Neuropsychological Results Research Articles

Subjective memory impairments in early detection of dementia: Relation to acceptability of lumbar puncture in memory clinic patients

In memory clinics, biomarker-based diagnostic tools for early detection and differential diagnosis of dementia are increasingly important, even if their acceptance by patients is relatively low. The aim of study was to examine whether sociodemographic and clinical features of memory clinic patients are associated with acceptance of lumbar puncture (LP). Of particular interest was the patients' self-perception of memory decline (subjective memory impairment, SMI) accompanied by related concerns that might affect decision to consent to LP. Consecutive patients were examined in a day-care hospital on two consecutive days in order to implement a diagnostic procedure based on the S3 guideline "Dementia" including offer of LP. We assessed demographic and clinical variables such as depression, anxiety, neurocognitive performance and dementia severity (Clinical Dementia Rating, CDR). Furthermore, patients were interviewed about perceived memory decline and were classified on this basis - independent of their neuropsychological results - into three groups: no SMI, SMI without concerns or SMI with concerns. Of 44 patients (73.8 ± 8.3 years; 27 f/17 m; CDR < 1: n = 16, CDR = 1: n = 28), 29 had SMI with concerns. These patients tended to be younger and had a higher level of education than those who did not report SMI (n = 7) and those perceiving SMI without concerns (n = 8). Furthermore, patients without SMI more frequently had a dementia syndrome. Patients who agreed to lumbar puncture (n = 23) were - compared to patients refusing LP (n = 17; 4 patients had to be excluded because of medical contraindication for immediate LP) - more likely male, had significantly more frequent SMI with concerns and performed poorer on declarative memory tasks. Binary regression analysis yielded SMI with concerns, a more impaired memory performance and male sex as significant predictors for consenting to LP. The study provides evidence that patient characteristics such as subjective and objective memory impairment as well as sex may affect the likelihood to consent to a generally less accepted biomarker-based dementia diagnostic procedure such as LP.

Redox dysregulation as a link between childhood trauma and psychopathological and neurocognitive profile in patients with early psychosis

Exposure to childhood trauma (CT) increases the risk for psychosis and affects the development of brain structures, possibly through oxidative stress. As oxidative stress is also linked to psychosis, it may interact with CT, leading to a more severe clinical phenotype. In 133 patients with early psychosis (EPP), we explored the relationships between CT and hippocampal, amygdala, and intracranial volume (ICV); blood antioxidant defenses [glutathione peroxidase (GPx) and thioredoxin/peroxiredoxin (Trx/Prx)]; psychopathological results; and neuropsychological results. Nonadjusted hippocampal volume correlated negatively with GPx activity in patients with CT, but not in patients without CT. In patients with CT with high GPx activity (high-GPx+CT), hippocampal volume was decreased compared with that in patients with low-GPx+CT and patients without CT, who had similar hippocampal volumes. Patients with high-GPx+CT had more severe positive and disorganized symptoms than other patients. Interestingly, Trx and oxidized Prx levels correlated negatively with GPx only in patients with low-GPx+CT. Moreover, patients with low-GPx+CT performed better than other patients on cognitive tasks. Discriminant analysis combining redox markers, hippocampal volume, clinical scores, and cognitive scores allowed for stratification of the patients into subgroups. In conclusion, traumatized EPP with high peripheral oxidation status (high-GPx activity) had smaller hippocampal volumes and more severe symptoms, while those with lower oxidation status (low-GPx activity) showed better cognition and regulation of GPx and Trx/Prx systems. These results suggest that maintained regulation of various antioxidant systems allowed for compensatory mechanisms preventing long-term neuroanatomical and clinical impacts. The redox marker profile may thus represent important biomarkers for defining treatment strategies in patients with psychosis.

Mechanism of cognitive impairment in chronic patients with putaminal hemorrhage: A diffusion tensor tractography.

It is not clear whether the fornix and cingulum are involved in cognition after putaminal hemorrhage (PH). We investigated structural changes and differences of the neural tracts, and the relationship between the integrity of the neural tracts and cognition not only at the affected but also at the unaffected side.Sixteen patients with left chronic putaminal hemorrhage and 20 healthy volunteers were enrolled. Using diffusion tensor tractography (DTT), we compared fiber number (FN), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of the neural tracts between patient and control groups. The relationship between the neural tract parameters and neuropsychological results was also analyzed.The left fornix FN was significantly lower than the right fornix FN in the patient group. Except for the cingulum FA, the neural tracts parameters for both the affected and unaffected hemispheres differed significantly between the groups. The fornix FA and ADC at the affected side were significantly correlated with intelligence quotient (IQ), mini-mental status examination (MMSE), and short-term memory. Interestingly, the fornix ADC at the unaffected side was significantly correlated with MMSE. However, none of the cingulum parameters was correlated with neuropsychological results.The fornix integrity is critical for cognitive impairment after putaminal hemorrhage.

Urinary dysfunction in traumatic brain injury survivors – A retrospective study

Survivors of a traumatic brain injury (TBI) frequently suffer from urinary dysfunction. Possible causes are midbrain dysfunction and primary lesions, but cognitive and behavior factors may also play a role. Overactive bladder (OAB) is a frequent urinary disturbance as opposed to urinary retention. In this study, we aim to investigate altered findings in urodynamic tests and possible relations to other TBI outcomes. A retrospective study was conducted with 24 post-TBI patients (21 male, 3 female) admitted to our unit during a 3 year period. Exclusion criteria included stroke, spinal cord injury, previous history of urological pathology or surgery and absence of urodynamic evaluation. Information was gathered relative to results of urodynamics, TBI imaging, initial GCS scale, urinary symptoms, vesical regime, neuropsychological and ultrasound results. Of the 24 patients studied, all had severe TBI with a mean age of 40.1 years and a predominance of motor vehicle related accidents (66.7%) and axonal diffuse injury (62.5%). Median time from TBI was 7.5 months and only 2 patients had a normal urodynamic study. Urinary symptoms were present in 17 (70.8%) patients and the majority (58.3%) had filling symptoms. There was previous history of urinary tract infection in 32% patients. Neuropsychological evaluation was altered in all but one of the assessed patients. The majority had OAB (62.4%) and altered bladder sensation (70.8%). Mean total vesical capacity was 343.6 mL. Elevated postvoid residual volume (37.5%) and detrusor sphincter dyssynergia (37.5%) was observed. Most patients had urinary symptoms and an overactive bladder. A subset of patients showed detrusor sphincter dyssynergia, a finding not frequently described. Cognitive impairment can play a role in urologic dysfunction and pseudodyssynergia might be present during the urodynamic test. Further studies are needed to assess urologic dysfunction in severe TBI survivors.

School future of teenagers with a severe brain injury after a hospitalization at the Centre Médical et Pédagogique pour Adolescents in Neufmoutiers-en-Brie France

To study the school progress of teenagers with a severe brain injury at the end of their inpatient stay at rehabilitation center of the Centre Médical et Pédagogique pour Adolescents . All of them have benefited from both schooling and rehabilitation at the same time. Only patients aged between 12 and 17 years and hospitalized between 2012 and 2017 were included in the study. Demographic data (age, sex), initial Glasgow coma scale (GCS), duration of coma, duration of intubation, time between accident and hospitalization in rehabilitation, duration of stay in rehabilitation, neuropsychological assessment results, school level prior to the brain injury and at the end of the hospitalization were noted. Eighty-six brain injury cases were examined. Only 25 patients were included in the study among them 17 males and 8 females. The average age at admission was 15.8 ± 1.7 years. The average time between accident and hospitalization in rehabilitation was 145 ± 269 days. The average duration of stay in rehabilitation was 260 ± 197 days. The average GCS was 5.6 ± 1.8. The average duration of coma was 9.9 ± 4.1 days. The average duration of intubation was 14 ± 6 days. Twenty teenagers have resumed their school education. Ten students have returned to pre-traumatic brain injury level, four patients have increased to a level higher than before the accident. Two patients were redirected to apprentiship studies, two referred to Training and Orientation Assessment Unit and two have resumed their education with additional support. Teenagers with severe brain injury require multidisciplinary rehabilitation and appropriate school education. The follow up of this population should be extended beyond hospitalization in a rehabilitation center.

Systematic review of self-reported cognitive function in cancer patients following chemotherapy treatment.

Cognitive symptoms are common in cancer patients, with up to 70% reporting cognitive symptoms following chemotherapy. These symptoms can have a major impact on how an individual functions in all aspects of their lives. This review evaluates self-reported cognitive function and its associations with neuropsychological tests and patient-reported outcomes in adult cancer patients who received chemotherapy treatment for a solid cancer. A search of multiple databases (Medline, Ovid at Nursing, PsycINFO, Allied and Complementary Medicine) from 1936 to 2017 was conducted, identifying 1563 unique articles, of which 101 met inclusion criteria. Of the 101 included studies, 48 (47%) were cross-sectional and 38 (38%) longitudinal in design, with 12 (12%) randomised controlled trials. A minority (26%) incorporated a healthy control arm in the study design, whilst the majority (79%) were in women with breast cancer. There was diversity in the assessment of self-reported cognitive symptoms. A total of 43 of 44 studies that sought an association between self-reported cognitive function and patient-reported outcomes found a moderate to strong association. Overall, 31 studies showed a lack of association between self-reported cognitive symptoms and neuropsychological results, whilst 14 studies reported a significant association between the two, but the association was often restricted to limited cognitive domains. The review found widespread heterogeneity in the assessment of self-reported cognitive symptoms and consistently absent or weak association with neuropsychological test scores. This research highlights the need for a standardised approach to measurement of self-reported cognitive symptoms in cancer patients.

A Systematic Review of the Neuropsychological Sequelae of People Diagnosed with Anti N-Methyl-D-Aspartate Receptor Encephalitis in the Acute and Chronic Phases.

A systematic review was conducted to investigate the emerging cognitive profile for people diagnosed with anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis. Ten papers met the review criteria including five neuropsychological case studies and five case series; three of the 10 studies used matched controls. The cognitive functioning of 54 participants (46 female: eight male) was studied. Paper quality assessment was undertaken and outcomes summarized. Neuropsychological results during the acute phase (≤12 months) and chronic phase (>12 months) were extracted and a narrative review of the papers' findings undertaken. A range of neuropsychological test batteries were used across the studies, administered between one and four times. The review revealed difficulties with memory, particularly delayed verbal memory, and executive functioning. This may be consistent with the role of NMDA receptors in the limbic system, specifically the hippocampus, which are thought to be essential to aspects of learning and memory. To date, there is a paucity of high quality neuropsychological and psychological research concerning the impact of anti-NMDAR encephalitis on cognitive function and psychosocial wellbeing, both of adults and particularly of those under 18 years. Significant limitations of the literature reviewed include lack of attention to pre-morbid functioning, insufficient rationale for neuropsychological battery choice, use of samples of convenience, and limited translation of neuropsychological findings into rehabilitation. Limitations of this review include exclusive focus on an adult population and the necessity of a narrative review given the methodological diversity in studies making up the evidence base.

Face processing in a case of high functioning autism with developmental prosopagnosia

The ability to "read" the information about facial identity, expressed emotions, and intentions is crucial for non‑verbal social interaction. Neuroimaging and clinical studies consequently link face perception with fusiform gyrus (FG) and occipital face area (OFA) activity. Here we investigated face processing in an adult, patient PK, diagnosed with both high functioning autism spectrum disorder (ASD) and developmental prosopagnosia (DP). Both disorders have a significant impact on face perception and recognition, thus creating a unique neurodevelopmental condition. We used eye‑tracking and functional magnetic resonance imaging (fMRI) method. Eye‑tracking and fMRI results of PK were compared to results of control subjects. Patient PK showed atypical gaze‑fixation strategy during face perception and typical patterns of brain activations in the FG and OFA. However, a significant difference between PK and control subjects was found in the left anterior superior temporal sulcus/middle temporal gyrus (aSTS/MTG). In PK the left aSTS/MTG was hypo‑activated in comparison to the control subjects. Additionally, functional connectivity analysis revealed decreased inter‑hemispheric connectivity between right and left aSTS/MTG in 'ASD and DP' patient during face recognition performance as compared to the control subjects. The lack of activity in the left aSTS/MTG observed in the case of the clinical subject, combined with the behavioral, eye‑tracking, and neuropsychological results, suggests that impairment of the cognitive mechanism of face recognition involves higher level of processing. It seems to be related to insufficient access to semantic knowledge about the person when prompted by face stimuli.

Safety and Efficacy of Anti-dementia Agents in the Extremely Elderly Patients with Dementia.

BackgroundThere are debates on representation and generalizability of previous randomized controlled trials about anti-dementia agents in the oldest old population. In this context, we aimed to investigate the efficacy and safety of anti-dementia agents in the very elderly patients with dementia.MethodsWe conducted a retrospective study of patients with dementia 1) who were 85 years or older, 2) got started anti-dementia agents, and 3) went through follow-up evaluation about one year thereafter. As a control, patients with dementia who were less than 85 years old with similar inclusion criteria were randomly selected during the same period. The adverse drug effects and discontinuation rates were investigated with self-reported complaint after starting or increasing anti-dementia drugs. For efficacy outcome, we also analyzed the change in neuropsychological results during follow-up period.ResultsA total of 77 dementia patients who were at least 85 years were enrolled. As a control group, 78 patients with dementia who were younger than 85 was analyzed. The adverse drug effects were observed in 26 (33.3%) patients in the younger old and in 26 (33.8%) in the oldest old (P = 0.095). Twenty-one patients (26.9%) in the younger old group and 13 patients (16.9%) in the oldest old group discontinued their medication (P = 0.131). There were no differences between the two groups about changes of Mini-Mental State Examination and Instrumental Activity of Daily Living scores over time.ConclusionThe use of anti-dementia agents in the oldest old dementia patients may be safe and effective as the younger old dementia patients.

Surgical Treatment of Mesiotemporal Lobe Epilepsy: Which Approach is Favorable?

Mesiotemporal lobe epilepsy is one of the most frequent causes for pharmacoresistant epilepsy. Different surgical approaches to the mesiotemporal area are used. To analyze epileptological and neuropsychological results as well as complications of different surgical strategies. This retrospective study is based on a consecutive series of 458 patients all harboring pharmacoresistant mesiotemporal lobe epilepsy. Following procedures were performed: standard anterior temporal lobectomy, anterior temporal or key-hole resection, extended lesionectomy, and transsylvian and subtemporal selective amygdalohippocampectomy. Postoperative outcome was evaluated according to different surgical procedures. Overall, 1 yr after surgery 315 of 432 patients (72.9%) were classified Engel I; in particular, 72.8% were seizure-free after anterior temporal lobectomy, 76.9% after key-hole resection, 84.4% after extended lesionectomy, 70.3% after transylvian selective amygdalohippocampectomy, and 59.1% after subtemporal selective amygdalohippocampectomy. No significant differences in seizure outcome were found between different resective procedures, neither in short-term nor long-term follow-up. There was no perioperative mortality. Permanent morbidity was encountered in 4.4%. There were no significant differences in complications between different resection types. In the majority of patients, selective attention improved following surgery. Patients after left-sided operations performed significantly worse regarding verbal memory as compared to right-sided procedures. However, surgical approach had no significant effect on memory outcome. Different surgical approaches for mesiotemporal epilepsy analyzed resulted in similar epileptological, neuropsychological results, and complication rates. Therefore, the approach for the individual patient does not only depend on the specific localization of the epileptogenic area, but also on the experience of the surgeon.

Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy.

Cognitive symptoms are common after cancer, but poorly associated with neuropsychological results. We previously reported colorectal cancer (CRC) patients had more cognitive impairment than controls. Here, we explore relationships between cognitive symptoms and neuropsychological domains. Subjects with CRC (N=362) and 72 healthy controls completed neuropsychological assessments and Functional Assessment of Cancer Therapy-Cognition (FACT-COG) at baseline (pre-chemotherapy) and 6, 12, and 24months. Associations between neuropsychological and FACT-COG scores were explored: perceived cognitive impairment (PCI), perceived cognitive ability (PCA), impact of PCI on quality of life (CogQOL). Of 362CRC subjects, 289 had loco-regional disease and 173 received chemotherapy (CTh+). At baseline, groups did not differ on total FACT-COG, PCI, or PCA scores. All scores, except PCA, were worse at 6months in CTh+. CRC patients not receiving chemotherapy did not differ from controls on FACT-COG domains. PCA associated weakly (r=0.28-0.34) with attention/executive function, visual memory, and global deficit score. There was no association between PCI and neuropsychological domains. Fatigue, anxiety/depression, and poorer quality of life were associated with PCI and CogQOL (r=0.44-0.51) in CRC patients. No association was seen between total FACT-COG or PCI, and neuropsychological domains. A weak-moderate association was found between PCA and attention/executive function and visual memory. The study was registered with clinicaltrials.gov (trial registration: NCT00188331). Cognitive symptoms are associated with fatigue, anxiety/depression, and poorer quality of life, and do not appear to be related to actual cognitive performance. Rates were lower than that reported in breast cancer survivors. Cognitive symptoms were greatest in those who received chemotherapy, with no significant difference between the non-chemotherapy survivors and healthy controls.

Systematic Review of Published Primary Studies of Neuropsychology and Neuroimaging in Trichotillomania.

Existing models of trichotillomania (TTM; hair pulling disorder) rely heavily on a biological predisposition or biological pathogenesis of the disorder, but fail to capture the specific neuropsychological mechanisms involved. The present systematic review aims to scope existing neuropsychological studies of TTM to explore gaps in current models. A systematic literature search was conducted to detect all published primary studies using neuropsychological and neuroimaging measures in a cohort of individuals experiencing TTM. Studies addressing neuropsychological function were divided into domains. Findings from imaging studies were considered within brain regions and across methodology. Thirty studies with a combined 591 participants with TTM, 372 healthy controls and 225 participants in other types of control group were included. Sixteen studies investigated neuropsychological parameters, and 14 studies pursued neuroimaging technologies. Available studies that used neuropsychological assessments and reported a statistically significant difference between those with TTM and controls ranged in effect size from 0.25 to 1.58. All domains except verbal ability and visual ability reported a deficit. In neuroimaging studies, several structural and functional brain changes were reported that might be of significance to TTM. Only tentative conclusions can be made due to the use of multiple methodologies across studies, a major limitation to meaningful interpretations. Positive neuropsychological and neuroimaging results require replication, preferably with multi-site studies using standardized methodology. Increased standardized testing and analyses across the literature, as a whole, would improve the utility and interpretability of knowledge in this field. (JINS, 2018, 24, 188-205).

P379 Assessment of cognitive function in children with benign childhood epilepsy with centrotemporal spikes: An event related EEG desynchronization and synchronization study

Objective Quantitative analysis of brain responses to cognitive tasks using event related desynchronization (ERD) and event related synchronization (ERS) and correlation the results with scores of neuropsychological tests in patients with BCECTS. Methods Our study included 50 children (30 patients and 20 matched controls). Clinical assessment, Neuropsychological tests, Behavioral measures, P300 averaging and Quantitative EEG analysis were carried out for patients? and control groups, in addition to brain imaging for the patients. Alpha power ERD and ERS were measured as the percent decrease or increase in alpha power produced by target tones relative to reference intervals in six different brain regions during an auditory oddball paradigm. Results Epileptic children showed a statistically significant poorer cognitive performance in the neuropsychological and behavioral tests (verbal IQ, performance IQ, letter cancellation test and number of correct responses). Moreover, both groups showed diffuse alpha power attenuation in response to the target tones, however this alpha power ERD was significantly smaller in epileptic children compared to healthy group. No significant P300 wave latency or amplitude difference was elicited between both groups and no significant correlation between alpha ERD percentage and neuropsychological results. Conclusions Children with BCECTS have subtle cognitive dysfunction, particularly in the domains of language, memory, attention and executive functions. The smaller alpha power ERD in epileptic children may be an electrophysiological index of disruptive brain activation related to the cognitive dysfunction with BCECTS. However, alpha power ERD/ERS technique could be complementary rather than supplementary to neuropsychological testing in cognitive assessment of those children.

O129 Intellectual functioning and P300 potential in adolescents with newly diagnosed multiple sclerosis

Objectives EBM literature offers no data on cognitive impairment in patients diagnosed with MS in childhood and adolescence. The aim of the study was to assess intellectual function in children and adolescents with MS. Methods The study involved 17 children aged 11.5–17 years with newly diagnosed MS hospitalized in the Department of Pediatric Neurology, Jagiellonian University in Cracow. All patients underwent neuropsychological and neurophysiological examination (endogenous evoked P300 potential). The cognitive and emotional functioning was assessed using the Wechsler tests (Polish edition), DUM (a visual learning test), and clinical trials of memory, attention, executive functioning and praxis. The P300-induced auditory stimulus examination was performed on the KeyPoint Natus in accordance with the International Federation for Clinical Neurophysiology recommendations. The results received were evaluated per own standards and following parameters were recognised as abnormal: prolongation of P300 wave above 2 SD and/or decrease in the amplitude of more than 50%. Results The neuropsychological results show that none of the examined children with newly diagnosed MS had visuospatial difficulties. The immediate auditory memory span is very well developed in all patients (above average). The study found a slight increase in P300 latency (321.76 ± 21.70 ms), higher amplitude (13.93 ± 8.63 uV), and a shorter period of reaction time (324.93 ± 163.68 ms) compared to the control group (the latency −298.14 ± 38.76 ms, the amplitude of −9.64 ± 7.32 uV,the reaction time −380.11 ± 79.94 ms). Discussion The results obtained are consistent with those of the references. Conclusions: 1 Patients with newly diagnosed MS in childhood and adolescence do not show significant cognitive impairments in neuropsychological examination. 2. The active demyelinating process in the initial period of the disease does not impair cognitive functioning as assessed with P300. Significance: The proper functioning of young people with newly diagnosed MS is found.

Towards reporting standards for neuropsychological study results: A proposal to minimize communication errors with standardized qualitative descriptors for normalized test scores

ObjectiveRapid, clear and efficient communication of neuropsychological results is essential to benefit patient care. Errors in communication are a lead cause of medical errors; nevertheless, there remains a lack of consistency in how neuropsychological scores are communicated. A major limitation in the communication of neuropsychological results is the inconsistent use of qualitative descriptors for standardized test scores and the use of vague terminology. Patients and methodsPubMed search from 1 Jan 2007 to 1 Aug 2016 to identify guidelines or consensus statements for the description and reporting of qualitative terms to communicate neuropsychological test scores was conducted. The review found the use of confusing and overlapping terms to describe various ranges of percentile standardized test scores. ResultsIn response, we propose a simplified set of qualitative descriptors for normalized test scores (Q-Simple) as a means to reduce errors in communicating test results. The Q-Simple qualitative terms are: ‘very superior’, ‘superior’, ‘high average’, ‘average’, ‘low average’, ‘borderline’ and ‘abnormal/impaired’. A case example illustrates the proposed Q-Simple qualitative classification system to communicate neuropsychological results for neurosurgical planning. ConclusionsThe Q-Simple qualitative descriptor system is aimed as a means to improve and standardize communication of standardized neuropsychological test scores. Research are needed to further evaluate neuropsychological communication errors. Conveying the clinical implications of neuropsychological results in a manner that minimizes risk for communication errors is a quintessential component of evidence-based practice.

MEG biomarker of Alzheimer's disease: Absence of a prefrontal generator during auditory sensory gating.

Magnetoencephalography (MEG), a direct measure of neuronal activity, is an underexplored tool in the search for biomarkers of Alzheimer's disease (AD). In this study, we used MEG source estimates of auditory gating generators, nonlinear correlations with neuropsychological results, and multivariate analyses to examine the sensitivity and specificity of gating topology modulation to detect AD. Our results demonstrated the use of MEG localization of a medial prefrontal (mPFC) gating generator as a discrete (binary) detector of AD at the individual level and resulted in recategorizing the participant categories in: (1) controls with mPFC generator localized in response to both the standard and deviant tones; (2) a possible preclinical stage of AD participants (a lower functioning group of controls) in which mPFC activation was localized to the deviant tone only; and (3) symptomatic AD in which mPFC activation was not localized to either the deviant or standard tones. This approach showed a large effect size (0.9) and high accuracy, sensitivity, and specificity (100%) in identifying symptomatic AD patients within a limited research sample. The present results demonstrate high potential of mPFC activation as a noninvasive biomarker of AD pathology during putative preclinical and clinical stages. Hum Brain Mapp 38:5180-5194, 2017. © 2017 Wiley Periodicals, Inc.

Altered spontaneous brain activity pattern in cognitively normal young adults carrying mutations of APP, presenilin-1/2 and APOE ε4

ObjectiveTo explore genetic effects of amyloid precursor protein (APP), presenilin-1/2 and apolipoprotein E (APOE) ε4 on brain structural and functional alterations in cognitively normal young adults. Materials and methodsEighty healthy adults (mean age 24.0±2.5years; n=18, APP/presenilin-1/2 group; n=31, APOE ε4 group; n=31, control group [without above-mentioned gene mutation]) underwent high-resolution T1-weighted 3D anatomical imaging, resting-state functional MR imaging and neuropsychological assessments. We used voxel-based morphometry and regional homogeneity (ReHo) algorithms to investigate brain structural and functional changes among three groups, and performed correlation analyses between the brain regions with statistically significant difference and neuropsychological results. ResultsNo brain structural changes were found, however, ReHo values were increased in right parietal-frontal lobes in APOE ε4 group, and decreased in the left middle temporal gyrus in APP/presenilin-1/2 group compared with controls (all P<0.05). Compared with APOE ε4 group, decreased ReHo values of bilateral temporal lobes were shown in APP/presenilin-1/2 group (P<0.05). ReHo values of right superior frontal gyrus in APOE ε4 group positively correlated with neuropsychological tests scores(P<0.05). ConclusionCognitively normal young adults carrying APOE ε4 or APP/presenilin-1/2 had different spontaneous brain activity patterns without cerebral structural differences.

Different Hippocampus Functional Connectivity Patterns in Healthy Young Adults with Mutations of APP/Presenilin-1/2 and APOEε4.

This study aims to explore the hippocampus-based functional connectivity patterns in young, healthy APP and/or presenilin-1/2 mutation carriers and APOE ε4 subjects. Seventy-eight healthy young adults (33 male, mean age 24.0±2.2years; 18 APP and/or presenilin1/2 mutation carriers [APP/presenilin-1/2 group], 30 APOE ε4 subjects [APOE ε4 group], and 30 subjects without the above-mentioned genes [control group]) underwent resting-state functional MR imaging and neuropsychological assessments. Bilateral hippocampus functional connectivity patterns were compared among three groups. The brain regions with statistical differences were then extracted, and correlation analyses were performed between Z values of the brain regions and neuropsychological results. Compared with control group, both APOE ε4 group and APP/presenilin-1/2 group showed increased functional connectivity in medial prefrontal cortex and precuneus for the seeds of bilateral hippocampi. The APOE ε4 group displayed increased functional connectivity from bilateral hippocampi to the left middle temporal gyrus compared with the control group. Moreover, compared with the APP/presenilin-1/2 group, the APOE ε4 group also had markedly increased functional connectivity in right hippocampus-left middle temporal gyrus. The Z values of right hippocampus-left middle temporal gyrus correlated with various neuropsychological results across all the subjects, as well as in APOE ε4 group. Young healthy adults carrying APOE ε4 and APP/presenilin-1/2 displayed different hippocampus functional connectivity patterns, which may underlie the discrepant mechanisms of gene-modulated cognitive dysfunction in Alzheimer's disease.

Assessment of Cognitive, Emotional, and Motor Domains in Patients with Diffuse Gliomas Using the National Institutes of Health Toolbox Battery.

Patients with brain tumors are known to have deficits in cognitive, motor, and emotional domains. Comprehensive evaluation of the patient with brain tumor includes taking into account all these domains at baseline and throughout treatment. Standard neuropsychological assessment methods, however, are lengthy, expensive, and often are variable. The authors appraised the feasibility of using a brief, inexpensive, comprehensive, and standardized neuropsychological battery, the National Institutes of Health (NIH) Toolbox, to assess these domains in patients with diffuse glioma. Eighteen patients were recruited and completed the NIH Toolbox Cognitive Battery, 2 motor tests (Grip Strength and Grooved Pegboard), and the NIH Toolbox Emotional Battery. Fully corrected T scores are reported, as well as composite scores of fluid and crystallized cognition. Follow-up cognitive (n= 13) and motor assessment (n= 12) were performed at 1 month after surgery. The total time to complete the battery was approximately 60 minutes. A total of 78% of patients demonstrated significant impairment on one or more cognitive test, whereas 37% had impaired fluid cognition. Crystallized and overall composite cognitive scores were relatively intact, with 16% of patients showing significant impairment. A total of 22% of patients had impaired strength in the left hand, and 22% had impaired dexterity in both hands. In addition, 50% of patients showed impairment in one or more emotional domain. At 1 month after surgery, a significant decrease in crystallized cognition was observed. The NIH Toolbox represents a feasible alternative to current neuropsychological batteries in the assessment of neurosurgical patients. It can be administered quickly, inexpensively, and will give the neurosurgical community a common currency when reporting neuropsychological results.

Neuropsychological Impairments in Hematological Malignancies Patients Expected to Allo-BMT

Introduction: Hematological malignancies treatment is associated with various side effects, some of them are inversive, other - not. The psychiatric disorders including deficits in cognition functions frequently occur (Vybornykh et al. Int J. of Hematol Res 2016; 2 (1) 103-114). Cognitive impairments (for example, in attention, memory domains) in pre and post bone marrow transplantation (BMT) period are common disabling disturbance, associated with further decrease in quality of life among hematological malignancy patients. Neuropsychological impairment understanding can facilitate to patients future rehabilitation. It is very important to study of existing cognitive impairments in the pre-allo-BMT period.Aim: To define the main neuropsychological impairments before BMT.Materials: 32 patients with various hematological malignancies in pre-allo-BMT period with multiple myeloma (MM) (n=16), acute lymphoblastic leukemia (ALL) (n=10), acute myeloid leukemia (AML) (n=6). Mean age of the 32 study participants (13 men and 19 women) was 31.6 (+-8.5 years). Neuropsychological assessment was made by using Luria neuropsychological battery, also self-reported questionnaire was used. Statistical analyzes were performed using the licensed package Statistica for Windows 5.5.Results and discussion: In 75% (n=24) patients observed decrement (15.7% population norms) in one or more cognitive domain (more 1-1.5 st.dev.). Results in attention, memory, motor skills and complex executive function tests were most likely to be decreased (р. = 0.01). 1-1.5 st.dev. was denoted as mild deficiency and 2-3 st.dev denoted as moderate to total deficiency; within this criteria: 75% (n=24) of participants had at least mild deficits in psychomotor skills, 50 %(n=16) moderate to total (including impairment in kinetic and kinesthetic praxis). 37,5% had deficits in executive function (n=7 - mild and n=5 - moderate to total impairment). 87% (n=28) had deficits in verbal memory (n=10 mild and n=18 moderate to total). 34% (n=11) in attention (n=4 - mild, n=7 - moderate to total). Also it was found the significant correlation (р=0.05) between patients cognitive impairments self-reports and results of neuropsychological assessment which confirmed deficits. In 25% (n=8) patients were no observations of discernible symptoms of neuropsychological impairments. Therefore on the basis of qualitative and quantitative analysis of neuropsychological approach and results of neuropsychological assessment can be supposed that patient’s cognitive impairments probably connected with deficits in basal structures and left hemisphere.Conclusion: Memory, attention, motor skills and complex executive functions are most damaged cognitive domains (probably depends on preceded chemotherapy and some others risk factors) in patients with hematological malignancies before BMT, but their intimate investigation can help in prospective neuropsychological rehabilitation and socialization of patients, so further research of cognitive impairments in dynamics needed to be done. DisclosuresNo relevant conflicts of interest to declare.