, p = 0.003), fractional occupancy (t = 1.73, p = 0.042) and transition probability (t = 2.46, p = 0.008) over the course of six neurofeedback training sessions. Similarly, the group (G1) shows higher scores (t = 2.13, p = 0.032) and faster reaction times (t = 2.22, p = 0.028) in Stroop task, along with increased score in Mindfulness Attention Awareness Scale (MAAS-15) questionnaire (t = 2.306, p = 0.012). Audiovisual neurofeedback may enhance training effectiveness, potentially achieving the same outcomes in fewer sessions compared to visual-only feedback. However, sufficient training days are essential for effect consolidation. This highlights the feasibility of completing neurofeedback training, a significant challenge in practice.

Association of Normative and Non-Normative Brain Networks With Cognitive Function in Patients With Temporal Lobe Epilepsy.

Despite their temporal lobe pathology, a significant subgroup of patients with temporal lobe epilepsy (TLE) is able to maintain normative cognitive functioning. In this study, we identify patients with TLE with intact vs impaired neurocognitive profiles and interrogate for the presence of both normative and highly individual intrinsic connectivity networks (ICNs)-all toward understanding the transition from impaired to intact neurocognitive status. This retrospective cross-sectional study included patients with TLE and matched healthy controls (HCs) from the Thomas Jefferson Comprehensive Epilepsy Center. Functional MRI data were decomposed using independent component analysis to obtain individualized ICNs. In this article, we calculated the degree of match between individualized ICNs and canonical ICNs (e.g., 17 resting-state networks by Yeo et al.) and divided each participant's ICNs into normative or non-normative status based on the degree of match. 100 patients with TLE (mean age 42.0 [SD: 13.7] years, 47 women) and 92 HCs were included in this study. We found that the individualized networks matched to the canonical networks less well in the cognitively impaired (n = 24) compared with the cognitively intact (n = 63) patients with TLE by 2-way mixed-measures analysis of variance (impaired vs intact mean difference [MD] -0.165 [-0.317, -0.013], p = 0.028). The cognitively impaired patients showed significant abnormalities in the profiles of both normative (impaired vs intact MD -0.537 [-0.998, -0.076], p = 0.017, intact vs HC MD -0.221 [-0.536, 0.924], p = 0.220, and impaired vs HC MD -0.759 [-1.200, -0.319], p < 0.001) and non-normative networks (impaired vs intact MD 0.484 [0.030, 0.937], p = 0.033, intact vs HC MD 0.369 [0.059, 0.678], p = 0.014, and impaired vs HC MD 0.853 [0.419, 1.286], p < 0.001) while the intact patients showed abnormalities only in non-normative networks. At the same time, we found that normative networks held a strong, positive association with the neuropsychological measures, with this association negative in non-normative networks. Our data demonstrated that significant cognitive deficits are associated with the status of both canonical and highly individual ICNs, making clear that the transition from intact to impaired cognitive status is not simply the result of disruption to normative brain networks.

Microangiopathy in temporal lobe epilepsy with diffusion MRI alterations and cognitive decline

White matter microvascular alterations in temporal lobe epilepsy (TLE) may be relevant to acquired neurodegenerative processes and cognitive impairments associated with this condition. We quantified microvascular changes, myelin, axonal, glial and extracellular-matrix labelling in the gyral core and deep temporal lobe white matter regions in surgical resections from 44 TLE patients with or without hippocampal sclerosis. We compared this pathology data with in vivo pre-operative MRI diffusion measurements in co-registered regions and neuropsychological measures of cognitive impairment and decline. In resections, increased arteriolosclerosis was observed in TLE compared to non-epilepsy controls (greater sclerotic index, p < 0.001), independent of age. Microvascular changes included increased vascular densities in some regions but uniformly reduced mean vascular size (quantified with collagen-4, p < 0.05–0.0001), and increased pericyte coverage of small vessels and capillaries particularly in deep white matter (quantified with platelet-derived growth factor receptorβ and smooth muscle actin, p < 0.01) which was more marked the longer the duration of epilepsy (p < 0.05). We noted increased glial numbers (Olig2, Iba1) but reduced myelin (MAG, PLP) in TLE compared to controls, particularly prominent in deep white matter. Gene expression analysis showed a greater reduction of myelination genes in HS than non-HS cases and with age and correlation with diffusion MRI alterations. Glial densities and vascular size were increased with increased MRI diffusivity and vascular density with white matter abnormality quantified using fixel-based analysis. Increased perivascular space was associated with reduced fractional anisotropy as well as age-accelerated cognitive decline prior to surgery (p < 0.05). In summary, likely acquired microangiopathic changes in TLE, including vascular sclerosis, increased pericyte coverage and reduced small vessel size, may indicate a functional alteration in contractility of small vessels and haemodynamics that could impact on tissue perfusion. These morphological features correlate with white matter diffusion MRI alterations and might explain cognitive decline in TLE.

Executive function and cortical thickness in biomarker aMCI

Introduction Memory deficits are the primary symptom in amnestic Mild Cognitive Impairment (aMCI); however, executive function (EF) deficits are common. The current study examined EF in aMCI based upon amyloid status (A+/A−) and regional atrophy in signature areas of Alzheimer’s disease (AD). Method Participants included 110 individuals with aMCI (A+ = 66; A− = 44) and 33 cognitively healthy participants (HP). EF was assessed using four neuropsychological assessment measures. The cortical thickness of the AD signature areas was calculated using structural MRI data. Results A + had greater EF deficits and cortical atrophy relative to A − in the supramarginal gyrus and superior parietal lobule. A − had greater EF deficits relative to HP, but no difference in signature area cortical thickness. Discussion The current study found that the degree of EF deficits in aMCI are a function of amyloid status and cortical thinning in the parietal cortex.