Neuropsychological Measures Of Memory Research Articles

Validity of the MoCA as a cognitive screening tool in epilepsy: Are there implications for global care and research?

This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) as the gold standard. Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC-CoDE taxonomy divided participants into IC-CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests. IC-CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336-2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency. This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed. The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood.

7 The MOCA Versus Neuropsychological Testing in Assessing Presence of Memory Impairment and MCI

Objective:The Montreal Cognitive Assessment (MOCA) is a brief cognitive screener, widely used by providers to detect mild cognitive impairment (MCI). It encompasses 30 questions, assessing executive functioning, visuospatial skills, language, memory, attention, and orientation. Although the MOCA has been shown to have high sensitivity (90%) and specificity (87%) for detecting MCI, existing studies have primarily included participants who were already diagnosed with amnestic MCI via neuropsychological testing. Since several factors beyond the presence of MCI can contribute to low performance on the MOCA (e.g., premorbid IQ, fatigue, mood symptoms), over-reliance on the MOCA runs the risk of falsely identifying individuals as having cognitive impairment. The MOCA’s memory subtest raises particular concern as there are several language-based tasks between the learning and delay trials, introducing the potential for interference effects. Thus, the MOCA’s ability to accurately identify those at risk for MCI in the community remains unclear. The objective of the present study was to evaluate: (1) the MOCA’s association with neuropsychological memory measures; and (2) its ability to distinguish between neurocognitive groups (intact vs. MCI vs. dementia).Participants and Methods:This study involved a retrospective analysis of fifty-one patients (M age=72.58 [7.90]; M education= 16.37 [16.37]) who underwent neuropsychological evaluation. Standardized scores for total list-learning (HVLT; CVLT-bf) were used to capture memory encoding; retention % scores were used to capture memory storage. MOCA scores included Total MOCA, MOCA-Orientation, and the MOCA Memory Index (MOCA-MEM). MOCA-MEM was calculated based on Julayanont et al., 2014— (Free-Delayed Recall*3) + (Category-Cued Recall*2) + Multiple Choice-Cued Recall. Bivariate correlations were conducted for the MOCA and neuropsychological test scores. Participants were divided into three diagnostic groups, classified by the neuropsychologist: (1) Cognitive Intact (CI; n=13); (2) MCI (n=26); and (3) Major Neurocognitive Disorder/Dementia (MNCD; n=11). Analysis of covariance was used to analyze differences between the cognitive groups on Total MOCA, MOCA-Orientation, and MOCA-MEM.Results:Total MOCA correlated with word-list learning (r=.434, p=.004) and retention% (r=.306, p=.049). MOCA-MEM was correlated with word-list learning (r=.367, p=.042); it did not significantly correlate with retention%. MOCA-Orientation had the strongest correlation with retention0/) (r=.406, p=.009). Means of Total MOCA significantly differed between CI (25.31[2.56]), MCI (22.04[4.14]), and MNCD (15.44[4.13]). MOCA-MEM only differentiated CI (10[3.66]) and MNCD (5.71[2.14]); it did not differentiate MCI (6.94[3.13]) from either CI or MNCD.Conclusions:Our findings suggest that the MOCA has limitations in accurately classifying memory deficits in older adults. First, our study suggests that the MOCA-MEM reflects encoding rather than memory storage. Given that deficiency in encoding may be secondary to other cognitive deficits, such as attention and executive dysfunction, performance on MOCA-MEM cannot readily delineate the presence of an amnestic process. Second, the findings show that MOCA-MEM does not differentiate between patient groups with intact cognition versus MCI, nor those with MCI versus MNCD. These findings argue the importance of neuropsychological evaluation in deciphering patterns of memory performance and the presence of an amnestic process.

Blood-Derived Progenitor Cells Are Depleted in Older Adults with Cognitive Impairment: A Role for Vascular Resilience?

Depletion of blood-derived progenitor cells, including so called "early endothelial progenitor cells", has been observed in individuals with early stage Alzheimer's disease relative to matched older control subjects. These findings could implicate the loss of angiogenic support from hematopoietic progenitors or endothelial progenitors in cognitive dysfunction. To investigate links between progenitor cell proliferation and mild levels of cognitive dysfunction. We conducted in vitro studies of blood-derived progenitor cells using blood samples from sixty-five older adults who were free of stroke or dementia. Peripheral blood mononuclear cells from venous blood samples were cultured in CFU-Hill media and the number of colony forming units were counted after 5 days in vitro. Neuropsychological testing was administered to all participants. Fewer colony forming units were observed in samples from older adults with a Clinical Dementia Rating global score of 0.5 versus 0. Older adults whose samples developed fewer colony forming units exhibited worse performance on neuropsychological measures of memory, executive functioning, and language ability. These data suggest blood progenitors may represent a vascular resilience marker related to cognitive dysfunction in older adults.

Piecing it together: Relationships between hippocampal subfields and cognitive impairment along the Alzheimer’s disease spectrum

AbstractBackgroundThe ability to form hippocampal‐dependent memories declines steadily in normal aging, and exponentially in people with probable Alzheimer’s disease (AD). Correspondingly, the whole hippocampal formation follows the same trajectories of decline. Critically, pathological changes to distinguishable hippocampal subfields and related cognitive abilities are not well characterized in. Herein, we investigated how these hippocampal subfield and neuropsychological memory measures interact.MethodStructural MRI and neuropsychological data were collected from 29 biomarker‐confirmed individuals on the AD spectrum (ADS) and a comparison group of 17 biomarker‐negative healthy adults to examine the interactions between subfield‐specific hippocampal integrity and cognitive markers. Cognitive assessments included the Wechsler Logical Memory (WMS‐IV) and Hopkins Verbal Learning (HVLT‐R) tests. High resolution hippocampal subfield volumes (CA1, CA2, CA3, dentate gyrus, and subiculum) were measured from a dedicated T2‐weighted MRI slab of the hippocampi (TSE; 0.4 x 0.4 x 2.0 mm), co‐registered to a routine T1‐weighted MRI (MPRAGE; 1.0 x 1.0 x 1.0 mm), using automated hippocampal subfield segmentation (ASHS) software and the UPENN atlas consisting of scans of MCI individuals and older adults (Yushkevich et al., 2015). We performed a cross‐sectional analysis of the relationship between hippocampal subfield volume and behavioral performance on measures of learning and declarative memory. Relationships between hippocampal subfields and neuropsychological subtests were probed using multivariate models contrasting ADS and controls, while controlling for age, education, and intracranial volume.ResultWe show that hippocampal subfield volumes robustly predict performance on subtests of WMS‐IV, but not HVLT‐R, regardless of group. Moreover, we report unique contributions of CA3 on learning, subiculum on recognition, and CA2 and CA3 on recall. By dividing the hippocampal formation into distinguishable subfields using ultra high‐resolution MRI, we further elucidate their contributions to ADS‐related neurocognitive declines in learning and memory.ConclusionSubfield‐specific atrophy in the human hippocampus may constitute a sensitive measure of neurocognitive decline in patients on the AD spectrum. These results suggest that the atrophy of specific hippocampal subfields selectively influence subprocesses of learning and memory, and that these measures may be used to better model disease trajectories among individuals on the Alzheimer’s disease spectrum.

Perception of memory performance after first seizure in patients with and without an epilepsy diagnosis

ObjectivesMemory complaints in patients with epilepsy have been well-studied. Although memory complaints are commonly reported by patients with chronic epilepsy, to date, few studies exist on memory complaints at the onset of epilepsy. The present study investigated the presence of memory complaints and their relation to mood and memory performance in patients after their first seizure. Thereby, we examined differences between individuals who received a diagnosis of epilepsy immediately with the occurrence of their first seizure and those who were diagnosed as having the first epileptic seizure, without fulfilling the ILAE criteria for the diagnosis of epilepsy. MethodsSixty-one patients participated in the study and completed, among others, a memory task and questionnaires on memory complaints and depression after their first epileptic seizure. We investigated the level of memory complaints and their correlation and accuracy in classification with a memory measure. We compared patients who received an epilepsy diagnosis after the first seizure with those who did not. ResultsMemory complaints did not correlate with objective memory performance. Classification into impaired/unimpaired showed low concordance between memory complaints and neuropsychological memory measures. After their first epileptic seizure, patients reported few memory complaints overall (10%), and there were no differences in memory complaints between patients with and without an epilepsy diagnosis. ConclusionAt epilepsy onset, in contrast to established epilepsies, memory complaints are rare. Although influences of anticonvulsant drugs and seizures are not present at the beginning of epilepsy, this substantial absence of memory complaints at epilepsy onset emphasizes the need for comprehensive neurological and psychological treatment early with the given diagnosis. Treatment should focus on anticonvulsant drug regimens, patients’ concerns and convey realistic expectations.

P300 Amplitude in Relation to Age, Neuropsychological Performance, and Genetic Risk for Alzheimer’s Disease

The P300 event-related potential (ERP) is associated with aging and risk for Alzhiemer’s disease (AD) and mild cognitive impairment (MCI). Our study sought to replicate previous findings regarding P300 amplitude, age, and neuropsychological outcomes. We also sought to fill gaps in the literature by assessing associations in a primarily healthy sample of older adults (aged 60-75) and through use of comprehensive assessment procedures for ERPs, neuropsychological outcomes, and a genetic risk score (i.e., BDNF, APOE, and PSEN1 mutations). Approximately 25% of our total sample (N=72) met criteria for possible or probable mild cognitive impairment. We assessed whether the P300 elicited by auditory (oddball) and visual (go/nogo) paradigms were associated with performance across neuropsychological tests commonly used in clinical settings, which include cognitive domains of semantic, episodic, and visual memory, executive functioning, language (confrontation naming), abstract reasoning (visual and verbal), and attention. Further, we examined associations between P300 and multiple genetic risks for AD. Our findings demonstrated differences in outcomes between audio and visual tasks of P300, with visual tasks tending to show stronger relationships with neuropsychological and genetic factors. Neuropsychological measures of memory and executive functioning were most closely related to visual P300 amplitude. P300 amplitude was also significantly associated with a genetic risk score for AD, despite the sample generally performing in the normal range on most neuropsychological tasks. Overall, our study has implications for use of the P300 for early detection of risk for AD and for improving our understanding of the P300 as a cognitive biomarker.

Surgical disconnection of epilepsy network correlates with improved outcomes

PurposeA novel software algorithm combining non-invasive EEG and resting state functional MRI data to map networks of cortex correlated to epileptogenic tissue was used to map an epilepsy network non-invasively. The relationship between epilepsy network connectivity and outcomes after surgery was investigated using this non-invasive and non-concurrent modeling algorithm. MethodScalp EEG and resting state functional MRI were acquired for nineteen patients with temporal lobe epilepsy. The hypothetical irritative zone was mapped, and resting state functional MRI data was used to model regions functionally correlated with the irritative zone. Epilepsy network connectivity was measured in patient with temporal lobe epilepsy (n = 19) both pre- and post-operatively. Temporal networks were also mapped in healthy control participants (n = 6). ResultsThirteen of nineteen patients (68 %) were seizure free after 20.3 ± 4.8 months. Epilepsy network connectivity within the temporal lobe was significantly higher among patients with temporal lobe epilepsy compared to the healthy control patients (p < 0.05). Disconnection of the epilepsy network was significantly higher in patients who were seizure free. Using spearman rho analyses, neuropsychological function after surgery was found to be relatively better in patients with higher degree of epilepsy network disconnection. ConclusionsThe magnitude of network disconnection after surgery was strongly associated with increased rates of seizure freedom and relatively better neuropsychological measures of memory and naming function. It was shown that seizure-free outcomes and relatively improved neuropsychological function correlated with surgical disconnection of a highly synchronous epilepsy network.

Illiteracy, dementia risk, and cognitive trajectories among older adults with low education.

To investigate whether illiteracy was associated with greater risk of prevalent and incident dementia and more rapid cognitive decline among older adults with low education. Analyses included 983 adults (≥65 years old, ≤4 years of schooling) who participated in a longitudinal community aging study. Literacy was self-reported ("Did you ever learn to read or write?"). Neuropsychological measures of memory, language, and visuospatial abilities were administered at baseline and at follow-ups (median [range] 3.49 years [0-23]). At each visit, functional, cognitive, and medical data were reviewed and a dementia diagnosis was made using standard criteria. Logistic regression and Cox proportional hazards models evaluated the association of literacy with prevalent and incident dementia, respectively, while latent growth curve models evaluated the effect of literacy on cognitive trajectories, adjusting for relevant demographic and medical covariates. Illiterate participants were almost 3 times as likely to have dementia at baseline compared to literate participants. Among those who did not have dementia at baseline, illiterate participants were twice as likely to develop dementia. While illiterate participants showed worse memory, language, and visuospatial functioning at baseline than literate participants, literacy was not associated with rate of cognitive decline. We found that illiteracy was independently associated with higher risk of prevalent and incident dementia, but not with a more rapid rate of cognitive decline. The independent effect of illiteracy on dementia risk may be through a lower range of cognitive function, which is closer to diagnostic thresholds for dementia than the range of literate participants.

Effectiveness of a manualised group training intervention for memory dysfunction following stroke: a series of single case studies

Purpose: Deficits in memory are common following stroke and have been independently linked with poorer outcomes. Outcomes and best-practice processes of post-stroke memory rehabilitation remain equivocal.Materials and method: In this study an AB with follow up single-case design was repeated across four participants to explore the effectiveness of a compensatory memory skills group in patients with stroke. Target behaviour was subjective everyday and prospective memory failures, assessed weekly. Secondary outcomes included goal attainment and performance on neuropsychological tests of memory. Following three-week baseline, participants completed six weekly two-hour sessions of a manualised memory group. Data was analysed visually and statistically.Results and conclusion: Frequency of everyday memory complaints reduced for all participants during the six-week post-intervention period. This change was significant for three participants. One of the four participants reported a significant reduction in the frequency of prospective memory failures during the maintenance period. All participants described attaining at least one memory specific goal following intervention. Group participation did not result in meaningful change on neuropsychological measures of memory. Taken together, results provided preliminary support for the effectiveness of group-based compensatory memory rehabilitation for reducing subjective everyday memory failures and functional goal attainment.IMPLICATIONS FOR REHABILITATIONMemory skills group training can improve subjective everyday memory and functional goal attainment in community dwelling survivors of stroke.Participants who are closer to date of injury may show greater changes in self-awareness as a consequence of group participation than those who are further from injury.Exploration of change following memory rehabilitation on standard neuropsychological tests may not be the best way to capture improvement following memory skills group training. A focus on functional memory outcomes is recommended to facilitate translation to person-centred clinical practice.

Cognitive-Affective Verbal Learning Test: An integrated measure of affective and neutral words.

Despite growing affective-memory research, only 2 potential clinical measures have been published, each with limitations. We describe the development and piloting of an integrated memory measure for neutral and affectively valenced words, the Cognitive-Affective Verbal Learning Test (C-AVLT). The C-AVLT and mood self-report measures were administered to 124 healthy university students in Study 1, with readministration to 40 students after 1 week. In Study 2, the C-AVLT and other neuropsychological measures of memory and emotion were administered to 61 patients referred for polysomnogram evaluation of obstructive sleep apnea (OSA). Study 1 supported the C-AVLT's internal and test-retest reliabilities, as well as concurrent validity, that is, the affective-bias scores but not performance scores correlated with self-reported mood. In Study 2, convergent, criterion (specifically cross-sectional concurrent validity), and incremental validity were supported with regard to both performance and affective-bias scores within the OSA sample. We demonstrated the C-AVLT is a reliable and clinically useful measure of both memory and affective-processing bias in 2 samples. Future clinical and research recommendations for the C-AVLT are discussed, including broadening normative data and criterion validity data in psychiatric and neurological samples. (PsycINFO Database Record

Randomized, double-blind, placebo-controlled clinical trial of choline supplementation in school-aged children with fetal alcohol spectrum disorders

Background: Prenatal alcohol exposure results in a broad range of cognitive and behavioral impairments. Because of the long-lasting problems that are associated with fetal alcohol spectrum disorders (FASDs), the development of effective treatment programs is critical. Preclinical animal studies have shown that choline, which is an essential nutrient, can attenuate the severity of alcohol-related cognitive impairments.Objective: We aimed to translate preclinical findings to a clinical population to investigate whether choline supplementation can ameliorate the severity of memory, executive function, and attention deficits in children with FASDs.Design: In the current study, which was a randomized, double-blind, placebo-controlled clinical trial, we explored the effectiveness of a choline intervention for children with FASDs who were aged 5–10 y. Fifty-five children with confirmed histories of heavy prenatal alcohol exposure were randomly assigned to either the choline (n = 29) or placebo (n = 26) treatment arms. Participants in the choline group received 625 mg choline/d for 6 wk, whereas subjects in the placebo group received an equivalent dose of an inactive placebo treatment. Primary outcomes, including the performance on neuropsychological measures of memory, executive function, and attention and hyperactivity, were assessed at baseline and postintervention.Results: Compared with the placebo group, participants in the choline group did not differentially improve in cognitive performance in any domain. Treatment compliance and mean dietary choline intake were not predictive of treatment outcomes.Conclusions: Findings of the current study do not support that choline, administered at a dose of 625 mg/d for 6 wk, is an effective intervention for school-aged (5–10 y old) children with FASDs. This research provides important information about choline’s therapeutic window. Combined with other studies of choline and nutritional interventions in this population, this study emphasizes a further need for the continued study of the role of nutritional status and supplementation in children with FASDs and the contributions of nutrition to neurocognition. This trial was registered at clinicaltrials.gov as NCT01911299.

Cognitive dysfunction in patients with renal failure requiring hemodialysis.

Background and Objectives:Renal failure patients show significant impairment on measures of attention and memory, and consistently perform significantly better on neuropsychological measures of memory and attention, approximately 24 hours after hemodialysis treatment. The objectives are to determine the cognitive dysfunction in patients with renal failure requiring hemodialysis.Materials and Methods:A total of 60 subjects comprising of 30 renal failure patients and 30 controls were recruited. The sample was matched for age, sex, and socioeconomic status. The tools used were the Standardized Mini-Mental State Examination and the Brief Cognitive Rating Scale.Results:The patients showed high cognitive dysfunction in the pre-dialysis group, in all the five dimensions (concentration, recent memory, past memory, orientation and functioning, and self-care), and the least in the 24-hour post dialysis group. This difference was found to be statistically significant (P=0.001).Conclusion:Patients with renal failure exhibited pronounced cognitive impairment and these functions significantly improved after the introduction of hemodialysis.

Individual variation in a cholinergic receptor gene modulates attention

Cholinergic influences on attention are well documented and recent evidence indicates that genetic variation in the α4β2 nicotinic receptor affects attentional networks of the brain. Several behavioral and electrophysiological studies have shown that a common polymorphism in the CHRNA4 gene (rs1044396) affects aspects of visual and auditory attentional processing. We examined genetic effects on neuropsychological measures of memory and attention in an adult life-span sample (N=488). TT homozygotes perform speed and attention tasks more slowly than TC or CC allele carriers, with stronger effects on complex attention tasks in participant 70–79 years of age. There are no parallel effects on memory function. The results are consistent with clinical studies indicating that reduction in nicotinic receptor efficiency affects attention and speed, but not memory. Both normal age-related changes in receptor function and incipient pathology may have contributed to the results.

Medial temporal fMRI activation reflects memory lateralization and memory performance in patients with epilepsy

Memory difficulties are a frequent cognitive complaint of patients with chronic epilepsy. Previous studies have suggested that the presence of a seizure focus causes reorganization of brain mechanisms underlying memory function. Here we examine whether seizure onset in the left hemisphere and onset in the right hemisphere have different effects on memory lateralization and whether longer duration of epilepsy is associated with increased lateralization of memory functions to the unaffected hemisphere. We hypothesized that hemisphere of onset and duration of epilepsy would influence plasticity of memory mechanisms, similar to the plasticity observed for language mechanisms. Healthy controls (HC, N = 10) and patients with epilepsy ( N = 23, 11 with a left- and 12 with a right-hemisphere focus) performed a scene-encoding fMRI task at 4 T. Active voxels (relative to scrambled image viewing) were identified for each participant. Memory laterality indices (LIs) were calculated in three regions of interest (ROIs) designed on the basis of HC group data: a functional ROI, an anatomical–hippocampal ROI, and an anatomical–medial temporal ROI encompassing hippocampus and parahippocampal gyrus. In healthy controls, LIs were suggestive of slight left lateralization of encoding memory for pictures. Patients with right hemisphere epilepsy showed a nonsignificant increase in degree of left lateralization. In contrast, patients with left hemispheric epilepsy showed right-lateralized activation, differing significantly from controls and from patients with right hemispheric epilepsy. Neuropsychological measures of memory (WMS-III Story Recall) across epilepsy patients predicted LIs in the anatomical ROIs: higher scores were associated with more left-lateralized medial temporal fMRI activation. Neither age of onset nor duration of epilepsy was significantly related to LI. These results indicate that focal epilepsy may influence the functional neuroanatomy of memory function.

Evaluation of a Structured Group Format Memory Rehabilitation Program For Adults Following Brain Injury

To evaluate the impact of an 8-session structured group format memory rehabilitation program on impaired memory functioning. Adults with traumatic brain injury (N = 10) or cerebral vascular accidents (N = 2). A waitlist control study with pregroup, postgroup, and 1-month follow-up assessments. WECHSLER MEMORY SCALE-REVISED: Neuropsychological assessments of memory (California Verbal Learning Test, Wechsler Memory Scale-Revised logical memory, visual-paired associates, and Rey Complex Figure) and both self-report and significant other report of behaviors indicative of memory difficulties and the use of memory strategies. Participation in the memory group increased participants' knowledge of memory and memory strategies as well as use of memory aids and strategies; reduced behaviors indicative of memory impairment; and had a positive effect on neuropsychological assessments of memory (eg, delayed recall for words and figures). All significant improvements exceeded change experienced by waiting-list controls and were maintained at 1-month follow-up assessment. While extension of the findings is needed, the memory group has a positive impact on both neuropsychological measures of memory and everyday memory functioning.

The Effect of 3‐Year Treatment with 0.25 mg/day of Micronized 17β‐Estradiol on Cognitive Function in Older Postmenopausal Women

To evaluate the effect of ultra-low-dose (0.25 mg/d) micronized 17beta-estradiol on cognitive function in older postmenopausal women. Randomized, placebo-controlled trial conducted for 3 years. Academic health center in greater Hartford, Connecticut. Fifty-seven healthy, community-dwelling, older postmenopausal women. Women received 0.25 mg/d of micronized 17beta-estradiol (estrogen therapy (ET), n=32) or placebo (n=25); all women who had not had a hysterectomy received 100 mg/d of oral micronized progesterone for 2-week periods every 6 months. Neuropsychological measures of memory, language, mood, and executive function were collected at baseline, 3 months, and 36 months. Measures of executive function included the Controlled Oral Word Association Test, the Trail Making Test, and the Wisconsin Card Sorting Test. The Boston Naming Test was used to measure language skills. The Symbol Digit Modalities Test was used as a measure of sustained attention. Measures of memory included the Complex Figure Test, Fuld Object Memory Test, and a selected subtest from the Wechsler Memory Scale. Scores from the Geriatric Depression Scale and the Beck Anxiety Inventory were used to assess symptoms of depression. No differences were found between ET and placebo on any of the neurocognitive measures or depression instruments, nor were there any differences when the groups were stratified according to age. This small study, which had adequate power to detect change in some but not all domains of cognition tested, revealed that low-dose estrogen neither benefits nor harms cognitive function in older women after 3 years of treatment, but confirmation is needed from larger trials.

The effects of acute tryptophan depletion and serotonin transporter polymorphism on emotional processing in memory and attention

Polymorphism at the serotonin transporter linked polymorphic region (5-HTTLPR) has been associated with neuroticism, increased risk for affective disorders and greater vulnerability to mood change following serotonin (5-HT) depletion. The aim of the present study was to investigate whether the cognitive effects of 5-HT depletion were differentially affected by genotype at the 5-HTTLPR polymorphism, using neuropsychological measures of memory and attention. We utilized the acute tryptophan depletion (ATD) technique to temporarily reduce 5-HT synthesis in two groups of healthy volunteers pre-selected on the basis of 5-HTTLPR genotype, 15 of the ll genotype and 15 of the ss genotype, in a double-blind, placebo-controlled crossover design. As expected, ATD resulted in a robust reduction in plasma tryptophan concentration in both genotype groups. However, the genotype groups differed in terms of the effect of ATD on cognitive performance. The ss genotype group showed impaired verbal recall following depletion, while episodic memory was unimpaired by ATD in the ll genotype group. Averaging across depletion condition, the ss genotype group outperformed the ll genotype group on tests of episodic memory and attention. Neither group was significantly affected by ATD on measures of emotional state. These data confirm previous reports that ss individuals are particularly vulnerable to 5-HT depletion, but extend these findings to the cognitive domain. The unexpected finding that ss volunteers showed improved memory and attention relative to ll volunteers suggests a possible evolutionary advantage to possession of the s allele, which may offset the disadvantage of vulnerability to depression following stressful life events.

Cognitive Reserve and the Relationship Between Depressive Symptoms and Awareness of Deficits in Dementia

Cognitive Reserve and the Relationship Between Depressive Symptoms and Awareness of Deficits in Dementia

Mild cognitive impairment and everyday functioning in older adults

The relations between mild cognitive impairment without dementia (MCI/CIND) and everyday functional abilities were examined using data from the Canadian Study of Health and Aging (CSHA). Individuals were identified with MCI/CIND if both caregiver report and clinician judgment agreed on the presence of cognitive impairment in the absence of dementia. Cross-sectional and longitudinal comparisons indicated that individuals with MCI/CIND demonstrated a broad range of impairment in instrumental activities of daily living (IADL) compared to individuals with no cognitive impairment (NCI). In cross-sectional analyses, neuropsychological measures of memory and psychomotor speed were significantly related to impairment in eight areas of functioning. In addition, poorer memory performance was significantly predictive of future impairment in money management. A research personnel award was provided by the Canadian Institutes of Health Research, Institute of Aging, to support HT in the preparation of this manuscript. The Canadian Study of Health and Aging (CSHA) was funded by the Seniors’ Independence Research Program, through the National Health Research and Development Program (NHRDP) of Health Canada (project no. 6606-3954-MC(S)). Additional funding was provided by Pfizer Canada Incorporated through the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Activity Program, NHRDP (project no. 6603-1417-302 (R)), Bayer Incorporated, the British Columbia Health Research Foundation (projects no. 38 (93-2) and no. 34 (96-1)). The CSHA was coordinated through the University of Ottawa and the Division of Aging and Seniors, Health Canada.

Reduced binocular depth inversion in regular cannabis users

The binocular depth inversion illusion (BDII) has been shown to be a sensitive measure of impaired visual information processing under conditions including cannabinoid-intoxicated states, alcohol withdrawal, sleep deprivation, and in patients with positive symptoms of schizophrenia. This study assessed whether the BDII could detect subtle cognitive impairment due to regular cannabis use by comparing 10 regular cannabis users and 10 healthy controls from the same community sources, matched for age, sex, and premorbid IQ. Subjects were also compared on measures of executive functioning, memory, and personality. Regular cannabis users were found to have significantly higher BDII scores for inverted images. This was not due to a problem in the primary processing of visual information, as there was no significant difference between the groups for depth perception of normal images. There was no relationship between BDII scores for inverted images and time since last dose, suggesting that the measured impairment of BDII more closely reflected chronic than acute effects of regular cannabis use. There were no significant differences between the groups for other neuropsychological measures of memory or executive function. A positive relationship was found between EPQ-R-psychoticism and cannabis, tobacco, and alcohol use. Cannabis users also used significantly larger amounts of alcohol. However, no relationship was found between BDII scores and drug use other than cannabis or psychoticism. Compared to the other neuropsychological tests used, the BDII appears to be a more sensitive tool for the detection of subtle impairments in visual information processing related to chronic cannabis use.