Psychomotor Performance In Patients Research Articles

Psychomotor Performance in Patients with Obstructive Sleep Apnea Syndrome.

PurposeDeterminants of obstructive sleep apnea (OSA) are hypoxemia and hypercapnia, as well as (micro) arousals from sleep, resulting in chronic sleep fragmentation, sleep deprivation, and excessive daytime sleepiness (EDS). All of the above-mentioned factors might contribute to psychomotor impairment seen in OSA patients. Additionally, this study aimed to assess the contribution of BMI, age, EDS assessed with Epworth sleepiness scale (ESS), and severity of OSA assessed with apnea-hypopnea index (AHI) to the reaction time on chronometric tests in OSA patients and controls. It is hypothesized that moderate and severe OSA have adverse effects on reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination assessed by chronometric psychodiagnostic test battery.Patients and MethodsThis study was conducted on 206 male participants; 103 of them had moderate or severe OSA diagnosed by whole-night polysomnography/polygraphy. Control participants (N=103), matched to patients with OSA by age and BMI, had no reported OSA in their medical history, no increased risk for OSA, nor EDS. All participants were assessed with three chronometric psychodiagnostic tests, measuring the reaction time of perception to visual stimulus, of solving simple arithmetic operations, and of psychomotor limbs coordination.ResultsParticipants from the OSA group achieved impaired results compared to control participants in minimum single task solving time in speed of solving simple arithmetic operations (3±0.9 and 2.6±0.6, P<0.001), and in minimum solving time of a single task in complex psychomotor limbs coordination (0.69±0.2 and 0.61±0.1, P=0.007). Regression analysis revealed no significant contribution of daytime sleepiness to the results achieved in each of the tests.ConclusionIt is concluded that severe OSA impaired speed of perception, convergent, and operative thinking. Moreover, it is suggested that EDS did not contribute to poor psychomotor outcome in patients with OSA in this study, when age was controlled for.

Evaluation of psychomotor performance in patients with obstructive sleep apnea syndrome

Evaluation of psychomotor performance in patients with obstructive sleep apnea syndrome

Impaired neurocognitive and psychomotor performance in patients with inflammatory bowel disease

Limited evidence exists regarding cognitive and psychomotor function in patients with inflammatory bowel disease (IBD). Therefore, we aimed to compare the neurocognitive and psychomotor function of 60 IBD patients with 60 age/sex-matched controls. Computer-based instrument Complex Reactinometer Drenovac (CRD) was used for assessment of cognitive domains: convergent thinking (simple mathematical tasks; CRD-11), perceptive abilities (light signal position discrimination; CRD-311) and sophisticated operative thinking (complex psychomotor coordination; CRD-411). The most important analyzed parameters were total test solving time (TTTS); minimal time of particular test solving (TMIN) and total number of wrong reactions (NER). Performance in all three cognitive tests showed statistically significantly longer TTTS and TMIN in IBD patients (P < 0.05), while there was no significant difference in NER. Aforementioned findings were adjusted for BMI, age and duration of education. Our study has shown impaired neurocognitive and psychomotor function in IBD patients compared to controls, especially in mental processing speed and mental endurance of perceptive abilities, convergent thinking and complex operative thinking.

A comparative study of effect of sodium valproate &amp; flunarizine on psychomotor performance in patients of common migraine: A randomized, parallel, open label, prospective observational study

Introduction: Psychomotor performance results from the coordination of sensory and motor system through the integrative and organizational process of brain and central nervous system. Psychotropic drugs may adversely affect work performance which depends on psychomotor activities. Both valproate and flunarizine are widely used drugs in prophylaxis of migraine and they are known to have effect on psychomotor performance. Hence this study was carried out to evaluate the effect of valproate & flunarizine on psychomotor performance in patients of migraine with the help of battery of subjective & objective psychomotor tests over a period of 8 weeks. Materials and Methods: Patients were allocated to one of the two groups on first day of examination. Baseline psychomotor tests were measured using battery of tests including critical flicker fusion test (CFFT), hand steadiness test (HST), arithmetic ability test & reaction time monitoring. At the end of 4 weeks & 8 weeks, again tests using same methods employed previously were performed. Efficacy was calculated by using Migraine dairy template (0, 4, 8 weeks) & CGI Scale (end). A total of 44 patients were recruited with 22 patients in each arm. Results: Flunarizine (n=20) & valproate (n=20) significantly increased CFFT, AAT scores at the end of 8 weeks compared to baseline and significantly reduced HST, RT, Frequency, Duration and severity at the end of 8 weeks compared to baseline. When flunarizine was compared to valproate no statistical significance was found in scores of CFFT, AAT, HST, RT, Frequency, duration, severity, global improvement and efficacy index. Conclusion: Flunarizine & Valproate were found to be equally efficacious to improve psychomotor performance. Keywords: Sodium valproate, Flunarizine, Psychomotor, Migraine, Prophylaxis, Performance.

Effect of buprenorphine on psychomotor functions in patients on buprenorphine maintenance

Patients on buprenorphine maintenance for opioid dependence often abuse its additional doses over and above the maintenance dose. Being a psychoactive agent, it may affect psychomotor performance with all its consequences, for example, effect on quality of life. This study was conducted to assess the effects of its additional doses on psychomotor performance in patients who are maintained on it. This was an interventional study, carried out in an in-patient setting in a tertiary care national drug dependence treatment center. It included 19 subjects maintained on buprenorphine, 4 mg/d (s/L) for at least a month. Maintenance dose was followed by three administrations of buprenorphine, 2 mg, at two hourly intervals (cumulative dose design). Subjects were assessed on digit symbol substitution test, trail making, digit span, and delayed recall, after each administration and the next morning. Performance of subjects on Digit Symbol Substitution Test (chi2 = 52.98, p < 0.000) and Trail Making Test-A (chi2 = 26.29, p < 0.000) and B (chi2 = 42.08, p < 0.000) improved significantly with each assessment while other tests were unaffected. Improvement in psychomotor performance (which could be true effect of drug itself or a result of other factors, eg, inadequate maintenance dose or practice effect) though contrasting with some of the earlier findings, does have significant clinical implications regarding the long-term use of buprenorphine. It would be worthwhile repeating this type of study in a placebo controlled design to further verify the results.

The long-term effects of mandibular advancement splint on cardiovascular fitness and psychomotor performance in patients with mild to moderate obstructive sleep apnea: a prospective study.

Obstructive sleep apnea (OSA) manifests as a reduction or complete cessation of airflow despite an ongoing inspiratory effort, leading to hypoxemia and hypercapnia. The inability to maintain normal breathing reduces the oxygen saturation in blood leading to a cycle of various systemic implications. Hence, a prospective single arm study was planned to evaluate the long-term (2years) effect of oral appliance on cardiovascular fitness and psychomotor performance in patients with mild to moderate obstructive sleep apnea. Thirty dentulous OSA patients (25 males; 5 females; age 41±4years; BMI 22±5; AHI 5-30) were included in the study. All the patients were assessed for systolic blood pressure (SBP), diastolic blood pressure (DBP), apnea/hypopnea index (AHI), lipid peroxidation, and psychomotor vigilance test at baseline, 6months, 1year, and 2years after wearing mandibular advancement splint (MAS). A significant reduction in AHI, blood pressure, and lipid peroxidation was observed following MAS use. Psychomotor vigilance test showed marked improvement in response time with almost 0 count of lapses after 2years of MAS use. The present study suggested that MAS can be helpful in improving cardiovascular fitness and cognitive response in patients with mild to moderate OSA.

Improvement of Cognitive and Psychomotor Performance in Patients with Mild to Moderate Obstructive Sleep Apnea Treated with Mandibular Advancement Device: A Prospective 1-Year Study.

This study aimed to provide the evidence on effect of mandibular advancement device (MAD) therapy on long-term cognitive and psychomotor performance, excessive daytime sleepiness, and quality of life in patients with mild to moderate obstructive sleep apnea (OSA). A total of 15 patients with mild to moderate OSA were treated with MAD therapy and they were followed up after 3 mo and 1 y of therapy. The patients were tested on three different tests of cognitive and psychomotor performance using the computer-based system Complex Reactionmeter Drenovac (CRD-series) at baseline and at the time of follow-up, and the 36-Item Short Form Health Survey (SF-36) questionnaire and Epworth Sleepiness Scale were used to assess their quality of life and excessive daytime sleepiness, respectively. The mean apnea-hypopnea index (AHI) decreased significantly from 22.9 ± 5.9 events/h at baseline, to 9.7 ± 4.5 events/h after 1 y of MAD therapy (p < 0.001). There was significant improvement on all three CRD-series tests used after 1 y of MAD therapy, considering total test solving time (TTST) and minimal single task solving time (MinT), whereas total number of errors committed during the tests (TE) remained unchanged. Self-reported measures, excessive daytime sleepiness, and three domains of quality of life, social functioning, general health perception, and health change following MAD therapy showed significant improvements after 1 y of MAD therapy. This study demonstrates significant improvements in cognitive and psychomotor performance, particularly in the domain of perceptive abilities, convergent thinking (constructing and solving simple mathematical tasks) and psychomotor reaction times, excessive daytime sleepiness, and quality of life in patients with mild to moderate OSA following MAD therapy.

Immediate effect of mind sound resonance technique on state anxiety and cognitive functions in patients suffering from generalized anxiety disorder: A self-controlled pilot study.

Objectives:To compare the immediate effect of mind sound resonance technique (MSRT) with supine rest (SR) on state anxiety and psychomotor performance in 15 (eight male and seven female) right-handed generalized anxiety disorder patients (GAD) with an age range of 34.8 ± 12.8 years.Materials and Methods:Self as control design was followed. Diagnosis of GAD was made by a psychiatrist using sections of the Mini International Neuropsychiatric Interview (MINI). Participants practiced MSRT or SR (as control intervention) for 30 min at the same time for two consecutive days. The sequence of intervention was assigned randomly to the participants. State anxiety was assessed using state trait anxiety inventory (STAI; Form X1). Digit letter substitution task (DLST) was used to assess psychomotor performance, which involves visual scanning, mental flexibility, sustained attention, psychomotor speed and speed of information processing. Intervention was given in a quiet dark room on an empty stomach. Subjects received a training of MSRT and SR for 1 week before the data were taken. A pre-recorded audiotape was used to administer the technique of MSRT. Difference in scores after baseline and intervention was used to check normality, and was found to be normally distributed by the Kolmogrov–Smirnov test. The changes in STAI, DLST and difference in scores before and after two interventions (MSRT and SR) were compared using the paired samples t test.Results:As compared with baseline, STAI scores reduced and DLST scores increased significantly (STAI; P < 0.01; DLST; P < 0.01) after MSRT. After SR, there was a significant reduction in STAI scores from baseline (STAI; P < 0.05), but there was no significant change in the DLST scores (P = 0.26). Comparison of the difference in scores for DLST and STAI before and after the two interventions (MSRT and SR) showed a significantly higher score for DLST (P < 0.05) and a significantly lower score for STAI (P < 0.01) for MSRT as compared with SR.Conclusion:This pilot study suggests that MSRT may have a potential role in reducing state anxiety and enhancing psychomotor performance in patients suffering from GAD immediately after the practice. These findings need confirmation from studies with a larger sample size and randomized controlled design, which are implicated in the future.

Assessing Cognitive and Psychomotor Performance in Patients with Fibromyalgia Syndrome.

IntroductionPatients with fibromyalgia syndrome (FMS) generally present with chronic widespread pain, accompanied by a range of additional and non-specific symptoms, such as fatigue, disturbed sleep, and cognitive dysfunction, which tend to increase with overall severity. Previous studies have shown moderate cognitive impairment in patients with FMS, but there are few valid data explicitly assessing the relevance of these findings to everyday functions, such as driving ability. Therefore, we studied patients with FMS to assess the impact of FMS on tests that predict driving ability.MethodsFemale patients with FMS were prospectively compared to a historical control group of healthy volunteers. The test battery comprised assessments of visual orientation, concentration, attention, vigilance, motor coordination, performance under stress, and reaction time.ResultsA total of 43 patients were matched to 129 controls. The results indicated that the patients’ psychomotor and cognitive performances were significantly non-inferior when compared to healthy controls (with 0.05% alcohol), with the exception of motor coordination. Patients and healthy controls showed an age-related decline in test performance. Correlations were smaller in patients and reversed for vigilance which was linked to a greater FMS symptom load in younger patients.ConclusionThe results of the present study demonstrate that, in general, the driving ability of patients with FMS was not inferior to that of healthy volunteers based on a standardized computer-based test battery. However, variables, such as younger age, depression, anxiety, fatigue, pain, and poor motor coordination, likely contribute to the subjective perception of cognitive dysfunction in FMS.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-014-0028-0) contains supplementary material, which is available to authorized users.

P-53 - The effect of administration of a single methadone dose on psychomotor performance in patients addicted to opioids during substitution therapy

Objective The aim of the study is to assess graphomotor and psychomotor skills of people treated with substitution therapy in opiate addiction. Methods 36 patients were examined twice, immediately before and about 1.5h after oral administration of therapeutic dose of methadone. The original test implemented on a tablet was used. A task in the first part was to map, as accurately as possible, geometric shapes printed on the sheet of paper by drawing on contour, and in the second part to sign up on the sheet. The patients used dominant hand. The software used allows to make analysis of the motion's parameters: time, force levels, speed and acceleration of the plot, amplitude and frequency of hand tremors. Results The amplitude of tremors in the spectrum of variations in 13 of the 16 components analyzed in the drawing task and all the components in the spectrum of the instantaneous velocity tremors were reduced. In the signature task a significant reduction in the average amplitude of tremors for medium and higher spectral components (from the 4 th up) and a reduction in the amplitude of tremors in the spectrum of instantaneous velocity for most precisely analyzed components was observed. Conclusion A single dose of methadone in opioid-addicted individuals reduces dominant hand tremors, particularly in the 1 st spectrum component frequency for the drawing test. This indicates improvement in graphomotor and psychomotor function.

Comparing Two Measures of Psychomotor Performance in Patients With HIV: The Coin Rotation Test and the Modified HIV Dementia Screen

Psychomotor slowing is an early symptom of HIV-associated dementia. The Modified HIV Dementia Scale (MHDS) is a fast, reliable measure of HIV-associated dementia. However, literacy may influence the psychomotor speed subscale (MHDS-PS). Psychomotor speed might be more accurately assessed using the Coin Rotation Test (CRT). This study examined the CRT's validity in assessing psychomotor speed in HIV+ patients by comparing it with the MHDS-PS. We also investigated whether demographic, education, or HIV-related variables were associated with either measure. The sample consisted of 204 HIV+ patients at a community health clinic. All participants completed the MHDS and CRT as part of admission to the clinic. Demographic, education, and disease data were also obtained. Correlations revealed good convergent validity between the CRT and MHDS-PS. Gender did not significantly affect CRT performance but did affect MHDS-PS performance. CRT performance was less affected by education than MHDS-PS performance. The CRT is a valid measure of psychomotor speed in HIV+ patients and may be more accurate than the MHDS-PS, particularly in individuals with lower levels of education.

The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia

Objectives of this study were to investigate the effects of prolonged-release melatonin 2 mg (PRM) on sleep and subsequent daytime psychomotor performance in patients aged > or =55 years with primary insomnia, as defined by fourth revision of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Patients (N = 40) were treated nightly single-blind with placebo (2 weeks), randomized double-blind to PRM or placebo (3 weeks) followed by withdrawal period (3 weeks). Sleep was assessed by polysomnography, all-night sleep electroencephalography spectral analysis and questionnaires. Psychomotor performance was assessed by the Leeds Psychomotor Test battery. By the end of the double-blind treatment, the PRM group had significantly shorter sleep onset latency (9 min; P = 0.02) compared with the placebo group and scored significantly better in the Critical Flicker Fusion Test (P = 0.008) without negatively affecting sleep structure and architecture. Half of the patients reported substantial improvement in sleep quality at home with PRM compared with 15% with placebo (P = 0.018). No rebound effects were observed during withdrawal. In conclusion, nightly treatment with PRM effectively induced sleep and improved perceived quality of sleep in patients with primary insomnia aged > or =55 years. Daytime psychomotor performance was not impaired and was consistently better with PRM compared with placebo. PRM was well tolerated with no evidence of rebound effects.

The effects eszopiclone 3mg on next day driving ability, cognitive and psychomotor function in patients with primary insomnia

Background:We investigated the impact of eszopiclone 3mg on next day driving ability (on-the-road brake-reaction-time, BRT) and cognitive and psychomotor performance in patients with primary insomnia.Methods:Patients with DSM-IV primary insomnia completed this study. Treatment was administered 30min before bedtime, and next day driving ability was assessed by on-the-road BRT approximately 9.5 hours postdose. A cognitive test battery measured residual effects on information processing, divided attention, psychomotor tasks, and working memory. Overnight polysomnography was conducted to assess sleep architecture; subjective ratings of morning sedation and sleep quality were also obtained.Results:There were no significant differences in BRT following night time administration of eszopiclone 3mg compared with placebo (p=0.39) and there were no significant differences in objective cognitive tests of information processing, divided attention, psychomotor tasks and working memory (p values>0.15). No significant effect on subjective next day ratings of morning sedation, coordination or mood was observed (p values>0.22). There was improvement compared with placebo (p<0.0001) in subjective ease of getting to sleep and quality of sleep the morning following dosing, and no perceived impairment of behavior following awakening or early morning awakenings. Polysomnography demonstrated significant improvements in sleep onset and maintenance.Conclusion:In this study, the first to assess next day on-the-road driving in primary insomniacs following hypnotic use, eszopiclone 3mg improved both objective and subjective measures of sleep onset and maintenance without residual impairments on next day driving ability or cognitive and psychomotor performance.Support for this study provided by Sepracor Inc., Marlborough, MA.

The Effect of Opioids on Driving and Psychomotor Performance in Patients With Chronic Pain

The Effect of Opioids on Driving and Psychomotor Performance in Patients With Chronic Pain

The Effect of Opioids on Driving and Psychomotor Performance in Patients With Chronic Pain

This study compared the psychomotor performance and driving ability of patients with chronic pain managed with stable regimens of opioid analgesics with that of normal healthy volunteers. The hypothesis was that patients with chronic pain on stable opioid analgesic regimens operate their automobiles safely with proficiency equal to normal volunteer controls. Patients were evaluated for errors while driving their own automobile through a predetermined route in the community, including variable residential and highway conditions, and for speed and accuracy on repeated trials through a 5-station obstacle course that evaluated forward and reverse driving, turning, and parallel parking. Patients also completed the Test of Variables of Attention and the Digit Symbol Substitution Test. No significant differences were observed among groups in driving performance in the community and on the obstacle course or on the Test of Variables of Attention. Results on dependent measures within the opioid group generally were not correlated with morphine equivalent daily opioid doses, which averaged 118 mg (median 40 mg). Many patients with chronic pain, even if treated with potent analgesics such as morphine and hydromorphone, show comparable driving ability as normals.

DECREMENTS IN VIGILANCE AND COGNITIVE FUNCTIONING ASSOCIATED WITH RAGWEED-INDUCED ALLERGIC RHINITIS

Wilken JA, Berkowitz R, Kane R. Ann Allergy Asthma Immunol. 2002;89:372–380Previous studies have shown adverse effects on sedation, cognition, and psychomotor performance in patients with allergic rhinitis with or without medical therapy. This study was done to further delineate the impact and consequences of symptomatic allergic rhinitis on vigilance and a wide range of tests of cognitive function.Two hundred ninety-six adults (mean age: 36–37 years) were studied in an allergen exposure unit (AEU). The subjects had a minimum 2-year history of ragweed-associated allergic rhinitis with positive prick/puncture or intradermal skin tests to ragweed. The patients were not allowed to be on any other medications for allergy, asthma or central nervous system (CNS) depressants or stimulants.This was a randomized, parallel-group, single-center study. The patients were all asymptomatic during an initial screening period and for baseline testing. The patients were administered a battery of automated neuropsychologic tests at baseline. The primary measure was the Kay Continuous Performance Test (KCPT), which is a measure of vigilance or the ability to maintain a certain level of arousal or attention while engaged in a monotonous or repetitive task. Secondary tests measured working memory, psychomotor speed, reasoning/computation, and divided attention. After the asymptomatic screening period and baseline testing, subjects were divided into symptomatic or asymptomatic groups. The symptomatic group was exposed to a consistent pollen level in the AEU. The symptomatic subjects could have as many as six 90-minute allergen exposure sessions over a 7-day period until they achieved specified levels of symptoms. Then, the testing was repeated as well as repeated in an asymptomatic control group with allergic rhinitis who had no pollen exposure in the AEU.Symptomatic allergic rhinitis had major adverse impacts on measures of vigilance. Symptomatic subjects performed significantly worse than asymptomatic subjects on all parameters of the KCPT. The cognitive battery of tests also showed a negative impact on a broad range of cognitive functions in symptomatic allergic rhinitis subjects. The greatest effect sizes were for tests measuring working memory and psychomotor speed.Symptomatic, untreated allergic rhinitis subjects were found to have a significant decrement on measures of vigilance and a broad range of cognitive functions.Another study showing cognitive changes in patients with allergic rhinitis. Another reason not to compound the problem with first-generation, sedating antihistamines.

Less Driving Impairment on Buprenorphine than Methadone in Drug-Dependent Patients?

Less Driving Impairment on Buprenorphine than Methadone in Drug-Dependent Patients?

Short term and long term effects of venlafaxine and trimipramine on cognitive psychomotor performance in patients with major depression

Short term and long term effects of venlafaxine and trimipramine on cognitive psychomotor performance in patients with major depression

Neurological signs and psychomotor performance in patients with schizophrenia, their relatives and healthy controls

Schizophrenic patients (DSM-III-R) were consecutively recruited and 39 were included. Twenty-one were first-episode and 18 were chronic schizophrenic patients. Thirty of the patients were on neuroleptic medication. Thirty-three parents were included, of whom nine were classified as `family history positive' and 22 as `family history negative' of a disposition to psychosis. Fifty-five healthy controls volunteered. The subjects were investigated according to a protocol divided into neurological signs and psychomotor performance (finger-tapping rate, Purdue pegboard test, pronation–supination test, gait and hand-grasp strength). Seventy-eight percent of the patients and 7% of the controls were classified as globally aberrant in signs. The patients and their parents, classified as `family history positive', exhibited a similar laterality pattern in a finger-tapping test improving performance with the preferred hand, significantly different from the performance of the `family history negative' parents and normal subjects. Duration of illness, neuroleptic medication and negative symptoms were not related to the occurrence of neurological signs and psychomotor performance. These findings indicate that neurological aberrations are present at the onset of illness and that hereditary factors are associated with motor laterality.

Neurological signs and psychomotor performance in patients with schizophrenia, their relatives and normals

Neurological signs and psychomotor performance in patients with schizophrenia, their relatives and normals