Neuropsychological Test Variables Research Articles

2 1991 Gulf War Women Veterans: Neurotoxicant Exposures and Cognitive Outcomes

Objective:The women who served in the 19901991 Persian Gulf War (GW) are unique in that they were the first group to have fewer restrictions in terms of military occupations and exposure to combat. Of the nearly 41,000 US troops who were women deployed to the GW, many were serving in frontline positions and were exposed to the same toxicants as their male counterparts. Toxicant exposures such as pesticide sprays and creams, oil well fires, diesel fuels, chemical and biological warfare (CBW) agents and anti-nerve gas (PB) pills have been found to result in cognitive impairments across a range of neuropsychological tests. Our research team has been following cohorts of women who were deployed to the GW and correlated exposures with neuropsychological outcomes. Overall, in small cohorts of women veterans we found that higher levels of exposures to pesticide sprays and creams and CBW are correlated with short-term memory, mood, and motor deficits. These findings were different from those of their male counterparts. In a recently developed data-repository we have compiled larger groups of women veterans to validate our prior findings.Participants and Methods:The current study is an analysis of data from a national bio/data-repository (Boston Biorepository Recruitment and Integrative Network for Gulf War Illness; BBRAIN) which includes key data samples from prior GW studies that have been merged and combined into retrospective datasets. Data include general health and chronic symptom questionnaires, demographics, deployment and self-reported exposure histories (separated into no exposure, fewer than 7 days exposure and greater than or equal to 7 days exposure), as well as key neuropsychological test variables. Three separate datasets were combined to include 62 women. Exposures to chemical alarms, oil well fires, pesticide cream or spray, pesticide fogging, and PB pills were self-reported. Linear regression models were produced for each continuous cognitive outcome, modeled on a given exposure, and controlling for age, education level, PTSD, and other exposures.Results:Of the 62 women, the majority were White (77%). 74% of women surveyed were employed and 55% were married. 63% of women had at least a high school education. Deployed women who had > 7 days of exposure to pesticide sprays, CBW, smoke from oil well fires, and PB pills were more likely to show deficits in the areas of verbal learning and short-term memory (p < .03) and those with exposure to CBW, smoke from oil well fires, pesticides creams and PB pills had more errors on a test of executive functioning (p < .01). These data differ from the findings from cohorts of men.Conclusions:These data validate the findings of our prior studies and add credence to the need for separate analyses for men and women. The unique outcomes may lead to individualized treatments for women veterans that may also help women with similar exposures from other deployments in addition to women with occupational exposures.

A - 182 Comparison of the Short Test of Mental Status to Traditional Neuropsychological Tests.

The Short Test of Mental Status (STMS) was developed by Kokmen and colleagues as a brief cognitive screening test. Existing research has found the STMS to be sensitive in detecting cognitive impairment in patients with Mild Cognitive Impairment (MCI). The STMS has also been shown to be comparable to other cognitive screening instruments, including the Montreal Cognitive Assessment (MoCA). However, the relationship between the STMS and traditional neuropsychological tests has yet to be evaluated. This study sought to explore the concordance between the STMS test items and neuropsychological test variables in a mixed clinical sample. Neuropsychological test data was collected from an archival database for 150 adults (Mean age = 71.4years) referred to an interdisciplinary dementia care clinic at an academic medical center. Descriptive statistics for the demographic and test variables were produced. Pearson correlations were used to examine the relationships between the STMS total score, STMS item scores, and the neuropsychological test variables. Statistically significant correlations were found between the STMS item scores and their corresponding neuropsychological tests: Orientation (r = 0.46-0.56), Attention (r = 0.39-0.51), Registration-Trials (r = 0.32-0.50), Calculations (r = 0.30-0.41), Construction (r = 0.43), Information (r = 0.56), and Recall (r = 0.61-0.71). The STMS total score was significantly correlated with all neuropsychological test scores (r = 0.30-72). The STMS shows strong concordance with traditional neuropsychological tests in a dementia clinic sample. Future analyses will include examining construct validity of the STMS with different clinical groups and diagnoses as well as an exploration of the underlying factor structure of the STMS.

How We Work Now: Preliminary Review of a Pediatric Neuropsychology Hybrid Model in the Era of COVID-19 and Beyond.

ObjectiveAlthough telehealth has become a central component of medical care in response to the coronavirus disease 2019 (COVID-19) pandemic, comprehensive pediatric neuropsychological assessment over virtual platforms lacks empirical efficacy. This paper presents: a) the results of a quality improvement project examining the feasibility of in-person evaluation in the context of safety measures that alter test standardization, b) the impact such changes had upon neuropsychological test scores, and c) how using a hybrid model of clinical service delivery affected access to care.MethodWe compared demographic and outcome variables between patients seen during the pandemic (N = 87) to a group of patients seen in our service immediately prior to COVID-19 (N = 87). A subset of those patients were case-matched for age and diagnosis (N = 39 per group). Children seen for neuropsychological re-evaluation during the pandemic (N = 10) were examined using pairwise comparison.ResultsGroups did not differ on age, sex, or FSIQ. Despite changes to standardized administration, no group differences were found for any selected neuropsychological test variables in the larger sample or subsamples. In fact, all variables were moderately to highly correlated in the re-evaluation subgroup. The hybrid model expedited feedback sessions and increased face-to-face (telehealth) feedbacks.ConclusionsA hybrid model incorporating modified in-person testing and intake and feedback encounters via telehealth may be a feasible and effective way to provide pediatric neuropsychological services. These preliminary findings suggest such novel aspects of neuropsychological evaluation could represent an improvement over pre-COVID models, especially in rural settings.

Cognitive impairment without altered levels of cerebrospinal fluid biomarkers in patients with encephalitis caused by varicella-zoster virus: a pilot study

Varicella-zoster virus (VZV) is one of the most common agents causing viral infections of the central nervous system (CNS). VZV encephalitis is associated with severe neurological sequelae, despite antiviral treatment. Cognitive impairment has been reported and VZV has been associated with dementia. Our aim was to investigate the cognitive impairment and cerebrospinal fluid biomarkers in a follow-up study of patients with VZV encephalitis. Thirteen patients with VZV encephalitis, diagnosed by detection of VZV DNA in cerebrospinal fluid (CSF) by PCR and concomitant symptoms of encephalitis, were included. Neuropsychological assessment in parallel with a lumbar puncture to obtain CSF was performed 1.5–7 years after acute disease. The CSF biomarkers neurofilament light chain (NFL), S100B, glial fibrillary acidic protein (GFAP), amyloid-β (Aβ) 40 and Aβ42, total tau (t-tau) and phosphorylated tau (p-tau) were analysed and compared to controls (n = 24). Cognitive impairment was shown in the domains of executive functions and speed/attention and to a minor degree in the domains of learning/memory and language, indicated by a significantly poorer performance on seven neuropsychological test variables. No convincing evidence of alterations in concentrations of biomarkers in the CSF were shown. Our results indicate that patients with VZV encephalitis suffer from cognitive impairment long time after acute disease. Importantly, these impairments do not seem to be accompanied by biomarker evidence of ongoing neuronal or astrocytic injury/activation or induction of dementia-related brain pathologies by the infection.

F92. COMPARISONS BETWEEN CANNABIS USERS AND NON-USERS PATIENTS WITH FIRST-EPISODE PSYCHOSIS IN NEUROCOGNITIVE FUNCTIONING: A META-ANALYSIS

BackgroundPatients with first episode psychosis (FEP) frequently report cannabis use although its effects on cognitive functioning are still unclear. Several studies suggest a decrease in the executive function, verbal memory and working memory of FEP cannabis users (González-Pinto et al., 2016; Mata et al. 2008) while other studies show improvements in the neurocognitive function of this group (Setién-Suero et al., 2017, Cuhna et al., 2013, Leeson et al., 2012, Yücel et al., 2012; Rodríguez-Sánchez et al., 2010) or even absence of neurocognitive differences between FEP cannabis users and non-users (Burgra et al., 2013). This meta-analysis aims to explore the magnitude of effect of cannabis use on neurocognition in patients with FEP.MethodsArticles for consideration were identified through extensive literature searches using online databases, which included PubMed, Medline and PsychInfo. The search was limited to English language articles. The used keywords were: “first episode psychosis” OR, “neurocognition and cannabis”, in combination with a number of neuropsychology-related terms including “neurocog*” and “neuropsycholog*”. Given that other substances including alcohol, cocaine, and stimulants are associated with altered cognitive performance, studies in which participants met for poly-substance use disorders, even if there was preferential use towards cannabis, were excluded. Eight studies from 2008 to 2017 met inclusion criteria from a total sample of 16 initial studies. Five hundred and eighteen of these participants were cannabis users with FEP, and 639 were patients with no cannabis use. A total of 58 effect sizes of neuropsychological test variables were categorized into 4 cognitive domains (premorbid IQ, executive functioning, working memory and verbal memory and learning). Age of first cannabis use, duration of cannabis use, percentage of males and age were abstracted and assembled as moderator variables. Standardized mean differences were computed for each cognitive domain between cannabis-using patients and patients with no history of cannabis use. Negative effect sizes would display better cognitive functioning of non-cannabis users. We employed a meta-analytic three level model to combine effect sizes across studies.ResultsEffect sizes were not significantly different from zero in any of the neurocognitive domains when FEP cannabis users and non-users patients were compared [working memory (d= -0.03, SE=0.15, CI = -0.33–0.26, p=0.83), executive function (d= 0,14, SE=0.16, CI = -0.17–0.45, p=0.37), verbal memory and learning (d= 0.04, SE=0.15, CI = -0.25–0.33, p=0.27) and premorbid IQ (d= 0.06, SE=0.09, CI = -0.24–0.12, p=0.50)]. Only one moderator variable resulted significant in the executive function denoting superior performance in FEP cannabis-using patients as they were older.DiscussionCannabis use is not related to an ameliorated or improved neurocognitive functioning in patients with a first episode psychosis. This is consistent with previous studies which showed absence of differences in the neurocognitive functioning between FEP cannabis users and nonusers (Burgra et al., 2013). However, it has been demonstrated that continued cannabis intake worsens cognitive performance although some of the FEP patients had better premorbid capacities (González-Pinto, 2016). Moreover, the doses and the different types of cannabis preparations may interfere the present results. Meta-analysis on longitudinal studies which include these potential moderator variables may be performed in the future.

P.3.004 - Neuropsychological correlates of ADRA2A(rs1800544) and COMT(rs4680) polymorphisms in Turkish ADHD patients

Introduction The complex etiology of ADHD has a strong genetic component. ADRA2A (rs1800544) and COMT (rs4680) polymorphisms are two of the most studied gene polymorphisms in ADHD etiology. However, there is still debate about their indication ofcreating different neuropsychological phenotypes in ADHD.In this study, we aimed to investigate the effects of these polymorphisms on neuropsychological traits among Turkish ADHD patients. Also, the relationship between ADHD symptoms, subtypes and neuropsychological test variables were studied. Methods To examine the phenotypic discrepencies of these genotypes, Continuous Performance Test(CPT) and Trail Making Tests (TMTA-TMTB) were conducted for 121 genotyped ADHD patients between 6-18 years old. Omission- commission errors and mean response time were used as CPT variables. Besides this, completing times, errors and corrections were the variables recorded for TMTA and TMTB. Mental retardation was excluded with Wechsler Intelligence Scale for Children-4 (WISC4)/Wechsler Intelligence Scale for Children –Revised (WISC-R) in the study. Diagnosis and subtype discrimination were confirmed and comorbidities except learning and disruptive behaviour disorders were excluded by using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Clinical Global Impression –Severity Scale (CGI-S) documented clinical severity, whereas Global Assesment of Functioning Scale (GAS) stated clinical functionality. Conners’ Parent (CPRS) and Teacher Rating Scales (CTRS) were used for determining ADHD symptoms and severity. The statistical analyses were conducted with SPSS 21.0. Mann-Whitney U, Kruskal–Wallis, Spearman correlation tests were used and p Results No relationship was detected between ADRA2A,COMT polymorphisms and CPT,TMT variables. CPT commission errors were found more frequent in the combined subtype, while TMTA corrections were more seen in the inattentive subtype.The learning problem subscale of CPRS and hyperactivity, behaviour problem subscales of CTRS were found associated with CPT commission errors. The hyperactivity, oppositional behaviour subscales of CPRS were related to TMTA errors and corrections whereas behaviour problem subscale of CPRS was only associated with TMTA corrections. The hyperactivity and behaviour problem subscales of CTRS were found correlated with TMTA completing time, errors and corrections. Only attention deficiency subscale of CTRS was found associated both with TMTA corrections and TMTB completing time and errors. CPT parameters were found associated with neither clinical severity nor functioning.However, low clinical functionality ( Conclusions ADRA2A and COMT polymorphisms were not found to be associated with a specific neuropsychological phenotype. While CPT did not predict clinical severity or functioning, longer TMT completing time and more TMT corrections were found associated with lower functionality. Although the results of neuropsychological tests were in accordance with ADHD subtypes, neuropsychological traits did not differ in a homogeneous manner in ADHD patients. Consequently, instead of using the neuropsychological traits in distinguishing groups, they may be helpfully used for supporting clinical evaluation in ADHD. In addition, further studies with whole genome sequencing technics are warrented to better understand the role of polymorphisms in ADHD etiology.

"The effectiveness and unique contribution of neuropsychological tests and the δ latent phenotype in the differential diagnosis of dementia in the uniform data set": Correction to John et al. (2016).

Archival data requested from the NACC provided clinical diagnostic groups that were paired to 1 another through a genetic matching procedure. For each diagnostic pairing, 2 separate logistic regression models predicting clinical diagnosis were performed and compared on their predictive ability. The shared variance approach was represented through the latent phenotype δ, which served as the lone predictor in 1 set of models. The unique variance approach was represented through raw score values for the 12 neuropsychological test variables comprising δ, which served as the set of predictors in the second group of models. Examining the unique patterns of neuropsychological test performance across a battery of tests was the superior method of differentiating between competing diagnoses, and it accounted for 16-30% of the variance in diagnostic decision making. Implications for clinical practice are discussed, including test selection and interpretation. (PsycINFO Database Record

The effectiveness and unique contribution of neuropsychological tests and the δ latent phenotype in the differential diagnosis of dementia in the uniform data set.

Two main approaches to the interpretation of cognitive test performance have been utilized for the characterization of disease: evaluating shared variance across tests, as with measures of severity, and evaluating the unique variance across tests, as with pattern and error analysis. Both methods provide necessary information, but the unique contributions of each are rarely considered. This study compares the 2 approaches on their ability to differentially diagnose with accuracy, while controlling for the influence of other relevant demographic and risk variables. Archival data requested from the NACC provided clinical diagnostic groups that were paired to 1 another through a genetic matching procedure. For each diagnostic pairing, 2 separate logistic regression models predicting clinical diagnosis were performed and compared on their predictive ability. The shared variance approach was represented through the latent phenotype δ, which served as the lone predictor in 1 set of models. The unique variance approach was represented through raw score values for the 12 neuropsychological test variables comprising δ, which served as the set of predictors in the second group of models. Examining the unique patterns of neuropsychological test performance across a battery of tests was the superior method of differentiating between competing diagnoses, and it accounted for 16-30% of the variance in diagnostic decision making. Implications for clinical practice are discussed, including test selection and interpretation. (PsycINFO Database Record

Can memory and executive functions in patients with obsessive–compulsive disorder predict outcome of cognitive behavioural therapy?

Background: Most studies find that patients with obsessive–compulsive disorder (OCD) have impaired memory and executive functions. Cognitive behavioural therapy (CBT) is the recommended psychotherapeutic treatment of patients with OCD. We hypothesized that impairments in memory and executive functions would predict poor outcome of CBT. Aim: To investigate whether memory and executive functions in patients with OCD could predict outcome of CBT. Methods: We assessed 39 patients with OCD before CBT with neuropsychological tests of memory and executive functions, the Hamilton Depression Rating Scale, and the Global Assessment of Functioning Scale. Furthermore, we assessed severity of OCD symptoms before and after CBT using the Yale–Brown Obsessive Compulsive Scale. Results: There were no statistically significant differences between recovered (41%) and non-recovered patients (59%) on any neuropsychological test variables or on any baseline demographic variables. Furthermore, change in OCD symptoms was not predicted by neuropsychological test performances or baseline severity of OCD symptoms. The only statistically significant finding was that non-recovered patients had lower social functioning before CBT than recovered patients (p = 0.018, d = 0.797). Conclusions: Memory and executive functions in patients with OCD could not predict outcome of CBT, but level of social functioning may be a predictor of CBT outcome. Some of the main clinical implications are that we cannot use memory and executive functions, or baseline severity of OCD symptoms to determine which patients should be offered CBT.

Neurotoxicity from prenatal and postnatal exposure to methylmercury

The extent to which postnatal methylmercury exposure contributes to neurobehavioral delays is uncertain. Confounding may occur because the child's dietary exposure likely correlates with the mother's. This conundrum was examined in the Faroese birth cohort 1 born in 1986–1987. Exposure parameters included mercury concentrations in maternal hair at parturition, cord blood, and child blood and hair at the age-7 clinical examination (N=923). In regression analyses, the child's current blood-mercury at age 7 (N=694) showed only weak associations with the neuropsychological test variables, but visuospatial memory revealed a significant negative association. Mutual adjustment caused decreases of the apparent effect of the prenatal exposure. However, such adjustment may lead to underestimations due to the presence of correlated, error-prone exposure variables. In structural equation models, all methylmercury exposure parameters were instead entered into a latent exposure variable that reflected the total methylmercury load. This latent exposure showed significant associations with neurodevelopmental deficits, with prenatal exposure providing the main information. However, postnatal methylmercury exposure appeared to contribute to neurotoxic effects, in particular in regard to visuospatial processing and memory. Thus, addition in the regression analysis of exposure information obtained at a different point in time was not informative and should be avoided. Further studies with better information on exposure profiles are needed to characterize the effects of postnatal methylmercury exposure.

Contribution of cortical lesion subtypes at 7T MRI to physical and cognitive performance in MS

Evaluate cross-sectionally the contribution of focal cortical lesion (CL) subtypes at ultra-high-field MRI and traditional MRI metrics of brain damage to neurologic disability and cognitive performance in a heterogeneous multiple sclerosis (MS) cohort. Thirty-four patients with early or established disease including clinically isolated syndrome, relapsing-remitting MS, and secondary progressive MS were scanned on a human 7-tesla (7T) (Siemens) scanner to acquire fast low-angle shot (FLASH) T2*-weighted images for characterization of white matter and deep gray matter lesion volume, and CL types. Patients also underwent anatomical 3T MRI for cortical thickness estimation, and neuropsychological testing within 1 week of the 7T scan. Twenty-seven patient scans were acceptable for further analysis. Neurologic disability was measured using the Expanded Disability Status Scale. Type III-IV CLs had the strongest relationship to physical disability (ρ = 0.670, p < 0.0001). White matter lesion volume and type I CLs are each significantly associated with 6 of 11 neuropsychological test variables. Type III-IV CLs significantly correlate with 4 of 11 neuropsychological test variables whereas type II CLs, deep gray matter lesion volume, and cortical thickness metrics are less frequently associated with cognitive performance. Leukocortical (type I) and subpial (III-IV) CLs identified on 7T FLASH-T2* sequences are potential cortical biomarkers of cognitive and neurologic status in MS.

Neuropsychological deficits in drug naïve, non-depressed obsessive-compulsive disorder patients

There are several studies that compared neuropsychological performance of OCD patients with healthy controls. However, there are hardly any studies which have used drug-naïve as well as non-depressed OCD subjects in their studies. The present study compared eighteen drug-naïve non-depressed OCD patients with similar number of age, education and sex matched healthy controls on neuropsychological tests. The tests used are block design, object assembly, Visuospatial Working Memory Test, Verbal Working Memory Test, Complex Figure Test, Stroop Test and Wisconsin Card Sorting Test. In addition to usual significance testing, Effect Sizes were calculated. In addition, correlation was done between neuropsychological test variables and clinical variables. The results did not show any significant correlation between any of the clinical variables and neuropsychological test variables. On the other hand, patients showed significant deficits mainly in executive functions and organizational strategy with respect to visuospatial functions. The observed deficits can be attributed to both dorsolateral prefrontal cortex and orbitofrontal cortex involvement.

Different safety profiles of risperidone and paliperidone extended‐release: a double‐blind, placebo‐controlled trial with healthy volunteers

The present study investigated subjective experiences related to secondary negative symptoms and cognitive performance in healthy volunteers in response to the repeated administration of paliperidone extended-release (ER) and risperidone in a double-blind, placebo-controlled trial. Participants (n = 32) received a fixed dose of one of three study medications for three consecutive days: 6 mg of paliperidone ER, 3 mg of risperidone, or placebo. Subjects were evaluated at baseline and after the first and third administrations of the medications by using the Neuroleptic-Induced Deficit Syndrome Scale and the Scale for the Assessment of Negative Symptoms. Cognitive function was measured at baseline and after the third administration of the medications by using the computerized neuropsychological test. Risperidone was associated with more detrimental subjective experiences compared with paliperidone ER and placebo (p < .05), and these differences persisted after controlling for mental and physical sedation. Analysis of computerized neuropsychological test variables revealed significant differences in the changes in Stroop word-color test results from baseline between the paliperidone ER and risperidone groups (p < .005) and between the placebo and risperidone groups (p < .005). These results suggest that paliperidone ER may have a better safety profile than risperidone in terms of negative subjective experiences and cognitive function among normal volunteers.

A new Brief computerized cognitive screening battery (CompCogs) for early diagnosis of Alzheimer's disease.

Screening tests for early diagnosis of dementia are of great clinical relevance. The ideal test set must be brief and reliable, and should probe cognitive components impaired in Alzheimer’s disease (AD).ObjectivesTo develop a new Computerized Cognitive Screening test (CompCogs), and to investigate its validity for the early diagnosis of AD, and evaluate its heuristic value in understanding the processing of information in AD.MethodsThe computerized neuropsychological performance battery, originally including six tests, was applied in forty seven patients with probable mild AD and 97 controls matched for age and education. This computerized neuropsychological test battery, developed with MEL Professional, allows control of timing and order of stimuli presentation, as well as recording of response type and latency. A brief-screening version, CompCogs, was selected using the most discriminative neuropsychological test variables derived from logistic regression analysis. Full battery administration lasted about 40 minutes, while the CompCogs took only 15 minutes.ResultsCompCogs included the Face test (correct response) and Word and Forms with Short term memory tests (reaction time). CompCogs presented 91.8% sensitivity and 93.6% specificity for the diagnosis of AD using ROC analyses of AD diagnosis probability derived by logistic regression.ConclusionsCompCogs showed high validity for AD early diagnosis and, therefore, may be a useful alternative screening instrument.

Computerized Maze Navigation and On-Road Performance by Drivers With Dementia

This study examined the ability of computerized maze test performance to predict the road test performance of cognitively impaired and normal older drivers. The authors examined 133 older drivers, including 65 with probable Alzheimer disease, 23 with possible Alzheimer disease, and 45 control subjects without cognitive impairment. Subjects completed 5 computerized maze tasks employing a touch screen and pointer as well as a battery of standard neuropsychological tests. Parameters measured for mazes included errors, planning time, drawing time, and total time. Within 2 weeks, subjects were examined by a professional driving instructor on a standardized road test modeled after the Washington University Road Test. Road test total score was significantly correlated with total time across the 5 mazes. This maze score was significant for both Alzheimer disease subjects and control subjects. One maze in particular, requiring less than 2 minutes to complete, was highly correlated with driving performance. For the standard neuropsychological tests, highest correlations were seen with Trail Making A (TrailsA) and the Hopkins Verbal Learning Tests Trial 1 (HVLT1). Multiple regression models for road test score using stepwise subtraction of maze and neuropsychological test variables revealed significant independent contributions for total maze time, HVLT1, and TrailsA for the entire group; total maze time and HVLT1 for Alzheimer disease subjects; and TrailsA for normal subjects. As a visual analog of driving, a brief computerized test of maze navigation time compares well to standard neuropsychological tests of psychomotor speed, scanning, attention, and working memory as a predictor of driving performance by persons with early Alzheimer disease and normal elders. Measurement of maze task performance appears to be useful in the assessment of older drivers at risk for hazardous driving.

Language Disturbances as a Side Effect of Prophylactic Treatment of Migraine

Language disturbances have been previously described as word-finding difficulties in epileptic patients. These disturbances have been recently reported in migraineurs in treatment with topiramate but they have never been defined and assessed in these patients with the aid of neuropsychological testing. To verify the occurrence of language disturbances as a side effect of topiramate treatment in episodic and chronic migraine patients. Language disturbances were recorded on the basis of spontaneous reports of 30 migraine patients treated with topiramate and 2 control groups (20 patients treated with other prophylactic drugs and 20 patients without prophylactic treatment) and were explored with neuropsychological tests. Psychiatric comorbidity was assessed using Zung Anxiety and Depression Scales. Language disturbances were referred by 26.7% (n=8) of patients during topiramate treatment but by none of the patients in the 2 control groups. All patients in the topiramate group had a worse performance on all tests compared to patients of the 2 control groups. Moreover, in the topiramate group, patients with referred language disturbances had higher scores for all neuropsychological test variables, indicative of a worse performance. Some language functions (Trail Making Tests A and B) seemed to be influenced by the concomitant presence of psychiatric comorbidities, particularly anxiety and depression. It can be hypothesized that a disorder such as migraine, which involves numerous cortical and subcortical circuits implicated in the transmission and behavioral and emotional processing of pain, represents a facilitated substrate for the occurrence of language disturbances due to topiramate. This could be the expression of a more generalized impairment of cognitive processing. These aspects should be investigated in prospective studies involving larger migraine patient samples.

Cognitive and Cardiac Outcomes 5 Years After Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery

Conventional coronary artery bypass graft surgery with use of cardiopulmonary bypass (on-pump CABG) is associated with excellent long-term cardiac outcomes but also with a high incidence of cognitive decline. The effect of avoiding cardiopulmonary bypass (off-pump CABG) on long-term cognitive and cardiac outcomes is unknown. To compare the effect of off-pump CABG and on-pump CABG surgery on long-term cognitive and cardiac outcomes. The Octopus Study, a multicenter randomized controlled trial conducted in the Netherlands, which enrolled 281 low-risk CABG patients between 1998 and 2000. Five years after their surgery, surviving patients were invited for a follow-up assessment. Patients were randomly assigned to receive either off-pump (n = 142) or on-pump (n = 139) CABG surgery. The primary measure was cognitive status 5 years after surgery, which was determined by a psychologist blinded to treatment allocation who administered 10 standardized validated neuropsychological tests. Secondary measures were occurrence of cardiovascular events (all-cause mortality, stroke, myocardial infarction, and coronary reintervention), anginal status, and quality of life. After 5 years, 130 patients were alive in each group. Cognitive outcomes could be determined in 123 and 117 patients in the off-pump and on-pump groups, respectively. When using a standard definition of cognitive decline (20% decline in performance in 20% of the neuropsychological test variables), 62 (50.4%) of 123 in the off-pump group and 59 (50.4%) of 117 in the on-pump group had cognitive decline (absolute difference, 0%; 95% confidence interval [CI], -12.7% to 12.6%; P>.99). When a more conservative definition of cognitive decline was used, 41 (33.3%) in the off-pump group and 41 (35.0%) in the on-pump group had cognitive decline (absolute difference, -1.7%; 95% CI, -13.7% to 10.3%; P = .79). Thirty off-pump patients (21.1%) and 25 on-pump patients (18.0%) experienced a cardiovascular event (absolute difference, 3.1%; 95% CI, -6.1% to 12.4%; P = .55). No differences were observed in anginal status or quality of life. In low-risk patients undergoing CABG surgery, avoiding the use of cardiopulmonary bypass had no effect on 5-year cognitive or cardiac outcomes. isrctn.org Identifier: ISRCTN69438133.

Neuropsychological Impairment as a Consequence of Football (Soccer) Play and Football Heading: Preliminary Analyses and Report on University Footballers

Previous research has claimed neuropsychological impairment occurs as a result of professional and amateur football play, and, specifically, football heading. However, much of this research exhibits substantial methodological problems (Rutherford, Stephens, & Potter, 2003). By investigating less committed amateur level footballers, the current study sought to gain some insight into the developmental history of any neuropsychological consequences of football play. University football, rugby and noncontact sports players were compared on a range of biographical and neuropsychological test variables. While playing their chosen sports, rugby players sustained many more head injuries than footballers and noncontact sportsmen, but footballers did not sustain significantly more head injuries than noncontact sportsmen. The number of head injuries sustained predicted Trails B and TAP Divided Attention latencies in a positive fashion. After controlling for the number of head injuries sustained, sport group effects were detected with TAP Divided Attention accuracy scores, with footballers exhibiting poorest performance. After controlling for the number of head injuries sustained, the total amount of heading done by footballers predicted the number of Wisconsin Card Sorting category shifts in a negative fashion. Nevertheless, over interpretation of all of these results should be resisted because of the exploratory nature of the analyses and the possibility that the sport groups may differ in ways other than just the nature of their sports activities. This research was funded by the Wellcome Trust, Grant Ref: 054248.

The relationship of neuropsychological test performance with the PANSS in antipsychotic naı̈ve, first-episode psychosis patients

Background: Chronic schizophrenia patients have been sampled for factor analytic studies to identify the factor structure of the Positive and Negative Syndrome Scale (PANSS). Many of these studies have identified a cognitive factor, which may provide useful information about patients for whom formal neuropsychological testing is unavailable. However, the relationship between the clinically rated cognitive factor and performance-based cognitive test scores has not been thoroughly examined, particularly in patients who are early in the course of illness. Objectives: The validity of the PANSS cognitive factor was examined in a sample of antipsychotic naı̈ve, first-episode psychosis patients and the PANSS items that best predicted cognitive functioning were identified. Method: PANSS scores and performance on a battery of cognitive tests from the baseline assessment of a clinical trial of 167 neuroleptic naı̈ve patients with schizophrenia-like illnesses were analyzed. Results: Factor analysis revealed a five-factor model that was consistent with previously described factor models from samples of chronically treated patients. There were modest correlations (less than r=0.44) between the derived cognitive factor and six of the neuropsychological test variables (Wisconsin Card Sorting Test total errors and number of categories correctly sorted, WMS-R immediate and delayed recall scores, Category Fluency total score, and WAIS-R digit symbol). Five PANSS items (P6, N5, N6, G2, and G10) were identified that predicted global cognitive functioning; however, 66% of the variance in cognitive functioning remained unexplained. Conclusions: A PANSS cognitive factor can be identified in first-episode, neuroleptic naı̈ve patients. However, clinical ratings of cognitive deficits lack sensitivity and specificity and thus should not be relied upon fully.

Effect of high dose interferon alpha monotherapy in patients with chronic hepatitis C genotype 1

Background: Chronic schizophrenia patients have been sampled for factor analytic studies to identify the factor structure of the Positive and Negative Syndrome Scale (PANSS). Many of these studies have identified a cognitive factor, which may provide useful information about patients for whom formal neuropsychological testing is unavailable. However, the relationship between the clinically rated cognitive factor and performance-based cognitive test scores has not been thoroughly examined, particularly in patients who are early in the course of illness. Objectives: The validity of the PANSS cognitive factor was examined in a sample of antipsychotic naı&#x0308;ve, first-episode psychosis patients and the PANSS items that best predicted cognitive functioning were identified. Method: PANSS scores and performance on a battery of cognitive tests from the baseline assessment of a clinical trial of 167 neuroleptic naı&#x0308;ve patients with schizophrenia-like illnesses were analyzed. Results: Factor analysis revealed a five-factor model that was consistent with previously described factor models from samples of chronically treated patients. There were modest correlations (less than r=0.44) between the derived cognitive factor and six of the neuropsychological test variables (Wisconsin Card Sorting Test total errors and number of categories correctly sorted, WMS-R immediate and delayed recall scores, Category Fluency total score, and WAIS-R digit symbol). Five PANSS items (P6, N5, N6, G2, and G10) were identified that predicted global cognitive functioning; however, 66% of the variance in cognitive functioning remained unexplained. Conclusions: A PANSS cognitive factor can be identified in first-episode, neuroleptic naı&#x0308;ve patients. However, clinical ratings of cognitive deficits lack sensitivity and specificity and thus should not be relied upon fully.