Poor Verbal Fluency Research Articles

B - 11 Alien Limb and Corticobasal Degeneration: a Neuropsychological Case Study

Abstract Objective The patient presented with alien limb, frequently associated with corticobasal degeneration, an atypical parkinsonian syndrome with rigidity, akinesia, dystonia, cortical sensory deficit, and apraxia. Subjective memory complaints are also common. Neuropsychological performance typically includes poor performance on verbal fluency and measures tapping into executive functioning, but confrontation naming and verbal comprehension are initially well-preserved. Method The patient is a right-handed 69-year-old male who developed the sensation of alien limb in his left arm 2 years prior, in which his left hand did not feel “real.” Additionally, the patient presented with memory difficulties, mild word-finding problems, and physical/motor complaints (i.e., limb apraxia, tremor, bradykinesia, occasional limb dystonia, and postural instability) for approximately 2 years. The patient sought neuropsychological assessment to clarify his cognitive functioning in light of his neurologic symptoms. Results Premorbid functioning was in the exceptionally high range, with 18 years of education. Neuropsychologically, immediate memory was generally average, and generally low average delayed memory and recognition abilities. Mild inefficiencies were observed in executive functioning and semantic fluency. Otherwise, the patient performed generally average across other tasks of language, including confrontation naming, and attention. Conclusions In light of the literature, it is expected that corticobasal degeneration will be associated with subjective memory difficulties, executive dysfunction and poor verbal fluency. The patient presented with generally intact memory, mild executive dysfunction, and poor semantic fluency abilities. Given the patient’s high intelligence, he may be more sensitive to cognitive lapses. Neuropsychological results, along with his reported parkinsonian features, are fairly consistent with possible incipient corticobasal degeneration.

Association between oral health and cognitive impairment in older adults: Insights from a Six-year prospective cohort study

ObjectiveThis study aims to investigate the relationships between four baseline oral conditions (periodontal status, dental caries, tooth wear, and dentition) and repeated global cognition or domain-specific cognition (memory, executive function, attention, and verbal fluency) in non-demented older adults over time. MethodsThis prospective cohort study (2011–2019) enrolled 516 non-demented community-dwelling older adults (age ≥ 65) to explore the association between oral health and cognitive function. Global and domain-specific cognition were assessed biennially (four repeats) using a battery of neuropsychological tests. The baseline oral health conditions were examined, including periodontal status, dental caries, tooth wear, and dentition. The association of these oral conditions with cognition was evaluated by generalized linear mixed models. Stratified analyses were performed by important covariates. ResultsOver time, dental caries was associated with poor memory in two different logical memory tests (β^= -0.06 and β^= -0.04). Incomplete dentition with less than 28 teeth was associated with poor performance in attention (β^= -0.05) and verbal fluency (β^= -0.03). These associations became more evident in those with an elevated inflammatory marker (IL-6, β^= -0.11 to -0.08). In contrast, tooth wear was associated with better memory in two different logical memory tests (β^= 0.33 and β^= 0.36) and better executive function (β^= 0.06) over time, and this association became more evident in those with the lowest inflammatory marker (IL-6, β^= 0.10). ConclusionsDental caries and incomplete dentition were associated with poor memory, attention, and verbal fluency performance. Conversely, tooth wear was associated with better memory performance and executive function. Clinical SignificanceFor early prevention of dementia, an evaluation of multiple dental and periodontal status in older adults helps predict the risk of dementia in the preclinical phase. Maintaining intact tooth structure without caries progression and eventually tooth loss may help prevent the worsening of memory, attention, and verbal fluency over time.

Accelerometer-Measured Sedentary Behavior Patterns, Brain Structure, and Cognitive Function in Dementia-Free Older Adults: A Population-Based Study.

Sedentary behavior is associated with cognitive impairment, but the neuropathological mechanisms underlying their associations are poorly understood. To investigate the associations of accelerometer-measured sedentary behavior patterns with brain structure and cognition, and further to explore the potential mechanisms. This community-based study included 2,019 older adults (age≥60 years, 59% women) without dementia derived from participants in the baseline examination of MIND-China (2018-2020). We assessed sedentary parameters using an accelerometer and cognitive function using a neuropsychological test battery. Structural brain markers were assessed on the structural brain MRI scans in a subsample (n = 1,009). Data were analyzed using the general linear, isotemporal substitution, and mediation models. In the total sample (n = 2,019), adjusting for multiple covariates and moderate-to-vigorous-intensity physical activity, longer mean sedentary bout duration was linearly related with lower z-scores of global cognition, verbal fluency, and memory (ptrend < 0.05), whereas greater total sedentary time was linearly associated with lower z-scores of global cognition, verbal fluency, and memory only among individuals with long sedentary time (>10 h/day) (ptrend < 0.05); Breaking up sedentary time with same amount of light-intensity physical activity was significantly associated with higher verbal fluency and memory z-scores (p < 0.05). In the MRI subsample (n = 1,009), separately entering structural brain MRI markers into the mediation models substantially attenuated the associations of mean sedentary bout duration with global cognition, verbal fluency, and memory z-scores. Prolonged uninterrupted sedentary time is associated with poor global cognition, memory, and verbal fluency among rural older adults, and structural brain markers could partially mediate the association.

Sarcopenia using muscle mass prediction model and cognitive impairment: A longitudinal analysis from the English longitudinal study on ageing

BackgroundLiterature on the association between sarcopenia and cognitive impairment is largely unclear and mainly limited to non-European populations. Therefore, the aim of this study is to explore if the presence of sarcopenia at the baseline could increase the risk of cognitive impairment in a large cohort of older people participating to the English Longitudinal Study of Ageing (ELSA), over ten years of follow-up. MethodsSarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index at the baseline, using a muscle mass prediction model; cognitive function was evaluated in the ELSA through several tests. The results are reported in the whole sample adjusted for potential baseline confounders and after matching sarcopenic and non-sarcopenic participants with a propensity score. Results2738 people (mean age: 68.7 years, 54.4% males) were included. During the ten years of follow-up, sarcopenia was associated with significantly lower scores in memory (p < 0.001), verbal fluency (p < 0.001), immediate word recall (p <0.001), delayed word recall (p = 0.018), and in recall summary score (p < 0.001). After adjusting for eight potential confounders, the presence of sarcopenia was significantly associated with poor verbal fluency (odds ratio, OR= 1.417, 95% confidence intervals, CI= 1.181–1.700) and in propensity-score matched analyses (OR=1.272, 95%CI= 1.071- 1.511). Conclusions and implicationsSarcopenia was found to be associated with a significantly higher incidence of poor cognitive status in a large population of elderly people followed up for 10 years, suggesting it may be an important potential risk factor for dementia.

Slow information processing speed elucidates impairment in executive function tests in people with Multiple Sclerosis (P13-3.008)

<h3>Objective:</h3> Analyze the association between performance on speeded and nonspeeded tasks of executive functions (EFs) and slow information processing speed (IPS) in people with Multiple Sclerosis (PwMS). <h3>Background:</h3> IPS and EFs are impaired domains in PwMS. However, it is unclear if executive deficits can be explained by slow IPS. <h3>Design/Methods:</h3> 74 PwMS were included (RR=86.2%, PP=4.3%, SP=9.6%; 74% female; age: 46.12±12.48 years; Physical disability (EDSS): 3.60±2.57; disease duration: 14.85±10.69 years). Measures: IPS: Symbol Digit Modalities Test; EFs: Speeded task of cognitive flexibility (Verbal Fluency), nonspeeded task of cognitive flexibility (Brixton Spatial Anticipation Test), nonspeeded task of working memory (Verbal Backward Digit Span); Clinical variables: EDSS, Fatigue Severity Scale and Beck Depression Inventory-II. A probit regression was performed, the results are shown in predicted probabilities format. <h3>Results:</h3> 47% of PwMS have slow IPS. IPS was associated with EDSS and all EFs measures (<i>p</i>=0.00) and did not correlated with fatigue and depression (<i>p</i>&gt;0.05). For the regression model, IPS, EDSS and EFs tasks were analyzed. Brixton and backward span tests lost significance when physical disability was controlled. Finally, the regression model had verbal fluency (Coefficient:-.49;<i>p</i>=0.001) and physical disability (Coefficient:.21; <i>p</i>=0.02) as independent variables. R²28%. Prob.chi2=0.00. For the predicted probabilities, verbal fluency was divided into 4 groups, controlling physical disability, and it was found that the probability of having poor verbal fluency with poor IPS is very high in the 1st and 2nd groups (.89 and .68, lowest confidence interval 0.53) and the probability of having high verbal fluency and slow IPS is very low in the 3th and 4th groups (.38 and .14, highest confidence interval 0.50), with no overlapping confidence intervals. Correctly classified 72%. <h3>Conclusions:</h3> Impairments on speeded task of EFs can be associated with slow IPS. It is important to include speeded and unspeeded tasks in the assessment of EFs to capture the effective deficit. <b>Disclosure:</b> Maria Sol Román has nothing to disclose. Miss Bardoneschi has nothing to disclose. Ms. Gatti has nothing to disclose. Mrs. De Los Santos has nothing to disclose. Mr. Iglesias Passada has nothing to disclose. Miss Daniele has nothing to disclose. Maria Laura Saladino has nothing to disclose. Fernando Caceres has nothing to disclose. Sandra Vanotti has received research support from Merck S.A.,Buenos Aires, Argentina, an affiliate Merck S.A.,Buenos Aires, Argentina, an affiliate of Merck KGaA, Darmstadt, Germany Merck KGaA, Darmstadt, Germany.

Semantic fluency deficits and associated brain activity in Parkinson’s disease with mild cognitive impairment

People living with Parkinson’s disease (PD) with poor verbal fluency have an increased risk of developing dementia. This study examines the neural mechanisms underpinning semantic fluency deficits in patients with PD with mild cognitive impairment (PD-MCI) compared to those without MCI (PD-NC) and control participants without PD (non-PD). Thirty-seven (37) participants with PD completed a cognitive assessment battery to identify MCI (13 PD-MCI). Twenty sex- and age-matched non-PD patients also participated. Participants were scanned (3T Siemens PRISMA) while performing semantic fluency, semantic switching, and automatic speech tasks. The number of responses and fMRI data for semantic generation and semantic switching were analyzed. Participants also completed a series of verbal fluency tests outside the scanner, including letter fluency. Participants with PD-MCI performed significantly worse than PD-NC and non-PD participants during semantic fluency and semantic switching tasks. PD-MCI patients showed greater activity in the right angular gyrus than PD-NC and non-PD patients during semantic switching. Increased right angular activity correlated with worse verbal fluency performance outside the scanner. Our study showed that the PD-MCI group performed worse on semantic fluency than either the PD-NC or non-PD groups. Increased right angular gyrus activity in participants with PD-MCI during semantic switching suggests early compensatory mechanisms, predicting the risk of future dementia in PD.

Ambient air pollutants and indoor air quality are associated with cognitive impairment in older adults: A six‐year cohort study

AbstractBackgroundExposure to air pollutants have known to increase the risk of cognitive impairment. Some older adults spend a long time indoors. However, limited studies have evaluated the effect of time staying indoors on the association between exposure to ambient air pollutants and cognitive function in older adults.MethodThis cohort study is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research (2011‐present). A total of 605 older adults were recruited at baseline (2011‐2013) with three biennial follow‐ups, and 496 participants were included after exclusion. The data of six air pollutants including sulphur dioxide, nitrogen dioxide, particulate matter in diameter ≤ 2.5µm (PM2.5) and 2.5‐10µm (PMcoarse), carbon monoxide, and ozone were obtained from 26 monitor stations of Taiwan Environmental Protection Administration (TEPA) between 1993 and 2019. Spatial‐Time Analysis Rendering with Bayesian Maximum Entropy was utilized to estimate the individual air pollutants’ exposure. Hours staying indoors were collected across four seasons. Generalized linear mixed model was utilized to explore the association between long‐term exposure to air pollutants and global or domain‐specific cognitive function (memory, attention, executive function, and language) over 6 years adjusted for some covariates. Stratified analyses were performed by median hours staying indoors every day.ResultThe mean age of the study participants were 72.4 years at baseline. PM2.5 was the only pollutant with a 14‐year average level (29.0 µm/m3) higher than the TEPA air quality standards. An interquartile range (IQR) increase in PM2.5 was associated with poor global cognition (β=‐0.19) and executive function (β=‐0.08), and the former effect became more evident in those with hours staying indoors &lt; 13 hours/day (β=‐0.31). An IQR increase in PMcoarse was associated with poor global cognition (β=‐0.21) and verbal fluency (β=‐0.10), which became more evident in those stayed indoors ≥13 hours/day (β=‐0.32 and ‐0.13, respectively). Exposure to PMcoarse was associated with poor attention (β=‐0.15). No significant association was observed between other air pollutants and the performance of logical memory.ConclusionLong‐term exposure to PM2.5 or PMcoarse showed detrimental effect on cognitive function in community‐dwelling older adults and indoor air quality may play a role on these associations.

Cognitive predictors of longitudinal positive symptom course in clinical high risk for psychosis

BackgroundClinical High Risk (CHS) for psychosis is a state in which positive symptoms are predominant but do not reach a level of severity that fulfils the criteria for a psychotic episode. The aim of this study has been to investigate whether cognition in subjects with newly detected CHR affects the longitudinal development of positive symptoms. MethodsFifty-three CHR individuals fulfilling the criteria for attenuated positive syndrome in the Structural Interview for Prodromal Syndromes (SIPS) were included. At inclusion, all participants completed a neurocognitive battery consisting of tests measuring attention, verbal memory, verbal fluency, executive functions and general intelligence. Cognitive domain z-scores were defined by contrasting with observed scores of a group of matched healthy controls (n = 40). Associations between cognitive performance at inclusion and longitudinal measures of positive symptoms were assessed by using generalised linear models including non-linear effects of time. All regression models were adjusted for age and gender. ResultsOverall, SIPS positive symptoms declined over the time period, with a steeper decline during the first six months. Deficits in executive functions were assossiated witn a higher load of positive symptoms at baseline (p=0.006), but also to a faster improvement (p=0.030), wheras those with poor verbal fluency improved more slowly (p=0.018). ConclusionTo our knowledge, this is the first study that follows CHR subjects by means of frequent clinical interviews over a sustained period of time. The study provides evidence of an association between executive functions, including verbal fluency, with the evolvement of positive symptoms.

Psychological pain and depression: it’s hard to speak when it hurts

Objective To investigate the neuropsychological features of depressed patients reporting high level of psychological pain. Methods Sixty-two inpatients were included and divided into two groups according to the level of psychological pain assessed by a Likert scale. Cognitive abilities were assessed using the Trail Making Test, the Stroop test, and Verbal Fluency Test (semantic and phonemic verbal fluency). Univariate and multivariate analyses were performed to determine neuropsychological factors associated with a high level of psychological pain. Results The median level of psychological pain was 8/10. High level of psychological pain was associated with poor phonemic verbal fluency performance in men (p = 0.009), but not in women, even after controlling for confounding factors (age, level of depression, anxiety). Groups did not differ on the Trail Making Test, the Stroop test, or the semantic verbal fluency measure. Conclusion Psychological pain is a specific clinical entity that should be considered to be more significant than just a symptom of depression. High level of psychological pain appears to be associated with a deficit of phonemic verbal fluency in depressed men. This finding could help to target psychotherapeutic treatments and improve screening. Key points Patients with high psychological pain do not differ on the Trail Making Test, the Stroop Test or the Sematic Verbal Fluency Measure to patients with low psychological pain High psychological pain is associated with a deficit in phonemic verbal fluency in depressed men Future research should aim to clarify gender differences in psychological pain in participants with and without major depressive disorder, as well as explore the complex relationship between cognition and the different forms of pain (psychological, physical and psychosomatic)

Long-Term Exposure to Air Pollutants and Cognitive Function in Taiwanese Community-Dwelling Older Adults: AFour-Year Cohort Study.

Previous studies have assessed limited cognitive domains with relatively short exposure to air pollutants, and studies in Asia are limited. This study aims to explore the association between long-term exposure to air pollutants and cognition in community-dwelling older adults. This four-year prospective cohort study recruited 605 older adults at baseline (2011-2013) and 360 participants remained at four-year follow-up. Global and domain-specific cognition were assessed biennially. Data on PM2.5 (particulate matter≤2.5μm diameter, 2005-2015), PM10 (1993-2015), and nitrogen dioxide (NO2, 1993-2015) were obtained from Taiwan Environmental Protection Administration (TEPA). Bayesian Maximum Entropy was utilized to estimate the spatiotemporal distribution of levels of these pollutants. Exposure to high-level PM2.5 (>29.98μg/m3) was associated with an increased risk of global cognitive impairment (adjusted odds ratio = 4.56; β= -0.60). High-level PMcoarse exposure (>26.50μg/m3) was associated with poor verbal fluency (β= -0.19). High-level PM10 exposure (>51.20μg/m3) was associated with poor executive function (β= -0.24). Medium-level NO2 exposure (>28.62 ppb) was associated with better verbal fluency (β= 0.12). Co-exposure to high concentrations of PM2.5, PMcoarse or PM10 and high concentration of NO2 were associated with poor verbal fluency (PM2.5 and NO2: β= -0.17; PMcoarse and NO2: β= -0.23; PM10 and NO2: β= -0.21) and poor executive function (PM10 and NO2: β= -0.16). These associations became more evident in women, apolipoprotein ɛ4 non-carriers, and those with education > 12 years. Long-term exposure to PM2.5 (higher than TEPA guidelines), PM10 (lower than TEPA guidelines) or co-exposure to PMx and NO2 were associated with poor global, verbal fluency, and executive function over 4 years.

Performance on Daily Life Activities and Executive Functioning in Parkinson Disease

Purpose: This study aimed to know the impact of executive functions on the performance of instrumental activities of daily living in Parkinson disease (PD). Methods: A cross-sectional descriptive study was conducted with 94 participants (64 PD and 30 controls). Results: The poor inhibitory control and verbal fluency in PD could be related to their performance on instrumental activities of daily living as poorer executive performance directly influences the motor and process skills needed to perform instrumental activities of daily living. Conclusion: Our results suggest that rehabilitation activities for these executive tasks could be of interest for the performance of PD patients.

Association of baseline semantic fluency and progression to mild cognitive impairment in middle-aged men.

To test the hypothesis that individual differences in episodic memory and verbal fluency in cognitively normal middle-aged adults will predict progression to amnestic mild cognitive impairment (MCI) after 6 years. The cohort analyzed included 842 male twins who were cognitively normal at baseline (mean 56 years) and completed measures of episodic memory and verbal fluency at baseline and again 6 years later (mean 62 years). Poor episodic memory predicted progression to both amnestic MCI (odds ratio [OR], 4.42; 95% confidence interval [CI], 2.44-10.60) and nonamnestic MCI (OR, 1.92; 95% CI, 1.32-3.44). Poor semantic verbal fluency also independently predicted progression to amnestic MCI (OR, 1.86; 95% CI, 1.12-3.52). In the full sample, a semantic-specific fluency latent variable at wave 1 (which controls for letter fluency) predicted change in episodic memory at wave 2 (β = 0.13), but not vice versa (β = 0.04). Associations between episodic memory and verbal fluency factors were primarily explained by genetic, rather than environmental, correlations. Among individuals who were cognitively normal at wave 1, episodic memory moderately to strongly predicted progression to MCI at average age 62, emphasizing the fact that there is still meaningful variability even among cognitively normal individuals. Episodic memory, which is typically a primary focus for Alzheimer disease (AD) risk, declined earlier and more quickly than fluency. However, semantic fluency at average age 56 predicted 6-year change in memory as well as progression to amnestic MCI even after accounting for baseline memory performance. These findings emphasize the utility of memory and fluency measures in early identification of AD risk.

Impacts of Kidney Dysfunction and Cerebral Cortical Thinning on Cognitive Change in Elderly Population.

Cerebral cortical thickness is a neuroimaging biomarker to predict cognitive decline, and kidney dysfunction (KD) is associated with cortical thinning. This study aimed to investigate the effects of KD and cortical thinning on cognitive change in a prospective cohort study. A total of 244 non-demented participants were recruited from elderly health checkup program and received cognitive exams including Montreal Cognitive Assessment (MoCA) and different cognitive domains at baseline and three biannual follow-ups afterwards. KD was defined as having either glomerular filtration rate <60 ml/min/1.73 m2 or proteinuria. Cortical thickness of global, lobar, and Alzheimer's disease (AD) signature area were derived from magnetic resonance imaging at baseline, and cortical thinning was defined as the lowest tertile of cortical thickness. Generalized linear mixed models were applied to evaluate the effects of KD and cortical thinning on cognitive changes. KD was significantly associated with the decline in attention function (β= -0.29). Thinning of global (β= -0.06), AD signature area (β= -0.06), temporal (β= -0.06), and parietal lobes (β= -0.06) predicted poor verbal fluency over time, while temporal lobe thinning also predicted poor MoCA score (β= -0.19). KD modified the relationship between thinning of global, frontal, and limbic, and change of logical memory function (pinteraction < 0.05). When considering jointly, participants with both KD and cortical thinning had greatest decline in attention function compared with those without KD or cortical thinning (β= -0.51, ptrend = 0.008). KD and cortical thinning have joint effect on cognitive decline, especially the attention function. Reverse associations may exist between cortical thinning and memory function in participants with KD, though the results should be interpreted cautiously as an exploratory analysis.

B-71 The Effect of Bilingualism on Verbal and Design Fluency Performance in Traumatic Brain Injury Survivors and Healthy Adults

Abstract Objective Traumatic brain injury (TBI) impacts neurocognitive function. Language is also known to influence test performances. We examined the relationship between TBI and monolingualism/bilingualism on verbal and design fluency tests. Method The sample (N = 74) consisted of 33 healthy controls (18 bilingual; 15 monolingual), 15 acute TBI participants (6 bilingual; 9 monolingual), and 26 chronic TBI participants (15 bilingual; 11 monolingual). Acute TBI participants were tested 6 months post-injury and chronic TBI participants were tested 12 months or more post-injury. The Delis-Kaplan Executive Function System Letter Fluency (DKEFS-LF), Category Fluency (DKEFS-CF), Category Switching Fluency (DKEFS-CSF), and global verbal fluency composite (DKEFS-GVF) scores assessed verbal fluency; DKEFS fill-dots (DKEFS-FD), empty dots (DFEFS-ED), dot switching (DKEFS-DS), and global design fluency composite (DKEFS-GDF) scores assessed design fluency; and global verbal and non-verbal fluency composite (DKEFS-GF) assessed overall fluency. 3X2 ANOVAs were conducted to evaluate the effect of monolingualism/bilingualism on fluency performance in TBI and controls. Results The groups (control and TBI groups) differed for DKEFS-LF, p = .048, ηp² = .09, DKEFS-CF, p = .000, ηp² = .21, DKEFS-GVF, p = .004, ηp² = .15, DKEFS-ED, p = .008, ηp² = .13, DKEFS-GF, p = .001, ηp² = .20, with controls outperforming TBI groups on the DKEFS-CF, DKEFS-GVF, and DKEFS-GF. Furthermore, controls outperformed acute TBI participants on the DKEFS-LF and DKEFS-ED. Main effects were found for bilingualism/monolingualism on DKEFS-CF, p = .035, ηp² = .06, with bilinguals outperforming monolinguals. No interactions were found. Conclusion The TBI group had poor verbal and design fluency in contrast controls. Unexpectedly, bilinguals outperformed monolinguals on a task of verbal category fluency. Revealing that in the present study bilinguals have better semantic verbal fluency abilities.

Factors Associated with Having a Will, Power of Attorney, and Advanced Healthcare Directive in Patients Presenting to a Rural and Remote Memory Clinic.

A Will, Power of Attorney, and Advanced Healthcare Directive are critical to guide decision-making in patients with dementia. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). Ninety-five consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they had legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. Seventy (73.7%) patients had a Will, 62 (65.3%) had a Power of Attorney, and 21 (22.1%) had an Advanced Healthcare Directive. Having a Will was associated with good quality of life (p = 0.001), living alone or with a spouse or partner only (p = 0.034), poor verbal fluency (p = 0.055), and European ethnicity (p = 0.028). Factors associated with having a Power of Attorney included good quality of life (p = 0.031), living alone or with a spouse or partner only (p = 0.053), and poor verbal fluency (p = 0.015). Old age (p = 0.015), poor verbal fluency (p = 0.023), and greater severity of cognitive and functional impairment (p = 0.023) were associated with having an Advanced Healthcare Directive. Our results indicate that poor quality of life, good performance on verbal fluency, Indigenous ethnicity, and living with others are associated with a lower likelihood of legal documents in patients with dementia. These factors can help physicians identify patients at risk of leaving their legal affairs unattended to. Physicians should discuss the creation of legal documents early on in patients with signs of dementia.

Subacute Subdural Hematoma Presenting as Non-Fluent Aphasia

We present the case of a 69-year-old male, alcohol consumer, who was brought in by the ambulance for language impairment with onset two days prior to presentation in our hospital. Medical history revealed therapeutically neglected gout and colchicine allergy. On neurological exam, the patient presented predominantly motor aphasia with poor verbal fluency and anomic elements, mild right-sided hemiparesis 4/5 MRC and right-sided Babinski sign. Still, he was conscious and cooperative, and denied any recent head trauma or headache. Based on clinical picture, an acute cerebrovascular event was suspected, and the patient was hospitalized. However, brain CT revealed a late subacute subdural hematoma in the left hemisphere, with maximum thickness of 20 mm and displacement of median structures by 12 mm to the right (subfalcine herniation). The patient was then rapidly transferred to a Neurosurgical department for appropriate treatment and care.

Cortical volume and 40-Hz auditory-steady-state responses in patients with schizophrenia and healthy controls.

BackgroundAbnormalities in the 40-Hz auditory steady-state response (ASSR) of the gamma range have been reported in schizophrenia (SZ) and are regarded as important pathophysiological features. Many of the previous studies reported diminished gamma oscillations in SZ, although some studies reported increased spontaneous gamma oscillations. Furthermore, brain morphological correlates of the gamma band ASSR deficits have rarely examined. We investigated different measures of the 40-Hz ASSR and their association with brain volumes and psychological measures of SZ.MethodsThe 40-Hz ASSR was measured for 80 dB click sounds (1 ms, 500-ms trains at 40-Hz, with 3050 to 3500 inter-train interval) using electroencephalography with 64 electrodes in 33 patients with SZ (male: 16, female: 17 (age range: 21–60)) and 30 healthy controls (HCs) (male: 13, female: 17 (age range: 23–64)). Four gamma oscillation measures (evoked power, spontaneous oscillations (baseline and total power), and inter-trial phase coherence (ITC)) were assessed. The source activities of the ASSR were also analyzed. Brain volumes were assessed using high-resolution magnetic resonance imaging and voxel-based morphometry and superior temporal gyrus (STG) volume measures were obtained.ResultsPatients with SZ had larger total and evoked powers and higher ITC than HCs. Both groups showed significantly different association between mean evoked power and right STG volume. In HCs but not SZ, mean evoked power showed significant positive correlation with right STG volume. In addition, the two groups showed significantly different association between verbal fluency and mean evoked power. High evoked power was significantly correlated with poor verbal fluency in SZ.ConclusionsThe current study found increased gamma oscillation in SZ and suggests significant involvement of the STG in gamma oscillations.

P.001 Factors associated with having a will, power of attorney and advanced healthcare directive in patients presenting to a rural and remote memory clinic

Background: A will, power of attorney and advanced healthcare directive are critical to guide decision-making in people with cognitive decline. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). Methods: 95 consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they have legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. Results: 70 patients had a will, 62 had a power of attorney and 21 had an advanced healthcare directive. Having a will was associated with good quality of life (p=0.001), living alone (p=0.034), poor verbal fluency (p=0.055) and European ethnicity (p=0.028). Factors associated with having a power of attorney included good quality of life (p=0.031), living alone (p=0.053) and poor verbal fluency (p=0.015). Old age (p=0.015), poor verbal fluency (p=0.023) and severity of cognitive and functional impairment (p=0.023) were associated with having an advanced healthcare directive. Conclusions: Our results indicate that poor quality of life, good verbal fluency, non-European ethnicity and living with others are associated with a lower likelihood of creating legal documents in patients with cognitive decline

The impact of severity, course and duration of depression on olfactory function

BackgroundPeople with diagnosed depression often express a reduced olfactory capacity, although previous studies exhibited mixed results. However, research focused mainly on psychiatric inpatients and potential influence variables were rarely considered. We therefore examined the influence of severity, course and duration of depression on olfactory function. Methods101 out-patients with depressive disorders (mean age = 37.8y, SD = 12.6y; 64 women) underwent a detailed medical anamnesis, tests of olfactory threshold and identification and tests of cognitive function. The participants were grouped according to their severity, course and duration of depression. ResultsWhile severity of depressive symptoms did not affect olfactory function, course and duration of depression did. Recurrent depressive disorders were associated with reduced odor identification, and the duration of disease was negatively related to odor threshold. Those results were partly explained by reported frequent colds, which were more prevalent among long lasting depressive patients, and by poor verbal fluency, which was more frequent among recurrent depression. LimitationsThe interpretation is limited by the cross-sectional research design that does not allow causal interpretation, and by the assessment of medical history which was based on patients´ reports. ConclusionsOur results support the idea that depression is not uniformly related to olfactory impairment, but depends on duration and course of depression. The results generate the hypothesis that reduced olfactory identification is caused by cognitive impairment in recurrent depression. Moreover, the relation between olfactory threshold and depression might be partially caused by a cumulative damage of the olfactory epithelium after frequent respiratory diseases.

Lower Activation in Frontal Cortex and Posterior Cingulate Cortex Observed during Sex Determination Test in Early-Stage Dementia of the Alzheimer Type.

Face-labeling refers to the ability to classify faces into social categories. This plays a critical role in human interaction as it serves to define concepts of socially acceptable interpersonal behavior. The purpose of the current study was to characterize, what, if any, impairments in face-labeling are detectable in participants with early-stage clinically diagnosed dementia of the Alzheimer type (CDDAT) through the use of the sex determination test (SDT). In the current study, four (1 female, 3 males) CDDAT and nine (4 females, 5 males) age-matched neurotypicals (NT) completed the SDT using chimeric faces while undergoing BOLD fMRI. It was expected that CDDAT participants would have poor verbal fluency, which would correspond to poor performance on the SDT. This could be explained by decreased activation and connectivity patterns within the fusiform face area (FFA) and anterior cingulate cortex (ACC). DTI was also performed to test the association of pathological deterioration of connectivity in the uncinate fasciculus (UF) and verbally-mediated performance. CDDAT showed lower verbal fluency test (VFT) performance, but VFT was not significantly correlated to SDT and no significant difference was seen between CDDAT and NT for SDT performance as half of the CDDAT performed substantially worse than NT while the other half performed similarly. BOLD fMRI of SDT displayed differences in the left superior frontal gyrus and posterior cingulate cortex (PCC), but not the FFA or ACC. Furthermore, although DTI showed deterioration of the right inferior and superior longitudinal fasciculi, as well as the PCC, it did not demonstrate significant deterioration of UF tracts. Taken together, early-stage CDDAT may represent a common emerging point for the loss of face labeling ability.