Neuropsychological Test Battery Research Articles

Middle-age cerebral small vessel disease and cognitive function in later life: a population-based prospective cohort study.

Cerebral small vessel disease (cSVD) is a major pathologic substrate of vascular contribution to cognitive impairment. However, population based long-term longitudinal cognitive function data in relation to cSVD are rare. We investigated the relationship between cSVD and cognitive decline over time in middle-aged through elderly population. This prospective cohort study was conducted in a community-based adult population (avg. age 58.5±6.4) who underwent both magnetic resonance imaging (MRI) and comprehensive neuropsychological tests at baseline (2011-2014). The participants were followed-up with the same neuropsychological test battery 4-yearly in two more cycles (in 2015-2018 and 2019-2022). A total of 2454 participants who were free of dementia and cerebrovascular disease at baseline with cognitive function testing at least 2 time points over the time were analyzed. Data analysis was performed from May 1, 2023 to January 31, 2024. SVD was defined by the presence of any of the visible MRI markers (age-related white matter change, lacunes and cerebral microbleeds) at baseline. The main outcomes were multivariable adjusted mean differences of cognitive test performances by cSVD groups over time. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol-coding, Trail Making Test-A, and Stroop Test. To examine the relationship between cSVD and cognitive function, we used linear mixed model for repeated measurements to compare the means (95% CIs) by cSVD groups. Of the total, 908 (37.0%) participants had cSVD on MRI reading at baseline. By location, cSVD were mostly found in the frontal lobe followed by basal ganglia area of the brain. None of the cognitive test scores, except Trail Making Test-A, were significantly different between the cSVD groups at baseline. At 8-year follow-up, participants without cSVD performed significantly better than participants with cSVD in Stroop-color reading [Mean difference 1.19 (95% CI: 0.02-2.36), p=0.0451] and visual reproduction-recognition [Mean difference 0.11 (95% CI: 0.01-0.21), p=0.0221]. While no other cognitive tests showed any differential changes by cSVD groups, logical memory (Story Recall Tests) increased and Stroop-word reading decreased over time in both cSVD groups almost identically. Silent cSVD was independently associated with decline in executive functioning over 8-year follow-up period in this Korean middle-aged through elderly general population. Future studies considering wider spectrum of cSVD and longer follow-up durations may help predict further cognitive outcomes. This study was funded by the Korea Centers for Disease Control and Prevention.

Obsessive-compulsive personality disorder increases cognitive inflexibility in people with coronary artery disease.

Cardiovascular diseases such as coronary artery disease (CAD) have a high prevalence of psychiatric comorbidities, that may impact clinically relevant outcomes (e.g., cognitive impairment and executive dysfunction). Obsessive-compulsive personality disorder (OCPD) is a common psychiatric comorbidity in CAD. It has a distinct cognitive profile characterised by inflexible thinking and executive dysfunction, which in turn may affect treatment adherence. However, the impact of OCPD on cognitive functioning in CAD is under-researched. We aimed to investigate the impact of OCPD on executive function in individuals with CAD undergoing rehabilitation, using cognitive tests relating to inflexibility and executive planning. Seventy-eight adults (median age 59 [53.0-66.0] years) with CAD were tested within three days of hospital admission for cardiac rehabilitation occurring within two weeks of experiencing an episode of unstable angina or myocardial infarction. The Compulsive Personality Assessment Scale (CPAS) was used to evaluate OCPD traits. Neurocognitive testing was performed using the Cambridge Automated Neuropsychological Test Battery (CANTAB) including tests of set shifting (Intra-Extra Dimensional [IED] Set Shifting), and executive planning (Stockings of Cambridge [SOC]). Ten individuals with CAD fulfilled the operational criteria for DSM-5 OCPD. Individuals with comorbid OCPD made more IED intra-dimensional shift reversal errors (2.0 [2.0-4.0] vs. 1.0 [1.0-2.0], p=.004), reflecting a difficulty inhibiting previously learnt responses. When all participants were analysed as a group, negative associations were found between individual OCPD traits and other aspects of cognitive performance. Hoarding trait was associated with increased initial thinking time on the SOC at five moves (ρ=0.242, p=.033), while the need for control and rigidity traits were each associated with increased initial thinking time on the SOC at two moves (respectively, ρ=0.259, p=.022; ρ=0.239, p=.035), reflecting slower executive planning. A preoccupation with details trait was associated with fewer errors on a compound discrimination stage of the IED (ρ=-0.251, p=.026). After controlling these correlations for gender and age, significant associations remained with hoarding (β=0.243, p=.036), need for control (β=0.341, p=.005) and rigidity (β=0.259, p=.038) traits. Preliminary evidence suggests that individuals with CAD and comorbid OCPD traits show greater inflexibility than those without OCPD. Several OCPD traits were associated with slower planning, even after controlling them for age and gender. This may have implications for the success of rehabilitation.

Dietary intakes of flavonoids in relation to cognitive function among middle-aged and older adults: results from the Chinese Square Dance Cohort.

Objective: The study aims to explore the association between intake of dietary flavonoids and global cognition, domain-specific cognition and mild cognitive impairment (MCI) in middle-aged and older adults in China. Design: A cross-sectional study. Methods: This study used baseline data collected during 2021-2023 from the Chinese Square Dance Cohort. Dietary information was collected using a semi-quantitative food frequency questionnaire, and flavonoid intakes were calculated. Cognitive function was evaluated using a battery of neuropsychological tests, and global cognition was assessed using the composite z-score. Participants with MCI were diagnosed by Petersen's criteria. The relationship between flavonoid intake and cognitive score was determined using multiple linear regression and presented as β values with 95%CIs. The association of flavonoid intake with MCI was evaluated using logistic regression models and presented as odds ratios (ORs) with 95%CIs. Results: Among 3990 middle-aged and older participants, the median (P25-P75) age was 63 (59-67) years, and 85.05% were females. After adjusting for various covariates, compared to the lowest quartile (Q1), the highest intakes (Q4) of total flavonoids, anthocyanidins and flavan-3-ols, flavanones, flavones, flavonols, procyanidins, and isoflavones were associated with higher composite z-scores, with β values (95%CIs) of 0.12 (0.06, 0.17), 0.15 (0.10, 0.21), 0.09 (0.04, 0.15), 0.11 (0.06, 0.17), 0.08 (0.02, 0.13), 0.09 (0.03, 0.14), and 0.09 (0.04, 0.15), respectively. In addition, higher dietary intakes of anthocyanidins and isoflavones were associated with lower odds of MCI, where the corresponding ORs (95%CIs) for Q4 were 0.69 (0.51, 0.94) and 0.72 (0.54, 0.97), respectively. Conclusion: Higher flavonoid intakes were related to better cognitive function. These findings suggest a beneficial effect of flavonoid intake on the cognitive aging process.

Long-COVID and postural orthostatic tachycardia syndrome: a preliminary comparison of neuropsychological performance.

The aim of the study is to analyze and compare the cognitive profile between 59 patients with long-COVID [LC; 30 of them with and 29 without a positive coronavirus disease 2019 (COVID-19) confirmatory test] and 31 patients with postural orthostatic tachycardia syndrome (POTS) and a matched group of 39 healthy control participants. Participants were examined on a battery of neuropsychological tests, including verbal memory, visuospatial abilities, attention, processing speed, verbal fluency, working memory, and visual memory. Anxious-depressive symptomatology was also analyzed and then controlled for possible influence on cognitive performance. Patients with LC and POTS showed significantly lower performance compared with healthy peers. Differences on anxious and depressive symptoms were also found between the clinical and control groups, resulting in LC without a positive confirmatory test group exhibiting the highest rates of anxious symptoms. After controlling the effects of anxious-depressive symptomatology, the differences were eliminated for some of the cognitive variables, but additional differences were found between patients with LC and POTS after post hoc analysis. Findings from the present study contribute toward the reinforcement of the evidence on cognitive alterations associated with LC and POTS. Anxious-depressive symptomatology has to be considered in both clinical groups since it could be affecting cognitive performance.

Genetic Prοpensity for Different Aspects of Dementia Pathology and Cognitive Decline in a Community Elderly Population

In the present study, we investigated the association of genetic predisposition with specific dimensions of dementia pathophysiology for global and domain-specific cognitive decline in older adults. The sample was drawn from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study, comprising 512 cognitively normal individuals over 64 years of age, with a mean follow-up of 2.9 years. Cognitive function was evaluated through a neuropsychological test battery, while genetic predisposition was assessed based on two distinct Polygenic Risk Scores (PRS) for amyloid-beta 42 (Aβ42) and white matter hyperintensities (WMH). The association of each PRS with the cognitive decline rate was examined using generalized estimating equation models. In the whole sample, higher PRSs Aβ42 (β = −0.042) and WMH (β =−0.029) were associated with a higher rate of global cognitive decline per year, an association which remained significant in age, sex, and education subgroups. Moreover, higher PRSs Aβ42 and WMH were related to significant memory decline only in females, older, and highly educated participants. Thus, while the association of both PRSs with global cognitive decline over time was independent of age, sex, or education, the relationship of the specific PRSs with the memory decline rate appeared to vary depending on these factors.

Effectiveness and utilization of a cognitive screening program for primary geriatric care

BackgroundEffective detection of cognitive impairment in the primary care setting is limited by lack of time and specialized expertise to conduct detailed objective cognitive testing and few well-validated cognitive screening instruments that can be administered and evaluated quickly without expert supervision. We therefore developed a model cognitive screening program to provide relatively brief, objective assessment of a geriatric patient’s memory and other cognitive abilities in cases where the primary care physician suspects but is unsure of the presence of a deficit.MethodsReferred patients were tested during a 40-min session by a psychometrist or trained nurse in the clinic on a brief battery of neuropsychological tests that assessed multiple cognitive domains. Short questionnaires covering subjective cognitive complaints, symptoms of depression, and medical history were also administered. Results were conveyed to a dementia specialist who reviewed them and returned their judgement of the validity of the cognitive complaint to the primary care provider. Retrospective medical records review was carried out for a random (stratified) half of the sample to determine how screening results were utilized. Screening tests were repeated after two years in a subset of 69 patients.ResultsThe 638 patients screened (mean age = 75.9 years; mean education = 14.9 years; 58% women) were classified by screening as having normal cognition (n = 177), depression (with possible cognitive changes; n = 115), mild cognitive impairment (MCI; n = 107), or dementia (n = 239). Classification accuracy was shown by high agreement with the eventual clinical diagnosis in the medical record (69%; Cohen’s Kappa = .38; p < .001; 77% if MCI and dementia were collapsed; Cohen’s Kappa = .58; p < .001) and longitudinal decline in cognitive test scores only in those initially classified as having MCI or dementia. Medical records documented discussion of screening results with the patient in 69% of cases (80% if MCI or dementia was detected) and often referral to a specialist (62%), new brain imaging (54%), or change in medication (58%) when screening indicated potential cognitive impairment.ConclusionThe cognitive screening program was well accepted by primary care providers as an efficient and effective way to evaluate concerns about cognitive decline in older adults.

Sex and APOE genotype modulate neuropsychological profile and depression in temporal lobe epilepsy.

Temporal lobe epilepsy is the most common form of focal epilepsy, often associated with cognitive impairments, particularly in memory functions, and depression. Sex and APOE ε4 genotype play a crucial role in modulating cognitive outcomes and depression in various neurological conditions like Alzheimer's disease. However, the combined effects of APOE genotype and sex on cognitive performance and depression in temporal lobe epilepsy have not been previously investigated. This study aims to (i) identify impaired cognitive performance and clinically relevant depression; (ii) explore the interaction between sex and APOE ε4 genotype on cognitive performance and depression in individuals with temporal lobe epilepsy. We used a comprehensive battery of neuropsychological tests to assess domains such as learning and memory, attention, executive functions, language, and visuo-spatial constructional skills and the Hamilton Depression Rating Scale. We also performed APOE genotyping to assess its role in the study. The final sample was composed by fifty-four patients (53.7% female). Cognitive performance and depression were analyzed using normative cut-off scores. To examine the main effects and interactions of sex and APOE ε4 carrier status on neuropsychological test scores and the Hamilton Depression Rating Scale, we also conducted a two-way Analysis of Variance (ANOVA). Female APOE ε4 carriers compared to normative cut-offs, exhibited poor performance on multiple test scores, including the MMSE, The Rey Auditory Verbal Learning Test (immediate and delayed recall), The Corsi Block-Tapping Task, The Verbal Fluency Test, The Raven's Standard Progressive Matrices and The Pentagon-copying Test. Males showed impairment only in visuo-spatial short-term memory. ANOVA analysis revealed significant main effects of APOE ε4 status and sex on the MMSE, The Rey Auditory Verbal Learning Test, The Verbal Fluency, The Raven's Standard Progressive Matrices and The Pentagon-copying Test scores. Specifically, female APOE ε4 carriers performed consistently worse than other groups on many tasks. For depression, only an effect of sex emerged. Females scored higher besides APOE genotype. These findings underscore the importance of considering both sex and APOE genotype when assessing cognitive performance in patients with temporal lobe epilepsy. The significant cognitive deficits we observed among females carrying the APOE ε4 allele highlight previously unexplored genetic and sex-related influences on cognition. This has potential implications for personalized therapeutic strategies, emphasizing the need for targeted assessment and intervention.

MicroRNA in neuroexosome as a potential biomarker for HIV-associated neurocognitive disorders.

HIV-associated neurocognitive disorder (HAND) is a complication of chronic inflammation caused by HIV infection that impairs cognitive and motor functions. HAND can occur at any age, regardless of the duration of infection, even in people living with HIV (PLWH) whose blood viral load is controlled by antiretroviral therapy. The diagnosis of HAND requires a battery of neuropsychological tests, which is time-consuming and burdensome, limiting its effectiveness for screening PLWH. Here, we aimed to identify biomarkers for quantitatively diagnosing and screening for HAND using minimally invasive blood tests. Neuronal-derived exosomes (neuroexosomes) were isolated from the peripheral blood of PLWH, and the transcriptomes of their microRNAs (miRNAs) were analyzed. We identified five upregulated miRNAs (hsa-miR-16-5p, hsa-miR-26a-3p, hsa-92a-3p, hsa-miR-103a-3p, and hsa-miR-185-5p), and two downregulated miRNA (hsa-miR-3613-3p and hsa-miR-4668-5p) in PLWH diagnosed with HAND (HAND PLWH). Functional analysis of five miRNAs whose expression levels increased in HAND PLWH using the database showed that these miRNAs are involved in motor proteins and endocytosis, which are associated with nerve function. The expression levels of hsa-miR-16-5p, hsa-miR-103a-3p, and hsa-miR-185-5p were significantly higher than those in the non-HIV controls and non-HAND PLWH, suggesting that these miRNAs are potential biomarkers for HAND. Since there were no changes in known dementia miRNA biomarkers in HAND PLWH, the miRNAs identified in this study will allow for early differentiation of HAND.

Neurological post-COVID syndrome is associated with substantial impairment of verbal short-term and working memory

A substantial proportion of patients suffer from Post-COVID Syndrome (PCS) with fatigue and impairment of memory and concentration being the most important symptoms. We here set out to perform in-depth neuropsychological assessment of PCS patients referred to the Neurologic PCS clinic compared to patients without sequelae after COVID-19 (non-PCS) and healthy controls (HC) to decipher the most prevalent cognitive deficits. We included n = 60 PCS patients with neurologic symptoms, n = 15 non-PCS patients and n = 15 healthy controls. Basic socioeconomic data and subjective complaints were recorded. This was followed by a detailed neuropsychological test battery, including assessments of general orientation, motor and cognitive fatigue, screening of depressive and anxiety symptoms, information processing speed, concentration, visuomotor processing speed, attention, verbal short-term and working memory, cognitive flexibility, semantic and phonematic word fluency, as well as verbal and visual memory functions. Neurologic PCS patients had more complaints with significantly higher fatigue scores as well as higher levels of depressive and anxiety symptoms compared to Non-PCS and HC. Deep neuropsychological assessment showed that neurologic PCS patients performed worse in a general screening of cognitive deficits compared to HC. Neurologic PCS patients showed impaired mental flexibility as an executive subfunction, verbal short-term memory, working memory and general reactivity (prolonged reaction time). Multiple regression showed fatigue affected processing speed; depression did not. Self-reported cognitive deficits of patients with neurologic PCS including fatigue, concentration, and memory deficits, are well mirrored in impaired performance of cognitive domains of concentration and working memory. The present results should be considered to optimize treatment algorithms for therapy and rehabilitation programs of PCS patients with neurologic symptoms.

Associations between lifelong cognitive reserve, Alzheimer's disease-related plasma biomarkers, and cognitive function in dementia-free older adults: A population-based study.

Cognitive reserve (CR), typically measured through socio-behavioral proxies, can partially explain better cognitive performance despite underlying brain aging or neuropathology. To examine the associations of CR with mild cognitive impairment (MCI) and cognitive function while considering Alzheimer's disease (AD)-related plasma biomarkers. This population-based cross-sectional study included 4706 dementia-free individuals from MIND-China. Data on AD-related plasma biomarkers were available for 1204 individuals. A composite CR score was generated by integrating education, occupational complexity, mental activity, and social support, using structural equation modeling. A neuropsychological test battery was used to assess the function of episodic memory, executive function, attention, and verbal fluency. MCI and subtypes of MCI were defined according to the Petersen's criteria. Data were analyzed using general linear and logistic regression models. Controlling for AD-related plasma biomarkers, higher educational attainment was associated with better performance in all four examined cognitive domains (p < 0.001) and with lower likelihoods of MCI, amnestic MCI (aMCI), and non-aMCI (p < 0.05); late-life mental activity was significantly related to lower likelihoods of MCI and aMCI (p < 0.05). Midlife occupation and late-life social support were not significantly associated with MCI or subtypes (p > 0.05). Higher composite CR scores were related to better performance in all the examined cognitive domains as well as lower likelihoods of MCI, aMCI, and non-aMCI (p < 0.05). Greater composite CR, derived from the CR indicators across different stages of the lifespan, is associated with better cognitive function independent of AD-related plasma biomarkers, driven mainly by early-life educational attainment.

Diagnostic accuracy of the Montreal Cognitive Assessment in screening for cognitive impairment in initially hospitalized COVID-19 patients: Findings from the prospective multicenter NeNeSCo study

Abstract Objective: This study aimed to investigate the prevalence and nature of cognitive impairment among severely ill COVID-19 patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it. Method: We evaluated cognition in COVID-19 patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into z-scores. Scores within each cognitive domain were averaged and categorized as average and above (z-score ≥ −0.84), low average (z-score −1.28 to −0.84), below average (z-score −1.65 to −1.28), and exceptionally low (z-score &lt; −1.65). Patients were classified with cognitive impairment if at least one domain’s z-score fell below −1.65. We assessed the MoCA’s accuracy using both the original cutoff (&lt;26) and an “optimal” cutoff determined by Youden’s index. Results: Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below −1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of &lt;24, maintained sensitivity while improving specificity to 81%. Conclusions: Cognitive impairment prevalence in initially hospitalized COVID-19 patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to &lt;24 improves specificity.

Exploring the cognitive vulnerabilities in traumatic brain injury: A cross-sectional study conducted in an urban south India cohort.

Traumatic brain injury (TBI) can be primary/secondary injury which may culminate in cognitive impairment. This study aims to study the prevalence and to evaluate the cognition in participants afflicted with mild/moderate TBI. The study considered 1464 participants aged ≥ 45 years from Tata Longitudinal Study of Aging (TLSA). Among them, 48 participants with TBI and 48 age, gender, education-matched healthy controls were included in the study. Based on duration of lack of consciousness (LOC), participants were screened for mild (≤30 mins) or moderate (>30 mins-24 hrs) TBI. After excluding three participants with missing data for LOC and one participant with severe TBI, we considered 44 participants. Cognition was evaluated using COGNITO (Computerized Assessment of Adult Information Processing) neuropsychological test battery. Generalized Linear Model (GLM) was performed to assess the relationship between TBI and cognition (unadjusted (model 1), adjusted for age, gender, education (model 2) and adjusted for age, gender, education Apolipoprotein E E4 (model 3)). Prevalence of TBI is 3.3 %. Model 1 revealed that participants with mild/moderate TBI performed poorer in implicit memory task and had lesser reaction time. Adjusted models (Model 2, 3) revealed that TBI participants had lesser reaction time when compared to healthy controls. TBI did not seem to significantly affect cognitive functioning except implicit memory. Therefore, TBI might act as a risk factor for decline in certain domains of cognition.

Effect of melatonin on postoperative cognitive function in elderly patients submitted to transurethral resection of the prostate under spinal anesthesia

Hospitalization for Transurethral Prostate Resection (TURP) involves circadian rhythm disturbance - a possible cause of Postoperative Neurocognitive Disorder (POCD) in elderly patients. This study investigated whether melatonin ameliorated this effect. A double-blind, randomized clinical trial used a battery of neuropsychological tests to evaluate cognitive performance of 118 patients aged ≥ 60, before TURP with spinal anesthesia, and at 21- and 180-days PO. Patients received 10 mg of melatonin, or a placebo, on the night before surgery and 1-, 2- and 3-days PO. Delayed neurocognitive recovery in the two groups at 21 days PO was compared using the Chi-Squared test; individual performances in each test at each date were compared using the General Mixed Model. Results with p < 0.05 were considered significant. Pre-surgery, both groups had significant cognitive deficits. Delayed cognitive recovery at 21 days PO was the same in both. There were no cases of POCD at 180 days. The melatonin group performed better in the delayed-recall FOME, which assesses memory, and in the Digit Span test, which assesses attention and cognitive flexibility. Unexpectedly, global neurocognitive performance was improved at 180 PO in both groups. Melatonin had no statistical effect on POCD, but a selective beneficial effect was observed in two cognitive areas. The high prevalence of preoperative cognitive impairment may be related to the lower urinary tract symptoms which were reasons for the surgery; the unexpected improvement of cognitive performance in all patients at 180 days PO may reflect alleviation of these symptoms.

ADL+: A Digital Toolkit for Multidomain Cognitive, Physical, and Nutritional Interventions to Prevent Cognitive Decline in Community-Dwelling Older Adults.

Current research highlights the importance of addressing multiple risk factors concurrently to tackle the complex etiology of dementia. However, limited evidence exists on the efficacy of technology-driven, multidomain community-based interventions for preventing cognitive decline. To evaluate the efficacy of ADL+, an artificial intelligence (AI)-enabled digital toolkit integrating cognitive assessments and multidomain interventions, on outcomes of cognitive function, activity levels, and quality of life in older adults at risk of cognitive decline. Adherence and usability were also evaluated. We conducted a quasi-experimental study including community-dwelling older adults aged 60 years and above without dementia, but with subjective memory complaints (AD8 score ≥ 2). Participants received a six-month intervention (app-based cognitive training, personalized nutritional, physical, and social activities recommendations) or a control group treatment (cognitive health educational package). The primary outcome was a change in neuropsychological test battery (NTB) Z-scores (NTB composite and its individual domains: attention, processing speed, memory, and executive function). Secondary outcomes were activity levels (Frenchay Activities Index, FAI), and quality of life (EQ-5D). Outcomes were assessed at the end of the intervention and three months post-intervention using linear mixed-effects models. 96% of participants in the intervention and 89% in the control group completed the study. At six months, the intervention group showed a significant NTB composite score improvement (mean change: 0.086 (95% CI 0.020 to 0.15)), with a between-group difference of 0.17 (95% CI 0.071 to 0.27). Significant differences in attention, processing speed, and memory domains were observed, with benefits sustained in the processing speed domain at nine months. The control group's FAI scores declined at six months (mean change: -1.04 (95% CI -1.83 to -0.26)), while the intervention group's scores remained stable. The intervention group's EQ-5D visual analogue scale (VAS) scores improved at both six and nine months, with between-group differences of 4.06 (95% CI 0.23 to 7.90) at six months and 5.12 (95% CI 0.81 to 9.43) at nine months. Adherence was high, while average usability scores were obtained. The ADL+ toolkit shows potential beneficial effects on cognitive function, activity levels, and quality of life for older adults at risk of cognitive decline. Findings will guide future randomized controlled trials and implementation efforts.

Generating fair, reliable, and accurate neuropsychological test norms for people with HIV in a low- or middle-income country

AbstractEffective neuropsychological assessment of people with HIV (PWH) in low- and middle-income countries (LMICs) is hampered by the unavailability of adequate test norms. We aimed to: (1) develop demographically-corrected (regression-based) South African (SA) normative data for an HIV appropriate neuropsychological test battery for Xhosa home-language speakers; (2) compare the utility of those norms to that of (i) internal standardization norms and (ii) US test publisher norms; and (3) determine the criterion validity of the newly-developed norms. 114 controls and 102 demographically comparable Xhosa home-language people living with HIV completed a well-establised, standard HIV neuropsychological test battery assessing seven cognitive domains. Using a common performance metric (z-score), we compared control and PWH test performance and examined the extent to which the three different normative datasets embedded demographic effects e.g., education. Using internal standardization norms, analyses detected medium-sized correlations of overall test performance with age and education. Correlations were fully corrected for by the newly-developed demographically-corrected norms. Using demographically-corrected norms, PWH performed significantly more poorly than controls in five cognitive domains, whereas using internal standardization norms and test-publisher norms, PWH performed significantly more poorly than controls in one and two domains, respectively. Demographically-corrected norms estimated 43.1% of PWH were cognitively impaired; these estimates were 22.5% using test-publisher norms and 19.6% using internal standardization norms. Demographically-corrected SA norms were more sensitive to cognitive impairment in PWH than the other sets of norms. Expansion of this regression-based method to create population-appropriate norms will benefit research and clinical practice in LMICs.

Understanding Cognitive Performance, Psychological Factors, and Personality Traits in Women Exposed to Intimate Partner Violence.

Intimate partner violence (IPV) might increase the risk of depression, traumatic stress and affect cognitive performance. We analyzed the cognitive performance, psychological factors, and personality traits of 136 Brazilian women (n = 70 exposed to IPV and n = 66 non-exposed) aged 18 years or older. We utilized clinical interviews, the NEO Personality Inventory, and a neuropsychological testing battery. The statistical analyses employed moderation within variables, resulting in determination coefficients (r2) of 0.15 and 0.35. The husband was the primary aggressor, physical violence was the most frequent (90.6%). Women exposed to IPV exhibited more symptoms of post-traumatic stress disorder (PTSD), depression, neuroticism, difficulties in visual memory, and visuospatial abilities. The analysis indicated the influence of IPV, neuroticism, PTSD, and depression on the cognitive performance of the exposed to IPV.

Cognitive decline profiles associated with lewy pathology in the context of Alzheimer’s disease neuropathologic change

BackgroundAlzheimer’s disease neuropathologic change (ADNC) and Lewy pathology (LP) often coexist in cognitively impaired individuals. These pathologies’ relative distribution and severity may modify these individuals’ clinical presentation, cognitive profile, and prognosis. Therefore, we examined the contributions of LP and concomitant ADNC to disease survival and profiles of cognitive decline in preclinical and clinical stages in a large neuropathologically diagnosed group.MethodsWe evaluated 597 participants with LP and 491 participants with intermediate/high ADNC in the absence of LP from the National Alzheimer Coordinating Center (NACC) database. At baseline, 237 participants were cognitively normal (CN), 255 were diagnosed with mild cognitive impairment (MCI), and 596 with dementia. Cognition was assessed using three cognitive domain scores (i.e., Memory, Executive, and Language) from the NACC Uniform Dataset (UDS) neuropsychological test battery, MMSE, and Clinical Dementia Rating (CDR). Multivariate adaptive regression splines were used to evaluate associations between baseline cognitive scores and mean annual rate of change over two years. The likelihood of progression to MCI or dementia was assessed using Cox hazard models.ResultsNeocortical LP, independent of the clinical diagnosis, was associated with lower Executive and higher Language and Memory scores at baseline, whereas Braak V-VI neurofibrillary tangle pathology was associated with lower Memory and Language scores. Similarly, neocortical LP was associated with faster Executive decline, whereas Braak V-VI neurofibrillary tangle pathology was associated with faster Memory and Language decline. A clinical diagnosis of Lewy Body Dementia (i.e., a strong LP phenotype) was associated with the LP cognitive profile and shorter disease duration. Progression to incident MCI or dementia was primarily associated with the degree of tau pathology; neocortical LP or a diagnosis of Lewy Body Dementia only predicted progression when those with intermediate/high ADNC were excluded.ConclusionsLP and ADNC differentially affected cross-sectional and longitudinal cognitive profiles in a large autopsy sample. Concomitant Braak V-VI neurofibrillary tangle pathology had a strong impact on clinical progression in those with LP, regardless of the initial stage. Thus, LB and ADNC co-pathology interact to affect cognitive domains that may be used to track Lewy Body disease longitudinally and as outcome measures in therapeutic trials.

Hypothalamic volume is associated with age, sex and cognitive function across lifespan: a comparative analysis of two large population-based cohort studies.

Emerging findings indicate that the hypothalamus, the body's principal homeostatic centre, plays a crucial role in modulating cognition, but comprehensive population-based studies are lacking. We used cross-sectional data from the Rhineland Study (N=5812, 55.2±13.6 years, 58% women) and the UK Biobank Imaging Study (UKB) (N=45,076, 64.2±7.7 years, 53% women), two large-scale population-based cohort studies. Volumes of hypothalamic structures were obtained from 3T structural magnetic resonance images through an automatic parcellation procedure (FastSurfer-HypVINN). The standardised cognitive domain scores were derived from extensive neuropsychological test batteries. We employed multivariable linear regression to assess associations of hypothalamic volumes with age, sex and cognitive performance. In older individuals, volumes of total, anterior and posterior hypothalamus, and mammillary bodies were smaller, while those of medial hypothalamus and tuberal region were larger. Larger medial hypothalamus volume was related to higher cortisol levels in older individuals, providing functional validation. Volumes of all hypothalamic structures were larger in men compared to women. In both sexes, larger volumes of total, anterior and posterior hypothalamus, and mammillary bodies were associated with better domain-specific cognitive performance, whereas larger volumes of medial hypothalamus and tuberal region were associated with worse domain-specific cognitive performance. We found strong age and sex effects on hypothalamic structures, as well as robust associations between these structures and domain-specific cognitive functions. Overall, these findings thus implicate specific hypothalamic subregions as potential therapeutic targets against age-associated cognitive decline. Institutional funds, Federal Ministry of Education and Research of Germany, Alzheimer's Association.

Brain tumor-related epilepsy: an overview on neuropsychological, behavioral, and quality of life issues and assessment methodology.

Brain tumor-related epilepsy (BTRE) is a rare disease in which brain tumor (BT) and epilepsy overlap simultaneously and can have a negative impact on a patient's neuropsychological, behavioral, and quality of life (QoL) spheres. In this review we (a) addressed the main neuropsychological, behavioral, and QoL issues that may occur in BTRE patients, (b) described how BT, BTRE, and their respective treatments can impact these domains, and (c) identified tools and standardized evaluation methodologies specific for BTRE patients. Neuropsychological disorders and behavioral issues can be direct consequences of BTRE and all related treatments, such as surgery, anti-cancer and anti-seizure medication, corticosteroids, etc., which can alter the structure of specific brain areas and networks, and by emotional aspects reactive to BTRE diagnosis, including the possible loss of autonomy, poor prognosis, and fear of death. Unfortunately, it seems there is a lack of uniformity in assessment methodologies, such as the administration of different batteries of neuropsychological tests, different times, frames, and purposes. Further research is needed to establish causality and deepen our understanding of the interplay between all these variables and our intervention in terms of diagnosis, treatment, psychosocial assessment, and their timing. We propose that the care of these patients to rely on the concepts of "BTRE-induced disability" and "biopsychosocial model" of BTRE, to prompt healthcare providers to handle and monitor BTRE-related psychological and social aspects, as to maintain the patient's best possible QoL.

Нейропсихологическое исследование когнитивных функций у подростков с сахарным диабетом 1 типа

Type 1 diabetes mellitus (DM1) is a complex disease, in the model of responsible attitude to the treatment of which it is important to take into account cognitive characteristics that determine the ability to take responsibility for treatment in order to achieve glycemic control. Cognitive impairments can affect the quality of patients' self-control: they can be the reason for skipping injections, incorrect calculation of bread units, the required dose of insulin etc. The purpose of this research was to establish the features of the cognitive status of adolescents with DM1 in comparison with healthy adolescents from the point of view of the neuropsychological approach being developed in Russian psychology. Methods used: a single-center cross-sectional study of 38 patients with DM1 (13 boys/25 girls) and 30 conditionally healthy children (20 boys/10 girls) aged 12 to 17 y/o was conducted. The study was conducted on the bases of the Endocrinology Department No. 1 of the Russian Children's Clinical Hospital with the Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia (Moscow, Russia) and General Education School No. 1321 “Kovcheg” (Moscow, Russia) in May-Nov. 2023. The method of medical documentation analysis coupled with the psychodiagnostics method (battery of neuropsychological tests by A.R. Luria with a quantitative assessment of the results according to J.M. Glozman (2012)) were used. The duration of the examination was 60 to 75 minutes. Results: in the group of adolescents with DM1 compared with adolescents in the control group there were deficits in the domains of thinking (p≤0.05), memory (p≤0.01), neurodynamic indicators of mental activity (p=0.001), regulation and control (p=0.026), manual praxis (p=0.030) and spatial representations (p=0.001). Conclusion: the study results showed the need for timely correctional psychological classes for children with DM1 aimed at improving their cognitive functions. In the future, such classes could lead to an improvement in the quality of implementing a responsible attitude to health, improving glycemic control and DM1 compensation in general as well as reducing the number of complications in future life.